Muhammad Ahmad, Azfar Farogh, Imtiaz Ahmad, Khalid Mahmood Gill, Syed Shahid Hussain.
Can we call it a Diabetic Hand?.
J Surg Pak Jan ;7(4):24-7.

To know the frequency and to evolve the grading system of diabetic hand a prospective study was designed and carried out at the Medical and Surgical Departments of Bahawal Victoria Hospital, Bahawalpur from 1-02-2000 to 31-12-2001. Adult patients who had a random plasma glucose level of >11.1 mmole/L or a fasting serum glucose level of >7.0 mmole/L, with a hand lesion (cellulitis, abscess or gangrene etc) were included in the study. All the patients with carpel tunnel syndrome, Dupuytren`s contracture, arthritis. trigger finger/thumb etc were excluded from the study. Detailed history and examination were carried out noting especially the mode of presentation, numbness/ altered sensations, history of trauma and nature of the job. A total of 56 patients with diabetic hand fulfilled the inclusion criteria. Most of them were middle-aged males. Right hand was the predominant one to be involved in 73.7% and right thumb was involved in 19 cases. Almost all the affectees were manual workers. More than half of the patients presented with deep-seated infections of the hand. 38% of the patients developed spontaneous bacterial infection. History of trauma was present in 29%. One third of the patients did not know the cause of diabetic hand. Streptococci were the most frequent microorganisms (23%) isolated followed by Staphylococci (16%). Operative treatment included various modalities. All the diabetics with hand infection should be graded and early interventions should be undertaken to halt the disease process. Every effort should be directed to `save the hand` while performing any intervention.

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