Surgeon confidence in an outpatient settingHAND - Tập 8 - Trang 430-433 - 2013
Michiel G. J. S. Hageman, Jeroen K. J. Bossen, John D. King, David Ring
We have the impression that provider uncertainty arises from either nonspecific pathology or disproportionate symptoms and disability, both of which correlate with symptoms of depression, heightened illness concern, and low patient self-efficacy. This study tested the primary null hypothesis that there is no correlation between provider confidence and patient self-efficacy. Eighty-five patients visiting an orthopedic hand and upper extremity surgeon completed the Pain Self-Efficacy Questionnaire (PSEQ). The surgeon’s confidence in the diagnosis, optimal treatment, expected outcome, and the anticipated satisfaction of the patient and the referring doctor were measured with five questions rated on 5-point Likert scales (Physician Confidence Scale). Overall physician confidence was high and there was no correlation between the PSEQ score and the Physician Confidence Scale. Provider confidence was significantly lower for nonspecific diagnoses, but there was no significant difference between the mean PSEQ for the 72 patients with a specific diagnosis and the 12 patients with nonspecific diagnoses. Physician confidence did not relate with self-efficacy in this study. Level of Evidence: Prognostic, level II
Di chuyển tế bào sau khi ghép mô synovium tại vị trí sửa chữa gân Dịch bởi AI HAND - - 2012
Masanori Hayashi, Chunfeng Zhao, Kai Nan An, Peter C. Amadio
Nền tảngGần đây chúng tôi đã báo cáo rằng các ghép mô synovium từ bao gân có khả năng tăng tốc độ hồi phục gân khi được cấy vào vị trí sửa chữa. Mục tiêu của nghiên cứu này là điều tra ảnh hưởng của hướng ghép synovium sau khi cấy ghép, bằng cách so sánh khả năng di cư của các tế bào từ bề mặt tạng và bề mặt thành vào gân trong mô hình nuôi cấy mô chó.
Phương phápGhép mô synovium được đặt vào bên trong một vết đứt gân hoàn toàn, với một trong hai bề mặt tạng hoặc bề mặt thành hướng về phía đầu gần của gân bị đứt. Số lượng tế bào di cư được định lượng bằng một xét nghiệm di chuyển tế bào. Phương pháp miễn dịch mô học định tính và kính hiển vi laser huỳnh quang cũng đã được sử dụng vào ngày thứ 10.
Kết quảNhiều tế bào synovial được đánh dấu đã được quan sát thấy trong gân mà bề mặt tạng của ghép mô synovium hướng về. Các tế bào di cư cũng được quan sát thấy ở phía bề mặt thành, nhưng số lượng ít hơn so với các tế bào ở bề mặt tạng. Tất cả các tế bào di cư đều biểu hiện α-actin cơ trơn.
Kết luậnChúng tôi nhận thấy rằng hướng của ghép ảnh hưởng đến di cư của tế bào. Việc phát hiện này có ý nghĩa lâm sàng hay không cần phải được nghiên cứu in vivo.
#ghép mô synovium #di cư tế bào #sửa chữa gân #mô hình nuôi cấy mô chó
The treatment of extensor lag of the middle finger following crushing–penetrating injuries of the metacarpophalangeal joint: case seriesHAND - Tập 9 - Trang 534-538 - 2013
Yoshitaka Hamada, Naohito Hibino
We aimed to introduce a surgical option for crushing–penetrating injuries around the metacarpophalangeal (MP) joint of the middle finger with extensor reconstruction of the interphalangeal (IP) joints. We also assessed the outcomes of patients using this surgical protocol. First, MP joint reconstruction was performed early (mean, 1.2 weeks after injury) using free autogenous cartilage or bone graft. We next performed a tendon transfer using a modified Brand method (M. Brand) at the same setting of extensor tendon tenolysis (mean, 4.7 months after injury) in order to extend the IP joints as a bonus for mutilating injuries of the hand. The mean arc of motion of each MP and IP joint increased after the M. Brand procedure. In one patient, worsening of palmar subluxation at the base of the proximal phalanx at the MP joint was observed. We found that tendon transfer by M. Brand achieves additional reconstruction for patients who have an IP joint extension lag after a crushing–penetrating injury around the MP joint. On the basis of these encouraging findings in this small series of cases, we recommend the M. Brand procedure after the MP joint stabilizes, as an optional bonus for mutilating injured hand.
