Lesiones de punta de dedo: experiencia en el manejo en los últimos 5 años en un centro pediátrico / Fingertip injuries: experience in handling the last 5 years in a pediatric center

Las lesiones de punta de dedo son comunes en pacientes pediátricos que acuden a salas de Emergencia; son causadas por accidentes en el hogar y con aplastamiento en puerta como principal mecanismo de trauma. El tratamiento se realiza individualizado por cirujanos plásticos y cirujanos pediátricos en dependencia de la herida y el compromiso tisular. El propósito de este estudio es describir el manejo de pacientes con lesiones de punta de dedo en un centro pediátrico. Se realizó un análisis de historias clínicas en el período entre enero 2015 y diciembre 2020, se evaluaron 228 pacientes atendidos en el Hospital de Niños Dr. Roberto Gilbert Elizalde, en Guayaquil, Ecuador. Los resultados incluyen un predominio de pacientes en edad preescolar (67%), masculinos (56%) y de mano derecha (53%). Los dedos más afectados fueron el medio y anular. Los procedimientos fueron realizados por cirujanos plásticos (55%) y la técnica electiva fue bajo anestesia general. La extensión del daño involucró tejidos blandos (92%), avulsión de uña (29%) y fracturas asociadas (15%). El 3% de los pacientes presentó complicaciones que requirieron seguimiento. El tipo de reparo se seleccionó en dependencia de la extensión de la herida, se realizaron suturas simples (37%) y suturas complejas con reparo de la uña (27%). Nuestros datos son similares a los descritos en la literatura internacional, con buenos resultados a largo plazo, menor tasa de complicaciones y respuestas similares en los reparos realizados por cirujanos plásticos y cirujanos pediatras.

Fingertip injuries are common in pediatric patients who present to the emergency room. They are usually caused by accidents at home, being door-crush the main mechanism. Treatment is performed on an individual basis, by a Plastic or General Pediatric Surgeon, according to the wound findings and tissue involvement. The purpose of this study is to describe the management on a pediatric center in patients with a fingertip wound. A descriptive and retrospective analysis of medical records was carried out from January 2015 until December 2020. In this period 228 patients were seen in the Dr. Roberto Gilbert Elizalde Children´s Hospital in Guayaquil, Ecuador. A high incidence was found in the preschool age with 67% of cases. The injuries were more common in males (56 %) and more predominant on the right hand (53%). The most affected fingers were the middle and annular. Procedures were mostly performed by Pediatric Surgeons (55%) and the elective technique was under general anesthesia. Damage extension of the fingertip included soft tissues in 92% of patients, nail avulsion in 29% and associated fractures in 15%. Only 3% of patients developed complications that required follow up. The type of repair was selected according to the extension of the injury. Mostly simple sutures (37%) and complex sutures with nail repair (27%)were used.Our data is similar to the one found in international literature, with good long-term outcomes, minor complications and similar results when the repair was performed by a Plastic or Pediatric surgeon

Trauma complexo da mão parte II: lesão óssea, amputação e reimplante, perda de substância dos dedos, lesão da polpa digital e lesão ungueal / Complex trauma of the hand, part II: bone injury, amputation and replantation, loss of fi nger substance, digital pulp injury and nail injury

O trauma da mão representa uma das lesões que com maior frequência pode deixar sequelas funcionais importantes. A idade mais afetada é a economicamente ativa. Valorizamos o conhecimento adequado do primeiro atendimento e do manejo das lesões mais frequentes na mão traumatizada. Nesta segunda parte, serão abordados os fundamentos e conceitos considerados como essenciais na lesão óssea, amputações e reimplantes, perda de substância na mão, lesão da polpa digital e do complexo ungueal. Procuramos orientar a conduta dos médicos nas diversas situações clínico-cirúrgicas para diminuir o grau de complicações e sequelas (AU)

Hand trauma is one of the injuries that can most often leave important functional sequelae. The most affected age group is economically active people. We appreciate proper knowledge of the initial treatment and management of the most common injuries in the traumatized hand. In this second part we address the fundamentals and concepts considered essential in bone injury, amputation and replantation, loss of substance in the hand, and injuries of digital pulp and ungual complex. We aim to guide the conduct of physicians in different clinical and surgical situations to reduce the degree of complications and sequelae (AU)

Buddy Taping: Is It a Safe Method for Treatment of Finger and Toe Injuries?

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.

Fenómeno de Raynaud con lesiones isquémicas digitales: tratamiento con bloqueo de ganglio estrellado: presentación de un caso / Digital ischemic lesions associated to Raynaud's phenomenon treated with stellate ganglion block: case report

El fenómeno de Raynaud consiste en la aparición paroxística de espasmo vascular, que afecta a pequeñas arterias y arteriolas cutáneas, de las extremidades. Se manifiesta con palidez extrema, que puede ir seguida de cianosis y posterior rubicundez durante la fase hiperémica. Se acompaña generalmente de disestesias y, en forma ocasional, también de dolor. Generalmente, presentan escasa repercusión sistémica asociada. Los principales desencadenantes son el frío y el estrés emocional. El bloqueo del ganglio estrellado es utilizado frecuentemente para el diagnóstico y tratamiento de múltiples sindromes dolorosos crónicos. Con el bloqueo de la actividad simpática, se produce una vasodilatación de los vasos de la extremidad superior, cabeza y cuello, siendo éste el sustrato para su utilización en cuadros de insuficiencias vasculares de las zonas inervadas. Presentamos el caso de un bloqueo de ganglio estrellado en una paciente con lesiones isquémicas digitales secundarias a un fenómeno de Raynaud primario.

The sudden onset of vascular spasm, affecting small arteries and skin arterioles of limbs is known as Raynaud's phenomenon. it includes severe paleness sometimes followed by cyanosis and redness during the hyperemic phase. Usual findings are dysestesias and ocassionally pain. Normally it causes a small systemic impact. The most relevant triggering factors are cold and emotional stress. Stellate Ganglion Block is frequently used to diagnose and treat several chronic pain syndromes. The sympathetic activity block causes the vasodilation of the arms, head and neck, and this is the substratum for using it in vascular impairment syndrome. We present a stellate ganglion block in a patient with isquemic digital lesions secondary to Raynaud phenomenon.

Tratamiento de las lesiones tendinosas del flexor profundo de los dedos en la zona 2 mediante injerto tendinoso del palmar menor y movilización temprana protegida / Treatment for tendinous injuries of the flexor digitorum longus in zone 2, by tendinous grafting harvested from the flexor carpi radialis brevis and early protected mobilization

Se realizó un estudio prospectivo, observacional, analítico, longitudinal con una serie de 20 pacientes en quienes se repararon 23 tendones flexores profundos lesionados en la zona 2, con injerto del palmar menor o del flexor superficial con técnica de Kessler y movilización temprana protegida con férula de Kleinert. La evaluación se hizo con la escala de Strickland para el total de la movilidad activa (TMA). Los resultados fueron considerados excelentes en 14 casos (70 por ciento) por haber recuperado un TMA de 150 grados o más; fueron buenos 3 con TMA de 125 a 149; regulares 2 de 100 a 124 y solamente en un caso el resultado fue malo con menos de 100

Dedo en resorte por nódulo del tendón flexor: tratamiento mediante electromagnetoterapia en atención primaria / Trigger digit by nodule of the tendon flexor: treatment with electromagnetotherapy in primary care

Se realizó un ensayo clínico fase temprana II, abierto, no secuencial, en 50 pacientes mayores de 16 años con el diagnóstico de dedo en resorte que acudieron a la consulta de Ortopedia del Policlínico Comunitario Centro de Camagüey, entre mayo de 1995 y mayo de 1996. Los pacientes se dividieron en 2 grupos, uno recibió régimen de corriente discontinuo y el otro, régimen continuo, con una eficacia similar para ambos. El promedio de sesiones necesarias para solucionar el resorte fue de 10. El 100 porciento de los pacientes tratados obtuvo curación del resorte al terminar el tratamiento. Sólo en 1 se observó recidiva antes de los 3 meses de aplicado éste. En la muestra estudiada no se constató la aparición de reacción adversa. Por los resultados obtenidos en este trabajo preliminar se puede considerar que la electromagnetoterapia constituye una posibilidad de tratamiento conservador para esta afección catalogada de eminentemente quirúrgica, siendo factible su aplicación incluso en la atención primaria

