Session 12: Hand/wrist
15. November
09:00 - 10:00
Lokale: Auditorium
Chair: Maiken Stilling & Morten Kjær
Hans Tromborg1, Søren Moller2, Alice Ørts Hansen1
1 Department of Orthopaedic Surgery, Odense University Hospital, Odense C 2 OPEN – Odense Patient data Explorative Network, Odense University Hospital, Odense C
Background: The purpose of this study was to identify patients at risk of experiencing reduced functioning (Disabilities of the Arm, Shoulder and Hand short-form questionnaire (Q-DASH)) three and twelve months after hand surgery.
Aim: The hypothesis was that patients’ baseline sense of coherence (SOC-13) and scores on the Pain Catastrophizing Scale (PCS) influence functioning at 3 and 12 months post-surgery.
Materials and Methods: This study followed patients from referral to scheduled hand surgery through one year post-surgery. The primary outcome, was measured using the Q-DASH. Demographic information was collected at baseline along with the SOC-13 and PCS. We applied penalized lasso regression for model selection, evaluating change in Q- DASH from baseline to 3 and 12 months, as well as QDASH level at baseline, 3 months, and 12 months. Additionally, logistic regression was employed for the dichotomous outcome of Q-DASH not having improved at 3 and 12 months, to explain association with functioning.
Results: 421 patients aged 18-70 participated, baseline age was 50.6 (SD 13.5); 58% were women. Even the most parsimonious model, incorporating clinical characteristics along with SOC-13 and PCS questions, could not reasonably explain total variation in Q-DASH change after 3 and 12 months Item 2, 3, and 7 from SOC-13, along with item 3, 7, and 11 from PCS, were included in most models. Being an early retiree (4.53), having a whiplash (14.06) or other diseases (7.13) had negative effects on functioning, while long tertiary education (-5.27) and employment at referral (-8.17) are positive predictors. Investigating the dichotomous outcome of Q- DASH not improving from baseline to 3 months, the most parsimonious model predicts non-improvement in Q-DASH at 3 months with 70% accuracy. The SOC-13 scale alone predicts with 61% accuracy. Our models couldn´t predict Q-DASH not having improved from baseline to 12 months any better than the overall prevalence of non- improvement in the cohort.
Interpretation / Conclusion: Variables explaining 51% of the variation in Q- DASH score three months post-surgery have been identified SOC is a valuable factor indicating patients who have not improved three months after surgery
1 Department of Orthopaedic Surgery, Odense University Hospital, Odense C 2 OPEN – Odense Patient data Explorative Network, Odense University Hospital, Odense C
Background: The purpose of this study was to identify patients at risk of experiencing reduced functioning (Disabilities of the Arm, Shoulder and Hand short-form questionnaire (Q-DASH)) three and twelve months after hand surgery.
Aim: The hypothesis was that patients’ baseline sense of coherence (SOC-13) and scores on the Pain Catastrophizing Scale (PCS) influence functioning at 3 and 12 months post-surgery.
Materials and Methods: This study followed patients from referral to scheduled hand surgery through one year post-surgery. The primary outcome, was measured using the Q-DASH. Demographic information was collected at baseline along with the SOC-13 and PCS. We applied penalized lasso regression for model selection, evaluating change in Q- DASH from baseline to 3 and 12 months, as well as QDASH level at baseline, 3 months, and 12 months. Additionally, logistic regression was employed for the dichotomous outcome of Q-DASH not having improved at 3 and 12 months, to explain association with functioning.
Results: 421 patients aged 18-70 participated, baseline age was 50.6 (SD 13.5); 58% were women. Even the most parsimonious model, incorporating clinical characteristics along with SOC-13 and PCS questions, could not reasonably explain total variation in Q-DASH change after 3 and 12 months Item 2, 3, and 7 from SOC-13, along with item 3, 7, and 11 from PCS, were included in most models. Being an early retiree (4.53), having a whiplash (14.06) or other diseases (7.13) had negative effects on functioning, while long tertiary education (-5.27) and employment at referral (-8.17) are positive predictors. Investigating the dichotomous outcome of Q- DASH not improving from baseline to 3 months, the most parsimonious model predicts non-improvement in Q-DASH at 3 months with 70% accuracy. The SOC-13 scale alone predicts with 61% accuracy. Our models couldn´t predict Q-DASH not having improved from baseline to 12 months any better than the overall prevalence of non- improvement in the cohort.
