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Patient-reported outcomes and function after surgical repair of the ulnar collateral ligament of the thumb. Legerstee, I. W. F., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Symptoms prevalence study Topic : Thumb UCL mcpj - Outcomes This prospective study investigated patient-reported outcomes following thumb UCL repair. A total of 76 participants, who underwent open surgical repair for a complete thumb UCL rupture, were included in the study. Hand function (Michigan Hand Outcomes Questionnaire) was measured at baseline, 3, and 12 months. Patient satisfaction was measured on a likert-scale from "Poor" to "Excellent". The results showed that patients' function improved from 65% to 87% by 12 months. Older age appeared to be a risk factors for lower 12-month postoperative functional outcomes. A total of 25% of patients reported excellent outcomes at 12 months. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, open surgical repair of thumb UCL ruptures yields good clinical results, with one out of four patients reporting excellent outcomes at 12 months. However, older patients tend to have worse outcomes. When seeing patients with ucl injuries, it appears that early vs delayed surgery does not affect outcomes . Open Access URL : https://doi.org/10.1016/j.jhsa.2023.05.003 Abstract Purpose: The purpose of this study was to report prospectively collected patient-reported outcomes of patients who underwent open thumb ulnar collateral ligament (UCL) repair and to find risk factors associated with poor patient-reported outcomes. Methods: Patients undergoing open surgical repair for a complete thumb UCL rupture were included between December 2011 and February 2021. Michigan Hand Outcomes Questionnaire (MHQ) total scores at baseline were compared to MHQ total scores at three and 12 months after surgery. Associations between the 12-month MHQ total score and several variables (i.e., sex, injury to surgery time, K-wire immobilization) were analyzed. Results: Seventy-six patients were included. From baseline to three and 12 months after surgery, patients improved significantly with a mean MHQ total score of 65 (standard deviation [SD] 15) to 78 (SD 14) and 87 (SD 12), respectively. We did not find any differences in outcomes between patients who underwent surgery in the acute (<3 weeks) setting compared to a delayed setting (<6 months). Conclusions: We found that patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. We did not find an association between injury to surgery time and lower MHQ total scores. This suggests that acute repair for full-thickness UCL tears might not always be necessary. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Occult amyloid deposition in older patients presenting with bilateral carpal tunnel syndrome or multiple trigger digits. Gray, A. M., Patel, A. C., Kaplan, F. T. D., Merrell, G. A. and Greenberg, J. A. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Symptoms prevalence study Topic : Carpal tunnel syndrome/Trigger finger - Amyloidosis This prospective study investigated the prevalence of amyloidosis among older patients presenting with bilateral carpal tunnel syndrome (CTS) or multiple trigger digits (TDs). A total of 56 patients were included in the study. The results showed that 9 (16%) participants tested positive for amyloid deposition. Demographics and medical comorbidities were similar between amyloid-positive and -negative patients. However, amiloid was more common in people with multiple trigger fingers (24%) compared to patients with bilateral CTS (10%). As a practical rule of thumb, clinicians may consider screening men over 50 and women over 60 with bilateral CTS or multiple trigger fingers as these factors combined increase the likelihood of having the condition. Early diagnosis of amyloidosis is critical for providing patients with the best treatment options, and hand surgeons are uniquely positioned to help make an early diagnosis. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, amiloidosis in people with trigger finger or bilateral carpal tunnel is estimated to be present in 24% and 10% of patients respectively. Clinically, men over 50 and women over 60 with bilateral CTS or multiple trigger digits should be screened for amyloidosis. Early diagnosis of amyloidosis is key for initiating treatment and monitoring of cardiac involvement, as it is associated with a higher risk of cardiac complications. This screening may not be possible if percutaneous release of A1 pulley for trigger finger becomes more common. URL : https://doi.org/10.1016/j.jhsa.2023.05.008 Abstract Purpose: The diagnosis of amyloidosis is important for early intervention, disease monitoring, and prevention of complications and progression. Carpal tunnel syndrome (CTS) and trigger digit (TD) are two common conditions associated with early disease. The purpose of this study was to define disease prevalence among patients with bilateral CTS and multiple TDs and assess for an increased rate of diagnosis in the presence of both. Methods: Men older than 50 years and women older than 60 years of age diagnosed with bilateral CTS, multiple TDs, or a combination of the 2 were prospectively enrolled in our study. Tenosynovial biopsy samples taken at the time of surgery were tested for the presence of amyloid using Congo red staining. Demographic and medical covariates were also collected and analyzed for differences between amyloid-positive and -negative