Hand problems presenting to a district general hospital accident and emergency department

An audit was carried out of 1000 consecutive patients presenting with hand problems to a busy district general hospital (DGH), accident and emergency department (A&E). Hand problems accounted for 11% of all A&E presentations. Over 50% of cases were examined radiologically with 37% of these having positive findings. Most patients were male (66%) and manual workers (34%). Only 2.8% of patients required admission, and 50% were discharged with no follow-up. Less than 5% were referred by their general practitioner (GP) and these patients presented during office hours (08.00-18.00 h). The vast majority of the presenting patients could have been treated in a modern, well equipped GP surgery.

Severe infections following fish bone and spine injuries

Injuries by fish bones and spines can cause severe infections and tissue necrosis, more extensive than one would expect in such small wounds. This paper describes the injuries and the treatment of 25 patients.

The management of human bite injuries of the hand

Human bites of the hand cause small wounds that are often incorrectly treated as "minor' injuries. We reviewed the management and outcome of patients with human bite or "punch' injuries of the hand. Significant morbidity resulted from late presentation and inadequate initial management. We propose a treatment protocol, in which all patients are immediately referred and admitted to hospital for surgical debridement.

[Injuries caused by motorized lawn mowers--hand injuries the most common ones]

The powerful forces involved in the function of motorized lawnmowers can cause serious injuries. The study reported was based on a series of 81 cases of injury, that were treated at University Hospital, Umeå. Direct trauma to hand and foot was the most common injury mechanism, though high energy expulsion of objects from the machine was not uncommon. A common cause of direct trauma to hand or foot was attempting to clear grass or other matter from the vicinity of the rotating blades. Hand injuries were most common and occurred predominantly in men, whereas women and children accounted for a greater proportion of missile injuries instead. 25 per cent of all hand and foot injuries were amputating fractures. The preventive measures that could and should be implemented to reduce the risk of these injuries include improved shielding of rotating and heated parts, prevention of missile ejection, and the introduction of dead-man grip. The use of protective gear, and greater care in the use of motor mowers generally, would also reduce the risk of injury.

Unusual ritual burns of the hand

Six hands from five patients were seen with full-thickness burns following a ritual practice between June 1993 and June 1994. Three hands were treated with excision and medium-thickness split-skin grafts, one patient was treated with a medium-thickness split skin graft taken from the instep of the foot. The first patient with bilateral burns of the palms refused surgery and returned 3 months later with contractures of the palms. The results of the treated hands are presented.

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.

Multiple carpometacarpal dislocations. A case report and review of treatment

Carpometacarpal dislocations of the ulnar four joints are rare injuries that are usually associated with high-energy trauma. Given the small number of cases reported, there exists some controversy regarding their optimal management. The case of a 27-year-old man who sustained a dorsal dislocation (without associated fractures) of the ulnar four carpometacarpal joints as a result of a fall from a height is presented. The literature regarding these hand injuries is reviewed, and the need for anatomic reduction and stabilization is discussed.

Needle stick injury. Reducing the risk

The incidence of penetrating skin wounds and needle penetration of gloves during operation was studied in orthopaedic surgeons. Significant hand wounds were found in 11% of surgeons before operations. Glove penetration during closure of the deep tissues occurred in 16% of outer gloves and 6% of inner gloves when standard needle points were used. The surgeon sustained a needle-stick injury in 6% of this group. When a needle with a protective point was used, there were no glove perforations. This simple precaution reduces the risk of transmission of blood-borne disease during operation.

Vibrotactile perception thresholds as determined by two different devices in a working population

OBJECTIVES

The purpose of this study was to investigate whether two devices for measuring vibrotactile perception thresholds produced similar results on an individual basis and to compare the thresholds in the presence or absence of sensorineural hand symptoms and vibration exposure.

METHODS

Vibrotactile perception thresholds were measured with a vibrameter and a tactilometer in 178 men. The tactilometer uses seven discrete frequencies from 8 to 500 Hz, and the vibrameter uses one frequency (100 Hz). Agreement was assessed from the correlations and from a comparison of subjects who had thresholds above the upper quartile of each device as to the presence of sensorineural hand symptoms and occupational vibration exposure.

RESULTS

The correlation between the vibrameter and the tactilometer (125 Hz) was 0.59. The agreement between the vibrameter and the tactilometer (63 Hz), when the upper quartile was used as a limit, had a sensitivity of 0.56 and a specificity of 0.85. The sensitivity and specificity for the agreement with symptoms were 0.44 and 0.79, respectively, for the tactilometer and 0.40 and 0.78, respectively, for the vibrameter. The indices combined from the different frequencies of the tactilometer did not improve the agreement.

