Department of Trauma and Orthopedic Surgery, Emergency Department, Ernst-Moritz-Arndt-University Greifswald, Germany.
Forensic Sci Int. 2010 May 20;198(1-3):74-8. doi: 10.1016/j.forsciint.2010.01.003. Epub 2010 Jan 29.
Hand injuries due to circular saws are a common reason for patients seeking medical care in emergency departments. With respect to cases of insurance fraud, these injuries are of medico-legal interest. It is the aim of this study to investigate the critical circumstances of the incidents, the accident mechanism, and the specific injury patterns of circular saw related hand injuries with regard to accident insurance coverage.
Circular saw related hand injuries for the years 1999 through 2007 were followed-up and assessed in detail. Type, severity and pattern of the injury were assessed. An accident analysis investigated characteristic of the activities, of the saws, of the stock/cutting material, operational activities of the operators prior to/at the time of the incident, and detailed information on the insurance status.
The follow-up study encompassed 114 patients. A majority of these were covered by private or statutory accident insurances. Compensation payments were made in all cases. All lesions involved one hand, mainly the left non-dominant hand. Thumb and index were at highest risk for injury. One-finger injuries occurred mainly at the middle or distal phalanx. With increasing number of affected fingers, the level of the injury moved closer to the proximal phalanx. A majority of injuries occurred during do-it-yourself activities. Among blade contact injuries, the so-called kickback-mechanism was at highest risk.
Positive circumstantial indications of a self-inflicted injury, which are often cited in the literature are less conclusive for the medico-legal decision finding. The detailed anatomic description of any lesions and the alleged accident mechanism as initially described by the patients in the emergency setting is the basis for any later accident reconstruction.
圆锯导致的手部损伤是患者前往急诊室就医的常见原因。在涉及保险欺诈的情况下，这些损伤具有医学法律意义。本研究旨在调查事故的关键情况、事故机制以及与圆锯相关的手部损伤的具体损伤模式，以确定其是否符合意外保险范围。
对 1999 年至 2007 年期间的圆锯相关手部损伤进行了随访和详细评估。评估了损伤的类型、严重程度和模式。通过事故分析，调查了活动、锯片、待切割材料的特征，操作人员在事故发生前/时的操作活动，以及有关保险状况的详细信息。
随访研究共纳入 114 名患者。其中大多数人参加了私人或法定事故保险。所有病例均进行了赔偿支付。所有损伤均累及单手，主要为左手非优势手。拇指和食指受伤风险最高。单指损伤主要发生在中节或末节指骨。随着受影响手指数量的增加，损伤水平更接近近节指骨。大多数损伤发生在 DIY 活动期间。在锯片接触损伤中，所谓的反弹机制风险最高。
文献中常提到的自我伤害的间接证据，对于医学法律裁决的发现并没有决定性作用。任何后续的事故重建都应以患者在急诊室最初描述的任何损伤的详细解剖描述和涉嫌事故机制为基础。
