Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 398
Filter
1.
Rev. bras. ortop ; 57(4): 629-635, Jul.-Aug. 2022. tab, graf
Article in English | LILACS | ID: biblio-1394887

ABSTRACT

Abstract Objective To evaluate the epidemiologic profile, the time until care, and the type of conduct taken regarding patients who are victims of accidents with circular saws and their resulting injuries, and to make a comparison with the literature. Methods A cross-sectional descriptive study reviewing the medical records of patients cared for from April to December 2018, analyzing age, gender, injured side, affected fingers, month and time of the accident, type of injuries, procedures performed in the emergency room, time elapsed between trauma and admission to the operating room, and reapproach during hospitalization. Results A total of 54 male patients aged between 15 and 72 years were care for. The left side was more affected, and the most frequent type of lesion involved the thumb, which had to be amputated in many cases. In total, 23 patients underwent reimplantation, 3 of which were macroreimplantations. Regarding the time of trauma, 26 cases occurred between noon and 4 p.m., and the time elapsed between the accident and the admission to the operating room was ≥ 6 hours in 84% of the patients. Conclusion Circular saw lesions are predominantly severe, with a potential for leaving permanent sequelae, and they affect mainly the thumb. The characterization of the type of injury and the initial care conditions obtained in the present study may contribute to the policy of prevention and care of patients who are victims of circular saw injuries. Level of Evidence IV; Case Series.


Resumo Objetivo Avaliar o perfil epidemiológico, o tempo até o atendimento, e o tipo de conduta tomada em pacientes vítimas de acidentes com serra circular e lesões decorrentes, e fazer uma comparação com a literatura. Métodos Estudo descritivo transversal, com revisão do prontuário de pacientes atendidos de abril a dezembro de 2018, analisando idade, sexo, lado lesado, dedos acometidos, mês e horário do acidente, tipo de lesões, procedimentos realizados na urgência, tempo decorrido entre o trauma e entrada em sala cirúrgica, e reabordagem durante a internação. Resultados Foram atendidos 54 pacientes do sexo masculino com idade entre 15 e 72 anos. O lado esquerdo foi o mais acometido, e o tipo de lesão mais frequente, a amputação, envolvendo principalmente o polegar. No total, 23 pacientes foram submetidos a reimplante, e, entre eles, 3 macrorreimplantes. Quanto ao horário do trauma, 26 ocorreram entre 12h e 16h, e o tempo decorrido entre o acidente e a entrada em sala cirúrgica foi ≥ 6 horas em 84% dos pacientes. Conclusão As lesões por serra circular são predominantemente graves, com potencial de deixar sequelas permanentes, e acometem principalmente o polegar. A caracterização do tipo de lesão e as condições de atendimento inicial obtidas neste trabalho poderão ajudar na política de prevenção e atendimento a pacientes vítimas de ferimentos por serra circular. Nível de Evidência IV; Série de Casos.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Aged , Accidents , Hand Injuries/etiology , Hand Injuries/prevention & control , Hand Injuries/epidemiology
2.
Rev. bras. ortop ; 57(1): 108-112, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365734

ABSTRACT

Abstract Objective To describe and compare the results obtained with a secondary healing protocol for fingertip amputations and their relationship to injury severity according to the Allen classification. Methods Medical records of 127 fingertip injuries were revised, and a retrospective, comparative, analytical study the amputations treated conservatively was performed. Injury characteristics, healing time, and complications were described and analyzed. Results Between April 2017 and May 2019, 127 fingertip injuries were treated conservatively. The average age of the sample was of 28.33 years. The average healing time was of 4.31 weeks. The complications during the follow-up were observed in 18.9% (n= 24) of the cases, but none require revision treatment. A statistically significant relationship between the development of complications and treatment revision according to the Allen classification was not found (p ≥ 0.05). Conclusion The proposed secondary healing protocol has shown to be safe and effective in types 1 to 3 fingertip amputations in the Allen classification, and it should be included as a therapeutic option even in injuries of greater extension than those that have traditionally been limited to.


