RESUMEN
BACKGROUND: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. METHODS: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. RESULTS: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. CONCLUSIONS: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.
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Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Arteria Radial , Humanos , Femenino , Masculino , Colgajo Perforante/irrigación sanguínea , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Arteria Radial/trasplante , Traumatismos de la Mano/cirugía , Mano/cirugía , Mano/irrigación sanguínea , Adulto Joven , Estudios de Seguimiento , Resultado del Tratamiento , Estudios de FactibilidadAsunto(s)
Ultrasonografía , Articulación de la Muñeca , Humanos , Articulación de la Muñeca/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Diagnóstico Diferencial , Traumatismos de la Mano/diagnóstico por imagenRESUMEN
BACKGROUND: Early and accurate diagnosis is critical to preserve function and reduce healthcare costs in patients with hand and wrist injury. As such, artificial intelligence (AI) models have been developed for the purpose of diagnosing fractures through imaging. The purpose of this systematic review and meta-analysis was to determine the accuracy of AI models in identifying hand and wrist fractures and dislocations. METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagnostic Test Accuracy guidelines, Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to October 10, 2023. Studies were included if they utilized an AI model (index test) for detecting hand and wrist fractures and dislocations in pediatric (<18 years) or adult (>18 years) patients through any radiologic imaging, with the reference standard established through image review by a medical expert. Results were synthesized through bivariate analysis. Risk of bias was assessed using the QUADAS-2 tool. This study was registered with PROSPERO (CRD42023486475). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: A systematic review identified 36 studies. Most studies assessed wrist fractures (27.90%) through radiograph imaging (94.44%), with radiologists serving as the reference standard (66.67%). AI models demonstrated area under the curve (0.946), positive likelihood ratio (7.690; 95% confidence interval, 6.400-9.190), and negative likelihood ratio (0.112; 0.0848-0.145) in diagnosing hand and wrist fractures and dislocations. Examining only studies characterized by a low risk of bias, sensitivity analysis did not reveal any difference from the overall results. Overall certainty of evidence was moderate. CONCLUSION: In demonstrating the accuracy of AI models in hand and wrist fracture and dislocation diagnosis, we have demonstrated that the potential use of AI in diagnosing hand and wrist fractures is promising. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Inteligencia Artificial , Fracturas Óseas , Luxaciones Articulares , Traumatismos de la Muñeca , Humanos , Traumatismos de la Muñeca/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Traumatismos de la Mano/diagnóstico por imagen , Fracturas de la MuñecaRESUMEN
Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction.
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Quemaduras , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Humanos , Quemaduras/cirugía , Quemaduras/terapia , Quemaduras/complicaciones , Traumatismos de la Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Contractura/cirugía , Contractura/etiología , Contractura/prevención & control , Resultado del Tratamiento , Deformidades Adquiridas de la Mano/cirugía , Deformidades Adquiridas de la Mano/etiologíaRESUMEN
Reconstruction of bony defects is challenging. Most cases can be solved by means of nonvascularized bone grafts, either corticocancellous or cancellous. However, when the defect is long, there is a combined soft tissue defect, infection, a poor scarred bed, and when a piece of cartilage needs to be included, a vascularized bone graft is preferred. This article features a review of the most useful flaps for small and long defects in the hand and upper limb.
