Hand and Wrist Injuries in Boxing and the Martial Arts.

Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention.

HBO2 in snake envenomation (atrox albinus rattlesnake): a case report in a human.

A patient suffered from an envenomation that, at his hospitalization, was judged severe: Grade 3 out of 3, as defined in clinical studies for CroFab™ antidote [Crotalidae Polyvalent Immune Fab (Ovine)]. In addition to the usual antivenom treatment we applied adjunctive hyperbaric oxygen (HBO2) therapy. Our aim was to facilitate better control of the lesions, already presenting as problematic wounds and at high risk of necrotizing soft tissue infection with compartment aspects. The regimen consisted of six treatments, one daily at 2.4 atmospheres absolute at 25 minutes x3 (75 minutes) at FiO2=1, with two five-minute air breaks interposed. The therapy was well tolerated in spite of the patient's declared trait of claustrophobia. Our findings at a long-term follow up suggest that HBO2 therapy may be reasonably and effectively administered at least in the post-acute phase of such occurrences.

Management of a Dehisced Hand Wound Using Hydrogen Peroxide, Electrical Stimulation, Silver-containing Dressings, and Compression: A Case Study.

Wound dehiscence is the separation of a wound along surgical sutures. A 57-year-old, otherwise healthy mechanic presented with a large open wound of >1 month duration on his left hand. His wound had dehisced after treatment that involved cleansing, surgical sutures, and oral antibiotics. He presented with a 5.0 cmx0.7 cmx0.3 cm lesion through the palmar creases of the hand with edema around the fourth and fifth digits and a callous formation around the distal portion of the wound. The wound had scant serosanguinous drainage and some induration at the periwound area, as well as a moderate foul odor. Tendons were not affected, but function was limited, the hand was painful, and the patient had been unable to work. Treatment was initiated with twice-a-week immersion of the hand in hydrogen peroxide diluted with water subjected to high-voltage pulsed current electric stimulation (HVPC). The wound was dressed with silver-containing dressings secured with stretch gauze and a compression garment. The wound was completely closed after 9 visits (35 days). No functional limitations of the hand or fingers, no cosmetic defect, and no wound recurrence were noted 9 months after healing. Although uncommon, dehisced wounds, especially in certain anatomical locations such as the hand, can be difficult to heal and may cause long-term problems with functioning. The treatment combination facilitated expedient healing of this dehisced hand wound. Research is needed to help elucidate the observations from this case study.

Hand surgery using local anesthesia.

Most hand traumas and elective surgical disorders of the hand can be treated quickly, easily, inexpensively, and effectively in an outpatient clinic. Although many surgeons prefer general anesthesia, the senior author routinely uses local anesthesia without sedation almost exclusively for carpal and cubital tunnel release, fasciectomy, arthrodesis, arthroplasty, synovectomy, and trauma, including the repair of tendons, nerves, ligaments, fractures, and soft tissue defects. After completing more than 10,000 procedures, the authors have found great benefits through the use of local anesthesia, which are detailed in the article.

Sea urchin injuries to the hand: a case report and review of the literature.

Sea urchin injuries to the hand are uncommon. A variety of home remedies can be found on the internet and other sources for dealing with this problem in the acute setting. Many long term complications such as granulomas, arthritis, and tenosynovitis can result from a neglected sea urchin injury. We report an unusual case of a patient with a remote sea urchin injury who presented with ulnar digital nerve paresthesias. A traumatic neuroma was found on surgical exploration. We review the literature on injuries to the hand caused by sea urchins and their management. Management of sea urchin injuries to the hand with retained spines requires surgical debridement in order to prevent significant long term complications including stiffness, tenosynovitis, granulomas, and arthritis.

Case report: Hyperbaric oxygen in the treatment of puff adder (Bitis arietans) bite.

INTRODUCTION: The puff adder (Bitis arietans) is a venomous viper mainly found in sub-Saharan Africa. Due to its common occurrence and potent venom, it is considered to be the most dangerous snake in Africa, responsible for most snakebite fatalities there. Puff adder bites outside Africa are rare and involve captive vipers. We present the unusual case of puff adder envenomation in an Austrian man. CASE REPORT: A 26-year-old Austrian man was bitten by a puff adder that he kept illegally in his home. On admission he showed signs of local and systemic toxicity. He was stabilized with antivenom, intravenous fluids, catecholamines and packed platelets. Hyperbaric oxygenation was begun due to incipient compartment syndrome on the second day and continued until the eleventh day, when the patient had recovered completely and could be discharged. DISCUSSION: The venom of Bitis arietans can cause serious systemic and local complications. Our patient suffered from both. Systemic signs included hemodynamic as well as hemostaseologic impairment. Local effects included swelling and incipient compartment syndrome. Systemic and local treatment, including hyperbaric oxygenation, effected a full recovery. We suggest that, whenever feasible, hyperbaric oxygenation should be considered as adjunct treatment in snake bites to avert adverse outcomes.

Hyperbaric oxygen therapy after Bothrops lanceolatus snake bites in Martinique: a brief report.

Every year 10 to 20 cases of snake bites are reported on the Caribbean island of Martinique. The only snake involved, Bothrops lanceolatus, is endemic on the island, and its bite may lead to systemic multifocal thrombotic complications in the'absence of the monospecific antivenom. Between January 1988 and January 2009, more than 250 snake bites have been reported, and five patients were treated with hyperbaric oxygen (HBO2) therapy for local complications. The patients were male, bitten on the leg or the hand, and presented with severe complications such as necrotizing soft tissue infections, compartment syndrome or abscesses despite prompt wound care and administration of antivenomous serum. Outcomes were favorable for these five patients, except for one who was left with a functional defect of the hand. Although snake bites are not part of the currently recommended indications for HBO2 therapy, local complications, namely compartment syndrome, necrotizing soft tissue infections and enhancement of healing in selected problem wounds, are approved uses of HBO2 therapy as defined by the Hyperbaric Oxygen Therapy Committee and would benefit from prospective studies.

