Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Background: The aim of flexor pollicis longus (FPL) repair is to create a construct that is strong enough to withstand forces encountered during rehabilitation and to achieve an optimal active range of motion. The aim of this study was to: (1) assess factors influencing active thumb interphalangeal (IP) joint flexion; and (2) assess the factors associated with reoperation. Methods: Retrospectively, 104 patients with primary repair of a Zone II FPL laceration from 2000 to 2016 were identified. A medical chart review was performed to collect patient-, injury-, and surgery characteristics as well as the degree of postoperative active IP-flexion and occurrence of reoperation. Bivariate analyses were performed to identify factors influencing active IP-flexion and factors associated with reoperation. Results: The reoperation rate was 17% (n = 18) at a median of 3.4 months (range: 2.3-4.4). Indications for reoperation mainly included adhesion formation (n = 10, 56%) and re-rupture (n = 5, 28%). The median range of active IP-flexion was 30° (interquartile range [IQR]: 20-45) at a median of 12.4 weeks (IQR: 8.1-16.7). Solitary injury to the thumb (β = 17.9, P = .022) and the use of epitendinous suture (β = 10.0, P = .031) were associated with increased active IP-joint flexion. No factors were statistically associated with reoperation. Conclusions: About 1 in 5 patients undergo reoperation following primary repair of a Zone II FPL laceration, mostly within 6 months of initial surgery. The use of epitendinous suture is associated with greater active IP-flexion. Patients with multiple digits injured accompanying a Zone II FPL laceration have inferior IP-joint motion.

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Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal Joint Arthroplasty for the Arthritic Joint: A Retrospective Cohort Study

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1709088 ◽

2020 ◽

Author(s):

Bo J. W. Notermans ◽

Jonathan Lans ◽

Ryan P. Ponton ◽

Jesse B. Jupiter ◽

Neal C. Chen

Keyword(s):

Reoperation Rate ◽

Proximal Interphalangeal Joint ◽

Joint Arthroplasty ◽

Factors Associated ◽

System A ◽

Initial Surgery ◽

Younger Age ◽

Pip Joint ◽

Amount Of Knowledge

Abstract Introduction The rate of reoperation after pyrocarbon proximal interphalangeal (PIP) joint arthroplasty ranges from 5.9 to 37% and complications such as radiographic loosening, deformity, dislocation, and stiffness are common. Because of the limited amount of knowledge around these problems, we evaluated factors associated with reoperation after pyrocarbon PIP arthroplasty. Materials and Methods We retrospectively included all adult patients that underwent primary PIP pyrocarbon implant arthroplasty between 2002 and 2016 at one institutional system. A total of 45 patients, with a mean age of 55 (standard deviation: 14), underwent 66 PIP arthroplasties. To address for within individual correlations, we only included fingers treated at patients’ initial surgery (n = 54) in our statistical analysis. These patients were predominantly diagnosed with noninflammatory arthritis 73% (n = 33). Arthroplasty was performed upon 10 index, 22 middle, 20 ring, and 2 small fingers. Results The reoperation rate after pyrocarbon PIP arthroplasty was 30% over a median follow-up of 25 months (interquartile range: 8.7–54). Indications for reoperation consisted of subluxation (n = 6), stiffness (n = 5), swan-neck deformity (n = 3), and soft tissue complications (n = 2). Younger age (p = 0.025), male sex (p = 0.017), and noninflammatory arthritis (p = 0.038) were associated with a higher reoperation rate. Conclusion In this study, our reoperation rate after pyrocarbon PIP arthroplasty was 30%. This study suggested that younger patients, males, and patients with noninflammatory arthritis are at higher risk of reoperation. We recommend considering these factors when selecting candidates for pyrocarbon arthroplasty. Future studies should focus on prospectively researching these factors in comparison with other implants.

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Modelling of a Partially Loaded Road Tanker during a Braking-in-a-Turn Maneuver

Actuators ◽

10.3390/act7030045 ◽

2018 ◽

Vol 7 (3) ◽

pp. 45 ◽

Cited By ~ 2

Author(s):

Frank Otremba ◽

José Romero Navarrete ◽

Alejandro Lozano Guzmán

Keyword(s):

Road Safety ◽

Load Transfer ◽

Dynamic Interaction ◽

Performance Measure ◽

Lateral Stability ◽

Safety Level ◽

Factors Associated ◽

Braking System ◽

Factors Influencing ◽

Fill Level

Road safety depends on several factors associated with the vehicle, to the infrastructure, as well as to the environment and experience of vehicle drivers. Concerning the vehicle factors influencing the safety level of an infrastructure, it has been shown that the dynamic interaction between the carried liquid cargo and the vehicle influences the operational safety limits of the vehicle. A combination of vehicle and infrastructure factors converge when a vehicle carrying liquid cargo at a partial fill level performs a braking maneuver along a curved road segment. Such a maneuver involves both longitudinal and lateral load transfers that potentially affect both the braking efficiency and the lateral stability of the vehicle. In this paper, a series of models are set together to simulate the effects of a sloshing cargo on the braking efficiency and load transfer rate of a partially filled road tanker. The model assumes the superposition of the roll and pitch independent responses, while the vehicle is equipped with Anti-lock braking System brakes (ABS) in the four wheels. Results suggest that cargo sloshing can affect the performance of the vehicle on the order of 2% to 9%, as a function of the performance measure considered. A dedicated ABS system could be considered to cope with such diminished performance.

