Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

Evaluation of Circular Saw Injuries in a Reference Center in Microsurgery and Reimplantation / Avaliação de lesões por serra circular em um centro de referência em microcirurgia e reimplantes

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.

Circular saw misuse is related to upper limb injuries: a cross-sectional study

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.

Envenomation by an opisthoglyphous snake, Erythrolamprus aesculapii (Dipsadidae), in southeastern Brazil

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.

Reconstructive dosimetry for cutaneous radiation syndrome

According to the International Atomic Energy Agency (IAEA), a relatively significant number of radiological accidents have occurred in recent years mainly because of the practices referred to as potentially high-risk activities, such as radiotherapy, large irradiators and industrial radiography, especially in gammagraphy assays. In some instances, severe injuries have occurred in exposed persons due to high radiation doses. In industrial radiography, 80 cases involving a total of 120 radiation workers, 110 members of the public including 12 deaths have been recorded up to 2014. Radiological accidents in industrial practices in Brazil have mainly resulted in development of cutaneous radiation syndrome (CRS) in hands and fingers. Brazilian data include 5 serious cases related to industrial gammagraphy, affecting 7 radiation workers and 19 members of the public; however, none of them were fatal. Some methods of reconstructive dosimetry have been used to estimate the radiation dose to assist in prescribing medical treatment. The type and development of cutaneous manifestations in the exposed areas of a person is the first achievable gross dose estimation. This review article presents the state-of-the-art reconstructive dosimetry methods enabling estimation of local radiation doses and provides guidelines for medical handling of the exposed individuals. The review also presents the Chilean and Brazilian radiological accident cases to highlight the importance of reconstructive dosimetry.

Avaliação dos indicadores de qualidade de vida, capacidade funcional e alterações osteomusculares em camareiras de hotéis da orla marítima de Maceió, Alagoas / Evaluation of the indicators of quality of life, functional capacity and musculoskeletal changes in hotel maids of the sea coast of Maceió, Alagoas

Introdução: Os distúrbios osteomusculares relacionados ao trabalho são responsáveis por uma parcela significativa das causas de queda de rendimento do trabalhador. Objetivo: O objetivo neste trabalho foi avaliar os indicadores de qualidade de vida, capacidade funcional e alterações osteomusculares em camareiras de hotéis da orla marítima do município de Maceió, Alagoas. Métodos: Este estudo descritivo do tipo transversal e quantitativo foi realizado com 36 camareiras, por meio da aplicação de três questionários validados no Brasil. Resultados: Verificou-se que a maioria delas apresentou uma qualidade de vida relativamente boa. Referente às alterações osteomusculares, constataram-se predomínio de lesões em punho, mãos, dedos e na região lombar, além disso, observou-se que quanto maior a idade e o tempo de exercício na profissão menor a capacidade funcional. Conclusão: Sugere-se a implementação de medidas preventivas de doenças relacionadas ao trabalho e promotoras de melhor condição de saúde para as camareiras.

Introduction: The work-related musculoskeletal disorders are responsible for a significant portion of the causes of falling income of the worker. Objective: The aim in this study was to evaluate the indicators of quality of life, functional capacity and musculoskeletal changes in hotel maids of the seacost in the city of Maceió, State Alagoas. Methods: This cross-sectional descriptive and quantitative study was conducted with 36 hotel maids of the seacost of Maceió, reaching the objective through the application of three validated questionnaires in Brazil. Results: It was found that most of the hotel maids had a relatively good quality of life, with a predominance of lesions in the wrist, hands, fingers and lower back, moreover, it was observed that the greater age and duration of exercise as hotel maid, minor the functional capacity. Conclusion: It was suggested the implementation of preventive measures of work-related diseases and promote better health condition for the hotel maids.

