Impact of COVID-19 on the Work, Health, and Quality of Life of Brazilian Hand Surgeons.

BACKGROUND: To evaluate the impact of coronavirus disease 2019 (COVID-19) on the clinical practice, health, and quality of life of Brazilian hand surgeons when only essential services and emergency procedures were being provided. METHOD: A questionnaire of 50 questions was sent to members of the Brazilian Society of Hand Surgery addressing work and life routines before the pandemic and during the initial quarantine period from April to August 2020. RESULTS: Two hundred ten hand surgeons answered the questionnaire; 55.2% lived in the southeast region and worked in the capital and metropolitan regions, in both the private and public systems. Thirty-eight percent of the sample had other sources of income besides medicine, and due to a drop of 50% or more in the volume of consultations and surgeries, one-third had to apply for financial loans or access personal savings, and 69% made financial cuts in their domestic and life routines. More than 40% gained weight and stopped doing physical activities, while 20% lost weight and started physical activities. Approximately 30% were diagnosed with COVID-19, 92% of whom had mild symptoms and quarantined at home, and 89% had psychological symptoms such as anxiety, fear, insecurity, and insomnia. CONCLUSIONS: Coronavirus disease 2019 had a significant impact on the lives of Brazilian hand surgeons by drastically reducing the number of consultations and surgical procedures, generating not only financial difficulties but also changes in the exercise routine, changes in body weight, associated psychological symptoms, and changes in the family/life routine.

Trigger Finger or De Quervain Tenosynovitis after Surgical Treatment for Carpal Tunnel Syndrome.

Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography.

Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (∼12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We conclude that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

External Delta Fixator in the Postoperative Management of Microsurgical Flaps in the Lower Limb: Experience of a Tertiary Hospital.

Objective To evaluate the use of external fixators in the delta-type kickstand configuration as an adjuvant method in the postoperative period of patients submitted to free flaps in the lower limbs. Methods A total of 17 external delta fixators were used in patients submitted to free flaps in the lower limbs. The surgical technique was performed in a standardized manner, with the distal pin located 6 cm proximally to the anastomosis, and the proximal pin, 6 cm distally to the anterior tuberosity of the tibia. Results The mean age of the sample was of 34.76 years (range: 15 to 66 years). In total, 11 men and 6 women were selected. The posterior tibial artery was used in 14 cases, and the anterior tibial artery, in 3 cases. The mean time of use of the external fixators was of 3.88 weeks. The rate of reoperation was of 17.64%; that of retail loss was of 11.76%; that of success rate was of 88.23%; and the rate of infection was of 5.9%. Conclusion The use of delta-type fixators as an adjunct method in the postoperative period is reliable; however, more studies are needed to evaluate its true role in the postoperative period.

Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays.

Objectives The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis. Methods An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs. Results A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%). Conclusion Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.

Internal Fixation of Scaphoid Nonunion with Humpback Deformity Using Iliac Graft and Volar Plate: Series of Eight Cases.

Objectives The aim of the present article is a clinical and radiographic evaluation of scaphoid nonunion with humpback deformity using an iliac graft and a volar plate. Methods Eight patients were followed-up prospectively, all male, with a mean age of 39.6 years old, with scaphoid waist nonunion, with an average of 19 months of trauma without previous surgery. The patients were treated with a graft removed from the iliac crest and a 1.5 mm blocked volar scaphoid plate (Medarthis AG, Basel, Switzerland). The patients were followed-up with radiographic evaluations and computed tomography (CT) scans in the preoperative period and 1 month, 3 months, 6 months and 1 year after the operation. The carpal height and the scaphosemilunar and intrascaphoid angles were measured preoperatively, 3 months, and 1 year postoperatively. The function was assessed preoperatively and repeated 1 year postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-related Wrist Evaluation (PWRE scores), as well as by measurement of forceps clamp and wrist and thumb range of motion. Results All cases were consolidated, with an average time of 3.38 months. Two complications were observed: an infection of the iliac surgical wound and a plaque element placed in the scapholunate space. Two patients opted to remove the implant because they had a painful click at maximum wrist flexion. There was improvement in the parameters of wrist and thumb range of motion and pinch strength in all measurements, with statistical significance for the PRWE and the scapholunate angle. Conclusion Although our sample was small, we achieved consolidation in all cases; the complications were expected in the literature and there were improvements in the radiographic patterns, in the functional assessment, and in the pain scale of our patients.

Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups.

OBJECTIVES: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands. METHODS: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress. RESULTS: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process. CONCLUSION: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.

SPRING PLATES IN DISTAL RADIO FRACTURES: "IN VITRO" MECHANICAL PROPERTIES.