Resumo Objetivo Descrever e comparar os resultados obtidos com um protocolo de cicatrização secundária para amputações das pontas dos dedos e sua relação com a gravidade da lesão de acordo com a classificação de Allen. Métodos Foram revisados os prontuários clínicos de 127 lesões nas pontas dos dedos, e realizou-se um estudo retrospectivo, comparativo e analítico das amputações tratadas de forma conservadora. Foram descritas e analisadas as características da lesão, o tempo de cicatrização, e as complicações. Resultados Entre abril de 2017 e maio de 2019, foram tratadas de forma conservadora 127 lesões nas pontas dos dedos. A idade média da amostra era de 28,33 anos. O tempo médio de cicatrização foi de 4,31 semanas. As complicações apresentadas durante o acompanhamento afetaram 18,9% (n = 24) dos casos, porém nenhum exigiu tratamento de revisão. Não foi encontrada relação estatisticamente significativa entre o desenvolvimento das complicações e a revisão do tratamento de acordo com a classificação de Allen (p ≥ 0,05). Conclusão O protocolo de cicatrização secundária proposto mostrou-se seguro e eficaz nas amputações das pontas dos dedos conforme os tipos de 1 a 3 da classificação de Allen, e deve ser incluída como opção terapêutica mesmo em lesões de maior extensão do que aquelas tradicionalmente limitadas.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Wound Healing , Wounds and Injuries , Retrospective Studies , Guidelines as Topic , Finger Injuries , Hand Injuries , Amputation
3.
Article in Spanish | LILACS, BINACIS | ID: biblio-1378022

ABSTRACT

El Comité Editorial quiere brindar a sus lectores una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la Ortopedia y Traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definiendo su uso e incluyendo bibliografía original y actualizada. Nivel de Evidencia: V


The Editorial Committee wants to provide its readers with an update on the commonly used scales. The use of tables and scales is a widespread practice in Orthopedics and Traumatology. The measurement and quantification of clinical, functional, and radiographic aspects have become essential tools for decision-making in different aspects of healthcare activity. We carried out a review of the most used scales, defining their use and including original and updated literature. Level of Evidence: V


Subject(s)
Orthopedics , Injury Severity Score , Trauma Severity Indices , Surveys and Questionnaires , Disability Evaluation , Hand Injuries
4.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367130

ABSTRACT

Introducción: Las lesiones en las manos causadas por amoladora son comunes y generalmente ocurren en adultos jóvenes. En países en desarrollo, el ámbito doméstico y el trabajo informal son los escenarios más frecuentes. El objetivo de este estudio fue describir factores asociados a las lesiones por amoladora, y cuantificar y clasificar las heridas, según la gravedad y la región anatómica de la mano involucrada. Materiales y Métodos: Se realizó un estudio epidemiológico, retrospectivo. Entre 2016 y 2020, estudiamos a los pacientes con heridas de mano causadas por amoladora. Se analizaron el nivel educativo, la experiencia con la herramienta, el material cortado, el uso de equipo de protección personal, la edad y el sexo. Para determinar el patrón de las lesiones se realizó un análisis clínico-anatómico y radiológico detallado e individualizado. La gravedad fue evaluada con el Hand Injury Severity Score. Resultados: Se evaluó a928 pacientes (920 hombres y 8 mujeres, edad promedio 42 años). Solo el 22,4% usaba equipo de protección personal en el momento del accidente. El 84,5% (776 casos) realizaba tareas inusuales para la que esta herramienta no fue diseñada. La mano más afectada fue la izquierda (62,06%). En 784 pacientes, las heridas involucraban los dedos, el patrón de asociación predominante fue entre el 2do y 3er dedo (54,44%). Las lesiones fueron leves (24,1%), moderadas (41,3%), graves (26%) y mayores (8,6%). Conclusiones: Las lesiones por amoladora pueden resultar devastadoras. Una actualización epidemiológica reforzaría la necesidad de desarrollar métodos preventivos con el fin de disminuir su alta incidencia. Nivel de Evidencia: IV


Introduction: Hand injuries caused by angle grinders are frequent and generally take place among young adults. In developing countries, the domestic and informal work environments are the most frequent places where this could happen. The present study is aimed at describing associated factors to these types of injuries. Lesions were quantified and classified according to the sever-ity and anatomic region of the hand involved. Methods: An epidemiologic, retrospective study was performed between 2016 and 2020. The patients' level of education, previous experience using the machine, use of personal protective equipment (PPE), sex, and age were analyzed. To determine the pattern of the injuries, a clinical-anatomical and a detailed and individualized radiological analysis were performed on each patient. The severity was measured using the "Hand Injury Severity Score" (HISS). Results: 928 patients were studied (920 men, 8 women, average age of 42 years [range 18-67]). Only 22.4% were wearing PPE at the time of the accident. 776 participants were performing tasks for which the tool was not intended (84.5%). The left hand was the most af-fected (60%). In 784 patients, the injuries involved their fingers (84.48%); the predominant pattern was the index and middle finger (55%). According to the HISS, 24.1% were minor injuries, 41.3% were moderate, 26% were serious, and 8.6% were severe. Con-clusions: Injuries caused by an angle grinder can be devastating. We believe that an epidemiological update is likely to increase the need to develop preventive methods to decrease its high incidence. Level of Evidence: IV


Subject(s)
Adult , Tendon Injuries , Accidents, Occupational/statistics & numerical data , Finger Injuries , Hand Injuries , Amputation, Traumatic
5.
Rev. bras. ortop ; 56(4): 528-532, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1341177

ABSTRACT

Abstract Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions. The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization. The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation. Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, which interferes with the normal function of the hand and can lead to articular degenerative changes. The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.


