Traumatic Hand Injury Research Articles

A Geospatial Analysis of Hand Trauma Care: A Statewide Cross-Sectional Study.

Traumatic hand injuries often present with high acuity, but little is known about the influence of geospatial and socioeconomic factors on the timely delivery of care. This cross-sectional study used the Michigan Trauma Quality Improvement Program database, a state-wide registry with 35 level I or II trauma centers. Adult patients sustained hand trauma requiring urgent operative treatment between 2016 and 2021. Zip codes of injury location were linked with the corresponding percentile score on the Area Deprivation Index (ADI), a comprehensive measure of neighborhood disadvantage. Multiple regression analyses were used to determine associations of patient, injury and geospatial characteristics with the odds of sustaining acute hand trauma and time to operative treatment. Among 1,826 patients, the odds of sustaining acute hand trauma based on the ADI followed a bimodal distribution. Female sex, smoking, obesity, work-related injury and residence in a minor city were associated with increased odds, while younger age, comorbidities, and rural residence were associated with decreased odds. For 388 patients who underwent surgery within 48 hours, time to treatment was significantly increased in the highest ADI quintile, for patients who underwent fracture fixation, and for those with severe global injury severity. Multi-system injuries, moderate global injury severity and direct admission to an orthopaedic service were associated with shorter times to treatment. Patients in areas with greater neighborhood disadvantage may experience delayed operative care after acute hand trauma. This study highlights the importance of considering underserved populations and geospatial factors when determining the allocation of hand surgery resources. Prognostic Level III.

Ray resection in pediatric population after trauma injuries.

The aim of this study is to assess the functional, emotional, and social adaptation of pediatric patients submitted to a hand ray resection to treat a traumatic hand injury. Retrospective study of pediatric patients undergoing hand ray resection, in the period 2013-2022, performed in two hospital institutions. Inclusion criteria: age less than 18 years, primary/secondary resection due to traumatic etiology and follow-up time of more than 1 year. Data concerning demographic information, lesion location, traumatic mechanism and surgical description were collected. Functional outcomes (QuickDASH Score), social and emotional integration (PEDSQL) and satisfaction were evaluated. Seven patients were included, with male predominance (n = 4) and the right side was the most affected (n = 5). Median age at the time of surgery was 10 years (2-15). Primary ray resection, without previous revascularization, was performed in three patients. Secondary ray resection was performed in four patients. Three patients with an unsuccessful revascularization procedure attempt another patient with a sequela with severe deformity. All patients presented a good adaptation to daily living activities, with good pinch and grip function. The median follow-up was 4 years (min:1; max:9). The scores were collected on six out of seven patients. Median QuickDASH score of 14 (min:11; max:22), and PEDSQL[physical] of 95.31 (min:78.13; max:100) and PEDSQL[social] of 93.47 (min:66.3; max:100). Hand ray resection is a rare procedure in pediatric age and usually difficult for patients and parents to accept. However, it is a useful and safe technique that allows for an improvement in overall hand function and psychosocial readaptation in specific and selected cases. Level of evidence: Level of evidence IV - case series.

First Contact Management of Traumatic Hand Injuries

Performing a comprehensive history and physical examination is the first stage in treating any hand injury. This includes finding out the mechanism and timing of the injury, hand dominance, tetanus status, the patient's occupation, and baseline function. It is critical that the primary care physician oversee initial care in order to promote prompt healing and reduce long-term morbidity. It's crucial to identify injuries that need to be sent to hand surgeons as away. To enable prompt therapy of such an accident, direct phone communication between the on-call hand surgeon and the primary care physician is crucial.

