ifssh
August 2018www.ifssh.info

ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

VOLUME 8 | ISSUE 3 | NUMBER 31 | August 2018

TIPS AND TECHNIQUESPHALANGEAL NECKFRACTURES IN CHILDREN

HAND THERAPY:

HAND THERAPY IN ROMANIACONTROVERSIESTRUTHFULNESS IN
MEDICAL DATA REPORTING

CONTROVERSIES AND BESTPRACTICES FOR ACUTE SCAPHOID
FRACTURE MANAGEMENTTHE CHANGING LANDSCAPEOF EVIDENCE-BASEDMEDICINE
1

EDITORIAL

www.ifssh.info

August 2018www.ifssh.info

VOLUME 8 | ISSUE 3 | NUMBER 31 | August 2018

Watch your language!
The use of inappropriate language.

•“the majority of patients were happy”,•“we have observed satisfaction amongst mostDuring my odd fifty years in medicine, I have listenedcontents

patients”,

to well over 10 000 presentations at various scientific•“more than half would have the operation again”,

meetings, seminars, congresses and academic•“our results were satisfactory”,

conferences.

•“on average this procedure is promising”,•“the results look promising”,

Over the years one has developed a filtering mechanism•“we had no come-backs”,

when listening to a presenter. In most cases the aim•“our data indicates a positive outcome”,

of the speaker (..and of course I include myself as•“the good and excellent results encouraged us”,

Watch your language!

Phalangeal neck fractures in children

a speaker!) is to convince the audience of a certain•“we are impressed with this implant”,- Ulrich Mennen- M. M. Al-Qattan

concept, idea, and nowadays, a new gadget or implant.

•“the preliminary results are promising”•“our final results will be presented at the next

The words and phrases used to convince are often, and

2

4

LETTER TO THE EDITOR

meeting”,

Truthfulness in Medical Data Reporting- Marc Garcia-Elias

I mean often, inappropriate, meaningless and non-•

“we are happy with our results so far”,

sensical. To use a “Trumpism”: the language used is•“no major complications were recorded”.

“fake”.

7

anything.

8

proven results for written articles. Yet, when it comesto presentations, vague, ambiguous terminology andStop wasting the Delegates’ precious and expensive

sentences are draped in eloquent language which, to thetime with quasi talk and euphemisms.

unsuspecting/un-sceptical listener sounds convincing

NOMINATING COMMITTEE- Michael Tonkin

This language is non-sense. It does not mean
We demand evidence based, accurate factual and

EDITORIAL

SECRETARY-GENERAL REPORT- Daniel J. Nagle

12

PIONEER PROFILES

and worth remembering. And to the newer members ofLet’s be civilised and honest in what we as colleagues• Miguel Vargas Busquets

our profession the convincing presentation may soundproclaim to be true. Let’s be more diligent when

• Robert Malcolm McFarlane

like gospel-truth, worthy of following.

listening, but even more so when presenting.

This is especially true and sadly much more common inWith sincere regards,

The Changing Landscape of Evidence-Basedrecent years when commercial interests are involved.

UlrichMedicine - Leonard C. Marais

The number of sponsored talks and workshops has

14 SPECIAL FEATURE

18

escalated exponentially. And so has the “sales talk”

HAND THERAPY
Hand Therapy in Romania

become increasingly sophisticated.

- O.D Olariu
My plea is: Do not confuse “opinion” with “fact”.
PROF. ULRICH MENNEN

20 RESEARCH ROUND-UP

Let me give just a few examples of “fake facts” dressed

EDITOR: IFSSH EZINE

Controversies and best practices for acutein “fake opinions”, which I have collected over the years

PAST PRESIDENT: IFSSH

scaphoid fracture managementfrom keynote speakers at international congresses:

www.ulrichmennen.co.za- Nina Suh and Ruby Grewal

2

22 TIPS AND TECHNIQUES

28 MEMBER SOCIETY NEWS• Association of Chinese-speaking Hand
Surgeons United (ACU) and the fourth Annual
Jixia Hand Surgery Forum• Canadian Society for Surgery of the Hand
(CSSH)• Chilean Society for Surgery of the Hand
• Austrian Society for Surgery of the Hand
• Argentine Society for Surgery of the Hand
• Columbian Association for Surgery of the
Hand• Brazilian Society for Surgery of the Hand
(SBCM)

37 ART
Wood Carving

38 SHARE SECTIONIFSSH Exco and Delegates Council Meeting

40 UPCOMING EVENTS
List of global learning events and conferencesfor Hand Surgeons and Therapists
Photo: Members of the IFSSH Exco June 2018,
Copenhagen, Denmark3

LETTER TO THE EDITOR

www.ifssh.info

Truthfulness in
Medical Data Reporting

EDITORIAL

August 2018

only wish, when writing these lines, is to encourage theWhy didn’t we critically appraise the poor evidence

new generations of surgeons to be thorough in theirthat existed at that time about the chances of successassessment of reported findings and not to believeof that technique? Why so much emphasis in aeverything that has been published just because itprocedure that had not been shown long term results

looks good. When publishing, I urge them to have noyet? I am afraid that we did it because, in our naivety,hesitation to be completely truthful with their results,

we did not like unsolved “mysteries” in our treatment

particularly about the limitations of their studies.

portfolios. Whatever the cost, we wanted to believe

Indeed, as an audience member, I am more likely

on the overwhelming collective enthusiasm about ato believe an honest publication/presentation with

When she entered my office, I didn’t know that I would

did not sublux beyond the dorsal edge of the radius, as

technique that, in our simplified ways of understanding

less overwhelming but truthful results, rather than alearn an important lesson that day. Like most of

it usually does, but it laid down within the limits of the

carpal mechanics, it just made sense. Fortunately she

pristine paper with suspiciously perfect outcomesmy patients, she had a long story to tell. She started

cartilage covered scaphoid fossa. That created a stable

turned down my offer, and I didn’t have to face theexperiencing pain in her right wrist on September

platform through which loads could be transferred. As

consequences of my overly enthusiastic judgment.

1989, when she was 19-years-old, and working as aa consequence, her pain started to subside, and slowly,

hairdressing apprentice at her mother’s hair salon. It

but steadily, she recovered most of her hairdressing

This story illustrates how much relying on a new

took a number of tests for her doctors to put a name toabilities. Needless to say, her wrist was stiffer thantechnique with insufficient outcome information canthat pain: idiopathic necrosis of the lunate, also known

before, but functionally useful. “I wonder what would

potentially end up harming patients. Certainly, I didn’t

trapezio-trapezoid fusion: long-term follow-up

as lunato-malacia or Kienböck’s disease (KD). She

have happened had I followed that doctor’s advice”, sheknow it at the time, but in 2003 there was alreadystudy. J Orthop Sci. 2003;8(3):319-22.

needed no tests to guess that her future as a hair stylist

whispered dryly. Certainly, she was not aware that theenough evidence suggesting that fusing the STT joint

was at stake.

“long-haired doctor” was me.

did not guarantee lunate healing.2 On the contrary,(*) This essay includes ideas raised by different fellows

it alters carpal kinematics to a point where moreof the Institut Kaplan during an informal case oriented

1.

Watson HK, Ryu J, DiBella A. An approach to
Kienböck’s disease: triscaphe arthrodesis. J Hand
Surg Am. 1985;10: 179-87.

2.

Minami A, Kato H, Suenaga N, Iwasaki N. Scapho-

The weeks that followed could be described as a

Was I honest when, 27 years ago, I proposed anthan a third of patients develop painful dorso-radial

discussion of the subject: “Truthfulness in medical data

succession of treatment failures. Nothing appeared

STT fusion to that lady? I am not completely sure.

impingement, a complication said to be prevented byreporting”. Particularly active in this regard were Dirck

to work. By the end of June 1990, the avascular lunate

According to most dictionaries, for a person to beresecting the dorsal rim of the radial styloid.

Añaños, FRACS, from Perth, Western Australia; Richard

was definitively fractured, and the joint was weakercompletely honest, aside from well-intentioned, must

and more painful than ever. Worried, she went to see aalso be truthful, that is, actively and continuously

Needless saying, this wouldn’t be a fair comment if it

Dalia López Watson, MD, from Punta Arenas, Chile;

wrist specialist, a “young, long-haired doctor” who had

engaged in checking the correctness of one’s beliefs,

did not contain the following clarification. The caseDaniela Pérez, MD, from Santiago, Chile; Philip Mathew

spent time in the USA investigating wrist problems.

statements and/or actions. Was my recommendation

discussed above is not an attempt to point a finger

FRCS(Orth), form London, UK; and Amer Mustafa-

Her first impression was encouraging: nobody hadcorrect? It all depends on what we considered correct

at those who propose the STT fusion for a variety

Gondolbeu, MD, from Lleida, Spain

examined her wrist as meticulously as him. His final

back then. Let’s not forget that we were in the earlyof conditions. That the lunate healing effect of therecommendation, however, surprised her. Instead of

90’s and that Evidence-Based-Medicine still was inprocedure could not be proven in my patients with KD

MARC GARCIA-ELIAS

a list of conservative measures to control the disease,

its infancy. At that time, the most frequently used

does not mean that the fusion may not be of help in

MD PHD. INSTITUT KAPLAN,

he gave her only one option: to surgically fuse thetreatment alternative for KD was a leveling procedure,other circumstances. The lesson that I learned that day

BARCELONA, SPAIN(*)

scaphoid to the distal row. At that stage, only a scapho-

most commonly a radial shortening osteotomy. In the

had to do with how easy it is for a young surgeon to be

trapezio-trapezoidal (STT) arthrodesis could prevent

adult, the technique gives clinically mixed results, themore influenced by the apparently successful results

her lunate from collapsing and becoming chronically

lunate collapsing most of the times, but the patientsuggested in a big title, than by the real limitations of apainful, he concluded emphatically. Reluctant to

had less pain and better function than before surgery.

procedure stated in the last paragraph.

accept surgery as the only means to alleviate her pain,

Fusing the STT joint was another alternative. Assumed

she declined his help and left the room convinced

to unload the lunate more effectively than a leveling

But let’s return to the initial question. Was I honestthat a “wait and see” strategy couldn’t be as bad anprocedure, the STT fusion was regarded by many as

when I recommended a technique without complete

alternative as that doctor’s recommendation.

a novelty worth being tried. I was not an exception.

information of their long term outcome? I guess I wasThat turned out to be a smart move. As expected, theWhen that young hairdresser entered my office, I saw

not. Certainly, I do not intend to become a preacher offragmented lunate collapsed. The scaphoid, however,

the opportunity I was looking for.

honesty nor accuse any colleague of the opposite. My

41

Jamieson FRACS (Orth), from Hobart, Tasmania;

5www.ifssh.info

VOL 12 NO 3 | JULY 2018

SPOTLIGHT ON IFSHT MEMBERSOCIETY: JAPANThe Japan Hand Therapy Society (JHTS), established in 1988, holds annual meetings in collaboration with The Japanese Society for Surgery of theAnne McGregor from St George’s Hospital, University of London covered assessments of hand injuries, burns, nerve injuries, congenital deformities
and splinting, among other topics. IFSHT donateda dynamometer to the College of Health Sciences,
The University of Zimbabwe.

