GC233 Common Hand Injuries
Common hand injuries encompass a spectrum of traumatic conditions including fractures, tendon lacerations, dislocations, ligament injuries, and nerve or vascular damage that compromise hand function and require prompt evaluation and management.
Common Hand Injuries — Pathology & Management Principles
This lecture (GC 233) by Prof. Ip Wing Yuk covers the pathology and management principles of common hand injuries. It is a clinically-oriented, high-yield lecture for the Fourth Summative Exam. The hand is the body's interface with the outside world — and its most distal position makes it the body part most prone to injury. The lecture systematically walks through:
- Distal dorsal injuries — nail/nail bed/distal phalanx (crush injuries, open fractures, subungual haematomas)
- Distal volar injuries — soft tissue loss, wound management philosophy (conservative vs. surgical coverage)
- Common bony injuries — Boxer's fracture, proximal phalanx fractures, Colles' fracture, scaphoid fracture
- Common tendon injuries — Mallet finger, Boutonnière deformity, flexor tendon injuries (FDP/FDS testing)
- Subungual haematoma — office procedure (trephination)
- Hand rehabilitation — edema control, functional position, splinting, dynamic mobilization, strengthening
Why this matters for exams: The examiners love practical clinical reasoning — "What tissues are cut?", "What is the plan of management?", wound coverage ladders, scaphoid fracture complications, tendon examination. A scaphoid fracture question appeared in the 2022 MCQ Q2 [1]. Carpal tunnel syndrome appeared in 2021 MCQ Q15 [2]. Understanding the approach from first principles (anatomy → injury mechanism → tissue layers → management) is the key to scoring well.
"The hand is the body part to reach the outside world; the most distal part is most prone to injury." [1]
This is the foundational principle of the lecture. Because the hand is the most distal structure used to interact with the environment, it is disproportionately exposed to trauma. Injuries can be volar (palm side) or dorsal (back of hand). The terminal part of each digit is the most vulnerable.
2. Distal Dorsal Hand Injuries
"Patient's thumb was crushed by closing door. The nail was avulsed. The terminal part of digit is most prone to injury." [1]
Plan of management follows the standard clinical approach:
- History — when, how, where [1]
- Physical examination — systematically assess anatomical layers at this region
- Investigation — X-ray
- Treatment — based on findings
"Anatomical layers at this region: nail plate, nail bed, distal phalanx." [1]
Understanding the layered anatomy is essential because each layer can be independently injured:
| Layer | Structure | Clinical Significance |
|---|---|---|
| Superficial | Nail plate | Protective covering; if avulsed, nail bed exposed |
| Middle | Nail bed (sterile matrix + germinal matrix) | Germinal matrix produces nail growth; sterile matrix adheres nail to bed |
| Deep | Distal phalanx (D/P) | Fracture fragments can lacerate nail bed from inside out |
High Yield — Nail Bed Laceration Mechanism
"Nail bed laceration can be outside-in or inside-out injury. Inside-out laceration by fracture fragment of D/P. Communicates with atmosphere — open fracture." [1]
- Outside-in: Direct crushing force damages nail plate → nail bed → may fracture distal phalanx
- Inside-out: Comminuted fracture of distal phalanx → sharp bone fragment punctures nail bed from deep to superficial → the fracture now communicates with the atmosphere through the nail bed wound → this is by definition an open fracture
Why this distinction matters: An open fracture dramatically changes management — it requires antibiotics, careful wound toilet/debridement, and repair of the nail bed. The risk is infection and osteomyelitis of the distal phalanx.
"Possible complication: infection & osteomyelitis" [1]
"Principles of fracture management: Reduction if necessary. Immobilization if necessary. Always rehabilitation." [1]
This is a universal orthopaedic principle but has a specific application here:
- Tuft fractures generally do NOT need reduction — they are stable and will heal with conservative management
- Immobilization is optional for tuft fractures — a simple protective splint may suffice
- Rehabilitation is ALWAYS necessary — this is non-negotiable
"DIPJ joint motion does not put loading on tuft fracture of D/P." [1]
Why? Because the FDP inserts at the base of the distal phalanx, and the extensor terminal tendon also inserts at the base. When the DIPJ flexes or extends, the force is transmitted through these tendons at the base — not through the tuft. So DIPJ movement is mechanically safe.
