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PubMed2005

[Study on the effect of pedicle skin flap of subdermal vascular plexus on repairing the hand injury].

OBJECTIVE: To summarize the operation opportunity and recovery effect of pedicle skin flap of subdermal vascular plexus on repairing the raw surface of hand injury. METHODS: From January 1999 to June 2004, the thoracic or abdominal pedicle skin flap of subdermal vascular plexus was used to repair the raw surface of hand with defect of skin and soft tissue in 22 patients with hand injury. 17 cases were males, 5 cases were females, the ages ranged from 9 to 42. The causes of hand injury including avulsed wound in 12 cases, mangled injury in 2 cases, hot crush injury in 5 cases, electric burn in 3 cases; 13 cases needed emergency operation, 9 cases needed operation in 3 to 7 days. The thoracic or lower abdominal flap was selected depending on the raw surface of hand injury. Subcutaneous fat was trimmed and retained the thickness of 2 to 4 mm. The skin flap was designed into 2 to 3 leaves to form several pedicle skin flap of subdermal vascular plexus, which were used to repair defect of skin and soft tissue of several fingers. The defect site of skin and soft tissue of hand were put into flap. RESULTS: A little of skin flap in distal end became necrosis in 1 case after operation, but recovered fully after changing dressing to the raw surface. The rest of the flaps all survived. Follow-up was conducted 3 months to 2 years. The pedicle skin flap was living,the skin of the recipient site was smooth and integrated, color and luster was satisfactory and texture was soft. The disrupted pedicle skin flap needed no trimming. The hand function was significantly recovered. CONCLUSION: To repair the defect of skin and soft tissue in the hand injury by using thoracic or lower abdominal pedicle skin flap of subdermal vascular plexus has the forte of shorter course of treatment and better functional recovery and good outlook. It is one of the ideals for repairing the hand injury with defect of skin and soft tissue.

Adolescent↗
PubMed2005

[Predictive value of the HISS-scoring system for estimation of trauma severity and the time off work after hand injuries].

BACKGROUND: The estimation of the time off work depending on the injury pattern and severity is of major interest in the treatment of hand injuries. The predictive value of the HISS score (Hand Injury Severity Scoring System) was evaluated. MATERIAL AND METHODS: According to this score, 184 work-related injuries (1999 to 2002) were analyzed prospectively, excluding injuries of both hands. The median age was 37.9 years (18 to 65 years), 11 % of the patients were female. RESULTS: A significant correlation was established between the HISS score and the time off work (p < 0.0001, r = 0.51). The score also correlated with the degree of work incapacity (p < 0.0001). CONCLUSION: Our data confirm the predictive value of the HISS score for the early estimation of the time off work resulting from hand injuries. However, the estimation is limited to injuries distal to the wrist.

Accidents, Occupational↗
PubMed1991

Does training reduce the incidence of industrial hand injuries?

The incidence of industrial hand injuries remains high despite the introduction of statutory measures and other advances in health and safety awareness. A prospective study was undertaken to determine if training before employment helps to reduce these injuries. A significant number of patients did not receive any training and this may have played a part in their injury but other contributory factors, such as human error, must also be taken into consideration. Some recommendations are made for future prevention.

Accidents, Occupational↗
PubMed2004

[Hand injuries in the Krakow Region].

The material of 1199 patients with hand injuries treated in the II Department of Surgery in Krakow within the years 1987-2000 was epidemiologically elaborated. The adult population in this region counts 850,228 thousand inhabitants, therefore the number of hand injuries demanding special procedures amounts 5.74 for 10 thousand inhabitants yearly. Hand injuries most frequently affected young manual workers before 40 years of age (p < 0.001). Almost one half of accidents occurred at home (45.29%), and only 19.68% were work-related (p < 0.001). Machinery accidents (34.87%) and cutting with glass (18.43%) were two the most common causes of these injuries (p < 0.001). After the operation, prevalent number of patients (72.56%) were treated as an outpatient. The mean period of whole treatment amounts 76.95 +/- 67.81 days. It has been depended on the severity of injury and complications as well (p < 0.001). 90.59% of patients returned to previous work, and 4.89% of patients had to change their work. Disability pension was given to 4.50% of all patients.

