RESUMEN
Hyperbaric oxygen therapy (HBOT) has been used as an adjuvant treatment for crush injury because it can improve tissue hypoxia and stimulate wound healing. However, the actual role of HBOT in crush hand injury is still unknown. This study is to assess the efficacy of HBOT for crush hand patients, as well as the impact of HBOT initiation timing. Between 2018 and 2021, 72 patients with crush hand injury were retrospectively reviewed. The patients were divided into the HBOT and control group, and each group had 36 patients. The average session of HBOT was 18.2 (5-32 sessions) per patient, and no patient had a complication related to the treatment. The two groups had similar demographics, but HBOT group had larger injured area (73.6 ± 51.0 vs. 48.2 ± 45.5 cm2 , p = 0.03). To better control the confounding factors, we performed the subgroup analysis with cut-off injured area of 50 cm2 . In the patients with smaller injured area (â¦50 cm2 ), the HBOT group had shorter wound healing time (29.9 ± 12.9 vs. 41.0 ± 18.9 days, p = 0.03). The early HBOT group (first session ≤72 h post-operatively) had shorter hospital stay (8.1 ± 6.4 vs. 15.5 ± 11.4 days, p = 0.04), faster wound healing (28.7 ± 17.8 vs. 41.1 ± 18.1 days, p = 0.08) and less operations (1.54 ± 0.78 vs. 2.41 ± 1.62, p = 0.06) although the latter two didn't achieve statistical significance. HBOT is safe and effective in improving wound healing of hand crush injury. Early intervention of HBOT may be more beneficial. Future research is required to provide more evidence.
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Lesiones por Aplastamiento , Traumatismos de la Mano , Oxigenoterapia Hiperbárica , Humanos , Cicatrización de Heridas , Estudios Retrospectivos , Traumatismos de la Mano/terapia , Lesiones por Aplastamiento/terapiaRESUMEN
Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).
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Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Anciano , Humanos , Huesos del Metacarpo/cirugía , Estudios Retrospectivos , Australia , Programas Nacionales de Salud , Fracturas Óseas/cirugía , Costos y Análisis de Costo , Tornillos ÓseosRESUMEN
INTRODUCTION: Military doctors usually deal with hand wound management. Their practice sometimes takes them far from any specialized surgical center. The WALANT could be a powerful tool for doctors operating in nuclear submarines or as part of special forces. This is a comparative, prospective and multicenter study. The hypothesis was that the management of hand wounds by military doctors specifically trained in WALANT and in the surgical exploration of hand wounds allowed a diagnosis as effective as in the FESUM center. PATIENTS AND METHODS: Military doctors, usually operating in isolated conditions, were trained at WALANT. Then, this method was used for the exploration of hand wounds in the emergency room, in a center outside FESUM. At the end, two different questionnaires were completed respectively by the patient and the operator. They aimed to assess various criteria such as the overall satisfaction of the patient and the operator, the level of pain felt or the ability of the operator to establish a precise lesion assessment. The results were compared with those obtained under the same conditions by hand surgeons in the FESUM centre. RESULTS: No significant difference was found between the two centers in terms of diagnostic capacity, satisfaction, comfort and perceived pain intensity. DISCUSSION: Under cover of prior training, the WALANT is effective for the exploration of hand wounds by submariner doctors and members of the special forces. Its use makes it possible to establish a precise injury report and this in material and human conditions approaching as closely as possible those of the armed forces on mission. The comfort of the patient remains preserved. CONCLUSION: The WALANT represents an effective tool for the exploration and lesion assessment of hand wounds outside the FESUM centre. Since emergency conditions are similar to those encountered in operational conditions, its use is also possible in situations specific to military doctors: nuclear submarines, special forces on mission. LEVEL OF EVIDENCE: III; comparative study, retrospective, multicentre.
