1/247. Plastic injection injury of the hand.A unique case of injection of plastic material into the hand is reported. Treatment was simple because the molten plastic solidified, separated readily from the surrounding tissues and could be withdrawn without fragmentation. There was no evidence of serious damage to the surrounding tissues by the plastic before it has cooled and set. The mechanism of the injury is explained and the need for simple safety precautions is noted.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/247. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. case reports.Three patients with open fractures of the hand associated with bone loss were treated within four to six hours of injury by corticocancellous bone grafting and soft tissue coverage after meticulous debridement, copious irrigation of the wounds, and broad-spectrum antibiotics given intravenously. Long term follow-up was uneventful and showed that the graft had taken and healed well with early and full restoration of function and a good cosmetic result. Immediate corticocancellous bone grafting of an injured hand could be used in selected cases with well-debrided, surgically clean wounds as long as there is a rich blood supply. Adequate bone fixation, soft tissue coverage, and broad-spectrum antibiotics given intravenously will remove the risk of infection. Hand architecture is corrected while wound contracture and secondary deformity are avoided. Both patients' discomfort and hospital costs are considerably reduced.- - - - - - - - - - ranking = 0.2keywords = injury (Clic here for more details about this article) |
3/247. Ultrasonic assistance in the diagnosis of hand flexor tendon injuries.In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
4/247. helium vapour injury: a case report.We report a case in which quick freeze injury occurred to both hands by helium vapour at extremely low temperatures. At the time of injury the victim was wearing protective gloves which were removed quickly after the accident. This prompt removal of gloves reduced the depth and severity of the injury. Initially he was treated by rapid thawing by immersing the hands in luke warm water (37 degrees C) and administering heparin by drip to prevent microvascular thrombosis. Delayed skin grafting was performed with good functional recovery. The circumstances accompanying this injury and preventive measures are discussed.- - - - - - - - - - ranking = 1.6keywords = injury (Clic here for more details about this article) |
5/247. Full-thickness burn to the hand from an automobile airbag.An 18-year-old male was involved in a single car motor vehicle accident in which the driver's side airbag was deployed. He presented to the trauma center with complex injuries to the left hand, lacerations to the scalp, and a full-thickness burn to the ulnar aspect of the right hand that included the hypothenar area and the fifth digit. The patient was admitted to the trauma center and received immediate consultation from the burn service. He underwent debridement and split-thickness skin grafting of 50 cm2 of the right hand on postburn day 3. The graft became necrotic and the patient underwent debridement of the skin and the abductor minimi muscle of the right hand on postburn day 32. Split-thickness skin grafting and release of flexion contracture were successfully completed 18 days later. The police and fire departments reported that the airbag showed signs of thermal destruction. Upon request, Honda motors submitted information from the TRW safety systems and material safety data sheet (Mesa, Ariz, issued 1989) that showed that airbag canisters contain the chemicals sodium azide and cupric oxide. water may react with sodium azide to form highly toxic and explosive hyfrazoic acid. These chemicals are converted to sodium hydroxide, which can cause significant chemical burns. In addition, these chemicals may ignite when exposed to live electrical wires or temperatures greater than 300 degrees F. We conclude that burns associated with damaged deployed airbags in motor vehicle accidents may be the results of both chemical and thermal injury. The extent of the burn wound may be underestimated, as our case illustrates. Full-thickness burns resulting from airbag deployment may require more aggressive initial debridement and treatment.- - - - - - - - - - ranking = 0.2keywords = injury (Clic here for more details about this article) |
6/247. Natural gas inflation injury of the upper extremity: a case report.High-pressure injection injury is well known to hand surgeons. We present a case of low-pressure inflation injury to the upper extremity. Our experience with this injury, its treatment, and the eventual outcome are discussed.- - - - - - - - - - ranking = 1.4keywords = injury (Clic here for more details about this article) |
7/247. Partial transient osteoporosis of the hand.OBJECTIVE: To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. DESIGN AND patients: Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. RESULTS: All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. CONCLUSION: PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand.- - - - - - - - - - ranking = 0.2keywords = injury (Clic here for more details about this article) |
8/247. keratoacanthoma centrifugum marginatum arising from a scar after skin injury.Among the variants of solitary keratoacanthoma, keratoacanthoma centrifugum marginatum (KCM) is characterized by the lack of a tendency toward spontaneous remission and by continuous centrifugal spread. We describe a case of KCM arising from the scar after an old skin injury. The lesion appeared on the dorsum of the right hand, grew peripherally for 30 months, and became a tumor with a multinodular margin and central atrophy. A biopsy specimen from the edge of the tumor showed features resembling typical solitary keratoacanthoma.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
9/247. The ping-pong ball microphone: facilitating speech for a patient with hand burns and a tracheostomy.patients who have sustained thermal injuries may require tracheostomies as a result of facial burns; these operations may also be required after prolonged intubation for smoke inhalation injury or respiratory failure. For a patient with a temporary tracheostomy, speech may be achieved by occluding the opening of the tracheostomy cannula with the tip of a finger, thereby directing airflow through the vocal cords and allowing phonation to be produced. However, some patients who also have hand burns may not be able to cover the opening of the tube because of the injuries to their fingers and the bulky dressings covering them. A simple tracheal occluder can be made out of a ping-pong ball and a syringe casing. The device presented in this article allows for the restoration of speech in the types of patients described above, and it promotes purposeful movement of their upper extremities.- - - - - - - - - - ranking = 0.2keywords = injury (Clic here for more details about this article) |
10/247. Pediatric hand injuries due to home exercycles.The clinical presentation and management of 19 children who sustained injuries by stationary exercise bicycles were reviewed retrospectively. These injuries represented 32 traumatized digits with a minimum of 2-year follow-up. The index and long fingers were most commonly involved. Wheel-spoke injuries typically produced repairable nerve and tendon lacerations, and full functional recovery in these cases was common. The chain/sprocket injury involved a crushing mechanism and frequently produced severe injury including amputations that were not salvageable. Stationary exercise bicycles represented a predictable source of severe hand injury in children between the ages of 18 months and 5 years. adult supervision was not reliable in preventing contact between an operating exercycle and a child's hand. We recommend that children not be allowed access to any stationary exercycle machinery, whether it is in use or not. safety design considerations should focus on not only shielding the wheel spokes, but also (and perhaps even more important) on enclosing the entire chain axis and gear interface. In addition to these design considerations, public education will be critical in reducing the incidence of injury.- - - - - - - - - - ranking = 0.8keywords = injury (Clic here for more details about this article) |
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