August 2020

www.ifssh.info

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

VOLUME 10 | ISSUE 3 | NUMBER 39 | AUGUST 2020

SPECIAL FEATURES

DEFINING THUMB OPPOSITION

HAND THERAPY

SOMATOSENSORY REHABILITATION
OF NEUROPATHIC PAIN

Convenient Myths
RESEARCH ROUND-UP: “IS DUPUYTREN’SDISEASE REALLY A ‘DISEASE OF THE
VIKINGS’?”

SHARE SECTION: THE HISTORY OF HAND SURGERYAT THE UNIVERSITY HOSPITAL POLYCLINIC OF
MODENA, ITALY1

ADVERTISMENT

www.ifssh.info

August 2020

HAND SURGERY

4(Asian-Pacific Volume)

An International Journal Devoted to Hand and Upper Limb Surgery and Related Research
Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand

6

Find out more 
about this journal

8

Research Papers
Evolution of the Ring Concept for the Forearmand Its Implication on Treatment: From Galeazzi,
Monteggia, Essex-Lopresti, and Darrach to theCurrent Era
Kate Elzinga and Kevin Chung
Association between Functional Outcomes andRadiographic Reduction Following Surgery for
Distal Radius Fractures
Ronit Wollstein, Raviv Allon, Yoav Zvi,
Alan Katz, Sharon Werech and Orit Palmon
Long-Term Results of Surgically Treated Radial
Polydactyly – An Outcome Correlation Study
Ching Man Yeung, Alexander Kai Yiu Choi,
Jennifer Wing Sze Tong, Winnie Fok,
Yat Fai Chan and Yuk Yin Chow
Percutaneous A1 Pulley Release Combined with
Finger Splint for Trigger Finger with Proximal
Interphalangeal Joint Flexion Contracture
Tzu-Cheng Yang, Duretti Fufa, Hui-Kuang
Huang, Yi-Chao Huang, Ming-Chau Changand Jung-Pan Wang
Metaphyseal Core Decompression of the Distal
Radius for Early Lunate Necrosis
Christoph U. Schulz
Minimum Ten-Year Outcomes of Partial Ulnar
Nerve Transfer for Restoration of Elbow Flexion in
Patients with Upper Brachial Plexus Injury
Yusuke Nagano, Daisuke Kawamura,
Alaa Terkawi, Atsushi Urita, Yuichiro Matsui
and Norimasa Iwasaki
Forearm Shortening Impact on Pronation andSupination
Luis Schnapp, Salih Colakoglu, Jose Couceiro,
Amir Oron, Guy Brock and Rodrigo N. Banegas
Asymmetric 6-Strand Flexor Tendon Repair –Biomechanical Analysis Using Barbed Suture
Jasmin Shimin Lee, Yoke-Rung Wong and
Shian-Chao Tay

2Post-Exertional MRI Is Useful as a Tool for
Diagnosis and Treatment Evaluation for Chronic
Exertional Compartment Syndrome of Forearms
Akiko Tominaga, Kozo Shimada, Ko Temporin
and Ryosuke Noguchi
Diabetic Hand Infection: An Emerging Challenge
Ahmed Suparno Bahar Moni, Monirul Hoque,
Rayhan Ali Mollah, Razia Sultana Ivy and I
srat Mujib
Ulnar Nerve Strain in Functional Elbow andShoulder Motions
Chaiyos Vinitpairot, Surut Jianmongkol,
Tala Thammaroj and Settapon Wattanakamolchai
Systematic Review of the Use of Patient Reported
Outcome Measures in Studies of ElectivelyManaged Hand Conditions
Hawys Lloyd-Hughes, Luke Geoghegan,
Jeremy Rodrigues, Michele Peters, David Beard,
Andrew Price and Abhilash Jain
Outcomes of the Hemi-Hamatum Arthroplasty
Karlis Verdins and Vadims Nefjodovs
Arthroscopic Thermal Shrinkage: A Novel
Method for the Treatment of Chronic Volar Plate
Instability at the Metacarpal Phalangeal Joint of
the Thumb
Yu Chung Wong and Pak Cheong Ho
Thumb Carpometacarpal Arthroplasty with
Dynamic Suspension Sling Using Extensor Carpi
Radialis Tendon
Takehiko Takagi, Yuka Kobayashi and
Masahiko Watanabe
Surgical Treatment of Chronic Hand Ischemia:
A Systematic Review and Case SeriesDavid L. Colen, Oded Ben-Amotz, Thibaudeau
Stephanie, Arman Serebrakian, Martin J. Carney,
Patrick A. Gerety and L. Scott LevinEDITORIAL

Editor-in-Chief

Professor and Chairman(Seoul National University Hospital & Seoul
National University College of Medicine,South Korea)- Ulrich Mennen"disease of the Vikings’?”

PRESIDENT'S MESSAGE

Yuan-Kun Tu (E-Da Hospital, Taiwan)
Raja Sabapathy (Ganga Hospital, India)
Alphonsus Chong (National University

Hospital, Singapore)

Carpal Tunnel Release Surgery Plus Intraoperative
Corticosteroid Injection versus Carpal Tunnel
Release Surgery Alone: A Double Blinded Clinical
Trial
Mohammad Mottaghi, Mostafa Zare,
Hamid Pahlavanhosseini and Mina Mottaghi
Case Reports
Radial Half of the Second Metacarpal Bone andthe First Dorsal Interosseous Muscle Composite
Flap for Treating the First Metacarpal Bone
Defect: A Case Report
Disorn Janesaksrisakul, Nontich Pongernnak
and Navapong Anantavorasakul
Impaired Extension of the Digits due to Bilateral
Idiopathic Intrinsic Contracture: A Case Report
Yuki Kawasaki, Soichi Ejiri, Michiyuki Hakozaki
and Shinichi Konno
Stress Fracture of the Ossification Center of the
Scaphoid in a Skeletally Immature Gymnast
Hiroyuki Fujioka, Tetsuo Nishikawa, Yohei Takagi,
Takanori Oi and Shinichi Yoshiya- Daniel J Lawson- Bruce Winney- Marc Garcia-Elias- Dominic Furniss

SECRETARY-GENERAL REPORT

16 PIONEER PROFILES

18- Michael Ng

Reflections by a confined president

Virchel Wood

Co-Editors

RESEARCH ROUND-UP“Is Dupuytren’s disease really a

10 OBITUARY

Goo Hyun Baek, MD, PhD

31

Convenient Myths- Goo Hyun Baek

Latest Articles: Volume 24, Issue 03 (Sep 2019)
A Comparison of Radiographic Outcomes between
3D Preoperative Planning and Conventional
Planning in the Osteosynthesis of Distal Radius
Fractures
Yuichi Yoshii, Yasukazu Totoki, Wen-lin Tung,
Kenichi Akita and Tomoo Ishii

VOLUME 10 | ISSUE 3 | NUMBER 39 | AUGUST 2020

contents

THE JOURNAL OF

Submission at http://jhs-ap.org
https://www.worldscientific.com/jhs

www.ifssh.info

34 MEMBER SOCIETY NEWS• Mexican Society for Surgery of the Hand
• The Association of Chinese-speaking Hand
Surgeons United• Chilean Society for Hand and Microsurgery• The Ecuadorian Society for Surgery of the
Hand• Harilaos Theodore Sakellarides• Korean Society for Surgery of the Hand

• Robert Henry Cradock Robins• Austrian Society for Surgery of the Hand

SPECIAL FEATURES• Australian Society for Surgery of the Hand
• Belgian Society for Surgery of the Hand

Thumb opposition: its definition and my• Colombian Society for Surgery of the Hand

approach to its measurement• Brazilian Society for Surgery of the Hand

- Michael Tonkin• Asociacion Argentina de Cirugia de la Mano y

22 HAND THERAPY• Somatosensory Rehabilitation ofReconstructiva del Miembro Superior

54 SHARE SECTION

		 Neuropathic Pain

The history of Hand Surgery at the University

		 - Karin Boer

Hospital Polyclinic of Modena, Italy

		 - Tara L Packham- Paolo Bedeschi

		 - Esther Vögelin- Antonio Landi

		 - Claude J Spicher• EFSHT Virtual Congress:
		 1 – 4 September 2020

63 UPCOMING EVENTS
List of global learning events and conferencesfor Hand Surgeons and Therapists

30 ART
Image - Albert M. Mennen

3

EDITORIAL

www.ifssh.info

August 2020

ADVERTISMENT

Convenient Myths
I used to tell my patients who presented withAt present, during the COVID-19 viral pandemic, thisDupuytren’s disease that the cause might have apractice of storytelling has become quite evident.

genetic origin which may come from the Vikings, who

Pseudo-scientific “facts” and false informationin turn probably got it from a tribe who migrated fromabound, and are propagated by lay people, politicians

Northern Europe to Greenland (1). The Vikings, during

and scientists. Of course scientists do not get it

their widespread military campaigns, left their genes

right all the time. There are just too many known

in certain countries, hence the “higher prevalence” ofand unknown variables. Even if a research finding

Dupuytren’s disease in places like Ireland, Scotland,

seems to be irrefutable, scientists should at most be

and the Scandinavian countries. This story was ofcautiously dogmatic.

course told with tongue-in-cheek, but probably soconvincingly, than many patients preferred to believe

How then do we debunk false information? The

it as true and even delighted in thinking that a hidden

following set of questions may help to determine thepart of their ancestry had been revealed to them!

reliability of any new claims:

In medicine we have many similar examples of1.

helpful stories to explain certain conditions or

2. Is the claim verified and reviewed by otherphenomena to patients. These may not necessarily

What scientific evidence accompanies the claim?
scientists (experts, peers)?

be based on scientific facts or experience, but they3.

make nice stories. And over time, as they pass from

4. What biases or allegiances does the claimant

one medical generation to the next, they become

What is the track record of the claimant?
have?

so entrenched that we may even think of them and5.

share them as truth. One such intriguing story is

6. Can the claim be repeated by independent testing?

What collaboration exists with other scientists?

being debunked in the article on the supposed origin
of Dupuytren’s disease by Ng M, Lawson D.J., Winney
B., and Furniss D.,(2) which is reviewed in the section

Take care and be safe,“Research Roundup”.
UlrichScience does not have all the answers. We make

Editor: IFSSH Ezine

claims based on the best available evidence at any

Past President IFSSH

given time, and as new information becomes available,"Pioneer of Hand Surgery"claims and theories are revised. These claims arewww.ulrichmennen.co.za

supposed to be based on available peer reviewed data
- not thumb-sucked. Science exists, in the first place,

1.

McFarlane Robert M. “On the origin and spread of

to try and get answers to questions, problems andDupuytren’s disease”. J of Hand Surgery (volume

uncertainties we have about the universe and all that27, issue 3, p 385-390, June 2002).

it comprises. However, since the dawn of humankind,

2. Ng M, Lawson D.J., Winney B., and Furniss D.,

myths and stories have been created and retold in“Is Dupuytren’s disease really a ‘disease of theorder to make sense of mystery and explain theVikings’?” J of Hand Surgery (E)(volume 45, issue

unexplainable.

3, p 273-279)

4

5

PRESIDENT'S MESSAGE

www.ifssh.info

Reflections by aconfined president

PRESIDENT'S MESSAGE

August 2020

Once this catastrophe has passed, we should remember this. In a few years we may reflect about this situation.
How do you want to be remembered? In a good mood, as a helping person, a contributing citizen, generous? Orbeing selfish, complaining, in a bad mood?
Yes, we are going to get out of this tunnel. No doubt. And from it we may emerge more human, more sensitive toother people's suffering, and with clearer priorities. And if this virus gives us back some of the humanity we had
lost, let us celebrate this outcome.

Dear Friends,
Overwhelmed by circumstances that nobody could have predicted, I thought that my message should not forget
what is going on these days in our world. But, I would not think it appropriate to waste your time proposing
another technical paper on how to cope effectively with this pandemic. The one published by our friends fromSingapore in the last issue of Ezine was exact, concise and effective. You will also find a number of similar
communications in this current Ezine. Thank you all for sharing your sincere experience.

Marc Garcia-Elias
President: IFSSH

Today I’ll share with you some thoughts about what it really means to be confined in a world we thought wemastered, when it is obvious that we don’t. Some of these thoughts came to me by reviewing some notes that I(1) https://victorkuppers.wordpress.com/

took during a teleconference by Victor Küppers (1), a Dutch writer who lives in Camprodon, in Catalonia, Spain.
He was so clear, so straightforward in what it really means to be confined by a pandemic, that I felt compelled toshare some of his opinions.
These months have been difficult to most of us. In many regions of the globe, life has been hard, sad, andsometimes unbearable. We have seen people dying from this terrible pandemic, young people in improvised
ICUs, old people in field hospitals, sick patients in residencies, army soldiers on the streets. We have been
through all sorts of reactions: discouragement, worry, fear and panic. We all have had moments of anxiety,and yet, this is a tunnel, not a well, and from a tunnel, one can escape. We don't know when, nor under what
conditions, but let’s be confident. Hopefully, we’ll see the light at the end of the tunnel, real soon. These are
hopeful words with great healing potential.
To most of us, this has been the first time that we have been locked up, at home, apparently healthy, for morethan two months. If you ever said "I don't have time", you will not be allowed to say it anymore. You had thatwonderful opportunity for as long as the confinement was there. Did you take advantage of it? Time for what
you may ask? Time to rest, time to be with the family, time to reflect, to put order in your life, time for yourhobbies, for what you normally can't do. Or did you spend this time lying on the couch just watching TV series?
It has been time to learn how to complain less. Time to remember that we are here to help each other. We had
become a selfish society, very materialistic, consumerist, where the most important values were success,fame, wealth and applause. And now we realize that the essence of the human being is altruism, empathy,
compassion, kindness. After this confinement, we all should be more sensitive to other people's needs andsuffering. We've been created to be good.

6

7

SECRETARY-GENERAL REPORT

www.ifssh.info

Message fromSecretary-General

SECRETARY-GENERAL REPORT

August 2020

Thus generating the “Amended and Restated Bylaws”, which are not apiecemeal update of specific articles, was rather a complete restatementof the bylaws. Great attention was given to be certain the Amended andRestated Bylaws capture the intent of the old bylaws but do so in a more

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

coherent and succinct way incorporating up-to-date legal conventions

IFSSH DISCLAIMER:

and best practices.

The IFSSH ezine is theofficial mouthpiece of theFollowing the meeting, the Amended and Restated Bylaws wereInternational Federation of

distributed to all IFSSH Delegates via email. As we will be unable to meet

Societies for Surgery of theDear colleagues,

decreases have now been regained and the treasury

in person in the near future, voting has been organised electronically and

Hand. The IFSSH does not

Trusting that you, your families and friends are well.

has been able to provide for numerous educational

we ask that all societies consider the proposal distributed to the delegate

endorse the commercial

The COVID-19 pandemic has upended nearly every

sponsorships recently (as detailed in the May 2020and cast their vote through the described methods by 10 September 2020.

advertising in thismedical discipline, dramatically affected patient

IFSSH Newsletter).

The 2020 Delegates’ Council Meeting will be held as a virtual meeting on

publication, nor the content

12 September 2020. Full details will be distributed to delegates by earlyor views of the contributors

care, and has had far-reaching effects on scientificmeetings. Most of the medical congresses or

The IFSSH website, overseen by the Historian, David

August. We look forward to seeing all of the familiar faces, even if this isto the publication.

conferences have been postponed, cancelled, or

Warwick, has increased again in its content:

through our computer screens instead of in our Council meeting room!

