Accidental circular saw hand injuries: trauma mechanisms, injury patterns, and accident insurance.

INTRODUCTION: Hand injuries due to circular saws are a common reason for patients seeking medical care in emergency departments. With respect to cases of insurance fraud, these injuries are of medico-legal interest. It is the aim of this study to investigate the critical circumstances of the incidents, the accident mechanism, and the specific injury patterns of circular saw related hand injuries with regard to accident insurance coverage. PATIENTS AND METHODS: Circular saw related hand injuries for the years 1999 through 2007 were followed-up and assessed in detail. Type, severity and pattern of the injury were assessed. An accident analysis investigated characteristic of the activities, of the saws, of the stock/cutting material, operational activities of the operators prior to/at the time of the incident, and detailed information on the insurance status.
RESULTS: The follow-up study encompassed 114 patients. A majority of these were covered by private or statutory accident insurances. Compensation payments were made in all cases. All lesions involved one hand, mainly the left non-dominant hand. Thumb and index were at highest risk for injury. One-finger injuries occurred mainly at the middle or distal phalanx. With increasing number of affected fingers, the level of the injury moved closer to the proximal phalanx. A majority of injuries occurred during do-it-yourself activities. Among blade contact injuries, the so-called kickback-mechanism was at highest risk.
CONCLUSION: Positive circumstantial indications of a self-inflicted injury, which are often cited in the literature are less conclusive for the medico-legal decision finding. The detailed anatomic description of any lesions and the alleged accident mechanism as initially described by the patients in the emergency setting is the basis for any later accident reconstruction.