Long-term functional outcomes after total wrist arthrodesis.

Current literature surrounding functional outcomes after total wrist arthrodesis is limited by short follow-up or limited use of validated patient reported outcome measures (PROMs). The primary aim of this study was to describe long-term functional outcomes following wrist arthrodesis. Secondary aims were to describe the incidence of complications and patient satisfaction. This was a retrospective single-center study. Patients with a minimum of 10-year follow-up completed a questionnaire including the Patient-Rated Wrist Evaluation (PRWE), the Quick version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, the EQ-5D-5L score, and a question assessing satisfaction. Presence of a complication was also assessed. During the study period 66 patients underwent total arthrodesis. At a median follow-up of 15 years, complete patient reported outcomes were available for 34 patients. Thirty-two patients were lost to follow-up. Mean age at surgery was 49 and 16 patients were female. Mean PRWE and Quick-DASH scores were 44.8 (SD 27.7; range 0-96) and 41.9 (SD 23.6; range 2.3-97.7) respectively. Twenty-eight patients were satisfied. Nine patients reported complications. There were six cases of hardware removal and two cases of prominent metalwork. One patient underwent revision surgery for non-union. Presence of a complication did not affect the Quick-DASH or PRWE scores. Median EQ-5D-5L score was 0.7. This long-term follow-up suggests high levels of patient satisfaction and health related quality of life, despite significant functional disability. The complication rates are not insignificant, although the presence of a complication did not affect functional outcomes.

Long-term outcomes following surgical repair of acute injuries of the thumb metacarpophalangeal joint ulnar collateral ligament.

The primary aim of this study was to describe the long-term patient reported outcomes following surgical repair of acute injuries to the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL). The secondary aims were to describe the long-term health related quality of life, patient satisfaction and complication rate. From a single surgeon series, 30 patients were identified over an 11 year period (February 2000-February 2011). QuickDASH, EQ-5D-5L, and satisfaction scores were collected from 22 patients (73%) at mean 183 month follow up. The median QuickDASH score was 2.27. Median EQ-5D-5L was 0.88. Satisfaction rate was 82%, Net Promotor Score was 90. Significantly worse QuickDASH scores were seen in patients that developed MCP joint arthrosis or had had subsequent ipsilateral hand injuries (median 39.7 vs 2.27; p = 0.002). All the patients employed at the time of surgery returned to work without long-term adaptations. Surgical repair of acute UCL injury generally provides an excellent long-term functional outcome and satisfaction rate. Complications are rare but where MCP joint arthrosis develops functional outcomes can be significantly worse.

The impact of socioeconomic deprivation on congenital hand differences: A retrospective cohort study.

Socioeconomic deprivation is an established risk factor for a range of adverse perinatal and infant outcomes. The primary aim of this study was to investigate any association between socioeconomic deprivation and the prevalence of Congenital Hand Differences (CHDs). This retrospective cross-sectional study was undertaken at a single tertiary referral center over a five year period (March 2015 to February 2020). The inclusion criterion was all patients referred for a review at a CHD clinic. As a measure of socioeconomic status, patients were assigned to a deprivation quintile using the Scottish Index of Multiple Deprivation (SIMD): quintile 1 indicates the most deprived area and quintile 5 indicates the least deprived area. CHDs were classified according to the Oberg-Manske-Tonkin (OMT) Classification. During the study period 259 patients were identified. The overall prevalence of CHD was 15 per 100,000 per year, mean referral age was 2.6 years (Standard Deviation: 4 years) and 135 patients (52%) were female. Areas of greater social deprivation had a significantly higher prevalence of CHD (22 per 100,000 per year in quintile 1 vs. 13 per 100,000 per year in quintile 5; p < 0.001), surgery (75% of patients in quintile 1 vs 43% of patients in quintile 5; p = 0.003), and younger referral age (1.5 years in quintile 1 vs 4.4 years in quintile 5; p = 0.003). This study has shown a greater CHD prevalence rate amongst patients from more socially deprived areas. In the most deprived group, the patient referral age was also significantly younger and surgical intervention rate was higher.

