May 2020

www.ifssh.info

ifssh

VOLUME 10 | ISSUE 2 | NUMBER 38 | MAY 2020

ezine

CONNECTING OUR GLOBAL HAND SURGERY FAMILY

SPECIAL FEATURESCONSENSUS WRIST INDEX TOOLAN ALTERNATIVE MANAGEMENTAPPROACH TO THE TREATMENT OFCOMPLEX PHALANGEAL FRACTURES:
THE POOLE FINGER TRACTION SPLINT

Visualizing
comprehensive
outcomemeasurements
UPCOMING EVENTSHAND THERAPYMEMBER SOCIETY NEWSREFLECTIONS ON
COVID-19
RESEARCH ROUNDUP
1ADVERTISMENT

www.ifssh.info

May 2020

contents

THE JOURNAL OF

4- Ulrich Mennen

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

5

Find out more 
about this journal

6

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

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

LETTER

32 SPECIAL FEATURES
Consensus Wrist Index Tool:
Gaining a comprehensive picture of thepatient’s function and perspective

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- Ronit Wollstein- Sarah G. Ewald

36 HAND THERAPY
An alternative management approach to thetreatment of complex phalangeal fractures:

Women in Surgery of the Hand - "WISH”

The Poole Finger Traction Splint- Eva-Maria Baur

A non- invasive splinting system

SECRETARY-GENERAL REPORT- Goo Hyun Baek

Latest Articles: Volume 24, Issue 03 (Sep 2019)
Research Papers

EDITORIAL
Our quest to do better(Asian-Pacific Volume)

A Comparison of Radiographic Outcomes between
3D Preoperative Planning and Conventional
Planning in the Osteosynthesis of Distal Radius
Fractures
Yuichi Yoshii, Yasukazu Totoki, Wen-lin Tung,
Kenichi Akita and Tomoo Ishii

VOLUME 10 | ISSUE 2 | NUMBER 38 | MAY 2020

- Esther Vögelin

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

www.ifssh.info

10 OBITUARY
Evelyn J. Mackin

16 COVID-19
The Covid-19 pandemic
		 - Ulrich Mennen
How COVID-19 has impacted the Hand Surgery
specialty in Singapore
		 - Sarah KW Huan

- Sarah Bradley

41 ART
Walking sticks - wood carvings

42 RESEARCH ROUND-UP
The methodological requirements for clinicalexamination and patient-reported outcomes,
and how to test them
- Roberto S Rosales- Isam Atroshi

44 MEMBER SOCIETY NEWS- Chew Wei Chong• Swiss Society for Surgery of the Hand

- Sreedharan S/O Sechachalam• American Association for Hand Surgery- Soumen Das De• Turkish Society for Surgery of the Hand

- Mark E Puhaindran• American Society For Surgery Of The Hand

- Kevin JH Wong
- Andrew YH Chin

26 CONGRESS REPORTAn update on the developments for the

48 IFSSH SPONSORSHIPSThe Touching Hands / IFSSH

50 PERSONAL OPINIONS

London IFSSH & IFSHT Congress 2022

Hand & Nerve- David Shewring- Jörg Bahm

30 PIONEER PROFILES

53 UPCOMING EVENTS• Takayuki Miura

List of global learning events and conferences• Ronald L. Linscheidfor Hand Surgeons and Therapists

3

EDITORIAL

www.ifssh.info

Our quest to do better

LETTERMay 2020

Women in Surgery of
the Hand - "WISH”
WISH would like to re-affirm its aim and make acorrection in the article published in the previous
IFSSH Ezine (February 2020).

- Identifying gender barriers in hand surgery and		 developing solutions to remove them
- Identifying safety issues for female hand

Two aspects in medicine, and in particular surgery

combined evaluation in a visual image. The result

and rehabilitation, still need much research andminimises bias, and indicates the interrelationship

History of WISH

		 cancer rate in female hand surgeonsrefinement. They are linked; one leads to the other.

between the various factors.

The first meeting of WISH was held during the IFSSH• To provide leadership - to represent the perspective

Congress in Berlin in June 2019. A decision was takenof women on Hand Surgery committees

		 surgeons including radiation safety eg. breast 		Firstly, how can we be more “certain”? Even with ourIn this issue, we will revisit this same concept

to stay together, start a mailing list and try to become• To promote flexible training within the workplace fortrained clinical acumen, exact physical measurements

to combine and inter-relate variables andmore “official”. The next meeting was held during thethe purposes of:and armamentarium of sophisticated diagnostic

measurements.

APWA Congress in Seoul in November 2019.

tools, we often struggle to make or find the correct

Our Special Feature presents a multi-author, multi-

diagnoses.

centre research project to explore how best to measure

The Australian colleagues planned a “leadership		 children, partners, parents)

the outcome of management of complex wrist

session” during the APFSSH Congress, but• To engage in research and exploring solutions

In spite of accumulating as much objective

conditions. This is an on-going project and invites

unfortunately this had to be cancelled on the last day

regarding:information as possible, it may often still not be clear

input from all corners to improve its effectiveness andof the Congress due to the outbreak of the covid-19- Health risks in pregnancy

whether our conclusions are in fact the real cause

applicability.

pandemic. If you would like to join or know more about- Operating theatre sessions and on-call inof the ailment troubling our patient. This has been
touched on in a previous IFSSH Ezine.

(1)- Parental leave- Family members requiring heightened care (eg.

WISH, please contact: (Eva-Maria Baur) baur@baurThe article in Research Roundup discusses thefromberg.de, (Isabell Mehling) isabellmehling@web.de,methodological requirements for clinical examination.

or (Jennifer Green ) jennifer.green@gmail.com,

		pregnancy- Return to work and support after parental leave		 eg. breastfeeding/expressing as a hand surgeon• To research the policies of IFFSH member

The other question, which is equally daunting, is how
to measure precisely the efficacy of our management

The following is a summary of the aims of WISH:

organisations with regard to leadership, selection,

efforts (surgery , rehabilitation/therapy), which are of• To advocate gender issues, career support, training,training, health and well-being of women in the handcourse based on our initial diagnoses and treatment.

flexibility and educational opportunities for womensurgery and provide feedback to the IFSSH for theinterested in pursuing a career in hand surgery.

purposes of sharing this information and• To liaise with medical students and junior doctors, toencouraging best practice by member organisations.

Since every case is different, it is in many instances
impossible to measure scientifically and precisely

Happy hands!

surgery as a career by:

the outcome of management. There are just too many
variables, biases and subjective influences.

encourage and promote more women to pursue hand

Ulrich- Creating visible role models

in the February 2020 Ezine: “Avanthi Mandaleson, Vice

Editor: IFSSH Ezine- Providing career advice opportunities

President of the Australian Orthopaedic Association”- Providing educational opportunities

should read "Avanthi Mandaleson from the Australian

An example is congenital differences. An attempt
to evaluate multiple factors which influence results

1. IFSSH Ezine August 2019 #35• To evaluate gender specific issues in the field of hand

was published in 2004 . The “disc-o-gram” takes

2. Mennen, U. “Arthrogryposis Multiplex Congenita:

surgery, including:into account a number of influencing factors,

functional classification and the AMC dis-o-gram”

measurements, individual patient variations, evaluator

J Hand Surgery(B&E) Aug2004 Vol 29B No4 p363-367(2)observations and patient opinion, and presents the4

NB: Please note the following correction to the article- Monitoring trends and statistics related toOrthopaedic Association”
Best regards

		 numbers of women training and working in hand

Dr. Eva-Maria Baur

		surgerybaur@baur-fromberg.de

5

SECRETARY-GENERAL REPORT

www.ifssh.info

Message fromSecretary-General

May 2020

SECRETARY-GENERAL REPORTand the New Zealand Hand Surgery Society and their

The week after the course, procedure rooms wererespective hand therapy colleagues, as well as theopened in two of the largest hospitals in Kenya for

Asia-Pacific Wrist Association. The national and

WALANT surgery. Upon completion of the course,international audience members were appreciative ofpositive feedback was provided by participants and

Dr Moran’s extensive contribution to the meeting.

unused funding was returned to the IFSSH. The
full report is available in the May IFSSH Ezine and

The Touching Hands / IFSSH Hand Surgery

on the website: https://ifssh.info/ifssh-sponsored-

Workshop at Mount Kenya University, January 24theducational-projects.php-25th 2020
IFSSH Educational Sponsorship

Developing Country Registration Grant: APFSSH
Dr Don Lalonde approached the CES with an

Best wishes to all,Congress, Melbourne, March 2020

The IFSSH remains committed to providing funding

application detailing a workshop to be run in Nairobi,

for the conduct of educational projects worldwide. In

Kenya in January 2020 - “Managing upper extremity

The IFSSH provided US$10,000 to the 12th Congress ofthe first three months of 2020, IFSSH support has been

surgery in and out of theater with surgeon provided

the Asian-Pacific Federation of Societies for Surgery

directed to the first IFSSH Harold Kleinert Visiting

tumescent local anesthesia”. This was organised inof the Hand, specifically to allow reduced registration

Professor, two sponsored projects have been completed

conjunction with Professor Pankaj Jani, the President

rates for those from developing countries. The

and a further two projects have secured funding.

of COSECSA (College of Surgeons of Eastern, Central,

Congress was held in March with pleasing attendance

and South Africa), who facilitated invitations to theand a full scientific programme. A report of the use of
the funding will be placed on the IFSSH website.

The global pandemic of the COVID-19 virus is an
unprecedented threat in recent history, and causes fear

IFSSH Harold Kleinert Visiting Professorship:program directors and trainers from the 24 COSECSA

to everybody on earth.

Dr Steven Moran, March 2020

accredited hospitals in Kenya. The application wasendorsed by the American Society for Surgery ofHand Surgery fellowship, West Africa

All the medical personnel have to face the risk of

The IFSSH is delighted to have supported the firstthe Hand. The IFSSH granted US$10,000 which wascoming in contact with infected people, including

IFSSH Harold Kleinert Visiting Professor. Dr Steven

specifically directed towards providing free attendance

The IFSSH was recently approached regarding theourselves, with or without symptoms.

Moran (Mayo Clinic, Rochester, USA) undertook a

for approximately 80 local surgeons/trainees.

intention to introduce a West African hand surgery

teaching programme to a number of Australian andtraining fellowship as a joint project of the hand

Even though we are in danger, we are very proud of our

Asian-Pacific audiences in March 2020. His nomination

The course report details that the goal of the two day

surgeons at Komfo Anokye Teaching Hospital (Kumasi,

vocation.

for this Visiting Professorship was submitted by thecourse was to have all attendees be able to safely inject

Ghana), the American Society for Surgery of the Hand

organizing committee of the 12th APFSSH Congress.

tumescent local anesthesia in an almost painless(ASSH) and the American Association for Hand Surgery

manner. This would cut the need for costly sedation(AAHS). This Fellowship is in the establishment stages

Dr Moran travelled firstly to Sydney and conducted

and improve patient safety for most hand surgery.

and financial assistance was sought to provide theteaching sessions with local and international hand

In addition, the evidence behind safe field sterility

annual Ghana College accreditation fee. The IFSSH

XVth IFSSH – XIIth IFSHT Congress, London: Change

surgery fellows, followed by sessions with orthopaedic

was reviewed to enable much of Kenyan surgery tohas pledged US$4350 to allow this process to proceedof Dateand plastic surgery registrars. His Sydney visit

move to more affordable procedure room field sterility

and continue for the first three years. Progress reports

concluded with lectures and clinical advice to the New

out of the main operating room, as it has in Canada.

will be provided to the IFSSH and distributed via theSouth Wales Hand Surgery Association.

Eliminating sedation and full operating room sterility

Delegates’ Council.

‘Greater love hath no man than this, that a man lays
down his life for his friends (patients).’

The London 2022 Organizing Committee are continuingwith the preparations for the 15th IFSSH Congress.

for many procedures will improve access to surgery

Please note that the dates have been altered. The

The second component of the Visiting Professorshipfor many who cannot afford unnecessary sedation andInternational Consortium for Health Outcomes

Congress will now be held on 6th - 10th June 2022 atincluded numerous lectures at the Australian Hand

unnecessary full operating room sterility for many

Measurement (ICHOM):

the ExCeL London Convention Centre.

