Injuries of the wrist joint: complications, treatment. Rules for hand immobilization after surgery

Very reliable transport immobilization of the head and cervical vertebrae provided Bashmakov bandage using two staircases Kramer tires, superimposed in mutually perpendicular planes. Before application, both splints are lined with a fairly thick cotton-gauze pad, which is secured with a bandage. Both tires are then simulated. The sagittal splint is bent along the topography of the head from front to back, leaving a visor 8-10 cm long in front at forehead level. Further downwards the splint should follow the contours back surface neck and thoracic spine. The frontal splint is modeled in the transverse direction around the cranial vault with a sagittal splint applied to it. The end sections of the front splint are modeled along the contour of the lateral surfaces of the neck and shoulder girdle. To prevent the front splint from interfering with movements in the shoulder joints and to more securely hold the bandages fixing it, the ends of the splint are bent upward. When applying a Bashmakov bandage, first fix the sagittal splint to the body with circular rounds of the bandage, and at waist level with a waist belt. Then a frontal splint is applied, fixing it to the shoulder girdle with cross-shaped bandages, and finally both splints are secured on the head with a circular bandage. It is possible to transport a victim with a splint on a stretcher, either on the stomach or on the back.

Immobilization for injuries to individual parts of the torso and limbs has a number of features.

Transport immobilization for injuries in the cervical spine can be carried out by applying a circular cotton-gauze collar (Schanz) to the neck area (a collar-type bandage rests on the forearms at the bottom, reaches the occipital bone at the top and lower jaw). The bandage can be based on a cardboard plate, which provides rigidity to the bandage and prevents head movement.

Transport immobilization for fractures of the lower jaw is performed by fixing it with a “bridle” bandage to the intact upper jaw or with a circular bandage over the head. A board wrapped in cotton wool and gauze is placed under the lower jaw. It is also possible to apply a sling bandage .

Transport immobilization for fractures of the upper jaw can be done using improvised means. A wooden stick, branch, or ruler is inserted between the upper and lower rows of teeth and its ends are tied to a circular bandage applied to the cranial vault.

Fractured ribs can be the result of a direct blow, compression, or fall. Sharp pain occurs in the area of ​​the fracture, aggravated by breathing, coughing, and sneezing. The sharp edges of rib fragments can damage intercostal vessels and nerves, the lung and lead to the development of pneumo- or hemothorax. In order to reduce pain and eliminate cough, the victim can be given oral analgin, amidopyrine, and codeine preparations.

Transport immobilization for rib fractures produced by superimposing on chest tight circular (spiral) bandage. If there is no bandage, the chest can be wrapped in a towel, sheet, piece of cloth and sewn up at the moment of exhalation.

One of the most severe injuries is a fracture of the spine, which can occur during emergencies and as a result of an accident. This may be the result of a fall or jump from a height, a blow to the back during a traffic accident, or compression from excessive weights during natural disasters. Fractures of the cervical vertebrae can occur in divers when they hit their heads on the bottom of a reservoir, etc.

Signs of damage to the vertebrae are acute pain in the back when trying to move, complete or partial paralysis of the limbs (lack of movement and skin sensitivity), arising from combined trauma spinal cord.

In case of spinal fractures or suspected fractures, the victim should not be seated or lifted to his feet. He needs to be given peace horizontal position on your back on a flat, hard surface. It is necessary to give painkillers (orally or parenterally) and carefully immobilize. In case of a fracture of the cervical vertebrae, the victim is transported with mandatory immobilization of the head, as is the case with injuries to the skull.

Transport immobilization for spinal injuries in the conditions of a traffic accident, they are performed using such improvised means as boards, shields, etc. The victim is carefully and carefully placed on his back and secured with a gauze bandage or other available means. If there are no available means, the victim is laid on a flat surface and in this position awaits the arrival of the ambulance team. Transporting or simply moving a victim with vertebral injuries always poses a risk of injury to the spinal cord from a displaced vertebra.

Fracture of the pelvic bones. No less serious injury is fracture of the pelvic bones, which is very often accompanied by damage to the internal pelvic organs and the development severe shock. The causes of a fracture can be a fall from a height, compression by the wheels of any mechanical vehicle, swipe etc. Symptoms of such injury are sharp pain at the slightest attempt to move the lower limbs, inability to move independently. Due to the fact that immobilization with splints is impossible in this area, the victim is given a position in which pain is reduced and secondary injuries are less likely internal organs bone fragments.