FESSH, COPENHAGEN 2019

Anne Wajon, IFSHT President, presented an IFSHT
activity update to the IFSSH Council during theFESSH conference. Amongst other updates, she
discussed the provision of IFSHT travel grants to
support therapists teaching in Nepal and Rwanda.

The 30th annual meeting of JHTS in Tokyo. Nineteen executive members were
elected, and Dr. Mineo Oyama was elected President (front row, 5th from left).
Hand. The 30th annual meeting, held in Tokyo in
April 2018, had 670 therapists and surgeons attending. Dr. Moroe Beppu (St. Marianna University
School of Medicine, APFSSH President 2012-2014)
and Ms. Karen Shultz (CHT, Universityof Colorado) were keynote speakers. Dr.
Mineo Oyama was elected President of
JHTS, together with the new executive members.
The next congress will be in Sapporo in April 2019.
JHTS welcomes therapists from other countries tojoin the Congress.

HANd REHABILITATION IN ZIMBABwE

Zimbabwe, a developing country, has experienced
an economiccrisisover
the last decade. As aresult, many
clinics lackbasic equipment
forhand
as- Prof. Masanganise, Dean, College of Health Sciences, Thes e s s m e n t University of Zimbabwe receives a dynamometer fromand therapy. IFSHT, together with Ms. Chikwanha, chairperson, DeDr. F.C. Mu- partment of Rehabilitation.
chemwa,aplastic surgeon, conducted a refresher workshop
at the department of Rehabilitation, University ofZimbabwe onJanuary 16-19, 2018 for students,
physiotherapists and occupational therapists. The
workshop, facilitated by Magan Blakeway and1 1 t h Tr i e n n i a l I F S H T C o n g re s s|

B e r l i n , G e r m a ny

BERLIN SITE VISIT, JUNE 2018

Members of InterCongress (IC), IFSSH, FESSH,
and the German Hand Surgery (DGH) and Therapy (DAHTH)
societies werejoined
by
Anne
Wajon
for a tour ofCity Cube, theL to R: Anne Wajon (IFSHT), Melinda Szabo, Dan Nagle venue of the(IFSSH), Zsolt Szabo (IFSSH), Jorg van Schoonhoven IFSHT/IFSSH(DGH), Denise Schuler (IC), Isabell Faad (IC), and Max Congress. DeHearle,(DGH/FESSH). Not pictured: Beate Jung and Da- tailed plans for
niela Neye (DAHTH).
the scientificand social program were discussed. With less than
one year until the Congress begins, registration
and abstract submission is now open at: http://
ifssh-ifsht2019.com.

August 2018

MESSAGE FROM THE NOMINATING COMMITTEE

Message
Delegates and societies are reminded that Pioneer nominations for

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

outstanding and exceptional contribution to hand surgery must be

IFSSH DISCLAIMER:

received by the administrative office by 17 December 2018.

The IFSSH ezine is theofficial mouthpiece of theNominations must follow the format detailed in the May 2018 IFSSH

International Federation ofEzine and previous IFSSH newsletter and be accompanied by theSocieties for Surgery of theappropriate documentation, which is listed on the website, along

Hand. The IFSSH does notwith the checklist document confirming that all criteria have beenendorse the commercial

completed.

advertising in thispublication, nor the content

Nominations for President-Elect, Secretary General-Elect, Historian

or views of the contributors

and Member-at-large will be considered at the Berlin IFSSH

to the publication.

Congress Delegates’ Council meeting. These nominations must be

Subscription to the IFSSH

received from a member society, signed by the society President andezine is free of charge andthe society IFSSH delegate, or from members of the IFSSH Executive

the ezine is distributed on a

Committee, and may be received up to and including the time of thequarterly basis.

Delegates’ Council meeting (according to current By-laws).
Should you be interested to
However, we recommend that nominations be forwarded to theadvertise in this publication,

IFSSH administrative office by 17 December 2018. It is intended

please contact the Editor:that delegates consider an amendment to the By-laws at the Berlin

ezine@ifssh.info

meeting to establish this more formal process of nomination to the
Executive Committee.

IFSSH EZINEEDITORIAL TEAM:EDITOR:IFSSH EZINEThe IFSHT contribution to the April 2018
EZINE is “Low-Profile
Dynamic PIP Joint Orthosis” by Joy Hanna,a physiotherapist from
Brisbane,
Australia.
The paper focuses ona low-profile dynamic
PIP joint orthosis and its application. Please submit
an article to for the ezine to: informationofficer@
IFSHT.org.

Professor Ulrich Mennen

For hand therapy educational events, go to “National/International Education Events” under “Education” at www.IFSHT.org.

Tamrin Hansen|

J u n e 1 7-2 1 , 2 01 9|

i f s s h - i f s h t 2 01 9. co m

(Past President of the IFSSH)
DEPUTY EDITOR:
Professor Michael Tonkin(Immediate Past President of
the IFSSH)
GRAPHIC DESIGNER:MICHAEL TONKIN

TO SUBSCRIBE GO TO:CHAIR, IFSSH NOMINATING COMMITTEE

www.ifssh.info/ezine.html

IMMEDIATE PAST PRESIDENT

67

SECRETARY-GENERAL REPORT

www.ifssh.info

Secretary-General
Report

SECRETARY-GENERAL REPORT

August 2018

impact the quality of hand surgery in Sudan. As per the“social media.” Thanks to Dr. Warwick the IFSSH now has

IFSSH Protocols, each recipient of a grant will provide thea Twitter account. Dr. Warwick has been busy uploading

IFSSH with a written report of their experience which will

Tweets of the recent Copenhagen meeting and I encourage

be shared with the IFSSH member societies through the

you to follow the IFSSH at: @IFSSHand.

IFSSH Ezine and Newsletter.
We are now moving toward the 14thTriennial IFSSH
Dr. Goo Hyun Baek, the Secretary General Elect andcongress that will be held in Berlin 17 -21 June 2019. The

Dr. Raja Sabapathy, the Member-at-Large, presented

hosting German Society for Surgery of the Hand (DGH) andrecommendations to clarify and simplify the grant

the German Society for Hand Therapy (DAHTH) during a

The IFSSH Executive Committee (ExCo) and Delegates’

sponsorship guidelines.) Dr. Szabo stressed that theapplication process. Their recommendations wererecent site visit, provided a thorough tour of the congress

Council met in Copenhagen during the June 2018 XXII

success of the IFSSH outreach endeavours rests squarely

reviewed by the ExCo and will be communicated to thevenue and overview of the meeting educational and social

FESSH Congress. The ExCo and IFSSH Delegates are indeed

on the shoulders of the IFSSH member societies. The

Delegates in an upcoming Newsletter.

activities to Dr. Szabo and Dr. Nagle as well as to Annegrateful for the hospitality extended to the IFSSH ExCo andCommittee for Educational Sponsorship (CES) stands readyDelegates by the FESSH leadership Dr. Michel Boeckstyns

to support hand surgery education but the IFSSH member

The ability to support educational grants of course, isand Dr. Max Haerle, members of the local organizing(Congress President) and Dr. Maurizio Calcagni (FESSH

societies are the primary originators of such educational

dependent on the financial health of the IFSSH. Dr. Danielcommittee, were most gracious hosts during the Berlin

Secretary-General).

events.

Nagle the IFSSH Secretary General, updated the Delegatessite visit. The new Berlin CUBE Congress Center will serveon the IFSSH finances and was happy to report that the

our needs well and the city of Berlin offers a dazzling array

Wajon (President of the IFSHT). Dr. Jörg van Schoonhoven

The ExCo meeting was held on Wednesday 13 June 2018. All

The Committee for Educational Sponsorship (Dr. Marc

organization is financially healthy and is well positionedof cultural and gastronomic options. The local hosts have

ExCo members were in attendance. The Delegates’ Council

Garcia-Elias (chair), Dr. Goo Hyun Baek and Dr. Raja

to continue to provide educational grants. The funds ofmade a commitment to provide excellent educational

Meeting was held the following day and was attended by

Sabapathy with input from Dr. David Warwick) has funded

the IFSSH are conservatively invested and continue tocontent at an affordable price. I hope to see you at the

29 Delegates along with delegates from the Asian Pacific

two applications for support since the Delegates’ Council

grow and generate revenue used to help fund the IFSSH

Berlin CUBE June 17 -21, 2019!

Federation of Societies for Surgery of the Hand (APFSSH),

last met in San Francisco. Dr. Zuidam of the Department ofphilanthropic endeavours.

the FESSH, the South American Federation of Societies

Plastic, Reconstructive and Hand Surgery of the Erasmus

for Surgery of the Hand, Hand and Wrist Biomechanics

Medical Centre in Rotterdam, Netherlands, was awarded aDr. Steven Hovius, the Chair of the Hand and Wrist section

Triennial IFSSH Congresses

International, and the congress chairs of the upcoming

grant of $10,000 in support of the Esser Masterclass series.

of the International Consortium for Health Outcomes

XIVth IFSSH – XIth IFSHT Congress – Berlin, Germany

2019 Berlin (Dr. Jörg van Schoonhoven) and 2022 London

The Esser Masterclasses are anatomy-based hands- on-

Measurement (ICHOM), provided an overview of the ICHOM

17-21 June, 2019. www.ifssh-ifsht2019.com(Dr. David Shewring) IFSSH Congresses.

courses that provide education in the field of hand surgery

project. The Hand and Wrist project will look at the existing

XVth IFSSH – XIIth IFSHT Congress – London, United

and are endorsed by the Netherlands Society for Surgery

hand surgery outcome measurement tools and design a

Kingdom. 2022 (Dates to be confirmed)

Dr. Zsolt Szabo, IFSSH President, addressed the Delegatesof the Hand. In keeping with the general philosophy ofcore set of measurements that would be applicable forand stated that the dissemination of hand surgery

the IFSSH to support those in need, the ExCo provided

the most frequently performed hand surgery procedures.

National and Regional hand surgery meetingsknowledge, particularly to those areas of the world which

this grant with the stipulation that the money be used to

Dr. Hovius asked for IFSSH endorsement and financial

Please see announcements in the IFSSH Ezine and IFSSH

are underserved by hand surgeons, is one of the IFSSH’s

reduce the registration fee for those physicians in needsupport for the project. The IFSSH delegates agreed thewebsite.

most important activities. He pointed out that the IFSSH

of financial assistance. The grant was also to be used to

ICHOM would be of benefit to world hand surgery and voted

stands ready to support regional and local hand surgery

support the online education platform that will allow theunanimously to endorse the project and provide it with acongresses and fellowships. He reminded the Delegates

Esser Masterclass resources to be shared with those who$10,000 grant.

that the IFSSH has created the Harold Kleinert Visiting

cannot physically attend the courses. A second grant wasProfessorship which is designed to provide up to $20,000

provided to Dr Mohamed Abdelrahman, a plastic surgeon

The IFSSH Historian, Dr. David Warwick, has been leading

to support the visit of a qualified senior hand surgeon tofrom Sudan, to enable him to undertake further handthe charge to bring the IFSSH communications capabilities

a hand surgery centre. (Please go to the IFSSH website

surgery training in Shandong, China. Dr. Abdelrahman’s

into the 21st century. He, along with Dr. Sabapathy and ourfor more information on the Harold Kleinert Visiting

grant request was supported by the Association of Chinese-

Webmaster Santhosh Kumar, has been diligently updating

Professorship http://ifssh.info/fellowship-grants.html

Speaking Hand Surgeons United and was very carefully

the IFSSH website which will go live in the near future.

and http://www.ifssh.info/Educational_Sponsorship_

reviewed. It was felt that furthering Dr. Abdelrahman’s

In addition to the website update Dr. Warwick has been

DANIEL J. NAGLE MD

Guidelines.pdf for information regarding the IFSSH

hand surgery education had the potential to significantly

investigating how the IFSSH might benefit from the use of

SECRETARY GENERAL IFSSH

8

FUTURE MEETINGSBest wishes to all from the IFSSH Executive Committee.

