Treatment of post-burn upper extremity, neck and facial contractures: report of 77 cases

BACKGROUND

Post-burn contractures severely deteriorate life quality. We aimed to present our treatment protocols for post-burn sequelae and the contractures that cause functional limitations.

METHODS

Seventy-seven cases with post-burn contracture were treated in our clinic. Post-burn contractures occurring after a burn injury affected the upper extremity, face and neck in 60, 17 and 6 cases, respectively. Skin grafts, local flaps such as advancement flaps, Z-plasties, K-plasties, regional flaps such as posterior interosseous flap, tissue expanded flaps, and free flaps were used according to the severity of the contractures.

RESULTS

In one patient with type II axillary contraction, recurrence was seen. Full range of motion was achieved in the 3.6-year follow-up period in elbow contractures. Eight of 71 phalangeal joint contractures recurred. Two patients underwent reoperation for neck contracture recurrences.

CONCLUSION

Excellent results were seen with prefabricated flaps, which were used for the facial reconstruction.

[High pressure injection injuries of the hand. Rare but often underestimated]

INTRODUCTION

Injection injuries of the hand are often underestimated because the full extent of the injury often only emerges after a delay. Flap coverage is often needed to avoid amputation.

CASE REPORT

In the case presented an epoxy resin injection trauma to the left index finger occurred. A critical blood circulation resulted and after demarcation of the injury a radical débridement was carried out. A heterodigital island flap was used to reconstruct the dorsum of the finger and 3 years after the trauma the patient has no impairments in daily activities.

DISCUSSION

The extent of the injury and the carcinogenic properties of the injected material are crucial for adequate treatment of injection injuries. Patients should be referred to specialized hand centers at an early stage.

International surgery: causes of hand injuries in a developing country

BACKGROUND

In emerging economies such as Nigeria, trauma and hand injuries in particular are on the rise. The aim of this study was to document the causes of hand injuries in Nigeria.

METHODS

This was a prospective study conducted between Aug. 1, 2006, and July 31, 2007. We obtained objective information about patient demographic data, occupation, dominant and injured hand, and place and cause of injury. We assessed injury severity using the Hand Injury Severity Score (HISS).

RESULTS

A total of 74 patients with hand injuries were included. The male:female ratio was 1.8:1, and the average age was 26.9 years. Most patients were right-hand dominant, and 56.8% of injuries affected the dominant hand. Engineers and technicians represented 27% of patients with hand injuries, which was the largest group encountered during the study. Most cases occurred because of road traffic injuries, followed by machine injuries. Injuries commonly occurred at the work place and on the road. In total, 57.1% of patients with mechanical injuries were admitted to hospital. The majority received minor surgical treatment, and 16.2% had a digit amputated. The average HISS was 54.35. In total, 64.8% of the injuries were classified as minor or moderate. Sixty percent of admissions were patients with a HISS of severe or major injury.

CONCLUSION

Hand injury in this part of the world is commonly due to road traffic collisions and machine accidents, and the injuries are usually severe. Hand injuries are commonly seen among technicians and civil or public servants; these people constitute the economic work force.

[The method of noncontact detection of the hand lesion area]

Basing on clinical material--216 injured persons with the hand burns--the method of distant detection of the hand affection area was elaborated. On the skitz (with contours of the hand palm and back surfaces, divided by orientirs on anatomic-functional regions with determined indices of every region area toward general area of the hand) the contours of the hand burn affection were lined, total area of the segments affected calculated, permitting to determine the relative area of affection of the hand external cover in presence of superficial and deep burns and their general area. While clinical trial, there was noted, that the method secures simple, precise and painless detection of the hand affection area, do not demand material-technical resources and essential expanses of time, is simply repeated and may be applied in surgical practice for optimization of treatment of the hand burn trauma.

Sea urchin injuries to the hand: a case report and review of the literature

Sea urchin injuries to the hand are uncommon. A variety of home remedies can be found on the internet and other sources for dealing with this problem in the acute setting. Many long term complications such as granulomas, arthritis, and tenosynovitis can result from a neglected sea urchin injury. We report an unusual case of a patient with a remote sea urchin injury who presented with ulnar digital nerve paresthesias. A traumatic neuroma was found on surgical exploration. We review the literature on injuries to the hand caused by sea urchins and their management. Management of sea urchin injuries to the hand with retained spines requires surgical debridement in order to prevent significant long term complications including stiffness, tenosynovitis, granulomas, and arthritis.