The victim is placed on a flat, hard surface (wide board, shield). The legs are bent at the knees and hip joints and spread apart (frog position). A cushion from available means is placed under the knees - a pillow, a blanket, a coat, etc. A handy means for immobilization in case of damage to the pelvic bones can be a shield made of any hard material, on which it is advisable to first place a mattress or a replacement bedding. The position of the victim must be fixed with a bandage and not change during transportation.

In case of injuries to the spine and pelvic bones, it is necessary to carry out anti-shock measures.

Transport immobilization upper limb in the absence of standard splints, it can be carried out according to the type of autoimmobilization by bandaging it to the body using the type of applying a Deso fixing bandage or using a scarf bandage and improvised splints.

In case of fractures of the bones of the upper limb, it is given the following position: the arm is slightly retracted shoulder joint and bent at a right angle at the elbow joint, the hand is slightly extended at the wrist joint and the palm is facing the stomach, the fingers of the hand are bent and cover a dense cotton-gauze roller.

A clavicle fracture is characterized by pain in the area of ​​injury, and the function of the upper limb is impaired. The sharp edges of bone fragments can be easily felt through the skin.

Open clavicle fractures can be complicated by trauma subclavian vein, which, if its wall is damaged through and through, can lead to gas embolism.

Transport immobilization for clavicle fracture consists of applying a scarf bandage or a Deso bandage fixation bandage. Transport immobilization of the clavicle can be accomplished using cotton-gauze rings or applying a cruciate bandage.

With a fracture of the humerus Optimal immobilization can be achieved by applying a Kramer splint. The splint is applied from the healthy forearm along the back surface of the injured shoulder, forearm to the metacarpophalangeal joints and reinforced with bandaging.

For fractures of the forearm bones splinting is carried out from the middle third of the shoulder to the metacarpophalangeal joints of the hand with flexion at the elbow joint up to 90° and subsequent fixation of the splint by bandaging. When using improvised means of immobilization, it is also necessary to exclude movements in the elbow and radio-metacarpal joints.

Splinting wrist joint performed in the extension position. The splint is applied from elbow joint to the fingertips along the palmar (front) side of the forearm.

For splinting fingers they are given a semi-bent position, for which a cotton-gauze ball is placed in the hand.

Transport immobilization lower limb in the absence of special standard splints, it can be carried out by bandaging the damaged limb to a healthy one or by using improvised splints.

With a fracture of the femur transport immobilization is carried out with standard or improvised splints. In the second option, an external improvised splint is applied from armpit to the sole of the foot, and the inner one - from the groin fold to the sole. After this, the splints are bandaged (fixed) to the body and to the leg, thereby immobilizing all three large joints lower limb - hip, knee and ankle.

With a fracture of the leg bones external and internal splints are also applied and fixed from the middle of the thigh to the sole of the foot.

Foot in all cases of transport immobilization of the lower limb, it should be located and fixed at a right angle to the lower leg.

The wrist joint is formed on one side by the ends of the ulna and radius bones, on the other by the small bones of the wrist. There are numerous ligaments around the joint capsule that allow you to move the hand in different directions.

The brush consists of 3 parts. The wrist is formed by eight bones arranged in 2 rows. 5 depart from them metacarpal bones, creating the base of the brush. The phalanges of the fingers are attached to them. To ensure small movements in the hand there are many tendons and nerves. It is well supplied with blood.

Hand injuries are widespread and varied. After providing first aid for such injuries, you should consult a doctor, because the consequence may be loss of hand function.

Bruise and compression

Bruises of the wrist joint are very painful, since its capsule is not protected by muscles. When a hand is bruised, swelling quickly appears, and subcutaneous hemorrhage often forms - a hematoma. This is especially true for injury to the fingertip, for example, when hit with a hammer.

At severe bruise need to do X-ray because the bones of this part of the body are very thin and break easily.

First aid consists of applying ice or at least a damp cloth and immobilizing it. After swelling decreases and in the absence of inflammation, warming begins. It is recommended to use ointments with anti-inflammatory and analgesic effects (fastum-gel and others). If blood has accumulated under the nail, it is better to remove it in the surgical office of the clinic, this will relieve the pain.