Resumo A luxação traumática isolada da articulação trapézio-metacárpica é uma lesão rara que faz parte de menos de 1% de todas as lesões de mãos. Os autores apresentam dois casos de luxação traumática isolada da articulação trapézio-metacárpica. Um dos casos foi tratado com redução fechada e imobilização com gesso, e o outro foi tratado com redução fechada, fixação com fios Kirschner, e imobilização com gesso. O primeiro paciente teve um bom resultado funcional e não mostrou sinais de instabilidade trapeziometacarpal. O paciente tratado com fios Kirschner apresentou sinais de instabilidade clínica e subluxação radiológica. A luxação isolada da articulação trapeziometacarpal é uma lesão rara que pode causar instabilidade articular que interfere com a funcionalidade normal da mão e pode resultar em mudanças articulares degenerativas. O melhor manejo dessa lesão ainda é controverso, já que ainda faltam evidências na literatura que mostrem a superioridade de um tratamento em relação ao outro.


Subject(s)
Humans , Male , Adult , Middle Aged , Thumb/injuries , Joint Dislocations/therapy , Hand Injuries
6.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353992

ABSTRACT

El colgajo perforante de la arteria circunfleja ilíaca superficial se utiliza para la reconstrucción de los miembros, sobre todo, en el dorso de las manos y los pies, en la zona de flexión articular y en cirugía maxilofacial, porque es un colgajo fino, flexible y versátil. Presentamos tres pacientes: dos casos pediátricos para la reconstrucción de secuelas traumáticas de la mano y el dorso del pie, y un adulto para la reconstrucción de una quemadura del dorso de la mano. Conclusiones: El colgajo perforante de la arteria circunfleja ilíaca superficial es ideal para el dorso de la mano, el pie y los pliegues articulares. Pese a las variaciones anatómicas en el nacimiento de la arteria circunfleja ilíaca superficial, el dominio de las técnicas microquirúrgicas y de la supermicrocirugía permite tomar, con seguridad, un colgajo de dimensiones moderadas o grandes, fino, con baja morbilidad en la zona dadora. Nivel de Evidencia: V


The superficial circumflex iliac artery perforator (SCIP) flap is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. We presented 3 cases of SCIP flap reconstructions. Two pediatric cases for the reconstruction of traumatic sequelae of the hand and dorsal foot. One adult case for the reconstruction of a severe burn of the dorsal hand. Conclusion: The SCIP flap is ideal for the reconstruction of the dorsal aspect of the hand, foot, and flexion crease. Despite the anatomical variations in the origin of the superficial circumflex iliac artery, the use of microsurgical techniques and super-microsurgery allows safe harvesting of a thin flap of moderate to large dimensions, with low morbidity in the donor area. Level of Evidence: V


Subject(s)
Child, Preschool , Child , Adult , Surgical Flaps , Soft Tissue Injuries , Hand Injuries , Iliac Artery
7.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(3): 222-233, ago. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1340623

ABSTRACT

Introducción: En estudios experimentales y clínicos, los resultados con el tornillo excéntrico transfisario medial para producir varo fueron alentadores. El propósito de este estudio fue determinar si colocar un tornillo en el fémur proximal es un gesto eficaz y seguro en caderas espásticas de niños con parálisis cerebral. Materiales y Métodos: Se incluyó a pacientes con parálisis cerebral infantil y caderas en riesgo. Se compararon la serie A: pacientes con liberación de partes blandas más colocación de un tornillo excéntrico transfisario medial en el fémur proximal y la serie B: pacientes solo con liberación de partes blandas. Se determinaron el test de Rang, el índice de migración de Reimer, el ángulo cervicodiafisario y las complicaciones, antes de la cirugía y después. Resultados: Se operó a 18 pacientes (36 caderas): 10 de la serie A y 8 de la serie B, con una mediana de edad de 51 meses y una mediana de seguimiento, de 3 años. Al comparar por delta de medianas todas las variables preoperatorias y posoperatorias, hubo una diferencia estadísticamente significativa solo en el delta de mediana del ángulo cervicodiafisario de las caderas izquierdas (-5 vs. 0, p 0,02). Conclusiones: La liberación de partes blandas es eficaz para prevenir la luxación de la cadera espástica. La colocación de un tornillo transfisario excéntrico en la cadera espástica no produjo cambios y no fue inocua. La hemifisiodesis medial de la cadera es una atractiva solución teórica para tratar los problemas ocasionados por el valgo excesivo, pero se requieren más estudios. Nivel de Evidencia: III


