| 51. |
- Mobargha, N, et al.
(författare)
-
The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study
- 2016
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 41:4, s. 374-379
-
Tidskriftsartikel (refereegranskat)abstract
- Stability of the thumb carpometacarpal joint relies upon equilibrium between its ligaments, muscular support and joint congruity. We wanted to identify the muscles important in preventing or increasing dorsoradial subluxation of this joint. In ten cadaveric hands, a Fastrak® motion tracking device was used to assess the effects of individual isometric muscle loading on the base of the thumb metacarpal relative to the radius and to the base of the middle finger metacarpal. We found that the first dorsal interosseous muscle caused the least dorsoradial translation and highest distal migration of the base of the first metacarpal, whereas abductor pollicis longus was the primary destabilizer, increasing dorsoradial misalignment. The findings show different impacts of these muscles on joint alignment and stability, which suggests that treatment should be targeted to enhance the action of the primary stabilizing muscle, the first dorsal interosseous muscle.
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| 52. |
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| 53. |
- Nordenskjöld, J., et al.
(författare)
-
Prevalence and incidence of doctor-diagnosed Dupuytren's disease : A population-based study
- 2017
-
Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 42:7, s. 673-677
-
Tidskriftsartikel (refereegranskat)abstract
- The prevalence and incidence of doctor-diagnosed Dupuytren's disease in the general population is unknown. From the healthcare register for Skåne region (population 1.3 million) in southern Sweden, we identified all residents aged 3/420 years (on 31 December 2013), who 1998 to 2013 had consulted a doctor and received the diagnosis Dupuytren's disease (International Classification of Diseases 10th Revision code M720). During the 16 years, 7207 current residents (72% men) had been diagnosed with Dupuytren's disease; the prevalence among men was 1.35% and among women 0.5%. Of all people diagnosed, 56% had received treatment (87% fasciectomy). In 2013, the incidence of first-time doctor-diagnosed Dupuytren's disease among men was 14 and among women five per 10,000. The annual incidence among men aged 3/450 years was 27 per 10,000. Clinically important Dupuytren's disease is common in the general population.
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| 54. |
- Pan, CH, et al.
(författare)
-
Outcomes of Nerve Reconstruction for Radial Nerve Injuries Based on the Level of Injury in 244 operative cases
- 2010
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 35:5, s. 385-391
-
Tidskriftsartikel (refereegranskat)abstract
- We report a single surgeon series of 244 patients with radial nerve injuries who had nerve repair, neurolysis, or nerve graft over a 17-year period. 44 patients had a Level I or infraclavicular injury, 37 had a Level II injury within the spiral groove of the humerus, 104 had a Level III injury from the lateral arm to antebrachial fossa and 64 had a Level IV injury affecting the posterior interosseous nerve. Nerve grafting was used most frequently in all groups, and was the only method of reconstruction for level II injury. At 21.5 months follow up, Level IV injuries had significantly better outcome of finger and thumb extension, while wrist extension recovered in at least 80% of the patients irrespective of the level of injury. The radial nerve recovered better if repaired or reconstructed within 5 months of injury.
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| 55. |
- Peimer, C A, et al.
(författare)
-
Safety and tolerability of collagenase Clostridium histolyticum and fasciectomy for Dupuytren's contracture
- 2015
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 40:2, s. 141-149
-
Tidskriftsartikel (refereegranskat)abstract
- Safety was evaluated for collagenase Clostridium histolyticum (CCH) based on 11 clinical trials (N = 1082) and compared with fasciectomy data in a structured literature review of 48 European studies (N = 7727) for treatment of Dupuytren's contracture. Incidence of adverse events was numerically lower with CCH vs. equivalent complications from fasciectomy (median [range] incidence), including nerve injury (0% vs. 3.8% [0%-50+%]), neurapraxia (4.4% vs. 9.4% [0%-51.3%]), complex regional pain syndrome (0.1% vs. 4.5% [1.3%-18.5%]) and arterial injury (0% vs. 5.5% [0.8%-16.5%]). Tendon injury (0.3% vs. 0.1% [0%-0.2%]), skin injury (16.2% vs. 2.8% [0%-25.9%]) and haematoma (77.7% vs. 2.0% [0%-25%]) occurred at a numerically higher incidence with CCH than surgery. Adverse events in CCH trials not reported after fasciectomy included peripheral oedema; extremity pain; injection site pain, haemorrhage and swelling; tenderness; pruritus and lymphadenopathy. CCH-related adverse events were reported as predominantly injection-related and transient. These results may support clinical decision-making for treatment of Dupuytren's contracture.
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| 56. |
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| 57. |
- Rajan, S., et al.
