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.

Total Wrist Arthrodesis: A Preoperative Test to Predict Functional Outcomes.

Objective The study aims to demonstrate an evaluation method to predict the functional success of total wrist arthrodesis (TWA) and assist its indication. Methods A prospective study including ten patients submitted to (TWA) posttraumatic arthritis. Exclusion criteria were patients who lost postoperative follow-up or incomplete information in the medical record. The objective functional assessment (handgrip strength, three-point pinch, lateral pinch and pulp-pulp pinch) and the subjective functional assessment (DASH, PRWE, EVA) were evaluated in 3 different periods: (1) Before surgery without articular anesthesia, (2) Before surgery under articular anesthesia and (3) 12 weeks after the surgical procedure. Results There was an increase in handgrip strength in all three pinches measurements after pain relief, both after joint anesthesia and after the consolidation of the arthrodesis (p < 0.05). In the comparisons between the subjective evaluations (DASH, PRWE and VAS), the patients had better scores in the postoperative evaluation after 12 weeks (p < 0.05). There was no statistical difference when comparing the mean strength values found after anesthesia and after 12 weeks of TWA. Conclusion the outcomes could propose an assessment protocol for patients with indication for TWA, in which patients with good response to intra-articular anesthetic infiltration would benefit from the effects of the surgical procedure.

Evaluation of the COVID-19 Infection Rate in the Perioperative Period of Elective Surgeries of the Hand and Microsurgery.

BACKGROUND: After the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease 2019 [COVID-19]), the world started reducing the number of elective surgeries to reduce the transmission of the coronavirus. Some priority elective surgeries were performed, and there was no increase in contagion rates due to safety protocols and protection measures. The study aims to present the coronavirus infection rate of elective hand surgeries and microsurgery performed during pandemics. METHODS: A retrospective study evaluating 188 patients submitted to elective surgical procedures. The exclusion criteria were patients infected by COVID-19 before the surgery and patients who submitted to trauma surgery. Only 108 patients were eligible for this study. The mean age was 47.8 years (range: 15 days-81 years). There were 63 females and 45 males. They were divided into 2 groups: outpatient (n = 49) and inpatient (n = 59) procedures. RESULTS: The overall COVID infection rate was 6.48%. The outpatient infection rate was 2.08%, whereas the inpatient infection rate was 10.17% (Student t test: P = .089). The main factor correlated with infection in the postoperative period was the number of postoperative outpatient visits (Student t test: P = .089). No statistical differences were observed between the variables studied, but there was a tendency for patients who submitted to inpatient surgery to get infected by COVID-19 (P = .089). The statistical power was 0.8 (Cohen's d test), showing that large samples are needed to analyze the correlation better. CONCLUSION: We concluded that the safety of performing elective hand surgery during the pandemic remains unclear, and more studies with larger samples are needed.

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.

Total Wrist Arthrodesis: A Preoperative Test to Predict Functional Outcomes / Artrodese total do punho: Um teste pré-operatório para prever resultados funcionais

Abstract Objective The study aims to demonstrate an evaluation method to predict the functional success of total wrist arthrodesis (TWA) and assist its indication. Methods A prospective study including ten patients submitted to (TWA) posttraumatic arthritis. Exclusion criteria were patients who lost postoperative follow-up or incomplete information in the medical record. The objective functional assessment (handgrip strength, three-point pinch, lateral pinch and pulp-pulp pinch) and the subjective functional assessment (DASH, PRWE, EVA) were evaluated in 3 different periods: (1) Before surgery without articular anesthesia, (2) Before surgery under articular anesthesia and (3) 12 weeks after the surgical procedure. Results There was an increase in handgrip strength in all three pinches measurements after pain relief, both after joint anesthesia and after the consolidation of the arthrodesis (p < 0.05). In the comparisons between the subjective evaluations (DASH, PRWE and VAS), the patients had better scores in the postoperative evaluation after 12 weeks (p < 0.05). There was no statistical difference when comparing the mean strength values found after anesthesia and after 12 weeks of TWA. Conclusion the outcomes could propose an assessment protocol for patients with indication for TWA, in which patients with good response to intra-articular anesthetic infiltration would benefit from the effects of the surgical procedure.

