THE EFFECT OF WORKERS OR 3RD-PARTY COMPENSATION ON RETURN TO WORK AFTER HAND SURGERY

Objectives: To investigate the role of compensation in recovery from s caphoid internal fixation. Design: Retrospective review of patients wh o had had scaphoid internal fixations performed by one surgeon between 1 September 1981 and 31 December 1994 with a minimum follow-up of six months. Setting: Private practice oi a specialist hand surgeon. Patie nts: 202 patients who attended for the minimum of six months' follow-u p, and for whom accurate details of return-to-work lime were available . Intervention: Internal fixation of scaphoid fractures using the Herb ert bane screw without postoperative immobilisation. Main Outcome meas ures: Return-to-work time and compensation status. Results: Overall, p atients receiving compensation took more than twice as long as private ly insured individuals to return work after scaphoid internal fixation (7.3 v. 3.3 weeks). There was no difference for clerical workers, but for manual workers compensable individuals took significantly longer (P< 0.001) to return to work. Compensation status did not affect bony union, postoperative wrist function, pain or patient satisfaction. Con clusions: Compensation encourages a slower return to work after surger y. The current compensation system could save millions of dollars each year by incorporating incentives to return to work without sacrificin g good surgical results.