Subjects -> MEDICAL SCIENCES (Total: 8196 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (205 journals)
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MEDICAL SCIENCES (2241 journals)            First | 1 2 3 4 5 6 7 8 | Last

Showing 601 - 800 of 3562 Journals sorted alphabetically
Extreme Physiology & Medicine     Open Access   (Followers: 1)
F&S Reports     Open Access  
F&S Science : Official journal of the American Society for Reproductive Medicine     Open Access  
Facial Plastic Surgery & Aesthetic Medicine     Full-text available via subscription   (Followers: 7)
Facta Universitatis, Series : Medicine and Biology     Open Access  
Family Medicine and Community Health     Open Access   (Followers: 8)
Family Practice     Hybrid Journal   (Followers: 17)
Family Practice & Palliative Care     Open Access   (Followers: 5)
Family Practice Management     Full-text available via subscription   (Followers: 4)
Faridpur Medical College Journal     Open Access  
FEM : Revista de la Fundación Educación Médica     Open Access  
Finlay : Revista de Enfermedades no Transmisibles     Open Access  
Fisioterapia     Full-text available via subscription   (Followers: 2)
Fisioterapia & Saúde Funcional     Open Access  
Flugmedizin · Tropenmedizin · Reisemedizin - FTR     Hybrid Journal  
FMC - Formación Médica Continuada en Atención Primaria     Full-text available via subscription  
Folia Medica     Open Access  
Folia Medica Indonesiana     Open Access  
Folia Morphologica     Full-text available via subscription  
Folia Phoniatrica et Logopaedica     Full-text available via subscription   (Followers: 1)
Fontanus     Open Access   (Followers: 1)
Food Hydrocolloids for Health     Open Access  
Foodborne Pathogens and Disease     Hybrid Journal   (Followers: 11)
Foot & Ankle Specialist     Hybrid Journal   (Followers: 4)
Foot and Ankle Clinics     Full-text available via subscription   (Followers: 12)
Foot and Ankle Online Journal     Full-text available via subscription   (Followers: 6)
Forensic Science International : Mind and Law     Open Access   (Followers: 4)
Forum Medycyny Rodzinnej     Hybrid Journal  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontières     Full-text available via subscription   (Followers: 3)
Frontiers in Digital Health     Open Access   (Followers: 4)
Frontiers in Medical Technology     Open Access  
Frontiers in Medicine     Open Access   (Followers: 2)
Frontiers in Network Physiology     Open Access   (Followers: 2)
Frontiers in Neuroprosthetics     Open Access   (Followers: 6)
Frontiers in Synaptic Neuroscience     Open Access   (Followers: 2)
Frontiers in Tropical Diseases     Open Access  
Frontiers of Medical and Biological Engineering     Hybrid Journal  
Frontiers of Medicine     Hybrid Journal   (Followers: 2)
Fuss & Sprunggelenk     Hybrid Journal  
Future Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Future Prescriber     Hybrid Journal  
Future Science OA     Open Access  
Gaceta Médica Boliviana     Open Access  
Gaceta Médica Espirituana     Open Access  
Galen Medical Journal     Open Access  
Galician Medical Journal     Open Access   (Followers: 1)
Galle Medical Journal     Open Access  
Gefäßmedizin Scan     Hybrid Journal  
Gender and the Genome     Open Access   (Followers: 1)
Gene Expression     Full-text available via subscription   (Followers: 1)
General Reanimatology     Open Access  
Genes     Open Access   (Followers: 2)
Genome Instability & Disease     Hybrid Journal  
Geoforum     Hybrid Journal   (Followers: 25)
Gestão e Desenvolvimento     Open Access  
Ghana Medical Journal     Open Access   (Followers: 1)
GigaScience     Open Access   (Followers: 4)
Gimbernat : Revista d’Història de la Medicina i de les Ciències de la Salut     Open Access  
Glia     Hybrid Journal   (Followers: 5)
Global Advances in Health and Medicine     Open Access  
Global Bioethics     Open Access   (Followers: 5)
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Journal     Open Access   (Followers: 2)
Global Journal of Integrated Chinese Medicine and Western Medicine     Open Access  
Global Journal of Cancer Therapy     Open Access  
Global Journal of Fertility and Research     Open Access  
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Infectious Diseases and Clinical Research     Open Access   (Followers: 1)
Global Journal of Medical and Clinical Case Reports     Open Access  
Global Journal of Obesity, Diabetes and Metabolic Syndrome     Open Access   (Followers: 2)
Global Journal of Perioperative Medicine     Open Access  
Global Journal of Rare Diseases     Open Access  
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Reproductive Health     Open Access  
Grande Medical Journal     Open Access  
Growth Factors     Hybrid Journal   (Followers: 2)
GSTF Journal of Advances in Medical Research     Open Access  
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi     Open Access  
Hamdan Medical Journal     Open Access  
Hämostaseologie     Hybrid Journal   (Followers: 4)
Hämostaseologie     Open Access  
Hand     Hybrid Journal   (Followers: 4)
Hand Clinics     Full-text available via subscription   (Followers: 6)
Hand Therapy     Hybrid Journal   (Followers: 11)
Hard Tissue     Open Access  
Head & Face Medicine     Open Access   (Followers: 1)
Head and Neck Cancer Research     Open Access  
Head and Neck Tumors     Open Access  
Health Information : Jurnal Penelitian     Open Access  
Health Matrix : The Journal of Law-Medicine     Open Access  
Health Notions     Open Access  
Health Science Journal of Indonesia     Open Access  
Health Science Reports     Open Access   (Followers: 1)
Health Sciences and Disease     Open Access   (Followers: 1)
Health Sciences Review     Open Access  
Health Security     Hybrid Journal   (Followers: 1)
Healthcare Technology Letters     Open Access  
Hearing, Balance and Communication     Hybrid Journal   (Followers: 6)
Hearts     Open Access   (Followers: 1)
HEC Forum     Hybrid Journal   (Followers: 1)
Heighpubs Otolaryngology and Rhinology     Open Access  
Heilberufe     Hybrid Journal  
HeilberufeSCIENCE     Hybrid Journal  
Heilpflanzen     Hybrid Journal   (Followers: 8)
Helicobacter     Hybrid Journal  
HemaSphere     Open Access   (Followers: 2)
Hemoglobin     Hybrid Journal  
Hepatology, Medicine and Policy     Open Access  
HERALD of North-Western State Medical University named after I.I. Mechnikov     Open Access  
Herald of the Russian Academy of Sciences     Full-text available via subscription  
Herzschrittmachertherapie + Elektrophysiologie     Hybrid Journal  
Highland Medical Research Journal     Full-text available via subscription  
Hipertensión y Riesgo Vascular     Full-text available via subscription  
HIV Australia     Full-text available via subscription   (Followers: 3)
Homeopathy     Hybrid Journal   (Followers: 1)
Homoeopathic Links     Hybrid Journal  
Hong Kong Physiotherapy Journal     Open Access   (Followers: 14)
Horizonte Medico     Open Access  
Hormones : International Journal of Endocrinology and Metabolism     Hybrid Journal  
Hospital a Domicilio     Open Access  
Hospital Practices and Research     Open Access  
Hospital Topics     Hybrid Journal   (Followers: 1)
Hua Hin Sook Jai Klai Kangwon Journal     Open Access  
Huisarts en wetenschap     Hybrid Journal   (Followers: 4)
Human & Veterinary Medicine - International Journal of the Bioflux Society     Open Access   (Followers: 4)
Human Factors in Healthcare     Open Access   (Followers: 2)
Human Fertility     Hybrid Journal   (Followers: 4)
Humanidades Médicas     Open Access  
I.P. Pavlov Russian Medical Biological Herald     Open Access  
Iatreia     Open Access  
Ibnosina Journal of Medicine and Biomedical Sciences     Open Access  
IDCases     Open Access  
IEEE Journal of Biomedical and Health Informatics     Hybrid Journal   (Followers: 14)
IEEE Journal of Electromagnetics, RF and Microwaves in Medicine and Biology     Hybrid Journal  
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 5)
IEEE Open Journal of Engineering in Medicine and Biology     Open Access   (Followers: 1)
IEEE Transactions on Medical Robotics and Bionics     Hybrid Journal   (Followers: 3)
IEEE/ACM Transactions on Computational Biology and Bioinformatics     Hybrid Journal   (Followers: 18)
IJID Regions     Open Access   (Followers: 1)
IJS Global Health     Open Access  
IJU Case Reports     Open Access  
iLiver     Open Access   (Followers: 6)
Im OP     Hybrid Journal  
Image Analysis & Stereology     Open Access   (Followers: 1)
IMAGING     Full-text available via subscription   (Followers: 1)
Imaging in Medicine     Open Access  
Imaging Journal of Clinical and Medical Sciences     Open Access   (Followers: 1)
Imam Journal of Applied Sciences     Open Access  
Indian Journal of Ayurveda and lntegrative Medicine Klue     Open Access   (Followers: 4)
Indian Journal of Burns     Open Access   (Followers: 2)
Indian Journal of Clinical Medicine     Open Access  
Indian Journal of Community and Family Medicine     Open Access   (Followers: 3)
Indian Journal of Community Medicine     Open Access   (Followers: 1)
Indian Journal of Health Sciences and Biomedical Research KLEU     Open Access   (Followers: 2)
Indian Journal of Medical Microbiology     Open Access   (Followers: 1)
Indian Journal of Medical Research     Open Access   (Followers: 3)
Indian Journal of Medical Sciences     Open Access   (Followers: 2)
Indian Journal of Medical Specialities     Hybrid Journal  
Indian Journal of Otology     Open Access   (Followers: 1)
Indian Journal of Public Health     Open Access   (Followers: 1)
Indian Journal of Transplantation     Open Access  
Indian Spine Journal     Open Access  
Indo-Pacific Journal of Phenomenology     Open Access   (Followers: 1)
Indonesia Journal of Biomedical Science     Open Access   (Followers: 1)
Indonesian Biomedical Journal     Open Access  
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Indonesian Journal of Medicine     Open Access  
Indonesian Journal of Tropical and Infectious Disease     Open Access  
Infant Observation: International Journal of Infant Observation and Its Applications     Hybrid Journal   (Followers: 1)
Inflammation     Hybrid Journal   (Followers: 3)
Inflammation Research     Hybrid Journal   (Followers: 4)
Info Diabetologie     Full-text available via subscription   (Followers: 1)
Infodir : Revista de Información científica para la Dirección en Salud     Open Access  
Informatics in Medicine Unlocked     Open Access  
Injury Prevention     Hybrid Journal   (Followers: 6)
InnovAiT     Hybrid Journal   (Followers: 1)
Innovare Journal of Health Science     Open Access  
Innovare Journal of Medical Science     Open Access  
Innovation in Aging     Open Access   (Followers: 1)
Inside Precision Medicine     Full-text available via subscription   (Followers: 6)
Insights in Biology and Medicine     Open Access  
Integrative and Complementary Therapies     Full-text available via subscription   (Followers: 6)
Integrative Medicine Insights     Open Access   (Followers: 1)
Integrative Medicine International     Open Access   (Followers: 1)
Integrative Medicine Research     Open Access   (Followers: 3)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 12)
Intelligence-Based Medicine     Open Access  
Intelligent Medicine     Open Access   (Followers: 1)
intensiv     Hybrid Journal   (Followers: 1)
interactive Journal of Medical Research     Open Access  
Interdisciplinary Perspectives on Infectious Diseases     Open Access   (Followers: 1)
Interdisciplinary Sciences : Computational Life Sciences     Hybrid Journal   (Followers: 2)
Internal Medicine     Open Access   (Followers: 1)
International Biomechanics     Open Access   (Followers: 1)
International Health     Hybrid Journal   (Followers: 5)
International Health Trends and Perspectives     Open Access  
International Journal for Numerical Methods in Biomedical Engineering     Hybrid Journal   (Followers: 2)
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 10)
International Journal of Academic Medicine     Open Access   (Followers: 1)

  First | 1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Hand
Journal Prestige (SJR): 0.503
Citation Impact (citeScore): 1
Number of Followers: 4  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1558-9455 - ISSN (Online) 1558-9447
Published by Sage Publications Homepage  [1174 journals]
  • Hand and Wrist Injuries Associated With Application of Physical
           Restraints: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Shawn Khan, Adam Mosa, Adam Clayton, Steven McCabe
      Abstract: HAND, Ahead of Print.
      While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand and wrist. This paper seeks to characterize the safety of physical restraints by summarizing its effects on hand and wrist function and disability. Relevant studies were gathered through an independent double selection and extraction process using 3 electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to June 19, 2020. A total of 16 studies involving 807 participants were included. Lesion to the superficial branch of the radial nerve was the most commonly reported injury noted in 82% (42/55) of hands examined. A total of 6% (5/77) of examined hands had bony injury, including 3 radial styloid fractures and 2 scaphoid fractures. Both studies on zip ties noted presence of handcuff neuropathy, with 1 case report documenting severe rapidly progressing ischemic monomelic neuropathy. Overall, the use of handcuffs and zip ties is associated with entrapment neuropathies and bony injury to the hand and wrist. Further studies of higher quality evidence are necessary to understand the effects of physical restraint on hand function and disability.
      Citation: HAND
      PubDate: 2022-07-02T06:27:15Z
      DOI: 10.1177/15589447221105548
       
  • Surgeons’ Recommendations for Return to Work After Carpal Tunnel
           Release

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      Authors: Tobias N. von Bergen, Risa Reid, Matthew Delarosa, John Gaul, Christopher Chadderdon
      Abstract: HAND, Ahead of Print.
      Background:Recommendations and expectations regarding return to work (RTW) after carpal tunnel release (CTR) are often inconsistent. The study aim was to describe preferences of American Society for Surgery of the Hand (ASSH) members for perioperative management of patients following CTR, emphasizing surgeon preference regarding RTW.Methods:A survey was sent to all ASSH members with active e-mail addresses. The primary outcome was the recommended time frame for patients to RTW full duty. Secondarily, associated factors with RTW were evaluated.Results:In total, 4109 e-mail surveys were sent with 632 responses (15%). The highest proportion of respondents perform>100 CTRs per year (43.2%), have been practicing for>20 years (38.1%), and perform CTR using standard, open approach at outpatient surgery centers. The primary surgeon made recommendations about RTW in 99.5% of cases. For desk-based duties, the median recommended RTW time was 3 days; for duties requiring repetitive, light lifting of
      Citation: HAND
      PubDate: 2022-06-29T07:27:08Z
      DOI: 10.1177/15589447221085700
       
  • Radial Osteotomy With Callus Distraction for the Correction of Severe
           Madelung Deformity

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      Authors: Hirotaka Sugiura, Emiko Horii, Shukuki Koh
      Abstract: HAND, Ahead of Print.
      We report a case of an 11-year-old girl with bilateral severe Madelung deformity who underwent radial osteotomy with callus distraction. The distal radial articulation was corrected at surgery, and a unilateral fixator was subsequently used for callus distraction. No postoperative complication was noted. The patient did not need any additional surgeries for correction of the deformity. Forty-three months after surgery, the patient had a nearly full range of motion without any pain. Forearm deformity was not noticeable, except for surgical scar on both wrists.
      Citation: HAND
      PubDate: 2022-06-20T12:14:17Z
      DOI: 10.1177/15589447221095113
       
  • Outcomes in Ballistic Injuries to the Hand: Fractures and Nerve/Tendon
           Damage as Predictors of Poor Outcomes

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      Authors: Patrick M. Dugom, Mitchell P. Jester, William H. Archie, Duy M. Huynh, Josh F. Scarcella, Yifan Guo
      Abstract: HAND, Ahead of Print.
      Background:Gunshot injuries can be devasting, regardless of their location. However, ballistic injuries involving the upper extremity have not been thoroughly investigated. The goal of this study is to evaluate the injury patterns and outcomes of patients who sustained gunshot injuries to the hand.Methods:A retrospective chart review of patients with gunshot injuries to the upper extremity at a single, level 1 trauma center between January 2016 and December 2017 was performed. Patient demographics and mechanisms of injuries were reviewed. The injury patterns, location, tendon/nerve involvement, and bony involvement were analyzed. Surgical interventions and long-term outcomes were reviewed. Outcomes were compared using the presence of fractures and nerve/tendon injuries as independent variables.Results:In all, 32 patients met our inclusion criteria. Of these, 15 patients had gunshots to the hand, 10 patients to the fingers, and 7 patients involving both the finger and hand. In patients with isolated hand injuries, 60% had fractures and 53% had nerve/tendon injuries. The presence of fractures was associated with a 7.9-fold increase in tendon and nerve injuries (P = .032). Patients who sustained tendon/nerve injuries had significantly higher rates of permanent disability (P = .01). The presence of a fracture leads to a higher likelihood of long-term complications, although not statistically significant (P = .13).Conclusion:Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries. The presence of fractures is associated with a higher incidence of nerve and tendon injuries. Involvement of these structures is linked to an increased risk of long-term disability.
      Citation: HAND
      PubDate: 2022-06-13T12:46:07Z
      DOI: 10.1177/15589447221092111
       
  • A Cadaveric Comparison of Approaches for Exposure of the Volar Distal
           Radius: Is There a Utilitarian Approach'

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      Authors: William J. Warrender, Daniel J. Wagner, Reed W. Hoyer, Gregory A. Merrell, William B. Kleinman, Brandon S. Smetana
      Abstract: HAND, Ahead of Print.
      Background:It remains unclear whether exposure for planned fixation of distal radius fractrues is superior with any given approach, and whether a single utilitarian approach exists that permits reliable complete exposure of the volar distal radius.Methods:A cadaveric study was performed using 10 matched specimens. Group 1 consisted of 3 radially based approaches (standard flexor carpi radialis [FCR], standard FCR with radial retraction of FCR and flexor pollicis longus [FPL] tendons, extended FCR). Group 2 consisted of 2 ulnarly based approaches (volar ulnar, extended carpal tunnel). The primary outcome was total width of exposed distal radius at the watershed line. Mann-Whitney U and Wilcoxon rank testing was used to identify differences.Results:The standard FCR approach exposed 29 mm (90%), leaving on average 3 mm (10%) of the ulnar corner unexposed. Retracting the FCR and FPL tendons radially allows for an extra 1 mm of volar ulnar corner exposure. Finally, converting to an extended FCR approach provided 100% exposure in all specimens. The volar ulnar exposure however provided exposure to only 9 mm (37%), leaving 20 mm (62.5%) left unexposed radially. The extended carpal tunnel provided exposure to 21 mm (65%), leaving 11 mm (35%) radially unexposed. Differences between each group were statistically significant (P < .05).Conclusions:The extended FCR approach exposed 100% of the volar distal radius in our study and may serve as a utilitarian volar surgical approach for exposure and fixation of distal radius fractures. Additional knowledge of the limitations of alternative approaches can be helpful in surgical planning.
      Citation: HAND
      PubDate: 2022-06-13T11:38:56Z
      DOI: 10.1177/15589447221094320
       
  • Can Diffusion Tensor Imaging Apparent Diffusion Coefficient Diagnose
           Carpal Tunnel Syndrome' A Systematic Review and Meta-Analysis

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      Authors: Adam G. Evans, Maurice D. Morgan, Benjamin A. Aiken, Patrick E. Assi, Jeremy T. Joseph, Tigran Kesayan, Lauren M. Mioton, Isaac V. M. Esteve, J. Bradford Hill, Wesley P. Thayer, Salam Al Kassis
      Abstract: HAND, Ahead of Print.
      Magnetic resonance diffusion tensor imaging (DTI) can detect microstructural changes in peripheral nerves. Studies have reported that the median nerve apparent diffusion coefficient (ADC), a quantification of water molecule diffusion direction, is sensitive in diagnosing carpal tunnel syndrome (CTS). Five databases were searched for studies using ADC to investigate CTS. Apparent diffusion coefficient (measured in mm2/s) were pooled in random-effects meta-analyses. Twenty-two studies met criteria yielding 592 patients with CTS and 414 controls. Median nerve ADC were measured at the level of the distal radioulnar joint (CTS ADC: 1.11, 95% CI: 1.07-1.15, I2 = 54%; control ADC: 1.04, 95% CI: 1.01-1.07, I2 = 57%), pisiform (CTS ADC: 1.39, 95% CI: 1.37-1.42, I2 = 0%; control ADC: 1.27, 95% CI: 1.23-1.31, I2 = 59%), hamate (CTS ADC: 1.40, 95% CI: 1.36-1.43, I2 = 58%; control ADC: 1.27, 95% CI: 1.25-1.28, I2 = 47%), and as an combination of several measurements (CTS ADC: 1.40, 95% CI: 1.37-1.47, I2 = 100%; control ADC: 1.39, 95% CI: 1.24-1.53, I2 = 100%). Median nerve ADC is decreased in individuals with CTS compared to controls at the levels of the hamate and pisiform. ADC cut-offs to diagnose CTS should be established according to these anatomic levels and can be improved through additional studies that include use of a wrist coil.
      Citation: HAND
      PubDate: 2022-06-13T11:37:37Z
      DOI: 10.1177/15589447221096706
       
  • Does Time to Operative Intervention of Distal Radius Fractures Influence
           Outcomes'

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      Authors: Farhan Ahmad, Mithun Neral, Harry Hoyen, Xavier Simcock, Kevin Malone
      Abstract: HAND, Ahead of Print.
      Background:No investigation has analyzed the time from injury to operative intervention and its effect on complications and functional outcomes in distal radius fractures. This investigation aimed to establish whether the time to surgical intervention from injury was associated with the observed rate of complications in distal radius fractures.Methods:A retrospective review of all orthopedic trauma patients who came to our center was conducted from 2008 through 2014. Patients who sustained closed distal radius fractures were included. A postoperative complication following distal radius fracture was defined as reoperation, superficial or deep infection, complex regional pain syndrome, new-onset carpal tunnel syndrome, tendon irritation, and symptomatic hardware.Results:In all, 190 patients were included in the study with a mean age of 48 years (SD ±14.7). According to the AO-Müller/Orthopaedic Trauma Association classification, radiographs revealed 80 A fractures, 15 B fractures, and 95 C fractures. Thirty distal radii were fixed within 0 to 3 days after injury, 91 patients within 4 to 10 days, and 69 patients after 10 days. Overall, 28 complications (14.7%) were identified. There was no statistical difference in the rate of complications between the time interval groups (P = .17).Conclusions:Despite the increased popularity of surgical intervention for distal radius fractures, the optimal parameters to maximize patient outcomes have yet to be clearly defined. Time to intervention did not affect the rate of postoperative complication and range of motion.
      Citation: HAND
      PubDate: 2022-06-11T10:04:33Z
      DOI: 10.1177/15589447211072219
       
  • The 5-Item Modified Frailty Index for Risk Stratification of Patients
           Undergoing Total Elbow Arthroplasty

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      Authors: Adam M. Gordon, Charles A. Conway, Bhavya K. Sheth, Matthew L. Magruder, Jack Choueka
      Abstract: HAND, Ahead of Print.
      Background:Frailty, quantified using the 5-item modified frailty index (mFI-5), has been shown to predict adverse outcomes in orthopaedic surgery. The utility in total elbow arthroplasty (TEA) patients is unclear. We evaluated if increasing frailty would correlate with worse postoperative outcomes.Methods:A retrospective assessment of patients in the American College of Surgeons National Surgery Quality Improvement Program undergoing primary TEA was performed. The mFI-5 was calculated by assigning 1 point for each comorbidity (diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status). Poisson regression was used to evaluate mFI-5 scores on complications, length of stay (LOS), and adverse discharge. A significance threshold was at P < .05.Results:In total, 609 patients were included; 34.5% (n = 210) were not frail (mFI = 0), 44.0% (n = 268) were slightly frail (mFI = 1), and 21.5% (n = 131) were frail (mFI ≥ 2). As mFI score increased from 0 to ≥ 2, the following rates increased: any complication (9.0%-19.8%), major complication (11.0%-20.6%), cardiac complication (0.0%-2.3%), hematologic complication (3.3%-9.2%), adverse discharge (2.9%-22.9%), and LOS from 2.08 to 3.97 days (all P < .048). Following adjustment, Poisson regression demonstrated patients with a mFI ≥ 2 had increased risk of major complication (risk ratio [RR]: 2.13; P = .029), any complication (RR: 2.49; P = .032), Clavien-Dindo IV complication (RR: 5.53; P = .041), and adverse discharge (RR: 5.72; P < .001).Conclusions:Frailty is not only associated with longer hospitalizations, but more major complications and non-home discharge. The mFI-5 is a useful risk stratification that may assist in decision-making for TEA.
      Citation: HAND
      PubDate: 2022-06-11T10:03:23Z
      DOI: 10.1177/15589447221093728
       
  • Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year
           Analysis

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      Authors: Samantha N. Weiss, Grace V. Gilbert, Pietro Gentile, John P. Gaughan, Sandra Miskiel, Andre Pagliaro, Rey Ramirez, David A. Fuller
      Abstract: HAND, Ahead of Print.
      Purpose:Concern exists that Medicare physician fees for procedures have decreased over the past 20 years. The Centers for Medicare & Medicaid Services (CMS) is set to re-evaluate these physician fees in the near future for concern that these procedures are overvalued. Our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2019 for the top 20 most billed hand and upper extremity surgical procedures at our institution.Methods:The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology codes most frequently utilized in orthopedic hand and upper extremity procedures in 2019. The Physician Fee Schedule Look-Up Tool from the CMS was queried for annual physician fee data. Monetary data were adjusted for inflation using the consumer price index of Urban Research Series (CPI-U-RS) and expressed in 2019 constant US dollars (USD). The average annual and total percent change in reimbursement were calculated via linear regression for all procedures (P < .05).Results:Accounting for inflation, the total average physician reimbursement decreased by 20.9% from 2000 to 2019, with 12 of 20 codes decreasing by more than 20%. The greatest decrease pertained to arthrodesis of the wrist at 33.9%. Upon linear regression, all procedures were found to decrease annually, with arthrodesis of the wrist decreasing by an average of 2.3% annually over this period.Conclusions:Over the past 2 decades, physician reimbursement for hand and upper extremity procedures has significantly decreased.
      Citation: HAND
      PubDate: 2022-06-07T09:15:05Z
      DOI: 10.1177/15589447221096708
       
