Atypical forearm fractures associated with long-term bisphosphonate use: the perspective of a hand surgeon

Bisphosphonates have been widely used to treat osteoporosis, but atypical femoral fractures have emerged as serious complication. Similar fractures of the forearm have been reported since 2010 and retrospective studies have revealed a number of details. Clinicians should remember that bisphosphonates can affect all bony structures in the body. When misdiagnosed as an ordinary fracture and treated with surgical fixation, unexpected nonunion may occur. Therefore, I would like to share our experience from the perspective of a hand surgeon.

Stenosing flexor tenosynovitis of the hand (trigger finger)

Trigger finger is the second cause of consultation with the hand surgeon. In 2009, Kerrigan published a strategy for the treatment of this pathology, which consists of two infiltrations with corticosteroids in the sheath of the flexor tendons at the level of the A1 pulley, followed by percutaneous or open surgical release, following the algorithm described by the author. 140 files that met the inclusion criteria were analyzed. It was found that the female gender is the most frequently affected during the sixth decade of life in 46%. The most frequently affected finger is the third, affects the right hand in 44% and both hands in 29%. 91% of the patients received a first infiltration and only 31% of these received a second infiltration. The surgical procedure was decided in 33% of the patients. The longest follow-up was 180 months and the shortest was 3 months with 100% of asymptomatic patients. The algorithm proposed by Kerrigan in the treatment of this pathology is a good strategy that has a high success rate without having to perform a surgical procedure as the first treatment option.

BENEFITS OF THE WALANT TECHNIQUE AGAINST THE COVID-19 PANDEMIC

ABSTRACT Objective: Evaluate the experience of private and public health services with the WALANT procedure in the COVID-19 pandemic. Methods: This is a retrospective, multicenter longitudinal study gathering cases of hand surgery subjected to the WALANT technique in the Hospitals Dr. Radamés Nardini and IFOR during the COVID-19 pandemic (August 2020). As a parameter, the verbal numerical rating scale for twenty patients referring to the preoperative, intraoperative and postoperative periods was applied. Results: The patients did not feel any pain during surgery, which showed the efficiency of the anesthetic technique in its purpose. Conclusion: The results indicate the WALANT technique as beneficial when facing the COVID-19 pandemic, as the main differential of the technique is that it is applied by a well-trained orthopedic hand surgeon. Level of Evidence IV, Case Series.

Avascular necrosis with non-union of the scaphoid managed with a dorsal pedicled vascularised bone graft of the distal radius – a case report

Avascular necrosis (AVN) of the scaphoid is common following proximal pole fractures due to an arduous retrograde arterial vascular supply and it is a challenge to the hand surgeon. The treatment for scaphoid non-union with avascular necrosis is vascularized or non-vascularized bone grafts. Non vascularised bone grafts (NVBGs) can be categorized as autograft or allograft and cancellous or cortical bone grafts. Vascularised bone grafts promote biological healing and revascularizes ischaemic bone and they are free or pedicled grafts. Pedicled vascularised bone grafts maintain the vascular supply of the donor bone graft and this leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the non-vascularised graft with good clinical and radiological outcomes. In this paper, we have treated avascular necrosis of scaphoid with a pedicled vascularised bone graft based on the 1, 2 intercompartmental supraretinacular artery (1, 2-ICSRA) that resulted in a favourable outcome.

Assessment of Telemedicine and Phone Consultation Effects on Rate of Hand Transfers to Trauma Centers and Specialty Services Referrals

Background Telemedicine consultation can increase patients’ access to subspecialty care and decrease the number of unnecessary hospital transfers. In 2014, the Arkansas Hand Trauma Telemedicine Program (AHTTP) was established to extend specialized hand care throughout Arkansas. The purpose of this study is to assess whether transfers are affected when consultation with a hand specialist is performed by phone compared with using a live audiovisual consultation. Methods We reviewed data from the first year of the AHTTP. Data collection included type of consultation (telephone only or live audiovisual), need for transfer, and type of transfer (general orthopedic or hand specialist). Results In 2014, the first year of AHTTP there were 331 hand injuries identified; of those, 298 used the AHTTP with 195 (65%) using telemedicine and 103 (35%) using phone consultation only. The use of video when compared with phone consultation did not significantly affect the decision to transfer ( P = .42) or alter the rate of transfer for general orthopedic or hand specialist care ( P = .25). Conclusions The assessment of both phone and telemedicine modalities showed that there was no significant difference in transfer rates for either consultation, highlighting that communication with a hand surgeon was the key to accurate assessment of the need for transfer.

