Corrective Osteotomy of Malunited Fractures of the Distal Radius Using a Combined Surgical Approach

Background: Malunited distal radius (DR) fractures following conservative treatment range from 6% to 80% of clinical observations. Surgical treatment is used to return the articular surface of the radius to original anatomical position and to restore the natural transfer of strength, wrist kinematics, and function of the entire hand. The aim of this research was to study and analyze the results of corrective osteotomy of malunited distal radius fractures using a combined approach. Methods: From 2008 to 2018, 43 patients with malunited DR fractures who underwent surgery using a combined approach were followed up. Long-term results (1 year after surgery) were studied in detail in 32 patients. Indications for surgery were determined taking into account, first, complaints of severe pain in the wrist during exertion, decreased hand strength, and limited mobility of the wrist. Results: Five patients (15.6%) reported a number of minor complications: intra-articular screw placement (2), incorrect reposition (1), transient neuropathy of the superficial branch of the radial nerve (1), and delayed fracture consolidation (1). In addition, another 5 patients reported the progression of wrist arthritis. Suppurations of the surgical wound and malunited fragments were not reported. Conclusions: During reconstructive interventions, a combined approach with palmar plating provides optimal conditions for corrective osteotomy, adequate reposition and plastic repair of the bone defect, and minimization of the number of complications.

Carpal tunnel syndrome: Does preoperative disease severity influence the outcome of mini-open surgery?

In the practice of carpal tunnel surgery, open decompression of the median nerve in carpal tunnel syndrome (CTS) is recognized as the therapeutic priority. However, the speed and completeness of postoperative recovery of sensitivity and function depend on the initial clinical manifestations of the disease and the severity of the electrophysiological disorder. The aim of this study was to investigate the influence of preoperative clinical and electrophysiological factors on the outcome of surgical treatment of patients with CTS of varying severity. One-hundred and eighty-nine open decompressions of the median nerve via a mini-open incision were performed in 161 patients with idiopathic CTS. Clinical observations were classified in 5 groups, according to severity. Treatment results were evaluated per group at 6 weeks and 3, 6 and 12 months after surgery. In all cases, there was improvement and positive dynamics according to clinical and electroneuromyographic data. Open decompression of the median nerve via mini-open incision can achieve significant clinical and functional improvement in the majority of patients with CTS. However, the most favorable results were mainly seen in patients with initial severity classified in the first, second and third (lower severity) groups.

Opening-wedge V-shaped corrective osteotomy for malunited fractures of metacarpal bones

Currently, the most commonly used method of treatment of patients with fractures of the metacarpal bones is closed reposition with immobilization of short-arm cast. This often leads to dislocation of fragments, their malunion, which leads to wrist functionality disorders and reduces the quality of patients' life. The main way to eliminate the deformities ‒ osteotomy of the metacarpal bones, followed by osteosynthesis. Purpose of the study ‒ to give a clinical assessment of the results of surgical treatment of patients with posttraumatic deformities of the Metacarpals, based on the use of a new method of corrective osteotomy. Methods. The proposed new method V-shape open angle of the osteotomy of the metacarpal bones whit malunion, followed by subsequent fixation of mini-plates (RF Patent for the invention No. 2651893 from February 20, 2017). The long-term results (in one year) of treatment of five operated patients with the consequences of closed fractures of the fourth and fifth metacarpal bones are presented. The state of the bone corn was studied by standard x-rays of the hand in two projections and by computed tomography. The angular deformity of the fragments was measured, the range of active movements in the metacarpophalangeal joints and the grip force were determined. Pain intensity was assessed by visual analogue scale, day-by-day activity-by DASH test, the results were divided into excellent, good, satisfactory and unsatisfactory by Buechler table. The frequency and nature of postoperative complications were also analyzed. Results. In all clinical cases, positive outcomes were obtained: angular deformity was corrected, the range of motion in the metacarpophalangeal joints and grip strength improved, and the functional parameters of the hand increased. In one clinical case stiffness was formed in the metacarpophalangeal joint, which required revision operation. Summary. Corrective V-shaped osteotomy of the metacarpal bones at the top of their deformation allows to restore the alignment of the fragments and prevent shortening of the bone. The use of stable osteosynthesis with low-profile mini-plates makes possible early functional management of patients, which prevents stiffness in the joints of the fingers.

Trigger finger: assessment of surgeon and patient preferences and priorities for decision making

PURPOSE

To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons.

METHODS

One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid.

RESULTS

Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids.

CONCLUSIONS

Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TF-differences that might be addressed by a decision aid.

CLINICAL RELEVANCE

Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making

PURPOSE

This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid).

METHODS

One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid.

RESULTS

Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process.

CONCLUSIONS

There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures.

CLINICAL RELEVANCE

Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.