Original Article
Review of catastrophic hand diagnosis over 15 years in a tertiary hospital: Do we make proper use of the term?
Revisión del diagnóstico de mano catastrófica a lo largo de 15 años en un hospital terciario: ¿hacemos un uso adecuado del término?
Read
1863
Timeswas read the article
325
Total PDF
1538
Total HTML
Share statistics
array:24 [ "pii" => "S1988885618300889" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.12.002" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "764" "copyright" => "SECOT" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:35-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441518301164" "issn" => "18884415" "doi" => "10.1016/j.recot.2018.06.001" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "764" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:35-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 122 "formatos" => array:2 [ "HTML" => 79 "PDF" => 43 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Revisión del diagnóstico de mano catastrófica a lo largo de 15 años en un hospital terciario: ¿hacemos un uso adecuado del término?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "40" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Review of catastrophic hand diagnosis over 15 years in a tertiary hospital: do we make proper use of the term?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1027 "Ancho" => 1583 "Tamanyo" => 81364 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribución de la afectación por dedo en las manos catastróficas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. García-Martínez, U. Fernández-Álvarez, T. Fernández-Ardura, A. Fernández-García, M. de Juan-Marín, A. Pérez-Arias" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "García-Martínez" ] 1 => array:2 [ "nombre" => "U." "apellidos" => "Fernández-Álvarez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Fernández-Ardura" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Fernández-García" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "de Juan-Marín" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Pérez-Arias" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885618300889" "doi" => "10.1016/j.recote.2018.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300889?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518301164?idApp=UINPBA00004N" "url" => "/18884415/0000006300000001/v1_201901020605/S1888441518301164/v1_201901020605/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885618300841" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.11.006" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "756" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:41-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "41" "paginaFinal" => "48" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 104174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Insertion of needle distal to arthrodesis to produce compression.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Rios Ruh, L. López Capdevila, A. Domínguez Sevilla, J. Roman Verdasco, A. Santamaría Fumas, J.M. Sales Pérez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Rios Ruh" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "López Capdevila" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Domínguez Sevilla" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Roman Verdasco" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Santamaría Fumas" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Sales Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441518300845" "doi" => "10.1016/j.recot.2018.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518300845?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300841?idApp=UINPBA00004N" "url" => "/19888856/0000006300000001/v1_201901100606/S1988885618300841/v1_201901100606/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1988885618300907" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.12.004" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "769" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2019;63:29-34" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Results of partial resurfacing of humeral head in patients with avascular necrosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "29" "paginaFinal" => "34" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados de la artroplastia parcial de superficie para el tratamiento de pacientes con necrosis ósea avascular del húmero proximal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1752 "Ancho" => 1583 "Tamanyo" => 255790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">51-Year-old patient diagnosed with humeral head ABN treated with partial resurfacing arthroplasty (HemiCup<span class="elsevierStyleSup">®</span>). (A and B) Radiography and magnetic resonance imaging of the left shoulder showing signs of subchondral collapse, and integrity of the glenoid surface (Cruess 3). (C) Intraoperative image showing loss of humeral head sphericity. (D) Control radiography at 52 months postoperatively, showing good outcome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Ranalletta, A. Bertona, I. Tanoira, L.A. Rossi, S. Bongiovanni, G.D. Maignón" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Ranalletta" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Bertona" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Tanoira" ] 3 => array:2 [ "nombre" => "L.A." "apellidos" => "Rossi" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Bongiovanni" ] 5 => array:2 [ "nombre" => "G.D." "apellidos" => "Maignón" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300907?idApp=UINPBA00004N" "url" => "/19888856/0000006300000001/v1_201901100606/S1988885618300907/v1_201901100606/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Review of catastrophic hand diagnosis over 15 years in a tertiary hospital: Do we make proper use of the term?