| 1. |
- Gustafsson, Margareta, 1952-, et al.
(author)
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Ten years follow-up of health and disability in people with acute traumatic hand injury : pain and cold sensitivity are long-standing problems
- 2011
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In: Journal of Hand Surgery - British and European Volume. - : SAGE Publications. - 0266-7681 .- 1532-2211. ; 36:7, s. 590-598
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Journal article (peer-reviewed)abstract
- The aim of this study was to investigate health and disability in people with acute traumatic hand injury 10 years after the accident. A consecutive sample of patients from the Department of Hand Surgery was followed up by means of a postal questionnaire containing the instruments EQ-5D for assessment of health and DASH for assessment of disability. Questions were added about cold sensitivity, numbness and aesthetic problems. The 97 people with various acute hand injuries had greater problems with impairments of hand function than with limitations of activities and participation in daily life. Pain was more common than among the general Swedish population. Cold sensitivity was reported by 78% and was associated with both worse impairments and greater limitations on activity and participation. Despite problems with pain and cold sensitivity, they reported good health and a low degree of disability.
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| 2. |
- Hultgren, T., et al.
(author)
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Structural characteristics of the subscapularis muscle in children with medial rotation contracture of the shoulder after obstetric brachial plexus injury
- 2010
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In: Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:1, s. 23-28
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Journal article (peer-reviewed)abstract
- The aim of this study was to obtain a better understanding of the cause of the medial rotation contracture of the shoulder after obstetric brachial plexus lesions by studying the morphology of the shortened subscapularis muscle. Muscle biopsy specimens were harvested from 13 children with obstetric brachial plexus palsy who underwent corrective surgery for the rotation contracture. The majority of the subscapularis muscle biopsy samples had an essentially normal morphology and showed a predominance of type I myosin heavy chain isoform, while one biopsy showed signs of marked fibrosis and a predominance of type II myosin heavy chain isoform. The findings support the assumption that shortening of the subscapularis is caused primarily by the nerve injury, which weakens the antagonistic lateral rotators, but that direct injury to the muscle might be a contributory factor.
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| 3. |
- Johan, Scheer, 1967-, et al.
(author)
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Radioulnar laxity and clinical outcome after a distal radius fracture do not correlate after a distal radius fracture
- 2011
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In: Journal of Hand Surgery - British and European Volume. - : SAGE Journals online. - 0266-7681 .- 1532-2211. ; 36:6, s. 503-508
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Journal article (peer-reviewed)abstract
- Injury to the triangular fibrocartilage complex associated with distal radius fracture may cause symptoms of ulnar instability. Assessed by a radioulnar stress test, increased laxity of the distal radio-ulnar joint has in two previous studies been depicted to be associated with poorer outcome. This prospective study of 40 adults investigates the correlation of this test with functional outcome as measured by DASH. No clinically significant difference was found in relation to this test at two and five years after injury. Therefore using this test alone to decide whether or not to perform an acute repair of the TFCC cannot be recommended.
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| 4. |
- Wangdell, Johanna, 1971, et al.
(author)
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Satisfaction and performance in patient selected goals after grip reconstruction in tetraplegia
- 2010
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In: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:7, s. 563-568
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Journal article (peer-reviewed)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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| 5. |
- Afendras, G, et al.
(author)
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Hemi-hamate osteochondral transplantation in proximal interphalangeal dorsal fracture dislocations: a minimum 4 year follow-up in eight patients.
- 2010
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In: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 35:8, s. 627-631
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Journal article (peer-reviewed)abstract
- Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with special reference to the development of osteoarthritis and its relation to clinical symptoms in eight patients, mean age 49 (25-66) years. After a mean of 60 (48-69) months, the arc of motion was 67 degrees (45 degrees -95 degrees ) at the PIP joint and grip strength was 91% of the uninjured side. The visual analogue score for pain (0-100) was 10 (0-70) mm. Severe arthritis (grade IV) was found in two and mild arthritis (grade II) in another two patients, but only one of these four cases had troublesome pain. The hemi-hamate technique is an attractive alternative to other treatment options, but some cases develop osteoarthritis in the medium term.
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| 6. |
- Andersson, G-B, et al.
(author)
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Children with surgically corrected hand deformities and upper limb deficiencies: self-concept and psychological well-being.
