1) The document discusses hand trauma management experiences at PIMS Hospital in Islamabad, Pakistan between January 2008 and May 2008. During this period, 403 patients with various types of hand injuries were treated. 2) The most common causes of injury were machinery (54.8%), road traffic accidents (25%), and burns (3.7%). Most injuries involved soft tissue and skeletal injuries (77.7%), while 13 patients lost fingertips and 24 lost digits. 3) Common surgical procedures included K-wire fixations, flaps, and skin grafts. Post-operative complications such as infection and stiffness occurred in a small percentage of patients. The average hospital stay was 11 days.

1. Hand TraumaHand Trauma
Muhammad Saaiq
Department of Plastic & ReconstructiveDepartment of Plastic & Reconstructive
Surgery. July 25, 2008Surgery. July 25, 2008

2. HAND TRAUMA: MANAGEMENT EXPERIENCE AT PIMS, ISLAMABAD,
PAKISTAN.
By: Muhammad Saaiq
International Bhurban Conference on Applied
Sciences and Technology (IBCAST 2009)
At:
Centres of Excellence in Sciences
and Applied Technologies ( CESAT ), Islamabad.
Jan 19, 2009.

3. The Hand

5. Skeletal Injury alone
Soft tissue ± Skeletal injury
Loss of Digits / Hand

6. Various FracturesVarious Fractures

7. Carpal InjuriesCarpal Injuries

37. INITIAL ASSESSMENT
AND
MANAGEMENT

38. RECONSTRUCTIVE PRORITIESRECONSTRUCTIVE PRORITIES
1) TO PRESEVE VIABILITY / RESTORE CIRCULATION1) TO PRESEVE VIABILITY / RESTORE CIRCULATION
2) GOOD SOFT TISUE COVERAGE2) GOOD SOFT TISUE COVERAGE
33) SKELETAL ALIGNMENT AND STABILIZATION) SKELETAL ALIGNMENT AND STABILIZATION
4) RESTORATION OF NERVE FUNCTION4) RESTORATION OF NERVE FUNCTION
5) RESTORATION OF JOINTS MOBILITY5) RESTORATION OF JOINTS MOBILITY
6)6) RESTORATION OF TENDON FUNCTIONRESTORATION OF TENDON FUNCTION

39. RECONSTRUCTIVE LADDERRECONSTRUCTIVE LADDER

40. Split Thickness Skin Grafts / Full Thickness Skin GraftSplit Thickness Skin Grafts / Full Thickness Skin Graft

41. TurnTurn--over Flapover Flap

42. Atasoy Kleinert FlapAtasoy Kleinert Flap

43. CrossCross--finger Flapfinger Flap

44. Abdominal FlapAbdominal Flap

45. Groin FlapGroin Flap

46. Posterior Interosseous Artery FlapPosterior Interosseous Artery Flap

48. Toe Transfer ?Toe Transfer ?

49. Preparation for Definitive SurgeryPreparation for Definitive Surgery
SoaksSoaks

50. VAC DressingVAC Dressing

51. Storage of Amputated PartsStorage of Amputated Parts

52. Physical RehabilitationPhysical Rehabilitation

53. Psychological RehabilitationPsychological Rehabilitation

55. KK--Wire DriversWire Drivers

57. Modified Gustilo Classification/ GradingModified Gustilo Classification/ Grading
I - Tidy laceration <1cm length,
No soiling, crush or tissue loss.
II - Tidy laceration <2cm in length,
Inside out, No soiling or tissue loss,
Partial muscle laceration.
III a - Laceration >2cm,
Penetrating or puncturing projectile,
Frankly soiled.
Adequate bone coverage.
III b - 3a plus Periosteal elevation and
stripping.
III c - 3b + Neurovascular injury.

58. Our PIMSOur PIMS’’
(( Jan 2008 to May 2008 )Jan 2008 to May 2008 )

59. Male
82%
Female
18%
Gender Distribution (n=403)Gender Distribution (n=403)

60. Age Distribution (n=403)Age Distribution (n=403)
7
33
103
109
80
47
24
0
20
40
60
80
100
120
0-10 11 20 21-30 31-40 41-50 51-60 61-70
AGE ( YEARS)
NUMBEROFPATIENTS

61. 221
101
25
23
15
7
6
3
2
0 50 100 150 200 250
Machines
RTAs
Household
Fircrakers
Electrical
Burns
Assaults
Sports
FAIs
Distribution of the Causes (n=403)Distribution of the Causes (n=403)

62. Distribution of Hand Injuries OverallDistribution of Hand Injuries Overall
(n=403)(n=403)
INJURY NUMBERS
1 Skeletal injury alone 89
2 Soft tissue ± Skeletal injury 314
3 Loss of fingertips 13
4 Loss of digits 24
5 Loss of Hand(s) 27

63. Associated Injuries (n=21)Associated Injuries (n=21)
ASSOCIATED INJURY NUMBERS
1 Long bone Fracture 7
2 Head Injury 4
3 Abdominal/ Thoracic Injury 8
4 Pelvic Fracture 2

64. Surgical Procedures Undertaken among HandSurgical Procedures Undertaken among Hand
trauma Victimstrauma Victims (n=403)(n=403)
Procedure Numbers
1 K-wire Fixations 151
2 Flaps 53
3 STSGs 61
4 Fasciotomy/ Compartment
Release
12
5 Replants 02
6 Miscellaneous 33

65. COMPLICATIONSCOMPLICATIONS
COMPLICATIONS NUMBERS
1 Wound Infection 23
2 Flap tip Necrosis 4
3 Hand Stiffness 3
4 Failed Digital Replant 1

66. Rate of Hospitalization :Rate of Hospitalization : 10.91%10.91%
Average Hospital stay:Average Hospital stay: 11 days ( Range 511 days ( Range 5--
33 days)33 days)
Inhospital Mortality:Inhospital Mortality: NilNil

72. CONCLUSIONCONCLUSION
&&
MESSAGEMESSAGE

73. Muhammad SaaiqMuhammad Saaiq
Department of Plastic & Reconstructive Surgery.Department of Plastic & Reconstructive Surgery.