Introduction: Animal and clinical studies have shown promising results for the varus-producing placement of a medial eccentric transphyseal screw. The purpose of this study was to establish if the placement of a screw in the proximal femur is an effective and safe approach for spastic hips in children with cerebral palsy (CP). Materials and Methods: We compared two series of pediatric CP patients (Gross Motor Function Classification System [GMFCS] III, IV and V) with "hips at risk." Series A patients were treated with soft-tissue release plus a medial eccentric transphyseal screw in the proximal femur. Series B patients were only treated with soft-tissue release. Patients were evaluated pre and postoperatively to determine their Rang test score, Reimer's migration index (MI), diaphyseal cervical angle, and complications. Results: From a total of 18 patients operated, 36 hips, 55% (10) belonged to the A Series and 45% (8) to the B Series. The median age was 51 months (IQR, 41-108). The median follow-up was 3 years (IQR, 2.4-5.8). The comparative analysis of all preoperative and postoperative variables yield only one statistically significant difference: the median left hip diaphyseal cervical angle (-5 vs. 0, P 0.02). Conclusions: The release of soft tissues was effective to prevent the spastic hip dislocation. The placement of medial eccentric transphyseal screw in spastic hips produced some complications and no beneficial changes. Medial hemiphysiodesis of the hip remains nothing but an attractive theoretical solution for the treatment of problems caused by excessive valgus. However, further studies are warranted. Level of Evidence: III


Subject(s)
Surgical Flaps , Thumb/injuries , Finger Injuries/surgery , Hand Injuries
8.
Rev. bras. ortop ; 55(1): 1-7, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092680

ABSTRACT

Abstract Arthroscopy is a surgical technique whose indication for wrist injuries has grown in recent years. Athletes are subject to traumatic injury to the wrist due to training overload or the intensity of the activity during competition. The need of a quick return to sports practice makes arthroscopy a very useful minimally invasive technique in these situations. The authors present indications of sports-related injuries to the wrist that can be treated by arthroscopy. A literature review is also presented.


Resumo A artroscopia é uma técnica cirúrgica que tem sido cada vez mais usada para a abordagem de lesões no punho. Atletas estão sujeitos a lesões traumáticas no punho devido à sobrecarga de treinamento ou à intensidade da atividade em competição. A necessidade de retornar o mais breve possível à pratica esportiva faz da artroscopia uma técnica minimamente invasiva muito útil nessas situações. Os autores apresentam as principais indicações de tratamento de lesões esportivas por artroscopia. Foi feita uma revisão da literatura.


Subject(s)
Humans , Arthroscopy/methods , Athletic Injuries , Sports , Wounds and Injuries , Wrist Injuries/diagnosis , Athletes , Return to Sport , Hand Injuries/diagnosis
9.
Article in Spanish | LILACS, BINACIS | ID: biblio-1146279

ABSTRACT

Presentamos el caso de un paciente varón de 37 años que llegó al servicio de urgencias a raíz de traumatismo de alta energía (caída en bicicleta). Previa valoración inicial y una vez descartadas lesiones vitales. se objetiva dolor y deformidad en muñeca derecha, por lo que se realiza radiografía simple que demuestra una luxación carpometacarpiana de los cinco radios de la mano. Se procede a la reducción quirúrgica bajo anestesia y fijación interna, restableciendo la relación anatómica normal. La luxación carpometacarpiana es una lesión poco frecuente y en ocasiones difícil de diagnosticar por lo que puede pasar desapercibida. No existe una evidencia clara con respecto al método diagnóstico y tratamiento específico de éste tipo de lesiones. De todas formas, las recomendaciones son una correcta reducción y osteosíntesis articular para alcanzar un resultado satisfactorio y función de agarre


Subject(s)
Accidental Falls , Carpometacarpal Joints/injuries , Hand Injuries
10.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(Supl. de Asociación Argentina de Cirugía de la Mano): S2-S11, 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352418

ABSTRACT

Objetivos: Evaluar los resultados clínicos y radiográficos de pacientes con fracturas extrarticulares de falanges y metacarpianos de la mano, tratados mediante osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados.materiales y métodos: Estudio prospectivo que incluyó a pacientes >18 años con fracturas cerradas transversales u oblicuas cortas, ex-trarticulares, de falanges y metacarpianos tratadas entre noviembre de 2016 y junio de 2019. La serie estaba integrada por 47 pacientes, con 76 fracturas (28 de metacarpianos, 27 de falange proximal y 21 de falange media). Se evaluaron los resultados clínicos y funcionales con goniometría, registrando el rango de movilidad activa total. La evaluación radiográfica se realizó sobre la base de los criterios establecidos por Pun y cols. Todos los pacientes completaron el cuestionario QuickDASH en el examen final. Resultados: El tiempo promedio de seguimiento fue de 24.5 meses. El rango de movilidad activa total promedio fue de 238° para todas las fracturas, 252° para las de metacarpianos y 230° para las de falanges. Se observó la consolidación radiográfica de todas las fracturas. El tiempo promedio de retorno a la actividad habitual fue de 79 días. El resultado final del cuestionario QuickDASH fue 4,5. No hubo complicaciones ni cirugías secundarias. Conclusiones: La osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados resultó una alternativa eficaz para el tratamiento de fracturas extrarticulares de falanges y metacarpianos. Nivel de Evidencia: II