Glenoid track measurement using magnetic resonance imaging arthrography is predictive of recurrent instability following arthroscopic shoulder stabilisation.

PURPOSE: The primary aim of this study was to investigate medium-term survivorship following arthroscopic Bankart repair (ABR) for anterior glenohumeral instability. The secondary aim was to determine whether the pre-operative magnetic resonance (MR) arthrography glenoid track measurement predicted recurrent instability following ABR. METHODS: Over a 9-year period (2008-2017), 215 patients underwent ABR. Median age was 26 years (IQR 22-32.5; range 14-77). There were 173 males (81%). 175 patients (81%) had available pre-operative MR arthrography, which was used to determine the presence of "off-track" bone loss. Retrospective analysis was undertaken to determine recurrence of instability at a median follow-up of 76 months (range 21-125 months). Survivorship analysis was undertaken using Kaplan-Meier methodology: the endpoints examined were repeat dislocation, revision stabilisation, and symptomatic instability. RESULTS: 56 patients (26%) presented with further instability, including 29 patients with recurrent dislocation and 15 patients required revision stabilisation. Cumulative incidence of instability was 10% at 1 year, 27% at 5 years and 28% at 7 years. No significant difference in instability was seen between men and women 7 years after stabilisation (19% vs 17%; p = 0.87). Age at time of surgery did not predict recurrence. "Off-track" lesions were identified in 29 patients (16.1%). The incidence of redislocation was significantly higher in these patients (24% vs 3%; p = 0.01; relative risk 7.2; 95% CI 2.45-20.5; p = 0.001). Recurrent instability without frank redislocation was also significantly higher in this group (60% vs 18%; RR 3.33, 95% CI 2.02-5.20; p < 0.0001). CONCLUSIONS: This study has reported a significant rate of recurrent instability in longer-term follow-up after ABR. It has also identified pre-operative MR arthrography as an important predictor of recurrent instability, which may be used to risk stratify patients with anterior instability in a typical UK population. LEVEL OF EVIDENCE: III (cohort study).

Hand-arm vibration and outcomes of surgery for Dupuytren's contracture.

BACKGROUND: Dupuytren's contracture was recently designated a prescribed occupational disease when it occurs in patients with previous hand-arm vibration (HAV) exposure. AIMS: The aims of this study were to describe the impact of self-reported HAV exposure on upper limb function and satisfaction following surgery for Dupuytren's contracture. METHODS: Paired pre- and postoperative Quick version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) and patient satisfaction questionnaires were prospectively collected from all patients undergoing surgery for Dupuytren's contracture over a 6-year period. Patients self-reported HAV exposure duration. RESULTS: Results were available for 425 hands (65%) at mean 13 months postoperatively. There were 111 patients (26%) that reported HAV exposure. The prevalence of HAV exposure was significantly greater in male compared with female patients (32% versus 4%; P < 0.001). A statistically significant difference in preoperative (difference 7.47; 95% confidence interval 4.78-10.17; P < 0.001) and postoperative QuickDASH score (difference 6.78; 95% confidence interval 2.69-10.88; P < 0.001) was observed between the two groups, but difference in QuickDASH improvement was not significantly different (difference 1.76; 95% confidence interval -1.58 to 5.10; P > 0.05). No significant difference in satisfaction rate or return to work was observed between the two groups. CONCLUSIONS: Previous HAV exposure influenced the pre and postoperative function in patients undergoing surgery for Dupuytren's contracture, but had no effect on satisfaction or return to work. Further prospective research will be required to determine whether the introduction of a compensatory framework will have a more profound effect on the functional outcomes of surgery.

Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery.

The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range 17-62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. LEVEL OF EVIDENCE: Therapeutic level III (Retrospective Cohort Study).

Extensor indicis transfer improves function in patients after rupture of the extensor pollicis longus tendon.

