Abstract
This study aims to determine if the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for assessing adhesion in metacarpal fractures by comparing two clinical measures, namely single-digit-force and extensor lag (i.e., the difference between passive extension and full active extension). The Fisher–Tippett block-matching method and a Kalman-filter algorithm were used to determine the relative displacements in 39 healthy subjects and 8 patients with metacarpal fractures. A goniometer was used to measure the extensor lag, and a force sensor was used to measure the single-digit-force. Measurements were obtained twice for each patient to evaluate the performance of the AI in assessing the progress of rehabilitation. The Pearson correlation coefficient was calculated to quantify the various correlations between the AI, extensor lag, and single-digit-force. The results showed strong correlations between the AI and the extensor lag, the AI and the single-digit-force, and the extensor lag and the single-digit-force (r = 0.718, −0.849, and −0.741; P = 0.002, P < 0.001, and P = 0.001, respectively). The AI in the patients gradually decreased after continuous rehabilitation, but remained higher than that of healthy participants.
Highlights
Injuries to the hand, wrist, and fingers account for more than one million emergency department visits by workers annually in the United States[1]
Many methods have been reported for the quantitative assessment of the extent of tendon adhesion, including measuring the work output of the digital flexion at maximal digital flexion[4], gliding excursions by fixed loading[5], adhesion breaking strength[6], flexor digitorum profundus (FDP) tendon excursion with free motion of the chicken toe[7,8,9] and simultaneous measurement of the flexion angle and gliding force with unrestricted movement of the chicken toe[10]
The present study aims to test the hypothesis that the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for determining the extent of adhesion in patients with metacarpal fractures and identifying the locations of suspected adhesions
Summary
Many methods have been reported for the quantitative assessment of the extent of tendon adhesion, including measuring the work output of the digital flexion at maximal digital flexion[4], gliding excursions by fixed loading[5], adhesion breaking strength[6], flexor digitorum profundus (FDP) tendon excursion with free motion of the chicken toe[7,8,9] and simultaneous measurement of the flexion angle and gliding force with unrestricted movement of the chicken toe[10] Most of these studies entailed invasive experiments and animal testing and did not involve human patients; most importantly, they performed only gross evaluations of the extent of tendon adhesion. The present study aims to test the hypothesis that the relative displacement between the extensor digitorum communis (EDC) tendon and its surrounding tissues can be used as an adhesion index (AI) for determining the extent of adhesion in patients with metacarpal fractures and identifying the locations of suspected adhesions. Emphasis is placed on verifying whether this index is correlated with extensor lag and single-digit-force, which are two clinical measures currently used for evaluating the gross extent of such adhesion[2]
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