Clinical analysis of 1301 children with hand and foot fractures and growth plate injuries.

BACKGROUND: Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment. METHODS: We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed. RESULTS: Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet. CONCLUSIONS: In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.

Comprehensive analysis of power tool injuries: implications for safety and injury prevention.

BACKGROUND: Power tools are essential for productivity but carry significant injury risks. Addressing power tool injuries across diverse age groups is vital, as existing research predominantly focuses on specific occupational or non-occupational groups, leaving a gap in understanding various age cohorts within the diverse American population. This study aims to comprehend power tool injury epidemiology, raising awareness about the importance of targeted safety measures for enhancing public health. METHODS: Using a ten-year retrospective approach, this study analyzed National Electronic Injury Surveillance System (NEISS) data from US hospital emergency departments (2013-2022). Demographic and temporal trends were examined, and associations between injury occurrence and categorical variables, including injured body parts, gender, and race, were explored. RESULTS: In 2013, power tool injuries were highest in the "51-60″ age group (23.70 %), followed by "41-50″ (17.31 %) and "61-70″ (19.38 %). Injury rates varied across age groups over the years. Notably, the "41-50″ age group showed a significant decrease in injuries over time (χ² = 17.12, p < .05), indicating a notable temporal trend. Hand injuries were predominant (39.08 %), followed by finger (19.19 %), lower arm (11.25 %), upper arm (8.79 %), and face (4.04 %). Lacerations constituted the most frequent injury type (60.89 %), alongside fractures, amputations, foreign body insertions, and contusions/abrasions. Significant associations emerged between injury occurrence and gender (χ² = 6.19, p < .001), as well as race (χ² = 7.42, p < .001). Males accounted for the majority of injuries (95.97 %), while white individuals constituted the largest proportion (91.84 %). Females and domestic settings exhibited increasing proportions of power tool injuries. CONCLUSIONS: The higher incidence among middle-aged individuals in domestic settings, coupled with evolving gender dynamics, underscores the need for targeted safety measures. Our findings contribute crucial novel insights, emphasizing tailored preventive strategies to enhance safety outcomes in the multifaceted landscape of power tool use.

[Psychosocial repercussions of hand injuries and support for patients]. / Répercussions psychosociales des accidents de la main et accompagnement des patients.

PSYCHOSOCIAL REPERCUSSIONS OF HAND INJURIES AND SUPUPORT FOR PATIENTS. There are many nonmedical factors influencing a patient's return to work. To optimize care, the practitioner must be aware of the need to go beyond the scope of their own specialty. In particular, they must be able to identify patients with psychological comorbidity and/or chronic pain, in order to direct them as early as possible towards appropriate care. They must also pay particular attention to administrative requests whether these come from the patient themselves or from their insurers. Last but not least, the decompartmentalization of professional practices and the improvement of communication between the stakeholders are essential, although very complex to implement. In the Île-de-France and Centre regions of France, two associations offer support that meets all these best practices.

RÉPERCUSSIONS PSYCHOSOCIALES DES ACCIDENTS DE LA MAIN ET ACCOMPAGNEMENT DES PATIENTS. Il existe de nombreux facteurs autres que médicaux influençant le retour à l'emploi des patients. Afin d'optimiser la prise en charge, le soignant doit avoir en tête qu'il est nécessaire de sortir du champ de sa spécialité. Il doit notamment être capable d'identifier les patients présentant une comorbidité psychique et/ou des douleurs chroniques afin de les orienter au plus tôt vers une prise en charge adaptée. Il doit également porter une attention toute particulière aux demandes administratives, qu'elles émanent du patient lui-même ou de ses assurances. Enfin, il est primordial, bien que très complexe à mettre en oeuvre, de décloisonner les pratiques professionnelles et d'améliorer la communication entre les acteurs. En Île-de-France et en région Centre, deux associations proposent un accompagnement répondant à l'ensemble de ces bonnes pratiques.

HOW TO PREVENT HAND INJURIES - REVIEW OF EPIDEMIOLOGICAL DATA IS THE FIRST STEP IN HEALTH CARE MANAGEMENT.

