Synopsis
Examine hand wounds before anaesthesia, identify rotational fracture deformity and flexor or extensor discontinuity, protect bites and open joints, and coordinate stable splintage, repair and early hand therapy.
- Remove rings before swelling progresses and record hand dominance, occupation, contamination, timing and exact finger position at injury.
- Examine before local anaesthetic: resting posture, tenodesis, digital cascade, active flexion and extension, two-point sensation and capillary refill.
- Test flexor digitorum profundus by holding the PIP extended and asking for DIP flexion; test superficialis while adjacent fingers are held extended.
Key red flags
A clenched-fist wound over a metacarpophalangeal joint is a human bite with possible tendon and joint inoculation until proved otherwise.
The injured finger overlaps or scissors beneath a neighbour when the patient flexes toward the scaphoid.
Investigation priorities
Define fracture, dislocation, joint involvement and radiopaque foreign body.
Management branches
A fracture, wound or tendon injury is suspected.
- Remove rings, control bleeding and record cascade, tenodesis, isolated tendons, sensation and perfusion.
- Expose and photograph wounds, identify bite or contamination and obtain appropriate radiographs.
The closed fracture is stable, extra-articular and has no rotation or tendon deficit.
Key medicines
Co-amoxiclav for an adult human biteWhen not penicillin-allergic and the local bite pathway agrees, give co-amoxiclav 625 mg orally three times daily; prophylaxis is commonly 3 days and treatment 5 days, extended for deeper infection.
Paracetamol for adult hand painGive 500 mg to 1 g orally when required, at least 4 hours apart and no more than four doses or 4 g in 24 hours.