Return to Usual Work Following an Ulnar Shortening Osteotomy: A Sample of 111 Patients.

PURPOSE: The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors influencing the median time until return to their usual work. METHODS: We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression. RESULTS: In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device. CONCLUSIONS: Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Patient-Reported Outcomes 1 Year After Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis.

PURPOSE: Implant survival, range of motion, and complications of proximal interphalangeal joint arthroplasty have been reported often, but patient-reported outcomes are less frequently described. This study evaluated patients' experiences during the first year after proximal interphalangeal joint arthroplasty, measured with the Michigan Hand Outcomes Questionnaire (MHQ). The primary focus was the reduction of patient-reported pain after proximal interphalangeal joint implant placement and the percentage of patients who considered this reduction clinically relevant, indicated by the minimal clinically important difference (MCID). METHODS: Data were collected prospectively; 98 patients completed the MHQ before and at 3 and 12 months after surgery. Our primary outcome was the change in the pain score. An increase of 24 points or more was considered a clinically important difference. Secondary outcomes included changes in MHQ total and subscale scores and MCIDs, range of motion (ROM), patient satisfaction with the outcome of the surgery, and complications. RESULTS: The pain score improved significantly, from 42 (95% confidence interval, 38-46) at baseline to 65 (95% confidence interval, 60-69) at 12 months after surgery. The MCID was reached by 50% (n = 49) of patients. The ROM did not improve, reoperations occurred in 13% (n = 13) of patients, and swan neck deformities only occurred among surface replacement implants. CONCLUSIONS: Although most patients undergoing arthroplasty for osteoarthritis experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% (n = 49) of patients. Patients with high MHQ pain scores before surgery are at risk for postoperative pain reduction that will not be clinically relevant. Likewise, the other subscales of the MHQ improved after surgery, but reached a clinically relevant improvement in only 46% (n = 45) to 63% (n = 62) of patients. This knowledge can be used during preoperative consultation to improve shared decision making. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Joint-sparing versus nonjoint-sparing reconstruction of the radius following oncologic resection: A systematic review.

BACKGROUND AND OBJECTIVES: Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjoint-sparing (NJS) reconstructions following oncologic resection of the distal radius. METHODS: A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates. RESULTS: A total of 52 nonrandomized cohort studies (n = 715) were included. PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1° vs. 25.6°) and the range of pronation-supination was greater in NJS reconstructions (133.6° vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct. CONCLUSIONS: This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects. However, about 6% of JS reconstructions are eventually revised to a NJS construct. Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.

Long-term patient-reported outcome measures following limb salvage with complex reconstruction or amputation in the treatment of upper extremity sarcoma.

BACKGROUND AND OBJECTIVES: This study compares long-term patient-reported outcomes between patients that underwent limb-salvage surgery with complex reconstruction by free or pedicled flap (LS) or amputation. Additionally, the need for revision surgery is compared. METHODS: A total of 43 patients were studied at a median follow-up of 9.54 years. Sixteen patients completed questionnaires regarding functional outcome and mental wellbeing. Functional outcomes were measured by using the Toronto Extremity Salvage Score (TESS), QuickDASH, and PROMIS Upper Extremity instruments. Mental wellbeing was assessed using the PROMIS Anxiety and Depression instruments. Revision surgery was assessed for the entire follow-up. RESULTS: The median TESS scores were 96.0 versus 71.7 (p = 0.034) and the PROMIS Upper Extremity scores were 50.1 versus 40.3 (p = 0.039) for the LS and amputation cohorts, respectively. No significant difference was found regarding symptoms of anxiety (52.7 vs. 53.8; p = 0.587) or depression (52.0 vs. 50.5; p = 0.745). Of the patients in the LS cohort 51.6% required at least one reoperation compared to 8.33% in the amputation cohort. CONCLUSIONS: LS surgery maintains functional benefits over amputation after almost a decade of follow-up. Still, mental wellbeing seems to be comparable between these patients, whereas LS procedures are associated with a sixfold increased need for reoperations.

Medium to Long-Term Follow-Up After Pyrocarbon Disc Interposition Arthroplasty for Treatment of CMC Thumb Joint Arthritis.