Initial patient demographics affecting return to original work after traumatic hand injury in a rural area in Japan: A retrospective single-center study

BackgroundTime off work after traumatic hand injury not only affects individuals but also has socioeconomic repercussions, becoming a serious problem from the viewpoint of labor shortages. In depopulated rural areas, the impact of labor shortages due to time off work is more serious than in urban areas; however, few studies have examined return to original work in rural areas. The purpose of this study was to investigate the patient demographics at the time of hand injury that affect return to original work in a rural area of Japan. MethodsWe retrospectively examined 246 patients with traumatic hand and/or forearm injuries who were working at the time of injury, and who underwent surgical operations and postoperative rehabilitation in a level II hospital in a rural agricultural area. We examined patients' initial demographic data, including gender, age, occupation (white or blue collar), employment status (self-employed, full-time, or part-time workers), complications other than hand injury, workers’ compensation, dominant hand injury, and injury severity as determined using the modified Hand Injury Severity Score. Multivariate logistic regression analysis examined the association between initial patient demographics and return to original work within 150 days after injury. ResultsIn total, 186 patients (76 %) were able to return to original work within 150 days. A multivariate logistic regression analysis showed that three explanatory variables (i.e., severity of injury, complications other than hand injury, and female gender) significantly compromised return to original work. ConclusionsIn the treatment of traumatic hand injury, intensive support should be provided for return to original work for patients who are expected to have difficulty returning to work quickly. In addition, labor shortages can be mitigated by sharing information with the workplace about patients’ prospects of return to original work.

Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort

BackgroundFollowing traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis.MethodsA prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) ‘Health Today’ analogue scale (0–100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses—accounting for covariates including cultural identity—were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis.ResultsFrom 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting ‘good or better’ global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), ‘no’ anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ ‘Health Today’ (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar.ConclusionsDespite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.

Retrospective Evaluation of Patients with Traumatic Hand Injuries

Objective: This study aimed to retrospectively examine the demographic, etiologic, and clinical characteristics of patients with traumatic hand-wrist injuries and to profile patients with the goal of contributing to preventive measures and protective programs. Methods: The records of 225 patients who came to the Hand Rehabilitation Unit of our clinic with a traumatic hand injury in the last 5 years were reviewed retrospectively. Many parameters were recorded, including demographic characteristics such as age, sex, and occupation, as well as information about the injured hand, dominant hand, type of injury, injured tendon and zone, number of affected fingers, and associated structures. Results: The study included 225 patients. Tendon injuries occurred most frequently in the 3rd decade. Of the injuries, 31.1% were caused by occupational accidents and 55.1% occurred in the dominant hand. Of the tendon injuries, 64% were flexor tendon injuries and 32.4% were extensor tendon injuries. Extensor Digitorum Communis (EDC)-3 tendons were involved in 11.6% of extensor tendon injuries, and Flexor Digitorum Superficialis (FDS)-4/Flexor Digitorum Profundus (FDP)-5 tendons were involved in 18.2% of flexor tendon injuries. In nerve injuries, median and ulnar nerves were equally affected (14.2%). Conclusion: Tendon injuries primarily affect young male workers, resulting in significant disability and an inability to work. Epidemiologic data can expand our knowledge about injury patterns. Occupational training and the prevention of occupational accidents can help patients improve their functional capacity and minimize their economic burden.

The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.

Securing perforator flap perfusion by using dynamic infrared thermography (DIRT) in complex traumatic hand surgery – A case report

A complex traumatic hand injury may pose a challenge for the reconstructive surgeon. Perforator flaps provide the surgeon with an option in managing such injuries. Securing perfusion of the perforator flap is essential, as partial, or total flap loss yield poor functional and cosmetic outcome, often requiring reoperation. We report a case of a 28-year -old male suffering a mutilating hand injury after a car accident. Reconstruction was performed with a free microvascular lateral arm flap, and perfusion of the flap was monitored pre-, intra-, and postoperatively with dynamic infrared thermography (DIRT).The purpose of this report is to highlight the usefulness of DIRT as a novel perfusion imaging modality in the management of complex traumatic hand injury. • Dynamic infrared thermography (DIRT) can be used in complex traumatic hand surgery for perforator mapping. • DIRT can be used to evaluate flap perfusion intra- and postoperatively. • DIRT can be used to evaluate patency of the microvascular anastomose. • DIRT is a non-invasive, non-contact imaging modality that provides reliable information on skin perfusion.

Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury.

Hand injuries affect a person's functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. One hundred and fifteen adult workers with hand injuries aged 18- 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045- 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person's return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction's score, DASH disability/symptoms' score and duration of the injury. As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.

Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries.

