How does left-hand dominance affect the risk of major hand injuries. What are the implications for workplace safety and tool design. Can specific measures reduce injury rates among left-handed individuals. How do minor hand trauma rates compare between left and right-handed people.

The Surprising Link Between Left-Handedness and Hand Injuries

A groundbreaking study has shed light on the relationship between hand dominance and the risk of major hand injuries. Researchers at the Philadelphia Hand Center conducted a retrospective review of 125 patients treated for digital amputation and 116 patients with minor hand trauma. The results reveal a startling disparity in injury rates between left and right-handed individuals.

Key Findings of the Study

• 35% of patients with digital amputations were left-handed
• Only 11% of patients with minor hand trauma were left-handed
• Left-handed individuals were more likely to injure their dominant hand (70%) compared to right-handed individuals (51%)
• Power saws were the most common cause of amputating injuries

These statistics paint a concerning picture for left-handed individuals in environments where hand injuries are a risk. The relative risk of sustaining an amputating injury is 4.9 times greater for left-handed people compared to their right-handed counterparts.

Understanding the Disproportionate Risk for Left-Handed Individuals

The study’s findings raise important questions about the factors contributing to the heightened risk for left-handed people. Several potential explanations emerge:

Tool and Equipment Design

Many tools and pieces of machinery are designed with right-handed users in mind. This can lead to awkward or unsafe handling by left-handed individuals, potentially increasing the risk of accidents.

Workplace Layout

Assembly lines and workstations are often configured for right-handed operation. Left-handed workers may need to adapt their movements or work in less ergonomic positions, which could contribute to a higher injury risk.

Training and Safety Protocols

Safety training and protocols may not adequately address the unique challenges faced by left-handed workers, leaving them more vulnerable to accidents.

The Psychological Impact of Hand Dominance on Injury Risk

Beyond the physical aspects, there may be psychological factors at play in the increased injury risk for left-handed individuals. Research in neuropsychology has explored differences in cognitive processing and spatial awareness between left and right-handed people.

Spatial Awareness and Motor Control

Some studies suggest that left-handed individuals may process spatial information differently, which could impact their interaction with tools and machinery. This could potentially lead to a higher risk of accidents in certain situations.

Adaptation to a Right-Handed World

Left-handed people often need to adapt to a world designed for right-handed use. This constant adaptation might lead to fatigue or moments of decreased attention, potentially increasing the risk of accidents.

Minor Hand Trauma: A Different Story

Interestingly, the study found that minor hand trauma occurs at rates proportional to the distribution of left-handedness within the general population. This suggests that the increased risk for left-handed individuals is primarily associated with more severe injuries.

Possible Explanations for the Discrepancy

• Minor injuries may be less influenced by tool design and workplace layout
• Left-handed individuals may be more cautious in everyday tasks due to lifelong adaptation
• The nature of activities leading to minor injuries may be less affected by hand dominance

This discrepancy highlights the need for targeted interventions focused on preventing major hand injuries among left-handed workers.

Implications for Workplace Safety and Tool Design

The study’s findings have significant implications for workplace safety practices and the design of tools and equipment. To address the disproportionate risk faced by left-handed individuals, several measures should be considered:

Ergonomic Design Solutions

Manufacturers should prioritize the development of ambidextrous tools and equipment that can be safely and comfortably used by both left and right-handed individuals. This may include features such as reversible handles, adjustable guards, and symmetrical control layouts.

Workplace Modifications

Employers should assess their workstations and assembly lines to ensure they can accommodate left-handed workers without compromising safety or efficiency. This might involve creating mirror-image workstations or providing adjustable equipment that can be easily reconfigured for left-handed use.

Enhanced Safety Training

Safety training programs should incorporate specific modules addressing the challenges faced by left-handed workers. This could include demonstrating proper technique for left-handed tool use and highlighting potential hazards that may be more pronounced for left-handed individuals.

Personal Protective Equipment (PPE)

Manufacturers should ensure that PPE, such as gloves and arm guards, is available in designs that provide optimal protection and comfort for left-handed users.

