GENERAL: ESSENTIAL TIPS FOR DEALING WITH TRAUMA
Failure to diagnose a foreign body
Failure to diagnose a ruptured tendon
Exposed joint capsule in the fist
Beware of bites, high pressure guns and puncture wounds
Be cautious of fractures and dislocations around the elbow in children
Always assume (and look for) the presence of nerve, tendon or artery injury.
Buried wooden splinters, gravel and slivers of glass are old traps—if suspected and not found on simple exploration, order high-resolution ultrasound, which is good at detecting wood and glass. CT is best.
Falling on the outstretched hand
Consider the following fractures: Colles and Smith (distal radius); scaphoid; radius and ulna shafts; head of radius; Bennett’s fracture (carpo-metacarpal joint of thumb); supracondylar (children); neck and shaft of humerus, clavicle and the dislocations—lunate and shoulder.
Jumping or falling from a substantial height onto feet
Always consider a fractured calcaneum, talus, spine (especially lumbar) or pelvis and central dislocation of hip. Concussion can follow.
Vascular complications of fractures and dislocations
Upper limb: supracondylar fracture of humerus (brachial artery); compartment syndrome of flexor muscles.
Lower limb: supracondylar fracture of femur (popliteal vessels); dislocation of knee; disruption of pelvis (up to 5000 mL of blood).
Always look for a peripheral nerve injury.
If using a small tourniquet such as a rubber band for haemostasis, clip on a small artery forceps so it is not forgotten when you finish.
You can get concussion from a heavy fall onto the coccyx/sacrum.
Think of a sewing needle in the knee or in the feet of children for unexplained pain.
Treat (evacuate) haematomas of the nasal septum and ear because they can collapse cartilage.
Beware of pressure gun injuries into soft tissue, especially those involving oil and paint.
Beware of a painful immobile elbow in a child—look for a fracture that can cause trouble later.
Beware of the scaphoid fracture after a fall onto an outstretched hand. Examine the snuffbox.
Finger injuries can be treated by simple means, providing there are neither tendon nor nerve injuries complicating the lacerations or compound fractures involved.
Not all finger tip loss demands an immediate graft or tidy-up amputation. If there is no exposed phalanx tip and the area of exposed subdermal tissue is small, conservative management is best. Remember that a grafted finger tip is insensate. If the amputated skin tip is available, it should be replaced (use Steri-Strips or ...