Pub Date : 2016-12-01Epub Date: 2016-03-09DOI: 10.1177/1558944715628000
Alan Sull, Serkan Inceoglu, Montri D Wongworawat
Background: Advances in suture material and geometry have fueled interest in barbed suture tenorrhaphy. Theoretically, barbed suture allows better load distribution, smoother gliding under pulleys, and improved tendon blood flow. Minimal data exist on whether barbed tendon repair may benefit from supplementation by a peripheral stitch. The purpose of this study is to determine whether peripheral suture repair increases gap resistance in both conventional and barbed core repairs, increases maximum tensile strength, and fails before or after the core repair. Methods: Porcine flexor tendons were harvested and assigned randomly into 4 groups of 10 of varying suture constructs (3-0 PDS™ or 3-0 V-Loc 180™ core with or without peripheral 5-0 Vicryl™ repair). Core repairs were performed using a modified 4-strand cruciate repair. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. Results: Peripheral repair improved 2-mm gap resistance in all repairs, regardless of core suture type, conventional (173% increase) or barbed (204% increase). No change in the maximum tensile strength was found in either core suture type with peripheral repair. Peripheral repairs always failed before core repairs, at a significantly higher load of 74.2 ± 20.4 N in barbed versus 57.8 ± 12.2 N (P = .04) in conventional core repairs. Conclusions: The addition of peripheral repair improved gap resistance but not ultimate tensile strength in both conventional and barbed flexor tendon repairs in linear testing. The 4-strand cruciate flexor tendon repairs using barbed suture may require peripheral repair to withstand physiologic loads, as core repair alone using barbed suture was insufficient.
{"title":"Does Barbed Suture Repair Negate the Benefit of Peripheral Repair in Porcine Flexor Tendon?","authors":"Alan Sull, Serkan Inceoglu, Montri D Wongworawat","doi":"10.1177/1558944715628000","DOIUrl":"10.1177/1558944715628000","url":null,"abstract":"<p><p><b>Background:</b> Advances in suture material and geometry have fueled interest in barbed suture tenorrhaphy. Theoretically, barbed suture allows better load distribution, smoother gliding under pulleys, and improved tendon blood flow. Minimal data exist on whether barbed tendon repair may benefit from supplementation by a peripheral stitch. The purpose of this study is to determine whether peripheral suture repair increases gap resistance in both conventional and barbed core repairs, increases maximum tensile strength, and fails before or after the core repair. <b>Methods:</b> Porcine flexor tendons were harvested and assigned randomly into 4 groups of 10 of varying suture constructs (3-0 PDS™ or 3-0 V-Loc 180™ core with or without peripheral 5-0 Vicryl™ repair). Core repairs were performed using a modified 4-strand cruciate repair. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. <b>Results:</b> Peripheral repair improved 2-mm gap resistance in all repairs, regardless of core suture type, conventional (173% increase) or barbed (204% increase). No change in the maximum tensile strength was found in either core suture type with peripheral repair. Peripheral repairs always failed before core repairs, at a significantly higher load of 74.2 ± 20.4 N in barbed versus 57.8 ± 12.2 N (<i>P</i> = .04) in conventional core repairs. <b>Conclusions:</b> The addition of peripheral repair improved gap resistance but not ultimate tensile strength in both conventional and barbed flexor tendon repairs in linear testing. The 4-strand cruciate flexor tendon repairs using barbed suture may require peripheral repair to withstand physiologic loads, as core repair alone using barbed suture was insufficient.</p>","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"479-483"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-10DOI: 10.1177/1558944716647355
J. Buckwalter V, Apurva S. Shah
Background: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral pectoral muscle agenesis and ipsilateral hand deformity. Methods: A comprehensive review of the medical literature on Poland anomaly was performed using a Medline search. Results: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral, simple syndactyly with ipsilateral limb hypoplasia and pectoralis muscle agenesis. Operative management of syndactyly in Poland anomaly is determined by the severity of hand involvement and the resulting anatomical dysfunction. Syndactyly reconstruction is recommended in all but the mildest cases because most patients with Poland anomaly have notable brachydactyly, and digital separation can improve functional length. Conclusions: Improved understanding the etiology and presentation of Poland anomaly can improve clinician recognition and management of this rare congenital condition.
