Interposition Arthroplasty Versus Hematoma and Distraction for the Treatment of Osteoarthritis of the Trapeziometacarpal Joint

Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. However, the best treatment option was not defined yet

Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

Background Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts

Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps

Purpose To review the outcomes of 8 patients with painful median nerve neuromas at the wrist treated with external neurolysis and covered with pedicled perforator adipofascial flaps. Methods Between 2004 and 2010, we treated 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function. All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale. Results Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site. Conclusions Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. We do not believe that a free flap is of any particular advantage over a local pedicle flap which we suggest using to protect the median nerve. Type of study/level of evidence Therapeutic IV. © 2014 ASSH r Published by Elsevier, Inc. All rights reserved

Use of integra artificial dermis to reduce donor site morbidity after pedicle flaps in hand surgery

Purpose To assess the results obtained with Integra artificial dermis to cover donor site following the harvesting of pedicle flaps for hand reconstruction.Methods Between April 2010 and August 2013, 11 patients (8 men and 3 women; mean age, 37 y) were treated with Integra Dermal Regeneration Template (Integra LifeSciences, Inc., Plainsboro, NY) to cover donor defects after raising pedicle flaps for hand and finger reconstruction: radial forearm flap (4 cases), ulnar artery perforator flap (2 cases), and heterodigital island flap (5 cases). After neodermis formation the silicone layer of the artificial dermis was removed (on average after 22 days) and a split- or full-thickness epidermal autograft placed.Results No infections, hematoma, or bleeding were recorded during the entire phase in which the artificial skin was applied. Two patients experienced a partial skin graft loss. Median follow-up was 20 months, and results included an average Vancouver Scar Scale rating of 2.7 and an average DASH score of 39. There were no cases of graft adherence to the underlying tendons or muscles.Conclusions Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. Despite the drawback of an additional surgical procedure (secondary skin graft), the use of this artificial skin produced soft-tissue augmentation and graft-skin quality, reducing donor site morbidity. Type of study/level of evidence Therapeutic IV

Alternative method for thumb reconstruction. Combination of 2 techniques: Metacarpal lengthening and mini wraparound transfer

Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period. © 2013 American Society for Surgery of the Hand

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial

BACKGROUND Distal radius fractures (DRFs) are a common challenge in orthopaedic trauma care, yet for those fractures that are treated nonoperatively, strong evidence to guide cast treatment is still lacking. AIM To compare the efficacy of below elbow cast (BEC) and above elbow cast (AEC) in maintaining reduction of manipulated DRFs. METHODS We conducted a prospective, monocentric, randomized, parallel-group, open label, blinded, noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs. Two hundred and eighty patients > 18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period. Noninferiority thresholds were defined as a 2 mm difference for radial length (RL), a 3 & DEG; difference for radial inclination (RI), and volar tilt (VT). The trial is registered at Clinicaltrials.gov (NCT03468023). RESULTS One hundred and forty-three patients were treated with BEC, and 137 were treated with AEC. The mean time of immobilization was 33 d. The mean loss of RL, RI, and VT was 1.59 mm, 2.83 & DEG;, and 4.11 & DEG; for BEC and 1.63 mm, 2.54 & DEG;, and 3.52 & DEG; for AEC, respectively. The end treatment differences between BEC and AEC in RL, RI, and VT loss were respectively 0.04 mm (95%CI: -0.36-0.44), -0.29 & DEG; (95%CI: -1.03-0.45), and 0.59 & DEG; (95%CI: -1.39-2.57), and they were all below the prefixed noninferiority thresholds. The rate of loss of reduction was similar. CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF. Being more comfortable to patients, BEC may be preferable for nonoperative treatment of DRFs

3D Printed models of distal radius fractures

3D printing, also known as additive manufacturing or ‘‘rapid prototyping’’, is a low cost technology that uses a 3D computer representation to create solid objects from a feedstock material. In the literature studies report that 3D printed models for orthopedic conditions can improve surgeons’ evaluation of patient-specific anatomy and pathology by way of tactile and visual experience [1–4]. However, it has not been analysed yet how far models may support the surgeon by selecting the most adequate surgical procedure, and which effect they may have on patient’s understanding (and in some cases on their approval) of the surgical procedure they will undergo. In this paper, we present our initial experience preparing and using 3D printed models of the bony anatomy of distal radius fractures and we describe their effect on surgical planning and patient information

Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study

BACKGROUND: Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. Aim. To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. DESIGN: Proof-of-concept, pilot, randomized controlled trial. SETTING: University hospital. POPULATION: Twenty adult outpatients with distal radius fracture due to wrist injury. METHODS: All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. RESULTS: No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. CONCLUSIONS: Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. CLINICAL REHABILITATION IMPACT: The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions