The exploded hand syndrome: logical evaluation and comprehensive treatment of the severely crushed hand

Severe compressive trauma to the hand presents with multiple soft-tissue and osseous manifestations that often appear unrelated, leading to underrecognition and potential undertreatment of the complex injuries. Approaching the crushed hand with a logical and systematic diagnostic plan allows surgeons to recognize the location and severity of the injury portfolio and direct comprehensive treatment. Both for emphasis and for the purpose of describing the hydraulic mechanism of tissue failure, the term exploded hand syndrome is proposed. The exploded hand connotes the compendium of clinical findings that include skin failure at the webspaces or glabrous border, atypical (usually longitudinal) fracture patterns of the tubular bones, and axial carpal dissociations. These are accompanied by extensive compromise of the interosseous musculature that is extruded or may exhibit evolving compartment syndrome. Understanding the trauma mechanism and patterns of injury in the exploded hand will maximize awareness and guide surgical reconstruction and rehabilitation.