Prognostic Factors for Conservatively Treated Sagittal Band Injuries of the Metacarpophalangeal Joint

Abstract

There is no financial information to disclose. Most sagittal band injuries of the metacarpophalangeal (MP) joint are conservatively treated by extension orthoses, but little information is currently available on unsatisfactory outcomes after the treatment. We asked whether baseline patient characteristics (age, gender, hand dominance, and occupation), injury type and severity, or mode of treatment (time to treatment, duration of orthosis application) would be related to patients’ functional outcomes 6 months after sagittal band injuries. A total of 94 patients who had been diagnosed with closed sagittal band injury and initially treated with 4 weeks of MP joint blocking orthosis were enrolled (Table 87-1). The response to treatment, including finger range of motion (ROM), extensor tendon instability, and functional outcome measured as Quick-Disability of the Arm, Shoulder, and Hand score were assessed at 24-week follow-up. The factors that were assessed for their influence on the outcomes were age, sex, occupation, type of injury, injury severity, time to treatment, and the duration of orthosis use. After 24 weeks’ follow-up, 67 (71%) patients had achieving good to excellent outcomes with 78% recovery of grip strength, 90% recovery in ROM, and mean QuickDASH scores of 15. However, 27 (29%) patients had undergone surgical repair owing to persistently symptomatic tendon subluxation (Table 87-2). There were significantly more manual laborers in the failure group than in the success group (P = .02). Subjects in the treatment failure group were older (P = .06), had longer symptom durations (P = .01), and were more likely to have grade III injuries (P = .02) than were those in the success group. Multivariable analysis revealed that manual labor (odds ratio [OR], 3.4), longer symptom duration (OR, 3.9), and grade III injury (OR, 2.4) were associated with a higher likelihood of conservative treatment failure for sagittal band injuries. •MP joint blocking orthosis for sagittal band injury led to mostly satisfactory results, with 71% of patients achieving good to excellent outcomes.•Manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure.Table 87-1Demographic and clinical characteristics of participants.CharacteristicsNumber or ScoreParticipants94Mean age (y)36 ± 15Male/female65 (69%) / 29 (31%)Heavy manual labor/clerical with repetitive work/others (including unemployed)23 / 34 / 37Injured side (dominant:nondominant)58 (62%): 36 (38%)Location ( index/middle/ring/little finger)9 / 50 / 24 / 11*Injury severity (II:III)38 (40%): 56 (60%)Sports-related/not sport-related29 (31%) / 65 (69%)Time to diagnosis and treatment (wks)2.0 ± 1.1Duration of use of orthosis (wks)4.0 ± 1.7Values expressed with mean ± SDs or number of cases (proportion [%]); *Injury severity was evaluated using Rayan and Murray’s classification. Open table in a new tab Table 87-2Clinical and radiologic differences between treatment success and failure groupsCharacteristicsSuccess Group (n = 67)Failure Group (n = 27)P valueMean age (years)34 ± 1440 ± 14.06Sex (male/female)46/2119/8.87Manual labor12 (18%)11 (41%).02Dominant side41 (61%)17 (63%).57*Injury severity (III)37 (55%)19 (70%).02Injury type (sports-related)18 (27%)11 (41%).19Duration of symptom (wks)1.7 ± 1.12.8 ± 1.4<.01Duration of use of orthosis (wks)4.2 ± 1.83.6 ± 1.6.11Values expressed with mean ± SDs or number of cases (proportion [%]); *Injury severity was evaluated using Rayan and Murray’s classification. Open table in a new tab Values expressed with mean ± SDs or number of cases (proportion [%]); *Injury severity was evaluated using Rayan and Murray’s classification. Values expressed with mean ± SDs or number of cases (proportion [%]); *Injury severity was evaluated using Rayan and Murray’s classification.