Operative strategies for hand injuries in multiple trauma.: A systematic review of the literature

Objective. Hand injuries are not life threatening but crucial in multiple trauma because of their long-term functional results. The goal of this systematic review was to derive recommendations for diagnostic and treatment procedures from a systematic review of the literature. Methods. Articles on hand injuries in multiple trauma and articles on clinical trails for isolated hand injuries were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). Results. The special management of hand injuries in multiple trauma requires accurate diagnostic procedures, differentiated therapy strategies, and adequate timing. Depending on type and extent of the injury, there are substantial differences for primary or secondary operative treatment. Conclusion. Hand injuries represent important lesions in multiple trauma. Due to the life-threatening situation they may be overlooked in the beginning of the treatment. Because of their long-term consequences for function and health-related quality of life, hand injuries require an early and accurate diagnosis and a differentiated treatment strategy.