Pyrolytic carbon hemiarthroplasty in the management of proximal interphalangeal joint arthritis.

PURPOSE: To review clinical, subjective, and radiographic results of pyrocarbon hemiarthroplasty for proximal interphalangeal (PIP) joint arthritis. METHODS: A total of 42 fingers in 38 patients underwent PIP joint hemiarthroplasty between 2005 and 2011. Preoperative diagnoses included 28 with osteoarthritis or posttraumatic arthritis and 10 with inflammatory arthritis. Average age at the time of surgery was 56 years. Digits treated included: index (10), middle (20), ring (9), and little (3). Average follow-up was 4.6 years (minimum, 2 y). RESULTS: There was considerable improvement in patient satisfaction measures including Canadian Occupational Performance Measure for both performance and satisfaction and Disabilities of the Arm, Shoulder, and Hand and visual analog scale pain scores. There was no significant change in motion or grip and pinch strength after surgery. Four joints were revised for failure: 3 underwent arthrodesis and 1 was converted to a silicone PIP joint arthroplasty. Radiographic outcomes in surviving implants demonstrated a Sweets and Stern grade 0 in 37 implants and grade 3 in 1. CONCLUSIONS: Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. Clinical and patient satisfaction outcomes compared favorably with published outcomes of arthroplasty. Radiographic outcomes of PIP joint hemiarthroplasty were encouraging with respect to implant position and loosening. Compared with total joint arthroplasty, proximal hemiarthroplasty is a simple procedure that preserves more bone stock and would allow for better success of salvage options such as arthrodesis and revision arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Identification of three novel FGF16 mutations in X-linked recessive fusion of the fourth and fifth metacarpals and possible correlation with heart disease.

Nonsense mutations in FGF16 have recently been linked to X-linked recessive hand malformations with fusion between the fourth and the fifth metacarpals and hypoplasia of the fifth digit (MF4; MIM#309630). The purpose of this study was to perform careful clinical phenotyping and to define molecular mechanisms behind X-linked recessive MF4 in three unrelated families. We performed whole-exome sequencing, and identified three novel mutations in FGF16. The functional impact of FGF16 loss was further studied using morpholino-based suppression of fgf16 in zebrafish. In addition, clinical investigations revealed reduced penetrance and variable expressivity of the MF4 phenotype. Cardiac disorders, including myocardial infarction and atrial fibrillation followed the X-linked FGF16 mutated trait in one large family. Our findings establish that a mutation in exon 1, 2 or 3 of FGF16 results in X-linked recessive MF4 and expand the phenotypic spectrum of FGF16 mutations to include a possible correlation with heart disease.

A qualitative study of coping in the early stage of acute traumatic hand injury.

Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.

Patient-controlled regional analgesia (PCRA) at home: controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia.

BACKGROUND: The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. METHODS: Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery. RESULTS: Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection. CONCLUSIONS: This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.