Wrist Surgery Research Articles

Effect of Ultrasound-guided Nerve Block With 0.75% Ropivacaine at the Mid-forearm on the Prevalence of Moderate to Severe Pain After Hand Surgery

PurposeThis study tested the hypothesis that ultrasound-guided mid-forearm nerve block with 0.75% ropivacaine reduces the prevalence of moderate to severe pain after wrist and hand surgery, and provides prolonged postoperative analgesia with minimal motor blockade. MethodsThirty patients undergoing elective wrist and hand surgery were randomly assigned to 1 of 2 groups: group R (n = 15) and group NS (n = 15). We combined an ultrasound-guided supraclavicular brachial plexus block with mid-forearm median, radial, and ulnar nerve block in all patients. The supraclavicular brachial plexus was blocked with 20 mL of 1.5% lidocaine, and the mid-forearm nerves were blocked with 15 mL of either 0.75% ropivacaine (group R) or normal saline (5 mL each nerve) (group NS). A blinded observer provided a numeric rating pain score at 1, 2, 6, 12, 24, and 48 hours after surgery. The durations of sensory and motor blockade, patient satisfaction, morphine requirement for postoperative pain rescue, and adverse events were recorded. FindingsThe prevalence of moderate to severe pain in group R was significantly lower than that in group NS (33% vs 86%; P = 0.008). The highest mean (SD) numeric rating pain score (worst pain) in group R was lower than that in group NS (2.7 [1.9] vs 5.6 [2.9]; P = 0.004), and the median (Q1, Q3) amount of morphine required for postoperative pain rescue in group R was lower than that in group NS (0 [0, 6] vs 8 [6, 10]; P = 0.001]. Additionally, there were no differences in the durations of motor blockade between the 2 groups. ImplicationsBased on the findings from this study, ultrasound-guided mid-forearm nerve block with 0.75% ropivacaine significantly reduces the prevalence of moderate to severe pain after wrist and hand surgery, provides long-term postoperative analgesia, and facilitates the return of motor function in the upper limb. Chinese Clinical Trial Registry identifier: ChiCTR-IOR-15007278 (October 2015).

Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial.

Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%-17.1%] vs 24.4% [interquartile range, 10.2%-31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%-11.1%] vs 19.3% [interquartile range, 13.7%-33.2%]; P = 0.001) were also lower in group CP than in group NC. The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769.

F28. Carpal tunnel syndrome in patients with and without diabetes mellitus in upper Egypt: The impact of electrophysiological and ultrasonographical studies

Carpal tunnel syndrome (CTS) is the most common form of entrapment neuropathies. In addition, previous studies stated that diabetes mellitus (DM) is also considered as a risk factor with a higher incidence of CTS in patients with pre-diabetes. Nerve conduction studies alone do not provide spatial information regarding the nerve or its attendant abnormalities. US can detect the median nerve compression characteristics; provide anatomical images of the median nerve, neighboring structures and space occupying lesions as ganglia neural tumors. US has been used in clinical evaluation of CTS in diabetic neuropathy. The purpose of this study is to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non- DM-CTS patients. To correlate the diagnostic results in both DM and non-DM-CTS patients. Thirty-six non-diabetic patients and twenty-five diabetic patients with CTS were assessed. their ages ranged 23–82 years old (mean ± SD 35.01 ± 3.17 years. Pregnant women, those diabetic patients with clinical and electrophysiologic diagnosis of diabetic polyneuropathy, those with history of underlying disorders associated with CTS such as renal and hepatic diseases, patients with gout, rheumatoid arthritis or thyroid disease, patients with previous wrist surgery (including carpal tunnel injection), and those with clinical or electrophysiological evidence of accompanying condition that mimics CTS as cervical radiculopathy. A written consent was obtained from all participants and approval from the local ethics committee of Faculty of Medicine, Aswan and Assuit Universities was obtained All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography. The diagnostic criteria of electrodiagnostic tests for CTS were according to Delisa et al. (1994). The median nerve was examined in the transverse and longitudinal planes along the carpal tunnel by gray scale US to investigate the presence of median nerve compression criteria, including the measurement of cross sectional area (CSA) and flattening ratio of median nerve. High mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups.Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients. The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. The electrodiagnostic parameters are not predictors of CTS in patients with diabetes.The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.