Surgery Society Registrar Review Course and as aprocedures. Dr Don Lalonde (Touching Hands), Dr Peter

Hand and Wrist Conditions (Adult)

keynote speaker at the 12th Congress of the Asian-

Nthumba (Kenya plastic Surgeon) and Professor Pankaj

Updates are available via the Congress website: https://

Pacific Federation of Societies for Surgery of the Hand

Jani (past COSECSA president) provided the lectures

The ICHOM Adult Hand and Wrist Conditions

www.ifssh-ifsht2022.co.uk/(APFSSH). The APFSSH Congress was organised inand commentaries to optimize sharing of knowledge.

working group, chaired by Dr Steven Hovius, received

conjunction with the Australian Hand Surgery Society

6$10,000 in IFSSH funding in 2018 during the project’s

7

SECRETARY-GENERAL REPORT

establishment. The aim of this project is to compile a minimum set ofhand surgery outcome measures that are relevant to particular diagnoses
and it is hoped that these become widely accepted for standardised
reporting. More information about this project is available on the ICHOM
website - https://www.ichom.org/portfolio/hand-and-wrist-conditions/

www.ifssh.info

May 2020

ADVERTISMENT

ifssh
ezine

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

The international working group (approximately two-thirds surgeons,

official mouthpiece of the

one-third therapists) has continued their rounds of research andInternational Federation of

consultation and are now inviting comments on the current draft - http://

Societies for Surgery of thebit.ly/HandWristOR. To finalise this work, ICHOM have requested further

Hand. The IFSSH does notfunding from the IFSSH and $5000 has been awarded.

endorse the commercial
advertising in thisIf your society is planning education programmes and needs support topublication, nor the content

fulfil the goals, please consider if it may be appropriate to submit a requestor views of the contributors

to the IFSSH. The full guidelines and reports of sponsored programmes areto the publication.

available via https://ifssh.info/educational_sponsorship.php.

Subscription to the IFSSH
ezine is free of charge andFuture Meetings

the ezine is distributed on aquarterly basis.

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

Should you be interested to

The triennial IFSSH Congresses are as follows:advertise in this publication,please contact the Editor:

XVth IFSSH – XIIth IFSHT Congress – London, United Kingdom
6th - 10th June, 2022

ezine@ifssh.info

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

IFSSH EZINEEDITORIAL TEAM:

29th March - 3rd April, 2025

EDITOR:
Professor Ulrich Mennen
Past President: IFSSH
DEPUTY EDITOR:
Professor Michael Tonkin
Past President: IFSSH
GRAPHIC DESIGNER:
Tamrin Hansen
tamrin.hansen@gmail.com

Goo Hyun Baek
Secretary-General, IFSSH
Email: secretary@ifssh.info

8

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

OBITUARY

www.ifssh.info

Evelyn J. Mackin, PT
United States of America (1922-2020)

OBITUARYMay 2020

The Hand Rehabilitation Foundation in Philadelphia

Always actively involved, in 1977 she met with a grouphas sponsored the meeting, for many years. As a boardof six hand therapists at a hand surgery meeting inmember and then its Executive Director, Ms. Mackin

the United States. These six therapists became thesupported endless educational opportunities for bothcore founding members of American Society of Hand

hand therapists and hand surgeons.

Therapists and Ms. Mackin served as president in
1982. During her tenure as president, she launched
a newsletter entitled the International Network, toto return to work. This dream became reality whenassure dialogue with hand therapists worldwide.

they established the Philadelphia Hand Centre,

Due to Ms. Mackin’s contacts in the publishing(now named Philadelphia Hand to Shoulder Centre)

world because of her editorship of Rehabilitation ofwhich over the ensuing years has become a model

the Hand, she was instrumental in establishing thetraining centre for countless therapists and surgeons,

Journal of Hand Therapy in 1987 and serving as its

including those who have visited from otherfirst editor until 1998.

countries.
During her clinical years at the hand centre, Ms.
Mackin delivered more than 112 lectures in the UnitedFirst edition of Rehabilitation of the Hand

States and made 53 trips to 21 different countries tolecture while she also authored 11 individual works

First edition of Rehabilitation of the Hand In 1976 Ms.

and 33 works jointly with others. Additionally, she

Mackin spearheaded the creation of the first edition ofparticipated in five clinical research studies.

the book, Rehabilitation of the Hand, serving as one of
the editors for the first five editions. Well recognized

Ms. Mackin speaking with therapists at the FirstTo assure hand therapy knowledge was shared asas the core text on hand rehabilitation, it is now a two-

IFSSH Congress, Rotterdam, 1980

widely as possible, in 1976 she was instrumental involume book entitled Rehabilitation of the Hand andorganizing the first Philadelphia meeting entitled

Upper Extremity, soon to be in its 7th edition and well

In 1980, Ms. Mackin encouraged numerous therapists““Surgery and Rehabilitation of the Hand,” which is

known to all. Additionally, Ms. Mackin was a co-editor

to informally meet in Rotterdam during the first

The International Federation of Societies of Hand

now in its 46th year and remains one of the largest

with Dr. Hunter and Dr. Schneider, and Mackin for two

Congress of the International Society for Surgery of

Therapists (IFSHT) honours the memory of Ms. Evelyn

educational meetings for hand therapists in the world.

editions of Tendon Surgery in the Hand published in

the Hand. (IFSSH). It was at this meeting that the seed

J. Mackin, PT. Many describe her as “the mother of

Ms. Mackin always set aside funds to sponsor at least

1987 and 1997.

was planted for an international hand therapy society.

hand therapy.”

one foreign therapist to attend the meeting.

Then during the French Hand Surgery and Hand
Therapy Societies meetings in 1986 in Paris, France,

Born in Jersey City, N.J. USA, Evelyn Mackin had early

Ms. Mackin led a group to form an international hand

dreams of becoming an architect; she wanted to build

therapy society.

bridges.
The International Federation of Societies for Hand
She earned her degree in Physical Therapy at the

Therapy (IFSHT) was founded in 1987 and Ms.

University of Pennsylvania in 1944 and after working

Mackin served as the first President. The inauguralas a physical therapist with children and veterans,

IFSHT congress was held in Tel Aviv in 1989 with aand raising her son Glenn, in 1967 Ms. Mackinsmall number of founding member countries. IFSHT

began working with Dr. James Hunter at Thomas

currently has 36 active member countries, seven

Jefferson University. Ms. Mackin, Dr. Hunter, and Dr.

associate member countries and ten corresponding

Lawrence Schneider dreamed of providing complete

Evelyn Mackin (front row, third from left) with her

Ms. Mackin showing the first edition of the Journal

member countries, representing roughly 8,500

care of the hand patient, including preparing themstaff at the Philadelphia Hand Centreof Hand Therapy at the first editorial board meetingtherapists worldwide.

10

11

OBITUARY

www.ifssh.info

Jean-Claude Rouzaud, (France) IFSHT President

Hospital in the United Kingdom. We spent a week

1992 to 1995

together and my lasting memory is the feeling she

I met Evelyn in 1986 in Paris during the French

Inaugural Meeting of IFSHT in Tel Aviv. Front Row L to R: Corrianne Van Velze (South Africa), Dominque

OBITUARYMay 2020

gave me that we had been friends for a long time

Society for Surgery of the Hand (GEM) Congress

instead of just a few days. She had a warm generous

with a group of therapists at a restaurant at thenature, happy to share what ever knowledge she had

Palais des Congrès. During our discussion, Evelyn

with others. She promoted and encouraged thoseshared her idea to establish an international society

who were keen to learn and had a gift of being able

for the rehabilitation of the hand. This dream ofto recruit others to join her in her ventures, myself

the International Federation of Societies for Hand

included, to the IFSHT, one of the many projects she

Therapy (IFSHT) took shape against all odds andinspired. Not many people could claim the hugecontinues to be successful.

international friend and

I was fortunate to becolleague network

Thomas & Jean-Claude Rouzaud (France), Evelyn Mackin & Judy Leonard (USA) Carolyn Miekle (Newchosen to be a part of

Evelyn had; she was

Zealand). Second Row L to R: Helena Hae-Shya Ma (Tiawan), observer; Barbara Somekh & Rosalie Kupfer-this visionary society

our figurehead, mentor

Halstuch (Israel) Sue Boardman & Victoria Frampton (UK); Rosemary Prosser (Australia); Rosa Bolotta

to serve as the firstand friend and will be(Italy). Third Row L to R: Zbigniew Sliwinski (Poland), Paul Van Lede & Jacques Ottier (Belgium); Philippe

Secretary General of theremembered always.

Charmagne (France)

IFSHT. I can never thank
Evelyn enough; I am

Corrianne van Velze,

Ms. Mackin has been recognized by numerous

At the 9th IFSHT Triennial Congress and 12th IFSSH

indebted to her for the(South Africa) IFSHT

organizations for her many contributions. In 1986,

Triennial Congress in 2013, Ms. Mackin traveled toopportunity she gave me

President 1998 to 2001

she was awarded the first Nathalie Barr Lectureship

New Delhi, India at the age of 90 to be honored as

to grow both personallyI first met Evelyn in

by ASHT. The Hand Rehabilitation Foundation ina Legend in The Field of Hand Therapy where she

and professionally.

Philadelphia has established the Evelyn J. Mackingave her last official address to the IFSHT and IFSSH

Hand Therapy Fellowship to promote clinical training

1989 in Tel Aviv, at the

Her quiet strength

first IFSHT Congress.

community. Ms. Mackin reflected on her careerand great determination

It was one of thosein hand management and patient care. The American

and the growth of hand therapy from the informal

gave us the courage

special moments in myHand Therapy Foundation has established thegathering in Rotterdam to the establishment andto better ourselves.

life – meeting Evelyn,

Evelyn Mackin Grant for Education by a Traveling

growth of the IFSHT. She described her memories as

All who worked with

with whom I had

Hand Therapist. The Evelyn Mackin Triennial Awarda tapestry of her life, reflective of the people she had

her had the greatest

corresponded (by snail

given by IFSHT supports therapists from developing

met, the surgeons and therapists who influenced her,respect for her; handmail) and whose book,countries to attend the Triennial IFSHT Congress.

and the places she had visited.

therapists owe her a

the Rehabilitation of thelot. Her intelligence and persistence allowed her toHand (1st ed), I referred to often. She was incredibly

Ms. Mackin served as a role model for hand therapists

change preconceptions and break down barriers.

warm and kind and made me feel so welcome in theboth professionally and personally as she believed

She remained an honorary guest in France for manyfamily of hand therapists.

life should be balanced. She concluded by saying: “Iyears. It is with great sorrow that I say goodbye tourge all of you to keep that passion for life, for yourher.

profession, and for your personal life as well, because I
truly belief you need a balance.”

Ms. Mackin (5th from left) with other IFSHT past-

A meeting was held with the representatives
from all the countries who attended the congress
and a committee was established. I volunteered forVictoria Frampton, (United Kingdom) IFSHT

the position of Historian and together with Evelyn

President 1995 to 1998

(President) and Jean-Claude (Secretary-General), we

Through the following reflections by IFSHT past

I met Evelyn in 1979 when she came to visit

presidents, the IFSHT is adding to this tapestry of

Dr Wynn Parry at the Royal National Orthopaedic

formed the first executive committee.
Evelyn shared her knowledge and skills withmemories of Evelyn J. Mackin, PT.

presidents in India; 2013

12

13

OBITUARY

www.ifssh.info

everyone, all over the globe. She spread the word far

Margareta Persson, (Sweden) IFSHT President 2004

and wide and emphasised cooperation and sharing

to 2007

Unassuming, gracious, and generous, Evelyn

clinicians and their patients. It was a pleasure andsaw the possibility for everyone to contribute andan honor to become personally acquainted with her

Evelyn has meant so much, and still does, as

be involved. The most fitting tribute we can makethrough the IFSHT. She was an example to us all,therapists, but also with hand surgeons. She madea forerunner in the field of hand therapy. She is

to Evelyn Mackin’s memory is just that: contributeinspiring and always encouraging.

sure that hand therapists were respected by handsuch a wonderful example of a strong wise handto the learning of others whether it be supporting

surgeons and encouraged us all to work together. Her

therapist full of energy and willingness to share her

the IFSHT Evelyn Mackin IFSHT Congress Grant,

Anne Wajon, (Australia) IFSHT President 2016 tomotto was “Pass it on” and through doing this we doknowledge, experience and wisdom.

presenting a paper, writing an article, mentoring an

2019of knowledge and ideas not only among handour bit to make sure that Evelyn’s legacy lives on.

One always felt included in the hand therapy

inexperienced therapist, serving on a committee or

I had the pleasure of meeting Evelyn at the Silent

My heartfelt gratitude goes to Evelyn for her caring,family when she was around. I remember her sweet

leading a discussion. As Evelyn encouraged: “Pass it

Auction, which I chaired in Delhi in 2013. She offeredenthusiasm for her work and the example she set forkindness combined with an almost royal excellenceon.”

to support IFSHT by promoting the items for sale andus all. May she rest in peace.

in her approach.
We have such a fine example to follow as hand

Annette Leveridge, (United Kingdom) IFSHT

therapists, thank you Evelyn!

