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Propédeutique du poignet et de la main traumatiques

par El Kazzi, Wissam;Bahm, Jorg ;Gkotsi, A.;Moungondo, Fabian ;Schuind, Frederic
Référence Revue médicale de Bruxelles, 41, 6, page (334-339)
Publication Publié, 2020-12-01

Article révisé par les pairs

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Résumé :

The wrist and hand belong to a complex osteo-articular system capable of a multitude of movements. Whether on the dorsal or palmar side, nerve, tendon and vascular structures are of paramount anatomical and functional importance. Hand and wrist injuries are a common reason for emergency room visits. A brief but precise history and a methodical initial clinical examination are able to give a diagnostic hypothesis. Additional tests will then be prescribed based on the clinical findings. The diagnosis of closed trauma is based on good quality centered x-rays, but the rate of misdiagnosis is more frequent on the wrist due to difficulties in the realization and interpretation of initial x-rays. This is one of the reasons to refer the patient to a specialized consultation the day after the trauma. Dislocations and fractures-dislocations must immediately be reduced and immobilized. Displaced joint fractures should be identified as they are surgical. Sprains of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb remain suspect of a Stener lesion until proven otherwise because they are terrible. The diagnosis of hand wounds is based on surgical exploration in the operating room because even if the clinical examination is performed under good conditions, surgical lesions can be missed. Surgery of vascular-nervous pedicles or tendons is reserved for specialist in hand surgery. Follow-up and rehabilitation depend on the diagnosis and the surgical procedure. The initial treatment of traumatized hands has a decisive influence on their future. This treatment must be complete, requiring a mastery of both osteosynthesis techniques, flap cover and microsurgery, to reduce secondary interventions and functional sequelae. This treatment begins with a good initial management in the emergency room or in the general practitioner's office.