Relationship between median nerve vascularization before tourniquet release and the Boston Carpal Tunnel Questionnaire: a cohort study.

The results of this study suggest that a decreased vascularization of the median nerve after releasing the carpal tunnel predicts an inferior clinical improvement assessed by the Boston Carpal Tunnel Questionnaire.

National validation of the nursing Intensive-Care satisfaction scale: Research protocol.

AIM: Validate the Nursing Intensive-Care Satisfaction Scale in ICUs throughout Spain. Identify the improvement strategies recommended by the patients and professionals. DESIGN: Quantitative psychometric methodology and a cross-sectional descriptive correlational design. METHODS: The study population will be all patients discharged from 19 participating ICUs in Spain. Consecutive sampling (n = 564). Once discharged from the ICUs, they will receive the questionnaire and then, after 48 hours it will be given to them again to analyse the temporal stability. To validate the questionnaire, the internal consistency (Cronbach's Alpha) and temporal stability (test-retest) will be analysed. RESULTS: Improve the quality of nursing care by modifying, changing or strengthening behaviours, skills, attitudes or areas for improvement involved in the process.

Psychometric properties of the Nursing Intensive Care Satisfaction Scale: A multicentre cross-sectional study.

BACKGROUND: Patient satisfaction with nursing care is an indicator of patient satisfaction with the hospital stay in general. The Nursing Intensive Care Satisfaction Scale is the only scale about patient satisfaction with nursing care received in an intensive care unit that incorporates the critically ill patient's perspective into its design and validation. We validated the scale nationally, incorporating intensive care units at public and private hospitals of different levels of complexity in Spain. OBJECTIVES: The objective of this study was to validate in Spanish intensive care units the Nursing Intensive Care Satisfaction Scale, a patient-centred questionnaire that evaluates recently discharged intensive care patients' satisfaction with the nursing care they received. DESIGN: We used a psychometric quantitative methodology and a descriptive cross-sectional design. SETTING AND PARTICIPANTS: The study was conducted in intensive care units at level II and III public and private hospitals throughout Spain. The study population was all patients discharged from intensive care units from December 2018 to December 2019 from the 19 participating hospitals. We used consecutive sampling until reaching a sample size of 677 patients. The assessment instruments were given to patients at discharge and 48 h later to measure temporal stability. METHODS: The validation process included the analysis of internal consistency (Cronbach's α coefficient), temporal stability (test-retest), construct validity through a confirmatory factor analysis, and criterion validity using the Pearson correlation coefficient and three criterion items that assessed similar constructs. RESULTS: The reliability of the scale was 0.97, and the factors obtained values between 0.87 and 0.96. The intraclass correlation coefficient for the total scale was 0.83, indicating good temporal stability. Construct validity showed a good fit and a four-factor structure, in accordance with the theoretical model. Criterion validity presented a correlation that was between moderate and high (range: 0.46 to 0.57). CONCLUSIONS: The Nursing Intensive Care Satisfaction Scale has good psychometric properties, demonstrating its ability to accurately measure patient satisfaction across a range of contexts in Spain. Continuous monitoring of satisfaction will allow nurses to identify areas for improvement that can increase the quality of care.

Satisfaction of intensive care unit patients linked to clinical and organisational factors: A cross-sectional multicentre study.

BACKGROUND: The satisfaction of critical care patients with the nursing care they receive is a key indicator of the quality of hospital care. OBJECTIVES: The objectives of this study were to analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and sociodemographic, clinical, and organisational variables. DESIGN: This was a prospective, descriptive correlational study. SETTING AND METHODS: The population consisted of all patients discharged from the intensive care units (ICUs) of 19 hospitals in Spain between December 2018 and December 2019. The level of satisfaction was measured using the validated Nursing Intensive Care Satisfaction Scale, and sociodemographic, clinical, and organisational data were collected. RESULTS: Participants' mean age (n = 677) was 59.7 (standard deviation: 16.1), and 62.8% of them were men (n = 426). Satisfaction with the nursing care received was 5.66 (SD: 0.68) out of a possible 6. The score for overall satisfaction presented statistically significant relationships with the hours of mechanical ventilation (p = 0.034), with the participant's perception of own health status (p = 0.01), with the participant's perceived degree of own recovery (p = 0.01), with the hospital's complexity level (p = 0.002), with the type of hospital (p = 0.005), and with the type of ICU (p = 0.004). Finally, the logistic regression model shows that the Nursing Intensive Care Satisfaction Scale score was not linked to age or sex but did have a statistically significant relationship with the perceived degree of recovery (p < 0.001) and the type of ICU (p=<0.001). The variables that predicted satisfaction were age, degree of recovery, and the type of ICU. CONCLUSION: Several studies show that patient satisfaction is related to the patient's perceived health status and perceived degree of recovery, a finding that is confirmed in our study. Our study moves beyond these outcomes to show that the hours of mechanical ventilation and the characteristics of the hospital also have a significant relationship with patients' satisfaction.