Resumo Objetivo O estudo tem como objetivo demonstrar um método de avaliação para predizer o sucesso funcional da artrodese total do punho (ATP) e auxiliar na sua indicação. Métodos Um estudo prospectivo incluindo dez pacientes submetidos a ATP por artrite pós-traumática. Os critérios de exclusão foram pacientes que perderam o acompanhamento pós-operatório ou informações incompletas no prontuário. A avaliação funcional objetiva (força de preensão manual, pinça de três pontos, pinça lateral e pinça polpa-a-polpa) e a avaliação funcional subjetiva (DASH, PRWE, EVA) foram avaliadas em 3 momentos diferentes: (1) Antes da cirurgia sem anestesia articular, (2) Antes da cirurgia sob anestesia articular e (3) 12 semanas após o procedimento cirúrgico. Resultados Houve aumento da força de preensão palmar nas três medidas de pinça após o alívio da dor, tanto após a anestesia articular quanto após a consolidação da artrodese (p < 0,05). Nas comparações entre as avaliações subjetivas (DASH, PRWE e VAS), os pacientes tiveram melhores escores na avaliação pós-operatória após 12 semanas (p < 0,05). Não houve diferença estatística ao comparar os valores médios de força encontrados após a anestesia e após 12 semanas de ATP.

In vivo standardization of bone ultrasonometry of the clavicle.

OBJECTIVE: The assessment of fracture union includes physical examination and radiographic imaging, which depend on the examiner's experience. The development of ancillary methods may avoid prolonged treatments and the improper removal of implants. Quantitative bone ultrasonometry has been studied for this purpose and will soon be included in clinical practice. The aims of the present study were to assess the feasibility of using this technique on the clavicle and to standardize its in vivo application. METHODS: Twenty adult volunteers, including 10 men and 10 women without medical conditions or a previous history of clavicle fracture, underwent axial quantitative ultrasonometric assessment using transducers in various positions (different distances between the transducers and different angulations relative to the clavicle). RESULTS: Similar values of wave propagation velocity were obtained in the different tested set-ups, which included distinct distances between the transducers and angular positions relative to the clavicle. There were significant differences only in the transducers positioned at 0° and at 5 or 7 cm apart. CONCLUSIONS: The use of bone ultrasonometry on the clavicle is feasible and the standardization of the technique proposed in this study (transducers placed at 45° and at 7 cm apart) will allow its future application in clinical trials to evaluate the healing process of diaphyseal fractures of the clavicle.

Functional outcomes of proximal row carpectomy: 2-year follow-up.

OBJECTIVE: : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis. METHODS: : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique. RESULTS: : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patients. CONCLUSION: : Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.

Influence of the osteosynthesis plate on ultrasound propagation in the bone.

OBJECTIVE: To analyze the influence of steel plates for osteosynthesis on the velocity of ultrasound propagation (VU) through the bone. METHODS: The transverse coronal and sagittal velocity of ultrasound propagation underwater were measured on the intact bone and then on assemblies of the same bone with two types of osteosynthesis plates (DCP and semi tubular), fixed onto the dorsal side of the bones. The first arriving signal (FAS) was the ultrasound parameter used, taking the coronal and sagittal diameters as the distances to calculate velocity. Intergroup statistical comparisons were made at significance level of 1% (p<0.01). RESULTS: Velocity was higher on the intact bones than on the bone-plate assemblies and higher for the semitubular than for the compression plates, although differences were not statistically significant for most comparisons (p=0.0132 to 0.9884), indicating that the steel plates do not interfere significantly with ultrasound wave propagation through the bone-plate assemblies. CONCLUSION: The velocity reduction effect was attributed to the greater reflection coefficient of the steel as compared to that of bone and water. Ultrasonometry can, thus, be used in the evaluation of healing of fractures fixed with steel plates. Experimental Study.

Congenital syndactyly: case by case analysis of 47 patients.

