Hans-Eric Rosberg

Prospective study of patients with injuries to the hand and forearm: Costs, function, and general health.

Patients with injured hands and forearms of varying severity [Hand Injury Severity Score (HISS)] were studied prospectively, including analysis of costs, hand/arm function (DASH), and health status (SF-36). Costs, duration of sick-leave, DASH-score (high score; impaired function) increased by severity of injury (higher HISS) and the greatest proportion of total costs resulted from lost production. Most employed patients returned to work within a year, but even minor injuries were expensive. HISS and costs of care during an emergency were significantly associated with duration of sick-leave, although HISS did not fully explain variation in costs and duration of sick-leave. DASH-score at one year was associated with variation in age, HISS, and residual health care costs. Results of DASH and subgroups for physical and bodily pain on SF-36 were consistent. Injuries to hand and forearm may generate high costs for society in terms of health care and long periods of sick-leave (lost production), but even minor injuries should be accounted for.

Epidemiology of hand injuries in a middle‐sized city in southern Sweden: a retrospective comparison of 1989 and 1997

Case notes of patients with hand injuries that required referral to our department in 1989 and 1997, were analysed retrospectively. The incidence of such an injury was at least 7/1000 inhabitants/year (12% of the patients seen in the orthopaedic Accident and Emergency department). Most of the patients were young men with minor injuries, most commonly injured during leisure activities. Only 22% of the patients who worked were injured at work, but such injuries increased the risk of admission to hospital. The amount of sick leave was significantly shorter in 1997, and 77% of the workers were off work for less than two months. There was a reduced risk of injury during July, November, and December, and on Tuesdays. Type and range (type/mechanism/severity) of injuries differed slightly between the years and among the various age groups. Epidemiological data about hand injuries that affect young patients of productive age, are important to optimise resources and organisation of the health care system.

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

BackgroundTo study costs and outcome for serious hand and arm injuries during the first year after the trauma.MethodsIn 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. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work.ResultsThe 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].ConclusionsDespite 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.

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

Abstract 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.

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

Abstract 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.

Hand function in children with radial longitudinal deficiency

BackgroundIn children with hypoplasia or aplasia of the radius (radial longitudinal deficiency) manual activity limitations may be caused by several factors; a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited range of motion in the fingers and impaired grip strength. The present study investigates the relation between these variables and activity and participation in children with radial dysplasia.MethodsTwenty children, age 4–17 years, with radial longitudinal dysplasia Bayne type II-IV were examined with focus on the International Classification of Functioning and Health, version for Children and Youth (ICF-CY) context. Body function/structure was evaluated by measures of range of motion, grip strength, sensibility and radiographic parameters. Activity was examined by Box and Block Test and Assisting Hand Assessment (AHA). Participation was assessed by Children’s Hand-use Experience Questionnaire (CHEQ). Statistical correlations between assessments of body function/structure and activity as well as participation were examined.ResultsThe mean total active motion of wrist (49.6°) and digits (447°) were less than norms. The mean hand forearm angle was 34° radially. Ulnar length ranged from 40 to 80% of age-related norms. Grip strength (mean 2.7 kg) and Box and Block Test (mean 33.8 blocks/minute) were considerably lower than for age-related norms. The mean score for the AHA was 55.9 and for CHEQ Grasp efficiency 69.3. The AHA had significant relationship with the total range of motion of digits (p = 0.042). Self-experienced time of performance (CHEQ Time) had significant relationship with total active motion of wrist (p = 0.043). Hand forearm angle did not show any significant relationship with Box and Block Test, AHA or CHEQ.ConclusionIn radial longitudinal deficiency total range of motion of digits and wrist may be of more cardinal importance to the child’s activity and participation than the angulation of the wrist.

Return to work after a serious hand injury.

OBJECTIVES This paper explores factors important for return to work (RTW) in people who have sustained a serious hand injury. PARTICIPANTS Forty people aged 19-64, with a severe or major hand injury were recruited consecutively during 2005-2007. METHODS A self-administered and study specific questionnaire, including demographic data and standardised questionnaires for function, disability, daily occupations, health, quality of life, sense of coherence and several open questions was sent out by mail twelve months after injury. Open questions regarding RTW were also included. RESULTS The results showed that 27 people had returned to work within twelve months and 13 had not. Factors related to RTW and general work motivations were divided into individual factors, and factors related to the work environment and rehabilitation. The most prominent differences between the groups were individual factors, such as higher perceived disability, reduced hand function, and dissatisfaction with daily occupations resulting in a lower physical quality of life. The no RTW group had also more ward days (inpatient care) and lower sense of coherence. CONCLUSIONS These findings support the idea that the RTW process can be more dependent on the persons own ability and motivation than on the severity of the hand injury. Suggestions for intervention and further studies are presented in the discussion.

Multifocal Neurilemomas in the Same Upper Extremity:Case report

Multifocal neurilemomas in different nerves of the same upper extremity are rare. A 36-year-old woman presented with five neurilemomas involving the main trunks of the median and radial nerve and digital nerves of her left upper extremity. These were excised and she recovered without complications. Fifteen years later she presented with several recurrences which were removed, and two years after that she required a further operation to excise tumours. At the time of writing she has at least five tumours on different nerves of her left arm but these are causing her no problems.

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.

Identification of three novel FGF16 mutations in X-linked recessive fusion of the fourth and fifth metacarpals and possible correlation with heart disease.

Nonsense mutations in FGF16 have recently been linked to X‐linked recessive hand malformations with fusion between the fourth and the fifth metacarpals and hypoplasia of the fifth digit (MF4; MIM#309630). The purpose of this study was to perform careful clinical phenotyping and to define molecular mechanisms behind X‐linked recessive MF4 in three unrelated families. We performed whole‐exome sequencing, and identified three novel mutations in FGF16. The functional impact of FGF16 loss was further studied using morpholino‐based suppression of fgf16 in zebrafish. In addition, clinical investigations revealed reduced penetrance and variable expressivity of the MF4 phenotype. Cardiac disorders, including myocardial infarction and atrial fibrillation followed the X‐linked FGF16 mutated trait in one large family. Our findings establish that a mutation in exon 1, 2 or 3 of FGF16 results in X‐linked recessive MF4 and expand the phenotypic spectrum of FGF16 mutations to include a possible correlation with heart disease.