Objective: To study the clinical and radiological outcomes of patients with extra-articular phalangeal and metacarpal fractures who were treated with minimally invasive internal fixation using retrograde intramedullary compression screws.materials and me-thods: Prospective study in patients over 18 years of age treated for simple, transverse or short oblique, extra-articular phalangeal and metacarpal fractures between November 2016 and June 2019. The series included 47 patients and 76 fractures: 28 metacar-pal bones (MC), 27 proximal phalanges (PP), 21 middle phalanges (MP). Clinical and functional outcomes were assessed with goniometry, documenting the total active range of motion (TAM). Radiological outcomes were assessed using the criteria proposed by Pun et al. All patients completed the Quick DASH questionnaire at last follow-up. Results: The average follow-up period was 24.5 months. All study fractures average TAM was 238°, metacarpal TAM was 252°, and phalangeal TAM was 230°. Radiograph evaluation showed fracture consolidation in all cases. Average time taken to return to normal daily activities was 79 days. Average final Quick DASH score was 4.5. There were no complications nor secondary surgeries. Conclusions: Minimally invasive internal fixation with retrograde intramedullary compression screw proved to be a highly effective option in the treatment of extra-articular phalangeal and metacarpal fractures. Level of Evidence: II


Subject(s)
Finger Phalanges/injuries , Metacarpal Bones/injuries , Fractures, Bone , Hand Injuries
11.
Rev. bras. cir. plást ; 34(3): 423-427, jul.-sep. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047173

ABSTRACT

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.


Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.


Subject(s)
Humans , Male , Adult , History, 21st Century , Postoperative Complications , Surgical Procedures, Operative , Surgical Flaps , Wounds and Injuries , Burns , Burns, Electric , Wound Closure Techniques , Forearm , Forearm Injuries , Hand , Hand Injuries , Intraoperative Complications , Postoperative Complications/surgery , Postoperative Complications/rehabilitation , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/rehabilitation , Surgical Flaps/adverse effects , Wounds and Injuries/surgery , Wounds and Injuries/rehabilitation , Burns, Electric/surgery , Burns, Electric/complications , Diagnostic Techniques and Procedures , Wound Closure Techniques/rehabilitation , Forearm/surgery , Forearm Injuries/surgery , Forearm Injuries/complications , Forearm Injuries/rehabilitation , Hand/surgery , Hand Injuries/surgery
12.
Rev. bras. ortop ; 54(2): 134-139, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013698

ABSTRACT

Abstract Objective To define the major epidemiological features of upper limb penetrating injuries, as well as to identify the causes and the frequency of these lesions at the Instituto de Ortopedia e Traumatologia, a hand surgery center in the city of São Paulo, state of São Paulo, Brazil. Methods The present study was based on a sample of consecutive patients from our orthopedics and traumatology institute from May 2014 to May 2016. Data were collected by telephone, and a prestructured questionnaire regarding data and features of the lesions was applied. Descriptive statistics and proportions comparison with the chi-squared test were performed with a p-value < 5% considered as statistically significant. Results At first, 1,648 records were considered and, after applying the exclusion criteria and eliminating duplicate records, 598 records were included in the present study. Most of the patients weremale (77.8%), right-handed (95.82%), with an average age of 37.27 years old.Manual laborers were the most injured individuals (50.00%), and fingers were the most affected site (51.84%). Glass was the most frequent etiologic agent (33.77%). The prevalence of amputation was higher in industrial machinery injuries (p < 0.05) when compared with other causes. Younger patients (< 18 years old) had more glass-related injuries, while older patients ( 60 years old) had more traumas caused by power tools (p < 0.05). Women had more injuries resulting from razors and glass (p < 0.05). Manual laborers had a higher frequency of power tools and industrial machinery-related injuries (p < 0.05) and a higher prevalence of amputations (p < 0.05). Conclusion Themost frequent etiology was glass, especially in individuals < 18 years old.Women and older patients (> 60 years old) presented a high frequency of traumas caused by razors and power tools, respectively. More severe injuries were caused by machinery and were related with work activity.