The Management Outcome of Acute Hand Injury in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia

Background: Hand is the most commonly injured part of our body. The aim of treatment islways to restore its movement; strength and dexterity. The quality of primary treatment often determines the maximal potential for recovery. The objective of this study was to evaluate the management outcome and consequences of the injured hand. Methods: Between 1st January 2005 and 31st December 2005; a total of 253 patients were treated in Tikur Anbessa University Hospital for acute hand injury that presented within the first 24 hours of the occurrence. We evaluate the mechanism of injury; types and duration of treatments and complications. Results: The mean age was 32 years and the male to female ratio was 7:1. The majority of patients were wood worker (32) followed by laborers (25) and machine operators (15).Three quarter of the injuries occurred at work; of which 74were caused by machines. The commonest injuries included fracture in 39of which the majority (85)mwere compound;amputation in 31and soft tissue injury in 26. The injury severity was moderate and above in 54. Most were managed at emergency out-patient department and the average total treatment time was 93 days. The average impairment of hand function before and after treatment was 6and 19respectively. The main reason for more loss of function after treatment were more proximal corrective amputation (31); prolonged immobilization (28)in nonfunctional position (17)); healed in unacceptable position (19) and infection (13).Final results were poor in 62; this was not significantly associated with severity of the injury.Conclusion: Improving treatment of injured hand and establishing specialized center for hand injury may shorten duration of treatment and improve result

Analysis of hand fractures in Kuwait

To analyze hand fractures in Kuwait and to detect any findings that characterize our population A retrospective study Al-Razi Hospital, Kuwait All patients with hand fractures seen in the hand unit in 2005 were included in this study. Incidence of hand fractures, site and location of fracture The annual incidence of hand fractures was 93.5 per 100,000 individuals. The age group 25-34 years had 35.6% of fractures and represented the biggest group in carpal, metacarpal and phalangeal fractures. The male to female ratio was 5:1 and the right to left hand ratio was 1.2: 1. Non-Kuwaiti nationals had 61% of fractures and 66.7% out of them sustained their fractures at work. The little finger is the most frequently injured finger and the terminal phalanx is the most frequently injured bone. In children the majority of fractures occur at home and crush injury was the mechanism in 79.9% of children four years old and younger. Our results show that a high percentage of fractures occur in non-Kuwaiti nationals at work and there is a high male to female ratio. This is partly explained by the composition of the population in Kuwait

Sea urchin granuloma / Granulomas por ouriços-do-mar

Injuries caused by venomous and poisonous aquatic animals may provoke important morbidity in humans. The phylum Echinoderma include more than 6000 species of starfish, sea urchins, sand dollars, and sea cucumbers some of which have been found responsible for injuries to humans. Initial injuries by sea urchins are associated with trauma and envenomation, but later effects can be observed. Sea urchin granuloma is a chronic granulomatous skin disease caused by frequent and successive penetration of sea urchin spines which have not been removed from wounds. The authors report a typical case of sea urchin granuloma in a fisherman and its therapeutic implications.

Os acidentes por animais aquáticos traumatizantes e venenosos podem provocar morbidez importante em humanos. Equinodermos marinhos incluem mais de 6000 espécies de estrelas-do-mar, ouriços-do-mar, "bolachas-de-praia" e pepinos-do-mar. Vários equinodermos têm sido responsabilizados por acidentes em humanos. Granulomas por ouriço-do-mar são lesões de caráter granulomatoso, crônicas, causada por acidentes com espículas de ouriço-do-mar. Os autores relatam um caso típico de granulomas por ouriço-do-mar ocorrido em um pescador e enfatizam as implicações terapêuticas aplicadas.

Shock eléctrico asociado a fractura de falange media del dedo medio de mano izquierda / Electric Shock associated to fracture of half phalange of the half finger of hand left

Lesiones por shock eléctrico son descritas en la literatura determinando lesiones locales y sistémicas. Lesiones esqueléticas como luxaciones y fracturas son infrecuentes en nuestras emergencias; aparentemente asociadas a contracciones tetánicas de la musculatura circundante. Describimos un paciente femenino, 43 años, ingresado a la emergencia posterior a sufrir choque eléctrico con electrodoméstico (nevera), refiere sitio de entrada en cara volar de los últimos cuatro dedos de mano izquierda, con exposición aproximada de 30 segundos, se interrumpe desconectando electrodoméstico, niega perdida de conciencia y traumatismo directo e indirecto en miembros. Niega antecedentes importantes. Signos vitales normales, sin signos de traumatismo corporal, posterior al ingreso refiere molestia para la flexo-extensión de mano izquierda, presentando dolor a la palpación profunda sobre la Falange Media del dedo medio. La Radiografía Postero-Anterior evidencia fractura espiroidea no desplazado desde apífisis distal hasta diáfisis de Falange medial del dedo medio de la mano izquierda. Es inmovilizada con férula digital, observada durante 24 horas y egresada previo descarte de lesiones sistémicas importantes. Estas fracturas son de fácil diagnóstico cuando comprometen articulaciones y huesos grandes pero nunca olvidar las fracturas de huesos y articulaciones pequeñas ante una clínica leve.