  • Acute Thumb Reconstruction With Medial Femoral Condyle and Radial Forearm
           Free Flaps: A Case Report

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      Authors: Andrew P. Golin, Zach Zhang, Imran Ratanshi, Colin W. McInnes
      Abstract: HAND, Ahead of Print.
      Traumatic thumb injuries often result in significant functional disability. With segmental bone loss, reconstructive options include antibiotic cement with delayed bone graft, revision amputation with webspace deepening, metacarpal distraction osteogenesis, index pollicization, bone flap, and free toe transfer. We present a case of a subtotal thumb amputation just distal to the metacarpal phalangeal joint resulting in loss of both soft tissue and a segmental bone defect of the proximal and distal phalanx. Reconstruction was initially performed with a chimeric bone free flap from the medial femoral condyle with a vastus medialis muscle cuff to provide soft tissue coverage. A revision soft tissue coverage procedure was required and a radial forearm free flap was utilized. His reconstruction restored his missing bone and soft tissue, and provided stability with sufficient grip strength and metacarpophalangeal function resulting in a satisfactory functional outcome.
      Citation: HAND
      PubDate: 2022-06-07T05:24:31Z
      DOI: 10.1177/15589447221096705
       
  • Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs

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      Authors: Eugenia Lee, Quinn A. Stillson, Henry D. Seidel, Sarah Bhattacharjee, Jason L. Koh, Jason A. Strelzow, Lewis L. Shi
      Abstract: HAND, Ahead of Print.
      Background:Distal triceps ruptures are rare, and complete ruptures are commonly treated with surgery. Studies of patients in small cohorts with distal triceps tear have reported outcomes and risk factors; however, large-scale data are scant. This study seeks to determine current trends, outcomes, and risk factors of distal triceps tears.Methods:Within a large insurance claims database, distal triceps repair patients were identified through Current Procedural Terminology coding with concomitant distal triceps International Classification of Diseases, 9th Revision/10th Revision diagnosis codes and 1-year active status before and after surgery. Demographics, total costs, 90-day complications, and revision rates within 1 year of index surgery were analyzed. Logistic regression was performed for revision and complication rates using sex, age, and comorbidities (anabolic steroid use, diabetes, ischemic heart disease, tobacco use, rheumatoid arthritis, and chronic kidney disease).Results:A total of 8143 patients were included in the cohort. Male patients and patients aged 40 to 59 years comprised most of the study population. The postoperative complication rate was 5.8%, and the 1-year revision rate was 2.6%. Male sex, age >60 years, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease were statistically significant risk factors for higher 90-day complication rates. Anabolic steroid use significantly increased the risk of surgical revision.Conclusions:Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. Complications are generally low, with age >60 years, male sex, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease as risk factors for 90-day complications and prior anabolic steroid use as a risk factor for 1-year revision surgery. This information can help to improve education and expectations of this procedure.
      Citation: HAND
      PubDate: 2022-06-06T11:47:16Z
      DOI: 10.1177/15589447221095114
       
  • Social Disparities in the Management of Trigger Finger: An Analysis of 31
           411 Cases

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      Authors: Peter G. Brodeur, Jeremy E. Raducha, Kang Woo Kim, Cameron Johnson, Elliott Rebello, Aristides I. Cruz, Joseph A. Gil
      Abstract: HAND, Ahead of Print.
      Background:Cost and compliance are 2 factors that can significantly affect the outcomes of non-operative and operative treatment of trigger finger (TF) and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF.Methods:Adult patients (≥18 years old) were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology (CPT) procedural codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database. Each diagnosis was linked to procedure data to determine which patients went on to have TF release. A multivariable logistic regression was performed to assess the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation index (SDI), Charlson Comorbidity Index, and primary insurance type. A P-value < .05 was considered significant.Results:Of the 31 411 TF patients analyzed, 8941 (28.5%) underwent surgery. Logistic regression analysis showed higher odds of receiving surgery in females (odds ratio [OR]: 1.108) and those with workers compensation (OR: 1.7). Hispanic (OR: 0.541), Asian (OR: 0.419), African American (OR: 0.455), and Other race (OR: 0.45) had decreased odds of surgery. Medicaid (OR: 0.773), Medicare (OR: 0.841), and self-pay (OR: 0.515) reimbursement methods had reduced odds of receiving surgery. Higher social deprivation was associated with decreased odds of surgery (OR: 0.988).Conclusions:There are disparities in demographic characteristics among those who receive TF release for trigger finger related to race, primary insurance, and social deprivation.
      Citation: HAND
      PubDate: 2022-06-06T11:45:03Z
      DOI: 10.1177/15589447221094040
       
  • Can the Sup-ER Protocol Decrease the Prevalence and Severity of Elbow
           Flexion Deformity in Brachial Plexus Birth Injuries'

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      Authors: Leeor Yefet, Doria Bellows, Marija Bucevska, Rebecca Courtemanche, Kim Durlacher, Sally Hynes, Cynthia Verchere
      Abstract: HAND, Ahead of Print.
      Background:Brachial plexus birth injuries (BPBIs) can often result in functional and cosmetic deficits including, according to a recent scoping review, elbow flexion contractures in up to 48%. A treatment algorithm that includes a custom long-arm orthosis to optimize early glenohumeral joint positioning (Sup-ER protocol) has been shown to improve shoulder range of motion. Although the protocol was not intentionally designed to affect the elbow, this study investigates the prevalence and severity of elbow flexion contractures in children treated with that protocol.Methods:This prospective cross-sectional cohort study examined 16 children aged 4 and older with BPBI severe enough to be treated with the Sup-ER protocol. Passive and active elbow flexion and extension range of motion (ROM) were assessed in both arms. Elbow flexion contractures were defined as > 5o from neutral.Results:Within the cohort of 16 patients (mean age: 7.0 years, range: 4.5-11.6 years), the mean maximal passive elbow extension was -6.2° in the affected arm and + 5.1° (hyperextension) in the unaffected arm. Zero patients had a severe elbow flexion contracture (>30o) and only 6/16 met the lowest threshold definition of elbow flexion contracture (>5o), with a mean onset at 22 months of age.Conclusions:This study suggests an unintended decreased prevalence and severity of elbow flexion contractures in children with more severe BPBI treated with the Sup-ER protocol, relative to published values.
      Citation: HAND
      PubDate: 2022-06-06T09:43:07Z
      DOI: 10.1177/15589447221093673
       
  • Parent Perspectives for Type B Ulnar Polydactyly Management

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      Authors: Gunnar J. Goebel, Scott N. Loewenstein, Joshua M. Adkinson
      Abstract: HAND, Ahead of Print.
      Background:Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly.Methods:We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications.Results:The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child’s hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants.Conclusions:Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child’s outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.
      Citation: HAND
      PubDate: 2022-06-06T06:57:47Z
      DOI: 10.1177/15589447221096707
       
  • Including a Vessel Loop in Wound Closure Facilitates Suture Removal
           Following Open Carpal Tunnel Release

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      Authors: Mary C. Frazier, L. Beren H. Tomooka, Nicholas Foeger, Hugh J. Hagan, Peter J. Apel
      Abstract: HAND, Ahead of Print.
      Background:Many hand surgeons prefer to close palmar wounds with non-absorbable mattress sutures. Suture removal can be painful and time-consuming. In this study, we investigated if suture removal can be facilitated by including a vessel loop in wound closure following open carpal tunnel release (CTR).Methods:Overall, 47 patients aged 18 to 75 undergoing elective primary open unilateral CTR completed this unblinded, prospective randomized controlled superiority trial. Subjects were randomized into 1 of 2 study arms: (1) wound closure without a vessel loop (standard, n = 28); or (2) wound closure with a vessel loop (vessel loop, n = 19). Data were collected on time for wound closure and for suture removal. A visual analog scale (VAS) was used to assess satisfaction and pain with suture removal.Results:There were no significant differences between the 2 groups in patient demographics or time for suture placement. Visual analog scale satisfaction with suture removal was significantly lower in the standard group (8.6 ± 2.6) compared to vessel loop group (9.9 ± 0.28, P < .05). VAS pain with suture removal was significantly higher in the standard group (2.6 ± 2.7) versus vessel loop group (0.68 ± 1.1, P < .01). Additionally, suture removal time was significantly longer in standard group (84 seconds ± 83) versus vessel loop group (31 seconds ± 13, P < .0001).Conclusions:Addition of a vessel loop in wound closure for primary open CTR increases patient satisfaction and reduces pain with and time taken for suture removal.
      Citation: HAND
      PubDate: 2022-06-06T05:20:00Z
      DOI: 10.1177/15589447221092062
       
  • A Comparative Cost Analysis of Local Anesthesia versus Brachial Plexus
           Block for Complex Hand Surgery

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      Authors: Aslan Baradaran, Fanyi Meng, Mehrad Mojtahed Jaberi, Roderick Finlayson, Stephanie Thibaudeau
      Abstract: HAND, Ahead of Print.
      Background:Local anesthesia has shown to be safe and cost-effective for elective hand surgery procedures performed outside of the operating room. The economic benefits of local anesthesia compared to regional anesthesia for hand surgeries performed in the operating room involving repair of tendons, nerves, arteries, or bones are unclear. This study aimed to compare costs pertinent to hand surgeries performed in the main operating room under local anesthesia (LA) or brachial plexus (BP) block.Methods:We performed a cross-sectional study on the first 70 randomized patients from a prospective controlled trial of anesthesia modalities for hand surgery. The primary objective was to determine the mean anesthesia-related cost, and the secondary objectives were to analyze block performance time, block onset time, duration of anesthesia, duration of surgery, and time in the recovery room.Results:The mean anesthesia-related cost of performing hand surgery under LA as a wrist and/or digital block was $236 ± 30, compared to $435 ± 43 for BP, a difference of $199 per case. The mean block performance time was shorter for LA (1.3 minutes) versus BP (7.0 minutes). The mean anesthesia-related time was longer in BP (30.7 ± 16 minutes) compared to LA (17.7 ± 6.7 minutes), and consequently the total anesthesia time was longer in BP.Conclusions:We demonstrated that local anesthesia compared to brachial plexus block achieved substantial cost savings in complex hand surgeries by decreasing major expenses. In an era of cost-consciousness, the use of LA represents an important modality for health systems to optimize patient flow and increase cost-effectiveness.
      Citation: HAND
      PubDate: 2022-06-06T05:16:36Z
      DOI: 10.1177/15589447221092061
       
  • Forearm Lipoma Causing PIN Compression: Literature Review and
           Meta-Analysis of Predictors for Motor Recovery

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      Authors: Christopher Cheng, Ayesha Punjabi, Sven Gunther, Kyle Chepla
      Abstract: HAND, Ahead of Print.
      Background:Lipomas are a rare cause of posterior interosseous nerve (PIN) compression. A systematic review of predictors for motor recovery has not been performed. This study sought to evaluate whether patient or lipoma characteristics are associated with motor recovery and could be used to determine when immediate tendon transfers at the time of excision should be performed.Methods:Articles describing patients with forearm lipomas resulting in PIN compression with motor weakness were included. Patient age, gender, symptom duration, laterality and largest dimension of lipoma, surgical intervention, and motor recovery were identified. Article quality was assessed via the Methodological Index for Non-Randomized Studies criteria.Results:Thirty articles reporting on 34 patients were identified. Average age was 58.2 years. Average largest lipoma dimension was 5.7 cm. All patients underwent lipoma removal, and 2 had concomitant tendon transfers. In all, 73.5% of patients had complete motor recovery at an average of 9.7 months. Patient age and largest dimension of lipoma, and duration of symptoms were not significant predictors of motor recovery. Symptom duration was a significant predictor of motor recovery in binary regression, particularly if < 18 months.Conclusions:The majority of patients with PIN weakness secondary to lipoma are likely to have complete motor recovery after excision alone. Concomitant tendon transfers should be considered for patients symptomatic for greater than 18 months. Further, adequately powered, studies are required to stratify risk factors and evaluate other modalities to identify the minority of patients who would benefit from immediate tendon transfer.
      Citation: HAND
      PubDate: 2022-06-03T09:31:45Z
      DOI: 10.1177/15589447221096710
       
  • A Novel Prescription Method Reduces Postoperative Opioid Distribution and
           Consumption: A Randomized Clinical Trial

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      Authors: John M. Yanik, Natalie A. Glass, Lindsey S. Caldwell, Joseph A. Buckwalter V, Timothy P. Fowler, Ericka A. Lawler
      Abstract: HAND, Ahead of Print.
      Background:Prescription opioid abuse in the United States has risen substantially over the past 2 decades. Narcotic prescription refill restrictions may paradoxically be contributing to this epidemic. We investigated a novel, refill-based opioid prescription method to determine whether it would alter postoperative narcotic distribution or consumption.Methods:In this randomized controlled trial, patients undergoing internal fixation of distal radius fractures or thumb carpometacarpal joint arthroplasty received either a single prescription for all postoperative narcotics (control arm) or the same amount of pain medication divided into 3 equal prescriptions to be filled as needed (experimental arm). Outcomes included total narcotics dispensed, measured in morphine milligram equivalents (MME) through a prescription monitoring program, patient-reported opioid consumption versus opioid not consumed, and a satisfaction survey.Results:Forty-eight participants were enrolled; 25 were randomized to the control arm and 23 to the experimental arm. At 8 weeks post-op, fewer opioids had been dispensed to the experimental arm (177 ± 94 vs 287 ± 123 MME, P = .0025). At 6-week follow-up, the experimental arm reported lower narcotic consumption (124 ± 105 vs 214 ± 110 MME, P = .0131). Subanalysis of the independent surgeries yielded similar results. Some patients reported insurance issues when filling subsequent prescriptions. Consequently, although 100% of control arm patients reported good pain control, only 82.6% of experimental arm patients said likewise (P = .0455).Conclusions:This randomized clinical trial demonstrated that patients obtained and consumed fewer narcotics when postoperative opioids were given in a refill-based prescription method. More research is needed to determine whether this opioid distribution method is reproducible, translatable, and feasible.
      Citation: HAND
      PubDate: 2022-06-03T09:29:04Z
      DOI: 10.1177/15589447221096709
       
  • Accuracy and Safety of Non-Image Guided Trigger Finger Injections: A
           Cadaveric Study

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      Authors: Daniel D. Binz, Thomas W. Mitchell, Scott A. Mitchell
      Abstract: HAND, Ahead of Print.
      Background:Stenosing flexor tenosynovitis is commonly treated by injection of corticosteroids into the flexor tendon sheath. However, there is no consensus in the literature regarding the optimal technique, specifically when not utilizing ultrasound guidance. Here, we present a cadaver study in which 3 common techniques of flexor sheath injection were compared with regard to their accuracy and safety profiles.Methods:Fifteen fresh-frozen cadaver hands (60 digits) were evenly divided into 3 groups (20 digits per group). Digits in each group were injected with methylene blue dye using 1 of the 3 techniques (palmar-to-bone, palmar supra-tendinous, and mid-axial). The fingers were then dissected and were inspected for location of dye, as well as injury to tendon or digital nerves.Results:The mid-axial technique demonstrated the greatest accuracy with the highest rate of all intra-sheath injection, 15 of 20 digits (75%), while the palmar-to-bone technique produced the most combined intra- and extra-sheath injections, 13 of 20 digits, (65%) and the palmar supra-tendinous technique resulted in the most all extra-sheath injections, 9 of 20 digits (45%). The difference in rates of all intra-sheath injection was significant (P = .01). The mid-axial technique also produced the fewest intra-tendinous injections 0 of 20, although this result did not reach statistical significance (P = .15).Conclusions:Compared to other common non-image guided flexor tendon sheath injection techniques, the mid-axial injection technique was found to be the most accurate in producing all intra-sheath injection and least likely to result in intra-tendinous injection.
      Citation: HAND
      PubDate: 2022-06-03T09:26:29Z
      DOI: 10.1177/15589447221093676
       
  • The Prevalence of Depression and PTSD in Adults With Surgically Managed
           Traumatic Upper-Extremity Amputations

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      Authors: Samuel Cohen-Tanugi, Risa Reid, Bryan J. Loeffler, R. Glenn Gaston
      Abstract: HAND, Ahead of Print.
      Background:Upper-extremity limb loss has been associated with serious psychological sequelae. Despite advancements in surgical procedures and prostheses for upper limb amputees, it is critical to recognize the psychosocial component of these patients’ care. Although the role of psychological factors in outcomes is increasingly acknowledged, little is known about the prevalence of depression and post-traumatic stress disorder (PTSD) in the civilian population after traumatic upper-extremity amputation.Methods:In this retrospective observational single-center study, adult patients evaluated for traumatic upper limb amputations from 2016 to 2019 completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analogue Scale, the Center for Epidemiologic Studies Depression Scale, and the Primary Care PTSD Screen during visits. All data underwent descriptive statistical analysis.Results:Thirty-nine adult patients treated for upper-extremity traumatic amputation completed patient-reported outcomes (PROs) questionnaires. The median final follow-up time for our cohort was 17 months from amputation. Twenty patients (51%) screened positive for depression and 27 (69%) for PTSD during follow-up. The median time from amputation to first positive screening was 6.5 months for depression and 10 months for PTSD. The physical component score of Veterans RAND 12-Item Health Survey (VR-12) was significantly worse for patients with depression. The Median DASH and mental component score of VR-12 were significantly worse for patients with PTSD.Conclusion:Upper-extremity limb loss has a significant impact on mental health, which in turn affects PROs. The high prevalence of depression and PTSD in traumatic upper-extremity amputees underscores the necessity for screening and multidisciplinary treatment.
      Citation: HAND
      PubDate: 2022-06-03T09:24:22Z
      DOI: 10.1177/15589447221093671
       
  • Association of Acute Trapeziometacarpal Joint Dislocation and Trapezium
           Fracture in a 14-Year-Old Boy: A Case Report

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      Authors: Andrea Minini, Alessandro Fagetti, Federico Tamborini, Danilo Di Giovanna, Andrea G. Salvi, Jacopo Maffeis, Federico Sibona, Mario Cherubino
      Abstract: HAND, Ahead of Print.
      Fracture-dislocation of the trapeziometacarpal (TM) joint in adolescent patients is a rare injury, with only 3 cases reported in literature to our knowledge. Its low incidence, together with the complexity of the anatomy and biomechanics of TM joint, may represent a challenge for surgeons in choosing the best treating option. Here, we report a case of a TM fracture dislocation in a 14-year-old boy treated with percutaneous Kirschner wire pinning. The results we obtained endorsed our choice in patients for whom closed reduction is achievable.
      Citation: HAND
      PubDate: 2022-06-01T11:02:40Z
      DOI: 10.1177/15589447221092121
       
  • Characterization of Trapezial Pommel in Relation to Radiographic and Wear
           Patterns in Carpometacarpal Osteoarthritis

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      Authors: Alexandra T. Bourdillon, Lauren Shapiro, Faes D. Kerkhof, Nicole A. Segovia, Arnold-Peter Weiss, Amy L. Ladd
      Abstract: HAND, Ahead of Print.
      Background:Trapezial pommel, or ulnar osteophyte positioned at the vertex of the saddle-shaped facet, is a consistent structural appearance in osteoarthritis (OA) of the first carpometacarpal. This study investigates its relation to radiographic measures (modified Eaton staging and thumb OA [ThOA] index) and wear patterns (trapezial surface morphology and cartilaginous eburnation).Methods:In all, 137 whole trapezia were explanted from 116 patients and evaluated for Eaton staging, morphology (saddle, cirque, or dish), and eburnation (degree of cartilaginous effacement) of the articular surface of the trapezium. In total, 131 Robert’s views and 126 stress views were reviewed by 2 blinded senior surgeons for ThOA index and pommel size. Statistical analyses included Spearman correlation and linear regression.Results:Standardized pommel size achieved good intrarater reliability (correlation coefficient: 0.80-0.98) and moderate interrater reliability (correlation coefficient: 0.60-0.67). The ThOA index and pommel size were significantly correlated across Robert’s (rs = 0.51) and stress views (rs = 0.64). The ThOA index better distinguished between stages compared with pommel size. All the radiographic measures inversely correlated with preserved cartilage and varied across morphologies. Pommel size differed significantly between dish and saddle, and the ThOA index was significantly different between all morphologies when using stress views.Conclusions:We reliably quantified the pommel feature and demonstrated significant correlations with other radiographic and topologic measures of arthritic disease. If future studies can demonstrate that the pommel is a pathogenic process in ThOA and its correction can curb disease progression, the identification of the pommel feature may help guide targeted intervention.
      Citation: HAND
      PubDate: 2022-06-01T11:00:37Z
      DOI: 10.1177/15589447221093670
       
  • Trapeziectomy, Partial Trapezoidectomy, and Abductor Pollicis Longus Dual
           Loop Ligament Reconstruction for Advanced Basal Joint Arthritis: Long-Term
           Outcome of 150 Cases

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      Authors: Charles P. Melone, Andrew J. Lovy, Mark Ciaglia, BaiJing Qin
      Abstract: HAND, Ahead of Print.
      Background:Although hand surgeons usually concur that arthroplasty is indicated for disabling basal joint arthritis, controversy persists regarding the preferred surgical methods. This article describes a novel technique of trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus (APL) dual ligament reconstruction, and reports the long-term results of 150 cases. Based on this experience, we hypothesize that this technique is a reliably effective and durable surgical option for basal joint arthritis.Methods:This study evaluated consecutive patients with Eaton and Littler advanced stage III/IV basal joint arthritis, treated by this procedure, and followed for a minimum of 10 years. Outcome assessment included grip and pinch strength, thumb mobility, radiographic parameters, pain relief, and patient-reported outcomes as measured with the Disabilities of the Arm, Shoulder, and Hand (DASH) scoring system.Results:A total of 150 thumbs in 124 patients with an average follow-up of 13.5 years (range, 10-22 years) were studied. Alleviation of pain and patient satisfaction were constant outcomes, and the mean DASH score was a normative 8.7. Grip and pinch strength were significantly improved (P < .001), carpometacarpal joint malalignment and adduction deformities were consistently corrected, complications were few, and revision surgery was unnecessary.Conclusions:These results support the premise that trapeziectomy and partial trapezoidectomy with APL dual ligament stabilization is a reliable and durable arthroplasty for basal joint arthritis with distinct advantages and equally favorable outcomes when compared with other frequently employed methods.
      Citation: HAND
      PubDate: 2022-05-30T10:14:56Z
      DOI: 10.1177/15589447221092060
       
  • Ultrasound Cross-Sectional Area of the Median Nerve Is Not a Predictor of
           Patient Reported Outcomes After Carpal Tunnel Release

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      Authors: Nicholas F. Aloi, Morgan R. Kohls, Jeffrey C. Wera, John R. Fowler
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this study was to evaluate the relationship between cross sectional area (CSA) of the median nerve on ultrasound (US) with pre- and postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores. We hypothesize that there is a positive correlation between CSA and the ΔBCTQ after carpal tunnel release (CTR).Methods:This was a single center study. During a 6-year period (2014-2020), CSA of the median nerve on US and BCTQ scores were collected prospectively for patients presenting with the chief complaint of numbness and tingling in the upper extremity. Patients who underwent CTR and presented for their 6-week follow-up had repeat measurements of the CSA and BCTQ. These patients were included in this study. Patients were then divided into ultrasound positive (CSA ≥ 10) and ultrasound negative (CSA < 10) groups. These groups were compared on the basis of demographics, preoperative BCTQ scores, postoperative BCTQ scores, and 6-week ΔBCTQ score.Results:US-positive and-negative groups did not differ significantly in their preoperative BCTQ, postoperative BCTQ, or ΔBCTQ scores. Both groups did, however, experience significant improvement when comparing preoperative to postoperative BCTQ scores within their respective US group.Conclusion:Regardless of the preoperative CSA of the median nerve, patients who underwent CTR experienced a significant improvement in their BCTQ results. US-positive patients experienced no greater improvement than US-negative patients. These results would suggest that US is not a good predictor of subjective surgical outcome measures such as the BCTQ.
      Citation: HAND
      PubDate: 2022-05-25T07:05:20Z
      DOI: 10.1177/15589447221093677
       
  • A Prospective Analysis of Patient Characteristics Affecting the Outcome of
           Dorsal Splinting for Soft Tissue Mallet Injuries

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      Authors: Ali Azad, Gary Kegel, James Phelps, Astrid Marshall, Marissa P. Lafer, Madeline Rocks, Louis Catalano, O. Alton Barron, Steven Glickel
      Abstract: HAND, Ahead of Print.
      Background:Much has been written about the diagnosis and treatment of soft tissue mallet injuries. However, there has been little regarding the characteristics of this injury affecting patients’ prognosis. The purpose of this prospective study was to identify factors influencing the outcome of treatment of soft tissue mallet injuries.Methods:Patients diagnosed with soft tissue mallet injuries were enrolled prospectively in a protocol of dorsal splinting for 6 to 12 weeks, followed by weaning over 2 weeks and then evaluated at 6, 9, and ≥12 months.Results:Thirty-seven patients (38 digits) completed the study. Treatment success was defined as a final extensor lag of 0 were not associated with treatment failure. Radiographic and clinical extension lag were statistically comparable.Conclusions:This study shows strong association between the success of splint treatment, younger patient age, and compliance with the treatment protocol. Despite this finding, most patients did not report any functional limitations, irrespective of the treatment success. In contrast to prior results, time to treatment and initial extensor lag did not significantly affect treatment success.
      Citation: HAND
      PubDate: 2022-05-25T07:01:47Z
      DOI: 10.1177/15589447221093674
       
  • Socioeconomic Disparities in Surgical Care for Congenital Hand Differences

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      Authors: Christopher L. Kalmar, Brian C. Drolet
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country.Methods:Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors.Results:During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals (P < .001). Patients with above-median income (P < .001), non-white race (P < .001), commercial insurance (P < .001), living in an urban community (P < .001), and not living in an underserved area (P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital (P < .001).Conclusions:Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges.
      Citation: HAND
      PubDate: 2022-05-25T06:57:52Z
      DOI: 10.1177/15589447221092059
       
