Abstract
Purpose
Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries.
Methods
65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery.
Results
Our results show that as many as 40% of injuries are missed on examination initially by casualty officers but only 10% are missed on re-examination post admission. Factors such as alcohol intoxication and distracting injuries seem to play a role in the casualty examination being difficult.
Conclusion
Underlying injuries to structures in the forearm and hand are often missed on initial examination of lacerations involving the forearm and hand. Re-examination post admission of the patient is essential to avoid underestimating the extent and time of surgery required to treat the patient. Factors identified as possibly contributing to this are alcohol intoxication, distracting injuries and language problems in the casualty setting.
NO DISCLOSURES
