Acute Hand Research Articles

Carpometacarpal Dislocation with Third Metacarpal Fracture.

Case PresentationA 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. The dislocation was reduced bedside in the ED and ultimately underwent closed reduction surgical management with orthopedic surgery.DiscussionMetacarpal fractures result from high-force impact injuries and account for 30–40% of all hand injuries. The most common sites of second through fifth metacarpal fractures are at the neck and the shaft, with the majority involving the fifth metacarpal neck (commonly coined “boxer’s fractures”). Carpometacarpal (CMC) dislocations are a rare injury associated with high-force impact trauma to the wrist. These injuries account for as little as 1% of all acute hand and wrist injuries.1,2 Carpometacarpal dislocations are often difficult to diagnose on physical examination due to significant soft tissue swelling, and they can easily be missed on anterior-posterior views of the hand. Lateral and oblique plain radiograph views are essential in the diagnosis as they are more likely to show dislocations. Despite appropriate plain radiographic views, subtle CMC dislocations may be difficult to discern dependent on the level of dislocation or subluxation and overlapping of joints. These injuries are rare due to otherwise highly stable ligamentous and muscular attachments within the wrist. Because of these attachments, dislocations are often associated with concomitant metacarpal fractures.3

Ultrasound-Guided Nerve Blocks for Painful Hand Injuries: A Randomized Control Trial.

Objectives: Traumatic hand injuries present to emergency departments frequently. Pain secondary to these injuries is typically managed with opioids, which may be inadequate and have side effects. Ultrasound (US)-guided forearm nerve blocks have emerged as an alternative modality for patients with acute pain from isolated extremity injuries.Methods: We performed a non-blinded, consecutive, randomized pragmatic trial of US-guided forearm nerve blocks using medium and long-acting anesthetic versus usual care for a six-day period around July 4th, 2017. Adults who sustained a traumatic or blast injury of their hands were considered. Consecutive emergency department patients were consented, enrolled and randomized into a study group (block) or control (standard care). The study group received a US-guided forearm block using a 50/50 mix of 1% lidocaine and 0.5% bupivacaine. The primary outcome was median pain scores via a 100-point visual analog scale at 15, 60, and 120 minutes after the nerve block compared to the baseline pain score. The secondary outcome was mean morphine equivalents administered.Results: Sixteen patients were screened and 12 were randomized: six to the treatment group and six to the control group. Median pain reduction from baseline at 15, 60, and 120 minutes in the forearm block group was -35 (IQR=10), -30 (IQR=50), and -20 (IQR=70, versus -5 (IQR=10), -20.5 (IQR=20), -20 (IQR=70) in the control group. At all time points, patient-reported pain scores decreased significantly over baseline in the forearm block group, whereas non-significant reductions in pain scores occurred in the control group.Conclusion: US-guided forearm blocks for acute traumatic hand injuries resulted in greater pain relief when compared to usual care.

QS4: Fat Grafting for the Dysesthetic Digit: A Discussion of Technique And Pilot Data

Purpose:Digital amputation represents a common injury requiring acute hand surgery intervention. These injuries are often complicated by pain, hypersensitivity, dysesthesia, cold intolerance, and contour deficits/pulp atrophy. Many secondary procedures exist to address these concerns; however, they are often limited by undesirable donor site morbidity and/or complex rehabilitation. There is currently no single gold standard for treatment of the dysesthetic digit. Free adipose transfer via lipofilling offers to correct these defects by providing soft, healthy bulk to the amputated site with minimal comorbidity. Here we describe a protocol and preliminary data for providers considering adipose transfer to the dysesthetic digit.Methods:We examined 113 patients who sustained digit amputations between 2010 and 2019. Patients sustained an average of 1.6+/-0.9 amputations per trauma. 13 patients were identified with chronic pain, dysethesia, cold intolerance, or hypersensitivity that persisted after therapy. Controlling for reversible nail bed pathology, 10 patients demonstrated primary chronic dysesthesia.Results:4 of 10 patients presenting for chronic amputation stump dysesthesia elected for fat grafting to the fingertip. All patients reported improved pain and reduced dysesthesia/hypersensitivity post-intervention. 3 patients required no further intervention after one round of grafting; 1 patient underwent repeat grafting. Of the non-grafted group, 66.7% (4/6) progressed to revision amputation. There were no operative revision amputations after grafting.Conclusions:Fat grafting to the fingertip offers a simple, safe, and easily accessible technique to augment soft tissue bulk at the digital stump. Our preliminary data suggests that this may be an effective option to manage digital dysesthesia/hyperesthesia.

