Hand Surgeons and Orthopedic Trauma Surgeons Call Coverage of Acute Upper Extremity Injuries: Where Should the Line Be Drawn?

BACKGROUND: There is a lack of consensus as to which subspecialty service should cover acute upper extremity injuries in the emergency department (ED). The purpose of the present study is to understand how upper extremity injuries are currently triaged to specialists and to assess the current opinion among hand and orthopedic trauma specialists as to how these injuries should be best triaged based on injury location and severity.

METHODS: The American Association for Hand Surgery (AAHS) membership and Orthopaedic Trauma Association (OTA) membership were surveyed using a 28-item online questionnaire.

RESULTS: A total of 103 responses from the AAHS and 114 responses from the OTA were received. Nearly 50% of the respondents report no formal anatomic line as to how upper extremity injuries are triaged to specialists from the ED. Approximately 57% of the AAHS respondents feel that hand call should begin at the distal radius or proximal, while 71% of the OTA respondents feel that hand call should begin at the radiocarpal joint or distal. There was increasing agreement that more complex injuries be assigned to the hand surgeon.

CONCLUSIONS: There is agreement that proximal to the elbow, the trauma consultant should be called, and distal to the distal radius, the hand consultant should be called. However, there is a lack of agreement as to who should be responsible for call between the elbow and the hand. To optimize patient care, better allocate consultant resources, and minimize conflict between consultants, establishing anatomic guidelines for consultation should be considered.