(författare)
-
The Niebauer-Cutter prosthesis in excision arthroplasty of the trapezium
- 1982
-
Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 14:3, s. 295-303
-
Tidskriftsartikel (refereegranskat)abstract
- Sixteen patients had excision arthroplasty of the trapezium, using the Niebauer-Cutter prosthesis. The average period of postoperative follow-up was thirteen months. All patients had severe preoperative disabilities and the majority were relieved from resting pain and pain during active use of their hands. The postoperative range of motion with regard to the palmar and radial abduction was found to be satisfactory, while varying degrees of limitation of circumduction was the rule. There was no correlation between the patients' own judgment of the postoperative benefits and the objectively measured range of motion. One patient had a luxation of the prosthesis, while another had a subluxation when opposing the thumb. This frequency of luxation/subluxation seems to be less than that experienced with the other common type of prosthesis, the Swanson prosthesis. Although it is obvious that the ideal prosthesis for treatment of disabilities in the carpometacarpal joint of the thumb is still not available, it was concluded that the Niebauer-Cutter prosthesis is the best choice at the present.
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| 58. |
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| 59. |
- Redfern, James A. I., et al.
(författare)
-
Complication rates and modes of short and medium-term failure in Motec total wrist arthroplasty: an international cohort study
- 2023
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289.
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse the short- and medium-term complications of the Motec total wrist arthroplasty (TWA). Identifying exact modes of failure and their causes should allow surgeons to avoid or mitigate these risks in the future. Retrospective analysis of prospectively collected data from six hand surgeons at five international centres provided details of 171 Motec TWAs. The mean follow-up was 5.8 years (range 18 months to 12 years). There were 33 (19%) complications within our cohort, with a revision rate of 8.2% (14 revisions). There was no difference in complication rates between metal-on-metal and metal-on-polymer articulations. Failure of osseointegration was the most common complication. Problems with soft tissue balancing, implant impingement related osteolysis, bony impingement and metacarpal fracture were found to be other preventable causes of failure in this series. Elimination of these preventable complications will improve survival rates for this implant.Level of evidence: IV
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| 60. |
- Rein, S, et al.
(författare)
-
Histopathological analysis of the synovium in trapeziometacarpal osteoarthritis
- 2019
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 44:10, s. 1079-1088
-
Tidskriftsartikel (refereegranskat)abstract
- Dorsoradial and anterior oblique ligaments were harvested during surgery in 13 patients with symptomatic trapeziometacarpal osteoarthritis, which had been graded preoperatively by a modified Eaton-Littler radiographic grading. Ligaments, including the periligamentous synovium, were stained with S100 protein, neurotrophic receptor p75, protein gene product 9.5, calcitonin gene related peptide, acetylcholine, substance P, neuropeptide Y, noradrenaline, N-methyl-D-aspartate-receptor and Met/Leu-enkephalin. The synovium was classified as showing no, low-grade or high-grade synovitis. Free nerve endings had higher immunoreactivity for substance P than for N-methyl-D-aspartate-receptor, enkephalin and noradrenaline. The synovial stroma had less immunoreactivity for N-methyl-D-aspartate-receptor than for noradrenaline, substance P and calcitonin gene related peptide. There was no relation between the grade of osteoarthritis and the visual pain analogue scale, synovitis score, immunoreactivity of all antibodies and quantity of free nerve endings or blood vessels. Synovium in trapeziometacarpal joint osteoarthritis produces several neuromediators causing a polymodal neurogenic inflammation and which may serve as biomarkers for osteoarthritis or therapeutic targets.
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| 61. |
- Reinholdt, Carina, 1968, et al.
(författare)
-
Rebalancing the tetraplegic wrist using extensor carpi ulnaris-tenodesis.
- 2013
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 38:1, s. 22-28
-
Tidskriftsartikel (refereegranskat)abstract
- Patients with cervical spinal cord injury and tetraplegia often present with a radial deviation deformity of the wrist owing to impaired active wrist flexion and extension. Tenodesis of the extensor carpi ulnaris can help optimize grip strength. The purpose of the study was to compare reconstruction of the grip with and without extensor carpi ulnaris-tenodesis, as well as evaluating the outcome of the procedure. The grip strength of the group with tenodesis of the extensor carpi ulnaris was twice as strong as of the group without the tenodesis and with similar wrist joint flexion-extension range of motion. Correction of the wrist deformity enables a more ergonomic use of the hand. This may also help prevent shoulder pain, which is common among patients with tetraplegia.
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| 62. |
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| 63. |
- Renberg, Markus, et al.
(författare)
-
Patient-reported outcome measures and their association to the original Strickland classification after flexor tendon repair
- 2023
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 48:7, s. 661-667
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the relationship between patient-reported outcome measures (PROMs) and the original Strickland classification after flexor tendon injuries in Zones 1 and 2. Data were collected from the Swedish national health care registry for hand surgery (HAKIR). The studied PROMs were the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) and the patient questionnaire from the HAKIR (HQ-8). Complete data of both range of motion (ROM) and PROMs were available for 215 patients at 3 months after surgery, and for 150 patients at 12 months after surgery. We found that QuickDASH values were low and similar between all groups as classified by the Strickland system at 12 months. A statistically significant difference between PROM values (for stiffness and satisfaction) was found only between the Strickland groups Fair and Good, but not between Poor and Fair or Good and Excellent. This suggests that further categorization according to the Strickland classification is less important to the patients as long as they regain 70% of their ROM.
