AIN to Ulnar Motor Nerve Transfer Meta Analysis

Background: There are currently few comprehensive studies of end-to-end and “supercharged” reverse end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers for treatment of ulnar neuropathy. The authors performed a literature review existing published literature to evaluate the indications for, and utility of, AIN-ulnar nerve transfer as a treatment method and to inform future treatment decisions. Methods: A literature review was performed based on the following inclusion criteria: inclusion of anterior interosseous nerve or AIN, ulnar nerve or ulnar motor nerve, transfer or nerve transfer, and outcome, motor, clinical, ulnar neuropathies, ulnar nerve paralysis, treatment or function. Exclusion criteria included animal studies or studies not in English. Results were analyzed based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council (MRC) graded strength. Preoperative and postoperative differences were evaluated by independent t-test and Mann-Whitney U-test. Results: Literature search identified 103 unique articles. Following screening, 13 full-text articles were reviewed. 9 articles met the inclusion criteria, of which 5 pertained to the reverse end-to-side (SETS) technique and 4 pertained to the end-to-end technique. 130 patients (mean age, 40.8 +/- 12.8 years) were included overall, and 114 patients had sufficient follow-up to evaluate functional outcomes. The mean time to surgery was 5.4 +/- 2.2 months and the mean follow-up period was 18.2 +/- 27.0 months. Injuries to the ulnar nerve and diagnoses varied, but all patients had preoperative clinical evidence of ulnar weakness, and the majority of patients (70%) had documented preoperative decreased grip or key pinch strength and/or motor MRC grade. Other indices included weak index crossover, interosseous atrophy, and denervation evidenced by electromyography of the first dorsal interosseous (FDI) muscle. Motor MRC grade, DASH score, and grip and key pinch strength all improved significantly from their preoperative baseline. Conclusion: Both end-to-end and SETS nerve transfer produced significant improvement in motor function. Nerve transfer is an effective treatment method of both transection and compression injuries, with outcomes comparable to or better than traditional nerve grafts

A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery.

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients\u27 pain experience and opioid consumption after carpal tunnel release (CTR) surgery. METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded. RESULTS: During the day of surgery and the first day following surgery, patients in the group with counseling reported significantly fewer prescribed opioid pills consumed compared with patients in the group without counseling, while experiencing no significant difference in pain level experience. In addition, patients in the group with counseling reported a significantly lower number of total pain pills consumed over the course of the study than the group without counseling. No major adverse reactions were noted in either group. CONCLUSIONS: Preoperative opioid counseling was found to result in a significant decrease in overall opioid consumption after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II

Complications Associated with Volar Locking Plate Fixation of Distal Radial Fractures.

Volar locked plating is the most frequently utilized method for internal fixation of distal radial fractures. The overall complication rate for volar plating of distal radial fractures appears to be relatively low compared with other operative fixation methods. Carpal tunnel syndrome is the most commonly reported complication. However, this may occur after a distal radial fracture regardless of treatment method, with reported rates ranging from 0% to 20% with conservative management and 0% to 14% with volar plating. Extensor tendon rupture has been reported at rates of 0% to 4% and is the most frequent complication requiring plate removal. Variable-angle volar locking plates may be associated with fewer implant-related complications as a result of their greater degree of screw placement customization compared with fixed-angle volar locking plates

FREQUENCY OF FUNGAL MYCOFLORA ON RICE

Introduction: Rice (Oryza sativa L.) is the second best essential cereal crop of the world as well as of Pakistan. There are various fungal pathogens that attack on rice and cause various rice diseases. Methods: Therefore, the present experiments were done to isolated different fungi associated with seeds, stems, and leaves of commercially grown rice varieties and of mainly isolated species. Results: Several fungi, namely, Magnaporthe oryzae, Curvularia lunata, Helminthosporium oryzae, Fusarium moniliforme, Alternaria alternata, Nigrospora oryzae, and Aspergillus niger were isolated from seeds, stems, and affected leaves of rice. Conclusion: In our research, the frequency of fungal mycoflora on rice has been calculated and the maximum isolates of Fusarium spp. have been found

Meta-analysis of repair techniques for mixed nerve damage

BACKGROUND: Injuries to the upper extremity are common and can occur with trauma, surgery, or compression. Particularly, injuries that result in complete transection often require surgical intervention in attempt to restore function and quality of life. Classically, nerve autografts have been used as the gold standard to repair these peripheral lesions. An alternative to the autologous nerve graft is the use of the processed nerve allograft. limited research exists in comparing sensory and motor outcomes of allograft nerve repair in the upper extremity with data for autograft repair. In this systematic review and meta-analysis, we set out to cumulate results of motor and sensory outcomes of allograft peripheral nerve lesion repair and compare those results with outcomes of autograft repair. METHODS: Current literature on motor and sensory outcomes of autograft and allograft peripheral nerve repair were reviewed using British Medical Research Council (MRC) score of sensory recovery or British Medical Research Council (MRC) muscle strength grading system and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 12 articles were reviewed and 826 nerve repairs were analyzed. RESULTS: The mean gap length for the allograft group and autograft group was 28.6 mm and 24.7 mm, respectively. In terms of MRC sensory and motor outcomes, allograft repair was statistically superior to autograft repair. Complication data was insignificant. CONCLUSIONS: Based on the current updated meta-analysis using recent data, we found that both autograft and allograft repair have reasonable outcomes. Yet, processed nerve allograft repair out-performed autograft repair

Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-Analysis and Systematic Review

Introduction: Injuries to the digital nerves are common with trauma to the hand; surgery is often required to repair injured nerves. Surgical management of digital nerve injuries includes neurorrhaphy or use of allograft, autografts, and conduits. Objective: In light of the increasing availability and utilization of digital nerve repair constructs, an updated meta-analysis was undertaken in order to comparatively review the available evidence to determine differences in outcomes. Methods: We reviewed the most current literature on sensory outcomes of various digital nerve repair techniques using static two-point discrimination (S2PD), moving two-point discrimination (M2PD), Semmes Weinstein–Monofilament testing (SWMF) and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: In terms of S2PD outcomes, autograft repair was found to have the highest percent of repairs with “good” and “excellent” sensory outcome followed by allograft repair, conduit repair, and neurorrhaphy (95% vs. 80% vs. 78% vs. 76%). In terms of SWMF outcomes, autograft repair reported the highest percentage of “normal” and “diminished light touch” sensation, followed by allograft, neurorrhaphy, and conduit repair (95% vs. 70% vs. 59% vs. 47%). Of the studies that reported complications, allograft repair had the highest complication rate (9%). Discussion: Combining “good” and “excellent” S2PD results and “normal” and “diminished light touch” SWMF showed that autograft repair may yet still provide the best sensory outcome results in repair of injured digital nerves. Allograft repair may pose the greatest risk for complication

Pain Management Strategies in Hand Surgery.

Modern anesthetic agents have allowed for the rapid expansion of ambulatory surgery, particularly in hand surgery. The choice between general anesthesia, peripheral regional blocks, regional intravenous anesthesia (Bier block), local block with sedation, and the recently popularized wide-awake hand surgery depends on several variables, including the type and duration of the procedure and patient characteristics, coexisting conditions, location, and expected length of the procedure. This article discusses the various perioperative and postoperative analgesic options to optimize the hand surgical patients\u27 experience

A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students

Background: The United States opioid epidemic is a devastating public health crisis fueled in part by physician prescribing. While the next generation of prescribers is crucial to the trajectory of the epidemic, medical school curricula designated to prepare students for opioid prescribing (OP) and pain management is often underdeveloped. In response to this deficit, we aimed to investigate the impact of an online opioid and pain management (OPM) educational intervention on fourth-year medical student knowledge, attitudes, and perceived competence. Methods: Graduating students completing their final year of medical education at Sidney Kimmel Medical College of Thomas Jefferson University were sent an e-mail invitation to complete a virtual OPM module. The module consisted of eight interactive patient cases that introduced topics through a case-based learning system, challenging students to make decisions and answer knowledge questions about the patient care process. An identical pre- and posttest were built into the module to measure general and case-specific learning objectives, with responses subsequently analyzed using the Wilcoxon matched-pairs signed-rank test. Results: Forty-three students (19% response rate) completed the module. All median posttest responses ranked significantly higher than paired median pretest responses (p \u3c 0.05). Comparing the paired overall student baseline score to module completion, median posttest ranks (Mdn = 206, IQR = 25) were significantly higher than median pretest ranks (Mdn = 150, IQR = 24) (p \u3c 0.001). Regarding paired median Perceived Competence Scale metrics specifically, perceived student confidence, capability, and ability in opioid management increased from disagree (2) to agree (4) (p \u3c 0.001), and student ability to meet the challenge of opioid management increased from neither agree nor disagree (3) to agree (4) (p \u3c 0.001). Additionally, while 77% of students reported receiving OP training in medical school, 21% reported no history of prior training. Conclusion: Implementation of a virtual, interactive module with clinical context is an effective framework for improving the OPM knowledge, attitudes, and perceived competence of fourth-year medical students. This type of intervention may be an important method for standardizing and augmenting the education of future prescribers across multiple institutions

Use of High-Speed X ray and Video to Analyze Distal Radius Fracture Pathomechanics.

The purpose of this study is to investigate the failure sequence of the distal radius during a simulated fall onto an outstretched hand using cadaver forearms and high-speed X ray and video systems. This apparatus records the beginning and propagation of bony failure, ultimately resulting in distal radius or forearm fracture. The effects of 3 different wrist guard designs are investigated using this system. Serving as a proof-of-concept analysis, this study supports this imaging technique to be used in larger studies of orthopedic trauma and protective devices and specifically for distal radius fractures