488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist

ObjectivesEvaluate the incidence of digital infarction and tissue necrosis using local anesthesia with 1% lidocaine and 1:100,000 epinephrine in wrist, hand, and fingers surgeries, without a tourniquet, without sedation, and without an anesthesiologist. MethodsPatients with wrist, hand, and fingers disorders prospectively underwent surgery under local anesthesia with 1% lidocaine and 1:100,000 epinephrine. The primary outcomes evaluated were the presence of digital infarction and tissue loss due to necrosis. As secondary outcomes, the need for the use of sedatives, tourniquet, anesthesiologist assistance, or surgery suspension were evaluated. ResultsFifty-three wrists, 307 hands, and 128 fingers were anesthetized with lidocaine and epinephrine without any complications related to epinephrine. There was no patient that presented with any of the primary or secondary outcomes. ConclusionsWrist, hand, and fingers surgeries can be safely performed with local anesthesia with 1% lidocaine and 1:100,000 epinephrine, without sedation, without a tourniquet, and without an anesthesiologist.

Neurologic complications in common wrist and hand surgical procedures.

Nerve dysfunction after upper extremity orthopedic surgery is a recognized complication, and may result from a variety of different causes. Hand and wrist surgery require incisions and retraction that necessarily border on small peripheral nerves, which may be difficult to identify and protect with absolute certainty. This article reviews the rates and ranges of reported nerve dysfunction with respect to common surgical interventions for the distal upper extremity, including wrist arthroplasty, wrist arthrodesis, wrist arthroscopy, distal radius open reduction and internal fixation, carpal tunnel release, and thumb carpometacarpal surgery. A relatively large range of neurologic complications is reported, however many of the studies cited involve relatively small numbers of patients, and only rarely are neurologic complications included as primary outcome measures. Knowledge of these neurologic outcomes should help the surgeon to better counsel patients with regard to perioperative risk, as well as provide insight into workup and management of any adverse neurologic outcomes that may arise.

What's New in Hand and Wrist Surgery.

1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota aE-mail address: [email protected]

Complex Regional Pain Syndrome After Distal Radius Fracture Is Uncommon and Is Often Associated With Fibromyalgia.

Complex regional pain syndrome (CRPS) is frequently diagnosed in patients recovering from surgery or injury. The symptoms and signs included in consensus diagnostic criteria for CRPS are expected after injury. Categorizing symptoms and signs that occur on a continuum as disproportionate or not is subjective and prone to bias. Psychiatrists and psychologists do not diagnose CRPS and instead measure and treat anxiety and catastrophic thinking on its continuum. Given the expected variation in subjective diagnoses such as CRPS, this study addresses factors associated with use of this diagnosis and how it influences care. (1) Among patients recovering from fracture of the distal radius, what factors are associated with the diagnosis of CRPS? (2) Are patients diagnosed with CRPS after distal radius fractures, as opposed to those without CRPS, more likely to have a bone scan, stellate ganglion block, therapy, or subsequent surgery? Using the Truven database, we identified 59,765 patients treated for a distal radius fracture from 2012 to 2014, of whom 114 (0.19%) were diagnosed with CRPS. The Truven Health MarketScan database is an administrative claims data set of commercially insured patients and this analysis only included patients with complete enrollment from 2012 through 2014. Bivariate analyses sought differences between patients diagnosed with and patients not diagnosed with CRPS. All factors with p < 0.05 were included in a multivariable logistic regression model. The covariates older age (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.011-1.048; p = 0.002), gender (women at greater risk, OR, 3.86; CI, 1.99-7.49; p < 0.001), concomitant fracture of the distal ulna (OR, 1.54; CI, 1.05-2.23; p = 0.029), open fracture (OR, 0.414; CI, 0.192-0.895; p = 0.025), and comorbid fibromyalgia (OR, 16.0; CI, 4.92-51.8; p < 0.001) were independently associated with a diagnosis of CRPS among patients recovering from a fracture of the distal radius. Patients diagnosed with CRPS are more likely than other patients with a distal radius fracture to have had a bone scan (OR, 66.0; CI, 8.19-532; p < 0.001), physical or occupational therapy (OR, 3.89; CI, 2.68-5.67; p < 0.001), and subsequent wrist surgery (OR, 2.52; CI, 1.65-3.84; p < 0.001). No one had a stellate ganglion injection. We found that a coded diagnosis of CPRS is uncommonly applied to patients on the higher range of pain, stiffness, and limitations after fracture of the distal radius-most commonly in women and in association with another nonspecific, objectively unverifiable diagnosis (fibromyalgia)-and that this label may lead to more testing and invasive treatment. Future research should address the utility and value of diagnoses that create subjective categories for aspects of human illness that occur on a continuum. Level III, prognostic study.

