Meat Grinder Injury (somewhat graphic)

[George K]

[Doctor Phibes]

Oh my God. I don't know what else to say.

On a side note, it's nice to see that the city of Glasgow has contributed something so strangely appropriate to the world of medicine.

[George K]

@doctor-phibes GCS has been a thing for a long time.

[Doctor Phibes]

@george-k I'm fairly sure that a Glaswegian invented the coma.

[Klaus]

I don't quite get the medical lingo. How did the patient end up? Amputation? If so, how did they remove the device without hurting the "healthy" part of the arm that was still stuck?

[George K]

@klaus after they did the nerve block they were able to reverse the machine. Thumb and little finger were spared, but digits 2-4 were amputated. He had fractures of the bones at the wrist.

They didn't think the block was going to last long enough to fix the fractures, so they put him to sleep. Wrist fractures were stabilized with wires (actually thin metal rods, about 1mm in diameter). The little finger was intact but also fractures, and that was fixed with a wire.

They washed up and cleaned all the dead meat at the wound site and then sewed the wound together where the missing fingers were.

The discussion centers on the anesthetic management.

[Klaus]

Ah, thanks. Yes, I saw the discussion about anesthetic management and missed the description of what eventually happened.

Sounds like a comparably good outcome.

[George K]

I hated hand injuries. Most were due to industrial mishaps (crush injury by various machines), but there was the occasional idiot fireworks injury.

We had a very aggressive hand surgeon who used to want to reimplant any amputation of a finger. He was motivated, but at least he was slow. These cases used to take at least 10 hours or so. We had one on Memorial Day weekend in 1988 (yes, I remember that Sunday).

I'm sure that techniques have gotten much better since then, and the surgery isn't as tedious as it was.

The problem with re-implants was that the rehab and subsequent disability were often worse than dealing with an amputation. Another hand surgeon's philosophy was, "Never reimplant one digit unless it's the thumb." Made sense to me.

One of our residents was missing his right index finger. I don't remember the cause of the injury, but it was when he was in his late childhood, early teens. You'd never know that he was missing a finger until you shook hands with Tom. He's now chairman of a large academic department.

[Klaus]

How functional will a reattached finger be, if everything goes well?

[Jolly]

Big grinder can be even worse. There is a reason you use a push tool when grinding meat.

[George K]

@klaus said in Meat Grinder Injury (somewhat graphic):

How functional will a reattached finger be, if everything goes well?

That's sort of the point of the second surgeon. Not worth it. YOu'll be more functional without the finger (as long as it's not the thumb, of course). Of course, that may well have changed in the last years.

2016:

"Finger amputations cause emotional and social trauma to patients in addition to physical trauma. Although there are individual differences, the primary goal for most patients is to regain use of their fingers and return to their lives [1]. Finger replantation requires a difficult and complex rehabilitation program, but results are highly satisfactory in the long term."

One study I found looked at the DASH score for surgery. This is a subjective evaluation by the patient:

https://orthotoolkit.com/dash/

Here's the only thing I could find.

https://pubmed.ncbi.nlm.nih.gov/17462311/

The subjective outcome of the achieved replantation reached an overall DASH score of 12.3. Patients after thumb replantation reached a score of 10.0, after a single finger replantation DASH 11.2 and after multiple finger amputations and replantation of at least one finger, DASH 16.1.

[Klaus]

Hm, but what does that mean in practice?

If I have a reattached finger,

• will I feel touch, warmth etc. similar to the original finger?
• can I use all muscles and joints like in the original finger?
• which everyday-thing could I do? Could I, say, play piano or the violin with it?

[George K]

@klaus said in Meat Grinder Injury (somewhat graphic):

If I have a reattached finger,

will I feel touch, warmth etc. similar to the original finger?

If the nerves are reattached and healed properly, probably. Though a large number of people complain about sensitivity to cold.

can I use all muscles and joints like in the original finger?

Presumably, but with residual stiffness, I assume. After my minor finger surgery almost 5 weeks ago, I still have pain and stiffness. Hopefully that'll resolve in the next months. Look at @Horace 's experience with hand surgery.

which everyday-thing could I do? Could I, say, play piano or the violin with it?

No idea, but I doubt it, and that's just a POOMA guess.

[Larry]

A guy comes home from work and tells his wife. "I got fired today. I got my dick stuck in the pickle slicer.."

His wife says "oh my goodness! What happened to the pickle slicer?"

The ma's says "they fired her too....."

[Mik]

Perspective is a wonderful thing. I’m in the ER at B North. A good friend hit her head on ice. They just took her back for a ct.

Whatever happens she’s in better shape than this guy.

[taiwan_girl]

@Klaus said in Meat Grinder Injury (somewhat graphic):

How functional will a reattached finger be, if everything goes well?

A friend of mine from Taiwan had his big toe replacing one of his thumbs.

He seems to function okay, but it is on his "non dominant" hand.

I dont know him well enough to know the background on the replacement.

[George K]

@taiwan_girl said in Meat Grinder Injury (somewhat graphic):

big toe replacing one of his thumbs.

That's been pretty much standard for a long time.

I wonder what the level of his functionality is.