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Traumatic hand injuries: getting a grip on prehospital hand trauma assessment & management.
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[Hand injuries in a hospital without a hand specialist].
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Hand injuries due to soccer.
Fifty-two hand injuries due to soccer were seen in one season. Approximately one-third of these were in goalkeepers, due mainly to contact with the ball; two-third were in other members of the team, due to either contact with a player or the ground.
[Hand injuries in adolescents].
MATERIAL AND METHODS: Based on the materials of 134 adolescent patients (age 15-19) with hand injuries treated in the II Department of Surgery of the Jagiellonian University between 1987-2000 results of treatment were described. The adolescents constituted 11.8% of all patients treated due to hand injuries. RESULTS: Home was the most common place of the accident (59 patients - 44.01%), and the most common mechanism of injury was cutting by the glass or another sharp tool (61 patients - 45.52%). The mild and moderate injuries predominated (112 patients - 83.58%). 39 patients (29.10%) were treated after alcohol abuse; unfortunately. 35 patients (26.12%) were hospitalized from 1 to 24 days (av. 7.14 days). Time to obtain complete recovery reached max. 270 days but av. 55.56 days. Various degree of the persistent limitation of the hand function were observed in 65 patients (48.5%). Two of them (1.49%) got the disability pension and 8 (5.77%) had to change former job and activities. CONCLUSION: The time of the complete cure could be shorter and the extent of persistent post-traumatic impairment of the patients with the heavy hand injuries could be limited if they would be treated in the specialized centers for hand surgery.
[Hand injuries in workers on the eastern shore of Marcaibo Lake in the state of Zulia, Venezuela, 1986-1993].
In order to analyze the frequency, injury rate and cause of on site accidents to the hands of workers on the east coast of lake of Maracaibo in Zulia State, data was obtained from the accident reports registered with the Venezuelan Institute of Social Security. An occupational hand injury was defined as a traumatic injury to the hands, fingers or wrists that occurred while the employee was at work; that resulted from a single exposure to a hazardous agent. The following variables were analyzed: age, severity, economic activity, material agent, mechanic cause, type of injury, type of accident and unsafe action. The frequency rate was used to analyze the annual accident rate. During the period under study 2.456 injuries to the hand were registered, representing 36% of the total injuries reported; 95% were light injuries, 5% incapacitating and two cases resulted in the death of the worker. 72% of the injuries were located in the fingers, 22% in the hands and 6% in the wrists. The greatest frequency of injuries were found in the economic activity in mines and quarries with a rate of 123.1 per thousand. The age group most affected was of 20-29 years (42%), Wounds or contusions and crushings were the injuries most commonly reported, in 39% and 36% of the cases respectively. The main type of injuries were caused by run over, running into or blow from objects. The principal agents causing injuries were materials, substances and radiations in 45% of the cases. It is concluded that the hand injury rate is very high in the exploitation of mines and quarries and represents the main cause of worker's disability.
Hand injuries in children at King Fahd Hospital of the University in Saudi Arabia (1989-1991).
We study the pattern of hand injuries in children presenting to a university hospital in the eastern province of Saudi Arabia. A retrospective study evaluating all pediatric patients 12 years old or less with hand injuries excluding burns that attended the plastic surgery clinic at King Fahd Hospital of the University between January 1989-December 1991. One hundred and one cases were identified. Male to female ratio was 1.5:1, 68% were Saudis. Most injuries were domestic and caused by doors. The commonest type of injury was laceration (32.5%), fingertips were involved in 50.5% of cases. Nerve injury occurred in 21.8%, only digital nerves were affected. Most hand injuries in children occurred at home and are preventable. Familiarity with such injuries by the healthcare providers in emergency situations is of diagnostic and therapeutic importance. This attitude will lead to the best possible outcome functionally and cosmetically. Furthermore, such a practice will go along way in improving the morbidity and mortality pattern of these surgical casualties among innocent children.
Hurling-related hand injuries.
