Initially, all surgeons in Australia were generalists and those with an interest in the anatomy of the hand performed hand surgery. Early hand surgeons, such as Benjamin Rank, excelled and Rank and Wakefield's Textbook of Hand Surgery was widely used throughout the world. Eventually, groups of like-minded surgeons formed the Australian Hand Club in 1972, which subsequently became formalised as The Australian Hand Surgery Society (AHSS), in 2001. A very high standard of hand surgery has been achieved in Australia, with most hand surgeons having trained in either plastic surgery or orthopaedic surgery, and then further trained in Fellowships in Europe or North America. Bernard O'Brien and John Hueston achieved international recognition in the field of microsurgery and Dupuytren's surgery. Wayne Morrison has been responsible for pioneering work in toe–to–hand transfer and basic research. Tim Herbert changed the way fractures of the scaphoid are managed throughout the world. In 2007 the AHSS commenced a Travelling Fellowship Programme to facilitate an increased involvement in Australia in academic hand surgery and to foster contacts between hand surgeons of the future. At the present time, the AHSS is concentrating on education and training in order to raise the overall standard of management of hand surgery, particularly in relation to after hours' trauma. This is particularly necessary in rural and regional areas where hand surgery has traditionally been treated by occasional practitioners. There is a risk that hand surgery falls between the two stools of plastic surgery and orthopaedic surgery and the AHSS wishes to further formalise training and education within the Royal Australasian College of Surgeons (RACS) as a single training stream in the future. There are potential threats both within and without, with safe working hours a particular threat in relation to reducing both the quantity and quality of training. The future will almost certainly involve greater emphasis on biomaterials and prosthetic compounds, but trying to ensure a uniformly high standard of hand surgery management throughout the country will remain as a primary focus

This study aims to determine the incidence of surgical site infection leading to reoperation for sepsis following minor hand procedures performed outside the main operating room using field sterility in the South African setting. The investigators retrospectively reviewed the records of 485 patients who had WALANT-assisted minor hand surgery outside a main operating theatre, a field sterility setting between March 2019 and April 2023. The primary outcome was the presence or absence of deep surgical site infection that required reoperation within four weeks. Cases included where elective WALANT minor hand procedures, a minimum age of 18 with complete clinical records. The patients were mostly female (54.8%), with a mean age of 56.35 years. The majority of cases were trigger finger and carpal tunnel release. An overall 485 cases were reviewed, the deep surgical site infection rate resulting in reoperation within 4 weeks post-operatively was 1.24% ((95% Confidence Interval (CI) 0.0034 to 0.0237); p = 0.009). Minor hand procedures performed under field sterility using WALANT have a low surgical site infection rate. The current study's infection rates are comparable to international surgical site infection rates for similar surgeries performed in main operating rooms using standard sterilisation procedures. Field sterility is a safe and acceptable clinical practice that may improve work efficiency in public sector

Pediatric hand surgery in general requires special considerations and this is even more true when planning surgery in children with CP. It is important for the surgeon to realize that the functional problems these children exhibit have their cause in a brain damage which is not amenable to hand surgical treatment. Therefore it is crucial to carefully analyze each child’s impairment including the voluntary motor control and the child’s specific needs before endeavoring into surgery. Associated impairments, such as mental retardation, nutritional problems, epilepsy, dystonia or severe sensory deficits may influence decision-making, but the crucial factor is often the child’s own wish for an improved function. A child that completely neglects his or her extremity is usually not helped by surgery, at least not in an attempt to get a better hand function. Hand surgery in CP mainly comes down to three techniques: 1. Reducing strength in spastic muscles by release operation, either at the origin of the muscle, at the insertion or as a fractional lengthening at the musculo-tendinous junction, 2. Increasing strength in weak antagonists by tendon transfer or 3. Stabilizing joints through an arthrodesis or a tenodesis. Most often a combination of these techniques is used. Almost all hand surgeons in this field have acquired their personal choice of procedures and scientific support for the benefits of the different techniques is scarce. My personal arsenal will be described in the panel but includes biceps-brachialis muscle release at the elbow, pronator teres rerouting, flexor carpi ulnaris to extensor carpi radialis brevis (Green’s) transfer and adductor pollicis muscle release in the palm combined with extensor pollicis longus rerouting for the thumb-in-palm deformity. In my mind, it is not most important which tendon transfer that is selected, but the choice of which child to operate and at what age. It is also important to tension the tendon transfers exactly right and to plan the postoperative treatment properly. The surgeon should, of course, also make sure that the child’s and the parent’s expectations on the results are realistic. Botulinum toxin A has now been used for several years in the treatment of children with cerebral palsy and the drug has been shown to be safe and effective in reducing muscle tone both in the lower and the upper extremities. It has been more difficult to show effects on hand function especially in the long-term perspective. I will present our treatment protocol for botulinum toxin injections. In 1994, a population-based health care program for children with CP was started in Lund in southern Sweden. All children in our region with a diagnosis of CP, born after Jan 1st 1990 are invited to follow the program which includes regular measurements of range of motion in extremity joints, standardized radiographic examinations of the hip joints and registration of surgery and spasticity treatments. The program, called CPUP has been very successful in the prevention of spastic hip dislocation, wind swept position and contractures. Some early results from the upper extremity part of CPUP will be presented. We believe that the program in time will give us valuable information on the natural course of joint motion and impairment of hand function in children with CP

1. The modifications of standard Z-plasty technique that are necessary for its successful use in hand surgery are discussed with particular reference to the limiting factors imposed by the anatomical characteristics of the hand. 2. The use of the Z-plasty in Dupuytren's contracture and contracted scars is discussed

Aims. Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma. Methods. This will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria. Discussion. The Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication. Cite this article: Bone Jt Open 2024;5(4):361–366

The use of regional anaesthesia for upper limb surgery has been increasing in popularity recently. It is safe, effective and has financial benefits. We report the activity in a tertiary hand surgery unit over one year. This department performs elective and trauma surgery between 8am and 7pm. Out of hours surgery is performed in main theatres. A total of 3335 cases were performed in Hand Surgery theatres between 1st August 2008 and 1st August 2009. Of these, 1791 had a regional block. The ages of these patients ranged from 13 to 92 years (Median = 46 years, Mean = 47 years). 1030 were male and 761 were female. 1011 regional block procedures were performed by a Consultant Anaesthetist, with 266 performed by a trainee and 472 by non-career grade. 646 procedures were for trauma surgery with 1145 for elective surgery. 87 procedures were arthroscopic. A vast range of surgery was safely performed under regional block. There were no significant complications. All regional nerve blocks were performed with the aid of ultrasound. Training of junior anaesthetists was benefited by performing the nerve blocks. Patients required very little time to recover following nerve block when compared to recovery after general anaesthesia, with resultant reduction in resource requirements. We conclude that the use of regional nerve block anaesthesia for hand surgery benefits both the patient and the hospital

