Fractures and dislocation of the hand is a body injury involving complex structures and multiple functions, which frequently occur as they represent 10%-30% of all fractures. Such fractures and dislocation of the hand should be treated in the context of stability and flexibility; and tailored treatment is required in order to achieve the most optimal functional performance in each patient since deformation may occur if not treated, stiffness may occur with unnecessarily excessive treatment, and both deformation and stiffness may occur coincidently with inappropriate treatment. Stable injuries can be fixed with splintage whereas surgery is actively considered for unstable injuries. In addition, surgeons should keep in mind that as the surgical intervention is done aggressively, aggressive rehabilitation must be followed in correspondence with the surgical intervention. Successful outcome requires effort to prevent any potential complication including nerve hypersensitivity and infection. Finally, it is also important that the patient to know that swelling, stiffness, and pain may last for a long period of time until the recovery of fractures and dislocation of the hand.
Dislocations* ; Finger Injuries ; Hand* ; Humans ; Hypersensitivity ; Pliability ; Rehabilitation

OBJECTIVETo study the effects of ultrashort wave combined with sequential pressure treatment on the functional recovery of deeply burned hands in the early stage of healed wounds in hands.

METHODSSixty-five patients with burn of unilateral hand were hospitalized from July 2012 to June 2013 in our center. Injured hands of 35 patients were treated with active movement, ultrashort wave, sequential pressure therapy, and pressure gloves, and the other 30 patients were treated with active movement and pressure gloves 10-31 days after the wounds were healed according to the will of patients. The former 35 patients were regarded as comprehensive treatment (CT) group, and the latter 30 patients were regarded as routine treatment (RT) group. Before treatment and 4 weeks after treatment, the appearance of injured hands was observed; the circumference of the proximal segment of thumb, index, and middle fingers and that of the palmar crease and wrist crease were measured to evaluate swelling of injured hand; score and grade of function of injured hands were evaluated with a Carroll Upper Extremity Functional Test. Data were processed with t test and rank sum test.

RESULTS(1) Four weeks after treatment, appearance of 30 injured hands in group CT was improved, which was close to that of the normal hand of each patient, while contracture deformity of metacarpophalangeal joints and interphalangeal joints was observed in the other 5 injured hands. Four weeks after treatment, no obvious change in the appearance of 17 injured hands in group RT was observed compared with that before treatment, while hyperextension of metacarpophalangeal joints, flexion of interphalangeal joints, and adduction deformity of thumb were observed in the other 13 hands. (2) Four weeks after treatment, the circumferential values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands in group CT were respectively lower than those before treatment (with t values 3.26-4.24, P values below 0.01), and the circumferential values of the proximal segment of thumb and middle fingers and the wrist crease of injured hands in group RT were respectively lower than those before treatment (with t values 2.02-2.44, P values below 0.05). The difference values of circumference values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands between before treatment and 4 weeks after treatment were respectively (0.491 ± 0.022), (0.583 ± 0.089), (0.486 ± 0.021), (1.100 ± 0.076), (0.751 ± 0.053) cm in group CT, which were significantly higher than those in group RT [(0.306 ± 0.021), (0.277 ± 0.022), (0.320 ± 0.027), (0.700 ± 0.052), (0.483 ± 0.048) cm, with t values respectively 5.94, 3.11, 5.02, 4.22, 3.68, P values below 0.01]. (3) Four weeks after treatment, scores of function of injured hands in groups CT and RT were respectively higher than those before treatment (with t values respectively 14.40 and 4.00, P values below 0.001), and the grades of function of injured hands were respectively improved (with u values respectively 6.93 and 3.29, P values below 0.01). The difference value of scores of function of injured hands between before treatment and 4 weeks after treatment was (51.1 ± 2.2) points in group CT, which was significantly higher than that of group RT [(32.5 ± 4.8) points, t = 3.52, P < 0.001].

CONCLUSIONSUltrashort wave combined with sequential pressure and routine rehabilitation treatment of deeply burned hands in the early stage after wounds in hands are healed can obviously reduce the swelling of injured hands, which provides a favorable condition for active movements and systematic rehabilitation treatment later.

Burns ; rehabilitation ; therapy ; Contracture ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Pressure ; Recovery of Function ; Treatment Outcome ; Wound Healing

OBJECTIVETo investigate the therapeutic effects of microsurgical one-stage repair of hand flexor tendon injuries.