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "40" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. García-Martínez, U. Fernández-Álvarez, T. Fernández-Ardura, A. Fernández-García, M. de Juan-Marín, A. Pérez-Arias" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "García-Martínez" "email" => array:1 [ 0 => "ire.garciamartinez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "U." "apellidos" => "Fernández-Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "T." "apellidos" => "Fernández-Ardura" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Fernández-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "de Juan-Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Pérez-Arias" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía Plástica, Estética y Reparadora, Fundación Hospital de Jove, Gijón, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía, Universidad de Oviedo, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Cirugía Plástica, Estética y Reparadora, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión del diagnóstico de mano catastrófica a lo largo de 15 años en un hospital terciario: ¿hacemos un uso adecuado del término?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 929 "Ancho" => 1583 "Tamanyo" => 104187 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Number of diagnoses of catastrophic hand per year in the Plastic, Cosmetic and Repair Surgery Department.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Gripping is the basic function of the hand, i.e., the ability to make use of the thumb in opposition to the other long fingers.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Injuries to the hand are frequent, with an incidence of 15 per 1,000 individuals per year. They occur in one third of industrial accidents,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in one in 5 traffic accidents, and they are the cause of one in every 3 cases of disability. Mutilations are a challenge for hand surgeons, whose aim will be re-implantation or the recovery of function so that the patient is able to recommence their work and/or everyday activities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The term “catastrophic hand” has traditionally been used to define lesions that affect all or almost all of the tissues and functional systems of the hand (the skin, bones and joints, the arteries and veins, sensory and motor nerves and the muscles and ligaments) usually accompanied by the amputation of fingers. Nevertheless, we have no widely accepted definition or universal criteria for diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2007 Scheker and Ahmed<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> proposed a model that takes five structures into consideration: (1) skin coverage; (2) the vascular system (arteries and veins); (3) the sensory and motor nerve system; (4) the system of muscles and tendons, and (5) the system of joints and bones. They defined a catastrophic injury as one in which damage occurred to at least three of these structures, on condition that one of them is the skin coverage or system of bones and joints.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, the first requisite for the correct treatment of the lesion is a classification system that makes it possible to set reconstruction objectives. According to Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> the criteria for an “acceptable hand” in aesthetic and functional terms are the presence of 3 fingers and the thumb. The minimum finger length is at the level of the middle phalange, which means that the proximal interphalangeal joint (PIJ) must be preserved. The minimum length of the thumb is at the level of the distal phalange, preserving the interphalangeal joint (IJ). The presence of 2 fingers (keeping the integrity of the PIJ) and the thumb constitutes what is known as the “tripod pincer”, which is considered to be the minimum requirement for satisfactory functioning. The presence of one finger (with a complete PIJ) and thumb constitutes the “basic hand”, which makes a very weak pincer motion possible with a mechanism that offers minimum grip. We consider any form of finger amputation that fails to meet the criteria for an “acceptable hand” to be a “disabled hand”. Two different injuries must be differentiated within the latter category, both of which are grouped under the term “severe hand injuries” as it is impossible to achieve an “acceptable hand” by means of reconstructive procedures. These two injuries are the “mutilated hand” and the “metacarpal hand”. We consider a “mutilated hand” to have 2 or 1 fingers. The most widely accepted definition of a “metacarpal hand” is the one described by Wei et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> in 1997, which distinguishes between 2 subgroups: “type I metacarpal hand”, which corresponds to the amputation of all of the fingers proximal to the proximal phalange, with a normal thumb or one amputated distal to the IJ, and “type II metacarpal hand”, which corresponds to the amputation of all the fingers proximal to the proximal phalange, with a thumb that is amputated proximal to the IJ. This classification shows how functionally important the thumb is, given that its amputation is equivalent to a 40% loss of hand function and a 25% loss of the function of the whole locomotor apparatus.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aims of our study are to describe the clinical and epidemiological characteristics of the patients diagnosed “catastrophic hand” by the Plastic and Cosmetic Surgery Department of the Hospital Universitario Central de Asturias (HUCA) from 2000 to 2015, to analyse how the use of the said term by medical professionals has evolved and to undertake a review of the bibliography to propose a better definition of the term, according to scientific publications.