When the hand is compressed by a heavy object, extensive hemorrhage occurs and the skin and muscles are damaged. In this case, you need to make a tight bandage, apply cold, give your hand exalted position and be sure to contact a traumatologist. The same assistance is needed in case of damage interphalangeal joints. In this case, blood accumulates in the joint cavity, which must be removed.

Ligament damage

Injury to the ligaments of the wrist joint is possible with a sudden movement of large amplitude, for example, when falling on your hand. The same applies to injuries to the tendons in the hand. In the latter case, there is often a separation of small bone fragments to which the tendons are attached. As a result, a subluxation forms in the joint, and blood accumulates in its cavity.

This injury is accompanied by severe pain, swelling and impaired mobility in the affected joint. Sometimes there are pathological movements: bending the finger to the side or excessive hyperextension. This is typical for injuries with avulsion of a bone fragment. First aid is cold, rest and elevated position of the hand. Then you should go to the emergency room.

The movements of the fingers are provided by groups of tendons: on outer surface- extensors, on the palmar - flexors. If the extensor muscle attached to the nail phalanx, it stops straightening and seems to hang down. If the ligament going to the lower phalanx is injured, a double contracture is formed: the middle phalanx is bent, the nail is hyperextended, and the finger takes on a zigzag shape. In the latter case, surgery is necessary to restore the hand's function.

The flexor tendons are affected by cut wounds palms. Sometimes such injuries occur as a result of a sharp blow of the terminal phalanx on a hard surface. These injuries are manifested by the inability to bend the fingers or clench them into a fist. Attempting such movements must be done very carefully because they can cause the ends of the tendons to separate, making treatment more difficult. Therefore, in case of such an injury, you should immobilize the limb, place a tennis ball or a foam sponge in the victim’s palm and immediately consult a doctor, preferably a specialized trauma department. Treatment is only surgical.

Dislocation and fracture

Deformation of the hand after injury, as well as impairment of its function, may indicate a dislocation or fracture.

A dislocation in the wrist joint occurs as a result of an unsuccessful fall on the hand. In this case, the hand moves to the back side. Displacement towards the palm is rare. Nerve bundles and blood vessels are compressed, which leads to severe pain, numbness of the hand, inability to move, swelling and poor circulation.

If the hand is shifted to the rear, a deformity in the form of a step is determined in the area of ​​the wrist joint. With a palmar dislocation, the hand bends and the fingers clench. First aid consists of immobilizing the hand, which must be done using a board, plywood or similar hard object. You need to see a surgeon. You cannot correct a dislocation on your own, as this will further damage the joint.

If one of the wrist bones is dislocated, you can feel the bony protrusion at the top of the hand. This is accompanied by swelling of the wrist and impaired movement. Often patients do not pay attention to this, which leads to a significant deterioration in hand function. If you have a wrist injury, you should use a hard splint and be sure to take an x-ray.

The same assistance is needed for a victim with a dislocated metacarpal bone. This injury occurs when falling on a clenched fist. The back surface of the hand swells and changes shape. The palm becomes shorter than the healthy one, the fingers do not clench into a fist.

If you fall on your hand with your hand straightened thumb it is likely to dislocate the metacarpophalangeal joint. The finger moves to the back of the hand, extends significantly, its nail phalanx is bent, and the palmar eminence at the base of the finger protrudes excessively. Finger movements are impossible. The finger must be fixed in this position using a splint. This dislocation can be reduced under anesthesia.

Appears when dropped or hit. Their symptoms are similar to those of other injuries to this part of the body: pain, swelling, abnormal shape of the hand, shortening of the finger. To clarify the diagnosis, an x-ray is required. If a fracture is suspected, the hand should be immobilized, cold applied to it, a piece of foam rubber placed in the palm and the victim taken to the emergency room.

Wounds

An open injury may be stabbing, cutting, bruising, laceration, or chopped. It can be complicated by injury to tendons, nerves, blood vessels, or separation of the phalanx of the finger.

If there is an abrasion, you do not need to see a doctor. The skin is cleaned of impurities and gently washed. Then the wound is treated with a solution or brilliant green. A small injury is covered with a bactericidal plaster, and if necessary, a sterile bandage is applied.

