Epidemiological analysis of hand fractures in a tertiary hospital
Análise epidemiológica das fraturas de mão em um hospital terciário

INTRODUCTION

Accidents that affect the hands are already considered an epidemic, mainly work accidents and those resulting from urban violence, directly affecting the individual’s economic situation and quality of life, often causing absence from work and impairment or even incapacity in daily life activities and practical life activities. There are numerous work-related injuries, resulting from traumas such as burns, erythema, fractures, and crushing.¹

Hands are more vulnerable to fractures than other parts of the body. They constitute approximately 5-20% of all fractures and 40% of upper limb fractures. The underlying causes of these injuries vary considerably according to demographic characteristics².

OBJECTIVE

The involvement of the hand stands out because it is an important anatomical unit when carrying out daily activities. Therefore, treatment aimed at functional recovery is necessary, which depends on the experience and skill of the professional who will perform such a procedure to achieve a satisfactory result³.

METHOD

This is a cross-sectional, analytical study with a quantitative approach, carried out through a retrospective and descriptive analysis of a database from the Instituto Doutor José Frota (IJF), a tertiary hospital located in Fortaleza-CE, between September 2021 and June 2022, regarding hand fractures. The subjects involved in the study were patients with hand fractures admitted to the hospital between January 2018 and June 2022. The study was approved by that institution’s Research Ethics Committee (CEP) under opinion number 5,069,371.

Data for the epidemiological characterization of patients were recorded using an online questionnaire in Google Forms format, in which there were variables such as sex, age group, origin, mechanism of trauma, and hand and bones affected.

Quantitative data were organized in a spreadsheet using the Microsoft Excel 2019 program. Descriptive statistical analyses were performed. Categorical variables were expressed as a percentage or frequency, as well as determination of the p-value, Fisher’s exact test, or Pearson’s Chi-square, with p<0.005 being assigned as data of statistical relevance. The data is presented in tables and graphs.

RESULTS

Two hundred ninety patients participated in the study, 85.7% male and 14.3% female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. Of the patients studied, 148 were from the interior of the state of Ceará (51.6%) and 139 (48.4%) from the capital, as represented in Table 1.

Table 1 - Demographic characteristics of patients with hand fractures at Instituto Doutor José Frota.

Furthermore, according to the data studied, the main trauma mechanism observed was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14% ). Furthermore, 58.8% of patients had their left hand affected, and 38.7% had their right hand, followed by 2.7% who had both hands, as shown in Table 2.

Table 2 - Characteristics related to patients’ hand trauma.

Regarding the mechanism of trauma related to hand fractures, the main attribute was traffic accidents in most age groups. However, for the sample between 40 and 59 years old, there was a predominance of fractures resulting from work accidents (Graph 1).

Graphic 1 - Distribution of trauma mechanisms by age group.

Graphic 1 - Distribution of trauma mechanisms by age group.

Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). It stands out, above all, in patients aged between 20 and 39 years (Graph 2).

Graph 2 - Distribution of fractured bones by age group.

Graph 2 - Distribution of fractured bones by age group.

Graphs 3 to 6 show the distribution of patients by fractured bone and affected finger and hand.

Graph 3 - Distribution of patients with metacarpal fracture by affected finger and hand. MD: right hand; ME: left hand.

Graph 3 - Distribution of patients with metacarpal fracture by affected finger and hand. MD: right hand; ME: left hand.

Graph 4 - Distribution of patients with proximal phalanx fracture by affected finger and hand.

Graph 4 - Distribution of patients with proximal phalanx fracture by affected finger and hand.

Graph 5 - Distribution of patients with middle phalanx fractures by affected finger and hand. MD: right hand; ME: left hand.

Graph 5 - Distribution of patients with middle phalanx fractures by affected finger and hand. MD: right hand; ME: left hand.

Graph 6 - Distribution of patients with distal phalanx fracture by affected finger and hand. MD: right hand; ME: left hand.

Graph 6 - Distribution of patients with distal phalanx fracture by affected finger and hand. MD: right hand; ME: left hand.

DISCUSSION

Among the limbs and their functions in the human organism, one stands out due to the great complexity and roles played, such as the ability to transmit and capture sensations and the performance of delicate movements or those requiring strength. These attributions allow human beings to produce activities necessary for their existence, such as carrying out work activities, perceiving objects in space, communicating, using and building devices, and even defending themselves. This limb in question is the hand, which is made up of 27 bones, various muscles, ligaments, tendons, vessels, nerves, and tissues. However, it is a comparatively fragile structure, in addition to being very exposed and vulnerable to trauma, which can compromise its ability to function⁴.

In this circumstance, the present study showed a higher prevalence of male individuals (85.7%) compared to female individuals (14.3%), which is in agreement with the study by Vieira et al.⁵, which showed a higher prevalence of males at approximately 92.8%, while females were only 7.14%. The data also agree with those of Albuquerque et al.⁶, who described 65.4% of fracture cases in data collected from male patients from the interior of Ceará. In addition, the data obtained in this sample demonstrate that young adults had a higher incidence [138 (47.6%)] compared to other age groups, which converges with the study by Hill et al.⁷, who described an average age of 27.2 years, in addition to the mode of 21 and 25 years and variation between 1 and 93 years of age. However, when comparing with Albuquerque et al.⁶, who analyzed the epidemiological profile of fractures in Ceará, the average age was 40.7 years; a small difference can be seen in the epidemiological profile when compared to data from specific fractures of the hand bones.

Regarding the mechanism of trauma, the data collected indicate that most of them were due to traffic accidents (36.4%), followed by work accidents (26.9%) and shortly after firearm-related events ( 14%) and bladed weapons (7.2%), data that are similar to other existing ones, such as those by Vieira et al.⁵, who presented automobile accidents as the main mechanism of trauma (26.2%), followed by accidents of work (19%). It should be added that traffic accidents were also more prevalent in the study by Fonseca et al.⁸, which obtained a 17.5% prevalence.

To restore anatomy and function after a fracture, it is necessary to undergo treatment, which is determined by the presentation of the fracture, the degree of displacement, and the difficulty in maintaining reduction, but, in general, the majority of hand fractures are well managed with conservative treatment^9,10.

However, in this research, surgical treatment was most observed, in which osteosynthesis with Kirschner wires was mostly the most prevalent, performed in 229 individuals (79%), followed by rigid internal fixation in 27 people (9.3%) and amputation in 18 (6.2%). Conservative treatment (4.5%), closed/open reduction (4.1%), and bone graft (2.8%) were performed less frequently. Surgical treatment with Kirschner wires was used in most of the data collected, following what was also described by Vieira et al.⁵, in which this treatment was performed in more than 88% of cases.

According to the Ministry of Health, in 2015, there were 5.9 million hospitalizations in the Unified Health System (SUS)11 in Brazil’s 20 to 59 age group. Excluding hospitalizations for pregnancy, childbirth, and the postpartum period, males have the highest number of hospitalizations (51%). These data are in line with what was obtained in the current study, which demonstrated that men were the individuals most affected by hand trauma and that the most prevalent age group was between 20-39 years old.

In the current study, the most affected bones were the phalanges, followed by the metacarpals and, finally, the carpal bones. These data follow the study by Jindal et al.¹², in which 75% of the fractures evaluated involved phalanges and metacarpals. Of these, the most affected bones were also the phalanges, with 59%.

CONCLUSION

The present study corroborates the data present in the literature. In this way, the repetition of a pattern of prevalence in young male adults is evidenced, with traffic and work accidents as the main mechanism of trauma, as well as bones affected by hand fractures.