  • Contrast Enhanced Computed Tomography in the Diagnosis of Acute Pyogenic
           Flexor Tenosynovitis

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      Authors: Devon M. Myers, Craig Goubeaux, Brian Skura, Patrick J. Warmoth, Benjamin C. Taylor
      Abstract: HAND, Ahead of Print.
      Background:The diagnosis of infectious flexor tenosynovitis (FTS) has historically been made based on physical exam using Kanavel’s signs. The specificity of these findings has come into question. We looked to evaluate the use of contrast-enhanced computed tomography (CT) in increasing the successful diagnosis of FTS.Methods:Two adult cohorts were formed, one of patients with FTS confirmed in the operating room and the second of patients with ICD.10 identified finger cellulitis (FC), without concomitant FTS. Demographics, laboratory values, CT scans, and examination findings were evaluated. Axial CTs were evaluated in the coronal and sagittal planes and tendon sheath/tendon width were measured. The tendon sheath/tendon was recorded as a ratio in the coronal (CR) and sagittal (SR) planes. Continuous and dichotomous variables were analyzed and measures of sensitivity, specificity, and predictivity were calculated. Seventy patients were included, 35 in the FTS cohort and 35 with FC.Result:A higher number of Kanavel signs were present in the FTS group (2.9 vs. 0.5, P < .05), with CR and SR both being significantly larger in the FTS group (P < .05). CR and SR cutoffs ≥ 1.3 provided high sensitivity, specificity, and positive predictive value (PPV) for FTS. Likelihood of FTS increased 5.9% and 5.5% for every 0.1 increase in CR and SR, respectively, with a 14% increase for every additional Kanavel sign.Conclusion:In conclusion, CT ratios are useful in identifying FTS; and when used on their own or in combination with Kanavel’s signs, CR and SR objectively improve the diagnosis of FTS.
      Citation: HAND
      PubDate: 2022-05-25T06:53:32Z
      DOI: 10.1177/15589447221092058
       
  • Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of
           Mild-to-Moderate Carpal Tunnel Syndrome: A Markov Cost-Effectiveness
           Decision Analysis

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      Authors: Kevin M. Klifto, Christopher S. Klifto, Tyler S. Pidgeon, Marc J. Richard, David S. Ruch, Stephen H. Colbert
      Abstract: HAND, Ahead of Print.
      Background:Platelet-rich plasma (PRP) or corticosteroid injections may be used to conservatively treat mild-to-moderate carpal tunnel syndrome (CTS). We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of mild-to-moderate CTS.Methods:Markov modeling was used to analyze the base-case 45-year-old patient with mild-to-moderate CTS, unresponsive to conservative treatments, never previously treated with an injection or surgery, treated with a single injection of PRP, or methylprednisolone/triamcinolone 40 mg/mL. Transition probabilities were derived from level-I/II studies, utility values from the Tufts University Cost-Effectiveness Analysis Registry reported using visual analog scale (VAS), Boston Carpal Tunnel Questionnaire Symptom severity (BCTQ-S), and Boston Carpal Tunnel Questionnaire Functional status (BCTQ-F), and costs from Medicare, published studies, and industry. Analyses were performed from healthcare/societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay thresholds were $50 000 and $100 000. Deterministic/probabilistic sensitivity analyses were performed.Results:From a healthcare perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$13.52/quality-adjusted-life-years (QALY), BCTQ-S: -$11.88/QALY, and BCTQ-F: -$16.04/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 941.12 versus $375 788.21, BCTQ-S: $417 115.09 versus $356 614.18, and BCTQ-F: $421 706.44 versus $376 908.45. From a societal perspective, compared to PRP injections, the ICER for corticosteroid injections measured by VAS: -$1024.40/QALY, BCTQ-S: -$899.95/QALY, and BCTQ-F: -$1215.51/QALY. PRP versus corticosteroid injections provided a NMB measured by VAS: $428 171.63 versus $373 944.39, BCTQ-S: $416 345.61 versus $354 770.36, and BCTQ-F: $420 936.95 versus $375 064.63.Conclusions:PRP injections were more cost-effective than methylprednisolone/triamcinolone injections from healthcare and societal perspectives for mild-to-moderate CTS.
      Citation: HAND
      PubDate: 2022-05-23T05:15:53Z
      DOI: 10.1177/15589447221092056
       
  • Lidocaine Nerve Block Diminishes the Effects of Therapeutic Electrical
           Stimulation to Enhance Nerve Regeneration in Rats

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      Authors: Grace C. Keane, Evan B. Marsh, Daniel A. Hunter, Lauren Schellhardt, Eric R. Walker, Matthew D. Wood
      Abstract: HAND, Ahead of Print.
      Background:Although electrical stimulation (ES) can improve nerve regeneration, the impact of nerve block, such as lidocaine (Lido), on the therapeutic benefits of ES remains unclear. We used a rat tibial nerve transection-and-repair model to explore how either preoperative (PreOp) or postoperative (PostOp) nerve block affects ES-related improvement in regeneration.Methods:Lewis rats were used in 1 of 2 studies. The first evaluated the effects of extraneural Lido on both healthy and injured nerves. In the second study, rats were randomized to 5 experimental groups: No ES (negative control), PreOp Lido, ES + PreOp Lido, PostOp + ES, and ES (positive control). All groups underwent tibial nerve transection and repair. In both studies, nerves were harvested for histological analysis of regeneration distal to the injury site.Results:Application of extraneural Lido did not damage healthy or injured nerve based on qualitative histological observations. In the context of nerve transection and repair, the ES group exhibited improved axon regeneration at 21 days measured by the total number of myelinated fibers compared with No ES. Fiber density and percentage of neural tissue in the ES group were greater than those in both No ES and PreOp Lido + ES groups. ES + PostOp Lido was not different from No ES or ES group.Conclusions:Extraneural application of Lido did not damage nerves. Electrical stimulation augmented nerve regeneration, but Lido diminished the ES-related improvement in nerve regeneration. Clinical studies on the effects of ES to nerve regeneration may need to consider nerve block as a variable affecting ES outcome.
      Citation: HAND
      PubDate: 2022-05-17T10:30:23Z
      DOI: 10.1177/15589447221093668
       
  • Postoperative Immobilization of Scaphoid Fractures: A Comprehensive Review
           of the Literature

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      Authors: Michael Simon, Pasquale Gencarelli, Jason Yang, Justin N. Elkhechen, John P. Avendano, David Kirschenbaum, Brian M. Katt
      Abstract: HAND, Ahead of Print.
      The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. Reports of successful management with brief postoperative immobilization suggest that earlier restoration of function may be achieved by limiting the duration of immobilization. However, the risk of nonunion and its associated complications suggest that a more conservative approach with extended immobilization could optimize fracture healing. This paper presents a thorough review of the relevant literature and summarizes the myriad postoperative immobilization protocols and their reported outcomes. Postoperative immobilization protocols and reported outcomes for displaced, comminuted, and proximal pole fractures are discussed separately. The literature is reviewed following different operative techniques, including open reduction internal fixation and percutaneous screw fixation. Vigilant postoperative care of scaphoid fractures managed surgically is warranted to monitor for signs of nonunion while attempting to regain motion and strength to the injured wrist.
      Citation: HAND
      PubDate: 2022-05-16T11:47:07Z
      DOI: 10.1177/15589447221093675
       
  • Ten-Year Trends in Level of Evidence in Hand Surgery

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      Authors: Reid E. Tompkins, Michael M. Polmear, Kyle J. Klahs, John P. Scanaliato, Leon J. Nesti, John C. Dunn
      Abstract: HAND, Ahead of Print.
      Background:The purposes of this study were to analyze the trends in Oxford level of evidence (LOE), LOE of most-cited articles, and association between LOE and journal impact factor (IF) and SCImago Journal Rank (SJR) over a 10-year period (2009-2018) in 3 prominent hand surgery journals, specifically HAND, Journal of Hand Surgery (American Volume) (JHS), and Journal of Hand Surgery (European Volume) (JHSE).Methods:All articles published from 2009 to 2018 in HAND, JHS, and JHSE were reviewed for assigned or available LOE. Data were pooled and analyzed for trends in LOE; relationship among IF, SJR, and LOE; and citation density.Results:A total of 3921 total publications were tabulated from 2009 to 2018, with the majority of studies being level V (1700, 43%) and fewer studies being level I (146, 4%). Over the 10-year study period, there was no significant change in frequency of level I studies for any journal. HAND trended significantly toward higher LOE, JHS trended toward higher LOE, and JHSE trended toward decreased LOE without significance. Among all journals, the annual number of articles and the average LOE were independent significant predictors of IF and SJR. Statistically significant correlations were found between citation density and LOE for JHS and HAND.Conclusions:Higher quality evidence is becoming more prevalent in the hand surgery literature over the past 10 years. Annual articles, average LOE, and level I and II and level IV articles were significant predictors of increasing IF and SJR.
      Citation: HAND
      PubDate: 2022-05-13T09:37:38Z
      DOI: 10.1177/15589447221093672
       
  • Patient-Reported Outcomes After Surgical Treatment of Early Osteoarthritis
           of the First Carpometacarpal Joint

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      Authors: Merel H. J. Hazewinkel, Peter DiGiovanni, Satoshi Miyamura, Jonathan Lans, Neal C. Chen, Kiera Lunn, Jesse B. Jupiter
      Abstract: HAND, Ahead of Print.
      Background:The goals of this study are to describe the reoperation rates in patients who underwent Wilson osteotomy compared with patients who underwent carpometacarpal (CMC) arthroplasty for early-stage arthritis and to evaluate the factors influencing the patient-reported outcomes.Methods:Retrospectively, 52 patients who underwent surgery for stage I/II osteoarthritis of the thumb carpometacarpal were identified, consisting of 17 (33%) patients who underwent Wilson osteotomy and 35 (67%) who underwent carpometacarpal arthroplasty. A total of 28 (55%) patients completed the outcome questionnaires, consisting of 11 (39%) patients who underwent Wilson osteotomy and 17 (61%) patients who underwent carpometacarpal arthroplasty. We performed a multivariable linear regression model to identify factors associated with the Numeric Rating Scale (NRS) pain intensity at final follow-up.Results:Among the patients who underwent CMC arthroplasty, 2 had a reoperation. Among the patients who underwent Wilson osteotomy, 3 had a reoperation. Among the patients who completed the outcome questionnaires, the median quick Disabilities of the Arm, Shoulder and Hand score was 10 and the median NRS Pain Intensity score was 0. In multivariable analysis, the postoperative Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI) was independently associated with higher postoperative NRS pain scores.Conclusion:In younger patients with stage I/II CMC osteoarthritis, Wilson osteotomy may be a reasonable alternative to CMC arthroplasty. Outcomes were similar between both groups at mid-term follow-up, with only a slightly higher pain score in the osteotomy group. In patients with stage I/II carpometacarpal osteoarthritis, the PROMIS PI is the main factor indicating successful outcomes.
      Citation: HAND
      PubDate: 2022-05-13T09:34:06Z
      DOI: 10.1177/15589447221093669
       
  • Use of Plain Radiography of Uninjured Wrists as Patient-Specific Markers
           of Successful Reduction of Unilateral Distal Radius Fractures

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      Authors: Lyahn K. Hwang, Nicolas Greige, Fei Wang, Joseph K. Yi, Matthew D. Treiser, Joseph A. Ricci
      Abstract: HAND, Ahead of Print.
      Background:The standard of care of distal radius fractures requiring operative intervention involves restoration of anatomical alignment radiologically by comparing preoperative films and intraoperative fluoroscopy with established values based on population norms. The objective of this study is to evaluate the use of plain radiographs obtained from the uninjured wrist of patients who present with unilateral displaced distal radius fractures as a measure of successful achievement of anatomical realignment.Methods:A retrospective review was performed on 133 consecutive patients who presented from August 2020 to August 2021 with a diagnosis of unilateral distal radius fracture as confirmed on 3-view plain radiography. Patients who had bilateral radiographs and underwent open reduction and internal fixation were included. The primary outcome measure was comparison of radial inclination, radial height, tilt, and ulnar variance measured by 3 observers on preoperative, 1-week postoperative, and uninjured contralateral wrist films.Results:Twenty-one patients were included for analysis. Comparison of postoperative radiologic parameters with the contralateral uninjured extremity revealed a mean radial inclination difference of 3.8°, radial height difference of 2.0 mm, volar tilt difference of 6.3°, and ulnar variance difference of 0.9 mm. The average postreduction radial height was found to deviate from contralateral radial height significantly more than from the historic radial height parameter (2.0 vs 0.6 mm, P < .001).Conclusion:Attempts at achieving distal radius fracture reduction to within historical normal limits may result in an increased deviation from patient-specific anatomical parameters, especially with respect to radial height.
      Citation: HAND
      PubDate: 2022-05-03T07:12:21Z
      DOI: 10.1177/15589447221092057
       
  • Sauvé-Kapandji and Darrach Salvage Procedure Rates and Perioperative
           Parameters for Distal Radioulnar Joint Arthritis and Instability

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      Authors: Reece Moore, Ryan O’Leary, Gilberto Gonzalez, Fernando A. Herrera
      Abstract: HAND, Ahead of Print.
      Background:Distal radioulnar joint (DRUJ) instability and arthritis are often painful and functionally limiting pathologies. Two common salvage procedures for DRUJ dysfunction are the Darrach and Sauvé-Kapandji (S-K) procedures. This study aims to provide an analysis of national Darrach and S-K procedure utilization rates and patient demographics.Methods:A national ambulatory surgery database, the 2018 Nationwide Ambulatory Surgery Sample, was filtered for Darrach and S-K procedure encounters. Data related to patient demographics and medical history, indications for DRUJ salvage, and concurrent hand/wrist procedures were collected.Results:Database analysis revealed 1044 Darrach and 223 S-K procedure encounters. Patients undergoing Darrach procedures were older (60 vs 57, P = .002) and more likely to be women (66.1% vs 54.6%, P < .05). Patients aged
      Citation: HAND
      PubDate: 2022-05-02T10:56:55Z
      DOI: 10.1177/15589447221092055
       
  • Bilateral Ulnar Nerve Injury in the Wrist: Comparison of First Webspace
           Muscle Reconstruction by Opponens Nerve Transfer in the Right Hand Versus
           Direct Ulnar Nerve Repair in the Left Hand

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      Authors: Jayme A. Bertelli, Elspeth J. R. Hill, Amir Arami, Anna Seltser
      Abstract: HAND, Ahead of Print.
      We report a case of a bilateral glass injury to the wrist with transection of flexor tendons and the ulnar nerve and artery in a 60-year-old male patient. Two days after his accident, we repaired all divided structures, and on the right hand, we added the transfer of the opponens motor branch to the deep terminal division of the ulnar nerve aimed at first dorsal interosseous and adductor pollicis muscle reinnervation. After surgery, the patient was followed over 24 months. Postoperative dynamometry of the hand, which included grasping, key-pinch, subterminal-key-pinch, pinch-to-zoom, and first dorsal interosseous muscle strength, indicated recovery only in the nerve transfer side.
      Citation: HAND
      PubDate: 2022-05-02T10:54:56Z
      DOI: 10.1177/15589447221085665
       
  • What a Waste! The Impact of Unused Surgical Supplies in Hand Surgery and
           How We Can Improve

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      Authors: Dalibel Bravo, Cassandra Thiel, Ricardo Bello, Akini Moses, Nader Paksima, Eitan Melamed
      Abstract: HAND, Ahead of Print.
      Background:The US health care system is the second largest contributor of trash. Approximately 20% to 70% of waste is produced by operating rooms, and very few of this waste is recycled. The purpose of this study is to quantify the opened but unused disposable supplies and generate strategies to reduce disposable waste.Methods:A single-center prospective study to evaluate the cost of opened but unused single-use operating room supplies was completed by counting the number of wasted disposable products at the end of hand surgery cases. We used χ2 test, t test, Wilcoxon rank-sum test, and simple linear regression to assess the associations between patient and case variables and the total cost of wasted items. Environmentally Extended Input Output Life Cycle Assessment methods were used to convert the dollar spent to kilograms of carbon dioxide equivalent (CO2-e), a measure of greenhouse gas emissions.Results:Surgical and dressing items that were disposed of and not used during each case were recorded. We included 85 consecutive cases in the analysis from a single surgeon’s practice. Higher cost from wasted items was associated with shorter operative time (P = .010). On average, 11.5 items were wasted per case (SD: 3.6 items), with a total of 981 items wasted over the 85 cases in the study period. Surgical sponges and blades were 2 of the most unused items. Wasted items amounted to a total of $2193.5 and 441 kg of CO2-e during the study period.Conclusions:This study highlights the excessive waste of unused disposable products during hand surgery cases and identifies ways of improvement.
      Citation: HAND
      PubDate: 2022-04-29T09:03:01Z
      DOI: 10.1177/15589447221084011
       
  • Radial Sided Triangular Fibrocartilage Complex Tears: A Comprehensive
           Review

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      Authors: Nicholas A. Messina, Kieran S. Dowley, Jeremy E. Raducha, Joseph A. Gil
      Abstract: HAND, Ahead of Print.
      When evaluating the available literature on the diagnosis and management of triangular fibrocartilage complex tears (TFCC), ulnar tears comprise the major focus of TFCC literature. Radial-sided (Class 1D) tears are seldom researched or discussed. The purpose of this study was to review the methods for identifying and treating radial-sided TFCC lesions, by examining the anatomy of the TFCC, the pathology of its radial portion, diagnostic techniques, and both surgical and nonoperative treatments. The avascular nature of the radial TFCC may influence its healing potential. Magnetic resonance arthrogram is the gold standard for non-invasively diagnosing a radial-sided tear. Non-operative management should be exhausted prior to surgical intervention, which commonly involves an inside-out repair involving radial trans-osseous sutures. Still, the literature is limited by patient sample size and therefore requires a greater population of class 1-D tears to confirm optimal diagnostic and treatment methods.
      Citation: HAND
      PubDate: 2022-04-11T06:31:44Z
      DOI: 10.1177/15589447221084125
       
  • Two Parallel Headless Compression Screws for Scaphoid Fractures:
           Radiographic Analysis and Preliminary Outcome

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      Authors: Eliseo V. DiPrinzio, James D. Dieterich, Amanda L. Walsh, Andrew J. Warburton, Andy L. Chang, Michael R. Hausman, Jaehon M. Kim
      Abstract: HAND, Ahead of Print.
      Background:Despite surgical fixation, the scaphoid nonunion rate remains at 3% to 5%. Recent biomechanical studies have demonstrated increased stability with 2-screw constructs. The objective of our study is to determine the preliminary union rate and anatomic feasibility of 2-screw surgical fixation for scaphoid fractures.Methods:This study is a retrospective case series of 25 patients (average age 32 years) with scaphoid fractures treated with 2 parallel headless compression screws (HCS). Postoperative evaluation included Mayo Wrist Score (MWS), range of motion, time to union, and return to activity. Bivariate analysis for gender and Pearson correlation coefficient for body size (height, weight, and body mass index) was conducted against radiographically measured scaphoid width, screw lengths, and the distance between the 2 screws.Results:All fractures healed with an average time to union of 9.9 weeks (median 7.6 weeks; range: 4.1-28.3). The mean MWS was 93.3 (range: 55-100), with 3 complications (12%), one of which affected the outcome of the surgery. The bivariate analysis demonstrated that the female gender was associated with significantly smaller scaphoid width (P = .004) but a similar distance between the 2 screws (P = .281). The distance between the 2 screws and the body size demonstrated a weak-to-no correlation.Conclusions:The 2-screw construct for scaphoid fracture achieved a favorable union rate and clinical outcome. Gender was the only variable significantly associated with scaphoid width and screw length. The distance between the screws was constant regardless of gender and body size, indicating that the technique for parallel screw placement can remain consistent.Type of Study:Therapeutic.Level of Evidence:Level IV.
      Citation: HAND
      PubDate: 2022-04-11T06:30:54Z
      DOI: 10.1177/15589447221081879
       
  • Reoperation After Operative Treatment of Open Finger Fractures

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      Authors: Kamilcan Oflazoglu, Lisanne J. H. Smits, Hinne Rakhorst, Kyle R. Eberlin, Marco J. F. P. Ritt, Neal C. Chen
      Abstract: HAND, Ahead of Print.
      BackgroundOur primary aim was to develop a prediction model for return to the operating room (OR) after open finger fractures by studying the reoperation rate of open finger fractures based on patient demographics, injury mechanism, injury severity, and type of initial surgical fixation. The secondary aim was to study the predictors for secondary surgery due to nonunion, postoperative infection, and secondary amputation.MethodsIn the retrospective chart review, 1321 open finger fractures of 907 patients were included. Demographic-, injury-, and treatment-related factors were gathered from medical records.ResultsWe found that open fractures involving the thumb had lower odds of undergoing secondary surgery. Crush injury, proximal phalangeal fracture, arterial injury, other injured fingers, and other injuries to the ipsilateral hand were associated with higher odds of undergoing secondary surgery. However, the associated factors we identified were not powerful enough to create a predictive model. Other injury to the ipsilateral hand, vein repair, and external fixator as initial treatment were associated with postoperative nonunion. Crush injury and proximal phalangeal fracture were associated with postoperative infection. No factors were associated with secondary amputation.ConclusionsA quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment. Furthermore, fractures involving the thumb have less reoperation, while fractures involving the proximal phalanx have poorest outcomes.
      Citation: HAND
      PubDate: 2022-04-08T06:54:32Z
      DOI: 10.1177/15589447211043191
       
  • Ultrasound Use by Upper Extremity Surgeons in 2020: A Survey of ASSH
           Members

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      Authors: Cory Demino, Kathleen Koesarie, Jay Smith, John R. Fowler
      Abstract: HAND, Ahead of Print.
      Background:The use of musculoskeletal ultrasound (US) among hand surgeons appears to be increasing. The purpose of this study was to determine the utilization patterns and attitudes regarding US among American Society for Surgery of the Hand (ASSH) members in 2020 as well as the changes in usage patterns since a previous survey in 2015.Methods:In 2020, an updated and expanded 27-question survey was distributed to 4852 members of the ASSH. Questions assessed respondent demographics, training, and practice patterns, and access, utilization, training, and opinions pertaining to US.Results:A total of 418 surveys (8.6%) were analyzed. Compared to 2015, there was an increase in the percentage of respondents using US for diagnostic purposes (51%-68%), as well as having personal access to US machines (43% to 58%). US use to assist in diagnosing carpal tunnel syndrome increased from 19% to 27%. The most common reason for using US was convenience and practice efficiency, while the most common reasons for not using US was no machine access. In 2020, 33% of respondents performed US-guided injections.Conclusions:Compared to 2015, the majority of responding upper extremity surgeons now have personal access to US machines. Utilization of diagnostic US appears to be increasing, and two-thirds of respondents believed that US use will continue to increase among upper extremity surgeons.
      Citation: HAND
      PubDate: 2022-04-02T09:33:41Z
      DOI: 10.1177/15589447221082170
       
  • The Effect Immobilization Mechanisms Have on Radiographic Outcomes and
           Complication Rates in the Conservative Treatment of Distal Radius
           Fractures: A Systematic Review

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      Authors: Adam A. Jamnik, Jose Chacon, Angel X. Xiao, Eric R. Wagner, Michael B. Gottschalk
      Abstract: HAND, Ahead of Print.
      Distal radius fractures (DRFs) are among the most common fractures in the United States. Despite their high incidence, there is no consensus on the optimal type of cast or splint to treat these fractures. The purpose of this systematic review is to evaluate the available literature pertaining to the outcomes for different constructs used to conservatively treat DRFs. A literature search of PubMed, Medline, and Embase was conducted to identify research comparing the outcomes of various immobilization mechanisms. In particular, endpoints included complications (eg, loss of reduction, pain), radiographic outcomes, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. A total of 1655 articles were identified during the literature search, and 22 ultimately fulfilled inclusion criteria. These 22 studies included 1826 conservatively treated DRFs. The different immobilization mechanisms were divided into 8 groupings: above-elbow casts, above-elbow splints, below-elbow casts, below-elbow splints, gutter or spica casts, gutter or spica splints, dorsal-volar splints, and dorsal splints. Qualitative review of the studies determined that below-elbow constructs result in equal or better functional and radiologic outcomes when compared with above-elbow constructs. Meta-analysis demonstrated that a statistically significant difference (P = .04) existed in the incidence of loss of reduction between the immobilization constructs, although post hoc analysis did not detect significant differences between 2 particular constructs.
      Citation: HAND
      PubDate: 2022-04-02T09:32:01Z
      DOI: 10.1177/15589447221081864
       
  • The Effect of Thumb Carpometacarpal Joint Corticosteroid Injections on
           Outcomes Following Arthroplasty

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      Authors: Amr M. Tawfik, Justin N. Elkhechen, Jomar Aryee, Francis Sirch, Peter Filtes, Brian M. Katt
      Abstract: HAND, Ahead of Print.
      Background:Prior studies suggest steroid injections may affect infection rates following thumb carpometacarpal joint (CMCJ) arthroplasty. However, it is unclear whether injections prior to CMCJ arthroplasty affect functional outcomes, primarily Quick Disabilities of the Arm, Shoulder, and Hand (qDASH).Methods:We retrospectively identified patients who underwent thumb CMCJ arthroplasty from 2015 to 2019. Patients who had qDASH scores reported preoperatively, and at 5 and 11 months postoperatively were included. Charts were reviewed for the presence or absence of prior corticosteroid injection to the CMCJ and complications. Delta qDASH was calculated by subtracting the patients’ postoperative qDASH scores from the preoperative qDASH scores.Results:In all, 350 CMCJ arthroplasty patients were identified, 177 who had received at least 1 steroid injection and 173 who were steroid-naïve. No significant differences existed in delta qDASH scores postoperatively between the injection and naïve groups at 5 months (28.5 vs 28.6) or 11 months (31.2 vs 31.9). Whereas there were no significant differences in rates of major complications between the 2 groups, minor complications were higher in the injection group (16.4% vs 9.2%). Patients who received more than 3 injections did not have worse 5-month or 11-month delta qDASH scores or complication rates than those with fewer than 3.Conclusions:Preoperative CMCJ steroid injection status does not affect major complication rates or functional outcomes following CMCJ arthroplasty. However, injections increase the rate of minor complications. The qDASH and complication rates following CMCJ arthroplasty are not affected by receiving greater than 3 injections preoperatively.
      Citation: HAND
      PubDate: 2022-04-02T09:29:37Z
      DOI: 10.1177/15589447221081862
       
