Fist Injuries and Septic Involvement

Abstract

Fist injuries vary greatly, depending on the nature of objects that cause them and the force of impact. In the majority of cases we are concerned with microtraumas, which account for 90 per cent of all fist injuries. The infection can be either primary or secondary. At first sight such injuries appear to be insignificant, and the patient is therefore left in the care of young and inexperienced doctors, assistants or even members of the nursery staff. At this point, it is necessary to emphasize the fact that even among a large number of general practitioners there Is a tendency to treat the inflammatory processes of the fist in a way quite contrary to the dictates of modern surgery, hence grave errors and sins of omission. A number of advanced cases with necrosis of the tendons and sequestration of the bone are being treated daily in one of our major Surgery Institutes, cases that had been treated conservatively by means of compresses and the like.

Of the greatest importance in cases of any injuries, and perhaps of vital importance for the fate of the patient himself, is the administration of first aid, the object of which is the liquidation of primary and the prevention of secondary infection.

As regards injuries and infection generally, and those of the fist in particular, it can safely be stated that the more correct, thorough and timely the surgical aid the less grave are the consequences and the shorter the duration of treatment.

For a proper treatment of an injured and infected fist a thorough knowledge is needed of the anatomy of physiology of all elements of which this complex organ is composed.

The clinical picture of an inflammatory purulent process of the fist is conditioned by the anatomical structure of the skin and its subcutaneous tissue. Due to the shape of perpendicularly placed threads of the binding tissue in the palm, pus under pressure penetrates into the depths of the fist. This mechanical component is the cause of untoward consequences, since it tends to stimulate the tightening of tissue which, in its turn, occasions severe pain and disturbance of circulation. It is these two factors combined with infection and toxic products that create conditions conducive to necrosis of the tissue affected by the process.

The basic principles of modern therapy in septic wounds and injuries of the fist can be set out briefly as follows: The treatment consists in a timely operation being performed with the object of providing an outlet for pus, thus preventing further damage to tissue, the spreading of inflammatory purulent process, and resorption of toxic products.

Surgical intervention proceeds under general anaesthesia, thus ensuring freedom from pain.

Incision is made at a point found to be the most sensitive, which is determined by probing.

In performing the operation o haemostatic bandage is necessary since it temporarily arrests bleeding and makes convenient the removal of damaged and necrotic tissue away from the operative field.

Surgical intervention needs to be combined with adequate antibiotic treatment, the two kinds of therapy being complementary and productive of best results.

To sum up, surgical treatment combined with antibiotics as an adjuvant continues to be the principal and basic therapy.