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Tobler-Ammann B, Beckmann-Fries V, Calcagni M, Kämpfen A, Schrepfer L, Vögelin E. Outcomes of 218 primary single-finger flexor tendon repairs up to 1 year after surgery: a multicentre cohort study. J Hand Surg Eur Vol 2023; 48:911-919. [PMID: 37401125 DOI: 10.1177/17531934231184737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
In this retrospective multicentre cohort study, we present the results of primary single-finger flexor tendon repairs in zones 1 to 3 between 2014 and 2021. Data from 218 patients were retrieved with their demographics, injury and surgery characteristics and therapy outcomes. The data were systematically collected and analysed at predefined time points up to 1 year after surgery. A good to excellent return of motion was achieved by 77% (Tang classification) and 92% (American Association for Surgery of the Hand classification) of patients at 1 year. The tendon rupture rate was 8.7%. Time had a significant impact on the recovery of finger motion and grip strength of up to 1 year, of patient satisfaction and upper extremity function up to 26 weeks, and of pain up to 13 weeks after surgery. Our results demonstrate that it is worthwhile to assess therapy outcomes over various measurement periods, as some outcomes may continue to improve up to 1 year after flexor tendon repair surgery.Level of evidence: III.
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Tobler-Ammann BC, Beckmann-Fries V, Calcagni M, Kämpfen A, Schrepfer L, Vögelin E. Outcomes of Primary Flexor Tendon Repairs in Zones 2 and 3: A Retrospective Cohort Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:445-453. [PMID: 37521557 PMCID: PMC10382891 DOI: 10.1016/j.jhsg.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/31/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The aims of this retrospective cohort study were to present outcomes of zone 2 and 3 primary flexor tendon repairs and to evaluate how clinical outcomes change over time within and between zones of injury at weeks 6, 13, and 26. Methods Data were retrieved from a multicenter flexor tendon cohort registry from 2014 to 2021. The inclusion criteria were: (1) adult patients after primary flexor tendon surgery in zone 2 or 3, (2) flexor digitorum profundus laceration of >50%, (3) 4-6 multistrand flexor digitorum profundus core suture, and (4) early active motion protocol. The primary outcome was the range of motion. Secondary outcomes were strength, patient satisfaction on an 11-point Likert scale, and self-reported physical function measured with the Disability of the Arm, Shoulder, and Hand questionnaire 6, 13, and 26 weeks after surgery. Results We evaluated 33 patients after 39 tendon repairs in zone 3 and 174 repairs in zone 2 of 163 patients. Range of motion significantly improved over time in both zones (P < .001 to .01). Between-group range of motion differences were nonsignificant except for week 26 (P < .001) for the zone 3 group. Hand strength significantly improved in both zones over time (P < .001 to .01), while between-zone strength differences were statistically nonsignificant (P = .37 to .93). Patient satisfaction was generally good to high (mean 6.8 to 8.0 points) with significant within-group changes in both zones (P < .001). There were no relevant between-zone differences in Disability of the Arm, Shoulder, and Hand scores at any time point. Conclusions Patients had significantly improved clinical outcomes in both zones. The zone of injury significantly affected the total active motion scores at the final assessment after 26 weeks for the zone 3 injuries. For the secondary outcomes hand strength, patient satisfaction, and Disability of the Arm, Shoulder, and Hand scores, we discovered no significant between-group differences. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | - Vera Beckmann-Fries
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexandre Kämpfen
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Lorena Schrepfer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
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Lotter O, Lieb T, Molsner J, Breul V. Predictors for Clinical Outcomes Related to Upper Extremity Musculoskeletal Disorders in a Healthy Working Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179171. [PMID: 34501760 PMCID: PMC8430676 DOI: 10.3390/ijerph18179171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
A wide range of endpoints and methods of analysis can be observed in occupational health studies in the context of work-related musculoskeletal disorders (WMSDs). Comparison of study results is therefore difficult. We investigated the association between different clinical endpoints and the presence of upper extremity WMSDs in a healthy working population. Furthermore, the influence of socio-demographic, work-related, and individual predictors on different endpoints was examined. Two self-administered questionnaires were distributed to 70 workers and employees. In addition, a standardized physical examination and an industry test were performed in this cross-sectional study. Correlations between WMSDs and clinical endpoints were analyzed with the Spearman method and prediction ellipses. Multiple regression models were used to study the strength of associations with a pre-defined set of potential influencing factors. The prevalence of WMSDs was 56% (39/70). Disabilities of Arm, Shoulder, and Hand (DASH) score/pain under strain showed the strongest correlations with WMSDs. When analyzing the correlation between WMSDs and pre-selected predictors, none of the predictors could be identified as a risk factor. The DASH score remains a close candidate for best surrogate endpoint for WMSDs detection. Standardized analysis methods could improve the methodological quality of future occupational health studies.
