Aims

In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow.

The October 2023 Wrist & Hand Roundup³⁶⁰ looks at: Distal radius fracture management: surgeon factors markedly influence decision-making; Fracture-dislocation of the radiocarpal joint: bony and capsuloligamentar management, outcomes, and long-term complications; Exploring the role of artificial intelligence chatbot in the management of scaphoid fractures; Role of ultrasonography for evaluation of nerve recovery in repaired median nerve lacerations; Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial; Rehabilitation following flexor tendon injury in Zone 2: a randomized controlled study; On the road again: return to driving following minor hand surgery; Open versus single- or dual-portal endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials.

Aims

The ‘pink, pulseless hand’ is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse. The management guidelines are based on the assessment of perfusion, which is difficult to undertake and poorly evaluated objectively. The aim of this study was to review the available literature in order to explore the techniques available for the preoperative clinical assessment of perfusion in these patients and to evaluate the clinical implications.

The December 2022 Wrist & Hand Roundup³⁶⁰ looks at: Anti-tumour necrosis factor therapy for early-stage Dupuytren’s disease; Patient experiences of scaphoid waist fractures and their treatment; Postoperative complications following open a1 pulley release for a trigger finger or thumb; How certain are findings in distal radius fractures: a systematic review of randomized controlled trials; Partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function; Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures; How is reduction lost in distal radius fractures in females aged 50 years and older; The HAND-Q: psychometrics of a new patient-reported outcome measure for clinical and research applications.

Outcomes following carpal tunnel release are generally favorable. Understanding factors that contribute to inferior outcomes may allow for strategies targeted at improving results in these patients. Our purpose was to determine if patients' underlying personality traits, specifically resiliency and catastrophization, impact their post-operative outcomes following carpal tunnel release. A prospective case series was performed. Based on our power analysis, 102 patients were recruited. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale (PCS) and the Brief Resiliency Scale (BRS). A single surgeon, or his resident under supervision, then performed an open carpal release under local anaesthetic. Our primary outcome measure was a repeat BCTQ at three- and six-months. Univariate and multivariate analysis was performed to assess the correlation between PCS and BRS scores and final BCTQ scores. Forty-three and sixty-three participants completed the BCTQ at three and six months respectively. All patients showed improvement in their symptoms (p = 0.001). There was no correlation between patients PCS or BRS and the amount of improvement. There was also no correlation between PCS or BRS and the patients' raw scores at baseline or follow-up. Patients self-assessed resiliency and degree of pain catastrophization has no correlation with the amount of improvement they have three or six months post-operatively. Most patients improved following carpal tunnel release, and patients with low resiliency and high levels of pain catastrophization should expect comparable outcomes to patients without these features

Abstract. Background. Lateral and medial epicondylitis, more commonly known as Tennis and Golfer's elbow, can cause chronic pain and significant functional impairment in working-age patients. For patients with refractory epicondylitis, platelet rich plasma (PRP) of which ACP is a type, is commonly used as an alternative to surgical intervention, but its efficacy is unproven. Objective. To assess the mid-term outcomes of ultrasound guided ACP injections for patients with refractory epicondylitis who have failed conventional conservative treatment. Methods. 77 patients who were treated with PRP for refractory epicondylitis were included in the study. The mean age of patients was 50.3 years (range 36–70), with 30% men and 70% women. The Oxford Elbow Score (OES) and progression to surgery were used to assess the mid-term outcomes. Results. The mean follow up duration was 2.1 years (range 1.0 – 4.2). Post-procedure OES was recorded for thirty-three patients, of these, thirty-one patients (94.0%) demonstrated an improvement in their OES at mid-term follow-up compared to their pre-op score. The mean change in OES was +16 (range −7 to +34), 81.8% exhibited a minimally important change (MIC) in OES of greater than 8.2 points. Of all seventy-seven patients, seventeen (22.1%) underwent open release and twenty-seven (35.1%) patients were lost to follow up. Conclusion. Ultrasound guided ACP injections can be an effective treatment for refractory epicondylitis and is likely to prevent the need for surgery. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Aims

The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery.

