Michigan Hand Outcomes Questionnaire Score Research Articles

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations.

Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Use of Tourniquet Under Sedation Anesthesia or the Walant Techniques in Bilateral Carpal Tunnel Surgery: A Comparative Analysis

Aim: The objective of the study was to compare the outcomes and patient satisfaction of two different anesthesia techniques; wide-awake-local anesthesia-no tourniquet (WALANT) and sedation anesthesia with a tourniquet, in open carpal tunnel release surgery for bilateral cases.
 Material and Methods: The study included 57 patients (41 female, 16 male) who underwent carpal tunnel release surgery between January 2016 and September 2021. The files were retrospectively evaluated and included in the present study. Patient evaluations were conducted using QuickDASH and Michigan Hand Outcomes Questionnaire scores before surgery, on the 15th day after suture removal, and at six months postoperatively. Surgical duration and complications were also recorded. Statistical analyses were performed to compare the outcomes between the two groups.
 Results: Both QDash and MHQ scores were analyzed for anesthesia effects on hands. The study's reliability was ensured by an 85% statistical power, 95% confidence level, and p

Patient-Reported Outcome Measures After Endoscopic Cubital Tunnel Release With At Least 1-Year Postoperative Follow-up.

The primary objective of this study was to investigate midterm outcomes following endoscopic cubital tunnel release (ECuTR) with the Seg-Way system using patient-reported outcome measures (PROMs). A secondary aim was to evaluate symptom resolution as assessed through Dellon's stage, McGowan's grade, and Messina's criteria and recurrence following ECuTR. Functional outcomes were assessed in 38 patients who underwent 43 surgeries. Details on baseline characteristics as well as preoperative and postoperative symptoms were collected. Patient-reported outcome measures were administered with at least 1-year follow-up in all patients. Mean age of patients was 50.2 ± 16.1 years, with 20 men (52.6%) and 18 women (47.4%). Postoperatively, pain completely resolved in 21 (72.4%), while sensory and motor deficits improved completely in 22 (56.4%) and 11 (64.7%) patients, respectively. Mean time interval between ECuTR and PROMs was 26.3 (13-63) months. Median Michigan Hand Outcomes Questionnaire score was 73.2 (48-91). Median Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale (NRS) scores were 12.9 (7-35) and 2.5 (0-5), respectively. Most of the patients were satisfied postoperatively with a median satisfaction score of 4 (3-5). There was a significant difference in median DASH and NRS scores between patients with and without concomitant proximal nerve disease. Endoscopic cubital tunnel release is a safe and effective option for surgical management of primary cubital tunnel syndrome. The presence of other proximal nerve disease is associated with poorer outcomes, less symptom resolution, and higher recurrence rates. One-year postoperative PROMs show equivalence to those reported in other studies following open cubital tunnel release.

Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects.

Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.

FUNCTIONS, SLEEP, FATIGUE AND QUALITY OF LIFE IN PATIENTS WITH SCLERODERMA DURING COVID-19: CROSS - SECTIONAL STUDY

Purpose: COVID-19, which has affected people in various ways, has also shown to cause various limitations on the lives of Scleroderma patients. The current study aims at evaluating the upper extremity functions, sleep quality, fatigue, and health-related quality of life in Scleroderma patients and to determine the factors affecting upper extremity functions.&#x0D; Methods: A total of 83 participants were recruited in this study. Of the participants, 39 were Scleroderma patients (mean age 43.28±9.96 years) and 44 were healthy controls (mean age 40.05±8.89 years). The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcomes Questionnaire (MHQ) were applied to evaluate upper extremity functions of the participants. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and the Scleroderma Health Assessment Questionnaire (SHAQ) were used to evaluate the sleep quality, fatigue, and health-related quality of life, respectively.&#x0D; Results: Scleroderma patients had significantly lower scores in hand functions, sleep quality, fatigue, and health-related quality than the healthy group (p=0.001). The correlations between DASH and PSQI (r=0.559, p=0.001), FSS (r=0.496, p=0.001), SHAQ scores (r=0.754, p=0.001) were highly positive. Similarly, a high correlation was found between MHQ and SHAQ scores (r=-0.679, p=0.001).&#x0D; Conclusion: Upper extremity functions and health-related quality of life were found to be affected in patients with Scleroderma. It was revealed that upper extremity functions were affected by sleep quality, fatigue, and health-related quality of life. Therefore, knowing all these effects and their relationships with each other allows to draw a systematic treatment plan on Scleroderma patients.