9www.ifssh.info

August 2018

14th IFSSH Berlinth
11 IFSHTTRIENNIALCONGRE SS 201917–21 June 2019COMBINED FESSH CONGRESSFESSH

Federation ofEuropean Societies forSurgery of the Hand

IFSSH & IFSHTTRIENNIAL CONGRESS AND FESSH CONGRESS 201917th to 21st June in Berlin, Germany

Abstract submission is open

congress venue CityCube impressed(deadline 30 September 2018)

the participants with its professional

until 30 September 2018.

and flexible infrastructure which

To stay up-to-date and to receive

In June - directly after the successful

offers a lot of possibilities for the

all important information please

FESSH Congress in Copenhagencongress and the exhibition.

click here http://ifssh-ifsht2019.

and exactly one year before thecom/newsletter/ and register for the

Triennial IFSSH & IFSHT Congress

The abstract submission platform is

newsletter. Due to data protection2019 - the organizing committee

open since 1st March 2018. According

regulations we need your permission

met the IFSSH President Zsolt Szabo

to the congress mission “Building

to inform you about the Congress.

and the Secretary General Daniel

bridges – Together Hand in Hand”

The organizing committee is looking

Nagle as well as the IFSHT President

it is our aim to bring together all theforward to meeting you in Berlin!

Anne Wajon in Berlin to present thevarious disciplines of hand surgery

city and the event location of theand therapy from all parts of theJÖRG VAN SCHOONHOVEN

upcoming congress. Berlin presented

world. Please feel kindly invited to& MAX HAERLE & ANDREAS

itself with the most beautiful sunny

actively participate in the scientific

EISENSCHENK & NATASCHA

weather and the multifunctional

program and submit your abstract

WEIHS

10

11

PIONEER PROFILES

www.ifssh.info

Miguel Vargas BusquetsMD (1936-1993), Puerto Rico
MiguelRobert Malcolm McFarlane
MD, MSc, FRCSC (1927 – 2006), Canada

Busquets,

Plastica del Oeste, Inc” (ICPO). He was Founder Member

Bob McFarlane was born in

information obtained from that study was too extensive tobetter known as Mickey, wasand Past-President of the Puerto Rico Society for

London, Ontario, Canada on

be published in a journal but was included as a chapter inborn in Mayaguez, Puerto

Surgery of the Hand. He was the driving force behind

May 28, 1927. He graduated in

the book, Dupuytren’s Disease by McFarlane, McGrouther,

Rico in 1936. He completed

the acceptance of the Puerto Rico Society for Surgery of

medicine from the University

and Flint that was published in 1990.

his college education at thethe Hand as a member of the International Federationof Western Ontario (UWO) in

Mayaguez Campus of theof Societies for Surgery of the Hand. He was Founder

1951. He gained certification in

His other interest included the etiology and treatment

University of Puerto RicoMember of the Puerto Rico Society for Plastic Surgery

general surgery before takingof camptodactyly. Prof. McFarlane was the author of 52

and his medical studies atand its President for four terms of office. He was afurther training in plastic andscientific papers, 42 book chapters, and two books. He has

the Medical School of themember of the American Association for Hand Surgery

hand surgery in London andbeen an associate editor of the Plastic and Reconstructive

University of Zaragoza inand the American Society for Surgery of the Hand. He

Leeds, England, with Rainsford

Surgery Journal, and both of the American and British

Spain, graduating in 1964.

was Corresponding Member of the Argentinian Hand

Mowlem and Mortimer Shaw,

Journals of Hand Surgery. He is a Past-President of The

Society. He was very active in teaching hand surgery inand in Chicago with Sumner L. Koch, Michael L. Mason,

Canadian Society of Plastic Surgeons and The American

While in medical school he demonstrated his deep

Puerto Rico and travelled the whole world spreading theJohn Bell and William Stromberg.

Society for Surgery of the Hand, and an honorary member

commitment to science and medicine and his

gospel of excellence in surgery of the hand.

outstanding organizing ability.

VargasPIONEER PROFILES

August 2018

As a student, heof several National Hand Surgery Societies.
After his return to Canada in 1960, he established apublished works on microbiology and organized the

One of his greatest satisfactions was his tenure as

residency program in plastic surgery at UWO andAs Delegate, Secretary-General, and President of the IFSSH,

Association of Hispanic Students in Zaragoza which

Secretary General of the IFSSH, to which he dedicatedremained Head of the Division of Plastic Surgery until

he has travelled to many countries as an ambassador ofhelped to cement excellent relationships between the

an incredible amount of time from 1989 until the time

his retirement in 1992, as Emeritus Professor of Surgery.

the Federation to encourage the development of hand

Latin-American students and the city. During his stayof his sudden death on 17 November, 1993. His untiring

At that time he joined Jim Roth to establish The Hand

surgery and hand therapy, as well as the formation ofin Zaragoza he was invested as a Knight of Our Lady deefforts and correspondence with all its members helpedand Upper Limb Centre at St. Joseph’s Health Centre in

Hand Societies to join the IFSSH.

Pilar, the Patron Saint of Zaragoza and Spain, a highly

to bring the Federation closer together. The American

London.

prestigious national organization. Dr. Vargas trainedSociety for Surgery of the Hand named one of its libraryin surgery at the District Hospital of the University ofrooms in his honour.

His early research concerned the delay phenomenon indaughters. During his student years he was regarded

Puerto Rico School of Medicine in 1967 and finished his

His wife, Tati, was always at Mickey’s side, giving him

pedicle skin flaps and other methods of preventing flap

as one of the most outstanding athletes in Canada. He

surgical training at the Dallas Veterans Administrationencouragement and support.

necrosis. He developed a flap in the rat that became thewas included in the Canadian Olympic team in 1948

Hospital (1968-1970). He took his training in plastic

Miguel, Oscar and Alberto.

standard experimental model in which to study necrosis.

(London, UK) and had the honour to be the team flag

Since his residency he has had a consuming interest in

bearer. He participated in numerous other sport activities

They have three sons,surgery at the Parkland and Affiliated Hospitals of the

He married his wife Patricia in 1951 and they had three

University of Texas Southwestern Medical School (1971-

Miguel Vargas Busquets was honoured as “Pioneer of

Dupuytren’s disease. He extended the anatomical studies

throughout his life.

1972) and became Diplomate of the American Board ofHand Surgery” in Vancouver, B.C., Canada, in 1998, atof previous surgeons such as Kaplan, Gosset, Littler,

included breeding of horses, and of course created the

Plastic Surgery in 1974.

the Seventh Congress of the International Federation of

Stack, and Thomine by identifying the specific fascial

inevitable model train setup for his grandchildren.

Societies for Surgery of the Hand.

structures responsible for joint contracture. Within theHis other non-medical interests

After his training, Mickey returned to Mayaguez

Dupuytren’s Disease Committee of the International

Bob McFarlane passed away on 27 February 2006. For hisand became very active in the medical community

Federation of Societies for Surgery of the Hand (IFSSH),

immense contribution to Hand Surgery internationally,

especially in the practice of hand and plastic surgery.

he conducted an epidemiological study of surgical

Robert M McFarlane was honoured “Pioneer of Hand

He founded the first clinic for ambulatory surgery inpatients that began in 1980 and collected data on 11500

Surgery” in 1998 at the Seventh Congress of the IFSSH in

Puerto Rico in 1981 and named it “Instituto de Cirugia

patients, provided by 108 surgeons from 12 countries. The

Vancouver, B.C., Canada.

12

13

SPECIAL FEATURE

www.ifssh.info

The Changing Landscape of

Evidence-Based
Medicine
LEONARD C. MARAIS PHD

SPECIAL FEATURE

August 2018

how simple it can be tomanipulate a p-value
by simply changing avariable. “Data dredging”
6

and the shotgun approachto data analysis involves
bombarding data withstatistical tests until
something significant
is found. The problem
is that as clinicians
we are not necessarily“

Performing highquality research thatis based on excellent
protocols that
employ standardized
international outcome
measures willallow subsequent
incorporation into
meta-analysis, which
in turn strengthens
our evidence base.

science is neither infallible
nor comprehensive.7 The
author points out that too
many medical studies cannot
be replicated and that manystudies with negative findings
never get published. Thisso-called publication bias is
illustrated by the fact that
only 17% of surgical papers
published between 2000
and 2006 reported negative

It is difficult to find fault with the reasoning behindscanning through the titles would take an inordinate

adequately equipped

the move towards an evidence-based approach inamount of time. Staying abreast of the available evidencewith either the skill or

the teaching and practice of clinical medicine. Withis made even more difficult by the number of journals

the time to detect all thenumerous therapeutic options available, treatmentthat we have to follow. It is no longer sufficient to follow

subtle errors, biases or

strategy selection has to be based on more than justthe two or three “major” discipline specific journals.

statistical manipulations

intuition and prior experience. Furthermore, there

Articles of significance are now found in a wide range ofpresent in the evidence

are several strong arguments for the need to practice

publications, necessitating an alternative approach. The

base. A recent personal

Evidence-Based Medicine (EBM). We have seen novel

second, and perhaps the more pertinent, challenge weexperience, while

implant technologies entering the market, only to exit

face relates to the quality of data and the interpretation

reviewing a “big data”

relatively shortly afterwards. Recall metal-on-metal

thereof. In his landmark article, Ioannidis (by means of apaper for an international

hip articulations being hailed as the solution to all ourrather complex argument) proposes that most publishedpublication, attests toproblems? Less than five years later we saw reports of 49%

research findings may be false. The author argues that

this. On the face of it all

failure rates at six-year follow-up. In addition, researchresearch findings from underpowered, early-phaseappeared well with the manuscript. Something peculiar,

over expert opinion and mechanistic rationale, it is ironic

continues to disprove long-standing orthopaedic axioms.

clinical trials would be true about one in four times, or

however, prompted me to discuss the findings with anthat its widespread acceptance has been based on expert

We can, with relative confidence, now say that debriding

even less frequently if bias is present. Ioannidis goesexperienced statistician. After careful scrutiny several

opinion and mechanistic reasoning, rather than EBM

an open fracture within six hours is not as important as

one step further stating that claimed research findings

serious scientific flaws (albeit accidental) came to light,‘evidence’ that it actually works”.10

previously believed.2 This principle is also illustrated by

may often be simply accurate measures of the prevailingwhich essentially invalidated the findings. None thea recent randomized study that found no advantage inbias. Thus, most medical research operates in areas withless, the article was subsequently published in a different

