Michigan Hand Outcomes Questionnaire Score Research Articles

Non-operative treatment of metacarpal fractures and patient-reported outcomes: a multicentre snapshot study

Abstract Purpose This study aimed to investigate practice variation in non-operative treatment methods and immobilisation duration for metacarpal fractures, and to evaluate patient-reported outcomes. Methods Conducted in 12 Dutch hospitals over three months in 2020, this study included adult patients with non-operatively treated solitary metacarpal fractures. Fractures were classified into intra-articular base, extra-articular base, shaft, neck, and intra-articular head fractures. The treatment methods (functional treatment allowing digit mobilisation or immobilisation) and immobilisation duration were assessed. Patient-reported outcomes were evaluated using the Michigan Hand Outcomes Questionnaire (MHQ) at three months post-trauma. Results Of 389 included patients, shaft fractures were most common (n = 150, 39%), with 93% immobilised, followed by fifth metacarpal neck fractures (n = 93, 24%), with 75% immobilised. Immobilisation rates for fifth metacarpal neck fractures varied between hospitals, ranging from 29% (95% CI 0.10–0.58) to 100% (95% CI 0.78–1.00). The median immobilisation duration for all fractures was 23 days (IQR: 20–28), and hospital setting was independently associated with this duration. Patients with metacarpal shaft fractures immobilised for less than 21 days had higher MHQ scores compared to those immobilised for 21 days or more (median (IQR) 83 (76–100) versus 71 (57–89), p = 0.026). Conclusions The results showed practice variation in the treatment of metacarpal fractures, especially in the treatment of fifth MC neck fractures, with some hospitals following the Dutch guideline that advocates functional treatment while others did not. There are suggestions that prolonged immobilisation of metacarpal shaft fractures may lead to a worse MHQ score. These findings underscore the need for adherence to treatment protocols and emphasize functional treatment to potentially improve patient outcomes and cost-effectiveness.

Which would you choose again? Comparison of trapeziometacarpal implant versus resection arthroplasty in the same patient.

We invited 14 women who had undergone implant arthroplasty in one thumb and resection-suspension-interposition arthroplasty (RSIA) in the other to a follow-up visit at a median time of 2.2 and 6.2 years after implant and RSIA, respectively. In total, 12 patients were satisfied or very satisfied with the outcome after implant arthroplasty, while eight patients reported this level of satisfaction for RSIA. Of the patients, 10 would choose an implant again, one would choose RSIA and three patients were undecided. The brief Michigan Hand Outcomes Questionnaire score and key pinch and grip strengths were significantly higher at follow-up for the thumb with the implant arthroplasty. Two revision operations were done 1.5 years after RSIA. Patients were satisfied with both procedures, but if they had to choose again, they would prefer implant arthroplasty.Level of evidence: III.

A Prospective Comparative Study of Ray Resection versus Amputation through Proximal Phalanx for Nonviable Digits of Upper Limb

Abstract Background Finger amputations aim at preserving function and optimizing cosmesis. The crucial decision here is whether to preserve a stump or to do a ray amputation. The present study aimed to compare the functional outcome and postoperative quality of life after ray amputation or amputation through the proximal phalanx. Methods A prospective study was conducted from January 2019 to June 2020 in patients requiring single-finger amputation through the proximal phalanx or metacarpal. Patients were divided into two groups; Group A: amputation through the proximal phalanx and Group B: ray amputation of the finger. The following functional parameters were assessed: grip strength, hand circumference, palmar volume, and webspace span. The Michigan Hand Outcomes Questionnaire (MHQ) score was employed to score hand function and aesthesis at 6 months in both hands. Results Thirty patients were enrolled. Findings in 26 patients (52 hands) were subjected to further analysis, 12 in Group A and 14 in Group B. Patients in both groups lost grip strength significantly compared with their contralateral normal hands (29.22 ± 14.88 [Group A] and 34.57 ± 19.12 [Group B]); however, it was statistically nonsignificant between the two groups. There was reduced mean palmar circumference in both groups' involved hands, but the decrease in circumference was statistically significant, only for Group B. Group B patients scored better in all the six subscales of the MHQ; however, only the Aesthetics score was significantly superior. The operated hand's webspace span increased significantly with respect to the normal contralateral web by a mean of 4.55 mm. Conclusion The study concluded that both the surgical options for the level of amputation should be discussed with the patients in detail, taking into account their occupational and personal requirements. Our study findings will help to objectively counsel the patients regarding expectations in functional and aesthetic outcomes following either technique.

