谢宗义《外科学教学资料》05.Hand injury for students.pptVIP

Hand injury Xiangjun Cheng Department of Orthopedics The Second Affiliated Hospital of CQMU Introduction of Hand The most complex and versatile structure in the human body 27 bones more than 30 muscles a vast web of ligaments and tendons Complicated vascular and nervous system Hand Positions Resting position of hand The position in which the forearm is midway between pronation and supination, the wrist is at 10° to 15° dorsiflexion, and the phalanges are slightly flexed. The thumb is in partial opposition and forward. Functional position of hand Consists of dorsiflexing both the wrist between 20° and 35° and the proximal interphalangeal joints between 45° and 60°. The thumb is abducted and in opposition and alignment with the pads of the fingers. Hand Positions Resting position of hand This position would be changed if some structures (e.g. tendons or nerves) damaged Functional position of hand Facilitate locomotion of hand (e.g. grasp, making a fist) for manipulative tasks Causes of hand injury stab Penetrating trauma Blunt trauma: injury by club, injury by falling… Crushing injury Firearm wound: bullet wound, explosion injury… Various kinds of hand injury Various kinds of hand injury Principles in treatments to hand injury Section 1 Injury to skin of hand Open hand injury Careful history taking and physical examination 1 location and character 2 estimate skin defect 3 judgement of skin vitality How to predict the skin vitality Section 1 Injury to skin of hand Color and temperature of kine Digital pressure capillary reaction Shape and size of the damaged skin Reversed or antegrade avulsion Bleeding from skin edge Section 1 Injury to skin of hand Section 1 Injury to skin of hand Treatment of skin injury of hand Section 1 Injury to skin of hand Common-used skin grafts or flaps Common-used skin grafts or flaps Section 1 Injury to skin of hand Section 1 Injury to skin of hand Common-used skin grafts or flaps Section 1 Injury to skin of hand Commo