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The benefit of including a psychological evaluation of a worker with a hand injury is that additional diagnostic and prognostic information regarding the patient is obtained. Psychological evaluations examine the emotional and social factors that can either complicate recovery from injury or aid in rehabilitation.
A case report is presented of a left hand injury in a four-year-old girl with a bone defect of the mid hand caused by a spindle conveyor. The technical problems both of age and bone reconstruction where the epiphysis is missing, are discussed.
Osteomyelitis and pyarthrosis may complicate hand injuries and soft-tissue infections, resulting in characteristic radiographic findings. Evaluation of 78 patients revealed bone or joint abnormalities in 10% of individuals. Distinct pathways are available for spread of bacteria which become lodged in the soft tissues of the hand. Such routes include tendon sheaths, fascial planes and lymphatics. An understanding or pertinent anatomy allows the radiologist to predict the site and pattern of soft tissue, articular and osseous alterations.
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This paper is a review of the hand injuries occurring in the Yorkshire Wool Industry and referred to the Regional Plastic Surgery Unit for skin replacement, or other treatment, during the years 1965-1984. A total of forty-one cases has been seen, and although the number employed in the industry has fallen about fivefold, the injuries referred yearly have remained approximately constant. An analysis of the types of injury has been made and the improvement in the results is shown with changes in the method of acute treatment. The case for early referral, active initial treatment and early mobilisation is very obvious from the results.
The Hand Injury Severity Score was retrospectively applied to a group of workers' compensation cases in Wisconsin, USA. A statistically significant correlation was found between the score and the time interval between injury and the end of healing. These results are comparable to the findings in the original study of Campbell and Kay (1996). We provide some suggestions for further development of this scoring system.
The manner in which hand injuries affected six professional musicians and their music making is described. The need to take into account the particular requirement of hand function in each musician, when planning reconstructive surgery, is emphasised.
Artificial ski slope skiing is a popular sport in Great Britain with significant risk of injury. We reviewed 36 patients who had been treated for hand injuries excluding the wrist in our plastic surgery department over a 14-month period after skiing on an artificial ski slope. Specifically, they were 15 fractures of the digits, 3 dislocations of the finger joints, 7 ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, and 11 bruises and abrasions. The mean age of the patients was 28 years, and there were 20 men and 16 women. It is concluded that the hardness of the surface of the artificial ski slopes could be responsible for the types of injuries.
The primary care physician can accurately diagnose hand injuries by obtaining a thorough patient history and performing a complete physical examination of the hand. When the severity of injury is doubtful, immobilization in a splint with next-day referral is appropriate. Immediate consultation should be obtained with nerve or vascular damage, fracture-dislocation injuries, open fractures, substantial skin loss, or flexor tendon injuries at or distal to the wrist.
INTRODUCTION: Injuries of the hand have an enormous impact on hand function and on quality of life. Occupational injuries are a major cause of morbidity and mortality in India and their incidence has been steadily increasing. Sugarcane crushers produce juice using dangerous procedures. OBJECTIVE: The objective of this study was to determine the knowledge, attitudes, and practices among sugarcane crushers in India and thus assist in the formulation of effective preventive strategies. SETTING: A block (area) in the Vellore District, South India (population 100 000). SUBJECTS AND METHODS: All sugarcane crushers living in this area (n = 32) were included. A single observer, using a questionnaire, conducted personal on-site interviews. RESULTS: Carelessness was involved in 63% of injuries. Sixteen per cent felt that machines with improved safety features are required; 40% supported the use of special gloves, although 19% considered them a hindrance. Eighty eight per cent did not consider the long duration of work as a risk factor and 38% were fatalistic (God's will); 50% thought the injuries were due to "bad luck". CONCLUSION: Sugarcane crushers do not perceive the need for safer equipment. To overcome fatalistic views, and persuade this group to take other safety measures, safety education will need to take into consideration their socioeconomic and educational status.
The purposes of this article are 1) to compare contrasting ways of documenting pain, 2) to identify the usefulness of information each method provides, and 3) to examine implications for hand therapy. Participants are tracked for 12 months in an ongoing study of Adaptation to Hand Injury that incorporates quantitative measures of both intensity and functional impact of pain, as well as semistructured qualitative Adaptation Interviews that elicit and document patients' responses to pain and injury experience. Each method of documenting pain tells us something important. Numeric measures of pain intensity (Visual Analog Scale) allow us to document change over time and identify relationships between intensity and self-reported changes in daily life as documented in a structured questionnaire (Disabilities of Arm, Shoulder, and Hand). Qualitative interviews provide an individual perspective on responses to pain and disability and the personal beliefs and experiences that influenced the responses of each unique individual. Findings support the importance of studying more about the clinical behaviors of our patients for better treatment outcomes and recommend the use of qualitative research in helping us to uncover this knowledge.
The purpose of this study was to investigate the relationship between glove use and acute traumatic occupational hand injury. We used a case-crossover, within-subject study design to control for differences between individuals such as occupation, injury history, age, gender, risk-taking behavior, manual dexterity, and muscle strength. A total of 1166 hand-injured workers were interviewed regarding the use of gloves at the time of the injury. The self-reported average duration of glove use in the previous work month was the measure of expected exposure to wearing gloves. Nineteen percent of subjects reported wearing gloves at the time of the injury. The expected exposure to glove use in the past work month was 27.9%. Glove use was associated with a lower risk of lacerations and punctures but not crush, fractures, avulsions, amputations, dislocations; the risk of the former two injury types was estimated to be 60-70% lower while wearing gloves. Glove use is only one component of a comprehensive hand injury prevention approach that might include the identification and elimination of sharp hazards, engineering controls, safety warnings, training in high-risk situation awareness, and proper selection and timing of glove use.
