Hand20 Scores Research Articles

Posterolateral Locked Plate and Percutaneous Medial Screw Fixation for Distal Humerus Fractures in Elderly.

Background: A high incidence of ulnar nerve-related complications has been reported in open reduction and internal fixation for distal humerus fractures (DHFs). To minimise ulnar nerve damage, we used a percutaneous medial screw combined with a posterolateral plate in the elderly. The aim of this study was to evaluate the postoperative complications and functional outcomes of this method. Methods: Data from patients aged over 65 who underwent this surgical procedure for DHFs at a single Level I trauma centre from 2013 to 2021 were extracted. Postoperative complications, reoperations, mean range of motion, Mayo Elbow Performance Index (MEPI) scores and Hand20 scores were retrospectively evaluated. All patients in this study received postoperative rehabilitation by hand therapists at our hospital. Results: We identified 28 patients treated with this method. The mean follow-up period was 8.6 ± 3.7 months. The median intraoperative time was 125 minutes (interquartile range: 105-157 minutes). None of the patients developed ulnar nerve neuropathy, but one patient (3.7%) experienced radial nerve dysfunction. Two patients (7.4%) had nonunion. Implant failure occurred in three patients (11.1%) due to migration of the medial screw. One patient (3.7%) amongst them underwent reoperation. The mean flexion to extension arc was 97 ± 18°, 116 ± 19°, and 116 ± 19° at 1-, 3- and 6-month follow-ups, respectively. According to the MEPI, 20 patients achieved excellent results, seven patients achieved good results and one patient achieved a fair result at the last follow-up. The median Hand20 score was 4.3 (interquartile range: 2.1-14.0) at the 6-month follow-up. Conclusions: The posterolateral plate and medial screw method showed good functional outcomes and few nerve-related complications. This modified method might be a better option for DHFs in elderly patients. Level of Evidence: Level IV (Therapeutic).

How does Fixation Alignment Affect Surgical Outcomes in Arthrodesis for Thumb Carpometacarpal Osteoarthritis?

Abstract Purpose Arthrodesis is a traditional surgical procedure for treating thumb carpometacarpal (CMC) osteoarthritis. Previous studies have investigated surgical outcomes, focusing on the fixation technique, bone union rate, and surgical complications but not on the postoperative alignment of the thumb CMC joints. Therefore, we aimed to investigate how thumb fixation alignment affects the surgical outcomes of thumb CMC arthrodesis. Patients and Methods Twenty-six patients (28 thumbs) who achieved bone union after arthrodesis with more than 1-year follow-up were retrospectively analyzed. We measured the radial abduction and palmar abduction angles and change in thumb length (Δthumb length) on postoperative radiographs and the first metacarpal rotation angle on postoperative computed tomography. Moreover, we investigated the 1-year clinical outcomes, including the Disabilities of Arm, Shoulder, and Hand (DASH) score, Hand20 questionnaire score, visual analog scale (VAS) score for pain, Δgrip strength, Δpulp pinch, and Δkey pinch strength. The correlation between the postoperative alignment and clinical outcomes was also statistically analyzed. Results The mean radial abduction, palmar abduction, first metacarpal rotation angles, and Δthumb length were 20.8 degrees, 34.4 degrees, 109.4 degrees, and −1.8 mm, respectively. Radial abduction and palmar abduction angles were positively and negatively correlated with Δgrip strength (r = 0.37 and −0.37), respectively. The first metacarpal rotation angle was positively correlated with the DASH score (r = 0.51), Hand20 score (r = 0.48), and VAS score for pain (r = 0.42). ΔThumb length had no correlation with clinical outcomes at 1-year follow-up. Conclusion Thumb fixation alignment has an impact on the surgical outcomes of thumb CMC arthrodesis. To obtain a successful outcome, it is important to add slight pronation and avoid excessively small radial abduction and excessively large palmar abduction.

Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study

BackgroundReverse homodigital artery island flap (RHDI) has reported some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been performed to decrease these complications. This study aimed to provide a review of the CRDI procedure and to compare the clinical outcomes of CRDI with RHDI. MethodsRHDI has been performed for fingertip amputations with the deficit of 1.5–2.5cm before 2018, and CRDI has been performed since 2018. We assessed functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. ResultsWe identified 22 patients who underwent RHDI and ten patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing in RHDI was 47.0 days (IQR: 34.3–55.8), and that in CRDI was 34.5 days (IQR: 29.3–44.3). The hook nail deformity occurred significantly more frequently in RHDI compared to in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found significantly more in RHDI than in CRDI (36.4% vs. 0,0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260º–280º). The median postoperative Hand20 scores were similar between the two groups. ConclusionCRDI was associated with superior clinical outcomes in terms of lower rate of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.

Effect of wrist orthoses on upper limb function, activities of daily living, and stress response.

This study examined the effects on upper limb function, activities of daily living, and stress responses when wearing a wrist orthosis made of padded fiberglass or thermoplastic and provided essential information for selecting an orthosis. Thirty-one healthy adults performed two tests while not wearing a wrist orthosis, wearing a padded fiberglass wrist orthosis, and wearing a thermoplastic wrist orthosis. The Purdue Pegboard Test examined upper limb control. In the second test, the actions indicated by the Hand20 questionnaire were performed while wearing a wrist orthosis. An electrocardiogram was obtained before and after each test to identify any changes in sympathetic nervous system activity. The Purdue Pegboard Test scores were significantly higher when not wearing a wrist orthosis than when wearing wrist orthosis, and the Hand20 scores for all question were significantly lower. Thermoplastic wrist orthoses had fewer restrictions for upper limb function compared to padded fiberglass wrist orthoses, however activities of daily living were more limited. The low frequency/high frequency ratio and high frequency measures showed no significant differences. Pegboard test scores and the Hand 20 scores suggest that a wrist orthosis causes restriction of upper limb function.

The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint

This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism. We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism. The mean active flexion and extension of the PIP joint was 105° and-4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request. The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints. Therapeutic V.

Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap Using Nail Bed Graft for Fingertip Amputation with Replantation.

Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes. Therapeutic, III.

Comparison of Surgical Outcomes for Arthrodesis and Arthroplasty for Thumb Carpometacarpal Osteoarthritis in Female Workers

BackgroundBoth arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) arthroplasty are reliable surgical procedures for thumb carpometacarpal (CMC) osteoarthritis. Here, we compared surgical outcomes between arthrodesis and T + LRTI for female workers aged over 40 years with thumb CMC osteoarthritis to determine an optimal procedure. Patients and MethodsFourteen thumbs of 13 patients who underwent arthrodesis with locking plates and 11 thumbs of 10 patients who underwent T + LRTI and were followed up for at least 12 months were retrospectively analyzed. For the two groups, we investigated the range of motion (ROM) of the thumb, grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, Hand20 score, and visual analog scale (VAS) scores for pain at 1-year follow-up and compared them between the two groups. In addition, we investigated surgical complications and resumption of work. ResultsBoth procedures provided similar subjective outcomes in terms of Hand20 and VAS scores; however, arthrodesis provided significantly larger ROM of the metacarpophalangeal and interphalangeal joints of the thumb, grip and pinch strength, and DASH score, whereas T + LRTI provided a significantly better palmar abduction at 1-year follow-up. There were three and four postoperative complications in the arthrodesis and T + LRTI groups, respectively. One patient in the arthrodesis group had resigned, whereas two patients in T + LRTI had changed their jobs to less physically demanding ones postoperatively. ConclusionBoth procedures satisfy female workers aged over 40 years with thumb CMC osteoarthritis. Nevertheless, arthrodesis can provide favorable outcomes that are equal to or better than T + LRTI.

