09Mar 2020

EVALUATION OF KNOWLEDGE OF EMERGENCY PHYSICIANS REGARDING ASSESSMENT AND INITIAL MANAGEMENT OF HAND INJURIES

  • Institute of Emergency Medicine, Peerless Hospital and B.K. Roy Research Centre, Kolkata-700094, India.
  • Clinical Director & Head of Department of Emergency Medicine, Peerless Hospital and B.K.Roy Research Centre.
  • Attending Consultant, Department of Emergency Medicine, Peerless Hospital & B.K. Roy Research Centre, Kolkata.
  • Associate Consultant, Department of Emergency Medicine, Peerless Hospital & B.K. Roy Research Centre, Kolkata.
Crossref Cited-by Linking logo
  • Abstract
  • References
  • Cite This Article as
  • Corresponding Author

Introduction: We encounter acute traumatic injuries of the hand and wrist very often in the emergency department, ranging from simple soft tissue laceration to life threatening injuries.So for the optimum treatment of any serious hand injury depends upon early recognition and appropriate referral. This can only be achieved with a thorough understanding about the evaluation and management of hand injuries by the Emergency physicians. Aims and Objectives: To assess the knowledge on initial management of common hand injuries presenting to emergency department. To understand the importance of evaluation and management of hand injuries and for prompt referral and further expert management (surgical). Limitations of the Study: The study populations are being tested upon a confined set of questionnaire and it may not cover the entire range of questions. Physicians will be selected randomly, which may not represent ideal demographic scenario of physicians in our country. As some of the questionnaires are being distributed by e-mails, there is a high possibility of low response. Methodology: Over a 12-month period of all doctors working in the department of emergency and trauma care, working in the private and govt. sectors of the state of West Bengal, were asked to solve the questionnaire based on clinical scenarios of hand injuries which included evaluation of the same and the primary management .The clinical experience of these doctors varied from post graduate trainees to senior consultants in the field of emergency and trauma care. All replies were assessed by one individual. Results and Discussion: In our study we found that 25(16.7%) emergency physicians were ≤30 years old, 61(40.7%) emergency physicians were 31-40 years old and 64(42.7%) emergency physicians were 41-50 years old.43 (28.7%) emergency physicians were Female and 107(71.3%) emergency physicians were Male. Questions on the Haemorrhage Control, Fight Bites, Burns, Nerve Examination, Fractures, Tendon Injury, Radiology and local anaesthesia were answered correctly by most of the emergency physicians, but there was significant knowledge deficit in the questions based on Amputation , Nail bed injury and High pressure injection injury. Overall ,our study shows that there is significant knowledge deficit amongst the emergency physicians ,out of the twenty questions on various hand injuries presenting to ED,10(6.7%) emergency physicians had 100% correct answers, 35(23.3%) emergency physicians had 50% correct answers and 105(70.0%) emergency physicians had below 50% correct answers.Hence this study showed significant knowledge deficit in assessment and management of hand injuries amongst Emergency Physicians.


