Understanding the injured hand: management of the first 48 hours
AbstractCorrect positioning of the injured hand in the first 48 hours after injury is critical to ensure that optimal mobility of the hand is preserved.1 With the cooling-off regimen indicated in burns, dressings must be in contact with the burnt skin, with added dressings to keep those in place,2 limiting hand mobility for that period. The extensor collateral ligaments are the weakest at preserving mobility, and shortening of the collateral ligaments of the metacarpophalangial joints (MCP joints), proximal interphalangial joints (PIP joints) and distal interphalangial joints (DIP joints) occurs very quickly with incorrect positioning of the hand.2 Collateral ligament shortening is an irreversible condition, leading to major loss of hand function and adding to the development of contractures on either side of the hand, depending on which ligaments are damaged.3 The ideal position for the MCP joints is at a 90 angle, if the flat hand is taken as the 0 starting point (Figure 1 and 2).4 For the PIP and DIP joints, 10-15 flexion is needed for optimal protection and preservation of hand functionality.4
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