November 2019www.ifssh.info

ifssh

VOLUME 9 | ISSUE 4 | NUMBER 36 | NOVEMBER 2019

SPECIAL FEATURE:

ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILYPRESERVATION OF SKELETALHEALTH IN THE LONG TERM
GLUCOCORTICOID PATIENTHAND THERAPYMINDFULNESS, HEALTH COACHING
AND HAND THERAPY

The effect ofSteroids on
Bone

UPCOMING EVENTSMEMBER SOCIETY NEWSIFSSH SPONSORSHIPS
1

www.ifssh.info

November 2019www.ifssh.info

VOLUME 9 | ISSUE 4 | NUMBER 36 | NOVEMBER 2019

THE JOURNAL OF

HAND SURGERY(Asian-Pacific Volume)

contents

An International Journal Devoted to Hand and Upper Limb Surgery and Related Research
Journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
Submission at http://jhs-ap.org
https://www.worldscientific.com/jhs

Find out more 
about this journal

4Latest Articles: Volume 24, Issue 03 (Sep 2019)
Research Papers
Evolution of the Ring Concept for the Forearmand Its Implication on Treatment: From Galeazzi,
Monteggia, Essex-Lopresti, and Darrach to theCurrent Era
Kate Elzinga and Kevin Chung
Association between Functional Outcomes andRadiographic Reduction Following Surgery for
Distal Radius Fractures
Ronit Wollstein, Raviv Allon, Yoav Zvi,
Alan Katz, Sharon Werech and Orit Palmon
Long-Term Results of Surgically Treated Radial
Polydactyly – An Outcome Correlation Study
Ching Man Yeung, Alexander Kai Yiu Choi,
Jennifer Wing Sze Tong, Winnie Fok,
Yat Fai Chan and Yuk Yin Chow
Percutaneous A1 Pulley Release Combined with
Finger Splint for Trigger Finger with Proximal
Interphalangeal Joint Flexion Contracture
Tzu-Cheng Yang, Duretti Fufa, Hui-Kuang
Huang, Yi-Chao Huang, Ming-Chau Changand Jung-Pan Wang
Metaphyseal Core Decompression of the Distal
Radius for Early Lunate Necrosis
Christoph U. Schulz
Minimum Ten-Year Outcomes of Partial Ulnar
Nerve Transfer for Restoration of Elbow Flexion in
Patients with Upper Brachial Plexus Injury
Yusuke Nagano, Daisuke Kawamura,
Alaa Terkawi, Atsushi Urita, Yuichiro Matsui
and Norimasa Iwasaki
Forearm Shortening Impact on Pronation andSupination
Luis Schnapp, Salih Colakoglu, Jose Couceiro,
Amir Oron, Guy Brock and Rodrigo N. Banegas
Asymmetric 6-Strand Flexor Tendon Repair –Biomechanical Analysis Using Barbed Suture
Jasmin Shimin Lee, Yoke-Rung Wong and
Shian-Chao Tay

2

A Comparison of Radiographic Outcomes between
3D Preoperative Planning and Conventional
Planning in the Osteosynthesis of Distal Radius
Fractures
Yuichi Yoshii, Yasukazu Totoki, Wen-lin Tung,
Kenichi Akita and Tomoo Ishii
Post-Exertional MRI Is Useful as a Tool for
Diagnosis and Treatment Evaluation for Chronic
Exertional Compartment Syndrome of Forearms
Akiko Tominaga, Kozo Shimada, Ko Temporin
and Ryosuke Noguchi
Diabetic Hand Infection: An Emerging Challenge
Ahmed Suparno Bahar Moni, Monirul Hoque,
Rayhan Ali Mollah, Razia Sultana Ivy and I
srat Mujib
Ulnar Nerve Strain in Functional Elbow andShoulder Motions
Chaiyos Vinitpairot, Surut Jianmongkol,
Tala Thammaroj and Settapon Wattanakamolchai
Systematic Review of the Use of Patient Reported
Outcome Measures in Studies of ElectivelyManaged Hand Conditions
Hawys Lloyd-Hughes, Luke Geoghegan,
Jeremy Rodrigues, Michele Peters, David Beard,
Andrew Price and Abhilash Jain
Outcomes of the Hemi-Hamatum Arthroplasty
Karlis Verdins and Vadims Nefjodovs
Arthroscopic Thermal Shrinkage: A Novel
Method for the Treatment of Chronic Volar Plate
Instability at the Metacarpal Phalangeal Joint of
the Thumb
Yu Chung Wong and Pak Cheong Ho
Thumb Carpometacarpal Arthroplasty with
Dynamic Suspension Sling Using Extensor Carpi
Radialis Tendon
Takehiko Takagi, Yuka Kobayashi and
Masahiko Watanabe
Surgical Treatment of Chronic Hand Ischemia:
A Systematic Review and Case SeriesDavid L. Colen, Oded Ben-Amotz, Thibaudeau
Stephanie, Arman Serebrakian, Martin J. Carney,
Patrick A. Gerety and L. Scott Levin

Are you absolutely sure?

Editor-in-Chief

Goo Hyun Baek, MD, PhD

Professor and Chairman(Seoul National University Hospital & Seoul
National University College of Medicine,South Korea)

Co-Editors

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

Hospital, Singapore)

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

EDITORIAL- Ulrich Mennen

5

6

PRESIDENT REPORT

24 HAND THERAPY
Mindfulness, Health Coaching and Hand
Therapy- Marc Garcia-Elias- Debbie Larson

LETTER TO THE EDITORHISTORIAN & SOCIAL MEDIAIFSSH- Past and Future				- David Warwick

10 OBITUARY• Giorgio Brunelli

12

Pen BoxPresident: Acceptance Speech- Jörg Bahm

8

23 ART

SECRETARY-GENERAL REPORT- Goo Hyun Baek

14 PIONEER PROFILES• Harold Bolton

30 MEMBER SOCIETY NEWS• Israeli Society for Surgery of the Hand
• Indian Society for Surgery of the Hand
• Colombian Society for Surgery of the Hand
• American Society for Surgery of the Hand

36 IFSSH SPONSORSHIPS• International Consortium for Health
Outcomes Measurement• Esser Masterclass Fellowship• Hand Surgery Fellowship in Shandong China

42 UPCOMING EVENTS
List of global learning events and conferencesfor Hand Surgeons and Therapists• Isidor Kessler

16 SPECIAL FEATURES
Preservation of skeletal health in the longterm glucocorticoid patient			
- Erich J Raubenheimer

3

EDITORIAL

www.ifssh.info

PRESIDENT REPORT

November 2019

President Report

EDITORIAL

Are you absolutely sure?

FROM THE IFSSH PRESIDENT
Dear Colleagues,

have small hand surgery societies to find ways toassist them. In those countries that do not haveThree months ago, I took up the presidency of the

any such societies, we are looking at ways for thoseInternational Federation of Societies for Surgery of theindividual colleagues to also become part of our

A known saying may reveal more insight than meets

extent a mystery. New revelations are regularly madeHand (IFSSH) after a successful meeting in Berlin.

Federation. The concept of “orphan hand specialists”

the eye.

which changes our understanding and approach all

After these three months we are still basking in the

may not be ideal, but at least it helps us to be aware of

the time. Many so-called facts which we have accepted

glow of a capital considered by some the “greatest

the problem and seek ways to enable them to officiallyThree things need to be considered when facing

as facts have been replaced over the years. Should thiscultural extravaganza one could imagine” (David

also become members of the IFSSH.

decision making:not be taken into account as well?

Bowie 1970). After all what we saw, and enjoyed, our1.

The known facts.

2.

The known unknown facts.

3.

The unknown unknown facts.

gratitude to the organizers is endless. Indeed, the way

As it was more than 53 years ago, our main objective

Suggesting a diagnosis and a treatment plan forthey handled the many obstacles that such complex

remains education and promotion of hand surgery

a patient should be a very careful and consideredorganization involved was impressive. Thanks a lot!

world wide. We will do our best to fulfill this mandate
which we have accepted as your Exco.

process. Multiple pieces of information, the known,
It would be prudent to consider this advice even for us

partially known and awareness of the possible yet toAlso, only three months, and yet, I am glad to say thatas clinicians.

be discovered, should form part of our mindset when

the renewed Executive Committee has worked hard,

After Berlin, I am sure that you all will agree with me

being confronted with a clinical problem.

aware of the important commitment we have acceptedthat amongst the IFSSH members there are manyat this year’s IFSSH Delegates Meeting. We are striving

experts and many colleagues with much experience,and that we all need to share our knowledge.

Before embarking on a course of action, ie treatment,
we have to ensure that our investigative conclusion, ie

The question therefore is:to find ways to improve our bylaws. By reviewing ourdiagnosis, is correct.

Am I absolutely sure about my diagnosis, which will

membership performance and achievements, we are

dictate the treatment options and ultimate best result?

trying to set new objectives: how to get younger, more

I wish you a successful 2020, full of health andenergetic surgeons involved. Why are women underhappiness in your personal life.

We have been trained to consider known facts. Bloodpressure, temperature, biochemical tests, special

Sincere regards,

represented in our Federation? How do we make theinvestigations, etc. can be regarded as known facts.

UlrichMembership more aware of the goals and expectations

Best regardsof the IFSSH Charter? To this end, we are evaluating
However, do we consider the known unknown facts

the history and structure of the current set of bylaws.

which may be just as important , and which may

Yes, it is brainstorming time, and we take it very

influence the diagnostic outcome? The physiologicalseriously.

response to our prescriptions by the patient’s uniquegenetic make-up, or the unpredictable connective

As we stated in Berlin, aside from redefining our

tissue reaction during the healing process after

future, we also should build on the projects of oursurgery may be examples.

predecessors. In this respect, we have assigned
specific missions and tasks to the members of the
Executive Council. We want to see the IFSSH grow by

But even more daunting is what influence theunknown unknown facts which still have to be

Ulrich Mennen

bringing new partners to the Federation.

discovered might play in diagnosis making. Our

Editor: IFSSH Ezine

We wish to engage with developing countries who

intricate and complicated bodies are still to a large

Past President: IFSSH

4

Marc Garcia-Elias
President of IFSSH

5

LETTER TO THE EDITOR

www.ifssh.info

Letters to the Editor

LETTER TO THE EDITOR

November 2019rehabilitation, and a psychologist analyses the general

References

background- all of this under the supervision and•guidance of a qualified hand surgeon).