President 2001 to 2004
I first met Evelyn at the French Hand Meeting in
Paris in 1986, when Evelyn and a group of American

took the opportunity to talk to passing therapists andLynne Feehan, (Canada) IFSHT President 2010 to2013
There simply are not enough words or ways

Judy C. Colditz, (USA) IFSHT President 2007 to 2010
No one has had more influence on thesurgeons.
I subsequently became President of IFSHT in
Buenos Aires in 2016. Evelyn was unable to attend

to state how much Evelyn has done for thethis meeting but called to talk to all members ofinternational community of hand therapists. I wasthe Executive Committee during our committee

hand therapists were meeting with internationallydevelopment of hand therapy than Evelyn Mackin.

privileged to spend two days with Evelyn on her 90th

meeting. She was interested to discuss IFSHT

famed hand surgeons to discuss plans for the future

Not only did she urge others to write and present

birthday when I stayed in her home to film a video

activities and always took a keen interest in theof hand therapy and surgery internationally. Evelyn

information about the evolving science of handfor presentation at the IFSHT congress in India.

recipients of the Evelyn Mackin IFSHT Congress

was poised, eloquent and enthusiastic at all times, as

therapy, but she also brought us together to share the

These are two days in my life I will always remember

Grant; those therapists who IFSHT and IFSSH

one came to expect.

information. Not one of us has escaped the benefit

and cherish. Her passion for a global community ofsponsor to attend the triennial congress. Evelyn’sof her tireless efforts to pioneer a new medical

hand therapists that connect and learn from eachlifelong passion for hand therapy has been an

speciality.

is inspirational. I know that there are hundreds ofinspiration for us all.

I really got to know Evelyn from 1992 when I
was the UK delegate to the IFSHT Council meeting,leading on to my election on the executive

I personally recall the occasional phone call fromtherapists and surgeons around the world who have

Compiled by Judy C. Colditz, (USA) IFSHT

committee. It was Evelyn who encouraged me to

Evelyn, asking me to contribute in some way. It wasalso been touched and inspired by Evelyn to do more

President 2007 to 2010 & Susan de Klerk, (Southstand for election as President of the IFSHT and

impossible to say no to her enthusiasm; she always

and do better. Thank you, Evelyn . . . your passion

Africa) IFSHT Information Officer 2019 – 2022.

who gave me support and advice throughout mymade it seem it would be such a loss if you did not

and love for hand therapy will live on in all of as weyears on the executive committee. She became aparticipate.

“Pass it on” to others.

very good friend as well as advisor and I welcomed

14

OBITUARYMay 2020

Her accomplishments are many, including

regular letters from her until more recent times.

the conceptualization and birth of IFSHT. One

Sarah Ewald, (Switzerland) IFSHT President 2013 to

A very generous person, spontaneous and always

accomplishment of which many may not be aware

2016

willing to encourage me, particularly as I became

was her single-handed effort to assure the Journal of

involved with setting standards for education forHand Therapy, of which she was the first editor, washer can do attitude and enthusiasm resulted intherapists across the world. Rehabilitation of the

included in Index Medicus. Without this inclusion,

lasting contributions to the world of hand therapy.

Hand and Upper Extremity has been a wonderful tool

no one would be able to find information in the

As one of the original editors of the classic reference

and source of knowledge for all who treat conditions

journal. She made endless phone calls seeking

book “Rehabilitation of the Hand and Upperof the hand and upper extremity and I shall always

support letters (this was before computers). She was

Extremity”, soon to be published in the 7th edition,

remember Evelyn with love, gratitude and respect.

proud of the journal and it being recognized by Index

she along with other pioneers in the field of hand

Medicus as one of the speciality sciences within

therapy and hand surgery created an enduring

medicine.

legacy of knowledge that benefits countless

Evelyn Mackin was a team player with a vision,

15

COVID-19

www.ifssh.info

COVID-19

May 2020

have an epigenetic effect? What long term effects arecommunicate our lectures, seminars, conferences andrecovering patients left with? Why does the virus infectcase discussions in real time and more frequently.

multiple organs (lungs, heart, brain, gut, kidneys, etc)

We have to be careful not to become impatient within some patients and others have no symptoms, but

the well-intended restrictions imposed by authorities.

are spreaders of the virus? The questions go on. It will

The danger lies in grabbing onto and believing false

help to understand the bigger picture if we all would

statements and untested claims. Unfortunately

consciously accept the fact that the Covid-19 virus will

examples such as claiming the efficacy of certain

be with humanity permanently, and will change muchdrugs or baseless pronouncements by some leaders

The Covid-19 pandemicof our familiar routines.

will continue to occur. These sinister utterances

The Covid-19 pandemic has caught each one of us off

have lost their jobs, and their businesses are going

the ability to build hospitals in record time are now ofguard; some much, much more than others. And somebankrupt.

practical value. Highly trained soldiers are expected

Once the pandemic has settled, which will hopefully be

to change their mind-sets radically and become thesoon, a new dispensation and a new norm seems to bediametrically opposite, namely peace officers.

inevitable for all. It may then be a matter of survival of

sadly gave their life while fighting in the frontline.
The nature and epidemiology of this virus isdampen and skew the efforts and progress that serious
It is ironic that all the trillions of dollars spent on

scientists around the world are trying to make.

military armamentarium to kill and destroy, is useless

The prudent attitude would be to stay calm, act

in fighting this microscopic piece of RNA. Only the

responsibly, and be certain about information before

military support systems such as hospital ships andsending it on.

This new corona virus is more vicious than any of us

mostly still unknown. Statistics and numbers arehave seen or experienced. It is more infectious thaninterchanged regularly as if these two terms are theIs humanity going to survive? Of course. Most patients

Every new day, as more information is gathered, wemost and spreads more readily. It also has more timesame. This causes much confusion and ill-information.

get better. This should not be the question.

learn more. This adjusts our understanding, as well as

to spread as the infectious period is much longer, andThese figures clog our television screens and are to

What we should be asking is whether humanity,

decision and policy making. Projections and models

due to more patients surviving, this period of viralsome extent meaningless, because nobody truly knows

and each one of us individually, will learn from this

therefore change all the time.

shedding is prolonged.

how many of us have, or have had the virus. It seems

disaster. Will we spend more of our tax money on

So, what are we to make of the period after themost who get infected get better or do not even knowsocial upliftment, health and population education,

lockdowns? May we dare to suggest ideas? It should be

The full destructive force still has to be manifested, butthey were infected. Only if this figure is known can theand ethical food sourcing? When will leaders realise

obvious that unspecified lifting of the current, effective

the devastating social and financial impact worldwide

real morbidity and mortality statistics be determined.

that petty politics and self-interest (greed) do not

restrictions would undoubtedly lead to a second spike

is by now catastrophic for many millions of people.

Many serology-based antibody tests are presently

belong in a world with artificial borders. We live inin new cases and deaths.

being developed and investigated for their reliability

a global village. We are all in this together. We may

and specificity to answer this question.

inadvertently be forced to revisit current economic

Staged lifting seems to be a reasonable option, BUT

systems and social orders.

only on condition that diligent measures are in

It is prudent to issue directives and orders on how
to behave to combat the spread of this virus. Somethe adapted.

well-equipped and socially well-off countries let

Also, only if this overall figure is better known, will

their citizens roam freely (and with disastrous

it be possible to determine the quality of immunity.

Secondly, over time we have become obsessed withother places of congregation for testing not only forconsequences). Other countries have strict instructions

Developing a vaccine is technically complicatedattending endless conferences, congresses andthe presence of the virus, but also for antibodies toand regulations regarding movement, travel, physicaland will probably take much more than 18 months.

meetings all over the planet. This viral outbreak has

determine immunity. Equally important, methods for

distancing and lock-downs which are enforced by the

So far, in some viral infections such as HIV/AIDS,

also forced us to rethink ways to communicate sociallycontact tracing, as well as clear evacuation strategies

police and army. Let us spare a thought for the fact

development of successful vaccines have not yet beenand professionally. The Internet has enabled us tomust be in place. Are we there yet? This is not athat most people globally cannot practically do “social

possible. Vaccines are based on our bodies reacting

use various ways and platforms to relate with one

political question. This is a basic, practical question of

distancing”, do not have any savings or resources

to a virus by producing antibody proteins. Someanother. Consider all the advantageous side effects

common sense. It may still take some time to get there.

to live on, do not have alternatives to using publicquestions complicate the development of a vaccineof this pandemic. We will dramatically cut down on

Until then, do we have a choice?

transport, do not have private toilets, do not haveeven more. Is the protection going to be short term or

the global carbon footprint, we will be more available

adequate medical care, do not even have clean water,long term? What role does herd-immunity play? Does

professionally and for our families, we will reduce

Stay healthy and positive.

are undernourished and often immune-compromised,

this virus cause harm to a developing foetus, or will it

the chances to further spread dreaded diseases, andUlrich Mennen

16

place at the workplace, schools, colleges, offices, and17

COVID-19

www.ifssh.info

COVID-19

May 2020

Electronmicroscope images Covid 19 Source: www.news18.com

How COVID-19 has
impacted the Hand
Surgery specialty in
Singapore
CONTRIBUTING AUTHORS:

Microsurgery, National University Hospital

INTRODUCTION

Singapore has stepped up measures to deal with

The coronavirus disease 2019 (COVID-19) outbreakthe increasing prevalence of COVID-19, with thewas first reported in December 2019 as a cluster

introduction of elevated safe distancing measuresof viral pneumonia in Wuhan, China . It has since

as a ‘circuit breaker’ for four weeks starting from 3

spread relentlessly worldwide, with the World Health

April 2020. This involves closure of all non-essential

Organization (WHO) declaring it a public healthservices across the whole country, implementation of

emergency of international concern on 30 January

workplace telecommuting and advising the general20202 and pandemic on 11 March 20203.

public to stay at home as far as possible9.

The first case of COVID-19 in Singapore was confirmed

HOW HAND SURGERY PATIENTS HAVE BEEN

on 23 January 2020. There has been a small but steady

AFFECTED BY COVID-19

increase in the number of cases, until Singapore raised

Singapore is unique in that Hand Surgery is a

the Disease Outbreak Response System Condition

stand-alone, independent specialty. The patient

12,3

1. Sarah KW Huan¹

CORRESPONDING PERSON:(DORSCON) alert level to orange on 7 February 2020.

demographics within Hand Surgery varies widely.

2. Chew Wei Chong¹

A/Prof Andrew YH Chin

This indicates the disease is contained, but severe

Conditions such as arthritis and osteoporotic fractures

3. Sreedharan S/O Sechachalam²

Senior Consultant

and spreads easily between people (Figure 1). At theare linked to degeneration and advanced age, whereas

4. Soumen Das De³

Department of Hand and Reconstructive

time of writing this article, COVID-19 has infected oversports injuries and industrial accidents are more

5. Mark E Puhaindran³

Microsurgery,one million people across the world , with a mortality

common in the younger population.

6. Kevin JH Wong²

Singapore General Hospitalrate of 5.6%. Transmission is mainly via respiratory

7. Andrew YH Chin¹

Email: andrewthechin@hotmail.com

droplets and contact6, but recent studies have further

Although COVID-19 mortalities are more common in

Mobile: +6592330426

shown that asymptomatic carrier transmission is also

people over 50 years old with chronic comorbidities10,11,

possible, which makes management and containment

a number of cases occurring in the younger population

1.
2.
3.

Department of Hand and Reconstructive

4

5

Microsurgery, Singapore General Hospital

DECLARATION:

even more challenging . As yet, there is no known

have been reported in Singapore, with 80% of the

Department of Hand and Reconstructive

No conflict of interest from each of the contributing

antiviral treatment beyond supportive care.

first 1000 cases being less than 60 years old12.

Microsurgery, Tan Tock Seng Hospitalauthors

7, 8

Additionally, the most recent outbreak in foreign
worker dormitories13 has opened up new challenges in

Department of Hand and Reconstructive

managing such patients with active hand conditions.
ACKNOWLEDGEMENTS:

Hence, it is important to stay cautious and vigilant

The authors would like to thank all the staff from the above 3 hospitals who have contributed to thewhen seeing all patients.

content of this article.
Figure 1. Singapore’s DORSCON Alert levels system

18

19

COVID-19

www.ifssh.info

COVID-19

May 2020

MEASURES TAKEN TO PREVENT COVID-19 SPREAD:*Segregation of staff

Daily emergency hand surgery calls are also covered

other specialties to cover the emergency department,

STAFF

As the COVID-19 coronavirus is extremely contagious,by members of the same team. At times, there will be

to run mobile medical teams dealing with mass

there is a need to segregate staff into various self-

situations when there is a lack of manpower, such as

outbreaks in the dormitories, to augment the staffing*Personal Protective Equipment (PPE)

reliant functional teams, with minimal physicalonly one junior (medical officer and/or registrar grade)at intensive care units and assist the intensivists andThis consists of a surgical gown, gloves, mask andcommunication between members of different teams.

staff on emergency 24-hour call and the senior staff

also assist the infectious disease specialists at the

goggles or face shield (Figure 2). Wearing of PPE with

The functional team structure comprises a minimum

has to do a step down call to augment the junior should

isolation wards.

a N95 mask is mandatory when seeing patients whoof 3 members (up to a maximum of 5), led by a Hand

there be a marked increase in clinical activity at theare suspected or diagnosed cases of COVID-19. All

Surgeon specialist (consultant or attending grade) withemergency department (Figure 3).

healthcare workers have been trained in the usage of

2 other junior staff (medical officer/registrar grade).

