Common Hand Injuries Research Articles

Bennett Fractures: A Biomechanical Model and Relevant Ligamentous Anatomy.

This study examined a palmar beak fracture model to determine which thumb carpometacarpal (CMC) joint ligament is the primary ligament relevant to the pattern of injury. Six fresh-frozen cadaveric wrists were used. The radius, ulna, and first metacarpal were secured and tested with a materials testing system, holding the wrist in 20° extension, 20° ulnar deviation, and 30° palmar abduction of the first metacarpal. Testing consisted of preconditioning cycles followed by compressive loading at 100 mm/s. We confirmed fractures with fluoroscopy and dissected the specimens to examine the CMC joint ligaments. The metacarpal was stressed through a range of motion to determine which maneuvers reduced or displaced the fractures. Our model successfully created palmar beak fractures in all cadaveric specimens. All fractures were displaced and intra-articular. The anterior oblique ligament (AOL) was thin and partially attached to the palmar beak fracture fragment. The ulnar collateral ligament was attached in its entirety to the fracture fragment and represented a thicker, more robust ligament compared with the AOL. Radial abduction and pronation of the metacarpal reduced fracture displacement. Extension of the CMC joint or tensioning the AOL did not decrease fracture displacement. This model successfully created a reproducible and clinically relevant palmar beak fracture in a biomechanical setting. The primary ligament attached to the palmar beak fracture fragment was the ulnar collateral ligament, and not the AOL as previously described. These findings suggest that the AOL may not be a substantial contributor to palmar beak fracture morphology. A refined description of the ligamentous anatomy of the palmar break fracture enhances opportunities for improved reduction and treatment of this common hand injury.

Isolation and Characterization of Multipotent Turkey Tendon-Derived Stem Cells

Tendon injuries are among the most common and severe hand injuries with a high demand for functional recovery. Stem cells have been identified and isolated from different species and a variety of tissues for the sake of regenerative medicine. Recently, turkey has been suggested as a potential new large animal model for flexor tendon-related research. However, turkey tissue-specific stem cells have not been investigated. Here, we presented the isolation and verification of tendon-derived stem cells (TDSCs) from 6- to 8-month-old heritage-breed turkey. TDSCs were isolated from turkey flexor tendon by plating nucleated cells at the determined optimal density. Approximately 4% of the nucleated cells demonstrated clonogenicity, high proliferation rate, and trilineage differentiation potential after induction culturing. These cells expressed surface antigens CD90, CD105, and CD44, but did not express CD45. There was a high level of gene expression of tenogenic markers in TDSCs, including mohawk, collagen type I, tenascin C, and elastin. Turkey TDSCs also expressed transcription factors PouV, Nanog, and Sox2, which are critically involved in the regulation of stemness. The successful isolation of tendon-derived stem cells from turkey was beneficial for future studies in tendon tissue engineering and would help in the development of new treatment for tendon diseases using this novel animal model.

Irreducible Dislocations of the Proximal Interphalangeal Joint: Algorithm for Open Reduction and Soft-tissue Repair.

The "jammed finger" is among the most common hand injuries and may include simple sprains, dislocations, fractures, and fracture-dislocations. In contrast, irreducible dislocations of the proximal interphalangeal joint are rare injuries. However, they must not be overlooked in the primary assessment, because persistent subluxation may lead to joint contracture, severely compromising hand function. Irreducible dislocations are challenging injuries with interposed soft tissues, preventing closed reduction. Thorough preoperative diagnosis and soft-tissue imaging guide the approach to open reduction and repair of injured periarticular structures. We introduce a systematic algorithm with considerations on classification and management of irreducible proximal interphalangeal joint dislocations. The algorithm is useful for the primary assessment and for hand surgeons responsible for open reduction and rehabilitation.

