Palmar Side Research Articles

Palmar Displacement in Distal Radius Fractures following Extension Injuries of the Wrist

Fractures of the distal radius have been traditionally classified based on the suspected mechanism of injury. Among clinicians, the terms "Colles" and "Smith" fractures are commonly used to refer to a distal radius fracture that is either displaced to the dorsal (Colles) or palmar (Smith) side of the radius. When analysing x-rays, it is not uncommon for a Smith fracture to be detected in cases where patients describe a fall on the wrist in an extended position. Thus, the question arises how a flexion-type fracture can occur after an extension injury. So far, only little research has been conducted into this subject. The aim of this study was to analyse the mechanisms of injury that lead to various types of distal radius fractures. Particular emphasis was placed on "Smith" fractures and on the biomechanical, physiological and anatomical characteristics that contribute to their occurrence. To assess these relationships, data of fractures were collected following a life-like fracture simulation using a "drop-bench" in non-formalin fixated human specimens. These fractures were produced between January 2016 and December 2021. Biographic data of all specimens used were available. Additionally, all biomechanical and physical characteristics of the fracture simulation were fully documented. Of the 122 specimens with a full data set, 17 (13.9%) fractures were determined to be Smith fractures based on their radiological appearance. In 10 of these flexion fractures, the wrist was set in dorsal extension. The mean angle of extension was 86.3 degrees for flexion fractures compared to 90.5 degrees for extension fractures. Six out of 10 Smith-type fractures that were set in dorsal extension were also exposed to pronation, whereas only one was exposed to supination. The mean potential energy for fracture creation was 168.0 joules for Smith fractures in dorsal extension, whereas all other fractures showed a mean of 185.2 joules. It can be concluded that a Smith fracture is not limited to being the result of a fall on the wrist in a flexed position. The same fracture may also be the result of a fall with the wrist in an extended position if certain physical factors are applicable.

Hand and wrist complete degloving: A case report and litterature review

Complete hand degloving injuries are traumatic avulsion injuries causing the skin to pull away from the underlying tissues and are most often caused by industrial machinery. We present the case of a degloving trauma of the whole fingers, hand, and wrist resulting in a "watch hand" by analogy with the "ring finger" and discuss alternatives and recommendations from the rare cases described of similar traumas. A 33-year-old manual worker, a non-smoker with no significant medical or surgical comorbidities, was admitted for a complete skin avulsion of the left hand and wrist following a work-related accident with a trommel-type industrial roller. Our approach covered the five fingers and the dorsal aspect of the hand and wrist with an artificial dermal matrix, while the palmar side of the hand and wrist was covered with a pedicled groin flap in emergency. At 15months, the patient's sensitivity was classified as S1 on the sensory evaluation scale, joint mobility was less than 30°, and the residual hand retained what we might call "basic" functions, i.e., a counterweight when carrying loads and the ability to pick up and hold a light object in the thumb-index grasp. Complete soft tissue hand defects are exceptional and require urgent treatment. If re-implantation is not possible, combining a dermal matrix with a pedicled flap is a simple salvage solution. The risks of vascular, infectious, and stiffening complications in these traumas are high and must be prevented. Patients must be warned of the severity of the trauma, the need for secondary surgeries to restore a policy-digital grip, and the poor functional results expected.

