title: Fractures and dislocations of the hand in polytrauma patients: Incidence, injury pattern and functional outcome.
abstract: BACKGROUND
  Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in polytrauma patients.
  
  
  METHODS
  A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma.
  
  
  RESULTS
  In a cohort of 2046 polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury).
  
  
  CONCLUSIONS
  The incidence of hand injuries in polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS).
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: ferree.steven@gmail.com.
authors.forename: Steven
authors.initials: S
authors.lastname: Ferree
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: q.m.j.vandervliet@gmail.com.
authors.forename: Quirine M J
authors.initials: QMJ
authors.lastname: van der Vliet
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: markvanheijl@hotmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: van Heijl
authors.affiliation: Utrecht Traumacenter, Utrecht, The Netherlands. Electronic address: marijnhouwert@hotmail.com.
authors.forename: Roderick M
authors.initials: RM
authors.lastname: Houwert
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl.
authors.forename: Luke P H
authors.initials: LPH
authors.lastname: Leenen
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, The Netherlands. Electronic address: f.hietbrink@umcutrecht.nl.
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006230:Hand Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D012189:Retrospective Studies
keywords: DASH; Functional outcome; Hand injuries; PRWHE; Polytrauma