  • Complications Following Endoscopic and Open Trigger Finger Release: A
           Retrospective Comparative Study

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      Authors: Ather Mirza, Justin Mirza, Terence L. Thomas, Luke Zappia, Jacob Abulencia
      Abstract: HAND, Ahead of Print.
      Background:Open trigger finger release (OTFR) and endoscopic trigger finger release (ETFR) are effective methods in treating stenosing tenosynovitis. However, a paucity of literature exists comparing the techniques. This study describes and compares postoperative complications following OTFR and ETFR at a single institution.Methods:Patients undergoing trigger finger release between 2018 and 2020 within a single institution were identified. Electronic medical records were reviewed for patient demographics, surgical history, surgical characteristics, and clinical outcomes. Major and minor postoperative complications were assessed. Secondary outcome measures included tourniquet time and procedure time. Statistical analysis evaluated associations between postoperative complications, surgical technique, patient demographics, and surgical characteristics.Results:In total, 57 patients (80 digits) were included in the study: 42 digits treated with OTFR and 38 digits treated with ETFR. Mean follow-up time was 57.6 ± 69.0 days (range, 7-307 days) for ETFR and 34.2 ± 26.3 days (range, 6-120 days) for OTFR. Overall, major, and minor complication rates for the cohort were 8.8%, 1.8% and 7.0%, respectively. There were no major complications following ETFR and 1 following OTFR (4%), the isolated case being postoperative Chronic regional pain syndrome. Minor complication rates were similar following OTFR (8%) and ETFR (6%). Persistent digit stiffness and swelling were found to be the most prevalent minor complications (n = 2, respectively), followed by wound dehiscence (n = 1). Female patients were significantly more likely to experience postoperative complications.Conclusions:Major complications following trigger finger release are unlikely; however, minor complications are prominent. Patients treated with OTFR and ETFR showed similar postoperative complication rates. Continued investigations into the benefits of ETFR are warranted.
      Citation: HAND
      PubDate: 2022-03-31T06:30:42Z
      DOI: 10.1177/15589447221081869
       
  • Longitudinal Tear of the Central Slip Causing Painful and Unusual Snapping
           of the Finger: A Case Report

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      Authors: Peter Y. W. Chan, Virak Tan
      Abstract: HAND, Ahead of Print.
      The most common cause for catching or snapping in the finger is stenosing tenosynovitis, that is, trigger finger. Although less common, snapping can also occur as a result of extensor mechanism injury. Among these injuries, sagittal band rupture is most common and leads to snapping at the metacarpophalangeal joint. Snapping at the proximal interphalangeal (PIP) joint is rare with only 4 reported cases; reported mechanisms of PIP joint snapping include retinacular ligament injury or tendon impingement. We present a unique case of painful finger snapping at the PIP joint as a result of longitudinal tear of the central slip, leading to sudden subluxation of one-half of the central slip and conjoint lateral band with flexion of the PIP joint.
      Citation: HAND
      PubDate: 2022-03-31T06:27:31Z
      DOI: 10.1177/15589447221081876
       
  • Wrist Arthrotomy Saline Load Test

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      Authors: Joseph P. Scollan, Morad Chughtai, Jessica L. Churchill, Ahmed K. Emara, Ben Brej, Andrew Steckler, Alexandra Ferre, Paul Saluan, Joseph F. Styron
      Abstract: HAND, Ahead of Print.
      Background:Failure to recognize a potential wrist arthrotomy may lead to missed septic arthritis and devastating sequelae. The saline load test is routinely used to recognize traumatic arthrotomies of other joints; however, there are limited data optimizing this test for the wrist. The purpose of this study was to investigate and perform saline load testing to identify traumatic arthrotomies of the wrist.Methods:This was a cadaveric study of 15 wrists. Traumatic arthrotomies were created using a blunt trocar through the 3-4 portal. A 3-mL syringe with 0.1 mL markings was used to inject methylene blue dyed saline into the wrist through the 1-2 portal. Once extravasation was visible from the atherectomized site, the volume was recorded.Results:The mean (range) volume injected to identify the arthrotomy of all wrists was 1.22 mL (range, 0.1-3.1 mL). Multivariate regression demonstrated that cadaver age, laterality, and extension range of motion were not significantly associated with the injected saline volume at extravasation (P> .05, each). Greater joint range of motion was independently associated with higher saline volume load for extravasation (odds ratio: 1.049; 95% confidence interval: 1.024-1.075; P = .003).Conclusions:We found that 2.68 and 3.02 mL of methylene blue dyed saline offered 95% and 99% sensitivity, respectively, for diagnosing traumatic wrist arthrotomy. The maximum volume of saline needed to recognize an arthrotomy was 3.1 mL. We recommend this be the minimum volume used to evaluate a traumatic wrist arthrotomy.
      Citation: HAND
      PubDate: 2022-03-28T05:28:53Z
      DOI: 10.1177/15589447211043194
       
  • Radiographic Thumb Metacarpal Subsidence Following Ligament Reconstruction
           With Tendon Interposition and Suture-Only Suspension Arthroplasty in the
           Treatment of Basal Joint Arthritis

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      Authors: Maria A. Munsch, Thomas M. Suszynski, John R. Fowler, Marshall L. Balk, William C. Hagberg, Glenn A. Buterbaugh, Joseph E. Imbriglia
      Abstract: HAND, Ahead of Print.
      Background:The thumb carpometacarpal (CMC) joint is a common source of osteoarthritis. Following trapeziectomy, ligament reconstruction with tendon interposition (LRTI) is considered a “gold standard” treatment, but suture-only suspension arthroplasty (SSA) has recently emerged as a simpler alternative. Currently, there is no objective radiographic study comparing subsidence following these 2 techniques.Methods:This study is a retrospective review of 23 patients (10 LRTI, 13 SSA) that had at least 6 months of radiographic follow-up following thumb CMC arthroplasty. Posteroanterior radiographs at a preoperative timepoint, and at the 2-week and greater than 6-month postoperative timepoints were evaluated for actual trapezial height, as well as trapezial height normalized to capitate, thumb metacarpal, and proximal phalangeal heights. Normalized trapezial heights were calculated, and preoperative values were compared with greater than 6-month postoperative values. In addition, actual and normalized trapezial heights following LRTI and SSA were compared at each timepoint.Results:Mean trapezial height decreased from approximately 12 to 5 mm (reduction of ~60%, P < .05) in both groups with no differences when comparing LRTI and SSA at each timepoint. All normalized trapezial heights revealed differences from preoperative to greater than 6-month postoperative timepoints, but no differences between LRTI and SSA.Conclusions:Ligament reconstruction with tendon interposition and SSA exhibit equivalent actual and normalized trapezial heights over a greater than 6-month postoperative time course.
      Citation: HAND
      PubDate: 2022-03-24T09:17:54Z
      DOI: 10.1177/15589447221084014
       
  • Effect of Perioperative Corticosteroid Administration on Early
           Postoperative Range of Motion and Functional Outcomes Following
           Dupuytren’s Fasciectomy

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      Authors: Stephanie A. Kwan, Jacob E. Tulipan, Daniel Hameed, Jonas L. Matzon
      Abstract: HAND, Ahead of Print.
      Background:The purpose of the study was to evaluate whether perioperative corticosteroid (CS) administration improves early postoperative range of motion (ROM) and function in patients undergoing Dupuytren’s fasciectomy.Methods:We retrospectively identified 58 patients who underwent Dupuytren’s fasciectomy by a single fellowship-trained orthopedic hand surgeon from 2016 to 2020. During this time period, 51 digits in 34 patients received a single intraoperative dose of 10 mg of intravenous dexamethasone followed by a 6-day oral methylprednisolone taper course (CS group), and 37 digits in 24 patients did not (control group). Postoperatively, all patients started hand therapy within 1 week of surgery. At 2 and 6 weeks, patients had ROM data and Disabilities of the Arm, Shoulder, and Hand (DASH) scores collected by a blinded hand therapist. Paired t tests were used to compare the change in ROM and DASH scores at weeks 2 and 6.Results:The 2 cohorts had similar preoperative ROM. At 2 weeks postoperatively, the CS group had greater metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) flexion. There was no difference in MP, PIP, or DIP extension. At 6 weeks postoperatively, the CS group had greater PIP flexion. There was no difference between the groups in MP extension, MP flexion, PIP extension, DIP extension, or DIP flexion. Mean DASH scores were significantly lower in the CS group at weeks 2 and 6. There were no postoperative deep infections or complications requiring surgery in either group.Conclusion:Perioperative CS administration appears to be safe and to improve early ROM and DASH scores following Dupuytren’s fasciectomy.
      Citation: HAND
      PubDate: 2022-03-24T05:55:16Z
      DOI: 10.1177/15589447221084013
       
  • The One-Bone Forearm: A Review

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      Authors: Iqbal Multani, Joshua Xu, Jamil Manji, Richard D. Lawson, David J. Graham, Brahman S. Sivakumar
      Abstract: HAND, Ahead of Print.
      The one-bone forearm (OBF) is a salvage technique that may be used to correct global forearm instability secondary to osseous defects. This study aims to provide an overview of the contemporary literature regarding the OBF. A literature review was conducted electronically across MEDLINE, Embase, and PubMed databases in May 2020. Studies were eligible for inclusion if published in the English language; detailed the use of the OBF procedure to correct forearm instability; and were original data studies reporting qualitative or quantitative outcomes. Thirty-four studies, describing a cohort of 210 patients undergoing 211 OBFs, were documented in the literature. The primary etiology necessitating the OBF was trauma, followed by genetic/congenital disorders and infections. Technically, the OBF was most frequently achieved via an end-to-end osteosynthesis with plate fixation. In total, 85.0% (154/182) of OBF were fused in neutral rotation or varying degrees of pronation. Union was achieved in more than 80.0% (174/211) of OBFs. The OBF is a feasible salvage technique that has been used for a wide spectrum of pathology, providing satisfactory outcomes in most cases.
      Citation: HAND
      PubDate: 2022-03-24T05:52:55Z
      DOI: 10.1177/15589447221084010
       
  • The Effect of Upper Extremity Tourniquet Time on Postoperative Pain and
           Opiate Consumption

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      Authors: David E. Ruckle, Alexander C. Chang, Montri Daniel Wongworawat
      Abstract: HAND, Ahead of Print.
      Background:There is widespread use of pneumatic tourniquet for both upper and lower extremity orthopedic surgeries. Tourniquet use improves visualization, decreases blood loss, and as a result, decreases operative time. Exceeding a certain amount of tourniquet time can cause lasting neuromuscular damage. Orthopedic procedures cause significant pain, and the perioperative narcotic prescriptions after orthopedic surgery have been identified as one of the major contributors to the opioid epidemic. Our aim was to determine whether increasing tourniquet time had a negative impact on immediate postoperative opiate usage in the upper extremity, and to determine other factors associated with increased immediate postoperative opiate usage.Methods:A retrospective medical record review was performed on patients who underwent volar pleading for fracture fixation between January 2014 and December 2019 at a single institution. Postoperative pain, morphine equivalent dose (MED) usage, and demographic variables were collected. Multivariable analysis was performed, with P < .05 considered significant.Results:Immediate postoperative MED consumed was not correlated with operative time, tourniquet time, preoperative substance usage, or sex. However, postoperative MED consumed was correlated with preoperative narcotic use, high body mass index (BMI), and fracture surgery complexity.Conclusions:Tourniquet usage under current guidelines does not appear to have an effect on postoperative pain and narcotic usage. Preoperative narcotic usage, BMI, and surgery complexity are significant factors for postoperative opiate consumption.
      Citation: HAND
      PubDate: 2022-03-24T05:51:15Z
      DOI: 10.1177/15589447221084009
       
  • Validation of a Smartphone-Based Institutional Electronic Data Capture
           System for Thumb Carpometacarpal Joint Arthroplasty

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      Authors: Morad Chughtai, Joseph P. Scollan, Ahmed K. Emara, Yuxuan Jin, Peter J. Evans, David B. Shapiro, Joseph F. Styron
      Abstract: HAND, Ahead of Print.
      Background:The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty.Methods:The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets.Results:The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control.Conclusions:This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.
      Citation: HAND
      PubDate: 2022-03-24T05:49:35Z
      DOI: 10.1177/15589447221082163
       
  • Impact of COVID-19 on the Work, Health, and Quality of Life of Brazilian
           Hand Surgeons

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      Authors: Amanda Favaro Cagnolati, Fernanda Ruiz Andrade, Luiz Garcia Mandarano-Filho, Nilton Mazzer, Cláudio Henrique Barbieri, Neal C. Chen
      Abstract: HAND, Ahead of Print.
      Background:To evaluate the impact of coronavirus disease 2019 (COVID-19) on the clinical practice, health, and quality of life of Brazilian hand surgeons when only essential services and emergency procedures were being provided.Method:A questionnaire of 50 questions was sent to members of the Brazilian Society of Hand Surgery addressing work and life routines before the pandemic and during the initial quarantine period from April to August 2020.Results:Two hundred ten hand surgeons answered the questionnaire; 55.2% lived in the southeast region and worked in the capital and metropolitan regions, in both the private and public systems. Thirty-eight percent of the sample had other sources of income besides medicine, and due to a drop of 50% or more in the volume of consultations and surgeries, one-third had to apply for financial loans or access personal savings, and 69% made financial cuts in their domestic and life routines. More than 40% gained weight and stopped doing physical activities, while 20% lost weight and started physical activities. Approximately 30% were diagnosed with COVID-19, 92% of whom had mild symptoms and quarantined at home, and 89% had psychological symptoms such as anxiety, fear, insecurity, and insomnia.Conclusions:Coronavirus disease 2019 had a significant impact on the lives of Brazilian hand surgeons by drastically reducing the number of consultations and surgical procedures, generating not only financial difficulties but also changes in the exercise routine, changes in body weight, associated psychological symptoms, and changes in the family/life routine.
      Citation: HAND
      PubDate: 2022-03-24T05:46:34Z
      DOI: 10.1177/15589447221081871
       
  • Comparing the Radiologic and Functional Outcome of Radial Shortening
           Versus Capitate Shortening in Management of Kienböck’s Disease

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      Authors: Farid Najd Mazhar, Paniz Motaghi, Mohammad Reza Kooshesh, Omid Mahmoudinasab
      Abstract: HAND, Ahead of Print.
      Background:Kienböck’s disease is the avascular necrosis of the lunate bone. There is no consensus on the treatment strategy to avoid joint deterioration. This trial is conducted to compare the functional and radiological outcomes of radial shortening and capitate shortening techniques, in patients with avascular necrosis of lunate.Methods:Patients with a confirmed diagnosis of Kienböck’s disease who met the inclusion criteria were randomly divided into radial shortening and capitate shortening groups and treated by allocated technique. Physical examination and radiologic evaluations were performed before and 6 and 12 months after the operation.Results:A total of 52 patients (52 wrists) of stage II or III Kienböck’s disease were assessed for eligibility, 12 patients in the radial shortening group, and 17 patients remained until the end of the study. Patients in both groups achieved a satisfactory outcome, with no report of postoperative complications. None of the outcome measures, ranges of motion, grip, and pinch strengths were significantly different between the groups. The outcome was not considerably different in patients with positive or negative ulnar variances who were treated by capitate shortening technique.Conclusions:The capitate shortening technique which is performed through a smaller incision, and takes less time as compared with radial shortening can be advantageous for patients with stage II or III Kienböck’s disease regardless of the ulnar variance. This method can be as effective as classical methods such as radial shortening in improving clinical and functional symptoms after surgery while causing fewer complications.
      Citation: HAND
      PubDate: 2022-03-24T05:45:32Z
      DOI: 10.1177/15589447221081564
       
  • Giant Cell Tumor of the Triquetrum: Clinical Case and Literature Review

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      Authors: Adrià Calderon, Amalia Martínez-Ruiz, Teresa Subirà-i-Álvarez, Luis Oraa, Xavi Llorens, José Maria Mora
      Abstract: HAND, Ahead of Print.
      Giant cell tumor (GCT) is a benign, locally aggressive neoplasm with little incidence at the carpal bone level. We present a case of pyramidal bone GCT that required open biopsy for diagnosis. As a definitive treatment, en bloc resection of the pyramidal bone and luno-capitate arthrodesis were performed to avoid frequent relapses of these neoplasms and ensure proper functionality of the anatomical segment.
      Citation: HAND
      PubDate: 2022-03-24T05:45:16Z
      DOI: 10.1177/15589447221077374
       
  • Surgical Demographics of Acute Hand Compartment Syndrome

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      Authors: Derrick W. Williams, George S. M. Dyer, Arvind von Keudell, Dafang Zhang
      Abstract: HAND, Ahead of Print.
      Background:We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome.Methods:A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery).Results:The mean age of our cohort was 45 years, and 33 patients (62%) were men. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%). Associated hand fractures were present in 15 (28%) patients. The surgically released compartments varied; the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released.Conclusions:The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in “found down” compartment syndrome. Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome.
      Citation: HAND
      PubDate: 2022-03-21T10:28:17Z
      DOI: 10.1177/15589447221084012
       
  • Salter-Harris Type III Fracture of the Distal Phalanx: A Rare Juxtaphyseal
           Variant

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      Authors: Edward J. Testa, Stephen E. Marcaccio, Lindsay R. Kosinski, Matthew C. Jones, Julia A. Katarincic
      Abstract: HAND, Ahead of Print.
      Juxtaphyseal fractures of the distal phalanges of upper extremity digits are most commonly of the Salter-Harris II variety and occur most commonly in the thumb. The diagnosis of this injury is essential as it may present as an open fracture with a nailbed injury (“Seymour fracture”). However, an intra-articular, epiphyseal fracture may also occur and mimic a mallet deformity or Seymour fracture. Prompt diagnosis is essential to rule out an open fracture and obtain anatomical alignment and stability to attempt to reduce complications such as physeal arrest. Here, we present a patient with a displaced Salter-Harris type III fracture of his thumb distal phalanx and review his management and early-term outcome. We present this case to bring attention to this rare and unique injury, review the available literature, and discuss management and outcomes.
      Citation: HAND
      PubDate: 2022-03-21T10:25:01Z
      DOI: 10.1177/15589447221082165
       
  • Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse
           Digital Artery Island Flap

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      Authors: Satoshi Usami, Sanshiro Kawahara, Kohei Inami, Yuichi Hirase
      Abstract: HAND, Ahead of Print.
      Background:This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method.Methods:This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel’s sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups.Results:There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion.Conclusions:Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.
      Citation: HAND
      PubDate: 2022-03-21T10:23:30Z
      DOI: 10.1177/15589447221081863
       
  • Performance Outcomes and Return to Sport Following Metacarpal Fractures in
           Major League Baseball Players

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      Authors: Nicholas R. Pagani, Suleiman Y. Sudah, Michael A. Moverman, Richard N. Puzzitiello, Mariano E. Menendez, Michael S. Guss
      Abstract: HAND, Ahead of Print.
      Background:Major League Baseball (MLB) players are at risk for metacarpal fractures; however, little is known regarding the impact of these injuries on future performance. The purpose of this study was to determine whether MLB players who sustain metacarpal fractures demonstrate decreased performance on return to competition in comparison to the performance of control-matched peers.Methods:Data for MLB position players with metacarpal fractures incurred over 17 seasons were obtained from injury reports, press releases, and player profiles. Age, position, career experience, body mass index (BMI), injury mechanism, handedness, and treatment were recorded. Individual season statistics for the 2 seasons immediately before injury and the 2 seasons after injury were obtained. Controls matched by player position, age, BMI, career experience, and performance statistics were identified. A performance comparison of the cohorts was performed.Results:Overall, 24 players met inclusion criteria. Eleven players with metacarpal fractures were treated with surgery (46%) and 13 (54%) were treated nonoperatively. Players treated nonoperatively missed significantly fewer games following injury compared with those treated operatively (35.5 vs 52.6 games, P = .04). There was no significant difference in postinjury performance when compared with preinjury performance among the fracture cohorts. Players with metacarpal fractures treated nonoperatively had a significant decline in their Wins Above Replacement (WAR) 2 seasons postinjury (1.37 point decline) in comparison to matched controls (0.84 point increase) (P = .02). There was no significant difference in WAR 1 or 2 seasons postinjury for players with metacarpal fractures treated operatively in comparison to the control cohort.Conclusions:Major League Baseball players sustaining metacarpal fractures can expect to return to their preinjury performance levels following both nonoperative and operative treatment. However, players treated nonoperatively may witness a decline in their performance compared with peers over the long term. Orthopedic surgeons treating professional athletes with metacarpal fractures should consider these outcomes when counseling their patients and making treatment recommendations.
      Citation: HAND
      PubDate: 2022-03-21T10:22:46Z
      DOI: 10.1177/15589447221081565
       
  • Factors Affecting Functional Recovery After Volar Locking Plate Fixation
           for Distal Radius Fractures

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      Authors: Takafumi Hosokawa, Tsuyoshi Tajika, Morimichi Suto, Hirotaka Chikuda
      Abstract: HAND, Ahead of Print.
      Background:There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF.Methods:The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months.Results:A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model.Conclusions:Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.
      Citation: HAND
      PubDate: 2022-03-18T09:32:09Z
      DOI: 10.1177/15589447221082156
       
  • Predictors of Digital Amputation in Diabetic Patients With Surgically
           Treated Finger Infections

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      Authors: Ella Gibson, Carrie R. Bettlach, Emma Payne, John Daines, Linh Vuong, Corinne Merrill, Ida K. Fox, Mitchell A. Pet
      Abstract: HAND, Ahead of Print.
      Background:Diabetes is a well-established risk factor for severe digital infection, and patients are more likely to require digital amputation for adequate source control. This study aims to identify factors predictive of digital amputation compared with preservation in patients with diabetes who present with surgically treated finger infections.Methods:Current Procedural Terminology (CPT) and International Classification of Diseases Versions 9 and 10 (ICD-9/10) databases from a single academic medical center were queried to identify patients with type 1 or type 2 diabetes mellitus who underwent surgical treatment in the operating room for treatment of a digital infection from 2010 to 2020. Electronic medical records were reviewed to obtain historical and acute clinical variables at the time of hospital presentation. Bivariate and multivariable regression were used to identify factors associated with amputation.Results:In total, 145 patients (61 digital amputation, 84 digital preservation) met inclusion criteria for this retrospective cohort study. Mean hospital stay was 6 days, and the average patient underwent 2 operations. Multivariable analysis revealed that the presence of osteomyelitis, ipsilateral upper extremity dialysis fistula, end-stage renal disease, and vascular disease each had significant independent predictive value for amputation rather than digital preservation.Conclusions:Digital amputation is common in the setting of diabetic finger infection. The 4 variables found to independently predict the outcome of amputation can be understood as factors which decrease the likelihood of successful digital salvage and increase the potential consequence of ongoing uncontrolled infection. Further study should focus on clinical factors affecting surgical decision making and how the treatment rendered affects patient outcomes.
      Citation: HAND
      PubDate: 2022-03-14T10:05:44Z
      DOI: 10.1177/15589447221082160
       
  • Systematic Comparison of Ligament Reconstruction With Tendon Interposition
           and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis

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      Authors: Austin E. Wininger, Erin I. Orozco, Alex Han, Matthew B. Burn, Shari R. Liberman
      Abstract: HAND, Ahead of Print.
      Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient-reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. Inclusion criteria were level I-IV evidence articles reporting postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. Study methodological quality, risk of bias, and recommendation strength were assessed. This systematic review included 31 studies for final analysis with 1289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores, while key pinch and grip strength inconsistently improved following both procedures. Complication rate was similar between the 2 procedures; LRTI 12% and SBS 13%. Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies, and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these 2 techniques for the treatment of first carpometacarpal joint arthritis, larger prospectively designed studies of high-quality evidence are necessary.
      Citation: HAND
      PubDate: 2022-03-11T05:08:26Z
      DOI: 10.1177/15589447211043217
       
  • Postoperative Functional Analysis of Double Crush Versus Single Peripheral
           Nerve Decompression: A Retrospective Study

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      Authors: Conrad Stoy, Pedro Beredjiklian, Tyler Kreitz, Jacob Tulipan
      Abstract: HAND, Ahead of Print.
      Background:Double crush (DC) syndrome patients presenting with C6-7 radiculopathy and median nerve compression in the carpal tunnel report greater nerve irritability and weakness postdecompression than isolated peripheral nerve decompression. We hypothesize that patient-reported outcome is inferior following release at both cervical spine and wrist versus a single site of decompression.Methods:Patients that underwent either anterior cervical decompression and fusion (ACDF) for C6-C7 radiculopathy, carpal tunnel release (CTR), or both within 5 years (DC) were identified. A total of 477 patients were analyzed (157 DC, 203 CTR, and 117 ACDF). Post-operative outcome Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Neck Disability Index, and visual analog scale (VAS) scores were collected at an average of 2 years postoperatively.Results:QuickDASH scores were higher in the DC group versus CTR group (36 vs 22, P < .0002). Postoperative disability in the ACDF group was significantly higher than the DC group (50 vs 36, P < .017). There were no differences between ACDF and DC groups in arm pain intensity, but the CTR group demonstrated significantly greater arm pain intensity than the DC group (5.7 vs 3.6, 10-point scale, P < .01).Conclusions:Patients undergoing ACDF and CTR have greater postoperative disability than those undergoing CTR alone, but less postoperative functional disability and pain than ACDF alone, indicating cervical radiculopathy may contribute a greater proportion of long-term disability postoperatively. Additionally, CTR had greater postoperative arm pain than DC patients, potentially indicating high rates of undiagnosed cervical radiculopathy or other sources of arm pain in these patients.
      Citation: HAND
      PubDate: 2022-03-11T05:08:00Z
      DOI: 10.1177/15589447211038681
       