PPE and fitted with National Institute of Occupational

The reason for adopting this concept is that should any

Safety and Health (NIOSH)-certified N95 respirators. If

member of the team be exposed to the coronavirus;

N95 masks do not fit, powered air-purifying respirators

the entire team is compromised and the affected team[1]

On the job training, refresher courses in critical careand infectious disease management and even learning

Medical Officer

Registrar

Consultant

new skills such as performing a nasal swab on asuspected COVID-19 case are conducted to ensure

G

I

K

C

E

effectively. Everyone is forced out of their comfort

all the doctors are equipped to fight the ongoing war(PAPRs) are used instead. Staff training was conducted

will have to suspend clinical services and be isolatedA

for the use and maintenance of PAPR. With assiduous

for a 14-day period before they are allowed back into

H

J

L

zones and expected to contribute wholeheartedly touse of PPE, so far, there have been no reported cases

the workforce provided they have been asymptomatic

B

D

F

fight the crusade against the invisible enemy. Staff whoof staff contracting COVID-19 while in the line of duty.

throughout their isolation period. The other unaffected
teams will continue to render patient care and ensure-Lare pregnant or immunocompromised are exempt fromFor managing non-COVID-19 patients, a minimumG

requirement for all staff is to wear a surgical maskthat clinical services are not compromised. Even

H

I

M

during consultation and glove up when performing

during daily clinical activities such as inpatient rounds

A

D

E

physical examination.

and clinics, individual team members are constantly_____________________________________________

reminded to practice responsible physical distancing

Figure 3. An example of a weekly department

to stay within the current respective hospitals that

N95 masks in our context may also refer to filteringfrom each other – keeping a minimum distance of 1

emergency call roster where A-F are members of

they have been posted to. However, each institution

face piece respirators (FFRs) found across otherm apart) and also to stagger their meal times so as toone team, and G-M are members of another team.

is still obliged to fulfil the training requirements

countries,

minimize contact.

[1]

direct care of suspected or diagnosed COVID-19 cases.
*Education and Research
Residency rotations were also frozen, ensuring staff

amidst this pandemic with adjustments and creative

e.g. FFP2 (Europe), KN95 (China), P2 (Australia/New

Besides being based in one hospital for the majority

ways of teaching and assessments through online

Zealand), Korea 1st class (Korea), or DS (Japan).

of the time, some of our colleagues also provide

platforms in lieu of physical meetings or teaching_____________________________________________

subspecialty coverage and services to other hospitals

sessions. Increased use of simulators and simulated

to varying degrees. However, due to the current

assessments are also being employed during suchpandemic, cross-coverage by these staff between

times.

14

various hospitals has been halted to reduce risk ofinter-hospital infection by healthcare staff.

In view of this pandemic, all research related to
COVID-19 is supported and enhanced. Non-COVID-19*Provision of services in managing COVID-19

related research is allowed to continue withDuring a pandemic situation, just like in war times,

modifications to study protocols. Activities that can be

it is inevitable that manpower will be stretched anddone remotely are encouraged with reduced staffing inoften, all specialty departments are expected to provide

laboratories and facilities where on-site supervision

reinforcements from the existing pool of doctors

and practical work is required. Researchers canto beef up critical areas and services to combat thecontinue to work remotely on developing better

coronavirus. The concept of delayering and blurring of

methodologies and more comprehensive data analysis,ranks and specialty practice is very much advocated.

and focus on touching up of grant applications andmanuscripts.

Figure 2a. Staff in full PPE: N95 mask, goggles,
Senior staff members together with the junior ones aresplash-proof disposable gown, surgical cap,covered shoes and latex gloves.

20

Figure 2b. PAPR

15

assigned to assist and work alongside colleagues from21

COVID-19

www.ifssh.info

COVID-19

May 2020*Communications

SURGERIES

with touch-screen devices. These machines andbe emphasized and discussed with patients,

Daily updates from the Ministry of Health, Singapore*Pre-operative Carethe HEPA filter undergo regular disinfection andespecially in chronic and benign cases where(MOH) guidelines as well as hospital routine

Non-urgent elective surgeries requiring overnight

maintenance checks. The number of staff involved intiming is not of critical essence such as

instructions are made available via electronic means

hospitalisation have been postponed. This is to free upsuch surgeries are limited to reduce the risk of cross-degenerative joint diseases, repetitive strain

and circulated to all staff. Help is made available formore beds within the hospital for treatment of patients

infection. All surgeons are required to wear full PPE

injuries, stable deformities and uncomplicatedstaff suffering from anxiety and burnout.

with suspected or diagnosed COVID-19 if required.

with PAPRs. Local or regional anaesthesia is preferredclosed fractures, etc.

Day surgery, trauma, infection and tumour surgery

over general anaesthesia as this reduces the potential

Face-to-face in-person communication and large groupprocedures are allowed to continue, though surgeonsof generating aerosols.

meetings have been suspended since late January

are advised to keep the number at a maximum of 2

when the first case of COVID-19 in Singapore wascases per list.

announced. Weekly business meetings and education

OUTPATIENT CLINICS
Clinic numbers were reduced as far as possible*Post-operative Careto minimize risk of patients developing COVID-19

Post-operative recovery is conducted in the same

infection from visiting the hospital. Patients with non-sessions are held via an online tele-conferencing

Time-sensitive elective surgery patients are called

operating theatre instead of the usual post-anaesthetic

urgent appointments (for both follow up cases and new

platform.

a day before surgery and screened for respiratory

care unit (PACU). All the surfaces of machines withinreferrals) were rescheduled to a later date and informed

symptoms or positive travel history. If they have either

the theatre are cleaned with ammonium chloride

accordingly. Consultation via teleconferencing*Infection Prevention Measuresof the above, the surgery will be postponed. Patientsdisinfectant wipes and non-single-use instruments

platforms has been considered, especially for patients

Staff have been advised to defer all travel as per thewho present in the emergency setting are screened onsent for decontamination and autoclaving. The

with chronic and stable conditions. Medical indemnity

MOH guidelines . Staff who had returned from affectedarrival and those who fulfil the criteria for suspected

operating theatre is then cleaned with sodium

companies have been supportive in providing coverageoverseas destinations prior to the guideline were

COVID-19 infection are immediately referred to the

hypochlorite 1000ppm and treated with hydrogenfor doctors in such unprecedented times withinplaced on a 14-day leave of absence (LOA) and advised

Infectious Disease (ID) department on call team andperoxide vaporization or ultraviolet-C irradiation .

reasonable circumstances.

to monitor themselves for symptoms while at home.

tested for the virus via nasal swabbing. These patients

However, this also increases the turnover time between

All patients who attend the outpatient clinic undergo a

are admitted to the isolation ward and co-managed

cases.

basic screening at the entrance. This entails measuring

16

17

their temperature with a thermal scanner and asking

Temperatures are measured twice daily and recordedwith the ID team. If it is possible to delay the operation

online. Staff who develop a fever or any acutewithout compromising on patient care, surgery should*Changes to surgical practicethem for a declaration of risk factors (travel history,

respiratory symptoms are advised to seek treatment at

be adjourned until results of 2 viral nasal swabs (done1.

Anaesthesia: The fact that perioperative pain

contact history and/or respiratory symptoms). Febrile

the staff clinic.

24 hours apart) are negative. However, any patientmanagement in most of hand surgery cases canpatients are referred directly to the ED while patientsrequiring immediate surgery will be operated on

be managed under regional and local anaesthesia

with risk factor(s) are transferred to the isolation room

Staff who have cared for patients with COVID-19, werewith necessary precautions as described below. Thisand nerve blocks together with the advent andwhere outpatient consultation, wound management

required to continue with their clinical work with asituation has only occurred once to date with one of

popularity of Wide-Awake Local Anaesthesia

and application of splints or casts take place. Staff who

surgical mask and monitor themselves for symptoms.

our patients who needed emergency surgery for early

Without Tourniquet (WALANT) in recent years,

see patients in the isolation room are required to wear

If inadequate PPE was worn, they will be evaluated bynecrotizing fasciitis and had a recent history of travelsuch hand surgery cases, emergency or elective,

full PPE and the room is decontaminated after use.

an infectious disease (ID) specialist for infection risk.

to a country where COVID-19 cases are prevalent.

can be operated without the requirement ofventilators or anesthetist support. This frees up the

CONCLUSION

Subsequent management is planned in accordance*Peri-operative Careventilators and anaesthetist involvement, which

Modification of workflows in multiple areas iswith the MOH guidelines for healthcare workers

Suspected or diagnosed COVID-19 patients areare precious and scarce resources/expertise in thenecessary to prepare for the ongoing COVID-19

exposure to COVID-19; if the staff was in close contact

transported with a surgical face mask to the operating

treatment of severe cases of COVID-19.

pandemic. All these measures implemented aim towith the patient they are issued with a Quarantine

theatre along a designated route to minimise contact

Reduction of operative time and theatre usage:

minimize contact between the possible sources ofOrder for 14 days while casual contacts are followed up

with others. A separate operating theatre complex

Use of implants under normal circumstances

COVID-19 and the surrounding environment, whilewith phone surveillance monitoring.

with a High-Efficiency Particular Air (HEPA) filter ismay be altered, e.g. plate fixation of fractures may

at the same time ensure that patient care remains

assigned for surgery to be performed on suspected

make way for pins and wires under these times toa priority. This will reduce the risk of transmission

or diagnosed COVID-19 patients. Single-use andminimize operating time usage and exposure of

between these infective sources and other patientsdisposable equipment are utilized as much as possible.

patients to prolonged surgical times.

or healthcare professionals involved in patient care,

Consideration of conservative and non-surgicaland eventually help to control the spread of infection

management of cases: Such alternatives should

across the hospital and the country.

The surfaces of intraoperative monitoring machines
are covered with plastic wrap and charting is done

22

2.

3.

23

COVID-19

www.ifssh.info

REFERENCES

sg/news-highlights/details/circuit-breaker-to-

1.

minimise-further-spread-of-covid-19

2.

Report of clustering pneumonia of unknown
etiology in Wuhan City. Wuhan Municipal Health

10. Du Y, Tu L, Zhu P et al. Clinical Features of 85 Fatal

Commission, 2019. Available from URL: http://wjw.

Cases of COVID-19 from Wuhan: A Retrospective

wuhan.gov.cn/front/web/showDetail/2019123108989

Observational Study. Am J Respir Crit Care

World Health Organization. Statement on theMed. Published online 3 April 2020. Doi: 10.1164/

second meeting of the International Healthrccm.202003-0543OC

Regulations (2005) Emergency Committee

3.

COVID-19 in Elderly Patients: A Comparison with(2019-nCoV). Available from URL: https://www.

Young and Middle-Aged Patients. J Infect 2020. Doi:

who.int/news-room/ detail/30-01-2020-statement-

10.1016/j.jinf.2020.03.005
Singapore is locally transmitted: What we know

regarding- the-outbreak-of-novel-coronavirus-

about every single case so far. Accessed April 2020(2019-ncov)

from https://www.straitstimes.com/singapore/

World Health Organisation. WHO Director-General’shealth/novel-coronavirus-cases-in-singapore
cases in Singapore, links found between Mustafa

who.int/dg/speeches/detail/who-director-general-

Centre and clusters in foreign worker dormitories.

s-opening-remarks-at-the-media-briefing-on-

Accessed April 2020 from https://www.straitstimes.

covid-19---11-march-2020com/singapore/record-287-new-covid-19-cases-in-raised to DORSCON Orange. 7 Feb 2020. Accessed

6.

7.

spore-links-found-between-mustafa-centre-andclusters-in

April 2020. Available from URL: https://www.moh.

14. 3M Technical Bulletin. Comparison of FFP2, KN95,

gov.sg/news-highlights/details/risk-assessment-

and N95 and Other Filtering Facepiece Respiratory

raised-to-dorscon-orange

Classes. January 2020, Revision 2.

World Health Organization. Coronavirus disease

15. 3M Powered & Supplied Air Respiratory Protection.

2019 (COVID-19) Situation Report – 82. 11 April 2020.

Available from URL: https://www.3m.com/3M/

Centers for Disease Control and Prevention. How

en_US/company-us/all-3m-products/~/All-

COVID-19 spreads. Available from URL: https://

3M-Products/Safety/Personal-Safety/Personal-

www.cdc.gov/coronavirus/2019-ncov/about/Protective-Equipment/Powered-Supplied-Air-Respitransmission.html (accessed April 2020).

rators/?N=5002385+8709322+8711017+8711405+8720

Bai Y, Yao L, Wei T. Presumed Asymptomatic Carrier

539+8720547+3294857497&rt=r3

Transmission of COVID-19. JAMA. Published online
8.

13. The Straits Times. Record 287 new Covid-19– 11 March 2020. Available from URL: https://www.

4. Singapore Ministry of Health. Risk assessment

5.

