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Objectives: Injuries to the hand and wrist from sport and exercise are common and costly. This cost-of-illness analysis was performed to estimate the economic implications of hand and wrist injuries that were sustained as a result of participation during sport or exercise., Perspective: Cost estimates were calculated from resource use in the emergency, inpatient and outpatient settings from the perspective of one public healthcare service., Setting: Alfred Health, a large public health service with two emergency departments located in Victoria, Australia., Methods: This descriptive epidemiological study used ICD-10 diagnostic codes and electronic billing records to identify 778 potential cases for inclusion. Electronic medical records were screened and reviewed to extract demographic and patient care journey data., Results: 692 individuals, (n=761 individual zone of injuries), were included. Australian Rules Football (ARF) was the largest contributor to injuries (20.2%) followed by riding bicycles (15.9%. The total cost of all injuries was $790,325, with a median cost per case of $278 [IQR $210-$282] in the Emergency Department n=692, $3328 [IQR $2242-$6441] in the inpatient setting n=76 and $630 [IQR $460-$870] in the outpatient setting n=244., Conclusions: Hand and wrist injuries sustained from sport and exercise contribute to a significant financial burden on the healthcare system. Future research that considers the costs that occur outside of the public healthcare service is required estimate the burden associated with these injuries comprehensively. Injury prevention programs may mitigate the observed injury trends., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings., Methods: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit., Results: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach., Conclusions: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.

Background: Injuries to the hand and wrist are estimated to account for between 10% and 30% of all ED presentations. The economic burden placed on the healthcare system can be extensive and rise sharply with increase in injury severity., Objectives: This cost-analysis was performed with the aim of estimating the economic implications of ED attendances for hand and wrist injuries from the perspective of one Australian public health network., Methods: Data from two EDs were retrieved from the electronic billing records of one large health network across two financial year periods (2014-2015 and 2015-2016) using ICD-10 codes. All costs that resulted from the treatment of any acute hand or wrist injury across the 2 year period were calculated and are presented by age, sex, injury type and mechanism of injury., Results: A total of 10 024 individuals presented to the two EDs in the 2 year period, accounting for approximately 5.4% of all presentations. The most common presentations were males (62.2%), people aged 25-34 years (26.9%) and lacerations (31.2%). The total cost in the 2 year study period was $3 959 535.38 ($1 923 852.38 in 2014-2015; $2 035 683.00 in 2015-2016). The mean cost per presentation was $383 (95% CI [$373, $393]) in 2014-2015 and $407 (95% CI [$394, $421]) in 2015-2016., Conclusions: Acute hand and wrist injuries contribute to a significant volume of ED presentations each year in one Australian public health network leading to significant expenditure and health resources. Further research into how to best utilise resources and reduce avoidable injuries should be priority areas to reduce the cost of these injuries to the healthcare system and society., (© 2019 Australasian College for Emergency Medicine.)

According to the Malaysian Department of Statistics motor vehicle accidents are the third leading cause of death in Malaysia and accounts for 7.4% of premature deaths in 2016. With the invention of the airbag, the number of serious injuries and fatalities have been reduced significantly. However, there has also been a corresponding increase in the number of injuries attributable to these devices. The patient narrated in this case report sustained a mixed dermal thickness burn over the upper limb as a result of an airbag deployment. She recovered without other life threatening injuries.

Purpose: Flexor tendon lacerations are a common and debilitating injury for thousands of Americans annually. Despite this, no study has attempted to estimate the economic impact of these injuries. The objective of this study was to estimate the economic impact of flexor tendon lacerations in America., Methods: The cost of flexor tendon lacerations to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients in the United States presenting with complete flexor tendon lacerations who underwent surgical repair. The secondary cohort was defined by all patients who required reoperation within 1 year of their initial operation. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured., Results: Flexor tendon lacerations incur an estimated cost of between US $240.8 and US $409.1 million annually to the American medical system. The total direct cost per injury is estimated to be US $13,725, whereas estimates to the indirect costs range from US $60,786 to US $112,888., Conclusions: Flexor tendon lacerations represent an important economic burden to our health care system, even when compared with other common hand conditions. Specifically, indirect costs, such as missed workdays, are the major contributor toward the total cost these injuries incur on society, accounting for upward of 89% of the total cost. This suggests that we should focus our efforts to improve treatments and rehabilitation protocols which decrease these indirect costs.

Although the upper extremity is the most commonly injured part of the body, many studies have indicated that there is a lack of emergency hand coverage in the United States. In 2010, our laboratory evaluated on-call hand coverage in Tennessee (TN) and found that only 7% of hospitals had a hand surgeon on call for emergency cases at all times. In 2014, the Affordable Care Act (ACA) was implemented with the goal of increasing overall access to care and decreasing health care costs. Hand surgeons were surveyed on their attitudes toward the ACA, and the majority of surgeons surveyed disagreed or strongly disagree that the ACA would improve access to emergent hand surgery. This study aimed to determine if there has been an increase in emergency hand coverage in TN since the implementation of the ACA. A survey was administered to all hospitals in TN with both an emergency department and operating room to determine the percentage of TN hospitals offering elective hand surgery and on-call emergency hand coverage. With 94% of TN hospitals responding to the emergency department survey, we determined that there has been a 138% significant increase in the percentage of hospitals reporting 24/7 emergency hand coverage by a hand specialist since our last study in 2010. There has also been a significant increase in elective hand coverage in TN, although much smaller at 13% since 2010. This study suggests that there has been an overall increase in access to hand care in TN since the implementation of the ACA, most profoundly seen in the increase in hand specialists available for emergent cases.