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Anestesia Local , Traumatismos de la Mano , Humanos , Anestesia Local/métodos , Estudios de Factibilidad , Estudios Prospectivos , Estudios Retrospectivos , Traumatismos de la Mano/cirugíaRESUMEN
BACKGROUND: South Africa is faced with one of the highest rates of violent crime in the world. Accordingly, therapists treat high numbers of deliberate hand injuries. There is, however, a paucity of literature exploring the lived experiences of these survivors. PURPOSE: The aim of this study was to describe and interpret the meaning of living through a violent hand amputation and replantation, the impact on occupational adaptation and to reflect on therapeutic intervention, within the context of South Africa. STUDY DESIGN: An exploratory embedded single case study using a qualitative approach. METHODS: Interpretative phenomenological analysis was used to analyze data from: 8 interviews with the primary participant, over a period of 33 months; an interview with his work colleague; interviews with 5 health professionals; a review of the occupational therapy rehabilitation file and a review of the audio-visuals, recorded over 2-years. RESULTS: This narrative reveals a man who understood his terrifying assault to be part of a southern African ritual of spiritual origin - using human body parts for traditional medicine (muti crime) or witchcraft. He perceived his expensive hand replantation and therapy as surreal and violence as normal. Challenges highlighted the importance of being attentive to the psychosocial sequelae of violence; and the most valuable part of therapy was perceived as occupational engagement. CONCLUSIONS: The perception of attempted muti murder situates this extreme and unusual case study as a novel contribution to the medical and rehabilitation literature. South African therapists are urged to be actively involved in changing the culture of violence, and hand therapists are reminded of the importance of applying holistic and occupation-based intervention.
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Traumatismos de la Mano , Terapia Ocupacional , Masculino , Humanos , Sudáfrica , Reimplantación , Traumatismos de la Mano/rehabilitación , ManoRESUMEN
BACKGROUND: The purpose of this study was to review the rate and type of infectious complications after surgical fixation of hand fractures managed under wide-awake local anesthesia with no tourniquet (WALANT) in minor procedure rooms outside the main operating room. METHODS: A two-surgeon retrospective chart review was performed of patients who received surgical fixation of hand fractures under WALANT in minor surgery from March of 2014 to March of 2019. RESULTS A TOTAL OF: patients, with distal phalanx ( n = 16), middle phalanx ( n = 7), proximal phalanx ( n = 11), or metacarpal ( n = 26) fractures, were included in the study. The average patient age was 37 years, with a higher proportion of male patients (51:7). Two patients had two fractures each. Thirty of the 58 cases were already open fractures. Fixation was performed using either plates and screws (25 of 58) or nonburied Kirschner wires (31 of 58). Thirty-six percent of patients (21 of 58) were treated with prophylactic antibiotics. One patient developed postoperative cellulitis. The only case of osteomyelitis occurred in a patient with risk factors known to increase rates of infectious complications (open fracture, smoking history, and >24 hours from injury to treatment). No infectious complications occurred in those who sustained closed fractures. CONCLUSIONS: Although the minor surgery environment varies significantly from that of the main operating room, infection rates after surgical fixation of hand fractures using WALANT in this setting remain low (3.4 percent), with no documented infections in fractures that were referred closed and opened surgically for operative fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Fracturas Abiertas , Traumatismos de la Mano , Adulto , Anestesia Local/métodos , Antibacterianos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fracturas Abiertas/cirugía , Traumatismos de la Mano/cirugía , Humanos , Masculino , Procedimientos Quirúrgicos Menores , Estudios RetrospectivosRESUMEN
BACKGROUND: Fractures of the hand, specifically the metacarpals and phalanges, are a common injury. Whilst many of these fractures can be treated non-operatively, a number of advances have led to the increase in popularity of surgical intervention. The aim of this study was to assess and describe trends in management of phalangeal and metacarpal fractures in Australia over the last two decades. METHODS: A review was conducted of the Medicare Benefits Scheme (MBS), specifically querying the item numbers pertaining to the management of metacarpal and phalanx fractures. Data was recorded as the incidence per 100 000 patients. RESULTS: Overall, there was a statistically significant decrease in the incidence of closed reduction of metacarpal and phalanx fractures, with a converse statistically significant increase in open reduction internal fixation. CONCLUSION: This study demonstrates that over the last 20 years, there has been a decrease in closed reduction of intra- and extra-articular phalangeal and metacarpal fractures, with a converse but smaller increase in open reduction and fixation. These trends are likely multi-factorial in aetiology, and should be monitored to guide resource allocation and health provision in the future.
