Hand Injuries Research Articles

Management of Complex Hand and Wrist Ligament Injuries.

Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.

The Effect of Upper Extremity Slings (UESs) on Balance in Young Adults.

Upper extremity slings (UESs) are frequently provided for patients with a hand or forearm injury. However, their effect on balance has not been well explored. We sought to characterize the effect of a UES on balance in young adults. Healthy young adult participants with no injuries acting as a proxy for the general young adult patient population using UESs balanced on a BioDex Balance System platform: once while wearing a UES and once without wearing it, to serve as their own control. Participant weight, height, gender, hand dominance, overall stability index, anterior/posterior stability index, and medial/lateral stability index were recorded. Comparisons were analyzed with paired t-tests and linear regression analysis. Results: No significant difference in the three stability index scores were found between UES and no UES usage. Height and weight were found to have positive significant relationships with the overall stability index during UES usage. Conclusions: Our study demonstrates the feasibility of assessing balance discrepancies between the sling and nonsling usage in a broader patient population and suggests that height and weight may impact balance negatively during UES use.

The Minimum Clinically Important Difference for the Patient-Rated Wrist Evaluation in Surgical Fixation of Distal Radius Fractures: Does Hand Dominance Make a Difference?

BackgroundDistal radius fractures (DRFs) are common orthopaedic injuries. They can be treated in many ways, but the volar locking plate (VLP) is more frequent. Currently, there is limited information regarding the minimum clinically important difference (MCID) in surgically treated DRFs. The purpose of this study was to calculate MCID values for the Patient-Reported Wrist Evaluation (PRWE) in the setting of VLP-treated DRFs. MethodsA retrospective review was conducted for patients with isolated, surgically-treated DRFs with a VLP. Exclusions included any concomitant procedure other than a carpal tunnel release, skeletal immaturity, polytrauma, open fracture, or missing PRWE data. MCID was calculated using PRWE, an overall health question, and the anchor-based method. ResultsA total of 131 patients were identified. Approximately 54.2% injured their dominant hand. AO/OTA classification 23C was the most common (n=89, 67.9%). Average baseline, 6-week, and 12-week PRWE were 71.8 ± 19.6, 34.3 ± 20.1, and 21.2 ± 18.0 respectively. This corresponds to an average change from baseline PRWE at 6 weeks and 12 weeks of -37.5 ± 23.4 and -50.6 ± 22.3, respectively.Average MCID values for 6 weeks and 12 weeks were 43.1 ± 18 and 56.0 ± 20.0, respectively (p<0.001). Hand dominance did not correlate with MCID value (rs = 0.084 at six weeks, rs = 0.099 at 12 weeks). MCID value additionally did not correlate with sex, AO/OTA classification, smoking status, ASA score, or BMI. Treatment at a level 1 trauma center and diagnosis of anxiety and/or depression correlated with a higher 6-week MCID value (rs = 0.308 and rs = 0.410, respectively). Increasing age weakly correlated with higher 12-week MCID value (rs = 0.352). ConclusionsThis study demonstrated an MCID calculation using an overall health anchor. MCID value varied with follow-up time and correlated weakly with age, diagnosis of anxiety and/or depression, and treatment facility, but it did not correlate with injury of the dominant hand. Future research should analyze how to apply MCID and identify successful treatment in the setting of DRF care.

