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Clinical Outcomes of Explosion Injuries to the Hand

King, Elizabeth A. MD; Siljander, Breana R. MD; Ozer, Kagan MD

doi: 10.1097/SAP.0000000000001447
Hand Surgery
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Purpose The purpose of this study is to report clinical outcomes in a cohort of 12 patients with explosion injuries to the hand.

Methods Twelve male patients with a mean age of 42.4 years (SD, 7.2) were examined at a mean of 54 months after sustaining explosion injuries to the hand. All patients underwent primary reconstruction and early soft tissue coverage within 72 hours after their injuries. Total active range of motion and moving 2-point discrimination in each digit were recorded along with hand injury severity score (HISS), disability of the arm, shoulder, and hand (DASH) score, and American Medical Association (AMA) impairment ratings.

Results For digits saved, the average total active motion at final follow-up was 215 degrees (SD, 66.5). Twenty-two digits had 6-mm 2-point discrimination, and 17 digits had 8- to 10-mm 2-point discrimination. Eight of the 12 patients had secondary procedures. We found a strong correlation between initial HISS and DASH scores at final follow-up. There was also a strong correlation between AMA impairment rating and DASH scores.

Conclusions Early reconstruction provides protective sensation and preserves some function after explosion injuries. Preoperative HISS correlates with the long-term functional outcome as measured by DASH scores. For this group of patients, postinjury AMA impairment ratings also correlate with functional outcomes for the upper extremity.

From the Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.

Received September 17, 2017, and accepted for publication, after revision February 15, 2018.

This work received no external funds. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Conflicts of interest and sources of funding: none declared.

Reprints: Kagan Ozer, MD, Department of Orthopaedic Surgery, University of Michigan, 2098 S. Main St, Ann Arbor, MI 48105. E-mail: kozer@med.umich.edu.

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