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Background: The use of a self-adherent, elastic bandage is a practical way to dress finger injuries. Multiple reports describe iatrogenic injuries from elastic bandages, ranging from skin necrosis to finger gangrene, necessitating amputations. This study investigated whether elastic bandages can compromise digital perfusion by occluding arterial blood flow in healthy volunteers and evaluated the utility of pulse oximetry as a monitoring tool for digital perfusion. A technique for safe bandage application is proposed. Methods: A commercially available elastic bandage was wrapped around the index finger of 20 healthy volunteers at varying degrees of stretch. Digital perfusion measurements were carried out using photoelectric pulse transduction, laser Doppler flowmetry, and pulse oximetry. Intracompartmental pressure measurements were recorded using a separate in vitro experimental model. Results: Elastic bandages applied at maximum stretch did not change digital brachial index or pulse oximetry values, suggesting arterial blood flow was preserved distal to the bandage. Intracompartmental pressure measurements at maximum stretch remained below the systolic digital pressure. In contrast, superficial dermal perfusion fell to 32% of normal as measured by laser Doppler flow, at 100% bandage stretch. Conclusion: This study suggests a risk for iatrogenic injury when using elastic bandages for finger dressings. While arterial inflow was never compromised, pressures were high enough to occlude superficial venous outflow, which may begin at 20% bandage stretch. Pulse oximetry failed to detect changes distal to applied dressings, and we do not recommend it to detect digital vascular compromise in this setting. [ABSTRACT FROM AUTHOR]

This prospective study aimed to evaluate the outcomes of the use of dermal templates for lengthy volar soft tissue defects (1.5–4 cm) in the fingers. The volar soft tissue defects of 15 patients (19 fingers) were treated with Lando dermal template coverage between June 2022 and November 2022. We evaluated sensory recovery, scar formation, and overall appearance of the repair site at an average of 13 months (range, 12–17 months) of follow-up. The defect healed in all cases. We found an average static 2-point discrimination of 7 mm (range 4 to 14 mm). Scar formation was evident in all cases. The repair did not restore the bulkiness of the volar finger, especially in the finger with the bony exposure. Nail deformities and joint contracture were observed in some cases. Dermal template repair does not restore normal sensation and inevitably leads to scar formation when the defect is longer (>1.5 cm). Bulkiness of the volar finger is not restored in most patients, especially when there was bone or tendon exposure in the initial wound site. [ABSTRACT FROM AUTHOR]

Objective To explore the application and clinical effect of artificial dermis in repairing skin and soft tissue defects at the end of fingers. Methods From March 2022 to March 2023, 25 patients (27 fingers) with skin and soft tissue defects of distal fingers were repaired with artificial dermis in the Department of Hand Surgery of Jiangyin Hospital affiliated to Nantong University. The wound area was 0.5 cm×1.0 cm~1.5 cm×2.5 cm. After debridement, the artificial dermis covered the wound, changed dressing regularly after operation, and the artificial skin was removed in 4 weeks. Results The wounds of 25 cases (27 fingers) repaired with artificial skin healed in one stage. During the follow-up of 6 to 18 months, the fingertips had soft texture, beautiful appearance, no obvious scar contracture, no pigmentation and good finger movement function. The sensation of the flap recovered well and there was no cold sensitivity and tingling. The two-point discrimination was 3~8 mm. The activity of the distal interphalangeal joint is normal and the function of the opposite finger is good. According to the trial standard of upper limb function evaluation of hand surgery Association of Chinese Medical Association, the excellent and good rate is 100%. Conclusion The operation of repairing skin and soft tissue defect of distal finger with artificial dermis is safe and simple, there is no donor site injury, the finger is full, the texture is soft, and the activity and sensory function recover well. It is a safe and reliable treatment method. [ABSTRACT FROM AUTHOR]

