Hand injury from powered wood splitters

We describe the types of hand injury sustained from powered wood splitters. Information about all patients with such injuries treated at the Department of Hand Surgery, University Hospital, Uppsala, during the period 1995-2001 was collected from their records, and from written questionnaires and telephone interviews. Fourteen of the 131 patients found were below the age of 15. There was no change in the annual injury rate for inpatients. Wedge splitters caused 82% and screw splitters 18% of all injuries. The part of the hand most often injured by screw splitters was the metacarpus and by wedge splitters the index finger. Screw splitters caused palmar perforation, avulsion of the thumb, and shredding injuries. Traumatic amputation and devascularising injuries were also common. Hand injury from powered wood splitters is an important and continuing problem. Most injuries are caused by wedge splitters, injuries caused by screw splitters differ from those caused by wedge splitters. Preventive measures are needed and should include keeping children away from splitters. Further research to facilitate prevention is warranted.     

Assessment of the severity of injuries to hands by powered wood splitters

Abstract

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting one of the two main types of splitter.     

Assessment of the severity of injuries to hands by powered wood splitters

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting one of the two main types of splitter.     

Causes and consequences of hand injuries

BACKGROUND: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment. METHODS: Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs. RESULTS: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%). CONCLUSIONS: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.     

手外伤流行病学描述性研究

目的 通过对本院就诊的手外伤患的流行病学调查了解本行政区手外伤病例的构成、发病特点和社会影响及意义。方法 对2001年7月～2002年6月，在本院就诊的2664例急诊和住院手外伤患进行问卷调查，作描述性研究分析。结果 于外伤患占本院同期就诊患的3.56‰，以男性20～40岁青年居多，工伤占76.0％，开放性损伤占95.3％，手指损伤占74.2％，工伤患中私营企业员工占68.O％。结论本组手外伤患以男性青年为主，主要是私营企业的员工，与机器设备差、无安全保护措施、无熟练专业技能、劳动强度大等因素有关，手外伤对个人和社会造成很大损失，应加强对私营企业的安全生产监管，积极预防手外伤的发生。     

Epidemiology of isolated hand injuries in the United Arab Emirates

AIM To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries.METHODS All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics,location, mechanism/time of injury, and length of hospital stay were all analyzed.RESULTS Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury(67.1%), followed by the home(17.1%)and road(6.2%). Machinery caused 36.2% of all injuries,followed by heavy object(20.5%) and fall(11%). Cases injured at home were young(P 0.0001) with an associated higher incidence of females(P 0.0001).CONCLUSION Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.     

Economic consequences of accidents to hands and forearms by log splitters and circular saws: cost of illness study

We estimated costs associated with injuries to hands from log splitters and circular saws used to cut up firewood and assessed the value of prevention. The study was carried out as a cost of illness study with an incidence approach based on 57 consecutive patients (median age 51; range 8-81) with injuries to the hand or forearm. Twenty-six of the 57 had an amputation which required microsurgery and 31/57 had various injuries. Median Hand Injury Severity Score (HISS) reflecting the severity of all injuries was 67 (range 6-332). Median DASH score after 2-7 years was 12.5 (0-73.3). Total cost (direct costs, costs of lost productivity, and lost quality of life) was estimated to roughly EUR 14 million (EUR 2.8 million/year), where the cost of lost quality of life is 82% of the total cost and loss of productivity and direct costs are 9% each. Injuries sustained from log splitters and circular saws account for considerable costs, but first and foremost human suffering.     

Causes of hand injuries in a developing country

Background

In emerging economies such as Nigeria, trauma and hand injuries in particular are on the rise. The aim of this study was to document the causes of hand injuries in Nigeria.

Methods

This was a prospective study conducted between Aug. 1, 2006, and July 31, 2007. We obtained objective information about patient demographic data, occupation, dominant and injured hand, and place and cause of injury. We assessed injury severity using the Hand Injury Severity Score (HISS).

Results

A total of 74 patients with hand injuries were included. The male:female ratio was 1.8:1, and the average age was 26.9 years. Most patients were right-hand dominant, and 56.8% of injuries affected the dominant hand. Engineers and technicians represented 27% of patients with hand injuries, which was the largest group encountered during the study. Most cases occurred because of road traffic injuries, followed by machine injuries. Injuries commonly occurred at the work place and on the road. In total, 57.1% of patients with mechanical injuries were admitted to hospital. The majority received minor surgical treatment, and 16.2% had a digit amputated. The average HISS was 54.35. In total, 64.8% of the injuries were classified as minor or moderate. Sixty percent of admissions were patients with a HISS of severe or major injury.