But, if evidenced-based medicine is somewhat flawed:

the damage control concept in the treatment of femur

very low probability for true findings and large or highlyinternational medical journal. Another problem with the

Where to go to from here? The problem does not

shaft fractures in poly-trauma patients. Interestingly,

significant effects may actually more likely be signs ofquality of “the evidence” has to do with the interpretationnecessarily lie with the EBM premise but “the evidence” orpatients treated with external fixation in this series hadlarge bias.

of the data analysis. Abdullah and co-workers found thatdata, and the access to it. In fact, thoughtful meta-analysis

28% of orthopaedic randomized controlled trials withis an extremely useful tool to address many of the

1

3

4

an increased time in ICU on ventilation compared to”findings.8 Furthermore,
Stahel and Mauffrey argues
that EBM may not only
be stifling innovation inorthopaedic surgery, it may
also compromise patient
safety.9 Notably, there is a lackof evidence supporting the
EBM approach. Perhaps EveryPalmer and Howick stated it
best: “Given that EBM firmly
favours an empirical approachpatients treated by reamed nailing of the femur. And thus,

Furthermore, a culture of reliance of p-values has

negative findings were underpowered. This means thatpreceding problems. We simply cannot return to the days

the evidence-based tenet remains largely intact.

emerged. There are however numerous problems witha large proportion of studies reporting “no significant

of unverified anecdotes. In terms of the quality of data,

the use of p-values. P-hacking, also known as selective

difference” is in fact not adequately powered to detect anovel methodologies have emerged that also rekindle the

It is, however, becoming increasing difficult to practicereporting or inflation bias, typically involves theclinically meaningful difference between groups, which

value offered by experienced and knowledgeable experts.

and teach evidence-based medicine in the field of

misreporting of true effect sizes. It occurs, for example,

then leads to inappropriately failing to reject the nullExpert consensus-based medicine (ECBM) is a new

musculoskeletal medicine. The first obstacle we facewhen researchers selectively employ certain statistical

hypothesis. These factors have led to many questioning

concept that appears to be sensible alternative to guideis the sheer quantity of data. For example, a cursory

methodologies and/or data eligibility criteria in order tothe value of EBM in its current guise.

our practice in areas where evidence is limited.8 A recent

Google Scholar search for articles related to carpal

obtain a significant result. Aschwanden has eloquently

In 2014 Gary Klein argued for the retirement of theexample of this strategy is the ‘International Consensus

tunnel syndrome revealed about 137 000 items. Even

illustrated, with the aid of an interactive infographic,

idea of EBM based in the fact that the science behind

Meeting on Surgical Site and Periprosthetic Joint

14

5

5

15

SPECIAL FEATURE

www.ifssh.info

Infection’.11 This guideline was developed using the Delphi

validity, it can rarely mimic every clinical scenario.

methodology, which seems to be growing in popularity.

Therefore external validity may be increased, for example,

12

by minimizing inclusion criteria (a strategy popular in“some of the current large research projects).

….too many
medical studies
cannot be replicatedand that manystudies with negative
findings never get
published”

Increasing the power of a study can also enhanceinternal validity. While increasing the sample size
remains a valuable strategy, large studies have numerous

SPECIAL FEATURE

August 2018“….how simple it
can be to manipulate
a p-value by simply
changing a variableproblems. Caution should be applied when interpretinglarge studies, as they are more likely to find a formallystatistical significant difference for a trivial effect that is

References:

not really meaningfully different from the null. Ioannidis,

1.

”

A ‘Hidden Threat’ for Patient Safety and SurgicalInnovation? Bone Joint J 2014;96-B:997-9.
10. Every-Palmer S, Howick J. How evidence-based
medicine is failing due to biased trials and selective
publication. J Eval Clin Prac 2014;20:908-914.
11. Gehrke T, Parvizi J. Proceedings of the International
Consensus on Periprosthetic Joint Infection. J
Arthsoplasty 2014;29(2 Suppl):4.
12. Hsu C-C, Sandford BA. The Delphi technique:making sense of consensus. Prac Assess Res Eval
2007;12(10):1-8.

Langton DJ, Jameson SS, Joyce TJ, et al. Accelerating

13. Pannucci CJ, Wilkins EG. Identifying and Avoiding

therefore, suggests that large studies should ideally target

failure rate of the ASR totsl hip replacement. J Bone

Bias in Research. Plat Reconstr Surg 2010;126(2):619-

major concepts (rather than specific questions) with a

Joint Surg (Br) 2011;93-B:1011-16.

25.

4

considerably high pre-test probability of being true so

Prodromidis AD, Charalambous CP. The 6-Hour Rule

14. Godwin M, Ruhland L, Casson I, et al. Pragmaticthat a significant research finding will lead to a post-test

for Surgical Debridement of Open Tibial Fractures: A

controlled clinical trials in primary care: Theprobability that would be considered quite definitive.

Systematic Review and Meta-Analysis of Infection

struggle between external and internal validity. BMC

Another strategy to improve external validity would be to

and Nonunion Rates. J Ortho Trauma2016;30:397-402.

Med Res Methodol 2003;3:28.

keep the source populations closely related to the target

2.

3.

Rixen D, Steinhausen E, Sauerland S, et al.

15. Ornish D. 2014: What scientific idea is ready for

population. In other words the population studies should

Randomized, controlled, two-arm, interventional,

retirement? Large Randomized Controlled Trials.

Instead of retiring EBM in its entirety we could rather

accurately reflect the population in whom the study

multicenter study on risk-adapted damage control

Available from: https://www.edge.org/responses/

focus our attention on improving the quality of ourfindings are to be implemented. This may imply smaller

orthopedic surgery of femur shaft fractures inwhat-scientific-idea-is-ready-for-retirement. Date lastevidence. Traditionally, the ideal trial is described as

more focused studies.

multipletrauma patients. Trials 2016;17:47.

accessed: 17 January 2017.

4.

having high internal validity while maintaining highexternal validity. This balance is unfortunately difficult

Logistical and financial challenges are significant

to achieve and high internal validity often comes at the

obstacles to large multicentre randomized controlledexpense of external validity. Internal validity reflects

Ioannidis JPA. Why Most Published Research
Findings Are False. PLoS Med 2005;2(8):e124.

Prof Len Marais

Abdullah L, Davis DE, Fabricant PD, et al. Is There

Head of Department

trials. It is probably best to collaborate with international

Truly “No Significant Difference”? Underpowered

Department of

the elimination of bias from a study, ensuring thatpartners, in this regard. However, there is a growing

Randomized Controlled Trials in the Orthopaedic

Orthopaedics,

the findings are representative of the true association

awareness that size does not always matter, and a

Literature. J Bone Joint Surg Am2015;97:2068-73.

Nelson R Mandela School

between exposure and outcome. Internal validity can berandomized controlled trial may introduce its own

Aschwanden C. Science Isn’t Broken. FiveThirtyEightof Medicine, University ofincreased for example by performing larger, registeredbiases. Where does that leave the average clinical2015. Available from: https://fivethirtyeight.com/

KwaZulu-Natal(and therefore scrutinized) studies with standardized

researcher? In my opinion there is still significant value

features/science-isnt-broken/#part1 (Last accessed: 15

719 Umbilo Road, Durban,

outcome measures and extremely low risk of bias.

to be had from smaller, well-designed, focussed analytical

February 2018).

4001, South Africa

External validity refers to the degree to which researchresearch projects, especially in relation to innovative

Klein G. 2014: What scientific idea is ready for

T: +27 31 260 4297; M: +27

findings can be applied to other groups or populations.

research fields where the principles and premises are

retirement? Evidence-Based Medicine. Available from:82 904 7277;

Clinical scenarios are complex, involving a wide range of

not well established. Performing high-quality researchhttps://www.edge.org/responses/what-scientific-

E: maraisl@ukzn.ac.za W:

variables, while scientific research tends to be simplified.

that is based on excellent protocols that employ

idea-is-ready-for-retirement. Date last accessed: 17

scm.ukzn.ac.za

Take the following hypothesis: Does total shoulder

standardized international outcome measures will allow

January 2017.

arthroplasty result in a decreased rate of unplanned

subsequent incorporation into meta-analysis, which inreoperation when compare to hemi-arthroplasty inturn strengthens our evidence base. Ultimately, it is nottowards publishing positive results in orthopedic andpatients over the age of 50 years. While the researchnecessarily the EBM principle that appears to be thegeneral surgery: a patient safety issue? Patient Safety

question needs to be pragmatic in order to allow the

major concern but the way we reach our conclusions.

in Sugery 2007;1:4.

13

14

necessary scientific rigor, and thus maximize internal

16

5.

6.

15

7.

8.

9.

Hasenboeler EA, Choudry IK, Newman JT, et al. Bias

Stahel PF, Mauffrey C. Evidence-based medicine.

17HAND THERAPY

www.ifssh.info

Hand Therapy in
Romania
O.D OLARIU,. MSC.

HAND THERAPY

August 2018

The concept of a team approach in Hand Surgery andTherapy was introduced in the hospital under theleadership of Prof. Georgescu and his therapy team.
He emphasises when training interns and therapists
in his team the importance of comprehensive
management covering both the pre- and postsurgical periods. Regular case discussions among
the team are conducted to promote communication
between surgeons and therapists. Therapists arealso encouraged to attend operations in order to have

Romania is situated in the south-east part of Europe. It was a communist

a better understanding of the surgical techniques,

nation after WWII, but has reformed to a Republic in 1991, with a multiparty

protocol and post-surgical management. One of thepolitical system, market economy and individual rights of free speech andbenefits is early edema control and active mobilization

religion. Romania is a full member of the European Union since 2007.

which can be conducted in a safe manner with muchbetter treatment outcomes.

Hand Surgery and Therapy in Romania evolved 15 years ago throughthe hard work of Prof. Alexandru V Georgescu, MD, PhD, Head of the
Department of Plastic Surgery, Cluj-Napoca Recovery Hospital. As a Plastic
Surgeon with an interest in Hand Surgery and Therapy, along with devoted
professionals from the field, the Romanian Society for Surgery of the Hand
was established. A few years later, working with a young group of Plastic
Surgery residents, Physiotherapists and other rehabilitation professionals,
they developed the hand therapy specialty. In Romania, instead of the
traditional separations between occupational and physical therapists, thetherapists distinguish their professional boundaries by subtle didactic
training differences to work in different specialties, such as in the field of
rheumatology and neurology.

