Routine daily activities and pain intensity according to the results of the initial examination of patients with polystructural injuries of the upper extremities

Purpose. This article analyzes the structure of the total sample of patients with polystructural injuries of the upper extremities depending on the severity of injuries and the type of reconstructive interventions and evaluates the results of the initial examination according to the indicators of activity of daily life and intensity of pain syndrome with the determination of the most severe clinical group. Materials and methods. The study involved 56 patients with gunshot wounds of the upper extremities after reconstructive interventions. Patients were divided into groups according to the severity of the polystructural injury (I-IV grade). All study participants underwent an initial examination using the DASH questionnaire, the modified Frenchay scale (MFS), and the visual analogue pain scale (VAS). Mathematical statistical methods were used to analyze the structure of the total sample and identify the most severe clinical group. Results. The initial examination of 56 patients after gunshot wounds of the upper extremities in the post-acute period revealed the prevalence of grade IV severity (55%), in terms of distribution by segments, the most common injuries were in the shoulder-elbow segment (37%). Initial condition in the group as a whole (n=56): VAS=7 points, DASH=61.5, MFS=72.5 — pronounced pain syndrome and functional deficit. The Kruskal-Wallis test did not reveal significant differences between groups I, II, combined III-IV for pain, MFS and DASH before treatment (H=1.50; 3.57; 0.80; p>0.05). However, group II (nerve plastic surgery) tends to have the worst results: the highest pain (rank 31.04), the lowest MFS function (rank 26.31), the highest DASH disability (rank 31.38). Such results may be due to neuropathic pain, paresis and sensory deficits, which limit activity more than musculoskeletal defects in grade IV in the post-acute period. When comparing the performance of the four most difficult tasks of the modified Frenchay scale (MFS), statistically significant intergroup differences were found only in the task of “simulating cutting food” (H=6.96; p=0.031), where the worst results (the lowest mean rank 19.46) were recorded in group II (peripheral nerve plastic surgery). Conclusions. Despite the lack of statistical significance, grade II polystructural injury was functionally the most severe according to the visual analogue scale, MFS and DASH scales, and one statistically significant task of the MFS scale. This partially contradicts the expectations that grade IV (muscle/bone defects) would have the worst prognosis, and indicates the key role of the nerve defect (grade II) as a limiting factor in functional recovery.