Compared with general anaesthesia, brachial plexus (BP) anaesthesia improves patient satisfaction and accelerates hospital discharge after ambulatory hand surgery; however, variable success rates and typical onset times up to 30 minutes have limited its widespread use. Increasing availability of high-resolution portable ultrasound has renewed interest in more proximal approaches to the BP, previously thought to carry unacceptable risk. The aim of this study was to compare the onset times of ultrasound guided supraclavicular and infraclavicular BP block in patients undergoing ambulatory hand surgery. With ethics committee approval, patients presenting for hand surgery were prospectively randomised to either supraclavicular (trunks/divisions) or infraclavicular (cords) BP block. A single experienced operator (MF) placed all blocks using ultrasound only guidance. A blinded observer (AP, SY) assessed pinprick sensory and motor block on 3-point scale (normal=2, reduced=1, absent=0) in the median, ulnar, radial and musculocutaneous nerve territories every five minutes, or until blocks were complete. A single general anaesthesia without influence from the unblended anaesthetist. Of the first 27 patients recruited, block placement details and Intraoperative data are presented in There was a trend to faster onset times and higher success in group infraclavicular, however, this did not reach statistical significance. Interim results are so far inconclusive for the superiority of one approach. Both techniques were well tolerated and had a high success rate for surgical anaesthesia

Aims: The aim of this study was to evaluate the haemo-dynamic and blockade effects of 25 μg and of 200 μg adrenaline adding to 1.5% lidocaine under axillary brachial plexus blockade. Methods: Fifty patients presenting for hand surgery were randomly divided into two groups. Patients were received either 5 ml saline containing 25 μg adrenaline firstly and thereafter 35 ml 1.5% plain lidocaine in Group 1, and 5 ml saline alone firstly and thereafter 200 μg adrenaline adding to 35 ml 1.5% lidocaine in Group 2. Haemodynamic data were measured from 1st to 10th minute after axillary injection at 1 minute interval. After operation, time to first sensation of pain related to the surgical site and clinical recovery of motor block were recorded. Results: Complete anaesthesia in three nerves was achieved 85% of patients in Group 1 and 90% in Group 2. First analgesic request time was not different between the groups. Motor blockade duration time in Group 1 (124.6±12.1min) was significantly shorter than that of Group 2 (140.4±19.0 min) (p< 0.05). Conclusions: We consider that the lower of adrenaline added to 1.5% lidocaine technique offers better haemodynamy, and blockade properties. We suggest that the technique using lower adrenalin doses may be useful for especially cardiac patients if they need for forearm and hand surgery

Wrist fusion, ulna head resection and fusion of the MP or PIP joints are not anymore the only operations that can be offered to patients with RA. The modern medical treatment has changed the course of the disease and we are not anymore in front of patients with major joint destruction, very bad hand function and low demands. Young ladies with well controlled disease expect surgery to result in restitution of function which allows a life close to normal in terms of work and leisure time activities. If pain relief remains the main indication it has to be associated with reconstruction of function, preserving mobility and increasing grip strength. For these reasons it appears necessary to limit fusions and increase the use of joint implants. Accurate evaluation of the patients’ need and expectations will help in the choice of the appropriate surgical procedure to achieve the treatment goal.

Aims

Hand trauma accounts for one in five of emergency department attendances, with a UK incidence of over five million injuries/year and 250,000 operations/year. Surgical site infection (SSI) in hand trauma surgery leads to further interventions, poor outcomes, and prolonged recovery, but has been poorly researched. Antimicrobial sutures have been recognized by both the World Health Organization and the National Institute for Clinical Excellence as potentially effective for reducing SSI. They have never been studied in hand trauma surgery: a completely different patient group and clinical pathway to previous randomized clinical trials (RCTs) of these sutures. Antimicrobial sutures are expensive, and further research in hand trauma is warranted before they become standard of care. The aim of this protocol is to conduct a feasibility study of antimicrobial sutures in patients undergoing hand trauma surgery to establish acceptability, compliance, and retention for a definitive trial.

Introduction: Common pathologies seen in hand clinics include Dupuytren’s contracture, ganglia and trigger digits. Some patients can be treated in the out patient department by percutaneous fasciotomy, aspiration, or percutaneous A1 pulley release. The effectiveness and safety of these procedures has been documented in the literature. There are no studies investigating the cost effectiveness these of treatments.

Aim: Our aim was to compare the cost of treatment of Dupuytren’s contracture, ganglia and trigger digits in the out-patient department with the operating theatre.

Methods: All patients seen in a new patient hand clinic with a diagnosis of Dupuytren’s contracture, trigger digit or ganglion of the wrist or hand were prospectively identified over a 6 month period.. The number undergoing a procedure in the out-patient clinic or theatre was recorded.

Costings of theatre time and out-patient time were obtained from the hospital management.

Results: 80, 26, and 52 patients were treated with regard to Dupuytrens contracture, ganglia, and trigger digits respectively over the 6-month period. Of these, 37, 23, and 44 were treated by an out patient procedure, and 43, 3 and 8 underwent a formal operation.

Based on a cost of £216 per out-patient clinic session, the cost of the out-patient procedures was calculated at £1872 over 6 months, or £3744 per annum. Based on a theatre cost of £1785 per session, to perform all the clinic procedures as formal operations would have cost £60,690 over 6 months, or £121380 per annum. The cost savings were therefore £117636 per annum.

Discussion: We conclude that outpatient interventions for dupuytrens disease, ganglions and trigger digits results in significant cost savings over formal surgical treatment.

AIM: The aim of this study is to assess the efficacy of different treatment options for wrist ganglia.

METHODS AND RESULTS: 1700 cases were reviewed retrospectively. Of the respondents to the questionnaire, 457 (65%) patients had dorsal, 255 patients (35%) volar wrist ganglia.

Dorsal ganglia had been treated by observation in 99 (22.4%), aspiration in 57 (12.9%), aspiration plus injection in 37 (8.4%) or surgery in 249 (56.3%) of the cases. The analysis showed that the recurrence rates were 39%, 74.5%, 28.5%, and 35% respectively for each type of treatment. Scar tenderness was present in more than half of surgically treated patients. Repeat surgery was performed in 20 out of 70 (28.5%) recurrent cases. The satisfaction rate did not correlate with the recurrence rate.

For volar ganglia, treatment had been observation in 49 (19.2%), aspiration in 13 (5%), aspiration plus injection in 12 (4.7%) or surgery in 153 (60%) of the cases. The analysis showed that the recurrence rates were 28.5%, 92%, 25.5%, and 33.3% respectively. Scar tenderness was present in 67% and sensory loss in 32% of surgically treated patients. Repeat surgery was only performed in 18 out of 52 (34.6%) recurrences. The satisfaction rate was highest in the aspiration and injection group, which had the lowest recurrence rate among all treatment modalities.

CONCLUSION: The treatment of wrist ganglia needs a rethink in the light of the current findings as the complications may be difficult to justify in such a self-limiting condition.

Aims

The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires.

Aims

The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone.

We surgeons are privileged in having a profession which also encompasses a craft; by it we should have understanding of the problems of craftsmanship in modern life. Ultimately it is at the core of human happiness. Craftsmanship is based upon creative ability, good design, the almost loving conflict of man and material, and the consequent unification of both in completion. Craftsmanship is only possible as a manifestation of individuality. Integrity and invulnerability are its outcome.

May it not be that in the atomic age (if there is one outside of destruction) there may be a return to the craftsman's life of the eighteenth century; not of necessity for the maintenance of economic life, because that will be done for him by the machine, but rather for the maintenance of health?

