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Introduction
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Hand surgery is specialist work. It requires knowledge of the complex static and functional anatomy of the hand. Recognize your potential limitations in the field of hand surgery. Realize that many injuries of the hand, if it concerned yourself, can make your work as a physician impossible. No patient will blame you if you refer him for further assessment. In this book the term ‘hand surgeon’ is used. Hand surgery in Europe is a recognized specialism in seven countries. It refers to a surgeon with a proven experience and interest in all aspects of hand surgery; and to one who works within an infrastructure that can provide optimal aftercare. The knowledge level may be demonstrated by passing a European examination in hand surgery. Through inspection and good physical examination, it is possible to determine which structure is damaged. Additionally, an X-ray can be taken on indication. Arterial bleeding can always be stopped by a pressure bandage and elevation. Do not use tourniquets and do not place clamps ‘blindly’. If, after inspection, there is an indication for treatment to be continued in the operation theatre, further anesthesia and exploration of the wound in the Emergency Department are contraindicated. In the case of serious injuries, however, it may be beneficial to provide a regional (brachial plexus block) anesthesia in anticipation of surgery. Remember: don’t throw anything away!
Tendon laceration
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
If there is any concern for flexor tendon injury, it is recommended to approximate the external wound, place the patient in a dorsal splint, and refer to a hand surgeon within 1–3 days. Splints should keep the wrist in 30° of flexion and the metacarpophalangeal joint in 70° of flexion to reduce the degree of tendon retraction.
Neuromuscular disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Flexion deformity of the fingers Spasticity of the long flexor muscles may give rise to clawing. Highly selective motor neurectomy has recently regained favour as a potential treatment for spasticity while, for contractures, the flexor tendons can be lengthened individually at the risk of provoking a swan neck deformity. If the deformity is severe, a forearm muscle slide may be more appropriate. Ideally these operations should be undertaken by a specialist in hand surgery. If the fingers can be unclenched only by simultaneously flexing the wrist, it is obviously important not to extend the wrist by tendon transfer or fusion.
Patient-reported ‘treatment injuries’ after hand surgery. A review of 1321 claims submitted to the Norwegian system of patient injury compensation 2007–2017
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sunniva Martine Kolstad Addison, Lisa Sofie Albrigtsen, Ida Rashida Khan Bukholm, Hebe Désirée Kvernmo
The field of hand surgery includes hand trauma and electively treated hand disorders. Hand surgery accounts for a large number of cases. Statistics from Scandinavia and Europe show that hand injuries are one of the most common emergency room injuries, accounting for 1/5 − 1/3 of cases [1–3]. Many patients also receive elective treatment for hand disorders. There has been a steady increase in the overall number of patient-reported claims submitted to the Norwegian System of Patient Injury Compensation (NPE). It is unknown to what extent this increase applies to treatment injuries after hand injuries or disorders, but it is likely that hand surgery claims have shown similar increases. Hand surgery treatment ranges from simple to complex procedures. Increased complexity places greater demands on hand surgery competence. Treatment injuries may potentially occur where expertise is not matched to procedure complexity.
Effect of electromyographic biofeedback training on functional status in zone I-III flexor tendon injuries: a randomized controlled trial
Published in Physiotherapy Theory and Practice, 2023
Umut Eraslan, Ali Kitis, Ahmet Fahir Demirkan, Ramazan Hakan Ozcan
A hand surgeon had operated on all participants and the surgery was undertaken 16.55 ± 24.40 (3–108) hours after the injury. Under regional (axillary block) or general (laryngeal mask airway) anesthesia and following the application of a tourniquet, surgical exploration of the region was undertaken through a Bruner incision. Tendon repairs were performed with a 4-strand Modified Kessler Method, which uses a core suture with 3–0 polypropylene and epitendinous sutures with 5–0 polypropylene (Kamal and Yao, 2017). Except for a patient in Group 1 whose A4 pulley was released due to impairment of tendon gliding, care was taken to intraoperatively protect the tendon sheath and A2-A4 pulleys.
Hand function 6 weeks following non-surgically treated proximal phalangeal fractures and factors associated to upper extremity disability
Published in European Journal of Physiotherapy, 2023
Katarina Mortazavi, Ingela K. Carlsson, Lars B. Dahlin, Elisabeth Ekstrand
If conservative non-surgical treatment is decided upon, the patients are referred to the rehabilitation unit at the Hand Surgery Department for cast removal and the start of rehabilitation at an appropriate time according to the treating hand surgeon’s decision, usually 2–3 weeks after the injury according to present clinical routines and agreements. If the patients suffer from persistent pain, due to suspected instability or other fracture-related problems, contact with the responsible hand surgeon is made for an additional assessment and X-ray.