BACKGROUND: Hand injuries are common affecting all ages, genders, and geographic regions. They can result in long term disability and mortality, while they place a significant financial burden in society. Although, hand injuries can be prevented. Preventive strategies can be designed, but knowledge of injuries' epidemiological characteristics is required beforehand. METHODS: We performed a review of the current literature related to hand injuries to identify their incidence, patients' demographics, type, mode, and time of the injury. RESULTS: Hand injuries constitute 6.6% to 28.6% of all injuries presenting to the Emergency Department and 28% of injuries to the musculoskeletal system. They mainly affect young male labourers. Occupational and home accidents are the commonest injury modalities, while traffic road accidents constitute a significant reason for hand injuries as well. Lacerations account for most hand injuries, followed by crush injuries, fractures and amputations. Most occupational injuries occur in the beginning of the week and especially during the morning shift, while there has been identified an increase in the number of hand injuries during the summer months. CONCLUSIONS: Hand injuries are an important health problem with impact on patient's life and on the society. Although they can be prevented. Preventive strategies need to be addressed towards many directions and people's activities, since prevention will have an important impact on people's quality of life and society's well-being.

Epidemiology of adult hand injuries presenting to a tertiary hand surgery unit: a review of 4216 cases.

This study investigates the pattern of hand injuries presenting to a UK regional tertiary centre. All referrals to our Hand Surgery Unit in 2019 were reviewed. Subgroup analyses of sex, deprivation, occupational injuries and assault cases were carried out. Over the study period, 4216 cases were referred. Most were male (70%), with a median age of 36 years and from a deprived area (75.2%). Soft tissue injury was documented in 53.6% and bone injury (fracture/dislocation) in 52.4%. Surgical management was required in 2214 (52.5%) cases. Work-related injuries accounted for 16.7% of cases and were more likely to require surgery. Assault-related injuries accounted for 8% of cases, with a male preponderance. Our findings can help facilitate service provision and guide regional and national prevention policies.Level of evidence: III.

Revenue Generation and Follow-up for a Hand Trauma Program for Emergency Department Patients in an Inner-City Metropolitan Area.

BACKGROUND: Although hand trauma care has proved to be profitable, loss of trauma patients from a system may lead to revenue loss. Our study aimed to (1) elucidate the economic effect of hand trauma programs, (2) quantify the potential fiscal effect of loss of follow-up, and (3) determine factors contributing to leakage of patients from the healthcare system. METHODS: Revenue data were retrospectively extracted for all adult hand trauma patients within a multicenter healthcare system from 2014 to 2018. Demographic and encounter factors were analyzed using Wilcoxon rank-sum test for differences in continuous variables, Pearson chi square test for categorical variables, and odds ratios. A follow-up model was created using logistic regression. RESULTS: A total of 56,995 (31% new, 69% established) hand trauma encounters were recorded. Follow-up was markedly affected by many factors, including new vs. established patients. Of the 17,748 new patients, 8638 (48.6%) returned for subsequent care, generating $34M. The patients who did not return may have lost $176M for the system. CONCLUSIONS: Many factors lead to loss of follow-up. Understanding these factors can help target efforts to minimize leakage of hand trauma patients. Hand trauma introduces new patients to hospitals, generating notable revenue. Leakage of hand trauma patients has substantial revenue losses.

Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort.

BACKGROUND: Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS: A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS: From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS: Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.

Occupational hand trauma - Mechanism of injury and transient risk factors in Jerusalem.

