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Retained foreign bodies and puncture wounds are common injuries to the hand. A detailed history and physical examination prior to treatment are essential. If surgical removal of a foreign body or surgical exploration of a puncture wound is decided upon, it must be performed under adequate anesthesia and tourniquet control.
The case of a 25 years old industrial worker is reported, who suffered an extensive avulsion of his left hand in a rubber roller injury. The middle and ring fingers hand to be amputated. The skin loss was covered simultaneously by an axillary pedicled flap for the thumb, two pedicle flaps from the upper arm for the index and small fingers and split thickness skin grafts for the dorsum of the hand. In a second stage, sensation of the tips of thumb and index finger was restored by two innervated full thickness skin grafts from the dorsum of the foot.
Management and treatment of complex mutilated upper extremity injuries often can be challenging and at times seemingly formidable. A reconstructive surgeon's ability to mobilize, transpose, and transfer tissues has allowed not only closure of complex wounds but also restoration of function and form. Use of "spare parts" from an otherwise unsalvageable limb represents the ultimate form of reconstruction that probes the creative mind and challenges the reconstructive knowledge of the surgeon. In this article, the authors review and discuss the use of various "spare parts" in the treatment of mutilating hand injuries.
A retrospective study prompted by the high incidence of traumatic hand injuries was undertaken to ascertain the nature of hand conditions treated at the Plastic and Reconstructive Surgery Unit of the Johannesburg Hospital in 1992, 1993, and 1994. This three-year period marked a historically significant stage of political change that was accompanied by a high degree of violence and that occurred within a wider context of high unemployment, social upheaval, and stress associated with uncertainty about the future. Conditions treated with splinting, therapeutic activity, and home programs included complex traumas of the upper limb, tendon and nerve injuries, fractures, and burns. Assaults accounted for the largest number of injuries, and lesions to tendons predominated.
This article familiarizes physicians with common farm equipment that can cause devastating hand injuries. The focus is on farm-related injuries to the hand and stresses the degree of soft tissue injuries, discusses avulsion injuries, and acute management principles. Types of injuries, their pathophysiology, case reports, and treatments also are reviewed. This article also stresses how these injuries differ from the urban trauma patient.
This article stresses that all contact injuries to the hand require careful documentation and close follow-up. The late manifestations of such an injury can be very significant if it leads to impairment of the power of the worker's grasp.
We present our experience of two cases in which we carried out pollicisation of the index metacarpal based on the first dorsal metacarpal artery and venae comitans. Both cases were complex severe hand injuries where the initial injury was the result of a firework exploding while held in the hand. In both cases the radial side of the superficial palmar arch was destroyed by the injury. In both cases there was virtually complete loss of the thumb ray and amputation of the index through the base of the proximal phalanx. A useful opposition post has been created from vascularised index metacarpal with free flap soft tissue reconstruction.
A preoperative prognostic grouping has been worked out for flexor tendon injuries in the no man's land, based on the works of Boyes and Buck-Gramcko. Prognosis of the secondary reconstructive procedures is influenced mostly by the age of the patient, the time elapse from the injury and the type, severity and combination of the hand injury (the so called preoperative state) as it was found in own experiences as well as in the literature. Bearing these aspects in mind, a classification has been worked out, with excellent, good, fair and bad preoperative prognostic values in the flexor tendon injuries, This classification makes the correlation and evaluation of the results more precise in those departments, where the care of the patients requiring hand surgery is performed according to the modern standards. With this grading of prognosis, a more adequate operation can be selected, according to the severity of tendon injury, with better results.
Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.
High-pressure injection injury hides the true extent of the lesions behind an apparent small and harmless puncture of the finger or the hand. Through clinical description, we wish to point out the need for prompt treatment to avoid mutilating and function-threatening complications. We wish to outline the role of the emergency physician who must be aware of the incidence of high-pressure injection injury and become accustomed to early referral to a surgeon, experienced in extensive surgical exploration, removal of foreign bodies, and rehabilitation. The open-wound technique gives the best results. We also point out that failure to refer may become an increasing focus of negligence claims.