  • Gender Diversity in Hand Surgery Leadership

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      Authors: Alyssa K. Brisbin, Wendy Chen, Ezequiel Goldschmidt, Brandon T. Smith, Debra A. Bourne
      Abstract: HAND, Ahead of Print.
      Background:Diversity in leadership drives innovation; however, women are underrepresented in leadership positions across academic medicine. The aim of this study was to assess the current gender representation in hand surgery leadership positions.Methods:This was a cross-sectional analysis of leaders in hand surgery. Leaders were defined as President, Board and Committee members of the American Society for Surgery of the Hand and the American Association for Hand Surgery, as well as hand surgery fellowship program directors and physician lead editors of peer-reviewed hand journals. The representation of women in leadership was compared to the percentage of female hand fellows over the same period. Years in practice, academic rank, additional degrees, h-index, m-index, National Institutes of Health (NIH) funding, publications, and citations were compared between male and female leaders.Results:Twenty-nine of 213 leadership positions (13.6%) are held by women which is fewer than would be expected based on hand surgery fellowship composition. Female leaders were earlier in practice than their male counterparts (13.5 ± 5.7 versus 20.8 ± 11.1 years, P < .01). Women were more likely to hold position of assistant professor and less likely to be full professors (P < .05). There was no gender difference in NIH funding, h-index, m-index, publications, or citations. The greatest gender disparity was at the level of National Society President, which is a title held by only 2 women and 119 men.Conclusions:Gender disparities in hand surgery exist and are accentuated at the leadership level. Further work is needed to decrease leadership promotion disparities between men and women.
      Citation: HAND
      PubDate: 2022-03-11T05:05:24Z
      DOI: 10.1177/15589447211038679
       
  • Primary Distal Interphalangeal Joint Tenosynovial Chondromatosis of the
           Small Finger: A Case Report With Literature Review

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      Authors: Hunter Benvenuti, Christopher D. Liao, Brian Pinsky, Michael Christy
      Abstract: HAND, Ahead of Print.
      Primary synovial chondromatosis is a rare, benign proliferative disease of the joint synovium, tenosynovium, or bursal lining, in which cartilage metaplasia leads to the development of multiple intra-articular and periarticular loose osteocartilaginous bodies. This disease usually involves larger joints (knee, hip, elbow, and shoulder), but it has also rarely been reported in the hand. Patients with this disease complain of pain, swelling, nodules, and decreased range of motion of the affected joint. Due to its nonspecific symptoms and low prevalence, this disease often goes misdiagnosed, leading to delays in patient treatment. In the literature to date, there are only a few reports of primary synovial chondromatosis. In this case report, we present a patient with a rare case of primary synovial chondromatosis localized to right small finger distal interphalangeal joint.
      Citation: HAND
      PubDate: 2022-03-11T05:03:57Z
      DOI: 10.1177/15589447211049520
       
  • Risk Factors for Loss of Reduction After Open Reduction and Internal
           Fixation of Isolated Olecranon Fractures in Adults

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      Authors: Erik S. Contreras, Daniel J. Lynch, Sarah Hatef, Amy L. Speeckaert, Kanu S. Goyal
      Abstract: HAND, Ahead of Print.
      Background:We sought to determine whether any relevant patient, fracture, surgical, or postoperative characteristics are associated with loss of reduction after plate fixation of isolated olecranon fractures in adults.Methods:Patients who underwent open reduction and internal fixation of an olecranon fracture at our institution over an 11-year period were analyzed. Electronic patient charts and radiographic images were reviewed to gather patient, fracture, surgical, and postoperative data. Statistical analysis to explore the differences between groups was performed.Results:Seven of 96 patients experienced a loss of fracture reduction diagnosed at a median of 19 days after their initial surgery (range: 4-116 days). The radiographic mode of failure of all patients who lost reduction was proximal migration of the proximal fracture fragment with or without implant failure. The group that lost reduction had a significantly smaller proximal fragment (14.2 vs 18.6 mm), a higher incidence of malreduction with a persistent articular step-off greater than 2 mm (6/7 vs 14/89), a greater distance between the most proximal screw and the olecranon tip (19.8 vs 13.5 mm), a higher proportion of constructs with screws placed outside of the primary plate (4/7 vs 14/89), and a higher proportion of patients that were not immobilized postoperatively (3/7 vs 8/89).Conclusions:Our results suggest anatomical reduction at the articular surface and adequate fixation of the proximal fragment are key factors in maintenance of reduction, with smaller proximal fragments being at higher risk for failure. A period of postoperative immobilization may decrease the risk of loss of reduction.
      Citation: HAND
      PubDate: 2022-03-10T06:15:55Z
      DOI: 10.1177/15589447221075667
       
  • Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren
           Contracture in the Short-Term Postoperative Period: A Matched Analysis

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      Authors: Samantha Maasarani, Corinne E. Wee, Christina D. Lee, Syed I. Khalid, Sarah Layon, Shelley S. Noland
      Abstract: HAND, Ahead of Print.
      Background:This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both.Methods:PearlDiver’s Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received.Results:The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts.Conclusions:Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.
      Citation: HAND
      PubDate: 2022-03-07T06:03:55Z
      DOI: 10.1177/15589447221077375
       
  • On the Road Again: Return to Driving Following Minor Hand Surgery

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      Authors: Mary C. Frazier, Darren T. Hackley, Tonja M. Locklear, Ariel E. Badger, Peter J. Apel
      Abstract: HAND, Ahead of Print.
      Background:Patient return-to-driving following minor hand surgery is unknown. Through daily text message surveys, we sought to determine return-to-driving after minor hand surgery and the factors that influence return-to-driving.Methods:One hundred five subjects undergoing minor hand surgery received daily text messaging surveys postoperatively to assess: (1) if they drove the day before and if so; (2) whether they wore a cast, sling, or splint. Additional patient-, procedure-, and driving-related data were collected.Results:More than half of subjects, 54 out of 105, returned to driving by the end of postoperative day #1. While patient-related factors had no effect on return-to-driving, significant differences were seen in anesthesia type, procedure laterality, driving assistance, and distance. Return-to-driving was significantly later for subjects who had general anesthetic compared to wide awake local anesthetic with no tourniquet (4 ± 4 days vs 1 ± 3 days, P = 0.020), as well as for bilateral procedures versus unilateral procedures (5 ± 5 days vs 1 ± 3 days, P = 0.046). Lack of another driver and driving on highways led to earlier return-to-driving (P = 0.040 and, P = 0.005, respectively).Conclusions:Most patients rapidly return to driving after minor hand surgery. Use of general anesthetic and bilateral procedures may delay return-to-driving. Confidential real-time text-based surveys can provide valuable information on postoperative return-to-driving and other patient behaviors.
      Citation: HAND
      PubDate: 2022-03-07T06:00:03Z
      DOI: 10.1177/15589447221077363
       
  • HbA1c and Infection in Diabetic Elective Hand Surgery (A Veterans Affair
           Medical Center Experience 2012-2018)

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      Authors: Loretta Coady-Fariborzian, Christy Anstead
      Abstract: HAND, Ahead of Print.
      Background:Hemoglobin A1c (HbA1c) is an indicator of glucose control over a 3-month period. The plastic surgery service began screening HbA1c levels prior to surgery when a trend in infectious complications was noted in diabetics. We made a cutoff value of < 8% for elective hand surgery.Methods:The institutional review board approved a 7-year retrospective chart review (#201900402) 2012 through 2018 of our elective diabetic hand surgery cases. Data collected included: surgery, HbA1c levels within 3 months before surgery, glucose finger sticks day of surgery, and infectious complications up to 30 days after surgery. A Fisher exact test using a P value of < .05 and a logistic regression analysis using a P value of < .05 were used to determine statistical significance between infectious complications and screening.Results:In all, 848 cases were recorded in the data base. Infection complication rates before and after screening were not statistically significant (P = .44). All major complications (3) requiring a return to the operating room involved surgery within the flexor sheath before screening was enforced. This was not statistically significant (P = .25). The relative risk of an infectious complication involving the flexor sheath in unscreened patients was 3.66. A logistic regression analysis found no correlation with infectious complications based on the 3 variables of screening time (P = .99), preoperative finger stick values (P = .12), or HbA1c levels (P = .29).Conclusion:The data did not support our guidelines for enforcing HbA1c cutoff levels prior to elective hand surgery. Consider enforcing levels < 8% when the flexor sheath may be violated.
      Citation: HAND
      PubDate: 2022-03-07T01:28:03Z
      DOI: 10.1177/1558944720937363
       
  • Charges for Distal Radius Fracture Fixation Are Affected by Fracture
           Pattern, Location of Service, and Anesthesia Type

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      Authors: Avi D. Goodman, Peter Brodeur, Aristides I. Cruz, Lindsay R. Kosinski, Edward Akelman, Joseph A. Gil
      Abstract: HAND, Ahead of Print.
      Background:This study sought to characterize charges associated with operative treatment of distal radius fractures and identify sources of variation contributing to overall cost.Methods:A retrospective study was performed using the New York Statewide Planning and Research Cooperative System database from 2009-2017. Outpatient claims were identified using the International Classification of Diseases-9/10-Clinical Modification diagnosis codes for distal radius fixation surgery. A multivariable mixed model regression was performed to identify variables contributing to total charges of the claim, including patient demographics, anesthesia method, surgery location (ambulatory surgery center [ASC] versus a hospital outpatient department [HOPD], operation time, insurance type, Charlson Comorbidity Index, and billed procedure codes.Results:A total of 9029 claims were included, finding older age, private primary insurance, surgery performed in a HOPD, and use of local anesthesia (vs general or regional) associated with increased total charges. There was no difference between gender, race, or ethnicity. Additionally, open reduction and internal fixation (ORIF), increased operative time/fracture complexity, and use of perioperative medications contributed significantly to overall costs.Conclusions:Charges for distal radius fracture surgery performed in a HOPD were 28.3% higher than compared to an ASC, and cases with local anesthesia had higher billed claims compared to regional or general anesthesia. Furthermore, charges for percutaneous fixation were 54.6% lower than ORIF of extraarticular fracture, and claims had substantial geographic variation. These findings may be used by providers and payers to help improve value of distal radius fracture care.Level of Evidence:Level III
      Citation: HAND
      PubDate: 2022-03-05T06:27:52Z
      DOI: 10.1177/15589447221077379
       
  • Treatment and Management of Upper Extremity Dysfunction Following
           Transradial Percutaneous Coronary Intervention: A Prospective Cohort Study
           

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      Authors: Elena S. Cheung, Eva M. Zwaan, Ton A. R. Schreuders, Marcel J. M. Kofflard, J. Henk. Coert, Marco Alings, Alexander J. J. IJsselmuiden, Carlo A. J. Holtzer
      Abstract: HAND, Ahead of Print.
      Background:The transradial artery access is the benchmark approach in transradial percutaneous coronary intervention (TR-PCI). The purpose of this study was to evaluate the different complications, treatments, and outcome of upper extremity dysfunction following a TR-PCI.Methods:This was a prospective cohort substudy of patients with access-site complications. The study population consisted of 433 patients treated with TR-PCI. Referral to the hand center was mandated if the patient experienced new-onset or increase of preexistent symptoms in the upper extremity. Patients were followed up to the last control visit (5-7 months after the index procedure) at the hand center. Outcome results were categorized in “symptom-free,” “improvement of symptoms,” and “no improvement.”Results:Forty-one (9% of total) patients underwent assessment at the hand center. Most frequent referral indication was pain in the intervention arm. Women, preexisting sensibility disorder, and osteoarthritis in the intervention arm were associated with increased odds of referral. The most common complications diagnosed were carpal tunnel syndrome (n = 18) and osteoarthritis (n = 15). Thirty patients required further medical treatment. Immobilization therapy was most applied. Seventeen (4% of total) patients had persisting symptoms despite medical treatment.Conclusions:The occurrence of complications in the upper extremity after a TR-PCI is small. Despite medical treatment, symptoms persisted in 4% of all patients treated with TR-PCI. Possible explanations for the persisting symptoms are exacerbation of latent osteoarthritis and carpal tunnel syndrome by trauma-induced edema. Awareness of TR-PCI-induced complications among all specialists is essential to optimize patient care.
      Citation: HAND
      PubDate: 2022-03-05T06:23:04Z
      DOI: 10.1177/15589447211073832
       
  • Billing and Utilization Trends for Hand Surgery Indicate Worsening
           Barriers to Accessing Care

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      Authors: Jung Ho Gong, Chao Long, Adam E. M. Eltorai, Kavya K. Sanghavi, Aviram M. Giladi
      Abstract: HAND, Ahead of Print.
      Background:Hospitals and providers may increase hand surgery charges to compensate for decreasing reimbursement. Higher charges, combined with increasing utilization of ambulatory surgical centers (ASCs), may threaten the accessibility of affordable hand surgery care for uninsured and underinsured patients.Methods:We queried the Physician/Supplier Procedure Summary to collect the number of procedures, charges, and reimbursements of hand procedures from 2010 to 2019. We adjusted procedural volume by Medicare enrollment and monetary values to the 2019 US dollar. We calculated weighted means of charges and reimbursement that were then used to calculate reimbursement-to-charge ratios (RCRs). We calculated overall change and r2 from 2010 to 2019 for all procedures and stratified by procedural type, service setting, and state where service was rendered.Results:Weighted mean charges, reimbursement, and RCRs changed by + 21.0% (from $1,227 to $1,485; r2 = 0.93), +10.8% (from $321 to $356; r2 = 0.69), and -8.4% (from 0.26 to 0.24; r2 = 0.76), respectively. The Medicare enrollment-adjusted number of procedures performed in ASCs increased by 63.8% (r2 = 0.95). Trends in utilization and billing varied widely across different procedural types, service settings, and states.Conclusions:Charges for hand surgery procedures steadily increased, possibly reflecting an attempt to make up for reimbursements perceived to be inadequate. This trend places uninsured and underinsured patients at greater risk for financial catastrophe, as they are often responsible for full or partial charges. In addition, procedures shifted from inpatient to ASC setting. This may further limit access to affordable hand care for uninsured and underinsured patients.
      Citation: HAND
      PubDate: 2022-03-03T09:47:18Z
      DOI: 10.1177/15589447221077367
       
  • Elevated Body Mass Index Negatively Impacts Recovery of Shoulder Abduction
           Strength in Triceps Motor Branch to Axillary Nerve Transfers

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      Authors: Aneesh Karir, Linden K. Head, Maria C. Médor, Gerald Wolff, Kirsty U. Boyd
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this work was to evaluate the clinical outcomes of triceps motor branch to axillary nerve transfers and to identify prognostic factors which may influence these outcomes.Methods:A retrospective cohort included all patients who underwent a triceps motor branch to axillary nerve transfer (2010-2019) with at least 12 months of follow-up. The primary outcome measure was shoulder abduction strength assessed with British Medical Research Council (MRC) grade.Results:Ten patients were included with a mean follow-up of 19.1 (SD 5.9) months. Compared with preoperative MRC shoulder abduction strength (0.2 SD 0.4), patients significantly improved postoperatively (2.8 SD 1.6; P = .005). Increased body mass index (BMI) was significantly associated with worse postoperative MRC (P = .014).Conclusion:Triceps motor branch to axillary nerve transfer is a beneficial procedure for restoring shoulder function in patients presenting with either isolated axillary nerve or brachial plexus pathology. Patients with elevated BMI may not have as robust strength recovery and should be counseled carefully regarding prognosis.
      Citation: HAND
      PubDate: 2022-03-03T08:58:30Z
      DOI: 10.1177/15589447221075664
       
  • Volar Plating of Scaphoid Fractures: A Retrospective Case Series

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      Authors: Konrad A. Lemke, Rejith V. Mannambeth, Christopher J. Carman, Steve Csongvay
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this study was to evaluate the rate of union of scaphoid fractures managed with volar plating and assess postoperative complications.Methods:Retrospective consecutive case series of 28 patients with scaphoid fractures, 9 acute and 19 chronic nonunions, undergoing surgical fixation with volar scaphoid plating by a single surgeon between 2013 and 2019. Patients were followed up for a minimum of 3 months with scaphoid bony union being confirmed on radiograph or computed tomography. Postoperative complications and need for plate removal were recorded.Results:Overall union rate of 96% with all 19 chronic nonunions demonstrating radiological union and 1 of 9 acute fractures not uniting and requiring revision surgery. The only postoperative complication identified was symptomatic plate impingement which necessitated plate removal in 57% of cases.Conclusions:This case series demonstrates volar plating of scaphoid fractures can be used as an alternative technique to achieve union.
      Citation: HAND
      PubDate: 2022-03-01T07:04:28Z
      DOI: 10.1177/15589447221075674
       
  • Gabapentinoid Prescribing for Carpal Tunnel Syndrome

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      Authors: Jessica I. Billig, Vidhya Gunaseelan, Maryam Yazdanfar, Erika D. Sears, Theodore J. Iwashyna, Tammy Chang, Jennifer F. Waljee
      Abstract: HAND, Ahead of Print.
      Background:Gabapentinoids, including gabapentin and pregabalin, are commonly prescribed for neuropathic pain, but robust evidence recommends against using gabapentinoids for the treatment of carpal tunnel syndrome (CTS). We aimed to quantify national prescribing patterns of gabapentinoids for CTS.Methods:We performed a retrospective population-based cohort study using claims data of gabapentinoid-naïve patients with a new diagnosis of CTS (2009-2016). Our primary outcome was a new gabapentinoid fill for CTS. We assessed temporal trends and characteristics associated with a gabapentinoid fill. Multivariable logistic regression was used to evaluate the association between patient-level factors and a new gabapentinoid fill for CTS.Results:Of the 248 324 previously gabapentinoid-naïve patients with CTS, 9589 patients (4%) filled a gabapentinoid prescription. Sixty-one percent were prescribed by primary care providers or medical subspecialists. Patients with a history of neck pain (odds ratio [OR]: 1.31, 95% confidence interval [CI], 1.25-1.38), back pain (OR: 1.25, 95% CI, 1.20-1.31), arthritis (OR: 1.25, 95% CI, 1.18-1.31), and other pain conditions (OR: 1.26, 95% CI, 1.20-1.31) were associated with an increased odds of a new gabapentinoid fill. In addition, patients with a history of alcohol or substance use disorder were significantly associated with a new gabapentinoid prescription fill (OR: 1.33, 95% CI, 1.20-1.47).Conclusions:Despite evidence recommending against the use of gabapentinoids for CTS, gabapentinoids were frequently initiated among those with higher risk for misuse, including substance use disorders. Given the effectiveness of bracing or surgery for CTS and the risks associated with gabapentinoids, efforts aimed at disseminating evidence-based treatment for CTS are critical to minimize the harms of gabapentinoid misuse.
      Citation: HAND
      PubDate: 2022-02-28T07:30:26Z
      DOI: 10.1177/15589447211063544
       
  • Future Fracture Risk in Upper Extremity Fracture and Non-Fracture Patients

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      Authors: Thany Seyok, Jamie E. Collins, Samantha J. Erikson, Julia F. Charles, Brandon E. Earp
      Abstract: HAND, Ahead of Print.
      Background:Upper extremity (UE) fragility fractures are common and strong predictors of subsequent fractures. To investigate the relative importance of an UE fragility fracture in determining future fracture risk, we conducted a cross-sectional study to compare future fracture risk between patients presenting for osteoporosis evaluation after an UE fragility fracture and a similarly aged cohort of patients without an UE fracture.Methods:In all, 129 UE fracture patients seen in our bone health clinic (BHC) and 114 non-fracture UE fracture patients seen in an UE clinic completed clinic intake surveys assessing for fracture risk factors. Prefracture fracture risk (PFFR) and fracture risk assessment tool (FRAX) scores estimated the future fracture risks at the timepoint before and after the UE fragility fracture event, respectively. The primary study outcome was the 10-year risk of future fracture.Results:The 10-year probability of major osteoporotic and hip fractures were significantly higher among the BHC group when estimated with FRAX. When estimated with PFFR score, there was no difference in the 10-year probability of hip fracture between the groups. Prevalence of secondary osteoporosis and glucocorticoid use was higher in the BHC group, and prevalence of rheumatoid arthritis was higher in the UE clinic group.ConclusionsThis study underscores the importance of an UE fragility fracture in determining the risk of future fracture. A fragility fracture of the UE should be considered a sentinel event and physicians who evaluate these patients should recognize them as a high-risk group for future hip fracture.
      Citation: HAND
      PubDate: 2022-02-26T12:57:50Z
      DOI: 10.1177/15589447211049521
       
  • Reoperation Following Zone II Flexor Tendon Repair

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      Authors: Luca L. Bruin, Jonathan Lans, Frederick Wang, Kyle R. Eberlin, Neal C. Chen
      Abstract: HAND, Ahead of Print.
      Background:The goal of zone II flexor tendon surgery is to perform a repair with sufficient strength to withstand the forces encountered during rehabilitation. Postoperative rerupture and adhesion formation may lead to reoperation. This study aimed to determine the factors associated with reoperation after primary zone II flexor tendon repair.Methods:In this retrospective case series, a total of 252 fingers in 201 patients underwent zone II flexor tendon repair. A medical record review was performed to collect data regarding patient demographics, injury and treatment characteristics and postoperative complications including reoperation. Reoperation was defined as any unplanned surgical procedure performed after initial flexor tendon repair.Results:There were 49 fingers (19%) in 42 patients that underwent reoperation at a median of 5.5 (interquartile range: 2.8-7.9) months. Older age, workers’ compensation, and a Kessler-type repair of the flexor digitorum profundus were independently associated with reoperation.Conclusions:In vitro studies suggest that Kessler-type repairs are inferior compared with other suture configurations. Our study demonstrates a clinical correlation to these biomechanical studies. Our results suggest that Kessler-type repairs are inferior compared with non-Kessler-type repairs, due to postoperative complications requiring secondary surgeries.
      Citation: HAND
      PubDate: 2022-02-26T12:47:37Z
      DOI: 10.1177/15589447211043220
       
  • Arthroplasty of the Proximal Interphalangeal Joint With the TACTYS
           Prosthesis: Clinical and Radiographic Results With a Mean Follow-up of 5
           Years

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      Authors: Tim Philips, Bert Vanmierlo, Jean F. Goubau
      Abstract: HAND, Ahead of Print.
      Background:Degenerative arthritis of the proximal interphalangeal (PIP) joint of the long fingers is a common disorder affecting mainly a female middle-aged population. Conservative treatment is often effective, but in some cases, pain can persist which can lead to invalidating function. Besides denervation and arthrodesis, arthroplasty is a valuable alternative treatment. The goal of this retrospective study was to determine the clinical and radiological outcomes of the TACTYS prosthesis with a mean follow-up of more than 5 years.Methods:Between October 2005 and August 2019 10 joints in 9 patients, one patient had two prostheses in two separate fingers (4 males and 6 women) were treated for painful degenerative arthritis of the long fingers with a TACTYS prosthesis (Stryker Inc, Kalamazoo, Michigan). Power grip and pinch force were tested preoperatively and postoperatively, and the functional outcome survey is performed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), recall QuickDASH, and Patient-Rated Wrist Evaluation standardized questionnaires scored of 100 and the Visual Analog Scale (VAS) from 0 to 10.Results:Mean follow-up was 65.70 months (range: 23-106). Mean age was 71.5 years (range: 64-83). QuickDASH score evolved from 68.43 to 41.92, range of motion from 37.5° to 45.1°, VAS from 6.65 to 1/10. Power grip and precision pinch evolved from 16.44 to 20.80 kg and 1.97 to 2.85 kg, respectively.Conclusions:TACTYS arthroplasty can be proposed for people who have been treated long enough with unsuccessful conservative treatment. Infection rate is still the highest complication, which can evolve in invalidating arthrodesis. It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain.
      Citation: HAND
      PubDate: 2022-02-26T12:41:00Z
      DOI: 10.1177/15589447211030962
       
  • Upper Extremity Infection Related to Intravenous Drug Use: Considering the
           True Cost of the COVID-19 Pandemic and Lockdown

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      Authors: Matthew McRae, Yaeesh Sardiwalla, Omri Nachmani, Emma Price, Minh Huynh, Christopher Coroneos
      Abstract: HAND, Ahead of Print.
      Background:The COVID-19 pandemic caused significant morbidity and mortality in people who inject drugs (PWID). Upper extremity soft tissue infections are frequently associated with intravenous drug use (IVDU) due to poor compliance with aseptic technique. In Canada, multiple safe injection sites providing clean injection supplies closed, leaving many PWID with no alternatives to inject safely. It was hypothesized that these closures will correspond with increased morbidity and mortality among PWID. The main objective of this study was to determine the effect of the COVID-19 pandemic on the incidence of upper extremity infections in PWID.Methods:This was a retrospective chart review study. The primary outcome of interest was the frequency of upper extremity infections in PWID. Data were filtered to include only those patients presenting to the emergency department between March to June of 2019 and 2020. Chi-squared analysis was used to compare the number of IVDU patients among patients with upper extremity skin infections between these time periods.Results:The number of IVDU patients treated for upper extremity infections in Hamilton significantly increased during the pandemic, relative risk = 2.0 (95% confidence interval [CI]: 1.3-2.9, P = .0012,) while total upper extremity infections numbers have decreased overall. During the pandemic, PWID made up a larger proportion of upper extremity infections (χ2 = 10.444, P = .00123). Demographic data such as age and sex of IVDU patients presenting with upper extremity infection was not significantly affected by the pandemic.Conclusions:The effect of the pandemic on accessing harm reduction services has led to evident increases in morbidity as described by this study. Further research on the impact of closures in PWID is needed to quantify these harms and work toward mitigation strategies.
      Citation: HAND
      PubDate: 2022-02-23T06:30:49Z
      DOI: 10.1177/15589447221077377
       
  • Effects of Premixing Betamethasone and Lidocaine on Chondrocyte
           Inflammation in an In Vitro Model

