RESUMO
BACKGROUND: Acute upper extremity injuries remain one of the most common consultations in the emergency departments for plastic surgery services. These injuries can affect a person's quality of life and negatively affect work-related or social interactions if not properly managed. We aim to evaluate our experience and management in a specialized referral center in Mexico City. METHODS: A retrospective review was performed. All patients with hand trauma managed by our service from July 2010 to June 2015 were included; their demographic characteristics were described as well as the most common patterns of injury, management, and outcome. RESULTS: A total of 4751 patients with injuries in the upper extremities were included, 77% were males with a mean age of presentation of 26.9 ± 17.9 years; the age group most commonly affected was between 16 to 30 years (39%); 54% of the cases affected the right hand. Lacerative wounds were the most common mechanism of injury (60.7%), followed by blunt trauma (28.7%). Management was surgical in 87% of the cases. CONCLUSIONS: Upper extremity trauma encompasses a wide range of clinical presentations, from simple lacerations to catastrophic injuries that require extensive or multiple reconstructive procedures. The clear understanding of the trauma mechanisms and how they are related with certain patterns of injury might maximize awareness and guide a surgeon's management effectively.
Assuntos
Traumatismos do Braço/epidemiologia , Traumatismos do Braço/cirurgia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/cirurgia , Procedimentos de Cirurgia Plástica , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Adulto , Traumatismos do Braço/etiologia , Criança , Estudos Transversais , Feminino , Traumatismos da Mão/etiologia , Hospitais Gerais , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Evidence on effectiveness of ergonomic interventions to reduce mechanical demands of the upper extremity is scarce in agriculture. OBJECTIVE: To conduct an ergonomic intervention to reduce mechanical exposures on workers during manual flower cutting, while emphasizing postural education and reduction of force requirements. PARTICIPANTS: Seventy seven workers (20 to 55 years old; 80% women) from six companies that cultivate roses participated in this study. METHODS: Participants from three companies were randomly assigned to control and intervention groups. A postural education program and a maintenance program was designed and implemented in the intervention group aiming to achieve more neutral postures of the wrist and forearm and to reduce force requirements during rose cutting. Changes in self-reported effort and upper extremity postures, kinematics and muscular activity between baseline and follow-up assessments were evaluated. RESULTS: Most of the observed changes in the evaluated mechanical exposures were moderate for both groups. The intervention group showed differential improvements compared to the control group for 95th percentile forearm pronation (intervention group went from 50.6 to 35.6°; control group went from 18.4 to 34.7°); and to some degree for the maximum wrist radial deviation (the intervention group went from 17° to 7.6°; control group went from 10.1° to 7.8°). Also, the mean elbow flexion for the control group was reduced from 62.3 to 48.4°, whereas it increased from 52.2 to 57.3° in the intervention group. No differential changes between the intervention and control groups were observed for the kinematic variables, except for an unexpected reduction in the 95th percentile velocity of wrist flexion-extension in the control group, which was not observed in the intervention group. Lastly, although observed changes in muscular activity were not statistically significant, improvements were observed for the intervention group for the flexor and extensor carpi radialis and the flexor carpi ulnaris; although the opposite was true for the extensor carpi ulnaris. CONCLUSIONS: Important although sometimes mixed results were achieved with this field intervention, focusing on postural and force requirement demands. The positive results are encouraging considering the presence of typical limitations observed in field intervention studies.
Assuntos
Doenças dos Trabalhadores Agrícolas/etiologia , Doenças dos Trabalhadores Agrícolas/prevenção & controle , Traumatismos do Braço/etiologia , Traumatismos do Braço/prevenção & controle , Ergonomia , Flores , Adulto , Doenças dos Trabalhadores Agrícolas/epidemiologia , Traumatismos do Braço/epidemiologia , Fenômenos Biomecânicos , Colômbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PosturaRESUMO
A incidência de lesões traumáticas dos membros superiores em um hospital terciário além de ser elevada, possui uma grande variedade. Neste sentido torna-se importante a criação de um banco de dados único, para conhecer o perfil dos pacientes atendidos. Objetivo: traçar o perfil dos pacientes com lesões traumáticas dos membros superiores, atendidos pela Fisioterapia no Centro de Reabilitação do Hospital das Clínicas de Ribeirão. Método: foram avaliadas 223 fichas de pacientes (58 mulheres e 116 homens), com idade média de 34,54 (± 19,05) anos, encaminhados pelo ambulatório de ortopedia do referido hospital. Resultados: do total de casos analisados, as lesões de punho e mão obtiveram maior incidência (60,99%), seguidos por lesões de ombro (20,63%), cotovelo (12,55%), braço (3,59%) e antebraço (2,24%). Nas lesões de punho e mão o mecanismo de trauma com maior porcentagem foi o acidente de moto, relacionado com as fraturas múltiplas de ossos da mão. Queda da própria altura, acidente motociclístico e queda de escada foram os mecanismos de trauma, correlacionando com as fraturas de úmero proximal, luxação de ombro e fraturas de escápula respectivamente. Conclusão: Foi verificada a incidência de lesão, mecanismo de trauma e as características da população para futuramente aprimorar os protocolos específicos para as disfunções e investir em campanhas de prevenção.
