Deworming the Grinder for Successful Extrication of a Mangled Hand: A Case Report and Review of Literature

Grinding machine injuries are known to cause severe mutilating injuries of the upper limb. In some cases, the machinery equipment may still be attached to the limb when the patient reaches the hospital. In treating these injuries, the patient’s hemodynamic status should be the first priority of resuscitation. Following this and whenever possible, a reversal of the grinding mechanism should be done to free the limb as this would allow assessment of the extent of zone-of-injury prior to starting the surgical procedure. We report a case of a 28-year-old male who sustained a mangled hand injury that was successfully extricated from an industrial grinding machine, thereby allowing preservation of precious length of the limb during surgery. This case highlights the importance of adhering to safety precautions at the workplace to reduce the risk of potential occupational hazards when dealing with machinery equipment.

The favorable donor site in microsurgery: Nerve and vein graft harvest from the dorsum of the foot

BACKGROUND AND OBJECTIVE: In complex hand traumas nerves and vessels are often destructed without the possibility for primary repair. For bridging defects of nerves, veins and arteries grafts are necessary. Commonly nerve and vein grafts from adjacent donor sites as the wrist, forearm or cubital region are harvested. METHODS: This study is a retrospective cohort study. Between 2017 and 2019, 10 patients with complex hand injuries were treated. There were 8 males and 2 females, with an average age of 39 years (range 8–63 years). In all cases grafts were used of the dorsum of the foot for reconstructing of the severed digital nerves and arteries. All donor sites could be closed primarily. RESULTS: In 100%of cases nerves and veins of the dorsum of the foot showed a good size match as well as adequate length for a sufficient repair. The overall Hand Injury Severity Score (HISS) was determined with a median of 86 (range 57 to 286). In the area of the donor site no relevant complications were seen. CONCLUSIONS: In complex hand injuries the dorsum of the foot is a favorable donor site for nerve and vein graft harvest.

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

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.

On rehabilitation of patients with severe traumatic hand injury (case history)

Reconstruction of flexor tendons anatomic continuity at the level of osteofibrous canals is one of the most challenging in hand surgery. Due to the complex anatomy of the hand and a high risk of developing postoperative adhesions choosing the optimal treatment protocol remains crucial during flexor tendons rehabilitation period. Surgeons and rehabilitation specialists agree that a number of poor results of flexor tendon surgery can be caused by a wrong postoperative treatment, violation of treatment protocols or just by the lack of adequate rehabilitation measures. The aim of this study is analysis and the description of the case history of treating the teenager with concomitant hand injury after staged reconstructive and restorative nerve and tendon surgery. Materials and methods. The study analyses the use of intratissual electric stimulation (ITES) combined with the complex of special exercises for recovery of upper extremity function at the outpatient rehabilitation stage in patients who underwent nerve and tendon surgery. The objective pain syndrome and trophic innervation of the injured extremity assessment was performed by measuring skin surface electric potential using Gerasimov’s method. The results were interpreted according to “Personalized system of assessing the results of treating trauma and orthopedic patients”. Results. “Combination treatment in the rehabilitation of the upper extremity” proved to be effective to fight pain syndrome and trophic dysfunction of the nervous system. It allows the patient to do the complex of special exercises to prevent limb contracture if used during the late rehabilitation period. It is an efficient method of preventing and treating neurotrophic dysfunctions. Conclusion. The pathogenetically substantiated method of treating upper extremity, the use of intratissual electric stimulation at the outpatient rehabilitation stage of humerus fractures prove to be effective.