Open de-gloving hand injuries with exposed tendons and bones require coverage by a flap.Conventionally used groin or abdominal flaps are cumbersome to patients due to extensive dressing and prolonged passive positioning of the hand until pedicle division. Superficial circumflex iliac artery (SCIA) flap is evolved from a traditional groin flap, and because of its thinness, pliability, and concealed donor site, it is an ideal option for single-stage reconstruction of traumatic hand defects avoiding discomforting passive hand position, joint stiffness, and unexpected flap avulsion which were associated with traditional groin flap.All patients with exposed bones or tendons due to traumatic hand injuries who opted for free flap coverage during the year 2018 to 2020 were enrolled in our study. After initial debridement, the wound was covered with a free SCIA flap. Duration of hospital stay, days out of work, the number of dressings required, postoperative complications, and any secondary procedures for flap readjustment were noted till six months postoperatively. A total of eight patients were included in the study. The mechanism of injury was road traffic accidents in a single patient and occupational injury in eight patients. The average duration of hospital stay was six days after reconstructive surgery. The average number of dressings a patient had was 18, and only two patients required flap thinning. Only one patient had a postoperative infection which was managed with dressings and antibiotics. One patient had peripheral flap necrosis. We had zero flap re-exploration. Therefore, we conclude that hand defects coverage with SCIA flap leads to a smaller number of working days lost and rarely requires secondary procedures.

Assessment of the factors affecting the loss of workforce in patients with traumatic hand injury

Objective: This study aimed to examine the factors affecting the loss of workforce, including the time to return to work and workrelated situations in patients with traumatic hand injury who were taken to a hand rehabilitation program. Materials and Methods: The patients aged between 18-65 years with a history of traumatic hand injury in the last five years were analyzed retrospectively. Demographic and clinic data were taken from the medical records, and work-related problems were obtained by telephone calls. The severity of hand injury was assessed with Modified Hand Injury Severity Score (MHISS). Results: A total of 147 patients (129 males, 18 females; mean age 39.83±10.4 years) were included. The duration of return to work was correlated with total MHISS (rho=0.262 p=0.003) while not related to age, education level, gender, or injured hand’s dominance (p&amp;gt;0.05). Duration of return to work after hand injury and total MHISS were lower in the patients who had job modifications (p&amp;lt;0.001, p=0.002). Job modification rate, salary reduction, and patient-reported hand dexterity loss were higher in patients with work-related injuries (p&amp;lt;0.05). Conclusion: This study highlighted that the increasing severity of hand injury caused a prolonged time to return to work, or job scope changes.

The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders.

We investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with psychological disorders thought to be influencing recovery from elective and traumatic hand conditions. Demographic data and psychological assessment scores (Primary Health Questionnaire 9 (PHQ9), General Anxiety Disorder Assessment (GAD7), Impact of Event Scale (IES)) were prospectively collected before and after CBT treatment. One hundred and fourteen patients underwent CBT with 81 completing treatment. Full data was available for 78 (68%) patients. Mean age was 43 (range 13-84) and 63% were women. Sixty-one per cent had sustained a traumatic hand injury. PHQ9, GAD7 and IES scores decreased significantly following treatment. Many patients with hand conditions have associated psychological problems that may influence outcome. CBT in a hand unit setting appears to be an effective treatment. Further research with a control group should investigate whether CBT improves psychological health or if this may occur as patients recover from their physical hand disorder regardless of CBT.Level of evidence: IV.

RETRACTED: Can a Blade-StoppingMechanism on Circular Table Saws Reduce the Severity of Hand Injuries in Contact Scenarios? A Cadaveric Study

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief. After online publication, communication between the authors and a reader resulted in some further investigation by the authors. The additional data collected by the authors suggested that the reported findings are not accurate. The authors found the data published in Table 1 was invalidated by an incorrect model. The editor discussed the errors with the authors and contacted the Research Director at the authors' institution, and it was agreed that a retraction was necessary. Based on the discussions with the authors and their institution, the editor and authors have concluded that the study contains errors.

