[Emergency treatment of hand trauma in France, an important public health challenge].

For decades hand trauma surgery was a small branch of general surgeons' practice. Only after the second world war did some orthopaedic or plastic surgeons with specific training in microsurgery start to sub-specialize in hand surgery. In the past 50 years, National Hand Societies have been created all over the world Hand trauma represents a significant proportion of emergency room attendance, and 20-25 % of traumatic emergencies. Most hand trauma patients are manual workers, who are sometimes injured at work. Hand injuries can result in lengthy periods off work. Incorrect emergency assessment and treatment by a non specialist surgeon can lead to poor outcomes. This can also increase the costs to society, owing to the need for further surgical procedures and physiotherapy. Hand trauma can be prevented by providing a safer environment at home, at work and in the playground Better trauma outcomes can be achieved by early referral to a Hand Center. In France, there are now almost 50 hand trauma centers. These are open 24 hours a day, 365 days a year, with a specialist hand surgeon on call. The latter will have diplomas in microsurgery and in hand and upper limb surgery, plus two years of experience as a fellow in a hand surgery unit. There is now a European Federation of Hand Trauma Centers (FESUM: Federation Européenne des services d'Urgence-mains) with hand centers in Belgium, Italy, Germany, the UK, Luxembourg, Spain and Switzerland These work under the umbrella of the European Federation of Societies for Surgery of the Hand (FESSH). However, only a small percentage of hand trauma victims are referred to such a centers. Awareness of these centers must be improved among both health care professionals and the public.