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.

Additional Metadata
Keywords audit, finger, fracture, function, hand, injury, metacarpal, outcome, phalanx, treatment
Promotor S.E.R. Hovius (Steven)
Publisher Erasmus University Rotterdam
Sponsor The Esser Foundation, Erasmus Medisch Centrum, Nederlandse Vereniging voor Plastische Chirurgie, Foreest Instituut, Medisch Centrum Alkmaar, Nederlandse Vereniging voor Handchirurgie, Biomet Nederland B.V., Allergan Medical
ISBN 978-90-73118-10-2
Persistent URL
Oosterom, van, F.J.T. (2008, September 3). Facts of fractures of the hand. Erasmus University Rotterdam. Retrieved from