When cut and chopped wounds The damage cannot be washed out. You just need to carefully clean the surrounding skin of contamination, treat it with an antiseptic and apply a sterile pressure bandage to stop the bleeding.

Puncture wounds are characterized by severe pain and slight bleeding. The edges of the damage quickly close, which creates conditions for the development of infection. In the depths of the wound it often remains foreign body. For puncture wounds and bite injuries, serious complications, therefore it is necessary to introduce serum against and. Apply a sterile bandage and consult a doctor.

With a hand wound it is possible profuse bleeding, to stop it, a hemostatic tourniquet is used above the injury site. In summer it can be applied for 2 hours, in the cold season - for no more than an hour and a half. A note is placed under the tourniquet indicating the time it was applied.

If the phalanx of a finger is torn off, it is necessary to stop the bleeding with a tourniquet, apply a sterile bandage and urgently go to a surgical hospital. The cut-off fragment is not washed. It is wrapped in a clean (preferably sterile) cloth and placed in plastic bag which needs to be tied tightly. This bag is placed in another one filled with snow or cold water. During transportation, such a container must be kept suspended to avoid tissue compression.

If the avulsion is not complete, the limb is immobilized and cooled. The incident must be immediately reported to the ambulance dispatcher and the victim transported to the emergency room as soon as possible. surgery department. Often the severed segment can be restored using microsurgical techniques. Here crucial has time elapsed since the injury.

The viability of the brush at temperatures below +4 degrees is maintained for 12 hours, at more high temperature– up to 6 hours; for a finger injury, these periods are 16 and 8 hours, respectively.

Splinting

In case of injury to the hand and wrist joint, the limb must be immobilized. For this, standard tires or improvised means are used: planks, pieces of plywood or thick cardboard. The hand must be fixed in such a way that the fingers are slightly bent, the thumb is abducted, and the hand is slightly bent to the back. Place a soft cloth or foam roller in your palm.

The splint is bandaged to the palmar surface of the forearm from the elbow to the wrist, its end should protrude beyond the nail phalanges. It should not be strengthened too tightly, as the tissues swell quickly. The hand is placed on a scarf. The hand is raised with the healthy hand. It is useful to apply cold.

If your finger is damaged, you can use a ruler. It is bandaged or tied with a scarf from the middle of the forearm. The end of such a splint should protrude beyond the nail phalanx.

Bandages

You can bandage the wound with a regular bandage, adhesive plaster, or use a small tubular bandage (the recommended parts of the body are indicated on the packaging of such dressing material).

A spiral bandage is applied to one finger. Take a bandage 2-3 cm wide, wrap it around the wrist several times, then lower it along the back of the hand diagonally to the nail phalanx and begin to bandage the finger in a spiral, rising to its base. If the bandage is too wide, it needs to be folded around the nail to secure it well. The bandage is completed with circular tours on the wrist. For a tighter bandage, the spiral rounds of the bandage from the base of the finger do not lead to the wrist, but return to the nail phalanx. These repetitions are done several times.

A spica bandage is made on the thumb. After circular tours on the wrist, the bandage is led to the tip of the finger, wrapped around it and passed along the back of the wrist to the palm, then returned to the finger again. Make several such tours, gradually moving towards the base of the finger. This is how the phalanges are retracted to the side. The bandage is attached to the wrist.

If it is necessary to bandage all fingers separately, use a spiral bandage. On right hand First they bandage the thumb, and on the left - the little finger. After bandaging the finger, make a circular tour on the wrist and return to the nail phalanx of the next one.

For this purpose, bandages, an individual dressing package, a waist belt, a scarf, a rope, etc. are used.

Immobilization for foot and toe injuries

If the foot is injured, it posterior section give a plantar flexion position at an angle of 120 °; the knee joint is bent to an angle of 150-160°. If the forefoot is damaged, it is fixed at an angle of 90 °, as a result of which it falls off.

makes it necessary to fix the knee joint. The height of the splint is limited to the upper third of the shin (Fig. 13-16, 13-17).