Explaining Personalized Activity Limitations in Patients With Hand and Wrist Disorders: Insights from Sociodemographic, Clinical, and Mindset Characteristics

ObjectivesTo investigate the association of sociodemographic, clinical, and mindset characteristics on outcomes measured with a patient-specific patient-reported outcome measure (PROM); the Patient Specific Functional Scale (PSFS). Secondly, we examined whether these factors differ when a fixed-item PROM, the Michigan Hand Outcome Questionnaire (MHQ), is used as an outcome. DesignCohort study, using the aforementioned groups of factors in a hierarchical linear regression. SettingTwenty-six clinics for hand and wrist conditions in the Netherlands. ParticipantsTwo samples of patients with various hand and wrist conditions and treatments: n=7111 (PSFS) and n=5872 (MHQ). InterventionsNA. Main Outcome MeasuresThe PSFS and MHQ at 3 months. ResultsThe PSFS exhibited greater between-subject variability in baseline, follow-up, and change scores than the MHQ. Better PSFS outcomes were associated with: no involvement in litigation (β[95% confidence interval=-0.40[-0.54;-0.25]), better treatment expectations (0.09[0.06;0.13]), light workload (0.08[0.03;0.14]), not smoking (-0.07[-0.13;-0.01]), men sex (0.07[0.02;0.12]), better quality of life (0.07[0.05;0.10]), moderate workload (0.06[0.00;0.13]), better hand satisfaction (0.05[0.02; 0.07]), less concern (-0.05[-0.08;-0.02]), less pain at rest (-0.04[-0.08;-0.00]), younger age (-0.04[-0.07;-0.01]), better comprehensibility (0.03[0.01;0.06]), better timeline perception (-0.03[-0.06;-0.01]), and better control (-0.02[-0.04;-0.00]). The MHQ model was highly similar but showed a higher R2 than the PSFS model (0.41 vs 0.15), largely due to the R2 of the baseline scores (0.23 for MHQ vs 0.01 for PSFS). ConclusionsHealth care professionals can improve personalized activity limitations by addressing treatment expectations and illness perceptions, which affect PSFS outcomes. Similar factors affect the MHQ, but the baseline MHQ score has a stronger association with the outcome score than the PSFS. While the PSFS is better for individual patient evaluation, we found that it is difficult to explain PSFS outcomes based on baseline characteristics compared with the MHQ. Using both patient-specific and fixed-item instruments helps health care professionals develop personalized treatment plans that meet individual needs and goals.

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis.

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.

Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud's Phenomenon.

In periarterial sympathectomy for intractable Raynaud's phenomenon, the extent of adventitiectomy as well as postoperative outcomes and hand perfusion assessment tools remain debatable. We evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitiectomy in the treatment of refractory Raynaud's phenomenon using objective measurements and patient-reported outcomes. Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up. The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery (p=0.02). The median number of ulcers decreased (p<0.001) and the median digital skin temperature increased (p<0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function (p≤0.001), activities of daily living (p=0.001), work performance (p=0.02), pain (p<0.001), physical function (p=0.053), and general health (p=0.048), as well as mental aspects, such as patient satisfaction (p<0.001) and mental health (p=0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function (r=0.46, p=0.04), work performance (r=0.68, p=0.001), physical function (r=0.51, p=0.02), and patient satisfaction (r=0.35, p=0.03). The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment.

Minimal clinically important difference of the Michigan Hand Outcomes Questionnaire score and the pain visual analogue scale in conservative treatment of trigger finger.

