bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Reverse Second Dorsal Metacarpal Artery Flap for the Treatment of First Web Retraction
Authors: Ribak Samuel , Tietzmann Alexandre , da Gama Sérgio Augusta , Hirata Helton Hiroshi , Gomes Mogar Dreon
Published: September 2016

Objective: To describe and present the results of surgical technique with the use of skin flap of second dorsal metacarpal artery retrograde flow to the treatment of patients with retraction of the first web space of the hand and, when necessary, apply longer flaps to cover the palm of the hand. Methods: Sixteen patients were operated with retraction of the first web space. In 6 patients, there was also scar retraction of the palm, in addition to the web space. Before surgery, the angle of opening of the first web space was measured, and the degree of shrinkage was divided into 3 groups: mild, moderate, and severe. Eleven cases were considered serious and 5 moderate. The authors describe in detail the surgical technique. Results: All 16 flaps had survival (100 cases). In 3 cases, there was partial suffering of about 10% of the distal area of the flap with transient ischemia and in 2 cases epidermolysis occurred, all with satisfying results. Retail dimensions ranged on average 10 cm in length and 2.2 cm in width, on average. In 87.5% of the cases there was total closure of the donor area. The opening of the first commissure ranged from 51° to 83° (average of 73.5°). Conclusion: The use of the cutaneous flap of the second metacarpal dorsal artery is reliable and it shows good results for the treatment of retractions of the first web space. It can be considered a good option for cases that present beyond the web space, retraction of the palm.
Biological Characteristics of Adipose-Derived Stem Cells in Macrodactyly
Authors: Yang Xi , Jiang Yongkang , Wang Bin
Published: September 2016

Background: Macrodactyly is a congenital disease characterized by the aggressive overgrowth of adipose tissue in digits or limbs, with or without hyperostosis and nerve enlargement. Somatic mutations in PIK3CA contribute to heterogeneous segmental overgrowth phenotypes. To reveal the pathological feature of this disease, the biological characteristics of adipose-derived stem cells (ADSCs) in macrodactyly (Mac-ADSCs) were systematically investigated in this study. Methods: Cell morphology was observed by microscopy; cell surface markers, cell cycle, and apoptosis were analyzed by flow cytometry, and cell proliferation was evaluated using MTT assay. Adipogenic, osteogenetic, and chondrogenic differentiation potential were also tested. Results: Compared with the ADSCs in human abdominal subcutaneous adipose tissue (Sat-ADSCs), the Mac-ADSCs showed no obvious difference in the expression of CD markers and cell apoptosis. But the proliferative activity enhanced obviously in vitro ( P < .05).The osteogenic capability significantly increased and chondrogenic potential also enhanced, while the adipogenic potential was decreased. Conclusions: These biological characteristics were in accordance with the clinical manifestation of abnormal fat accumulation and bone hypertrophy in macrodactyly. Thus, early surgical intervention of the disease may be beneficial for controlling osteogenesis of the digits.
Clinical Efficacy of Microvascular Anastomotic Coupler in Upper Limb Replantation
Authors: Xia Lei , Xu Yuben , Zhao Junzhang , Li Peng , Huang Liangku
Published: September 2016

Objective: Microvascular anastomotic coupler has gained popularity in anastomosis surgery over the last 2 decades. However, evaluation of its impact on patency rate in upper limb replantation is barely reported. In this study, we aim to access clinical efficacy of microvascular anastomotic coupler in the application of upper limb replantation. Methods: From March 2013 to August 2015, a retrospective study was conducted in 6 consecutive patients with amputated upper limbs who underwent replantation. Among these patients, replantation was performed in 2 patients with middle upper arm amputation, 1 patient with elbow amputation, 2 with forearm amputation, and 1 with wrist disarticulation. Twenty-seven microvascular anastomotic couplers were applied in anastomosis of 2 brachial arteries, 4 ulnar arteries, 3 radial arteries, 6 cephalic veins, 4 basilic veins, 4 venae comitantes of brachial arteries, and 4 venae comitantes of ulnar arteries. Revascularization time, patency rate, complications, and viability of limbs were evaluated. Results: Patency rate of vessels in all 6 patients was 100%, and average duration of operation was 5 hours, whereas the mean time for anastomoses was 4 minutes, without postoperative vascular crisis. All replanted limbs survived after an average follow-up of 2 to 12 months; blood flow was patent and no thrombosis occurred over the site of anastomosis by Doppler vascular ultrasound. Conclusion: The microvascular anastomotic coupler serves as a powerful instrument in upper limb replantation by achieving high patency rate, high viability, and low complication rate.
A Surgical Training Program of Flexor Tendon Suture Using Pettitoes
Authors: Amako Masatoshi , Arino Hiroshi , Takashima Kenichi , Isaji Masashi , Nemoto Koichi , Chiba Kazuhiro
Published: September 2016