Cryoglobulinemic Vasculitic Mononeuritis Multiplex in a Teenager

We present a 16-year-old girl with chronic distal purpura and mild intellectual disability of undetermined etiology. She developed subacute distal limb pain and ulcerations followed by acute asymmetric hand weakness and numbness. She was hospitalized for a rash exacerbation, uncontrolled pain, and concerns for a drug reaction related to neuropsychiatric medications, oxcarbazepine, and guanfacine. Initial evaluation revealed weakness of bilateral wrist flexors (left dominant), bilateral finger extensors (mild), bilateral first dorsal interosseous and abductor digiti minimi (severe), and left deep finger flexors and abductor pollicis brevis (severe). There was left-hand large fiber sensory loss in the medial palmar and dorsomedial aspects. There was no weakness or sensory loss in her legs. Deep tendon reflexes were unobtainable except at the Achilles tendons bilaterally. Cranial nerves were intact, and mental status was consistent with her pre-existing intellectual disability and impulsivity.

Technical points of Ilizarov external mini-fixator for the treatment of phalanx fractures

The Ilizarov external mini-fixator (IEMF) has become an effective tool for the treatment of acute and chronic hand and foot injuries and deformity correction due to its advantages of easy fixation, good holding power, and artful appearance. However, there are relatively few clinical reports on this technique. Materials and methods From June 2019 to March 2021, we preformed IEMF on 113 patients with open phalanx fractures as emergency surgery, and all patients had 3–6 months follow-up. Results All fractures achieved clinical healing. Among them, pin site infection occurred in 8 fractures (7.07 %), arthrolysis occurred after 6 fractures (5.3 %), and 4° rotation malunion occurred in 3 cases (2.65 %).

Acute Hand Infections - Survey of the Pathogen Spectrum and appropriate Antibiotics

Acute infections of the hand can be a pathology with severe consequences. Alongside the surgical therapy, it is necessary to establish a systemic antiinfective therapy as well. The most frequent bacteria in acute hand infections are Staphylococcus aureus and, less frequently, different Streptococci. If the infection is the result of a bite wound, the most frequently found bacterium is Pasteurella multocida. Fortunately, the susceptibility to frequently used antibiotics in the (middle-)European area is quite good - according to the literature, resistances are rare. First line antibiotics are 1st and 2nd generation cephalosporins as well as aminopenicillins in combination with beta-lactamase inhibitors. Especially in multi-morbid patients or infections with unusual aetiology, a broader bacterial spectrum is to be expected. It is very effective to collect a tissue sample or swab for microbiological analysis before the establishment of the antiinfective therapy to gain valuable information about the prospective therapy. Ultimately, hand infections are a pathology to be treated with increased attention to avoid severe complications. A close cooperation with the involved specialties and physiotherapists should be sought to guarantee the best possible outcome.

Comparative Study for Anaesthetic Quality with the Addition of Clonidine, Fentanyl or Dexmedetomidine to 0.5℅ Ropivacaine in Supraclavicular Brachial Plexus Block at a Tertiary Hospital

Background: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5℅ ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of sensory and motor blockade, prolongs the duration of the sensory blockade as compared to fentanyl. Dexmedetomidine shortens the onset of sensory and motor blockade much more than clonidine.

496 The Use of Virtual Trauma Clinics (VTC) In the Assessment of Acute Hand Trauma; A Service Evaluation

Abstract As a UK tertiary referral centre for hand trauma the current COVID outbreak has led to the reconfiguration of trauma services. We evaluate the impact of our newly introduced VTC on our hand trauma service, comparing a cohort of patients who were managed pre-COVID, with our current revised pathway. We carried out a service evaluation of all those patients processed by the VTC over 14 days in April 2020 (n = 184). We collected prospective data on timing of referral to assessment and surgery. This data was compared to a matched period in April 2019 (n = 162). Post VTC there has been a significant reduction in time to clerking and time to surgery (p = < 0.001), with 98.1% being clerked within 1 day of referral. Post VTC 12.9% of patients were discharged directly from VTC, all other patients had definitive treatment in a single trip. VTC has shown a clear benefit to patients with definitive management provided in a single trip in all cases. Whilst we have been able to clerk patients earlier any improvement in time to surgery depends on theatre staffing and availability, which differed in the two cohorts and certainly will as we move forward into normal services.

