Use of Smartphones as a Risk Factor for the Development of Morbidities in the Wrist and Fingers / Uso de smartphones como fator de risco para o desenvolvimento de morbidades no punho e nos dedos*

Abstract Objective To investigate the long-term use of smartphones as a risk factor for the development of morbidities in the wrist and fingers. Methods The present is a descriptive, exploratory study with a quantitative approach based on injury prevalence among one hundred smartphone users of a private university in the state of Pernambuco, Northeastern Brazil. We applied a semi-structured questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), as well as the Visual Analog Scale (VAS) and the Finkelstein, Phalen, reverse Phalen, and Tinel signal tests on the wrist. Results The average of the sample was of 22.73 years, with a prevalence of single, right-handed female participants. Most of them had been using smartphones for 5 to 10 years, and 85% reported discomfort in the wrist and fingers while using the device, with numbness as the most prevalent symptom. Most clinical tests were negative, and the Finklestein test showed greater positivity. The BCTQ is composed of a symptom severity scale (S scale) and a functional status scale (F scale): the overall score on the S scale was of 1.61, indicating mild to moderate symptoms, and the F scale revealed that the symptoms did not affect functionality. Conclusion There was a significant correlation between the length of use of smartphones and discomfort in the wrist and fingers; as such, smartphones are a risk factor for the development of morbidities.

Resumo Objetivo Investigar o uso de smartphones em longo prazo como fator de risco para o desenvolvimento de morbidades no nível do punho e dos dedos. Métodos Realizou-se um estudo descritivo, exploratório, de abordagem quantitativa, para a obtenção de medidas de prevalência com cem acadêmicos usuários de smartphones de uma faculdade privada localizada no sertão de Pernambuco. Foram aplicados um questionário semiestruturado e o Questionário de Síndrome doTúnel do Carpo de Boston (Boston Carpal Tunnel Questionnaire, BCTQ, na sigla em inglês), além da Escala Visual Analógica (EVA) e dos testes de Finkesltein, Phalen, Phalen reverso, e sinal de Tinel no punho. Resultados A idade média da amostra foi de 22,73 anos, com prevalência de solteiros, de destros, e do sexo feminino. O tempo de uso do smartphone indicado pela maioria dos participantes era entre 5 e 10 anos, e 85% da amostra relatou já ter sentido desconforto no punho e nos dedos durante o uso do aparelho, sendo a dormência o sintoma mais prevalente. Com relação aos testes clínicos, houve prevalência de resultados negativos, e o de Finklestein apresentou maior positividade. Quanto ao BCTQ, dividido em duas escalas, uma de gravidade dos sintomas (escala G) e uma de estado funcional (escala F), a média geral das pontuações foi de 1,61 na escala G, o que indica sintomas de leve a moderados, já a escala F revelou que os sintomas não afetavam a funcionalidade. Conclusão Foi possível observar uma correlação significativa entre o tempo de uso dos smartphones e a presença de desconforto no punho e nos dedos, o que indica que se trata de um fator de risco para o desenvolvimento de morbidades.

Costo de la atención médica en el trauma severo de mano / Cost of medical care in severe hand trauma

Resumen: Objetivo: Determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia «Lomas Verdes¼ de la patología del trauma complejo de mano calificado como riesgo de trabajo. Material y métodos: Se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. Resultados: Se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. Conclusión: La presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.

Abstract: Objective: To determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic «Lomas Verdes¼ of the pathology of complex hand trauma classified as occupational risk. Material and methods: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. Results: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. Conclusion: The presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.

Disability of Arm, Shoulder and Hand and Michigan Hand Outcomes Questionnaires: Exploring Responsiveness and Diagnostic Performance in a Sample of Outpatients with and without Hand and Wrist Complaints / Questionários Disability of the Arm Shoulder and Hand e Michigan Hand: Explorando a responsividade e performance diagnóstica em amostra de pacientes ambulatoriais com e sem queixas nas mãos e punho

