Crushed Hand and Wrist

September 14, 2005
Thomas A. Keel, MS

A 22-year-old soldier's left hand, wrist, and distal forearm were crushed by an object that weighed 90.8 kg (200 lb). There were no signs of open fracture; soft-tissue injuries were obvious. No neurovascular deficit was discerned in the limb.

A 22-year-old soldier's left hand, wrist, and distal forearm were crushed by an object that weighed 90.8 kg (200 lb). There were no signs of open fracture; soft-tissue injuries were obvious. No neurovascular deficit was discerned in the limb.

Anteroposterior and lateral x-ray films ruled out fracture. Soft-tissue air fluid levels-primarily of the wrist and distal radius-were noted on the lateral view. Air fluid levels can be signs of gas-producing anaerobic pyogens, such as gangrene. Despite the acute rather than chronic nature of the lesion, anaerobic cultures were taken; aerobic cultures were obtained as well.

Management of infection in tight hand compartments is difficult. Because of the risk of aerobic bacterial drug resistance and anaerobic threat, soft-tissue injury, even without osseous fracture, warrants in-depth investigation.

Both cultures were negative for bacteria. After 72 hours, this patient's injuries were irrigated, cleaned, closed, and packed and dressed. The hand healed without sequelae.

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