Mallet finger (baseball finger)

MALLET FINGER (BASEBALL FINGER)

A mallet finger occurs when the extensor tendon at the tip of a finger ruptures. The rupture of this tendon can involve the tendon alone, be associated with a small bone fragment or fracture or can be associated with a fracture that requires significant care.

The force applied to the finger can come from something as simple as tucking in a bed sheet or can come from a direct blow to the end of a finger. Mallet finger has also been known as baseball finger.

Mallet finger.

A mallet finger often begins with pain at the distal joint of the finger.  At times there is an immediate loss of motion while at other times the finger seems to stay straight for a while and only later starts to lose its ability to be extended actively at the tip.  At times there is an injuries are typically closed in that the skin and nail is intact but at times there is an injury to the skin or nail bed as well. In severe cases the injury is associated with an open injury to the joint or bone, a so called open or compound fracture.

In adults the injury can involve the joint surface.  In children it can involves the growth plate or physis.

The diagnosis is often made based upon the type of injury and the appearance of the finger.  The fingertip will droop down and there is a loss of active motion.  Often the finger can be passively pushed up to straighten it but the independent active motion to extend the digit at the tip has been lost

X-rays are often taken to further delineate the injury and see how much if any bone, joint or

Types of splints used to treat mallet finger. A, Dorsal aluminum splint. B, Commercial splint.

Reproduced with permission from Culver JE Jr: Office management of athletic injuries of the hand and wrist. Instr Course Lect 1989;38:473-482.

 growth plate is involved

Treatment depends largely upon the extent the soft tissue and underlying boney injury.

Tendon rupture without bone injury

Most of these mallet finger injuries can be treated with splinting.  The splint can be applied in a variety of ways depending upon the injury.  Typically the split is left in place full time for six to eight weeks with a time for part time splinting after that depending upon what daily activity is done by the patient with a typical part time period of 3 – 4 weeks.  In some situations pinning of the joint is used rather than a splint

Tendon rupture with a small bone fragment

These injuries typically are treated like non-boney injuries

Tendon rupture with a large bone fragment involving the joint.

 These injuries may respond to splinting and splinting is often used however a small bump may always be present a t the joint.  At times if the doctor feels that that the bone fragment is large enough and the joint may be unstable surgery may be offered.  During surgery pins or small screws may be used and the joint itself may be pinned to prevent motion during the healing process.

  

Above: X-rays showing fracture at the insertion of the extensor tendon. In the first image on the left the fragment is displaced.  This will heal with a bump but will be able to be treated with a splint.  IN the image on the right the joint has subluxed.  This will  need to have surgical repair.

In adults with severe open injury more immediate surgery may also be offered

Children

In children the doctor needs to differentiate between these injuries that require reduction or realignment of the bone without surgery and those who may have a portion of the nail bed significantly torn or retained within the fracture site or growth plate.  Often children will not have a tendon injury but a fracture through the physis which appears to be a mallet injury.  X-rays often will reveal this.

 

Mallet deformity from a fracture across the growth plate in a child is different than the adult fracture or tendon avulsion

Late or Delayed Treatment in adults

Delayed treatment of mallet finger deformity may consist of splinting initially and at times surgical methods are offered to correct chronic deformities and other associated joint and tendon problems that may accompany the chronic situation

Results

Most mallet fingers heal well, although often there is a slight loss of full extension. The slight extension loss typically has no effect on hand of finger function, but if left untreated it can cause other issues to occur in the finger due to tendon imbalance. While treatment of a closed mallet finger is not an acute emergency, the improper, partial or untreated injury can lead to further problems such as a swan neck deformity.

 Swan neck deformity from tendon imbalance and laxity at the proximal joint.

CNN : Can you really re-grow a fingertip? ... is misleading.

