Early Versus Delayed Surgical Treatment in Open Hand Injuries: a Paradigm Revisited

Background: To date it remains unclear if a delayed surgical treatment of open hand injuries after more than 6 h may be detrimental to outcome. Previous investigations by McLain et al. (J Hand Surg Am 16:108-112, 1980 9), Nylen and Carlsson (Scand J Plast Reconstr Surg 14:185-189, 1991 10) could not find statistical proof of correlation between infection rate and delayed surgical treatment after open hand injuries up to 18 h. The current study was designed to investigate the outcome of early versus delayed surgical treatment after open hand injury.

Patients And Methods: A retrospective data analysis of all patients sustaining an open hand injury between January 1 and December 31 2006 was performed. Patients with incomplete data records were excluded. Patients were stratified according to time delay of surgical treatment and injury complexity. Complications, revision rate, and functional outcome were also investigated.

Results: Between January 1 and December 31 2006 a total of 458 patients with open hand injuries were treated at the University Hospital of Berne, Switzerland. The records were retrospectively analyzed and a subgroup of 100 patients were randomly determined for standardized follow-up evaluation. There were no significant differences regarding infection, complication, and revision rate between early (<6 h) and delayed (6-24 h) surgical treatment of open hand injuries. Independently from the time point of surgical treatment, patients with complex injuries and longer operative times had an increased infection rate (p = 0.05) and revision rate (p = 0.003).

Conclusions: Delayed surgical treatment (6-24 h) of open hand injuries did not increase infection or revision rates in open non-devascularizing hand injuries.