Conclusion

Hand injury in this part of the world is commonly due to road traffic collisions and machine accidents, and the injuries are usually severe. Hand injuries are commonly seen among technicians and civil or public servants; these people constitute the economic work force.     

What kinds of hand injuries are more likely to result in amputation? An analysis of 6549 hand injuries

We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. The risk of amputation was higher in men, workers and those in the 15-24 and 45-54 year-old age groups. Compared to home, commercial areas were the places with highest risk, followed by farms and industrial/construction areas. The majority of amputations occurred in industrial/construction areas (87%). Among objects/substances producing injury, watercraft led to the highest risk of amputation and contact with machinery was the mechanism with highest risk. Press machines were the most frequent objects causing amputation both in men and women, followed almost equally by powered wood cutters in men. Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.     

Fractures and dislocations of the hand in polytrauma patients: Incidence,injury pattern and functional outcome

IntroductionInjuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients.MethodsA single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1–6 years after trauma.ResultsIn a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0–31) and the PRWHE 14 (IQR 0–41). Patients with a concomitant upper extremity injury (p = 0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p = 0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury).ConclusionThe incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS).     

木工机械致手外伤的流行病学特点

目的 探讨木工机械致手外伤的流行病学特点。方法 分析广东省顺德市乐从医院自1995年1月至2001年12月，因木工机械致手外伤的3846份病史。根据致伤机械类别、受伤特点，分析该群体的流行病学特征。结果 该类手外伤占手外伤总数的90．9％。外伤高发月份为每年的2、3月份以及9、10月份(家具生产旺季)。每天以11：00～12：00，16：00～17：00为高发时段。木工铣床是最常见的致伤机械，多指复合组织缺损为其特征。结论 重视乡镇及个体私营企业的手外伤预防工作，是减少事故发生的有效方法。     

Risk factors for screw breach and iatrogenic nerve injury in percutaneous posterior pelvic ring fixation

BackgroundPercutaneous screw fixation of the posterior pelvic ring is technically demanding and can result in cortical breach. The purpose of this study was to examine risk factors for screw breach and iatrogenic nerve injury.MethodsA retrospective review at a single level-one trauma center identified 245 patients treated with 249 screws for pelvic ring injuries with postoperative computed tomography (CT) scans. Cortical screw breach, iatrogenic nerve injury, and associated risk factors were evaluated.ResultsThere were 86 (35%) breached screws. The breach rate was similar between screw types (33% S1-iliosacral (S1-IS), 44% S1-transsacral (S1-TS), 31% S2-IS, and 30% S2-TS) and was not associated with patient characteristics, Tile C injuries, or corridor size or angle. The overall rate of screw revision for screw malpositioning was 1.2% (3/249). Iatrogenic nerve injuries occurred in 8 (3.2%) of the 249 screws. Screws that caused iatrogenic nerve injuries had greater screw breach distances (5.4 vs. 0 mm, MD 5, CI 2.3 to 8.7, p < 0.0001), were more likely to be S1-IS screws (88% vs. 47%, PD 40%, CI 7 to 58%, p = 0.006), more likely to be placed in Tile C injuries (75% vs. 44%, PD 31%, CI -3 to 55%, p = 0.04), and there was a trend for having a screw corridor size <10 mm (75% vs. 47%, PD 28, CI -6 to 52%, p = 0.06). Of the 7 iatrogenic nerve injuries adjacent to screw breaches, two nerve injuries recovered after screw removal, three recovered with screw retention, and two did not recover with screw retention.ConclusionScrew breaches were common and iatrogenic nerve injuries were more likely with S1-IS screws. Surgeons should maintain a high degree of caution when placing these screws and consider removal of any breached screw associated with nerve injury.     

Incidence,epidemiology, and operative outcome of replantation or revascularisation of injury to the upper extremity

Abstract

We retrospectively studied the epidemiology of adult patients admitted for possible replantation or revascularisation of an injured upper extremity during the period June 2003 to May 2008. A total of 121 patients were admitted (71 graded severe), mean 24 (14 graded severe), being admitted each year. The annual rate of amputation injuries in the referral area of 1.5 million was 1.5/100 000 and for severe amputation injuries 0.9/100 000. Most injuries occurred in patients aged 41–50. Fifty-eight patients had the accident during working hours (36 severe), and 62 during leisure time (34 severe). The survival rate for subtotal amputations was 77% and for total amputations 55%. Of 15 further vascularisation procedures, two succeeded at the metacarpal level. Most of the accidents occurred during wood-processing with circular saws or powered wood splitters. More efforts should focus on preventing such injuries.     

