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Szapary HJ, Meulendijks MZ, Moura SP, Veeramani A, Gomez-Eslava B, Hoftiezer YAJ, Chen NC, Eberlin KR. Phalangeal Fractures Requiring Vascular Reconstruction: Epidemiology and Factors Predictive of Reoperation. Hand (N Y) 2024; 19:247-255. [PMID: 35852405 PMCID: PMC10953521 DOI: 10.1177/15589447221109635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Demographic information related to phalangeal fractures that undergo simultaneous vascular repair, as well as their complication and reoperation profiles, remain incompletely understood. This study aimed to examine the patient and fracture characteristics influencing the outcomes after these injuries in a large Unites States adult patient cohort and to identify risk factors associated with unplanned reoperation of these fractures. METHODS A retrospective study was performed, identifying 54 phalangeal fractures in 48 patients; all fractures were also associated with vascular injuries requiring repair. Patients with digital amputations were excluded. A manual chart review was performed to collect epidemiologic, radiographic, and surgical outcome information. RESULTS The incidence of phalangeal fractures undergoing vascular repair was higher in the non-dominant hand, middle finger, proximal phalanx, and phalangeal shaft. Most (52.9%) fractures were due to occupational injury, with the most common mechanism being sharp injuries. More than half of the fractures had a nerve injury, and 13% required a vein graft for vascular repair. More than half of the fractures required at least one reoperation, most commonly due to "stiffness/tendon adhesion" (50%) and "nonunion or delayed union" (21.4%). In multivariable analysis, thumb (odds ratio [OR]: 35.1, P = .043) and index (OR: 14.0, P = .048) fingers' fractures were found to be independently associated with unplanned reoperation. CONCLUSIONS Phalangeal fractures requiring vascular repair occurred most often in the occupational setting and more than 50% required at least one unplanned reoperation. Injuries sustained in the thumb and index finger were more likely to undergo unplanned reoperation, which may guide initial treatment decision-making and postoperative follow-up.
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Affiliation(s)
- Hannah J. Szapary
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Steven P. Moura
- Massachusetts General Hospital, Boston, USA
- Boston University, MA, USA
| | - Anamika Veeramani
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Barbara Gomez-Eslava
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Neal C. Chen
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
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Yoshimura R, Kamble R, Dunlop R, Wormald J. Acute Hand Injury in Surfing: A Case Report. Wilderness Environ Med 2024; 35:74-77. [PMID: 38379481 DOI: 10.1177/10806032231223323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Hand injuries from surfing tend to be severe and require medical attention. Follow-up of a surfing injury is difficult because many patients are visiting and go home after treatment. We report a case of a surfing hand injury sustained abroad, which was treated upon the patient's return, allowing for follow-up. The mechanism of injury was traction and torsion from the surfboard leash while surfing. The patient was initially treated for nailbed injury but presented later back home after persistent pain, for which an unstable distal phalanx fracture in their right ring finger was found by x-ray. This was surgically reduced with K-wire insertion and nailbed repair. Postoperatively, the injured finger was kept in a splint, and the patient had physiotherapy. Pain was significantly reduced, and the patient regained sufficient function. Considering a fracture as a differential for finger injury caused by the surfboard leash may prevent management delays. Injury may be prevented through education and redesign of the surfboard leash.
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Affiliation(s)
- Ryo Yoshimura
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Rituja Kamble
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Justin Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Weber AD, Reissner L, Schweizer A. Stress Fractures of the Distal Phalanx in Skeletally Immature Sport Climbers. Wilderness Environ Med 2023; 34:562-566. [PMID: 37821298 DOI: 10.1016/j.wem.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/01/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023]
Abstract
Stress fractures in the distal phalanx of skeletally immature patients are rare and previously unreported clinical occurrences. We report on 2 adolescent sport climbers with such fractures of the dorsal metaphysis of the distal phalanx at the point where parts of the extensor tendon insert. A conservative treatment approach alone was sufficient in healing this fracture type in both patients after 12 wk. Clinicians should be informed of the existence of this rare clinical phenomenon and counsel patients that a conservative treatment approach may result in complete healing without the need for an invasive procedure.
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Affiliation(s)
- Andreas D Weber
- Hand Surgery Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Lisa Reissner
- Hand Surgery Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andreas Schweizer
- Hand Surgery Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Sjöman AE, Grønhaug G, Julin MV. A Finger in the Game: Sport-Specific Finger Strength Training and Onset of Injury. Wilderness Environ Med 2023; 34:435-441. [PMID: 37550103 DOI: 10.1016/j.wem.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Strength training has proved to be an effective way to prevent injuries, but the evidence of the impact of strength training on finger injuries is lacking. A fingerboard is a sport-specific tool used by climbers for strength training of fingers. In this study, we searched for associations between fingerboard training and finger injuries in climbers with different lengths of climbing experience and levels of performance. METHODS A web-based survey was used to collect information on self-perceived pain or injury in fingers (SPIIF) and regular fingerboard training (RFT). The survey was administered to the Finnish climbing community. Data were analyzed using contingency tables; chi-square was used to evaluate statistical significance. RESULTS No significant correlations between SPIIF and RFT were found when analyzing all the participants (n=434) together. In climbers with 6 y or more in the sport, SPIIF was not common and RFT was negatively associated with SPIIF (χ2 [1, n=200]=4.57; P=0.03). In contrast to this, in male climbers who had been climbing for less than 6 y and had advanced to 7a level or higher (French lead/Font bouldering), SPIIF was common and RFT was positively associated with SPIIF (χ2 [1, n=75]=4.61; P=0.03). CONCLUSIONS We suggest that doing RFT may prevent SPIIF in climbers with a long background in the sport as fingerboard training can help build stronger fingers and thereby stronger tendons and ligaments. Climbers with fewer years in the sport and less adaptation to the fingers should be cautious with their training loads and RFT to avoid finger injuries and pain.
