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Tamulevicius M, Bucher F, Dastagir N, Maerz V, Vogt PM, Dastagir K. Demographic shifts reshaping the landscape of hand trauma: a comprehensive single-center analysis of changing trends in hand injuries from 2007 to 2022. Inj Epidemiol 2024; 11:25. [PMID: 38872185 PMCID: PMC11170831 DOI: 10.1186/s40621-024-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Hand injuries constitute up to 30% of the total cases treated in emergency departments. Over time, demographic changes, especially an aging population, and shifts in workplace safety regulations and healthcare policies have significantly impacted the landscape of hand trauma. This study aims to identify and analyze these evolving trends over nearly two decades. METHODS In this retrospective, cross-sectional study, we investigated patients who were admitted to the high-volume regional hand trauma center of a university hospital between January 2007 and December 2022. We analyzed trends in patients' demographics and annual alterations of injuries. For the comparative analysis, patients were divided into two groups based on the time of presentation: the early cohort (2007-2014) and the current cohort (2015-2022). RESULTS A total of 14,414 patients were admitted to our emergency department within the study period. A significant annual increase in patient age was identified (R2 = 0.254, p = 0.047). The number of presentations increased annually by an average of 2% (p < 0.001). The incidence of the following hand injuries significantly increased: sprains/strains (+ 70.51%, p = 0.004), superficial lacerations (+ 53.99%, p < 0.001), joint dislocations (+ 51.28%, p < 0.001), fractures (carpal: + 49.25%, p = 0.003; noncarpal: + 39.18%, p < 0.001), deep lacerations (+ 37.16%, p < 0.001) and burns and corrosions (+ 29.45%, p < 0.001). However, rates of amputations decreased significantly (- 22.09%, p = 0.04). CONCLUSIONS A consistent and significant annual increase in both the total number of injuries and the average age of patients was identified. An aging population may increase injury rates and comorbidities, stressing healthcare resources. Our study underscores the need to adapt healthcare structures and reimbursement policies, especially for outpatient hand injury care.
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Affiliation(s)
- Martynas Tamulevicius
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Florian Bucher
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nadjib Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Vincent Maerz
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Vasdeki D, Barmpitsioti A, De Leo A, Dailiana Z. HOW TO PREVENT HAND INJURIES - REVIEW OF EPIDEMIOLOGICAL DATA IS THE FIRST STEP IN HEALTH CARE MANAGEMENT. Injury 2024; 55:111327. [PMID: 38281348 DOI: 10.1016/j.injury.2024.111327] [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: 04/25/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Hand injuries are common affecting all ages, genders, and geographic regions. They can result in long term disability and mortality, while they place a significant financial burden in society. Although, hand injuries can be prevented. Preventive strategies can be designed, but knowledge of injuries' epidemiological characteristics is required beforehand. METHODS We performed a review of the current literature related to hand injuries to identify their incidence, patients' demographics, type, mode, and time of the injury. RESULTS Hand injuries constitute 6.6% to 28.6% of all injuries presenting to the Emergency Department and 28% of injuries to the musculoskeletal system. They mainly affect young male labourers. Occupational and home accidents are the commonest injury modalities, while traffic road accidents constitute a significant reason for hand injuries as well. Lacerations account for most hand injuries, followed by crush injuries, fractures and amputations. Most occupational injuries occur in the beginning of the week and especially during the morning shift, while there has been identified an increase in the number of hand injuries during the summer months. CONCLUSIONS Hand injuries are an important health problem with impact on patient's life and on the society. Although they can be prevented. Preventive strategies need to be addressed towards many directions and people's activities, since prevention will have an important impact on people's quality of life and society's well-being.
