Traumatic Hand Injuries presenting to Orthopedic Unit of a Regional Referral Hospital, Oman

Dhar Dinesh1, M.S.Ortho; Nabeel Eltag Karadawi2, MBch

1 Senior Specialist Orthopaedics, Nizwa Regional Referral Hospital, Oman;
2 Medical Officer Orthopedics, Nizwa Regional Referral Hospital, Oman.

Conflict-of-interest statement: The author (s) declare (s) that there is no conflict of interest regarding the publication of this paper.

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Correspondence to: Dinesh Dhar, Senior Specialist Orthopaedics, Nizwa Regional Referral Hospital, Oman.
Email: dinesh612003@yahoo.com
Telephone: +968-92357505

Received: September 23, 2019
Revised: December 15, 2019
Accepted: December 20 2019
Published online: February 28, 2020


Introduction: Hand is a prized component of human body with a unique function and structure. Any injury to this part can lead to significant disability. In the changing mechanized world we see more cases of hand injuries every day of varying patterns. A better understanding of such injuries can help us to identify those individuals at risk, plan proper management protocols and preventive measures in order to reduce the incidence and improve prognosis.

Methodology: This is a retrospective study conducted over period of 12 months (01/01/2018-31/12/2018) in which Ninety cases of hand injuries who presented to our department were included. The clinical notes of these patients were reviewed from the hospital computerized patient data and all relevant information was recorded in the predesigned perform as regards demographic data, occupation place, causes, pattern of injury, and treatment done. HISS (Hand injury severity score) was used for assessment of final functional outcome after analysis of all variables.

Results: Ninety patients (66 males/24 females) with mean age of 26.4years were enrolled in our study. Majority of patients were Omani nationals (85.5%) followed by expatriates (14.5%) with 64 (71.1 %) patients presenting within 03-06 hrs of injury to hospital. Maximum number of injuries 46 (51.1%) were observed during time interval from 07 am to 05 pm during months of September and November. Majority of patients numbering 37 sustained injuries while at work (machine injuries /fall of heavy objects) followed by household and motor vehicle accident (MVA) related injuries. Highest percentage of injuries was observed in household workers 28 (31.2%) followed by unskilled workers 23 (25.5%). The Little finger (25.6%) and ring finger (21.1%) were most commonly injured digits. Distal phalanx was the most commonly involved region of finger. Combined injuries along with Open fractures and dislocations accounted for majority of injuries seen in our study.Final results were good in 44 (48.9%) with moderate grade of HISS in 48 (53.3%) cases.

Conclusion: Hand injuries in this part of world are mainly occupational related injuries which to great extent are preventable. Proper education, training at work place with proper safety measures will help in preventing large number of such injuries.

Key words: Hand Injuries, Demography, Fracture dislocation, Tendon injury

© 2020 The Author (s). Published by ACT Publishing Group Ltd. All rights reserved.

Dinesh D, Karadawi NE. Traumatic Hand Injuries presenting to Orthopedic Unit of a Regional Referral Hospital, Oman.Journal of Gastroenterology and Hepatology Research 2020; 7 (1): 1232-1235 Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/2808


Hand is a complex intricate organ with variety of functions ranging from simple grasp, fine movements, touch sensation and dexterity which constitute important tool in mans day to day living activities. Hand injuries account for 5-10% of all injuries seen in emergency department and 28% of all injuries of musculoskeletal system[1].

Hand injuries when occurring in association with other injuries are often neglected in developing world. Majority of injuries are seen in young adults and affecting dominant hand[2]. These injuries can be functionally disabiling, psychologically crippling and economically disastrous for the patient. The aim of the treatment is to restore function, pain relief and cosmesis so the management of such injuries needs to be precise and comprehensive so as to restore function at the earliest.

The Common causes of hand injuries include machine injuries, sharp objects, falls of heavy weights and motor vehicle accidents (MVA) and the presentation of such injuries can vary from simple lacerations to traumatic amputations[2]. In our hospital we don’t have specialized hand unit so majority of cases of hand injuries are being managed by orthopedic department.

The present study was undertaken with the main objective to evaluate the pattern of hand injuries along with its management, outcome and identify the complications and morbidity caused by these injuries and suggest preventive measures which in future can help to decrease such injuries.


A retrospective cross sectional descriptive study was carried out in the department of orthopedics Nizwa regional referral hospital, Al Dakhliya Governorate, Oman. The study included ninety patients who presented with acute hand injuries from Ist January 2018 to 31st December 2018. Other 12 patients during this period with incomplete documentation and follow up were excluded. For the purpose of of study Hand injury was defined as any injury occurring distal to wrist crease.

Data was collected using combination of electronic hospital case note review, radiographic review and clinical assessment notes and compiled on structured form which included variables: Age, sex, occupation, hand involved, place mode and duration of injury, part of hand involved, type and extent of injury and management modalities. Plain radiographs of hand were obtained in all cases.

Campbell and Kay Hand injury severity score (HISS) was used to assess the severity of Injury[3].

The data was analyzed using SPSS version 16. Descriptive statistics along with percentages of all data was recorded.


