Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 1  |  Page : 8-11

Pattern of hand injuries seen in the accident and emergency unit of an urban orthopedic hospital


1 Department of Clinical Services, National Orthopaedic Hospital, Dala Kano, Nigeria
2 Department of Surgery, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Osun State, Nigeria

Date of Web Publication8-Oct-2015

Correspondence Address:
Ochuko Rex Dafiewhare
Department of Clinical Services, National Orthopaedic Hospital Dala, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0794-9316.166853

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  Abstract 

Background: The development of hand surgery in our subregion is still very much in its infancy. At the national level, very little documentation exists on the patterns of hand injuries. This study was aimed at determining the patterns of hand injuries seen in an urban orthopedic hospital in Kano, Kano State, Nigeria.
Patients and Methods: A retrospective study of 101 cases of hand injuries presenting between April 2009 and April 2010 in the accident and emergency unit was carried out.
Results: There were 86 (85.1%) and 15 (14.9%) males and females, respectively. The mean age of the patients was 25.69 ± 14.04 years. Out of all the patients, 55.4% were presented within 6 h of injury. Traumatic amputations and fractures were the commonest types of injury. There was no significant difference between left and right hand involvement in injuries. The triad of occupational injuries, injuries from road accidents, and domestic accidents was the most common. Traditional bone setters played very little role in the prehospital management of injuries.
Conclusion: Occupational hand injuries are most common among young working males. Early presentation of the patients and low involvement of traditional bone setters reflect the severity of hand injuries to victims.

Keywords: Occupational hand injuries, hand, hand injuries, traditional bone setters


How to cite this article:
Dafiewhare OR, Ajibade A. Pattern of hand injuries seen in the accident and emergency unit of an urban orthopedic hospital. Nigerian J Plast Surg 2015;11:8-11

How to cite this URL:
Dafiewhare OR, Ajibade A. Pattern of hand injuries seen in the accident and emergency unit of an urban orthopedic hospital. Nigerian J Plast Surg [serial online] 2015 [cited 2019 Aug 19];11:8-11. Available from: http://www.njps.org/text.asp?2015/11/1/8/166853


  Introduction Top


Hand injuries remain an aspect of surgery that continues to be managed by practitioners in different specialties and many times by general practitioners. The gray areas in our surgical practice are result of the very little exposure of medical students in training at undergraduate level to hand surgery. The absence of adequate systematic documentation of the patient in the accident and emergency rooms is another reason. The development of hand surgery in our subregion is still very much in its infancy with most of the specialized care being provided by plastic and orthopedic surgeons with “interest” in hand surgery. Very little is documented about the epidemiology of hand injuries at the national level. This study was aimed at determining the pattern of hand injuries seen in an urban orthopedic hospital in Kano, Kano State, Nigeria. This study will serve as a springboard to appreciate how these injuries are happening around us and kindle greater interest in this field of surgery.


  Patients and Methods Top


A retrospective collection of data on patients who presented to the accident and emergency unit between April 2009 and April 2010 was done. The hand was defined as the part of the upper extremity distal to the wrist. Patients with wrist and hand injuries with incomplete documentation were excluded.

Data were collected on the following variables: Age, gender, duration of injury before presentation, etiology, side effects, traditional bone setter intervention, diagnosis, and treatment. Univariate analysis was done with Epi Info Version 3.5.1 (August 2008) (Centers for Disease Control and Prevention, Atlanta, GA, USA) If the distribution was normal, the measures of central tendency and dispersion were mean ± standard deviation but if it was skewed, the measures were mean (range).


