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AIM: Early diagnosis of scapholunate ligament (SLL) injuries is crucial to prevent progression to debilitating osteoarthritis. Four-Dimensional Computed Tomography (4DCT) is a promising dynamic imaging modality for assessing such injuries. Capitalizing on the known correlation between SLL injuries and an increased scapholunate distance (SLD), this study aims to develop a fully automatic approach to evaluate the SLD continuously during wrist motion and to apply it to a dataset of healthy wrists to establish reference values. MATERIALS AND METHODS: 50 healthy wrists were analysed in this study. All subjects performed radioulnar deviation (RUD), flexion-extension (FE), and clenching fist (CF) movements during 4DCT acquisition. A novel, automatic method was developed to continuously compute the SLD at five distinct locations within the scapholunate joint, encompassing a centre, volar, dorsal, proximal, and distal measurement. RESULTS: The developed algorithm successfully processed datasets from all subjects. Our results showed that the SLD remained below 2 mm and exhibited minimal changes (median ranges between 0.3 mm and 0.65 mm) during RUD and CF at all measured locations. During FE, the volar and dorsal SLD changed significantly, with median ranges of 0.90 and 1.27 mm, respectively. CONCLUSION: This study establishes a unique database of normal SLD values in healthy wrists during wrist motion. Our results indicate that, aside from RUD and CF, FE may also be important in assessing wrist kinematics. Given the labour-intensive and time-consuming nature of manual analysis of 4DCT images, the introduction of this automated algorithm enhances the clinical utility of 4DCT in diagnosing dynamic wrist injuries.
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Tomografía Computarizada Cuatridimensional , Hueso Semilunar , Hueso Escafoides , Articulación de la Muñeca , Humanos , Tomografía Computarizada Cuatridimensional/métodos , Masculino , Femenino , Adulto , Articulación de la Muñeca/diagnóstico por imagen , Valores de Referencia , Hueso Escafoides/diagnóstico por imagen , Hueso Semilunar/diagnóstico por imagen , Rango del Movimiento Articular/fisiología , Ligamentos Articulares/diagnóstico por imagen , Persona de Mediana Edad , Voluntarios Sanos , Algoritmos , Adulto JovenRESUMEN
ABSTRACT: Neuromas are a substantial cause of morbidity and reduction in quality of life. This is not only caused by a disruption in motor and sensory function from the underlying nerve injury but also by the debilitating effects of neuropathic pain resulting from symptomatic neuromas. A wide range of surgical and therapeutic modalities have been introduced to mitigate this pain. Nevertheless, no single treatment option has been successful in completely resolving the associated constellation of symptoms. While certain novel surgical techniques have shown promising results in reducing neuroma-derived and phantom limb pain, their effectiveness and the exact mechanism behind their pain-relieving capacities have not yet been defined. Furthermore, surgery has inherent risks, may not be suitable for many patients, and may yet still fail to relieve pain. Therefore, there remains a great clinical need for additional therapeutic modalities to further improve treatment for patients with devastating injuries that lead to symptomatic neuromas. However, the molecular mechanisms and genetic contributions behind the regulatory programs that drive neuroma formation-as well as the resulting neuropathic pain-remain incompletely understood. Here, we review the histopathological features of symptomatic neuromas, our current understanding of the mechanisms that favor neuroma formation, and the putative contributory signals and regulatory programs that facilitate somatic pain, including neurotrophic factors, neuroinflammatory peptides, cytokines, along with transient receptor potential, and ionotropic channels that suggest possible approaches and innovations to identify novel clinical therapeutics.
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Neuralgia , Neuroma , Miembro Fantasma , Humanos , Calidad de Vida , Neuroma/etiología , Neuralgia/etiología , BiologíaRESUMEN
This study developed a deep learning model for fully automatic segmentation and labelling of wrist bones from four-dimensional computed tomography (4DCT) scans. This is a crucial step towards implementing 4DCT for diagnosing wrist ligament lesions, reducing time-consuming analysis of extensive data.
