Enchondromas are benign bone tumours originating from cartilages. It is mainly discovered incidentally in radiographs or due to symptoms like pathological fracture or pain. Conservative treatment through regular check-up and surgical excision using curettage are the two major treatment methods for enchondromas. This review concludes that small localized asymptomatic lesions can be treated conservatively while most expanding or symptomatic lesions should be treated with simple curettage. Adjuvant treatments like high-speed burring or alcohol instillation are not recommended.
In multi-strand suture methods consisting of several suture rows, the different length of core suture purchase between each suture row may affect the strength of repairs. We evaluated the influence of the different length of core suture purchase between each suture row on the strength of 6-strand tendon repairs. Rabbit flexor tendons were repaired by using a triple-looped suture technique in which the suture purchase length in each suture row was modified. Group 1, all lengths are 8-mm. Group 2, all lengths are 10-mm. Group 3, two are 10-mm and one is 8-mm. Group 4, one is 10-mm and two are 8-mm. The repaired tendons were subjected to load-to-failure test. The gap strength was significantly greater in Group 1 and Group 2 than in Group 3 and Group 4. This study demonstrates that maintaining equal core suture purchase lengths of each suture row increases the gap resistance.
The literature on Dupuytren's contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren's contracture and perform a citation analysis. Utilizing the Web of Science, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren's contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence. The 50 most cited articles represent many important landmarks in Dupuytren's treatment and contain several seminal works by experts in the field. Whilst the top 50 list highlights the important papers on the condition, they certainly do not provide information about the quality of the evidence of the research, as most papers presented level 4 or 5 evidence.
Background: Flaps have been used in upper limb surgery for varied indications including coverage of soft tissue defects, interposition and to provide a pliable bed for gliding structures among others.Methods: We report our use of the radial artery perforator based adipofascial flap in nine patients, five with rigid radioulnar synostosis, three with recalcitrant carpal tunnel syndrome and one with a soft tissue defect.Results: All our patients with radioulnar synostosis regained good functional rotations of the forearm with no recurrence at follow up. The patients with recalcitrant carpal tunnel also had resolution of symptoms with no recurrence. The flap healed well in all the patients.Conclusions: We propose this flap as a viable, versatile reconstructive option for the hand and upper limb.
INTRODUCTION:Replantation surgery is an established treatment for amputated digits, and published literature report a high success rate. However, a proportion of replantations do encounter postoperative problems with vascularity, but the incidence is unknown. Although there are studies that look at the factors affecting the success of replantations and the management of postoperative replantations, there is little literature available on this transitional period. We introduce the term "troubled replantation" to describe the replantation that manifests any form of vascular insufficiency after replantation surgery. Our study focuses on reviewing our centre's experience with the management and outcomes of troubled replantations.MATERIALS AND METHODS:Data was collected retrospectively from 389 digital replantations performed in our centre over an 11 year period. We included only single level digital replantations. We analysed the perioperative data, and the measures taken postoperatively to promote their survival.RESULTS:There were a total of 137 troubled digits (35.2%). 53 digits responded to non-surgical measures such as dressing change and bedside bleeding procedures. 27 digits required re-exploration surgery, of which 16 survived. The majority of troubled replantations were due to arterial causes, and manifested signs within the first 48 h. 69 troubled digits (51%) survived. The remainder did not respond to any form of treatment including re-explorations and ultimately failed.CONCLUSION:One third of all replantations are troubled replantations, and half of these eventually fail despite any intervention. As troubled replantations can lead to postoperative failure, it is important to understand this clinical scenario in order to improve immediate postoperative care.
Scaphoid non-union, particularly following internal fixation, is a vexing problem. A retrospective review was conducted analysing the outcome of 4 patients who failed initial open reduction and internal fixation of scaphoid fractures. Three fractures were located in the waist and the fourth in the proximal pole. All patients underwent screw exchange and Bone Morphogenic Protein (BMP)-2 sponge placement with no additional bone grafting. Patients were immobilised for 4 weeks and followed with serial radiographs in all cases and CT scans in 3 cases. All patients demonstrated evidence of bony union at an average of 53 days from surgery and ultimately returned to pain-free full activity. There were no complications. BMP-2 and screw exchange yielded a 100% union rate in patients with established scaphoid non-union. While this retrospective study represents a small number of patients and clearly requires further investigation, it presents a promising technique for managing a difficult clinical problem.
