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Hand Therapy Consulting regularly shares current news and information on hand therapy practices from around the world, including information on common hand problems, trends in hand therapy exercises and treatment as well as updates and announcements on our own research and activities.

 

In the event of a serious traumatic amputation of the hand, patients currently have one of 3 options available to them:

1.  Hand replantation if the tissues are viable and if the severed hand is professionally cared for immediately after the accident.This procedure is carried out of if the hand can function without pain and the goal would be to give the patient back as much function as possible.

2. Amputation if the tissues are too damaged and the hand cannot be replanted. A cosmetic or prosthetic hand may be offered to improve the cosmetic appearance and function of the hand.

3. Hand transplantation if a hand replantation is not an option, surgeons can offer the patient a hand transplantation whereby a donor hand is transplanted onto the recipient's forearm. Am operation such as this requires a team of up to 20 surgeons who connect the arteries, veins, tensonds and bones. Immune suppresant drugs are used to prevent the rejection of the donor hand by the body.

 

All thre options above will require a highly skilled hand therapist to rehabilitate the injured person to ensure maximum return to function.

Now researchers are developing a robotic hand which has intricate motion capabilities. In additin, the researchers are planning to grow human tissue onto the robotic hand, which would mean that a person could be provided with and entirely NEW hand in the event of an accident. Researchers put the hand through a laser scanner and then 3D printed artificial bones to match. The hand can be operated remotely by wearing a glove covered in sensors.

For more information on this incredible scientific development, please click on the following link:

http://www.techinsider.io/researchers-to-grow-tendon-on-robot-hand-2016-2

 

                                           INITIAL X-RAY                                                                             FINAL X-RAY

Mechanism of Injury:

In October 2015, Chris sustained a crush injury to his right index finger, resulting in an open comminuted fracture of the  middle phalanx. There was no nail bed damage, vascular compromise or nerve damage. Chris was taken to Sandton Clinic and was seen by Dr Juan Marin, Orthopaedic Surgeon. Dr Marin informed Chris that the fracture would need to be fixated with K Wires. Chris would not give consent to the use of K Wires or Plate & Screw Fixation as he wanted to return to sporting activities as soon as possible.

Noval Surgical Procedure:

Dr Marin was aware of the use of a figure of eight tension band suture to stabilise nail bed and distal phalangeal fractures (Memon, 2012, Patanker, 2007, Bristol & Verchere, 2007 and Bindra, 1997) but these sutures were placed dorsally over the skin and nail bed injury. The multi-fragment fracture of the middle phalanx required reduction and internal fixation. Therefore Dr Marin adapted the previously described technique to provide internal fracture fixation by using a K Wire to drill diagonally across the middle phalanx in both directions. A figure-of eight tension band using Fiber Wire 2 was then threaded through the holes drilled by the K wire to internally fixate the fracture.

Hand Therapy:

Chris was referred to Hand Therapy 2 weeks after surgery. An orthosis was applied dorsally to the right index finger to provide support and pain relief. In the absence of K wires, early active mobilisation of the index finger PIP and DIP joints could be performed. Treatment included wound and scar management, active and passive mobilisation of the right index finger and strength re-training. Chris attended 12 hand therapy appointments over a period of 4 months.

Outcome:

Chris can achieve a composite fist, but is unable to make a tight fist die to the scar tissue that is present over the dorsum of the DIPJ. He has regained full functional use of the hand. Grip and pinch strength are normal in the right hand when compared to the left. Chris is very satisfied with the outcome of the intervention and is grateful that his hand surgeon respected his wish to not have K wire fixation and rather applied an innovative technique.

The technique was successful and should be considered in the future management of comminuted fractures of the finger.

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