Assessment of Pain Severity and Grip Strength as the Most Accurate Predictors of the Outcome of Treatment of Distal Radial Fractures.

BACKGROUND: Distal radial fractures are common injuries, accounting for approximately 25% of fractures in the paediatric population and up to 18% of all fractures in the elderly age group. Assessment of treatment outcomes of these fractures includes objective measurements of wrist joint range of motion and grip strength as well as subjective parameters such as the intensity of perceived pain, hand function and quality of life. The recent years have ushered in a trend towards using several outcome measures for a more comprehensive evaluation of the results of the treatment. The objective of this study was to investigate whether the assessment of pain severity and grip strength is sufficiently accurate for correct assessment of the outcome of the treatment of distal radial fractures. MATERIALS AND METHODS: One hundred and two patients, 79 women (77%) and 23 men (23%), at a mean age of 54 years with distal radial fractures were treated operatively. Treatment outcomes were assessed at 3 and 6 months by measurements of intensity of pain (according to a numerical rating scale, NRS), grip strength (with a dynamometer) and hand function with the DASH questionnaire. The results of these measurements were compared in order to investigate the strength of the possible correlation between variables. RESULTS: An analysis of the correlation between the variables of interest at 3 and 6 months' assessment showed statistically significant correlations (Spearman rank test, R=0,26-0,41; p<0,01). The NRS correlated negatively with grip strength (less pain - greater strength) and positively with DASH scores (less pain - better hand function). The correlation between grip strength and the DASH was the strongest (Spearman rank test R=0,61; p<0,001, showing that greater power of the hand indicated better function, whereas weaker grip indicated worse function. CONCLUSIONS: 1. The severity of pain and the degree of weakness of the hand show (independently of each other) a very good correlation with the comprehensive assessment of hand function using the DASH questionnaire. 2. It follows that pain severity and hand weakness are sufficient to reliably assess the outcome of the treatment of a distal radius fracture.

Inherited Variants in the COL11A, COL1A, COL5A1, COMP, GSTM1 Genes and the Risk of Carpal Tunnel Syndrome.

The pathogenesis of most cases of carpal tunnel syndrome is not clearly defined. There are some aspects of the disease that suggest a potential effect of genetic predispositions. Mutations (variants) within the genes encoding various subtypes of collagen synthesis, oligomerisation in the endoplasmic reticulum and inactivation of reactive oxygen species may be involved in the development of carpal tunnel syndrome. The objective of this study was to determine the role of DNA alterations within the COL11A, COL1A, COL5A1, COMP and GSTM1 genes in the pathogenesis of carpal tunnel syndrome based on a Polish population. STUDY DESIGN: In the discovery phase, a total of 96 patients with familial aggregation of CTS were genotyped using a Next Generation Sequencing panel in order to find possible mutations within the studied genes. The potential pathogenicity of the detected variants was investigated using the predictions of several in-silico algorithms and the TaqMan technology. In the association phase of the study, a group of 345 CTS patients and 1035 healthy controls were genotyped. RESULTS: A total of 35 splice-site or exonic non-synonymous variants were detected by NGS. We did not identify any clearly pathogenic or likely pathogenic alternations. The 30 variants were identified as benign or likely benign. Five missense changes were predicted as VUS and selected for association study. The COL5A1 c.1595 C>T (p.Ala532Val) was detected in one out of 345 cases and three out of 1035 controls (P=1, OR=1); this indicates that the variant is a neutral alteration. Four remaining variants - c.2840 C>A, c.5395 G>A, c.1331 C>G, c.1590 C>A - were present in none out of the 345 CTS patients and none out of 1035 controls. CONCLUSION: The main finding of this study was that there was no independent association between the variants of five examined genes and carpal tunnel syndrome. Four uncertain variants were identified that seem to be extremely rare in the Polish population.

Is a routine histopathological examination justified for all tumours resected from the upper extremity?

