Injury Mechanisms, Management Patterns, and Early Outcomes After Surgical Treatment of Hand Trauma: A Franco-Romanian Two-Center Cohort Study

Background: Management of surgically treated hand trauma varies according to injury characteristics, referral pathways, and institutional practice, particularly regarding postoperative antibiotic therapy and wound cleansing. This study compared injury patterns, management strategies, and early postoperative outcomes between two European referral centers and evaluated reported practice through a parallel surgeon survey. Methods: We conducted a retrospective two-center cohort study including 360 adults undergoing surgical treatment for hand trauma between April 2024 and March 2025 in Le Mans, France (n = 270), and Iași, Romania (n = 90). Injury mechanisms, anatomical involvement, postoperative antibiotic use and duration, wound irrigation and cleansing practices, follow-up, and postoperative infection were compared. Because the cohorts differed substantially in case mix, a secondary sensitivity analysis was performed using the Romanian acute-injury subgroup (n = 63). A parallel anonymous survey included 70 French and 40 Romanian surgeons involved in hand trauma care. Results: Injury mechanisms differed between centers (p < 0.001), with powered-tool or machinery injuries occurring in 34.4% of Romanian and 15.6% of French patients. The Romanian cohort also had higher frequencies of tendon injury (90.0% vs. 30.7%), neurovascular involvement (57.8% vs. 14.1%), joint involvement (23.3% vs. 12.2%), and associated fracture (27.8% vs. 5.2%; all p ≤ 0.016). Continued postoperative antibiotics were administered to 97.8% of Romanian and 55.2% of French patients (p < 0.001). Among treated patients, 1- to 3-day courses predominated in Romania (85.2% vs. 16.2%; p < 0.001). Wound-cleansing practices also differed substantially. Among patients with documented follow-up, postoperative infection was identified in 3/90 Romanian patients (3.3%) and 3/171 French patients (1.8%; p = 0.418). In the Romanian acute-injury subgroup, infection occurred in 1/63 patients (1.6%). Survey responses also demonstrated variation in postoperative antibiotic duration and perceptions of existing recommendations. Conclusions: Substantial center-level variation was observed in case mix, postoperative antibiotic prescribing, treatment duration, and wound-cleansing practices. Few postoperative infections were documented among patients with available follow-up; however, differences in eligibility criteria, injury complexity, and follow-up completeness preclude conclusions regarding comparative treatment effectiveness. Survey findings provided complementary evidence of variability in reported practice rather than validation of the center-level clinical findings. Prospective multicenter studies using standardized injury classification and follow-up are needed to develop more consistent, risk-based approaches to antimicrobial and wound management in hand trauma.