Burst Injuries of First Web Space of Hand

A Prospective and Retrospective Study

Abstract

Background: Blast hand injuries, primarily seen during wartime, are now frequently encountered in major civilian trauma centres.

Objectives: To evaluate the etiology and demographic pattern of burst injuries of the hand, to outline the possible pathomechanics, and to formulate reconstructive solutions.

Study Design: Hospital-based prospective and retrospective study

Methods: Patients with burst injuries of the first web space of the hand, who reported to SKIMS Accident and Emergency Department and underwent treatment under the Department of Plastic and Reconstructive Surgery. Altogether, 26 patients were included in the study, which comprise the cases of tear gas shells, stun shells, firecracker, cell phone, and pressure cooker blast injury.

Results: The mean age of the patients was found to be 23 years, 96% were males, and the dominant hand was more frequently injured 80%. Among the 26 patients described seven revascularizations and one reimplantation have been done, all in acute settings with a good outcome.

Conclusion: The most common pattern of injury comprised of a first web space split with variable degrees of thenar muscle injury, dorsal dislocation of the CMC joint of the thumb. The severity of the injury, as well as the incidence of injury, decreased from radial to ulnar aspect of the hand.

Implications: The outcome of reimplantation and revascularization was quite encouraging, so formalization of amputations should not be the predominant course of action.