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This study of industrial hand injuries describes the nature of commonly encountered injuries, the significance of hand dominance, and the circumstances contributing to the cause of injury. Although many histories were unique, and the contributory factors correspondingly diverse, some recommendations can be made for future prevention and investigation.
Severe psychological symptoms after severe work-related hand injury, manifested as posttraumatic stress disorder, are not significantly potentiated or sustained by concomitant litigation if the patient has had early psychologic intervention. This study does not support assumptions about "accident neurosis" that delays recovery from the psychological sequelae of severe work-related hand injury.
Severe, work-related hand injuries are often accompanied by a significant number of psychological symptoms that are frequently associated with posttraumatic stress disorders. These symptoms occur in the following four domains of psychological functioning: cognitive, affective, physiological, and behavioral. This study examined the incidence of a variety of symptoms occurring with work-injured patients. Interviews were conducted at 1 week, 3 months, 6 months, 12 months, and 18 months after injury. Symptom frequencies were recorded. The results indicate that many of these symptoms were persistent 18 months later and continued to be significantly debilitating. The results support the need for psychological intervention after severe, work-related hand injuries.
Defined by severe injuries of several digital structures and by lesions of several axes, complex hand injuries raise numerous problems of management. The activity of the unit "S.O.S. Hand-Reimplantation" of the Boucicaut Hospital petmitted us to determine the various clinical and socio-professional aspects. In the first part of this article, a statistical study permitted us to define the classes, types and prognosis. In the second part, the repair of each digital structure is considered (skin, bone, joint, extensors, flexors, nerves, vessels) in the light of a complex hand injury. The role of the covering skin in the quality of the results seems very important. The long-term results, their socio-professional consequences, thus permit one to draw up a therapeutic management which aims to repair the maximum number of lesions during the first stage of the operation. The interest of microsurgical repairs of the vessels and nerves requires operation of these complex hand injuries as an emergency, which requires appropriate surgical facilities.
More than one fifth of patients in a group involved in cycle crashes sustained hand injuries. The average time off work as a result of the hand injury in our study was 17.6 days. The number and severity of hand injuries would be reduced by the wearing of proper gloves and this is recommended. The gloves currently sold as "cycling" gloves are not adequate.
OBJECTIVES: Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. DATA SOURCES: The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. STUDY SELECTION: Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. DATA EXTRACTION: Data were extracted directly from the sourced articles. DATA SYNTHESIS: The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. CONCLUSION: Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.
Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.
The management of hand injuries forms an important part of the hospital accident and emergency service, and early recognition and informed management are essential for a favourable outcome (Frazier et al., 1978). In Edinburgh a routine system of hand management is well established and includes the training of casualty officers. In order to evaluate the effectiveness of the hand service in the Accident and Emergency Department, Royal Infirmary of Edinburgh, a prospective study was undertaken to compare the outcome of treatment of hand injury by a routine system with treatment over a similar period by more experienced registrars in hand surgery training posts (Hand Fellows).
The aim of this study was to investigate the incidence of hand injuries due to farming accidents in a defined population with a representative mixture of agricultural activities. During a 12-month period all agricultural accidents treated at the five hospitals in the County of Ringkøbing, Denmark were prospectively registered. Follow-up was done by telephone interview 4 months after the accident. Of the 260 persons injured in agricultural accidents, 117 (45%) had lesions of the upper extremity and 73 persons (28%) had hand injuries. The most common injuries were lacerations and amputations (45%) followed by fractures (36%). Mean sick leave was 25 days, and mean work impairment was 31 days in patients with hand injuries.
The National Electronic Injury Surveillance System reports that the fingers and hand are the most frequent body parts injured at work and treated in hospital emergency departments. In this study, we describe the type, location, and severity of occupational hand injuries among 1166 patients recruited from 23 occupational health clinics in five New England states. Subjects ranged in age from 18 to 77 years, with a mean of 37.2 years (SD, 11.4), and approximately 75% were men. In decreasing order of frequency, subjects were employed in machine trades, service work, structural work, and less frequently, in benchwork, professional, technical managerial and clerical, and sales work. The majority of subjects (83.4%) had a single type of injury: 62.6% were lacerations, 13.1% were crush injuries, 8.0% were avulsions, and 6.1% were punctures. Metal items, such as nails, metal stock, and burrs accounted for 38.4% of the injuries, followed by hand tools with blades and powered machinery (24.4% and 12.3%, respectively). Hand tools with blades were least likely to result in multiple types of injuries, whereas powered machines or nonpowered hand tools were more likely to result in multiple types of injuries than other injury sources. The generalizability of these results should be limited to clinic-based patients employed in similar occupations. The results of this study may suggest possible prevention strategies for acute traumatic hand injuries.
