Fractures and dislocations of the hand in polytrauma patients: Incidence,injury pattern and functional outcome |
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| Institution: | 1. Department of Surgery, University Medical Centre Utrecht, The Netherlands;2. Utrecht Traumacenter, Utrecht, The Netherlands;1. Department of Surgical, Seinäjoki Central Hospital, Seinäjoki, Finland;2. Science Center Pirkanmaa Hospital District, Tampere Finland and School of Health Sciences, University of Tampere, Finland;3. Department of Surgical, Oulu University Hospital, Oulu, Finland;4. Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland;1. Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China;2. Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China;1. Department of Orthopaedic Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea;2. Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea;3. Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea;4. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea;5. Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea;6. Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea;7. Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, South Korea;1. Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, United States;2. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States;3. Office of Translation to Practice, Mayo Clinic, Rochester, MN, United States;4. Mayo Medical School, Mayo Clinic, Rochester, MN, United States;5. Department of Surgery, University of Minnesota, Minneapolis, MN, United States;1. Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands;2. Haaglanden Medical Center, Department of Trauma Surgery, The Netherlands;3. Department of Medical Decision Making/Quality of Care Institute, Leiden University Medical Center, Leiden, The Netherlands |
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| Abstract: | IntroductionInjuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients.MethodsA single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1–6 years after trauma.ResultsIn a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0–31) and the PRWHE 14 (IQR 0–41). Patients with a concomitant upper extremity injury (p = 0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p = 0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury).ConclusionThe incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS). |
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| Keywords: | Polytrauma Hand injuries DASH PRWHE Functional outcome |
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