Flexor Tendon Injuries

Flexor tendon injuries are common hand injuries that can significantly affect hand function. Treatment of these injuries requires a thorough understanding of the intricate anatomy and biomechanics of flexor tendons. The goals of reconstruction include restoration of tendon continuity, preservation and reconstruction of the pulley system, maximizing tendon gliding, and minimizing adhesion formation. Surgical treatment, in conjunction with postoperative hand therapy, provides enhanced function. This review provides the surgeon with the relevant anatomy, pearls of clinical evaluation, necessary investigative studies, management algorithms, surgical techniques, rehabilitation protocols, and approaches to common complications. It ends with a discussion of basic and translational research currently being undertaken to address the challenges posed by flexor tendon injuries and how this research can potentially advance patient care. This review contains 16 figures, 5 tables and 55 references Key words: flexor tendon, flexor tendon injuries, flexor tendon reconstruction, flexor tendon repair, hand, hand surgery, injury, surgical technique, tendons

Range of movement, power and pinch grip strength post flexor tendon repair

Background: Flexor tendon injuries (FTI) are common hand injuries that pose a challenge to the multi-disciplinary team. Despite being the most researched topic in hand literature, the optimal surgical and post-operative treatment of FTI remains unclear and results after flexor tendon repair (FTR) continue to be unpredictable.Purpose: The purpose of this study was to determine the range of movement (ROM), power and pinch grip strength post FTR and to establish factors that may affect these.Method: The study was conducted at an academic hospital in Gauteng, South Africa, between January 2013 and September 2015. At one, three and six months post FTR, the ROM of the injured and contralateral finger(s) were measured. At three and six months post FTR the participants’ bilateral power and pinch grip strength were also measured.Results: One hundred and twenty-six participants (n=126) enrolled in the study. There was a drop-out rate of 48%, leaving 65 participants that completed six months’ follow-up: 41 males (63%) and 24 females (37%) with mean age of 32 years (SD±10, n=65). Out of 65 participants, 2% (n=1) had an excellent outcome, 32% (n=21) a good outcome, 32% (n=21) a fair outcome and 34% (n=22) a poor outcome with regard to ROM. At six months post FTR the average power grip was 60% (SD±25, n=65) of the unaffected hand, while the average pinch grip was 52% (SD±42, n=65) of the unaffected hand. Sixty-eight per cent (n=44) of patients had post-operative complications: the most common complication was tenodesis/adhesions (25%, n=16), followed by contracture (22%, n=14). Four patients (6%) had ruptures and 11 (17%) underwent further surgery. Factors that had a positive effect on outcome at six months post FTR were: younger age, no associated injury, less duration between injury and surgery, having controlled active motion instead of passive motion occupational therapy protocol, and not having a language barrier. Injury in zone IV was associated with worse ROM and power grip strength than other zones.Conclusion: Although there were some promising outcomes, during this period participants did not consistently achieve the good or excellent outcomes that are achieved in some developed countries.Level of evidence: Level 4

Evaluation of uncomplicated isolated extensor tendon injury repair of hand in Amritsar (India)

Introduction: Extensor tendon injury is one common hand injury occurring in young individuals. Extensor tendons are superficially located with minimal amount of subcutaneous tissue that predisposes the extensor mechanism to more complex tendon injuries. Surgical repair of extensor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well planned postoperative programme. Aim and Objectives: We conducted this study to find out common causes of extensor tendon injuries, evaluation of hand function after repair of extensor tendon injuries and evaluation of effect of time elapsed between onset of injury to tendon repair on the final outcome. Methodology: The functional outcome after tendon repair was assessed by calculating Total Active range of Motion (TAM). Results: We concluded that the higher percentage of excellent and good cases is might be attributable to strong and meticulous repair in which more aggressive physiotherapy was tolerated by the patients and the tendons should be repaired preferably primarily.

Evaluation of extensor tendon repair of hand

Extensor tendon injury is one common hand injury occurring in young individuals. Extensor tendons are superficially located with minimal amount of subcutaneous tissue that predisposes the extensor mechanism to more complex tendon injuries. Surgical repair of extensor tendon requires an exact knowledge of anatomy, careful adherence to some basic surgical principles, sound clinical judgment, strict atraumatic surgical technique and a well-planned postoperative programme. We conducted this study to find out common causes of extensor tendon injuries, evaluation of hand function after repair of extensor tendon injuries and evaluation of effect of time elapsed between onset of injury to tendon repair on the final outcome. The functional outcome after tendon repair was assessed by calculating Total Active range of Motion (TAM). After the evaluation of result we concluded that the higher percentage of excellent and good cases is might be attributable to strong and meticulous repair in which more aggressive physiotherapy was tolerated by the patients and the tendons should be repaired preferably primarily.

