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Barbat P, Henry AS, Pop A, Claudic Y, Saraoui W, Hu W. [Macroreplantation of the upper extremity: Inventory in 2024]. ANN CHIR PLAST ESTH 2024; 69:355-375. [PMID: 38997852 DOI: 10.1016/j.anplas.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
Macro-amputations are extremely serious traumas and represent one of the rare extreme emergencies in hand and upper limb surgery. Their rarity, especially in our developed countries, makes their treatment relatively unknown by surgical and anesthetic teams. However, the action plan to use during a macro-reimplantation, the decisive elements of pre- and post-operative management, and the key stages of the surgery, must be perfectly known, because they determine the success of a major reimplantation, for the limb survival and the future functional result. After a brief historical overview, the literature review proposed here provides an opportunity for an update on these formidable injuries and propose a treatment algorithm to guide the medical team in the management of these complex patients.
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Affiliation(s)
- Pierre Barbat
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - Anne Sophie Henry
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - Anastasia Pop
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - Yannis Claudic
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - Wyçal Saraoui
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - Weiguo Hu
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
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Yang K, Jiuzheng Deng, Pan Y, Yuan Y, Duan G, Zhu J. Secondary Thumb Reconstruction via Ectopic Banking of Bony Phalanges From a Nonreplantable Amputated Thumb: A Follow-Up Study. J Hand Surg Am 2024; 49:607.e1-607.e7. [PMID: 36038426 DOI: 10.1016/j.jhsa.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/14/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate the radiological and functional results of secondary thumb reconstruction via ectopic banking of bony phalanges from a nonreplantable amputated thumb. METHODS Thumb reconstruction was performed using the bony phalanges from a nonreplantable amputated thumb that were ectopically banked in a subcutaneous pocket. A wraparound flap was harvested from the ipsilateral great toe and wrapped around the bone graft. After surgery, the results were assessed in terms of infection, range of motion, bone union of the graft, and signs of osseous resorption of the reconstructed thumb. RESULTS Fifteen patients underwent secondary thumb reconstruction using this technique between January 2003 and October 2018. Ten patients were followed up for at least 6 months (6 months to 9 years) and were included in this study. All wraparound flap transfers were viable. No bone graft infection was observed. In the 6 cases in whom the interphalangeal joint was not fused, the interphalangeal joint motion ranged from 5° to 60° with an average of 35.0° ± 15.1°. The metacarpophalangeal joint motion ranged from 5° to 66°, with an average range of motion of 48.2° ± 23.6° for the cases in whom the joint was not fused. In 8 of the 10 patients, the time of bone ectopic banking was within 10 days. In these patients, bone union with no osseous atrophy was observed. In 2 patients whose phalanx was banked for more than a month, different degrees of bone resorption of the grafted phalanx were evident after transplantation, although no further treatment was required. CONCLUSIONS Bony phalanges from a nonreplantable amputated thumb can be ectopically banked and used for secondary reconstruction of the thumb. The duration of banking before thumb reconstruction should be no more than 2 weeks. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Kai Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiuzheng Deng
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yongwei Pan
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Ye Yuan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guman Duan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jianjin Zhu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Renfro KN, Eckhoff MD, Trevizo GAG, Dunn JC. Traumatic Finger Amputations: Epidemiology and Mechanism of Injury, 2010-2019. Hand (N Y) 2024; 19:278-285. [PMID: 36154498 PMCID: PMC10953531 DOI: 10.1177/15589447221122826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Traumatic finger amputations are a common and well-known hand injury, yet there are few studies addressing long-term epidemiologic data and associated mechanisms of injury. This paper aims to use a large national database to identify the relationship of patient demographics and mechanism of injury in finger amputations. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for finger amputations in the United States from 2010 to 2019. Patient demographic information was collected and analyzed by gender, race, age, and further statistical analysis was performed to determine correlations with consumer products. RESULTS Finger amputations accounted for an estimated 234,304 emergency department visits from 2010 to 2019. Most of the patients were male (79%) and identified as white (46.2%). The most commonly implicated products overall were power saws and related power tools, followed by doors and then lawn mowers. A bimodal age incidence was observed with the highest incidence rates occurring in children ages 0 to 4, followed by a second peak incidence rate in the adults ages 65 to 74. The most common mechanisms of injury were found to differ in patients less than 19 and those 20 and over. CONCLUSION Traumatic finger amputations have a bimodal incidence with changing epidemiology and mechanism of injury with age. The first peak occurs from ages 0 to 4, involves predominantly doors, and has a male to female ratio of 1.30. The second peak occurs from ages 65 to 74, involves mostly power saws, and has a male to female ratio of 6.68. LEVEL OF EVIDENCE Prognostic, Level IV.
