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Broken glass injuries: Three year analysis
Abstract
Aims: Patients with broken glass injuries who were sent to our Neurophysiology laboratory for the last three years were included in this retrospective study. The information about age, clinical signs and electrophysiological data were evaluated. Methods: The study was designed as a retrospective study and only broken glass injuries due to various reasons were investigated, excluding traffic accidents and earthquake wounds. Results: Eighty-five patients were included in the study. Mean age of the patients was 22.3 years. Mean time before coming to hospital after injury was 21.8 months. Injury localization was the arm in 4 patients, elbow in three patients, forearm in 33, wrist in 41, palm in 3, hand dorsum in 1, leg in 1 and foot in 3 patients. Seventy patients had right and at 19 patients had left extremity lesions. As for the electrophysiological findings; 9 were normal, 30 patients had ulnar, 27 had median, 16 had ulnar and median, 2 had radial and 1 had peroneal and posterior tibial nerve lesions. Of these, 59 of the nerve lesions were on the right, 17 were on the left side. Conclusions: Young males are dominantly affected from glass injuries and the localization is most frequently at the right arm and wrist. The main complaints are related to motor and sensory deficits and the clinical examination supports this finding. The probability of having an ulnar and/or median nerve lesion is the highest and most frequently motor fibers are partially and sensory fibers are totally affected.
... Most of the small abrasions heal but some end with tendon, nerve, and blood vessel cuts. (5) Usually, tendon ruptures are managed surgically with associated injuries and post-operatively physiotherapy rehabilitation is carried out. The therapeutic program involves pain management, passive to active range of motion exercise for wrist-elbow-shoulder gradually progressing the intensity, grip strengthening exercises, muscle energy technique, postural control, and biceps advance strengthening exercise. ...
The Biceps Brachia is an anterior arm muscle consisting of two heads that bridge the shoulder girdle to the forearm. The distal biceps tendon from both heads may converge or remain anatomically separate before attachment to the radial tuberosity. The incidence of distal biceps rupture is 1.2/100,000 per year and is mostly seen in middle-aged men. The rupture of the biceps tendon is a relatively less common lesion making this case unique. Physiotherapy rehabilitation post-surgery is found to be effective; it includes management of pain, increase range of motion exercises, strengthening exercises, muscle energy technique, cardiovascular fitness, all these together helps to improve patient outcomes. A case of the 40-year-old female is presented in this case report who underwent traumatic glass-cut injury in proximal forearm resulting in distal bicep-tendon repair with ulnar artery injury and ulnar nerve neuropathy. After surgical reconstruction patient presented with pain in the shoulder, elbow, and wrist, reduced range of motion, strength, and grip strength leading to difficulty in performing activities of daily living. Surgical history, clinical findings, outcomes, and rehabilitation are mentioned in this report. We report that there is a significant improvement in stability, range of motion, muscle strength, relief from pain, and improvement in the patient's functional level and outcomes.
A total of 181 patients with 254 injured nerves in the upper limbs were prospectively studied. The ages of the patients ranged from 6 weeks to 70 years, with a mean of 25.9 years and a male to female ratio of 4:1. The site of injury for 123 nerves in 83 patients was the wrist. A torn wound was the commonest type of injury, causing nerve damage in 127 patients. The ulnar nerve (114) was more frequently involved than other nerves. There were 92 median, 34 radial and 14 cervicobrachial nerves. The nerve injury was missed at the initial emergency operation in 31 patients (17 per cent). Glass of various types caused the injury in 89 patients involving 119 nerves. Of all glass wounded nerves 60 per cent were caused by domestic architectural window, door and furniture glass. Accidental fall or punch and forced opening or closure were the mechanism of injury in 71 patients. Strict glass safety regulations and education of the public on the dangers of glass are recommended for prevention of glass-related injuries.
Two cases of delayed median nerve division after laceration of the wrist by glass are described. In both there was no neurological damage at the time of the original injury. However, retained fragments of glass were subsequently responsible for division of the median nerve in both cases and of the surrounding tendons in one. Radiographs were an important diagnostic aid in treating the delayed injury.
A series of 13 patients with an injury of the accessory nerve in the posterior cervical triangle is reported. In 11 patients the nerve was damaged during a lymph node biopsy and in two cases there was a sharp glass injury. Paralysis of the trapezius muscle occurred with resulting deformity and loss of function of the shoulder. Nine patients were operated on. In five cases neurolysis, in two cases neurorrhaphy and in two cases reconstruction with a sural nerve graft were performed 3-17 months after the injury. The result was good or fair in six operative cases. Five of these were neurolyses. In one instance good and in three cases fair recovery was achieved without operation. All but one of the patients were able to return to their former employment. The mean follow-up time was 20 months.
One hundred and twenty-six bar staff (median length of service 2.7 years) working in 42 randomly selected public houses in South Glamorgan were interviewed and examined in the workplace to investigate the incidence, characteristics and treatment of lacerations from bar glassware. 41 per cent reported previous injury, 13 per cent on five or more separate occasions. All injuries but one were of the hand. After 13 per cent of incidents, treatment had been sought in an A & E department, but 58 per cent of incidents causing hand lacerations were not treated. Straight-sided (nonik) one pint (0.6 l) capacity glasses were responsible for two-thirds of injuries, usually during stacking and washing of used glasses. Of bar-workers familiar with toughened glassware, 86 per cent favoured its use on safety grounds. It was concluded that the incidence of sharps (glass) injury was unacceptably high and that this was also a potential cause of cross-infection in this group of workers.
In patients with hand injury, careful clinical examination is necessary, even in cases of seemingly trivial lesions such as small puncture wounds. Four patients, two women aged 18 and 51 years and two men aged 16 and 28 years, presented with a small volar cut caused by a glass fragment (three patients) and a saw. They suffered from loss of motor function, loss of sensibility or loss of circulation in one finger. They were treated by plastic surgery. Lesions of tendons and peripheral nerves can be diagnosed by relatively simple tests. It is important to recognize them at an early stage because adequate treatment may result in recovery of the sensibility and the motor function. Even a 'dead' finger may be salvaged.