Resumo Objetivo Definir as principais características epidemiológicas dessas lesões, bem como identificar a causa e a frequência de ferimentos penetrantes no membro superior atendidos no Instituto de Ortopedia e Traumatologia da nossa instituição. Métodos O estudo se baseou em uma amostra de pacientes consecutivos atendidos no Instituto de Ortopedia e Traumatologia dessa instituição, demaio de 2014 amaio de 2016. Os dados foram coletados por contato telefônico, aplicou-se um questionário pré-estruturado sobre os dados e as características das lesões. A análise estatística foi feita de forma descritiva e a comparação das proporções através do teste de quiquadrado, associado ao valor de p, com significância < 5%. Resultados Foramconsiderados 1.648registros inicialmente e, após aplicados os critérios de exclusão e excluídos os duplicados, 598 pacientes foram incluídos na análise final. A maioria dos pacientes era do gênero masculino (77,80%), destros (95,82%), com média no momento do trauma de 37,27 anos. Os trabalhadores manuais foram os mais lesionados (50,00%) e a topografia mais acometida foram os dedos (51,84%). Dentre os agentes etiológicos, destaque para o vidro (33,77%). A prevalência de pacientes comamputação foi maior nos ferimentos por máquinas industriais (p < 0,05) quando comparada com outros agentes etiológicos. Pacientes com menos de 18 anos apresentaram maior frequência de ferimentos ocasionadas por vidro (p < 0,05). Já os pacientes com 60 anos ou mais apresentaram maior prevalência de ferimentos pormáquina de corte (p < 0,05). Mulheres apresentaram maior frequência de ferimentos por lâmina e por vidro (p < 0,05). Os trabalhadores manuais apresentaram maior prevalência de ferimentos por máquinas de corte e industriais (p < 0,05) e maior prevalência de amputações (p < 0,05). Conclusão O agente etiológico mais frequente é o vidro, com relevância maior em menores de 18 anos. Em mulheres e idosos, há grande frequência de lesões causadas por lâminas e máquinas de corte, respectivamente. Lesões de maior gravidade são causadas por máquinas, associadas a atividade laboral.


Subject(s)
Humans , Male , Female , Wounds and Injuries , Wounds, Penetrating , Serial Cross-Sectional Studies , Hand Injuries
14.
Clinics ; 74: e1076, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019701

ABSTRACT

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Equipment Failure/statistics & numerical data , Forearm Injuries/etiology , Hand Injuries/etiology , Brazil/epidemiology , Accidents, Occupational/statistics & numerical data , Cross-Sectional Studies , Risk Factors , Forearm Injuries/epidemiology , Hand Injuries/epidemiology
15.
Article in English | WPRIM | ID: wpr-762832

ABSTRACT

BACKGROUND: Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games. METHODS: A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game. RESULTS: Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34–1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends. CONCLUSIONS: There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.


Subject(s)
Baseball , Delivery of Health Care , Facial Injuries , Hand Injuries , Hand , Humans , Incidence , Marketing , Motorcycles , Resource Allocation , Retrospective Studies , Sports , Trauma Centers
16.
Article in English | WPRIM | ID: wpr-762814

ABSTRACT

BACKGROUND: The aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation. METHODS: Forty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension (TcPO₂) was measured before and after infiltration, and changes in TcPO₂ were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation. RESULTS: Thirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. TcPO₂ readings showed significant decreases (P<0.05) following both one-per-mil tumescent (99.9±5.7 mmHg vs. 37.2±6.3 mmHg) and normal saline (103±8.5 mmHg vs. 48.7±5.9 mmHg) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis. CONCLUSIONS: One-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.


Subject(s)
Constriction , Epinephrine , Groin , Hand Injuries , Ischemia , Necrosis , Oxygen , Rats, Wistar , Reading , Reperfusion Injury , Replantation , Skin , Vasoconstriction
17.
Article in English | WPRIM | ID: wpr-739381

ABSTRACT

BACKGROUND: Hand injuries caused by chain saws, electric saws, and hand grinders range from simple lacerations to tendon injuries, fractures, and even amputations. This study aimed to understand the distribution of various types of hand and upper extremity injuries caused by power tools, in order to help prevent them, by investigating the incidence and cause of power tool injuries treated over a 4-year period at a single institution in Korea. METHODS: We reviewed the medical records of patients who visited a single institution for power tool-induced injuries from 2011 to 2014. The distribution of sex, age, injured body part, type of injury, and mechanism of injury sustained by patients who received hand and upper extremity injuries from using an engine saw, electric saw, or hand grinder was evaluated. RESULTS: Among 594 subjects who were injured by power tools, 261 cases were hand and upper extremity injuries. The average age was 53.2 years. Tendon injury was the most common type of injury. An electric saw was the most common type of power tool used. More injuries occurred in non-occupational settings than in occupational settings. CONCLUSIONS: In this study, power tool-induced hand and upper extremity injuries were mostly caused by direct contact with electric saw blades. More injuries occurred due to non-occupational use of these tools, but the ratios of amputations and structural injuries were similar in the non-occupational and occupational groups.