Soft pneumatic actuators for pushing fingers into extension

BackgroundCompliant pneumatic actuators possess many characteristics that are desirable for wearable robotic systems. These actuators can be lightweight, integrated with clothing, and accommodate uncontrolled degrees of freedom. These attributes are especially desirable for hand exoskeletons, where the soft actuator can conform to the highly variable digit shape. In particular, locating the pneumatic actuator on the palmar side of the digit may have benefits for assisting finger extension and resisting unwanted finger flexion, but this configuration requires suppleness to allow digit flexion while retaining sufficient stiffness to assist extension.MethodsTo meet these needs, we designed an actuator consisting of a hollow chamber long enough to span the joints of each digit while sufficiently narrow not to inhibit finger adduction. We explored the geometrical design parameter space for this chamber in terms of shape, dimensions, and wall thickness. After fabricating an elastomer-based prototype for each actuator design, we measured active extension force and passive resistance to bending for each chamber using a mechanical jig. We also created a finite element model for each chamber to enable estimation of the impact of chamber deformation, caused by joint rotation, on airflow through the chamber. Finally, we created a prototype hand exoskeleton with the chamber parameters yielding the best outcomes.ResultsA rectangular cross-sectional area was preferable to a semi-obround shape for the chamber; wall thickness also impacted performance. Extension joint torque reached 0.33 N-m at a low chamber pressure of 48.3 kPa. The finite element model confirmed that airflow for the rectangular chamber remained high despite deformation resulting from joint rotation. The hand exoskeleton created with the rectangular chambers enabled rapid movement, with a cycle time of 1.1 s for voluntary flexion followed by actuated extension.ConclusionsThe developed soft actuators are feasible for use in promoting finger extension from the palmar side of the hand. This placement utilizes pushing rather than pulling for digit extension, which is more comfortable and safer. The small chamber volumes allow rapid filling and evacuation to facilitate relatively high frequency finger movements.

The ulnar digital artery perforator flap for little finger defects: Using the abductor digiti minimi as a landmark – Surgical technique

This surgical technique article outlines the planning and harvesting methods for the ulnar digital artery perforator (UDAP) flap, using the abductor digiti minimi as a landmark for flap elevation. This approach demonstrates a reliable perforator and offers a wide range of coverage for little finger reconstruction, both on the palmar and dorsal sides. The UDAP flap is technically straightforward and easily accessible and results in minimal donor site morbidity, making it a highly viable option for little finger defects. The technique’s simplicity and effectiveness represent a significant advancement in reconstructive surgery for the little finger.

Review of extraosseous and intraosseous blood supply of the carpal bones

The blood supply of the carpal bones has been updated and described with new dissection, vascular filling and imaging techniques. It is very important to know the vascular anatomy of the carpal bones in order to predict vascular insufficiency and associated avascular necrosis that may occur as a result of any injury such as fracture. This article reviews the extraosseous and intraosseous vascular supply of the carpal bones. The carpal bones are supplied by three vascular arches formed by the radial, ulnar and anterior interosseous arteries on the dorsal and palmar sides of the wrist. These contribute to the dorsal and palmar carpal vascular systems, which consist of transverse arteries connected by longitudinal anastomoses. The scaphoid and capitate have a high risk of avascular necrosis, while the trapezium, triquetrum, pisiform and 80% of the lunate have a lower risk. With the development of new imaging techniques, new information is added to the literature. With the increase in three-dimensional studies, intraosseous vascularity and its correlation with carpal bone fractures and its relationship with avascular necrosis will be revealed more clearly.

Further experiments and remarks regarding the possible formation of blood stains on the Turin Shroud: stains attributed to the nailing of the hands

The formation of red discolorations (‘blood stains’) on the Turin Shroud (TS), a Christian relic believed to be the burial cloth of Jesus of Nazareth, is controversially discussed. We performed experiments to identify possible explanations for the formation of the stains on the hands and forearms of the Turin Shroud Man (TSM). In preliminary non-standardised experiments, after applying blood to the dorsal and palmar side of the probands’ wrists, they moved their arms around at their own discretion to provoke blood flows as similar as possible to those on the TS. A blood stain pattern similar to that on the left wrist could be provoked by slowly turning the wrist to the ulnar side. In contrast, a branched pattern of multiple streaks, as depicted on the forearms, was difficult to reproduce. In a standardised test setup, the probands moved their dry, dirtied, or oiled arms jerkily in a predetermined sequence of movements. More body hair only slightly facilitated the formation of a branched pattern. On oiled skin, however, the formation of branches was significantly facilitated. This may support the hypothesis that the blood stains on the forearms were formed by moving the body between the unnailing and the burial. The formation of a branched pattern seems feasible if the arms were moved jerkily and were possibly exposed to water and oils postmortem (e.g. transporting the washed and oiled body). Nevertheless, the well-defined blood stains with multiple branchings are difficult to explain. Additionally, the blood stains on the forearms may have originated from deep scourging wounds, where dried blood was again mobilised by water (and oil). We are aware that no reliable conclusions about the formation of the ‘blood stains’ on the TS can be drawn from our findings. However, they may contribute to the discussion on this topic.