  Results Top


One hundred and five patients with hand injuries presented to the accident and emergency unit during the study period. Four of them were excluded because of incomplete information, leaving 101 patients. There were 86 (85.1%) males and 15 (14.9%) females (male-to-female ratio = 5.7:1). The mean age of the patients was 25.69 ± 14.04 years. The age distribution is shown in [Figure 1]. The median duration of injury before presentation ranges from 30 min to 672 h; in our case, it was 5 h. The number of patients who presented within 6 h, 24 h, 48 h, and 72 h of injury were 56 (55.4%), 85 (84.2%), 89 (88.1%), and 91 (90.1%), respectively.
Figure 1: Age distribution of patients

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The right and left hands were equally injured, with 50 (49.5%) injuries to each hand. One patient sustained extensor tendon injury in both hands. Only three (3.0%) patients had prehospital intervention by traditional bone setters. The triad of occupational injuries, injuries from road traffic crash, and domestic injuries was the most common [Table 1]. With respect to occupational injuries, 20 left hands and 24 right hands where affected. 42 of the accidents occurred within manufacturing industries. Open fractures and traumatic amputation were commonly diagnosed in the injured patients [Table 2]. Two of the traumatic amputations were subtotal.
Table 1: Etiology of hand injuries

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Table 2: Diagnosis of 101 hand injuries (type of injury)

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Treatment offered included debridement, reduction of the dislocations, Kirschner wire fixation of the fractures, primary or delayed tendon and nerve repair, suturing of the laceration, refashioning of traumatic amputation, and surgical amputation. The indications and etiology in the 31 patients who had amputation (including refashioning) are shown in [Table 3] and [Table 4], respectively.
Table 3: Indications for amputation/refashioning

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Table 4: Etiology of hand injuries in patients who had amputation/refashioning

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  Discussion Top


Hand injury is the most common type of injury occurring in an accident. Occupational injuries, injuries in road traffic accidents, and domestic injuries were the three most common types of hand injuries accounting for a total of 88.1%. The industrial workplace remains the commonest place for hand injuries to occur.[1],[2],[3] A great part of many production lines still depends on manually performed tasks with an ever present risk of injuries occurring. We found road traffic accidents to be more common in the etiology of hand injures in our region than domestic accidents.[4],[5] Domestic accidents and injuries from leisure activities tend to be less severe and even though accounting for larger number of cases in some studies,[6],[7],[8] they do not feature significantly in our study because our center is a referral one and usually only more severe injuries are presented on referral to us.[1],[3]

Injuries occurring between 20 years and 39 years constituted majority of our study population. In this young active population that constitutes the greater workforce, hand injuries are the commonest. They are more adventurous and are more likely to take physical risks. They also form the lower cadre staffing by virtue of work experience and, therefore, are more likely to be assigned the most physical and often high-risk jobs. Aged workers are more likely to have more supervisory or managerial jobs. The lower work experience of the young population may also contribute to their vulnerability to work-related accidents.[2],[5],[9],[10]

Occupational hand injuries usually occur in male workers worldwide.[10],[11],[12],[13] We observed a male-to-female ratio of 5.7:1. This is comparable to the ratios 7:1 and 8.5:1 reported by Ahmed [5] in Ethiopia and Serinken [14]et al., respectively, in Turkey. Lower values of 3:1 observed by Sorock et al.[10] reflects a more Western work environment where more women are involved in industrial occupations. In Nigeria, women still constitute only a very small part of the workforce. This is much more evident in the industrial workplace where they are virtually absent. The deeply conservative lifestyle further limits the movement of women and, therefore, they are also far less likely to have injuries from road traffic accidents. Females are more likely to have injuries relating to domestic chores. Traditionally, in our setting, managing the home is the duty of the woman who does most of the household chores herself.

There was no significant difference between left and right hand involvement in injuries.[1] Most manual jobs require the use of both hands at the same time, making the chances of injury fairly equal for both the hands. We were not able to demonstrate the relationship between hand dominance and injury side due to inconsistent documentation.[2],[9] This highlights the need to develop the practice of proper documentation with regard to hand injuries and encourage further interest in this subspecialty.

A majority of patients presented early following trauma. We regard 84.2% presenting within 24 h and 90.1% presenting within 72 h as early because many of our patients are referred from other centers after receiving initial basic care. Significant hand injuries leave little place for second guessing and patients presenting in peripheral hospitals are likely to be referred early. Daily wage earners are most affected by hand injuries for whom prompt early presentation is necessary.

