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PubMed2003

[Costs of hand emergencies].

In France at the present time, there is no comprehensive registry of hand injuries. Three types of occurrences; motor vehicle accidents, work accidents, and accidents incident to activities of daily living, are covered by different types of insurance. It is the individual insurance companies, payers of the indemnification, who maintain registries of these accidents. Statistics on work accidents are very detailed and consistent, but they are oriented toward risk management. The aggregate cost of traumatic injuries to the hand is not known. Only large financial institutions are equipped to determine appropriate preventive measures and to establish premium rates based on loss experience. In 2001, hand injuries accounted for 27% of work accidents causing loss of work of at least 1 day. About 29.8% of these work accidents caused permanent partial impairment. About 17.7% of total days lost and 18.2% of the total costs of permanent impairment were due to hand injuries. In the system of compensation for work accidents, there is a major difference in the cost according to the severity of the impairment. If the permanent impairment is equal to or less than 9%, a lump sum payment is made, but if the permanent impairment is over 9%, the worker receives regular payments for the rest of his life. In 2000, the average cost of a work injury with partial permanent impairment of over 9% was [symbol: see text] 85,405, while the average cost of a lump sum settlement was only [symbol: see text] 1479, a ratio of 57 to 1. The compensation costs represent 80% of the cost of work accidents, while the cost of treatment, including all providers and institutions, makes up only 20% of the cost. Compensation for sequelae of accidents in the course of daily life is new for the insurance companies, although these accidents are frequent and often cause significant repercussions in the professional lives of victims because of the loss of hand function. Provision of optimal treatment for these traumatic injuries from the very first moment is the best strategy for the third party payers. Better results of treatment not only reduce the costs of compensation for permanent partial impairment, but also greatly diminish the psychological impact on the injured worker. In the future, the management of the costs of these work injuries will become a priority. Pressure from consumers, which is growing, will favor this trend through the intermediary of private insurance companies.

Accidents, Occupational↗
PubMed1993

Nerve injuries in the hand.

Nerve injuries of the hand are an important problem for the emergency physician because most are diagnosed in the emergency setting. Successful diagnosis and treatment are critical if the injured patient is to regain full hand function. Emergency department management relies on the knowledge of hand and forearm functional anatomy and techniques for diagnosing loss of nerve function. Once a nerve injury has been diagnosed, issues such as primary versus secondary repair must be discussed with the hand surgeon. The hand surgeon must consider whether to pursue an epineurial or fascicular repair and must use additional techniques for diagnosing return of nervous function. Lack of nerve regeneration, chronic paresthesias, neuromas, and sympathetic dystrophy can complicate the successful return of hand nerve function after injury.

Emergencies↗
PubMed2005

Divergent dislocation of the ring and little finger carpometacarpal joints--a rare injury pattern.

Hand injuries due to longitudinal forces in the line of the metacarpals demonstrate unusual dislocation patterns. We describe a case of volar intra-articular fracture dislocation of the ring finger carpometacarpal joint in association with a pure dorsal dislocation of the little finger carpometacarpal joint. Open reduction supplemented with Kirschner wire fixation restored normal carpometacarpal joint anatomical relations and achieved an excellent clinical result.

Adult↗
PubMed1988

Roping injuries in the hand: mechanism of injury and functional results.

Twenty-two patients with roping injuries to 38 digits, including 19 patients injured while team roping, are discussed. Ten digits in nine patients were successfully revascularized or replanted. Seven digits in three patients failed after initial success. One patient is included in both categories. The failure rate is 41 percent for all 17 digits. Average follow-up is 18 months. The dominant hand was injured in 83 percent of team roping injuries; the thumb is the most commonly injured digit. Average interphalangeal motion for thumb replants is zero; for revascularizations, it is 47 degrees. There was 43 percent return of pinch strength for thumb replants compared to 83 percent return for a single thumb revascularization. The most common mechanism of injury was catching the roping thumb in the "thumb up" position during dallying. There are good motion and pinch strength with thumb revascularizations provided tendons and the interphalangeal joint are intact. Reconstruction of the flexor pollicis longus in the replanted thumb gave poor results. Primary tenodesis or arthrodesis is recommended.

