How do I Treat a Broken Finger?

Refers to the person who was broken due to trauma. Refers to those who have anthrax black without pus, also known as broken finger cricket, because the disease can cause finger breaking, so it is called broken finger.

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Broken finger introduction

Disease Name: Broken Finger

Refers to the person who broke because of trauma. See "The First Edition of Waizhi Shoushifang". There are: "Missing the fingers by mistake, mixing them with the fragrant powder, and covering them with silk cotton for seven days. Avoid falling into the wind and blowing wind .... The true hematoxylin is mixed with the broken fingers indirectly, and the external silkworm cocoons are firmly bound for several days. That's it. "

Refers to those who have anthrax black without pus, also known as broken fingers, because the disease can cause broken fingers, so called broken fingers. Out of "Surgery Dacheng" Volume II. Treatment should be based on warming the Yangmai pulse, promoting blood circulation and removing blood stasis, and those who are not effective in drug treatment at the later stage should be cut off to relieve their poison. See the anthrax section for details.

First aid method for severed fingering event

In modern society, finger breakage caused by machinery, traffic accidents, and other causes is increasing. Hand functions are extremely complex and prosthetic limbs are difficult to replace. After the finger is disabled, the patient will lose the ability to work to varying degrees, which will seriously affect life and affect the family and society. Therefore, replantation surgery should be performed as far as possible when the finger is broken.

China's microsurgery has developed rapidly, and the level of replantation of broken fingers ranks among the highest in the world. Many patients with injured and severed fingers were rescued and carefully treated by the doctor in time. The severed fingers were replanted to survive, and their functions were basically restored. This aspect depends on the hospital's excellent equipment, the doctor's noble medical ethics and superb technology, and at the same time the correct treatment on the spot is also very important.

Correctly storing broken fingers is the basis and prerequisite for successful replantation. However, it is often difficult to get correct guidance from the medical staff at the scene of the trauma, and the rescuers are panicked and often make mistakes. Here we remind everyone to pay attention to the following points when encountering broken fingers:

In the event of an accident, the wounded must first be rescued, checked for spinal cord and nerve injuries, and protected to prevent causing or aggravating injuries. If there is bleeding, according to the bleeding site, pressure bandaging, shiatsu, tourniquet and other methods should be used to stop bleeding to prevent shock. If fracture or dislocation is suspected, don't fix it by yourself first, simply fix it with splint, plaster or substitute.

After doing this or at the same time, you should deal with broken fingers. Sometimes the fingers are not completely severed, and there is still a little skin or tissue connected. There may be small blood vessels, which are sufficient to provide nutrition and avoid finger necrosis. Be careful and protect them properly to prevent blood vessels from being twisted or stretched.

If there is bleeding in the stump of the broken finger, the bleeding should be stopped first. After the limbs and fingers are severed, although the blood is nourished, there is still vitality in the short term, and the degeneration and rot will occur after a long time. Refrigerated storage of broken fingers can reduce their metabolism and maintain vitality. The temperature is low in winter, which is easy to achieve; it is hot in spring and autumn, especially in summer.

In this case, it is especially important to quickly refrigerate and cryopreserve the broken fingers. The broken fingers can be wrapped with a substitute such as a sterile dressing or a relatively clean cloth towel, and sealed with a plastic film on the outside. After that, put it in a suitable container such as an ice bottle, put ice cubes around it, and transfer it to the nearby hospital with replanting conditions with the patient. Ice cubes can be taken from the refrigerator. It is difficult to obtain temporarily, and can be replaced by ice lolly and ice cream. Broken fingers should not be in direct contact with ice cubes or ice water to prevent frostbite degeneration. Alcohol can denature proteins, so it is absolutely contraindicated to immerse broken limbs (finger) directly in alcohol. For rinsing, use only saline. Hypertonic or hypotonic solutions are harmful to tissue cells and will affect the survival rate of replantation. They should not be used for soaking or washing off fingers. In some cases, broken fingers can be swallowed by animals such as pigs, dogs, and chickens. In this case, the animal can be killed immediately, and the severed finger can be removed from the stomach. There is still the possibility of replanting. If there is a slight delay, the broken finger will be digested and deformed by the gastric juice of the animal, making it difficult to survive.

How to rescue a finger

First Aid First Aid

If the limb is injured by the machine, stop the machine immediately and quickly remove the broken (rolled off) limb. Do not remove the limb by reversing the machine to prevent the limb from being damaged again.

