Department of Pediatric Orthopaedics and Pediatric Hand Emergencies, Robert Debré Hospital, Public Hospitals of Paris (AP-HP), Paris University.
Department of Orthopaedic Surgery and Hand Emergencies, Private Hospital Les Peupliers, Paris.
J Pediatr Orthop. 2021 Apr 1;41(4):236-241. doi: 10.1097/BPO.0000000000001727.
Hand wounds are frequent in children (31% of hand injuries) and one possible mechanism responsible for profound laceration is metal fences while climbing. These injuries usually require a surgical look to explore soft-tissue damages, but the literature is poor regarding surgical findings and outcomes after this kind of traumatism. The aim of the study was therefore to report a consecutive series of hand and finger wounds caused by metal fences in children, focusing on surgical findings and potential complications.
All consecutive hand or finger deep wounds caused by metal fences treated between January 2013 and December 2018 were retrospectively reviewed. Inclusion criteria were age below 18 years and a minimum follow-up of 2 years. Complications and surgical revisions were analyzed.
A total of 1265 patients were operated for hand or finger deep wounds during the study period, among which 74 were caused by metal fences. The mean age at surgery was 11.3±0.4 years, and the majority of patients were men (80%). Associated injuries were found in 55.4% of the patients including nerves (n=29) or tendons sections/disinsertion (n=6), and sheath (n=16) and pulleys (n=6) tearing. At a mean follow-up of 2.6±0.2 years, 12% of the patients required revision surgery for an irreducible flexion contracture secondary to a contractile scar and consisted of complete scar excision and zigzag flap. Additional tenoarthrolysis was required during the procedure, for 6 patients because of a persisting flexion contracture after excision.
Metal fences surgical palmar wounds in children are impressive lesions by their extended skin damages. Serious associated lesions (collateral pedicle or flexor tendons) were found in 1 case of 3. However, these injuries are not benign and should be carefully monitored clinically during the first postoperative month to look for potential contractile scars that can require revision.
Level IV-retrospective cohort study.
手部创伤在儿童中较为常见（占手部损伤的 31%），导致深度撕裂的一个可能机制是攀爬时金属栅栏。这些损伤通常需要手术探查软组织损伤情况，但关于此类创伤的手术发现和结果的文献较少。因此，本研究旨在报告一系列由儿童攀爬金属栅栏导致的手部和手指创伤，重点关注手术发现和潜在并发症。
回顾性分析 2013 年 1 月至 2018 年 12 月期间因金属栅栏导致的手部或手指深部创伤的连续病例。纳入标准为年龄<18 岁且随访时间至少 2 年。分析并发症和手术修复情况。
研究期间共对 1265 例手部或手指深部创伤患者进行了手术治疗，其中 74 例由金属栅栏引起。手术时的平均年龄为 11.3±0.4 岁，大多数患者为男性（80%）。55.4%的患者合并其他损伤，包括神经（n=29）或肌腱部分/撕脱（n=6）、鞘（n=16）和滑车（n=6）撕裂。平均随访 2.6±0.2 年后，12%的患者因收缩性瘢痕导致无法复位的屈曲挛缩而需要再次手术，手术包括完全切除瘢痕和 Zigzag 皮瓣。由于切除后仍存在屈曲挛缩，6 例患者需要进一步行肌腱松解术。
儿童手掌部金属栅栏创伤的皮肤损伤广泛，是严重的创伤。3 例患者中发现了严重的合并损伤（侧副支或屈肌腱）。然而，这些损伤并非良性，术后第一个月应密切临床监测，以发现可能需要修复的收缩性瘢痕。
IV 级-回顾性队列研究。
