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Complicated Axial Fracture Dislocations of the Hand- The Leather Plating Machine Injuries
Sreekanth Raveendran, MS, Ortho, PDFHS; Binu.P Thomas, MS
Dr Paul Brand Centre for Hand Surgery, Christian medical college Vellore, Vellore, India

Introduction: We report nine patients with a previously undescribed combination of injuries by “leather plating machine” resulting in a “terrible triad” of axial fracture-dislocation of wrist, third degree burn and acute compartment syndrome of hand. Leather plating machine (LPM) is used for processing leather for shoes. This has two heated plates which hydraulically compress leather sheets, cut, and iron and imprint texture. When hand gets caught between the plates accidently, it imparts an axial compression and thermal injury along with shear component as victim tries to pull hands wedged between plates free resulting in the above injuries.
Materials & Methods: A retrospective study of patients presenting with LPM injury from January 2005 to June 2011 were done. The demographics, clinical presentation, associated injuries, treatment and final outcome of this unique injury was analyzed. Emergency fasciotomy was done for acute compartment syndrome and axial fracture-dislocations were treated by open/closed reduction and fixation. Third degree burns were treated with debridement, skin resurfacing. All patients underwent rigorous hand therapy postoperatively. The minimum follow-up was 2 years and the outcome evaluated by DASH and Mayo wrist score.
Observations: M: F ratio was 8:1. Right hand was predominantly affected (3.5R: L). The average age was 30.8 years. Six patients had axial ulnar, three patients both axial ulnar & radial and one axial radial injury. Seven patients had compartment syndrome and 30burn to hand. Eight patients had thumb web burst while one had hypothenar burst. The deep branch of ulnar nerve was severed in three cases requiring repair. All cases required debridement and fixation. One patient underwent amputation of non-viable fingers. One had flap cover and two required skin grafts. Seven out of nine had severe stiffness of hand. The mean TAM for the seven patients was 1090 while two patients with no compartment syndrome mean TAM was 2240. DASH and Mayo scores also were done. None of the patient went back to old profession.
Conclusion: The leather plating machine injury to hand produces unique pattern of injury characterized by the terrible triad of axial fracture-dislocation of the wrist, third degree burn and acute compartment syndrome of the hand . The outcome of this injury was uniformly poor. Safety measures to prevent this injury are suggested.

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