Treatment of open hand injuries: does timing of surgery matter? A single-centre prospective analysis

Abstract

The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.

Key Words::

• Delayed treatment
• open hand injuries
• outcome

Acknowledgements

The trial was performed according to the rules and regulations of the cantonal ethical authority, which included no written informed consent of each patient due to the study design: quality control study, routine treatment with no additional trial treatment or data acquisition, anonymised data storage. Neither the manuscript nor parts of it has been published elsewhere. Preliminary data were presented at the XVth Congress of the Federation of European Societies for Surgery of the Hand (FESSH) 2010 in Bucharest/Romania by Professor Mihai A. Constantinescu.