Subject(s)
Amputation , Arm Injuries , Epidemiologic Studies , Hand Injuries , Hand , Humans , Incidence , Korea , Lacerations , Medical Records , Occupational Groups , Tendon Injuries , Upper Extremity
18.
Rev. Soc. Bras. Med. Trop ; 52: e20190055, 2019. graf
Article in English | LILACS | ID: biblio-1013312

ABSTRACT

Abstract Snakebites by aglyphous or opisthoglyphous snakes are common in Brazil. We report a case of snakebite by the opisthoglyphous Erythrolamprus aesculapii. The victim presented with pain, edema, and bleeding at the bite site, along with erythema, similar to a Bothrops envenomation. In this type of snakebite, if the snake is not brought to the hospital, the victim may receive unnecessary serum therapy, with the risk of adverse reactions to the antivenom. The possibility of reducing after-effects with anti-inflammatory drugs and early antibiotic therapy for secondary infection need to be further investigated, preferably in multicenter studies, while observing good clinical practice.


Subject(s)
Humans , Animals , Male , Young Adult , Snake Bites/complications , Snake Venoms/poisoning , Colubridae , Hand Injuries/etiology , Snake Bites/drug therapy , Brazil , Betamethasone/therapeutic use , Accidents, Occupational , Hand Injuries/drug therapy , Histamine Antagonists/therapeutic use
19.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088683

ABSTRACT

Introducción: Las luxaciones carpo-metacarpianas son lesiones poco frecuentes, que van del 0.5 al 1% de las luxaciones de los huesos de la mano. Siendo extremadamente infrecuente la luxación simultanea de los 5 dedos. Objetivo: El objetivo de nuestro trabajo es documentar una lesión poco frecuente producida en un paciente asistido en nuestro centro. Así como realizar una puesta a punto sobre las medidas diagnósticas y terapéuticas de dicha lesión. Caso clínico: Se presenta el caso de un hombre de 63 años, diestro, artesano en hierro y madera, que sufre un accidente de tránsito de alta energía en moto versus auto, sufriendo traumatismo en mano derecha, sin presentar otros traumatismos. De la exploración física, en el departamento de emergencia, se constata la mano derecha dolorida con gran deformidad en dorso. Se diagnosticó: luxación dorsal carpo-metacarpiano de los 5 metacarpianos, con fractura del sector distal del trapecio, trapezoide, hueso grande y ganchoso. Se realizó reducción cerrada en block quirúrgico con anestesia general, siendo la reducción inestable se colocan agujas de Kirschner para su estabilización. Se confecciona, además, una férula de yeso de protección. Se solicitó una tomografía computada de control donde se objetiva buena reducción de las 5 articulaciones carpo-metacarpianas. Se retiraron las agujas de Kirschner a las 6 semanas. A los 3 meses de la lesión presenta una mano indolora, con buen rango de movilidad, con disminución a la fuerza prensil máxima comparada con la contralateral. El paciente reanuda sus tareas, incorporándose totalmente al trabajo a los 6 meses. Presenta, al año de la cirugía, un score de DASH excelente. Discusión: Las luxaciones de los 5 metacarpianos son lesiones extremadamente raras. Se han reportado en el mundo menos de 20 casos. A pesar de los elementos clínicos sugestivos, el diagnostico de esta lesión es difícil, siendo fundamental contar con un enfoque radiológico de perfil estricto de mano. Los resultados de esta lesión son inciertos, la función de la mano y la muñeca se mantiene pero frecuentemente asociado a una reducción de fuerza prensil. Este tipo de trauma lleva, en mayor o menor grado, al desarrollo de artrosis carpo metacarpiana a largo plazo.


Introduction: Carpometacarpal join dislocations, are really infrequent injuries, with an incidence that goes from 0,5 to 1% of all bone hand dislocations. Being extremely rare the simultaneous luxation of all five fingers. Objectives: Our work objective is to report a very infrequent injury found on a patient treated at our medical center. As well as getting up to date with diagnosis and treatment of such injury. Clinical case: A 63 year old male case is presented, right-handed, wood and iron artisan, who was involved in a high-impact car crush against a motorbike, suffering a trauma on his right hand, without any other injuries. At the emergency room, the physical examination showed a painful right hand deformed on the back. His diagnosis was dorsal carpometacarpal luxation of all 5 metacarpus, with a distal fracture of the trapezium, trapezoid, capitate and hamate bones. A closed reduction at the surgical room was performed, with general anesthesia, being the reduction unstable therefore Kirschner needles were used for stabilization. A plaster cast was used for its protection. A control tomography was performed showing good reduction of all 5 carpometacarpal joints. Kirschner needles were taken out 6 weeks later, at which point the rehabilitation program was started with the physiatrist team. Three months after the injury, the hand was painless, with a good range of movement, a diminished maximum catching strength compared with the other hand. The patient restarted his usual chores, fully reincorporating to his job 6 months later. He presents an excellent DASH score one year after surgery. Discussion: Luxation of all 5 metacarpus is an extremely rare injury. It has been reported less than 20 cases worldwide. In spite of clinical suggestive elements, the diagnosis of this injury is quite difficult, being of great importance to count with x-rays with a straight profile incidence of the hand. The results of this injury are uncertain; the functionality of the hand and wrist is frequently sustained associated with a reduction of the catching strength. This type of trauma will end up developing in greater or lesser degree, long term carpometacarpal arthrosis.


