An unusual presentation of pacifier thumb duplication with VACTERL association: Case report and review of literature.

INTRODUCTION AND IMPORTANCE: Polydactyly of the hand is a common anomaly among pediatrics, which can present in conjugation with other syndromes or on its own. Various types can be seen, ranging from the involvement of skin only to a completely formed digit. We report the first case of pacifier type thumb duplication presenting with VACTERL association. Herein, we also summarize the existing literature of the distinctive features and management of pacifier polydactyly. CASE PRESENTATION: A premature male infant with intrauterine growth restriction due to maternal type II diabetes was referred for a soft tissue attachment to the left hand. The infant showed VACTERL association signs, including a single kidney, small atrial septal defect, and ventricular septal defect. Examination revealed preaxial polydactyly with a cystic swelling connected to the palm. CLINICAL DISCUSSION: Preaxial polydactyly is the second most common congenital hand anomaly, and its pathology is thought to involve the disruption of apoptosis during embryonic development. Pacifier-type polydactyly is a unique variation characterized by severe edema of the soft tissue digit, believed to be caused by physical damage in utero. The case presented did not require surgical intervention as the duplicated thumb underwent spontaneous autoamputation as opposed to other cases in the literature. CONCLUSION: This is the first reported case of pacifier-type thumb duplication in a patient with VACTERL association. The presentation of this condition adds to the existing body of literature on VACTERL association. Surgical removal is the treatment of choice for pacifier polydactyly, but spontaneous resolution can occur.

Anterior Open Bite Treated With Palatal Crib and Myofunctional Therapy: A Case Report.

The most prevalent oral habit and one of the most often habitual behavioral patterns in preschool-aged children is thumb-sucking. This behavior is crucial to the development of malocclusion and must be addressed carefully since it may cause a secondary tongue thrust that worsens the issue. Developing an effective treatment plan requires determining the underlying cause, which may include psychological, physiological, and or anatomical factors. Overall prevention of behavior needs to be planned for successful outcomes. One such device for treating tongue-thrusting and thumb-sucking habits is the palatal crib. The present case shows the possible effectiveness of palatal crib use in conjunction with myofunctional therapy for a child whose diagnosis involves habitually holding the tongue low and sucking the thumb that causes an anterior open bite (AOB). An 11-year-old boy with flared and spaced upper and lower incisors also had an AOB. Myofunctional therapy was combined with palatal cribs to help the tongue reposition itself and discourage the habit of sucking. The AOB was successfully corrected with an appropriate overjet and overbite after a total of three months of treatment.

The Figure-of-Eight Ligament Reconstruction in Thumb Carpometacarpal Instability: Surgical Technique and Clinical Outcomes.

PURPOSE: This study reviewed the results of the figure-of-eight ligament reconstruction, a technique used in the surgical management of thumb carpometacarpal (CMC) instability. This technique establishes joint stability through forces originating within the CMC joint, providing volar and dorsal support. METHODS: We evaluated the outcomes of 15 patients with nontraumatic, nonarthritic thumb CMC instability treated with the figure-of-eight ligament reconstruction technique. This technique involves routing a graft of the palmaris longus tendon through the base of the first metacarpal and trapezium bone in a figure-of-eight fashion. Preoperative visual analog scale (0-100) for pain and Michigan Hand Outcomes Questionnaire total scores were compared with 3- and 12-month postoperative scores. Secondary outcomes included strength, range of motion, patient satisfaction, return to work, and complications. RESULTS: A significant improvement between intake and 12 months after surgery was observed for both Michigan Hand Outcomes Questionnaire total scores (53, SD 3 vs 70, SD 4) and visual analog scale pain scores (63, SD 4 vs 36, SD 7). Additionally, after surgery, restored thumb CMC joint stability was reported for all patients. Strength and range of motion improved between intake and 12 months after surgery. The median return to work was 6 weeks. Nine (60%) patients rated their satisfaction as "excellent" or "good," and 11 (73%) patients said that they would undergo the surgery again. CONCLUSIONS: The figure-of-eight ligament reconstruction significantly improves pain and function in patients with thumb CMC instability while restoring joint stability and preserving range of motion, making it a suitable technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The prevalence of spontaneous resolution among pediatric trigger thumb: a systematic review and meta-analysis.