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Huesos del Carpo , Aprendizaje Profundo , Humanos , Tomografía Computarizada Cuatridimensional/métodos , Muñeca , Ligamentos Articulares , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
BACKGROUND: Animal bite wounds are common and can cause serious hand infections. Risk factors not only include the oral flora of the animal and the anatomy of the teeth, but also the comorbidities of the bitten patient. CASE DESCRIPTION: In this case report we describe a 46-years old female patient with comorbidities, including diabetes mellitus type 2 and peripheral artery disease, suffering a fulminant hand infection after a domestic rat bite with the newly described bacterium Rodentibacterratti. Despite extensive antibiotic therapy and surgical debridement, a ray amputation was inevitable to maintain adequate hand function. CONCLUSION: Infections after animal bites may be caused by a variety of pathogens. The pathogen Rodentibacterratti has not previously been associated with infections in humans and future research is indicated to assess therapeutic strategies. Patients should be referred to a (plastic) surgeon if there is no clinical improvement within 48 hours of initiating antibiotic treatment.
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Mordeduras y Picaduras , Diabetes Mellitus Tipo 2 , Animales , Ratas , Humanos , Femenino , Persona de Mediana Edad , Mordeduras y Picaduras/complicaciones , Antibacterianos/uso terapéutico , Factores de Riesgo , Desbridamiento , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológicoRESUMEN
Trigger finger is a common condition affecting the hand. Therapeutic variability surrounds the management of trigger finger, especially in the mild cases. The aim of this study was to survey secondary care surgeons to describe the current management of trigger fingers. The steering group developed a survey for hand surgeons. Following piloting, the survey was distributed to hand surgeons in the United Kingdom and The Netherlands. A total of 713 plastic surgeons and orthopaedic surgeons were invited to participate in the online survey and 440 (62%) surgeons completed the survey. In both mild and moderate cases of trigger finger, steroid injection was the preferred treatment option. Open surgery was the treatment of choice for severe cases. However, there was variation in delivery of care, including type and dosage of steroid, site of injection, interval between injections, maximum number of injections, type of incision and treatment of patients with diabetes or rheumatoid arthritis. This highlights the need for a better evidence base for the treatment of trigger fingers.
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Ortopedia , Cirujanos , Trastorno del Dedo en Gatillo , Humanos , Inyecciones , Esteroides/uso terapéutico , Trastorno del Dedo en Gatillo/cirugíaRESUMEN
AIMS: Ulnar-sided wrist pain has historically been equated to lower-back pain of wrist surgery. Little is known about the relationship between psychosocial profile and the manifestation of ulnar-sided wrist pathology and their treatment outcomes. This study aimed to determine the impact of pain catastrophising, psychological distress, illness perception, and patients' outcome expectations on patient-reported pain and hand function before and one year after surgery for ulnar-sided wrist pathology. PATIENTS AND METHODS: We included patients who underwent surgical treatment for ulnar-sided wrist pathology. Before surgery, patients completed the Pain Catastrophising Scale (PCS), Patient Health Questionnaire (PHQ), Brief-Illness Perception Questionnaire (B-IPQ), and Credibility/Expectancy Questionnaire (CEQ). Pain and dysfunction were assessed before (n = 423) and one year after surgery (n = 253) using the Patient Rated Wrist/Hand Evaluation (PRWHE). Hierarchical linear regression was used to assess the relationship between psychosocial factors and the preoperative PRWHE score, postoperative PRWHE score, and change in PRWHE. RESULTS: Psychosocial variables explained an additional 35% of the variance in preoperative PRWHE scores and 18% on postoperative scores. A more negative psychosocial profile was associated with higher (worse) preoperative PRWHE scores (PCS: B = 0.19, CI = [0.02-0.36]; B-IPQ Consequences: B = 3.26, CI = 2.36-4.15; and B-IPQ Identity, B = 1.88 [1.09-2.67]) and postoperative PRWHE scores (PCS: B = 0.44, CI = [0.08-0.81]) but not with the change in PRWHE after surgery. Higher treatment expectations were associated with a lower (better) postoperative PRWHE score (CEQ expectancy: B = -1.63, CI = [-2.43;-0.83]) and a larger change in PRWHE scores (B =|1.62|, CI = [|0.77; 2.47|]). CONCLUSION: A more negative psychosocial profile was associated with higher pain levels and dysfunction preoperatively and postoperatively. However, these patients showed similar improvement as patients with a more feasible psychosocial profile. Therefore, patients should not be withheld from surgical treatment based on their preoperative psychosocial profile alone. Boosting treatment expectations might further improve treatment outcomes. LEVEL OF EVIDENCE: III (Cohort study).
