Management Of Hand Injuries Research Articles

AI in Hand Surgery: Assessing Large Language Models in the Classification and Management of Hand Injuries.

Background: OpenAI's ChatGPT (San Francisco, CA, USA) and Google's Gemini (Mountain View, CA, USA) are two large language models that show promise in improving and expediting medical decision making in hand surgery. Evaluating the applications of these models within the field of hand surgery is warranted. This study aims to evaluate ChatGPT-4 and Gemini in classifying hand injuries and recommending treatment. Methods: Gemini and ChatGPT were given 68 fictionalized clinical vignettes of hand injuries twice. The models were asked to use a specific classification system and recommend surgical or nonsurgical treatment. Classifications were scored based on correctness. Results were analyzed using descriptive statistics, a paired two-tailed t-test, and sensitivity testing. Results: Gemini, correctly classifying 70.6% hand injuries, demonstrated superior classification ability over ChatGPT (mean score 1.46 vs. 0.87, p-value < 0.001). For management, ChatGPT demonstrated higher sensitivity in recommending surgical intervention compared to Gemini (98.0% vs. 88.8%), but lower specificity (68.4% vs. 94.7%). When compared to ChatGPT, Gemini demonstrated greater response replicability. Conclusions: Large language models like ChatGPT and Gemini show promise in assisting medical decision making, particularly in hand surgery, with Gemini generally outperforming ChatGPT. These findings emphasize the importance of considering the strengths and limitations of different models when integrating them into clinical practice.

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

Variations in the extensor indicis proprius muscle in the Burmese population: implications for hand reconstructive surgery

BackgroundThe use of extensor indicis proprius (EIP) muscle tendon for tendon grafting and transplantation in the management of hand injuries is common. Anatomical variations of the EIP tendons have been reported with variable prevalence and presentation in different populations worldwide. Knowledge of possible variation patterns is crucial in reconstructive surgery. The current study aims to describe the prevalence of anatomical variations of the EIP in the Burmese population. MethodsA total of 50 cadavers (39 males, and 11 females) were dissected. Both upper limbs of each cadaver were observed. The presence of the EIP, the number of tendons, the origin and insertion of the muscle and its relation with the extensor digitorum communis (EDC) were recorded and variations reported. ResultsOf the 100 limbs studied in the 50 cadavers, only 1/100 limb was reported to have an absent EIP muscle and tendon. Of the remaining 99/100 limbs examined, one of them consists of a double tendon, that is, EIP and extensor indicis et medii communis (EIMC) were inserted separately onto the index finger and middle finger respectively on the dorsum of the left hand. Further to this, there is one case in which an extra muscle belly was observed in the EIP tendon, this muscle is commonly known as the extensor digitorum brevis manus muscle. All the EIP variations were observed in the male cadavers only. ConclusionOf the 50 cadavers studied, 3/100 limbs exhibited EIP variations in the current studied population. Population-specific studies on these variations may aid in a better understanding of the different anatomical patterns of the muscles in the dorsum of the hand. This may lead to improved diagnosis and surgical management of injuries to the dorsum of the hand and for the use of the EIP tendon in surgical grafts and transplantations.

Role of SWCR Guidelines in the Management of Hand Injury

The society for Wound Care and Research was founded with the aim of promoting the practice of better wound care and research. The society carries out academic, clinical, research, and social activities in a calculated manner aimed at improving wound healing. SWCR guidelines have 4 components with the acronym SWCR where S stands for systematic analysis of patient and wound, W for wound bed preparation, C for clinical decisions, and R for repair, reconstruction &amp; rehabilitation. Hand injury is a commonly seen and a leading cause of work-related disability. Appropriate wound management and meticulous reconstruction followed by rehabilitation in a systematic manner are of utmost importance in these patients to improve their quality of life and return to work in them. Injuries of the hand are particularly challenging from the viewpoint of healing and reconstruction as they require restoration of both functionality and aesthetics. These difficulties can be overcome by systematically approaching the wound through SWCR guidelines. This review article provides a summary of the benefits of using SWCR guidelines in the management of hand injuries.

Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients

BackgroundHand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization.ObjectiveThe objective of this study is (1) to provide epidemiological information on hand injuries and their patterns and (2) to visualise the frequencies of affected areas of the hand in relation to the most common trauma mechanisms using color-coded heatmaps.MethodsThis prospective single-center observational trial conducted at a surgical emergency department in Germany collected data of hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, diagnostic and therapeutic measures were analyzed. Color-coded heatmaps were generated marking anatomic danger zones.Results435 patients with a mean age of 39.5 were included. Most patients admitted on their own initiative (79%). Leisure and sport injuries were most frequent (75%). Digiti II–V were injured most commonly (43%), followed by metacarpals (19%) and the thumb (14%). Blunt trauma and cuts accounted for most injuries (74%). Hand-graphics depicted color-coded frequencies of the affected areas of the palmar and dorsal aspect of the hand for the most common types of injury, as well as the most frequent circumstances of accident. Elective surgery was recommended in 25% of cases, and hand surgical follow-up was proposed in over 50% of cases.ConclusionsThe dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.

Management of Hand Injuries: a Six-year Experience from Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background: Hand injuries can ruin patients’ ability to work with their hands. This could lead to depression and social isolation. It is imperative that hand injuries be reconstructed to as near normal as possible.Patients and Method: A prospective study was undertaken from January 2005 to December 2010 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana to document the pattern of hand injuries, and the outcome of management. The patients were evaluated clinically. Wound debridement was done; the defects were repaired using reconstructive techniques matched to the type of injury.Result: Ninety-five patients (71 males) were treated. Male: female ratio was about 3:1. Their ages ranged from 2 to 60 years with mean (± SD) of 29.5 (± 12.9). Of the 102 hands injured, 52 were right. The right was the dominant hand in 65%. Both dominant and nondominant hands were injured equally. 5% of the injuries were isolated; 95% were combined. The distribution of mechanisms of injuries was as follows: avulsion, sustained through road traffic accidents (37%), crush injuries (25. 3%), sharp injuries (including spaghetti wrists) (19%) machine mangling (11%), burns (8.4%), blunt injuries (15%), human bites (2.1%), snake bite (1.1%), gunshot (4.2%), and injection injuries (2.1%). Patients’ occupations were: farmers 23%, mechanics (20%), traders (11%), factory workers (5%), followed by 2% each of teachers, electricians and civil servants, and 1% each of drivers and pastors; 5% were unemployed. Ofthe remainder, 16 % were children and 11% students. Surgical procedures performed were groin flap (30%), exploration and repair (24%), skin grafting (21%), debridement alone (13%) cross finger flap (7%). decompression of carpal tunnel,(3%) and terminalisation(2%)Conclusion: Severe hand injuries requiring reconstructive surgery were sustained through road traffic accidents Farmers, traders, mechanics and children are at risk of severe combined hand injuries.

EP.FRI.148 Profile and management of Hand injuries in a tertiary institute

Abstract Aims To outline the demographic profile and outcome of hand injuries in a tertiary institution Methods This study was done over a period of 4 years in a tertiary institution in patients presenting with open hand injuries and management protocols will be discussed based on presentation in emergency and opd of burn and plastic surgery. Results Majority of patients were labourers or skilled artisans who sustained injury during operation of machines and right hand was predominantly affected. Maximum injuries occurred in night time. Traumatic amputations were commonly seen along with involvement of thumb in some patients. Various reconstructive options will be discussed based on the involvement of hand injury. Conclusion Proper knowledge of mechanism of injury can guide in the management of patients. Exposure to machines and hazard prevention should be taught in factory establishments or threshers for reducing this menace.

Pattern of hand injuries: a two year review of cases in S. Nijalingappa Medical College and HSK Hospital, Bagalkot

Background: Hand injuries are common, leading to loss of function with attendant psychological consequences. The pattern of the injuries varies from place to place, responsible for a significant hospital emergency visit and most of which are seen by non-hand specialists. It is pertinent that those who may come across the patients understand this pattern.Methods: A retrospective review of records of patients presenting with hand injuries to the plastic surgery department over a two year period was carried out highlighting the pattern of the injury.Results: A total of 95 patients predominantly males sustained hand injuries. Most of the patients were in their 20s. Road traffic injury been the commonest cause of injury followed by machines with high incidence of injury of the Right hand which was 53.6%. Soft tissue injuries occurred in 79% of cases, bony injuries occur 14% of cases and tendon injuries in 7% cases.Conclusions: Understanding the pattern of injury can impart positively on the management of hand injuries and for its preventive measures of safe road and education of the people on the use of tools and machines in our environment.