Catfish stings and the venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794).

The ability of catfish to inflict extremely painful wounds with their pectoral and dorsal stings has been well known for many decades. The venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794) is constituted by a single, sharp and stout sting immediately in front of the soft-rayed portion of the pectoral fins. The sting has well developed articulations, making it possible for it to become erect and locked. The toxicological centres in Poland have recorded 17 cases of envenomations caused by stinging catfish and African catfish; the injury was accompanied by intense pain, numbness of the site, dizziness, local oedema and erythema. In addition, systemic symptoms such as tachycardia, weakness and arterial hypotension were observed. The treatment of these injuries should include cleansing of the wound and surrounding area. Immersion of the wounded extremity in hot water (45 degrees C) was used for the pain control. An attempt to remove any spinal sheath or remnant must be undertaken. Antibiotic management depends on several factors: the age and immune status of the victim, the interval between injury and presentation, or the presence of a foreign body. The most serious long-term complications of sting envenomation involve infections.

Copper sulphate burns to the hands, a complication of traditional medicine.

An 11-year-old girl of Bedouin origin presented with infected burns on the dorsum of both her hands. The burns had an unusual configuration in the form of spirals, and child abuse was suspected. The family reported that the burns had been caused by a treatment, for head aches, dispensed by a traditional healer, which involved applying a blue fluid on the hands. Chemical analysis of the implicated substance identified it as copper sulfate. The local and systemic effects of copper sulfate are reviewed as well as traditional healing methods that may lead to burn injuries. When clinicians encounter bizarre patterns of injury they must consider besides the possibility of abuse also, more unusual etiologies.

Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients.

Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases).Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic multiple occlusions of the digital arteries (57.4%). All patients were advised to change their occupational exposure. They were given vasodilators, including calcium channel blocker (n = 37) and buflomedil (n = 12); 36 patients (76.6%) also received oral platelet aggregation inhibitors. Twenty-one patients with digital ischemia/necrosis were further given hemodilution therapy to reduce the hematocrit level to 35%. In 3 patients with HHS-related digital necrosis who exhibited partial improvement with vasodilators, prostacyclin analog therapy (a 5-day regimen of intravenous prostacyclin analog) was instituted, resulting in complete healing of digital ulcer in these 3 patients. Other conservative treatment options included controlling risk factors (smoking cessation, low-lipid diet, therapy for arterial hypertension) and careful local wound care of fingers in the 20 patients with digital necrosis. Only 2 patients, exhibiting digital necrosis and multiple digital artery occlusions, with nonthrombotic ulnar artery aneurysm underwent reconstructive surgery, that is, resection of the aneurysm with end-to-end anastomosis of the ulnar artery. The median length of follow-up in patients with HHS was 15.9 months. Thirteen patients (27.7%) exhibited clinical recurrences of HHS; the median time of HHS recurrence onset was 11 months. Outcome of HHS relapse was favorable with conservative measures in all cases. Awareness of HHS is required to increase suspicion of the disorder so that further exposure to risk factors like repetitive hypothenar trauma can be avoided for these patients; this is of great importance for their overall prognosis. We found favorable outcomes in most patients after conservative measures were initiated; therefore we suggest that surgery may be undertaken in the subgroup of patients who exhibit partial improvement while receiving conservative therapy. Finally, because we observed recurrence of HHS in 27.7% of patients, we note that HHS patients require close follow-up, including both regular and systematic physical vascular examination.

Alternative therapies in the treatment or oral self-injurious behavior: a case report.

This paper presents the case of a child with severe mental retardation and a history of oral self-injurious behavior (SIB). While the behavior was refractory to a number of dental interventions, some success was achieved through a combination of behavioral therapy techniques and therapeutic touch (a relaxation technique). Etiologies of SIB are discussed, along with descriptions of alternatives to traditional dental therapy for this difficult problem.

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data.

OBJECTIVE: To determine the acute injury profile in each of six sports and compare the injury rates between the sports. DESIGN: Analysis of national sports injury insurance registry data. SETTING: Finland during 1987-91. SUBJECTS: 621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate. MAIN OUTCOME MEASURES: Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors. RESULTS: 54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability. CONCLUSIONS: Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.

High-pressure injection injuries.

The use of high-pressure injection devices has resulted in an unusual type of injury to the upper extremity. Though on initial inspection the wound often appears benign, tissue damage beneath the skin is extensive. These injuries are surgical emergencies that demand prompt evaluation and treatment.

Hand injuries caused by high pressure injection. Contribution of loco-regional anaesthesia.

In a reported case of accidental high pressure injection of white spirit into a finger, the authors emphasise the great contribution of regional anaesthesia maintained from the initial trauma until the lesions are stable. Trauma to the hand caused by injection of paint or grease solvents results in tissue destruction and later necrosis and fibrosis. Secondary amputations are required in many cases. Regional anaesthesia of the stellate ganglion and brachial plexus produces analgesia and vasodilatation of peripheral arteries by inhibition of the sympathetic tone. This vasodilatation limits the necrotic process and promotes the supply of drugs to the injured tissues. Regional anaesthesia is of great benefit for surgical excision and avoids extended amputation.