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Affiliation(s)
| | | | | | - John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
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Rob E, Druel T, Jalaguier T, Walch A, Gazarian A. Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap. J Hand Surg Eur Vol 2023; 48:920-925. [PMID: 37211794 DOI: 10.1177/17531934231172081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap.Level of evidence: IV.
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Affiliation(s)
- Edouard Rob
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
- Service de chirurgie orthopédique, Hôpital Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Thibault Druel
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Jalaguier
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
| | - Arnaud Walch
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
- Service de chirurgie orthopédique, Hôpital Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Aram Gazarian
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
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BATTISTON B, FACCENDA C, FULCHIGNONI C, ADANI R, ZOCCOLAN A, BRAGHIROLI L, FONZONE CACCESE A, DE VITIS R, CATENA N, TOS P. Indications to upper and lower limb replantations. MINERVA ORTHOPEDICS 2023; 74. [DOI: 10.23736/s2784-8469.23.04310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2024]
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Maslow JI, LeMone A, Scarola GT, Loeffler BJ, Gaston RG. Digital Nerve Management and Neuroma Prevention in Hand Amputations. Hand (N Y) 2023; 18:838-844. [PMID: 35130747 PMCID: PMC10336821 DOI: 10.1177/15589447211065074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation. METHODS All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores. RESULTS A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas (P < .01). CONCLUSIONS Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker's compensations status were significantly associated with symptomatic neuroma formation.
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Affiliation(s)
- Jed I. Maslow
- Vanderbilt Orthopaedic Institute, Nashville, TN, USA
| | | | | | - Bryan J. Loeffler
- OrthoCarolina Hand Center, Charlotte, USA
- Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - R. Glenn Gaston
- OrthoCarolina Hand Center, Charlotte, USA
- Atrium Musculoskeletal Institute, Charlotte, NC, USA
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Kim GM, Powell JE, Lacey SA, Butkus JA, Smith DG. Current and emerging prostheses for partial hand amputation: A narrative review. PM R 2023; 15:392-401. [PMID: 35038226 DOI: 10.1002/pmrj.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
Partial hand amputation can have a tremendous range of impact and functional loss on a person's life. One solution to improve function and address some of the problems that partial hand amputees face is to fit them with a prosthesis. Partial hand prosthetic devices range in a wide spectrum in both function and aesthetics. At this time, there is no one, perfect prosthetic device that can replace what is lost. Many individuals with partial hand amputation require more than one prosthetic device. In this review article, we explored and compared several prosthetic options that have been investigated and marketed by researchers and companies. Some of these options include passive, body-powered, activity-specific, and externally-powered prostheses. Lastly, we described our experiences with partial hand prostheses at Walter Reed National Military Medical Center.
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Affiliation(s)
- Gabriel M Kim
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jordan E Powell
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sean A Lacey
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Josef A Butkus
- Occupational Therapy Service, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Douglas G Smith
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedic Surgery at the University of Washington, Seattle, Washington, USA
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Góngora Rodríguez E, Guirao Cano L, Samitier Pastor B. [Update on prosthesis for partial hand and finger amputations]. Rehabilitacion (Madr) 2022; 56:375-382. [PMID: 35641345 DOI: 10.1016/j.rh.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Partial hand and finger amputations are relatively rare but devastating due to the consequences they provoque. In addition, they are more likely than lower limb amputations in car accidents, work accidents and by certain weapons of war. Men are going to have a much higher risk of traumatic amputation than women, with a rate 6.6 times higher. Fitting can be a complex process and a challenge for professionals. For this reason, it is important to know all the options available on the market that can meet the needs of patients, from cosmetic to myoelectric prostheses. Fitting requires the coordinated activity of a multiassistant clinical work team, the center of the team being the person who has suffered the amputation, who must have all the information possible to be able to actively participate in decision-making.