Pattern Of Hand Injuries in a Teaching Hospital of a Developing Country

INTRODUCTION: Hand injuries are common and are responsible for a significant hospital emergency visit and most of which are seen by non hand specialists. The pattern of the injuries varies from place to place. It is pertinent that those who may come across the patients understand this pattern. MATERIALS &amp; METHODS: A retrospective review of records of patients presenting with hand injuries to the emergency unit and in OPD unit over two year period was carried out highlighting the pattern of the injury.RESULTS: The common cause of hand injury in these patients was fodder cutter machines which is 53 patients (30.6%) followed by industrial machines injury in 36 patients (20.8%), road traffic accidents in 30 patients (17.3%), physical assault in 19 patients (10.9%), threshing machines in 13 patients (7.5%), fall in 9 patients (5.2%), falling objects in 8 patients (4.6%), door injury in 2 patients (1.15%) and sports injury in 1 patient (0.5%). The injury was more common in young adults between 15 to 34 years of age with the mean age of 24.5 years. Most of the injury occurred during work by fodder cutter machine and industrial machines or other causes as road traffic accidents. In the present study, 17.3% cases had injury on Saturday comprising 80.9% of males and 53.1% of cases had fractures with high incidence of injury of the Right hand which was 53.7%. Most of the cases having fractures were of Gustilo II variety (28.2%) and 94.2% of cases were of minor to moderate grades of severity of hand injury on grading by HISS grading.CONCLUSION: Understanding the pattern of injury can impart positively on the management of hand injuries and for its preventive measures.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, page: 29-32

Management of metacarpal and phalangeal fractures with JESS fixator: A prospective study

The human hand architected to show an exceptional movements and is often a most vulnerable to various degree of injuries caused often by road traffic accidents and industrial accidents. Treatment of hand injuries involves in joint range improvement and redevelopment of coordinative movements. Joshi’s external stabilizing system (JESS) provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints. This study designed to assess the efficacy of JESS in management of Hand injuries. Study includes 50 patients of both sexes and all age groups with open or close type of hand injuries. All the patients were allowed to complete clinical and radiological assessment before and after surgical procedure along with subsequent follow up. Various types of distractors (30%) were applied because majority fractures were intra-articular and in 18% cases basic and extended hand frames were used. Fixators was removed within 6 weeks and in 68% wounds were healed at that time of fixator removal. Swelling was commonly associated complications in 32% cases. The incidence of non-union and delayed union of fractures was 8%, 10% respectively. At the time of final follow up 62.8% metacarpophalangeal joints, 64% of interphalangeal joints, 63% of proximal metacarpophalangeal joints, 63.5% of distal metacarpophalangeal joints and 62% of wrist joints regained their normal movements. In 74% cases grip strength was remains normal. JESS is simple, modular and low expensive. It assists the surgeon in obtaining tissue stabilization, spontaneous revascularization and tissue expansion by gradual and controlled distraction.

Acute hand injury splinting - the good, the bad and the ugly.

Injuries to the hand comprise 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. The initial assessment and management of hand injuries is usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In the Department of Orthopaedic Hand Surgery, Morriston Hospital, we regularly observe patients presenting to the specialist hand fracture clinics having had initial management that shows no appreciation for the treatment objectives or the safe positions for splinting. This article aims to provide guidance for frontline staff on the management of hand fractures, with particular emphasis on the appropriate nonoperative care to avoid any unnecessary morbidity.

Management of Hand Injuries: Part III.

Assessment of Acute Hand Injuries was discussed in Part I (). Part I reviewed approaches to the assessment of the patient with a hand injury and established a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand were discussed, and examples of the assessments were provided. Diagnostic approaches to support physical findings were discussed, and methods of radiological assessment provided assistance to the audience in making appropriate diagnosis in relation to hand injuries. Management of bony hand injuries was discussed in Part II. In Part II, the authors also described the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. In this article, Part III, the management of tendon, ligamentous, neurovascular, and other specific hand injuries, along with the management of selected chronic hand conditions, is discussed.

Rock climbers’ management of hand injuries and perceptions on seeking healthcare: A mixed methods analysis

This study examined rock climbers’ behaviors and perspectives on utilizing healthcare for climbing-related hand injuries. Twenty-eight climbers were interviewed and completed questionnaires on thei...