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed an observational and descriptive study of the patients diagnosed “catastrophic hand” who were admitted to the Plastic Surgery Department or who were treated in the Emergency Department of the HUCA in the period from 2000 to 2015. This hospital is the reference centre of the Principality of Asturias. We obtained the approval of the Research Ethics Committee of the Principality of Asturias.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We carried out a search in Pubmed using the following MeSH (Medical Subject Headings) terms: <span class="elsevierStyleItalic">injuries</span>, <span class="elsevierStyleItalic">hand</span>; <span class="elsevierStyleItalic">hand injury</span>; <span class="elsevierStyleItalic">injury, hand</span>; <span class="elsevierStyleItalic">mutilated, hand</span>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Together with the Clinical Documentation Service we undertook sampling of clinical history numbers, following ICD-10 search criteria: main diagnosis S68 (traumatic amputation of the wrist and hand), with the secondary diagnoses of S67 (traumatism due to impact of the wrist and hand) and S69 (other traumatisms and unspecified ones of the wrist and hand).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The inclusion criteria were patients diagnosed “catastrophic hand” who were admitted to the Plastic Surgery Department of the HUCA or who were treated in the Emergency Department by members of the Plastic Surgery Department (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The period of time studied was from 1 January 2000 to 31 December 2015.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The exclusion criteria were patients who, having been selected by the ICD-10 search criteria, were not diagnosed “catastrophic hand”.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The variables described are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">We used the classifications proposed by Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and Wei et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> to our results, thereby defining them as hands that were “acceptable”, “mutilated”, “metacarpal <span class="elsevierStyleSmallCaps">i</span>”, “metacarpal <span class="elsevierStyleSmallCaps">ii</span>”, “disabled”, “tripod” and “basic”.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Categorical and discrete quantitative variables are expressed numerically and as percentages. Quantitative variables are expressed as an average ± standard deviation, or as a mean ± the interquartile range.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Discrete variables were compared using the <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test, and quantitative variables were compared using the Student <span class="elsevierStyleItalic">t</span>-test and the ANOVA test, using Bonferroni's test to correct the level of significance.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Descriptive and comparative analysis was carried out using the Stata 13 statistics program (version 13.0, StataCorp.; College Station, Texas, USA).</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">There were 133 diagnoses of “catastrophic hand” in the Plastic Surgery Department of the HUCA in the period from 2000 to 2015. Of these cases, 124 (93.2%) were men vs. 9 (6.7%) in women. The patients were aged from 17 to 86 years old (with an average age of 46.6 years old). The highest number of diagnoses were recorded in 2003, with 19 cases (14%), followed by 2001 with 16 cases (12%) and 2006 with 15 patients (11%). On the contrary, from 2009 to 2015 a reduction in the number of cases was detected, at from 1 to 5 cases per year (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The month with the highest incidence of cases was April, with 17 cases (12.8%); and the day of the week with the most cases was Monday, with 29 cases (21.8%).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The average duration of hospitalisation was 6 days, with an interquartile range (p25–p75) of 3–9 days. There were 87 patient transfers (65.4%) from other healthcare areas to the HUCA. There were 72 industrial accidents (54.2%), of which 63 (87.5%) were in the secondary sector, 6 (8.3%) were in the primary sector and 4 (5.5%) were in the tertiary sector (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). 58 patients (43.61%) were not injured at work. Of these, 15 (25.86%) were retired. No data on this question were found in the clinical histories of the other patients.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the medical comorbidities of the patients together with whether or not they smoked. Regarding the causal mechanism, there were 80 cases of incision-impact (60.1%). The left hand was the most frequently involved, with 79 cases (59.4%), as opposed to 54 right hands (40.6%). The average number of injured fingers is 3.7, and the third or middle finger is affected the most often, while the thumb is affected the least often (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Fifty two patients (39.1%) had no amputated fingers, while 29 (21.8%) had one finger amputated and only 3 patients (2.3%) had all five fingers amputated (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Combined treatment was applied the most frequently in all of the fingers, including osteosynthesis, vascular, nerve, tendon and skin suture.