After more than 20 years repairing hand trauma, I am sure that primary prevention is the best way to avoid disability, pain, cost, time of work and handicap.
Despite fantastic progress during these years, surgery is still unable to restore a perfect hand following severe injuries.
Even seemingly benign lesions may have very heavy consequences. Physical, functional and social impairments are common for the patients of course, but also for the community in terms of financial compensation.
Occupational accidents have been considerably reduced over the last decade in developed countries, thanks to improvements in industrial security features encouraged by economic incentives and law enforcement. There is still a lack of prevention regarding young, inexperienced manual labor apprentices, or unskilled laborers, working in temporary jobs. Overcoming the obstacles of prevention methods requires education, worker participation and often requires legal measures
Since 2003, I felt that it was my duty -as a hand trauma surgeon- to help prevention. Hand surgeons –more than anyone- have the authority to educate people through meetings, leaflets, videos and web sites.
Hand surgeons are also able to collect precise epidemiologic data in order to inform people and Health administration.
These are my contributions to prevention:
Creation of the “Réseau Prévention Main”
I created this network to improve the concern and cooperation of all heath professionals around the patients presenting a hand injury. This project was accepted and entirely supported by regional Health Administration since 2003. It gathers public and private hospitals, surgeons, therapists, social workers, psychologists, General Practitioners, etc.
More than 300 new patients are included in the network each year.
The network provides prevention at three levels:
- Primary prevention to prevent the injury itself
- Secondary prevention to prevent sequels due to inadequate treatments
- Tertiary prevention to reduce socio-economical and psychological consequences of physical and functional disability
For more information : visit the web site[http://www.reseaumain.fr/accueil.php ]
Prevention commission of the FEdération des Services d’Urgences Mains
The prevention commission of the FESUM played an important role in the development of hand trauma prevention in France. FESUM achieved several prevention campaigns including oral presentations in major companies and large-scale distribution of prevention leaflets to consumers and health professionals.
Jean-Claude Guimberteau and Ph Bellemère set up a “National Campaign for the Prevention of Hand Trauma” which was launched in Paris in October 2010 and has successfully travelled in France through more than 15 cities ending in Paris in December 2013. These events were very successful in directing the attention of consumers and administration towards hand prevention in daily life [http://www.fesum.fr/spip.php?rubrique49].
Prevention commission of the FESSH [FESSH IC 1 pp 43-46]
With Dr Bellemère and Dr Kaleli, we created a Prevention commission at a European level with the Federation of the European Societies for Surgery of the Hand.
This commission gathers contributions of 35 European countries.
This commission was able to create leaflets [booklett FESSH 2013] and organize International congresses:
In Bursa, 2009
In Berlin, 2012
In Vienna 2013[http://www.handpreventioncongress2014.org]
Ring finger avulsion prevention device
Skin degloving injuriy caused by a ring is probably the first cause of complete finger amputation in teenagers and adults. The causes of the injury are numerous and it can occur at home, at work, in recreation and even on the battlefield. Pulling the ring may tear the skin, subcutaneous tissues, nerves and blood vessels resulting in a complete amputation [stages of injury].
This accident is particularly chocking because it mutilates youngsters that where not aware of the danger. The most frequent context is a boy passing over a fence to recover his ball and loosing his finger when he comes down the fence as the ring gets trapped in a barb wire.
This device was called “Adlife”, was tested, patented and sold to one of the largest ring fabrics in Europe [adlife JHSE]. Unfortunately, for commercial reasons, the device was not proposed to customers, the merchants being afraid that mentioning an accident would scare the couples and discourage them to buy any ring.
The Commission for protection of users of the Industry Ministery made an official recommendation but this did not have any effect.
Eventually, the device is not commercialized anymore and the ring finger injuries are still as frequent as before.