Article
Treatment of severe traumatic hand injuries
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Published: | February 6, 2020 |
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Introduction: Severe traumatic hand injuries are difficult to treat, even for experienced hand surgeons. This study evaluated treatment outcomes. Severe traumatic hand injuries were defined as bone and joint injuries involving the carpal and metacarpal bones, with associated soft tissue injuries, or soft tissue defects with and without bone and joint injuries.
Materials: We reviewed 21 cases (men, 17; women, 4; average age, 46.1 years) of severe traumatic hand injuries treated between 2009 and 2017. The injuries included: amputation at a metacarpal or carpal bone (8), bone and joint injury between carpal and metacarpal bone, with associated soft tissue injury (4), and soft tissue defect with and without bone and joint injury (9).
Results: Osteosynthesis and arthroplasty were performed in 13 and 5 cases, respectively. Tenorrhaphy, vascular anastomosis, and nerve suturing were performed in 13, 9, and 7 cases, respectively. A free or pedicled flap and skin grafting were needed in 10 and 13 cases, respectively. Amputated hands were saved in 6 of 7 cases. Microsurgical technique was needed in 13 cases. For functional recovery, joint mobilization, tenolysis, and free or local flaps were performed in 12, 9, and 13 cases, respectively. The average number of procedures for each case was 5.8.
Summary: Most cases of severe traumatic hand injury require multiple operations, leading to prolonged treatment, and functional disorders, such as contractures, tend to persist. Optimal treatment requires evaluation of the injured hand at the first visit and determination of the treatment goal in each case. Additional operations, such as joint mobilization, tenolysis, and free or local flaps must be effectively performed.