Aranyi Z, Csillik A, Devay K, Rosero M,
Barsi P, Böhm J and Schelle T: Ultrasonographic
identification of nerve pathology in neuralgic

Dear Paco,

Later on, I focused myself on brachial plexus

I come to my last point: education.

amyotrophy: enlargement, constriction, fascicular

I have read your recent contribution about CRPS insurgery, especially in children, and more generally

Especially our FESSH and IFSSH congresses are

entwinement, and torsion.				

the IFSSH Ezine (August 2019 #35) very carefully, and I

on peripheral nerve surgery and the treatment of

big events, supposed to cover all aspects of our

Muscle and Nerve 2015 503-511

appreciate your input as much as your editorial in theneuropathic pain (my strategy is summarized in a

discipline. But look how poorly nerves and pain

JHSE. I agree with you on most points, but think thatrecent paper written together with Winkel and Zyluk

issues are represented. Either we talk for hours

need more interdisciplinary and holistic treatment.

your explanations do not cover all aspects of CRPS.

in 2018).

about carpal or ulnar tunnel surgery, or we organize

Neurology, Psychiatry and Brain Research 2018 28

panels for brachial plexus surgery, where always the

24-28

•

Bahm J, Winkel R, Zyluk A: Neuropathic pain: We

As I am myself committed to the “difficult pain

I totally agree when you state that CRPS is a dustbinsame twenty or thirty colleagues talk and listen to

problems“ in the upper limb now for almost 25 years,(and it is up to us surgeons to sort out things), thatthemselves. We all know of course colleagues who

Guidelines						beginning during my hand surgical training at Aachen

there is a lot of mal-doctoring and that pain clinics areinvestigated CRPS for years, like you and Andrzej

ISBN-10:90-8523-124-8 Utrecht 2006

University Hospital. My consultations rapidly became

like graveyards.

Zyluk from Poland (Goebel et al 2019). Even otherthe difficult, chronic pain cases, because I never giveBut your hypothesis of an “irritated“ median nerve andspecialists contribute much on CRPS (have a look at

Eccleston C, Eisenberg E, McCabe CS, Moseley GL,

up and I take time for all the patients, so I perfectly

its decompression does not solve all aspects and may

the CRPS type I Guidelines from 2006, issued by both

Perez R, Perrot S, Terkelsen A, Thomassen I, Zyluk

understand your concerns.

be misleading. Sometimes we definitely do not find thethe Netherlands Society of Rehabilitation Specialists

A and Wells C: Standards for the diagnosis andmagic key in a given patient, especially in the chronicand Anaesthesiologists). But you obviously raise an

management of complex regional pain syndrome:Within my training time, two facts influenced me a lot:

pain patient, as the pain memory and whole socio-

issue where most of our colleagues are not really

Results of a European Pain Federation task force.

1.

In a controlled animal experimentation in rabbits, I

psycho-biological adaptation initiated a new adaptive

interested in, unless it concerns one of their own

Eur J Pain 2019 23 641–651

was unsuccessful in reproducing CRPS in hint limb

behaviour and “fake” limb integration.

patients, or one of their family members.

•

•

•

by nerve and /or vascular irritation, although the2.

Goebel A, Barker C, Birklein F, Brunner F, Casale R,

Vispo Seara JK, Krimmer H and Lanz U:
Monofaszikuläre Nervenrotation (monofascicular

scintigraphic examination showed postoperatively

I actually still claim that a syndrome (sum ofThank you in anticipation for your response, andnerve rotation)					inconstant changes of limb perfusion and bone

symptoms) like CRPS does exist, that nerves

thank you for taking these patients into your surgeon´s

Handchir.Mikrochir.Plast.Chir 1994 26 190-193

tracer fixation (unpublished data, due to the lack ofare frequently affected (and we should find out

heart.

“conclusion”).

how, by compression, torsion (Vispo Seara et al

I met Albrecht Wilhelm in 1995, a real pioneer in1994), metabolic changes seen in the huge field ofGerman hand surgery. He has worked for years on

neuropathies, etc.) and that research and care forpain issues in the hand and upper limb, did his PhD on

these people must progress.

the joint innervation of the upper limb (Wilhelm 1958)•

Wilhelm A: Zur Innervation der Gelenke deroberen Extremität. Zeitschrift für Anatomie undYours sincerely

Entwicklungsgeschichte 1958 120: 331-371•

Wilhelm A: Die Gelenkdenervation undJörg Bahm

ihre anatomischen Grundlagen. Hefte zur

Reconstructive Microsurgery and Hand Surgery Unit

Unfallheilkunde 1966 86: 1-109(giving raise to the “denervation“ surgery- Wilhelm

Yes, we need to listen very carefully to their

Franziskushospital Aachen, Germany1966); and analysed how an unrecognized thoracic

complaints, especially how they describe their pain.

jorg.bahm@belgacom.net

outlet syndrome could together with a more peripheral

Yes, we should care much more about them (Bahm ettrigger, like a little trauma or surgery, start a CRPS

al 2018).

(Wilhelm 1985). He also published about nerve fascicle

6

Complex Regional Pain Syndrome type I•

Wilhelm A: Das Radialisirritationssyndrom (radial
nerve irritation syndrome) Handchirurgie 1970 2
139-142•

Wilhelm A, Wilhelm F: Das Thoracic Outlet
Syndrom und seine Bedeutung für die

torsion giving sudden pain and palsy (Wilhelm 1970)

In Germany, we actually have an in-patient strategy

Chirurgie der Hand (thoracic outlet syndrome

This last condition becomes actually very interesting

called “hand surgical complex therapy“ allowing

and its importance in hand surgery).		

when one tries to understand Parsonage-Turner or

us to admit those complex patients for two to

Handchirurgie 1985 17 173-187

TOS syndromes (Aranyi et al. 2015). Wilhelm during

three weeks in the hospital and to treat them by an

his time published mostly in German, and his articles

interdisciplinary team (the anaesthetist performs

are not Pubmed-rated: a pity, as today only English

a scalene block to make them pain-free, ergo- andwritten medical science matters.

physiotherapists work on sensory and motor

7

HISTORIAN AND SOCIAL MEDIA REPORT

www.ifssh.info

HISTORIAN AND SOCIAL MEDIA REPORT

November 2019

Historian & Social
Media Report

INSTAGRAM
This opened on 10th July 2019 @IFSSHand. and by
12th August had already gained 690 followers. It has
a particularly strong following in South America andSpain.

IFSSH- PAST AND FUTURE
IFSSH is proud of its roots and its heritage; the IFSSH
Historian preserves that heritage. But as we move

The EZINE is also available on the website- every

into the future, Social Media must be embraced by thesingle past edition is available as a pdf download. So

IFSSH, combining the past and the future.

you can see the past news, histories, scientific articles,
and much more.

WEBSITETake a look at the new website www.ifssh.info
The Hand Surgery Worldwide book is available as a
By 8th October 2019, people from 114 countries havedownload for anyone to read.

visited the website, an average of 19 visits each day.

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

Finally
Use the Website- it is a great resource. Have a lookat the History tab, learn about the Pioneers who got
hand surgery to where we are today, follow IFSSH on
Instagram and Twitter and spread the IFFSH news.

There is a new Archive Tab with 4 sections relevantto the history of our Federation: Delegates Meetings;
Giants of Hand Surgery; Pioneers of Hand Surgery andAnother new feature is the EVIDENCED BASEDthe Swanson Lecture.

HAND SURGERY UPDATE link- an initiative from the
University of Nottingham with a monthly update of all

David Warwick

Under the Member Nations Tab you can find a list

systematic reviews in hand Surgery- just click on the

TWITTERof all the Member Societies and their histories. If

link….

A twitter account was opened in May 2018 @IFSSHand.

your national history is missing- please send it to

By 8th October 2018, it has gained 700 followers andme – davidwarwick@handsurgery.co.uk or tweet@

has sent out 170 tweets. Within an hour of a post on

handwrist.

either Twitter or Instagram, usually 200 people have

Historian: IFSSH

viewed the post, and by 24 hours over 500 people!

8

9

OBITUARY

www.ifssh.info

Giorgio Brunelli (1925-2018)

OBITUARY

November 2019to spend some time abroad in Fellowships to broaden their educational
exposure.
He founded the Italian Society for Microsurgery in 1981 and was still thehonorary President until his passing.

ifssh
ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILYIFSSH DISCLAIMER:
The IFSSH ezine is the

Giorgio Brunelli was anphysiology of the spinal cord and its chances to be

He was the President of the International Society of Microsurgery in 1984

official mouthpiece of theeclectic surgeon being

healed after a lesion.

and President of the International Federation of Societies for Surgery ofInternational Federation of

the Hand from 1995 to 1998 and was nominated IFSSH “Pioneer of Hand

Societies for Surgery of theSurgery” in 1998.

Hand. The IFSSH does nota great orthopaedic
surgeon, a world pioneer

He was the ideal follower of the thoughts andin microsurgery and handteachings of his Italian and foreign Masters: Poli fromsurgery, a passionate

Milan, Merle D’Aubignè from Paris, Bunnel from theGiorgio Brunelli has performed over 25,000 surgical procedures, 3,500 ofadvertising in thisresearcher in many fields

U.S.A. as well as Böhler from Wien and Möberg fromwhich with microsurgical techniques. He was the author of 466 papers inpublication, nor the content

especially in the peripheral

Göteborg. He also continued the contact and friendshippeer-reviewed journals, 30 book chapters and 10 scientific texts.

or views of the contributors

and central nervous systemwith many other pioneers of hand surgery andand it’s plasticity. He is

microsurgery: Buck-Gramko, Chen-Zhong-Wei, Gilbert,

Besides his scientific and surgical work, Giorgio Brunelli was a successful

Subscription to the IFSSH

considered the father ofHunter, Meyer, Merle, Millesi, Morrison, Pho, Santos

athlete in various disciplines: fencing, swimming, and was the regionalezine is free of charge andMicrosurgery in Italy.

Palazzi, Soukakos, Sunderland, Tubiana, Tamai, Terzis,

university champion of cross-country skiing in 1948. He loved vintage

the ezine is distributed on a

Urbaniak and many others.

cars and as a gentleman driver he took part in various races and several

quarterly basis.

endorse the commercial

to the publication.

MilleMiglia car races.

Brunelli was born in 1925. The choice of studying
Medicine came as a consequence and inspiration

He developed many innovative techniques in handfollowing serving in the Army during the war when hesurgery and microsurgery. Among the leading

Brunelli loved nature in all its expressions which he used to portray withadvertise in this publication,

worked in a small field hospital.

ones: prostheses of various joints, metal andhis Nikon camera. He also loved to paint, and calling him an amateur-please contact the Editor:

plastic materials for surgical use, microsurgicalpainter is highly out of scope. Several exhibitions of his paintings andezine@ifssh.info

He graduated in Medicine at the University of Parma inreconstructions of nerves and limbs, robotics and aphotos were organized in Italy throughout the years. He also published1949.

closer relationship between orthopaedics and all theseveral historical novels and, by virtue of his intellectual passion for

new scientific discoveries. Many of his techniques

neuroscience, scientific essays were published, such as “From Neurons to

IFSSH EZINEEDITORIAL TEAM:

Giorgio Brunelli had a very successful surgicalare still in use to this day: motor and sensory nerve

the Self” and “Conscious Ego”.

