Why all finger fractures should be referred to a hand surgery service: A prospective study of primary management

The quality of the treatment of finger fractures by Accident and Emergency Department staff has been prospectively assessed during a six-month period. 678 finger fractures were seen in the A. & E. Department. The primary treatment of 624 of these was performed by the A. & E. staff, but in 169 of these (27%), the treatment was inappropriate. Most management errors were elementary: they included failure to prescribe antibiotics for compound fractures, failure to reduce displaced fractures accurately and unsatisfactory splintage. It is recommended that all finger fractures should be assessed and treated by surgeons with training in the management of hand injuries.

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A Modification of the Technique for Intravenous Regional Blockade for Hand Surgery

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0423 ◽

2000 ◽

Vol 25 (6) ◽

pp. 575-577 ◽

Cited By ~ 13

Author(s):

C. H. J. THAM ◽

B. H. LIM

Keyword(s):

Prospective Study ◽

Regional Anaesthesia ◽

Hand Surgery ◽

Subjective Assessment ◽

Distal Forearm ◽

Operating Field ◽

Experienced Pain ◽

Intravenous Regional Anaesthesia ◽

A Prospective Study

A prospective study was conducted to assess a modification to Bier’s intravenous regional anaesthesia which introduced a third temporary distal forearm tourniquet. This confines the injected lignocaine to the hand, resulting in a higher local lignocaine concentration. Subsequent exsanguination of the limb then channels the remaining intravascular lignocaine under the distal cuff of a double tourniquet. Of the 18 patients, none experienced pain during operation and all tolerated the tourniquet without significant discomfort. Mild postoperative giddiness was noted in one patient. No other anaesthetic complications were encountered. In a subjective assessment of the bloodlessness of the operating field, two were ranked satisfactory, ten good and six excellent. None of the patients required re-exsanguination when using this technique.

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Re. Clinical value of electrodiagnostic testing following repair of peripheral nerve lesions: a prospective study. Th. H.J. Van de Kar, J.B. Jaquet, J. Meulstee, C.B.H. Molenaar, R.J. Schimsheimer, S.E.R. Hovius. Journal of Hand Surgery 2002: 27B(4): 345–349.

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00022-6 ◽

2003 ◽

Vol 28 (3) ◽

pp. 282-283

Author(s):

J. Henk Coert ◽

Marcel F. Meek

Keyword(s):

Peripheral Nerve ◽

Prospective Study ◽

Hand Surgery ◽

Clinical Value ◽

Nerve Lesions ◽

Electrodiagnostic Testing ◽

Peripheral Nerve Lesions ◽

A Prospective Study

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HAND SURGERY ON ANTICOAGULATED PATIENTS: A PROSPECTIVE STUDY OF 121 OPERATIONS

Hand Surgery ◽

10.1142/s0218810410004680 ◽

2010 ◽

Vol 15 (02) ◽

pp. 109-113 ◽

Cited By ~ 22

Author(s):

Ian Edmunds ◽

Zorik Avakian

Keyword(s):

Prospective Study ◽

Hand Surgery ◽

Dental Surgery ◽

Significant Complication ◽

Risk Of Bleeding ◽

Increased Risk ◽

A Prospective Study ◽

Anticoagulated Patients ◽

Anticoagulant Medication

The management of anticoagulated patients requiring surgery presents a challenge to hand surgeons. The risk of bleeding related complications needs to be weighed up against the increased risk of thrombotic events if anticoagulants are altered or ceased. There is literature reporting the safety of hand, skin, eye and dental surgery on patients taking anticoagulants, and there is literature highlighting the risks associated with altering regular anticoagulant medication. However, it is common practice to cease or alter patients' anticoagulants peri-operatively for hand surgery. We report a prospective study of 107 patients taking anticoagulants who underwent 121 hand operations from December 2005 to August 2009. There was only one significant complication, that being a haematoma which occurred in a patient taking clopidogrel. We conclude that interruption to therapy with warfarin (provided the INR is not greater than 3.0), clopidogrel or clopidogrel with aspirin is unnecessary for patients undergoing hand surgery.

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