BACKGROUND: Trigger thumb is a prevalent hand condition observed in children, and its management remains a topic of considerable debate, ranging from mere observation to surgical intervention. In recent times, there has been a growing interest in exploring nonoperative treatments as alternatives to surgical procedures for managing pediatric trigger thumb. Gaining insight into the prevalence of spontaneous resolution in pediatric trigger thumb is of paramount importance. However, the literature presents a wide variation in estimates regarding the prevalence of this spontaneous resolution, highlighting the need for further investigation and consensus. The aim of this review was to estimate the overall prevalence of spontaneous resolution among pediatric trigger thumb. METHODS: This study meticulously followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to May 2024.Inclusion criteria were studies reported only observation spontaneous resolution pediatric trigger thumb, aged up to 14 years, reported at least 10 thumbs and followed up time at least 3 months. Confounded intervention treatment measure studies were excluded. To synthesize the prevalence rates from individual studies, we employed a random-effects meta-analysis. In order to uncover the sources of heterogeneity and to compare prevalence estimates across different groups, we performed sensitivity and subgroup analyses. To meticulously evaluate the quality of the included studies, the Joanna Briggs Institute's quality assessment checklist was employed. Furthermore, to assess the heterogeneity among the studies, both Cochran's Q test and the I² statistic were utilized. RESULTS: A total of eleven studies were included for the final analysis, with 599 pediatric trigger thumbs. Our final meta-analysis showed that more than one-third of these pediatric trigger thumb cases resolved spontaneously, with a resolution rate of 43.5% (95% CI 29.6-58.6). Subgroup analyses showed that in terms of age at the first visit, the prevalence of spontaneous resolution in the less than 24 months group and in the 24 months or older group was 38.7%(95% CI 18.1-64.4)and 45.8%(95% CI 27.4-65.4), respectively. There was no significant difference between the two groups(P = 0.690). When analyzing follow up time, the prevalence of spontaneous resolution in the 24 months or longer group and in the less than 24 months group was 58.9%(95% CI 41.6-74.2)and 26.8%(95% CI 14.7-43.8), respectively.There was significant statistical differences between the two groups(P = 0.009). Based on the initial severity of interphalangeal (IP) joint flexion contracture, the prevalence of spontaneous resolution in the 30 degrees or less group and in the other measurements group was 54.1%(95% CI 31.5-75.1)and 37.1%(95% CI 21.9-55.4), respectively.There was no significant difference between the two groups(P = 0.259). CONCLUSION: Our study demonstrates that a significant proportion of pediatric trigger thumbs resolve spontaneously. This finding highlights the benefits of early observation in managing this condition. By prioritizing non-operative observation, both parents and surgeons are better equipped to make informed decisions regarding the treatment of pediatric trigger thumb, potentially reducing the need for surgical intervention.

Validation of HAND OA US inflammatory and structural damage score (HOUSE) for thumb base joints: Systematic review on truth & discrimination.

OBJECTIVES: Recently, the HAND osteoarthritis (OA) ULTRASOUND (US) Examination (HOUSE) inflammatory and structural damage scores were developed by the OMERACT US working group. However, the thumb base was not or only partly included. This systematic review examines US scoring methods and scanning techniques assessing thumb base OA, alongside existing evidence on validity, reliability, and responsiveness. METHODS: A comprehensive search strategy in three different databases identified 30 eligible studies. RESULTS: In general, studies predominantly focused on US assessment of the carpometacarpal (CMC) 1 joint, with fewer investigating the scaphotrapeziotrapezoid (STT) joint. Most studies utilized a semiquantitative scale for scoring structural and inflammatory features, aligning with the HOUSE scoring system. Validity was supported by a limited number of studies, with one demonstrating a positive association between US structural damage and radiographic damage, and another showing a similar association with function. Associations between US inflammatory features and pain were observed, albeit with some variability. Reliability was from moderate to good for the CMC1 joint but limited for STT joint. Responsiveness varied across studies. The methodological quality of included studies varied, indicating areas for future research improvement. CONCLUSION: While promising, additional research is necessary to validate the HOUSE scoring system and improve its clinical utility for thumb base OA assessment. Future research should concentrate on optimal scanning positions and on the reliability and responsiveness of the HOUSE scoring system.

