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#1
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11-21-2012, 12:43 PM
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 ♚ Legacy Gold Member ♚ Poster Rank:34 Female Join Date: Nov 2008 Posts: 43,403
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Exploded Hand Syndrome
Severe compressive trauma to the hand causes complex injuries leading to the term 'exploded hand syndrome'. The exploded hand connotes the compendium of clinical findings that include skin failure at the webspaces or glabrous border, atypical (usually longitudinal) fracture patterns of the tubular bones, and axial carpal dissociations. These are accompanied by extensive compromise of the musculature that is extruded or may exhibit evolving compartment syndrome. Understanding the trauma mechanism and patterns of injury in the exploded hand will maximize awareness and guide surgical reconstruction and rehabilitation. 1. (A) The palmar surface of an exploded hand in a child. The crushing trauma created a fissure in the palmar skin that started in the second webspace, then propagated across the palm. This example is interesting because the digits also exhibit the manifestations of hydraulic trauma. (B) In this case the dorsal skin also was injured. The exposed metacarpal head and large area of tissue loss are consistent with the syndrome.  2. (A) Palmar view of an exploded hand. The thenar muscle extrusion that often is characteristic of the syndrome is accompanied by the entire degloving of the palmar skin. The area of skin failure is at the glabrous border. (B) The skin flap is elevated to show the flattened and crushed deep tissues. A Penfield 4 elevator is placed in the carpal canal to show this attenuated structure.  3. A classic picture of the exploded hand. The thenar musculature has been extruded through the thin frenulum of the first webspace. The skin failure has propagated dorsally as a traction tear rather than a direct laceration.  4. (A) The appearance of this exploded hand more resemble those of a saw injury, although the mechanism was that of a crush between 2 heavy metal objects. (B) The true extent of the crush is appreciated in these surgical photographs. Although the hand is flattened and has extensive superficial-and deep-tissue failure, the tendons are intact—a key difference between a laceration and a compressive injury. (C) As an indication of the extreme amount of compressive force that this exploded hand experienced, the lunate is seen in the instrument (arrow), having been extruded through the dorsum of the hand.  |
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#2
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11-21-2012, 02:55 PM
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| ★ Legacy Member ★ Poster Rank:6907 Join Date: Oct 2012 Posts: 30 Mentioned: 0 Post(s) Quoted: 2 Post(s)
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Re: Exploded Hand Syndrome
Pics of hand injuries always freak me out.....all since I nearly lost half of my left hand when I got it stuck in an automatic industrial saw.....I heard the saw blade coming up from below and struck at the control desk in total panic, managed to hit the emergency switch in the very last second. Got away with a very bruised and sore hand. To this day I still get sick to my stomach just by thinking about it. |
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#7
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12-13-2012, 09:19 PM
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| So Fucking Banned Poster Rank:1967 Male, last I checked. Join Date: May 2012 Posts: 255 Mentioned: 2 Post(s) Quoted: 18 Post(s)
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Re: Exploded Hand Syndrome
Oh that is just god awful. Anything to do with injured hands always makes me go a big rubbery one - I just can't handle it easily. I look, but holy shiiiit.  |