METHODSAmong 97 patients with (182 flexor tendons) hand injuries, 59 patients were male and 38 patients were female, ranging in age from 6 to 65 years, with an average of 32 years. Twenty-two patients got injuries by glasses, 32 patients got injuries by knife, 29 patients got injuries by saw, and 14 patients got crush injuries. The tendon injuries in this study consisted of 12 cases of I zone, 35 cases of II zone, 28 cases of III zone, 8 cases of IV zone and 14 cases of V zone. Sixty-eight patients complicated with injuries of blood vessel and nerve, and 53 patients also had fingers fractures. All the patients were treated with modified Kessler method to repair tendon at one-stage, and were given early rehabilitation step by step.

RESULTSAfter the treatment, 97 patients were followed up from 3 to 24 months. According to TAM standard, 48 patients got an excellent result, 39 good, 8 fair and 2 bad.

CONCLUSIONMicrosurgical one-stage tendon repair should be applied. Early rehabilitation and microsurgery repair are important for preventing tendon adhesion.

Adolescent ; Adult ; Aged ; Child ; Female ; Hand Injuries ; rehabilitation ; surgery ; Humans ; Male ; Microsurgery ; methods ; Middle Aged ; Tendon Injuries ; rehabilitation ; surgery

OBJECTIVE: To evaluate the results of driver training program for the handicapped. METHOD: Retrospective study on the 699 disabled who participated in the two-months driver training program at the NRC (National Rehabilitation Center) from January 1995 to May 1998. RESULTS: 1) Of these subjects, 70.4% were men and 29.6% were women. 2) According to the disability grading system by the Ministry of Health and Social Welfare of Korea, 19.2% of the subjects had the first grade disability, 28.2% the second grade, 26.3% the third grade, 18.3% the fourth grade, 6.3% the fifth grade, and 1.4% the sixth grade. 3) The licensing rate was 74.6% for the first grade, 64.7% for the second grade, 70.9% for the third grade, 73.6% for the fourth grade, 55.8% for the fifth grade, and 70% for the sixth grade. 4) The licensing rate was the highest in the subjects with spinal cord injury (79.2%) and the lowest in the subjects with stroke (45.0%). 5) Overall, 78.2% of subjects licensed with automatic transmission and 21.8% with hand- control. On the other hand, in the subjects with spinal cord injury, 42.5% licensed with automatic transmission and 57.5% with hand-control. CONCLUSION: The mean licensing rate of this program was 69.2%. Further study is required for the effect of cognitive function on driving test and various driving aids to promote the licensing rate for the handicapped.
Disabled Persons* ; Education* ; Female ; Hand ; Humans ; Korea ; Licensure ; Male ; Rehabilitation Centers* ; Rehabilitation* ; Retrospective Studies ; Social Welfare ; Spinal Cord Injuries ; Stroke

PURPOSE: To analyze the final results of a two-stage flexor tendon reconstruction in the hand with the early postoperative combined protocol of controlled motion, and to identify the prognostic factors associated with the final results. MATERIALS AND METHODS: Nine cases of two-stage flexor tendon reconstructions in 9 patients, who had been unable to flex their digits due to old flexor tendon injury, were examined. Using the modified Boyes' injury severity classification, the digits were classified as grades 1, 2 and 3 in 1, 5 and 3 patients, respectively. The average follow-up period was 1 year and 8 months and the final results are expressed using the Buck-Gramcko assessment system. RESULTS: Eight out of nine hands were graded as excellent and one patient whose injury severity had been graded 3 was graded as good. Excellent results were found in patients with a more than 10-year interval between the injury and the stage I procedure. Of the 3 patients who had undergone contracture release two were excellent and one was good. All 5 patients with a pulley reconstruction had excellent results. Complications involved one infection at the distal incision site, one tendon rupture and four flexion contractures. CONCLUSION: A two-stage flexor tendon reconstruction with an early postoperative combined protocol of controlled motion is a useful procedure for restoring the flexor performance in old badly scarred digits. The excellent or good results might be due to following: the early protected rehabilitation incorporating two protocols, a pulley reconstruction and protection, flexion contracture release, an initial injury with less than moderate grade and the young age of the patients.
Cicatrix ; Classification ; Contracture ; Follow-Up Studies ; Hand* ; Humans ; Rehabilitation ; Rupture ; Tendon Injuries ; Tendons*

