Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures

Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers’ compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.

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Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

The Surgery Journal ◽

10.1055/s-0038-1637002 ◽

2018 ◽

Vol 04 (01) ◽

pp. e29-e33 ◽

Cited By ~ 7

Author(s):

Jose Couceiro ◽

Higinio Ayala ◽

Manuel Sanchez ◽

Maria De la Red ◽

Olga Velez ◽

...

Keyword(s):

Return To Work ◽

Grip Strength ◽

Kirschner Wire ◽

Kirschner Wires ◽

Active Motion ◽

Contralateral Hand ◽

Total Active Motion ◽

Quick Dash ◽

Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

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Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers: reduction and K-wire fixation leaving the metacarpophalangeal and proximal interphalangeal joints free

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411405943 ◽

2011 ◽

Vol 36 (7) ◽

pp. 577-583 ◽

Cited By ~ 10

Author(s):

Mohammad M. Al-Qattan

Keyword(s):

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Industrial Workers ◽

Active Motion ◽

Wire Fixation ◽

Total Active Motion ◽

K Wires ◽

Pin Tract Infection ◽

Transverse Fractures

A series of 35 adult male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were treated with reduction and K-wire fixation leaving the metacarpophalangeal and interphalangeal joints free to move immediately after surgery. At final follow-up, the total active motion score of the injured finger was graded as excellent, good, fair, or poor if it was greater than 240°, 220–240°, 180–219°, or less than 180°, respectively. Complications were also documented. The results were compared with our previously published series of these fractures treated with two other techniques: percutaneous K-wires immobilizing the metacarpophalangeal joint and open reduction and interosseous loop wire fixation. The final TAM scores in the current study were excellent in 43%, good in 29%, fair in 14% and poor in 14%. Four out of the 35 patients (11%) had minor pin tract infection. These results were significantly better than the results following percutaneous K-wire fixation immobilizing the metacarpophalangeal joint indicating that immediate mobilization of all joints has a significant effect on the outcome.

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The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

Hand ◽

10.1177/1558944720963894 ◽

2020 ◽

pp. 155894472096389

Author(s):

Stefano Lucchina ◽

Angelo D’Ambrosio ◽

Cesare Fusetti ◽

Marco Guidi

Keyword(s):

Adverse Effects ◽

Grip Strength ◽

Proximal Phalanx ◽

Extensor Tendon ◽

Active Motion ◽

Adipofascial Flap ◽

Vas Score ◽

Total Active Motion ◽

Sample Characteristics ◽

Dorsal Plating

Background: Extensor tendon adhesions occurring after proximal phalangeal (P1) fractures are not uncommon. A previous report described the use of an adipofascial flap (AFF) to prevent adhesions after dorsal plating of the P1. The purpose of the study is to examine the results of open reduction and internal fixation with the use of an AFF (F group) and without (N group, that is, no flap used) in a larger group of patients. Methods: A retrospective study involving a period of 11 years was conducted involving results of 21 unstable fractures of the P1 of the fingers in 18 patients. In all, 12 fingers were treated without any flap (N group) and 9 fingers were treated with the AFF (F group). For each patient, the total active motion (TAM) ratio, and the grip strength (Jamar) ratio were assessed, and adverse effects and the 10-point visual analogue scale (VAS) score were recorded. For statistical analysis, sample characteristics were described using mean ± standard deviation and median, and a Bayesian approach was used for inferential analysis. Results: In the F group, the TAM ratio (84% ± 13% vs 65% ± 17%) was higher with a lower rate of adverse effects (OR: 0.067, 95% CI, 0.0035-0.58,) and a lower VAS score with evidence of the positive effect of the AFF. The Jamar ratio was similar in the 2 groups (F group 80% ± 25% vs N group 79% ± 19%) with no associated effect of the AFF on grip strength. Conclusions: The AFF is a reliable tool to reduce adhesions between plates and the extensor apparatus of the P1 and may be useful to improve finger function after plating of P1 fractures. Type of study/LOE: Therapeutic, Retrospective, Level IV

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Functional reconstruction of severe hand injuries using allogeneic tendons: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060520955032 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052095503

Author(s):

Gu Heng Wang ◽

Tian Mao ◽

Shu Guo Xing ◽

Ya Lan Chen ◽

Yu Xuan Zhang ◽

...