"Pinching will put loading to fracture fragment and should be avoided." [1]
Why? Pinch grip applies axial compressive force directly through the pulp → tuft → compresses the fracture fragments. This disrupts healing and causes pain.
"Active joint motion should be encouraged to prevent stiffness and continue the original motor program." [1]
The motor program concept: If a joint is immobilized for too long, the brain's motor cortex "forgets" the movement pattern. Early active motion maintains the neural pathway:
"Signal from motor cortex → through CNS, peripheral nerve to motor units → excitation of motor units results in muscle contraction → force transmission through tendon to tendon insertions → bone/joint needs to be intact to have joint motion" [1]
"Germinal matrix is intact and new nail regrows progressively." [1]
If the germinal matrix (the proximal nail fold region where nail cells proliferate) is intact, a new nail will grow. Complete nail regrowth takes approximately 3–6 months. If the germinal matrix is destroyed, permanent nail deformity results.
3. Distal Volar Injuries — Soft Tissue Loss
"What tissues are cut? What are the sizes of cut surfaces?" [1]
The lecture emphasises a systematic approach: when you see a volar fingertip wound, think about which tissue layers are involved and whether deep structures are exposed.
"Whitish tissue: exposed tendon/bone. Urgency to cover — may be desiccated and become necrotic. Skin layer is most important to replenish." [1]
| Deep Tissue Exposed? | Implication | Management |
|---|---|---|
| No — only subcutaneous tissue visible | Wound can granulate and re-epithelialize spontaneously | Conservative treatment has a role [1] |
| Yes — tendon or bone visible (whitish tissue) | Tendon/bone will desiccate → necrotic if not covered urgently | Surgical coverage required |
High Yield — Conservative vs Surgical for Fingertip Injuries
"No deep tissue exposed → Conservative treatment has a role." The wound heals by re-epithelialization and granulation tissue formation, but "conservative treatment needs months" and has high social cost (80% salary of worker during recovery = work-related injury burden). [1]
"Progressive healing by re-epithelialization & granulation tissue formation" [1]
Small fingertip defects without exposed deep structures can heal by secondary intention. The body lays down granulation tissue (new capillaries + fibroblasts + collagen) from the wound bed, and epithelial cells migrate from wound edges.
"Large injury with volar & dorsal injuries: Debridement of dead tissue. Suturing of viable tissue." [1]
Principles:
- Remove necrotic tissue (debridement)
- Preserve and suture viable tissue
- If defect too large for primary closure → reconstructive ladder
The lecture walks through options from simple to complex:
| Option | Description | Indication | Notes |
|---|---|---|---|
| Skin graft | Split-thickness or full-thickness skin harvested from donor site | Moderate defects without exposed bone/tendon | Simple but may not be durable on fingertip |
| V-Y plasty | V-shaped incision converted to Y-shaped closure to advance local tissue | "For transverse cut" [1] | Local advancement flap |
| Volar advancement flap | "Volar advancement flap for thumb" [1] — Moberg flap | Thumb tip volar defects | Advances palmar skin distally |
| Neurovascular island flap from index finger dorsum | "A flap with skin, subcutaneous tissue, blood supply, nerve supply is transferred from dorsum of index finger to the thumb tip defect. Index finger defect covered with skin graft." [1] | Large thumb tip injury | Preserves sensation |
| Partial toe transfer | "Perfect replacement is tissue from toe. Partial toe transfer. Need arterial, venous and nerve anastomosis." [1] | Best tissue match for fingertip pulp | Microsurgical procedure |
"Functionally the thumb is equivalent to 4 fingers." [1]
This is why the reconstructive effort for thumb injuries is much greater. Loss of thumb function is devastating — it accounts for ~50% of hand function (opposition, pinch, grip). Hence the use of more complex flaps and even free tissue transfer for thumb reconstruction.
