A Prospective, Randomized Trial of Splinting After Minicarpal Tunnel Release.

PURPOSE: To determine if any significant differences exist in patient-reported or clinical outcomes among 3 different postoperative orthotic regimens: no orthosis, removable orthosis, and plaster nonremovable orthosis-following miniopen carpal tunnel release (CTR) surgery for symptomatic isolated carpal tunnel syndrome. METHODS: A total of 249 patients received a miniopen CTR and were subsequently randomized into 1 of 3 orthotic regimens: 80, no orthosis; 83, removable orthosis; and 86, nonremovable orthosis-to be removed at the first postoperative visit 10 to 14 days later. Patient-reported outcomes included the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) surveys, Levine-Katz Symptom Severity and Functional Status Scales, and Pain at Rest and in Action using the Numerical Pain Rating Scale. Clinical outcomes included wrist range of motion, grip, and lateral pinch strengths. All outcomes were evaluated bilaterally at 10 to 14 days, 6 weeks, and 3, 6, and 12 months after surgery by evaluators blinded to the assigned regimen. Demographic information was obtained before surgery, and complications were recorded throughout the study. RESULTS: There were no statistically significant differences in any patient-reported or clinical outcomes at any follow-up period except at 6 and 12 months: the lateral pinch strength of the nonremovable orthosis group with CTR in the dominant hand was weaker than both of the other groups. Patient demographic characteristics did not significantly influence the outcomes at any time. Scar tenderness was the most commonly observed complication followed by stiffness. There were 2 cases each of complex regional pain syndrome and superficial wound dehiscence and 1 case of wound infection that resolved with oral antibiotics. CONCLUSIONS: The postoperative orthotic regimen does not change any patient-reported outcome up to at least 12 months following miniopen CTR. Lateral pinch strength was weaker in the nonremovable orthosis group at 6 and 12 months. Our data do not support the use of any postoperative orthosis following routine miniopen CTR. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Complications of K-wire fixation in procedures involving the hand and wrist.

PURPOSE: Surgeons often use smooth K-wires for bone stabilization in the hand and wrist. The purposes of this study were to observe the incidence of postoperative complications of K-wire fixation in the hand and wrist and to identify associated risk factors. METHODS: A total of 189 patients underwent bone and soft tissue procedures in the hand and wrist with insertion of 408 smooth K-wires. All patients were instructed to comply with a uniform pin care protocol and were observed for a minimum of 1 examination after pin removal. Complications were categorized as minor or major, with 3 subcategories for infectious complications. We compared total complications and infectious complications with patient age, comorbidities, soft tissue integrity, pin exposure (external or buried), number of pins inserted, pin location, compliance with pin site care, and empiric antibiotic treatment. RESULTS: We found that 39 patients experienced postoperative complications involving 58 K-wires (14% of all pins). Most complications were minor, commonly superficial pin track infection (24 pins, 6% of all pins). Major complications occurred less frequently (11 pins, 3% of all pins) and included complications that led to additional surgery (deep infection, malunion, or nonunion) and fractures through the pin track. The development of an infectious complication was associated with 2 factors: pin location in the hand versus the wrist and poor compliance with pin site care. Patient age, medical comorbidities, soft tissue integrity, pin exposure, number of pins inserted, and empiric antibiotic treatment had no statistically significant relationships to the occurrence of complications. CONCLUSIONS: Complications with smooth K-wire fixation in the hand and wrist are relatively uncommon. Most complications involve minor, superficial pin track infections. Location of pins in the hand as compared with the wrist and poor patient compliance with pin site care may increase the risk of infection.