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| 64. |
- Renberg, Markus, et al.
(författare)
-
Rehabilitation following flexor tendon injury in Zone 2: a randomized controlled study
- 2023
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 48:8, s. 783-791
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare an early active motion (EAM) regimen to a modified Kleinert passive motion therapy in Zone 2 flexor tendon injuries with regards to range of motion (ROM), grip strength and patient-reported outcome measures (PROMs). Seventy-two patients were included. At 3 months postopera-tively, we found no difference in total active motion (TAM) between the EAM and the Kleinert groups (median 195.5 degrees, range 115 degrees -273 degrees versus median 191.5 degrees, range 113 degrees -260 degrees), but a significantly better grip strength (median 76%, range 44%-99% versus median 54%, range 19%-101%; p < 0.0005) in the EAM group. Disabilities of the Arm, Shoulder and Hand (DASH) score as well as patient-reported weakness, cold intol-erance and problems in daily activities also favoured the EAM group. At 12 months postoperatively, there was no difference in TAM, grip strength or any of the PROMs used. We conclude that EAM leads to a quicker recovery in terms of grip strength and PROMs, but that both regimens lead to similar results at 12 months.
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| 65. |
- Roche, A. D., et al.
(författare)
-
Upper limb prostheses: bridging the sensory gap
- 2023
-
Ingår i: Journal of Hand Surgery-European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 48:3, s. 182-190
-
Tidskriftsartikel (refereegranskat)abstract
- Replacing human hand function with prostheses goes far beyond only recreating muscle movement with feedforward motor control. Natural sensory feedback is pivotal for fine dexterous control and finding both engineering and surgical solutions to replace this complex biological function is imperative to achieve prosthetic hand function that matches the human hand. This review outlines the nature of the problems underlying sensory restitution, the engineering methods that attempt to address this deficit and the surgical techniques that have been developed to integrate advanced neural interfaces with biological systems. Currently, there is no single solution to restore sensory feedback. Rather, encouraging animal models and early human studies have demonstrated that some elements of sensation can be restored to improve prosthetic control. However, these techniques are limited to highly specialized institutions and much further work is required to reproduce the results achieved, with the goal of increasing availability of advanced closed loop prostheses that allow sensory feedback to inform more precise feedforward control movements and increase functionality.
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| 66. |
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| 67. |
- Rosales, Roberto S., et al.
(författare)
-
The methodological requirements for clinical examination and patient-reported outcomes, and how to test them
- 2020
-
Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 45:1, s. 12-18
-
Forskningsöversikt (refereegranskat)abstract
- This article presents the methodological requirements for clinical examination and patient-reported outcomes measurements. The assessment of any measurement for clinical research in hand surgery is difficult. A method of measuring a criterion could be 100% reliable but 100% invalid. Bias may be present in our assessment if we do not take into account the methodological requirements related to reliability, validity, and responsiveness of our measures. Reliability refers to intra-observer agreement, inter-observer agreement, or agreement between two methods of assessment, and, for patient-reported measures, internal consistency and test–retest reliability. Validity is the capability of a clinical method to measure what it proposes to measure. Assessing validity involves comparing a measure with one or more other measures, and, if possible, with a reference standard criterion. Responsiveness is the ability to detect important clinical change. The Consensus-based Standards for the Selection of Health Measurement Instruments provides the standards required for design and recommended statistical analyses of patient-reported outcome measures.
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| 68. |
- Rosén, Birgitta, et al.
(författare)
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Enhanced early sensory outcome after nerve repair as a result of immediate post-operative re-learning: A randomized controlled trial.
- 2015
-
Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 40:6, s. 598-606
-
Tidskriftsartikel (refereegranskat)abstract
- We assessed the use of guided plasticity training to improve the outcome in the first 6 months after nerve repair. In a multicentre randomized controlled trial, 37 adults with median or ulnar nerve repair at the distal forearm were randomized to intervention, starting the first week after surgery with sensory and motor re-learning using mirror visual feedback and observation of touch, or to a control group with re-learning starting when reinnervation could be detected. The primary outcome at 3 and 6 months post-operatively was discriminative touch (shape texture identification test, part of the Rosen score). At 6 months, discriminative touch was significantly better in the early intervention group. Improvement of discriminative touch between 3 and 6 months was also significantly greater in that group. There were no significant differences in motor function, pain or in the total score. We conclude that early re-learning using guided plasticity may have a potential to improve the outcomes after nerve repair. Level of evidence: II.
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| 69. |
- Rosén, Birgitta, et al.
(författare)
-
Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.
- 2007
-
Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32:1, s. 31-37
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Tidskriftsartikel (refereegranskat)abstract
- The "Sensor Glove System" offers an alternate afferent inflow from the hand early after nerve repair in the forearm, mediated through the hearing sense, implying that deprivation of one sense can be compensated by another sense. This sensory "by-pass" was used early after repair of the median nerve with the intention of improving recovery of functional sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. In a prospective multicentre clinical study, one group (n = 14) started early after surgery with sensory re-education using the Sensor Glove System and the control group (n = 12) received conventional sensory re-education, starting 3 months postoperatively. The patients were checked regularly during a 1-year period, with focus on recovery of tactile gnosis. After 12, months, tactile gnosis was significantly better in the Sensor Glove System group. This highlights the timing for introduction of training after nerve repair, focusing on the importance of immediate sensory re-learning.
