Defining Key Features in Patient Perspectives of Hand Aesthetics.

BACKGROUND: The hand is highly visible and contributes to an individual's aesthetic image and perceived age. Current perspectives on hand aesthetics are primarily based on expert opinion rather than on lay population perspectives, which are less understood. Our study explores general population perceptions on the features that contribute most to an attractive hand. METHODS: Participants rated the attractiveness of 20 standardized hands as well as the appearance based on each characteristic: freckles, hair presence, skin tone, wrinkles, vein appearance, and soft tissue volume. The relative importance of each feature was assessed by comparison with overall attractiveness scores through multivariate analysis of variance. RESULTS: A total of 223 participants completed the survey. Soft tissue volume ( r = 0.73) was most strongly correlated with overall attractiveness, followed by wrinkles ( r = 0.71), skin tone consistency ( r = 0.69), veins ( r = 0.65), freckles ( r = 0.61), and hair ( r = 0.47). Female hands were perceived as more attractive, with a mean rating of 4.7 of 10, compared with 4.4 in males ( P < 0.001). Participants correctly identified the gender of 90.4% of male hands and 65.0% of female hands. Age was strongly inversely correlated with attractiveness ( r = -0.80). CONCLUSIONS: Soft tissue volume is the most important factor in lay perception of hand aesthetics. Female and younger hands were perceived as more attractive. Hand rejuvenation may be optimized by prioritizing soft tissue volume with filler or fat grafting, with secondary priority on resurfacing to address skin tone and wrinkling. An understanding of the factors most important to patients in aesthetic appearance is critical to achieving a pleasing result.

Trapeziectomy, Partial Trapezoidectomy, and Abductor Pollicis Longus Dual Loop Ligament Reconstruction for Advanced Basal Joint Arthritis: Long-Term Outcome of 150 Cases.

BACKGROUND: Although hand surgeons usually concur that arthroplasty is indicated for disabling basal joint arthritis, controversy persists regarding the preferred surgical methods. This article describes a novel technique of trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus (APL) dual ligament reconstruction, and reports the long-term results of 150 cases. Based on this experience, we hypothesize that this technique is a reliably effective and durable surgical option for basal joint arthritis. METHODS: This study evaluated consecutive patients with Eaton and Littler advanced stage III/IV basal joint arthritis, treated by this procedure, and followed for a minimum of 10 years. Outcome assessment included grip and pinch strength, thumb mobility, radiographic parameters, pain relief, and patient-reported outcomes as measured with the Disabilities of the Arm, Shoulder, and Hand (DASH) scoring system. RESULTS: A total of 150 thumbs in 124 patients with an average follow-up of 13.5 years (range, 10-22 years) were studied. Alleviation of pain and patient satisfaction were constant outcomes, and the mean DASH score was a normative 8.7. Grip and pinch strength were significantly improved (P < .001), carpometacarpal joint malalignment and adduction deformities were consistently corrected, complications were few, and revision surgery was unnecessary. CONCLUSIONS: These results support the premise that trapeziectomy and partial trapezoidectomy with APL dual ligament stabilization is a reliable and durable arthroplasty for basal joint arthritis with distinct advantages and equally favorable outcomes when compared with other frequently employed methods.

Distal Radius Fractures in the Elderly: Use of the Volar Bearing Plate.

BACKGROUND: Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate. METHODS: We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity. RESULTS: Fifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured -0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes. CONCLUSIONS: Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.

An enigmatic brainstem posterior fossa ganglioglioma in an adult.

Ganglioglioma is a rare central nervous system neoplasm representing 0.4% to 1.7% of all brain tumors and most frequently occurs in the pediatric population with an incidence of 7.6%. These tumors are usually slow-growing and well-circumscribed solid or cystic lesions. Gangliogliomatosis infrequently occurs in the frontal lobe, pineal gland, basal ganglia, hypothalamus, and optic chiasm, with very few reports of brainstem ganglioglioma. We report a case of a 35-year-old female who initially presented with headache, vertigo, ataxia, saccadic dysfunction, dysarthria, and dysmetria for several years due to an unknown etiology. Her brain imaging showed multiple lesions in the pons and the cerebellum with cystic changes and size reduction and enlargement over the next few years while her neurological symptoms continued to worsen. The patient received courses of steroid treatment that improved her neurological symptoms, suggesting an inflammatory component of her disease. Extensive workup for an inflammatory or infectious etiology was unfruitful and two brain biopsies were inconclusive. A third biopsy showed atypical glial nuclei, binucleated cells, and Rosenthal fibers and the presence of BRAF V600E mutation was detected. The diagnosis of gangliogliomatosis was consequently established. This case illustrates that gangliogliomatosis may present with the waxing-and-waning neurological signs and symptoms. It can masquerade inflammatory processes in the central nervous system on brain imaging and deserves careful consideration in the diagnosis of patients with an indolent course of neurological deterioration.