http://repub.eur.nl/res/aut/15060/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/19734/ 2010-05-01T00:00:00Z Cold intolerance is a well-known phenomenon that develops in the first months after hand injury and generally does not decrease over time. In this study, we evaluated the prevalence and severity of cold intolerance after hand fracture in 129 patients using the Cold Intolerance Symptom Severity (CISS) questionnaire. Patients with nerve and/or vascular injuries were excluded. The response rate was 59%. The mean CISS score was 23. Pathological cold intolerance, defined as a CISS score over 30, was experienced by 38% of the patients. Cold intolerance is common after hand fractures and can be severely disabling in some patients. http://repub.eur.nl/res/pub/13146/ 2008-09-03T00:00:00Z In order to assess and possibly improve our practice of hand fracture treatment, studies were performed that led to this thesis, introduced in chapter 1. An evidence-based protocol and manual of operative treatment of fractures of phalanges was compiled, chapter 2. The results of operative treatment of phalangeal fractures at the department of Plastic, Reconstructive, and Hand Surgery of the Erasmus University Medical Center, Rotterdam, the Netherlands were assessed and risk factors for nonunion and malunion identified, chapter 3. The digital functional loss in severely injured hands was quantified (chapter 4). Associated soft tissue injury, level of injury, and arthrodesis were risk factors for diminished function. A quantification of digital functional loss for combinations of these risk factors was made. In chapter 5, correlation between impairment and disability was assessed following treatment for severe hand injuries. No statistically significant correlation existed between AMA impairment ratings for the hand and DASH (disability) module scores. A prospective study audit was performed on quality of treatment of phalangeal and metacarpal fractures, chapter 6. Eighty-three percent of diagnoses were correct and 89% of treatment plans were according to protocol, 80% healed properly, and osteosynthesis was deemed adequate in 81% of cases. In chapter 7, financial and logistic impact of phalangeal and metacarpal fractures was prospectively assessed. Hospital costs, hospital visits, days in the hospital, number of operations, and period off work were recorded. Variables that influenced outcome data were statistically tested. In chapter 8 results of the aforementioned studies are discussed, and recommendations for improvement of operative treatment of phalangeal and metacarpal fractures are provided. http://repub.eur.nl/res/pub/36144/ 2007-01-01T00:00:00Z Purpose: Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. Methods: The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. Results: Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. Conclusions: The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.