Case of the Day: Hand Trauma

Today in minors I saw 2 interesting cases of hand trauma. 

Case 1: Builder 

I first saw a builder who sustained a laceration to the dorsal aspect of his dominant hand following a heavy pack of slate tiles falling on it. The wound was irrigated using 1.5 litres of saline. We then gave him a nerve block - followed by some local to the tissue surrounding the wound - ouch, this was the most painful part for the patient. The wound was then explored - which had lots of debris. The man was very veiny - and bleeding was a problem! Without adequate methods of haemostasis we used a more old school method.  It became evident that the ligament to the ring finger had been 100% cut and the capsule of the MCP joint had been breached. We used sterile water to clean the wound along with hydrogen peroxide. Finally we sutured the wound using mattress sutures and then placed him in a volar block. He was referred to plastics for further management.

Ok, so here are some questions on this case  -

1. What nerves did we block and how?

2. What do the nerves that we blocked supply in the hand?

3. What did we use to aid haemostasis?

4. What ligament had been cut and what is its function?

5. What crucial investigation have I not mentioned?

6. What crucial piece of management have I missed?

7. What other piece of important information do you think the plastic surgeons asked for?

8. Why would water rather than saline be better at cleaning the wound?

Hand Anatomy and local anaesthesia will be discussed in another post.