Broken finger to stop bleeding

You can use a clean dressing or cloth to apply pressure to the wound to stop bleeding. If necessary, you can use a tourniquet, but remember to relax the tourniquet every hour for 10-15 minutes.

() Broken finger, broken finger (limb) refrigeration method

The breaking finger is wrapped with more than 8 layers of gauze, placed in a plastic bag without leaks or tied tightly with the mouth of the bag facing upwards, and then placed at about 10 ° C in a container with ice. Broken fingers have replanting conditions within 15 hours at normal temperature, such as replanting conditions within 36 hours after refrigerated treatment.

Broken Finger Fast Transfer

The patient's injured hand and severed finger should be wrapped, the pain can be stopped, and it can be fixed with splint and bandage, and sent to the nearest hospital with hand surgery specialty as soon as possible for replantation. Pay attention to supine and raise injured limb during transportation

In addition, experts from the Beijing clinic of Fuzhou Fuxing Orthopedic Hospital have suggested that when dealing with broken fingers:

1. It is forbidden to put broken fingers directly on ice cubes;

2. It is forbidden to soak the broken fingers in any disinfectant or physiological saline;

3. It is forbidden to put the broken finger in the pocket or under the armpit.

() First aid method for broken finger (finger)

First, pay attention to whether the injured person is in shock or other combined injuries. If there is shock or other life-threatening combined injuries, they should be rescued quickly.

Second, if there is active bleeding on the cross section, apply a clean dressing and pressure bandaging to stop bleeding. It is best not to use a tourniquet. When a tourniquet must be applied, it should be relaxed once every half an hour.

3. Most severed limbs should be fixed and then transferred.

4. Completely broken limbs should be wrapped with sterile dressings or clean cloths, towels, etc., kept in a low temperature method (ice blocks are placed around, but not soaked with any liquid), and sent to the hospital as soon as possible. During the transfer process, contact the receiving hospital as much as possible to make necessary preparations for acceptance.

V. Indications for surgery: 1. There are no other injuries, and the general condition can tolerate the surgery. 2. If shock has occurred, the severed limb can be debrided and kept at low temperature while the anti-shock is actively anti-shock, and the operation can be performed after the shock is stable. 3, local conditions: based on the location of the break, injury and future recovery of comprehensive consideration. It has certain functions after replantation.

Nursing method after severed finger replantation

Fingerless environment

The ward is clean and tidy, maintaining air circulation, controlling visiting personnel and preventing cross infection. Ultraviolet disinfection room is 1-2 times a day, and the room temperature is controlled between 24-26 degrees. In order to maintain local temperature, it can be irradiated with 60-100W baking lamps with a lamp distance of 30-50CM. Inform patients and family members that the distance cannot be adjusted to avoid burns. Humidity is 60% -70%. If the temperature is too low, it will cause vasospasm to impede blood circulation. If it is too high, it will accelerate tissue oxygen metabolism.

Sever finger position

The patient needs to be absolutely bedridden for 7-10 days after the operation. Due to changes in body position, blood pressure in the body can be changed. Anastomosis vessels are extremely sensitive to transient changes in blood pressure, which is prone to spasm. The affected limb should be cushioned slightly above the heart level to promote Venous return, relieve swelling of the limbs, should be braked to maintain functional position.

Observation of revascularization of severed fingers

The local blood circulation should be closely observed after the operation, and blood circulation disorders should be found and resolved in time.

Within 24-72 hours after surgery, it is a high incidence period of anastomosis of circulatory crisis, so it should be observed every 1-2 hours. Among them, the indicators of blood circulation of replanted limbs need to be closely observed: skin color, skin temperature, fingertips Abdominal tension, capillary regurgitation, bleeding from the lateral incision of the fingers, etc. The above indicators should be comprehensively analyzed and judged correctly. Color and temperature are reliable indicators of subcutaneous blood flow.

(A) refers to body color

The change of finger color after sever finger replantation is the most easily observed objective index. After the replantation of the completely severed finger body, the distal finger body blood vessels have been denervated, so they are all in an expanded state. Therefore, the replanted finger color is rudder than the normal finger.

