RESUMO
Background: There is no clear census as to which operative technique provides better recovery for radial nerve injuries. Therefore, in this systematic review, we examined the functional recovery, patient-reported outcomes, and complications of tendon transfer (TT) and nerve transfer (NT). Methods: Five electronic databases were searched for studies (>10 cases per study) comparing NT and TT regardless of the study design (observational or experimental). Manual search was also conducted. The quality was assessed by the NIH tool. Outcomes included functional recovery, patient-reported outcomes (DASH score, satisfaction, and inability to return to work), and complications. The prevalence was pooled across studies using STATA software, and then, a subgroup analysis based on the intervention type. Results: Twenty-one studies (542 patients) were analyzed. Excellent recovery, assessed by the Bincaz scale, was higher in the TT group (29 % vs. 11 %) as well as failure to extend the fingers (49 % vs. 9 %). No significant difference was noted between both groups regarding DASH score (mean difference = -2.76; 95 % CI: -12.66: 6.93). Satisfaction was great in the TT group (89 %) with a limited proportion of patients unable to return to work (7 %). Complications were slightly higher in the TT group (8 % vs. 7 %) while 18 % of patients undergoing TT requiring revision surgery. Radial deviation was encountered in 18 % of patients in the TT group and 0 % in the NT group. The quality was good, fair, and poor in 2, 13, and 6, respectively. Conclusions: In radial nerve injuries, although tendon transfer may seem to provide better functional motor recovery than nerve transfer, it is associated with a higher rate of failure to extend the finger. Given the large confidence interval, the accuracy of this finding is questioned. However, a great proportion of those patients require revision surgery afterward. Additionally, tendon transfer is associated with a greater complication rate than nerve transfer, particularly radial deviation.
RESUMO
Rice bodies, a rare finding in clinical practice, are commonly observed in the shoulders and knees of affected individuals. However, they can occur in the wrist as well. Herein, we report a case of a female presenting with painful swelling in the right wrist that lasted with a history of carpal tunnel syndrome, rheumatoid arthritis, and history of median nerve decompression two years ago. A potential diagnosis of infectious diseases and gout was excluded through negative cultures and laboratory findings. X-rays showed no significant findings; however, magnetic resonance imaging revealed findings suggestive of rice bodies that were confirmed by additional proton dense fat-saturated imaging. The mass was then removed by extensive debridement and sent for pathological assessment, which showed multiple nodules containing fibrin and polymorphonuclear cells. The patient did not experience recurrence during the follow-up period. Rice bodies, although rare, can occur in the wrist, and this imposes several challenges associated with their diagnostic and management protocols.