Mast cell presence in tendon sheaths of trigger fingers: implications on pathogenesis and clinical presentation

Trigger finger is a common hand disorder; however, its pathogenesis remains unknown. In this study, we aimed to investigate mast cells, fibroblast activators that synthesize collagen, in the tendon sheaths of trigger fingers. We investigated the presence of mast cells and their association with changes in the collagen content of the tendon sheath and clinical data. We performed a multicenter prospective study of 77 adult patients with trigger finger who had undergone resection of the first annular pulley between August 2012 and January 2020. The tendon sheath was immunostained with an anti-tryptase antibody to confirm mast cell presence. The percentage of collagen in the tendon sheath was determined by picrosirius red staining observed through a polarization microscope. The clinical data, including the duration from symptom onset to surgery, severity, pain numerical rating scale, and Hand20 scores, were evaluated. Tryptase-positive mast cells were recognized in 83.5% of all specimens. The mast cell presence group (Group P) had a significantly higher percentage of type-3 collagen in the tendon sheath than the non-mast cell presence group (Group N) (Group P, 15.6%; Group N, 12.7%; p = 0.03). Moreover, Group P had significantly higher pain numerical rating scale (Group P; 5, Group N; 3, p = 0.04) and Hand20 (Group P; 35.5, Group N; 13.0, p = 0.01) scores than Group N. These findings suggest that mast cell presence in the tendon sheath of the trigger finger is related to the pathology and clinical symptoms of trigger finger.

Facteurs de pronostic préopératoires exposant à une mauvaise récupération précoce après une trapézectomie avec reconstruction ligamentaire et arthroplastie d’interposition tendineuse dans le traitement de la rhizarthrose

BackgroundTrapeziectomy with ligament reconstruction and tendon interposition (LRTI) is performed for treating thumb carpometacarpal osteoarthritis. However, patients occasionally experience delayed postoperative recovery. Although several prognostic factors associated with long-term outcomes have been identified, the factors associated with delayed recovery after trapeziectomy with LRTI have not been identified. HypothesisWhen we define major disability in the early postoperative period at 3 months after LRTI surgery as delayed recovery, some preoperative factors can influence with delayed recovery. Moreover, delayed recovery can influence the long-term therapeutic outcome. Patients and MethodsThirty thumbs that underwent trapeziectomy with LRTI (mean follow-up period, 29.3 months) were retrospectively analyzed. Major disability was defined by both DASH and Hand20 scores≥35 after surgery, and patients were divided into groups 1 (major disability; n=9) and 2 (no major disability; n=21) according to the scores at 3 months after surgery. Preoperative data, including age, sex, preoperative symptom duration, dominant hand surgery, concurrent surgery with LRTI, previous orthopedic surgery, employment, stage of osteoarthritis, thickness of the trapezium, metacarpophalangeal hyperextension deformity, DASH score, Hand20 score, visual analogue scale (VAS) scores for pain, grip strength, pinch strength, and range of motion of the thumb were compared between groups to identify the factors indicating a poor prognosis at 3 months after surgery. We also compared the clinical outcomes at the 12-month and final follow-up. ResultsDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were significantly more frequent in group 1, while the other factors did not show significant intergroup differences. Moreover, group 1 showed significantly poorer DASH score, grip and pinch strength, and active flexion of the thumb metacarpal joint at both the 12-month and final follow-up. This group also showed significantly poorer Hand20 and VAS scores at the final follow-up. DiscussionDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were associated with poor recovery at 3 months after trapeziectomy with LRTI. Moreover, major disability at 3 months after surgery influenced poor clinical outcomes at the 12-month and final follow-ups. These data could be useful for counseling patients regarding the expected recovery duration and outcomes after LRTI surgery. Level of evidenceIV; retrospective therapeutic study.

Preoperative prognostic factors associated with poor early recovery after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis

BackgroundTrapeziectomy with ligament reconstruction and tendon interposition (LRTI) is performed for treating thumb carpometacarpal osteoarthritis. However, patients occasionally experience delayed postoperative recovery. Although several prognostic factors associated with long-term outcomes have been identified, the factors associated with delayed recovery after trapeziectomy with LRTI have not been identified. HypothesisWhen we define major disability in the early postoperative period at 3 months after LRTI surgery as delayed recovery, some preoperative factors can influence with delayed recovery. Moreover, delayed recovery can influence the long-term therapeutic outcome. Patients and methodsThirty thumbs that underwent trapeziectomy with LRTI (mean follow-up period, 29.3 months) were retrospectively analyzed. Major disability was defined by both DASH and Hand20 scores≥35 after surgery, and patients were divided into groups 1 (major disability; n=9) and 2 (no major disability; n=21) according to the scores at 3 months after surgery. Preoperative data, including age, sex, preoperative symptom duration, dominant hand surgery, concurrent surgery with LRTI, previous orthopedic surgery, employment, stage of osteoarthritis, thickness of the trapezium, metacarpophalangeal hyperextension deformity, DASH score, Hand20 score, visual analogue scale (VAS) scores for pain, grip strength, pinch strength, and range of motion of the thumb were compared between groups to identify the factors indicating a poor prognosis at 3 months after surgery. We also compared the clinical outcomes at the 12-month and final follow-up. ResultsDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were significantly more frequent in group 1, while the other factors did not show significant intergroup differences. Moreover, group 1 showed significantly poorer DASH score, grip and pinch strength, and active flexion of the thumb metacarpal joint at both the 12-month and final follow-up. This group also showed significantly poorer Hand20 and VAS scores at the final follow-up. DiscussionDominant hand surgery, previous orthopedic surgery, and preoperative poor DASH score were associated with poor recovery at 3 months after trapeziectomy with LRTI. Moreover, major disability at 3 months after surgery influenced poor clinical outcomes at the 12-month and final follow-ups. These data could be useful for counseling patients regarding the expected recovery duration and outcomes after LRTI surgery. Level of evidenceIV; retrospective therapeutic study.

Radial Osteotomy for Kienböck Disease: Clinical and Radiological Comparison between Younger and Older Patients

Background: The usefulness of radial osteotomy for older patients remains unclear. The purpose of this study was to compare the clinical and radiological outcomes of radial osteotomy with volar locking plate between younger and older patients with Kienböck disease stages II to IIIB. Methods: This was a retrospective comparative study of 21 consecutive patients treated at our department. Lichtman's classification was used for staging, and four patients had stage II, six patients had stage IIIA, and 11 patients had stage IIIB disease. We divided them into two groups to compare the radiological and clinical results between younger (younger than 40 years) and older patients. The mean follow-up periods in the younger and older groups were 4 and 3.6 years, respectively. For radiological assessment, we evaluated the carpal height ratio (CHR), Stahl index, and union of the fractured lunate. For clinical assessment, we examined the range of motion of the wrist, grip strength, numeric rating scale (NRS) for pain, and the patient-reported Hand20 score preoperatively and at the final follow-up. Results: There were 12 patients in the younger group with a mean age of 23 years (range, 12-37 years), and 9 in the older group with a mean age of 56 years (range, 40-74 years). There were no intra- and post-operative complications in either group. Radiological improvement, including CHR, Stahl index, and union of the fractured lunate, was more common in the younger group than in the older one, as was the case for clinical improvement. However, even in the older group, significant clinical improvement, including the range of motion of the wrist, NRS for pain, and the Hand20 score, was seen postoperatively. Conclusions: Radial osteotomy appears to be a safe and reliable option in older symptomatic patients with Kienböck disease stages II to IIIB.

Évolution dans le temps de la trapézectomie avec « anchois » et reconstruction ligamentaire pour le traitement de l’arthrose carpo-métacarpienne

