Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.

Langzeitergebnisse nach plastisch-chirurgischer Defektdeckung durch neurovaskulären Insel-Lappen bei Fingerkuppenverletzungen

Verletzungen der Fingerkuppen stellen einen häufigen Grund für die Vorstellung in der Notaufnahme dar. Während viele Verletzungen konservativ behandelt werden können, benötigen einige Patienten eine operative Versorgung. Dabei kommen verschiedene operative Verfahren zur Anwendung, darunter eine Fingerkuppenrekonstruktion mit einer neurovaskulären Insel-Lappenplastik. Ziel der neurovaskulären Insel-Lappenplastik ist die Wiederherstellung einer taktil sensiblen und wieder belastungsfähigen Fingerkuppe ohne ein Längendefizit des Fingers. In der vorliegenden Studie wurden Langzeit-Behandlungsergebnisse mit einer mittleren Nachuntersuchungsdauer von 105 Monaten bei 28 Patienten mit 29 durch neurovaskuläre Insel-Lappenplastiken rekonstruierten Fingerkuppen in der Berufsgenossenschaftlichen Unfallklinik Frankfurt am Main erfasst. Die untersuchten Patienten hatten zum Zeitpunkt der Verletzung ein Durchschnittsalter von 38,4 Jahren. Es handelte sich überwiegend um männliche und berufstätige Patienten. Es wurden nur Fingerkuppenverletzungen mit freiliegenden Knochen (Allen-Klassifikation Zone III und IV) operativ versorgt. In unserer Studie traten am häufigsten die Verletzungen am Mittelfinger, Zeigefinger und Ringfinger auf. Die Mehrheit der Fingerkuppenverletzungen geschah in Folge eines Arbeitsunfalls, die Arbeitsunfähigkeitsdauer betrug ca. 6,1 Wochen. Die maximale Größe eines neurovaskulären Insel-Lappen lag bei 6 x 3,5 cm. Alle Patienten waren mit den Behandlungsergebnissen anhand der numerischen Rating-Skala und des DASH Fragebogens bezüglich Funktionalität sowie dem ästhetischen Outcome zufrieden und würden sich wieder operieren lassen. Die Sensibilität konnte anhand der Zwei-Punkte-Diskrimination sowie Semmes-Weinstein Monofilament-Testes als gut bewertet werden und normale physiologische Werte erreichen. Die Narbe war überwiegend weich und in der Mehrheit der Fälle entsprach sie anhand der Vancouver Scar Scale Werte annähend der normalen Haut. Zwei Drittel der Patienten gaben keine Schmerzen in Ruhe an. Die Hälfte der Patienten gaben Schmerzen unter Belastung anhand der numerischen Rating-Scala an. Trotz der hohen Anzahl von Krallennagelbildungen in 56,5 % und einer Differenz der Nagellänge bzw. Form waren alle Patienten mit dem Erhalt des Nagels zufrieden und haben dies subjektiv nicht als störend empfunden. Als besonders beeinträchtigend wurde eine Kälteempfindlichkeit von 48,3 % Patienten beschrieben. Der Mittelwert der Fingerkraft im Schlüsselgriff mit Hilfe des Pinch-Gauge zwischen Daumen und den vier Fingerspitzen im Wechsel wurde bei fast allen Messungen an den gesunden Fingern gering größer gemessen ohne eine statistisch signifikante Differenz. Die Messung der Handkraft mittels Jamar-Dynamometer ergab ein Defizit von 8,8 % (Vergleich betroffene zur gesunden Hand). Bei drei von 24 Patienten hat sich eine Beugekontraktur im Interphalangealgelenk von 5°, 15°, 20° und bei einem von 22 Patienten im distalen Interphalangealgelenk von 10° gebildet. Zum Nachuntersuchungszeitpunkt wurden durch die Untersucherin ein Hoffmann-Tinel- Zeichen in 24,1 % und Druckschmerz in 17,2 % im Bereich der verletzten Fingerkuppe festgestellt. Subjektiv empfand kein Patient diese Symptome als störend und alle berufstätigen Patienten konnten ihre vor dem Unfall ausgeübte Tätigkeit wieder aufnehmen. Diese Studie konnte belegen, dass die Defektdeckung der Fingerkuppenverletzungen mit Hilfe von neurovaskulären Insel-Lappenplastiken ein sehr gutes ästhetisches und funktionelles Ergebnis mit einer fast identischen Hautqualität erzielt. Mit dieser Methode konnte eine Wiederherstellung des Weichteilgewebes der sensiblen Fingerkuppe auch bei großflächigen Defekten der Fingerkuppe erreicht werden. Die subjektive Patientenzufriedenheit mit dieser Rekonstruktionsmethode ist hoch.