{"title":"Presentation and Treatment of Poland Anomaly","authors":"J. Buckwalter V, Apurva S. Shah","doi":"10.1177/1558944716647355","DOIUrl":"https://doi.org/10.1177/1558944716647355","url":null,"abstract":"Background: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral pectoral muscle agenesis and ipsilateral hand deformity. Methods: A comprehensive review of the medical literature on Poland anomaly was performed using a Medline search. Results: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral, simple syndactyly with ipsilateral limb hypoplasia and pectoralis muscle agenesis. Operative management of syndactyly in Poland anomaly is determined by the severity of hand involvement and the resulting anatomical dysfunction. Syndactyly reconstruction is recommended in all but the mildest cases because most patients with Poland anomaly have notable brachydactyly, and digital separation can improve functional length. Conclusions: Improved understanding the etiology and presentation of Poland anomaly can improve clinician recognition and management of this rare congenital condition.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"389 - 395"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716647355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-14DOI: 10.1177/1558944715616098
Donevan R. Westerveld, David J. Hall, W. Richards
Background: Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy characterized by high incidence of local recurrence, distant metastases, regional nodal metastases, and high mortality. Clinically, MCC presents as a persistent asymptomatic red/pink shaped nodule, usually smaller than 2 cm with nontender intracutaneous swelling, with rapidly growing localized disease with lymph node metastases preceding distant metastases. Because of its rare nature and the lack of comprehensive understanding of the disease, management of MCC has been controversial. Methods: An 87-year-old retired Caucasian male with a history of tobacco use, chronic sun exposure, and multiple squamous and basal cell carcinomas presented with a 1.8 × 1.3 cm red, nontender nodule on the dorsum of the proximal phalanx of the left long finger first noticed 6 months prior to presentation. Biopsy was consistent with MCC after which he was treated with wide local excision, full-thickness skin grafting, and sentinel lymphadenectomy (1/4 nodes positive) followed by adjuvant radiation therapy. Results: He recovered appropriately and was clinically and radiographically disease free at 2.5-year follow-up. Conclusion: Although it remains rare, MCC has increased in incidence over the last several decades and has a predilection to occur over sun exposed areas. Highly aggressive, it has a high incidence of regional and distant metastasis as well as local recurrence. As a result, it is important that practitioners involved in the care of skin and hand lesions be aware of this condition and the need for a multidisciplinary treatment approach.
{"title":"Merkel Cell Carcinoma of the Hand","authors":"Donevan R. Westerveld, David J. Hall, W. Richards","doi":"10.1177/1558944715616098","DOIUrl":"https://doi.org/10.1177/1558944715616098","url":null,"abstract":"Background: Merkel cell carcinoma (MCC) is a relatively rare and aggressive cutaneous neuroendocrine malignancy characterized by high incidence of local recurrence, distant metastases, regional nodal metastases, and high mortality. Clinically, MCC presents as a persistent asymptomatic red/pink shaped nodule, usually smaller than 2 cm with nontender intracutaneous swelling, with rapidly growing localized disease with lymph node metastases preceding distant metastases. Because of its rare nature and the lack of comprehensive understanding of the disease, management of MCC has been controversial. Methods: An 87-year-old retired Caucasian male with a history of tobacco use, chronic sun exposure, and multiple squamous and basal cell carcinomas presented with a 1.8 × 1.3 cm red, nontender nodule on the dorsum of the proximal phalanx of the left long finger first noticed 6 months prior to presentation. Biopsy was consistent with MCC after which he was treated with wide local excision, full-thickness skin grafting, and sentinel lymphadenectomy (1/4 nodes positive) followed by adjuvant radiation therapy. Results: He recovered appropriately and was clinically and radiographically disease free at 2.5-year follow-up. Conclusion: Although it remains rare, MCC has increased in incidence over the last several decades and has a predilection to occur over sun exposed areas. Highly aggressive, it has a high incidence of regional and distant metastasis as well as local recurrence. As a result, it is important that practitioners involved in the care of skin and hand lesions be aware of this condition and the need for a multidisciplinary treatment approach.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"NP24 - NP29"},"PeriodicalIF":0.0,"publicationDate":"2016-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944715616098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65573938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-09DOI: 10.1177/1558944715627241
Parker H. Johnsen, S. Wolfe
Background: Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Methods: Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. Results: At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5- at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. Conclusion: This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.