12. The Straits Times. 1 in 2 coronavirus cases inhealth-regulations-(2005)-emergency-committee-

opening remarks at the media briefing on COVID-19

16. Ministry of Health Singapore. Public Health Travel

February 21, 2020. Doi:10.1001/jama.2020.2565

Advisory (Updated 18 Mar 2020). Accessed April

Hu Z, Song C, Xu C et al. Clinical Characteristics

2020 from https://www.moh.gov.sg/covid-19

of 24 Asymptomatic Infections With COVID-19

17. Wong J, Goh QY, Tan Z et al. Preparing for a

Screened Among Close Contacts in Nanjing, China.

COVID-19 pandemic: a review of operating outbreak

Sci China Life Sci. Published 4 Mar 2020. Doi:

response measures in a large tertiary hospital in

10.1007/s11427-020-1661-4

Singapore. Can J Anesth 2020. Doi: 10.1007/s12630-

9. Ministry of Health Singapore. Circuit Breaker to

ADVERTISMENT

11. Liu K, Chen Y, Lin R, Han K. Clinical Features ofregarding the outbreak of novel coronavirus

on-the-second-meeting-of-the-international-

May 2020

020-01620-9

minimise further spread of COVID-19. 3 April 2020.
Accessed April 2020 from https://www.moh.gov.

24

25

CONGRESS REPORT

www.ifssh.info

CONGRESS REPORTMay 2020

AN UPDATE ON THE DEVELOPMENTS FOR THE LONDONIFSSH&IFSHT
Congress 2022

Preparations are continuing apace for the 2022 IFSSH/

venue for 2022) while extensive refurbishments are

IFSHT congress in London. Anticipation is building andbeing carried out at the Palace of Westminster.

we are getting very excited about it! This article is tobring you the latest news and developments from this.

The move is planned for 2025 but the QEII will becommandeered for preparatory work from 2022. They

The most important thing to let you know about is awere running behind schedule and the likelihoodchange of venue and also a change of date….

is that this will not happen, but it remained apossibility. When I first learned of this early last year,

We learned last year that there was a possibility of the

I provisionally booked an alternative venue at theHouse of Lords, which is the upper house of the UK

ExCeL Centre, which is situated in the Docklands, East

Parliament, decanting into the QEII centre (our booked

London.

Despite the projected schedule delay, the CEO at QEII

venue with easily enough space to accommodate 4000

was not able to secure an assurance from government

delegates, or more if necessary (QEII would have beenministers that the QEII venue would be available forcapped at a maximum of 2500). Unlike QEII, it can

2022. Our deadline for a decision was 31 January 2020.

provide a vast central space for industry.

We could not afford to take the chance of being left
without a venue and so we have decided to move theAccommodation for delegates in the vicinity of ExCeL

Congress to the ExCeL Centre.

is plentiful and will be less expensive than in central
London. If delegates decide that they would prefer toThis will entail a change of date to earlier in June. The

stay in central London, then transport options fromvenue is booked for 5 - 11 June 2022, with the Congress

the centre to ExCeL are good. There is the Docklands

proper running 6 – 10 June 2022. Fortunately, this will

Light Railway (DLR) and also an underground tube

not conflict with the proposed dates for EFFORT.

connection, due to be completed next year. If people

ExCeL https://www.excel.london , which is situatedwant to take a particularly scenic route then there arein the London Docklands, was one of the venues forriver boats departing from major London piers every 20

the 2012 London Olympics. It has several significant

minutes https://www.thamesclippers.com/route-time-functional advantages. ExCeL has a more horizontal

table.

footprint than QEII and so will be much more easily
navigable during the Congress. It is a much bigger

26

All in all, we see this as a very positive development.

27

CONGRESS REPORT

www.ifssh.info

We have engaged the services of Asszisztencia, abeing developed and there are several pages yet to becompany based in Budapest, to help us organise andwritten. Some of it still needs to be updated to reflect

run the Congress. I have had experience in dealing

the move from QEII to ExCeL, but it should be a usefulwith Asszisztencia over the last few years during mysource of information.

May 2020

CONGRESSADVERTISMENTREPORTtime on FESSH Council and I have found them to beinvariably extremely competent and efficient. They will

Finally, we were due to carry out a detailed site visit

be a great asset.

to ExCeL in mid-May, but with the advent of COVID-19
this will be delayed. As I write this, there have been“over 1000 deaths from COVID-19 in one day in the UK.

The most
important thing to
let you know about
is a change of venue
and also a change ofdate….

”

After the successful meeting in Berlin and with the

The ExCeL centre has now been converted into theworld’s largest field hospital to accommodate 4000 of
the critically ill. It was constructed in less than two
weeks and the first patients have just been admitted
there. In 2022, when the world has recovered, we will
hopefully be able to look back upon this dreadfulchapter in history and reflect on it. The ExCeL may be
an apt and appropriate venue for this.
We look forward to welcoming you to London in 2022…
Best wishes and stay safe!
David Shewring
Chair, Organising Committee IFSSH&IFSHT 2022

Congress being held for a consecutive time in Europe,
there will be an inevitable impact on FESSH. This
Congress will therefore be a combined meeting with
FESSH XXVII. We will be providing facilities for allof the requirements of FESSH, including the EBHS
Diploma examination.
The programme for the Congress is starting totake shape. The programme committee, led by
Jonathan Hobby and assisted by Wee Lam, includes
representatives from all of the world’s continents.
There will be a core series of instructional lectures,the topic for which is Tendon Disorders of the Hand
and Wrist and we have a publishing deal with Thiemeto produce an accompanying book, which will be
included in the registration fee for surgeons.
The website for IFSSH/IFSHT 2022 is up and runninghttps://www.ifssh-ifsht2022.co.uk . It is constantly

28

29

PIONEER PROFILES

www.ifssh.info

PIONEER PROFILES

May 2020

Takayuki Miura

Ronald L. LinscheidJapan (1930-2020)

United States of America (1929 – 2012)

Takayuki Miura was born in the Mie Prefecture, Japan on 26 February 1930.

Ronald L. Linscheid was born on 14 June 1929 in Hutchinson, Kansas, USA.

He graduated from the Nagoya University School of Medicine in 1955 andHe completed his Orthopaedic residency at the Mayo Clinic in 1962. His

joined the Department of Orthopaedic Surgery the next year. In 1961 hementor Dr. Paul Lipscomb arranged a Hand Training Fellowship with Dr.

became Chief Resident in the same Department, and in 1967 Chief of theJoseph H. Boyes in Los Angeles California, after which he returned to join the

Orthopaedic Department of the Kariya Toyota Hospital. The next year hestaff of the Department of Orthopaedic Surgery at the Mayo Clinic.

was promoted to Assistant Professor at the Nagoya University School of
Medicine, followed by Associate Professor in 1983 and later in the same year

In 1967 Dr. James H Dobyns and he formed a clinical hand unit within thefull Professor for the next 10 years. Professor Miura was granted Emeritus

Orthopaedic Department. They collaborated on a number of clinical inquiries,

Professor status in 1993, and promoted to Director of the Health Centre at themost particularly on disorders of the wrist. This included descriptions of

Chukyo University.

scapholunate and lunatotriquetral dissociations, ulnar translations, scaphoid
fracture deformation, Kienbock’s disease, carpal instability nondissociative,

In 1989 Miura became President of the Japanese Orthopaedic Association,scaphotrapezial deformities and other carpal fractures and sprains.

and later Honorary Member of both the Japanese Orthopaedic Association

Interest in these entities helped to initiate the formation of the Orthopaedic

and the Japanese Society for Surgery of the Hand . In 1988 Prof Miura

Biomechanics Laboratory in 1969.

presided over the 31st Annual Meeting of the Japanese Society for Surgery of the Hand, and in 1990 over the 63rd
Annual Meeting of the Japanese Orthopaedic Association.

The awarding of several NIH grants to study hand function with Dr. E.Y. Chao led to an early mathematical modelof the hand and subsequent studies on quantitative description of intrinsic muscle, scaphoid fracture mechanics,

He has a long list of publications which cover a wide variety of subjects. His main interest however was articles

forces acting at the trapeziometacarpal joint, kinematics of the carpus, kinematics of the distal radioulnar joint

on Congenital Differences which included the management of syndactyly, triphalangeal thumb, skin cover of theand its ligamentous constraints. An early interest in the pathophysiology of rheumatoid deformity extended toinjured hand, duplicated thumb, symbrachydactyly and the cleft hand.

the design and clinical testing of arthroplastic procedures in the hand, wrist and elbow. Later interests include
anthropology and the hand in human evolution.

Takayuki was married to Naoko. He died on 1 February 2020 a few weeks before his 90th birthday.
A member of many societies he has held officer and committee positions, among the most prestigious being the
At the 8th International Congress of the IFSSH in Istanbul, Turkey in June 2001, Takayuki Miura was honored as

President of the American Society for Surgery of the Hand 1989-1990. Honors include the Kappa Delta Award“Pioneer of Hand Surgery”.

1984 for “Biomechanics of the Hand”, Emanuel B. Kaplan Award 1986 for “Intrinsic Musculature of the Hand”,
1st ASSH Distinguished Hand Lectureship, 1987, 1st Herbert H. Stark Memorial lectureship 1992, Distinguished
Mayo Clinician Award 1992, and Richard J Smith Lecture ASSH Annual Meeting 2000. He has an extensive
bibliography.
Ronald and his wife Carol raised six children. Other interests included aviation, drawing, sculpture, tennis, golf
and skiing. He passed away on 10 June 2012.
Ronald L. Linscheid was honoured by the IFSSH as “Pioneer of Hand Surgery” at it’s Eighth Congress inIstanbul,
Turkey on 10 June 2001.

30

31

SPECIAL FEATURE

www.ifssh.info

Consensus Wrist
Index Tool:
GAINING A COMPREHENSIVE PICTURE OF THE
PATIENT’S FUNCTION AND PERSPECTIVE.
As providers of health care, and specifically care for

effectively measure/evaluate outcomes of treatment.

conditions of the hand, wrist and upper extremity,

This will allow us to judge our own results and to

we strive to deliver appropriate treatment for thedecide what is adequate and appropriate. In handpatient’s condition in general but also tailored for theconditions, despite its evident importance, thespecific needs and expectations of each patient. Withability to correctly evaluate outcomes has remained

the continuous advance of therapeutic and diagnostic

incomplete. This is due to the complexity of hand andmedicine on one hand and the economic consequences

especially wrist anatomy, mechanics, and the wideof these developments on the other hand, as we believe

range of functional tasks and treatment options used,

we should, delivering care has become increasingly

including conservative and surgical alternatives.

SPECIAL FEATURE

May 2020

widely used. Such a tool will enable not only a better

create a comprehensive picture of the patients status.

understanding of outcomes but will also allow better

It is a core testing tool for wrist conditions that willcommunication and true comparison between different

likely need the addition of a supplement tool forprocedures and interventions.

specific conditions.

We have initiated an effort to establish a consensus

A preliminary trial was performed in multiple centerswrist index tool that will be detailed and specific to thewith the purpose of refining the tool in June 2019 andpatient but will also be standardized and easy to apply

presented at the 14th IFSSH and 11th IFSHT Triennial

allowing for comparison and evaluation of outcomes.

Congress in Berlin. The measurements are uploaded

An international, multidisciplinary forum of experts

to an excel file, which provides a “spider diagram” ofin this field (including hand surgeons, hand therapists

the patient’s objective and subjective results at three

and clinical trial specialists) met in 2018 (Table 1) andpoints in time. This is similar to the disc-o-gram

reached a consensus for an outcome evaluation tool.

introduced by Mennen (2004). Other tools for wrist
evaluation have been suggested (Herzberg et al. 2018).
However, this tool based on the diagram is unique inTable 1: List of participating expertsthat it gives equal weight to the clinician’s findings andpatient’s perspective.

Participants

Country

Marianne Arner

SwedenMD, Prof

Vera Beckmann

Switzerland

PT, MME

Sarah Ewald		

Switzerland

OT, MA Ed

Liesbeth Hemelaers

Switzerland

OT, PT, MSc

Currently utilized functional evaluations may lack

Johanna Ismaier

Germany

OT

Currently, this has become one of the major challenges

the ability to adequately measure what is needed andfacing our profession and is a problem across the

may not be sensitive enough to determine significant

Patrici Kammermann

Switzerland

OT

board in all specialties and all countries. We deal withdifferences when comparing treatment regimens. In

Joy MacDermid

CanadaPT, PhDconstantly increasing pressure and oversight fromaddition, the availability of a wide array of functional

Miriam Marks

Switzerland

PT, PhDbodies that do not understand our profession and havetests each testing a different specific function makes it

Sarah Mee		UK

OT, MSc

motion measurements of the wrist and forearm,no interest in quality of care. It is unclear how to pushdifficult to compare results of different studies. Patient

Brigitte Sparl

Austria

OT, MScgrip strength measurements with wrist in neutral,back on these issues in an efficient manner.

report versus performance has become standard

Frederik Schuind

Belgium

MD, Profsupination and pronation.

