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. 2020 Jul-Aug;11(4):517-522.
doi: 10.1016/j.jcot.2020.03.028. Epub 2020 Apr 11.

Guidelines for management of crush injuries of the hand

Amitabha Lahiri  1
Affiliations

Guidelines for management of crush injuries of the hand

Amitabha Lahiri. J Clin Orthop Trauma. 2020 Jul-Aug.

Erratum in

Abstract

Crush injuries of the hand involve damage to multiple structures within the hand, loss of tissue, devascularisation and possibly amputation of digits. They are complex and difficult to classify. Each injury has a unique pattern and requires a unique plan of management. There are no set procedures that can be described, however fundamental principles can be laid down to guide surgical management. Optimum management requires a planned and decisive approach. The surgeon or the team must be well versed with techniques necessary for management of all the structures within the hand, microsurgery and free tissue transfer. The essential components of management are, accurate assessment of the injury and creating a reconstructive plan by structures. The essential components for primary surgery are precise and complete debridement, skeletal stabiliation, vascular repair and if vessels are exposed, soft tissue cover. Secondary surgery should include procedures to enhance the function of the hand or to improve the aesthetics of the hand. These include bone grafting, fusion, tendon and nerve reconstruction, flap de-bulking and toe to hand transfers. The following article is a concise synthesis of the fundamental principles which a hand surgeon must understand while undertaking these challenging procedures.

Keywords: Amputation; Crush; Hand; Reconstruction; Trauma.

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Figures

Fig. 1
Fig. 1
Severe crush injury involving the palmar to the dorsal aspect of the hand. The flexed posture of fingers indicates intact flexors (A,B,C). V-sign (C) between index finger and the rest of the fingers indicates fractures of metacarpals. X-ray of the hand (D).
Fig. 2
Fig. 2
A preoperative visualisation of the expected trauma based on initial examination and the operative plan (A&B). Picture of the hand after debridement(C).
Fig. 3
Fig. 3
Unconventional fixation of the metacarpals using K wires in single coronal plane to avoid penetration of the flap and allow removal of implants if infection developed under the flap(A). Combined groin and superficial epigastric flap (B).
Fig. 4
Fig. 4
Function of the hand approximately four months after trauma (A through D). Complete bone union (E).
See this image and copyright information in PMC

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