Lower Extremity Polydactyly Does Not Disturb Finding One's Feet.

Little is known about functional outcomes in children with treated lower extremity polydactyly (LEP). No classification system has been shown to be prognostically useful for functional outcomes. This study investigates whether children with treated LEP learn to walk at an age comparable to the population and whether the SAM (severity of syndactyly, axis deviation and metatarsal involvement) classification system is prognostically useful. In a retrospective cohort of 18 patients, we tested for associations between patient characteristics and SAM scores, age at learning to walk, and ability to fit off-the-shelf shoes. The proportion of children with treated LEP able to walk at 18 months of age was compared with the general population. We found no association between the age at which the 17 participants learned to walk and the severity of syndactyly (p = .214), axis deviation (p = .723) and metatarsal involvement (p = .781), nor between the proportion of patients able to wear off-the-shelf shoes compared to those requiring extra wide off-the-shelf shoes and the severity of syndactyly (p = 1.000), axis deviation (p = 1.000) and metatarsal involvement (p = 1.000). We found a trend between older age at surgery and the need for extra wide off-the-shelf shoes (OR = 1.008, p = .080). We found no significant difference in the proportion of children able to walk at 18 months between our patients (proportion = 1.00) and the general population (proportion = 0.95) (p = 1.000). We found no significant association between different SAM scores and functional outcomes, and none in the proportion of children able to walk at 18 months between treated LEP patients and the general population.

Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study.

BACKGROUND: Scapholunate dissociation is the most common form of carpal instability. However, there is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation. METHODS: Quick-Disabilities of Arm, Shoulder and Hand (DASH)-questionnaire results, post-operative satisfaction, range of motion and grip strength are analyzed. RESULTS: A median Quick-DASH of 54.6 was observed pre-operatively which significantly improved to a median of 28.4 after the procedure (p < 0.001). Median follow-up was 24 months. Of 46 completely followed-up patients, 31 patients (67.4%) reported that they were satisfied with the outcome. Thirty-seven patients (80.4%) would recommend the procedure to a friend. Thirty-five patients (76.1%) reported some kind of complaint in the operated hand during follow-up. There was no association of severity of symptoms and co-morbidities with the outcome. Neither palmar flexion, nor dorsal extension was significantly different between the operated and non-operated wrist. The operated wrists were observed to have less grip strength than non-operated wrists. CONCLUSIONS: The presented method seems to be as successful as other techniques described in literature. It is less invasive, thus more patient friendly without harming feasibility of future salvage options. However, post-operative complaint rate was quite high.

Atraumatische Ruptur der Extensor Hallucis Longus Sehne.

An atraumatic rupture of the extensor hallucis longus tendon is a rare injury. Chronic overload due to contact sports, bony anomalies, previous operations, and drug injections close to the tendon have been reported as a cause. We report the case of a young patient who presented with an acute loss of function in his extensor hallucis longus tendon for no apparent reason.

Rare causes of closed rupture of the flexor tendon.

Closed injuries to the flexor tendon are relatively rare. We present three rare causes of closed injury to the flexor tendon. Early recognition and adequate treatment by a specialised hand surgeon are crucial for the prognosis of such cases. Delayed diagnosis and treatment often require secondary reconstruction of the flexor tendon, which results in a worse functional outcome.

Elevated Infant Mortality Rate among Dutch Oral Cleft Cases: A Retrospective Analysis from 1997 to 2011.

OBJECTIVES: First, to determine the infant mortality rate (IMR) for Dutch patients with isolated oral clefts (OC) as well as for patients with clefts seen in association with other malformations. Second, to conduct a similar analysis per cleft type: cleft lip with or without cleft palate (CP), CP (including Robin sequence). Third, to examine the underlying causes of death. MATERIAL AND METHODS: A retrospective review of the charts of patients with OC born in the period 1997-2011 and treated in three regional cleft centers in the Netherlands. RESULTS: One thousand five hundred thirty patients with OC were born during the study period and treated in the cleft centers. The overall IMR for all clefts was 2.09%, significantly higher than the general Dutch IMR of 0.45%. In a subanalysis per cleft type, the IMRs were 1.22, 1.38, 2.45, and 3.62% for cleft lip, cleft lip with CP, CP, and Robin sequence, respectively. The mortality rates for isolated OC did not differ significantly from the general Dutch rate. Causes of death were congenital malformations of the heart in 40.6%, airway/lungs in 15.6%, nervous system in 15.6%, infectious disease in 12.5%, and other or unknown in 15.6%. CONCLUSION: The elevated IMR observed in Dutch patients with OC is almost exclusively caused by associated congenital malformations. After diagnosis of an oral cleft an in-depth medical examination and a consult by the pediatrician and clinical geneticist is imperative to instigate the appropriate medical management.

Local treatment of chronic wounds: in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes.

BACKGROUND: A chronic wound is defined as an area where the skin is not intact that fails to heal within eight weeks. Such wounds usually develop on the lower limbs as a complication of diabetes, venous insufficiency, or inadequate arterial perfusion. Most of the roughly 45,000 limb amputations performed in Germany each year are necessitated by non-healing chronic wounds. METHODS: In the development of this S3 guideline, a systematic search was performed that yielded 4998 references including 38 randomized, controlled trials and 26 systematic reviews, which were used as the basis for the recommendations and statements made in the guideline. Twelve member societies of the umbrella Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF), as well as the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft, and patient representatives participated in the consensus rounds in which the guideline's recommendations and statements were agreed upon. RESULTS: This guideline contains seven evidence-based recommendations and 30 good clinical practice (GCP) recommendations. Evidence-based recommendations are given in favor of hydrogel, hyperbaric oxygenation, and integrated care, and against the use of medicinal honey and growth factors. Terms are defined precisely in order to ease communication and to specify what is meant by "wound debridement" (a procedure performed by a physician) as opposed to cleansing a wound. Under the premise of preventing pain, exudation, and maceration, local therapeutic agents can be chosen on the basis of the scientific evidence, the patient's preference, the physician's experience, and the wound situation. Costs should also be considered. CONCLUSION: Scant evidence is available to answer many of the relevant questions about chronic wounds. There are valid data in support of hyperbaric oxygen and integrated care. More research is needed.