Subscription to the IFSSH

changed into on-line communications.

•

The Delegates’ Council meeting as well as the
Executive Committee meeting of the IFSSH were•planned to be held during the FESSH Congress in June
2020. However, we could not make it due to social

27 June 2020, and the following is a summary.

ezine is free of charge and(description and report) - https://ifssh.info/ifssh-

Future Meetings

the ezine is distributed on asponsored-educational-projects.php

A detailed list of national and regional hand surgery meetings is available

quarterly basis.

profiles of Past-Presidents have been incorporated

on the IFSSH website. The triennial IFSSH Congresses are as follows:- https://ifssh.info/past_president.php•

restriction and the travel ban.
The on-line executive committee meeting was held on

all grant recipients are now listed on the website•

Should you be interested tomore society histories have been added - https://

XVth IFSSH – XIIth IFSHT Congress – London, United Kingdom

advertise in this publication,

ifssh.info/member_nation-histories.php

6 - 10 June, 2022

please contact the Editor:

a further educational resource (provided byezine@ifssh.info

Larry Hurst) has been added - https://www.

XVIth IFSSH – XIIIth IFSHT Congress – Washington D.C., USA

handsurgeryresource.org/

29 March - 3 April, 2025

IFSSH EZINEEDITORIAL TEAM:

Executive Committee news
With the disruptions to travel and congresses, theThe legalities and future congresses of the IFSSH were

I do hope that this disaster will come to an end before long, and that all of

EDITOR:IFSSH held an online Executive Committee meeting todiscussed by Daniel Nagle (President-Elect). A review

you stay fine physically and mentally.

Professor Ulrich Mennen

discuss progress since the Berlin 2019 gathering andof the bylaws has been occurring since the Berlin

decide on plans for the future.

meeting, following feedback from the Council members

Sincerely,

The IFSSH President, Marc Garcia-Elias, acknowledged

and their societies. The Executive Committee, after

Goo Hyunthat since the hand surgery community most recently

reviewing the current bylaws felt that it was necessary

Professor Michael Tonkin

met during the APFSSH Congress in March (Melbourne,

to update the IFSSH bylaws to bring them into

Past President: IFSSH

Australia), there have been significant worldwide

compliance with current not-for-profit best practices

changes caused by Covid-19. Disruptions have occurred

and the State of Illinois not-for-profit laws. The ExCo,

GRAPHIC DESIGNER:

to personal lives, hand surgery practices and hospitals,

in order to assure the integrity and thoroughness

Tamrin Hansen

and the IFSSH ExCo pay their respects to those whoof this process, engaged the services of an attorneywww.foxydesign.co.za

have assisted throughout the crisis worldwide andwith expertise in not-for-profit law and bylaws. (Theremember those who have lost their lives.

Federation is registered in the state of Illinois in the

Past President: IFSSH
DEPUTY EDITOR:

United States and is therefore subject to that state’s

Goo Hyun Baek

Financially the IFSSH is in a pleasing position. As forlaws.) This process included a complete review and

Secretary-General, IFSSH

many, fluctuations occurred around the pandemic but

restatement of the current bylaws.

Email: secretary@ifssh.info

8

TO SUBSCRIBE GO TO:
www.ifssh.info
administration@ifssh.info
9

OBITUARY

www.ifssh.info

OBITUARY

August 2020

Virchel E. Wood, MD

longitudinal bracketed epiphysis in Rubinstein-Taybi syndrome andcoined the term the “kissing delta phalanx”. The kissing delta phalanx
is now recognized as a radiologic clue to several uncommon or rareclinical disorders involving the hand. He also came up with the term

United States of America (1934 - 2020)“Super digit” to denote two forms of digital fusion. Type 1 consists of
two metacarpals that support a single oversized digit, while type II is asingle metacarpal that supports two or more digits distally.

Dr. Virchel E. Wood (Woodie) was a true pioneer of congenital handsurgery. He began his career as an orthopaedic resident at theIn addition to reporting on unique anatomy, he also had insight on more

University of Massachusetts in Worchester, Massachusetts. Following

The first CHASG meeting in Windsor,

common disorders such as syndactyly, sharing his years of expertise

residency, his academic pedigree started with a hand fellowship underEngland, 1994. Virchel is 2nd fromin a well-cited article or thoracic outlet syndrome, publishing 7 peer

Dr. Robert Carroll at Columbia University (Harlem Hospital) in New York,the left.

reviewed papers on the topic with over 400 citations.

in 1966. Dr. Wood then served his country (1967-1969) at Fort Leonard
Wood, Missouri, USA., during the Viet Nam War, and for a period he

Dr. Simo Vilkki recalls that Virchel was intent on fully understanding anatomic entities he was studying andserved as Chief of the Orthopaedic Service. Dr. Wood then resumed

would carefully dissect large numbers of cadaveric specimens to ensure that his conclusions were supported.

his education with a second fellowship at the University of Iowa

He was an avid reader and was able to foresee the benefits of new technology. For example, he promoted

under Dr. Adrian Flatt, a noted expert in congenital hand anomalies.

microvascular methods in hand trauma supporting replantation surgery as early as 1974, when the success was

He continued his exploration of congenital hand surgery spending

still unsure.

additional time learning pollicization techniques and syndactyly repairs
from Dr. Dieter Buck-Gramcko in Hamburg, Germany and later he studied

Dr. Terry Light notes that Virchel had a thirst for understanding our world that drove him to learn and share whatbrachial-plexus treatments with Dr. Alain Gilbert in Paris.

he had learned through writing and teaching. He was sincere, earnest and always interested. His passion forlearning about pediatric hand anomalies led him to travel widely in search of ideas and information. He looked

After his training he set up a private practice in Walla Walla Washington, but before long was recruited by his

closely at his own experience and shared what had worked, what conditions needed better treatments and what

Alma Matter, Loma Linda University, in 1971 to serve as Chief of Hand Service and the Hand Fellowship Director.

conditions had best not be surgically treated. In 1995 Light led a project for the American Society for Surgery

Over the next 36 years he trained 76 hand fellows and 190 orthopedic residents and influenced numerous medicalof the Hand (ASSH) to identify the most influential papers in congenital hand surgery. Virchel Wood had more

students. The orthopaedic department renamed the hand fellowship “The Virchel E. Wood Hand Fellowship” in his

papers in the top group than any other author in the world. Thus, he was awarded “The Most Frequently Cited

honor. After his retirement, Dr. Wood’s distinguished career was further recognized with an appointment as an

Author in Congenital Hand Literature for the past 50 years” by the ASSH.

Emeritus Professor.
In 1993 at the ASSH annual meeting, Dr. Wood with several other colleagues founded the Congenital Hand Anomaly
Woodie’s gentle warmth is consistent with his Native American heritage

Study Group (CHASG). Woodie was enthusiastic about the concept of CHASG - an opportunity to periodically meetas part of the Wampanoag tribe from Massachusetts, the tribe that firstwith like-minded colleagues and safely share successes as well as challenges.

extended warmth to the Pilgrims landing at Plymouth Rock. Although
soft spoken in person, his pen was a force to be reckoned with. Virchel
Wood wrote over 121 peer reviewed articles, 14 book chapters, 110 oralpresentations and won 26 academic awards.
In addition to scientific works he wrote poetry and motivational articles
regarding ethics and moral behavior for church journals.
Dr. Wood was a keen observer with a gift for conveying an observation
Presenting little finger pollicization,in practical, but memorable terms frequently worthy of citation. He

Congenital Hand Anomaly Study

was part of the team that first identified os acromiale, an un-united

Group (CHASG) Meeting, 2011, Vietossification center of the acromion that is associated with increased

Woodie and Esther relaxing during a CHASG

Dr. Wood together with Dr. Simo Vilkki & Dr. ToshihikoNam.

risk of rotator cuff tears. He recognized the occurrence of duplicatedmeeting in Sydney Australia, 1997

Ogino during Loma Linda CHASG meeting in 2002

10

11

OBITUARY

Dr. Wood reviewing a complex hand anomaly with Drs. Michael

www.ifssh.info

Virchel and Obediah

OBITUARY

August 2020

Virchel singing in the Heralds of Hope Men’s Chorus

Tonkin, Marybeth Ezaki and Steven Hovius at a CHASG meeting in

Dr. Wood with Dr. Kerby Oberg and Dr.
Adrian Flatt, Dallas 2012

Viet Nam, 2011
Dr. Marybeth Ezaki writes, Virchel Wood was my teacher, mentor, and friend. For me, he resides in the pantheon

Dr. Kerby Oberg first met Dr. Wood as a medical student. “I had read an article about fingertip regeneration andof "Jedi Knights" of hand surgery, not just congenital hand surgery. When I first entering the world of kids'

was enamored about the possibility of limb regeneration”, so with manuscripts in hand, I arranged a meeting

hands, I was asked to write a paper on radial polydactyly and in researching it I had a peek into the way

with Dr. Wood to discuss the possibilities of a research project on the topic. Wood shrugged his shoulders andVirchel's mind worked - meticulous, thorough, painstaking and questioning. I relied on his "out of the box"

said – “it’s possible, but not terribly practical. For most people, if they cut off a fingertip, they would prefer tothinking to guide me in choosing tendon transfers for paralytic hand conditions. I felt "safe" in employing

get back to work rather than wait around for it to grow back.” This captures his insight into repairs – not justwhat he had written and counseled. Virchel and Esther took me into their circle of friends, and made me feel

what was possible, but what was practical. Nevertheless, he found time to mentor a developmental biologist

so welcome as they showed me their beautiful garden, his special trees, and his beloved parrot Obediah, whointerested in limb regeneration. In 1993 when I presented our project on regenerative wound healing entitledwas happiest perched on Virchel's shoulder. I was fortunate to have traveled the world with the Woods and“Intrauterine and juxtanatal repair of syndactyly in fetal mice” at the Annual American Society for Surgery ofexperience the wonder of seeing a 3 million year old hominid with a tiny brain and an anatomically modern

the Hand, Virchel invited me to join a group that formed during that meeting - the Congenital Hand Anomalies

hand in situ in a South African cave, and the fun of sharing traditional Japanese meals in traditional JapaneseStudy Group (CHASG). He thought my perspective on developmental biology and limb development would be

attire, while seated on the tatami floor. Virchel was the curator of the natural history museum at Loma Linda

helpful. It shifted the trajectory of my research projects and career, and for that, I will always be indebted to

University and proudly shared details of all the specimens as he showed me "his" collection.

Virchel.

The words that come to mind when I think of Virchel are devout and gentle. He lived his faith, quietly but

Dr. Barry Watkins recalls Woodie’s profound impact on his career, following his footsteps into an orthopaedic

profoundly. I will remember him most for his gentle and humble approach to his patients, his family, and his

hand specialty, and focusing on congenital deformities. Virchel did not dabble. When interested in something,friends. With his comprehensive knowledge of anatomy and pathology of the hand, he loved to teach as well as

he would research it to the utmost. His publications frequently focused on concerns that were not wellmentor medical students, residents, fellows and colleagues.

described or studied. Seeing the need, he would tackle it relentlessly and publish to share the knowledge he had
gained. His hobbies reflected this as well. Interested in gemstones, he studied in depth and became a certified

Dr. Gary Frykman, Wood’s longtime partner and co-author at Loma Linda University, remembers that Woodie

gemologist. With this knowledge in hand he collected an amazing variety of gemstones, spheres, minerals, andwas always writing something, even on vacation. He delved deeply into the literature and enlightened us on

natural artifacts of which he knew every detail. Each morning before surgery, Virchel would awake at 4am andmany obscure congenital conditions of the hand. With his comprehensive knowledge of anatomy and pathology

review a collection of manila folders that he kept on each surgery. Each folder stuffed with the most pertinentof the hand, he loved to teach as well as mentor medical students, residents and fellows. In addition to his vast

articles, anatomical diagrams, and notes from prior cases, and each updated frequently. This dedication to

medical publications, he published for lay journals over 60 prose articles and poems. He was an Associate

being as knowledgeable and prepared as possible to help each patient every time, no matter how often he had

Member of the International Society of Poets. Woodie was a lifelong vegetarian. He was also a modest, frugal,

performed that surgery, was an example to us all. He deeply cared for and respected each patient, from newborn

and spiritual man with a commitment to music. He had a rich baritone voice and loved to sing in men’s chorale

to elderly, and they loved him for it. I have “congenital” patients in their 30’s and 40’s that still ask me about himgroups.

when they bring their children in to see me.

1213

OBITUARY

www.ifssh.info

Dr. Wood, Curator of Gems and Minerals for the World

August 2020CONGRESSADVERTISMENTREPORT

Dr. Wood at his desk at home

Museum of Natural History, La Sierra University, Riverside,
California, USA
In an article published in celebration of Dr. Wood being awarded the Alumnus of the Year at Loma Linda
University and the establishment of the Virchel E. Wood Endowment Fund, Virchel commented that of his
numerable awards, citations and contributions, he is most satisfied that his life-work has substantiallycontributed to the knowledge about congenital hand anomalies. Dr. Wood had a rich life yet with modeled
humility by spending little on his own life style. We who knew him are quite enriched by having him part of ourlives.
Perhaps Dr. Wood's life philosophy was best captured in a poem he wrote:“

What Is Life
Do not waste your time.
Each second must count,
for Life
Is now in session.….

”Kerby C. Oberg (koberg@llu.edu) and Barry Watkins (BWatkins@llu.edu)
Loma Linda University, California, USA

14

15

PIONEER PROFILES

www.ifssh.info

Harilaos Theodore
Sakellarides (1922 – 2011)

MD, PhD, FAAOS, FACS, FRCSPIONEER PROFILES

August 2020

Robert Henry Cradock
Robins (1923-2015)
MA, MB.BChir, FRCS (Eng)

Harilaos Theodore

President of the American Academy of Neurologic andRobert Henry Cradock Robins

Orthopaedic Surgeon at the Royal Cornwall Hospital in

Sakellarides was born 13

Orthopaedic Surgeons, as well as visiting professor at

was born on 7 August 1923

Truro until his retirement in 1988.

August 1922 in Kalambaka,teaching hospitals in Greece, Romania and India.

in High Wycombe, England.