EDITOR:and academic career. He became the Director of antransfers, ligament reconstruction of wrist instabilities,

Orthopaedic Surgery Unit at the age of 35, and became

direct muscle neurotization, hyponeurotization

Profits from all his different passions were all channeled to his Foundation

the University Chair in Orthopaedics in Brescia in 1971.

in spasticity, CMC thumb instability and arthritis

and research projects, which will continue following the path he has set.

Should you be interested toProfessor Ulrich Mennen

treatment, a novel technique for wrist fusion, muscle

Past President: IFSSH
DEPUTY EDITOR:

Brunelli's achievements were many in his pioneeringin vein combined grafts for short nerve gap repair,

Brunelli’s work has been acknowledged and praised internationally.

Professor Michael Tonkin

work, such as the first total hip joint replacement inoriginal brachial plexus neurotizations, ulnar nerve

He gained recognition from Nobel Prize laureates, such as Rita Levi

Past President: IFSSH

Italy in 1963 and the introduction of microsurgicaltransfer to help tetraplegic patients stand up, etc.

Montalcini who sponsored his candidacy for the Nobel Prize for Medicine

techniques in Italy in 1965. In 1972 he was the first tofor his contributions to Basic and Applied Research and knowledge of the

GRAPHIC DESIGNER:

C.N.S.

Tamrin Hansen

perform brachial plexus surgery in Italy and the first

In Brunelli's professional life, teaching was always

to replant a total limb amputation In 1973. He earned aa very important endeavor. As the head of the

Honoris Cause Degree from the University of Wroclaw,

Orthopaedic Department at the University of Brescia

Bruno Battiston

and in the Eighties he focused on Experimental

from 1971 to 1997, he introduced the practical

President of the Italian Society for Surgery of the Hand (SICM)

Research on the treatment of spinal cord lesions. He

microsurgical courses which are still the basis of our

founded the Spinal Cord Foundation collecting money

present day educational activity in the Italian Society

Pierluigi Tos

to support laborious researches on the anatomy andfor Microsurgery. Brunelli also advised young doctors

International IFSSH Delegate for SICM

10tamrin.hansen@gmail.com

TO SUBSCRIBE GO TO:
www.ifssh.info
administration@ifssh.info
11

SECRETARY-GENERAL REPORT

www.ifssh.info

Secretary-General
ReportNovember 2019

SECRETARY-GENERAL REPORT•

Yih Liu - Taiwanese Society for Surgery of the Hand•

Alain Charles Masquelet - French Society for Surgery of the Hand•

Roberto Melendez Escobar - Colombian Association for Surgery of the Hand•

Ulrich Mennen - South African Society for Surgery of the Hand•

Akio Minami - Japanese Society for Surgery of the Hand•

Nash Naam - Egyptian Society for Surgery of the Hand and Microsurgery•Oğuz Polatkan- Turkish Society for Surgery of the Hand•

Jaime León Restrepo Espinal - Colombian Association for Surgery of the Hand•

Nelson Enrique Socorro Medina - Venezuelan Society for Surgery of the Hand and Reconstruction of the

At the opening ceremony of the 14 th Triennial Congress of the International Federation of Societies for Surgery

Upper Limbof the Hand and the 11 th Triennial Congress of the International Federation of Societies for Hand Therapy which•Peter J. Stern - American Society for Surgery of the Hand

were held in the Berlin from June 17 through June 21, 2019, 37 surgeons from 19 member societies were honoured•

Lam-Chuan Teoh - Singapore Society for Hand Surgery

as ‘IFSSH Pioneers of Hand Surgery’.

•Maggali Pastora Torrealba Marin - Venezuelan Society for Surgery of the Hand and Reconstruction of theUpper Limb

Dr David Shewring from the organizing committee of the 15 th IFSSH Congress and 12 th IFSHT Congress which•

Joseph Upton, III - American Society for Surgery of the Hand

will be held in London from 27 th June to 1 st July, 2022, reported that the Queen Elizabeth II centre (Westminster)•IrinaVisa - Romanian Society for Surgery of the Hand

has been booked as the congress venue – capacity of 3,000. This is convenient for central hotels within walking•

Fu-Chan Wei - Taiwanese Society for Surgery of the Hand

distance and an easy commute from cheaper hotels. The website is active - https://www.ifssh-ifsht2022.co.uk/•

Andrew J. Weiland - American Society for Surgery of the Hand

The 2019 Pioneer booklet details their careers and achievements: https://ifssh.info/pioneers_hand_surgery.php.
IFSSH Pioneers of Hand Surgery, 2019

We congratulate these surgeons and thank them for inspiring future generations of hand surgeons.

37 surgeons from 19 societies were honoured in Berlin at the triennial IFSSH Congress for their exceptional
contributions to Hand Surgery:

IFSSH Educational Sponsorship•

Govindasamy Balakrishnan - Indian Society for Surgery of the Hand

The IFSSH website has been updated to include details of the educational pursuits sponsored over the years•

Claudio Henrique Barbieri - Brazilian Society for Surgery of the Hand

- https://ifssh.info/ifssh-sponsored-educational-projects.php. The projects demonstrate a wide range of ideas•

Alexandros E. Beris - Hellenic Society for Surgery of the Hand

undertaken through many different methods across numerous locations worldwide.

•Peter Burge - British Society for Surgery of the Hand

If your society is planning education programmes and needs support to fulfil the goals, please consider if it•

Edie Benedito Caetano - Brazilian Society for Surgery of the Hand

may be appropriate to submit a request to the IFSSH. The full guidelines are available via https://ifssh.info/•İsmail Hakki Çalli - Turkish Society for Surgery of the Hand

educational_sponsorship.php.

•

Robert A.Chase - American Society for Surgery of the Hand•

David Chwei-Chin Chuang - Taiwanese Society for Surgery of the Hand

Future Meetings•

Felipe Coiffman - Colombian Association for Surgery of the Hand

A detailed list of national and regional hand surgery meetings is available on the IFSSH website. The triennial•

William P. Cooney - American Society for Surgery of the Hand

IFSSH Congresses are as follows:•

Kazuteru Doi - Japanese Society for Surgery of the Hand

XVth IFSSH – XIIth IFSHT Congress – London, United Kingdrom 27th June - 1st July, 2022•

Diego Fernandez - Swiss Society of Hand Surgery

XVIth IFSSH – XIIIth IFSHT Congress – Washington D.C., USA 29th March - 3rd April, 2025•

Richard H. Gelberman - American Society for Surgery of the Hand•

Jochen B. Gerstner Bruns - Colombian Association for Surgery of the Hand•

Alain Gilbert - French Society for Surgery of the Hand•

Carl-Göran Hagert - Swedish Society for Surgery of the Hand•

Geoffrey Hooper - British Society for Surgery of the Hand•

Jesse B. Jupiter - American Society for Surgery of the Hand•

Ahmet Karaogȗz - Turkish Society for Surgery of the Hand

			Goo Hyun Baek•

Johan M. G. Kauer - Dutch Society for Surgery of the Hand

			Secretary-General, IFSSH•

Kwang Suk Lee - Korean Society for Surgery of the Hand

			Email: secretary@ifssh.info

12

13

PIONEER PROFILES

www.ifssh.info

PIONEER PROFILES

November 2019

Harold Bolton

Isidor Kessler

Britain (1918 - 2015)

Israel (1926 - 2007)

Harold Bolton was born incrash, when an aeroplane carrying holidaymakers from

Isidor Kessler was born insilastic digital joint implants, several distractingBlackpoolon

Mallorca to Manchester airport crashed into an area

Bulgaria on 19 August 1926,

devices for bone lengthening and a “grasping suture” for

15 August 1918. His father,close to the Stockport town centre. Bolton was a member

obtained his medical degree

tendon repair which bears his name.

Alexander Black Bolton, wasof the Second Hand Club the forerunner of the British

at the University of Sofia inthemanagingofSociety for Surgery of the Hand, and Assistant Editor to1951, and immigrated in theaconfectionary

company;

Graham Stack from 1969 t0 1986 for “The Hand” and latersame year to Israel.

his mother, Nina Bolton née

as it was renamed “The Journal of Hand Surgery” He

Houldsworth,a

was a consultant hand surgeon in Stockport and Buxton

He completed his Generalthey had two children, a son Michael and a daughter

director of the company. He

from 1980 to 1985, when he retired from the NHS. He

andGalia.

attendedcarried on in private practice until 1987 and as a member

training in 1959, and workedinBritain,directorwasHuttonalsoGrammarHe retired in 1991 from active work.
Isidor was married to Elena, a clinical pathologist, andOrthopaedic

Surgery

School and then King Edward VII School in Lytham Stof the Medical Appeals Tribunal until 1991.

in the Department of Traumatology at the Tel Aviv

At the Eighth Congress of the International Federation

Annes, and went on to study medicine at Manchester

Harold Bolton published on aspects of the rheumatoid

Central Clinic until 1965. During this time he developedof Societies for Surgery of the Hand, held in Istanbul,

Medical School. He gained a BSc in anatomy andhand, joint replacements in the rheumatoid hand anda special interest in surgery of the hand. This led him

Turkey in June 2001, Isidor Kessler was honoured asphysiology in 1939 and qualified as a doctor in July 1942

primary tendon repair.

becoming a Sterling Bunnell Fellow in Hand Surgery“Pioneer of Hand Surgery”

with the Butterworth medical prize and the John Henry
Agnew prize in children’s diseases.

at the Presbyterian Medical Centre in San Francisco,
He was president of the British Society for Surgery of the

California as well as at the Stanford University in Palo

Hand in 1983. He was a council member of the British

Alto, California , USA from 1965 to 1966.

He was a house surgeon at Manchester Royal Infirmary

Orthopaedic Association and a fellow of Manchester

to Sir Harry Platt. From 1942 to 1946 he served in the

Medical Society.

RAMC, in India, Burma and Palestine. He left the Armywith the rank of acting lieutenant colonel.

Upon his return to Israel, he organised the firstindependent Department of Hand Surgery at the Kaplan

At university he played tennis, fives and hockey. He later

Hospital, Rehoboth in 1971 and was its head until 1991.

enjoyed fishing and golf, and was president of Romiley
Following his demobilisation, he returned to Manchester

Golf Club in 1983.

as a registrar at the Royal Infirmary. He gained his FRCS

of the Hand, and became the second President.

in 1948 and from 1948 to 1951 was a senior registrar at

In 1949, he married Barbara. They had two sons – Martin

the Royal Infirmary under Platt, David Griffiths and John

Alexander and Robert Andrew.

