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Seasonal variability, in terms of warm weather, has been demonstrated to be a significant risk factor for surgical site infections (SSIs). However, this remains an underexposed risk factor for SSIs, and many clinicians are not aware of this. Therefore, a systematic review and meta-analysis has been conducted to investigate and quantify this matter. METHODS: Articles were searched in Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar, and data were extracted from relevant studies. Meta-analysis used random effects models to estimate and compare the pooled odds ratios (OR) and corresponding confidence intervals (CIs) of surgery performed during the warmest period of the year and the colder period of the year. RESULTS: The systematic review included 20 studies (58,599,475 patients), of which 14 studies (58,441,420 patients) were included for meta-analysis. Various types of surgical procedures across different geographic regions were included. The warmest period of the year was associated with a statistically significant increase in the risk of SSIs (OR 1.39, 95%CI: [1.34-1.45], P < 0.0001). Selection of specific types of surgical procedures (eg, orthopedic or spinal surgery) significantly altered this increased risk. CONCLUSIONS: The current meta-analysis showed that warm weather seasons are associated with a statistically significant risk increasement of 39% in developing SSIs. This significant risk factor might aid clinicians in preoperative patient information, possible surgical planning adjustment for high risk patients, and potentially specific antibiotic treatments during the warmer weather seasons that could result in decrease of SSIs.

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BACKGROUND: When interventions to the hand are aimed at improving function of specific fingers or the thumb, the RIHM (Rotterdam Intrinsic Hand Myometer) is a validated tool and offers more detailed information to assess strength of the involved joints besides grip and pinch measurements. METHODS: In this study, strength was measured in 65 thumbs in 40 patients diagnosed with thumb hypoplasia. These 65 thumbs were classified according to Blauth. Longitudinal radial deficiencies were also classified. The strength measurements comprised of grip, tip, tripod and key pinch. Furthermore palmar abduction and opposition of the thumb as well as abduction of the index and little finger were measured with the RIHM. FINDINGS: For all longitudinal radial deficiency patients, grip and pinch strength as well as palmar abduction and thumb opposition were significantly lower than reference values (P<0.001). However, strength in the index finger abduction and the little finger abduction was maintained or decreased to a lesser extent according to the degree of longitudinal radial deficiency. All strength values decreased with increasing Blauth-type. Blauth-type II hands (n=15) with flexor digitorum superficialis 4 opposition transfer including stabilization of the metacarpophalangeal joint showed a trend toward a higher opposition strength without reaching statistical significance (P=0.094),however compared to non-operated Blauth-type II hands (n=6) they showed a lower grip strength (P=0.019). INTERPRETATION: The RIHM is comparable in accuracy to other strength dynamometers. Using the RIHM, we were able to illustrate strength patterns on finger-specific level, showing added value when evaluating outcome in patients with hand related problems.

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BACKGROUND: Pollicization of the index finger is a well-established treatment in type IIIB to type V hypoplastic thumbs. However, there is a lack of quantitative outcome studies, and little is known about the outcome differences between patients with mild and severe longitudinal radial deficiencies. Therefore, the aim of this study was to quantitatively assess and compare outcome after pollicization in severe and mild longitudinal radial deficiency and compare outcome to healthy controls. METHODS: In total, the authors included 24 patients with 30 affected hands. The study group consisted of 16 male patients and eight female patients with a mean age of 14 years. Median time between pollicization and evaluation was 9.4 years. Active and passive range of motion, extrinsic and intrinsic strength, sensibility, and patient and parent satisfaction were measured in patients with mild and severe longitudinal radial deficiency. Means are expressed as a percentage of normative data, and standard deviations and ranges were calculated. The independent samples t test was used to compare means between groups. RESULTS: In the overall pollicization group with associated longitudinal radial deficiency, range of motion and strength were significantly diminished compared with normative data. In severe longitudinal radial deficiency, all strength measurements were significantly more affected than in mild longitudinal radial deficiency. CONCLUSIONS: Overall, range of motion and strength of pollicizations were diminished compared with normative data. In severe longitudinal radial deficiency, this was even more pronounced. Despite this outcome, patients and their parents were very satisfied with function and appearance of the new thumb.

