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Explosions are responsible for severe hand injuries. Due to their extremely important functional role, lesions of the thumb and first commissure must be identified separately during assessment of the lesions. No classification of these injuries has been proposed since the one defined by Mac Gregor and Jackson. Based on their experience of 11 injuries, the authors propose a classification divided into four stages of increasing severity. In the emergency situation, the severe forms with disruption of the blood supply have a very poor prognosis. In the other forms, the degree of opening of the first commissure is of fundamental importance. Secondarily, the functional prognosis of the hand is dominated by retraction of the first commissure, ankylosis of the trapezo-metacarpal joint or its preservation during amputations.

The authors have transferred the posterior part of the deltoid muscle to the triceps in 21 tetraplegics. A modification of Moberg's technique has been employed utilising a strip of fascia lata reinforced by Dacron sutures to allow rehabilitation after only 3 weeks. Despite limited active extension of the elbow and diminished power, results were considered to be satisfactory by the patients. They benefited from a greater range of movement of the hand, an improved possibility of bearing weight, improvement in the use of wheelchairs and better ability to express their bladder.