"Cosmetically not pleasing" [1] — refers to the appearance after V-Y plasty or other simpler procedures, which may not give ideal cosmesis.
4. Common Bony Injuries in Hand & Wrist
"Fracture 5th metacarpal neck (Boxer's fracture): Benign nature. Conservative treatment with early mobilization." [1]
Mechanism: Punching with a closed fist — the 5th metacarpal neck is the weakest point and fractures with dorsal angulation.
Why conservative? The 5th CMC joint has significant mobility (~30° of flexion/extension), which compensates for residual angulation. Up to 40–50° of angulation at the 5th metacarpal neck can be accepted without significant functional deficit.
Management: Buddy taping or ulnar gutter splint with early ROM exercises.
"Most situations can be treated conservatively with splint. Occasionally need fixation in case of multiple fractures in one hand." [1]
Why fixation for multiple fractures? If multiple fingers are fractured, you cannot splint them all independently and still maintain function. Operative fixation (e.g., K-wires, mini-plates) allows earlier mobilization and prevents global hand stiffness.
"Dinner fork deformity" [1]
Mechanism: Fall on outstretched hand (FOOSH) — the distal radius fragment displaces dorsally, creating the classic dinner fork appearance when viewed from the side.
Classic deformity description:
- Dorsal displacement and angulation
- Radial shortening
- Radial deviation of the distal fragment
- Supination of the distal fragment
"Conservative treatment with cast for simple fracture, complicated fracture needs operation." [1]
| Feature | Conservative | Operative |
|---|---|---|
| Fracture type | Simple, minimally displaced, extra-articular | Intra-articular, comminuted, unstable, significantly displaced |
| Method | Below-elbow cast (or above-elbow if needed) after reduction | ORIF with volar locking plate, external fixation, K-wires |
| Duration | ~6 weeks in cast | Early mobilization post-fixation |
4.4 Scaphoid Fracture
Extremely High Yield — Scaphoid Fracture
"Physical signs of fracture scaphoid:
- Classical sign: Local tenderness at anatomical snuffbox and scaphoid tubercle
- Special blood supply: from distal to proximal
- Complication if not treated appropriately: nonunion, avascular necrosis
- Difficult to diagnose un-displaced fracture, need advanced imaging
- If not available, immobilize and recheck X-ray in 10–14 days" [1]
Blood supply is retrograde — the main arterial supply enters distally and flows proximally. This means:
- Proximal pole fractures have the highest risk of avascular necrosis (AVN) because the fracture cuts off blood supply to the proximal fragment
- Waist fractures also carry AVN risk but less so than proximal pole
- Distal pole fractures have the lowest AVN risk
Un-displaced scaphoid fractures may show no fracture line on initial X-ray because:
- The fracture line is a hairline crack that may not be visible until bone resorption occurs at the fracture site (takes ~10–14 days)
- If clinical suspicion is high (snuffbox tenderness + mechanism of FOOSH), treat as fractured — immobilize in a scaphoid cast (thumb spica) and repeat X-ray in 10–14 days
- Alternative: MRI or CT (advanced imaging) can diagnose occult fractures immediately
- Nonunion — the fracture fails to heal, leading to chronic wrist pain and weakness
- AVN — proximal pole dies due to loss of blood supply → collapse → secondary osteoarthritis (scaphoid nonunion advanced collapse = SNAC wrist)
The 2022 Fourth Summative MCQ Q2 asked: "A 45-year-old man fell on an outstretched hand. On examination, he had tenderness around the anatomical snuff box of his right hand. What is the BEST initial imaging test to perform?" Answer: D. Hand X-ray with scaphoid views [3]. This is classic exam fare — always get scaphoid views (posteroanterior in ulnar deviation + lateral + oblique), not just a standard hand AP.
5. Common Tendon Injuries
"Mallet finger deformity: most common extensor injury." [1]
Mechanism: Forced flexion of the DIPJ against an actively extending finger (e.g., ball striking the fingertip). This ruptures the terminal extensor tendon or avulses a fragment of bone from the dorsal base of the distal phalanx.