Randomized feasibility trial of replacing or discarding the nail plate after nail-bed repair in children.

BackgroundNail‐bed injuries are the most common hand injury in children. Surgical dogma is to replace the nail plate after repairing the nail bed. Recent evidence suggests this might increase infection rates and returns to clinic. The aim of this feasibility trial was to inform the design and conduct of a definitive trial comparing replacing or discarding the nail plate after nail‐bed repair.MethodsThis study recruited participants from four hand units in the UK between April and July 2015. Participants were children under the age of 16 years with a nail‐bed injury requiring surgery. They were randomized to either having the nail plate replaced or discarded after nail‐bed repair. The follow‐up method was also allocated randomly (postal versus clinic). Information was collected on complications at 2 weeks and 30 days, and on nail‐plate appearance at 4 months using the Zook classification. Two possible approaches to follow‐up were also piloted and compared.ResultsDuring the recruitment phase, there were 156 potentially eligible children. Sixty were randomized in just over 3 months using remote web‐based allocation. By 2 weeks, there were two infections, both in children with replaced nail plates. The nail‐replaced group also experienced more complications. There was no evidence of a difference in return rates between postal and clinic follow‐up.ConclusionRecruitment was rapid and nail‐bed repair appeared to have low complication and infection rates in this pilot trial. The findings have led to revision of the definitive trial protocol, including the mode and timing of follow‐up, and modification of the Zook classification.

Simultaneous Bony Mallet Fingers of Two Phalanx in a Patient: A Rarely Seen Case Report

Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal Mallet finger deformity is a common hand injury and usually occurs after a direct impact of sudden and extreme trauma forcing the distal interphalangeal joint to get flexion with an extended proximal interphalangeal joint. Deformity is especially associated with ball use disrupting the extensor mechanism at the base of distal phalanx. Mallet finger deformity in acute stage can be treated by immobilization of distal interphalangeal joint with hyperextension splints. But the surgery becomes the choice in delayed cases and if there is a fracture including more than one third of articular surface of distal interphalangeal joint or distal phalanx volar subluxation. In the literature there are great sum of studies including mallet finger deformities as simultaneous, bilateral or multiple variations and treatment strategies. But in the literautre there is no study about simultaneous bony mallet fingers deformity reported. Here, we present the case of a 30 year old female with simultaneous bony mallet fingers in the third and fourth ray and the conservative treatment of with splinting for six weeks. At the last time follow up the patient was able to use her hand without any diffuculty and she had full range of motion of distal interphalangel joint.

Turkey model for flexor tendon research: in vitro comparison of human, canine, turkey, and chicken tendons

BackgroundFlexor tendon injuries are one of the most common hand injuries and remain clinically challenging for functional restoration. Canine and chicken have been the most commonly used animal models for flexor tendon–related research but possess several disadvantages. The purpose of this study was to explore a potential turkey model for flexor tendon research. MethodsThe third digit from human cadaveric hands, canine forepaws, turkey foot, and chicken foot were used for this study. Six digits in each of four species were studied in detail, comparing anatomy of the flexor apparatus, joint range of motioņ tendon excursion, tendon cross-sectional area, work of flexion, gliding resistance at the level of the A2 pulley, modulus of elasticity, suture retention strength, and histology across species. ResultsAnatomically, the third digit in the four species displayed structural similarities; however, the tendon cross-sectional area of the turkey and human were similar and larger than canine and chicken. Furthermore, the turkey digit resembles the human's finger with the lack of webbing between digits, similar vascularization, tendon excursion, work of flexion, gliding resistance, mechanical properties, and suture holding strength. More importantly, human and turkey tendons were most similar in histological appearance. ConclusionsTurkey flexor tendons have many properties that are comparable to human flexor tendons which would provide a clinically relevant, economical, nonhuman companion large animal model for flexor tendon research.