We investigated the minimal clinically important difference (MCID) of the Michigan Hand Outcomes Questionnaire (MHQ) and the pain visual analogue scale (VAS-pain) after conservative treatment of trigger finger. This secondary analysis of a randomized controlled trial compared pain reduction, symptoms and functional improvement at 12 weeks. Patients included were at least 18 years old and able to complete MHQ and VAS-pain at enrolment and 12 weeks after treatment. The MCIDs of MHQ and VAS-pain were evaluated using a distribution-based, anchor-based and receiver operating characteristic (ROC) curve-based approach. Of the 117 patients, the MCIDs of MHQ and VAS-pain using a distribution-based approach were 5.3 and 0.6, respectively; applying ROC method were 23.5 and 2.5, respectively; and using anchor questions were 15 and 2, respectively. These MCID values by anchor-based method with a minimal difference of 15 for MHQ and 2 for VAS-pain are recommended as primary evidence to determine clinically significant improvement after conservative treatment of trigger finger.Level of evidence: I.

Open hand fractures: a prospective analysis of functional outcomes and risk factors for infection after initial management in the emergency department.

Open hand fractures are common orthopaedic injuries, historically managed with early debridement in the operating room. Recent studies suggest immediate operative treatment may not be necessary but have been limited by poor follow-up and lack of functional outcomes. This study sought to prospectively evaluate these injuries treated initially in the emergency department (ED), without immediate operative intervention, to determine long-term infectious and functional outcomes using the Michigan Hand Outcomes Questionnaire (MHQ). Adult patients with open hand fractures managed initially in the ED at a Level-I trauma center were considered for inclusion (2012-2016). Follow-up and MHQ administration occurred at 6weeks, 12weeks, 6months, and 1year. Logistic regression and Kruskal-Wallis testing were used for analysis. Eighty-one patients (110 fractures) were included. Most had Gustilo Type III injuries (65%). Injury mechanisms most commonly included saw/cut (40%) and crush (28%). Nearly half of all patients (46%) had additional injuries involving a nailbed or tendon. Fifteen percent of patients had surgery within 30days. The average follow-up was 8.9months, with 68% of patients completing at least 12months. Eleven patients (14%) developed an infection, of which 4 (5%) required surgery. Subsequent surgery and laceration size were associated with increased odds of infection, and at one-year, functional outcomes were not significantly different regardless of fracture classification, injury mechanism, or surgery. Initial ED management of open hand fractures results in reasonable infection rates compared to similar literature and functional recovery demonstrated by MHQ score improvements over time.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures

In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from-6° to-14°) and Michigan Hand Outcome Questionnaire score (median difference,-1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. Therapeutic IV.

Treatment of intra-articular phalangeal fractures of the hand by Suzuki frame external fixator

Purpose This study aims to evaluate the functional, clinical, and radiological outcome of treatment of fractures of proximal interphalangeal joints of the hand by the Suzuki frame external fixator technique. Patients and methods A prospective study was held in Benha University Hospital that included 20 patients with intra-articular proximal interphalangeal joint (PIPJ) fractures treated with the Suzuki frame external fixator technique. All of the patients were followed up for a minimum period of 12 weeks, and the maximum period of follow-up was 36 weeks. Postoperatively, plain radiographs were used for assessing fracture reduction, congruity, and healing. The visual analog score and the Michigan Hand Outcome Questionnaire were used for functional evaluation. PIPJ range of motion and hand grip strength were also assessed. Results The mean age of the studied patients was 33.85 ± 8.65 years, and there was a male predominance (75%). The left hand was affected in 12 (60%) patients. The nondominant hand was involved in 13 (65%) patients. The mechanisms of injury were crushing by hard object (45%), followed by falling on the ground (35%), and sports injury (20%). The mean time from injury was 2.05 ± 1.88 days. The mean time of surgery was 17.55 ± 3.1 min. The mean time of the bony union was 11.8 ± 2.9 weeks. The mean time of the frame removal was 4.7 ± 0.57 weeks. At the final follow-up, all patients had no residual pain. The average PIPJ-range of motion was 86.25 ± 9.6°, and the average grip strength was 89.9 ± 8.19% as compared with the healthy side. The mean normalized Michigan Hand Outcome Questionnaire score was 86.1 ± 11.26 points, with seven, 10, and three patients having excellent, good, and fair results, respectively. Complications included pin-tract infection (three cases), stiffness (one case), aseptic loosening and osteolysis at head of proximal phalanx (one case), and flexion contractures (one case). Conclusion The pins and rubber traction frame technique is simple, reliable, available, reproducible, time saving, and cost-effective for managing complex PIPJ fractures while allowing early joint mobilization, which is proven to be effective in achieving high satisfactory functional results.