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Perspectives of Healthcare Professionals Regarding Factors Associated with Antimicrobial Resistance (AMR) and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia

Antibiotics ◽

10.3390/antibiotics10070878 ◽

2021 ◽

Vol 10 (7) ◽

pp. 878

Author(s):

Mohamed A. Baraka ◽

Amany Alboghdadly ◽

Samar Alshawwa ◽

Asim Ahmed Elnour ◽

Hassan Alsultan ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Inappropriate Prescribing ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Sectional Study ◽

Key Factors ◽

Eastern Province ◽

Cross Sectional ◽

Factors Associated ◽

Factors Influencing

Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted survey specific with closed-ended questions. A value of p < 0.05 was considered to be statistically significant. All data analysis was performed using the Statistical Package for Social Sciences (IBM SPSS version 23.0). 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All of the respondents acknowledged effectiveness, previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) as being key factors influencing physicians’ choice during antimicrobial prescribing. The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials were reported to be common practices. Furthermore, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials, and the use of antimicrobials without a physician’s prescription (i.e., self-medication) represent key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

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Treatment Patterns and Clinical Outcomes in Korean Cancer Patients With Venous Thromboembolism: A Retrospective Cohort Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620979575 ◽

2021 ◽

Vol 27 ◽

pp. 107602962097957

Author(s):

Soo-Mee Bang ◽

Jin-Hyoung Kang ◽

Min Hee Hong ◽

Jin-Seok Ahn ◽

So Yeon Oh ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Clinical Outcomes ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Bleeding Events ◽

Factors Associated ◽

Vein Thrombosis ◽

Medical Chart Review ◽

Deep Vein

This study assessed epidemiologic data and clinical outcomes, including venous thromboembolism (VTE) recurrence and bleeding events, in patients with cancer-associated VTE, and assessed factors associated with clinical outcomes. Data were extracted from retrospective medical-chart review of adult patients diagnosed with cancer-associated deep vein thrombosis or pulmonary embolism who received anticoagulation treatment for ≥3 months. Patients were classified by: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and other anticoagulants. First VTE recurrence and bleeding events, and factors associated with their occurrence, were assessed during the initial 6 months of treatment. Overall, 623 patients (age: 63.7 ± 11.3 years, 49.3% male) were included (119, 132, and 372 patients in LMWH, DOACs and other anticoagulants groups, respectively). The cumulative 6-month incidence of VTE recurrence was 16.6% (total), 8.3% (LMWH), 16.7% (DOACs), and 20.7% (other); respective bleeding events were 22.5%, 11.0%, 12.3%, and 30.7%). VTE recurrence and bleeding rates differed only between LMWH and other anticoagulants (HR 2.4, 95% CI: 1.2-5.0 and 3.6, 1.9-6.8, respectively). These results highlight the importance of initial VTE treatment choice for preventing VTE recurrence and bleeding events. LMWH or DOACs for ≥3 months can be considered for effective VTE management in cancer patients.

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A path analysis study of factors influencing hospital staff perceptions of quality of care factors associated with patient satisfaction and patient experience

BMC Health Services Research ◽

10.1186/s12913-017-2718-x ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Sandra G. Leggat ◽

Leila Karimi ◽

Timothy Bartram

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Path Analysis ◽

Patient Experience ◽

Hospital Staff ◽

Staff Perceptions ◽

Analysis Study ◽

Factors Associated ◽

Factors Influencing

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Differences in Morphology, Cytoskeletal Architecture and Protease Production Between Zone II Tendon and Synovial Fibroblasts in vitro

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00140-2 ◽

2003 ◽

Vol 28 (5) ◽

pp. 465-470 ◽

Cited By ~ 12

Author(s):

R. RAGOOWANSI ◽

U. KHAN ◽

R. A. BROWN ◽

D. A. MCGROUTHER

Keyword(s):

