Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Hand and Finger Injuries: One ER Physician's Story
Medical Author: John P. Cunha, DO
Medical Editor: Melissa Conrad Stöppler, MD
As an emergency room physician, I frequently see hand injuries. More than
1,000,000 U.S. workers receive treatment in emergency departments annually for
acute hand and finger injuries. The U.S. Bureau of Labor Statistics estimates that
approximately 110,000 workers with hand and finger injuries lose days from work
annually - second only to back strain and sprain in terms of work days lost.
I injured my hand when I was 18 years old, and since then I have taken a
special interest in treating hand injuries.
While working in a restaurant I accidentally stuck my index finger into a
mechanical cheese grating machine and ground off the tip of my finger. I
suffered traumatic nail bed damage, an
open fracture, and tendon injury to the
dorsum (back side) of my finger.
I went directly to the local emergency department where I was seen by a
resident physician who took some
X-rays and then prepared to repair the
extensive lacerations.
During the procedure the doctor injected lidocaine (a common local
anesthetic) directly into the area surrounding my wounds to anesthetize my
finger, which was incredibly painful - more painful than the initial injury. The
doctor put in several stitches to stop the bleeding and bandaged my finger with
a splint. I was referred to a hand surgeon for follow-up the next day.
Intricate in design and function, the hand is an amazing work of anatomic
engineering. Form follows function in the hand; therefore, any injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require
proper medical evaluation.
The goal with injuries to the hand is a rapid and accurate initial evaluation
and treatment. In other words, once an injury occurs, the doctor strives to begin medical treatment quickly so the short- and long-term effects
on the hand can be minimized.
The hand consists of 27 bones (including the 8 bones of the wrist). When the other associated structures (nerves, arteries, veins, muscles, tendons, ligaments, joint cartilage,
and fingernails) are considered, the potential for a variety of injuries exists when trauma involves the hand.
Hand injuries account for nearly 10% of hospital
emergency department visits. A series of 1,000 consecutive hand injuries showed the following distribution: 42% lacerations (cuts), 27% contusions (bruises), 17% fractures (broken bones), and 5% infections.
Hand injuries account for about 17% all workday loss injuries.
The most common cause of the injuries was blunt trauma (50%) followed by injury from a sharp object (25%).
Hand Injury Causes
Hand injuries can be divided into six general categories:
The hand is a marvelously complex part of the human anatomy. Every year, however, millions of people experience broken bones within their hands. Because we are so dependent on our hands, even a small loss of function can result in a lifelong disability. A broken hand will often require a visit to a doctor, and it may require months of rehabilitation care.
The hand is composed of 27 bones, including those in the wrist. Broken bones most commonly result from a direct blow to
or by the hand, or a fall onto the hand. Common injuries include fractures of the fingertip,
broken knuckles, or fractures of the thumb.
When doctors describe the bones in the hand, they use several terms.
Carpals or carpal bones are the 8 bones in the wrist. They are not actually part of the hand but are vital for its function.
Metacarpals are the 5 bones that form the palm of the hand.