Adolescent↗
PubMed1994

Physeal and periphyseal injuries of the hand. Patterns of injury and results of treatment.

To the authors' knowledge, this is the largest study assembled of finger fractures in children. Distribution of fractures according to location within the hand (see Fig. 1), location within the phalanges themselves, and the percent of epiphyseal fractures as well as the age distribution of the patients are all similar to what has previously been presented in smaller studies. Previously unreported synchronous and double epiphyseal injuries were identified. For the most part, thanks to the remodeling capacity and rapid healing of children's bone, treatment is short and complications are few. Nevertheless, as in other locations, there is a limited capacity to remodel angular deformity and no capacity to remodel rotational deformity. The clinical information in our study conflicts somewhat with previously described anatomic information about the insertion of ligaments with respect to the growth plate. Bogumill and Hankin and Janda have suggested that the ligaments insert primarily on the epiphysis in the proximal phalanx, and on the epiphysis and metaphysis in the middle and distal phalanges. Taken by itself, this information would suggest that a Salter-Harris III mechanism would be relatively more common at the MP joint, and the Salter-Harris II and IV mechanism (where the proximal fragment includes bone both proximal and distal to the growth plate at the point where the ligament is attached) would be relatively more common at the more distal levels. In fact, the opposite was true. The Salter-Harris II mechanism made up an overwhelming majority of the percentage of injuries of the MP joint, whereas the Salter-Harris III mechanism predominated at the PIP joint and was relatively common at the DIP joint as well. This would seem to suggest that either the contribution of ligament insertion distal to the growth plate of the PIP and DIP joints is not functionally important or that other factors are involved in the injury mechanism at both levels and play a role in producing these injuries. Further study will be required, possibly involving experimental fracture production to help elucidate this issue. Finally, it is critical to recognize and properly treat the four major categories of injury that constitute a small percentage of the total but a large percentage of the complications. The condylar and subcondylar fractures must be identified by obtaining a true lateral film by whatever means necessary. If undisplaced, they need to be adequately immobilized, possibly including the entire arm of a small child, and if displaced, they almost always require internal fixation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1993

Special injuries of the hand.

Unique injuries resulting from high-pressure injection, wringer washers, cornpickers, and snowblowers are presented. Epidemiology, pathophysiology, clinical presentation, and management are reviewed. These injuries commonly require surgical intervention. Prompt recognition and treatment can greatly influence prognosis.

Accidents, Home↗
PubMed1992

Frequency of glove puncture in the post mortem room.

The post mortem room is a potential source of danger from contamination caused by glove punctures. The objective of this study was to assess the incidence of hand injury and hand contamination during post mortem examinations. A prospective study of injury and glove puncture rate was conducted during post mortem examinations performed in 1990 on adults in Northwick Park Hospital mortuary. Four pathologists and two assistants performed a total of 44 post mortem examinations on adults. All participants completed a questionnaire after each examination, recording the total number of gloves used and the number of hand injuries and glove perforations sustained. Just over 8.3% of gloves were punctured; 31.8% of these punctures went unnoticed. Evisceration was the procedure most likely to result in hand contamination. The study highlights a significant risk which could be reduced by more care, frequent glove changes, and hand washing during post mortem examinations. In particular, gloves should be changed and hand washed when evisceration has been completed.

Autopsy↗
PubMedDate not supplied

Optimum management of hand blast injuries.

A series of 27 blast and gunshot injuries of the hand is presented. These wounds exhibit a spectrum of complexity and may include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and amputations. A systematic management sequence is outlined to evaluate, treat, reconstruct and rehabilitate these hands, with the primary goal of obtaining early maximal function. Since these injuries vary in nature and complexity, this management sequence is specifically adapted to deal with the individual injury. A "reconstructive ladder" of techniques is utilized, ranging from "simple" (e.g., direct closure, skin grafts, local flaps) to "complex" (free flaps, toe-to-thumb transfer). The individual procedure selected is the most straightforward, consistent with expediency and early return of a functional hand. The return of these hands to function has been facilitated by recent advances in tissue assessment, free tissue transfer, and skilled hand therapy.