BackgroundDespite satisfactory mid-term and long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) procedures for thumb carpometacarpal osteoarthritis, there is limited literature describing detailed chronological changes in early-phase postoperative outcomes. We investigated chronological changes of subjective, objective, and radiological outcomes within 1 year post-trapeziectomy with LRTI using a longitudinal evaluation and analyzed clinical factors associated with patient-reported subjective outcomes. HypothesisSome parameters influence patient-reported subjective outcomes during the early postoperative period. Patients and methodsNineteen patients (mean age, 67.3 years) who underwent trapeziectomy with LRTI were evaluated preoperatively and at 3, 6, and 12 months postoperatively to investigate objective (grip strength, pinch strength, range of motion [ROM] of the interphalangeal [IP] joint, metacarpophalangeal [MP] joint, and carpometacarpal [CMC] joint, Kapandji score), subjective (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Hand20 questionnaire score, and visual analog scale [VAS] for pain), and radiological outcomes (trapezial space height and its ratio). Factors affecting DASH and Hand20 scores were analyzed. ResultsGrip strength and pinch strength were decreased at 3-month follow-up. It required 6 months to recover preoperative strength and 12 months for significant improvement. VAS for pain, DASH, and Hand20 scores were significantly improved at 3-month follow-up, continuing to improve until 12 months. The trapezial space height and its ratio decreased approximately 50% at 3-month follow-up, with no further changes at 6 or 12 months. Both DASH and Hand20 scores were strongly correlated with VAS for pain during activity within 6 months post-surgery and moderately correlated with ROM of the thumb at 3 months post-surgery; however, they were not correlated with grip and pinch strength as well as the trapezial space height ratio within 12 months post-surgery. DiscussionTrapeziectomy with LRTI for thumb carpometacarpal osteoarthritis provided early subjective improvements in outcomes as early as 3 months post-procedure. However, more than 6 months are required to determine objective improvements in outcomes. To obtain early patient-reported satisfactory outcomes, we should focus not on improving hand and finger strength, but on treating postoperative surgical site pain and preventing thumb stiffness. Level of evidenceIV, retrospective therapeutic study.

Chronological changes in surgical outcomes after trapeziectomy with ligament reconstruction and tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis

BackgroundDespite satisfactory mid-term and long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) procedures for thumb carpometacarpal osteoarthritis, there is limited literature describing detailed chronological changes in early-phase postoperative outcomes. We investigated chronological changes of subjective, objective, and radiological outcomes within 1 year post-trapeziectomy with LRTI using a longitudinal evaluation and analyzed clinical factors associated with patient-reported subjective outcomes. HypothesisSome parameters influence patient-reported subjective outcomes during the early postoperative period. Patients and methodsNineteen patients (mean age, 67.3 years) who underwent trapeziectomy with LRTI were evaluated preoperatively and at 3, 6, and 12 months postoperatively to investigate objective (grip strength, pinch strength, range of motion [ROM] of the interphalangeal [IP] joint, metacarpophalangeal [MP] joint, and carpometacarpal [CMC] joint, Kapandji score), subjective (Disabilities of the Arm, Shoulder, and Hand [DASH] score, Hand20 questionnaire score, and visual analog scale [VAS] for pain), and radiological outcomes (trapezial space height and its ratio). Factors affecting DASH and Hand20 scores were analyzed. ResultsGrip strength and pinch strength were decreased at 3-month follow-up. It required 6 months to recover preoperative strength and 12 months for significant improvement. VAS for pain, DASH, and Hand20 scores were significantly improved at 3-month follow-up, continuing to improve until 12 months. The trapezial space height and its ratio decreased approximately 50% at 3-month follow-up, with no further changes at 6 or 12 months. Both DASH and Hand20 scores were strongly correlated with VAS for pain during activity within 6 months post-surgery and moderately correlated with ROM of the thumb at 3 months post-surgery; however, they were not correlated with grip and pinch strength as well as the trapezial space height ratio within 12 months post-surgery. DiscussionTrapeziectomy with LRTI for thumb carpometacarpal osteoarthritis provided early subjective improvements in outcomes as early as 3 months post-procedure. However, more than 6 months are required to determine objective improvements in outcomes. To obtain early patient-reported satisfactory outcomes, we should focus not on improving hand and finger strength, but on treating postoperative surgical site pain and preventing thumb stiffness. Level of evidenceIV, retrospective therapeutic study.

Validity and reliability study of the Turkish version of the Hand20 questionnaire

Background/aim This study aimed to translate and validate the Turkish version of the Hand20 questionnaire.Materials and methods Patients who had upper extremity involvement and stable symptoms for the previous 4 weeks in their upper extremities were included in the study. Patients who were illiterate or used a splint during the day were excluded from the study. Participants completed the Turkish version of the Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire once and the final version of the Hand20 questionnaire twice in a 7-day interval. Internal consistency and reliability of the questionnaire was assessed. Moreover, correlations between Hand20 and DASH-T scores were analyzed using Spearman’s correlation coefficient.Results A total of 104 patients participated in the study. The Turkish version of the Hand20 met the set criteria of reliability and validity. Internal consistency (Cronbach’s alpha = 0.93) and test-retest reliability were excellent (r = 0.82). Hand20 showed a positive and statistically significant correlation with DASH-T (r = 0.76, P < 0.001).Conclusion The results showed that the Turkish version of the Hand20 had excellent test-retest reliability and validity. As a result of this study, it was determined that Hand20 was a valid and reliable instrument to measure the upper extremity disabilities of Turkish-speaking patients.