Keyword(s):

Cell Count ◽

Grip Strength ◽

Hand Function ◽

Hand Injuries ◽

Pinch Strength ◽

Dash Score ◽

Active Motion ◽

Functional Reconstruction ◽

Total Active Motion

Objective To evaluate the effectiveness and safety of allogeneic tendons for functional reconstruction of severe hand injuries. Methods From August 2007 to July 2014, we performed functional reconstruction with tendon allografts for severe hand injuries affecting two or more tendons. At the final follow-up, we assessed total active motion (TAM); pincer pinch strength; grip strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of satisfaction; and adhesion. We measured the white blood cell count, C-reactive protein concentration, erythrocyte sedimentation rate, total T-cell count, and CD4+T/CD8+T ratio to evaluate the immune response and check for infection. Results Ten patients received 26 allogeneic tendons to reconstruct hand function. The average follow-up period was 50.0 months (range, 24–82 months). The TAM was 126.4° (12°–253°), pincer pinch strength was 0.83 kg (0–4.5 kg), and grip strength was 13.69 kg (4–41.5 kg). The DASH score was 14.25 (3.3–30.8), and seven and three patients were satisfied and partially satisfied, respectively. One patient developed tendon adhesion. All immune and infectious parameters were within the reference range. Conclusion Functional reconstruction using allogeneic tendons for severe hand injuries with multiple tendon defects was effective and safe; however, more research is needed.

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Reconstruct Flexor and Extensor tendon in Severe Hand Injury Using Allogenic tendon: A Retrospective study

10.21203/rs.2.11695/v1 ◽

2019 ◽

Author(s):

Gu Heng Wang ◽

Tian Mao ◽

Shu Guo Xing ◽

Ya Lan Chen ◽

Yu Xuan Zhang ◽

...

Keyword(s):

T Cell ◽

Grip Strength ◽

Tendon Rupture ◽

Extensor Tendon ◽

Hand Injury ◽

Pinch Strength ◽

Active Motion ◽

Flexor Tendon Rupture ◽

Total Active Motion

Abstract Background To evaluate the effective and safety of reconstruction of flexor and extensor tendon in hand using allogenic tendon with 2- to 7.6-year fellow-up. Methods Between August 2007 and July 2014, we performed tendon allografts for 14 patients who suffered from severe hand injury with 2 or more tendon defects. 10 patients have been followed-up, 6 cases of flexor tendon rupture with defect, 3 cases of extensor tendon rupture with defect, 1 case with flexor and extensor tendon rupture with defect. Tendon allografts were used to repair tendon defects in order to reconstruct the function of flexion or extension. At the final follow-up visit, the total active motion (TAM), grip strength, pinch strength, DASH and the degree of satisfaction were measured. The WBC, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Total T cell and CD4+T/CD8+T were measured to evaluate the response related to immune and infection. Results The average follow-up period was 50.0 months (range 24-82 months). The mean motion of TAM was 129.9°(rang 12-259°), pinch strength was 0.76Kg (rang 0-4.5Kg), grip strength was 18.67Kg (rang 4-46Kg), the score of DASH was 14.25 (rang 3.3-30.8), 7 patients were satisfied and 3 patients were partially satisfied with the results. The results of WBC, CRP, ESR, Total T cell and CD4+ T/CD8+ T were mostly in normal field. Conclusion In severe hand injuries with multiple tendon defects, reconstruction of flexor and extensor tendon in hand using allogenic tendon is an effective and safe treatment.

