Outcomes Of Hand Surgery Research Articles

WALANT surgery of the hand: state of the art.

Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

Preliminary Outcomes of Scapholunate Ligament Augmentation with Internal Brace Technique

Injury to the scapholunate (SL) interosseous ligament (SLIL) is a common cause of carpal instability. Internal brace augmentation has been used in various ligament repair procedures; however, further investigation of its outcomes in hand surgery is needed. This study aimed to examine outcomes for patients who underwent SLIL repair with internal brace augmentation. Patients who underwent SLIL repair with the internal brace technique and had at least 1 year of follow-up were contacted. Available patients returned for an in-person evaluation with new radiographs and physical examination. If patients could not be contacted but had x-rays and physical examinations performed at greater than 1 year after surgery, these data were collected from their medical records. Participating patients completed the QuickDASH and Patient-Rated Wrist Evaluation surveys and rated their satisfaction with the surgery. Outcomes assessed included wrist range of motion, grip strength, scaphoid shift test, SL gap, SL angle, and radiographic evidence of radiocarpal arthritis. We collected outcomes for 14 SLIL repairs among 13 patients (12 male). Mean length of the follow-up was 41 months (n= 14, 17-64). Mean QuickDASH and Patient-Rated Wrist Evaluation scores were 6.1 (0-43.2) and 9.6 (0-65), respectively. Radiographic measurements remained stable from immediate to latest follow-up, and no radiocarpal arthritic changes were noted. However, SL gap decreased from a mean of 5.33 mm (3.4-6.7) before surgery to 3.34 mm (2-4.6) at the latest follow-up, and SL angle decreased from a mean of 79.5° (67°-97°) before surgery to 67.3° (51°-85°) at the latest follow-up. All scaphoid shift tests were stable. Therefore, SL internal brace augmentation has favorable short-term results with improvements in pain, function, satisfaction, and carpal alignment at greater than 1 year postoperatively. This technique can be an effective option for the management of SL instability in the short term. Therapeutic IV.

Automated Reporting of Patient Outcomes in Hand Surgery: A Pilot Study.

Obtaining patient-reported outcomes (PROs) is becoming a standard component of patient care. For nonacademic practices, this can be challenging. From this perspective, we designed a nearly autonomous patient outcomes reporting system. We then conducted a prospective, cohort pilot study to assess the efficacy of the system. We created an automated system to gather PROs. All operative patients for 4 surgeons in an upper-extremity private practice were asked to participate. These patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires preoperatively and received follow-up e-mails requesting patients to complete additional QuickDASH questionnaires at 3, 6, and 12 weeks postoperatively and to complete a 13-week postoperative satisfaction survey. Response rates and satisfaction levels are reported with descriptive statistics. Sixty-two percent of participants completed the 3-week assessment, 55% completed the 6-week assessment, and 43% completed the 12-week assessment. Overall, 35% of patients completed all questionnaires, and 73% completed at least 1 postoperative assessment. The collection of follow-up questionnaires required no additional time from the clinical staff, surgeon, or a research associate. Automated e-mail assessments can collect reliable clinical data, with minimal surgeon or staff intervention required to administer and collect data, minimizing the financial cost. For nonacademic practices, without access to additional research resources, such a system is feasible. Further improvements in communication with patients could increase response rates.

The Fragility Index in Hand Surgery Randomized Controlled Trials

Randomized controlled trials (RCTs) are the gold standard for comparing clinical interventions. Statistical significance as reported via a P value has been used to determine if a difference between clinical interventions exists in an RCT. However, P values do not clearly convey information about the robustness of a study's conclusions. An emerging metric, called the fragility index (the number of subjects who would need to change outcome category to raise the P value above the .05 threshold), is an indirect measure of how likely a repeat of the trial would reach the same conclusions. This study addressed the fragility of RCTs using dichotomous outcomes in hand surgery. Using systematic searching of the MEDLINE database, we identified hand surgery RCTs published in 11 high-impact journals published in the last decade (2007-2017). Studies were identified that involved 2 parallel arms, allocated patients to treatment and control in a 1:1 ratio, and reported statistical significance for a dichotomous variable. The fragility index was calculated using Fisher's exact test, using previously published methods. Five hand surgery RCTs were identified for inclusion reporting a range of fragility indices from 0 to 26. Two of the trials (40%) had a fragility index of 2 or less. Two of the trials (40%) reported that the number of patients lost to follow-up exceeded the fragility index, meaning that results of the patients lost to follow-up could theoretically completely reverse the study conclusions. The range of fragility indices reported in the recent hand surgery literature is consistent with previous reporting within orthopedic surgery. The fragility index is a useful metric to analyze the robustness of the study conclusions that should complement other methods of critical evaluation including the P value or effect sizes. Our results emphasize the need for future efforts to strengthen the robustness of RCT conclusions.

