Hand injuries - epidemiology, costs and outcome

Hand injuries have a profound impact not only on the patient’s activity of daily living and during leisure time but also on working capability. Such injuries may therefore also generate substantial costs for society in terms of sick-leave and treatment. In the present thesis, the panorama, costs (within the health-care system, due to lost production and total costs), outcome and health status of patients with hand injuries in Malmö, Sweden and in Southern Sweden for especially flexor tendon injuries (zone II) and median and ulnar nerve injuries in the forearm as well as other hand injuries were investigated retro- and prospectively. Descriptive epidemiology, health economic methods, and health questionnaires (DASH & SF-36) were used to describe and analyse these factors. The incidence was around 7 hand injuries/1000 inhabitants/year in Malmö, representing 12% of the workload at an Acute & Emergency Unit. Most injuries occurred during leisure time (2/3), mainly affecting young men, and the majority of the injuries were minor, although causing sick leave but usually low costs (< EUR 2500). Only 22% of the injuries in the age group 18-65 years were work related, but such injuries increased the risk of admission to hospital. A decrease in the number of days for sick leave, an increased risk for children to get hand injuries as well as a slight change in type of injuries were observed between 1989 and 1997 (an 8-year interval). There was a reduced risk of injury during July, November and December and on Tuesdays. The median total cost for a nerve injury in the forearm was EUR 45 800 and for a flexor tendon injury EUR 15 600, mainly due to lost production (87% and 65% of total costs, respectively). Factors, such as complications during rehabilitation and more than four concomitant tendon injuries, influenced the costs for repair and rehabilitation of flexor tendon and median and ulnar nerve injuries, respectively. Mobilization regimes, such as active mobilization and rubber band mobilization, after flexor tendon repair increased the costs, but improved the outcome. The costs and sick leave for hand injuries of different severity, analysed in a prospective study, was associated with the score for severity (HISS) of the injury. The DASH-score was not found to be significant in the analysis of the length of sick leave but DASH-score at one year was associated with variation in age, HISS and health care costs. SF36 was not useful as a method to study health status after a hand injury. The data in the present thesis can be used to optimise the treatment and rehabilitation of hand injuries, reallocate resources as well as to improve prevention of such injuries, which usually affect young persons in a productive age

Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up.

Abstract A fracture of the proximal interphalangeal (PIP) joint at the base of the middle phalanx is rare, but is a challenge to treat. Posttraumatic osteoarthritis is a known complication causing impaired hand function and disability. The aim of the present retrospective study was to evaluate characteristics and outcome of complex PIP joint fractures treated by the pins and rubbers traction system (PRTS). Medical records of 42 patients with fractures treated with a PRTS in 1999-2010 were reviewed, and followed-up by questionnaires (QuickDASH, CISS, self-composed questionnaire). Eighteen of the 42 were clinically examined. The fractures were divided into three types of fractures: volar lip, dorsal lip, and pilon fractures. The volar lip fracture was most frequent (26/42; dorsal lip 3/42; pilon 13/42). Most fractures were sport-related (19/42; 45%) and males predominated (M:F ratio = 1.8). All fractures united. Infection occurred in 17/41 (41%) cases. Radiological signs of posttraumatic osteoarthritis were found in 25/41 (61%) patients. In 18/42 patients, where a clinical evaluation was performed, 66% of contralateral total active range of motion (TAM), 93% grip strength, and 100% pinch strength were achieved. The volar lip fracture had the best outcome according to the self-reported QuickDASH and CISS score and regained 77% of contralateral TAM. Fractures of the PIP joint in the middle phalanx can be treated with the PRTS, but reduced mobility, grip strength, infection, and osteoarthritis are seen. The device is well tolerated by the patients, easy to apply, and with ready accessible materials for the surgeon

Long-term results of syndactyly correction by the trilobed flap technique focusing on hand function and quality of life.

