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. 2009 Mar;4(1):44-9.
doi: 10.1007/s11552-008-9125-z. Epub 2008 Aug 29.

Patterns in blast injuries to the hand

Ron Hazani  1 , Rudolf F Buntic, Darrell Brooks
Affiliations

Patterns in blast injuries to the hand

Ron Hazani et al. Hand (N Y). 2009 Mar.

Abstract

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.

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Figures

Figure 1
Figure 1
Percentage of injuries in the fingers, mid-palm, first web space, thenar eminence, and hypothenar eminence (n = 62).
Figure 2
Figure 2
Distribution of amputations, near-complete amputations, joint disarticulations, and fractures. IP Interphalangeal, DIP distal interphalangeal, PIP proximal interphalangeal, MCP metacarpophalangeal, MC metacarpal, CMC carpometacarpal (n = 62).
Figure 3
Figure 3
Microsurgical reconstructive procedures following a blast hand injury (n = 62).
Figure 4
Figure 4
Flaps used for soft tissue reconstruction and first web space release (n = 62).
Figure 5
Figure 5
Pathomechanics of a blast injury while exerting a hyperextensive force at the articular level. The figure demonstrates joint disarticulation, volar plate disruption, and intrinsic muscle rupture.
Figure 6
Figure 6
A 33-year-old right-hand-dominant man with a right-hand blast injury from an M-1000 firecracker explosion. The wound demonstrates a significant thenar eminence avulsion with degloving injuries of the thumb and long finger. The pattern is consistent with the predominantly radial distribution of injuries in the hand.
Figure 7
Figure 7
A 15-year-old right-hand-dominant man with a right hand blast injury following a firecracker explosion (unspecified). Tissue avulsion at the first web space and hypothenar eminence with exposure of the flexor pollicis longus and multiple palmar lacerations. The pattern is consistent with hyperabduction and hyperextension of the thumb and widening of the first web space.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.jhsa.2005.12.009', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.jhsa.2005.12.009'}, {'type': 'PubMed', 'value': '16632060', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16632060/'}]}
    2. Adani R, Tarallo L, Marcoccio I, Fregni U. First web-space reconstruction by the anterolateral thigh flap. J Hand Surg (Am). 2006;31:640. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/00000637-200110000-00018', 'is_inner': False, 'url': 'https://doi.org/10.1097/00000637-200110000-00018'}, {'type': 'PubMed', 'value': '11601586', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11601586/'}]}
    2. Akyurek M, Safak T, Kecik A. Coverage of thumb wound and correction of first webspace contracture using a longitudinally split reverse radial forearm flap. Ann Plast Surg. 2001;47:453. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '885018', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/885018/'}]}
    2. Biemer E. Replantation of fingers and limb parts(:) technique and results. Chirurg. 1977;48:353. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '17003215', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17003215/'}]}
    2. Bumbasirevic M, Lesic A, Mitkovic M, Bumbasirevic V. Treatment of blast injuries of the extremity. J Am Acad Orthop Surg. 2006;14(Suppl):S77. - PubMed
    1. None
    2. Buncke HJ. Digital reconstruction by second-toe transplantation. In: Buncke HJ, editor. Microsurgery: transplantation–replantation. An atlas text. Philadelphia: Lea & Febiger; 1991. p. 61–101.