The recent CNN report about a woman's fingertip regenerating is misleading. As a hand surgeon I have treated hundreds of these injuries with serial dressing changes and little else. For an orthopedic surgeon or a hand surgeon this type of injury and its typical treatment is as basic as taking care of a non-displaced fracture or treating carpal tunnel syndrome.  This was an unfortunate injury, but the result is as expected. In this case it appears that there was not any tissue regeneration. The skin healed over the bone but no length was added. If you look closely at the photos, the fingertip shortening is equivalent to the length of the lost tissue. The original injury had a small part of the nail plate attached to skin and fat. The nail grew out past the residual skin but the skin and fat never regenerated any lost length. The story is misleading. While great credit is due to the researchers for their work. In this scenario the product cited is not going to make a significant difference. Please read the readers comments in the blog from the CNN followup story. (and look closely at the fingertip photos)

Can you really re-grow a fingertip?

pagingdrgupta.blogs.cnn.com

On a normal day, Dr. Stephen Badylak’s office at the University of Pittsburgh receives five or six e-mails requesting help from people who’ve lost various body parts, particularly fingertips or toe tips.

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FW: lawnmower safety for kids

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LAWNMOWERS CAN BE DANGEROUS TO YOUR HEALTH

Devastating accidents to the hand and fingers can occur when used improperly

SPRINGFIELD- Every summer, lawnmowers are constantly running as homeowners try to keep their yards trim and beautiful. Unfortunately, “lawnmowing season” brings many people, especially children, with devastating hand injuries to emergency departments such as Baystate Medical Center.

            According to the American Society for Surgery of the Hand, every year more than 74,000 small children, adolescents and adults are injured by rotary, hand and riding power mowers due to the improper handling of lawnmowers.

            “Every summer we see patients, both adults and children, who come into our office with severe injuries to their hand and fingers,” said Dr. Jeffrey Wint of the Hand Center of Western Mass.

“Often parents will give their children a ride on the lawnmower as a treat, but this can be very dangerous, as kids can fall off and get injured. Adults who attempt to maintain mowers without taking proper safety precautions often get injured, too,” added Dr. Wint, who is a member of the medical staff at Baystate Medical Center.

  According to Dr. Wint, 20 percent of lawnmower injuries are to the hand, wrist or fingers and about 25 - 50 percent of those injuries result in amputation. He noted that injuries from lawnmower accidents can be devastating and extremely hard to treat.

“Injuries can become contaminated from soil or dirt from the mower, which can lead to serious infections resulting in amputations,” Dr. Wint warned.

Most injuries can be avoided by using common sense and practicing safe mowing. To stay safe while mowing:

      Never allow children to operate the machine.

n       Children under age 6 should remain indoors when the lawn is being mowed.

Be alert and turn machine off if a child enters the area.

Tragic accidents can occur if the operator is not alert to the presence of children. Children are often attracted to the machine and the mowing activity. Never assume that children will remain where you last saw them

n       Safety training is essential for those old enough to operate a lawnmower.  Supervise your children     until you are satisfied they understand how to safely operate the mower and can manage the task alone.

n       Never service mowers while in operation and always keep them in good working order.

n       Do not use hands or feet to clean mower, especially around the blade, because even with the mower off, there can still be tension on the blade, which can spin rapidly once cleared. Always use a stick or broom handle to remove any obstruction

n       When mowing a slope with a walk-behind mower, mow across the face of the slope, not up and down.

n       When using a riding mower, go up and down the slope rather than across to avoid tipping over.

n       Read mower's instruction manual and do not remove safety devices or guards.

Do not mow in bad weather, in poor light, or on wet grass.

Use extreme care when approaching blind corners, shrubs, and trees, or other objects that may block your view of a child.

      Never allow passengers, other than the operator, on riding mowers.

Never carry children, even with the blade(s) shut off. They may fall off and be seriously injured or interfere with safe mower operation. Children who have been given rides in the past may suddenly appear in the mowing area for another ride and be run over or backed over by the machine

n       Do not operate lawnmower while barefoot and wear gloves, long pants and goggles.

          

  Parents need to remember that lawnmowers are not toys and must be used appropriately. Many children have died from accidents on or around mowers. Dr. Wint warns that lawnmowers can be “a potential lethal weapon and just as dangerous as giving a child a loaded gun.”

Wint cites the American Society for Surgery of the Hand which offers these revealing figures:

Kinetic energy (motion) imparted by a standard rotary blade is comparable  to three times the muzzle energy of a .357 Magnum pistol. Blade speed can eject a piece of wire or an object at speeds up to 100 miles per hour.