This study was designed to evaluate correlations between the hand injury severity scoring system (HISS) and measures of impairment and disability obtained 6 months after a hand injury. A statistically significant positive correlation was found between the severity of the injury (HISS) and residual impairment, as measured with the American Medical Association's (AMA) "Guides to the evaluation of permanent impairment, 4th edition". No statistically significant correlation was found between the severity of the injury (HISS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which measures disability from the patient's perspective. There was however a statistically significant correlation between AMA total body impairment measured and the results of the DASH questionnaire. The results indicate the potential of the HISS for predicting the final impairment after hand injuries.
Progress achieved in surgical approach to hand injuries have called for reconsideration of earlier recommendations for expert assessment. While in the past, emphasis used to be laid on judgement of loss caused by amputation, today primary attention must be given to assessment of the individual finger which had been surgically reconstructed but has been left with impaired function. An account is given of the functional relevance that should be attributed to each of the functional elements of a hand, and reference is made to consequences from loss of functions. Some recommendations are suggested for expert assessment.
Antimicrobial drugs are commonly used in the treatment of mutilating hand injuries. Valid arguments for the use of systemic antibiotics can be made despite the lack of data clearly documenting their efficacy in this clinical scenario. There is no information to support the use of topical agents in open hand injuries. When choosing an appropriate systemic antibiotic, the physician should consider unique characteristics of these injuries, the various environments in which they occur, and the potential infecting organisms. The duration of antibiotic use is arbitrary but should be minimized to avoid complications and the development of bacterial resistance.
BACKGROUND: The treatment of large and complex hand injuries is particularly challenching concerning the functional and cosmetic outcome. In this kind of injuries the primary defect cover is of paramount importance and so the initial situation for secondary reconstructive options may be evidently improved. MATERIAL & METHODS: Between October 1986 and Mai 1996 43 patients with large complex and combined hand injuries were primarily treated with 49 free flaps. The mean follow-up was 39 (6 to 92) months, the mean hospital stay was 19 (8 to 40) days. Depending on the time of the reconstruction and based on a classification established in our clinic, the patients were distributed among three groups: primarily (within 24 hours), delayed (between 2 and 7 days), and late (after 7 days till 3 weeks posttraumatically) reconstruction. RESULTS: Within the group of primary reconstruction the best results could be achieved, since radical debridement and primary defect cover by healthy tissue (free flap) led to physiological wound healing. That caused reduced hospital stay thus decreased costs, since flap failure, infection and multiple secondary surgical interventions could be diminished. Also earlier rehabilitation and reintegration into social life and profession was achievable. CONCLUSION: Due to the obtained results a primary treatment of large and complex hand injuries through radical debridement and reconstruction with free flaps seems to be effective and should already be considered in the emergency room.
Four hundred eleven individuals who had suffered temporary unilateral hand injuries were assessed on five hand preference behaviors after their recovery. Measures of shifts to contralateral hand use experienced during and after the recovery period were taken. The best predictor of hand use shifts during the injury recovery period was whether the injury was to the preferred or nonpreferred hand. The incidence of postinjury contralateral shifts was low but was greater than that observed over a simulated injury period in a control group of 384 individuals who had not experienced a hand injury.
Hand injuries exceed 20% of all occupational injuries. This article reviews the history of 237 hand injuries mostly occurred in craftsmen and farmers. The results allow us to make some considerations on the role of occupational physician in their prevention.
We report five cases of hand injuries caused by spiked palisade railings. One patient sustained an open fracture of the distal phalanx with a disruption of the nail bed, and two patients had digital nerve injuries. Two patients presented with the railing still impaled in the fingers, one of whom had an ischaemic digit at presentation. All patients were male, between 9 and 12 years of age, and presented in the course of 1 month. Railings of this type would appear to be a significant cause of hand injuries, which may be prevented by legislation or a change in railing design.
The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.