REPLANTATION OF THE THUMB OR REVISION OF AMPUTATION: AN EPIDEMIOLOGICAL STUDY.

OBJETIVE: This article presents a retrospective cohort study analyzing patients from IOT-FMUSP who underwent replantation or revision amputation procedures for traumatic thumb amputation between 2013 and 2020. METHODS: The study included 40 patients in the replanted group and 41 patients in the amputed group. The patients were divided according to the level of amputation and their medical records were analyzed. RESULTS: A total of 81 patients with digital amputation were analyzed, consisting of 79 males and 2 females, with mean ages of 43 and 49 for the amputed and replanted groups, respectively. According to the Biemer classification, 28.4% had proximal amputation, while 71.6% had distal amputation. The most common occupation was bricklayer (19.75%), and 80.24% were manual workers. Of the patients, 65% returned to their previous work, with 77.77% of them having amputation on their non-dominant hand, mostly caused by circular saw accidents (77.77%). The replantation success rate was 78%, with an average ischemia time of 9 hours and door-to-room time of 2 hours. CONCLUSION: the study findings revealed that traumatic thumb amputation predominantly affects working-age males with a low education level and the success rate of replantation was high in this ischemia time and door-to-room conditions. Level of Evidence II, Retrospective study.

OBJETIVO: Este artigo consiste em um corte retrospectivo que analisou vítimas de amputação traumática do polegar submetidas a reimplante ou procedimentos de regularização da amputação no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medica da Universidade de São Paulo (IOT-FMUSP). Métodos: Foram analisados 40 pacientes reimplantados e 41 pacientes regularizados, que foram separados conforme o nível da amputação e, após, tiveram seus prontuários médicos analisados. RESULTADOS: Foram analisados 81 pacientes com amputação digital (79 homens e 2 mulheres), com idade média de 43 anos e 49 anos (Grupo Amputado e Grupo Reimplante, respectivamente) e 28,4% deles tinham amputação proximal, de acordo com a classificação de Biemer, enquanto 71,6% tinham amputação distal. A ocupação mais comum foi a de pedreiro (19,75%), mas 80,24% eram trabalhadores manuais. 65% dos pacientes retornaram ao trabalho anterior. 77,77% dos pacientes afetaram a mão não dominante, e a serra circular causou 77,77% das amputações. A taxa de sucesso para reimplantes foi de 78%. O tempo de isquemia foi de 9 horas e o tempo de porta-quarto foi de 2 horas. Conclusão: O estudo revelou que as taxas de reimplante foram altas nas condições de isquemia e tempo porta-sala, e a maioria dos pacientes vítimas de amputação traumática do polegar são homens em idade de trabalho e com baixa escolaridade. Nível de Evidência II, Estudo retrospectivo.

Open vs. closed reduction with pinning for displaced Rockwood and Wilkins' type C thumb metacarpal base fractures in children.