Comparative study of Negative Pressure Wound therapy Vs. Local antibiotic cream dressings in acute hand burns second-degree superficial to deep

Background: The hand is one of the most common parts of the body involved in burns, i.e., 80%. Even minor burns in the hand may result in severe limitations of function. Early initiation of physiotherapy, topical antibiotic cream treatment, collagen application, splintage, passive exercise for second-degree superficial burns. Materials and methods: A prospective comparative study was conducted in 10 patients with acute hand burns due to thermal burns (scald, flame). All patients with second-degree superficial to intermediate thickness burns were given Negative pressure wound therapy (indigenous NPWT Kit) to one hand and local antibiotic cream to the other hand or other parts of the body to study clinical profile and outcome. Results: A total of 10 patients were studied. The majority of patients were in 19 to 30 years of age group 6 patients (60%), five females, and one male. Pediatric patients account for 4 patients (40%), two female and two male children. Incidence of burns in females 70% and males’ group 30%. Significant reduction in postburn edema in NPWT hand compared to topical antibiotic cream dressing. Healing is fast in NPWT applied hand/part. Conclusion: Negative Pressure Wound Therapy for Acute second-degree superficial burns showed promising results in wound healing and reduced post-burn edema burn in hand in our study.

Simultaneous enterovirus EV-D68 and CVA6 infections causing acute respiratory distress syndrome and hand, foot and mouth disease

BackgroundAlthough most enterovirus (EV) infections can be asymptomatic, these viral agents can cause serious conditions associated with central nervous system, respiratory disease and uncommon manifestations of hand, foot and mouth disease (HFMD). EV-coinfections have been rarely reported with development of complications and severe clinical outcome. An atypical case of a child presenting HFMD and severe acute respiratory syndrome, co-infected with EV-D68 and CVA6, is reported herein.Case presentationA 3-year-old boy was admitted in the emergency department unit showing fever, abdominal pain and tachycardia. Twenty-four hours after hospitalization the child developed severe clinical symptoms associated with HFMD and was discharged after recovery. Two days later, the child was readmitted with fever, cough and respiratory distress. RT-PCR and Sanger sequencing confirmed positivity for EV-D68 and CVA6 in oro and nasopharynges swabs and vesicles fluid, respectively. Phylogenetic analysis based on VP1 gene sequences suggested that CVA6 was closely related with HFMD viruses circulating in Turkey, while EV-D68 was genetically related to a Chinese strain.ConclusionsTo the best of our knowledge, this case is the first report of a double infection caused by CVA6 and EV-D68, which shed light on the pathogenesis of enterovirus infections. Further studies must be conducted to ascertain the role and clinical significance of EV co-infections, as well as a potential synergistic pathway between these viruses.

113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center

Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.

Ameliorative Effect of Turmeric and Cocoa Extract against Acute Second hand Exposure of Tobacco Smoking on Hepatocytes and Enterocytes in Albino Rats: Ultra structural Study

Background and aims: Smoking posse’s serious health problems because there is no specific substance alleviate its toxicity. The aim of this study was to investigate the effective plant extract containing antioxidants(turmeric and cocoa), that may reduce the cytotoxicity induced by secondhand exposure of cigarettes and waterpipe smoking. Material and Methods: Seventy-two adult male albino rats were equally divided into 9 group (n=8 per group). Extracts were delivered to each group intraperitoneal, and the exposure to cigarette and waterpipe smoking was performed using a smoking machine for a period of 30 days. After the exposure period, tissues of interest (liver and small intestine) were removed and processed for transmission electron microscopy. Results: Oral treatment of turmeric and cocoa extract with smoking exposure showed less vacuolization and better cellular architecture with regular nuclear envelope of hepatocytes, reduce or absence of blebbing, retain the normal shape and size of mitochondria, increase the proportion of euchromatic chromatin in nuclei,but turmeric extract showed better enhancement in term of reducing vacuolization. turmeric or cocoa crude extract preserve the typical length of microvilli with a uniform organization from the apical part of enterocytes and decreased vacuolization in the cytosol of enterocytes. However, mitochondria appeared less polymorphic in shapes with distinct cristae and matrix in enterocytes of the turmeric treated group than the cocoa once. Conclusion: Tobacco smoking-induced adverse effects on hepatocytes and enterocytes, this study showed that treatment with turmeric and cocoa attenuatethe toxicity of tobacco smoking.

Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature.

Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.

Insurance Status and Disparities in Outpatient Care after Traumatic Injuries of the Hand: A Retrospective Cohort Study.

