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by Kellicker PG
(Hand Trauma; Hand Injury)

Definition

A mutilating hand injury is severe damage to the hand. It will make it hard or impossible to use the hand. The injury may include damage to bones, tendons, soft tissues, nerves, and skin. It can become a life-threatening condition.

If you have this type of injury, call for medical help right away. Immediate care may result in a better repair. It can also decrease the chance of further damage. Serious infections and long term disability can develop without care.

Causes

Mutilating hand injuries can be caused by a variety of factors, including:

  • Industrial accidents
    • Machine injuries
    • Power tool injuries
  • Crushing accidents
  • Burns
  • Chemical exposure
  • Car accidents
  • Farming injuries

Risk Factors

Factors that may increase your chance of injury include:

  • Job that requires use of dangerous machinery
  • Removing safety guards from machinery, such as power saws or wood chippers
  • Short-cuts and improper technique while using machinery
  • Not shutting power to tool when using hands to remove clogged grass from lawn mowers or snow from snow blowers
  • Operating machinery or vehicles under the influence of alcohol or drugs

Symptoms

Injury to the hand is often obvious. Common symptoms include:

  • Excessive bleeding
  • Amputation of hand or fingers
  • Ripped skin
  • Skin loss
  • Open wound
  • Exposed bone or tendons
  • Pain
Severe Hand Trauma
hand trauma
© Nucleus Medical Media, Inc.

Diagnosis

The doctor will quickly assess the injury. The wound will be checked. Nerves and tendons of the hand will be tested.

Image tests will show more detail of the damage. They can show damage to the bones, nerves, tendons, and skin. Tests may include:

Anesthesia may be given. It will block pain so that the doctor can examine the wound more closely.

Treatment

Immediate care will stop any bleeding. An IV will be started to give fluids and pain medicine. A hand specialist may be needed. Other steps may include:

Tetanus Shot

Bacteria on the skin can enter the body through damaged skin. This can lead to a serious infection called tetanus. If you have not had a recent tetanus vaccination, you may be given one. It will help your body find and attack the bacteria.

Medicine

Medicine may help in the following ways:

  • Pain medicine—to help during recovery
  • Anesthesia—to block pain during medical care
  • Antibiotics—to prevent an infection

Wound Irrigation

The wound will be flushed out with water. It will help to remove any debris that may be trapped in the wounds. This will help to prevent infection.

Hand Surgery

Immediate surgery may be needed. Less severe injury will be dressed and splinted. A surgical plan can be made later.

The goal of surgery is to repair as much damage as possible. It may be able to save some function in the hand. Several surgeries are often needed for this type of injury.

Rehabilitation

Rehab can help to regain movement in the hand. It can also help to make changes if there are some limits to hand movement. Rehab may include:

  • Physical therapy
  • Occupational therapy

Prevention

To help reduce your chance of a hand injury:

  • Do not operate machinery that you are unfamiliar with.
  • Follow all safety instructions when operating tools or machinery. Be especially careful when using snow blowers and lawn mowers.
  • Do not put fingers or hands near moving parts of machinery.

RESOURCES

Hand Care—American Society for Surgery of the Hand  http://handcare.assh.org 

OrthoInfo—American Academy of Orthopaedic Surgeons  http://www.orthoinfo.org 

CANADIAN RESOURCES

Canadian Orthopaedic Foundation  http://www.canorth.org 

The Canadian Society of Plastic Surgeons  http://www.plasticsurgery.ca 

References

Fingertips injuries and amputations. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/fingertip-injuries-and-amputations/. Updated July 2016. Accessed January 7, 2019.

Kamrani RS, Mehrpour SR, Aghamirsalim MR. High-pressure plastic injection injury of the hand: case report. Occup Med (Lond). 2011;61(7):518-520.

Mallet finger. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T113875/Erectile-dysfunction . Updated June 5, 2017. Accessed Accessed January 7, 2019.

Neumeister MW, Brown RE. Mutilating hand injuries: principles and management. Hand Clinics. 2003;19(1):1-15.

Snowblower and lawnmower injuries. American Society for Surgery of the Hand Hand Care website. Available at: http://www.assh.org/handcare/hand-arm-injuries/Snowblower-and-Lawnmower-Injury-prevention. Accessed January 7, 2019.

4/25/2014 DynaMed Plus Systematic Literature Surveillance.  https://www.dynamed.com  : Bruno MA, Weissman BN, Kransdorf MJ, et al. American College of Radiology (ACR) Appropriateness Criteria for acute hand and wrist trauma. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteHandAndWristTrauma.pdf. Updated 2013. Accessed April 25, 2014.

Revision Information