Aims. Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. Methods. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. Results. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. Conclusion. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results. Cite this article: Bone Jt Open 2023;4(4):219–225

In the field of hand surgery, physicians are working to improve patient satisfaction by offering several minor procedures in the physician's office via the WALANT method. We seek to investigate the degree of patient satisfaction, out of pocket cost, convenience and comfort experienced with in-office hand procedures. A ten question survey consisting of a ten-point Likert scale of agreement and questions asking for a numerical answer was administered via phone call to 33 patients treated with minor hand operations in the office setting in the United States. There were 18 male and 15 female respondents with an average age of 65.59±12.64 years. Respondents underwent procedures including trigger finger release (18), needle aponeurotomy (7), and other minor hand operations. Survey responses indicated strong agreement with questions 1-3 and 6–8, with responses averaging 9.60±0.23 in these positive metrics. Questions 4 and 5, which asked whether the surgery and recovery period were painful, respectively, averaged 2.65±0.49, indicating a mild level of disagreement that either was “painful”. Additionally, most patients responded that they did not take time off work (12) or are not currently employed (11). Other respondents (3) reported taking between one to five days off work post-operatively. 27 respondents also reported an out of pocket cost averaging $382±$976, depending on insurance coverage. Patients reported a small degree of pain in the operative and post-operative period, a high degree of comfort and convenience and a high degree of satisfaction. Likewise, the patient-reported out of pocket cost was far lower than comparable surgical costs in alternate settings. These results support the use of in-office procedures for minor hand surgeries from a patient perspective and indicate a nearly universal intent to repeat any future hand operations in the office setting

In-office surgeries have the potential to offer high quality medical care in a more efficient, cost-effective setting than outpatient surgical centers for certain procedures. The primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive bleeding or other surgical complications. This study serves to investigate these concerns and determine whether in-office hand surgeries are safe and clinically effective. A retrospective review of patients who underwent minor hand operations in the office setting between December 2020 and December 2021 was performed. The surgical procedures included in this analysis are needle aponeurotomy, trigger finger release, mass/foreign body removal and reduction of hand/wrist fracture with or without percutaneous pinning. No major complications requiring extended observation or hospital admission occurred. 122 of the 132 patients (92.4%) were successfully treated with no complications and only mild symptoms within one month of surgery. Five patients (3.8%) returned to the office for pain, inflammation and/or stiffness of the affected finger, with two of the five returning due to osteoarthritis and/or pseudogout flare-ups. Five additional patients returned due to incomplete treatment with continued presence of Dupuytren's contracture (3), trigger finger (1) or infected foreign body (1). One patient (0.8%) developed infection, due to incomplete removal of an infected foreign body, which was subsequently treated with antibiotics and complete foreign body removal. The absence of major complications and high success rate for minor hand procedures shows the high degree of safety and efficacy which can be achieved via the in-office setting for select procedures. While proper patient selection is key, our result shows the in-office procedure room setting can offer the necessary elements of sterility and hemostatic support for several common hand surgeries

The February 2024 Wrist & Hand Roundup. 360. looks at: Occupational therapy for thumb carpometacarpal osteoarthritis?; Age and patient-reported benefits from operative management of intra-articular distal radius fractures: a meta-regression analysis; Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study; Semi-occlusive dressing versus surgery in fingertip injuries: a randomized controlled trial; Re-fracture in partial union of the scaphoid waist?; The WALANT distal radius fracture: a systematic review; Endoscopic carpal tunnel release with or without hand therapy?; Ten-year trends in the level of evidence in hand surgery

The June 2023 Wrist & Hand Roundup. 360. looks at: Residual flexion deformity after scaphoid nonunion surgery: a seven-year follow-up study; The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders; Bite injuries to the hand and forearm: analysis of hospital stay, treatment, and costs; Outcomes of acute perilunate injuries - a systematic review; Abnormal MRI signal intensity of the triangular fibrocartilage complex in asymptomatic wrists; Patient comprehension of operative instructions with a paper handout versus a video: a prospective, randomized controlled trial; Can common hand surgeries be undertaken in the office setting?; The effect of corticosteroid injections on postoperative infections in trigger finger release

The February 2023 Wrist & Hand Roundup. 360. looks at: ‘Self-care’ protocol for minimally displaced distal radius fractures; Treatment strategies for acute Seymour fractures in children and adolescents: including crushed open fractures; Routinely collected outcomes of proximal row carpectomy; Moving minor hand surgeries in the office-based procedure room: a population-based trend analysis; A comparison between robotic-assisted scaphoid screw fixation and a freehand technique for acute scaphoid fracture: a randomized, controlled trial; Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger; Two modern total wrist arthroplasties: a randomized comparison; Triangular fibrocartilage complex suture repair reliable even in ulnar styloid nonunion

The October 2023 Wrist & Hand Roundup. 360. 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. Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery. Methods. Using the ClinicalTrials.gov (CTG) and the International Clinical Trials Registry Platform (ICTRP) databases, we comprehensively surveyed clinical trials of decellularized tissue use in orthopaedic surgeries registered before 1 September 2022. We evaluated the clinical results, tissue processing methods, and commercial availability of the identified products using academic literature databases and manufacturers’ websites. Results. We initially identified 4,402 clinical trials, 27 of which were eligible for inclusion and analysis, including nine shoulder surgery trials, eight knee surgery trials, two ankle surgery trials, two hand surgery trials, and six peripheral nerve graft trials. Nine of the trials were completed. We identified only one product that will be commercially available for use in knee surgery with significant mechanical load resistance. Peracetic acid and gamma irradiation were frequently used for sterilization. Conclusion. Despite the demand for decellularized tissue, few decellularized tissue products are currently commercially available, particularly for the knee joint. To be viable in orthopaedic surgery, decellularized tissue must exhibit biocompatibility and mechanical strength, and these requirements are challenging for the clinical application of decellularized tissue. However, the variety of available decellularized products has recently increased. Therefore, decellularized grafts may become a promising option in orthopaedic surgery. Cite this article: Bone Joint Res 2023;12(3):179–188

The second wave of COVID-19 infections in 2021 resulting from the delta strain had a significantly larger impact on the state of New South Wales, Australia and with it the government implemented harsher restrictions. This retrospective cohort study aims to explore how the increased restrictions affected hand trauma presentations and their treatment. Retrospective analysis was performed on patients who underwent hand surgery from the period of June 23 – August 31 in 2020 and 2021 at a level one trauma centre in Western Sydney. During the second-wave lockdown there was an 18.9% decrease in all hand trauma presentations. Despite widespread restrictions placed on the manufacturing, wholesale, retail and construction industries, there was an insignificant difference in work injuries. Stay-at-home orders and reduced availability of professional tradespersons likely contributed to an increase in DIY injuries. Significant reductions in metacarpal and phalangeal fractures coincided with significantly curtailed sporting seasons. The findings from this study can assist in predicting the case-mix of hand trauma presentations and resource allocation in the setting of future waves of COVID-19 and other infectious diseases

The COVID-19 pandemic has disrupted all segments of daily life, with the healthcare sector being at the forefront of this upheaval. Unprecedented efforts have been taken worldwide to curb this ongoing global catastrophe that has already resulted in many fatalities. One of the areas that has received little attention amid this turmoil is the disruption to trainee education, particularly in specialties that involve acquisition of procedural skills. Hand surgery in Singapore is a standalone combined programme that relies heavily on dedicated cross-hospital rotations, an extensive didactic curriculum and supervised hands-on training of increasing complexity. All aspects of this training programme have been affected because of the cancellation of elective surgical procedures, suspension of cross-hospital rotations, redeployment of residents, and an unsustainable duty roster. There is a real concern that trainees will not be able to meet their training requirements and suffer serious issues like burnout and depression. The long-term impact of suspending training indefinitely is a severe disruption of essential medical services. This article examines the impact of a global pandemic on trainee education in a demanding surgical speciality. We have outlined strategies to maintain trainee competencies based on the following considerations: 1) the safety and wellbeing of trainees is paramount; 2) resource utilization must be thoroughly rationalized; 3) technology and innovative learning methods must supplant traditional teaching methods; and 4) the changes implemented must be sustainable. We hope that these lessons will be valuable to other training programs struggling to deliver quality education to their trainees, even as we work together to battle this global catastrophe

