RESUMEN

A consecutive group of 250 patients underwent medico-legal assessment at a mean of 24 (±13) months following upper limb injuries. Each had completed questionnaires to assess function (Quick-DASH) and cold intolerance (CIQ36) before clinical assessment following which their whole limb impairment percentage was calculated. The mean(±SD) whole limb impairment, QDASH and CIQ36 scores were 9(±14)%, 43(±24) and 17(±10), respectively. There was a significant correlation between whole limb impairment and QDASH, although some patients reported surprisingly high disability levels despite minimal or no objective functional impairment. Whilst useful qualitative information can be obtained from questionnaires, the correlation between subjective and objective scores is weak albeit statistically significant. Individual patients can show marked discrepancies between objective and subjective functional scores. The results of questionnaires in individual medico-legal patients should be treated with caution.

Asunto(s)

RESUMEN

Four hundred adult claimants underwent medico-legal assessment following upper limb injuries. Dynamometry was performed on each using the Jamar five handle-position test. Injury causes loss of power and there is a significant relationship between the percentage loss of power and the measured whole limb impairment. This paper presents a new approach for the analysis of the tests. The normal physiological length-tension pattern of muscle is maintained in the majority of claimants albeit with modifications due to the specific effects of injury on hand function. This paper provides normative data for the analysis of dynamometry in this population and makes recommendations for parameters that suggest that a test is a true reflection of capacity and thus useable in court.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND AND AIM: The options for treating patients with Dupuytren's contracture have broadened with the introduction of collagenase. Although the literature would suggest that collagenase treatment is effective, has few complications and is popular with patients, it has not been widely commissioned by the National Health Services of the United Kingdom and other European countries due to concerns about cost. The aim of this study was to compare the cost of surgical fasciectomy to collagenase injections for the treatment of Dupuytren's contracture in a single centre. METHOD: Prospective data on 40 patients undergoing fasciectomy or collagenase injection (20 patients in each group) were collected between January and March 2013. Financial data on the costs of the procedures, equipment, theatre time and follow-up appointments were calculated. RESULTS: The average cost of an open partial fasciectomy pathway was £ 7115.34 and that of a collagenase pathway was £ 2110.62. Eight collagenase patients had physician-led follow-up appointments and only three had hand physiotherapy appointments. By contrast, every fasciectomy patient had at least one physician and one physiotherapist follow-up appointment routinely. CONCLUSION: The results of this study demonstrate that collagenase treatment for Dupuytren's contracture of a single digit in selected patients is just over £ 5000 less than treatment for the same condition using surgical fasciectomy. Collagenase-treated patients require much less physician- and physiotherapist-led postoperative follow-up.

Asunto(s)

RESUMEN

INTRODUCTION: Patient reported outcome measures are central to National Health Service quality of care assessments. This study investigated the benefit of elective hand surgery by the simultaneous analysis of pain, function and appearance, using a three-dimensional (3D) graphical model for evaluating and presenting outcome. METHODS: A total of 188 patients scheduled for surgery completed pre- and postoperative questionnaires grading the severity of their pain, dysfunction and deformity of their hand(s). Scores were plotted on a 3D graph to demonstrate the degree of 'normalisation' following surgery. RESULTS: Surgical groups included: nerve compression (n=53), Dupuytren's disease (n=51), trigger finger (n=20), ganglion (n=17) or other lump (n=21), trapeziometacarpal joint osteoarthritis (n=10), rheumatoid disease (n=5) and other pathology (n=13). A significant improvement towards normality was seen after surgery in each group except for patients with rheumatoid disease. CONCLUSIONS: This study provides a simple, visual representation of hand surgery outcome by plotting patient scores for pain, function and appearance simultaneously on a 3D graph.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Forty-three hands in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated randomly to undergo a trapeziectomy through either an anterior approach or the posterior (dorsoradial) approach. Forty hands were available for review at a median of 33 months postoperatively. The demographic characteristics, severity of disease and pre-operative measurements of the two groups were indistinguishable. Trapeziectomy resulted in significantly improved objective and subjective function in both groups, but the anterior approach group had better outcomes for power, scar tenderness and satisfaction. Scar-related complications were three times more common in the posterior group. Trapeziectomy is a good method of treating osteoarthritis of the thumb base, but outcomes for the anterior approach are equally good or better than with the posterior.

