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PubMedDate not supplied

Characteristics in addition to size of the contralateral hand predict hand volume but are not clinically useful.

Traditionally, therapists who treat hand edema have used the volume of the contralateral hand to estimate normal or pre-injury hand volume. This presupposes that for the average person the difference in volumes between the two hands is so small that it is clinically insignificant. Left and right hand volumes, as well as a number of other hand characteristics, and health history were collected for a sample of 512 persons. Over 15% of the subjects had a measured volume difference of 30 ml or more. The difference in absolute and relative volumes between hands was minimally affected by gender, age, lifestyle, hand dominance, size of the largest hand, health problems, or previous hand injuries. Regression analysis uncovered a number of characteristics, including gender, handedness, and age, that predicted hand volume over and above the contralateral hand, but they boosted the proportion of variance explained only from 0.968 to 0.973, a clinically insignificant increase. It was concluded that the traditional methods of estimating pre-injury volume are still useful.

Adolescent↗
PubMed2000

Incidence of neurapraxia in digital nerve injuries.

Hand surgeons presented with a hand or finger laceration and an abnormal static two-point discrimination (> or =10 mm) must determine which patients require surgical exploration. There appears to be a paucity of data in the literature defining the incidence and nature of neurapraxia in this setting. A study was conducted in a busy urban practice to better understand this problem. To determine the incidence of intact nerves (i.e., neurapraxia) in digital nerve injury patients, the authors reviewed experience with 152 patients who presented with isolated digital nerve injuries over a 33-month period. Preoperative return of sensation and negative exploration cases were combined and referred to as the trauma-induced neurapraxia (TIN) group. There were 18 non-repair cases among the 152 isolated digital nerve injuries, giving a 12 percent incidence of TIN. Sensory recovery among the TIN patients ranged from 12 days to 6 months. In this study, the authors defined a group of patients who did not require surgical repair for isolated digital nerve injury as TIN cases. The TIN group represented 12 percent of the digital nerve trauma patients and required long follow-up for sensory recovery. This information is an important part of patient education and informed consent.

Fingers↗
PubMed1990

Neurovascular injuries in the hands of athletes.

Neurovascular injuries are rare in the athlete. Prevention is the ultimate goal. Modification of protective devices, alteration of technique, and education may help avoid some of the neurovascular problems described in this article. Early recognition and appropriate conservative treatment may alleviate the need for surgical intervention.

Athletic Injuries↗
PubMedDate not supplied

Hot-press hand burn treatment.

Hand injuries are common in the workplace. Modern industrial machines cause complex occupational hand injuries. Hot-press contact hand burns generally are encountered by workers in the dry-cleaning industry. Seventeen patients with hot-press hand burns were treated at the University of California-Irvine Medical Center Burn Center. Eight patients (47%) required skin grafting, seven (41%) were treated with hydrotherapy only, and two (12%) needed flaps. These results were not what we expected.

Adolescent↗
PubMed1993

Extensor tendon injuries of the hand.

Extensor tendon injuries are often initially evaluated and diagnosed in the Emergency Department. These injuries may be painfully obvious or frightfully subtle, but if the emergency physician has a firm understanding of the anatomy involved and he or she embarks on a careful and complete history and physical examination, the diagnosis should be made. There are various considerations in the ultimate treatment and outcome for the patient, and the patient's best interests are served when the emergency physician provides the initial appropriate treatment and proper disposition.

Emergencies↗
PubMed1992

The hand: field evaluation and treatment.

A careful field evaluation is mandatory to ensure prompt recognition of a potentially debilitating hand injury. The major responsibility of the examination is to rule out any possible serious injury prior to returning the athlete to competition. This article deals with both on-the-field evaluation and recognition and sideline management of injuries to the hand.

Athletic Injuries↗
PubMed2003

[Hand surgery training].

Training of the hand surgeon HAND SURGEON A CONCEPT: The hand surgeon is supposed to be in charge of all the hand lesions regarding, skeleton, muscles, tendons, nerves and vessels. He has to be able to insure reparation and coverage of all of them. So he is involved in all the structures, which insure integrity and function of the hand. PURPOSE AND WAYS OF TRAINING: To obtain the asked ability, the hand surgeon training has to be global and sustained by two underlying surgical specialities: orthopedic surgery and plastic and reconstructive surgery. From 2000 after many years of dealings, a Right to the Title in Hand Surgery was born. This Right to the Title wants to be the formal recognition of the specific training of the hand surgeon. For the well-recognized ancient hand surgeons they need to be confirmed by one's peers. Now a day the hand surgeon has to satisfy to this specific training: Passed the complete training and exam of the Orthopedic or Plastic surgery board. Spent at least 6 months as resident in the other underlying specialty. Passed a microsurgery examination. Passed one of the four national Hand Surgery diplomas (DIU/Inter-Universitary Diploma). The examinations have been harmonized. A common formation is delivered regarding hand surgery, the way of examination is the same and the formation is 2 years long. The final exam is presented in front of board of examiners where a teacher of one of the other three national diplomas is present. Spent at least 2 years in a formative hand surgery unit, listed by the French College of Hand Surgeons, as senior surgeon. Those requirements are heavy to assume and need a heavy personal involvement. That seems to be necessary to have an ability level as high as possible. Emergency surgery practice is absolutely necessary in this training. All the 17 university formative hand surgery units listed by the French College of Hand Surgeons are members of the FESUM (European Federation of the Emergency Hand Units). Unfortunately it is non-sufficient to train the necessary number of hand surgeons needed in France today. So we try to obtain from the authority the formal recognition of a training period in private practice. Eleven out of the 28 hand units listed as formative by the French College of Hand Surgeons are in private practice and may be recognized as formative in the hand surgeon training. That needs to create an official agreement between university and private Units. This part of the training is yet accepted by the Right to the Title commission for a 6-month training period. But this needs a legal modification or adaptation of the private units legal status so they will be able to offer a quite equivalent conditions of training. Now a days 233 surgeons in France passed the Right to the Title. Among them, the oldest do not have emergency practice any more. So unfortunately, out of 1,400,000 hand injuries a year in France, only few are actually cared by hand surgeons. The emergency training needs at least a three to four senior surgeons team, operating and caring emergencies, 24 h a day, 365 days a year. They need to be surrounded by high-level technical facilities for this type of surgery. Only this type of unit may have a frequent severe hand traumatology practice, especially regarding microsurgery. But on the other hand a less complex hand unit operating only planed surgery and less complicated emergencies, may also be definitively formative. This only depends on the hand surgeon's qualification. It is only with a very demanding and high-level training program that our credibility as hand surgeon may be definitively established. The mainstay of this training is the combined action of the FESUM, the French College of Hand Surgeons and the DIU diploma. The Right to the Title formally confirms that training. For university or private unit, to be a member of the FESUM, must continue to guarantee a high level training regarding emergencies as in number as in complexity. We proposed as minimum level of practice (a year) to be a formative hand surgery unit: 10-15 hand and upper limb replantations; 25-30 very severe hand injuries (revascularization etc.); at least 1000-1500 hand surgery procedures.