To compare 24-month patient-reported outcomes after surgical treatment or casting in patients age 60 years of age or older with unstable distal radius fractures (DRF's). The Wrist and Radius Injury Surgical Trial (WRIST), is the largest randomized, multicenter trial in Hand Surgery, which enrolled 304 adults with isolated, unstable DRF's at 24 institutions. WRIST participants were followed for 24 months- longest follow-up among prospective studies comparing four treatment methods. Patients who agreed to surgical treatment (n=187) were randomized to internal fixation with volar plate (VLPS), external fixation, or percutaneous pinning; patients who preferred conservative management (n=117) received casting. The primary outcome was 24-month Michigan Hand Outcomes Questionnaire (MHQ) Summary score. Secondary outcomes were MHQ Domain scores. At 24-month assessment, participants' mean MHQ Summary score was 86 (95% CI: 83,88), representing good hand function. Participants reported good return of their Activities of Daily Living (ADLs) with a mean MHQ ADL score of 88 (95% CI: 85,91). Finally, participants were satisfied, with a mean MHQ Satisfaction score of 84 (95% CI: 80,88). There were no significant differences in score by treatment group in any MHQ domain at 24 months. Six weeks after surgery, VLPS participants scored significantly higher than the other three groups on (ADLs) and Satisfaction (both p<0.0001), whereas participants who received external fixation scored significantly lower than the casting and VLPS groups on the same domains. By the 3-month assessment, the gap between VLPS and casting had disappeared but external fixation participants continued to report significantly worse scores. External fixation participants did not report comparable ADL scores to the other three groups until 12 months after surgery. Participants reported good outcomes 24 months after DRF regardless of treatment. Casting and VLPS are both acceptable treatments for older adults. The decision between the two treatments should be made considering patient goals regarding recovery speed and desire to avoid surgical risks. External fixation should be avoided because of worse outcomes in the year after surgery and the risk of pin site infections

The December 2023 Wrist & Hand Roundup. 360. looks at: Volar locking plate for distal radius fractures with patient-reported outcomes in older adults; Total joint replacement or trapeziectomy?; Replantation better than revision amputation in traumatic amputation?; What factors are associated with revision cubital tunnel release within three years?; Use of nerve conduction studies in carpal tunnel syndrome; Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis; Association between radiological and clinical outcomes following distal radial fractures; Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study

Aims. Our purpose was to determine the quality of current randomised controlled trials (RCTs) in hand surgery using standardised metrics. Materials and Methods. Based on five-year mean impact factors, we selected the six journals that routinely publish studies of upper extremity surgery. Using a journal-specific search query, 62 RCTs met our inclusion criteria. Then three blinded reviewers used the Jadad and revised Coleman Methodology Score (RCMS) to assess the quality of the manuscripts. Results. Based on the Jadad scale, 28 studies were of high quality and 34 were of low quality. Methodological deficiencies in poorly scoring trials included the absence of rate of enrolment, no power analysis, no description of withdrawal or dropout, and a failure to use validated outcomes assessments with an independent investigator. Conclusion. A large number of RCTs in hand, wrist, and elbow surgery were of suboptimal quality when judged against the RCMS and Jadad scales. Even with a high level of evidence, study design and execution of RCTs should be critically assessed. Methodological deficiencies may introduce bias and lead to statistically underpowered studies. Cite this article: Bone Joint J 2017;99-B:94–9

Aims

The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults.

It has been shown that extremity injuries form a large proportion of the operative surgical workload in conflict situations. Injuries to the hands are an important subgroup and hand surgery has a long association with military surgery. While most hand injuries do not require surgical intervention, those that do, require that military surgeons should be well versed in the principles of hand surgery. The concepts of staging and/or damage control surgery are well applied to this region. The nature of military medical support necessarily changes in the transition from war fighting to a post-conflict phase. We examine the activity in the sole British Military Hospital serving a multi-national divisional area in Iraq over 2004. During this post conflict phase, the spectrum of hand trauma is characterised. The overwhelming majority of hand trauma resulted in soft tissue injury. There was a clear predisposition to hand trauma for males, manual workers, combat soldiers and engineers/mechanics. X-ray imaging is heavily used in this environment. Even where soldiers are returned to duty they are often restricted in the duties that they can perform. The results of this study reinforce the relevance of basic principles of hand trauma management, particularly in challenging environments. These knowledge and skill requirements should be emphasised for the war surgeon and the emergency physician. Hand surgery is an evolving speciality that continues to find clear and direct applications for the military surgeon

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The purpose of this survey study was to examine the demographic and lifestyle factors of women currently in orthopaedic surgery.

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In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery.

The December 2014 Wrist & Hand Roundup360 looks at: ultrasound for carpal tunnel diagnosis; where we are at with management of undisplaced scaphoid fractures; ARPE for thumb metacarpals?; extravasation injuries in the hand and wrist; research and practice in hand surgery; and physio ineffective in hand osteoarthritis

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The aim of this retrospective study was to evaluate the rate of conversion to surgical release after a steroid injection in patients with a trigger finger, and to analyze which patient- and trigger finger-related factors affect the outcome of an injection.

Aims

The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service.

The April 2023 Wrist & Hand Roundup³⁶⁰ looks at: MRI-based classification for acute scaphoid injuries: the OxSMART; Deep learning for detection of scaphoid fractures?; Ulnar shortening osteotomy in adolescents; Cost-utility analysis of thumb carpometacarpal resection arthroplasty; Arthritis of the wrist following scaphoid fracture nonunion; Extensor hood injuries in elite boxers; Risk factors for reoperation after flexor tendon repair; Nonoperative versus operative treatment for displaced finger metacarpal shaft fractures.

Aims

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons.

Aims

Dupuytren’s contracture is characterized by increased fibrosis of the palmar aponeurosis, with eventual replacement of the surrounding fatty tissue with palmar fascial fibromatosis. We hypothesized that adipocytokines produced by adipose tissue in contact with the palmar aponeurosis might promote fibrosis of the palmar aponeurosis.

The December 2015 Wrist & Hand Roundup360 looks at: Fuse or replace? The index PIPJ; A solution for the unstable DRUJ at last; Anatomical reconstruction in place of arthroplasty?; The Welsh ‘fight bite’; Does surgeon empathy improve results?; Regional or local for wrist analgesia; The evidence for wrist arthroplasty; FPL rupture a hidden problem?; Deciding on surgery in the distal radius; Composing that paper in hand surgery

Historically human and animal bites to the hand have resulted in significant morbidity in relation to the high risk of contamination and subsequent infection. Our study aimed to assess the outcomes following such injuries in terms of infection requiring further intervention through specialist referral to the hand surgery team at our hospital. 124 consecutive patients attending the A&E department over a three month period in 2011 were included in this retrospective study which provided 126 separate cases due to bilateral injuries (110 animal: 16 human). Data was obtained from the electronic patient management system. The demographics of each patient were recorded followed by type of bite sustained including number and size of lacerations. 79% of patients presented within 24 hours and the majority before 6 hours from injury. The majority of the forearm bites were documented as superficial abrasions and none of these went on to develop problems with infection, so the study concentrated on bite injuries to the hand of which there were 99 cases. Most hand injuries were a single puncture or laceration (64%) but in 9 cases there were greater than 3 separate wounds. 5 cases were directly referred to the Hand surgery team with 4 requiring admission and of these 3 required washout and debdridement in theatres. The remaining 94 cases were managed solely by A&E. Of these 94 cases 87 pts received Abx and 78 pts had a lavage. Overall 68% received both Abx and lavage. Subsequent to discharge from A&E only 3 developed problems with infection later (2 requiring specialist input) they were all dog bites and in keeping with the ‘typical’ bite pattern seen in other pts. The study concluded that bites not involving joint, tendon or bone have only a small chance of causing infection provided good initial treatment

Aims

The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome.

