Definition

A mutilating hand injury is severe damage to the hand. The injury may include damage to bones, tendons, soft tissues, nerves, and skin. It can become a life-threatening condition.

If you have this type of injury, call for medical help right away. Immediate care may result in a better repair and decrease the chance of further damage. Untreated, this can lead to a serious infection.

Causes

Mutilating hand injuries can be caused by a variety of factors, including:

• Industrial accidents
  • Machine injuries
  • Power tool injuries
• Crushing accidents
• Burns
• Chemical exposure
• Car accidents
• Farming injuries

Risk Factors

Factors that may increase your chance of injury include:

• Having an occupation that requires use of dangerous machinery
• Removing safety guards from machinery, such as power saws or wood chippers
• Using short-cuts and improper technique while using machinery
• Using your hands to remove clogged grass from lawn mowers or snow from snow blowers without shutting off the power
• Operating machinery or vehicles under the influence of alcohol or medications that cause impairment during use

Symptoms

Injury to the hand is obvious. Bone, tendons, skin, nerves, and soft tissue may all be damaged. Common symptoms include:

• Excessive bleeding
• Amputation of hand or fingers
• Ripped skin
• Skin loss
• Open wound
• Exposed bone or tendons
• Pain

Diagnosis

When you are brought to the emergency room, a doctor will quickly assess your injury. Your wound will be inspected and your hand’s nerves and tendons will be tested. You will be asked to explain how the injury happened. You will also be asked which of your hands is dominant.

Imaging tests assess damage to the bones, nerves, tendons, skin, or other soft tissues. These may include:

• X-rays
• CT scan

You may need examination under anesthesia to:

• Allow the doctor to closely examine your wound
• Remove debris or dirt

Treatment

Immediate treatment is focused on stopping any bleeding. The doctor will make sure your vital signs are stable. An IV will be started to give you fluids and medications. You may be referred to a hand specialist for surgery. Depending on your injury, you may receive the following treatment:

Prevention

To help reduce your chance of a hand injury:

• Do not operate machinery that you are unfamiliar with.
• Follow all safety instructions when operating tools or machinery. Be especially careful when using snow blowers and lawn mowers. These commonly used tools result in many hand injuries each year.
• Do not put fingers or hands near moving parts of machinery.

OrthoInfo—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

The Canadian Society of Plastic Surgeons http://www.plasticsurgery.ca

Hammig B, Jones C. Injuries related to snow blowers in the United States: 2002 through 2008. Acad Emerg Med. 2010;17(5):566-569.

Kamrani RS, Mehrpour SR, et al. High-pressure plastic injection injury of the hand: case report. Occup Med (Lond). 2011 Aug 8.

Neumeister MW, Brown RE. Mutilating hand injuries: principles and management. Hand Clinics. 2003;19:1-15.

Snowblower and lawnmower injuries. American Society for Surgery of the Hand HandCare website. Available at:
http://handcare.assh.org/Portals/1/SnowblowerInjuries%20WEB%20ONLY.pdf
Accessed December 30, 2013.

Tintinalli JE, Kelen GD, et al. Tintinalli’s emergency medicine: A Comprehensive Study Guide. 6th Ed. United States: The McGraw-Hill Companies; 2004; Chapter 268, Injuries to the Hand and Digits.

4/25/2014 DynaMed’s Systematic Literature Surveillance.
http://www.ebscohost.com/dynamed:
Bruno MA, Weissman BN. American College of Radiology (ACR) Appropriateness Criteria for acute hand and wrist trauma. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteHandAndWristTrauma.pdf. Updated 2013. Accessed April 25, 2014.