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Falanges de los Dedos de la Mano , Fracturas Óseas , Traumatismos de la Mano , Huesos del Metacarpo , Anciano , Australia/epidemiología , Falanges de los Dedos de la Mano/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/epidemiología , Fracturas Óseas/cirugía , Traumatismos de la Mano/cirugía , Humanos , Huesos del Metacarpo/cirugía , Programas Nacionales de SaludRESUMEN
OBJECTIVE: Wrist fractures constitute the most frequently occurring upper limb fracture. Many individuals report persistent pain and functional limitations up to 18 months following wrist fracture. Identifying which individuals are likely to gain the greatest benefit from rehabilitative treatment is an important research priority. This systematic review aimed to summarize effectiveness of rehabilitation after wrist fracture for pain and functional outcomes and identify potential effect moderators of rehabilitation. METHODS: A comprehensive search of 7 databases (including MEDLINE, EMBASE, and the Physiotherapy Evidence Database) was performed for randomized controlled trials involving adults >50 years of age who sustained wrist fracture and had received 1 or more conservative treatments (eg, exercise/manual therapy, lifestyle, diet, or other advice). Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers. Results of included trials were summarized in a narrative synthesis. RESULTS: A total of 3225 titles were screened, and 21 studies satisfying all eligibility criteria were reviewed. Over one-half of the included studies (n = 12) comprised physical therapist and/or occupational therapist interventions. Rehabilitative exercise/manual therapy was generally found to improve function and reduce pain up to 1 year after wrist fracture. However, effects were small, and home exercises were found to be comparable with physical therapist-led exercise therapy. Evidence for the effects of other nonexercised therapy (including electrotherapy, whirlpool) was equivocal and limited to the short term (<3 months). Only 2 studies explored potential moderators, and they did not show evidence of moderation by age, sex, or patient attitude of the effects of rehabilitation. CONCLUSION: Effectiveness of current rehabilitation protocols after wrist fracture is limited, and evidence for effect moderators is lacking. Currently available trials are not large enough to produce data on subgroup effects with sufficient precision. To aid clinical practice and optimize effects of rehabilitation after wrist fracture, potential moderators need to be investigated in large trials or meta-analyses using individual participant data. IMPACT: Many patients report persistent pain and functional limitations up to 18 months following wrist fracture. Effectiveness of current rehabilitation protocols after wrist fracture is limited and may be due to insufficient targeting of specific rehabilitation to individuals who are likely to benefit most. However, evidence for effect moderators is lacking within the currently available literature. To aid clinical practice and optimize effects of rehabilitation, investigating potential moderators of rehabilitation in individuals with wrist fracture via large trials or meta-analysis of individual participant data is research and policy imperative.
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Traumatismos de la Mano , Fracturas del Radio , Traumatismos de la Muñeca , Adulto , Humanos , Dolor , MuñecaRESUMEN
Hand burns are common injuries that can result in long-term impairment of hand function. Enzymatic debridement (ED) prevents damage to the viable dermis due to the procedure's selectivity and has become an option for obtaining an accurate depth assessment and enabling wound re-epithelialization with less skin graft use. We conducted a prospective study from July 2015 to July 2018, which enrolled patients with deep partial-thickness hand burns and treated them with ED using bromelain. After a specified period, we assessed the patients' hand function, using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHOQ) to assess their disabilities and activities of daily life, respectively. We assessed the hand joint range of motion using a goniometer and assessed scar quality with the Vancouver Scar Scale (VSS). We analyzed 72 patients with 90 burned hands at 3 months and, at the final assessment, 69 patients with 86 burned hands. Fire was the most common cause of the burns. Bromelain allowed for early debridement (73.6% during the first 24 h). At the 3-month evaluation, the mean DASH and MHOQ scores were 2.35 and 97.9%, respectively, with a high inverse correlation between the 2 types of scores (Spearman's rho, -0.78; p < .001). The mean wrist flexion and extension were 85.7 and 80°, respectively, the mean metacarpophalangeal flexion was 88.3°, the proximal interphalangeal (PIP) flexion was 112.9°, and the thumb opposition was 77°. The mean VSS score was 2.87. At the final evaluation, with a minimum follow-up of 391 days, the mean DASH and MHOQ scores were 0.18 and 99.71%, respectively. ED with bromelain in deep partial-thickness hand burns resulted in normal values at 3 months and at over 1 year of follow-up, with complete restoration of function and quality of life and good scar results.
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Quemaduras , Traumatismos de la Mano , Quemaduras/cirugía , Desbridamiento/métodos , Traumatismos de la Mano/cirugía , Humanos , Estudios Prospectivos , Calidad de Vida , Trasplante de PielRESUMEN
The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.