The finger body changed from ruddy to pale, indicating that the broken finger is in an ischemic state, which can be caused by arterial spasm or embolism. Cold and pain can often cause vasospasm. For this reason, the fingers and forearms after replantation in winter or cold areas are best wrapped with cotton wool to keep the temperature in the ward maintained at a room temperature of 24 to 26 ° C. When all the above conditions are met, when the replanted finger changes from ruddy to pale, arterial spasm should be suspected first, and 30 ~ 60mg of papaverine should be injected intramuscularly and given analgesic treatment. Close observation, usually after 10 ~ 30 minutes The posterior arterial spasm is relieved, and the finger body changes from pale to ruddy; if the above measures are taken and the observation time is not improved, and the possibility of arterial embolism is suspected, surgical exploration should be taken; if the finger body changes from ruddy to gray, the finger Abdominal tension is low, and there is a small amount of dark blood flowing slowly from the side to side of the finger. This indicates that there is no arterial blood supply to the broken finger, and the vein is still unblocked. The bleeding is caused by venous reflux and is still an arterial crisis. Surgical exploration should be performed. The body changes from ruddy to dark purple, and the abdomen tension is high, which indicates that the venous return is impaired. At this time, a small incision can be made on the side of the finger with a scalpel, and the dark purple blood can be seen immediately, and bright red blood will soon flow out. From purple to red. If the bleeding stops, the finger is dark purple again, indicating that the venous crisis has not been resolved, and surgical exploration should be performed in time to reconstruct the venous return. After replantation, if the body of the finger is waxy white, the abdomen tension is high, and the end of the finger is cut open to discharge bright red blood, which indicates that the finger has good blood supply, and this phenomenon mainly refers to the excessive ischemic time of the body. The cells have begun to degenerate, increasing the permeability of the capillaries. Once the finger is broken, the cells (tissues) are edema, the tension between the tissues is increased, the peripheral circulation is blocked, and it appears waxy white. Generally, after 1 to 2 days of heat preservation and anticoagulation treatment, the finger body can be changed from waxy white to cherry red, and some cases return to pink, and capillary refilling occurs.

(Two) finger body temperature

The change of finger temperature is an important indicator that directly reflects the blood circulation after the replantation of the broken finger. Skin thermometers were routinely used for contact detection after surgery and recorded in a timely manner. In order to obtain the correct finger temperature data, each time a broken finger is tested, the room temperature should be recorded in time. The finger temperature of the healthy finger should be tested first, and then the finger temperature should be tested. For each broken finger, if the arteries on both sides of the finger are anastomosed, and more veins are repaired, the temperature of this broken finger is roughly the same as that of the healthy finger, sometimes even slightly higher than that of the healthy finger; if only one finger artery is repaired The temperature of the finger is slightly lower than that of the healthy side by 1 to 2 ° C. If the temperature of the broken finger is 4 to 5 ° C lower than that of the healthy finger, it means that the blood circulation of the broken finger has been impaired. At this time, a comprehensive analysis should be performed according to other observation indicators. If the temperature of the finger gradually decreases, the body of the finger changes from ruddy to pale, indicating that the indicator has impaired arterial blood supply. In the process of detecting the finger temperature, if it was found that the finger temperature rose slightly at that time, and the finger body gradually changed from rosy to dark purple, and then the finger temperature gradually decreased, and when the finger temperature changed from 3 to 4 ° C, the finger body changed from red to red. Purple, refers to the temperature drop, but there is still capillary refilling phenomenon, and the response is rapid, indicating that most of the body's veins return to the obstacle, but there is still a small amount of reflux. If the temperature of the finger remains the same, the finger may survive. The temperature continued to drop, the finger body was dark purple, and the sides of the finger were open to blood. The finger body changed from purple to red, indicating that the venous return was completely impaired and embolism occurred. Surgical exploration should be performed in time to remove the vein in the embolized section for re-suture or vascular graft repair Otherwise, it is difficult for the fingers to survive.

(Three) capillary refilling observation

After complete replantation of the fingers, the distal fingers were denervated, the blood vessels were dilated, and the surrounding capillaries were full. Therefore, within a few days after replantation, the fingers are rudder than normal fingers, and capillary refilling is more pronounced than normal fingers. During the test, you can use the head of a matchstick or the tester's fingers to gently press the fingertips or nails. At this time, the pressed skin or nails are pale. Once the pressure is removed, the compressed area is within 1 to 2 seconds. From pale to ruddy, this is called normal capillary refill test. If it refers to the blood supply failure of the body, not only the body is pale, but also the capillary refilling phenomenon cannot be detected, which indicates the occurrence of arterial crisis. If the finger body is gray-purple, the temperature is low, it is fashionable to test the capillary refilling phenomenon. There are some reactions, but the filling time is extremely slow. The overflow of purple venous blood from the side incision is still an arterial blood supply disorder. The above phenomenon is caused by venous blood reflux. If the finger body changes from ruddy to purplish red, the capillary refilling phenomenon is rapid, indicating that the return of the broken finger vein is mostly blocked. If the finger becomes dark purple, the finger's abdominal tension is significantly increased, and there is no capillary refilling phenomenon. Once the side is cut and opened, the dark purple blood flows out first, followed by bright red blood, and the finger body can restore the capillary refilling phenomenon. Embolism occurs due to venous reflux disorders.