The Role of Research in Improving Hand Safety

While this study provides valuable insights, further research is needed to fully understand the relationship between hand dominance and injury risk. Future studies could explore:

• The effectiveness of ambidextrous tool designs in reducing injury rates
• The impact of left-hand-specific safety training on accident prevention
• Potential neurological or biomechanical factors contributing to the increased risk for left-handed individuals
• Long-term outcomes and rehabilitation success rates for left-handed individuals following major hand injuries

By continuing to investigate these areas, researchers can help drive the development of more effective safety measures and interventions.

A Call to Action: Protecting All Workers

The findings of this study serve as a wake-up call for industries where hand injuries are a significant risk. Employers, manufacturers, and safety professionals must work together to create environments and tools that protect all workers, regardless of hand dominance.

Steps for Immediate Action

1. Conduct workplace assessments to identify potential hazards for left-handed workers
2. Invest in ambidextrous or left-handed specific tools and equipment
3. Revise safety training programs to address left-handed worker needs
4. Encourage open communication with left-handed employees to identify areas for improvement
5. Regularly review and update safety protocols to ensure they remain effective for all workers

By taking these steps, employers can create safer work environments and potentially prevent life-altering injuries.

The Broader Implications of Hand Dominance Research

While this study focuses on hand injuries in workplace settings, the implications of hand dominance research extend far beyond occupational safety. Understanding the impact of handedness on various aspects of life can lead to improvements in many areas:

Education

Insights from hand dominance research can inform educational practices, ensuring that left-handed students have equal opportunities to learn and develop skills without unnecessary obstacles.

Sports and Athletics

Understanding the biomechanics and cognitive processes associated with hand dominance can help athletes optimize their training and performance, regardless of their dominant hand.

Medical Treatment

Knowledge of how hand dominance affects injury patterns and recovery can inform medical treatment protocols, potentially leading to better outcomes for patients with hand injuries.

Consumer Product Design

Beyond workplace tools, this research can influence the design of everyday items, making them more accessible and user-friendly for left-handed individuals.

By continuing to explore the implications of hand dominance across various fields, researchers and practitioners can work towards creating a more inclusive and safer world for individuals of all hand preferences.

Left-hand dominance and hand trauma

. 1995 Nov;20(6):1043-6.

doi: 10.1016/S0363-5023(05)80157-1.

J S Taras 
¹
, M J Behrman, G G Degnan

Affiliations

Affiliation

• ¹ Philadelphia Hand Center, PA 19107, USA.

• PMID:

  8583055

• DOI:

  10.1016/S0363-5023(05)80157-1

J S Taras et al.

J Hand Surg Am.

1995 Nov.

. 1995 Nov;20(6):1043-6.

doi: 10.1016/S0363-5023(05)80157-1.

Authors

J S Taras 
¹
, M J Behrman, G G Degnan

Affiliation

• ¹ Philadelphia Hand Center, PA 19107, USA.

• PMID:

  8583055

• DOI:

  10.1016/S0363-5023(05)80157-1

Abstract

To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%. The left-handed were more likely to have an amputating injury of their dominant hand than were the right-handed (70% compared with 51%, respectively). The most common mechanism of amputating injury was by power saw. The present data suggest that left-handed individuals have a relative risk of sustaining an amputating injury that is 4.9 times greater than the right-handed individuals, while minor hand trauma occurs at rates proportional to the distribution of left handedness within the population. Additional safety measures and the redesigning of tools, assembly lines, and workstations are recommended to help decrease the incidence of serious hand injury among left-handed individuals.

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MeSH terms

Wrist, hand and finger problems

Wrist, hand and finger problems can cause a range of symptoms including:

• pain
• swelling and stiffness
• pins and needles or numbness

In many cases, new pain or a flare-up of long-standing wrist, hand and finger problems should begin to settle within 6 weeks without the need to see a healthcare professional.

What causes wrist, hand and finger problems?

Problems with the wrist, hand, and fingers are common and can be caused by simple things like carrying out repetitive tasks or an injury during sport or a fall.

As you get older, normal age-related changes can cause your wrist, hand or finger problem to flare-up now and again, often for no reason.

Can wrist, hand and finger pain cause problems elsewhere?

You may feel pain and stiffness in your forearm. This should improve as your problem gets better.

Sometimes you can experience altered sensation like pins and needles or numbness in your hand or fingers when the nerve is the irritated. If you have these symptoms speak to your GP.