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Traumatismos de los Dedos , Fracturas Óseas , Traumatismos de la Mano , Luxaciones Articulares , Fracturas Óseas/diagnóstico por imagen , Humanos , Pulgar/diagnóstico por imagen , Pulgar/lesiones , UltrasonografíaAsunto(s)
Anestesia Local/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Traumatismos de la Mano/cirugía , Hemostasis Quirúrgica/instrumentación , Traumatismos de los Tendones/cirugía , Transferencia Tendinosa , Torniquetes , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Lidocaína , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Clenched fist injury is associated with a high risk of infectious complications and is commonly managed with formal irrigation and debridement in the operating theatre. The purpose of this study was to determine outcomes associated with irrigation and debridement of clenched fist injuries under local anaesthesia using field sterility outside the operative theatre. In this single centre study, 232 patients were identified with clenched fist injury and 210 were treated with a standard protocol beginning with administration of intravenous antibiotics and then irrigation and debridement at the bedside. Primary outcome measures were the need for repeat debridement and complications. Secondary outcome measures included factors associated with the need for repeat debridement. Fifteen of the 210 patients (7%) required repeat debridement. Patients with cultures positive for gram-negative organisms had a significantly increased risk of repeat debridement. Irrigation and debridement under local anaesthesia using field sterility results in an acceptably low risk of complications or need for repeat debridement.Level of evidence: IV.
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Traumatismos de la Mano , Infertilidad , Anestesia Local , Desbridamiento , HumanosRESUMEN
Treatment of acute injuries of the hand Abstract. Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. But first, we highlight the different methods of local anesthesia and discuss the use of a tourniquet or vasoconstriction with adrenalin - WALANT - instead.
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Mordeduras y Picaduras , Traumatismos de los Dedos/diagnóstico , Traumatismos de la Mano/diagnóstico , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/terapia , Anestesia Local , Mano , Humanos , Uñas/lesiones , TorniquetesAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Traumatismos de la Mano/terapia , Accesibilidad a los Servicios de Salud/organización & administración , Control de Infecciones/organización & administración , Servicio Ambulatorio en Hospital/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Anestesia Local , COVID-19 , Traumatismos de la Mano/diagnóstico , Humanos , Control de Infecciones/métodos , Londres , Modelos Organizacionales , Procedimientos Ortopédicos , Atención Perioperativa/métodos , Procedimientos de Cirugía Plástica , SARS-CoV-2 , Triaje/métodos , Triaje/organización & administraciónRESUMEN
Background: Bromelain-based enzymatic debridement has been introduced as an alternative to surgical excision in deep partial thickness and full thickness burns. We aimed to analyze effectiveness and predictors of spontaneous epithelialization after enzymatic debridement of deep hand burns.Methods: All patients who received enzymatic debridement for deep partial thickness or full thickness burns of the hands at our institution in the last 5 years were identified. Demographic, clinical and outcome data were collected and analyzed. For patients with deep partial thickness burns, Kaplan-Meier log-rank and subsequent multivariate Cox-regression analysis were performed to identify predictors of spontaneous epithelialization.Results: 44 patients and 52 hands were treated in the observation period. Among these, 14 had full thickness burns and received split thickness skin grafts. In the 38 hands with deep partial thickness burns, predictors of 28-day epithelialization were total burn extent and mechanism of burn injury. During the first 3 years, 8 out of 13 treated deep partial thickness burns received split thickness skin grafts after a median of 3 days. The following 3 years, 5 out of 25 deep partial thickness burns received surgery after a median of 14 days.Conclusions: Enzymatic debridement is a useful tool in the treatment of burned hands but the decision-making and correct timing of operative intervention in deep partial thickness burns after debridement requires experience. In our cohort, spontaneous healing of deep partial thickness burns was best in patients with contact burns and less than 15% burn TBSA.