“

The concept ofa team approach in
Hand Surgery andTherapy”

Mr. Octavian and Ms. Judy Colditz, ex-president of
IFSHT at the Philadelphia Hand Meeting in 2006

In 2005, the First International Course on Hand Surgery

Mr. Ocravian D Olariu is a qualified physical therapist

and Hand Therapy was held in Romania with invited

who graduated in 2004 with a MS degree on chronic

foreign guests presenting the most updated protocols

rehabilitation conditions. He has been practicing handused worldwide. The course was held a further threetherapy for 15 years and is actively engaged in thetimes until 2010 when the FESSH Congress took place

management of the traumatized hand. He has won

in Bucharest, the capital of Romania.

the Dorothy B. Kaufmann Educational Scholarship in

In March 2006, Mr. Octavian D Olariu was invited

2006 for his contribution towards development of theto join the Philadelphia Hand Meeting. He won thetherapy in Romania. He continues tp work closely with

Dorothy B. Kaufmann Educational Scholarship for theAlexandru V Georgescu MD to further develop Hand

development of hand therapy in Romania. In the same

Therapy in Romania

year, the Department of Plastic Surgery, Cluj-Napoca
Recovery Hospital, won the Vargas International Hand
Therapist Teaching Award in Romania.
A team of hand surgeons and hand therapists was established in Romania in 2005
(led by Prof. Georgescu, seated, and Mr. Octavian, 1st from left)

18

19

RESEARCH ROUND-UP

www.ifssh.info

CONTROVERSIES AND BEST PRACTICESFOR ACUTE SCAPHOID FRACTURE MANAGEMENT
Nina Suh and Ruby Grewal
Journal of Hand Surgery (European) January 2018 edition (Volume 43,
Issue 1, p4-12)

RESEARCH ROUND-UP

August 2018

5.

Controversy persists regarding the treatment

4. Will you be conducting further research/of waist fractures with agreement in the

publishing further work on this topic? If so, what

literature that displaced waist fractures should

will it entail?

be treated operatively to reduce the fracture andYes, we will be investigating further into the impact

avoid development into non-union. However,of scaphoid fractures on the development of arthritis

consultation with the patient should bein the wrist. Our immediate research studies involve

undertaken for non-displaced waist fractures, as

biomechanical investigations into scaphoid graft

the evidence from earlier operative intervention

options and the impact of scaphoid morphology on

is encouraging for faster union times, earlier

arthritis development.

Early advanced imaging such as a CT or MRI

return to work, and increased cost-effectiveness.

article?

within the first week of injury should be

However, cast immobilization is also a viable

Nina Suh, MD, FRCSC

Acute scaphoid fractures are common wrist injuries

considered for high-demand patients whotreatment option based on more recent CT-based

Assistant Professor

that continue to elicit debate from surgeons regarding

present with radial-sided wrist pain and negative

studies, with comparable union rates and time to

Roth|McFarlane Hand & Upper Limb Centre, St.

the most appropriate diagnostic and management

radiographs and who wish to avoid unnecessary

union whilst avoiding operative complications.

Joseph’s Hospitalalgorithms. The main reason for writing this article

cast immobilization.

A CT to confirm stability before opting for

University of Western Ontario

casting and a CT to confirm union before castLondon, Ontario

discontinuation is recommended.

Nina.Suh@sjhc.london.on.ca

1. What were your main reasons for writing this1.

was to examine the current literature and trends in an

2. Inclusion of the thumb in a cast has not been

attempt to provide the reader with an evidence-based

shown to increase scaphoid union rates ordiscussion regarding current controversies of interest

accelerate time to union.

to clinicians. In addition, we attempted to provide

3.

There is no conclusive evidence to favour one

3. What should all hand surgeons (and or handrecommendations for the best treatment practices

surgical approach over another, so surgeons

therapists) reading your article understand about

for acute scaphoid fractures based on the current

should select the approach they are mostthe findings of your research?

literature.

proficient with and that provides the best

All hand surgeons and hand therapists should

visualization and fixation of the fracture.

understand that the findings of our research is based

2. What are the most interesting/important results

Furthermore, a single compression screw alongon the current evidence and, as such, is subject toand conclusions of your article?

the axis of the scaphoid is a supported method ofchange as new technological advances and research is

The most important conclusion of our study was thatfixation for scaphoid fractures.

added to the literature. However, we believe our article

4. Distal pole scaphoid fractures may be treated non-demonstrates the importance of not only taking thefractures, there remains significant heterogeneity

operatively with predictably high union rates andCT characteristics of the fracture into consideration,in management algorithms making comparisons of

no long term negative sequelae while proximal

but also the physical demands and immobilizationdifferent studies difficult. Some of the most clinicallyscaphoid fractures should be treated operatively toconcerns of the patient before making a treatment

relevant results were:

maximize union rates and shorten time to union.

decision.

despite the abundance of literature on acute scaphoid20

21

TIPS AND TECHNIQUES

www.ifssh.info

Phalangeal neckfractures in children

TIPS AND TECHNIQUES

August 2018

then “swivel” the head from 90o

stepwise algorithm for the surgicalto 180o . A type IIIa fracture may

management of Type II fractures

be made into a type IIIb fracture

was recently published by Matzonby the emergency room physician

and Cornwall20.

4

who is attempting to do a closed
reduction18. Excessive longitudinal
traction converts the 90o rotation
Fig 3: The 4 sub-types of type III

into 180o rotation.

TIPS AND PEARLS OF WISDOM

fractures. Note that there is no

M. M. Al-Qattanbone-to-bone contact between

What is the management of Type I

the two fracture fragments.

fractures?
Phalangeal neck fractures are
unstable. Hence, Type I fractures

Fig 5: The ‘joy stick” or “lever”

What is the essential radiologicalfractures are displaced, but there isare treated with a full above-elbow

technique for reducing type IIA

view for diagnosis of phalangeal

still bone-to-bone contact between

cast in young children for 4 weeks.

fractures.

neck fractures, and why?

the proximal and distal fractureThis ensures that the fracture will

A lateral X-ray is essential forfragments. The distal fragment is

not be displaced.

determining the fracture type. The

almost always dorsally displaced

A-P X-ray view may even miss the(Fig 2a). Al-Qattan named it thepresence of a fracture (Fig 1).

“cap” fracture because the lateralFig 4: The 4 sub-types of type II

fractures?

open reduction as mentioned

view resembles a person with afracture as per the extended Al-

Type II fractures should be treated

above.

pushed-up cap (Fig 2b). Type III

Qattan’s classification.

by closed reduction and K-wire

What are the surgical tips in Type II
fracture management?

What is the management of Type II2fractures are displaced with no1.

2.

Every effort is made to avoid

Always do the closed reduction

fixation. Every effort should bein the operating room underC-arm guidance.

Prof. M. M. Al-Qattanbone-to-bone contact between the

What is the patho-mechanics ofmade to avoid open reduction

Professor of Hand Surgery at

two fracture fragments (Fig. 3).

types IIIa and IIIb fractures?

because open reduction is known toKing Saud University, Riyadh

In 2015, Al-Qattan sub-classified

These fracture types are only seen

be associated with risk of stiffness

attempts of closed reduction

Saudi Arabia

type II fractures into four sub-when the mechanism of injury

and avascular necrosis. The “gentle

may result in commination of

moqattan@hotmail.com

types according to fracture line

is by entrapment of the digit in apressure-flexed joint” techniquethe fractured head5.

configuration (Fig. 4).

closing door. The phalangeal headis an effective closed reduction

has no tendon attachments; andtechnique . Under C-arm guidance,

thick wire may ‘split” the head
into two fragments.

3

3.

Always be “gentle”; vigorous

4. Always use a thin K-wire. A

3

For unknown reasons, phalangeal

Fig 1. a) An A-P view shows

the head is held to the proximal

the finger joints are flexed andneck fractures in children have anwhat seems to be a greens stick

epiphysis by collateral ligaments.

the surgeon then applies gentle

unusual high incidence in Saudi

undisplaced phalangeal neck

The closing door separates the

manual pressure dorsally over thethe K-wire into the fractured

Arabia. Being a Professor of Hand

fracture.

phalangeal head from the diaphysis.

phalangeal head. If that fails tohead.

Surgery at King Saud University, Ib) The lateral view shows the

The child then withdraws theobtain reduction, a percutaneousdeveloped a special interest in thesecompletely displaced fracture.

entrapped digit from the closing

K-wire is placed dorsally into theacross the joints in order todoor. The created traction force

fracture site. The wire is thenreduce the post-operative joint
stiffness.

fractures and the classification of

5.

6.

Try to avoid multiple passes of

Try to avoid passing the K-wirethese fractures bears my nameWhat is the classification of theseFig 2. a) Type II fracture with

opens up the space at the fracture

lifted-up to act as “joy-stick” or a17

. Frequently, I ask my trainees

fractures, and what do we mean

the distal fragment dorsallysite, allowing the phalangeal head“lever” to reduce the fracture (Fig 5),

the following questions to teachby the “cap” fracture?

displaced.

to swivel to 90 position (Type IIIa).

similar to the Kapandji techniqueHand surgeons may accept

them the tips and pearls of wisdom

In 2001, Al-Qattan classified theseb) This resembles a person with a

In a swinging door, the digit may be

19

used in distal radius fractures .

crossing the DIP joint with theregarding the management of thesefractures into 3 types: Type I are

pushed-up cap.

caught twice in the door, and theOnce reduced, a K-wire is thenK-wire because mild stiffness

fractures.

un-displaced fractures. Type II

second withdrawal traction willinserted for fracture fixation. A

at this joint is well-tolerated.

1-

22

1

o

23

TIPS AND TECHNIQUES

www.ifssh.info

TIPS AND TECHNIQUES

August 2018

Various techniques of joint-freea) The intramedullary pre-bentis the most difficult because the

Al-Qattan recommended explaining

K-wire fixation of phalangeal neckwire technique,dorsal fragment is very thin and is

this to the parents (before surgery)

fractures are shown in Figure 6.

b) The crossed K-wire

usually seen in very young children.

and documenting the expected

What are complications of phalangeal

are bone grafts required?

The intramedullary pre-bent wire

technique,

Manipulation and reduction areoutcome and complications inneck fractures in children?

Al-Qattan showed that preoperativetechnique avoids the joints andc) Types IIb and IIc may bedifficult and have a higher risk ofthe medical file for medico-legal

Out of all paediatric hand fractures,

examination of the digit determines

this technique is inspired by thetreated with oblique K-wires,

iatrogenic comminution.

reasons.

phalangeal neck fractures are

the need for bone grafting in the“bouquet” technique of Foucher ind) The peri-articular techniqueknown to have the highest

management of non-union (without

adult metacarpal neck fractures .

proposed by Al-Qattan for

What is the management of Type III

Do mal-united phalangeal neckcomplication rate. These include:

avascular necrosis) of phalangeal

Crossed K-wires may be used incap fractures of the proximal

fractures, and why do they raise a “redfractures remodel?

delayed union, malunion, nonunion,

neck fraction. If the digit is flail,type IIA fractures; and obliquephalanx avoids passing acrossflag”?

Although phalangeal neck fractures

avascular necrosis of the phalangeal

bone grafting is always required. In

K-wires may be used in types II B/C

the MP and PIP joints.