"Proximal interphalangeal joint arthroplasty for osteoarthritis: Long-term follow-up of patient satisfaction, Michigan Hand outcomes Questionnaire scores, and reoperations."

Previously published research describes short-term outcomes after proximal interphalangeal (PIP) joint arthroplasty, however, long-term outcomes are scarce. Therefore, we evaluated patient-reported outcomes and complications after a follow-up of at least five years following PIP joint arthroplasty. We used prospectively gathered data from patients undergoing PIP joint arthroplasty with silicone or surface replacement implants. Time points included preoperative, one year, and at least five years postoperatively. We were able to include 74 patients. Primarily, we focussed on patient satisfaction with the treatment outcome, measured using a validated 5-point Likert scale. Secondary outcomes included the question whether patients would undergo the same surgery again, the assessment of factors associated with (dis)satisfaction, the Michigan Hand outcomes Questionnaire (MHQ), and the number of reoperations. The mean follow-up was seven years (SD 1.2, range 5-11 years). Patient satisfaction was excellent in 14 (19%), good in 17 (23%), reasonable in 18 (24%), moderate in 10 (14%), and poor in 15 (20%) patients. Seventy-three percent of patients (n=54) would undergo the same procedure again. We found no factors associated with (dis)satisfaction. All MHQ scores improved significantly in the first year after surgery and did not deteriorate afterward. Sixteen (16%) fingers required a reoperation, of whom 3 (4%) needed a prosthesis replacement. Patient satisfaction with treatment outcomes seven years post-PIP implant surgery ranges from moderate to good for many patients, with a notable proportion expressing dissatisfaction. Patient-reported outcomes improve primarily within the first year and remain stable at five years or more. II.

Long-term results of the Malingue technique in the surgical treatment of Dupuytren's disease

ObjectivesThe choice of surgical technique for aponeurectomy in Dupuytren’s disease is controversial due to varying outcomes and complication rates. The Malingue plasty has shown mathematical and mechanical advantages, but long-term efficacy and results compared to other techniques have never been reported.This study aimed to evaluate the long-term functional, esthetic and recurrence outcomes of Malingue plasty in Dupuytren's disease. Material and methodsThe study included patients who underwent aponeurectomy with Malingue plasty performed by a highly experienced surgeon between January 2014 and December 2016, with a minimum follow-up of 5 years. Preoperative records were analyzed. At follow-up, extension lag was analyzed in each joint (metacarpophalangeal, proximal interphalangeal and distal interphalangeal) in each operated finger, as well as signs of recurrence or extension of the disease. Function and esthetics were assessed using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) questionnaire and the Michigan Hand Outcomes Questionnaire. ResultsOut of 107 eligible patients, 55 were included in the study after exclusions and loss to follow-up. Three patients required revision surgery for recurrence during follow-up. All preoperative deformities of the proximal interphalangeal and metacarpophalangeal joints were corrected postoperatively, and no intraoperative or postoperative complications occurred. Mean extension deficit at follow-up was 18.1 °. Only the little finger showed significant loss of correction (p = 0.02). Mean QuickDASH score was 13.2 and the overall Michigan Hand Outcomes Questionnaire score was 91.8%. Recurrence affected 50% of patients according to the Leclercq criteria and 27.5% according to the Felici criteria. ConclusionAlthough Malingue plasty did not improve the recurrence rate in Dupuytren's disease compared with other techniques, its advantages in terms of functional improvement and complications make it an interesting surgical option.