Objectives: Flexor tendon suture requires a high level of surgical skills, and repeated training is important for young surgeons to acquire sufficient techniques. Presurgical trainings using supplementary materials have been recommended from the viewpoint of medical ethics, although senior surgeons had obtained their surgical skills through “on the job training.” However, there have been few reports on training programs using supplementary materials. To acquire optimal surgical skills, we have established an original training program of tendon suture for the residents using pettitoes (pig’s trotters). Flexor tendons of pettitoes are very similar to human flexor tendons, and young surgeons can learn surgical skills with repeatable sutures. The purposes of this report are to present our training program of flexor tendon suture using pettitoes and to assess the efficacy of this program. Methods: Forty residents participated in the program and answered a questionnaire. After brief instruction, each resident was exposed to the flexor tendons of pettitoes. The flexor tendons were cut and repaired with Tsuge’s 4-strand technique using 4-0 loop nylon threads. Residents were instructed not to grip the tendons with the forceps, and suture them as atraumatic as possible. Post program evaluation was performed using the questionnaire data. Results: All participants were able to understand the theory and concept of flexor tendon suture and could complete the flexor tendon sutures in any manner under the guidance of an instructor; however, they could not accomplish sutures fully using the atraumatic techniques. They evaluated that they have gained 65% (25%-100%) of the ideal atraumatic technique in the self-assessment test. All participants rated our program as good or excellent. Conclusions: Pettitoes are readily available from butcher shops and cost only 100 yen (approximately US$1.00) in Japan. Flexor tendons of pettitoes are very similar to the human tendons, and the participants can learn the theory of suture, difficulty of the procedure, and the fun of hand surgery. Flexor tendon sutures using pettitoes can be recommended in the training program of hand surgery for young residents.
Is There a Role for Ultrasound During the Enzymatic Lysis of Dupuytren’s Cord? Our Preliminary Results
Authors: Pino Sergio , Cano Gisele , Borras Joan Enric , Til Luis , Subira Teresa
Published: September 2016

Objective: The enzymatic lysis of Dupuytren’s cord with collagenase clostridium histolyticum (CCH) was approved for the treatment of adult patients with the Dupuytren disease with one palpable cord. Ultrasound is useful in the assessment of Dupuytren. We present our study comparing two groups of patients using ultrasound guided or not during enzymatic lysis of Dupuytren’s cord. Materials and Methods: We present a retrospective study comparing two groups, ultrasound guided or not. Ultrasound is used in localization and infiltration of Dupuytren’s cord and the contracture extension, using Esaote MyLab One Touch with 5 to 13 MHz linear, placed longitudinal and axial to the cord. Between 2012 and 2015, we treated 115 patients with a single cord treated by enzymatic lysis with CCH: 66 patients guided group and 49 not guided. We analyzed the results according to complications (contusion, hematoma, lymphangitis, infection, tendon rupture, vasculonervous lesion . . .) and clinical success, for every cord and affected joint, defined as flexum 0° to 5° of joint after 30 days. Results: We do not have statistic differences between two groups, according to complications. The clinical success between two groups was significantly higher (20.4%, 10%-30.6% with P value, .00564), and the clinical success in metacarpophalangic joint of annular finger is significantly higher (16.8%, 4%-30% with P value, .04454) for ultrasound-guided group. Conclusion: Ultrasound is able to help enzymatic lysis in the Dupuytren disease to improve clinical success, even more if we have a cord with metacarpophalangeal joint contracture in annular finger. The short-term results of this noninvasive therapy are promising; however, we do not have a long follow-up.
Effect of Electroacupuncture at Zuansanli (ST36) on Dorsal Random-Pattern Skin Flap Survival in a Rat Model
Authors: Wang Li-Ren , Lin Ding-Sheng
Published: September 2016

Objective/Hypothesis: Random skin flap is commonly used for wound repairing and reconstruction. Electroacupuncture at Zuansanli (ST36) could effetely activate cholinergic system and enhance skin microcirculation blood perfusion. The article aims to study the effects of electroacupuncture at Zuansanli (ST36) on random-pattern flap survival rate in a rat model. Materials and Methods: Eighteen male Sprague-Dawley rats were randomly divided into 3 groups: control group (no postoperative electroacupuncture), study A group (postoperative electroacupuncture at non-acupoint areas, 10 Hz for 30 min/d), and study B group (postoperative electroacupuncture at Zuansanli, 10 Hz for 30 min/d). The “McFarlane flap” rat models were established on the rats’ dorsum. The survival area of the reaped flaps was measured on day 7 after the operation. Inflammation reactions were evaluated by hematoxylin-eosin–stained slices, and vascular endothelial growth factor (VEGF) expression was determined through a streptavidin/peroxidase-based protocol. Besides, superoxide dismutase and malonyldialdehyde contents were examined by oxidase enzymatic method and thiobarbituric acid. Results: The mean survival area of the flaps in the study B group was significantly larger than those in the control group and study A group. Superoxide dismutase activity and VEGF expression increased significantly in the study B group compared with those in the control group and study A group. Malonyldialdehyde level and inflammation in the study B group were significantly decreased compared with those in the control group and study A group. Conclusions: Electroacupuncture at Zuansanli (ST36) can improve random flap survival rate effectively.
The Effect of a Decision Aid on Decisional Conflict in Patients With Carpal Tunnel Syndrome
Authors: Gong Hyun Sik , Park Jin Woo , Kim Ka Hyun , Kim Jihyeong , Baek Goo Hyun
Published: September 2016