patients. Results: Fifty-six patients were enrolled in the study, and nine patients tested positive for amyloid deposition. The demographics and medical comorbidities were similar between amyloid-positive and -negative patients. Thirty patients with bilateral CTS were enrolled, and four tested positive for amyloid. For patients with multiple TDs, a total of 17 patients were enrolled, and 4 tested positive for amyloid. Among patients with multiple TDs, only men tested positive for amyloid and were, on average, younger than those who tested negative (61 and 73 years, respectively). Patients presenting with a combination of CTS and TD did not exhibit increased amyloid discovery. Conclusions: Hand surgeons should consider tenosynovial biopsy in men older than 50 years and women older than 60 years presenting with either bilateral CTS or multiple TDs. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Isometric thumb extension exercise as part of a multimodal intervention for de Quervain’s syndrome: A randomised feasibility trial. McBain, B., Rio, E., Cook, J., Sanderson, J. and Docking, S. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Therapeutic Topic : De Quervain tenosynovitis - Resistance training This randomised controlled feasibility study assessed the safety of a multimodal intervention, including isometric thumb extension exercises, for people with de Quervain's syndrome. A total of 28 participants were randomised into either a high- or low-load exercise group. Outcomes included adherence and safety (e.g. worsening of pain) and were measured at baseline, two weeks, six weeks, and 14 weeks. Splinting was provided for the first two weeks and then gradually weaned over the course of the following four weeks. Education was provided in the form of an education booklet and individualised advice was given throughout the study period. The exercises were started at 2 weeks and involved high (70% of maximum) vs low (25% of maximum) load isometric exercises. The results showed that both groups demonstrated statistically significant and clinically important improvements in pain and function at 6 and 14 weeks, with 93% exceeding the MCID for improvements in global rating of change. Exercise adherence rate was >80%, with no drop-outs and a low number of adverse events. High or low-intensity isometric exercises were both deemed safe options for these patients. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, high or low intensity isometric thumb extension exercises appear to be a safe and feasible intervention for people with de Quervain's syndrome, and may be beneficial in improving pain and function. This is in line with previous research showing that graded resistance exercises appear to be effective in the treatment of tendinopathies , once the reactive stage (acute phase) has settled. This research appears to provide further support for the use of splinting for a short period of time, followed by weaning after two weeks. This is especially relevant considering that continuous or intermittent splint wearing for 7.5 weeks does not appear to have a large therapeutic effect . URL : https://doi.org/10.1177/17589983231158499 Abstract Introduction: De Quervain syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain syndrome and to explore differences between high-load and low-load isometric exercise. Methods: This parallel-group randomised clinical feasibility trial included individuals with de Quervain syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Results: Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusions: Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial. Núñez-Cortés, R., et al. (2023) Level of Evidence : 1a- Follow recommendation : 👍 👍 👍 👍 (4/4 Thumbs up) Type of study : Therapeutic Topic : Carpal tunnel syndrome - pain education This randomised controlled trial investigated the effectiveness of adding pain neuroscience education to a telerehabilitation program for patients with carpal tunnel syndrome (CTS). A total of 30 patients were included. Pain intensity, pain catastrophizing, kinesiophobia, symptom severity, function, symptoms of anxiety and depression, quality of life, and self-perception of improvement were measured at baseline and six weeks follow-up. Participants in the control group group received a total of 3 telerehabilitation sessions via WhatsUp, during which the patients performed the exercises shown below under the supervision of a physiotherapist. The experimental group received the same intervention plus a pain education session on the same day of the first appointment. Results showed that the addition of pain neuroscience education improved kinesiophobia to a clinically relevant level compared to exercise alone. There were no group differences between the two groups across the other outcomes, however, most patients improved to a clinically relevant level from baseline to follow-up. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, pain neuroscience education combined with exercise in a telerehabilitation program can be beneficial for patients with carpal tunnel syndrome (CTS). This intervention can lead to short-term improvements in kinesiophobia, however, it does not appear to modify symptoms. These findings are supported by previous evidence showing that the combination of pain neurophysiology education and exercise is more effective than exercise alone in people with persistent pain . URL : https://doi.org/10.1016/j.msksp.2023.102835 Abstract Background: Previous studies have shown positive results of pain neuroscience education (PNE) combined with exercise in patients with chronic musculoskeletal disorders. However, the effects of this intervention in patients with carpal tunnel syndrome (CTS) admitted to a telerehabilitation program remain unexplored. Objective: To compare the effectiveness of a 6-week telerehabilitation program based on PNE + exercise versus exercise alone on patient-reported outcomes after treatment and at 6-weeks post-treatment follow-up in patients with CTS awaiting surgery. Design Randomized controlled trial. Methods: Thirty participants were randomly assigned to the PNE + exercise or exercise-only group. Outcome measures included pain intensity, pain catastrophizing, kinesiophobia, symptom severity, function, symptoms of anxiety and depression, quality of life, self-perception of improvement. Inferential analyses of the data were performed using a two-factor mixed analysis of variance. Results: Twenty-five participants completed the study. A significant time × group interaction with a large effect size was observed for kinesiophobia (F = 6.67, p = 0.005, ηp2 = 0.225) and symptom severity (F = 4.82, p = 0.013, ηp2 = 0.173). No significant interaction was observed for the other variables (p > 0.05). A significant difference in self-perceived improvement was observed in favor of the PNE + exercise group after treatment (p < 0.05). Although there were significant and clinically relevant improvements within the PNE + exercise group in pain intensity and catastrophizing, there were no significant differences between the groups. Conclusions: The addition of PNE to a telerehabilitation exercise program showed short-term improvements in kinesiophobia and symptom severity and greater self-perceived improvement in patients with CTS awaiting surgery. This study highlighted the benefits of including PNE in telerehabilitation interventions for patients with CTS. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Factors associated with self-reported pain and hand function following dorsal wrist ganglion excision. Greminger, M., et al. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Wrist ganglion excision - Factors influencing recovery This cohort study assessed prognostic factors associated with the recurrence of dorsal wrist ganglion following surgical excision. A total of 308 patients with a dorsal wrist ganglion cyst were included. Diagnostic methods varied across surgeons but US and MRI imaging were often utilised. All participants completed forms at baseline and 3 months follow-up. These forms included demographic characteristics, previous surgery to the hand, pain intensity, treatment credibility, and symptoms duration. The results showed that recurrence of dorsal ganglion following surgery, treatment of the dominant hand, longer symptoms duration, higher baseline pain intensity, and lower treatment credibility contributed to higher levels of pain and worse hand function at three months post-surgery (see figure below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, worse outcomes following wrist gangliong cyst removal are associated with previous surgery, treatment of the dominant hand, longer pain duration, higher baseline pain, and lower treatment credibility. Clinicians should take these findings into account during patient counselling and expectation management. Psychological factors such as treatment credibility should also be considered when assessing outcomes following ganglion excision. There is a growing body of evidence suggesting that patients' expectations not only affect treatment outcomes (e.g. hand OA , DRF ) but also the outcome of our assessment . URL : https://doi.org/10.1177/17531934231153029 Abstract This study aimed to analyse which factors contribute to pain and limited hand function after dorsal wrist ganglion excision. We included 308 patients who underwent surgery between September 2017 and August 2021. Patients completed baseline questionnaires and the patient-rated wrist/hand evaluation questionnaire at baseline and 3 months postoperatively. We observed an improvement in postoperative pain and hand function, but individual outcomes were highly variable. We performed stepwise linear regression analyses to examine which patient characteristics, disease characteristics and psychological factors were associated with postoperative pain and hand function. Higher postoperative pain intensity was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment and longer symptom duration. Worse hand function was associated with recurrence following prior surgery, worse baseline hand function and lower treatment credibility. Clinicians should take these findings into account during patient counselling and expectation management. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Does radiographic alignment correlate with patient-reported functional outcomes and posttreatment complications in older patients treated for wrist fractures? Lawson, A., et al. (2023) Level of Evidence : 2c Follow recommendation : 👍 👍 👍 (3/4 Thumbs up) Type of study : Prognostic Topic : Radius fracture – x-ray alignment This retrospective study assessed the correlation between radiographic alignment and functional outcomes in older patients (>60 yrs old) with distal radius fractures. In addition, it compared the outcomes of people who had undergone an open reduction internal fixation (ORIF) vs those who had undergone conservative management. The results showed no association between functional outcomes at 12 months and radiographic alignment at 6 weeks. Furthermore, people treated conservatively had poorer radiographic alignment than the ORIG group, however, there were no differences on functional outcomes between these two groups at 12 months. Routine 6-week imaging may be unnecessary as radiographic findings do not correlate with patient-reported outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, radiographic parameters at 6 weeks post distal radius fracture are not associated with functional outcomes at 12 months in people over the age of 60. As a result, routine radiographs at six weeks post distal radius fracture may be questionable. In contrast, it appears that greater levels of pain catastrophising and depression following a distal radius fracture negatively affect pain levels , disability , and finger stiffness . As a result, we should focus on these factors more as they appear to have significant repercussions on our patients. URL : https://doi.org/10.1016/j.jhsa.2023.02.012 Abstract Purpose: Surgical treatment of distal radius fractures provides better fracture alignment than closed reduction; however, surgical treatment does not lead to better patient-reported function at 12 months. The aims of this study were to report the radiographic outcomes from the Combined Randomized and Observational Study of Surgery for Fractures In the distal Radius in the Elderly trial, investigate the association between radiographic outcomes and patient-reported function, and explore whether this association was affected by posttreatment complications and direction of malalignment. Methods: This study used the outcomes of the Combined Randomized and Observational Study of Surgery for Fractures In the distal Radius in the Elderly trial, which is a combined randomized and observational trial that compared volar-locking plate fixation with closed reduction and cast immobilization, to treat distal radius fractures in patients aged ≥60 years. Four radiographic outcomes (dorsal angulation, radial inclination, ulnar variance, and articular step) were reported at the following three time frames: (1) baseline, (2) after treatment, and (3) ≥6 weeks by treatment group. Secondary analysis was correlation of 12-month patient-reported function scores with 6-week radiographic measures for each of four radiographic parameters, and a subgroup analysis was conducted to investigate if this was affected by posttreatment complications. Tertiary analysis investigated if direction of malalignment affected the secondary analysis. Results: We recruited 300 participants (166 randomized and 134 observational); 113 had volar-locking plate fixation, and 187 had closed reduction. There were no between-group differences for each of the four pretreatment radiographic parameters, but there were between-treatment group differences for all four radiographic parameters apart from articular step. We found no association between patient-reported function at 12 months and each of the four radiographic parameters at 6 weeks. This lack of association was unaffected by posttreatment complications and the direction of malalignment. Conclusions: For patients with wrist fractures aged ≥60 years, final radiographic alignment did not correlate with patient-reported function at 12 months. These findings were not affected by treatment type, and there was no association between radiographic alignment and posttreatment complications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Approach to tendinopathies of the upper limb: What works. Brown, R. D. and Kennedy, S. A. (2023) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Tendinopathies – Conservative and surgical interventions This expert opinion discusses the causes and complications of persistent tenosynovitis, tendon adhesions, and tendon instability in the upper limb. It explains that tendon adhesions can occur at the surgical site and can cause a pulling sensation/pain. Persistent tenosynovitis can occur in the same location or elsewhere in the same digit (e.g. following trigger finger release). The authors also mention revision surgery options for persistent lateral elbow pain, which include denervation or anconeus flap coverage. Non-operative treatments such as hand therapy and splinting can be used to improve impairments. If conservative approaches are not sufficient, adhesions and/or capsular contracture can be managed surgically. Neuropathic pain post-surgery should be kept in mind as a differential diagnosis and psychosocial factors should be considered especially when assessing persistent tendon presentations that are unresponsive to treatment. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, upper limb tendinopathies require a focused history and physical examination to clarify the source of symptoms . Non-operative treatments such as hand therapy/exercise and splinting can be used to improve range of motion, strength, pain, and coping skills . Neuropathic pain post-surgery (due to lesion of superficial nerve endings) and psychological factors should be considered as contributors to symptoms. In particular, psychosocial factors appear to be predictors of recovery following both conservative treatment (e.g. trigger finger , DeQuervain ) and more invasive interventions for the upper limb (e.g. recovery post CT release ). URL : https://doi.org/10.1016/j.hcl.2023.02.010 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Is hyperpronation more effective than supination for reduction of a radial head subluxation? Bertucci, N. and Cowling, K. (2018) Level of Evidence : 5 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Pulled elbow - Treatment review This is a systematic review assessing the effect of different reduction approaches for children with radial head subluxation (pulled elbow). I scored the paper with low ratings because of the limited information about the review process provided by the authors. A total of 8 studies, for an overall 811 participants, were included in this study. The results showed that hyperpronation is more effective than supination-flexion for reducing radial head subluxation in pediatric patients. However, the evidence was of low quality. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, hyperpronation appears to be more effective than supination-flexion for reducing radial head subluxation in pediatric patients. These findings appear to be in line with a much older study . If we are ever considering using this technique for an acute injury in children, we should make sure that no other pathologies (e.g. fractures) are explaining the presentation. URL : https://doi.org/10.1016/j.annemergmed.2018.01.002 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Radial head arthroplasty for fracture: Implant survivorship and outcomes at mean follow-up of 8 years. Campbell, B. R., Rengifo, S., Wickes, C. B., Amer, K. M. and Ilyas, A. M. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Prognostic Topic : Radial head replacement – Long-term outcomes This retrospective study assessed the long-term outcomes of radial head arthroplasty (RHA). A total of 89 patients with unstable fractures of the elbow were included in the analysis. The implant survival rate was 96% at 10-year follow-up, and the mean Quick Disability of the Arm, Shoulder, and Hand score was 9 (mild disability). Reoperation rates were highest within the first 12 months of the index surgery (90%), and fractures with associated elbow dislocation were at a higher risk for reoperation. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, radial head arthroplasty is a reliable successful treatment for radial head/neck fractures that cannot be managed conservatively. At 8-10 year follow-up, people only present with mild disability of their upper limb. Patients should be monitored closely for the first 12 months post-surgery as that is when stiffness/complications are most likely to occur. If you would like to know more which radial head fractures require surgery, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2023.04.020 Abstract Purpose: The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. Methods: A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. Results: A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81–128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. Conclusions: Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Open fractures of the hand: A new classification based on risk score to predict infection requiring re-debridement. Atthakomol, P., Thachooprakorn, N., Phinyo, P. and Manosroi, W. (2023) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Prognostic Topic : Infections - Open hand fractures This retrospective study proposed a new classification system for open hand fractures to predict the risk of infection requiring re-debridement. A total of 846 were included in the study. Of these patients, 4% (33 participants) developed an infection. Five independent predictors were identified: diabetes mellitus or immunocompromised condition, injuries from a bite, fractures with comminution/bone loss, neurovascular injuries and inadequate soft tissue coverage. The sensitivity and specificity of the classification system to predict low-risk infection were 91% and 41%, respectively. The discriminative ability of the predicted score was demonstrated by an AUC of 0.79, indicating a moderate to high predictive value. Keep in mind that the ability of this study to correctly predict infections in a new independent sample has not been assessed yet. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, open hand fractures can be classified into three risk categories based on a risk score. Factors such as diabetes mellitus or immunocompromised condition, injuries from a bite, fractures with comminution/bone loss, neurovascular injuries and inadequate soft tissue coverage can increase the risk of infection requiring re-debridement. These results appear to be in line with previously published papers, which found diabetes , and a freshwater injury to be risk factors for the development of hand infections post-surgery/laceration. URL : https://doi.org/10.1177/17531934231187553 Abstract We developed a classification for open hand fractures based on risk score to predict the risk of infection requiring re-debridement. A total of 846 retrospectively included patients underwent multivariable analysis with backward elimination to derive the predictive risk score from independent predictors. The incidence of infection requiring re-debridement was 4%. Independent predictors include diabetes mellitus or immunocompromised condition, injuries from a bite, fractures with comminution/bone loss, neurovascular injuries and inadequate soft tissue coverage. The area under the receiver operating characteristic curve of the prediction score was 0.79. The new classification system for open hand fractures divides patients into three groups: low-risk open fractures (Type I, score <1); moderate-risk open fractures (Type II, score 1 to 2.5); and high-risk open