The primary aim was to determine the improvement in patient-reported functional outcomes (PROMs) following extensor indicis proprius (EIP) transfer for a closed rupture of the extensor pollicis longus (EPL) tendon. Secondary aims were to analyze the impact of this procedure on health-related quality of life (HRQoL) and satisfaction. Preoperative and one-year postoperative PROMs were collected prospectively at a single institution over a two-year period (2014-2016). The primary outcome measure was the QuickDASH score. Patients also completed satisfaction scores, and the EQ-5D-5L score was used to evaluate HRQoL. Paired data was available for 12 patients (92%) at mean 19 months following surgery. A statistically-significant improvement in mean QuickDASH score was observed from 29.7 (SD: 21.7) preoperatively to 15.2 (SD: 16.4) postoperatively (p?=?0.05). Nine patients reported an improvement, one patient reported no change, and the remaining two reported deterioration in QuickDASH score. Median EQ-5D-5L improved significantly from 0.82 (IQR: 0.71 - 1.0) to 0.93 (0.77 to 1.0) postoperatively (p?

Comorbid status influences quality of life following carpal tunnel decompression.

The aim of this study was to characterize the change in health-related quality of life following carpal tunnel decompression. Pre- and postoperative Euroqol 5 Dimensions scores were collected prospectively over three years. Outcomes were available for 435 of 563 patients (77%); mean age was 62 years. Comorbid status was described using the Charlson Comorbidity Index. Change in Euroqol 5 Dimensions scores declined with increasing age and Charlson Comorbidity Index: the greatest improvement in quality of life occurred in the youngest group (+0.07 vs. -0.07 in the oldest group; p < 0.001) and patients with the lowest Comorbidity Index (+0.05 vs. -0.07 in the highest comorbidity group; p < 0.001). Charlson Comorbidity Index was an independent predictor of worse change in Euroqol 5 Dimensions scores on regression analysis. Carpal tunnel decompression results in significant improvement in health-related quality of life in younger patients with minimal comorbidities, but not in older patients with more comorbidities. We advise interpreting the Euroqol 5 Dimensions scores with caution in this patient cohort. LEVEL OF EVIDENCE: III (cohort study).

Occupation classification predicts return to work after carpal tunnel decompression.

BACKGROUND: The relationship between hand function, employment status and return to work (RTW) after carpal tunnel decompression (CTD) is unclear. AIMS: To investigate predictors of RTW following CTD. METHODS: We prospectively collected pre-operative and 1-year post-operative outcomes and RTW data for all patients undergoing CTD at one centre between 29 May 2014 and 29 May 2017. We used the Standard Occupation Classification 2010. RESULTS: Pre- and post-operative results were available for 469 (79%) of the 597 patients who had CTD surgery. Pre-operatively, 219 (47%) were employed, 216 (46%) were retired, 26 (6%) were not working due to long-term illness and eight (2%) were unemployed. Complete data sets were available for 178 (81%) of the 219 employed patients, of whom 161 (90%) were able to RTW. Of the rest, five (3%) had changed jobs and 12 (7%) were unable to work. Median RTW time was 4 weeks (interquartile range [IQR] 2-6 weeks). Significantly more patients undertaking manual labour were unable to RTW (15% versus 5%; P < 0.05). There was no significant difference in mean number of weeks absent between manual (5.7; 95% confidence interval [CI] 4.9-6.5) and non-manual workers (6.2; 95% CI 4.8-7.6) (P > 0.05). Median pre-operative (difference 15.9; 95% CI 4.5-25) and post-operative (difference 43.2; 95% CI 13.6-43.2) hand function scores were significantly worse in patients who did not RTW (P < 0.05). CONCLUSIONS: Most patients can RTW within 1 year of CTD. Failure to RTW is more likely in manual workers and patients with poorer pre-operative hand function.

Correction to: Tram system related cycling injuries.

The author would like to correct the errors in the publication of the original article. The corrected details are given below for your reading.

Tram system related cycling injuries.

INTRODUCTION: Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients' confidence cycling, together with time off work and cycling. METHODS: A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone. RESULTS: 191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001). CONCLUSIONS: TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.