We present a retrospective analysis of 32 patients admitted over a 5-year period to a metropolitan regional trauma center with recently induced subcutaneous ("skin pop") illicit drug injectional injuries involving the hand. Cocaine derivatives were the most frequently reported illicit drug used (75%). All patients had local disease manifested by subcutaneous abscess formation, and several had regional disease (cellulitis, lymphangitis, or lymphadenopathy), but only one patient had systemic illness. Microbiological analysis revealed endogenous integumentary and oral flora sensitive to oral preparations of several antibiotic medications including cephalosporins. Primary therapy included intravenous administration of antibiotic medications in all instances and simple incision and drainage under local anesthesia in 26 patients (81%). Six patients (19%) required more radical operative therapy. All patients were hospitalized and recovered without sequelae, with preservation of hand function after follow-up evaluation, which ranged from weeks to months, except for 1 patient who required digital amputation because of necrosis. Although the issue of compliance in terms of wound and general medical care for this patient population is problematic, analysis of the data suggested that patients with illicit drug injectional injuries of the hand confined to subcutaneous regions could be effectively and safely managed in outpatient settings by simple wound care and orally administered cephalosporin medications.
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We evaluated a response-blocking procedure for reducing the self-injurious hand mouthing of 2 adults with profound disabilities. The procedure reduced mouthing in both cases. The results suggest research is warranted to delineate the behavioral process responsible for the effect of response blocking and to determine the procedure's long-term utility.
High-pressure injection injuries of the hand have a reputation for being dangerous for individual fingers and even for whole hand. Usually appearing innocuous at presentation because of small puncture entry wound, these injuries result in severe damage of most internal structures in finger and hand due to extensive penetration of injected substance. This paper reviews the outcome of the treatment of such injuries in 10 patients: 9 sustained injection of toxic paint, and one lead shot. All the patients were operated on: eight a few hours after injury and two with 3 days delay. The surgical technique included wide exposure from site of injection up to the farthest place in which foreign substance was seen. Thorough debridment of injected material and contaminated tissue was performed with careful preservation of neurovascular structures and tendons. Wounds were not closed, but managed by open technique. In all patients wounds healed well: in 3 by secondary intention, in 6 by delayed closure and 2 were covered by skin grafts. No amputation was performed. Final results were assessed form 1.5 to 3.5 years after initial injury (mean at 2.5 years). Two patients complained of moderate pain related to the weather, five of cold intolerance and two of impaired sensation on fingertips. Active range of motion of affected fingers was in whole group from 90% to 104% (mean 97%) of the range of motion of unaffected fingers from the other side. Range of motion of the wrist (2 patients) was 76% and 117% of range of motion of the other side. Pinch grip strength was from 81% to 116% (mean 99%), and global grip strength from 77% to 119% (mean 97%) of the other side. All patients went back to their previous jobs and periods of sick leave were from 2 weeks to 6 months (mean 3 mo). Excellent results achieved in this study--full functional recovery in 9 of 10 patients confirm the effectiveness of aggressive treatment by open wound technique of such injuries.
Nineteen cases of high pressure injection injuries in the hand were treated between 1973 and 1998. Same surgical treatment plan was followed in all cases: excision of the penetration point, irrigation, debridement and synovectomy if opening of the flexor sheath was noted, and skin closure to allow early mobilisation. All cases concerned men, work injuries, and volar aspect of the hand. The elapsed time between injection and initial surgery ranged from 1 hour to 1 month with a mean of 6.5 days. Eighteen patients out of 19 were reviewed with a mean follow up of 12 years. In 11/19 cases, (58%) oil was injected. The results of oil injection cases have been analysed: the quantity of oil and the preoperative delay (if more ten hours) are associated with poor functional results or complications. Two amputations, two cases of skin necrosis at the injection point, and one case of infection are reported. One case of oleoma of the thumb is described. The specificity of injuries by industrial oil under pressure must be known: paint or white spirit are more toxic than oil which was in all cases injected in the dominant hand (no high pressure injection tool but a defect in the pipe). An important inflammatory reaction with functional sequelae is caused by foreign bodies in oil. Extraction of oil off the injured tissues is difficult because oil is not visible. A specific information is necessary for farmers and truck driver, very exposed population.
We reviewed 27 patients who required 28 groin flaps for repair of hand injuries. Flap necrosis due to ischemia developed in 18% of the patients. Flap ischemia did not develop after elevation of the flap or partial division of the pedicle. All flap necroses occurred after final (total) division of the pedicle (p less than 0.05). Flap necrosis was more common following immediate insetting of the flap than after delaying the inset, but this difference was not statistically significant. Flap necrosis did not develop if the pedicle was divided in two stages, with the first stage consisting of either preliminary ligation of the superficial circumflex iliac vessels or full-thickness division of a portion of the width of the flap. Our complication rate was much lower than that previously reported for groin flaps.