Introdução: As luxações carpo-metacarpianas são lesões raras, variando de 0,5 a 1% das luxações dos ossos da mão. O deslocamento simultâneo dos 5 dedos é extremamente incomum. Objetivo: O objetivo do nosso trabalho é documentar uma lesão rara produzida em um paciente assistido em nosso centro. Bem como realizar um set-up nas medidas diagnósticas e terapêuticas da referida lesão. Caso clínico: O caso de um homem de 63 anos, destro, artesão em ferro e madeira, que sofre um acidente de motocicleta de alta energia em uma motocicleta contra um carro, sofrendo traumatismo em sua mão direita, sem apresentar outras lesões, é apresentado. A partir do exame físico no pronto-socorro, há uma dor na mão direita com grande deformidade nas costas. Foi diagnosticado: luxação metacarpal do dorsal do carpo dos 5 metacarpos, com fratura do setor trapézio distal, trapézio, osso grande e hamato. Uma redução fechada foi realizada em um bloco cirúrgico com anestesia geral, com a redução instável sendo colocada com fios K para estabilização. Uma tala de gesso protetora também é feita. Solicitou-se tomografia computadorizada de controle, onde foi observada boa redução das 5 articulações carpo-metacarpianas. Os fios de Kirschner foram removidos às 6 semanas. Aos 3 meses após a lesão, ele apresenta uma mão indolor, com boa amplitude de mobilidade, com diminuição da força preênsil máxima em comparação com a força contralateral. O paciente retoma suas tarefas, ingressando totalmente no trabalho aos 6 meses. Um excelente escore DASH é apresentado um ano após a cirurgia. Discussão: As luxações dos 5 metacarpos são lesões extremamente raras. Menos de 20 casos foram relatados no mundo. Apesar dos elementos clínicos sugestivos, o diagnóstico dessa lesão é difícil, sendo fundamental a abordagem radiológica do perfil estrito da mão. Os resultados dessa lesão são incertos, a função da mão e do punho é mantida, mas freqüentemente associada a uma redução na força de preensão. Este tipo de trauma leva, em maior ou menor grau, ao desenvolvimento de artrose metacarpal do carpo a longo prazo.


Subject(s)
Humans , Male , Middle Aged , Joint Dislocations/surgery , Joint Dislocations/diagnostic imaging , Carpometacarpal Joints/injuries , Hand Injuries/surgery , Hand Injuries/diagnostic imaging , Bone Wires , Hand Injuries/rehabilitation
20.
Rev. Col. Bras. Cir ; 45(4): e1912, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-956570

ABSTRACT

RESUMO Objetivo: relatar a experiência da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no tratamento de lesões cutâneas por extravasamento acidental de drogas. Métodos: foram incluídos os pacientes com lesões por extravasamento de drogas num período de 18 meses. Os seguintes parâmetros foram avaliados retrospectivamente: idade, diagnósticos durante internação e comorbidades, níveis séricos de albumina e hemoglobina, local de internação, droga envolvida, segmento anatômico acometido, conduta terapêutica e óbito durante internação. Resultados: foram acompanhados 14 pacientes. A principal droga envolvida foi a noradrenalina (21%). Todos os pacientes foram submetidos a desbridamento da necrose tecidual. Três pacientes foram submetidos a retalhos após preparo do leito com terapia por pressão negativa, com bons resultados. Sete pacientes não tiveram tratamento definitivo de suas lesões por falta de condições clínicas. Conclusão: o tratamento definitivo por meio de retalhos se mostrou adequado para os casos de feridas por extravasamento de drogas em tecido subcutâneo, quando há exposição de estruturas nobres, em pacientes com condições clínicas favoráveis.


ABSTRACT Objective: to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. Methods: we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. Results: we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. Conclusion: in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.


Subject(s)
Humans , Infant , Aged , Aged, 80 and over , Norepinephrine/adverse effects , Subcutaneous Tissue/pathology , Extravasation of Diagnostic and Therapeutic Materials/surgery , Hand Injuries/chemically induced , Surgical Flaps , Retrospective Studies , Middle Aged , Necrosis/surgery
SELECTION OF CITATIONS
SEARCH DETAIL