OBJECTIVE: To assess and report clinical data from patients with syndactyly. METHODS: A retrospective review of 47 patients treated between April 2002 and April 2012. RESULTS: Among the 47 analyzed patients, 33 (70%) were male and 14 (30%) female. The total number of syndactylies was 116. The right hand was affected in 19 patients (40%), the left hand in 12 (24%) and 31 (36%) were bilaterally compromise. Sixteen patients (34%) also presented genetic syndromes. Among the 31 (66%) patients without syndromes, 12 (39%) had isolated syndactyly and 19 (61%) presented association with other hand anomalies. The third web space was affected 45 (39%) times; the fourth, 35 (30%) times; the second, 22 (19%) times and the first web space 14 (22%) times. Simple syndactyly was found 68 (59%) times, complete syndactyly in 44 (65%) and incomplete in 24 (55%). Complex syndactyly was found 48 (41%) times. CONCLUSION: The results in this study are similar to the literature. Epidemiological Study .

Influence of cortical bone thickness on the ultrasound velocity.

OBJECTIVE: An experimental in vitro study was carried out to evaluate the influence of cortical bone thickness on ultrasound propagation velocity. METHODS: Sixty bone plates were used, made from bovine femurs, with thickness ranging from 1 to 6 mm (10 of each). The ultrasound velocity measurements were performed using a device specially designed for this purpose, in an underwater acoustic tank and with direct contact using contact gel. The transducers were positioned in two ways: on opposite sides, with the bone between them, for the transverse measurement; and parallel to each other, on the same side of the bone plates, for the axial measurements. RESULTS: In the axial transmission mode, the ultrasound velocity speed increased with cortical bone thickness, regardless of the distance between the transducers, up to a thickness of 5 mm, then remained constant thereafter. There were no changes in velocity when the transverse measures were made. CONCLUSION: Ultrasound velocity increased with cortical bone thickness in the axial transmission mode, until the thickness surpasses the wavelength, after which point it remained constant. LEVEL OF EVIDENCE: Experimental Study.

In vivo standardization of bone ultrasonometry of the clavicle

OBJECTIVE: The assessment of fracture union includes physical examination and radiographic imaging, which depend on the examiner’s experience. The development of ancillary methods may avoid prolonged treatments and the improper removal of implants. Quantitative bone ultrasonometry has been studied for this purpose and will soon be included in clinical practice. The aims of the present study were to assess the feasibility of using this technique on the clavicle and to standardize its in vivo application. METHODS: Twenty adult volunteers, including 10 men and 10 women without medical conditions or a previous history of clavicle fracture, underwent axial quantitative ultrasonometric assessment using transducers in various positions (different distances between the transducers and different angulations relative to the clavicle). RESULTS: Similar values of wave propagation velocity were obtained in the different tested set-ups, which included distinct distances between the transducers and angular positions relative to the clavicle. There were significant differences only in the transducers positioned at 0° and at 5 or 7 cm apart. CONCLUSIONS: The use of bone ultrasonometry on the clavicle is feasible and the standardization of the technique proposed in this study (transducers placed at 45° and at 7 cm apart) will allow its future application in clinical trials to evaluate the healing process of diaphyseal fractures of the clavicle.

Functional outcomes of proximal row carpectomy: 2-year follow-up

ABSTRACTOBJECTIVE: To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tisMETHODS: This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this techniqueRESULTS: Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patientsCONCLUSION: Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.

Influence of the osteosynthesis plate on ultrasound propagation in the bone

Analisar a influência das placas de aço de osteossíntesesobre a velocidade de propagação de ultrassom (VU) através doosso. Métodos: Foram medidas as VUs subaquáticas transversalcoronal e sagital no osso intacto e a seguir nas montagens domesmo osso com dois tipos de placas de osteossíntese (DCP esemitubular), fixadas na face dorsal do osso. O primeiro sinal achegar (first arriving signal, FAS) foi o parâmetro ultrassônico utilizadopara as medidas, tomando os diâmetros coronal e sagitalcomo distância percorrida para o cálculo da VU. Comparaçõesestatísticas intergrupos foram feitas ao nível de significância de1% (p<0,01). Resultados: A VU foi maior em ossos intactos doque nas montagens osso-placa, mas as diferenças entre os gruposnão foram significativas para a maioria das comparações(p=0,0132 a 0,9884), indicando que as placas de aço não interferemsignificantemente com a VU através das montagens osso--placa. Conclusão: O efeito de redução da VU nas montagensfoi atribuído ao maior coeficiente de reflexão do aço comparadoao osso e à água. Do ponto de vista prático, a ultrassonometriapode ser empregada para a avaliação da consolidação de fraturasfixadas com placas de aço. Estudo experimental...