A Study on The Effects of the Absence of Palmaris Longus Tendon on Handgrip Strength of Athletes

The study aims to find out the incidence of the absence of palmaris longus tendon and to study the effects of the case on handgrip strength of athletes. We studied whether 190 athletes (male n= 80, mean age: 18.9� 2.2; female n= 110, mean age: 18.5� 1.2) included in our study had palmaris longus tendon or not. Then, the handgrip strength values of the athletes were obtained by using a Jamar dynamometer, according to the recommendations of the American Association of Hand Therapists. Total number of participants having no palmaris longus tendon was 59 (31.05%) and it was observed that 37(19.47%) of these individuals didn�t have the tendon in both hands. The number of participants with unilateral tendon absence was 22 (11.5%). The tendon was absent in right hand of 10 individuals (5.26%) and in left hand of 12 individuals (6.31%). After controlling age, height, body weight and body mass index variables of the groups, it was observed that the presence or the absence of palmaris longus tendon in both hands of male athletes didn�t cause any statistical effects on handgrip strength of the athletes. However, left handgrip strength of female athletes with palmaris longus tendon in left hand was found to be higher than left handgrip strength of female athletes with no palmaris longus tendon (p[.01). According to the findings of the study, we might state that the presence or the absence of palmaris longus tendon does not cause a significant effect on handgrip strength of both hands of male athletes (p].05) and that its presence causes a significant effect on left handgrip strength of female athletes (p[.01).

Validating the Capability for Measuring Age-Related Changes in Grip-Force Strength Using a Digital Hand-Held Dynamometer in Healthy Young and Elderly Adults

Background. Grip-force performance can be affected by aging, and hand-grip weakness is associated with functional limitations of dasily living. However, using an appropriate digital hand-held dynamometer with continuous hand-grip force data collection shows age-related changes in the quality of hand-grip force control may provide more valuable information for clinical diagnoses rather than merely recording instantaneous maximal hand-grip force in frail elderly adults or people with a disability. Therefore, the purpose of this study was to indicate the construct validity of the digital MicroFET3 dynamometer with Jamar values for maximal grip-force assessments in elderly and young adults and confirmed age-related changes in the maximal and the quality of grip-force performance using the MicroFET3 dynamometer in elderly people. Methods. Sixty-five healthy young (23.3±4.5 years) and 50 elderly (69.5±5.8 years) adults were recruited and asked to perform a validity test of the grip-force maximum voluntary contraction (MVC) using both the dominant and nondominant hands with a Jamar dynamometer and a MicroFET3 dynamometer. Results. A strong correlation of maximal grip-force measurements was found between the MicroFET3 dynamometer and Jamar standard dynamometer for both hands in all participants (p<0.05). Although, the results showed that a lower grip force was measured in both hands by the MicroFET3 dynamometer than with the Jamar dynamometer by 49.9%~57% (p<0.05), but confidently conversion formulae were also developed to convert MicroFET3 dynamometer values to equivalent Jamar values for both hands. Both dynamometers indicated age-related declines in the maximum grip-force performance by 36.7%~44.3% (p<0.05). We also found that the maximal hand-grip force values generated in both hand by the elderly adults were slower and more inconsistent than those of the young adults when using the MicroFET3 dynamometer. Conclusions. This study demonstrated that the digital MicroFET3 dynamometer has good validity when used to measure the maximal grip force of both hands, and conversion formulae were also developed to convert MicroFET3 dynamometer force values to Jamar values in both hands. Comparing with the Jamar dynamometer for measuring grip force, the MicroFET3 dynamometer not only indicated age-related declines in the maximum grip-force performance but also showed slower and more inconsistent maximal hand-grip strength generation by the elderly.