Purpose: Although a model for shared decision making is important for patient-centered care, decisional conflict can emerge when patients participate in the decision making. A decision aid is proposed to provide information and to involve patients more comfortably in the decision-making process. We aimed to determine whether a decision aid helps patients with carpal tunnel syndrome (CTS) experience less decisional conflict regarding their decision for surgery. Methods: Eighty CTS patients were randomized into 2 groups. The test group was given a decision aid in addition to regular information and the control group was given regular information only. The decision aid was a short video format that explains diagnosis and treatment options for CTS. We evaluated patients’ decisional conflict regarding their decision for surgery. We also evaluated patients’ knowledge about the disease and the perceived functional status as measured by the Disabilities of Arm, Shoulder and Hand (DASH) Questionnaire. Results: There was no difference in the Decisional Conflict Scale between both groups. Patients who viewed the decision aid had significantly better knowledge of CTS than those who did not. There was no correlation between the knowledge level and the Decisional Conflict Scale. However, higher DASH scores were correlated with lower decisional conflict. Conclusions: This study found that a decision aid does not reduce decisional conflict in patients with CTS, although it can help the patients be better informed. This study suggests that effective doctor-patient communication continues to be the most important way to reduce the decisional conflict in patients with CTS, and should be more emphasized for patients with less severe symptoms, as they have greater decisional conflict than those with severe symptoms.
The Nerve of Henle
Authors: Zancolli E. P. , Piazza D. , Kaufman C. , Scheker L. R. , Zancolli E. A.
Published: September 2016

Objective: The Nerve of Henle (NH) is described as a branch of the ulnar nerve (UN) in the forearm. The objective is to study the existence and anatomic relations of the NH in fresh cadaveric specimens and identify the presence of sympathetic fibers of the ulnar innervation and ulnar artery (UA) in the forearm. Material and Methods: The UN was dissected in 18 fresh cadaveric forearms from the medial epicondyle to the pisiform under 3.5X magnification. The origin of the NH was measured from the medial epicondyle and the pisiform. The NH was identified and dissected in its course with the UA throughout the forearm. The ulnar innervation was divided in 3 segments. The 2 cm nerve samples were obtained from each segment. Additional UA samples were obtained in 3 specimens prior and post the NH reaches the artery, to study its sympathetic innervation. The nerve and artery samples were stained for sympathetic fibers using Tyrosine hydroxylase antibody (ABCAM catalog no. ab62111) and anti-rabbit Ig-HRP (Life Technologies, catalog no. 65-6120). Fascicles area of the nerve samples were measured using Motic Images Plus. The number of sympathetic fibers per fascicle studied was quantified in 5 specimens. Results: The NH was present in 100% of the specimens. In all, 83% had a typical presentation (McCabe and Kleinert). In the typical presentation, the NH divided proximally in the forearm from UN on average 10.23 cm distal to the medial epicondyle and 15.4 cm proximal to the pisiform. In the atypical presentation (17% of the specimens), the NH divided on average 17.9 cm distal to the medial epicondyle and 8.76 cm proximal to the pisiform. The dorsal sensory branch divided from the UN on average 7.91 cm proximal to the pisiform. Sympathetic nerve fibers were found in all the fascicles studied of the nerve samples. However, when analyzing the area of the fascicles studied, the NH had a higher number of sympathetic fibers per square millimeter compared with the UN and dorsal sensory nerve. The UA appear to present more sympathetic fibers between the media and adventitia after the NH reaches the artery. Conclusion: The NH was observed in all the forearms studied (100%). Previous studies described the presence of NH up to 58% of the specimens. We think that the main difference in the presence of NH is because we only used fresh cadaveric forearms. A proximal origin of the NH was the most common presentation. In all the cases, the NH joined the UA in the forearm after exiting the UN, showing a strong anatomic relation between these 2 structures. Immunochemistry confirmed the presence of sympathetic fibers in all the nerves of the ulnar innervation. If we consider the area of the fascicles studied, the greatest carrier of sympathetic fibers per square millimeter in the ulnar innervation was the NH. It appears that the UA presents more sympathetic fibers between the media and adventitia after the NH reaches the artery. There might be a place for NH resection in the treatment of vasospastic disorders.
Is Electroneurography Mandatory for Carpal Tunnel Syndrome Diagnosis?
Authors: Czinke Zoltán , Bábás Geza , Bajdik Beata , Rimaszeki Zsolt , Urban Ferenc , Szabo Zsolt
Published: September 2016