Adapting to the COVID-19 pandemic: a survey of UK and European hand surgery units

Hand surgery services had to rapidly adapt to the coronavirus disease 2019 (COVID-19) pandemic. The aim of the Reconstructive Surgery Trials Network #RSTNCOVID hand surgery survey was to document the changes made in the United Kingdom and Europe and consider which might persist.A survey developed by the Reconstructive Surgery Trials Network, in association with the British Association of Hand Therapists, was distributed to hand surgery units across the UK and Europe after the first wave of COVID-19. It was completed by one consultant hand surgeon at each of the 44 units that responded.Adult and paediatric trauma was maintained but elective services stopped. Consultations were increasingly virtual and surgery was more likely to be under local anaesthetic and in a lower resource setting.Many of the changes are viewed as being beneficial. However, it is important to establish that they are clinically and cost effective. These survey results will help prioritise and support future research initiatives.

Jain’s hand retractor system and stand: an innovative device for hand surgery

Solo hand surgery is becoming increasingly common, mostly due to a lack of assistants and dedicated operating theatres. The solo hand surgeon faces challenges of proper hand positioning, elevation, and skin flap/tissue retraction. Most commercially available hand retractors or stands do not address all the relevant problems and are not economically feasible for trainee surgeons. The Jain’s hand retractor system and stand, described herein, provides solutions to all these problems, and its simple design helps surgeons to reproduce it easily.

Considerations for Hand Surgery in Patients With Scleroderma

Systemic sclerosis (scleroderma, SSc) is an autoimmune disease that causes significant dysfunction to multiple organ systems, including the musculoskeletal system. It poses significant challenges to the hand surgeon, including calcinosis, ischemic changes, Raynaud phenomenon, tendinopathies, synovitis, and joint contractures. Patients with SSc also suffer from multiorgan dysfunction, which makes them high-risk surgical patients. The hand surgeon must understand the pathophysiology, treatment strategies, and special operative considerations required in this population to avoid complications and help maintain or improve hand function.

The Inter- and Intra-observer Reliability of Three Methods for Evaluating Carpal Collapse

Background: Kienbock’s disease is a rare and debilitating condition. The decision for surgical intervention majorly depends on the extent of the carpal collapse. Therefore, the accurate measurement of carpal collapse is of critical importance. Objectives: The current study assessed the inter and intra-observer reliability of the three most frequent methods in measuring carpal height and determining carpal collapse. Methods: Fifty-Nine photocopied radiograms were reviewed by three observers (one senior orthopedic resident, one fellowship-trained hand surgeon, and one senior radiology resident) at 3 consecutive time points. Besides, one-week intervals were considered between the evaluations. The evaluated measures included the Carpal Height Ratio (CHR), Revised Carpal Height Ratio (RCHR), and Capitate-Radius (CR) index. The reliability of the measurements in determining the carpal height was examined using the Intraclass Correlation Coefficient (ICC). The agreement of the measures on determining the presence or absence of the carpal collapse was assessed by Cohen’s Kappa (K) value. Results: The overall inter and intra-observer reliability of the CR index in quantifying the carpal collapse was measured as 0.863 and 0.942, respectively. The overall inter and intra-observer reliability of CHR in quantifying the carpal collapse was computed to be 0.615 and 0.891, respectively. The overall inter and intra-observer reliability of RCHR in quantifying the carpal collapse equaled 0.412 and 0.792, respectively. The overall K for determining the presence or absence of a carpal collapse was calculated as 0.776, 0.683, and 0.549 for CR index, CHR, and RCHR, respectively. Conclusion: The CR index is the most reliable approach to measure carpal height. Furthermore, it is appropriate for determining the presence or absence of carpal collapse.