Management of Hand Injuries: a Six-year Experience from Komfo Anokye Teaching Hospital, Kumasi, Ghana

Abstract

Background: Hand injuries can ruin patients’ ability to work with their hands. This could lead to depression and social isolation. It is imperative that hand injuries be reconstructed to as near normal as possible.
Patients and Method: A prospective study was undertaken from January 2005 to December 2010 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana to document the pattern of hand injuries, and the outcome of management. The patients were evaluated clinically. Wound debridement was done; the defects were repaired using reconstructive techniques matched to the type of injury.
Result: Ninety-five patients (71 males) were treated. Male: female ratio was about 3:1. Their ages ranged from 2 to 60 years with mean (± SD) of 29.5 (± 12.9). Of the 102 hands injured, 52 were right. The right was the dominant hand in 65%. Both dominant and nondominant hands were injured equally. 5% of the injuries were isolated; 95% were combined. The distribution of mechanisms of injuries was as follows: avulsion, sustained through road traffic accidents (37%), crush injuries (25. 3%), sharp injuries (including spaghetti wrists) (19%) machine mangling (11%), burns (8.4%), blunt injuries (15%), human bites (2.1%), snake bite (1.1%), gunshot (4.2%), and injection injuries (2.1%). Patients’ occupations were: farmers 23%, mechanics (20%), traders (11%), factory workers (5%), followed by 2% each of teachers, electricians and civil servants, and 1% each of drivers and pastors; 5% were unemployed. Of
the remainder, 16 % were children and 11% students. Surgical procedures performed were groin flap (30%), exploration and repair (24%), skin grafting (21%), debridement alone (13%) cross finger flap (7%). decompression of carpal tunnel,(3%) and terminalisation
(2%)
Conclusion: Severe hand injuries requiring reconstructive surgery were sustained through road traffic accidents Farmers, traders, mechanics and children are at risk of severe combined hand injuries.