title: [Rollover hands: classification of injuries and therapeutic strategy].
abstract: The term Rollover hands (ROHs) corresponds to a loss of compound tissue from the back of the hand. Our aim was to specify the injuries associated with this type of accident and codify the therapeutic strategy.
  
  
  METHODS
  Twenty-one ROHs were reviewed with an average follow-up of 38 months. Skin coverage included 15 pedicle flaps (two posterior interosseous, 13 pedicled groin flaps), and three free flaps (two external brachial or one parascapular).
  
  
  RESULTS
  We identified: seven stage IA injuries where the extensor apparatus could be directly sutured; Seven stage IB injuries requiring a tendon graft; Stage II, like stage 1B but with bone and joint lesions or damage to the wrist extensors as well, and Stage III for which over 50% of the intrinsic muscles had been destroyed. All patients recovered their grasp. The mean active extension deficit for each finger was -20.9° for the whole digital chain and a 194.4° TAM. Palmo-digital grip strength was 51.3% on the controlateral side, and the mean DASH score was 16.1.
  
  
  CONCLUSIONS
  Our study demonstrates the prognostic value of the proposed classification and importance of restoring high-quality skin covering. Reconstruction of the extensor apparatus must be envisaged once the condition of the bone and joints has become stable. Vascularised tendon grafts may be indicated when early mobilisation allowing restoration of a glliding surface around the tendon is impossible, or for loss of substance of over 5 cm. Damage to the intrinsic muscles is a very poor prognostic factor.
authors.affiliation: Chirurgie de la main, du membre supérieur et des nerfs périphériques, CHRU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. bertrand-coulet@wanadoo.fr
authors.forename: B
authors.initials: B
authors.lastname: Coulet
authors.forename: J G
authors.initials: JG
authors.lastname: Boretto
authors.forename: C
authors.initials: C
authors.lastname: Lazerges
authors.forename: M
authors.initials: M
authors.lastname: Cesar
authors.forename: O
authors.initials: O
authors.lastname: Mares
authors.forename: M
authors.initials: M
authors.lastname: Chammas
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006230:Hand Injuries / Q000145:classification* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D055815:Young Adult