Objective: Our hypothesis was that there is no difference in the results of patients operated after electrophysiologically proven carpal tunnel syndrome, and the patients operated because of typical symptoms and physical examination only. Method: A retrospective evaluation was performed of our database on the patients operated in the Miskolc Hand Surgery Center. The age of the patients, the time interval from the first symptoms, and the result of electroneurography (ENG) was registered. The subjective level of numbness and pain in the fingers was checked preoperatively and postoperatively at 1 week, and at 5 weeks later. For evaluation of the subjective symptoms, a Visual Analogue Scale (VAS) of 1 to 10 was used. Results: In the last year, there were 193 patients operated for carpal tunnel syndrome in our unit. In all, 30.5% of them was operated without any electrophysiological examination. Due to bilateral symptoms, and concomitant other hand disorders, we had to exclude 27 patients from the study. The mean age of the patients was 60.2 in the first group, and 56 in the second. The treatment was the same in all the cases: open carpal tunnel release without synovectomy. The time interval between the first symptoms and the operation was 6 months to 1 year in average for both groups. The preoperative daytime numbness in the fingers was 6.31 VAS points for the patients operated without ENG and 5.63 in the other group. Night pain was 5.8 and 5.5 in the groups. Postoperatively the changes in the daytime numbness was 3.0 VAS points for the group without ENG, and 3.3 VAS points without ENG after 1 week, and 0.2 more points decrement was registered for both groups 5 weeks later. The night pain has decreased to 1.5 points right after the operation regardless of the preoperative ENG result. The overall satisfaction rate of the patients at the 6-weeks control was 9.0 points for the first group, and 8.9 for the second group. Conclusion: The 2 groups of patients turned out to be homologue. There was no significant difference in the preoperative registered data. Postoperatively the tendency of the decreasing daytime numbness and the disappearing night pain was about the same. As the patient’s satisfaction rate was the same in the 2 groups, we can conclude that if the anamnestic information and the physiological examination are typical for carpal tunnel syndrome, the electrophysiological examination is not mandatory for the decision making.
Benefits of the “e-Informed Consent” in Hand Surgery for the Surgeon and the Patient
Authors: Candelier Gilles , Apard Thomas , Lemerle Jean Pierre
Published: September 2016

Introduction: Information consent is a legal and ethical requirement when planning a surgical procedure. Information shared must be clear and honest to achieve a real process of shared decision making. Purpose: The purpose of this study was to validate an online tool of information consent. Method: This web application provided to the patient multimedia information resources (information about the pathology and its inherent risks of treatment) and allowed the surgeon to ensure suitable understanding of the patient with a conclusive evidence in a personal folder. We conducted a prospective study from February 2015 to February 2016. In all, 145 adult patients (48 men, 97 women, mean age 52 years) suffering an unilateral carpal tunnel syndrome (CTS) were included. They all had a personal mobile phone number for an e-signature. The questionnaire applied to CTS consisted of 18 items with binary answers yes/no, with a possibility of reinformation. Indeed, the patient was asked to reevaluate his answer with the possibility not to validate the issue. Each item must be checked and validated by the patient before discovering next one. The questions concerned the knowledge of the disease (physiopathology and causes) and its treatment (technical procedures), the risks (infection, reflex sympathic dystrophy, pain, lack of grip strength), and the expected benefits (disparition of paresthesia/pain, sensitivity of finger tips). At the end, the questionnaire was validated with an electronic signature via a SMS code. Results: The average duration of consent was 7 minutes 30 seconds (3-31). All patients validated their e-consent. In decreasing order, the items which needed reformulation were reflex sympathetic dystrophy (32%), the risk of injury to the median nerve (23%), the ability to adapt to the intraoperative gesture circumstances (10%), the hygiene regulations (4%), and a disagreement about the side to be treated (3%). There were no electronic signature failure. Conclusion: The use of this online application allowed patients to have access to informative and suitable content that seemed subjectively relevant (no invalidation). It allowed the patient to participate in its therapeutic options. Thus, the surgeon could assess the quality of the information that he delivered and the insurance that the consent was obtained. Further questionnaires about other pathologies will be developed, thanks to this first experience.
The Relationship Between Early Symptom Relief and Surgical Outcomes in Moderate to Severe Cubital Tunnel Syndrome
Authors: Kwak Sang Ho , Bae Jung Yun , Baek Goo Hyun
Published: September 2016

Introduction: Moderate to severe cubital tunnel syndrome usually need surgical treatment. Some patients feel subjective symptom relief shortly after the surgery while others do not. In this study, we want to know whether patients with early symptom relief had different clinical characteristics and surgical outcomes compared with patients without early symptom relief. Materials and Methods: From January 2013 to February 2015, 39 surgical cases with moderate to severe stage cubital tunnel syndrome (Mcgowan grade IIA, IIB, III) were included. In all, 21 patients (17 male, 4 female, mean age 54.6 ± 12.6) reported subjective symptom relief within 14 days from surgery. In addition, 18 patients (16 male, 2 female, mean age 54.7 ± 11.4) did not report early symptom relief. Clinical characteristics including hand dominance, gender, smoking history, type of surgery, age, symptom duration, range of motion, grip strength, key pinch strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and Mcgowan grade were analyzed retrospectively using t test or chi-square test. Surgical outcomes measured at 3 months, 6 months, 12 months after the operation were analyzed using repetitive measured analysis of variance (ANOVA) or chi-square test. Results: The key pinch strength ( P < .001) was different between groups. Postoperative 12 months Krout Wilson criteria ( P = .039) were associated with the early symptom relief. The QuickDASH score and grip strength was improved as time passed, but no difference was observed between groups. Conclusion: Early symptom relief was associated with key pinch strength and surgical outcomes in patients with moderate to severe cubital tunnel syndrome.
Outcomes of the 6-Strand M-Tang Repair for Zone 2 Primary Flexor Tendon Repair in 45 Digits
Authors: Zhou Xiang , Li Xiang Rong , Qing Jun , Chen Jing , Tang Jin Bo
Published: September 2016

