RESUMO
ABSTRACT: In forensic pathology, forensic onychology studies fingernails and toenails for medicolegal purposes. It mainly deals with DNA profiling from nails, toxicological analysis for detecting poisons, and the collection of trace evidence present under the nails. Injuries to fingernails and their interpretation for medicolegal purposes are the neglected areas of this study. We have discussed the most common types of fingernail injuries and their significance. We found that their notification has significant value in drowning cases, defense wounds on the palm, self-inflicted cuts, burns, electrocution, blunt trauma, physical assault, sexual offenses, and other issues like torture. We emphasize the examination of fingernails in the autopsy and medicolegal clinical examination for better administration of law and justice.
Assuntos
Unhas , Humanos , Unhas/química , Unhas/patologia , Afogamento , Queimaduras/patologia , Patologia Legal , Tortura , Traumatismos dos Dedos/patologia , Traumatismos por Eletricidade/patologiaRESUMO
This brief report is a retrospective review of three cases of iatrogenic digital ischemia and clinical outcome at six months. Hand injuries are one of the most common injuries that occur in the working population. Iatrogenic digital ischemia is a rare condition that can be avoided by proper wound management. After the correct initial treatment is provided, it is important to apply the wound dressing correctly to avoid iatrogenic trauma or ischemia. Currently, there is no consensus regarding the best treatment for these injuries. Our aim is to remind clinicians of this rare condition, and to highlight prevention and treatment strategies.
Assuntos
Serviço Hospitalar de Emergência , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/patologia , Dedos/irrigação sanguínea , Isquemia/etiologia , Isquemia/patologia , Adulto , Feminino , Traumatismos dos Dedos/terapia , Humanos , Isquemia/terapia , MasculinoRESUMO
We describe a case of persistent tenosynovitis in the right fourth finger of a 50-year-old man that after almost a year of workup was found to be related to osteomyelitis caused by Mycobacterium arupense. The few cases found in the literature were associated with traumatic injuries, environmental contamination, and months of misdiagnosis. Treatment is challenging as there are limited data available on antimicrobial susceptibility and potential side effects of current therapy options.
Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Osteomielite/diagnóstico , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/microbiologia , Traumatismos dos Dedos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Osteomielite/microbiologia , Osteomielite/patologia , Tenossinovite/diagnóstico , Tenossinovite/microbiologia , Tenossinovite/patologiaRESUMO
Closed rupture of the thumb flexor tendon pulleys is rare and, to our knowledge, the MRI findings associated with this injury have not been described in the radiology literature. The injury can result in nonspecific clinical and physical exam findings and advanced imaging may be crucial to diagnosis. A familiarity with the normal anatomy of the flexor mechanism of the thumb and the imaging appearance of pathology is therefore necessary. We report a case of a 31-year-old female nurse with ruptures of several of the thumb flexor pulleys and the corresponding findings on MRI.
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Traumatismos dos Dedos/patologia , Traumatismos dos Tendões/patologia , Polegar , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , RupturaRESUMO
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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Traumatismos em Atletas/etiologia , Traumatismos dos Dedos/etiologia , Dispositivos de Proteção da Cabeça/efeitos adversos , Lesões dos Tecidos Moles/etiologia , Ferimentos Penetrantes/etiologia , Traumatismos em Atletas/patologia , Traumatismos em Atletas/cirurgia , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Humanos , Masculino , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento , Ferimentos Penetrantes/patologia , Ferimentos Penetrantes/cirurgia , Adulto JovemRESUMO
The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.
Assuntos
Artrite Psoriásica/complicações , Entesopatia/etiologia , Traumatismos dos Dedos/etiologia , Artropatias/etiologia , Doenças da Unha/complicações , Psoríase/complicações , Adulto , Estudos de Casos e Controles , Entesopatia/patologia , Feminino , Traumatismos dos Dedos/patologia , Humanos , Artropatias/patologia , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Dislocations of the carpometacarpal (CMC) joints are uncommon and are frequently missed on standard radiographs of the hand. Dislocations could be dorsal or palmar; dorsal dislocations are seen more frequently. Palmar dislocations can be either ulnopalmar or radiopalmar. Stable CMC dislocations could be successfully treated conservatively, while unstable dislocations are mostly treated operatively. The purpose of this report is to present a patient with an isolated ulnopalmar dislocation of the fifth CMC joint, satisfactorily treated with closed reduction and casting.
