Our hands are the most valuable tool for daily work and a link between us and the environment. In work injuries, upper extremity and more specifically the hand, is a high incidence of injuries because the vast majority of tasks pass through our hands and as a result, is the location where they settle most accident if one third of occupational injuries, fourth part of sick leave and a fifth of disability (1).
Due to the morbidity (damage) that this type of injury and expense involved to companies is fundamental reason to know and prevent trauma to the hands.
injury rates
According to published works, and our experience shows that work-related injuries affect more young men -The average age of patients with hand injuries is 33 years, being the most common mechanisms of injury hyperextension (20%), cutting with sharp objects (15%), falls (12%) and hitting with an object (10%). The mechanism of injury that determines admission to the hospital includes an object contusions (20%), road traffic injuries (19%), fall (20%) and machinery (15%).
hand injury in an average of 20 days off work, these figures vary depending on the lesion produced.
Figure 1 - A and B) fingertip injury with loss of part distal finger. C) on the back of his hand injury with loss of substance.
From a clinical standpoint, with the highest incidence of injuries in emergency departments are the cuts, fractures, pinched or crushed by machinery in the distal fingers (Fig. 1).
The condition causes these injuries are related to the type of work performed. The causes are as diverse as the instruments used in work activities so that no profession is exempt from industrial accidents, with adequate instruction in the prevention of occupational hazards optimal health measure to avoid them. Often The woodworkers have various injuries to tell and some boast of their history.
The mechanism of injury is determined by the instruments used in work activity, hence, as the material is used for cutting saws and shears, will lead incised wounds of varying depth depending on the intensity of the cut. The machine that uses gears to operate and causes avulsion fractures associated and presses cause serious crush injuries to members. It is therefore particularly important to know the mechanism of injury and type of instrumental cause, as prognostic factors in treatment and patient outcomes.
Figure 2. A and B) Amputation of arm at level of proximal humerus .. C) Replantation member during suturing of the injured structures and plate fixation of humeral fractures.
Different suffered hand injuries in the workplace are classified as incised wounds, contusions and incised, contused. The most important parameters to evaluate this type of injury is the time elapsed since the injury, the environment in which it was made, the presence of associated injuries and the instrumental cause of the injury.
While all these parameters make the prognosis of the injury are the time and cause of the injury the most relevant. On the first point, the time sets the standard to follow. In incised wounds with more than 6 hours after onset is not performed by primary closure considered contaminated and must be closed by secondary intention, ie a few days. Tissues can be maintained without movement (the case of amputation) about 6 hours in proximal regions of the upper (warm ischemia time) and up to 12 hours if kept in cold tissue (cold ischemia time). In the case of the fingers, these times increase at 12 hours (warm ischemia time) and up to 24 hours of cold ischemia time. If we respect these shown it is possible reimplantation of the tissue, as seen in Figure 2.
fractures of the distal radius (wrist) are high-impact injuries in the workplace lesions associating with neighboring structures, especially in young patients where the trauma is usually high energy level. There are three types of injury associated: 1) fracture of the carpal bones, 2) carpal ligament injuries and 3) soft tissue injury (2).
Figure 3: Injury grouting under high pressure into the hand of a worker.
special mention for his severity is injury produced by high pressure systems, such as cement and painting, as the high energy that penetrate the tissues and the time when the material is in contact, are risk factors for necrosis of these (3) .
Figure 4. Hand amputation at the metacarpal. Thumb was revascularized and continues with long fingers, it can be seen on radiographs of bone fixation in replantation- this
Treatment Treatment varies depending on the type of injury, being necessary to meet the following basic guidelines to prevent infections and various complications: assessing injury or concomitant injuries of vessels or nerves, thorough cleaning with saline solution the focus of injury and antibiotic coverage, in case of fracture fixation and primary closure in the case of incised injury, repair of vascular structures, nerve or tendon and get a proper skin coverage.
regarding replantation treatment is to apply all the concepts mentioned above in a single surgical procedure to obtain a therapeutic success given the complexity of the injury, which combine in many cases tendon injuries, vascular, bone and soft tissue. Prevention
Given the high incidence of hand injuries, prevention of occupational risks is an essential element to reduce the high accident rate at work. Prevention must be made from various areas, beginning with maintaining a proper job title and instruments and have security systems appropriate passive and active.
instruction on the proper use of hands at work, the appropriateness of the activity of the worker to their physical and mental health and training in security measures are measures essential to reduce the incidence of accidents.
Several studies reviewed, we note the existence of factors in workplace accidents. The low level of experience work, work stress, low security measures, the age of 33, job dissatisfaction, changes in sleep, smoking and / or consume alcoholic beverages during working hours and level of physical activity are factors that determine the occurrence of injuries in the workplace (4.5).
is therefore particularly important to take measures to reduce the incidence of these injuries and the most effective is training in risk prevention. Bibliography
1 Marty J, Porcher B, Autissier R. "Hand Injuries and occupational accidents. Statistics and prevention." Ann Chir Main. 1983;2(4):368-70.
2 García-Elías M. "Lesiones asociadas a las fracturas de la extremidad distal del radio. Patología del aparato locomotor, 2007; 5 Supl. II: 22-25".
3 Wong TC. "High-pressure injection injuries of the hand in a chinese population". Journal of Hand surgery 30B: 6:588-592.
4 Kumar Ghosh A. "Relationships of working conditions and individual characteristics to occupational injuries: A case-control study in coal miners".
5 Chau N, Mur JM, Benamghar L, Siegfried C, Dangelzer JL, Français M, Jacquin R, Sourdot A. "Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study. Am J Ind Med 2004 Jan; 45 (1) :84-92.
Dr. Santiago Amillo, Apt. Of Orthopaedic Surgery and Traumatology of the University Clinic of Navarra, and Dr. Luis M ª Romero, Apt. Orthopaedic Surgery Traumatology of the University Clinic of Navarra
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