Syndactyly is usually corrected surgically during the first years of life. The trilobed flap, a surgical method that does not require skin grafting, was developed in the 1990s and the short-term results were comparable with previously reported techniques. Here we report on long-term outcomes, focusing on how children perceive their hand function and quality of life when they grow up. A total of 19 patients (29 web spaces) were operated on between 1990 and 2000, and followed-up 16 years later with questionnaires and clinical tests. The patients reported low QuickDASH scores, normal sensibility and dexterity, and minor cold intolerance. Only two reoperations, due to early web creep, were needed. The condition minimally affected the choice of occupations, leisure activities and perceptions of appearance. The trilobed flap technique for release of syndactyly provides a good long-term outcome with good hand function and minimal impact on the quality of life

Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery : Experience in 307 Patients

Aim. We discuss technical points, the safety, and efficacy of ultrasonic bone shaver in various spinal surgeries within our own series. Methods. Between June 2010 and January 2014, 307 patients with various spinal diseases were operated on with the use of an ultrasonic bone curette with microhook shaver (UBShaver). Patients' data were recorded and analyzed retrospectively. The technique for the use of the device is described for each spine surgery procedure. Results. Among the 307 patients, 33 (10.7%) cases had cervical disorder, 17 (5.5%) thoracic disorder, 3 (0.9%) foramen magnum disorder, and 254 (82.7%) lumbar disorders. Various surgical techniques were performed either assisted or alone by UBShaver. The duration of the operations and the need for blood replacement were relatively low. The one-year follow-up with Neck Disability Index (NDI) and Oswestry Disability Index (ODI) scores were improved. We had 5 cases of dural tears (1.6%) in patients with lumbar spinal disease. No neurological deficit was found in any patients. Conclusion. We recommend this device as an assistant tool in various spine surgeries and as a primary tool in foraminotomies. It is a safe device in spine surgery with very low complication rate

Costs and outcome for serious hand and arm injuries during the first year after trauma - a prospective study

Background: To study costs and outcome for serious hand and arm injuries during the first year after the trauma. Methods: In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Coxregression analysis stratifying for mechanism of injury was used to analyse return to work. Results: The majority of the 45 included patients (median 42 years 16-64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+ 34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age > 50 years (+ 52%), injury at work (+ 40%) and partial labour market activity (+ 66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury]. Conclusions: Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure

Economic consequences of accidents to hands and forearms by log splitters and circular saws: Cost of illness study

We estimated costs associated with injuries to hands from log splitters and circular saws used to cut up firewood and assessed the value of prevention. The study was carried out as a cost of illness study with an incidence approach based on 57 consecutive patients (median age 51; range 8--81) with injuries to the hand or forearm. Twenty-six of the 57 had an amputation which required microsurgery and 31/57 had various injuries. Median Hand Injury Severity Score (HISS) reflecting the severity of all injuries was 67 (range 6--332). Median DASH score after 2--7 years was 12.5 (0--73.3). Total cost (direct costs, costs of lost productivity, and lost quality of life) was estimated to roughly EUR 14 million (EUR 2.8 million/year), where the cost of lost quality of life is 82% of the total cost and loss of productivity and direct costs are 9% each. Injuries sustained from log splitters and circular saws account for considerable costs, but first and foremost human suffering

What Determines the Costs of Repair and Rehabilitation of Flexor Tendon Injuries in Zone II? A Multiple Regression Analysis of Data From Southern Sweden.

The epidemiology and costs of repair and rehabilitation of zone 11 flexor tendon injuries in 135 patients from the southern part of Sweden were analysed. The little finger was most frequently injured (43%), usually with a knife (46%), and 30% of the injuries were work related. Total median costs within the health-care sector for the injuries were SEK 48,500 (1 EURO = 9.23 SEK, 4/1/2002). Costs in other sectors were SEK 93,000. Active mobilization or mobilization with rubber band traction increased costs within the health-care sector (SEK 7400 or SEK 6000, respectively) but improved range of movement (5-7%). Immobilization had a higher complication rate (rupture or need for secondary procedures), which in itself increased total costs by 57%. Non-linear effects were found between age and costs within the health-care sector and the outcome

Injury to the human median and ulnar nerves in the forearm - analysis of costs for treatment and rehabilitation of 69 patients in southern sweden.

This study analysed the costs of median and ulnar nerve injuries in the forearm in humans and factors affecting such costs. The costs within the health-care sector and costs of lost production were calculated in 69 patients with an injury to the median and/or ulnar nerve in the forearm, usually caused by glass, a knife, or a razorblade. Factors associated with the variation in costs and outcome were analysed. The total median costs for an employed person with a median and an ulnar nerve injury were EUR 51,238 and EUR 31,186, respectively, and 87% of the total costs were due to loss of production. All costs were higher for patients with concomitant tendon injuries (greater than or equal to4 tendons). The costs within the health-care sector were also higher for patients who changed work after the injury and if both nerves were injured. Outcome was dependent on age and repair method