Crush Injury to the Hand
Crush injuries involve damage to multiple structures: bone, soft tissue, vessels, and nerves. The primary enemy is Edema (swelling), which leads to stiffness and fibrosis ("The Stiff Hand").
1. Immediate Management
- Debridement: Removal of dead tissue.
- Skeletal Fixation: K-wires to stabilize fractures.
- Edema Control: Elevation (Hand above heart) is crucial.
2. Compartment Syndrome
The hand has 10 compartments. Increased pressure leads to muscle necrosis.
- Signs (5 Ps): Pain (out of proportion, especially on passive stretch), Pallor, Paresthesia, Pulselessness, Paralysis.
- Treatment: Emergency Fasciotomy.
3. Physiotherapy & Splinting
- POSI (Position of Safe Immobilization): Wrist extended 30°, MCPs flexed 70-90°, IPs extended 0°. This prevents collateral ligament shortening.
- Early Motion: Essential to pump out fluid.
25 Practice MCQs
Q1. The "Position of Safety" (Intrinsic Plus) involves:
Answer: A). Prevents contracture of collateral ligaments.
Q2. The earliest sign of Compartment Syndrome is:
Answer: B). Pulselessness is a very late/terminal sign.
Q3. The main cause of the "Stiff Hand" is:
Answer: A). Fluid turns to "glue".
Q4. How many compartments are in the hand?
Answer: A). 4 dorsal interossei, 3 volar interossei, thenar, hypothenar, adductor.
Q5. Elevation of the hand should be:
Answer: A). Uses gravity to drain venous blood.
Q6. Fasciotomy is:
Answer: A). Saves the muscles from necrosis.
Q7. Ischemic contracture of the intrinsic muscles leads to:
Answer: A). Intrinsics shorten and pull MCPs into flexion.
Q8. Which modality helps with desensitization of hypersensitive scars?
Answer: A). Retrains the nervous system.
Q9. Volkmann's Ischemic Contracture is a sequela of:
Answer: A). Muscle tissue dies and is replaced by fibrous scar.
Q10. Coban wrap is used for:
Answer: A). Self-adherent wrap applied distal to proximal.
Q11. "Mangle" injury refers to:
Answer: A). Severe industrial accident.
Q12. Contracture of the first web space (Thumb adduction) prevents:
Answer: A). Vital to maintain web space span with splints.
Q13. Delayed primary closure means:
Answer: A). To ensure no infection or necrosis exists.
Q14. Which ligament shortens if MCPs are immobilized in extension?
Answer: A). Leading to inability to flex (extension contracture).
Q15. Hyperbaric Oxygen Therapy is used to:
Answer: A). Helpful in crush/ischemia.
Q16. Complex Regional Pain Syndrome (CRPS) is a high risk in crush injuries. True/False?
Answer: A). Due to nerve irritation and massive swelling.
Q17. Dynamic splints are used to:
Answer: A). "Creep" lengthens tissues.
Q18. Degloving injury implies:
Answer: A). Requires flap coverage or grafting.
Q19. Replantation (reattachment) is most successful in:
Answer: A). Vessels and nerves are easier to find and repair.
Q20. Retrograde massage should be done:
Answer: A). To assist venous/lymphatic drainage.
Q21. The "No-Fly" concept refers to:
Answer: A). Circumferential casts are dangerous in acute crush.
Q22. Which tendon is often used as a graft?
Answer: A). Absent in 15% of population, expendable.
Q23. Leeches are sometimes used for:
Answer: A). They secrete hirudin (anticoagulant).
Q24. Stiffness is best prevented by:
Answer: A). "Motion is lotion".
Q25. Intrinsic tightness test (Bunnel-Littler) differentiates:
Answer: A). Compare PIP flexion with MCP extended vs flexed.
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