Patterns in blast injuries to the hand.
Blast injuries to the hand are not just a wartime phenomenon but also quite common in rural communities throughout northern California. The purpose of this study is to review our experience with blast injuries in the community and review the most common patterns in an attempt to identify the pathomechanics of the hand injury and the reconstructive procedures that are required. This is a retrospective study of blast injuries to the hand treated between 1978 and 2006. Medical records, X-rays, and photos were reviewed to compile standard patient demographics and characterize the injury pattern. Explosives were classified based on their rate of decomposition. Reconstructive solutions were reviewed and characterized based on whether damaged tissues were repaired or replaced. Sixty-two patients were identified with blast injuries to their hand. Patients were predominantly male (92%) with an average age of 27 years. Firecrackers were the most commonly encountered explosives. Thirty-seven patients were identified as holding a low explosive in their dominant hand and were used for characterization of the injury pattern. The apparent pattern of injury was hyperextension and hyperabduction of the hand and digits. Common injuries were metacarpophalangeal and interphalangeal joint hyperextension with associated soft tissue avulsion, hyperabduction at the web spaces with associated palmar soft tissue tears, and finger disarticulation amputations worse at radial digits. Given the mechanisms of injury with tissue loss, surgical intervention generally involved tissue replacement rather than tissue repair. Blast injuries to the hand represent a broad spectrum of injuries that are associated with the magnitude of explosion and probably, the proximity to the hand. We were able to identify a repetitive pattern of injury and demonstrate the predominant use for delayed tissue replacement rather than microsurgical repair at the acute setting.
Hazani
Ron
R
Division of Plastic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, ACB Building, 2nd Floor, Louisville, KY 40292, USA. Ronmdsurg@hotmail.com
Buntic
Rudolf F
RF
Brooks
Darrell
D
Int Surg. 1990 Apr-Jun;75(2):109-14
2379989
Plast Reconstr Surg. 1997 Jan;99(1):122-8
8982195
J Hand Surg Br. 1988 May;13(2):130-5
3385286
J Hand Surg Br. 1998 Oct;23(5):578-82
9821597
J Hand Surg Am. 1983 Sep;8(5 Pt 1):507-8
6630925
J Am Acad Orthop Surg. 2006;14(10 Spec No.):S77-81
17003215
Orthop Clin North Am. 1977 Apr;8(2):309-18
896165
Br J Plast Surg. 1973 Oct;26(4):398-405
4759982
Plast Reconstr Surg. 1997 Oct;100(5):1200-11
9326781
J Hand Surg Am. 2006 Apr;31(4):640-6
16632060
Ann Surg. 1973 Feb;177(2):167-73
4572781
Chirurg. 1977 Jun;48(6):353-9
885018
Ann Plast Surg. 2001 Oct;47(4):453-7
11601586
J Bone Joint Surg Am. 1968 Jul;50(5):945-54
5676833