{"title":"Successful Nerve Transfers for Traumatic Brachial Plexus Palsy in a Septuagenarian","authors":"Parker H. Johnsen, S. Wolfe","doi":"10.1177/1558944715627241","DOIUrl":"https://doi.org/10.1177/1558944715627241","url":null,"abstract":"Background: Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Methods: Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. Results: At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5- at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. Conclusion: This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"30 1","pages":"NP30 - NP33"},"PeriodicalIF":0.0,"publicationDate":"2016-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944715627241","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944715614860
M. Gottschalk, M. Danilevich, H. Gottschalk
Background: Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. Methods: A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. Results: The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Conclusions: Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.
{"title":"Carpal Coalitions and Metacarpal Synostoses","authors":"M. Gottschalk, M. Danilevich, H. Gottschalk","doi":"10.1177/1558944715614860","DOIUrl":"https://doi.org/10.1177/1558944715614860","url":null,"abstract":"Background: Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. Methods: A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. Results: The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Conclusions: Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"271 - 277"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944715614860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65573861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944716660555ae
Xiao-fang Shen, Yongjun Rui, Mingyu Xue
Hypothesis: Reconstruction of radial polydactyly with a boot-shaped neurovascular island flap can result in good outcomes. Materials and Methods: A number of techniques are used for reconstruction of radial polydactyly, with the aim of reconstruction to obtain a stable, mobile thumb of adequate size and shape. Techniques include preserving the ulnar (or radial) thumb, reconstructing a contour defect with a boot-shaped neurovascular island flap and the Bilhaut-Cloquet procedure. A persistent problem is the asymmetry between the reconstructed and normal contralateral thumb. Between 2013 and 2015, 9 thumbs in 8 patients had reconstruction with a boot-shaped neurovascular island flap. The study group included 1 Wassel type I, 6 Wassel type IV, and 2 Wassel type VII. A boot-shaped neurovascular island flap was dissected out from the thumb to be removed. Specific modifications include the use of Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct deviation of the reconstructed thumb’s interphalangeal (IP) joint in the Wassel type IV thumb duplication. Results: All boot-shaped neurovascular island flaps survived with good contour and shape, and obtained symmetry eponychial fold compared with the contralateral thumb. Reconstruction of radial polydactyly with a boot-shaped island neurovascular flap allows for good symmetry in shape and size following reconstruction, especially where 2 digits are equal or almost equal in size. Summary Points: A boot-shaped neurovascular island flap can be used for reconstruction of radial polydactyly with good outcomes.
{"title":"Boot-shaped Neurovascular Island Flap for Reconstruction of Radial Polydactyly","authors":"Xiao-fang Shen, Yongjun Rui, Mingyu Xue","doi":"10.1177/1558944716660555ae","DOIUrl":"https://doi.org/10.1177/1558944716660555ae","url":null,"abstract":"Hypothesis: Reconstruction of radial polydactyly with a boot-shaped neurovascular island flap can result in good outcomes. Materials and Methods: A number of techniques are used for reconstruction of radial polydactyly, with the aim of reconstruction to obtain a stable, mobile thumb of adequate size and shape. Techniques include preserving the ulnar (or radial) thumb, reconstructing a contour defect with a boot-shaped neurovascular island flap and the Bilhaut-Cloquet procedure. A persistent problem is the asymmetry between the reconstructed and normal contralateral thumb. Between 2013 and 2015, 9 thumbs in 8 patients had reconstruction with a boot-shaped neurovascular island flap. The study group included 1 Wassel type I, 6 Wassel type IV, and 2 Wassel type VII. A boot-shaped neurovascular island flap was dissected out from the thumb to be removed. Specific modifications include the use of Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct deviation of the reconstructed thumb’s interphalangeal (IP) joint in the Wassel type IV thumb duplication. Results: All boot-shaped neurovascular island flaps survived with good contour and shape, and obtained symmetry eponychial fold compared with the contralateral thumb. Reconstruction of radial polydactyly with a boot-shaped island neurovascular flap allows for good symmetry in shape and size following reconstruction, especially where 2 digits are equal or almost equal in size. Summary Points: A boot-shaped neurovascular island flap can be used for reconstruction of radial polydactyly with good outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"34 1","pages":"27S - 27S"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716660555ae","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944716660555as
W. Hülsemann, F. Winkler, M. Mann
Background: Frequently we find atypical tendon insertions when we correct duplicated thumbs. Tendon realignment is mandatory to gain upright position. The insertion of the flexor tendon can be centralized by transposing it ulnarly. But tendon sheath cannot be centralized perfectly. Recurrence of radial tilt at the interphalangeal (IP)-joint level in growth is possible. We want to investigate whether the upright position persists and how often a recurrence can be expected. Patient and Method: We retrospectively analyzed our patients operated from 2000 to 2010 with a minimum follow-up of 3 years postoperation. They are analyzed for sex, age at operation, type of duplication, position, and active and passive range of motion of the IP-joint. Results: Over a period of 11 years, we had operated 28 children with a double thumb showing an atypical flexor tendon insertion which was corrected by tendon transposition: 24 patients came to a follow-up, 3 to 12 years postoperation (mean, 5.2 years). Mostly (n = 16) they suffered by a Wassel IV duplication. Ten patients received a perfect result (straight thumb without deviation), 5 children a light deviation of 10°, and 8 patients developed a clear visible radial deviation of 20° or functional disturbing 30° flexion position of the IP-joint. The malposition developed mainly 5 years postoperation. Four patients of these underwent IP-arthrodesis for secondary correction and 2 are scheduled for this. The IP-joint was always stable and had mostly no, and in some cases up to 40° active mobility. Conclusion: As far as our experience goes, the transposition of the flexor tendon insertion is initially a technique which works for straightening up the IP-joint of a doubled thumb. The impediment in growth occurred mostly around 5 years after the transposition and can be corrected by a straightening IP-arthrodesis.
