Emergency medicine clinics of North America
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Nail bed and fingertip injuries are commonly seen in the Emergency Department. Each of these injuries must be evaluated carefully not only for the acute situation but for the possible long-term effects. ⋯ Fingertip injuries must provide the patient with a sensitive fingertip with sufficient length for effective use of the finger. The initial care and treatment are vital for the best patient outcome.
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Unique injuries resulting from high-pressure injection, wringer washers, cornpickers, and snowblowers are presented. Epidemiology, pathophysiology, clinical presentation, and management are reviewed. These injuries commonly require surgical intervention. Prompt recognition and treatment can greatly influence prognosis.
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Flexor tendon injuries can be problematic injuries from the time of occurrence until the patient returns to full and complete recovery. There are many misadventures that can occur along the way. ⋯ An appropriate referral should be initiated soon after an injury is determined. The hand surgeon has many considerations and obstacles in flexor tendon repairs, but good to excellent results can be expected in up to 80% of patients if the emergency physician and the hand surgeon work together to ensure an optimal patient outcome.
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Extensor tendon injuries are often initially evaluated and diagnosed in the Emergency Department. These injuries may be painfully obvious or frightfully subtle, but if the emergency physician has a firm understanding of the anatomy involved and he or she embarks on a careful and complete history and physical examination, the diagnosis should be made. There are various considerations in the ultimate treatment and outcome for the patient, and the patient's best interests are served when the emergency physician provides the initial appropriate treatment and proper disposition.