Open hand fractures: 2 years of experience at a hand centre

Background Despite open hand fractures being relatively common, little has been published regarding their prevalence, mechanism of injury and outcomes. Methods A retrospective case note review was performed of all patients presenting with open metacarpal, proximal and middle phalangeal fractures over a 25-month period at a regional hand centre. Results Eighty-five patients were included (median age 43 years). BSharp^ injury was the commonest mechanism (39 %). Forty-three percent were managed with open reduction and internal fixation; this group was significantly more likely to require revision surgery compared to other fixation methods. Four patients developed nonunion. Overall superficial infection rate was 9.4 %, one patient developed deep infection, and there were no cases of osteomyelitis. No infections developed in the group receiving oral antibiotics alone. Conclusions Further research is necessary, but we postulate that some open hand fractures are suitable for day case surgery with oral antibiotic prophylaxis. The follow-up after these injuries is often protracted, and patients should be counselled accordingly, particularly of the high risk of revision surgery in patients managed with open reduction internal fixation. © Springer-Verlag Berlin Heidelberg 2015.