Hand Surgery

Bend sensors fundamental characteristic is to furnish an electrical resistance value related to the angle they are bent. This feature can be successfully exploited to realize wearable systems capable to measure human static and dynamic postures. In particular some efforts have been made to determine finger joint movements of human hands and it has been demonstrated the feasibility of using the so called data glove system as a goniometric device. The repeatability of such system is quite good for general purposes but it is still not sufficient for specific applications (for instance in virtual surgery). So here we introduce a novel application method of bend sensors and demonstrate how it can be useful to improve the system repeatability.

Aim: To present the clinical profile and management of symmetrical peripheral gangrene and review the literature available on the subject. Methods: Ten patients of Symmetrical peripheral gangrene after initial resuscitation and vital supports were managed either conservatively or amputation was planned depending upon individual case. Results: Of ten patients, nine survived and one died. Three patients among survivors required amputations. Two patients required delayed skin grafting after wound care, dressing and debridement. Four patients recovered with auto amputation of digits. Conclusion: Presentation of symmetrical peripheral gangrene is usually with septicemic shock and history of dehydration and gastroenteritis are mostly present. Early aggressive conservative therapy may save life of patient.

Pyogenic flexor tenosynovitis is an acute closed space infection of the flexor tendon sheaths of the hand. There is marked patient discomfort and severe limitation of the flexor tendon function. The distress is due to the presence of purulent infection within the tight flexor tendon sheath akin to compartment syndrome causing harm to muscle Delay in the diagnosis or treatment can harm the blood supply leading to tendon necrosis and permanent disability. The management is prompt surgical decompression. A 37-year-old pleasant soldier presented to our treatment facility with pain, swelling and pus discharge from the palmar aspect of left index finger distal interphalangeal crease following a penetrating injury 5 days ago. Based on clinical features, he was diagnosed as a case of acute pyogenic flexor tenosynovitis of index finger of left hand. He underwent prompt decompression and debridement in a two-stage procedure. In Stage 1-Incision and drainage of the pus was done along with irrigation of the wound. Three days later in Stage 2-relook debridement and wound closure was done. At 9 months follow up his range of motion was functionally good but for mild flexion deformity at the proximal interphalangeal joint. Pyogenic flexor tenosynovitis necessitates timely recognition and urgent intervention. The treating orthopaedic surgeons should be familiar with the four cardinal signs of Kanavel. Prompt surgical intervention holds the key to preventing complications like tendon necrosis and bone osteomyelitis.

Despite all efforts made by healthcare systems around the world to prevent medical errors from occurring, their incidence rates are still increasing, prompting the World Health Organization (WHO) to describe it as an epidemic problem. Realizing it is a thorny, sensitive subject, difficult to reach a consensus on, and despite the scarcity of sources related to hand surgery in particular, as well as the reluctance of some individuals and official institutions to provide information about it, we decide to tackle the issue because of its importance, especially since most of these errors are preventable and avoidable, by analyzing 245 cases detected or referred to the hand clinic in Benghazi between January 2020 and December 2021, who were suffering iatrogenic adverse effects related to previous surgical interventions. After excluding the non-surgical errors, we found that the percentage of intraoperative technical errors in hand surgery was 39.1%, with inadequate procedures being the most common at a rate of 65.6% and the lack of appropriately efficient equipment being the reason for 32.4% of these errors. To conclude, practical special training in hand surgery and the discovery of the root causes of these errors are the best ways to reduce them to a minimum.

We have previously shown that the ability to mechanically extend Dupuytren's contractures in vivo by the Continuous Elongation Technique before surgery resulted in increased metalloproteinase activity. However, under these conditions it was not possible to show whether the response was proportional to the mechanical stimulus or was inflammatory cell mediated. Using an in vitro system of controlled extensions in which inflammatory involvement is absent, we have now shown that there is a clear correlation between the load applied to the tissue and the release of matrix metalloproteinase-2. The subsequent degradation of the collagen results in a loss of mechanical strength reported in the preceding paper.

Thumb metacarpophalangeal (MCP) joint subluxation is rare, with dorsal displacement being the most common type. Volar subluxations are exceptionally uncommon and frequently overlooked due to their subtle presentation and inconclusive imaging findings. We report a rare case of type B volar subluxation of the thumb MCP joint associated with complete ulnar collateral ligament (UCL) injury, initially missed on clinical and radiological evaluation. This case highlights the importance of maintaining a high index of suspicion, careful assessment, and timely surgical intervention to restore stability and function.