Clinical appearance: Drooping of the DIPJ — the patient cannot actively extend the DIPJ.
"Treated with short mallet splint." [1]
Why a splint works: The splint holds the DIPJ in full extension (or slight hyperextension) continuously for 6–8 weeks. This allows the ruptured tendon ends to approximate and heal. The key is uninterrupted splinting — if the finger is allowed to flex even once during treatment, the healing resets.
Common Exam Trap
Students confuse mallet finger with boutonnière deformity. Mallet = DIPJ droops (terminal tendon). Boutonnière = PIPJ flexion + DIPJ hyperextension (central slip rupture). They are at different levels of the extensor mechanism.
"Buttonnaire deformity (rupture central slip): Acute traumatic injury can be treated with long mallet splint or operation." [1]
Mechanism: Forced flexion of the PIPJ ruptures the central slip of the extensor tendon. The lateral bands then slip volarly below the PIPJ axis of rotation, becoming flexors at the PIPJ and hyperextensors at the DIPJ.
Deformity pattern:
- PIPJ fixed in flexion
- DIPJ hyperextended
"Boutonnière" = buttonhole in French — the proximal phalanx head "buttonholes" through the torn central slip between the lateral bands.
Treatment:
- Acute: Long mallet splint (holding PIPJ in extension) or surgical repair of central slip
- Chronic: Much harder to treat — may require reconstruction
5.3 Flexor Tendon Injuries
"Normal hand posture: Loss of flexor tone indicates flexor problem." [1]
The resting hand has a natural cascade of increasing flexion from the index to the little finger. Each finger rests in slight flexion due to the resting tone of the flexor tendons. If one finger sits in abnormal extension compared to the others, suspect a flexor tendon laceration.
"Loss of DIPJ flexion indicates FDP injury." [1]
Test: Hold the PIPJ in extension and ask the patient to flex the DIPJ. This isolates FDP function because:
- FDS inserts at the middle phalanx (flexes PIPJ)
- FDP inserts at the base of the distal phalanx (flexes DIPJ)
- If you block PIPJ motion, only FDP can flex the DIPJ
| Tendon | Insertion | Joint Flexed | Clinical Test |
|---|---|---|---|
| FDS | Middle phalanx (split insertion) | PIPJ | Hold all other fingers in extension; ask patient to flex the tested finger at PIPJ |
| FDP | Base of distal phalanx | DIPJ | Hold PIPJ extended; ask patient to flex DIPJ |
"Open tendon repair." [1]
Flexor tendon lacerations require surgical repair — the tendon will not heal by itself in the flexor sheath. Repair is followed by a structured rehabilitation protocol with dynamic splinting (see below).
6. Subungual Haematoma
"Subungual haematoma: small one will gradually resorbed." [1]
Blood collects between the nail bed and the nail plate after crush injury. Small haematomas are tolerable and self-resolve.
"Bigger subungual haematoma is very painful." [1]
Why so painful? The nail plate is rigid and firmly adherent. Blood accumulating underneath creates pressure in a confined space → stretches pain fibres in the nail bed → severe throbbing pain.
High Yield — Subungual Haematoma Trephination Procedure
"Safe small office procedure:
- Light the spirit lamp
- Straighten out the paper clip and heat the tip in the flame until it becomes red hot
- Apply the red hot tip of the paper clip to the central point of the subungual haematoma. It will burn a hole in the nail and blood will escape through the hole." [1]
Why it works: The heated metal tip cauterizes through the nail plate (which is keratin — it melts/burns easily). The nail bed is not damaged because the blood layer acts as a thermal buffer. The release of pressure gives immediate pain relief.
Key points:
- No anaesthesia needed (the nail plate has no nerve endings)
- The hole should be at the central point of the haematoma
- Alternative: use a battery-powered cautery device or an 18G needle twirled between fingers
7. Hand Rehabilitation
"Good operation and good rehabilitation are essential to good outcome." [1]
"Rehabilitation is to regain maximal function after injury or illness." [1]
"Start at the time of injury: prevent edema. Edema fluid induces adhesion between tissue layers." [1]
Why start early? Post-injury edema leads to fibrin deposition between tissue layers (tendons, joint capsules, ligaments). This fibrin organizes into adhesions which restrict gliding of tendons and joint motion. Once adhesions form, they are difficult to break down.