In phalangeal neck fractures, theare located away from the physis,

head, stiffness, digit deformity,

contrast, trimming of the sclerotic

fractures. For Type IIA fracturesphalangeal head is ischemic (themal-united fractures may remodel

partial resorption of the phalangeal

bony edges and K-wire fixationof the proximal phalanx of theblood supply is only through theas shown in Figure 8. Cornwall

head leading to deviation of the(without bone grafting) is sufficient

fingers, Al-Qattan popularized thecollateral ligaments). In all type

and Waters recommended thefinger, resorption of the diaphysis

to obtain union in non-flail digits

peri-articular technique. Al-Qattan

III fractures (Fig 3) the collateralfollowing criteria for taking the(i.e. the proximal fracture fragment),

with non-union 10-13,15.

obtained excellent results using

ligaments are either twisted orconservative wait-and-see approach

iatrogenic comminution of thethis technique in paediatric anddisrupted; and hence the risk of

in mal-united paediatric capphalangeal head during closed

What are the surgical tips ofadult cap fractures

avascular necrosis of the fractured

fractures: mal-alignment should

reduction, iatrogenic splitting of

performing bone grafting fortransverse shaft fractures of thehead is high. Types III C and D

be accepted only in the sagittal

the phalangeal head during thephalangeal neck fracture non-union inproximal phalanx

fractures are usually open fracturesplane, congruent adjacent joints,

insertion of a large-sized K-wire,young children?

and may be associated withand acceptance by the family toand the formation of a bony spur in

All papers published in the world

neurovascular injury. Fixation withwait and to have regular follow-up

the sub-condylar fossa leading toliterature on this topic were by

K-wires is usually done through thefor several months awaiting theblockage of finger flexion

Al-Qattan10-13,15. For unknown

21

3,6,7

23,24

as well as(Fig 7).

Fig 7: An intra-operative view of

924

remodelling.

In non-united phalangeal neckfractures, (without avascular necrosis)

10-15,25.

existing laceration. Type III B andreasons, the thumb is the most

most Type III A fractures requirecommonly affected digit. As

open reduction through a dorsal

mentioned above, the presentation

approach.

is a short flail thumb which is amajor disability functionally anda cap fracture of the proximal
phalanx using the peri-articular

What do we mean by troublesome

cosmetically. Furthermore, there

technique. Note that thephalangeal neck fractures?

is also no effective IP joint motion.

metacarpal head is spared and8

In 2016, Al-Qattan defined five

The surgical tips are as follows:that the wire catches the sub-criteria that will qualify the fracturea) use a longitudinal mid-dorsal

chondral bone of the fractured

to be regarded as “troublesome”:

incision. b) remove the sclerotic

head.

vascular compromise of the digit,edge of the proximal fracture

concurrent partial amputation offragment aggressively. In contrast,

What is the easiest and what is thethe fractured digit, the presence

removal of the sclerotic edge frommost difficult Type II fracture toof phalangeal head commination,

the phalangeal head is done very

manage, and why?

concurrent growth plate injury

carefully with a curette or a rongeur;Type II C with a “flange” is the

distal to the fractured head, andand do not perforate the articulate

Fig 6: Joint free techniques ofeasiest because the “flange”

all Type III fractures. The outcome

cartilage. c) there are two possible

K-wire fixation of phalangeal neckmakes it easy to manipulate andof management of these fractures

sources of bone graft: outer cortical

fractures:

fixation may be done throughtends to be poor and the risk

Fig 8: a) The child presented to me 4 weeks after injury with malunion.

calvarial bone graft10 or iliac crest

the flange (see Fig 6c). Type II D

of avascular necrosis is high.

b) Complete remodelling 5 months later with full range of motion.

bone graft11,13. In young children, the24

25

TIPS AND TECHNIQUES

www.ifssh.info

TIPS AND TECHNIQUES

August 2018

iliac crest has an apophysis which

into the distal fracture fragment

REFERENCES:ElShayeb A. Remodeling inRasool MN, El-Shayeb A,

should be split and protected. d)to exit at the tip of the digit. Then

1.

Al-Qattan MM. Phalangeal

a malunited phalangeal neckHassanain J. A unique fracture

MM. Closed reduction andfirst insert the K-wire retrograde

push the K-wire antegrade throughneck fractures in children.

fracture. Injury 2004; 35(11):1207-

pattern of the proximal phalanx

percutaneous “peri-articular”

the bone graft, the diaphysis

Classification and outcome in10.

in children: fractures throughsingle k-wire fixation forof the proximal phalanx and66 cases. J Hand Surg Br. 2001;

10. Al-Qattan MM, Cardoso E,

the phalangeal neck with andisplaced unstable transverse

the metacarpal. e) the cortico-

26(2):112-21.

Hassanain J, Hawary MB,

attached dorsal bony flange.

fractures of the proximal

Al-Qattan MM. The

Nandagopal N, Pitkanen J.

Injury 2004; 35(11):1185-91.

phalanx in elderly osteoporotic

the bony defect snugly. However,cartilaginous cap fracture.

Nonunion following subcapital

17. Al-Qattan MM. Saw injuries

women: A case series of five

do not over-stretch the thumb

Hand Clin 2009; 16(4):535-9.

(neck) fractures of the proximal

causing phalangeal neckpatients. Int J Surg Case Rep

Al-Qattan MM, Al-Qattan AM.

phalanx of the thumb in

fractures in adutls. Ann Plast

2017; 39:110-114.

secondary to over-stretching of the

A review of phalangeal neckchildren. J Hand Surg Br 1999;

Surg 2012; 69(1):38-40.

neurovascular bundles. f) keep thefractures in children. Injury

24(6):693-8.

wire for 6 weeks. g) only expect

2015:46:935-44.

cancellous bone graft should fill up

to avoid vascular compromise

2.

3.

24. Cornwall R, Waters PM.
Remodeling of phalangeal neck

11. Al-Qattan MM. Nonunion andBennet GC. Children’s proximal

fractures malunions in children:

Al-Qattan MM. A closed

avascular necrosis following

phalangeal neck fractures with

Case Report. J Hand Surg Am

at final follow-up. However, thisphalangeal neck fracture withphalangeal neck fractures in

180 degrees rotational deformity.

2004; 458-61.

does not affect parent satisfaction

180-degree rotation of thechildren. J Hand Surg Am 2010;

J Hand Surg Br 1995; 20(3):353-6.

because the thumb length has beenphalangeal head and concurrent

35(8):1269-74.

restored, and restoration of thumbdisplaced Salter-Harris II

stability greatly improves function.

fracture. Ann Plast Surg 2012;

A demonstrative example is shown

5-10 degrees of motion at the IP joint

in Figure 9 a, b and c.

4.

5.

6.

7.

12. Al-Qattan MM. Neglected

19. Londner J, Salarazard B, Gay

nonunion of phalangeal necktechnique of intrafocal pinningof fractures of the proximal

69(1):35-7.

fractures of the thumb infor phalangeal neck fracturesphalanx in children. J Hand

Al-Qattan MM. Iatrogenic

children: the outcome of delayedin children. Chir Main 2008;

Surg AM 1987; 12:1079-82.

comminution of the phalangeal

bone grafting in adulthood. Ann

27:20-5.

head during reduction or

Plast Surg 2012; 68(3);276-8.

fixation of phalangeal neck

13. Al-Qattan MM, Abu Al-Sahar

20. Matzon JL, Cornwall R. A
stepwise algorithm for surgicalfractures. Can J Plast Surg 2012;

H, Al-Mugaren FM. Nonunion

treatment of type II displaced20(4):233-6.

without avascular necrosis ofpediatric phalangeal neck

Al-Qattan MM. Phalangeal

finger phalangeal neck fractures

fractures. J Hand Surg AM 2014;

neck fractures in adults. J Hand

in children. Report of 4 cases. J

39(3):467-73.

Surg Br 2006; 31(5):484-8.

Hand Surg Am 2014; 39(8):1529-

Al-Qattan MM. Phalangeal

34.
14. Al-Qattan MM. Phalangeal

21. Foucher G. “Bouquet”
osteosynthesis in metacarpal
neck fractures: A series of 66

neck fracture with concurrent

patients. J Hand Surg Am 1995;

Injury 2010; 41(10):1084-9.

vascular injury. J Hand Surg

20 (Suppl): 86-9.

Al-Qattan MM, Al-Munif DS,

Eur Vol 2009; 34(1):104-9.

Al-Hammad AK, Al-Fayez DJ,

15. Al-Qattan MM. Marked

Hanouneh S. The outcome ofresorption of the thumbof the shaft of the proximal

management of “troublesome”

proximal phalanx following

phalanx of the fingers invs. “non-troublesome”

open reduction and K-wireindustrial workers: reduction

phalangeal neck fractures infixation of a phalangeal neckand K-wire fixation leaving

children less than 2 years of age.

fracture in a child: Case report.

the metacarpo-phalangeal

Fig 9 a,b,c Demonstration of bone

J Plast Surg Hand Surg. 2016;

J Hand Surg Am 2015; 40(4):688-

and proximal interphalangeal

grafting for non-union of a cap

50:93-101.

91.

joints free. J Hand Surg Eur Vol

fracture of the thumb:

9.

TT. Subcondylar fossa
reconstruction for malunion

phalanx of the fingers in adults.
8.

25. Simmons BP, Peters

A, Samson P, Legre R. A newneck fractures of the proximal

26

18. Newington DP, Craigen AM,

23. Al-Lazzam A, Al-Qattan

Al-Qattan MM, Rasool MN,

16. Al-Qattan MM, Hashem FK,

22. Al-Qattan MM. Displaced
unstable transverse fractures

2011;36(7):577-83.

27

MEMBER SOCIETY NEWSwww.ifssh.info

Member Society News
ASSOCIATION OF CHINESESPEAKING HAND SURGEONSUNITED (ACU) AND THE FOURTHANNUAL JIXIA HAND SURGERY
FORUM

MEMBER SOCIETY NEWS

August 2018

CANADIAN SOCIETY FOR SURGERY
OF THE HAND (CSSH)

currently lead the society.
The CSSH has already started planning the scientific

The Canadian Society for Surgery

program for the 2019 annual meeting and would like toschools of philosophy (about the same period as Jixia).

of the Hand (CSSH) was reborn

extend an invitation to all members of the IFSSH, hand

The presenters to the fourth annual Jixia Forum infrom the previously known MANUS

surgeons and hand therapists from around the world2018 included groups of presenters from Shandong

in 2016. Its inaugural meeting

to join us on the East Coast of Canada in Saint John’s,

Provincial Hospital, Nantong University Hospital,

was held in conjunction with

Newfoundland. June 25th, 2019 – save the date!

Tianjin Hospital and Beijing Jishuitan Hospital, andthe Canadian Society of Plastic

CHILEAN SOCIETY FOR SURGERY OF
THE HANDattendees from many other hospitals. This year’s forum

Surgeons (CSPS) meeting in the nation’s capital of

The Association of Chinese-speaking Hand Surgeons

started from 8 am, ended at 8 pm, non-stop except a

Ottawa. This first meeting brought together an all-United had an annual Jixia Hand Surgery Forum andfew tea breaks. The meetings have strict regulations tostar cast of speakers from the worlds of orthopaedic

ACU Congress on 1-2 June 2018 in Jinan with overensure free and in-depth discussion with strict timing

surgery, plastic surgery, and hand therapy. It was a

History

500 attendees (Figures 1 and 2). The speakers andfor each presenter or debater.

tremendous success, even forcing a last-minute venue

Organised hand surgery in Chilechange to a larger room! This was followed by anotherdeveloped in the early 1950`spresenters to both events were from mainland China,
Taiwan, Hong Kong and overseas. The two invited

The Jixia Hand Surgery Forum had several featured

outstanding line-up of speakers at the 2017 meeting

under the umbrella of the Chilean

keynote lectures in the ACU meeting were given by

sessions: wrist disorders, tendon repair, wide awake

in Winnipeg, including special guest Professor Oskar

Orthopaedic and Traumatology

Dr Roberto Adani from Italy and Chih-Hung Lin fromhand surgery, functional evaluation of the hand andAszmann from Vienna, Austria.

