Blast injuries to the hand: Pathomechanics, patterns and treatment

Abstract

Purpose:To characterize the common patterns of injury in detail in cases of blast injuries to the hand and to outline the possible pathomechanics of these patterns of injury while describing the treatment modalities for the same as practiced in our center.Materials and Methods:A review of admitted patients in our department from september 2009 through december 2010 of blast injuries to the hand was made. Each patient had a careful characterization of their injuries as mild, moderate or severe with the help of X-rays, clinical photographs and operative notes. The treatment of these patients during hospital stay was also documented.Results:Of the 55 patients studied, 5 patients suffered mild injuries with no bony injuries or dislocations, 26 patients had moderate injuries characterized by fractures and dislocations in addition to soft tissue injuries and 24 patients had severe injuries characterized by variable degrees of amputations. The most common injury type was to the radial aspect of the hand characterized by a first web split and a dislocation of the CMC joint of the thumb associated with fracture of the central metacarpals and amputations of the index and long fingers in some cases. Injury to the ulnar aspect was rare. Injuries were treated by repair as well as replacement done mostly in a serial fashion.Conclusion:Depending on the mode of injury, blast injuries to the hand can have varying patterns of injury, which can have important implications in the treatment and rehabilitation of a patient.

Pediatric Hand Blast Injury Profile in Emergency Room of Dr. Hasan Sadikin General Hospital Bandung

“…The rest of the fingers are more firmly fixated on the metacarpals, although each fingers still have a mechanical function when grasping objects. 12 To grasp an object, such as fireworks or firecrackers, thumb and index finger emulates with other fingers as supporting structures and stabilizes the grip. 12 When the explosive is triggered when it is still held or in near proximity of the hand, several vectors acting centrifugally may cause injuries to the hand.…”

“…12 To grasp an object, such as fireworks or firecrackers, thumb and index finger emulates with other fingers as supporting structures and stabilizes the grip. 12 When the explosive is triggered when it is still held or in near proximity of the hand, several vectors acting centrifugally may cause injuries to the hand. The vector of the blast may cause tears of the first interdigital web space.…”

Prevalence and patterns of cracker blast injuries of the hand

“…In a significant number of cases, homemade firecrackers are the cause of explosion. 12 The predominance of the right hand in such injuries may be an accident while hurling a cracker or due to mischievous behavior of firing the cracker with bare hands.…”

“…The MCP joints in the other fingers resist disruption to some extent because the proximally unattached volar plate in these joints permits some degree of hyperextension and shock absorption. 12 The IP joints have fixed volar plates and are therefore unyielding and usually disrupt from the injury leading to amputations of these fingers. The center of the hand comprises of 2 and 3 metacarpals fixed to the carpus in the hand and their shafts become the weakest target and are subject to fracture from the effect of the blast.…”

“…12 For gripping an object like a bomb, the primary action is provided by the thumb and the index finger with a supportive part played by the ulnar fingers while the long finger stabilizes the grip. 12 Therefore, when an explosion occurs with the object being held in the hand or in close contact with the hand, there are several injury vectors acting in a centrifugal direction radiating from the major point of contact with the hand which is the thinner eminence. This is subject to the brunt of the damage by the injury vectors which leads to a first web split.…”