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Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413517204 ◽

2013 ◽

Vol 40 (4) ◽

pp. 384-391 ◽

Cited By ~ 5

Author(s):

S. M. Cha ◽

H. D. Shin ◽

K. C. Kim ◽

I. Y. Park

Keyword(s):

Analogue Scale ◽

High Speed ◽

Proximal Phalanx ◽

Healing Time ◽

Complete Healing ◽

Pathological Fractures ◽

Active Motion ◽

The Mean ◽

High Speed Burr

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients treated with different adjuvant methods after curettage for enchondromas of the hand. Sixty-two patients with enchondroma were treated with high-speed burring (29 patients) or alcohol instillation (33 patients) after curettage. The mean follow-up was 40.8 months. No significant differences in the visual analogue scale, Disabilities of the Arm, Shoulder, and Hand scores, total range of active motion, grip strength, and complete healing time were observed between the groups. The distribution of the results of the formula by Wilhelm and Feldmeier were not significantly different between the groups. No surgery-related complications, postoperative pathological fractures, or recurrence was found in either group. For the treatment of enchondroma in the metacarpal and proximal phalanx, alcohol instillation immediately after curettage was as effective as extensive curettage using a high-speed burr.

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Pilot Study on Frailty and Functionality on Routine Clinical Assessment in Allogeneichematopoietic Cell Transplantation to Predict Outcomes

Blood ◽

10.1182/blood-2019-126071 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 380-380 ◽

Cited By ~ 1

Author(s):

Maria Queralt Salas ◽

Eshetu G Atenafu ◽

Ora Bascom ◽

Leeann Wilson ◽

Arjun Law ◽

...

Keyword(s):

Stem Cell ◽

Pilot Study ◽

Stem Cell Transplantation ◽

Grip Strength ◽

Cell Transplantation ◽

Waiting Time ◽

Acute Gvhd ◽

Number Of Patients ◽

And Function

Introduction: Frailty can adversely affect the outcomes of allogeneic hematopoietic stem cell transplantation (alloHSCT) but is difficult to measure in busy transplant clinics. The limited published studies have used dedicated trained persons and comprehensive geriatric assessment (GA) tools, which are time consuming (Muffly LS, Haematologica 2014; Holmes HM, J Geriatr Oncol 2014; Rodrigues M, J Geriatr Oncol 2019). The difficulty in application of GA tools by transplant clinicians, residents and nurses in their clinics has resulted in low adoption rates in routine practice. At our center we adopted selected tests for frailty and function which could be conducted during pre-transplant consultation in a busy clinic, without extra waiting time for patients, and using existing staff. The Timed up and Go test (TUGT) was adopted as it could be done in any closed clinic room, without need for a corridor. Thus it was considered safer than a gait speed test and was even applicable to patients in "isolation". We aim to share a preliminary analysis of the applicability and correlation between our selected frailty assessment with transplant outcomes and complications. Methods: Patients referred for transplant underwent the following assessments conducted by different providers. All ages were included. Relevant tests and source of data are as follows: Frailty and function by clinician evaluating (a) Clinical Frailty scale (CFS) with 9 points based on clinical judgement (Rockwood 2005) (b) Lawton's Instrumental activities of daily living (IADL). Objective physical performance by nursing BMT coordinator using (a) TUGT and (b) Grip strength using hydraulic "Jamar" hand dynamometer conducted in clinic room at time of documentation. Self assessment by patient completing (a) Self-rated health (SRH) question and (b) a question on falls. Blood tests (a) CRP (b) Albumin. The present study is a single center prospective observational study. Patients who did not proceed to transplant were excluded. Ninety-six consecutive adult allo-HSCT patients were eligible for the present analysis, updated on July 2019. The parameters were individually correlated with overall survival (OS), non-relapse mortality (NRM), cumulative incidence (cum.Inc) of acute GVHD, median time of transplant hospitalization and readmissions. Multivariate analysis was not performed in this pilot study due to limited number of patients and low frequency of adverse events. Results: Baseline characteristics and main post-transplant information are noted in Table 1. Median follow up of cohort was 5 months. Table 2 shows the main outcomes (with normal values). For the entire cohort the median OS at 6 months was 73.9% (range 61.7-82.8), NRM at day+100 was 8.7% (range 2.6-14.7), Cum.Inc of Acute GVHD 41.1% (range 30.1-52.1), Cum.Inc gr II-IV acute GVHD was 25.7% (range 15.6-35.9). Relapse occurred in 8 cases (8.3%) and deaths in 23 (23.9%). A TUGT of more than 10 seconds and raised CRP predicted poor OS (p<0.05). Abnormal TUGT, SRH question score of <A (excellent), lower albumin levels and raised CRP levels correlated with high NRM (p<0.05). A Clinical Frailty Score of more than 2, limitations of 1 or more IADLs, Grip strength below normal for age and sex, TUGT >10 seconds, SRH question <A, and lower albumin level were significant predictors for a longer median duration of transplant hospitalization. No frailty or functionality parameter correlated significantly with the Cum.Inc of any grade of acute GVHD, grade II-IV acute GVHD or the risk of rehospitalization after alloHSCT. Conclusions: Our pilot study shows that with selected brief tools, frailty and functionality can be assessed as part of routine clinical practice in allogeneic-stem cell transplantation in all age groups without extra waiting time for patients or additional human resources. TUGT is a useful prognostic tool which can be conducted in a clinic room and correlates with OS, NRM, and duration of hospitalization. Larger number of patients and longer follow-up will help to evaluate the different assessment modalities as prognostic tools in allo-HSCT and their wider applicability. Disclosures Michelis: CSL Behring: Other: Financial Support. Mattsson:Gilead: Honoraria; Celgene: Honoraria; Therakos: Honoraria.