Smooth Muscle Actin ◽

Adhesion Formation ◽

Synovial Fibroblasts ◽

Active Role ◽

Protease Production ◽

Filamentous Actin ◽

Alpha Smooth Muscle Actin ◽

Fibroblast Migration ◽

Zone Ii

Fibroblast migration is an integral component of the processes resulting in the formation of restrictive adhesions in the injured tendon, especially in Zone II. Pre-requisites for cell migration are an intact cytoskeleton and an ability to biochemically degrade the extra-cellular matrix. The relative characteristics of fibroblasts from the fibro-osseus sheath (SC), the tissue surrounding the tendon in Zone II, and the endotenon (TC) with respect to morphology, cytoskeletal structure and ability to produce matrix metalloproteinases (MMPs) 2 and 9 were compared in vitro. It was found that SCs were larger in size and demonstrated greater amounts of intra-cellular alpha-smooth muscle actin (α-SMA) and intra-membranous vinculin. Filamentous actin (F-actin) fibres in SCs were more densely packed and concentrated, resulting in stress fibres. The SCs also produce greater amounts of MMP-2 and MMP-9 compared to TCs. These observations imply that SCs play an active role in adhesion formation and should be specifically targeted to inhibit or treat tendon adhesions.

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Factors associated with delay in presentation among patients for oral cancer

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0067 ◽

2019 ◽

Vol 8 (12) ◽

pp. 1003-1071

Author(s):

Xinyan Zhang ◽

Dongling Liu ◽

Hongmei Dong ◽

Yuxiang Li ◽

Ye Zhang ◽

...

Keyword(s):

Oral Cancer ◽

Cancer Patients ◽

Lower Risk ◽

Cross Sectional Study ◽

Cancer Knowledge ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Factors Influencing ◽

Oral Cancer Patients

Aim: This study aimed to determine factors that influence delay in presentation among oral cancer patients. Materials & methods: A cross-sectional study with 128 Oral cancer patients receiving treatment from the Hospital of Stomatology, at Jilin University, in China, was conducted. Results: A total of 78 patients delayed seeking treatment for more than 3 weeks after noticing symptoms of oral anomaly. Patients who were male, farmers (Odds ratio [OR] = 2.617; 95% CI: 1.90–3.64), or currently smoking (OR = 4.651; 95% CI: 1.21–9.46), were more likely to delay. Patients alerted to the problem at a physical exam had much lower risk of delay than patients who discovered the disease independently (OR = 0.029; 95% CI: 0.01–0.30). Higher coping style scores (OR = 0.747; 95% CI: 0.47–1.18) and oral cancer knowledge scores (OR = 0.886; 95% CI: 0.60–2.01) were significantly correlated with shorter delays. Conclusion: Delay in presentation may be achieved through regular oral health screening and improved public education about factors influencing delay.

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“Flu-Floppers”: Factors Influencing Families’ Fickle Flu Vaccination Patterns

Clinical Pediatrics ◽

10.1177/0009922819901002 ◽

2020 ◽

Vol 59 (4-5) ◽

pp. 352-359 ◽

Cited By ~ 2

Author(s):

Benjamin N. Fogel ◽

Steven D. Hicks

Keyword(s):

Decision Making ◽

Influenza Vaccination ◽

Conceptual Framework ◽

Strong Predictor ◽

Common Reason ◽

Vaccination Rates ◽

Factors Associated ◽

Flu Vaccination ◽

Factors Influencing ◽

Vaccine Decision Making

While influenza vaccination in the prior year is a strong predictor of subsequent vaccination, many families do not have static vaccination patterns. This study examined factors guiding influenza vaccination decisions among parents whose children sporadically received the influenza vaccination (flu-floppers). We administered surveys to 141 flu-flopper families. Surveys included 21 factors associated with vaccine decision making. A conceptual framework of “passive” and “active” decision making was used to assess parental motivators behind vaccine decisions. The most common reason for vaccinating was a desire to prevent influenza (45%). The most common reason for not vaccinating was a belief that influenza vaccination is not effective (29%). Most parents (88%) reported an active reason in years when their child was vaccinated, while only 43% reported an active reason when their child was not vaccinated ( P < .00001). These findings may guide efforts to increase influenza vaccination rates in children most amenable to vaccination.

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Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.07.002 ◽

2004 ◽

Vol 29 (6) ◽

pp. 531-535 ◽

Cited By ~ 45

Author(s):

M. SIROTAKOVA ◽

D. ELLIOT

Keyword(s):

Primary Repair ◽

Early Mobilization ◽

Flexor Pollicis Longus ◽

Longus Tendon ◽

Active Mobilization ◽

Flexor Pollicis Longus Tendon

This study reports our treatment of divided flexor pollicis longus (FPL) tendons by primary repair from 1999 to 2002. Forty-eight FPL repairs were performed using two Kessler two-strand repairs with a cross-linked Silfverskiöld circumferential suture. All were rehabilitated by early active mobilization. Excellent or good results were observed in 73/77% of cases (White/Buck–Gramcko assessments, respectively). No patients (0%) ruptured their repair as a result of early active mobilization. Two patients (4%) developed post-operative infections with wound and tendon dehiscence. This combination of repairs addresses the problem of rupture of FPL during early mobilization which we experienced in previous studies. Its problems and alternatives are discussed.

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