Feasibility of a warp-knitted shape memory alloy rehabilitation glove

Shape memory alloys (SMAs) have an innate property that allows them to return to a memorized form when stimulated. They have been recently designed as flexible fabrics for use in wearable assistive devices. This study aimed to develop a rehabilitation assistive glove with good wearability for a hemiplegic patient using a knitted SMA with a high-unidirectional contractile response. We fabricated warp-knitted SMA actuators, which had higher contractile responses than those of weft-knitted SMA. The use of a knitting loom allowed these actuators to fit all the fingers of a patient. We developed a full-fabric glove, placed the SMA wires on the finger regions to form a tendon-driven structure, and attached knitted SMA actuators to the dorsal and palmar sides of the hand to assist flexion and extension. The joint range of motion after glove actuation increased by 11.620% and 141.710% in flexion and extension, respectively. The range of motion improved more with glove rehabilitation than with thermal stimulation or no actuation. The grip force also increased by 52.400% after rehabilitation exercises. The safety of the heat generated during actuation was confirmed, and its applicability as a thermal stimulus was validated (based on increased skin temperature). These outcomes suggest the practical potential of warp-knitted SMAs in fully fabricated wearable assistive devices.

Transmetacarpal replantation

Introduction. Transmetacarpal amputation (TA) distal to the superficial palmar arch is one of the most difficult procedures in replantation surgery because it requires the reconstruction of blood vessels, muscles, tendons, bones, nerves, and skin. We present a case of a patient with TA of the left hand and microsurgical replantation. Case report. A 23-year-old left-hand dominant male worker with a positive smoking history sustained TA from a radial saw blade and avulsion injury of the palmar side of the thumb with no other apparent injuries. The time between the amputation and replantation was 4 hrs. The patient sustained the amputation at the level of metacar-pophalangeal joints. The successful replantation included: wound and intrinsic muscles debridement, microvascular anastomoses of the blood vessels, internal fixation of the metacarpal bones, neurorrhaphy, tenorrhaphy, and wound closure with local skin flap for thumb soft tissue defect. The patient was followed for seven years postoperatively. Conclusion. The replantation surgery requires a specialized department and well-educated teams of hand microsurgeons, orthopedic surgeons, and anesthesiologists. The most imortant factors that influenced the outcome after the replantation in the presented case included the type and level of injury, ischemia time, comorbidities, age, smoking history, and physical therapy.

Traceability of Geographic Origin Using Human Skin and Oral Microbiota.

To explore the possibility of using human skin and oral microorganisms to estimate the geographic origin of an individual through the sequencing analysis of bacterial 16S rRNA gene. Microbial DNA was extracted from the palm and oral microorganisms of the Han population in Shanghai and Chifeng, Inner Mongolia, and the composition and diversity of the microbiota were analyzed by full-length 16S rRNA gene sequencing. Then, differential species were screened and a geographic location prediction model was constructed. The compositions of palm and oral microorganisms between Shanghai and Chifeng samples were both different. The abundance and uniformity of palm side skin microorganisms were higher in Chifeng samples than in Shanghai samples, while there was no significant difference in oral microorganisms. Permutational multivariate analysis of variance (PERMANOVA) confirmed that the β-diversity between the samples from the two places were statistically significant, and the coefficients of determination (R2) for skin and oral samples were 0.129 and 0.102, respectively. Through principal co-ordinates analysis (PCoA), the samples from the two places could be preliminarily distinguished. The predictive model had the accuracies of 0.90 and 0.83 for the geographic origin using the skin and oral samples, respectively. There are differences in the compositions of palm and oral microbiota between Han populations in Shanghai and Chifeng. The prediction model constructed by the random forest algorithm can trace the unknown individuals from the above two places.

The development of prediction model for cuffed tracheal tube size from the middle finger in pediatrics: a concise and feasible approach.