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Arthroscopic Foveal Reattachment of the Triangular Fibro Cartilaginous Complex

Journal of Wrist Surgery ◽

10.1055/s-0040-1702929 ◽

2020 ◽

Vol 09 (03) ◽

pp. 256-262

Author(s):

Gwénolé Kermarrec ◽

Gilles Cohen ◽

Peter Upex ◽

Didier Fontes

Keyword(s):

Grip Strength ◽

Distal Radioulnar Joint ◽

Wrist Arthroscopy ◽

Unaffected Side ◽

Mattress Suture ◽

Radioulnar Joint ◽

Number Of Patients ◽

First Choice ◽

Functional Scores

Abstract Background Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. We present a simple all inside knotless repair, providing a strong bony fixation in the fovea. Materials and Methods Through 3–4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously through the TFCC to place a mattress suture at its free end. It is then reattached to the fovea with an impacted anchor. Retrospective Study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B, EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluation was based on a compared measurement of the grip strength, pain on a visual analogic scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability. We also used functional scores: Mayo modified wrist score (MMWS), Quick disability arm, shoulder and hand (DASH), and patient-related wrist evaluation (PRWE). The average follow-up was 29.4 months (range 9–42 months). Results On postoperative evaluation, pain was reduced by 5 points (range 1–9) and grip strength averaged 94% of the unaffected side. Range of motion averaged 92% on the unaffected side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent for 1, good for 1, and satisfactory for 3 patients. Quick Dash averaged 17.68 (range 0–38.6) compared with preoperative average of 59.48 (range 45–77) with an amelioration of 43 (range 34–57).PRWE averaged 20 (range 1–41.5) compared with preoperative average of 60.3 (range 33.5–76.5) with an amelioration of 41 (range 32–58). We reported no complications and particularly no lesions of the dorsal sensory branch of the ulnar nerve. Conclusions We present a simple arthroscopic technique using a single suture anchor placed in the ulnar fovea. Repairs performed with this technique are simple and the results achieved seem to be similar to those obtained with conventional open or arthroscopic techniques, although further investigation with an increased number of patients and follow-up are required. It however became our first choice of treatment in European Wrist Arthroscopy Society (EWAS) 2 lesions of the TFCC.

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