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Handchirurgie --- Chirurgie --- Hand

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Introduction: The palmar skin often retracts in patients with Dupuytren’s disease (DD) before the development of severe contractures. The Cutometer MPA 580 is a non-invasive, objective measurement tool that can detect these early decreases in skin elasticity to evaluate disease progression and forecast a therapy plan. Nevertheless, good reproducibility of the measurements is required to utilize the device for diagnostic and prognostic purposes. In this cross-sectional analytical study, we proposed a new standardized and fine-tuned measurement protocol to investigate the impact on the reliability of the measurements. Methods: Two observers measured the palmar skin elasticity of 25 DD patients (31 hands) and 30 healthy controls (30 hands) in a standardized way. Two sites on the affected palmar fascia were rigorously selected and marked by an experienced hand surgeon according to skin involvement. The two sites for the healthy controls were predefined. Intra- and interobserver reliability was assessed through the intra-class correlation coefficient (ICC). Second, an independent samples t-test was performed to validate the difference in skin elasticity between the two marked sites on the DD-affected hand. Results: Moderate to good ICC values were found for the intra-observer reliability on the site where the skin was fused (0.649;0.972) and loose (0.578;0.896) to the affected palmar fascia (DD). Moderate values were found for the interobserver reliability on the fused (0.655) and loose (0.634) skin sites. The same for the ICC values on the distal palmar crease site of the healthy controls: a moderate to good intra- (0.673;0.831) and moderate interobserver (0.549) reliability. The measurements on the healthy controls' ulnar site of proximal digit IV had poor intra-and interobserver reliability. Regardless of the reliability, the Cutometer was able to detect significant differences in maximal skin deformation (Uf) between the two places. Discussion: These results indicate that the standardized measurements and tailored site selection with relocation protocol have the potential to improve the reliability of the measurements for the Uf parameter, but measurements can still suddenly become unreliable and thus unusable. Small relocation displacements and excessive force cause great differences between the measured values of repeated measurements on the same subject (outliers). We conclude that further improvements need to be made first to overcome these limitations before the device can be utilized as an objective outcome measure for DD patients in clinical practice.

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Achtergrond: triangulair fibrocartilagineus complex (TFCC) scheuren kunnen leiden tot chronische post-traumatische distaal radioulnair gewricht (DRUJ) instabiliteit. Dit is een moeilijk te behandelen probleem. Verschillende chirurgische technieken zijn beschreven voor het herstel van de stabiliteit. Deze technieken zijn complex en er bestaat geen duidelijkheid over de voorkeurstechniek. Doel: de verschillende chirurgische opties en hun outcome voor de behandeling van DRUJ instabiliteit beschrijven en vergelijken. Methoden: in de literatuur werd gezocht naar studies over de chirurgische behandeling van post-traumatische chronische DRUJ instabiliteit. De resultaten van de Adams anatomische reconstructie, de artroscopische anatomische reconstructie, varianten van de Adams procedure, de Herbert Sling methode en het open en artroscopisch TFCC herstel werden met elkaar vergeleken. Resultaten: in deze review werden 37 studies met een totaal van 900 patiënten geïncludeerd. De Adams anatomische reconstructie resulteerde in blijvende stabiliteit bij gemiddeld 87% van de patiënten, de artroscopische anatomische reconstructie bij 81%, het artroscopisch TFCC herstel bij 81%, het open TFCC herstel bij 80% en de variabele methoden bij 85%. Discussie: de keuze voor de meest adequate chirurgische procedure voor het herstel van DRUJ instabiliteit is een complexe opgave. De Adams anatomische reconstructie is heden een gekende en betrouwbare methode. Verschillende minder invasieve methoden bieden een veelbelovend alternatief. Er is nood aan gerandomiseerde prospectieve studies en vergelijkende studies met overeenkomende outcome parameters om de technieken met elkaar te kunnen vergelijken.

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Surgeons started to look for a solution for distal radioulnar joint (DRUJ) pathology over 100 years ago. The therapy options vary from resection of the distal ulna to arthroplasty. The purpose of the study was to check if the semi-contrained arthroplasty of the DRUJ is a trustworthy procedure and to compare the outcome of our population to results in literature and look for consistancy. This study describes the results of 20 patients who underwent a replacement of the DRUJ. Between 2010 and 2015, 28 patients received an Aptis implant. Twenty out of these 28 patients were available for evaluation after a mean follow-up of 62.5 months. We examined the functional outcome and evaluated the DASH, PRWE and a VAS pain score. The mean DASH, PRWE and VAS pain score were 33.5, 38.7 and 4, resectively. The mean flexion and extension were 68° and 57° respectively and the mean pronation and supination were 80° and 69°. The grip strenght recovered to 59% and pinch strenght to 71% after surgery compaired to the non-operated side. One implant was removed because of persistend pain and synovitis which brought our survival rate to 95%. Since the start of this implant overall good results were reported with a survival rate between 96 and 100%. Review of literatur showed mean PRWE scores between 29 and 33 and DASH scores between 23 and 27. In our study we found comparable results with high satisfaction rates.

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Background: Early mobilisation is essential in complete recovery of digit function after primary flexor tendon repair in zone II injuries. Two methods of rehabilitation are current clinical practice: controlled active motion and passive motion. Despite the abundance of publications on rehabilitation protocols, no consensus exists on the preferred post-operative management. Methods: The MEDLINE database was searched for articles published after 1989. Articles with comparative designs were included. The primary outcome was the difference in total active motion between protocols using the Strickland Criteria. The secondary outcome was the relative rupture rate. Both primary and secondary outcome were analysed according to publication year and complexity of the core suture. Results: One hundred and four articles were identified. Seven were ultimately included. The controlled active motion protocol produced excellent or good ratings in 80.74% of digits and a rupture rate of 8.57%. Correspondingly the controlled passive motion protocol achieved 58.28% and a rupture rate of 5.24%. Multi-strand and recent repairs yielded a lower rupture rate but showed no effect on total active motion. Conclusions: We provided weak evidence supporting controlled active motion as the best post-operative management after flexor tendon injuries in zone II. Our data further show that controlled active rehabilitation methods do not increase the risk of rupture when a multi-strand technique is used. We therefore argue that the optimal management of flexor tendon injuries in zone II would be an active motion protocol after a multi-strand core suture.