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Affiliation(s)
- E Góngora Rodríguez
- Servicio de Rehabilitación, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - L Guirao Cano
- Servicio de Rehabilitación, Hospital Asepeyo Sant Cugat, Sant Cugat del Vallès, Barcelona, España
| | - B Samitier Pastor
- Servicio de Rehabilitación, Hospital Asepeyo Sant Cugat, Sant Cugat del Vallès, Barcelona, España
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Karahan G, Yamak K, Demirkoparan M, Altay T, Kucuk L. An uncommon injury: Motorcycle chain injury of the hand, its socioeconomic outcome, and prevention. Orthop Traumatol Surg Res 2022; 108:102800. [PMID: 33383185 DOI: 10.1016/j.otsr.2020.102800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of the study was to define the characteristics of motorcycle chain injuries leading to serious limb loss, evaluating its socioeconomic outcome. HYPOTHESIS The severity of injury with motorcycle chain is associated with hospitalization day and morbidity. MATERIAL AND METHODS Total of 3486 patients applied to the two Centers of the Hand Surgery Clinic and 42 of them with injuries originating from squeezed hands between the motorcycle chain and the rear sprocket were included. Injured extremities were evaluated with the MHISS. In the retrospective analyses, patients were divided into groups according to the severity of injury and compared and patients who underwent replantation, flap and primary repair treatment protocols were also compared. RESULTS The number of patients with dominant hand injuries was 33 patients (78.5%). Inquiry of education level revealed that 24 (57.1%) patients graduated from primary school. According to MHISS, 76.2% of patients had major and severe injuries (mean: 95.05). Mean hospitalization time was 2.83 (range: 1-8) days. Mean time to returning to work was 2.71 (range: 1-5) months. The hospitalization days and return to work were longer in patients have major injury according to MHISS (p=0.006). The necrosis was observed three of the 9 (33.3%) replanted fingers. Flap necrosis was observed in two of the 15 (13.3%) cases. DISCUSSIONS Most of these injuries are severe and major according to MHISS. As the severity of the injury increases, the duration of hospital stay and the return to work are prolonged. LEVEL OF EVIDENCE IV; Economic/Decision Analysis.
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Affiliation(s)
- Gokhan Karahan
- Bozyaka Education and Research Hospital, Orthopedics and Traumatology Department, Karabaglar 35000, Izmir, Turkey.
| | - Kamil Yamak
- Bozyaka Education and Research Hospital, Orthopedics and Traumatology Department, Karabaglar 35000, Izmir, Turkey
| | | | - Taskin Altay
- Bozyaka Education and Research Hospital, Orthopedics and Traumatology Department, Karabaglar 35000, Izmir, Turkey
| | - Levent Kucuk
- University Faculty of Medicine, Orthopedics and Traumatology Hand Surgery Department, Izmir, Turkey
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Shi J, Sun Y, Han Y, Chai M, Liu H, Wang J. A finite element analysis on the biomechanical performance of implant-retained finger prostheses designed for Asians. J Plast Reconstr Aesthet Surg 2022; 75:4048-4053. [DOI: 10.1016/j.bjps.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/19/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
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Plotsker E, Wolfe EM, Slavin BR, White N, Cook J, Panthaki ZJ. A characterization of home maintenance equipment-related hand and lower arm injuries. J Clin Orthop Trauma 2022; 31:101943. [PMID: 35844978 PMCID: PMC9278494 DOI: 10.1016/j.jcot.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/23/2021] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade. METHODS The National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019. Our analysis grouped patients into 10-year age groups. We defined types of appliances and injuries Chi-square tests were used to compare the most common injury mechanisms by age group. RESULTS Between 2010 and 2019, 30,336 total cases of home workshop equipment-related upper extremity injuries were recorded; 2,574 (8.48%) of these affected females, compared to 27,762 (91.52%) of the cases affecting males. Across all age groups, males were between 6 and 13 more times likely to be injured than females (p < 0.001). Between 2010 and 2019, we recorded a decline in total injuries from 168,795 to 147,584, with a Pearson correlation coefficient of -0.68 (p = 0.031). The appliances most likely to injure those in their 10s through 40s were mechanical tools such as screwdrivers. Meanwhile, those in their 50s through 70s were most likely to be injured by saws. Both amputations and avulsions were found to significantly increase with age (p = 0.038, p = 0.027, respectively). Most injuries result from manual tools and saws. DISCUSSION Males are significantly more likely to incur injuries than females from maintenance equipment, and risk of avulsions and amputations increase significantly with age. This aligns with previous research which also suggested that older saws were most likely to injure older individuals; namely, following new regulations on saws, older adults were more likely to be affected. This is especially worrisome in light of recent research showing that older adults with amputations are less likely to be offered replantations. Overall, these results can continue to guide and optimize community interventions on an epidemiological basis.