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| 70. |
- Rubensson, Carin, et al.
(författare)
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Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability
- 2018
-
Ingår i: Journal of Hand Surgery, European Volume. - : SAGE PUBLICATIONS LTD. - 1753-1934 .- 2043-6289. ; 43:4, s. 369-374
-
Tidskriftsartikel (refereegranskat)abstract
- During 1994-2003, we treated 20 patients with post-traumatic radial-sided wrist pain and dynamic radiocarpal instability. After arthroscopy confirmed no disruption of the radioscaphocapitate ligament and an increased laxity of the ligament, we passed a strip of the radioscaphocapitate ligament through the long radio-lunate ligament. The rationale of this procedure was to increase tension of the two ligaments and to close the space of Poirier. Eighteen patients were assessed after 1-3.7 years (mean 2.5 years). Four patients were symptom-free and 11 patients were markedly improved. Fourteen patients were followed for 11-15 years; four patients were symptom-free and eight patients were markedly improved. Two reported unchanged symptoms and none was worse in the follow-up. Based on our findings, we suggest a cause of post-traumatic radial-sided wrist pain is laxity of the radiocarpal joint. We conclude that our surgical procedure increases tension in the radioscaphocapitate and long radio-lunate ligaments and decreases wrist pain at rest and during activity. Level of Evidence: IV
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| 71. |
- Sanchez-Delgado, G, et al.
(författare)
-
Assessment of handgrip strength in preschool children aged 3 to 5 years
- 2015
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 40:9, s. 966-972
-
Tidskriftsartikel (refereegranskat)abstract
- We investigated whether there is an optimal grip span for determining the maximum handgrip strength in preschool children and if it is influenced by gender, age, or hand size. A total of 292 preschool children (3–5 years; 59.2% boys) carried out the handgrip strength test with different grip spans (4.0, 4.5, 5.0, 5.5, and 6.0 cm). The hand size was also measured. We also determined the reliability of the optimal grip span in another group of children ( n = 56, 57% boys) who did the test twice, with a 3-hour difference between tests. The results showed that 4.0 cm is the optimal grip span to determine the maximum handgrip strength in preschool children. This result applied to both genders, all age groups, and hand sizes. Paired t-tests showed no significant differences between test and retest. These findings may guide clinicians and researchers in selecting the optimal grip span when measuring handgrip strength in preschool children. Level IV
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| 72. |
|
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| 73. |
- Scheer, Johan, et al.
(författare)
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Radioulnar ratio in detection of distal radioulnar joint instability associated with acute distal radius fractures
- 2010
-
Ingår i: JOURNAL OF HAND SURGERY (EUROPEAN VOLUME). - : Elsevier Science B. V., Amsterdam. - 1753-1934 .- 2043-6289. ; 35E:9, s. 730-734
-
Tidskriftsartikel (refereegranskat)abstract
- Lesions of the triangular fibrocartilage complex (TFCC) are commonly associated with distal radius fractures and may adversely affect the functional outcome. This prospective study evaluated computed tomography, using the radioulnar ratio (RUR), to detect laxity of the distal radioulnar joint in 48 consecutive patients with acute distal radius fractures and compared the results with a radioulnar stress test. We found the clinical stress test to be reliable in chronic cases, but the RUR method of questionable value in both acute and chronic cases.
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| 74. |
- Scherman, Peter, et al.
(författare)
-
One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren's contracture: A two-centre prospective randomized clinical trial.
- 2015
-
Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934.
-
Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to compare early and 1 year outcome of needle fasciotomy and collagenase injection for Dupuytren's disease. Inclusion criteria were primary Dupuytren's contracture excluding the thumb with a palpable cord and a total extension deficit, i.e. a fixed flexion from 30° to 135° with less than 60° in the proximal interphalangeal joint. The most affected ray was randomized to either treatment at two centres. Passive extension deficits for each joint before and after treatment, and at 3 and 12 months, were recorded together with complications. A total of 96 rays in 93 patients were included. The average total extension deficits before treatment were 60° or more in both groups, and were largely made up of contractures at the metacarpophalangeal joints. The deficits were reduced by 75% in both groups at 3 months and by 70% in both groups at 12 months. Four patients in the needle fasciotomy group and eight patients in the collagenase group had skin ruptures. At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement.
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| 75. |
- Scherman, Peter, et al.
