The Assessment and Management of the Injured Hand--J. 1. P. James THE ASSESSMENT AND MANAGEMENT OF THE INJURED HAND

My role is to consider the problems involved in assessing the injured hand on its arrival at hospital and the management thereafter. Although the main emphasis of these discussions relate to loss and damage to the skin, my concern must necessarily be also with the contents within the skin of the hand; the soft tissues, the special structures, nerves, tendons, bones and joints. Obviously this must be dealt with in principle rather than detail. HISTORY When a patient presents with a wounded hand it is important o know how the injury occurred, whether by cutting or crushing, the latter implies great danger from oedema at a later stage whereas cutting means clean division of anatomical structures though implying much subsequent reconstructive surgery. The age of the patient, whether he is right or left handed, his work and the specific actions of his hand in this, his important hobbies; these factors may well determine some of the decisions at the primary operation. EXAMINATIO