Patient-Reported and Clinical Outcomes After Tendon Autograft Reconstruction of the Thumb Ulnar Collateral Ligament

This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon autograft. Furthermore, the patient-reported outcomes of patients with persistent instability after reconstruction and patients with concomitant metacarpophalangeal joint arthritis diagnosed during surgery were analyzed. Patients undergoing reconstruction with a tendon autograft between December 2011 and February 2021 were included. Michigan Hand Outcomes Questionnaire (MHQ) scores at baseline were compared with those at 3 and 12 months after surgery. Stability was tested at 3 months after surgery. Tip and key pinch strength and metacarpophalangeal joint range of motion were measured at baseline and 12 months after surgery. We included 31 patients with thumb UCL insufficiency or failed UCL surgery who underwent reconstruction. The MHQ total score improved significantly from 62 at baseline to 75 at 3 months and continued to increase to 84 at 12 months after surgery. The MHQ function and pain scores improved significantly from intake to 3 and 12 months after surgery. Twenty-six of 31 patients (84%) regained postoperative metacarpophalangeal stability. Key pinch strength improved significantly 12 months after surgery from 5.2 kg at baseline to 6.4 kg at 12 months. The MHQ total, pain, and function scores of patients with persistent instability remained similar from baseline to 12 months after surgery. In four patients with metacarpophalangeal arthritis, the MHQ total and pain score improved significantly from baseline to 3 and 12 months after surgery. Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. Although the sample size of patients with thumb metacarpophalangeal arthritis diagnosed during surgery was small, they reached adequate patient-reported outcomes at 12 months after surgery. Therapeutic IV.

Outcomes of Radial Forearm Free Flap Closure With Split-Thickness Skin Graft Versus Primary Closure.

This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site. Patients with RFFF (2015-2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ). 198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165). STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. 3 Laryngoscope, 134:4266-4273, 2024.

Efficacy of mirror therapy in improving hand function post flexor tendon repair

The aim of this study was to determine the efficacy of mirror therapy (MT) in improving the total active range of motion (AROM) of the affected finger, hand grip strength, and hand function in patients with flexor tendon repair (FTR) in zone II. The study was an open-label, parallel-group, randomized controlled trial. Thirty patients with zone II FTR, aged 20-45 years, were recruited and randomized into two equal groups: the MT group and the sham MT group. The intervention began in the fourth week post-operation, consisting of thirty minutes of MT or sham MT, three sessions per week for four weeks, in addition to the traditional physical therapy (PT) program. The total AROM of the interphalangeal (IP) joints of the affected fingers, hand grip strength, and hand function were assessed. After four weeks of intervention, the percentage change in total AROM was 25.7% in the MT group and 19.93% in the sham MT group. Additionally, hand grip strength and Michigan Hand Outcomes Questionnaire (MHQ) scores showed greater improvement in the MT group compared to the sham MT group (p < 0.05). Adding MT to the traditional PT program may be more effective than the traditional PT program alone in improving the AROM of the interphalangeal (IP) joints of the operated fingers, grip strength, and MHQ scores.

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations.

Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Use of Tourniquet Under Sedation Anesthesia or the Walant Techniques in Bilateral Carpal Tunnel Surgery: A Comparative Analysis

Aim: The objective of the study was to compare the outcomes and patient satisfaction of two different anesthesia techniques; wide-awake-local anesthesia-no tourniquet (WALANT) and sedation anesthesia with a tourniquet, in open carpal tunnel release surgery for bilateral cases.
 Material and Methods: The study included 57 patients (41 female, 16 male) who underwent carpal tunnel release surgery between January 2016 and September 2021. The files were retrospectively evaluated and included in the present study. Patient evaluations were conducted using QuickDASH and Michigan Hand Outcomes Questionnaire scores before surgery, on the 15th day after suture removal, and at six months postoperatively. Surgical duration and complications were also recorded. Statistical analyses were performed to compare the outcomes between the two groups.
 Results: Both QDash and MHQ scores were analyzed for anesthesia effects on hands. The study's reliability was ensured by an 85% statistical power, 95% confidence level, and p

Patient-Reported Outcome Measures After Endoscopic Cubital Tunnel Release With At Least 1-Year Postoperative Follow-up.