Andreas Schweizer

Switzerland

MD, Prof

Ruud Selles		

Netherlands

Researcher

Belgium

PT PhD, Profdifficult.

practice in many settings. Commonly used measures

Very preliminary data suggests that this tool may
provide improved patient specific data, but may needsome modification to be used for comparison or
standardization
How this is used in practice is illustrated in thefollowing example: a 60 year old male with a distal
radius fracture is evaluated eight weeks post injury,
the following evaluations are performed: range ofWe believe that we need to document the quality of ourallow us to evaluate and compare a specific outcome

care even more robustly by integrating a standardized

such as grip strength or range of motion or theapproach by measuring outcome into our daily

patient’s perception of his or her function, but a global

Jean-louis Thonnard

practice. One way to do this is to acquire consensus

picture of the outcome that combines these factors andLucelle van de Ven-Stevens Netherlands

OT / PhD

the patient specific functional scale (PSFS) (Stratford

data, in order to evaluate the quality of the offered

incorporates a functional measure remains elusive.

Esther Vögelin

Switzerland

MD, Prof

et al. 1995), which asks the patient to identify and rate

Daniel Weber

SwitzerlandMD

three tasks that are important to them. A more global

Ronit Wollstein

USA

MD, Prof

treatment and to develop guidelines that reflect the

The patient ‘s perspective is gathered through the useof defined interview questions: the Single Answer
Numeric Evaluation (SANE) (Williams et al. 2000), andcurrent state of the art, combining evidence-based

Furthermore, some tests are not applicable in the

research with the clinical perspective. It is much better

setting of a private clinic or busy academic center.

to be judged according to standards that are accepted

Many of these take time and may be too expensive

The tool is comprised of previously validated tests,2019) . The patient is asked to complete the PRWHE

and relevant to providing appropriate treatment thanto administer. A comprehensive and detailed

including patient related outcome measures (PROMs)

questionnaire and the Michigan Hand Questionnaire

by economic or political standards.

standardized functional evaluation will need to be

and objective clinical measurements. The data fromwork module (5 Questions) (Chung et al. 1998). ThisAs an initial step in this process we should be able toeasily applicable in any clinical setting, in order to be

the measurements is inserted into an excel file toentire process is completed in 15 minutes or less.

32

picture is gained with the Patient Rated Wrist and
Hand Evaluation (PRWHE) (Macdermid et al. 1998,

33

SPECIAL FEATURE

www.ifssh.info

SPECIAL FEATURE

May 2020

activities are a priority for him. Overall, the patient

Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy

has rated his hand function as 35% of normal. As

Canada, 1995;47:258-263.

treatment progresses, measurements are repeated.

•

The interval between measurements is defined by theclinician. The Consensus Wrist Index Tool as seen in

evaluation method and the Lysholm score. Clin Orthop Relat Res 2000;373:184-192•

Figure 1 compares these same data points over time:
12 weeks (yellow) and 20 weeks (green). At 20 weeks

MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: A
reliable and valid measurement tool. J Orthop Trauma. 1998;12:577e586.

•

all parameters show improvement and the patient has
rated his hand function as 85% of normal.

Williams GN, Taylor DC, Gangel TJ, Uhorchak JM, Arciero RA. Comparison of the single assessment numeric

MacDermid, J. C. (2019). The PRWE/PRWHE update. Journal of Hand Therapy, 32(2), 292–294. doi: 10.1016/j.
jht.2019.01.001•

Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand
Outcomes Questionnaire. J Hand Surg Am. 1998 Jul;23(4):575–87.

In our experience thus far, the utilization of the CWIT
tool is appreciated by patients and has provided
the clinician with more insight into the patient’s
challenges and perspective.
Figure 1: Consensus Wrist Index Tool (CWIT): thelarger the circle the greater the function and well-

We are now in the midst of a study to assessbeing of the patient. The smaller the circle, thethe applicability of this proposed CWIT tool. We

poorer the function and well-being of the patient.

hypothesize, that patients and therapists/surgeons

Shown above with data from three different points

administering the evaluation tool in the different

in time, data points on the left are objective

clinical settings will find that it is:measurements: wrist range of motion and grip
strength. On the right the lines on the spider plot

1) Easy and economical to administer

represent patient rated outcome measurements.

2) Will reflect true patient outcome
Though this is a work in progress, this is a first step inEsther Vögelin MD, Prof,

Ronit Wollstein MD Prof,

Sarah G. Ewald OT, MA Ed

The clinician then requires 5 minutes to enter thewhat we see as a critical effort to preserve our ability toesther.voegelin@insel.ch,ronitwollstein@gmail.com,

sgewald@city-handtherapie.chmeasurements into the Consensus Wrist Index Tool

treat hand patients accurately and adequately.

(CWIT), which is an excel file. The tool calculates therange of motion and grip strength ratios between the

We welcome any comments regarding our approachaffected and healthy hands, as well as the scores forand plan to update the community in June 2020.

the interview questions and patient rated outcome
measures. This initial data is automatically plotted

Referencesin red on the “spider diagram” (Figure 1) and provides•

Vögelin E, Wollstein R, Ewald SG. A Single Score as

both the clinician and the patient with a picture of his

a Comprehensive Outcome Measure for the Wrist.

or her situation. In this case, the patient and clinician

Presentation at 14th IFSSH & 11th IFSHT Triennial

note that range of motion is limited primarily inCongress in Berlin. Abstract no.: IFSSH19-1640

extension and flexion; all other areas are recovering•

Herzberg G, Burnier M, Nakamura T. A new Wrist

quite well. Grip strength overall is 50% of the healthy

Clinical Evaluation Score. J Wrist Surg 2018;7:109–

hand and is particularly reduced when the wrist

114.

is pronated (see wrist index diagram above). The•

Mennen U. Arthrogryposis multiplex congenita:

clinician learns that the patient primarily has pain

functional classification and the AMC disc-o-gram.

when he tries to work in his garden and use a saw,

J Hand Surg Br. 2004 Aug;29(4):363-7.

that he is not able to open jars or play tennis, these34•

Stratford, P., Gill, C., Westaway, M., & Binkley, J.

35

HAND THERAPY

www.ifssh.info

AN ALTERNATIVE MANAGEMENT APPROACH TO
THE TREATMENT OF COMPLEX PHALANGEALFRACTURES:

The Poole Finger
Traction Splint
A NON- INVASIVE SPLINTING SYSTEM
Background

HAND THERAPYMay 2020

with the MCPs in flexion to offload the interossei
whose forces are pulling the proximal fragment into
flexion and the distal fragment into extension. In
contrast a comminuted pilon fracture may be splinted
with the digit in extension in order to optimise theligamentotaxis effects. Critical to the ligamentotaxis
effect is the stabilisation of the digit proximallyby applying a non-elastic tape across the proximal
phalanx.
The traction is achieved by attaching a theraband strip
from a frame that extends beyond the end of the digit
Fig 2. The Original PFTS

to the nail which has a dressing hook attached to itwith superglue. Our learning from early experiences ofA case series of 54 patients with 39% extra articular

the splint prompted the addition of zinc oxide tape overand 60% intra articular fractures enabled the collection

the hooks base which distributes the forces away fromof outcome data. A mean TAM of 220 degrees was

the nail bed which, without it can cause nail avulsion,

demonstrated, which according to ASSH criteria

especially in cases where there is severe comminution
or shortening where more traction is required. (Fig.3).

The management of acute complex phalangeal

Fig 1. In the clinical application the proximal portion

represents a good outcome. There were no statisticallyfractures present a challenge to both the surgeon andis fixed at point A, traction makes point B movesignificant differences between intra and extra

therapist as they are commonly unstable and difficult

distally, points C & D converge and move away fromarticular fractures or those in the middle or proximal

Traction tension is set by assessing pain with passive

to treat. Several treatment options are available to thepoint A. If the capsulo-ligamentous and tendon

phalanges. In 2010 a MSc dissertation examined the

motion, in general when traction is sufficient more

surgeon ranging from k-wires, screws and plates tostructures are analogous to the horizontal lines

feasibility of non- invasive traction in the context of all

motion is afforded with less pain, and the effect isvarious forms of traction. Many of these methods havethey apply a vice like compression to whatever lies

other forms of traction in use. (Bradley 2010).

immediate. This is a pragmatic simple method thatthe potential also to deliver complications such as

between them, e.g. dorsally displaced fragments,

post-operative stiffness, pain and infection.

and the joint space is widened.

requires no complex measuring system or an x-ray toThis integrative review of the literature concluded that

evaluate fracture reduction. In general blue therabandthe PFTS was able to provide comparable outcomes

is now used as this allows for adequate traction tension

Traction is often favoured as a treatment option as it

and in some cases superior outcomes to other forms of

without fatiguing too quickly between appointments.

uses the principle of ligamentotaxis which involves

invasive traction commonly in use. Traction systems

Any digit including the thumb and multiple digits can

the application of distal traction to the digit that allows

in general are best suited to pilon type fractures though

be managed effectively in this system. (Fig.4).

both the reduction of articular fragments and thewe have used them successfully in spiral, oblique andrealignment of joint surfaces by providing tension oncomminuted fractures in both the proximal or middle

their ligamentous and volar plate attachments (Schenk

phalanges. Our experience as therapists with close

1994), see Fig. 1.

collaboration of our surgical colleagues has led to achange in pathway in complex phalangeal fracture

The Poole Finger traction splint (PFTS) evolved in 2002

management which is now therapy led.

out of a clinical challenge of a highly comminuted baseof middle phalanx fracture that was not conducive toSplint principles

surgical reduction. The task of stabilising the fracture

The splint base is made of a thermoplastic that must

was delegated to the hand therapy service; the 1stneed for early mobilisation whilst maintaining fracture

be drapeable, e.g. orfit colours, tailorsplint. The splint

Poole traction splint was created and applied to thestability; there were other forms of non-invasive

base is moulded according to the characteristics ofpatient, with a successful outcome (Fig. 2). A literature

traction already in use at that time but none allowed

the fracture pattern, e.g. a dorsally angulated proximal

Fig 3. A hook is superglued to the nail andreview on traction methods strongly supported thefor mobilisation, so this was prioritised.

phalanx fracture that is shortened would be splinted

reinforced with zink oxide tape36

37

HAND THERAPY

www.ifssh.info

HAND THERAPYMay 2020

assisted motion is assessed, if this is manageable with

The work of the Poole Hospital Hand therapy team has

no significant increase in pain then this is started inbeen shared at national conferences in the UK, andorder to get some tendon glide over the fracture site.

internationally at the IFSHT Argentina 2015 and Berlin

The patient will attend weekly and maintain the splint

2019 Congresses. The next step is to undertake further

for 3-4 weeks, specifically until clinical healing has

research to facilitate further national and internationaltaken place. Thereafter usual hand therapy treatment

adoption.

approaches are used to address any residual ROM andfunction deficits.

References:
Schenk RR. The Dynamic Traction Method –Fig 6. The original fracture, lateral and b) In

combining movement and traction for intra-articular

traction. Full anatomical reduction of the fracture

fractures of the phalanges. HandClinics. 1994b; 10: 187-

is not always seen on the Xray in traction, however

198.

functional ability improved significantly
Bradley S (2010) The feasibility of using non invasive
Other benefits noted have been the rapid reduction in

splinting methods for the management of complex

oedema, rarely are oedema management modalities

phalangeal fractures: an integrative review of theused in combination with the splint. The biggest

literature. MSc Dissertation University of Derby

benefit is clearly that the patient is spared an operationand there have been significant cost savings.
Fig 4. An example of the PFTS applied to 3 digits
The Future
The exercise regime (Fig.5).

In 2015 The PFTS was recognised in the UK healthcare

In the first week the patient bends the wire passively

system having won an innovations grant which has

flexing and extending the finger within a comfortableenabled the development of a training programme torange. This is repeated 10x every hour. It can be

Fig 5. The exercise regime

modified according to the individual’s response. On

disseminate the PFTS into the NHS throughout the UK.
The system has been adopted by seven NHS Trusts tooccasion no movement has been instigated where

What have we learnt?

date. It has also been recognised by Health Education

the fracture is highly unstable or pain is prohibitive,

The journey so far has delivered some unexpected

England, who awarded me a NHS Shine award forthough this is rare. Pain relief in general is immediate.

findings. We have consistently found there to be ainnovation.

The splint remains in situ 24/7 in order to maintainradiological mismatch to function. It has taken sometension through healing. An x-ray is taken at thetime to develop confidence to trust in the functional

return visit at the beginning of week 2 to assess

outcomes versus the radiographic findings. In a case

Sarah Bradley

fracture position in the PFTS. The decision to continue

example below of a 17 year old boy who injured his

MSc (Hand Therapy Derby), DipCOT

with treatment is made however based on clinicalthumb playing rugby the traction was applied within 1

Advanced Occupational Therapist in Hand Therapy

presentation.

week post fracture.

