Abstract
Purpose:
Distal phalangeal injury is one of the most common hand injuries. Distal phalanx is very small area, but in the patients who injure in this area, hospiltalization is often necessary. Some of the patients need the long hospital stay for three or more weeks. Assessment of trends of the injuries may help in enhancing patient education and designing the management plan. We analyzed the characteristics of inpatients with distal phalangeal injuries and the predictors of long-term hospitalization.
Methods:
A retrospective review of inpatients with distal phalangeal injuries was performed consecutively from June 2008 to July 2015. Patient demographics and outcomes were compared with chi-squared analysis and Student's t-test. Using multivariate regression analysis, predictors of long-term hospitalization were identified.
Results:
Five hundred and twelve patients were investigated. The rate of long-term hospitalization was 21.9%. Multivariate logistic regression model revealed that diabetes mellitus, operation time of three or more hours, amputation injury, injury sustained at an industrial place, complication, distant flaps, and replantation were significant risk factors of long-term hospitalization.
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Table 1.
Table 2.
Complication | No. (%) |
---|---|
Total | 68 (13.3) |
Partial necrosis of flap or skin graft | 29 (42.6) |
Total necrosis of flap or skin graft | 10 (14.7) |
Wound dehiscence | 17 (25.0) |
Surgical site infection | 12 (17.6) |
Table 3.
Table 4.
Demographics | Short term hospitalization (under 3 wk) | Long term Hospitalization (3 wk or more) | p-value |
---|---|---|---|
No. of patients | 400 | 112 | |
Sex | |||
Male | 309 (78.6) | 84 (21.4) | 0.982 |
Female | 91 (76.5) | 28 (23.5) | 0.974 |
Age | |||
<20 | 44 (91.7) | 4 (8.3) | 0.997 |
20-40 | 112 (80.0) | 28 (20.0) | 0.994 |
40-60 | 192 (76.7) | 65 (25.3) | 0.134 |
>60 | 52 (77.6) | 15 (22.4) | 0.981 |
Hand | |||
Left | 195 (79.3) | 51 (20.74) | 0.407 |
Right | 205 (77.1) | 61 (22.9) | 0.395 |
No. of fingers | |||
One | 341 (79.9) | 86 (20.1) | 0.914 |
Two | 34 (65.4) | 18 (34.6) | 0.334 |
Three | 16 (72.7) | 6 (27.3) | 0.882 |
Four | 9 (81.8) | 2 (18.2) | 0.992 |
Location | |||
Thumb | 71 (82.6) | 15 (17.4) | 0.993 |
Index | 132 (74.6) | 45 (25.4) | 0.52 |
Middle | 88 (74.6) | 30 (25.4) | 0.617 |
Ring | 65 (86.7) | 10 (13.3) | 0.997 |
Little | 44 (78.6) | 12 (21.4) | 0.988 |
Type of injury | |||
Crushing | 166 (84.7) | 30 (15.3) | 0.952 |
Laceration | 118 (86.8) | 18 (13.2) | 0.975 |
Avulsion | 26 (81.3) | 6 (18.7) | 0.924 |
Amputation | 90 (60.8) | 58 (39.2) | <0.001a) |
Distal phalangeal fracture | 0.045a) | ||
No | 290 (80.8) | 69 (19.2) | |
Yes | 110 (71.9) | 43 (28.1) | |
Terminal tendon injury | |||
No | 248 (72.3) | 95 (27.7) | 0.172 |
Yes | 152 (89.9) | 17 (10.1) | |
Nail structure injury | 0.128 | ||
No | 301 (80.9) | 71 (19.1) | |
Yes | 99 (70.7) | 41 (29.3) | |
Diabetes mellitus | 0.007a) | ||
No | 381 (79.4) | 99 (20.6) | |
Yes | 19 (59.4) | 13 (40.6) | |
Hypertension | 0.251 | ||
No | 352 (77.2) | 104 (22.8) | |
Yes | 48 (85.7) | 8 (14.3) | |
Smoking | 0.041a) | ||
No | 237 (78.5) | 65 (21.5) | |
Yes | 163 (77.6) | 47 (22.4) | |
Anesthesia | |||
Local | 354 (78.3) | 98 (21.7) | 0.879 |
Regional | 31 (77.5) | 9 (22.5) | 0.348 |
General | 15 (75.0) | 5 (25.0) | 0.047a) |
Primary surgery | |||
Skin grafts | 55 (84.6) | 10 (15.4) | 0.912 |
Local flaps | 327 (85.6) | 55 (14.4) | 0.934 |
Distant flaps | 9 (20.9) | 34 (79.1) | <0.001a) |
Replantation | 9 (40.9) | 13 (59.1) | <0.001a) |
Operation time | |||
<1 hr | 236 (89.7) | 27 (10.3) | 0.995 |
1-3 hr | 147 (68.4) | 68 (31.6) | 0.073 |
>3 hr | 17 (50.0) | 17 (50.0) | <0.001a) |
Wound complication | <0.001a) | ||
No | 375 (84.5) | 69 (15.5) | |
Yes | 25 (36.8) | 43 (63.2) | |
Partial necrosis | 5 (17.2) | 24 (82.8) | |
Total necrosis | 0 | 10 (100) | |
Dehiscence | 13 (76.5) | 4 (23.5) | |
Surgical site infection | 7 (58.3) | 5 (41.7) | |
Education | 0.879 | ||
No/Obligation | 195 (78.3) | 54 (21.7) | |
High | 205 (77.9) | 58 (22.1) | |
Injury place | |||
Farm | 74 (77.9) | 21 (22.1) | 0.892 |
Industrial place | 164 (68.3) | 76 (31.7) | 0.031a) |
Residence | 162 (91.5) | 15 (8.5) | 0.927 |
Injury time | |||
0:00-6:00 | 37 (94.9) | 2 (5.1) | 0.998 |
6:00-12:00 | 113 (80.1) | 28 (19.9) | 0.917 |
12:00-18:00 | 144 (71.3) | 58 (28.7) | 0.162 |
18:00-24:00 | 106 (81.5) | 24 (18.5) | 0.934 |
Time to hospital | |||
<0.5 hr | 263 (76.0) | 83 (24.0) | 0.617 |
0.5-2 hr | 108 (81.2) | 25 (18.8) | 0.945 |
>2 hr | 29 (87.9) | 4 (12.1) | 0.981 |
Table 5.
Variable | Odds ratio | 95% Confidence interval | p-value |
---|---|---|---|
Amputation injury | 3.494 | 1.382-8.830 | 0.008a) |
Distal phalangeal fracture | 1.094 | 0.523-2.287 | 0.811 |
Diabetes | 4.410 | 1.195-6.276 | 0.026a) |
Uncontrolled (hemoglobin A1c >10.0%) | 1.559 | 0.002-8.691 | 0.543 |
Smoking | 1.200 | 0.546-2.636 | 0.650 |
General anesthesia | 0.477 | 0.133-1.716 | 0.257 |
Primary surgery | |||
Distant flap | 19.609 | 7.611-50.518 | <0.001a) |
Replantation | 6.045 | 2.079-17.582 | 0.001a) |
Operation for >3 hr | 5.264 | 1.617-7.134 | 0.006a) |
Wound complication (necrosis of skin graft of flap) | 7.297 | 3.266-16.300 | <0.001a) |
Injury at industrial place | 2.969 | 1.556-5.663 | 0.001a) |