bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Drug Therapy Improved Nerve Regeneration and Function
Authors: Forés Joaquim , Romeo-Guitart David , González-Pérez Francisco , Navarro Xavier , Casas Caty
Published: September 2016

Background: Injured peripheral nerves regenerate their lost axons but functional recovery in humans is frequently disappointing. This is particularly important when injuries require regeneration over long distances and/or over long time periods. In addition, neurotmesis caused by nerve root avulsion may lead to a progressive loss of axotomized motoneurons (MNs) which sometimes avert warranty for surgical nerve repair. Using a bottom-up experimental approach using rat models of peripheral nerve injuries and sophisticate molecular biology and computational tools we ended up with a selected combination of FDA-approved drugs repurposed for its unexpected use in traumatology. In previous studies, using experimental models of nerve root avulsion, we validated that the drug combination (C1) exerted neuroprotection of almost 60% of spinal motoneurons (MNs) and exhibited anti-inflammatory properties reducing glial reactivity. Currently, we aim to verify the regenerative potential of C1. Methods: We use a model of crush injury in rat (Sprague Dawley) sciatic nerve. To asses functional recovery of denervated muscles, the compound muscle action potentials (CMAP) evoked in response to sciatic nerve stimulation were recorded in gastrocnemius and plantar muscles during the follow up. The recovery of locomotion function was assessed by the walking track analysis. At end point, we analysed neuromuscular junction’s reinnervation by plantar muscle immunohistochemistry. Results: We are now presenting that in a crush model of the sciatic nerve, the animals treated with oral administrated C1 presented acceleration in nerve regeneration analysed by electrophysiological recordings. Treated rats presented around 40 and 60% of increased amplitude of the CMAP of the gastrocnemius and plantar muscles, respectively compared with vehicle group after 35 days post-injury. Consequently, C1 treated rats showed an improved sciatic nerve functional index of 50% respect to controls. Besides, the number of reinnervated end-plates at the plantar muscle was 20% higher in C1 treated rats than in controls. Finally, walking track assessment revealed that locomotor function was better achieved after the treatment with C1. Conclusion: Overall, we set up and validated a new platform for therapy discovery to treat nervous system traumatic injuries.
Long-Term Outcome of Step-Cut Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome
Authors: Papatheodorou Loukia K. , Baratz Mark E. , Sotereanos Dean G.
Published: September 2016

Objective/Hypothesis: Extra-articular ulnar-shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar-shortening osteotomy without special jigs for ulnar impaction syndrome. Materials and Methods: A retrospective review was performed of 164 consecutive patients who underwent step-cut ulnar-shortening osteotomy between 2000 and 2010. Eighty-eight patients were female and 76 were male with a mean age of 36.8 years. Idiopathic ulnar impaction syndrome was diagnosed in 116 patients, while a posttraumatic etiology was seen in 48 patients. The step-cut osteotomy had its long arm oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5 mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance by shortening the ulna 2 to 3 mm and not to create neutral variance. Ulnar variance was assessed radiographically preoperatively and postoperatively with the pronated grip view in all patients. The preoperative ulnar variance ranged from +1 mm to +6 mm. Results: Mean follow-up was 62.4 months (24-86 months). Union of the osteotomy was achieved with a mean of 8.2 weeks. The union rate was 98.78%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, −1 mm to +1.5 mm) after a mean overall shortening of 2.5 mm. Modified Mayo Wrist Scores improved significantly from a mean of 47.3 (25-65) preoperatively to 88.8 (60-100) postoperatively. All patients returned to their work in a mean of 4 months. Hardware removal was performed in 12 patients (7.3%) due to plate-related symptoms. No other complications were encountered. Conclusions: The step-cut ulnar-shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed early return to functional activities. Palmar placement of the plate diminishes the need for plate removal caused by irritation. The step-cut ulnar-shortening osteotomy is a simple and cost-effective technique for ulnar-shortening without the use of special instrumentation in patients with ulnar impaction syndrome.
Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Pseudarthrosis
Authors: Lukas Bernhard , Kindler Christian , Deglmann Claus
Published: September 2016