Society (SCHOT) when the worker´sTaiwan. The ACU meeting had free paper sessions,microsurgical repair and reconstruction (Figure 3). The

symposiums, and educational sessions.

forum also has two sessions which were loved by all

The most recent CSSH meeting was held in theInstitute created. The first hand surgeons andattendees: a free report session open to the attendees

picturesque mountain landscape of Jasper, Alberta.

pioneers were Drs. Walterio Ihl and Victor Mouat. They

Jixia, the name of the hand surgery forum, is derived

to discuss cases with slides or videos, as well as a

The scientific program did not disappoint, putting

developed and spread the knowledge and interest infrom the Jixia Academy, a higher education institutedebate session of 7 topics with participation by all

on display the collaborative approach to high-Hand Surgery.

established 360 BC in Qi (an ancient country of China)

attendees (Figures 4 and 5).

quality hand surgery knowledge dissemination thatfor free exploration and dissemination of knowledge

The motto printed on the badges of all attendees read:the society has become known for. Its objectives

During the 1970´s the Hospital del Trabajador was

and thoughts. Jixia had a forum for strident debates“In free, equal and academic pursuing atmosphere, let

included improved patient communication strategies

established to provide treatment for work related

among the major schools of thought and displayed

us learn together”.

to decrease complication rates, technical alterations

injuries. Dr. Victor Mouat was the first director andto get better results in hand procedures, and bettersoon this hospital became the ‘mecca’ for orthopaedic

post-operative rehabilitation protocols after handsurgery and this resulted in attracting surgeons for thesurgery. The schedule featured Dr. Amitava Gupta

different specialities in orthopaedic surgery.

an agonistic ambiance equal to that in the Atheniancompensation law was passed and the Traumatology

from Louisville, and a number of young speakers fromacross the country. Once again, the meeting was a
massive success, further building on the momentum
from the two previous years.
The achievements of the society thus far have been a
direct result of the incredible efforts that have been
put forth by its executive. Dr. Paul Binhammer, theIFSSH representative and past president of the society,recently passed on the torch to internationally known
Dr. Don Lalonde. President elect Dr. Avi Islur, secretary

28

Dr. Heather Baltzer, and executive director Francine

This picture was taken during the IFSSH Congress inDimambro round out the core group of individuals that

Buenos Aires( 2016)

29

MEMBER SOCIETY NEWSwww.ifssh.info

August 2018

JOURNAL HIGHLIGHTSMEMBER SOCIETY NEWS

Soon thereafter the first Hand Surgery Team was

Our current president is Dr. Juan Manuel Breyer andaseptic bone necrosis of the lunate. Ludwig Kirchmayra bomb in 2000. The procedure was conducted at thecreated under the leadership of Dr. Rossel. Other

our IFSSH delegate is Dr. Lorena Parra.

(1873-1928) developed a tendon suture technique in

Plastic and Reconstructive Surgery Department led by

the hand, later known as Kichmayr repair. Arthur

Prof. Piza-Katzer and the Trauma Surgery Department

institutions where created for the treatment of work
related injuries under the leadership of Dr. R. Gonzales

The next annual meeting will be held in Santiago de

Steindler (1878-1959) performed elbow flexion plasty

led by Doz. Pechlaner together with the Department ofand Dr. J. C. Uribe. These hand surgery teams trained

Chile from 15 to 17 November 2018.

and tendon transpositions in the hand. Lorenz

Visceral, Transplant and Thoracic Surgery led by Prof.

Böhler (1885-1973) gained worldwide fame with his

Margreiter. In Austria, a total of four bilateral hand or

work on fracture treatment and emphasized theforearm transplantations have been performed thus

dedicated care for hand injuries. He was one of thefar.

most of the hand surgeons who later migrated to otherhospitals spreading hand surgery all over Chile.

Everyone is welcome to participate and enjoy Chile!

During the early 1990´s the South-American Hand

The Chilean Society for Surgery of the Hand andmost distinguished personalities in Austrian trauma

Surgery Federation gave us tremendous support byMicrosurgery

surgery. Josef Ender (1915-1980) published on theClinical practiceEnder plate and scaphoid plating. Otto Russe (1913-

In 2017 among 272 medical units in Austria taking1983) performed scaphoid pseudarthrosis surgery,care of 8,8 million inhabitants, four are FESSH

known as Russe bone grafting.

certified Hand Trauma Centers where all handorganizing meetings. This enabled us to meet andbefriend international hand surgeons. Many visitscame from Drs. Eduardo A. Zancolli, Arlindo Pardini,
Eduardo R. Zancolli, Walter Manna Albertoni, JoseMaria Rotella, Rames Mattar and Mario Rodriguez

socimanochile@gmail.com

AUSTRIAN SOCIETY FOR SURGERY
OF THE HAND

Sammartino, amongst many others. This led us totrauma (including replantation) is treated by qualified
In the more recent decades, Jörg Böhler (1917-2005)

hand surgeons. These hand trauma centers arecompleted the German translation of “Surgery ofgeographically balance-distributed, with two in thecreate the Chilean Society for Surgery of the Hand and

Hand Surgery in Austria

the Hand” written by Bunnell and founded “Wiener

east, one in the middle and one in the western part ofsubsequently our Society became an active member ofAustria has an notable position in the European

Handkurse”, a course series, that is still being held

the country.

the South-American Federation of Societies for Surgery

history of hand surgery, mostly due to a number oftoday. He was awarded “Pioneer of Hand Surgery” byof the Hand, as well as the International Federation of

dedicated internationally well-known Austrian handInternational Federation of Societies for Surgery of

In 2011 there were 6,1 million people insured

Societies for Surgery of the Hand.

surgeons. It was in the early twentieth century when

the Hand (IFSSH) in 2001. Ernst Scharizer (1922-2009)

with the government public accident insurance

Austrian surgeons recognized that specialized hand

was an editor of the “Handchirurgie” (changed in(population in Austria at that time was 8,4 Million).

During the early 2000´s while Dr. Alberto Perez was

surgery education is essential to provide optimal care1983 into “Handchirurgie, Mikrochirurgie, Plastische

The government insurance is divided into four

the head of the Hand Surgery Service at the Hospitalfor hand injuries. The professional spirit and efforts

Chirurgie”). Emil Beck (1931-2001) published onmain sections: general trauma insurance company

del Trabajador and as a result of the international

have continued by Austrian surgeons up to this day.

surgical treatment of Kienbock disease, including(Allgemeine Unfallversicherungsanstalt – AUVA),

transposition of a vascularized pisiform bone into theinsurance for Austrian federal railway and coal

exposure, young surgeons began to spend time abroad
learning skills such as microsurgery, arthroscopy and

Early contributors to hand surgery

lunate bone (Beck’s procedure). Hanno Millesi (1927-

organisation (Versicherungsanstalt für Eisenbahnen

other techniques from renowned surgeons based at

Just to name some of these Austrian surgeons who2017) played a key role in peripheral nerve surgery,und Bergbau), insurance for government employees

Nancy, Paris, Kleinert institute, Massachusetts Generalcontributed to hand surgery: Johannes Hartlieb (1400-

and was a co-editor of the “Handchirugie” and was(Versicherungsanstalt öffentlicher Bediensteter) and

Hospital , Mayo Clinic, Hospital for Special Surgery in1468) published the earliest German-written bookawarded with “Pioneer of Hand Surgery” by the IFSSH

insurance for farmers (Sozialversicherungsanstalt derNY, Barcelona, Madrid, European Wrist Arthroscopyof hand surgery “Buch von der Hand”. Simon Zeller

in 1998, and was a founding member of the Austrian

Bauern). Besides these four, there are a few private

Society, Sydney and many other places, thus improving(1746-1816) used a triangular dorsal flap to repair theSociety for Surgery of the Hand (ÖGH). Hildegunde

Insurance Companies.

the knowledge, the interest and participation in ourinterdigital space after syndactyly correction. Karl

Piza- Katzer (1999-2008) focused on the treatment

own and international meetings.

Langer von Edenberg (Ritter von Edenberg) (1819-of congenital hand deformities, and was awarded

According to the AUVA report in 2011, 109,408

1887) described Spaltlinien der Haut (skin ridges).

with the IFSSH title, “Pioneer of Hand Surgery” inindustrial accidents occurred in Austria. Of these,

We are now a vibrant and growing National Society

Wenzel Leopold Gruber (1814-1890), an Austrian

2013. Sigurd Pechlaner is a founding member of the

38,6% affected the hand ie a total of 42,231 handand a member Society of the South-American andanatomist, published numerous works on anatomicalÖGH, with main interest in wrist trauma, and edited

injuries in Austria during that year. The main injuries

International Federation with 300 plus members,variations of the hand, including the Martin-Gruber“Atlas of Hand Surgery”, was awarded with the IFSSH

were wounds and superficial lesions next to fractures,

participating in monthly meetings and an annual

connection (connection of the ulnar and median“Pioneer of Hand Surgery” award in 2016.

dislocations, spraining. Most were located on one

Congress. We hosted the South-American Federation

nerve at the forearm). Carl Nicoladoni (1847-1902)

Congresses in 2001 and 2015, which were presided byreconstructed the thumb with pollicisation of toes

Hand surgeons in the Medical University Innsbruck

The main mechanism of injury was contact with aDrs. Alberto Perez and Jorge Vergara respectively.

and developed techniques for tendon transpositions.

performed a bilateral hand transplantation in a

sharp or pointed object like knifes, cutters, syringes,

Robert Kienböck (1871-1953), a radiologist, describedpatient who sustained a bilateral hand amputation byneedles, glass and steel sheets. The overall costs

30

finger, the thumb, the metacarpal region and the wrist.

31

MEMBER SOCIETY NEWSwww.ifssh.info

August 2018

JOURNAL HIGHLIGHTSMEMBER SOCIETY NEWSspent for the treatment of these hand injuries wereVice Director

Academic activity and continuing medical education.

In addition, two courses on advanced experimental

284,516,798 Euro. The average cost per injury was 6,737

Department of Trauma Surgery

Two courses on cadaveric specimens were carriedmicrosurgery with rat models were also carried out

Euro. These facts and costs led to the establishment

Medical University Innsbruckout: one on lower limb microsurgery flaps for(Lead by Dr. Garat and Secretary Dr. Boretto). Thisof a committee for hand injury prevention

Anichstrasse 35

reconstructive surgery (Led by Dr. Levy, Dr. Boretto,

activity has been taking place since 2010 and has

consisting of insurance companies, medical doctors,

A-6020 Innsbruck, Austria

and Dr. Muratore) and the other on upper limb

always received physicians, not only from all parts

representatives of the government and industry. The

Tel. +43-(0)512-504-80873

peripheral nerve surgery (Led by Dr. Levy and Dr.

of our country but also from different Latin American

3rd European Hand Prevention Congress took place

Fax +43-(0)512-504-67-80873

Muratore).

countries (Colombia, Brazil, Chile, Peru, Bolivia, andin 2014 in Vienna. The aim was to establish ways towww.unfallchirurgie-innsbruck.at

Uruguay).