Accidents, Home↗
PubMed2006

Transient risk factors for acute traumatic hand injuries: a case-crossover study in Hong Kong.

OBJECTIVES: To identify the remediable transient risk factors of occupational hand injuries in Hong Kong in order to guide the development of prevention strategies. METHODS: The case-crossover study design was adopted. Study subjects were workers with acute hand injuries presenting to the government Occupational Medicine Unit for compensation claims within 90 days from the date of injury. Detailed information on exposures to specific transient factors during the 60 minutes prior to the occurrence of the injury, during the same time interval on the day prior to the injury, as well as the usual exposure during the past work-month was obtained through telephone interviews. Both matched-pair interval approach and usual frequency approach were adopted to assess the associations between transient exposures in the workplace and the short-term risk of sustaining a hand injury. RESULTS: A total of 196 injured workers were interviewed. The results of the matched-pair interval analysis matched well with the results obtained using the usual frequency analysis. Seven significant transient risk factors were identified: using malfunctioning equipment/materials, using a different work method, performing an unusual work task, working overtime, feeling ill, being distracted and rushing, with odds ratios ranging from 10.5 to 26.0 in the matched-pair interval analysis and relative risks ranging between 8.0 and 28.3 with the usual frequency analysis. Wearing gloves was found to have an insignificant protective effect on the occurrence of hand injury in both analyses. CONCLUSIONS: Using the case-crossover study design for acute occupational hand injuries, seven transient risk factors that were mostly modifiable were identified. It is suggested that workers and their employers should increase their awareness of these risk factors, and efforts should be made to avoid exposures to these factors by means of engineering and administrative controls supplemented by safety education and training.

Accidents, Occupational↗
PubMed2002

[Industrial hand injuries by punch machines: a case-control study].

OBJECTIVE: To identify factors associated with industrial hand injuries by punch machines. METHODS: From September, 1999 to June, 2000, 108 patients of industrial hand injuries by punch machines were collected. For each patient, 2 controls were randomly selected. One was from the same industry; the other was from a big industry with thousands of punch machines. They matched on gender, job and age. In-person interviews were conducted to collect data on demographics, work history, work characteristics, work injuries, work organization, health behaviors, anthropometric and psychological factors. The Eysenck Personality Questionnaire (EPQ) was selected to evaluate the psychological performance. Risk factors were examined via multivariate logistic regression techniques. RESULTS: There were four important factors affecting hand injuries by punch machines: The first was the length of service index (odds ratio [OR] = 0.972, 95% confidence interval [CI] = 0.957, 0.988). The second index was neuroticism (OR = 1.649, 95% CI = 1.264, 2.151). A safety equipment index (OR = 0.260, 95% CI = 0.123, 0.547) and a safety operation criterion index (OR = 0.136, 95% CI = 0.064, 0.286) were also significant factors. CONCLUSIONS: Results suggest that the accident-prone population are those who have shorter service length and neurotic psychological performance. It may reduce the incidence of industrial hand injuries by punch machine to strengthen the appliance of safety equipment and enforcement of safety operation criterion, especially to the accident-prone population.

Accidents, Occupational↗
PubMedDate not supplied

Long-term disability following high-voltage electric hand injuries.

Fifty-eight patients who sustained high-voltage electric hand injuries over a ten-year period were reviewed to determine the incidence of long-term disability. Patients were divided into two groups, depending on whether or not they had sustained a current or noncurrent injury. Follow-up ranged between three months and nine years, with an average of 29.5 months. In Group A' (current group), 34 patients had 52 hand injuries. In this group, 21 patients required operative intervention to relieve vascular or neurologic compression. Thirty percent of explored limbs were subsequently amputated. Of the remaining extremities, 42% had normal function while 58% had diminished or greatly diminished function. There were 24 patients in Group B (noncurrent group) with 35 hand injuries. Function was diminished in 23%, greatly diminished in 14%, and absent in 3% of cases. The amputation rate and the residual functional deficit in Group A concurs with those of previously reported series. Although there is a significant inevitable morbidity after noncurrent injuries, many patients may benefit from nerve/muscle conduction studies and physical therapy.

