Diagnostic accuracy of preoperative clinical examination in upper limb injuries.

BACKGROUND

Injuries in hands and forearms may cause significant discomfort and disability.

AIM

To evaluate the accuracy of preoperative clinical examination in depicting lesions caused by penetrating wounds of hands or forearms.

SETTING AND DESIGN

This prospective study was conducted from August 2006 to September 2009 at Kashani University Hospital, Isfahan University of Medical Sciences, Iran.

MATERIALS AND METHODS

Two hundred and fifty patients with clean penetrating injury to the hand/forearm were enrolled in this study. After patient's data registration, a careful clinical examination and routine exploration without expansion of wound were done by an orthopedic resident. Each tendon was tested at each joint level. Nerves were evaluated with a two-point discrimination test, and arteries were tested with palpable pulses. Surgical exploration was done by a single hand surgeon in operation room. Accuracy of clinical examination was compared to surgical examination.

RESULTS

During the study period, 180 (72%) males and 70 (28%) females with mean age of 28±4 years participated. The preoperative examination showed a predominance of the volar zone IV injuries followed by volar zone II, III, thumb zone II, volar zone V and thumb zone III. Despite the enough accuracy of preoperative examinations in dorsal side injuries of hands and forearms (error rate = 8.3%), the preoperative examinations significantly underestimated the amount of damage to soft tissues on the volar side of hands and forearms (error rate = 14%).

CONCLUSIONS

The precise surgical evaluations should be considered in patients with penetrating injury to the hand or forearm, especially in those with volar side injuries.