Fatal bilateral lower-limb deep vein thrombosis and pulmonary embolism following single digit replantation.

Venous thromboembolism in hand surgery is rare. There is no report in the literature on postoperative mortality from venous thromboembolism following microsurgery in upper limbs. We report the case of a 56-year-old Chinese man who died from pulmonary embolism as a result of bilateral lower-limb deep vein thrombosis following prolonged surgery under general anaesthesia after replantation of a finger. This case raises awareness of the need for precautions against venous thromboembolism following prolonged microsurgery and identification of high-risk patients.

Current management of acute scaphoid fractures: a review.

The aim of this review was to present currently available evidence on the management of acute scaphoid fractures. Acute scaphoid fractures are usually diagnosed by a combination of history, physical examination, and radiography. However, in many patients scaphoid fractures are still missed. Thus, the general trend is to over-treat patients with a suspicion of scaphoid fracture. Many aspects of scaphoid fracture management are still controversial and different institutions vary in their approach.

Epidemiology of occupational hand injury in Hong Kong.

OBJECTIVES: To study the epidemiology of occupational hand injuries and associated social and industrial factors. DESIGN. For this retrospective case series of patients with occupational hand injuries, case records were retrieved to gather data. In addition, all the subjects were interviewed by a single interviewer using a predesigned questionnaire. SETTING: Division of Hand Surgery, Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong. PATIENTS: A total of 250 patients with occupational hand injuries were treated during the period from 1999 to 2001. This period was chosen to obtain 10 years of follow-up data to assess return to work and any secondary injuries. MAIN OUTCOME MEASURES: Personal particulars (gender, age, marital status, education level, length of stay in Hong Kong, type of employment, wage system, personal habits, family size, number of breadwinners, income), type of industry and mode of injury, causes of injury according to the worker, work conditions, type of injury, and treatment given. RESULTS: Two groups of workers in our study had more occupational hand injuries, namely those with less than 1 year of experience on a new job and immigrants from China. Factors associated with a large proportion of occupational hand injuries were male gender with personal risk factors (smoking and regular consumption of alcohol, long working hours), and in the case of machine operators, inadequate training and use of safety devices. CONCLUSION: Occupational hand injuries lead to loss of working hours and compensation. For prevention, the workplace should be made into a safer and work-friendly environment. Workers should also have sufficient training.

Multiple triggering in a girl with Ehlers-Danlos syndrome: case report.

We report a case of multiple triggering associated with Ehlers-Danlos syndrome. We postulate that the propensity for tendon degeneration in Ehlers-Danlos syndrome coupled with repetitive microtrauma might lead to fraying of the tendon fibers and, consequently, triggering. Indeed, in our case, debridement of the tendons rather than resection of A1 pulley resulted in a good long-term functional outcome 2 years after surgery.

Overprotection and the psychological states of cerebral palsy patients and their caretakers in Hong Kong: a preliminary report.

OBJECTIVE: To examine the relation between perceived overprotection and the psychological states of cerebral palsy patients and their primary caretakers in Hong Kong. DESIGN: Cross-sectional survey, in which data of 14 pairs of cerebral palsy patients and their caretakers were analysed. SETTING: Duchess of Kent Children's Hospital, Hong Kong. PARTICIPANTS: Cerebral palsy patients and their primary caretakers in Hong Kong. MAIN OUTCOME MEASURES: Perceived overprotection and psychological states. RESULTS: Nearly two thirds of the 14 patients (mean age of 15 years) and 86% of the 14 primary caretakers (mean age of 47 years) perceived various levels of overprotection. For both patients and caretakers, perceived overprotection was positively associated with anxiety and unhappiness. The patients' and caretakers' psychological states and perception of overprotection were not related to the actual motor ability of the patients. Perceived overprotection of the patients was not related to that of the caretakers. CONCLUSION: Caretakers should be mindful that a well-meaning move may have undesirable consequences. More support and child-rearing education should be considered for caretakers.

"A free thenar flap--a case report".

We present a case report of a free thenar flap surgery done for a volar right hand middle finger, distal and middle phalanx degloving injury. A free thenar flap is a fasciocutaneous sensate flap supplied by a constant branch of the superficial radial artery and its variable nerve supply. It has a distinct advantage of low donor site morbidity, better cosmesis and texture of the flap. No immobilization is required postop. The donor site can be closed primarily.

The use of Disabilities of the Arm, Shoulder, and Hand Questionnaire in rehabilitation after acute traumatic hand injuries.

This longitudinal observational prospective study evaluates the use of a self-reported measure Disabilities of the Arm, Shoulder, and Hand (DASH) in assessing traumatic hand injury patients. A total of 146 subjects were invited to fill out a validated questionnaire (DASH) during their first consultation and at discharge from therapy. The findings revealed a significant improvement in DASH scores upon discharge from therapy. The use of Quick DASH, an 11-question shortened version of the full 30-question DASH, also generated similar results with the psychometric properties maintained. Despite the low correlation between DASH and the therapists' measures of recovery of power grip, the results of this study confirmed the effectiveness of using the DASH in assessing traumatic hand injury patients. Clinical implications suggest that the DASH can be used to assess the improvement in the functional status of traumatic hand injury subjects, as well as to enhance therapists' understanding of the subjects' perspective regarding their disability, and to assist in effective treatment planning. Further study on the application of the Quick DASH in larger population, and its association with functional status is suggested.

Physiological and biomechanical principles in splinting the traumatised hands.

The aim of this article is to review the biological sequence of wound repair and the rationale of using splintage to modify the healing process. Appropriate use of splintage and controlled stress can prevent adhesion and periarticular fibrosis. Splinting prescribed at appropriate timing and methods will enhance wound healing and tissue remodelling. In reverse, it will cause permanent damage to the tissues.