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Affiliation(s)
- Oliver Lotter
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Academic District Hospital, Zeppelinstrasse 21, 78532 Tuttlingen, Germany
- Correspondence: ; Tel.: +49-7424-950-4491; Fax: +49-7424-950-4499
| | - Tobias Lieb
- Office for Occupational and Hand Therapy, Neuhauser Strasse 85, 78532 Tuttlingen, Germany;
| | - Jochen Molsner
- IAS-Group for Occupational Health Management, Koenigstrasse 6, 78532 Tuttlingen, Germany;
| | - Viktor Breul
- Department of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz, 78532 Tuttlingen, Germany;
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Hosokawa T, Tajika T, Suto M, Chikuda H. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores in 961 Japanese volunteers. J Orthop Surg (Hong Kong) 2021; 28:2309499020970656. [PMID: 33169638 DOI: 10.1177/2309499020970656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes recently have been used to assess treatment outcomes. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is a particularly convenient and useful tools. However, data on the normative values of Japanese population are lacking, so the present study was conducted to gather this information. METHODS We assessed 1098 volunteers over 18 years of age (363 men and 735 women, average 50 years old) who had not received upper limb treatment in a medical facility. These participants included our institution's staff, their family members, and the participants in the group meetings held by institution's staff. Their occupations were also examined. We divided occupations into nonmanual and manual labor. These factors of the participants were then analyzed to clarify which (if any) influenced the QuickDASH. RESULTS Valid answers were obtained from 961 subjects (87.5%). The median score was 2 (mean: 4.8) in the overall population, 0 (mean: 2.6) in men, and 2.5 (mean: 6.0) in women. The scores increased with age and were higher in women than in men. There were no significant differences by manual labor. Female sex and older age were identified as factors that influenced the QuickDASH score in the multiple regression analysis. There were high correlations among QuickDASH, work and sports/music scores. CONCLUSIONS The present study provided QuickDASH scores for Japanese volunteers who had not received upper limb treatment in a medical facility. The scores were associated with older age and female sex. This study helps us to know the degree of potential upper limb impairment in the general population, and will help in populational strategies as primary and secondary preventive medicine for upper limb-related diseases.