Abstract Objective The present study aimed to verify whether, in an adult population with nontraumatic complaints in the upper limbs, (1) the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) are susceptible to a "ceiling effect" when compared with a sample of healthy subjects; and (2) to determine cutoff points for diagnostic performance and the intercorrelation for DASH and MHQ in both samples. Methods This was a prospective, comparative, nonrandomized study. In total, 150 subjects were included, with 75 in the case group (with disease) and 75 in the control group (without disease). This was a sample of patients recently admitted to a hand surgery outpatient clinic. Controls were matched to clinical cases according to inclusion. The ceiling effect was determined by a maximum response rate (> 15%); receiver operating characteristic (ROC) curves determined cutoff points for sickness definition, and DASH and MHQ sensitivity and specificity. Statistical significance was set at p < 0.05. Results The DASH and MHQ questionnaires had no ceiling effect for the case group. In this group, 18 (24%) patients had the maximum DASH score, but none (0%) had the maximum MHQ score. For the control group, 1 (1.33%) subject had the maximum DASH score, but none scored for MHQ. For case determination, DASH scores of 7.1 had 80% sensitivity and 60.3% specificity, whereas MHQ scores of 76.9 had 56.2% sensitivity and 97.3% specificity. Conclusion The DASH and MHQ questionnaires are reliable tools to measure the impact of hand and wrist morbidities on daily activities, and they are not susceptible to ceiling effects. The DASH questionnaire is more sensitive for patient identification, whereas the MHQ is more specific. As such, the MHQ seems more appropriate when a more specific functional increase is expected.

Resumo Objetivo Verificar se, em uma população adulta com queixa não traumática dos membros superiores, (1) os questionários Disability of the Arm, Shoulder and Hand (DASH, na sigla em inglês) e Michigan Hand Questionnaire (MHQ, na sigla em inglês) estão suscetíveis ao "efeito de teto", comparando com amostra de não-doentes; (2) determinar pontos de corte de performance diagnóstica e correlação interquestionários para DASH e MHQ em ambas as amostras. Método Estudo prospectivo, comparativo e não randomizado. Incluímos 150 pacientes, 75 no grupo caso (com doença) e 75 no grupo controle (sem doença). Trata-se de amostra de pacientes recém-admitidos em ambulatório de cirurgia da mão. Os controles foram pareados de forma balanceada de acordo com a inclusão dos casos. Determinamos a presença de efeito de teto por meio da taxa de respostas máximas (> 15%) e associamos curvas receiver operating characteristic (ROC, na sigla em inglês) para a determinação de pontos de corte para a determinação de doentes, associados a medidas de sensibilidade e especificidade. Consideramos p < 0.05 para significância estatística. Resultados Os questionários DASH e MHQ não demonstraram o efeito de teto para o grupo com doença. A porcentagem de pacientes do grupo caso com nota máxima foi de n = 18 (24%) no DASH e de 0% no MHQ. Para o grupo sem doença, 1 (1,33%) dos participantes pontuou com nota máxima para DASH, enquanto nenhum pontuou para o MHQ. Na determinação de casos, escores de DASH de 7,1 apresentam sensibilidade de 80% e especificidade de 60,3%. Para o MHQ, um escore de 76,9 apresenta sensibilidade de 56,2% e especificidade de 97,3%. Conclusão Os questionários DASH e MHQ são ferramentas confiáveis na mensuração do impacto das morbidades das mãos e dos punhos nas atividades diárias dos pacientes e não são suscetíveis a efeito de teto. O questionário DASH é mais sensível para a identificação de doentes, enquanto o MHQ é mais específico. Em situações nas quais se espera um incremento funcional mais discreto (ou mais específico), o MHQ parece mais adequado.

Colgajo inguinal de Mac Gregor para la reconstrucción de mano traumática / Mc Gregor Inguinal flap for reconstruction of traumatic hand

