To define population-based incidence, demographics and claim rates, as well as clinical presentation and claims duration and costs for work-related hand fractures in British Columbia (BC), Canada in 2001.
Methods
A BC-linked health data-set one-year retrospective review of all reported work-place hand fracture injuries in BC in 2001 with additional evaluation of individual health care and claims data from randomly selected individuals with a compensation claim in 2001.
Results
There were 14,654 hand fractures, of which 14% (2085) were work related; an annual incidence rate of 11/10,000 workers. Males accounted for 88% (1488/2085) of the fractures and the mean age was 39 (SD: ±12). Only 60% (290/482) of randomly selected people filed a compensation claim. Of these claims, 90% (260) had a validated hand fracture injury, 72% (218) were non-articular and 13% (38) had complex associated tissue injuries. About 69% (180) had no or simple closed reduction, 82% (213) had no additional fixation, 63% (163) were immobilized for at least 21 days and 9% (24) developed a secondary complication that required surgery. Average days off work was 46 (range 0–290) and average claims cost was $5500 CDN (range $145–$56,900).
Conclusions
Hand fractures are a common workplace injury in BC, with a significant proportion of workers not claiming compensation. These injuries generally presented clinically as simple fractures that were managed conservatively with few complications. Despite this, there was still a significant socioeconomic burden primarily due to lost work-place productivity due to time loss from work. These findings likely reflect similar trends for work-related hand fractures throughout Canada and other countries with similar health care and workers' compensation systems.
JohansenA, EvansRJ, StoneMD, RichmondPW, LoSV, WoodhouseKW. Fracture incidence in England and Wales: a study based on the population of Cardiff. Injury1997;28:655–60
2.
MeltonLJ, CrowsonCS, O'FallonWM. Fracture incidence in Olmsted county, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int1999;9:29–37
3.
CooperC, DennisonEM, LeufkensHG, BishopN, van StaaTP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res2004;19:1976–81
4.
Court-BrownCM, CaesarB. Epidemiology of adult fractures: a review. Injury2006;37:691–7
5.
IslamSS, BiswasRS, NambiarAM, Incidence and risk of work-related fracture injuries: experience of a state-managed workers' compensation system. J Occup Environ Med2001;43:140–6
6.
FeehanLM, ShepsS. Incidence and demographics of hand fractures in British Columbia, Canada: a population based study. J Hand Surg2006;31A:1068–74
7.
JacksonLL. Non-fatal occupational injuries and illnesses treated in hospital emergency departments in the United States. Inj Prev2001;7(Suppl. I):i21–6
8.
Bureau of Labor Statistics, U.S. Department of Labor, Survey of occupational injuries and illnesses, 2005. Case and demographic characteristics for work-related injuries and illnesses involving days away from work: 2005. Number of nonfatal occupational injuries and illnesses involving days away from work by part of body and selected natures of injury or illness. 2005. See http://www.bls.gov/iif/oshwc/osh/case/ostb1675.pdf (last accessed November 2008)
9.
BullN, RiiseT, MoenBE. Occupational injuries reported to insurance companies in Norway from 1991 to 1996. J Occup Environ Med1999;41:788–93
10.
ChungKC, SpilsonSV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg (Am)2001;26:908–15
11.
StantonJS, DiasJJ, BurkeFD. Fractures of the tubular bones of the hand. J Hand Surg Eur2007;32:626–36(PMID: 17993422)
12.
Center for Health Services and Policy Research (CHSPR) at the University of British Columbia. BCLHD – Data Services. See http://www.chspr.ubc.ca/data (last accessed November 2008)
13.
Research Secretariat. WorkSafeBC. See http://www.worksafebc.com (last accessed November 2008)
14.
World Health Organization. International Classification of Diseases (ICD). See http://www.who.int/classifications/icd/ (last accessed November 2008)
15.
British Columbia Government, BC STATS Service BC. Ministry of Labour and Citizens' Services. 2001Census Profile, British Columbia. See http://www.bcstats.gov.bc.ca/data/cen01/profiles (last accessed November 2008)
16.
HuffakerWH, WrayRC, WeeksPM. Factors influencing final range of motion in the fingers after fractures of the hand. Plast Reconstr Surg1979;63:82–7
17.
StricklandJW, SteichenJB, KleinmanWB, FlynnN. Factors influencing digital performance after phalangeal fractures. In: SticklandJW, SteichenJW, eds. Difficult Problems in Hand Surgery. St Louis, USA: C.V. Mosby Co., 1982: pp. 126–39
18.
BartonNJ. Fractures of the hand. J Bone Jt Surg1984;66B:159–67
19.