OBJECTIVESTo prospectively evaluate patient related outcome measures after total wrist arthroplasty (TWA) using four different total wrist implants operated at a single referral center in Sweden.METHODS206 primary TWAs were assessed preoperatively and after one year postoperatively with respect to the following eight outcome measures: Range of motion (flexion/extension, radial/ulnar deviation, pronation/supination), hand grip strength, Canadian Occupational Performance Measure (COPM), performance and satisfaction, Visual Analog Scale (VAS) pain scores at rest and in activity.RESULTSThe Maestro TWA had a significantly greater improvement of radial/ulnar deviation than the Biax and Remotion TWAs. COPM performance and satisfaction improved more for the Maestro and Universal 2 prostheses than the Biax and Remotion.CONCLUSIONSAll four TWAs offer reduced VAS-scores and improved COPM-scores with preserved hand grip strength and somewhat improved range of motion. The Maestro TWA performed favorably compared to the Remotion TWA. Implant design may affect patient related outcome.
A total of 16 fingers of 16 patients were subjected to fingertip reconstruction using the reverse digital artery island flap (RDAIF). We evaluated the influences of postoperative flap congestion, initial harvested flap size, patient's age and smoking habit on postoperative final flap size and postoperative range of total active motion (TAM) in affected fingers at a mean interval of 11.4 months. In the results, final flap size and TAM showed a tendency to decrease with increase in the initial harvested flap size and age. Eventually, the final flap size moved towards the size of the fingertip defect. Factors of flap congestion and smoking habit had little influence on the change in flap size and TAM. In conclusion, wide harvested flaps showed significant postoperative reduction in size compared with the small flaps, and extensive skin defect after flap harvest caused a decrease in postoperative TAM. Thus, the size of the harvested RDAIF should be comparable to that of the fingertip defect to prevent postoperative decrease in range of motion in affected fingers, and indication of this flap to the elderly needs to be considered.
Hand SurgeryVol. 20, No. 01, pp. 197-198 (2015) LETTER TO THE EDITORNo AccessIMPROVED COMMUNICATION OF COMPLICATIONS DURING THE CONSENT PROCESS IN HAND SURGERYR. J. Lambert and H. J. C. R. BelcherR. J. LambertDepartment of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UKCorrespondence to: Dr. R. J. Lambert, Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, Sussex, RH19 3DZ, UK. Tel: (+44) 771-334-8420. and H. J. C. R. BelcherDepartment of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UKhttps://doi.org/10.1142/S0218810415200014Cited by:0 PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail References I. H. Khan and G. Giddins, J. Hand. Surg. Eur. 35(1), 61 (2010). Crossref, ISI, Google ScholarG. Wortz, J. Med. Pract. Manage. 26(4), 203 (2011). Medline, Google Scholar A. M. Chen et al. , Ann. R. Coll. Surg. Engl. 88 , 482 ( 2006 ) . Crossref, Medline, ISI, Google ScholarA. Atreyet al., J. Bone. Joint. Surg. Br. 90(4), 422 (2008). Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Recommended Vol. 20, No. 01 Metrics History Received 15 August 2014 Accepted 20 August 2014 Published: 20 January 2015 PDF download
Irreducible volar subluxation should be considered when assessing a patient with flexion deformity of the proximal interphalangeal finger joint (PIPJ). Primary assessment requires careful examination of the collateral ligaments and extensor tendon. Preoperative imaging such as ultrasound and MRI can help identify the interposed structures and plan the subsequent operation. Although rare, irreducible volar subluxation due to radial collateral ligament interposition is an important entity to be aware of. Prompt and appropriate management can prevent joint stiffness and loss of function.
We aimed to validate a cross-culturally adapted version of the Persian Michigan Hand Outcomes Questionnaire (MHOQ). We followed the Beaton's guideline to translate the questionnaire to Persian. We administered the final version to 223 patients among which 79 patients returned 3 days later to respond to the Persian MHOQ for the second time. In the first visit, respondents also filled the Disabilities of the Arm Shoulder and Hand (DASH) and rated the pain based on the Visual Analogue Scale (VAS). Cronbach's alpha for the total MHOQ was 0.79 which showed good internal consistency. Intraclass correlation coefficient (ICC) for the total MHOQ was 0.84 which demonstrated good reliability between test and retest. The absolute correlation coefficient between total MHOQ and the DASH was as high as 0.74. Persian version of the MHOQ proved to be a reliable and valid instrument to be implemented among Persian population with the hand and wrist disorders.
