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PubMed2000

[Strategy for defect coverage in extensive degloving and crush injuries of 4 fingers].

Severe crush injuries with avulsion require specific treatment strategies. Usually we find complete loss of soft tissue, nerves and vessels, where only tendons and parts of the phalanges are preserved. Primary reconstructive procedures are usually not possible due to the complexity of the injury with severely destroyed structures. Bone shortening should be avoided in order to maintain finger length and motion. Therefore, emergency soft-tissue coverage represents the first step. Later, sensibility and mechanical stability of the skin should be restored. In our clinic, seven patients with this injury pattern were treated. Three cases involved four finger crush-avulsion injuries. In all cases, we performed a primary soft-tissue coverage with a pedicled flap. In a second session, the skin areas of the first web space of both feet were transplanted as neurovascular flaps. With this strategy, a useful hand function could be restored. The functional results are described and advantages and disadvantages of various techniques discussed.

Adult↗

PubMed1993

[Finger tip injuries. A comparative study of silver sulfadiazine and fucidin gauze].

Eighty-eight superficial finger-tip lesions were randomized after thorough cleaning to either silver sulphadiazine treatment of Fucidin fusidic acid gauze. In the silver sulphadiazine group the wounds were covered with a non-sterile PVC gloce and redressed at least every third day; in the other group Fucidin gauze was applied and a tubigauze dressing was left in situ for ten days, after which a new dressing was applied. All patients were treated until healed and followed for at least six months after injury. Patients in the silver sulphadiazine group required shorter time for healing and shorter sick leave. The treatment is recommended because of the easy procedure and the good results.

Adult↗

PubMed1982

[Accidental circular saw injuries].

Two hundred twenty-six accident reports and medical statements concerning circular-saw injuries were evaluated. All injuries occurred on hands. Left and right hands were hurt share and share alike. Among the 125 isolated one-finger injuries an obvious stepwise decrease in frequency from thumb to little finger and from fingertip to finger basis was found. The more proximal the wound lay, the more frequent a localization diagonal or parallel to finger axis was registered. Most accidents hurt skin or soft tissue. Bone lesions occurred less frequent and were characterized by splinters or fractures instead of cuts. Subtotal or total amputations were described in some cases. All lay on fingertips. Nearly the same was seen in two-finger cases. Among three- to five-finger injuries (often diagonal) a few cases of total amputation at the base phalanx were described. The severeness of injuries increases with the number of fingers hurt. A complete cut-like sharp-edged amputation was never seen in the material presented.

Accidents, Home↗

PubMed2004

Thenar flap for severe finger tip injuries in children.

Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distal-based thenar flap. The injuries were palmar oblique amputations or avulsion injuries involving the pulp and the nail bed. The pedicles of the thenar flaps were divided after 18 to 25 days and none suffered any necrosis. At the final follow-up, no interphalangeal joint contractures were found, the average two point discrimination was 5mm, the thenar scar was asymptomatic and the subcutaneous tissue of the thenar flap was providing sufficient bulk to produce a rounded contour, like a normal fingertip. The thenar flap is a useful technique for use with severe fingertip injuries when local flaps cannot provide enough soft tissue and replantation is not possible.

Amputation, Traumatic↗

PubMed2004

Analysis of prognostic factors in ring avulsion injuries.

PURPOSE: To report 105 cases of ring avulsion injuries, examine the factors affecting rate of survival and functional outcome after reconstruction, and evaluate whether these data provide enough evidence to support attempts to repair these injuries. METHODS: A retrospective cohort study was conducted in 105 patients with 105 ring avulsion injuries of all grades of severity treated at our center between 1977 and 2003. Factors that could affect the outcome included personal (gender, age, smoking history, vascular disease, diabetes mellitus, alcohol abuse), injury (finger affected, level of skeletal injury, presence of tendon and nerve injury, Urbaniak class as modified by Kay et al, presurgery time), and surgery features (number of arteries and veins reconstructed primarily and with vein grafts). Results were interpreted based on survival and final function. Function was measured by the presence of pain, range of motion, and 2-point discrimination. RESULTS: Of the 86 digits with inadequate circulation, 11 digits had primary amputation. Reconstruction was attempted in 75 digits. Fourteen digits had secondary amputation because of revascularization failure. Failure was attributed to artery problems in 5 digits and to vein problems in 5 digits and was unknown in 4 digits. The overall survival rate was 81%. CONCLUSIONS: Cigarette smoking is not associated with higher risk of revascularization failure. Reconstruction of 2 or more veins resulted in higher survival rates compared with reconstruction of only 1 vein. Level of bone injury is not an accurate indication of whether to attempt reconstruction. Primary nerve repair does not lead to a good sensory recovery in most digits. Patients who had their digits finally amputated had variable periods of hypersensitivity at the stump, which prolonged their convalescence time.