Background: The Compensation for Occupational Injuries and Diseases Act No. 130 of 1993, as amended in 1997 (COIDA), provides payment to healthcare providers for treatment of occupational injuries in South Africa (SA). Patients and employers are often unaware of procedures for claiming, and patients then carry the burden of costs themselves. Additionally, under-billing results in a loss of income for treating hospitals. Hand injuries are common occupational injuries and form the focus of this study., Objectives: To investigate whether occupational hand injuries treated at the Martin Singer Hand Unit at Groote Schuur Hospital, Cape Town, were accurately captured and allocated correct professional fee coding and billing. Accurate capturing and billing would allow for access to the Compensation Fund and allocation of finances to improve service delivery, as well as avoid unnecessary costs to otherwise uninsured patients., Methods: All new hand injuries presenting to the hand unit at the hospital in August 2017 were sampled in a retrospective folder review. Injuries on duty (IODs) were identified and analysed further. Coding and billing were compared with independent private quotes., Results: Sixty new hand injuries presented during the month. Fifteen were IODs, but only 6 were recognised by administration. The other 9 were billed at minimum income rates and 5 of these patients also had operations, which were not billed for. A total of ZAR88 871.99 was under-billed in terms of professional fees only. The 9 incorrectly classified patients had to bear costs themselves at a median of ZAR130.00 each., Conclusions: There were large discrepancies in billing for occupational hand injuries. This resulted in costs to the patients and loss of income for the facility. Access to the Compensation Fund is vital in financing resources in the overburdened public sector. Suggestions for improvement include accessing COIDA funds in order to improve administration at the unit, so improving identification, coding and billing of occupational hand injuries.

Numerous demographic, socioeconomic, and injury factors influence a burn patient's hospital course. Compared to the typical burn patient, frostbite injury frequently impacts those with high rates of mental illness, substance abuse, and those suffering homelessness. Our aim was to examine differences in the hospital course of frostbite patients compared to those with burns limited to the hands and feet. Patients with frostbite injury and those with isolated hand and/or foot burns were identified in the National Burn Repository. The database was cleaned based on published protocols. Patients were excluded if they had an inhalation injury recorded or unknown. Patients with frostbite injury were significantly older and more likely to be male. Frostbite patients were less frequently covered by commercial insurance (25.3% vs 41.7%). Mean total BSA (TBSA) did not differ between the two groups (frostbite: 2.1 and burn: 1.7, P = .195). The mean intensive care unit (ICU) days and requirement for mechanical ventilation were not significantly different between the two groups, however frostbite patients were significantly more likely to require ICU care (26.5% vs 13.7%, P = .002). Hospital length of stay (LOS) was significantly longer in frostbite patients (8.1 vs 4.0 days, P < .001) and hospital charges were significantly higher in frostbite patients ($43,400 vs $15,600, P < .001). Factors associated with increased hospital charges included mechanism, age, gender, race, TBSA, hospital LOS, ICU, and mechanical ventilation. Factors associated with increased LOS included mechanism, age, gender, race, TBSA, ICU stay, and mechanical ventilation. On multivariate analysis, all factors, except gender, remained independent predictors of increased hospital LOS. A comparison of similarly injured patients treated at burn centers showed frostbite injury as a significant predictor of increased LOS and hospital costs compared to burn-injured patients.

Purpose: To date, there have been no studies identifying the cost differential for performing closed reduction internal fixation (CRIF) of hand fractures in the operating room (OR) versus an ambulatory setting. Our goal was to analyse the cost and efficiency of performing CRIF in these two settings and to investigate current practice trends in Canada., Methods: A detailed analysis of the costs involved both directly and indirectly in the CRIF of a hand fracture was conducted. Hospital records were used to calculate efficiency. A survey was distributed to practicing plastic surgeons across Canada regarding their current practice of managing hand fractures., Results: In an eight-hour surgical block we are able to perform five CRIF in the OR versus eight in an ambulatory setting. The costs of performing a CRIF in the OR under local anaesthetic, not including surgeon compensation, is $461.27 Canadian (CAD) compared to $115.59 CAD in the ambulatory setting, a 299% increase. The use of a regional block increases the cost to $665.49 CAD, a 476% increase. The main barrier to performing CRIFs in an outpatient setting is the absence of equipment necessary to perform these cases effectively, based on survey results., Conclusion: The use of the OR for CRIF of hand fractures is associated with a significant increase in cost and hospital resources with decreased efficiency. For appropriately selected hand fractures, CRIF in an ambulatory setting is less costly and more efficient compared to the OR and resources should be allocated to facilitate CRIF in this setting., (Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. In comparison, leisure-time hand injuries show a significantly higher accident rate: 60% of hand injuries occur during leisure time. Far fewer safety measures are taken and a lack of adequate training and a disregard for safety recommendations are observed.This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%.These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.

Accidents with powered wood splitters cause a distinct group of hand injuries in which the injury spectrum ranges from a minor lesion to mutilating defects. We studied these injuries in order to assess the consequences and estimate the associated costs. A 2-year cohort of patients was retrospectively identified from medical records. The details of the injuries and the treatment were collected, and estimates of the resources used were based on hospital billing and the average costs of sick leave and disability. A total of 67 patients were identified and seven of those were children. Most patients sustained a major hand injury and an emergency microsurgical operation was indicated in 40% of patients. The total cost associated with the injuries was estimated at €3.33 million (£2.56 million, US$3.62 million). The treatment of this relatively small number of injuries demands substantial medical resources, and most of the costs are due to sick leave and disability. Level of evidence IV.

Background: Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity., Objective: This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature., Materials and Methods: A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries., Conclusions: Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This study aimed to explore the most common hand injury errors occurring in Emergency Departments in England. A Freedom of Information request was made to the NHS Litigation Authority for claims data related to hand injuries in English Emergency Departments from 2004 to 2014. All successful hand injury claims against an individual DGH ED were also analysed. Two hundred and eighteen successful claims were made, costing a total of £6,273,688.22. Diagnosis error was the most common successful claim (97). Four successful claims were brought against the Emergency Department. Causes of error included the use of inappropriate views and failure to correlate imaging with clinical findings. Hand injury diagnostic error has been the most common cause of successful litigious claims against Emergency Departments over the past 10 years. This paper demonstrates that fracture recognition and clinical diagnosis of hand injuries are key areas to target to reduce error rates., (© The Author(s) 2016.)

A clear disparity in the pattern and provision of surgical care exists, particularly for patients with vulnerable socioeconomic backgrounds. For hand-injured patients in particular, this discrepancy has been frequently shown in their receiving appropriate care. With the advent of the Affordable Care Act and with Medicaid expansion on the horizon, more patients will be requiring access to care. Safety net programs have been shown to provide equivalent levels of care for patients compared with non-safety net providers, and the survival of these hospitals for the disadvantaged is essential to providing quality care for this growing patient population. In this article, the authors review the factors that affect the barriers to care, the importance of safety net hospitals, the epidemiology of the hand-injured patient, and how the Affordable Care Act will impact these safety net programs.

Background: Hand and wrist injuries are very common at the Emergency Departments (ED), and among the most costly injury types in the working population. The purpose of this study was to explore the causes of non-trivial hand and wrist injuries (i.e., hand fractures, wrist fractures and complex soft-tissue injuries) in working-age adults in order to identify target areas for prevention., Methods: Data were extracted from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry and from a patient follow-up survey in working-age adults (aged 20-64 years) in the period 2008-2012. An incidence-based cost model was used to estimate healthcare costs, and an absenteeism model for estimating the productivity costs. Total costs were calculated by external cause, subdivided in their main categories (home, sports, work, traffic and violence) and their most important subclasses., Results: Total costs of these injuries in The Netherlands were US $410 million per year, of which 75% (US $307 million) productivity costs. Males represented 66% (US $271 million) of the total costs. Within the male group, the group 35-49 years had the highest contribution to total costs (US $112 million), as well as the highest costs per case (US $10,675). Work-related injuries showed the highest costs per case (US $11,797), however, only 25% of the total costs were work-related. The top five causes in terms of total costs were: accidents at home (falls 23%, contact with an object 17%), traffic (cycling 9%) and work (industrial work 4%, and construction work 4%)., Conclusion: Hand and wrist injuries are a major cause of healthcare and productivity costs in working-age adults. To reduce the costs to society, prevention initiatives should be targeted at major contributing causes, that are mainly related to activities at home (falls, contact with an object) and accidents at the road (cycling)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Plastic surgeons are frequently consulted for hand and facial injuries, and patients are often transferred to trauma centers for evaluation of these problems. The authors sought to identify the frequency and impact of "unnecessary" transfers for emergency evaluation by a plastic surgeon at a Level I trauma center., Methods: The authors reviewed more than 32,000 consecutive emergency department encounters at their institution between April of 2009 and April of 2013 and found 1181 patients transferred for evaluation by plastic surgery. Using a retrospective chart review, necessity of transfer was determined based on the intervention performed at the authors' institution and the availability of resources at the transferring site., Results: Of all the patients referred for "emergency" evaluation, 860 (74.1 percent) were unnecessary. Transfers for hand-related issues were more likely to be coded as unnecessary compared with referrals for facial trauma and infection (76 percent versus 66 percent; p < 0.001). The average time from referral to discharge from the emergency department was 412 minutes. The expense for these unnecessary transfers exceeded $4.6 million., Conclusions: This is the first intervention-based study evaluating the impact of unnecessary transfer for evaluation of hand and facial emergencies. Using a framework based on objective outcomes, the authors found that fewer than one-third of patients required emergent transfer for evaluation by a plastic surgeon, and almost half did not receive an intervention following transfer. Based on patient time and financial expenses for these unnecessary evaluations, improvements could be made in both quality and cost of care by limiting inappropriate emergency department referrals.

