The effect of workers' or third-party compensation on return to work after hand surgery.
OBJECTIVES
To investigate the role of compensation in recovery from scaphoid internal fixation.


DESIGN
Retrospective review of patients who 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 of a specialist hand surgeon.


PATIENTS
202 patients who attended for the minimum of six months' follow-up, and for whom accurate details of return-to-work time were available.


INTERVENTION
Internal fixation of scaphoid fractures using the Herbert bone screw without postoperative immobilisation.


MAIN OUTCOME MEASURES
Return-to-work time and compensation status.


RESULTS
Overall, patients receiving compensation took more than twice as long as privately insured individuals to return to 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.


CONCLUSIONS
Compensation encourages a slower return to work after surgery. The current compensation system could save millions of dollars each year by incorporating incentives to return to work without sacrificing good surgical results.