Evaluation of Occupational Crush Fractures of the Hand and Time Off Work

Occupational injuries of the hand are a major cause of disability. This study analyzes crush injury fractures of the hand and resultant time off work at a Level I Trauma Center in Providence, Rhode Island.

Adult patients presenting to the emergency department with acute fractures to the metacarpals or phalanges following occupational hand crush injuries between July 2011 and June 2023 were retrospectively identified. Patients were evaluated for demographic variables, injury patterns, treatment, and time to return to work (RTW). Bivariate and multivariate regression analyses assessed RTW in relation to covariates with a significance level set at <0.05.

One hundred and thirty-five (135) patients met study criteria, of which the mean age of presentation was 42.4. Almost all patients were engaged in manual labor (n = 123, 91.1%); 78.5% of injuries were open fractures (n = 106), 20.0% were intra-articular (n = 27) and 54.8% were comminuted (n = 74). Amputation injury occurred in 30.4% (n = 41) of cases. One-third, (n = 45, 33.3%) required surgery. The median RTW was 67.5 days post- injury. Regression analysis demonstrated that Hispanic/ Latino ethnicity, increased age, intra-articular fractures and middle phalanx and metacarpal fractures were significantly associated with longer RTW.

Occupational hand crush fractures are associated with considerable time off work, with a median of 67.5 days demonstrated in our cohort. Several factors may be associated with prolonged RTW, including older age and more complex injury patterns. These findings underscore the importance of providing equitable care to facilitate timely RTW.