Rice. 13-16. Application of a ladder splint for fractures of the leg bones and ankle joint(splint and splint application)

Rice. 13-17. Application of a ladder splint for fractures of the shin bones and ankle joint (fixation of the splint with a bandage)

It must be remembered that when the foot is injured, significant traumatic swelling and compression of the soft tissues always occur.

This can lead to the development of bedsores as a result of pressure from shoes or tight bandaging. Therefore, before applying a splint, it is recommended to remove or cut shoes.

Immobilization for closed fractures of the first finger is carried out with narrow strips of adhesive plaster, which are applied to the finger and foot in the longitudinal and transverse directions, but without much tension (loosely) to avoid subsequent compression of the swollen soft tissues of the finger.

It is especially dangerous in this regard to apply closed circular strips of plaster.

Possible mistakes:

In case of damage to the hindfoot, the knee joint is not fixed;

In case of damage to the forefoot, the foot is fixed in a plantar flexion position;

Shoes are not removed or cut when there is a risk of swelling.

Immobilization for injuries of the lower leg and ankle joint

In addition to bandaging to a healthy limb, any flat hard objects of sufficient length can be used. They are fixed along the damaged limb with bandages, scarves, belts, handkerchiefs, rope, etc. In case of damage to this location, it is necessary to fix not only the damaged lower leg, but also the knee and ankle joints, so the splints should reach the upper third of the thigh and capture the foot, fixed at an angle of 90 ° to the lower leg. Reliable immobilization is achieved using two or three ladder splints. A posterior scalene splint is applied from the upper third of the thigh and 7-8 cm distal to the ends of the fingers. Before application, the splint must be carefully modeled. The foot area is perpendicular to the rest of the tire. A “socket” is formed for the heel, then the splint follows the contours of the calf muscle, and in the popliteal region it is bent at an angle of 160°. The side stair tires are bent in the shape of the letter “P” or “G”. They secure the lower leg on both sides.

Immobilization is the creation of a position of immobility (immobility) of a limb or other part of the body during damage, inflammatory or other painful processes, when the damaged (diseased) organ needs a state of rest. Immobilization can be temporary (for the period of transportation to medical institution etc.) or permanent (creation of conditions necessary for fusion of bone fragments, wound healing, etc.). Permanent immobilization(it is usually also called therapeutic) is carried out, as a rule, by a doctor, less often by a paramedic. The most common method of immobilization with therapeutic purpose is an overlay plaster cast. There are many other methods of immobilization, for example, immobilization using special orthopedic devices, pneumatic (inflated with air for better contact with the surface of the body) splints, devices for connecting bones, in which metal knitting needles are passed through their fragments (Ilizarov apparatus, etc.), traction along the axis of the damaged limb behind a bracket with a needle passed through the bone (the so-called skeletal traction) and etc.

Transport immobilization is one of the most important first aid measures for fractures and other severe injuries.

Immobilization of the injured part of the body must be done at the scene of the incident. Its task is to protect the damaged part of the body from additional injury during the delivery of the victim to medical institution, where this temporary immobilization, if necessary, will be replaced with one of the permanent options.

Transportation of victims, especially with fractures, without immobilization even for a short distance is unacceptable, as it can lead to increased displacement bone fragments, damage to nerves and vessels located next to movable bone fragments. For large soft tissue wounds, as well as open fractures, immobilization of the damaged part of the body prevents the rapid spread of infection. For severe burns (especially of the extremities), it helps to make them less severe in the future. Transport immobilization occupies one of the leading places among other measures to prevent such a formidable complication of severe injuries as traumatic shock.

At the scene of an accident, it is most often necessary to use improvised means for immobilization in case of injuries, for example, strips or gutters made of various hard materials (boards, branches, sticks, skis, etc.), to which they are fixed (bandaged, reinforced with belts, etc.). ) damaged part of the body. In the absence of available means, sufficient immobilization can be created by pulling something injured hand to the body, hanging it on a scarf, and in case of a leg injury, bandaging one leg to the other. Splinting is the main method of immobilizing an injured limb while the victim is being transported to a medical facility.

There are many various standard transport tires, which usually impose medical workers. However, in most cases, in case of injuries, you have to use so-called improvised splints, which are made from strips of plywood, hard cardboard, pieces of thin boards, sticks, bundles of rods, etc. To fix such a splint, you can use either a bandage or other materials, for example fabric, towel, scarf, belt.

