scholarly journals Early Functional Treatment and Modern Cast Making for Indications in Hand Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
S. Bohr ◽  
N. Pallua
Keyword(s):  
Clinical Outcome ◽  
Patient Compliance ◽  
Treatment Option ◽  
Hand Surgery ◽  
Hand Injuries ◽  
Nonsurgical Treatment ◽  
Joint Movement ◽  
Conflicting Objectives ◽  
Early Functional Treatment ◽  
Contracture Formation

Cast treatment can serve both as a nonsurgical treatment option and as a means for providing postoperative protection. However, with the duration of immobilization intervals, the benefits of cast treatment, especially in hand surgery, are at risk of being outweighed by undesired drawbacks such as joint stiffening and contracture formation. In order to minimize potential complications commonly associated with cast treatment, efforts to further improve cast making must attempt to reconcile two conflicting objectives: (1) to achieve stability and rigidity at the site of injury (e.g., fracture retention) and (2) to allow free range of joint movement as early as possible. In addition, in order to assure patient compliance, modern cast treatments should aim to improve wearing-comfort of the cast. This paper describes modern cast designs for four common types hand injuries, with sample cases highlighting the clinical outcome of each treatment.

scholarly journals Penile traction therapy and Peyronie’s disease: a state of art review of the current literature

2012 ◽  
Vol 5 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Eric Chung ◽  
Gerald Brock
Keyword(s):  
Patient Compliance ◽  
Treatment Option ◽  
Current Literature ◽  
Peyronie’S Disease ◽  
Nonsurgical Treatment ◽  
Conservative Approach ◽  
Penile Length ◽  
Peyronie's Disease ◽  
State Of Art

In recent years, penile traction therapy (PTT) has gained considerable interest as a novel nonsurgical treatment option for men with Peyronie’s disease (PD) and short penises. The current published literature suggests that selected cases of PD may benefit from a conservative approach with PTT, resulting in increased penile length and reduction of penile deformity. It appears to be safe and well tolerated but requires a great deal of patient compliance and determination. This article reviews the current literature pertaining to the use of PTT in men with PD, short penises and in the setting of pre- and postprosthesis corporal fibrosis.

Optimising Hand Surgery during COVID-19 Pandemic

2021 ◽  
Vol 26 (01) ◽  
pp. 84-91
Author(s):  
Shivangi Saha ◽  
Suvashis Dash ◽  
Mohammed Tahir Ansari ◽  
Ashish Dhanraj Bichupuriya ◽  
Amit Kumar Gupta ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Hand Surgery ◽  
Patient Characteristics ◽  
Operative Management ◽  
Hand Injuries ◽  
Care Needs ◽  
Use Of Resources ◽  
Flap Cover

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.

scholarly journals Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study

2019 ◽  
Vol 8 (11) ◽  
pp. 2000
Author(s):  
Ermanno Vitale ◽  
Caterina Ledda ◽  
Roberto Adani ◽  
Mario Lando ◽  
Massimo Bracci ◽  
...  
Keyword(s):  
High Pressure ◽  
Hand Surgery ◽  
High Viscosity ◽  
Hand Injuries ◽  
Medical Emergency ◽  
Early Management ◽  
Iron And Steel ◽  
Occupational Physicians ◽  
Pressure Injection ◽  
High Pressure Injection

Hand injuries after high-pressure injection are a medical emergency. These events occur frequently in workers during industrial cleaning, painting, and lubrication, and may have devastating consequences, leading to eventual amputation and poor functional outcomes. The authors have investigated the evolution, management, and outcome. Medical records of occupational medicine units and hand surgery units were collected in order to spot the high-pressure gear accident cases. Records were analyzed by dividing the subjects into two groups: those treated within 6 h and after 6 h of the trauma. A follow-up was carried out at least 1 year after treatment; the post-treatment outcomes were assessed. Of the 71 (100%) subjects, 26 (37%) were treated ≤6 h and 45 (63%) >6 h. A total of 28% (n = 20) underwent amputation. In 61% of cases, accidents had occurred in the iron and steel sector. High viscosity materials with a delayed treatment beyond 6 h seemed to determine compartmental syndrome and following amputation. A significantly better outcome was reported among subjects treated ≤6 h compared to those treated >6 h, 20% (n = 7) versus 26% (n = 9), respectively. Early management of this type of injury is crucial. The results of this study may contribute to providing guidelines to occupational physicians in order to best manage this type of emergency.