The impact of wrist fracture, surgical repair and immobilization on patients: a qualitative study

Objective: To investigate patients’ experience following wrist fracture, surgical repair and immobilization. Design: A qualitative investigation involving individual participant interviews. Setting: A metropolitan trauma service. Subjects: In all, 31 participants were consecutively recruited from three groups within a randomized controlled trial comparing immobilization for one (n = 11), three (n = 10) or six weeks (n = 10) following surgical treatment for wrist fracture. Intervention: Individual interviews were conducted within three months of cast removal. Questions prompted discussion of the experience of fracture, surgery and immobilization. Interviews were audio-recorded, transcribed verbatim. At least two independent researchers performed coding and theming following principles of thematic analysis. Results: Two themes were identified: (1) impact of the injury varies widely and (2) health care consumers want trustworthy dialogue. Participant reports indicated that recovery from wrist fracture, surgery and immobilization is challenging with significant changes to social role and increased dependence. For many, lack of empathy from health professionals and limited acknowledgement of the personal impact of injury led to dissatisfaction. Health professionals did not consistently tailor communication or adopt strategies to address specific needs for pain management, education and support requirements. There was no evidence that processes were implemented to enhance participant recall and comprehension. Most participants experienced their cast as a barrier to function. However, within the group of participants immobilized for one week, a number felt the cast was removed too soon. Conclusion: Participant reports indicate that recovery from surgically repaired wrist fracture is challenging. Opportunities exist to refine care in pain management, education and active engagement of patients in their care.

Wrist malpractice claims in Northern Norway 2005–2014. Lessons to be learned

ABSTRACTRough weather conditions in the subarctic areas of Norway may influence on the risk of wrist fracture. We implemented data from the Norwegian System of Patient Injury Compensation (NPE). All claims due to wrist surgery, performed at the public hospitals in Northern Norway, during 2005-2014 were analyzed. We employed the ICD-10 classification codes S52.5 (fracture of distal end of radius) and S52.6 (fracture of distal end of radius and ulna). Treatment was defined by NCSP codes. 84 patients (0.3%) complained. Females complained four times more often than males did (P = 0.005) and received five times more frequently a compensation (P < 0.001). NPE accepted 34 claims (40%) for injury compensation (0.1% of patients). The percentage of claims accepted for compensation decreased from 48% to 30% during study period, probably due to delay in filling claims. The main causes of complains were pain, reduced range of motion, malfunction and weakness (35/84). The main causes of compensation were “operative treatment should have been performed” (14/34) and “wrong operative method applied” (13/34). The mean amount per compensation was €14,927 (€0–€52,995). Stonger focus on quality of care, updated guidelines and shared decission-making may reduce the number og complains and compensations.