{"title":"Thumb Duplication With Atypical Flexor Tendon Insertion","authors":"W. Hülsemann, F. Winkler, M. Mann","doi":"10.1177/1558944716660555as","DOIUrl":"https://doi.org/10.1177/1558944716660555as","url":null,"abstract":"Background: Frequently we find atypical tendon insertions when we correct duplicated thumbs. Tendon realignment is mandatory to gain upright position. The insertion of the flexor tendon can be centralized by transposing it ulnarly. But tendon sheath cannot be centralized perfectly. Recurrence of radial tilt at the interphalangeal (IP)-joint level in growth is possible. We want to investigate whether the upright position persists and how often a recurrence can be expected. Patient and Method: We retrospectively analyzed our patients operated from 2000 to 2010 with a minimum follow-up of 3 years postoperation. They are analyzed for sex, age at operation, type of duplication, position, and active and passive range of motion of the IP-joint. Results: Over a period of 11 years, we had operated 28 children with a double thumb showing an atypical flexor tendon insertion which was corrected by tendon transposition: 24 patients came to a follow-up, 3 to 12 years postoperation (mean, 5.2 years). Mostly (n = 16) they suffered by a Wassel IV duplication. Ten patients received a perfect result (straight thumb without deviation), 5 children a light deviation of 10°, and 8 patients developed a clear visible radial deviation of 20° or functional disturbing 30° flexion position of the IP-joint. The malposition developed mainly 5 years postoperation. Four patients of these underwent IP-arthrodesis for secondary correction and 2 are scheduled for this. The IP-joint was always stable and had mostly no, and in some cases up to 40° active mobility. Conclusion: As far as our experience goes, the transposition of the flexor tendon insertion is initially a technique which works for straightening up the IP-joint of a doubled thumb. The impediment in growth occurred mostly around 5 years after the transposition and can be corrected by a straightening IP-arthrodesis.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"32S - 33S"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716660555as","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944716660555BS
J. Neto, J. C. Belloti, J. D. Dos Santos, V. Y. de Moraes, Flávio Galopa, C. Fernandes
Objective: In the treatment of unstable fractures of the distal radius, there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Scale [VAS]). The final assessment was given at 12 months postoperatively. Results: In the final evaluation, there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, P = .58), and pain by VAS (0.84 for the LVP group and 0.53 for the BEF group, P = .39). Treatment with LVP was more effective than one with BEF in early evaluation with 8 weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, P = .0012). In the group treated with LVP, there were 11.7% of complications, and in the group treated with external fixator, 26.3%. There were 3 treatment failures in the group treated with LVP and none in the other group. Conclusions: There were no assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early 8-week assessment, there was a positive difference to the LVP method.
