›PIP free
›Zone III central slip concern
›PIP full extension
›DIP free
›Zone V-VI dorsal hand laceration
›Wrist slight extension
›MCP extension support as needed
›Post-splint checks
›Capillary refill
›Sensation
›Pain trend
›Joint alignment issues
›Indications
›Fracture-dislocation with tendon avulsion
›DIP or PIP subluxation with mallet fracture
›Analgesia and anesthesia
›Local anesthesia options
›Digital nerve block
›Lidocaine 1% 3-5 mL per digit
›With epinephrine per local protocol
›Wrist block for multiple digits
›Median nerve block
›Ulnar nerve block
›Systemic analgesia options
›Acetaminophen PO 1000 mg
›Maximum 4000 mg per 24 hours
›Ibuprofen PO 400-600 mg
›Avoid in renal failure or high bleed risk
›Morphine IV 0.05-0.1 mg/kg
›Repeat every 5-10 minutes to effect
›Procedural sedation if required (ACEP Level B)
›Ketamine IV 1 mg/kg
›Additional 0.5 mg/kg as needed
›Continuous monitoring
›Airway-ready setup
›Reduction principles
›Gentle traction and countertraction
›Reverse mechanism when clear
›Avoid repeated forceful attempts
›Post-reduction
›Neurovascular re-check
›Post-reduction radiographs
›Immobilization in stable position
Open fracture medications and timing
›Antibiotics and wound care
›Timing
›First dose within 60 minutes for open fracture (Class I)
›Earlier for gross contamination
›Regimens
›Cefazolin IV 2 g
›Repeat every 8 hours while inpatient
›If beta-lactam anaphylaxis
›Clindamycin IV 600-900 mg every 8 hours
›If severe contamination
›Add gentamicin IV 5 mg/kg
›Add metronidazole IV 500 mg every 8 hours
›Local wound care
›Saline irrigation
›Nonadherent dressing
›Avoid tight circumferential wraps
DVT prophylaxis when relevant
›VTE prevention considerations
›Upper extremity immobilization
›No routine pharmacologic prophylaxis for isolated hand injury
›Consider prophylaxis only with major risk factors and prolonged immobility
›High-risk features
›Active cancer
›Prior VTE
›Major trauma with multisystem injury
›Prolonged hospitalization