The exploded hand syndrome: a report of five industrial injury cases

Abstract

The term 'exploded hand syndrome' refers to a specific type of crush injury to the hand in which a high compressive force excessively flattens the hand leading to thenar muscle extrusion through burst lacerations. Out of 89 crushed hands seen over a period of seven years, only five had exploded hand syndrome. They were all male industrial workers ranging in age between 24 and 55 years. All patients had thenar muscle extrusion. Other concurrent injuries included fractures/dislocations, compartment syndrome, and ischaemia. All patients were treated by excision of the extruded intrinsic muscles, as well as primary management of concurrent injuries. All patients had functional assessment including: motor power and sensory testing, range of motion of hand joints, and the quick DASH score. Objective testing showed reduced sensibility in the thumb, reduced grip strength (mean 52% of contralateral hand), reduced pinch strength (mean of 27% of contralateral hand), reduced thumb opposition (the mean Kapandji Score was 5 out of 10), and deficits in the range of motion of the metacarpophalangeal and interphalangeal joints of the thumb. The quick DASH score ranged from 11 to 49 and only two patients were able to go back to regular manual work.

My journey in hand surgery: combining patient care, clinical and basic science research

“…I work as a part-time hand surgeon at a hospital treating industrial injuries. These injuries are well described in the literature, and I described two specific patterns: the ‘exploded hand syndrome’ is caused by a high and sudden compressive force on the hand, which is frequently of very short duration, leading to intrinsic muscle extrusions through burst skin lacerations (Al-Qattan, 2013e); in contrast, the ‘triad injury’ of multiple metacarpal fractures, compartment syndrome of the hand and acute median nerve dysfunction (Al-Qattan, 2008a) is caused by a sustained compressive force on the hand.…”

Etiology of Trauma-Related Acute Compartment Syndrome of the Hand: A Systematic Review

“…Six articles provided relevant data about seven fractured patients who developed ACS (5.4% of all patients) [ 13 , 15 , 26 , 28 , 31 , 40 ]. Two of these identified 1st metacarpal bone being the most prevalent site of fracture leading to up to two cases (28.8%) of fractured patients causing ACS [ 15 , 28 ], followed by other types of fracture which represent one case for each type - 2nd, 3rd, and 4th metacarpal bones fracture [ 26 ], 3rd metacarpal and triquetrum [ 15 ], distal radius and ulnar styloid fracture [ 13 ], distal radius, scaphoid, triquetral, and capitate bones [ 31 ] and dislocation of hamate with hook fracture (Table 2 ) [ 41 ].…”

Hand Surgery in Saudi Arabia

“…This led to the accumulation of a vast experience with such injuries along with numerous related publications. [10][11][12] Inflammatory hand conditions are common worldwide. Tuberculosis is endemic in Saudi Arabia; as a result, tuberculosis of the hand is frequently seen in clinical practice.…”