Hand Trauma: Causes, Symptoms, Complications and Treatment

Hand trauma and replants represent a remarkable advancement in medical science since the first successful thumb reimplantation in 1968. Today, surgical teams achieve success rates in replantation procedures, offering hope to patients facing upper extremity amputations.

This article explores the various aspects of hand trauma, treatment options, and the latest developments in reimplantation procedures. Readers will learn about different types of injuries, available treatments, and essential preventive measures to protect hand health.

What is Hand Trauma?

The intricate design of the human hand makes it particularly vulnerable to injury. Hand trauma encompasses any injury to the fingers, hands, or wrists, affecting bones, tendons, ligaments, nerves, blood vessels, and other structures. With 27 bones (including eight wrist bones) and numerous associated tissues, even minor injuries can lead to significant functional impairment if not correctly treated.

Hand trauma occurs commonly in everyday life. These injuries require prompt medical attention as the potential for devastating outcomes increases significantly when treatment is delayed.

Doctors classify hand trauma into several general categories:

• Burns: Ranging from first-degree (redness and pain) to third-degree (charred skin with nerve damage), caused by heat, chemicals, or electricity
• Lacerations: Deep cuts or tears from sharp objects, which may require stitches for severe cases
• Fractures and dislocations: Breaks in bones or separation of connected bones at joints
• High-pressure injection injuries: Commonly occurring on the dominant hand from devices like paint guns, appearing minor but potentially severe
• Infections: Treatable with antibiotics initially but may require tissue removal if advanced.
• Soft tissue injuries: Affecting muscles, ligaments and tendons, including contusions, sprains, and tendonitis
• Amputations: Loss of a limb resulting from trauma or disease

What are the Symptoms of Hand Trauma?

Symptoms of hand trauma vary widely depending on the specific injury type and severity. 

The pain might worsen when gripping, squeezing, or moving the hand. Alongside pain, patients typically experience swelling, tenderness, and bruising. These four symptoms—pain, heat/redness/bruising, swelling, and stiffness with loss of function—are hallmark signs of soft tissue injuries to the wrist or hand.

Functional limitations often accompany hand trauma, manifesting as:

• Stiffness or inability to move fingers or thumb
• Decreased range of motion
• Weakness in the hand
• Difficulty in gripping objects

Sensory changes frequently occur with certain injuries, especially those involving nerves:

• Numbness in the hand or fingers
• "Pins and needles" sensation
• Burning or tingling, particularly in the thumb, index, and middle fingers

Specific injury types present with characteristic symptoms:

• Burns show tenderness or complete numbness, tissue loss, skin texture changes, redness, blistering, and potentially black areas of tissue.
• Fractures and dislocations present with tenderness, obvious deformity (such as crooked fingers), swelling, discolouration, decreased range of motion, numbness, weakness, and sometimes bleeding.
• High-pressure injuries cause pain, swelling, and occasional skin discolouration.
• Infections typically involve tenderness, localised warmth, redness, swelling, decreased range of motion, and rarely fever.
• Lacerations present with tenderness, bleeding, numbness, decreased movement range, weakness, and pallor (pale appearance).
• Soft tissue injuries and amputations show tenderness, deformity (sometimes with tissue and bone loss), swelling, discolouration, bleeding, weakness, and numbness.

What are the Causes of Hand Trauma?

Hand injuries result from a wide range of incidents across various settings. 

• Accidents 
• Impact during recreational activities or sports 
• Workplace environments pose significant risks for hand trauma. Machinery accidents 
• Kitchen mishaps resulting in cuts and burns
• Falls where hands are used to break the impact
• Handling certain tools, equipment or heavy machinery involving high pressure, extreme temperatures or moving parts

What are the Risk Factors for Hand Trauma?

Workplace environments pose the highest risk. These may vary significantly across industries:

• Manufacturing and industrial work creates exposure to machinery, causing lacerations, cuts, punctures, and potential amputations
• The food service industry presents dangers from burns, knife slips, and finger amputations during food preparation
• Construction and repair involves power tools and heavy materials, increasing the risk of crush injuries
• Retail and service sectors experience repetitive motion disorders from repeated tasks
• Office environments often lead to carpal tunnel syndrome from computer use
• Prior injury history significantly influences future risks. 

Additional factors impacting hand trauma risk include performing unfamiliar tasks outside normal job requirements, using defective materials, underlying cardiovascular disease, extended sleep patterns (nine or more hours nightly), and high alcohol consumption.

Sports activities create substantial risk, especially contact sports like wrestling & football, as well as high-speed activities such as biking and skateboarding.

Other factors may include RTA, Accidental fall, and assault.

What are the Complications of Hand Trauma?

Immediate complications often include infections, particularly with bite wounds. Blood vessel, tendon and nerve damage represent another serious concern following hand trauma. Patients experiencing numbness or circulation problems should seek immediate medical attention.