Introduction. The role for hip arthroscopy (HS) in combination with periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia has not been clearly defined. In this study, we assessed midterm outcomes of concurrent hip arthroscopy and PAO (HS/PAO) for the treatment of symptomatic acetabular dysplasia with associated intra-articular pathology. Methods. We performed a retrospective review of concurrent HS/PAO cases in a prospectively collected institutional hip preservation database. From November 2005 to December 2012, 85 hips in 80 patients underwent combined HS/PAO. Two hips had a diagnosis other than acetabular dysplasia and 12 hips were lost to follow up, leaving 71 hips for analysis at mean 6.6-year follow-up (range 4–11 years). Hips were evaluated using the University of California, Los Angeles (UCLA) Activity Score, modified Harris Hip Score (mHHS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore. Hips were stratified into preserved or failed groups, with failure defined as conversion to THA or a symptomatic hip (mHHS <70 or WOMAC pain subscore > 10). Complications were recorded and graded by the Clavien-Dindo classification. Regression analyses were performed to identify the interaction between patient factors, radiographic measures, and surgical details with outcome. Results. At final follow-up, two hips had undergone THA and an additional 15 hips were deemed symptomatic. 54 hips (76.1%) did not undergo conversion to THA or meet symptom thresholds, and this group had mean mHHS 92.1 ± 8.8, UCLA activity score 7.8 ± 2.1, and WOMAC pain subscore 1.8 ± 2.4. In univariate analysis, no patient factors, pre- or post-operative radiographic metrics, or intra-operative findings or procedures were associated with failure. There were 3 (4.2%) major complications (Clavien-Dindo Grade III or IV), and 5 patients underwent repeat surgery for recurrent symptoms (4 hip arthroscopy, 1 open psoas release with ramus osteoplasty) during the follow up period with resolution of symptoms following repeat surgery. Conclusion. This study demonstrates that concurrent hip arthroscopy and periacetabular osteotomy is associated with good clinical outcomes and an acceptable complication profile at midterm follow up

Aims. Few studies have examined the long-term outcome of carpal tunnel release (CTR). The aim of this study was to evaluate the patient-reported long-term outcome of CTR for electrophysiologically severe carpal tunnel syndrome (CTS). Patients and Methods. We reviewed the long-term outcome of 40 patients with bilateral severe CTS who underwent 80 CTRs (46 open, 34 endoscopic) between 2002 and 2012. The outcomes studied were patient-reported outcomes of numbness resolution, the Boston Carpal Tunnel Questionnaire (BCTQ) score, and patient satisfaction. Results. The mean follow-up was 9.3 years. Complete resolution of numbness was reported by 93.8% of patients, persistent numbness by 3.8%, and recurrent numbness by 2.5%. The mean BCTQ symptom score was 1.1 (. sd. 0.3; 1.0 to 2.55) and the mean Boston function score was 1.15 (. sd. 0.46; 1.0 to 3.5). 72.5% of patients were asymptomatic and had no functional impairment. Men had poorer outcomes than women and patients < 55 years had poorer outcomes than patients ≥ 55 years. All patients who had undergone endoscopic CTR reported complete resolution of numbness compared with 89.1% of those who had undergone open release (p = 0.047). There was no significant difference in outcome between dominant and non-dominant hands. Patient satisfaction rates were good. There were no adverse events. Conclusion. CTR has a favourable outcome and good rates of satisfaction, even in patients with bilateral severe CTS at a mean of nine years after surgery. Endoscopic CTR has a higher rate of numbness resolution than open surgery. There were no significant differences in outcome between the dominant and non-dominant hand. Cite this article: Bone Joint J 2017;99-B:1348–53

Aims

Manipulation under anaesthetic (MUA) is a recognised form of treatment for patients with a frozen shoulder. However, not all patients benefit. Some have persistent or recurrent symptoms. There are no clear recommendations in the literature on the optimal management of recurrent frozen shoulder after a MUA. We aimed to address this issue in this study.