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Forty-six of the 133 patients (34.6%) had some type of complication. Necrosis was the most common complication, with the following results for each finger: 7 thumbs (38.9%); 13 forefingers (50%); 11 middle fingers (37.9%); 11 ring fingers (45.8%) and 5 little fingers (29.4%). This shows that the percentage of complications caused by necrosis is higher than those of all the other causes.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Thirty-six patients (27.1%) required surgery for the treatment of sequelae.</p><p id="par0115" class="elsevierStylePara elsevierViewall">No statistically significant differences were found between the number of fingers that were injured and the duration of hospitalisation. Nor was any association found between the causal mechanism and the number of fingers that were injured.</p><p id="par0120" class="elsevierStylePara elsevierViewall">According to the classifications proposed by Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and Wei et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> we had 89 “acceptable hands” (67%), 20 “tripod hands” (15%), 7 “basic hands” (5.3%), 4 “mutilated hands” (3%), 4 “type I metacarpal hands” (3%), one “type II metacarpal hand” (0.8%) and 8 “disabled hands” (6%) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Complex mutilating hand injuries are a challenge for surgeons. Loss of the ability to grip gives rise to a severe functional limitation that has to be overcome by applying reconstructive objectives.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study shows that the most frequent patient profile diagnosed “catastrophic hand” in the HUCA corresponds to a man with an average age of 46 years old who had suffered an industrial accident. This also explains why the most frequent causal mechanism of the injury was incision-impact.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The percentage of accidents suffered by retired patients stands out at 26%, and this is probably due to the ageing of the population in Asturias.</p><p id="par0140" class="elsevierStylePara elsevierViewall">On the other hand, we recorded more than 60% of patient transfers from other medical catchment areas in the Principality of Asturias to the HUCA. This is due to the fact that the said hospital is the reference centre for reconstructive surgery.</p><p id="par0145" class="elsevierStylePara elsevierViewall">An article in Spanish that uses the term “mano catastrófica” was published by Herrera-Tenorio and Gómez-Cansino,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> of the Hospital General de Puebla (Mexico). They define catastrophic hand injuries as those which are multistructural and affect the bone tissue, tendons, neurovascular structures and skin to different degrees. They record a total of 25 patients over a 6 year period who were diagnosed “catastrophic hand” and who required reverse flow forearm skin flap grafts. They emphasise skin defects and coverage of the same instead of reconstruction following finger amputations, showing the range over which the term “catastrophic hand” is used. The majority of their patients were men, although they had an average age of 28.2 years old, which is considerably younger than we recorded in the HUCA. Likewise, the main causal mechanism of the injury was impact, followed by firearms, while we only recorded 20% of cases of impact, and in our case the most frequent mechanism was incision-impact, and with no case caused by firearms due to the difference between the rates of criminality in both countries.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In terms of how the patients were treated, the use of combinations of several surgical techniques stands out. These include osteosynthesis, vascular, nerve and tendon suture and skin coverage, all of which we include in the “combined treatment” variable, given that as these are complex lesions, by definition they affect all of the structures in the hand, and we found very few cases in which treatment consisted of a single technique.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The average duration of hospitalisation was relatively short, at less than one week (6 days). This may be due in part to the fact that only 46 of the 133 (34.6%) patients operated had a complication of some type. Necrosis was the most frequent complication, and this was probably due to the causal mechanism of the injury.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Joint rigidity was the most frequent sequela. This was also the case in the work by Herrera-Tenorio and Gómez-Cansino,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and this was mainly due to the causal mechanism of the lesion (impact or firearm). It should be pointed out that 36 of the 46 patients with sequela required secondary surgery. This was probably because some of them required medical treatment and/or rehabilitation rather than surgery for chronic pain, rigidity or sensory neuropraxia.</p><p id="par0165" class="elsevierStylePara elsevierViewall">We believe that the most appropriate definition of catastrophic hand is the one that refers to the impossibility of achieving an acceptable hand by means of reconstructive procedures, i.e., a “mutilated hand” or a “metacarpal hand”.</p><p id="par0170" class="elsevierStylePara elsevierViewall">When the classifications proposed by Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and Wei et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> as described above are applied, only 9 of the 133 patients may be considered to be true cases of “catastrophic hand”, amounting to 6.7% of the total number of cases recorded. On the basis of these data we may conclude, as we suspected at the start of the study, that in the majority of categories (67% “acceptable hands”, 15% “tripods” and 4.5% “basic hand”) the said diagnosis was applied erroneously, given that the vast majority were hands that could be rendered acceptable by means of reconstructive procedure.