‘‘Pattern and Functional Outcome of Hand Injuries among Patients Treated at Muhimbili Orthopaedic Institute (MOI)

Abstract

Background Hand and fingers are most often injured in work place. For acutely injured hand, the treatment goals are to alleviate pains, repair the injured structures, prevent complications, and restoring the normal function. Hand injuries can result in a considerable society burden including costs for the provision of acute health care services, as well as, reduced socioeconomic productivity due to the injured person’s limited capacity to perform daily functional activities throughout their recovery Hand injuries are common at MOI; 10-15 persons with hand injuries are attended at MOI emergency department every month(4). Objectives: To determine pattern and short term functional outcome of hand injuries among patients attended at MOI. Methodology: A descriptive prospective hospital based study was conducted at MOI on adults aged 18years and above with hand injuries from June 2016-May 2017. Convenience sampling technique was used to get the sample size. 70 patients met the inclusion criteria and were recruited after consenting for the study. Data were collected with help of one research assistantguided with a structured questionnaire and BMHQ. Goniometer and ruler were used accomplish data collection process. The outcome was assessed using objective and subjective criteria at 2nd, 6th, and 12th week post treatment. The objective outcome was assessed using Belsky`s, Gingrass`s criteria for fingers and thumb injuries and Dargan`s criteria for tendon injuries. The subjective criteria was assessed using BMHQ. The data obtained were analyzed using SPSS version 20. Results: A total of 70 patients with hand injuries were recruited with 66 being evaluated for outcome. The modal age group was 20-29 years. Males outnumbered females in a ratio of 6.8:1.Among the recruited patients, 54.3% had a primary education.45.7% depend on petty business to sustain their life. The right hand was affected more than the left hand. The right hand was dominant hand in 87.1%.Road traffic crashes, machines and assaults were the leading causes of hand injuries. 72.9% were open injuries and 27.1% were closed injuries. The open injuries included acerations 42.9%, traumatic amputation 12.9%, abrasions 8.6%, crush and degloving injury 8.6%. Phalanges of the middle finger were the most fractured bones. Among the phalanges comminuted fracture pattern was the most common 38.9%.The transverse fracture pattern was common among the metacarpals. Dislocation was most noted in the interphalangeal joints where proximal interphalangeal joint was dislocated in 38.5% and distal interphalangeal joint was dislocated 23.1%.Extensor tendons were injured in 58.3% while the flexor tendons were injured in 41.7%.Among the flexor tendons, flexor digitorum superficialis was the most injured tendon in 60%. The functional outcome using objective criteria was good to excellent. The mean MHQ score was 79.7% Conclusion: From this study it is observed that most hand injuries are due to road traffic crashes, machines and assaults. The fifth and second metacarpals are the most frequently injured. When joint dislocation occurs, the interphalangeal joints are the most likely to be affected. Flexor digitorum superficialis and Extensor digitorum communis are the leading tendons to be injured. Skeletal pain and deformity are the commonest complications of hand injuries however adhering to physiotherapy largely minimize the deformity. The functional outcome of hand injuries at MOI is good to excellent in terms of overall hand function, activities of daily living, pains, work performance, aesthetics and patient satisfaction with hand function. The mean MHQ score was 79.7% at three months.