Aims

The aims of this study were to evaluate the clinical and radiological outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients with rheumatoid arthritis.

The best surgical treatment of lateral epicondylitis remains uncertain. Recently radiofrequency microtenotomy (RFMT) has been proposed as a suitable surgical treatment. We aim to compare open release with RFMT and present the results of our randomised controlled trial. Patients with symptoms of tennis elbow for at least 6 months who had failed to respond to conservative management were included in the trial. They were randomised to open release or RFMT. Outcome measures included grip strength, pain and DASH scores. 41 patients were randomised, 23 to RFMT and 18 to open release, 2 patients withdrew from the study. Our results show that both treatments give a significant benefit at all time points for DASH and pain scores, but only open release gives a significant improvement in grip strength. Comparing the two treatments the only significant difference is the open group have better pain scores at 6 weeks, but this is not seen at later follow up. In conclusion both groups have shown benefit from the treatments, but one is not shown to be clearly superior

The June 2015 Wrist & Hand Roundup360 looks at: Collagenase and Dupuytren’s disease – a genuine alternative to surgery?; iPad PROMise?; Should we learn how to do endoscopic carpal tunnel release?; Two-week radiographs a relic of the past?; Bible? Aspirate or excise?; Patient expectations and trapeziometacarpal osteoarthritis; Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

The April 2015 Wrist & Hand Roundup360 looks at: Non-operative hand fracture management; From the sublime to the ridiculous?; A novel approach to carpal tunnel decompression; Osteoporosis and functional scores in the distal radius; Ulnar variance and force distribution; Tourniquets in carpal tunnel under the spotlight; Scaphoid fractures reclassified; Osteoporosis and distal radial fracture fixation; PROMISing results in the upper limb

We report a new surgical technique of open carpal tunnel release with subneural reconstruction of the transverse carpal ligament and compare this with isolated open and endoscopic carpal tunnel release. Between December 2007 and October 2011, 213 patients with carpal tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to 67) were recruited from three different centres and were randomly allocated to three groups: group A, open carpal tunnel release with subneural reconstruction of the transverse carpal ligament (n = 68); group B, isolated open carpal tunnel release (n = 92); and group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no significant difference between the groups in terms of severity of symptoms or lateral grip strength. Compared with groups B and C, group A had significantly better functional status, cylindrical grip strength and pinch grip strength. There were significant differences in Michigan Hand Outcome scores between groups A and B, A and C, and B and C. Group A had the best functional status, cylindrical grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during carpal tunnel decompression maximises hand strength by stabilising the transverse carpal arch. Cite this article: Bone Joint J 2015;97-B:221–8

Aim:. To investigate the clinical outcomes of elbows with post-traumatic stiffness treated by open surgical release. Methods:. A retrospective review was completed on thirty-five consecutively managed patients who underwent an open elbow release for post-traumatic stiffness between 2007 and 2012. Pre-operative and post-operative range of motion (ROM), pain scores and functional outcomes were recorded. Results:. Mean follow-up was 31 months (6–84). The cohort consisted of 20 male and 15 female patients with an average age at time of surgery of 34 years (17–59). The interval from injury to time of release was 26 months (6–180). An improvement in mean ROM from 49° (0°–105°) to 102° (55°–150°) was obtained. The improvement in ROM in patients with pre-operative heterotopic bone was 61° compared to 45° in patients without heterotopic bone. The mean Mayo Elbow Performance Score improved from 44 pre-operatively to 82 at most recent follow-up. Mean VAS scores improved from 5.9 pre-operatively to 2.8 at most recent follow-up. Patients rated the affected elbow a mean of 73% as compared to the contralateral/normal side (50–100%). Apart from a 10% incidence of transient ulnar nerve neurapraxia in patients who had a medial or combined approach, complication rates and functional outcomes were comparable between medial, lateral and combined approaches. Conclusion:. Open release for post-traumatic elbow stiffness results in satisfactory functional outcomes in the majority of cases, with no significant differences between medial, lateral or combined approaches