Return to Play After Forearm and Hand Injuries in the National Basketball Association.

Background:Hand injuries can result in significant time away from competition for professional basketball players. Time to return to play after hand injuries in elite athletes has not been well described.Purpose:To report the return to play from metacarpal fractures, phalangeal fractures, and thumb ligament tears in National Basketball Association (NBA) players over a 5-year period.Study Design:Descriptive epidemiology study.Methods:The NBA transaction report was analyzed from January 2009 to May 2014. Players were identified if they were added to the inactive list (IL), missed games due to their injury, or underwent surgery as a result of hand injury. Number of games missed due to injury, days spent on the IL, and age at injury were calculated by injury type and location.Results:One hundred thirty-seven injuries were identified: 39 injuries to the hand and 98 injuries to the finger. Three major injury patterns were identified and analyzed: metacarpal fractures (n = 26), phalangeal fractures (n = 33), and thumb ligament tears (n = 9). The type of injury sustained affected return to play (P < .05). All thumb ligament tears required surgery and had the longest return to play of 67.5 ± 17.7 days (P < .05). The return to play for surgically treated metacarpal fractures (56.7 ± 26.3 days) was significantly greater than nonsurgically treated metacarpal fractures (26.3 ± 12.1 days; P < .01). Return to play for surgically repaired phalangeal fractures (46.2 ± 10.8 days) trended greater but was not significantly different than phalangeal fractures treated nonsurgically (33.3 ± 28.5 days; P = .21).Conclusion:Hand injuries in professional basketball players can lead to prolonged periods of time away from competition, especially after surgery. This study provides guidelines on expected return to play in the NBA after these common hand injuries.

Exercise Treadmills: A Cause of Significant Hand Burns in Young Children.

A pediatric nurse practitioner and an occupational therapist were impressed by the number and severity of treadmill-related hand burns encountered in their outpatient burn clinic. They observed that treadmill burns appeared to be deeper compared with other contact hand burns. Literature review revealed that research was inadequate in this area. A retrospective chart review was conducted, and a total of 384 patients were found to receive treatments at a regional level 1 pediatric burn center for treadmill and contact hand burns from 2010 to 2014. Age distribution, severity, and negative outcomes were compared between treadmill hand burns and contact hand burns. Recommendations for primary caregivers to prevent treadmill hand burns were given. Treadmill burns were the second most common hand injury mechanism after stovetop burns. Both hot surface contact burns and treadmill burns were more frequently seen in patients 0 to 4 years of age. Treadmill hand burns were more severe than contact hand burns in depth of injury (24.5 vs 1.4% full thickness), need for operative intervention (6.4 vs 0.0%), mean number of burn appointments (4.9 vs 1.9), median time to skin closure (25.2 days vs 11.0 days), and median length of care (51.0 days vs 11.0 days). Treadmill hand burns were frequently seen, and they were more severe and required an increased level and duration of care in comparison with other contact hand burns.

An analysis of the most common types of hand injury mistakes and their cost in the acute setting.

This study aimed to explore the most common hand injury errors occurring in Emergency Departments in England. A Freedom of Information request was made to the NHS Litigation Authority for claims data related to hand injuries in English Emergency Departments from 2004 to 2014. All successful hand injury claims against an individual DGH ED were also analysed. Two hundred and eighteen successful claims were made, costing a total of £6,273,688.22. Diagnosis error was the most common successful claim (97). Four successful claims were brought against the Emergency Department. Causes of error included the use of inappropriate views and failure to correlate imaging with clinical findings. Hand injury diagnostic error has been the most common cause of successful litigious claims against Emergency Departments over the past 10 years. This paper demonstrates that fracture recognition and clinical diagnosis of hand injuries are key areas to target to reduce error rates.

