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During a fall, a skier sustained two fractures of the metacarpal bones despite special safety hand grips on the ski-sticks. Altered design of these grips is recommended as a prophylactic measure.
A group of hand injury patients was followed up 2-3 years after their injury. Compared to a non-patient control group hand injury patients were more externally oriented, and reported more psychological symptoms. Based on their General Health Questionnaire scores, the patients were divided into a low score and a high score group. High GHQ scores were associated with external locus of control, less social activities, and dissatisfaction with social life. The medical rating of loss of earning capacity was not predictive of overall occupational or psychosocial adjustment. Suggestions are made for future research into determinants of occupational adjustment of these patients.
BACKGROUND: Workers with acute hand injuries account for over 1 000 000 emergency department visits annually in the United States. AIMS: To determine potential transient risk factors for occupational acute hand injury. METHODS: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders. RESULTS: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects. CONCLUSION: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work.
Hand injuries in children are seen frequently in the office and the emergency room. Basic principles determine which fractures, tendon injuries, dislocations, nerve injuries, fingertip injuries, infections, and amputations can be treated by the primary physician and which should be referred to a specialist.
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Explore the source record for details and available documents.
Wrist and hand injuries are common occurrences. These are often caused by a fall on the outstretched hand, but other mechanisms, from sports-related injuries to high-speed motor vehicle collisions, can lead to injuries that may be subtle on initial imaging or may produce characteristic radiographic findings. In all cases, careful attention to certain anatomic details along with a sound understanding of different injury patterns should allow an accurate diagnosis to be made. The following this article illustrates these concepts, emphasizing features that should be familiar to both radiologists and orthopedic surgeons.
A prospective investigation of all hand injuries seen at a major general hospital during a period of one year has been made. Over 900 hand injuries have been registered and systematically been followed up during the period of treatment. The survey includes the frequency, severity and treatment of the hand injuries. Furthermore there is an estimation of the medical and socio-economical consequences of the hand injuries. It is shown that hand injuries are extremely usual and imply enormous costs to the community. Postgraduate tranining in hand surgery is therefore desirable for all those general and orthopaedic surgeons, who deal with the treatment of patients with hand injuries.
In patients with hand injury, careful clinical examination is necessary, even in cases of seemingly trivial lesions such as small puncture wounds. Four patients, two women aged 18 and 51 years and two men aged 16 and 28 years, presented with a small volar cut caused by a glass fragment (three patients) and a saw. They suffered from loss of motor function, loss of sensibility or loss of circulation in one finger. They were treated by plastic surgery. Lesions of tendons and peripheral nerves can be diagnosed by relatively simple tests. It is important to recognize them at an early stage because adequate treatment may result in recovery of the sensibility and the motor function. Even a 'dead' finger may be salvaged.
Traumatic hand injuries can be devastating experiences both physically and psychologically. The plastic surgery nurse who can identify the various responses that routinely occur with hand injured patients is better prepared to normalize their experiences and implement the necessary interventions toward overall rehabilitation. This article will provide an overview of specific characteristics and emotional reactions following hand injuries, factors that influence adjustment, and nursing management that promotes optimal recovery.
Remote results of hand injuries in 78 patients (93% males, 7% females) aged 16-82 (mean 39 years) were analyzed statistically and economically. Injuries sustained at work constituted 61%. All patients were operated on emergency basis, hospital stay ranged 1-93 days (mean 14 days). Further treatment on an outpatient basis lasted 4.5 months on an average. According to own 3-grade scale 24% results were rated good, 33%-fair and 43%-poor. Fifty-one per cent of patients resumed previous occupation, 17% found less demanding work and 15% were unable to work. Accident compensation fund was granted to 56% of patients. Great social cost of hand injuries is underlined in the paper.
BACKGROUND: Acute hand injury is the leading cause of occupational injury treated in United States' hospital emergency departments (e.g., laceration, crush or fracture). To identify risk factors for traumatic hand injuries, we conducted a case-crossover study of transient exposures (e.g., being rushed) for acute occupational traumatic hand injury. METHODS: The case-crossover method, which uses subjects as their own controls, was used to identify risk factors for occupational hand injury. Two hundred and thirty-two subjects were recruited from 17 occupational health clinics in New England and interviewed by telephone a median of 1.2 days after their injury. The a priori hazard period was defined as 10 min before the injury. Two control periods were used: one was 60-70 min prior to the injury (matched-pair interval analysis); the other was the total work-time exposed, on average, in the previous month (usual frequency analysis). RESULTS: In the usual frequency analysis, the relative risk for using malfunctioning or different-from-usual equipment or tools in the hazard period was 25.5 (95% confidence interval = 18.4-35.2). Relative risks were also significantly elevated for performing a task using an unusual work method, doing an unusual task, being distracted, or being rushed. Wearing gloves appeared to be protective (relative risk = 0.8, 95% CI = 0.5-1.2). Matched-pair interval analysis, where appropriate, provided similar findings but had much wider confidence intervals. CONCLUSIONS: This study demonstrates that the case-crossover design is a feasible and efficient method for studying transient risk factors for sudden-onset traumatic occupational hand injury. The usual frequency analysis proved more useful than the match-pair approach to control period selection.
The number of hand injuries in overall occupational injuries has remained constant over the last fifteen years. Injuries to the dominant hand and the non-dominant hand are assessed differently. Because of changes in the work environment with increase in mechanization, key-boards, and demands on fine motor skills, the question arises whether this differential evaluation is still proper.
The restoration of hand sensibility should be a high priority in providing soft tissue coverage for extensive hand injuries. Initial wound management may be effectively provided by conventional techniques, including skin grafts and groin flaps as a first stage. Once the magnitude of the injury is determined and the reconstructive goals are established, many of these procedures can be performed at a second operation. More circumscribed tissue losses, in which restoration of sensibility is the primary reconstructive goal, may be addressed in the acute or semiacute setting with primary sensory flap reconstructions. The advantage of this approach is that dissection of vessels and nerves is generally easier without the problems of scarring and fibrosis, thereby significantly hastening functional recovery.
The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children. The incidence was low in toddlers (34/100,000), more than doubled in preschool children (73/100,000), and steeply increased to around 20-fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and preschool children. Crushing was the most common cause of hand injury (64%), and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in the little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the phalanges. Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.
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Pediatric hand surgeons in Europe and North America are aware of the yearly "outbreak" of pediatric hand injuries on Halloween from carving pumpkins. This study reports another yearly "outbreak" of hand injuries--in Saudi Arabia from slaughtering sheep. During the 3 days of festivities following the Hajj ceremony, hundreds of thousands of sheep are slaughtered. Over 4 consecutive years, 298 patients attended the emergency room of Riyadh Central Hospital with injuries related to the slaughtering of animals sustained during the 3 days of festivity. Almost three quarters of patients (73%) were injured on the first day of festivity. The majority (92%) were nonprofessionals. Children accounted for 6.7% of patients. In adults, the female-to-male ratio was 1:7. The most common mechanism of injury was a knife cut (80.9%). Almost three quarters of injuries (73.5%) affected the hands, with more involvement of the left than the right hand. Only 7.7% of patients with hand injuries were admitted to the hospital for treatment. It was concluded that implementing safety measures while slaughtering, and educating the general population would be important in the prevention of these hand injuries in Saudi Arabia.