The effect of intraoperative nerve identification technique on distally-based dorsal fasciocutaneous flap for thumb and fingertip reconstruction

IntroductionThumb and fingertip resurfacing continues to be a challenge for hand surgeons, as the treatment varies widely. Being donor nerves in the flap for sensory restoration, the dorsal cutaneous nerves in hand have been widely described in the literature. However, their applications in providing anatomical information to sufficiently harvest the longitudinal axis of a robust flap are usually underestimated. This study reports reconstruction of thumb and fingertip defects with the distally based dorsal fasciocutaneous (DDF) flap and explores the effect of intraoperative nerve identification technique on clinical outcomes. HypothesisThe nerve identification technique can contribute considerably to the improvement of flap circulation, with less risk of poor venous return. Materials and methodsA retrospective study was conducted in 89 patients who had thumb or fingertip defects treated with the DDF flap from February 2014 to June 2020. Patients were divided into two groups based on whether intraoperative nerve identification technique was used. Flap survival was evaluated. The follow-up was conducted by using smartphone or by face-to-face visit. Time for complete wound healing, time to return to work, hand performance, the total active motion of the joints and static two-point discrimination of flaps were analyzed. ResultsThe 46 flaps (group A) that underwent intraoperative nerve identification technique had an 8.7% venous congestion rate versus a 27.9% venous congestion rate in the 43 flaps (group B) without using nerve identification technique (p=0.018). The mean follow-up was 11.08 (range 6–26) months. Time for complete wound healing and time to return to work were significantly shorter in group A (p=0.026 and p=0.012). Michigan Hand Outcomes Questionnaire (MHQ) scores were similar between groups. In the face-to-face follow-up, there was no significant difference in the total active motion of the injured fingers and static two-point discrimination between the two groups (p=0.657 and p=0.182). DiscussionThe use of nerve identification technique could decrease the odds of postoperative venous congestion in DDF flap for thumb and fingertip reconstruction, and result in improved outcomes in terms of time for complete wound healing and time to return to work. Level of evidenceIII; retrospective comparative study.

Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed With Casting vs Surgery

Casting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age. To examine how chronologic age compares with measures of physiologic age in DRF treatment recovery. This retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016. Participants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Participants were stratified by chronologic age, number of comorbidities, and activity status. The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. Partial correlation (PC) analysis adjusted for confounding. The final cohort consisted of 293 participants (mean [SD] age, 71.1 [8.89] years; 255 [87%] female; 247 [85%] White), with 109 receiving casting and 184 receiving surgery. Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean [SD] score, -0.46 [0.21]; P = .03). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean [SD] score, 12.21 [5.18]; PC = 0.27; P = .02) and 12 months (mean [SD] score, 13.25 [5.77]; PC = 0.17; P = .02). Comorbidities were associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years. In this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting. ClinicalTrials.gov Identifier: NCT01589692.