Assessment of the severity of hand injuries using "hand injury severity score", and its correlation with the functional outcome

INTRODUCTION: Objective assessment of hand injuries is a complex subject. However, an objective assessment, leading to a score, can help in predicting outcome and can be used as a research tool. Campbell and Kay have devised one such score known as "hand injury severity score" or HISS [J. Hand. Surg. [Br.] 21 (3) (1996) 295]. A study on this score has been carried out in our institute. The idea was to see if the hand injury severity score, correlates with the functional outcome as measured by disability arm shoulder and hand score (DASH), after a period of minimum 2 years. METHOD: All the hand injury patients admitted in the hospital were assessed at the time of admission, and objective information was documented on a hand injury documentation form. The form captured all the data required to calculate "hand injury severity score" . A sample of 70 patients admitted during the first 6 months of 1999 was taken and their scores were calculated. The sample was selected such, that it had a reasonable representation of hand injuries of all severities. After obtaining a due approval from ethics committee, all these 70 patients were sent a DASH questionnaire. A total of 23 patients replied. Spearman's rank correlation test was used to analyse the correlation between the severity of hand injury as assessed using HISS, and functional outcome as measured using DASH. Correlations between the outcome and skeletal component score, outcome and motor component scores, and outcome and Integument component scores, were assessed separately. RESULTS: The study shows a statistically significant association ( r = 0.7182, P = 0.000165) between the severities of injury and the functional outcome. The functional outcome also shows a statistically significant association with the severity of injury to skeletal component (r = 0.5151, P = 0.014083) and motor component (r = 0.6797, P = 0.000507). However, the severity of injury to integument component, as measured by HISS, does not show any association with the outcome (r = 0.3571, P = 0.102736). This study supports the overall structure of the HISS. However an improvement in the integument component scoring is required to improve overall accuracy.     

Self-Reported Symptoms of Cold Intolerance in Workers with Injuries of the Hand

Cold intolerance is a well-recognized complication of crushing injuries and amputations in the hand. These symptoms are usually thought to resolve within 2 years of injury. The objectives of our study were to determine the prevalence and course over time of self-reported symptoms of cold intolerance in workers with hand injuries. Files from a large worker's compensation carrier were randomly selected from index years 2, 4, 6, and 10 after a claim was made. Cohorts comprising cases with diagnostic codes corresponding to traumatic hand injuries and codes referring to non-trauma diagnoses in the hand were assembled for each of the years under consideration. A questionnaire was mailed to a total of 7,088 asking questions related to the symptom of cold intolerance. Twenty-five percent of the surveys were returned. Over 90% of trauma patients from all 4 years reported symptoms of cold intolerance. The rate of cold intolerance in the non-trauma group was between 59% and 69%. Individuals reporting cold intolerance indicated worsening over time in 50% of cases and improvement in only 9%. The severity of injury did not appear to be a factor in the development of cold intolerance. Symptoms of cold intolerance are highly prevalent in workers with significant hand injuries. Workers with non-trauma hand conditions also report a substantial prevalence of this symptom. The development of cold intolerance is not related to injury severity. The symptoms remain either static or deteriorate slightly over time. Improvement is experienced by less than 10% of patients.     

创伤性结肠损伤的特点及诊治体会

目的探讨创伤性结肠损伤的特点和救治体会。方法回顾分析我院1995年1月~2003年12月结肠外伤48例的临床资料。结果结肠损伤中刀刺伤占71%,腹部钝性伤占25%,火器伤4%。合并多发伤或多脏器伤35例,一期修补或切除吻合46例,结肠局部切除 近端造口2例,手术死亡1例,十二指肠损伤漏诊1例,术后死亡3例,切口感染及脂肪液化7例,严重腹腔感染3例。结论结肠损伤以开放性穿透性损伤为多见,常伴有其他脏器伤,且结肠损伤具有一定的隐匿性,易误诊、漏诊,引起严重感染,影响愈合。治疗上强调尽早手术,术中探查应全面仔细,谨防遗漏,一期修补或切除吻合对绝大多数结肠损伤是安全可靠的。     