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Trasplante Óseo , Colgajos Quirúrgicos , Humanos , Trasplante Óseo/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Extremidad Superior/cirugía , Resultado del Tratamiento , Traumatismos de la Mano/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos del Brazo/cirugíaRESUMEN
Objective: To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds. Methods: The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm. Results: All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively. Conclusion: The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
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Traumatismos de la Mano , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos de la Mano/cirugía , Adolescente , Estudios Retrospectivos , Anciano , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Cicatrización de Heridas , Desbridamiento/métodos , Resultado del Tratamiento , Mano/cirugía , Traumatismos de los Tejidos Blandos/cirugíaRESUMEN
BACKGROUND: The neurocutaneous flap was developed based on the understanding that every superficial cutaneous nerve includes vessels, also known as vasa nervorum or paraneural vessels, which run around and inside the nerves and deliver blood to the skin above. A cutaneous perforator connected to paraneural vessels that vascularize the skin and nerves is referred to as a neurocutaneous perforator. The lateral antebrachial cutaneous nerve (LACN), the most dependable blood supply from the primary underlying veins of the neurocutaneous flap, is the subject of this study. METHODS: We reviewed the results of 30 flap coverage procedures in 10 children. The applied flap was based distally along the radial aspect of the hand and wrist. The pivot point of the flap was located dorsally. This study considered patients with posttraumatic tissue loss, vital structure exposure, or hand contractures with an LACN flap. There was a case-by-case assessment. RESULTS: Thirteen male patients were included; their ages ranged from 6 to 65 years. Demographic data, preoperative cause of trauma, and postoperative complications were collected. Statistically significant improvements were observed after flap healing. CONCLUSIONS: The LACN flap is a more versatile flap with less morbidity than other alternative flaps for coverage of soft tissue defect restoration around the hand, wrist, and distal forearm.
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Procedimientos de Cirugía Plástica , Humanos , Masculino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Anciano , Adulto Joven , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugía , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Colgajo Perforante/inervación , Resultado del Tratamiento , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Colgajos Quirúrgicos/trasplante , Traumatismos de la Mano/cirugíaRESUMEN
The study included 40 patients of both genders who underwent skin transplantation after a hand injury. The study aims to evaluate the oxidative stress parameters in patients' blood and serum levels of galectin-3 in order to investigate gender differences pre- and post- skin transplantation. The results of the study suggest a significant increase in superoxide anion radical levels, catalase activity, and reduced glutathione levels in females before skin transplantation. The surgical treatment caused significant increase in superoxide anion radical and hydrogen peroxide levels as prooxidants in males, while superoxide dismutase and catalase activity were also increased 7 days after the procedure. In females, superoxide anion radical and TBARS levels increased after surgical procedure as well as the activity of catalase. Regarding galectin-3 levels, a significant interaction between gender and time was observed (gender×time; p=0.000). Correlation analysis of different oxidative stress markers with gal-3 revealed the existence of a significant negative correlation of superoxide anion radical, catalase, and reduced glutathione with gal-3, but only in female patients. It can be concluded that OS as well as galectin-3 play important roles at least in the first 7 days of the postoperative period.
Asunto(s)
Catalasa , Galectina 3 , Glutatión , Traumatismos de la Mano , Estrés Oxidativo , Trasplante de Piel , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Proteínas Sanguíneas , Catalasa/sangre , Catalasa/metabolismo , Galectina 3/sangre , Galectina 3/metabolismo , Galectinas , Glutatión/sangre , Glutatión/metabolismo , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/sangre , Traumatismos de la Mano/metabolismo , Peróxido de Hidrógeno/sangre , Peróxido de Hidrógeno/metabolismo , Caracteres Sexuales , Factores Sexuales , Superóxido Dismutasa/sangre , Superóxido Dismutasa/metabolismo , Superóxidos/metabolismo , Superóxidos/sangre , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismoRESUMEN
OBJECTIVE: Severe hand electrical injuries often occur in functional areas such as joints; the repair requires attention to both appearance and function due to the visibility of the hand. This study aimed to present the clinical experience of successfully repairing hand electrical injuries using improved forearm venous flaps. METHODS: From 2020 to 2022, 15 cases of severe hand electrical injuries were diagnosed, including 10 males and 5 females. Among them, 6 cases were repaired in the first web space, 4 in the thumb, 3 in the index finger, 2 in the middle finger, 2 in the ring finger, and 2 in the little finger. The size of venous flaps ranged from 2.0 cm × 1.8 cm to 12 cm × 4.0 cm. All patients underwent repair using improved forearm venous flaps. The follow-up period ranged from 5 to 8 months. RESULTS: All flaps survived without serious complications. All patients were satisfied with the postoperative aesthetics and function of their hands. CONCLUSION: The improved forearm venous flap is a simple and reliable method for repairing hand electrical injuries.