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Articulación de la Muñeca , Muñeca , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Encuestas y Cuestionarios , Articulación de la Muñeca/cirugíaRESUMEN
BACKGROUND: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. MATERIALS AND METHODS: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. RESULTS: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen's d = -1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. CONCLUSION: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. LEVEL OF EVIDENCE: Therapeutic III.
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Cúbito , Articulación de la Muñeca , Humanos , Osteotomía , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Cúbito/cirugía , Articulación de la Muñeca/cirugíaRESUMEN
The aim of this study was to assess return to work (RTW) after open Triangular Fibrocartilage Complex (TFCC) reinsertion. RTW after open surgery for TFCC injury was assessed by questionnaires at 6 weeks, 3 months, 6 months, and 12 months post-operatively. Median RTW time was assessed on inverted Kaplan-Meier curves and hazard ratios were calculated with Cox regression models. 310 patients with a mean age of 38 years were included. By 1 year, 91% of the patients had returned to work, at a median 12 weeks (25%-75%: 6-20 weeks). Light physical labor (HR 3.74) was associated with RTW within the first 15 weeks; this association altered from 23 weeks onward: light (HR 0.59) or moderate physical labor (HR 0.25) was associated with lower RTW rates. Patients with poorer preoperative Patient-Rated Wrist Evaluation (PRWE) total score returned to work later (HR 0.91 per 10 points). Overall cost of loss of productivity per patient was 13,588. In the first year after open TFCC reinsertion, 91% of the patients returned to work, including 50% within 12 weeks. Factors associated with RTW were age, gender, work intensity, and PRWE score at baseline.
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Fibrocartílago Triangular , Adulto , Humanos , Modalidades de Fisioterapia , Reinserción al Trabajo , Encuestas y Cuestionarios , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/cirugía , Articulación de la MuñecaRESUMEN
A 79-year-old woman consulted a plastic surgeon, because since 3 years she had a large wound at the base of her left index finger. Histology of a skin biopsy showed cutaneous squamous cell carcinoma. Because of the extension of the defect, amputation of the index finger with a split-skin-graft was performed.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Amputación Quirúrgica , Biopsia , Carcinoma de Células Escamosas/cirugía , Femenino , Dedos/patología , Humanos , Neoplasias Cutáneas/cirugíaRESUMEN
INTRODUCTION: Cold hypoxia is a common factor in cold tissue preservation and mammalian hibernation. The purpose of this study was to determine the effects of cold preservation on the function of the retractor (RET) muscle of the hamster in the non-hibernating state and compare these with previously published data (van der Heijden et al., 2000) on the rat cutaneus trunci (CT) muscle. MATERIALS AND METHODS: After cold storage (16 h at 4 degrees C), muscles were stimulated electrically to measure maximum tetanus tension (P(0)) and histologically analyzed. The protective effects of addition of the antioxidants trolox and deferiprone and the calcium release inhibitor BDM to the storage fluid were determined. RESULTS: After storage, the twitch threshold current was increased (from 60 to 500 microA) and P(0) was decreased to 27% of control. RET morphology remained unaffected. RET muscle function was protected by trolox and deferiprone (P(0), resp., 43% and 59% of control). Addition of BDM had no effect on the RET. CONCLUSIONS: The observed effects of cold preservation and of trolox and deferiprone on the RET were comparable to those on CT muscle function, as reported in a previously published study (van der Heijden et al., 2000). Both hamster RET and rat CT muscles show considerable functional damage due to actions of reactive oxygen species. In contrast to the CT, in the RET cold preservation-induced functional injury could not be prevented by BDM and was not accompanied by morphological damage such as necrosis and edema. This suggests that the RET myocytes possess a specific adaptation to withstand the Ca(2+) overload induced by cold ischemia.