Greece. After his graduation

After school he completed

In 1956 Robins, with four other founder members, started

as a medical doctor in 1950

Sakellarides has a long list of publications in peer

his medical degree at Queens

the “Second Hand Club” in the UK. It was called “Second”

in Greece, he continued hisreviewed international journals which are devoted

College in Cambridge, andbecause a few years earlier 12 senior surgeons formed

training in Orthopaedic

to hand surgery and orthopaedics. In 1963, he wasclinical training at the St.

the “Hand Club” and wanted to keep it exclusive to a

Surgery, Plastic Surgery,recognised by his colleagues for his new and innovative

Bartholomew’s Hospital in

maximum of 12 members. This allowed them to have

Trauma Surgery andsurgical techniques, and was featured in a 2-pageLondon and house jobs atdinner on Friday evenings at the Athenaeum Club in

Hand Surgery, including

article in TIME magazine. He was a clinician for overthe Royal United Hospital in

London, with a short scientific meeting on the Saturday

fellowships at the Cochin Children’s Hospital in Paris,

60 years, and used to teach his students: “Always, do no

Barth. The war saw him being called up as a ship’s doctor

morning. Amongst the excluded this became known asRoyal National Orthopaedic Hospital in London,harm”

in the merchant navy. After the war he was appointed as“the dining club with hand surgery as gossip”. The Second

the Luccock Medical Research Fellow in the Department

Hand Club became the British Society for Surgery of the

Birmingham Accident Hospital in Birmingham,
Croydon Hospitals in London and Hospital for Special

Harilaos was married to Loukia and they had twoof Surgery at King’s College in Newcastle where he

Hand (BSSH) in 1968 and he was elected its President inSurgery in New York. In 1959 he was invited to join

daughters and a son together. He died on 27 April 2011

became responsible for the treatment of hand injuries and1979. The original journal, the “Proceedings of the Second

the Massachusetts General Hospital in Boston whereat the age of 88 jears.

infections. Because of the large volume of industrial hand

Hand Club”, later became the “Journal of Hand Surgery”, of

injuries, he claimed to be the first surgeon in the UK towhich he was editorial board chairman for 10 years.

he was one of the founders of the Department ofHand Surgery. In 1965 Sakellarides joined the Boston

Harilaos Theodore Sakellarides was honoured as

focus solely on surgery of the hand! In 1952 his research

University Medical Centre as Assistant Clinical“Pioneer of Hand Surgery” at the Eighth Congress of the

led to be awarded the Sir James Berry prize by the Royal

Robert Robins served on numerous boards and councils,

Professor of both Hand and Orthopaedic Surgery for 30

International Federation of Societies for Surgery of theCollege of Surgeons (England) for his dissertation titledamongst others the Cornwall Area Health Authority,

years. During this time he also served as Chief of Hand

Hand in Istanbul, Turkey in June 2001.

“The treatment and preservation of the injured hand”.

examiner for the Edinburgh College FRCS, chairman of theSurgery at the Franciscan Children Hospital.

BOA Subcommittee on Hand Assessment Charts, and theThis research also earned him the Hunterian Lecture in

Royal College of Surgeons (England) Board. He was twice

Harilaos Sakellarides was certified in both Greece

1954. This evolved into a textbook “Injuries and Infections

a British Council Fellow. His hobbies included gardening,

and the USA and held a series of noteworthy hospitalof the Hand” which was published in 1961. He publishedsailing, fishing, art, folk music and Morris dancing. Robert

and academic appointments. He has been an active

extensively on various other aspects of the hand as well

H.C. Robins married his wife Shirley in 1953, and they had

participant in numerous Hellenic and Internationalas orthopaedics. Robins moved to the Princess Elizabetha daughter and three sons. Robert died on 23 FebruarySocieties (in all 39!) including Fellow of the American

Orthopaedic Hospital in Exeter as Senior Registrar. While

2015 at the age of 91.

Academy of Orthopaedic Surgeons, Fellow of the Royalat Exeter he became the Council of Europe TravelingCollege of Surgeons, Fellow of the American College of

Fellow to Sweden and France, and in 1960 a British

In 2001 at the 8th Congress of the IFSSH in Istanbul,

Surgeons, Academie de Surgerie of France, President

Orthopaedic Association Travelling Fellow to North

Turkey, Robert H. C. Robins was honoured “Pioneer ofof the Hellenic Hippocratic Orthopaedic Society,

America. The next year Robins was appointed Consultant

Hand Surgery”

16

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SPECIAL FEATURE

www.ifssh.info

Thumb opposition

ITS DEFINITION AND MY APPROACH TO ITSMEASUREMENTSPECIAL FEATURE

August 2020

Circumduction is the path followed by the thumb

two factors which determine the available range ofin movement from full supination of 30 degrees

motion in specific TMC joint positions. During TMC(reposition); to neutral rotation of 0 degrees when the

joint flexion and abduction, thumb pronation occurs

thumbnail is at 90 degrees to the frontal plane with

automatically as a consequence of joint shape and

20 degrees of extension and 30 degrees of abduction

ligament tension. The APB, opponens pollicis and(neutral position), to full pronation of 90 degrees withflexor pollicis brevis (FPB) arise ulnar to the axis of thethe thumbnail parallel to the frontal plane of the palm

TMC joint and are inserted distally radial to this axis.

(opposition) (Figure 1).

With contraction of these muscles, TMC joint flexion,

Thumb opposition and its measurement are complex

Terminology

topics because of differences in a) definitions, b) use of

The trapeziometacarpal (TMC) joint allows movement

The sources of opposition movements

APB and FPB insert distal to the MP joint, both play aterminology, c) identification of opposition movement

in extension/flexion (alternatively termed radial

The sources of the movement components ofrole in radial deviation and possibly, although at best

components, and d) application of measurement

abduction/adduction) in the frontal plane; abduction/

opposition remain arguable. Smith (1987) believes

minimally, in pronation of that joint.

techniques. This review attempts to provide someadduction (alternatively, antepulsion/retropulsion) inthat abduction/adduction, although primarily

clarity to these differences.

the sagittal plane; and supination/pronation (rotation

occurring at the TMC joint, is also present at the

Measurement of opposition

around the longitudinal thumb axis) (Figure 1). The firstmetacarpophalangeal (MP) joint. Most agree (Zancolli,

Methods range from angular measurements ofDefinition of opposition

two are angular movements and the third is an axial

1979). In the clinical example of the congenital

movements with a goniometer (Smith, 1987) toOpposition of the thumb is defined as the positioning

rotation.

hypoplastic thumb, MP joint radial deviation

the clinical application of the Kapandji scale of(abduction) is increased, in combination with ulnar

opposition movements (I to 10) (Kapandji, 1986) toof the thumb pad diametrically opposite to the distal

abduction and pronation occur simultaneously. As

pad of the middle finger, be this positioning for grasp

I prefer to use the terminology extension/flexion

collateral ligament insufficiency, to cater for loss ofmore sophisticated measurements with sensors suchof small or large objects. Opposition is the placement

and abduction/adduction for movements in the

TMC abduction.

as a gyroscope (Kuroiwa et al., 2018). All have someof the thumb in the position rather than the activity offrontal and sagittal planes, and not those in brackets.

achieving grasp (Smith, 1987).

Nevertheless, both are used by different authors.

problems. For instance, angular measurement of
Rotation is mainly at the TMC joint with some present

pronation is unreliable, relying on the assessment ofat the MP joint (Milford, 1988; Smith, 1987), althoughthumbnail angle with the plane of the palm (frontal

some such as Zancolli (1979) agree with Kaplan (1965)

plane).

and consider that the totality of rotation of the thumbin opposition (90 degrees pronation from the neutral

From the above, we can see that most opposition

position) is produced at the TMC joint level.

movement occurs at the TMC joint with some
contribution from the MP joint. In measurement of

The third component of TMC movement in opposition

opposition are we measuring TMC joint abduction,is flexion. Flexion, of course, is also present at MP andpronation and flexion or are we measuring the ability

interphalangeal (IP) joints. These are not opposition

to reach a position which incorporates opposition as amovements but allow the thumb to oppose specificpart? To achieve the position of tip-to-tip opposition

anatomical targets such as the ulnar-palmar aspectdemands MP and IP joint flexion of either or bothof the hand. That is, they allow the thumb to attain

thumb and finger. These are not positions that can

opposition positions that are not possible without MP

be reached through TMC and MP joint opposition

and IP joint flexion.

movement alone. This is also so for attainment of many
Kapandji positions of opposition (Kapandji, 1986).

The muscle controllers of the three TMC movements

18

are the thenar muscles, the most important being the

A recent publication from Kuroiwa et al, (2019)

abductor pollicis brevis (APB). The extrinsic flexor

assesses opposition using a gyroscope to measure TMC

pollicis longus (FPL) contributes secondarily to TMC

abduction and pronation only and compares thesejoint flexion. The shape of the TMC joint and themeasurements with Kapandji scores. From the abovechanging tension in TMC joint ligaments are the otherinformation we can see that measurement of TMC

19

SPECIAL FEATURE

www.ifssh.info

SPECIAL FEATURE

August 2020

joint abduction and pronation is not inclusive of all

thumb must oppose the anterior part of the digit, NOT

For valid measurement of opposition in either

components of opposition movements. Nevertheless,digit tip or anterior pulp of one digit to the side of thecircumstance, explanation of the intent and application

their conclusion that these two movements reach aother digit. The same applies to Kapandji positions 7 toof the correct methodology, as detailed above, areplateau and do not increase after Kapandji position

10, when with IP and MP joint flexion combined withabsolute necessities. We must decide whether we

6 is valid. In other words, opposition as measured by

maximal abduction and pronation, the anterior tip ofwish to measure thumb TMC joint abduction andthese two parameters does not indicate increasing

the thumb, NOT its side, must oppose the appropriate

pronation or whether we wish to document an ability

opposition after Kapandji position 6.

crease. Figure 2 of the Kuroiwa publication raises someto oppose in different thumb positions? In the example

doubts as to whether this methodology was followedof congenital thumb hypoplasia referred to earlier,Therefore, perhaps we would do better to consider

correctly, particularly for positions 9 and 10 when

MP and IP joint flexion may be compromised. In these

the Kapandji score as an indicator of the ability to

Kapandji’s forbidden palm crawling appears to be

circumstances, the resulting Kapandji score may also

attain a position requiring opposition rather than as

present, despite the best of intentions of the authors.

be a reflection of these anomalies and not simply

a pure measurement of opposition movement. To be

This position is not opposition and measurementsa reflection of poor opposition. The concept of theMichael Tonkin

fair to Adelbert Kapandji, he acknowledged with someof pronation and abduction when palm walking are

Kapandji score as a measure of movement of the thumb

Professor Emeritus

emphasis that attainment of position 10 to the distal

not valid indicators of opposition, regardless of theat many levels is more apparent.

Past President IFSSH

palmar crease of the little finger, for instance, could be

sophistication of measurement device.

achieved through ‘crawling of the thumb across thepalm’.

michael@thetonkins.net
References
Kapandji A. Cotation clinique de l’opposition et deFigure legend

Despite some concerns with the methodology ofla contre-opposition du pouce. Ann Chir Main, 1986,

Figure 1. Extension and flexion in the frontal plane

The example of congenital thumb hypoplasia is again

Kuroiwa et al. (2019), I agree that we should question

5: 67-73.

and abduction and adduction in the sagittal plane. The

pertinent. An individual with this condition may

whether attainment of Kapandji positions 6 to 10 is

Kaplan EB. Functional and Surgical Anatomy of thethumb positions in circumduction from 30 degrees

reach position 10 without opposition but with radialevidence of an increasing opposition capacity, when

Hand. Ed.2. Philadelphia. JB Lippincott, 1965.

supination (A), to neutral position (B), through maximal

deviation (abduction) at the MP joint and MP andthis function is measured only by TMC abduction andKuroiwa T, Fujita K, Nimura A et al. A new method

abduction (C), to 90 degrees of pronation (D). Redrawn

IP joint motion. Kapandji was at pains to point out

pronation. In clinical practice, to measure these twoof measuring the thumb pronation and palmar

after Eduardo Zancolli. Note that the course of purethat this was not opposition and that the preceding

movements, I prevent thumb MP and IP joint flexion.

abduction angles using a three-axis gyroscope. J

abduction/adduction follows an oblique plane of 15

Orthop Surg Res. 2018, 13: 288.

degrees in relation to the true sagittal plane.

My approach•••

positions 1 to 6 must be achieved to allow progress toposition 10. These truths introduce the concept that

The individual aligns the anterior aspect of the thumban increasing Kapandji score indicates optimal if not

pulp against the lateral aspects of the index finger

A, Fujita K. Measurement of thumb pronation andAcknowledgement:

maximal movement at many joint levels, MP and IP

proximal phalanx -position 0 (no pronation); thepalmar abduction angles with a small motion

Previously published injoints as well as the TMC joint, and that it is not simply

middle phalanx-position 1; and the terminal phalanx-

sensor: a comparison with Kapandji scores. J Hand

Journal of Hand Surgery European 2020, 45:315-7.

a measurement of increasing opposition.

position 2. For positions 3 to 6, the anterior pulp of

Surg Eur. 2019, 44: 728-33.

Republished with permission.

the thumb is opposed maximally to the anterior pulps••

Kuroiwa T, Nimura A, Suzuki S, Sasaki T, Okawa

Milford Lee. The Hand. 3rd Edn. St. Louis, CV

Many authors have emphasised that maximal rotationof index, middle, ring and little fingers. This is anin pronation brings the plane of the thumbnail paralleleffective method of measurement of increasing TMC

to that of the palm (frontal plane)- see definition

and MP joint abduction and increasing pronation fromof opposition. This is perhaps the most relevant of

0 to 90 degrees. Note that this method removes thumbpractical points in measurement of opposition. As the

MP and IP joint flexion. It is not a measure of the ability

Hand Surgery, 2nd Edn. Philadelphia and Toronto.

thumb abducts and flexes across the palm at TMC joint

to oppose in all thumb positions. However, if I wish to

JB Lippincott Company, 1979: 104-35.

level, pronation increases from the resting position,measure the ability to oppose the thumb in a tip-to-tip

when the thumbnail is at 90 degrees to the frontal

manner with index to little fingers- positions 3 to 6,

plane, to a position of 0 degrees -maximum pronation,and to oppose the thumb to other anatomical parts-

as described above. Whether thumb opposition to digit

positions 7 to 10, it is necessary to include increasing

is tip-to-tip, requiring IP joint flexion, or it is pulp-to-

thumb MP and/or IP joint flexion.

Mosby, 1981: 218-20.
•

Smith Richard J. Tendon Transfers of the Hand andForearm. Little, Brown and Company, 1987: 57-63.

•

Zancolli Eduardo. Structural and Dynamic Bases ofpulp with minimal or no flexion, the anterior part of the20

21HAND THERAPY

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Somatosensory
Rehabilitation of
Neuropathic Pain
Boer K., Packham T.L., Vögelin E., Spicher, C.J

HAND THERAPY

August 2020

the touch, temperature, pain and vibro-tactile senses.

The patient is asked to choose the most appropriate

A lesion, due to trauma, entrapment, metabolic

qualifiers to describe her/his perception of pain

dysfunction or biochemical injury (Woolf & Manion,

and to quantify the intensity of each sub-group of1999) can affect the peripheral nerves and thus thequalifiers (i.e. from 0-5).

somatosensory nervous system. Multiple studies inanimal models of nerve injury demonstrate immune

The total score, ranging from 0-100, can differentiate

and histochemical changes of the nerve resulting

sensory pain from affective pain. Sensory pain

in excitatory activity of the peripheral and central

is somatic pain (soma body) and affective pain is

nervous system in the brain as a pain sensation.

semantic pain (sema meaning). The qualifiers may(Schmid et al, 2013; Calvo et al, 2015).

also give preliminary indications about the type ofneuropathic pain suffered by the patient, includingThis means that a cutaneous nerve branch lesion,

tactile hypo-aesthesia (spontaneous neuropathic

in the periphery, can induce spontaneous painpain) or static mechanical allodynia (SMA) (touched-signals through the somatosensory nervous system,

evoked neuropathic pain).

Worldwide, 450 million people suffer from chronic

could probably be neuropathic pain.

including but not limited to a phenomenon in which

neuropathic pain. This pain is spontaneous,Finnerup et al. (2016) proposed an algorithm fora simple touch is perceived as painful (Spicher et al.,

To diagnose neuropathic pain, the SRM assesses

disrupting sleep, unresponsive to many drugs anddiagnosing neuropathic pain. In summary:2017).

the sensitivity of the skin. Two different types ofoften without clear anatomical etiology. This pain
forces people to consult many medical doctors orchanges are distinguished. Tactile hypo-aesthesia,
If the patient’s history suggests that the pain may

Clinical anatomy

partial loss of sensitivity, and SMA: “pain due to atherapists, without relief. Most treatments focus

be related to a neurological lesion or disease and

The cutaneous nerves form a very complex

stimulus that does not normally provoke pain” (IASP

on coping with pain without reducing it. The

not to other causes such as inflammation or non-network just below the skin. Across the body,2011). Both types are diagnosed in different ways.

