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• Cognitive impairments may be developed post nerve injuries of upper limb. • There is no cognitive impairment post musculoskeletal injuries to upper limb without nerve damage. • Cognitive impairments appear within one month post traumatic upper limb injuries. The purpose of this study was to investigate the association between cognitive impairments and traumatic upper limb injuries of the acute phase. A cross-sectional observational study was conducted with three groups: a nerve-injury group, a without nerve injury group, and a control group (uninjured participants). Demographic characteristics (e.g. age, sex, body mass index, and education) and traumatic characteristics (duration since injury, injury side, pain, light touch sensation, hand motor function) were recorded. Short-term memory and executive functions were assessed using Rey Auditory and Verbal Learning Test (RAVLT) and Stroop Color and Word Test (SCWT, including SIECT and SIECN), respectively. The study comprised 43 participants in the nerve-injury group, 30 participants in the group without nerve injury, and 104 participants in the control group. Generalized linear model was applied to explore the difference of cognitive functions among three groups with impactors. Significantly poorer performance on the RAVLT was observed in the nerve-injury group compared to the other two groups, and lower score of SIECT in nerve-injury group was lower compared to the control group. However, there was no significant difference of SIECN among three groups. In addition, traumatic characteristics did not significantly impact RAVLT and SIECT (p > 0.05) in all injured participants. Traumatic nerve injury to the upper limb appears to be associated with both short-term memory and executive function impairment, whereas musculoskeletal injuries without nerve damage showed no cognitive impairment. Therefore, it is important to monitor cognitive function following upper limb nerve injuries. [ABSTRACT FROM AUTHOR]

Introduction Methods Community and consumer involvement Results Conclusion PLAIN LANGUAGE SUMMARY Throughout the COVID‐19 pandemic, outpatient hand therapy services were restricted. The use of telehealth was adopted to continue to provide care to patients with hand injuries.This survey aims to investigate patient satisfaction with hand therapy delivered via telehealth in a NSW public tertiary referral metropolitan setting and explore whether this differs for specific hand injury/conditions and treatments offered.Patients using hand therapy services via telehealth between 28 June 2021 and 27 May 2022 responded to a bespoke electronic survey. Participants were grouped depending on their particular injury/condition and treatment received. Analysis was conducted using MS Excel, and correlations were determined by using Fisher's exact test.No consumers were involved in the study design or analysis.Sixty‐eight of 262 patients responded to the survey (26% response rate). Overall results showed high patient satisfaction (n = 55, 81%) with hand therapy delivered via telehealth with most patients agreeing that telehealth should be offered going forward (n = 59, 87%). Benefits reported by patients included convenience, reduced travel time and parking issues, and time saving. Patients receiving therapy for ‘finger thumb bony injury with K wires’ demonstrated a statistically significant association of lower satisfaction with telehealth (n = 3, 43%, P = 0.02). Patients receiving wound care over telehealth were just as satisfied with their experience (n = 15, 82%) as overall results (n = 55, 81%).The survey suggests that patients are satisfied with their experience of telehealth for hand therapy. Patients with finger thumb bony injuries with k wires may be less suitable for telehealth. Wound care appears to be well received over telehealth in a hand therapy population.There is little evidence to guide hand therapists in which conditions or injuries patients find can be managed well with telehealth. Patients who answered a survey about their experience with telehealth for their hand therapy management overall reported satisfaction with the experience. Some patients had undergone surgery for broken fingers and thumbs using wires to hold the bone together while it healed. These patients were less likely to find telehealth satisfactory for their hand therapy care. Most patients requiring wound care over telehealth found this satisfactory. [ABSTRACT FROM AUTHOR]