Objective/Hypothesis: Nonunions of scaphoid are routinely treated by reconstruction with interposition of cancellous bone grafts from the iliac crest or distal radius. In unfavorable situations as persistent pseudarthrosis following surgical reconstruction or avascular proximal pole, vascularized bone grafts are preferred. Free vascularized bone grafts from the medial femoral condyle were introduced as an additional tool for reconstruction and showed promising results. Material and Methods: In this study, 71 scaphoid nonunions or pseudarthrosis were followed after reconstruction with vascularized bone graft form the medial femur. In 15 cases, an osteocartilaginous graft was used to replace the proximal pole. After a minimum follow-up of 6 months (64 patients), following data were evaluated: consolidation, complications, donor site morbiditiy, pain in rest and stress, range of motion, grip strength, and Krimmer score. Results: Consolidation rate was 88%, in 19.6 % minor complications occurred. Range of motion did not change significantly, 89% grip strength of opposite site could be regained. Pain (VAS) in rest was reduced by 73%, in stress by 51%. Donor site morbiditiy is tolerable: 14.5% had mild symptoms after 3 months, reducing to less than 2% after 6 months. Krimmer Score resulted in very good and good results in 60% of the cases. Conclusion: Reconstruction of scaphoid pseudarthrosis with the free medial femoral condyle bone graft is an adequate technique to reach high consolidation rates in unfavorable situations. Postoperative function improves in terms of grip strength and pain reduction. Range of motion impairment usually persists. The surgical technique is challenging, but the quality of the bone graft is superior to the pediculated bone grafts of the distal radius. In addition, the distal femur offers the possibility of a osteocartilaginous graft to replace the complete proximal pole. Frequently, salvage surgery like 4 corner fusion can be avoided by this technique.
Three-Corner Fusion for Management of SNAC and SLAC Wrists
Authors: ElKaref Essam
Published: September 2016

Objective: Presenting the results of fusion of the lunate bone with capitate and hamate bones plus excision of scaphoid and triquetrum in management of scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists, looking in particular at the resulted range of wrist motion. Hypothesis: Four corners fusion is considered the golden standard treatment of SNAC and SLAC wrists in the last decade. It is designed to result in relieving pain while maintaining a reasonable hand grip power and preserving some wrist mobility. Yet, many of the candidates wished to have a better arc of wrist movements. Materials and Methods: In a longitudinal study, 3 corner fusion procedure has been performed in 18 patients (12 had SNAC wrists and 6 had SLAC arthritis). Whereas, fusion between lunate, capitates, and hamate was performed together with excision of both of scaphoid and triquetral bones. Also excision of 3 to 4 mm of the radial styloid was carried out for all cases. Results: To date, all cases that were operated with this procedure eventually go into union in a period between 8 to 10 weeks. After an average followed-up period of 19 months (range, 13 to 40 months), the mean of flexion-extension arc of motion of their wrists decreased from 67% (preoperatively) to 62% (postoperatively) compared with the opposite side (range, 55% to 74%). The mean postoperative grip strength increased from 52% to 78% of the opposite side (range, 62% to 100%). None of the patients needed any further surgery and 75% were satisfied and 25% were pleased with the results. Conclusions: Results of 3 corner fusion are promising. The resulted range of wrist motion is relatively better than that obtained with 4 corner fusions, while grip strength and other clinical parameters are yet comparable.
Inside-Out Method to Develop Volar Arthroscopic Portals of the Wrist in Cadaveric Specimens
Authors: Naroura Ismael , Zemirline Ahmed , Taleb Chihab , Collon S. , Liverneaux Philippe
Published: September 2016

Introduction: Three direct volar arthroscopic portals to the wrist have been previously described: 2 radiocarpal and 1 midcarpal. This study aims at systematically describing 4 volar arthroscopic portals through mini-invasive incisions using inside-out approach from known posterior portals. Method: Four arthroscopic volar wrist portals were studied on 6 hand specimens with an inside/out technique: a radial radiocarpal approach (RRCA), an ulnar radiocarpal approach (URCA), a radial midcarpal approach (RMCA), and an ulnar midcarpal approach (UMCA). Each volar approach corresponded to a posterior approach: a 3/4 portal for RRCA, a 4/5 portal for URCA, a posterior radial midcarpal approach for RMCA, and a posterior ulnar midcarpal approach for UMCA. Results: The average range of motion of the scope through the RRCA was 65° of radial inclination and 71.66° of ulnar inclination, through the URCA was 62.5° in radial inclination and 64.16° in ulnar inclination, through the RMCA was 61.66° in radial inclination and 60° in ulnar inclination, and through the UMCA was 59.16° in radial inclination and 68.33° in radial inclination. No iatrogenic injury to important anatomical structures was noted. Conclusions: Results showed it was possible to perform these 4 volar portals through an inside/out technique with incisions mirroring the posterior portals. They were easy to perform, safe, and seemed useful in indications for ligament or bony intracarpal repairs.
Preventable Repeat Wrist Arthroscopies
Authors: Löw Steffen , Spies Christian , Unglaub Frank , van Schoonhoven Jörg , Prommersberger Karl-Josef , Mühldorfer-Fodor Marion
Published: September 2016