Background. Despite the known multifactorial nature of scaphoid wrist fracture non-union, a possible genetic predisposition for the development of this complication remains unknown. This pilot study aimed to address this issue by performing Single Nucleotide Polymorphisms (SNPs) analysis of specific genes known to regulate fracture healing. Materials and Methods. We reviewed 120 patients in a retrospective case-control study from the Hand Surgery Department of Asepeyo Hospital. The case group comprised 60 patients with confirmed scaphoid wrist non-union, diagnosed by Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). The control group comprised 60 patients with scaphoid fracture and complete bone consolidation. Sampling was carried out with a puncture of a finger pad using a sterile, single-use lancet. SNPs were determined by real-time polymerase chain reaction (PCR) using specific, unique probes with the analysis of the melting temperature of hybrids. The X2 test compared genotypes between groups. Multivariate logistic regression analysed the significance of many covariates and the incidence of scaphoid wrist non-union. Results. We found significant differences in subjects who had a smoking habit (p=0.001), high blood pressure (p<0.001), and surgical treatment (p=0.002) in patients with scaphoid non-union. There were more Caucasians (p=0.04) and males (p=0.001) in the case group. Falls were the main mechanism of fracture. The CC genotype in GDF5 (rs143383) was more frequent in patients with scaphoid non-union compared to the controls (p=0.02). CT was prevalent in the controls (p=0.02). T allele in GDF5 was more frequent in patients without non-union (p=0.001). Conclusions. Individuals who were carriers of the CC genotype in GDF5 showed higher susceptibility to suffering scaphoid wrist non-union. Furthermore, being a carrier of CT and T allele suggests that this could be behave as a protection factor against non-union. This is the first clinical study to investigate the potential existence of genetic susceptibility to scaphoid wrist fracture non-union. Level of evidence. Level III, Cross Sectional Study, Epidemiology Study

Introduction: There are risks attached to performing hand surgery and not just due to the fact that there are many important structures in a compact area, but because of increasing litigation. To date the cost of litigation is unknown. We have reviewed NHSLA data for closed litigation claims from 1995–2001. Method: NHSLA provided data detailing litigation claims and settlements for orthopaedic hand problems. Data sets include: incident date, creation date, incident details, damages paid, defence costs, claimant costs, total claim, cause, injury location, speciality. We analysed the data with respect to: A& E, inpatients, out-patients department and surgery to understand where most claims were made and subsequent costs. Results: There is a clear trend of increasing numbers of litigation cases, successful claims and settlement amounts. The clinical areas making the most claims and resulting in the greatest costs are: 1-Surgery, 2-Outpa-tients, 3-A& E, 4-Inpatients and lastly 5-Administration. The top 5 pathologies claimed for are: 1-wrist fracture, 2-carpal tunnel release, 3-ganglion excision, 4-metacarpal fracture, and 5-missed scaphoid fractures. Conclusion: This data is very interesting as litigation is a very emotive and sensitive issue. We confirm that litigation is on the rise and needs to be addressed. It’s evident that the majority of claims involve routine procedures or routine management decisions. Of note there are no cases relating to more complex hand surgery or difficult management issues

Aims: Department of Hand Surgery in the National Institute of Traumatology and Oxyology – before 2001: National Institute of Traumatology – was established in 1959 as the first independent hand surgery department in Hungary. Our Institute was the centre of operations for thumb reconstruction nearly in 2 decades in Hungary. Methods: The techniques for thumb reconstruction, selected after considering many factors, will be presented in my lecture. All the treatment options we applied in our practice for thumb reconstruction will be summarized in the form of a table. In the first period we performed 3 stage thumb reconstructions (31 cases). This period was followed by the method of elongation acquired from professor Ivan Matev, mainly in young growing patients, but also performed in adults by extending the indications (36 cases). Phalangization proved to be an excellent technique in many patients when the major part of the first phalanx was preserved after the injury (47 cases). Results: Indications, surgical technique and results achieved with all these three methods will be highlighted in my presentation

Aims

The aim of this study was to investigate the feasibility of application of a 3D-printed megaprosthesis with hemiarthroplasty design for defects of the distal humerus or proximal ulna following tumour resection.

Aims

Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency.

Aims

The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates.

Used routinely in maxillofacial reconstructive surgery, the chondrocostal graft is also applied to hand surgery in traumatic or pathologic indications. The purpose of this overview was to analyze at long-term follow-up the radiological and histological evolution of this autograft, in hand and wrist surgery. We extrapolated this autograft technique to the elbow by using perichondrium. Since 1992, 148 patients have undergone chondrocostal autograft: 116 osteoarthritis of the thumb carpometacarpal joint, 18 radioscaphoid arthritis, 6 articular malunions of the distal radius, 4 kienbock's disease, and 4 traumatic loss of cartilage of the proximal interphalangeal (PIP) joint. Perichondrium autografts were used in 3 patients with elbow osteoarthritis. Magnetic Resonance Imaging (MRI) was performed in 19 patients with a mean follow-up of 68 months (4–159). Histological studies were performed on: i) perioperative chondrocostal grafts (n=3), ii) chondrocostal grafts explanted between 2 and 48 months after surgery (n=10), and iii) perioperative perichondrium grafts (n=2). Whatever the indication, the reconstruction by a chondrocostal/ostochondrocostal or perichondrium graft yielded satisfactory clinical results at long-term follow-up. The main question was the viability of the graft. -. For rib cartilage grafting: The radiological study indicated the non-wear of the graft and a certain degree of ossification. The MRI and histology confirmed a very small degree of osseous metaplasia and graft viability. The biopsies showed neo-vascularization of the cartilage that had undergone morphological, constitutional and architectural changes. Comparison of these structural modifications with perioperative chondrocostal graft histology is in progress. -. For perichondrium grafting: The first cases gave satisfactory clinical results but must be confirmed on a larger number of patients. Histological results highlighted a tissue composed of one fibrous layer and one cartilage-like layer, a common composition of supporting tissue. Despite the strong mechanical strain in the hand and wrist, chondrocostal graft is a biological arthroplasty that is trustworthy and secure over the long term, although it can cause infrequent complications inherent to this type of surgery. Despite the inevitable histological modification, the cartilage remains alive and is of satisfactory quality at long term follow-up and fulfills the requirements for interposition and reconstruction of an articular surface. The perichondrium graft constitutes a new arsenal to cure cartilage resurfacing. The importance of perichondrium for the survival of the grafted cartilage, as previously reported, as well as its role in resurfacing, is being investigated

Aims

Studies on long-term patient-reported outcomes after open surgery for triangular fibrocartilage complex (TFCC) are scarce. Surgeons and patients would benefit from self-reported outcome data on pain, function, complications, and satisfaction after this surgery to enhance shared decision-making. The aim of this study is to determine the long-term outcome of adults who had open surgery for the TFCC.