Adult↗
PubMed1978

Dupuytren's disease--the influence of occupation and previous hand injuries.

The influence of handedness, work and previous hand trauma is studied in 901 persons with Dupuytren's disease, collected in an epidemiological study of 15,950 citizens in a small, Norwegian town. Dupuytren's disease occurred in all occupational groups, but the prevalence was higher and the contracture more severe in people doing hard manual work than in people doing light or non manual work. Persons with Dupuytren's disease has sustained previous hand trauma more frequently than the general population, and the interval between trauma and first sign of disease was usually a few years. Previous hand injuries were definitely more common among people doing hard manual work, but even when these were excluded from the work material, Dupuytren's disease was still more common among people doing hard manual work, than in people doing light or non manual work. The study has indicated that Dupuytren's disease in certain cases is precipitated and/or aggravated by both work and definite hand injury.

Aged↗
PubMed1977

Bacterial colonization of mutilating hand injuries and its treatment.

A total of 120 hand injuries were reviewed. Sixty-seven occurred between 1965 and 1972 and were analyzed retrospectively, and 53 occurred between 1972 and 1974 and were analyzed prospectively. The bacterial colonization was determined in 86 injuries. Injuries sustained while handling farm implements tended to be colonized by mixed gram-negative and gram-positive isolates. The gram-negative isolates usually were resistant to all antibiotics, with the exception of gentamicin. However, nine bacterial isolates were resistant to all agents tested. Injuries sustained in the home or industry were colonized by gram-positive organisms. Most were susceptible to semisynthetic penicillinase-resistant penicillins such as methicillin and its congeners. The use of parenteral prophylactic antimicrobial agents in the treatment of mutilating hand injuries was not significant in preventing infection, and their use does not seem to be indicated in farm implement-related injuries. Antimicrobials are of value in home- and industrial-related injuries only when the status of the wound so indicates.

Anti-Bacterial Agents↗
PubMed1988

[Primary management and secondary reconstructive surgery of severe combined hand injuries].

Primary treatment and secondary reconstructive surgery of severe mutilating hand injuries are associated with challenging problems. Conventional and microneurovascular reconstructive methods must be integrated into the therapeutical rationale. The technical and tactical principles essential to obtain an optimal rehabilitational result are discussed. Simple sensitive grip tools will provide better functional long time results than modern prosthetic devices.

Adolescent↗
PubMed1992

Hand injuries in volleyball.

We studied the long-term sequelae of hand injuries as a result of playing volleyball. In a retrospective study, 226 patients with injuries of the hand who were seen over a 5-year period at our Trauma Department, were investigated. Females accounted for 66% of all injuries. The mean age was 26 years, with a peak in the age group of 15 to 29 years. Sprains and strains were observed most frequently (39%), followed by fractures (25%) and contusions (16%). The fingers were involved in 44% of the cases. Most injuries of the hand occurred in recreational players. Recreational players had more left-sided injuries, whereas competition players had more right-sided injuries (P less than 0.005), suggesting that lack of skill is an important determinant. Left-handedness was associated with an increased risk of hand injury in recreational players. One third of the volleyball players did not go to work or school for a median of 4 weeks as a result of the injury. In a survey after a mean period of 5 years, a high percentage of patients had complaints: 28% cited stiff and crooked fingers with limitations and tenderness in the movements as main inconveniences. We consider this incidence disturbingly high, regarding the seemingly innocent nature of these injuries.

Adolescent↗
PubMed1983

[Hand injuries and occupational accidents. Statistics and prevention].