Charnley. He then spent a year as a surgical fellow in
Chicago working with Sumner L Koch.

Kessler was the founder of the Israel Society for Surgery

He was Associate Professor of Surgery at the Hebrew
University-Hadassah Medical School in Jerusalem.

Harold Bolton died on 10 December 2015. He was 97.
He was Corresponding Member of the American Society

In 1952, he was appointed as a consultant orthopaedic

Harold Bolton was bestowed the honour “Pioneer of Hand

for Surgery of the Hand since 1980, a Honorary Member

surgeon to the north Manchester group of hospitals.

Surgery” at the Eighth Congress of the Internationalof the Bulgarian Society for Surgery of the Hand since

Two years later, he became a consultant orthopaedic

Federation of Societies for Surgery of the Hand in

1996, and participated and lectured in numerous

surgeon for the Stockport and Buxton group. In 1960, he

Istanbul, Turkey in June 2001.

medical events all over the world.

at the Devonshire Royal Hospital in Buxton. In June

(Addapted from The Royal College of Surgeons of

Isidor Kessler published about 100 articles. His research

1967, he dealt with casualties from the Stockport air

England, Plarr's Lives of the Fellows)

included the development of new surgical techniques,

established the Manchester region hand surgery centre

14

15

SPECIAL FEATURE

www.ifssh.info

Preservation of skeletal
health in the long term
glucocorticoid patient

November 2019

SPECIAL FEATURE

Effect on cartilage
Long term GC therapy impairs skeletal growth through direct and indirect influences on the cartilage of thegrowth plates. 3 The clinical benefit of administration to children with juvenile rheumatoid arthritis should
therefore be carefully weighed against the potential impact on skeletal growth. Although the mechanism is notclear, there are indications that suspension of GC administration may result in accelerated activity in the growthplates with catch-up growth.4
Effect on bone
Skeletal fractures are particularly prevalent in long term GC patients who are at high risk for osteoporosis.5,6 It
has been estimated that long term GC therapy is implicated in more than one quarter of vertebral fractures inpatients with secondary osteoporosis.7 Chronologically the impact of long term GC therapy on the skeleton is
generally divided in early rapid- and late protracted phases. The classical explanation for the action of GCs on theskeleton relates to the reduction of calcium uptake from the GIT and renal tubules and suppression of gonadal-

Introduction:and other anabolic hormones. In order to replenish the blood calcium which results from the negative impact on

The therapeutic indications of glucocorticoids (GCs) were unknown

calcium resorption, hyperparathyroidism with skeletal anabolism is induced. Although this biochemical pathway

until Hench, Reichstein and Calvin from the Mayo Clinic received theplays a role in accelerated skeletal breakdown during long term GC therapy, recent studies on genetically

coveted Nobel Prize in Medicine and Physiology in 1950 for discovering

modified mice unlocked a plethora of information on the direct and indirect effects of GC’s on the cells involved

their dramatic effect on rheumatoid arthritis. Due to the potent

in bone metabolism and provides an explanation for two phases of skeletal anabolism.

immunosuppressive action, GCs remain the choice of treatment forchronic inflammatory disorders such as arthritis, asthma and allergic

During the early phase, which lasts for approximately 6 months, rapid bone loss is the result of increased

reactions. A significant percentage of patients with rheumatoid arthritis

osteoclast activity with bone resorption.8,9 The mechanism is related to GC’s ability to upregulate the expression

are on long term GC therapeutic regimes. It is estimated that 1% of the USof the receptor activator of nuclear factor kappa β ligand (or RANKL) released by osteocytes which throughpopulation receives GCs and about 10 million prescriptions for GCs areparacrine action, stimulate osteoclast activity with subsequent accelerated bone catabolism (Figure 1). The

issued annually in the US despite conservative recommendations on thegradual decline of bone resorption towards the end of the rapid phase of bone loss is probably linked to theindications for their clinical use. Prolonged GC administration impacts

lifespan of osteoclasts, which is significantly shorter than that of osteocytes. The initial phase of rapid bone loss

on several tissue types and metabolic processes resulting in atrophy ofis followed by a protracted phase during which the GCs exert a negative impact on osteoblast differentiation,muscles, skin and mucosal linings, depression, insulin resistanc e andproliferation, functions and survival.10 The differentiation of the bone forming cell line is inhibited through aErich J Raubenheimer

skeletal catabolism. Bone is the only tissue actively degraded during longredirection of the differentiation pathway of stem cells towards fat cells and chondrocytes (Figure 2).11(MChD, PhD, DSc)

term GC administration and the preventative management of fractures inConsultant: Ampath

this cohort of patients is often neglected in clinical practice. The aim of

In addition, GCs supress the elaboration of osteoprotegerin (OPG) by osteocytes. Under physiologicalHistopathology Laboratory

this paper is to provide guidelines for the preservation of skeletal health incircumstances, OPG acts as a decoy receptor for the osteoclast activator, RANKL, thereby inhibiting osteoclast

Pretoria,

patients on long term GCs.

stimulation through the RANKL pathway. GC’s also stimulate the elaboration of sklerostin by osteocytes, a1

potent autocrine inhibitor of bone formation.10 The mapping of these pathways not only clarifies some of the

Universities of Pretoria, South
Africa and Catholic University of

Skeletal complications of long term GC therapy

mechanisms involved in GC induced bone catabolism, but also provides a scientific basis for the development

Leuven, Belgium

Physiological release of endogenous GCs promotes bone and cartilageof therapeutic regimes directed at the modulation of cell signalling in patients on long term GC therapy. It is

Contact detail: ejraub@fox5.co.za

health which is ironically the opposite effect of long term exogenous

important to note that the influence of GCs on the skeleton is not only through direct interaction with the cells

administration. The hormone is the primary mediator of the circadianinvolved in bone metabolism, but also through the modulation of white blood cells which play a profound role

rhythm and stress response which is linked to amongst other actions its

in bone metabolism. This field of research is expanding rapidly through the characterization of cell boundcapacity to induce rapid metabolism of glucose. During malnutrition andglucocorticoid receptors and the growing understanding of the molecular patterns of ligand induced genomic

Cushing’s syndrome, endogenous concentration of GC increases and thetranscription of cells.10 With the large number of patients on long term GCs, pharmaceutical companies are

skeletal impact is similar to what occurs during long term exogenous GC

certain to invest in research aimed at developing effective drugs with the efficacy of GCs and without theiradministration.

skeletal shortcomings.

16

2

17

SPECIAL FEATURE

www.ifssh.info

SPECIAL FEATURE

November 2019

Recommendations for fracture risk assessment

calcium supplementat ion, are in the low dosage range of GC administration and without a history of fractures.

The fracture risk of patients on long term GCs is substantially influenced by the dose, patient demography, race,

More detail is provided in the report from which the recommendations were sourced. 12age, gender, history of falls and fractures and co-factors for osteoporosis such as immobility, muscle weakness,
frailty, old age, diet, tobacco use, alcohol consumption and gonadal atrophy. Current knowledge indicates that

Recommendations for preventative management

addressing these factors form the mainstay of the preventative management regime of patients on long term GCs.

It is of fundamental importance for the maintenance of skeletal health in patients on long term GCs to address
the diet and lifestyle factors mentioned previously. Irrespective of the outcome of the fracture risk assessment,

The American College of Rheumatology published the first in a series of recommendations for the prevention

correction of the risks through counselling and lifestyle manag ement forms the mainstay of skeletal

and treatment of GC induced osteoporosis in 1996. The most recent guidelines follow a scientific cumulative

preservation in the long term GC patient. Calcium intake should be between 1000 1200 mg and vit D 600 800 IU

assessment of the literature published before 2017 and include therapies for the management of osteoporosis

per day. In addition to lifestyle changes, the recommendations for the prevention of GC induced osteoporosis

which were approved by the American Food and Drug Administration before 2015. Based on clinical trials,

reflected in Table 2 are advised as best clinical practice. 12

12

13,14

the

dose of GCs administered to patients is separated in low (< than 7.5 mg per day) or high (> than 7.5 mg per day).
Table 2: Recommendations in addition to lifestyle changes for the prevention of fractures in
Fracture risk assessment should be performed at initiation of long term GC therapy. The literature lacks pertinent

patients on long term GC therapy (adapted from Buckley, Guyatt, Fink et al 2017). 12

data for the prediction of fractures in children and individuals younger than 40 years of age. For adults older than
40 years, the fracture risk should be estimated by using the FRAX tool developed by the University of Sheffield15
with adjustments for the bone mineral density (BMD) and GC dose prescribed. The risk of osteoporotic fractures
calculated for a patient receiving long term GC therapy with this tool should be increased by 1.15 and if the GC
dose is above 7.5 mg/day by a factor of 1.2.12 Table 1 summarizes the steps which are presently regarded as best

CLINICALRECOMMENDED PREVENTATIVE STEPSChildren 4-17 yrs taking > 0.1 mg/kg GC’s/day

Oral BP, calcium & vit D		

for 3 months and with osteoporotic fractures

practice in the initial risk assessment of the GC patient, stratified according to the age of the patient. Due to theChildren 4-17 yrs treated for > 3 months with GC’s

Life style modifications, calcium & vit D

preferential use of oral bisphosphonates (BPs) in GC patients with moderate and high fracture risks, a thorough

Adults with organ transplants and glomerular

Consult with nephrologist; consider		

history of a reaction against the drugs in the BP group must be obtained before onset of therapy. Readers

filtration rate > 30ml/min

denosumab in place of BP

are referred to the product information provided by the manufacturers and recent review articles for more

Adults > 30 yrs receiving very high dosages GC’s

Oral BP, calcium & vit D

information on the pharmaceutical actions and complications of BP administration.

