Study on the prevention and nursing intervention of infection after flap transfer for hand trauma

To analyze the factors associated with infection after flap transfer for hand trauma and use them to develop nursing strategies and observe the effects of their application. Eighty-two patients admitted to our hospital for flap transfer for hand trauma from January 2020 to May 2020 were selected for the retrospective analysis. Logistic regression analysis was performed to analyze the factors associated with postoperative infections to develop care strategies. Another 88 patients admitted for flap transfer for hand trauma from September 2020 to June 2021 were retrospectively analyzed and divided into the observation (n = 44) and control groups (n = 44) according nursing strategies that they received. The operative time, intraoperative bleeding, incision healing time, first postoperative time to get out of bed on their own and hospital stay were compared between the 2 groups. The patients postoperative adverse effects and flap survival rates were also counted. visual analogue score, total active motion, manual muscle test, Barthel index, self-rating anxiety scale, self-rating depression scale scores were used to assess patients pain, hand function recovery and psychology before and after treatment. Logistic regression analysis manifested that postoperative bed rest time, affected limb immobilization, and pain were independent factors affecting postoperative infection after flap transfer (P < .05). After using targeted care strategies, the observation group had dramatically shorter operative time, intraoperative bleeding, incision healing time, time to first postoperative bed release on their own, and hospital stay, less postoperative pain and adverse effects, and higher flap survival rate than the control group (P < .05). Total active motion, manual muscle test, and Barthel index were higher in the observation group than in the control group after treatment, while self-rating anxiety scale and self-rating depression scale scores were lower than in the control group (P < .05). Finally, total satisfaction was higher in the observation group than in the control group (P < .05). Postoperative bedtime, fixation of the affected limb, and pain are independent factors affecting postoperative infection after flap transfer for hand trauma. Implementing infection prevention care strategies based on these factors can effectively improve the safety of flap transfer, reduce the possibility of infection, and shorten the recovery period of patients, which has high clinical application value.

Evaluation of a Diagnostic-Therapeutic Algorithm for Finger Epiphyseal Growth Plate Stress Injuries in Adolescent Climbers

BACKGROUND

Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending.

PURPOSE

To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d'Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score.

RESULTS

Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3.

CONCLUSION

The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future.

ANALYSIS OF THE PREVALENCE OF INJURIES AND ASSOCIATED FACTORS IN BRAZILIAN CLIMBERS

ABSTRACT Introduction Many Brazilians became climbing enthusiasts in the 20th century, and the activity was recently included as an Olympic sport at the Tokyo 2020 Olympic Games. With the increase in the number of climbers seeking to beat personal and/or competitive records, the number of injuries has also increased. Objectives To verify the prevalence of injuries in Brazilian climbers, as well as their association with sociodemographic characteristics and sport performance. Methods A cross-sectional, descriptive and analytic observational study was conducted from March 2018 to May 2018 with the application of a virtual questionnaire for 266 Brazilian climbers. The statistical analysis was performed subsequently. Results The prevalence of injuries in Brazilian climbers was 71.8%. The main characteristics of the injuries that merited special attention were musculotendinous site (50.8%), sport climbing (22.0%), upper limb (50.3%) and mechanism of abrupt movement (20.4%). The most popular treatment was medical in combination with physiotherapy (34.5%), and time off was generally more than 30 days (50.3%). There was a significant association (p <0.05) of the injuries with age, gender, region of the country, BMI, level of education and involvement in other sports, as well as athletic and recreational category, climbing time, basic course certificate, warming up, monthly rock climbing and weekly indoor climbing frequency, and the climbing grade. Conclusion Due to the increase in the popularity of the sport and the high prevalence of climbers with a history of injuries, multiprofessional follow-up is needed to procure risk reduction programs and to enhance climbers’ awareness of the factors associated with these injuries. Level of Evidence III; Study of nonconsecutive patients, without consistently applied ‘’gold’’ reference standard.