Adolescent↗
PubMed1987

Tool design for prevention of hand and wrist injuries.

Incorrect hand tool designs can cause a variety of cumulative trauma disorders. Design elements of size, shape, texture, purpose, ease of operation, shock absorption, and weight must be properly applied in the design process to fulfill the physical safety needs of consumers and working people and to prevent the appearance of pathologic changes in the tissues of the hand and wrist.

Accidents, Occupational↗
PubMed2002

Hand and fingertip injuries in children.

BACKGROUND: Hands are frequently injured in children. To date, the literature has focused on the type and treatment of hand injuries. This study examines the epidemiology of hand and fingertip injuries in children who present to an emergency department (ED). DESIGN: Retrospective chart review. SETTING: Pediatric emergency center of an urban ED. PARTICIPANTS: All patients over a period of 8 months who presented with a chief complaint of hand injury. METHODS: A total of 17,859 charts were reviewed during the study period; 382 patients were enrolled in the study (male preponderance of 1.4:1; median age, 10 y). RESULTS: The most frequent injury setting was outdoors (47%). The most frequent injuries were lacerations (30%), followed by fractures (16%). Only five patients required hospitalization (1.3%). The digits are the most commonly injured part of the hand, particularly the thumb (19%). Fingertips are involved in 21% of cases. Radiographs and consultations were obtained in 64% and 16% of cases, respectively. Infection occurred in 14 (3.7%) patients. CONCLUSION: Hand injuries occur in a bimodal distribution in children. Children younger than 2 years suffered fingertip injuries in the home, and children aged 12 to 16 years suffered hand injuries. Sports injuries tend to present late and are the most common cause of hand fractures.

Adolescent↗
PubMed1993

Nailgun injuries of the hand.

Nailgun injuries of the digits and palm are an occupational hazard for carpenters. Sixty-five percent of all nailgun injuries have been reported to involve the hand. Clinically they can be further classified into three types, varying with the injury and the prognosis. Prompt nail removal after i.v. antibiotics, minimal wound debridement, operative curettement of the nail tract with removal of any foreign material, irrigation, open wound drainage, and nonoperative treatment of skeletal injuries resulted in healing without infection and with good function in seven cases.

Adult↗
PubMed1990

Fatal hand tool injuries in construction.

Past research on occupational hand tool injuries has generally focused on nonfatal injuries. Most such injuries occur at the point where energy is transferred to the material being worked, eg, at the edge of a saw blade or the point of a drill. Assuming that hand tool injuries that are fatal will differ from nonfatal injuries, 62 Occupation Safety and Health Administration reports were analyzed. Four patterns emerged when the type of contact with energy was used to classify incidents. Fatal injuries occurred when (1) contact was made with energy that supplies power to the hand tool, (2) energy normally transferred to the material being worked is transferred to the worker, (3) workers or materials fall, and (4) potential energy is encountered in the work environment. Analysis showed that almost all such injuries could be prevented by application of existing safe work practices.

Accidental Falls↗
PubMed1999

[Abdominal bipedicled subepidermal vascular-network flap in repair of degloving injury of hand].

OBJECTIVE: To evaluate the clinical result of repairing degloving injury of hand with abdominal bipedicled subdermal vascular-network flap in emergence. METHODS: From 1994 to 1997, 19 cases with degloving injury of hand were treated with two flaps, one flaps with the inferior epigastric artery as pedicle, another with superficial epigastric artery. The two skin flaps were designed oppositely to cover the injured hands. RESULTS: All the flaps survived. Followed up for 1 to 3 years, the contour of hands were fine. Extension of fingers was normal and opponers of thumbs was good. Range of flexion of metacarpo-phalangeal joints was from 45 to 60 degrees, and the proximal interphalangeal joints was from 10 to 25 degrees. CONCLUSION: For the subdermal vascular network, the bipedicled flaps of abdomen in repair of degloving injury of hand have sufficient blood supply, strong resistance to infection, high survival rate, and good contour.

Adolescent↗