Women of child bearing age, on effective contOral BP, calcium & vit D

16

raceptives and in moderate and high fracture risk 		
categories		
Table 1: Initial risk assessment (Adapted from Buckley, Guyatt, Fink et al 2017)12
CHILDREN

ADULTS < 40 YEARSADULTS > 40 YEARS

Physical examination*, obtain history and dosage of GC administration, determine secondary risk factors forosteoporosis 		No further initial assessment

History of fractures or other significant

FRAX with GC dose correction,		osteoporosis risk factors

bone mineral density test		

If no: no further testing					

If yes: bone mineral density test

All adults taking > 2.5 mg CG’s per day

Calcium & vit D

Adults < 40 yrs, low fracture risk

Calcium & vit D

Adults < 40 yrs, moderate to high fracture risk

Oral BP, calcium & vit D

Adults > 40 yrs, low fracture risk*

Calcium & vit D

Adults > 40 yrs, moderate to high fracture risk*

Oral BP, calcium & vit D* determined with FRAX analyses 15 with correction for GC dose
The choice for supplemental medication in most medium- and high risk patients is oral administration of oneof the second or third generation BPs, also referred to as the nitrogen- containing BPs. This category of anti-

The physical examination should include parameters such as the patients’ weight, height, muscle strength,

osteoporotic drugs is selected due to their lower costcompared to alternate drugs, convenience of administration

spinal tenderness, skeletal deformity and space between the lower rib and upper pelvis (which if reduced

and lack of evidence of a superior result achieved by another pharmaceutical product.

indicates undiagnosed spinal fractures).
The nitrogen containing BPs (alendronate, risedronate and pamidronate) bind reversibly to bone surfaces,
The fracture risk assessment should be repeated every 13 years for patients on continuous GC therapy and whosuspend osteoclast stimulation and induce their apoptosis through the inhibition of enzyme pathways

receive no osteoporosis medication other than vitamin D (vit D) and calcium. Less frequent testing is advised

responsible for cytoplasmic fibre assembly and membrane ruffling. 17 This reduces the efficiency of attachment

for patients older than 40 years of age, those who are on specific osteoporosis therapy in addition to vit D andof osteoclasts to bone surfaces thereby counteracting the induction of rapid bone loss by GCs during the first18

19

SPECIAL FEATURE

www.ifssh.info

November 2019

6 months of long term therapy. There are indications that BPs also preserve osteoblast survival, 18,19 offsetting

Acknowledgement

the second phase of skeletal anabolism induced by long term GC therapy. Besides esophageal irritation andProf C Noffke for proof reading the manuscript.

SPECIAL FEATURE

erosions the nitrogen-containing oral administered BPs are relatively complication free. Esophageal irritation
can be minimized by swallowing the drug with water and remaining in an upright position for an hour after

Key References

administration. Patients on oral BPs should not take aluminium and magnesium containing medications such as1.

anti-acids simultaneously due to their chelating action and subsequent neutralization of the BP.

Fardent L, Petersen I, Nazreth I. Monitoring of patients on long-term glucocorticoid therapy: a populationbased cohort study. Medicine (Baltimore) 2015;94:e647.

BP alternatives should only be considered if the benefits outweigh the potential complications. If BPs are

2.

Gat-Yablonski G, Phillip M. Nutritionally-induced catch-up growth. Nutritients 2015;7:517-51.

3.

Simon D, Fernando C, Czernichow P, Prieur AM. Linear growth and final height in patients with systemic

contraindicated for medical reasons, teriparatide (inconvenient due to cost and daily injections), denosumab

juvenile arthritis treated with long term glucocorticoids. J Rheumatol 2002;29:1296-1300.

(no data on safety in patients on immunosuppressive therapy) and raloxifene (particularly in women where

4. Lui JC, Nilsson O, Baron J. Growth plate senescence and catch-up growth. Endocr Dev 2011;21:23-29.

bisphosphonates are contra indicated) could be considered. Readers are referred to the product information of

5.

12

the manufacturers and recent reviews on the alternative drugs used in the prevention of osteoporosis for more
information.

women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 2006;39:253-9.
6.

20Angeli A, Guglielmi G, Dovio A, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal
Curtis J, Westfall AO, Allison J et al. Population-based assessment of adverse events associated with longterm glucocorticoid use. Arthritis Rheumatol 2006;55:420-6.

7.

Follow-up treatment

Res 2000:15:993-1000.

The selected preventative management regime should be followed throughout the duration of GC administration.
A different class of osteoporosis drug may be considered in adults older than 40 years and who either had afracture more than 18 months after initiation of BP therapy or who maintain a significant decline in bone mineraldensity despite BP therapy. The intra venous (IV) route of administration of one of the nitrogen-containing
12

BPs (zoledronic acid or pamidronate) is indicated in cases where a lack of patient compliance is the cause of
the poor response. Clinicians should be aware of the acute phase reaction, potential kidney damage and other

Van Staa TP, Leufkens HG, Abenhaim L et al. Use of oral corticosteroids and risk of fractures. J Bone Miner

8.

Canalis E, Bilezikian JP, Angeli A, Giustina A. Perspectives on glucocorticoid- induced osteoporosis. Bone
2004;34:593-8.

9. Laan F, van Riel PL, van de Putte LB et al. Low-dose prednisone induces rapid reversible axial bone loss inpatients with rheumatoid arthritis: a randomized controlled study. Ann Intern Med 1993;119:963-8.
10. Hartmann K, Koenen M, Schauer S et al. Molecular actions of glucocorticoids in cartilage and bone during
health, disease and steroid therapy. Physiol Rev 2016;96:409-47.

complications associated with the IV route of BP administration.

11. Worthley DL, Churchill M, Compton JT, et al. Gremlin 1 identifies a skeletal stem cell bone, cartilage andPatients older than 40 years who have completed 5 years of BP therapy and persist in the moderate and highfracture risk categories, should continue the oral BP regime with calcium and vit D supplementation for 7-10
years. If patient adherence to the regime is a problem, the bone mineral density further decreases or new

reticular stromal potential. Cell 2015;160:269-84.
12. Buckley L, Guyatt G, Fink HA et al. 2017 American Collage of Rheumatology guideline for the prevention andtreatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol 2017;69:1521-37.

fractures develop, the alternate drugs mentioned above are recommended with IV BPs as the first choice.

13. Solomon DH, Katz NJ, Jacobs JP, et al. Management of glucocorticoid induced osteoporosis in patients withrheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheumatol

There is substantial evidence that when GC therapy is terminated, the fracture risk of most cases declines.

7,9This is most likely due to a suspension of the direct and indirect influences of GCs on bone which were briefly
mentioned previously. It is strongly recommended to continue with BP administration if the patient remains in

2002;46:3136-42.
14. Feldstein AC, Elmer PJ, Nichols GA, Herson M. Practice patterns in patients at risk for glucocorticoid-induced
osteoporosis. Osteoporos 2005;16:2168-74.

the high fracture risk category upon termination of GC therapy. In patients receiving oral BPs and who are in the

15. https://www.she.ac.uk/FRAX/tool/jsp

low risk fracture category, BP administration could be suspended after cessation of GC therapy.

16. Raubenheimer EJ, Noffke CEE, Lemmer LB et al. Pharmaceutical management of bone catabolism: the12bisphosphonates. SA Orthop J 2019;18:47-52.
Conclusion

17. Hall A, Rho GTPases and the actin cytoskeleton. Science 1998;5350:509-14.

Bone is the only tissue type actively catabolized during long term GC therapy and the slumbering process of the

18. Plotkin LI, Lezcano V, Thostenson J, et al. Connexin 43 is required for the anti-apoptotic effect ofskeletal breakdown only manifests at a late stage when a debilitating pathological fracture focusses attention on

bisphosphonates on osteocytes and osteoblasts in vivo. J Bone Miner Res 2008;23:1721-21.

the preventable complication. The accumulation of data in the literature indicates that the fracture risk can bepredicted at onset of GC therapy and an effective patient-tailored preventative management program instituted.
As knowledge on the pathways of the action of GCs on bone unfolds, more targeted preventative management
regimes will certainly reach clinical practice in the near future.

20

19. Bellido T, Plotkin LI. Novel actions of bisphosphonates in bone: preservation of osteoblast and osteocyte
viability. Bone 2008;49:50-55.
20. Raubenheimer EJ, Miniggio H, Lemmer, LB, van Heerden WFP. The role of bone remodelling in maintaining
and restoring bone health: an overview. Clin Rev Bone Miner Metab 2017;15:90-97.

21

www.ifssh.info

ART

November 2019

Art Exibit # 9

Pen Box | Carved wood | Tanzania

2223

HAND THERAPY

www.ifssh.info

Mindfulness, Health
Coaching and Hand
Therapycan be a valuable skill for handsurgeons and hand therapists.
Health coaching offers an entirely
different way of interacting withpatients with complex needs. Itemphasizes the need to develop arecovery plan that is realistic andachievable and to not expect strict“

Health coaching recognizes
that a therapy programme
is far more effective if it ismeaningful to the patient”adherence to a generic programme.
Crucially, this plan is developed

pain persists, many patients still

confidence in performing a task inby the patient with support frombelieve it is damaging to participate

the presence of pain (self-efficacy).

the clinician. It is essential thein painful activity. This leads

Self-efficacy has been shown to berehabilitation plan has meaning forto reduced independence with

one of the most important factors

the patient.

a negative impact on mood thatin achieving a good functional

perpetuates the fear-avoidanceoutcome when recovering from a
musculoskeletal condition.

Psychosocial risk factors correlate

and are at risk of a reduced self-

highly with patient reported pain

reported functional outcome.

and functional outcome following

25% of the UK adult population

This is achieved through functional

cycle. The simple act of asking ahand surgery. Despite this, handexperience some form of a mental

goal setting, a health coaching

patient what activities they would

therapists and hand surgeons arehealth problem each year and 10-

skill any clinician can implement.

like to perform better can provide

A Word of Caution- A well-meaning

not trained to support patients with

14% of UK adults have a moderate

Functional goal attainment ora shift in thinking. It is no longer

clinician may spot fear-avoidance

psychosocial challenges. Although

to severely disabling chronic pain

goal setting becomes the focus ofdangerous to function in the

behaviour in a patient and wish toeasy to blame a “non-compliant”

condition.

therapy sessions, not improvement

presence of pain. It is healthy andhelp them overcome this. A typicalin impairment such as range ofnecessary.

impulse is to tell the patient theypatient for a lack of progress, it is of

Debbie Larson,

HAND THERAPY

November 2019

motion and strength.

are fine and it is safe to return togreater value to develop our skills

An awareness of these factors

to support patients with complex

can allow for a psychologically

Grading the goals with a tool suchnormal tasks. This can help someneeds.

enhanced approach with the viewas the Patient Specific Functional

patients but can have a negativeof achieving a better outcome for

Scale can also be a revelation.

impact on more vulnerable patients.

the patient.

Tasks that previously seemedThis statement can be too generic,overwhelming for the patient,unachievable and dismissive of
their very real pain.