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Affiliation(s)
- Takafumi Hosokawa
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan.,Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Morimichi Suto
- Department of Orthopaedic Surgery, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Demetri L, Lans J, Gottlieb R, Dyer GSM, Eberlin KR, Chen NC. Long-term Patient-Reported Outcomes After Surgery for Hypothenar Hammer Syndrome. Hand (N Y) 2020; 15:407-413. [PMID: 30417693 PMCID: PMC7225894 DOI: 10.1177/1558944718810860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: This study aims to describe the long-term patient-reported outcomes after surgery for hypothenar hammer syndrome (HTHS) and to identify factors associated with inferior outcomes. Methods: We retrospectively identified 27 patients who underwent surgical intervention for HTHS from 2002 to 2016. Fifteen patients (56%) completed outcome questionnaires: Quick Disabilities of the Arm, Shoulder, and Hand, Cold Intolerance Symptom Severity (CISS) survey, Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test, and Patient-Reported Outcomes Measurement Information System Pain Interference Computer Adaptive Test. The median questionnaire follow-up was 7.2 years (interquartile range, 3.1-9.9). Outcomes were compared across different surgical techniques, and the influence of patient-related factors on outcomes was also evaluated. Results: Six (40%) patients experienced complete symptom resolution, 6 (40%) had improvement without complete resolution, 1 (7%) had resolution followed by recurrence, and 2 (13%) reported no improvement. The most common symptom after surgical intervention was cold intolerance. Questionnaire scores were similar across ligation, direct repair, and vein graft vascular reconstruction. Patients had better CISS scores if they had surgery on their nondominant hand (13.2 vs 38.6) and did not have a manual labor job (18.1 vs 40.5). Conclusions: Surgery for HTHS leads to moderate long-term improvement in patient-reported outcomes. Different surgical techniques yield similar symptomatic relief. Manual labor and surgery of the dominant hand are associated with worse CISS scores.
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Affiliation(s)
- Leah Demetri
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Jonathan Lans
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Rachel Gottlieb
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - George S. M. Dyer
- Harvard Medical School, Boston, MA, USA,Brigham and Women’s Hospital, Boston, MA, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Neal C. Chen
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA,Neal C. Chen, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
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Lotter O, Lieb T, Breul V, Molsner J. Is Repetitive Workload a Risk Factor for Upper Extremity Musculoskeletal Disorders in Surgical Device Mechanics? A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1383. [PMID: 32098053 PMCID: PMC7068592 DOI: 10.3390/ijerph17041383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 02/20/2020] [Indexed: 11/25/2022]
Abstract
To assess the prevalence of upper extremity work-related musculoskeletal disorders (WMSDs) among surgical device mechanics compared to a control group, a total of 70 employees were included and assigned to three occupational groups (grinders, packers, and control). Personal factors, work exposure, manual skill, and complaints were assessed by two self-administered questionnaires and an industry test. WMSDs were diagnosed in a standardised clinical examination. The two-one-sided t-tests (TOST) procedure was used to test the clinical equivalence of the respective grinding and packaging groups vs. the control group in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score. Thirty-nine study participants (56%) experienced at least one WMSD at the elbow, forearm, and/or wrist, mainly with signs of epicondylitis and nerve entrapment at the medial elbow. The risk of grinders developing upper extremity WMSD was about 2.5-times higher and packers had an 8.6-fold higher risk of a clinically relevant DASH > 29 compared to the control group. However, these differences were not statistically significant. The groups were also proven to be clinically equivalent in terms of DASH score. Surgical device mechanics do not seem to have worse DASH values or be at higher risk of upper limb WMSDs compared to a control group. This is the first study to analyse and compare different workplaces in this industry that are also common in other industries.
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Affiliation(s)
- Oliver Lotter
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Academic District Hospital, Zeppelinstrasse 21, 78532 Tuttlingen, Germany
| | - Tobias Lieb
- Office for Occupational and Hand Therapy, Neuhauser Strasse 85, 78532 Tuttlingen, Germany;
| | - Viktor Breul
- Department of Medical Scientific Affairs, Aesculap AG, Am Aesculap Platz, 78532 Tuttlingen, Germany;
| | - Jochen Molsner
- IAS-Group for Occupational Health Management, Koenigstrasse 6, 78532 Tuttlingen, Germany;
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Stahl S, Hentschel PJH, Santos Stahl A, Meisner C, Schaller HE, Manoli T. Comparison of clinical and radiologic treatment outcomes of Kienböck's disease. J Orthop Surg Res 2015; 10:133. [PMID: 26306571 PMCID: PMC4550042 DOI: 10.1186/s13018-015-0276-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/09/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose The clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck’s disease (KD) progression exists. Methods Out of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups. Results There were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant. Conclusions The study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease. Level of evidence Therapy, level III, retrospective comparative study with prospectively collected data.
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Affiliation(s)
- Stéphane Stahl
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Pascal J H Hentschel
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Adelana Santos Stahl
- Department for Plastic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany.
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University of Tübingen, Silcherstr. 5, 9572076, Tübingen, Germany.
| | - Hans-Eberhard Schaller
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Theodora Manoli
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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Simon P, Unterhauser F, von Roth P, Schmidmaier G, Winkler T. [Treatment of Mason type II radial head fractures by percutaneous reduction]. Unfallchirurg 2015; 117:341-7. [PMID: 23494162 DOI: 10.1007/s00113-012-2340-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The therapeutic algorithm for the treatment of Mason type II radial head fractures is still controversially discussed. This study describes the technique of percutaneous fracture reduction without additional internal fixation of the radial head as an alternative to open reduction and presents the results of the method. MATERIAL AND METHODS The data from 26 out of 30 patients with a Mason type II radial head fracture who had been consecutively treated with percutaneous fracture reduction were evaluated retrospectively. The analysis comprised the disabilities of shoulder and hand (DASH) score, the Mayo elbow performance score (MEPS) and data from the radiological examinations. RESULTS The average follow-up time was 21 months (range 6-47 months). In 22 cases (85 %) an anatomical reduction could be achieved, 2 cases (8 %) showed a complete redislocation of the fragment and 2 cases (8 %) a partial redislocation. The average DASH score was 5.6 points (range 0-56) and the average MEPS was 93.8 (range 60-100). Only 4 patients (15 %) reported persisting functional impairment with a DASH score >10. CONCLUSIONS The method of percutaneous reduction of radial head fractures without additional internal fixation in Mason type II fractures has been demonstrated to be a good alternative to open reduction.
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Affiliation(s)
- P Simon
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Freie und Humboldt-Universität Berlin, Charitéplatz 1, 10117, Berlin, Deutschland,
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King PR, Ikram A, Lamberts RP. The treatment of clavicular shaft fractures with an innovative locked intramedullary device. J Shoulder Elbow Surg 2015; 24:e1-6. [PMID: 24950947 DOI: 10.1016/j.jse.2014.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Displaced and shortened clavicular shaft fractures can be treated by intramedullary fixation; however, hardware migration and soft tissue irritation at the insertion site have complicated its use. The aim of this study was to determine whether the new Sonoma CRx intramedullary device (Sonoma Orthopedic Products Inc, Santa Rosa, CA, USA) could be used successfully to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of shoulder without the development of secondary complications. METHODS Displaced and shortened clavicular shaft fractures in 47 consecutive patients were treated with the CRx device. Incision size was captured during the surgical procedure. The union rate was evaluated postoperatively. Shoulder function was assessed by Disabilities of the Arm, Shoulder and Hand (DASH) score, the Constant Shoulder Score, and a range of motion score. Patients were assessed after 3 to 6 months (group I), 6 to 9 months (group II), or 9 to 12 months (group III) postoperatively. RESULTS Union was achieved in all patients at the time of review, without any incidence of hardware migration. Postoperative complications developed in 3 patients, comprising infection in 1 and hardware failure in 2. No differences among the groups were found for the DASH score (P = .33), Constant Shoulder Score (P = .38), and range of motion score (P = .96). The DASH, Constant Shoulder, and range of motion scores were similar to other successful treatment options, such as plating. CONCLUSION The Sonoma CRx is a good alternative device to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of the shoulder. Future research should focus on when nailing and plating should be used to treat clavicular shaft fractures most optimally.
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Affiliation(s)
- Paul R King
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Ajmal Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint. Arch Orthop Trauma Surg 2014; 134:1633-9. [PMID: 25288029 DOI: 10.1007/s00402-014-2092-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period. MATERIALS AND METHODS Eleven patients (range 21-50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46-114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)). RESULTS A mean DASH score of 6.7 (range 0-22.5) and mean MMWS of 91.8 (range 75-100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases. CONCLUSIONS Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.