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Maxwell J, Friedland J, Kirsh B, Beaton D. The Value Filter: A Novel Framework for Psychosocial Adjustment to Traumatic Upper Extremity Amputation. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:87-95. [PMID: 34009557 DOI: 10.1007/s10926-021-09976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
Purpose Upper extremity traumatic amputation due to work injury is a devastating injury with poor outcomes. As it does not appear to follow existing theories of psychosocial adjustment to injuries and illness, we sought to understand this problem by asking those who have sustained the injury, how they try to adjust. Methods Qualitative methods were used to interview 11 participants within 3 years of their accident. Questions included "Tell me about the impact of the amputation on your life". Data were systematically gathered and analyzed using a grounded theory (constructivist) approach which led to a preliminary model of adjustment. Results The Value of the Hand, and the Value of Working and Doing, emerged as central phenomena and created a Value Filter through which our participants' new experiences were interpreted. Two interacting themes, Instability of the Core Identity, and Efforts to Stabilize the Self, describe the effects of the process which either interfered with or promoted the formation of new values that, in turn, could lead to adjustment. Conclusions The preliminary model helps explain psychosocial adjustment for individuals with a traumatic upper extremity amputation due to work injury. The model may also be useful with other acquired injuries where the lost body part was deemed highly valuable for the individual's sense of self.
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Affiliation(s)
- Joanne Maxwell
- Holland Bloorview Kids Rehabilitation Hospital, 50 Kilgour Road, Toronto, ON, M4G 1R8, Canada.
| | - Judith Friedland
- Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Bonnie Kirsh
- Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Dorcas Beaton
- Institute of Work and Health, 400 University Ave Suite 1800, Toronto, ON, M5G 1S5, Canada
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Gao C, Yang L, Ju J, Gao Y, Zhang K, Wu M, Yang L, Lu X, Hou R, Guo Q. Risk and prognostic factors of replantation failure in patients with severe traumatic major limb mutilation. Eur J Trauma Emerg Surg 2022; 48:3203-3210. [PMID: 35050386 PMCID: PMC9360147 DOI: 10.1007/s00068-021-01876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/04/2021] [Indexed: 11/06/2022]
Abstract
Purpose Traumatic mutilation of major limbs can result in limb loss, motor disability, or death. Patients who had replantation failure needed to undergo additional surgeries (even amputation) and had a longer length of hospital stay. Here, we determined the risk and prognostic factors of replantation failure in patients with traumatic major limb mutilation. Methods This retrospective study included adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group from October 18, 2016 to July 31, 2020. Demographic, and clinical characteristics including traumatic conditions, laboratory findings, mangled extremity severity scores (MESS), treatments, and outcomes of the patients were collected. Data were used to analyze predictors and risk factors for replantation failure. Results Among the 66 patients, 48 (72.7%) were males, the median age was 47.0 years old. Replantation failure occurred in 48 patients (72.7%). The area under the curve of the joint prediction of lactic acid on admission, 72-h cumulative fluid balance, and albumin level immediately postoperatively was 0.838 (95% confidence interval [CI], 0.722–0.954; P < 0.001) with a sensitivity of 89.7% and a specificity of 69.2%. Lower limb trauma (odds ratio [OR] 8.65, 95% CI 1.64–45.56, P = 0.011), mangled extremity severity scores (OR 2.24, 95% CI 1.25–4.01, P = 0.007), and first 72-h cumulative fluid balance > 4885.6 mL (OR 10.25, 95% CI 1.37–76.93, P = 0.024) were independent risk factors for replantation failure. Conclusions Lower limb trauma, mangled extremity severity scores, and cumulative water balance were associated with replantation failure, implying that fluid management is necessary for major limb salvage. More studies are needed to explore the predictive power of indicators related to tissue oxygenation and wound healing for replantation failure. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01876-w.
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Affiliation(s)
- Chang Gao
- Department of Emergency and Critical Care Medicine, Dushu Lake Hospital Affiliated to Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
- Medical Center of Soochow University, Suzhou, Jiangsu, China
| | - Ling Yang
- Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jihui Ju
- Department of Orthopaedic, Ruihua Affiliated Hospital of Soochow University (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China
| | - Ye Gao
- Department of Critical Care Medicine, Taicang Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Keran Zhang
- Department of Critical Care Medicine, Ruihua Affiliated Hospital of Soochow University (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China
| | - Mingming Wu
- Department of Critical Care Rehabilitation Medicine, Suzhou Ruisheng Rehabilitation Hospital (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China
| | - Lijuan Yang
- Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoting Lu
- Department of Emergency and Critical Care Medicine, Dushu Lake Hospital Affiliated to Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China
- Medical Center of Soochow University, Suzhou, Jiangsu, China
| | - Ruixing Hou
- Department of Orthopaedic, Ruihua Affiliated Hospital of Soochow University (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China.
| | - Qiang Guo
- Department of Emergency and Critical Care Medicine, Dushu Lake Hospital Affiliated to Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China.