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      Authors: Michael J. Sayegh, Camille Pinpin, Christopher G. Larsen, Eric V. Neufeld, Jessica M. Intravia, Kate W. Nellans, Lewis B. Lane, Daniel Grande
      Abstract: HAND, Ahead of Print.
      Background:It is common practice for hand surgeons to premix corticosteroids with a local anesthetic and store the mixture in pre-loaded syringes for rapid use during clinic. However, any possible loss of efficacy with this practice has never been studied. The purpose of this study, therefore, is to determine whether premixing betamethasone sodium phosphate/betamethasone acetate (BSP) and lidocaine (L) at different time intervals from injection has diminishing anti-inflammatory effects on chondrocytes in vitro.Methods:Human articular chondrocytes were partitioned into six groups: two controls and four experimental conditions. The negative control had growth media only. The positive control had growth media and inflammatory cytokines (interleukin-1β and oncostatin M). Experimental conditions were additionally treated with BSP alone or BSP mixed with lidocaine (BSP + L) at the time of treatment (0 hours), or at 4 or 24 hours prior. Relative expressions of inflammatory genes were measured.Results:Relative to the positive control, chondrocytes in all experimental conditions decreased expression of TNF-α, MMP-3, and ADAMTS-4. Chondrocytes exposed to BSP only or BSP + L at 4 hours or 24 hours prior to treatment decreased expression of IL-8. Chondrocytes exposed to BSP only or BSP + L at 0 hours or 4 hours prior to treatment decreased expression of MMP-1. There were no significant differences in expression of IL-6 or MMP-13.Conclusions:Treatment with BSP + L prepared in pre-loaded syringes at varying time intervals up to 24 hours prior to injection does not significantly impact the ability of the mixture to reduce expression of certain key inflammatory mediators in vitro.
      Citation: HAND
      PubDate: 2022-02-23T06:26:07Z
      DOI: 10.1177/15589447221077346
       
  • Innovative Quantitative Assessment of Hand Function in Carpal Tunnel
           Syndrome

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      Authors: Susanna Alloisio, Ciro Mennella, Federica Viti, Antonio Novellino, Stefano Tognon
      Abstract: HAND, Ahead of Print.
      Background:Carpal tunnel syndrome (CTS) compromises fine sensorimotor function during activities of daily living and affects a large number of individuals with high burden costs for society. The purpose of this study was to quantitatively characterize fine movement skills in CTS patients preoperatively and at 1 month postoperatively by means of a sensor-engineered glove, in order to provide new insights for evaluative and finally therapeutic purposes.Methods:Forty-one CTS patients and 41 age- and gender-matched healthy controls (HC) were analyzed by adopting the engineered glove Hand Test System (HTS), which previously demonstrated its reliability and sensitivity to detect hands dysfunction in several neurological diseases. A sub-group of 11 CTS subjects was re-tested 1 month after surgery. Three parameters—touch duration (TD), inter-tapping interval (ITI), and movement rate (MR)—were considered to characterize hand function.Results:The affected hand of CTS patients generally showed worst finger opposition performances than HC. Comparing the dominant hand, all parameters were able to significantly discriminate CTS patients from HC. Considering the nondominant hand, the best performing parameter in discriminating CTS from HC was TD. The follow-up assessment at 1 month after surgery showed that considered parameters were able to monitor patients’ recovery. In particular, the TD parameter recorded at the 3 different assigned task modalities resulted significantly enhanced.Conclusions:Results of this pilot study proved the validity of the parameters obtained through the sensor-engineered glove to assess objectively hand functional status and surgical outcomes in CTS.
      Citation: HAND
      PubDate: 2022-02-22T05:18:14Z
      DOI: 10.1177/15589447221075675
       
  • Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on
           Geographic Socioeconomic Disadvantage'

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      Authors: Rafa Rahman, Amy L. Xu, Suraj A. Dhanjani, Bo Zhang, Suresh K. Nayar, Casey J. Humbyrd, Dawn LaPorte
      Abstract: HAND, Ahead of Print.
      Background:While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs.Methods:We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient’s ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05.Results:There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] (P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage.Conclusions:Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care.Level of Evidence:Level III
      Citation: HAND
      PubDate: 2022-02-22T05:16:10Z
      DOI: 10.1177/15589447221075669
       
  • Botulinum Toxin A for the Treatment of Sympathomimetic Pressor-Induced
           Digital Hand Ischemia in the Critically Ill Intensive Care Unit Patient

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      Authors: Henning De May, Avra S. Laarakker, Gregory Borah
      Abstract: HAND, Ahead of Print.
      Vasopressor-induced ischemia of the hand, while relatively rare, is a severe complication in critically ill intensive care unit (ICU) patients requiring high concentrations of sympathomimetic pressors and often results in digit necrosis and amputation. Currently, there are no widely accepted approaches for treating this cause of peripheral digital ischemia. Case reports have demonstrated that reducing the concentration of vasopressors that patients are given may reverse the progression of ischemic events prior to necrosis. While this approach is at odds with the principle of “life over limb,” it demonstrates that digit necrosis can be reversed, resulting in improved outcomes. Here, we present a therapeutic strategy for treating digital limb ischemia in the septic ICU patient without the need to lower systemic vasopressor dose by using locally injected botulinum toxin A into ischemic hands.
      Citation: HAND
      PubDate: 2022-02-22T05:14:08Z
      DOI: 10.1177/15589447221075666
       
  • Nonoperative Management of Humerus Fractures in Patients With Ispilateral
           Hemiparesis or Hemiplegia

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      Authors: Raahil S. Patel, John J. Bartoletta, Nicholas F. Munaretto, Adam J. Tagliero, Peter C. Rhee
      Abstract: HAND, Ahead of Print.
      Background:Patients with upper limb dysfunction from a brain injury often have different goals of treatment and expectations following a fracture of the upper extremity. This study retrospectively reviewed outcomes of nonoperative management of acute humerus fractures in patients with severe ipsilateral hemiparesis or hemiplegia.Methods:Patients who had sustained an acute humerus fracture managed nonoperatively, greater than 1 year following an upper motor neuron (UMN) injury resulting in ipsilateral severe hemiparesis or hemiplegia at a single tertiary care center from 1988 to 2019, were reviewed. Fractures were classified using the AO-Müller/Orthopaedic Trauma Association and/or Neer classifications. Primary outcome measures included House classification level of function, pain, achievement of and time to radiographic union, and the need for subsequent surgical procedures.Results:Ten distinct nonoperatively managed humerus fractures—3 proximal (11A23), 5 mid-shaft (12A2b = 1, 12A2c = 2, 12A3a = 1, 12A2b = 1), and 2 distal (13A2 = 1, 13 C1 = 1)—were identified in 8 patients (6 women and 2 men) with ipsilateral hemiparesis or hemiplegia. The median radiographic follow-up was 20 months (range: 78 days to 12 years). The median clinical follow-up was 33.5 months (range: 100 days to 12 years). All patients presented with severe pain that was absent at final follow-up. Radiographic union was achieved in all patients with a mean time to union of 90.9 ± 39.3 days (range: 35-185 days). No patients required operative management.Conclusions:Nonoperative management of humerus fractures in patients with an ipsilateral UMN injury might result in reliable pain relief and union without the need for further surgical intervention. Management of humerus fractures in this patient population should be individualized toward their goals of care.
      Citation: HAND
      PubDate: 2022-02-22T05:12:28Z
      DOI: 10.1177/15589447211073835
       
  • Boston Carpal Tunnel Questionnaire Scores Alone Do Not Predict Surgical
           Intervention for Patients With Carpal Tunnel Syndrome

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      Authors: Frank R. Chen, Jona Kerluku, Joseph E. Manzi, Aaron Z. Chen, Joseph T. Nguyen, Lauren E. Wessel, Daniel A. Osei, Duretti T. Fufa
      Abstract: HAND, Ahead of Print.
      Background:With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS.Methods:Patients diagnosed with CTS from January 2017 to February 2020 completed BCTQ questionnaires prior to in-person office visits. Demographics, comorbidities, and highest level of intervention recommended were recorded for each patient as conservative, injection, or surgery. Pearson χ2 and independent-samples t tests were conducted to determine whether BCTQ symptom severity and functional scores were associated with intervention type.Results:A total of 200 patients with CTS were included. Of these, 103 were recommended conservative or injection treatment and 97 were recommended surgery. There were no differences in comorbidities between groups, including other upper extremity pathology (P = .57), previous upper extremity surgery (P = .32), hypertension (P = .17), hypothyroidism (P = .15), rheumatoid arthritis (P = .34), and diabetes (P = .30). Between these groups, there were no differences in BCTQ symptom severity score (symptom severity scale [SSS]; P = .16) or BCTQ functional severity score (functional severity scale [FSS]; P = .96).Conclusions:There is no correlation between comorbidities and BCTQ SSS or FSS score, and offering surgery for CTS. In an era of minimizing non-essential health care visits, the BCTQ is insufficient in screening patients as potential surgical candidates.
      Citation: HAND
      PubDate: 2022-02-22T04:30:00Z
      DOI: 10.1177/15589447211072226
       
  • Classic Type of Epithelioid Sarcoma of the Distal Upper Extremity:
           Clinical and Oncological Characteristics

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      Authors: Farhad Farzaliyev, Hans-Ulrich Steinau, Andrej Ring, Paula Beck, Jendrik Hardes, Arne Streitbürger, Lars Erik Podleska
      Abstract: HAND, Ahead of Print.
      Background:The classic type of epithelioid sarcoma (ES) is a rare, aggressive soft tissue neoplasm that most commonly affects the distal upper extremities of young patients. This study aimed to assess clinical features and provide a long-term report of the oncological outcome.Methods:We retrospectively analyzed our clinical database for patients with ES of the distal upper extremities.Results:Twenty-three patients with ES of the distal upper extremity were treated surgically between January 1990 and August 2018. ES affected most commonly the palmar side of young patients. The most common site affected by a sarcoma was the wrist in 47.8% of cases, followed by metacarpals and fingers with 34.8% and 17.4%, respectively. Most of the patients were treated according to the protocols of interdisciplinary tumor boards with multimodal therapy. A local recurrence was observed in 7 patients (30.4%). The 5 - and 10-year recurrence-free survival was 80.4% (95% confidence interval [CI]: 68.6-76.8) and 60.9% (95% CI: 53.5-68.3), respectively. The 5- and 10-years disease-specific survival was 89.9% (95% CI: 87-92.8) and 61.9% (95% CI: 56.5-67.3), respectively. Five patients (21.7%) had metastasis in regional lymph nodes.Conclusion:The classic type of ES represents a group of high-grade sarcomas, which affect the dominantly distal upper extremity. Specific clinical, diagnostic, and oncological characteristics make it difficult to diagnose and therapy. Wide tumor resection as a part of multimodal therapy remains a more viable and common treatment option for patients with ES on distal extremities. High rates of lymph node metastasis are typical for ES.
      Citation: HAND
      PubDate: 2022-02-21T07:08:19Z
      DOI: 10.1177/15589447221075745
       
  • Congenital Bilateral Anomaly of the Flexor Pollicis Longus Tendon Without
           Thenar Atrophy: A Case Report

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      Authors: Iris H. M. Meeuwis, Dick J. Venderink, Wim I. M. Verhagen
      Abstract: HAND, Ahead of Print.
      In this case report, we describe an adult patient with bilateral congenital absence of the m. flexor pollicis longus (FPL) without any other anomalies or thenar atrophy. The FPL muscle acts to flex the thumb and is innervated by the anterior interosseous nerve. Impaired function of the FPL muscle may have several causes. A bilateral anomaly of the FPL tendon is a rare phenomenon, with only a few cases having been reported. This case report does not only demonstrate the diagnosis of bilateral FPL tendon anomaly by physical examination and magnetic resonance imaging, it also includes the embryological development of the FPL muscle and tendon.
      Citation: HAND
      PubDate: 2022-02-21T07:05:09Z
      DOI: 10.1177/15589447221075673
       
  • Open versus Single- or Dual-Portal Endoscopic Carpal Tunnel Release: A
           Meta-Analysis of Randomized Controlled Trials

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      Authors: Denis P. Koong, Vincent V. G. An, Haren Nandapalan, Richard D. Lawson, David J. Graham, Brahman S. Sivakumar
      Abstract: HAND, Ahead of Print.
      Background:Compared to the traditional open carpal tunnel release (OCTR), the additional safety and efficacy benefits of endoscopic carpal tunnel release (ECTR) remains unclear. The aim of this study is to evaluate the outcomes of ECTR versus conventional OCTR as well as determine if a difference exists between the 2 most common endoscopic techniques: the single-portal and the dual-portal endoscopic technique.Methods:We conducted a systematic literature search of Medline, Embase, PubMed, and the CENTRAL. Additional articles were identified by handsearching reference lists. We included all randomized controlled trials that compared outcomes of ECTR with OCTR technique. Outcomes assessed included length of surgery, patient reported symptom and functional measures, time to return to work, and complications. A sub-group analysis was performed to indirectly compare single- versus dual-portal endoscopic approaches. Statistical analysis was performed via a random-effects model using Review Manager 5 Software.Results:A meta-analysis of 23 studies revealed a significantly higher incidence of transient postoperative nerve injury with ECTR, regardless of the number of portals, as compared with OCTR, although overall complication and re-operation rates were equivalent. Scar tenderness was significantly diminished with dual-portal endoscopic release when compared to single-portal and open methods. The rates of pillar pain, symptom relief, and patient reported satisfaction did not differ significantly between treatment groups.Conclusions:Although endoscopic surgery may be appealing in terms of reduced postoperative morbidity and a faster return to work for patients, surgeons should be mindful of the associated learning curve and higher incidence of transient nerve injury. Further study is required to identify if an advantage exists between different endoscopic techniques.
      Citation: HAND
      PubDate: 2022-02-18T10:38:34Z
      DOI: 10.1177/15589447221075665
       
  • Older Patients Demonstrate PROMIS Outcomes Comparable to Younger Cohorts
           After Carpal Tunnel Release

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      Authors: Calvin H. Englert, Warren C. Hammert
      Abstract: HAND, Ahead of Print.
      Background:The utility of Patient-Reported Outcomes Measurement Information System (PROMIS) in monitoring clinical progress after carpal tunnel release (CTR) in patients of different ages remains unknown. We sought to evaluate early PROMIS scores in elderly patients (ie, those aged ≥65 years) after CTR and compare those with all younger patients after CTR.Methods:Patients presenting to a single academic medical center for CTR between September 2018 and January 2020 completed PROMIS physical function (PF), pain interference (PI), and upper extremity (UE) computer adaptive tests and answered a single 5-point Likert-scale question evaluating subjective changes in their condition following CTR. Patients were divided into 3 age groups, and preoperative and postoperative PROMIS scores were compared.Results:In all, 214 patients fit inclusion criteria: 86 aged 18-54 years, 71 aged 55-64 years, and 57 aged ≥65 years. Subjective improvement was reported in 70.9% (n = 61), 84.5% (n = 60), and 71.9% (n = 41) of patients aged ≤54, 55-64, and ≥65 years, respectively. Patients aged ≤54 years showed significantly worse UE scores (P = .02), whereas those aged 55-64 years demonstrated significant worsening in all 3 PROMIS domains (P < .01). Patients aged ≥65 years who reported subjective improvement after CTR demonstrated significant improvement in PI scores (P = .03), whereas significant worsening of all PROMIS scores was observed in the subset of patients aged 55-64 years who reported subjective improvement (P < .01, .04, and .04 for PF, PI, and UE, respectively).Conclusions:Younger patients showed worsening in PROMIS scores after CTR, whereas elderly patients did not show similar magnitude reductions in PROMIS scores. Moreover, the subset of elderly patients endorsing subjective improvement after CTR had reduced PI scores, consistent with less postoperative pain limitations.
      Citation: HAND
      PubDate: 2022-02-18T10:34:08Z
      DOI: 10.1177/15589447211073828
       
  • The Aesthetics of Digit Amputation

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      Authors: John Collar, John Smetona, Jingwen Zhang, Yanhong Deng, James Clune
      Abstract: HAND, Ahead of Print.
      Background: The goal of surgery, when treating a patient with a traumatized hand, is to restore function. The importance of the aesthetics on a patient’s psychological well-being should also be considered. The biomechanical ideals for creating a useful hand after digit amputation have been defined; however, ideal aesthetic levels for finger amputation have not been elucidated. The purpose of this study was to determine the general population’s visual preferences for different levels of digit amputation in the hand. Methods: In all, 310 participants were surveyed to identify preferences of different levels of single digit amputations in dorsal and volar views. A normal hand was digitally manipulated to simulate various levels of digit amputation. The aesthetics of amputation at the distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, and ray amputation were compared to one another via rank order. Average rank for each level of amputation for a digit was determined. Results: Amputation at the DIP was favored over all other levels; however, ray amputation was the second most aesthetic, particularly in the middle and ring fingers even when compared to amputation at the PIP level. Conclusion: When presented a choice at which level to perform a completion amputation or a primary amputation of a digit, and functionality at multiple levels of amputation is equivocal, aesthetic outcomes should be considered. Amputation at the DIP joint is preferable, but ray amputation is aesthetically more pleasing than amputation at the PIP or MCP joints in the index, middle, ring, and small fingers.
      Citation: HAND
      PubDate: 2022-02-17T12:04:17Z
      DOI: 10.1177/15589447211065073
       
  • Extensor Tendon Injury After Volar Locking Plating for Distal Radius
           Fractures: A Systematic Review

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      Authors: Jennifer A. Kunes, Daniel Y. Hong, Justin E. Hellwinkel, Liana J. Tedesco, Robert J. Strauch
      Abstract: HAND, Ahead of Print.
      Distal radius fractures are common orthopedic injuries. Treatment has varied historically, but volar locking plating currently predominates. Although flexor tendon injury is a well-studied complication of this operation, extensor tendon injury is less well studied. The purpose of this review is to search the literature and present the epidemiology, presentation, and treatment of this complication. The Cochrane, EMBASE, PubMed, and SCOPUS databases were searched for the terms “volar” + “radius” + (“plate” OR “plating”) + “extensor.” Ninety final studies were included for analysis in this review. The incidence of extensor tendon rupture varies from 0% to 12.5%; the extensor pollicis longus is most commonly ruptured. The presentation and management of extensor tendon injury after injury, intraoperatively, and postoperatively are summarized. Radiographic views are described to detect screw prominence and minimize intraoperative risk. Extensor tendon injury after volar locking plate for distal radius fractures is an uncommon injury with several risk factors including dorsal screw prominence and fracture fragments. Removal of hardware and tendon transfers or reconstruction may be necessary to prevent loss of extensor mechanism.
      Citation: HAND
      PubDate: 2022-02-16T06:04:52Z
      DOI: 10.1177/15589447211068186
       
  • Proximal Interphalangeal Joint Congruity: A Biomechanical Study

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      Authors: Kenneth H. Levy, Joey S. Kurtzman, Evan H. Horowitz, Qurratul-Ain Dar, Westley T. Hayes, Steven M. Koehler
      Abstract: HAND, Ahead of Print.
      Background:Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity.Methods:Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA).Results:Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion.Conclusions:Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.
      Citation: HAND
      PubDate: 2022-02-14T07:10:42Z
      DOI: 10.1177/15589447211060419
       
  • Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button
           Suspensionplasty for Thumb Carpometacarpal Arthritis

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      Authors: Akemi Maeda, Ryosuke Ikeguchi, Takashi Noguchi, Rie Yamawaki, Manabu Nankaku, Maki Ando, Koichi Yoshimoto, Daichi Sakamoto, Shuichi Matsuda
      Abstract: HAND, Ahead of Print.
      Background:This study represents the clinical results, especially range of motion (ROM) improvement, of arthroscopic partial trapeziectomy with suture-button suspensionplasty for symptomatic grade II and III thumb carpometacarpal arthritis with a minimum 1-year follow-up.Methods:Thirty-two patients (mean: 67.5 years) with grade II and III thumb carpometacarpal arthritis treated with arthroscopic partial trapeziectomy with suture-button suspensionplasty were retrospectively followed up for at least 1 year. The physical assessments included ROM, pain visual analogue scale (VAS), strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The physical variables were retrospectively compared before surgery and at the final follow-up.Results:Preoperative radial abduction and palmar abduction (45.4 ± 16.4° and 54.3 ± 13.9°, respectively) were significantly increased at the final follow-up (59.7 ± 16.9° and 65.5 ± 14.2°, respectively). Preoperative VAS score, pinch strength, and DASH score (70.5 ± 14.0, 57.2 ± 24.8% and 36.8 ± 14.8, respectively) were also significantly improved at the final follow-up (7.9 ± 9.1, 91.0 ± 39.6%, and 11.7 ± 10.5, respectively). Complications involved 1 case of irritation of the superficial branch of the radial nerve and 1 case of dystonia. Two suture-buttons were removed due to patient discomfort.Conclusions:A significant increase in ROM and pain relief was obtained after suture-button suspensionplasty with arthroscopic partial trapeziectomy.
      Citation: HAND
      PubDate: 2022-02-12T10:49:36Z
      DOI: 10.1177/15589447221075663
       
  • Wrist Arthroscopy Using the 2R Portal: Is It Safer Than the 1,2
           Portal'

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      Authors: Katharine M. Hinchcliff, Nicholas Munaretto, Lauren K. Dutton, Taghi Ramazanian, Sanjeev Kakar
      Abstract: HAND, Ahead of Print.
      Backgroud:The purpose of this study was to compare the 1,2 with a novel 2R portal in terms of proximity to critical structures.Methods:Wrist arthroscopy was performed on 8 fresh frozen cadavers via the 1,2 and 2R portals. External anatomy was then dissected under loupe magnification. The closest distance between the portals and surrounding anatomical structures was measured in millimeters using digital calipers.Results:The 1,2 portal was significantly closer to radial artery and first extensor compartment tendons than the 2R portal. The radial artery was on average 1.32 mm from the 1-2 portal and 14.25 mm from the 2R portal. The 2R portal was significantly closer to the second and third extensor compartment tendons. The closest branch of the superficial branch of the radial nerve (SBRN) was on average 2.04 mm from the 1-2 portal and 7.59 mm from the 2R portal, but this was not statistically significant.Conclusions:We advocate using the 2R portal preferentially to the 1,2 portal when treating radial sided wrist pathology to decrease the risk of iatrogenic radial artery and SBRN injury.
      Citation: HAND
      PubDate: 2022-02-11T06:56:14Z
      DOI: 10.1177/15589447221075668
       
  • Comparison of 4 Different 4-Strand Core Suturing Techniques for Flexor
           Tendon Laceration: An Ex Vivo Biomechanical Study

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      Authors: Mohammad Nassar, Asser Sallam, Sherif Sokkar, Hesham Abdelsadek, Mohamed Zada
      Abstract: HAND, Ahead of Print.
      Background:Forces applied to the repaired flexor tendon should not exceed its yield force during early postoperative rehabilitation to prevent gapping and rupture. We aimed to biomechanically compare the tensile strengths and the 2-mm gapping of 4 different 4-strand core suturing techniques for flexor tendon repair.Methods:Fifty-six goat deep digital flexor tendons were repaired with the 4-strand double-modified Kessler, the 4-strand augmented Becker, the 4-strand Savage, and the 4-strand modified Tang techniques. All tendons were repaired with 4-0 polyester for core suture and 5-0 polyester for continuous epitendinous running suture. The specimens were subjected to static linear tensile testing by applying a single linear load-to-failure pull. After the linear load testing, the yield load, the ultimate strength of the repaired tendons, and the force exerted to yield a 2-mm gap were measured.Results:All peripheral sutures ruptured near the yield point. All core suture techniques were similar regarding the yield force. The augmented Becker 4-strand technique had the greatest ultimate strength (98.7 [82-125.3] N). The modified double Kessler technique was the weakest in resisting a 2-mm gap formation. The 4-strand modified Tang repair had the shortest (11.3 [7-15] minutes), while the 4-strand augmented Becker had the longest operative time (29 [23-33] minutes).Conclusions:All 4 techniques demonstrated similar yield force, with differences in operative time, ultimate strength, and resistance to gapping. Future clinical studies can further elucidate their appropriateness for early active motion protocols.
      Citation: HAND
      PubDate: 2022-02-08T12:55:51Z
      DOI: 10.1177/15589447211073831
       
  • Primary Resection of the Ulnar Slip of Flexor Digitorum Superficialis in
           the Persistently Triggering Patient After A1 Pulley Release

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      Authors: Daniel B. Polatsch, Remy V. Rabinovich, Michael A. Casden, Steven Beldner, Omar F. Rahman
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this study was to determine the occurrence of patients undergoing primary trigger finger release (TFR) that underwent ulnar superficialis slip resection (USSR) for decompression and to determine which digit was most commonly affected.Methods:A retrospective chart review was conducted of all cases of open TFR performed by a single surgeon. The following data were obtained: age, sex, laterality, affected digit, and consideration for USSR. All patients failed nonoperative treatment of at least 1 steroid injection. The occurrence of patients who underwent TFR and USSR and which digit(s) most commonly underwent USSR were determined. The average patient age that underwent USSR, frequency by sex, and relative occurrence of USSR in each digit were computed. Statistical calculations were conducted using χ2 analysis (P < .05).Results:A total of 911 primary open TFRs were performed in 631 patients over a 16-year period. A total of 20 TFRs in 20 patients underwent USSR (2.2%). The long finger was the most commonly affected digit (40%) that required simple decompression. Within all USSR cases, the long finger was the most commonly affected digit. The index finger was the second most affected (30%), and there were no cases in the small finger.Conclusions:This study determined the occurrence of primary TFR cases that underwent USSR, with the long finger being the most commonly affected digit. Surgeons may consider this additional procedure to perform a larger decompression than simple A1 pulley release alone.
      Citation: HAND
      PubDate: 2022-02-08T12:54:49Z
      DOI: 10.1177/15589447211073829
       
