Early psychological aspects of severe hand injury.

We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%). Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.

Intraosseous wiring of complex hand fractures.

Our results with the use of intraosseous wires for 72 complex, open fractures are reported. The technique is described, and attention to detail is emphasized. The technique is indicated especially for articular or comminuted fractures with multiple small fragments. It also provides solid, anatomic fixation for other types of fractures and for replants. A K-wire may be added if necessary and is usually used if there has been some bone loss. Complications have been few, most the result of displacement at the fracture site due to improper use of the technique. A major advantage of the solid fixation obtained with this technique is that it avoids or minimizes the need for postoperative splinting and allows early active and passive range of motion. It is our impression that this has minimized joint stiffness and tendon adhesions and improved functional results.