fractures (Type III, score >2.5), based on the risk of infection requiring re-debridement. Re-debridement and delayed primary closure are suggested for type III open fractures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Lacertus syndrome: One term – two different pathologies. Berezin, P. A. and Zolotov, A. S. (2023) Level of Evidence : 5 Follow recommendation : 👍 (1/4 Thumbs up) Type of study : Diagnostic/Therapeutic Topic : Lacertus syndrome and pronator syndrome - What is the difference? This is a letter to the editor that describes the authors' opinion on the differences between Lacertus Syndrome and Chronic Exertional Compartment Syndrome of the Pronator Teres. These two conditions are characterized by pain in the antero-medial portion of the proximal forearm. Lacertus Syndrome cause compression of the median nerve and may be associated with reduction in grip and pinch strength, and worsening of fine motor skills. In contrast Compartment Syndrome of the Pronator Teres is cause by compression of this muscle by the lacertus fibrosus. This condition is usually associates with swelling of the muscle and pain in the medial elbow. Imaging as well as history taking are useful to differentiate between the two conditions. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical take home message : Based on what we know today, Lacertus Syndrome and Chronic Exertional Compartment Syndrome of the Pronator Teres are two rare conditions of the anterior/medial proximal elbow. Either can present with decreased strength in the fist and pinch, and worsening of fine motor skills. Despite the authors suggesting that lacertus fibrosus is the one negatively impacting the median nerve (see table above), there are case studies/expert opinions showing that both the lacertus fibrosus and the pronator teres can lead to compression of the median nerve. URL : https://doi.org/10.1177/17531934231170347 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Reliability and validity of the hook test for diagnosis of distal biceps tendon ruptures. Baylor, J. L., et al. (2023) Level of Evidence : 3b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Diagnostic Topic : Hook test – Sensitivity and specificity This diagnostic study assessed the validity and reliability of the Hook Test (HT) for diagnosis of distal biceps tendon ruptures. A total of 28 patients with a high probability of distal biceps rupture as per specialist assessment, completed advanced imaging (MRI or US) and underwent surgery for diagnostic/therapeutic purposes. The results showed that the sensitivity and specificity of the HT were 96% and 67%, respectively, and advanced imaging demonstrated 100% sensitivity and specificity. Inter specialist reliability was high. Keep in mind that to keep this test is much more useful when you suspect a distal biceps rupture before completing the test. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the distal biceps hook test (HT) may be used as a screening and diagnostic test, however, it should not be used in isolation as we don't know how it would perform across a group of patient with more heterogeneous presentations compared to this study. History as well as advanced imaging modalities are likely to help in the identification of distal biceps ruptures. If you want to know more about orthopaedic tests for the elbow or about the postero-lateral rotatory drawer test, which has undergone better validation, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2023.07.004 Abstract Purpose: Although the initial description of the distal biceps tendon (DBT) hook test (HT) reported 100% sensitivity (Sn) and specificity (Sp), subsequent retrospective series have demonstrated imperfect validity. The purpose of this investigation was to prospectively assess the validity and reliability of the HT for complete DBT ruptures. We aimed to determine the Sn/Sp and interrater reliability for the HT. Methods: A consecutive series of adult patients presenting to our outpatient clinics with an elbow complaint was prospectively examined. Patients were included if they had undergone advanced imaging (magnetic resonance imaging or ultrasound) that imaged the DBT and underwent DBT repair. There were four participating surgeons, all of whom were blinded to magnetic resonance imaging/ultrasound prior to performing the HT. To determine the Sn/Sp of the HT and advanced imaging, intraoperative findings served as the primary reference standard. The interrater reliability of the HT was calculated for cases in which a primary examiner (surgeon) and secondary examiner (physician assistant or resident) performed the HT. Results: Of 64 patients who had undergone advanced imaging, 28 (44%) underwent DBT surgery and were included in the assessment of Sn/Sp. The mean age was 49 years, and all patients were men. The Sn and Sp of the HT were 96% and 67%, respectively. Advanced imaging demonstrated 100% Sn and Sp. Twenty-five patients were evaluated by a primary and secondary examiner. The interrater reliability was substantial (Cohen kappa, 0.71). Conclusions: The Sn and Sp of the HT were 96% and 67%, respectively, when assessed prospectively. Advanced imaging findings (magnetic resonance imaging/ultrasound) demonstrated 100% Sn and Sp. The HT can be performed reliably by examiners with varying experience levels. Considering the imperfect validity of the HT, we caution against the use of this examination alone to diagnose DBT ruptures. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings