D. S. Urias1, E. Lotton1, K. Shayesteh1 1Conemaugh Memorial Medical Center,Surgery,Johnstown, PA, USA
Introduction:
Hand fractures are the second most common fracture in the upper extremity and can be missed in the setting of life threatening injuries. These fractures contribute to a loss in millions of dollars in days off work and billions in healthcare annually. The associated loss of function/pain, and high estimated health care/productivity costs have encouraged us to investigate fracture patterns of the hand in the trauma population to determine if a link was present. Thus help trauma services decrease morbidity by decreasing the time to intervention and decrease the economic burden.
Methods:
We conducted a retrospective, observational study, at Duke Life Point-Conemaugh Memorial Medical Center a rural Level 1 Trauma center in Johnstown, PA, to investigate the mechanism, patterns of injury and management for fractures of the phalanges/metacarpals encountered in trauma patients. The study period was January 2011 – October 2014 and included all patients evaluated and admitted by the trauma department with hand fractures.
Results:
During the four year period, 4,378 trauma patients were evaluated and admitted, of which 2% experienced 107 fractures of the hand. The most common mechanism of injury was motor vehicle accident (MVA) occurring 59% of the time. Metacarpal fractures accounted for the majority of the fractures at 61% with phalangeal fractures accounting for 39%. The little metacarpal was the most commonly fractured bone contributing to 21% of all fractures. When categorized by mechanism of injury the most common fracture for those involved in an MVA was the little metacarpal at 22% and the thumb metacarpal was the second most common at 19%.
Conclusion:
The fracture pattern identified in our study is an adjunct to the National Hospital Ambulatory Medical Care Survey of 1998 of all emergency room visits, where they reported on both hand and forearm fractures. They found falls to be the most common mechanism at 47% (MVA ranked fourth at 7%), with the metacarpals accounting for 18% of all hand and forearm fractures. Thus, our study provides additional data for evaluating the trauma patient in the acute setting to decrease the likelihood of missed injuries.