Hand reconstruction specialists in Italy have been working hard for seven hours to save the functionality of Robert Kubica’s right hand tonight after a high speed accident in a rally car this morning. After the operation finished, Dr Igor Rossello explained that an amputation was a possibility but that following surgery “the hand is alive,” although he added that ” we will have to wait a week before we will know if it will survive. ” More surgery might well be needed. He added that a recovery period of a year was to be expected.
Tonight I called a friend in London, Richard Young, who is a plastic surgeon specialising in hand reconstruction at Chelsea and Westminster Hospital, for some insight into hand crush injury, of which he has extensive experience.
I wanted to know what the risks are in a situation such as this and likely recovery times. The caveat for all of what follows is that we do not know the precise details and therefore this is not a specific prognosis on Kubica, more some general medical principles for my -and your – background understanding.
Apparently when they say a hand is at risk of amputation it is because the blood supply to the hand has been severed. That is the first thing to restore and that has clearly been done, although it sounds as though there is some waiting to be done to see if the blood vessels will function again properly. Then it’s a question of whether the doctors can restore full functionality, to the level which an F1 driver needs. This means repairing the nerves and tendons and their work will determine whether Kubica will race again. How long the recuperation will take depends on how severe the injury was in the first place. If the doctor is now saying up to a year, it must have been a very severe injury.
Dr Rossello has said tonight that the repair of the nerves in the hand is the big doubt in terms of whether the hand will regain functionality.
The first point is that the energy in the accident was clearly very great if it also caused long bone injury such as the broken leg and arm which Kubica suffered. Kubica’s hand appears to have been crushed by some armco entering the cockpit. So the extent of the hand crush injury was likely to have been severe.
The hand has many small muscles, tendons and nerves, which if crushed are likely to reduce the ability to roll the fingers in and to make fine movements, such as picking up a pin or in the case of an F1 driver, operating the buttons and dials on the steering wheel. Damage to the nerves will impair feeling and this can take at least three months to return.
As for rehabilitation it is long and crucially there is no short cut. Sometimes when athletes break a bone they can speed up the repair by sitting in a chamber to boost oxygen or blood flow, but that will not apply in this case.
Here we are dealing with tendons and these must be protected for up to three months before any effort can be put through them, otherwise the tendons rupture again. Also if there is severe damage to nerves in the hand or forearm the ability to make fine movements can be lost forever.