Purpose: Despite advances in extremity trauma care and reconstructive microsurgery, management of the traumatic amputations remains a challenge. The majority of patients will forever experience some level of disability even with replantation or advanced prosthetics. The goal of this article is to familiarize hand and reconstructive surgeons with the current state of upper extremity transplantation, so they better can educate their amputee patients regarding this as an option following limb loss. Methods: Current literature, in addition to the international registry on hand and composite tissue transplantation, was reviewed to assemble a summary of outcomes in upper extremity replantation and transplantation. Results: Sensory and functional outcomes of replantation and transplantation are comparable. Reported complications of immunosuppression are similar to those of other solid organ transplants. The financial cost of hand transplantation is high, but comparable to the lifetime cost of prosthesis use. Conclusion: While the risk of immunosuppression is a serious consideration for patients pursuing hand transplantation, in the well-selected and informed patient, hand transplantation can dramatically improve patient reported to outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether there is a difference in hand bone mineral density (BMD) between patients with traumatic hand injuries and healthy volunteers during the immobilization process, as well as to examine the change in BMD during follow‑up and the effect of denervation on BMD. In addition, we aimed to compare the BMD in the dominant and nondominant hands. Methods: The study involved patients aged 18–55 years who had undergone surgery for hand tendon injuries (TIs), with or without accompanying nerve injury, and subsequently sought rehabilitation at our outpatient clinic. The study groups were comprised patients with TI, those with tendon and nerve injury (TNI), and healthy volunteers. Results: The study examined 24 patients with TI, 23 with TNI, and 31 healthy volunteers. In the healthy control group, the BMD of the dominant hand was significantly higher than that of the nondominant hand (P < 0.001). At 4 weeks, there was no significant decrease in BMD observed in the TI and TNI groups compared to controls (P > 0.05). However, at the 4th month, both groups showed a significant decrease in BMD, with the TNI group exhibiting higher changes (P < 0.05). Injuries to the dominant hand did not result in significant changes in BMD at 4 weeks and 4 months (P > 0.05). However, a significant decrease in BMD was observed in injuries to the nondominant hand compared to controls at 4 months (P < 0.05). Notably, nondominant hand TNI patients experienced a significant reduction in BMD during the 4th month compared to the 4th week (P < 0.05). In addition, a significant correlation (r = 0.567) was found between grip strength and BMD value in the 4th month of patients with hand injuries. Conclusion: In patients with traumatic hand injuries, nondominant hand injury and/or nerve injury may lead to a decrease in BMD in addition to immobilization. [ABSTRACT FROM AUTHOR]

Background: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications. Methods: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases. Results: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps. Conclusions: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space. [ABSTRACT FROM AUTHOR]

Purpose: This study compared the outcomes of intra-articular fracture reduction for distal radius fractures. Methods: Among 180 patients who underwent open reduction and plate fixation, the exclusion criteria were as follows: non-acute fracture (>1 month), an accompanying ulnar neck fracture, a distal ulnar fracture requiring fixation, fixation through the dorsal approach, other accompanying hand fractures, the absence of preoperative or postoperative computed tomography (CT), and follow-up for <1 year. Intra-articular fractures were evaluated through CT. Forty-eight patients with intra-articular fractures were studied. Displaced intra-articular fractures were defined as: (1) articular step-off ≥1 mm, (2) fracture gap ≥2 mm, or (3) gross incongruence. Reduction was classified as good (n=23) or poor (n=25) based on postoperative CT. The pain visual analogue scale (pVAS), the quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and range of motion of the wrist joint were compared between both groups. Results: No significant between-group differences were found in the preoperative demographic data and the postoperative pVAS and quick DASH scores (pVAS: 0.6 vs. 0.8 and quick DASH: 9.4 vs. 10.2 in the good vs. poor reduction groups, respectively). However, the flexion-extension arc was significantly restricted in the poor reduction group (162° in the good reduction group vs. 146° in the poor reduction group, p<0.001). Conclusion: The reduction of the articular surface was not related to pain and functional results at the mid-term follow-up after the surgical treatment of intra-articular distal radius fractures. However, insufficient fracture reduction affected the postoperative range of motion. [ABSTRACT FROM AUTHOR]