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Affiliation(s)
- Anna E Sjöman
- LAUREA University of Applied Science, Espoo, Finland.
| | - Gudmund Grønhaug
- Department of Sport, Food and Natural Sciences, Faculty of Education, Western Norway University of Applied Sciences, Campus Sogndal, Norway Arts and Sports, Sogndal, Norway
| | - Mikko V Julin
- LAUREA University of Applied Science, Espoo, Finland
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5
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Bärtschi N, Scheibler AG, Schweizer A. Palmar Shift of the Proximal Interphalangeal Joint in Different Grip Positions as a Potential Risk Factor for Periphyseal Injuries in Adolescent Climbers. Wilderness Environ Med 2023; 34:451-456. [PMID: 37550105 DOI: 10.1016/j.wem.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/01/2023] [Accepted: 06/27/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate different grip positions as a contributing factor for primary periphyseal stress injuries of the finger phalanges in climbing. METHODS Ultrasound imaging of the proximal interphalangeal joint was performed on 37 asymptomatic adolescent climbers. Longitudinal images were obtained of middle and ring fingers of both hands in different grip positions (open, half-open, and crimp), unloaded and loaded. The translation between the dorsal head of the proximal phalanx and the shaft of the middle phalanx was measured in an unloaded and loaded situation for all grip positions. The resulting difference was determined as the palmar shift. RESULTS The mean age of the study population was 13 y. Results showed a palmar shift of 0.57 mm in a loaded crimp grip position compared to 0.13 mm in an open position and 0.20 mm in a half-open grip position. With a P value of <0.001, this shift was significantly higher in a crimp grip position compared to open or half-open grip positions. CONCLUSIONS This leads to an increase in joint incongruity and much higher peak forces on the dorsal aspect of the epiphyseal-physeal-metaphyseal complex, which is particularly vulnerable during the adolescent growth spurt. Thus, climbing and training behavior should be adapted accordingly during this phase by avoiding the crimp grip position until epiphyseal fusion.
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Affiliation(s)
- Natalie Bärtschi
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Anne-Gita Scheibler
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
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Schweizer A. [Sport Injuries to Wrist and Fingers]. Praxis (Bern 1994) 2023; 112:605-608. [PMID: 37971484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION About one fifth of all sports accidents involve the hand. Many injuries can be diagnosed and treated easily. However, some of them such as fractures of the scaphoid or the hamate of the hamulus are difficult to detect with conventional radiographs and are often missed without a CT scan. Ligament injuries such as the skier's thumb must be recognized and treated properly, often surgically. There are also sport-specific injuries, such as the closed rupture of a flexor tendon pulley in climbers, which otherwise occur rarely and are little known. These topics, pitfalls and tricks will be discussed.
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Affiliation(s)
- Andreas Schweizer
- Abteilung Handchirurgie, Universitätsklinik Balgrist, Zürich, Schweiz
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Whitsell N, Van Demark R. Delayed Presentation of a Flexor Digitorum Profundus Avulsion Injury: A Case Report. S D Med 2022; 75:124-128. [PMID: 35708578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Avulsion of the flexor digitorum profundus (FDP) tendon is a relatively common injury in athletes. Also known as "jersey finger," it can also occur in nonathletes, and is often not initially diagnosed. Early diagnosis and repair are essential to regaining optimum return of function. We report a case of a 37-year-old woman who was seen six weeks following an undiagnosed FDP avulsion injury. Due to finger stiffness and the delayed diagnosis, she was treated with occupational therapy to maximize finger range of motion. The anatomy, classification, diagnosis, and treatment options for FDP avulsion injuries are discussed. The goal of this paper is to increase awareness for this injury, resulting in early diagnosis and prompt treatment.
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Affiliation(s)
- Nathan Whitsell
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Affiliation(s)
- Ko Matsuoka
- Department of Dermatology (Matsuoka, Tanaka, Nomura), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Dermatology (Matsuoka), Tsuchiura Kyodo General Hospital, Tsuchiura, Japan; Department of Dermatology (Tanaka), Mito Saiseikai General Hospital, Mito, Japan
| | - Ryota Tanaka
- Department of Dermatology (Matsuoka, Tanaka, Nomura), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Dermatology (Matsuoka), Tsuchiura Kyodo General Hospital, Tsuchiura, Japan; Department of Dermatology (Tanaka), Mito Saiseikai General Hospital, Mito, Japan
| | - Toshifumi Nomura
- Department of Dermatology (Matsuoka, Tanaka, Nomura), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Dermatology (Matsuoka), Tsuchiura Kyodo General Hospital, Tsuchiura, Japan; Department of Dermatology (Tanaka), Mito Saiseikai General Hospital, Mito, Japan
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Abstract
Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ. Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped. The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger. The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.
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Affiliation(s)
| | - Chad Chang
- University Hospital of North Durham, Durham, U.K..
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10
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Iruretagoiena X, De la Fuente J, Rodríguez-López ES, Davila F, Dorronsoro A, Goenaga L, Blasi M. Longer Tendon-Bone Distances of the A2 and A4 Annular Pulleys in Experienced High-Level Sport Climbers: Injury or Adaptation? Wilderness Environ Med 2021; 32:450-456. [PMID: 34538713 DOI: 10.1016/j.wem.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Experienced high-level climbers are subject to a number of bone and soft tissue changes over the years and are also among the most exposed to pulley injuries. One of the main consequences of pulley rupture is the separation of the flexor tendons from the subjacent phalanges, also known as bowstringing. The purpose of this study was to determine whether this population has asymptomatic bowstringing of the A2 and/or A4 pulleys as determined by tendon-bone distance (TBD) values when compared to nonclimbers. METHODS High-resolution ultrasound TBD measurements in active forced flexion were made for the A2 and A4 pulley of the ring finger bilaterally. Participants were 21 asymptomatic sport climbers who had 21 consecutive years of climbing at a level above 9.66 in the International Mountaineering and Climbing Federation difficulty metric scale. Control subjects were 21 age-matched nonclimbers. RESULTS A significantly longer TBD-25% (0.3 mm) and 35% (0.4 mm) for the A2 and A4 pulleys, respectively-was found in the experienced climbers group (experienced climbers group: A2 1.6±0.5 mm and A4 1.6±0.4 mm; nonclimbers group: A2 1.2±0.1 mm and A4 1.2±0.2 mm). CONCLUSIONS Our results suggest that bowstringing of A2 and A4 pulleys occurs in asymptomatic experienced high-level climbers, which could be interpreted as either an adaptive mechanism to workloads endured over years of climbing or a consequence of underdiagnosed pulley ruptures.
