{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:49:03Z","timestamp":1792144143328,"version":"4.4.0"},"reference-count":25,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPHS"],"abstract":"<jats:p>Objective: To investigate the association between preoperative glycated hemoglobin (HbA1c) and upper limb function (Disabilities of the Arm, Shoulder and Hand [DASH] score) at 6 months post-surgery in patients with fracture-related infection (FRI) after upper limb trauma, and to test the mediating role of rehabilitation initiation time.\nMethods: This retrospective cohort study included 100 patients with FRIs after upper limb trauma surgery (September 2020 to August 2025). Demographic characteristics, fracture features, HbA1c levels, time to initiate rehabilitation, and debridement frequency of patients were collected. With the DASH score at 6 months after surgery as the outcome variable, multiple linear regression was used to analyze the association between HbA1c and functional prognosis, and the Bootstrap method was used to test the mediating effect of rehabilitation initiation time.\nResults: HbA1c was significantly positively correlated with the DASH score (\u03b2 = 6.90, 95% CI 3.91\u20139.89, p &lt; 0.001). Recovery initiation time played a partial mediating role between the HbA1c and the DASH scores, with a mediating ratio of 27% (indirect effect 2.04, 95% CI 0.63\u20133.59, p = 0.004). There was no significant interaction between HbA1c and recovery initiation time or debridement frequency (p &gt; 0.05). Thresholding effect analysis did not find a definite breakpoint (log-likelihood ratio test p = 0.220), and HbA1c was linearly related to the DASH score.\nConclusion: Preoperative HbA1c is independently associated with 6-month upper limb function in patients with post-traumatic infection, with rehabilitation initiation time playing a partial mediating role. Clinicians should prioritize glycemic control and initiate rehabilitation as early as safely possible.<\/jats:p>","DOI":"10.2340\/jphs.v61.46666","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:27:56Z","timestamp":1792142876000},"page":"249-256","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between functional prognosis in patients with infection after upper limb trauma: a predictive model based on HbA1c stratification and the mediating role of delayed rehabilitation"],"prefix":"10.2340","volume":"61","author":[{"given":"Sheng","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YiFei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinTao","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HongLei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BiYun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"171315","doi-asserted-by":"crossref","unstructured":"Rupp M, Walter N, Bartl S, et al. Fracture-related infection-epidemiology, etiology, diagnosis, prevention, and treatment. Dtsch Arztebl Int. 2024;121(1):17\u201324.","DOI":"10.3238\/arztebl.m2023.0233"},{"key":"171316","doi-asserted-by":"crossref","unstructured":"Walter N, Rupp M, Hierl K, et al. Long-term patient-related quality of life after fracture-related infections of the long bones. Bone Joint Res. 2021;10(5):321\u2013327.","DOI":"10.1302\/2046-3758.105.BJR-2020-0532"},{"key":"171317","doi-asserted-by":"crossref","unstructured":"Yeager MT, Gross EG, Rutz RW, et al. Developing a risk score for predicting multiple revision surgeries in patients with fracture-\u00adrelated infections. J Am Acad Orthop Surg. 2025;33(19):e1151\u2013e1159.","DOI":"10.5435\/JAAOS-D-24-00494"},{"key":"171318","doi-asserted-by":"crossref","unstructured":"Khan U, Crespi Z, Nham F, et