- Medical Center of Soochow University, Suzhou, Jiangsu, China.
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Pomares G, Coudane H, Dap F, Dautel G. Secondary finger amputation after a work accident. Orthop Traumatol Surg Res 2021; 107:102968. [PMID: 34033921 DOI: 10.1016/j.otsr.2021.102968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The main aim of the present study was to compare motives between patients requesting secondary finger amputation following or unrelated to a work accident. The secondary objective was to assess correlation between sick leave duration and motive for amputation following a work accident. METHOD A single-center retrospective study was conducted over an 11-year period in a hand clinic. Cases of secondary totalizing post-traumatic finger amputation at metacarpal base level were included. Exclusion criteria comprised non-traumatic amputation, age<16 years and thumb amputation. In all, 216 patients met the inclusion criteria. The main endpoints assessed motives in requests for secondary metacarpal base amputation: esthetic, functional or administrative. Secondary endpoints comprised accident-to-surgery interval, gender and age, amputated digit and dominant-side involvement. RESULTS Motive correlated significantly with gender (p<0.05). Administrative motives almost exclusively concerned males (21 males, 1 female) and predominantly concerned work accidents (19 vs. 3). Accident-to-surgery intervals were significantly longer in case of administrative motive (25.7 months, vs. 10.8 months for functional and 9 months for esthetic motives). Accident-to-surgery intervals were significantly longer in case of work accidents (15.2 vs. 9.5 months). DISCUSSION Age and gender influenced patients' attitudes in post-traumatic finger amputation. Work-accident status influenced attitudes in a quarter of cases; we consider it unlikely that this can be reduced to claims for compensation, but that it is rather a matter of undiagnosed pathological grief. These findings highlight the importance of early follow-up of victims of traumatic amputation and early screening for pathological grief.
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Affiliation(s)
| | | | - François Dap
- Pôle médico-chirurgical central, centre hospitalier universitaire de Nancy, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Gilles Dautel
- Centre chirurgical Emile Gallé, 49, rue Hermite, 54000 Nancy, France
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15
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Estoppey D, Pomares G, Jager T. Long-term outcome of a "short" anterograde homodigital neurovascular island flap with a simple or double V-Y plasty. Orthop Traumatol Surg Res 2021; 107:102981. [PMID: 34102334 DOI: 10.1016/j.otsr.2021.102981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/11/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterograde homodigital neurovascular island flaps are very useful for reconstructing proximal fingertip amputations with exposed bone but have the disadvantage of bringing about proximal interphalangeal joint (PIPJ) stiffness. The addition of a single or double V-Y plasty increases mobility without having to extend the dissection beyond the PIPJ. The purpose of this study was to examine the long-term functional outcome of patients who received a "short" anterograde homodigital neurovascular island flap with a single or double V-Y plasty. Our primary hypothesis was that this flap did not induce PIPJ stiffness and our secondary hypothesis was that it preserved good fingertip sensation. MATERIALS AND METHODS This was a retrospective study of patients operated between August 2017 and February 2019. The inclusion criteria were the following: a fingertip amputation caused by either a crush or laceration injury with exposed bone, treated during the acute phase of the injury or for secondary necrosis (attempted replantation or subtotal amputation) and classified as type II oblique palmar, type III or type IV amputations according to the Allen classification system. The assessment criteria were: joint mobility, sensory evaluation with the two-point discrimination and Semmes-Weinstein monofilament tests, time to healing, postoperative complications, postoperative splinting, duration of work stoppage, perioperative smoking, cold intolerance, touch hypersensitivity, nail deformity and excluded finger. RESULTS Nine patients (mean age 53.9 years [32-67]) were operated, of which eight long fingers and one thumb. One procedure was complicated by skin flap necrosis. At the mean follow-up of 22.4 months [16-31], the mean mobility for the metacarpophalangeal joint (MCPJ), proximal interphalangeal joint and distal interphalangeal joint (DIPJ) were 92-0-0°, 97.8-1.5-0° and 60.3-6.8-0°, respectively. In comparison to the contralateral side, a significant difference was only detected in the DIPJs. The mean two-point discrimination in the proximal portion of the flaps were 7.1mm on the ulnar side (p<0.05) and 7.6mm on the radial side (p<0.01), while in the distal portion they were 7.3mm (p<0.01) and 7.8mm (p<0.01). The Semmes-Weinstein monofilament test also detected significantly reduced sensation. CONCLUSION The combination of a "short" anterograde homodigital neurovascular island flap with a single or double V-Y plasty seems to avoid PIPJ stiffening while preserving good fingertip sensation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Daniel Estoppey
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg.