BACKGROUND: Distal radius fractures are one of the most common orthopedic injuries and appear in various patterns. Volar plate fixation is not always considered the gold standard treatment. OBJECTIVE: To measure the resistance of a fragment-specific fixation assembly model obtained by plate fixation associated with different K-wire sizes. METHOD: In this original experimental study, novel II, axial compression of bone materials was tested. RESULTS: In both groups, the maximum force supported by the fixation method in our study was ten times greater than the physiological load to which the wrist was subjected under physiological conditions. DISCUSSION: In this study, we obtained encouraging results when compared to results reported in the literature. Our study showed that our bone fixating system was mechanically adequate for articular fractures of the intermediate column of the radius (Melone classification). The results were similar or superior to the results of pressure resistance and stiffness when data from the literature was used as reference. CONCLUSION: The proposed fixation method demonstrated adequate resistance for fixation of the intermediate column of the distal radius. Increasing K wire size caused augmented resistance of the fixation. Level of Evidence II, Prospective comparative study.

INTRODUÇÃO: A fratura da extremidade distal do rádio é uma afecção frequente, com variedade de apresentações e nem sempre são passíveis de fixação volar única. OBJETIVO: Quantificar a resistência obtida no modelo experimental de fixação do fragmento específico, utilizando fio de Kirschner pré moldado, associado a fixação proximal com placa e parafuso. MÉTODOS: Estudo experimental original, nível II, no qual foram realizados ensaios mecânicos com objetivo de avaliar a resistência a compressão axial. RESULTADOS: Os valores de força máxima suportada pelo método de fixação foram pelo menos 10x maiores do que a carga fisiológica a qual o punho é submetido. DISCUSSÃO: A fixação do tipo fragmento específico vem se mostrando útil e segura, permitindo uma mobilidade precoce segura. Os resultados analisados demonstraram que a montagem proposta em nosso estudo foi mecanicamente adequada para a fixação das fraturas articulares da borda volar ulnar (classificação de Melone) do rádio, tendo resultados semelhantes ou superiores quando comparados a literatura, avaliando a rigidez e a pressão o qual o sistema foi submetido. CONCLUSÃO: O método de fixação proposto demonstrou resistência adequada para fixação das fraturas da coluna intermediária do rádio. O aumento da espessura do fio provocou um aumento da força resistida da montagem. Nível de Evidência II, Estudo prospectivo comparativo.

Trigger Finger or De Quervain Tenosynovitis after Surgical Treatment for Carpal Tunnel Syndrome / Dedo em gatilho ou tenossinovite de De Quervain após tratamento cirúrgico da síndrome do túnel do carpo

Abstract Objective To evaluate the open surgical treatment for carpal tunnel syndrome as a risk factor for the development of stenosing tenosynovitis that results in trigger finger and De Quervain disease. Materials and Methods A retrospective study analyzing the medical records of patients submitted to open surgical release of carpal tunnel syndrome between 2010 and 2021 in a secondary- and tertiary-level hospital. The following data were collected: pathological history, duration of the follow-up after the surgical treatment for carpal tunnel syndrome, development of trigger finger or De Quervain tenosynovitis, affected fingers, and the interval between the end of surgery and symptom onset. Results We evaluated 802 patients of both genders and with a mean age of 50.1 (±12.6) years. The mean follow-up was of 13 (±16.4) months. The mean time until the development of trigger finger was of 61.4 months, and of 73.7 months for De Quervain disease. The incidence of development of De Quervain disease was of 4.12%, and for trigger finger it was of 10.2%. The most affected digits were the thumb (47.6%), the middle (24.4%), and the ring finger (8.54%). Age was the only factor that showed an association with the risk of developing trigger finger, with an increase of 2% for each increase in age of 1 year. Conclusion The incidence rates for the development of De Quervain disease (4.12%) and trigger finger (10.2%) after the surgical treatment for carpal tunnel syndrome were like those described in the literature. Only age was a factor that influenced the development of trigger finger.