Occasionally, problems felt in your wrist, hand or fingers can be due to a neck problem. This can happen even when you don’t feel pain in your neck. People with this sort of problem often describe the pain as pins and needles, sharp, hot or burning pain.

If you have any of these symptoms it would be helpful to read about neck problems.

Self-help

There are a number of things you can do to help your wrist, hand or finger problem.

Keeping your wrist, hand and fingers moving is an essential part of your treatment and recovery.

How to get moving

Within the first 24 to 48 hours after your wrist, hand or finger problem has started you should try to:

• reduce your activities but move as much as your symptoms allow
• put your hand in a supported position if it’s comfortable, when resting
• move the area gently for 10 to 20 seconds every hour when you’re awake

After 48 hours:

• try to use your hand more – exercise really helps and can relieve pain
• do whatever you normally would and stay at, or return to work – this is important and is the best way to get better

It’s beneficial to do specific exercises that can help in your recovery. They may be challenging at the beginning so just do what you can and try to build it up over time.

Exercises to help with wrist, hand and finger problems

Benefits of keeping active

Keeping active’s the single best thing you can do for your general health.

Being physically active can:

• maintain your current levels of fitness – even if you have to modify what you normally do, any activity is better than none
• keep your other muscles and joints strong and flexible
• prevent a recurrence of the problem
• help you aim for a healthy body weight

Avoid sports or heavy lifting until you have less discomfort and good movement. Remember to warm up fully before you start sporting activities.

Pain treatments

The following can help to reduce the pain:

• pain medication – this can help you move more comfortably, which can help your recovery
• heat or ice packs

More about taking painkillers.

Treating with ice or heat

Heat or ice can be beneficial in the management of musculoskeletal pain.

Ice is most beneficial if your wrist, finger or hand problem is related to an injury. You can try heat to help your pain levels if there’s no swelling and your symptoms are not related to a recent injury.

Never place ice or heat directly on your skin. Use a barrier, like a towel, to protect your skin from a burn.

How long you use ice as a treatment can vary. However, you should generally apply heat or ice for up to 15 minutes. You should also leave a few hours between treatments.

You should stop treating the area with ice or heat and seek advice from a medical professional if you notice an increase in redness, discolouration or blistering of the skin.

If you have any issues with circulation or sensation, you shouldn’t use ice or heat as a treatment for wrist, hand or finger pain.

Work

It’s recommended you stay at or return to work as quickly as possible during your recovery. You don’t need to be pain and symptom-free to return to work.

Help and support

Following this advice, you should see gradual improvements over time.

You should see the biggest change in your symptoms within the first couple of weeks. Most problems should have improved within 6 weeks.

If your wrist, or hand and finger problem hasn’t improved within 6 weeks of following this advice, it’s a good idea to talk to a healthcare professional about your symptoms.

Find out how to access MSK services in your area.

causes, diagnosis, treatment in Yaroslavl

Hand injuries can be different, both in the location and in the nature of the damage. They occur in everyday life, during sports and professional activities. Injuries, hands can lead to structural changes in tissues, up to sprains and fractures. Therefore, immediately after traumatization, it is recommended to contact a traumatologist who will prescribe an X-ray examination and other diagnostic methods to make an accurate diagnosis and assess the degree of damage to the limb.

In the Clinic “CONSTANTA” you are always ready to receive qualified specialists in the field of traumatology with rich practical experience. Even if it seems to you that the hand injury is minor and you can get by with home treatment, it’s not worth the risk – it’s better to visit a doctor who will conduct an examination and assess the extent of the damage. Our Clinic is considered one of the best in Yaroslavl, as we have innovative equipment that is actively used for the diagnosis and treatment of diseases. Competent employees are always ready to discuss with the patient the questions of interest to him and provide qualified medical assistance in the framework of a particular clinical case.

How do hand injuries appear?

Symptoms of hand injuries depend primarily on the degree of damage. Contrary to popular belief, some patients do not feel severe pain even with arm fractures. Therefore, without professional skills and knowledge, the patient cannot visually determine what kind of injury has been received.

The main signs of a hand injury:

• soreness at the site of injury;
• puffiness;
• hematoma formation;
• restricted mobility;
• tissue redness;
• local temperature increase.

