Rock climbing injuries

Three-quarters of elite and recreational sport climbers will suffer upper extremity injuries. Approximately 60% of these injuries will involve the hand and wrist, the other 40% will be equally divided between the elbow and the shoulder. Most injuries will be tendonopathies secondary to strains, microtrauma or flexor retinacular irritation. However, up to 30% of these injuries in up to 50% of elite climbers will involve the proximal interphalangeal (PIP) region. These injuries are more serious and consist of varying degrees of flexor digitorum sublimis insertional strains, digital fibro-osseous sheath ruptures and PIP joint collateral ligament strains. Early changes in climbing schedules, stretching and exercise habits, and protective digital taping are necessary to protect and rehabilitate these athletes.

[High-pressure injection injuries--underlying traumas are often disguised]

High-pressure injection injuries to the hand are often associated with severe morbidity, and should be considered surgical emergencies. The severity of these injuries is due to vascular compromise and the inflammatory nature of the material injected. Recommended treatment generally involves surgical decompression and meticulous removal of foreign material if a disastrous outcome is to be avoided.

Ring avulsion injuries and the basketball player

As basketball increases in worldwide popularity, more epidemiological data on injury rate and type will be documented. A serious ring avulsion injury (Urbaniuk Class I) is here reported in an adolescent incurred while attempting a slam dunk. The management of this injury is discussed as well as safety concerns for coaches and supervisory staff.

The acute pathologic changes of paint-injection injury and correlation to surgical treatment: a report of two cases

The early histologic changes of digital tissues after paint-injection injury support the urgent need to remove all contaminated tissue. Paint causes immediate tissue necrosis on contact and then incites an immediate necrotizing inflammatory reaction that persists if the tissues are not completely debrided. Early histopathologic changes include vessel thrombosis, tissue necrosis, and acute necrotizing inflammatory infiltrate, all occurring only hours after injection injury. In light of these histologic changes, if paint cannot be completely removed from digital arteries in an attempt to salvage the finger, then the wound should be left open and the finger monitored for further necrosis in response to the retained paint.

Longitudinal study on factors related to the course of vibration-induced white finger

Follow-up surveys were conducted in 1982 and 1988 to investigate factors affecting the course of vibration-induced white finger (VWF). Subjects were 353 patients, aged 40 to 70 at the start of the 1982 survey, who were receiving treatment for hand-arm vibration syndrome. Between 1982 and 1988, the attacks of VWF decreased, while numbness and pain in the hand changed slightly. Finger skin temperature showed a tendency to increase, but recovery time in nail compression tests was unchanged. Vibration perception threshold and grasping power tended to become worse. Of the 177 patients with VWF in 1982, 55 (31%) had no VWF in 1988. The improvement in VWF depended on its severity assessed by the frequency of attacks, the extent of the affected finger phalanges and the Stockholm vascular (V) stage at the start of the 1982 survey. The improvement was observed in 46% of the 1V (mild) stage cases, against only 17% of the 3V (severe) stage cases. Patients in the 2V (moderate) and 3V stages had lower finger skin temperature than those without VWF (the 0V stage). Patients with milder VWF seemed more likely to improve. Continued use of vibratory tools was found to be an unfavourable factor for improvement of VWF. Age, smoking and drinking habits, and medical complications showed no significant effects on the course of VWF.

Two-level dorsal dislocation of the little finger

The case of an elderly man who suffered simultaneous interphalangeal joint dislocation in one finger as a result of a hyperextension force on both the distal and proximal interphalangeal joints is presented. This case differs from the few reports of this type of injury in the literature both in its mechanism of injury and time to reduction. Most reports have been in athletes who are actively involved in a sport, whereas the present case was the result of a fall. Also, successful reduction was achieved almost 2 weeks postinjury, indicating that, even with this amount of delay, these injuries can be effectively treated with closed reduction.

Toe to hand transfer in children. Part 1: technical aspects

Between 1988 and 1994 40 children (age range 9 months-14 years) with either congenital (85%) or acquired hand deformities underwent reconstruction by microvascular autotransplantation of one or more toes. Fourteen underwent a single toe transfer whilst 26 had two second toes transferred to one hand. In 14 of these cases both second toes were transferred at one operation. Whether one or two toes were transferred, the children spent on average 9 days in hospital. None of the transfers failed but 75% of the children underwent staged additional surgery to improve appearance and function. Thirty-seven of the 40 children attended with their parents for follow-up examination by an independent surgeon, a physiotherapist and a clinical psychologist in order to evaluate the results and consequences of surgery. This paper presents the technical considerations for this surgery and examines the influence of the transfer on growth.

[Interposition of the extensor tendon in a subcapital metacarpal fracture]

A case of an irreducibled subcapital fracture of the fifth metacarpal bone caused by interposition of the extensor tendon to the fifth finger and the intertendineous connection between the fourth and the fifth extensor tendons is described. To reduce the fracture the surgeon had to remove interposed tissue.