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Affiliation(s)
- Xeber Iruretagoiena
- Department of Physical Therapy, Universidad Camilo José Cela, Madrid, Spain; Eskura Osasun Zentroa, Beasain, Spain; Department of Physical Therapy, Universidad of Deusto, San Sebastian, Spain
| | | | | | - Fernando Davila
- Orthopedics Department, Clínica Pakea-Mutualia, San Sebastián, Spain
| | | | | | - Marc Blasi
- Plastic Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain
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Abstract
BACKGROUND Although fingertip and nail bed injuries have a high incidence, appropriate management of nail bed injuries remains controversial. This study is the completion of data derived from nail bed injuries with follow-up of a minimum of 6 months to suggest an appropriate treatment. METHODS In the retrospective study, we analyzed data from 549 nail bed injuries for 6 years and age, type of injury, fractures, treatment methods, and outcomes were reviewed. Results were determined and these were divided to identical to the opposite group, abnormalities based on Zook criteria. Statistical analysis was done according to injury category (type, site, nail substitute, and fracture) and overall final grade. RESULTS Over 50% (293 cases) had excellent results. Rates of very good, good, fair, and poor results were 22.6%, 11.3%, 6.2%, and 6.6%, respectively. Poorer results were obtained for fold injuries, crush, and avulsive injuries. The presence of a fracture was associated with poor results. CONCLUSIONS The cause of poor results is thought to be multifactorial. Although, overall outcomes were good, nail splitting, nail roughness, and nail adherence can cause dirtiness, catching, bending, and various cosmetic problems. Thus, careful suture and replacement of nail to nail fold are important to reach good results.
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Affiliation(s)
- Ja Hea Gu
- From the Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY
| | - Su Hyun Choi
- Hand Surgery Center, W Hospital, Dalgubeol-daero, Dalseo-gu, Daegu
| | - Jae Hee Yoon
- Department of Plastic Surgery, Dankook University Hospital, Manghyang-ro, Dongnamgu, Cheonan, Chung Nam, Republic of Korea
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12
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Acar E. Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation. Hand Surg Rehabil 2021; 40:477-483. [PMID: 33848652 DOI: 10.1016/j.hansur.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7-21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone. Level of evidence: IV.
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Affiliation(s)
- E Acar
- Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara City Hospital, Üniversiteler Caddesi, Bilkent Bulvarı No:1, 06800 Çankaya/Ankara, Turkey.
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13
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Lin YC, Lin IL, Chou TFA, Hsu LC, Chiang PY, Lin WP. Multiple Beneficial Effects of High-dose BoNT-A Injection to Improve Wound Healing and Spasticity in a Patient With Hypoxic Encephalopathy Due to High-voltage Electrical Injury. Wounds 2020; 32:E34-E37. [PMID: 32813671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION High-voltage electrical injuries remain a difficult challenge for physicians. The survivors often have complicated wounds over the trunk or extremities, and some of them may develop hypoxic encephalopathy. The emergence of spasticity following hypoxic encephalopathy may further interfere with the healing of wounds. CASE REPORT The authors report the case of a 17-year-old male with strong spasticity of finger flexors graded 4 by the Modified Ashworth Scale (0-5) after electric shock. He also had a nonhealing wound on the flexor side of the left index finger after 6 weeks of standard wound care. The wound measured 0.3 cm × 0.3 cm × 0.2 cm in size. The authors hypothesized that wound healing was negatively affected by spasticity and expected the wound might heal gradually after reducing the strong spasticity of the index finger. The authors employed electrical stimulator for guidance and injected high-dose (50 units/muscle) botulinum toxin type A into the flexor digitorum superficialis and the flexor digitorum profundus of his left index finger. At 7 days following administration, focal spasticity of these muscles in the left index finger decreased from 4 to 1 on the Modified Ashworth Scale. At 21 days post administration, the wound healed completely. CONCLUSIONS For patients with hypoxic encephalopathy due to high-voltage electrical injury, botulinum toxin type A injection may be an option of therapeutic approach for both reduction of spasticity and facilitation of wound healing.
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Affiliation(s)
- Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Ling Lin
- Department of Medical Laboratory Sciences and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chieh Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ying Chiang
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
An athlete's hands are susceptible to a variety of acute and cumulative traumas depending on their chosen sport. Depending on the timing of the injury, the immediate requirements of the athlete, and future aspirations, treatment strategies may need individual customization. This article offers a brief review of the anatomy and complex function of the extensor mechanism, discusses the etiologies of various extensor injuries, and outlines the multiple treatment options and expected outcomes.
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Affiliation(s)
- Spencer Skinner
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA.