Purpose: This study analyzed the epidemiology of pediatric hand lacerations in children under 6 years old, focusing on age-related characteristics and the household objects that caused these injuries. Methods: We conducted a retrospective study of patients under 6 years old who presented with hand lacerations at our emergency department from January 2016 to December 2023. Data were collected on demographics, injury-related factors (the affected hand and finger, injury location, and injury-causing object), need for surgical intervention, and damage to deep structures. Patients were categorized as infants (0–1 years), toddlers (1–3 years), or preschoolers (3–6 years). We recorded the frequency, surgical intervention rates, and affected deep structures for each injury-causing object. Results: Of 153 children treated for hand lacerations, toddlers were the most frequently injured (47.7%), followed by preschoolers (44.4%) and infants (7.8%). The index and middle fingers were particularly vulnerable in toddlers and preschoolers, while infantile injuries more commonly affected the palm. Among 31 identified objects, knives/blades, particularly cutting knives (13.7%) and broken glass (13.1%), were the leading causes, with injuries occurring primarily at home. Surgical intervention was necessary in 11.1% of cases, with eyebrow razors (33.3%) most often requiring surgery and causing damage to deep structures, including arteries, nerves, and flexor tendons. Conclusion: The study highlights the significant role of developmental behaviors in pediatric hand laceration risk. Many injuries were caused by everyday household objects, including eyebrow razors, that are often underestimated as potential dangers. Preventive measures and guardian education are crucial to reduce the incidence of these injuries. [ABSTRACT FROM AUTHOR]

Introduction. Transmetacarpal amputation (TA) distal to the superficial palmar arch is one of the most difficult procedures in replantation surgery because it requires the reconstruction of blood vessels, muscles, tendons, bones, nerves, and s kin. We present a case of a patient with TA of the left hand and microsurgical replantation. Case report. A 23-year-old left-hand dominant male worker with a positive smoking history sustained TA from a radial saw blade and avulsion injury of the palmar side of the thumb with no other apparent injuries. The time between the amputation and replantation was 4 hrs. The patient sustained the amputation at the level of metacarpophalangeal joints. The successful replantation included: wound and intrinsic muscles debridement, microvascular anastomoses of the blood vessels, internal fixation of the metacarpal bones, neurorrhaphy, tenorrhaphy, and wound closure with local skin flap for thumb soft tissue defect. The patient was followed for seven years postoperatively. Conclusion. The replantation surgery requires a specialized department and well-educated teams of hand microsurgeons, orthopedic surgeons, and anesthesiologists. The most important factors that influenced the outcome after the replantation in the presented case included the type and level of injury, ischemia time, comorbidities, age, smoking history, and physical therapy. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional and radiological outcomes of treatment of volar Barton’s fractures using T plate with and without distal end screws. Methods: This randomized control trial was conducted at the department of Orthopedics, Mayo Hospital, Lahore, Pakistan from December 2021 to May 2022. Total 60 patients (30 in each group) were randomly allocated to either group A (T-Plate with distal end screws) or B (T-Plate without distal end screws). Patients were followed up on day-0, day-14, day-28 and day-90. Assessments of patients were done by Green O’Brien Score for pain, Modified Warden Score for callus formation on radiographs at 12-weeks of follow-up and Stewart Score for displacement of fracture. Results: At 90th day, significant difference was seen in Green O’Brien Score (Excellent score: Group-A: 80% vs. Group-B: 90%, p=0.278) while Stewart scores remained comparable (Excellent Score: Group-A: 93.33% vs. Group-B: 96.67%, p=0.221) between treatment groups. Fracture healing assessed with Modified Warden score for score 4 did not show significant difference between both groups at 90th day. i.e. (Group-A: 96.67% vs. Group-B: 96.67%). However, callus formation assessed with Modified Warden score for score 3 showed significant differences between groups at 90th day. i.e. (Group-A: 53.33% vs. Group-B: 86.67%, p=0.001). Conclusion: Both treatment approaches appear to yield comparable outcomes in terms of clinical assessment, Stewart scores, and fracture healing, with a potential advantage for T-plate without distal end screw in callus formation at the 90th day. [ABSTRACT FROM AUTHOR]

