Hand trauma involving nerve, muscle, and vascular injuries require appropriate tests. Patients with broken fingers sometimes need to detect prothrombin time, fibrinogen, etc. I. Examination of skin injury 1. Understanding the site and nature of the wound: According to the local anatomical relationship, the possibility of injury to various important subcutaneous tissues such as tendons, nerves, blood vessels, etc. is initially presumed. 2.Estimation of skin defect: whether there is a defect in the skin of the wound, the size of the defect, whether it can be directly sutured and whether it will affect the wound healing after direct suturing. 3, the determination of skin vitality: the nature of the injury is an important factor affecting the vitality of the injured skin. Cutting wounds, skin edge vitality is good, the wound is easy to heal; crushing injuries, can cause extensive skin avulsion; skin exfoliation injuries, the skin surface is intact, while the skin and its underlying tissue is subtle separation, the skin and its base blood circulation interrupted, seriously affect the survival of the skin, should be given great attention. The following methods can help determine the viability of the skin. (1) skin color and temperature, such as the same as the surrounding, the skin vitality is normal; such as damage to the local pale, blue and cold, indicating poor vitality. (2) capillary reflux test
That is, when pressing the skin surface skin color becomes white, after releasing the finger pressed skin color quickly back to red, said good vitality; skin color recovery is slow, or even do not recover, then the vitality is poor or no vitality. (3) The shape and size of the flap The lingual flap and double-tipped bridgelike flap have good vitality, while the distal part of the lobulated or polygonal flap is often less vital, and the tip part is prone to necrosis after suturing. Tendon rupture shows a change in the resting position of the hand. When the flexor tendon is ruptured, the extension angle of the finger is increased. In the case of extensor tendon rupture, the flexion angle of the finger is increased and the active flexion or extension function of the finger is lost, and there are some typical deformities such as deep and superficial flexor tendon rupture, and the finger is straight. A rupture of the dorsal proximal extensor tendon of the metacarpophalangeal joint results in flexion of the metacarpophalangeal joint, an injury to the dorsal extensor tendon of the proximal phalanx results in flexion of the proximal interphalangeal joint, and an injury to the dorsal extensor tendon of the middle phalanx results in flexion of the terminal phalanx of the finger in a hammer finger deformity. It should be noted that if more than one tendon is involved in the same joint function, one of the tendon injuries may not show obvious dysfunction. The motor and sensory functions of the hand are innervated by the median nerve, ulnar nerve and radial nerve, which are composed of nerve roots from the brachial plexus, and the flexion and extension muscles of the wrist and fingers and the branches of the innervated nerves are located in the proximal forearm. The nerve damage caused by hand trauma is mainly manifested by hand sensory function and intrinsic hand muscle dysfunction. The main manifestations are the thumb to palm dysfunction and thumb and index finger pinching dysfunction caused by the paralysis of the thumb short extensor muscle of the median nerve, the palmar side of the hand, the thumb, index, middle finger and ring finger radial half of the metacarpal surface, the thumb interphalangeal joint and the index, middle finger and ring finger radial half of the interphalangeal joint to distant sensory dysfunction. Fourth, the examination of vascular injury The hand is rich in blood flow, with more collateral circulation, mainly by the ulnar artery and radial artery blood supply. The ulnar and radial arteries communicate with each other in the palm of the hand with the superficial palmar arch and the deep palmar arch. When the two arterial arches of the palm are intact, separate injuries to the ulnar and radial arteries rarely cause impaired blood circulation in the hand. V. Examination of bone and joint injury Local pain, swelling and dysfunction, suspected bone and joint injury, such as obvious shortening of the finger, rotation, angular or lateral deformity and abnormal activity can be diagnosed as fracture. X-rays should be taken for suspected fractures to understand the type and displacement of fractures and to prepare for their treatment, therefore, X-rays should be included as a routine examination for hand trauma.