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Affiliation(s)
- Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Sue A Brown
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia
| | - John W Lum
- Jaeb Center for Health Research, Tampa, Florida
| | - Boris P Kovatchev
- University of Virginia Center for Diabetes Technology, Charlottesville, Virginia
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16
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Choi J, Randev S, Brahmbhatt S, Altschuler EL. Isolated Lesion of the Fourth Digit Extensor Muscle Belly Fascicle. Am J Phys Med Rehabil 2019; 98:e64-e65. [PMID: 31094859 DOI: 10.1097/phm.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Junghoon Choi
- From the Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, New York
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17
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Farrell T, McDonald C, Sheehan E. An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling. Ir Med J 2019; 112:875. [PMID: 30892853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim To highlight the dangers of hurling helmet modification. Methods A case report highlighting the consequences of modifying a hurling helmet from factory settings. Results Photographic evidence of a penetrating injury from helmet modification. Conclusion Rule changes to allow referees to inspect helmets before games take place.
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Affiliation(s)
- T Farrell
- Orthopaedic Department, Midlands Regional hospital, Tullamore, Co. Offaly
| | - C McDonald
- Orthopaedic Department, Midlands Regional hospital, Tullamore, Co. Offaly
| | - E Sheehan
- Orthopaedic Department, Midlands Regional hospital, Tullamore, Co. Offaly
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18
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Vedel PN, Tranum-Jensen J, Dahlin LB, Brogren E, Søe NH. [Deformities of the finger joints]. Ugeskr Laeger 2017; 179:V04170324. [PMID: 29208202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Extension of the fingers is a complex act. Boutonnière deformity is defined by flexion at the proximal inter-phalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint due to disruption of the central slip of the extensor tendon. Swan neck deformity is defined by hyperextension at the PIP joint and flexion at the DIP joint, and the pathology is divided into intrinsic, extrinsic, and articular. The deformities are a result of imbalance of the tendons and ligaments in the fingers. Treatment is depending on the underlying cause and includes surgery and non-operative treatment. Functional gain and risk must be realistically assessed.
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Schultz J, Leupold S, Grählert X, Pfeiffer R, Schwanebeck U, Schröttner P, Djawid B, Artsimovich W, Kozak K, Fitze G. Study protocol for a randomized controlled pilot-trial on the semiocclusive treatment of fingertip amputation injuries using a novel finger cap. Medicine (Baltimore) 2017; 96:e8224. [PMID: 29019891 PMCID: PMC5662314 DOI: 10.1097/md.0000000000008224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Fingertip amputation injuries are common in all ages. Conservatively treated fingertips can regenerate skin and soft tissues to form a functionally and cosmetically excellent new fingertip. Little is known about this ability that, in humans, is confined to the fingertips. Even less is known about the role of the bacteria that regularly colonize these wounds without negative impact on regeneration and healing.As an alternative to surgery, self-adhesive film dressings are commonly used to establish a wet chamber around the injury. These dressings leak malodorous wound fluid eventually until the wound is dry. Having that into consideration, we have therefore developed a silicone finger cap that forms a mechanically protected, wet chamber around the injury for optimal regeneration conditions. It contains a puncturable reservoir for excess wound fluid, which can be thus routinely analyzed for diagnostic and research purposes.This study protocol explains the first randomized controlled trial (RCT) on the semiocclusive treatment of fingertip amputations in both children and adults comparing traditional film dressings with the novel silicone finger cap. Being the first RCT using 2 medical devices not yet certified for this indication, it will gather valuable information for the understanding of fingertip regeneration and the design of future definitive studies. METHODS AND ANALYSIS By employing an innovative pseudo-cross-over-design with a dichotomous primary endpoint based on patients preference, this pilot study will gain statistically significant data with a very limited sample size. Our RCT will investigate acceptance, safety, effectiveness, and efficacy of this novel medical device while gathering information on the clinical course and outcome of conservatively treated fingertip injuries. A total of 22 patients older than 2 years will be randomly assigned to start the conservative treatment with either the traditional film-dressing or the novel finger cap. The treatment will be changed to the other alternative for another 2 weeks before the patient or the guardian is confronted with the decision of which method they would prefer for the rest of the treatment (if required). ETHICS AND DISSEMINATION Ethical approval (EK 148042015) of the study protocol has been obtained from Institutional Review Board at the TU Dresden. The trial is registered at the European Database on Medical Devices (EUDAMED-No.: CIV-15-03-013246) and at ClinicalTrials.gov (NCT03089060).
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Affiliation(s)
| | | | | | | | | | - Percy Schröttner
- Institute of Medical Microbiology and Hygiene, Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse
| | | | | | - Karol Kozak
- Fraunhofer Institute for Material and Beam Technology IWS Dresden
- Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Fetscherstrasse, Dresden, Germany
- Wrocław Medical University, Wybrzeże Ludwika Pasteura 1, Wrocław, Poland
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Josiassen M, Partoft S, Leicht P, Astrup J. [Partial finger amputation after weever sting and second-degree burn]. Ugeskr Laeger 2017; 179:V01170064. [PMID: 28689545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The greater weever (Trachinus draco) is the only venomous fish in Denmark, and if stung by the weever the venom may cause symptoms such as pain, headache, nausea, dizziness and in severe cases systemic allergic reaction or tissue necrosis. The venom is heat-labile and should therefore be treated with warm water to the afflicted area. We report a case of a patient who was stung in the second finger and because of the treatment, he got a second-degree burn, that may have enhanced the effect of the venom, thus resulting in partial finger amputation.
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Whitten T, Bjork J, Neitzel D, Smith K, Sullivan M, Scheftel J. Notes from the Field: Francisella tularensis Type B Infection from a Fish Hook Injury - Minnesota, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:194. [PMID: 28231234 PMCID: PMC5657846 DOI: 10.15585/mmwr.mm6607a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On June 27, 2016, the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) was notified of a suspected Francisella tularensis isolate cultured at a hospital laboratory. The isolate was confirmed as F. tularensis type B at MDH PHL by reverse transcription-polymerase chain reaction, culture, and direct fluorescent antibody testing. Francisella tularensis subspecies tularensis (type A) and holarctica (type B) bacteria are the causative agents of tularemia.