Objective: To evaluate indications and reasons for repeat wrist arthroscopies to identify preventable cases. Materials and Methods: For this retrospective, 2-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by their underlying pathologies (lesions of the central or peripheral part of the triangular fibrocartilage complex [TFCC], scapholunate (SL) ligament, cartilage, septic or aseptic arthritis) and by the causes that necessitated repeat arthroscopies (insufficient preoperative diagnostics, insufficient documentation at primary arthroscopy, uncertainty of diagnosis despite previous arthroscopy, progress of the underlying disease, recurrent symptoms after primary successful treatment). Results: Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar TFCC avulsions, the remaining 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic arthroscopy prior to therapeutic arthroscopy in 49 (37%) wrists, 48 of which had TFCC pathologies, while the remaining had a SL ligament lesion. Uncertainty of diagnosis despite previous arthroscopy led to another 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a suspected central TFCC lesion, and 2 for uncertainty concerning the integrity of the SL ligament. Inadequate photo or video documentation necessitated arthroscopic reassessment of the cartilage in 16 (12%) wrists. Conclusions: In this series, 2 out of 3 revision arthroscopies could potentially have been prevented. The inconsequent use of available modern magnetic resonance imaging (MRI) techniques and the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures.
Microstructure Study of the Normal Lunates and Kienböck Lunates With MicroCT Imaging
Authors: Xiong Ge , Xiao Zirun , Wang Haihua , Guo Shigong , Tao Jianfeng
Published: September 2016

Objective: To compare the microstructure of normal lunates and Kienböck lunates with MicroCT. Materials and Methods: Seventeen fresh lunates from the patients with stage III Kienböck disease and 8 normal lunates were scanned with MicroCT. Four regions of interest were selected to measure the trabecular parameters. The number and diameter of the nutrient foramina were measured. Results: All the Kienböck lunates had bony discontinuity at the distal surface like a greenstick fracture. Within the 3 regions in the distal surface, the bone volume, bone volume density, and the structure model index were significantly larger in the middle region when compared with those of the palm and dorsal regions. Conversely, trabecular separation and bone surface/bone volume were smaller in the middle region. Comparing the central trabecular bones of the Kienböck lunates with those of the normal lunates, we found the bone volume, bone volume density, and bone surface were significantly larger in Kienböck lunates while the trabecular separation and trabecular pattern factor were significantly smaller. There was no significant difference for the number and diameter of the nutrient foramina between 2 sides of Kienböck lunates. The diameters of the nutrient foramina of the Kienböck lunates were significantly larger on the dorsal side and smaller on the palmar side when compared with normal lunates ( P < .05). Conclusion: In Kienböck lunates, the bony disruptions were mostly located in the palmar or dorsal area where it was shown to be structurally weaker from trabecular bone structure analysis, leading to separation of the distal part of the fracture, disruption of blood supply, poor bone remodeling, and proneness to secondary fracture and eventual collapse.
Failed Scaphoid Surgery With Nonunion, Bone Defect, and Loose Headless Screw Treated by Nonunion Resection, Bone Grafting, and Scaphoid Plating
Authors: Kebrle Radek , Helmut Tomas , Schmoranzova Alena
Published: September 2016

Objectives: Failed scaphoid osteosynthesis or failed scaphoid nonunion treatment with headless screw lead to a persistent scaphoid nonunion with loose screw, bone defect that is not just between proximal and distal fragment but also around loose screw within these fragments. Stable intramedullary screw fixation is seldom possible. In these cases, stable fixation maybe performed by using scaphoid plate and angular stable screws. Patient and Methods: Ten consecutive patients with persistent scaphoid nonunion after primary osteosynthesis for fracture treatment or after secondary treatment for scaphoid nonunion were within the group. Size of the fragments and bone defect within proximal and distal fragments did not allow operating surgeon to use headless screw for stabilization. All patients were treated by screw removal, nonunion resection, bone grafting by autograft from iliac crest, and stabilization by 1.5 mm scaphoid plate with angular stable screws through volar approach. Surgery was followed by 6 weeks of casting and 6 weeks of protected mobilization. All patients were followed clinically and radiologically at 2, 6, 12, and 24 weeks after surgery until clear signs of healing or nonhealing of the scaphoid. In case of doubts about the healing process, computed tomography (CT) scan was used for confirmation and patients were followed up to 18 months after surgery. In 2 patients with screw inserted from proximal pole, second approach was used with stabilization through volar approach. In 2 patients, removal of the screw was impossible so it was decided to leave the screw within the bone with grafting around it and applying adjacent plate stabilization on top. Results: Eight patients healed the scaphoid. Wrist synovitis disappeared with scaphoid stabilization. Pain subsided to 0 in 6 with return of full wrist motion and function. In 2 cases, residual motion limitation of 20° and 30° with residual pain at the end of motion arc in heavy load persisted. Two patients that failed to heal have persistent wrist synovitis, motion limitation, and pain with function restriction. One of the persistent nonunions was 9 years old nonunion and second had small proximal fragment with difficulty to fix proximal fragment with screws. In 4 patients, plate was removed in second setting. Discussion: Persistent scaphoid nonunion after previous attempts to heal it with loose headless screw within the bone mean structural problem for operating surgeon due to necessity to reconstruct shape of the bone and stabilize it by osteosynthesis. Intramedullary screws cannot be used in this occasion. Extramedullary stabilization by scaphoid plate and angular stable screws owes reliable stabilization necessary for scaphoid healing and maybe treatment of choice as we have shown in this presentation.
Treatment of Symptomatic Distal Interphalangeal Joint Arthritis
Authors: Papatheodorou Loukia K. , Lin Edward , Sotereanos Dean G.
Published: September 2016