  1. Rajneesh Jindal, Neera Jindal, Ankur Dass. Prevalence of Hand Fractures: A Clinical Study.International Journal of Contemporary Medical Research ISSN: 2393-915X; Volume 3 Issue 11 November 2016.
  2. Ghiya MN, Murty S, Shetty N, Rodney D\'Cunha,Proper training and sensitisation towards the need and technique of anaesthesia. Department of Plastic Surgery and Department of Emergency Medicine,St.johns medical college,Karnataka,Bangalore,(2016).
  3. Hile D, HileL(2015). The emergent evaluation and treatment of hand injuries. EmergencyMedicine Clin North Am. 2015 May;33(2):397-408. doi: 10.1016/j.emc.2014.12.009. Epub 2015 Feb 26.
  4. Australian Safety and Compensation Council. Work related hand and wrist injuries in Australia, 2008. Available athttp://safeworkaustralia.gov.au
  5. Otto C. ABC of Emergency Radiology. Oxford, UK: Blackwell Publishing Ltd; 2007.
  6. Overton DT, Uehara DT. Evaluation of the injured hand. Emerg Med Clin North Am. 1993;11:585?600.
  7. Talan DA, Abrahamian FM, Moran GJ, Mower WR, Alagappan K, Tiffany BR, et al. Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds. Ann Emerg Med. 2004;43:305?14.
  8. Harrison B, Holland P. Diagnosis and management of hand injuries in the ED. Emerg Med Pract. 2005;7:1.
  9. Guly HR. Diagnostic errors in an accident and emergency department. Emerg Med J. 2001;18:263?9.
  10. Mathur N, Sharma KK. Medico-economic implications of industrial hand injuries in India. J Hand Surg Br. 1988;13:325?7.
  11. Examination of the Injured Hand; Electronic Textbook of Hand Surgery
  12. Andreisek G, Crook DW, Burg D, et al; Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006 Sep-Oct26(5):1267-87.
  13. Diagnosis And Management Of Hand Injuries In The ED; EB Medicine
  14. Kollitz KM, Hammert WC, Vedder NB, et al; Metacarpal fractures: treatment and complications. Hand (N Y). 2014 Mar9(1):16-23. doi: 10.1007/s11552-013-9562-1.
  15. Hackney LA, Dodds SD; Assessment of scaphoid fracture healing. Curr Rev Musculoskelet Med. 2011 Mar 84(1):16-22.
  16. Daniels JM 2nd, Zook EG, Lynch JM; Hand and wrist injuries: Part I. Nonemergent evaluation. Am Fam Physician. 2004 Apr 15
  17. Casting of Scaphoid Fractures; Wheeless\' Textbook of Orthopaedics
  18. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries Curr Rev Musculoskelet Med 2008;1:97?102.
  19. Garnham A, Ashe M, Gropper P. Wrist, hand and finger injuries. In: Clinical Sports Medicine. Brukner P, Karim K, editors. Revised 3rd edn. Sydney: McGraw-Hill, 2009.
  20. Leggit JC, Meko CJ. Acute finger injuries: Part II. Fractures, dislocations and thumb injuries. Am Fam Physician 2006;73:827?34.
  21. Wang QC, Johnson BA. Fingertip injuries. Am Fam Physician 2001;63:1964?6.
  22. Anderson D. Skier?s thumb. Aust Fam Physician 2010;39:575?7.
  23. Handoll HHG, Vaghela MV. Interventions for treating mallet finger injuries.Cochrane Database Syst Rev 2004;3:CD004574.
  24. Palmer RE. Joint injuries of the hand in athletes. Clin J Sport Med 1998;17:513?31.
  25. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev 2008;1:CD003861.
  26. Therapeutic guidelines ? Antibiotic (electronic). Skin and soft tissue infections: bites and clenched fist injuries. Available at http://online.tg.org.au/complete [Accessed 3 January 2011].
  27. Medeiros IM, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev 2001;2:CD001738.
  28. Brown RE. Acute nail bed injuries. Hand Clin. 2002;18(4):561?75.
  29. Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. PlastReconstr Surg. 2008;122(3):105e?17e.
  30. Bickel KD, Dosanjh A. Fingertip reconstruction. J Hand Surg Am. 2008;33(8):1417?9.
  31. Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand. 2012;7(1):18-22. (Retrospective study; 92,601 patients)
  32. Campbell SG, Croskerry P, Bond WF. Profiles in patient safety: A ?perfect storm? in the emergency department. AcadEmerg Med. 2007;14(8):743-749. (Review article)
  33. Barbeau G, Arsenault F, Gugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plesthysmography: comparison with the Allen?s test in 1010 patients. Am Heart J. 2004;147(3):489-493. (Cross-sectional analytical study; 1010 patients)
  34. Schumer E, Friedman F. Pulse oximetry for preoperative vascular assessment in a thumb near amputation. J Emerg Med. 1995;13(6):753-755. (Case report)