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Affiliation(s)
- Dionysia Vasdeki
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece.
| | - Antonia Barmpitsioti
- 1st Department of Orthopaedic Surgery, KAT General hospital, Kifisia, Athens 14561, Greece
| | - Anna De Leo
- Department of Plastic Surgery, The London Welbeck Hospital, London W1G 8EN, United Kingdom
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece; Department of Hand, Upper Extremity Surgery and Microsurgery, Iaso Thessalias, Nikaia, Larissa 41500, Greece
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Karzon AL, Nazzal EM, Cooke HL, Heo K, Okonma O, Worden J, Hussain Z, Chung KC, Gottschalk MB, Wagner ER. Upper Extremity Fractures in the Emergency Department: A Database Analysis of National Trends in the United States. Hand (N Y) 2024:15589447231219286. [PMID: 38264985 DOI: 10.1177/15589447231219286] [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] [Indexed: 01/25/2024]
Abstract
BACKGROUND Upper extremity (UE) fractures are a common reason for emergency department (ED) visits, but recent data on their epidemiology are lacking. This study aimed to describe the incidence, demographics, patient characteristics, and associated health care factors of UE fractures, hypothesizing that they would remain prevalent in the ED setting. METHODS Using the Nationwide ED Sample database, patients presenting to the ED with UE fractures in 2016 were identified, and population estimates were used to calculate incidence rates. Data on insurance status, trauma designation, cost, and teaching status were analyzed. RESULTS The study identified 2 118 568 patients with UE fractures, representing 1.5% of all ED visits in 2016. Men accounted for 54.2% of UE fractures, with phalangeal fractures being most common. Distal radius and/or ulna fractures were most common in women (30.4%). The greatest proportion of UE fractures (23.2%) occurred in patients aged 5 to 14 years (1195.5 per 100 000). Nontrauma centers were the most common treating institutions (50.4%), followed by level I (19.5%), II (15.3%), and III (12.8%) centers. The greatest proportion of fractures (38.3%) occurred in the southern United States. Emergency department cost of treatment was almost 2-fold in patients with open UE fractures compared with closed. CONCLUSION This study provides important epidemiological information on UE fractures in 2016. The incidence rate of UE fractures in the ED has remained high, with most occurring in the distal radius, phalanges, and clavicle. In addition, UE fractures were most common in younger patients, men, and those in the southern United States during the summer. These findings can be useful for health care providers and policymakers when evaluating and treating patients with UE fractures.
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Affiliation(s)
| | | | | | - Kevin Heo
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Kevin C Chung
- University of Michigan Medical School, Ann Arbor, USA
| | | | - Eric R Wagner
- Emory University School of Medicine, Atlanta, GA, USA
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Fulchignoni C, Covino M, Pietramala S, Lopez I, Merendi G, De Matthaeis A, Franceschi F, Maccauro G, Rocchi L. Hand Trauma in Emergency Department Management in Older Adults ≥ 80 Years Old: A Twenty-Year Retrospective Analysis. Geriatrics (Basel) 2023; 8:112. [PMID: 37987472 PMCID: PMC10660491 DOI: 10.3390/geriatrics8060112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
The prevalence of hand injuries increases with age, with elderly patients being more prone to hand lesions due to a combination of factors, such as reduced bone density and muscle strength, impaired sensation, and cognitive impairment. Despite the high incidence of hand injuries in the elderly population, few studies have addressed the management and outcomes of hand lesions in this age group. This study aimed to analyze the characteristics and management of hand lesions in patients over 80 years old. The authors conducted a retrospective analysis of medical records of patients over 80 years old who reached their Emergency Department with hand lesions between 2001 and 2020. Data on demographics, injury characteristics, and management were collected and analyzed. A total of 991 patients with hand lesions were included in the study, with a mean age of 84.9 years. The most common causes of injuries were domestic accidents (32.6%) and traffic accidents (12.8%). The most frequent types of hand lesions were fractures (23.5%) and superficial wounds (20.5%). Overall, 23.4% underwent surgical treatment for their hand issue, and 22.1% had associated injuries, among which, the most common were head trauma and other bone fractures. In conclusion, hand lesions in patients over 80 years old are frequent and pose significant challenges in diagnosis and management. Particular attention should be paid to associated injuries and limit indications to surgery when strictly necessary.
