Orthopedic consultation is required for joint capsule penetration, open fractures, nerve lacerations, lacerations of the EHL, TA, or Achilles tendon, and for suspected compartment syndrome. Hand surgery consultation must be obtained for all flexor tendon lacerations, as well as for extensor tendon lacerations distal to the MCP joint, and should be considered for extensor tendon lacerations proximal to the MCP joint. With peripheral nerve and tendon injuries, it is appropriate for the emergency physician to close the skin and have the patient followed in the consultant's office within the next few days. Injury to the large, named arteries requires vascular surgical consultation.
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