Four Extremity Amputation and Bionic Prosthesis Supply after Disseminated Intravascular Coagulation: A Follow-Up on Functionality and Quality of Life after Bionic Prosthesis Supply

Biometric analysis hand parameters in young adults for prosthetic hand and ergonomic product applications

This study aimed to evaluate the superficial anatomy, kinesiology, and functions of the hand to reveal its morphometry and apply the findings in various fields such as prosthetic hand and protective hand support product design. We examined 51 young adults (32 females, 19 males) aged between 18-30. Hand photographs were taken, and measurements were conducted using ImageJ software. Pearson correlation analysis was performed to determine the relationship between personal information and the parameters. The results of the measurements showed the average lengths of finger segments: thumb (49.5±5.5 mm), index finger (63.9±4.1 mm), middle finger (70.7±5.2 mm), ring finger (65.5±4.8 mm), and little finger (53.3±4.3 mm). Both females and males, the left index finger was measured longer than the right index finger. The right ring finger was found to be longer than the left in both sexes. Additionally, length differences between fingers in extended and maximally adducted positions were determined: thumb-index finger (56.1±6.2 mm), index-middle finger (10.7±4.1 mm), middle-ring finger (10.8±1.4 mm), and ring-little finger (25.6±2.7 mm). Other findings included the average radial natural angle (56.4°±10.5°), ulnar natural angle (23.4°±7.1°), radial deviation angle (65.2°±8.2°), ulnar deviation angle (51.2°±9.6°), and grasping/gripping angle (49.1°±5.8°). The average angles between fingers in maximum abduction positions were also measured: thumb-index finger (53.4°±6.5°), index-middle finger (17.2°±2.6°), middle-ring finger (14.3°±2.3°), and ring-little finger (32.1°±7.0°). The study examined the variability in the positioning of proximal interphalangeal joints during maximum metacarpophalangeal and proximal interphalangeal flexion, coinciding with maximum distal interphalangeal extension movements. The focal points of our observations were the asymmetrical and symmetrical arches formed by these joints. This study provides valuable hand parameters in young adults, which can be utilized in various applications such as prosthetic design, ergonomic product development, and hand-related research. The results highlight the significance of considering individual factors when assessing hand morphology and function.

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

Background

Severe hand injuries significantly limit function and esthetics of the affected hand due to massive trauma in skeletal and soft tissues. Surgical reconstruction is often unsatisfactory, so bionic prostheses are a consideration. However, assessment of functional outcomes and quality of life after surgical reconstruction to guide clinical decisions immediately after injury and in the course of treatment remain difficult.

Methods

We conducted a prospective follow-up analysis of patients with severe hand injuries during 2016–2018. We retrospectively evaluated initial trauma severity and examined current functional status, quality of life, general function, and satisfaction in everyday situations of the hand. We also developed a novel Hand Bionic Score to guide clinical recommendation for selective amputation and bionic prosthesis supply.

Results

We examined 30 patients with a mean age of 53.8 years and mean initial severity of hand injury (iHISS) of 138.4. Measures indicated moderate quality of life limitations, moderate to severe limitation of overall hand function, and slight to moderate limitation of actual hand strength and function. Mean time to follow-up examination was 3.67 years. Using the measured outcomes, we developed a Hand Bionic Score that showed good ability to differentiate patients based on outcome markers. Appropriate cutoff scores for all measured outcome markers were used to determine Hand Bionic Score classifications to guide clinical recommendation for elective amputation and bionic prosthetic supply: < 10 points, bionic hand supply not recommended; 10–14, bionic supply should be considered; or > 14, bionic supply is recommended.

Conclusions

While iHISS can guide early clinical decisions following severe hand injury, our novel Hand Bionic Score provides orientation for clinical decision-making regarding elective amputation and bionic prosthesis supply later during the course of treatment. The score not only considers hand function but also psychological outcomes and quality of life, which are important considerations for patients with severe hand injuries. However, future randomized multicenter studies are needed to validate Hand Bionic Score before further clinical application.

Level of evidence: Level III, risk/prognostic study.