Hand Deformities in Hajdu-Cheney Syndrome: A Case Series of 3 Patients Across 3 Consecutive Generations.

Hajdu-Cheney syndrome is a rare condition characterized by acro-osteolysis, osteoporosis, and multiple craniofacial anomalies. The goal of treatment is to reduce the associated symptoms and to prevent osteoporotic fractures. This is a report of 3 patients across consecutive generations demonstrating variable phenotypic severity. The hand surgeon was the first medical care provider visited by the patients because of the shortening of the fingers.

A randomized controlled trial of dorsal web space versus palmar midline injection of steroid in the treatment of trigger digits.

One hundred and sixty patients were enrolled in a prospective randomized controlled trial to assess whether a steroid injection through the dorsal web space was less painful than the palmar midline technique in the treatment of trigger digits and whether they were equally effective. There were 116 women and 44 men with a mean age of 60 years. The mean visual analogue score for pain during the injection was 3.6 in the dorsal web space group and 5.4 in the palmar midline group on a scale of 0-10. The overall success of treatment in the dorsal group was 67%, whereas it was 56% in the palmar group. No complications were noted. We concluded from this study that the dorsal web space technique is less painful and at least as effective as the palmar midline technique.Level of evidence: I.

Nonoperative Treatment of Ulnar Carpometacarpal Fracture-Dislocations.

Background Ulnar carpometacarpal (CMC) joint dislocations and fracture-dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description This is a series of eight ulnar CMC joint dislocations and fracture-dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture-dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

Denervation for Proximal Interphalangeal Joint Osteoarthritis.

PURPOSE: To assess the clinical and functional outcomes of proximal interphalangeal (PIP) joint denervation using a volar approach in the treatment of PIP joint osteoarthritis. METHODS: We retrospectively reviewed 11 cases treated from June 2007 to June 2016. The patients were identified and outcomes collected through a single institution's registry, collecting demographic data, comorbidities, preoperative and postoperative visual analog scale (VAS) for pain, and Disorders of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: The ring finger was the most commonly treated. The VAS for pain improved from 7.8 to 1.4, and the DASH questionnaire improved from 43.6 to 8.7. The PIP joint active range of motion also improved from 52° to 79°. Two patients reported postoperative digital paresthesia that resolved spontaneously. There were no major complications. CONCLUSIONS: Proximal interphalangeal joint denervation is a safe technique. It achieves good clinical results and, in case of failure, a more traditional and aggressive operation remains possible. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Bilateral Nonsynchronous Pacinian Corpuscle Neuroma.

Pacinian corpuscles are rapidly adapting mechanoreceptors distributed in the dermis of the fingers and palm of the hand. A neuroma of the pacinian corpuscle is rare and extremely painful, with only a few cases reported in the literature. A 71-year-old man with pain and swelling on his left index finger, initially diagnosed as tenosynovitis resistant to nonsurgical treatment, was referred to our center. During surgery, a cluster of spherical, gray lesions close to the digital nerve was found and excised. The pathological diagnosis was neuroma of the pacinian corpuscles. Two years later, he reported the same clinical findings on his right index finger with no improvement after nonsurgical treatment. During surgery, the same lesions were found and also identified as pacinian corpuscle neuromas.

The reverse Sauvé-Kapandji procedure for the treatment of (posttraumatic) proximal radioulnar synostosis.