Patients with benign hand tumors are indicated for surgery according to patient-rated outcome measures

This study assessed the treatment outcomes of upper extremity benign tumors using the patient-rated outcome measures of Hand20 questionnaire. In total, 304 patients who underwent surgery for benign bone and soft tissue tumors of the upper limb were included. Tumors were classified into three size groups: <1cm, 1-3cm, and >3cm. Tumors were divided with respect to location: digit, hand, wrist, forearm, elbow, upper arm, or axilla. We prospectively assessed responses to the Hand20 questionnaire that was administered both before and after surgery. The mean Hand20 and pain scores significantly improved after surgery in patients with ganglion cysts, giant cell tumors of the tendon sheath, enchondromas, or pyogenic granulomas. For patients with hemangiomas, schwannomas, or glomus tumors, although the mean pain scores improved significantly following surgery, there were no significant changes in the mean Hand20 scores. However, the statistical power for this analysis was low. The mean Hand20 and pain scores improved significantly, regardless of the size grouping. The mean Hand20 scores significantly improved after surgery in patients with finger, thumb, hand, or wrist tumors. Except for elbow to axillary tumors, the mean pain scores significantly improved in all patients. The results of Hand20 and pain scores suggest that most patients with benign hand tumors are indicated for surgery, but the degree of improvement differs according to tumor pathology and location but not size.

Anterior interosseous nerve and posterior interosseous nerve involvement in neuralgic amyotrophy

ObjectivesThe aim of this study was to gain a better understanding of anterior interosseous nerve and posterior interosseous nerve involvement in neuralgic amyotrophy. MethodsIn a retrospective chart review, 51 cases (49 patients) with anterior and posterior interosseous nerve syndrome were investigated in terms of their symptoms, course of disease, and prognosis. ResultsPatients first presented with pain in 52.9% of cases. The location of the pain was distal to the shoulder in most cases (85.1%). Sensory involvement was found in 27.5% of patients, and patients with pain before paresis had fewer sensory symptoms (p=0.006). Neurolysis significantly improved Hand20 scores, but conservative treatment did not (p=0.020 vs. 0.204). ConclusionsPatients with anterior interosseous nerve and posterior interosseous nerve affection in neuralgic amyotrophy had less pain. Neurolysis can be superior to conservative treatment in the patients with focal constrictions and no spontaneous recovery.

Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system.

Effects of depression and inflammatory factors on chronic conditions of the wrist.

Chronic conditions of the wrist may be difficult to manage because pain and psychiatric conditions are correlated with abnormal function of the hand. Additionally, intra-articular inflammatory cytokines may cause pain. We aimed to validate the measurement of inflammatory cytokines in these conditions and identify features associated with symptoms. The study included 38 patients (18 men, 20 women, mean age 43 years) with a chronic condition of the wrist who underwent arthroscopy. Before surgery, the Self-Rating Depression Scale (SDS), Hand20 questionnaire and a visual analogue scale (VAS) for pain were used. Cytokine and chemokine levels in the synovial fluid of the wrist were measured using enzyme-linked immunosorbent assays and correlations between the levels with pain were analysed. Gene expression profiles of the synovial membranes were assessed using quantitative polymerase chain reaction. Older patients had high pre-operative Hand20 scores. One-year post-operative Hand20 and VAS scores and pre-operative VAS scores correlated with SDS scores. Post-operative VAS scores negatively correlated with the expression of nerve growth factor and SDS scores positively correlated with the expression of tumour necrosis factor-alpha and negatively correlated with the expression of tumour necrosis factor-converting enzyme. There was a positive correlation between depression and chronic conditions of the wrist. Levels of some cytokines correlate with pain and depression. Additionally, cytokines may be important in the assessment and treatment of chronic conditions of the wrist and depression. Cite this article: Bone Joint J 2016;98-B:961-8.