(författare)
-
Three-year recurrence of Dupuytren’s contracture after needle fasciotomy and collagenase injection : a two-centre randomized controlled trial
- 2018
-
Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 43:8, s. 836-840
-
Tidskriftsartikel (refereegranskat)abstract
- Collagenase injection and needle fasciotomy have similar short-term outcomes in the treatment of Dupuytren’s contracture. The purpose of this study was to compare the recurrence rate of these two procedures 3 years after index treatment of primary disease. We enrolled 93 patients (96 rays) from a previous two-centre randomized controlled trial. The rays that had been retreated or showed an increase in the total passive extension deficit of 30° or more compared with 3 months after treatment were regarded as recurrences. Seventeen of 40 needle fasciectomies and 12 of 36 of collagenase injections had recurred. This difference was not statistically significant. We conclude that collagenase injection and needle fasciotomy have similar 3-year recurrence rates in the treatment of Dupuytren’s contracture. Level of evidence: I.
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| 76. |
- Schmidt, Viktor, et al.
(författare)
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Functional outcomes are restored a decade after a distal radius fracture : a prospective long-term follow-up study
- 2024
-
Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 49:3, s. 322-328
-
Tidskriftsartikel (refereegranskat)abstract
- We performed an 11-13-year prospective follow-up of patients after a distal radial fracture (DRF) to investigate the association between fracture malunion, radiocarpal osteoarthritis and clinical outcome. In total, 292 patients responded to patient-reported outcome measures; of them, 242 underwent clinical examination. Clinical outcomes improved with time. A decade after fracture, median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 5, EuroQol Five-dimensions score was 1.0, and range of motion and grip strength were 96% of the contralateral side. Neither osteoarthritis (6%) nor pseudoarthrosis of the ulnar styloid (30%) affected the outcomes. Dorsal tilt, radial inclination, ulnar variance and intra-articular extension did not affect long-term clinical outcomes or the risk of osteoarthritis. Recovery after a DRF is an ongoing process that lasts years. A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes.Level of evidence: II.
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| 77. |
- Schmidt, Viktor, et al.
(författare)
-
Marginal secondary displacement in fractures of the distal radius at follow-up - an important predictor for late displacement and malunion
- 2023
-
Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 48:6, s. 524-531
-
Tidskriftsartikel (refereegranskat)abstract
- Treatment recommendations in fractures of the distal radius are often based on the degree of displacement and functional demands. The fracture may be within an acceptable radiological range, but a marginal deterioration in alignment then occurs between the initial visit and follow-up. This may pose a risk for late displacement that may require further treatment. We secondarily analysed prospectively collected data and included 165 patients. We found that marginal secondary displacement (odds ratio (OR) 9.7), anterior comminution (OR 8.8), loss of anterior apposition (OR 6.8) and dorsal comminution (OR 2.6) were predictors of late displacement. Marginal secondary displacement is an important predictor of late displacement and malunion in fractures of the distal radius. Clinicians should not unequivocally accept general guidelines on alignment but also assess a deterioration in fracture alignment on radiographic follow-up and be aware of the potential need for surgery to avoid malunion in cases that show early secondary displacement, even when radiographic measures are within acceptable limits.Level of evidence: III.
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| 78. |
- Schriever, T, et al.
(författare)
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Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study
- 2023
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 48:1, s. 20-26
-
Tidskriftsartikel (refereegranskat)abstract
- The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5–10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height–length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity ( n = 33) and no deformity ( n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function. Level of evidence: IV
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| 79. |
- Semisch, M, et al.
(författare)
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Histological assessment of the triangular fibrocartilage complex
- 2016
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 41:5, s. 527-533
-
Tidskriftsartikel (refereegranskat)abstract
- The morphological structure of the seven components of triangular fibrocartilage complexes of 11 cadaver wrists of elderly people was assessed microscopically, after staining with Hematoxylin-Eosin and Elastica van Gieson. The articular disc consisted of tight interlaced fibrocartilage without blood vessels except in its ulnar part. Volar and dorsal radioulnar ligaments showed densely parallel collagen bundles. The subsheath of the extensor carpi ulnaris muscle, the ulnotriquetral and ulnolunate ligament showed mainly mixed tight and loose parallel tissue. The ulnolunate ligament contained tighter parallel collagen bundles and clearly less elastic fibres than the ulnotriquetral ligament. The ulnocarpal meniscoid had an irregular morphological composition and loose connective tissue predominated. The structure of the articular disc indicates a buffering function. The tight structure of radioulnar and ulnolunate ligaments reflects a central stabilizing role, whereas the ulnotriquetral ligament and ulnocarpal meniscoid have less stabilizing functions.
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| 80. |
|
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| 81. |
- Sletten, IN, et al.
(författare)
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Inter- and intra-rater reliability of the Oberg-Manske-Tonkin classification of congenital upper limb anomalies
- 2022
-
Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 47:10, s. 1016-1024
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Tidskriftsartikel (refereegranskat)abstract
- On two occasions, five surgeons classified a cohort of 150 consecutive patients with congenital upper limb anomalies according to the Oberg–Manske–Tonkin classification (2020 update). We estimated reliability for the main anomaly code by means of Cohen’s kappa (Κ) for ten rater pairs for five common and easily distinguishable anomalies (Group 1), and for all the other anomalies (Group 2). Inter-rater reliability for all patients ( n = 150) was substantial, almost perfect for Group 1 ( n = 64), but only moderate for Group 2 ( n = 86). Intra-rater reliability was higher for all groups. We suggest simplifications to the Oberg–Manske–Tonkin classification and highlight specific requirements for instructions to increase its reliability. Level of evidence: I
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| 82. |
- Stjernbrandt, Albin, et al.
