Diagnosis and treatment of a closed and inverted metacarpal head fracture.

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Abstract

11. J Hand Surg Am. 2024 Nov;49(11):1138.e1-1138.e6. doi: 10.1016/j.jhsa.2023.01.025. Epub 2023 Apr 1. Swelling, Stiffness, and Dysfunction Following Proximal Interphalangeal Joint Sprains. Cheesman QT(1), Kwan SA(1), DeFrance MJ(1), Jennings JD(2), Rivlin M(3), Matzon JL(4). Author information: (1)Jefferson Health Orthopaedic Surgery Residency - New Jersey, Stratford, NJ. (2)Reconstructive Orthopaedics, Sewell, NJ. (3)Rothman Orthopaedic Institute, Philadelphia, PA. (4)Rothman Orthopaedic Institute, Philadelphia, PA. Electronic address: jonas.matzon@rothmanortho.com. PURPOSE: Proximal interphalangeal (PIP) joint sprains are common injuries that often result in prolonged swelling, stiffness, and dysfunction; however, the duration of these sequelae is unknown. The purpose of this study was to determine the duration of time that patients experience finger swelling, stiffness, and dysfunction following a PIP joint sprain. METHODS: This was a prospective, longitudinal, survey-based study. To identify patients with PIP joint sprains, the electronic medical record was queried monthly using International Classification of Disease, Tenth Revision, codes for PIP joint sprain. A five-question survey was emailed monthly for 1 year or until their response indicated resolution of swelling, whichever occurred sooner. Two cohorts were established: patients with (resolution cohort) and patients without (no-resolution cohort) self-reported resolution of swelling of the involved finger within 1 year of a PIP joint sprain injury. The measured outcomes included self-reported resolution of swelling, self-reported limitations to range of motion, limitations to activities of daily living, Visual Analog Scale (VAS) pain score, and return to normalcy. RESULTS: Of 93 patients, 59 (63%) had complete resolution of swelling within 1 year of a PIP joint sprain. Of the patients in the resolution cohort, 42% reported return to subjective normalcy, with 47% having self-reported limitations in range of motion and 41% having limitations in activities of daily living. At the time of resolution of swelling, the average VAS pain score was 0.8 out of 10. In contrast, only 15% of patients in the no-resolution cohort reported return to subjective normalcy, with 82% having self-reported limitations in range of motion and 65% having limitations in activities of daily living. For this cohort, the average VAS pain score at 1 year was 2.6 out of 10. CONCLUSIONS: It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV. Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jhsa.2023.01.025