Feasibility of four-dimensional preoperative simulation for elbow debridement arthroplasty.

BackgroundRecent advances in imaging modalities have enabled three-dimensional preoperative simulation. A four-dimensional preoperative simulation system would be useful for debridement arthroplasty of primary degenerative elbow osteoarthritis because it would be able to detect the impingement lesions.MethodsWe developed a four-dimensional simulation system by adding the anatomical axis to the three-dimensional computed tomography scan data of the affected arm in one position. Eleven patients with primary degenerative elbow osteoarthritis were included. A “two rings” method was used to calculate the flexion-extension axis of the elbow by converting the surface of the trochlea and capitellum into two rings. A four-dimensional simulation movie was created and showed the optimal range of motion and the impingement area requiring excision. To evaluate the reliability of the flexion-extension axis, interobserver and intraobserver reliabilities regarding the assessment of bony overlap volumes were calculated twice for each patient by two authors. Patients were treated by open or arthroscopic debridement arthroplasties. Pre- and postoperative examinations included elbow range of motion measurement, and completion of the patient-rated questionnaire Hand20, Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score, and the Mayo Elbow Performance Score.ResultsMeasurement of the bony overlap volume showed an intraobserver intraclass correlation coefficient of 0.93 and 0.90, and an interobserver intraclass correlation coefficient of 0.94. The mean elbow flexion-extension arc significantly improved from 101° to 125°. The mean Hand20 score significantly improved from 52 to 22. The mean Japanese Orthopaedic Association-Japan Elbow Society Elbow Function Score significantly improved from 67 to 88. The mean Mayo Elbow Performance Score significantly improved from 71 to 91 at the final follow-up evaluation.ConclusionWe showed that four-dimensional, preoperative simulation can be generated by adding the rotation axis to the one-position, three-dimensional computed tomography image of the affected arm. This method is feasible for elbow debridement arthroplasty.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0996-9) contains supplementary material, which is available to authorized users.

Benign Hand Tumors Have a Clear Indication for Surgery According to the Patient-rated Outcome Measures: Level 4 Evidence

Hypothesis: The purpose of this study was to report the patient-rated outcome measures (PROMs) using the Hand20 questionnaire (Suzuki et al. JBJS 2010) before and after surgery of the benign upper limb tumor. We hypothesized that benign upper limb tumors have a clear indication for surgery according to the PROMs. Methods: This study included 301 consecutive patients with histories of benign bone and soft tissue tumors of the upper limb, who had undergone surgery. There were 130 male and 171 female patients with a mean age of 45 years (range, 11e87 years). The diagnoses included 72 ganglions, 37 vascular tumors, 31 giant cell tumors of tendon sheath (GCTTS), 24 schwannomas, 21 lipomas, 21 enchondromas, 17 glomus tumors, 16 fibromas, 15 exostoses, 12 epidermoid cysts, 6 vascular leiomyomas, 6 granulomas, and 23 others. The tumors were located on the finger in 147 cases, hand in 51 cases, wrist in 61 cases, forearm in 18 cases, elbow in 16 cases, and upper arm and axilla in 8 cases. Tumor size was classified into 3 groups: smaller than 1 cm (45 cases), between 1 and 3 cm (157 cases), and larger than 3 cm (99 cases). We have prospectively assessed PROMs using Hand20 questionnaire before and after surgery. The mean period from surgery to assessment was 21 months (range, 6e78 months). Results: The mean Hand20 and pain scores significantly improved in patients with ganglions, vascular tumors, GCTTS, schwannomas, enchondromas and lipoma. The mean pain scores in patients with glomus tumors improved significantly, but the mean Hand20 scores improved without significance. In patients with fibromas, exostoses, epidermoid cysts, granulomas, and vascular leiomyomas, both the mean Hand 20 and pain scores improvedwithout statistical significance. (Figure 1 and 2).