›Splint immobilization position based on tendon group
›Suspected partial tendon laceration
›Avoid bedside tendon repair if uncertain depth
›Urgent hand surgery follow up within 24 to 72 hours
Neurovascular injury management
›Neurovascular pathway
›Digital nerve laceration suspected
›Early hand surgery referral
›Sensory mapping documentation pre anesthesia when possible
›Arterial injury suspected
›Immediate hand surgery consult
›Warmth and elevation while awaiting definitive care
Imaging and testing sequence
›Diagnostic sequencing
›Radiographs if foreign body concern
›Ultrasound if tendon continuity unclear
Antibiotics and tetanus
›Antibiotic strategy
›Clean simple laceration without deep injury
›No antibiotics routine
›Consider if high risk host
›Bite wound or gross contamination
›Amoxicillin clavulanate PO 875 mg twice daily
›Duration 3 to 5 days prophylaxis local protocol dependent
›Penicillin allergy option local protocol dependent
›Doxycycline PO 100 mg twice daily
›Add metronidazole PO 500 mg twice daily if anaerobe coverage needed
›Tetanus prophylaxis
›Unknown or incomplete vaccination and dirty wound
›Tdap
›Tetanus immune globulin per local protocol
›Up to date vaccination
›Booster timing based on wound type
Closure and immobilization
›Closure considerations
›Delayed primary closure if heavily contaminated
›Avoid tight closure if swelling expected
›Splinting
›Suspected flexor tendon injury
›Dorsal blocking splint
›Wrist flexion and MCP flexion position per hand surgery protocol
›Suspected extensor tendon injury
›Extension splinting across involved joint
›Maintain joint alignment
Reassessment loop
›Reassessment
›Neurovascular recheck after anesthesia and after splint
›Pain reassessment within 30 to 60 minutes
›Bleeding reassessment after closure and dressing
17Disposition/dispo21
Admit and OR pathway
›Admission or urgent OR
›Arterial injury requiring repair
›Open fracture
›Joint violation requiring washout
›Flexor tenosynovitis concern
›High pressure injection injury
Observation pathway
›Observation
›Uncertain tendon injury with high functional risk
›Pain control requiring parenteral meds
Discharge criteria
›Discharge criteria
›Hemostasis achieved
›Normal perfusion
›No concern for complete tendon laceration requiring immediate repair
›Reliable follow up within 24 to 72 hours
›Splint and dressing tolerated
Follow up timing
›Follow up
›Hand surgery within 24 to 72 hours for tendon or nerve concern
›Wound check in 2 days if high risk wound
›Suture removal timing by location
›Hand and fingers often 10 to 14 days local protocol dependent
›Palm often 14 days local protocol dependent
18Discharge Instructions/di23
Copy discharge instructions
›Summary
›You have a cut on your hand that may involve deeper structures like tendons that move the finger
›Your hand has been cleaned and dressed and may be splinted to protect healing
›Wound care
›Keep the dressing clean and dry for 24 hours
›After 24 hours gentle soap and water around the wound
›No soaking in a bath pool or hot tub until healed
›Splint care
›Keep the splint on at all times unless told otherwise
›Do not test finger strength against resistance
›Medications
›Take pain medicine as directed
›If antibiotics were prescribed take all doses as directed
›Follow up
›Hand specialist follow up within ___ days
›Wound check within ___ days if instructed
›Return to ED now for
›Finger becomes cold pale or blue
›New numbness or worsening numbness
›Increasing pain not controlled with medication
›Increasing swelling redness warmth or pus
›Fever
›Bleeding that does not stop with 10 minutes of firm pressure
19References/r6
Guidelines and core sources
›Key references
›CDC Tetanus prophylaxis guidance 2024
›IDSA Skin and soft tissue infections guideline 2014
›American Society for Surgery of the Hand acute hand injury resources 2023
›British Society for Surgery of the Hand standards for hand trauma care 2020
›AAOS management of open fractures and antibiotic prophylaxis resources 2022
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.