DuncanRW, FreelandAE, JabaleyME, MeydrechEF. Open hand fractures: an analysis of the recovery of active motion and of complications. J Hand Surg (Am)1993;18:387–94
20.
FusettiC, MeyerH, BorischN, SternR, SantaDD, PapaloizosM. Complications of plate fixation in metacarpal fractures. J Trauma2002;52:535–9
21.
Van OosteromFJ, EttemaAM, MulderPG, HoviusSE. Functional outcome after surgical treatment of phalangeal fractures in severely injured hands. Scand J Plast Reconstr Surg Hand Surg2005;39:238–41
22.
FreelandAE, OrbayJL. Extra-articular hand fractures in adults: a review of new developments. Clin Orthop Relat Res2006;445:133–45
23.
KurzenP, FusettiC, BonaccioM, NagyL. Complications after plate fixation of phalangeal fractures. J Trauma2006;60:841–3
24.
SahinF, YucelSD, YilmazF, ErgozE, KuranB. Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures (article in Turkish). Acta Orthop Traumatol Turc2006;40:274–9
25.
FeehanLM, BassettK. Is there evidence for early motion following an extra-articular hand fracture?J Hand Ther2004;17:300–8
Statius MullerMG, PoolmanRW, van HoogstratenMJ, StellerEP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg2003;123:534–7
28.
KadlubN, DaninoA, TrostO, RobeN, MalkaG. Boxer's fracture: cost evaluation orthopaedic or surgical treatment (article in French). Chir Main2006;25:152–5
29.
BansalR, CraigenMA. Fifth metacarpal neck fractures: is follow-up required?J Hand Surg2007;32B:69–73
30.
BaileyDA, WedgeJH, McCullochRG, MartinAD, BernhardsonSC. Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am1989;71:1225–31
31.
ParfittAM. The two faces of growth: benefits and risks to bone integrity. Osteoporos Int1994;4:382–98
32.
DeJongeJJ, KingmaJ, van der LeiB, KlasenHJ. Phalangeal fractures of the hand. An analysis of gender and age-related incidence and aetiology. J Hand Surg1994a;19B:168–70
33.
DeJongeJJ, KingmaJ, van der LeiB, KlasenHJ. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury1994b;25:365–9
34.
TideriusCJ, LandinL, DuppeH. Decreasing incidence of fractures in children: an epidemiological analysis of 1,673 fractures in Malmo, Sweden, 1993–1994. Acta Orthop Scand1999;70:622–6
35.
LarsenCF, MulderS, JohansenAM, StamC. The epidemiology of hand injuries in the Netherlands and Denmark. Eur J Epidemiol2004;19:323–7
36.
ThompsonA. The consequences of underreporting workers' compensation claims. CMAJ2007;176:343–4
37.
QuinlanM, MayhewC. Precarious employment and worker's compensation. Int J Law Psych1999;22:491–520
38.
RosenmanKD, GardinerJC, WangJ, Why most workers with occupational repetitive trauma do not file for workers' compensation. J Occup Environ Med2000;42:25–34
39.
ShannonHS, LoweGS. How many injured workers do not file claims for worker's compensation benefits. Am J Ind Med2002;42:467–73
40.
FanZJ, BonautoDK, FoleyMP, SilversteinBA. Underreporting of work-related injury or illness to workers' compensation: individual and industry factors. J Occup Environ Med2006;48:914–22
41.
BiddleJ, RobertsK, RosenmanKD, WelchEM. What percentage of workers with work-related illnesses receive worker's compensation benefits. J Occup Environ Med1998;40:325–31
42.
PereraJ. The pattern of tissue damage in occupational trauma. Ceylon Med J1996;41:15–8
43.
SkovO, JeuneB, LauritsenJM, BarfredT. Time off work after occupational hand injuries. J Hand Surg (Br)1999;24:187–9
44.
RaimbeauG. Costs of hand emergencies (article in French). Chir Main2004;22:258–63
45.
RosbergHE, CarlssonKS, DahlinLB. Prospective study of patients with injuries to the hand and forearm: costs, function and general health. Scand J Plast Reconstr Surg Hand Surg2005;39:360–9
46.
DiasJJ, Garcia-EliasM. Hand injury costs. Injury2006;37:1071–7
47.
TrybusM, LorkowskiJ, BrongelL, HladkiW. Causes and consequences of hand injuries. Am J Surg2006;192:52–7
48.
FeehanLM, ShepsS. Treating hand fractures: population-based study of acute health care use in British Columbia. Can Fam Physician2008;54:1001–7
49.
IpWY, NgKH, ChowSP. A prospective study of 924 digital fractures of the hand. Injury1996;27:279–85