Sử Dụng Tourniquet Trong Phẫu Thuật Chi Trên Dịch bởi AI HAND - - 2011
Emeka Oragui, A.M.J. Parsons, Thomas C. White, Umile Giuseppe Longo, Wasim Khan
Tourniquet là những thiết bị nén có tác dụng ngăn chặn dòng chảy máu tĩnh mạch và động mạch đến các chi, thường được sử dụng trong phẫu thuật chi trên. Với nguy cơ tiềm tàng về các biến chứng, đã có cuộc tranh luận về việc tourniquet có nên được sử dụng thường xuyên hay không. Trong bài đánh giá này, chúng tôi sẽ xem xét các thiết kế khác nhau, nguyên tắc và các yếu tố thực tiễn liên quan đến việc sử dụng tourniquet ở chi trên. Tourniquet khí nén hiện đại có nhiều tính năng thiết kế giúp nâng cao độ an toàn. Tài liệu hiện tại cho thấy rằng nguy cơ xảy ra các biến chứng liên quan đến tourniquet có thể được giảm đáng kể bằng cách chọn áp lực bơm căng dựa trên áp lực tắc mạch của chi, và bằng cách hiểu rõ hơn về mức áp lực thực sự trong mô mềm, cũng như các hiệu ứng của chiều rộng và hình dạng của cuff. Bằng chứng liên quan đến thời gian sử dụng tourniquet, vị trí đặt và tình trạng thiếu máu của chi cũng được thảo luận, cùng với những lưu ý đặc biệt ở những bệnh nhân mắc bệnh tiểu đường, tăng huyết áp, vôi hóa mạch, bệnh hồng cầu hình liềm và béo phì. Chúng tôi cũng cung cấp một bài đánh giá dựa trên bằng chứng về nhiều biến chứng cục bộ và toàn thân có thể phát sinh từ việc sử dụng tourniquet chi trên, bao gồm đau, rỉ máu và các chấn thương về thần kinh, cơ và da. Bằng chứng trong tài liệu cho thấy tourniquet chi trên có lợi cho việc tạo ra điều kiện phẫu thuật tối ưu và việc sử dụng tourniquet hiện đại liên quan đến tỷ lệ sự kiện bất lợi thấp. Với sự cải thiện về kiến thức và công nghệ, tỷ lệ sự kiện bất lợi nên tiếp tục giảm. Chúng tôi khuyến nghị sử dụng tourniquet trong phẫu thuật chi trên khi không có chống chỉ định.
CMC Arthroplasty of the Thumb: A ReviewHAND - Tập 2 - Trang 232-239 - 2007
Kristofer S. Matullo, Asif Ilyas, Joseph J. Thoder
Arthritis of the first carpometacarpal (CMC) joint of the hand is a common and often debilitating disease. Diagnosis can be readily made with history, physical exam, and radiographic evaluation. Patients with advanced disease who have failed conservative treatment modalities have multiple surgical options including ligament reconstruction, resection arthroplasty, silicone implantation, tendon interposition, or total joint arthroplasty. This article will describe the variety of approaches to treatment as well as the author’s preferred method.
Implanted passive engineering mechanism improves hand function after tendon transfer surgery: a cadaver-based studyHAND - Tập 10 - Trang 116-122 - 2014
Katherine L. Mardula, Ravi Balasubramanian, Christopher H. Allan
The purpose of this study was to investigate if a new tendon transfer surgical procedure that uses an implanted passive engineering mechanism for attaching multiple tendons to a single donor muscle in place of directly suturing the tendons to the muscle improves hand function in physical interaction tasks such as grasping. The tendon transfer surgery for high median ulnar palsy was used as an exemplar, where all four flexor digitorum profundus (FDP) tendons are directly sutured to the extensor carpi radialis longus (ECRL) muscle to restore flexion. The new procedure used a passive hierarchical artificial pulley system to connect the muscle to the tendons. Both the suture-based and pulley-based procedures were conducted on N = 6 cadaver hands. The fingers’ ability to close around four objects when the ECRL tendon was pulled was tested. Post-surgery hand function was evaluated based on the actuation force required to create a grasp and the slip between the fingers and the object after the grasp was created. When compared with the suture-based procedure, the pulley-based procedure (i) reduced the actuation force required to close all four fingers around the object by 45 % and (ii) improved the fingers’ individual adaptation to the object’s shape during the grasping process and reduced slip by 52 % after object contact (2.99° ± 0.28° versus 6.22° ± 0.66°). The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.