Background: The treatment of severely displaced Rockwood and Wilkins' type C (RWC) thumb metacarpal basal fractures remains controversial in children. This retrospective study aimed to compare the efficacy of two treatment methods, open vs. closed reduction with pinning of such injuries. Methods: This study included 30 patients with open physes, 14 boys and 16 girls, who all received either closed or open reduction treatment. The primary outcomes of interest included healing time, complications, and functional results, which were evaluated using the improved Mayo score standard. The minimum follow-up period was 24 months, with a mean of 30.3 months (range 24.0-45.0 months). Statistical significant was defined as P < 0.05. Results: All fractures were healed within 7 weeks after surgery, regardless of which surgical approach was used. However, the recovery time was markedly faster in the closed group, with a mean of 4.2 weeks, than in the open group, with a mean of 4.7 weeks (P < 0.05). The operation time for closed group, taking 20 min in average, was also shorter than that for open group (P < 0.05). The total incidence of mild complications was lower for patients in the closed group than for patients in the open group (6.3% vs. 21.4%, P < 0.05). No major complications were observed in either group. In the closed group, a total of 15 patients exhibited excellent outcomes, while only one patient demonstrated good outcomes. On the other hand, in the open group, 12 patients experienced excellent outcomes, whereas two patients had good outcomes. There were no instances of osteomyelitis, refractures or nonunion, avascular necrosis (AVN), or premature physeal closure in either group. Conclusion: The data from the open group and closed group procedures for severely shifted RWC fractures in children indicate comparable prognoses and complication rates between the two groups. Obviously closed reduction, in particular, offers several advantages over open procedure, including shorter surgical duration, fewer K-wires required, and no need for open incisions. Consequently, closed reduction is the preferred method for treating such RWC fractures.

Prevalence and Characteristics by Age and Sex in Pediatric Trigger Digits: Nationwide Analysis Using Korea Health Insurance Dataset.

Background: Pediatric trigger digit (TD) does not appear at birth but is diagnosed after birth by finding a flexion contracture of the thumb or other fingers. The reported incidence of pediatric TDs varies from 0.5 to 5 cases per 1,000 live births without sex-specific predominance. We performed a nationwide large-scale study to determine the prevalence and incidence of pediatric TDs and analyzed operative treatment for pediatric TDs using the National Health Insurance data of South Korea. Methods: Patients with pediatric TDs, aged 0-10 years between 2011 and 2020, were included in this study. Children born between 2011 and 2015 were set as the reference population and followed up until 2020. We calculated the prevalence and incidence rates of pediatric TDs according to age and sex and analyzed the operation rate, age at surgery, time interval from initial diagnosis to surgery, and follow-up period. Patient selection and treatment were based on International Classification of Diseases, 10th Revision (ICD-10). Results: The prevalence rates of pediatric TDs ranged from 0.063% to 0.084%. Girls had a higher prevalence rate (0.066%-0.094%) than boys (0.060%-0.075%). The total incidence rate was 77.6/100,000 person-years, and the incidence rate was higher in girls (84.8) than in boys (70.7). Among 2,181,814 children born between 2011 and 2015, 12,729 were diagnosed with pediatric TDs, of which 1,128 (8.9%) underwent operative management. The means of age at initial diagnosis, age at surgery, and the time interval between diagnosis and operation were 2.76 ± 1.91 years, 3.79 ± 2.19 years, and 1.15 ± 1.71 years, respectively. Conclusions: High prevalence and incidence rates of pediatric TDs were found in 2- to 3-year-old patients. Among pediatric patients, 8.9% underwent operative management that was most frequently conducted between 2 and 3 years of age (within 1 year of initial diagnosis).

Establishing a Research-Related Patient and Family Advisory Council for a Surgical Specialty.

Engaging patients and family members in formal feedback for health care processes can be impactful, especially when cultivating new care and research protocols. However, most surgical groups lack established systems for enlisting these critical stakeholders. This is a descriptive report of how we built our Patient and Family Advisory Council (PFAC) through a multistep process with patients, providers, research staff, and administrators. We also detail how it has advanced research, care, and mutually beneficial collaboration at our hand center. For example, our PFAC has provided vital input on multiple grant submissions, assisted with the development of a web-based digital application for thumb arthritis therapy, and improved our patient care approaches. To successfully create and sustain a PFAC, there must be commitment from multiple stakeholders across clinical, research, administration, and leadership spectra. Through this alliance, all stakeholders can develop better care and investigative strategies.

