Radiographs Consultation and Disposition

Radiologic evaluation should include at a minimum a posteroanterior (PA), lateral, and oblique projection. Similar projections are used for the digits, except that the x-ray beam is centered over the digits. Actual or suspected injuries of tendons and nerves should be referred to a hand specialist. Whether consultation is provided in the emergency department or in follow-up (1 to 3 days) depends on local resources. Often the skin can be closed, the hand splinted in the position of function, and at follow-up the wound can be extended, explored, and definitive repair performed by the hand specialist. Most hand specialists prefer to do definitive repair within a 3-to 5-day window after acute injury. While most tendon injuries <20 percent may not be surgically repaired, hand specialist follow-up and rehabilitation are still necessary to accurately determine the extent of injury, minimize scarring and tendon contraction, and minimize neuroma formation.

For patients with hand or digit lacerations that are sutured in the emergency department, and where there is no suspicion of neurovascular or tendon injury, follow-up evaluation and suture removal in the emergency department should always include repeat hand examination to make sure that significant injuries have not been missed.

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