It is very important to produce transport immobilization as soon as possible. You should not try to undress the victim, as this will further injure already damaged tissue. The splint is placed over clothing. It is advisable to wrap it with cotton wool or some other soft cloth, especially if the splint is applied to a bare surface, since the pressure of a splint without a soft pad can cause bedsores. If there is a wound, for example if there was open fracture limbs, clothing should be cut (possibly at the seam, but in such a way that the entire wound becomes clearly accessible), then an aseptic bandage should be applied to the wound and only then immobilization should be carried out. At heavy bleeding from the wound, when it is necessary to use a hemostatic tourniquet, it is applied before splinting and is not covered with a bandage. It is necessary to place a note under the tourniquet indicating the time of its application. You should not strongly tighten the limb with separate rounds of a bandage (or its substitute) for “better” fixation of the splint, as this can cause circulatory problems or damage to the nerves located here. If after application transport tire It was noticed that the constriction did occur; it is necessary to cut it or apply the splint again. In the winter season and in cold weather, especially during long-term transportation, after splinting, the damaged part of the body is well wrapped.

When applying improvised splints, it is necessary to remember that at least two joints located above and below the damaged area of ​​the body must be fixed. If the splint does not fit well, it does not fix the damaged area, slips and can cause additional injury.

Immobilization of the head and neck necessary for all skull injuries, severe concussions, fractures or dislocations of the cervical vertebrae and extensive soft tissue injuries. For an improvised tire in such cases, a backing rubber circle or inner tube of a passenger car (motorcycle) is suitable. To immobilize the lower jaw, you can make a prash-shaped bandage or place a hard object wrapped in cotton wool under the victim’s chin, which should be bandaged to the head. To immobilize the neck, use a cardboard or cotton-gauze collar. To make it, take a piece of cardboard, cut out a strip, the width of which is equal to the distance from the chin to the middle of the sternum, and the length is slightly greater than the circumference of the neck. The width of the ends of the cardboard strips should be smaller. Then they wrap the cardboard thin layer cotton wool and bandage it. An improvised splint is placed around the neck (if the neck is tilted to the side or turned, then this position should not be changed) and the splint is secured with rounds of bandage, not very tight, so as not to disrupt blood circulation.

In case of injury to the upper limb at shoulder level, as already noted, it can be hung on a scarf or bandaged to the body. If there is a splint more suitable for immobilization at hand, then it is applied from the hand to the opposite shoulder blade, and the elbow joint is fixed in a bent position (approximately at a right angle). This is easily achieved if a wire splint is used for immobilization. When using cardboard for a splint, it should not be bent at the level of the elbow, since this material is not strong enough and weakly fixes the bent arm. It is better to make 2 improvised splints - one from the shoulder blade to the elbow, the other from the elbow to the fingers, and then, bending the arm at the elbow joint, supplement the immobilization with a fixing scarf.

If the arm is injured at the level of the forearm the splint is applied from the fingers to the elbow joint or middle third shoulder In the absence of available means of immobilization, the arms can simply be bandaged to the body. If there is no bandage, then the arm is suspended on a scarf. In case of injuries, when it is necessary to immobilize the hand, a tightly rolled cotton-gauze roll or tennis ball is placed in the palm, and then the forearm and hand are fixed to the splint.

To immobilize in case of injuries to the spine and pelvis, the victim is carefully laid on a flat, hard surface, such as a shield or thick wide boards.

For hip fractures Be sure to fix the entire leg. To do this, it is better to use 2 tires (strong enough, such as boards). One of them should be long (or armpit to outer ankle), and the other is short (from the crotch to the inner ankle). A long splint is fixed to the torso and injured leg (together with a short splint), the foot is placed at a right angle.

In case of damage to the leg and foot it is necessary to immobilize the ankle and knee joints. In the absence of available means, a healthy leg is “used” as an improvised splint, bandaging the damaged one to it.

The wrist joint is formed by the ends of the ulna and radius and small bones of the wrist. Around the joint capsule in large quantities ligaments are located, which allows the hand to move in different directions.

The human hand consists of three parts. The wrist is formed by 8 bones, which are arranged in two rows, and 5 metacarpal bones extend from them, which create the base of the hand. The phalanges of the fingers are attached to these metacarpal bones. In order for a person to make small movements with the hand, it has many tendons and nerves, and it is well supplied with blood.