PURPOSE: Pyrocarbon disc interposition arthroplasty has been designed for the surgical treatment of Eaton-Glickel grade II/III carpometacarpal thumb joint arthritis. This study presents the results of this technique with a minimum 5-year follow up. METHODS: We assessed 4 questionnaires for patient-reported outcome measurements in a cross-sectional study: the Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand questionnaire, Michigan Hand Questionnaire, and questions about satisfaction at the 5-year follow up. We evaluated grip and pinch strength, range of motion, and the radiological position of the disc. Finally, a Kaplan-Meier survival analysis was performed. RESULTS: A total of 164 thumbs (in 137 patients) were available for follow-up varying from 5 to 12 years. Median Patient-Rated Wrist and Hand Evaluation, Disabilities of Arm, Shoulder, and Hand, and Michigan Hand Questionnaire scores were 17, 18, and 76, respectively. The satisfaction score was 9 (Likert scale of 1-10). Grip and pinch strength reached nearly 100% compared with the contralateral hand. Range of motion resulted in a Kapandji score of 10. Thumb height showed a marginal loss and the Kaplan-Meier survival curve showed a survival rate of 91%. CONCLUSIONS: Our study suggests that pyrocarbon disc interposition arthroplasty is a reliable and feasible treatment for carpometacarpal thumb joint arthritis at medium-term follow-up. It was associated with a high level of patient satisfaction; it maintained thumb height and the implant survived in 91% of patients. Strength and range of motion were comparable to the contralateral hand after a minimum follow-up of 5 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Squamous Cell Carcinoma of the Nail Unit: Review of the Literature.

Squamous cell carcinoma of the nail unit (SCCNU) is often misdiagnosed and improperly treated because it mimics a number of other conditions. This review details current knowledge of anatomy, pathophysiology, clinical presentation, diagnosis, and treatment of SCCNU. A heightened clinical awareness is critical to treating SCCNU and preventing development of advanced disease at which time amputation is needed and metastasis may occur. Physicians should consider SCCNU in each case of a nail abnormality unresponsive to topical treatment. For adequate diagnosis and excision of SCCNU, timely and appropriate specialist referral is necessary.

State of the art review. Upper extremity revision nerve compression surgery.

Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.

An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients.

Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.

Psychosocial and functional impact of successful digital replantation - A cohort study of 36 patients with a median follow-up of 6 years.

INTRODUCTION: This study aims to evaluate the long-term psychosocial and functional outcomes of successful digital replantation following traumatic amputation. METHODS: Patients that underwent successful replantation (i.e. no secondary amputation following replantation) of one or more traumatically amputated digits between January 2009 and April 2019 were invited to participate in this study. In addition to a custom questionnaire on psychosocial and socioeconomic aspects of life, various Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires regarding global health, upper extremity function, and depressive symptoms were completed. Bivariate analyses were performed to identify significant associations between outcomes and explanatory variables. RESULTS: Thirty-six patients were successfully enrolled and completed the questionnaires at a median follow-up of 6.1 years. The median PROMIS score for Upper Extremity Function (40.6) was considerably different from the score that is typically found in the general population (all PROMIS instruments are calibrated with a control group score of 50.0), but the median PROMIS scores for Global Health - Physical (49.0), Global Health - Mental (50.7), and Depression (45.6) were comparable to those among the general population. Dominant hand injury, a greater number of injured digits, higher age at the time of injury, and the need for neuropathic pain medication were associated with lower Upper Extremity Function scores (all p < 0.05). Additionally, the presence of neuroma was associated with negative changes in both household finances and mental well-being (p < 0.05). CONCLUSIONS: At long-term follow-up, a majority of patients that underwent replantation of traumatically amputated digits seem to cope well based on psychosocial and functional outcomes. However, neuropathic pain and the presence of neuroma are strong negative factors. Specific attention to digital nerves at the time of surgery is crucial in the management of traumatic amputations.

"Proximal interphalangeal joint arthroplasty for osteoarthritis: Long-term follow-up of patient satisfaction, Michigan Hand outcomes Questionnaire scores, and reoperations."