BScOT, MSc Hand Therapy,
Accredited Hand Therapist

There are some risk factors that

MBCT and MBSR Teacher

suggest a patient may benefit from

Spire Norwich Hospital, Norwich,a more supportive approach instead

Health Coachingcan feel more achievable when

United Kingdomof standard treatment alone. These

Health Coaching is usedmeasured in increments. The

debbie.larson@spirehealthcare.

signs include:

increasingly in primary care toclinician can reassure the patient

It can lower their mood andcom•

Multiple pain sites

support patients with chronicthat small increases in discomfort

motivation even further. If time•

Pain for more than one year

conditions to develop healthy

Patient led functional goal setting

are to be expected when a newis short, it is more helpful to ask if•

Anxiety and/or depression

behaviours to improve theirwith support from the handactivity is introduced.

there is one thing the patient would•High functional disability

prognosis. Health coaching

therapist•

A lack of confidence inacknowledges the challenges

performing activities (low self-

patients face in introducing new

efficacy)

24

like to do better. Ask them what
Further reassurance can bea first step towards achieving thisFunctional goal setting is aprovided by helping the patient

could be, reassure them a slightbehaviours and empowers themtransformational process for many

develop a plan to manage theincrease in discomfort is normal

to make changes that are practicalpatients. Fear and avoidance of

pain if it becomes distressing.

and help them formulate a plan if

It is reasonable to assume afor them. With greater awareness

functional tasks is necessary,

Motivation is provided by reviewing

they become too uncomfortable.

significant proportion of patientsthat many patients present withand actively encouraged, in thethe goals at each appointment andattending a hand clinic will havechallenging health and social

acute phase of recovery to protect

celebrating small improvements.

some of the above risk factors

circumstances, health coaching

the injured limb. However, whenThis builds the essential skill of25

HAND THERAPY

www.ifssh.info

HAND THERAPY

November 2019

Health coaching recognizes thatthe skills to deal with mental

thoughts, feelings and sensations

based cognitive therapy courses depending on what

K, Konstantinou K, Main C, Mason E, Somervillea therapy programme is far more

health problems. It has been shownaround pain and disability and tothey need. There are still some patients I’m not able

S, Sowden G, Vohora K, Hay E. Comparison ofeffective if it is meaningful to thethat physiotherapists who haveshift their focus to their present

to help, but I can certainly support a greater number

stratified primary care management for low backpatient. A time-pressured clinician

received basic training in cognitive

moment experience without

than I could with just my hand therapy skills. Whether

pain with current best practice (STarT Back): a

may expect all patients to adhere

behavioural therapy (CBT) can help

judgement or striving for it to besomeone needs an exercise programme, healthrandomised control trial. The Lancet. 2011, 37B:

to a generic programme, however

patients with psychosocial risk

different than it is.

coaching to achieve functional goals or to learn MBCT

1560-1571.

there are many patients who arefactors overcome low back pain

not capable of this. With a little

better than standard treatment

With practice, this reduces theirlive a more fulfilling life. It has certainly made my job

Rice D, Skidmore B, Kenny S, Hutton B, Poulin

awareness and flexibility, we canalone. Psychologically enhanced

distress and enables them tomore rewarding.

P. Comparative evaluation of group-based

engage more patients through ancare has not yet been widely

gain a calmer and more balanced

individualised health coaching

adopted by the hand surgery andperspective on their health. From

References

behavioural therapy for the treatment andapproach.

therapy community but it has thethis point, they can begin to engage•

Artus M, Campbell P, Mallen CD, Dunn K, vanmanagement of chronic pain: A systematic review

promise of being an essential skill.

in meaningful activities that give

der Windt A. Generic prognostic factors forand network meta-analysis. Evidence-Basedthem a sense of pleasure andmusculoskeletal pain in primary care: a systemic

Mental Health. 2019, 22: 26-35.

CBT helps people notice andaccomplishment. This can result

review. BMJ-Open. 2017, 7: e012901.

change problematic thoughts

in an improvement in mood andor behaviours so a patient can

Mindfulness-Based Cognitive
Therapyto accept difficulty, I hope I’m helping more people to

Khoo E, Small R, Cheng W, Hatchard T, Glynn B,

mindfulness-based stress reduction and cognitive••

Oh Y, Drijkoningen T, Menendez M, Claessen F, Ring

Canadian Agency for Drugs and Technologies

D. The Influence of Psychological Factors on thefunction and a reduction in pain

in Health. Trained Health Coaches for Chronic

Michigan Hand Questionnaire. Hand. 2016, 12(2):feel better. In acute care, it can

and anxiety facilitating a greater

Disease Prevention or Management: A Review of

197-201.

be difficult to convince someone

sense of wellbeing.

Clinical and Cost-Effectiveness and Guidelinesthat changing their thoughts

https://www.ncbi.nlm.nih.gov/books/NBK343961/

patients: a report of a patient specific measure.

Cherkin DC, Sherman KJ, Balderson BH. Effect ofPhysiotherapy Canada. 1995, 47: 258–262.

condition when there has beenenvironment requires training. It

tissue damage. Another approachis not intuitive for hand surgeons

mindfulness-based stress reduction vs cognitive

may be warranted. Evidence

and therapists to help a patient

behavioural therapy or usual care on back pain andhas emerged that mindfulness

accept their condition. We arefunctional limitations in adults with chronic low

based interventions (MBI) aretrained to fix them, especially inback pain: A randomized clinical trial. JAMA. 2016,

Learning to practise mindfulness

equivalent to CBT in helping

acute care. It can be difficult for a315(12): 1240-1249.

in week one of the 8-weekpatients to manage low backpatient to engage with accepting

mindfulness-based cognitivepain. MBI acknowledges andtheir current state and this needs

L. Psychological factors are associated with thetherapy course.

accepts challenges are present. It

to be approached with sensitivity

outcome of physiotherapy for people with shoulder

can provide a viable way forward

and skill. The first step in learning

pain: a multi-centre longitudinal cohort study.

Health coaching can be helpful

for a distressed patient who has

how to incorporate mindfulness

British Journal of Sports Medicine. 2016, 0: 1-8.

however even this can be too

experienced an injury, received all

into clinical practice is to complete

challenging for a more vulnerable

appropriate treatment, and is noan 8-week mindfulness course

Jones G. Prevalence of chronic pain in the UK: apatient. Their difficulties

longer progressing.

for oneself. Only by learning andsystematic review and meta-analysis of population

practising these techniques will

studies. BMJ Open. 2016, 6: e010364.

are overwhelming them and••Chester R, Jerosch-Herold C, Lewis J, Shepstone

Fayaz A, Croft P, Langford RM, Donaldson L,a psychological approach is

MBI sits under the umbrella of

one be able to support patients

indicated.

Acceptance and Commitment

through the transition from fixing

M, Goodall S, Smith L. Goal setting practice in

Therapy. Accepting difficulty

their difficulties to accepting them.

chronic low back pain. What is current practice•

Stratford PW, Gill C, Westaway MD, Binkley JM.
Assessing disability and change on individual

Teaching mindfulness in a clinical••[Internet]. Ottawa (ON). 2016, Jan 6. Available from:and behaviour will improve theirGardner T, Refshauge K, McAuley J, Hubsher

Although some hand clinics have

without striving for change reduces

access to a specialist psychologist,

the physical and mental stress

I am now able to offer patients

Physiotherapy Theory and Practice. 2018, DOI:

it is becoming increasingly

response and thus can reduce

hand therapy, health coaching and10.1080/09593985.2018.1425785

important that all clinicians havesuffering. Patients learn to accept

one to one 8-week mindfulness-26•

and is it affected by beliefs and attitudes?

•

Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn27

www.ifssh.info

November 2019

VOL 13 NO 4 | SEPT 2019

SPOTLIGHT ON SOUTH AFRICANSOCIETY OF HAND THERAPISTSSCANDINAVIAN HAND SOCIETYCONGRESSThe South African Society of Hand Therapists(SASHT) was established in November 1988. Corrianne van Velze and Prof Ulrich Mennen were both instrumental in bringing SASHT to fruition 31 years ago.
We are proud that they were recipients of awards fortheir contributions to the field presented at the IFSSH
and IFSHT congress in Berlin, Germany, 2019. SASHT
currently has 134 members, mostly occupational therapists with seven physiotherapy members. We havethree regional groups, active in the major cities ofSouth Africa, and plans fora fourth regional group in
the Free State. Courses areoffered on a regular basis.
The current executive committee is planning towards
making courses accessible
to the large number oftherapists serving persons
with hand injuries in rural
areas through exploring
life streaming platforms.
SASHT maintains a close
relationship with the South African Society of Hand
Surgery (SASSH) and attend and present at the annual SASSH refresher course and conference. SASHT
offers members a research grant to support researchendeavours within the field. The SASHT website iswww.sasht.org.za.

Almost 400 hand surgeons and therapists met in Tallinn, Estonia from 22nd - 24th August 2019 for the
Scandinavian
Hand Society
Congress withguest society,Singapore. The
programme
was varied andinteresting anddrew
professionals
from
all Baltic andScandinavian
Statue with outstretched hands, Tallinn, Estonia
countries. The
surgeons and therapists combined inseveral sessions including topics suchas management ofwrist
pathologies
and management of
CMCJ OA of. Tallinn
is a stunning city andthe Estonian hosts
arranged a array ofactivities to enable
participants to appreciate it. The congress took place ina converted power
station providing innovative and incredConference venue, Tallinn, Estonia
ible environments for
lectures and networking. It is recommended to put
this meeting into your annual congress schedule!

MESSAGE FROM IFSHTPRESIDENT NICOLA GOLDSMITH

It is with honour that I accepted the role of President of IFSHT in Berlin
2019. Through my term,
I hope to ensure IFSHT
continues its mission
to join hand therapists
across the world. I aim
to encourage new member countries and support the corresponding
and associate membersthat we have to build thehand therapy infrastructure in their country. I look forward to working with you all. Start planning your visit
to London for the 2022 Congress!

28

1 2 t h Tr i e n n i a l I F S H T Co n g re s s| London, England

IFSSH EZINE

If you want to know what the IFSHT
does, read the IFSHT President’s Report in the recent edition of the IFSSH Ezine electronic publication.
Hand therapy contributions to the
Ezine are welcome; send your contribution to: informationofficer@ifsht.
org.

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

|

J u n e 2 7-J u l y 1 , 2 0 2 2| www. i f s s h - i f s h t 2 0 2 2 . c o . u29k

MEMBER SOCIETY NEWSwww.ifssh.info

Member Society NewsISRAELI SOCIETY FOR SURGERY
OF THE HAND

November 2019

MEMBER SOCIETY NEWS7. Public relations – exposing the impact anddiversity of our work to the public as well as
policy makers in the health care community andadministration.

of the Israeli Medical Association and presidentof the Israeli Orthopedic Society and several otherinternational guests.

The Israeli Society Crosses the Atlantic
The Israeli Society (ISSH) was the guest society at

During this meeting, the future of hand surgery in

the recent 39th Brazilian Hand Society conference

Israel was discussed and the efforts made by the

The 30th anniversary of the Israeli Hand Society

held in Gramado, during 1-3 of August. The resort

society to advance the status of our profession.

celebrated with an ISSH history Kahoot! session

town in the south of Brazil was the perfect setting

Although Hand Surgery was recognized as anfor a fruitful meeting and a great chance for the

independent profession 30 years ago by thesociety members to study differences in hand

Israeli authorities, there is still work to be done.

surgery practice and plan further collaborations.