Hurling is a contact sport, associated with significant morbidity. We have identified specific hand injuries sustained by participants and quantified the functional and financial implications of these injuries. Over a 3-month period, all hand injuries seen in the fracture clinic of our regional trauma unit were studied prospectively. Of the 123 consecutive injuries, 41 (33%) were sustained during hurling matches. Metacarpal (47%) and proximal phalangeal (37%) fractures were the most frequent. Eight hurlers (20%) required surgical intervention. Only four (10%) of the injured players were wearing hand protection. The mean cost of injury to the player was pound 615. We suggest the introduction of the mandatory use of hand protection for hurling.
A profile of sports hand injuries in an accident and emergency department.
OBJECTIVE: To establish a profile of sports hand injuries requiring treatment in an urban accident and emergency (A&E) department, and to determine the extent to which these injuries resulted in morbidity. METHODS: A one year prospective observational study at the Royal Victoria Infirmary, Newcastle upon Tyne. All patients presenting to the A&E department between 29 July 1995 and 28 July 1996 with a hand injury sustained during sporting activity and who received follow up by A&E or plastic surgery units were enrolled. Patients were contacted by telephone or post at median of four months after injury (range two to 13) for their assessment of the outcome. RESULTS: 262 cases were enrolled into the study. The median age for males was 21 years (range 7 to 55) and for females 16 (range 9 to 40). Follow up data were obtained by telephone in 206 (79%), and by letter in a further 26 (10%). Fractures were the commonest injury (68%), followed by soft tissue injuries (20%) and dislocations (11%). The thumb was the site affected most commonly overall, and in 10 of 17 ski related injuries; next most frequent sites were little and ring fingers. Males sustained 79% of the injuries, and 54% of these occurred during football. Netball/basketball caused 63% of female injuries. Follow up indicated that mild impairment in terms of pain, stiffness, or deformity was common (45%), while the incidence of moderate pain or serious problems was 11%. CONCLUSIONS: Sporting injuries to the hand commonly require treatment in the A&E department. Telephone/postal follow up of such injuries indicates that significant short term and longer term impairment of function may result. Suitable target areas for injury prevention are secondary schools, football (in males), and netball/basketball.
Skin coverage in occupational hand injuries.
Intact skin is vital after occupational hand injuries. The best bone, tendon, and neurovascular repairs are meaningless without suitable skin coverage to protect them. This article presents various methods of providing skin coverage in the hand after occupational injuries and follows the same thought process that surgeons should use in selecting the most appropriate method of repair.
Pediatric hand injuries due to exercise bicycles.
METHODS: This is a 5-year retrospective review of hand injuries caused by exercise bicycles among 34 children. RESULTS: Mean age was 3 years and 5 months. Accidents were caused most commonly by impingement of the fingers between the chain and sprocket wheel (77%), but injuries caused by spinning wheel spokes (23%) were generally more severe. Injuries were usually of the avulsion type and ranged in severity from lacerations (43%) to fractures (19%) to amputations (38%). The central digits (87%) were involved more frequently than the border digits (13%). Replantation was possible for 33% of the amputated digits, with 50% of the fingers surviving. CONCLUSION: The avulsive nature of these injuries should be taken into consideration when attempting replantation. Increased community awareness and equipment safety modifications are needed to eliminate this preventable problem.
Management of potentially infected complex hand injuries.
Fifteen patients with contaminated, and thus potentially infected, hand injuries were treated. All had segmental bone loss: six metacarpals, three proximal phalanges, three middle phalanges, and three joint injuries. The treatment was based on the simultaneous primary application of external minifixators and antibiotic-loaded bone cement beads and completed by early bone grafting. This external fixation and internal antibiotic treatment has synergic effect both mechanically and biologically. Thus potentially infected fresh injuries were treated in exactly the same way as an established osteomyelitis. Although there were a few minor wound problems and superficial pin tract infections, there were no deep infections, and no bone grafts were lost. All of the patients were grafted with autologous bone taken from the ilium within 7 to 8 days. Rehabilitation time was markedly decreased by this method, and all of the patients returned to work within 8 months.
Pediatric hand injury induced by treadmill.