Motivation: Occupational injuries cause short-term, direct costs as well as long-term follow-up costs over the lifetime of the casualties. Due to shrinking budgets accident insurance companies focus on cost reduction programmes and prevention measures. For this reason, a decision support system for consequential cost calculation of occupational injuries was developed for the main Austrian social occupational insurance institution (AUVA) during three projects., Methods: This so-called cost calculation tool combines the traditional instruments of accounting with quantitative methods such as micro-simulation. The cost data are derived from AUVA-internal as well as external economic data sources. Based on direct and indirect costs, the subsequent occupational accident costs from the time of an accident and, if applicable, beyond the death of the individual casualty are predicted for the AUVA, the companies in which the casualties are working, and the other economic sectors., Results: By using this cost calculation tool, the AUVA classifies risk groups and derives related prevention campaigns. In the past, the AUVA concentrated on falling, accidents at construction sites and in agriculture/forestry, as well as commuting accidents. Currently, among others, a focus on hand injuries is given and first prevention programmes have been initiated. Hand injuries represent about 38% of all casualties with average costs of about 7,851 Euro/case. Main causes of these accidents are cutting injuries in production, agriculture, and forestry. Beside a low, but costly, number of amputations with average costs of more than 100,000 Euro/case, bone fractures and strains burden the AUVA-budget with about 17,500 and 10,500 € per case, respectively., Conclusion: Decision support systems such as this cost calculation tool represent necessary instruments to identify risk groups and their injured body parts, causes of accidents, and economic activities, which highly burden the budget of an injury company, and help derive countermeasures to avoid injuries. Target-group specific, suitable prevention measures for hand injuries can reduce accidents in a cost-effective way and lower their consequences., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hand injuries are very common, especially in young adults of working age, and the consequences of these accidents on work capacity are significant: for the patient, a seemingly simple wound can cause prolonged time off work and jeopardize the pursuit of his career; for the community, the financial burden is colossal, mainly because of compensation, which represents 80% of the total cost (time off work and indemnity for sequelae). While substantial progress have been made in the prevention of occupational accidents, which account only for one third of hand injuries, improving the management of hand trauma should be undertaken through a better organization of existing resources and in particular: the prevention of domestic accidents, the orientation of the patients to an appropriate hand trauma center and patient coaching systematically when time off work exceeds three months. These measures have been shown in the literature to greatly improve the rate and speed of return to work.

Hand injuries are some of the most commonly treated injuries at trauma emergency services. Their treatment may be costly and even more so when inappropriate treatment results in complications. The amount paid for the treatment of this kind of injuries may increase dramatically if one considers the direct costs (medical care) and the indirect costs (compensation-loss of profits) resulting from the severity of damage and its sequelae. The objective of this paper is to reveal certain figures that help measure the economic impact that these injuries represent and find ways to optimize resources, minimize costs and improve the care of these patients.

Objective: We evaluated work-related injuries involving a hand or fingers and associated costs among a cohort of 24,830 carpenters between 1989 and 2008., Methods: Injury rates and rate ratios were calculated by using Poisson regression to explore higher risk on the basis of age, sex, time in the union, predominant work, and calendar time. Negative binomial regression was used to model dollars paid per claim after adjustment for inflation and discounting., Results: Hand injuries accounted for 21.1% of reported injuries and 9.5% of paid lost time injuries. Older carpenters had proportionately more amputations, fractures, and multiple injuries, but their rates of these more severe injuries were not higher. Costs exceeded $21 million, a cost burden of $0.11 per hour worked., Conclusions: Older carpenters' higher proportion of serious injuries in the absence of higher rates likely reflects age-related reporting differences.

Background: To study costs and outcome for serious hand and arm injuries during the first year after the trauma., Methods: In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work., Results: The majority of the 45 included patients (median 42 years 16-64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury]., Conclusions: Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure.

Background: Diagnosis-Related Groups (DRG) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis, we compared the Austrian and the German DRG systems., Method: The 15 most common hand surgical diagnoses and their corresponding operative treatment were transferred into the Austrian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared., Results: The mean values and the median values of the upper and lower thresholds of length of stay as well as the average length of stay were all lower in Austria compared to Germany. Reimbursement in Germany was higher in 13 of 19 cases. Total proceeds amounted to 1.67 million in the German and 1.70 million in the Austrian health care system. Considering the purchasing power applying consumer prize parities, the difference of reimbursement between the countries rose to 130,000 which equals a difference of almost 8%., Conclusion: Reimbursement of the top 15 diagnoses in hand surgery in Austria is 8% higher than in Germany. Except for one case, mean values as well as upper and lower thresholds of length of stay are considerably shorter in Austria. Comparison of international data to refine a national compensation system is advocated.