CONCLUSIONS

Some of the discrepancy between the measurement of the vibrameter and tactilometer can be explained by differences in the equipment, the measurement procedures, and the examiner, combined with high inter-and intraindividual variability. Neither of the two devices was superior when the results were compared as to the occurrence of hand symptoms and vibration exposure. As evaluated in this study vibrotactile perception threshold has a restricted value for screening and diagnostic purposes on an individual basis.

Computer-assisted evaluation of hand and arm function after thermal injury

Comprehensive care of the burned upper extremity requires accurate and complete evaluation of function, including two-point discrimination, active and passive range of motion, and grip strength. These evaluations, when performed serially during a course of therapy, are time-consuming and manpower-intensive. We tested the utility and accuracy of a commercially available computer-assisted impairment evaluation system when used to automate and standardize measurement of upper-extremity function. The function of 80 upper extremities was evaluated with both the conventional and the computer-assisted methods. The time required to perform a complete examination with each method was recorded, and measurements of grip strength and total active motion made with both methods were compared. Complete upper-extremity evaluation required an average of 20.3 minutes with the computer-assisted method, compared to 62.9 minutes with conventional means. Measurements of extremity function with computer-assisted and conventional methods had correlation coefficients of 0.984 for grip strength and 0.996 for total active motion. The computer-assisted impairment evaluation system was found to be a useful and accurate adjunct in the acute and rehabilitative management of burned upper extremities.

Magnetic resonance imaging characteristics of a lead pencil foreign body in the hand

Foreign body detection and removal from the hand can present a challenging problem for the hand surgeon. Imaging studies often are of little help and may even be misleading regarding the size and location of the object. This article reports imaging techniques used in the detection of foreign bodies and presents a case in which magnetic resonance imaging was used to localize a lead-pencil foreign body in the hand prior to surgical removal. We also present the results of magnetic resonance imaging analysis of several lead pencils, showing a similar signal that indicates that iron and magnesium were responsible for the artifact seen on the magnetic resonance image.

Traumatic arm amputation, an uncommon parachuting injury

Parachuting is a unique method of deploying troops. Accidents in parachuting are common, but usually carry minimal risk for severe injury. Most accidents occur during landing and injuries often affect the lower limbs and spine. Traumatic amputation of a limb is an extremely rare event in parachuting. We present a case of a parachutist who suffered a traumatic amputation of the left hand during jumping off the plane.

[Burns risk caused by the interaction of NIR at radiofrequency and metal structures at a building site]

This study pointed out an induced electric field originated from two radio aerials and measured on two cranes being in an neighbour building site. On the basis of the results of the calculations effectuated, it has been showed that the values of the electric field were within the IRPA reference values; although these values, the metallic structures of the two cranes seemed to interfere with the electromagnetic field as well as to create some situations of risk for the workers of the building site. At last, for this reason were suggested some techniques of primary prevention.

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data

OBJECTIVE

To determine the acute injury profile in each of six sports and compare the injury rates between the sports.

DESIGN

Analysis of national sports injury insurance registry data.

SETTING

Finland during 1987-91.

SUBJECTS

621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate.

MAIN OUTCOME MEASURES

Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors.

RESULTS

54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability.

CONCLUSIONS

Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.

The composite groin fascial free flap

Seven patients with extensive loss of soft tissue, extensor tendon, and exposure of bone and joint of dorsum of hand and foot were treated with free composite flaps from the groin area. To retard the adhesion by scarring, membrane interposition between tendon and bone was recommended. The groin flap, based on superficial circumflex iliac vessels, was combined with a well-vascularized external oblique aponeurosis. The groin skin flap provided skin coverage, and the aponeurosis was used simultaneously to create a gliding surface for reconstructed tendons in a single one-stage procedure. All composite free-tissue transfers were successful. The advantages of this technique are: (1) a single, one-stage procedure; (2) fewer adhesions of reconstructed tendons, and no need of secondary tenolysis; and (3) good cosmesis and minimal morbidity at donor site.

[Hand and arm vibration syndrome caused by mechanical screw driver]

Authors performed angiological, neurological and radiological examination of 17 persons working with power screw-drivers. Vibration measurement of the tools was made too. 10 patients had symptoms and signs corresponding to the hand-arm vibration syndrome. The vibration of some tools exceeded the maximal allowable acceleration level according to ISO 5349. On the ground of the results authors conclude that some power screw-drivers can cause hand-arm vibration syndrome. The importance of choosing of the right tools and the significance of the periodical examinations are underlined in the prevention of the damages.