Objective/Hypothesis: Arthritis at the distal interphalangeal (DIP) joint often results in pain and deformity. Arthrodesis of the DIP joint is commonly performed for symptomatic arthritis that has not responded adequately to nonoperative treatment. Although a variety of techniques have been described for DIP joint arthrodesis, the end result is a motionless joint. DIP fusion also carries the risk of malunion, nonunion, and implant-related complications. We hypothesize that an alternative technique involving an open dorsal cheilectomy and DIP joint debridement would result in adequate pain relief and cosmesis, while preserving joint motion and avoiding the potential complications associated with DIP arthrodesis. We present our experience with 78 patients with symptomatic osteoarthritis of the DIP joint who underwent an open dorsal cheilectomy and debridement of the DIP joint. Materials and Methods: There were 70 women and 8 men with a mean age of 64 years (range, 52-74 years) at the time of the surgery. The dominant hand was involved in 59 patients. The most common fingers were the middle (36 patients) and index (33 patients). Preoperative radiographic assessment demonstrated Kellgren and Lawrence grade 3 osteoarthritis in 44 patients and grade 4 in 34 patients. In all patients, through a lazy “S” incision over the dorsal DIP joint, an arthrotomy was performed on each side of the extensor tendon and debridement of the joint was performed removing osteophytes from the DIP joint, while preserving the insertion of the extensor mechanism. At completion, the DIP joint was immobilized in an extension splint. At 4 weeks postoperatively, the splint was removed and physical therapy was initiated for active range of motion. At the final follow-up, pain level, satisfaction, and DIP joint range of motion were assessed. Results: The mean final follow-up was 37 months (range, 24-62 months). All clinical parameters demonstrated statistically significant improvement at final follow-up. Mean patient pain visual analogue scale scores improved from 8.3 preoperatively to 1.2 postoperatively. Patient satisfaction scores significantly improved by an average of 7 points. Mean flexion contracture of the DIP joint significantly improved from 11.4° preoperatively to 4.6° postoperatively. There were no postoperative infections or tendon rupture. Six patients experienced mild extensor tendon weakness at the DIP joint. No patients required additional surgery. No other complications were encountered. Conclusions: Open dorsal cheilectomy and debridement of the DIP joint in patients with symptomatic DIP joint osteoarthritis is a safe and reliable alternative procedure. This surgical technique reduces pain while preserving DIP joint motion.
Surgical Treatment of Acute Perilunate Dislocations and Fracture Dislocations in a Specialized Center
Authors: Bernal Luis Alejandro Satizabal , Herrera Diego Alejandro Davalos , Gonzalez Elkin Lozano
Published: September 2016

Introduction: Acute perilunate dislocations and fracture dislocations are uncommon but severe carpal injuries. Different treatment options have been recommended with a recent trend in open reduction and internal fixation. The purpose of this study is evaluate a cohort of patients who received a specific surgical treatment for acute perilunate dislocations and fracture dislocations of the carpus in the first 72 hours after trauma and with open reduction and internal fixation through isolated dorsal approach in a specialized trauma and hand surgery center, between February 2008 to February 2014. Method: A series of 20 perilunate dislocations and fracture dislocations was studied of which 19 were male and 1 female patient. The average age at time of injury was 32 years (20-48 years), and the upper extremity that most often committed was right (64%). The dominant hand was affected in 80% of cases. The most common mechanism of trauma was traffic accident (90%). Pure perilunate dislocations were more frequent (50%), trans-scaphoid perilunate fracture dislocation (40%) and trans-styloid perilunate fracture dislocations (10%). The average follow-up period was 39.5 months (17-72 months). Results: Patients were assessed subjectively with a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, with average of 3.18 (0-10) and with a standard deviation of ±3.2; and visual analogue scale (VAS) with average score of 1.5 (1-4) and with a standard deviation of ±0.81. Objectively results were assessed by active range of motion with flexion-extension arc averaging 132° with a standard deviation of ±13.6, average supination arc of 154° with a standard deviation of ±5.8 arc, and finally radial and ulnar motion of 39° with a standard deviation of ±8. Two complications were reported in the series, the most serious related with pin tract infection, deep wound infection, and associated with scapholunate dissociation recurrent, and osteoarthritic changes that required additional surgery with proximal row carpectomy. The second complication reported with a residual hematoma in the carpal tunnel that required surgical drainage with later success. Conclusions: Early surgical treatment is considered as important in many studies and a determining factor in obtaining satisfactory clinical and functional results. In this study, all patients were treated timely (less than 72 hours), which we believe was determinant in obtaining excellent average results in the parameters evaluated with evidence of just 2 related complications.
Percutaneous Scaphoid Screw Fixation
Authors: Mahmoud Mostafa , Moharram Ashraf , Ban Sherif , El-Xeni Ahmed , Seif-Alnasr Abdullah
Published: September 2016