Mining activities are known as high-risk working environments and operational activities, they are categorized as one of the most dangerous activities in modern industry today. The mining industry ranks among the highest producers of injuries and lost working days. There are many types of injuries that contribute to this lost working days, finger injury is one of them. Fingers are reported to be one of the most injured body parts. This research carried out on a mining company in Indonesia, PT X, within a period of three years (2020-2022). Statistical analysis was performed to look for patterns of finger injury based on year of occurrence, classification, type, and source of injury, number of lost working days, type of employee, and business unit involved. There is an alarming upward trend in the number of finger injuries and lost working days resulting from them, although overall the number of injuries has decreased. This calls for immediate preventive measures to focus on finger injuries and focuses on changing worker behavior towards safe work behavior, applied to both permanent employees and contractor employees. [ABSTRACT FROM AUTHOR]

Introduction The rates of hand injuries in the structure of total of injuries range from 30 to 50 % in recent decades. The improvement of approaches to the choice of optimal options for treatment of injuries of the distal phalanges of fingers that ensure the preservation of anatomical integrity and function of fingers remains relevant. The purpose of the work was a comparative analysis of the clinical efficacy of various methods for surgical treatment of trauma to the distal phalanx of fingers. Methods Forty-seven patients (18 men and 29 women, mean age 34.2 ± 13.3 years) with injuries to the distal phalanges of the fingers were examined and treated. The patients were divided into 2 groups. Group 1 (comparison) was 25 patients. Conventional approaches to the formation of finger stumps were used by shortening the bone part of the phalanx, forming two opposite flaps and applying several interrupted sutures; group 2 (main group) were 22 patients treated according to the surgical tactics developed by us. The proposed tactics of reconstructive plasty of the defects in the nail phalanges of three joint fingers involves the formation of a stump of the nail phalanx with a visual effect of elongation of the phalanx due to local or cross-plasty with dermo-fascial flaps. Comparison of treatment results in the groups of patients was performed 1, 3, 6, 12 months after reconstruction operations. Results It was established that the use of the developed surgical treatment of the injury to the distal phalanx of the fingers results in less severity (compared to the use of standard methods) of pain on days 10-21 after surgery (by 44.8-54.3 %), lower levels of the Quick DASH indicators after 3-12 months, decrease in Vancouver scoring of skin scar severity changes after 6-12 months, higher patient satisfaction with the functional result of treatment. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to hand injuries has been proposed. Discussion The results of the study indicate the effectiveness of the developed method of plastic surgery of fingertip defects of nail phalanges in the three joint fingers by moving the palmar-lateral and dorsal-lateral blood-supplied flaps from the fingers of the same name and neighboring fingers without shortening the bone stumps of the nail phalanges while achieving an esthetic result by visual lengthening of the fingertip phalanx. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to patients with finger injuries has been proposed.

• Relative motion flexion (RMF) orthoses allow hand use while healing a boutonniere. • RMF orthoses use quadriga effect on single-muscle-four-tendon extensors & flexors. • The author's rationale and experience in use of RMF orthoses to manage boutonniere. • Chronic boutonniere can be nonsurgically managed using RMF orthoses. • The relative motion concept relies on alterations to adjacent MCP joint positions. Retrospective. Boutonniere deformity (BD) is a troublesome injury occurring from rupture of tissue connecting the extrinsic to intrinsic tendon systems. This causes loss of interphalangeal joint balance, and immobilization often results in adherence and difficulty restoring balance. Review of relative motion flexion (RMF) orthotic use for safe healing during functional activity in 23 patients, and explanation of the rationale. Anatomic rationale and clinical experience is reviewed in 8 acute BD patients utilizing RMF orthoses for 6 weeks, and for chronic BD patients, 3 months after serial casting. All patients met the Strickland and Steichen criteria for "excellent" results following treatment, with an average of 35° increase in ROM. The anatomic rationale for relative motion recognizes that altering relative positioning between adjacent metacarpophalangeal (MCP) joints produces a protective favorable impact on interphalangeal forces during hand function using 15°-20° greater MCP joint flexion. This provides dorsal and volar protective benefits because the extensor digitorum communis (EDC), a single-muscle-four-tendon system, attaches to the intrinsic lateral band (LB) tendons. With greater MCP flexion, dorsal EDC force is increased, pulling lateral bands medially, while on the volar surface the downward pull of the lumbrical on LB is relaxed due to origin from the flexor digitorum profundus tendon of the injured digit, also a single-muscle-four-tendon system. The RMF orthosis permits protected active motion during functional activity with acute BD. In patients with chronic BD and adequate passive extension, an RMF orthosis for 3 months also produced encouraging results. Management of acute BD with RMF orthoses provided earlier recovery of motion and hand function. Similar results occurred for chronic BD using serial casting for adequate extension followed by 3 months of RMF orthotic use and should be attempted prior to surgical intervention, with surgery remaining an alternative. [ABSTRACT FROM AUTHOR]