Selecting the optimal tracheal tube size is critically important for pediatric patients. Age-based formulas are often used, but still have limitations. The aim of this prospective study was to investigate whether middle finger measurements correlate with cuffed tracheal tube size and to further develop a prediction model based on these measurements. Patients under 12 years of age scheduled for elective surgery involving tracheal intubation were enrolled in the study. The length was determined from the tip of the distal metacarpal to the palm's root on the palm side, while the circumference was measured at the base of the palm using a soft tape measure. The appropriate cuffed tracheal tube size was determined based on specific criteria. If the tube encountered resistance during insertion or required an airway pressure >25 cmH2O to detect an audible leak, it was replaced with a tube 0.5 mm smaller. Conversely, if an audible leak occurred at an airway pressure <10 cmH2O, or peak pressure >25 cmH2O, or the cuff pressure >25 cmH2O to achieve a seal, the tube was exchanged for one with a 0.5 mm larger. Linear regression analysis was used to examine the association between middle finger circumference and length with the cuffed tracheal tube size. Subsequently, regression equations were constructed based on the results of the linear regression analysis and their predictive performance was compared to the conventional age-based formulas, including the Khine formula and Motoyama formula. The predictive performance was evaluated by mean absolute error (MAE), root mean square error (RMSE), and prediction accuracy. A total of 261 patients were analyzed in our study. The mean age of the patients was 46.19±35.83 months. The linear relationship was observed between the cuffed tracheal tube size and the middle finger circumference and middle finger length with R2 values of 0.77 and 0.73, respectively. In comparison to conventional age-based formulas, both middle finger circumference and middle finger length demonstrated superior predictive performance, characterized by lower MAE and RMSE, as well as higher prediction accuracy. Notably, the regression equation based on the middle finger circumference obtained the higher predictive accuracy of 0.590, with an MAE of 0.259 and an RMSE of 0.333 as opposed to the predictive accuracy of 0.391, MAE of 0.349, and RMSE of 0.473 derived from conventional age-based formulas. Based on the regression coefficients of linear regression, simplified formulas were proposed, with the middle finger circumference-based formula emerging as the most accurate and simple option. The appropriate cuffed tracheal tube size could be predicted by the middle finger circumference. Our proposed formula 'cuffed tracheal tube internal diameter (mm) = middle finger circumference (cm) - 0.2' has the potential to improve the selection of the cuffed tracheal tube size in pediatric patients.

Angioleiomyoma - A Case Report.

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery. Level of Evidence: Level V (Therapeutic).

Prevalence of Primary Palmar Hyperhidrosis and its Impact on Hand Grip Strength and Quality of Life

Background: Primary palmar hyperhidrosis is a disorder resulting in abnormally excessive sweating of palmar side of hand. Patients present with cold and wet hands. It can also occur in combination with other areas like soles, axillae, and craniofacial region. Objective: To estimate prevalence of primary palmar hyperhidrosis in Faisalabad and its impact on hand grip strength and quality of life. Methods: This analytical cross-sectional study was conducted at Dermatology departments of three tertiary care hospitals of Faisalabad, Pakistan. Sample size was calculated using formula. Both genders with age ranging from 15 to 65 years were selected as participants using convenient sampling. Participants filled self made form which included demographics, screening and valid and reliable quality of life measuring tools (HDSS and Keller scale). Then, after screening, grip strengths of hyperhidrotics (group 1) and non-hyperhidrotics (group 2) were measured using modified sphygmomanometer test (cuff method) and were compared. Data were analyzed using SPSS version 22. Results: Prevalence of primary palmar hyperhidrosis was 15.5% (11/71) consisting of 6 females and 5 males. Age of onset occurred during 5-15 years. 63.64% patients had positive family history. 90.91% patients had normal (18.5-24.9) BMI. Mean right and left grip strength values of hyperhidrotic patients were 168.55±55.446 and 157.55±44.568, respectively. Mean right and left grip strength values in non-hyperhidrotic participants were 157.63±53.126 and 148.67±53.85, respectively. 54.55% patients reported 3 on HDSS. On Keller scale majority reported mild to severe distress especially when shaking hands with others, writing papers, driving cars, grasping heavy objects, and wearing gloves. Conclusion: Current study showed 15.5% prevalence rate of primary palmar hyperhidrosis. Hand grip strength values of hyperhidrotic patients were higher when compared with non-hyperhidrotic participants. Majority of patients reported barely tolerable sweating which resulted in mild to severe distress experienced during activities of daily living.