Interpretation / Conclusion: Variables explaining 51% of the variation in Q- DASH score three months post-surgery have been identified SOC is a valuable factor indicating patients who have not improved three months after surgery
Laura Houstrup Matthiesen1,3, Simon Toftgaard Skov1,3,4, Jeppe Lange2,3
1. Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; 2. Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark; 3. Department of Clinical Medicine, Aarhus University; 4. Department of Orthopedic Surgery, Aalborg University Hospital
Background: The risk of recurrence after Percutaneous Needle Fasciotomy (PNF) for Dupuytren’s Contracture is a main point of criticism and has been reported up to 85% after just five years. A recent British study estimated the reoperation rate due to recurrence to be 34% within 10 years post PNF. The reoperation rate following PNF has not yet been assessed in a Scandinavian context.
Aim: The aim of this study was to estimate the reoperation rate due to recurrence in a large Danish cohort of PNF-treated patients.
Materials and Methods: This is a register-based, follow-up study on PNF-treated patients at Silkeborg Regional Hospital, Denmark, between 2007 and 2015. The first PNF procedure during the study period was defined as index procedure. Succeeding data were extracted from the Danish National Patient Registry and the Danish Civil Registration System in 2018 to identify possible reoperation procedures. Medical records were reviewed to validate reoperations performed at Silkeborg Regional Hospital (Silkeborg cohort). We evaluated the “true” reoperation rate based on the Silkeborg cohort with further best/worst case scenario on the total cohort.
Results: A total of 2,257 unique patients (3,331 PNF- treated fingers) were identified. Of those, 1,724 (76%) patients (2,511 (75%) fingers) were included in the Silkeborg cohort. The reoperation rate in the Silkeborg cohort was 28% at a median follow-up time of 6.8 (IQR: 4.6-9.3, min-max: 1.0-11.7) years. The reoperation rate in the total cohort was estimated to be between 21% and 46% at median follow-up time of 7.2 (IQR: 4.9-9.5, min-max: 1.0-11.7) years.
Interpretation / Conclusion: This study provides valuable information on reoperations after PNF in a large Scandinavian cohort. This yields important new information for patients and doctors about treatment options and risks.
1. Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; 2. Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark; 3. Department of Clinical Medicine, Aarhus University; 4. Department of Orthopedic Surgery, Aalborg University Hospital
Background: The risk of recurrence after Percutaneous Needle Fasciotomy (PNF) for Dupuytren’s Contracture is a main point of criticism and has been reported up to 85% after just five years. A recent British study estimated the reoperation rate due to recurrence to be 34% within 10 years post PNF. The reoperation rate following PNF has not yet been assessed in a Scandinavian context.
Aim: The aim of this study was to estimate the reoperation rate due to recurrence in a large Danish cohort of PNF-treated patients.
Materials and Methods: This is a register-based, follow-up study on PNF-treated patients at Silkeborg Regional Hospital, Denmark, between 2007 and 2015. The first PNF procedure during the study period was defined as index procedure. Succeeding data were extracted from the Danish National Patient Registry and the Danish Civil Registration System in 2018 to identify possible reoperation procedures. Medical records were reviewed to validate reoperations performed at Silkeborg Regional Hospital (Silkeborg cohort). We evaluated the “true” reoperation rate based on the Silkeborg cohort with further best/worst case scenario on the total cohort.
Results: A total of 2,257 unique patients (3,331 PNF- treated fingers) were identified. Of those, 1,724 (76%) patients (2,511 (75%) fingers) were included in the Silkeborg cohort. The reoperation rate in the Silkeborg cohort was 28% at a median follow-up time of 6.8 (IQR: 4.6-9.3, min-max: 1.0-11.7) years. The reoperation rate in the total cohort was estimated to be between 21% and 46% at median follow-up time of 7.2 (IQR: 4.9-9.5, min-max: 1.0-11.7) years.