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PURPOSE: Triphalangeal thumb is a congenital malformation characterized by an additional phalanx of the thumb. Although surgical treatment of this condition is common practice, in the past this was not generally advised. Therefore, a population with an untreated triphalangeal thumb is still present. The purpose of this study is to compare function and appearance of adults with an untreated triphalangeal thumb to a normal population. METHODS: Twelve adults with 23 hands with an untreated triphalangeal thumb, unilateral or bilateral, were examined using objective measurements (thumb movement, joint instability, pain, and strength) and subjective measurements (visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; and Short Form 36 health survey). RESULTS: Objective measurements showed no limitations in range of motion or in grip and pinch strength. No joint instability was found in the interphalangeal joints. Five thumbs had instability in the metacarpophalangeal joint. Strength of the thumb in anteposition was diminished to 64% compared to a normal population. Opposition was diminished to 62%, and metacarpophalangeal joint flexion strength was diminished to 61%. The patients scored lower compared to a normal population for the domain of social functioning in the Medical Outcome Study 36-item short form health survey; the Disabilities of the Arm, Shoulder, and Hand questionnaire showed no differences. Visual analog scale scores for appearance of the thumb were scored low (2.2 of 10) by the adults, in contrast to visual analog scale scores for function (7.7). CONCLUSIONS: The examined group of adults with an untreated triphalangeal thumb had adequate thumb movement. Thumb strength was diminished for all specific thumb functions (anteposition, opposition, and thumb flexion), as low as 55%, compared to normal controls. Self-rated scores indicate that patients perceived their functionality as good. The appearance, however, was rated much lower, implying a dislike of the thumb by the patients. This indicates that the main impact of an untreated triphalangeal thumb in daily functioning might not be the diminished function but rather the dissimilar appearance. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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STUDY DESIGN: Test-retest reliability study on grip strength in children. INTRODUCTION: Measuring grip strength in children is difficult because of the weight and size of the instrument, brief attention span, and possible lack of task understanding. Therefore, adaptations to the measurement protocols to improve reliability would be very important for research and clinical evaluation. PURPOSE: In this study, we compared the reliability of a grip strength dynamometer (Lode dynamometer, Lode BV, Groningen, The Netherlands) using three different protocols. METHODS: Test-retest reliability of the American Society of Hand Therapists protocol in 104 healthy children (4-12 years) was compared with the reliability in 63 healthy children of a visual feedback protocol and a suspension protocol reducing weight of the instrument. RESULTS: For the total group, intraclass correlation coefficients for the dominant and nondominant hands were 0.95-0.97 for all protocols, indicating that all three protocols were reliable. CONCLUSION: No statistically significant difference was found among the reliability of the different protocols, but the suspension protocol produced small but significantly higher force levels. LEVEL OF EVIDENCE: Not applicable.

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PURPOSE: Previously, we studied normative and reliability data of palmar thumb abduction measurements (conventional goniometry, the Pollexograph thumb, the Pollexograph metacarpal, the Inter Metacarpal Distance, the American Society of Hand Therapists method, and the American Medical Association method) in healthy adults. Because many interventions aiming to improve palmar abduction are performed at an early age, the goal of this study was to assess normative and reliability data of these measurement methods in children. METHODS: We performed measurements with the Pollexograph thumb, the Pollexograph metacarpal and Inter Metacarpal Distance in 100 healthy children to acquire normative data. A retest was performed in 63 children to assess intraobserver reliability. RESULTS: Mean active and passive palmar abduction measured with the Pollexograph thumb was 62 degrees (range, 40 degrees to 76 degrees). The range of motion of the Pollexograph metacarpal was smaller (mean 49 degrees, range, 32 degrees to 64 degrees). The mean Inter Metacarpal Distance was 50 mm (range, 36-70 mm). Intraclass correlation coefficients of the Pollexograph thumb, Pollexograph metacarpal, and Inter Metacarpal Distance indicated excellent reliability (intraclass correlation coefficients between 0.85 and 0.92). CONCLUSIONS: Normative Pollexograph thumb and Pollexograph metacarpal data showed that means measured in children are comparable to values found in healthy adults. Reliability data indicated that the Pollexograph thumb, the Pollexograph metacarpal, and Inter Metacarpal Distance are also reliable measurement methods in children.

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The surgical strategy in patients with myasthenia gravis (MG) is influenced by the suspicion of thymoma based on mediastinal imaging. Aim of this retrospective study was to analyse the accuracy of CT of the mediastinum in predicting the histological findings in patients with MG referred for thymectomy. Thirty-four CT-scans of MG patients referred for thymectomy between October 1989 and October 2003 were retrospectively evaluated by three cardio-thoracic surgeons and three radiologists. Data were analysed by Kappa statistics to judge inter-observer variance and were compared to the histopathological findings to determine predictive value. Observer agreement among the radiologists was fair (Kappa=0.28) and among the cardio-thoracic surgeons slight (Kappa=0.08). The average negative predictive value of no thymoma on CT was 91% (range 78-100%). The average positive predictive of thymoma on CT value was only 39% (range 29-58%). The average sensitivity of CT imaging in the study population was 75% (range 25-100%) and the average specificity was 62% (range 42-81%). In patients with MG undergoing thymectomy, CT is helpful in detecting thymoma, but the high inter-observer variation indicates that it remains difficult to distinguish lymphoid follicular hyperplasia from thymoma. This will influence the surgical strategy in patients with myasthenia gravis.