Background: Trigger finger is often found in adults, accompanied by pain, swelling, and limited movement. If conservative treatment fails, surgical release of the A1 pulley will be performed. Percutaneous trigger finger release is a new surgery method with rapid recovery that includes a good outcome, but there is also more reluctance to use this standard technique than open surgery. This article, therefore, presents a comparison of the long-term outcomes of both methods across different factors, similarities, and patient groups. The study hypothesized that the percutaneous trigger finger release had a far better result than open surgery. Study methodology: Between 2012 and 2022, a total of 166 patients with trigger finger treated with either open A1 pulley release (n = 83) or percutaneous release (n = 83) were enrolled in the study. The outcomes were evaluated in both short-term and long-term periods. The disabilities of the arm, shoulder, and hand questionnaire scores (DASH) and visual analog scale (VAS) scores before and after surgery were compared between the two groups for bleeding, digital nerves, artery injury, inability to bend the finger, and others at different points at a two-year follow-up. Results: Both groups of patients were statistically similar in age and gender. There was no significant difference in the number of DASH scores and VAS scores for pain between the two groups before surgery. However, the group that underwent percutaneous trigger finger release had a very low differentiation at three months. Pain scores and other variables returned to normal with no difference between the groups at two-year long-term follow-up. No significant differences were found in complications, such as traumatic pain, digital nerves, and arterial injuries, between the groups. Conclusion: The study found that percutaneous trigger finger release in trigger finger patients was more practical than traditional open surgery in supporting their long-term clinical outcomes. This technique results in less pain and less bleeding, and the complications were not that different from traditional open surgery in two years.

Objective: To compare short-term clinical outcomes between mini-incision carpal tunnel release (MCTR) using the ProMIS kit and conventional open carpal tunnel release (OCTR) in patients with carpal tunnel syndrome (CTS). Methods: In this single-center, prospective randomized trial, 90 adults with idiopathic CTS were allocated 1:1 to OCTR or MCTR. All procedures were performed by a single fellowship-trained hand surgeon, and postoperative care was standardized. The primary endpoint was change in Boston Carpal Tunnel Questionnaire (BCTQ) symptom severity and functional status scores at 2 months. Secondary outcomes were visual analog scale (VAS) pain, Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, grip strength, scar length, and procedure-related complications. Analyses followed the intention-to-treat principle. Results: Forty-fve participants were randomized to each group; most were middle-aged women. Baseline clinical characteristics were comparable. At 2 weeks, the MCTR group reported lower VAS pain and better PRWE and QuickDASH scores than the OCTR group, indicating faster early functional recovery. By 1 and 2 months, between-group diferences in pain, BCTQ, PRWE, QuickDASH, and grip strength were small and not clinically important. No major complications, including iatrogenic nerve or tendon injury, wound infection, or reoperation, occurred in either group. Conclusion: MCTR using the ProMIS kit ofered modestly faster early recovery than conventional OCTR while providing similar short-term symptom relief, functional improvement, and safety. MCTR appears to be a reasonable alternative to standard open release for CTS, but larger trials with longer follow-up are warranted.

Hypospadias, when the urethral opening is located on the ventral side of the penis, is one of the most common congenital malformations with an incidence of 3 per 1000 males.1 Hypospadias is considered a complex trait caused by several genetic and environmental factors; low birth weight, for example, is associated with an increased risk for hypospadias.2–5 Most cases of hypospadias are sporadic but about 10% of the boys have a relative with the malformation.4,6–9 There are families with an autosomal dominant inheritance pattern of hypospadias.4,10 Hypospadias is also a manifestation in some rare single gene traits affecting sex differentiation, for example, the X linked partial androgen insensitivity syndrome and the recessive 5-alpha-reductase deficiency.11–13 However, these syndromes are characterised by severe hypospadias in association with other genital malformations such as cryptorchidism, bifid scrotum, and penoscrotal transposition. Hand-foot-genital syndrome (HFGS) is an aut...

Introduction Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8-12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. In a survey-based study, 218 surgeons reviewed 16 patient scenarios of CT-confirmed nondisplaced waist fractures treated with cast immobilization for 8 or 12 weeks and recommended for or against additional cast immobilization. Clinical variables included patient sex, age, a description of radiographic fracture consolidation, fracture tenderness and duration of cast immobilization completed (8 versus 12 weeks). To assess the impact of clinical factors on recommendation to continue immobilization we calculated posterior probabilities and determined variable importance using a random forest algorithm. Multilevel logistic mixed regression analysis was used to identify surgeon characteristics associated with recommendation for additional cast immobilization. Results Unclear fracture healing on radiographs, fracture tenderness and 8 (versus 12) weeks of completed cast immobilization were the most important factors influencing surgeons' decision to recommend continued cast immobilization. Women surgeons (OR 2.96; 95% CI 1.28-6.81, p = 0.011), surgeons not specialized in orthopedic trauma, hand and wrist or shoulder and elbow surgery (categorized as 'other') (OR 2.64; 95% CI 1.31-5.33, p = 0.007) and surgeons practicing in the United States (OR 6.53, 95% CI 2.18-19.52, p = 0.01 versus Europe) were more likely to recommend continued immobilization. Conclusion Adoption of shorter immobilization times for CT-confirmed nondisplaced scaphoid waist fractures may be hindered by surgeon attention to fracture tenderness and radiographic appearance.