INTRODUCTION: Although prevalent, and variable geographically, there is little information on the incidence and risk factors for occupation hand trauma in our health care system. This pilot study was designed to determine the optimal data collection methods for transient risk factors locally METHODS: All adult patients with occupational hand trauma treated at an emergency department (ED) during a three-month period were interviewed, either in person or by phone, using a case crossover designed questionnaire, regarding occupation and exposure to potential transient risk factor. RESULTS: Of 206 patients treated with occupational trauma during the study period, 94 had trauma distal to the elbow (46%). Patient compliance was high - 89% of the patients consented to phone interviews and 83% completed in-person ED interviews. In the 75 patients which participated in the study, several risk factors were found to be significant, including machine maintenance and being distracted, including by a cellular phone. We found lack of job experience, limited training on the job site and reports of previous injuries in these workplaces to be prevelent. DISCUSSION: The risk factors implicated in this study are similar to those reported in previous studies at other locations and are modifiable although this is the first report linking cellular phone use and occupation trauma. This finding should be further examined in a larger group and according to occupational categories. Compliance with the study was high, in person or with phone interviews, making these options viable for further studies. Several minor changes to the questionnaire were suggested although it did conform with the case-crossover study design. According to this study, standard preventive measures may be lacking in Jerusalem and should be implemented more uniformly, including specific workplace safety plans and education and taking into consideration the risk factors documented here.

RSTN COVID Hand: Hand trauma in the United Kingdom and Europe during the COVID-19 pandemic.

The COVID-19 pandemic rapidly impacted the delivery of hand surgery services throughout the UK and Europe; from triage to treatment. Our aim was to assess the impact on management of common hand trauma injuries to inform future service delivery and research. The Reconstructive Surgery Trials Network led a service evaluation during the first wave of COVID-19 in 2020. Data was collected on hand injury management during the COVID-19 pandemic and was compared to the management clinicians would have delivered prior. Across 35 hand surgery units, 2540 patients with hand trauma were included. There was an increase of between 3% and 7% in non-operative management of injuries, apart from flexor tendon injuries where management remained unchanged. Cases triaged by a consultant doubled, with a 22% increase in the see-and-treat model. There was a move to operating in low-resource settings; a 13% increase in the use of minor operating theatres and 10% in clinic rooms. Use of WALANT, absorbable sutures, and remote follow-up also increased by 16%, 24%, and between 11% and 25%, respectively. The reported 30-day complication rate was 3.2%, with a surgical site infection rate of 1.8%. The pandemic led to rapid change in many aspects of hand trauma care. It was the impetus for increased out-of-theatre operating, use of local anaesthetic, and more non-operative management of injuries, without an increase in complication rate. Further research needs to assess the clinical and cost-effectiveness of these changes to ensure that COVID-19 is a catalyst for a modern, evidence-based, and environmentally sustainable delivery of hand trauma services.

Hand Injury among Patients Visiting Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The hand is a complex organ responsible for activities of daily living, making it susceptible to injuries and accidents. Hand injuries can result in significant functional impairment and it occurs in a younger productive age group. Therefore, it is important to understand the prevalence and patterns of hand injuries. The aim of the study was to find out the prevalence of hand injuries among patients visiting the emergency department of a tertiary care centre. Methods: A descriptive cross-sectional study was in the Emergency Department of a dedicated trauma centre from 1 June 2022 to 31 August 2022. Ethical approval was obtained from the Institutional Review Board (Reference number: 148412078179). Demographic profile, pattern, and mechanism of hand Injuries of all 96 consecutive patients were assessed after taking informed consent. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 4679 patients visiting the emergency department of the trauma centre, hand injuries were seen in 96 (2.05 %) (1.64-2.46, 95% Confidence Interval). Conclusions: The prevalence of hand injuries was found to be lower than in other similar studies done in similar settings. Keywords: finger injuries; hand injuries; occupational injuries.

Distribution and pattern of hand fractures in children and adolescents.