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In recent years hand surgeons have become aware of the ambiguity that arises through use of the term “catastrophic hand” when defining a complex hand injury. There is now a clear tendency to cease using this term and to replace it with a more specific description of the lesion in question. We were able to detect this downward tendency in our series, as the majority of diagnoses took place from 2000 to 2005, with a notable fall after 2006.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In 2016 the reconstructive surgery team of Chang Gung Memorial Hospital under Dr. Wei<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> introduced the new term “<span class="elsevierStyleItalic">metacarpal-like hand</span>”<span class="elsevierStyleItalic">.</span> This refers to the amputation of all of the fingers and the thumb proximal to their functional length, except for 1 or 2 fingers, including the thumb. These lesions may also be classified as “catastrophic” according to the classification proposed by Del Piñal.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The treatment of choice are transplants of the toes to the hand. The toes make it possible to improve the functioning of the hand proportionally to the existing deficit. They make it possible for us to achieve a simple or tripod pincer movement in metacarpal and mutilated hands, while in less severe cases they make a practically <span class="elsevierStyleItalic">ad integrum</span> anatomical and functional restoration possible.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">This study has limitations due to its retrospective nature, most especially a possible distortion of the information during data gathering. On the other hand, although our sample size is not small in comparison with other published series, we believe that a larger number of cases would increase the statistical power of the study.</p><p id="par0190" class="elsevierStylePara elsevierViewall">To summarise, we believe that the term “catastrophic hand” expresses confusion. Although classically it referred to severe hand trauma with major loss of tissue and functionality, we agree that the definition suggested by Dr. Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> is the most appropriate, and we support limiting its usage to cases that meet the criteria for a “mutilated” or “metacarpal” hand.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Level of evidence</span><p id="par0195" class="elsevierStylePara elsevierViewall">Level of evidence III.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of people and animals</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experiments took place in human beings or animals.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data confidentiality</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this paper.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this paper.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1135235" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1067335" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1135236" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1067334" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-01-31" "fechaAceptado" => "2018-06-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1067335" "palabras" => array:4 [ 0 => "Hand injury" 1 => "Finger injury" 2 => "Injury" 3 => "Hand" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1067334" "palabras" => array:4 [ 0 => "Lesión de mano" 1 => "Lesión de dedo" 2 => "Lesión" 3 => "Mano" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of patients diagnosed with ‘catastrophic hand’ by the plastic surgery department in a tertiary hospital in the period between 2000–2015, analyse the evolution of the use of the term ‘catastrophic hand’ and conduct a review of the literature with a view to proposing the optimal definition for said expression.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a descriptive and retrospective study of patients diagnosed with ‘catastrophic hand’ who required hospital care by the plastic surgery department of a tertiary hospital in the period between 2000–2015. We conducted a literature review on the use of the term ‘catastrophic hand’ and we applied the classifications proposed in the publications consulted to our results.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The number of ‘catastrophic hand’ diagnoses was 133. We observed a downward trend in the use of the term over the years. Applying classifications based on the impossibility of recovery of an acceptable hand (presence of three long fingers and thumb) by reconstructive procedures, only 9 out of 133 patients could be considered to have ‘catastrophic hands’, constituting 6.7% of the total cases.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The term ‘catastrophic hand’ has different meanings, and this generates ambiguity. The use of a classification based on the possibility of obtaining an acceptable hand diminishes its use and improves the approach for such injuries.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We advocate limiting the use of ‘catastrophic hand’ to cases that meet criteria of ‘mutilated hand’ and ‘metacarpal hand’ to avoid indiscriminate use of the term and optimise therapeutic management.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Describir las características de los pacientes diagnosticados de «mano catastrófica» por el Servicio de Cirugía Plástica en un hospital de tercer nivel en el periodo comprendido entre 2000 y 2015; analizar la evolución del uso del término «mano catastrófica», y realizar una revisión bibliográfica con el objetivo de proponer la definición más óptima de dicha expresión.