Hand surgery & rehabilitation最新文献

Complications of trapeziometacarpal arthroplasty are uncommon, but are classified as intra- and post-operative, dislocation and loosening being the main causes of revision surgery. Periprosthetic fracture and ossification are rare. Whenever possible, prosthetic revision techniques consist in partial or total replacement with modular implants. Trapeziectomy-ligamentoplasty is the last-resort revision technique, with results similar to those of primary trapeziectomy-ligamentoplasty.

Three-dimensional analysis of bones, especially for preoperative planning of corrective osteotomy in fracture malunion, assumes that the bilateral extremities exhibit a symmetrical mirror image when projected onto each other. No studies are available for phalanges. Three-dimensional bone models of all phalanges of 20 healthy participants (40 hands) were created from computed tomography data. For each phalanx, the difference between the left and right sides were assessed with respect to axis of rotation, ulnoradial deviation, flexion-extension and bone length. The average absolute side difference was small, but with significant differences of extension-flexion (mean 1.1°), supination-pronation (mean 1.8°), ulnoradial deviation (mean 0.9°) and translation (mean 0.2 mm). All left proximal phalanges were significantly pronated in comparison to the right side. The differences are likely unimportant, especially in corrective osteotomy using advanced 3D techniques.

The authors used a pisiform autograft to fill trapezial bone defect and allow revision of a trapeziometacarpal prosthesis. At 18 months, the patient regained a level of indolence and resumed her daily activities. LEVEL OF EVIDENCE: IV.

Tendon-related complications comprise a significant portion of overall complications following volar locked plating of distal radius fractures. While much is known about the effect of prominent hardware in the volar and dorsal metaepiphyseal region of the distal radius, less is known about the effect of hardware prominence in the dorsal meta-diaphyseal region. The purpose of this anatomic study was to evaluate the safety of dorsal screw penetration at the proximal holes of volar locking plates. We applied a 7-hole volar locking plate to the distal radius of 10 cadaver forearms. Screws were intentionally protruding on the dorsal side. Measurements were taken from each protruding dorsal screw-tip to the nearest point on the abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor digitorum communis, noting whether the nearest point was on the tendon or muscle belly. Results indicated that the muscle bellies of the abductor pollicis longus and extensor pollicis brevis were the structures most at risk from dorsal screw prominence, and that there was a smooth transition from the extensor pollicis brevis to abductor pollicis longus being the focus of risk as one moves from distal to proximal along the plate. The extensor pollicis brevis was most at risk at hole 3, and the abductor pollicis longus was most at risk at hole 6. All cases of direct contact between a protruding screw and the abductor pollicis longus or extensor pollicis brevis consisted of contact with the muscle belly, not the tendon. Average anteroposterior distal radius thickness ranged from 13.9 mm at the most distal proximal screw hole to 11.5 mm at the most proximal screw hole. We also found that the extensor pollicis longus tendon was at risk of contact with a protruding screw, but only at the most distal proximal screw hole. Overall, dorsal screw penetration at the proximal holes of volar locking plates appeared to be safe, particularly as one moves proximally along the plate.

Background: Chronic ulnar extensor tendon dislocation at the metacarpophalangeal joint causes permanent extension deficit and ulnar drift. Several soft tissue procedures have been described for realignment of the extensor tendon in post-traumatic reducible instability or in combination with joint replacement in case of altered metacarpophalangeal joint in inflammatory conditions. However, no studies reported correction of both extension lag and ulnar deviation following isolated surgical treatment of ulnar extensor tendon dislocation at the metacarpophalangeal joint. The present study evaluated the clinical and functional results of isolated correction of chronic non-traumatic ulnar extensor tendon dislocation at metacarpophalangeal level using the modified Dell technique.

Hypothesis: The study hypothesis was that the modified Dell technique allows realignment of the extensor apparatus and correction of both metacarpophalangeal extension lag and ulnar drift.

Patients and methods: 10 patients (24 fingers), operated on between June 2012 and May 2019, were evaluated at a mean follow-up of 36 months. The etiologies were rheumatoid arthritis in 17 cases, Jaccoud arthropathy due to systemic lupus erythematosus in 4, and degenerative in 3. A radial strip of distal-based extensor tendon, passed around the radial collateral ligament of the metacarpophalangeal joint downward from the surface, was sutured proximally to the remaining extensor tendon using the Pulvertaft technique.