Hypothesis: Application of a screw to the fractured scaphoid as perpendicular to the plane of the fracture as possible is a key to proper healing. Using the previously proposed radiographic predictor of healing that uses the sum of smaller angles (SSA) of intersection between the proposed screw position and the plane of the fracture in 3 radiographs (posterior anterior [PA] in ulnar deviation, 45 pronation, and supination oblique), we suggested classifying fractures of the scaphoid into volarly accessible “V type” and dorsally accessible “D type” according to the SSA >160° and <160°, respectively. The proximal pole of the scaphoid at the dorsal apex is considered V type and proximal to it is considered D type. Methodology: Prospectively, we fixed the 176 scaphoid fractures percutaneously between 2005 and 2013. The proposed screw passage through the retrograde route was drawn on the 3 mentioned radiographs and the SSA was calculated. We classified 133 fractures (75.6%) as V type (113 waist and 20 proximal pole) and 43 fractures (24.4%) as D type (27 waist and 16 proximal pole). The V type fractures were fixed through retrograde route by cannulated Herbert screw and the D types through antegrade route using mini-incision to protect the extensors and avoid capsular teathering exposing the screw entry. No immobilization was used for both methods and we allowed early range of motion (ROM) exercises a early return to office work. Patients with gross comminution or associated fracture or ligament injury were excluded from this study. Results: In the V type, union occurred in all but one patient (99.2%) at a mean 7.6 weeks (6-12) with no need to supplementary antiglide wire. Two patients with screw prominence in the scaphotrapezial joint needed screw removal after bone union. Five of 85 patients had radiographic scapho-trapezium-trapezoid arthrosis after 5 years, but asymptomatic. In the D type, union occurred in all patients (100%) at a mean 8.1 weeks (6-12). Two patients with screw prominence in the radioscaphoid joint had screw remotion after union; three patients had a painful scar and one had extensor pollicis longus (EPL) adhesions. Both groups had comparable demographics, union rate and time, complication rate, and need for second surgery. Conclusion: Classifying scaphoid into V and D types help the choice of proper fixation route for predictable outcome.
Multimodal Diagnostic Approach to Monoarthritis of the Wrist
Authors: Kim Jihyeung , Bae Kee Jeong , Rhee Seung Hwan , Gong Hyun Sik , Lee Young Ho , Baek Goo Hyun
Published: September 2016

Objective: The aim of this study was to evaluate both the performance characteristics of magnetic resonance imaging (MRI) in the differential diagnosis of monoarthritis of the wrist and the predictive ability of the 1987 American College of Reumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria. Methods: The 29 patients with monoarthritis of the wrist retrospectively reviewed in this study underwent preoperative MRI with or without a white blood cell (WBC) scan. Their diagnoses were confirmed histologically after open synovectomy. Synovitis, bone erosion, and bone edema, as seen on MRI, were measured by 2 readers independently using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) system. Receiver operating characteristic (ROC) curves were used to calculate the cutoff differentiating rheumatoid arthritis (RA) from other diseases. The optimized cutoff point for each parameter was determined using Youden index. Results: The areas under the ROC curves for the synovitis, bone erosion, and bone edema scores were 0.892, 0.853, and 0.752, respectively. The cutoff values of these scores to predict RA were 5, 48, and 19, respectively. The sensitivity and specificity of the 1987 ACR criteria were 50% and 92% and those of the 2010 ACR/EULAR criteria were 60% and 75%. Conclusion: The OMERACT RAMRIS system provides a valuable tool to differentiate RA from tuberculosis and undifferentiated chronic monoarthritis in patients with wrist monoarthritis. A multimodal diagnostic approach using MRI, WBC scan, and histologic evaluation is recommended if the diagnosis cannot be established based on clinical, biochemical, and radiographic evaluations.
Superior Tactile Discrimination in the Phantom Hand Map in Forearm Amputees
Authors: Wijk Ulrika , Björkman Anders , Antfolk Christian , Björkman-Burtscher Isabella , Rosén Birgitta
Published: September 2016