La reconstrucción de la mano traumática con pérdida de sustancia, plantéa una reconstrucción con procedimientos quirúrgicos, que proporcionen una cubierta adecuada de piel y tejidos blandos con el uso de Colgajos fasciocutáneos. En el presente caso, el uso del Colgajo Inguinal de Mc Gregor es una técnica que pemite alcanzar resultados significativos para restablecer la funcionalidad de la zona afectada, al realizar un tratamiento inmediato y de mantenimiento oportuno, se disminuye de manera notable las secuelas posteriores. Hablando de historia Mc Gregor y Jackson en 1972 describiéron el colgajo inguinal, vascularizado por la arteria circunfleja ilíaca superficial rama de la arteria femoral, siendo el único consagrado por el uso (no solo utilizándose como colgajo pediculado, sino también como colgajo libre) para la cobertura de afecciones de cabeza, cuello, tronco y extremidades, permitiendo un resultado funcional y estetico aceptable. El presente trabajo reporta el caso de un paciente de sexo masculino de 6 años 7 meses de edad, con antecedente de traumatismo en mano izquierda por explosión de dinamita, con pérdida de sustancia y amputación traumática del 1er. y 2do. dedos de la mano izquierda.Dra. Jessika Fernández Nino de GuzmánCirujana Plástica y ReconstructivaHospital del Niño Dr. Ovidio Aliaga Uría La Paz, Seguro Social Universitario La Paz. Consultorio asistencial: Edificio Plaza 15, PB oficina 7, calle 15 Calacoto Nro. 8054. Movil : 788 76976jessita_jess@hotmail.com.

The reconstruction of the traumatic hand with substance loss, involves a reconstruction with surgical procedures, which provide an adequate covering of skin and soft tissues with the use of fascio cutaneous Flaps. In the present case, the use of Mc Gregor's Inguinal Flap is a technique that allows to achieve significant results to restore the functionality of the affected area, when performing an immediate and timely maintenance treatment, the subsequent sequelae are significantly reduced. Speaking of history Mc Gregor and Jackson in 1972 described the inguinal flap, vascularized by the superficial iliac circumflex artery branch of the femoral artery, being the only one consecrated by the use (not only used as a pedicle flap, but also as a free flap) for coverage of head, neck, trunk and limb conditions, allowing an acceptable functional and aesthetic result. Present work reports the case of a 6 years and 7 months old male patient, with history of left-hand trauma due to dynamite explosion, with substance loss and traumatic amputation of the 1st. and 2nd. Fingers.

Caso Clínico: Fractura expuesta grave del dedo índice. Cirugía de rescate con colgajo adipofascial vascularizado homodigital reverso / Case report: Severe index finger open fracture. Surgical rescue with homodigital vascularized adipofascial reverse flap.

INTRODUCCIÓN: Los traumas de mano tienen una alta incidencia alrededor del mundo y representan alrededor del 30% de todos los accidentes y visitas a servicios de urgencias, siendo las lesiones de la punta del dedo un subtipo común de trauma de mano. El manejo inicial y la elección del tratamiento adecuado son importantes, el principal objetivo es la cobertura de tejidos para así evitar amputaciones innecesarias, prevenir complicaciones y pérdida de funcionalidad. CASO CLÍNICO: Paciente masculino de 32 años que sufrió trauma por aplastamiento en mano derecha que produce herida con pérdida de tejido en falanges distales de segundo y tercer dedo y amputación traumática parcial de falange distal del segundo dedo. EVOLUCIÓN: Se realizó técnica quirúrgica de colgajo adipofascial vascularizado homodigital reverso en segundo dedo y manejo conservador de fractura, sin complicaciones. Se llevó un control semanal por 2 meses con resultados funcionales, biológicos y estéticos favorables. El tercer dedo se trató con limpieza quirúrgica y colocación de vendaje suboclusivo con evolución favorable. CONCLUSIÓN: El colgajo adipofascial dorsal homodigital reverso tiene varias ventajas sobre otros tipos de colgajos más convencionales; es una técnica simple, segura y confiable, con buenos resultados postquirúrgicos en cuando a funcionalidad, estética y recuperación, requiere de un solo tiempo quirúrgico y brinda la cobertura necesaria de los tejidos expuestos tanto óseos como blandos, con mínima morbilidad del sitio donante.(au)