Nursing care after hand replantation based on Roy's adaptation model: A case report

BackgroundHand injuries are very complex and worrying in terms of hindering activities of daily living, functionality and self-care skills. Hand injuries are caused by traumatic events, resulting in a partial or complete loss. The focus of acute treatment is surgical replantation. AimIn this study, nursing care and nursing experiences of a patient who was replanted as a result of hand trauma were discussed in the light of the Roy Adaptation Model. CaseThe male patient admitted to the emergency room due to traumatic amputation was a 49-year-old farmer. He lost his hand to an agricultural tool while working the land and was taken to the hospital within 4 h. He was taken up for emergency surgery for replantation. He has a history of diabetes mellitus. Nursing follow-up and interventions were applied by evaluating the data according to four adaptation modes (physiological needs, self-concept, role function and interdependence) within the scope of the Roy Adaptation Model. Conclusionand Suggestions: Patients experience difficulties (loss of function, financial problems, loss of role, psychological traumas) due to disability after injury. Therefore, nurses should know the underlying physiological risks, complications, and interventions to recognize and respond to situations that cause the loss of the reattached limb. Nursing models can identify patients' needs and problems, prevent complications, provide quality care, and manage the process. This study discussed the postoperative nursing care of a patient based on Roy's Adaptation Model.

Exotic (non-native) snakebite envenomation in Japan: A review of the literature between 2000 and 2022

A limited number of studies have investigated the clinical characteristics of snakebite envenomation by exotic (non-native) snakes in Japan. This study reviewed the literature to determine the status and risk of bites by exotic pet snakes in Japan. We reviewed reports of snakebite due to exotic snakes in Japan published between 2000 and 2022, excluding reports of bites by snakes native to Japan, such as Gloydius blomhoffii, Rhabdophis tigrinus, and Protobothrops flavoviridis. During the study period, 11 exotic snakebites were recorded, involving 11 species. The majority of those bitten (10/11 cases) were male, all cases were hand injuries, and there were no fatalities. The snakes responsible belonged to the Colubridae (4/11 cases), Viperidae (4/11 cases), and Elapidae (3/11 cases) families. Cases of envenomation by G. brevicaudus, Bungarus candidus, and Dendroaspis angusticeps were of particular interest. Ten of the eleven patients developed local cytotoxic signs, and three developed “compartment syndrome,” in which the surgeons performed decompressive incisions. Two bites from elapid snakes and one from a viperid snake resulted in respiratory failure. Antivenom was given in two cases. Complications were observed, such as acute kidney injury, rhabdomyolysis, coagulopathy, and residual dysfunction of the affected finger. Emergency rooms should be prepared to manage patients who have been bitten by exotic snakes, even though the number of reported cases is not high in Japan. Initial stabilization of patients is crucial, before a definitive diagnosis is made, as with native snakebite envenomation. Finger bites are reported in most cases, which may result in functional impairment of the fingers. In order to collect more comprehensive patient data in Japan, a reporting system for all snakebite envenomations should be considered.

Relationship between hand stereotypies and purposeful hand use and factors causing skin injuries and joint contractures in individuals with Rett syndrome

BackgroundSkin injuries and joint contractures in the upper limbs are observed in approximately 50 % of individuals with Rett syndrome, respectively. AimsTo investigate the relationship between stereotypic hand movements and purposeful hand skills, items related to these, and factors that cause upper extremity skin injuries and joint contractures in individuals with Rett syndrome. Study designWe conducted a cross-sectional observational study in 2020 with families belonging to either of the two largest Rett syndrome organizations in Japan. SubjectsIn 2020, we sent a questionnaire to 194 Japanese families. Outcome measuresWe used descriptive statistics to indicate frequency in each question. We analysed the association between hand stereotypies and purposeful hand use, their associations with each questionnaire item, and the relationship between the occurrence of skin injuries and joint contractures. ResultsWe acquired information from 72 cases. We found correlations between stereotypy frequency with reaching and between purposeful hand use with intellectual development grade and hand function. Hand and finger skin injuries and elbow and finger joint contractures were associated with wringing/washing, grasping, locomotion, reaching, and intellectual development grade. We identified cut-off points for the occurrence of elbow and finger joint contractures of 10 years 6 months, ability to roll over, finger feeds only, and understanding of simple words. ConclusionsDirect interventions can reduce hand stereotypies and increase purposeful hand use, while related items can be addressed with indirect interventions. Evaluations of factors that cause skin injuries and joint contractures can prevent their occurrence.

