Primary care of the injured hand, part 1

Because the hand is the most frequently injured part of the body, primary recognition of injured structures, careful assessment of damage, and appropriate treatment or referral by the primary care physician are critical. Most fingertip injuries heal with conservative care. Ideally, the healed wound should be covered with well-padded skin, be free of scar tissue, and not adhere to underlying bone. Crushing fingertip injuries associated with underlying fractures are often overlooked initially, with resultant infection, nonunion, and nail deformity. In the evaluation of flexor tendon injuries, recognition of the location of severed tendon is critical. Improved surgical techniques, when performed by an experienced hand surgeon, have yielded gratifying results, especially in the primary repair of tendon severance in the distal portion of the digit and palm. Mallet deformities at the distal interphalangeal joint are treated with extension splinting for minimum of six weeks without immobilization of the proximal interphalangeal joint. Open reduction is often required when an associated fracture involves more than 30% of the articular surface.