BACKGROUND: Hand trauma has a high incidence worldwide, it accounts nearly 30% of all trauma and medical visits to emergency rooms, fingertip injuries are the most common among hand trauma. The initial management and the proper choice of treatment are important, the main objective is to achieve adequate tissue coverage, in order to avoid unnecessary amputation, prevent complications and functionality loss. CASE REPORT: A 32-year-old male patient presented with crush trauma on right hand resulting in injuries with tissue loss on the fingertips of the second and third finger and traumatic partial amputation of the distal phalanx of the second finger. EVOLUTION: Surgical technique of homodigital vascularized adipofascial reverse flap was performed in second finger and the fracture was managed conservatively, without complications. A weekly follow up was carried out for 2 months with favorable functional, biological and aesthetic results. The third finger was treated with surgical irrigation and debridement and placement of a sub-occlusive bandage, with favorable outcome. CONCLUSION: Homodigital adipofascial reverse dorsal flap has advantages over other types of conventional flaps; it is a simpler, safe and reliable technique, with good postsurgical outcomes in terms of functionality, aesthetics and recovery, needing only one intervention and offering the appropriate coverage to exposed bone and soft tissue, with minimal repercussions on the donor site.(au)

Clinical application of modified transthecal digital block in treatment of hand trauma in children / 吉林大学学报(医学版)

Objective: To probe the advantages and clinical application value of modified transthecal digital block in the treatment of hand trauma in the children, and to provide the references for the selection of anesthesia methods for surgery. Methods: A total of 102 patients (104 digits) required acute or chronic hand surgery were selected. The patients were divided into two groups by the method of random number table, 54 patients (54 fingers) were treated with traditional digital block (traditional digital block group), and 48 patients (50 fingers) were anesthetized with modified transthecal digital block (modified transthecal digital block group). The pain detection was performed on the 4 sites within 5 min after anesthesia by using the method of Face, Legs, Activity, Cry, Consolability Behavioral Tool (FLACC) ( 0. 05). Compared with traditional digital block group, the average onset time of anesthetic drug of the patients in modified transthecal digital block group was shortened (P<0.05), and the average dose of anesthetic drug was decreased (P<0. 05). Conclusion: The modified transthecal digital block has the advantages of smaller dose, quicker effect, easier operation, and less pain. It is suitable for the clinical application in the treatment of hand trauma in the pediatric patients.

Influencing factors of anxiety and depression in patients with industrial hand injury atadmission / 现代临床护理

Objective To study anxiety and depression status in patients with industrial hand injury at admission and look into the influencing factors. Method A total of 154 patients who had industrial hand injury were enrolled in the investigation by self-rating anxiety scale (SAS)and self-rating depression scale (SDS)into mental status of patients once at admission. Results The incidence rates of anxiety and depression were 40.9%(63/154)and 37.0%(57/154),respectively.21.4%(33/154)of the patients had both anxiety and depression.The data from SPSS22.0 software and multivariate Logistic regression analysis showed that anxiety and depression were closely related to age,hand function and education.Conclusion The incidences of anxiety and depression in patients with hand injury and work-related injury is significantly higher than that of healthy people, which is closely related to their age, education and hand function.

Reconstrução tardia na mão traumatizada com perda de múltiplos dedos / Late reconstruction of a traumatized hand with loss of multiple fingers

As lesões mutilantes de mão são um desafio para o cirurgião de mão e o paciente. O cirurgião deve tomar decisões desde o debridamento inicial, escolhendo quais dedos e articulações serão preservadas e uso apropriado das partes a serem retiradas. A reconstrução tardia é a segunda parte dessa difícil tarefa. Dificuldade que se atribui à particularidade de cada lesão, do grande número de possibilidades de tratamento e seus diversos níveis de complexidade que devem ser adequados à necessidade e motivação pessoal de cada paciente. Este relato de caso apresenta uma reconstrução tardia de mão com perda de indicador e dedo médio com transplante de articulação metacarpofalângica de indicador para função de interfalangeana proximal de dedo médio.

Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.

Effects of Horticultural Training Based on Healing Garden on Hand Function after Operation for Hand Trauma / 中国康复理论与实践

Objective To observe the effect of horticultural training based on healing garden as rehabilitation for post-operation of hand trauma.Methods From January,2015 to December,2016,78 patients with functional disorder after operation for hand trauma were random-ized into control group and observation group equally.All the patients accepted routine rehabilitation,while the observation group accepted horticultural training based on healing garden in addition,for 28 days.They were assessed with Total Active Movement(TAM),Disability of Arm Shoulder and Hand(DASH),and Upper Extremity Function Test(UEFT)before and after treatment.Results The scores of TAM, DASH and UEFT improved in both groups after treatment(t>10.632,P<0.001),and improved more in the observation group than in the con-trol group(t>2.269,P<0.05).Conclusion The horticultural training based on healing garden may promote the recovery of movement of fin-gers,function of hand and upper limbs in patients after hand trauma.