(författare)
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Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire : a population study
- 2021
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 46:7, s. 731-737
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Tidskriftsartikel (refereegranskat)abstract
- Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity. Level of evidence: III
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| 83. |
- Svernlov, Birgitta, et al.
(författare)
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Conservative treatment of the cubital tunnel syndrome
- 2009
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 34:2, s. 201-207
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Tidskriftsartikel (refereegranskat)abstract
- Conservative treatment of the cubital tunnel syndrome was evaluated in a randomised study of 70 patients with mild or moderate symptoms (Dellon, 1989). All patients were informed about the cause of symptoms and allocated to three groups: night splinting, nerve gliding and control. Evaluation consisted of Canadian Occupational Performance Measure, visual analogue pain scales, strength measurements and neurophysiological examination, before treatment and after six months. Fifty-seven patients were followed for six months. Fifty-one (89.5%) were improved at the follow-up. There were no significant differences between the groups in any of the recorded variables. Night splints and nerve gliding exercises did not add favourably. Routine neurophysiological examination seems unnecessary since 76% of the patients with typical symptoms had normal findings and 75% with pathological findings improved. Patients with mild or moderate symptoms have a good prognosis if they are informed of the causes of the condition and how to avoid provocation.
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| 84. |
- Svingen, Jonas, et al.
(författare)
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Risk factors for reoperation after flexor tendon repair : a registry study
- 2022
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Ingår i: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 47:10, s. 1071-1076
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to identify risk factors for reoperations after Zones 1 and 2 flexor tendon repairs. A multiple logistic regression model was used to identify risk factors from data collected via the Swedish national health care registry for hand surgery (HAKIR). The studied potential risk factors were age and gender, socio-economics and surgical techniques. Included were 1372 patients with injuries to 1585 fingers and follow-up of at least 12 months (median 37 IQR 27-56). Tendon ruptures occurred in 80 fingers and tenolysis was required in 76 fingers. Variables that affected the risk of rupture were age >25 years (p < 0.001), flexor pollicis longus tendon injuries (p < 0.001) and being male (p = 0.004). Injury to both finger flexors had an effect on both rupture (p = 0.005) and tenolysis (p < 0.001). Understanding the risk factors may provide important guidance both to surgeons and therapists when treating patients with flexor tendon injuries.
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| 85. |
- Sward, EM, et al.
(författare)
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The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function
- 2022
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 47:8, s. 798-804
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Tidskriftsartikel (refereegranskat)abstract
- This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018–2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not. Level of evidence: II
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| 86. |
- Sward, EM, et al.
(författare)
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The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis
- 2022
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Ingår i: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 47:8, s. 805-811
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Tidskriftsartikel (refereegranskat)abstract
- This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome. Level of evidence: II
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| 87. |
- Swärd, Elin M., et al.
(författare)
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The epidemiology of scaphoid fractures in Sweden : a nationwide registry study
- 2019
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 44:7, s. 697-701
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Tidskriftsartikel (refereegranskat)abstract
- The epidemiology of scaphoid fractures has been described in limited populations, and incidence reports have been inconsistent. We investigated the nationwide incidence of scaphoid fractures by evaluating data on 34,377 patients in the Swedish National Patient Register for the years 2006–2015 regarding diagnosis, age, sex and treatment. The data were validated in 300 random patients, and incidence rates were adjusted accordingly. Forty-one per cent of the initially diagnosed fractures were false positives. The adjusted true fracture incidence rate was 22 per 100,000 person-years. During the decade studied incidence rates decreased in younger men and increased in middle-aged women. The incidence of surgical treatment vs. non-operative treatment did not change over time. Men were treated surgically more often than women (6% vs. 3%) and had a greater risk for nonunion (3% vs. 1%).
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| 88. |
- Terenghi, Giorgio, et al.
(författare)
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The nerve injury and the dying neurons : diagnosis and prevention
- 2011
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Ingår i: Journal of hand surgery. European volume. - Oxford : Churchill Livingstone. - 1753-1934 .- 2043-6289. ; 36E:9, s. 730-734
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Forskningsöversikt (refereegranskat)abstract
- Following distal nerve injury significant sensory neuronal cell death occurs in the dorsal root ganglia, while after a more proximal injury, such as brachial plexus injury, a sizeable proportion of spinal motoneurons also undergo cell death. This phenomenon has been undervalued for a long time, but it has a significant role in the lack of functional recuperation, as neuronal cells cannot divide and be replaced, hence the resulting nerve regeneration is usually suboptimal. It is now accepted that this cell death is due to apoptosis, as indicated by analysis of specific genes involved in the apoptotic signalling cascade. Immediate nerve repair, either by direct suturing or nerve grafting, gives a degree of neuroprotection, but this approach does not fully prevent neuronal cell death and importantly it is not always possible. Our work has shown that pharmacological intervention using either acetyl-L-carnitine (ALCAR) or N-acetyl-cysteine (NAC) give complete neuroprotection in different types of peripheral nerve injury. Both compounds are clinically safe and experimental work has defined the best dose, timing after injury and duration of administration. The efficacy of neuroprotection of ALCAR and NAC can be monitored non-invasively using MRI, as demonstrated experimentally and more recently by clinical studies of the volume of dorsal root ganglia. Translation to patients of this pharmacological intervention requires further work, but the available results indicate that this approach will help to secure a better functional outcome following peripheral nerve injury and repair.