Several hospital lack official units, some do not

The Israeli Delegation to the Brazilian hand society

The delegation of surgeons and therapists, headed

have full call service for emergency cases andmeeting with the Brazilian colleagues

by the chairman of the Israeli Society, Dr. Shai Luria,

the independent status of the profession is notdiscussed a large spectrum of subjects including

recognized by others. Several steps have been taken

novel treatment options for burns, thumb basal

to advance these goals –joint arthritis and carpal tunnel release, geographic
diversity in hand trauma and implications of1.

Upgrading training in Israel, including thesmart phone use on upper extremities. Other

revision of criteria for training centers andtopics included treatment of high-energy gunshot

syllabus.

wounds, scaphoid fracture malunion and wrist
biomechanics.
The Israeli delegates participated in international
panels discussing scapholunate injuries, ulnar
sided wrist pain and congenital deformities.

2. Active participation in educational and research

The 30th anniversary of the Israeli Hand Society

activities in the European community – FESSH

celebrated with Dr. Richard Gelberman of the US

research committee, Journal of Hand Surgery

and Dr. Stephane Romano of France.

(Eur. Vol.) and the FESSH academy.
3. Promoting excellence – the Israeli Society
offers two annual grants – for the best results

Dr. Milton Pignataro of Porto Alegre (right) and Dr.
Shai Luria of Jerusalm (left)

on the national board exams and for best study
Dr. Yafi Levanon participated in the hand therapy

presented at an international meeting.

sessions as a representative of the ISSH group for

4. Studying the impact of hand trauma andhand therapy and discussed the evaluation of ADL

exposing the medical community to theafter trauma and novel technology in the service ofmagnitude of this problem and methods torehabilitation.

promote injury prevention.
5. Exposing hospitals and health care providers

30 year anniversary of the Israeli Society forwith suboptimal service due to lack of resources

Surgery of the Hand

and demanding the upgrading of these services.

During the summer meeting of the Israeli Society,

6. Placing hand surgery in line with other surgery

the 30th anniversary of the society was celebrated

subspecialties such as pediatric surgery,in Hertzlia. Dr. Richard Gelberman from the US

cardiothoracic and vascular surgery, which have

Dr. Yafi Levanon of the Israel group for hand

was the society guest, in addition to the president

achieved a more independent status in Israel.

therapy at the therapist meeting in Brazil

30

31

JOURNALHIGHLIGHTSMEMBER SOCIETY
NEWS

www.ifssh.info

November 2019

MEMBER SOCIETY NEWSINDIAN SOCIETY FOR SURGERY
OF THE HAND (ISSH)(established 1973)
Indian Society for Surgery of the Hand conducted
its 43rd Annual meeting, ISSHCON 2019, at Puri,

The Indian Society has an International Travelingin the state of Odisha from 13th to 15th September

Fellowship named after Dr Robert Acland, which2019. Although the city had been ravaged by

was set up based on the sale proceeds of his great

cyclone Fani, a few weeks earlier, the organizers

red manual of Microsurgery. Now it is in its 10th

put up a good effort to provide the delegates with ayear and it provides a sum of Rs100,000 as a mid-great meeting.

career award for a member to travel overseas to

COLOMBIAN SOCIETY FORSURGERY OF THE HAND

centers of excellence in Hand Surgery. Further

On the 23 and 24 November 2018, the Colombo-

ISSH has two eponymous orations named after the

we have 2 Inland Traveling Fellowships. From

Venezuelan Binational Meeting of Hand Surgery

doyens, Prof R Venkataswami and Prof B B Joshi.

this year, through the sponsorship of Dr Venkata

was held in the city of Cúcuta. 100 people signed up

Prof R Venkataswami oration was delivered by Dr

Bodavula, from St Louis, USA, five microsurgery

for the event with the participation of 15 speakers

Hidehiko Kawabata of Japan and the Prof B B Joshi

lab training fellowships have been instituted

from Colombia, Ecuador, Chile and Venezuela.

oration was delivered by Dr Scott Oishi from thefor trainees in Hand Surgery and they will takeUSA.

the course at the Ganga Microsurgery Lab at

The recent social and economic situation in

Coimbatore.

Venezuela has made the realization of academic
activities very difficult. Because of this, theISSH Conducts Basic Hand Surgery Courses to

Venezuelan and Colombian Hand Surgery Societies

propagate Hand Surgery in smaller towns.

joined together to organize this meeting in the

A Mid Term CME is conducted every year with theColombian city of Cúcuta, near the Venezuelan

We hope that this activity of integration between

aim to keep the Plastic and Orthopaedic Surgeonsborder.

neighbouring countries will continue to be biennial.
This is why we have scheduled the next Binational

updated on the latest trends in Hand Surgery.
Registration for the event was completely free

Dr Scott Oishi at ISSHCON, 2019
Apart from these, the ISSH endorses a number ofand the financial support was provided by theother courses in Surgery of the Hand, Surgery ofColombian Society for Surgery of the Hand. Also,

Peripheral Nerves and Surgery of the Wrist.

the speakers from Chile and Ecuador paid their own

ISSH has begun a unique program called ‘Holding

travel costs.

meeting for 20-21 November 2020.

Hands’, in which it funds a visit of a senior Hand
Surgeon to a young Hand Surgeon, who is setting up
a new hand surgery practice. The motto is to takelearning to the learner.
Dr Hidehiko Kawabata at ISSHCON, 2019
ISSH will increase its international exposure by
The next annual meeting of the ISSH will be held

being the Guest Society for the American Society forat the historic coastal city of Mahabalipuram, off

Surgery of the Hand meeting at San Antonio, Texas

Chennai from 11th to 13th September, 2020.

in October 2020.

British Society for Surgery of the Hand will be the
Guest Society for this meeting.

Dr Ravi Mahajan		

Dr Pankaj Ahire

The orators for this meeting are Mr Simon Kay andPresident, ISSH		

Hon Secretary, ISSH

Mr Gregory Packer.

www.issh.org			secretary@issh.org

32

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MEMBER SOCIETY NEWSwww.ifssh.info

AMERICAN SOCIETY FORSURGERY OF THE HAND

November 2019

collaboration including the physicians-onlylistserv;•

subscriptions to all ASSH newsletters; and more!

Become a Member of the American Society for
Surgery of the Hand

Young International Membership dues are $200 US

Apply by 3 February 2020

per year and applications are accepted any timethroughout the year. To learn more and apply, visit

ASSH is pleased to invite all surgeons trained in the

http://www.assh.org/About-ASSH/Join-ASSH/

hand and upper extremity to apply to be an ASSH

Become-a-Member/Young-International-Member!

International or Young International member.
If you have questions or need assistance completing
As an International Member, you will receive:

an application or obtaining supporting materials,•

a subscription to The Journal of Hand Surgery;

please contact Mary McCarthy at mmccarthy@assh.

•

access to Hand-e (the ASSH education websiteorgwith hundreds of carefully curated recorded
lectures, technique videos and more);•discounts on books, courses, and our Annual
Meeting;•

wonderful opportunities for networking andcollaboration including the physicians-onlylistserv;•

subscriptions to all ASSH newsletters; and more!

International Member applications must be received
by 3 February 2020.
International Membership Dues are $350 US per
year. Apply Now at http://www.assh.org/AboutASSH/Join-ASSH/Become-a-Member/InternationalMember!
The ASSH Young International Membershipcategory is open to international surgeons who havecompleted a post-graduate program in disorders of
the upper limb within the last 5 years.
You will enjoy benefits like:•a subscription to The Journal of Hand Surgery;•access to Hand-e (the ASSH education website
with hundreds of carefully curated recorded
lectures, technique videos and more);•discounts on books, courses, and our Annual
Meeting;•34

wonderful opportunities for networking and

35

IFSSH SPONSORSHIPS

www.ifssh.info

ICHOM Hand and Wrist Standard Set
ICHOM: work and vision
The International Consortium for Health Outcomes Measurement, ICHOM (www.ichom.org), is a
non-for-profit organization with the mission to unlock the potential of value-based health care by:defining global Standard Sets of outcome measures that really matter to patients for important
medical conditions and by driving adoption andreporting of these measures worldwide.
We are currently developing a Hand and Wrist
Standard Set, with the aim of identifying healthcare outcomes that are relevant for Adult ( 18years) patients with Hand and Wrist conditions. We
seek to balance a comprehensive view ofmeasurements for evaluating hand and wrist
conditions with a feasible recommendation thatproviders can reliably implement. Our aim is that
this Standard Set will help to improve healthoutcomes and standardise the measurement ofpatient centered outcomes for hand and wrist Figure 1 Scope of ICHOM Hand and Wrist Standard Set
conditions across the world.
Project Process
ICHOM facilitates and organizes
teleconference meetings with
the Working Group members towork through the developmentof the Standard Set in a
structured way. Additionally,
ICHOM
facilitates
patient
engagement activities to gather
patient feedback to inform theworking group process. The
Chair of this Standard Set is Dr.
Steven Hovius of Radboud
University Medical Center,
Netherlands. The ICHOM Hand
and Wrist Set Working Group Figure 2 Geographical distribution and composition of the working group
comprises of 19 international leaders with broad expertise including: researchers in PROMs, registryleaders, quality improvement and data scientists, and clinical leaders.
During the Working Group process, a series of systematic reviews of literature are performed andpatient surveys are distributed to identify outcomes, outcomes measures, and important case-mix
variables. Through a modified-Delphi process, outcomes and outcome measures are voted forinclusion in the Set based on working group and patient representative consensus. At the completionof the working group process, the working group will have defined a core list of outcome domains
and associated measures that assess success in managing hand and wrist conditions from thepatient’s perspective. Also, a set of baseline case-mix adjustment variables and standardised
36

www.ichom.org І Incorporated in Delaware, United States of America
US Company Headquarters registered as 501(c)(3) І 399 Boylston St. 6th floor І Boston, MA, 02116, USA