Sensor-based Safety Alarm System for Injury Prevention in Chaff cutter machine

Agricultural activities pose significant hazards, leading to high rates of fatal and non-fatal injuries, particularly with the increased use of farm mechanization. One common machine used in farming is the chaff cutter or chaff cutter, which can cause permanent upper limb (hand) injuries during operation. To address this critical issue, a microcontroller-based alarming system was developed to provide advance warning when a worker's hand enters the injury-prone zone of the chaff cutter machine. The system incorporated a passive infrared (PIR) sensor that detected infrared radiation emitted by the human body. Extensive testing was conducted under various conditions, including different distances between the sensor and the human hand, hand orientations, room temperature, and fodder temperature, using subjects of different age groups. The Response Surface Methodology (RSM) was employed to derive regression equations for these parameters. The optimal distance for sensor placement was found to be 125mm ahead of the identified danger zone on the feeding chute. The sensor system showed good response for pronated and supinated hand orientations, followed by the holding position, under different temperature conditions. A temperature range of 24 to 27°C was identified as ideal for optimal sensor performance. Additionally, the speed of hand movement or fodder pushing and the worker's response to the audible frequency were found to effectively alert them. The developed alarming system can significantly enhance safety measures in chaff cutter machines, mitigating the risk of upper limb injuries and improving the overall well-being, productivity, and economic status of farmworkers.

Improving hand therapy delivery during care transitions in multisystem trauma patients

High-quality hand therapy is critical to maximising functional capacity and optimising overall outcomes following hand injuries. Therapy delivery requires clear communication between surgeons and occupational therapists. At Sunnybrook Health Sciences...

Finger Tip Replantation Tamai Zone II – A Case Report

Fingertip injury is one of the most commonly encountered injuries in the emergency department. In our country, hand injuries can happen for various reasons, and motorbike chain injuries are the commonest. In this case report, we present a complete traumatic amputation of the right index finger at the distal interphalangeal joint caused by a motorbike chain injury. This index finger injury falls under the category of a crush avulsion. The nerve was not repaired, but the digital artery and vein were repaired during reattachment. The patient expressed satisfaction with the surgical results three months after the procedure, both in terms of functionality and appearance. This case report aims to present a successful reimplantation of the index finger without nerve repair. KeyWords: Fingertip, Tamai Zone II, Motorbike chain, Replantation

Carpometacarpal dislocation second to fifth with associated hamate fracture: A case report of rare injury

Carpometacarpal (CMC) dislocation of the second to fifth metacarpals is an extremely rare hand injury that results from high-energy trauma. It is inherently unstable, especially if it is associated with concomitant carpal or metacarpal fractures.We report the case of an 18-year-old male who sustained a motorbike injury at the level of the second to fifth CMC joints, which was associated with a hamate fracture. The patient failed initial conservative treatment, and so one week later he underwent closed reduction of the second to fifth carpometacarpal dislocations and Kirschner wire fixations from the second to fifth metacarpals. He then underwent open reduction and internal fixation of the hamate fracture using a mini-fragment plate and screws.This type of hand trauma is often overlooked due to radiological misinterpretations. It is important to pay attention to significant soft tissue swelling in this injury. Percutaneous pinning is still considered the gold standard and safest procedure for this injury.This is a rare hand injury that requires careful radiological assessment and meticulous and stable reduction. We believe that open reduction is advantageous in certain circumstances.

Effect of Occupation-Based Intervention Using the ADOC-H Combined With Physical Function-Based Intervention on Patients With Distal Radius Fractures: A Retrospective Case-Control Study.