A Five-Year Review of Tag Rugby Hand Injuries

Tag rugby is one of the fastest growing sports in Ireland. It is a soft-contact team game that is loosely based on the rugby league format except players try to remove Velcro tags from their opponents’ shorts rather than engage in a typical rugby tackle. The purpose of this study was to examine all tag rugby associated hand injuries over a five-year period in three large tertiary referral hospitals in Ireland. Using the patient corresponding system, 228 patients with hand injury related tag rugby injuries were observed from 2010 to 2015. There were 138 males and 90 females in the study and over 40% of patients required surgery. Most of the patients were young professionals with an average age of 30. Twenty-five patients worked in the financial services whilst there were 23 teachers. Fractures accounted for 124 of the 228 injuries and mallet injuries accounted for 53. Eighty percent of all injuries occurred during the tackle. The mean number of days missed from work was 9.1 ± 13.8 days. These injuries resulted in an average of seven hospital appointments per patient.Considering it is a soft-contact sport, it is surprising the number of hand injuries that we have observed. Although safety measures have been introduced to decrease the number of hand injuries in recent years, there is a need for further improvements. Better player education about seeking prompt medical attention once an injury occurs, coupled with longer shorts worn by players may improve measures for the sport.     

Acute management of exercise treadmill-associated injuries in children

BACKGROUND: Exercise treadmills have grown in popularity in the past few years. The addition of this type of equipment in the home offers opportunity for injury, particularly in children. METHODS: Patients were identified both prospectively and retrospectively by review of the trauma registry and medical records. Patient data, medical treatment, and hospital costs were obtained from medical records. Functional outcome was assessed by the modified Michigan Hand Outcomes Questionnaire. RESULTS: Nine patients were observed with 14 injuries. The average age was 3.4 years, with average clinical follow-up of 9.1 weeks. The primary injury was friction burn (eight of nine), with one patient sustaining a thumb distal tuft fracture. Two patients required operations and all patients had a good functional outcome (124.5 of 125 on the Michigan Hand Outcomes Questionnaire). CONCLUSION: Treadmill-associated injuries primarily involve hand injury in children. These injuries usually do not require surgical intervention and are preventable. Prevention modalities include additional manufacture safety features, warning labels, and parental education.     

结直肠损伤86例治疗分析

目的探讨结直肠损伤处理的经验。方法对 86例结、直肠损伤患者的临床资料进行回顾性分析。结果 86例结、直肠损伤均经手术治疗 ,并发其他脏器损伤 6 1例 ,一期单纯修补或切除吻合术占 88% (76 / 86 ) ,无肠瘘发生。二期肠造口或外置术占 1 2 %。死亡率为 1 0 % ,近 1 0年来已下降为 4 %。结直肠损伤的主要死亡原因为多发伤、出血性休克与严重感染。结论结、直肠损伤以钝性闭合伤为主 ,一期手术应为首选 ;二期手术仅适用于结肠重度损伤、腹腔重度污染、全身病情严重需行“损伤控制手术”和直肠中、下段损伤者     

Clinical and user-friendly classification of traumatic digital nerve injuries of hand

INTRODUCTION: Surgical findings of traumatic neurapraxia and neurotmesis in digital nerve injuries of hand have significantly different prognosis and surgeons managing such injuries must be able to provide the expected incidence of these injuries along with decision on surgical exploration. There is a paucity of data in the literature defining the incidence of traumatic neurapraxia and neurotemesis in lacerated hand injuries with clinical features of digital nerve injury. MATERIALS AND METHODS: We carried out a study in an urban practice to understand this problem on 81 consecutive patients with 82 digital nerve injuries over 1.5 years. Seventy-two percent of the injuries were caused mainly in the domestic accidents by glass and knife. All patients had clinical features of digital nerve injury. RESULTS: Operative findings revealed nerve damage in 76 patients (confidence interval at 95% = 91-97). Seventy-one had severed nerves and underwent repair (CI at 95% = 80-95). There were 7% patients with operative findings of normal looking nerves and 6% of bruised but intact nerves. All of these 13% patients who did not require surgical repair were grouped as traumatic neurapraxia and showed complete clinical recovery. CONCLUSION: Traumatic neurapraxia in digital nerve injuries of the hand are not uncommon, as previously thought, following lacerated injuries to hand and have favourable prognosis. This information is important for clinicians in getting more informed consent and patient education. The classification of digital nerve injuries into traumatic neurapraxia and neurotemesis appears logical for its practical application in routine clinical practice.