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Open hand fractures: a prospective analysis of functional outcomes and risk factors for infection after initial management in the emergency department

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Open hand fractures are common orthopaedic injuries, historically managed with early debridement in the operating room. Recent studies suggest immediate operative treatment may not be necessary but have been limited by poor follow-up and lack of functional outcomes. This study sought to prospectively evaluate these injuries treated initially in the emergency department (ED), without immediate operative intervention, to determine long-term infectious and functional outcomes using the Michigan Hand Outcomes Questionnaire (MHQ).

Methods

Adult patients with open hand fractures managed initially in the ED at a Level-I trauma center were considered for inclusion (2012–2016). Follow-up and MHQ administration occurred at 6 weeks, 12 weeks, 6 months, and 1 year. Logistic regression and Kruskal–Wallis testing were used for analysis.

Results

Eighty-one patients (110 fractures) were included. Most had Gustilo Type III injuries (65%). Injury mechanisms most commonly included saw/cut (40%) and crush (28%). Nearly half of all patients (46%) had additional injuries involving a nailbed or tendon. Fifteen percent of patients had surgery within 30 days. The average follow-up was 8.9 months, with 68% of patients completing at least 12 months. Eleven patients (14%) developed an infection, of which 4 (5%) required surgery. Subsequent surgery and laceration size were associated with increased odds of infection, and at one-year, functional outcomes were not significantly different regardless of fracture classification, injury mechanism, or surgery.

Conclusions

Initial ED management of open hand fractures results in reasonable infection rates compared to similar literature and functional recovery demonstrated by MHQ score improvements over time.

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Acknowledgements

The authors would like to thank Dr. Wei Xue for her contributions to the statistical analysis. Her efforts were crucial to the completion of this work.

Funding

Research reported in this publication was supported by the University of Florida Clinical and Translational Science Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. No other funding was used for this work.

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Authors and Affiliations

  1. University of Florida College of Medicine, P.O. Box 100138, Gainesville, FL, 32610, USA

    David Spencer Nichols

  2. Department of Orthopedic Surgery, University of Florida, 3450 Hull Road, Third Floor, Room 3341, Gainesville, FL, 32607, USA

    Nicholas Newsum, Aimee Struk, MaryBeth Horodyski & Robert Matthias

  3. Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, P.O. Box 100138, Gainesville, FL, 32610, USA

    Ellen Satteson

  4. Department of Biostatistics, University of Florida, 2004 Mowry Rd. 5th Floor, Gainesville, FL, 32603, USA

    Guanhong Miao

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Correspondence to Robert Matthias.

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D. Spencer Nichols, Nicholas Newsum, Ellen Satteson, Guanhong Miao, Aimee Struk, MaryBeth Horodyski, and Robert Matthias declare they have no conflict of interest. No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Nichols, D.S., Newsum, N., Satteson, E. et al. Open hand fractures: a prospective analysis of functional outcomes and risk factors for infection after initial management in the emergency department. Eur J Orthop Surg Traumatol 33, 3449–3459 (2023). https://doi.org/10.1007/s00590-023-03549-3

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