BACKGROUND: Previously published research describes short-term outcomes after proximal interphalangeal (PIP) joint arthroplasty, however, long-term outcomes are scarce. Therefore, we evaluated patient-reported outcomes and complications after a follow-up of at least five years following PIP joint arthroplasty. METHODS: We used prospectively gathered data from patients undergoing PIP joint arthroplasty with silicone or surface replacement implants. Time points included preoperative, one year, and at least five years postoperatively. We were able to include 74 patients. Primarily, we focussed on patient satisfaction with the treatment outcome, measured using a validated 5-point Likert scale. Secondary outcomes included the question whether patients would undergo the same surgery again, the assessment of factors associated with (dis)satisfaction, the Michigan Hand outcomes Questionnaire (MHQ), and the number of reoperations. RESULTS: The mean follow-up was seven years (SD 1.2, range 5-11 years). Patient satisfaction was excellent in 14 (19%), good in 17 (23%), reasonable in 18 (24%), moderate in 10 (14%), and poor in 15 (20%) patients. Seventy-three percent of patients (n=54) would undergo the same procedure again. We found no factors associated with (dis)satisfaction. All MHQ scores improved significantly in the first year after surgery and did not deteriorate afterward. Sixteen (16%) fingers required a reoperation, of whom 3 (4%) needed a prosthesis replacement. CONCLUSION: Patient satisfaction with treatment outcomes seven years post-PIP implant surgery ranges from moderate to good for many patients, with a notable proportion expressing dissatisfaction. Patient-reported outcomes improve primarily within the first year and remain stable at five years or more. LEVEL OF EVIDENCE: II.

Changes in hand function and health state utility after cubital tunnel release using the United Kingdom Hand Registry.

This study aimed to analyse and contrast changes in health-related quality of life (HR-QoL) and hand symptoms in the first 6 months after surgical treatment for primary cubital tunnel syndrome. Data originated from the United Kingdom Hand Registry. HR-QoL was assessed using the generic EuroQol five-dimensional assessment tool (EQ-5D-5L) and hand symptoms using the Patient Evaluation Measure (PEM). In total, 281 patients were included in the statistical analysis. Cubital tunnel release resulted in clinically relevant relief of hand symptoms. However, no improvement in HR-QoL was detected by the EQ-5D-5L. As a result, current health economic models, such as those used by the National Institute for Health Care Excellence (NICE) in the UK, might conclude that cubital tunnel release is not cost-effective. This discrepancy requires exploration, and hand-specific preference-based measures might be needed for value-based healthcare in hand surgery.Level of evidence: III.

Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition.

BACKGROUND: Pyrocarbon disk interposition for carpometacarpal (CMC) thumb joint osteoarthritis can be performed with a flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strip. With the FCR technique, a ligament reconstruction is performed in addition to disk fixation, whereas with the APL technique the disk is simply secured in place. Our aim is to compare long-term postoperative outcomes between both techniques. METHODS: In this observational study, we included 106 patients in 2 centers operated on between 2006 and 2011. We assigned patients to the FCR group or the APL group based on the respective tendon strip used. As a primary outcome, we analyzed postoperative key pinch. In addition, we analyzed postoperative tip pinch and tripod pinch, grip strength, range of motion, thumb height maintenance, and patient-reported outcome measures (PROMs). RESULTS: The analysis showed clinically important stronger key pinch for the APL group (ß = 1.28 kg). Tip pinch and grip strength showed higher outcome for the FCR group (ß = 1.22 kg and 5.14 kg, respectively). Palmar abduction was in favor of the FCR group and opposition in favor of the APL group, but these were interpreted as not clinically relevant. Radiological thumb height maintenance and PROMs showed no clinical difference. CONCLUSIONS: Pyrocarbon disk interposition arthroplasty for CMC thumb joint osteoarthritis can be secured with an APL or FCR tendon strip. At long-term follow-up, use of an APL tendon strip results in significantly higher key pinch and better opposition. Tip pinch, grip strength, and palmar abduction were better after use of the FCR tendon strip. The choice of the tendon strip can be based on outcomes considered most important for the individual patient.

Stronger pinch strength at long-term follow-up after pyrocarbon disc interposition arthroplasty compared to trapeziectomy with ligament reconstruction and tendon interposition for CMC-1 osteoarthritis.

BACKGROUND/INTRODUCTION: In this study, we wanted to compare the pyrocarbon disc interposition arthroplasty (PDI) with trapeziectomy plus ligament reconstruction tendon interposition (LRTI). Primarily, we tested whether PDI resulted in a higher pinch strength. Secondarily, we compared the grip strength, range of motion (ROM), patient reported outcomes, satisfaction and complications. METHODS: Due to scarcity of preoperative hand measurements, we performed a descriptional cross-sectional cohort study of patients operated between 2006 and 2014, with a minimum of 5 years of follow-up. Patients were treated with PDI or LRTI. We determined key pinch strength as primary outcome, followed by tip- and tripod pinch, grip strength, palmar abduction and opposition; the Michigan Hand Outcome Questionnaire (MHQ), Patient Reported hand and Wrist evaluation (PRWHE), satisfaction and complications. Propensity score matching was used to match both study groups on demographic variables. A ratio of 2:1 was used resulting in inclusion of 62 (of 154) PDI and 31 (of 31) LRTI thumbs. RESULTS: The PDI-group patients showed stronger key and tip pinch strength than the LRTI group (p=0.027 and p=0.036 respectively). Tripod pinch, grip strength and ROM were equal for both groups. MHQ and PRWHE were comparable, with higher satisfaction for the PDI group. Eight PDI patients were converted to LRTI due to pain. CONCLUSION/DISCUSSION: This study confirmed our hypothesis that key and tip pinch strength is stronger after PDI compared to LRTI for CMC-1 joint osteoarthritis. Both techniques have comparable outcomes considering patient reported outcome (MHQ and PRWHE), ROM and complications.

