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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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Briffa J, Willemot L, Dong X, Larsen M. Novel reverse Ishiguro Kirschner wire technique for the repair of osseous flexor digitorum profundus avulsion injuries. ANZ J Surg 2023; 93:2254-2256. [PMID: 37025018 DOI: 10.1111/ans.18444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/27/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023]
Affiliation(s)
- James Briffa
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Laurent Willemot
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Xavier Dong
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Mikko Larsen
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
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Rivera-Saldívar G, Rodríguez-Luna CE, Orozco-Aponte NI. [Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T378-T386. [PMID: 37364725 DOI: 10.1016/j.recot.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/08/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde vs. antegrade Kirschner wires. MATERIAL AND METHODS Comparative, longitudinal, prospective study at a third-level trauma centre in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilisation with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION Stabilisation with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.
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Affiliation(s)
- G Rivera-Saldívar
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico.
| | - C E Rodríguez-Luna
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico
| | - N I Orozco-Aponte
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico
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Rivera-Saldívar G, Rodríguez-Luna CE, Orozco-Aponte NI. Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:378-386. [PMID: 36801251 DOI: 10.1016/j.recot.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. MATERIAL AND METHODS Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.
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Affiliation(s)
- G Rivera-Saldívar
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, México.
| | - C E Rodríguez-Luna
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, México
| | - N I Orozco-Aponte
- Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, México
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Kuchtaruk A, Yu SSY, Iansavichene A, Davidson J, Wilson CA, Symonette C. Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5147. [PMID: 37621918 PMCID: PMC10445783 DOI: 10.1097/gox.0000000000005147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023]
Abstract
Background Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM. Methods Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done. Results There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments. Conclusions Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.
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Affiliation(s)
- Adrian Kuchtaruk
- From the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Alla Iansavichene
- Library Services, London Health Sciences Centre, London, Ontario, Canada
| | - Jacob Davidson
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Claire A. Wilson
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Caitlin Symonette
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
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Collis JM, Mayland EC, Wright-St Clair V, Rashid U, Kayes N, Signal N. An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study. J Hand Ther 2023; 36:593-605. [PMID: 35953335 DOI: 10.1016/j.jht.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.
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Affiliation(s)
- Julie M Collis
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand.
| | - Elizabeth C Mayland
- Western Sydney University, School of Health Sciences, Campbelltown, New South Wales, Australia
| | | | - Usman Rashid
- Auckland University of Technology, Health & Rehabilitation Research Institue, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
| | - Nada Signal
- Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand
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Vervloesem N, Glassey N, Kerr A. Rehabilitation following extra-articular proximal phalangeal fractures of the fingers in adults: a scoping review. HAND THERAPY 2023; 28:45-59. [PMID: 37904862 PMCID: PMC10584068 DOI: 10.1177/17589983231155270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/19/2023] [Indexed: 11/01/2023]
Abstract
Introduction Proximal phalangeal fractures are common and can have a significant impact on hand function. Therefore, it is important to optimise post-operative rehabilitation. A scoping review was undertaken to map the existing evidence on rehabilitation of proximal phalangeal fractures of the fingers in adults. Methods A comprehensive search was conducted which included database searching, reference searching, hand searching of journals, and searching for grey literature. Eight articles were included after screening for eligibility. Results Three studies researched surgical interventions and five studies conservative management. The immobilisation period varied between 5 days to 3 weeks in the surgical studies, and between 3 to 7 weeks in the conservative studies. Active exercise therapy was started immediately with conservative management, while in the surgical studies time to commence exercises varied between 5 days and 3 weeks. All studies reported good results in mobility with a mean total active motion ranging from 240° to 258.9°. Patients reported little pain at final follow-up and grip strength recovered to 96% compared to the unaffected side. Studies reporting on function and patient satisfaction lacked transparency. Conclusions All studies had a moderate to high risk of bias and the results of the included studies should therefore be interpreted with caution. More high-quality randomised controlled studies with an a priori research protocol and a standard set of outcome measures are necessary to research whether early motion, an intrinsic plus splint leaving the wrist free, and the inclusion of additional treatment modalities can result in a better and/or faster recovery.