Objective: To report the clinical and functional outcomes of our patients with complete divisions of flexor tendons in zone 2 using a 6-strand core M-Tang repair method and partial early active motion protocol and examines the possible factors affecting the functional outcomes. Materials and Methods: We conducted a retrospective review of all patients who underwent flexor tendon in zone 2 of digits repair from November 2013 to July 2015 by a single surgeon in our department. A total of 45 digits (8 thumbs and 37 fingers) in 36 consecutive patients (9 females and 27 males) with complete divisions of flexor digitorum profundus (FDP) tendon, with or without concomitant flexor digitorum superficialis (FDS) lacerations in zone 2 of digits were included. We repaired flexor tendons in zone 2 using a 6-strand core M-Tang repair method using two groups of looped nylon sutures and partial early active motion protocol starting from postoperative day 4. We analyzed the different excellent and good rates of digits of different variables using the Fisher discriminate analysis. Results: The patients were followed for 7 to 18 months after surgery, and functional outcomes were evaluated with Strickland criteria. The recovery of function was excellent in 31 (68.9%), good in 8 (17.8%), and fair in 6 (13.3%) digits. There were no repair ruptures. No bowstringing was found in the fingers after venting of a part of the A2 pulley during follow-up. No significant differences were observed in the excellent/good rate among all different digits. However, we found that the recovery outcome of male patient was greater than female patient ( P, .002). Conclusions: We conclude that the 6-strand M-Tang core repair combined with partial early active motion is safe, and outcomes of the repair are generally good or excellent when surgeons and therapist follow the surgical and rehabilitation guidelines.
Functional Result of Tendon Transfers and Releases for the Upper Extremity in Spastic Hemiplegic Cerebral Palsy
Authors: Carrasco Marcia , Méndez Manuel , Aguilera Marcela , Naranjo Gianette , Parot Catalina
Published: September 2016

Purpose: To evaluate the functional and postural outcomes with Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) Test, stereognosis of tendon transfers, and releases for the upper extremity, in adolescents with spastic hemiplegic cerebral palsy (CP). Material and Methods: Prospective study of 11 patients with spastic hemiplegic CP, 8 men, 4 female, between 10 and 16 years of age (mean, 13 years). Inclusion criteria were no fixed articular deformity and patients capable to follow instructions. Surgery consists in a one-time procedure of tendon transfers and releases according to SHUEE and clinical preoperative evaluation. Surgical procedures were done considering individual evaluations as follows: adductor pollicis (AP) release and extensor pollicis longus (EPL) rerouting, 11 patients; extensor carpi ulnaris (ECU) to extensor carpi radialis longus transfer (ECRL), 6 patients; flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) transfer, 3 patients; pronator teres (PT) rerouting, 4 patients; release of the FCU, 3 patients; release of the PT, 4 patients; superficial finger flexor tendons release, 3 patients; and swan deformity correction, 3 patients. Before tendon transfer, muscles were previously assed by dynamic electromyography to confirm phasic behavior. Postoperative protocol includes 1-month cast immobilization followed by 20 sessions of physical therapy, orthotic, and scar compression. Assessment with SHUEE, 12-element stereognosis test, and HOUSE classification (JH House) were done at preoperative, 6 and 12 months after surgery. Results: Friedman analysis of the 3 sections of the SHUEE was done. The spontaneous functional analysis of SHUEE (SFA) improves from 53% preoperative to 62% at 12 month of surgery, which was not significant ( P, .12). Dynamic positional analysis (DPA) improves significantly from 53% preoperative to 64% at 6 months and 76% at 12 months of surgery ( P, .004), the best result was in wrist and the worse was thumb. There were significant improvements of the grasp and release analysis (GRA) from 82% to 100% at 12 months ( P, .002). No significant changes in stereognosis were observed improving from 50% to 75% ( P, .05). Functional classification of HOUSE before surgery was 3 to 7. All patients improved their function in HOUSE scale 1 or 2 levels at 6 months and 1 to 3 levels at 12 month. Conclusions: Tendon transfers and releases for the upper extremity in spastic hemiplegic CP adolescents without fixed articular deformities improves dynamic position, grasp and release, and HOUSE level of function.
Evaluation of Interobserver Agreement in the Albertoni’s Classification for Mallet Finger
Authors: de Souza Almeida Vinicius Alexandre , Fernandes Carlos Henrique , dos Santos Baptista Gomes Joao , Fernandes Francisco Schwartz , Fernandes Marcela , Nakachima Luis Renato , Faloppa Flavio , Albertoni Walter Manna
Published: September 2016

Objective: To measure the reliability of Albertoni’s classification for mallet finger. Methods: We performed an evaluation using a questionnaire where there were 43 pictures of radiographs of the distal interphalangeal joint with mallet finger. All lesions were classified by Albertoni’s classification, for a total of 19 respondents (12 hand surgeons and 7 interns). It was then evaluated by the interobserver agreement using the kappa coefficient, separated by groups—(1) tendon avulsion, (2) avulsion fracture, (3) fracture of the dorsal lip, and (4) phisis injury—and subgroups (each group divided into 1 and 2). Results: Agreement was excellent for the group A (k, 0.95 [0.93-0.97]) and remained good when separated into A1 and A2; group B was reasonable (k, 0.42 [0.39-0.44]), and poor when separated into B1 and B2; in the group C, agreement was good (k, 0.72 [0.70-0.74]), but when separated into C1 and C2, it became moderate. In group D, agreement was always bad (k, 0.16 [0.14-0.19]). The general agreement was moderate, with k, 0.57 (0.56-0.58). Conclusion: Albertoni’s classification evaluated for interobserver agreement is considered a reproducible classification by the method used in the research.
Benign Hand Soft Tissue Masses
Authors: Paz Susana Rodríguez , Fuentes Ruth Galtés , Segura Aureli Oriol , Vives Carles Nadal , Tarragó Antonio Rañé
Published: September 2016