Burning more than calories: treadmill friction injuries in children

Treadmill injuries in young children are a serious but little documented problem. Friction burns occur when the hands come into contact with the moving belt resulting in deep burns that often require hospital admission and surgery. The aim of this study was to assess the nature and prevalence of injuries sustained and to highlight treadmill friction burns as a public health issue previously undocumented in Ireland. A retrospective chart review from January 2006 until March 2008 was performed and functional outcome was assessed by the modified Michigan Hand Outcomes Questionnaire. Eight girls and four boys from one year and seven months to seven years and five months were treated. Eight children required admission to hospital and to date three have required surgery for their injuries. This is a new and increasing problem in Ireland which must be highlighted.

[Hand-arm vibration syndrome in a nurse carrying out gypsum cutting operations]

BACKGROUND

A professional nurse, employed mainly on gypsum cutting operations, developed a hand-arm vibration syndrome with Raynaud's phenomenon, neurosensitive disorders and impairment of the bone and joints apparatus of the hand and arm.

METHODS

The nurse underwent diagnostic investigations (cold test, X-ray of the upper limbs, blood tests); also the vibration levels transmitted from instrument were measured and the exposure times were established.

RESULTS AND CONCLUSIONS

Clinical investigations showed the presence of a hand-arm vibration syndrome with secondary Raynaud's phenomenon and environmental surveys revealed very high vibration levels, such as could be associated with the disease with a causal relationship. In the literature no reports exist of the vibration syndrome being associated with health care workers in orthopaedic departments. The case described in this study occurred because of peculiar organisational factors that most likely have never occurred in other hospitals or orthopaedic departments.

Risks for, and causes of, injuries to the hand and forearm: a study in children 0 to 6 years old

Ninety-six children aged 0-6 years with unintentional hand injuries were referred to the Department of Hand Surgery between 2002 and 2003. Either parents, medical staff, or both, completed a questionnaire (response rate 79/96; 82%) about the circumstances of the injury. The incidence of injuries referred for treatment was 33.4/10,000 people/year. Seventy-five percent (59/79) of all injuries occurred at home, and only 8% (6/79) in a day-care centre. The risk was highest between 4 p.m. and 8 p.m. (incidence rate ratio 5.17, 95% confidence interval 2.12 to 17.7) and in 6 year old children (IRR 4.89, 95% CI 1.58 to 37.68). Adults were present when 66/79 children (84%) were injured. Most injuries occurred during play (39/79; 49%). Stuck in front doors (23/79; 29%) (closed by a child) was common. There was no increase in incidence in children with a foreign background (IRR 1.19, 95% CI 0.64 to 2.28). Advice about prevention will be distributed to parents to encourage safer environments in homes.

Bracing and rehabilitation for wrist and hand injuries in collegiate athletes

Athletic injuries of the hand and wrist are common. The key to management of these injuries is prevention. Certain sports require athletes to participate in positions that pose a higher risk of injury to the fingers and wrists. Once healing of the injured digit and wrist has occurred, rehabilitation of the injury is important. This requires close communication between the therapist and the strength and conditioning coach to allow strengthening exercises but limit traction to the involved injury in order to limit the risk of reinjury. Finally, once the injury has been rehabilitated, protective playing casts and splints are useful to allow the athlete to return early to competition and to decrease the risk of reinjury.

Behavioural treatment of post‐traumatic and vibration‐induced digital cold sensitivity

Cold sensitivity is a common problem after all types of hand injuries. The aim of the present study was to assess possible effects of treatment by Pavlovian conditioning, a behavioural treatment method for digital cold sensitivity where whole body cold exposure becomes associated with warm hands. Eighteen hand-injured patients and nine patients with vibration-induced problems in their hands completed the treatment. Questionnaires and questions, assessment of perception of touch/pressure and skin temperatures after cold provocation, was made before and after the completed period of treatment and after 6 and 12 months. The results indicated subjective improvement in the hand-injured group in contrast to a lack of response in the vibration group. An increased digital skin temperature after treatment was noted for the vibration-exposed group only, which however did not persist at 6 and 12 months' follow-up.

Cold injury from liquid petroleum gas

Cold injury by liquid petroleum gas is produced by evaporation that causes damage by cold to vital structures. We present two cases of exposure to pressurised liquid petroleum gas during an industrial accident.

