Novel implant design of the proximal interphalangeal joint using an optimized rolling contact joint mechanism

Background The aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics. Methods In total, 10 participants with normal PIPJs were enrolled in this study. True lateral finger radiographs were obtained in 10° increments from 0º (full extension) to 120° flexion of PIPJ. Radiographs were used to determine the average center of rotation, which formed the basis of a mathematical expression of the PIPJ kinematics. The variations in extensor tendon excursions in relation to the range of motion of PIPJ were determined using results from previous cadaveric studies. As the next step, a PIPJ implant design using an RCJ mechanism that was most consistent with the mathematically expressed PIPJ kinematics and tendon excursions was determined using a constrained optimization algorithm. Results The final proposed PIPJ implant had a relatively constant center of rotation over the entire PIPJ range of motion among the participants. In addition, the extensor tendon excursions of the proposed implant as applied to the phalangeal bones were similar to those of the human tendon. The proposed PIPJ implant achieved an acceptable position of the RCJ surface on the proximal and middle phalanges, which was derived from the constrained optimization algorithm. Conclusions A novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions.This research was supported by the Seoul National University Bundang Hospital Research Fund (grant no. 14-2017-001) and in part by the convergence technology development program for bionic arm through the National Research Foundation of Korea (NRF) funded by the Ministry of Science & ICT (no. 2015M3C1B2052817). The funders had no role in the study design, data collection, analysis and interpretation, and writing the manuscript

Use of a decision aid did not decrease decisional conflict in patients with carpal tunnel syndrome

Background Although a model for shared decision-making is important for patient-centered care, decisional conflict can emerge when patients participate in the decision-making. A decision aid is proposed to provide information and to involve patients more comfortably in the decision-making process. We aimed to determine whether a decision aid helps patients with carpal tunnel syndrome (CTS) experience less decisional conflict regarding their decision-making for surgery. Methods Eighty patients with CTS were randomized into two groups. The test group was given a decision aid in addition to regular information and the control group regular information only. The decision aid consisted of a 6-min videoclip that explains diagnosis and information regarding surgery for CTS with other treatment options. We evaluated patients decisional conflict regarding surgery, knowledge about CTS, and symptom severity as measured by the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire. Results There was no difference in the decisional conflict scale (DCS) between both groups (p = 0.76). The test group had significantly better knowledge than the control group (p = 0.04). There was no correlation between the knowledge score and the DCS (p = 0.76). However, less severe symptoms were correlated with greater decisional conflict (r = −0.29, p = 0.02). Conclusions We found that a decision aid does not reduce decisional conflict in patients with CTS, although it can help them be better informed. This study suggests that although a decision-aid is effective for patient education, doctor-patient communication should be more emphasized for patients with less severe symptoms, as they can have greater decisional conflict. Trial Registration SNUBH Registry 1510/317-003 Registered November 13, 201

