Hand Census 1998: Mapping Hand and Wrist Fractures across the US
Hand and forearm injuries are common in the emergency room (ER). But how common? And who's most at risk?

To answer these questions, these authors examined the results of a large national survey of nearly 400 hospitals. In 1998, the survey included reports from about 24,000 cases seen in the ER.

There were 352 cases of hand and forearm fractures. From this number, the authors estimate that there are 1,465,874 hand and forearm fractures seen in ERs across the US each year. These kinds of fractures make up about 1.5 percent of all ER visits.

Most of the fractures (44 percent) happened to the bones on the thumb and little-finger sides of the forearm. These bones (the radius and ulna) allow the hand to rotate.

Fractures of the finger were the next most common (23 percent). Fractures of the bones in the top of the hand (metacarpus) and wrist (carpus) made up 18 and 14 percent of the injuries, respectively. Less than one percent of the injuries involved more than one part of the hand. 

Hand and forearm fractures were most likely to happen at home (30 percent). A smaller proportion of the injuries happened on the street or in recreational and sports areas (14 percent each). The injuries were generally not work related (75 percent).

Accidental falls were the most common cause of injury (47 percent). Being hit by a person or object was the next most common cause (15 percent); this included sports-related injuries.

Children ages 5 to 14 had more hand and forearm injuries than any other age group (26 percent). This group had the highest rate of radius/ulna fractures. Young adults (ages 15 to 24) had the highest rate of metacarpal fractures. And young children (ages 0 to 4) had the highest rate of multiple hand fractures. However, patients over 85 had the highest rate of wrist and finger fractures, possibly because of accidental falls.

Hand and forearm injuries happened equally to men and women. But women were more likely to hurt their forearms and wrists, whereas men were more likely to hurt the tops of their hands and fingers.

Of the racial groups, whites had the most fractures. They also had the most ER visits overall. There were no differences between blacks and Asians in hand and forearm fractures. American Indians had the lowest rate of fractures.

Hospitals in the South and Midwest saw the most hand and forearm fractures (30 and 31 percent, respectively). Hospitals in these locations also treated more cases overall.

Though almost half of the injuries were covered by insurance, patients paid for their own medical care about 16 percent of the time. This reflects the national statistic that 15 percent of US residents are uninsured.

The authors hope that this information will be used to prevent hand and forearm fractures in high-risk groups, such as children and the elderly.
Kevin C. Chung, MD, and Sandra V. Spilson, MPH. The Frequency and Epidemiology of Hand and Forearm Fractures in the United States. In The Journal of Hand Surgery. September 2001. Vol. 26A. No. 5. Pp. 908-915.