title: 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.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, University Hospital Berne and University of Berne , Switzerland.
authors.forename: Bettina H
authors.initials: BH
authors.lastname: Juon
authors.forename: Michelle
authors.initials: M
authors.lastname: Iseli
authors.forename: Janett
authors.initials: J
authors.lastname: Kreutziger
authors.forename: Mihai A
authors.initials: MA
authors.lastname: Constantinescu
authors.forename: Esther
authors.initials: E
authors.lastname: Vögelin
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004203:Disinfection / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006230:Hand Injuries / Q000175:diagnosis* / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000503:physiopathology* / Q000517:prevention & control; D013557:Switzerland; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Delayed treatment; open hand injuries; outcome