Occupation-based intervention (OBI) involves daily and meaningful activities for evaluation and intervention. Recently, the "aid for decision-making in occupation choice for hand" (ADOC-H) was developed to facilitate OBI in patients with hand injuries. We aimed to examine the efficacy of OBI using the ADOC-H combined with physical function-based interventions (PBI) for patients with distal radius fractures (DRF). Patients with DRF were retrospectively allocated to two groups, ADOC-H group (n = 14) and PBI group (n = 14), and compared. Improvements in the Pain Catastrophizing Scale magnification and Hospital Anxiety and Depression Scale and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were significantly higher in the ADOC-H group than in the PBI group (p < .05). The groups showed no differences in measure of physical function, such as range of motion and grip strength. OBI using the ADOC-H combined with PBI is clinically useful for patients with DRF as it promotes use of the injured hand for daily activities in a step-by-step approach, improving psychological difficulties in using the hand.

Physical and Mental Health Assessment Among School Age Children in Islamic School, Medan

Children are individuals under the age of 18 years with significant physical and mental growth and development. But, in fact, this growth and development cannot be achieved perfectly. Based on the survey results, several factors are the causes of the child's optimal growth and development, such as economic factors, the level of knowledge and education of the mother. If examined, this factor is closely related to family poverty factors. Not only that, the data related to children's mental health is also almost non-existent, so that children not only face problems related to physical problems, but also problems related to psychological disorders. Therefore, it takes an intervention that can be done on children in optimizing physical and mental health. In this case an approach is needed in the form of school-based intervention in organizing a program for examining the physical and mental health of children. Program implementation has been carried out at the Tahfidz Plus Khoiru Ummah School, at the kindergarten level (17 children) and elementary school (30 children, grade 1-5 elementary school) by coordinating with school teachers who are responsible for each class. The first action taken was a physical examination for all kindergarten and elementary school children. Based on the results of the physical examination, there is no abnormality on the child's health scale. Child health problems found only with flu and cough problems. To overcome this, children have been taught related to health promotion in an effort to prevent disease by demonstrating proper hand washing, proper toothbrushing, wound care and diarrhea. For a physical examination of mental health, screening is done by inviting children to talk about their daily lives during a physical examination while identifying other symptoms outside the instrument checklist. There are 2 instruments used in children's mental health screening, namely Early Childhood Screening Assessment which will be used for kindergarten children and instruments for Social, Academic &amp; Emotional Behavior Risk Screener for elementary school children. Based on the results of temporary screening, there was only one elementary school child who needed further treatment and needed more accurate discussion with the class teacher at the next meeting.

Sensitive peripheral nerve repair during COVID-19 emergency: does the outpatient surgical setting work as well as the operating theater?

BackgroundNerve injuries are a common occurrence among hand injuries, which at the time of the COVID-19 emergency, did not appear to have reduced their incidence. The treatment of these injuries is urgent, but the pandemic has led to a reduction in the availability of resources and a consequent reorganization of activities. Principles about Wide-Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery expressed by LaLonde helped hand surgeons to adapt to this new condition by demonstrating a possible outpatient pathway for the treatment of hand traumatic conditions. In the present study, we bring our experience in nerve repair at time of COVID-19 emergency.MethodsWe retrospectively enrolled in this study all patients surgically treated for a peripheral nerve injury (PNI) during the COVID-19 emergency period from March 2020 to March 2022. Demographical, anamnestic, surgical, and postoperative data were recorded and analyzed. Persisting Tinel was set as the primary outcome, while hypoesthesia and other complications as secondary outcomes.ResultsThirty-six patients have been enrolled. Despite some difference in group homogeneity in term of hypertension and multi-digital involvement, we registered no difference in term of outcomes (P > 0.05) between patient operated in surgical theater and in outpatient clinic and between the various techniques of nerve repair employed (P > 0.05).ConclusionsNerve repair on an outpatient facility is technically feasible and was found in this study to be safe and effective. Compared to hospitalization, the outpatient setting has a more “agile” organization and lower costs, making it preferable in selected cases.Level of evidence: Level IV, Therapeutic.

