Evaluation Of Clinical And Cost Analysis Of Patients Applying To The Emergency Service With Extensor Tendon Incision In The Upper Extremity

Abstract

ABSTRACT Bacground/Aims: Hand trauma is common in emergency departments, with approximately 20% of regional traumas involving hand injuries. Extensor tendon lacerations, often caused by sharp objects, are frequently encountered but may be overlooked, leading to significant morbidity. This study aims to retrospectively review cases of extensor tendon lacerations in the upper extremities to highlight the importance of thorough evaluation and management in the emergency department. Methods: A single-center retrospective study included 114 patients presenting to the emergency department with extensor tendon lacerations. Data on patient demographics, injury characteristics, treatment, complications, and costs were collected and analyzed. Statistical analysis was performed using SPSS version 26.0. Results: The majority of patients were male adults, with sharp objects such as knives being the most common cause of injury. Extensor tendon repairs were predominantly performed in the emergency department, with complications observed in 14.9% of cases. The mean cost of treatment was $255.97. Factors influencing the decision to perform repair in the operating room included patient age, injury characteristics, and associated injuries. Conclusions: Extensor tendon lacerations in the upper extremities represent a significant burden in emergency departments. Our findings emphasize the importance of thorough evaluation and timely management to prevent missed diagnoses and optimize patient outcomes. Repairing extensor tendon injuries in the emergency department can be cost-effective and efficient, but careful consideration of patient and injury factors is necessary to determine the most appropriate treatment setting.

Keywords

• Extensor Tendon Incısıon
• Upper Extremities
• Cost Analysis

Supporting Institution

no

Ethical Statement

Ethics Committee Approval: Ethics committee approval was obtained from the Clinical Ethics Committee of our 3rd Level Training and Research Hospital (dated 10/08/2021 with the Ethics Committee No. KAEK/2021.05.88), and the study was started. The entire study was conducted in accordance with the Declaration of Helsinki.

Thanks

We want to thank the Emergency Medicine and Orthopedics Clinics staff of our hospital for their contribution to our study.

Üst Ekstremite Ekstansör Tendon Kesisi İle Acil Servise Başvuran Hastaların Klinik ve Maliyet Analizinin Değerlendirilmesi

Abstract

ÖZET Amaç El travması acil servislere sık başvuru nedenleri arasındadır. Bölgesel travmaların yaklaşık % 20'si el yaralanmalarını içermektedir. Genellikle keskin nesnelerin neden olduğu ekstansör tendon kesileri sık karşılaşılan ancak gözden kaçabilen, ciddi morbiditeye yol açabilen yaralanmalardır. Bu çalışma, acil serviste kapsamlı değerlendirme ve yönetimin önemini vurgulamak için üst ekstremitelerdeki ekstansör tendon kesisi vakalarını retrospektif olarak gözden geçirmeyi amaçlamaktadır. Yöntemler Ekstansör tendon kesisi nedeniyle acil servise başvuran 114 hasta tek merkezli retrospektif olarak çalışmaya dahil edildi. Hasta demografisi, yaralanma özellikleri, tedavi, komplikasyonlar ve maliyetlere ilişkin veriler toplandı ve analiz edildi. İstatistiksel analiz SPSS 26.0 versiyonu kullanılarak yapıldı. Bulgular Hastaların çoğunluğu yetişkin erkekti ve yaralanmaların en yaygın nedeni bıçak gibi keskin nesnelerdi. Ekstansör tendon onarımları ağırlıklı olarak acil serviste yapıldı ve vakaların %14,9'unda komplikasyon görüldü. Ortalama tedavi maliyeti 255,97 dolardı. Ameliyathanede onarım yapma kararını etkileyen faktörler arasında hastanın yaşı, yaralanma özellikleri ve ilişkili yaralanmalar yer alıyordu. Sonuç Üst ekstremitedeki ekstansör tendon kesileri acil servislerde önemli bir yük oluşturmaktadır. Bulgularımız, gözden kaçan tanıları önlemek ve hasta sonuçlarını optimize etmek için kapsamlı değerlendirme ve zamanında yönetimin önemini vurgulamaktadır. Acil serviste ekstansör tendon yaralanmalarının onarılması uygun maliyetli ve verimli olabilir, ancak en uygun tedavi ortamının belirlenmesi için hasta ve yaralanma faktörlerinin dikkatli bir şekilde değerlendirilmesi gereklidir.