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Traumatismos por Electricidad , Antebrazo , Traumatismos de la Mano , Colgajos Quirúrgicos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Antebrazo/cirugía , Antebrazo/irrigación sanguínea , Traumatismos de la Mano/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Traumatismos por Electricidad/cirugía , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Adulto Joven , Adolescente , Venas/cirugía , Venas/lesiones , Venas/trasplante , Resultado del TratamientoRESUMEN
RATIONALE: Nocardia infection is commonly regarded as an opportunistic pulmonary pathogen affecting debilitated or immunocompromised individuals. Brain abscesses caused by Nocardia farcinica are rare and pose a diagnostic challenge. Traditional diagnostic techniques for identifying Nocardia species, such as blood culture, microscopy, and pathology, have shown inadequate performance. In the reported case, we applied metagenomic next-generation sequencing (mNGS) to diagnose a case of brain abscess due to N. farcinica. PATIENT CONCERNS: A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month. DIAGNOSES: The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS. INTERVENTIONS: Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin. OUTCOMES: The patient's symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions. LESSONS: Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.
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Antibacterianos , Absceso Encefálico , Traumatismos de la Mano , Nocardiosis , Nocardia , Humanos , Femenino , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Absceso Encefálico/microbiología , Absceso Encefálico/etiología , Absceso Encefálico/diagnóstico , Nocardia/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , Traumatismos de la Mano/complicaciones , Imagen por Resonancia Magnética , Secuenciación de Nucleótidos de Alto RendimientoRESUMEN
Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.
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Artroscopía , Traumatismos en Atletas , Cartílago Articular , Traumatismos de la Mano , Traumatismos de la Muñeca , Humanos , Traumatismos de la Muñeca/terapia , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos en Atletas/terapia , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/cirugía , Traumatismos de la Mano/terapia , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/diagnóstico , Artroscopía/métodos , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Volver al Deporte , Examen FísicoRESUMEN
ABSTRACT: This case report describes a 45-year-old man whose left hand was skewered by a catfish spine while he was attempting to dehook the fish. Catfish spines can create punctures, lacerations, and foreign body injuries. The catfish spine generally is serrated, which can make removal difficult.
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Bagres , Cuerpos Extraños , Traumatismos de la Mano , Linfangitis , Humanos , Masculino , Persona de Mediana Edad , Animales , Cuerpos Extraños/complicaciones , Traumatismos de la Mano/etiología , Linfangitis/etiología , Linfangitis/diagnósticoRESUMEN
Residual intravenous foreign bodies following hand trauma are relatively rare; only a few previous reports of this situation are available. It has been reported that foreign bodies often migrate to the heart and atrium dextrum. Herein, we report a recent case of needle breakage in the dorsal vein of the hand that was removed with lignification using an intraoperative C-arm fluoroscopy machine and tape tourniquet to avoid proximal movement during removal. The mandate should be to remove within the capacity allowed so that rare cases and terrible complications can be avoided. The case was seen at The Yanji City, Jilin Province, China at the Yanbian University Hospital emergency at February 20, 2023.
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Cuerpos Extraños , Agujas , Humanos , Agujas/efectos adversos , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Masculino , Traumatismos de la Mano/cirugía , Fluoroscopía , Venas/lesiones , Venas/diagnóstico por imagen , Venas/cirugía , Administración IntravenosaRESUMEN
Alignment, longitudinal growth, and function of the musculoskeletal unit of the pediatric hand is complex due to the combination of open growth plates, ossification variations, and their relationship with finger tendinous and ligamentous attachments. This review presents the basics of normal development, acquired and congenital variations, and traumatic conditions of the pediatric hand from the perspective of the pediatric musculoskeletal radiologist and hand surgeon. This multimodality imaging article focuses on non-oncologic and non-rheumatologic conditions of the pediatric hand, inclusive of fingers, thumb, and metacarpal bones.