Immediately after the damage, carefully inspect the brush: are there deep abrasions, cuts on the skin, are bone fragments visible. Even if the integrity of the skin is not broken, before contacting a doctor, carry out an antiseptic treatment. Use any antiseptic you have at home – hydrogen peroxide, chlorhexidine, diluted alcohol. Wipe or irrigate the area with an antiseptic solution to reduce the risk of secondary infection. Then apply a non-tight sterile bandage and go to an appointment with a traumatologist.

Many patients cannot accurately describe the mechanism of injury. If the pain intensifies even after first aid, the specialist may suspect the development of a compartment syndrome, which is characterized by an increase in pressure in the fascial space. A common cause of the development of compartment syndrome is shrapnel damage, which often leads to malnutrition of muscle tissue and the spread of the infectious process.

In most cases, hand injuries are not accompanied by prolonged pain and a high risk of complications. The most dangerous are open injuries, which can be complicated by the addition of an infection and occur with severe circulatory disorders (ischemia). In such cases, prompt medical attention is needed. Only a qualified specialist can assess the degree of damage to the soft and hard tissues of the hand, identify hidden and obvious blood flow disorders and injuries of large or small vessels.

Fortunately, up to 70% of hand bruises are mild and do not require hospitalization or serious treatment. Most often, patients injure their fingers during sports training and solving everyday problems. With age, bone density decreases, so even slight behavior or compression can lead to a crack or fracture.

Hand injuries often occur in childhood. They arise as a result of active games, during physical education. The problem of early diagnosis of injuries in children is that the child often cannot specifically describe his feelings and evaluate them. Even with cracks and fractures, some babies do not complain of severe pain, and sometimes children cry for a long time from a slight bruise, greatly frightening their parents. It is better to play it safe and still contact a specialist so that the doctor examines the site of damage and, if necessary, prescribes additional diagnostics.

Tendon injuries of the hand

Tendons are characterized by increased elasticity and ability to stretch. When muscle tissue contracts, it is the tendon that pulls the bone along with it, providing active movement. With tendon injuries, motor activity is sharply limited – the patient cannot bend and unbend the hand. Complete tendon ruptures require surgery. It should be carried out in the first few hours after the injury.

Wrist bruises

The classic bruise of the soft tissues of the hand is very common in the practice of traumatologists. It is accompanied by reddening of the tissue, moderate soreness and swelling, local fever. and no serious treatment is required in this case. Specialists are limited to local anesthetics, which help to quickly relieve swelling and relieve pain.

If, in addition to a bruise, a violation of the integrity of tissues is detected, it is necessary to use antiseptics, and, if necessary, antibacterial agents. This will prevent the spread of infection. In some cases, it is required to immobilize the limb until the diagnosis is clarified.

The quality of primary antiseptic treatment directly affects the purity of infectious complications. Many patients do not pay attention to the need to decontaminate the injury site before meeting with a traumatologist. After treatment with an antiseptic and dressing, it is recommended to apply dry cold to reduce the risk of bleeding and the formation of a large hematoma.

Fractures of the bones of the hand

The share of fractures of the bones of the hand accounts for up to 30% of all injuries of the skeletal system. As a rule, the injury occurs in everyday life, when falling with an emphasis on the brush. There may be a fracture of the wrist, phalanges of the fingers or metacarpal bones. An accurate diagnosis can be established by the results of an X-ray examination. Most often, specialists encounter bone fractures as a result of accidental injuries or when heavy objects fall on the hand.

Fractures of the metacarpal bones are open and closed, with and without signs of displacement, multiple, single, intra-articular and extra-articular. They can be combined with damage to other structures of the hand. Medical tactics are selected individually, based on examination data, taking into account the general well-being of the patient, his age and the nature of the damage. Diagnosis of hand injuries includes taking an anamnesis and conducting certain diagnostic studies. During the examination and communication with the patient, the doctor finds out the approximate time of the injury, the patient’s complaints, determines the presence or absence of movement restrictions.

Dislocations of the hand

Dislocation in the wrist joint occurs mainly during falls with an emphasis on the hand or during a direct blow with a fist or a heavy object. Also, the injury occurs with a strong arching of the hand. After injury, the patient complains of sharp pain in the area of ​​the wrist joint. Visually, you can determine the pronounced swelling of the tissues and severe pain during palpation. Motor activity in the joint is sharply limited. If during the injury there was compression of the median nerve, then there will be a loss of sensitivity in the innervated zone.