Most lesions of the upper extremity are common and benign, and the need for a routine pathology evaluation of these specimens has often been questioned. This study aimed to evaluate the concordance of the initial clinical and final histological diagnoses of tumours which, based on clinical presentation and intraoperative findings, are most likely benign or malignant, and to answer the question whether or not a routine histopathological examination is justified for all tumours in the upper extremity. MATERIAL AND METHODS: We analysed the results of histopathological examinations of benign tumours resected in 346 patients and malignant tumours resected in 6 patients. RESULTS: Our analysis showed a 100% concordance between the initial (clinical) diagnoses of the tumours as benign or malignant and their final histopathological diagnoses. Only in 12 cases (3.5%) of initially benign tumours did the clinical presentation and/or intraoperative findings raise doubts. CONCLUSIONS: The results of this study show that a routine histological evaluation of all tumours resected from the upper extremity is not justified and may be confined to selected cases in which clinical presentation and/or intraoperative findings raise doubts.

Outcomes of Surgery for Benign Tumours in The Upper Extremity.

Benign tumours of the upper extremity are common in hand surgeons' practice. The most commonly diagnosed are giant-cell tumours of the tendon sheath and lipomas. THE OBJECTIVE: of this study was an investigation into the distribution of tumours in the upper limb, their symptomatology and outcomes of surgery, particularly regarding the rate of recurrence. MATERIAL AND METHODS: A total of 346 patients, 234 women (68%) and 112 men (32%), who had undergone surgery for tumours located in the upper extremity which were not ganglion cysts were enrolled into the study. The follow-up assessment was performed at a mean of 21 months (range 12-36) post-operatively. RESULTS: The most common tumour in this study was giant cell tumour of the tendon sheath - 96 cases (27.7%), followed by lipoma - 44 cases (12.7%). Most lesions - 231 (67%) were localized in the digits. A total of 79 (23%) recurrences were noted, the most common after surgery for rheumatoid nodules - 43.3% and the giant-cell tumours of the tendon sheath - 31.3%. The independent factors increasing risk of recurrence following the tumour's resection were: histological type of the lesion - the giant-cell tumour of the tendon sheath (p=0.0086) and the rheumatoid nodule (p=0.0027), as well as a combination of incomplete (non-radical) and not "en block" resection of tumours. A brief review of the literature referring to the presented material is offered.

Changes in organization of activity of hand surgery department during the COVID-19 pandemic.

The COVID-19 pandemic has impacted many medical specialties throughout the world, including hand surgery. Emergency hand surgery deals with a wide spectrum of injuries, including bone fractures, nerve, tendon and vessel cuts, complex injuries and amputations. These traumas occur independently to the phase of the pandemic. The objective of this study was presentation of changes in organization of activity of hand surgery department during the COVID-19 pandemic. Modifications of the activity were described in details. Over a period of the pandemic (from April 2020 to March 2022), a total of 4150 patients were treated, in this number 2327 (56%) with acute injuries and 1823 (44%) with common hand diseases. Forty-one (1%) patients were diagnosed COVID-19 positive, 19 (46%) with hand injuries and 32 (54%) with hand disorders. One case of work-related COVID-19 infection was registered in the 6-people clinic team in analysed period. Results of this study show effectiveness of measures undertaken in the authors institution to prevent the coronavirus infection and viral transmission in hand surgery staff.

Ten-Year (2010-2019) Activity Report of the Replantation Service for Hand and Finger Amputations in Poland.