{"title":"Treatment of Reducible Unstable Fractures of the Distal Radius","authors":"J. Neto, J. C. Belloti, J. D. Dos Santos, V. Y. de Moraes, Flávio Galopa, C. Fernandes","doi":"10.1177/1558944716660555BS","DOIUrl":"https://doi.org/10.1177/1558944716660555BS","url":null,"abstract":"Objective: In the treatment of unstable fractures of the distal radius, there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Scale [VAS]). The final assessment was given at 12 months postoperatively. Results: In the final evaluation, there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, P = .58), and pain by VAS (0.84 for the LVP group and 0.53 for the BEF group, P = .39). Treatment with LVP was more effective than one with BEF in early evaluation with 8 weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, P = .0012). In the group treated with LVP, there were 11.7% of complications, and in the group treated with external fixator, 26.3%. There were 3 treatment failures in the group treated with LVP and none in the other group. Conclusions: There were no assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early 8-week assessment, there was a positive difference to the LVP method.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"45S - 45S"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716660555BS","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944716660555aw
M. Baas, S.E.R. Hovius, R. Galjaard, P. J. V. D. Spek, C. A. V. Nieuwenhoven
Purpose: Congenital upper limb anomalies (CULA) can present isolated or as a part of a syndrome or association. Therefore, surgeons dealing with CULA should be aware of associated diseases and anomalies. The newly accepted Oberg, Manske, and Tonkin (OMT) classification allows for registration of a wide spectrum of CULA. Therefore, providing associated diseases for each hand anomaly in the classification would aid differential diagnosis formulation in clinic and investigation of causal genes in research. The first aim of this study was to review the Human Phenotype Ontology (HPO) database for diseases and causative genes that can be related to hand anomalies present in the OMT classification. The second aim was to relate associated anomalies and inheritance patterns to improve differentiation between the diseases. Methods: The HPO database was reviewed for all diseases with a known causative gene related to hand anomalies. All hand phenotypes were classified according to the OMT classification; nonhand phenotypes were classified into anatomical groups. TIBCO Spotfire Software was used to visualize the contribution of each anatomical group to a given disease and to prioritize diseases based on this contribution. Results were compared with literature cases and to a current HPO tool, Phenomizer. Results: In total, 514 hand phenotypes were obtained, 384 could be classified in the OMT classification, and 1403 diseases could be related to the OMT classification. Differentiation between diseases is illustrated by examples. Comparison to recently published hand phenotypes reveals that all were present in our data set. Gene prioritization using our methodology was better than Phenomizer in 4/5 examples. Conclusions: We present an OMT-classification-based methodology to aid clinicians in differential diagnosis formulation in patients with CULA. Furthermore, we enable discrimination between the diseases by providing insight in the differences in disease presentation. Gene prioritization and visualization in the proposed system outperforms systems in current use.
目的:先天性上肢畸形(CULA)可以单独出现，也可以作为综合征或关联的一部分。因此，处理CULA的外科医生应注意相关疾病和异常。新近接受的Oberg, Manske, and Tonkin (OMT)分类允许对CULA的广谱进行登记。因此，在分类中为每一手部异常提供相关疾病有助于临床鉴别诊断的制定和研究中病因基因的调查。本研究的第一个目的是回顾人类表型本体论(HPO)数据库中与OMT分类中手部异常相关的疾病和致病基因。第二个目的是将相关的异常和遗传模式联系起来，以改善疾病之间的区分。方法:回顾HPO数据库中与手部异常相关的已知致病基因的所有疾病。所有手部表型均按照OMT分类进行分类;非手表型被划分为解剖组。TIBCO Spotfire软件用于可视化每个解剖组对给定疾病的贡献，并根据这种贡献对疾病进行优先排序。结果与文献病例和当前HPO工具Phenomizer进行了比较。结果:共获得514种手部表型，可归为OMT分型的384种，可归为OMT分型的疾病1403种。疾病之间的区别是用例子来说明的。与最近发表的手部表型比较显示，所有这些都存在于我们的数据集中。在4/5的样本中，使用我们的方法进行基因优先排序优于Phenomizer。结论:我们提出了一种基于omt分类的方法，以帮助临床医生对CULA患者进行鉴别诊断。此外，我们通过提供疾病表现差异的见解，使疾病之间的区分成为可能。提出的系统中的基因优先排序和可视化优于当前使用的系统。
{"title":"Identification of Associated Genes and Diseases in Patients With Congenital Upper Limb Anomalies","authors":"M. Baas, S.E.R. Hovius, R. Galjaard, P. J. V. D. Spek, C. A. V. Nieuwenhoven","doi":"10.1177/1558944716660555aw","DOIUrl":"https://doi.org/10.1177/1558944716660555aw","url":null,"abstract":"Purpose: Congenital upper limb anomalies (CULA) can present isolated or as a part of a syndrome or association. Therefore, surgeons dealing with CULA should be aware of associated diseases and anomalies. The newly accepted Oberg, Manske, and Tonkin (OMT) classification allows for registration of a wide spectrum of CULA. Therefore, providing associated diseases for each hand anomaly in the classification would aid differential diagnosis formulation in clinic and investigation of causal genes in research. The first aim of this study was to review the Human Phenotype Ontology (HPO) database for diseases and causative genes that can be related to hand anomalies present in the OMT classification. The second aim was to relate associated anomalies and inheritance patterns to improve differentiation between