Patient Satisfaction After Bilateral Thumb Carpometacarpal Osteoarthritis Surgery.

This study seeks to determine whether patients with bilateral thumb carpometacarpal osteoarthritis were sufficiently satisfied with their surgeries to choose to undergo surgery again. The null hypothesis is that patients are dissatisfied with the results of the first surgery. Out of 46 living patients meeting enrollment criteria, 41 were enrolled and evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Enneking musculoskeletal score. The average DASH score was 17.37. The average Enneking musculoskeletal score was 88.21. Of 41 patients, one expressed unwillingness to undergo the next procedure, three indicated that they would reluctantly do surgery again, and four were satisfied. The remaining 33 subjects were enthused with their functional result, expressing willingness to undergo the procedure again. At an average follow-up of 44.9 months, most patients are satisfied with bilateral thumb carpometacarpal surgery for osteoarthritis. Consent for the contralateral surgery implies that the outcome of the first surgery was sufficiently acceptable to seek surgery on the contralateral thumb. (Journal of Surgical Orthopaedic Advances 26(4):250-256, 2017).

Manifestations and treatment of the hand in adult congenital erythropoietic porphyria.

Congenital erythropoietic porphyria (CEP) is a rare enzymatic disorder of heme metabolism, leading to the accumulation of porphyrins in the skin and subdermal structures. We present the case of a 34-year-old, right-hand-dominant, male patient with CEP. The patient had developed a chronic open subluxation of the left index finger proximal interphalangeal joint due to skin necrosis. We successfully treated the patient with proximal interphalangeal arthrodesis. This case demonstrates that childhood-onset CEP can also manifest in the adult hand. Considering the patient's age, the destructive nature of the disease, and the poor quality of function in older patients with childhood CEP, surgical intervention was necessary to avoid further digital length loss. Although the treatment described in this case report is not uncommon, we found it essential to present this case because the clinical presentation of CEP is rare.

Determinants of grip strength in healthy subjects compared to that in patients recovering from a distal radius fracture.

PURPOSE: Grip strength is influenced primarily by body mass index, sex, and age. It is also partly voluntary and correlates with symptoms of depression. This study examined whether psychological factors influence grip more in the setting of injury than in healthy volunteers. METHODS: Grip strength was evaluated in one hundred subjects, 50 healthy individuals and 50 patients 6 weeks after a nonsurgically treated fracture of the distal radius. Grip strength was measured as the mean of 3 attempts, and patients completed questionnaires for arm-specific disability (Disabilities of the Arm, Shoulder, and Hand), depression, pain anxiety, catastrophic thinking, and negative thoughts in response to pain. RESULTS: The mean grip strength in the injured group was 55% of the uninjured side. Pain anxiety accounted for 9% of the variability in grip strength in injured wrists. Among healthy patients, sex was the only correlate of dominant-side grip strength, and body mass index accounted for 8% of the variation in the grip strength of the nondominant side divided by the dominant side. CONCLUSIONS: The majority of the variation in grip strength remains unaccounted for, but physical factors correlate best with grip strength and percent grip strength of the nondominant side divided by the dominant side in healthy patients, and psychological factors correlate best with absolute grip in patients recovering from distal radius fractures. CLINICAL RELEVANCE: The influences on grip strength are complex, but the differences among recovering and healthy patients demonstrate a role for nonphysical factors in grip strength during recovery.

Adverse events of open A1 pulley release for idiopathic trigger finger.

PURPOSE: To classify and report adverse events of trigger finger release in a large cohort of patients. METHODS: We retrospectively reviewed 1,598 trigger finger releases performed by 12 surgeons in 984 patients between 2001 and 2011. Adverse events were classified based on a system derived from the Centers for Disease Control and Prevention criteria and clinical experience. Risk factors for various adverse events were sought in bivariate and multivariable statistical analysis. RESULTS: At the latest follow-up, 66 patients (7%), or 84 operated trigger digits (5%), experienced a documented adverse event. The most common adverse events were recovery issues in 46 patients (3%) (such as postoperative symptoms treated with steroid injection or slow recovery of motion treated with hand therapy), wound problems in 30 patients (2%) (consisting of suture abscess, superficial infection, or wound separation), persistent postoperative triggering in 10 patients (0.6%), and recurrent triggering in 4 patients (0.3%). Diabetes mellitus was associated with wound problems, slow recovery of motion, and recurrence. Concomitant carpal tunnel release on the same side was associated with slow recovery. CONCLUSIONS: Fourteen patients, less than 1%, in this cohort experienced an adverse event, such as persistent or recurrent triggering, requiring secondary surgery. No nerve injury or deep infection occurred in our cohort. One in 15 patients experienced a minor transient or treatable adverse event, and patients with diabetes were at greater risk. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.