He said there is a need to create an awareness of the potential dangers of lawnmowers, as many of the accidents are preventable.

“It is heartbreaking to see some of these children’s injuries,” said Dr. Wint. “Remembering these few safety precautions and using sound judgment can keep everyone safe and lawns looking great this summer.”

                                              

Needle Aponeurotomy Massachusetts

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Needle Aponeurotomy for Dupuytren's Contracture ... The Hand Center or Western Massachusetts is the only medical practice in Western Massachusetts dedicated to the care of the hand and upper extremity.

Use caution when using snow blowers

Updated: Wednesday, 09 Dec 2009, 9:39 PM EST
Published : Wednesday, 09 Dec 2009, 7:43 PM EST

• Lynn Barry

With the first significant snowfall here, people should use extreme caution when using snow blowers.

Each year, 5,000 people in this country suffer a hand injury from using a snow blower. Some of those injuries can be severe like losing a finger.

Hand surgeon, Dr. Jeffrey Wint of the Hand Center of western Massachusetts says if you're snow blower jams, turn it off and never put your hands or feet in the intake or outtake.

If you have a snow blower that has a clutch, disengage the clutch. Then wait or delay about 10-15 seconds because it takes time for the machine to calm down and then use a stick.

Dr. Wint also said that 500 people each year lose a finger as a result of a snow blower injury.

Recommendations for safe use of a jammed snow blower snow blowers include : (OCD STICK)

1. If the snow blower jams, immediately turn it OFF

2. Disengage the CLUTCH

3.DELAY.. Wait 10 seconds after shutting of to allow Impeller Blades to stop rotating

4. Always use a STICK or broom handle to clear impacted snow. The stick most be strong enough to avoid breakage or eye injures can result from flying fragments

5. Never put your hand near chute or around blades

6. Keep all shields in place. Do not remove safety devices on machine

7. Keep hands and feet away from moving parts

8. Keep a clear head, concentrate and ...

Do not drink alcoholic beverages before using a snow blower

As physicians dedicated to the care of the Hand and Upper extremity we want to inform the public concerning the perils and pitfalls of improper snow blower use. Physicians, nurses, allied health professionals and therapists who deal with these injuries live in fear of the first heavy wet snow of the season. Invariably injuries are seen despite general knowledge that these injuries occur. These safety tips cannot guarantee against injury but hopefully if you are reading these or even better spreading these... it is one more step towards preventing these types of injuries.

News organizations and weather services can help.

Conditions that are associated with a higher incidence of injuries, hay wet snow exceeding 6 inches of accumulation and temperatures above 28 degrees Fahrenheit offer good opportunities to provide warning for the public. We need your help to reduce the incidence of these preventable injuries.

Patient's Choice Award 2009

Dr. Jeffrey Wint has been honored by his patients with a Patients' Choice Award for 2009. Every month, over 40,000 patients rate the effectiveness of their physicians online at www.vitals.com. Of the nations 720,000 active physicians, less then 5 % were accorded this honor by their patients in 2009.