Investigating the Relationship Between Neighborhood Social Deprivation and Time to Specialty Orthopedic Care for Pediatric Trigger Thumb.

Purpose: Pediatric trigger thumb is a common condition resulting in referral from primary care to specialty care. Access to pediatric hand specialty care is a complex issue influenced by a multitude of social factors, including socioeconomic status. The aim of this study is to investigate the relationship between area deprivation and the time from primary care referral to presentation to specialty care for pediatric trigger thumb. Methods: Participants were pediatric patients with trigger thumb. Patient-level area deprivation was reflected by the area deprivation index (ADI). We analyzed the relationship of the ADI to patient demographics (age and sex), trigger thumb treatment (surgical vs nonsurgical), and time to initial hand surgical visit after referral and surgical management when indicated. Results: Among 163 patients with trigger thumb, 52% were men. Mean age at referral for trigger thumb was 2.9 ± 1.7 years. Mean ADI for patients diagnosed with trigger thumb was 57.8 ± 23.4 for the 2018 data set and 57.3 ± 23.6 for the 2021 data set, on a scale of 1 (low) to 100 (high). The median time from referral from primary care to presentation to orthopedic care for trigger thumb was 34 days. Upon presentation to treating hand surgeon, 118 patients (72.4%) underwent surgical release. We found no difference in ADI between men and women nor between patients treated operatively or with nonsurgical management. We found a weak positive correlation between ADI and time from initial referral to presentation to the treating hand surgeon. There was no correlation between ADI and time from initial hand surgical evaluation and surgical management in patients indicated for surgery. Conclusions: Pediatric trigger thumb patients from areas with higher ADI have a slightly longer delay between initial referral and their initial visit with an orthopedic hand specialist. Although we found a delay in initial evaluation by the treating hand surgeon in patients with higher ADI, ADI status was not different between patients managed with surgical and nonsurgical treatment nor between men and women. Clinical relevance: Neighborhood ADI weakly correlated with increased time from referral to accessing specialty orthopedic care for trigger thumb. This may suggest a need for more equitable access to specialty care for patients with pediatric trigger thumb from high ADI areas.

Holt-Oram Syndrome With Atrial Septal Defect.

Holt-Oram syndrome is an autosomal dominant condition marked by heart and upper limb defects. Holt and Oram were the first to narrate this in 1960. Holt-Oram syndrome is the prototype of heart-hand syndromes and has recently been mapped to the long arm of chromosome 12 (12q2). This syndrome was described in 1960 by Dr Mary Holt and Dr Samuel Oram. It is an autosomal dominant condition resulting from a mutation in TBX5 located on chromosome 12q24.1, which regulates cardiac and limb morphogenesis. It must be differentiated from heart-hand syndrome type II (Tobatznik's syndrome) and heart-hand syndrome type III (MIM No. 140450), which are phenotypically similar. The latter do not map to 12q2, and atrial septal defects do not occur in these conditions. This syndrome is distinguished by heart problems as well as thumb aplasia or hypoplasia. It is sometimes referred to as atriodigital syndrome, upper limb-cardiovascular syndrome, heart-hand syndrome, cardiomelic syndrome, or cardiac limb syndrome. Other upper-limb anomalies include aplasia or hypoplasia of the radius, arm length variation, atypical forearm pronation and supination, uncommon thumb resistance, sloping shoulders, and restricted shoulder movement. All those who are affected have an aberrant carpal bone, which might be the only sign of the illness. Seventy-five percent of those with Holt-Oram syndrome have a congenital cardiac defect, which most frequently affects the septum. In this case, we report a girl who is 4 years and 6 months old and is a known case of Holt-Oram syndrome with an atrial septal defect. She underwent device closure and had come to the pediatric op with fever and cough.

Functional and patient reported outcomes of Pyrocardan implants for carpometacarpal osteoarthritis.