To analyze the influence of steel plates for osteosynthesison the velocity of ultrasound propagation (VU) through the bone.Methods: The transverse coronal and sagittal velocity of ultrasoundpropagation underwater were measured on the intact bone and thenon assemblies of the same bone with two types of osteosynthesisplates (DCP and semi tubular), fixed onto the dorsal side of thebones. The first arriving signal (FAS) was the ultrasound parameterused, taking the coronal and sagittal diameters as the distancesto calculate velocity. Intergroup statistical comparisons were madeat significance level of 1% (p<0.01). Results: Velocity was higheron the intact bones than on the bone-plate assemblies and higherfor the semitubular than for the compression plates, althoughdifferences were not statistically significant for most comparisons(p=0.0132 to 0.9884), indicating that the steel plates do not interferesignificantly with ultrasound wave propagation through thebone-plate assemblies. Conclusion: The velocity reduction effectwas attributed to the greater reflection coefficient of the steel ascompared to that of bone and water. Ultrasonometry can, thus, beused in the evaluation of healing of fractures fixed with steel plates.Experimental study...

Análise casuística da sindactilia congênita: experiência com 47 pacientes / Congenital syndactyly: case by case analysis of 47 patients

OBJETIVO: Analisar e comparar as características dos pacientes com sindactilia congênita com os dados da literatura.MÉTODOS: Estudo retrospectivo baseado na análise do prontuário médico de 47 pacientes tratados em um período de 10 anos.RESULTADOS: Dos pacientes, 33 (70%) eram do sexo masculino e 14 (30%) do feminino. O número total de sindactilias foi de 116. A mão direita foi acometida em 19 casos (40%), a mão esquerda em 12 (24%) e em 17 (36%) o acometimento foi bilateral. Dezesseis (34%) pacientes possuíam síndromes genéticas. Entre os 31 (66%) não-sindrômicos, 12 (39%) apresentavam sindactilias isoladas e 19 (61%) associação com outras malformações da mão. O terceiro espaço foi acometido 45 (39%) vezes, seguido do quarto espaço com 35 (30%), do segundo com 22 (19%) e do primeiro com 14 (12%). As sindactilias simples foram encontradas 68 (59%) vezes, sendo completas em 44 (65%) situações e parciais em 24 (55%). As complexas foram identificadas 48 (41%) vezes.CONCLUSÃO: Os resultados obtidos na presente série são muito semelhantes aos dados encontrados na literatura. Estudo Epidemiológico.

OBJECTIVE: To assess and report clinical data from patients with syndactyly.METHODS: A retrospective review of 47 patients treated between April 2002 and April 2012.RESULTS: Among the 47 analyzed patients, 33 (70%) were male and 14 (30%) female. The total number of syndactylies was 116. The right hand was affected in 19 patients (40%), the left hand in 12 (24%) and 31 (36%) were bilaterally compromise. Sixteen patients (34%) also presented genetic syndromes. Among the 31 (66%) patients without syndromes, 12 (39%) had isolated syndactyly and 19 (61%) presented association with other hand anomalies. The third web space was affected 45 (39%) times; the fourth, 35 (30%) times; the second, 22 (19%) times and the first web space 14 (22%) times. Simple syndactyly was found 68 (59%) times, complete syndactyly in 44 (65%) and incomplete in 24 (55%). Complex syndactyly was found 48 (41%) times.CONCLUSION: The results in this study are similar to the literature. Epidemiological Study.

