Analysis of functional outcome of complex forearm injuries (original) (raw)
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Management of patients with forearm and hand injuries
International Surgery Journal, 2020
Background: Injuries to the hand and the forearm, particularly crush injuries have always been a major challenge to even the best of surgeons, whether it is a major case of a mangled hand by a high pressure injury or even a small case as an injury to the tip of the finger by getting squashed in a closing door. Any injuries in the forearm and the hand requires a very meticulous and thoughtful approach towards coverage with the aim of maximal restoration of function as well aesthetic appearance. Methods: The study was conducted in the
Clinical profile of patients with forearm and hand injuries
International Surgery Journal, 2020
Background: Hand injuries are among the most frequent injuries, constituting between 6.6% and 28.6% of all injuries. Hand and forearm injuries, however small or large they may be do have a significant impact on the society in terms of cost of treatment, hospital stay and costs of lost production and hence the importance of this study.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over the period of 12 months. Subjects were recruited from patients presenting in emergency/surgery OPD, HIMS, Dehradun with a primary diagnosis of soft tissue injuries in the forearm and the hand. A total of 114 patients were included in the study.Results: Overall mean age of the subjects in our study was 28.21±15.71. The highest incidence was in the age group of (20-40) years i.e. 62 (54.30%). Male to female ratio in our study was 6.6:1. Maximum injuries occurred as workplace and industrial injuries. This contribute...
RESuLtS Of thE tREAtmENt Of mAjOR, cOmPLEx hANd INjuRIES
Complex hand injuries are associated with serious consequences including long period off-work, permanent disability, inability to return to original profession or to work at all. As these injuries are common, they create considerable economical consequences and, therefore, it is desirable their treatment would be as perfect as possible to reduce potential loss of function. the aim of the study was analysis of the structure of complex, multi-structural hand injuries and evaluation of the outcomes of the treatment of these injuries in both medical (recovery of function) and economical (period of inability to work and costs of medical care) aspects. material and methods. The study presents the results of treatment of 78 patients suffered from severe, major hand injuries, involving damage of at least two of four anatomical structures within the hand or wrist (bones, tendons, arteries or nerves) as well as severe injury involving at least two digits. Functional results were assessed at a mean of 10 months after the accident. Tendons were repaired in all 42 patients, bones were fixed in 29 (69%), nerves were repaired in 21 (50%), arteries in 14 (33%) and in two patients skin defect was covered by the flap (one local and one groin flap). Results. Total active motion of affected digits amounted 2/3 of normative active motion of the healthy digits and total grip strength approximated half of the grip strength of the unaffected hand. In patients with nerve injuries, a satisfactory recovery of sensation in the affected digits was obtained. Dexterity of the hand in daily activity was scored 30 points in DASH scale. Injury-related duration of sick leave in 31 patients worked at the time of the accident amounted 4.4 months in average (range 1-12). A total of 27 subjects (87% of worked) returned to work: 24 to their previous profession and three had to qualify for a new job. Total hospital costs of the treatment in the analysed group amounted a mean of 2600 PLN. conclusion. The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.
Presentation and outcome of Hand trauma in a Plastic surgical unit. Ann Pak Inst Med Sci 2009; 5 (3) :131-5. , 2009
Objective: To determine the frequency of various causes of hand trauma and the pattern of outcome in terms of traumatic amputation of fingers / hand, duration of hospital stay, complications/ morbidity and mortality. Materials and Methods: All hand injured patients of either gender over 14 years of age, receiving treatment indoor or at outpatient department or managed in emergency department were included in the study by consecutive sampling technique. The sociodemographic profile of the patients, cause of injury, type of injury, type of surgical procedure undertaken, any complications and morbidity etc. were all recorded on a proforma. A follow-up of two months was done to document any late complications. The data were subjected to statistical analysis. Results: Out of a total of 138 patients, 84.78 % (n=117) were males while 15.21 % (n=21) were females. The mean age was 28 ± ± ± ± 11.35 years. Majority of the patients (69.56 %) were in their 2nd and 3rd decades of life. Two patients had left hand dominance while the remainder had right hand dominance. Occupation-wise 38.40% (n=53) patients were machine operators, 12.31%(n=17) were labourers / manual workers, while the remainder belonged to various other professions. Majority of the patients 63.04% (n=87) were socioeconomically poor. Machines constituted the commonest cause of hand trauma (38.40%), followed by road traffic accidents (15.94 %). Bone fracture was the most common injury (45.65 %), followed by cuts / lacerations (18.11 %) and fingertip losses (17.39 %). The rate of traumatic amputation of hand was 5.07 %. The rate of hospitalization was 11.59 %(n=16). The average hospital stay was 10.7 ± ± ± ± 5.40 days. There was no in-hospital mortality. Conclusion: Hand trauma predominantly affects young males who have occupational exposure to different machines. It is associated with a high rate of traumatic amputation of hand and digits. Most of the cases result from avoidable occupational hazards.
