Degree of Master of Medicine in Orthopaedic surgery Department of Orthopaedics Faculty of Health Sciences University of Witwatersrand / The hand is an intricate and important body appendage which plays a vital role in our activities of daily living. Flexor tendon injuries to the hand make up a large amount of patients seen at hospitals all over the world. Hand injuries are quite common and contribute to approximately 28% of injuries to the human body. A prospective study was conducted, with patients who had sustained flexor tendon hand injuries. The patients who presented to Chris Hani Baragwanath Academic Hospital from 02 March 2015 to 29 July 2015 were included in the study. The aim of this study was to document and identify the causes (mechanism of injury) and demographic details of patients presenting with flexor tendon injuries at Chris Hani Baragwanath Academic Hospital hands unit. There were 96 patients in the study, with 80 being right hand dominant and 16 being left hand dominant. Zones II and zones III were the most common flexor zones affected (27 each). There was also a significant amount of zone V injuries (23). Zone IV was the least common zone affected (5). The results also showed that the most common injury to flexor tendons of the hands occurred in young adult males, the majority of whom were unemployed. This disproves our hypothesis, as it was hypothesised that most injuries would occur in the work place. This study was undertaken in an attempt to reduce the incidence and frequency of hand injuries in our community, by assessing the common causes and patient particulars of flexor tendon injuries. This information can now be used to teach awareness which now can be used in the work place. / MT2017

Made available in DSpace on 2015-07-22T20:50:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-25. Added 1 bitstream(s) on 2015-08-11T03:26:32Z : No. of bitstreams: 1 Publico-549%20-%2011769.pdf: 1027011 bytes, checksum: 549288ebc09400ab5c317f529c1f6f07 (MD5) / Objetivo: Estabelecer parâmetros da superfície palmar para localização precisa do limite proximal da polia flexora A1, nos dedos indicador, médio, anular e mínimo, e avaliar o comprimento dessa polia. Métodos: Foram estudados 280 dedos de 70 mãos de 35 cadáveres frescos, mensurando-se inicialmente a distância entre as pregas digitopalmar e interfalangeana proximal (medida A), seguindo-se com a dissecação dos dedos e mensuração da distância entre o limite proximal da polia A1 e a prega digitopalmar (medida B), bem como o comprimento da polia A1 (medida C), em cada dedo. A análise estatística foi feita com a utilização do teste multivariado “T²” de Hotelling e do teste “t” para amostras pareadas. Resultados: Após a análise estatística, foi constatado que não há diferença significante entre as medidas A e B em cada dedo (p-valor > 0,05). Também não se evidenciou diferença significante (p-valor > 0,05) entre as medidas correspondentes para cada dedo de ambas as mãos (AxA), (BxB) e (CxC). Foi observado que o comprimento médio da polia A1 em milímetros no dedo indicador é de 9,83; no médio, de 10,71; no anular, de 9,66, e, no mínimo, de 8,06. Conclusões: A distância entre as pregas digitopalmar e interfalangeana proximal deve ser usada como referência cutânea da superfície palmar para a localização precisa do limite proximal da polia A1 na palma da mão, dando mais segurança na realização de procedimentos cirúrgicos como a liberação percutânea do “dedo em gatilho”. / Purpose: We conducted this study to establish palmar surface parameters to allow for the exact location of the proximal limit of the flexor tendon A1 pulley in the index, middle, ring and little fingers and to evaluate the length of this pulley. Methods: We studied 280 fingers on 70 hands of 35 fresh human cadavers, initially measuring the distance between the digital-palmar and proximal interphalangeal creases (measure A), followed by dissection of the fingers and measurement of the distance between the proximal limit of the A1 pulley and the digital-palmar crease (measure B) and the length of the A1 pulley (measure C). A statistical analysis was carried out using Hotelling’s multivariate T2 test and the paired samples t-test. Results: No statistically significant difference was found between measures A and B in each finger (p > 0.05). The average length of the A1 pulley, in millimeters, was 9.83 in the index finger, 10.71 in the middle finger, 9.66 in the ring finger, and 8.06 in the little finger. Conclusions: The distance between the digital-palmar and proximal interphalangeal creases should be used as a cutaneous reference of the palmar surface for the exact location of the proximal limit of the A1 pulley in the palm of the hand, ensuring greater safety in surgical procedures such as percutaneous release of trigger finger. / TEDE / BV UNIFESP: Teses e dissertações

The object of this work is to chart an educational process of ambulant patients undergoing a planned arm surgery due to carpal tunnel syndrome or trigger finger and creating a functional educational material that leads to a change of knowledge and skills of those patients and that can be used by nurses during their work. The three questions to achieve the objectives were: 1) How does the educational process of the patient look like before arm surgery? 2) How is the patient educated on post-operative regime? 3) How are the educational activities implemented in patients undergoing arm surgery? The research project was aimed to the qualitative investigation. Generally the research survey was structured into two phases, the results are summarized in the practical part. The first phase was focused on observation of professional object and depth semi-structured interviews with patients who underwent an arm surgery were made. This survey was supplemented by direct structured observation of nurses in the process of educational activities. Six nurses were altogether involved in the survey. In the second phase, the educational material based on the obtained results, was made for the nurses to use during their work. This material includes educational cards and maps of care instructions for given diseases. Effectivnes of this material was subsequently verified by more semi-structured interviews with six patiens. The results of the survey showed that in the workplace where the respondents underwent the surgery, the educatinal process was singificantly eliminated and for its realization the nurses did not have satisfactory conditions, especially time and spatil conditions. During the educatinal process the nurses were using monologues teaching methods. Demonstration and practical methods were missing. Nurses were not using teaching aids that can make the educatinal process more effective. The results of this work can elucidate the educational reality in surgeries and focus attention on this sector, often neglected in expert literature.