"Early phase: edema control, protect damaged tissue during recovery phase, maintain gliding of tissue layers, active/passive/dynamic passive motion of mobilization. Later phase: strengthening and work hardening, sensory/motor re-education." [1]
| Phase | Goals | Methods |
|---|---|---|
| Early | Edema control | Compression (boxing glove dressing), elevation (drip stand NOT arm sling) |
| Early | Protect damaged tissue | Splintage |
| Early | Maintain tissue gliding | Passive and active ROM exercises |
| Later | Strengthen | Graded resistance exercises |
| Later | Re-educate | Sensory re-education (after nerve repair), motor re-education |
| Later | Return to work | Work hardening — simulate job demands |
"Volar tissue are bound to deeper tissue by fascial layer so edema cannot occur. Fluid collected in dorsum of hand with loose subcutaneous tissue." [1]
Why dorsal edema? The palmar skin is anchored to the palmar aponeurosis by vertical fibrous septa — fluid cannot accumulate. The dorsal skin has loose areolar subcutaneous tissue — fluid collects here preferentially.
"More severe edema involves the dorsum of digits → Claw hand deformity." [1]
Why claw deformity from edema? Dorsal edema pushes the MPJs into hyperextension and IPJs into flexion. This is because:
- Edema stiffens the collateral ligaments in a position of extension at the MPJ
- The intrinsics cannot counteract this
- The IPJs fall into flexion due to gravity and FDP tone
"Control edema with compression: Boxing glove." [1]
"Elevation with a drip stand rather than arm sling." [1]
Why drip stand > arm sling? An arm sling keeps the hand at chest level (below heart level when standing/sitting). A drip stand elevates the hand above heart level, which uses gravity to promote venous and lymphatic drainage.
Why this position?
- MPJ flexion (70–90°): The collateral ligaments of the MPJ are longest (tautest) in flexion. If immobilized in extension, the collateral ligaments shorten and the MPJ develops a fixed extension contracture
- IPJ extension (0°): The volar plates of the IPJs are thickest and can contract in flexion. Keeping IPJs extended prevents volar plate contracture
- Thumb abducted: Prevents first web space contracture, which would eliminate opposition
"Functional position inside the boxing glove: MPJ flexed, IPJs extended, Thumb abducted." [1]
"Splint to lift up fingers and wrist while waiting for recovery of radial nerve." [1]
This refers to a wrist drop splint (cock-up splint) for radial nerve palsy — it holds the wrist and fingers in extension to maintain functional position while the nerve recovers.
"Dynamic splint for flexor tendon repair." [1]
Kleinert splint / Duran protocol: After flexor tendon repair, a dynamic splint with rubber bands allows passive flexion (via rubber band traction) while the patient actively extends. This maintains tendon gliding while protecting the repair from active flexion forces that could rupture the suture.
"Strengthening exercises" and "Work rehabilitation: Train up tasks of their job demand." [1]
Functional rehabilitation means progressively increasing resistance and replicating the specific movements required for the patient's occupation.
8. Integration with Related GC Lectures
The GC 182 lecture on "Chopped and stabbed wound" [4] emphasises:
- Correct priority in management of multiple injuries (ABCDE first)
- Documenting wounds correctly — location, size, shape, direction, foreign bodies
- Photograph or sketch the wound before surgical repair [4]
In hand injuries specifically, always assess for:
- Digital nerve injury — test two-point discrimination on each side of each finger
- Digital artery injury — Allen's test, capillary refill
- Combined tendon + nerve + vessel injuries — common in palmar lacerations
A nail bed laceration with underlying distal phalanx fracture communicating with the atmosphere = open fracture (Gustilo-Anderson classification applies). This links to the GC 231 lecture on open fractures: principles include debridement, antibiotics, fracture stabilization, and soft tissue coverage [5].
In children, always consider physeal injuries (Salter-Harris classification). A child's "Boxer's fracture" equivalent may involve the physis of the metacarpal neck — different implications for growth disturbance [6].
9. Exam Intelligence
| Trap | Correct Answer | Why Students Get It Wrong |
|---|---|---|
| "Best initial imaging for suspected scaphoid fracture" | Scaphoid views X-ray (not standard hand AP, not CT) | Students choose CT/MRI thinking it's more sensitive — but the question asks "initial" |
| "Which tendon is injured if DIPJ cannot flex?" | FDP (not FDS) | Students confuse FDS and FDP insertions |
| "Why does edema collect on dorsum of hand?" | Loose subcutaneous tissue dorsally; palmar tissue tethered by fascial septae | Students assume edema should be palmar because injury is palmar |
| "Functional position of hand" | MPJ flexed, IPJ extended, thumb abducted | Students reverse MPJ/IPJ positions |
| "Complication of missed scaphoid fracture" | AVN and nonunion | Students say malunion (less relevant for scaphoid) |
| "Why encourage DIPJ motion in tuft fracture?" | Tendons insert at base of DP, not tuft — DIPJ motion doesn't load the tuft | Students think all movement is harmful to any fracture |
| Condition | Level | Deformity | Treatment |
|---|---|---|---|
| Mallet finger | DIPJ | Drooping DIPJ (can't extend) | Short mallet splint × 6–8 weeks |
| Boutonnière | PIPJ | PIPJ flexion + DIPJ hyperextension | Long mallet splint or surgery |
| Swan neck (not in this lecture but important DDx) | PIPJ | PIPJ hyperextension + DIPJ flexion | Usually RA-related; splinting/surgery |
10. Past Paper Questions
2022 Fourth Summative MCQ Q2 [3]:
"A 45-year-old man fell on an outstretched hand. On examination, he had tenderness around the anatomical snuff box of his right hand. What is the BEST initial imaging test to perform? A. Hand computed tomography B. Hand ultrasound C. Hand X-ray (AP) D. Hand X-ray with scaphoid views"
Correct answer: D. Hand X-ray with scaphoid views
Rationale: Standard hand AP does not adequately visualize the scaphoid. Scaphoid views include PA in ulnar deviation (elongates the scaphoid), lateral, and oblique views. CT/MRI are not first-line. Ultrasound has no role here.
2021 Fourth Summative MCQ Q15 [2]:
"A 52-year-old lady complained of a gradual onset of numbness and tingling over the radial 3 and half fingers of her right hand. The paresthesia started to appear at night but later progressed to day time as well, and was relieved by shaking the hand and wrist. It may also come about when she lifted some heavy supermarket bags for a few minutes. What is the MOST LIKELY diagnosis? A. Carpal tunnel syndrome B. Cervical radiculopathy C. de Quervain disease D. Fracture of the distal radius"
Correct answer: A. Carpal tunnel syndrome
Rationale: Classic features — nocturnal paraesthesia in median nerve distribution (radial 3½ fingers), relieved by shaking (flick sign), provoked by sustained gripping. de Quervain's causes radial wrist pain, not numbness. Cervical radiculopathy would follow a dermatomal distribution and usually involves neck/shoulder symptoms.
2020 Fourth Summative SAQ Q2 (partial relevance) [7]:
"A 45-year-old lady complained of multiple joint pain involving both hands, elbows and wrists for 1 year... Name four possible deformities in the hands and wrists if the disease further progresses."