Trauma clinic follow-up: Predictors of nonattendance and patient-reported reasons for no show

Introduction The objectives of this study were to identify factors associated with nonattendance to follow-up in patients seen for traumatic hand and facial injuries at an urban Level 1 trauma center and to elucidate patient-reported reasons for nonattendance. Methods A retrospective chart review was performed for all patients seen for hand and facial trauma at our institution over a 2-year period. Demographic data, including race, insurance status, and incomes based on zip code data, were collected for all patients. Injury patterns, interventions, and patient disposition were analyzed. A binomial multivariate logistic regression was conducted to identify predictors of nonattendance to follow-up. All patients who were lost to follow-up over the last 12-month period were contacted via phone to identify reasons for nonattendance to determine whether they had followed up with another provider and to analyze long-term injury sequelae. Results After exclusion criteria were applied, there were 889 patients included in the analysis, with 31% of patients lost to follow-up. Factors significantly associated with follow-up nonattendance included patients who sustained injuries from gunshot wounds or assault, had no insurance or were out of network, and who received no acute intervention for their injuries. Forearm, wrist, and fingers fractures; facial fractures and lacerations; performing a procedure in the ED or operating room; and commercial insurance were all independent predictors of clinic attendance. The most common reasons for nonattendance cited by patients were “did not feel the need” (28%), lack of transportation (20%), and scheduling conflicts (19%). Conclusions Clinic follow-up for patients sustaining hand and facial trauma at a Level 1 trauma center is impacted by the socioeconomic factors that make this patient population particularly vulnerable to injury.

Operative Pediatric Hand Trauma.

This study aims to describe the epidemiology of hand injuries in pediatric patients undergoing surgical treatment. A retrospective analysis of patients with traumatic hand injuries surgically treated over a 7-year period. A total of 155 patients were included. Fracture was the most common injury type (74.8%), most of which were open (54.3%). Incidence of articular fractures increased with age. The predominant mechanism of injury before age 10 was crush. In toddlers, only central digits were affected. Good functional results were achieved (Quick-DASH 1.37 ± 4.90). The incidence of hand injuries requiring surgery increased with age. The mechanism and segment affected varied with age groups. Although good functional results are expected, complications may occur 33% and secondary surgical procedures in 7.7%.

Nerves in Continuity Following Hand Trauma: A Descriptive Report.

Understanding the clinical presentation of nontransected nerve injuries in acute hand trauma/wrist trauma will help in early intervention, which is vital for maximizing return of function in patients. This retrospective study evaluated patients who experienced traumatic hand injuries with nerve in continuity within the zone of injury. This was a single-center retrospective chart review of 20 patients with hand or wrist trauma resulting in damage to bone, tendon, or soft tissues within Zones II to V. Patients were 18 to 70 years of age and had documented visualization of at least one nerve within the zone of injury at the time of surgery but no documented full or partial nerve transection. The cohort was characterized using descriptive statistics including mechanism of injury, extent of strength and sensation deficits, and outcomes. Resolution of symptoms was defined as full, partial, or none. Of the 20 patients included in the study, 15 patients (75%) showed symptoms of impaired nerve function either prior to surgery or at the first post-surgical follow-up visit. Without direct nerve treatment, only 23% (3/13) of patients experienced full recovery based on qualitative sensory assessment. However, patients reporting pain after surgery (57%; 8/14) showed full recovery from pain despite no direct nerve treatment. In our retrospective cohort of patients with hand/wrist trauma that presented with an intact nerve in continuity, we found that a majority showed symptoms of nerve injury. Further, these patients showed slow recovery over time with a minority achieving partial or full recovery or improvement in pain.

Taking hold of hand trauma in KwaZulu-Natal, South Africa.

Trauma in KwaZulu-Natal province in South Africa constitutes at least 17.8% of overall emergency cases, with hand trauma being common. Based on these statistics, the authors of this study aimed to identify and describe the most common traumatic hand injuries managed in the province including current trends and intervention practices of occupational therapists to inform future intervention. Using a mixed-method convergent parallel design, 41 therapists completed an online survey, and 12 therapists participated in two focus group discussions. Survey responses were analysed using descriptive statistics, and the audio-recorded and transcribed focus group discussions were analysed deductively using thematic analysis. Flexor tendon injuries (88%), extensor tendon injuries (73%), fractures (83%) and combined hand injuries (73%) were the most common injuries noted. Sufficient theoretical knowledge (95%), clinical judgement (93%), available resources (88%), relevant practical experience (83%) and surgeon hand therapy protocols (88%) were identified as essential in managing traumatic hand injuries. Challenges included having limited resources, late referrals and poor communication hindering multidisciplinary practice. Therapists face challenges in managing traumatic hand injuries, which inhibits optimal intervention planning. These factors may inevitably negatively influence outcomes achieved through occupational therapy for this group of patients.

