Excellencies - Hand Surgery

Traumatic Pathology

Tendon injuries

What they are

Tendons are the instrument by which the muscles can flex and extend wrist and hand; they fit on the bones and can be compared to smooth, flexible and very resistant ropes. A shallow cut wound can cause a curtain injury, especially in some areas of the wrist where tendons flow very close to the skin. Less frequently it can be caused by an abrupt traumatic event, in the absence of skin cuts, that tears the tendon from its insertion on the bone.

How to care

The treatment is surgical and is intended to restore the continuity of the tendon and restore its function.
Early treatment gives better guarantees of success. The intervention depends on the type of injury.
If a tendon is completely cut, the head connected to the muscle retracts as if it were an elastic band: for this reason it is sometimes necessary to explore the wound by widening its dimensions; the two heads are then sutured together. If the tendon has been torn, it must be fixed again on the bone. The surgery is performed under anaesthesia of the upper limb only.
In the post-operative, following a period of immobilization, physiotherapeutic treatment with static and dynamic tutors and exercises aimed at preventing stiffness and adherence between tendons and surrounding structures is of fundamental importance.
Adherencies in particular, as a result of the physiological healing process, are a possible cause of failure of surgical treatment and their removal may require further intervention.

Fractures

What they are

A fracture is an interruption in the continuity of a bone that usually occurs following a traumatic event. A fracture can be broken down if the two abutments move and are no longer aligned on the same axis, or compounded if the fragments remain on the same axis; a fracture can be closed, if there is no laceration of muscle or skin tissue, or exposed, when a abutment tears the skin: in these cases the risk of infection increases.
Fracture of the wrist or fingers is a relatively common pathology. In general it manifests itself with violent pain, deformation of the limb, swelling, functional and movement incapacity, swelling and bruising.

Diagnosis is generally made with an X-ray.

How to care

The application of a closed brace or pinstripe device may be sufficient in the treatment of a composite and stable fracture or one that has been reduced. In some types of broken fractures, bone ends can be held in the correct position by using metal wires or percutaneous screws. Other cases require surgery and the use of synthetic media such as threads, screws or plaques to stabilize the bone.

In major hand injuries, a portion of bone may be missing or the fracture is such that it cannot be repaired directly. In such cases, it is necessary to use a bone graft taken from another part of the body to ensure greater stability. Bone callus formation, part of the healing process, takes a long time and involves a variable period of immobility. After bone healing, joint problems or loss of strength may remain. Physiotherapy will be essential in these cases.

Nerve injuries

What they are

Nerves are fragile structures and can be damaged by excessive pressure, tear or cutting. If nerve fibers are damaged, the correct signal conduction is missing and the symptoms may be of a motor (paralysis of inner and sensory muscles) and sensory nature (loss of sensitivity at the site of the injured nerve distribution); symptoms can rarely be isolated only for the sensory or motor nerves.

How to care

All peripheral nerve lesions should be operated quickly, preferably as a matter of urgency. The treatment, therefore, is of a surgical type and involves the microsurgical suture of the two cut garments with appropriate wires and optical instruments.
If, on the other hand, it is advisable to repair a lesion with a large loss of substance or in case of late lesions, the use of a nerve graft is recommended; this means taking a nerve from another part of the body or setting up muscles in the vein to fill the space and thus allowing the fibres upstream of the interruption to regenerate and reach the other end of the nerve. Healing is a slow process and the rate of nerve growth depends on the patient’s age, the mode of trauma and other factors.

In the post-operative it is important to prevent joint stiffness and the progressive atrophy of the muscles innerated by the injured nerve; for this purpose, physiotherapy and the packaging of targeted braces is of fundamental importance.