[Emergency services for the hand: a necessity]

Every year in France there are 500,000 hand injuries; the number of injuries has remained constant over the last ten years and constitutes one-third of all work-related accidents. At the emergency department for hand surgery from Nancy University Hospital the treatment of hand injuries is the third part of the global activity. There have been significant advancements in the field of hand surgery in the last twenty years due to development of microsurgical techniques which make it possible to revascularize tissue that otherwise would die. Surgeons who treat hand injuries usually have been trained in the fields of orthopedics, traumatology, plastic surgery, and microsurgery. The improved results--attributable to new techniques and early treatment--pointed to the need for organizing emergency services for hand injuries that would operate on a 24-hour basis. In 1979, a group of French surgeons founded the Federation of Emergency Treatment of Hand Injuries that today represents 27 centers in France and 19 others in countries of the European Community. These emergency wards work in conjunction with other centers dealing with emergency service, e.g., the Fire Department, Ambulance service, Industrial Medicine, etc... Over a period of 15 years, the benefits reaped from treating these injuries as true emergencies (less than 6 hours ischemia) based on the principle of Immediate Repair with Early Mobilization (IREM) are both functional and social in nature: in 90% of cases, the patient resumes professional and economic activity and the rate of partial disability is 30% lower than that observed in cases treated in non-specialized centers. Given these results that are acknowledged by all who work in emergency service in general, we think that emergency wards for hand injuries should be an integral part of the overall plan coordinating emergency services in France.