Replantation of amputated hands is now considered a routine procedure in countries representing high standards of medical care. However, organization of care for patients with hand amputations is not uniform and varies from country to country, even in the European Union. This article presents organization of the Replantation Service for hand amputations in Poland, and ten-year activity report of the Service. Data to this report were obtained by mailing questionnaires to seven participating departments.A total of 974 patients, 871 men (89 %) and 103 women (11 %) at a mean age of 40 years with total or subtotal amputations or other severe upper limb-threatening injuries were admitted to the seven units participating in the Service. The most common injury was multidigital amputation - 353 (36 %), followed by the thumb - 282 (29 %), the metacarpal and wrist - 231 (24 %) and the forearm and arm - 108 (11 %) amputations. The most common operation was replantation of totally amputated hands/fingers - 368 cases (38 %), followed by revascularization of subtotal amputated hands/fingers - 344 (35 %). Primary reconstruction of a complex injury to the hand was performed in 135 patients (14 %). The rate of survival of the replanted/revascularized hands/fingers was a mean of 80 %. The report is supported by literature review about replantation services in other countries.

Outcomes of Surgery for intramuscular Haemangiomas in the Extremities.

PURPOSE: The objective of this case-series study was an assessment of outcomes of surgery for intramuscular haemangiomas in the extremities. PATIENTS AND METHODS: Three women and one man with a mean age of 28 (23 - 34) years were operated on for intramuscular haemangiomas in the extremities, 3 in the forearms, and 1 in the calf. Three of them, 2 after resection of tumours from the forearm, and one after resection of the tumour in the calf, were available for follow-up assessment at an average of 1.5 (1 - 2) years after surgery. For patients with the tumour in the forearm, preoperative and at the follow-up examination pain was registered with use of the numeric rank scale (NRS), grip strength with the Jamar dynamometer, and function of the extremity with the quickDASH questionnaire. In the patient with the lower limb involvement, pain at the operation site, and efficiency (dexterity) of gait were evaluated. RESULTS: All 3 patients with a follow-up examination reported significant reduction of pain. With regard to grip strength and hand function, one patient had significant improvement, whereas in the other, there were no real changes compared to preoperative. The patient with the calf involvement had no symptoms and walked normally. Over the follow-up period, no recurrence was noted. CONCLUSION: The results of this small case-series study show that operative treatment of these rare tumours is safe and effective, however, it may be challenging in some cases.

Outcomes of Coverage of Soft Tissue Defects in the Thumb with a "Kite Flap".

Deep soft tissue injuries and defects in the digits such as pulp amputation and degloving injuries are relatively frequent in hand surgical practice. Injuries around the thumb constitute a specific subtype, because their fitting requires the use of techniques that are different from standard. Many different surgical options have been described for the treatment of these serious lesions, depending on site and size of the defect, as well as on bone exposition. The "kite flap" is one of the most popular and frequently used. Results of the treatment of 14 of the 22 patients whose defects in the thumb were fitted with the kite flap are presented. The flaps healed in all patients. At the mean follow-up of 3 years all patients declared satisfaction with the result of surgery. Most of them had slightly limited mobility of the operated thumbs but with no significant translation to the function of the hands, which was very good. The results of this study show that the kite flap is useful in reconstruction of soft tissue defects around the thumb, which are difficult to cover by more conventional techniques.

13 years of hand surgery without an anesthesiologist. An analysis of efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists.

<b><br>Introduction:</b> The assistance of anaesthesiologist is considered an inseparable part of most surgical procedures, with the exception of a small proportion of minor procedures performed under local anaesthesia. In hand surgery, a vast majority of procedures, even those lasting several hours, can be carried out under regional (brachial plexus block) or local (infiltration) anaesthesia. These can be delivered by the surgeons themselves, allowing the surgeries to be carried out without the assistance of anesthesiologists.</br> <b><br>Aim:</b> The aim of this study was to analyze the efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists in the course of hand surgery procedures performed within the institution headed by the author of this article.</br> <b><br>Material and methods:</b> The analysis was based on the records of anesthesia protocols filled out by the surgeons who delivered the anesthesia and who operated on the patients. The variables considered included the efficacy of anesthesia and the anesthesia-related adverse effects and complications.</br> <b><br>Results:</b> Over a period of 13 years (2010-2022), a total of 24,703 surgeries were delivered; of these, 22,228 (91%) surgeries were carried out without anesthesiologists, with anesthesia being delivered by the surgeon him/herself. The efficacy of these procedures (local anasthesia and brachial plexus blocks combined) was 99%. A total of 631 (2.8%) anesthesia-related adverse reactions were recorded, most of them being transient, requiring immediate interventions and not leading to any serious sequelae. In only 17 cases (0.07%), adverse effects resulted in cancellation and rescheduling of the elective surgery.</br> <b><br>Conclusions:</b> Pre-surgical anesthesia as delivered prior to hand surgery procedures by the surgeons without the assistance of anesthesiologists is effective and safe while being associated with numerous benefits for patients, surgeons and the health care system's budget.</br>.