Effect of Heparin on Post-Operative Adhesion in Flexor Tendon Surgery of the Hand

Flexor tendon laceration is a common hand injury. Timely and correct diagnosis of this defect is an important factor for restoring hand function. Post-operative adhesion is a frequent problem after tendon repair and its prevention is difficult in some types of tendon lacerations. There have been some controversial studies on the positive effect of some materials and substances on prevention of these adhesions. This study aims to evaluate effects of the Heparin in postoperative tendon adhesions. In this clinical trial, 100 patients with laceration of flexor tendons in zone II of the hand were enrolled. The patients were randomly divided into two groups. In the first group, 0.5cc Heparin (5000IU/cc) was injected into each tendon ends before tendon repair. In the control group, repair was carried out without any heparin injection. After 3months the total active range of motion (TAROM), mean extension gap (MEG) and mean flexion gap (MFG) were measured and compared between these two groups. The TAROM and MEGs were not significantly different between two groups; but MFGs were significantly better in Heparin treated group (P < 0.02). However rupture rate was significantly higher in heparin treated group (P = 0.003). Heparin may improve the tendons function and reduce the postoperative adhesions in zone II of the hand; however there is a significant risk of tendon rupture.

The Impairments and Functional Outcomes of Patients Post Flexor Tendon Repair of the Hand

Backgrounds: Flexor tendon injuries are common hand injuries for which optimal surgical and postoperative treatment has not yet been established. The variability in results is great, with good outcomes being achieved in specialized hands units in developed countries. Minimal research has been undertaken in developing countries, in particular South Africa, regarding flexor tendon repair (FTR) and the outcomes thereof. Objectives: The purpose of this study was to establish the range of movement (ROM), grip strength, and hand function at 6 months post FTR as well as to determine the factors that affect the impairments and functional outcome at 6 months post FTR. Materials and Methods: The study was conducted at a tertiary hospital in South Africa. At 1, 3, and 6 months post FTR, the ROM of the injured and contralateral finger(s) were measured using a finger goniometer. The Total Active Motion (TAM) classification system was applied to each affected digit, and the average TAM was determined for the participants’ affected hand. At 3 and 6 months post FTR, the participants’ bilateral power and pinch grip strength were measured using a Jamar dynamometer and a pinch meter. The power and pinch grip strengths were calculated as a percentage of the unaffected hand. At 3 and 6 months post FTR, participants performed the Jebsen Hand Function Test (JHFT), and a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was administered in an interview format. Results: A total of 126 participants enrolled in the study. There was a dropout rate of 48%, leaving 65 participants who completed 6 months follow-up, 41 males (63%) and 24 females (37%) aged 32 years (SD ± 12, n = 65). Out of 65 participants, 2% (n = 1) had an excellent outcome, 32% (n = 21) had a good outcome, 32% (n = 21) had a fair outcome, and 34% (n = 22) had a poor outcome with regard to TAM. At 6 months post FTR, the average power grip was 60% (SD ± 25, n = 65) of the unaffected hand while the average pinch grip was 52% (SD ± 42, n = 65) of the unaffected hand. The average score on the QuickDASH questionnaire was 19.34 (SD ± 16.89) at 6 months. Of the 41 participants who were employed prior to injury, 71% (n = 29) had returned to work by 6 months post surgery and scored an average of 15.89 (SD ± 23.74) on the QuickDASH work module. Sixty-eight percent (n = 44) of the patients had postoperative complications: the most common complication was tenodesis/adhesions (25%, n = 16), followed by contracture (22%, n = 14). There were only 4 ruptures (6%, n = 4) in this sample. Eleven participants (17%) underwent further surgery. The factors that affect the impairments and functional outcome at 6 months post FTR include age, zone of injury, number of digits injured, associated injury, delay between injury and surgery, and language barrier. Conclusion: Although there were some promising outcomes, during this period, participants did not consistently achieve the good or excellent functional outcomes achieved in developed countries. More research needs to be conducted regarding the outcome of FTR in South Africa, particularly in the public sector.

Partially Divided Flexor Tendon Injuries: Should They Be Repaired or Not?

The correct management of partially divided flexor tendon injuries is still controversial. Opinions vary regarding whether partially divided flexor tendon injuries should be repaired. Flexor tendon injuries are common because the tendons lie close to the skin. The tendons are therefore exposed to injuries like lacerations and crush injuries, and occasionally they can rupture from where they are joined to the bone. Tendon injuries are the second most common hand injuries in orthopedic patients.