Emergency Treatment↗
PubMed1989

Anatomy of the hand.

The anatomy of the hand is efficiently organized to carry out a variety of complex tasks. These tasks require a combination of intricate movements and finely controlled force production. The shape of the bony anatomy in conjunction with the arrangement of soft tissues contributes to the complex kinesiology of the hand. Injury to any of these structures can alter the overall function of the hand and therefore complicate the therapeutic management. The purpose of this article is to review the anatomy of the hand with special emphasis on structures that relate to management of hand injuries.

Hand↗
PubMed1997

Detection of submaximal effort with computer-assisted grip strength measurements.

The purpose of this study was to establish a simple observation to help in distinguishing patients who are giving their maximal effort during computer-assisted grip strength measurements from those who are not. Preliminary observations had suggested that maximal effort with this grip-strength device was characterized by greater force in the radial digits than the ulnar digits and a small variability in force between individual grasps. These observations were then prospectively analyzed in the following groups: (a) 178 assembly workers tested during a routine screening at a computer manufacturing company and during pre-placement physicals; (b) 196 workers with a hand injury or cumulative trauma disorder who were seeking consultation for medical treatment; (c) 55 workers with a hand injury or cumulative trauma disorder being measured to determine their return to work status or impairment rating; and (d) 58 asymptomatic volunteers. The volunteers were instructed to perform the maximal grip in the same fashion as the other groups and then to repeat the test exerting a submaximal effort they estimated to be 50% of their own maximal effort. The results of this study demonstrated that there is a highly significant association, P < 0.001, between the presence of a "total pattern" (radial over ulnar force being less than 1.0, unilateral grip variation greater than 15%, and difference between the left and right grip variation greater than 5%) and the presence of submaximal effort during grip-strength measurements.

Adult↗
PubMed2001

Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand.

Closed tendon injuries of the hand are frequently seen in the emergency department. Unlike open tendon injuries, however, these injuries are often missed on initial presentation. Early recognition and treatment can decrease the pain, dysfunction, and long-term sequelae associated with these injuries. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner. Injuries discussed include rupture of the flexor digitorum profundus, mallet finger, central slip rupture, extensor hood rupture, and ulnar collateral ligament injury.

Emergency Service, Hospital↗
PubMed1978

[Amputation involving the hand: indication and technique (author's transl)].

More than 3% of all work-related hand injuries result in partial or total amputation of fingers or hands (of 14621 patients with hand injuries, 479 patients had 878 amputations). When there is no possibility or indication for microsurgical replantation, the aim of the surgical effort is to rebuild a sensitive, vigorous grasp. The different procedures for plastic surgery of the hand are discussed.

Accidents, Occupational↗
PubMed2003

Fracture fixation in the mutilated hand.

Early anatomic (or near anatomic; lingers do not impinge or overlap during flexion or extension) stable fracture fixation provides the foundation for successful wound management and for the repair, reconstruction, and healing of all damaged tissues in a mutilating hand injury. It also plays an instrumental role in pain control and affords an optimal opportunity for timely and favorable rehabilitation of and recovery from mutilating injuries of the hand. Kirschner or other wiring systems or mini external fixators may be used for simple fractures, in children, when rapid fracture fixation is necessary, and for provisional fracture fixation. Mini plates should be considered for fractures with comminution or loss and in instances of multiple fractures. Fingers with segmental injury of three or more tissues should be considered for early amputation to avoid prolonged and impaired recovery of the hand. Every effort should be made to preserve the thumb and its function by repair or reconstruction.

Adult↗
PubMedDate not supplied

Crush injuries to the hand and forearm.

Crush injuries to the hand and forearm from mechanical devices and heavy equipment are a frequently seen injury in heavily industrialized areas. These injuries are particularly difficult due to their unpredictability, individualized nature and often devastating results. To optimize the outcome for these patients, it is essential to educate the nursing staff on emergent as well as ongoing care, form a systemized plan of care, and recruit patient and family support. A multiskilled group effort will be required to allow the patient with crushed tissue to realize optimal potential and return to a functional position in society.

Adult↗