www.handctr.com

Endoscopic Surgery Speeds Recovery for Patients with Carpal Tunnel Syndrome print this page email to a friend The bane of data processors, carpenters, musicians, lumberjacks -- anyone whose job requires frequent, repetitive bending of the wrist -- carpal tunnel syndrome has been called the "new industrial epidemic." Although the prevalence of the condition is not known, the National Institute of Occupational Safety and Health reports that 15 to 25 percent of workers employed in construction, food preparation, clerical work, production, fabrication and mining are at risk for cumulative trauma disorders like carpal tunnel syndrome. The traditional surgical treatment for the condition required an incision in the palm. While this procedure successfully relieved the wrist pain, tingling and numbness that characterize carpal tunnel syndrome, it often created incisional problems. The location of the incision increased the chances that small nerve branches in the hand might be cut, producing discomfort in the scar. Thanks to a new surgical procedure used at Baystate Medical Center, many of these problems are being eliminated. Baystate hand surgeons are the first in the area to utilize endoscopic surgery to treat carpal tunnel syndrome -- a technique that markedly reduces the size of the necessary incision, resulting in a faster recovery and, for many patients, a more rapid return to work. "Although carpal tunnel surgery has been performed successfully for years, some of the minor problems associated with the open-palm method have prevented patients from receiving the full benefit of the procedure," says Jeffrey C. Wint, M.D., an orthopedic hand surgeon at Baystate who uses the endoscopic technique. "For people who work with their hands, the time spent recovering from a major incision in their palm can be a significant setback." Causes and Cures Carpal tunnel syndrome arises when repetitive wrist motion causes swelling of the tissues within the carpal tunnel. The transverse carpal ligament is unyielding and the median nerve is compressed. The initial symptoms are wrist pain and a tingling sensation in the fingers, usually felt when the hand is at rest. If not corrected, the condition can produce numbness and weakness throughout the hand, making simple tasks such as holding a newspaper or turning on a faucet painful or impossible. Surgery has been able to alleviate these symptoms by cutting the ligament that overlies the median nerve at the juncture of the wrist and hand. Until recently, however, the only means of access to the ligament has been through an incision in the palm.

Use caution when using snow blowers

Updated: Wednesday, 09 Dec 2009, 9:39 PM EST
Published : Wednesday, 09 Dec 2009, 7:43 PM EST

• Lynn Barry

SPRINGFIELD, Mass. (WWLP) - With the first significant snowfall here, people should use extreme caution when using snow blowers.

Each year, 5,000 people in this country suffer a hand injury from using a snow blower. Some of those injuries can be severe like losing a finger.

Hand surgeon, Dr. Jeffrey Wint of the Hand Center of western Massachusetts says if you're snow blower jams, turn it off and never put your hands or feet in the intake or outtake.

If you have a snow blower that has a clutch, disengage the clutch. Then wait or delay about 10-15 seconds because it takes time for the machine to calm down and then use a stick.

Dr. Wint also said that 500 people each year lose a finger as a result of a snow blower injury.

Snow Blower Safety OCD STICK

As the first snowfall comes to the Northeast, we are reminded all too often of the devastating effecets of a snowblower injury to the hand. It is important to keep a few snowblower safety tips in mind.

If you remember anything SNOWBLOWER SAFETY ....OCD STICK

If a snow blower jams, turn it off, disengage the clutch, delay, wait until the machine has less torque as there may be still some "spin" left in the impeller. Finally use a stick or broom handle to clear the snow. Never use hands, fingers or feet. It is often the impeller that spins very quickly in the outflow chute that causes injury as the advancing finger dosnt know that this it at the bottom of the chute.

Heavy wet snow, greater than 6 inches and in conditions greater than 28 degrees F are associated with a greater frequency of injury. The most common injury is to the middle finger in a male aged 44 years.

PLEASE BE CAREFUL..OCD STICK

Put a stick on your snow blower, an old broom handle or a hockey stick tied to the hand works well. ( remember to watch out for flying debris ..your eyes.. as well)

Pumpkin Carving Dangers

Hand Surgeons Warn of Pumpkin Carving Dangers

Use caution during the Halloween season, and take steps to prevent hand injuries when carving.

“Every Halloween season we see four or five patients—both adults and children—who come into our office with severe injuries to their hands and fingers,” says Jeffrey Wint, MD, an ASSH member from The Hand Center of Western Massachusetts, Springfield, MA. “Treatment can often run three to four months from the time of surgery through rehabilitation.”

To prevent hand injuries, the ASSH suggests the following safety tips

Carve at a Clean, Dry, Well-lit Area
Wash and thoroughly dry all of the tools that you will use to carve the pumpkin: carving tools, knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

Always Have Adult Supervision
“All too often we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own,” says Wint. “Even though the carving may be going great, it only takes a second for an injury to occur.”

Leave the Carving to Adults
Never let children do the carving. Wint suggests letting kids draw a pattern on the pumpkin and have them be responsible for cleaning out the inside pulp and seeds. When the adults do start cutting, they should always cut away from themselves and cut in small, controlled strokes.

Sharper is not Better
“A sharper knife is not necessarily better because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it,” says Wint. “An injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.”