The long-term consequences of untreated hand trauma include:

• Chronic stiffness and mobility issues: Limited range of motion, difficulty holding items, and trouble performing daily tasks like typing or buttoning shirts
• Bone deformities: Malunions (improper healing) can significantly impair hand function when bones aren't properly aligned during healing
• Delayed union or nonunion fractures: Some fractures take longer to heal (delayed union) or fail to heal at all (nonunion) without medical intervention
• Osteoarthritis: Fractures extending into joints often develop arthritis years later, causing pain and swelling
• Complex regional pain syndrome (CRPS): A chronic condition characterised by persistent pain and sensitivity

Treatments for Hand Trauma

Doctors often start with conservative approaches before considering surgical interventions for hand injuries. Where there is no obvious tissue damage at the time of examination.

• Conservative Management: The RICE method serves as the foundation for many hand trauma treatments. This approach includes resting the injured hand, applying ice packs for 15-20 minutes several times daily, compressing with elastic bandages, and elevating the hand to reduce swelling. 
• Immobilisation: Doctors use splints, casts, or braces to keep the injured hand still during healing. This temporary restriction of movement relieves pain and promotes proper healing of bones, tendons, and tissues.
• Medications: Doctors typically recommend medications, including non-steroidal anti-inflammatory drugs (NSAIDs), to reduce swelling and discomfort in pain management. 
• Physical Therapy: Therapists design specific exercises and splints to restore strength, improve range of motion, and enhance hand function. Occupational therapists often suggest workplace modifications to prevent reinjury during daily activities.
• Surgery: Severe hand trauma may require surgical intervention for the following conditions:
  • Closed reduction and fixation realign broken bones using wires, rods, splints, or casts
  • Tendon repair connects damaged tendons through direct surgery, often within 24 hours for acute injuries
  • Nerve repairs restore function through reattachment or nerve grafts
  • Fasciotomy relieves pressure in compartment syndrome
  • Surgical drainage removes pus collections from infections

How do You Prevent Hand Trauma?

Prevention of hand trauma requires consistent attention to safety practises in both work and personal environments. According to OSHA estimates, 71% of all hand injuries could be prevented using personal protective equipment, specifically safety gloves.

• Proper ergonomics plays a vital role in prevention, especially for conditions like Carpal Tunnel Syndrome. Adjusting workstations to ensure correct wrist alignment while typing or using a mouse significantly reduces strain. Regular breaks during repetitive tasks allow hands and wrists to rest, preventing stiffness and potential injuries.
• Strengthening exercises for hand and forearm muscles support joints and decrease injury risks. 
• Equally important is maintaining a healthy weight, as obesity creates additional stress on joints, including wrists.
• When handling potentially hazardous materials or equipment, these protective measures are essential:
  • Choose the right gloves for specific tasks – different gloves provide optimal cut, impact, heat, chemical and abrasion resistance for various scenarios
  • Ensure gloves fit properly – oversized gloves decrease dexterity, while too-small gloves restrict movement and cause discomfort.
  • Remove rings and bracelets before donning gloves, as jewellery can affect fit and create snags.
  • Inspect gloves regularly for wear and replace damaged ones immediately

Conclusion

Hand trauma remains a significant medical challenge affecting thousands of people annually, particularly in workplace settings. Though these injuries can be severe, proper prevention strategies and timely medical intervention lead to successful outcomes.

Safety measures like wearing appropriate protective equipment and following ergonomic practices significantly reduce injury risks.

FAQs

1. What are the treatment options for Hand trauma injuries?

Treatment typically begins with the RICE method—rest, ice, compression, and elevation. For persistent inflammation, anti-inflammatory injections containing steroid and anaesthetic medication may help reduce pain. Severe injuries might require direct surgical intervention.

2. How long does it take to recover from a hand reimplantation surgery?

Rehabilitation typically begins in the first postoperative week with oedema control and splinting. Active exercise programmes usually start after the eighth week. The recovery timeline varies based on the reimplantation location—fingers with distal reimplantations complete active rehabilitation by 10-12 weeks, while proximal reimplantations require longer rehabilitation. 

3. Can nerve function be fully restored after a hand reimplantation?

Complete nerve function restoration remains challenging after reimplantation. Fast-adapting touch receptors can become reinnervated. However, patients often experience aberrant sensory regeneration and abnormal connections between sensory and motor fibres. Despite these limitations, many patients regain protective sensation and partial motor function.

4. Are there alternative treatments for reimplantation?

Completion or revision amputation sometimes offers better and faster recovery than reimplantation. Pollicisation (moving a partially amputated digit to the thumb position) can restore function for thumb amputations. Another option involves replanting a less significant amputated digit to the thumb stump or providing a small bone graft and flap cover for the stump length.

5. What are the most common types of hand trauma implants used in surgery?

The following are some common hand implants:

• Bone plates 
• Screws 
• Pins 
• Nails (or rods) 
• Flexible wires 
• Staples 
• Bioabsorbable implants