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22
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Banting J, Meriano T. Hand Injuries. J Spec Oper Med 2017; 17:93-96. [PMID: 29256203 DOI: 10.55460/g5mx-dcaw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
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Abstract
The volar V-Y flap is used in transverse or dorsal oblique amputations in fingertip injuries; however, its use is contraindicated in patients with volar oblique amputations and cannot advance distally enough to cover the defect. The aim of this report is to describe a technique of double V-Y flap to cover fingertip defects in which a simple V-Y flap is not enough. This technique allows advancement between 30% and 50% farther than the original, simple V-Y flap. Report of cases a series of fingertip amputation covered with this technique. This technique was performed in 7 patients between 25 and 64 years old, with transverse, volar and dorsal oblique defects in the fingertip. The advancing of the flap was between 3 and 5 mm. There were no infections or necrosis of the flaps. In all patients there were acceptable aesthetic results with 2-point discrimination between 4 and 6 mm in the proximal flap and up to 10 mm in the distal flap with a minimum follow-up of 6 months. With this double V-Y flap, we have seen a good coverage even in volar oblique amputation. In addition, it is possible to advance up to 5 mm more with this second V-Y flap without compromising the vitality of the flap. It is a simple and reproducible technique that can be used on any finger, with good results, without flap necrosis.
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Affiliation(s)
- Luis C Díaz
- *Asotrauma Clinic, Ibagué †Orthopedics and Traumatology Unit, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
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Hadj Hassine Y, Hmid M, Baya W. Trauma of the hand from circular saw table: a series of a 130 cases. Tunis Med 2016; 94:851. [PMID: 28994884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Trauma of the hand from a circular saw table is a common occurrence in developing countries it tends to occur in young hand working people and it causes a serious lesions. METHODS It was a retrospective series about a 130 cases of hand trauma from circular saw table. Epidemiological features, treatment, and permanent disabilities left by hand trauma from circular saw table were studied to identify ways to prevent such an accident. RESULTS The average age was 31.24 years, these patients were exclusively men, 62% were apprentice wood workers, and the left hand was twice more injured than the right hand. Regarding clinical aspects, in 77% of cases, two or more fingers were injured, tip amputations of the left fingers predominated (49%), in 50% of the cases of hand wounds occurred to the dorsum of the hand, and extensor tendon injuries were observed twice more than flexor tendon injuries. Regarding the surgical treatment, performing an amputation stump was the most practiced primary surgery (107 cases i.e. 82% of primary surgeries). Arthrodesis, reconstructive flap surgery, and spongy bone grafts were the most practiced secondary surgeries (79% of secondary surgeries). Joint stiffness was the most observed complication (26%). CONCLUSION Hand injuries from circular saw table such as those described in this study will continue to challenge the skill of surgeons devoted to the restoration of function and form to the damaged hand. Prevention, of course, should be the goal because of the severe functional and psychological impairment that may result from them.
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Yamazaki H, Kato H, Nakatsuchi Y, Murakami N, Hata Y. Closed Rupture of the Flexor Tendons of the Little Finger Secondary to Non-Union of Fractures of the Hook of the Hamate. ACTA ACUST UNITED AC 2016; 31:337-41. [PMID: 16580104 DOI: 10.1016/j.jhsb.2005.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2005] [Revised: 12/25/2005] [Accepted: 12/30/2005] [Indexed: 11/22/2022]
Abstract
We report six patients with closed flexor tendon rupture affecting the little finger, occurring secondarily to non-union of the hook of the hamate bone. The ununited fragments were separated from the basal part of the hook by more than 1 mm. The fragments were also rounded and showed marginal sclerosis. Non-union was located in the middle part of the hook in three patients, the tip in two, and the base in one. At operation, the fragments were removed in all patients. Five patients were treated by free tendon grafts using three palmaris and two plantaris grafts and one underwent tendon transfer. Postoperative total range of active motion of the little finger averaged 218° (range 185–265°). All patients returned to their original employment. This series would suggest that flexor tendon rupture can occur after fracture of the hook of the hamate bone, even when the ununited fragment is small and/or rounded.
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Affiliation(s)
- H Yamazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto City, Nagano, Japan.
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26
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Jansen T. [He was perhaps bitten by a wild sheep]. MMW Fortschr Med 2016; 158:7. [PMID: 27323970 DOI: 10.1007/s15006-016-8403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Sobel D, Constantin N, Or O. [CLIMBING HIGHER--COMMON INJURIES IN ROCK CLIMBERS]. Harefuah 2016; 155:348-387. [PMID: 27544986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rock climbing is becoming an increasingly popular sport in Israel with more and more climbing walls being built in the cities and new routes being traced on cliffs around the country. Our account describes the case of a 15 years old climber with chronic pain (without trauma) in the 3rd finger of the right hand. A stress fracture, involving the proximal interphalangeal joint (SH3) of the middle phalanx, was diagnosed. The fracture healed following two months of rest with gradual return to activity. As this sport becomes more common, there is an increasing need for knowledge about the characteristic injuries, their diagnosis and treatment. Although considered an extreme sport, most of the injuries are overuse injuries, mainly to the upper limbs. Finger flexor tendon pulley rupture being one of the most common. Diagnosis is based on history, physical examination and ultrasonography. Conservative treatment is successful for most injuries, while more complicated cases require surgical intervention.
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28
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Taves J, Satre T. Reducing Amputation Rates After Severe Frostbite. Am Fam Physician 2015; 92:716. [PMID: 26554411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jennifer Taves
- University of Minnesota/St. Cloud Hospital Family Medicine Residency Program, St. Cloud, MN, USA
| | - Thomas Satre
- University of Minnesota/St. Cloud Hospital Family Medicine Residency Program, St. Cloud, MN, USA
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Tong E, Dorairaj J, O'Sullivan JB, Kneafsey B. Deep Full Thickness Burn to a Finger from a Topical Wart Treatment. Ir Med J 2015; 108:283-284. [PMID: 26625656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of a deep full thickness burn from topical formic acid. Our patient developed a burn over her proximal interphalangeal joint (PIPJ) of her finger, secondary to inappropriate application of an anti-wart treatment. The burn required extensive deridement, and the resultant defect was reconstructed using a subcutaneous flap from the adjacent finger (a reverse cross finger flap). She was reviewed six months post-surgery, and overall she has a sub-optimal result. This incident was referred to the Irish Medicine's Board who have since reviewed the case and ordered the manufacturer to alter their usage instructions.