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Traumatismos de la Mano , Humanos , Niño , Traumatismos de la Mano/diagnóstico por imagen , Mano/diagnóstico por imagen , Deformidades Congénitas de la Mano/diagnóstico por imagenRESUMEN
Ectopic transplantation of the hand remains a rare, innovative yet valuable operation in select cases of trauma and amputation. We aim to describe a novel technique of complex hand reconstruction using a two-stage ectopic implantation of the contralateral upper limb. A male patient with a near complete avulsion amputation of the right upper limb at the level of the mid-forearm and a crushing injury to his left hand was admitted after a farming accident. The right palm was ectopically transplanted to the left lower limb and both upper limbs underwent debridement with vacuum assisted dressings (VACs). There was eventual dieback of the left thumb, ring and little finger with a large palmar soft tissue defect that was eventually reconstructed using segments of the ectopically transplanted limb in two separate operations. The patient made an uneventful postoperative recovery and managed to regain protective sensation and gross motor function of his reconstructed hand.
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Amputación Traumática , Traumatismos de la Mano , Procedimientos de Cirugía Plástica , Humanos , Masculino , Traumatismos de la Mano/cirugía , Amputación Traumática/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Lesiones por Aplastamiento/cirugíaRESUMEN
In this report, we present an injury to the hand caused by an exploding vaping device. This report summarizes the burn, blast and chemical injury, and discusses best practice for treatment. This case provides a warning to healthcare professionals and the public about the potential for and the seriousness of this injury. We hope to emphasize the rising incidence of vaping among children, the injuries that may occur, and the methods for treatment.
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Traumatismos de la Mano , Vapeo , Humanos , Traumatismos de la Mano/etiología , Vapeo/efectos adversos , Masculino , Sistemas Electrónicos de Liberación de Nicotina , Quemaduras/etiología , Traumatismos por Explosión/etiología , NiñoRESUMEN
BACKGROUND: The management of upper limb injury is aimed at a timely return to work, and other activities of daily living. The modified hand injury severity score (MHISS) has been found to predict a return to work. Upper limb injuries are common in our subregion, but there is little or no data on the time to return to work. AIM: This study, therefore, aimed to determine the prevalence of return to work and to identify the predictors of time to return to work following reconstruction of upper limb injuries. METHOD: This was a cross-sectional analytic study carried out between April 2022 and March 2023. The statistical test was at a confidence interval of 95%, and statistical significance set at a P value of <0.05. RESULT: A total of 49 upper-limb-injured patients had reconstruction in the time under review. Male-to-female ratio was 4.4:1. The mean MHISS was 87.9 ± 79.2. Of the 43 patients who participated in the return-to-work analysis, 41.9% had returned to work, with a mean time of 14.3 ± 10.5 weeks. Work-related injuries (r = 0.357, P = 0.019), male gender (r = 0.354, P = 0.020), and MHISS (r = 0.333, P = 0.029) correlated significantly with late return to work. On multiple logistic regression, work-related injuries (ß =0.321, P = 0.037), MHISS (ß =0.376, P = 0.032), and male gender (ß =0.326, P = 0.044) were found to be the significant predictors of late return to work. CONCLUSION: There is a low prevalence of return to work, with a high mean time to return. Work-related injuries, MHISS, and male gender are significant predictors of time to return to work.
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Reinserción al Trabajo , Extremidad Superior , Humanos , Masculino , Femenino , Reinserción al Trabajo/estadística & datos numéricos , Estudios Transversales , Nigeria/epidemiología , Adulto , Persona de Mediana Edad , Extremidad Superior/lesiones , Extremidad Superior/cirugía , Factores de Tiempo , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Adulto Joven , Traumatismos de la Mano/cirugía , Traumatismos de la Mano/rehabilitación , Traumatismos de la Mano/epidemiología , Adolescente , Puntaje de Gravedad del Traumatismo , Traumatismos del Brazo/cirugía , Traumatismos del Brazo/epidemiología , Traumatismos del Brazo/rehabilitaciónRESUMEN
BACKGROUND: Injuries caused by explosions or pyrotechnic devices can lead to severe hand injuries with potential long-term consequences for both the affected individual and the healthcare system. The implementation of a nationwide ban on fireworks during the New Year festivities was only temporarily enforced as part of the protective measures during the Covid-19 pandemic. These two exceptional years provide an opportunity for evaluation as a model experiment to demonstrate the impact of a fireworks ban on the frequency of explosion-related hand injuries. MATERIALS AND METHODS: In a multicentre study, five German hand trauma centres retrospectively collected and analysed all pyrotechnic-related injuries that occurred within seven days around the New Year celebration between 2017 and 2023. RESULTS: Severe hand injuries from explosions were significantly less frequent at New Year celebrations during the pandemic period compared with data collected in the years before and after Covid-19. After the return to regular sales laws and celebrations in December 2022, a significant increase in injuries was observed, surpassing even the pre-Covid period. Epidemiological data confirmed a high proportion of minors and male victims. The highest number of injuries was observed on New Year's Eve and the first day of January, with adults mainly being injured during the festivities, while children and adolescents were mainly injured during the first days of January. CONCLUSIONS: A national ban proved to be an effective method to prevent severe hand injuries caused by explosive devices and their lifelong consequences. The data obtained in this multicentre study can serve as a basis for informed policy action.
