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PubMed1983

Wound botulism: a life-threatening complication of hand injuries.

Botulism is usually associated with the ingestion of food contaminated with Clostridium botulinum, and these organisms occasionally contaminate traumatic injuries. It is unusual for them to result in clinical infection, but when this occurs, it is a catastrophe completely out of proportion to the degree of wound injury. A case is presented in which typical manifestations of descending cranial nerve and generalized motor paralysis were noted. Prolonged respiratory and general supportive assistance was required, as is usually the case. Although mortality rates in this disease are high, recovery is usually complete in survivors and was true in this instance.

Adult↗
PubMed2006

The use of vascularized phalanx for the first metacarpal bone defect in a mutilating hand injury. Case report.

In this case report, the use of middle phalanx of index finger for reconstruction bone defect of the first metacarpal is described. The reasons for this kind of usage and 1-year follow-up of the patient are discussed. During the follow-up, a pseudoarthrosis was observed in the repaired first ray. And this may be considered as a useful complication, when there is stiffness in the carpometacarpal joint. It may be a result of a stiff joint or vice versa.

Adolescent↗
PubMedDate not supplied

Return-to-work programs following occupational hand injuries.

Return-to-work programs are no longer luxuries that only the major industries can afford to provide. Direct cost savings can be documented with the use of such programs, but just as important is the message that the company cares and looks out for the employee's best interest. The occupational medicine team's responsibility to the patient and the employer no longer ends with the provision of quality medical treatment. The ultimate goal is to return the patient to his or her job. Return-to-work programs successfully facilitate that process.

Disability Evaluation↗
PubMed1994

[The dependence of the results of dermatoplasty in treating hand injuries on their location and the methods employed].

Results of 392 operations, conducted with application of various methods, are presented: free grafting--132 operations, using local tissues--104, using the flaps on the temporary feeding pedicle--146, using the flaps on the vascular pedicle--10. Majority of interventions conducted were done in emergency. In 32 patients the primary reconstructive-recovering operation combined with epidermic grafting using feeding pedicle was conducted, in 26 of whom good or satisfactory result was noted. Temporary disablement duration was average (72 +/- 3.1) days long. Satisfactory result while the free autodermoplasty conduction was noted in 83% of observations, after the plasty using local tissues--in 79%, and applying the flaps on the temporary feeding pedicle--in 92%.

Hand Injuries↗
PubMed1997

Timing of free microsurgical tissue transfer for the acute phase of hand injuries.

Because of favourable survival rates in replantation surgery and a high standard of free tissue transfer the interval between injury and microsurgical reconstruction has become gradually shorter. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to urgent procedures done within 72 hours. Bearing in mind the infection rates that have been reported of 1.5% for the acute phase and 17.5% for the late phase, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1995 we did 72 acute post-traumatic free tissue transfers to the upper extremity in our unit within 72 hours (urgently). There were no significant differences in the incidence of infections when acute were compared with urgent procedures. As a result we support the concept of urgent operations. The following advantages are to be considered: urgent operations allow a second look operation, the viability of the extremity can be assessed, and the reconstructive procedure can be planned more precisely. Last but not least, the procedure is done during the day time with better operating conditions.

Hand Injuries↗
PubMed1994

[The so-called "minor hand injury" and its socioeconomic sequelae].

A study was carried out involving 167 patients who had received primary treatment in alio loco for injuries diagnosed as 'minor cuts, twists and sprain', and who were then seen in the out-patient department at a later date. The patient group was analyzed with regard to the following: a more precise identification of the initial injury, the initiated treatment regimen and more particularly, the socio-economic consequences of the injury. Duration of treatment programmes, loss of working days and compensatory payments were cost-analyzed. The results showed that a delayed primary surgical intervention was possible in only 17% of cases, it was necessary to alter the treatment regimen in 29% and in 28% it was no longer realistic even to initiate treatment. Comparisons between this population and a group of a patients who had received adequate primary care showed that in the study group length of treatment and days lost at work was prolonged by the factor 1.3; furthermore the number of cases in which the reduction of working ability was 20% and more was increased by 2.7. Increased costs incurred by financial compensations were approx. DM 27,000/patient.

Absenteeism↗
PubMed2003

Hand injuries due to high-pressure injection devices for painting in shipyards: circumstances, management, and outcome in twelve patients.

BACKGROUND: Injuries due to high-pressure injections are frequently underestimated occupational accidents, which may have disabling outcomes. METHODS: The occupational injuries logbooks of two shipyards were examined. Twelve accidents due to the utilization of high-pressure equipment were reported. Data were obtained by reviewing the employers' logbooks and hospital records. RESULTS: Contaminants were epoxy paint and stucco, paint solvent, hydraulic and industrial oil. In three cases, the palm was injured and the fingers in nine. In 91% of cases, the accident occurred in the last 2 hr of the work shift. Mishandling (n = 9) and rupture of the high-pressure equipment (n = 3) were the causes. Mean time to medical treatment was 42.5 hr (SD 56.0). Ten workers were permanently disabled. CONCLUSIONS: Prompt surgical intervention with debridement and decompression was done in two workers, who healed completely. The ten patients who were not treated immediately eventually experienced a high rate of disability and five of them also suffered amputation.