Hand injuries are quite common, after each there is a risk of loss of hand function, so before the doctor arrives, the victim can only be given first aid, and qualified treatment will be prescribed by specialists.

Injury

Since the capsule of the wrist joint is not protected by muscles, it is always very painful. Bruise of the hand is characterized by rapid developing edema, a hematoma (subcutaneous hemorrhage) often forms. These characteristic signs of a bruise appear especially clearly when the fingertip is injured - for example, when it is hit with a hammer. The bones of this part of the body are quite thin and break easily, so in the event of a severe bruise, it is imperative to do and exclude (or confirm).

After the swelling has decreased somewhat, you can carry out procedures to warm the bruised area, but only if the doctor confirms the absence of an inflammatory process.

To warm up, you can use ointments with anti-inflammatory and analgesic effects, which include Fastum-gel. Often, when there is a bruise, blood accumulates under the nails of the injured hand - it must be removed in the surgical office outpatient facility, which will lead to significant relief and the disappearance of dull, aching pain.

Compression

If the hand is compressed by any heavy object, then extensive hemorrhage immediately occurs, muscle damage occurs and skin. First aid in case of such an injury is to apply tight bandage, applying cold. The injured hand must be given an elevated position. Compression is an injury that will definitely require qualified medical attention!

Ligament damage

Injury to the ligaments of the wrist joint is possible with a sudden movement of large amplitude - for example, this often happens when falling on your hand. The same statement applies to injuries to the tendons of the hand, but in this case, small bone fragments to which the tendons are attached are often torn off. The result of such an injury is subluxation of the joint, and blood accumulates in its cavity.

Note: Ligament damage is always accompanied by severe pain, swelling and impaired mobility in the affected joint. Often, with such an injury, pathological movements are observed - for example, the victim may bend his finger to the side, or move it in the opposite direction: this will characteristic feature separation of a bone fragment.

First aid for such injuries consists of applying cold, resting the affected joint and placing the hand on an elevated position.

It is imperative to seek qualified medical help.

In order for the fingers to move, tendons are needed - extensors on the outer surface, flexors on the inner surface.

• Symptoms will vary:
• If damage occurs to the extensor muscle, which is attached to the nail phalanx, then it stops straightening and “hangs.”
• If the ligament leading to the lower phalanx is injured, then a double contracture is observed: the middle phalanx bends, the nail phalanx hyperextends, and the finger takes on a zigzag shape.
• If double contracture occurs, the treatment will be surgical; without surgery it is impossible to restore the functioning of the hand.

The flexor tendons are most often affected by incised wounds of the palm. Such injuries are characterized by the inability to bend the fingers or clench them into a fist. The victim must attempt such movements with extreme caution because the ends of the tendons may become separated, making treatment more difficult.

First aid for such an injury consists of immobilizing the limb by placing a tennis ball or a foam sponge into the injured palm. You should immediately seek help from a doctor in the trauma department - such injuries can only be treated surgically.

Dislocation of the wrist joint wrist joint occurs, as a rule, due to an unsuccessful fall on the hand. With such an injury, the hand moves to the back, but displacement of the palm is extremely rare. Dislocation causes compression of blood vessels and nerve bundles, which manifests itself acute pain

, numbness of the entire hand, inability to make any movements, swelling and poor circulation.

Note: If the hand moves to the rear, then a deformity in the form of a step can be detected in the wrist joint. Palmar dislocation does not limit movement of the hand and fingers. First aid for such an injury is to immobilize the hand - this is done using a fragment of a board or plywood, or any hard object.

Under no circumstances should you adjust a dislocation yourself, as this will lead to additional injury to the joint. If it happened, then you can feel the bony prominence in the upper part of the hand. This condition is accompanied by swelling of the hand and some disturbance of movements. Often, patients do not pay attention to such an injury at all; this can lead in the future to a significant deterioration in the movement of the hand, so you should put a splint on the injured arm and go to a medical facility.

It is often found metacarpal dislocation– this injury occurs when falling on a clenched fist, after which the surface of the hand immediately swells, its surface changes. The affected palm becomes shorter than the healthy one, and the fingers do not clench into a fist.

