AN ANALYSIS OF THE INDICATIONS FOR, AND ASSESSMENT OF THE OUTCOMES OF SECONDARY SURGERY AFTER PRIMARY REPAIR OF INJURIES WITHIN THE UPPER LIMB

Abstract

Introduction: The objective of the study was the analysis of the indications for, and assessment of the outcomes of secondary interventions after primary repair of injuries within the upper limb in the authors’ institution – Department of General and Hand Surgery of the Pomeranian Medical University in Szczecin (a tertiary care unit).

Material and methods: Answers on questionnaires (including DASH) mailed to 33 patients were the subject of the analysis. The group consisted of 27 men and 6 women, mean age 36 years, in whom secondary interventions were performed at a mean of 8 months after primary surgery.

Results: Injuries were grouped in five categories: tendon lacerations, hand or finger amputations, nerve sections, complex tissue injuries, and isolated finger fractures. The most common cause of secondary intervention was incomplete finger movement and lack of opposition of the thumb. The most common operations included tenolysis, arthrolysis and opponensplasty. The outcomes of secondary surgery from patients’ perspective were overall good: 13 (39%) patients reported significant improvement, 16 (48%) moderate, and only 4 (13%) patients had no benefit. Twenty­‍‑five patients regained full, or almost full hand function (DASH scores 2–39), and 8 (24%) had moderately to severely impaired function (DASH 40–80). Twenty­‍‑eight patients returned to work.

Conclusions: Primary repair of upper limb injuries (even severe) in the tertiary institution was adequate, and secondary interventions rarely necessary. The most common indication was incomplete finger movement caused by ineffective postoperative mobilization. The important role of rehabilitation for the final outcome of the treatment of hand injuries was emphasized.