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Frío , Contracción Muscular , Músculo Esquelético/fisiología , Preservación de Órganos , Animales , Cromanos/farmacología , Cricetinae , Deferiprona , Masculino , Mesocricetus , Contracción Muscular/efectos de los fármacos , Músculo Esquelético/anatomía & histología , Soluciones Preservantes de Órganos/farmacología , Piridonas/farmacología , RatasRESUMEN
BACKGROUND: The hamster retractor muscle (RET) is used as an in vivo model in studies of skeletal muscle ischemia-reperfusion injury. The RET is unique in that the muscle can be isolated while preserving the primary vascular supply so that its contractile function can be measured simultaneously with local microvascular responses to experimental interventions. The goal of this study was to understand the anatomical origin of the vascular supply to the RET and determine whether the RET can be used as a free flap after surgical isolation of the thoracodorsal vessels. METHODS: Microdissection was performed to determine the anatomy of the vasculature that supplies and drains the RET. RESULTS: Distinct numbers and patterns of feed arteries (2-4) and collecting veins (1-3) were identified (n = 26 animals). Dye injection (n = 8) of the thoracodorsal artery demonstrated that the RET remains perfused following its isolation on the thoracodorsal pedicle. Heterotopic allograft transplantation of the RET (n = 2) was performed by anastomosing the thoracodorsal vessels to the femoral vessels using the end-to-side technique. CONCLUSIONS: The anatomical relationships indicate that the RET can be used as a free flap model for evaluating the effect of preservation strategies and transplantation on skeletal muscle microcirculation and contractile function.
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Mesocricetus/anatomía & histología , Músculo Esquelético/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Animales , Cricetinae , Masculino , Microcirugia , Músculo Esquelético/trasplante , Trasplante HomólogoRESUMEN
OBJECTIVE: Vasodilation originating within the microcirculation ascends into proximal feed arteries during muscle contraction to attain peak levels of muscle blood flow. Ascending vasodilation (AVD) requires an intact endothelium, as does conducted vasodilation in response to acetylcholine (ACh). Whereas ischemia-reperfusion (I-R) can affect endothelial cell function, the effect of I-R on AVD is unknown. The authors tested the hypothesis that I-R (1h-1h) would impair AVD. METHODS: Using the retractor muscle of anesthetized hamsters, contractions were evoked using field stimulation (200 ms at 40 Hz every 2 s for 1 min) and ACh was delivered using microiontophoresis (1 microm tip, 500-4000 ms pulse at 800 nA). Feed artery responses were monitored 500-1500 microm upstream. RESULTS: Neither resting (51 +/- 4 microm) nor maximal diameter (81 +/- 5 microm; 10 microm sodium nitroprusside) following I-R (n = 8) were different from time-matched controls (n = 10). With peak active tension of 23 +/- 4 mN x mm(-2), control AVD was 26 +/- 2 microm. Following I-R, active tension fell by 48% (p < .05) and AVD by 57% (p < .05). Stimulation at 70 Hz restored active tension but AVD remained depressed by nearly half (p < .05), as did local and conducted responses to ACh. Nevertheless, control responses to 500 ms ACh were restored by increasing stimulus duration to 4000 ms. CONCLUSIONS: Ischemia-reperfusion impairs the initiation of feed artery dilation with muscle contraction and with ACh while conduction along the vessel wall is preserved. Respective components of endothelial cell signaling events may differ in their susceptibility to I-R.
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Músculo Esquelético/irrigación sanguínea , Daño por Reperfusión/fisiopatología , Vasodilatación , Acetilcolina/farmacología , Animales , Arterias/fisiopatología , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Cricetinae , Células Endoteliales/metabolismo , Endotelio/fisiopatología , Masculino , Mesocricetus , Músculo Esquelético/fisiopatología , Vasodilatadores/farmacologíaRESUMEN
The aim of this study was to investigate if the preservation of isolated skeletal muscles for 16 h at 4 degrees C could be improved by pre-storage perfusion (PSP). Two rat muscle models were used: the soleus (SOL) and a posterior strip of the cutaneous trunci (CT). The effects of a 10 min PSP (at 25 degrees C) with University of Wisconsin solution (UW) or HTK-Bretschneider solution (HTK) on muscle function were analysed. The perfusion model was validated by the demonstration that the SOL and CT could be perfused with donor blood, UW and HTK at a flow rate of 0.2 ml x min(-1) x g(-1) muscle for 10 min without any immediate adverse effects on muscle weight, function (maximum tetanus tension) and cytoarchitecture (multivariate analysis of variance, P >0.05; n =6). For each muscle type and for each solution, six perfused and six non-perfused muscles were stored for 16 h at 4 degrees C. In the perfused groups, the storage and perfusion solution were matched. For both muscle types, the function (maximum tetanus tension), weight and cytoarchitecture of pre-storage perfused muscles was not preserved any better than that of non-perfused muscles, irrespective of the solution used (multivariate analysis of variance, P >0.05). We conclude that PSP for 10 min with UW and HTK does not improve the preservation of function of rat skeletal muscles during storage for 16 h at 4 degrees C.