Total of ninety patients were included in our study. Males 66 (73.3%) and females 24 (26.6%) out of which majority were Omani nationals (85.5%) followed by expatriates all from Indian subcontinent (14.5%) (Table 1). Age of the patients ranged from 15 to 60 years with maximum number of injuries observed in age group of 21-40 years (Tables 2, 4) with mean age of 26.4 years.

Maximum number of injuries 46 (51.1%) were observed during time interval from 07 am to 05 pm. followed by 32 (35.5%) from 05 pm to 12 midnight and only 12 (13.4%) cases were recorded from 12 midnight to 07 am. Maximum number of cases in our study were recorded in September and November months. As per occupation 23 (25.5%) patients were unskilled workers (labourers, helpers, farm workers), 14 (15%) were skilled workers (mechanics, fitters, welders,painters, plumbers) followed by household workers 28 (31.2%), students 07 (7.8%), employees 02 (2.2%) and others 16 (17.8) (Table 2).

Time of presentation: 64 (71.1%) patients arrived in hospital within 03-6 hours of injury and 14 (15.5%) after 06 hours of injury. Only 05 (5.5%) patients presented in first hour and 08 (8.9%) within 03 hours of injury (Table 3).

Table 1 Socio -Demographic Distribution of patients.
S.noCharacter Number     Percentage
1Gender  Omani Expats Omani/Expat
Male 66 (73.3%)551083.8%/15.1%
Female 24 (26.6%)22291.7% /8.3%
Total9077 (85.5%)12 (13.3%) 
2Age (years)Males  Females  
0-2020 (22.3%) 06 (17.7%) 
21-4033 (36.6 %) 07 (07.8%) 
41-60 or more19 (21.1%) 05 (05.6%) 

Table 2 Distribution of patients according to occupation.
S.no Occupation Number Percentage
1Unskilled workers 2325.50%
2Skilled workers1415.50%
3Household workers2831.20%
4Employees 22.20%
5Student 77.80%
6Others 1617.80%

Table 3 Time interval between Injury and first presentation to hospital.
S.noVariables Number Percentage
1<0-1hrs 55.50%
21-3hrs 88.90%

Patients injured at work place accounted for 37 (41.1%) while 53 (58.9%) patients sustained injuries other than workplace (MVA, door entrapment injuries, glass/ sharp object injuries, etc). Machine and crushing injuries accounted for nearly 27 (30%) of all injuries followed by MVA 10 (11.1%) (Tables 4, 5, 6).

Table 4 Distribution of patients according to cause of Injury.
S.no Mode of Injury NumberPercentage
1MVA 1011.10%
2Machine 1718.90%
3Fall of heavy objects 2022.20%
4Entrapment 1617.70%
5Glass Injuries1213.30%
6Knife Injuries910%
7Animal Bites22.20%
8Others 44.55

Table 5 Distribution of hand Injuries as per age and causative mechanism.
S.noVariable Age GroupTotal
1MVA02 (20%)06 (60%)02 (60%) 10 (11.1%)
2Machine 05 (29.5%)09 (52.9%)03 (17.6%) 17 (18.9%)
3Heavy object06 (30%)10 (50%)04 (20%) 20 (22.2%)
4Knife Injury02 (22.2%)05 (55.61%)02 (22.2%)09 (10%)
5Glass Injury03 (25%)06 (50%)03 (25%)12 (13.3%)
6Entrapment 09 (56.31%)03 (18.7%)04 (25%)16 (17.7%)
7Animal bites 0 (0%)0 (0%)02 (100%)02 (2.2%)
8Others 01 (25%)01 (25%)02 (50%)04 (4.5%)
 Total 26402470

Table 6 Hand Injuries distribution as per site and mechanism.
 VariableLocation of InjuryTotal
workRoad Home Other
1MVA 01 (1.44%) 09 (90%) 0 (0%) 0 (0%)10
2Machine 11 (64.9%) 04 (23.5%) 02 (11.8%) 0 (0%)17
3Heavy object 08 (40%) 04 (20%) 06 (30%) 01 (11.1%)20
4Knife Injury 02 (22.2%) 0 (0%) 06 (66.7%) 01 (11.1%)9
5Glass Injury 04 (33.3%) 02 (16.7%) 05 (41.7%) 01 (8.31%)12
6Entrapment 04 (25%) 03 (18.7%) 09 (56.3%) 0 (0%)16
7Animal bite 0 (0%) 0 (0%) 01 (50%) 01 (50%)2
8Others 01 (25%) 01 (25%) 01 (25%) 01 (25%)4
9Total 312330690

Little finger (25.6%) and ring finger (21.1%) were most commonly involved digits followed by thumb (20%), Index (17.8 %) and middle finger (15.6%) respectively. Distal Phalanx was the most commonly injured phalanx in the digits (Table 7).

In 82 (91.1%) of patients the dominant hand was involved and non dominant in 08 (8.9%) patients. No case of bilateral hand injury was reported in our study (Table 8). Open fracture dislocations was the most common injury sustained followed by tendon injuries (Table 9).

Management: 59 (65.5%) patients were managed non operatively by immobilization, strapping and plaster immobilization. 31 (34.%%) patients were managed operatively (Table 10).