A new method of continuous blood pressure monitoring using multichannel sensing signals on the wrist

Hypertension is a worldwide health problem and a primary risk factor for cardiovascular disease. Continuous monitoring of blood pressure has important clinical value for the early diagnosis and prevention of cardiovascular disease. However, existing technologies for wearable continuous blood pressure monitoring are usually inaccurate, rely on subject-specific calibration and have poor generalization across individuals, which limit their practical applications. Here, we report a new blood pressure measurement method and develop an associated wearable device to implement continuous blood pressure monitoring for new subjects. The wearable device detects cardiac output and pulse waveform features through dual photoplethysmography (PPG) sensors worn on the palmar and dorsal sides of the wrist, incorporating custom-made interface sensors to detect the wearing contact pressure and skin temperature. The detected multichannel signals are fused using a machine-learning algorithm to estimate continuous blood pressure in real time. This dual PPG sensing method effectively eliminates the personal differences in PPG signals caused by different people and different wearing conditions. The proposed wearable device enables continuous blood pressure monitoring with good generalizability across individuals and demonstrates promising potential in personal health care applications.

Assessing the impact of industrial glove use on perceived hand dexterity, function, and strength

Prevention of musculoskeletal occupational hazards is an important topic in extractive industries. This study quantifies the impact of three styles of industrial metacarpal gloves on dexterity, gripping, pinching, and torquing tasks. Results indicated that wearing metacarpal gloves duplicated the time to complete a dexterity task from an average of 57 s for bare hands to 127 s for gloved hands. The highest drop in gripping force occurred while wearing a thicker glove, while gloves with thinner palmar sides produced smaller but similar force reductions of around 6%. The highest pinching force was obtained while wearing the thinnest glove, with a rise of 15%. Self-perception of exertion while wearing gloves varied between genders. Given that dexterity, grip, and pinch strength outcomes varied based on glove materials, the authors propose a new hand safety concept model to promote a multi-factorial approach to balance the risks and benefits of prospective personal protective equipment.

Ultrasound Investigation of the Radial Nerve's Superficial Branch: Reducing the Risk of K-Wire Insertion Damage in Distal Radius Fractures.

Kirschner wire (K-wire) insertion during surgery for distal radius fractures carries a risk of damaging the radial nerve's superficial branch. In this prospective study, we investigated the relationship between the radial nerve's superficial branch and the radius using ultrasound to minimize risk. We collected data from 101 healthy volunteers (202 limbs; 51 men; mean age: 40.6 years). We ultrasonographically assessed the courses of the radial nerve's dorsal and superficial palmar branches at 0, 1, 2, and 3 cm proximal to the radial styloid process tip. The positional relationship between the radial nerve's superficial branch and the radius was determined by splitting the radius's ultrasound map into 4 sections (R1-R4) from the palmar side. The section containing the dorsal and palmar branch midpoints was determined for each height. In many limbs, the dorsal branch tended to wrap from the proximal palmar to the distal dorsal side at 1 to 2 cm proximal to the radial styloid process tip. In approximately 90% of limbs, the palmar branch ran along the radius's palmar side rather than the radial surface. A small incision enabling direct view may be the best approach for avoiding nerve damage when the superficial branch is less than or equal to 2 cm proximal to the tip of the radial styloid process. Inserting the K-wire from the dorsal side of the radius may be safer for more proximal locations. We recommend a preoperative ultrasound examination to determine the course of the superficial branches of the radial nerve in each patient.