Long-term follow-up of patients treated with pyrocarbon disc implant for thumb carpometacarpal osteoarthritis: the effect of disc position on outcomes measures.

Pyrocarbon disc interposition arthroplasty is an effective treatment for thumb base osteoarthritis. However, as with all implant techniques, the disc can (sub)luxate over time. The relationship between disc position, the experienced pain, and the necessity for revision surgery is not known. This study evaluated the effect of radiographic pyrocarbon disc position on the Michigan Hand Questionnaire (MHQ) outcome measurement. In addition, the correlation between disc position and other factors, including pain intensity, thumb strength, and occupation, was assessed. In this retrospective study, we included 136 patients (161 thumbs) with a mean follow-up of 6.7 years (range 3.3-11). Radiographs were scored on disc position and classified as 'well aligned' (Grade 1) up to 'luxated' (Grade 4). A database used for outcome measures included MHQ scores, pain intensity, satisfaction, thumb strength, range of motion, occupation, and hand dominance. In bivariate analyses, we assessed any association between disc position and outcome measurements. Eighty of the 136 implants (59%) were well-positioned (not displaced), 41% were (slightly) displaced (grade 2-3). No relationship existed between the degree of disc displacement and MHQ scores. Manual labor occupation was the only factor that correlated with more severe disc displacement. We could not detect any association between disc position and other outcome variables including pain intensity, thumb strength, or hand dominance. In conclusion, our study suggests that radiographic disc displacement has little clinical consequences. Future studies must assess if there is a causality between heavy mechanical stress to the CMC1 joint and luxation of the pyrocarbon disc over time.Level of evidence: IV Therapeutic-Retrospective case series.

The past, present and future of the conservative treatment of distal radius fractures.

The distal radius fracture is a common fracture with a prevalence of 17% on the emergency departments. The conservative treatment of distal radius fractures usually consists of three to six weeks of plaster immobilization. Several studies show that one week of plaster immobilization is safe for non- or minimally displaced distal radius fractures that do not need reduction. A shorter period of immobilization may lead to a better functional outcome, faster reintegration and participation in daily activities. Due to upcoming innovations such as three-dimensional printed splints for distal radius fractures, a patient specific splint can be produced which may offer more comfort. Furthermore, these three-dimensional printed splints are expected to be more environmental friendly in comparison with traditional plaster casts.

Pyrocarbon Disc Interposition Arthroplasty (PyroDisk) for the Treatment of Carpometacarpal Thumb Joint Osteoarthritis.