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Traumatismos por Explosión , COVID-19 , Traumatismos de la Mano , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Alemania , Traumatismos de la Mano/epidemiología , Traumatismos de la Mano/prevención & control , Masculino , Estudios Retrospectivos , Femenino , Adulto , Traumatismos por Explosión/prevención & control , Traumatismos por Explosión/epidemiología , Adolescente , Niño , Persona de Mediana Edad , Adulto Joven , Pandemias/prevención & control , Anciano , Explosiones , Vacaciones y Feriados , Centros Traumatológicos , Preescolar , SARS-CoV-2RESUMEN
This study examines a rare case of frostbite on the hands caused by liquid nitrogen, focusing on the scar maturation process. Frostbite is typically less prone to abnormal scarring compared to burns, and this report contrasts the differences in scar maturation between the two. A 31-year-old male hospital employee sustained first- to second-degree frostbite on his gloved hands from a 20-s exposure to liquid nitrogen while changing a cylinder. Conservative treatment was applied, and the patient was monitored for 9 months. The deeply affected area took 50 days to epithelialize but healed without hypertrophic scarring. A mild extension contracture was noted in the distal interphalangeal joint of the right index finger, but the skin remained supple and soft. Incidents of liquid nitrogen-induced frostbite are uncommon, with only 14 cases reported in PubMed previously. In frostbite, the wound healing involves a slow replacement of damaged connective tissue, which acts as an internal splint, reducing wound contraction. This contrasts with burns, where rapid connective tissue replacement occurs, often leading to significant wound contraction due to the presence of myofibroblasts in granulation tissue. In the presented case, the slow healing process and minimal wound contraction led to mature scarring without abnormalities, underlining a distinctive healing trajectory in frostbite injuries compared to burns.
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Congelación de Extremidades , Traumatismos de la Mano , Nitrógeno , Humanos , Congelación de Extremidades/terapia , Masculino , Adulto , Traumatismos de la Mano/terapia , Cicatrización de HeridasRESUMEN
INTRODUCTION: Amateur and professional participation in sport and physical activity worldwide is increasing in popularity, which in turn is increasing the volume and types of injuries sustained by athletes. Ensuring these injuries are treated appropriately and efficiently is paramount for athletes' recovery and return to sport in a timely and safe manner. METHODS: A scoping review to map the evidence regarding the treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur athlete from contact sports. A search of seven electronic databases; SPORTdiscus, CINAHL, Medline, Scopus, Web of Science, Embase and Cochrane Library and grey literature was conducted in January 2024. The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Inductive content analysis was used to examine the data and the Critical Appraisal Skills Programme was used to appraise the quality of the included studies. RESULTS: Eight papers met the inclusion criteria and three themes emerged addressing the return to play/sport, surgical and conservative treatment and the most common/reoccurring injuries sustained from contact sports. CONCLUSION: Managing hand, wrist, finger, and thumb injuries in athletes requires a varied approach depending on the type of injury, treatment options, and external pressures. While conservative treatment is common and effective, surgical intervention may be necessary in certain cases to improve recovery and facilitate a faster return to sport. Preventive measures in high-risk sports settings could help reduce the incidence of these injuries.