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PubMed1987

Allogeneic bone in the treatment of tumors, trauma, and congenital anomalies of the hand.

Because autogenous bone grafts are histocompatible by definition and because the hand does not require massive bone grafts, one may question the indications for using allogeneic bone in the hand. Although humans have been shown to develop donorgraft specific antibodies following large osteochondral allografts, these antibodies have not yet been noted after smaller bone grafts nor is the clinical significance of these antibodies clear. The use of allogeneic bone better satisfies the architectural and strength requirements for reconstruction when there is a need for osteochondral grafts, strong cortical grafts to allow secure fixation and early motion, and small tubular grafts that meet the demands of minimizing bulk in the hand. For the repair of osteochondral defects, autogenous grafts (ie, fibular head or metatarsal head) impose donor site deficits that can be clinically significant. In addition, grafts such as the fibular head do not provide reconstruction of a congruent joint surface. Strong cortical bone is an asset in metacarpal reconstruction; it enhances the quality of internal fixation, which in turn allows hand therapy to be started early, an essential treatment following hand injuries. A stiff hand after reconstruction will result despite excellent bony reconstruction if the fixation does not allow early motion. Autogenous cortical grafts donor sites (eg, ulna or tibia) can cause donor site morbidity, including fracture of weakened bone. The need for small tubular grafts is especially important in pediatric patients. Strong autogenous corticocancellous grafts are difficult to obtain in children, and these grafts are bulky and difficult to insert. In addition, for adults and children, the lack of a donor site means a much shorter hospital stay.

Adult↗
PubMed2006

Vibrio infection associated with finning injury of the hand.

BACKGROUND: Penetrating injury by fish fins is common and often overlooked. Vibrio spp. are known worldwide for their virulence, quickly causing soft-tissue infection and lethal septicaemia. Vibrio infection following finning injury is rare, but can result in devastating complications in susceptible individuals. AIM: To elucidate the clinical significance of such injury. METHOD: Between July 2003 and September 2005, nine cases of Vibrio infection caused by finning injury to the hand were retrospectively reviewed. Clinical data, including skin presentations, treatment course and outcomes, were collected and reviewed. RESULTS: In our group of nine patients, seven had concurrent hepatoma, diabetes mellitus, cirrhosis, chronic renal insufficiency or the effects of long-term steroid use; three had wound infections manifested by cellulitis or tenosynovitis and six had life-threatening necrotising soft-tissue infections. Vibrio spp. were identified from the wound (n=4), blood (n=1), and both (n=4). Symptoms appeared within a few hours to 3 days after injury, with 50% of patients developing symptoms within 24h; three patients were hypotensive upon admission; one patient received antibiotic therapy only and eight required emergency fasciotomy. All patients survived and none required amputation. The mean hospital stay was 23.2 days. CONCLUSIONS: Vibrio infections after finning injury can produce bacteraemic necrotising soft tissue-infections, especially in individuals with a systemic illness. Health education should include a recommendation to wear protective gloves while handling fish. Early antibiotic and surgical treatment can avoid potentially life-threatening complications.

Adult↗