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Lima C, Lima A, Degenhardt Ä, Valverde N, Da Silva F. Reconstructive dosimetry for cutaneous radiation syndrome. Braz J Med Biol Res 2015; 48:895-901. [PMID: 26445332 PMCID: PMC4617115 DOI: 10.1590/1414-431x20144337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/05/2014] [Indexed: 01/08/2023] Open
Abstract
According to the International Atomic Energy Agency (IAEA), a relatively significant number of radiological accidents have occurred in recent years mainly because of the practices referred to as potentially high-risk activities, such as radiotherapy, large irradiators and industrial radiography, especially in gammagraphy assays. In some instances, severe injuries have occurred in exposed persons due to high radiation doses. In industrial radiography, 80 cases involving a total of 120 radiation workers, 110 members of the public including 12 deaths have been recorded up to 2014. Radiological accidents in industrial practices in Brazil have mainly resulted in development of cutaneous radiation syndrome (CRS) in hands and fingers. Brazilian data include 5 serious cases related to industrial gammagraphy, affecting 7 radiation workers and 19 members of the public; however, none of them were fatal. Some methods of reconstructive dosimetry have been used to estimate the radiation dose to assist in prescribing medical treatment. The type and development of cutaneous manifestations in the exposed areas of a person is the first achievable gross dose estimation. This review article presents the state-of-the-art reconstructive dosimetry methods enabling estimation of local radiation doses and provides guidelines for medical handling of the exposed individuals. The review also presents the Chilean and Brazilian radiological accident cases to highlight the importance of reconstructive dosimetry.
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Affiliation(s)
- C.M.A. Lima
- Instituto de Radioproteção e Dosimetria, IRD/CNEN, Rio de Janeiro,
RJ, Brasil
| | - A.R. Lima
- Instituto de Radioproteção e Dosimetria, IRD/CNEN, Rio de Janeiro,
RJ, Brasil
| | - Ä.L. Degenhardt
- Instituto de Radioproteção e Dosimetria, IRD/CNEN, Rio de Janeiro,
RJ, Brasil
| | - N.J. Valverde
- Fundação Eletronuclear de Assistência Médica, Rio de Janeiro, RJ,
Brasil
| | - F.C.A. Da Silva
- Instituto de Radioproteção e Dosimetria, IRD/CNEN, Rio de Janeiro,
RJ, Brasil
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Valiente-González L, Martínez-Pérez T, Jiménez-Martínez Y, Martínez-Fernández R, Viñuelas-Chicano M, Gómez-Ruiz CJ, Pérez-García JI, Morillas-Ariño J, Pérez-Vigara G, García-Cano-Lizcano J, Pérez-Sola Á. Acral injury as first manifestation of a metastatic adenocarcinoma of the colon. Rev Esp Enferm Dig 2015; 107:171-172. [PMID: 25733041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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32
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Manivannan G, Karthikeyan G, Das P, Babu G. Cost effective cosmetic prosthesis for lost digits. LEPROSY REV 2015; 86:117-123. [PMID: 26065156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Leprosy causes nerve damage which leads to repeated injuries or ulcers causing the loss or absorption of digits. The loss of digits is also common in traumatic injuries. Irrespective of the etiology, the loss of a finger has a considerable negative functional and psychological impact on an individual. In order to solve these problems, prostheses are provided to patients. This short report demonstrates the advantages of using liquid latex in making a low cost cosmetic prosthesis. The possibility of using latex material offers a practical alternative where silicone prosthesis is not affordable.
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Affiliation(s)
- Ignasi Galtés
- Unitat de Medicina Legal i Forense, Departament de Psiquiatria i de Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain,
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Sahin C, Cesur C, Sever C, Eren F. Finger injury from over-exposure to an industrial gamma radiation source. Burns 2014; 41:e8-e10. [PMID: 25249387 DOI: 10.1016/j.burns.2014.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 11/17/2022]
Abstract
The aim of this paper was to report a rare cause of radionecrosis and its long-term results. Iridium-192 ((192)Ir) is commonly used for radiography as a gamma ray source to locate flaws in welds and metal components in gas and oil industry. A 38-year-old man was subjected to radiation unintentionally. One month after the exposure wounds were appeared on the second and third fingers, and they were treated by conventional wound care and hyperbaric oxygen therapy. However wounds were relapsed one year later that brought the patient to us. The wounds were treated by wound care and hyperbaric oxygen therapy. When the patient was brought to us one year later the result was interesting. The third finger's pulp (there was not any wound one year before) was contracted and one third of the distal phalanx was exposed.
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Affiliation(s)
- Cihan Sahin
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey.
| | - Ceyhun Cesur
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
| | - Celalettin Sever
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
| | - Fikret Eren
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery and Burn Unit, Istanbul, Turkey
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Abstract
A 39-year-old woman sustained a small wound on the palm of her right hand, which quickly healed naturally; however, a month later pain and limited range of motion were noted in her right finger. Surgery revealed the radial half of the flexor digitorum superficialis (FDS) tendon was ruptured and formed a flap, which hooked at the entrance of the A1 pulley. The proximal stump was sutured to the remaining ulnar (normal) side of the FDS tendon. Locking occurs between the tendon flap and the tendon sheath; therefore, when there is no fibrous tendon sheath near the partially ruptured tendon, locking will not occur.
