Complex hand injuries are those which involve more than one functionally significant anatomic structure of the hand (i.e vessels, nerves, tendons, bones). The epidemiologic and management characteristics of these injuries, encountered in a specialized center covering an urban and agricultural population, were recorded and studied.

Between 1997 and 2002 the Orthopaedic Department of the University of Ioannina surgically treated 211 complex hand injuries in 190 patients with a mean age of 35 year (range 2.5–73). The majority of patients were male (89%). The incidence of these injuries was low at the extremes of the age distribution (children and adults over 60 years old). The greatest incidence was in the 15–30 year old age group. The mechanism of the injury was found to be clean cut trauma in 31% and avulsion or crushing in 69%; with the later being frequent agricultural injuries. Fifty-nine per cent of the injuries were viable, while 41% where non-viable (complete amputation in 63% and incomplete in 37%). Of the non viable injuries 66% eventually underwent stump configuration. Primary repair of only one anatomical structure was performed in 58%, most commonly osteosynthesis and tendon suturing. In 42% primary repair of more than one structure was performed, most commonly osteosynthesis and tendonorrhaphy in avulsion injuries and neuroraphy combined with tendonorrhaphy in clean cut injuries.

Complex hand injuries are frequently seen in young male adults and the most common mechanism of injury is avulsion-crushing. Most of them are work-related accidents, so prevention should focus on adherence to safety guidelines. Management of such injuries requires special surgical techniques and expertise, necessary for staged reconstruction.