Objective: To evaluate soft tissue masses of the hand and the wrist with ultrasonography and to correlate radiological diagnosis with pathological findings. Material and Methods: Fifty-eight suspected benign soft tissue tumors of the hand were evaluated with ultrasound preoperatively, retrospectively over an 8-year period. The radiological diagnosis was then compared with histopathology. Results: There were 29 females (50.8%). The mean age was 50 ± 13.7 years (range, 17-76 years). Forty-two masses were in the right hand (72.4%). The locations included the triphalangeal fingers (53.4%), thumb (20.68%), hand (20.7%), and wrist (10.34%). The most frequent pathological diagnosis was giant cell tumors of tendon sheath (GCTTS; n = 18). Less frequent tumors were the epidermal inclusion cyst (n = 9), vascular tumors (n = 8), ganglion cyst (n = 7), fibromas (n = 5), lipoma (n = 3), granulomatous foreign body reaction (n = 2), nonspecific inflammation (n = 2), and only one case of mixoma, one of neurofibroma, one of fibrokeratoma, and one of gouty tophus. A preoperative sonography diagnosis was given in the 79% of cases, and this was discrepant with the definitive histological diagnosis in 36%. We compared the discrepant and the concordant diagnosis with the most experimented sonographers or the less experimented, and we did not found significant statistical differences ( P, .1). The tumor that was most likely to have a discrepant diagnosis was the epidermal inclusion cyst (38%), as well as with the clinical evaluation (22.2%) and the surgeons’ macroscopic evaluation (50%). Less frequent discrepant diagnosis were the fibromas (14.2%), followed by non specific synovitis (n = 2), GCTTS (n = 2), fibrokeratoma (n = 1), lipoma (n = 1), neurofibroma (n = 1), angioleiomioma (n = 1), and tophus (n = 1). We evaluate the sensitivity and specificity of sonography in the diagnosis of GCTTS with the 84.6% and the 69.7%, respectively ( P, .001). The vascular tumors (3 cases of angioleiomioma, 3 cases of glomic tumor, 1 case of angioma, and 1 case of pseudotumor due to trombosis) had better sensibility (83.3%) and specificity (97.5%) with sonography ( P < .0001), as well as ganglion cyst (sensibility, 83.3% and specificity, 90%; P, .005). Discussion: Sonography can help in the preoperative diagnosis of hand soft tissues masses but, according to our results, its specificity is low to establish the specific diagnosis. In most conditions, imaging findings are nonspecific, and diagnosis rests on pathologic evaluation.
Treatment of Scaphoid Nonunion by Surgery and Extracorporeal Shockwave Therapy
Authors: Quadlbauer S. , Pezzei Ch. , Reb P. , Hausner T. , Leixnering M.
Published: September 2016

Objective/Hypothesis: Nonunion of the scaphoid is even today a challenge for the treating hand surgeon. Main cause of a scaphoid nonunion is the missed fracture, an inadequate immobilization or a fracture in the proximal third. As a consequence, scaphoid nonunion led to an osteosclerosis at the fracture surfaces and tilting of the fracture (“humpback deformity”). These changes consequently result in the end in a carpal collapse, the so-called scaphoid nonunion advanced collapse (SNAC) wrist. Several methods for treating scaphoid nonunion are available, like sole bone graft in the technique according to Matti-Russe, with or without additional stabilization by a headless bone screw or plate. In the last decades, Extracorporeal Shockwave Therapy (ESWT) has become an established procedure for nonunion treatment. However, the mechanism of shockwave therapy is poorly understood, but it is considered verified, that it leads to angiogenesis and vasculogenesis in the treated tissue, which causes a persisting increase of blood supply. Main aim of this study was to investigate union rate and clinical outcome of a combined treatment of scaphoid nonunion by surgery and ESWT. Material and Methods: Twenty-three patients with scaphoid nonunion treated by nonvascularized bone graft from the iliac crest, followed by ESWT within 2 weeks postsurgery, were investigated. A scaphoid plate was used in 11 patients, a double cannulated compression screw (CCS) in 9 patients, and 1 CCS in 3 patients. Age, gender, range of motion (ROM), date of surgery, the last follow-up examination, and surgical technique were included in the statistical analysis. Disabilities of the Arm, Shoulder and Hand (DASH) scores, Patient Rated Wrist Evaluation (PRWE), the Green O’Brien Score, and the Michigan Hand Questionnaire score were determined for all patients. A computed tomography (CT) was performed to analyze union and signs of osteoarthritis. An existing dorsal intercalated segment instability (DISI) deformity, a SNAC wrist, or a humpback deformity were registered. Results: The mean duration of follow-up was 20 ± 10 months. In the last CT, 87% of scaphoid nonunions healed. All scaphoid nonunions treated by plate showed union at follow-up. The mean DASH score was 12 ± 13 points, PRWE 12 ± 12 points, and Michigan Hand Questionnaire score 86%. The mean Green O’Brien was 87, which indicates a good clinical outcome. The mean ROM in the sagittal plane was 88 ± 18% while forearm rotation was 98 ± 5% compared with the healthy side. Two patients had a humpback deformity and 5 a mild DISI deformity. No patient had a SNAC wrist. Conclusion: The results of this case series suggest that a combination of surgery and extracorporeal shockwave is suitable for treating scaphoid nonunion with a good functional outcome. An additional finding was that all nonunions treated by a scaphoid plate healed at follow-up.
Midcarpal and STT Arthritis in Patients With CMC Arthritis
Authors: Katzel Evan B. , Shakir Sameer , Fowler John , Buterbaugh Glenn A. , Imbriglia Joseph E.
Published: September 2016

