Hand injury without any deficit: Is systematic surgical exploration justified?

Area of Science:

• Orthopedics
• Trauma Surgery
• Hand Surgery

Background:

• Hand wounds are common, affecting 700-4000 per 100,000 people annually.
• Clinical examination may not detect all underlying major structure damage in hand wounds.
• Undetected damage can lead to significant functional deficits.

Purpose of the Study:

• To determine the incidence of major structure damage in hand wounds with no apparent clinical deficit.
• To assess the reliability of clinical examination in diagnosing hand wound injuries.

Main Methods:

• Prospective study of patients over 12 years old with hand wounds deeper than the dermis.
• Patients underwent surgical exploration under regional anesthesia if no clinical deficit was observed.
• Surgeons completed anonymous forms detailing wound characteristics and identified major structure damage.

Main Results:

• Out of 145 clinically normal hand wounds, 58.6% showed evidence of major structure damage upon surgical exploration.
• This highlights a high rate of occult injuries in seemingly minor hand wounds.

Conclusions:

• Clinical examination by a hand surgeon is insufficient to rule out major structure damage.
• Systematic surgical exploration of all hand wounds, regardless of initial clinical findings, is recommended.
• This approach aims to prevent potential functional sequelae from undetected injuries.