A human, allogeneic cortical bone screw for distal interphalangeal joint (DIP) arthrodesis: a retrospective cohort study with at least 10 months follow-up

IntroductionThe prime requisites of a good digital arthrodesis are a painless and stable union in a proper position. Arthrodesis of the distal interphalangeal joint of the fingers is not without potential complications including nonunion, malunion, and deep tissue infections. The Shark Screw® is a human, cortical bone allograft for osteosynthesis and an alternative to metal or bioabsorbable devices in orthopedics and trauma surgery. The primary hypothesis is that the fusion and complication rate, using the Shark Screw®, is at least similar to those reported in the literature, using metal or bioabsorbable screws.Material and methodsThis retrospective cohort study analyzes the fusion and complication rate and the patient satisfaction of distal interphalangeal joint arthrodesis of 27 fingers with the human allogeneic cortical bone screw. Complications, Disabilities of Arm, Shoulder, and Hand Questionnaire (Quick-DASH) score and Michigan Hand Outcomes Questionnaire (MHQ) score, grip and pinch strength and fusion angle were investigated.ResultsThe mean follow-up was 23 months. At 6 weeks after surgery, fusion was obtained for all fingers. There was no surgical complication that required revision surgery. An average fusion angle of 13.6° ± 10.7° was measured. VAS pain score decreased significantly from 6.9 before surgery to 0.14 after surgery. The Quick-DASH score decreased from 10.7 to 7.8. The MHQ score improved in all sub-scores.ConclusionThe complication rates, using the Shark Screw® for DIP joint arthrodesis, are lower compared to the results reported in the literature for other surgical techniques. Complications related to the human allograft cortical bone screw itself were not observed. The bone screw is completely remodeled into the host bone and further hardware removal is not necessary.Level of evidenceIV.

Outcome of functional treatment with a Lucerne Cast in patients with hand fractures: a retrospective case series.

The purpose of this study was to determine the clinical outcome of patients treated with a functional Lucerne Cast (LuCa) for different types of hand fractures. Static casting has traditionally been the preferred treatment for hand fractures. However, functional casting may lead to good functional outcomes, less stiffness, and earlier return to work. A retrospective case series of all consecutive patients with a metacarpal or proximal phalangeal fracture treated with a LuCa between 2018 and 2019 was conducted. A total of 90 patients were included. Clinical data were collected directly from the patient's medical records. Functional outcome was assessed with the Michigan Hand Outcomes Questionnaire (MHQ). The median MHQ score was 95 (IQR 83-100) with a median follow-up of 23months. Complications occurred in 7 of 90 patients (8%). Functional impairment occurred in two (2%) patients. Functional impairment was defined as stiffness, persisting rotational deformity, a boutonnière or swanneck deformity. Persisting pain or CRPS occurred in six (7%) patients. The LuCa shows to be effective in the functional treatment of both metacarpal and proximal phalangeal fractures with excellent patient-reported outcomes but at a relatively high rate of persisting pain.

Comparison of Treatment Methods of Thumb-Tip Defects With Phalangeal Bone Exposure: Modified Heterodigital Neurovascular Island Flap Versus Free Lateral Great Toe Flap

Modified heterodigital neurovascular island flaps and free lateral great toe flaps are dependable methods for treating thumb-tip defects with phalangeal bone exposure. We retrospectively analyzed and compared the details and results of the two methods. This retrospective study included 25 patients with thumb injuries with phalangeal bone exposure treated between 2018 and 2021. Patients were categorized as per the following surgical methods: (1) modified heterodigital neurovascular island flap (12 patients, finger flap group) and (2) free lateral great toe flap (13 patients, toe flap group). The Michigan Hand Outcome Questionnaire, aesthetic appearance, Vancouver Scar Scale, Cold Intolerance Severity Score, static 2-point discrimination, Semmes-Weinstein monofilament, and range of motion of the metacarpophalangeal joint of the injured thumb were evaluated and compared. In addition, operation time, hospital stay, return-to-work time, and complications were recorded and compared. In both groups, the defect was successfully repaired, with no cases of complete necrosis. The 2 groups had similar mean scores in static 2-point discrimination, Semmes-Weinstein monofilament, range of motion, and Michigan Hand Outcome Questionnaire scores. The aesthetic appearance, scarring, and cold tolerance of the toe flap group were better than the finger flap group. The operation time, hospital stay, and return-to-work time in the finger flap group were shorter than the toe flap group. The finger flap group had 2 complications-a superficial infection and 1 case of partial flap necrosis. The toe flap group had 3 complications-a superficial infection, 1 case each of partial flap necrosis, and partial skin graft loss. Both treatments can achieve satisfactory results; however, they each have advantages and disadvantages. Therapeutic IV.