Aims

The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery.

Aim: This study involved a postal questionnaire survey to know the attitude of consultant orthopaedic surgeons in U.K. with regards to their postoperative management of Dupuytren’s surgery patients. Methods & Results: A questionnaire was sent to Orthopaedic surgeons practising in UK. 573 consultants replied to the questionnaire. 169 surgeons (29.49%) stated to have special interest in hand surgery. 357 surgeons (62.3%) stated having no interest in hand surgery. 43 surgeons did not reply to the questionnaire. 81 surgeons (14.13%) always used post operative splintage.109 surgeons (19.03) used splintage most of the time, 126 surgeons (21.98%) rarely used it and 89 surgeons (15.53%) stated never using any form of splintage. Most of them used static splintage (45.20%) and only 5.23% used dynamic splintage.11 surgeons stated using both the types of splintage. 267 surgeons did not questionnaire. Majority of the surgeons applied a static splint (pop slab, thermoplastic splint) after the surgery while others applied it after reducing the dressing within 2 weeks of the operation. 264 (46.07%) surgeons did not reply to the question. In majority of cases the splint was applied by the occupational therapist. The surgeon, physiotherapist, and orthotist in some cases also applied the splint. Individual comments from surgeons made an interesting reading. After an initial period of continuous splintage majority of the surgeons used night splintage only. 265 surgeons did not reply to the question. Mostly the splint-age was used for 4–6 weeks. Although the spectrum of splintage varied from 2 weeks to 24 weeks. Some of the surgeons stated their own clinical practice in their comments. 179 surgeons stated always referring their patient for postoperative physiotherapy. 13 surgeons (2.26%) never referred their patients for physiotherapy. 77 surgeons on very odd occasions had postoperative physiotherapy for their patients. Majority of surgeons started the physiotherapy between 1 and 2 weeks, after the stitches have been removed. 107 surgeons favoured early commencement of hand exercises within first week of surgery. 224 surgeon did not reply to this question. Most of the surgeons followed the patients for two to four months. Longer follow up was done for patients with recurrence, severe or bilateral disease. Also those patients, who had proximal interphalangeal joint contracture and other risk factors, were followed for a longer period. Some of the surgeons commented following them for life in their clinical practice. Conclusion: This survey revealed interesting facts regarding the management of Dupuytren’s contracture surgery patients. The disparity in reply clearly indicates the need for further research with attention to long term funtional results

Aims

The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis.

The collagenase of Clostridium Histolyticum enzyme infiltration is a mini-invasive treatment method for Dupuytren's disease which has emerged in recent years as an alternative to traditional surgery (selective aponeurectomy). Although both treatments are effective in the long term, a wider use of the enzyme is spreading worldwide. Indications and protocol of administration of collagenase are strictly regulated by the Italian Drug Administration Agency (AIFA). In the present study an off-label use of this medication has been experienced, in terms of wider indications and more numerous infiltration sites in the same cord (Multipoint technique) and in additional cords affecting other digits (Multicord technique). All patients suffering from Dupuytren's disease and accessing the Hand Surgery outpatient at Rizzoli Institute were considered for the study, between february 2014 and february 2016. Inclusion criteria were Dupuytren's disease and a positive tabletop test. The collagenase injection was indicated for degrees of passive extension deficit (PED) higher than AIFA regulations (MCPJoints >50° and PIPJoints >45°). These patients were compared with the same PED subgroup of surgical patients who were treated through aponeurectomy. Since the drug is dispensed in vials of 0.90 mg, but according to the protocol only 0.58 mg are to be infiltrated, the injection of the remaining 0.32 mg that would otherwise remain unused was experienced. Therefore, in patients who had only one pathological cord in the hand, the first point of the cord to be treated was inoculated with 0.58 mg, according to standards, while two additional points were selected along the fibrosis and injected with the remaining 0, 32 mg. This group was compared with patients treated with the traditional 0.58 mg only on a single cord. In patients in whom the presence of more than a single pathological cord was found, the worse lesion was injected with the usual 0.58 mg as by legislation and the second cord was infiltrated with the 0.32 mg residue and the results obtained within the second cord were compared with those achieved with the usual dose of 0.58 mg. The endpoints considered were the perioperative variations of passive extension deficit (PED) and range of motion (ROM), both expressed as degrees. Data were statistically analyzed in order to find any possible significance in the comparison of groups. Comparing the surgical patients with those treated with collagenase, for the same degrees but higher than AIFA reference, both methods showed a reduction of contracture by at least 50% at 30 days and an improvement of ROM (p>0.05), with fewer complications in those treated enzymatically (p<0.01). Infiltrating the whole dose of collagenase (0.90 mg) through the multipoint mode, has enabled an easier handling of the cord at 24 hours post-injection, a reduction in contracture of at least 50% at 30 days allowing a dowstaging of the disease and a better and faster recovery of hand function, than the classic treatment, although these results are not statistically significant (p>0.05). For degrees of contractures within AIFA indications for collagenase, the 0.32 mg dose is sufficient to cause the lysis of a cord with similar results compared to the greater AIFA-recommended dose of 0.58, in terms of all considered endpoints, with no statistically significant difference (p >0.01). This study confirms the success of treatment with collagenase compared to surgical treatment, in terms of efficacy, safety, more rapid recovery and less invasiveness. In addition, through further clinical studies, AIFA regulations can be gradually safely and effectively extended in terms of a progressive widening of indications and modalities including:. Indication to collagenase for PED higher than 50° (MCP joints) or 45° (PIP joints). Multiple injections in the same cord with the whole content of the vial (0.90 mg). Injections in multiple cords with the whole content of the vial (0.90 mg)

Aims

This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time.

In recent years, there has been an increase in using self- admistrated questionnaires to accurately assess intervention outcomes in hand surgery to determine the quality of healthcare. This study aims to evaluate whether the Manchester Modified Disabilities of the Arm, Shoulder and Hand (M2DASH) questionnaire is a valid, reliable, responsive, and unbiased outcome measure for Carpal Tunnel syndrome compared to the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, Boston questionnaire (BQ), and Nerve Conduction Studies (NCS). Method. 48 patients with CTS confirmed by NCS completed the M2DASH, original DASH, and the BQ, at least twice at different time intervals. The scores obtained from M2DASH were compared and correlated with the DASH, BQ, and NCS to assess validity, reliability, responsiveness, and bias of the questionnaires. Results. Validity analysis for M2DASH showed strong positive correlations with the Original DASH and BQ. No significant correlation was obtained from correlating with NCS. Reliability testing confirmed that the M2DASH is internally consistent and reproducible outcome. Significant results for responsiveness were noted in BQ symptom severity scale only. There was no age, gender, hand dominance, or side affected bias in all three questionnaires. Conclusions. The M2DASH is a valid, reliable, and unbiased outcome measure for CTS. In terms of responsiveness this study demonstrated that M2DASH & DASH is weak in detecting the clinical change for CTS, except for the BQ. Further assessment of responsiveness specifically for CTS is required in order to implement this questionnaire in clinical practice to accurately obtain results reflecting the patients progression

Aims

Patients with a triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. The surgical procedure of TFCC reinsertion aims to improve function in patients with this injury in whom conservative treatment has failed. The purpose of this study was to investigate the outcomes of open TFCC reinsertion.