Introduction: Carpometacarpal (CMC) arthroplasty provides well-documented pain relief with preservation of thenar function. Nevertheless, a segment of the population undergoing this procedure will continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a major contributor to persistent pain after CMC arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. The goal of this study is to establish the radiographic prevalence of midcarpal arthritis in patients with CMC arthritis and/or STT (scaphotrapezotrapezoid) arthritis. Methods: Patients with basal joint arthritis were identified from a billing search using International Statistical Classification of Diseases and Related Health Problems (ICD)-9 code 716.94. Hand radiographs were retrospectively reviewed and graded using the Eaton classification and Sodha classification for CMC arthritis. STT arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis. Results: In all, 896 x-rays were reviewed. The overall prevalence of STT arthritis in this population was 64%. The overall prevalence of midcarpal arthritis in this population was 23.5%. The prevalence of midcarpal arthritis in patients with radiologic evidence of CMC arthritis was 25.4%. The prevalence of severe midcarpal arthritis was 7%. Conclusions: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24%. The presence of 2 locations of arthritis may explain persistent hand and wrist pain in this population despite CMC arthroplasty. Clinically, this data will allow hand surgeons to better educate patients with basal joint and midcarpal arthritis regarding the possibility of incomplete pain relief following CMC arthroplasty.
Total Distal Radioulnar Joint Arthroplasty
Authors: Breyer Juan Manuel , Perez Alfonso , Vergara Pamela , Sotelo Paula
Published: September 2016

Objective: The total distal radioulnar joint (DRUJ) arthroplasty is an alternative of treatment of patients with symptomatic DRUJ due to advanced chondral damage, chronic ligamenteous instability, and failed resection arthroplasty (Sauvé-Kapandji, Darrach, etc.). The objective of this study is to assess the outcomes of total DRUJ arthroplasty in a case-series at mid-term follow-up. Methods: We performed a prospective evaluation of 5 patients, mean age 43.3 years (range, 32-56), with more than 4 years (mean 6.6 years, median 6 years) after a total DRUJ prosthesis (Aptis Medical). The indication was in 3 cases due to a posttraumatic arthritis (2 chronic instability and 1 postfracture arthritis), 1 primary arthritis in an ulna minus wrist, and 1 failed symptomatic Sauvé-Kapandji. Patients were symptomatic for a mean of 47.6 months prior the DRUJ prosthesis, all had chronic pain with daily pain medication and had a median of 2 wrist surgeries previous to the prosthesis (range, 0-4). We assessed the outcomes of range of motion, pain, Disabilities of the Arm, Shoulder and Hand (DASH), and Patient Rated Wrist Evaluation (PRWE) scores at short-term and mid-term follow-up. Results: All patients had a significant improvement after the arthroplasty, at short-term (3-6 months) and mid-term. At the last evaluation, the mean arc of flexo-extension was 143° and prono-supination 148°. DASH score was 6.2 (range, 0-21.6) and PRWE score 17.2 (range, 0-53). Only 1 patient had mild to moderate pain, with occasional need of pain medications. Four patients required additional procedures, all of them at short-term (mean 12.3 months). One patient had an acute local infection treated with surgical debridement and implant preservation. Two patients had extensor tenosinovitis requiring tenolysis and 1 patient had excision of distal ulna calcifications. No patients have required implant removal and there have no sign of radiographic loosening. Conclusion: In this series of patients treated with a total DRUJ prosthesis, we observed a substantial clinical improvement, with preservation of motion, pain relief, and high functional levels, at short-term and mid-term follow-up. We consider the total DRUJ arthroplasty an excellent treatment option in selected patients with severely DRUJ damage.
Outcome of Ulnar Shorting Osteotomy
Authors: Hollevoet Nadine , Declercq Jonas , Vanhove Wim , Benis Szabolcs
Published: September 2016