Assessment of Validity, Reliability, Responsiveness and Bias of Three Commonly Used Patient-Reported Outcome Measures in Carpal Tunnel Syndrome

In recent years there has been an increase in the use of self-administered questionnaires to accurately assess intervention outcomes in hand surgery in order to determine the quality of healthcare. This prospective study aims to evaluate and assess the validity, reliability, responsiveness, and bias of a number of outcome measure for Carpal Tunnel Syndrome (CTS) including the disease-specific Boston questionnaires (BQ), and the region-specific Disability of Arm, Shoulder, and Hand (DASH) questionnaires and Manchester Modified Disabilities of the Arm, Shoulder and Hand (M(2)DASH) questionnaires, and comparing the results to Nerve Conduction Studies (NCS). Forty-eight patients with clinical signs of CTS confirmed by NCS completed the BQ, DASH and M(2)DASH questionnaire at different time intervals peri-operatively. The scores were analysed to assess validity, reliability, responsiveness, and bias of the questionnaires. Validity analysis for the three questionnaires showed strong positive correlations and there was no age, gender, hand dominance, or side affected bias in the questionnaires. No significant correlation was obtained between the questionnaires and NCS. Significant results for responsiveness were noted in BQ symptom severity scale only. 1. This study ha show n that the BQ, DASH and M(2)DASH questionnaires are valid and reliable outcome measures for CTS. 2. In terms of responsiveness, the DASH and M(2)DASH questionnaires are not as responsive as the BQ scores over the initial post-operative recovery period. 3. We would therefore recommend that the Boston Questionnaire be used to assess early post-operative patient related outcome measures for Carpal Tunnel Syndrome.

Outcomes of hand surgery in the patient with rheumatoid arthritis.

Surgeons have long been striving to develop new surgical procedures to improve functional outcomes for a variety of hand and wrist deformities resulting from rheumatoid arthritis (RA). The purpose of this review is to assess the latest surgical outcomes related to hand and wrist surgery in the patient with RA. There is a lack of outcome studies in RA hand and wrist surgery to justify many of the surgical procedures proposed for the treatment of the rheumatoid hand. However, advances made by the silicone metacarpophalangeal arthroplasty (SMPA) group regarding hand reconstruction for RA patients have improved patient care for this widely used procedure. Prophylactic versus therapeutic procedures are also discussed. Rheumatoid hand is one of the earliest presentations of RA, and the progression of rheumatoid hand disease can be unpredictable. There are a number of surgical treatments for the rheumatoid hand and careful sequential planning of the surgical procedures can maintain patients' hand function and in many cases should enhance outcomes of the rheumatoid hand by correcting existing deformities. An early introduction to a hand surgeon can inform patients of available options and allow longitudinal assessment of structural and functional changes that could be treatable by future surgical interventions.

Outcome Measurement in Hand Surgery: Report of a Consensus Conference

This is a report of the second conference on Outcomes of Hand Surgery that took place at the Pulvertaft Hand Centre, Derby on the 19th-20th May 2001. The first meeting took place in 1993 and the discussions of this meeting led to the publication of a paper (Macey, 1995). The group participating in the second conference comprised surgeons, therapists, researchers, psychologists and a health economist (see Appendix I). The aim of this report is not to give a comprehensive and fully referenced overview, but to provide a summary of the key issues for consideration and to put forward some current views on the topic of outcome measurement in the field of Hand Surgery.