Prospective Randomized Clinical Trial Comparing 3-Point Prefabricated Orthosis and Elastic Tape Versus Cast Immobilization for the Nonsurgical Management of Mallet Finger.

PURPOSE: The purpose of this randomized trial was to compare the outcomes of using a 3-point prefabricated orthosis with elastic tape versus cast immobilization for the management of nonsurgical mallet finger. METHODS: This study was conducted in a single center. Individuals with a mallet injury requiring nonsurgical management were randomized to 6 weeks of full-time immobilization with either a 3-point prefabricated orthosis and elastic tape or a cast for distal interphalangeal joint extension. Outcomes were assessed at 12 weeks after the initiation of full-time immobilization and 6 months after injury. RESULTS: A total of 70 individuals agreed to participate in the study between April 2017 and April 2021. No statistically or clinically significant differences were found between the groups regarding distal interphalangeal joint extension lag, distal interphalangeal joint flexion deficits, function according to the brief Michigan Hand Outcome Questionnaire, and pain on the Numeric Pain Rating Scale. The overall findings for both treatment groups included means of <15° of extensor lag and minimal pain (mean, <1.2 of 10) at the 6-month outcome assessment. CONCLUSIONS: The use of a 3-point prefabricated orthosis with elastic tape and cast are both appropriate immobilization options for the management of nonsurgical mallet finger. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Comparing Morbidities of Bone Graft Harvesting from the Olecranon Process and the Distal Radius.

UNLABELLED: The aim of this study is to compare donor-site morbidities between patients who underwent bone graft harvesting from either the olecranon process (OP) or the distal radius (DR). METHODS: We evaluated 44 patients who underwent bone graft harvesting from the OP (25 cases) or the DR (19 cases) for various procedures in the ipsilateral upper extremity. Follow-up averaged 14 (OP group) and 19 months (DR group). Outcome measures included visual analog scales (VAS) for graft harvest-site pain and scar appearance, joint motion, and x-rays of the graft harvest and recipient sites. The VAS scores ranged from 0 to 10 with a low score reflecting no pain and excellent satisfaction and a high score reflecting severe pain and poor satisfaction. RESULTS: The VAS scores for pain averaged 0.4 (OP) and 0.5 (DR), and the VAS scores for scar appearance averaged 0.3 (OP) and 0.7 (DR). These differences were not significant. Within each group, there were no significant differences between the operative and nonoperative limbs for elbow or wrist motion. Early graft harvest-site complications involved 1 superficial wound infection (OP) and 1 wound dehiscence (DR). A graft harvest-site defect was detected by x-ray in 84% of OP cases and in 67% of DR cases. Bone healing at the graft recipient sites was observed in more than 87% of cases in both groups. CONCLUSIONS: Bone graft harvesting from either the OP or the DR led to comparable patient- and evaluator-determined outcomes with low risks of complications. Surgeons can safely use either option.

Flexor superficialis abductor transfer with carpal tunnel release for thenar palsy.

PURPOSE: In patients with advanced chronic carpal tunnel syndrome (CTS) the ability of the thumb to abduct and perform functional opposition is impaired greatly, primarily because of denervation and paralysis of the abductor pollicis brevis muscle. The purpose of this study was to evaluate the results of transfer of the flexor digitorum superficialis to the abductor pollicis brevis for restoration of thumb abduction in thenar paralysis caused by advanced chronic CTS. METHODS: Fifty patients (51 hands) with advanced CTS and loss of thumb abduction had a flexor digitorum superficialis transfer (37 small, 10 ring, 4 middle finger donors) to the abductor pollicis brevis with simultaneous carpal tunnel release (49 of 51 endoscopic). Thirty patients (60%) were women with an average age of 70 years (range, 35-90 y). Forty-three patients (84%) were in their sixth through eighth decades. We analyzed retrospectively preoperative and postoperative abduction, abduction strength, thenar muscle recovery and function, and patient satisfaction and complications. RESULTS: All patients reported improved thumb and hand function. Thumb abduction increased almost 20 degrees and 3 British Medical Research Council strength grades. Abduction was improved by the transfer in all patients, with some thenar recovery found in 35 of 40 cases followed-up longer than 12 months. Harvest of the flexor digitorum superficialis from the ring and middle fingers was associated with donor finger proximal interphalangeal joint contracture, although harvest from the small finger was not. CONCLUSIONS: Carpal tunnel release with simultaneous flexor digitorum superficialis-to-abductor pollicis brevis transfer provides satisfactory results for patients with profound CTS and thenar paralysis. The use of the small finger superficialis as the donor motor has minor morbidity compared with other methods and has predictable improvement and patient satisfaction. This transfer method is combined easily with endoscopic carpal tunnel release (as in 49 of our 51 cases), 2-portal, or open method releases.