Traditional bone setters were involved in the initial care of only three patients (3%) in this study. These cases were associated with delayed presentation at the accident and emergency unit. Hand injury is not typically treated by this group of caregivers. The complexity of the anatomy of the hand and its tendency to very poor outcomes in nonspecialized management has probably made it unattractive to them. Traditional bone setters have been known to be very involved in the management of fractures of the limbs.[15],[16]

Traumatic amputations and fractures were the commonest type of injuries.[3],[5],[9] One-third of the patients (54.8%) had occupational injuries; they require amputation for refashioning of severely injured hands. The relative importance of occupational injuries is similar to the finding of O'Sullivan and Colville.[17] The consequent disability with its social implications for the affected families underscores the need for proper training of workers and enforcement of safety consciousness in the workplace. Minor cases are rare. Simple lacerations accounted for only 4% as the hospital is a referral center and such cases would likely be managed in peripheral centers.


  Conclusion Top


The triad of occupational injuries, injuries in road traffic accidents, and domestic accidents, occurring mainly in the third and fourth decades of life, were the commonest causes of hand injuries. Early presentation of patients and the unlikely prehospital involvement of traditional bone setters reflect the great importance attached to the hand. Promotion of safety measures in the workplace and homes and prevention of road traffic crashes would help in reducing the incidence of hand injuries. Introducing courses on the treatment of hand injury among undergraduate and postgraduate medical students, and encouraging them to take up sub-specialization in this area will increase the skill level of the potential care providers.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflict of interest.

 
  References Top

1.
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2.
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3.
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Ahmed E. The management outcome of acute hand injury in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. East Cent Afr J Surg 2010;15:48-56.  Back to cited text no. 5
    
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Rosberg HE, Dahlin LB. Epidermiology of hand injuries in a middle-sized city in southern Sweden: A retrospective comparison of 1989 and 1997. Scand J Plas Reconstr Surg Hand Surg 2004;38:347-55.  Back to cited text no. 7
    
8.
Larsen CF, Mulder S, Johansen AM, Stam C. The epidemiology of hand injuries in The Netherlands and Denmark. Eur J Epidermiol 2004;19:323-7.  Back to cited text no. 8
    
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Adigun IA, Ogundipe KO, Aderibigbe AO. Pattern of hand injuries in a teaching hospital of a developing country: A three year review of cases. Int J Hand Surg 2006;1.  Back to cited text no. 9
    
10.
Sorock GS, Lombardi DA, Hauser RB, Eisen EA, Herrick RF, Mittleman MA. Acute traumatic occupational hand injuries: Type, location, and severity. J Occup Environ Med 2002;44:345-51.  Back to cited text no. 10
    
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Packer GJ, Shaheen MA. Patterns of hand fractures and dislocations in a district general hospital. J Hand Surg Br 1993;18:511-4.  Back to cited text no. 11
    
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Skov O. The incidence of hospital-treated occupational hand injuries. J Hand Surg Br 1994;19:118-9.  Back to cited text no. 12
    
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Hill C, Riaz M, Mozzam A, Brennen MD. A regional audit of hand and wrist injuries. A study of 4873 injuries. J Hand Surg Br 1998;23:196-200.  Back to cited text no. 13
    
14.
Serinken M, Karcioglu O, Sener S. Occupational hand injuries treated at a tertiary care facility in western Turkey. Ind Health 2008;46:239-46.  Back to cited text no. 14
    
15.
Olaolorun DA, Oladiran IO, Adeniran A. Complications of fracture treatment by traditional bonesetters in southwest Nigeria. Fam Pract 2001;18:635-7.  Back to cited text no. 15
    
16.
Nwadiaro HC, Nwadiaro PO, Kidmas AT. Ozoilo KN. Outcome of traditional bone setting in the middle belt of Nigeria. njsr 2006;8:44-8.  Back to cited text no. 16
    
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O'Sullivan ME, Colville J. The economic impact of hand injuries. J Hand Surg Br 1993;18:395-8.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Patients and Methods
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