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Missed injuries in the acutely traumatised hand
C M Morrison1, N W Thompson, K J Herbert
1The Northern Ireland Plastic and Maxillofacial Service, The Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast BT16 1RH.
The Ulster Medical Journal
|July 19, 2003
Summary
Missed acute hand injuries are uncommon, with 3.2% of patients experiencing delayed diagnosis. Early and thorough clinical examination is crucial for preventing these missed injuries.
Area of Science:
- Orthopedics
- Trauma Surgery
- Emergency Medicine
Background:
- Acute hand injuries frequently present to emergency departments.
- Accurate and timely diagnosis is critical for effective management and patient outcomes.
- Missed injuries can lead to prolonged recovery, complications, and patient dissatisfaction.
Purpose of the Study:
- To determine the incidence of missed injuries among patients with acute hand trauma.
- To identify the types and mechanisms of missed hand injuries.
- To evaluate the time to detection for missed hand injuries.
Main Methods:
- Prospective study of 500 consecutive patients with acute hand injuries.
- Patients referred from accident and emergency departments in Northern Ireland.
- Definition of a 'missed injury' included inappropriate treatment or return due to persistent symptoms.
Main Results:
- A total of 16 missed injuries (3.2%) were identified.
- Missed injuries included tendon injuries (7), isolated nerve injuries (4), and mixed tendon/nerve injuries (4).
- One case involved a ruptured ulnar collateral ligament; 13 were open injuries, most commonly from glass lacerations.
Conclusions:
- Missed hand injuries are uncommon but do occur in Northern Ireland.
- Thorough clinical examination and accurate documentation are essential for preventing missed injuries.
- Timely detection of missed injuries averaged 11 days.