Hand-injured patients seen in the emergency department can often be followed as outpatients for definitive care and rehabilitation. Many face barriers to continuing care in the outpatient setting that impact quality of care delivery. The authors aimed to evaluate patterns of outpatient follow-up after initial emergency department evaluation of traumatic hand injuries, identify factors associated with poor follow-up, and suggest areas for improvement. In this retrospective cohort study, the authors reviewed records of adult patients with acute hand injuries referred for outpatient follow-up after initial plastic surgery consultation in the emergency department of a single urban Level I trauma center over a 12-month period (n = 300). Patients were grouped by insurance (i.e., no insurance, Medicaid, Medicare, or private). Outcomes included completion of outpatient follow-up, hand therapy participation, and emergency department return visits. Factors significantly associated with failure to follow up included male sex (OR, 3.58; 95 percent CI, 1.57 to 8.16), uninsured status (OR, 3.47; 95 percent CI, 1.48 to 8.16), Medicaid insurance (OR, 4.46; 95 percent CI, 1.31 to 15.25), and lack of a driver's license (OR, 3.35; 95 percent CI, 1.53 to 7.34). Hand therapy attendance and unexpected emergency department return visits also varied significantly by insurance type (p < 0.001). There is a significant disparity in the use of outpatient care after emergency department visits for acute hand injuries. Uninsured and Medicaid-insured patients are significantly less likely to initiate recommended hand specialty follow-up, and significantly less likely to complete follow-up even when established with an outpatient clinic. Future research should evaluate targeted interventions for at-risk patients.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Acute Hand and Wrist Trauma.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Acute Hand and Wrist Trauma.

10 years of hand traumatology - an epidemiological, structural and economic analysis at a maximum care provider

Hand surgery in Germany has been subject to structural changes that strongly affect the balance between medicine and economics. On the one hand there is a shift of elective hand surgery from the inpatient to the outpatient sector. On the other hand - so our observations - emergency hand trauma cases are more concentrated in bigger hospitals. Given this background there is a lack of statistical data on the management of hand trauma care and treatment of patients with hand injuries. This article discusses a 10-year-analysis of hand traumatological cases treated at a maximum care hospital regarding epidemiological, structural and economic aspects. Using a database query using ICD codes, inpatient hand trauma cases were identified between 2009-2018 and analyzed with regard to epidemiological and economic indicators (age, gender, comorbidities, case-mix-index (CMI), revenue, length of stay, length of surgery) using PIVOT tables. Patients under the age of 16 years, forearm fractures and intensive care patients were excluded. In the study period the typical hand surgical trauma patient was male with an average age of 44 years. The Patient-Clinical-Complexity-Level (PCCL) was 0 in 80 % of all cases. The proportion of work-related injuries averaged around 25 %. The three top diagnose related groups (DRG) were the I32F (18.5 %), X01B (11.3 %) and the I32A (7.2 %). A striking point was the massive increase in the overall number of trauma cases over the years from approx. 300 cases in 2009 to over 1000 cases per year in 2018 with a shift of the main workload to on-call and night-shift hours away from core working times. In the study period 4 of 5 others hospitals located in a distance of 100 km reduced and stopped treatment of emergency hand cases. The average length of a hospital stay was approx. 4-5 days, the average cut/suture time less than 60 minutes and the average CMI 1.23. Those cases generate an average proceed of € 4370 in 2018, whereby the cases generated by the work-related injuries averaged € 387 less. On the assumption that the number of emergency hand trauma cases did not really increase in the study period we think that there was a concentration of such cases in a few centres still providing extensive treatment for hand injuries while in smaller hospitals care for emergency hand trauma cases is progressively reduced. However, hand injuries may be worth a second thought for economic reasons because they can create reasonable revenues with rather little effort.If a critical number of patients is exceeded, costs of service provisions can be significantly amortized by the proceed generated by treatment. In those hospitals still taking care for acute hand injuries the workload especially in standby duty increased. What may have a negative input on the numbers of treated elective hand surgery cases.

High Incidence of Hand Injuries From Blocking in Elite Taekwondo Despite the Use of Protective Gear: A 5-Year Descriptive Epidemiology Study.