Interpretation / Conclusion: This study provides valuable information on reoperations after PNF in a large Scandinavian cohort. This yields important new information for patients and doctors about treatment options and risks.
Karina Liv Hansen1,2,
1) Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Orthopaedic Surgery, Rigshospitalet Denmark
Background: Each year, approximately 25 Danes experience a major hand injury requiring replantation or revascularization. These injuries significantly impact everyday life.
Aim: Explore the functioning and quality of life 1- 4 years after a replantation or revascularization of one finger, several fingers, or the hand.
Materials and Methods: A cross-sectional study of Danish-speaking participants aged 18 and above, who underwent a replantation or revascularization of fingers or hand between July 2018 and August 2022. Data regarding injury, function, work, symptoms, sense of coherence (SOC), and quality of life (EQ5D) is collected through phone interview and questionnaires. Functioning is measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH). The severity of the injury was determined from patient’s medical records using the MHISS score. Results are analyzed statistically to identify differences and correlations between variables.
Results: Sixty out of 83 patients participated (72%). Most were male (85%) with an average age of 48 and had a vocational education or medium-cycle higher education. Half of the participants were on sick leave for less than six months. The median DASH score was 15.8 and the medium Eq5D-VAS score was 80.The most common issues were cold intolerance and stiffness. Results show no significant correlation between injury severity and DASH (rs=0.1), although a significant correlation between SOC and DASH (rs=0,43) was found.
Interpretation / Conclusion: Functioning and quality of life are slightly affected 1-4 years post-injury, with cold intolerance and stiffness being common issues. SOC and DASH show significant correlation.
1) Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark 2) Department of Orthopaedic Surgery, Rigshospitalet Denmark
Background: Each year, approximately 25 Danes experience a major hand injury requiring replantation or revascularization. These injuries significantly impact everyday life.
Aim: Explore the functioning and quality of life 1- 4 years after a replantation or revascularization of one finger, several fingers, or the hand.
Materials and Methods: A cross-sectional study of Danish-speaking participants aged 18 and above, who underwent a replantation or revascularization of fingers or hand between July 2018 and August 2022. Data regarding injury, function, work, symptoms, sense of coherence (SOC), and quality of life (EQ5D) is collected through phone interview and questionnaires. Functioning is measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH). The severity of the injury was determined from patient’s medical records using the MHISS score. Results are analyzed statistically to identify differences and correlations between variables.
Results: Sixty out of 83 patients participated (72%). Most were male (85%) with an average age of 48 and had a vocational education or medium-cycle higher education. Half of the participants were on sick leave for less than six months. The median DASH score was 15.8 and the medium Eq5D-VAS score was 80.The most common issues were cold intolerance and stiffness. Results show no significant correlation between injury severity and DASH (rs=0.1), although a significant correlation between SOC and DASH (rs=0,43) was found.
Interpretation / Conclusion: Functioning and quality of life are slightly affected 1-4 years post-injury, with cold intolerance and stiffness being common issues. SOC and DASH show significant correlation.
Pernille Melbye1,3, That Minh Pham1,3, Niels-Peter Brøchner Nygaard4, Carsten Hanshelge Kock-Jensen4, Per Hviid Gundtoft1,2, Bjarke Viberg1,3
1) Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding- University Hospital of Southern Denmark 2) Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital 3) Department of Orthopaedic Surgery and Traumatology, Odense University Hospital 4) CRPS center Region of South Denmark, Hospital of South West Jutland
Background: Distal radius fractures (DRF) are the most common fractures with a rising incidence due to the growing elderly population. One of the most severe complications to DRF is development of Complex Regional Pain Syndrome (CRPS). The incidence rate of CRPS following DRF varies widely in the literature, ranging from 1%-51%, usually with small sample sizes. The diagnostic criteria known as the The Budapest criteria, were established in 2004 and revised in 2007 to avoid overdiagnosis.
