Long-term Results after Restoring Flexor Tendon Injury in Children Younger than Age 10 Years

Background: In regard to the rarity of pediatric tendon lacerations compared with the adult population, sparse knowledge exists. Published reports indicate that the incidence of “good” flexor tendon repair outcomes is low. This study aimed to determine the injury pattern and demographics of pediatric flexor tendon injuries over the past decade.Methods: A retrospective chart review of all flexor tendon injuries between 2005 and 2015 was performed. Parameters reviewed included demographics, injury mechanism, repair technique, outcomes, and complications.Results: A total of 20 patients with a median age of 4 years and 4 months experienced 45 tendon injuries. The most common cause of injury was glass (n = 10), with the most common digit injured being the index finger (n = 8). Zone II had the highest number of injuries (n = 14). The modified Kessler core and peripheral running sutures technique were used in all primary repairs (n = 18). Using author designed evaluation system, 80% of patients experienced excellent recovery. Four patients had good results. Only one patient complicated with rupture necessitating further surgery that its final evaluation was excellent.Conclusions: The outcome of restoring flexor tendon injury of children is satisfactory, and we recommend that

Misnomers in Hand Surgery

Hand surgery literature is full of disease names and terms. Some of them are misnomers, which are misleading to physicians outside the specialty. Therefore, we decided to collect all misnomers and provide them via this paper. Considering development of sciences in future, perhaps avoidance from new misnomers is impossible, but awareness of this fact, lead us to be more ingenious in interpretation. On the other hand, we believe his collection would be interesting for most specialists in hand surgery and as well informative for others

Recurrence rate after radial club hand surgery in long term follow up

<ul><li><strong>BACKGROUND</strong>: Radial club hand includes wide spectrum of  alformations that involve radial side of forearm. Conservative treatments are recommended to the milder types and surgical  nterventions specially centralization for the severe forms. Recurrence after centralization is one of the challenging problems in this anomaly. In this study, we assessed the recurrence rate of centralization in radial club hand surgery in long term follow up.</li><li><strong>METHODS</strong>: In this retrospective study, we reviewed the records and radiographies of 9 patients with radial club hand who underwent centralization to correct the deformity in the hand surgery department. Patients' age, type of the thumb anomaly, associated anomalies in other systems, involved side, type of radial club hand, hand-forearm angle preoperative, post operative and in the last follow up visit, and centralized wrists motion range in the final follow up visit were all assessed and reported.</li><li><strong>RESULTS</strong>: Eleven cases of radial club hand in nine patients underwent centralization. Mean age at the time of the centralization was 17 (6-72) months and mean follow up was 90 (48-170) months. Preoperative hand-forearm angle was 75 (30-110) degrees, immediate postoperative angle was 25 (15-35) degrees and in the last follow up visit it was 52 (40- 60) degrees. The amount of correction was 66% and loss of correction in long term was 54%.</li><li><strong>CONCLUSION</strong>: Centralization still can be a standard procedure in treatment of patients with radial club hand with acceptable results.</li><li><strong>KEYWORDS</strong>: Radial Club Hand, Radius/Surgery, Recurrence, Surgical Treatment, Wrist, Deformity.</li></ul&gt

Assessment of the Relative Lengths of the Fingers of the Human Hand

Background:Traumatic or congenital events can result in injury and functional deficiency in the hand and we need to reconstruct the fingers at times. Studies are available in the pediatric and adult age groups to assess the length of the thumb. But to the best our knowledge no measurement of the relative clinical length of all fingers has been reported in the literature. We performed this study to assess the clinical relative lengths of the fingers of the human hand by using surface landmarks. Methods: Fifty male and fifty female healthy participants were involved in the   study. We assessed the distances between the tips of fingers from the distal wrist crease while the thumb and other fingers were held in adducted position. We also assessed the ratio of all fingers including the thumb to the middle finger.Results: One hundred normal hands in 100 healthy volunteers were included in the study, 50 women and 50 men; the average age was 32(20- 50) years.The distance of tips of fingers from distal wrist crease were 93.6(86-120),156.4 (142-185), 166.9 (150-200), 156.3(150-188),132.4(114-168) millimeter in females respectively for the first to the fifths fingers and the same figures for male participants were 107.9(102-121),170.6(153-191),182.6(166-204),172.2(158-193),144.1(129-168)millimeter. The ratios of first, second, fourth and fifth fingers to the middle finger were 60 %, 94 %, 95 %, 79 % for males respectively and 59 %, 94 %, 94 %, 78 % for females. Conclusion: The authors believe that, the relative length of fingers can help the surgeon to decide confidently in the reconstruction of hand and fingers because this   method is simple and easy use

The Psychometric Features of the Patient-Rated Wrist Evaluation in Iranians With Scaphoid or Distal Radius Fracture

Objectives: It is essential to have a suitable instrument for the accurate assessments of pain and disability outcomes during interventions; such tools also help to guide hand surgery and rehabilitation programs in distal radius or scaphoid fracture. This study aimed to evaluate the psychometric features of the Patient-rated Wrist Evaluation (PRWE) questionnaire in Iranians with a history of scaphoid and distal radius fractures. Methods: One hundred and fifty subjects with a history of scaphoid and distal radius fractures were recruited from hospital-based outpatient hand clinics and completed the PRWE, 2 and 7 days after the occurrence of fracture. Additionally, the Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH), the percentage of Wrist Range of Motion (%ROM), Visual Analog Scale Pain/Disability (VAS-P, VAS-D), Short-form Health Survey (SF-36) questionnaires, and pinch and grip strength (%) were conducted in the study participants. Cronbach’s alpha (α) coefficient and Intraclass Correlation Coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability of the scale, respectively. Pearson or Spearman correlation coefficient was calculated for assessing the test’s construct validity. Results: No floor or ceiling effect was found. A very high test-retest reliability was obtained for the PRWE’s total score and subscores (ICC≥0.92). Cronbach’s α coefficient was obtained as ≥0.78 for the PRWE and its subscales. The PRWE total score presented a weak to strong (0.24-0.74) correlation with the average values of %ROM, %power grip, %pinch strength, VAS-P, VAS-D, SF-36, and Quick-DASH. The standard error of the measurement of PRWE total score equaled 3.93; its smallest real difference was 10.86.  Discussion: The PRWE presented acceptable validity and excellent reliability for measuring disability and pain in individuals with the scaphoid and distal radius fractures in Iran

Extension Block Pining for Treatment of Bony Mallet Finger

Background:The goal of this report is to show our results with extension block technique for treatment of mallet fracture. The indications for this technique were the presence of a large bone fragment,and palmar subluxation.Methods:We retrospectively assessed the results of treatment in 14 mallet fractures  which have been treated by extension block technique to determine the range of motion in distal interphalangeal joint and associated complications.Results:According to the Crawford criteria there were 6 excellent,4 good and 4 fair  results. At an average follow-up period of 19 months, the average extension lag and the  average final active flexion of distal interphalangeal joint were 6° and 54° respectively.Conclusion:We have found that this technique effective and minimally invasive and it does not disrupt the remaining extensor mechanism.This technique requires percutaneous transarticular pin, which does not allow early joint mobilization and requires meticulous pin care with regular dressings. In our opinion,joint transfixation is probably the commonest reason for incomplete restoration of the joint range of motion