Anaesthesia for open wrist fracture surgery in adults/elderly

Anaesthetic technique for open surgery of acute distal for arm fracture in adults/elderly is not well defined. Regional anaesthesia, general anaesthesia or a combined general and regional block may be considered. General anaesthetic technique, the timing and drug/drug combination for the regional block must also be considered. This is a study around published studies assessing anaesthtic technique for wrist surgery. A systematic database search was performed and papers describing the effect of anaesthetic techniques were included. We found sparse evidence for what anaesthetic technique is optimal for open wrist fracture repair. In total only six studies were found using our inclusion criteria, which all supported the short term, early recovery benefits of regional anaesthesia as part of multi-modal analgesia. More protracted outcomes and putting the type of block into context of quality of recovery and patients’ satisfaction is lacking in the literature. The risk for a pain rebound when the block vanishes should also be acknowledged. Therefore, further high quality studies are warranted concerning the anaesthetic technique for this type of surgery.

Costal osteo-chondral autograft in hand and wrist surgery

Previous studies have described osteo-chondral costal vascularized autograft with a pedicled myo-osteous serratus anterior, a transverse rectus abdominis myocutaneous flap combined with vascularized costal cartilages and a case of vascularized osteochondral costal graft to replace the proximal pole of the scaphoid, partially successful. This study evaluates the feasibility of vascularized osteo-chondral costal autografts in the treatment of hand and wrist degenerative and post traumatic arthritis+ and describe the different types of possible grafts adapted to this specific indication. Sacrifice of the a rib cartilage to access the internal mammary vessels for breast reconstruction has become frequent and safe, with very few thoracic complications. This piece of cartilage resected and thrown away could be kept to reconstruct other deficient part of the body, with minimal complications. This study is based on thorax CT scans with intravenous contrast injection, wrist and hand CT scans, anatomic cadavers’ dissections data and information obtained in the literature. Random patients were included from the imaging software database of public hospitals of Marseille, we selected ten (five women and five men) normal thoracic injected CT- scans and ten normal hand and wrist CT-scans (five women and five men). Precise measures of ribs and carpal bones size and vessels’ (internal mammary arteries) position and size were taken on these scans. We then did dissections to put into practice the alternatives deducted from CT scans studies. The morbidity of previous costal vascularized autografts is important, and the vascularization not very reliable (based on anastomoses, secondary vessels). A myo-osteous flap implies a large and bulky tissue, which is difficult to manage in hand and wrist surgeries. Degenerative and post-traumatic arthritis of hand and wrist joints are still difficult to treat with generally bad outcomes, in certain situations other vascularized grafts (femoral condyle graft, iliac crest graft) are proposed. This work points out different possible safe sites of osteo-chondral costal vascularized autograft's harvest. These possible grafts have strong vascularization's reliability, large vessels’ caliber, long pedicle, and very low donor site morbidity. The third or fourth rib either cartilage only or osteo-chondral graft can be harvested on the internal mammary vessels (with direct branches to the periosteum). Another ideal location, even more for women (scar in the inframammary fold), is the sixth rib, more prone to cartilaginous harvest only, based on the musculo-phrenic artery.

Six cas de série de patients de Magnezix®. Une vis métallique absorbable pour la fixation de la fracture du carpe et des fusions entre les carpes

