COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

Concurrent carpal tunnel syndrome and pronator syndrome: A retrospective study of 21 cases.

PURPOSE: Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered and the proximal compression sites are easily overlooked. We retrospectively studied 21 concurrent cases in our series from 2009 to 2015 and report the results. PATIENTS AND METHODS: The typical symptoms were pain, tingling, and numbness of the radial 3½ digits. If paresthesia involved the thenar eminence and proximal forearm pain was noted in cases of carpal tunnel syndrome, carpal tunnel syndrome combined with pronator syndrome was considered. Additionally, nocturnal paresthesia symptoms are absent in pronator syndrome. Therefore, if nocturnal symptoms occurred in pronator syndrome, carpal tunnel syndrome was considered. We included concurrent carpal tunnel syndrome and pronator syndrome. We used arthroscopic release of the transverse carpal ligament and open decompression for the pronator teres in cases that underwent surgery for the first time. However, recurrent carpal tunnel cases were treated with the open carpal tunnel release and open pronator decompression procedure in our hospital. The two-point discrimination was used for evaluation of sensory deficit. The grip and pinch (thumb tip to index) strength were measured by dynamometry and pinch gauge respectively. RESULTS: We retrospectively reviewed 344 cases of sustained carpal tunnel syndrome or pronator syndrome from the medical records of our institution. Of the 344 cases, 322 involved carpal tunnel syndrome alone, 1 involved pronator syndrome alone, and 21 involved carpal tunnel syndrome combined with pronator syndrome. The 21 cases of carpal tunnel syndrome combined with pronator syndrome were included in our study. Among the total cases of carpal tunnel syndrome, 6% (21/343) had pronator syndrome. The patients included 3 men and 18 women with a mean age of 52 years (range: 42-69 years). Electromyography (EMG) and nerve conduction studies were routinely performed. Postoperative evaluation showed that 15 out of 21 patients (71%) were completely relieved of pain and paresthesia and had no sensory deficit, satisfied strength improved (>85% of the opposite hand). Six patients (29%) had occasional paresthesia and pain, but no sensory deficit; grip and pinch strength deficit were recorded (<50% of the opposite hand). Six cases of these partially relieved patients had recurrent carpal tunnel syndrome but no one needed to perform tendon transfer for thenar muscle atrophy. CONCLUSION: It is important to consider the diagnosis of double crush syndrome of the median nerve, as carpal tunnel syndrome combined with pronator syndrome may impede treatment of the carpal tunnel syndrome.

Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius.

Arthroscopy was used to help to reduce intra-articular fractures of the distal radius and treat soft tissue injuries in 33 acute cases. The fractures were treated by reduction under arthroscopic control and percutaneous fixation either with or without external fixation. The triangular fibrocartilage complex (TFCC) was torn in 18 of 33 patients (54%). All tears were peripheral and were repaired with arthroscopic procedures. Scapholunate (SL) ligament injuries prevailed in six (18%) patients; most of them exhibited instability in the SL joint. They received SL ligament debrided and transfixed with K-wires. Four (12%) of the patients suffered lunotriquetral (LT) ligament injuries; three of them also received transfixation with K-wires. Six (18%) of the patients exhibited chondral fractures. All fractures healed without measurable incongruity of joint surface and at follow-up (24 to 36 months), 11 patients displayed excellent results and 22 patients displayed good results according to the Mayo modified wrist score.

A modified Bristow procedure for recurrent anterior shoulder dislocation.

BACKGROUND: Dislocation of the shoulder is one of our earliest frequent injuries. Many procedures have been evaluated for treatment of the condition since the mid 1960s. The modified Bristow procedure was initially described in 1970 by May. Technically easy, the procedure is very effective in prevention of redislocation, and has gained popularity over two decades of use. METHODS: A retrospective study was done of 32 patients with recurrent anterior shoulder dislocation, who had received modified Bristow procedure during the years 1987 through 1991 in this Hospital. Average followup period was 26 months. RESULTS: At postoperative evaluation, average loss of external rotation and abduction as compared to the nonoperated side were 15 and 10 degrees, respectively. There was no limitation on daily activity, but some little restriction in extreme throwing sports was found. Postoperative complications included three patients who had bone block resorption and one patient who had superficial wound infection. There was no redislocation nor implant loosening in the study. CONCLUSIONS: This procedure is technically easy, had a low rate of complication, a high degree of patient satisfaction and very effectively prevents redislocation.

Bronchoprovocation test in the normal and in asthmatics.

The bronchoprovocation test has been widely used in diagnosis of bronchial asthma. Forty-eight cases under tentative diagnosis of bronchial asthma, with complaints of cough, shortness of breath, and wheezing, were studied by using histamine and methacholine. Their baseline pulmonary functions were all normal. Among the Fourteen cases, histamine and methacholine provocation tests were both negative in 14 cases (29%) (Group 1). There were 18 cases (37%) of allergic asthmatics with positive challenge to either histamine (2 cases) or methacholine (1 case) or both (15 cases) (Group 2). There were 16 cases (34%) of nonallergic asthmatics with positive challenge to either histamine (2 cases) or methacholine (3 cases) or both (11 cases) (Group 3). In Group 2, the average PD20 FEV1 for methacholine and histamine was 25.8 +/- 8.2 BU and 22.9 +/- 7.1 BU respectively; the average PD25 FEF25-75 for methacholine and histamine was 19.4 +/- 7.0 BU and 21.1 +/- 7.1 BU respectively. The sensitivities, compared between both agents, were nearly the same. In Group 3, the average PD20 FEV1 for methacholine and histamine was 35.1 +/- 9.0 BU and 54.5 +/- 9.6 BU respectively; the average PD25 FEF25-75 for methacholine and histamine was 27.9 +/- 8.6 BU and 50.2 +/- 9.6 BU respectively. Methacholine is more sensitive in detecting airway hyperreactivity in this group. When these two groups of asthmatics were compared, Group 2 patients were more sensitive to challenges with histamine and methacholine (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)