Assuntos
Articulações Carpometacarpais/lesões , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Assistência ao Convalescente , Idoso , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/patologia , Redução Fechada/métodos , Traumatismos dos Dedos/patologia , Fratura Avulsão/diagnóstico por imagem , Mãos/diagnóstico por imagem , Traumatismos da Mão/patologia , Humanos , Masculino , Radiografia/métodos , Doenças Raras , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis. METHODS: 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding. RESULTS: Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group. CONCLUSIONS: The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.
Assuntos
Amputação Traumática/diagnóstico por imagem , Amputação Traumática/patologia , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/patologia , Dedos/irrigação sanguínea , Adulto , Angiografia , Meios de Contraste , Lesões por Esmagamento/diagnóstico por imagem , Lesões por Esmagamento/patologia , Avulsões Cutâneas/diagnóstico por imagem , Avulsões Cutâneas/patologia , Edema/patologia , Feminino , Fibrina/metabolismo , Dedos/diagnóstico por imagem , Fluoroscopia , Hemorragia/patologia , Hérnia/patologia , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Ácidos Tri-IodobenzoicosAssuntos
Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Fraturas Expostas/cirurgia , Transplantes/transplante , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/reabilitação , Articulações dos Dedos/patologia , Fraturas Expostas/patologia , Fraturas Expostas/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: The management of finger deep burns is still problematic for the surgeon. Due to the fineness and the thickness of the subcutaneous tissue, after excision there is an important risk of exposure of the underlying tissue like bone, nerve or tendons. Local flaps (random pattern flap and pedicle flap) allowed ensuring a good quality covering with a tissue with many advantages (good thickness, sensitivity). On the contrary of all other techniques, flaps can be used independently from the vascular quality of the wound bed. Despite those advantages, the literature is poor to report the experience of flap in the management of finger deep burn. MATERIAL AND METHODS: We report our experience in the use of such technique with a series of 49 flaps. The cohort consisted of 34 patients (22 men and 12 women) who were treated in our unit between 2003 and 2012. RESULTS: Of the 49 flaps made, 71,4% were homodactyl flaps. 22,5% were heterodactyl flaps and 6,1% were intermetacarpian (second space) flaps. The rate of success was 87,8%. We reviewed 16 patients out of 34 patients operated, 20 of the 49 flaps performed (40,8%). The patients were reviewed by an independent surgeon. The average follow-up at this consultation was 4,25±2,46 years. The monofilament test was positive for 17 flaps (85% of cases). For the Weber's test, we found a normal perception threshold for 11 flaps (55%), with an average test at 2,8mm (2-4mm). Normal motricity was found at the donor site in 14 of the 16 patients evaluated for 18 of the 20 revised flaps (90% of cases). In terms of cosmetic result, the average overall score obtained at the patient's own evaluation was 0.85. That obtained by the evaluator was equal to 0.55, with no significant difference (scale range from 0 best results to 5 worse results). DISCUSSION: Hand and finger burns are frequent and benefit from rapid, high-quality coverage, enabling early mobilization to combat secondary stiffness problems. The high success rate of our series, as well as the quality of the functional and cosmetic results obtained, demonstrate the reliability and the interest of the digital flaps.
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Queimaduras/cirurgia , Traumatismos dos Dedos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/patologia , Criança , Pré-Escolar , Feminino , Traumatismos dos Dedos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Fingertip amputation is the most common amputation encountered by hand surgeons. Treatment decisions are multifactorial, based on mechanism, level of injury, tissue loss, associated injuries, and patient preference, among others. In this article, we present use of the thenar flap in combination with bone graft and split-thickness nail bed graft to address the tripartite loss of distal phalanx, soft tissue, and nail bed. This method allows for a full-length and functional reconstructed fingertip that is aesthetically satisfactory and does not require microsurgical techniques.