This is a case series of carpal fracture fixations and intercarpal fusions using the Magnezix® absorbable metallic screw. The Magnezix® screw is an absorbable metallic bone screw that is replaced with “bone-like” tissue on full absorption. The screw is made of a magnesium alloy and as such is able to be metabolised by the body. The screw is cannulated and comes in varying sizes. This implant has been used in Ireland for 18 months now but has been widely used in Europe. Six cases in total are presented using the 3.2 mm Magnezix® screw + three scaphoid fixations (two acute and one revision case) and three inter-carpal fusions (one middle column fusion, one trapezio-trapezoid fusion and a third CMCJ fusion). One screw was used in the acute scaphoid fixations+ two screws were used for the revision fixation of scaphoid with bone grafting + two screws for the first two inter-carpal fusion cases and one screw of the third CMCJ fusion. All procedures were carried out by the author. Follow-up of between 6 months and 18 months is available for all patients. One patient has temporarily been lost to follow-up (an acute scaphoid fixation – partial healing at six weeks was noted on imaging). Of the remaining five cases, four were clinically united on follow-up and imaging showed progression of healing at six weeks and twelve weeks in the remainder. Gas formation and lucency is evident on all post-operative films and is recognised in the use of this implant. No systemic complications are reported. One failure of fixation occurred due to technical issues in the middle column fusion case. This case series presents favourable follow-up series of this “new” absorbable magnesium alloy screw with potential benefits that can be utilised in hand and wrist surgery. The screw shows further promising results in the presented cases other than the failure for technical issues. The screw has added benefits of not needing to be removed also and could show advantageous properties if the “bone-like tissue” produced on full absorption can add strength to fusion masses. Further longer term follow-up is required.

Hand and wrist joint procedures in sclerodermic patients – a systematic review

Hand reconstructive surgery in systemic sclerosis has long time been considered a taboo due to the frequent global stiffness and menaced wound healing associated with digital ischemia and skin tightness. We assumed that joint procedures to sclerodermic hands or wrists have not a higher rate of infection, wound healing problem or non-union in comparison to non-sclerodermic population. We systematically reviewed the literature assessing these complications after performing joint reconstruction in hands and wrists of sclerodermic patients. Studies were identified through systematic review of the available literature in the Pubmed Medline, Cochrane Central Register of Controlled Trials, Embase, Web of Science database up to May 3rd, 2017. Database was searched using a set of search terms, which described systemic sclerosis, bone and joint surgery, and hand or wrist surgery. Only studies including joint procedures in hands or wrists of sclerodermic patients that were related to the functional outcomes and morbidity after surgery were selected. Reviews were excluded. Studies relevant to soft tissue reconstruction in sclerodermic hands or wrists, such as digital sympathectomy, autologous adipose-derived stromal vascular fraction, vascular reconstruction or management of finger ulcers were also excluded. Results A total of 265 unique articles were identified in PubMed. Thirty-eight titles selected for abstract review. Twenty-nine abstracts did not meet the inclusion criteria or did not evaluate our predefined endpoint and were excluded. Nine articles were fully read and two more articles were considered irrelevant and excluded. Seven studies were deemed eligible for our systematic review. One hundred and sixteen sclerodermic patients were found. A total of 402 joint procedures in sclerodermic hand and wrist were exported. The operations concerned metacarpophalangeal and interphalangeal arthroplasty, joint replacement or fusion, Kapandji procedures, osteotomy of the finger and removal of the hardware. A low complications rate in terms of infection or digital ischemia after surgery was mentioned to all studies. In most of the cases, wound healing was uneventful and only in some cases, it was described slow. In cases of joint fusion, bone healing was successfully achieved. The functional outcome was reliable in all the cases. The wrist and hand joint procedures in systemic sclerosis were found to be reliable and related to low morbidity in terms of infection rate, wound healing and bone union. Results from future studies will unquestionably contribute to further establishment of knowledge about the therapeutic outcome after surgery in these suboptimal conditions of the sclerodermic hand.

The use of osteochondral flaps in the treatment of carpal disorders.

Vascularized osteochondral flaps have been described for use in reconstruction of the wrist, providing the benefits of osteochondral grafts in addition to the benefit of osseous and subchondral perfusion via the microvascular pedicle. Various harvest sites have been described including the medial and lateral femoral trochlea and the proximal third metatarsal. The reconstructed surfaces described include the cartilage surfaces of the scaphoid, lunate, capitate and radius. The ability to transfer analogous osteochondral surfaces poses the possibility for new motion-preserving alternatives for difficult articular problems previously treated with salvage procedures. A description of the procedures and reported outcomes are provided, as well as a discussion of the role of these procedures in the future of wrist surgery.

