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Contusions and lacerations

Contusions are the most common injury in the hand. Care must be taken to rule out more serious injuries such as fractures and ligamentous or tendinous injuries. A contusion can lead to trauma-induced tendonitis; however, the majority of these, too, can be treated with time and conservative measures.

Lacerations of the hand also are very common in sports. They require thorough evaluation of the tendons, nerves, and blood supply, with particular attention to the nerves of the fingers. Simple lacerations can be treated with irrigation, loose closure, and protection as necessary. Lacerations over the joints require careful evaluation of extension into the joint. The position of the hand when the injury occurred is important: with a clenched fist laceration the lesion may appear not to have penetrated the joint when the hand is flat—this is the so-called ‘tooth injury’ which is often overlooked. If there is extension into the joint, or an associated fracture, a doctor should be consulted immediately. The doctor will perform a thorough irrigation and debridement, and prescribe antibiotic prophylaxis for at least 48 hours. For all lacerations the athlete should ensure that antitetanus vaccination is up to date.

If lacerations are neglected and not properly cleaned, bacterial infection may ensue, necessitating prolonged treatment. If an infection does occur, a doctor should be consulted immediately. Treatment includes antibiotics and possibly surgical drainage to clean out the wound and prevent further spread. Infected wounds on the hand must never be neglected, since the consequences can be catastrophic.

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