Surgical exploration of hand wounds in the emergency room: Preliminary study of 80 personal injury claims.
The SHAM Insurance Company in Lyon, France, estimated that inadequate hand wound exploration in the emergency room (ER) accounted for 10% of all ER-related personal injury claims in 2013. The objective of this study was to conduct a critical analysis of 80 claims that were related to hand wound management in the ER and led to compensation by SHAM.



Eighty claims filed between 2007 and 2010 were anonymised then included into the study. To be eligible, claims had to be filed with SHAM, related to the ER management of a hand wound in an adult, and closed at the time of the study. Claims related to surgery were excluded. For each claim, we recorded 104 items (e.g., epidemiology, treatments offered, and impact on social and occupational activities) and analysed.



Of the 70 patients, 60% were manual workers. The advice of a surgeon was sought in 16% of cases. The most common wound sites were the thumb (33%) and index finger (17%). Among the missed lesions, most involved tendons (74%) or nerves (29%). Many patients had more than one reason for filing a claim. The main reasons were inadequate wound exploration (97%), stiffness (49%), and dysaesthesia (41%). One third of patients were unable to return to their previous job. Mean sick-leave duration was 148 days and mean time from discharge to best outcome was 4.19%. Most claims (79%) were settled directly with the insurance company, 16% after involvement of a public mediator, and 12% in court. The mean compensatory damages award was 4595Euros.



Inadequate surgical exploration of hand wounds is common in the ER, carries a risk of lasting and sometimes severe residual impairment, and generates considerable societal costs.



IV.
Service de chirurgie orthopédique et traumatologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: mouton.jor@gmail.com.
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J
Mouton
Service de chirurgie orthopédique et traumatologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: hadrien.houdre@gmail.com.
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H
Houdre
Service de chirurgie orthopédique et chirurgie de la main, clinique du Cèdre, 950, rue de la Haie, 76230 Bois-Guillaume, France. Electronic address: rbtf.beccari@gmail.com.
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R
Beccari
Service de chirurgie orthopédique et traumatologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
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Tarissi
SHAM Insurance Company, 18, rue Édouard-Rochet, 69008 Lyon, France. Electronic address: melanie.autran@sham.fr.
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M
Autran
Service de chirurgie plastique et chirurgie de la main, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: Isabelle.Auquit@chu-rouen.fr.
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I
Auquit-Auckbur
D000293:Adolescent; D000328:Adult; D000368:Aged; D035881:Compensation and Redress; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005260:Female; D005383:Finger Injuries / Q000601:surgery; D005602:France; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D011787:Quality of Health Care; D062707:Return to Work; D018582:Sick Leave; D013708:Tendon Injuries / Q000601:surgery*; D013933:Thumb / Q000293:injuries; D014942:Workers' Compensation; D055815:Young Adult
Compensation; Hand injuries; Litigation; Personal injury claims; Wounds