Translation of a patient-surgeon relationship assessment instrument (Q-PASREL) into six languages.

The Questionnaire for Patient-Surgeon Relationship (Q-PASREL) is a French "Patient-Reported Experience Measure" for hand surgery patients. It is the only one which considers the impact of the patient-surgeon relationship on time to return to work and cooperation by the surgeon for administrative issues. It has been shown that a good Q-PASREL score is associated with shorter sick leave and faster return to work. To make this instrument available to more countries, we translated the Q-PASREL into six languages (English, Spanish, German, Italian, Arabic and Persian), following a validated "translation and cultural adaptation" process guideline. This process includes multiple forward and backward translations, discussions and reconciliations with final harmonization and cognitive debriefing. For each language, a team was set up, comprising a key in-country hand surgery consultant, native target-language speaker and fluent in French, and several forward and back translators. The final translated versions were reviewed and approved by the project manager. The six versions of Q-PASREL are now available in the appendices of this publication.

[Implant arthroplasty in the metacarpophalangeal and proximal interphalangeal finger joints]. / Übersicht über die Endoprothetik an den Fingergrund- und Mittelgelenken.

BACKGROUND: Osteoarthritic changes in the finger joints are common, especially in the elderly population. Without adequate treatment, these changes can lead to pain, joint deformity, instability or impaired motion. Operative treatment options can be divided into prosthetic joint replacement, joint fusion and denervation. PATIENTS/MATERIAL AND METHOD: During the last decades, various prosthetic implant designs have appeared on the market. This article provides an overview of implant evolution, current implants, clinical results and promising technical novelties. RESULTS: Due to favourable clinical long-term results, low revision rates and low costs, the proven silicone spacer has been the gold standard since the 1960 s. In the index and middle finger, lateral stability is crucial to providing a counter bearing to the thumb for a strong key pinch. Medullary-anchored prostheses and modular surface replacement designs have a higher intrinsic stability and may thus be advantageous in the index and middle finger. These implants show promising clinical medium-term results. CONCLUSION: In the past, technical novelties from big joint replacements could not automatically be translated to the finger joints and other parts of the hand. However, new trends such as customised or 3D-printed prosthetic implants are slowly beginning to gain importance in hand surgery.

[Implant Arthroplasty in the Hand and Wrist]. / Endoprothetik an der Hand und am Handgelenk.

Implant Arthroplasty in the Hand and Wrist Abstract. The first implant arthroplasties were conducted as early as the end of the 19th century. After a few decades, during which surgeons focused on the hip and knee, research on joint arthroplasty of the hand and wrist was intensified. Today, it is possible to implant a prosthesis in nearly every joint of the hand and wrist, giving us an alternative to joint fusion in severe joint destruction. The main advantage of arthroplasty is the preservation of motion. In the metacarpophalangeal and proximal interphalangeal joint every new implant is rivaled by the silicone spacer which has proven its value over decades. Further, no implant in the thumb carpometacarpal joint was able to outmatch the time-tested trapezectomy with LRTI (ligament reconstruction and tendon interposition) due to high implant-loosening rates in the past. In wrist arthroplasty, studies have shown good results concerning pain reduction, function and grip strength. Complication rates however are still higher compared to joint fusion. The results improved with the latest implant designs, yet long-term outcomes, especially for the young, high-demand patients, are missing.

Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients.

BACKGROUND/AIM: Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis often associated with an underlying disease, and clinical data or larger studies are rare. METHODS: In this retrospective study, disease characteristics, clinical manifestations, and treatment response were evaluated in a Swiss cohort of PG patients. RESULTS: In participating centers, 34 cases (21 females) of PG were analyzed based on clinical and histological presentation between 2002 and 2012. The mean age at diagnosis was 61.2 years; 50% of the patients experienced only 1 episode of PG. In 13 cases (out of 20), recurrences occurred during PG therapy; 64.1% showed only 1 lesion simultaneously. The predominant localization was the lower limb (67%). The lesions were disseminated in 26.6%. At the time of diagnosis or recurrence, the mean diameter was 37.6 mm and the mean ulcer size was 10.3 cm2. C-reactive protein (CRP) was elevated in 73.2%; leukocytosis was present in 58.9% and neutrophilia in 50.9%. At least 1 associated comorbidity was present in 85% (the most prominent being cardiovascular disease). The most often used systemic treatments were steroids (68.3%), cyclosporine A (31.7%), dapsone (31.7%), and infliximab (13.3%), and the most often used topicals were tacrolimus 0.1% (48.3%) and corticosteroids (35%). PG healed completely at discharge in 50.8%. The average time to diagnosis was 8 months, and the mean duration to healing was 7.1 months. CONCLUSION: PG is a difficult-to-diagnose skin disease. Here, markers for inflammation such as CRP, leukocytosis, and neutrophilia were elevated in 50-73% of the PG patients.