AIMS: The primary aim of this study was to assess functional and patient reported outcomes among those with first carpometacarpal joint osteoarthritis treated with the Pyrocardan implant (Stryker-Wright Medical) in Ireland. The secondary aim of this study was to assess implant survival and revision rates. METHODS: We conducted a single surgeon retrospective study assessing 40 Pyrocardan arthroplasties among 37 patients, with a minimum of 6 months follow-up. Patient reported outcomes were assessed via quick disability of the arm, shoulder and hand (quick DASH) questionnaire, the visual analog score (VAS) for pain, and patient rated wrist evaluation (PRWE) questionnaire. Functional scores were assessed via lateral key pinch strength and Kapandji scores. Implant survival, complication and revision rates were also recorded. RESULTS: Forty Pyrocardan implants among 37 patients were included. Mean follow-up was 2.5 years with a 97.5% implant survival rate. One patient underwent revision to trapeziectomy and Weilby sling. Eighty-eight percent of survey responders admitted that they would undergo the operation again, and 75% declared a 75-100% improvement in symptoms. Post-operative pain scores include a mean VAS of 2.07, quickDASH of 22.82, and PRWE of 26.92. Of those tested, there was an average increase in post-operative lateral key pinch, and 89% obtained a post-operative Kapandji score equal to or better than pre-operative scores. CONCLUSIONS: This is the first study assessing the Pyrocardan interpositional arthroplasty in Ireland. The implant appears to produce good functional and patient reported outcomes. There is high satisfaction and low revision rate, producing a reliable and successful surgical technique for treating CMC joint osteoarthritis.

[Translated article] Temporary work disability following trapezial resection and suspension arthroplasty for thumb carpometacarpal osteoarthritis.

PURPOSE: The aim of this study is to assess the time to return to work (TRW) in patients undergoing trapezial resection using the Mini TightRope® system at our centre and to investigate factors that might delay return to work following this surgery. MATERIAL AND METHODS: A retrospective study was conducted on patients who underwent Trapezial resection and suspensionplasty using the Mini TightRope® system between 2015 and 2016, with a minimum one-year follow-up. Telephone interviews were conducted along with a review of medical records and radiology reports, as well as temporary work disability documents, collecting epidemiological and occupational data. Groups were compared based on age, gender, dominant hand, biomechanical occupational requirements of the patients, and whether they had experienced prior temporary work disability. RESULTS: A total of 36 patients (29 women and 7 men) with an average age of 55.7 years were included. The median time to return to work was 126 days. Self-employed workers re-entered the workforce 72 days earlier on average; workers who had experienced prior temporary work disability had a greater total temporary work disability duration and took 91 days longer to return to work compared to those who had not. CONCLUSIONS: Patients employed by others and those who had experienced prior temporary work disability before the surgery had longer temporary work disability periods. In our study, no differences were observed based on gender, dominant hand, or biomechanical work demands of the intervened patients.

Simple trapeziectomy for thumb basal joint arthrosis. Forty-four thumbs re-reviewed after 7.5 years.

Background: Due to favorable results in the literature we changed our standard procedure in 2010 from trapeziectomy with LRTI to simple trapeziectomy for thumb basal joint arthrosis. A review of 49 operated hands after two years showed good results, similar to those we had obtained after LRTI. Objective: We have now re-reviewed these patients to see if the good results persist over time. Methods: All patients from the earlier study were contacted and 40 patients with 44 operated thumbs were re-reviewed after a mean of 7.5 years. Results: The mean pain score (0-100) was 14 (SD:22) compared to 18 (25) at the earlier review. There was no significant change in ability to perform ADL activities between reviews. Mean VAS (0-100) for clumsiness fell significantly between early and late review (67 (SD:18) versus 45(27); p â€‹< â€‹0.019), although clumsiness was reported by an increased number of patients. VAS for general satisfaction had improved from 23 (SD:28) to 13 (22) between reviews (p â€‹< â€‹0.01). The mean QuickDASH and PRWHE scores were practically unchanged. There was significantly improved thumb abduction and ulnar/radial deviation at the wrist. There was a significant reduction in power grip and key pinch in both the operated and the contralateral un-operated hands compared to the earlier review. Radiographs showed a slightly reduced mean distance between the first metacarpal and the scaphoid. Conclusion: We conclude that the good results after simple trapeziectomy persist.

