Patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations : a multicentre snapshot study

Abstract

Aims: To evaluate patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations, and to identify factors that are associated with worse patient-reported outcomes.

Methods: This cross-sectional, multicentre snapshot study included all adult patients with metacarpal and phalangeal fractures or dislocations during a three-month period between August and October 2020. The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) three months after injury. The MHQ scores were compared to normative MHQ scores of 90 points of the affected hand of patients who sustained unilateral trauma derived from a previous study. Subgroup analyses were performed for the most common injury types. Multivariable linear regression was used to study associations between patient characteristics and worse MHQ scores.

Results: The MHQ scores of 512 patients were analyzed. The median MHQ score was 80 (IQR 65 to 91) for nonoperatively treated patients (n = 398) and 78 (IQR 66 to 85) for operatively treated patients (n = 114). After nonoperative treatment, 104/398 patients (26%) reached a MHQ score equal to or better than the normative MHQ score, ranging between 11% (1/9) and 42% (13/31) among the nine most common injury types. After operative treatment, this was 11% (13/114), ranging between 10% (3/29) and 31% (5/16) among the three most common injury types. No significant differences in MHQ scores were found between common injury types. Older age, the presence of hand comorbidities, and referral to hand therapy were associated with a worse MHQ score after nonoperative treatment.

Conclusion: These results suggest that most patients have not returned to a normal hand function within three months following metacarpal and phalangeal fractures or dislocations. Older age, the presence of hand comorbidities, and referral for hand therapy were associated with worse hand functioning after nonoperative treatment. The findings are relevant for clinicians to evaluate recovery and for patients to manage their expectations.

Fig. 1

Flow diagram of included patients. MHQ, Michigan Hand Outcomes Questionnaire.

Fig. 2

Michigan Hand Outcomes Questionnaire (MHQ) total and subdomain scores three months post-injury for patients treated nonoperatively (n = 398). The horizontal green line across each boxplot denotes the normative MHQ value, providing a reference for normal hand function. The boxplots illustrate the median (red line), IQR (box), and potential outliers (dots) for each MHQ domain.

Fig. 3

Michigan Hand Outcomes Questionnaire (MHQ) total and subdomain scores three months post-injury for patients treated operatively (n = 114). The horizontal green line across each boxplot denotes the normative MHQ value, providing a reference for normal hand function. The boxplots illustrate the median (red line), IQR (box), and potential outliers (dots) for each MHQ domain.

Fig. 4

Patient-reported hand function according to the Michigan Hand Outcomes Questionnaire (MHQ) score by injury type three months post-injury for patients treated nonoperatively. The bars represent the percentage of patients reporting normal hand function (orange) versus decreased hand function (yellow) in comparison to the normative MHQ score of 90. The numbers within each bar indicate the count of patients in each category. MC, metacarpal; PIPJ, proximal interphalangeal joint; P1, proximal phalanx; P2, middle phalanx; P3, distal phalanx.

Fig. 5

Patient-reported hand function according to the Michigan Hand Outcomes Questionnaire (MHQ) score by injury type three months post-injury for patients treated operatively. The bars represent the percentage of patients reporting normal hand function (orange) versus decreased hand function (yellow) in comparison to the normative MHQ score of 90. The numbers within each bar indicate the count of patients in each category. MC, metacarpal; P1, proximal phalanx; P2, middle phalanx.