Promise of open TFCC surgery

Routine outcome measurements as a critical prerequisite of Value-BasedHealthcare have received considerable attention recently. There has been lessattention for the last step in Value-Based Health Care where measurement ofoutcomes also leads to improvement in the quality of care. Probably this is notwithout reason, since the last part of the learning cycle: “Closing the loop”, seemsthe hardest to implement.The journey from measuring outcomes to changing daily care can be troublesome.As early adopters of Value-Based Healthcare, we like to share our 10 years ofexperience in this journey. Examples of feedback loops are shown based on outcome measurementsimplemented to improve our daily care process as a focused hand surgery andhand therapy clinic.Feedback loops can improve shared decision making, monitor or predicttreatment progression over time, extreme value detection, improve journal clubs,and surgeon evaluation.Our goal as surgeons to improve treatment should not stop at the act ofimplementing routine outcome measurements.We should implement routine analysis and routine feedback loops, because realtime performance feedback can accelerate our learning cycle

Surgical stabilization for symptomatic carpometacarpal hypermobility; a randomized comparison of a dorsal and a volar technique and a cohort of the volar technique

BACKGROUND: Hypermobility of the first carpometacarpal joint is mostly surgically treated with a volar approached stabilization by Eaton, but recent studies indicate the importance of the dorsoradial and intermetacarpal ligaments (DRL and IML) for carpometacarpal joint stability. The aim of this study was to compare a dorsal and volar technique for primary carpometacarpal hypermobility regarding pain and functional outcome. METHODS: Patients with non-degenerative, painful carpometacarpal hypermobility were included and were randomly assigned to either the volar technique using the FCR, or a dorsal technique using the ECRL. After premature termination of the trial, we followed all patients treated with the volar approach. Pain, strength, and ADL function using DASH and Michigan Hand Questionnaires (MHQ) were measured at baseline and 3 and 12 months after surgery. RESULTS: After including 16 patients, the randomized trial comparing the volar and dorsal technique was terminated because of significant increased pain in the dorsal group. Although none of the other outcome measures were significant in the underpowered comparison, in line with the pain scores, all variables showed a trend towards a worse outcome in the dorsal group. Between 2009 and 2012, 57 thumbs were surgically stabilized. We found significant better pain and MHQ scores, and after 1 year improved grip and key pinch strength. Patients returned to work within 8 (±7) weeks, of which 85 % in their original job. CONCLUSIONS: Surgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength. We recommend a volar approach. Level of Evidence: Level I, therapeutic stud

Life Span of Silicone Gel-Filled Mammary Prostheses

The discussion on possible side effects of implanted silicone has resulted in a growing number of patients inquiring whether or not their mammary prostheses are intact and when failure of the prostheses is to be expected. Between November 1988 and May 1995, 182 patients had their silicone mammary prostheses replaced, repositioned, or removed one to three times. Capsular contraction, dislocation, pain paresthesia, and/or suspected rupture were common indications for surgery. To try and be able to provide an indication as to the correlation of implant age and integrity, we recorded the status of all 426 prostheses observed during secondary surgery. In this selected group of patients, approximately 50 percent of the mammary prostheses with an implant age of 7 to 10 years showed gel bleed or rupture. Applying the survival Kaplan-Meier curve, 50 percent of implants may be expected to bleed or be ruptured at the age of 15 years. Rupture was observed more frequently than gel bleed. It seems that there is no chronologic relation between gel bleed and rupture