Crush injuries of the hand in children in the Asir region, Saudi Arabia

The aim of this study was to report on crush injuries of the hand in children in the Asir region of Saudi Arabia, caused by domestic meat mincing machine. Case note of all the patients seen and treated over an eight-year period [1988 - 1996] were developed. There were nine boys and two girls, aged between 14 and 48 months. Both right and left hands were about equally affected. Total of 43 digits were involved. The middle finger was most commonly involved and the thumb least involved. Removal of hand from the machine was effected using a special hydraulic device. Adequate safety devices must be incorporated into the designing of all meat mincing machines. Safety warnings must be packaged with the machines. When such accidents occur, attempts should be made to forcibly pull-out the trapped hand

Amputaçäo traumática da extremidade distal dos dedos da mäo: tratamento conservador / Traumatic amputation of the distal extremity of the hand fingers: conservative treatment

Dezessete casos de amputaçoes traumáticas da extremidade distal dos dedos da mao foram estudados prospectivamente, tratados conservadoramente com o uso de aparelho gessado oclusivo após desbridamento ósseo e de partes moles, com anestesia por bloqueio interdigital, em caráter ambulatorial e sem antibioticoterapia. Aspectos relevantes da literatura foram revistos, com especial ênfase nas vantagens dos tratamentos conservadores em relaçao aos cirúrgicos, quais sejam, a praticamente ausência de complicaçoes importantes, a baixa morbidade e o baixo custo do método e a nao necessidade de profissional altamente especializado para sua realizaçao. Nossos resultados estao em total acordo com a literatura, já que nao tivemos nenhuma complicaçao importante, com média de tratamento de 5,5 semanas, sem restriçoes dos movimentos dos dedos acometidos e sensibilidade praticamente normal dos cotos amputados, com rápido retorno às atividades profissionais originais, com ótimos resultados cosméticos, fazendo deste método o preferencial nas amputaçoes traumáticas da extremidade distal dos dedos da mao.

Fratura dos metacarpianos e falanges / Fracture of metacarpals and phalanges

O presente trabalho procura dar uma orientaçäo aos médicos, que possam vir a se deparar com mäos traumatizadas. Mostra a classificaçäo das fraturas dos metacarpianos e falanges, faz uma abordagem, acerca dos tratamentos básicos preconizados e tece consideraçöes suscintas sobre as complicaçöes advindas, tanto relativas aos tratamentos como conseqüentes às próprias fraturas

Mallet finger: classification

Based on results of a prospective study of 200 patients with "mallet finger", the author establishes criteria to divide the injuries into recent and late. In view of the radiologic and anatomic findings as well as the extent of "falla" of the distal phalanx, a classification that allows prognosis and type of most adequate treatment for each case, is proposed.

Dedo en resorte en adultos y niños

Se analizan 105 pacientes con 143 dedos en resorte, en un lapso de 19 años(1969-1987) en la ciudad de Cúcuta y para una mejor compresión y por ser diferente su etiología, menifestaciones clínicas y tratamiento, se clasifican en adultos y niños. 94 adultos y 11 niños. El tratamiento en los adultos se hace inicialmete con infiltraciones de Corticoides, con resultados satisfactorios en el 65 por ciento; por no mejorar en el 35 por ciento se procede al tratamiento quirúrgico (sección de la vaina tendinosa) con resultados excelentes. En los niños el tratamiento fue quirúrgico en el 100 por ciento de los casos. Destacamos el manejo de un paciente adulto con 10 Dedos en Resorte, situación no reportada en la literatura revisada por nosostros y el de un niño con 8 Dedos en Resorte Congénitos, de lo cual sólo han sido publicados 3 casos en la Literatura Inglesa hasta 1983