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Bromelaínas/uso terapéutico , Quemaduras/terapia , Desbridamiento/métodos , Traumatismos de la Mano/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Repitelización , Estudios Retrospectivos , Trasplante de Piel , Adulto JovenRESUMEN
Burn-induced compartment syndrome represents a serious and acute condition in deep circumferential burns of the extremities which, if left untreated, can cause severe complications. The surgical escharotomy that releases the high subdermal pressure is the therapeutic treatment of choice for burn-induced compartment syndrome. Guidelines for escharotomy indications and timing include pressure greater than 30 mm Hg and 6 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia). Nevertheless, despite the need for an early as possible pressure release, escharotomy is often delayed when a capable surgeon is not available, or if the indication is not completely clear to justify potential risks associated with surgical escharotomy. Early treatment of circumferential burns of the extremities with a Bromelain-based enzymatic agent NexoBrid® may represent a less traumatic and invasive procedure to reduce intra-compartmental pressure, replacing surgical escharotomy. This case study of 23 patients describes the variation of compartmental pressure in patients with circumferential burns of the extremities treated with NexoBrid® enzymatic escharotomy-debridement. All the patients were treated with NexoBrid® within 2 to 22 hours post-injury in our Burn Intensive Care Center. The excessive pressure recorded before treatment returned to normal below 30 mm Hg and an approximately 60% reduction of the compartmental pressure was observed in most cases within 1 hour from NXB application. On NexoBrid® removal after 4 hours complete debridement-escharotomy of the burns was achieved. Enzymatic escharotomy-debridement appears to be a useful and safe method to reduce postburn compartmental pressure. Additional randomized, well-controlled powered studies are needed to further support these results.
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Bromelaínas/uso terapéutico , Quemaduras/complicaciones , Cicatriz/terapia , Síndromes Compartimentales/terapia , Desbridamiento , Traumatismos de la Mano/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Quemaduras/terapia , Cicatriz/complicaciones , Cicatriz/patología , Síndromes Compartimentales/etiología , Síndromes Compartimentales/patología , Femenino , Traumatismos de la Mano/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
This study aimed to investigate exposure adjusted injury incidence rates and profiles associated with training and competition in an elite taekwondo athlete population. 82 athletes were investigated for injuries over a period of 5 years. Individual fight time exposure for training and competition was recorded. The type and location of the injuries were classified and exposure-adjusted injury incidence rates (IIR) were calculated per 1000 h for training and competition. 66 athletes with a mean age of 19.3±4.2 years and 172 injuries were included in the final data assessment. The exposure adjusted IIR was significantly higher during competition (p<0.001) with a rate ratio of 6.33 (95% CI 4.58-8.69). Ankle and foot region as well as hand and wrist were most affected with significant higher IIR in competition (p<0.001). Joint injuries, fractures, and bruising occurred the most. Fractures occurred mainly to the hand and wrist region. Future investigations should focus on exposure adjusted injury data including analyses of the detailed mechanism leading to especially severe injuries to improve specific injury prevention in competition and promote evolution of protective gear.
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Traumatismos en Atletas/epidemiología , Conducta Competitiva/fisiología , Artes Marciales/lesiones , Acondicionamiento Físico Humano/efectos adversos , Adolescente , Adulto , Traumatismos del Tobillo/epidemiología , Femenino , Traumatismos de los Pies/epidemiología , Traumatismos de la Mano/epidemiología , Humanos , Incidencia , Masculino , Estudios Prospectivos , Traumatismos de la Muñeca/epidemiología , Adulto JovenRESUMEN
Hands are often affected from burns, due to their unprotected exposure to thermal injuries. Burn injuries also pose a major threat for hands as there is a high risk of severe functional and aesthetical disabilities. Bromelain-based enzymatic debridement is a novel treatment alternative for early surgical excision of burn eschar. This case study describes three patients who were treated with enzymatic debridement in deep thermal burns of the hand.
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Bromelaínas/uso terapéutico , Quemaduras , Desbridamiento/métodos , Traumatismos de la Mano , Cicatrización de Heridas/fisiología , Adulto , Anciano , Quemaduras/terapia , Cicatriz/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de PielRESUMEN
Most unstable metacarpal and phalangeal fractures for which operative treatment is indicated can be reduced and stabilized with either open or closed techniques using local anesthetic with epinephrine instead of intravenous sedation or general anesthesia. With the patient wide-awake during surgery, the hand can be taken through active range of motion to assess fracture stability. In this article, the authors review the rationale and technique for wide-awake, local anesthesia, no tourniquet surgery in the treatment of phalangeal and metacarpal fractures and impart pearls to optimize the patient experience and illustrate common fixation techniques using percutaneous Kirschner wires. The intraoperative assessment of fracture stability permits an accelerated, protected-range-of-motion protocol that minimizes postoperative stiffness and facilitates expedient recovery.