Type of Work and Preoperative Ability to Perform Work Affect Return to Usual Work Following Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis.

The time until return to work (RTW) and possible factors affecting this time after proximal interphalangeal (PIP) joint arthroplasty are unknown. Therefore, we aim to evaluate the RTW after PIP joint arthroplasty for osteoarthritis and assess factors affecting the time until return to their usual work. We used prospectively gathered data from 74 patients undergoing PIP joint arthroplasty with daily hand surgery practice routine outcome collection. Standardized RTW questionnaires were completed at 6 weeks and 3, 6, and 12 months after surgery. Return to work was defined as the first time a patient reported returning to work and performing the original work for a minimum of 50% of the original hours a week, as stated in the patient's contract. Second, we evaluated baseline factors affecting the time until RTW. The probability of RTW within 12 months after surgery was 88%. The median time until RTW was 8 weeks (interquartile range: 4-10). Physical occupational intensity (hazard ratio [HR]: 0.36, P = .001) and the baseline Michigan Hand Outcomes Questionnaire work scores (HR: 1.02, P = .005) were independently associated with RTW. In conclusion, patients returned to work after a median of 8 weeks following PIP arthroplasty. Patients with medium or heavy physical occupations returned to work later than patients with light physical occupations. Better patient-reported work outcomes at baseline also led to an earlier RTW. This information can be valuable for providing adequate information during the preoperative consultation.

Upper Limb Nerve Transfer Surgery in Patients With Tetraplegia

Cervical spinal cord injury (SCI) causes devastating loss of upper extremity function and independence. Nerve transfers are a promising approach to reanimate upper limbs; however, there remains a paucity of high-quality evidence supporting a clinical benefit for patients with tetraplegia. To evaluate the clinical utility of nerve transfers for reanimation of upper limb function in tetraplegia. In this prospective case series, adults with cervical SCI and upper extremity paralysis whose recovery plateaued were enrolled between September 1, 2015, and January 31, 2019. Data analysis was performed from August 2021 to February 2022. Nerve transfers to reanimate upper extremity motor function with target reinnervation of elbow extension and hand grasp, pinch, and/or release. The primary outcome was motor strength measured by Medical Research Council (MRC) grades 0 to 5. Secondary outcomes included Sollerman Hand Function Test (SHFT); Michigan Hand Outcome Questionnaire (MHQ); Disabilities of Arm, Shoulder, and Hand (DASH); and 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Outcomes were assessed up to 48 months postoperatively. Twenty-two patients with tetraplegia (median age, 36 years [range, 18-76 years]; 21 male [95%]) underwent 60 nerve transfers on 35 upper limbs at a median time of 21 months (range, 6-142 months) after SCI. At final follow-up, upper limb motor strength improved significantly: median MRC grades were 3 (IQR, 2.5-4; P = .01) for triceps, with 70% of upper limbs gaining an MRC grade of 3 or higher for elbow extension; 4 (IQR, 2-4; P < .001) for finger extensors, with 79% of hands gaining an MRC grade of 3 or higher for finger extension; and 2 (IQR, 1-3; P < .001) for finger flexors, with 52% of hands gaining an MRC grade of 3 or higher for finger flexion. The secondary outcomes of SHFT, MHQ, DASH, and SF36-PCS scores improved beyond the established minimal clinically important difference. Both early (<12 months) and delayed (≥12 months) nerve transfers after SCI achieved comparable motor outcomes. Continual improvement in motor strength was observed in the finger flexors and extensors across the entire duration of follow-up. In this prospective case series, nerve transfer surgery was associated with improvement of upper limb motor strength and functional independence in patients with tetraplegia. Nerve transfer is a promising intervention feasible in both subacute and chronic SCI.