救急外来で形成外科対応を行った前腕以遠の外傷660例の検討

Investigation of 660 Cases of Forearm and Hand Trauma Treated by Plastic Surgeon in an Emergency Department

はじめに

　令和2年の国勢調査によると，島根県は65歳以上の占める割合が34.2 ％（全国4位）と高齢者が多く 1），産業は林業・漁業の従事者が比較的多いのが特徴である 2）。当院は，人口約20万人の島根県松江市内で，唯一形成外科医が複数名在籍する救急指定病院である。松江医療圏には周辺の中山間部が含まれ 3），隠岐諸島からの搬送もあるため，山陰地方の中核病院の1つとして，広範囲の救急外傷に対応している。これまでこの地域における手の外傷の特徴を検討した報告はなかったため，今回われわれは，前腕以遠の外傷について，患者特性や発生の時間的特性を検証し，当院に望まれる対応と，特に労働災害における事故防止のための予防策について検討を行った。

　Purpose: Ours tertiary emergency hospital in Matsue City (population approx. 200,000) is the center that manages emergency trauma cases throughout the eastern region of Shimane Prefecture. We investigated the patient and temporal characteristics of forearm and hand trauma cases in order to improve awareness regarding the prevention of these injuries.

　Patients and Methods: We retrospectively analyzed the cases of 660 patients with a forearm injury and/or hand trauma (473 men, 187 women) who visited our emergency department between January 2016 and December 2021, excluding the cases involving self-inflicted wounds, animal bites, and burns.

　Results: Occupational injuries comprised 20.8% of all of the injuries in this patient series. Most of the ambulance transfers were for patients with mild injuries, whereas 26.3% of the walk-in patients presented with a severe injury. The number of occupational injuries was highest on Tuesdays (bimodal peaks observed at 10 a.m. and 4 p.m.), with the maximum number of injuries in patients aged 20–29 years.

　Conclusion: Our analyses revealed that approximately one in four walk-in patients presented with a severe hand or forearm injury. The occupational injuries tended to be associated with the patientsʼ inexperience on the job, laxity, and/or accumulated fatigue. Based on the present results, we conclude that effective training, safety management under regular supervision, and an active use of breaks may be effective strategies for preventing forearm and hand injuries.