Clinical effect of treatment for hand trauma with free flap of radial artery superficial palmar branch / 局解手术学杂志

Objective To investigate the clinical effect of the treatment for hand trauma with free flap of radial artery superficial palmar branch.Methods Selected 100 cases of patients with hand trauma who were treated in our hospital from January 2013 to December 2015.All the patients were treated with free flap of radial artery superficial palmar branch.The postoperative necrosis rate,survival rate,and infection rate of flap of all the patients were observed.All the patients were followed up for 6 months,and the healing of fracture were evaluated by X-ray examination so as to evaluate the hand function recovery.Results After the treatment,there were 9 cases of flap local necrosis and 10 cases of local infection,and the necrosis rate and infection rate were 9% and 10% respectively.The infection was controlled effectively after the symptomatic treatment and the flaps all survived.The swelling degree of skin flap was slight and the appearance was good.After 6 months of follow-up, the 100 cases all get epithelization completely.The X-ray examination showed that the fracture healing is good,with 7 cases of hook nail deformity and 5 cases of slow nail regeneration.The hand function recovery was excellent in 73 cases (73%),good in 16 cases (16%),and medium in 10 cases (10%).Conclusion It is an effective treatment for hand trauma with free flap of radial artery superficial palmar branch,as it can receive high flap survival rate and good recovery of hand function.

Effect of Work Injuries Rehabilitation Investigate System on Early Intervention of Hand Trauma Rehabilitation / 中国康复理论与实践

Objective To establish a management system to promote early rehabilitation for work injured patients. Methods The 2015 hospitalized patients were set as control group (n=16,635), and the 2016 hospitalized patients were set as observation group (n=15,372). The control group was hospitalized for injury data collection surveys and was not implemented systematic rehabilitation propaganda, rehabilita-tion assessment and rehabilitation guidance. However, the observation group hospitalized after establishment of the Work Injuries Rehabilita-tion Investigation System and accepted work injuries rehabilitation intervention, such as rehabilitation propaganda, rehabilitation assessment and rehabilitation guidance. The changes of hand trauma rehabilitation indicators were compared between two groups. Results The rate of work injuries rehabilitation intervention was 80.6%in the observation group. In the observation group, the proportion of the patients who re-ceived early rehabilitation treatment in the designated hospital (56.8%) was significantly higher than that of the control group (17.0%) (χ2=2603.683, P<0.001);the proportion of injured patients who were admitted to the designated work injuries rehabilitation institutions (9.4%) was higher than that of the control group (4.3%) (χ2=285.906, P<0.001). The proportion of patients evaluated as disability in the observation group (17.4%) was significantly less than that of the control group (26.3%) (χ2=235.327, P<0.001). The disability score was significantly lower in the observation group (6.23±1.29) than in the control group (8.26±1.16) (t=68.371, P<0.001). Conclusion The Work Injuries Reha-bilitation Investigation System can promote the early rehabilitation for the hand trauma patients in the designated hospital for work injuries, improve the proportion of hand trauma patients to enter the designated work injuries rehabilitation institutions to receive rehabilitation treat-ment, reduce the proportion of disabled persons, and reduce the degree of disability, effectively promote the overall recovery of patients with hand trauma.

Effect of Work Injuries Rehabilitation Investigate System on Early Intervention of Hand Trauma Rehabilitation / 中国康复理论与实践