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y método</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio descriptivo y retrospectivo de los pacientes diagnosticados de «mano catastrófica» que requirieron atención hospitalaria por el Servicio de Cirugía Plástica de un hospital terciario en el periodo comprendido entre 2000 y 2015. Efectuamos una revisión bibliográfica acerca del uso del término «mano catastrófica» y aplicamos a nuestros resultados las clasificaciones propuestas en las publicaciones consultadas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El número de diagnósticos de «mano catastrófica» fue de 133. Objetivamos una tendencia descendente en el empleo del mencionado término con el transcurso de los años. Aplicando clasificaciones basadas en la imposibilidad de recuperación de una mano aceptable (presencia de 3 dedos largos y pulgar) mediante procedimientos reconstructivos, tan solo 9 de 133 pacientes podían ser considerados «manos catastróficas», constituyendo un 6,7% del total de casos.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El término «mano catastrófica» posee diferentes acepciones, generando ambigüedad. El uso de una clasificación basada en la posibilidad de obtener una mano aceptable disminuye su utilización y mejora el abordaje de dichas lesiones.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abogamos por limitar el uso de «mano catastrófica» a los casos que cumplan criterios de «mano mutilada» y «mano metacarpiana» para evitar su uso indiscriminado y optimizar su manejo terapéutico.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Martínez I, Fernández-Álvarez U, Fernández-Ardura T, Fernández-García A, de Juan-Marín M, Pérez-Arias A. Revisión del diagnóstico de mano catastrófica a lo largo de 15 años en un hospital terciario: ¿hacemos un uso adecuado del término? Rev Esp Cir Ortop Traumatol. 2019;63:35–40.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1217 "Ancho" => 2159 "Tamanyo" => 121958 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flow diagram.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 929 "Ancho" => 1583 "Tamanyo" => 104187 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Number of diagnoses of catastrophic hand per year in the Plastic, Cosmetic and Repair Surgery Department.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 924 "Ancho" => 1583 "Tamanyo" => 71775 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The sectors in which injured patients worked (%).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1027 "Ancho" => 1583 "Tamanyo" => 85840 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribution of finger involvement in catastrophic hands.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 925 "Ancho" => 1583 "Tamanyo" => 84701 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Number of fingers involved in the catastrophic hands (%).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 922 "Ancho" => 1583 "Tamanyo" => 91784 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Distribution of injured hand involvement according to the classification subgroups of Del Piñal<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> (%).</p>" ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Demographic data</td><td class="td" title="table-entry " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Date of birth \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Occupation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Original medical catchment area \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Patient background</td><td class="td" title="table-entry " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tobacco consumption \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Accident characteristics</td><td class="td" title="table-entry " align="left" valign="top">Date \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mechanism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Days of hospitalisation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Side \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of digits involved \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Characteristics of the injury</td><td class="td" title="table-entry " align="left" valign="top">Level of amputation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skin involvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular involvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nerve involvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tendon involvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="7" align="left" valign="top">Treatments</td><td class="td" title="table-entry " align="left" valign="top">Amputation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dislocation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nerve repair \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular repair \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tendon repair \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reimplantation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Revascularisation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Complications</td><td class="td" title="table-entry " align="left" valign="top">Necrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Loss of substance \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Sequelae</td><td class="td" title="table-entry " align="left" valign="top">Joint rigidity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anaesthesia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic pain \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1936713.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Variables included in the study.