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Background: Robotic-assisted therapy (RAT) is a relatively new technology used in the treatment of children with cerebral palsy (CP). RAT has the main advantage of offering an attractive environment, better maintaining the motivation of the child during therapy. Also, it offers the possibility of a repetitive, intensive and frequent practice. In children with unilateral CP, RAT has been increasingly used to improve the function of the upper limb. Chen et al. (2013) concluded with their systematic review that RAT appears to be promising, though mainly case studies were included. Objective: This review aims to provide an overview of the more recent literature that examined the effectiveness of RAT in the rehabilitation of the upper limb function in children with unilateral CP. Methods: A literature search in Pubmed, Cinahl, Cochrane, Embase, and Web of Science was conducted systematically from July 2013 up to November 2018. Studies including children with unilateral CP, aged 1 until 18 years, were included when the effectiveness of RAT on upper limb function was examined. Results: The search resulted in seven studies, including four case studies, two randomized controlled trials, and one randomized cross-over study. Five different robotic systems were used across these studies. The total dosage of therapy varied between 5 and 40 hours, with a duration of 1-12 week(s). The results indicate that RAT leads to improvements on each level of the International Classification of Functioning, Disability and Health. Conclusion: This review indicates that the use of RAT in the rehabilitation of the upper limb function is beneficial and is better compared to conventional therapy. However, studies of higher quality, including larger sample sizes and with a longer follow-up are needed to confirm the results of this review.

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Background and Study Aims: Total Elbow Arthroplasty (TEA) is pivotal in treating elbow pathology. In this retrospective study conducted at a university hospital between 2003 and 2019, the long-term outcome and implant survival of semi-constrained TEA implants is assessed. Materials and Methods: A series of 122 semi-constrained elbow implants were included, with a minimum 2-year follow-up and three prosthetic designs: 94 Coonrad-Morrey, 11 Latitude, and 17 Nexel prosthesis. Comprehensive patient demographics, surgical indications and adverse events are detailed. Prospective data, including Visual Analogue Score (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Mayo Elbow Performance Score (MEPS), were collected during follow-up. Radiographic evaluation was performed to asses wear or loosening. Implant survival was analyzed using Kaplan-Meier survival curves. Results: The primary TEA Coonrad-Morrey group had a survival of 96% at 5 years, 92% at 10 years and 70% at 15 years, aligning with earlier reports, but emphasizing the need for ongoing vigilance. The Latitude implant had a 100% 5-year survival, while Nexel demonstrated a 78% 5-year survival, highlighting the importance of long-term follow-up duration. Adverse events occurred in 31.3%, with periprosthetic fractures (8.2%), ulnar nerve neuropathy (7.4%), and infections (4.2%) most prevalent. Revision (13.1%) was primarily indicated due to loosening (4.1%) and periprosthetic fractures (4.1%). Survival analysis indicated comparable outcomes between primary and revision TEA. Conclusions: Although the postoperative complication rate is quite high, this study provides comparable good mid- to long-term functional outcome of semi-constrained TEA. A similar high short-term survival was seen in Coonrad-Morrey and Latitude designs, but lower in Nexel. However, all implants demonstrated an increasing revision rate in long-term follow-up. Ongoing monitoring, careful implant consideration and nuanced adverse event interpretation are crucial for optimizing long-term outcome of TEA. Keywords: Total elbow arthroplasty, semi-constrained implants, implant survival, patient outcomes, adverse events, revision surgery. Level of evidence: III

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Background: Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) and trapeziometacarpal prosthesis (TMP) are two commonly used procedures for first carpometacarpal joint osteoarthritis. Long-term outcome of pain, satisfaction and function does not differ between these two procedures, but prosthesis are known to have a higher complication rate at long-term. The purpose of this study is to compare the short-term outcome of trapeziectomy with LRTI with TMC prosthesis. Methods: Following words were used to search in the Pubmed database, the Cochrane library and science direct database: thumb base osteoarthritis, LRTI, trapeziectomy, trapeziometacarpal osteoarthritis, surgical management, trapeziometacarpal arthrosis, rhizarthrosis, joint prosthesis, thumb arthroplasty, short-term outcome. Used parameters were force, pain, mobility, functionality and complication. The articles describing short-term outcome (3- 6 months) of LRTI or TMC prosthesis were included in this review. Results: TMC prosthesis gave faster pain relief compared with trapeziectomy and LRTI. Overall, there was a better strength in the TMP group. There was a lack of information about the short-term functionality. The mobility recovers faster in the TMP group, but they all used other scores or measurements which makes it difficult to compare the studies. Conclusion; We could confirm the faster pain relief in the prosthesis group and overall a faster recovery of strength and mobility. In the prosthesis group were more short-term complications. More studies are needed to evaluate the short-term recovery of strength, the mobility, functionality and satisfaction more detailed.

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Full thickness grafting can be considered after fasciectomy for Dupuytren contracture in severe cases with skin shortage or in radical dermofasciectomy. It is a common dogma that these skin grafts may prevent disease recurrence. We reviewed 47 patients after fasciectomy and full-thickness skin grafting for Dupuytren contracture after a follow-up of 3 to 16 years. Recurrence beneath the skin graft and extension of the disease in the rest of the hand were recorded. The age of onset, gender and factors considered to influence the outcome due to fibrosis diathesis such as bilateral disease, family history and ectopic lesions, were noted. The classification of R. Tubiana was used to grade the severity of the disease at the time of surgery and at the time of follow-up. None of the patients manifested recurrence underneath the skin grafts, but the disease did extend in 83%. Disease extension was more likely in patients with a higher fibrosis diathesis. We thus conclude that skin grafting may prevent disease recurrence underneath the grafts, but extension of the disease is correlated to fibrosis diathesis. Therapeutic level IV, cohort study

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De behandeling van ringavulsieletsels is moeilijk en veel auteurs beschreven teleurstellende resultaten. Recentere studies tonen echter meer bevredigende resultaten, voornamelijk dankzij de vooruitgang van de microchirurgie. Er zijn veel gevallen beschreven van succesvolle replantaties van hooggradige ringavulsie letsels. Urbaniak klasse I wordt gedefinieerd als adequaat bevloeid, klasse II als inadequaat bevloeid en klasse III letsels zijn compleet geamputeerd of “degloved”. Urbaniak klasse I en II worden best microchirurgisch gereconstrueerd. De behandeling van Urbaniak klasse III is patiëntgebonden en de beslissing over welke behandeling aangepakt wordt dient samen met de patiënt genomen te worden. Een replantatie kan geprobeerd worden bij IVi en IVd letsels volgens Adani, bij IVp letsels wordt beter een revisie amputatie of rijresectie uitgevoerd.