Introduction
Hand surgery has long been a critical field in medicine, addressing a wide range of traumatic injuries often arising from industrial settings [
1]. Historically, in countries like Korea with strong manufacturing and manual labor sectors, industrial accidents were a major contributor to hand injuries [
2]. However, recent years have witnessed significant changes in this landscape, driven by globalization, automation, and advancements in workplace safety. The implementation of improved safety protocols and protective equipment, coupled with the relocation of some industries overseas, has led to an apparent decline in severe traumatic hand injuries in Korea [
3].
These shifts have raised concerns within the hand surgery community about the future of their field. There is a growing perception that the demand for hand surgeons might be declining due to a reduced incidence of industrial injuries requiring surgical intervention. However, this perception has not been systematically verified through comprehensive data analysis, particularly in the Korean context.
Furthermore, Korea’s rapidly aging population presents additional challenges and opportunities in the field of hand surgery. With one of the fastest aging rates among OECD (Organisation for Economic Co-operation and Development) countries, the proportion of the elderly population has increased significantly, leading to changes in injury patterns [
4]. This demographic shift is particularly relevant given the high prevalence of osteoporosis among older adults in Korea, which has shown a steady increase over the past decade [
5]. The combination of an aging population and increased osteoporosis prevalence suggests a potential shift in the nature of hand injuries, from primarily industrial trauma to age-related and fragility-associated injuries [
6].
Given these substantial changes in both demographics and industrial safety regulations as well as technological advancements over the past decade, it is crucial to examine the actual trends in hand injuries in Korea. The primary objective of this study is to analyze national data on hand injuries from 2010 to 2023, focusing on trends in the incidence of crush injuries, amputations, fractures, and lacerations. By examining these trends, the author aims to determine whether they support the hypothesis of a declining field or suggest an evolution in the types of injuries hand surgeons are treating, while also evaluating the impact of unexpected events, such as the coronavirus disease 2019 (COVID-19) pandemic. This analysis will provide insights into the evolving nature of hand injuries in Korea and their implications for the field of hand surgery.
Methods
Ethics statement: This study used anonymized, publicly available data from the Health Insurance Review and Assessment Service (HIRA) Big Data Open Portal, which is provided for research purposes. As per the data use policy of HIRA, no additional ethical approval was required for this study. The study adhered to the principles of the Declaration of Helsinki and followed the data protection regulations set by HIRA.
1. Study design
This retrospective study analyzed data from the Health Insurance Review and Assessment Service (HIRA) Big Data Open Portal [
7] between January 1, 2010 and December 31, 2023. The study focused on trends in the incidence of hand injuries, specifically examining crush injuries (S67), amputations (S68), fractures (S62), and lacerations (S61). The HIRA database contains comprehensive health insurance claims data, covering nearly all of the Korean population (over 97%), including both National Health Insurance beneficiaries and Medical Aid recipients, thus providing a robust representation of national health trends [
8].
2. Data source
Data were obtained from the HIRA Big Data Open Portal [
7], a platform that provides access to anonymized health insurance claims data for research purposes. This database includes information on diagnoses, procedures, and expenditures from both outpatient and inpatient cases across the Republic of Korea. The data used in this study were pre-processed and validated by HIRA, ensuring the absence of missing values or outliers.
3. Injury classification
Hand injuries were classified according to the Korean Standard Classification of Diseases codes as follows:
• Crush Injuries (S67): Injuries caused by compression or entrapment of the fingers, hand, or wrist.
• Amputations (S68): Complete or partial loss of fingers or parts of the hand.
• Fractures (S62): Bone fractures of the fingers, hand, or wrist.
• Lacerations (S61): Lacerations and open wounds of the fingers, hand, or wrist.
4. Data analysis
Annual patient numbers for each injury type (crush injuries, amputations, fractures, and lacerations) were extracted from the HIRA database for the years 2010 to 2023. The following analyses were performed:
A. Descriptive statistics: Mean, standard deviation, minimum, and maximum values were calculated for each injury type over the study period.
B. Time series decomposition: Using the statsmodels library (ver. 0.13.2) in Python, the data were separated into trend, seasonal, and residual components. This method helps identify long-term trends, cyclical patterns, and irregular fluctuations in the data.
C. Percentage change: The total change in patient numbers from 2010 to 2023 was calculated and expressed as a percentage change, providing a clear measure of overall trends.