A persistent median artery piercing the median nerve: a review and clinical implications

BackgroundThis case report documents a rare variation of a persistent median artery. Normally a transient vessel present during embryologic development of the limbs, the median artery typically regresses by the eighth week of life as the radial and ulnar arteries predominate the distal vascular supply of the hand. In a subset of the adult population, this artery remains as a persistent median artery which most often ends in the carpal tunnel or hand without significant vascular dependence.Case presentationAn 84-year-old female cadaver was found bilaterally to have an artery that penetrated the median nerve in the forearm, continued through the carpal tunnel, then joined the superficial arch, giving rise to the common digital artery to the second webspace. It also gave rise to the radialis indicis, the princeps pollicis, and an anastomotic branch to the radial artery.ConclusionsThis anatomic variant of a persistent median artery piercing the median nerve, traversing the carpal tunnel, and providing aberrant primary blood supply to a large area of the hand are details clinically relevant to those who treat hand disorders and injuries.

Occupational therapy approach in a specific case of extensor tenorrhaphy in zone VII

Introduction: Hand is an important structure for the performance of all Activities of Daily Living and for its perfect functioning it is necessary all its anatomical structures in complete harmony. Tendon injuries caused by agents such as glass and knives are very frequent in hand injuries and their sequelae generate incapacity for work performance and Activities of Daily Living. These are associated with lesions of the skin, nerves, and arteries. Anatomical knowledge of the hand is essential because lesions can progress to complex sequelae if not treated properly. Objective of the study: The objective of the present case study is to reflect on the intervention of Occupational Therapy in a hospital context with a patient submitted to tenorrhaphy of zone VII extensors, during a period of 13 consecutive weeks. Methods: It is intended to carry out a prospective case study of mixed analysis, in which a patient who performed OT at the Physical Medicine and Rehabilitation Service of the Centro Hospitalar Universitário do Algarve (CHUA) – Portimão Unit. Results: The treatment performed at the level of edema, scar, pain, muscle strength, range of motion and performance and satisfaction of the activities identified as significant by the patient, provided an improvement in the sensorimotor recovery of the extensors in zone VII of the hand with optimization of functional gains. Conclusion: The Occupational Therapy approach contributed to the patient's recovery, avoiding major complications and a faster and more favorable return to their usual activities. Although extensor tendon injuries are frequent, there is a lack of scientific evidence on the subject. Therefore, further studies in hand therapy, to validate the therapeutic techniques comparing the data with the existing ones, must be conducted.

Radiographic views for hand fractures - call for three view national uk guidelines - a quality improvement study.

A three-view radiographic examination (comprising of antero-posterior, oblique and lateral views) is crucial for the accurate assessment and subsequent decision making in hand fracture management. The superiority of a three-view examination, compared to only two-views, has been demonstrated by multiple studies, citing increased diagnostic accuracy and reduced rates of misdiagnosis. As such, the American College of Radiology (ACR) now recommend a standard three-view examination for finger and hand injuries, despite this no formal guidance exists in the United Kingdom. Out of the 235 patients referred to our tertiary hand trauma unit with a confirmed hand fracture, less than half (45%) had three-view radiographic examination performed. Less than two-thirds (57%) of metacarpal fractures had three-views available at assessment in our unit, with the lateral radiograph most commonly lacking (38%). Less than a third (30%) of phalangeal fractures had all three-views, with the oblique view most commonly absent (64% of cases). Reviewed radiology protocols from six local hospitals were inconsistent; all recommended three-views for suspected metacarpal fractures, but only two for suspected phalangeal injuries. Despite the superiority of a three-view examination and no additional cost of a third view, over half of the patients in this study lacked a three-view radiographic series. We would like to call for national published guidance advocating the use of three-view radiographic series in all patients with a high hand fracture suspicion (as defined by the presence of swelling, bruising and/ or deformity) to reduce variability in local radiology hand fracture protocols and increase availability of three-view radiographs in the primary, secondary and tertiary setting.

