Snowblower injuries to the hand

We retrospectively reviewed the records of 62 patients who sustained serious hand injuries caused by snowblowers between 1981 and 1990. Frequency of injuries to digits tended to correlate with length (i.e., middle, index, ring, or small finger or thumb). Damage to tendons did not seem to follow any particular pattern. The majority of victims sustained multiple digital involvement. Complete versus partial amputation followed the same length distribution as did injured digits. Most of the injuries occurred to the dominant hand. When patients were further questioned regarding the circumstances and events leading to their injury, a recurring pattern was found. Most patients described a wet, heavy snow having recently fallen. The majority of the patients who were injured by placing their hands into the exit chute admitted that they were aware the machine was running, but thought that they had a greater clearance to the rotating impeller blade.

Injuries due to letter bombs

In Austria in late 1993 ten letter bombs were sent to outstanding persons who have been engaged in the care of foreigners. Four of these bombs detonated, when they were opened by the addressee. The remaining six bombs were discovered in time and could be deactivated by specialists. The construction of these bombs and the lesions sustained by the four victims will be discussed. The injuries mainly concerned the left hand, i.e., the hand used by right-handed persons to hold a letter when opening it. The way holding the letter was of crucial influence on the degree of injury, as with the same explosive charge (which can be assumed deducing from the investigation of the deactivated bombs) injuries varied considerably. They ranged from minor tissue-lesions to mutilated fingers and the risk of exsanguination.

Nail gun injuries of the hand

Nail gun injury of the hand is commonly encountered among workers in the construction industry. Successful management requires a thorough understanding of this unique injury, the recognition of nail shaft barbs, and appropriate nail removal and wound care, with referral when indicated. If barbs are encountered, nail removal involves cutting off the head of the nail and extracting the nail in the direction of entry.

Russell's sign. Subtle hand changes in patients with bulimia nervosa

Bulimia nervosa is a common eating disorder, affecting between 1% to 10% of adolescent girls and college aged women. Because excessive weight loss and amenorrhea are not significant features, as they are in anorexia, bulimia is much harder to diagnose. Orthopaedic surgeons have a unique opportunity to detect one of the few physical signs of the disease, which is skin lesions, consisting of abrasions, small lacerations, and callosities on the dorsum of the hand overlying the metacarpophalangeal and interphalangeal joints. These nondescript dorsal lesions are caused by repeated contact of the incisors to the skin of the hand that occur during self induced vomiting. This finding, known as Russell's sign, may be seen by orthopaedic surgeons during examinations for other reasons. Because eating disorders are recognized as a component of the female athlete triad of osteoporosis, amenorrhea, and eating disorders and because orthopaedic surgeons routinely care for female athletes susceptible to these disorders, recognizing this sign and its implications may have profound influence on the patient's musculoskeletal system and general health.

Late results after microvascular reconstruction of severe crush and avulsion injuries of the upper extremity

From 1978 to 1985, a total of 64 patients underwent successful hand and digit replantation/revascularisation for salvage after crush and avulsion trauma to their upper extremities. Forty-seven of them (39 males and 8 females) were followed between 10 and 17 years (mean: 12.6 years). The average age was 33.2 years. In 39 patients, replantations were performed: 37 digits (including seven thumbs), two hands, and three midhands. Eight patients underwent revascularizations in cases of subtotal amputations: two in the midhand, three at the wrist, and three at the lower arm. Concomitant injury to the hand or forearm was a feature of all cases. In 45 percent of the study population, secondary reconstructions were necessary. Outcomes were evaluated using Chen's classification (1981) and showed that 19 percent of the patients were classified grade 1, 49 percent grade II, 28 percent grade III, and 4 percent grade IV. Results demonstrated a greater patient age in the grade III group, and relatively more secondary operations in the grade IV patients.

[Causes for reoperations after osteosyntheses of finger and mid-hand fractures]

31 patients reoperated after osteosynthesis of a metacarpal or a phalangeal fracture were reviewed over a period of three years. The cause of injury was in 18 cases a crush, in six cases a fall, in five cases a saw injury, and in two cases axial trauma. A postoperative plaster splint immobilisation over a period of at least three weeks was carried out in 29 cases. Reoperation was necessary in most of the cases because of a loss of range of motion and a nonunion. The complication rate was independent of the method of fixation, but did depend on the type of injury. Fractures associated with soft tissue injury were more likely to develop complications.

Complex traumatic lesions of the hand. Definition and surgical treatment

Complex traumatic lesions of the hand constitute a frequent problem in surgical reconstruction. Often young subjects of full work age and with high functional requirements are affected. Thus, microsurgery has changed the quoad functionem prognosis of these lesions. In addition to presenting a modern definition of complex lesions, the authors expose and discuss a rational method of surgical treatment in light of the most recent possibilities of reconstruction offered by microsurgery of flaps and reimplantations. The conclusion is that only the constant presence of an expert microsurgical team permits a correct approach to this type of lesion.

Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation

Volleyball has become an extremely popular participation sport worldwide. Fortunately, the incidence of serious injury is relatively low. The sport-specific activity most commonly associated with injury is blocking. Ankle sprains are the most common acute injury. Recurrent sprains may be less likely to occur if an ankle orthosis is worn. Patellar tendinitis represents the most common overuse injury, although shoulder tendinitis secondary to the overhead activities of spiking and serving is also commonly seen. An unusual shoulder injury involving the distal branch of the suprascapular nerve which innervates the infraspinatus muscle has been increasingly described in volleyball players in recent years. Hand injuries, usually occurring while blocking, are the next most common group of injuries. Fortunately, severe knee ligament injuries are rare in volleyball. However, anterior crutiate ligament injury is more likely to occur in female players. Many of these injuries may be preventable with close attention to technique in sport-specific skills and some fairly simple preventive interventions.