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Affiliation(s)
- Nele Vervloesem
- The University of Derby, UK
- Biomedical Sciences Group, Locomotor and Neurological Disorders, Katholieke Universiteit Leuven, Belgium
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Choi J, Seo HJ, Shin J, Byun JH, Jung SN. The Effect of Steroid and Mannitol Combination Treatment on Postoperative Rehabilitation of Multiple Metacarpal Bone Fractures. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040783. [PMID: 37109741 PMCID: PMC10146106 DOI: 10.3390/medicina59040783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The expedient resolution of postoperative soft tissue edema is particularly important in hand surgery. Prolonged edema and pain become an obstacle to postoperative rehabilitation, delay return to daily life, and in severe cases, lead to a permanent decrease in range of motion. Based on the common physiology between postoperative hand swelling and complex regional pain syndrome (CRPS), we sought to determine if postoperative mannitol and steroid administration to multiple metacarpal bone fracture patients effectively reduces hand swelling and pain and is beneficial for hand rehabilitation. Materials and Methods: From March 2015 to February 2019, 21 patients who received closed pinning for multiple metacarpal fractures were included in a retrospective cohort study. The control group (n = 11) underwent a routine recovery, while the treatment group (n = 10) received dexamethasone and mannitol injections for five days postoperatively. Serial changes in the degree of pain and fingertip-to-palm distance (FPD) were measured in both groups. The duration from surgery to the initiation of rehabilitation and time to full grip was also compared. Results: Compared to the control, the treatment group showed a faster alleviation of pain scores from the postoperative fifth day (2.91 versus 1.80, p = 0.013), and faster recovery of FPD from postoperative two weeks (3.27 versus 1.90, p = 0.002). Time to physical therapy initiation (6.73 versus 3.80 days, p = 0.002) and full grip achievement (42.46 versus 32.70 days, p = 0.002) were also faster in the treatment group. Conclusions: The steroid-mannitol combination treatment for multiple metacarpal bone fracture patients in the acute postoperative phase promoted the reduction of hand edema and pain, leading to the earlier initiation of physical therapy, rapid improvement in joint motion, and faster achievement of full grip.
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Affiliation(s)
- Jangyoun Choi
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hye Jin Seo
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Jongweon Shin
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Jun-Hee Byun
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Sung No Jung
- Department of Plastic and Reconstructive Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Republic of Korea
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Gerg MJ, Hazak KM, Carrie BR, Melendez N, Jewell VD. Non-physical factors that impact return to work in individuals with upper extremity injuries: A scoping review. Work 2022; 73:93-106. [DOI: 10.3233/wor-211059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Upper extremity injuries may prevent adults from returning to work, impacting productivity, and engagement in meaningful employment. OBJECTIVE: The scoping review identified various non-physical factors that impact return to work (RTW) after an upper extremity injury. METHODS: Database searches included: CINAHL, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews. The authors further hand searched the journals Work and The Journal of Hand Therapy. Inclusion criteria included articles published in English, published from 2000–2020, and addressed the following topics: upper extremity injury, the client’s psychosocial perceptions of the injury, and return to work. RESULTS: After title and abstract review, 9 studies were identified for full-text review that examined various patterns related to non-physical factors that impact RTW. Three themes emerged from the full-text reviews including client self-efficacy, social determinants of health, and the need for holistic intervention approaches. CONCLUSIONS: Practitioners involved in the rehabilitation of working age clients with upper extremity injuries should remain cognizant of the non-physical factors that can impact return to work and incorporate holistic approaches like monitoring and addressing self-efficacy, psychosocial well-being, and social determinants of health into clinical practice.
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Affiliation(s)
- Michael J. Gerg
- Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Phoenix, AZ, USA
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
- Department of Occupational Therapy, School of Education Human and Health Sciences, Bay Path University, Longmeadow, MA, USA
| | - Kristin M. Hazak
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
- Department of Rehabilitation Services, Arizona Burn Center, Valleywise Health, Phoenix, AZ, USA
| | - Brittany R. Carrie
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
| | - Naomi Melendez
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
| | - Vanessa D. Jewell
- Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
- Division of Occupational Science and Occupational Therapy, Department of Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Buchanan H, Van Niekerk L, Grimmer K. Work transition after hand injury: A scoping review. J Hand Ther 2022; 35:11-23. [PMID: 33250399 DOI: 10.1016/j.jht.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/20/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic scoping review. INTRODUCTION Many factors are potentially associated with successful work-related transitions following hand injury. There is no current, comprehensive review of the literature to guide clinical practice. PURPOSE OF THE STUDY To comprehensively identify the current body of research evidence supporting return to work (RTW) after hand injury and identify gaps. METHODS A systematic search identified relevant, peer-reviewed, full text, English language primary qualitative or quantitative literature published since 2006. All authors independently determined whether studies should be included, assigned them to a hierarchy of evidence and extracted data. Decisions were defended and disagreements resolved in team meetings. Literature was summarized into key themes using common intent and constructs. RESULTS Of 259 potentially-relevant articles, 38 were relevant. Study designs included prospective observational, cross-sectional, and retrospective (n=9 each), mixed methods (n=3), qualitative (n=4), and opinion pieces (n=4). There were no experimental studies. The most commonly-reported key themes were prognostic factors for RTW (25 papers) and assessment tools (18 papers). Remaining themes of impact of injury on the individual, patient perspectives, other stakeholder perspectives, healthcare provider education, and treatment were reported in fewer than 10 papers each. There was little commonality in how research was conducted or reported. Gaps included lack of information on effective interventions, which prognostic factors should be routinely measured, and which assessment and outcome items to routinely use in practice. CONCLUSION Despite the impact of hand injury on capacity to RTW, there is limited evidence to inform successful work-related transitions.
