gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

HISS score and modified vascular HISS score correlation with short and long-term outcomes in complex hand injuries: a retrospective preliminary study

Meeting Abstract

  • presenting/speaker Letizia Senesi - Clinical Orthopeadics, DPT of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Francesco De Francesco - DPT of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Antonio Gigante - Clinical Orthopeadics, Ancona, Italy
  • Michele Riccio - DPT of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1233

doi: 10.3205/19ifssh0924, urn:nbn:de:0183-19ifssh09248

Published: February 6, 2020

© 2020 Senesi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Complex hand traumas (CHT) are critical injuries that involve three different structures in the same digital ray at least or one structure in two digital rays at least. These lesions are very difficult to approach and even if they are subject to immediate and correct surgery, outcomes are scarce due to the complexity of injury. The aim of the present study is to verify the incidence of CHT and to investigate the hand injury severity score (HISS) correlation with short and long terms outcomes in these patients.

Methods: From 2012 to 2016, we treated 227 CHT patients arrived in our department. Patients were classified by age, sex, traumatic mechanism, involved digital rays and type of surgical treatment. For each class of traumatic mechanism, we verified HISS score and its correlation with qDASH score recorded at follow-up. We also verified if HISS score might be a short-term prognostic factor.

Results and Conclusions: Among all 227 CHT patients, we counted 201 males and 26 females. The average age when trauma occurred was 49 for males and 47 for females. The most common mechanism of trauma was crushing (125 occurrences). Trauma were mostly pluri-digital (52%). Specifically, we focused on avulsion as mechanism of trauma which concerned 33 patients, accounting for 48 fingers in total (2 were excluded because they were ring finger avulsions). Amputation was performed immediately in 11 patients and in 4 cases at the second look. Eighteen where did not receive this treatment. Patients were classified retrospectively according to HISS score. Residual disability was evaluated with qDASH score at average time of 22 months after trauma. Statistical analysis was performed with Spearman's test and it shows a positive correlation between HISS score and qDASH (p=0.85, p=0.001). We also propose a modified HISS score (modified vascular HISS score, mV-HISS) with additional parameters for vessels examination, and we investigated its possible usefulness as short-term prognostic factor.

In conclusion, CHT are serious injuries with significant economic and social consequences for patients and represent a great challenge for hand surgeons. For avulsion as mechanism of injury, HISS score had a statistically significant prognostic factor in long terms outcomes for patients. mV-HISS score might be a valuable prognostic tool in understanding short terms outcomes in CHT.