Hand fractures represent commonly encountered injuries in pediatric patients. However, due to modern means of mobility and product safety, the occurrence and distribution of these fractures have changed during the last decades. Therefore, it was the aim of this study to present an update of the epidemiology, pattern, and treatment of hand fractures in a large pediatric cohort. All patients aged between 0 and 17 years treated in our Department in 2019 with fractures of the phalanges, metacarpus, or carpus were included. The medical records were reviewed for age, gender, injury mechanism, fracture localization, season, and treatment. Patients were divided into three different age groups (0-5, 6-12, and 13-17 years). A total of 731 patients with 761 hand fractures were treated during the 1-year study period. The mean age was 11.1 ± 3.5 years, and the majority was male (65%). Male patients were significantly older compared to female patients (p = 0.008). Also, 78.7% of the fractures affected the phalanges, 17.6% the metacarpals, and 3.7% the carpal bones. The proximal phalanges were the most commonly fractured bones (41.5%). Patients with fractures of the carpus were significantly older compared to children sustaining fractures of the metacarpus or phalangeal bones (p < 0.001). Sixteen percent of our patients were treated surgically; these patients were significantly older compared to conservatively treated patients (p = 0.011).  Conclusion: The epidemiology, mechanisms of injury, distribution, and treatment of hand fractures significantly varies among different age groups. This knowledge is of importance for educational purposes of younger colleagues entrusted with care of children and adolescents as well as development of effective prevention strategies. What is Known: • Pediatric hand fractures represent the second most common fractures in children. • The epidemiology of pediatric hand fractures has changed during the last decades and therefore there is a need for an update regarding distribution and epidemiology of pediatric hand fractures. What is New: • In this retrospective cohort study, 761 pediatric hand fractures of 731 patients were analyzed in detail. • The main mechanisms of younger patients were entrapment injuries, older children most commonly sustained their fractures due to ball sport injuries. There was an increasing rate of metacarpal and carpal fractures with increasing age, and these fractures had to be treated operatively more often than phalangeal fractures.

Comparison of Finger, Hand, and Wrist Injuries in the US Air Force to US Workers.

OBJECTIVE: Fingers, hands, and wrists (FHW) are the most frequently injured body parts in work-related injuries. This study described and compared FHW injuries among enlisted, officer, and civilian US Air Force (USAF) personnel to those in the US workforce. METHODS: All work-related, noncombat FHW injuries (≥1 lost workday) and demographics among USAF personnel and US workforce (2008-2018) were included. The USAF FHW injury rates were age adjusted to the US employment and compared by sex, source, event, and nature of the injuries. RESULTS: Finger, hand, and wrist injuries were significantly lower among the USAF personnel and among females. In both populations, FHW injuries from falls were higher and increased with age group among females. Males had higher overall FHW injuries from contact with objects and equipment. CONCLUSIONS: Prevention efforts should focus on understanding risk factors and sharing successful prevention activities.

Detailed analysis of surgically treated hand trauma patients in a regional German trauma centre.

Hand and forearm injuries are the most frequent reason for consultations in German emergency departments. Therefore, full recovery has a high social and economic relevance. In this study, data on surgically treated hand injuries in a regional German trauma centre between 01.01.2019 and 31.01.2021 were collected using the new German HandTraumaRegister of the German Society for Hand Surgery. These data were retrospectively analysed and correlated with mobility data of the Bavarian population, the 7-day incidence of Covid-19 infections in Germany and the number of elective hand surgeries. We found that a fall from standing height with consecutive distal radius fracture was the most common injury in women, whereas mechanism of injury and diagnosis were more diverse in men. The populations' mobility correlated well with the number of accidents, which in turn was reciprocal to the 7-day-incidence of Covid-19 infections. The number of elective hand surgeries expectedly dropped significantly during the state-imposed lockdowns. Knowing that mainly young men and elderly women suffer from hand injuries, tailored prevention measures may be elaborated. In order to reduce socioeconomic burden, care for hand injuries and elective hand surgeries must be guaranteed according to the frequency of their occurrence.

Clinical Characteristics and Treatment Patterns of Open Hand Fractures in the Pediatric Population.