Background: In Thailand, brachial plexus injury is a common traumatic injury that affects the function of the upper extremity. The current treatments focus mainly on improving the motor and sensory function. Apart from the motor and sensory deficit, these patients usually suffer from pain. Objective: The purpose of this study was to determine the prevalence and factors that relate to neuropathic pain in patients with brachial plexus injury. Methods: We collected data from March 2008 to July 2011. The DN4 Questionnaire was used to diagnose neuropathic pain in 95 patients. Results: The prevalence of neuropathic pain was as high as 76%. Majority of patients presented with hypoesthesia to pin prick, hypoesthesia to touch and numbness. Severity of neuropathic pain was significantly correlated with the type of brachial plexus injury. There was no difference between demographic characteristics of patients. Conclusion: Our study showed that the prevalence of neuropathic pain was high in brachial plexus injured patients. Therefore, surgeons should be aware of this common, yet underestimated, problem in brachial plexus injured patients.
The purpose of our study is to retrospectively compare the use of tension band (TB) wiring and dorsal plating (DP) for the fixation of fifth metacarpal (MC) neck fractures. A retrospective study of patients who had surgical treatment of 5th MC fractures from 2009 to 2013 was performed. Data including patient demographics, mechanism of injury, pre and postoperative pain score, range of motion (ROM), duration of follow-up and whether implants were removed were documented. Three radiological parameters: angulation (in degrees), radial-ulnar displacement (in millimetres) and MC height ratio were measured. There were a total of 84 patients with isolated closed 5th MC neck fractures, of which 41 underwent DP and 43 underwent TB. Patients who underwent DP demonstrated better improvement in fracture angulation, radial-ulnar displacement, MC height ratio and final ROM compared to those who underwent TB. This study has shown that DP is a viable surgical treatment option for 5th MC neck fractures.
Mycobacterial infections of the hand are extremely rare, with Mycobacterium chelonae being an especially uncommon source of infection. The following is a report of such an infection presenting as a collar-button abscess. The difficulty of isolating the organism, in addition to a low index of suspicion for it, resulted in a significant delay in appropriate treatment. The patient demonstrated an indolent course of infection and unresponsiveness to traditional treatments, both red flags that should raise concern for a mycobacterial cause. Eventually, repeated irrigation and debridement and a prolonged course of antibiotics resulted in the resolution of the patient's symptoms.
A complete brachioradialis tendon rupture, as an isolated incident, is extremely rare. Consequently, there is little to no literature on how this can occur and how to treat it. We present the case of a 44-year-old male with a complete, closed brachioradialis tendon rupture following a waterskiing accident. The clinical, imagining and operative findings are outlined alongside management and final outcomes. Our case highlights the effectiveness of a combined surgical and staged physiotherapy approach, for the management of a complete, closed brachioradialis tendon rupture, in an otherwise healthy man.
The English version of Hand20 questionnaire was translated into Greek and cultural adaptation was performed. The validity was assessed in 134 patients with a variety of upper limb disorders. A comparison of Hand20 and DASH was also performed. All patients completed EQ-5D, Hand20 and DASH questionnaire. Test-retest reliability was assessed in a subgroup of 37 patients. We assessed the convergent validity of Hand20 by correlating its scores to DASH and EQ-5D scores. We also compared the completeness of Hand20 and DASH. We found no statistically significant differences in Hand20 scores between the 1st and 2nd measurements as well as a strong correlation between Hand20 and the other two questionnaires. There were also better rates of response and fewer missing data even in elderly individuals.
Brachial plexus injuries (BPI) can be complicated by diaphragmatic paralysis (DP). This study determined the influence of DP on biceps brachii (BB) recovery after intercostal nerve transfer (ICNT) for BPI and investigated the respiratory complications of ICNT. The study included 100 patients, 84 showing no DP in preoperative and early postoperative chest radiographic images (non-DP group) and 16 with DP that persisted for over one year after surgery (DP group). The postoperative reinnervation time did not differ between groups. BB strength one year after surgery was lower in the DP group than non-DP group (p = 0: 0007). No differences were observed 2- 3 years after surgery. In the DP group, four patients had respiratory symptoms that affected daily activities and their outcomes deteriorated (p = 0: 04). Phrenic nerve transfer should not be combined with ICNT in patients with poor respiratory function because of the high incidence of respiratory complications.
PURPOSEThis study assesses the influence of A2 pulley integrity on the strength of the repair.METHODPart 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only.RESULTSNo difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out.DISCUSSIONThis study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°.CLINICAL RELEVANCEThe findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.
To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.
