Blast Injury to the Hand: Assessing the Injury Pattern and Functional Outcome of the Thumb

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Hand Surgery

Background:

• Blast injuries affect approximately 30% of 10,000 annual hand injuries in the US.
• The first web space and thumb carpometacarpal (CMC) joint are particularly vulnerable.
• Understanding injury patterns, salvageability, and functional outcomes is crucial for thumb preservation.

Purpose of the Study:

• To evaluate typical injury patterns of the thumb carpometacarpal (CMC) joint from blast trauma.
• To assess the salvageability and functional outcomes of thumbs following blast injury.
• To analyze the impact of injury severity on thumb range of motion (ROM).

Main Methods:

• Retrospective chart review of blast-injured hands (January 1995-July 2019), excluding penetrating trauma.
• Assessment of hand function via occupational therapy records.
• Independent classification of injury severity across soft tissue, neurovascular, and bone/joint structures.

Main Results:

• 23 hands from 21 patients were analyzed, with 20 thumbs evaluated.
• Most injuries were severe in at least one category (soft tissue, neurovascular, bone/joint).
• All 10 carpometacarpal (CMC) joint dislocations required surgical fixation; severely injured thumbs showed significantly decreased ROM (P < 0.05).

Conclusions:

• Blast hand injuries often lead to severe functional deficits, impacting thumb functionality and occupational capabilities.
• Half of the studied patients had severe damage to the thumb CMC joint.
• Objectively, severely injured thumbs demonstrated significantly worse ROM compared to mildly injured thumbs.