Review of catastrophic hand diagnosis over 15 years in a tertiary hospital: Do we make proper use of the term?

Abstract

ObjectiveTo describe the characteristics of patients diagnosed with ‘catastrophic hand’ by the plastic surgery department in a tertiary hospital in the period between 2000–2015, analyse the evolution of the use of the term ‘catastrophic hand’ and conduct a review of the literature with a view to proposing the optimal definition for said expression. Material and methodWe conducted a descriptive and retrospective study of patients diagnosed with ‘catastrophic hand’ who required hospital care by the plastic surgery department of a tertiary hospital in the period between 2000–2015. We conducted a literature review on the use of the term ‘catastrophic hand’ and we applied the classifications proposed in the publications consulted to our results. ResultsThe number of ‘catastrophic hand’ diagnoses was 133. We observed a downward trend in the use of the term over the years. Applying classifications based on the impossibility of recovery of an acceptable hand (presence of three long fingers and thumb) by reconstructive procedures, only 9 out of 133 patients could be considered to have ‘catastrophic hands’, constituting 6.7% of the total cases. DiscussionThe term ‘catastrophic hand’ has different meanings, and this generates ambiguity. The use of a classification based on the possibility of obtaining an acceptable hand diminishes its use and improves the approach for such injuries. ConclusionWe advocate limiting the use of ‘catastrophic hand’ to cases that meet criteria of ‘mutilated hand’ and ‘metacarpal hand’ to avoid indiscriminate use of the term and optimise therapeutic management.