D. Visualization: Line graphs were created for each injury type, showing the raw data along with the decomposed trend line, using matplotlib (ver. 3.5.2) library in Python.
E. Linear regression analysis: Simple linear regression was performed for each injury type to quantify the average annual change in patient numbers. The slope of the regression line indicates the average yearly increase or decrease in cases, while the R-squared value provides a measure of how well the linear model fits the data.
F. Chi-square test for trend: This test was conducted to assess whether the observed trends were statistically significant and non-random. It helps determine if the changes in injury rates over time are likely due to chance or represent a genuine trend.
All statistical analyses were performed using Python 3.8 with the statsmodels (ver. 0.13.2) and scipy (ver. 1.9.1) libraries. A p-value of <0.05 was considered statistically significant for all statistical tests.
Results
The analysis of hand injury trends in Korea from 2010 to 2023 revealed significant changes across different types of injuries (
Table 1).
1. Crush injuries (S67) (Fig. 1)
• Descriptive statistics: Mean, 52,306.07 (standard deviation [SD], 13,943.76) cases per year; range, 33,236 to 73,779.
• Time series decomposition: Showed a clear downward trend and relatively small residual components.
• Percentage change: 54.95% decrease from 2010 to 2023.
• Linear regression: Average annual decrease of 3,118.62 cases (p<0.0001, R2=0.9871), indicating a strong and consistent downward trend.
• Chi-square test for trend: χ²=38,026.51, p<0.0001, confirming a significant non-random trend.
2. Amputations (S68) (Fig. 2)
• Descriptive statistics: Mean, 12,247.36 (SD, 1,157.22) cases per year; range, 10,785 to 14,572.
• Time series decomposition: Revealed a steady downward trend.
• Percentage change: 24.18% decrease from 2010 to 2023.
• Linear regression: Average annual decrease of 268.42 cases (p<0.0001, R2=0.8615), suggesting a strong and consistent decline.
• Chi-square test for trend: χ²=1,324.76, p<0.0001, confirming a significant trend.
3. Fractures (S62) (Fig. 3)
• Descriptive statistics: Mean, 312,847.64 (SD, 20,610.55) cases per year; range, 270,651 to 361,103.
• Time series decomposition: Showed an overall increasing trend with some year-to-year variability.
• Percentage change: 16.19% increase from 2010 to 2023.
• Linear regression: Average annual increase of 2,024.62 cases (p=0.0228, R2=0.3637). The lower R2 value suggests more variability in this trend compared to other injury types.
• Chi-square test for trend: χ²=14,941.99, p<0.0001, indicating a significant non-random trend.
4. Lacerations (S61) (Fig. 4)
• Descriptive statistics: Mean 879,176.50 (SD: 34,962.89) cases per year, range 820,022 to 926,979.
• Time series decomposition: Revealed a slight downward trend with minimal fluctuations.
• Percentage change: 6.73% decrease from 2010 to 2023.
• Linear regression: Average annual decrease of 5,880.93 cases (p<0.0001, R2=0.7670), indicating a moderate but consistent downward trend.
• Chi-square test for trend: χ²=10,861.76, p<0.0001, confirming a significant trend.
All injury types showed statistically significant trends (p<0.05) in both chi-square tests and linear regression analyses. The time series decomposition and line graphs provided visual confirmation of these trends.
Crush injuries and amputations, often associated with industrial accidents, showed substantial and consistent decreases. Fractures increased overall, but with more year-to-year variability, possibly due to demographic changes such as an aging population or changes in physical activity patterns. Notably, fractures showed a significant drop in 2020, likely due to the COVID-19 pandemic, followed by a sharp increase in subsequent years. Lacerations showed a moderate but significant decrease over the study period.
These results suggest a changing landscape of hand injuries in Korea, with potential implications for healthcare resource allocation and preventive strategies in hand surgery.
Discussion
The analysis of hand injury trends in Korea from 2010 to 2023 reveals a significant transformation in the field of hand surgery, reflecting broader shifts in industrial practices, societal behaviors, and demographic changes. This discussion synthesizes the major findings, contextualizes them within broader societal trends, and identifies the implications for the field of hand surgery.