Background: Many amputees experience referred sensations described as sensations from the phantom fingers elicited by stimulation of specific skin areas on, eg, the residual limb—a phantom hand map (PHM). Some amputees have a very detailed PHM with a mapping of all fingers, while others have a more “simple” map containing 1 or 2 fingers and others do not have a map at all. The anatomical and physiological substrate behind the PHM is not completely understood. Here, we evaluated the sensory qualities of the PHM. Methods: Touch thresholds and discriminative touch of the PHM were assessed in 10 traumatic forearm amputees. They were assessed for ability to localize touch in the PHM areas, and they were also asked to grade how distinct and similar to normal touch the referred feeling was. Corresponding areas on the contralateral, intact forearm were used as controls. Results: Similar touch thresholds were seen in the PHM and the control site at the contralateral forearm. Tactile discrimination, requiring both detection of stimulus and interpretation, was significantly better in the PHM. The quality of touch in PHM areas compared with normal touch experience was rated as mean 7.4 (range, 3-10) on a visual analogue scale (0-10). Conclusions: This study provides initial data supporting the hypothesis that the PHM and the superior tactile discrimination in the PHM may be based on adaptation in brain function. Further investigations of the neural basis for the PHM are, however, needed to better understand its origin.
Modifiable Determinants of Bone Health in Women With Distal Radius Fracture
Authors: Dewan Neha , MacDermid Joy C. , MacIntyre Norma , Grewal Ruby
Published: September 2016

Background: Distal radius fracture (DRF) is an early and independent predictor of future osteoporotic (OP) fractures. Currently, there are no studies evaluating the role of modifiable risk factors on OP fracture risk in postmenopausal women (PMW) with DRF. Purpose/Objectives: To determine the extent to which modifiable risk factors such as balance, muscle strength, and physical activity can explain variability in bone mineral density (BMD) among women with DRF. Materials and Methods: The study was designed as a cross-sectional investigation of baseline data. Women aged 50 to 80 years with DRF were assessed for balance, muscle strength (grip strength, plantar flexion), and physical activity using reliable and validated measures. Dual-energy x-ray absorptiometry was used to assess areal BMD at the femoral neck (BMD-FN) and total hip (BMD-TH). Analysis: Stepwise multiple regression analysis was used to determine the extent to which modifiable risk factors (predictors) could explain variability in the BMD (outcome). Results: Women ( n = 67; mean age: 62.12 ± 7.45 years) were analyzed. Hand grip strength as an independent predictor explained 15% ( F = 11.26, P = .001) and 6% ( F = 4.18, P = .04) of total variability in BMD-FN and BMD-TH, respectively. Balance ( R2 = .10, F = 4.35, P = .04) and hand grip strength ( R2 = .32, F = 10.78, P = .003) explained significant variability in BMD-FN among 50- to 64-year-old ( n = 41) and among 65- to 80-year-old ( n = 25) PMW with DRF, respectively. Conclusions: Hand grip strength is the independent predictor of femoral neck and total hip BMD in PMW with DRF. Because hand grip strength and balance are modifiable factors that are related to bone health, they may represent useful prevention targets for hand therapists. We recommend evaluation of hand grip strength and balance as a component of OP risk factor assessment among women with DRF.
Bringing Patient Advisors to the Bedside of Digit Replantation Patients
Authors: Arsenault Josee , Vigneault Karine , Higgins Johanne , Pomey Marie-Pascale , Lahaie Valerie , Mercier Audrey-Maude , Laplante François , Moreau Maxim , Danino Alain
Published: September 2016

Purpose: Patient advisors are peer volunteers who have already been through a digit replantation. They are fully trained and viewed as full-fledged members of the care team. This proof-of-concept study was aimed at describing a model of care that brings patient advisors directly to the patient’s bedside. In this model, the patients’ perception of disability, the adherence to the rehabilitation process, and overall satisfaction were reported. Methods: A prospective pilot study was conducted from July 2014 to June 2015. All patients admitted to a center of expertise were offered the option to interact with patient advisor at bedside. Meetings were generally brief (15-30 minutes) and were proposed on the fifth day postsurgery as well as 8 and 16 weeks following surgery. The Disabilities of the Arm, Shoulder and Hand (DASH; 30 items scored 1-5) questionnaire was completed at 8 and 16 weeks follow-up as a measure of self-rated upper extremity disability and symptoms. All patients who had at least 1 interaction with a patient advisor were interviewed by telephone after study completion. The purpose of the interviews was to understand their expectations, the contribution of the patient advisor in their own care, and any possible reluctance or difficulty encountered (particularly when interactions were conducted via videoconferencing). Adherence to the rehabilitation process was also recorded and later compared to an estimate of 35% adherence generated from our Institution. Results: Based on an average of 9 patients, the DASH score completed at week 16 (27.6) showed a decrease of 33.8% when compared with that of week 8 (41.7). Adherence to treatment plan was respected in 55% of patients with patient advisor’s interaction, which was higher than estimations. Several key roles of the patient advisors emerged from the 18 interviews conducted on patients. Patient advisor is perceived as a care team member who will listen and support the patient, simplify the information conveyed by the care team, and finally break the patients’ loneliness, increasing their motivation toward the rehabilitation process. Conclusion: This study underlines the potential of patient advisors to improve the perception of disability and the adherence to the rehabilitation process in patients who have undergone digits replantation. Measurements of hand strength, range of motion, and sensibility as well as self-reported pain, posttraumatic stress disorder, and self-esteem were also performed; analyses are ongoing at present time. Further researches are required before widespread dissemination of the usefulness of patient advisors.
Client-Centered Rehabilitation for Outpatients With Hand-Related Injuries
Authors: Hansen Alice Ørts , Kristensen Hanne Kaae , Lauridsen Henrik H. , Cederlund Ragnhild , Tromborg Hans
Published: September 2016