Introduction: Ulnar shortening is a treatment option for ulnar wrist pain. Most frequently, this procedure is performed for ulnocarpal impingement, but it may also be useful in patients with persistent ulnar wrist pain after a sprain. The aim of the study was to assess outcome of patients who were operated on in our hospital with a diaphysial ulnar shortening osteotomy; to look for complications; and to find out if results were influenced by factors such as age, gender, hand dominance, smoking, type of osteotomy (horizontal or oblique), and length of follow-up; and whether or not a trauma was involved. Methods: Between 2006 and 2014, 37 out of 46 patients who were operated on in our hospital were available for evaluation with a mean follow-up of 54 months (range, 7-69). Mean age at the time of surgery was 39 years (range, 15-69), 24 were women, in 19 the dominant hand was involved, 15 were smokers, and in 28 a horizontal and in 9 an oblique osteotomy was performed. In 18 a trauma was involved, and in 14 there was an associated fracture of the radius or ulna. In all patients, Disability of Arm Shoulder and Hand (DASH) questionnaire, patient rated wrist hand evaluation (PRWE), visual analogue scale (VAS) for pain, satisfaction, and complications could be assessed, and in 25 grip strength and range of motion were determined. Statistical analyses (Mann-Whitney U test, independent samples t test) were performed to find out which factors had an influence on the outcome. Multiple regression analysis was done to assess influences on the DASH score. Results: Mean DASH was 22 (range, 0-75) and mean PRWE score 33 (range, 0-90). Mean VAS for pain was 2.6 (range, 0-7.8). Thirty patients were satisfied and 7 would not undergo the same operation again. In 17 the plate and screws had to be removed. In 3 cases with a horizontal osteotomy, a second operation had to be performed for nonunion. Two of them were smokers. Mean grip strength was 84%, mean wrist flexion 84%, extension 75%, pronation 85%, and supination 86% of the contralateral side. PRWE and DASH scores were significantly better in smokers. PRWE was significantly worse in posttraumatic ulnocarpal impaction syndrome. Multiple regression analysis showed a significantly better DASH score in smokers, in patients operated on the nondominant side and with a longer follow-up. Discussion and Conclusion: Ulnar shortening may not be able to solve ulnar wrist pain in all patients as one fifth was not satisfied. Complications should not be underestimated. Reoperations were needed in half of patients. Outcomes were better in idiopathic ulnocarpal impaction. In posttraumatic cases, ligamentous lesions may also play a role in causing ulnar wrist pain. Results were better when the follow-up was longer which may indicate that recovery after ulnar shortening may take long time or that patients may have adapted their activities. In contrast to other studies, outcome scores in the present study were better in smokers, but 2 of the 3 patients with nonunion were smokers.
Is It Useful to Assess Both QuickDASH and PRWE Scores?
Authors: Bodin Alexandre , Taleb Chihab , Lebailly Frederic , Liverneaux Philippe , Zemirline Ahmed
Published: September 2016

Objective/Hypothesis: Scoring systems are widely used in medicine and surgery. During the last decade, the reduced version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) has established itself as the main Patient Reported Outcome Measures (PROMs) questionnaire used by hand surgeons. Another measurement tool can be used when the condition affects more precisely the wrist: the Patient-Rated Wrist Evaluation (PRWE). The aim of this study is to find out how correlated these 2 scores are. Materials and Methods: More than 2000 wrist clinical evaluations (including QuickDASH and PRWE), performed for any kind of condition the last 2 years, were gathered and analyzed. Spearman’s rank correlation coefficient was used to compare the visual analogue scale (VAS) score for pain, QuickDASH, and PRWE values. Results: There is a high correlation between these 3 subjective scores. Spearman’s rank correlation coefficient reaches .70 when assessing VAS and QuickDASH, .73 when assessing VAS and PRWE, and .86 when assessing PRWE and QuickDASH. Conclusions: With the statistical power that provides a huge sample, it is proven that QuickDASH and PRWE scores are highly correlated. Thus, we can abandon one of them to spare time without loosing relevant information.
Resection of the Distal Pole of the Scaphoid in Symptomatic Scaphotrapeziotrapezoid Osteoarthritis and Symptomatic Scaphoid Nonunion
Authors: Wessing D. , Bachour Y. , Berkhout M. J. L. , Ritt M. J. P. F.
Published: September 2016

Purpose: Resection of the distal pole of the scaphoid is one of the surgical techniques applied for the treatment of painful scaphotrapeziotrapezoid osteoarthritis (STT-OA) and nonunion of fractures in the distal part of the scaphoid. Very few studies report on the outcome of this technique. The purpose of this study is to evaluate the midterm outcomes in a consecutive series of patients. Methods: This is a retrospective study in which we evaluated 13 patients (15 wrists) with a mean follow-up of 4.1 years. The indication for surgery was in all cases a STT-OA. We evaluated objective functional outcome measures (range of motion and grip strength) and patient-reported outcome measures (visual analogue scale for pain, Michigan Hand Questionnaire [MHQ], and Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]). The degree of dorsal intercalated segmental instability (DISI) and the postoperative complications were also assessed. Results: Extension and flexion averaged 61.6° and 74.3°, while radial and ulnar deviation averaged 16.7° and 27.8°, respectively. Grip strength at position 1 to 5, respectively, averaged 16.0, 23.6, 21.5, 18.3, and 15.6 kg. Reported pain averaged 2.1/10, MHQ 76.4/100, and QuickDASH 25.2/100. A mild postoperative DISI deformity was observed in 13 wrists with an average lunocapitate angle of 22.1° (range, 0°-44°) on radiographic evaluation without a correlation with reported pain scores. None of the opposite wrists, whether with or without STT-OA, displayed DISI deformity. The only observed complication was a complex regional pain syndrome in 1 case. Discussion: The midterm results for distal pole resection of the scaphoid in the treatment of STT-OA and scaphoid nonunion are satisfactory. Almost all patients develop a mild degree of DISI deformity, but this does not affect the outcome.