  35. Lawson D, Norley I, Korbon G. Blood flow limits and pulse oximeter signal detection. Anesthesiology. 1987;67(4):599-603. (Prospective study; 10 subjects)
  36. Kamyab A, Cook J, Sawhey S, et al. The role of the complete blood count with differential for the surgeon. Am Surg. 2012;78(4):493-495. (Retrospective study; 95 patients)
  37. DeSmet AA, Doherty MP, Norris MA, et al. Are oblique views needed for trauma radiography of the distal extremities? AJR Am J Roentgenol. 1999;172(6):1561-1565. (Prospective study; 1461 radiographs)
  38. Bruno MA, Weissman BN, Kransdorf MJ, et al. Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria? acute hand and wrist trauma. Available at: http://www.acr.org/~/media/0DA5C508B7E14323A1AE52F23543F093.pdf. Accessed March 3, 2014. (Expert consensus practice guideline)
  39. Nikken JJ, Oei EH, GInai AZ, et al. Acute wrist trauma: value of short dedicated extremity MR imaging examination in prediction of need for treatment. Radiology. 2005;234(1):116- 124. (Prospective randomized controlled trial; 87 patients)
  40. Mack MG, Keim S, Balzer JO, et al. Clinical impact of MRI in acute wrist fractures. Eur Radiol. 2003;13(3):612-617. (Prospective study; 54 patients)
  41. Wu TS, Roque PJ, Green J, et al. Bedside ultrasound evaluation of tendon injuries. Am J Emerg Med. 2012;30(8):1617-1621. (Prospective study; 34 patients)
  42. Lee DH, Robbin ML, Galliot R, et al. Ultrasound evaluation of flexor tendon lacerations. J Hand Surg Am. 2000;25(2):236-241. (Prospective study; 10 patients, 20 flexor tendons)
  43. Soubeyrand M, Biau D, Jomaah N, et al. Penetrating volar injuries of the hand: diagnostic accuracy of US in depicting soft-tissue lesions. Radiology 2008;249(1):228-235. (Prospective study; 26 patients)
  44. Altman RS, Harris GD, Knuth CJ. Initial management of hand injuries in the emergency patient. The American journal of emergency medicine. 1987 Sep 1;5(5):400-4.
  45. Cheung K, Hatchell A, Thoma A. Approach to traumatic hand injuries for primary care physicians. Canadian Family Physician. 2013 Jun 1;59(6):614-8.
  46. Ghiya MN, Murty S, Shetty N, D\'Cunha R. A descriptive study of hand injuries presenting to the adult emergency department of a tertiary care center in urban India. Journal of emergencies, trauma, and shock. 2017 Jan;10(1):19.
  47. Bowen WT, Slaven EM. Evidence-Based Management Of Acute Hand Injuries In The Emergency Department. Emergency medicine practice. 2014 Dec;16(12):1-25.
  48. Alphonsus CK. Principles in the management of a mangled hand. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2011 May;44(2):219.
  49. Chung KC, Shauver MJ, Saddawi-Konefka D, Haase SC. A decision analysis of amputation versus reconstruction for severe open tibial fracture from the physician and patient perspectives. Annals of plastic surgery. 2011 Feb;66(2):185.
  50. Wieschhoff GG, Sheehan SE, Wortman JR, Dyer GS, Sodickson AD, Patel KI, Khurana B. Traumatic finger injuries: what the orthopedic surgeon wants to know. Radiographics. 2016 Jul;36(4):1106-28.
  51. Jha S, Khan WS, Siddiqui NA. Suppl 1: Mammalian bite injuries to the hand and their management. The open orthopaedics journal. 2014;8:194.
  52. Pilling T, Govender P. Profile and management of the firework-injured hand. South African Family Practice. 2016 Apr 6;58(2):48-53.
  53. GOLDWYN RM. Management of Acute Hand Injuries: A Biological Approach. Archives of Surgery. 1974 Jul 1;109(1):126-7.
  54. Cheung K, Hatchell A, Thoma A. Approach to traumatic hand injuries for primary care physicians. Canadian Family Physician. 2013 Jun 1;59(6):614-8.
  55. Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. Suppl 1: An Overview of the Management of Flexor Tendon Injuries. The open orthopaedics journal. 2012;6:28.
  56. Vitale E, Ledda C, Adani R, Lando M, Bracci M, Cannizzaro E, Tarallo L, Rapisarda V. Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study. Journal of clinical medicine. 2019 Nov;8(11):2000.

[Febin Fareed, Indraneel Dasgupta, Sambit Maiti and Sudip Chakraborty (2020); EVALUATION OF KNOWLEDGE OF EMERGENCY PHYSICIANS REGARDING ASSESSMENT AND INITIAL MANAGEMENT OF HAND INJURIES Int. J. of Adv. Res. 8 (Mar). 268-309] (ISSN 2320-5407). www.journalijar.com


DR FEBIN FAREED
INSTITUTE OF EMERGENCY MEDICINE PEERLESS HOSPITAL AND B.K. ROY RESEARCH CENTRE

DOI:


Article DOI: 10.21474/IJAR01/10628      
DOI URL: http://dx.doi.org/10.21474/IJAR01/10628