Background: This study prospectively evaluated compliance and outcomes after rotator cuff repair in patients with and without Workers' Compensation claims., Materials and Methods: From December 2007 to January 2010, 42 consecutive patients with Workers' Compensation claims (Work Comp group), and 50 consecutive patients without a Workers' Compensation claim (non-Work Comp group) underwent arthroscopic rotator cuff repair and were enrolled in this study. Compliance with a postoperative protocol of shoulder immobilization and physical therapy was documented. Patients were monitored clinically for a minimum of 12 months., Results: Noncompliance with protocol was documented in 22 of 42 patients (52%) in the Work Comp group compared with 2 of 50 (4%) in the non-Work Comp group (P < .001). The Work Comp group had less improvement in preoperative to postoperative outcome scores for the American Shoulder and Elbow Surgeons (ASES) score (40.4 to 60.1), Simple Shoulder Test (SST) score (3.9 to 6.0) and visual analog scale (VAS) for pain (7.0 to 3.5) compared with the non-Work Comp group (ASES, 41.7 to 89.2; SST, 4.3 to 10.7; VAS, 6.2 to 0.35; P < .0001). The compliant Work Comp patients had more favorable results in final outcome scores (ASES, 73.1; SST, 7.9; VAS, 1.5) than noncompliant Work Comp patients (ASES, 48.4; SST, 4.3; VAS, 5.3; P < .0001)., Conclusions: Patients with Workers' Compensation claims demonstrated a high rate of postoperative noncompliance (52%) compared with patients without Workers' Compensation claims (4%) after rotator cuff repair. Those Workers' Compensation patients who had no evidence of noncompliance had significant improvements and more favorable outcomes than the noncompliant Workers' Compensation patients., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Background: Injuries to the hand and wrist account for approximately 20% of patient visits to emergency departments and may impose a large economic burden. The purpose of this study was to estimate the total health-care costs and productivity costs of injuries to the hand and wrist and to compare them with other important injury groups in a nationwide study., Methods: Data were retrieved from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry, and from a patient follow-up survey conducted between 2007 and 2008. Injury incidence, health-care costs, and productivity costs (due to absenteeism) were calculated by age group, sex, and different subgroups of injuries. An incidence-based cost model was used to estimate the health-care costs of injuries. Follow-up data on return to work rates were incorporated into the absenteeism model for estimating the productivity costs., Results: Hand and wrist injuries annually account for $740 million (in U.S. dollars) and rank first in the order of most expensive injury types, before knee and lower limb fractures ($562 million), hip fractures ($532 million), and skull-brain injury ($355 million). Productivity costs contributed more to the total costs of hand and wrist injuries (56%) than did direct health-care costs. Within the overall group of hand and wrist injuries, hand and finger fractures are the most expensive group ($278 million), largely due to high productivity costs in the age group of twenty to sixty-four years ($192 million)., Conclusions: Hand and wrist injuries not only constitute a substantial part of all treated injuries but also represent a considerable economic burden, with both high health-care and productivity costs. Hand and wrist injuries should be a priority area for research in trauma care, and further research could help to reduce the cost of these injuries, both to the health-care system and to society.

A typical consultation is based on a phone conversation between the consulting service and the surgeon. If the description given to the surgeon misrepresents the severity of the condition, unnecessary transfer of the patient could follow. In an attempt to reduce the occurrence of unnecessary transfers, we started supplementing our consultation with video captured with a cell phone camera demonstrating specific points in clinical examination of the hand. These videos were sent to the surgeon to clarify the clinical picture. We found this method useful in some cases in ruling out the need for urgent transfer.

Diagnosis-Related Group (DRG) is a classification system, which groups patients according to their diagnosis and resource consumption. Common hand surgical diagnoses and procedures were processed using national DRG-groupers of six European countries. The upper thresholds of length of stay (LoS) are indicated for every country with the exception of Spain. The mean value in the series was 9.9 days for Germany, 4.5 days for Austria, 10.7 days for Italy, 9.7 days for Sweden and 9.4 days for the United Kingdom (UK). Germany and Austria also have lower thresholds of LoS and the average LoS.Multiple finger replantation presented the highest single case reimbursement in Germany, Austria and the UK (13,825 €, 10,576 € and 9,198 €). Scaphoid non-union had the highest single case reimbursement in Italy (2,676 €), flap coverage of wounds in Spain (5,506 €) and trapeziometacarpal arthritis in Sweden (5,350 €). The mean values for single case reimbursement were as follows: Germany 3,211 €, Austria 2,821 €, Italy 1,947 €, Spain 3,594 €, Sweden 2,403 € and the UK 3,253 €. Ten out of 19 cases showed the highest reimbursement in Spain, followed by the UK (5 cases), Sweden (2 cases), Germany and Austria (1 case each). Applying the case numbers of our clinic to the reimbursement system of each country, total proceeds would be 2.25 million € in Spain, 1.79 million € in Germany as well as the UK, 1.75 million € in Austria, 1.63 million € in Sweden and 1.22 million € in Italy. The consequences of international differences in efficiency and reimbursement are hard to assess as they are influenced by multiple factors that are seldom purely market-driven. However, the consideration of international data for benchmarking and refinement of national compensation systems should be a useful instrument.

