Narrow Results

We studied the use of a continuous peripheral nerve block (CPNB) in the distal forearm and wrist immediately after emergent surgery for severe hand trauma in 22 hands. After emergent surgery, a 2–3 cm longitudinal incision was made at the distal forearm and an 18-gauge catheter was inserted along the peripheral nerves. All patients received postoperative analgesia by continuous infusion of 0.2% ropivacaine at 2 ml/h for seven to 21 days. Pain score remained low during postoperative period and only a small number of analgesic rescues were needed. There were no major complications related to the CPNB and one patient showed mild superficial infection at the insertion site that immediately recovered after catheter removal. This method provides good postoperative analgesia without loss of motor function in extrinsic hand muscles and should be considered as a postoperative pain management for severe hand trauma.

Aim: This study aims to examine the mechanism and subsequent treatment modalities of hand and wrist injuries sustained in a professional cricket team. Methods: We performed a retrospective review of prospectively collected injury data at Gloucestershire County Cricket Club (GCCC) over six seasons (2008–2013). We investigated all injuries sustained, treated by the team lead physiotherapist and senior author. Results: There were a total of 64 injuries recorded, with 55 (86%) hand and 9 (14%) wrist injuries. The little and ring fingers were the most commonly injured, and the most commonly occurring specific injury was distal interphalangeal joint dislocations. The majority of injuries, 33 (52%), occurred during fielding activities. There were a total of 10 fractures (16%), predominantly phalangeal, and only 7 players (11%) had injuries that required operative intervention. Conclusions: The majority of injuries sustained by professional cricketers occur in the little and ring fingers, whilst fielding during match situations. We recommend buddy strapping of little and ring fingers during fielding to prevent injury.

Incorrect usage of or accidents related to metallic mercury can be hazardous. Herein, we present a case of subcutaneous metallic mercury injection in the hand caused by a broken thermometer and surgical tips for this injury. A 43-year-old female patient visited our hospital due to mercurial injection injury at the left hand suffered 4 weeks previously. On gross findings, the mercury deposition was limited to the subcutaneous layer and enveloped by granulation tissue. The blood mercury level, which had been abnormally elevated, fortunately decreased to within normal levels within five months. Nonetheless, this initial elevation indicates the possibility of systemic complications after local absorption of mercury droplets into the general circulation. In conclusion, we recommend prompt and complete excision of mercury material to prevent local and systemic complications, and excising the granulation tissue in its entirety, while retaining the mercury droplets within, is recommended.

With the amazing increasing in number of participants, rock climbing has become a popular sport in the last decade. A growing number of participants, with different skill level, inevitably leads to an increased number of injuries related to this practice. The kind of lesions that can be observed in rock-climbers is very specific and often involves the hand. For this reason is very important for any hand surgeon that is exposed to sport injuries to know which and the most common injuries related to this sport and which are the basic principles for the treatment of those. The aim of this article is to review the literature that has been published in the last ten year in this topic. On the NCBI database 22 articles where found that where related to rock climbing lesion affecting the hand or the whole body. Differences where found according to kind of rock climbing activity that was analyzed, alpine climb leads to more serious injuries, often affecting the lower limb, while in sport and recreational rock climbing the upper limb and the hand are definitely the most affected parts. Flexor pulley lesions, followed by fractures and strains are the most common lesions affecting the hand that are related to this practice.

Background: Little is known regarding the effect timing of repair has on extensor tendon repair results. The purpose of this study is to determine if a relationship exists between the time of extensor tendon injury to extensor tendon repair and patient outcomes.

Methods: A retrospective chart review was conducted on all patients that underwent extensor tendon repair at our institution. The minimum time to final follow-up was 8 weeks. Patients were then divided into two cohorts for analysis; those that underwent repair less than 14 days after injury and those that underwent extensor tendon repair at or greater than 14 days after injury. These cohorts were further sub-grouped by zone of injury. Data analysis was then completed using a two-sample t-test assuming unequal variance and ANOVA for categorical data.

Results: A total of 137 digits were included in final data analysis, with 110 digits repaired less than 14 days from injury and 27 digits in the greater than or equal to 14 days to surgery group. For zones 1–4 injuries, 38 digits were repaired in the acute surgery group and eight digits in the delayed surgery group. There was no significant difference in final total active motion (TAM) (142.3° vs. 137.4°). Final extension was also similar between the groups (2.37° vs. 2.13°). For zones 5–8 injuries, 73 digits were repaired acutely, and 13 digits were repaired in delayed fashion. There was no significant difference in final TAM (199.4° vs. 172.7°). Final extension was also similar between the groups (6.82° vs. 5.77°).

Conclusions: We found time from extensor tendon injury to surgical repair did not affect final range of motion when comparing acute repair within 2 weeks from injury or delayed repair greater than 14 days from injury. Additionally, there was no difference in secondary outcomes, such as return to activity or surgical complications.

Level of Evidence: Level IV (Therapeutic)

Injection of mercury into the upper limb is a rare method of self-harm. We report two patients with varied clinical presentations – a 19-year-old male student who injected himself with mercury extracted from a sphygmomanometer bulb and reported to our emergency department 24 hours after the event and a 34-year-old industry worker who presented 2 years after injecting himself with elemental mercury. The management of mercury poisoning is described along with a brief review of literature. Mercury is a toxic element and adequate safety precautions must be taken by the surgical team in the management of such patients.

Level of Evidence: Level V (Therapeutic)