Keywords

• Maliyet analizi
• Ekstansör tendon kesisi
• Üst ekstremite

References

1. 1. Jarvik JG, Dalinka MK, Kneeland JB. Hand injuries in adults. Semin Roentgenol. 1991; 26:282–299.
2. 2. van Leerdam RH, Krijnen P, Panneman MJ, Schipper IB. Incidence and treatment of hand and wrist injuries in Dutch emergency departments. Eur J Trauma Emerg Surg. 2022 Dec;48(6):4327-4332. doi: 10.1007/s00068-021-01732-x.
3. 3. Moellhoff N, Throner V, Frank K, Benne A, Coenen M, Giunta RE, Haas-Lützenberger EM. Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients. Arch Orthop Trauma Surg. 2023 Mar;143(3):1715-1724. doi: 10.1007/s00402-022-04617-9.
4. 4. Angermann P, Lohmann M. Injuries to the hand and wrist: a study of 50,272 injuries. J Hand Surg. 1993;18B:642– 644.
5. 5. Thai JN, Pacheco JA, Margolis DS, Swartz T, Massey BZ, Guisto JA, Smith JL, Sheppard JE. Evidence-based Comprehensive Approach to Forearm Arterial Laceration. West J Emerg Med. 2015 Dec;16(7):1127-34. doi: 10.5811/westjem.2015.10.28327.
6. 6. Morrison CM, Thompson NW, Herbert KJ, Brennen MD. Missed injuries in the acutely traumatised hand. Ulster Med J. 2003 May;72(1):22-5.
7. 7. Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014 Sep;64(3):292-8. doi: 10.1016/j.annemergmed.2014.03.025.
8. 8. Campbell E, Pillai S, Vamadeva SV, Pahal GS. Hand tendon injuries. Br J Hosp Med (Lond). 2020 Nov 2;81(11):1-14. doi: 10.12968/hmed.2020.0141.

9. 9. Lopez MJ, Markel MD. Monopolar radiofrequency energy application to the dorsal extensor tendon apparatus in a canine model of tendon injury. J Hand Surg Am. 2006 Oct;31(8):1296-302. doi: 10.1016/j.jhsa.2006.07.008.
10. 10. Broback L-G, Ekdahl p-H, Aschan GW, Grenabo JK. Clinical and Socio-Ekonomical aspeckt of hand injuries. Acta Chir Scand 1978; 144:455.
11. 11. Baltzer HL, Hawker G, Pequeno P, Victor JC, Krahn M. A population-based study of the direct longitudinal health care costs of upper extremity trauma in patients aged 18-65 years. CMAJ Open. 2023 Jan 10;11(1):E13-E23. doi: 10.9778/cmajo.20210118. Erratum in: CMAJ Open. 2023 Feb 14;11(1):E169.
12. 12. Bai RJ, Zhang HB, Zhan HL, Qian ZH, Wang NL, Liu Y, Li WT, Yin YM. Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture. Chin Med J (Engl). 2018 May 5;131(9):1051-1058. doi: 10.4103/0366-6999.230721.
13. 13. Kumar K. Scenario of hand fractures in a tertiary hospital: a prospective study. Musculoskelet Surg. 2013 Apr;97(1):57-60. doi: 10.1007/s12306-012-0231-2.
14. 14. Gupta A, Gupta AK, Uppal SK, Mittal RK, Garg R, Aggarwal N. Demographic profile of hand injuries in an industrial town of north India: a review of 436 patients. Indian J Surg. 2013 Dec;75(6):454-61. doi: 10.1007/s12262-012-0536-2.
15. 15. Singer M, Maloon S. Flexor tendon injuries: the results of primary repair. J Hand Surg Br. 1988 Aug;13(3):269-72. doi: 10.1016/0266-7681_88_90083-6.
16. 16. Türker T, Hassan K, Capdarest-Arest N. Extensor tendon gap reconstruction: a review. J Plast Surg Hand Surg. 2016;50(1):1-6. doi: 10.3109/2000656X.2015.1086363.
17. 17. Aulicino PL. Acute injuries of the extensor tendons proximal to the metacarpophalangeal joints. Hand Clin. 1995 Aug;11(3):403-10.
18. 18. Wahl EP, Huber J, Richard MJ, Ruch DS, Mithani SK, Pidgeon TS. Patient Perspectives on the Cost of Hand Surgery. J Bone Joint Surg Am. 2021 Nov 17;103(22):2133-2140. doi: 10.2106/JBJS.20.02195. PMID: 34424868.
19. 19. Toros T, Isin BK, Erol K, Cetinkol E. Role of ultrasonography for evaluation of nerve recovery in repaired median nerve lacerations. J Hand Surg Eur Vol. 2023 Sep;48(8):725-730. doi: 10.1177/17531934231174603. Epub 2023 May 19. PMID: 37203386.