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation. [ABSTRACT FROM AUTHOR]

The dorsal metacarpal artery flap (DMAF) is irrefutable as an effective way of repairing long finger defects, and hand surgeons might consider using it for long finger reconstruction or degloved injury repair. Unfortunately, the DMAF containing a single dorsal metacarpal artery (DMA) hinders the treatment effect. The sensory restoration of long fingers and the reconstruction of phalangeal joints and tendon grafts are unsolved challenges as well. We reported our experience in reconstructing the index and middle finger by a reverse-island flap with two DMAs and dorsal metacarpal nerves (DMNs) with blood supply. We reviewed ten patients with finger-crush injuries affecting eight index fingers and two middle fingers. Degloving injuries occurred in two patients, and finger amputations occurred in eight others. Two patients received simple flap reconstruction, and eight received finger reconstruction, including seven from abandoned phalangeal joints and tendon grafts of the severed finger and one from the iliac crest bone graft. All patients underwent finger reconstruction by an expanded reverse-island flap consisting of two DMAs and DMNs up to a maximal size of 9 × 8 cm2. Postoperative follow-up evaluation showed a satisfactory appearance and functional recovery of the reconstructed fingers. We posit that the expanded reverse-island flap involving two DMAs and DMNs constitutes a feasible and safe option for restoring a severely damaged index or middle finger, particularly for patients who are unwilling to undergo toe-to-finger transplantation to reconstruct the injured long fingers. [ABSTRACT FROM AUTHOR]

Abstract Background Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures. Methods Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann–Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS. Results The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were − 3.55 and − 3.787, respectively, and the progress of the VAS score was significant (p

Closed flexor pulley injuries are a clinical entity of great interest in hand surgery, and these lesions could be observed mainly in rock-climbing athletes. An extensive literature search of PubMed, SCOPUS, Cochrane Library, and Web of Sciences databases on closed finger pulley rupture, related treatments, and outcomes were performed. All relevant information was used in this literature review. Many athletes are potentially exposed to these uncommon injuries. Therefore, these lesions require careful examination and a high index of suspicion to confirm the diagnosis and identify the degree of soft tissue injury, particularly in patients not involved in sporting activities. The data summarized in this literature review demonstrated that according to Schöffl's classification, conservative treatment should be indicated for low-grade injuries (grade 1 or 2), whereas surgical treatment should be performed in patients with more severe acute injuries (grade 4). Grade 3 flexor pulley injuries lie in a grey area where conservative and surgical treatment may give good clinical and return-to-sport patient results. [ABSTRACT FROM AUTHOR]

Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division. Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test. Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17–243 days) for large flaps and 42.81 days (range, 20–130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34. Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

