(2) Control of edema: Edema is a hand injury or postoperative complication, which can lead to fibrosis of joints, muscles, blood vessels and nerves for a long time and easily cause infection. Special attention should be paid to preventive measures: (1) Raise the affected limb: the elbow is higher than the shoulder, and the hand is higher than the elbow. When there is edema after operation, try to stretch the elbow for at least 3 to 5 days.
(2) Start active exercise as soon as possible: If the injury permits, start active exercise as soon as possible after the injury and operation, because even slight muscle contraction can greatly promote lymphatic reflux of hands and upper limbs.
(3) Pressure treatment An elastic bandage has fingers wound from the distal end to the proximal end for 5- 15 minutes and repeated several times a day.
B wearing elastic finger cuffs is suitable for single finger swelling.
C when wearing isotonic pressure gloves, pay attention to the close contact between fingertips and gloves to prevent edema fluid from staying.
(4) Massage: from the distal end, gradually move to the proximal end to promote the reflux of edema fluid.
(5) ultrashort wave therapy: once a day, each time 10 minutes, 5- 10 times as a course of treatment.
(3) Treatment of pain: Pain is one of the common problems in hand trauma, which can be roughly divided into three types: primary pain, residual pain and chronic pain.
(1) Primary pain: All trauma and surgical patients will feel pain, which is a normal reaction. If necessary, they should be treated with painkillers. Generally, the pain will be relieved after injury and within 2-3 weeks after operation, and it can also occur during passive traction in the later stage. This kind of pain is short-lived and can be accepted by ordinary patients.
(2) Residual pain: Patients still feel pain after injury and 3-4 weeks after operation due to too long limb fixation, lack of normal exercise or persistent edema.
(3) Chronic pain: The pain lasts for a long time after injury, which is a kind of secondary pain that is difficult to treat.
Pain treatment methods: ① physical therapy: hydrotherapy, hyperthermia, percutaneous nerve acupoint stimulation ② occupational therapy: choosing work activities that patients are interested in will help to divert attention, such as music therapy and skin painting techniques. ③ Drugs: nerve block and non-steroidal anti-inflammatory drugs.
(4) Muscle strength enhancement training: Different treatment methods are selected according to different treatment objectives and treatment amounts before, during and after treatment. For example, in the early stage of muscle strength enhancement, patients should actively exercise without resistance, and in the middle and late stage, resistance exercise should be gradually increased, such as holding plasticine and lifting sandbags with woodcut plates.
A plasticine can be slightly a little bit in the middle stage and a plasticine with high hardness in the later stage.
A Hold plasticine: put plasticine in the palm of the affected side, instruct the patient to shake plasticine vigorously in the palm, try to squeeze plasticine out of the palm, and repeatedly train the grip strength of the affected finger (Figure 10-2-6).
Figure 10-2-6 Holding plasticine
B pinch plasticine: pinch plasticine with the thumb and forefinger of the affected side, and repeat it several times to enhance the pinching force of the fingertips.
B woodcarving technology: use tools such as carving knives to carve wooden materials into handicrafts or daily necessities. In the process of making, the patient should hold a meat cleaver in one hand and a wooden board in the other. According to the carved patterns, they carved patterns on the wooden board bit by bit, which not only effectively enhanced the muscle strength of fingers, but also made patients feel a sense of accomplishment and helped to relieve pain.
C copper plate technology: draw patterns on copper plate or alloy plate, scrape and grind the patterns on the copper plate with tools such as scraper, so that the patterns show various movements in the production process, which can effectively train and improve the muscle strength of upper limbs and hands. (5) Application of assistive devices: Its function is to maintain the stability of fractures and promote healing. For example, the wrist joint (as shown in figure 10-2-7) of the metacarpal base fracture must be fixed in the dorsal extension.
The wearing time is 4~6 weeks.
Fig. 10-2-7 metacarpal fracture brace