Hand injury without any deficit: Is systematic surgical exploration justified?

Amsallem, Lior; Pierrart, J.; Werthel, Jean‐David; Delgrande, Damien; Bihel, Thomas; Sekri, Johanna; Zbili, David; Lafosse, Thibault; Masméjean, E.

doi:10.1016/j.hansur.2018.08.002

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Consequently 87.1% of all patients showed lesions requiring a specialized surgery care. This ratio strengthens the consensus established by the scientific groups (Hand Emergency Department Federation (FESUM), National Society of Emergency medicine (SFMU)), supporting the need of exploration under surgical procedure of every palmar hand and dorsal facing joint wounds (10)(11)(12)(13). This ratio also supports the value of a quality initial clinical examination, that in our cases is conducted by formed residents in hand surgery.…”

Section: Resultssupporting

confidence: 82%

See 1 more Smart Citation

Ambulatory hand emergency: 2 years-experience in an public university hospital center

Carricaburu¹,

Mouton²,

Nseir³

et al. 2021

Acta Orthop Belg

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Hand emergencies represent the most frequent traumatic injuries and outpatient surgery is still improving. It will achieve 70% of total surgeries by 2022. Our hand trauma center has been able to set up an emergency day surgery department in a university hospital center. With this article, we would like to report the ambula- tory care management and practice for hand emer- gencies in our university hospital center over 2 years. 892 patients suffering from hand traumas and managed in our day surgery department, were retro-spectively reviewed between January 2016 and December 2017. Patients’ demographic data, anesthe- tic data, trauma’s circumstances, medical care and surgical outcomes have been disclosed. A descriptive analysis and a statistical assessment was realized. Cut injury was the most recorded case, followed by impactions. Tendon injuries were the most frequent (32%), followed by fractures (26%), and exposed joints (18%). 13% of injuries were nil findings. Average patient care delay was 1.16 days. Mean of hospitalization was 7.5 hours. 16/892 patients needing intravenous antibiotics required hospitalization. 41 complications including 27 secondary surgeries were reported. Hospital facilities are forced to reassess their entire procedures to achieve efficiency and improvement for healthcare. Progress in outpatient surgery permits emergency management in hand surgery, improving patient cares both medically and economically.

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Section: Resultssupporting

confidence: 82%

“…This system allows us to practice surgery the following day after their initial consultation, in most of cases, avoiding an undue bed occupancy the day before surgery and the night later. This point permit to improving the efficiency of patient care (13).…”

Section: Discussionmentioning

confidence: 94%

Ambulatory hand emergency: 2 years-experience in an public university hospital center

Carricaburu¹,

Mouton²,

Nseir³

et al. 2021

Acta Orthop Belg

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“…Among gunshot wound patients with nerve deficits on examination, Pannell et al 9 found an intact nerve in 59% of explorations (24% of patients had nerve contusions and 17% had nerve lacerations). The combination of an abnormal nerve examination and the high likelihood for a negative nerve exploration 15,17 makes the decision to pursue exploration more challenging in patients with gunshot wounds. In this subset of patients, it may be reasonable to pursue initial nonoperative management with serial examinations to assess spontaneous recovery prior to exploration.…”

Section: Discussionmentioning

confidence: 99%

“…12 Previous studies have documented the discordance between clinical examination for a peripheral nerve injury and subsequent intraoperative findings. Amsallem et al, 15 for example, found that 58.6% of patients with normal preoperative examinations indeed had major injuries identified intraoperatively. Conversely, Miranda et al 10 reported 100% concordance with hand specialist examination and operative findings.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for a False-Negative Examination in Complete Upper Extremity Nerve Lacerations

Loewenstein

Wulbrecht

Leonhard

et al. 2019

Hand (New York, N,Y.)

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Background: Many patients with complete nerve lacerations after upper extremity trauma have a documented normal peripheral nerve examination at the time of initial evaluation. The purpose of this study was to determine whether physician-, patient-, and injury-related factors increase the risk of false-negative nerve examinations. Methods: A statewide health information exchange was used to identify complete upper extremity nerve lacerations subsequently confirmed by surgical exploration at 1 pediatric and 2 adult level I trauma centers in a single city from January 2013 to January 2017. Charts were manually reviewed to build a database that included Glasgow Coma Scale score, urine drug screen results, blood alcohol level, presence of concomitant trauma, type of injury, level of injury, laterality, initial provider examination, and initial specialist examination. Bivariate and multivariable analyses were performed to evaluate risk factors for a false-negative examination. Results: Two hundred eighty-eight patients met inclusion criteria. The overall false-negative examination rate was 32.5% at initial encounter, which was higher among emergency medicine physicians compared with extremity subspecialists ( P < .001) and among trauma surgeons compared with surgical subspecialists ( P = .002). The false-negative rate decreased to 8% at subsequent encounter ( P < .001). Risk factors for a false-negative nerve examination included physician specialty, a gunshot wound mechanism of injury, injury at the elbow, and age greater than 71 years. Conclusion: There is a high false-negative rate among upper extremity neurotmesis injuries. Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes.

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“…Jedoch können Verletzungen von Sehnen und/oder Nerven übersehen werden, und die erforderliche handchirurgische Versorgung unterbleibt. So stellten Amsallem et al fest, dass bei mehr als der Hälfte der klinisch unauffälligen Handverletzungen erst intraoperativ eine Beteiligung funktioneller Strukturen diagnostiziert wurde [2].…”

Section: Introductionunclassified

Notfallmedizinisches Management von Handverletzungen

Gunßer¹,

Säuberlich²,

Gäßler³

et al. 2020

Der Notarzt

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ZusammenfassungAuch wenn nicht jede Handverletzung lebensbedrohlich ist bzw. die Alarmierung eines Notarztes nach sich zieht, bedarf es in den meisten Fällen exakter anatomischer Kenntnisse. Am Unfallort stellt die Unübersichtlichkeit der Verletzungen oft eine große Herausforderung dar, die zur weiteren Versorgung meist in ein Traumazentrum mit handchirurgischer Expertise gehört. Im Beitrag werden die Grundlagen der Anatomie, die häufigsten Handverletzungen von Erwachsenen und Kindern und das jeweilige notfallmedizinische Management vorgestellt.

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Hand injury without any deficit: Is systematic surgical exploration justified?

Cited by 8 publications

References 15 publications

Ambulatory hand emergency: 2 years-experience in an public university hospital center

Ambulatory hand emergency: 2 years-experience in an public university hospital center

Risk Factors for a False-Negative Examination in Complete Upper Extremity Nerve Lacerations

Notfallmedizinisches Management von Handverletzungen

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