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J Hand Surg Am. 2007 Jan;32(1):91-5.

Impairment and disability after severe hand injuries with multiple phalangeal fractures.

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Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.



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.


The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores.


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.


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.

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