Synthetic Tape Augmentation for Thumb Carpometacarpal Joint Instability: Surgical Technique.

Background Dorsal thumb carpometacarpal (CMC) instability can occur after traumatic injury and can lead to persistent pain and dysfunction of the hand. We present a case report of a joint-sparing technique for recurrent thumb CMC instability after failed Eaton-Littler procedure. Case Description We describe a technique to repair the dorsal radial ligament and augment the repair with dorsal synthetic tape. To illustrate this technique, we describe a patient who underwent the synthetic tape augmentation procedure for recurrent thumb CMC instability after a failed Eaton-Littler reconstruction. Preoperative and postoperative grip strength, appositional pinch, oppositional pinch, radial abduction, palmar abduction, and postoperative quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) were recorded. At final follow-up 18 months after surgery, the patient had returned to manual work without any functional sequelae. The thumb CMC joint was stable and his postoperative QuickDASH score was 15.9. Literature Review Thumb CMC instability has traditionally been treated with Eaton-Littler ligament reconstruction which uses a slip of flexor carpi radialis tendon to reconstruct the deficient ligaments. More recently, the importance of the dorsal radial ligament in joint stability has been recognized and new procedures have been described to reconstruct the dorsal radial ligament. To our knowledge, synthetic tape augmentation for thumb CMC instability has not yet been described for this pathology. Clinical Relevance Synthetic tape augmentation for dorsal thumb CMC instability may be considered in the management of dorsal thumb CMC joint instability.

Daytime Functional Usage Versus Night-Time Wearing: Identifying the Optimal Wearing Regimen for a Custom-Made Orthosis in the Treatment of Trapeziometacarpal Osteoarthritis.

OBJECTIVE: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA). DESIGN: Randomized, controlled single-blind trial. SETTING: The rheumatology outpatient clinic of the University. PARTICIPANTS: Sixty participants diagnosed with trapeziometacarpal OA. INTERVENTIONS: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night. MAIN OUTCOMES MEASURES: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function. RESULTS: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006). CONCLUSIONS: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients.

Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis.

BACKGROUND: The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy. METHODS: A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year. All patients received an examination at each visit to include pain, range of motion, strength, and metacarpal height. Complications, concomitant procedures, and revision procedures were recorded as well. RESULTS: A total of 49 arthroscopic trapeziectomy procedures were recorded for 46 patients. The average preoperative visual analog pain scale score was 8.8 out of 10, and the postoperative score was 1 out of 10. All patients had a resolution of the carpometacarpal grind test postoperatively. The average preoperative key pinch, 3-point chuck, and grip strength were 9.8 lbs/in2, 7.8 lbs/in2, and 45 lbs/in2, respectively. Final 6-month postoperative key pinch, 3-point chuck, and grip strength were 11.0 lbs/in2, 9.8 lbs/in2, and 49.2 lbs/in2, respectively. Metacarpal height subsided on average 50%. We report one revision and no cases of radial sensory neuritis or flexor tendon rupture. CONCLUSIONS: Arthroscopic total trapeziectomy appears to be a safe and effective treatment for end-stage arthrosis of the thumb basal joint. LEVEL OF EVIDENCE: 2b Therapeutic; Individual Cohort Study.

Hybridized deep learning goniometry for improved precision in Ehlers-Danlos Syndrome (EDS) evaluation.

