It’s spring, and thoughts turn to improving and updating your home. Doing it on your own can save money and provide a sense of achievement. But plan those projects carefully, because do-it-yourself (DIY) often becomes “do-it-to-yourself.” For orthopedic physicians, DIY season usually means another round of treating lacerations, fractures and joint dislocations, along with strains and tears to tendons and ligaments — injuries especially affecting hands, wrists, elbows and shoulders. Statistics from the National Electronic Injury Surveillance System indicate more than a third of annual home-project mishaps involve hands and fingers; another 6% affect wrists and shoulders.
In a report published several years ago in the journal Hand, scientists determined that more than 45 percent of upper extremity injuries in general occur at home, with finger and hand lacerations, abrasions and fractures; wrist fractures; shoulder sprains; and lower-arm fractures having the highest incidence rates. Of course, totals in the report only include injuries that drove patients to seek hospital treatment. Patients who opted to self-treat at home — or who visited an urgent care center or their own physicians when complications developed — are not counted in the study.
Serious hand and finger puncture wounds and deep cuts top the DIY-emergency list. That’s not surprising, considering nails, screws, tacks and bolts, which are forcibly applied to wood, metal and other materials, are the reported culprits in almost 30 percent of home-improvement injuries. Falls from ladders, resulting in elbow, arm, shoulder and wrist sprains and fractures, as well as head injuries, account for another 11 percent; power saws, more than 8 percent, including finger amputations; and hammers, nearly 7 percent.
Instinctively, we outstretch arms and the palms of our hands to break a fall. But doing so can cause wrist strains and fractures, especially a break in the scaphoid bone, one of eight bones that compose the wrist; injuries to the phalanges or finger bones; fractures of the bones in the hand (metacarpals); and thumb sprains — not to mention possible dislocation and sprains of elbow and shoulder joints caused by the jolt of hitting the ground.
We need our hands
(and every other body part)
Aristotle said, “The hand is the tool of tools.” Our hands and wrists are amazing anatomical structures. They make us unique in the animal kingdom, owing to the presence of a thumb and flexibility of the carpometacarpal joints of our smallest fingers — “pinky” and ring finger — which can move across the palm of the hand, meet the thumb and create incredible grasping and gripping strength.
That’s why hand injuries — even injuries to just the thumb — can prove debilitating and life-altering. Think how many everyday activities — like holding eating utensils, changing light bulbs or writing with pen or pencil — would be exceedingly difficult to perform without use of a thumb, especially on the dominant hand. (Not to mention the ubiquitous texting.)
Unprotected hands, of course, are not only what’s at risk in DIY projects. Falling directly onto the shoulder, can dislocate the joint, tear the labrum — the joint’s supporting cartilage — and damage the rotator cuff, which stabilizes and helps control shoulder-joint rotation. A fall may also fracture the collarbone or cause a proximal humerus bone fracture in the upper arm.
All about prevention
Bottom line: Orthopedic injuries happen even to the most experienced do-it-yourselfer, but risks can be reduced by taking a few precautionary steps:
• Wear gloves appropriate to the job to protect hands.
• Follow the 4-1 rule for ladder placement. Pull the bottom of a ladder one foot away from the wall for every four feet of ladder height. And don’t lean out to the side when standing on the ladder. If you are too far away, spend the extra two minutes to climb down and move the ladder.
• Read — and adhere — to instructions for power tools. Position yourself properly when using these tools.
• Respect large gasoline- and battery-powered maintenance equipment, including lawnmowers and snowblowers. Completely disengage them — disconnect the spark plug wire — before making any adjustments to them.
• Keep the work area clean and well lit. Ensure the surrounding environment is free of hindrances, including children and pets.
• Don’t get overconfident. Don’t rush to complete a job.
• And, even though this is an orthopedic column, don’t forget your eyes. Wear goggles to protect them from any filaments or splinters that might fly up in your face.
Should an orthopedic injury occur, avoid going to the hospital emergency room, unless the mishap causes significant bleeding, major amputation or a large, severe open bone fracture, or involves an open bone fracture in which the ends of the broken bone break the skin. Contact an orthopedic physician specialist, instead. Orthopedic walk-in centers are beginning to crop up in many communities and are your best bet for accessibility, efficiency and expertise. The specialist can make a diagnosis much more quickly, with superior treatment of the problem at much less cost and with fewer tests than primary care or hospital ER physicians.
Alejandro Badia, M.D., FACS, is a hand and upper-limb surgeon and founder of the Florida-based Badia Hand to Shoulder Center and OrthoNOW, a walk-in orthopedic care clinic in Miami. For more, visit drbadia.com and orthonowcare.com.