18.03.19
Focusing on hand injury prevention would ensure vital benefits for the public and the NHS
Ian McNab, consultant orthopaedic hand surgeon and council member of the British Society for Surgery of the Hand, outlines how a focus on prevention to hand injury could wider benefits for the NHS and general public.
The NHS Long-Term Plan, released earlier this year, highlights how the prevention of avoidable health problems linked to smoking, alcohol and obesity is a key focus over the next decade to reduce the strain on the health service. This prevention focus is welcomed, although as a surgeon who sees a vast number of avoidable hand injuries, I know how much both the public and the NHS would benefit from reducing hand trauma.
If we prioritised hand injury prevention, we could ensure that more people avoided seriously damaging consequences as well as saving NHS resources. 20% of visits to A&E departments in England are currently for hand trauma – a significant caseload that could be minimised. Of the 4.58 million attendances at A&E for hand injuries in 2015-16, one in five (916,000) required specialist care and 240,000 needed surgery. The surgery we carry out ranges from fixing hand fractures and repairing tendons and nerves, to skin grafting and closing serious wounds.
Hand injuries predominantly affect the younger working population and can cause permanent disability. In addition, they can result in a significant cost to the patient, the NHS, and wider society – especially through time off work, medical costs, and lost productivity. As hand trauma care is generally urgent and prioritised ahead of elective (planned) care, reducing hand injuries would also allow surgeons to treat elective hand surgery cases more quickly so that people with painful conditions could enjoy an improved quality of life more quickly. With elective hand surgery for conditions such as osteoarthritis set to increase by almost 40% over the next 10 years, reducing the volume of trauma cases is very important.
Hand injuries can occur in all kinds of situations (all hand surgeons have stories of unusual injuries) but there are common incidents that we deal with. By encouraging people to be aware of the risks and how to avoid them, we can reduce the number of people presenting with serious damage to their hand.
Far from being ‘killjoys,’ this is about ensuring that people take care of their hands to maintain full use, allowing them to carry on enjoying hobbies and work. The human hand is very complex (it has 27 bones controlled by 24 muscle groups) and intimately connected with the brain, giving us both function and feeling. As so many patients tell us, it’s not until you damage your hand that you realise how vital it is.
A significant number of accidents are caused by people doing DIY or gardening with tools such as hedge trimmers, drills or saws. NHS Digital data shows there were more than 25,000 hospital admissions for gardening and DIY-related accidents between 2014-2017. By encouraging people to take simple safety precautions such as wearing gloves when gardening and following safety instructions when using power tools, we can minimise the risks.
There are other common hand hazards around the home. It sounds obvious, but care must always be taken when using kitchen knives. For example, they shouldn’t be used to separate frozen burgers, as it’s very easy to slip and cut the hand. We also see many injuries from people who have plunged their hand into murky kitchen sink water which is concealing a knife.
Using safety catches and door-stoppers around the home can be a simple but significant way to prevent children’s hand injuries. According to the Royal Society for the Prevention of Accidents, 30,000 children every year trap and seriously crush their fingers in doors at home, school, nursery, or in shops.
Hand safety in the workplace is also crucial. In 2016, there were more than 18,000 workplace injuries involving the hands and wrists, so it’s vital for employees to follow safety advice when using heavy machinery or farm equipment. There are legislative changes that could be made to help reduce hand injuries – both in workplaces and more broadly. For example, the British Society for Surgery of the Hand backs the call for graphic warning images on firework packaging to be made mandatory, to help reduce the thousands of hand injuries they can cause each year.
Of course, these are just some of the common risks. But by encouraging people to take good care of their hands and promoting important safety information, we can help reduce the strain on the NHS and ensure a more sustainable future for our health service. As the adage goes, prevention is better than cure.