Background: The thumb plays an important role in the function of the hand. Sensate reconstruction of the pulp is important in restoring function to the thumb. The aim of this study is to present outcomes of a sensate islanded first dorsal metacarpal artery (FDMA) flap used for the reconstruction of skin defects of the thumb. Methods: Patients who had a FDMA flap reconstruction of thumb pulp defects in the orthopaedics and traumatology clinic of affiliated hospital were included in the study. This included eight thumbs of eight patients. The range of motion, sensation and cosmetic satisfaction in the donor and recipient areas were evaluated at a minimum of 2-year follow-up. Results: There were no partial or complete flap failures. The mean static 2-point discrimination was 15 mm and the mean Semmes–Weinstein monofilament test score was 3.93. Cortical re-orientation was observed in 65% of patients. Near normal range of motion and Kapandji scores were regained in all patients. Conclusions: Excellent motion and sensory outcomes were obtained following the FDMA flap reconstruction of thumb pulp defects. The donor morbidity of the flap is minimal, and this flap can be considered as one of the primary options for reconstruction of thumb pulp defects. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown., Purpose: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion., Study Design: Retrospective cohort study., Method: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ., Results: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant., Conclusion: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion., Competing Interests: Declaration of Competing Interest Authors reported no potential conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.Methods: Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann-Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.Results: The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were - 3.55 and - 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).Conclusion: After a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function. [ABSTRACT FROM AUTHOR]

Simple Summary: Finger flexor tenosynovitis is among the most frequent overuse injuries in sport climbers. Targeted therapy is currently based mostly on reports of the anecdotal practical experience of single centers rather than scientific investigations, as there is very little research available on this pathology. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis treatments in sport climbers by retrospectively asking patients about injury triggers, therapy contents and outcomes. All patients were initially treated conservatively, and only one of the patients needed further therapy in the form of a single injection with hyaluronic acid; none of them underwent further operative treatment. The average symptom duration was 30.5 weeks, and all patients were able to resume climbing, with approximately 75% of them regaining or exceeding their initial climbing level. These good to excellent outcomes and no correlation between particular therapy contents and therapy outcome suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations from this study. The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations. [ABSTRACT FROM AUTHOR]

Injury to the A2 pulley is caused by high eccentric forces on the flexor‐tendon–pulley system. Accurate diagnosis is necessary to identify the most appropriate treatment options. This review summarizes the literature with respect to using ultrasound (US) to diagnose A2 pulley injuries, compares ultrasound to magnetic resonance imaging and computed tomography, and identifies current knowledge gaps. The results suggest that US should be used as the primary imaging modality given high accuracy, relatively low cost, ease of access, and dynamic imaging capabilities. Manual resistance is beneficial to accentuate bowstringing, but further research is needed to determine best positioning for evaluation. [ABSTRACT FROM AUTHOR]

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients’ risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.

Objective: To identify the most comfortable digital nerve block by comparing painfulness and efficiency of two commonly used digital nerve blocks: the volar subcutaneous nerve block and the traditional dorsal nerve block.Methods: Patients, age ≥ 18 years, presenting with an injury of the finger requiring regional anaesthesia were included. Patients were blindly randomized in receiving the one-injection subcutaneous volar nerve block (intervention group) or the two-injection traditional dorsal digital nerve block (control group). Primary outcome measure was discomfort of the injection. Secondary outcome measures were extent of anaesthesia in different regions of the finger, complication rate and satisfaction of the clinician.Results: In total, 409 patients were randomly allocated to the intervention group (N=209) or control group (N=200). Discomfort of the injection was not different between both anaesthetic techniques. The mean pain score (Numerical Rating Scale - NRS) of the intervention group was 4.57 (range 0 - 9, CI 4.27 - 4.87, SD 2.18). The mean pain scores of the control group were 4.63 for the first injection (range 0 - 10; CI 4.28 - 4.99, SD 2.36) and 4.51 for the second injection (range 0 - 10; CI 4.14 - 4.87, SD 2.44). The traditional dorsal digital nerve block was better in anesthetizing the dorsal side of the finger. The subcutaneous volar nerve block was better or equivalent in terms of extent of anaesthesia on the volar side of the finger.Conclusion: In patients requiring digital anaesthesia in the Emergency Department, the anaesthetic technique affects both the discomfort of the injection and extent of anaesthesia. The traditional dorsal digital nerve block is preferred for dorsal injuries. The subcutaneous volar nerve block is preferred for volar injuries. [ABSTRACT FROM AUTHOR]