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Amputação Traumática/cirurgia , Transplante Ósseo , Traumatismos dos Dedos/cirurgia , Unhas/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
History A 34-year-old man without underlying medical conditions came to the emergency department for evaluation of persistent pain over the volar portion of his right fifth finger after a fall during a football match 3 days before. At physical examination, the injured finger was swollen and purple. Passive and active flexion of the proximal and distal interphalangeal joints were compromised, without interphalangeal instability. Radiography was performed in the emergency department, and the patient was released with a diagnosis of a fifth digit sprain. After the senior radiologist (V.M.C.) reviewed the radiographs, the patient was called back for assessment with ultrasonography (US) on the same day. US was performed with an Aplio 500 unit (Toshiba Medical Systems, Tokyo, Japan) using a multifrequency linear array 7.2-18.0-MHz PLT-1204BX transducer focused at the level of the flexor tendon. The patient was sitting in front of the examiner, with the hand lying palm up on the examination bed. No abnormality was observed during color Doppler US.
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Traumatismos dos Dedos , Articulações dos Dedos , Dedos , Adulto , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Dedos/diagnóstico por imagem , Dedos/patologia , Dedos/cirurgia , Humanos , MasculinoRESUMO
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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Mordeduras e Picadas/complicações , Queimaduras/etiologia , Traumatismos dos Dedos/etiologia , Peixes Venenosos , Hipertermia Induzida/efeitos adversos , Amputação Cirúrgica , Animais , Mordeduras e Picadas/patologia , Mordeduras e Picadas/terapia , Queimaduras/patologia , Queimaduras/cirurgia , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Venenos de Peixe/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
RATIONALE: Slowly progressive hand ischemia is mostly associated with medical illness such as vasculitis, and in patients with smoking history, Buerger disease is often considered first. However, despite the very low incidence of vascular anatomical anomalies, they can lead to hand ischemia. And if there is no consideration for them, proper treatment cannot be selected. PATIENT CONCERNS: A 42-year-old male smoker presented with a slowly progressing 5th fingertip necrosis following blunt trauma. DIAGNOSES: Angiography revealed congenital hypoplasia of ulnar artery, and excluded Buerger disease or hypothenar hammer syndrome. INTERVENTIONS AND OUTCOMES: We reconstructed the necrotic fingertip using a 2nd toe pulp free flap to reflect the patient's need. LESSONS: In this case report, the authors emphasize that the possibility of anatomical anomaly should be considered as a cause of the ischemia. Vascular imaging should be undertaken to investigate the cause of ischemia of the hand.
Assuntos
Traumatismos dos Dedos/complicações , Dedos/irrigação sanguínea , Isquemia/etiologia , Artéria Ulnar/anormalidades , Adulto , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Dedos/patologia , Humanos , Isquemia/patologia , Masculino , NecroseRESUMO
A 45-year-old female patient presented to clinic with an almost completely embedded ring in the volar aspect of her right ring finger, with complete reepithelialisation over the superficial aspect of the ring. We present this unusual case of an embedded ring after an insect bite on the patient's ring finger. The patient had worn the ring for the previous 5 years without removing it and did not report any discomfort or traumatic injury. We discuss this case in the context of previously reported cases of an embedded ring, a rare presentation in itself, highlighting the key differences in both this patient's aetiology and the risk factors associated with the presentation.
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Traumatismos dos Dedos/etiologia , Corpos Estranhos/etiologia , Mordeduras e Picadas de Insetos/complicações , Joias , Feminino , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Corpos Estranhos/patologia , Corpos Estranhos/cirurgia , Humanos , Pessoa de Meia-IdadeRESUMO
High-pressure paint injection injury is an uncommon but well-described injury. The histologic features of long-term paint injection injury with retained material are less recognized. A 46-year-old male presented clinically as "recurrent giant cell tumor of tendon sheath." The right index finger demonstrated fusiform enlargement by a pigmented mass with diffuse infiltration into the soft tissue of the hand. Histologically the tumor showed multiple giant cells in a fibrotic stroma extending into the dermis. There were multiple types of foreign material including diffuse brown black pigment, weakly optically polarizing foreign material and white inclusions with a "train track" appearance. The cells were positive for CD68 and negative for S100 antigen. Further investigation revealed that the patient had a history of high-pressure paint injection injury to his digit 6 years prior. Foreign material injected under high pressure into tissues may result in a pseudo-neoplastic foreign body granulomatous reaction that can mimic giant cell tumor of tendon sheath. Our case demonstrates that this reaction can be florid and can have slow growth over years. A high index of suspicion, a good clinical history and careful examination can distinguish these 2 entities.