Pickleball- and Paddleball-Related Injuries to the Upper Extremity.

Introduction While pickleball and paddleball are rapidly growing as popular sports in the United States, research on the incidence of hand and upper extremity injuries and treatments in outpatient clinics are lacking. This study evaluates the incidence rates and treatment options, both surgically and nonsurgically, for patients presenting with pickleball/paddleball-related injuries. Methods A retrospective database search of our multispecialty, multilocation electronic medical record (EMR) system from 2015 to 2022 identified 204 patients with outpatient pickleball- and paddleball-related injuries. The data from these patients' charts were reviewed for injury incidences, treatment trends, and demographics. Results The majority of patients suffered wrist fractures due to a fall/dive and were treated nonsurgically. The most common surgical treatment, when required, was open reduction and internal fixation of the distal radius. We found that pickleball and paddleball players who sustained wrist fractures required surgery at a higher rate than the general population if above the age of 65. Conclusion As pickleball and paddleball continue to gain popularity, hand surgeons should be aware of the types of injuries that can occur and, when possible, counsel patients accordingly to try to prevent them.Additionally, hand surgeons should recognize the common treatments and outcomes that arise from pickleball/paddleball-related injuries.

Surgery in Major Traumatic Accidents of the Hand

The hand is one of the most important parts of the human body and its ability to perform everyday tasks is fundamental to the performance of daily life. The epidemiology of catastrophic hand injuries is varied, depending on the type of injury. These can be caused by car accidents, sports accidents, industrial accidents, and in some cases, acts of violence. Catastrophic hand injuries can also result from diseases, such as osteomyelitis or hand cancer. Advances in medical technology and surgical procedures have allowed surgeons to improve precision and control in repairing injuries to nerves, blood vessels, bones, tendons and skin.

Effectiveness of a telerehabilitation tablet app in combination with face-to-face physiotherapy for people with wrist, hand or finger injuries: A pragmatic multicentre clinical trial.

To evaluate whether, in patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app reduces the consumption of face-to-face resources and improves clinical recovery, compared to a conventional home exercise program prescribed on paper. Pragmatic, multicentre, parallel, two-group, controlled clinical trial with blinded assessor. Eighty-one patients with traumatic bone and/or soft tissue injuries of the hand, wrist and/or fingers recruited in four hospitals of the Andalusian Public Health System. The experimental group received a home exercise program using a touchscreen tablet application and the control group received a home exercise program on paper. Both groups received the same treatment of face-to-face physiotherapy. Number of physiotherapy sessions. Secondary outcomes were the duration of physiotherapy and clinical variables such as functional ability, grip strength, pain and manual dexterity. The experimental group required fewer physiotherapy sessions (MD -11,5 sessions; 95% CI -21.4 to -1.4), showed a shorter duration of physiotherapy (MD -3.8 weeks, 95% CI -7 to -1) and had better recovery of grip strength, pain and dexterity compared to the control group. In patients with trauma and soft tissue injuries of the wrist, hand and/or fingers, an exercise program performed on a touchscreen tablet-based app in combination with face-to-face physiotherapy reduces the consumption of face-to-face resources and improves clinical recovery, compared to conventional home exercise program prescribed on paper.

Functional Aspects of Hand Reconstructive Surgery

Hand reconstructive surgery has become an increasingly important specialty due to the increasing incidence of hand injuries in the general population. According to the World Health Organization, hand injuries are responsible for about 10% of all emergency department visits. The hand is a complex structure consisting of many bones, muscles, tendons, nerves, and blood vessels. Hand function is essential for performing everyday activities, such as eating, dressing, working, and participating in recreational activities. Hand injuries can have a significant impact on a patient's quality of life and can limit their ability to perform daily activities and work. Hand reconstructive surgery aims to restore hand function and improve the patient's quality of life. The choice of surgical technique should be based on the cause and severity of the injury, as well as the preferences of the patient and surgeon.