The primary objective of this study was to investigate midterm outcomes following endoscopic cubital tunnel release (ECuTR) with the Seg-Way system using patient-reported outcome measures (PROMs). A secondary aim was to evaluate symptom resolution as assessed through Dellon's stage, McGowan's grade, and Messina's criteria and recurrence following ECuTR. Functional outcomes were assessed in 38 patients who underwent 43 surgeries. Details on baseline characteristics as well as preoperative and postoperative symptoms were collected. Patient-reported outcome measures were administered with at least 1-year follow-up in all patients. Mean age of patients was 50.2 ± 16.1 years, with 20 men (52.6%) and 18 women (47.4%). Postoperatively, pain completely resolved in 21 (72.4%), while sensory and motor deficits improved completely in 22 (56.4%) and 11 (64.7%) patients, respectively. Mean time interval between ECuTR and PROMs was 26.3 (13-63) months. Median Michigan Hand Outcomes Questionnaire score was 73.2 (48-91). Median Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale (NRS) scores were 12.9 (7-35) and 2.5 (0-5), respectively. Most of the patients were satisfied postoperatively with a median satisfaction score of 4 (3-5). There was a significant difference in median DASH and NRS scores between patients with and without concomitant proximal nerve disease. Endoscopic cubital tunnel release is a safe and effective option for surgical management of primary cubital tunnel syndrome. The presence of other proximal nerve disease is associated with poorer outcomes, less symptom resolution, and higher recurrence rates. One-year postoperative PROMs show equivalence to those reported in other studies following open cubital tunnel release.

Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects.

Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.

FUNCTIONS, SLEEP, FATIGUE AND QUALITY OF LIFE IN PATIENTS WITH SCLERODERMA DURING COVID-19: CROSS - SECTIONAL STUDY

Purpose: COVID-19, which has affected people in various ways, has also shown to cause various limitations on the lives of Scleroderma patients. The current study aims at evaluating the upper extremity functions, sleep quality, fatigue, and health-related quality of life in Scleroderma patients and to determine the factors affecting upper extremity functions.&#x0D; Methods: A total of 83 participants were recruited in this study. Of the participants, 39 were Scleroderma patients (mean age 43.28±9.96 years) and 44 were healthy controls (mean age 40.05±8.89 years). The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcomes Questionnaire (MHQ) were applied to evaluate upper extremity functions of the participants. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and the Scleroderma Health Assessment Questionnaire (SHAQ) were used to evaluate the sleep quality, fatigue, and health-related quality of life, respectively.&#x0D; Results: Scleroderma patients had significantly lower scores in hand functions, sleep quality, fatigue, and health-related quality than the healthy group (p=0.001). The correlations between DASH and PSQI (r=0.559, p=0.001), FSS (r=0.496, p=0.001), SHAQ scores (r=0.754, p=0.001) were highly positive. Similarly, a high correlation was found between MHQ and SHAQ scores (r=-0.679, p=0.001).&#x0D; Conclusion: Upper extremity functions and health-related quality of life were found to be affected in patients with Scleroderma. It was revealed that upper extremity functions were affected by sleep quality, fatigue, and health-related quality of life. Therefore, knowing all these effects and their relationships with each other allows to draw a systematic treatment plan on Scleroderma patients.

Explaining Personalized Activity Limitations in Patients With Hand and Wrist Disorders: Insights from Sociodemographic, Clinical, and Mindset Characteristics