BACKGROUND: Hand strength deficit following digital replantation is usually attributed to the mechanical deficiency of the replanted digit. Zone 1 replantation, however, should not be associated with any mechanical deficit, as the joint and tendon are intact. We evaluate short-term motor functions in patients who have undergone single-digit zone 1 replantation. METHODS: A single-institution retrospective review was performed for all patients who underwent zone 1 replantation. Hand and pinch strengths were evaluated using standard dynamometers. Each set of measurements was pooled according to follow-up periods (within 1 month, 1 to 2 months, 2 to 3 months, and after 3 months). The uninjured hand was used as reference for measurements. RESULTS: The review identified 53 patients who had undergone zone 1 replantation and presented for follow-up visits. Compared to the uninjured hand, dynamometer measurements revealed significantly less strength for the hand with replanted digit at one month. The relative mean grip, pulp, and key pinch strength were 31%, 46%, and 48% of the uninjured hand. These three strength measurements gradually increased, with relative strength measurements of 59%, 70%, and 78% for 4-month follow up. CONCLUSIONS: Despite the lack of joint or tendon injury, strength of the injured hand was significantly lower than that of the uninjured hand during the 4 months following replantation. Improved rehabilitation strategies are needed to diminish the short-term negative impact that an isolated zone 1 replantation has on the overall hand strength.
Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Joints ; Pinch Strength ; Range of Motion, Articular ; Rehabilitation ; Replantation* ; Retrospective Studies ; Tendon Injuries ; Tendons

OBJECTIVETo observe the effect of comprehensive rehabilitation treatment on hand burn, and to make a cost-effectiveness analysis.

METHODSSixty-two patients with ninety-eight affected hands were divided into rehabilitation group (32 cases, 48 hands) and control group (30 cases, 50 hands). Patients in rehabilitation group received comprehensive rehabilitation treatment at early stage after burn; patients in control group were given instructions for function training at the same time. The functions of the hands to be restored including grasp, hold, pinch, nip, forearm pronation and supination, fetching, laying, and writing abilities of patients in both groups were quantitatively evaluated with Carroll's upper extremity function test before treatment and 5 months after. Direct medical costs of patients in both groups within 5 months were respectively added up to make a cost-effectiveness analysis.

RESULTSIn rehabilitation group, function of digital opposition, palmar opposition, holding, and pinching of 37 hands recovered well, with which patients could pick food, put on clothes, go to toilet, and self-care etc. independently. Function of digital opposition, palmar opposition, holding, pinching half recovered in 7 hands, accompanied with well recovered of metacarpophalangeal function, but recovery of function of interphalangeal joint was less satisfactory. Although patients could grasp and hold, they were still poor in fine and harmonized activities. Joint ranges of motion of 4 hands were poor with limited function, and this was resulted from not strictly following treatment for remaining granulation wound. In control group, 23 hands received reconstructive surgery, 14 of them recovered with good function, but were poor in most of fine and harmonized activities. Severe claw hands were found in 13 hands. The ratio between total mean cost value and total function increment value in rehabilitation group (181 +/- 11) was obviously lower than that in control group (298 +/- 30, P < 0.01).

CONCLUSIONSComprehensive rehabilitation treatment at early stage after hand burn has a good effect on prevention and treatment of hand deformity, promoting recovery of hand function and improving hand appearance. It is also less costly.

Adolescent ; Adult ; Burns ; rehabilitation ; Child ; Child, Preschool ; Cost-Benefit Analysis ; Female ; Hand Injuries ; rehabilitation ; Humans ; Male ; Middle Aged ; Rehabilitation ; economics ; Treatment Outcome ; Young Adult

Traumatic tetraplegia is an overwhelming injury often requiring permanent adaptations by patients and families. The greatest potential for improving the quality of life lies with rehabilitation and restoration of upper extremity function. Functional surgery of upper limb following tetraplegia is individualized based on functional level and can significantly improve hand functional quality of life. We haveobserved a 46-year old man with a C5 complete spinal cord injury and the patient had achieved functional improvement of upper extremity by functional surgery of upper limb for tendon transfer of posterior deltoid to triceps muscle and biceps tendon release.
Contracture* ; Elbow* ; Hand ; Humans ; Middle Aged ; Quadriplegia* ; Quality of Life ; Rehabilitation ; Spinal Cord Injuries ; Tendon Transfer ; Tenotomy ; Upper Extremity*

BACKGROUND: Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. METHODS: A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). RESULTS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. CONCLUSIONS: With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.
Arm ; Bandages ; Burns ; Classification ; Debridement ; Demography ; Follow-Up Studies ; Forearm ; Hand Transplantation ; Humans ; Reconstructive Surgical Procedures ; Rehabilitation ; Soft Tissue Injuries ; Upper Extremity* ; Wounds and Injuries ; Wrist

OBJECTIVE: To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT. METHODS: After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions. RESULTS: A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore. CONCLUSION: Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.
Animals ; Elbow ; Grooming ; Hand Strength ; Humans ; Inpatients ; Mass Screening ; Occupational Therapy ; Outcome Assessment (Health Care) ; Pinch Strength ; Rehabilitation ; Robotics ; Spinal Cord Injuries ; Spinal Cord ; Spinal Injuries ; Upper Extremity