Accuracy of the Preoperative Examination of Glass Injury to the Forearm and Wrist

A glass injury to the wrist and forearm is a common condition in adults and children that may cause significant discomfort and disability. This study was conducted to evaluate the accuracy of preoperative examination of this injury. In this prospective study, among patients referred to Kashani hospital in Isfahan, Iran from August 2006 to March 2008, 150 patients with glass injury to the wrist and forearm were enrolled. In this case, the first, careful clinical examination and routine exploration without expansion of wound was done by an orthopedic specialist and then surgical exploration in the operative room was done for the same patient by the same physician. The evaluated information was obtained and compared before and after treatment. Despite the enough accuracy of preoperative examination in glass injury of dorsal side of wrist and forearm, the preoperative examination significantly underestimated the amount of damage to tendons, nerves and arteries on the volar side of forearm and wrist. The most frequent injury pattern was the flexor digitorum superficialis (60%), median nerve (18%), and Flexor carpi ulnaris (16%). The most injured structure on dorsal side of forearm was Extensor digitorum tendons. It seemed that the preoperative examination, even when specifically evaluating for deficiencies is done, significantly underestimates the extent of glass injury to the volar side of wrist and forearm. If glass is implicated as a causative agent, careful orthopedic evaluation and surgical management should be considered even in sight of a normal preoperative examination.