Hand injury without any deficit: Is systematic surgical exploration justified?
Hand Surgery and Rehabilitation, 2019
Out of 100,000 inhabitants, 700 to 4000 suffer a hand wound each year. Numerous hand wounds that may not have a clinically evaluated deficit, actually have damage to a major structure after surgical exploration in the operating room (OR). The aim of our study was to evaluate the incidence of major structure damage within a population of patients presenting a hand wound with no deficit on the clinical examination.
European Journal of Trauma and Emergency Surgery, 2020
Background Trauma to the hand is common and potentially serious, impairing daily living and general quality of life. Patients are often unable to work for several months, with hand function improving only gradually. Here, we review the epidemiology of hand injuries treated at a tertiary referral hospital in Warsaw, Poland. Material and methods In this single-centre, retrospective study, we reviewed medical records of patients presenting to the A&E Unit of the Plastic Surgery Department, Centre of Postgraduate Medical Education in Warsaw, Poland, between January 2001 and December 2005. We assessed a number of patient and injury characteristics, including severity, scored with the Hand Injury Severity Scoring System (HISS), and time off work. Results Of 1091 patients with a hand injury, 84% were male and over half were under the age of 40 years. Hand injury commonly resulted in tendon damage (56.1%), especially to finger flexors (79%), and in skin loss (37.8%). Amputations occurred in 24.1% of cases, while fractures (9.6%) and nerve (6.1%) or joint (5.5%) damage were less common. HISS-graded injury severity was moderate in 28.6% of cases, over half of the patients suffered severe (25.5%) or major (26.5%) injuries, and minor injuries were relatively uncommon (19.4%). Conclusions Amongst patients admitted to our Department, the most common injuries were tendon damage, skin loss, and amputations. Over half of the patients presented with severe or major injuries and took six months or longer to return to work, suggesting they were likely to face substantial social and economic consequences of their injury. Level of evidence IV: retrospective series.
Severe complex injuries to the upper extremity: Revascularization and replantation
The Journal of Hand Surgery, 1991
Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result. Bone shortening osteotomies are a helpful way to reduce the soft tissue defect size. In contrast to earlier studies, clear correlations between the level of injury, degree of nerve lesion, bone pathology, and the number of major nerves involved, and the functional outcome achieved were not found. There was a weak correlation between the type of wound and the functional recovery ultimately obtained. (J HAND SURC 1991;16A:574-84.)
Journal of Evolution of medical and Dental Sciences, 2013
1. Consultant. Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh. 2. Assistant Professor. Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh. 3. Junior Resident. Department of Orthopaedics, MLB Medical College, Jhansi, Uttar Pradesh. 4. Lecturer. Department of Anaesthesia, MLB Medical College, Jhansi, Uttar Pradesh. 5. Assistant Professor. Department of Anaesthesia, MLB Medical College, Jhansi, Uttar Pradesh.
The place of local/regional perforator flaps in complex traumas of the forearm
Journal of Hand and Microsurgery, 2009
Background Our aim was to conduct a retrospective study regarding the advantages of doing the all-in-one reconstruction in the same step with the debridement, and the possibility of using the local/regional perforator flaps to cover the tissue defects. Methods We reviewed a series of 137 cases from 1999 until now, for acute traumas with tissue defects of the forearm. We performed a regional perforator flap in 16 cases, and a local perforator flap in 121 cases. These flaps were used for both simple and complex defects coverage, including 26 cases with fractures and devascularization. Results The follow-up was between 2 months and 2 years. In all the cases the extremity was salvaged and an useful functional recovery was obtained. A very good evolution, with complete survival of the flap was recorded in 133 cases. We completely lost only one flap, and registered minor complications in three cases. Conclusion The local perforator flaps represent a good and safe indication for small and medium defects in the forearm.