Accidents, Occupational↗
PubMed2003

Posterior interosseous artery flap in traumatic hand injuries.

INTRODUCTION: Nineteen cases of posterior interosseous artery (PIOA) flap were reviewed. The patients' mean age was 24 (range 14-53) years. MATERIALS AND METHODS: Nine patients were operated on as emergencies, and 10 patients were treated electively. Mean time of delay after trauma was 7.8 h (range 2-20 h) in emergency cases. Nine of them were non-replantable amputations. Skin defects were between 1.9 x 2.4 cm and 5.0 x 12.0 cm. Mean hospitalization time was 2.2 (range 1-5) days. RESULTS: Mean flap sensation was evaluated as 2.83-6.65 with the Semmes-Weinstein evaluation scale (only 2 patients scored less than 3.61). Five patients presented with discoloration and coolness. Average subjective evaluation was 8.2/10. Mean web opening after first web reconstruction was 40 degrees. One posterior interosseous neuropraxia ( recovered in 4 months), one distal flap necrosis, and one flap lost (due to infection) occurred as early complications. Mean follow-up was 12.8 months (range 15 days to 30 months). CONCLUSIONS: PIOA flap applications have reduced the need for lateral arm and radial forearm flaps and also shortened hospitalization time in clinical practice.

Adolescent↗
PubMed1984

Gas gangrene in traumatic hand injuries. Report of three cases.

Gaseous gangrene is an infection with anaerobies germs characterized by gaseous infiltration of soft tissues with quick and serious damage to the general state. Known in war time, it rages also in civilian practice. Two etiologies are dominating: post-trauma gaseous gangrenes, post-surgery gaseous gangrenes. Among post-trauma gaseous gangrenes, the ones on departure of inferior members are the most frequent arising from fractures or from luxations open or closed. Localisation on superior limbs is scarce, specially after soft parts' trauma. We report three cases of superior limbs' gaseous gangrene after seemingly benign trauma. Diagnosis has been set by the clinical surgery, and the presence of gas bubbles at soft tissues' radiography. It didn't exist any favorising agent such as diabetes, arterial insufficiency, intercurrent disease treated with corticoïdes or with immuno-depressors. Bacteriological levyings have not put the causal germ in evidence, this is due to levying conditions. Evolution of gaseous gangrene depends on quickness of diagnosis and treatment. This one includes surgical flattening, discharge's incisions and excisions of devitalized tissues, as well as antibiotherapy with 20 000 to 60 000 U penicilline by parenteral way. We didn't need appeal to hyperbare oxygenotherapy. Simple procedures of secondary repair surgery were sufficient to restoration of a normal function. Gaseous gangrene is a real surgical urgency, even without bacteriological proof.

Adult↗
PubMed1991

Patterns of occupational hand injury in pathology. The interaction of blades, needles, and the dissector's digits.

Details of injuries and exposures to body fluids while handling tissue that were sustained by 36 pathologists (nine residents and 27 staff pathologists) were ascertained by retrospective questionnaire. In the preceding year 56% (20/36) had sustained a cut or needlestick injury. A total of 72 individual injuries occurred and corresponded to one injury for every 2629 surgical specimens handled and for every 37 autopsies performed. Residents reported a five-fold excess in injuries compared with staff pathologists. The lesions described predominantly (67%) involved the oppositional area consisting of the distal thumb, index, and middle fingers of the nondominant hand; during dissection, when opposed to hold or retract tissue, these digits form a surface that is directly exposed to the cutting edge, and injury to this area may be termed dissector's digital injury. Injuries to other areas of the nondominant hand were much less numerous and the dominant hand was rarely injured. Splashes to the face and eyes and glove punctures were frequent. These injury and exposure rates are probably broadly representative of practice in areas of low acquired immunodeficiency syndrome prevalence and may be improved on with increasing concern about human immunodeficiency virus infection. It is likely, however, that development of comfortable protective devices, based on knowledge of the pattern and circumstances of injury, will be necessary to eliminate these occupational hazards.

Fingers↗
PubMed1993

Hand injuries on artificial ski slope.

50 consecutive patients with injuries due to skiing on an artificial ski slope were seen in our emergency department over a 16-month period; 76% of these involved the hand or wrist. 52.5% of hand lesions were fractures and only one-third of the first ray injuries were sprains of the ulnar aspect of the MP joint. These data significantly differ from those known for skiing on snow.

Adolescent↗
PubMed1978

Hand injuries: incidence and epidemiology in an emergency service.