ObjectivesTo investigate the association of sociodemographic, clinical, and mindset characteristics on outcomes measured with a patient-specific patient-reported outcome measure (PROM); the Patient Specific Functional Scale (PSFS). Secondly, we examined whether these factors differ when a fixed-item PROM, the Michigan Hand Outcome Questionnaire (MHQ), is used as an outcome. DesignCohort study, using the aforementioned groups of factors in a hierarchical linear regression. SettingTwenty-six clinics for hand and wrist conditions in the Netherlands. ParticipantsTwo samples of patients with various hand and wrist conditions and treatments: n=7111 (PSFS) and n=5872 (MHQ). InterventionsNA. Main Outcome MeasuresThe PSFS and MHQ at 3 months. ResultsThe PSFS exhibited greater between-subject variability in baseline, follow-up, and change scores than the MHQ. Better PSFS outcomes were associated with: no involvement in litigation (β[95% confidence interval=-0.40[-0.54;-0.25]), better treatment expectations (0.09[0.06;0.13]), light workload (0.08[0.03;0.14]), not smoking (-0.07[-0.13;-0.01]), men sex (0.07[0.02;0.12]), better quality of life (0.07[0.05;0.10]), moderate workload (0.06[0.00;0.13]), better hand satisfaction (0.05[0.02; 0.07]), less concern (-0.05[-0.08;-0.02]), less pain at rest (-0.04[-0.08;-0.00]), younger age (-0.04[-0.07;-0.01]), better comprehensibility (0.03[0.01;0.06]), better timeline perception (-0.03[-0.06;-0.01]), and better control (-0.02[-0.04;-0.00]). The MHQ model was highly similar but showed a higher R2 than the PSFS model (0.41 vs 0.15), largely due to the R2 of the baseline scores (0.23 for MHQ vs 0.01 for PSFS). ConclusionsHealth care professionals can improve personalized activity limitations by addressing treatment expectations and illness perceptions, which affect PSFS outcomes. Similar factors affect the MHQ, but the baseline MHQ score has a stronger association with the outcome score than the PSFS. While the PSFS is better for individual patient evaluation, we found that it is difficult to explain PSFS outcomes based on baseline characteristics compared with the MHQ. Using both patient-specific and fixed-item instruments helps health care professionals develop personalized treatment plans that meet individual needs and goals.

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis.

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.

Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud Phenomenon.

In periarterial sympathectomy for intractable Raynaud phenomenon, the extent of adventitectomy and postoperative outcomes and hand perfusion assessment tools remain debatable. The authors evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitectomy in the treatment of refractory Raynaud phenomenon using objective measurements and patient-reported outcomes. Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up. The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery ( P = 0.02). The median number of ulcers decreased ( P < 0.001), and the median digital skin temperature increased ( P < 0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function ( P ≤ 0.001), activities of daily living ( P = 0.001), work performance ( P = 0.02), pain ( P < 0.001), physical function ( P = 0.053), and general health ( P = 0.048), and mental aspects, such as patient satisfaction ( P < 0.001) and mental health ( P = 0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function ( r = 0.46, P = 0.04), work performance ( r = 0.68, P = 0.001), physical function ( r = 0.51, P = 0.02), and patient satisfaction ( r = 0.35, P= 0.03). The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment. Therapeutic, IV.

Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger.

We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger.Level of evidence: I.

Open hand fractures: a prospective analysis of functional outcomes and risk factors for infection after initial management in the emergency department.

Open hand fractures are common orthopaedic injuries, historically managed with early debridement in the operating room. Recent studies suggest immediate operative treatment may not be necessary but have been limited by poor follow-up and lack of functional outcomes. This study sought to prospectively evaluate these injuries treated initially in the emergency department (ED), without immediate operative intervention, to determine long-term infectious and functional outcomes using the Michigan Hand Outcomes Questionnaire (MHQ). Adult patients with open hand fractures managed initially in the ED at a Level-I trauma center were considered for inclusion (2012-2016). Follow-up and MHQ administration occurred at 6weeks, 12weeks, 6months, and 1year. Logistic regression and Kruskal-Wallis testing were used for analysis. Eighty-one patients (110 fractures) were included. Most had Gustilo Type III injuries (65%). Injury mechanisms most commonly included saw/cut (40%) and crush (28%). Nearly half of all patients (46%) had additional injuries involving a nailbed or tendon. Fifteen percent of patients had surgery within 30days. The average follow-up was 8.9months, with 68% of patients completing at least 12months. Eleven patients (14%) developed an infection, of which 4 (5%) required surgery. Subsequent surgery and laceration size were associated with increased odds of infection, and at one-year, functional outcomes were not significantly different regardless of fracture classification, injury mechanism, or surgery. Initial ED management of open hand fractures results in reasonable infection rates compared to similar literature and functional recovery demonstrated by MHQ score improvements over time.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures

In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from-6° to-14°) and Michigan Hand Outcome Questionnaire score (median difference,-1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. Therapeutic IV.