Aim: To report the incidence rate of CRPS in patients diagnosed with DRF and assess development of CRPS based on age, sex, choice of treatment, and time period.
Materials and Methods: Data was extracted from the Danish National Patient Register on patients above 18 years diagnosed with a DRF (S525) in the period 1997-2018. The primary outcome was incidence rate of CRPS diagnosis (M890, G564, T796B). Secondary outcomes were CRPS incidence rates divided by age (5-year groups), sex, treatment (surgery or no surgery within 21 days) and time.
Results: There were 276,145 DRF in that period with a median age of 64 (interquartile range 51- 71) and 75% were females. The total incidence rate of CRPS was 0.23% during the 22 years. The time to diagnosis was median 82 days (interquartile range 53-291 days). The incidence rate ranged from 0.04% to 0.51% with the 30-65 year olds having a significantly higher percentage that the average (p=0.000). There was a slight difference between men (0.19%) and women (0.25%) (p=0.002). There was a slightly higher percentage in the surgical treated group (0.33%) in comparison to the non-surgical group (0.21%) (p=0.000). There was a slight decrease in incidence rate after introduction of the Budapest criteria from 0.28% to 0.21% (p=0.000).
Interpretation / Conclusion: There was a low incidence rate of CRPS diagnosis after DRF treatment. However, there may a significant underreporting from undiagnosed patients but the incidence rate is definitely not high.
1) Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding- University Hospital of Southern Denmark 2) Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital 3) Department of Orthopaedic Surgery and Traumatology, Odense University Hospital 4) CRPS center Region of South Denmark, Hospital of South West Jutland
Background: Distal radius fractures (DRF) are the most common fractures with a rising incidence due to the growing elderly population. One of the most severe complications to DRF is development of Complex Regional Pain Syndrome (CRPS). The incidence rate of CRPS following DRF varies widely in the literature, ranging from 1%-51%, usually with small sample sizes. The diagnostic criteria known as the The Budapest criteria, were established in 2004 and revised in 2007 to avoid overdiagnosis.
Aim: To report the incidence rate of CRPS in patients diagnosed with DRF and assess development of CRPS based on age, sex, choice of treatment, and time period.
Materials and Methods: Data was extracted from the Danish National Patient Register on patients above 18 years diagnosed with a DRF (S525) in the period 1997-2018. The primary outcome was incidence rate of CRPS diagnosis (M890, G564, T796B). Secondary outcomes were CRPS incidence rates divided by age (5-year groups), sex, treatment (surgery or no surgery within 21 days) and time.
Results: There were 276,145 DRF in that period with a median age of 64 (interquartile range 51- 71) and 75% were females. The total incidence rate of CRPS was 0.23% during the 22 years. The time to diagnosis was median 82 days (interquartile range 53-291 days). The incidence rate ranged from 0.04% to 0.51% with the 30-65 year olds having a significantly higher percentage that the average (p=0.000). There was a slight difference between men (0.19%) and women (0.25%) (p=0.002). There was a slightly higher percentage in the surgical treated group (0.33%) in comparison to the non-surgical group (0.21%) (p=0.000). There was a slight decrease in incidence rate after introduction of the Budapest criteria from 0.28% to 0.21% (p=0.000).
Interpretation / Conclusion: There was a low incidence rate of CRPS diagnosis after DRF treatment. However, there may a significant underreporting from undiagnosed patients but the incidence rate is definitely not high.
Hans Christian Rasmussen1,2, Maya Bang1,2, Johanne Gade Lilleøre1,2, Kipp Olsen Josephine1,2, Lars Lindgren1,3, Annemarie Brüel4, Mats Bue1,2, Mads Kristian Duborg Mikkelsen1,2, Jesper Skovhus Thomsen4, Maiken Stilling1,2
1. Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; 3. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark; 4. Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Background: Several wrist immobilisation techniques and materials exist; however, documentation of their actual wrist stabilising effect and mechanical properties is warranted to support evidence- based recommendations in clinical practice.