Time 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. We 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. In 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. In 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. [ABSTRACT FROM AUTHOR]

Ulnar Neuropathy of the Elbow (UNE) is the second most common entrapment neuropathy. In this study, we aimed to determine the factors that may guide diagnosis and treatment by examining the electrodiagnostic (EDX), demographic data and upper extremity-related disability levels of patients with UNE. Demographic characteristics, symptom duration, EDX data and any other accompanying entrapment neuropathy, and the shortened Disabilities of the Arm, Shoulder, and Hand Injuries Questionnaire (Quick-DASH) scores were noted. The laterality, localization, factors associated with the severity of UNE, and the impact of the presence of Carpal Tunnel Syndrome (CTS) on disability have been studied in detail. 92 arms of 73 patients were included. The mean age of the patients was 47.71±13.99 years. 41 (56.2%) were male and 32 (43.8%) were female. 29 (39.7%) patients had at least one comorbid disease. Of the patients, 30 (41%) had left-sided UNE, 24 (33%) had right-sided UNE and 19 (26%) had bilateral UNE. The median symptom duration was 3 (1-12) months. 28 (38.4%) patients had also CTS. The median Quick-DASH score was 28 (9-80). There was also no significant association between UNE side and age or gender (p=0.439 and p=0.216, respectively). In 62 (67.4%) patients, the site of compression was 2 cm proximal to the medial epicondyle (ME). Symptom duration was statistically significantly longer in the moderate group than in the mild group, and in the severe group than in the mild UNE group (p<0.001 and p=0.035 respectively). When the association of compression neuropathy severity with gender and comorbidities was analyzed, no significant association was found (p=976 and p=330, respectively). In conclusion, UNE was more common in men, on the left side and 2 cm proximal to the ME. Controlled studies with more participants are needed to uncover factors that may guide the diagnosis and treatment of UNE. [ABSTRACT FROM AUTHOR]

Objectives. Associations between shift-work, musculoskeletal symptoms and absenteeism are poorly investigated in the manufacturing industry. This study aimed to investigate associations between working schedule, musculoskeletal symptoms and days of absenteeism among pulp and paper industry workers. Methods. Musculoskeletal symptoms of 904 workers were assessed through the Nordic Musculoskeletal Questionnaire. χ2 tests assessed associations between being a day-worker or shift-worker, the prevalence of musculoskeletal symptoms and days of absenteeism. Results. A significant association was found between working schedule and symptoms in the lower back in the last 12 months, with shift-workers presenting higher prevalence than day-workers (p = 0.022). Significant associations were also found between days of absenteeism and symptoms in the shoulders (p = 0.002), which mostly led to absenteeism of 100–365 days; elbows (p < 0.001), wrists/hands (p = 0.045) and ankles/feet (p = 0.042), which produced absenteeism mostly of 25–99 days; and dorsal region (p = 0.001), which mainly led to absenteeism of 10–24 days. No associations were found between working schedule and days of absenteeism (p = 0.265). Conclusion. Shift-work is associated with increased prevalence of lower back symptoms, but seems not to influence days of absenteeism. Shoulders seem to be the region leading to higher days of absenteeism, followed by elbows, wrists/hands, ankles/feet and the dorsal region. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery. Methods: Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management. Results: From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures. Conclusion: There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a 3D T1-weighted gradient-echo (3D T1GRE) computed tomography (CT)-like magnetic resonance imaging (MRI) sequence for detecting and assessing wrist and hand fractures compared to conventional CT. Methods: Subjects with acute wrist or hand fracture in CT underwent additional 3 T MRI including a CT-like 3D T1GRE sequence and were compared to patients without fractures. Two radiologists assessed fracture morphology on both modalities according to the Arbeitsgemeinschaft Osteosynthese (AO) and graded image quality and diagnostic confidence on a 5-point Likert scale. Besides diagnostic test evaluation, differences in image quality and diagnostic confidence between CT-like MRI and CT were calculated using the Wilcoxon test. Agreement of AO classification between modalities and readers was assessed using Cohen's Kappa. Results: Twenty-eight patients with 43 fractures and 43 controls were included. Image quality (3D T1GRE 1.19 ± 0.37 vs. CT 1.22 ± 0.42; p = 0.65) and diagnostic confidence (3D T1GRE 1.28 ± 0.53 vs. CT 1.28 ± 0.55; p = 1.00) were rated excellent for both modalities. Regarding the AO classification, intra- (rater 1 and rater 2, κ = 0.89; 95% CI 0.80–0.97) and interrater agreement were excellent (3D T1GRE, κ = 0.82; 95% CI, 0.70–0.93; CT, κ = 0.85; 95% CI, 0.75–0.94). CT-like MRI showed excellent sensitivity, specificity and accuracy for fracture detection (reader 1: 1.00, 0.92, 0.96; reader 2: 0.98, 0.94, 0.96). Conclusion: CT-like MRI is a comparable alternative to CT for assessing hand and wrist fractures, offering the advantage of avoiding radiation exposure. [ABSTRACT FROM AUTHOR]