Factors Affecting Willingness to Undergo Carpal Tunnel Release

Background: Factors regarding patient willingness to undergo or avoid joint replacement have been studied; however, these factors have not been studied in patients with carpal tunnel syndrome. To further understand the aspects that are important for a patient with carpal tunnel syndrome in deciding whether to have surgery, we identified factors that affect this decision in women and that are not related to Workers` Compensation status. Methods: We retrospectively reviewed 282 female patients with electrophysiologically confirmed carpal tunnel syndrome without a known cause who were recommended for carpal tunnel release by a single hand surgeon in a tertiary medical setting. Of those, thirty-six female patients who were not entitled to Workers` Compensation canceled the operation during the waiting period, which averaged four weeks. Thirty-three of them were surveyed with a questionnaire sent by mail, and eighteen completed surveys were reviewed at a mean follow-up of thirty-two months. Furthermore, seventy female patients who underwent carpal tunnel release were randomly sampled, and thirty-eight patients completed the survey. The operation and cancellation groups were compared with regard to the reasons for choosing or canceling surgery. Results: The groups were similar with regard to age, sociodemographic variables, follow-up length, initial electro-physiological findings, and functional status. The highest-ranked reason for choosing surgery was symptom severity rather than fear of progression or a positive electrodiagnostic result. Those who canceled the operation rated symptom improvement during the waiting period as the leading reason for doing so, but they were also concerned about transient weakness, the financial burden, and a scar or pillar pain. Disease persistence or recurrence was the issue of most concern in both groups. At the time of the final review, the functional status was significantly improved in both groups and no significant difference between the groups was detected. Conclusions: Women with carpal tunnel syndrome report that subjective symptom severity is the most important reason for undergoing surgery. Understanding this and other patient concerns may help physicians during patient-oriented consultation and decision-making. In particular, recommendations for carpal tunnel release on the basis of symptoms are reasonable from the perspective of the patient who has carpal tunnel syndrome without a known cause.Lee JY, 2008, J SHOULDER ELB SURG, V17, P570, DOI 10.1016/j.jse.2007.12.005Hudak PL, 2008, J BONE JOINT SURG AM, V90A, P1427, DOI 10.2106/JBJS.G.01077Park KK, 2007, CLIN ORTHOP RELAT R, P143, DOI 10.1097/BLO.0b013e31804ea0bcTaylor-Gjevre RM, 2007, CAN FAM PHYSICIAN, V53, P1186Rigler I, 2007, EUR J NEUROL, V14, P783, DOI 10.1111/j.1468-1331.2007.01855.xBallantyne PJ, 2007, ARTHRIT RHEUM-ARTHR, V57, P27, DOI 10.1002/art.22472*AAOS CARP TUNN SY, 2007, AM AC ORTH SURG GUIDSCHOLTEN RJ, 2007, COCHRANE DB SYST REV, V17, P3905Hawker GA, 2006, CURR OPIN RHEUMATOL, V18, P526Mazur DJ, 2005, HEALTH EXPECT, V8, P97FIGARO MK, 2005, J AMBUL CARE MANAGE, V28, P41Hawker GA, 2004, ARTHRIT RHEUM-ARTHR, V51, P635, DOI 10.1002/art.20524Figaro MK, 2004, HEALTH PSYCHOL, V23, P324, DOI 10.1037/0278-6133.23.3.324Chang HJ, 2004, ARTHRIT RHEUM-ARTHR, V51, P117, DOI 10.1002/art.20073AKELMAN E, 2004, HAND SURG, P867Moran M, 2003, J ARTHROPLASTY, V18, P442, DOI 10.1016/S0883-5403(03)00061-5RESENDE LA, 2003, ELECTROMYOGR CLIN NE, V43, P301Ang DC, 2002, MED CARE, V40, P471Hawker GA, 2001, MED CARE, V39, P206Bland JDP, 2000, MUSCLE NERVE, V23, P1280Trousdale RT, 1999, MAYO CLIN PROC, V74, P978Atroshi I, 1999, JAMA-J AM MED ASSOC, V282, P153Homan MM, 1999, SCAND J WORK ENV HEA, V25, P115Padua L, 1998, ITAL J NEUROL SCI, V19, P357Aulisa L, 1998, J HAND SURG-AM, V23A, P687Nathan PA, 1998, MUSCLE NERVE, V21, P711Concannon MJ, 1997, PLAST RECONSTR SURG, V100, P1452Asch DA, 1997, J CLIN EPIDEMIOL, V50, P1129Hudak PL, 1996, AM J IND MED, V30, P372Deber RB, 1996, ARCH INTERN MED, V156, P1414Hudak PL, 1996, AM J IND MED, V29, P602WRIGHT JG, 1994, J BONE JOINT SURG BR, V76B, P229LEVINE DW, 1993, J BONE JOINT SURG AM, V75A, P1585SIMINOFF LA, 1991, SOC SCI MED, V32, P813GRUNDBERG AB, 1983, J HAND SURG-AM, V8, P348

Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults

BACKGROUND: Plate osteosynthesis is the most commonly used technique for the treatment of diaphyseal forearm fractures in adults. However, application of a plate can disrupt the periosteal blood supply and necessitates skin incisions that may be unsightly, and there is a risk of refracture if the implant is removed. The purpose of this study was to assess the early results of the use of a contoured interlocking intramedullary nail to stabilize displaced diaphyseal fractures of the forearm. METHODS: Between January 2004 and July 2006, a total of thirty-eight interlocking intramedullary nails were inserted into the forearms of twenty-seven adults. Eighteen nails were used in the radius and twenty were used in the ulna to stabilize a diaphyseal fracture. The mean follow-up period was seventeen months. Functional outcomes were assessed with use of the Grace and Eversmann rating system, and patient-rated outcomes were assessed by completion of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: The average time to fracture union was fourteen weeks. There was one nonunion of an open comminuted fracture of the middle third of the ulna. There were no deep infections or radioulnar synostoses. According to the Grace and Eversmann rating system, twenty-two patients (81%) had an excellent result; three (11%), a good result; and two (7%), an acceptable result. The DASH scores averaged 15 points (range, 5 to 61 points). CONCLUSIONS: Our experience indicates that the advantages of an interlocking intramedullary nail system for the radius and ulna are that it is technically straightforward, it allows a high rate of osseous consolidation, and it requires less surgical exposure and operative time than does plate osteosynthesis. We suggest that the interlocking intramedullary nail system be considered as an alternative to plate osteosynthesis for selected diaphyseal fractures of the forearm in adults

