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1.
Front Public Health ; 10: 851175, 2022.
Article in English | MEDLINE | ID: covidwho-1952789

ABSTRACT

High-pressure injection injury of the hand is a rare but severe emergency, which requires full attention and timely treatment. However, the early symptoms may not be obvious. As the swelling and necrosis progress, the condition gradually worsens, and in severe cases, it may end with amputation. We report a particular case of a hand injection injury, which occurred to a worker who worked overtime to produce disinfectant during the Coronavirus Disease-19 (COVID-19) pandemic. Because of the chemical toxicity of the disinfectant and pressure's damage, although the emergency debridement was promptly performed, we still lost some fingers in the end. In the existing disinfection product manuals, we have not seen any tips on dealing with tissue injection injury. It may reduce workers' attention to injuries, leading to delays in emergency operations.


Subject(s)
COVID-19 , Disinfectants , Hand Injuries , Disinfectants/adverse effects , Disinfection , Hand Injuries/etiology , Hand Injuries/surgery , Humans , Pandemics
2.
PLoS One ; 17(2): e0263435, 2022.
Article in English | MEDLINE | ID: covidwho-1793529

ABSTRACT

INTRODUCTIONS: The rate of acute hand trauma visits to emergency departments (ED) and surgeries decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national lockdown during the first wave and the regional restrictions during the second wave on the rate of visits to the ED and urgent hand surgeries in Finland. METHODS: Material for this retrospective study was gathered from three Finnish hospitals All ED visits and urgent or emergency surgeries from January 2017 to December 2020 were included. Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and compared by incidence rate ratios (IRR). RESULTS: The incidence of hand injury was lower after the beginning of the lockdown in March 2020 (IRR 0.70 CI 0.63-0.78). After lockdown ended in May, the monthly incidences of ED visits returned to the reference level. During the lockdown, the incidence of fractures and dislocations was 42% lower in March (IRR 0.58 CI 0.50-0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57-0.80). The incidence of fracture repair surgeries was 43% lower in March 2020 (IRR 0.57 CI 0.35-0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36-0.98). Incidence of replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53-4.20) and 200% higher in July 2020 (IRR 3.00 CI 0.68-13.2) but these increases had high uncertainty. CONCLUSIONS: The rate of ED visits due to hand injuries decreased while the rate of emergency hand operations remained unchanged during the national COVID-19 lockdown in spring. After the lockdown, the incidences returned to reference level and were unaffected by regional restrictions during the second wave of pandemic.


Subject(s)
Emergency Medical Services/trends , Hand Injuries/epidemiology , Adult , COVID-19 , Emergency Medical Services/statistics & numerical data , Emergency Service, Hospital , Female , Finland/epidemiology , Hand/surgery , Hand Injuries/surgery , Hospitalization , Hospitals , Humans , Incidence , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
3.
J Hand Surg Eur Vol ; 47(6): 562-567, 2022 06.
Article in English | MEDLINE | ID: covidwho-1785101

ABSTRACT

COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.


Subject(s)
COVID-19 , Hand Injuries , Orthopedic Procedures , COVID-19/epidemiology , Hand/surgery , Hand Injuries/surgery , Humans , Pandemics
4.
Arch Orthop Trauma Surg ; 142(6): 1289-1299, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1704841

ABSTRACT

INTRODUCTION: Although Covid-19 and especially lockdown periods have affected our everyday live, its impact on hand traumatology is under investigated. MATERIALS AND METHODS: We retrospectively analyzed all patients presenting at a FESSH accredited HTRC and level 1 trauma center in Germany during the Covid-19 lockdown period and an equivalent timeframe in 2019 regarding incidence of hand trauma, injury mechanism, type of injury and hand surgeries. RESULTS: 338 patients presented at our department with acute hand injuries. A significant reduction of work-related accidents was found during lockdown contrary to an increase of do-it-yourself related trauma. Although the incidence of hand trauma decreased during lockdown by 18%, the rate of hand surgery increased in absolute and relative numbers. CONCLUSIONS: Although Covid-19 has negatively impacting elective and semi-elective surgeries, acute hand surgery has gained in importance represented by a shift from work related to do-it-yourself trauma and an increased rate of surgical treatment. LEVEL OF EVIDENCE: IV (therapeutic).