Scratch Collapse Test Localizes Osborne’s Band as the Point of Maximal Nerve Compression in Cubital Tunnel SyndromeHAND - Tập 5 - Trang 141-147 - 2009
Justin M. Brown, David Mokhtee, Maristella S. Evangelista, Susan E. Mackinnon
The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in cubital tunnel syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Cubital tunnel syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain in the ulnar nerve distribution or by the presence of weakness or wasting of the ulnar-innervated intrinsic hand muscles. All diagnoses were confirmed with electrodiagnostic studies. As part of the physical examination, the SCT was performed along three subdivided segments in the region of the cubital tunnel. Results of the SCT were recorded and correlated with intraoperative findings. Of the 64 patients evaluated, 44 had a positive SCT that was either more profound or solely present a few centimeters distal to the medial epicondyle in the region of Osborne’s band. All of these patients subsequently underwent anterior submuscular transposition and were found to have a tight compression point at Osborne’s band corresponding to their preoperative SCT. This study suggests that the scratch collapse test may be a reliable physical examination technique for localizing the point of maximal nerve compression in patients with cubital tunnel syndrome. That point, in this series, corresponded with Osborne’s band.
Radiographic Interpretation of Distal Radius Fractures: Visual Estimations versus Digital Measuring TechniquesHAND - - 2014
Michael O’Malley, Craig M. Rodner, Andrew W. Ritting, Mark P. Cote, Robin R. Leger, Harlan Stock, Jennifer Moriatis Wolf
Purpose Distal radius fractures are a common injury. In the emergency room, trainees regularly assess these fractures using visual estimation. Our hypothesis is that assessment of radiographic parameters has sufficient accuracy for rendering treatment consistent with formal measurements.
Methods This study compared visual measurements made by 25 orthopaedic residents and attending physicians to formal measurements made by a single fellowship trained musculoskeletal radiologist in a series of patients with distal radius fractures. A search was performed utilizing the ICD-9 code for distal radius fracture in all patients presenting to a single institution emergency department. Participants used visual estimation to rate 25 radiographs. Parameters estimated included radial inclination, radial height, volar tilt, and the presence of intra-articular displacement. Analysis using Lin concordance coefficients, Bland Altman plots, and the Kappa statistic evaluated the agreement between visual estimation and formal measurements. The proportion of raters whose estimates would have resulted in a course of treatment that conflicted with the formal reading quantified the potential impact of visual estimation on treatment.
Results Concordance coefficients were poor for radial inclination (ρc=0.13), radial height (ρc=0.24), and volar tilt (ρc= 0.46). The Kappa statistic for intra-articular displacement was 0.4. Analysis performed according to level of training did not result in substantial improvements in these statistics. Treatment based on visual estimates conflicted with formal readings 34 % of the time for radial inclination, 38 % of the time for radial height, 27 % of the time for volar tilt, and 31 % of the time for intra-articular displacement.
Discussion Visual estimation is not an adequate form of measurement for evaluation of patients with distal radius fractures. Physicians should be mindful of these results when developing treatment plans based solely upon visual estimation.
Subclavius posticus: an anomalous muscle in association with suprascapular nerve compression in an athleteHAND - Tập 10 - Trang 76-79 - 2014
Ashley C. Cogar, Parker H. Johnsen, Hollis G. Potter, Scott W. Wolfe
Subclavius posticus is a rare anomalous muscle that traverses from the costal cartilage of the first rib posterolaterally to the superior border of the scapula. We present an athlete who presented with incapacitating suprascapular nerve compression associated with a subclavius posticus diagnosed by MRI. Symptoms were relieved, and function was restored by decompression of the nerve and excision of the anomalous muscle. We present this case to bring awareness of the subclavius posticus as an anatomic variant and a potential additional source for compression in suprascapular neuropathy. We recommend high-resolution magnetic resonance imaging to evaluate cases of isolated suprascapular neuropathy. Level of Evidence: V
Barbed Sutures and Tendon Repair—a ReviewHAND - Tập 10 - Trang 6-15 - 2014
Ajul Shah, Megan Rowlands, Alexander Au
Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair. Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations. Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:
Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the non-uniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.