Since the introduction of Diagnosis Related Groups (DRGs) in 2004 in Germany the variables of remuneration changed continuously. Subjectively, reimbursement of DRG in hand surgery has a negative connotation among colleagues. We analyzed the development of reimbursement as well as the length of stay of inpatients over time in Hand Surgery considering various parameters concentrating on trends and correlation with macroeconomic parameters. The Top 10 diagnoses and therapies between 2004 and 2010 in our clinic were grouped and resulting DRGs with further linked data could be obtained. In addition to the Base Rate the Pay Base Rate (the effective Base Rate in a certain hospital considering compensatory payment) and the Z-Bax (the value that was reimbursed by the national health insurance per Base Rate) were used to calculate reimbursement. These were multiplied with the number of cases treated in 2009 obtaining the different total annual remuneration. The lower threshold of length of stay was constant over time, the middle length of stay became shorter in most of the Top 10 diagnoses whereas the upper threshold of length of stay was reduced to half of the time. The Base Rate and the Pay Base Rate increased by the end of the period but were outmatched by the Z-Bax as an indicator for the general level of reimbursement in Germany. Total remuneration between 2004 and 2009 was compared applying the Z-Bax and the Base Rate as well as the Pay Base Rate, respectively. For the latter, a surplus of 244 000 Euros and 311 000 Euros were calculated, respectively. No correlation with the Gross National Product or the Rate of Inflation could be found. The Pay Base Rate as the rate of effective payment in our clinic declined by 7% whereas the consumer price index gained 8,6% resulting in a loss of purchasing power of almost 16% in a 6-year period., (© Georg Thieme Verlag KG Stuttgart · New York.)

We estimated costs associated with injuries to hands from log splitters and circular saws used to cut up firewood and assessed the value of prevention. The study was carried out as a cost of illness study with an incidence approach based on 57 consecutive patients (median age 51; range 8-81) with injuries to the hand or forearm. Twenty-six of the 57 had an amputation which required microsurgery and 31/57 had various injuries. Median Hand Injury Severity Score (HISS) reflecting the severity of all injuries was 67 (range 6-332). Median DASH score after 2-7 years was 12.5 (0-73.3). Total cost (direct costs, costs of lost productivity, and lost quality of life) was estimated to roughly EUR 14 million (EUR 2.8 million/year), where the cost of lost quality of life is 82% of the total cost and loss of productivity and direct costs are 9% each. Injuries sustained from log splitters and circular saws account for considerable costs, but first and foremost human suffering.

Background: Hand injuries by labor accidents are first rank. It is necessary to have a multidisciplinary medical approach to frequently generated temporary and permanent disabilities that affect costs to an institution and to enterprise., Objective: To determine the direct cost (DC) and the indirect cost (IC) of complete and partial amputations in hand caused by labor injuries., Methods: An observational study was performed. The data was obtained from labor injuries with amputation of a finger or hand that received multidisciplinary management. The costs were calculated according to the list of Institutional Unit Costs. The IC were obtained with the "safety pays" program., Results: We included 48 cases. The average age was 32.17 years; the cost of surgical operations was $767,470; and the payment of a partial disability permanent was $1,032,670; the DC of the sample of 48 workers was $2,955,007 with an IC of $3,250,507 and a total cost of $6,205,515, the average cost per worker of $51,741 for DC, $56,915 for IC and $108,657 for the total cost., Conclusions: Costs of hand injures requires the creation of prevention programs.

We conducted this study to evaluate the hypothesis that the need for a higher level of care is the most important reason for the transfer of patients with hand trauma to a level I trauma center. We prospectively assessed 53 patients transferred to our level I trauma center for evaluation of an acute hand injury. Specialty of referring physician, case complexity as assessed with visual analog scale, and patient insurance status were obtained before transfer and were reassessed after arrival. Only 9 patients were examined by a surgeon before transfer. On the basis of injury severity, we judged that 40 of the 53 patients required the immediate care of a hand surgeon but that only 13 required the resources of a level I trauma center. Most of the patients were transferred without prior evaluation by a hand surgeon, despite there being an on-staff surgeon at many of the hospitals.