Early Functional Treatment and Modern Cast Making for Indications in Hand Surgery.

Cast treatment can serve both as a nonsurgical treatment option and as a means for providing postoperative protection. However, with the duration of immobilization intervals, the benefits of cast treatment, especially in hand surgery, are at risk of being outweighed by undesired drawbacks such as joint stiffening and contracture formation. In order to minimize potential complications commonly associated with cast treatment, efforts to further improve cast making must attempt to reconcile two conflicting objectives: (1) to achieve stability and rigidity at the site of injury (e.g., fracture retention) and (2) to allow free range of joint movement as early as possible. In addition, in order to assure patient compliance, modern cast treatments should aim to improve wearing-comfort of the cast. This paper describes modern cast designs for four common types hand injuries, with sample cases highlighting the clinical outcome of each treatment.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries – a prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries + as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3 weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X rays and ultrasound. We used a 1.9 mm arthroscope with only two 2 mm-long portals - one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2 mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X ray was performed to confirm the anchor position then physical examination after 3, 6 and 12 weeks. Analysis criteria were: – preoperative - demographic data, diagnosis conditions; – perioperative - duration of the surgery, all ligament lesions observed at 360°; – postoperative - MP range of motion and KeyPinch strength, pain, stability testing, time off work, potential complications (scare, nerve damage). All patients were reviewed three times. Preoperative criteria - all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria - duration of surgery was 24 minutes (15–32). Ligament assessment - all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria - in UCL ruptures (n = 14), postoperative X rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion - at 3 weeks - ROM - 50%, KeyPinch - 35% + 6 weeks - ROM - 85%, KeyPinch - 68% + 12 weeks - ROM - 90%, KeyPinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries: A prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries; as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 Radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X-rays (without stress) and US. We used a 1,9-mm arthroscope with only two 2-mm-long portals: one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2-mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X-ray was performed to confirm the anchor position then physical examination after 3,6 and 12 weeks. Analysis criteria were: – preoperative: demographic data, diagnosis condition; – perioperative: duration of the surgery, all ligament lesions observed at 360°; – postoperative: MP range of motion and key-pinch strength, (% of the contralateral side), pain, stability testing, time off work and sports, potential complications (scare, sensitive nerve damage). All patients were reviewed three times. Preoperative criteria: all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria: duration of surgery was 24 minutes (15–32). Ligament assessment: all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria: in UCL ruptures (n = 14), postoperative X-rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion: after 3 weeks: ROM: 50%, Key-pinch: 35%. After 6 weeks: ROM: 85%, key-pinch: 68%. After 12 weeks: ROM: 90%, key-pinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Time off work was 3 weeks (0–8). Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

An Educational Intervention to Improve Splinting of Common Hand Injuries

BackgroundHand trauma is a top presenting complaint to hospital emergency departments (EDs) and can become costly if not treated effectively. The cornerstone for initial management of the traumatized hand is application of a splint. Improving splinting practice could potentially produce tangible benefits in terms of quality of care and costs to society. ObjectivesWe sought to determine the following: 1) whether the present standard of ED splinting was appropriate and 2) whether a strategically planned educational intervention could improve the existing care. MethodsWe used a pre- and postprospective educational intervention study design. In the preintervention phase, patients referred to our hand clinic were assessed for injury and splint type. Splinting appropriateness was evaluated according to a predetermined hand surgeons' expert consensus. Next, an educational intervention was targeted at all ED staff at our institution. Postintervention, all patients were again evaluated for splint appropriateness. A follow-up evaluation was performed at 1 year to see the long-term effects of the intervention. ResultsThe most common mechanism of injury of referred patients was falling (35%), and the most frequent injury was metacarpal fracture (40%). Splint appropriateness increased significantly postintervention from 49% to 69% (p = 0.048). At follow-up after 1 year, splinting appropriateness was 70% (p = 0.041). ConclusionAppropriate hand splinting practice is essential for hand trauma management. Our results show that an educational intervention can successfully improve splinting practice. This quality of care initiative was low-cost and demonstrated persistence at 1 year of follow-up.