Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.
OBJECTIVE: To document long-term results associated with an coordinated plan of care for acutely burned hands in children. SUMMARY AND BACKGROUND DATA: Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported. METHODS: Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized. RESULTS: Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon. CONCLUSIONS: When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results. (+info)
Effectiveness of the A-V impulse hand pump.
Acute swelling of the hand is a common problem after trauma or surgery and is associated with both pain and loss of function. We describe a prospective study of 47 patients in which we assessed the effects of a pneumatic compression device (A-V impulse hand pump) on the swollen hand. The pump reduced swelling by increasing the velocity of venous return as demonstrated by Duplex scanning of the median cubital vein. Continuous use of the pump for 48 hours gave a reduction of 78.6% in swelling of the injured hand compared with the opposite, uninjured side. Even when used intermittently, with the pump on for 12 hours out of 24, a statistically significant effect was seen. There was a subjective reduction in pain and an objective improvement in function of the hand. Use of the pump resulted in a nearly normal hand by the time of discharge from hospital after, on average, 48 hours. (+info)
Pressure gun injection injuries of the hand.
Pressure gun injection injuries are becoming increasingly common. Their effect on the fingers and hands, especially when improperly managed, can be devastating. Therefore it is important to review features, clinical course, anatomic distribution and operative management of such injuries. If a useful hand and fingers are to be attained, rapid and thorough decompression and debridement of these injuries are essential. (+info)
Fracture epidemiology and control in a developmental center.
During 3.5 years, 182 fractures occurred among 994 residents of a developmental center. The fracture rate was 5.2 per 100 person-years (1.7 times greater than the rate in the US population). Fracture rate was significantly greater in residents with: epilepsy, older age, male gender, white race, independent ambulation, osteoporosis, and residence in intermediate care (versus skilled nursing) units; it was not affected by severity of mental retardation. Hand and foot bones were fractured in 58% of cases. Femur fracture occurred in 13 cases (7%). Fracture was caused by a fall in 41 cases (23%); its cause was indeterminable in 105 cases (58%). Fractures, occurring without significant injury, may be an important cause of preventable disability in this population. Control measures are suggested. (+info)
The wrist of the formula 1 driver.
OBJECTIVES: During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions. METHODS: The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically. RESULTS: Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs. CONCLUSIONS: This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers. (+info)
Anthropotechnological analysis of industrial accidents in Brazil.
The Brazilian Ministry of Labour has been attempting to modify the norms used to analyse industrial accidents in the country. For this purpose, in 1994 it tried to make compulsory use of the causal tree approach to accident analysis, an approach developed in France during the 1970s, without having previously determined whether it is suitable for use under the industrial safety conditions that prevail in most Brazilian firms. In addition, opposition from Brazilian employers has blocked the proposed changes to the norms. The present study employed anthropotechnology to analyse experimental application of the causal tree method to work-related accidents in industrial firms in the region of Botucatu, Sao Paulo. Three work-related accidents were examined in three industrial firms representative of local, national and multinational companies. On the basis of the accidents analysed in this study, the rationale for the use of the causal tree method in Brazil can be summarized for each type of firm as follows: the method is redundant if there is a predominance of the type of risk whose elimination or neutralization requires adoption of conventional industrial safety measures (firm representative of local enterprises); the method is worth while if the company's specific technical risks have already largely been eliminated (firm representative of national enterprises); and the method is particularly appropriate if the firm has a good safety record and the causes of accidents are primarily related to industrial organization and management (multinational enterprise). (+info)
Thermal perception threshold testing for the evaluation of small sensory nerve fiber injury in patients with hand-arm vibration syndrome.
The aim of the present study was to investigate whether thermal perception threshold testing is a useful method that could replace pain threshold testing in the evaluation of small sensory nerve fiber injury in vibration-induced neuropathy. Vibration, pain, and thermal (warm and cold) perception thresholds were examined on both middle fingers of 50 patients with hand-arm vibration syndrome and 29 healthy controls of similar age. The patients were divided into three subgroups according to the Stockholm Workshop sensorineural scale. Thermal (warm and cold) thresholds as well as vibration and pain thresholds were significantly more deteriorated among the patients than in the controls. Among the patients, warm thresholds elevated and cold thresholds lowered according to the Stockholm Workshop scale. Thermal thresholds were significantly correlated with pain thresholds, and the sensitivity of the thermal threshold testing tended to be greater than that of the pain threshold testing. The present findings indicate that thermal threshold testing for warm and cold perception can be a useful substitute for pain threshold testing to examine small nerve fiber injury in vibration-induced neuropathy. (+info)
Dentist's hand symptoms and high-frequency vibration.
The paper discusses characteristics of mechanical vibration as well as the mechanisms of vibration syndrome. Analysis of the relationship between the high-frequency vibration and the typical symptoms in the hands of the dentists is presented. Suggestions have been offered on how to limit exposure to vibration in the hands of dentists (+info)