Abstract

Objectives

Hand and wrist injuries comprise roughly 25% of emergency department visits and generate major costs. Growing incidence and surgical treatment highlight the need to understand resource use and economic impact.

Methods

We retrospectively analyzed Dutch adults (2017-2022) with phalangeal, metacarpal, or carpal fractures or finger dislocations in a level-2 trauma center. Resource use and treatments were recorded, costs calculated as volume × unit cost, and differences assessed with t tests, analysis of variance, and regression with bootstrap.

Results

A total of 8453 patients were included, with phalangeal fractures covering 49%. The overall mean cost of hand injuries was €1472 (bias-corrected and accelerated [BCa] 95% confidence interval [CI] €1443-€1501). Surgery was associated with higher costs (Δ €3963 (BCa 95% CI €3771-€4163) than conservative treatment. The distinct mean costs of surgery €6448 (BCa 95% CI €6161-€6776) and conservative €1208 (BCa 95% CI €1185-€1231) treatments were most expensive for carpal fractures. Because of different incidence ratios between patients who were operated on and those who were not, the mean treatment costs for metacarpal fractures was highest, €1737 (BCa 95% CI €1678-€1797), with costs of carpal and phalangeal fractures, respectively, finger dislocations averaging €1493 (BCa 95% CI €1432-€1560), €1327 (BCa 95% CI €1291-€1366), and €1178 (BCa 95% CI €1083-€1290) per incident. More men (12.1%) than women (6.9%) were operated (Δ 5.1%; 95% CI 3.9% to 6.4%).

Conclusions

This study highlights the economic burden of hand injuries. The results can inform hospital managers and guide strategies to optimize treatment pathways, potentially alleviating pressure on emergency departments and reducing costs in the healthcare system.