Objective To establish a management system to promote early rehabilitation for work injured patients. Methods The 2015 hospitalized patients were set as control group (n=16,635), and the 2016 hospitalized patients were set as observation group (n=15,372). The control group was hospitalized for injury data collection surveys and was not implemented systematic rehabilitation propaganda, rehabilita-tion assessment and rehabilitation guidance. However, the observation group hospitalized after establishment of the Work Injuries Rehabilita-tion Investigation System and accepted work injuries rehabilitation intervention, such as rehabilitation propaganda, rehabilitation assessment and rehabilitation guidance. The changes of hand trauma rehabilitation indicators were compared between two groups. Results The rate of work injuries rehabilitation intervention was 80.6%in the observation group. In the observation group, the proportion of the patients who re-ceived early rehabilitation treatment in the designated hospital (56.8%) was significantly higher than that of the control group (17.0%) (χ2=2603.683, P<0.001);the proportion of injured patients who were admitted to the designated work injuries rehabilitation institutions (9.4%) was higher than that of the control group (4.3%) (χ2=285.906, P<0.001). The proportion of patients evaluated as disability in the observation group (17.4%) was significantly less than that of the control group (26.3%) (χ2=235.327, P<0.001). The disability score was significantly lower in the observation group (6.23±1.29) than in the control group (8.26±1.16) (t=68.371, P<0.001). Conclusion The Work Injuries Reha-bilitation Investigation System can promote the early rehabilitation for the hand trauma patients in the designated hospital for work injuries, improve the proportion of hand trauma patients to enter the designated work injuries rehabilitation institutions to receive rehabilitation treat-ment, reduce the proportion of disabled persons, and reduce the degree of disability, effectively promote the overall recovery of patients with hand trauma.

Transtriquetral perihamate fracture-dislocation: case report / Fratura-luxação transtriquetral peri-hamato: relato de caso

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

RESUMO O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Reconstruções complexas de membros superiores e inferiores com retalhos de fluxo reverso: uma série de 32 casos / Complex reconstruction of the upper and lower limbs by using reverse-flow flaps: a series of 32 cases

Introdução: A reconstrução de partes moles após perdas de substância do terço distal dos membros superiores e inferiores, principalmente quando associada à exposição de estruturas nobres (osso, tendão, nervos ou vasos sanguíneos), continua a desafiar a cirurgia plástica. Os retalhos fasciocutâneos de fluxo reverso são uma eficiente opção cirúrgica na cobertura de lesões pequenas e médias nesta localização. Método: Foi realizado um estudo clínico retrospectivo, no período de janeiro de 2013 a dezembro de 2014, de uma série de 32 casos de traumas complexos em membros superiores e inferiores. Resultados: Foram realizados 24 retalhos de fluxo reverso nos membros inferiores e 8 nos membros superiores, observando-se uma cobertura eficaz dos defeitos. Conclusão: Os retalhos de fluxo reverso são confiáveis e apresentam arcos de rotação que permitem a cobertura de lesões diversas no terço distal de membros superiores e inferiores.

Introduction: Reconstruction of the soft tissues after loss of substance in the distal third of the upper and lower limbs, in particular when associated with the exposure of noble structures (bone, tendon, nerves, or blood vessels), remains a challenge in plastic surgery. Fasciocutaneous reverse flow flaps are an efficient surgical option for covering small and medium lesions in this location. Method: A retrospective clinical study was performed on a series of 32 cases of complex trauma of the upper and lower limbs treated between January 2013 and December 2014. Results: A total of 24 reverse-flow flaps were performed in the lower limbs and eight in the upper limbs, resulting in efficient coverage of the defects. Conclusion: Reverse-flow flaps are reliable and present rotation arcs that allow coverage of a variety of lesions in the distal third of the upper and lower limbs.

Effect of Electroacupuncture on Hand Function in Postoperative Patients with Hand Trauma / 上海针灸杂志

Objective To investigate the rehabilitative effect of electroacupuncture on hand function in postoperative patients with hand trauma.Methods Sixty-eight postoperative patients with hand trauma were randomly allocated to treatment and control groups, 34 cases each. The control group received routine rehabilitation therapy and the treatment group, electroacupuncture in addition. Pre-/post-treatment changes in thumb motor function, the distance from index, middle, ring and little fingers to the palm and the distance from the finger nails to the table were observed in the two groups after three months of treatment.Results There was a statistically significant post-treatment difference in the thumb motor function (abduction and opposition) grade between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in the distance from index, middle, ring and little fingers to the palm and the distance from the finger nails to the table in the two groups (P<0.01). There were statistically significant post-treatment differences in the distance from index, middle, ring and little fingers to the palm and the distance from the finger nails to the table between the treatment and control groups (P<0.01).Conclusion Electroacupuncture can effectively improve hand function in postoperative patients with hand trauma.