Pediatric hand injuries due to exercise bicycles

METHODS

This is a 5-year retrospective review of hand injuries caused by exercise bicycles among 34 children.

RESULTS

Mean age was 3 years and 5 months. Accidents were caused most commonly by impingement of the fingers between the chain and sprocket wheel (77%), but injuries caused by spinning wheel spokes (23%) were generally more severe. Injuries were usually of the avulsion type and ranged in severity from lacerations (43%) to fractures (19%) to amputations (38%). The central digits (87%) were involved more frequently than the border digits (13%). Replantation was possible for 33% of the amputated digits, with 50% of the fingers surviving.

CONCLUSION

The avulsive nature of these injuries should be taken into consideration when attempting replantation. Increased community awareness and equipment safety modifications are needed to eliminate this preventable problem.

[Rehabilitation of hand injured co-workers from the occupational medicine viewpoint (exemplified by a chassis and montage automobile industry]

The majority (about 25%) of work-related accidents involves injuries to the hands and fingers. Depending on type and severity of the injury, it can have profound consequences to an individual's professional future. Due to this basic insight, hand rehabilitation must include vocational rehabilitation.

Ax injuries of the hand

OBJECTIVE

To review a series of ax injuries of the hand.

DESIGN

Retrospective epidemiological review of 125 cases.

MATERIALS

Assessment from the notes of all injuries, with more detailed follow-up of 26 cases.

MEASUREMENTS

Levels of injury, surgery required, complications, results, patient satisfaction, methods of prevention.

CONCLUSIONS

Ax injuries are rare. They usually affect the thumb and index finger of the nondominant hand. As with all hand injuries, expertise in dealing with bone, tendon, nerve, and skin cover is essential. Even "minor" injuries may give rise to considerable morbidity. Our complication rate in replantation was 50%. Care should be taken here not to compromise the result by attempting to maintain the length of the bony skeleton. The long-term results (at 11 months to 12 years) were generally satisfactory, but cold intolerance may persist for many years. As with all accidents, prevention would be better than cure. Neither we nor the patients could think of any way of significantly reducing the incidence of these accidents. However, holding the ax by the neck seemed a common way of sustaining injury.

The consequences of punching glass

We carried out a retrospective and prospective study of 67 patients who had sustained hand injuries from punching glass over a period of 33 months. All had consumed alcohol and had argued with a partner. The mean age was 25 years, 90% were male and 56% were unemployed. Seventy per cent of injuries occurred between 23.00 and 04.00 hours. Total damage included division of 149 tendons, 33 nerves and nine arteries. Fifty-two per cent of patients required admission for more than 1 day. The mean number of follow-up visits was 3.6 and the majority needed hand therapy and occupational therapy services. Cost per injury was estimated as 1,120 pounds. Such injuries cause major disability in an already disadvantaged section of society. The challenge is to educate the susceptible patient group.

A survey of croquet injuries

Of 214 croquet players who responded to a questionnaire, 76 reported at least one injury to hand, wrist or forearm caused by striking the ball. There was no obvious relation to which of the three main grips the player applied to the mallet. Injuries were somewhat more frequent when the mallet shaft consisted of fibreglass than when it was wood, metal or carbon fibre, but a causal relation has not been established. Back injuries seem less troublesome in croquet than in golf.

Risks associated with occupational glass injury in bar staff with special consideration of hepatitis B infection

Since bar workers often sustain cuts from unwashed bar glasses, the aims of this study were to investigate risk of injury and to examine the sero-prevalence of markers for hepatitis B amongst bar staff. Ninety-one bar staff recruited by newspaper advertisement were asked about injury experience and life-style risks associated with transmission of hepatitis B and were tested for hepatitis B surface antigen (HBsAg) and core antibody (anti-HBc). Seventy-four per cent reported lacerations from broken glassware at work: 18% had sustained such injuries in more than 10 incidents. Fifty-five per cent of respondents reported occupational skin contact with body fluids. Anti-HBc prevalence for the study group was 1.1%, suggesting that bar staff were not at increased risk from hepatitis B infection. Although 30% wore gloves for high-risk tasks, there was no evidence that glove wearing prevented glass lacerations. This level of injury experience and exposure to body fluids is unacceptable and represents a potential risk of cross-infection. Hepatitis B immunization should be considered in this group. Urgent action, including the replacement, wherever possible, of annealed with tempered bar-glassware, is necessary to protect bar workers from glass injury.

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.

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.

Hand-arm symptoms related to impact and nonimpact hand-held power tools

Hand and arm symptoms among workers using impact and non-impact hand-held power tools were investigated in a cross-sectional study and a 5-year follow-up study. The study population consisted of concrete workers (n = 103), truck assemblers (n = 234), electricians (n = 101), platers (n = 140) and lumberjacks (n = 102). Of the original 680 subjects, we followed up 312 after 5 years. A questionnaire concerning ongoing hand and arm symptoms, daily exposure to hand-held power tools, type of tool used, and individual factors was administered. More workers using low-frequency impact tools than workers using non-impact tools reported symptoms in the elbows and shoulders. Elbow symptoms were accentuated in the cross-sectional study, while shoulder symptoms were accentuated in the follow-up study. Wrist symptoms were reported by more of those working with high-frequency impact tools than of those using only non-impact tools when the analyses were controlled for age, years in the occupation and smoking habits. A possible explanation of the results found in this study is that low-frequency impact vibration is transmitted to the upper arm, and thus the elbow and shoulder are at risk, while high-frequency impact vibration is attenuated in the hand and wrist and may predominantly cause symptoms there.