Patterns and Characteristics of Intentional Self-inflicted Hand Injuries among Military Personnel: A Retrospective Study and Proposal of Treatment Algorithm

Abstract

Background: Self-inflicted hand injuries have been described in the literature with varying nomenclature (factitious, malingering, and self-induced hand injuries). Identifying and treating these patients is complex and requires a multidisciplinary team approach at a high cost. There is a lack of literature that describes the different patterns and characteristics of hand injuries among military personnel, especially in Saudi Arabia. We conducted a chart review study involving military personnel who attended the emergency department with hand injuries in Saudi Arabia to fill this gap. Methods: This retrospective chart review study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. Our inclusion criteria included military personnel patients who presented to the emergency department with intentional self-inflicted hand-related injuries between 2016 and 2018. Results: A total of 274 cases were included; 241 (88%) were men. Injuries to the left hand (52.2%) were more common than injuries to the right hand. The most common injury site involved the little finger (45.6%). The majority were followed up (97.8%), and 28.8% of cases had a complication. The majority of fractures were managed with open reduction and internal fixation (63.9%). Moreover, the mean sick leave duration was 23 days. Conclusions: Self-inflicted injuries can be challenging to diagnose when patients are manipulative about the cause and mechanism. Most self-inflicted injuries involved the left little finger, and most were treated with open reduction and internal fixation. A self-inflicted injury is possible in the context of an unusual injury with a vague medical history.