Adolescent↗

PubMed1984

[Injuries caused by accidents with chain saws].

Accident reports and medical statements (a total of 719) concerning chain-saw injuries were evaluated. Chain-saw wounds can be found in all parts of the body, especially the thighs and fingers. The typical chain-saw wound is a multiple superficial laceration, soft tissue wounds are usually heavily bruised and jagged , and bone lesions are rare and superficial. Among 188 finger injuries, only 15 slight bone lesions were seen. The frequency of all injuries decreases as one progresses from the thumb to the little finger and from the finger tip to the finger. The more proximal the isolated finger injury, the more frequently is it diagonal or even longitudinal. Incomplete or complete finger amputations were not observed.

Accidents, Home↗

PubMed1989

[Electrophysiological and morphological changes in muscle-flexors of the fingers after injuries of the tendons in children].

The investigation of bioelectrical activity of flexors of the fingers in children at different terms after the injury and subsequent restoration of the tendons allowed to determine the dynamics of bioelectrogenesis of the muscles. Decrease in bioelectrical activity of the muscles was most expressed and stable during the first 6 months after the injury. The morphological studies carried out at that time demonstrated presence of lysis of some muscle fibers. Complete restoration of bioelectrical activity of the muscles was observed after suture of the tendons and autotendoplastn which was performed not later thay 4-6 months after the trauma. The investigation of dynamics of restoration of bioelectrical activity of the muscles allowed to determine the optimal terms for performing tendolysis.

Action Potentials↗

PubMed2005

The acute effects of mild traumatic brain injury on finger tapping with and without word repetition.

This study aimed to investigate the acute effects of mild Traumatic Brain Injury (mTBI) on the performance of a finger tapping and word repetition dual task in order to determine working memory impairment in mTBI. Sixty-four (50 male, 14 female) right-handed cases of mTBI and 26 (18 male and 8 female) right-handed cases of orthopaedic injuries were tested within 24 hours of injury. Patients with mTBI completed fewer correct taps in 10 seconds than patients with orthopaedic injuries, and female mTBI cases repeated fewer words. The size of the dual task decrement did not vary between groups. When added to a test battery including the Rapid Screen of Concussion (RSC; Comerford, Geffen, May, Medland & Geffen, 2002) and the Digit Symbol Substitution Test, finger tapping speed accounted for 1% of between groups variance and did not improve classification rates of male participants. While the addition of tapping rate did not improve the sensitivity and specificity of the RSC and DSST to mTBI in males, univariate analysis of motor performance in females indicated that dual task performance might be diagnostic. An increase in female sample size is warranted. These results confirm the view that there is a generalized slowing of processing ability following mTBI.

Adolescent↗

PubMed2006

Embedded ring injury of the middle finger in an amphetamine abuser.

Embedded finger-ring injury is not usually encountered in clinical practice, and most patients present with psychiatric or physical/mental impairment. We report herein an 18-year-old male amphetamine abuser who presented to our emergency department (ED) for embedded finger-ring injury over his left middle finger. The embedded ring was removed in the ED under heavy sedation, and the wound healed uneventfully over 2 weeks. Thereafter, the young man received psychiatric treatment. Embedded finger-ring injury has never been reported in a drug abuser before.

Adolescent↗

PubMed1991

Heterotopic ossification in a finger following head injury.

A case of digital periarticular heterotopic ossification is described. Such cases are extremely rare and diagnosis may be delayed. Spasticity, possibly in association with minor trauma, may contribute to the development of the process. Little experience exists of the management of such problems and a mobile joint may be difficult to achieve.

Accidents, Traffic↗

PubMed1994