Spectrum of hand injuries and their management at a tertiary care hospital using the hand injury scoring system

Abstract

Background: Hand injuries are a major health problem all around the world; both in developing as well as developed countries. There are various causes of hand injuries which include occupational injuries, leisure activities, road traffic accidents, falls and other domestic injuries. The aim of the present study was to create a database of hand injury patterns in PIMS for assessing and scoring the severity of hand injury. Methods: This was a descriptive study that analyzed 442 hand injuries that presented to the department of emergency services and the out-patient departments of plastic and general surgery in the PIMS, Puducherry, India. The demographics of the hand injuries have been analyzed and studied. Scoring of the hand injuries has been done by the hand injury severity scoring system (HISS).The management that was carried out for these patients has been documented and recorded. Results: A total 442 patients were included in the study. Among them 379 (85.75%) cases were male and 63 (14.25%) patients were female. Female subjects were more commonly affected in two age groups (1-15, 45-60). The distribution of the nature and etiology of injuries in both genders was similar, Occupational and crush injuries being the dominant mode of injury in both genders. 237 (53.6%) patients sustained injuries to their dominant hand, while 205 (46.4%) sustained injuries to their non-dominant hand. 31.09% of dominant hand injuries were found to be mild in severity. 28.43% of non-dominant hand injuries were found to be major in severity. There was an even distribution of injuries between severity scores among all the patients. The duration of hospital stay was increased with severity of hand injury. 221 (50%) patients followed up for less than one month following their hand injuries whereas 69 (15.61%) cases were lost to follow up. Among the followed up patients, 126 (74.12%) subjects said they were normal at follow up and 44 (25.88%) said they had some residual impairment following their hand injuries. Of them, daily activities of 33 patients were affected depending upon the severity of injury. 409 (92.53%) patients required some form of surgical treatment, whereas 33 (7.47%) patients required only conservative treatment for their hand injuries. Conclusions: HISS presented to be the important system for assigning the patients according to the score, in directing the patients to the precise management and seems to be popular for excellent functional outcome.