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Affiliation(s)
- Yasuhiro Seki
- Department of Orthopaedic Surgery, Kameda Medical Centre, Chiba 296-8602, Japan
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36
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Füessl HS. [The horrors of winter]. MMW Fortschr Med 2014; 156:32. [PMID: 24912262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Peters G, Learch T, White E, Forrester D. High-pressure paint gun injury: clinical presentation and imaging findings. Emerg Radiol 2014; 21:627-30. [PMID: 24570121 DOI: 10.1007/s10140-014-1204-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
High-pressure paint gun injuries are potentially devastating injuries that require emergent surgical incision and drainage. They result from erroneous equipment operation and accidental injection of a variety of substances at pressures high enough to breach the skin. The largely benign superficial appearance masks the extent of the underlying injury. In the absence of an appropriate history, the radiologist must recognize the characteristic radiographic findings and suggest the diagnosis to the clinician.
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Affiliation(s)
- Greg Peters
- , 37610 College Drive #201, Palm Desert, CA, 92211, USA,
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Chen PT, Lin CJ, Jou IM, Chieh HF, Su FC, Kuo LC. One digit interruption: the altered force patterns during functionally cylindrical grasping tasks in patients with trigger digits. PLoS One 2014; 8:e83632. [PMID: 24391799 PMCID: PMC3877056 DOI: 10.1371/journal.pone.0083632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022] Open
Abstract
Most trigger digit (TD) patients complain that they have problems using their hand in daily or occupational tasks due to single or multiple digits being affected. Unfortunately, clinicians do not know much about how this disease affects the subtle force coordination among digits during manipulation. Thus, this study examined the differences in force patterns during cylindrical grasp between TD and healthy subjects. Forty-two TD patients with single digit involvement were included and sorted into four groups based on the involved digits, including thumb, index, middle and ring fingers. Twelve healthy subjects volunteered as healthy controls. Two testing tasks, holding and drinking, were performed by natural grasping with minimal forces. The relations between the force of the thumb and each finger were examined by Pearson correlation coefficients. The force amount and contribution of each digit were compared between healthy controls and each TD group by the independent t test. The results showed all TD groups demonstrated altered correlation patterns of the thumb relative to each finger. Larger forces and higher contributions of the index finger were found during holding by patients with index finger involved, and also during drinking by patients with affected thumb and with affected middle finger. Although no triggering symptom occurred during grasping, the patients showed altered force patterns which may be related to the role of the affected digit in natural grasping function. In conclusion, even if only one digit was affected, the subtle force coordination of all the digits was altered during simple tasks among the TD patients. This study provides the information for the future studies to further comprehend the possible injuries secondary to the altered finger coordination and also to adopt suitable treatment strategies.
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Affiliation(s)
- Po-Tsun Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Ju Lin
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedic Surgery, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Feng Chieh
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (FCS); (LCK)
| | - Li-Chieh Kuo
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (FCS); (LCK)
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Kobayashi K, Fukasawa K. An adjustable Kirchner wire frame traction method for the treatment of dorsal fracture-dislocation of the distal interphalangeal joint. Hand Surg 2014; 19:455-457. [PMID: 25288293 DOI: 10.1142/s0218810414720368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We applied an adjustable traction method which enables early range of motion exercise for the dorsal fracture-dislocation of the distal interphalangeal joint, and obtained satisfactory results. The reduction of comminuted fragments or depression of the joint is unnecessary using the traction method, because early exercise accelerates the remodelling of the injured soft tissue, followed by the development of joint stability. This traction mechanism is independent of the vector force of the traction applied due to the frame-structure construction. Our method makes it easy to adjust the traction force in millimetre increments of the glove-finger length, and has broad range of traction force. In cases where the dislocation is persistent even after strengthening the traction force, a transverse-transfixing Kirschner wire (K-wire) can be inserted to hold the reduction securely against subluxation.
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Affiliation(s)
- Koichi Kobayashi
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki City 211-8510, Japan
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40
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Levy MJ, Gerold KB. Preventing ring associated injuries: think twice about wearing that ring. J Spec Oper Med 2014; 14:93-95. [PMID: 24604445 DOI: 10.55460/dcia-z71n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 06/03/2023]
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Lu J, Cui H, Zhang W, Li Q, He K, Peng Y, Bian Z. [Repair of degloving injury of fingertip with vascular pedicled cross finger flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27:1480-1483. [PMID: 24640370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. METHODS Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm x 2.3 cm to 4.2 cm x 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. RESULTS Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. CONCLUSION The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.
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Füessl HS. ["Sunburn" from the endoscope]. MMW Fortschr Med 2013; 155:33. [PMID: 24482925 DOI: 10.1007/s15006-013-2428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Niu R, Woodbridge AB, Smith BJ, Ruff SJ, Lawson RD. Mobile garbage bins and hand injuries in older people. Med J Aust 2013; 199:491-2. [PMID: 24099211 DOI: 10.5694/mja13.10212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To conduct a database search, chart and literature review of open extensor tendon and proximal interphalangeal joint injuries incurred while handling mobile garbage bins. DESIGN, SETTING AND PARTICIPANTS A review of medical records at a Sydney tertiary referral hospital and a NSW rural Level 2 trauma hospital from 1 January 2006 to 31 December 2010, identified through database searches of appropriate medical record codes and followed by a chart review. RESULTS We identified 11 patients with finger injuries from handling mobile garbage bins that necessitated hospital-based treatments. Their average age was 75 years. Eight patients required surgery. Patients typically fell while maintaining their grip on mobile garbage bin handles, causing abrasive injury to the dorsal aspect of the proximal interphalangeal joint. CONCLUSIONS Older patients are at risk of significant injuries to the dorsal side of their fingers when manoeuvring mobile garbage bins. This risk could be reduced by providing older members of the community with help to move their bins, or by modifying the design of bin handles. We propose a simple modification to the design of bin handles.
