The “grabbing” mechanism: a particularly severe pattern of rollover hand injuries

INTRODUCTION: Rollover hand injuries are uncommon but potentially devastating lesions. While typically described as dorsal injuries, cases involving the palmar side are rare. There are two different mechanisms of rollover hand injuries: the "grabbing" or the "hanging out" mechanism. The aim of this case-report was to describe a particularly severe pattern of rollover hand injury with palmar side injuries following the "grabbing" mechanism. CASE-REPORT: Three males patients sustained severe stage 3 lesions according to Coulet's classification following dune-buggy accidents with a "grabbing" mechanism. All cases exhibited combined dorsal and palmar injuries with bone, vascular, and tendinous involvement. Infectious complications were frequent, requiring serial debridement and flap coverage using posterior interosseous or groin flaps. One patient required a trans-metacarpal amputation due to ischemia. At a median follow-up of 21 months, all surviving digits demonstrated satisfactory healing and function, despite persistent intrinsic muscle paralysis. CONCLUSION: Buggy-specific hand injuries have so far been grouped under injuries caused by "rollover" mechanisms, involving vehicle overturning. However, the distinct mechanism of these injuries, which is linked to the presence of a safety cage, is more likely to result in palmar injuries with severe vascular damage. LEVEL OF EVIDENCE: IV.