Sports related fractures in children in north east England.
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OBJECTIVE: To describe the epidemiology of fractures among children seen with sports injuries in a district general hospital accident and emergency department. METHODS: A prospective study of children aged 5 to 15 years who presented with sport related fractures from 1 September 1997 to 31 August 1998. RESULTS: The 255 children who had sport related fractures represent 20% of children seen with sport related injuries in the 5-15 years age group during the study period. The mean age was 12 and the male to female ratio was 2:1. Overall, football, rollerblading, cycling, and netball injuries were the commonest causes of the fractures. However, among the boys, football and rollerblading injuries, and among the girls rollerblading and netball injuries, were the commonest causes of the fractures. The most common place where the injuries were sustained was in residential areas (44%) while falls accounted for 59% of the fractures. The fractures involved the upper limb in 90% of the children and the wrist (43%) and finger (23%) were the commonest sites. Rollerblading and football injuries were the commonest causes of wrist and finger fractures respectively. CONCLUSION: A fifth of children who are injured during sport sustain fractures. The various factors associated with an increased incidence of sport related fractures as well as possible preventive measures are discussed. (+info)
Fingertip injuries.
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The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injuries are vital to maintaining proper function of the hand and preventing permanent disability. A subungual hematoma is a painful condition that involves bleeding beneath the nail, usually after trauma. Treatment requires subungual decompression, which is achieved by creating small holes in the nail. A nail bed laceration is treated by removing the nail and suturing the injured nail bed. Closed fractures of the distal phalanx may require reduction but usually are minimally displaced and stable, and can be splinted. Open or intra-articular fractures of the distal phalanx may warrant referral. Patients with mallet finger cannot extend the distal interphalangeal joint because of a disruption of the extensor mechanism. Radiographs help to differentiate between tendinous and bony mallet types. Most mallet finger injuries heal with six to eight weeks of splinting, but some require referral. Flexor digitorum profundus avulsion always requires referral. Dislocations of the distal interphalangeal joint are rare and usually occur dorsally. (+info)
The kick with the stick.
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OBJECTIVE: To investigate the incidence and type of severe microscooter related injuries in adults. METHOD: Data were collected between January and September 2000 from the University Hospital Berne, the only referral centre for major trauma in that city, using the software package Qualicare, which connects clinical data with categorised keywords, allowing the immediate localisation of patient groups with defined diagnosis or other clinical information. RESULTS: Only 0.2% of the patients treated had suffered a microscooter accident. There were five head injuries: three facial lacerations, one fractured mandible, and one cerebral concussion. One patient showed clinical signs of a cervical whiplash injury without radiological findings. There were also two cases of finger laceration and two of muscular contusions of the lower extremities. CONCLUSIONS: Although only a small proportion of the trauma cases were the result of riding microscooters, a system of injury surveillance should be started. Furthermore, protective gear should be worn particularly when microscooters are ridden in the street. (+info)
Toe-to-finger transfer for post-traumatic reconstruction of the fingerless hand.
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OBJECTIVE: To assess the utility of toe-to-finger transfers (TFTs) for post-traumatic reconstruction of the fingerless hand. DESIGN: A case series. SETTING: A regional trauma centre. PATIENTS: Eight men, mean age was 36 years (range from 25-59 yr), who had lost all the fingers from a hand due to a crush-degloving injury (6 patients), frostbite (1 patient) or a burn injury (1 patient). INTERVENTION: TFT. Twelve TFTs were cone and the mean time from injury to reconstruction was 17.2 months. MAIN OUTCOME MEASURES: Objective (range of motion, moving 2-point discrimination, grip strength, key pinch, Jebsen-Taylor hand assessment, return to work) and subjective (activities of daily living and a questionnaire) measures. RESULTS: Eleven of the 12 transfers survived. Six of the 7 in whom the transfer was successful were available for follow-up (mean 45 mo). Range of motion was 10 degrees at the distal interphalangeal joint, 18 degrees at the proximal interphalangeal joint and 59 degrees at the metacarpophalangeal joint. Sensation was protective in all. Grip strength and key pinch were 26.1% and 70.2% of the contralateral hand respectively. Jebsen-Taylor assessment indicated that basic activities were possible but slowed. All 6 patients returned to work and could perform 92.6% of the activities of daily living unassisted. Hand and foot symptoms were mild. Two-thirds were appearance conscious, 5 of the 6 went on to altered vocations and all reported overall satisfaction as high. CONCLUSION: This study supports TFT for reconstruction of the fingerless hand in that, although transferred toe function may be poorer than a normal finger, the hand is restored to a useful, sensate and versatile functional unit, such that global hand and patient function, as well as patient satisfaction, are very good. (+info)
The V-Y plasty in the treatment of fingertip amputations.
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Fingertip amputations are injuries commonly seen by family physicians. The classification of fingertip injuries corresponds with the normal anatomy of the tip of the digit. There are three zones of injury; the V-Y plasty technique is used to repair zone II injuries. The plane of the injury can be described as dorsal, transverse or volar. The dorsal and transverse planes lend themselves to the use of the V-Y plasty technique. In carefully selected injuries, the family physician can use this technique to repair the injured digit. The use of a single V-Y plasty has replaced the original technique that repaired the digit and restored the contour of the fingertip. Good cosmetic and functional results can be obtained. Complications may include flap sloughing, infection and sensory changes. (+info)
An operation for partial closure of an epiphysial plate in children, and its experimental basis.
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In two cases of partial closure of epiphysial causing angular deformity, one of a finger and one of the lower end of a femur, the deformities were corrected by growth after resection of a small peripheral bone bridge and its replacement with a free transplant of fat. This procedure has a firm basis on experimental work. Thus, when part of a growth plate in the rabbit is destroyed but the formation of a bone bridge uniting epiphysis and metaphysis is prevented, the destroyed part is replaced by regeneration of cartilage from the adjacent parts of the plate. Moreover, it has been proved in rabbits that when a bone bridge is induced and later resected and replaced with fat, recurrence of the bridge can be prevented and subsequent growth may correct the deformity. (+info)
Reconstruction of chronic collateral ligament injuries to fingers by use of suture anchors.
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AIM: To evaluate the effectiveness of suture anchors in the reconstruction of chronic collateral ligaments of fingers. METHODS: We treated 8 patients, 6 with chronic instability of the collateral ligament of the thumb and 2 with the instability of the fifth finger, using the Statak suture anchor. A stable joint was achieved in each case, with no recurrent instability or pain within a mean of 14 months of the follow up. RESULTS: Postoperatively, each patient returned to his or her original job, their daily activities, and sports. There was no significant difference on manual stress testing measurements between operated and uninjured fingers. Mean pinch strength and range of motion were 90% (range, 78-104%) and 94% (range, 70-100%), respectively, compared to uninjured fingers. CONCLUSION: Suture anchor technique can be recommended as a simple and effective method of repairing the collateral ligament of fingers. (+info)
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Reimplantation of the nail root in fingertip crush injuries in children.
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A short cut review was carried out to establish whether reimplantation of the nail improved cosmetic outcome after crush injury to the fingertip in children. Altogether 35 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated. (+info)