Resumo Objetivo Avaliar o tratamento cirúrgico aberto da síndrome do túnel do carpo como fator de risco para o desenvolvimento das tenossinovites estenosantes formadoras do dedo em gatilho e da doença de De Quervain. Materiais e Métodos Estudo retrospectivo com análise dos prontuários de pacientes submetidos a liberação cirúrgica aberta da síndrome do túnel do carpo entre 2010 e 2021 em hospital de níveis secundário e terciário. Os seguintes dados foram coletados: histórico patológico, tempo de acompanhamento após o tratamento cirúrgico da síndrome do túnel do carpo, desenvolvimento de dedo em gatilho ou tenossinovite de De Quervain, dedos acometidos, e tempo decorrido entre o fim da cirurgia e o aparecimento dos sintomas. Resultados Foram avaliados 802 pacientes de ambos os sexos com média de idade de 50,1 (±12,6) anos. O tempo médio de seguimento foi de 13 (±16,4) meses. O tempo médio de desenvolvimento de dedo em gatilho foi de 61,4 meses, e o da doença de De Quervain, de 73,7 meses. A incidência de desenvolvimento da doença de De Quervain foi de 4,12% e a de dedo em gatilho, de 10,2%. Os dedos mais acometidos foram o polegar (47,6%), o médio (24,4%) e o anular (8,54%). A idade foi único fator que demonstrou associação com o risco de desenvolvimento de dedo em gatilho, com aumento de 2% a cada ano a mais de idade. Conclusão As taxas de incidência de desenvolvimento de doença de De Quervain (4,12%) e de dedo em gatilho (10,2%) após tratamento cirúrgico da síndrome do túnel do carpo foram semelhantes às descritas na literatura. Apenas a idade se apresentou como fator influenciador no desenvolvimento de dedo em gatilho.

Evaluations of Repaired Artery Patency in Forearm Wounds Using the Allen Test, Handheld Doppler and Doppler Ultrasonography / Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

Abstract Objective The purpose of the present study was to evaluate the rate of patency in the postoperative period of arterial injuries of the forearm secondary to penetrating trauma. The injuries were subjected to primary repair and examined with the Allen test and a handheld Doppler device, and the results were later confirmed with Doppler ultrasonography. Methods Eighteen patients were included, with a total of 19 arterial lesions, 14 ulnar lesions, and 5 radial lesions; one patient had lesions on both forearms. All patients underwent surgery and three clinical evaluations: the Allen test and assessment of arterial blood flow by a handheld Doppler device at 4 and 16 weeks after surgery and Doppler ultrasonography performed at 12 weeks after surgery. Results At the first clinical evaluation, 77% of the patients had patency based on the Allen test, and 72% had a pulsatile sound identified by the handheld Doppler device. In the second evaluation, 61% of the patients had patency based on the Allen test, and the rate of pulsatile sound by the handheld Doppler device was 72%, similar to that observed 2 months earlier. Based on the Doppler ultrasonography evaluation (~12 weeks after surgery), the success rate for arteriorrhaphy was 88%. Regarding the final patency (Doppler ultrasonography evaluation) and trauma mechanism, all patients with penetrating trauma had patent arteries. Conclusion We cde that clinical evaluation using a handheld Doppler device and the Allen test is reliable when a patent artery can be palpated. However, if a patent artery cannot be located during a clinical examination, ultrasonography may be required.

Resumo Objetivo O objetivo deste estudo foi avaliar a taxa de perviedade pós-operatória de lesões arteriais do antebraço secundárias a traumatismo penetrante. As lesões foram submetidas a reparo primário e examinadas com o teste de Allen e um dispositivo Doppler portátil; posteriormente, os resultados foram confirmados à ultrassonografia com Doppler. Métodos Dezoito pacientes foram incluídos, com um total de 19 lesões arteriais, 14 lesões ulnares e 5 lesões radiais; um paciente tinha lesões em ambos os antebraços. Todos os pacientes foram submetidos à cirurgia e três avaliações clínicas: o teste de Allen e a avaliação do fluxo sanguíneo arterial com um dispositivo portátil de Doppler na 4ª e 16ª semanas após a cirurgia e ultrassonografia com Doppler 12 semanas após o procedimento. Resultados Na primeira avaliação clínica, 77% dos pacientes apresentavam perviedade segundo o teste de Allen e 72% apresentavam som pulsátil identificado pelo Doppler portátil. Na segunda avaliação, 61% dos pacientes apresentaram perviedade com base no teste de Allen e a taxa de som pulsátil ao Doppler portátil foi de 72%, semelhante à observada 2 meses antes. À ultrassonografia com Doppler (cerca de 12 semanas após a cirurgia), a taxa de sucesso da arteriorrafia foi de 88%. Em relação à perviedade final (avaliação por ultrassonografia com Doppler) e mecanismo de trauma, todos os pacientes com traumatismo penetrante apresentavam artérias pérvias. Conclusão Concluímos que a avaliação clínica com um dispositivo Doppler portátil e o teste de Allen é confiável caso a artéria pérvia possa ser palpada. No entanto, a ultrassonografia pode ser necessária em caso de impossibilidade de localização de uma artéria pérvia durante o exame clínico.