Thirty-Day Reoperation and/or Admission After Elective Hand Surgery in Adults: A10-Year Review.

Whereas acute complications following elective hand surgery have been assumed to be rare, the incidence of 30-day unplanned reoperation and/or admission for the most common elective procedures has not been well described. Our goal was to calculate the incidence and identify the risk factors associated with these complications in a busy academic practice. Our institution's quality assurance database was examined retrospectively for unplanned reoperations and/or admissions within 30 days in adults undergoing elective procedures with 2 senior attending surgeons from February 2006 to January 2016. Each event was categorized by causative factor and charts were reviewed to establish risk factors and cultured organisms. Our billing database was examined for the concomitant procedural volume. In our cohort of 18,081 surgeries (57.6% carpal tunnel or trigger digit releases), 27 patients had an unplanned reoperation and/or admission within 30 days (0.15% total incidence; including carpal tunnel release, 0.10%; trigger digit release, 0.09%; major wrist surgery, 0.74%) including 17 infections (0.09%). These were unevenly distributed over time after surgery with 29.6% occurring within 7 days, 59.2% in 8 to 14 days, 11.1% in 15 to 21 days, and none between 22 and 30 days. Reoperations and/or unplanned admission within 30 days after elective hand surgery are infrequent (15 per 10,000 cases) and are most commonly related to infections (63.0%). More invasive surgeries are associated with a higher incidence than simpler procedures, and these complications are most likely to occur within 3 weeks after surgery. These data in elective patients do not cover certain clinically relevant outcomes, such as chronic pain or limited function, and may not be generalizable to all practices. Therapeutic IV.

Anaesthesia for open wrist fracture surgery in adults/elderly.

Anaesthetic technique for open surgery of acute distal for arm fracture in adults/elderly is not well defined. Regional anaesthesia, general anaesthesia or a combined general and regional block may be considered. General anaesthetic technique, the timing and drug/drug combination for the regional block must also be considered. This is a study around published studies assessing anaesthtic technique for wrist surgery. A systematic database search was performed and papers describing the effect of anaesthetic techniques were included. We found sparse evidence for what anaesthetic technique is optimal for open wrist fracture repair. In total only six studies were found using our inclusion criteria, which all supported the short term, early recovery benefits of regional anaesthesia as part of multi-modal analgesia. More protracted outcomes and putting the type of block into context of quality of recovery and patients' satisfaction is lacking in the literature. The risk for a pain rebound when the block vanishes should also be acknowledged. Therefore, further high quality studies are warranted concerning the anaesthetic technique for this type of surgery.

Normative data for the Patient-Rated Wrist Evaluation questionnaire

Study DesignCross-sectional study. IntroductionThe Patient-Rated Wrist Evaluation (PRWE) questionnaire is used to evaluate functional outcomes after treatment of wrist and hand injuries and nontraumatic conditions. Since patients commonly present with an injury, it is impossible to assess preinjury physical functioning. Therefore, it is important to be aware of the population-based normative data. Purpose of the StudyThe aim of this study was to determine the normative data for the PRWE questionnaire. Secondary, we aimed to determine if there were factors influencing these normative data. MethodsVisitors and employees of 4 hospitals were requested to participate. Excluded were all participants who were scheduled for surgery or were in treatment or after treatment for an injury of the wrist or hand within 1 year after trauma. All participants were asked to complete the PRWE questionnaire and were asked for their age, sex, history of wrist or hand fracture or surgery, daily activities, and the type of employment. The socioeconomic status was determined based on the zip code. ResultsThe median PRWE score was 0 (interquartile range: 0-8.5) and the mean score 7.7 (standard deviation: 15.0). Women had significantly higher scores compared to men, and younger individuals had significantly lower scores. Participants with a history of wrist or hand fracture or surgery, and participants who were unfit for work had significantly higher scores. Socioeconomic status was not correlated with the PRWE score. DiscussionThe purpose was to provide an representative overview of the normative data for the normal population. We did not want to present the data of an unnatural healthy population, which is not representative of the normal population. Deleting patients with chronic wrist or hand complaints, would have resulted in normative values which are not representable for the normal, average population. ConclusionLow scores are observed for the PRWE in the general population. These scores are age and sex dependent and are higher in individuals with a history of wrist or hand fracture or surgery or who are unfit for work.