The most notable finding from this study is the substantial decline in severe hand injuries, specifically crush injuries and amputations. This decline is likely driven by several intertwined factors. First, stricter workplace safety regulations, implemented by the Korean government [
9], have led to significant improvements in industrial environments [
10], particularly in high-risk sectors such as manufacturing and construction. Enhanced safety measures and mandatory adherence to protocols have reduced the occurrence of severe injuries [
11]. Second, the widespread adoption of automation has minimized direct human involvement in dangerous tasks, thus decreasing the risk of traumatic injuries [
12]. The introduction of ergonomic machinery and equipment designed with worker safety in mind has further contributed to this trend [
13]. Third, the relocation of some high-risk industries to other countries has reduced the number of workers exposed to hazardous environments domestically, further contributing to the reduction in severe hand injuries [
14]. These factors collectively indicate a positive trend toward industrial safety, yet they also bring new challenges for hand surgeons, who must adapt to shifting injury patterns.
In contrast to the decline in crush injuries and amputations, the study observed an increase in the incidence of fractures. This rise is likely attributable to demographic changes, particularly Korea’s rapidly aging population [
15]. As the population ages, the prevalence of osteoporosis and other conditions that increase susceptibility to fractures has risen, leading to an increase in age-related hand injuries [
6]. Additionally, changes in lifestyle, such as increased participation in recreational activities and sports, may also be contributing to this upward trend in fractures [
16]. Furthermore, the increase in fractures appears to require a multi-faceted analysis, including differentiation between open and closed fractures, and understanding age-based fracture patterns, especially around age 60 years. These findings suggest that while industrial trauma is decreasing, age-related injuries are becoming more prevalent, necessitating a shift in the focus of hand surgery from primarily trauma management to a broader scope that includes geriatric care and rehabilitation.
The slight decrease in lacerations further supports the notion of enhanced safety awareness and improved product designs. Safety improvements are not limited to industrial settings but extend into daily life, where product designs have become more user-friendly and safety-centric [
17]. This trend reflects a societal shift towards the minimization of everyday risks through better design and increased public awareness, reducing the overall incidence of such injuries.
The COVID-19 pandemic also had a discernible impact on hand injury patterns, with a notable drop in injury cases during 2020 [
18]. Social distancing measures, reduced industrial activity, and changes in daily routines all contributed to this decline. However, these effects were temporary, as injury numbers rebounded in the following years. It is also likely that the decrease in amputations and lacerations in 2020 was influenced by the decline in overall industrial activity, highlighting the complex interplay of factors beyond just lockdown measures. This highlights the complex interplay between social behavior and injury incidence, demonstrating that macro-level societal disruptions can significantly influence healthcare needs.
The evolving trends in hand injuries observed in this study suggest several implications for healthcare policy and hand surgery practice. The decline in severe traumatic injuries presents an opportunity for hand surgeons to expand their expertise beyond trauma to include areas such as geriatric care, minimally invasive techniques, and preventive strategies. Moreover, the increasing incidence of fractures calls for enhanced collaboration with other specialties, such as geriatrics and endocrinology, to address the needs of an aging population effectively. Additionally, differentiating between high-energy fractures and osteoporotic fractures, and understanding the specific fracture types such as scaphoid fractures common in younger individuals versus distal radius fractures prevalent in older populations, would provide valuable insights. However, the current HIRA classification system does not allow for this level of differentiation, representing a limitation of the present study. Future research with more detailed fracture classification data would help address these gaps and provide a clearer understanding of fracture patterns across age groups. Hand surgeons must be prepared to diversify their skills and adapt their practices to meet these changing demands.
The landscape of hand injuries in Korea is changing, driven by industrial, demographic, and societal shifts. While the decline in severe traumatic injuries represents a public health success, it also necessitates a strategic reorientation of the field of hand surgery. Future research should focus on more detailed injury characteristics, including open versus closed fractures, age-based patterns, and distinguishing between different fracture types, to better understand the underlying causes of these trends and to develop targeted prevention and treatment strategies. Additionally, analyzing occupational factors and emerging work-related conditions, such as triangular fibrocartilage complex injuries, cubital tunnel syndrome, and carpal tunnel syndrome, could provide deeper insights into the evolving nature of hand injuries. By embracing these changes and expanding their scope, hand surgeons can continue to play a crucial role in improving patient outcomes and adapting to the evolving needs of society.