Prevalência de lesões na temporada 2002 da Seleção Brasileira Masculina de Basquete / Prevalence of injuries of Brazilian Basketball National Team during 2002 season

Este estudo objetiva apresentar a prevalência, provável etiologia e localizaçäo das lesöes da Seleçäo Brasileira de Basquete masculina adulta durante a fase de preparaçäo e o 14º Campeonato Mundial de Basquetebol, em 2002. No total, foram 102 queixas correspondendo ao período de 1/7/02 a 10/9/02, com média de 2,55 lesöes/mês/jogador. Encontrou-se maior índice de lesöes atraumáticas, incluindo as musculares, doenças sistêmicas e lesöes tendinosas (66/102 queixas), ou seja, 64,7 por cento do total. Dentre as lesöes traumáticas, as mais freqüentes foram as entorses de tornozelo (13/102 lesöes) com 12,8 por cento, seguidas dos traumas diretos (contusöes) na regiäo das mäos (9/102 lesöes), com 8,8 por cento. Em relaçäo ao local de acometimento, as maiores queixas foram nos membros inferiores (49 /102), com 48,0 por cento e membros superiores (14/102), com 13,7 por cento. Quanto à gravidade, lesöes leves representaram 57,8 por cento, seguidas das moderadas e graves, com 32,4 por cento e 9,8 por cento, respectivamente. Em relaçäo à posiçäo de jogo, os pivôs foram os atletas que apresentaram maior número de queixas, 45, representando 44,1 por cento do total, sendo estas devido, principalmente, ao contato físico na regiäo do garrafäo. Dessa forma, por ser um esporte de extremo contato, as lesöes traumáticas, principalmente em mäos e coxas, e as entorses de tornozelo säo altamente representativas, sendo os membros inferiores os mais acometidos

Epidemiology of hand injury in Qatar

Hand injuries in Qatar have not been studied previously.In this study, 100 consecutive cases of hand injuries were studied to highlight the epidemiology of hand injuries in Qatar. The aim of this study is to compare the hand injuries in Qatar with other regions as we noticed most of our patients were involved in severe industrial injuries. The results were unique because manual workers were involved in industrial injuries in 59% of the cases which represents a high percentage in comparison to other studies so control measures should be taken. The male to female ratio was 10.1:1, with mean age for injury 29 years, the right and left hands were injured almost equally, the dominant hand was the right side in 99%, middle finger was the most frequently injured in 24.6% of the cases, distal phalanges were injured most frequently. The local people represent 20% of all cases of hand injuries. Discussion and explanation are included with each finding. Hand injuries are rarely life threatening but may cause major disability, loss of working days and severe psychological distress. In countries that are in the process of industrialization, factory regulations regarding safety are frequently implemented with laxity, as a result the incidence of industrial hand injuries is relatively high in developing countries

Nitric acid full thickness hand burn, delay excision and skin grafting

Nitric acid hand burn is rarely described in the literatures, there is no standard policy for management of this injury, and difficulties in assessing the depth of the burned area in the early stages of the disease makes primary excision and skin grafting delayed. The risk of stiff ness of the hand as a result of delay Eschar excision was managed by using krishner wire fixation of the metacarpophalangeal joint in functional position after Eschar excision

Accidentes de la mano en trabajadores de la costa oriental del lago de Maracaibo del Estado Zulia, Venezuela, 1986-1993 / Hand injuries in workers on the eastern shore of Marcaibo Lake in the state of Zulia, Venezuela, 1986-1993