The incidence of traumatic injuries of the upper limbs in a tertiary hospital has a wide variety. This is why the creation of a unified database becomes important-to know the patients profile. Objective: this study sought to determine the profile of patients with traumatic injuries of the upper limbs, treated by Physical Therapy in Rehabilitation Center of the Clinics Hospital of Ribeirão Preto. Method: Two hundred and twenty-three patient records were evaluated (58 women and 116 men). They had an average age of 34.54 (± 19.05) years and were referred by the orthopedic clinic of this hospital. Results: of the cases studied, wrist and hand injuries had the highest incidence (60.99%), followed by injuries of the shoulder (20.63%), elbow (12.55%), arm (3.59%) and forearm (2.24%). In injuries of wrist and hand, the trauma mechanism with the highest percentage was the motorcycle accident, associated with multiple handbone fractures. Falling down, motorcycle accidents, and falling off a ladder were the mechanisms of injury correlated with proximal humerus fractures, shoulder dislocations, and broken scapulas, respectively. Conclusion: the incidence of injury, trauma mechanism, and characteristics of the population was verified and further improvements in protocols for specific disorders and prevention can be made.
Assuntos
Humanos , Masculino , Feminino , Extremidade Superior , Centros de Reabilitação , Ombro/lesões , Perfil de Saúde , Traumatismos da Mão/epidemiologia , Traumatismos do Antebraço/epidemiologia , Traumatismos do Braço/epidemiologia , Traumatismos do Punho/epidemiologia , Epidemiologia Descritiva , Estudos Transversais , Prontuários MédicosRESUMO
Machete-related wounds are a source of appreciable morbidity in many developing nations. We describe a case of radial nerve injury resulting from a machete attack in Haiti. Twenty-two additional cases of machete-related wounds treated during a 3-month humanitarian mission to Haiti are reported. Sixty-five percent were accidental in nature, occurring from a variety of routine activities, whereas the remainder were secondary to assaults. The upper extremity was injured in 85% of the cases, often resulting in complicated wounds with nerve, tendon, and joint injuries. A treatment protocol for peripheral nerve injuries incurred in austere conditions is presented.
Assuntos
Traumatismos do Braço , Ferimentos Perfurantes , Adolescente , Adulto , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/patologia , Criança , Feminino , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Radial/lesões , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/patologiaRESUMO
Os autores realizaram um estudo retrospectivo, no período de janeiro a dezembro de 1997, com o intuito de estabelecer os distúrbios ortopédicos de maior prevalência, segundo sexo e faixa etária. No total, foram analisados 4.954 casos, sendo os dados obtidos junto ao banco de dados de sua instituição. Fratura do rádio e do cúbito foi o distúrbio mais prevalente (8,8 por cento), seguido de entorses e distensões (6,5 por cento). O sexo mais atingido foi o masculino (60,4 por cento) e a faixa etária mais freqüente foi entre 10 e 19 anos (18,2 por cento). Os autores discutem os resultados e comentam sobre o impacto socioeconômico dos distúrbios ortopédicos e traumatológicos
Assuntos
Humanos , Entorses e Distensões/epidemiologia , Fraturas do Rádio/epidemiologia , Prevalência , Traumatismos do Braço/epidemiologia , Ferimentos e Lesões/epidemiologia , Fraturas Ósseas/epidemiologiaRESUMO
The objective was to determine the prevalence of upper-limb and back pain among dentists (n = 358) and factors associated with these symptoms. Dentists were interviewed using a self-administered questionnaire containing data on sociodemographic, occupational, lifestyle, and psychosocial factors and presence, site, and characteristics of pain. Participation rate was 92.3%. 58% reported upper limb pain, with 22, 21, 20, and 17% for the arm, back, neck, and shoulder, respectively. 26% reported daily frequency and 40% classified pain as moderate or severe. In the multivariate analysis (multiple logistic regression), the factors associated with pain were: neck: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), compressor in the office (OR = 2.1; CI95%: 1.2-3.7), job satisfaction (OR = 0.3; CI95%: 0.1-0.9), and use of indirect vision (OR = 0.5; CI95%: 0.3-0.9); shoulder: income > 20 minimum wage (OR = 2.9; CI95%: 1.2-6.7), greater productivity (OR = 3.3; CI95%: 1.3-8.4), height > or = 160cm (OR = 0.3; CI95%: 0.2-0.7), and age 30-49 years (OR = 0.3; CI95%: 0.1-0.8); back: anxiety/depression (OR = 2.3; CI95%: 1.2-4.5), manual activity (OR = 0.4; CI95%: 0.2-0.9), and being married (OR = 0.5; CI95%: 0.3-0.9); arms: manual activity (OR = 1.8; CI95%: 1.0-3.2).
