The Exploded Hand Syndrome: Logical Evaluation and Comprehensive Treatment of the Severely Crushed Hand

Graham, Thomas

doi:10.1016/j.jhsa.2006.04.007

Cited by 36 publications

(13 citation statements)

References 17 publications

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“…Approaching the injured hand with a logical and systematic diagnostic plan allows surgeons to recognize the location and severity of the injury portfolio and primary comprehensive treatment. Understanding the trauma mechanism and patterns of injury in the injured hand will maximize awareness and guide surgical reconstruction, rehabilitation, and prevention [2].…”

Section: Discussionmentioning

confidence: 99%

Demographic Profile of Hand Injuries in an Industrial Town of North India: A Review of 436 Patients

Gupta

Uppal

et al. 2012

Indian J Surg

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There are not many injuries that rival the injured hand in complexity. A better understanding of biologic, behavioral, and socioeconomic risk factors potentially associated with hand injuries can help identify those individuals most at risk and define potential preventative measures to help reduce the incidence. We present a prospective study of 436 consecutive patients of hand and forearm injury treated over a period of 2 years. A serial recording of the demographic profile of the patient along with the type & cause of injury sustained, hand dominance, duration of hospital stay, time lag between injury and admission, type surgery preformed with intra-operative findings and the cost analysis was done. An expected male dominance in economically viable individuals of 21 to 30 years formed 50 % of the patients of which 22.9 % were labourers and students each. The malady was altercation (27.5 %) followed by industrial & road accidents. Post prandial period was most notorious with multiple neuro (27.05 %) vasculo (39.34 %) tendinous (60.66 %) injury common with even simple lacerations. Dominant hand injury was commonest. It is challenging to assess and treat an injured hand. This study defines the demography and the etiology behind the various cases of hand and forearm injury with the detailed trauma profile. The limitation of the study was absence of functional outcome. The necessity of hand trauma registry is a pre-requisite to quantify the burden of hand injuries and formulate a prevention strategy.

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Section: Discussionmentioning

confidence: 99%

Demographic Profile of Hand Injuries in an Industrial Town of North India: A Review of 436 Patients

Gupta

Uppal

et al. 2012

Indian J Surg

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“…Domestic cases described by Graham (2006) do well with simple management of concurrent injuries. In the most severe cases, such as those described by Del Piñal et al (2006), all hand intrinsics are degloved.…”

Section: Discussionmentioning

confidence: 93%

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

Al-Qattan

2012

J Hand Surg Eur Vol

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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.

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“…Unfortunately, over the early postoperative days, everything may slowly go to pieces, with infection developing in the deep tissues of the body of the hand, the skin suffering patchy necrosis, the revascularised fingers dying and, finally, the hand coming to distal amputation. This is not surprising if we consider how we have taken care of this injury in the past (Graham, 2006). Management has included bone fixation, bypassing the area of damage in the central part of the hand with vein grafts in order to revascularise the fingers and even providing cover of the vital structures with the help of free flaps, but the basic principle of total debridement of the deep tissues then obliteration of the dead space has not been carried out adequately.…”

Section: Discussionmentioning

confidence: 99%

Massive Hand Crush: The Role of a Free Muscle Flap to Obliterate the Dead Space and to Clear Deep Infection

Piñal

Pisani

García-Bernal

et al. 2006

Journal of Hand Surgery

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Death of tissue and/or deep infection leading to amputation is not an uncommon course of events after massive crush injuries of the central part of the hand. Management of this injury faces the dual problem of having to carry out debridement in the central part of the hand which is radical enough to remove all dead tissue but which, in itself, creates a huge dead space in the depths of the wound. Inadequate debridement and/or leaving a dead space which fills with fluid and detritus behind the flexor tendons leads on to infection, devascularisation of the fingers and amputation. This paper presents the results of very radical debridement of the hand dorsal to the flexor tendons, including the intermetacarpal spaces, and filling the dead space with a well-vascularised free muscle flap in two hands which were referred in a pre-amputation stage, with one already being infected. Both hands were salvaged.

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The Exploded Hand Syndrome: Logical Evaluation and Comprehensive Treatment of the Severely Crushed Hand

Cited by 36 publications

References 17 publications

Demographic Profile of Hand Injuries in an Industrial Town of North India: A Review of 436 Patients

Demographic Profile of Hand Injuries in an Industrial Town of North India: A Review of 436 Patients

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

Massive Hand Crush: The Role of a Free Muscle Flap to Obliterate the Dead Space and to Clear Deep Infection

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