Hand function 6 weeks following non-surgically treated proximal phalangeal fractures and factors associated to upper extremity disability

Abstract

Purpose: To describe hand function, and investigate adherence to a rehabilitation protocol and factors associated with upper extremity disability in non-surgically treated proximal phalangeal fractures. Material and methods: In a prospective cohort study, 86 patients (58 women, mean age of 49 years) were assessed at cast removal and 6 weeks follow-up. Adherence was registered in a diary. Factors potentially associated with disability were assessed in a logistic regression model. Results: At 6 weeks, the mean total active range of motion in the injured finger was 84% of the uninjured finger and median pain intensity levels were low (VAS <20). Mean grip strength was 66% of the uninjured hand and 28% perceived high upper extremity disability (QuickDASH score ≥30). Most patients adhered to exercise and night splint regime. The strongest associated factors with high upper extremity disability were more days in cast (Odds ratio 1.429, 95% CI 1.110–1.840) and fear of movement (Odds ratio 1.119, 95% CI 0.990–1.256) in the final regression model (Nagelkerke R Square 0.46). Conclusion: Most patients regain early satisfactory hand function, but a quarter still perceives high upper extremity disability. Longer immobilisation time in particular and fear of movement are important factors that may negatively affect the early outcome.