Complications in nail surgery are not that frequent. Apart from complications that are common to every hand procedure, intense pain is the major issue with nail surgery. To prevent complications, good knowledge of anatomy and physiology is required to avoid misdiagnosis or inappropriate technique. However, some complications, such as postoperative nail dystrophy, are unavoidable, and must be known and discussed with the patient prior to the procedure in order to prevent disappointment that may lead to medico-legal cases. This paper will discuss the most frequent complications encountered., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Background: Soft tissue defects to the dorsum of fingers are quite demanding for the reconstructive surgeon especially in the cases that bone and extensor tendons are exposed. The purpose of our study was to describe a new adipofascial island flap by a single dorsal digital perforator (dorsal adipofascial digital artery perforator, DADAP).Materials: Methods: In 8 patients (7 male, 1 female), 12 soft tissue defects to the dorsum of the fingers (3 index, 6 middle, 2 ring, 1 little finger), ranging from 1 × 2 cm to 2 × 4 cm, were reconstructed using the DADAP flap.Results: The flaps sizes ranged from 2.5 × 1.5 cm to 8 × 3 cm. The defects were covered in 9 cases by a propeller-rotation type flap and in 3 by a turn-over flap. In 4 cases a tendon graft was used to cover the tendon defect and in 3 cases an open joint was reconstructed. In all cases a splint thickness skin graft (SSG) covered the flaps. Mean follow-up was 18 months. One patient developed distal tip flap necrosis and was treated conservatively. Delayed wound healing with partial SSG failure due to haematoma was observed in 3 fingers, but the underlying flap was viable and complete healing was achieved by secondary intention.Conclusions: The use of DADAP flap is a fast, safe and reliable solution to cover the defects of the dorsum of fingers and can be performed under local anaesthesia as a day surgery. [ABSTRACT FROM AUTHOR]

Objective To explore the surgical method and clinical efficacy of flap from abandoned finger or partial finger transplantation in the repair of adjacent finger injury. Methods From May 2008 to June 2015, the flap from abandoned finger or partial finger transplantation was used to treat adjacent finger injury in 13 patients. The free flap from abandoned finger was used to repair the skin defect of adjacent finger in 8 patients, partial finger from abandoned finger was used to repair Ⅱo defect of adjacent finger in 2 patients, the pedicled flap from abandoned finger was used to repair the skin defect of adjacent finger in 3 patients and the sensation was reconstructed in 9 patients. Results The transplanted finger or flap in 11 patients survived successfully and the wounds healed in one stage. Epidermal necrosis of the transplanted flap occurred in 2 patients and the flaps survived after dressing change. All patients were followed up from 8 to 36 months, with an average of 18 months. The appearance of transplanted finger or flap was satisfactory and the color was similar to the adjacent fingers. The two-point discrimination of patients with reconstructed sensation was from 7 mm to 9 mm. The function of repaired finger was satisfactory. According to the upper extremity functional evaluation standard set up by hand surgery branch of Chinese Medical Association, 7 cases was excellent, 4 cases was good and 2 cases was poor. The excellent and good rate was 84.6%. Conclusion The flap from abandoned finger or partial finger transplantation could cover the wounds of adjacent finger without sacrifice another donor site. Getting the most out of things is a better way to make full of the abandoned finger. [ABSTRACT FROM AUTHOR]

Background. Over the last decade, rock climbing has become an increasingly popular sport. With the latest inclusion into the Olympic program, this trend will continue upward. Lately, specific tendon injuries on the hand (e.g. lumbricalis tendon injuries or tenosynovitis) are reported to be on the rise within climbing patients. Design. Clinical cohort study and comparison with literature data. Review of current therapeutic concepts. Methods. Tendon injuries to the hands of rock climbers were identified from our climbers patient database over the years of 2017/18. These were compared to the numbers of 2009-2012 and 1998-2001. The injuries were analyzed, and the results were compared with the current literature. Results. Within the ten most frequent injuries over the years 2017 and 2018, three were to the tendons and tendon sheath/pulleys. In a longitudinal comparison of patients in a climbing-specific sports medical clinic, the pulley injury is consistently the most frequent injury, followed by tenosynovitis and capsulitis of the finger joints. Conclusions. In rock climbers, tendon injuries of the hand are frequent and many of these specific to the sport. Special knowledge about their pathology, diagnostics and treatment is necessary as some of these injuries rarely occur in non-climbing patients. With the further advent of climbing, an increase in injury incidence is to be expected. [ABSTRACT FROM AUTHOR]