BACKGROUND: Open hand fractures are one of the most common injuries in the pediatric population. These injuries are at higher risk of infection, especially in cases of frank contamination. Several studies on adult hand fractures are available in the literature; however, pediatric open hand fractures have yet to be extensively studied. This study aimed to define pediatric open hand fracture's demographics, clinical characteristics, and treatment patterns. METHODS: Using the Protected Health Information database, pediatric patients (<18 y old) with the diagnosis of open hand fracture from June 2016 to June 2018 were extracted. Demographic, treatment, and follow-up data were collected. Clinical outcomes included readmission and postoperative infection rates. RESULTS: There were a total of 4516 patients who met the inclusion criteria; the median age was 7 years (interquartile range: 3 to 11); 60% males; 60% white. Displaced fractures occurred in 74% of patients, with the right hand (52%) and middle finger (27%) predominance. The most common mechanism of injury was a crushing injury in-between objects (56%). Associated nerve injury occurred in 78 patients (4%) and vascular injury in 43 patients (2%). Open reduction and internal fixation were performed in 30% of patients. Cephalosporins were the most commonly prescribed antibiotics (73%), followed by aminopenicillins (7%). Nine patients had complications related to surgical intervention (0.2%), and postoperative infection occurred in 44 patients (1%). CONCLUSIONS: Pediatric open hand fractures most often occur during childhood and more frequently in males. These fractures tend to be more distal and displaced; reduction and fixation are required in one-third of the cases. Despite the absence of treatment guidelines and variability, this injury exhibits low complication rates. LEVEL OF EVIDENCE: Level III, retrospective study.

Hand injuries with mole gun: A hidden danger.

BACKGROUND: Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms. METHODS: Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients' hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls. RESULTS: Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22-86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower. CONCLUSION: Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

Shedding light on work-related and non-work-related hand injuries from the social work perspective.

BACKGROUND: Upper extremity injuries may cause not only physical but also serious social and psychological problems in workers. OBJECTIVE: The aim of this study was to compare demographic and work-related features of persons with hand injuries who sustained a work-related or a non-work-related injury to gain insights into possible predisposing factors for work-related injuries as well as psychosocial consequences of hand injuries from the social work perspective. METHODS: This case-control study was conducted on 30 work-related and 30 non-work-related hand injury patients. The patients were evaluated using a questionnaire designed by the authors based on the principles of social work involving demographics, work-related features, thought-emotion-behaviour features, family and friend relationships, need for family support and professional psychosocial support. Survey data from both groups were statistically analysed using descriptive statistics, Chi-square and Fisher Exact test. RESULTS: When compared with the non-work-related hand injury group, the majority of the subjects of the work-related hand injury group were blue-collar workers (p = 0.003), had a lower level of education (p < 0.001), worked off-the-clock (p = 0.015), held the employer responsible for the accident (p < 0.001), needed more time to return to work (p = 0.014), were worried about the future (p = 0.045), and expressed loss of joy (p = 0.004). CONCLUSION: Hand injuries, regardless of their relation to work, lead to important psychosocial problems which need to be evaluated widely and carefully focusing on the patient and patient's environment, work environment in this case.

Firework Injuries to the Hand in the United States: An Epidemiological and Cost Analysis.

Although prior literature has evaluated firework injuries broadly, there are no focused investigations examining trends, etiology, and costs associated with firework injuries to the hand. The 2006 to 2014 National Emergency Department Sample (NEDS) was used. International Classification of Diseases, Ninth Revision (ICD-9) codes identified patients presenting to the emergency department with a firework-related injury of the hand that resulted in a burn, open wound, fracture, blood vessel injury, or traumatic amputation. A linear regression model was used to identify significant changes over time, with a significance threshold of P<.05. A total of 19,473 patients with a firework-related injury to the hand were included, with no significant change in the incidence from 2006 to 2014 (7.5 per 1,000,000 population). The greatest number of injuries occurred in July (57.1%), January (7.4%), and December (3.7%). Age groups affected were young adults (18-35 years; 43.6%), older adults (36-55 years; 19.2%), adolescents (12-17 years; 18.6%), and children (0-11 years; 16.1%). Nearly 74% of the injuries resulted in burns, 24.5% resulted in open wounds, 8.0% resulted in fracture, 7.6% resulted in traumatic amputation, and 1.4% resulted in blood vessel injury. Of 14,320 burn injuries, 15.2% had first-degree burns, 69.9% had second-degree burns, and 5.1% had third-degree burns involving the skin. The median emergency department charge was $914 and the median hospitalization charge (for inpatient admittance) was $30,743. Incidence of firework-related injuries to the hand has not changed over time. There is a need for better dissemination of safety information to mitigate the occurrences of these avoidable accidents. [Orthopedics. 2023;46(3):180-184.].