- 2011
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In: The Journal of Hand Surgery, European Volume. - : SAGE Publications. - 0266-7681. ; 36:9, s. 795-801
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Journal article (peer-reviewed)abstract
- We studied self-concept and psychological well-being in children with hand deformities and upper limb deficiencies. Ninety-two children, 53 boys, 39 girls, aged 9-11 years were included. The children were divided into two subgroups - one with milder (less visible) deformities and one with severe (more complex and visible) finger-hand-arm deformities. Of the 92 children, 79 had received reconstructive surgery, and 13 had been treated with prostheses. The Piers-Harris Children's Self-Concept Scale (PHCSCS) was used to measure self-esteem and well-being. Overall PHCSCS scores showed that the whole hand deformity group had 'good' self-concept with mean scores in excess of 60 points, equal to a comparison group of healthy children. Within the hand deformity group, those with mild deformities had lower scores than those with severe deformities. This result was also found in the group of boys but not in the girls. The children with severe deformities had even higher scores than the comparison group regarding the subscale 'Intellectual and School Status'. The children with milder deformities had lower scores than the comparison group regarding the subscale 'Popularity'.
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| 7. |
- Andersson, Jonny K, 1972, et al.
(author)
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Distal radio-ulnar joint instability in children and adolescents after wrist trauma.
- 2014
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In: Journal of Hand Surgery, European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 39:6, s. 653-661
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Journal article (peer-reviewed)abstract
- This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) joint instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ instability were Salter-Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusion, late DRUJ instability due to wrist fractures or isolated TFCC tears was found to be common in children and adolescents.Level of evidence: IV.
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| 8. |
- Brogren, Elisabeth, et al.
(author)
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Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2-4 years after fracture.
- 2011
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In: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 36E, s. 568-576
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Journal article (peer-reviewed)abstract
- Fractures of the distal radius in postmenopausal women may cause prolonged pain and disability, but little is known about their natural course beyond the first year. In this study, women of 50-75 years of age, initially treated with cast or external fixation, were examined 1 year after distal radial fracture and then re-evaluated after a mean of 3 (range, 2-4) years. The evaluation included pain, disability (DASH) scores, grip strength and range of motion. In the 49 participating women pain scores, grip strength and range of motion improved significantly, although the mean improvement was moderate or small. In a subgroup of 13 patients with moderate or severe malunion, the 1 year DASH score was significantly worse than in the remaining patients but improved significantly together with grip strength and range of motion. After fractures of the distal radius, pain, grip strength and range of motion continued to improve beyond 1 year, up to 2-4 years. Patients with malunion had more disability at 1 year but showed significant improvement at 2-4 years.
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| 9. |
- Carlsson, Ingela, et al.
(author)
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Cut-Off Value for Self-Reported Abnormal Cold Sensitivity and Predictors for Abnormality and Severity in Hand Injuries
- 2010
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In: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 35E:5, s. 409-416
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Journal article (peer-reviewed)abstract
- Our aim was to identify a cut-off value for self-reported, abnormal cold sensitivity and to identify cold sensitivity predictors after hand injuries. The Cold Intolerance Symptom Severity (CISS) questionnaire and a VAS question concerning discomfort on exposure to cold were investigated in 94 normal people and 88 patients. A CISS score >450 was defined as abnormal cold sensitivity. Multiple injured digits, an increased number of injured vessels, complete nerve injury and replantation were variables associated with high VAS scores. Factors linked to both abnormality and worse CISS or VAS scores were: the presence of bone injury; a larger number of repaired vessels; the use of vascular grafts and a high Hand Injury Severity Score (HISS). The causes of abnormality and severity suggest a multifactorial aetiology with bony, vascular and neural components. A cut-off for abnormality is useful for descriptive, comparative and assessment purposes.
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| 10. |
- Carlstedt, T
(author)
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An overture to basic science aspects of nerve injuries
- 2011
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In: The Journal of hand surgery, European volume. - : SAGE Publications. - 2043-6289. ; 36E36:9, s. 726-729
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Journal article (peer-reviewed)abstract
- Does the lack of improvement in surgical treatment of nerve injury despite thousands of years of research disturb you? Do you think that basic science has not really contributed to any advancement in the treatment of nerve injury? Have you contributed? Do you think that new molecular biology knowledge in nerve injury and repair is important? Knowing from basic science that the immature nervous system is more fragile would you agree with the view that to be ‘aggressive’ in surgery of the newborn with a brachial plexus injury could be unscrupulous? As molecular biology of the nervous system has demonstrated that the best conditions for regeneration occur immediately after an injury do you find the approach of postponing surgery until at least 3 months after a closed nerve injury to be ignorant and even negligent? Taking into account the normal occurrence of inhibitory molecules in the uninjured peripheral nerve do you think that functional improvement from end to side nerve repair is a myth? Are the recent attempts to artificially enhance nerve regeneration for instance in synthetical conduits like nature seen ‘through a glass darkly’? Do you agree that new concepts in surgical treatment of nerve injury are timely? Do you have the time?
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