Aim: This study aimed to assess the wrist stabilising properties of volar and dorsal short-arm splints made from four different materials and to evaluate their mechanical properties.
Materials and Methods: Dorsal and volar short arm splints made of plaster of Paris (8 layers), Woodcast (2 mm, rigid vented), X-lite (classic, 2 layers), or a 3D-printed material (polypropylene) were sequentially applied to ten cadaveric arm specimens and fixed in a radiolucent fixture. The maximum wrist flexion and extension relative to the neutral wrist position under an orthogonal load of 42 N was evaluated using radiographic imaging. In addition, a three-point bending test was performed on ten sheet duplicates of each splinting material.
Results: Plaster of Paris demonstrated better wrist stabilising properties when applied as a volar short arm splint, followed sequentially by Woodcast, X-lite, and 3D-printed polypropylene. However, when applied as a dorsal splint, Woodcast exhibited lower wrist flexion and similar wrist extension compared to plaster of Paris. The dorsal splints exhibited a mean wrist flexion of = 27° (95%CI: 23°–30°) compared to = 25° (95%CI: 22°–29°) for the volar splints. The mean wrist extension for the dorsal splints was = 13° (95%CI: 10°–17°) compared to = 22° (95%CI: 19°– 26°) for the volar splints. The mechanical properties of the Woodcast, X-lite, and 3D-printed splinting materials were surprisingly similar. Plaster of Paris exhibited a distinct stiffness of 146 (95%CI: 120–173) N/mm and a deflection at Fmax of 0.6 (95%CI: 0.5–0.7) mm compared to = 7.7 (95%CI: 7.4–7.9) N/mm and = 20 (95%CI: 18–22) mm for the other materials.
Interpretation / Conclusion: Irrespective of the splinting material, the dorsal splints showed better resistance to wrist extension, while the volar splints exhibited better resistance to wrist flexion. Plaster of Paris displayed better wrist stabilising properties and material stiffness than Woodcast, X-lite and 3D- printed polypropylene.
1. Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus N, Denmark; 2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; 3. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark; 4. Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Background: Several wrist immobilisation techniques and materials exist; however, documentation of their actual wrist stabilising effect and mechanical properties is warranted to support evidence- based recommendations in clinical practice.
Aim: This study aimed to assess the wrist stabilising properties of volar and dorsal short-arm splints made from four different materials and to evaluate their mechanical properties.
Materials and Methods: Dorsal and volar short arm splints made of plaster of Paris (8 layers), Woodcast (2 mm, rigid vented), X-lite (classic, 2 layers), or a 3D-printed material (polypropylene) were sequentially applied to ten cadaveric arm specimens and fixed in a radiolucent fixture. The maximum wrist flexion and extension relative to the neutral wrist position under an orthogonal load of 42 N was evaluated using radiographic imaging. In addition, a three-point bending test was performed on ten sheet duplicates of each splinting material.
Results: Plaster of Paris demonstrated better wrist stabilising properties when applied as a volar short arm splint, followed sequentially by Woodcast, X-lite, and 3D-printed polypropylene. However, when applied as a dorsal splint, Woodcast exhibited lower wrist flexion and similar wrist extension compared to plaster of Paris. The dorsal splints exhibited a mean wrist flexion of = 27° (95%CI: 23°–30°) compared to = 25° (95%CI: 22°–29°) for the volar splints. The mean wrist extension for the dorsal splints was = 13° (95%CI: 10°–17°) compared to = 22° (95%CI: 19°– 26°) for the volar splints. The mechanical properties of the Woodcast, X-lite, and 3D-printed splinting materials were surprisingly similar. Plaster of Paris exhibited a distinct stiffness of 146 (95%CI: 120–173) N/mm and a deflection at Fmax of 0.6 (95%CI: 0.5–0.7) mm compared to = 7.7 (95%CI: 7.4–7.9) N/mm and = 20 (95%CI: 18–22) mm for the other materials.