Background: While use of biocomposite temporary dressings in burn wounds is common practice, the complex anatomic structures of the hand make this treatment option challenging. For this reason, the Biobrane ((R)) Glove (Smith&Nephew) has been developed. However, limited information regarding burn treatment with Biobrane ((R)) Gloves can be found in the literature., Patients and Methods: Functional and cosmetic outcomes of 13 second degree burn wounds of the hand in 10 patients treated with Biobrane ((R)) Gloves were evaluated using the Vancouver scar scale (VSS) and the DASH-score (disabilities of the arm, shoulder and hand). We evaluated wound healing times and questioned patients about pain related to Biobrane ((R)) Glove treatment in comparison to conventionally managed second degree burn wounds in other parts of the body and about acceptance of Biobrane ((R)) Glove treatment. In addition, we estimated the costs for use and wound management time for both Biobrane ((R)) Glove treatment and conventional wound management for 14 days., Results: Burn wounds treated with Biobrane ((R)) Gloves had excellent functional and cosmetic outcomes [DASH score median of 0 (min. 0; max. 3.33) and VSS median of 3 (min. 0; max. 5)]. Wound healing times were lower (mean 9 days). According to patients' response to overall acceptance, 90% responded as being "very satisfied" with Biobrane ((R)) Glove treatment and 75% responded that Biobrane ((R)) Glove treatment was "much less painful" compared to conventional burn management. The material costs of the Biobrane ((R)) Glove treatment, over 14 days, were approx. double compared to conventional wound management costs. In contrast, the time required for conventional wound management over 14 days was four times longer than for treatment with Biobrane ((R)) Gloves. Thus, taking personnel expenses into consideration, total costs of Biobrane ((R)) Glove treatment are comparable to those of conventional wound management., Conclusion: Biobrane ((R)) Glove treatment of hand burns resulted in excellent functional and cosmetic outcomes, reduced pain compared to conventional wound management and high overall patient satisfaction. In conjunction with a significant reduction in wound management time, the Biobrane ((R)) Glove is an important and cost neutral tool in the treatment of second degree burn wounds of the hand.

Purpose: Injuries from electric saws cause considerable hand trauma. This study is designed to provide information detailing the costs of these injuries., Methods: The study was performed in a tertiary referral academic medical center. The records of patients injured by electric table saws were reviewed. Information regarding demographics, injury severity, medical expense, and time lost from work was analyzed. The patients were stratified by injury severity for further analysis. The mean wage for the region was used to estimate costs of time away from work. The Consumer Protection Agency's review was used to estimate the nationwide burden of these injuries., Results: The study group included 134 patients. Of these patients, 126 were male and 8 were female. The dominant hand was injured in 20; the nondominant, in 114. The mean age was 47.0 years. The mean time lost from work was 64 days. The mean cost of medical expenses for all patients was $22,086, with $8,668 in lost wages, for a total of $30,754 mean cost per injury. The total economic burden for the injuries in this study is $4,121,097. These injuries represent a spectrum of severity, with minor injuries incurring lower hospital fees and requiring less time off work as compared to more involved injuries., Conclusions: Electric saws cause a wide spectrum of injuries that result in not only tremendous physical and emotional pain but also substantial economic impact as well. Technologies that would prevent such injuries would be a socioeconomic advancement. Federal mandates to implement such technologies should be encouraged.

Background: Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996-2003., Methods: Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed., Results: Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days., Conclusion: The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.

Outcomes research in hand surgery provides patients and providers with objective, reliable information to assist in making medical decisions. Endpoint measures in outcomes research and the instruments used to evaluate these endpoints are often specific to a particular disease or region. Hand surgery has many different measurable outcomes that can be used to monitor the quality of surgical practice, inform practice guidelines, and aid in the appropriate allocation of healthcare resources. In this article, we review some research techniques available to study the following surgical outcomes of the hand: national trends in surgical care, surgical complications, objective measures of hand function, patient-reported measures of hand function, and economic burden.

Background: The US has a crisis of insufficient emergency coverage for hand trauma. One of the problems is the perceived financial loss associated with caring for this population. We evaluated the financial impact of treating emergency hand trauma patients on an academic medical practice and health care system., Study Design: We examined billing records for 2,632 hand patients seen in the emergency department in 2005 at the University of Michigan. Financial data were separated into inpatient professional and facility revenues and costs. Professional net revenue was calculated by applying actual collection rates to procedural charges. Facility revenue was calculated by applying actual collection rates to the following downstream charge categories: inpatient/operating room (including nursing, anesthesia, and pharmacy), clinic facility, radiology, and occupational therapy., Results: The payer mix for this analysis was 60.7% private insurance, 15.3% Medicare, 4.2% uninsured, 8.3% Medicaid, and 11.5% other. The net professional revenue and total costs for physician salary, malpractice, and benefits allocated to hand patients were $698,578 and $574,880, respectively, for a net profit margin of $123,698 (18%). Net health system facility revenue and total costs were $2,420,899 and $2,389,901, respectively, for a net profit margin of $30,998 (1%)., Conclusions: Hand trauma at this academic medical center is fiscally advantageous for the surgical department and marginally advantageous for the health care system. Providing access to hand trauma patients may be fiscally advantageous in certain settings when the proportion of nonreimbursed care can be controlled.

The investigation was carried out on 1199 patients treated for hand injuries in the II Department of Surgery of the Jagiellonian University between years 1987-2000. There were 225 patients injured while working with circular saw. These injuries were much more severe than others (p < 0.001) and patients with these injuries were more often (p < 0.001) admitted to the clinic. The length of total treatment was considerably longer (p < 0.001) and final results--worse than in other patients (p < 0.001)--permanent hand disability was almost three times larger. Disability pension was given to these patients much more frequently than to others (p < 0.001). The main reason of these injuries seems to be the common use of home-made circular saws without any protection devices and non-conformity to fundamental rules of work security. Patients with extensive multitissular hand injuries should be treated in specialistic centers of hand surgery, where the final results can be improved and the total costs of treatment considerably reduced.

