What are the red flags for hand & finger injury in urgent care?

Wound over a knuckle after a punch (“fight bite”) → Human bite into joint — wash out, antibiotics, hand surgeons today; Rotational deformity (fingers scissor on making a fist) → Unstable fracture — hand surgery; Tendon or digital nerve injury → Hand surgeons; High-pressure injection injury → Surgical emergency, even if it looks trivial; Kanavel signs (fusiform swelling, flexed finger, sheath tenderness, pain on passive extension) → Flexor sheath infection — hand surgeons today

What should I prescribe for hand & finger injury?

Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy)

● Urgent care clinic · 30-minute consult

Hand & finger injury

Q: What safety-netting advice should I give for hand & finger injury?

Advise the patient to return or seek help if: Finger becomes red, hot, swollen or very painful (infection); Numbness or the finger turns pale or blue; Unable to bend or straighten the finger.

Boxer’s fracture, mallet finger, crush injuries and the hand you must not miss.

Typical consult⏱ 20 min

Investigations🔬 X-ray if bony tenderness or deformity

Usual outcome💊 Buddy strap / splint + hand clinic

0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document

1Rule out first — red flags

If you find…	…then
Wound over a knuckle after a punch (“fight bite”)	Human bite into joint — wash out, antibiotics, hand surgeons today
Rotational deformity (fingers scissor on making a fist)	Unstable fracture — hand surgery
Tendon or digital nerve injury	Hand surgeons
High-pressure injection injury	Surgical emergency, even if it looks trivial
Kanavel signs (fusiform swelling, flexed finger, sheath tenderness, pain on passive extension)	Flexor sheath infection — hand surgeons today

4Decide — investigate only if it changes the plan

Investigation	Only if…
Hand or finger X-ray (2 views)	Bony tenderness, deformity, crush, or suspected foreign body (glass/metal)

5Treat & send home

Management & advice

5th metacarpal neck (boxer’s) fracture, no rotation → buddy strap / neighbour strap, early movement per local pathway
Mallet finger → mallet splint continuously for 6–8 weeks (keep the tip straight even when changing it)
Subungual haematoma → trephine if painful
Volar plate / simple sprains → buddy strap, early movement
Elevate; remove rings

Refer / follow-up

Fight bite, tendon/nerve injury, rotational deformity, nail-bed injury with fracture → hand surgery
Fractures → hand / fracture clinic per local pathway

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy

6Safety-net

Say it like this

This is a break in the bone below your little finger. It usually heals well with strapping to the next finger and keeping it moving. Keep your hand raised and take off rings. Come back today if the hand becomes red, hot and swollen or more painful, because that can mean infection.

Come back / call 111 — or 999 if severe — if:

Finger becomes red, hot, swollen or very painful (infection)
Numbness or the finger turns pale or blue
Unable to bend or straighten the finger

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Broken finger or thumbnhs.uk/conditions/broken-finger

8Document

Hand & finger injury — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — HAND & FINGER INJURY PRESENTING COMPLAINT: HISTORY Mechanism: punch, crush, hyperextension, ball to fingertip, sharp object: Hand dominance, occupation: Time of injury; any wound or bite: Numbness, weakness, unable to straighten the fingertip: Tetanus status: RED FLAGS (record present / absent) [ ] Wound over a knuckle after a punch (“fight bite”) [ ] Rotational deformity (fingers scissor on making a fist) [ ] Tendon or digital nerve injury [ ] High-pressure injection injury [ ] Kanavel signs (fusiform swelling, flexed finger, sheath tenderness, pain on passive extension) PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Look: deformity, swelling, wounds, cascade of fingers at rest: Rotation: make a fist — do fingers point to the scaphoid without overlapping?: Feel: metacarpals, phalanges, joints: Tendons: FDP, FDS, extensors individually; mallet (can’t extend DIP): Sensation in each digital nerve (2-point discrimination); capillary refill: INVESTIGATIONS: none required / Hand or finger X-ray (2 views) — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Broken finger or thumb Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Finger becomes red, hot, swollen or very painful (infection) - Numbness or the finger turns pale or blue - Unable to bend or straighten the finger Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More injuries & musculoskeletal

Ankle & foot injuryTwisted ankle or foot — Ottawa rules decide the X-ray.Knee injuryTwisting or direct knee injury — Ottawa knee rule, spot the ACL and locked knee.Wrist injury & scaphoidFall on the outstretched hand — distal radius vs scaphoid.Shoulder & collarbone injuryCollarbone fractures, ACJ injuries and the dislocated shoulder.