Dermoscopic monitoring of melanocytic skin lesions: clinical outcome and patient compliance vary according to follow-up protocols

2008 ◽  
Vol 159 (2) ◽  
pp. 331-336 ◽  
Author(s):  
G. Argenziano ◽  
I. Mordente ◽  
G. Ferrara ◽  
A. Sgambato ◽  
P. Annese ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Patient Compliance ◽  
Skin Lesions

scholarly journals Resurfacing of hand injury with groin flap: an analysis of thirty four cases

2014 ◽  
Vol 43 (1) ◽  
pp. 21-25
Author(s):  
Jagodish Chandra Ghosh ◽  
Samaresh Chandra Hazra ◽  
Sudhangsu Kumar Singha ◽  
Md Faroque Reza Aolad
Keyword(s):  
Free Flap ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Hand Injury ◽  
Hand Injuries ◽  
Joint Movement ◽  
Groin Flap ◽  
Flap Loss ◽  
Free Flap Transfer

Hand injuries are prevalent among the young adult and middle aged active people specially who are engaged with machinery works. Hand performs the unique and essential mechanical function and for fulfillment of this function it is imperative to provide good soft tissue coverage with sensibility. Skin grafting causes wound contraction and result in gliding of tendon directly under skin and is also unable to provide sensibility. Though cutting and slicing injury can be closed directly, crushing, degloving and avulsion injury needs coverage with a flap. Free flap require highly skilled microvascular anastomoting technique and needs expertise. Pedicle flap are suitable for this purpose where facilities for free flap transfer are not available. This prospective observational study which was done in National Institute of Traumatology and Orthopadic Rehabilitation during the period from January 2000 to december 2001 involving thirty four patients with a age range of 15-50 yrs who sustained hand injury from machinery injury, road traffic accident and electric burn.The patients were followed up at 4th (week), 6th (week), 8th (week), 16th and 20th week. Majority of patient are male. 58.82% of patient had suffered from machinery injury and 23.52% of patient had suffered from road traffic accident. During resurfacing of hand injuries, 58.82% of patient needed a flap length between 15 to 17 cm and rest of the patient (41.16%) requires flap length below 15 cm.Among all patients, 70.6% required 7 cm to 10 cm wide flap and rest of the patient between 5 cm to 7 cm. About 86% of patients had no loss of flap, 10.71% had marginal distal flap loss, 3.57% patient had distal flap loss up to 5% and no patient had distal flap loss >5%. Functional out come in terms of Eating, drinking, dressing,washing, writing were satisfactory in all cases except only one patient who developed stiffness of hand which was 3.58% of total patient. Functional outcome were evaluated in terms of eating, drinking, dressing, washing, writing and other purposeful movement; and also in terms of joint movement, power grip and pinching. All patient regained full range of movement except one patient who had deficit of finger movement. In conclusion groin flap can be a better choice for resurfacing the hand injury with acceptable results. This study recommends the use of groin flap as routine choice for resurfacing larger hand injuries. DOI: http://dx.doi.org/10.3329/bmj.v43i1.21372 Bangladesh Med J. 2014 January; 43 (1): 21-25

scholarly journals Reliability, usability and applicability of the ICD-11 beta draft focusing on hand injuries and diseases: results from German field testing

