Trauma of the hand from circular saw table: a series of a 130 cases

INTRODUCTION

Trauma of the hand from a circular saw table is a common occurrence in developing countries it tends to occur in young hand working people and it causes a serious lesions.

METHODS

It was a retrospective series about a 130 cases of hand trauma from circular saw table. Epidemiological features, treatment, and permanent disabilities left by hand trauma from circular saw table were studied to identify ways to prevent such an accident.

RESULTS

The average age was 31.24 years, these patients were exclusively men, 62% were apprentice wood workers, and the left hand was twice more injured than the right hand. Regarding clinical aspects, in 77% of cases, two or more fingers were injured, tip amputations of the left fingers predominated (49%), in 50% of the cases of hand wounds occurred to the dorsum of the hand, and extensor tendon injuries were observed twice more than flexor tendon injuries. Regarding the surgical treatment, performing an amputation stump was the most practiced primary surgery (107 cases i.e. 82% of primary surgeries). Arthrodesis, reconstructive flap surgery, and spongy bone grafts were the most practiced secondary surgeries (79% of secondary surgeries). Joint stiffness was the most observed complication (26%).

CONCLUSION

Hand injuries from circular saw table such as those described in this study will continue to challenge the skill of surgeons devoted to the restoration of function and form to the damaged hand. Prevention, of course, should be the goal because of the severe functional and psychological impairment that may result from them.

The Management of Hand Injuries Caused by Sea Urchin Spines

Injuries to the hand by sea urchin spines are not commonly seen in the United Kingdom. There are many varieties of sea urchins (Echinoidea) throughout the world. They have a spherical calcium carbonate exoskeleton covered with spines. Certain varieties may be venomous, in particular the flower urchin ( Toxopneustes pileolus) found in the Indo-Pacific oceans. Injury may also be caused by the urchin spines or pedicellaria (delicate seizing organs equipped with jaws) ( Auerbach, 1991 ; Smith, 2002 ). A small number of hand injuries associated with sea urchin spines have been reported in the literature.

Closed Multiple Tendinous Rupture of Flexors and Extensors of Hand: A Case Report

Multiple ruptures of the extensor and flexor tendons of the fingers, thumb and wrist at the musculotendinous junctions are reported after a blast injury.

[HAND INJURIES IN ROCK CLIMBERS]

Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has gained tremendous popularity in recent decades. More people are exposed to injuries associated with the unique biomechanical forces of rock climbing. A series of repetitive high torque movements of the upper limbs are needed to ascend a wall or rockface. These movements subject the hand and wrist to large forces, potentially resulting in ligament and tendon sprains or rupture and even bone fracture. This review describes the anatomy, biomechanics and the common hand injuries in rock climbers.

HBO₂ in snake envenomation (atrox albinus rattlesnake): a case report in a human

A patient suffered from an envenomation that, at his hospitalization, was judged severe: Grade 3 out of 3, as defined in clinical studies for CroFab™ antidote [Crotalidae Polyvalent Immune Fab (Ovine)]. In addition to the usual antivenom treatment we applied adjunctive hyperbaric oxygen (HBO₂) therapy. Our aim was to facilitate better control of the lesions, already presenting as problematic wounds and at high risk of necrotizing soft tissue infection with compartment aspects. The regimen consisted of six treatments, one daily at 2.4 atmospheres absolute at 25 minutes x3 (75 minutes) at FiO₂=1, with two five-minute air breaks interposed. The therapy was well tolerated in spite of the patient's declared trait of claustrophobia. Our findings at a long-term follow up suggest that HBO₂ therapy may be reasonably and effectively administered at least in the post-acute phase of such occurrences.

Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management

Friction blisters are a common sequela of many athletic activities. Their significance can range from minor annoyance to major performance disruptions. The latter is particularly true in baseball pitchers, who sustain repeated trauma between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers. Since 2010, 6 Major League Baseball (MLB) players accounted for 7 stints on the disabled list (DL) due to blisters. These injuries resulted in a total of 151 days spent on the DL. Since 2012, 8 minor league players spent time on the DL due to blisters. Moreover, there have been several documented and publicized instances of professional baseball pitchers suffering blisters that did not require placement on the DL but did result in injury time and missed starts. The purpose of this article is to review the etiology and pathophysiology of friction blisters with particular reference to baseball pitchers; provide an overview of past and current prevention methods; and discuss our experience in treating friction blisters in MLB pitchers.

[Spontaneous Tendon Ruptures in the Rheumatoid Hand]

A spontaneous tendon rupture is a direct consequence of rheumatoid inflammation and can appear without any noticeable impact, often during sleep. The patient then presents with inability to flex or extend metacarpophalageal or interphalangeal joints. Multiple ruptures resulting in impaired function of several fingers can also occur and markedly limit the hand's grip strength. A tear may arise from either mechanical injury to the tendon along its course over bone or connective tissues, or by biochemical action of lysosomal enzymes, released during the inflammation process, on the connective tissue of the tendon. Ischaemic damage to a part of the tendon due to constriction of vessels supplying the peritenonium is found in hypertrophic peri-tenosynovitis. Spontaneous ruptures can be prevented, in the first place, by early synovectomy and then by a number of prophylactic procedures on soft tissues and carpal bones, which can stop or at least slow down the development of severe axial deformities of the wrist and hand. Simple end-to-end suture of the stumps is usually not possible; tendon repair surgery using free grafts or, more often, intact tendon transfer is necessary. In the flexor part, transfer of the superficial flexor tendon to a stump of the deep flexor tendon is frequently performed; a free graft can also be used at a two-stage tendon reconstruction. The repair of flexor tendons is technically more demanding and the results are less satisfactory compared to repair surgery on the extensor tendon. Key words: rheumatoid arthritis, metacarpophalageal joint, interphalangeal joint, tendon rupture.

Musculoskeletal symptoms and associated risk factors among African hair braiders

African hair braiders are potentially subject to work-related musculoskeletal disorders (WMSDs) because they perform repetitive hand motions for many hours a day together with prolonged standing and/or prolonged sitting. A complete enumeration of African hair braiders was attempted in Oklahoma City (OKC) and Dallas/Fort Worth (DFW). Braiders were identified through the channels they typically use to offer services to clients. Potential risk factors and symptoms of WMSDs were assessed using an oral interview. Participation rates were 95% (18/19) in OKC and 83% (83/101) in DFW. More than 75% of braiders reported discomfort in the fingers, wrist/hand, upper back, and lower back. In multivariate analysis, years worked as a braider but not age was a significant risk factor (p < 0.005) for reported pain in the wrist/hand, time spent sitting during the work day was found to be a significant predictor (p < 0.05) of upper back pain and lower back pain, and time spent sitting and time spent standing during the work day were both significant predictors (p < 0.05) of shoulder pain. Braiders in OKC, where licensing requirements were stricter, were significantly more likely than braiders in DFW to work at home (67% vs. 4%, p < 0.001) and to report pain in the lower leg (p < 0.005) and ankle/foot (p < 0.05). The close-knit nature of the African hair braiding community makes it an appealing candidate for community-based participatory research aimed at further elucidating occupational health concerns and reducing risk.

Is hand-grip another culprit for the risk of fractures in HIV-positive patients?

Risk of bone fractures in patients with HIV infection is greater than in the general population, particularly in those co-infected with hepatitis viruses. We compared bone mineral density (BMD) and muscular strength, measured by hand grip test (HG), in HIV mono-infected and co-infected patients. T-score values were lower in HIV patients co-infected with hepatitis viruses vs. mono-infected individuals. Since no significant correlations between HG and T-scores were found, we hypothesize that these factors belong, at least in part, to independent pathways, so both should be taken into account as risks for fragility fractures. Larger prospective studies are needed to confirm this hypothesis.