First aid for bruises and other injuries of the hand

Immediately after the injury, the patient should make sure that he received a minor bruise and that no bones are visible at the site of the injury. The wound is washed with warm water and soap, gently dried and antiseptic treatment is carried out. Then you need to apply dry ice for 5-10 minutes. After this time, the hand must be examined again, check the activity of the fingers and the range of motion.

In case of damage to the hand with a violation of the integrity of the skin, it is necessary to apply a bandage from a sterile bandage. When properly applied, the bandage completely covers the damaged tissue, does not hinder movement and does not cause any pain. Make sure that the bandage does not squeeze the skin. If the tissues begin to turn blue, sensitivity decreases, this indicates that the bandage must be urgently loosened or replaced.

Dry ice should be applied every hour for 5-10 minutes. Usually this is enough to reduce pain and prevent the appearance of a hematoma. Intermittent cold therapy is effective for minor bruises and injuries. More serious injuries require specialist advice and a comprehensive examination.

The main tasks of the first emergency aid for injuries of the hand:

• limb immobilization to prevent the development of complications;
• stop bleeding from a wound;
• prophylactic antiseptic treatment;
• reduction of swelling, pain, signs of an inflammatory reaction.

Patients are not always able to give themselves first aid for hand injuries, especially if the wound is bleeding and there is a pronounced pain syndrome. If you cannot adequately assess the complexity of the situation and your condition, it is recommended that you immediately contact medical professionals. They themselves will carry out antiseptic treatment, relieve pain and, if necessary, use immobilization.

Treatment of hand injuries

Tactics of treatment for injuries of the hand is selected individually, depending on the degree of damage. Closed soft tissue injuries are treated on an outpatient basis, using special tight bandages that help with sprains and joint damage. Additionally, the use of warm compresses is recommended, but their use is prohibited in the first three days after injury (due to the risk of infection and bleeding).

To reduce pain, local remedies with anti-inflammatory and antiseptic properties are used. Cold is applied for 2-3 days, and after that you can use heat compresses on medical alcohol. It is allowed to apply warming ointments to injured tissues to quickly dissolve bruises and reduce pain.

In case of damage to the joints and bones, immobilizing and plaster bandages are used for a period of two weeks. A good therapeutic effect for hand injuries has physiotherapy, which includes various procedures: UHF, electrophoresis using a 10% calcium chloride solution or 0. 5% novocaine, diadynamic currents.

Patients with injuries of soft and hard tissues of the hand need to be examined by a qualified specialist. As a rule, it is enough to adhere to the general recommendations of a traumatologist in order to quickly recover. It is necessary to limit physical activity for the first 2 weeks, to protect the injured hand from negative external influences. The patient is prescribed cold, rest and elevated position of the limb. Often, for injuries, compression is used with elastic bandages, elastic bandages or splints. The first day the hand should be in an elevated position to ensure effective lymph circulation and prevent the occurrence of edema.

In the case of using a plaster cast, it is necessary to inspect the skin around the cast daily in order to detect areas with inflammation or discoloration of the tissues in time. If you notice cyanosis of the skin, you need to seek medical help to restore the normal blood supply to the tissues. If tissue areas with signs of an inflammatory reaction are found, it is recommended to use special lotions with anti-inflammatory and moisturizing effects.

Patients who suspect that they have a dislocation of the hand should immediately contact a traumatologist. The doctor will reposition the hand after high-quality anesthesia, and then fix the joint from the elbow to the base of the fingers with a plaster splint. If, even after reduction, the doctor determines the instability of the joint, additional fixation with Kirschner wires will have to be used. Compression of the median nerve requires surgery.

Rehabilitation after hand injuries

Rehabilitation is a mandatory step in the treatment of hand injuries. Rehabilitation measures may include physiotherapy techniques, massage, spa therapy, physiotherapy exercises, warming compresses, the use of therapeutic ointments. The effectiveness of rehabilitation depends on the motor activity and quality of life of the patient in the future. For the first months after the end of treatment, it is forbidden to expose the brush to increased physical exertion.

In our Clinic in Yaroslavl, you will be provided with the necessary assistance with hand injuries of any complexity. We are ready to answer all your questions and provide high-quality information support.