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| 89. |
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| 90. |
- Thorfinn, Johan, et al.
(författare)
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Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo
- 2012
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Ingår i: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME. - : SAGE Publications (UK and US). - 1753-1934 .- 2043-6289. ; 37E:2, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.
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| 91. |
- Tägil, Magnus, et al.
(författare)
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Correlation Between Range of Motion and Implant Fracture: A 5 Year Follow-Up of 72 Joints in 18 Patients in a Randomized Study Comparing Swanson and Avanta/Sutter Mcp Silicone Prosthesis
- 2009
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 34E:6, s. 743-747
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Tidskriftsartikel (refereegranskat)abstract
- Eighteen out of 18 rheumatoid patients (at one centre of a two-centre 30 patient study previously reported) with a mean age of 56 years, and 72/72 operated joints were randomized to Avanta/Sutter or Swanson MCP prostheses and followed for 5 years. Both ulnar deviation and extension lag were improved already at 6 weeks and remained improved at 5 years. The Avanta prosthesis had a better range of motion (ROM) than the Swanson. Six of nine patients with Avanta/Sutter implants had at least one implant fracture compared to 1/9 patients with the Swanson implant (P=0.05) but fracture did not change the outcome subjectively. The ROM at 3 months correlated with the occurrence of an implant fracture at 5 years and a greater early ROM may be related to implant fracture. At 5 years patients remained satisfied and the deformities remained corrected.
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| 92. |
- Tägil, Magnus, et al.
(författare)
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Ten years' experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up.
- 2014
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 39:6, s. 587-595
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Tidskriftsartikel (refereegranskat)abstract
- We prospectively assessed the subjective, objective, and radiographic results at 1, 2, and 5 years in 65 patients who had pyrocarbon proximal interphalangeal prostheses inserted between 2001 and 2010. Further operations were done on 10 of the 89 joints (four for prosthetic extraction and arthrodesis, two for component changes, and four for soft tissue procedures). At 1 year, the visual analogue scale score for pain at rest had improved to 0 cm from a pre-operative 4 cm, pain at activity from 6 to 1.8 cm, and Disability of the Arm, Shoulder and Hand score from 40 to 25. Range of movement and grip strength were unchanged. At 5 years, 31 joints (21 patients) had a complete radiographic follow-up. Seven proximal and 12 distal components showing zones of osteolysis at 1 year had stabilized and were inert or integrated at 5 years. Three proximal and three distal components had osteolytic zones at 5 years. Forty-seven of 59 patients were pain-free at rest at 1 year, and 19 of 21 at 5 years. No late revisions or loosening occurred.
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| 93. |
- Tägil, Magnus, et al.
(författare)
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Wound healing after hand surgery in patients with systemic sclerosis-a retrospective analysis of 41 operations in 19 patients.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32E:3, s. 316-319
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Tidskriftsartikel (refereegranskat)abstract
- t This retrospective study evaluates the results of 41 consecutive hand and forearm operations in 19 patients with systemic sclerosis performed between 1985 and 2000. The mean age of the patients was 50 (14-84) years. Twenty-seven operations were elective and 14 were acute, carried out for skin breakdown and/or skin necrosis. One minor wound healing problem occurred in the elective group. In the acute group, seven of 14 operations healed uneventfully. Four patients had necrosis/ infections after surgery, which required further surgery. Two patients had repeated wound infections. Another patient only healed after he stopped smoking. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely. In acute cases with spontaneous skin breakdown and/or necrosis and/or critically ischaemic fingers, wound healing is more precarious and several procedures may be necessary to achieve skin healing.
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| 94. |
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| 95. |
- Vikström, Pernilla, et al.
(författare)
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The effect of early relearning on sensory recovery 4 to 9 years after nerve repair : a report of a randomized controlled study
- 2018
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 43:6, s. 626-630
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Tidskriftsartikel (refereegranskat)abstract
- Twenty patients randomized to early sensory relearning (nine patients) or traditional relearning (11 patients) were assessed regarding sensory recovery 4 to 9 years after median or ulnar nerve repair. Outcomes were assessed with the Rosen score, questionnaires, and self-reported single-item questions regarding function and activity. The patients with early sensory relearning had significantly better sensory recovery in the sensory domain of the Rosen score, specifically, discriminative touch or tactile gnosis and dexterity. They had significantly less self-reported problems in gripping, clumsiness, and fine motor skills. No differences were found in questionnaires between the two groups. We conclude that early sensory relearning improves long-term sensory recovery following nerve repair. Level of evidence: I
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| 96. |
- von Kieseritzky, J., et al.