Injuries to children's hands caused by the engine belts of agricultural machines: classification and treatment

Injuries to children's hands with farm machinery, particularly tractors, are common in rural areas. We present 58 cases of hand injuries in children aged from 3 to 7 (mean 4.5), caused by the engine belts of agricultural vehicles, who were referred from the cities in Central Anatolia. The injury patterns among patients were similar. The injury generally starts from the middle phalanx of the third finger, crosses the proximal phalanx of the fourth finger and ends in the hypothenar region. The patients were categorised into five groups and treatment planned accordingly. The most commonly involved digit was the third finger and the thumb the least. Surgical treatment depended on the severity of the injury and included primary closure of the lacerations, tendon repair, fixation of fractures, grafting, and local flaps. Results of these injuries are generally poor, so prevention is more important.

Paediatric hand injuries at the Lagos University teaching hospital

BACKGROUND

Paediatric hand trauma represents a subset of hand injury that can be quite challenging to manage. Local studies on this injuries are few therefore a 4 year retrospective study at the Trauma and hand rehabilitation unit of the Lagos University teaching hospital was carried out.

OBJECTIVES

To determine the percentage of hand trauma occurring in the paediatric age group, the predominant age group involved, place of injury, the major injury types occurring as well as the most common surgical procedure required.

METHODS

The case records of all cases that presented at the hand rehabilitation clinic or the emergency center of the Lagos University teaching hospital over a 4 year period were reviewed. Those below the age of 12 years were studied. Their biodata, type of injury, place of injury and other details were obtained.

RESULTS

634 patients were seen over the study period, 61 cases of hand injuries were in the paediatric age group. Hand trauma constituted less than a third of all paediatric hand cases. The commonest age group affected was 2-6 years. Most of the injuries occurred around the home. Burns injury, blunt trauma, glass and knife cuts were the commonest causes of hand trauma. Soft tissue reconstruction was commonest procedure done.

CONCLUSION

Infants and toddlers were the most vunerable groups while burns injury was the commonest cause of hand trauma seen at the Lagos university teaching hospital.

[Professional biological risk factors of health care workers]

Health care workers are attributed to the group at highest risk of biological factors, as they are daily exposed to fluids of the human body. The risk of sharps injuries and exposure to blood is associated with bloodborne infections. The aim of this study was to determine the frequency and type of professional biological risk factors, to evaluate the use of personal protective devices, application of immunoprophylaxis to health care workers in the surgical departments. METHODS. A retrospective study was carried out from January to June 2006. Data were collected in the surgical departments of Hospital of Kaunas University of Medicine. An anonymous questionnaire survey was performed. RESULTS. More than half (51.4%) of the respondents experienced sharps injuries, 62.1% were exposed to biological fluids, and 39.6% of the workers experienced both injury and exposure. In all cases, the hands were injured during sharps injuries. Exposure of healthy skin and eyes to biological fluids occurred in 63% and 20% of the cases, respectively. Majority of exposures were blood splashes (60%). Physicians most frequently experienced sharps injury during the surgery (79.3%), nurses - during the preparation of instruments (35.1%), supporting staff - disposing the waste (75.8%). Commonly physicians were injured by surgical needles (72.4%), nurses - by needlestick (72.4%), and supporting staff - by glass waste (60.6%). Majority of the respondents (86%) were not vaccinated with HB vaccine. No personal protective equipment was used by 14.5% of the respondents during sharps injuries and 5% during exposures. CONCLUSIONS. More than half of the respondents experienced sharps injury or exposure to biological fluids during the study period. Physicians and nurses experience sharps injury and exposure to biological fluids more commonly as compared to supporting staff. Hepatitis B vaccination is insufficient among health care workers.

An insight into industrial accidents involving the hand

BACKGROUND

Industrial hand injuries are a common occurrence and contributes to a large segment of workers' morbidity. The main aim of this study was to look into the day pattern, types and location of upper limbs injures, identify the types of machines involved and highlight the treatment received.

MATERIALS AND METHODS

The present study was performed on 57 industrial workers admitted and treated by the Orthopaedic team of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for acute injuries sustained whilst working.

RESULTS

The majority of the workers were male (93%). The commonest age group involved was between 25-35 years (48%). The right hand was injured more then the left with majority of injuries involving the fingers. Interestingly, we also observed that injuries occurred more on Saturdays. Laceration was the most common injury followed by fractures and crush injuries. Treatment depends on the type and severity of injuries. For most lacerated wounds, treatment was debridement, primary suturing and antibiotic therapy. Injuries on Saturdays indicated that workers needed a longer time break especially during weekends after a long hectic week.

CONCLUSIONS

Injuries sustained by workers may be prevented by proper working techniques and conditions together with wearing of protective gadgets.