Recovery of finger sensibility and somatosensory evoked potentials following digit-to-digit replantation in man

Recovery of finger sensation and digital nerve function following digit-to-digit replantation was studied in 14 patients by clinical sensory evaluation and somatosensory evoked potentials (SEP) to digital nerve stimulation. The mean interval between injury and surgery was 8 +/- 3h; that between surgery and study was 25 +/- 7 months. Sensory examination revealed a mild hypersensitivity to cold. Pinprick, touch and hot sensations had nearly complete recovery, while vibration and two-point discrimination were impaired. In digital SEPs from the replanted side, the N9 component was present and normal in 8 patients (57%), whereas the N13 and N20 components had prolonged latency with normal central conduction time. Absence of the N9 component appeared to correlate with a more proximal level of injury and poor surgical outcome. The present data indicate that sensory recovery of the replanted digits was in general satisfactory but incomplete, and that over half of the patients had normal digital nerve conduction.

Acute radiodermatitis from accidental overexposure to X-rays

Approximately 2 weeks after accidental overexposure to X-ray radiation, a worker developed acute radiodermatitis on fingers of both hands. Exposure simulation indicated that total ionizing radiation absorbed by his fingers amounted to about 20 Gy. After 2 years, acute radiodermatitis evolved to chronicity of lesions with presence of atrophic skin, teleangiectasia, alopecia, and dyskeratosis on three right-hand fingers. Cytogenetic dosimetry of peripheral blood lymphocytes, performed 2 months after acute radiation, showed an increase of micronuclei (7% vs. 1 +/- 0.4% according to laboratory reference data). The increase was ascribed to the high dose of ionizing radiation absorbed by circulating lymphocytes in the vessels of overexposed tissues. The cytogenetic examination was repeated 27 months after acute irradiation; it was found that the percentage of micronuclei had been restored to within reference levels. The possibility of using cytogenetic dosimetry, following acute partial exposure to X-rays, not just as an indicator of previous exposure, but also as an indicator of the absorbed radiation dose is examined. Lastly, the possible stochastic effects that may set in on the skin of the affected fingers and the need for periodically monitoring the evolution of chronic skin lesions, are discussed.

Elbow, forearm, wrist, and hand injuries among sport rock climbers

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.

Reducing the rate of paramedic needlesticks in emergency medical services: the role of self-capping intravenous catheters

OBJECTIVE

To determine whether the frequency of unintentional needlesticks can be reduced by replacing conventional i.v. catheters with self-capping ones.

METHODS

Retrospective cohort, historically controlled study, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, for whom i.v. therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at i.v. access was examined during the 2 10-month periods, before and after introduction of a self-capping i.v. catheter.

RESULTS

For the 2 periods, the percentage of patients for whom i.v. access was attempted remained constant at 65%. The success rate for i.v. access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new catheter, 44 injuries were reported overall. Of these, 15 were due to unintentional needlesticks, 11 associated with contaminated needles. Following the system-wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrapolated annual incidence of contaminated needlesticks decreased from 169 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 i.v.attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI; 132, 330) to 15 (95% CI; 0, 40) per 100,000 i.v. attempts. The absolute number of needlesticks and the proportion of injuries due to needlesticks decreased significantly (p < 0.005).

CONCLUSION

The use of i.v. catheters with self-capping needles was associated with a significant reduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. The use of self-capping i.v. catheters was feasible and did not appear to be a deterrent to initiating i.v. therapy in the out-of-hospital environment.

Ring avulsion injuries in a field environment

Two soldiers are reported who sustained ring avulsion injuries while performing duties as part of Operation Provide Promise in Croatia (former Yugoslavia). These traction injuries inflicted on a ringed finger can present difficult diagnostic and treatment challenges in the field environment. They also can result in long-term disfigurement and disability. Due to the type of work performed and the equipment used by soldiers in the field environment, they are at particular risk for ring avulsion injuries. However, with appropriate education and precautions, these risks can be minimized.

Finger injuries from infant mittens; a continuing but preventable hazard

During the last 4 years, three infants have presented with finger-tip injuries secondary to entrapment in woollen/synthetic mittens. The accident happened at home in one case but the other two occurred in different neonatal units. Spontaneous amputation of the terminal phalanx of the index finger occurred in two patients but in the other there was complete healing. This problem may be avoided by restricting the use of mittens, by changing their design, and by a greater awareness of this hazard.

Biomechanical explanation of a simultaneous closed rupture of both flexor tendons in the same digit

Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. The authors describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The present paper highlights the importance of the mechanism of injury and explains biomechanical basis. The patient was treated by a two-stage reconstruction of the flexor digitorum profundus and regained full flexion and extension of the finger.

Surgical treatment of postburn boutonniere deformity

A new method of surgical treatment of postburn boutonniere deformity was used in 124 fingers of 66 patients. This method includes reconstruction of the lateral band's position of an extensor apparatus and anatomic continuity of a central band. Before tendon plasty, passive movements in a proximal interphalangeal joint are restored and contracture of others joints is released. If the soft tissue of the digital back is affected, tendon grafts are covered with a groin pedicled flap. With this method we could restore active movements in the proximal interphalangeal joint in 89.2 percent of the patients and avoid fusion or amputation. The failures were connected with serious intrajoint changes.