The commonest complication observed was persistent pain with joint stiffness and in 09 patients more than one complication was noted (Table 11). Results were Good in 44 (48.9%) cases (Table 12) with Moderate HISS in 48 (53.3%) cases (Table 13).

Table 7 Site of Injury in the hand as regards position of Phalanges.
S.no Variable Proximal MiddleDistal
1Thumb 07 (38.9%)---------11 (61.1%)
2Index finger 02 (12.5%)05 (31.3%)09 (56.2%)
3Middle finger 01 (7.1%)05 (35.8%)08 (57%)
4Ring finger 03 (15.8%)06 (31.6%)10 (52.6%)
5Little finger 03 (13.4%)08 (35%)12 (52%)

Table 8 Distribution of Injury according to dominant Hand.
  Variable Number Percentage
1Dominant Right 8291.10%
Left 00%
2Non-Dominant Left 88.90%
Right 00%

Table 9 Types of Injuries.
S.no Variable Number Percentage
1.Laceration /Degloving 1718.80%
2.Fracture 2022.20%
3. Amputation 910%
4. Dislocation 1213.40%
5. Tendon Injury 910%
6. Combined Injuries 2325.60%
 Total 90100%

Table 10 Management of patients.
S.noVariable Number Percentage
1Conservative 5965.50%
2Operations 3134.50%
 a. Terminalization /closure929.30%
 b. Fracture stabilization 825.80%
 c. Tendon repair929.30%
 d. Plastic surgical referral516.20%

Table 11 Complications.
S.no variablesNumber
1. Joint stiffness/Ankylosis7
2. Deformity2
3. Persistent pain 10
4. Keloid formation 2
5. Infections 2
6. Late complications 0
7. More than one complication 7
 Total 32

Table 12 Results.
S.no VariableNumber Percentage
1Excellent 2628.90%
2Good 4448.90%
3Poor 2022.20%

Table 13 Severity of hand Injuries.
S.no Grade HISS Number Percentage
2Moderate 21-504853.30%
3Severe 51-1001415.60%


Hand is an important tool used for day to day living which fulfills individuals social and economic responsibilities. Hand injuries are rarely fatal but can lead to serious disability. In this part of world with fast infrastructure development and lot of construction related activities where large number of expatriate workers are employed. Injury remains by far the second main cause of fatalities at 27.3 per 100,000 persons per year[4]. Very little literature is available on hand injuries in this region. The study was undertaken to study patients with acute hand injuries admitted to Nizwa hospital in order to identify risk factors, hand injury prevention and safety recommendations in this country.

In our study young males were predominantly affected (male: female ratio of 07:02) with maximum number of cases (51.2%) occurring during working time. In all expatriate male patients injuries occurred at place of work in contrast to Omani nationals where injuries predominantly were due to other causes not related to work place. The percentage of hand injuries and number of males in our study was lower as compared to other studies[1,4,5]. Work place related injuries among young males (21-40 years) accounted for majority of injuries followed by injuries sustained at home by women and children. Majority of women sustained sharp knife / glass injuries whereas door entrapment injuries were found in children thereby highlighting the importance of safe home environment and education for prevention of such injuries[4,6].

Fall of heavy objects and machine injury were leading causes for hand injury in our study which is same as reported by other authors[2,4,6]. Major risk factors for occupational hand injuries were malfunctioning equipment, working overtime, distraction, rush to finish job, lack of protective measures, inexperience, inattention and unfamiliarity with the job allotted[7,8].

Violence related injuries were not observed in our study in contrast to 10.8% violence (gunshot) related hand injuries by Ihekine et al[5] Camel bites (2.2%) were the only reported animal bites related hand injuries seen which is also reported by other authors from this region[4]. The digits were the most affected site of injury with Little and ring fingers being most affected in comparison to other studies where Index and Middle fingers are most affected[6,9]. The distal phalanx was the most affected part of digit probably due to it being the most exposed part in occupational injuries[10].

Varying patterns of injuries ranging from simple lacerations to amputations were seen in our study but open fractures dislocations were the most common type of injuries observed along with tendon injuries which are similar to as reported in other studies[6,9,10]. The frequency of cases was high during months of September and November in contrast to other studies where incidence is higher during summer[4]. Hospital stay of our cases was on average 5.6 days which is comparable to other series.

The overall results were Good in 48.9% cases. Poor outcome after hand injury usually is result of delayed initial management and in adequate rehabilitation. Our study HISS was found to be Moderate in 53.3% cases which is comparable to other studies from developing world[1,5].


Hand injuries are seen commonly in young males mostly related to occupational hazards of varying types. Awareness and education about safe use of machines at work place along with formulation and implementation of safety protocols in this sector can help in long run to prevent such injuries and thereby reduced disability arising from such injuries. Acute hand injury management curriculum should be made mandatory for all aspiring Orthopedic and plastic surgeons along with setting specialized hand surgery unit in all trauma catering hospitals.

Limitation of Study

This study had limitation of being retrospective with small sample size. More detailed analysis can be done by a prospective study, larger sample size and longer follow up.


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