The Reason Matters: Deep Wrist Injury Patterns Differ with Intentionality (Accident versus Suicide Attempt)

Area of Science:

• Trauma Surgery
• Hand Surgery
• Forensic Medicine

Background:

• Deep wrist injuries (DWIs) are clinically significant.
• Distinguishing injury patterns between suicidal and accidental DWIs is crucial but not well-established.

Purpose of the Study:

• To investigate and compare the injury patterns of suicidal versus accidental deep wrist injuries.
• To identify specific anatomical structures and injury characteristics associated with intentional self-harm wrist injuries.

Main Methods:

• Retrospective analysis of patients treated for acute DWIs between 2008 and 2016.
• Exclusion of isolated palmaris longus (PL) injuries and amputations.
• Determination of injury intentionality through psychiatric evaluation documentation.

Main Results:

• Approximately 20% of DWIs were from suicide attempts, predominantly on the nondominant hand (94.5%).
• Suicidal DWIs more frequently involved the median nerve, radial artery, PL, and flexor carpi radialis (FCR), particularly on the nondominant side.
• Accidental injuries were more associated with the ulnar artery and nerve on the dominant hand; FCR integrity showed an inverse relationship with radial artery injury in suicidal cases.

Conclusions:

• Suicidal and accidental DWIs exhibit significantly different injury patterns.
• Suicidal injuries are typically located on the nondominant radial side, whereas accidental injuries favor the ulnar side.
• Findings underscore that injury patterns from accidental DWIs cannot be extrapolated to suicidal injuries, necessitating distinct clinical assessment approaches.