Course Review: St. Thomas' Cadaveric Hand Trauma Course.

Hand trauma encompasses a wide range of problems from amputations to complex fracture patterns, presenting the plastic surgeon with a number of unique challenges. The hand is of paramount importance to work and activities of daily living, therefore, restoration of normal function is critical to every patient.The St. Thomas' Cadaveric Hand Trauma course is a 2-day interactive practical course that uses fresh-frozen cadaveric specimens to provide participants the opportunity to develop their skills in the management of common traumatic hand injuries. The course is held annually in London, United Kingdom at a cost of £600 GBP ($794). Here, we provide a critical evaluation of the course.

Ultrasound-Guided Nerve Blocks for Painful Hand Injuries: A Randomized Control Trial.

Objectives: Traumatic hand injuries present to emergency departments frequently. Pain secondary to these injuries is typically managed with opioids, which may be inadequate and have side effects. Ultrasound (US)-guided forearm nerve blocks have emerged as an alternative modality for patients with acute pain from isolated extremity injuries.Methods: We performed a non-blinded, consecutive, randomized pragmatic trial of US-guided forearm nerve blocks using medium and long-acting anesthetic versus usual care for a six-day period around July 4th, 2017. Adults who sustained a traumatic or blast injury of their hands were considered. Consecutive emergency department patients were consented, enrolled and randomized into a study group (block) or control (standard care). The study group received a US-guided forearm block using a 50/50 mix of 1% lidocaine and 0.5% bupivacaine. The primary outcome was median pain scores via a 100-point visual analog scale at 15, 60, and 120 minutes after the nerve block compared to the baseline pain score. The secondary outcome was mean morphine equivalents administered.Results: Sixteen patients were screened and 12 were randomized: six to the treatment group and six to the control group. Median pain reduction from baseline at 15, 60, and 120 minutes in the forearm block group was -35 (IQR=10), -30 (IQR=50), and -20 (IQR=70, versus -5 (IQR=10), -20.5 (IQR=20), -20 (IQR=70) in the control group. At all time points, patient-reported pain scores decreased significantly over baseline in the forearm block group, whereas non-significant reductions in pain scores occurred in the control group.Conclusion: US-guided forearm blocks for acute traumatic hand injuries resulted in greater pain relief when compared to usual care.

The impact of COVID-19 on traumatic hand injuries: A Turkish survey

Aim: Our aim in the study is to perform a comparative analysis of traumatic hand injuries during the quarantine period of the COVID-19 pandemic with data of the previous year and to research the effect of quarantine on hand injuries. Material and Methods: We retrospectively analyzed patients who presented to the emergency department with traumatic hand injuries between 16.03.2020 and 01.06.2020 and within the same period of 2019. Patients’ age, gender, injury mechanism, length of hospitalization, ethnic origin, presence of major and digital nerve injuries, presence of bone injury, emergency or elective surgery data were recorded. The data were analyzed statistically in comparison with the previous year. Results: A total of 301 patients participated in the study. There were 117 patients in 2020, and 184 patients in 2019. When patients of both years were examined in terms of age, gender and length of hospitalization, there was no statistically significant difference between the patients who were operated for hand injuries between 2020 and 2019 (p>0.05). When patients who were operated due to hand injuries were examined in terms of differences in ethnic origin, operation under emergency conditions and accompanying bone injury between both groups, a statistically significant difference was found between them (p<0.05). Discussion: A decrease was observed in the number of traumatic hand injuries admitted to the emergency department during the COVID-19 pandemic;however, there were no changes in etiology. These reference data can help healthcare systems prepare for future outbreaks and similar restrictions.