RESUMEN
Contrary to standard practice in the United Kingdom, primary surgery for Dupuytren's contracture can be performed safely on a day care basis provided that strict criteria are followed. Although demanding on Consultant surgical time, this policy offers a considerable saving in hospital resources.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/economía , Contractura de Dupuytren/cirugía , Deformidades Adquiridas de la Mano/cirugía , Adulto , Anciano , Anestesia de Conducción , Bupivacaína , Control de Costos , Contractura de Dupuytren/economía , Femenino , Estudios de Seguimiento , Deformidades Adquiridas de la Mano/economía , Humanos , Lidocaína , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Recurrencia , Distrofia Simpática Refleja/etiologíaRESUMEN
A study was carried out involving 167 patients who had received primary treatment in alio loco for injuries diagnosed as 'minor cuts, twists and sprain', and who were then seen in the out-patient department at a later date. The patient group was analyzed with regard to the following: a more precise identification of the initial injury, the initiated treatment regimen and more particularly, the socio-economic consequences of the injury. Duration of treatment programmes, loss of working days and compensatory payments were cost-analyzed. The results showed that a delayed primary surgical intervention was possible in only 17% of cases, it was necessary to alter the treatment regimen in 29% and in 28% it was no longer realistic even to initiate treatment. Comparisons between this population and a group of a patients who had received adequate primary care showed that in the study group length of treatment and days lost at work was prolonged by the factor 1.3; furthermore the number of cases in which the reduction of working ability was 20% and more was increased by 2.7. Increased costs incurred by financial compensations were approx. DM 27,000/patient.
Asunto(s)
Absentismo , Accidentes de Trabajo/economía , Traumatismos de la Mano/rehabilitación , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis Costo-Beneficio , Evaluación de la Discapacidad , Femenino , Deformidades Adquiridas de la Mano/economía , Deformidades Adquiridas de la Mano/rehabilitación , Traumatismos de la Mano/economía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Rehabilitación Vocacional/economíaRESUMEN
Clenched fist is a rare disorder of the hand associated with fixed contractures of fingers. The condition is often preceded by minor trauma or surgery, but these do not explain the severity of the contractures. Extension of the fingers is painful and hygienic problems can be considerable. Psychiatric disease is frequent in clenched fist patients. The patients may express a strong wish for amputations. In a review of eight patients with clenched fist who had claimed economic compensation from the Danish Patient Insurance Association, four patients had amputations. Three of them subsequently developed new contractures.