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Affiliation(s)
- Helen Buchanan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Lana Van Niekerk
- Division of Occupational Therapy, Department of Health and Rehabilitation Science, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Department of Health and Rehabilitation Science, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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Flexohand: A Hybrid Exoskeleton-Based Novel Hand Rehabilitation Device. MICROMACHINES 2021; 12:mi12111274. [PMID: 34832686 PMCID: PMC8621726 DOI: 10.3390/mi12111274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 12/28/2022]
Abstract
Home-based hand rehabilitation has excellent potential as it may reduce patient dropouts due to travel, transportation, and insurance constraints. Being able to perform exercises precisely, accurately, and in a repetitive manner, robot-aided portable devices have gained much traction these days in hand rehabilitation. However, existing devices fall short in allowing some key natural movements, which are crucial to achieving full potential motion in performing activities of daily living. Firstly, existing exoskeleton type devices often restrict or suffer from uncontrolled wrist and forearm movement during finger exercises due to their setup of actuation and transmission mechanism. Secondly, they restrict passive metacarpophalangeal (MCP) abduction-adduction during MCP flexion-extension motion. Lastly, though a few of them can provide isolated finger ROM, none of them can offer isolated joint motion as per therapeutic need. All these natural movements are crucial for effective robot-aided finger rehabilitation. To bridge these gaps, in this research, a novel lightweight robotic device, namely "Flexohand", has been developed for hand rehabilitation. A novel compliant mechanism has been developed and included in Flexohand to compensate for the passive movement of MCP abduction-adduction. The isolated and composite digit joint flexion-extension has been achieved by integrating a combination of sliding locks for IP joints and a wire locking system for finger MCP joints. Besides, the intuitive design of Flexohand inherently allows wrist joint movement during hand digit exercises. Experiments of passive exercises involving isolated joint motion, composite joint motions of individual fingers, and isolated joint motion of multiple fingers have been conducted to validate the functionality of the developed device. The experimental results show that Flexohand addresses the limitations of existing robot-aided hand rehabilitation devices.
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McDevitt J, Griffin M, Doyle D. Volar Plate Injuries of the Proximal Interphalangeal Joint. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Millrose M, Gesslein M, Kim S, Ottersbach C, Eisenschenk A, Asmus A. Results of a special interdisciplinary hand therapy program for work-related injuries. HAND SURGERY & REHABILITATION 2020; 39:575-579. [DOI: 10.1016/j.hansur.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/09/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
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Burley S, Di Tommaso A, Cox R, Molineux M. An occupational perspective in hand therapy: A scoping review. Br J Occup Ther 2018. [DOI: 10.1177/0308022617752110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction There have been calls for the occupational therapy profession to realign with its values around occupation. However, the profession faces challenges in practice areas that have historically been underpinned by a biomechanical approach, such as hand therapy. The aim of this scoping review was to describe what is known about an occupational perspective in the hand therapy literature. Method This scoping review utilised a recognised five-step approach. A search was conducted in four databases for papers published between 2005 and 2016. Numerical and thematic analyses were employed, using the Canadian Practice Process Framework as a theoretical framework. Results Fifty papers were included in the scoping review. Six themes were identified: the centrality of occupation; inconsistencies in terminology; where in the occupational therapy process?; informal discussion as a key occupational strategy; occupational therapists’ expectations of patients; and a bottom-up approach focusing on biomechanical strategies to implementing the plan. Conclusion Whilst there has been some integration of an occupational perspective into hand therapy literature, there are still challenges. Inconsistent terminology, the lack of an occupational perspective throughout the occupational therapy process and a bottom-up approach to interventions all demonstrate the continuing tensions between the biomechanical approach and an occupational perspective.