(D) Tension of the fingers

After replantation, the blood circulation of the finger is normal, and the above three indicators are also normal. The finger tension of the replanted finger is also normal, which is roughly the same as or slightly higher than that of the healthy finger, which means that the finger is full. If the finger is replanted, the finger is not only pale, but the finger collapses and becomes cold, which means that the tension of the abdomen is significantly reduced; if the finger is dark purple and there is no capillary refilling, it proves that the finger vein has returned. Obstacles (venous crisis), refers to a marked increase in abdominal tension. The abdomen tension is based on the subjective feeling of the tester, but this subjective feeling reflects the change of the finger body circulation, and it is a direct and simple detection index.

(E) open blood on the side of the finger

Observing bleeding with open blood on the side of the finger is a simple and clear observation index, and it is also a direct and effective method to identify arterial and venous circulation disorders. Methods: After the fingertips were sterilized with alcohol, use a No. 11 surgical blade to make an incision of about 3mm deep and 5mm in length on either side of the fingertips, and judge according to the bleeding rate and color. Bright red blood flowed out within 1 to 2 seconds of incision, and the normal circulation was indicated by rubbing with a normal saline cotton ball. If there was no bleeding after the incision, squeeze a little blood through the incision to explain the arterial blood supply. Obstacles; if you wait 3 to 5 seconds after the incision, a small amount of dark purple blood slowly leaks at the incision and continues to bleed slowly outward, which means that the venous blood in the body tissue returns, and the body has no arterial blood supply; if it flows out immediately after the incision Dark purple blood will soon flow out of bright red blood, and the flow zone will be faster. The finger body will change from purple to red, indicating that the finger body veins have a backflow disorder. If some dark purple blood flows out after incision, the amount will be small, and it will no longer flow out, but from Some plasma fluid leaked from the incision, which indicated that the venous crisis first occurred on the broken finger, and then the arterial crisis occurred again, and the exploration conditions were lost.

Each of the above five observation indicators has its significance. The most reliable and direct observation index is open end to side open blood, which can help doctors make more accurate judgments and take effective measures to rescue broken fingers.

The performance of the above five observation indicators in vascular crisis is:

The manifestation of arterial crisis: from the color, the fingers are pale, there is no capillary refilling phenomenon, the abdomen tension is low, the fingers are atrophied, the temperature of the fingers is lowered, which is usually 4-5 ° C lower than that of the healthy fingers. Bright red blood flowed out. When the above phenomenon occurs 1 to 3 days after surgery, arterial spasm should be suspected first, and intramuscular injection of papaverine 30 to 60 mg. Pay attention to symptomatic treatment of heat preservation and analgesia. After observation for 10 to 30 minutes, if it is caused by arterial spasm, the above symptoms Gradually disappear until normal blood circulation is completely restored. If the symptoms have not changed after the above treatment and prolonged observation time, arterial embolism should be suspected and surgical exploration should be performed; when the finger body changes from ruddy to gray, there is still some slow capillary refilling phenomenon. A small amount of dark purple blood spilled from the square incision, the speed is slow, and the temperature is low and the abdomen is cramped. The above phenomenon is still an arterial crisis. This phenomenon indicates that the replanted finger veins are smooth, the color and the bleeding veins are caused by reflux.

The manifestation of venous crisis: from the color view, the finger is purple, the capillary refilling response changes from rapidly to disappearing, the abdominal tension increases significantly, the finger temperature decreases, and the dark purple blood immediately flows out after the side incision of the finger, followed by Bright red blood flowed out, and the capillary refilling of the fingers reappeared at this time, and the temperature of the fingers gradually increased, but the tension of the abdomen did not improve. The above arteries still maintain blood supply and venous return disorders. If a small amount of dark red blood overflows after the incision through the fingers, followed by the exudation of plasma-like substances at the incision, there is still no capillary reaction, the temperature does not rise, the fingers are still dark purple, and the tension is slightly higher. This phenomenon It shows that the venous crisis is followed by the occurrence of arterial crisis. At this time, the opportunity for surgical exploration has been lost.