Relevant hand deformities in RA (for differentiation): Ulnar deviation of MCPJs, swan neck deformity, boutonnière deformity, Z-thumb, volar subluxation of MCPJs. This helps discriminate RA-related deformities from traumatic tendon injuries.
| Injury | Mechanism | Key Finding | Investigation | Treatment |
|---|---|---|---|---|
| Tuft fracture with nail bed injury | Crush (door) | Avulsed nail, open fracture risk | X-ray | Nail bed repair, abx, early DIPJ mobilization (avoid pinching) |
| Fingertip soft tissue loss (no deep tissue exposed) | Sharp/crush | Subcutaneous tissue visible | Clinical | Conservative: re-epithelialization |
| Fingertip soft tissue loss (deep tissue exposed) | Sharp/crush | Whitish tendon/bone visible | Clinical | Surgical: graft/flap/toe transfer |
| Boxer's fracture | Punching | 5th MC neck angulation | X-ray | Conservative, early mobilization |
| Colles' fracture | FOOSH | Dinner fork deformity | X-ray (AP + lateral wrist) | Cast vs ORIF |
| Scaphoid fracture | FOOSH | Snuffbox tenderness | Scaphoid view X-ray; MRI if occult | Thumb spica cast; recheck 10–14d if XR negative; surgery if displaced |
| Mallet finger | Ball/forced DIPJ flexion | DIPJ droop | X-ray (avulsion?) | Short mallet splint 6–8 weeks |
| Boutonnière deformity | Forced PIPJ flexion | PIPJ flexion + DIPJ hyperextension | Clinical | Long mallet splint or surgery |
| FDP laceration | Sharp (palmar wound) | Loss of DIPJ flexion, loss of flexor cascade | Clinical + explore | Open surgical repair |
| Subungual haematoma | Crush | Painful blue/black nail | Clinical | Trephination (hot paper clip) if large |
High Yield Summary
- The hand is the most distal organ — most prone to injury. Assess every hand injury by tissue layers: skin → subcutaneous tissue → tendon → bone.
- Nail bed laceration + distal phalanx fracture = open fracture → risk of osteomyelitis.
- Tuft fractures: FDP/extensor insert at base of DP → DIPJ motion is safe; pinching is not.
- Fingertip soft tissue loss: No deep tissue exposed → conservative; deep tissue exposed → surgical coverage (graft → flap → toe transfer). Thumb = equivalent of 4 fingers functionally.
- Boxer's fracture: Benign, conservative treatment.
- Colles' fracture: Dinner fork deformity; simple → cast, complicated → operation.
- Scaphoid fracture: Snuffbox + scaphoid tubercle tenderness; blood supply is distal-to-proximal → AVN risk; if XR negative but clinical suspicion high → immobilize + repeat XR 10–14 days or get MRI.
- Mallet finger: Most common extensor injury → short mallet splint. Boutonnière: central slip rupture → long mallet splint or surgery.
- Flexor tendon injury: Loss of flexor cascade; FDP = loss of DIPJ flexion; requires open repair.
- Subungual haematoma: Large/painful → trephinate with hot paper clip.
- Rehabilitation starts at time of injury: Edema collects dorsally (loose subcutaneous tissue). Functional position = MPJ flexed, IPJ extended, thumb abducted. Elevate with drip stand, not arm sling. Dynamic splinting after flexor tendon repair.
Active Recall - Common Hand Injuries
[1] GC 233. Common Hand Injuries.pdf (Lecture slides by Prof. Ip Wing Yuk) [2] 2021 Fourth Summative Assessment MCQ.pdf (Q15) [3] 2022 Fourth Summative MCQ.pdf (Q2) [4] GC 182. Chopped and stabbed wound in gang fight Nerves and vascular injury; Classification of injuries.pdf [5] GC 231. High Energy Trauma Open Fracture_Part 1.pdf [6] GC 232. Paediatric Musculoskeletal Injury [Updated in 2025].pdf [7] 2020 Fourth Summative SAQ.pdf (Q2)
GC232 Paediatric Musculoskeletal Injury
Musculoskeletal injuries in children, including fractures, dislocations, and soft tissue injuries, that require special consideration due to the presence of growth plates and ongoing skeletal development.
GC234 Common Foot And Ankle Conditions
Common foot and ankle conditions encompass a group of frequently encountered musculoskeletal disorders—including plantar fasciitis, ankle sprains, bunions, Achilles tendinopathy, and flat foot deformity—that affect the structural and functional integrity of the foot and ankle complex.