Use a Pumpkin Carving Kit
Special pumpkin carving kits are available in stores and include small serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue. “If they do get jammed and then wedged free, they are not sharp enough to cause a deep, penetrating cut,” says Wint.

Help for a Pumpkin Carving Injury
Should you cut your finger or hand, bleeding from minor cuts will often stop on their own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room visit may be required.

Dr. Wint is a Hand Surgeon who is currently in practice in Springfield, MA. He is a member of the ASSH and is on staff at Baystate Medical Center. He can be reached through his office and his website is at www.handctr.com

Copyright © ASSH 2009. Modified for this blog

Mano Cirujanos advierten de Pumpkin Carving Peligros

Tenga cuidado durante la temporada de Halloween, y tomar medidas para prevenir lesiones en la mano cuando la talla.

"Cada temporada de Halloween, vemos cuatro o cinco pacientes, adultos y niños-que vienen a nuestra oficina con graves heridas en las manos y los dedos", dice Jeffrey Wint, MD, miembro ASSH de The Hand Center del Oeste de Massachusetts, Springfield, MA. "El tratamiento a menudo puede ejecutar tres o cuatro meses desde el momento de la cirugía a través de la rehabilitación".

Para evitar lesiones en la mano, la ASSH sugiere los siguientes consejos

Esculpido en un limpio, seco y bien iluminado
Lave y seque todas las herramientas que utilizará para esculpir la calabaza: las herramientas de talla, un cuchillo, corte la superficie, y sus manos. Cualquier humedad en las herramientas, manos o mesa puede provocar caídas que pueden conducir a lesiones.

Siempre tienen Supervisión de Adultos
"Con demasiada frecuencia vemos pacientes adolescentes con lesiones porque los adultos se sienten los niños están lo suficientemente responsables como para ser abandonados a su suerte", dice Wint. "A pesar de que la talla se va muy bien, sólo toma un segundo por una lesión que se produzca".

Deja la talla para adultos
Nunca deje que los niños hacen la talla. Wint sugiere dejar los niños dibujar un patrón de la calabaza y hacer que se encargará de la limpieza de la pulpa interior y semillas. Cuando los adultos se inician el corte, que siempre deben cortar de sí mismos y cortadas en pequeños trazos controlados.

Sharper no es mejor
"Un agudo cuchillo no es necesariamente mejor, porque a menudo queda atascado en la parte más gruesa de la calabaza, que requiere la fuerza para eliminar", dice Wint. "Una lesión puede ocurrir si su mano es en el lugar equivocado cuando el cuchillo finalmente desaloja de la piel gruesa de la calabaza. Las lesiones son también sufrió cuando el cuchillo se desliza y sale por el otro lado de la calabaza en la mano puede ser la celebración firme. "

Utilice un kit de Carving Pumpkin
De calabaza Especial kits de talla están disponibles en las tiendas y son pequeñas sierras dentadas de calabaza que funcionan mejor porque son menos propensos a trabarse en el tejido de calabaza de espesor. "Si lo hacen se producen embotellamientos y, a continuación cuña libre, no son lo suficientemente aguda como para causar un profundo corte de penetración", dice Wint.

Ayuda para una lesión Carving Pumpkin
Si se corta un dedo o la mano, sangrando de cortes de menor importancia con frecuencia se detiene en su propia aplicando presión directa sobre la herida con un paño limpio. Si la presión continua no frenar o detener el sangrado después de 15 minutos, una visita a la sala de emergencia que sean necesarios.

Dr. Wint es un cirujano de la mano que se encuentra actualmente en la práctica en Springfield, MA. Él es un miembro de la ASSH y es en el personal en el Baystate Medical Center. Él puede ser alcanzado a través de su oficina y su página web está en www.handctr.com

Copyright © Sociedad Americana de Cirugía de la Mano de 2009. Modified for this blog

Endoscopic Carpal Tunnel Release PODCAST page gets Tiny URL

Endoscopic Carpal Tunnel Release PODCAST page gets Tiny URL

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Endoscopic Carpal Tunnel Release gets Tiny URL

Endoscopic Carpal Tunnel Release gets a tiny url

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