(författare)
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DendroPrime as an adhesion barrier on fracture fixation plates: an experimental study in rabbits
- 2020
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Ingår i: Journal of Hand Surgery-European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 45:7, s. 742-747
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Tidskriftsartikel (refereegranskat)abstract
- We tested the anti-adhesional effect of a new thiol-ene-based coating in a rabbit model. In 12 New Zealand white rabbits, the periosteum and cortex of the proximal phalanx of the second toe of both hind paws was scratched. Stainless steel plates were fixated with screws. One plate was coated with DendroPrime and the other left bare. The non-operated second toes of both hind paws of an additional four rabbits served as controls. Seven weeks after surgery, the soft tissue adhesion to the plates was evaluated macroscopically, and joint mobility was measured biomechanically. Toe joint mobility was about 20% greater and statistically significant in specimens with coated plates compared with the bare plates. Soft tissue overgrowth and, in some cases, synovitis or adhesions between the plate and the tendon were observed on all bare plates but not on any of the coated plates. We conclude that the thiol-ene-based coating can improve joint mobility by about 20%. This material has a potential to reduce adhesion around plates in fracture surgery.
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| 97. |
- Wade, Ryckie G., et al.
(författare)
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The diagnostic accuracy of 1.5T magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries
- 2018
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 43:3, s. 250-258
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Tidskriftsartikel (refereegranskat)abstract
- Identification of root avulsions is of critical importance in traumatic brachial plexus injuries because it alters the reconstruction and prognosis. Pre-operative magnetic resonance imaging is gaining popularity, but there is limited and conflicting data on its diagnostic accuracy for root avulsion. This cohort study describes consecutive patients requiring brachial plexus exploration following trauma between 2008 and 2016. The index test was magnetic resonance imaging at 1.5 Tesla and the reference test was operative exploration of the supraclavicular plexus. Complete data from 29 males was available. The diagnostic accuracy of magnetic resonance imaging for root avulsion(s) of C5-T1 was 79%. The diagnostic accuracy of a pseudomeningocoele as a surrogate marker of root avulsion(s) of C5-T1 was 68%. We conclude that pseudomeningocoles were not a reliable sign of root avulsion and magnetic resonance imaging has modest diagnostic accuracy for root avulsions in the context of adult traumatic brachial plexus injuries. Level of evidence: III
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| 98. |
- Wadsten, Mats Å., et al.
(författare)
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The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life
- 2018
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Ingår i: Journal of Hand Surgery, European Volume. - : Sage Publications. - 1753-1934 .- 2043-6289. ; 43:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- Late displacement of distal radius fractures, still in acceptable radiological position after 1–2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10–14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires.
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| 99. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Activity gains after upper limb surgery for spasticity in patients with spinal cord injury
- 2018
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Ingår i: Journal of Hand Surgery-European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 43:6, s. 613-620
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Tidskriftsartikel (refereegranskat)abstract
- Spasticity is a common and increasingly prevalent secondary complication of spinal cord injury. The aim of the study was to evaluate patient-experienced gains in prioritized activities after surgery to reduce the effects of spasticity in upper limbs in tetraplegia. The study includes evaluation of 30 operations for 27 patients performed on hypertonic tetraplegic hands during 2007-2015 using the Canadian Occupational Performance Measure. Activity performance increased at both 6 months and 12 months by a mean of 3.0 and 2.9 points, respectively. Satisfaction increased by 3.3 and 3.4, respectively. All types of activities improved, with wheelchair manoeuvring as one of the highest rated. The intervention increased prioritized activity performance and persisted at least 12 months after surgery. Patients with mild upper limb impairment showed greater improvement after surgery. After operation, patients were able to perform 71% of their prioritized activities, which they could not perform before. Patients' satisfaction with the performance was high. Level of evidence: IV
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| 100. |
- Wangdell, Johanna, 1971, et al.
(författare)
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Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia
- 2010
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Ingår i: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:7, s. 563-568
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of grip in tetraplegia aims to improve upper extremity performance and control in daily life. We evaluated the effects of surgery and rehabilitation on performance and satisfaction of patient identified activity goals in 20 patients (22 arms) who had grip reconstructions for both finger and thumb flexion. Patients assessed an improvement in both performance and satisfaction after surgery in all groups of activities assessed using the Canadian Occupational Performance Measure (COPM). The mean improvement at 6 and 12 months was 3.5 points better than the 2.5 points before surgery. Before surgery 36% of the goals identified were impossible to perform. After surgery, 78% of these goals were possible. The largest improvement was observed in the basic activity of 'eating' but significant improvement was also noted in activities generally regarded as complex and not measured in standard ADL such as 'doing housework' and taking part in 'leisure'.
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