Analysis of severe hand trauma injury frequency during "Munich's Oktoberfest" within the last 9 years in comparison to years with absence due to the COVID-19 pandemic.

INTRODUCTION: Within its 2 week period, the Oktoberfest attracts around 6 million visitors yearly to Munich, Germany. Due to alcohol intake, congested halls, and disorderly activities, numerous accidents occur. Although many hand injuries are observed, the impact of Oktoberfest on severe hand trauma injury frequency is under investigated. MATERIALS AND METHODS: Data from the regional emergency medical service (EMS) was analyzed over a 9 year period regarding the frequency of severe hand injuries during the world's largest fair and compared to the corresponding period in the years 2020 and 2021 where the event was cancelled due to the world-wide COVID-19 pandemic. Additionally, we compared the patient numbers during the same period in one Emergency Department of a level-1-trauma and hand trauma center located close to the venue. RESULTS: An exploratory description is made from data collected over a 9 year period (2013-2021) with focus on hand injuries before, during and after the "Oktoberfest". A total of 4017 hand injuries were allocated to hospitals by EMS. There was an increase in severe hand injuries by 66% during the 2-weeks-Oktoberfest-period compared to years where the Oktoberfest did not take place. Pre-pandemic statistics show an increasing severe hand trauma frequency of 57.5% in September, compared to EMS-referrals during the remanding year. CONCLUSION: The risk of injuring relevant structures of the hand during Oktoberfest is extremely high as compared to other parts of the body due to beer stein and fall-associated injuries. These injuries can lead to lifelong impairments. Our data are the first that quantifies and pinpoints the risk of severe injury to the hand during Oktoberfest and therefore, it is of great interest for visitors, hand surgeons, paramedics and emergency department healthcare workers.

The effect of weather and temporal factors on emergency hand trauma consultations.

INTRODUCTION: Fluctuations in the numbers of patient consultations in hand trauma emergency units are challenging in terms of both scheduling and the provision of sufficient resources. Trauma consultations in general are affected by both temporal and meteorological variables. As the genesis and epidemiology of hand trauma have their own characteristics, this study aimed to identify the influence of temporal and meteorological factors on hand trauma consultations. MATERIALS AND METHODS: All patients treated for hand trauma in our level one trauma center in 2019 were included in the study population and the data were analyzed in retrospect. The daily weather data, including temperature, sunshine duration, precipitation, humidity and wind speed, as well as temporal factors such as time of day, weekday and public holidays were considered and correlated with patient consultations. Gender differences were studied as well. RESULTS: We included 4787 hand trauma patients (66.4% male, mean age 38.4 ± 19.3 years, 31.7% occupational injuries). Significantly more consultations occurred on Saturdays as compared to weekdays (14.8 ± 0.6, n = 52 vs. 13.0 ± 0.2, n = 261; p = 0.028), and fewer occurred on official holidays (11.8 ± 0.5, n = 63 vs. 13.4 ± 0.2, n = 302; p = 0.0047). We found a significant positive correlation between daily consultations, sunshine duration (r = 0.14, p = 0.0056) and the mean temperature (r = 0.20, p < 0.0001); in contrast, a significant negative correlation between daily consultations and humidity (r = - 0.17, p = 0.001) was observed. Furthermore, fewer consultations were seen on days with precipitation (12.7 ± 0.3, n = 219 vs. 13.8 ± 0.3, n = 146; p = 0.009). The variation was considerably stronger in men. CONCLUSIONS: Hand trauma consultations increased with increasing temperatures, duration of sunshine, and decreasing humidity. Peak admissions were seen on Fridays and Saturdays. These findings can assist in predicting days with peak admissions to allocate resources appropriately.