| | - Germain Pomares
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg
| | - Thomas Jager
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg
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16
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Blum AG, van Holsbeeck MT, Bianchi S. Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions. Semin Musculoskelet Radiol 2021; 25:355-365. [PMID: 34450660 DOI: 10.1055/s-0041-1730414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.
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Affiliation(s)
- Alain G Blum
- Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France.,Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
| | | | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, Geneva, Switzerland.,Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva 14, Switzerland
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17
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Bao B, Wei H, Luo P, Zhu H, Hu W, Sun Y, Shen J, Zhu T, Lin J, Huang T, Li J, Wang Z, Li Y, Zheng X. Parietal Lobe Reorganization and Widespread Functional Connectivity Integration in Upper-Limb Amputees: A rs-fMRI Study. Front Neurosci 2021; 15:704079. [PMID: 34354568 PMCID: PMC8329664 DOI: 10.3389/fnins.2021.704079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
The right parietal lobe plays an important role in body image, and disorders of body image emerge after lesions in the parietal lobe or with parietal lobe epilepsy. Body image disorder also often accompanies upper-limb amputation, in which the patient misperceives that their missing limb is still part of their body. Cortical reorganization is known to occur after upper-limb amputation, but it is not clear how widespread and to what degree functional connectivity (FC) is reorganized post-amputation, nor whether such changes might be related to misperceptions of body image. Twenty-four subjects who had a traumatically upper-limb amputees (ULAs) and 24 age-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. Regions of interest (ROIs) in the right superior parietal gyrus (SPG_R) and right inferior parietal lobule (IPL_R) were defined using BrainNet Viewer. We calculated the amplitude of low-frequency fluctuations (ALFF) in ROIs and correlated the ROI mean amplitude of low-frequency fluctuations (mALFF) and mean scores on the phantom limb sensation (PLS) scale and beck depression index (BDI). We also calculated ROIs and whole-brain FC. Compared to the HC group, we observed significantly increased activation (mALFF) in ROIs of the ULA group. Moreover, correlation analyses revealed a significant positive correlation between ROI mALFF and scores on the PLS. There was a significant negative correlation between the SPG_R mALFF and BDI scores. Seed-based, whole-brain FC analysis revealed that FC in the ULA group significantly decreased in many brain regions across the entire brain. The right parietal lobe appears to be involved in some aspect of body awareness and depression in amputation patients. Upper-limb amputation results not only in reorganization in the local brain area formerly representing the missing limb, but also results in more widespread reorganization through FC changes in whole brain.
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Affiliation(s)
- Bingbo Bao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haifeng Wei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pengbo Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongyi Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wencheng Hu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Sun
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tianhao Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junqing Lin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tengli Huang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhibin Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xianyou Zheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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18
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Webster JB, Webster N, Borgia M, Resnik L. Frequency, severity, and implications of shoulder pain in people with major upper limb amputation who use prostheses: Results of a National Study. PM R 2021; 14:901-912. [PMID: 34219397 DOI: 10.1002/pmrj.12666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with upper limb amputation are potentially at increased risk of shoulder pain because they often perform compensatory movements to operate their prostheses and rely more heavily on their nonamputated limb for everyday activities. OBJECTIVE To describe the frequency, severity, associated factors, and implications of shoulder pain in people with unilateral major upper limb amputation who use prostheses. DESIGN Cross-sectional, observational design. SETTING National recruitment of people living in the community. PARTICIPANTS U.S. veterans and civilians (N = 107) with unilateral major upper limb amputation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Shoulder pain (any, ipsilateral and contralateral to amputation), activity performance (Activities Measure for Upper Limb Amputation), health-related quality of life (Veterans RAND 12-Item Health Survey mental component summary [MCS] and physical component summary [PCS]), and disability (Quick Version of the Disabilities of the Arm, Shoulder and Hand Score [QuickDASH]). RESULTS All participants completed a comprehensive in-person assessment. Participants were 97% male with a mean age of 57.1 years and a mean time since amputation of 23.4 years. The prevalence of any shoulder pain was 30% (15% ipsilateral, 25% contralateral, 10% bilateral). Shoulder pain intensity (0 to 10 scale) was moderate for both ipsilateral (mean 4.9, SD 2.0) and contralateral (mean 4.2, SD 2.0) pain. No significant difference in shoulder pain frequency was observed by amputation level. The prevalence of any shoulder pain was greater in those using a body-powered prosthesis (38% compared to 18% in externally powered users). Each additional year since amputation was associated with an increased likelihood of having contralateral shoulder pain (odds ratio: 1.05, confidence interval: 1.01, 1.10). In linear regression models, those with contralateral shoulder pain had worse PCS (β = -7.07, p = .008) and worse QuickDASH (β = 18.25, p < .001) scores. CONCLUSIONS In our sample of predominantly male veterans with major upper limb amputation, shoulder pain was a common condition associated with functional and quality of life implications. Among prosthesis users, the shoulder contralateral to the amputation was at greatest risk, with risk increasing with every year since amputation.
