Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace.

STUDY DESIGN: Retrospective cross-sectional case series. BACKGROUND: Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ. PURPOSE: In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint. METHODS: Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values. RESULTS: The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p <0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29) with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative). CONCLUSION: The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment.

BACKGROUND: We examined the visibility of fractures of hand and forearm in whole-body CT and its influence on delayed diagnosis. This study is based on a prior study on delayed diagnosis of fractures of hand and forearm in patients with suspected polytrauma. METHODS: Two blinded radiologists examined CT-scans of patients with fractures of hand or forearm that were diagnosed later than 24 h after admission and control cases with unremarkable imaging of those areas. They were provided with clinical information that was documented in the admission report and were asked to examine forearm and hands. After unblinding, the visibility of fractures was determined. We examined if time of admission or slice thickness was a factor for late or missed diagnoses. RESULTS: We included 72 known fractures in 36 cases. Of those 65 were visible. Sixteen visible fractures were diagnosed late during hospital stay. Eight more fractures were detected on revision by the radiologists. Both radiologists missed known fractures and found new fractures that were not reported by the other. Missed and late diagnoses of fractures occurred more often around 5 pm and 1 am. Slice thickness was not significantly different between fractures and cases with fractures found within 24 h and those found later. CONCLUSIONS: The number of late diagnosis or completely missed fractures of the hand and forearm may be reduced by a repeated survey of WBCT with focus on the extremities in patients with suspected polytrauma who are not conscious. LEVEL OF EVIDENCE: III.

Results of a special interdisciplinary hand therapy program for work-related injuries.

The importance of postoperative care of hand injuries is undisputed, but sometimes more intensive therapy is needed. The objective of this study was to evaluate the benefits of a specialized hand rehabilitation program supervised by hand surgeons. The outcomes and short-term follow-up of 76 patients with upper extremity injuries were analyzed through patient self-reported parameters as well as objective functional scores. Improvement in all self-assessed parameters during rehabilitation was statistically significant for the DASH (p<0.001) as well as the EQ-5D (p<0.05). Further improvement in the short-term (14 weeks) was only seen for the DASH score (p<0.05). During rehabilitation, there was a statistically significant improvement in all objective measurements. Among patients with finger injuries, 71% were able to return to work. Our specialized hand rehabilitation program provides benefits for all patients. There are differences between types of upper extremity injuries in terms of the effects and necessary treatments.

Proximal interphalangeal joint arthrodesis using a compression wire: A comparative biomechanical study.

Arthrodesis of the proximal interphalangeal joint is a proven technique for treating of a range of pathological conditions, including osteoarthritis. There are multiple surgical procedures. A biomechanical study was conducted to compare the stability of a compression wire to intraosseous wiring for the arthrodesis. Seventeen formalin-fixed human fingers were randomly assigned into two groups and the bone mineral density was determined. Arthrodesis in 20° flexion was performed using an oblique compression wire (n=8) or intraosseous wiring (n=9). The stability of the arthrodesis was tested by applying a tensile bending force until failure. The mean force needed to fail the compression wire arthrodesis and intraosseous wire arthrodesis was not significantly different (76.2N, SD 31N and 63.0N, SD 28N). There was no correlation between bone density and force to failure. The compression wire was within the approximate range achieved by intraosseous wiring in withstanding substantial force before failure. From a biomechanical point of view, a compression wire is feasible for PIP arthrodesis.

[Rehabilitation after flexor tendon injuries of the hand]. / Rehabilitation nach Beugesehnenverletzungen an der Hand.

BACKGROUND: Advances in basic research evaluating suture material, techniques, and maximum tendon load with regard to repair site failure help to decide between rehabilitation protocols after the repair of flexor tendon injuries. OBJECTIVES: The presentation and choice of rehabilitation protocols depending on the mechanism of injury and knowledge of the influencing factors concerning tendon load. Expected outcome after flexor tendon repair. METHODS: Evaluating recent literature and basic research investigations, and presenting expert opinions. RESULTS: Based on the mechanism of injury, the suture technique, the compliance of the patient, and the latest knowledge on tendon capacity help to choose from the basic principles of rehabilitation protocols: passive or early motion protocols, such as those described by Duran-Houser and Kleinert, in the majority of cases lead to good and fair results according to the Hand Functional Score of the American Society for Surgery of the Hand. A larger number of excellent functional results are seen after the rehabilitation of flexor tendon injuries using combined passive/active or completely active motion protocols, e.g., according to Small. In addition to choosing a specific protocol and considering different zones of injury, it is essential to thoroughly supervise therapy and to monitor the adjustment of splints. It is widely recommended that patients should be provided with additional scar treatment and physical therapy throughout their entire rehabilitation. CONCLUSIONS: Flexor tendon injuries, especially in zone 2, are still a challenge with regard to operative treatment and rehabilitation, with an unpredictable outcome. Further knowledge and advances in suture techniques and material will support the use of active motion protocols and improve functional results in the future.

[Operative options for rectification after failed osteosynthesis of the distal radius]. / Operative Rückzugsmöglichkeiten nach fehlgeschlagener Osteosynthese des distalen Radius.

BACKGROUND: Even in an era of clear improvements in implants and standardized treatment procedures, abortive osteosynthesis after distal radius fractures is not an uncommon complication. DIAGNOSTICS: Although not every malunion of the radius leads to complaints, affected patients often suffer from limitations in movement, reduction in strength, pain and aesthetic deficits. Following thorough clinical and imaging diagnostics a selection from the possible treatment options must be made taking the results obtained from the diagnostics into consideration. THERAPY: Operative possibilities are available for reconstructing the anatomical features as accurately as possible, functional improvement without correction of the malunion, pain reduction alone and combined procedures. CONCLUSION: Despite abortive osteosynthesis of distal radial fractures there are possibilities for anatomical reconstruction, retention of mobility and pain reduction. Taking the pathological deformities into consideration, the highest priority should be given to reconstructing the anatomical joint conditions as accurately as possible, even when the conservative treatment options were unsuccessful.