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Affiliation(s)
- Camillo Fulchignoni
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvia Pietramala
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ivo Lopez
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianfranco Merendi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea De Matthaeis
- Orthopedics & Traumatology Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Orthopedics & Traumatology Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Rocchi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Frostadottir D, Ekman L, Zimmerman M, Andersson S, Arner M, Brogren E, Dahlin LB. Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury. Sci Rep 2022; 12:4847. [PMID: 35318398 PMCID: PMC8941129 DOI: 10.1038/s41598-022-08926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
To investigate self-reported cold sensitivity and functional disability after a repaired digital nerve injury. We identified 3204 individuals operated with digital nerve repair in the Swedish national quality registry for hand surgery (HAKIR). Patient-reported symptoms, including cold sensitivity and perceived disability, were examined using two questionnaires (HQ-8 and QuickDASH), three and 12 months postoperatively. Patients with diabetes (n = 48; 3%) were identified in the Swedish National Diabetes Register (NDR). Cold sensitivity (scored 0–100) was the most prominent symptom among 1553 included individuals (998 men, 555 women; median age 41 [IQR 27–54] years). In the regression analysis, flexor tendon injury, hand fracture and injury to multiple structures predicted worsened cold sensitivity (6.9, 15.5 and 25.0 points; p = 0.005, 0.046 and < 0.001) at 12 months. Individuals with moderate (30–70) and severe (> 70) cold sensitivity had higher QuickDASH scores at three and 12 months postoperatively than individuals with mild cold sensitivity (6.0 and 5.5; 19.8 and 21.0 points; p = 0.001). Flexor tendon injury, injuries to multiple structures and diabetes had significant effect on QuickDASH scores at three, but not at 12, months postoperatively. Cold sensitivity is common after a digital nerve repair and impacts self-reported disability. A concomitant injury, particularly multiple injuries, predicts postoperative cold sensitivity.
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Affiliation(s)
- Drifa Frostadottir
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden. .,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Linnéa Ekman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Stina Andersson
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden
| | - Marianne Arner
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Brogren
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Lund University, Jan Waldenströms gata 5, 205 02, Malmö, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
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6
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Sandler AB, Scanaliato JP, Raiciulescu S, Nesti LJ, Dunn JC. The Epidemiology of Hand and Finger Lacerations in United States Emergency Departments. J Emerg Med 2022; 62:707-715. [PMID: 35177285 DOI: 10.1016/j.jemermed.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hand and finger lacerations presenting to U.S. emergency departments (EDs) are common, although the burden of these injuries is not well understood. OBJECTIVE Our aim is to describe the epidemiology and causes of hand and finger lacerations in U.S. EDs. METHODS This National Electronic Injury Surveillance System database review investigates hand and finger lacerations presenting to EDs in the United States from 2015 to 2019. RESULTS Annually, hand and finger lacerations account for 243,844 and 587,451 ED visits, respectively. Affected patients are frequently White (70.5%), male (63.4%), and aged 18 through 44 years (46.3%). The top three products linked to hand and finger lacerations are knives (30.5%), metal containers (4.2%), and drinkware (3.8%), and men are less likely to have injuries from these products than women, especially knives (odds ratio 0.76; 95% confidence interval 0.60-0.96; p < 0.02). Although a minority of hand and finger lacerations involve alcohol (1.2%), men have greater rates of alcohol involvement than women (χ21 = 11.7; p < 0.001). Lacerations frequently occur in the home (61.3%). Many patients (44.2%) present to very large hospitals, and nearly one-half of patients younger than 5 years and one-third of patients aged 5 through 17 years present to pediatric hospitals. Most patients (97.4%) are treated and released without admission and 0.2% are transferred to another hospital. Patients with alcohol, drug, or medication involvement are more likely to leave against medical advice, be admitted, or held for observation (p < 0.001). CONCLUSIONS Hand and finger lacerations result in a significant number of ED visits. A better understanding of injury trends and presentations can guide injury prevention in manufacturing, education, and public health.