Subject(s)
COVID-19 , Hand Injuries , Communicable Disease Control , Hand/surgery , Hand Injuries/epidemiology , Hand Injuries/surgery , Humans , Retrospective Studies , SARS-CoV-2 , Trauma Centers
5.
Ann Chir Plast Esthet ; 67(2): 86-92, 2022 Mar.
Article in French | MEDLINE | ID: covidwho-1698890

ABSTRACT

OBJECTIVES: In France, a lockdown was enforced from March 17 to May 11, 2020. It was renewed with different modalities from April 3 to May 3, 2021. Our objective was to compare the epidemiology of hand and wrist trauma injuries during these periods to a control period, with the hypothesis of a decreased incidence of hand and wrist trauma. METHODS: Patients consulting at a trauma emergency center of a university hospital labeled SOS-Mains were included during lockdowns, and were compared with a control group who consulted during an equivalent period in 2019. We retrospectively collected demographic and clinical data in relation to hand and wrist injuries. RESULTS: During lockdowns, there was an increase in these injuries relative to the total number of patients (from 16% to 22% and 18%). We found a decrease during the first lockdown in the number of fractures, amputations, burns, infections, injuries secondary to a work accident and isolated wounds but a significantly higher proportion of tendon and vasculonervous injuries in the first lockdown (12% vs. 4%). CONCLUSIONS: In first lockdown, the incidence of hand and wrist injuries decreased, but there was an increase in tendon and microsurgical injuries. This may be explained by the change in leisure activities. This underlines the importance of preventive measures concerning the risks related to some activities (use of sharp/motorized tools) in this context of health crisis.


Subject(s)
COVID-19 , Hand Injuries , Wrist Injuries , COVID-19/epidemiology , Communicable Disease Control , Hand Injuries/epidemiology , Hand Injuries/etiology , Hand Injuries/surgery , Humans , Incidence , Retrospective Studies , SARS-CoV-2 , Wrist Injuries/epidemiology , Wrist Injuries/etiology
6.
J Plast Reconstr Aesthet Surg ; 74(11): 3080-3086, 2021 11.
Article in English | MEDLINE | ID: covidwho-1293613

ABSTRACT

BACKGROUND: Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. RESULTS: Overall, 556 patients - 'Pre-COVID-19' (n = 310) and 'During COVID-19' (n = 246) - were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00-6.37 and p < 0.05). The absolute risk of SSI in the 'Pre-COVID-19' group was 2.3% and 5.3% in the 'During COVID-19' group. The relative risk of developing an SSI in the 'During COVID-19' group was 2.34 (95% CI, 0.95-5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups. CONCLUSION: The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3-5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.


Subject(s)
COVID-19/epidemiology , Hand Injuries/surgery , Surgical Wound Infection/epidemiology , Wrist Injuries/surgery , Adult , Cohort Studies , Female , Hand Injuries/epidemiology , Humans , Interrupted Time Series Analysis , Male , Middle Aged , Pandemics , Retrospective Studies , United Kingdom/epidemiology , Wrist Injuries/epidemiology , Young Adult
7.
Hand Surg Rehabil ; 40(3): 235-240, 2021 06.
Article in English | MEDLINE | ID: covidwho-1126833