Aim. To review the natural history of upper limb osteochondromas and assess their functional effect. Materials. We performed a retrospective casenote review of a consecutive patient cohort presenting between 1997–2012 with upper limb osteochondromas. Indications for surgical intervention were noted and considered to be cosmetic, functional (including pain relief) and ‘prophylactic’ in terms of deformity prevention. All patients were invited to complete questionnaires for the PODCI, DASH, OSS and MHS scores. Results. We identified 102 patients (62 male: 40 female; mean age = 13.3 years; range 3–31 years). 84 patients had multiple exostoses whilst 18 had a solitary lesion. 52 patients had shoulder girdle involvement (scapula, clavicle and proximal humerus), 51 forearm (Masada I (n=31) Masada II (n=9) Masada III (n=11)), and 38 hand involvement. 46/102 patients had concurrent lower limb lesions. 56 operative procedures were performed primarily for functional benefit. Shoulder girdle procedures (n=21) improved pressure related pain, scapular pseudowinging/dyskinesia and cuff impingement. Forearm procedures (n=35) were performed for functional and prophylactic reasons and involved excision with ulnar lengthening and radial deformity correction (n=15, Masada I), realignment osteotomy or radial head excision for subluxation (n=7, Masada II) and excision with internal fixation of concomitant osteotomy (n=13, Masada I/III). No hand surgery was performed. Radial head dislocations are associated with large ulnar lesions causing shortening > 0.15 total ulnar length. Osteochondromas of the upper limb are generally well tolerated: functional effects were most commonly present in lesions involving the forearm but significant patient benefit was noted following shoulder girdle procedures. The scoring systems used failed to discriminate well between the various procedures used and the perceived benefit. Conclusion:. Patient outcomes are related to surgical indications. Currently available PROMs are either inappropriate Qs (DASH) and/or non-validated (OSS, MHS) and/or non-specific (PODCI*) only 8 parameters for the upper extremity. Better-validated measures may be required. Level of evidence: IV

The Authors report a case about a scaphoid remowing’s wrong operation performed in anohter hospital on a woman who was affected by rizoarthrosis. The authors visited the woman in the clinical outpatients six months after the wrong operation. In the Centre of Hand Surgery and Microsurgery of Modena the Authors performed an operation of an arthrodesis of TM associated with a arthrodesis capitate-lunate-hamate on that woman. The Authors report the good clinical outcome and X-ray’s results

Treatment for the comminuted intra-articular fractures of base of phalanxes remains a challenging problem in hand surgery. The outcomes are commonly associated with pain, stiffness, chronic instability and degenerative arthritis of proximal interphalangeal (PIP) joints. We present our short term results in 12 consecutive patients suffering from these complex fractures treated by closed reduction and application of a dynamic external fixator (Giddins’s frame). The average range of movement achieved was 11–86 degrees and there were no serious complications. We used the construct with slight modification and in our experience this may be helpful to reduce the pin site infection. It is relatively simple, uses widely available equipment (K-wire), and compact thus allows more than one finger to be treated. Early return to work, good pain relief and high level of patient’s satisfaction was achieved. Our short term results were comparable to best previously published results. Based on our experience we recommend this easy technique to treat these complex fractures of IP joints

Aims

The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up.

The Patient Evaluation Measure (PEM) was designed at the Derby consensus meeting in 1995. It was validated for Carpal Tunnel Syndrome (CTS) in 2005 (Hobby et al) and was preferable to the DASH score for CTS assessment. We aimed to audit CTS treated by surgical decompression in our unit using the PEM, and to compare our results with the published literature. Thirty consecutive patients undergoing carpal tunnel decompression were questioned about one hand. Patients completed a preoperative PEM and a postoperative PEM at 3 months. Mean PEM scores improved from 41.3 to 23.9 (P< 0.001). Individual questions showed statistically significant improvements in mean scores: Feeling in the hand, Cold intolerance, Pain, Dexterity, Movement and Hand in general (all P< 0.001): Work (P< 0.005): ADL (P< 0.01): Movements, Grip and Appearance (P< 0.05). Our results are similar to previously published series, both overall, and for individual questions in the PEM. Results for Carpal Tunnel Decompression in our unit match those of other units. We found the PEM was easy to use; and effective, both in the assessment of patients with CTS, and for outcome measurement following surgical decompression. Our study supports the idea that the PEM could be used widely as an audit tool, to assist Hand Surgeon and/or Hand Surgery Unit Appraisal

Aims

The aim of this study was to evaluate the need for hand trauma services during the COVID-19 pandemic lockdown, specifically related to surgical requirements. This will provide useful information for planning and resource allocation in the event of any further lockdown.

Following a laboratory rat study where iliac crest was removed, the femoral vessels were placed as a pedicle through the centre of the graft which was wrapped in silastic sheeting and transplanted to the subcutaneous abdominal wall, which showed in all cases bone revascularisation and viability within three weeks. A human study followed in two patients with chronic complex scaphoid non unions where iliac crest was placed in the anterior interosseous pedicle in the proximal forearm. The pedicle was ligated proximally. Four months later, the graft was dissected on its pedicle distally to the scaphoid. In both cases, the scaphoid united and in both cases the bone was viable at biopsy. Rather than this tedious two stage procedure, Russe and Fisk grafts are routinely pedicled with the superficial radial vessels flowing retrograde at scaphoid bone grafting. At the same time of our rat study, Zaidemberg published his dorso-radial radius vascularised pedicled bone graft on the “irrigating artery”. The details were scant as they were at the oral presentation three years later. The irrigating artery was subsequently beautifully demonstrated in Zancolli’s Atlas of Hand Surgery and this and other dorsal pedicled bone grafts of the radius have been well described by Bishop and colleagues at the Mayo Clinic. The technique of 1-2 SRA (Zaidemberg) pedicled bone grafting is described in detail together with the indications for prefabrication and vascularised pedicled bone grafting and the necessary pre operative imaging information to plan and select the correct procedure

Purpose of the study: The efficacy of a new oestrogeneration biomaterial should be demonstrated by in vivo grafts in animal models. Critical filling of bone defects in the rat could be useful as a model before beginning studies in large animals such as the sheep, goat or dog. Creation of a critical defect in the rat femur has been described, but not standardized, leading to difficult comparison between series. In this work, we wanted to establish a detailed standardisable surgical protocol for the creation of a 6 mm femur defect in the rat. Material and methods: We compared three anaesthesia protocols using 18 mal Wistar rats aged 21 weeks. We developed a surgical procedure enabling study of the advantages of the different commonly used surgical devices either in research or clinic to achieve osteosynthesis and a 6 mm bone defect. We also compared two types of fixation plates (and screws) available on the marker: a 1.2 mm thick titanium plate used for hand surgery and a 1.5 mm steel plate (veterinary medicine). Our postoperative clinical and radiographic follow-up was designed to validate our operative protocol and evaluate osteoregeneration. Results: We demonstrated first that the use of multimodal anaesthesia radically improved the clinical outcome in the animals. We then demonstrated that the 1.2 mm titanium plates recommended in other studies were too fragile in our model and that the steel 1.5 mm veterinary plates were more adapted. We finally demonstrated the superiority of surgical devises to create a defect and for osteosynthesis. We described a postoperative protocol offering satisfactory evaluation, clinically and radiographically. Discussion: This work is the first describing this protocol in detail. Improvements in feasibility and cost will make a readily exploitable model for other laboratories. The follow-up on this work should be aimed at improving the quality and pertinence of the analysis methods for the assessment of bone regeneration. Conclusion: We propose a mode for the critical defect in rat femur bone as a reliable model for the study of osteogenic capacities of new biomaterials