ARGENTINE SOCIETY FOR SURGERY
OF THE HAND (AACM – “Asociación Argentina

Since 2007 the AACM has committed itself to reachde Cirugía de la Mano”)

two or three Regional Congresses. This year theseprevent hand injuries, and also in doing so, to reduce
the high medical expenditures for the government.
Around 200,000 Austrians are affected by Dupuytren’s

different provinces in Argentina and to carry out

contracture. The gold standard for the treatment

congresses were held in the province of La Pampa

is still partial fasciectomy. Since 2011 treatment

The Argentine Society for Surgery of the Hand

with Dr. Mauro D’Adam as regional coordinator and inwith collagenase was offered all-over the country.

(AACM) had a year of intense academic activity andthe province of Catamarca with Dr. Carlos Gonzalez as

To control the possible complications of the non-continuing medical education. Flowing from theregional coordinator.

surgical treatment, the Austrian Society for Surgery

Argentine and South American Conference in Octoberof the Hand decided that only surgeons with2017 in Buenos Aires, with 620 attendees, the newThree webinars, coordinated by Dr. Gustavo Teruya,

experience with Dupuytren’s surgery should use theexecutive committee led by President Dr. Violeta

were also carried out which included foreign andcollagenase. They would then be able to handle any

Levy, General Secretary Dr. Jorge Boretto, Minutes

national distinguished guests such as Dr. Luis

possible complication. An Austrian wide registry

Registrar Dr. Marcelo Mazzola, Financial Secretary Dr.

Shecker (USA), Dr. Lorena Parra (Chile), Dr. Eduardo

was established in 2011 for the use and results of

Alvaro Muratore, and other participants, established

Zancolli, Dr. Sergio Daroda, Dr. Gabriel Clembosky, Dr.

collagenase by the Medical University Innsbrucka workgroup with the purpose of performing several

Carlos Zaidenberg and Dr. Juan Carlos Cagnone.

and the Austrian Society for Surgery of the Hand,

activities of medical education for its associates andand it is still on going. More than 800 patients are

members of different Latin American Societies.

Finally, our annual congress will be held in Octoberpresently in this study and the long-term results, with2018 and is organised by President Dr. Cecilio

the complications and the recurrence rate will be

One significant step of our Society was the acquisition

Argañaraz and Secretary Christian Perrotto. Foreign

published soon.

of a new venue. This venue was designed for the

In June, the AACM carried out an updating course

guests will include Dr. Andrea Atzei, Dr. Alex Lluch,

primary purpose of having a place to carry out

which included a conference on WALANT surgery,and Dr. Luiz Franciosi.

Around 1% of Austria’s population is suffering from

attendance-based and virtual courses for ourwith Dr. Donald Lalonde as a special guest, as well as

rheumatoid arthritis. Hand surgeons with orthopaedic

associates. The new office has a lecture hall with aother renowned specialists. This course welcomed

D.G. Carla M. Cometto

background treat most of these cases. Generally, since

capacity for 40 attendees, a touch screen (i3TOUCH

280 attendees.

AACM Secretaría Curso de Junio y Congresos

the introduction of Biologic agents, the rate of surgical

86” E series with high-definition images which

treatment is decreasing.

operates at the touch of a finger or pen and reacts

Asociación Argentina de Cirugía de la Mano

instantly) and a room specially equipped for webinars.

Buenos Aires | Argentina

Edited: from the publication:(+54)11 4371-2282 / 4371-2452

Kastenberger T, Arora R. Hand surgery in Austria.

aacm.congresoycursojunio@gmail.com

J Hand Surg Eur Vol. 2018www.aacm.com.ar/cursos/congreso2018

Jul;43(6):679-681. doi: 10.1177/1753193418754788.

www.aacmyrms.org

PubMed PMID: 29925304.
Rohit Arora MD
Professor of Trauma Surgery

32

33

MEMBER SOCIETY NEWSCOLUMBIAN ASSOCIATION FOR
SURGERY OF THE HAND

www.ifssh.info

edition of ‘Plastic Surgery, Reconstructive Surgery
and Cosmetic Surgery’. In 2008 the 3rd edition in 6

MEMBER SOCIETY NEWS

August 2018

BRAZILIAN SOCIETY FOR SURGERY
OF THE HAND (SBCM)

volumes was published. One of these volumes was

The general public is also the focus of the Brazilian
Society. Every year it develops national and regionalawareness programs on pathologies that affectOn 1 July 1966, 29 dedicated Hand Surgeons createddedicated to ‘Hand Surgery and the Upper Limb’. In

The Brazilian Society for Surgery of the Hand (SBCM)

hands. The last one was about preventing fireworks

the first Hand Surgery Society in Columbia. This

2006 Dr. Julio Bermudez and Dr. Francisco Camacho

was founded in 1959 by 57 hand surgeons. Currently,

accidents, very common during regional festivals inSociety was founded to create more awareness for

published a manual for ‘Microsurgery Technique’ with

we have more than 700 members and it is one of theJune and the Soccer World Cup.

the need of Hand Surgeons. Dr. Paul W. Band was

the help of the Universidad del Bosque. Dr. Roberto

largest Members Societies of the IFSSH.

instrumental in the establishment of our Society. In

Melendez published a book called ‘Hand Surgery –1997 however, due to Colombian government laws, theEssential aspects for clinical practice’ in 2014. Also in

The SBCM has almost seventy years of history and,of Hand Surgery on 16-18 August 2018, in Fortaleza,name was changed from Society to Association.

2014, Dr. Enrique Vergara, president of the Columbian

from the outset, is committed to hold national andCeará, Brazil. SBCM President Milton Pignataro,

The first Hand Fellowship program was created by

Association at the time, was the editor of a bookinternational events and courses, contributing

Congress President Marcelo Rosa de Rezende andthe Military University Medical Faculty. This one

commissioned by the Association on injuries of theimportant international scientific knowledge at

Honorary Congress President Ronaldo Jorge Azze

year fellowship was aimed at Orthopedic or Plastic

hand, which included 16 surgeons and 2 physicalmeetings, as well as publishing in journals and hand

have developed a rich and varied program for theSurgeons who wanted to specialize in Hand Surgery,therapists as authors.

surgery books. SBCM has 31 training centers for Hand

event, focusing on arthroscopy and congenital

Surgery in Brazil.

deformities.

and was offered at two Bogota hospitals, the San

Our Society will host its 38th Brazilian Congress

Rafael Hospital Clinic and the Central Military

The Association published a second book in 2015 with

Hospital.

the title ‘Tendinitis and Tendinosis of the Elbow, ofSince 2017, the Brazilian Society announced its

To learn more about the Brazilian Society for Surgery

the Hand and associated injuries’. Sixteen members

intention to be the host country for the “2025 IFSSHof the Hand, visit the website:and 2 correspondents worked on this book. On 2017

Triennial Congress” which, accordingly to the rule of

SBCM - Sociedade Brasileira de Cirurgia da Mão

a 3rd book was published: ‘The Carpal Scaphoid’, withrotation, should be held in a country of the American

www.cirurgiadamao.org.br

editors Dr. Roberto Melendez and Dr. Fabio Suarez.

continents.

Twenty-one authors worked on this book including
1 physical therapist. Dr. Jaime Restrepo has madeThe Brazilian Society was represented by a large

notable contributions on micro-vascular anatomy

delegation of members at the FESSH 2018 Congress inresearch, especially of the fibula.

Copenhagen.
The Brazilian Hand Surgeons participated in the

From 22-25 August 2018 our Association will hold its

scientific program with 43 presentations among

National Congress in Medellin with 16 international

lectures and posters, and the SBCM again presented

Dr Paul Brand and Dr Roberto Laignelet Rueda with aspeakers. Also, during August the South American

Brazil as a candidate to host the IFFSH Congress inpatient.

Congress on Hand Surgery will take place in

2025.

Cartagena.
Dr. Jochen Gestner published multiple articles,
including, ‘Primary care and rehabilitation’ in

We will fully participate in the IFSSH Congress in

1980. With the help of Dr. Andres Echeverri he also

Berlin next year and will also bid to host the 2025

wrote ‘Concepts of Traumatology’. Dr. Felix Borreto

IFSSH Congress in the city of Cartagena, Columbia.

published ‘Hand Traumatology’ in 1996. Dr. Felipe
Coiffman translated and published in 1962 thework of Dr. Arthur Joseph Barsky’s first editionof ‘Congenital Anomalies of the Hand and their
Surgical Treatment’ written 1958. He translated Dr.
Bernard McC O’Brien’s publication of ‘Microvascular
Reconstructive Surgery’ which was published in
1980. Dr. Coiffman also published in 1986 the first

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August 2018ART

Art Exibit #4
Fruit Bowl

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August 2018

IFSSH Exco andDelegates Council
Meeting
JUNE 2018, COPENHAGEN, DENMARK38

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August 2018

UPCOMING EVENTSInternational Course
on Supermicrosurgery
Dear Colleagues,•

Pediatric Microsurgery

On behalf of the scientific program committee, It is•

Microsurgery in aged patients

our pleasure to invite you to the International Course•

EV-IC bypass

on Super-microsurgery (ICSM) which will be held on•

Esophageal reconstruction

12-14, October 2018 at the Shangri-La International•

Trunk and Torso reconstruction

Hotel, Jinan, China.

•

Perineal Reconstruction•

Other special topics of supermicrosurgery

The preliminary panels of the ICSM meeting will
include:A special panel about Difficulties Facing•

Hand and upper extremities

Microsurgery Practice in Developing Countries will•

Lower extremities

discuss the situation in 8 countries: Egypt, Sudan,•

Brachial plexus

Morocco, Nepal, Kyrgyzstan, India, Nigeria and•Facial reanimation

Pakistan•

Neuropathy of upper and lower extremities•

Micro lymphatic

Detail of the free paper section will be announced on•

Breast reconstruction

the website later.

•

All kinds of replantation (extremities, ear, nose,•

scalp, penis, and scrotum....)A shuttle bus will be available for transportation fromAll kinds of vascularized tissue allotransplantation

the airport to the hotels.

and related (face, hand, penis, uterus, larynx,
head, hepatic artery...)The official website: mhttps://www.2018icsm.com

Special flaps (super-tiny, super-huge, super-

The official Facebook page: https://www.facebook.

thin...)

com/2018icsm/•

Non-physiologic flap (venous flap, puzzle flap...)

The Facebook event page: mhttps://www.facebook.

•Special tricks to salvage the circulated

com/events/488653204883868/•

compromised flap•

Medical education and social media

Please forward this information to all your colleagues.

•

Clinical anatomy of microsurgery

Feel free to contact us if you have any further•

Special techniques in microsurgery

inquiries or suggestions.

•

The limit of the Microsurgery (longest andshortest time)

Looking forward to seeing you at our meeting and•

Deceptive reconstruction

eagerly awaiting for your participation.

•

Hi-Tech involved (3D printing, virtual reality,
artificial intelligence)

Best regards,•

Laboratory microsurgery

Usama Farghaly Omar, MD, M.Sc.

•

Robotic microsurgery

Orthopedic Surgeon, Al-Hekma Specialized Hospital,•

Cosmetic Microsurgery

Assiut, Egypt.

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August 2018

UPCOMING EVENTS

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