Profile of hand injuries in a specialist hospital in a developing country

Background:Hand injuries are common in this environment.They are rarely life threatening but can cause serious handicap.There is paucity of studies addressing the pattern and management of hand injuries in this locality.Patients and Methods: This is a one year prospective study (July 2011 to June 2012).All patients with hand injury that presented to the hospital and met inclusion criteria were recruited.The data was analyzed using the SPSS 17.0).Results were presented in tables,bar and pie charts using Microsoft Excel 2007.Results: 118 patients presented with hand injuries, representing 5.4% of the total number of patients seen. 8 were excluded from the study.87 (79.1%) were males and 23 (20.9%) were females.The mean age was 25.7yrs with a range of 0.8 to 80yrs and peak of 21- 30yrs. Students were most commonly affected; 29 (26.4%).The most common cause was domestic accident; 31 (28.2%), while fireworks resulted in 6 (5.5%) of injuries. 10 (9.1%) presented with gangrene.99 (90%) completed treatment while 10 (9.1%) signed against medical advice and 1 (0.9%) referred.Conclusion:Hand injuries are common with slight variation in pattern.Efforts should be made to reduce the incidence and improve initial care.Key words: Profile,Hand injuries,Developing country.

Management of Hand Injuries: Part II.

Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. "Assessment of Acute Hand Injuries" Part I was discussed in the Advanced Emergency Nursing Journal (). Part II herein discusses the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. Part III will discuss the management of tendon, ligamentous, neurovascular, and other special hand injuries along with the management of selected chronic hand conditions.

Developing hand therapy skills in Bangladesh: Experiences of Australian volunteers

IntroductionBangladesh is a developing country whose health system is highly dependent on project funding from foreign countries. Interplast Australia & New Zealand have supported volunteer hand therapists to provide training to local staff in the management of hand injuries and burns since 2006. ObjectivesWe aimed to explore and describe the volunteers' own experience and provide recommendations for future therapy capacity building projects in developing countries. MethodsThis qualitative study involved nine volunteer therapists, who attended a focus group to discuss their experiences, including the key milestones, challenges, and progress achieved. The two authors analyzed transcripts independently and emergent themes were discussed and identified by consensus. ResultsOverall the experience was extremely positive and rewarding for volunteers. Key learnings and challenges encountered in this project were cultural differences in learning styles, the need to adapt our approach to 2 facilitate sustainable local solutions, attrition of skilled local staff, and concerns regarding volunteer health and safety. Recommendations for similar projects include allowing adequate time for in-country scoping and planning, coordination and pooling of resources, and the use of strategies that encourage the shift to confident local ownership of ongoing learning and skill development. ConclusionVolunteering in a health capacity building program in developing countries can be a challenging but immensely rewarding experience. Programs designed to meet the health demands in developing countries should emphasize adequate training of professionals in the use of transferable, sustainable and cost effective techniques. Time spent in the scoping and planning phase is crucial, as is coordination of efforts and pooling of resources. Level of evidence2C.

The Management of Hand Injuries in a Role 2 Enhanced or Role 3 Facility: Part 2

The Management of Hand Injuries in a Role 2 Enhanced or Role 3 Facility: Part 2

The Management of hand injuries in a Role 2 Enhanced or Role 3 facility: Part 1

The Management of hand injuries in a Role 2 Enhanced or Role 3 facility: Part 1

Acute Management of Hand Injuries

Acute Management of Hand Injuries

Pattern Of Hand Injuries In A Teaching Hospital Of A Developing Country: A Three Year Review Of Cases

CONTEXT: Hand injuries are common, responsible for a significant hospital emergency visit, most of which are to non hand specialists. The pattern of the injuries varies from place to place. It is pertinent that those who may come across the patients understand this pattern.METHOD: A retrospective review of records of patients presenting with hand injuries to the emergency unit over a three year period was carried out highlighting the pattern of the injury.RESULTS: A total of 57 patients predominantly males sustained hand injuries. Most of the patients were in their 20s. The injuries occurred mostly at work with road traffic injury been the commonest cause of injury followed by machines. Students and drivers are the main victim, and amputation injury the usual injury sustained. Soft tissue injuries occurred in 76% of cases and bony injuries occur 24% of cases. CONCLUSION: Understanding the pattern of injury can impart positively on the management of hand injuries.