International Association for the Study of Pain (IASP)

neural tissue damage and if the pain distribution

the 240 cutaneous nerve branches are therefore

defines neuropathic pain as: “pain caused by a lesionis neuro-anatomically related, this may possibly

vulnerable to trauma and may consequently get

Diagnosing Hypo-aesthesia

or disease of the somatosensory nervous system”.

be neuropathic pain.

injured (Spicher et al., 2020 Mar). Trauma, surgery,If you presume the person is experiencing tactile

inflammation, nerve compression, polyneuropathy

hypo-aesthesia, the affected area is examined

1.

2. If the pain is associated with sensory signs,
The dysfunction of the somatosensory system may

such as “tingling”, “numbness”, “radiating”, “dull”

or any damage of the skin can damage the sensory

with an aesthesiometer in order to reveal theallow opportunities for treating this complex painfulor “tugging” in the same neuro-anatomicallynerve branches generating neuropathic pain. An

hypo-aesthetic territory. This is carefully mapped,

problem. Claude J Spicher, Occupational Therapist

distribution, this may probably be neuropathic

atlas of clinical anatomy was composed on the basis

following an established protocol. The boundaries ofand Certified Hand Therapist Switzerland, developed

pain.

of 3133 aesthesiographies mapping the partial loss

the hypo-aesthetic territory are drawn on an imageof sensitivity in people suffering from neuropathicof the affected body part. This map is called anaesthesiography (Spicher & Kohut, 2001).

a method to evaluate, diagnose and treat neuropathic

3. If a diagnostic test confirms a lesion or disease

pain. The Somatosensory Rehabilitation of painof the somatosensory nervous system explaining

pain, to help identify the lesion of involved

Method (SRM) can change and reduce neuropathic

the pain, the neuropathic condition is definite.

cutaneous nerve branches (Spicher et al, 2020 Mar).

pain, using the neuroplasticity of the somatosensory(Finnerup et al., 2016).

nervous system. This article presents an overview ofThis is the first clinical examination record of the
Diagnosing neuropathic pain

SRM (Fig. 1). In the middle of the delineated territory,

The article from Finnerup however does not describe

McGill Pain Questionnaire

the degree of hypo-aesthesia is determined bydiagnostic tests for neuropathic pain. The SRM is

In the SRM the McGill Pain Questionnaire (MPQ)

the pressure perception threshold (PPT) using the

Neuroscience foundations for SRM

descibes a series of useful, patient friendly, non-is used during treatment to describe and evaluate

different sizes of aesthesiometers from the Semmes-

We all know that nociception is vital for the survival

invasive tests.

pain (Melzack. 1975). The MPQ consists of a list

Weinstein monofilaments and by the static 2-pointof qualifiers that allows patients to describe theirdiscrimination value. The effect of sensory re-this method.

of the human being, alerting us to potential tissue
damage or other threatening conditions. If theSomatosensory nervous system

unique pain phenomena and assesses the intensity

education (Dellon, 2000) is measured by repeating

resulting pain perception is out of proportion to the

The somatosensory cortices in the brain areof each of these qualifiers (Spicher, 2006; Spicher etthe PPT and the static 2-point discrimination test.

tissue damage, is not resolved with normal healing,

responsible for processing somatosensoryal., 2020 Jan).

or is not associated with visible tissue damage, it

information from the skin and soft tissues, such as

22

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HAND THERAPY

Figure 1

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HAND THERAPY

August 2020

With a 15.0-gram monofilament the boundaries of theThis third clinical examination of the SRM

Continuing evaluation

painful skin are carefully mapped, always following

demonstrates a significant ‘inter-rater’ and ‘test-re-

By repeating the same diagnostic neuropathic pain

the same procedure. The points where the patienttest’ reliability (Packham et al., 2020 March).

tests, the progress can be monitored. A decrease

tells you STOP are drawn on an image of the affectedin the PPT and static 2-point discrimination value

body part. This map is called an allodynography

By mapping the aesthesiography and(Fig. 2). This is a new procedure for objective

allodynography, the pain becomes visual, instead ofclinical examination of static mechanical allodynia

only being felt by the person. Patients are usually

Gradual shrinking of the allodynic territory is an(Packham et al., 2020 January).

astonished by the accuracy of the drawing, whichindicator of SMA improvement, accompanied bycorresponds to the portion of skin where they

decreasing rainbow pain values. When SMA resolves,

experience neuropathic pain. During treatment, theone may find underlying hypo-aesthesia whichchanges of sensitivity on the Rainbow Pain Scale

has to be treated accordingly to prevent SMA fromare used to evaluate the progress, even if the pain

reappearing.

Figure 2means that the hypo-aesthesia is regressing.

intensity remains consistent for the patient (Fig. 2).
Conclusion
Somatosensory rehabilitation

Pain is always a discomforting and disabling

Once it is determined whether the patient has hypo-

limitation for participation in daily life activities. By

Aesthesiography at 0.4-gram of the tactile hypo-

aesthesia or SMA, the patient receives a specificdecreasing pain the person will experience increased

aesthesia territory of the right dorsal branchhome program with exercises.

participation. Somatosensory rehabilitation is amethod for diagnosing and treating neuropathic painof the ulnar nerve (7 February 2020). This
aesthesiography delineates the area on which

If the patient has spontaneous neuropathic pain,

originating from dysfunction of the somatosensory

the stimulus is not detected. The points marked

the exercises are performed in the hypo-aesthetic

nervous system. The pain is carefully mapped by

are the first point at which the patient cannot

territory (Fig. 1). By ‘waking’ the skin, pain is ‘put tolooking for areas of abnormal sensitivity of the skin.

feel. The arrows indicate the axis on which thesleep’.
The treatment, relying on the neuroplasticity ofstimulus was applied ie, from normal sensation
to no feeling. The triangle indicates the point

With SMA, the skin cannot be rehabilitated in thethe somatosensory nervous system, is performed

from which measures were taken.

painful territory as this provokes the pain. The

by patients themselves. The possibility to evaluate

15.0-gram - successive allodynographies forpatient is advised to avoid touching the painful areaeven the smallest change helps to encourage thethe left palmar branch of ulnar nerve of the left

as much as possible. A Distant Vibrotactile Counterpatient to continue with the exercises. The treatment

Diagnosing SMA

hand;

Stimulation (DVCS) is used to provide comfortableis tailored to fit the individual, but cannot be done

Allodynographyd0=first day of assessment

tactile stimuli.

without effort of the patient. Patience, activity

If you suspect that the patient suffers from SMA,

(16 July2013);

the Visual Analogue Scale (VAS) is used to measured19=19th day of treatment;

To be effective, the patient needs to perform these

the pain intensity. As soon as the patient perceives

d58= 58th day of treatment

sensory exercises 8 times a day, keeping two things

Finally, the 2c level of evidence-based practice -change in intensity he/she must say STOP. Patients(Létourneau, 2014)

in mind: exercises must always be perceived as

to treat Complex Regional Pain Syndrome of the

comfortable, and it is important to focus on theupper extremity with SRM (cohort n=48) – suggests

who have been in pain for a very long time get used

modification and exercises are essential for success.

to perceiving pain and it is difficult to map the

Rainbow pain scale

stimulation, because it is an active relearningthat this method may be an alternative to otherproblem if you don’t explain clearly what you expect

The rainbow pain scale (Spicher, 2006; Spicher etprocess. This can be compared with learning

conservative treatments (Packham et al., 2018). As

from the patient. The code used is: green when theal., 2020 Jan) is a procedure used to determine thea foreign language or learning how to play an

to medical malpractice in nerve injury (Krauss etpain at rest stays similar despite the application ofseverity of the SMA. This test passes through the

instrument. It needs determination, patience and aal., 2020), rehabilitation of neuropathic pain should

the 15.0-gram stimulus, orange when the discomfort

seven colours of the rainbow, going from red to violet,

lot of engaged practice. Education and adherenceemphasize the patient-clinician communication.

increases and red when the stimulus is perceived aseach color corresponding to increasing force levels

are essential for successful somatosensory

painful.

(0.03–15.0 gram) using the monofilaments (Spicher etrehabilitation.

al., 2008).

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August 2020

References

Prof PACKHAM Tara L

1.

Finnerup, N.B., Haroutounian, S., Kamerman, P., Baron, R., Bennett, D.L., Bouhassira, D. et al. (2016). Neuropathic

PhD, MSc, OT Reg (Ont) Prof,

pain: an update grading system for research and clinical practice. Pain,157(8), 1599-1606.

School of Rehabilitation

Woolf, C.J. & Mannion, R.J. (1999). Neuropathic pain: aetiology, symptoms, mechanisms, and management.

Sciences

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BOER Karin

Schmid, A.B., Coppieters, M.W., Ruitenberg M.J. & McLachlan, E.M. (2013). Local and Remote Immune-Mediated

Sciences, McMaster University,

CHT, CSTP, BSc OTInflammation After Mild Peripheral Nerve Compression in Rats. J Neuropathol Exp Neural, 72(7), 662-680.

HAMILTON Ontario (ON),

Bronovolaan 50

Canada2597 AZ DEN HAAG

distribution and composition in myelinated axons suppresses hyperexcitability following injury. Elife,

packhamt@mcmaster.ca

The Netherlands5(e12661), 1-26. doi: 10.7554/eLife.12661.

ronitwollstein@gmail.com,

kjboer@hetnet.nl

2.
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4. Calvo, M., Richards, N., Schmid, A.B., Barroso, A., Zhu L., Ivulic, D. et al. (2016). Altered potassium channel

5.

Spicher, C.J., Riedo, S., Packham, T.L. & de Andrade Melo Knaut, S. (2017). Neuropatic pain: Myth or reality?
e-News Somatosens Rehab, 14(2), 88-89.

6.

Spicher, C.J., Packham, T.L., Buchet, N., Quintal, I. & Sprumont, P. (2020 Mar). Atlas of Cutaneous Branch
Territories for the Diagnosis of Neuropathic Pain (1st edition in English stemming from the 3rdedition in
French published by Sauramps Médical) – Foreword: B. Kramer. Berlin, London, Tokyo, Shangai, New-York City:

SPICHER, Claude J

Springer-Nature.

CHT Switzerland

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Melzack, R. (1975) The McGill Pain Questionnaire: Major Properties and Scoring Methods. Pain, 1(3), 277-229.

Translational Neurosciences

Prof VOEGELIN Esther

8.

Spicher, C. & Kohut, G. (2001). Jean Joseph Emile Létiévant: A Review of His Contributions to Surgery andInstitute, Department ofMD

Rehabilitation. J Reconstr Microsurg, 17(3), 169-177.

Neurosciences and Movement

Hand and Peripheral

Dellon, A.L. (2000). Somatosensory testing and rehabilitation. Baltimore: The institute for peripheral nerve

Sciences,

Nerve Surgery, University

surgery.

Faculty of Sciences & Medicine,Bern,

10. Spicher, C.J. (2006). Handbook for Somatosensory Rehabilitation (1st edition). Montpellier, Paris: Sauramps

University of Freiburgh

Inselspital

Medical [The English translation of : Spicher, C. (2003). Manuel de rééducation sensitive du corps humain

FREIBURGH, Switzerland

BERN, Switzerland

humain (1ère édition) – Préface : J.-P. Roll. Genève, Paris: Médecine & Hygiène].

claude.spicher@unifr.chesther.voegelin@insel.ch

9.

11. Spicher, C., Barquet, O., Quintal, I., Vittaz, M. & de Andrade Melo Knaut, S. (2020 Jan). DOULEURSNEUROPATHIQUES : évaluation clinique & rééducation sensitive (4e édition) – Préface : F. Moutet. Montpellier,Paris : Sauramps Médical.
12. Spicher, C.J., Horisberger, F., Degrange, B., Freund, P. & Rouiller, E.M.. (2008). Static mechanical allodynia (SMA)
is a paradoxical painful HYPO-aesthesia: Observations derived from neuropathic pain patients treated withsomatosensory rehabilitation. Somatosens Mot Res, 25(1), 77-92.
13. Packham, T.L., Spicher, C.J., MacDermid, J.C. & Buckley, D.N. (2020 Jan). Allodynography : reliability of a newprocedure for objective clinical examination of static mechanical allodynia. Pain Med, 21(1), 101-108. doi.
org/10.1093/pm/pnz045
14. Packham, T.L., Spicher, C.J., MacDermid, J.C., Quintal, I. & Buckley, D.N. (2020 Mar). Evaluating a sensitive issue:
reliability of a clinical evaluation for allodynia severity. Somatosens Mot Res, 37(1), 22-27. doi.org/10.1080/0899
0220.2019.1704242
15. Létourneau, E. (2014). No Comment Nb 48. e-News Somatosens Rehab, 14(1), 31 (one page). Available (19th ofMarch 2020): http://www.neuropain.ch/sites/default/files/e-news/e-news_11_1_2.pdf#page=31
16. Packham, T., Spicher, C.J., MacDermid, J.C., Michlovitz, S. & Buckley, D.N. (2018) Somatosensory rehabilitation
for allodynia in CRPS of the upper limb: a cohort study. J Hand Ther, 31(1), 10-19. Available (19th of March 2020) :https://www.jhandtherapy.org/article/S0894-1130(17)30039-X/pdf
17. Krauss, E.M., Shankar, V., Patterson, J.J.M. & Mackinnon, S.E. (2020 Feb) Medical Malpractice in Nerve Injury of
the Upper Extremity. Hand (N Y), 1-7. Authors and contact details (listed from 1st to 4th)26

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HAND THERAPY

www.ifssh.info

HAND THERAPY

August 2020

Rehabilitation and is currently a PhD scholar in

The committee formed a strong working bond andMedical Sciences (Clinical Neuro-rehabilitation) atlook forward to rolling out planned ventures during

the University of Antwerp, Belgium. He is a Fellow of

our term of office (2019 – 2022).

the London Academy of Sports and Health Sciences inClinical Neurology Sciences and conducts research in

EFSHT
Virtual Congress:
1 – 4 September 2020

the area of rehabilitation of the upper limb in people
with stroke, among others.
Nigeria is the fourth corresponding member of the
IFSHT from the African continent (in addition to
Ethiopia, Ghana and Zimbabwe) and the 11th fromaround the world.
HAND THERAPY AND COVID 19
View the inspiring messages from our member
countries regarding hand therapy service delivery
during the global COVID 19 pandemic. https://ifsht.

Stacey Doyon (USA), Susan de Klerk (South Africa),org/page/hand-therapy-and-covid-19

Nicola Goldsmith (UK), Anne Wajon (Australia),
Maureen Hardy (USA), Peggy Boineau (USA)IFSHT EXCO MEETING: LONDON 2020
The current executive committee of the IFSHT was
fortunate to have had a face-to-face Exco meetingin London in February 2020. We were able to planand discuss the IFSHT mission and were also able tomeet with the organising committee for the London
2022 joint triennial Congress of the IFSSH and IFSHT(https://www.ifssh-ifsht2022.co.uk/default.aspx).