Asunto(s)

RESUMEN

Deliberate self-harm is common. It is usually by drug overdose or ingestion of other noxious substances, but self-harm by cutting or burning often comes to the attention of plastic surgeons. We report three variant cases involving insertion of paperclips, a ballpoint pen cartridge and sewing needles into the forearm. We discuss the management considerations of each case and emphasise the importance of actively addressing the underlying psychiatric problems for all instances of deliberate self-harm.

Asunto(s)

Asunto(s)

RESUMEN

Forty isolated, sharp digital nerve divisions, which had been repaired by microsurgical techniques, were reviewed between 12 and 36 months postoperatively (mean, 20 months). Half of the repairs had been splinted beyond the immediate postoperative period and half had not. Non-splinted patients returned to work significantly quicker than those who were splinted. Splinted patients reported more stiffness and cold intolerance but splinting made no difference to either the measured sensibility or movement of the digit. We would conclude that, after repair of sharp, uncomplicated digital nerve divisions, splinting beyond the immediate postoperative period is at least unnecessary and may be deleterious.

Asunto(s)

RESUMEN

Interruption of appropriate therapeutic warfarin therapy imposes a risk of morbidity and mortality on the patient. Strategies to reduce the risks of interruption impose relatively large costs in terms of prolonged hospital stay, medication and coagulation monitoring. We report a series of 47 consecutive surgical episodes on the hands of 39 patients without interruption of therapeutic warfarin anticoagulation and with an INR of between 1.3 and 2.9. There was no difficulty with intraoperative haemostasis. Two patients had minor bleeding-related complications with no long-term sequelae. The authors conclude that interruption to warfarin therapy is unnecessary if the INR is less than 3.0 and therefore inappropriate for therapeutically anticoagulated patients undergoing hand surgery.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

We randomly selected 39 patients undergoing excision of the trapezium for osteoarthritis of the first carpometacarpal joint into two groups, with mobilisation either at one or at four weeks after operation. The patients were reviewed at a median of six months (6 to 8). The clinical details, the severity of the disease and the preoperative clinical measurements of both groups were similar. Excision of the trapezium resulted in significant improvement in objective and subjective function. Comparison of the outcomes of the two groups showed no differences except that patients found early mobilisation significantly more convenient. Although there was no significant difference in the range of movement between the groups, there was a small loss of movement at the metacarpophalangeal joint in the late mobilisation group. Our findings show that simple excision of the trapezium is an effective procedure for patients with carpometacarpal osteoarthritis of the thumb and that prolonged splintage is neither necessary nor desirable.

Asunto(s)

RESUMEN

Seventy-one plastic surgeons and therapists, of varying levels of seniority and experience, were asked to examine a resin cast of an adult male hand and use estimation to measure the angles of the metacarpophalangeal and interphalangeal joints of each digit. Visual estimation by all subjects was inaccurate by a mean of approximately 25% (median percentage error 22, range 1-100). Consultants were the most accurate, whilst physiotherapists were the least. Regular goniometer users were no more accurate. However, hand surgery experience correlated with accuracy, as did a stated interest in hand surgery. Although visual accuracy improves with experience, it is still an inaccurate technique. We, therefore, recommend that goniometers should be used for measuring angles in hand surgery patients.

Asunto(s)

Asunto(s)

RESUMEN

Skin grafting is a well established technique for reconstructing areas of skin loss or excision in the hand. Traditional tie-over sutures often require operator assistance, do not allow adequate control when knotting and may cause unnecessary trauma to the graft when removed. We describe a new looped suture tie-over technique to secure and fix the graft dressings that is simple, quick, allows better knot-tying control and can be removed atraumatically.

Asunto(s)