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Abstract
Despite prevention efforts, burn injuries among auto mechanics are described in the literature. Electrothermal ring burns from car batteries occur by short-circuiting through the ring when it touches the open terminal or metal housing. This article describes a 34-year-old male auto mechanic who was holding a wrench when his gold ring touched the positive terminal of a 12-volt car battery and the wrench touched both his ring and the negative terminal. He felt instant pain and had a deep partial-thickness circumferential burn at the base of his ring finger. No other soft tissues were injured. He was initially managed conservatively, but after minimal healing at 3 weeks, he underwent a full-thickness skin graft. The graft incorporated well and healed by 4 weeks postoperatively. He had full range of motion. The cause of ring burns has been controversial, but based on reports similar to the current patient's mechanism, they are most likely electrothermal burns. Gold, a metal with high thermal conductivity, can heat up to its melting point in a matter of seconds. Many treatments have been described, including local wound care to split- and full-thickness skin grafts. Because most burns are preventable, staff should be warned and trained about the potential risks of contact burns. All jewelry should be removed, and the live battery terminal should be covered while working in the vicinity of the battery.
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Guglielmi G, Rossini M, Nicolosi MG, Ragno A, Lentini G, de Terlizzi F. Three-year prospective study on fracture risk in postmenopausal women by quantitative ultrasound at the phalanges. J Clin Densitom 2013; 16:341-346. [PMID: 22901551 DOI: 10.1016/j.jocd.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022]
Abstract
The purpose of this study was the calculation of fracture risk in a prospective study on postmenopausal women by quantitative ultrasound (QUS) at the phalanges. A total of 2341 postmenopausal women were recruited in 5 centers in Italy during 2006 and 2007 for QUS measurement during a screening program for osteoporosis. Two ultrasound parameters were collected: amplitude-dependent speed of sound (AD-SoS) and ultrasound bone profile index (UBPI). Women were then recontacted in 2010 and were asked about fracture occurrence during the period since previous QUS measurement. Data about new fracture occurred in this period, site and cause of fracture were requested. Two thousand two hundred eleven women were successfully recontacted. Mean age of the recruited women was 60.9 ± 10.0 yr, mean age at menopause was 49.3 ± 4.4 yr, mean body mass index (BMI) was 26.5 ± 4.6 kg/m². A total number of 108 new major osteoporotic fractures occurred during the 3-yr period, of which 23 are hip fractures, 51 are vertebral fractures. Relative risk (RR) per standard deviation (SD) decrease for major fractures was 1.77 (confidence interval [CI]: 1.59-1.97) for AD-SoS and 2.06 (CI: 1.78-2.37) for UBPI. When corrected for age, BMI, age at menopause, the RRs are still significant and equal to 1.44 (CI: 1.26-1.65) for AD-SoS and 1.67 (CI: 1.39-2.00) for UBPI. RR for vertebral fractures was 1.63 (CI: 1.41-1.88) for AD-SoS and 1.73 (CI: 1.44-2.08) for UBPI. RR for hip fractures was 1.92 (CI: 1.55-2.37) for AD-SoS and 2.68 (CI: 1.86-3.86) for UBPI. Ultrasound parameters AD-SoS and UBPI are able to significantly predict future major fractures in a prospective cohort of more than 2000 postmenopausal women.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy.
| | - Maurizio Rossini
- Department of Rheumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mario Guido Nicolosi
- Department of Gynecology and Obstetrics, Divisione Ospedaliera B, S. Anna Hospital, Torino, Italy
| | - Alessandro Ragno
- Department of Internal Medicine, Ospedale "Regina Apostolorum," Albano Laziale, Italy
| | - Giovanni Lentini
- Department of Gynecology and Obstetrics, Buccheri La Ferla FBF Hospital, Palermo, Italy
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Zhang W, Zhang W, Jiao C, Liu Y. [Repair of finger soft tissue defect with island flap based on vascular chain of cutaneous branch of dorsal metacarpal artery]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27:440-442. [PMID: 23757872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect. METHODS Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm x 0.8 cm to 5.2 cm x 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm x 1.0 cm to 5.5 cm x 3.8 cm. The donors were closed by suture or were repaired with skin graft. RESULTS Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230 degrees (mean, 204.6 degrees). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%. CONCLUSION The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can be used to repair finger tissue defect.
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Affiliation(s)
- Wenjing Zhang
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
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Fantus RJ. NTDB data points: Keep your hands and fingers off the table. Bull Am Coll Surg 2013; 98:66-67. [PMID: 23691685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Baba M, Harvey JN, Beard AJ, Lawson RD. Flexor digitorum profundus avulsion injuries in Oztag players. Med J Aust 2013; 198:196. [PMID: 23451961 DOI: 10.5694/mja12.11534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/17/2013] [Indexed: 11/17/2022]
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Ji B, Li JQ. [Forensic identification of 50 phalangeal fracture cases]. Fa Yi Xue Za Zhi 2013; 29:34-36. [PMID: 23646501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To study the characteristics of forensic identification of phalangeal fracture and to use a combination of medical records, imaging materials, and forensic examination data in identification. METHODS Fifty cases of phalangeal fracture involved in the forensic identification were collected from 2009 to 2011. The general situation, the distribution of fracture, the fracture morphology, the injury-causing objects and the results of identification were analyzed retrospectively. RESULTS Majority of the cases of phalangeal fracture were young and middle-aged men. The index finger and distal phalanx fractures were common. There was no difference in the number of phalangeal fracture between left and right hand. Most of the injury-causing objects were knives and sticks, followed by bricks and stones. CONCLUSION The injury-causing objects and modes are related to the morphology of fracture, the distribution of fracture and the severity of the injury. The comprehensive analysis is helpful in forensic identification of phalangeal fracture.
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Affiliation(s)
- Bin Ji
- Department of Forensic Medicine, Criminal Police Brigade of Hai men Public Security Bureau, Haimen, China.
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