EFSHT Congress Presidents Vera Beckmann-FriesNEW IFSHT CORRESPONDING MEMBER: NIGERIA

and Marianne von Haller are excited to announce thatthey are preparing a web-based congress for the same

The IFSHT welcomes

dates (1-4 September 2020) during which the congress

Auwal Abdullahi, as

in Basel would have taken place. Sessions will takethe new corresponding

place in the late afternoons, enabling participants torepresentative fromcontinue working and still take part in the congress.

Nigeria, Africa.

They wish to offer participants the possibility to

Abdullahi is a lecturer

attend the congress and to benefit from the manyin physiotherapy atinteresting symposia the session organisers have put

the Bayero University,

together, despite restrictions placed upon us all by the

Kano, Nigeria. He holds

global Covid-19 pandemic. Visit the website for more

a BSc in Physiotherapy,

information: http://fessh2020.com/#welcome

an MSc in Neurological

28

Auwal Abdullahi

29

ART

www.ifssh.info

Art Exibit # 12

RESEARCH ROUND-UP

August 2020

Dupuytren’s disease- really a disease of theVikings ?

Michael Ng, Daniel J Lawson, Bruce Winney, Dominic Furniss
Journal of Hand Surgery (European)( Volume 45 issue 3 p 273-279 )What were your main reasons for writing this

Genetic studies can also have other more

article?

immediate benefits. For example, working with

Recent times have seen an explosion in thePaul Werker’s group in the Netherlands we wereamount of genetic data that is available. The costable to show that a genetic risk score calculatedof sequencing a person’s entire genome is fallingin patients undergoing surgery for DD was able

rapidly, and can now be achieved for around $1000

to predict surgical recurrence, even when the

US. Many of us will have our genomes sequenced todiathesis factors were taken into account (DOI:

aid in our medical care within the next 10-20 years.

10.1097/PRS.0000000000005208).
This study paves the way for precision medicine in

Compared to other specialties, genetic studies
in Hand Surgery are relatively uncommon.
However, they can have very important benefits.
For example, my group along with others havedefined the common genetic variants thatpredispose to Dupuytren’s Disease (see doi: 10.1056/
NEJMoa1101029; doi: 10.1016/j.ajhg.2017.08.006).
These studies have shown that DD is caused by lotsof different genetic variants each of small effectcoming together with non-genetic factors to cause
the disease – very different to the old teaching of
it being an “autosomal dominant disease”. Thesestudies have identified lots of new biological

Albert M. Mennen 201030

Hand Surgery.

“…we did not findsupportive evidence
that DD is a ‘diseaseof the Vikings’”

pathways that are important in the biology of DD,

With regards to this study, we were intrigued

and may represent new therapeutic targets. Someby the long-held notion that DD is a “disease ofof these are currently under further investigation,

the Vikings”. Whilst we know that there is someso watch this space.

evidence that it is more common in Northern

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RESEARCH ROUND-UP

www.ifssh.info

RESEARCH ROUND-UP

August 2020

4. Will you be conducting further research/

If you are interested in learning more about the

publishing further work on this topic? If so, what

cutting edge of DD research, please do come to thewill it entail?

2021 International Conference on Dupuytren’s and

My group’s work spans the spectrum of research

Related Diseases (https://dupuytrensymposium.org)

from bench to bedside, encompassing genetics,

to be held in Oxford, UK in September 2021.

epidemiology, experimental medicine, clinical
trials, and health economics.
As well as continuing to work on Dupuytren’s
Disease, we also study the genetic origins of other
hand surgery conditions such as carpal tunnel
syndrome and osteoarthritis (see doi: 10.1038/
s41467-019-08993-6).
Our studies have also expanded to cover nonhand conditions (see doi 10.1101/2020.05.14.095653;
doi 10.1038/s41467-019-13145-x). In the future, weEuropeans, the evidence for a specific Norse

3. What should all hand surgeons and handwill increasingly use studies of single cells frominheritance is surprisingly weak. We set about

therapists reading your article understandpatients to provide an increasingly granular picture

trying to prove or disprove the theory from aabout the findings of your research?

of the biology of disease (see doi 10.1038/s41467-

genetic viewpoint.

For me, the most important lesson from this020-16264-y).

study is to constantly question dogma. Much of

Answers by:
Dominic Furniss DM MA MBBCh FRCS(Plast),

2. What are the most interesting/important

hand surgery and hand therapy is passed down

Sometimes, we also discover interesting things

Associate Professor, University of Oxford,

results and conclusions of your article?

from master to apprentice, with little room forabout biology in general. For example, we were the

Botnar Research Centre,

We looked for evidence of excess Norse inheritancequestioning the orthodoxy. Only if we constantly

first to discover genetic variants pre-disposing to

Honorary Consultant, Department of Plastic andin DD in several ways. Firstly, we hypothesised thatchallenge the “facts”, and generate high quality

being left handed (doi 10.1093/brain/awz257), andReconstructive Surgery,patients with DD would show a higher prevalence

evidence, will we move our specialty forwards.

correlated these variants with structural changes

Nuffield Orthopaedic Centre, Oxford,of Norse “Ancestry Informative Markers” compared

Research really is the future of Hand Surgery.

in the brain of left-handed people.

Oxford, OX3 7LD, UK

to controls. Next, we hypothesised that the DD
associated genetic variants would show an excess

We are driven forward by our patients demandingof Norse inheritance compared to sets of genetic

better care, and new treatments with better

variants drawn randomly from the genome. Thirdly,

efficacy and fewer side effects. We also use our

we looked to see if the genetic regions associatedskills in big data analysis and statistics to study

with DD were under more population specificthe epidemiology and health economics of handselection.

surgery conditions, giving insights into the costs,
effects and complications of surgical treatments in

Finally, we looked to see whether areas of thenational and international datasets.

UK with known high Norse influence (eg Scottish
Highlands) carried a higher genetic risk score

Finally, analysis of big data is being revolutionisedfor DD compared to other regions in the UK. In all

by artificial intelligence and related techniques.

analyses, we did not find supportive evidence that

Our group is exploring the potential applications

DD is a “disease of the Vikings”.

across a wide variety of applications.

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MEMBER SOCIETY NEWSwww.ifssh.info

August 2020

MEMBER SOCIETY NEWS

Member Society
MEXICAN SOCIETY FOR SURGERY OF THE HAND (AMCM)			

AMCM hand surgery meeting

Board members 2019-2021

Tlaxcala, Mexico
The following photos are from the successful AMCM Meeting in Tlaxcala, Mexico, which was attended by about
200 local and international delegates.

Dr. Joaquin DiazDr. Denisse Hernandez– Vice-president– Treasurer

Dr. Juan Ramon Bonfíl

Dr. Gilberto Herrera

Dr. Ulises Valero– President– Secretary– Secretary

Dr. Francisco García

Dr. Ignacio Bermudez

Dr. Emmanuel Ruiz

Dr. Victor Azpeitia-Lira – Vocal/Member– Vocal/Member– International– Volunteer surgical

Delegate

34

missions coordinator

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MEMBER SOCIETY NEWSwww.ifssh.info

17th South American Hand Surgery Meeting/35th Colombian hand surgery meeting - Cartagena, Colombia

August 2020

MEMBER SOCIETY NEWS

Altruistic Hand Surgery Missions.
For more than 20 years under the leadership of Dr

In alliance with the ASOCIMANO Colombian Society for Surgery of the Hand, Mexican hand surgeons and hand

Victor Azpeitia, our association has offered weeklong

therapists participated in the 17th South American Hand Surgery Meeting in Cartagena, Colombia.

free assistance once or twice per year to underresourced areas to diagnose and perform surgery
on all kinds of hand pathology, including congenital
differences.

“Una mano para tus manos” or “A hand to your hands”
surgical campaign.
Our International delegate Dr Emmanuel Ruiz with cooperation from his Hospital Muguerza Sur, establisheda regular campaign to pediatric patients in needof hand management in the northern part of the
Mexico. For the 3rd year in 2020, Dr Ruiz and many
volunteer surgeons, residents, anesthesiologists andhand therapist collaborate to make a change in thesechildren’s life, offering hand surgery and therapy
totally free.

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MEMBER SOCIETY NEWSwww.ifssh.info

MEMBER SOCIETY NEWS

August 2020

scheduled to for podium presentation and symposia.

Seminars”

THE ASSOCIATION OF CHINESESPEAKING HAND SURGEONSUNITED (ACHSU)			

We also have adopted webinar communication to keep

Due to pandemic of Covid19 in first half of this year, theMembers of the Association have been actively

updated. The advantage is that more experts from all

major Congress of the year of the Chinese-speaking

involved in online international educational activities

over the world can participate. Our President, Dr. J.R.

Association which was originally scheduled forthrough WeChat and Zoom. Drs. Zeng Tao Wang, Bo

Bonfil co-ordinated a large group of surgeons from Latin

early May was replaced by a virtual congress. Case

Liu, Chao Chen, Jun Tan and Tian Mao have delivered

America, Spain and Italy.

discussion, seminars, and online education sessions

online courses, and Jin Bo Tang was invited to lecture

The faculty uses different platforms but with a common

have regularly been carried out through WeChat andthrough Zoom to audiences in South America, United

objective, the sharing of knowledge in hand surgery

Zoom conferences. Since national and international

States of America, England and Asian countries.

with interactive participation between presenters andtravels were curtailed and the patient volume which

attendees.

decreased to less than 40% of the normal workload in

In fact, about 5 years ago, lecturing and conferences

the first 6 months of this year, members had more timethrough WeChat had become a major platform forWe thank all the doctors, students, residents, medical

for local conferences and educational forums withinconferences in conjunction with the main congresssocieties that walk side by side with us on thistheir own cities and in their own departments.

venue in mainland China. This hybrid conferenceContinuous medical education during the COVID-19
pandemic: “Seminarios Quedate en Casa” or “Stay Home

Again these will be presented as a virtual congress
instead in September 2020.

format enabled participation of members all overunprecedented journey.

our vast country as well as accommodating the huge
number of practicing hand surgeons in China. One
previous conference of our Association which washeld in 2016 had about 2000 “virtual” hand surgeons.
These virtual courses, conferences and congresses are
now a well-accepted format of sharing knowledge andacademic discourse.
Secretary of ACHSU: Chao Chen(853029430@qq.com)
Corresponding author: Jin Bo Tang
(jinbotang@yahoo.com)
For the last 5 years, The Association of Chinesespeaking Hand Surgeons United has used a
hybrid format for their on-site Congresses andsimultaneous real-time virtual broadcasting through
WeChat. This allows up to 2000 additional Hand
Surgeons throughout China to participate using
their smartphone App.
The 25th Anniversary Congress of the Federation ofEuropean Societies for Surgery of the Hand (FESSH)
invited our Association as their Guest Society.
More than 50 presentations from Chinese-speaking
hand surgeons were accepted and many have been

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MEMBER SOCIETY NEWSCHILEAN SOCIETY FOR HAND
AND MICROSURGERY 			

www.ifssh.info

August 2020

MEMBER SOCIETY NEWSWe know that this disease may fade away but hope thatwhat we have learned, what we valued most, will linger
forever and that friends can reunite again soon.

Dear friends and members of the IFSSH,
Sincerely hoping that everyone is healthy and well,Reflecting on the last months of 2019 and the first 6
months of 2020 many things come to mind.

Sociedad Chilena de Cirugía de Mano y Microcirugía

As probably many of you know in October 2019 a social

THE ECUADORIAN SOCIETYFOR SURGERY OF THE HAND
(ECUMANO)		

uprising occurred in Chile that lasted almost to the firstweek of March 2020, when all the attention and worries
shifted to the pandemic which caused the first victims
in our country, and it is still hitting us hard.

How the Sociedad Ecuatoriana de Cirugía de la Mano

This made us understand how vulnerable wetook advantage of the COVID 19 Pandemic.

are, especially those struggling with poverty anddiscrimination, but also made us understand how

The Ecuadorian Society for Surgery of the Hand

strong and adaptable we can be.

(ECUMANO), is a young Society. It was only recently
accepted as a member of the IFSSH at the last triennial

We were struck once again with the notion that as

Congress Berlin 2019. We had planned various courses

health care professionals we have a responsibility; weand academic meetings and activities for this year.

have a role in our society to provide comfort and hope.

We started organizing our first international course on

We are asked to be role models. Professional success,distal radius fractures in Ecuador in April, and have

wealth and other superficial things often grab us andbeen working for months.

steer us away from our calling, but for most of us thisCOVD-19 pandemic has been a wakeup call.

Invitations were sent out, and it seemed the dreamwas about to realize. Surgeons from different areas

We are a society of hand surgeons, but most of all, westarted to register and the financial resources wereare an organized group of friends that can offer morecovered. But suddenly the dream began to transformthan just hand surgery.

into a nightmare, all caused by the pandemic. First we

Most of our members are doing voluntary work

delayed the Course, and then it was cancelled. As thee.g. performing necessary surgery on vulnerable

pandemic became worse, courses and congresses all

patients who were put on a waiting list because of theover the word were being cancelled.

pandemic, or they donate money, clothing, food andtime, and a reassuring smile for those in need.

The executive of ECUMANO decided that these
difficulties should be taken as the opportunity to

It has been a time for social distancing but emotional

evolve. The Members took a decision to make thecloseness. We have never asked so many times, to soSociety “more digital”. The recently envisaged Course

many people and so sincerely: “Are you and your family

has now been transformed into the “first virtual courseOk?

on injuries of the distal forearm”.

We have never been so flexible, so adaptable and eager

After some planning and obtaining the necessary

to be a part of the solution rather than part of theresources, the virtual course took place in June

problem.

engaging senior Hand Surgeons from Latin America

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MEMBER SOCIETY NEWSwww.ifssh.info

MEMBER SOCIETY NEWS

August 2020(see fliers). It was a great success with more thanboard of directors and department heads managed

An epidemiological investigation team from the Korea

With only twenty percent of the hospital inpatientsa thousand attendees from 15 countries. Online

to sit together at 03:30. We had to decide what to do

Centre for Disease Control and Prevention (KDCD)

and no outpatients it was somewhat awkward in the

Courses have the added advantage that it allows morewith the 260 inpatients and how to inform them ofarrived and reviewed all the CCTV footage from the

beginning with too many employees. At that time, thedelegates to attend, apart from saving on travel andthe unpleasant news, not to mention the roughly 1000

hospital to analyze the flow of human traffic to reveal

explosion of confirmed cases from the now infamous

accommodation costs, as well as time away from home.

outpatients arranged to visit the clinic. Foremost, theall close contact incidences of the infected employee.

religious group overwhelmed Daegu leaving many

1000 outpatients and 65 operations booked for that

Fourteen people who were in close contact went

people stricken with panic and full of fear. Some

The pandemic is a hard blow to everyone all over the

day were to be cancelled by phone call explaining theinto self-isolation at home for two weeks. Sixty-five

employees from other hospitals in Daegu refused toworld. However, it forces one to be innovative and takesituation, a relatively easy decision to make comparedpeople who were identified within the contact group

work, accepting no pay and even risking job loss. At

advantage of new opportunities. As a young and small

with what was to be done with the post-operation

underwent COVID-19 tests immediately. Usually the

our hospital, another meeting was arranged to discuss

Society we are proud to have been able to hold a majorpatients in the hospital. We had to decide what to doresults were released six hours later, but because of

the temporary overstaffing issue and also emergency

course with quality and excellence.

with the patients who were recovering from operations

the sudden outbreak in Daegu at that time, the results

surgery. We reached a consensus to use vacation

but needed further observation or management. Also,

were delayed and we had to wait one and a half days

days to deal with overstaffing. In terms of emergency

if any discharged patients developed symptoms

which was a nerve racking experience. Miraculously,

surgery, there were many negative opinions on accountof COVID-19, it could result in serious community

all 65 people tested negative, which was, I believe,of the fear of infection. At that time, one of the scrub

infection.

attributed to the rigorous prevention measures taken

nurses persuaded those who were negative to resume

since January. We had already limited entrance to thenecessary surgery. These were her words: “I am alsoThis was to feel like the longest most harrowing nighthospital, instructed all staff members and patients to

struck with fear, worried that I might place my familyof my life. It was just the beginning of our combat

wear masks, and wash their hands frequently (Figure 1)

in danger when returning from work in the hospital.