The effect of comorbidities on the clinical profile and outcomes of surgery for carpal tunnel syndrome.

<b><br>Introduction:</b> The results of some studies show that predictors of less favourable outcomes of surgery for carpal tunnel syndrome might include the presence of comorbidities, such as diabetes and thyroid gland diseases. The role of these factors has not been clearly determined, but in most trials the patients burdened with comorbidities conducive to CTS are excluded from the analysis.</br> <b><br>Aim:</b> The aim of this study was to investigate the effect of concomitant diseases on the clinical profile and outcomes of surgery for carpal tunnel syndrome.</br> <b><br>Material and methods:</b> The study group consisted of 1117 patients - 909 women (81%) and 208 men (19%) - at a mean age of 63 years. A total of 972 patients (87%) declared having at least one comorbidity, whereas 145 patients (13%) declared no comorbidities. The measurements were performed preoperatively and at 6 months postoperatively; they included pain intensity, total grip and key-pinch strength, digital sensibility and hand function with Levine's questionnaire.</br> <b><br>Results:</b> At baseline, the patients with comorbidities had significantly worse digital sensiblility, weaker total grip strength and greater functional impairment of the hand, but only grip strength reached the minimal important difference (3.5 kg). Carpal tunnel release resulted in significant improvement in the tested variables for all patients, although the outcomes at 6 months were less favourable for those with comorbidities with regard to digital sensiblility, total grip and pinch strength and function of the hand. All these differences were statistically significant, but only grip strength reached the minimal important difference (2.9 kg).</br> <b><br>Conclusion:</b> The results of this study show that comorbidities in patients suffering from CTS had a statistically and clinically significant negative effect only on the total grip strength pre- and postoperatively, and no significant effect on the outcome of surgery, which was satisfactory in all patients.</br>.

Electrical Disturbances in Terms of Methods to Reduce False Activation of Aerial Fire Protection Systems.

The paper presents an analysis of false triggers of fire protection systems installed on aircraft. They not only cause task interruption but also have a direct impact on flight safety, forcing the crew to land in a risky area. Simulation models of electronic actuators were developed to determine the conditions under which false alarms occur. Testing of the simulation models was carried out in the computational package Matlab-Simulink and Circum-Maker for different electrical disturbance generation conditions. The simulation of overvoltage, voltage drops and voltage decays in the on-board electrical network supplying the fire protection system, occurring during the start-up of aircraft engines and during the switching on and off of on-board high-power devices, was studied. The conducted studies have practical applications since the simulation results are an important element for planning experimental tests of the SSP-FK-BI executive blocks under electrical disturbance conditions. Based on the simulation and experimental studies, the conditions causing false tripping of the fire protection system and the parameters for selected disturbance factors have been determined.

Outcomes of surgery for gouty tophi in the extremities.