In cases of isolated carpometacarpal (CMC) thumb joint osteoarthritis, a hemitrapeziectomy can be performed. To address the risk of subsidence of the first metacarpal, a pyrocarbon disc has been designed as an interposition prosthesis. The disc is made of pyrolytic carbon with the same elastic modulus as cortical bone, making it resistant to wear from surrounding bone. This property contributes to preservation of thumb length and prevents subsidence. The present video article shows the pyrocarbon disc interposition arthroplasty step by step. The procedure results in substantial pain reduction with good function and strength at long-term follow-up. The complication rate is comparable with that of other surgical tendinoplasties for CMC thumb joint osteoarthritis. The survival rate has been reported to be 91% at a minimum follow-up of 5 years1-3. CMC thumb joint osteoarthritis is a common pathology. If symptoms remain despite splinting and hand therapy, surgical treatment is often performed. The simple trapeziectomy is seen as the reference standard, with good results and fewer complications compared with other surgical procedures4-6. Despite this fact, many surgeons still prefer to combine trapeziectomy with a tendinoplasty in order to reduce the risk of proximal migration and impingement of the first metacarpal on the scaphoid7-9. However, the volume and stiffness of autologous tendons are far less than that of the trapezial bone. This might be one of the reasons that trapeziectomy with tendinoplasty does not lead to better results than simple trapeziectomy. To overcome the disadvantages of a tendinoplasty, the PyroDisk (Integra LifeSciences) was introduced for CMC thumb joint osteoarthritis to preserve thumb length and provide more stability than other traditional techniques. The disc is designed to be utilized after a distal hemitrapeziectomy for patients with CMC thumb joint osteoarthritis without involvement of the scaphotrapeziotrapezoid (STT) joint. Description: Preoperatively, review radiology images to confirm that the osteoarthritis is limited to the thumb CMC joint and that all appropriate tools for inserting the disc are available before beginning surgery. Next, the patient is placed with their arm on an arm rest. The CMC thumb joint is exposed via a dorsal longitudinal skin incision, sparing the dorsal radial nerve branches and the radial artery and accompanying venes. The capsule is opened with an H-incision. With 2 parallel cuts to the joint surface, the articular surfaces of the joint are removed. After resection of the articular joint surfaces, the residual width and height of the joint space after resection are measured. The central point in the joint surfaces is marked for the bone tunnels. With an awl, tunnels are created from the center of the joint surface to the proximal (trapezial bone) and distal (first metacarpal bone) and the dorsal side. The implant size is measured with the trial implants for correct size of the disc. A tendon strip of either APL (abductor pollicis longus) or FCR (flexor carpi radialis) tendon is harvested for use securing the disc. The disc is secured with the tendon strip from proximal through the trapezium, through the disc and distal through the first metacarpal, and is secured to itself at the trapezial bone. The position is checked under fluoroscopy. When the disc in the right position, the joint capsule and skin are closed and a plaster cast is applied with the thumb in abduction. Alternatives: Alternative treatments include hemitrapeziectomy without interposition; full trapeziectomy, with or without ligament reconstruction and/or tendon interposition; and joint resurfacing prostheses. Rationale: The advantage of pyrocarbon disc interposition arthroplasty over other treatment options is the preservation of the STT joint1. Therefore, the procedure is minimally harming the surrounding anatomy despite open surgery and has a high success rate in reducing pain while preserving function and strength. The risk of complications is comparable with that of other CMC joint arthroplasty techniques. A relatively high survival rate has been reported at a mean follow-up of 7 years (range, 5 to 12 years). In cases of recurrent pain, all other surgical options remain possible ("no bridges are burned"). The main disadvantage is the cost of the disc. Expected Outcomes: Our recent study of this technique showed good patient-reported outcomes, pain reduction, patient satisfaction, and preservation of strength and range of motion at a mean follow-up of 7 years1,2. The survival rate was 91%, with 3% failing as a result of disc dislocation. Other reasons of failure were STT osteoarthritis and pain without a specific cause. Important Tips: Preoperatively, make sure that only the CMC thumb joint has osteoarthritis and that the STT joint does not. In cases in which it is unclear whether the osteoarthritis is isolated to the CMC thumb joint, perform computed tomography to make certain10.Only a few millimeters of bone must be resected from the first metacarpal base and the distal trapezium. Both bone cuts must be made parallel to each other and perpendicular to the longitudinal axis of the first metacarpal bone.Bone tunnels must be exactly centered in the cut joint surfaces for proper implant positioning and to decrease the chance of subluxation.Size the implant properly and check movement and stability. Acronyms and Abbreviations: OR = operating roomFCR = flexor carpi radialisAPL = abductor pollicis longusPRWHE = Patient-Rated Wrist and Hand EvaluationDASH = Disabilities of the Arm, Shoulder and Hand QuestionnaireMHQ = Michigan Hand QuestionnaireROM = range of motionFU = follow-upCRPS = complex regional pain syndromeLRTI = ligament reconstruction and tendon interpositionMRI = magnetic resonance imagingCT = computed tomography.

The impact of COVID-19 pandemic on hand surgery: a FESSH perspective.

COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.

Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger.