KOREAN SOCIETY FOR SURGERY
OF THE HAND

against COVID-19. This unprecedented situation

Remaining open is essential as W hospital is thesuddenly before us, triggered hours of lively debate as

number one Hand and Reconstructive Microsurgery

we explored all the options and potential outcomes.

Centre in Korea. We pride ourselves on helping thoseThis ‘think aloud’ discussion went on until dawn whenin need. Although COVID-19 could pass by without

the sun rose. At ten in the morning, this bad news

any serious symptoms, it can also be fatal. But to be

would be announced nationwide by TV, SNS, and otherafraid of this and avoid emergency operations on

media hence the overnight meeting discussing ourbroken or amputated hands and feet, the medical

patients’ welfare. We decided to be transparent andstaff at W hospital would sacrifice its pride. If we doinform people as it is, and ask for their understanding.

not take care of our patients, who would? Retired

In-hospital announcement, web page updates, text

medical professionals returned to help, and even staff

messages and also letters were chosen as delivery

from other cities are coming to the aid of the now

methods. Tasks were assigned to the respective

overstressed Daegu medical workers.

departments. One hundred and seventy patients who

Figure 1. Entrance control at the main gate of the

had no contact with the infected employee, those

hospital to check body temperature and travel

whose antibiotics were discontinued following surgery,history.

How the “W Hospital”, Daegu, Korea, manages toand those who could manage with just oral antibiotics,

combat COVID-19

were to be discharged from hospital first thing in the

Our hospital was reopened after two days of a fullAt around 2am on 19 February 2020, I was woken by anmorning. Those leaving hospital were to be instructed

disinfection process following KDCD requirements. Byurgent phone call from the Daegu Disaster and Safety

to self-quarantine for two weeks. I, as representative

this time, Dalgubul-daero, the biggest street in Daegu,

Countermeasure Headquarters on COVID-19 informingof this hospital, personally sent messages to every one

which our hospital faces, was empty except for theme that one of our employees had tested positive forof the 90 inpatients who had to stay in hospital and tofrequent passing ambulances (Figure 2). It was likethe COVID-19. The employee, who worked on the first

those who visited our hospital during the previous two

a ghost town, with only sirens breaking the silence.

floor of the radiology department, had already been on

weeks informing them of our situation and to ask them

Although our hospital opened after the mandatory

Figure 2. The biggest street in Daegu which oursick leave for two days with cold and flu symptoms.

to visit a designated screening center if any of theclosing period, not one patient visited as we were on

hospital faces, was empty except for the frequent

An emergency meeting was called and doctors on thesymptoms developed.

the ‘closed hospital list’ broadcast on live TV news.

passing ambulances.

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MEMBER SOCIETY NEWSwww.ifssh.info

MEMBER SOCIETY NEWS

August 2020

I believe we should contribute to help our community

parking lot, a drive-through corona virus testing station

year (Figure 7).

in any way we can. I volunteer to scrub for emergency

was set up following the government guidelines (Figure

To perform emergency cases and elective operations,operations, and believe many of my co-workers would4). A public relief hospital service was also set up fordaily temperature checks were performed on all

do the same.”

outpatients. Fortunately, two public health service

employees without any exception and an entrance

doctors from the Korean Ministry of Health and Welfare

control center was set up to restrict family visits andwere appointed and worked with us for two weeks. W

enforce mask wearing, hand washing, and continuous

Hospital surgeons who had fewer elective operation

disinfection. All the patients who were scheduled forschedules volunteered in the Emergency Room andsurgery underwent screening tests in advance.

other public health centers.

Figure 3. Emergency replantation operation wearing
four-set protection equipment.

“

If testing was not possible before the operation due…tested negative,
which was,...
attributed to therigorous prevention
measures taken since
January”

Figure 5. The number of daily confirmed new

to severe injury, operation staff donned four types

COVID-19 cases in Korea and Daegu. four-set

of protective wear during the surgery. In addition,

protection equipment.

the operation room was closed down and rigorous
disinfection followed. The patient was then sent to
an isolation ward. Our hospital has four wards with a
total of 260 beds; one is used as an isolation ward forpatients with fever and patients who were operated
without first taking a corona virus test. Every timeafter an admitted patient developed fever a screening
test was done. The wait time for the result was likea recurring nightmare. If there were to be anotherpositive test, we all had to go through the samedifficult process of sending inpatients back, cancelling
operations and closing the hospital for a few days
again.

Since the first confirmed case in Korea on 20 January,

Figure 6. The number of cumulative cases ofa total of 11,503 people have been confirmed positive

COVID-19 in Korea and Daegu.

The war against COVID-19 is far from over and we arefor corona by the end of May, of which 6,884 werestill walking on thin ice which can break any day.

born in Daegu, accounting for 60 % (Figures 5 & 6). In

For a large general hospital to remain operational

the same period, the KCDC (Korea Centre for Diseasea lot of effort needs to be done. Everyone, including

Control and Prevention) reported that 271 people

all medical and non-medical workers, in- and out-

Figure 4. Drive-through COVID-19 screening centerhad died of corona, of which 186 (68%) occurred inpatients, their family members, employees of theat the parking lot right next to the hospital.

Daegu. These statistical figures show how serious

outsourcing companies which deal with parking andthe COVID-19 was in Daegu at the time. Comparedcleaning, and even the snack bar part time workers

After the meeting having been encouraged by thesewith last year, the number of elective and emergency

who come in and out of hospital have to be closely

touching words, we actively informed the local media,

operations and the number of outpatient and admitted

monitored. All the aforementioned people and theirbroadcasting outlets and university hospitals that ourpatients has decreased dramatically. Despite thefamily members are a composite part of the hospital.

Emergency Room was open and we would continue toharsh measurements between 19 February and the

No longer do I fall asleep from the daily work within

perform emergency operations (Figure 3). We provided

end of May, we successfully carried out 3,119 hand andfive minutes.

sufficient masks, face-shields, protective clothing,orthopedic operations, both elective and emergency

hand sanitizers and thermometers to all our employees

cases, without additional infection of patients and any

Figure 7. Comparison of the numbers of elective

With COVID-19 ever close by, restlessness and worry

with the help of the Daegu Medical Association andstaff. Fortunately, since May, all statistical numbers

and emergency operations at W Hospital in 2019 &rob me of peaceful sleep, causing me to wake up

public health centers. Additionally, in the outdoor

have increased again to around 90% compared to last2020.

several times in the early hours, paralyzed with

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MEMBER SOCIETY NEWSwww.ifssh.info

MEMBER SOCIETY NEWS

August 2020

fear and anxiety over the potential risks, and even

Sport facilities were closed from 17 March until 29 May

themselves at home or in the garden, which is more

suffering from heartburn. However, my harboredand ski resorts had to remain closed after 15 March.

than double the percentage of a week before the

doubts about the ability to overcome this COVID-19

Sport Trauma injuries are one of the most common

quarantine period (22.75% per average in week 7-10).

situation has transformed into a determination,

presentations at the Department of Trauma Surgery ingaining confidence from the successes achieved overInnsbruck, Tyrol. During the time of the pandemic, theHand surgery in Innsbruck has therefore certainly

the last few weeks and the proud teamwork of ourwork routine at our department changed dramatically.

changed significantly during the SARS-CoV-2 outbreakhospital staff. As everybody should, I have to protect

Not only did the total numbers of cases decreasein Tyrol. Elective operations had to be postponed frommyself; aware that everyone I come into contact withsignificantly, but also injury patterns changed.

16 March onwards and only emergency operations

could be a positive carrier. I work with the mindset

were performed, averaging one per day. But since weekthat even if I were infected, the patient I operate on

In week 7-10, before the first restrictions were22, the number of patients treated at the Department

should not get infected, resulting in the maximum

implemented, about 836 patients per week were treatedof Trauma Surgery in Innsbruck has increased again,use of protective gear. For the last three months, I

at the Department of Trauma Surgery in Innsbruck,

similar to previous years.

have gone nowhere but to the hospital and my home,which is similar to recent years (2017-2019; n= 845).

minimizing contact with people. At home I use aDr. Sang Hyun Woo

During the lockdown, the number of patients treated at

It remains to be seen whether a second wave of SARS-

separate bathroom. I eat alone and maintain distance

W General Hospitalthe emergency department decreased steadily every

CoV-2 infections will occur due to border openings,

from my family members.

W Institute for Hand & Reconstructive Microsurgery

week. The lowest point was reached in week 13 withloosening of contact bans, and lifting of restrictions in

Daegu, Korea

202 patients per week.

Austria.

Interestingly, the percentage of diagnosed hand

References

dramatically and many scheduled operations have

AUSTRIAN AUSTRALIAN HAND
SURGERY SOCIETY

injuries and forearm injuries increased during this[1] https://www.who.int/dg/speeches/detail/who-been cancelled. However I have been deeply moved

Traumatic Hand- and Forearm Injuries during SARS-

time. While hand injuries and forearm injuries

director-general-s-opening-remarks-at-the-media-

that many patients still came to receive scheduled

CoV-2 pandemic 2020accounted for 22% of all treated injuries in years 2017-briefing-on-covid-19---11-march-2020, website WHO, 11

2019, the percentage rose to 30% in week 13 in 2020.

March 2020

Due to the severity of the situation in Daegu, thenumber of patients in our hospital has declined

operations from other cities in Korea as well as fromother countries. I am deeply humbled and grateful for

On 11 March 2020 the WHO classified the outbreak ofFurthermore, amputations increased from an average[2] https://info.gesundheitsministerium.at/, website

their trust towards our professionalism at W hospital,

the Severe Acute Respiratory Syndrome coronavirusof 16 per week during the years 2017-2019 to 28 in

Ministry of Health Austria, 08.07.2020

and am determined to continue with dedication. I

2 (SARS-CoV-2) in 114 countries, with a combined

2020. In week 7-22 the most frequent hand injuries

believe doctors and nurses should dedicate their

total of 118,000 cases, as a pandemic [1]. In Austria,

and forearm injuries were cuts and stabs (n= 394),

Dr. Conelia Ower

abilities to their patients. They depend on us.

the first cases of COVID-19 were confirmed on 25

contusions and sprains (n= 770) and bone involvement

Department of Trauma Surgery,

My sincere thanks go out to all our staff members who

February (week 9) in Innsbruck, Tyrol. By 13 March(n= 592). During the same period, fractures of the hand

Medical University Innsbruck,

work day and night, remaining professional despite(week 11), the number of confirmed SARS-CoV-2 cases

and forearm decreased to less than a third per week (n=Tyrol, Austria

the grave personal risk ever present.

in Austria increased to 208 [2]. On 13 March, Tyrol, an15) as compared to levels before the restrictions (weekAustrian federal state, had been added to the list of

7-10; average n= 59). Contusions and sprains dropped

I witnessed heroic moments from my fellow workers

risk areas for an infection with SARS-CoV-2. Several

to on one-eighth (n= 7) of the baseline per week (weekthrough this experience. I want to thank all myrestrictions were implemented over the following

7-10; average n= 60)

overseas friends who expressed their concern anddays. From 15 March onward, people were not allowed

provided encouragement. I am also thankful for all theto leave their houses without a reasonable excuse. On

One reason for these findings is certainly the different

and limit the infection rate. International travel has

unexpected encouragement, supplies and attention

17 March (week 12) the restrictions were expanded:leisure time behavior of the population in times ofbeen banned. Australians returning from internationalfrom many companies from around the country. We

all restaurants, bars and clubs had to remain closed.

restrictions and lockdown. As soon as ski resorts

travel are quarantined. The states within Australia

are still safely hanging in here thanks to the devotion

For all Tyrolean communities quarantine was orderedand sport facilities were closed, acute injuries fromhave also been isolated. Elective surgery in both theand commitment of our mighty fellow workers.

from 18 March to 7 April (week 12-15). During this time

this sector were eliminated. Many patients reported

private and public sector was ceased. The private

period, all outdoor sport activities were prohibited.

having injured themselves while doing work at homehealth system and hospitals were commandeered

and gardening (n= 691). In week 13, 62% of patientsand controlled by the state and federal governments.

with hand or forearm injuries claimed to have injured

Emergency and urgent surgery continued under46

AUSTRALIAN HAND SURGERY
SOCIETY (AHSS)
Australia has been able to isolate from the pandemic

47

MEMBER SOCIETY NEWS

strict guidelines formulated by the state and federal
governments. One of the biggest challenges Australia
faced was the lack of personal protective equipment

www.ifssh.info

BELGIAN SOCIETY FOR SURGERY
OF THE HAND

MEMBER SOCIETY NEWS

August 2020

first prize was awarded to the highest grade who was
Michiel Cromheecke. His reward is free registration for

COLOMBIAN SOCIETY FORSURGERY OF THE HAND

the next FESSH or IFSSH meeting.

(PPE).
The Belgian Hand Group is proud to announce that on

The level of knowledge on hand surgery was high. All

While Australia did have a stockpile of PPE it was

27 June 2020, the first candidates for the Belgian Hand

examiners were very pleased to have noticed that theestimated that this would only last for one month. We

Surgery Certificate (BHSC) have successfully obtained

students learned much and demonstrated a profoundwere unable to source PPE and facemasks, in particular

their certificates! This 2-year inter-university training

and practical knowledge of hand surgery, which is the

N95 masks. Because of our isolation and the quarantine

was introduced in 2018, jointly organized by the 7intention of this BHSC course. We are convinced andmeasures that had been put in place, the anticipatedBelgian universities. The students are taught handpleased to have contributed to a higher level of quality

impact of the pandemic did not occur. Most states have

surgery at a basic level with theoretical and cadaveric

for future hand surgeons and are sure most of these

ASOCIACIÓN COLOMBIANA DE CIRUGÍA DE LA MANO

now removed the restrictions on elective surgery. In

courses in 8 separate 2-day modules. This education

candidates will further their career, hopefully with a

NIT. 830.054.636-7

early July some states experienced an increase in thecan prepare the students for the European Diploma

very successful European Diploma in Hand Surgery innumber of Covid-19 infections and as a result still havein Hand Surgery examination later in their careers

the coming years.

restrictions in place. The AHSS is working with theafter the required fellowship training. The admission

Royal Australian College of Surgeons, the Australian

to this course is subject to a selection procedure by

The next cycle for the BHSC is 2020-2022 - Morethought that it would be so fast and so forceful; we

Orthopaedic Association and the Australian Society

the BHSC steering committee in accordance with all

information at:were thinking it was an isolated virus in a distantof Plastic Surgeons to monitor the impact and theour universities’ internal regulations. It is open tocountry and at the moment we are in quarantine

response to Covid-19. We have come to realise that

European and extra- European orthopaedic, plastic orwithout reaching a peak. As medical personnel wefacemasks, eye shields, temperature monitoring andgeneral surgeons and residents, preferably in their last

constantly live in the anxiety of getting infected

hand washing have become a part of normal practice.