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Affiliation(s)
- Samantha Burley
- Occupational Therapist, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Amelia Di Tommaso
- Lecturer, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Ruth Cox
- Director of Occupational Therapy, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Matthew Molineux
- Professor and Head, Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Ataker Y, Uludag S, Ece SC, Gudemez E. Early active motion after rigid internal fixation of unstable extra-articular fractures of the proximal phalanx. J Hand Surg Eur Vol 2017; 42:803-809. [PMID: 28589776 DOI: 10.1177/1753193417709949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study is to describe active early rehabilitation in proximal phalanx fractures treated with rigid internal fixation. A total of 22 consecutive patients presenting with spiral, oblique or comminuted extra-articular fractures of the proximal phalanx were included in the study. All fractures were rigidly stabilized with plate and screws or screws alone and subsequently entered an active early rehabilitation programme. The mean follow-up period was 15.4 months (SD 10.1). Mean visual analogue scale pain score was 0.3 (SD 0.5) and Disability of the Arm, Shoulder and Hand score was 9.2 (SD 4.1). Mean total active motion was 241.9° (SD 18.3). According to the digital functional assessment, 86.3% of the patients had excellent results. Extension lags of the proximal interphalangeal joint were observed in seven fingers (mean lag, 3.4° (SD 5.5)). The results of this study demonstrated high patient satisfaction and good outcomes after the surgical technique and postoperative rehabilitation protocol described in open reduction and rigid internal fixation of proximal phalangeal fractures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Y Ataker
- 1 Physical Medicine and Rehabilitation, VKF American Hospital, Istanbul, Turkey
| | - S Uludag
- 2 Orthopaedics and Traumatology, VKF American Hospital, Istanbul, Turkey
| | - S C Ece
- 3 Department of Physical Medicine and Rehabilitation, VKF American Hospital, Istanbul, Turkey
| | - E Gudemez
- 4 Orthopaedics and Traumatology and Hand Surgery, Koc University School of Medicine, Istanbul, Turkey
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Weinstock-Zlotnick G, Page C, Ghomrawi HMK, Wolff AL. Responsiveness of three Patient Report Outcome (PRO) measures in patients with hand fractures: A preliminary cohort study. J Hand Ther 2016. [PMID: 26209162 DOI: 10.1016/j.jht.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical measurement. INTRODUCTION Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures. PURPOSE 1--To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2--To examine patients' PRO preference. METHODS 60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported. RESULTS Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p < .001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98-1.23; SRM: 1.31-1.49) and T1 and T3 (effect size: 1.21-1.54; SRM 1.49-1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35-.64, SRM: .38-.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use. CONCLUSIONS DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures. LEVEL OF EVIDENCE 2c.
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Hsiao PC, Yang SY, Ho CH, Chou W, Lu SR. The benefit of early rehabilitation following tendon repair of the hand: A population-based claims database analysis. J Hand Ther 2016; 28:20-5; quiz 26. [PMID: 25446518 DOI: 10.1016/j.jht.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/04/2014] [Accepted: 09/24/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A retrospective cohort. INTRODUCTION The benefits of early rehabilitation after hand tendon repair have not been analyzed using population-based datasets. PURPOSE OF THE STUDY to analyze whether early rehabilitation reduces the resurgery risk and the use of rehabilitation resources. METHODS Patients (n = 1219) who underwent hand tendon repairs followed by rehabilitation were identified from a nationwide claims database and divided into 3 groups: early (<1 wk after tendon repair), intermediate (1-6 wk), or late (>6 wk) rehabilitation. The resurgery rate and the use of rehabilitation resources after tendon repair were calculated. Cox proportional hazards models were used to evaluate the relevant predictors of resurgery. RESULTS The early rehabilitation group exhibited the lowest resurgery rate and used the fewest rehabilitation resources. Compared with late rehabilitation, early or intermediate rehabilitation conferred protective effects against resurgery in patients without a concomitant upper-limb fracture. CONCLUSION Our findings suggest the benefit of early rehabilitation after hand tendon repair. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pei-Chi Hsiao
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan 71004, Taiwan, ROC; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, No. 60, Sec. 1, Erren Road, Rende District, Tainan 71710, Taiwan, ROC
| | - Shu-Yu Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan 71004, Taiwan, ROC
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan 71004, Taiwan, ROC; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, No. 60, Sec. 1, Erren Road, Rende District, Tainan 71710, Taiwan, ROC
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan 71004, Taiwan, ROC; Department of Recreation and Health Care Management, Chia Nan University of Pharmacy and Science, No. 60, Sec. 1, Erren Road, Rende District, Tainan 71710, Taiwan, ROC
| | - Shiang-Ru Lu
- Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Sanmin District, Kaohsiung 80754, Taiwan, ROC.
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