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Klum M, Wolf MB, Hahn P, Leclère FM, Bruckner T, Unglaub F. Normative data on wrist function. J Hand Surg Am 2012; 37:2050-60. [PMID: 22960029 DOI: 10.1016/j.jhsa.2012.06.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE In clinical day-to-day life, grip strength, key pinch, and range of motion (ROM) serve to objectively evaluate treatment outcomes on wrist interventions. The goals of this study were to generate normative values of wrist function including the parameters of grip strength, key pinch, wrist ROM, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores in a healthy, working population, and to investigate the influence of age, sex, body weight and height, handedness, and work strain. METHODS We clinically examined 750 volunteer working subjects (363 women and 387 men, all white). We divided subjects into 2 groups depending on whether their labor involved high or low manual strain. We recorded participants' height, weight, grip strength, pinch strength, and wrist ROM. Each participant filled out a DASH questionnaire. RESULTS Grip strength and pinch strength showed a maximum at between 30 and 49 years of age. In men, body mass index, body height, and weight all correlated with grip strength and pinch grip. Whereas women exhibited greater grip strength on the right side, men showed nonsignificant greater grip strength on the left side. Wrist ROM was greatest for ages ranging between 18 and 29 years. The average DASH value for all male subjects was significantly less than that of female subjects. In a healthy working population, the DASH score increased yearly by an average of 0.2 points in men and 0.3 points in women. CONCLUSIONS This study showed that in a healthy working population, people 30 to 49 years of age had the highest grip strength and pinch strength. Age positively correlated with the DASH score and inversely related to wrist ROM. Persons employed in jobs with high manual strain presented with lower wrist ROM and higher DASH scores. CLINICAL RELEVANCE These data help to objectively evaluate wrist function and the effectiveness of therapeutic interventions.
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Affiliation(s)
- Matthias Klum
- Department of Hand Surgery, Vulpius Klinik, Bad Rappenau, Germany
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Manz S, Wolf MB, Leclère FM, Hahn P, Bruckner T, Unglaub F. Capsular imbrication for posttraumatic instability of the distal radioulnar joint. J Hand Surg Am 2011; 36:1170-5. [PMID: 21636224 DOI: 10.1016/j.jhsa.2011.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze functional and subjective outcomes of patients with posttraumatic dorsal instability of the distal radioulnar joint (DRUJ) treated by a dorsal capsular imbrication. METHODS We reviewed 11 patients (7 men and 4 women) with posttraumatic instability of the DRUJ who were treated by a capsular imbrication. The patients ranged in age from 18 to 48 years (average, 33 y). The duration of symptoms before surgery ranged from 3 weeks to 6 months (average, 5 mo). We evaluated subjective outcome measurements such as the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, questions regarding symptoms of pain and instability, and overall satisfaction. Objective outcome measurements were physical examination, standard radiographs, and a review of any surgical complications. Patients were asked whether they experienced wrist tenderness with applied pressure, swelling, scar sensitivity, or pain. We determined functional outcome using the Modified Mayo Wrist Score including range of motion and grip strength. The score was used to evaluate the surgical technique and enable comparison with other surgical methods used to treat instability of the DRUJ. RESULTS After surgery, the total mean DASH score was 15 points. Range of motion, grip strength, pain, and overall function resulted in a mean Modified Mayo Wrist Score of 88 points, and therefore a good functional outcome. Three patients were noted to have persistent mild DRUJ instability on the stress test but did not have symptoms. The only intraoperative or postoperative complications observed were transient paresthesias on the ulnar side of the hand. CONCLUSIONS Capsular imbrication for posttraumatic instability of the DRUJ is a highly effective procedure with few complications and good functional and subjective results even in cases with concomitant healed fractures of the radius or ulnar styloid. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Stefanie Manz
- Department of Hand Surgery, Vulpius Klinik, Bad Rappenau, Vulpiusstrasse 29, 74906 Bad Rappenau, Germany
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