Observation of Clinical Efficacy of Puerarin Combined with β-aescine Sodium in the Treatment of Patients with Postoperative Edema of Hand Trauma / 中国药房

OBJECTIVE:To observe the clinical efficacy of puerarin combined with β-aescine sodium in the treatment of pa-tients with postoperative edema of hand trauma. METHODS:118 patients with postoperative edema of hand trauma were random-ly divided into observation group (n=59) and control group (n=59) by number. Both groups were taken infrared physiotherapy and appropriate physical treatment such as hand functional exercise;patients in control group was added β-aescine sodium 10 mg based on the physical treatment,iv,once a day;observation group was added puerarin 200 mg based on the treatment of control group,iv,once a day. Both groups were taken 10 days for one course of treatment. Compared the swelling scores,perimeter of suf-fered limb and edema scores,clinical efficacy and adverse reactions of patients between the two groups before and after treatment. RESULTS:The symptoms of hand limb swelling in 2 groups were obviously improved(P<0.01 or P<0.05),however,observa-tion group was better than that of control group,with significant difference(P<0.05);after treatment,the swelling,perimeter of suffered limb and swelling score in observation group were lower than control group,with significant differences(P<0.05);the to-tal effective rate in observation group was 94.91% and control group was 83.05%,with significant difference(P<0.05). No ADR was found in 2 groups. CONCLUSIONS:Puerarin combination with β-aescine sodium has obvious efficacy and safety in the treat-ment of postoperative edema of hand trauma.

Efficacy and Pharmacoeconomics Evaluation of Piperacillin Sodium/Sulbactam Sodium in the Treatment of Bacterial Infections / 中国药师

Objective:To observe the effectiveness and security of piperacillin sodium/sulbactam sodium in the treatment of bacte-rial infections and perform the pharmacoeconomics evaluation. Methods: Totally 126 patients with hand trauma bacterial infections were divided into the control group and the treatment group. The control group was given piperacillin sodium/tazobactam sodium 2. 5g, ivd, bid, while the treatment group was treated with piperacillin sodium/sulbactam sodium 1. 25g, ivd, bid. After 14-day treatment, the clinical therapeutic effect and adverse reactions of the two groups were observed, and the cost-minimization analysis was carried out. Results:The effective rate of the treatment group was 93. 65%while that of the control group was 92. 06%(P>0. 05). The bac-terial clearance rate of the treatment group was 96. 83%while that of the control group was 95. 24% (P>0. 05). The incidence of ad-verse reactions of the treatment group was 4. 76% (3/63) while that of the control group was 9. 52%(P>0. 05). The cost-effective-ness of piperacillin/sulbactam was significantly lower than that of the control group (P<0. 05). Conclusion: The effectiveness and safety of the two groups show no obvious differences in the treatment of hand trauma bacterial infections, and both have good antibacte-rial effect with low incidence of adverse reactions. For the better economic benefits, piperacillin /sulbactam is worthy of promoted ap-plication.

Effect of Cutaneous Never Anastomosis on Sensory Reconstruction in Free Anterolateral Femoral Flap Repairing Wide Spreadly Dorsal Hand Soft Tissue Defect / 中国康复理论与实践

@#Objective To explore the effect of cutaneous never anastomosis on sensory recovery in repairing wide spreadly soft tissue defects in dorsal hand with free anterolateral femoral flap. Methods The cases with wide spreadly soft tissue defects in dorsal hand repaired with free anterolateral femoral flap from January 2006 to December 2012 were divided into 2 groups. The control group including 15 consecutive patients from January 2006 to January 2009, whose sensation was reconstructed in routine way. Other 15 consecutive patients from Febnary 2009 to December 2012 were as research group, whose sensation was reconstructed with the suture of cutaneous nevers of anterolateral femoral flaps and forearm. All the patients were followed up for 12~24 months. Results All the free flaps survived in both groups. There were 4 cases good of sensory recovery in the control group, and it was 11 in the research group. No ulceration happened. Conclusion Cutaneous never anastomosis may result in satisfactory sensory function in the patients with wide spreadly soft tissue descts in dorsal hand repaired with free anterolateral femoral flap.