Proximal radioulnar synostosis is a rare but highly disabling posttraumatic complication in periarticular elbow injuries. Surgical treatment is an option for functionally limiting proximal radioulnar synostosis; however, the approach can endanger local neurovascular structures, especially if the synostosis affects the level of the bicipital tuberosity. We report two cases of proximal radioulnar synostosis with a preoperative prono-supination range of motion of 0° and 15° treated by a reverse Sauvé-Kapandji procedure resecting a 1-cm section of the radial shaft distal to the bicipital tuberosity and leaving the synostosis in place. An improvement in prono-supination arc of motion of 82.5° was achieved at 2 years of follow-up with no complications associated with the technique. The reverse Sauvé-Kapandji procedure could be an option in the treatment of proximal radioulnar synostosis in selected cases.

The scratch collapse test in the diagnosis of compression of the median nerve in the proximal forearm.

Our purpose was to review the clinical usefulness of the scratch collapse test (SCT) in the diagnosis of proximal entrapment of the median nerve in the forearm. Eighteen consecutive cases were reviewed. The diagnosis was based on the patient's symptoms and signs. The SCT was positive in the affected forearm in all clinical assessments before surgery and it was negative in all after median nerve release. An anatomical reason for nerve compression was identified in all cases at operation. The SCT is a useful tool for the diagnosis of the proximal entrapment of the median nerve. LEVEL OF EVIDENCE: IV.

Combined Perihamate Peripisiform and Peritrapezium Open Axial Carpal Dislocation: Description of a New Pattern of Crush Injury.

BACKGROUND: Axial carpal dislocations and fracture-dislocations remain difficult to understand and to treat. The outcome is directly related to the injury pattern and long-term results are not good in most cases. METHODS: 39-year-old male admitted to our emergency department after his left hand was caught between 2 rollers for 10 minutes. He was diagnosed of an open axial carpal dislocation type B (perihamate peripisiform) and type E (peritrapezium) of Garcia-Elias. An extensive debridement, reduction of the carpometacarpal dislocations and stabilization with Kirschner wires was performed requiring a full thickness skin graft 14 days after the trauma. RESULTS: At 4-year follow-up, he had 70° of wrist extension, and 78° of wrist flexion, grip strength of 65% compared to the healthy side and x-ray showed mild signs of osteoarthritis. He was satisfied and returned to the same job. CONCLUSIONS: Axial carpal dislocations continue to be difficult injuries to address but also to classify. Since the prognosis depends on the injury pattern and other associated lesions, we believe that adding a type G which include the association of different patterns to the classification of Garcia-Elias could be useful not in changing the treatment but probably indicating a worse prognosis.

Dorsal Fracture-Dislocation of the Tarsal NavicularCase Report and Review of a Rare Injury.

Fracture-dislocations of the tarsal navicular are rare and highly complex injuries to the midfoot. The only published data on this type of fracture are clinical case reports. These injuries are normally caused by high-energy trauma, and their pathophysiology and most appropriate treatment remain unclear. We report a clinical case of a dorsal fracture-dislocation of the tarsal navicular bone associated with a medial swivel dislocation of the Chopart joint caused by a bicycle fall in a 20-year-old healthy man. Open reduction and percutaneous pinning in a novel arrangement was performed, with an excellent outcome 18 months after the injury.

Pacinian Corpuscles Neuroma. An Exceptional Cause of Pain in the Hand.

Pacinian corpuscles are rapidly adapting mechanoreceptors mainly distributed in the dermis of the fingers and palm of the hand. A neuroma of the Pacinian corpuscle is a rare and extremely painful condition with a few cases reported in the literature, most of them, associated with local or repetitive trauma. We present a 71-year-old man with history of pain and swelling on his left index without history of previous trauma initially diagnosed as tenosynovitis resistant to conservative treatment in which we observed, directly in the subcutaneous plane, spherical, gray and in clusters lesions closer to the collateral nerve which were described by the pathological study as neuroma of the Pacinian corpuscles.

The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases.