Poole Hospital, NHS Foundation Trust,
United Kingdom

In the main patients report a reduction in pain,

His fracture can be seen in Fig.6. He had 5 treatments

increase in ROM and a reduction in swelling. Whenin total. He recovered a pain free ROM as follows: MCP

they return at week 2 the splint traction is replaced; it

2-48, IPJ 10-70. A Kapandji score of 9 was achieved,

will be too long where the band has slackened form thePower grip was 100% and a tripod pinch 73% of theincrease in digit length and will fatigue a little fromcontralateral hand. QDASH score was 0 as assessed at 6

the exercise. Their hand is cleaned briefly and a cotton

weeks post fracture.

liner renewed. Then the patient’s comfort with active

38

sarah.bradley@poole.nhs.uk

Fig 7. Examples of the Poole Finger Traction Splint39

www.ifssh.info

www.ifsht.org

info@ifsht.org

VOL 14 NO 2 | MAR 2020

SPOTLIGHT ON ISRAEL SOCIETY
OF HAND THERAPYIN MEMORIAM

ART

May 2020

Art Exibit # 11

EVELYN MACKIN 1922 - 2020

The Israel Society of Hand Therapy was established in
1987 and proudly hosted the first International Congress of the IFSHT in Tel Aviv, Israel in 1989. In 2013
the society was re-established as a society under the
auspices of The Israel Society for Surgery of the Hand.
The society actively participates in an annual conference and an upper limb seminar presented by the Israel Society for Surgery of the Hand. In 2020 the seminar was presented by Yafi Levanon and Ayala Nota
(topic: shoulder rehabilitation). The Israel Society ofHand Therapy hosts annual one or two day, well attended
workshops.
International
speakers areinvitedto these
eventsand tod a t et h e yCurrent leaders of the Israel Society of Hand Therapy
h a v eincluded Debbie Schwartz, Carolyn and Katherine
Schofield (topic: splinting), Wim Brandsma (topic:
biomechanics), Vivian Dim (topic: Manual Edema Mobilization), Aviva Wolff (topic: the elbow and treatment of pain) and Margaret Persson (topic: functional
anatomy). A large group of Israeli delegates participated at the past IFSSH/IFSHT congress in Berlin,presenting their work.

IFSHT announces thepassing of its founderand first president (198692):
EvelynMackin,PT, February 2020 inPennsylvania, USA. Ms.
Mackin created manyother worldwide educational
opportunities
for hand therapists that
continue today. She wasa founding member ofthe ASHT, first organizerof the Philadelphia Hand
Meeting, founder andfirst editor of the Journal of Hand Therapy (1987-98) and one of the first editors of the well-known text “Rehabilitation of the Hand
and Upper Extremity.” Her motto was: “Pass it on,” andshe lived this through her endless contributions in sharing hand therapy knowledge and skills worldwide. Ms.
Mackin was awarded the IFSHT Lifetime Achievement
Award at the most recent IFSHT Congress in Berlin in
2019.
IFSHT continues to recognize her many contributions
through the Evelyn Mackin Triennial Award, establishedin 2010, supporting therapists from developing countries to attend IFSHT Triennial Congresses. More information on her incredible achievements are at www.IFSHT.org.

FESSH-EFSHT CONFERENCEBASEL, SWITZERLAND

The Swiss Society for Hand Therapy is hosting the 13th
Congress of the European Federation for Societies
for Hand Therapy (EFSHT) in Basel, Switzerland, 3 – 6June 2020. This triennial combined congress will takeplace in conjunction with the Federation of European
Societies for Surgery of the Hand (FESSH).

2013 EVELYN MACKIN IFSHT TRIENNIAL AWARD RECIPIENTS in New Delhi, India; L to R:
Sokny Leang (Cambodia), Sumanta Ray (Bangladesh), Evelyn Mackin, Apsara Ghimire(Nepal), Yuting Zhang (China), and Kalyani Hemalatha (Sri-Lanka)

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

40 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|J u n e 6 -1 0 , 2 0 2 2| www. i f s s h - i f s h t 2 0 2 2 . co . u kWalking sticks - wood carvings

41

RESEARCH ROUND-UP

www.ifssh.info

Research Roundup

May 2020

What should all hand surgeons and hand therapists reading yourarticle understand about the findings of your research?
Bias may be present in our assessment if we do not take into accountthe methodological requirements related to reliability, validity andresponsiveness of our measurements. The paper explains those basic

THE METHODOLOGICAL REQUIREMENTS FOR
CLINICAL EXAMINATION AND PATIENT-REPORTEDOUTCOMES, AND HOW TO TEST THEM

concepts, and supplementary material is provided mainly for those

Roberto S Rosales and Isam Atroshi

research. We do peer-review for many journals, even journals not

Journal of Hand Surgery (European) November 2019, Vol45, issue1,
p12-18RESEARCH ROUND-UP

hand surgeons and therapists who have special interest in knowing
the mathematical basis for the proposed analyses.
Using the correct methodology is an important issue in clinicalrelated to hand surgery, and we often face, during the review process,papers with important data collected after a long follow-up, butwith a high risk of bias due to the methodological problems in the

Roberto S Rosales, MD, PhD.

measurement assessment.

Unit for Hand and MicroSurgery .GECOT. La Laguna,

What were your main reasons for writing thisWe thank the Editor Dr Michel Boeckstyns for

The concepts included in our paper can help the readers to better

Tenerife, Spain. titorosales@

article?

his ideas to simplify the mathematical concepts

plan their research and decrease the risk of bias in their methods.

telefonica.net

In January 2019, we received an invitation fromand reduce the length of the paper and for theAlso, they will assist hand surgeons and therapists in interpretingthe Editors of The Journal Hand Surgery (European

tremendous work in editing the manuscript.

the results of published studies in their field and assessing theirstrengths and limitations and judge whether the findings would

Volume), to contribute to a special issue focusing

impact current clinical practice.

on the topic of clinical measurement and task

This paper is based on the International

assessment of the hand. We were selected to write

Classification of Functioning, Disability and Healththis paper because of our previous contributions(ICF) developed by the World Health Organization

Will you be conducting further research on this topic? If so, whaton the subject of measurement of function of the(WHO), which classifies functional measures

will it entail?

hand, but the paper of course had to go through theinto body function and structure, activity, andWe have elaborated on some of these concepts in a work published instandard peer review process. We felt that it would

participation (WHO, 2013).

The Ibero-American Journal of Hand Surgery (Rosales RS, Atroshi I.

be a good opportunity to spread basic concepts

Basics of Statistics for Clinical Research in Hand Surgery.

related to measuring outcomes in hand surgery.

Traditionally, the measurements used in hand

For example, use of patient-reported outcomes

surgery have focused on body function and

Rev Iberam Cir Mano. 2018,46:141–16. https://www.thieme-connect.

measures has become increasingly important

structure, such as radiographs, strength measures,com/products/ejournals/pdf/10.1055/s-0038-1675587.pdf). We are also

in hand surgery and therefore knowledge about

range of motion (ROM), two-point discrimination,

working on a paper about the applications of those concepts in meta-

the correct methodology and interpretation is

etc. Measurements of activity and participation,

analysis.

important.

such as patient-completed health-evaluation

Department of Clinicalquestionnaires and patient-reported outcomes

Sciences, Lund University,

What are the most interesting/important results(PRO), are now frequently used in hand surgery,

Lund, and Orthopedics

and conclusions of your article?

both in clinical practice and research. The

Hässleholm-Kristianstad,Our aim was to explain to the hand surgery

assessment of any measurement for clinical

Hässleholm Hospital,

community basic but often difficult concepts

research in hand surgery is difficult. A method of

Hässleholm. Sweden.

related to information bias (reliability and validity)

measuring a criterion could be 100% reliable but

isam.atroshi@med.lu.se

and to responsiveness, in a brief and easy-to-read

100% invalid; and a so-called valid and reliable

manner.

measurement may not necessary present enoughIsam Atroshi, MD, PhD.

responsiveness for outcomes assessment.

42

43

MEMBER SOCIETY NEWSwww.ifssh.info

Member Society NewsMEMBER SOCIETY NEWSMay 2020

The members of the Society at the General Assembly(GA) had to be convinced by President Hug andthe Council of the need to promote the importanceof hand surgery, but it would also involved higher
membership fees! So far many positive feedbacks
have been received.

President Urs Hug hosted the Swiss 52th Annual

AMERICAN ASSOCIATION FOR
HAND SURGERY

Hand Surgery and 21st Hand Therapist Congress from

SWISS SOCIETY FOR SURGERY OF
THE HAND
The past year saw several international high-21 -22 November 2019 in Interlaken, at the foothills ofDuring this time of crisis and uncertainty that thethe Eiger, Mönch and Jungfrau mountains. Over 660

COVID-19 pandemic has caused, the American

participants attended the congress and shared their

Association for Hand Surgery hopes for the healthknowledge with surgeons, therapists and the industry.

and safety of all in the hand care community. While

The main topic of the congress was “Evidence

we know the world will overcome this situation, theversus Eminence”. Many interactive, well moderated

coronavirus has presented us with challenges thatsessions included international guests as well as

many never thought we would face in our lifetime,

Hand therapists to compare the evidence from theRelief of the Swiss Society Council after the GA andand we know our hand care community will be part

literature with the ideas of eminent and experienced

acceptance of the increase of member fees!

of a demanding recovery period once this crisis has
passed. It is important that we lean on one another for

Hand Surgeons.

standing congresses. During the 14th IFSSH / 11th

support to stay strong for our families, friends, and our

IFSHT Triennial Congress in Berlin from 17-19 Junepatients.

2019 many bridges were built hand in hand between
Surgeons and Therapist.

The audience in the conference hall in Interlaken(Gothic and Renaissance style of the 19th century)
The Swiss Society for Surgery of the Hand is presently
campaigning to meet the requirements (Core Surgical
From right to left: Oskar Aszmann, Leila Harhaus,

Curriculum) of the Swiss College of Surgeons. This

Berthold Bickert, Susan MackInnon, Esther Vögelin,campaign includes a number of difficulties, including

at the nerve transfers session

increasing the awareness and the importance
While some of us are spending more time at home dueof hand surgery among the public, politicians,
Another scientific highlight was the 74th Annual

insurance companies and national health system

Meeting of the American Society for Surgery of the

stakeholders. This lack of awareness is amongst

Hand (ASSH) held in Las Vegas. President Scott Levinother facts, reflected in the low fee structure for out-

invited Austria, Germany and Switzerland as guest

patient surgery procedures. The campaign is called

which is the AAHS Annual Meeting which will takecountries and many host lectures, laboratory sessions,“Handfacts” and more information is on the website:

place January 13-16, 2021 in Kauai, Hawaii. Dr. Nashseminars and workshops were held with international

www.handfacts.ch

Naam, IFSSH Pioneer of Hand Surgery (honored inguest speakers.

44

www.handfacts.ch

to lock down and cancelled surgeries, and others havebeen recruited to serve in the front lines to combat

Esther Vögelin, Stephan Schindele and Urs Hug

COVID-19, there is a bright spot that we can focus on2019), and his Program Chairs Drs. Julie Adams and45

MEMBER SOCIETY NEWSwww.ifssh.info

Mark Rekant along with Cynthia Ivy, OTR/L, CHT andI hope to see many of you in Kauai in January 2021. It

Vanessa Smith, PA-C are planning an outstanding

will be wonderful time to reconnect and look ahead toscientific program. The theme for this meeting is

the next 50 years of hand care education with AAHS.

“Educate, Energize, Empower: The Next 50 Years.” The
Program Committee is planning for our traditional

Stay safe, stay healthy, and stay strong.

MEMBER SOCIETY NEWSMay 2020

AMERICAN SOCIETY FORSURGERY OF THE HAND

ASSH is proud to provide Hand.e free to the public
as part of our mission to advance the science andpractice of hand and upper extremity surgery though

75th Annual Meeting of the American Society foreducation. Read more about ASSH’s mission andSurgery of the Hand (ASSH)

membership opportunities on our website, www.

scientific presentations, surgery and therapy

ASSH.org.

workshops, and newer interactive sessions such as

Peter Amadio, MD

The ASSH will host its 75th Annual Meeting 1-3

Last Person Standing and Mentee/Mentor Trivia. They

AAHS Representative to IFSSH

October 2020 in San Antonio, Texas, USA. ASSH

Contact the ASSH with questions or comments at

President Martin I. Boyer, MD, FRCS(C) and Program

info@assh.org.

are also planning to repeat the AAHS Beach Party,
Kids Hands-on Workshop, and will host our annual
Welcome Reception and Dinner Dance which are open

TURKISH SOCIETY FOR SURGERY
OF THE HAND

to all attendees.

Chairs Dawn M. LaPorte, MD and Ryan P. Calfee, MD,
MSC have developed a rich and varied program. The
price of registration increases after 15 June 2020, so

The national congress of the Turkish Society forregister soon to reserve your spot at a discounted rate.