ABSTRACT

This work aimed to identify the lead causes of upper limb injury presenting to a busy hand and major trauma unit during the UK COVID-19 domestic lockdown period, in comparison to a cohort from the same period one year previously. Hand and upper limb injuries presenting to the host organization during a pre-lockdown period (23rd March 2019-11th May 2019) and the formal UK lockdown period (23rd March 2020-11th May 2020) were compared, using data collated from the host institution's hand surgery database. The UK lockdown period was associated with a 52% fall in the number of patients presenting to the service with hand and upper limb injuries (589 pre-lockdown vs. 284 during lockdown). There was a significant increase in the proportion of injuries due to machinery use during lockdown (38, 6.5% pre-lockdown vs. 33, 11.6% during lockdown, P = 0.009), other etiologies were consistent. The proportion requiring surgical management were similar (n = 272, 46.2% pre-lockdown vs. n = 138, 48.6% during lockdown, P = 0.50). The proportion requiring overnight admission fell (n = 94, 16.0% pre-lockdown vs. 29, 10.2% during lockdown, P = 0.022). COVID-19 related lockdown in the UK resulted in a reduction in the presenting numbers of hand related injuries; however almost half of these patients still required surgery. These data may be of use to other hand surgery centers for resource planning during future lockdown periods, and for injury prevention strategies in the post-COVID-19 world.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control , Hand Injuries/epidemiology , Hand Injuries/etiology , Upper Extremity/injuries , Cohort Studies , Hand Injuries/surgery , Humans , Orthopedic Procedures/statistics & numerical data , Pandemics , Patient Admission/statistics & numerical data , Retrospective Studies , United Kingdom/epidemiology , Upper Extremity/surgery
8.
Injury ; 52(4): 679-685, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1099131

ABSTRACT

INTRODUCTION: hand injuries are a common emergency mainly caused by domestic accidents or sport injuries. During the COVID-19 pandemic confinement period, with a cut off in transportation as well as in occupational and physical activities, we observed a decrease in medical and elective surgical activities but emergency cases of upper limb and hand surgery increased. MATERIALS AND METHODS: we conducted a retrospective epidemiological study to analyze two periods between the same dates in 2019 and 2020, for all the duration of the confinement period. We compared the numbers of consultations in the emergency department, elective surgeries, hand and upper limb emergency cases in our center and urgent limb surgeries in the nearby hospital. Then we compared the mechanisms and severity of injuries and the type of surgery. RESULTS: between 2019 and 2020 there was a decrease of consultations in the emergency department in our institution of 52%, a decrease of total elective surgeries of 75%, a decrease in surgeries for urgent peripheral limb injuries of 50%, whereas the hand and upper limb emergency remained stable or even increased by 4% regard to occupational and domestic accidents. There was a significant difference in the mechanism of injury with an increase of domestic accident and a decrease of occupational, road traffic and sport accidents. Severity of the injuries increased, with augmentation of the number of tissues involved and longer expected time of recovery. CONCLUSION: during the confinement period of the COVID-19 pandemic, despite an important reduction of medical activities, the amount and severity of hand emergency cases increased. A specific plan regarding duty shift organization for hand trauma should be maintained regardless of the sanitary situation.


Subject(s)
COVID-19 , Hand Injuries , Hand Injuries/epidemiology , Hand Injuries/surgery , Humans , Pandemics , Retrospective Studies
10.
Int Orthop ; 44(8): 1497-1501, 2020 08.
Article in English | MEDLINE | ID: covidwho-996376

ABSTRACT

PURPOSE: The lockdown imposed in France to cope with the COronaVIrus Disease 2019 (COVID-19) outbreak has led to major changes in the lifestyle of French citizens. The aim of our study was to study its impact on activity related to emergencies in hand and upper limb trauma in comparison to the same reference period in 2019. MATERIAL AND METHODS: All consecutive patients consulting for upper limb injury requiring urgent care at Georges-Pompidou European Hospital (HEGP), France, during the lockdown period (case group) and the equivalent period in 2019 (control group) were included. In each group, the type of accident, the anatomical location of the injury, and the treatment were reported and compared. RESULTS: Two hundred seventy-five patients were included in the case group in comparison to 784 patients in the control group. We observed a two-third decrease in the rate of upper limb emergencies (- 64.9%) in particular a drastic drop in the rate of road, work, and leisure accidents (10.4% vs 14.3%, p = 0.1151; 10.0% vs 22.6%, p < 0.0001; 13.1% vs 30.8%, p < 0.0001, respectively), and a clear increase in domestic accidents (66.5% vs 32.3%, p < 0.0001). The aetiologies were more dominated by lacerations of soft tissues (48.4%, vs 38.3%, p = 0.0034) and infections (8.7% vs 5.1%, p = 0.0299) with an increase in the indications for surgical management (51.2% vs 36.9%, p < 0.0001). Conversely, we observed fewer consultations for joint injuries (20.7% vs 30.7%, p = 0.0015) and fractures (22.2% vs 25.9%, p = 0.2210). CONCLUSION: The lockdown imposed in France has changes the etiologies and the management of hand and upper limb emergencies.