The natural history of pediatric trigger thumb

BACKGROUND: Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal joint in children. Although the surgical outcome is satisfactory, the indications for nonoperative treatment for this condition are not clear. The aim of the present study was to determine the rate of resolution of untreated pediatric trigger thumb. METHODS: Data on seventy-one thumbs in fifty-three children were collected prospectively. The dates of the first visits ranged from April 1994 to March 2004. Patients were diagnosed with pediatric trigger thumb during initial outpatient department visits. During the present study, no treatment such as passive stretching or splinting was applied. The amount of flexion deformity at the thumb interphalangeal joint was measured at every six-month follow-up visit, and the duration of follow-up was at least two years after diagnosis. The end point of follow-up was when the deformity caused pain or secondary deformity or prevented normal use of the hand. The median duration of follow-up was forty-eight months. RESULTS: Of the seventy-one trigger thumbs, forty-five (63%) resolved spontaneously. The median time from the initial visit to resolution was forty-eight months. There was no significant difference in the pattern of resolution between patients with unilateral and bilateral trigger thumb. Although resolution was not observed in the remaining twenty-six thumbs, flexion deformities improved in twenty-two thumbs. For the first two years after the initial visit, the mean flexion deformity significantly decreased over the one-year intervals (p 60% of patients. Moreover, the flexion deformity can be expected to show an improving pattern in patients who do not have resolution. This information may help both parents and surgeons to make decisions regarding the treatment of pediatric trigger thumb

Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. Surgical technique

BACKGROUND: The Bilhaut-Cloquet operation is a combined surgical procedure for the treatment of a symmetric bifid thumb. Although this procedure can obtain a normal-sized thumb with a stable interphalangeal joint, it has limitations, such as the technical difficulty of combining all segments of a duplicated thumb, possible later physeal growth arrest, joint stiffness, and nail plate deformity. We reviewed the results of our modification of this procedure for the treatment of Wassel type-II and III polydactyly of the thumb. METHODS: Seven patients, two with type-II and five with type-III polydactyly of the thumb, underwent this modified Bilhaut-Cloquet procedure and were followed for an average of fifty-two months. Cosmetic and functional assessments were made. RESULTS: All patients and parents were satisfied with the cosmetic and functional results. Compared with the preoperative motion, the postoperative range of motion of the interphalangeal joint was preserved in thumbs with type-III deformity and was increased in those with type-II deformity. No nail deformity or growth arrest occurred, and remodeling and hypertrophy of the distal phalanx occurred with time. CONCLUSIONS: Our modification of the Bilhaut-Cloquet procedure for the treatment of type-II and III thumb polydactyly is effective in preserving interphalangeal joint motion, minimizing nail deformity, and preventing growth arrest

Efficacy of neoadjuvant endocrine therapy compared with neoadjuvant chemotherapy in pre-menopausal patients with oestrogen receptor-positive and HER2-negative, lymph node-positive breast cancer

Introduction Neoadjuvant endocrine therapy (NET) has demonstrated efficacy in post-menopausal patients with hormone-responsive breast cancer. This trial was designed to compare the efficacy of neoadjuvant chemotherapy (NCT) with NET in pre-menopausal breast cancer. Patients and methods In this prospective, randomised, phase III study, oestrogen receptor (ER)-positive, HER2-negative, and lymph node-positive pre-menopausal breast cancer patients were recruited from 7 hospitals in South Korea. Enrolled patients were randomly assigned (1:1) to receive 24 weeks of either NCT or NET with goserelin and tamoxifen. The primary purpose was to evaluate the non-inferiority of NET compared to NCT using clinical response, assessed by MRI. Besides, pathological complete response rate (pCR), changes in Ki-67 expression, breast conservation surgery (BCS) rate, and quality of life were included as secondary endpoints. Results A total of 187 patients were assigned to receive NCT (n = 95) or NET (n = 92), and 87 patients in each group completed treatments. More NCT patients had complete response or partial response than NET patients using MRI (NCT 83.7% vs. NET 52.9%, 95% CI 17.6–44.0, p < 0.001) and callipers (NCT 83.9% vs. NET 71.3%, 95% CI 0.4–24.9, p = 0.046). Three NCT patients (3.4%) and one NET patient (1.2%) showed pCR (p < 0.005). No difference existed in the conversion rate of BCS (13.8% for NCT vs. 11.5% for NET, p = 0.531) and Ki-67 change (p = 0.114) between the two groups. Nineteen NCT patients had treatment-related grade 3 or worse events compared with none in the NET group. Conclusions Better clinical responses were observed in pre-menopausal patients after 24 weeks of NCT compared to those observed after NET. Trial registration Clinicaltrials.gov, NCT01622361. Registration June 19, 2012.This work was supported by the AstraZeneca Korea