Primary care of the injured hand, part 2

Nerve injuries in the forearm and hand are common, especially with concomitant tendon lacerations. The optimal time for repair of a clean sharp laceration is within the first 24 to 48 hours using magnification to achieve precise surgical reapproximation. Transfer to a facility equipped to perform replantation is indicated for multiple digit amputations, any thumb amputation, transmetacarpal amputation, wrist and arm amputation, and major amputations in children. Acute paronychial infections are treated with warm soaks, antibiotics, elevation, and immobilization. Surgical drainage is often indicated for a felon and should be done through a high midaxial incision. fractures of the hand are extremely common and require accurate diagnosis and precise anatomic reduction. Ensheathment syndromes--carpal tunnel syndrome, trigger finger, de Quervain's disease--are the most common nontraumatic disorders of the hand. If recognized and treated early they may resolve without need for surgery.