The authors confirm that the data supporting the findings of this study are available within the article.
Acute hand injuries are routinely managed by family medicine and primary care physicians. An appropriate initial assessment and treatment, early referral to a hand surgeon when indicated, and timeous referral to a hand therapist are imperative. A patient case report is presented reporting on the initial and subsequent assessment, treatment and outcomes at 3, 6, 7 and 9 months for a patient who sustained an acute finger injury. Finger range of motion (ROM), sensation, pain, time of wound closure, hand function measured with the standardised disability of the shoulder, arm and hand (DASH) questionnaire were the outcomes used. Pain, crepitus, decreased sensation, decreased ROM right index finger proximal interphalangeal joint (PIPJ) and dense scarring was measured at 9 months. Missed injuries or lack of recognition of injury severity leads to delayed referral to specialist hand surgeons and therapists, which lengthens recovery time and leads to sub-optimal outcomes. This article aims to provide the primary care practitioner with the initial management of a patient who sustained a traumatic hand injury whilst using a power tool.
Keywords: hand injuries, surgeon, hand, occupational therapy, COVID-19Research on the leading cause of hand injuries sustained during the COVID-19 pandemic in the United Kingdom showed an increase in injuries related to using machinery. 1 Primary care physicians routinely manage patients after sustaining acute hand injuries but timeous referral to hand surgeons when the extent of the injury necessitates further assessment and management is crucial. 2 The initial assessment, history taking and physical assessment are vital. It sets the scene for a complete objective hand assessment to ensure that all the compromised structures in the hand are optimally treated or a referral is made to a hand surgeon. A thorough history should include questions about the mechanism of injury, time of injury, hand dominance, the patient’s tetanus status and the baseline function and occupation of the patient. 2 The initial physical assessment must include but are not limited to a thorough inspection of the injured hand, including a comparison to the contralateral hand, noting any abnormal hand posturing of the hand, fingers and wound position, shape and whether the wound is clean or contaminated. A neurovascular assessment including the capillary refill test, sensory testing and moving two-point discrimination test, active and passive range of motion (ROM), where indicated according to the observed injury, joint stability testing, must be performed. 2,3
The management of acute hand injuries should be guided by the initial assessment and the wound. Open wounds must be irrigated and debrided. 2 Primary wound management determines the patient’s functional outcome following a hand injury. 4 Minimising oedema is imperative to hand injury management achieved through elevation 4 of the affected hand above the heart level. Fractures can easily be missed in the absence of X-rays. Scar formation and joint stiffness are frequent complications following hand fractures. 4 According to Karunadasa, 4 splinting in the emergency room is helpful to assist in pain management following hand injuries.
Following traumatic hand injuries, the correct initial management is imperative to prevent substantial morbidity related to poor hand function, decreased quality of life and low work productivity. Timeous referral to a hand surgeon, a hand therapist, occupational therapists (OT) or physiotherapist, is of great importance to ensure optimal outcomes. The article aims to provide the primary care practitioner with the initial management of a traumatic hand injury patient sustained whilst using a power tool.
A 56-year-old right-hand dominant male sustained an index finger injury on 6 June 2020 whilst at home in South Africa during the national lockdown period. He works as a site manager, is a handyman and is an avid fisherman. The injury occurred at home whilst cutting a piece of wood with a small angle grinder fitted with a steel wood cutting blade. He lost control of the grinder and the blade cut into the radial side of his right index finger ( Figure 1 ). He is a non-smoker has a background history of hypercholesterolemia with nil known drug allergies.