Hand injuries count for a 1/3 of all injuries at work, 1/3 of chronic injuries, 1/4 of lost working time, 1/5 of permanent disability. This varies from activity to activity and with the material element involved. An average of 22 working days are lost, but this varies according to lesion. The average permanent rate is 5.8% against 10% for accidents in generally. High rates are not very frequent (2% above 10%). The average cost is between 12,000 F and 15,000 F (at 1980 rates) of which more than 2/3 can be attributed to daily compensations. In 1980, the number of finger amputations can be estimated at 11,000 (3300 fo which were accidents at work) whose overall cost was 140,000,000 F, the daily compensations being 2/3 of this figure. The cost of insuring this risk is subscribed by employers, and the contributions are based on the nature of the risk. To prevent accidents and the after effects certain points must obviously be stressed. The return of patients into working life is vital, even before complete recovery from their injuries.

Absenteeism↗
PubMedDate not supplied

Hand injuries in boxing.

Investigations of 100 consecutive hand injuries in boxing have shown that 39% occurred in the area of the thumb, including the radial carpals, metacarpals and phalanges and their joints. These injuries were mostly caused by forced abduction of the thumb. Thirty-five percent of the injuries occurred at the base of Metacarpals 2 to 5, including the wrist joint, and arose from forced flexion of the wrist. Twenty-six percent occurred in the phalanges and the rest of the metacarpals, excluding the bases.

Athletic Injuries↗
PubMed2004

Problems experienced during the first year of an acute traumatic hand injury - a prospective study.

BACKGROUND: Evidence-based nursing of patients with acute traumatic hand injuries treated at the hand-surgical clinic calls for knowledge about long-term implications. AIMS AND OBJECTIVES: The aim of the study was to investigate consequences of an acute traumatic hand injury during the first year after the accident. Specifically, the objectives were to investigate changes in the experience of physical and psychological problems over time, frequencies of remaining problems and the impact of the injury on work situation and life situation 1 year after the accident. DESIGN: The study was prospective and followed the patients from the first weeks to 1 year after the accident. METHOD: Ninety-one patients were assessed three times during the year. Each time the patients answered study-specific questions, the Impact of Event Scale and the Hospital Anxiety and Depression Scale. RESULTS: Problems experienced decreased during the first 3 months but tended to remain unchanged during the rest of the year. In the 1-year follow-up, the majority of the patients experienced slight or moderate functional limitations in the hand, one-third had symptoms of trauma-related distress and one out of seven had troublesome pain. Half of the patients who had returned to work reported a worse work situation and 16% were still on the sick list. One-third of all patients considered their whole life situation to be worse as a result of the injury. Patients with amputations more often experienced a worse life situation. Blue-collar workers reported functional limitations and a worse life situation more often than white-collar workers. CONCLUSIONS: Patients with acute traumatic hand injuries requiring surgical treatment may experience problems, such as functional limitations, trauma-related distress and troublesome pain, with long-term implications for their work situation and life situation. RELEVANCE TO CLINICAL PRACTICE: Caring for hand-injured patients should include, not only surgical treatment and other actions for restoring the function of the hand, but also preventive action and follow-up of trauma-related distress and pain.

Absenteeism↗
PubMed2002

Descriptive epidemiology of a cluster of hand injuries from snowblowers.

The objective of the study is to describe the nature and type of snowblower-related hand injuries, including long term follow up. A retrospective study was performed of a cluster of patients injured by snowblower use, presenting to an urban Emergency Department (ED) following a major snowstorm. For each patient, demographic data and subsequent records from outpatient management were reviewed. Interviews were conducted 3 years later to assess long-term outcomes. Eleven patients, all male, presented to the ED with snowblower injuries, all to the hand. Injuries included soft tissue lacerations and partial to complete amputations. Ten patients were treated and released and one was admitted. In a 3 year follow-up, few patients reported major sequela. Almost half reported persistent pain, or minor disability. In conclusion, in our series, snowblower injuries resulted exclusively in trauma to the hand. Most injuries can be managed on an outpatient basis. Many patients experience persistent symptoms. All patients had entirely preventable injuries.

