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EXPLOSIONS IN THE HAND: A CONSISTENT INJURY PATTERN AND AN INDICATION FOR END‐TO‐SIDE NEURORRHAPHY
Author(s) -
Prasad V.,
Van zyl N.,
Kimble F. W.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04918_6.x
Subject(s) - medicine , degloving , thumb , neurovascular bundle , digital nerve , thenar eminence , hand injury , surgery , nerve injury , anatomy
The pattern of injury to the radial side of the hand produced by an exploding object is constant and well described1–4. The typical patient presents with a degloving laceration over the thenar eminence and first web space. Adductor pollicis is most severely injured with opponens pollicis, flexor pollicus brevis and abductor pollicus brevis sustaining relatively less damage. The skeletal and ligamentous components are also injured in a predictable way. The most common findings are a dislocation of the thumb carpometacarpal joint and/or a Bennett's‐type fracture. The neurovascular bundles are invariably damaged by explosions in the hand but the nerve injury presents us with an interesting problem. The palmar digital nerves are often avulsed from within the substance of the parent nerve leaving no suitable proximal end for repair. In addition the devitalised distal segment requires debridement which produces a nerve gap. Previous authors have not reported on their management of the nerves in this type of injury. We present three cases, illustrating a consistent injury pattern and with management of the digital nerve injuries by end‐to‐side nerve neurorrhaphy. As far as we are aware, this technique has not been described for this particular injury.