Avaliação ultrassonométrica da osteossíntese de compressão axial: estudo experimental / Ultrasonometric evaluation of axial compression osteosinthesis: experimental study

Objetivo: Medir a velocidade de propagação do ultrassom (VU) através de uma osteotomia transversal em tíbias de ovelha, antes e após a fixação com uma placa DCP. Métodos: Foram utilizadas dez montagens de uma placa DCP com o segmento diafisário das tíbias, no qual era feita uma osteotomia transversal. Foi realizada a medida subaquática transversal, nos planos coronal e sagital, e axial da VU, no osso íntegro, nas montagens sem osteotomia e, depois, com osteotomia sem e com a compressão axial pela placa DCP; comparações estatísticas foram feitas ao nível de significância de 1% (p<0,01). Resultados: Em comparação com a montagem com o osso intacto, a VU diminuiu com a adição da osteotomia e aumentou com a compressão axial, com significância somente para a modalidade axial de medida da VU. Conclusão: Concluiu-se que esse dado pode ser aplicável ao acompanhamento pós-operatório das osteossíntese com placa DCP, com a capacidade de demonstrar quando esta se torna ineficiente. Trabalho experimental.

Objective: To measure the ultrasound propagation velocity (UV) through a tibial transverse osteotomy in sheep, before and after the fixation with a DCP plate. Material and methods: Ten assemblies of a DCP plate with the diaphyseal segment of tibiae, in which a transverse osteotomy was made, were used. Both coronal and sagittal transverse and the axial UV were measured, first with the intact bone assembled with the plate and then with the uncompressed and compressed osteotomy; statistical comparisons were made at the 1% (p<0.01) level of significance. Results: Compared with the intact bone assembly, axial UV significantly decreased with the addition of the osteotomy and significantly increased with compression, presenting the same behavior for the other modalities, although not significantly. Discussion and conclusion: In accordance with the literature data on the ultrasonometric evaluation of fracture healing, underwater UV measurement was able to demonstrate the efficiency of DCP plate fixation. The authors conclude that the method has a potential for clinical application in the postoperative follow-up of DCP plate osteosinthesis, with a capability to demonstrate when it becomes ineffective. Laboratory investigation.

Influência da espessura do osso cortical sobre a velocidade de propagação do ultrassom / Influence of cortical bone thickness on the ultrasound velocity

OBJETIVO: Avaliar a influência da espessura do osso cortical sobre a velocidade de propagação do ultrassom (in vitro). MÉTODO: Foram utilizadas 60 lâminas ósseas confeccionadas a partir do fêmur de bovinos, com diferentes espessuras, variando de 1 a 6mm (10 de cada). As medidas da velocidade do ultrassom foram realizadas por aparelho projetado para este fim, utilizando técnica subaquática e por contato direto com auxílio de gel de acoplamento. Os transdutores foram posicionados de duas maneiras diferentes; opostos entre si, com o osso entre eles, sendo a medida chamada de transversal; e, paralelos na mesma superfície cortical, sendo a medida chamada de axial. RESULTADOS: Com o modo de transmissão axial, a velocidade de propagação do ultrassom aumenta conforme a espessura do osso cortical aumenta, independente da distância entre os transdutores, até a espessura de 5mm, mantendo-se constante após. Não houve alteração da velocidade quando o modo de transmissão foi transversal. CONCLUSÃO: A velocidade de propagação do ultrassom aumenta com o aumento da espessura da cortical óssea, no modo de transmissão axial, até o momento em que a espessura supera o comprimento da onda, mantendo a velocidade constante a partir de então. Nível de Evidência: Estudo Experimental.

OBJECTIVE: An experimental in vitro study was carried out to evaluate the influence of cortical bone thickness on ultrasound propagation velocity. METHODS: Sixty bone plates were used, made from bovine femurs, with thickness ranging from 1 to 6 mm (10 of each). The ultrasound velocity measurements were performed using a device specially designed for this purpose, in an underwater acoustic tank and with direct contact using contact gel. The transducers were positioned in two ways: on opposite sides, with the bone between them, for the transverse measurement; and parallel to each other, on the same side of the bone plates, for the axial measurements. RESULTS: In the axial transmission mode, the ultrasound velocity speed increased with cortical bone thickness, regardless of the distance between the transducers, up to a thickness of 5 mm, then remained constant thereafter. There were no changes in velocity when the transverse measures were made. CONCLUSION: Ultrasound velocity increased with cortical bone thickness in the axial transmission mode, until the thickness surpasses the wavelength, after which point it remained constant. Level of Evidence: Experimental Study.