Adult↗
PubMed1997

Predisposing factors to industrial hand injuries in Saudi Arabia.

A prospective study was performed on 108 consecutive cases of industrial hand injuries in Saudi Arabia to highlight predisposing factors to injury. Traumatic amputations and fractures of the radial three digits were the commonest injuries. Eighty patients (74%) worked for more than 8 hours per day, which is against Saudi labour law. Only 5% of the injured workers had similar jobs previously or formal training prior to employment. The majority (81%) admitted that safety measures were not being followed at the time of injury. Ten workers (9%) had a previous history of industrial hand injury. It was concluded that strict implementation of safety measures and Saudi labour law, proper training of employees, and the development of agencies for the prevention of occupational accidents would be important in the prevention of industrial hand injuries in Saudi Arabia.

Accidents, Occupational↗
PubMed2005

Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: a questionnaire survey.

BACKGROUND: Emotional distress is frequent in patients with acute traumatic hand injury during the first weeks after the accident. Knowledge of coping in relation to emotional distress could help to identify those who need support. OBJECTIVES: To describe the different kinds of coping used by patients in the early stage of recovery following an acute traumatic hand injury and to investigate differences in coping patterns in patients with and without symptoms of emotional distress. DESIGN: Questionnaire survey with a descriptive and comparative design. SETTING/PARTICIPANTS: A total of 112 patients with acute traumatic hand injury requiring inpatient treatment at the hand surgical clinic. Those with injuries caused by a suicide attempt or with known drug abuse were excluded. Method/main outcome measures: The patients answered a postal questionnaire at home 1-2 weeks after the accident. Emotional distress was assessed with the Hospital Anxiety and Depression scale. Coping was measured with the Jalowiec Coping Scale-40. RESULTS: Coping by "trying to keep the situation under control" and "trying to look at the problems objectively and see all sides" were most frequent. These strategies are typical for the confrontive coping style, which dominated in the actual illness-situation. Symptoms of emotional distress occurred in 32% of the patients. These patients used significantly more kinds of coping strategies and used confrontive and emotive coping strategies more often than the others. Coping by "hoping for improvement", "working tension off with physical activity", "trying to put the problem out of one's mind", "worrying", "getting nervous or angry" and "taking off by one self" were associated with emotional distress. Coping by "accepting the situation as it is" and "thinking that it is nothing to worry about" were more frequent in patients without emotional distress. CONCLUSIONS: Observations of the coping strategies associated with emotional distress in this study could help to identify patients in clinical practice that need nursing support. Coping associated with less emotional distress should be encouraged.

Activities of Daily Living↗
PubMedDate not supplied

[Functional and socioeconomic outcome of inpatient rehabilitation of patients with complex hand injuries].

PURPOSE: Evaluation of functional outcome and socio-economic results of patients with complex hand injuries after inpatient rehabilitation. PATIENTS AND METHODS: In a prospective investigation 36 patients with complex hand injuries received an intensive therapy regime under inpatient conditions. In all patients functional parameters of the hand (total active range of motion, palm to palm distance, spread between thumb and index finger, spread between thumb and little finger) and the score of Buck-Gramcko were registered initially and at the end of inpatient rehabilitation. Socio-economic data (kind of discharge, job reintegration, further treatment) were documented as well. RESULTS: The total active range of motion could be improved from 36% to 69%, spread D1-D5 from 18.5 to 20.7 cm and spread D1-D2 from 13.9 to 15.6 cm. The palp to palm distance of all fingers was reduced from 4.6 cm to 2.3 cm. The Buck-Gramcko score of all injured fingers improved from 4.2 points (poor) at admission, to 11.8 points (good) at discharge, At the end of inpatient rehabilitation 18 patients could return to their job either gradually or on full-time. CONCLUSION: Even patients with complex hand injuries, good functional results could be achieved by an intensive inpatient rehabilitation characterised by close medical supervision and guidance and tight clinical controls.

Adult↗