2 years of internship.

personally or those we love. The personal protection

As everyone knows, the pandemic affected our
professional practice and our personal life. We neverhttps://www.bhsc.be/equipment (PPE) has been insufficient and it is up toeach one to take the necessary measures.

In March 2019 the AHSS held a combined scientificThis first cycle was a tremendous success, in spite ofcongress with the Asian Pacific Federation of Societies

the first unexpected COVID 19 challenging months.

for Surgery of the Hand and the Asia Pacific Wrist

There were 21 students who finished the course

Our customary ‘face-to-face’ 36th Congress, which

Association. As a result of Covid-19 restrictions somesuccessfully and obtained the first BHSC certificates

was scheduled to take place in the city of Barranquillacountries were prevented from attending. Our initialafter fulfilling all requirements which included

in Colombia from 26 – 29 August 2020, will now takeregistration of approximately 1600 people fell to justattendance, examination, a publication, a paper andplace virtually on a new date, 25 – 26 September 2020.

below 1000 registrants. The last day of the four-day

a presentation on a topic of hand surgery. Due to theAlso, the bi-national Congress on Hand Surgery inmeeting was cancelled because of concerns about thecorona pandemic, the last 2 modules had to be re-conjunction with our colleagues in Venezuela whichrisk of infection. Fortunately, to our knowledge none oforganized online, which was a challenging and fast

was planned to take place on 27 November 2020,

the attendees contracted Covid-19. We now watch theadaptive procedure for the teachers and students.

has been cancelled due to the pandemic as well as
their current political and social situation. It will be

rapidly increasing number of people that are infectedaround the world and are acutely aware that we could

It was decided to organize the dual jury exam online

be in the same position within a short period of time.

as well. With the support of both our research andrescheduled.

education center (IORT) and a profession meeting

Fortunately we live in an era in which we can use

Jeff Ecker

organizing organization (‘Meet U There’), we managed

virtual devices and platforms such as webinars. This

President: Australian Hand Surgery Society

to establish a fully online live event exam with 16

allows us to carry out high-level scientific events(Editor: at the time of going to press, new strict

examiners, 4 juries and 22 candidates. Even the paperin partnership with the trade. It also allows us to

lock-down measures have been imposed in“defenses” occurred virtually. Every candidate was able

strengthen our bonds of brotherhood between Latin

Australia)

to undergo the examination in their preferred language

America and the rest of the world, and at the same time

viz. Dutch, French or English. The deliberation andimprove our medical education and knowledge for thethe results were organized in a joint online event. The

common welfare.

48

49

MEMBER SOCIETY NEWSBRAZILIAN SOCIETY FORSURGERY OF THE HAND (SBCM)

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MEMBER SOCIETY NEWS

August 2020

In addition we have the kind co-operation of

11 June:distinguished colleagues from South America andVirtual Clinical Athenaeum: Elbow fracture-

worldwide. This also resulted in a webinar partnership

dislocations. Simplifying the complex.

During this pandemic period all public health efforts

between the presidents of the Brazilian Society for

https://www.youtube.com/watch?v=WUWtRhPwQpg

and resources are directed towards combating theSurgery of the Hand, João Baptista Gomes dos Santos,

Covid-19 virus. The professional activities of theand the Latin American Federation, Jefferson Braga

26 June:Brazilian hand surgeons were greatly compromised

Silva.

46th Hand Surgery and Upper limb Updating

and are limited to emergency cases only.
The activities of the Brazilian Society for Surgery of
the Hand (SBCM) also suffered a great deal with the

ASOCIACION ARGENTINA
DE CIRUGIA DE LA MANO Y
RECONSTRUCTIVA DEL MIEMBROSUPERIOR

arrival of the Covid-19 pandemic. We do not foresee,

Course. Update on Peripheral Nerve Surgery. It wasa live virtual course with interactive participationof the audience, which was transmitted from our
AACM headquarters. We had as foreign guests
Joaquim Casañas (Spain), Jorge Clifton (Mexico) andin the short term, significant changes in the public

Due to the serious health situation of the Covid-19

Orlando Merced O'Neill (United States). We also had

health scenario. We were therefore obliged to makepandemic, the Government of Argentina has mandated

outstanding local speakers.

adjustments to the administrative, teaching andpreventive and obligatory social isolation from 20

https://www.youtube.com/watch?v=sUWho-YIXcc

training activities.

March 2020.
7 July:The 2020 Annual Congress, which, for the first time,

Since then, all scientific activities scheduled for thisParticipation of our Presidents in the Monthly Session

was to be held in the Amazon region, unfortunately had

year were suspended. For this reason, we had to adapt

with the Mexican Association of Hand Surgery.

to be canceled, as this region was strongly affected by

A webinar about congenital hand deformities.

to the new health situation, and we turned some of our

the infectious disease.  

Chair: Dr Henrique de Barros (2021 President electactivities into virtual events.

of SBCM)
Virtual AACM activities during the Covid-19 pandemic

The efforts of the Board of Directors was then focusedon maintaining, and even expanding the teaching andWe hope to overcome the current difficulties in searchcontinuing education activities through the electronicof better times, for a safe return to our noble practice.

17 April:
Virtual Clinical Athenaeum: MIPO technique inmedia. The podcast of SBCM called ‘Handcast’ wascreated by Webmão. The numbers of attendees

Dr. João Baptista Gomes dos Santos

humerus. From novice to expert.

increased markedly with the weekly webinars.

President

https://www.youtube.com/watch?v=g4Soi7t_Ffk&t=3s

Dr. Maurício Pinto Rodrigues

23 April:

Secretary

Videoconference
SOS, ART patient
https://www.youtube.com
watch?v=l6YAQaHyMFw&t=22s
28 May:We give each other a hand. Discussion of problem
cases contributed by AACM members.
https://www.youtube.com/watch?v=7napVT41ilM
4 June:Promedon Webinar Series: Hand and Wrist. Ulnar side

The logo of the Brazilian podcast, ‘Handcast’.

50

pathology of the wrist.

51

MEMBER SOCIETY NEWSwww.ifssh.info

Dr. Violeta Levy (2018 President):

10-12 September:

Vascularized bone grafting in upper limb

Advanced Course in Experimental Microsurgery

Dr. Enrique Pereira (2020 President):

TO BE RESCHEDULED

Current concepts in osteosynthesis of the distal

Cadaveric Course of Pediculated Flaps in the Upper

humeruLimb Injected preparations.

Dr. Alvaro Muratore (2021 President):

Enrique Pereira

Current concepts in osteosynthesis of the distal radius

President

Dr Martín Caloia (2019 President):

Gustavo Teruya

Treatment of scaphoid nonunion, my preferences

General Secretary

Next 2020 Scheduled Events:

Pablo E. Zancolli

August 2020

MEMBER SOCIETY NEWSPaul Pereira
13 August: Virtual Clinical Athenaeum: A B C in the

Executive Committee

management of tumors.

52

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The history of Hand Surgery at
the University Hospital
Polyclinic of Modena, Italy

At the May 1977 IFSSH Delegates Meeting in Edinburgh,
Bedeschi proposed a triennial IFSSH Congress, which
was adopted. The first IFSSH Congress was held in
Rotterdam, The Netherlands in 1980.
In 1978 Dr. Antonio Landi attended the Microsurgery
Centre of Bernard O’Brien in Melbourne, Australia for
four months. On his return to Modena, Landi was put incharge of micro-vascular services.
In the autumn of 1980, Proff. Mario Boni of Pavia andPaolo Bedeschi of Modena, in collaboration with the

PAOLO BEDESCHIITALIAN SOCIETY FOR SURGERY OF
THE HAND HONORARY PRESIDENTIFSSH PIONEER OF HAND SURGERYPAOLOBEDESCHI@GMAIL.COM

ANTONIO LANDI
ITALIAN SOCIETY FOR SURGERY OF THE
HAND PRESIDENT (2001-2003)
HAND UNIT CASA DI CURA TONIOLO, VIATOSCANA 34, BOLOGNA 40141, ITALY
LANDI_ANTONIO@VIRGILIO.IT

Ministry for Universities, were successful in introducing
Figure. 1 Modena, April 1964, first instructional Hand

Hand Surgery teaching into the Medical Degree Program,

Surgery Course. From left: Prof. Oscar Scaglietti,

which also involved the establishment of a Professor

guest of honour and lecturer, Dr. Paolo Bedeschi,

of Hand Surgery. In 1981 Prof. Alessandro Caroli fromSecretary of the Course and Prof. Augusto Bonola,

the University of Modena became one of the first

Director of the Course.

associated Professors of Hand Surgery in Italy, andunder his direction the Hand and Microsurgery Unit at
the Modena Polyclinic was established and became theProfessor Augusto Bonola: the founderDepartment, adequately equipped to treat all types of

In 1946 Prof. Augusto Bonola became the first Professor

orthopaedic conditions, particularly severe and complexof Orthopaedics at the University of Modena and started

injuries of the upper limb.

an Orthopaedic Clinic in the old Modena Polyclinic.

In April 1964 Bonola organised the first Instructional

regional centre for severe upper limb injuries and limb

Course in Hand Surgery in Italy in Modena (Fig. 1).

replantations. Caroli was elected SICM President from1985-1987.

Augusto Bonola was one of the eight founding members“La Mano” (The Hand), a treatise written in Italian by A.

of the IFSSH in Chicago in January 1966.

Bonola, A. Caroli and L. Celli, was published in 1982 [4].

In January 1964, the first issue of the “Rivista Italiana di
Dr. Paolo Bedeschi, who was an assistant in the

Chirurgia della Mano” (Italian Journal of Hand Surgery)

From 1967 to 1985:

From 1986 to 1998: the dawn of FESSH

Orthopaedic Clinic of Modena, visited Prof. Erik Moberg

was published in Italian.

Microsurgery of nerve lesions was introduced into the

Figure 2 captures a meeting held by the members of

Modena Clinic in 1967 by Bedeschi, who presented a

the IFSSH Scientific Committee on the microsurgicalin Sweden in 1960. On his return he was assigned thetask of treating most of the hand injuries of the Hand

Prof. Augusto Bonola chose as the SICM logo a copy ofreport at the 12th SICOT Congress in Tel Aviv in 1972 [3].

treatment of peripheral nerve surgery at the Third IFSSH

Surgery Service.

the cymatium on the gate which is found at the entrance

In 1975 the first Italian triennial post-graduate School ofCongress in Tokyo on 6 November 1986. The Members

hall of the Modena Old Hospital. At the base of theHand Surgery was founded in Modena by Bonola.

were (from left) Hanno Millesi of Vienna, Austria,

SICM (Società Italiana di Chirurgia della Mano), waslogo there is a quotation in Latin by Julius Casserius:

founded by eight founding members.

“Rimatur manus apta manum; mens erue mentem” (TheProf. Bedeschi was the IFSSH Delegate from 1973 to 1979,

On 8 December 1962, at the Orthopaedic andskilful hand of the surgeon dissects the hand; the mind

and SICM President from 1977-1979. He was appointed

Traumatologic Centre (CTO) of Florence, directed by Prof.

supports its comprehension) [1] [2]. Julius Casserius

Director of the Orthopaedic Clinic of Modena in 1976,

In July 1989 Caroli organized a European Hand Surgery

Oscar Scaglietti, Prof. Augusto Bonola was appointed(1552-1616) was a great anatomist, a surgeon and aafter the retirement of Prof. Augusto Bonola at themeeting in Taranto, Italy, with the aim to have a

SICM President, Prof. Umberto Mangini the SICM

lecturer at the Padua University. His great contribution

age of 70 years. He sadly died shortly afterwards on 9

combined European Federation.

Treasurer/Secretary and Dr. Paolo Bedeschi the Secretary

to the anatomy of the upper limb was published by Landi

December 1976. Bedeschi was promoted to Full Professor

In February 1990, delegates from 13 European Hand

to the SICM presidency.

A. et al. in the IFSSH Ezine May 2012 [2]. In 2016 Juliusof Orthopaedics in 1980.

Surgery Societies met in Paris and founded theCasserius was included in the list of “Giants of Hand

Bedeschi was also the organiser of the “A. Bonola

Federation of European Societies for Surgery of the Hand

In August 1963, the Orthopaedic Clinic moved to theSurgery”, at the 13th IFSSH Congress in Buenos Aires,

Courses" from 1977 until 1996.

(FESSH).

new Polyclinic of Modena, where it became a modern

Argentina.

54

Paolo Bedeschi of Modena, Italy, and George Omer of
Albuquerque, USA.

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Dr. Oliviero Soragni was elected SICM President from1997. The President of the Congress was Dr. Antonio

Mikael Keith were able to do two neuro-contol system

An appropriate logo was designed and it included a

1993-1995, the fourth SICM president from Modena.

Landi and the honorary President was Prof. Alessandro

implants on patients with the aim of restoring active

green direct access telephone number. The operative

Caroli (Fig. 3).

control of their paralysed hands in 1998.

centre was set up in the Modena Polyclinic (fig. 4).

The lecturers of the instructional course of the Congress

The Consensus Conference on Replantation and

In March 1999 the first European Consensus Conference

on “Stiffness of the joints of the upper limb” were:

Human Hand Transplantation

on replants and Human Hand Transplantation was held

Stephen A. Copeland for the shoulder, Norbert Gschwend

The Hand Unit of Modena raised the issue withinin Modena and the proceedings, in Italian and English,

for the elbow and Philippe Saffar and Antonio Landi for

SICM regarding the necessity to establish a national

were published in a dedicated issue of the Italian Journal

the wrist and hand. This complex topic was published incoordination system to deal with “micro-vascularof Hand Surgery [11].

English as a monograph [10].

casualties” all over Italy. A committee was approved andFigure. 2 Tokyo, November 1986, 3rd IFSSH

named CUMI (Coordinamento Urgenze Microvascolari

At the Conference a questionnaire was compiled,

On1 November 1997 Alessandro Caroli retired as the

Italia) and was directed by Paolo Bedeschi and Antonio

approved by the FESSH Council, and sent to 132

Director of the Hand Surgery and Microsurgery Unit atLandi as the secretary.

European Hand Centres. The questions were grouped

the Polyclinic of Modena, and was succeeded by Antonio

into three sections: organisational features, management

Landi.

and coordination and clinical aspects. Questions coved

Congress. Working breakfast of the three Members

aspects such as: indication and contraindication forof the IFSSH Commission for the study of thereplantation of a single digit, multiple digits and themicrosurgical treatment of peripheral nerve lesions.

sequence of replantation; the implications of chemical

From left: Prof. Hanno Millesi (Vienna), Prof.

contamination of the amputated parts; exposure

Paolo Bedeschi (Modena) and Prof. George Omer

to physical agents (eg. replantation of burned and(Albuquerque, New Mexico,USA).

frozen parts); replantation of hand and digits in organtransplanted patients; etc.

Prof. Bedeschi devised and introduced new or modified

Fifteen Centres in this survey encountered medico-legal

techniques in Hand Surgery. Five of these techniques

problems, but the surgeons were never prosecuted. Only

are: the honeycomb technique for Dupuytren'sin one case was there a compensation of 120,000 Euro

contracture, a digital-palmar variant of “open palm

paid by the Hospital [11].

technique”[5]; an anterior approach for proximal row

The FESSH Council delegated David Elliot and Antonio

carpectomy [6]; tripodal, a cement-less prosthesis

Figure. 3 Bologna, June 1997, 4th FESSH Congress.