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Traumatismos dos Dedos , Reação a Corpo Estranho , Tumor de Células Gigantes de Bainha Tendinosa , Células Gigantes de Corpo Estranho , Pintura , Sarcoma , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Traumatismos dos Dedos/metabolismo , Traumatismos dos Dedos/patologia , Dedos/patologia , Reação a Corpo Estranho/metabolismo , Reação a Corpo Estranho/patologia , Tumor de Células Gigantes de Bainha Tendinosa/metabolismo , Tumor de Células Gigantes de Bainha Tendinosa/patologia , Células Gigantes de Corpo Estranho/metabolismo , Células Gigantes de Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Proteínas S100/metabolismo , Sarcoma/metabolismo , Sarcoma/patologiaAssuntos
Acidentes de Trabalho , Cianose/tratamento farmacológico , Epinefrina/administração & dosagem , Traumatismos dos Dedos/tratamento farmacológico , Ferimentos Penetrantes Produzidos por Agulha/complicações , Nitroglicerina/administração & dosagem , Adesivo Transdérmico , Anafilaxia , Cianose/etiologia , Epinefrina/efeitos adversos , Feminino , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/patologia , Humanos , Pessoa de Meia-Idade , Nitroglicerina/uso terapêutico , Resultado do TratamentoRESUMO
Embedded ring injury is a rare condition often associated with mental illness or cognitive disorders. Clinical presentation varies from simple oedema to serious neurovascular deficits. We report the unusual case of a 69-year-old woman presenting with two embedded ring injuries. The rings had been in place for over 20 years, however she had no past medical history of psychiatric or neurological disorder. A non-invasive approach was decided to treat the patient by simply cutting the rings allowing to resolve the situation without further morbidity.
Assuntos
Traumatismos dos Dedos/etiologia , Corpos Estranhos/complicações , Joias/efeitos adversos , Amor , Metáfora , Idoso , Edema/etiologia , Feminino , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/terapia , Corpos Estranhos/diagnóstico , Corpos Estranhos/terapia , Humanos , Isquemia/etiologia , Competência Mental , Resultado do TratamentoRESUMO
The foremost goal of managing a mutilated hand is provision of adequate skin coverage. The most suitable method is free tissue transfer. The specific role of volar surface requires replacement tissue to have similar texture for aesthetically satisfactory and functionally acceptable outcomes. Hand surgeons must approach mutilating hand injuries with the recognition that no 2 injuries are ever the same. The injured hand must be evaluated on the individual demand and characteristics of hand use. Optimal function and aesthetic outcomes require appropriate selection of skin coverage. Lost tissues must be replaced like with like tissue.
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Traumatismos da Mão/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Traumatismos dos Dedos/patologia , Traumatismos dos Dedos/cirurgia , Traumatismos da Mão/patologia , Humanos , Ilustração Médica , Microcirurgia , Fotografação , Reimplante , Lesões dos Tecidos MolesRESUMO
BACKGROUND: Most microsurgeons believe that smoking and severity of injury adversely affect the outcome of digital replantation surgery. As countermeasures, several pharmacologic agents have been used for the perioperative period. The purpose of this retrospective study was to examine whether the rate of necrosis is appreciably different across smokers versus nonsmokers with prostaglandin E1 therapy. METHODS: The authors' study subjects included 144 patients (184 digits) who underwent replantation or revascularization between August of 2013 and August of 2015.The primary outcome was the incidence of total necrosis after replantation surgery, and the secondary outcomes were the rate of overall necrosis, proportion of total necrosis to overall necrosis, and total success. Intravenous administration of prostaglandin E1 was performed at the rate of 120 µg/day for 7 days after surgery in all patients. These outcomes of each injury type were compared between smoking and nonsmoking groups. RESULTS: Among the 184 injured digits, the incidence of total necrosis in smokers (23 percent) was higher than that in nonsmokers (17 percent), although no significant difference was shown (p = 0.36). The adjusted odds ratio was 1.17 (95 percent CI, 0.51 to 2.69). Similarly, there was no significant difference in the secondary outcomes between the two groups. CONCLUSION: The authors' retrospective study found no significant difference in the formation or extent of necrosis after replantation or revascularization between smoking and nonsmoking groups when all patients were treated with prostaglandin E1. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.