If there is a fall on the hand with the thumb straightened, then there is a high probability that there will be dislocation of the metacarpophalangeal joint. In this case, the finger moves to the back of the hand, is strongly extended, the nail phalanx becomes bent, and finger movements are impossible. First aid consists of fixing the finger in its original position (you cannot crush it or try to straighten it) - doctors will work on the dislocation, and the straightening procedure is carried out only under anesthesia.

Fracture of the hand

Bone fractures can occur from falls and impacts. The symptoms of such injuries are quite classic - pain, swelling, abnormal shape of the hand, shortening of the finger, inability to move the affected part of the hand. Since the symptoms of bruises and fractures are identical, you need to go to a medical institution and take an x-ray - this will clarify the diagnosis and carry out effective treatment measures.

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Wounds of the hand

Open damage can be of a different nature:

• pricking,
• cut,
• ragged,
• chopped,
• bruised.

Wounds are usually complicated by injury to tendons or blood vessels, or separation of a phalanx or entire finger.

The amount of first aid will depend on the type of wound:

If there is a wound to the hand, there may be severe/intense bleeding. To stop it, it is necessary to apply a tourniquet to the victim’s arm just above the wound site. IN summer period the tourniquet can remain in place for two hours, in the cold season - no more than one and a half hours. Be sure to include a note under the tourniquet with the specified time for applying the tourniquet!

Finger rupture: first aid

When a phalanx or entire finger is torn off, the first task is to stop the bleeding using a tourniquet. Then a sterile bandage is applied to the wound and the victim is immediately taken to a medical facility. The cut-off fragment cannot be washed - it is wrapped in a clean napkin (it is highly advisable to do this with a sterile napkin) and placed in a plastic bag. The bag with the fragment is placed in another bag with snow or cold water, and when transporting this container, care must be taken to ensure that there is no compression of the tissue.

If incomplete separation occurs, the limb must be cooled and immobilized. Then the victim is urgently taken to a medical facility - the likelihood of restoration of the severed fragment depends on how quickly the victim ends up on the operating table.

Note:The viability of the brush at a temperature of +4 degrees is maintained for 12 hours, at a higher temperature - a maximum of 6 hours. For a finger injury, these indicators correspond to 16 and 8 hours.

Splinting

If an injury to the wrist joint and hand occurs, then first of all you need to immobilize the injured limb. To do this, you can use either standard medical splints or improvised means - for example, thick cardboard, boards, plywood. The brush is fixed as follows:

• the fingers are slightly bent and a fabric/foam roller is placed in the palm;
• the thumb is moved to the side;
• the hand is slightly bent towards the back.

The splint is bandaged to the palmar surface of the forearm from the elbow to the wrist; its end must protrude beyond the nail phalanges. It will be useful to apply cold to the already immobilized hand, but you need to place your hand on a scarf.

If a finger is damaged, then a regular ruler can be used as a splint - it is tied/bandaged to the damaged finger.

Bandages

You can bandage the wound with a regular bandage, adhesive plaster, or use a small tubular bandage, the packaging of which indicates the parts of the body that can be bandaged with it.

A spiral bandage is applied to one finger. This is done as follows:

• take a bandage 2-3 cm wide and wrap it around the wrist several times;
• then the bandage is lowered along the back of the hand diagonally to the nail phalanx and they begin to bandage the injured finger in a spiral, rising to its base;
• if the bandage is wide, you can twist it around the nail, which will ensure that the bandage is well secured;
• You need to complete the procedure with circular tours on the wrist.

If it is necessary to bandage all the fingers, then also apply a spiral bandage. On the right hand, bandaging begins with the thumb, on the left - with the little finger. After bandaging one finger, make a circular tour around the wrist and return to the nail phalanx of the next finger.

To bandage your hand, you need to place cotton wool or gauze swabs/napkins between your fingers. For such bandaging, use a wide bandage (at least 10 cm) and wrap it around all fingers at once, then return to the wrist. Then they make a circular fastening and again go down to the fingers - gradually the entire hand will be bandaged. Thumb always need to be attached separately from the palm!

Note:if you don’t have a bandage at hand, you can use a scarf as a dressing material. Of course, such a bandage will not stop arterial bleeding, but it will help keep the arm immobilized and prevent contamination.