Comparison of analgesic effects of gabapentin and paracetamol post-operatively in patients with hand injury

Objective: Compare the analgesic effects of Gabapentin and Paracetamol post-operatively in patients with hand injury. Methods: This double blind, randomized control trial was conducted at the Department of Plastic Surgery, Dow University of Health Sciences Karachi; during March to August 2019. Fifty participants with hand injury and age ranged 18-60 were enrolled through consecutive sampling; while patients with multiple traumas, psychiatric illnesses, epileptic and pregnant were excluded. Informed written consent was obtained before enrollment of participants. Participants were randomly divided into two groups. Gabapentin (600 mg) and Paracetamol (1000 mg) were provided through anonymous packaging. Pain intensity was assessed using Visual Analogue Scale (VAS) along with self-designed questionnaire which was filled twice post-operatively (first at the time of drug intake once orally allowed and 6 hours later). Computer software SPSS 22 was used for analysis and comparison of results. Results: The analgesic effects of both the groups were analyzed using paired ‘t’ test which revealed statistically significant value i.e. <0.001 for each group. Though; the correlation coefficient was slightly more promising towards Paracetamol group (0.873 and 0.743 for Paracetamol and Gabapentin respectively). While in Gabapentin group there were more change of peaks were observed. Clinically more side effects were found in Gabapentin group. Conclusion: Both the drugs were found to be effective in pain management but Paracetamol had better pain control with relatively less side-effects. Key words: Pain, Hand injury, Gabapentin, Paracetamol. Continuous...

Rehabilitation cost share and cost analysis of traumatic hand injuries: Our single-center results

Objectives: This study aims to evaluate the cost expenses and rehabilitation share of hand and/or wrist injuries and to contribute to the development of health and economic policies. Patients and methods: A total of 59 patients (55 males, 4 females; mean age: 39.1±11.3 years; range, 20 to 64 years) who presented with hand and/or wrist injuries between January 2015 and December 2017 were retrospectively reviewed. Demographic data, hand injury information, and the Modified Hand Injury Severity Scores (MHISS) were retrieved from the patient file system. The cost analysis with direct and indirect costs was performed. Results: According to the MHISS, 27.1% of patients had a minor injury, 23.7% had a moderate injury, 18.6% had a severe injury, and 30.5% had a major injury. The mean direct cost of the patients was $726.00±641.87 and the total cost of the indirect cost was $2,776.93±1,619.00. The mean day-off time was 125±68.62 days. Indirect costs accounted for 79% of the total cost. The mean cost of rehabilitation was $150.18±86.88. Rehabilitation costs accounted for 4% of the total cost. There was a positive correlation between the MHISS and direct, indirect and total cost, but not between the MHISS and rehabilitation cost. Conclusion: The proportion of the share allocated to rehabilitation expenditures, which is the subunit of direct cost, is low and not related to the injury severity. The data obtained from the study contributed to the creation of evidence-based health and economic policies. We believe that these data also contribute to the planning of rehabilitation services according to the severity of injury which would improve the quality of life and return to work.

DESCRIPTIVE STUDY OF HAND INJURY ATTENDED AT TERTIARY CARE HOSPITAL WITH SPECIAL REFERENCE TO ASSESS SEVERITY OF HAND INJURY WITH HISS SCORE

Background: We conducted this study to establish the predictability of HISS system to hand strength in patients with traumatic hand injury. Methods: This retrospective study was conducted on 30 hospitalized patients for surgery in in Jaipur due to traumatic hand injury. All of them received rehabilitation occupational therapy in the same trauma center with established protocols and were supervised by the same group of therapists within one month after surgery. Passive/active range of motion exercise, hand grip strength training, proprioception/functional training were included in this standardized protocol. Results: The mean age of patients was 41.36±13.69 Yrs. Among them, 23 patients were male and 7 patients were female. 63.33% were dominant hand injured. The mean value of total HISS score is 53.21 ± 36.35. A positive correlation exists between the differences of the strength of two hands, and the severity shown by HISS system. Conclusion: In conclusion, initial anatomical injury severity assessed by HISS system may predict hand strength in traumatic hand injured patients after an adequate recovery period. Poor hand strength could be expected with initial high total HISS score. Keywords: HISS, Hand injury, Palmer pinch.