Psychological Issue in Hand Trauma

Acquired hand trauma is a significant event that often affects an individuals’ life in diverse manners. The present paper aims to review the psychological issues in hand trauma along with factors that affect recovery from the same. Method: A relevant search for literature on psychological issues in hand trauma was made across search engines like Google Scholar, Medline and Pubmed and relevant studies were selected for this review. The studies include those on symptomatology, course as well as treatment. The studies were analyzed critically along with inputs of personal clinical experience of the authors. Results: Psychological symptoms that occur after hand trauma together with the treatment methods that provide relief from psychological symptoms are discussed. Symptoms of post-traumatic stress disorder (PTSD), flashbacks, concerns with personal appearance, avoidance of reminders of the trauma and physiological arousal along with sleep issues have been discussed. The article also looks at the psychosocial effects of hand trauma including marital and sexual issues that may arise. Treatment interventions commonly used in the form of imagery and in vivo exposure with and without cognitive restructuring are explained along with psychoeducation approaches that may benefit these patients. Conclusions: It is important that surgeons and professionals dealing with hand trauma are aware of the psychological issues in hand trauma and to take appropriate steps to deal with any such problems that ensue.

Fatores associados ao retorno ao trabalho após um trauma de mão: uma abordagem qualiquantitativa / Factors associated with return to work following a hand injury: a qualitative/quantitative approach

OBJETIVOS: Descrever os trabalhadores que retornaram ao trabalho após um trauma de mão e analisar os fatores que se associaram a esse desfecho após três anos da alta da reabilitação. MÉTODOS: Foi realizado um estudo observacional, de corte transversal, com triangulação dos métodos quantitativo e qualitativo. A análise quantitativa utilizou um banco de dados com informações sociodemográficas, funcionais e clínicas referentes a 35 indivíduos, classificados em dois grupos (retornou/não retornou ao trabalho). Foi conduzida análise multivariada, utilizando o algoritmo CART (Classification and Regression Tree) para avaliar o valor preditivo de quatro modelos, identificando trabalhadores que retornaram ou não ao trabalho. A partir dos resultados da análise estatística, foi elaborado um roteiro semiestruturado para as entrevistas que foram realizadas com sete trabalhadores selecionados aleatoriamente da amostra. RESULTADOS: Dos 35 trabalhadores que participaram deste estudo, 30 retornaram e cinco não retornaram ao trabalho. A maioria era do sexo masculino, com média de idade de 37 anos, casada e de baixa escolaridade. As variáveis com maior força preditiva foram força de preensão, escores do desempenho ocupacional, categoria ocupacional e idade. O estudo qualitativo confirmou a natureza multifatorial do retorno ao trabalho, demonstrando que a presença de um profissional para acompanhar o processo, alguns ajustes no posto e no horário de trabalho, possibilitando uma continuidade do tratamento, e o auxílio-acidente podem contribuir para o sucesso do retorno. CONCLUSÕES: Este estudo evidenciou a complexidade do retorno ao trabalho de trabalhadores com lesão de mão, apontando vários fatores associados a esse desfecho e a importância de uma avaliação individualizada, centrada no trabalhador

OBJECTIVES: To describe workers who returned to work after a hand injury and to analyze the factors associated with this outcome three years after discharge from rehabilitation. METHODS: An observational, cross-sectional study was carried out with triangulation of quantitative and qualitative methods. The quantitative analysis used a database with sociodemographic, functional and clinical information on 35 individuals who were classified into two groups (return/no return to work). Multivariate analysis was conducted using the CART (Classification and Regression Tree) algorithm to assess the predictive value of four models, thereby identifying workers who had returned or not returned to work. Using the results from the statistical analysis, a semi-structured form was prepared for interviews, which were conducted with seven workers randomly selected from the sample. RESULTS: Out of the 35 workers who participated in this study, 30 returned and five did not return to work. The majority were male, married and of low educational level, and the mean age was 37 years. The variables with the greatest predictive power were grip strength, occupational performance scores, occupational category and age. The qualitative analysis confirmed the multifactorial nature of the return to work and demonstrated that the presence of a professional to follow-up the process, adjustments to the workstation and working hours (to enable treatment continuity) and also accident benefits may contribute to a successful return. CONCLUSIONS: This study showed the complexity of the return to work by workers with hand injuries, highlighting a number of factors associated with this outcome and the importance of individualized assessment centered on the worker.