Epidemiology of work-related hand and wrist injuries in a referral center: A descriptive study

BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.

Three Reverse Adipofascial Cross Finger Flaps Used for Coverage of Raw Areas on Two Fingers of a Patient with Blast Injury of the Hand—Case Report

We report a case of blast injury to the left hand which resulted in fractures of the fingers with exposure of bones and joints of the phalanges. We used three reverse adipofascial cross finger flaps raised at the same time from 2 fingers to reconstruct adjacent fingers of the patient. The patient recovered well postoperatively and had good range of movement of the fingers. This avoided the complications of the use of regional or distal flaps. To our knowledge, this is the first case reported in which three reverse adipofascial cross fingers flaps are raised at the same time, two of them from an injured finger, to cover three raw areas on two fingers of a patient.

A totally laparoscopic peritoneal free flap for reconstruction of hand

Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons. Here, we present a case of hand reconstruction with a totally laparoscopic peritoneal flap. The anterior rectus sheath was preserved in situ. The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand. The defect of the dorsal hand was 17 cm × 12 cm. The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications. A following split-thickness skin graft offered the suc- cessful wound closure. Motor and sensory function improved gradually within the first year follow-up. The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue de- fects accompanied by exposed tendons on the hand and foot.

Long-term effect of primary combined tissue transplantation on hand reconstruction

Objective: To analyze the long term effect of primary combined tissue transplantation on hand reconstruction. Methods: The data of 8 kinds of combined tissue transplantations employed to reconstruct the severely injured hands of 26 patients over the past 2 to 11 years were studied retrospectively. Among them, combined tissue transplantation taking the anterior lateral femoral flap as the main tissue unit was applied in 21 cases and taking the second toe as the main tissue unit was applied in 5 cases. Blood vessel anastomosis was performed in parallel in 16 cases, series in 6 cases and both in 4 cases. Results: Among the 60 free tissue units employed on 26 patients, 58 survived completely and the other 2 survived after dressing change because of postoperative partial necrosis. The patients were followed up for 2 11 years postoperatively, with an average of 3.5 years. According to the standard for function of reconstructed hands by Chinese Medical Association, excellent results were obtained in 10 cases, good in 12 cases, fair in 3 cases and bad in 1 case. Conclusions: Primary combined tissue transplantation, which may preserve the tissue vitality of injured hands to the maximum and thus facilitate function restoration of the hands, is a promising method in reconstructing severely injured hands.

Electronic artificial hand controlled by reconstructed digit

To treat the loss of part of the forearm with a multi dimension freedom electronic artificial hand, which is controlled by a reconstructed finger transplanted from the second toe to the forearm stump. Methods: The female patient was 19 years old, whose right hand and wrist were crushed into pieces by machine at work and her forearm was amputated at the level of 8 cm proximal to the wrist. The second toe of her left foot was transplanted to reconstruct the digit onto the stump of her forearm. Two months after the transplantation, the patient was transferred to the rehabilitation center for further rehabilitation training, which consisted of: training for adaptation to weight bearing, testing and training of sensibility to weight. testing and training for stability of the hand, and testing and training for the controlling function of the reconstructed digit.Results: The transplanted toe survived well. After rehabilitation the reconstructed digit functioned well. In testing the performance under control mandate, the accuracy rate of the electronic artificial hand was 100%. Conclusions: A 100% accuracy rate of the electronic artificial hand can be achieved by transplantation of the toe onto the stump of the forearm. It provides a useful pathway and an example for improvement of control accuracy of a multiple freedom electronic artificial hand and reduction of false action.

Blast Injury from Locally Manufactured“Hakka Patas”

Explosives are potentially harmful devices that can create an explosion by a rapid release of a pressurized gas consequent to a chemical reaction within the device.They can inflict a variety of injuries,due to the blast wave,fire,and shrapnel.The pattern and severity of injuries will be determined by various factors,including explosive potential and constituents such as shrapnel.Homemade explosive devices(HEDs)pose a further threat due to their volatile,unpredictable nature which can lead to accidental explosions.We present the case of a 28-year-old farmer who presented with extensive blast injury to the left hand from a“Hakka patas,”a HED endemic to Sri Lanka.The injuries to his hand consisted of extensive soft tissue and muscle loss,and fractures of metacarpal bones with amputation of the first distal phalanx.Low-grade explosives such as“Hakka patas”have the potential to cause injury greater than expected due to their volatile,unpredictable nature,causing accidental explosions.This can injure unintended targets,resulting in grave consequences.The specific pattern described in low-grade explosive injuries will be important to differentiate other explosive-related injuries for medicolegal purposes.

Rand reconstruction using heterotopic replantation of amputated index and little fingers

In cases of severe segmental injury across the hand and wrist, but one or other fingers are still in peak condition, the fingers can be selected for replantation at the forearm bones to restore pinch function. Here we reported an unusual case with a severe crush-avulsion amputated injury to the right hand caused by a machine accident. We conducted hand reconstruction using heterotopic replantation of the amputated index and little fingers.During 19 months follow-up, the bone union healed well with satisfactory outcome. The interphalangeal and metacarpophalangeal joint of the fingers after the heterotopic replantation had a good holding activity. This is a worthwhile procedure and the patient is satisfied with the result. The major disadvantage of this method is the poor appearance of the reconstructed fingers.