PURPOSE: To study the time to wound healing and recurrence rate achieved in the treatment of distal interphalangeal joint mucous cysts using the Zitelli modified bilobed flap. METHODS: We surgically treated 33 patients from January 2006 to June 2015. We assessed demographic data, comorbidities, location and size of the cyst, time to wound healing, and complications. RESULTS: The most affected finger was the right middle finger. All flaps survived and wounds healed in 14 days on average. The mucous cyst recurred in 1 of 33 cases. There were no major complications. CONCLUSIONS: The Zitelli bilobed flap can provide good-quality skin coverage over the distal interphalangeal joint in a short period. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Biceps to Triceps Transfer in Tetraplegic Patients: Our Experience and Review of the Literature.

Background: Management and indications for surgery in the tetraplegic patient are highly complex because of the substantial functional deficits that they present and their effect on their daily activity. Our purpose was to evaluate the functional outcome in tetraplegic patients who underwent biceps-to-triceps transfer surgery according to Zancolli's modified technique. Methods: This is a retrospective study of 6 biceps-to-triceps transfers using Zancolli's modified technique in 4 patients. Mean follow-up was 45 months. We evaluated each patient's DASH (Disabilities of the Arm, Shoulder and Hand) score before surgery and 12 months later. Results: In the 6 arms that underwent surgery, full and active elbow extension against gravity at 12 months after surgery was achieved. The mean DASH score was 73.2 preoperatively and 20.8 twelve months postoperatively. One complication occurred. One patient reported loss of elbow flexion preventing thigh lift for transfers. This was resolved with a program of rehabilitation and specific muscle strengthening Conclusions: Zancolli's modified technique is simple and effective, with few complications, whereby we can provide more autonomy for the tetraplegic patient.

Técnica de Bristow-Latarjet en la inestabilidad glenohumeral anterior / Bristow-Latarjet technique in the treatment of anterior shoulder instability

Objetivo: Analizar los resultados obtenidos a mediano plazo en los pacientes operados con la técnica de Bristow-Latarjet, según el valor del ISIS preoperatorio. Materiales y Métodos: Estudio retrospectivo de 33 pacientes intervenidos entre 2005 y 2012; media de la edad: 33 años (rango 21-68); media del seguimiento 6 años (rango 2-9). Se recogieron los resultados de las escalas de Rowe y Constant, el cuestionario DASH y una encuesta de valoración subjetiva del resultado por parte de cada paciente. Resultados: No hubo recidivas. Los puntajes medios posoperatorios fueron 74,6 (rango 15-100)en la escala de Rowe y 70 (rango 32-98) en la escala de Constant. En el cuestionario DASH, el valor promedio fue 22,9 (rango 0-73). El 79% de los pacientes se mostraron satisfechos con el resultado. En un paciente, se produjo la migración del tornillo, sin síntomas. No se identificaron otras complicaciones. Conclusiones: Consideramos, como está reflejado en la literatura, que la técnica de Bristow-Latarjet para tratar la inestabilidad glenohumeral anterior es una técnica fiable, y con una tasa de recidivas baja, por lo que debe emplearse como cirugía deelección en determinados casos. Para ello, creemos que la valoración preoperatoria con la escala ISIS es una buena guía a la hora de indicar el tipo de cirugía.

Objective: To analyze medium-term results in patients who underwent an open Bristow-Latarjet surgery considering the preoperative ISIS value. Methods: Retrospective study of 33 patients operated on between 2005 and 2012; average age: 33 years (range 21-68), median follow-up: 6 years (range 2-9). Results from Rowe and Constant scores, DASH questionnaire were registered and a subjective assessment of the result by each patient was also used. Results: No recurrence was reported. Mean Rowe score was 74.6 (range 15-100) and mean Constant score was 70 (range 32-98). The DASH questionnaire showed a mean value of 22.9 (range 0-73). Seventy-nine percent of patients were satisfied with the results. The migration of a screw occurred in one patient. There were no complications. Conclusions: We believe that Bristow-Latarjet technique is a reliableoption, with few complications and a low recurrence rate to treat chronic shoulder instability as reported in literature. Therefore, we believe that it should be used as primary surgery in some cases and the preoperative ISIS scale is an excellent and simple guide to correctly select the surgical technique for each patient.