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Hand Injury and A & E

Traumatic Hand Injuries: The Emergency Clinician's Evidence-Based Approach (Trauma CME)

The hand is a complex and dynamic structure that balances form and function. To many, the hand is a highly versatile tool used to interact with the surrounding world. To others, it is an instrument of expression and beauty. It is this dual purpose that makes the hand arguably one of our most important body parts and, perhaps second only to the face, the most representative of humanity.

Because of the hand’s constant utility, it is no surprise that traumatic hand injuries are encountered on nearly every shift in a busy emergency department (A&E). It is estimated that, depending on the setting, 5% to 30% of all injuries presenting to the A&E involve the hand (40% of home and work injuries and 15% to 20% of leisure and motor vehicle injuries).1,2 Presumably due to higher rates of machine-related jobs as well as higher risk-taking behavior, the male-to-female ratio of hand injuries is 1.7:1, and about 60% of all patients presenting with traumatic hand injuries are between 16 and 32 years of age.3 While mortality from isolated hand injuries is exceedingly rare, morbidity and loss of productivity is a major concern. Lacerations to the fingers ranks third among reasons for lost workdays in the United States, In the UK 80% of all LTI's are due to hand injury

Clearly, hand injuries as a whole contribute significantly to unemployment and loss of productive work hours.

Hand trauma presents with such a wide variety of conditions with differing outcomes that a commanding knowledge of hand trauma and anatomy is essential to any practicing emergency clinician. While most patients will require minimal treatment, emergency clinicians must be able to correctly identify conditions that threaten long-term hand function and those that require specialty consultation or surgical repair.