We use our hands for virtually every task of our day-to-day lives but unfortunately this means that our hands are often put in harm’s way. Traumatic hand injuries can be as simple as a laceration from a kitchen knife, or broken glass but more serious injuries can arise from industrial workplace incidents or accidents involving power tools.
When such injuries occur, a number of management considerations arise:
- Limitation of further damage and bleeding
- Prevention of infection
- Identification of structural injuries (bones, tendons, nerves, vessels)
- Repair of structural injuries
- Rehabilitation to restore function
The most important steps in first-aid management of such injuries are to limit the damage, control bleeding and present to an emergency department or clinic for further assessment and treatment.
Damage limitation is predominantly about removing the hand from the hazardous situation. In a industrial setting or when power tools are the culprit, this must be done in a way that does not endanger the other hand or other people.
Most bleeding after hand injuries can be controlled with local pressure and very rarely is a tourniquet device required. That said, if profuse or pulsatile bleeding is present, urgent presentation to an emergency department is necessary to ensure blood flow to critical structures can be assessed and restored if needed.
Emergency Department Treatment
Once you have reached a medical clinic or emergency department, a number of things will take place. For most contaminated hand injuries, antibiotics are indicated to minimise the risk of infection. Although sometimes given through a drip, oral antibiotics (most commonly Augmentin Duo Forte) can give broad enough coverage. A check of your tetanus immunity and a booster if required is also important.
Careful clinical examination can detect whether there is a significant structural injury to the tendons and nerves of the hand and whether the hand and finger have adequate circulation. Inspection within the wound can be of some use but often will not reveal the full extent of the injury. There are countless examples of relatively insignificant skin wounds harbouring significant structural damage within the hand.
X-rays should be taken routinely to exclude fractures or the presence of any retained foreign bodies within the hand. If there is any suspicion of a structural injury within the hand, you should be referred to a hand surgeon for further evaluation.
Surgical Treatment for Open Hand Injuries
Significant hand wounds most commonly are treated with surgical exploration under anaesthetic (local or general). This enables the surgeon to open the wound, and with adequate lighting and equipment evaluate any injuries to critical structures of the hand.
Thorough irrigation and debridement of the wound is important to minimise the risk of infection. Hand wounds that are contaminated with foreign material, especially if they are sutured close without being cleaned have a high risk of infection, which can significantly compromise hand function.
Once the wound has been adequately debrided, injured structures (bones, tendons, blood vessels and nerves are systematically assessed and repaired as necessary. A number of repair techniques are employed to ensure that you can start to move and rehabilitate your hand as soon as possible while these repairs are still healing.
When nerves are repaired, new nerve fibres will regrow from the repair site all the way down the nerve to restore sensation to the skin or motor function to the muscles. Nerves recover at different rates in each individual but on average can grow at a rate of 1mm per day so there is often a reasonable wait to see any meaningful nerve function after a repair.
Whilst most injuries in the hand can be repaired, restoring hand function requires careful rehabilitation following surgery. Rehab is a careful balance of protecting surgical repairs but also getting the hand moving to prevent scarring and stiffness. Most patients will be referred to a specialised hand therapist after surgery to help guide you through the rehabilitation process and ensure that you get the best possible outcome. Recovery from significant hand trauma can take up to 3-6 months.