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Affiliation(s)
- Alexis B Sandler
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
| | - Sorana Raiciulescu
- Department of Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Leon J Nesti
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
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Abdellatif HA, El Aziz Maaly MA, Soltan BSHI, Abduallah MS. Role of magnetic resonance imaging on fingers in diagnosis of post-traumatic tendon and ligament injuries. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00644-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Magnetic resonance (MR) imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, the condition of tendons, the presence of a tear, the number of affected tendons, the extent of tendon retraction, and the presence of associated lesions. This study was done to clarify the value of magnetic resonance imaging (MRI) in assessment of trauma-related injuries of the tendons and ligaments of the fingers and subsequently positively affect the surgical decisions in such cases.
Results
This study included 42 patients (33 males and 9 females) with a mean age of 35 years. All of them had history of trauma. Male affection was 78.5%, while females constituted only 21.5%, striking right-sided-hand affection (92.9%). The most affected finger was the thumb. The most common affected sites were extending from the metacarpophalangeal (MCP) till the proximal interphalangeal (PIP). The tendons were affected in 42.9%; meanwhile, ligamentous affection represented 57.2%. The flexor tendon tear represented by 28.6%%, while extensor tendon tear occurred in 14.3%. The study also showed that partial thickness tear is represented by 66.7%, while complete thickness tear occurred in about 33.3%. Bone marrow edema and post-traumatic tenosynovitis occurred in about 14% of cases.
Conclusions
Magnetic resonance imaging is an essential technique to obtain a correct pre-surgical diagnosis. It is of utmost importance to possess an in-depth knowledge of finger radiological anatomy in detail, as well as the appearance of the different pathologic entities on MRI. It provides a great assessment of the tendons and ligaments tear by whether partial or complete, any associated marrow edema or bony fragment avulsion and the extent of retraction in cases of complete tear.
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8
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Green R, Uzoho C, Arrowsmith J, Bainbridge C, Johnson NA. Tool and machinery-related hand injuries: a review of national Hospital Episodes Statistics and data from a tertiary hand unit. J Hand Surg Eur Vol 2021; 46:188-192. [PMID: 32903128 DOI: 10.1177/1753193420952265] [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: 02/03/2023]
Abstract
We sought to identify national trends in tool and machinery-related hand injuries. Hospital Episodes Statistics data in England from 1998 to 2017 were analysed. Data from our hand unit from 2011 to 2017 were also reviewed to establish the types of tool and machinery causing injury. During the 19-year study period 210,291 admissions occurred as a result of tool and machinery-related injuries. The overall incidence rate and mean age increased. The largest increase in incidence rate was in the oldest age group (75 years+). The incidence rate in children fell. During the period studied, 2150 patients underwent surgery in our unit for tool and machinery-related injuries. The hand was involved in 2069 (96%) of the injuries. Adult injuries were caused by a similar proportion of types of tool or machinery in all age groups. This study demonstrates a clear and sustained trend of increasing incidence of tool and machinery-related injuries in adults. The largest increase is in older patients.Level of evidence: IV.