During a four-month period, 1,164 patients presented to the surgical section of our Emergency Services (ES) with chief complaints involving the hand. Patient records were analyzed for several variables including demographics, diagnosis and therapeutic procedures. Lacerations were the most frequent injury, 61.5% (n=716) with deep structure injuries present in 6.1% (n=44). Of deep structure injuries, 36.4% were tendon lacerations, 27.2% were nerve injuries, and 36.4% were compound fractures. "Bites" accounted for 5.2% (37) of all lacerations, eight of which were human bites. Fractures were the second most frequent injury, (11.4%) and involved 143 separate bones. Infections were present in 7%; over half were paronychias. There were 42 (3.6%) thermal injuries.

Adolescent↗
PubMed2002

Hand injuries in young children from contact with vacuum cleaners.

OBJECTIVES: To assess the incidence of injuries to young children sustained by contact with a domestic vacuum cleaner and to highlight the potential for significant injury. An increase in public awareness of these risks might result in a reduction in morbidity. METHODS: Over a period of one year, all children attending with an injury sustained because of contact with a domestic vacuum cleaner had review of their case notes by the author. RESULTS: Four children were identified as having sustained friction burns to a hand after contact with a vacuum cleaner. All required treatment and several review appointments before satisfactory resolution was achieved. CONCLUSIONS: Although the number of cases seen was small, the potential for significant injury must be emphasised and public awareness increased in an attempt to reduce morbidity.

Burns↗
PubMedDate not supplied

Hand injuries from sea urchin spines.

Sea urchin spine injury is usually a benign process that rarely comes to the attention of a physician. Aside from the transient episode of excruciating pain which responds dramatically to hot water soaks, there is usually no residual disability. As in any puncture wound, tetanus prophylaxis and observation for latent infection is advised. Complications arise, however, when spines are embedded over bony prominences, within joints, or in contact with nerves. Cases are reported herein of the latter two problems occurring in the hand. A case of a neuropathy associated with sea urchin injuries has not been previously reported in the literature. When such injuries necessitate exploration, aseptic surgical technique is required.

Adult↗
PubMed1981

Rapid skin cover in hand injuries using the reverse-dermis flap.

When skin flap cover is needed to repair a hand defect it may prove impossible to use a local or cross-finger flap. Many types of distant flaps are available but these usually require a prolonged period of attachment. It is the purpose of this short paper to show that a direct reversed-dermis flap can provide good cover with a short attachment phase and allows early mobilisation.

Adolescent↗
PubMed1980

[Indications for osteosynthesis in childhood hand injuries (author's transl)].

The general indication for osteosynthesis in childhood can also be applied to the bones of the hand. The preferred operative procedure is to reduce and stabilize the fracture with one or two percutaneous Krischner-wire. Where there are defects in the bones or soft tissues, the use of a mini external fixation has proved rewarding, even on growing bones.

Adolescent↗
PubMed1999

Impairment of hand function and loss of earning capacity after occupational hand injury: prospective cohort study.

OBJECTIVE: To examine the loss of earning capacity and permanent impairment of a cohort of male patients who had experienced finger amputation due to occupational injury. DESIGN: Prospective cohort study. SETTING: University teaching hospital, Hong Kong. PATIENTS: Twenty-eight male patients aged 26 to 55 years who presented with work-related finger amputations in their dominant right hand from 1990 through 1991. MAIN OUTCOME MEASURES: Type and extent of amputation, and hand function before and after (mean, 11 months; range, 8-6 months) the patients' return to work. Assessment results were compared with patients' percentage loss of earning capacity as calculated using the scale described in the Employees' Compensation Ordinance of Hong Kong. RESULTS: Patients with injuries that corresponded to a loss of earning capacity of 12% or greater had a significant impairment in their hand function (P<0.05); the hand function of this group after their return to work significantly improved (P<0.05). There were no significant differences between the loss of earning capacity scores as calculated by the Hong Kong, American Medical Association, or Indian Medical Association scales. CONCLUSION: Patients whose loss of earning capacity of 12% or greater are likely to have significant long-term impairments of hand function. Thus, a more intensive rehabilitation programme should be provided to this group.

Journal Article↗
PubMed2004

Self-reinforced bioabsorbable miniplates for skeletal fixation in complex hand injury: three case reports.

We report our preliminary experience with 3 cases in which internal fixation with a self-reinforced poly-l/dl-lactide 70/30 miniplate and 1.5-mm or 2.0-mm screws were used to stabilize an open metacarpal fracture, a metacarpophalangeal arthrodesis in a thumb replantation, and an interposed bone graft for reconstruction of a thumb. Clinical and radiologic follow-up evaluation lasted for 12 to 20 months. Bone healing was uneventful in all 3 cases with no displacement or delayed union. The implants were biocompatible with no clinically manifested foreign body reaction. Because of the self-reinforcing manufacturing technique the plates have metal-like mechanical and handling properties. Complete late resorption makes self-reinforced poly-l/dl-lactide 70/30 miniplating systems an attractive alternative to metallic implants for skeletal stabilization of small bones of the hand.

Absorbable Implants↗