Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury - can sense of coherence be an indicator for rehabilitation focus?

Background: Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence. Methods: A postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed. Results: Almost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations. Conclusions: SOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus

Digital nerve injuries: Epidemiology, results, costs, and impact on daily life.

Epidemiology, results of treatment, impact on activity of daily living (ADL), and costs for treatment of digital nerve injuries have not been considered consistently. Case notes of patients of 0-99 years of age living in Malmö municipality, Sweden, who presented with a digital nerve injury and were referred to the Department of Hand Surgery in 1995-2005 were analysed retrospectively. The incidence was 6.2/100 000 inhabitants and year. Most commonly men (75%; median age 29 years) were injured. Isolated nerve injuries and concomitant tendon injuries were equally common. The direct costs (hospital stay, operation, outpatient visits, visits to a nurse and/or a hand therapist) for a concomitant tendon injury was almost double compared with an isolated digital nerve injury (6136 EUR [range, 744-29 689 EUR] vs 2653 EUR [range, 468-6949 EUR]). More than 50% of the patients who worked were injured at work and 79% lost time from work (median 59 days [range 3-337]). Permanent nerve dysfunction for the individual patient with ADL problems and subjective complaints of fumbleness, cold sensitivity, and pain occur in the patients despite surgery. It is concluded that digital nerve injuries, often considered as a minor injury and that affect young people at productive age, cause costs, and disability. Focus should be directed against prevention of the injury and to improve nerve regeneration from different aspects

Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

BACKGROUND: Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients’ satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. METHODS: Between 1994–2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS). RESULTS: The patients [272 (84%) men and 54 (16%) women; median age 39 years (1–81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0–88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS. CONCLUSIONS: A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients’ outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome

An increasing number of hand injuries in an elderly population - A retrospective study over a 30-year period

Background: Both the number and the proportion of elderly people in the society increase. The number of elderly subjects with a disability due to a disease has decreased resulting in more active elderly. Therefore, an increase in numbers of injury in the elderly population can be expected; a hypothesis that was investigated in the present study. Methods: Two-hundred sixteen patients with an age of > 65 years, and admitted to a hand surgery ward with a hand injury, were retrospectively collected at four different 2-years periods over a 30 years time (1980-81 to 2010-11). Information about patient gender, age at injury, injury place and mechanism (s), injured structures, duration of hospital stay, number of out patient visits and rehabilitation visits as well as social status was collected. The injuries were classified with the Modified Hand Injury Severity Score (MHISS). Results: Most injured patients were men (72%) and the number of patients who reported to be healthy significantly decreased (67% to 18%) during the study period. The number of injuries increased over the study period (n = 24 to n = 83/2-year period). Outside home was the most common injury place and a saw or a fall was the most frequent injury mechanism. Several fingers were most often injured. The majority of the injuries were classified to be Minor or Moderate (MHISS) and a fracture was the most common injured structure. Conclusions: We found an increased number of hand injuries over a 30-year period in combination with a decrease in patients reported health treated at a hand surgery ward. Further studies regarding hand trauma in the elderly population will be valuable for future prevention and rehabilitation of this patient group

Compartment syndrome in the forearms of two neonates.

Two neonates with proximal dorsal swelling and skin necrosis had median, ulnar, and particularly radial nerve palsies after birth, which was interpreted as compartment syndrome in the forearm. The swelling in case 1 disappeared, the skin lesion in case 2 healed, and the functions of nerves recovered almost completely in both cases, although the forearm and hand in the second patient were shorter and thinner than the contralateral side

Age does not affect the outcome after digital nerve repair in children – A retrospective long term follow up

Background Digital nerve injuries in children are not common, but they are considered to have an excellent prognosis, compared to adults, after nerve injury and repair. In studies including both children and adults age have been found to have an effect on outcome after nerve repair. Methods We investigated in a retrospective follow up study the long-time result after digital nerve injury and repair in children, 1–16 years of age (n = 38), and evaluate if age influences outcome. A group with young children, 1–10 years of age (n = 18), was compared with a group with older children, 11–16 years of age (n = 20). A clinical evaluation to evaluate sensation and grip strength was performed and questionnaires were used [Disability of the Arm, Shoulder and Hand (DASH), Cold Sensitivity Severity Scale (CISS), VAS-function and VAS-cosmetic] in median 40 months (range 12–131 months) after the injury and repair. Results All patient regained normal sensation. No correlations between age and monofilaments were found. Twenty children (52%) reported some problems with cold intolerance (i.e. CISS), but no other abnormal disability was found (i.e. DASH, VAS); again with no differences between the two groups. Conclusions Children have an excellent long-term recovery after a digital nerve repair and without any influence of age

Hand injuries in an older population - A retrospective cohort study from a single hand surgery centre

Background: Hand injuries occur at all ages. With an aging population globally an increasing number of hand injuries among the elderly is to be expected. The aim of the present study is to describe the health characteristics and detailed injury patterns for elderly with hand injuries, with incidence, as a background for further studies on the topic. Specific knowledge is currently lacking about hand injuries among this group. The study is a retrospective cohort study from a single hand surgery centre. Methods: Data were collected for 286 patients, aged > 65 years, treated for traumatic hand injury between July 1, 2013 and June 30, 2014 at the Department of Hand Surgery in Malmö. Results: Incidence was 21.3/10000 inhabitants/year. The 286 patients included comprised 145 women and 141 men. The men had more severe injuries, often involving a wound, while women most commonly sustained a fracture after a fall. The men were younger than the women and required more surgery/admissions. Among all patients, 13% were healthy, while 27% patients took ≥5 drugs, mainly for cardiovascular disease. Conclusions: The incidence of hand injuries among the elderly is lower than among a younger population. Men sustained more wounds from using hazardous equipment, while women sustained post-fall fractures. A minority of the elderly is healthy. Prevention of fall injuries is crucial and emphasising safety awareness might reduce injuries in both sexes