To ask questions or sign up for a consultation with a specialist, please call:
(4852) 37-00-85
Daily from 8:00 to 20:00

Injuries / tears / avulsions of the flexor and extensor tendons of the fingers – Hand injuries – Treatment and recovery

For the proper functioning of the hand, the coordinated work of the flexor and extensor tendons of the fingers is necessary. There are no muscles in the fingers, so their flexion and extension is realized due to the tendons of the muscles that are located on the forearm. The flexor tendons are located on the palmar surface of the hand, the extensor tendons are located on the back side directly under the skin. Each finger has two flexor tendons, superficial and deep. The deep flexor attaches to the nail phalanges and is responsible for bending them, while the superficial flexor attaches to the middle phalanges. Injuries to the flexors and extensors of the fingers are quite common due to the predominantly superficial location of the tendons. When the flexors of the fingers are injured, the end of the tendon located proximally is pulled, because of this it is very difficult to find the ends of the tendon when it breaks. When the extensor is injured, the tendon practically does not move, therefore, it is easier to treat.

Types of injuries

• Tears and avulsions of tendons
  Injuries to the flexors and extensors of the fingers of the hand are accompanied by a violation of their integrity with direct or indirect impact. In case of damage, a rupture and complete detachment of the tendon from its place of attachment to the bone fragment is possible.

  Injury Qualification:

  • Open and closed – depending on the violation of the integrity of the skin
  • Partial and complete – depending on the degree of damage
  • Fresh, stale and old – depending on the statute of limitations of the injury
  • Combined, isolated, and multiple – depending on the number of lesions
• Inflammatory processes
  • Tenosynovitis of the hand is an acute or chronic inflammation that occurs in the synovial membranes of the fibrous sheaths of the tendons of the muscles of the hand and fingers. Tendovaginitis is accompanied by a crunch during movements, a slight swelling along the affected tendon sheath
  • Tenosynovitis (or de Quervain’s disease) is a disease in which inflammation of the tendons of the thumb occurs. The pain associated with this ailment arises from the friction of the swollen tendons against the walls of the tunnel intended for their movement, at the base of the thumb and under it, as well as along the edge of the wrist joint. It is manifested by aching pain in the wrist area.
  • Knott’s disease (trigger finger, spring finger) is a disease of the flexor tendons of the fingers and the surrounding ligaments, the characteristic feature of which is a clicking that occurs when the fingers move. As the disease progresses, finger extension becomes almost impossible.

Symptoms

With ruptures or separations, the following symptoms are observed:

• If the tendons on the palmar surface of the hand or fingers are damaged, there is a violation of the flexion function, due to which the fingers are in an overextended state
• Injuries to the dorsum of the hand impair the extension function of one or more fingers
• Finger numbness and other sensory disturbances (with nerve damage)
• Finger deformity
• Edema
• Hemorrhage
• Tendon injury
• Visible soft tissue injury (open injury)

Which doctor to contact

• Traumatologist-orthopedist
• Surgeon

Diagnostics

• Detailed examination by a traumatologist of the injury site, diagnostic tests (flexion-extension of the fingers in one sequence or another)
• X-ray of fingers
• Ultrasound examination (ultrasound)
• Magnetic resonance imaging

Treatment

With damage to the extensor, two treatment options are possible: conservative and surgical. Damage at the level of the fingers can be cured without surgery, but subject to prolonged wearing of a cast or plastic splint. In all other cases, as well as with injuries of the flexor tendons, surgical treatment is indicated. The operation is a complex surgical intervention, often using microsurgical techniques. It consists in dissecting the skin and suturing the ends of the torn tendon under local or conduction anesthesia. In the postoperative period, the arm is necessarily fixed with a plaster cast.

When the ends of the tendons are crushed or torn, they are excised. In order to avoid postoperative flexion contracture, operations are performed to lengthen the tendon in the tendon-muscular part or its Z-shaped lengthening proximal to the area of ​​damage.

In some cases, with chronic injuries of the flexor tendons of the fingers (the presence of tendon defects 2 or more centimeters long), the patient is shown tendon plasty, or plasty with preliminary formation of the tendon canal using temporary tendon arthroplasty with a silicone endoprosthesis.