Clinical Outcomes of Explosion Injuries to the Hand

The purpose of this study is to report clinical outcomes in a cohort of 12 patients with explosion injuries to the hand.

Twelve male patients with a mean age of 42.4 years (SD, 7.2) were examined at a mean of 54 months after sustaining explosion injuries to the hand. All patients underwent primary reconstruction and early soft tissue coverage within 72 hours after their injuries. Total active range of motion and moving 2-point discrimination in each digit were recorded along with hand injury severity score (HISS), disability of the arm, shoulder, and hand (DASH) score, and American Medical Association (AMA) impairment ratings.

For digits saved, the average total active motion at final follow-up was 215 degrees (SD, 66.5). Twenty-two digits had 6-mm 2-point discrimination, and 17 digits had 8- to 10-mm 2-point discrimination. Eight of the 12 patients had secondary procedures. We found a strong correlation between initial HISS and DASH scores at final follow-up. There was also a strong correlation between AMA impairment rating and DASH scores.

Early reconstruction provides protective sensation and preserves some function after explosion injuries. Preoperative HISS correlates with the long-term functional outcome as measured by DASH scores. For this group of patients, postinjury AMA impairment ratings also correlate with functional outcomes for the upper extremity.