Background: There is evidence to support client-centeredness as an approach in occupational therapy, because it improves functioning in everyday living. However, client-centeredness is difficult to measure. Only a few studies investigate client-centeredness from the client’s perspective and few questionnaires measure clients’ experiences of the approach. To our knowledge, no one has measured the approach from an outpatient perspective. Because the approach was developed from theory and the professionals’ viewpoint, and because studies show only moderate agreement between clients’ and therapists’ views, it seems relevant to develop a questionnaire to measure the client’s perspective of client-centeredness in outpatient rehabilitation. Objective: The objective of this study was to develop a questionnaire to categorize the experience of client-centeredness in rehabilitation among patients with hand-related disorders. Materials and Methods: Focus group interviews in patients with hand-related disorders in different outpatient settings in Denmark have been completed to investigate the patient’s perspective of client-centeredness. Data were analyzed by deductive content analysis. Items have been generated from the interviews and core values from occupational therapy research. The preliminary questionnaire has been cognitively tested. Results: A preliminary analysis of the patient’s perspective of client-centeredness shows the following important themes: information, coordination between wards and professionals, involvement in decision making, being listened to, evaluation of body function, activity and participation, and enabling everyday life activities. A final analysis and a preliminary questionnaire will be presented at IFSHT-16. Conclusion: The preliminary analysis shows consistency in core values from occupational therapy literature and themes mentioned by patients with hand-related injuries. Patients consider involvement in rehabilitation to be crucial. It seems to be important for the quality of rehabilitation that measurement instruments to evaluate patients’ perceptions of client-centeredness are developed.
Functional Outcomes in Early Rehabilitation of 202 Distal Radius Fractures After Volar Fixation
Authors: Bordazahar Silvana , Citro Silvia , Marechal Claudine , Paz Veronica Mendonca , Sgandurra Gabriela
Published: September 2016

Introduction: The incorporation of stable fixation techniques over the past 10 years has allowed the early mobilization of distal radius fractures (DRFs), maximizing the chances of achieving optimal functional outcomes in rehabilitation. Purpose: The purpose of this study was to describe the functional outcomes after early rehabilitation for DRFs treated with volar plate fixation. Materials and Methods: A descriptive cross-sectional study was carried out on 202 patients with a DRF based on the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system. They were treated with open reduction over the 2006-2015 period. Baseline and final therapy evaluations were carried out to collect demographic data—gender, age, and occupation (Swanson)—and functional information—pain using the visual analogue scale (VAS), range of movement (ROM) with a goniometer, grip strength tested with a standard Jamar hydraulic hand dynamometer, and self-report outcomes with the Patient-Rated Wrist Evaluation (PREW). Results: Sample mean age was 56.2 years (SD, ±16.4); 73% of the group were women, 43% of whom performed manual labor. Fifteen percent of the group had associated injuries. On average, therapy started 4 weeks after surgery. Mean treatment period was 68 days and 93 days in the case of those with associated lesions. The median VAS score at the onset was 4 (minimum: 0, maximum: 10) and at the end of treatment was 0 (minimum: 0, maximum: 9) ( P < .0001). Mean ROM was 52.7° for flexion, 57.9° for extension, 78.4° for pronation, and 67° for supination. Mean grip strength was 19.85 kg. Mean PREW score was 13.4. Conclusion: The study results indicate that early therapy after DRF surgery optimizes ROM and grip strength with good functional recovery and a quick return to daily activities and work.
The Cross-cultural Adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) Patient-Reported Outcome Measure Into Bulgarian
Authors: Jacobson-Petrov Johanna , Simeonov Lyudmil
Published: September 2016

Objective: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a well-recognized measure of upper limb function and symptoms. This patient-reported outcome measure (PRO) has been translated and culturally adapted into 50 different languages. To date, there is no PRO measure available in the Bulgarian language to measure outcomes for upper extremity pathology. The purpose of this study was to translate and culturally adapt the DASH questionnaire into Bulgarian. Methods: The process of translation and cross-cultural adaptation consisted of a 5-step process: forward translation into Bulgarian, synthesis of the Bulgarian translations, back translation into English, review and revision of the pre-final Bulgarian version, and pilot testing of the pre-final Bulgarian version. The pre-final version was given to 45 patients in order to perform a preliminary assessment of content validity and internal consistency. Results: Forty-five patients (35 males, 10 females) participated in the pilot testing of the Bulgarian DASH. All patients had posttraumatic or postsurgical conditions to the digits, thumb, or wrist. The completeness of item response was good, and individual question responses were well distributed (1-5) except for 1 question about the ability to manage transportation needs (1-3). The mean DASH score was 30.34 (SD: 18.51), with a range of 0 to 67.50. Internal consistency of the total score was high (Cronbach α = 0.948). Conclusions: This pilot assessment of the Bulgarian DASH demonstrates excellent internal consistency and good content validity when compared with similar studies of cross-cultural adaptation of the DASH questionnaire. A more thorough investigation into the reliability, validity, and responsiveness of the Bulgarian DASH is still needed.
Hand Discomfort
Authors: Chai Siw Chui , Bear-Lehman Jane
Published: September 2016

