Hand injuries - epidemiology, costs and outcome

Hand injuries have a profound impact not only on the patient’s activity of daily living and during leisure time but also on working capability. Such injuries may therefore also generate substantial costs for society in terms of sick-leave and treatment. In the present thesis, the panorama, costs (within the health-care system, due to lost production and total costs), outcome and health status of patients with hand injuries in Malmö, Sweden and in Southern Sweden for especially flexor tendon injuries (zone II) and median and ulnar nerve injuries in the forearm as well as other hand injuries were investigated retro- and prospectively. Descriptive epidemiology, health economic methods, and health questionnaires (DASH & SF-36) were used to describe and analyse these factors. The incidence was around 7 hand injuries/1000 inhabitants/year in Malmö, representing 12% of the workload at an Acute & Emergency Unit. Most injuries occurred during leisure time (2/3), mainly affecting young men, and the majority of the injuries were minor, although causing sick leave but usually low costs (< EUR 2500). Only 22% of the injuries in the age group 18-65 years were work related, but such injuries increased the risk of admission to hospital. A decrease in the number of days for sick leave, an increased risk for children to get hand injuries as well as a slight change in type of injuries were observed between 1989 and 1997 (an 8-year interval). There was a reduced risk of injury during July, November and December and on Tuesdays. The median total cost for a nerve injury in the forearm was EUR 45 800 and for a flexor tendon injury EUR 15 600, mainly due to lost production (87% and 65% of total costs, respectively). Factors, such as complications during rehabilitation and more than four concomitant tendon injuries, influenced the costs for repair and rehabilitation of flexor tendon and median and ulnar nerve injuries, respectively. Mobilization regimes, such as active mobilization and rubber band mobilization, after flexor tendon repair increased the costs, but improved the outcome. The costs and sick leave for hand injuries of different severity, analysed in a prospective study, was associated with the score for severity (HISS) of the injury. The DASH-score was not found to be significant in the analysis of the length of sick leave but DASH-score at one year was associated with variation in age, HISS and health care costs. SF36 was not useful as a method to study health status after a hand injury. The data in the present thesis can be used to optimise the treatment and rehabilitation of hand injuries, reallocate resources as well as to improve prevention of such injuries, which usually affect young persons in a productive age