Satisfaction and functional outcome with “self-care” for the management of fifth metacarpal fractures
ConclusionFifth metacarpal fractures can be managed effectively through an Emergency Department protocol without any formal orthopaedic follow-up. This pathway lead to excellent patient-reported outcome measures and patient satisfaction. This protocol has reduced unnecessary hospital attendances for patients and increased the time available for clinicians to deal with more challenging injuries. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
The utility of ultrasound for diagnosing purulent infections of the upper extremity
ConclusionsUltrasound is not a sensitive method to detect the presence of abscess in the setting of upper extremity infection. However, in this population of patients with suspected abscess, the negative predictive value was high with and without the inclusion of ambiguous results, suggesting reasonable utility of ultrasound as a rule-out test.Level of EvidenceDiagnostic study, Level II (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
The influence of subluxation on the severity of symptoms, disability, and the results of operative treatment in TMC osteoarthritis with total joint arthroplasty
ConclusionsThis study indicates that radial subluxation may not be an important factor in symptoms and function in patients with symptomatic TMC osteoarthritis without severe scaphotrapezio (ST) joint degeneration. In addition, preoperative subluxation seems not to be important for the result after total joint arthroplasty. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
The Snow-Fink technique as an opposition tendon transfer for children born with a hypoplastic or absent thumb
ConclusionsAn opposition transfer using the FDS tendon of the ring finger through a window in the transverse carpal ligament is a simple and reliable technique for improving thumb function in children born with an absent or hypoplastic thumb. This transfer does not produce a concave deformity in the hypothenar eminence like the Huber transfer, provides better pronation, and affords concurrent stabilization of the MCP joint. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Postsurgical complications following distal radius volar plating in a diabetic population at short-term follow-up
ConclusionsDiabetics experienced a greater incidence of minor postsurgical complications following volar locked plating of distal radius fractures when compared to a matched, control population. The difference in outcomes is largely accounted for by the increased incidence of peripheral neuritis among diabetics. Diabetic patients should be counseled pre-operatively regarding their elevated risk profile. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Surgical correction of distal radius malunions using an anatomic radial locking plate
ConclusionsCareful mobilization of the branches of the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve is required. This technique affords the surgeon excellent access to three sides of the radius to help perform this complex surgery. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Modified brachioradialis wrap for stabilizing the distal radioulnar joint: case report
AbstractDistal radioulnar joint (DRUJ) stability requires competent static and dynamic soft tissues. Multiple DRUJ techniques have been described in the literature. Our method is a novel modification of the Gupta method of DRUJ stabilization used in a revision reconstruction on a patient with a total wrist arthroplasty. A brachioradialis graft is harvested and tunneled through Parona ’s space volar to the pronator quadratus and through the muscle body. The tendon is then brought dorsal between the radius and ulna to the dorsal side of the distal ulna and sutured to the floor of the 5th extensor compartment, as well as to...
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Finger injuries in a developing sport: cachibol (Newcomb Ball)
ConclusionsFinger injuries are more prevalent in cachibol than volleyball due to the unique characteristics of the game. Cachibol-related injuries are a growing cause for concern due to the growing number of cachibol players. This study may be useful in developing effective treatment protocols and injury prevention programs for cachibol players. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
“Hand surgeons probably don’t starve”: Patient’s perceptions of physician reimbursements for performing an open carpal tunnel release
ConclusionRespondents believed that hand surgeons should be reimbursed greater than 12 times the Medicare reimbursement rate of approximately $412 and that the physicians (surgeons and anesthesiologist) should command most of the health care funds allocated to this treatment. This study highlights the discrepancy between patient ’s perceptions and actual physician reimbursement as it relates to federal health care. Efforts should be made to educate patients on this discrepancy. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Relationship of age on enjoyment of physical activity in upper extremity illness
ConclusionsEnjoyment of physical activity does not decrease with age. Patient-specific expectations, goals and preferences for physical activity should be assessed prior to decision-making on treatment.Level of Evidence: Level IV, Prognostic Study case series (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Ulnar collateral ligament strain of the thumb metacarpophalangeal joint: biomechanical comparison of two postoperative immobilization techniques
ConclusionsWhile immobilized, valgus thumb force, as opposed to MP flexion, is a likely contributor to UCL strain during simulated pinch representing noncompliance during the postoperative period. Supplemental thumb MP pin fixation more effectively protects the UCL from valgus strain. UCL shortening with FPL loading likely represents paradoxical MP extension due to flexion of the distal phalanx against the distal splint, suggesting attempted thumb flexion with splint immobilization alone does not jeopardize UCL repair.Clinical RelevanceThis study provides a foundation to aid clinical decision-making after UCL repair. It re...
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Mini dorsal incision to the triangular fibrocartilage complex: a new surgical approach
We describe a mini incision approach which aims to preserve the structure and proprioception of the primary and secondary stabilisers of the wrist joint. This approach requires less dissection and provides adequate exposure to the distal aspect of the TFCC and allows visualisation of the distal radial ulna joint (DRUJ) with complete TFCC lesions. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
The effect of operative technique on ulnar nerve strain following surgery for cubital tunnel syndrome
ConclusionAn in situ release of the ulnar nerve at the elbow may relieve pressure on the nerve but does not address the problem of strain which may be the underlying pathology in many cases of ulnar neuropathy at the elbow (UNE). Transposition of the ulnar nerve anterior to the medial epicondyle addresses the problem of strain on the ulnar nerve. In addition, it does not create an increased strain on the ulnar nerve with elbow extension. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Scapholunate instability after distal radius volar plating
ConclusionsIn our representative population, scapholunate instability was uncommon, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. Thus, we did not find strong evidence for routinely delaying motion or pursuing further workup. When early radiographs clearly demonstrate acute scapholunate instability, more aggressive treatment may be appropriate for selected patients. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
Patients ’ preferences regarding the delivery of health care in a hand surgical practice
ConclusionsThe results of our study indicate that patients prefer typed information as opposed to e-mail or websites regarding their health care. Our study also suggests that patients are willing to endure longer wait times if they can be given a sooner appointment, and most prefer a specialist for their problems. These results will provide some guidance to the physician regarding what patients find most appealing. (Source: Hand)
Source: Hand - December 1, 2015 Category: Surgery Source Type: research