The study of the correlations between handgrip strength and some anthropometric characteristics of upper extremity of elite and sub-elite Olympic style weightlifting athletes

Background and Study Aim: Handgrip strength is widely used as a functionality parameter of the upper extremity and general health. The measurement of handgrip strength by dynamometry is a low cost, noninvasive method of simple applicability. The study aims to find out handgrip strength and its correlation with some anthropometric characteristics of the upper extremity and weightlifting performance of elite (international medalists) and sub-elite (national medalists) Olympic style weightlifting athletes. Material and Methods: We obtained anthropometric measurements of upper extremity of elite athletes (n=25 male, n= 20 female) and sub-elite athletes (n=25 male, n=29 female) in the study. Dominant and non-dominant handgrip strength measurements of the groups were obtained by a Jamar dynamometer, according to the recommendations of the American Association of Hand Therapists. Results:No statistically significant difference was observed in non-dominant handgrip strength of male elite and sub-elite weightlifting athletes. Similarly, no significant difference was observed in between some anthropometric characteristics of upper extremity and dominant and non-dominant handgrip strength of female elite and sub-elite weightlifting athletes. We didn’t find any asymmetry between dominant and non-dominant handgrip strength of study groups. We found a significant correlation between dominant and non-dominant handgrip strength of male and female elite athletes and their height, body weight, BMI and weightlifting performance. Conclusions: Consequently, we might explain that adding special exercises into the general trainings of athletes to develop handgrip strength might contribute to the weightlifting performance of the athletes.

Comparing the Camry dynamometer to the Jamar dynamometer for use in healthy Colombian adults

Objective: Hand grip strength can provide an objective index of general upper strength, but hand dynamometer has not been validated for use in Colombia. The objective was to determine the interchangeability between Camry electronic and Jamar hydraulic hand grip dynamometers in a population found on the campus of the Universidad Nacional de Colombia and the elderly living in a community. Methods: This was a cross-sectional concordance study on 18-88-year-old males and females. Data regarding their demographics, health, and anthropometric variables were collected/measured and the Lin concordance correlation coefficient (CCC) along with Bland-Altman plots were used for evaluating concordance regarding both devices. Results: One hundred and thirty-three subjects participated in this study (average age 47±20.74 years-old). Right hand (RH) grip strength was 32.15 ± 9.96 kg with the Jamar dynamometer and 29.95 ± 9.18 kg with the Camry device. It is worth highlighting that the Jamar instrument presents higher values than the Camry instrument (p <0.05). CCC was only significant at the population level and for the 40-59-year-old age group. Bland-Altman plots had narrow limits of agreement. Conclusion: We concluded that the Camry dynamometer could replace the Jamar dynamometer in the 40-59-year-old age group; furthermore, it would be appropriate for medical use in patient monitoring or follow-up due to the close values observed.

Extended dynamometry: reference values

Grip strength is used as a measure of capacity in disability and personal injury claims. Although seemingly an objective measure, it is widely recognized that it is fallible to the effects of sub-maximal effort. We have developed an extended test protocol that uses the five positions of a Jamar dynamometer. The protocol mitigates the effect of inconsistency while retaining the ability to detect sub-maximal effort. Dynamometry was undertaken in 242 volunteers (male:female, 124:118) with a median age of 39 years (range 18–89, interquartile range 29–52). Normative values for consistency, curve deviation and variation from the expected curve pattern are provided. None of these measures were significantly affected by laterality, hand dominance, sex or age despite the effects of these variables on grip strength. The study defines the methodology and reference values to allow assessment of both the capacity of a patient and the reliability of the test for use in medicolegal practice. Level of evidence: II