Newer programming is also being added such as a

Surgery of the Hand, which is traditionally held

Stump the Professor session and they are exploring

biannually, is planned to be held in the city of

All international attendees are invited to attend thean ultrasound course. The Hand Association meetingEskişehir, Turkey, from 15-18 November 2020.

welcome reception, “Handapalooza,” on Thursday,is the perfect blend of education and opportunity

1 October for music, games, and specialty Texan

to relax with family, and is just the style of meeting

Our congress, which will be held for the 17th time, has

foods. A ticket is included with each international

many will want to attend once we emerge from ourbecome a tradition as a social and scientific gathering

registration! Guest tickets may be purchased for an

current situation.

where hand surgery-lovers have been coming

additional fee.

together for over 40 years.
ASSH is pleased to welcome the Indian Society for

AAHS is also focusing on providing easily accessible
education during the COVID-19 crisis to residentsEskişehir is a modern city in Central Anatolia andSurgery of the Hand as the 2020 International Guest

and fellows as well as hand therapists and advanced

was home to the Phrygian civilization (is there

Society. The International Guest Society program

practice providers through an eight week webinar

anyone who does not know the stories of King Midas!),recognizes our global partners in the hand surgery

series. More information on this series can be found

one of the Anatolian civilizations in history, and it has

community, and we encourage our Indian colleagues

on the Hand Association website. Please encourage

special importance as it is on the Silk Road.

to actively participate in our scientific program.

your trainees, therapists, and advanced providers
to participate in this series, which is free to all

Members of the guest society will be recognized withregistrants.

a special interactive poster section, access to the
VIP Lounge and a special international membership

AAHS will again be offering the International Reverse

rate. Learn more about Guest Society benefits andSurgery Fellowship in 2021. The application isopportunities at www.ASSHAnnualMeeting.org.

currently online. The deadline for applications asof now is July 1, 2020, but may be extended based

Hand.e Online Learning Portal – Now Free Videos!

on how COVID-19 trends in the coming months. I

The world’s largest video database for hand surgery iswould encourage all who are interested and qualify tonow free to all users around the globe. Login or sign

apply as this is a wonderful educational opportunity

up today at https://www.assh.org/hande/s/ to gain

for those in developing areas around the world. An

The link for theaccess to 1,500 peer-reviewed surgical videos andInternational Reverse Therapy Fellowship will also

Congress details: http://

lectures. Hand.e is the “YouTube” of the hand surgery

be offered in 2021 with the application to be madeelcerrahisi2020.org/index2.

field. It quickly shows you the most useful videos inavailable later this year.

html

hand surgery.

46

47

JOURNALHIGHLIGHTSIFSSH SPONSORSHIPS

www.ifssh.info

IFSSH SPONSORSHIPS

May 2020

The Touching Hands/ IFSSH
HAND SURGERY WORKSHOP AT MOUNT KENYA
UNIVERSITY JANUARY 24TH -25TH 2020
Njuguna Chancellor Mount Kenya Univ.

Attentive participants

Hands on painless local injection workshop

Prof Pankaj Jani and Dr Peter Nthumba

Goal
The goal of the two day course was to have all attendees be able to safely inject tumescent local anesthesia inan almost painless manner. This would cut the need for costly sedation and improve patient safety for mosthand surgery. In addition, the evidence behind safe field sterility was reviewed to enable much of Kenyan
surgery to move to more affordable procedure room field sterility out of the main operating room, as it has in
Canada. Eliminating sedation and full operating room sterility for many procedures will improve access tosurgery for many who cannot afford unnecessary sedation and unnecessary full operating room sterility formany procedures.
Lecturers and facilitators
Dr Don Lalonde (Touching Hands), Dr Peter Nthumba (Kenya plastic Surgeon) and Professor Pankaj Jani (past
COSECSA president) provided the lectures and commentaries to optimize sharing of knowledge
Funding
The course was supported by the IFSSH and Touching Hands.
Attendance
The course was attended by over 80 surgeons (general, orthopedic, plastic) and surgery residents from all over
Kenya. Attendance data was captured for 75 of the attendees (see inserted attendance data)
Evaluation of the meeting
The course was evaluated by all participants in a precourse information sheet, a post course information
sheet, and an evaluation form conceived by Dr Kevin Chung’s team in Michigan. USA. An analysis ofthese evaluations by Dr Kristine Huynh kahuynh@med.umich.edu is forthcoming. The overall tone of theevaluations was very good to excellent by almost all attendees.
Outcome of the meeting
The week after the course, procedure rooms were opened in two of the largest hospitals in Kenya for WALANT
surgery. More followed.

48

49

PERSONAL OPINIONS

www.ifssh.info

PERSONAL OPINIONSMay 2020

afferent pathway has been damaged; disappointing forbrachial plexus or brain and must look beyond theboth the patient and unwary surgeon.

neurological injury.

Continual technical refinements have much to offer;

The growing limb teaches me how biomechanics change

highly selective, targeted nerve transfers are today

due to imbalanced motor couples, impaired bone growth,available to restore specific functions such as extension

and joint dysplasia. Hand function depends on upperof fingers (allowing a recovery of individual long finger

limb function and the hand surgeon cannot separate

extension) or small intrinsic muscle action (thumbthese interrelated problems and focus only on the hand

opposition, finger add- and abduction).

area. Moreover, the "general" hand surgeon cannot
continue to think about the functional hand without

Hand & Nerve

They are based on initial thoughts and descriptions

considering what Wilson wrote 20 years ago and whatof field pioneers like Narakas , setting the concept ofso many pioneers in nerve and hand surgery like Birch,a neurotisation using a nerve transfer; and Mennen

Brunelli, Gilbert, Lundborg, Moberg, Narakas, Wynn Parry

(2)

(3,

, examining the end- to- side co-aptation. They wereand others taught us over and over again.

further popularized through landmark technical papers

Understanding of surgical disorders of the peripheral

Dedicated to Prof. Rolfe Birch, British neuro-orthopaedic surgeon, with my deep respect and gratefulness,by Oberlin

nerves is an essential component of the practice offor his tremendous mentor- and friendshipsurgery, like of Mackinnon .

surgery of the hand and wrist.

Every serious hand surgeon should be aware about the

Today, the surgical refinement both for donors andHere are some examples:

published a remarkable book “The Hand. How its use

significance of advances in peripheral nerve surgery.

selective recipients has progressed a lot. But there are1.

shapes the brain, language, and human culture“ , where

After all, the exceptional range of movement in thelimits to cerebral plasticity, for nerve transfers withpatients attending doctors. Accurate diagnosis of

he describes the strong interrelation between the humanupper limb enables multiple orientations of the handthe objective of regaining cutaneous sensibility withthe cause is essential to adequate treatment (like inhand and our peripheral and central nervous systems, a

as a powered, mobile, sensory organ. The innervation of

accurate localisation are far more effective in the infant

osteoarthritis), but understanding and integration

relation which extends to our psyche and soul.

the whole limb is rich and complex: there is a particularthan in the adult.

of all aspects of pain treatment, from medication,

4)(5, 6)and extensive books on nerve transfer(7)

In 1998, the American neurologist Frank Wilson(1)concentration of sensory organelles in the hand and

The painful hand. Pain is the chief reason for

operation upon nerves (denervation), as well as

When in 2012 I had the privilege to host the FESSH

wrist, not only in the skin but in the deep afferent system

But: how poor is our understanding about sensation andan understanding of the patient´s personality,

congress in Antwerp, I added a short presentationalso, from muscles, tendons and joints.

pain transmission, how "standardised" is our view on

background, and his response to the pain.

outlining my personal view on the influence of recent

muscle de- and regeneration: probably, you are all aware

2.

CRPS. A particularly complex and difficult pain

achievements in peripheral nerve surgery upon daily

The postganglionic sympathetic vaso- and sudomotor

about time concerns in motor nerve reconstruction,state, indeed a nightmare for patient and doctor. A

hand surgery practice.

nerves are especially dense in the palm of the hand.

but the behaviour of motor end plates after nerve fibre

still debated pathophysiology. Careful, precise, andStereognosis is based upon movement. The blindfolded

degeneration remains largely unknown to us.

searching history and physical examination will

It is nearly thirty years since I began work with brachial

patient cannot recognise an object or texture simply

plexus surgery, and I frequently hear “Brachial Plexus:

placed upon the fingers; but can do so immediately byOver the years, I have attended many international andmedical and / or surgical treatment (see August 2019

ooouw, this is difficult“. As I am also fascinated by thefeeling that object or texture between the moving finger

national hand surgery congresses. I have found that

#35 IFSSH Ezine).

developments in wrist surgery over the last decades, I

and thumb, that is between the areas of skin so aptly

there are, in general, two categories of neurologicalstill wonder how so many colleagues become familiar

described by Erik Moberg as the “eyes” of the hand.

sessions: the popular ones about carpal and cubital

median nerve might have other problems, like atunnel, crowded. The "specialised" one about brachial

more proximal compression, a rare tumour, a cervico-with the complex anatomy of wrist ligaments, boneguide towards causation in most cases and allow

3.

Carpal tunnel problems. Although it is frequent, thevascularisation and cartilage changes. Isn´t that

We all expect success after musculo-tendinous transfers

plexus lesions, spasticity, tetraplegia, nerve research: 10-

brachialgia due to cervical arthritis, or a generalized

complicated as well? But then, everybody jumps in, as

designed to restore extension of wrist and digits, or lost

15 people including the speakers, where one "specialist"

neuropathy. All these possibilities should be born inpatient demands increase, new techniques proliferate,

movements of the thumb ray; but the rapid conversion

listens to his or her neighbour presenting. How may wemind.

and overall results seem promising. Moreover, there areof a flexor muscle to an extensor muscle, rests upon thechange this imbalance?

extensive biomechanical and functional research fields.

integrity of the deep afferent system. It is an example of
cerebral plasticity and it cannot take place if the deep50

4.

Complex and subtle disorders such asarthrogryposis. In some atypical cases, resembling

I frequently treat children after birth injuries to the

obstetric palsy, the lack of elbow flexion may be

51

PERSONAL OPINIONS

overcome by a nerve transfer if viable muscle iswww.ifssh.info

May 2020

UPCOMING EVENTS

Confusing? No contemplating!

still present. This may be checked before surgery byultrasonography and eventually electromyography.
Early muscle re-innervation provides rebalancing
across a joint and thereby may diminish or evenprevent later deformity (8).
5.

Work inability. In some countries and cultures, apainful or functionally disabled limb becomes the
only accepted reason to stay away from difficult,stressful, unacceptable working conditions.

6.

Cooperation with physio- and occupational
therapists- simply a must. But on an

Jörg Bahm MD PhD

interdisciplinary platform, same level exchange -Head of the section for plexus surgery

regarding patient evaluation and treatment. What

Department for Plastic, Hand and Burn Surgery

does the regular hand surgeon – still the conductor

University Hospital Aachen Germanyof the orchestra- really know about specific motor

email:jbahm@ukaachen.deand sensory re-education? About progressivefunctional re-validation? How often do we reallypractice interdisciplinary patient approach?
7.

Wrist surgeons recently discussed the role of theposterior interosseous nerve and the rationale
for systematic excision when operating a painful(1)Pantheon Books New York 1998

wrist. Interestingly, they actually wonder how much(2)Narakas AO (1987): Thoughts on neurotization of nerve

this nerve participates in wrist proprioception

transfers.

– and therefore it should not be sacrificed in a

in: Terzis JK: Microreconstruction of nerve injuries.

“standardised “manner.

Saunders, Philadelphia(3)Mennen U (1998): End-to-side Nerve Suture in the

We still continue to learn so much anatomical andPrimate (Chacma Baboon). Hand Surgery 3 (1): 1-6

surgical details about the hand and peripheral nerves.

(4)Mennen U (1998): End-to-side Nerve Suture in the

They are not difficult by nature, but frequently not

Human Patient.

explained well enough and not presented in a logical

Hand Surgery 3 (1): 7-15

pathophysiological order. We may never integrate ALL(5)Oberlin C, Ameur NE, Teboul F, Beaulieu JY, Vacher C

aspects of neuropathic pain, writer´s cramp or spasticity.

(2002): Restoration of elbow flexion in brachial plexus

But within our large hand surgical community, we

injury by transfer of ulnar nerve fascicles to the nerve toshould continue to learn from each other, we must strive

the biceps muscle. Tech Hand Up Extrem Surg 6: 86–90

to maintain a common language of understanding,(6)Oberlin C, Durand S, Belheyar Z, Shafi M, David E,

exchange and interaction; even if we think that our

Asfazadourian H (2008): Nerve transfers in brachialsubspecialties are quite separate.

plexus palsies. Chir Main 25: S1297–1302(7)Mackinnon SE (2015): Nerve surgery. Thieme, New

In a sense we are just at the beginning to understand theYorkcomplexity of the hand and how anatomy, physiology(8)Bahm J (2014): Arguments for a neuroorthopaedic

and pathology are integrated.

strategy in upper limb arthrogryposis. JBPPNI 17: 8–9

52

53

UPCOMING EVENTS

54

Dupuytren_A5_Flyer_print.indd 1

www.ifssh.info

28.03.19 13:38

May 2020

UPCOMING EVENTS

55

www.ifssh.info

56