Repair of a finger pulp or fingertip defect using a palmar rotatory flap pedicled with the perforating branch of the proper palmar digital artery: a retrospective study

BackgroundSoft tissue defects in the hand may result from trauma, oncological procedures, or severe infections. This study aimed to introduce an innovative method for repairing soft tissue defects on the palmar side of the distal segment of the affected finger or fingertip. We explored this surgical method and its curative effect on the volar rotation pedicled flap base on a perforator of the palmar digital artery (VRPF-PPDA) for repairing ventral or fingertip soft tissue defects of the distal segment of the affected finger without impairing its main blood vessels.MethodsBetween June 2019 and January 2021, 13 patients with finger pulp or fingertip soft tissue defects were treated with VRPF-PPDA. Flap survival rate, complication rate, two-point discrimination (2PD), and patient satisfaction were used to evaluate the efficacy of this method. The function of the affected finger was evaluated using the upper limb function evaluation method issued by the Trial Standards for Evaluation of Partial Function of the Upper Extremity of the Chinese Society for Surgery of the Hand of the Chinese Medical Association (CMA) and the Disabilities of the Arm, Shoulder, and Head (DASH) score, 6–12 months after the flap-based operation.ResultsThirteen patients (18 fingers) achieved complete flap survival. The finger pulp flap was full, and no complications occurred. 2PD checks of the flaps revealed that all of them were 4–10 mm in length. According to the Trial Standards for Evaluation of Partial Function of the Upper Extremity of the Chinese Society for Surgery of the Hand of the CMA, hand function was excellent in 12 patients (17 fingers) and good in one patient, with a mean DASH score of 26.05 ± 0.45. Eleven patients selected “excellent” on the subjective satisfaction survey, while the other two selected “good.”ConclusionVRPF-PPDA surgery is a simple, effective, minimally invasive, and reliable method for repairing soft tissue defects in the distal finger pulp or fingertips. Optimal esthetic reconstruction and anatomical and functional repair can be achieved in fingers repaired using the VRPF-PPDA surgical approach.

All-Dorsal Arthroscopic Ligamentoplasty (ADAL) in Scapholunate Instability Management: Surgical Technique

In advanced scapholunate instability, a scapholunate repair by open or arthroscopic ligamentoplasty is indicated. Although the radiographic results and functional scores are more or less satisfactory for open ligamentoplasty, it is often responsible for a decrease in joint amplitude postoperatively. Arthroscopic techniques are therefore of great interest, since they respect the joint capsule, but they remain technically difficult and demanding surgeries, requiring a good deal of experience in arthroscopy and using bone tunnels that are potentially a source of complications, as well as pinning to the palmar side of the wrist, which is potentially dangerous for the palmar structures of the wrist. We present a surgical technique of scapholunate ligamentoplasty under arthroscopy, focusing only on the dorsal scapholunate complex: all-dorsal arthroscopic ligamentoplasty. The advantages of all-dorsal arthroscopic ligamentoplasty are that it requires little material, does away with palmar approaches, and focuses only on the dorsal side, simplifying surgery and avoiding the creation of bone tunnels potentially at risk of fracture or avascular necrosis.

Free lateral tarsal artery perforator flap for repair of volar skin defect of thumb.

To investigate the effect of free lateral tarsal artery perforator flap in the repair of the volar skin defect of the thumb. From January 2020 to December 2022, the free lateral tarsal artery perforator flap was used to repair the skin defect of the palmar side of the thumb in 11 cases. There were 9 males and 2 females with an average age of 45 years (range, 35-62 years). The causes of injury were mechanical injury in 8 cases, traffic accident in 3 cases, combined with different degrees of tendon and bone exposure and injury. The time from injury to operation was 1 to 4 hours, with an average of 2.5 hours. The size of the flap ranged from 3.0 cm × 3.0 cm to 5.5 cm × 5.0 cm, and the donor site was repaired with the skin graft. All the flaps and skin grafts survived successfully, and the wounds healed in the first stage. All patients were followed up for 6 to 24 months, with an average of 15 months. The appearance of the flap was good, with normal color, no pigmentation, and a soft texture. The 2-point discrimination of the flap was 6 to 11 mm, with an average of 8.5 mm at 6 months after operation. At the last follow-up, 8 cases were excellent and 3 cases were good according to the trial standard of upper limb function evaluation of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the excellent and good rate was 100%. There was no significant effect on the sensation and function of the feet in the donor site, and the patient satisfaction was high. Free lateral tarsal artery perforator flap is a good choice to repair the skin defect of the palmar side of the thumb because of its simple operation, high survival rate and good sensory recovery of the recipient area.