PP.19.22] VALIDATION OF A NEW CENTRAL AORTIC PRESSURE MEASUREMENT EQUIPMENT AORTIC COMPARED WITH SPHYGMOCOR

Objective: To validate a new non-invasive Central Aortic Pressure (PAC) equipment by Aortic radial tonometry compared to Sphygmocor. Design and method: Subjects from 18 to 80 year old, stratified into 3 groups: <30, 30–60 > 60 years with equal number of hypertensive and healthy volunteers in each stratum. Exclusion criteria: BMI>30 Kg/m2, pregnancy, arrhythmias, wrist surgery or alterations that prevented radial pulse measurement. Anthropometric measurements were performed, the brachial blood pressure (BP) was measured in triplicate, so standardized with automatic device (OMROM HEM 705CP). Three measurements of the PAC were performed with the Aortic equipment (PACAort) and 3 with the Sphygmocor (PACSphyg) alternately, on the right side, without previous consumption of alcohol and coffee. Statistical analysis: Bland-Altman method to evaluate the degree of agreement between the measurements of both devices. The recommendations of the American Association for the Advancement of Medical Instruments (AAMI) were considered for the assessment of the degree of agreement: mean differences <5 mmHg and standard deviation <8 mmHg. Protocol approved by the institutional ethics committee. The study was carried out independently and for academic purposes. Results: 85 subjects, mean age 46 (18–80); 45 women and 40 men; BMI 25.1 ± 2.8; 6 measurements performed per patient (total 510 determinations). The PACAort was strongly correlated with the PACSphyg (R2 0.96; y = 0.31 + 0.99 p < 0.001). The mean PACSphyg was 109.3 ± 12.05 mmHg, the average PACAort 109.0 ± 12.2 mmHg. No bias or proportionality observed. The Bland-Altman method showed: mean of differences (PACSphyg - PACAort) 0.35 ± 2.43 mmHg (95% CI - 0.17 to 0.87). The coefficient of repeatability was 9.48 and coefficient of variation was 4.8% for Sphygmocor and 9.91 and 4.9% for Aortic.Conclusions: Measurement of PAC with Aortic equipment shows an excellent degree of agreement with Sphygmocor.

Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents.

Background To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. Purpose The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. Materials and Methods We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE). Results Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome. Conclusion Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings. Level of Evidence Level IV, therapeutic case series.

Using the Rasch Model to Develop a Measure of Participation Capturing the Full Range of Participation Characteristics for the Patients with Hand Injuries.

Objective The purpose of this paper was to report on the first step in the development of a new instrument to measure participation including the full range of its characteristics. Methods The 30-item participation behavior questionnaire (PBQ) was developed from four main sources (a literature review of the theatrical basis of participation, available participation measures, and interviews with patients and experts about participation). Item selection and the reliability and validity of the measure were explored using Rasch measurement modeling for analysis. Participants A total of 404 individuals referred to rehabilitation after hand, wrist, or upper extremity surgery to reduce impairment from trauma, at least 2 months post-injury. Results An initial pool of 100 items; reflecting 14 characteristics of participation was initially reduced to 91 items after review by 15 participation experts and then further reduced to 30 items by three rounds of Rasch analysis removing misfitting items. The final PBQ has a person reliability of 0.91 with separation of 3.22, indicating it can reliably differentiate four levels of participation. There are no misfitting items and the instrument is unidimensional. All 14 characteristics of participation were retained in the PBQ, and none of the 30 items refer specifically to upper extremity issues. Conclusion The 30 participation behavior items of the PBQ show promise of being a psychometrically sound measure of participation. Further research is needed to validate the PBQ in samples of people with a range of other disabilities.