Narendra S Mashalkar

Aim: To observe the demography of hand bone fractures and the surgical procedure outcome and to observe the anatomical site of individual metacarpal and phalangeal fractures with machine related injuries. Settings and Design: This is a retrospective record analysis of 182 cases of hand bone fractures associated with occupational related injuries. Materials and Methods: Records of traumatic hand bone fractures irrespective of age and sex referred from the emergency dept were reviewed. The records of pure soft tissue injuries of hand and burns were excluded. Data were analyzed and projected in the form of tables and figures. Analysis: Cross tabulation for the entire pattern was done, due to many variables statistical significant analysis could not be derived. Results: There were total 182 cases of which (90%) males, (9%) females and 2 cases where gender was not mentioned. Most of the age group were young adults (15 to 25yrs) with machine contact related injuries. Of machine related injuries, 29% had cutting machine injuries followed by press punching machine (27%). The most common phalanx involved in all categories of occupational injuries was distal phalanx. Conclusions: Most of the hand bone fractures were noted in the right hand of young males with compound fracture of distal phalanx being more commonly involved; most of them had multiple finger involvement. Cutting and press punching machines caused severe crush injuries, ending up in high number of revision amputation than concrete mixer and heavy objects fall on hand. Hence extra care and safety features with supervision by experts are required while operating these types of machines. Shaft of metacarpal and proximal phalangeal fracture were more commonly involved as per individual site analysis. Keywords: Occupational injuries, Hand bone fracture, Surgical procedures

Repairing cleft palate in a non-syndromic child is very challenging, given the size of oral cavity, a Pierre-robinsequence (PRS) makes matters worse on the operating table, as there is an added difficulty of micrognathia and relatively larger tongue. This paper is written with an objective of sharing our difficulties faced while operating in such a child, the technique used to cover the oral layer of soft palate, and to foresee such difficulties in the preoperative period in milder cases of Pierre robin sequence. Keywords: Isolated cleft palate, Pierre­robin sequence, Pre­operative evaluation, Intra operative modification

Endoscope in plastic surgery has played a role, wherever minimal scarring is required. An attempt to decrease the length of scar is one of the priorities of a surgeon, as this brings down the chance of scarring, pain and associated morbidity, with decreased hospital stay. Hand is an organ with intricate anatomy and many vital structures are densely packed in hand. This makes the available space scarce for another instrument to add into the hand. Hence endoscopic intervention in hand is negligible. The margin of error also remains negligible in hand, as it would compromise on the function of hand, which is an absolute necessity. Aesthetic appearance of hand is not as important as function; nevertheless if possible, one should also consider giving an aesthetic scar with good function of hand and these criteria will be the goal for any hand surgeon. Keywords: Carpal tunnel, Endoscopic assisted, Inter thenar space, Incisions

Foreign Bodies (F.B) are not uncommon in hand, as it is involved in day to day activities. Prompt removal during the initial examination is the norm, but sometimes foreign bodies (F.B) may be missed and they remain within the soft tissue for a long time either revealing itself at a later date as a sinus, swelling or an abscess. We present a case of retained FB in the dorsum of hand and the technique involved in retrieval of such a long standing FB. Keywords: Foreign Body, Hand, Magnification

Fungal infection of soft tissue is not uncommon, and they are very well managed by anti-fungal therapy. But not all are this fortunate as extensive soft tissue involvement may be intractable to medical line of management, adverse effects of anti-fungal medications may add insult to injury thus leading to increased morbidity and mortality. Surgical help at this juncture becomes mandatory as debulking of such infected soft tissue will allow the immune system of the body to take care of the residual disease by supplementary anti-fungal therapy. Hence in such extensive involvement reconstructive surgical intervention will eradicate the disease in toto with simultaneous cover with skin graft which will be a life saver. We present here such a case scenario wherein a team approach with timely diagnosis and reconstruction helped save the life of a case. Keywords: Extensive phycomycosis, Resurfacing, Single stage