Objective: The study aimed to explore preventive and treatment options used by university-level piano students in relieving hand discomfort. The study also explored piano students’ perception on the effectiveness of the selected options. Materials and Methods: This was an exploratory cross-sectional study. Undergraduate and graduate students majoring in piano studies or piano performance were asked to rate their level of hand discomfort using the Borg CR10 (category ratio) scale during a typical week. Students were then asked to indicate their preventive and treatment options used in relieving hand discomfort. Students were also asked to rate the effectiveness of the selected options. Results: The study recruited 105 piano students. There were 69 (65.7%) female and 36 (34.3%) male, with a mean age of 22.5 years (±4.03, range, 18-43). Twenty-three students indicated that they experienced no discomfort at all during a typical week. The remaining 82 students, on average, indicated having weak discomfort (score, 1.57 ± 1.25). Of these, 46 (56.1%) have participated in various preventive activities such as yoga (n = 24, 29.3%), fitness (n = 16, 19.5%), Alexander Technique (n = 11, 13.4%), and so on. It is noted that 16 students have received treatments such as hand therapy, psychological management, and acupuncture (each n = 3, 18.8%). Majority of students (n = 6, 37.5%) reported that the treatments have moderately relieved their discomfort. There is no significant difference in terms of level of discomfort between students who received treatment (score, 1.85 ± 1.33) and those who received no treatment (score, 1.51 ± 1.24). For students who received treatment, level of discomfort is associated positively with treatment options ( r = .59, P = .02). No association exists between level of discomfort and preventive options. Conclusions: Piano playing is often linked to hand discomfort. To overcome this, piano students have opted to participate in various preventive and treatment activities. Given no complete relief of discomfort after treatment was reported by piano students, this issue of hand discomfort warrants specific attention and close examination.
Dupuytren Disease Predicts Increased Cancer and Cardiovascular Mortality
Authors: Kuo Rachel , Prieto-Alhambra D. , Furniss D.
Published: September 2016

Objective/Hypothesis: Dupuytren disease is an inherited fibroproliferative disease of the palmer fascia and frequently leads to disability and reduced quality of life. Previous small studies from Scandinavia have suggested that Dupuytren disease might be associated with increased mortality. We therefore hypothesized that Dupuytren disease would be associated with an increase in all-cause mortality within the UK and that this excess mortality might be accounted for by an increase in cancer or cardiovascular deaths. Materials and Methods: We harnessed the UK Clinical Research Practice Database (CPRD), a large primary care database containing the anonymized health records of approximately 8% of the UK population between January 1995 and December 2013. Cases were defined according to a code list defined by 2 independent clinically qualified researchers, with consensus reached by a third. Controls were matched by age, sex, and geographical location. Linked mortality data were provided by the Office for National Statistics. All-cause mortality, all cancer-related deaths, deaths from colorectal cancer, and deaths from cardiovascular disease were analyzed separately. Cox regression was used to calculate hazard ratios (HR). Kaplan-Meier survival estimates were also calculated. Results: We identified 42 192 incident cases of Dupuytren disease within the data set, and matched 210 960 controls. We found that the incidence of Dupuytren disease in the UK has increased during the study period for both men and women: men from 0.0169% to 0.0568% per year; women from 0.0068% to 0.0281% per year. All-cause mortality for patients with Dupuytren disease compared with patients without Dupuytren disease is increased in the second decade after diagnosis (HR, 1.70; 95% confidence interval [CI], 1.48-1.97; P = .0000). All cancer mortality (HR, 1.56; 95% CI, 1.34-1.81; P = .0000), colorectal cancer mortality (HR, 1.53; 95% CI, 1.18-2.00; P = .0025), and cardiovascular disease mortality (HR, 1.362; 95% CI, 1.23-1.51; P = .0000) are all likewise increased in the second decade after diagnosis. Conclusions: We find that the incidence of Dupuytren disease in the UK increased over the period 1995-2013. Patients with Dupuytren disease have significantly higher mortality rates 20 years after diagnosis than the population without Dupuytren disease. Specifically, Dupuytren disease patients are more likely to die from all cancers combined, colorectal cancer, and cardiovascular disease. Further work will allow the identification of causal pathways within this data set. The delay from diagnosis of Dupuytren disease to increased risk of death is over 10 years, allowing time for interventions that might reduce mortality in this patient group.