al. Diabetes optimization in total joint arthroplasty: perioperative markers, pharmacologic strategies, and wound care best practices. J Am Acad Orthop Surg Glob Res Rev. 2026;10(2):e25.00214.","DOI":"10.5435\/JAAOSGlobal-D-25-00214"},{"key":"171319","doi-asserted-by":"crossref","unstructured":"Liang J, Liang Q, Wang X, et al. Perioperative glycemic control reduces the risk of retear in diabetic patients following arthroscopic rotator cuff repair: a meta-analysis. J Orthop Sci. 2025;30(1):78\u201384.","DOI":"10.1016\/j.jos.2024.01.003"},{"key":"171320","doi-asserted-by":"crossref","unstructured":"Di Luzio R, Dusi R, Mazzotti A, et al. Stress hyperglycemia and complications following traumatic injuries in individuals with\/without diabetes: the case of orthopedic surgery. Diabetes Metab Syndr Obes. 2020;13:9\u201317.","DOI":"10.2147\/DMSO.S225796"},{"key":"171321","doi-asserted-by":"crossref","unstructured":"Greene ST, McGee TL, Kot TC, et al. Hemoglobin A1c as a predictor of surgical site infection in patients with orthopaedic trauma. J Am Acad Orthop Surg Glob Res Rev. 2023;7(11):e23.00204.","DOI":"10.5435\/JAAOSGlobal-D-23-00204"},{"key":"171322","doi-asserted-by":"crossref","unstructured":"Li F, Han JF, Zhang QQ, et al. Effectiveness and safety of early rehabilitation in the prevention of postoperative complications after craniotomy: a systematic review and meta-analysis. Neurosurg Rev. 2026;49(1):119.","DOI":"10.1007\/s10143-025-04034-7"},{"key":"171323","doi-asserted-by":"crossref","unstructured":"Yassin M, Sharma V, Butt F, et al. Early peri-prosthetic joint infection after hemiarthroplasty for hip fracture: outcomes of debridement, antibiotics, and implant retention. Surg Infect (Larchmt). 2020;21(10):834\u2013839.","DOI":"10.1089\/sur.2019.295"},{"key":"171324","doi-asserted-by":"crossref","unstructured":"Roy S, Patra D, Ramprasad P, et al. Hyperglycemia-induced P300\/CBP acetyltransferase drives ZEB2-mediated proinflammatory macrophages and delays wound healing. JCI Insight. 2026;11(5):e192146.","DOI":"10.1172\/jci.insight.192146"},{"key":"171325","doi-asserted-by":"crossref","unstructured":"Lopez LF, Reaven PD, Harman SM. Review: the relationship of hemoglobin A1c to postoperative surgical risk with an emphasis on joint replacement surgery. J Diabetes Complications. 2017;31(12):1710\u20131718.","DOI":"10.1016\/j.jdiacomp.2017.08.016"},{"key":"171326","doi-asserted-by":"crossref","unstructured":"Arya S, Binney ZO, Khakharia A, et al. High hemoglobin A(1c) associated with increased adverse limb events in peripheral arterial disease patients undergoing revascularization. J Vasc Surg. 2018;67(1):217\u2013228.e1.","DOI":"10.1016\/j.jvs.2017.06.101"},{"key":"171327","doi-asserted-by":"crossref","unstructured":"Chen D, Liu S, Liu P, et al. Effect of elevated blood glucose on postoperative complications among diabetic patients after surgical treatment of torsional ankle fracture. Foot Ankle Int. 2024;45(8):839\u2013844.","DOI":"10.1177\/10711007241250005"},{"key":"171328","doi-asserted-by":"crossref","unstructured":"Burner T, Gohr C, Mitton-Fitzgerald E, et al. Hyperglycemia reduces proteoglycan levels in tendons. Connect Tissue Res. 2012;53(6):535\u2013541.","DOI":"10.3109\/03008207.2012.710670"},{"key":"171329","doi-asserted-by":"crossref","unstructured":"Lee JM, Veres SP. Advanced glycation end-product cross-\u00adlinking inhibits biomechanical plasticity and characteristic failure morphology of native tendon. J Appl Physiol (1985). 