This paper discusses the four aspects, which need attention if the management of hand injury is to improve globally. These areas include the provision of information, targeted education, relevant and well-supported audit and research and the improvement of infrastructure. The paper explores what needs to be done, the time frame for improvement and how this may be achieved. The strategy developed needs to remain sensitive to the local needs and capacity.

Hand injuries are important causes of impairment in the United States. They are one of the top causes for days lost from work and they impose a great economic burden on the country. In less affluent regions of the world, the impact of hand injuries on the population is even more dire, rendering the affected to life-long disability. When one considers that 85% of the world's population lives in low to middle income countries, the global deleterious effect of hand trauma becomes apparent. This paper is a review of pertinent literature available on the provision and delivery of trauma care around the world. While specific reference to hand surgery care is sparse, we will infer trauma management in these countries, synthesised from available literature, to the provision of hand surgery care. We will also examine programs around the world that are implemented at an affordable cost to the respective countries.

Injuries of the hand are common accounting for around a fifth of all emergencies presenting to emergency departments of most hospitals. Their treatment costs. Those that require more reconstruction, theatre time, stay in hospital and after care cost more. In the UK, over 100 million pounds is being spent per year in treating these injuries. However indirect expense to the patients and the consequences of permanent disability are seldom considered. This review discusses the direct and indirect costs of hand injury, the ability of countries to pay these costs and suggests some ways of minimising these costs.

Background: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment., Methods: Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs., Results: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%)., Conclusions: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.

Purpose: To assess the demographic patterns, clinical morbidity, and treatment costs associated with domestic animal bites to the hand., Methods: A retrospective review was performed on 111 patients who suffered either a dog or cat bite to the hand. Demographic data were collected for both the patient and the animal involved., Results: The patient population had suffered 71 dog bites and 40 cat bites. Two scenarios were identified that increased the likelihood of a bite: (1) attempting to separate fighting animals and (2) attempting to aid an injured animal. More than half of the victims (61 of 111) were bitten by an animal with which they were familiar. Bite injuries ranged from relatively minor wounds to major injuries that included open fractures, persistent deep infection including osteomyelitis, nerve laceration, tendon laceration, or tissue loss. Approximately two thirds of patients required hospital admission at least for intravenous antibiotics. Approximately one third of animal bite victims required at least 1 surgical procedure. Thirteen patients required long-term intravenous antibiotics and/or multiple surgeries and incurred medical expenses in excess of dollar 77,000., Conclusions: Domestic animal bites to the hand are common injuries that can produce considerable morbidity. Stray animals did not account for the majority of incidents. Bite prevention strategies should focus on careful handling of animals that are fighting or injured. Animal bite wounds often require intravenous antibiotics and hospitalization and the cost of care for deep infections can be enormous. Our patient population was selected from a small geographic area over a relatively short collection period, suggesting that domestic animal bite injuries may represent a major public health issue., Type of Study/level of Evidence: Prognostic, Level IV.

Material and Methods: Based on the materials of 134 adolescent patients (age 15-19) with hand injuries treated in the II Department of Surgery of the Jagiellonian University between 1987-2000 results of treatment were described. The adolescents constituted 11.8% of all patients treated due to hand injuries., Results: Home was the most common place of the accident (59 patients - 44.01%), and the most common mechanism of injury was cutting by the glass or another sharp tool (61 patients - 45.52%). The mild and moderate injuries predominated (112 patients - 83.58%). 39 patients (29.10%) were treated after alcohol abuse; unfortunately. 35 patients (26.12%) were hospitalized from 1 to 24 days (av. 7.14 days). Time to obtain complete recovery reached max. 270 days but av. 55.56 days. Various degree of the persistent limitation of the hand function were observed in 65 patients (48.5%). Two of them (1.49%) got the disability pension and 8 (5.77%) had to change former job and activities., Conclusion: The time of the complete cure could be shorter and the extent of persistent post-traumatic impairment of the patients with the heavy hand injuries could be limited if they would be treated in the specialized centers for hand surgery.

1287 patients were treated due to hand injuries from 1987 to 2001 in the 2nd Department of Surgery in Cracow. Long-term follow-up was performed in 1071 patients (83.22%). Objective assessment of function was evaluated on the basis of Swansons examination protocol. Long-term follow-up examinations of 626 patients (58.45%) demonstrates different level of persistent hand disability. The level of hand impairment ranged between 1-100% with the average of 13.6%. This study demonstrates a statistically significant correlation (p < 0.001) between severity of injuries, place of accident, mechanism of injuries and severity of hand impairment. The most severe injuries and disability were caused by mechanical equipment and were incurred by farmers and workers in the place of employment. The level of hand impairment were determined on the basis of the patient's ability to return to previous work. This study demonstrated a statistically significant association (p < 0.001) between the increasing posttraumatic hand impairment and decreasing probability of returning to pre-injury profession. Concluding, severe hand injuries should be treated in the specialist hand surgery centers. Such proceedings allow to minimize the extend of the permanent post-injury disability and increase of better results of the treatment.

The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.