The Krukenberg procedure in the bilateral amputee after electrical burn

Nine Krukenberg procedures were performed in 5 bilateral amputee patients suffering severe electrical injuries of both hands and wrists. The surgical procedure yielded functioning pincers in 7 of 9 operations. The patients could perform their daily activities very well and showed pronounced improvement in their self-confidence, self-reliance, and quality of life. The postoperative rehabilitation of these patients was not difficult. The Krukenberg procedure should be considered a substitute for prosthesis, especially in developing countries.

Fractures and ligamentous injuries of the wrist

Rapid diagnosis, appropriate management, and sport-specific rehabilitation are important in the management of any wrist injury in the athlete. The addition of technetium scans, CT, arthroscopy, and MRI in the evaluation of the athlete's wrist has provided valuable and powerful diagnostic tools. The versatility and relatively low invasiveness of arthroscopic intervention and the subsequent early return to activity make this technique especially attractive in the high-performance athlete. Suspicion of potential injuries, complete knowledge of wrist mechanics and anatomy, and a careful physical examination are still the most important tools in the evaluation of wrist injury. It is important to approach each athlete in a patient-oriented manner, taking into account the fact that many of these injuries have the potential to be career ending. Treatment that will provide the best possible long-term wrist function must be the physician's ultimate goal. In addition, the importance of appropriate and activity-specific rehabilitation cannot be overemphasized.

Rehabilitation of common athletic injuries of the hand and wrist

Rehabilitation of athletic injuries of the hand and wrist should begin at the time of injury. Early recognition and prompt medical attention can serve to minimize the initial effects of injury. A systematic evaluation should include assessment of deformity, joint instability, active and passive motion, edema, and nerve and tendon function. In spite of initial negative findings, painful joints should be protected. Joints of the hand and wrist are particularly vulnerable to the effects of aggressive rehabilitation. Signs of reaction to exercises should be closely observed. Upgrading of activity should only occur as soft-tissue healing will allow.

Early Restoration of Pinch Grip after Ulnar Nerve Repair and Tendon Transfer

Restoration of pinch in ulnar nerve lesions may be achieved within three or four weeks by a one-stage operation combining nerve repair and tendon transfer. We have been using this approach for nerve injuries of the upper limb since 1961, to meet the socio-economic needs of patients who would otherwise need splints and long-term physiotherapy. In our experience, the procedure of choice is transfer of E.I.P. to adductor pollicis and E.P.B. to the first dorsal interosseous. The operative technique and its results in 18 patients followed up for 37–515 days are discussed.

Stabilization of fractures in the hand and wrist with traumatic soft tissue and bone loss

Open type III fractures of the hand or wrist with severe bone and soft tissue loss justify aggressive treatment to restore anatomy, assure healing, and maximize functional recovery. The techniques of modern wound excision used at initial surgery predictably result in a decompressed and surgically clean wound within a few days from injury in the vast majority of cases. This allows a safe application of delayed primary internal fixation and bone grafting for fracture restoration or joint arthrodesis as well as early wound closure or coverage. The immediate or early application of stable external devices, internal fixation, or combinations of the two along with early bone grafting restores the structural integrity of the skeleton, reduces pain, protects other repaired and reconstructed tissues, promotes the healing, and supports early and intensive functional rehabilitation of the hand and wrist. Early wound closure or coverage minimizes scar formation. Together, the early sequencing of effective wound debridement with skeletal stabilization and bone grafting and early wound closure or coverage provide the most favorable circumstances for healing and functional recovery of the seriously damaged hand and wrist.

Coordinated teamwork in California industrial rehabilitation

This article describes a case study of an industrially produced hand injury that exemplifies the coordination and teamwork involved in vocational rehabilitation in the California Workers' Compensation system. This patient required multiple tendon and nerve transplant operations done with microsurgical techniques, hand therapy for functional and sensory retraining, job analysis, vocational evaluation, labor market survey, work-hardening experience, and an on-the-job training program to effect a successful outcome. An overview of the current status of the California Workers' Compensation system and current insurance perspectives are discussed.

[Effectiveness of the rehabilitation of patients with combined injuries of the flexor tendons and nerves of the fingers]

On the basis of a comparative analysis of results of the early (71 patients) and late (128 patients) rehabilitative treatment of injured tendons of flexors and nerves at the level of the lower third of the forearm and hand articulation it was established that early treatment resulted in more complete restoration of the extremity function and working capacity of the patients.

Low profile dynamic splinting of the injured hand

Dynamic splinting is a well-accepted modality in gaining joint motion in the injured hand. Presented is a splinting design system referred to as "low profile" dynamic splinting whereby high outriggers are avoided. A review of the literature reveals that this technique is based on the original design approach used by Dr. Sterling Bunnell. Described are the basic principles of the low profile design system, with illustrations of the system in specific splints and specific construction details. This splinting system is indicated for a stiff hand that has sustained direct trauma. Hands with a muscle imbalance secondary to a central nervous system or peripheral nerve lesion require a different splinting approach, which is not within the scope of this paper.

Rehabilitation of an electrical burn patient through thermal biofeedback

A 22-year-old male subject, with high-voltage electrical burns to one wrist, utilized differential relaxation and visual biofeedback to increase skin temperature in the damaged hand. Through 14 thermal biofeedback and passive relaxation sessions, the subject was able to produce temperature increases in his damaged hand of up to 21 degrees F, which considerably diminished the pain. Healing, feeling, and movement control seemed to progress with extreme rapidity, suggesting that axoplasmic transport was greatly enhanced.

Evaluation of the results of treatment of soft tissue injury

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