External Delta Fixator in the Postoperative Management of Microsurgical Flaps in the Lower Limb: Experience of a Tertiary Hospital / Fixador externo tipo delta no manejo pós-operatório de retalhos microcirúrgicos no membro inferior: Experiência de um hospital terciário

Abstract Objective To evaluate the use of external fixators in the delta-type kickstand configuration as an adjuvant method in the postoperative period of patients submitted to free flaps in the lower limbs. Methods A total of 17 external delta fixators were used in patients submitted to free flaps in the lower limbs. The surgical technique was performed in a standardized manner, with the distal pin located 6 cm proximally to the anastomosis, and the proximal pin, 6 cm distally to the anterior tuberosity of the tibia. Results The mean age of the sample was of 34.76 years (range: 15 to 66 years). In total, 11 men and 6 women were selected. The posterior tibial artery was used in 14 cases, and the anterior tibial artery, in 3 cases. The mean time of use of the external fixators was of 3.88 weeks. The rate of reoperation was of 17.64%; that of retail loss was of 11.76%; that of success rate was of 88.23%; and the rate of infection was of 5.9%. Conclusion The use of delta-type fixators as an adjunct method in the postoperative period is reliable; however, more studies are needed to evaluate its true role in the postoperative period.

Resumo Objetivo Avaliar o uso de fixadores externos, na configuração kickstand do tipo delta, como método adjuvante no período pós-operatório de pacientes submetidos a retalhos livres nos membros inferiores. Métodos Ao todo, 17 fixadores externos do tipo delta foram utilizados em pacientes submetidos a retalhos livres nos membros inferiores. A técnica cirúrgica foi realizada de forma padronizada, com o pino distal localizado 6 cm proximal à anastomose, e o pino proximal, 6cm distal à tuberosidade anterior da tíbia. Resultados A idade média da amostra foi de 34,76 anos (variação: 15 a 66 anos). Foram selecionados 11 homens e 6 mulheres. Utilizou-se a artéria tibial posterior em 14 casos, e a tibial anterior, em 3 casos. O tempo médio de uso dos fixadores externos foi de 3,88 semanas. A taxa de reoperação foi de 17,64%; a de perda do retalho foi de 11,76%; a de sucesso foi de 88,23%; e a taxa de infecção foi de 5,9%. Conclusão O uso de fixadores do tipo delta como método adjuvante no pós-operatório é confiável; porém, mais estudos são necessários para avaliar seu verdadeiro papel no pós-operatório.

Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups

OBJECTIVES: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands. METHODS: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress. RESULTS: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process. CONCLUSION: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.

Spring plates in distal radio fractures: "in vitro" mechanical properties / Placa mola nas fraturas distais do radio - propriedades mecânicas "in vitro"

ABSTRACT Background: Distal radius fractures are one of the most common orthopedic injuries and appear in various patterns. Volar plate fixation is not always considered the gold standard treatment. Objective: To measure the resistance of a fragment-specific fixation assembly model obtained by plate fixation associated with different K-wire sizes. Method: In this original experimental study, novel II, axial compression of bone materials was tested. Results: In both groups, the maximum force supported by the fixation method in our study was ten times greater than the physiological load to which the wrist was subjected under physiological conditions. Discussion: In this study, we obtained encouraging results when compared to results reported in the literature. Our study showed that our bone fixating system was mechanically adequate for articular fractures of the intermediate column of the radius (Melone classification). The results were similar or superior to the results of pressure resistance and stiffness when data from the literature was used as reference. Conclusion: The proposed fixation method demonstrated adequate resistance for fixation of the intermediate column of the distal radius. Increasing K wire size caused augmented resistance of the fixation. Level of Evidence II, Prospective comparative study.

RESUMO Introdução: A fratura da extremidade distal do rádio é uma afecção frequente, com variedade de apresentações e nem sempre são passíveis de fixação volar única. Objetivo: Quantificar a resistência obtida no modelo experimental de fixação do fragmento específico, utilizando fio de Kirschner pré moldado, associado a fixação proximal com placa e parafuso. Métodos: Estudo experimental original, nível II, no qual foram realizados ensaios mecânicos com objetivo de avaliar a resistência a compressão axial. Resultados: Os valores de força máxima suportada pelo método de fixação foram pelo menos 10x maiores do que a carga fisiológica a qual o punho é submetido. Discussão: A fixação do tipo fragmento específico vem se mostrando útil e segura, permitindo uma mobilidade precoce segura. Os resultados analisados demonstraram que a montagem proposta em nosso estudo foi mecanicamente adequada para a fixação das fraturas articulares da borda volar ulnar (classificação de Melone) do rádio, tendo resultados semelhantes ou superiores quando comparados a literatura, avaliando a rigidez e a pressão o qual o sistema foi submetido. Conclusão: O método de fixação proposto demonstrou resistência adequada para fixação das fraturas da coluna intermediária do rádio. O aumento da espessura do fio provocou um aumento da força resistida da montagem. Nível de Evidência II, Estudo prospectivo comparativo.