<b> Introduction:</b> Gouty tophi occur in approx. 50-60% of patients suffering from gout. Their occurrence is related to severity of disease and effectiveness of treatment. They develop more frequently in patients with long lasting and poorly controlled disease.</br></br> <b>Aim:</b> The aim of the study was to evaluate the results of surgical treatment of gouty tophi of the upper and lower extremities. </br></br> <b>Materials and methods:</b> The results of surgical treatment of gouty tophi in the extremities in 14 patients, 13 men and 1 woman, at a mean age of 51 years, are presented. Twelve patients had tophi localized in the upper extremities, whereas 3 had tophi in the lower limbs (1 patient had upper and lower extremity involved). The duration of disease to the operation was a mean of 8 years. </br></br><b> Results:</b> Seven patients received excision of a single tophus, and the remaining patients had 3-15 operations performed due to multiple tophi over a period from 3 months to 2 years. The treatment outcomes were assessed at a mean of 3 years (range 2-8) after the last operation in a form of phone interview. </br></br> <b>Conclusions:</b> All patients declared satisfaction from the result of treatment. No case of complication or tumor recurrence was noted. The results confirm usefulness of surgical treatment in this form of gout.

Bite wounds to the hand - a review.

Bite wounds occur as a result of bite by an animal or a human. They are relatively frequent due to the growing number of pets living with people, as well as from inadequate human-animal interactions. The knowledge of most surgeons about the management of these injuries is relatively outdated, whereas the current literature points to important changes in this field. The article presents several aspects concerning epidemiology, classification, bacteriology, and characteristics of bite wounds to the hand. Based on the actual literature, detailed rules for the management of these injuries are described. This information may prove useful in the daily practice of surgeons and doctors at emergency departments who are frequently faced with bite wounds.

Metastases of malignant neoplasms to the hand.

<b>Introduction:</b> Metastases of malignant neoplasms to the hand are very rare and constitute approximately 0.01% of whole distant metastases. They usually indicate generalized neoplastic disease, although sometimes can be a first manifestation of dissemination. </br></br> <b>Cases reports:</b> The study presents 4 cases of metastatic tumors to the hands in patients with diagnosis of renal (2) and lung cancer (1) and one of unknown point of origin. The lesions were localized in the fingers in two patients and in the wrist in the other two. The patient with wrist involvement received excisional biopsy of the lesion, followed by forearm amputation. Two patients with finger tumors had their affected fingers amputated. The patient with the cyst involving the wrist received local excision of the lesion. Operative wounds healed uneventfully in all patients, but 3 of them eventually died within one year from hand operation.

Outcomes of coverage of the soft tissue defects in the hand with a groin flap.

The article presents outcome of treatment of 31 patients, 28 men and 3 women, at a mean age of 37 years with excessive soft tissue defects within the hand, which were fitted with groin flaps. Long-term outcomes were assessed at a mean of 3,7 years following surgery (range 3-10) in 18 patients (58%) in a form of phone interview. Results. All flaps eventually healed, however complications occurred in 8 patients (26%). At a follow-up assessment most of the patients complained of slight pain when using the hand. Only 2 patients achieved full range of motion of the fingers in the operated hand, and remaining 16 reported various degree of limited fingers movements, both flexion and extension. None of patients considered his/her hand fully dexterous and a mean quickDASH score was 21,5 points what shows moderate impairment of hand function. The poorest outcomes were achieved in patients with tissue defects in fingers and in those who had performed simultaneous tendon repair. The results of this study show that a groin flap is useful in reconstruction of large and moderate tissue defects in the hand, which do not fit for covering by conventional methods.

Management of flexor tendon injuries in the digits: an update.

Currently used techniques of flexor tendon repair and methods of postoperative rehabilitation differ significantly from those used still 10-15 years ago. Techniques of the repair evolved from 2-strand sutures (the Kessler suture) in the direction of much stronger 4-strand and 6-strand sutures (the Adelaide and Savage sutures), what reduced the risk of failure of the repair and made possible more intensive rehabilitation. Also rehabilitation regimes changed on more comfortable for patients than older protocols and allowed to achieve better functional outcomes of the treatment. This study presents updated trends in management of flexor tendon injuries in the digits, with regard to operative technique and postoperative rehabilitation protocols.