BACKGROUND: Generalized Joint Hyper-mobility (GJH) can aid in the diagnosis of Ehlers-Danlos Syndrome (EDS), a complex genetic connective tissue disorder with clinical features that can mimic other disease processes. Our study focuses on developing a unique image-based goniometry system, the HybridPoseNet, which utilizes a hybrid deep learning model. OBJECTIVE: The proposed model is designed to provide the most accurate joint angle measurements in EDS appraisals. Using a hybrid of CNNs and HyperLSTMs in the pose estimation module of HybridPoseNet offers superior generalization and time consistency properties, setting it apart from existing complex libraries. METHODOLOGY: HybridPoseNet integrates the spatial pattern recognition prowess of MobileNet-V2 with the sequential data processing capability of HyperLSTM units. The system captures the dynamic nature of joint motion by creating a model that learns from individual frames and the sequence of movements. The CNN module of HybridPoseNet was trained on a large and diverse data set before the fine-tuning of video data involving 50 individuals visiting the EDS clinic, focusing on joints that can hyperextend. HyperLSTMs have been incorporated in video frames to avoid any time breakage in joint angle estimation in consecutive frames. The model performance was evaluated using Spearman's coefficient correlation versus manual goniometry measurements, as well as by the human labeling of joint position, the second validation step. OUTCOME: Preliminary findings demonstrate HybridPoseNet achieving a remarkable correlation with manual Goniometric measurements: thumb (rho = 0.847), elbows (rho = 0.822), knees (rho = 0.839), and fifth fingers (rho = 0.896), indicating that the newest model is considerably better. The model manifested a consistent performance in all joint assessments, hence not requiring selecting a variety of pose-measuring libraries for every joint. The presentation of HybridPoseNet contributes to achieving a combined and normalized approach to reviewing the mobility of joints, which has an overall enhancement of approximately 20% in accuracy compared to the regular pose estimation libraries. This innovation is very valuable to the field of medical diagnostics of connective tissue diseases and a vast improvement to its understanding.

Diagnosing Fanconi Anemia: A Rare Case Report From Rural India.

Fanconi anemia is a rare but most prevalent form of inherited aplastic anemia, predominantly transmitted in an autosomal recessive manner, except for one X-linked variant. It arises from mutations in the genes across 16 different complementation groups that are crucial for DNA stability. It is marked by a wide range of congenital malformations, progressive pancytopenia, and an increased risk of both hematological malignancies and solid tumors. The congenital abnormalities associated with it can affect various organ systems, including the skeletal system, with significant variability among patients. One similar case has been reported here, which had the typical clinical features of FA. Due to varied phenotypic presentation, diagnosing FA can be challenging. A Chromosomal Breakage Study using mitomycin C (MMC) or diepoxybutane (DEB) is a distinctive cellular marker that aids in the diagnosis.

Outcomes of Arthroscopic Debridement of the First Carpometacarpal Joint: A Systematic Review.

Background: Arthroscopic debridement is increasingly being utilised in patients with early-stage first carpometacarpal joint (FCMCJ) arthritis but has limited supportive evidence. This systematic review evaluates the literature, and reports on outcomes and adverse events following this procedure. Methods: An electronic literature search of PubMed, Embase, Medline and Cochrane Central, looking for studies describing outcomes following arthroscopic debridement in FCMCJ arthritis, was performed in November 2022. Studies where bony resection or interposition was performed as adjuncts were excluded. Reported outcomes included visual analogue scores (VAS) for pain; Disabilities of Arm, Shoulder and Hand (DASH) scores; pinch and grip strength; complications and re-operations. Results: Out of a total of 90 studies revealed from the search, only two studies were eligible for inclusion, with a cohort of 34 patients. Following arthroscopic debridement for FCMCJ osteoarthritis, the mean VAS improved by four units, mean DASH by 22 points, grip strength by 4.5 kg and pinch strength by 2 kg at mean follow-up of 18 months. The pooled complication and re-operation rates were 8.8% and 23.5%, respectively. Conclusions: There is a lack of evidence supporting the utility of FCMCJ arthroscopy and debridement in the management of patients with early arthritis. Although the limited evidence suggests that there may be some therapeutic benefit, further large-scale prospective studies need to be performed before making conclusive recommendations. Level of Evidence: Level III (Therapeutic).