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British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 8, Issue.: 11


Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries


Zafar Mahmood Khan1, Bina Nasim2, Tanvir Yadgir3, Omer Al Skaf3, Ahmed Sajjad1, Zulfiqar Ali1 and G. Y. Naroo4*

1Emergency Department, Rashid Hospital, P.O.Box 4545, Dubai, UAE.
2Internal Medicine Department, Rashid Hospital, P.O.Box 4545, Dubai, UAE.
3Dubai Corporation for Ambulance Services, Dubai, UAE.
4Rashid Hospital, Trauma Centre, P.O.Box 31865, Dubai, UAE.

Article Information
(1) Suryapratap Singh, Department of Neuro, Trauma and Spine Surgery, Narayana Medical College and Hospital, India.
(1) Matias Carvalho Aguiar Melo, Department of Medical Sciences, Universidade Federal do Ceará, Brazil.
(2) Anonymous, Kocaeli University, Turkey.
(3) Rohini Prasad, Department of Plastic, Reconstructive and Hand Surgery, Parvathy Hospital, Chennai, India.
Complete Peer review History: http://www.sciencedomain.org/review-history/9568


Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage. The aim of this study is (1) to determine the incidence of significant neurological, musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and musculotendinous injuries.
Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized as being missed if a patient had received inappropriate treatment or had returned due to persistent symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours duration were included. Non-accidental injuries were excluded.
Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%) sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%). Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%). Fifteen patients were offered an admission to hospital by the Trauma service for definitive treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients did not warrant admission and were discharged from the Emergency Department following appropriate treatment. Thirty seven patients were treated by Emergency Physicians and subsequently discharged. A missed tendon injury was reported in one patient (1.7%).
Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency Department is fundamental in recognizing tendon injuries.

Keywords :

Sharp objects; emergency room; limb injuries; tendon injuries; neurovascular injuries.

Full Article - PDF    Page 956-962

DOI : 10.9734/BJMMR/2015/17475

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