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">123 (92.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">124 (93%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">122 (92%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94 (71%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1936712.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Comorbidities and toxic habits.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Aszmann" 1 => "I. Vujaklija" 2 => "A. Roche" 3 => "S. Salminger" 4 => "M. Herceg" 5 => "A. Sturma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Sci Rep" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "9" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radical debridement, free flap coverage, and immediate reconstruction of the upper extremity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Scheker" 1 => "O. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hand Clin" "fecha" => "2007" "volumen" => "23" "paginaInicial" => "23" "paginaFinal" => "36" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe mutilating injuries to the hand: guidelines for organizing the chaos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Del Piñal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Plast Reconstr Aesthet Surg" "fecha" => "2007" "volumen" => "60" "paginaInicial" => "816" "paginaFinal" => "827" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metacarpal hand: classification and guidelines for microsurgical reconstruction with toe transfers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.C. Wei" 1 => "T.A. el-Gammal" 2 => "C.H. Lin" 3 => "C.C. Cuang" 4 => "H.C. Chen" 5 => "S.H. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1997" "volumen" => "99" "paginaInicial" => "122" "paginaFinal" => "128" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mutilating hand injuries: principles and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.W. Neumeister" 1 => "R.E. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hand Clin" "fecha" => "2003" "volumen" => "19" "paginaInicial" => "1" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12683442" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colgajos fasciocutáneos del antebrazo en el manejo de la mano catastrófica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.G. Herrera-Tenorio" 1 => "E. Gómez-Cansino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Ortop Mex" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "344" "paginaFinal" => "351" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metacarpal-like and metacarpal hand" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.F. ALDeek" 1 => "Y.T. Lin" 2 => "F.C. Wei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hand Clin" "fecha" => "2016" "volumen" => "32" "paginaInicial" => "549" "paginaFinal" => "554" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple microsurgical toe-to-hand transfer in the reconstruction of the severely mutilated hand: a series of fifty-nine cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.C. Wei" 1 => "B. Coessens" 2 => "D. Ganos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Chir Main Memb Super" "fecha" => "1992" "volumen" => "11" "paginaInicial" => "177" "paginaFinal" => "187" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction of severe transmetacarpal mutilating hand injuries by combined second and third toe transfer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.M. Tsai" 1 => "J.B. Jupiter" 2 => "T.W. Wolff" 3 => "E. Atasoy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "1981" "volumen" => "6" "paginaInicial" => "319" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7252101" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Informe sobre el trasplante de 250 dedos del pie a la mano consecutivos. Indicaciones, resultados, fracasos y nuevas aplicaciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Del Piñal" 1 => "F.J. García-Bernal" 2 => "C. Thams" 3 => "A. Studer" 4 => "J. Regalado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "257" "paginaFinal" => "262" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000006300000001/v1_201901100606/S1988885618300889/v1_201901100606/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006300000001/v1_201901100606/S1988885618300889/v1_201901100606/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300889?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 23 | 4 | 27 |
| 2024 September | 33 | 12 | 45 |
| 2024 August | 25 | 3 | 28 |
| 2024 July | 34 | 3 | 37 |
| 2024 June | 27 | 3 | 30 |
| 2024 May | 23 | 5 | 28 |
| 2024 April | 66 | 6 | 72 |
| 2024 March | 44 | 9 | 53 |
| 2024 February | 23 | 5 | 28 |
| 2024 January | 51 | 8 | 59 |
| 2023 December | 60 | 7 | 67 |
| 2023 November | 55 | 7 | 62 |
| 2023 October | 49 | 8 | 57 |
| 2023 September | 27 | 0 | 27 |
| 2023 August | 32 | 5 | 37 |
| 2023 July | 27 | 7 | 34 |
| 2023 June | 41 | 3 | 44 |
| 2023 May | 83 | 6 | 89 |
| 2023 April | 54 | 4 | 58 |
| 2023 March | 33 | 3 | 36 |
| 2023 February | 29 | 3 | 32 |
| 2023 January | 15 | 3 | 18 |
| 2022 December | 20 | 6 | 26 |
| 2022 November | 37 | 21 | 58 |
| 2022 October | 31 | 6 | 37 |
| 2022 September | 30 | 9 | 39 |
| 2022 August | 28 | 11 | 39 |
| 2022 July | 18 | 12 | 30 |
| 2022 June | 23 | 8 | 31 |
| 2022 May | 30 | 8 | 38 |
| 2022 April | 34 | 9 | 43 |
| 2022 March | 32 | 13 | 45 |
| 2022 February | 24 | 4 | 28 |
| 2022 January | 43 | 10 | 53 |
| 2021 December | 37 | 17 | 54 |
| 2021 November | 28 | 5 | 33 |
| 2021 October | 35 | 9 | 44 |
| 2021 September | 16 | 8 | 24 |
| 2021 August | 22 | 1 | 23 |
| 2021 July | 14 | 4 | 18 |
| 2021 June | 29 | 8 | 37 |
| 2021 May | 17 | 6 | 23 |
| 2021 April | 76 | 20 | 96 |
| 2021 March | 21 | 6 | 27 |
| 2021 February | 24 | 6 | 30 |
| 2021 January | 10 | 4 | 14 |
| 2020 December | 3 | 0 | 3 |
Show all