Background:Hand and wrist injuries are a common but underestimated issue in taekwondo. Detailed data on injury risk, patterns, and mechanism are missing.Purpose:To evaluate (1) the fight time exposure-adjusted injury incidence rate (IIR) and clinical incidence and (2) injury site, type, sport-specific mechanism, and time loss in taekwondo.Study Design:Descriptive epidemiology study.Methods:Athletes from a single national Olympic taekwondo training center were investigated prospectively for hand and wrist injuries during training and competition over 5 years. The Orchard Sports Injury Classification System Version 10 was used to classify injury type, and analysis of the anatomic injury site was performed. The mechanism of injury was classified as due to either striking or blocking techniques.Results:From a total of 107 athletes, 79 athletes (73.8%) with a total exposure time of 8495 hours were included in the final data set. During the study period, 75 injuries of the hand and wrist region were recorded despite the athletes using protective hand gear. The IIR was 13.9 (95% CI, 10.5-17.5) and was significantly higher during competition. The clinical incidence as an indicator for risk of injury was 60.7% (95% CI, 50.9-70.5). Finger rays were the most affected location (68%), and fractures (43%) and joint ligament injuries (35%) were the most common type of injury. Significantly more injuries were found on the dominant hand side (P < .001). Comparison of injury mechanisms demonstrated significantly more injuries at the finger rays deriving from blocking techniques (P = .0104). The mean time loss for all hand and wrist injuries was 15.7 ± 13.5 days (range, 3-45 days) and was highest for distal radial fractures, with a mean of 39.7 ± 4.8 days (range, 32-45 days).Conclusion:There was a significantly higher IIR for acute hand and wrist injuries in elite taekwondo athletes during competition, which resulted in considerable time loss, especially when fractures or dislocations occurred. Significantly more injuries to the finger rays were found during blocking despite the use of protective hand gear. Improvement of tactical skills and blocking techniques during training and improved protective gear appear to be essential for injury prevention.

Hand injuries during COVID-19: Lessons from lockdown

The two-month nationwide lockdown implemented in Australia in response to COVID-19 involved restrictions on social gatherings and non-essential services, resulting in marked changes to the distribution of time spent at home and in the workplace. Given the likelihood of future lockdowns, this study aimed to investigate whether the lockdown was associated with an alteration in the pattern of acute hand injuries admitted to Sydney Hospital Hand Unit relative to the same period in 2019, and whether target areas for preventative strategies could be identified.During the lockdown period in 2020, 332 acute presentations were noted, and in the same period in 2019, 310 cases were noted. The mean patient age was higher in 2020, largely due to a 327% increase in do-it-yourself (DIY) injuries. Workplace injuries increased in 2020 despite a 9.5% reduction in hours-worked, reflecting a redistribution of workers into manual labour jobs with a higher risk for hand injuries. Patients who suffered low-energy injuries at work were also significantly younger in 2020, suggesting this effect was most pronounced in younger age-groups, probably due to the shutdown of hospitality-based industries. Domestic violence-related injuries increased in 2020, highlighting the need to maintain resources to provide support in such cases at subspecialty hand units, which are often largely outpatient-centred. This study, therefore, identified a number of key areas that could be targeted in the event of future lockdowns, including messages regarding safe DIY activities, and more stringent requirements regarding worksite briefing and safety for people commencing labour-based jobs, especially if transferring from another industry.

Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study

IntroductionCustom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. Purpose of the StudyThis study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. Study DesignThis is a prospective cohort study. MethodsTwo hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system–related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence. ResultsOne hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01]. ConclusionsAmong our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.

Adolescent/adult-onset homocysteine remethylation disorders characterized by gait disturbance with/without psychiatric symptoms and cognitive decline: a series of seven cases.

Homocysteine remethylation disorders are rare inherited disorders caused by a deficient activity of the enzymes involved in the remethylation of homocysteine to methionine. The adolescent/adult-onset remethylation disorders are rarely reported. We analyzed the clinical and genetic characteristics of seven cases with adolescent/adult remethylation disorders, including 5 cases of the cobalamin C disease (cblC) and 2 cases of the methylenetetrahydrofolate reductase deficiency. The average onset age was 21.1 (range 14 to 40) years. All patients complained of gait disturbances. Other common symptoms included psychiatric symptoms (5/7) and cognitive decline (4/7). Acute encephalopathy, dysarthria, anorexia, vomiting, ketoacidosis, anemia, cataract, and hand tremor were also observed. The mean total homocysteine in serum when the patients were diagnosed was 94.6 (range 53.1-154.5) mol/L. Electrophysiological studies revealed neuropathy in the lower limbs (6/7). The brain MRI showed reversible altered signal from the dorsal portions of the cerebellar hemispheres (1/7), periventricular hyperintensity (2/7), and delayed/impaired myelination (2/7). The sural nerve biopsy performed in one case showed a modest loss of myelinated fibers. Five patients showed heterozygous mutations of the MMACHC gene, including c.482G>A (5/5), c.609G>A (2/5), and c.658-660delAAG (3/5). Two patients showed heterozygous mutations of the MTHFR gene, including c.698C>A (2/2), c.698C>G (1/2), and c.236+1G>A (1/2). The patients responded well to the treatments with significant improvements. Adolescent/adult-onset remethylation disorders are easily misdiagnosed. We recommend testing the serum homocysteine concentrations in young/adult patients with unexplained neuro-psychotic symptoms. Furthermore, individuals with significantly elevated serum homocysteine concentrations should be further tested by organic acid screening and genetic analysis.