Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Ortho: Hand

Jacki Davis, MD
  1. Any paronychia not amenable to treatment should be referred to a specialist for further work-up. Always remember mimics to paronychia including herpetic whitlow, distal phalanx fractures, malignancy, rheumatologic disorders (pemphigus vulgaris, psoriasis, Reiter’s syndrome, eczema). Chronic paronychia require a specialist for long term treatment.
  2. All patients in a fight have a fight bite until proven otherwise. A small study showed that without antibiotics there was a 60% infection rate for patients with fight bites. The study had to be stopped early secondary to the high number of infections.
  3. Assess MVC driver’s with thumb pain for a ulnar collateral ligament rupture. This can be missed on patients with multiple injuries. Any patient who c/o of thumb pain and was driving is at risk, which can lead to thumb instability and loss of grasp/pinch strength if not recognized. These patient usually present with reduced injuries therefore not being obvious on exam unless stress testing is performed.
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