We reviewed 17 patients with self-inflicted wrist injuries who were referred to the Department of Hand surgery from the Emergency Medicine Department from to We investigated the differences in demographic features age, gender, psychological diagnosis, alcohol consumption, prior suicide attempts and clinical features injury side, injury pattern, anatomical structures, distance from wrist crease.
Among the patients, 4 were female and 13 were male. The average distance from the wrist crease to the injured site was 3. The most frequently injured structures were palmaris longus tendon We conclude that a male with a previously diagnosed psychiatric disorder has a higher chance of inflicting a deeper injury. In terms of the implements used in self-inflicted injuries, we can predict the type of damage to some degree depending on the type of implement used.
In view of these characteristics, more appropriate evaluation can be implemented in the emergency room and those who deal with these patients primarily can cope more effectively for better long-term results. Peer Review reports. Suicide is a major public health concern and the increase of suicide cases is a serious social problem. It is the 10th leading cause of death worldwide and about one million people died from suicide every year [ 1 ]. In Korea, suicide has been the fourth leading cause of death and the most common cause in adolescents [ 2 ].
The most common causes of the patients who attempted suicide were self-poisoning or self-wrist cutting [ 3 ]. On average, there are 20—25 suicide attempts for every completed suicide, frequently by self-inflicted wrist cutting [ 4 ]. In the United States, the number of patients who attempted suicide and self-inflicted injury increased significantly over the past few decades [ 5 , 6 ]. Demographically, wrist-cutting suicide injuries were more common for under the age of 20 and females [ 5 ].
Self-cutting injuries have a low mortality rate, which means that most of suicide attempts end in survival. In surviving patients, this is a clinically significant problem because of the risk of permanent disabilities and the repetition of suicide attempts [ 7 ]. Self-inflicted wrist cutting injuries may vary from simple skin lacerations to deep wrist injuries. Consequently, this has a strong effect on the anatomical structures such as arteries, tendons, and nerves, which can lead to motor and sensory dysfunction.
Such patients have impaired ability not only to maintain work, hobbies or social activities but also to perform basic activities in daily life. Thus, wrist cutting injuries should be managed in terms of both psychological intervention and wound treatment [ 8 ].
For psychiatric diagnosis and treatment, all patients who are admitted to the emergency department for attempted suicide should be assessed by a psychiatrist [ 9 ]. In addition, in order to prevent any functional impairment, an initial appropriate evaluation and proper referral are of pivotal importance.
Thus, the objective of this study was to investigate the characteristics of self-inflicted wrist injuries in a single institution and share the perspectives from a hand surgeon so that those who deal with these patients primarily in the emergency room can manage these injuries more appropriately. We investigated all self-inflicted wrist injury patients who were referred to the Department of Hand Surgery from the Emergency Medicine Department in Seoul National University Bundang Hospital from to This study was conducted as a pilot study before a prospective study in the same institution had been initiated from The patients who had skin only injuries were excluded because primary closure was performed at the Emergency Medicine Department.
Demographic data age, gender, alcohol intake, psychological state and clinical features injury side, injury pattern, anatomical structures involved, distance from wrist crease were analyzed.
A psychological evaluation of all the patients was performed following attempted suicide by a psychiatrist from the Department of Psychiatry within the same institution. Patients were initially assessed in the Emergency Medicine Department and surgical treatment and postoperative wound care were performed by the Hand Surgery Department of Plastic and Reconstructive Surgery Department in the same institution. The outpatient follow-up period was at least three months and postoperative long-term disability was evaluated.
The long-term motor function was assessed by range of motion, opposition of the thumb, intrinsic function tests. Two-point discrimination test was performed in order to evaluate sensory function.
A total of 17 patients who attempted suicide by cutting their wrists were included in our study. Among the patients, four were females and 13 were males. The left wrist was involved in In Only in one case the injury occurred on the radial side of the forearm with involvement of the abductor pollicis longus and the extensor pollicis longus tendons.
The most frequently injured structures was the palmaris longus tendon The most frequently injured nerve was the median nerve The ulnar neuro-vascular bundle and the radial artery were involved only once each. Injuries of important anatomical structures are summarized in Table 1. Knife was the most common tool for suicide attempts, followed by glass Table 2. Alcohol intake prior to suicide attempts was higher in male patients.
All 4 patients with mood disorder had major depression and 2 patients with personality disorder had borderline personality disorder.
Among the 8 patients with deep injuries, 6 had a history of psychiatric disorders, whereas among the 9 superficially injured patients, only 3 had a previous psychiatric diagnosis.
When it comes to the long-term outcomes, 4 patients showed functional deficit in long-term follow-up period and all of these patients had nerve injuries including injuries of the median and the ulnar nerve.
Myrna M. Weissman, PhD. Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use.
Access your subscriptions. Abstract A year-old male was found dead in a water drum inside the bathroom of his house one morning. Publication types Case Reports. Will it come? I don't know I don't know that either. But I live each day as it comes and I still let it get to me. Be strong don't let depression get a hold of you. I don't see how knowing about someone's need of medication should affect anything.
It makes no sense to me. My best friend's friend commited suicide this year and it was so sad. I don't think that's the right thing to do. He said he was at work, but he was at the pub getting drunk. He used to come home drunk out of his mind and my mum and brothers used to just pack up and leave sometimes.
Also, in the middle of being a teenager and everything changing so fast, I hated myself and my body. I ended up turning bulimic 'cause I thought I was fat, and I had broken up with my boyfriend.
I used to slit my wrists and I still do. It's a sudden rush and helps me feel alive when nobody seems to listen. Now, my dad stopped drinking but I'm still bulimic, and my parents don't know I'm so depressed and haven't been happy in months. I don't know where to turn. I considered suicide because of my mom.
She punished me for something I never did, and I could not take it anymore, so I thought it would be the easy way out. Changing schools from junior high to the high school was a big change. I was stressed out all the time, and having a boyfriend didn't help.
We always got in fights, because he didn't know what I was going through, and neither did I.
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