2019 ◽  
Vol 31 (10) ◽  
pp. G174-G179
Author(s):  
Angelika Eisele ◽  
Caroline Dereskewitz ◽  
Cornelia Oberhauser ◽  
Sandra Kus ◽  
Michaela Coenen
Keyword(s):  
Interrater Reliability ◽  
Real Life ◽  
Routine Data ◽  
Clinical Information ◽  
Hand Surgery ◽  
Hand Injuries ◽  
Clinical Routine ◽  
Supplementary Section ◽  
Icd 10 ◽  
Functioning Assessment

Abstract Objective To test the interrater reliability when using the codes of the 11th revision of the International Classification of Diseases (ICD)-11 beta draft as well as ICD-10 and to explore the usability of the ICD-11 beta draft and the applicability of ICD-11’s Supplementary section for functioning assessment in hand injuries and diseases. Design We conducted a validation study of the ICD-11 beta draft complemented by a single-centre study to collect clinical routine data on functioning. Setting German hand surgery clinics. Participants Twenty-three physicians coded real-life cases containing diagnostic information on hand injuries and diseases. Additionally, clinical information of 100 patients was coded by 6 physicians and a nurse using ICD-11’s Supplementary section for functioning assessment. Main Outcome Measures Physicians coded 210 cases using the ICD-11 beta draft and ICD-10. Krippendorff’s alpha was calculated. Clinical routine data was coded using 38 functioning categories. Results Interrater reliability (Krippendorff’s alpha) of 0.67 for ICD-11 coding and 0.71 for ICD-10 coding was obtained, indicating substantial agreement. However, physicians reported a high proportion of problems with ICD-11 coding and slightly fewer problems with ICD-10 coding. The collected data on functioning could be mapped to ICD-11’s Supplementary section for functioning assessment. For some data, however, only unspecific codes were available. Conclusions Interrater reliability of ICD-10 and ICD-11 was satisfactory. Training material for ICD-11 is needed to further improve reliability and usability. Future users of ICD-11 should be encouraged to use the Supplementary section for functioning assessment to shed light on the problems patients experience in everyday life.

scholarly journals Bilateral Metacarpal Hands: Reconstruction With 6 Toe Transfers

Hand ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 465-471
Author(s):  
Neil F. Jones ◽  
David Graham ◽  
Katherine Au
Keyword(s):  
Functional Outcomes ◽  
Donor Site ◽  
Psychological Impact ◽  
Hand Surgery ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Hand Injuries ◽  
Great Toe ◽  
Hand Transplantation

Background: Bilateral metacarpal hand injuries are extremely rare, but probably represent the most difficult reconstructive challenge in hand surgery. Methods: We discuss the various options for metacarpal hand reconstruction, including the Krukenberg procedure, bionic prostheses, multiple toe-to-hand transfers, and possibly hand transplantation, and present the long-term functional outcomes, gait analysis, and psychological evaluation after a 4-stage reconstruction of bilateral metacarpal hands in a child using 6 toe-to-hand transfers—bilateral great toe transfers to reconstruct both thumbs and bilateral combined second-third monobloc transfers to reconstruct 2 fingers in each hand. Results: Reconstruction of bilateral metacarpal hands with 6 toe transfers yielded excellent functional results and patient satisfaction. Conclusions: Bilateral metacarpal hand injuries result in a devastating functional deficit and a major psychological impact. Multiple toe transfers (4, 5, or 6) provide an excellent reconstructive outcome with acceptable donor site morbidity.

Clinical outcome of T1 glottic carcinoma since the introduction of endoscopic CO2laser surgery as treatment option

Head & Neck ◽  
2008 ◽  
Vol 30 (9) ◽  
pp. 1167-1174 ◽  
Author(s):  
Elisabeth V. Sjögren ◽  
Ton P. M. Langeveld ◽  
Robert J. Baatenburg de Jong
Keyword(s):  
Clinical Outcome ◽  
Treatment Option ◽  
Glottic Carcinoma
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