Journal of Plastic, Reconstructive & Aesthetic Surgery
Analysis of 1430 hand fractures and identifying the ‘Red Flags’ for cases requiring surgery
Introduction
Hand fractures constitute 20% of hand injury patients who apply to emergency services.1 The human hand is a highly specialized and complex organ that needs individualized treatment protocols. For a patient to sustain his/her life without any compromise after a hand injury, the application of an appropriate treatment protocol is essential.
In the treatment of hand fractures, two main principles are imperative: 1) Reducing the fracture and 2) Stabilising the fracture in the reduced state.2 If these two principles are applied, surgically or not, well vascularized long bones of the hand will heal predictably. Conservative approaches are satisfactory in the majority of the cases.3,4 However, for selected cases, surgery should be performed. K-wires, regular plates, screws, cerclage wiring, intramedullary pinning, external fixators and sutures can be used for surgical treatment of hand fractures. The common purpose of all of these devices is to fixate reduced fracture segments and stabilise the fracture line during the recovery period.
Although the ‘reduce & stabilise’ principle is of essence during fracture treatment, a decision between treating with surgical and conservative approaches still needs to be made. For hand fractures, components that make up the injury can have endless combinations, and creating a guideline with strict principles for each injury is unfeasible. Yet, there are some indicators or ‘red flags’, which usually indicate the need for surgical treatment. Cheah and Yao reported that comminuted and spiral fractures, fractures with rotational deformities, excessive angulation and shortening should be considered for surgery.5 However, further studies are needed. The aims of the study are 1) to make a detailed descriptive analysis of injuries of patients presenting with hand fractures, 2) to determine the variables effective on the decision for surgery by retrospective questioning of the indications of the performed surgeries and 3) to present our departmental consensus on hand fracture treatment based on our experience.
Section snippets
Patients/Methods
After permission from the Local Ethics Committee (application number: E20–272), patients treated for metacarpal and phalangeal fractures at our institution between January 2015 and December 2019 were retrospectively reviewed. Patients with records lacking treatment details and plain radiographs, finger replantations and multi-trauma patients (e.g. cerebral haemorrhage and acute abdomen) were excluded.
Patient gender, age, finger/fingers involved in the injury, accompanying soft tissue injury,
Results
The study involved 1430 fractures of 1303 patients. Of 1303 patients, 1016 were male (77%) and 287 were female patients (23%). Age-based analysis showed 57% of all fractures were diagnosed in patients aged between 18 and 55 years (yrs). Preschool children (≤6 yrs, 4.5%) and geriatric patients (≥71 yrs, 2.1%) faceless hand fractures than other age groups (Table 1). Ninety-three percent of fractures occurred in single digits, and the remainder had multiple-digit involvement (Table 2). The fifth
Discussion
Hand injuries have physical, social and psychological effects on patients.7 Social and psychological effects may even be beyond the physical impairment.8 Successful treatment of hand injuries has a primary role in patient's returning to daily activities. This can only be achieved with a treatment plan developed after the evaluation of the patient in all aspects. The first and most important decision to be made during the planning of the treatment is whether to perform surgery.
Both in the
Declaration of Competing Interest
None of the authors have a financial interest in any of the products, devices or drugs mentioned in this manuscript. No funding was received for this article.
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None of the authors have a financial interest in any of the products, devices or drugs mentioned in this manuscript. No funding was received for this article.