Landi, supported by the then Secretary-General of FESSH

for the trapezium-metacarpal joint [7]; ministaple

Prof. Alessandro Caroli, honorary President of

Ann Nachemson, to compile a booklet on the consensus

in bio-resorbable material (poly-L-lactic acid), for

the Congress (left), delivers to Dr. Antonio Landi,

details. This document was distributed to the Delegates

osteosynthesis of fractures of the carpal scaphoid [8]; a

President of the Congress (right), the collection ofof the FESSH Meeting in Amsterdam in May 2002 [12].

two stage early surgical treatment for radial club hand,

medals representing the logo of the previous FESSH

by a radial-palmar release, external skeletal distraction

Congresses.

The Consensus Conference on Human Hand
Transplantation was preceded by an award ceremony.

and atraumatic centralization[9]. He retired on 1
November 1997 as Full Professor of Orthopaedics andIn 1998 the Modena Hand Unit was upgraded by a

An Honorary Degree by the University of Bologna was

Director of the Institute of the Orthopaedic Clinic at thegenerous allocation of 440 million Italian Lire, assigned

bestowed on Professor Göran Lundborg of Sweden in the

University of Modena. His place was taken by Prof. Luigi

by the Regional Health Authority of Emilia-Romagna.

Great Hall of St. Lucia on 5 March 1999 (fig. 5).

Celli. In 2001 during the IFSSH Congress in Istanbul,

Figure. 4 The logo of CUMI was designed by Rita

Professor Bedeschi was recognized as ‘Pioneer of Hand

In collaboration with Prof. Antonietta Vannini, Medical

Castellini, a qualified anatomical illustrator at

The Consensus Conference on Human Hand Transplant

Surgery’, and in 2003 he was nominated Honorary

Director of the Rehabilitation Institute of Montecatone,

the Rizzoli Institute. The Country of Italy lies on

was initiated in part by the first hand transplant done

President of the Italian Society for Surgery of the Hand.

which looked after patients who suffered from upper

the palm of the hand surrounded by “the white”

by Dr. Jean-Michel Dubernard in Lyon, France, on 23

The 4th FESSH Congress was held in Bologna in Junelimb spasticity and tetraplegia, Antonio Landi with

amputated fingers.

September 1998, who described in great detail the56

57

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surgical procedure, the anti-rejection therapy, early

was regularly attended by the professor of Paediatrics

complications and the patient status six months post-

S. Bernasconi, the head of the Orthopaedic Paediatrics

operation. On a follow-up, Prof. M. Merle, President of

Unit of Rizzoli Institute O. Donzelli, the geneticist A.

the French Society for Surgery of the Hand (GEM) was

Percesepe and the expert in rare diseases P. Ferrari.

allowed to do a clinical examination on the patient andThis unit became a national centre for congenital handconcluded that the functional outcome was extremely

dysplasias. Many publications have flowed from thispoor. He also remarked about the “premature” media

collaboration over the years [15-21]

reporting and the unfortunate hype this incident
has caused. The same sentiment was expressed byDissection on cadavers

colleagues from America, Sweden, Finland and theCadaveric dissection was historically influenced by

Italian Society of Surgery of the Hand [11].

Catholic Church as it was prohibited by Pope Bonifacio
Figure. 6 Prof. Sunderland seated in the first row.

VIII (1230-1294 ca). Subsequently a Papal Bull by Sisto

Prof. Giorgio Brunelli and Dr. P. Raimondi are seated

V, a former student of the University of Bologna, inFigure. 7A The Italian participants to the Coursein the back.

1471 restablished the possibility to perform anatomicalwith Dr. F. Darin at the centre of the picture.

dissection by medical students. The Bulla was reinforced
The rapid development of early brachial plexus surgery

by Pope Clemente VII in 1523.

was also taken up in 1976 at the Orthopaedic Institute in
Modena by Celli, Mingione, Rovesta and Landi.

Following a further period of denial by the Church,
Prospero Lambertini (1675-1758), Archibishop of Bologna

Landi spent two years from 1976 to 1978 as a clinicalwas elected Pope with the name of Benedetto XIV andlecturer at the Royal National Orthopaedic Hospital

thanks to his Catholic enlightened spirit, cadaveric(RNOH) in the Hand and PNI Unit headed by D.M. Brooks

dissections were again allowed.

and C.B. Wynn Parry. During this period, he focused his
attention on two main topics: the value of the Tinel sign

But unfortunately a new long period of obscurantism

Figure. 5 The ceremony of Laurea honoris causa:

in the brachial plexus lesions[13] and the role of thewas enacted by the Royal Decree of 1933 (and is still

Prof. Marchetti precedes Prof. Lundborg.

somatosensory evoked potential (SEPs) as a diagnostic

in force!), which prohibited this practice once again.

tool in brachial plexus lesions [14]. He was invited back

However the importation of cadaveric frozen parts fromThe longstanding interest in Brachial Plexus

in November 2008 by R Birch to the 7th Internationalabroad were ultimately considered legal and workshops,

Figure. 7B Dr. A. Gilbert looking after the trainees:

Injuries

Meeting on Brachial Plexus Injuries to share his

mainly in the arthroscopic field, are now carried out on

Dr. M. Abate in the front and Dr. A. Leti (right) andIn the early seventies several surgeons from all overextensive experience on SEPs.

regular basis in Italy.

Dr. N. Della Rosa on the left in the back.

Morelli, G. Brunelli, R. Vigasio, L. Celli, P. Raimondi,

Modena: The ‘24hour First Aid Service’ and theDuring the ban Italian Hand Surgeons did their anatomic

The Master’s Degree in Hand Surgery

A. Berger, A.C. J. Slooff, R. Birch and many otherestablishment of ‘Congenital Deformities of thedissections abroad, notably in France, thanks to the

In 2005-2006 the Chancellor of the University of Modenainternational surgeons) began to gather in the CliniqueHand Clinic’.

friendly relationship between F. Darin and A. Masquelet,

G. Pellacani approved the creation of the Master inLongeraie in Avenue 9 De la Gare in Lausanne,

In order to function optimally as a “24hour First Aid

at the University Descartes in Rue des Saints-Pères,Hand Surgery Degree in order to re-establish a training

Switzerland, under the leadership of Algimantas O.

Service” for hand injuries for the Emilia-Romagna

Paris.

program for the whole of Italy, which has been deprived

Narakas, to discuss the management of brachial plexus

Region, a dedicated area was assigned at the hospitalinjuries. Even after his death in 1993, this 3 yearlywith its own two emergency theatres.

Europe (H. Millesi, Y. Allieu, A. Gilbert, M. Merle, E.

meeting continued as the Algimantas Narakas Club. Sirof its independent specialisation in accordance to the
A number of junior members of SICM received € 500

new European rules. A. Leti was the driving force inbursary each from the Society to practice their surgicalcoordinating this process.

Sidney Sunderland attended these meetings regularly,

Also during 2004, the national congress of SICM was held

procedures in Paris. The teaching faculty included

taking notes like a student, and at the same time sharing

in Sardinia. The main topic was “The upper limb and

A. Masquelet, P. Raimondi, M. Ceruso, A. Landi and A.

In 2008 the Hand Unit in Modena was selected by IBRA

his enormous expertise with other attendees (fig. 6).

perinatal pathologies”. This triggered the establishment

Gilbert (fig. 7 A-7 B).

(International Bone Research Association) as its centreof the Congenital Deformity Outpatient Clinic which

58

in Italy. In September 2009 Landi was appointed Chief

59

SHARE SECTION

www.ifssh.infoof the Department of the Pathologies of the Locomotor
System.

joint arthroscopy.
•

Dr. R. Luchetti, president of SICM from 2013 to 2015,

SHARE SECTION

August 20207.

was also president of EWAS. The FESSH Congress

Percesepe A., Genetic Basis of Congenital Upper

Bedeschi P., Barca F., Mele R.: Protesi non cementata

Limb Anomalies: Analysis of 487 Cases of adella trapezio-metacarpale. GIOT, 1994, 20: 723-731.

Specialized Clinic Birth Defect Research. 2013, (PartBedeschi P., Osteosynthesis of the carpal scaphoidA) 97:798-805.

Accreditation of the Hand Trauma Centre in Modena waswill return to Italy for the third time (after Bologna

confirmed by FESSH in 2009.

and Milan) in 2023 in Rimini under his presidency.

with bio-resorbable mini-staples. Proceedings of theProf. G. De Santis switched to Plastic Surgery after

6th IFSSH Congress, Helsinki, 3-7 July 1995. Elsevier,A., Bernasconi S., Percesepe A., VACTERL (Vertebral

The “Aboriginal Guild”

his training in the O’Brien Unit in Melbourne, and in

Amsterdam, 1995: 79-83.

Defects, Anal Atresia, Cardiac Defects, Renal andDuring the period from 2010 to 2013 the Policlinic of2009 was appointed full Professor in the University

Bedeschi P., Correction chirurgicale precoce en deux

Limb Anomalies) Association: Disease Spectrum

Modena went through a critical time due to variousof Modena. He was the President of the World

temps de la main bote radiale, in Tubiana R., Traité dein 25 Patients Ascertained for Their Upper Limb

political conflicts regarding the administration of theCongress of Microsurgery held in Bologna in June

Chirurgie de la Main. Masson Ed., Paris, 1998, Tome 6:

Involvement. Journal of Pediatrics. 2013.

two main hospitals of the city. The medical units and the2019.

468-480.

•

administrative personnel of these two hospitals were•

Dr. R. Adani, also a former President of SICM as

8.

April 20-21, 1994.

9.

10. Copeland S., Gschwend N., Landi A., Saffar P.,

17. Carli D., Garagnani L., Lando M., Fairplay T., Landi

18. Landi A., Garagnani L., Leti Acciaro A., Lando M.,
Ozben H., Gagliano M.C., Hyaluronic acid scaffold

unnecessarily duplicated and obstinately maintained

well as of SIM (Italian Society of Microsurgery)

Stiffness of the joints of the upper limb. Dunitz Ed.,for skin defects in congenital syndactyly releaseby politicians. Funds to maintain this duplication wasstarted his career with A. Caroli in Modena andLondon, 1997, 85: 317-414.

surgery: a novel technique based on the regenerative

diverted from the medical departments.

as a microsurgery research fellow in 1989 in theLandi A., Atti della 1° Conferenza europea dimodel. Journal of Hand Surgery (Eur) Vol 2014 39:

University of Singapore with R. Pho. He was Head ofconsenso su reimpianti e trapianti a livello dell’arto994.

The vast majority of medical and paramedical personnel,

the Hand Unit of Verona from 2008 to 2015, and has

superiore. (Modena, 6-7 Marzo 1999), in Rivista didisillusioned and disgruntled, under the leadership of

now succeeded Antonio Landi and as the Head of

Chirurgia e Riabilitazione della mano e dell’arto

R., Ravazzolo R., Di Rocco M., Ferrari P., Kaplan F.S.,

the Thoracic Unit, U Morandi and the input from thethe Hand Unit in the Department of Orthopaedics insuperiore. Ed. Mattioli, Fidenza (PR), 1999; 36: 75-365.

Landi A., Shore E.M., Reissner C., Seemann P., ACVR1

Hand unit, founded the “The Aboriginal Guild” (named

Modena.

after the Aborigines of Arnhem Land of the Northern

11.

12. Landi A., Elliot. D., Consensus issues on replantation

19. Haupt J., Deichsel A., Stange K., Ast C., Bocciardi

p. Q207E causes classic fibrodysplasia ossificans

within the upper limb. Booklet del VIII Congresso

progressiva and is functionally distinct from

Territory of Australia, who declined to exploit theReferencesdella FEESH. Ed. Mattioli Amsterdam, Maggio 2002

engineered constitutively active ACVR1 p. Q207D

uranium discovered in their Reserve). This led to the1.

ISBN 88-86235-65-8.

variant. Hum Mol Genet. 2014 Oct 15; 23 (20): 5364-77.

Landi A., Rippa Bonati A., Leti Acciaro G., Martinelliestablishment of the Teaching Hospital of Modena in

Braglia G., Pellacani A., Storia del logo della SICM,

13. Landi A., Copeland S., Value of the Tinel sign in

Doi: 10.1093/hmg/ddu255. Epub 2014 May 22.

2016.

in Landi A., Catalano F., Luchetti R. Eds., Trattato dibrachial plexus lesions. Annals Royal College of

20. Malik S., Percin F.E., Bornholdt D., Albrecht B.,

Chirurgia della Mano, Verduci Ed., Roma, 2007, Vol. 1:

Surgeons of England, 61, London 1979, pp. 470-471.

XIX-XX.

The graduates of the Modena School
Apart from the above achievements by individuals

2.

14. Landi A. Copeland S., Wynn Parry C. B. et al. The

Percesepe A., Koch M.C., Fritz B., Khan R., Mumtaz
S., Karasu N.A., Grzeschik K-H., Mutations Affecting

Landi A., Garagnani L., Mancini M.: Lessons fromrole of somatosensory evoked potentials and nerve

the BHLHA) DNA- Binding Domain Cause MSSD,

associated with the University-Hospital Polyclinic of

Julius Casserius. Discovery and innovations by 17th

conduction studies in the surgical management ofMesoxial Synostotic Syndactyly with Phalangeal

Modena, graduates from this institution exceled in

century hand surgeon. IFSSH Ezine, 2012, May (6), (2):brachial plexus injuries. Journal of Bone and Joint

Reduction, Malik-Percin Type. The American Journal

various other ways:

8-13.

Surgery 1980; 62B: 492-496.

of Human Genetics 95, 649-659, December 4, 2014.

3.
•

Bedeschi P., Microsurgical treatment of peripheral

15. Spielmann M., Brancati F., Krawitz P. M., Robinsonn

21. Emakky A., Stanghellini I., Percesepe A., Role ofProf. L. Celli published the volume “Treatment of thenerve injuries. Proceedings of the 12th Congress ofP.N., Ibrahim D. M., Franke M., Hecht J., Lohan

Genetic Factors in the Pathogenesis of Radialelbow lesion: new aspects in diagnosis and surgical

SICOT, Tel Aviv, October 1972.

S., Dalhe K., Nardone A.M., Ferrari P., Wittler L.

Deficiensies in Humans. Current Genomics, 2015, Vol.

Bonola A., Caroli A., Celli L.: La Mano. Piccin Ed.,

Timmermann B., Landi A., Chan D., Mennen

16, No. 4.

Padova, 1981

U., Klopocki E., Mundlos S., Homeotic Arm-to-

Bedeschi P., Honeycombe technique. In: Mc Farlane

leg Transformation Associated with Genomic95) became the Director of the Orthopaedic and Hand

R.M., Mc Grouter D.A., Flint M.H. Eds. Dupuytren's

Rearrangements at the PITX 1 Locus, American

Unit in the Republic of San Marino. In the 1980s he

disease. Churchill Livingstone, Edinburg, 1990: 311-

Journal of Human Genetics. 2012,91(4):629-35 IF

introduced wrist arthroscopy in Italy.

314.

10.603.

techniques” in collaboration with

A. Celli and B.

4.

Morrey.
••60

Dr. Oliviero Soragni, former president of SICM (1993-

Dr. Pederzini who was trained by S. Copeland in the5.

6.

Bedeschi P., Modified volar approach for proximal

16. Carli D., Fairplay T., Ferrari P., Sartini S., Lando

UK, as well as by T. Rosenberg, J. Roth and T. Whipplerow carpectomy. Proceedings of the Symposium ofM., Garagnani L., Di Gennaro G.L., Di Pancrazio L.,

became one of the international experts in elbow

the French Institute for Surgery of the Hand. Paris,

Bianconi G., Elmakky A., Landi A., Bernasconi S.,

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