COST OF HAND INJURIES

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COST OF HAND INJURIES
1st European Hand Injury Prevention Congress,
25-27 june 2009 Bursa, Turkey

• Dr Philippe BELLEMERE
• Nantes - France

- Chairman of Hand injury prevention Committee
(Hand Trauma Committee of the FESSH) - President
of the FESUM (Fédération Européennes des Services
dUrgence Main)
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COST OF HAND INJURIES

• What means cost?
• What cost for what injury?
• Why is it a health public problem?
• How to limit the cost?

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What means the cost?

• Medical cost
• Surgery
• Implant
• Inpatient stay
• Medication (pain killer, antibiotic)
• Physiotherapy and orthesis
• Indirect cost
• Time off work
• Lost earnings
• Cost to the employer
• indemnification

Its a difficult work to define the cost
4
Indirect cost ratio

• Raimbeau G (France) Chir Main 200322258-263
• 80 in work related hand injuries
• Trybus M (Poland) Krakow university hospital
  study, 2003
• 96 170 hand injuries cases.
• Ljungberg E Swedish study, 2008
• 14 in young children hand injuries

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What cost for what injury?

• Minor injury
• Frequent
• Not expensive each
• Major injury
• Less frequent
• More expensive

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Cost of minor injury

• Hoxie S. (USA)
• J Hand Surg 200934A886-89
• Electric saw injuries
• minor injuries 34
• Time off work 24 days
• Cost 4200
• Indirect/medical cost 0,93

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Cost of minor injury

• Rosberg et al (Sweden)
• Scand J Plast reconstr Surg Hand Surg
  200539360-369.
• 2500 prospective study hand and forearm
  injuries
• 10 times less than severe injuries

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Cost of major injuries

• Hoxie S. (USA)
• J Hand Surg 200934A886-89
• Severe injuries with no microvascular or tendon
  surgery (fracture, skin )
• Time off work 60 days
• Cost 17 132
• Severe injuries with microvascular or tendon
  surgery (revascularisation, replantation .)
• Time off work 125 days
• Cost 40 224

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Fracture cost

• Metacarpal and phalangeal fractures
• Freehan L. (BC, Canada)
• Hand Therapy 200914 10-21
• Annual incidence rate 11/10 000 workers
• Cost 3505
• Scaphoid fracture
• Papaloïzos M. (Switzerland)
• J Hand Surg (Br) 200429116-9
• Operated 4 940
• Non operated 8 710

10
Tendon injury cost

• Rosberg HE (Sweden)
• J Hand Surg (Br)200328106-12
• 139 zone II flexor tendon injuries
• Cost 15 331 per case
• Medical cost 5255
• Indirect cost 10 076

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Nerve injury cost

• Rosberg HE (Sweden)
• J Hand Surg (Br) 20053035-9
• 69 patients
• Median nerve 51 238
• Ulnar nerve 31 186
• 87 of total cost loss of production
• Higher cost when
• Tendon injuries
• 51 increasement when injury of 4 tendons or
  more
• Both nerves injuries
• Changing work after injury

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Cost of Amputation

• Holmberg J (Sweden)
• J Hand Surg (Br) 199621576-80
• Replantation cost 1.4 annual salary
• 26 surgery
• 74 indirect cost
• Terminalisation cost 1/2 price
• Dap F (France)
• Ann Chir Main 1989878-83
• - Thumb replantation less cost than
  terminalisation

13
Dog and cat bite injury

• Benson LS (USA)
• J Hand Surg 200631A468-73
• Debridement and infection treatment
• Cost 5559

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To summarize.
Clio 3 15 000
uros
15
Estimation of cost () for operated patients in
France in 2007
??
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How to limit the cost?

• Treat in specialized unit HAND TRAUMA CENTER
• Improve effectiveness of surgery
• Dias J. Injury 2006371071-1077
• Decrease the duration of stay in hospital
• Avoid unnecessary surgery
• Avoid complication
• Limit disabilities and permanent impairment

Give to the patient the most adequate and
effective surgery
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How to limit the cost?

• Prevent hand injuries
• Education
• Improvement of machines and skills security