Interpretation / Conclusion: Irrespective of the splinting material, the dorsal splints showed better resistance to wrist extension, while the volar splints exhibited better resistance to wrist flexion. Plaster of Paris displayed better wrist stabilising properties and material stiffness than Woodcast, X-lite and 3D- printed polypropylene.
Louise Marie Nøhr1, Ane simony1,2, Charlotte Abrahamsen1,2
1. Department of Orthopedic Surgery, Kolding, Hospital Lillebelt 2. Institute for regional Health Services, University of Southern denmark
Background: Shared decision making (SDM) was introduced in hospital Lillebelt in 2019 and research reports that patients are more satisfied with their treatment, if they play an active role in choosing treatment. A Decision-Helper was constructed and introduced in the treatment for Colles fractures, and this was the first Decision-Helper introduced to patients choose treatment for an acute illness.
Aim: This study aimed to understand how patients experience shared decision-making (SDM) for an acute illness, and how it affects them when making decisions about the treatment of their distal radius fracture.
Materials and Methods: An exploratory, qualitative study design was performed to understand the patient's experience, during the choice of treatment with SDM. Twelve patients were recruited when they came to their first follow-up 5 days after the injury, in the outpatient clinic. Of them, ten were interviewed; three face to face and seven by telephone. All were women aged 57-87 years and all had a displaced Colles fracture, which had been reduced in the Emergency Room.
Results: When analyzing the interviews three themes emerged: 1) Acute situation. Patients was positive towards SDM, but found it demanding to participate in. Patients was still in crisis, 5 days after suffering from a fracture. Patients were unable to remember the information given in the ER, regarding the use of the Decision helper. Few had prepared themselves for the consult in the outpatient clinic. 2) Influence on treatment choice. It was unclear to the majority of patients, that cast or surgery, resulted in similar clinical outcomes. 3) The treatment decision was based on personal factors, more than the information received during the consult.
Interpretation / Conclusion: Patients primarily want to be included in the treatment decision. It is important to highlight that booth treatments are equal in clinical outcome, before introducing the Decision- Helper. The doctor´s demeanor is of great importance to the patient's experience. Introducing SDM in the clinical setting requires training and repeated observations, to succeed.
1. Department of Orthopedic Surgery, Kolding, Hospital Lillebelt 2. Institute for regional Health Services, University of Southern denmark
Background: Shared decision making (SDM) was introduced in hospital Lillebelt in 2019 and research reports that patients are more satisfied with their treatment, if they play an active role in choosing treatment. A Decision-Helper was constructed and introduced in the treatment for Colles fractures, and this was the first Decision-Helper introduced to patients choose treatment for an acute illness.
Aim: This study aimed to understand how patients experience shared decision-making (SDM) for an acute illness, and how it affects them when making decisions about the treatment of their distal radius fracture.
Materials and Methods: An exploratory, qualitative study design was performed to understand the patient's experience, during the choice of treatment with SDM. Twelve patients were recruited when they came to their first follow-up 5 days after the injury, in the outpatient clinic. Of them, ten were interviewed; three face to face and seven by telephone. All were women aged 57-87 years and all had a displaced Colles fracture, which had been reduced in the Emergency Room.
Results: When analyzing the interviews three themes emerged: 1) Acute situation. Patients was positive towards SDM, but found it demanding to participate in. Patients was still in crisis, 5 days after suffering from a fracture. Patients were unable to remember the information given in the ER, regarding the use of the Decision helper. Few had prepared themselves for the consult in the outpatient clinic. 2) Influence on treatment choice. It was unclear to the majority of patients, that cast or surgery, resulted in similar clinical outcomes. 3) The treatment decision was based on personal factors, more than the information received during the consult.
Interpretation / Conclusion: Patients primarily want to be included in the treatment decision. It is important to highlight that booth treatments are equal in clinical outcome, before introducing the Decision- Helper. The doctor´s demeanor is of great importance to the patient's experience. Introducing SDM in the clinical setting requires training and repeated observations, to succeed.