30 cases of iatrogenic injection injuries to the hand and upper limb are reported. 16 followed therapeutic injections (steroids--11 cases, infusions--five cases) and 14 occurred during anaesthetics procedures (local blocks--ten cases, general anaesthetics--four cases). Guidelines for minimizing the risk of injection injury are outlined.
As human encounters with hazardous marine life increase, emergency physicians are more frequently confronted with the management of resultant injuries. We present three cases involving hand injuries inflected by moray eels. Each was managed with local wound care and subsequent outpatient treatment with either oral ciprofloxacin or cefuroxime. One patient had mild residual hand dysfunction, and no patient developed wound infection. To better assess the bacteriology of such injuries, oral cultures were taken from captive moray eels and surrounding aquarium water. Culture and sensitivity analyses showed Vibrio and Pseudomonas to be the predominant species, both sensitive to ciprofloxacin, cefuroxime, tetracycline, and trimethoprim-sulfamethoxazole. We conclude that moray eel bites can be managed successfully with aggressive, local wound care and antibiotic coverage that targets Vibrio and Pseudomonas species.
This article addresses the prevalence of various hand and wrist injuries in a variety of sports. Multiple resources and references have been utilized to draw a perception of the types of injuries and the sports with which they are most commonly associated. It is hoped that this article will give the physician a greater understanding of the types of hand and wrist injuries they may expect to encounter in athletes.
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This retrospective study, conducted at the Indian Oil Corporation Ltd. (Assam Oil Division) Hospital, Digboi, in a period of 5 yr amongst workers of IOC Ltd. (AOD) describes work-associated injuries. Out of 2320 cases of different types of injuries involving workers over this period, 820 (35.3%) occurred at the workplace. 1430 (61.6%) at home or other places and 70 (3.1%) occurred on way to the workplace. Burn injuries were found in 132 cases (5.8% of the total injuries), but constituted 12.6% of the accidents at the workplace. The majority of the other injuries were soft tissue injuries, including sprains 1288 (55.5%) and hand injuries 688 (29.5%). Major burns (above 20% BSB) were found only in 5 cases. The most common sites of involvement in minor burns were the hands (45 cases), the legs (35 cases) and face (20 cases) with the remaining involving the chest and abdomen. Scald injury was observed in 66/132 (50%) cases, contact burns in 13/132 (10%) cases, flame burns in 33/132 (25%) cases, chemical burns in 11/132 (8.3%), and electrical burns in 9/132 (7%) cases. Mortality was 1.5%. Working days lost (man-days loss) in burn injuries was found to be higher in comparison to other injuries of similar severity. Causation of industrial burns is discussed and importance of prevention of burns in industries has been emphasised.
The majority of high-pressure injection injuries can produce serious damage to the hand. Nevertheless, the injury may follow a relatively benign course if the injected substance possesses a less harmful nature. Treatment for these injuries requires immediate and aggressive surgery in most circumstances, but conservative treatment may be justified in certain instances. During a 4-year period, eight cases of high-pressure injection injury were encountered. The types of injected material were: four from paint, and one each from grease, water, benzene, and hydraulic oil. Time is an important factor regarding the results, while the types of injected material modify the clinical courses. It is advisable that the etiology of high-pressure injection injury should be established initially, and this factor be taken into consideration in choosing treatment options.
Closed-tendon injuries of the hand and wrist are very common in the athletic population. Most of these injuries, if seen acutely, can be treated successfully with nonoperative management, although some do require operative treatment. It is those injuries, however, that go undiagnosed until the end of the season, which may result in permanent disability.
A quick and simple method of measuring the electrical resistance of the skin is presented as an objective test of peripheral nerve injury. Patterns of altered skin resistance in patients with nerve injuries were found to coincide with operative findings. The method can be used in the preoperative assessment of hand injuries and to monitor the recovery of nerve function.