gms | German Medical Science

Objectives/Interrogation: A series of fractures in finger phalanges in sailors' hands, occurring during their work at sea, with completely different retellings as to how the injuries were caused, raises suspicion on whether they could have been self-inflicted.

The aim of this report is to reproduce in cadaverous upper limbs the mechanisms related by patients and compare their fracture pattern. The results confirmed the hypothesis of self-inflicted injuries

Methods: Between 2014-2017, 76 patients were assisted in our center. They were sailors in fishing ships, presenting phalange fracture and finger traumatism. All of the cases were reported to have happened in the high seas and all of the fishermen work for three fishing companies with the same labor risk insurance company.

Classifing the fractures according to AO classification, we found that 41% belonged to type 78.2.2.3A1, 30% were type 78.2.2.2A1 and 18% type 78.3.3.2.C, 11% showed variable patterns.

42% had injuries in multiple fingers. 13% combined injuries in one finger. 45% had a single injury in only one of their fingers.

The mechanisms described were: 9 cases for winding, 28 for squid pills, 16 caused by doors, 5 for de-glazing, 9 for tray handling and 9 due to falls from height. In order to confirm our hypothesis related to self-inflicted injuries, we carried out cadaverous test using 34 three-phalange fingers reproducing the mechanisms described by patients.

Results and Conclusions: The cadaverous test showed a lack of relationship between the descriptions made by patients and the results obtained when reproducing the mechanism on cadaver upper limbs.

1.

In the case of simulated winding using a steel tube, showed only interphalangeal dislocation.

2.

As regards simulation of squid pills and de-glazing by using ice blocks, the results showed two type F3 fractures.

3.

In relation to injuries caused by slammed doors, two fractures were reproduced with different patterns, depending on the number of fingers involved.

Our hypothesis has been confirmed by using a hammer as injuring tool, which in 100% of the cases reproduced supracondylar fracture (78.2.2.3.A1) and diaphyseal fracture (78.2.2.2A1), which were the most frequent injuries in the patients assisted. The results obtained through cadaverous tests confirmed that the mechanism using a hammer by applying dorsal force.

It is worth mentioning that in 71% of the cases, the patients who were assisted related injuring mechanisms that did not coincide with the mechanism reproduced in cadaverous model.