the diseases. Methods: The HPO database was reviewed for all diseases with a known causative gene related to hand anomalies. All hand phenotypes were classified according to the OMT classification; nonhand phenotypes were classified into anatomical groups. TIBCO Spotfire Software was used to visualize the contribution of each anatomical group to a given disease and to prioritize diseases based on this contribution. Results were compared with literature cases and to a current HPO tool, Phenomizer. Results: In total, 514 hand phenotypes were obtained, 384 could be classified in the OMT classification, and 1403 diseases could be related to the OMT classification. Differentiation between diseases is illustrated by examples. Comparison to recently published hand phenotypes reveals that all were present in our data set. Gene prioritization using our methodology was better than Phenomizer in 4/5 examples. Conclusions: We present an OMT-classification-based methodology to aid clinicians in differential diagnosis formulation in patients with CULA. Furthermore, we enable discrimination between the diseases by providing insight in the differences in disease presentation. Gene prioritization and visualization in the proposed system outperforms systems in current use.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"34S - 35S"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716660555aw","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65574846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/1558944716660555co
A. Kachooei, Jos J. Mellema, Matthew A. Tarabochia, N. Chen, D. Ring
Purpose: To address the primary null hypothesis that there is no difference in the articular surface area of the lesser sigmoid notch involved among Mayo classes. Second, we analyzed the fracture line location and the pattern of lesser sigmoid notch articular surface involvement among Mayo classes. Methods: Using quantitative 3-dimentional computed tomography, we reconstructed and analyzed fractures involving the lesser sigmoid notch articular surface in 52 patients. Furthermore, we assessed the surface area involved in the fracture, the number of fracture fragments, and the location and direction of the fracture lines. Coronoid fractures were classified according to Mayo types. Results: There was no significant difference between Mayo types 1 and 2 in any characteristic of the involvement of the lesser sigmoid notch articular surface, whereas Mayo type 3 was significantly different from both Mayo types 1 and 2 in the area involved in the fracture (42% in Mayo type III vs 9% in Mayo types I and II), the number of articular fragments (>3 fragments in type III vs 2 fragments in types I and II), and the direction of fracture line (both horizontal and vertical lines in type III vs only horizontal line in types I and II). Conclusion: Mayo type III results in a more complex fracture, which might need to be addressed directly or indirectly during open reduction internal fixation of the olecranon fracture dislocations because changes in the geometry of lesser sigmoid notch may affect the radioulnar joint if it remains incongruent.
{"title":"Involvement of the Lesser Sigmoid Notch in Elbow Fracture Dislocations","authors":"A. Kachooei, Jos J. Mellema, Matthew A. Tarabochia, N. Chen, D. Ring","doi":"10.1177/1558944716660555co","DOIUrl":"https://doi.org/10.1177/1558944716660555co","url":null,"abstract":"Purpose: To address the primary null hypothesis that there is no difference in the articular surface area of the lesser sigmoid notch involved among Mayo classes. Second, we analyzed the fracture line location and the pattern of lesser sigmoid notch articular surface involvement among Mayo classes. Methods: Using quantitative 3-dimentional computed tomography, we reconstructed and analyzed fractures involving the lesser sigmoid notch articular surface in 52 patients. Furthermore, we assessed the surface area involved in the fracture, the number of fracture fragments, and the location and direction of the fracture lines. Coronoid fractures were classified according to Mayo types. Results: There was no significant difference between Mayo types 1 and 2 in any characteristic of the involvement of the lesser sigmoid notch articular surface, whereas Mayo type 3 was significantly different from both Mayo types 1 and 2 in the area involved in the fracture (42% in Mayo type III vs 9% in Mayo types I and II), the number of articular fragments (>3 fragments in type III vs 2 fragments in types I and II), and the direction of fracture line (both horizontal and vertical lines in type III vs only horizontal line in types I and II). Conclusion: Mayo type III results in a more complex fracture, which might need to be addressed directly or indirectly during open reduction internal fixation of the olecranon fracture dislocations because changes in the geometry of lesser sigmoid notch may affect the radioulnar joint if it remains incongruent.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"11 1","pages":"55S - 55S"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944716660555co","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65575203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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