In order to analyze the frequency, injury rate and cause of on site accidents to the hands of workers on the east coast of lake of Maracaibo in Zulia State, data was obtained from the accident reports registered with the Venezuelan Institute of Social Security. An occupational hand injury was defined as a traumatic injury to the hands, fingers or wrists that occurred while the employee was at work; that resulted from a single exposure to a hazardous agent. The following variables were analyzed: age, severity, economic activity, material agent, mechanic cause, type of injury, type of accident and unsafe action. The frequency rate was used to analyze the annual accident rate. During the period under study 2.456 injuries to the hand were registered, representing 36 of the total injuries reported; 95 were light injuries, 5 incapacitating and two cases resulted in the death of the worker. 72 of the injuries were located in the fingers, 22 in the hands and 6 in the wrists. The greatest frequency of injuries were found in the economic activity in mines and quarries with a rate of 123.1 per thousand. The age group most affected was of 20-29 years (42), Wounds or contusions and crushings were the injuries most commonly reported, in 39 and 36 of the cases respectively. The main type of injuries were caused by run over, running into or blow from objects. The principal agents causing injuries were materials, substances and radiations in 45 of the cases. It is concluded that the hand injury rate is very high in the exploitation of mines and quarries and represents the main cause of worker's disability.

Ferimentos de mäo em acidentes de trabalho / Injuries to the hand in occupational accidents

Este trabalho aborda os acidentes de trabalho com injúria de mäo atendidos num serviço de emergências médicas durante um período de 10 meses, retratando suas causas, características e fatores contribuintes. A taxa de acidentes de mäo correspondeu a 7,4 por cento do total dos acidentes havendo predomínio do sexo masculino numa razäo de 7,3:1. A idade média dos pacientes foi de 30,7 +- 12,6 (14-65 anos). näo ocorreu diferença de acometimento entre as mäos (direita/esquerda), assim como também näo houve relaçäo entre a mäo dominante e injúria. Da totalidade dos casos, 17,0 por cento necessitaram de tratamento especializado

Trauma do membro superior e mäo em acidentes do trabalho / Incidence of arm upper limb traumatisms in occupational accidents

Os autores realizaram um estudo com dados obtidos em uma revisäo de 12.436 prontuários de trauma de membro superior no período de janeiro/1983 a dezembro/1991, constatando-se um total de 11.307 traumas particulares da mäo. Para analisar os dados se elaborou um protocolo semelhante aos utilizados para pesquisa das mesmas informaçöes em serviços de iguais características de atendimento no país e no exterior. Os resultados revelaram que Caxias do Sl, sendo área de industrial metalúrgica, apresenta predomínio de acidentados do sexo masculino, entre a segunda e quarta década de vida e acidentando-se quase que só na empresa. Elaborou-se uma tabela de diagnósticos relacionada com outra que indica os primeiros tratamentos dispensados. A pesquisa investiga também a quantidade de sequelas e encaminhamentos, bem como o total de dias de afastamento do trabalho. Revela, por fim, que os dados de Caxias do Sul, quando comparados com áreas de iguais características no país e exterior, apresenta índices de acidentes e traumas do membro superior e, particularmente, da mäo, preocupantes. Tais índices sugerem descaso das autoridades, dos empresários e dos próprios operários no que diz respeito à segurança do trabalho. Tal fato revela um problema grave, devendo ser a soluçäo encontrada no mais curto espaço de tempo

Heridas de los miembros superiores (manos): sus causas, su diagnostico y su manejo / Upper limbs injuries (hands): their causes, diagnosis and management

Las heridas de mano tienen importantes consecuencias en la economia familiar. Este articulo analiza las diferentes causas de este tipo de trauma y revisa el manejo inicial adeacuado que debe ser tenido en cuenta por el personal medico y paramedico responsable del tratamiento de tales pacientes. Se analizan tambien algunos aspectos relacionados con las inmovilizaciones, cierre primario y tratamiento quirurgico posterior; tambien se analizan los diferentes tipos de lesiones causadas por maquinas.

El uso de transfijadores externos en los grandes traumatismos de la mano / The use of external transfixators in large traumas of the hand

Los fijadores externos, tienen aplicacion, en el tratamiento de fracturas abiertas de tipo dos y tres, es decir donde el dano de los tejidos blandos es grande. La experiencia de su uso en los miembros inferiores es grande, no asi en los miembros superiores. Se describe la fabricacion de un tutor de minimos requerimientos de material, de muy bajo costo, con buenos resultados en todos los casos. Sin complicaciones de importancia, se relata su uso, en 7 pacientes, uno de ellos en forma bilateral.