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Affiliation(s)
- Joseph B Webster
- Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University, Richmond, Virginia, USA.,Physical Medicine and Rehabilitation, Central Virginia VA Healthcare System, Richmond, Virginia, USA
| | | | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Linda Resnik
- Research Department, Providence VA Medical Center, Providence, Rhode Island, USA.,Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA
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19
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Boutrous ML, Tian Y, Brown D, Freeman CA, Smeds MR. Area Deprivation Index Score is Associated with Lower Rates of Long Term Follow-up after Upper Extremity Vascular Injuries. Ann Vasc Surg 2021; 75:102-108. [PMID: 33910047 DOI: 10.1016/j.avsg.2021.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
The Area Deprivation Index (ADI) has been shown to be a determinant of healthcare outcomes in both medical and surgical fields, and is a measure of the socioeconomic status of patients. We sought to analyze outcomes in patients with upper extremity vascular injuries that were admitted over a five-year period to a Level I trauma center sorted by ADI. All patients with upper extremity vascular injury presenting to a level one trauma center between January 2013 and January 2017 were retrospectively collected. The patients were divided into two groups based on their ADI with the first group representing the lowest quartile of patients and the second group the higher three quartiles. Patient's demographics were analyzed as well as modes of trauma, hospital transfer status prior to receiving care, type of intervention received, follow-up rates and outcomes including both complication and amputation rates. Over this time period, a total of 88 patients with traumatic upper extremity vascular injuries were identified. The majority of injuries were due to penetrating trauma (74/88, 84%) with 41% (10/24) of patients in the lower ADI being victims of gunshot wounds compared to 27% (17/64) of those in the higher ADI (P = 0.19). Patients in the lowest ADI quartile were more likely to be African Americans (P= 0.0001), and more likely to be transferred to our university hospital prior to receiving care (P= 0.007). Arrival Glasgow Coma Scale and Injury Severity Score were similar as was time spent in the emergency room. Length of stay trended longer in the lowest ADI quartile as compared to the higher ADI (7.5 vs. 11.8, P= 0.59). The rates of long term follow-up were significantly lower in patients with the lowest ADI scores as opposed to the higher ADI group (P= 0.0098), however, there was no statistically significant difference in outcomes between the two groups including both complication and amputation rates. The ADI is associated with lower rates of long term follow-up after upper extremity vascular injuries, despite patients in both the high and low ADI groups having similar outcomes in regards to complication and amputation rates. Further study is warranted to investigate the role of the socioeconomic status in outcomes following traumatic injury.
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Affiliation(s)
- Mina L Boutrous
- Division of Vascular and Endovascular Surgery, University of Connecticut, Farmington, CT, USA.
| | - Yuqian Tian
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Daniel Brown
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Carl A Freeman
- Trauma and Surgical Critical Care Division, St. Louis University, St. Louis, MO, USA
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
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20
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Mereu F, Leone F, Gentile C, Cordella F, Gruppioni E, Zollo L. Control Strategies and Performance Assessment of Upper-Limb TMR Prostheses: A Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:1953. [PMID: 33802231 PMCID: PMC8000641 DOI: 10.3390/s21061953] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
The evolution of technological and surgical techniques has made it possible to obtain an even more intuitive control of multiple joints using advanced prosthetic systems. Targeted Muscle Reinnervation (TMR) is considered to be an innovative and relevant surgical technique for improving the prosthetic control for people with different amputation levels of the limb. Indeed, TMR surgery makes it possible to obtain reinnervated areas that act as biological amplifiers of the motor control. On the technological side, a great deal of research has been conducted in order to evaluate various types of myoelectric prosthetic control strategies, whether direct control or pattern recognition-based control. In the literature, different control performance metrics, which have been evaluated on TMR subjects, have been introduced, but no accepted reference standard defines the better strategy for evaluating the prosthetic control. Indeed, the presence of several evaluation tests that are based on different metrics makes it difficult the definition of standard guidelines for comprehending the potentiality of the proposed control systems. Additionally, there is a lack of evidence about the comparison of different evaluation approaches or the presence of guidelines on the most suitable test to proceed for a TMR patients case study. Thus, this review aims at identifying these limitations by examining the several studies in the literature on TMR subjects, with different amputation levels, and proposing a standard method for evaluating the control performance metrics.
