Functional and subjective results of 20 thumb replantations

Zhang

Acta Orthopaedica et Traumatologica Turcica

et al. 2018

ObjectiveThe aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation.MethodsThirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20–65 years) were evaluated at the end of a mean follow-up time of 36 months (19–50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed.ResultsThe mean score for the DASH questionnaire was 6.6 (range: 0–39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05).ConclusionTotal grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up.Level of evidenceLevel IV, therapeutic study.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term functional, subjective and psychological results after single digit replantation

Zhang

Acta Orthopaedica et Traumatologica Turcica

et al. 2018

“…These outcomes are also used frequently to report results in research publications. 34,35 There is however a paucity of literature looking at these outcome measures and their reliability. In our study, the inter-rater reliability of the ROM measurements in patients with symptomatic OA was found to vary according to raters as well as for different movements of the thumb joint.…”

Section: Discussionmentioning

confidence: 99%

Measuring thumb range of motion in first carpometacarpal joint arthritis: The inter-rater reliability of the Kapandji Index versus goniometry

et al. 2015

Introduction: Goniometric measurement of thumb range of motion is often used as an outcome measure in assessing patients with first carpometacarpal osteoarthritis. Despite common use and demonstrated construct validity, the reliability of this technique has not been well established. The Kapandji Index is an alternate functional measure of thumb motion suitable for use with this client group. The purpose of this study was to examine the inter-rater reliability of the goniometric measures for thumb joint range of motion compared to the Kapandji Index in patients with first carpometacarpal joint osteoarthritis. Methods: Two independent assessors, who were blind to each other's measurements, measured thumb range of motion in 33 patients (54 thumbs). All participants were undergoing treatment for carpometacarpal joint osteoarthritis. Active range of motion was measured with a goniometer for all the thumb joints using a standardised measurement protocol. The Kapandji Index score was recorded. Relative reliability was assessed by using the intraclass correlation coefficient. Absolute reliability was also calculated by determining the standard error of measurement (SEM 68) and the minimal detectable difference (MDD 90). Results: Inter-rater reliability for the goniometer was highly variable ranging from poor to excellent (intraclass correlation coefficient 0.128-0.860). The SEM 68 ranged from 9 to 13 , and the resulting MDD 90 varied from 21 to 31 for the different thumb joints. The Kapandji Index had excellent inter-rater reliability among the different raters (intraclass correlation coefficient 0.772-0.917). Conclusions: Measurement of goniometric active range of motion of the thumb may have limited utility as a measure of clinical effectiveness for patients with carpometacarpal joint osteoarthritis. However, the Kapandji Index is a reliable measure of functional range of motion.

“…In addition, many of the retrospective studies include small patient numbers and often present contrary data findings. 18-22 Therefore, it was the objective of this study to perform a review of literature and meta-analysis to identify predictors of hand function following replantation in the context of 2-point discrimination (2PD), grip strength, and DASH score. We hope the presented data can help improve surgeon decision-making and educate patients regarding expected postreplant hand function.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Hand Function Following Digit Replantation: Quantitative Review and Meta-Analysis

Shaterian

Sayadi

Tiourin

et al. 2019

Hand (New York, N,Y.)

Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.