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Wrist and hand injuries in platform diving.

To permit a smooth entry into the water, platform divers assume a special position with their hands. An older method consists of hitting the water with both fists closed while holding one thumb in the palm of the other hand. In a newer technique fingers and wrists are hyperextended, the forearms pronated, and the hands overlapped. In this series of 21 divers, the injuries included 2 fractures and 5 sprains treated by conservative methods. Two divers required surgery: one with loose bodies in the radiocarpal articulation, the other with chronic rupture of the trapeziometacarpal ligament and synovitis of both extensor pollicis brevis and longus. Eighteen divers complained of pain caused by the impact of the hand with the water. A kinetic analysis with a video imaging system explains the mechanism and forces of water penetration.

Adult↗

Initial management of hand injuries in the emergency patient.

Failure to develop a proper routine for complete examination and documentation of the injured hand may result in the inability to make the proper diagnosis. Less than optimal treatment may result. Ultimately, the end result is unnecessary functional loss and, frequently, medical-legal difficulties. Initial emergency department management of acute hand is reviewed: recognition of surgical emergencies, proper initial treatment of tendon and nerve injuries, splinting, and record keeping are emphasized.

Emergencies↗

The law of workers' compensation as it applies to hand injuries.

From the author's own experience in over a decade of handling work-related claims involving the hand, fingers, and wrists, they are not only the most frequently seen work-related injuries but as a whole result in more disability, from the occupational standpoint, than those involving any other area of the body.

Hand Injuries↗

Hand injuries caused by high pressure injection. Contribution of loco-regional anaesthesia.

In a reported case of accidental high pressure injection of white spirit into a finger, the authors emphasise the great contribution of regional anaesthesia maintained from the initial trauma until the lesions are stable. Trauma to the hand caused by injection of paint or grease solvents results in tissue destruction and later necrosis and fibrosis. Secondary amputations are required in many cases. Regional anaesthesia of the stellate ganglion and brachial plexus produces analgesia and vasodilatation of peripheral arteries by inhibition of the sympathetic tone. This vasodilatation limits the necrotic process and promotes the supply of drugs to the injured tissues. Regional anaesthesia is of great benefit for surgical excision and avoids extended amputation.

Adult↗

Salvage and reconstruction of electrical hand injuries.

Electrical injury results in serious damage or amputation of the upper extremity in a significant percentage of survivors. Fourteen of sixteen patients with electrical injuries followed over a two and a half year period had major hand wounds. Careful wound assessment, management, and closure combined with appropriate reconstructive technics now available provide the greatest potential for restoration of satisfactory quality of life. Because these injuries are often of an industrial nature, occupational vigilance and prevention remain essential.

Abdomen↗

Carpal tunnel syndrome caused by hand injuries.

Although carpal tunnel syndrome associated with injury to the wrist is common, it is possible to overlook symptoms of median nerve compression caused by an ascending tenosynovitis secondary to trauma distal to the wrist. One should look for these symptoms in such patients who complain of pain and weakness of the hand, and release the carpal tunnel if nerve compression is suspected.

Carpal Tunnel Syndrome↗

[Faults and dangers in treating hand injuries (including tendons and bones) (author's transl)].

Diagnostic procedures include: critical examination of the wound of sensibility, of vascularization, of tendon function, of stability of bones and joints, and examination by roentgen diagnosis. Therapeutic procedures include: the operation, immobilization, active training of noninjured joints, and rehabilitation. Injuries of flexor tendons are treated by the specialist following the method of Kleinert; those of bones and joints can be easily stabilized by Kirschner pins.

Amputation, Traumatic↗

Psychosocial aspects of hand injuries and diseases.

More than 50% of patients with a diagnosable psychiatric disorder initially present with somatic symptoms, which often effectively distract the physician from the true illness. Moreover, the occupational setting is ripe for the emergence of psychosocial issues.

Absenteeism↗

Medical-legal problems in the emergency department related to hand injuries.

One of the areas that has become important to emergency medicine is that of risk management, which uses retrospective evaluation of improper medical encounters in an attempt to prevent future similar occurrences. Risk management involves the identification of the risk, the control of the risk, and the prevention of the risk.

Consultants↗