Assuntos
Traumatismos do Braço/epidemiologia , Dor nas Costas/epidemiologia , Transtornos Traumáticos Cumulativos/epidemiologia , Odontólogos/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Saúde Ocupacional , Dor/epidemiologia , Inquéritos e QuestionáriosRESUMO
The present study described the frequency of animal bites and attacks in the municipality of San Juan, Puerto Rico between the fiscal years 1996 through 1998. A total of 275 cases were reported to the San Juan Local Office of Environmental Health. The distribution of cases by gender was equal, and persons aged 18 years or older had the highest frequency of animal bites and attacks (52.9%). The animal species reported to be involved in the majority of animal bites was the dog (81.1%). Upper extremities were involved in 43% of these injuries. Animal bites caused by dogs were more often reported among male victims (87.4%) (p = 0.031). Approximately 41% of dog bites and attacks and 75% of bites and attacks caused by other animal species were documented as provoked (p = 0.002). More than 75% of the injuries in the head, face or neck involved children < 13 years whereas 65.9% of the injuries in the upper extremities involved adults (> 18 years) (p = 0.001). Animal bites and attacks in the upper extremities were more prominent among injuries caused by an animal species different to the dog (71%) (p < 0.001). We conclude that animal bites and attacks is a public health concern in light of the increasing pet population. Therefore, educational strategies towards the general population must stress careful supervision of the human-animal interaction as well as the general procedures to follow in case of an injury.
Assuntos
Mordeduras e Picadas/epidemiologia , Gatos , Cães , Adolescente , Adulto , Fatores Etários , Animais , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/etiologia , Criança , Estudos de Coortes , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/etiologia , Feminino , Humanos , Masculino , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/etiologia , Porto Rico/epidemiologia , Estações do Ano , Fatores SexuaisRESUMO
The present study described the frequency of animal bites and attacks in the municipality of San Juan, Puerto Rico between the fiscal years 1996 through 1998. A total of 275 cases were reported to the San Juan Local Office of Environmental Health. The distribution of cases by gender was equal, and persons aged 18 years or older had the highest frequency of animal bites and attacks (52.9 percent). The animal species reported to be involved in the majority of animal bites was the dog (81.1 percent). Upper extremities were involved in 43 percent of these injuries. Animal bites caused by dogs were more often reported among male victims (87.4 percent) (p = 0.031). Approximately 41 percent of dog bites and attacks and 75 percent of bites and attacks caused by other animal species were documented as provoked (p = 0.002). More than 75 percent of the injuries in the head, face or neck involved children < 13 years whereas 65.9 percent of the injuries in the upper extremities involved adults (> 18 years) (p = 0.001). Animal bites and attacks in the upper extremities were more prominent among injuries caused by an animal species different to the dog (71 percent) (p < 0.001). We conclude that animal bites and attacks is a public health concern in light of the increasing pet population. Therefore, educational strategies towards the general population must stress careful supervision of the human-animal interaction as well as the general procedures to follow in case of an injury.
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Adolescente , Animais , Mordeduras e Picadas/epidemiologia , Gatos , Cães , Fatores Etários , Estudos de Coortes , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/etiologia , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/etiologia , Porto Rico/epidemiologia , Estações do Ano , Fatores Sexuais , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/etiologiaAssuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Ferimentos e Lesões/epidemiologia , Diagnóstico da Situação de Saúde , Braço , Traumatismos do Braço/epidemiologia , Ferimentos e Lesões/classificação , Ferimentos e Lesões/etiologia , Causalidade , Traumatismos Craniocerebrais/epidemiologia , Hospitais Estaduais/estatística & dados numéricos , Traumatismos da Perna/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Distribuição por Idade , Fraturas Ósseas/epidemiologia , Hospitalização/estatística & dados numéricosRESUMO
Workers at a Nogales, Mexico, maquiladora plant that assembles medical devices were studied to determine the prevalence of upper-extremity cumulative trauma disorders (CTD). Subjects included production workers employed 6 months or longer; of the 148 eligible workers, 145 (98%) participated. Subjects had a mean age of 24.6 years (SD = 5.2; range, 17 to 45) and the mean length of employment was 3.5 years (SD = 2.5; range, 0.5 to 14). Job tasks were videotaped and analyzed for ergonomic risk factors, using pre-defined criteria. All jobs performed by study subjects were found to involve one or more ergonomic risk factors associated with the development of CTD. A CTD questionnaire and screening physical examination format, similar to that used by the National Institute of Occupational Safety and Health (NIOSH) in a chicken processing plant study, were administered. Period prevalence of CTD within the previous year, as reported on the questionnaire, was 28%. Prevalence of CTD was 17%, using data from the screening physical examination. Point prevalence (current pain data from the questionnaire plus positive symptoms on the screening physical examination) was 15%. CTD was reported more frequently in women than men (46% and 25%, respectively; P < 0.05) and in subjects who had worked at the plant less than one year (50%; P < 0.05). Workforce turnover (3% monthly) may have resulted in those affected by CTD leaving employment, reducing the apparent CTD rate in experienced workers.