Ergonomics and comfort in lawn mower handle positioning: An evaluation of handle geometry

Hand operation accompanied with any combination of large forces, awkward positions and repetition may lead to upper limb injury or illness and may be exacerbated by vibration. Commercial lawn mowers expose operators to these factors during actuation of hand controls and therefore may be a health concern. A nontraditional lawn mower control system may decrease upper limb illnesses and injuries through more neutral hand and body positioning. This study compared maximum grip strength in twelve different orientations (3 grip spans and 4 positions) and evaluated self-described comfortable handle positions. The results displayed force differences between nontraditional (X) and both vertical (V) and pistol (P) positions (p < 0.0001) and among the different grip spans (p < 0.0001). Based on these results, recommended designs should incorporate a tilt between 45 and 70°, handle rotations between 48 and 78°, and reduced force requirements or decreased grip spans to improve user health and comfort.

Reconstructive dosimetry for cutaneous radiation syndrome

According to the International Atomic Energy Agency (IAEA), a relatively significant number of radiological accidents have occurred in recent years mainly because of the practices referred to as potentially high-risk activities, such as radiotherapy, large irradiators and industrial radiography, especially in gammagraphy assays. In some instances, severe injuries have occurred in exposed persons due to high radiation doses. In industrial radiography, 80 cases involving a total of 120 radiation workers, 110 members of the public including 12 deaths have been recorded up to 2014. Radiological accidents in industrial practices in Brazil have mainly resulted in development of cutaneous radiation syndrome (CRS) in hands and fingers. Brazilian data include 5 serious cases related to industrial gammagraphy, affecting 7 radiation workers and 19 members of the public; however, none of them were fatal. Some methods of reconstructive dosimetry have been used to estimate the radiation dose to assist in prescribing medical treatment. The type and development of cutaneous manifestations in the exposed areas of a person is the first achievable gross dose estimation. This review article presents the state-of-the-art reconstructive dosimetry methods enabling estimation of local radiation doses and provides guidelines for medical handling of the exposed individuals. The review also presents the Chilean and Brazilian radiological accident cases to highlight the importance of reconstructive dosimetry.

Humeral Neck Fracture after Electrocution - Case Report and Literature Review

A case of left humeral neck fracture following electrocution is reported in a 56-year old man, associated with partial thickness burns on his left hand. A fracture after accidental electrical shock injury represents a very unusual situation, due to muscle contractions. Surgeons involved in the management of the electrocuted patients should be aware of the possibility of musculoskeletal injuries. Neglecting these injuries can lead to delay in diagnosis and to detrimental complications.

[HAND FRACTURES IN CHILDREN - CAUSES AND MECHANISMS OF INJURY]

Hand is extremely exposed to various loads and traumas of everyday tasks and activities, resulting in fist fractures being fairly common injuries. The most common mechanism of injury is a direct blow. This retrospective study analyzed the data on 274 children admitted for hand fractures at Clinical Hospital Center Zagreb in the period from 2006 to 2014. The study included 76 girls (28%) and 198 boys (72%). The average patient age was 11.9 years and most were between 10 and 13 years of age. Phalangeal fractures accounted for 80%, metacarpal fractures for 17%, and carpal fractures for 3% of all injuries. Most commonly injuries occurred during recreation (4 1%), at home (37%), at school (18%) and in the street (4%). Direct blow was the major cause of injury (76%), and 24% were caused by fall. Injuries during sport activities are the most common cause of the hand fractures in pediatric population and direct blow is the main mechanism of injury. The peak incidence is at the age of 10-13 years in boys and girls, so prevention should be aimed at this age group. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities.