November 2019

IFSSH SPONSORSHIPS

timepoints for outcomes measurement will be defined, to allow for meaningful comparisons andglobal benchmarking. Lastly, a peer-reviewed journal article detailing the development of the Set
will be published and Reference Guide describing instruments that should be used and technicaldetails for implementing the Standard Set will be provided and accessible to interested parties
worldwide.
Progress Check
As of May 2019 , there have been 12 International Working Group videoconference calls and 6
breakout sessions. The working group hasreached consensus on the classification of
5 tracks: a thumb, wrist, finger, nerve, andhand
trauma
track
and
their
corresponding
conditions
criteria,
outcome measures (tools) and outcome
measurement timepoints. The timepoints
for outcomes measurements have been
categorized as by two tracks ‘regular’ and'extended' tracks for cases requiring shortor longer follow-up respectively.
Following the finalization of the handtrauma track, which is still in progress, the Figure 3.Working Group members at the 2018 FESSH Congress
Working Group will be defining a track breakout session
hierarchy. This hierarchy will guide implementors of the Set on which track(s) to measure cases, andparticularly, complex, multi-structure cases, using the Hand and Wrist Standard Set. On June 19th,
the working group will be meeting during the 2019 FESSH congress to discuss the track hierarchy.
Earlier this month, some of the WG members attended the ICHOM Conference in Rotterdam,
Netherlands and the ICHOM team did a site visit of Xpert Clinic.
At the conclusion of the formal working group process, the Project Team which hold an open
validation period, in which a survey will be distributed to a wider network of patients, clinical andregistry leaders, and scientist to provide feedback on the recommendations of the Standard Set. The
feedback of the open validation surveys will be used to refine and finalise the Set. The final ICHOM
Hand and Wrist Standard Set will be published in the form of a flyer (two-page overview of the ICHOMStandard Set) , a reference guide (full detail of the Standard Set for institutions interested incollecting) and an academic publication. All the materials will be published on ICHOM’s website andwill be open access to promote the dissemination of the work.
Financial
The development of the ICHOM hand and Wrist is at 75% completion. The funding provided by thesponsors, including IFSSH, has been used to pay the salaries of the ICHOM Project Team: Director ofStandardisation/Manager oversight , Hand and Wrist Programme Manager (FTE) and Hand and Wrist
Research Associate (FTE). Additionally, funds have been used to cover operational and overhead
costs of delivering the monthly international conference calls (i.e. office rent, WebEx
videoconference subscription and Qualtrics survey platform subscription, research resources, etc.).
The funds were also used to cover the cost of travel of the ICHOM project team to the international
breakout sessions and for the conference tickets of working group members that attended the
ICHOM conference in May 2019. Lastly, the funds will also be used to create the promotional andmarketing materials (i.e. ICHOM flyer and reference guide), the journal publication (i.e. fee for open
access) and for any future updates and maintenance of the Standard Set.
www.ichom.org І Incorporated in Delaware, United States of America
US Company Headquarters registered as 501(c)(3) І 399 Boylston St. 6th floor І Boston, MA, 02116, USA
UK: Registered Company FC032114 І Hamilton HouseІ 4 Mabledon Place, Bloomsbury, London І WC1H 9BB

37

IFSSH SPONSORSHIPS

www.ifssh.info

ESSER MASTER CLASS FELLOWSHIPIFSSH SPONSORSHIPS

November 2019

IFSSH GRANT REPORT FOR HAND SURGERYFELLOWSHIP IN SHANDONG CHINA

The Esser Masterclass is a

Each year two places for eachDr. Michiel Zuidam

cadaver hands-on course on fivemasterclass are reserved andPlastic surgeon

Sudan is one of the largest countries

There are 6 teams in the Departmentof the challenges will be to getelements of the hand surgery:provided with a 50% reduced

Erasmus MC Rotterdam,in Africa, with a population ofof Hand and Foot Surgery – eachhold of hand and microsurgery

Nerves, Fractures, Tendons,

registration rate. There is also a

the Netherlands www.

around 37 million. It has suffered

team has 2 to 3 specialists – andinstruments and getting help for its

Osteo-Arthritis and Local flaps.

travel grant provided to one ofessermasterclass.com

from two prolonged civil wars

each team does a scheduled 24

establishment from experts outside

The Esser Masterclass is focused

the fellows.

between the North and South after

hours emergency on-call.

of Sudan.

on providing a tailored made andgaining independence from thehands on education by experts in

Last January during our course

United Kingdom in 1956. The firstI was attached to one team to

I have worked closely withthe field. Our mission is making

on tendon surgery we were

civil war which ended in 1972,

help with emergencies (tendons,colleagues and we are pleased tohigh-quality hand surgery

pleased to invite our first fellow:

started again in 1983. The second

fractures and re-implantations)announce that we have now formed

education accessible for every

Dr. Mohamed Adbelrahman

war and famine related effects

as well as with their elective day

the “Sudanese Society for Surgery ofhand surgeon around the globe

from Khartoum, Sudan. Dr

resulted in more than 2 million

surgery. The rest of the week

the Hand”.

and our motto is training from

Abelrahman is a plastic surgeon

deaths in two decades and 4 million

was following Prof. Wang at two

I do really appreciate the great

hand surgeons to hand surgeons.

focused on handsurgery. With

Dr Abdelrahman (right) receiving

people were displaced. A final

outpatient clinics and two operative

help from IFSSH and hopefully our

the travel grant is was possible

the Esser Master Class travel

North and South comprehensive

days, where he does congenital andcollaboration will continue in the

Esser Masterclass introduced

to attend the Esser Master

grant from Dr. Michiel Zuidam

agreement was signed in Januarycomplex trauma and microsurgery

future. Thank you.

a new education principle:class on tendons. For the next

(left)

2005. There are a huge number ofcases. Prof. Wang explained

FAIR-TRAED (Fair Transparent

courses fellow already have beentrauma hand patients and only

every case scenario and operative

Sincerely,

Education). FAIR-TRAED

selected. We are also developinga very few hand specialists. Forprocedures to me.

Mohamed Abdelrahman MDmeans that the registration

an educational platform. On

this reason, I wanted to pursue a

Also, I had the chance to learn andKhartoum, Sudan

fees are directly invested

this platform the presentations,

fellowship in Hand Surgery.

enhance my microsurgery skills inin the Esser Masterclasscourse books of the mastereducational materials to advanceclasses will be accessible. Also

I was offered a generous grant

most helpful.

hand surgery trainings. The

video’s providing additionalby the Educational Committee

During my six month fellowship I

organization and the faculty

information on surgery of theof the IFSSH to spend six

attended a very useful flap course

have a passion for hand surgery

hand will be published on thisDr Jason Wong, Manchester UK

months undertaking the Hand &run by the Department.

and support FAIR-TRAED which

platform. For surgeons from the(right) explaining to the fellow Dr

Microsurgery Fellowship in themeans that they do not receive

developing countries this will

Abdelrahman (left).

Department of Hand and Foot

Now, when I look back, I have gained

any financial compensation.

be a possibility to access all the

Surgery, Provincial Hospital ofa lot and learned much about the

The members of the SudaneseThis enables Esser Masterclass

information from the courses

Shandong University in China.

field of Hand Surgery. I am sure

Society for Surgery of the Hand

to keep the registration fees at awithout the necessity to beminimum.

physically present.

the animal laboratory which wasthere is still much to learn and once
Prof Wang is the head of the

I am settled I will try to attend extra

department and through his

specialized courses. I will also now

In line with the FAIR-TRAEDWe thank the IFSSH for theirsecretary he organized everything

be able to assist with those run byprinciple, Esser Masterclass insupport on the Esser Masterfor me – my visa, airport pick up

the Sudanese Orthopaedic Surgeon

collaboration with the IFSSHClass fellowship and educational

and accommodation.

Association.

developed the Esser Master

platform.

Class fellowship. The fellowshipis for hand surgeons form the

On behalf of the Esser Masterdeveloping countries.

Class

38

Participants of the Esser

The hospital is huge and has

Masterclass Tendons 2019 duringmultiple departments with state of

It is mandatory to establish a

Sudanese colleagues learn

hands on session.

the art equipment and research anddedicated hand surgery unit toessential skills for trauma andlaboratory facilities.

be able to help my people. Someelective cases

Courses are now helping

39

www.ifssh.info

40

November 2019

UPCOMING EVENTS

41

UPCOMING EVENTS

www.ifssh.info

UPCOMING EVENTS

November 2019

in.com

a
m
la
e
td
u
tit
s
n
-i
m
iu
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o
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m
www.sy

m
iu
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y
S
l
a
n
o
ti
a
InternINSTITUT DE LA MAIN

March, 13-14
2020

e Football
Fédération Française de • 75015
87 Boulevard de Grenell

PARIS, FRANCE

Dear Hand surgeon, Dear Colleague,
Scientific Board
G. Chick (CH)P. Bellemère (FR)G. Dautel (FR)B. Lussiez (MC)A. Tchurukdichian (FR)Scientific Commitee
M. Ceruso (IT)A. Ferreres (SP)M. Garcia-Elias (SP)E. Hagert (SE)D. Herren (CH)M. I. Winge (NO)Contact
info@foundationhandsurgery.org

The Foundation for Hand Surgery is a non-profit European organization, independent,
without industrial support or conflict of interest. The status of the foundation based in
Geneva can be consulted on the website www.foundation-handsurgery.org.
Its aim is to offer additional training opportunities for hand surgeons at all stages of
their professional training, from the early years to the final stages of perfecting theiralready acquired technical skills. Many invited experts from Europe are part of theeducation training program.
The sessions are taking place in Geneva at the Swiss Foundation for Innovation andTraining in Surgery (SFITS - Geneva University Hospital).
The program of the courses for 2019/2020 is available below.
Applicants participating in the training will be able to register on the dedicatedwebsite: https://www.foundation-handsurgery.org/overview/

Chairman :Anne VIDIL
Pierre MANSATThe Foundation for Hand Surgery solely relies on donations and sponsorships. To thisend, please note that each registration will need to be confirmed by a donation to theFoundation for Hand Surgery (minimum amount is 350 euros).
You can find more information about the donation process on our website:
https://www.foundation-handsurgery.org/donate/

We hope to see you and share our experiences.
Best regards,
Grégoire Chick, Gilles Dautel, Philippe Bellemère, Bruno Lussiez, Alain Tchurukdichian

t
n
e
m
e
g
a
n
a
m
d
n
a
is
s
e
n
e
g
o
Path
42

PROGRAMMEFoundation for Hand Surgery
Campus Biotech Innovation Park, Bâtiment F2/F3, Avenue de Sécheron 15, CH-1202 Geneva, Switzerland
Tel: +41 225 45 12 92 - info@foundation-handsurgery.org
www.foundation-handsurgery.org
nonprofit organization

43

UPCOMING EVENTS

www.ifssh.info

November 2019

12APFSSH/8APFSHT
12th Asian Pacific Federation of Societies for Surgery of the Hand &the 8th Asian Pacific Federation of Societies of Hand Therapists Triennial Meeting

11-14 March 2020 | Melbourne Convention and Exhibition Centre

apfssh2020.org

We look forward to seeing you in Melbourne from the 11th - 14th March
2020, to learn, be inspired, network with colleagues and enjoy everything
Melbourne has to offer.
WEB apfssh2020.org • CONTACT US info@apfssh2020.org

44

45

UPCOMING EVENTS

www.ifssh.info

November 2019

Arctic CULA (congenital upper limb anomalies) Symposium
SVALBARD, Norway 7-13 March 2020
https://www.spitsbergen.info/arcticCULAsymposium

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