Traditionally free vascularized flap transfers to the fingers connect to the proper digital artery and dorsal veins. We report our experience using the volar digital veins as recipient veins for free vascularized flap transfers in 14 fingers of 12 patients. One or two veins (three flaps with two veins, 11 flaps with one vein) of the flap were anastomosed to volar digital veins in the recipient site. The arteries of these flaps were connected to the proper digital arteries. All the transferred flaps survived. No vessel crisis occurred. Our patients demonstrated that volar veins can be the recipient veins for free flap transfers in the fingers without increased risk of venous crisis and flap loss. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Objective To explore the surgical method and clinical efficacy of dorsal fascial flap of the same finger with nerve anastomosis in the repair of finger lateral skin defects.Methods From June 2016 to September 2018, the wounds in 8 patients with finger lateral skin defects were repaired by dorsal fascial flap of the same finger. During the operation, the dorsal digital nerve was protected and transplanted into the flap. Then the broken end of the dorsal digital nerve was anastomosed with the broken end of the nerve at the distal end of the wounds. Results Eight cases of transplanted flaps and dorsal digital grafts survived. Five cases of flaps developed blisters after operation. After the blisters were drawn, the color of flaps was ruddy and the wounds healed in one stage. The follow-up was from 6 to 24 months, with an average of 10 months. The appearance and texture of the flap was good. No obvious pigmentation and swelling of the pedicle were found. The sensation of flap recovered well. The two-point discrimination was 10 to 12 mm. There was no obvious scar in the donor area. There was no obvious limitation in the movement of the joints and no obvious sensory disturbance in the dorsal finger skin. Conclusion The application of dorsal fascial flap of the same finger with nerve anastomosis in the repair of finger lateral skin defects can obtain satisfactory clinical efficacy. [ABSTRACT FROM AUTHOR]

Background: High-pressure injection injuries to the hand have been reported in both the community and industrial setting with varying levels of severity. However, there are little epidemiologic data regarding the prevalence of pressure-injection injuries. The purpose of this study is thus to describe trends in emergency department (ED) encounters associated with pressure injection injuries, thereby informing potential investments in research and education for these injuries., Methods: The National Electronic Injury Surveillance System (NEISS), a nationally representative database of all ED encounters, was queried for all high-pressure injection injuries from 2012 to 2021. Patient demographic and injury data were collected and analyzed to describe trends in incidence, patient demographics, and sequelae of hand injury associated with an ED encounter for a pressure injection-related injury., Results: There were an estimated 15 307 (95% confidence interval: 15 051-15 562) high-pressure injection hand injuries from 2012 to 2021. Injuries were more frequent on weekends with the highest incidence on Sundays (18.9%) and Saturdays (18.0%) and during late spring and summer months (58.6%), with peak incidence occurring in May (16.8%). High-pressure paint injuries demonstrated a significantly higher rate of infection (23.7% of injuries) than pressure washer injuries (3.7%); however, pressure washer injuries were much more common overall (90% vs 10%)., Conclusion: High-pressure injection injuries to the hand and upper extremity represent a particularly concerning injury mechanism. Prompt recognition and proper management are crucial for improving outcomes. People that utilize pressure washers for household projects should be aware of the risks associated with these machines and utilize proper safety techniques., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The aim of this study was to evaluate different grip positions as a contributing factor for primary periphyseal stress injuries of the finger phalanges in climbing., Methods: Ultrasound imaging of the proximal interphalangeal joint was performed on 37 asymptomatic adolescent climbers. Longitudinal images were obtained of middle and ring fingers of both hands in different grip positions (open, half-open, and crimp), unloaded and loaded. The translation between the dorsal head of the proximal phalanx and the shaft of the middle phalanx was measured in an unloaded and loaded situation for all grip positions. The resulting difference was determined as the palmar shift., Results: The mean age of the study population was 13 y. Results showed a palmar shift of 0.57 mm in a loaded crimp grip position compared to 0.13 mm in an open position and 0.20 mm in a half-open grip position. With a P value of <0.001, this shift was significantly higher in a crimp grip position compared to open or half-open grip positions., Conclusions: This leads to an increase in joint incongruity and much higher peak forces on the dorsal aspect of the epiphyseal-physeal-metaphyseal complex, which is particularly vulnerable during the adolescent growth spurt. Thus, climbing and training behavior should be adapted accordingly during this phase by avoiding the crimp grip position until epiphyseal fusion., (Copyright © 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Background: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms. Methods: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation. Results: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci. Conclusions: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons. [ABSTRACT FROM AUTHOR]