Management of a Dehisced Hand Wound Using Hydrogen Peroxide, Electrical Stimulation, Silver-containing Dressings, and Compression: A Case Study

Wound dehiscence is the separation of a wound along surgical sutures. A 57-year-old, otherwise healthy mechanic presented with a large open wound of >1 month duration on his left hand. His wound had dehisced after treatment that involved cleansing, surgical sutures, and oral antibiotics. He presented with a 5.0 cmx0.7 cmx0.3 cm lesion through the palmar creases of the hand with edema around the fourth and fifth digits and a callous formation around the distal portion of the wound. The wound had scant serosanguinous drainage and some induration at the periwound area, as well as a moderate foul odor. Tendons were not affected, but function was limited, the hand was painful, and the patient had been unable to work. Treatment was initiated with twice-a-week immersion of the hand in hydrogen peroxide diluted with water subjected to high-voltage pulsed current electric stimulation (HVPC). The wound was dressed with silver-containing dressings secured with stretch gauze and a compression garment. The wound was completely closed after 9 visits (35 days). No functional limitations of the hand or fingers, no cosmetic defect, and no wound recurrence were noted 9 months after healing. Although uncommon, dehisced wounds, especially in certain anatomical locations such as the hand, can be difficult to heal and may cause long-term problems with functioning. The treatment combination facilitated expedient healing of this dehisced hand wound. Research is needed to help elucidate the observations from this case study.

Epidemiology of pediatric hand fractures presenting to a university hospital in Central Saudi Arabia

OBJECTIVES

To investigate the epidemiology of pediatric hand fractures and to provide recommendations regarding prevention.

METHODS

Medical records and x-rays were retrospectively reviewed for age at the time of injury, gender, fracture pattern, place where the injury occurred, and mechanism of injury. The study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia between January 2005 and December 2011.

RESULTS

Of 361 cases reviewed, there were 291 (80.6%) male and 70 (19.4%) female patients. Most (46.2%) were in the age group of 13-18 years. For age group 1-4 years, the  most common place of occurrence was at home (81.3%) and for the group 13-18 years, outdoors was the place of occurrence (64.7%). Females were mostly injured at home while males had similar distribution of indoor and outdoor injuries. The most common causes of fractures were: door slams in the 1-8 years age group; falls at home, in the 9-12 years age group; and both falls at home and sports in the oldest age group (13-18 years). The little finger ray are the most frequently injured part of the hand followed by the middle finger.

CONCLUSION

Our series showed that most hand fractures in children occurred at home, which requires reevaluation of home settings. Implementation of safety measures during sports activities are relevant in the oldest age group.

Hand cumulative trauma disorders in Nigerian custom tailors: the need for redesign of manual scissors

Cutting scissors are important working tools for Nigerian custom tailors (CTs) but its usage apparently does not meet the ergonomics need of these artisans. A survey was carried out amongst CTs using questionnaires to obtain their background social-occupational demographics and observation methods to study their work performance, use of scissors and any cumulative trauma disorder (CTD) in their hands. Thicknesses of various fabrics were measured and comparison between Western world's custom tailoring job and the Nigerian type was done. The results showed some CTD risk factors with finger contusions on the 71 CTs evaluated. The right-hand contusions were traced to the constant usage of unpadded manual scissors with ungloved hands. Disparity between Western and Nigerian tailoring practice may account for the high occurrence of disorders in Nigerian CTs. Since hand dimensions are crucial in the design of hand tools, it is therefore concluded that hand anthropometry of Nigerian CTs and soft padding of manual scissors may mitigate CTD burdens on CTs' hands.

PRACTITIONER SUMMARY

Cumulative trauma disorders on the hands of low-income Nigerian CTs needed investigation. This was done via self-assessment and observational methods of the artisans’ work system. Frequent usage of unpadded manual scissors with un-gloved hands cause and exacerbate the problem. Hand anthropometry of users is crucial in scissors manufacturing.

Evidence-Based Management Of Acute Hand Injuries In The Emergency Department

Although injuries of the hand are infrequently life-threatening, they are common in the emergency department and are associated with significant patient morbidity and medicolegal risk for physicians. Care of patients with acute hand injury begins with a focused history and physical examination. In most clinical scenarios, a diagnosis is achieved clinically or with plain radiographs. While most patients require straightforward treatment, the emergency clinician must rapidly identify limb-threatening injuries, obtain critical clinical information, navigate diagnostic uncertainty, and facilitate specialist consultation, when required. This review discusses the clinical evaluation and management of high-morbidity hand injuries in the context of the current evidence.