2019;126(4):832\u2013841.","DOI":"10.1152\/japplphysiol.00430.2018"},{"key":"171330","doi-asserted-by":"crossref","unstructured":"Fessel G, Li Y, Diederich V, et al. Advanced glycation end-\u00adproducts reduce collagen molecular sliding to affect collagen fibril damage mechanisms but not stiffness. PLoS One. 2014;9(11):e110948.","DOI":"10.1371\/journal.pone.0110948"},{"key":"171331","doi-asserted-by":"crossref","unstructured":"Vaidya R, Lake SP, Zellers JA. Effect of diabetes on tendon structure and function: not limited to collagen crosslinking. J Diabetes Sci Technol. 2023;17(1):89\u201398.","DOI":"10.1177\/19322968221100842"},{"key":"171332","doi-asserted-by":"crossref","unstructured":"Tang Y, Kang L, Guo M, et al. Intertrochanteric fracture surgery patients with diabetes mellitus are prone to suffer perioperative neurological and endocrine\/metabolic complications: a propensity-score matched analysis. Ther Clin Risk Manag. 2022;18:775\u2013783.","DOI":"10.2147\/TCRM.S366846"},{"key":"171333","doi-asserted-by":"crossref","unstructured":"Alsheikh KA, Alrehaili HH, Alsabr AA, et al. Outcomes of surgical management of ankle fractures in patients with diabetes. J Taibah Univ Med Sci. 2024;19(4):800\u2013805.","DOI":"10.1016\/j.jtumed.2024.07.003"},{"key":"171334","doi-asserted-by":"crossref","unstructured":"Na A, Oppermann LM, Jupiter DC, et al. Diabetes mellitus blunts the symptoms, physical function, and health-related quality of life benefits of total knee arthroplasty: a systematic review with meta-analysis of data from more than 17 000 patients. J Orthop Sports Phys Ther. 2021;51(6):269\u2013280.","DOI":"10.2519\/jospt.2021.9515"},{"key":"171335","doi-asserted-by":"crossref","unstructured":"Nowotny B, Cavka M, Herder C, et al. Effects of acute psychological stress on glucose metabolism and subclinical inflammation in patients with post-traumatic stress disorder. Horm Metab Res. 2010;42(10):746\u2013753.","DOI":"10.1055\/s-0030-1261924"},{"key":"171336","doi-asserted-by":"crossref","unstructured":"Finger B, Brase J, He J, et al. Elevated hemoglobin A1c is associated with lower socioeconomic position and increased postoperative infections and longer hospital stay after cardiac surgical procedures. Ann Thorac Surg. 2017;103(1):145\u2013151.","DOI":"10.1016\/j.athoracsur.2016.05.092"},{"key":"171337","doi-asserted-by":"crossref","unstructured":"Godshaw BM, Ojard CA, Adams TM, et al. Preoperative glycemic control predicts perioperative serum glucose levels in patients undergoing total joint arthroplasty. J Arthroplasty. 2018;33(7S):S76\u2013S80.","DOI":"10.1016\/j.arth.2018.02.071"},{"key":"171338","doi-asserted-by":"crossref","unstructured":"Keller MM, Barnes R, Brandt C. Development of a clinical hand rehabilitation guideline for second to fifth metacarpal fracture rehabilitation: a Delphi method. Br J Occup Ther. 2024;87(7):414\u2013423.","DOI":"10.1177\/03080226241241990"},{"key":"171339","doi-asserted-by":"crossref","unstructured":"Yang Q, Yang H, Zhao J, et al. Enhanced recovery after surgery (ERAS) rehabilitation protocols significantly improve postoperative pain and recovery in ankle fracture surgery. Ther Clin Risk Manag. 2025;21:841\u2013850.","DOI":"10.2147\/TCRM.S517790"}],"container-title":["Journal of Plastic Surgery and Hand Surgery"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/46666\/55875","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/download\/46666\/55875","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:27:58Z","timestamp":1792142878000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/JPHS\/article\/view\/46666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":25,"URL":"https:\/\/doi.org\/10.2340\/jphs.v61.46666","relation":{},"ISSN":["2000-6764"],"issn-type":[{"value":"2000-6764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]}}}