Results are presented of a prospective audit of wound infection rates in patients undergoing surgery for hand injuries in a designated hand trauma day surgery unit. Hand trauma patients with suitable injuries referred from peripheral accident and emergency departments to the Hand Surgery Unit at Queen Victoria Hospital undergo surgery after a variable delay. Initial wound toilet is undertaken at referral and all patients are prescribed oral antibiotics while waiting up to five days for theatre. Time to operation and results of microbiological wound swabs in theatre were correlated with post operative wound infection rates in fifty patients. Initial analysis suggests little difference in subsequent wound infection rates between patients operated on within 48 hours and those delayed three to five days

Congenital Hand Deformities are probably the most frequent cause of non-traumatic complaint in consultations on paediatric hand surgery. The incidence of occurrence is about 1 in 500 live births. Some of these abnormalities are minor and do not interfere with function. Many, however, have a significant functional and/or cosmetic deformity. Only a few congenital malformations have a regular single gene mode of transmission, most have an irregular and unpredictable pattern of inheritance; sometimes occurs as part of a malformation syndrome or skeletal dysplasia, or in a sporadic way. In fact, the cause for 40 to 50% of these anomalies is “unknown”. Themes like handling the patient and parents and the psychological effects of the anomaly, the general principles of treatment, timing of surgery and the principles of reconstructive surgery are discussed. The classification proposed by A.B. Swanson and revised with the assistance of the Congenital Anomalies Committee of the International Federation of Societies fo Surgery of the Hand will be used to propose the general guides of treatment. The most common anomalies will be approached in more detail and the option of treatment is discussed in base of experience of the author

Introduction: In an already published prospective and randomised study the positioning of TKA with and without a navigation device was analyzed. The results with navigation were significantly better than free hand surgery. The issue of this study was to find out if navigation can improve MIS in TKA. Materials and methods: A three arm study was designed by the National Institute of Rheumatology. The study was prospective and externely evaluated. 30 persons have got TKA in an open technique with navigation, 30 cases have got MIS and another 30 MIS and navigation. Operation time, blood loss, early outcome and accuracy of the implantation was measured and compared. Results: MIS increases the operation time and leads to a significant better early outcome within the first ten days. The accuracy of the implantation is poorer in comparison to open techniques. Navigation doesn‘t improve the results because the malpositioning is caused by the final surgical step of impaction. This was verified by a radiological score analysis using a score developed in our hospital for the postoperative X-rays

Aims

We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue.

Hand surgery is rarely indicated in children with arthritis, but presents specific problems. The initial diagnosis can be difficult due to discrete clinical symptoms and limited radiological signs. A decreased wrist extension or finger joint stiffness can be early signs of arthritis in a child. Destruction of joint surfaces are difficult to evaluate since many skeletal parts in the hand, e.g. the carpal bones, are still not ossified in young children. Accelerated skeletal maturation can often be the only radiological sign of an active synovitis in the joint. The hands and wrists are often involved at an early stage of juvenile arthritis and different growth disturbances may occur, the most commonly seen is a shortening of the distal ulna. Surgery itself may also affect growth. When performing soft tissue surgery, like synovectomies or arthrolyses on the juvenile arthritic hand, a significant risk of postoperative joint stiffness has to be considered. Surgical treatment of arthritic hands in children are often delayed until adolescence, and doing any kind of surgery in a teenager is a difficult task which requires special attention and finesse. Personal experience from the Children’s Hospital in Lund, Sweden will be presented

Introduction: The choice of whether to use absorbable or non-absorbable suture in the closure of wounds following hand or upper limb surgery is usually surgeon dependent. In our unit both continuous absorbable subcutaneous suture and interrupted non-absorbable suture are utilised. The use of absorbable sutures offers a potential advantage to the patient and clinician in not requiring a clinic appointment for suture removal. The quality and aesthetic appearance of hand and upper limb surgical scars are of great importance to patients. Few studies have compared the aesthetic appearance of scars following the use of absorbable and non-absorbable suture in hand and upper limb surgical wound closure. Method: 50 consecutive patients having undergone day case hand surgery between August 2007 and May 2008 with absorbable suture wound closure were identified along with 50 consecutive patients over the same time period who underwent non-absorbable wound closure. Each was sent a questionnaire comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6 point patient scar assessment tool and the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Results: 100 patients were contacted by post and 70 responses were received (37 absorbable, 33 non-absorbable). Both groups had undergone a similar spectrum of procedures including carpal tunnel decompression, Dupuytrens fasciectomy, excision of lesions and trigger finger release. Age, sex and QuickDASH scores were not significantly different between groups. Mean VAS was not significantly different between groups (Non-absorbable group 82.4 (95% CI 74.7–90.2) Absorbable group 80.4 (95% CI 71.9–89.0)). No significant difference was found between groups in terms of pain, itching, scar colour, stiffness, thickness or irregularity. Conclusion: No significant difference in aesthetic appearance of scars exists following the closure of hand and upper limb wounds with either absorbable or non-absorbable suture. Either suture material can be used with confidence with respect to aesthetic outcome

Introduction: The use of mini C-arm systems has become established in hand surgery. Potential advantages of the mini C-arm include decreased radiation exposure by reducing screening time, increased distance from the beam, tighter beam collimation and surgeon control of the C-arm. Little has been written in the literature regarding their use in foot and ankle surgery. Aims: To compare the radiation dose and screening times delivered by the mini C-arm with standard fluoroscopy in elective foot and ankle surgical procedures. A secondary objective was to quantify the cost of both techniques. Patients and methods: We prospectively studied 137 patients who underwent fluoroscopic screening during various elective foot and ankle procedures. Of these 72 were screened using standard fluoroscopy and the remaining 55 using the mini C-arm. During each procedure screening time and radiation dose were prospectively recorded. The Dose Area Product (DAP) meters on both machines for the determination of radiation exposure and scatter to the operating theatre and staff were used. A cost benefit analysis for radiographer attendance and theatre delay was calculated. Results: The mean DAP for standard fluoroscopy was 7.43 CGycm2 (sd 9.41) whereas with the mini C-arm it was 3.46 CGycm2 (sd 3.51). There was a statistically significant reduction in the DAP (P = 0.0013). Mean screening time was 13 seconds (SD 14.7) with standard fluoroscopy and 14.5 seconds (SD 18.1) with the mini C-arm. No statistically significant difference was found between screening times. (p = 0.987). The potential total saving of the mini c-arm for 137 procedures was £4086. Conclusion: We recommend the use of the mini C-arm in foot and ankle surgery as it reduces radiation exposure and cost when compared to standard fluoroscopy. We acknowledge that there is a learning curve for surgeons to minimise screening time

Everywhere I visited, both in England and in other parts of Europe, I met with wonderful hospitality and friendliness. Generally our common language was English, and I felt thoroughly ashamed of my poor efforts at speaking other languages. During my tour in England, France, Germany, Austria, Italy, Denmark, Norway and Sweden I heard many new ideas propounded, and have seen many new and different methods of treatment. In particular I have been able to compare thoughts on such subjects as tuberculosis of the spine, congenital dislocation of the hip, osteoarthritis of the hip, scoliosis, many aspects of trauma, Perthes' disease, hand surgery, poliomyelitis, paraplegia, the treatment of cerebral palsy, rehabilitation of patients suffering from all kinds of orthopaedic disabilities, and surgical appliances. I am very grateful indeed to the British Orthopaedic Association for making this six-months' tour possible