[Hand grenade injuries. Surgical and medico-legal aspects].
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The hydraulic woodsplitter is a new labor-saving tool for woodstove users. A new spectrum of hand injury has been observed in association with its use. Twenty-three such injuries are reviewed. Among these were nine digit amputations, four of which were successfully replanted. There was a surprising preponderance of central digit injury, with border digit sparing due to the dominant role of the central digits in power grip of the log. Both human carelessness and faulty design features were instrumental in the production of injury.
A prospective study of 500 consecutive patients referred from accident and emergency departments in Northern Ireland with acute hand injuries was performed to assess the incidence of missed injuries. An injury was 'missed' if a patient was receiving inappropriate treatment or returned due to persistent symptoms despite being examined, treated and discharged. There were 16 (3.2%) missed injuries. Seven involved tendon only, four were isolated nerve injuries and four were mixed tendon and nerve injuries. The remaining case was a ruptured ulnar collateral ligament of the thumb metacarpophalangeal joint. Thirteen injuries were open, with a glass laceration being the most common mechanism of injury. The time to detection of a missed injury was on average 11 days (range 1-62 days). Missed hand injuries in Northern Ireland are uncommon but do occur. A thorough clinical examination and accurate injury documentation remain fundamental in their prevention.
Hand injuries are among the most frequent accidents seen in sports medicine. All too commonly they are considered trivial since the athlete may continue to participate actively and neglect his injury. The consequent delay in diagnosis and proper treatment may result in long-standing or even permanent disability. This paper describes the more commonly encountered hand injuries, their diagnosis and their optimal treatment. Included are soft-tissue injuries, ligamentous injuries, fractures and tendon avulsions. The basic principles applicable to skeletal and soft-tissue trauma of the hand, which physicians at all levels of sports medicine may encounter, are stressed.
Growing redistribution of injuries has been recordable from winter sport activities, in recent years, with the upper extremity being more often affected than in the past. This prompted the authors to undertake follow-up checks for the purpose of verifying therapeutic success of patients treated earlier for three frequent injuries which had quite often been underestimated or even overlooked, rupture of the ulnar ligament of the metacarpophalangeal joint of the thumb, fracture of the distal radius, and fracture of the scaphoid. Included in the follow-up check were 37 patients with rupture of the ulnar ligament, 34 with fracture of the distal radius, and 11 with scaphoid fracture. All of them had been treated by the authors, in 1982 and 1983. Periods between 4 and 26 months had passed from surgical treatment or beginning of conservative therapy at the time of the follow-up check.
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Scars are extremely problematic, especially due to their unstableness, particularly in weight bearing areas (maximum 70% of the stability of normal skin). The use of split-thickness skin grafts or meshed split-thickness grafts frequently produces poor cosmetic and functional results, full thickness skin is only available in small quantities, free tissue transfer creates severe donor site defects and is surgically challenging. INTEGRA Dermal Regeneration Template is a unique technology which allows permanent regeneration of functional autologous dermal tissue and appears as a new alternative to full-thickness skin grafting, skin expansion and even skin flaps for reconstructive surgery. We used the INTEGRA Dermal Regeneration Template in a patient with a scalped left hand and amputated fingers (Fig. 13, Ref. 10).
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