Subject(s)
Betacoronavirus , Coronavirus Infections , Hand Injuries , Pandemics , Pneumonia, Viral , Upper Extremity/injuries , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Emergencies , Female , France , Hand Injuries/surgery , Humans , Male , Middle Aged , SARS-CoV-2 , Trauma Centers , Universities , Upper Extremity/surgery , Young Adult
15.
Hand Surg Rehabil ; 39(5): 459-461, 2020 10.
Article in English | MEDLINE | ID: covidwho-696547

ABSTRACT

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.


Subject(s)
Coronavirus Infections/epidemiology , Emergency Treatment/statistics & numerical data , Hand Injuries/epidemiology , Hand Injuries/surgery , Pneumonia, Viral/epidemiology , Quarantine , Adolescent , Adult , Aged , COVID-19 , Child , Child, Preschool , Cross-Sectional Studies , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Infant , Male , Middle Aged , Pandemics , Retrospective Studies , Spain/epidemiology , Young Adult
17.
Hand Surg Rehabil ; 39(5): 454-458, 2020 10.
Article in English | MEDLINE | ID: covidwho-631560

ABSTRACT

Since the first cases were detected in China in December 2019, the COVID-19 pandemic has spread rapidly, collapsing many healthcare systems, and forcing them to adapt. Hand surgery has been indirectly affected by this scenario. This article aims to provide an overview on how Spanish hand surgeons have modified their daily practice. Based on a survey conducted nationwide, we observed a decrease in the number of emergency cases and cancellation of elective cases, shift to a more conservative treatment approach, use of personal protective equipment, and decrease in the number of outpatient visits and tests. Without definitive evidence at this point, knowing how we have dealt with the situation so far will help us adopt the needed measures to ensure both the patient's and surgeon's safety and manage available resources in future pandemics.


Subject(s)
Coronavirus Infections/epidemiology , Hand Injuries/surgery , Orthopedic Procedures/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians' , Reconstructive Surgical Procedures/statistics & numerical data , COVID-19 , Emergency Treatment/statistics & numerical data , Health Care Surveys , Humans , Pandemics , Spain/epidemiology
18.
Postgrad Med J ; 96(1137): 379-383, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-596393

ABSTRACT

INTRODUCTION: Managing healthcare service during pandemics and outbreaks is a challenging process. The aim is to keep patient safety as the priority, besides, continuing to provide essential healthcare services. METHODS: Situational audit was performed for the services rendered before and during COVID-19 pandemic and the elevation of the disease alert status, and a retrospective analysis of the attendance and procedures performed in the service. RESULTS: We present a methodology for performing a situational audit and generating service modification for hand and reconstructive microsurgery unit in a pandemic. There was no significant difference between the number of patients seen at outpatient clinics. However, there was a reduction in the numbers of total surgeries performed, with a 40% drop in the number of elective surgeries performed. There was also a reduction of cases seen in the emergency department hand clinic. DISCUSSION: COVID-19 pandemic is currently affecting not only the health service but also, other vital services all over the world. The pandemic puts significant challenges to acute surgical services in a hospital system involved in the management of the pandemic. Surgeons need to take proactive and a systematic approach in managing the available resources while maintaining essential surgical services. This paper provides the tools and methodology for doctors to plan their services in a pandemic situation. CONCLUSIONS: It is possible to maintain essential surgical services in a pandemic situation through rapid situational audits and generating localised strategies while considering the constraints imposed during the pandemics while maintaining patient and staff safety.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Hand Injuries/surgery , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Reconstructive Surgical Procedures/methods , COVID-19 , Clinical Audit , Humans , Microsurgery , Patient Safety , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2 , Singapore/epidemiology
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