Replacement of the distal radio-ulnar joint with asemi-constrained Scheker DRUJ prosthesis.

To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis. The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, aScheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty. Severe osteoporosis, active infection, immature skeleton, less than 14cm of the proximal ulna remaining. In supine position with the forearm in full pronation, an ulnar S‑shaped incision is made. The ulnar head is resected and the proximal part is brought to the palmar side to enable visualization of the sigmoid notch. Following preparation of the sigmoid notch and the proximal ulnar part of the radius, aradial plate is attached. When the position is verified with fluoroscopy, screw holes are drilled together with aseparate hole for the radial peg. Ametal stem is inserted in the ulnar shaft. Apolymer ball is then slid on to apolished peg on top of the ulnar stem. This polymer ball is seated in the socket of the radial plate and fixed with asmall metal cap. Radiographic images are made for confirmation of correct positioning and full pro- and supination is tested, after which the wound is closed. After 48 h of pressure bandages, patients are instructed to start with full range of motion and weight-bearing exercises under the guidance of ahand therapist. Weight-bearing is constrained to 10kg. We retrospectively assessed 50Scheker prostheses in 48patients treated between 2016 and 2021. The median age was 56years (IQR: 50-65) and 30 (60%) were female. Median follow-up was 29months (IQR: 12-48). The primary outcome was the PRWE score. The median PRWE score at the final follow-up was 23 (IQR: 4-52) for the operated side versus amedian PRWE score of 5 (IQR: 0-25) for the non-operated side (p < 0.005). Six patients had acomplication. Three patients developed extensor carpi ulnaris tendinitis with one patient requiring additional surgery. One patient developed aneuroma of the distal branch of the ulnar nerve that was surgically removed. One synovectomy was performed because of synovitis and one endoscopic ulnar release was performed because of hyperesthesia of the ulnar area. None of the prostheses had to be removed.

Wide-awake local anesthesia no tourniquet and dexamethasone (WALANT-D) for modified Camitz opponens plasty in severe carpal tunnel syndrome-a retrospective study of 30 cases

BackgroundTo analyze the outcome of modified Camitz opponens plasty using the wide-awake local anesthesia no tourniquet with dexamethasone (WALANT-D) technique in severe carpal tunnel syndrome (CTS). MethodsA retrospective review was performed in 30 hands of 27 patients who underwent Camitz opponens plasty for severe CTS between 2019 and 2021. All patients had 8 mg of dexamethasone mixed with WALANT. Preoperative active palmar abduction, grip strength, side, and pulp pinch strength, Kapandji score, and electrophysiological assessment of compound muscle action potential (CMAP) for abductor pollicis brevis (APB) were compared with the postoperative values. The palmaris longus had dual insertion into the abductor pollicis brevis and extensor expansion. The time interval of post-operative pain-free was noted. The Disabilities of the Arm, Shoulder, and Hand (DASH) and Carpal Tunnel Syndrome instrument (CTSI) also assessed the functional outcome. ResultsThe mean age of patients was 35 years (range 32–58 years). There were five male and 22 female patients. Of the female patients, three females had severe bilateral CTS. Twenty right and ten left hands were affected. The mean follow-up of our study was 12.5 months (range 10–14 months). The patients were pain-free for an average of 19.5 h postoperatively. There was a significant improvement in the thumb palmar abduction, grip strength, side, and pulp pinch strength, DASH score, CTSI, and APB-CMAP (p < 0.05) at the final follow-up. ConclusionsModified Camitz opponens plasty with a dual insertion into APB and extensor expansion effectively improves thumb opposition and daily activities. The tendon tensioning, checking the pulley impingement, appreciation of active movements, and a comfortable patient operative experience are advantages of the WALANT. Adding dexamethasone as an adjuvant to WALANT prolongs the analgesia and duration of the nerve block. Level of evidenceIV, Retrospective case study.