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Affiliation(s)
- Rebecca Green
- Pulvertaft Hand Centre, Derby, UK
- University of Nottingham, Nottingham, UK
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Florianovicz VC, Ferraresi C, Kuriki HU, Marcolino AM, Barbosa RI. Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2020; 38:743-749. [DOI: 10.1089/photob.2019.4800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Vivian Carla Florianovicz
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Cleber Ferraresi
- Postgraduate Program in Biomedical Engineering, Universidade Brasil, São Paulo, Brazil
| | - Heloyse Uliam Kuriki
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Alexandre Marcio Marcolino
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
| | - Rafael Inácio Barbosa
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina (UFSC), Araranguá, Brazil
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A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:175-181. [PMID: 32835183 PMCID: PMC7256509 DOI: 10.1016/j.jhsg.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 01/07/2023] Open
Abstract
Purpose Limited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery. Methods All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers. Surgical volume and resources, patient demographics, and injury patterns were compared before and after official shelter-in-place orders. Results A total of 58 patients underwent time-sensitive or emergent operations. Mean patient age was 42 years; mean injury severity score was 9 and median American Society of Anesthesiologist score was 2. There was a 40% increase in volume after shelter-in-place orders, averaging 1.4 cases/d. Indications for surgery included high-energy closed fracture (60%), traumatic nerve injury (19%), severe soft tissue infection (15%), and revascularization of the arm, hand, or digit(s) (15%). High-risk behavior, defined as lawlessness, assault, and high-speed auto accidents, was associated with a significantly greater proportion of operations after shelter-in-place orders (40% vs 12.5%; P < .05). Each institution dedicated an average of 3 inpatient beds and one intensive care unit-capable bed to upper-extremity care daily. Resources used included an average of 115 minutes of daily operating room time and 8 operating room staff or personnel per case. Conclusions Hand and upper-extremity operative volume increased after shelter-in-place orders at 2 major Level I trauma centers across the country, demanding considerable hospital resources. The rise in volume was associated with an increase in high-risk behavior. Type of study/level of evidence Therapeutic IV.
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11
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Reitan I, Dahlin LB, Rosberg HE. Patient-reported quality of life and hand disability in elderly patients after a traumatic hand injury - a retrospective study. Health Qual Life Outcomes 2019; 17:148. [PMID: 31470865 PMCID: PMC6716918 DOI: 10.1186/s12955-019-1215-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hand injuries occur at any age and cause disability in hand and arm function as well as impaired quality of life, but no study has focused on hand disability and quality of life in the elderly after a hand injury. Globally, the population over 60 years of age is expected to double by 2050 and more hand injuries are estimated among the elderly population. Our goal is to obtain more information and a better understanding of problems elderly patients experience after a hand injury to be able in the future to optimally relocate resources in the health care sector with respect to numbers and injury pattern as well as to health status of these patients. Methods Patients aged more than 65 years with a traumatic hand/wrist/forearm injury treated (July 1st 2013 - June 30th 2014) at department of Hand Surgery, Malmö, Sweden were included. Health-related outcome questionnaires, i.e. QuickDASH, SF-36, Visual Analogue Scale (VAS), Cold Intolerance Severity Score (CISS), and general information were mailed to the patients (time from injury: > 1.5–2.5 years). The participants were compared in groups according to age, gender, cold intolerance, injury severity and previous occupation. Results One hundred and thirty-seven participants responded [response rate 55%; non-responders (n = 113); only difference between groups was that non-responders were older]. Women were older than men at the time of injury (p = 0.04) and differed regarding living conditions. The main differences in QuickDASH, all VAS questions, and the majority of SF-36 subscales (p < 0.05) were found in the participants with CISS > 50, who experienced more impairment. More serious injuries (Modified HISS) were found to have higher QuickDASH and CISS score as well as more functional impairment (p < 0.05). Few differences were found in groups divided according to age, gender (although men experiencing less functional impairment in QuickDASH), previous occupation and injured hand. Conclusions Patients aged more than 65 years at the time a hand injury was sustained, generally experience a high-level quality of life and limited functional problems after such an injury, but patients with CISS > 50 and with a more serious injury were more severely affected.
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Affiliation(s)
- Ingrid Reitan
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden.,Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden.,Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden
| | - Hans-Eric Rosberg
- Department of Hand Surgery, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden. .,Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Jan Waldenströms gata 5, SE-20502, Malmö, Sweden.
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