  • Leadership Trends at Hand Surgery Fellowships

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      Authors: Nicholas C. Schiller, Amanda F. Spielman, Andrew J. Sama, Benjamin I. Schachner, Chester J. Donnally, Seth D. Dodds
      Abstract: HAND, Ahead of Print.
      Background:Fellowship directors (FDs) influence the future of trainees in the field of hand surgery. Currently, there are no studies that analyze the demographic background, institutional training, and academic experience of hand surgery FDs. This study aims to serve as a framework to understand the landscape of current leadership positions in hand surgery education and to identify opportunities to improve FD diversity.Methods:The American Society for Surgery of the Hand Fellowship Directory was reviewed to include all hand surgery fellowships in the United States. Collected demographic information regarding FDs included age, sex, ethnicity, residency/fellowship training, residency/fellowship graduation year, year hired by current institution, time since training completion until FD appointment, length in FD role, and H-index.Results:Of the 90 FDs included, 86.7% were men and 71.4% self-reported as Caucasian. The average H-index was 13.98 and significantly correlated with age and duration as FD; 71.1% of FDs were trained in orthopedic surgery. The most attended residency program was the University of Pennsylvania; Mayo Clinic and Harvard University were the most represented fellowship programs.Conclusion:This review reveals specific trends in demographic backgrounds, institutional training, and academic experiences among current FDs in hand surgery. Our observations, such as racial/ethnic and sex disparities, may offer opportunities to improve the representation of the communities these physicians serve. In addition, the trends described in this study provide objective data among current hand surgery FDs and could serve as a guide for individuals who desire academic leadership roles.
      Citation: HAND
      PubDate: 2022-02-08T09:38:09Z
      DOI: 10.1177/15589447211073977
       
  • The Current State of Fat Grafting in the Hand: A Systematic Review for
           Hand Diseases

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      Authors: Alexander N. Khouri, Widya Adidharma, Mark MacEachern, Steven C. Haase, Jennifer F. Waljee, Paul S. Cederna, Amy L. Strong
      Abstract: HAND, Ahead of Print.
      Autologous fat grafting (AFG) has traditionally been used for facial rejuvenation and soft tissue augmentation, but in recent years, its use has expanded to treat diseases of the hand. Autologous fat grafting is ideal for use in the hand because it is minimally invasive, can restore volume, and has regenerative capabilities. This review summarizes the emerging evidence regarding the safety and efficacy of AFG to the hand in several conditions, including systemic sclerosis, Dupuytren disease, osteoarthritis, burns, and traumatic fingertip injuries. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search on the use of AFG in hand pathologies was performed on October 8, 2020, in Ovid MEDLINE, Elsevier Embase, Clarivate Web of Science, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by 2 independent reviewers and a third reviewer adjudicated when required. Reviewers identified 919 unique hits. Screening of the abstracts identified 22 manuscripts which described the use of AFG to treat an identified hand condition. Studies suggest AFG in the hands is a safe, noninvasive option for the management of systemic sclerosis, Dupuytren contracture, osteoarthritis, burns, and traumatic fingertip injuries. While AFG is a promising therapeutic option for autoimmune, inflammatory, and fibrotic disease manifestations in the hand, further studies are warranted to understand its efficacy and to establish more robust clinical guidelines. Studies to date show the regenerative, immunomodulatory, and volume-filling properties of AFG that facilitate wound healing and restoration of hand function with limited complications.
      Citation: HAND
      PubDate: 2022-02-08T09:36:28Z
      DOI: 10.1177/15589447211066347
       
  • Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A
           Retrospective Review of 146 Cases

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      Authors: Matthew Wyman, Dallan Dargan, Diana Kazzazi, Jennifer Caddick, Victoria Giblin
      Abstract: HAND, Ahead of Print.
      Background:The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation.Methods:We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available.Results:Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (
      Citation: HAND
      PubDate: 2022-02-08T09:34:44Z
      DOI: 10.1177/15589447211066346
       
  • Digital Nerve Management and Neuroma Prevention in Hand Amputations

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      Authors: Jed I. Maslow, Alexis LeMone, Gregory T. Scarola, Bryan J. Loeffler, R. Glenn Gaston
      Abstract: HAND, Ahead of Print.
      Background:Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation.Methods:All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores.Results:A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas (P < .01).Conclusions:Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker’s compensations status were significantly associated with symptomatic neuroma formation.
      Citation: HAND
      PubDate: 2022-02-08T09:33:08Z
      DOI: 10.1177/15589447211065074
       
  • Does Proximal Hamate Graft for Proximal Scaphoid Reconstruction Restore
           Native Wrist Kinematics'

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      Authors: Marion Burnier, Joseph A. Gil, Alexander Hooke, Bassem Elhassan, Sanjeev Kakar
      Abstract: HAND, Ahead of Print.
      Background:The objective of this study was to determine whether reconstruction of the proximal pole of the scaphoid with a proximal hamate graft restores native carpal kinematics.Methods:A cadaveric study was designed assessing wrist kinematic after proximal hamate graft for proximal pole of the scaphoid nonunion. Wireless sensors were mounted to the carpus using a custom pin and suture anchor system to 8 cadavers. A wrist simulator was used to move the wrist through a cyclical motion about the flexion/extension and radial/ulnar deviation axes. Each specimen was tested under a series of 3 conditions: (1) a native state, “Intact”; (2) fractured scaphoid proximal pole, “Fracture”; and (3) post-reconstruction of the proximal pole of the scaphoid using a proximal hamate graft, “Graft.”Results:The fracture condition resulted in a statistically significant change in scapholunate kinematics across the entire arc of motion relative to the intact condition. Reconstruction with proximal hamate grafts restored scapholunate kinematics close to the intact state in both flexion/extension and radial/ulnar deviation axes. The lunocapitate flexion during wrist flexion was significantly different after the hamate graft reconstruction.Conclusions:Proximal hamate to scaphoid transfer resulted in restoration of near normal carpal kinematics to the intact state.
      Citation: HAND
      PubDate: 2022-02-08T09:30:48Z
      DOI: 10.1177/15589447211063570
       
  • Radiographic and Clinical Outcomes of Radioscapholunate Arthrodesis in
           Patients With Inflammatory and Posttraumatic Arthritis

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      Authors: Nicole A. Zelenski, Taylor P. Trentadue, Steve Moran, Marco Rizzo
      Abstract: HAND, Ahead of Print.
      Background:Radioscapholunate (RSL) fusion is performed for painful radiocarpal arthritis that is typically posttraumatic or inflammatory in nature. The purpose of this study was to determine whether patients with inflammatory conditions undergoing RSL fusion had comparable outcomes as those with posttraumatic arthritis and to determine factors impacting union.Methods:This was a retrospective review of all RSL fusions over a 25-year period. Demographic information, wrist range of motion, postoperative complications, and surgical technique, including presence or absence of resection of distal scaphoid pole, data were collected. Radiographs were examined for evidence of healing of the RSL fusion site as well as development of midcarpal arthritis.Results:Fifty-six patients underwent RSL fusion. Eight patients required revision of radiocarpal arthrodesis for painful nonunion. The fusion rate was 85.7%, and median 25th to 75th percentile (time to healing was 4.0 3.2-5.2) months. There were no differences in time to or rate of union by inflammatory arthropathy status. Grip strength increased significantly and pain decreased significantly with surgery. Union rate was 90% with the use of K-wires, screws, or staples, which was significantly greater than plates, fusion cups, or multiple implant types. The use of autologous bone graft significantly decreased the rate of nonunion and significantly decreased time to union by 3 months compared to allograft alone. Extension was significantly improved with scaphoid distal pole resection versus without distal scaphoid pole resection.Conclusions:Radioscapholunate (RSL) fusion is an effective treatment for radiocarpal arthritis but has high nonunion rates. Fixation with K-wires, screws, or staples and use of autograft confers improved union rate.
      Citation: HAND
      PubDate: 2022-02-08T09:28:51Z
      DOI: 10.1177/15589447211058834
       
  • Anemia Severity and the Risks of Postoperative Complications and Extended
           Length of Stay Following Primary Total Elbow Arthroplasty

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      Authors: Adam M. Gordon, Asad M. Ashraf, Bhavya K. Sheth, Matthew L. Magruder, Charles A. Conway, Jack Choueka
      Abstract: HAND, Ahead of Print.
      Background:Anemia is a modifiable risk factor that may influence postoperative complications following orthopedic surgical procedures. The objective was to determine the influence of preoperative anemia severity on postoperative complications and length of stay (LOS) following total elbow arthroplasty (TEA).Methods:The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2006 to 2019 for patients undergoing primary TEA. Using the World Health Organization definitions of anemia, patients undergoing TEA were stratified into 3 cohorts: nonanemia (hematocrit>36% for women,>39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate-to-severe anemia (hematocrit
      Citation: HAND
      PubDate: 2022-02-04T11:32:29Z
      DOI: 10.1177/15589447211073830
       
  • Isolated Compression of the Recurrent Motor Branch of the Median Nerve: A
           Case Report

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      Authors: Maurício Vieira de Pádua Maia, Luis Guilherme Rosifini Alves Rezende
      Abstract: HAND, Ahead of Print.
      Isolated compression of the recurrent motor branch of the median nerve is an uncommon condition encontered in the daily life of the hand surgeon. Its early identification and correction can optimize functional outcomes. Among the few causes described, there are only 2 case reports of compression by fascial bands. We present a case of isolated compression of the recurrent motor branch of the median nerve secondary to anomalous fascial bands in a 34-year-old male patient, with significant atrophy of the thenar musculature of the right hand. Electroneuromyography showed isolated involvement of abductor pollicis brevis, with no sensory changes. The patient underwent exploration and decompression, recovering opposition and thumb function in 6 months.
      Citation: HAND
      PubDate: 2022-02-03T09:04:07Z
      DOI: 10.1177/1558944721990779
       
  • Initial Treatment Choice Affects Cost-Effectiveness and Reintervention
           Rates for Dupuytren Contracture: A National Census Among Veterans Affairs
           Patients

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      Authors: James J. Drinane, Darren Gemoets, Yannick A. J. Hoftiezer, James Hoehn, Kyle R. Eberlin
      Abstract: HAND, Ahead of Print.
      Background:A multitude of treatments for Dupuytren contracture are available, including both invasive and minimally invasive options. This study compares the reintervention rates and costs associated with various treatment options for Dupuytren disease (DD) within the Veterans Affairs (VA) Health Administration.Methods:Using the Corporate Data Warehouse, a national census was performed including all patients treated for DD in years 2014 to 2020 within the VA health care system. Patients treated with collagenase clostridium histolyticum (CCH), percutaneous needle aponeurotomy (PNA), open fasciotomy, palmar fasciectomy, single finger fasciectomy, and multifinger fasciectomy were compared. The total cost of initial treatment was compared between modalities. The 5-year reintervention rates were compared using a Kaplan-Meier analysis.Results:During the study period, 8530 patients were treated for DD (3501 fasciectomy, 3351 CCH, 880 PNA, 798 fasciotomy). The overall median treatment cost was found to be the least for PNA (P < .0001). The 5-year reintervention rates were significantly lower for single finger fasciectomy (6.5%), operative fasciotomy (8.2%), and palmar fasciectomy (9%) when compared with PNA (12.3%), multifinger fasciectomy (13.1%), and CCH (14.4%) (P < .001). However, reintervention rates were comparable between patients treated with PNA, multifinger fasciectomy, and CCH (P> .05).Conclusions:Within the VA population, PNA is the most affordable procedure per treatment episode and is associated with reintervention rates that are comparable to those of CCH. Multifinger fasciectomy, CCH, and PNA had comparable reintervention rates. The differences in reintervention rates may partially be explained by patients’ willingness to consider additional treatment to correct any remaining or recurrent deformity.
      Citation: HAND
      PubDate: 2022-01-29T08:44:12Z
      DOI: 10.1177/15589447211072251
       
  • Preoperative A1c and Postoperative Infection in Elective Hand Surgery

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      Authors: Timothy P. Schweitzer, Steven L. Peterson
      Abstract: HAND, Ahead of Print.
      Diabetes mellitus affects 10.5% of the US population. Numerous studies have documented increased risk of complications for patients with diabetes after different types of surgery, including hand surgery. By aiming for a preoperative target hemoglobin A1c (A1c), the risk of surgical complications following elective hand surgery may be reduced for patients with diabetes. This literature review was conducted to evaluate the association between diabetes mellitus and surgical site infections and, more specifically, to determine whether there is any association between preoperative A1c level and postoperative infections in hand surgery. The risk for surgical site infections and wound complications appears to be higher for patients with insulin-dependent diabetes mellitus, but not necessarily for patients with noninsulin-dependent diabetes mellitus, when compared with patients without diabetes. The role of prophylactic antibiotics for patients with diabetes undergoing elective hand surgery was also considered. Prophylactic antibiotics have not been shown to be beneficial for healthy patients undergoing clean, elective hand surgery. However, preoperative antibiotics may have a protective role for some patients with poorly controlled hyperglycemia.
      Citation: HAND
      PubDate: 2022-01-29T08:40:12Z
      DOI: 10.1177/15589447211065493
       
  • Lunatocapitate and Triquetrohamate Arthrodeses for Degenerative Arthritis
           of the Wrist: A Midterm Follow-Up

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      Authors: Lili E. Schindelar, Mark L. Wang, John M. Bednar, Andrew J. Miller
      Abstract: HAND, Ahead of Print.
      Background:Degenerative arthritis of the wrist is a common condition often treated with 4 corner arthrodesis (FCA) or a partial wrist fusion. A number of limited intercarpal arthrodeses have been proposed for treatment of this condition. One technique, described by Wang and Bednar in 2012, involves fusion of the lunatocapitate and triquetrohamate joints. This study presents midterm follow-up of outcomes following this 2 column arthrodesis.Methods:From 2000 to present, patients who underwent lunatocapitate and triquetrohamate arthrodesis were evaluated. The original cohort from the 2012 study was reviewed, as well as any additional patients who since underwent this procedure. Only patients who had greater than 5 years of follow-up data were included. Outcomes included demographics, wrist range of motion, grip strength, complications, and radiographic evidence of union.Results:Twenty-one cases were included in the final analysis. Mean follow-up was 8.75 years. Wrist extension and flexion were 58% and 90% of the unaffected side, respectively. Grip strength was 92% of the unaffected side. Osseous union was achieved in 95.2% of cases. Two cases underwent revision surgery, one for nonunion and one following a fall.Conclusions:Lunatocapitate and triquetrohamate arthrodesis offers a treatment for wrist arthritis that yields good clinical outcomes, low nonunion rates, and no conversions to total wrist arthrodesis, as shown by 5-year follow-up data. Limited intercarpal arthrodesis is an alternative to FCA, with the advantage of a smaller surgical footprint and simpler technique, while still providing excellent mid- to long-term outcomes.
      Citation: HAND
      PubDate: 2022-01-28T10:06:01Z
      DOI: 10.1177/15589447211066351
       
  • Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint
           Arthroplasty With Pyrocarbon Disk Interposition

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      Authors: Cecile Maria Cornelia Agnes van Laarhoven, Marcus Chen Yee Tong, Mark van Heijl, Arnold Herman Schuurman, Brigitte Egeberta Petronella Adriana van der Heijden
      Abstract: HAND, Ahead of Print.
      Background:Pyrocarbon disk interposition for carpometacarpal (CMC) thumb joint osteoarthritis can be performed with a flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strip. With the FCR technique, a ligament reconstruction is performed in addition to disk fixation, whereas with the APL technique the disk is simply secured in place. Our aim is to compare long-term postoperative outcomes between both techniques.Methods:In this observational study, we included 106 patients in 2 centers operated on between 2006 and 2011. We assigned patients to the FCR group or the APL group based on the respective tendon strip used. As a primary outcome, we analyzed postoperative key pinch. In addition, we analyzed postoperative tip pinch and tripod pinch, grip strength, range of motion, thumb height maintenance, and patient-reported outcome measures (PROMs).Results:The analysis showed clinically important stronger key pinch for the APL group (β = 1.28 kg). Tip pinch and grip strength showed higher outcome for the FCR group (β = 1.22 kg and 5.14 kg, respectively). Palmar abduction was in favor of the FCR group and opposition in favor of the APL group, but these were interpreted as not clinically relevant. Radiological thumb height maintenance and PROMs showed no clinical difference.Conclusions:Pyrocarbon disk interposition arthroplasty for CMC thumb joint osteoarthritis can be secured with an APL or FCR tendon strip. At long-term follow-up, use of an APL tendon strip results in significantly higher key pinch and better opposition. Tip pinch, grip strength, and palmar abduction were better after use of the FCR tendon strip. The choice of the tendon strip can be based on outcomes considered most important for the individual patient.
      Citation: HAND
      PubDate: 2022-01-28T06:25:01Z
      DOI: 10.1177/15589447211040879
       
  • Hand Surgeons’ Understanding of Partial Hand Prostheses: Results of
           a National Survey Study

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      Authors: Emily M. Graham, Christopher M. Baschuk, Diane J. Atkins, Lana Hutchinson, Christopher C. Duncan, Shaun D. Mendenhall
      Abstract: HAND, Ahead of Print.
      Purpose:Partial hand amputations are devastating injuries that often negatively affect individuals and communities. Partial hand prostheses can mitigate the burdens of living with an amputation, especially when reconstruction alone cannot restore form or function. However, hand surgeons may be unfamiliar with these newer devices because the prosthetic field is rapidly progressing.Methods:An electronic survey was distributed to hand surgeon members of the American Association for Hand Surgery with the intent of assessing surgeons’ familiarity with partial hand prosthetic devices and their clinical applications. Survey items used Likert 5-point scales, rank order, multiple-choice, and yes/no question formats. Responses were compared by training background (orthopedic or plastic surgery) and by years of experience (≤10 years in practice or>10 years in practice).Results:Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2%) or consulting with a prosthetist prior to revisional surgeries (71.4%). Restoring gross motor function and reducing pain were important outcomes to the cohort (4.42 and 4.17, respectively). Plastic trained hand surgeons were more likely to list toe-to-hand transfers as treatment options for multilevel digital amputations (P = .03) and transmetacarpal amputations (P = .02). Senior hand surgeons were more likely to suggest no treatment for partial thumb amputations (P = .02).Conclusions:Expanding surgeon knowledge and encouraging collaboration within a multidisciplinary team may enhance amputee care.
      Citation: HAND
      PubDate: 2022-01-27T09:23:14Z
      DOI: 10.1177/15589447211068185
       
  • Dupuytren Cords Do Not Undergo Significant Histopathological Change After
           Collagenase Clostridium Histolyticum Injection

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      Authors: Meng Guo, Kai Yang, Nancy D. Kock, Roger Daley, William Dzwierzynski, John LoGiudice, Patrick Hettinger, Cameron Best, Anne Argenta
      Abstract: HAND, Ahead of Print.
      Background: Dupuytren disease creates thickened cords of the palmar fascia, leading to progressive flexion contractures that severely hinder hand function. Collagenase clostridium histolyticum (CCH) injection is a common, minimally invasive alternative to surgical excision of these cords. The impact of CCH injection on the histological architecture of Dupuytren cords has not been studied extensively. Methods: A series of 10 CCH-injected cords were evaluated histologically. Cellularity, architecture, and connective tissue organization were compared against uninjected Dupuytren cords and normal palmar fascia. Results: No significant histopathological differences between CCH-injected and CCH-uninjected cords were identified. Conclusions: Dupuytren cords do not demonstrate histological changes with prior exposure to CCH.
      Citation: HAND
      PubDate: 2022-01-27T06:15:34Z
      DOI: 10.1177/15589447211043204
       
  • Antibiotics Versus Surgery in Treatment of Early Flexor Tenosynovitis

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      Authors: Luke Latario, Jesse Abeler, Stephanie Clegg, Laura Thurber, Oghomwen Igiesuorobo, Marci Jones
      Abstract: HAND, Ahead of Print.
      Background:Treatment of pyogenic flexor tenosynovitis (FTS) historically involved surgical debridement supplemented with antibiotic therapy. No consensus exists on either: (1) the treatment algorithm for this infection; or (2) the clinical definition of “early” FTS. We performed a retrospective study to clarify indications for nonoperative management.Methods:We identified 40 patients with a diagnosis of FTS using Current Procedural Terminology and International Classification of Diseases, Tenth Revision, codes and a keyword search from an electronic medical record between 2011 and 2019. Patients underwent either surgical management (SG) (n = 20) or early antibiotics only (EAG) (n = 20). The surgical group was divided into patients with intraoperative purulence within the tendon sheath (PU) and those without purulence (NP).Results:The number of Kanavel signs and duration of days of symptoms were significantly greater in SG compared with EAG. Subgroup analysis of SG showed a greater number of days of symptoms in the NP group when compared with the PU group. No statistical significance was found with respect to age, smoking, or specific individual Kanavel signs between SG and EAG.Conclusions:Both duration of symptoms and number of Kanavel signs should be considered in suspected early FTS. Patients with shorter duration of symptoms and fewer Kanavel signs were treated successfully with antibiotics alone. Operatively confirmed FTS presented more acutely with fewer days of symptoms and a higher number of Kanavel signs. Patients with subacute presentations may represent inflammatory conditions and hand infections other than FTS.
      Citation: HAND
      PubDate: 2022-01-27T06:14:13Z
      DOI: 10.1177/15589447211043187
       
  • Early Mobilization After Basal Joint Arthroplasty: Clinical Results

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      Authors: Jacob B. Stirton, Kristy L. Kagy, Megan L. Mooney, Margaret K. Jain, Martin Skie
      Abstract: HAND, Ahead of Print.
      Background: Traditional rehabilitation for basal joint arthroplasty involves postoperative immobilization. We hypothesize that early motion is safe and will result in equivalent clinical outcomes to traditional rehabilitation. Methods: Patients undergoing ligament reconstruction and tendon interposition were randomized into 2 rehabilitation protocols. All patients were immobilized postoperatively in a thumb-spica splint for 2 weeks. The accelerated group (Group 1) was transitioned into a removable Carpometacarpal (CMC)-wrap with activity as tolerated, while the traditional group (Group 2) were immobilized for an additional 4 weeks. Patients were examined preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analog scale for pain (VAS), pinch and grip strength and thumb range of motion. Results: Ninety-three thumbs were randomized, 48 in group 1 and 45 in group 2. There were no statistically significant differences between the 2 groups preoperatively. DASH scores were significantly lower in the accelerated rehabilitation group at 6 weeks postoperatively compared to the traditional rehabilitation group, but these became equivalent by 12 weeks postoperatively. There were no statistically significant differences between the 2 groups with respect to postoperative VAS, key, pinch, or grip strength or thumb range of motion at all time points postoperatively. Conclusions: Early (12-week and 1-year) outcomes suggest early mobilization of patients following CMC arthroplasty does not compromise clinical results. Long-term data will determine the lasting effects of accelerated rehabilitation but may offer earlier return to function than traditional rehabilitation.
      Citation: HAND
      PubDate: 2022-01-27T06:10:51Z
      DOI: 10.1177/15589447211038699
       
  • Concurrent Validity of PROMIS With DASH and DVPRS in Transhumeral Amputees

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      Authors: Samir Sabharwal, Richard L. Skolasky, Jason M. Souza, Benjamin K. Potter, Jonathan A. Forsberg
      Abstract: HAND, Ahead of Print.
      Background:We sought to assess whether select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) significantly correlate with the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Defense and Veterans Pain Rating Scale (DVPRS) among transhumeral amputees.Methods:We prospectively administered DASH, DVPRS, and PROMIS (including Upper Extremity, Pain Interference, and Pain Behavior domains) testing to patients presenting for consideration of osseointegration after transhumeral amputation. Concurrent validity was assessed via Pearson correlation testing.Results:The mean DASH score of the cohort was 32.8. The mean DVPRS score was 1.8. The mean PROMIS scores were 33.8, 50.5, and 50.6 for Upper Extremity, Pain Interference, and Pain Behavior domains, respectively. Pearson testing demonstrated a significant, inverse correlation between DASH and PROMIS Upper Extremity scores (r = −0.85, P = .002). There was also significant correlation between DVPRS and PROMIS Pain Interference scores (r = 0.69, P = .03). The PROMIS Pain Behavior domain did not significantly correlate with either DASH or DVPRS.Conclusions:Patient-Reported Outcomes Measurement Information System Upper Extremity and Pain Interference scores demonstrated significant concurrent validity with traditional measures (DASH and DVPRS) of patient-reported outcome in our population of transhumeral amputees.
      Citation: HAND
      PubDate: 2022-01-27T06:08:31Z
      DOI: 10.1177/15589447211073833
       
  • Patient-Reported Lower Extremity Outcomes Following Fibula or Medial
           Femoral Condyle Free Flaps for Upper Extremity Defects

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      Authors: Megan R. Miles, Lauren Jacobson, John B. Hill, James P. Higgins, Aviram M. Giladi, Mitchell A. Pet
      Abstract: HAND, Ahead of Print.
      Background:Free fibula flap (FFF) and medial femoral condyle (MFC) flap are commonly used for upper extremity osseous reconstruction, yet donor-site morbidity has never been systematically compared.Methods:Patients who underwent an FFF or MFC for upper extremity extra-carpal osseous reconstruction at 3 academic hand centers were retrospectively identified. Only patients who underwent reconstruction for a defect in which either flap type is routinely used or has been described in the literature were deemed eligible. Patients who agreed to participate were asked to complete the Lower Extremity Functional Scale (LEFS) and Lower Limb Core Scale (LLCS). The reported population norm median score of LEFS is 77 points. The LLCS population norm mean score is 90.52 points.Results:Twenty-one patients (10 MFC, 11 FFF) were enrolled. The median LEFS score for patients after MFC was 76 (interquartile range [IQR], 49-80) points and 75 (IQR, 56-79) points after FFF. The median LLCS score for patients after MFC was 96.4 (IQR, 87.9-100) points and 100 (IQR, 91-100) points after FFF. Median LEFS scores were slightly below the population norm, whereas median LLCS scores were above the norm for both FFF and MFC. All patients stated they would have the surgery again and that any dysfunction or pain in the leg was justified by the benefit in the arm.Conclusions:When considering whether to use an MFC or FFF for upper extremity reconstruction, both flap types appear to result in modest and comparable donor-site morbidity.
      Citation: HAND
      PubDate: 2022-01-27T06:06:41Z
      DOI: 10.1177/15589447211073827
       