AIMS: The aim of this retrospective study was to evaluate the rate of conversion to surgical release after a steroid injection in patients with a trigger finger, and to analyze which patient- and trigger finger-related factors affect the outcome of an injection. METHODS: The medical records of 500 patients (754 fingers) treated for one or more trigger fingers with a steroid injection or with surgical release, between 1 January 2016 and 1 April 2020 with a follow-up of 12 months, were analyzed. Conversion to surgical release was recorded as an unsuccessful treatment after an injection. The effect of patient- and trigger finger-related characteristics on the outcome of an injection was assessed using stepwise manual backward multivariate logistic regression analysis. RESULTS: Treatment with an injection was unsuccessful in 230 fingers (37.9%). Female sex (odds ratio (OR) 1.87 (95% confidence interval (CI) 1.21 to 2.88)), Quinnell stage IV (OR 16.01 (95% CI 1.66 to 154.0)), heavy physical work (OR 1.60 (95% CI 0.96 to 2.67)), a third steroid injection (OR 2.02 (95% CI 1.06 to 3.88)), and having carpal tunnel syndrome (OR 1.59 (95% CI 0.98 to 2.59)) were associated with a higher risk of conversion to surgical release. In contrast, an older age (OR 0.98 (95% CI 0.96 to 0.99)), smoking (OR 0.39 (95% CI 0.24 to 0.64)), and polypharmacy (OR 0.39, CI 0.12 to 1.12) were associated with a lower risk of conversion. The regression model predicted 15.6% of the variance found for the outcome of the injection treatment (R2 > 0.25). CONCLUSION: Factors associated with a worse outcome following a steroid injection were identified and should be considered when choosing the treatment of a trigger finger. In women with a trigger finger, the choice of treatment should take into account whether there are also one or more patient- or trigger-related factors that increase the risk of conversion to surgery.Cite this article: Bone Joint J 2022;104-B(10):1142-1147.

Treatment of Recurrent Carpal Tunnel Syndrome with the Abductor Digiti Minimi Flap: A Case Series.

Background: Approximately 5% of patients experience recurrent symptoms after carpal tunnel release (CTR) and need revision surgery. Several surgical techniques have been described for recurrent carpal tunnel syndrome (CTS) and the abductor digiti minimi (ADM) flap is one of them. Literature concerning clinical results of the ADM flap for recurrent CTS is lacking. The aim of this study is to evaluate the outcomes of the ADM flap for recurrent CTS. Methods: We treated seven patients with the ADM flap (eight hands) between July 2016 and February 2019. Patient characteristics were assessed, and patients were asked about their symptoms (pain, sensation and paresthesia) before and after surgery. Postoperatively, we administered CTS symptoms, satisfaction with the surgery, patient-reported outcome measurements (BCTQ and QuickDASH) and whether they would undergo the same surgery again. Complications were also recorded Results: The median follow-up was 14 months. The success rate measured by CTS symptoms was 88%. Seven out of eight patients were satisfied with the results and two patients would not elect to undergo the same procedure again. Two patients reported having a weaker grip at the donor site. The median BCTQ symptom and function scores were 2.9 (1.7-3.5) and 2.6 (1.8-3.0) respectively. The median QuickDASH score was 41 (IQR 22-52). Complications reported were wound dehiscence (n = 1) and hypertrophic scar (n = 1). Conclusions: The outcomes of the ADM flap in patients with recurrent CTS were like other commonly used procedures in recurrent CTS. Level of Evidence: Level IV (Therapeutic).

Type of Work and Preoperative Ability to Perform Work Affect Return to Usual Work Following Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis.

BACKGROUND: The time until return to work (RTW) and possible factors affecting this time after proximal interphalangeal (PIP) joint arthroplasty are unknown. Therefore, we aim to evaluate the RTW after PIP joint arthroplasty for osteoarthritis and assess factors affecting the time until return to their usual work. METHODS: We used prospectively gathered data from 74 patients undergoing PIP joint arthroplasty with daily hand surgery practice routine outcome collection. Standardized RTW questionnaires were completed at 6 weeks and 3, 6, and 12 months after surgery. Return to work was defined as the first time a patient reported returning to work and performing the original work for a minimum of 50% of the original hours a week, as stated in the patient's contract. Second, we evaluated baseline factors affecting the time until RTW. RESULTS: The probability of RTW within 12 months after surgery was 88%. The median time until RTW was 8 weeks (interquartile range: 4-10). Physical occupational intensity (hazard ratio [HR]: 0.36, P = .001) and the baseline Michigan Hand Outcomes Questionnaire work scores (HR: 1.02, P = .005) were independently associated with RTW. CONCLUSION: In conclusion, patients returned to work after a median of 8 weeks following PIP arthroplasty. Patients with medium or heavy physical occupations returned to work later than patients with light physical occupations. Better patient-reported work outcomes at baseline also led to an earlier RTW. This information can be valuable for providing adequate information during the preoperative consultation.