Jessica Duggan1, Aron Lechtig2, Ian Watkins2, Jonathan Lans2, Arvind von Keudell3, Dafang Zhang3
1. Harvard Medical School, Boston, MA 2. Harvard Combined Orthopaedic Residency Program, Boston, MA 3. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
Background: Peripheral intravenous (PIV) infiltration and extravasation are common complications of IV fluid administration. They commonly result in mild symptoms, but the risk of serious injury should not be overlooked.
Aim: Here, we aim to investigate risk factors associated with major adverse events following PIV infiltration, which may help risk stratify those who require early surgical consultation.
Materials and Methods: Retrospectively, patients were identified who had a documented PIV infiltration or extravasation event at three academic hospitals between 2015 and 2022. Surgical consultation notes were obtained through medial record review. A major adverse advent was defined as a full-thickness injury requiring operative management (deep infection, compartment syndrome). A minor adverse event was defined as superficial injury (cellulitis, superficial thrombosis).
Results: 160 patients with PIV infiltration events were included (37.5% male), with an average age of 64.1 years. A surgical consult for a hand specialist was placed 35% of the time: orthopaedic surgery in 46.4% of cases and plastic surgery in 42.9%. Among these consults, 87.5% recommended supportive treatment (elevation, warm/cold compresses, serial exams). Major adverse events occurred in 4.4% (n=7) of patients, and minor adverse events occurred in 11.3% (n=18). Both ICU admission and current intubation status (i.e., intubated, sedated, and non-examinable) at the time of infiltration were significantly associated with adverse events (p=0.02, p=0.03, respectively). Current intubation status was significantly associated with operative management (p=0.001). The type of infiltrate (vesicant vs. non-vesicant) was not associated with adverse events or the need for surgery.
Interpretation / Conclusion: Robust characterization of PIV infiltration events may facilitate early identification of patients at risk of serious complications while also reducing the volume of surgical hand consultations. We found ICU admission and current intubation both to be associated with adverse events following PIV infiltration. Further work should be done to evaluate the risk of infiltration with different fluid types (vesicant, non-vesicant).
1. Harvard Medical School, Boston, MA 2. Harvard Combined Orthopaedic Residency Program, Boston, MA 3. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
Background: Peripheral intravenous (PIV) infiltration and extravasation are common complications of IV fluid administration. They commonly result in mild symptoms, but the risk of serious injury should not be overlooked.
Aim: Here, we aim to investigate risk factors associated with major adverse events following PIV infiltration, which may help risk stratify those who require early surgical consultation.
Materials and Methods: Retrospectively, patients were identified who had a documented PIV infiltration or extravasation event at three academic hospitals between 2015 and 2022. Surgical consultation notes were obtained through medial record review. A major adverse advent was defined as a full-thickness injury requiring operative management (deep infection, compartment syndrome). A minor adverse event was defined as superficial injury (cellulitis, superficial thrombosis).
Results: 160 patients with PIV infiltration events were included (37.5% male), with an average age of 64.1 years. A surgical consult for a hand specialist was placed 35% of the time: orthopaedic surgery in 46.4% of cases and plastic surgery in 42.9%. Among these consults, 87.5% recommended supportive treatment (elevation, warm/cold compresses, serial exams). Major adverse events occurred in 4.4% (n=7) of patients, and minor adverse events occurred in 11.3% (n=18). Both ICU admission and current intubation status (i.e., intubated, sedated, and non-examinable) at the time of infiltration were significantly associated with adverse events (p=0.02, p=0.03, respectively). Current intubation status was significantly associated with operative management (p=0.001). The type of infiltrate (vesicant vs. non-vesicant) was not associated with adverse events or the need for surgery.
Interpretation / Conclusion: Robust characterization of PIV infiltration events may facilitate early identification of patients at risk of serious complications while also reducing the volume of surgical hand consultations. We found ICU admission and current intubation both to be associated with adverse events following PIV infiltration. Further work should be done to evaluate the risk of infiltration with different fluid types (vesicant, non-vesicant).