The article presents a comprehensive review of the diagnosis, surgical treatment, and rehabilitation of patients with complex hand fractures, with a particular focus on phalangeal fractures. It highlights the prevalence of such injuries, especially in low- and middle-income countries, and underscores the significant socio-economic burden they impose due to healthcare costs and loss of productivity. The review compares various diagnostic tools, including conventional radiography, multislice computed tomography, and cone beam computed tomography, emphasizing the latter's potential for reducing radiation exposure while maintaining diagnostic accuracy. It also explores the use of automated diagnostic systems supported by deep learning techniques like convolutional neural networks, though noting their limited clinical application due to cost and accessibility. In terms of treatment, the article discusses both conservative and surgical approaches, with a detailed examination of external fixation methods, particularly the Ilizarov method and newer dynamic distraction external fixators. The Wide-Awake Local Anesthesia No Tourniquet technique is highlighted for its effectiveness and cost-efficiency in surgical settings. Rehabilitation strategies, including mirror therapy, robotic exoskeletons, and the use of 3D printing for customfit splints, are also reviewed, offering insights into improving functional outcomes post-surgery. As a result of the review, it is concluded that despite the availability of various diagnostic and treatment methods, further research is necessary to establish more effective, evidence-based protocols, particularly in resource-limited settings. This review serves as a valuable resource for microsurgeons and healthcare providers, emphasizing the need for continued innovation and research to improve the quality of care for patients with complex hand fractures. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality. Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence. Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments. Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment. Cite this article: Bone Jt Open 2024;5(8):652–661.

Abstract Introduction Hand injuries constitute up to 30% of the total cases treated in emergency departments. Over time, demographic changes, especially an aging population, and shifts in workplace safety regulations and healthcare policies have significantly impacted the landscape of hand trauma. This study aims to identify and analyze these evolving trends over nearly two decades. Methods In this retrospective, cross-sectional study, we investigated patients who were admitted to the high-volume regional hand trauma center of a university hospital between January 2007 and December 2022. We analyzed trends in patients’ demographics and annual alterations of injuries. For the comparative analysis, patients were divided into two groups based on the time of presentation: the early cohort (2007–2014) and the current cohort (2015–2022). Results A total of 14,414 patients were admitted to our emergency department within the study period. A significant annual increase in patient age was identified (R2 = 0.254, p = 0.047). The number of presentations increased annually by an average of 2% (p

Background Kite string injuries (manja cut injuries), particularly those caused by Chinese manja, are new culprit of emergencies especially in the month of January in Maharashtra region. These injuries commonly affect the neck, face, hands, and legs, especially among individuals traveling on two wheelers. The visibility challenge, where the kite's thread is difficult to see, further exacerbates the risk.