A case study is presented for 13 patients who were suffered from a fracture of a sesamoid of the hand and the ultrasound evaluation was done. The review of patients are presented with fractures of sesamoid bones of the hand which was detected by ultrasound and sonograms and videos were then obtained. Ultrasound examinations were performed by radiologist and radiographs and radiographic reports were presented. It also discusses the relation of hyperextension of a joint with the fractures.

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Background: Internal fixation modalities of unstable (>50 percent articular involvement) middle phalangeal volar lip fracture-dislocations include interfragmentary screw and volar buttress plating. This study investigates the mechanical properties (yield strength, ultimate tensile strength, and stiffness) of interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). Methods: Fifteen cadaveric digits (5 index, 5 middle, and 5 ring) were prepared by excising its skin envelope and flexor tendons while preserving the structures around the proximal interphalangeal joint. An oblique osteotomy involving 50 percent of the articular surface was performed, and this was fixed with based on its study group: interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). These specimens were then loaded to failure. Results: Yield strength was as follows: BP+S (33.5±9.76 N), IS (13.6±5.46 N), and BP (8.1±3.84 N). Ultimate tensile strength was as follows: BP+S (49.1±21.4 N), IS (15.6±5.19 N), and BP (8.86±3.99 N). Stiffness was as follows: BP+S (4.77±1.32 N/mm), IS (2.44±0.86 N/mm), and BP (1.84±0.71 N/mm). Conclusions: A buttress plate and screw construct confers significantly more stability than either interfragmentary screw or buttress plate only fixation in an experimental model. [ABSTRACT FROM AUTHOR]

Unsuccessful reconstruction of injured fingers can lead to poor outcomes. The aim of this article was to investigate the clinical application of the radial artery superficial palmar branch flap for soft-tissue reconstruction of the finger. We treated 125 patients with various finger injuries who underwent free radial artery superficial palmar branch flap reconstruction between October 2010 and March 2015. There were 46 distal finger injuries, 25 distal finger amputation following failed replantation and 54 palmar digital injuries with tendon, bone or joint exposure requiring soft-tissue reconstruction. Of the 125 cases, 114 flap reconstructions were considered successful. We believe that a free radial artery superficial palmar branch flap transfer is credible and useful for reconstructing various finger injuries.Level of Evidence: III [ABSTRACT FROM AUTHOR]

Objective To explore the method and efficacy of employing a distal pedicle of the second metacarpal dorsal artery cutaneous branch flap in the repair of digital soft tissue defects. Methods From March 2012 to October 2017, 15 patients (16 involved fingers) of soft tissue defects with tendon and bone exposure were repaired using a distal pedicle of the second metacarpal dorsal artery cutaneous branch flap. The area of the flap was from 2.5 cm × 1.6 cm to 3.6 cm × 2.6 cm. Results All flaps survived after surgery. All patients were followed up from 6 to 46 months. The texture of the flap was soft, and the recovery of finger function was satisfactory. The sensation of the skin flap was restored to S3 or S3+ postoperatively from 6 to 12 months. Conclusion The repair of digital soft tissue defects with a distal pedicle of the second metacarpal dorsal artery cutaneous branch flap was feasible and the efficacy was good. [ABSTRACT FROM AUTHOR]