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Affiliation(s)
- Federico Mereu
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.); (F.L.); (C.G.); (F.C.)
| | - Francesca Leone
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.); (F.L.); (C.G.); (F.C.)
| | - Cosimo Gentile
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.); (F.L.); (C.G.); (F.C.)
| | - Francesca Cordella
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.); (F.L.); (C.G.); (F.C.)
| | | | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.M.); (F.L.); (C.G.); (F.C.)
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21
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Garzón MO, Garcés M, Isaza D, Jaramillo S, Latorre V, Valderrama S. Characterization of workers covered by a risk insurance company in Colombia who suffered amputation. Rev Bras Med Trab 2020; 17:480-489. [PMID: 32685746 PMCID: PMC7363265 DOI: 10.5327/z1679443520190402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/10/2019] [Indexed: 11/05/2022] Open
Abstract
Background Scarcity of information on the sociodemographic, occupational and clinical characteristics of workers who suffer upper limb amputation hinders planning and implementing actions to improve their living and working conditions. Objective To investigate the sociodemographic, occupational and clinical characteristics of workers covered by a risk insurance company in Colombia who suffered upper limb amputations and investigate their association with risk categories. Methods Exploratory, descriptive, retrospective and analytical study of data relative to workers covered by a risk insurance company in Colombia who suffered upper limb amputation in the period from 1982 and 2017. Following approval by School of Medicine, CES University, and a risk insurance company, we developed a checklist to collect data on the variables of interest. We performed descriptive and bivariate analysis with 95% of confidence and error of 5%. Results The largest proportion of workers who suffered amputation were men aged 36 to 55 years old and residing in the Andean region of Colombia. Amputations mainly followed incidents during the performance of tasks, particularly in jobs in the secondary economic sector and classified as with type 3 risk. Conclusion We were able to identify some characteristics associated with accidents, including age, risk class, economic sector, care received and disability duration. The results point to the need for appropriate interventions for the benefit of workers and risk insurance companies.
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Affiliation(s)
- María Osley Garzón
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
| | - María Garcés
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
| | - Daniela Isaza
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
| | - Susana Jaramillo
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
| | - Valentina Latorre
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
| | - Sara Valderrama
- Doctor in Epidemiology and Biostatistics. Research Teacher. School of Medicine, CES University - Medellín, Colombia. Universidad CES School of Medicine CES University Colombia
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22
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Pyörny J, Huttunen TT, Mattila VM, Jokihaara J. Upper extremity replantation and revascularization in Finland between 1998 and 2016. J Plast Surg Hand Surg 2020; 54:297-301. [PMID: 32498580 DOI: 10.1080/2000656x.2020.1771720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emergency replantation and revascularization operations of upper extremity injuries demand considerable resources, but their actual occurrence is unknown. This study evaluated all emergency replantations and revascularizations in the upper extremity in Finland from 1998 to 2016. A total of 2,434 operations were identified within the study period. The average number of operations per year was 128 which corresponds with 2.4 operations per 100,000 person years. Operations were most common in persons aged 20 to 59 years and the rate of operations ranged from 1.4 to 5.0 per 100,000 person years. Thirteen percent of the patients were women and 87% were men. This study shows rates of emergency replantation and revascularization operations in upper extremity injuries and proves that the rates have been constant over the past 19 years in Finland.
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Affiliation(s)
- Joonas Pyörny
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Emergency, Anesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland.,The Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,COXA Hospital for Joint Replacement, Tampere, Finland.,Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
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23
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Tsoulou V, Karamolegou E, Kourakos M, Vasilopoulos G, Polikandrioti M. Association of State and Trait Anxiety Between Patients Who Had Undergone Traumatic Amputation and Their Family Caregivers. INT J LOW EXTR WOUND 2019; 18:176-185. [PMID: 31096796 DOI: 10.1177/1534734619848580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.
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