  • Selective Ulnar Nerve Decompression, Capsular Branch Denervation, and
           Arthroscopic Debridement as a Unique Technique to Improve Quality of Life
           for Avascular Necrosis of the Distal Humerus and Radius in a Young Patient
           With ALL

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      Authors: Nihaal Reddy, Austin Seaman, Ryan Jefferson, Tyler Evans, James Popp
      Abstract: HAND, Ahead of Print.
      Avascular necrosis (AVN), one of the most common therapy-related and debilitating side effects of antileukemic treatment, can adversely affect a patient’s long-term quality of life. Our case study presents a young woman with bilateral elbow AVN and hip AVN after acute lymphoblastic leukemia treatment, with a unique treatment strategy for her elbow pain. The treatment strategy included elbow joint denervation with arthroscopic debridement and distal humerus core decompression. The goal of this procedure was to improve symptomatic pain while retaining bone stock in the distal humerus hopefully allowing better function of the patient’s elbow. This treatment may not only improve the quality of life in a young patient but also delay the need for future surgery. Our patient had improved pain relief in her elbow postsurgery. This procedure may be used for pain control and may have beneficial future implications in this limited population.
      Citation: HAND
      PubDate: 2022-01-27T06:05:03Z
      DOI: 10.1177/15589447211072218
       
  • Rates, Barriers, and Facilitators of Outcome Collection on Hand Surgery
           Outreach to Low- and Middle-Income Countries

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      Authors: Jessica M. Welch, Robin N. Kamal, Maya Chatterjee, Lauren M. Shapiro
      Abstract: HAND, Ahead of Print.
      Background:Global outreach to low- and middle-income countries (LMICs) continues to grow in an effort to improve global health. The practice of quality measurement is empirically lacking from surgical outreach trips to LMICs, which may limit the safety and quality of care provided. Using convergent mixed-methods, we aimed to: (1) identify and evaluate barriers and facilitators to outcome measure collection; and (2) report the sample rate of such collection on hand surgery outreach trips to LMICs.Methods:Surgeons and administrators involved in hand surgery outreach trips completed a survey regarding rates of outcome measure collection and a semi-structured interview to explore barriers and facilitators of outcome collection. Survey data were reported descriptively. Interviews were recorded and transcribed, and excerpts were categorized according to the Pettigrew framework for strategic change (content, process, and context). Results were combined through convergent mixed-methods analysis.Results:Thirty-three participants completed the survey, and 21 participated in interviews. Rates of collection were the most common for total case number (83%) and patient mortality (65%). Longitudinal outcomes (eg, patient follow-up or time away from work) were less frequently recorded (9% and 4%, respectively). Content analysis revealed barriers related to each domain of the Pettigrew framework.Conclusions:This analysis demonstrates low levels of outcome collection on outreach trips and identifies priority areas for improvement. Developing context-specific solutions aimed at addressing barriers (eg, resource/database availability) and promoting facilitators (eg, collaborative relationships) may encourage higher rates of collection, which stands to improve patient safety, quality of care, and accountability when conducting outreach trips to LMICs.
      Citation: HAND
      PubDate: 2022-01-20T11:52:57Z
      DOI: 10.1177/15589447211072200
       
  • Outcomes of First Metacarpal Extension Osteotomy for Base of Thumb
           Arthritis

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      Authors: Jenny Chiang, David Graham, Richard Lawson, Brahman Sivakumar
      Abstract: HAND, Ahead of Print.
      Background:First metacarpal extension osteotomy (FMEO) aims to correct the adduction deformity associated with thumb arthritis, as well as improve the congruity at the first carpometacarpal (FCMC) joint. However, the benefits of this procedure are currently unclear. The purpose of this study is to investigate the outcomes of FMEO in the treatment of FCMC joint arthritis.Methods:Electronic databases were searched systematically for original data studies in the English language reporting outcomes following FMEO for base of thumb arthritis. Data were extracted from the text, tables, and figures of publications and meta-analyzed where possible.Results:Ten publications comprising 211 thumbs were included. FMEO was associated with an improvement in pain relief and patient-reported functional outcomes, however meta-analysis showed no significant long-term improvement in grip strength or lateral pinch grip. Although there was disease progression in one third of patients after FMEO, most did not require further procedures. Outcomes following secondary procedures was not analyzed in the literature. FMEO produced a range of minor complications, however, major complications were rare.Conclusions:The available evidence suggests FMEO does not improve grip or pinch strength. However, it may have a role in analgesia and improvement in functional outcomes. Further studies should compare outcomes of FMEO to continued nonoperative treatment, or other surgical options including arthroscopy or ligamentous reconstruction.
      Citation: HAND
      PubDate: 2022-01-20T11:51:14Z
      DOI: 10.1177/15589447211065071
       
  • Repeat Irrigation and Debridement of Upper Extremity Infections: Do Repeat
           Cultures Change Antibiotic Treatment Regimens'

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      Authors: Bradley D. Wiekrykas, Jeffrey C. Wera, Gavin Rallis, Mark K. Solarz
      Abstract: HAND, Ahead of Print.
      Background:Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections resolve with antibiotics alone, some require 1 or more surgical procedures in which culture data are obtained. The purpose of this study was to determine whether repeat cultures taken at subsequent irrigation and debridement of upper extremity infections changed antibiotic treatment.Methods:A retrospective review was performed using International Classification of Diseases, Ninth Revision codes to identify all adult patients with an upper extremity infection treated with 2 irrigation and debridement procedures with 2 separate culture data sets over a period of 5 years. Culture organisms and antibiotic sensitivity profiles were compared from each procedure, and changes in antibiotic treatment based on repeat culture information were identified.Results:In all, 183 patients who underwent 2 irrigation and debridement procedures with repeat culture data were identified. Organisms identified with repeat culture were the same or there was no growth in 153 patients and were different in 30 patients. The antibiotic treatment did not require a change in 170 (92.9%) of 183 patients. Of the 30 patients with different repeat cultures, antibiotic treatment changed in only 13 patients (43.3%). Patients who had a change in antibiotic treatment were more likely to have hepatitis C (P = .005).Conclusions:Repeat culture data changed antibiotic treatment in only 7.1% of patients from our cohort. Patients with hepatitis C were more likely to require a change in antibiotic management after obtaining repeat cultures.
      Citation: HAND
      PubDate: 2022-01-19T11:47:05Z
      DOI: 10.1177/15589447211068183
       
  • Potential Role for Non-Salvage Procedures in the Treatment of Kienböck
           Disease Stage IV: A Systematic Review

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      Authors: Patrick Qi Wang, Brynn P. Charron, Kevin T. K. Chan, Ruby Grewal, Nina Suh
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this systematic review is to identify whether non-salvage procedures can provide satisfactory and acceptable outcomes in Lichtman stage IV disease.Methods:The MEDLINE, Embase, and Cochrane databases were systematically searched for English publications between 1989 and 2019 that reported stage IV-specific primary treatment outcomes. Revisions and skeletally immature patients were excluded. Data extracted were patient demographics, pain scores, range of motion (ROM), grip strength, and patient-reported outcome measures (PROMs). The results were pooled into 3 categories: conservative management, non-salvage, and salvage procedures.Results:Data from 24 studies (n = 114 patients) were extracted. Compared with conservative management and non-salvage treatment (joint-leveling radial osteotomies, lunate reconstruction), salvage procedures (intercarpal and radiocarpal arthrodesis, proximal row carpectomy, total wrist arthroplasty) showed significantly decreased ROM in flexion-extension arc of motion (89° vs 95° vs 73°, respectively, P = .0001) and no significant differences in grip strength as a percentage of the contralateral side (83% vs 86% vs 79%, respectively, P = .28). All reported treatments provided pain relief, ability to return to previous occupations, and variable PROMs.Conclusions:In young, active, and labor-intensive patients, motion-preserving, non-salvage options may be worth trialing as they do not preclude future salvage options.
      Citation: HAND
      PubDate: 2022-01-19T11:44:45Z
      DOI: 10.1177/15589447211066613
       
  • Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected
           by Rheumatoid Arthritis

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      Authors: Paige E. Cummings, Matthew R. Claxton, Eric R. Wagner, Marco Rizzo
      Abstract: HAND, Ahead of Print.
      Background:Rheumatoid arthritis (RA) affecting the metacarpophalangeal (MCP) joint may warrant arthroplasty. The purpose of this study was to investigate implant survivorship, complications, radiographic outcomes, and clinical outcomes in patients undergoing MCP arthroplasty with a pyrocarbon implant to treat RA.Methods:In all, 124 MCP joint pyrocarbon arthroplasties in 40 patients performed to treat RA were reviewed. Operations were at the index (n = 43, 35%), middle (n = 33, 27%), ring (n = 27, 22%), and small (n = 21, 17%) fingers from 1998 to 2009 in 105 (85%) female and 19 (15%) male joints with a mean age of 54 ± 11 years. Mean postoperative follow-up was 6 ± 3 years. All patients achieved at least 2 years of follow-up.Results:Rates of implant survivorship at 1, 2, 5, and 10 years were 98%, 98%, 90%, and 81%, respectively. Fifteen percent (n = 18) of arthroplasties underwent revision at a mean 5 ± 3 years postoperatively. The overall reoperation rate was 29% (n = 36). Rates of survival from reoperation at 1, 2, 5, and 10 years were 85%, 84%, 76%, and 68%, respectively. Complications occurred in 32% (n = 40). Pain ratings improved postoperatively (P < .01). Arc of motion improved from 37 ± 21 to 43 ± 19 (P = .03). Both appositional and oppositional strength improved after surgery; however, there was no improvement in grip strength (P < .01).Conclusions:Metacarpophalangeal arthroplasty with a pyrocarbon implant demonstrated reliable improvement in pain and arc of motion in patients with RA. Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively.
      Citation: HAND
      PubDate: 2022-01-19T11:41:27Z
      DOI: 10.1177/15589447211063577
       
  • Analysis of Mechanoreceptors and Free Nerve Endings of the Transverse
           Carpal Ligament

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      Authors: Lana L. de Lima, Diego Ariel de Lima, Thiago H. B. Freire, Francisco A. A. Almeida, José A. D. Leite, Maria L. C. Cavalcante
      Abstract: HAND, Ahead of Print.
      Background: The treatment of carpal tunnel syndrome (CTS) by sectioning the transverse carpal ligament (TCL) is not exempt from complications. Some nerve branches may be damaged by the incision. The aim of this study is to identify and map the TCL nerve endings, serving as a guide for sectioning this structure in a zone with less nerve ending density. Methods: Ten TCLs were obtained from fresh frozen cadavers. The TCLs were measured, divided into 3 equal bands (radial, central, and ulnar), and submitted to cryostat sectioning. The sections were subjected to immunofluorescence with the protein gene product (PGP) 9.5 and confocal microscopy analysis. Results: All the specimens contained type I and type IV mechanoreceptors. Neural elements occupied 0.695 ± 0.056% of the ligament area. The density of the neural elements was greater in the radial, followed by the ulnar and central bands, with 0.730 ± 0.083%, 0.686 ± 0.009%, and 0.669 ± 0.031%, respectively. Conclusion: The present findings suggest that the region with the least potential for neural element injury during TCL release is the central third near the transition with the ulnar third. When performed distally to proximally with a slight inclination from the radial to the ulnar, this release compromises the lowest nerve element density. Topographically, the proximal limit of the release is the distal wrist crease, while the distal limit is the intersection of Kaplan cardinal line and the axis of the third webspace.
      Citation: HAND
      PubDate: 2022-01-17T06:00:16Z
      DOI: 10.1177/15589447211066974
       
  • Enhanced Recovery After Surgery: Standardized Postoperative Instructions
           in Hand Surgery

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      Authors: Matthew Novak, Jordan Blough, Reuben Falola, Wendy Czerwinski
      Abstract: HAND, Ahead of Print.
      Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.
      Citation: HAND
      PubDate: 2022-01-08T06:05:18Z
      DOI: 10.1177/15589447211065075
       
  • The “Fight Bite” Saline Joint Loading Test: Effectiveness in Detecting
           Simulated Traumatic Metacarpophalangeal Arthrotomies

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      Authors: Morad Chughtai, Joseph P. Scollan, Ahmed K. Emara, Ben Brej, Andrew Steckler, Jessica L. Churchill, Alexandra Ferre, Paul Saluan, Joseph F. Styron
      Abstract: HAND, Ahead of Print.
      Background: The saline load test is routinely used to recognize other joints’ traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation(P> .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required> 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.
      Citation: HAND
      PubDate: 2022-01-07T09:45:49Z
      DOI: 10.1177/15589447211068184
       
  • Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint
           Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible
           Outcomes

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      Authors: Christopher A. Worgul, Andrew B. Stein
      Abstract: HAND, Ahead of Print.
      Background:Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period.Methods:In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score.Results:Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score.Conclusions:EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.
      Citation: HAND
      PubDate: 2022-01-07T09:43:09Z
      DOI: 10.1177/15589447211066352
       
  • Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease
           Correlate With Electrodiagnostic Studies

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      Authors: Nicholas F. Aloi, Landon M. Cluts, John R. Fowler
      Abstract: HAND, Ahead of Print.
      Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy and is commonly evaluated using electrodiagnostic studies (EDSs). Ultrasound (US) has emerged as a potentially easier and more comfortable alternative to EDSs. The purpose of this study is to evaluate whether measurements of the cross-sectional area (CSA) of the median nerve via US correlate with the severity rating of CTS based on EDSs. Methods: A retrospective review of patients aged 18 years or older who underwent US and EDSs of the median nerve for CTS was performed. Sensory nerve action potential, distal motor latency, and compound muscle action potential were measured, and severity was graded on American Association of Neuromuscular and Electrodiagnostic Medicine guidelines. Cross-sectional area of the median nerve was measured via US at the wrist crease. Results: There was a significant association between increasing CSA and increasing EDS severity (P < .0001). The mean CSA for normal, mild, moderate, and severe CTS was 7.48 ± 2.00, 10.36 ± 2.53, 12.01 ± 3.64, and 14.34 ± 4.77 mm2, respectively. The area under the curve demonstrated the ability of median nerve CSA to discriminate between normal and abnormal EDSs with an optimal cutoff CSA of ≥10 mm2, as well as, the ability to discriminate between mild CTS and moderate to severe CTS at a cutoff CSA of greater than or equal to 12 mm2. Conclusions: The results of this study show that US measurements of the median nerve at the distal wrist crease discriminate between normal and abnormal EDSs, and between mild CTS and moderate to severe CTS.
      Citation: HAND
      PubDate: 2022-01-07T09:41:11Z
      DOI: 10.1177/15589447211066349
       
  • Prescription Opioids and Patient-Reported Outcomes and Satisfaction After
           Carpal Tunnel Release Surgery

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      Authors: Pragna N. Shetty, Kavya K. Sanghavi, Mihriye Mete, Aviram M. Giladi
      Abstract: HAND, Ahead of Print.
      Background:Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR.Methods:This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score.Results:Of 505 included patients, 405 received a postoperative prescription and 67 continued use at 2-weeks. These 67 patients reported lower bMHQ, lower satisfaction, and higher postoperative pain compared to those that discontinued. Multivariable regressions showed that receiving postoperative prescriptions did not significantly influence outcomes or satisfaction. However, remaining on the prescription at 2 weeks was associated with significantly lower bMHQ scores, particularly in patients reporting less pain.Conclusions:Patients remaining on a prescription after CTR reported worse outcomes compared to those who discontinued. Unexpectedly, the widest bMHQ score gap was seen across patients reporting lowest pain scores. Further research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures.Level of Evidence: Level III.
      Citation: HAND
      PubDate: 2022-01-07T09:35:27Z
      DOI: 10.1177/15589447211064365
       
  • Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison
           of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia
           

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      Authors: Clay B. Townsend, Tyler W. Henry, Jonas L. Matzon, Daniel Seigerman, Samir C. Sodha, Pedro K. Beredjiklian
      Abstract: HAND, Ahead of Print.
      Background:Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA.Methods:All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations.Results:Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group.Conclusions:This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.
      Citation: HAND
      PubDate: 2022-01-07T09:32:47Z
      DOI: 10.1177/15589447211064364
       
  • Magnetic Resonance Imaging to Investigate the Clinical Applicability of
           the Medial Femoral Trochlea Osteochondral Flap Within the Wrist

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      Authors: Jimmy H. Daruwalla, Jan Skrok, Mitchell A. Pet, Aviram M. Giladi, James P. Higgins
      Abstract: HAND, Ahead of Print.
      Background:The medial femoral trochlea (MFT) osteochondral flap is employed for reconstruction of unsalvageable scaphoid proximal pole nonunions. The convex surface of the cartilage-bearing proximal trochlea is used to replace the similarly contoured proximal scaphoid and articulate with the concave scaphoid fossa of the radius. A magnetic resonance imaging (MRI) comparison of the shape of the MFT as it relates to the native proximal scaphoid has not been previously performed. Our study aimed to quantifiably compare the shape of the MFT, proximal scaphoid, and scaphoid fossa.Methods:Using imaging processing software, we measured radius of curvature of the articular segments in MRI scans of 10 healthy subjects’ wrists and knees.Results:Compared with the scaphoid fossa, average ratio of the radius of circumference of the proximal scaphoid was 0.79 and 0.78 in the coronal and sagittal planes, respectively. Compared with the scaphoid fossa, average ratio of the radius of circumference of the MFT was 0.98 and 1.31 in the coronal and sagittal planes, respectively. The radius of curvature of the MFT was larger than the proximal scaphoid, in the coronal and sagittal planes. In the coronal plane, the MFT radius of curvature is nearly identical to the scaphoid fossa, a closer match than the scaphoid itself. In the sagittal plane, the radius of curvature of the MFT was larger than the radius of curvature of the scaphoid fossa.Conclusions:Our data suggest that the radius of curvature, in the sagittal and coronal planes, of the MFT and proximal scaphoid is disparate.
      Citation: HAND
      PubDate: 2022-01-07T09:20:58Z
      DOI: 10.1177/15589447211064363
       
  • Are Orthopedic Hand Surgeons Undercompensated for Time Spent in the
           Operating Room' A Study of Relative Value Units

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      Authors: Trevor Simcox, Sakib Safi, Jacob Becker, Jason Kreinces, Adam Wilson
      Abstract: HAND, Ahead of Print.
      Background:This study aims to investigate whether compensation is equitable among the most commonly performed orthopedic hand surgeries and when compared with general orthopedic procedures.Methods:The National Surgical Quality Improvement Program database was queried for all orthopedic procedures, from 2016 to 2018, performed more than 150 times using Current Procedural Terminology (CPT) codes. Physician work relative value unit (wRVU) data were obtained from the 2020 US Centers for Medicare and Medicaid Services fee schedule. Linear regressions were used to determine whether there was an association among wRVU, operative time, and wRVU per hour (wRVU/h). Reimbursement for hand surgery CPT codes was compared with that of nonhand orthopedic CPT codes. The CPT codes were stratified into quartile cohorts based on mean operative time, major complication rate, mortality rate, American Society of Anesthesiologists class, reoperation rate, and readmission rate. Student t tests were used to compare wRVU/h between cohorts.Results:Forty-two hand CPT codes were identified from 214 orthopedic CPT codes, accounting for 32 333 hand procedures. The median wRVU/h was significantly lower for procedures in the longest operative time quartile compared with the shortest operative time quartile (P < .001). Compared with hand procedures, nonhand procedures were found to have significantly higher mean operative time (P < .001), mean complication rate (P < .001), mean wRVU (P = .001), and mean wRVU/h (P = .007).Conclusions:The 2020 Physician wRVU scale does not allocate proportional wRVUs to orthopedic hand procedures with longer mean operative times. There is a decrease in mean reimbursement rate for hand procedures with longer mean operative time. When compared with general orthopedic procedures, hand procedures have a lower mean wRVU/h and complication rate.
      Citation: HAND
      PubDate: 2022-01-07T09:17:38Z
      DOI: 10.1177/15589447211064361
       
  • The Impact of Clinical Practice Guidelines on Preoperative Antibiotic
           Administration for Carpal Tunnel Release

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      Authors: Saurabh Mehta, Tannor Court, Alexander Graf, Cameron Best, Robert Havlik
      Abstract: HAND, Ahead of Print.
      Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited “insufficient evidence” in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board–approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c> 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.
      Citation: HAND
      PubDate: 2022-01-07T09:15:58Z
      DOI: 10.1177/15589447211063543
       
  • Clinical Outcomes of Severely Angulated Fifth Metacarpal Neck Fractures
           Treated Nonsurgically

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      Authors: Thomas J. France, Fraser J. Leversedge, Alexander Lauder
      Abstract: HAND, Ahead of Print.
      Background:Reasonable functional outcomes for nonoperative management of isolated, closed fifth metacarpal neck fractures with up to 70° angulation have been reported; however, reported outcomes for fractures with greater than 70° angulation are limited. This study describes clinical outcomes of nonsurgically treated fifth metacarpal neck fractures with angulation of greater than 70°.Methods:A retrospective review of patients treated between May 1, 2016, and May 1, 2020, included: (1) patients aged 18 years and above with an isolated, closed, fifth metacarpal neck fracture; (2) nonsurgical treatment; (3) healed fractures with angulation greater than 70° measured on oblique radiographs; and (4) minimum 6-month follow-up after injury. Photographic hand motion and patient-rated outcomes (Functional Hand Scale, Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], 12-item Short-Form Health Survey [SF-12]) were collected and reported.Results:A total of 364 fractures were identified; 11% (40/364) demonstrated angulation of greater than 70° (range: 71°-82°); and 15 patients (inclusion rate: 38%, 15/40) with mean fracture angulation of 73° (range: 71°-77°) participated in the study. Mean follow-up was 32 months (range: 8-120 months), the dominant hand was injured in 87% (13/15) of patients, and 47% (7/15) of patients worked in manual labor. All patients scored the highest rating of “very good” (range: 26-30 of 30 points) on the functional hand scale. A QuickDASH score of zero (no morbidity) was reported in 80% (12/15) of patients. About 87% (13/15) of patients had average or above-average scores on the SF-12 (mean = 109, range: 84-115).Conclusions:Patients with healed, isolated, closed fifth metacarpal neck malunions with severe angulation greater than 70° demonstrated acceptable functional outcomes based on patient-rated outcomes scoring.
      Citation: HAND
      PubDate: 2022-01-07T09:14:18Z
      DOI: 10.1177/15589447211063238
       
  • Validation of a Novel Smartphone-Based Electronic Data Capture System
           Following Surgical Fixation of Distal Radial Fractures

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      Authors: Joseph P. Scollan, Ahmed K. Emara, Morad Chughtai, Yuxuan Jin, Joseph F. Styron
      Abstract: HAND, Ahead of Print.
      Background:Large prospective institutional data provide the opportunity to conduct level II and III studies using robust methodologies and adequately powered sample-sizes, while circumventing limitations of retrospective databases. We aimed to validate a prospective data collection tool, the Orthopaedic Minimal Data Set Episode of Care (OME), implemented at a tertiary North American health care system for distal radial fracture (DRF) open reduction and internal fixation (ORIF).Methods:The first 100 DRF ORIFs performed after OME inception (February 2015) were selected for this validation study. A blinded review of the operative notes and charts was performed, and extracted data of 75 perioperative DRF ORIF procedure variables were compared with OME collected data for agreement. Outcomes included completion rates and agreement measures in OME versus electronic medical record (EMR)-based control datasets. Data counts were evaluated using raw percentages and McNemar tests. Cohen (κ) and concordance correlation coefficient analyzed categorical and numerical variable agreement, respectively.Results:Overall, OME demonstrated superior completion and agreement parameters versus EMR-based retrospective review. Nine data points (12.0%) demonstrated significantly higher completion rates within the OME dataset (P < .05, each), and 88% (66/75) of captured variables demonstrated similar completion rates. Up to 80.0% (60/75) of variables either demonstrated an agreement proportion of ≥0.90 or were solely reported in the OME. Of 33 variables eligible for agreement analyses, 36.4% (12/33) demonstrated almost perfect agreement (κ> 0.80), and 63.6% (21/33) exhibited almost perfect or substantial agreement (κ> 0.60).Conclusions:The OME is a valid and accurate prospective data collection tool for DRF ORIF that is reliably able to match or supersede traditional retrospective chart review. Future investigations could use this tool for large-scale analyses investigating peri/intraoperative DRF ORIF variables.
      Citation: HAND
      PubDate: 2022-01-07T09:11:58Z
      DOI: 10.1177/15589447211057301
       
  • Six-Strand Flexor Pollicis Longus Tendon Repairs With and Without
           Circumferential Sutures: A Multicenter Study

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      Authors: Géraldine Lautenbach, Marco Guidi, Bernadette Tobler-Ammann, Vera Beckmann-Fries, Elisabeth Oberfeld, Lorena Schrepfer, Sebastian Hediger, Alexandre Kaempfen, Esther Vögelin, Maurizio Calcagni
      Abstract: HAND, Ahead of Print.
      Background:The purpose of this study is to assess outcomes in flexor pollicis longus tendon repairs with 6-strand core sutures with and without circumferential sutures.Methods:A 6-strand core suture technique with and without circumferential sutures was used. Thirty-three patients were summarized in the C group (circumferential group) and 16 patients in the NC group (non-circumferential group). After the surgery, the wrist was stabilized with a dorsal blocking splint and a controlled early active motion protocol was applied. At weeks 6, 13, and 26 data on demographics, type of injury, surgery, postoperative rehabilitation, complications such as re-rupture and the following outcome measurements were collected: range of motion and its recovery according to the Tang criteria, Kapandji score, thumb and hand strengths, Disabilities of the Arm, Shoulder and Hand score, and satisfaction.Results:There were no significant differences in range of motion and strength between the 2 treatment groups. In both groups, the outcome measurements increased over time and they expressed similar satisfaction with the surgical treatment. In 4 patients of the C group tendon repair ruptured and in 1 patient of the NC group.Conclusions:Six-strand repair technique is an effective procedure to assure early active motion after flexor pollicis longus tendon injuries and good results can also be achieved by omitting the circumferential suture.
      Citation: HAND
      PubDate: 2022-01-07T09:10:25Z
      DOI: 10.1177/15589447211057295
       
 
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