Korea has recently seen an increase in pediatric hand injuries associated with treadmills. This study was conducted to identify the frequency, patterns, treatment and outcome of these injuries, in the hope of developing preventive programs. A retrospective review of the medical records of 25 children, all with treadmill-induced friction hand injuries, was conducted at the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the period of January 2002 to March 2004. The injuries constituted 1.4% of the total number of pediatric burn injury admissions. Male toddlers were affected more than female. The mean age of the children was 3.9+/-3.2 (3, 1-15) years old. Most injuries occurred in spring. Treadmill friction inflicted deep second or third degree burns, small in area (1.6+/-1.0% of TBSA). All lesions involved the hands and forearms, with 60% on the right. Most patients (64%) underwent surgical management 13+/-5 days after the injury. The volar surface of the hand was more affected than the dorsal side (27 versus 8). Treatment was mainly with full thickness skin graft (60%) and long-term surgical outcomes were excellent. Such injuries may be prevented by educating the public about the potential risks of the treadmill, and by the development of additional safety designs. Changes in management protocols and treatment policies would improve the provision of appropriate care.
[Results of replantation and severe hand injuries in children (author's transl)].
Within the framework of the reimplantation service which has operated in our clinic since June 1974, 23 amputations in children were admitted, out of a total of 184. 17 were complete, 6 were subtotal, and 21 were re-implanted. The healing-quota of 76% is particularly due to the much more generous indications in childhood. The difficulties in post-op. care, and the use of play in physiotherapy are mentioned. Experiences gained in the field of re-implantation, especially through microsurgery, have enabled progress to be made also in the other serious injuries of the hand in childhood.
Pattern of hand injuries in children and adolescents in a teaching hospital in Abha, Saudi Arabia.
Over a seven-year period, 136 children and adolescents with hand injuries were prospectively studied at the Accident and Emergency Department of Asir Central Hospital, Abha, Kingdom of Saudi Arabia, to determine the pattern of hand injury. The male:female ratio was 1.7:1.0, both left and right hands were relatively equally injured. The age group ranged from two months to 16 years (average 5.3 years). The finger most commonly injured was the middle finger (24.6%) followed by the index finger (18.7%). The most common type of hand injury was crush injuries caused by doors at home (52.2%), heavy objects (6.6%) and injuries caused by grinding machines (6.6%). Since youngsters are often unaware of the dangers in their environment it is necessary to redesign the doors of our homes with safety devices to prevent injuries. Application of hydraulic automatic door closures is a simple but useful way of ensuring smooth and safe closing of doors in homes.
Psychological reactions to hand injuries among semi-skilled Chinese workers.
It has been widely acknowledged that successful treatment and rehabilitation of patients suffering from hand injuries requires both physical as well as psychological interventions. However, little is understood about the psychological problems experienced by the patients during the course of their injury, recovery and latter adjustment. This paper outlines and presents some preliminary findings of a study on semi-skilled Chinese workers who suffered from hand injuries owing to industrial accidents in Hong Kong. The aim was to explore their reactions to their injuries, which, in most cases, left permanent damage. The patients were assessed within a month after they had been discharged from the hospital after the orthopaedic treatment was completed. Measures of their mood states (based on Analogue Subjective Feelings Scale) and self-esteem (based on Coopersmith Self-esteem Inventory) were taken. The results indicated significant difference between those who had suffered more severe disability and those who had suffered less disability in their self-esteem in the family. The general self-esteem score was much lower in those who had suffered more severely disabling hand injuries. The patients were under pressure in meeting the demands of the family and their work. The point of importance that emerged from this analysis was that the measures of rehabilitation should not only aim at making the patient meet the original demands but to try and change the environmental expectations to reduce his stress in coping.
[The treatment concept in severe hand injuries].
Treatment of complex injuries of the hand aims at best possible reconstruction of function and quick social and professional rehabilitation. This objective is hardly to achieve in most cases due to the severity of injury. Outcome depends on patients' age and injury pattern and essentially on the strategy of surgical treatment. Errors in prehospital emergency treatment can hardly be corrected, no matter how excellent the surgical technique may be. Traumatic multiple finger or thumb amputations are clear indications for replantation. Beginning with osteosynthesis, suture of tendons and ligaments the restoration of blood supply is the most important step. Nerve reconstruction should be performed immediately, but if tension free repair is impossible, secondary nerve grafting is preferred. Primary skin closure should be carried out if possible, in case of defects skin grafts, local or free flaps have to be used.