Results: Extension deficit improved significantly, by a mean 26° (-9° postoperatively vs -35° preoperatively, p < 0.001). MP joint ulnar drift also improved significantly, by a mean 15° (6° vs 21°, p < 0.001). Four fingers had preoperative swan neck deformity that improved postoperatively. There were 2 cases of recurrent dislocation.

Conclusion: The modified Dell technique showed favorable results in treating chronic non-traumatic ulnar extensor tendon dislocation at metacarpophalangeal level in the long fingers, with realignment of the extensor system and correction of both metacarpophalangeal extension lag and ulnar drift.

Level of evidence: Level 4, single-center retrospective observational study.

Trapeziometacarpal osteoarthritis is frequently associated with scaphotrapeziotrapezoid osteoarthritis. Long-term outcomes have not been reported for trapeziometacarpal protheses in patients with radiological pan-trapezial osteoarthritis that is symptomatic only in the trapeziometacarpal compartment. The primary objective of this retrospective multicenter multi-operator study was to evaluate the effectiveness of trapeziometacarpal arthroplasty for pain relief in patients with radiographic pan-trapezial osteoarthritis without symptomatic scaphotrapeziotrapezoid involvement. A total of 70 thumbs in 67 patients were evaluated by a single independent operator at a mean follow-up of 58 months. Scaphotrapeziotrapezoid osteoarthritis severity on Crosby score was stage II in 84% of patients and stage III in 16%. Mean pain score on visual analog scale decreased from 7.7 preoperatively to 1.3 at last follow-up. There were no reoperations at last follow up. These results suggest that, in patients with radiological pan-trapezial osteoarthritis without symptomatic involvement of the scaphotrapeziotrapezoid joint, a trapeziometacarpal prothesis yields good medium-term clinical outcomes. LEVEL OF EVIDENCE: III.

Lacertus syndrome presents a diagnostic and therapeutic challenge for hand therapists, requiring a comprehensive understanding of its clinical manifestations, diagnostic considerations and evidence-based therapeutic interventions. The present article aims to provide hand therapists with practical insights into recognizing and treating Lacertus syndrome, highlighting nerve gliding exercises, muscle stretching and ergonomic education. By addressing symptom management and preventive strategies, therapists can help patients relieve lacertus syndrome symptoms, optimize functional outcome and improve occupational status.

Background and aim: Virtual reality offers new clinical assessment and rehabilitation options that can complement or, in some cases, replace traditional methods. However, the applicability of using virtual reality tools for assessment of upper limb functional capacity has not been fully explored. We therefore developed an immersive virtual reality adaptation of the 6-Minute Pegboard and Ring Test (6PBRT-VR). The aim of the study was to test the validity and reliability of the 6PBRT-VR for the assessment of upper extremity functional capacity, and to assess the performance and feasibility of the proposed tool.

Methods: Thirty healthy young adults were included in the study. The participants performed the classical 6-Minute Pegboard and Ring Test first and then the 6PBRT-VR. The test-retest reliability of the 6PBRT-VR was assessed on intraclass correlation coefficient. Concurrent validity was assessed on the correlation between the 6PBRT-VR test-retest scores (number of rings moved) and the correlation between the scores from the classical 6-Minute Pegboard and Ring Test and the 6PBRT-VR. Convergent validity was assessed on correlations with handgrip strength and the total Quick Disabilities of the Arm, Shoulder, and Hand score. Cardiorespiratory responses were also measured (at baseline and after each test). Perceived arm fatigue was assessed on the Modified Borg Scale.

Results: The 6PBRT-VR exhibited excellent test-retest reliability, with an intraclass correlation coefficient of 0.866 (95% confidence interval 0.737-0.934). Mean 6PBRT-VR score correlated strongly with the mean score of the classical 6-Minute Pegboard and Ring Test (r = 0.817, p < 0.001). A significant association was found between the 6PBRT-VR and the classical 6-Minute Pegboard and Ring Test in terms of variations in heart rate, systolic blood pressure, and Modified Borg Scale score (p < 0.001). Mean 6PBRT-VR score showed moderate correlations with right (r = 0.571, p = 0.001) and left handgrip strength (r = 0.550, p = 0.002).

Conclusion: The 6PBRT-VR is a reliable and valid virtual tool for assessing upper-extremity functional capacity in young adults.