The clinical manifestation of severed finger ischemia after replantation: The finger body is waxy white, the finger temperature is low, the capillary refilling phenomenon disappears, the finger abdominal tension increases, and blood can quickly flow out from the side incision. After 1 to 2 days of treatment, the finger body gradually changed from waxy white to cherry red or light red, the finger temperature rose slightly, capillary refilling gradually began to appear, the abdominal tension was high, and blood was still flowing from the side incision of the finger. .

Severe Finger Pain Relief and No Smoking Guide

Pain and agitation are one of the factors that induce vasospasm. Effective analgesia is given 3-4 days after surgery, but analgesics should be used reasonably. Overdose can inhibit breathing and cause constipation. Smoking is strictly prohibited after replantation of severed fingers. Because of smoking and passive smoking, continuous spasm occurs in the blood circulation of the hand, and the blood flow is the key to the survival of the finger. Smoking can easily cause a replantation failure rate of more than 30%. Therefore, in order to survive on the fingers of yourself and others, you must absolutely prohibit smoking in the hand surgery ward.

Broken finger diet guide

Explain that after trauma and surgery, a large amount of protein is needed to promote wound healing. Encourage eating more high-protein foods such as chicken, fish, meat, eggs, and soy products. Pay attention to vitamin, iron, calcium, correct anemia, strengthen resistance, and promote fracture healing In addition, should also eat more fresh vegetables and fruits, drink plenty of water, fasting too hot and sour spicy food.

Application of broken finger anticoagulant drugs

Low molecular dextran is generally used to reduce the agglutination between red blood cells and the adhesion to blood vessel walls, and can increase blood volume and reduce blood viscosity to facilitate blood circulation. Intravenous infusion is usually 500-1000ML for 4-6 days. When heparin is used, the intravenous drip method is generally used to extend the clotting time to about 2 times that of a normal person at a rate of 8 to 12 drops per minute. Then maintained at this standard, discontinuation after 3 to 5 days of continuous administration. After using heparin for 10 minutes, it can play an anticoagulant effect. There is no bleeding tendency in the first one or two days, and after 3 days of continuous use, bleeding may occur. If it is used in excess, an equal amount of protamine can be used to neutralize heparin, so that heparin in the body is quickly ineffective. When using heparin, pay attention to the number of drops, generally not more than 8 to 15 drops per minute, or as directed by your doctor. Also ask the patient at any time for any discomfort.

Broken Finger Function Exercise

Replantation surgery can restore most of the replanted limbs to a certain or quite ideal function. In some cases, although the severed limbs were replanted to survive, the replanted limbs remained useless, and it was a pity to go there, forming a vegetation. The purpose of replanting the amputated limb is to restore the function of the injured limb and enable the patient to go to work as soon as possible. Therefore, on the basis of receiving the broken limb, it is necessary to restore the injured limb to the maximum function.

1. From the 5th day after the operation, instruct the patient to actively exercise the interphalangeal and metacarpophalangeal joints of the wrist, healthy fingers, 3h daily.

2. On the 14th day after the operation, the affected fingers do the exercises of holding or holding the sandbag with the help of the healthy fingers. The weight of the sandbag is 50-100g. Continue to actively move the normal joints of the affected hand for 3 hours daily.

3. On the 45th day after surgery, the Kirschner wire was removed, and the active and passive movements of the interphalangeal and metacarpophalangeal joints were performed under the guidance of a rehabilitation therapist 48 hours later. The speed of passive movement should be slow and gradually increase strength. When the limit angle is reached, hold it for 10-20 minutes, then slowly reduce the external force, and then repeat the extension and flexion. Passive exercise ranges from small to large, increasing daily or weekly. The active content of the affected finger is the activities of the palm fingers, interphalangeal joints in all directions, as well as the palms, fingers, grasping fists, and release fists. Assist the use of rubber band screen, screws and nuts to train finger strength, 6h daily.

4. On the 90th day after surgery, focus on training the flexibility, coordination, and accuracy of finger movements, such as racketing, pitching, catching, throwing, spoon, chopsticks, writing, combing, etc. The ability to operate, such as knotting, knotting, typing, and playing the piano, is 4h per day.