Trapeziometacarpal joint osteoarthritis (TMJ OA) is a progressive condition, particularly affecting postmenopausal women. Various surgical techniques have been proposed, but the optimal approach remains debated. This clinical study compares the clinical, functional, and radiological outcomes of two surgical treatments: suspension tenoplasty using the flexor carpi radialis tendon (Altissimi technique, AST) and a dual-mobility prosthesis. The main complications associated with these procedures include postoperative pain, De Quervain's syndrome, radial nerve injuries, and prosthetic component mobilization. In prosthetic arthroplasty, the most common complication is component mobilization (8%), while in tenoplasty, postoperative pain is the most frequent (15%). A total of 36 patients were randomized into two groups: 18 patients underwent AST (Group A), and 18 received trapeziometacarpal joint arthroplasty (Group B). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analogue Score (VAS), and Michigan Hand Outcomes Questionnaire (MHQ) at 3, 6, 12, and 24 months. Range of motion (ROM), Kapandji score, pulp pinch strength, hand grip strength (Jamar dynamometer), and radiological maintenance of the trapezial space (step-off measurement) were also evaluated. Both procedures resulted in significant pain reduction (VAS, p < 0.05) and functional improvement (DASH, MHQ, p < 0.05). ROM increased significantly in both groups. The Kapandji scores improved from 4.0 ± 1.1 to 9.2 ± 1.2 (Group A) and 4.3 ± 0.8 to 7.8 ± 1.4 (Group B) (p < 0.05). Group B grip strength results showed a greater increase in hand grip strength than Group A (p = 0.23). The radiographic step-off showed slight proximal migration of the first metacarpal in Group A, whereas Group B maintained joint height. No implant loosening or major complications were reported in either group. Both suspension tenoplasty and dual-mobility arthroplasty are effective in TMJ OA. AST ensures joint stability with minimal radiographic changes, whereas TJA provides superior grip strength and ROM recovery. The absence of major complications suggests that TJA is a safe alternative to AST, but its higher cost and potential for implant-related complications must be considered.

This report speculates a new type of two-strand flexor tendon repair, which incorporates the advantage of multiple anchor points of multistrand techniques. This article also highlights importance of considering comparative physics in tendon repair.

Hand flexor tendon repair with absorbable sutures has the advantage of leaving no foreign material within the tendon. However, clinical application of degradable materials in flexor tendon repair is limited to slow-absorbable PDS or Maxon sutures and commonly does not involve fast-absorbable sutures, probably, because of fear of ruptures. Meanwhile, a small number of reports have shown that in terms of tenorrhaphy failure fast-absorbable sutures are safe. It is also known that classical tendon repairs with a pull-out wire withstand intensive mobilization after wire removal. Furthermore, experimental research implies that fast-absorbable polyglycolic acid fibers seeded with tenocytes can strengthen tendon repair. The current article retrospectively analyses a series of 12 patients with predominantly complex hand injuries, in which 17 flexor digitorum profundus and four flexor pollicis longus tendon repairs with Vicryl (polyglactin 910, copolymer of polyglycolic and polylactic acid) were performed. Early postoperative passive mobilization was employed. The postoperative results were analyzed with particular reference to tenorrhaphy failure. Ruptures occurred in only two repairs. This was statistically insignificant when compared with a hypothetical set of cases consisting of only good and excellent outcomes. These results imply that hand flexor tendon repair with fast-absorbable sutures is rupture-safe if moderate postoperative mobilization is employed. However, as the calculated postoperative dynamics of the tenorrhaphy strength predicts failure of all fast-absorbable suture repairs during active motion at six weeks, more research is needed to clarify why this was not the case in the presented and other published series of patients.

Distal radius fractures are frequently associated with ulnar styloid fractures,
yet the clinical benefit of fixing the ulnar styloid remains uncertain. This
systematic review evaluated whether ulnar styloid fixation improves
pain, function, wrist mobility, or distal radioulnar joint (DRUJ) stability
following surgical treatment of distal radius fractures. A comprehensive
literature search of PubMed, Embase, Scopus, and the Cochrane Library
was conducted according to PRISMA 2020 guidelines, including studies
comparing outcomes with and without ulnar styloid fixation. Data on
pain, functional scores (DASH/PRWE), wrist range of motion, and DRUJ
stability were extracted, and risk of bias was assessed using ROBINS-I,
AMSTAR 2, or Cochrane RoB 2 tools. Nine studies comprising 680 adult
patients were included. Across these studies, routine ulnar styloid fixation
did not provide significant improvement in pain, functional outcomes, or
wrist mobility. Selective fixation for basal fractures associated with DRUJ
instability may offer targeted benefits. Overall, the evidence suggests
that routine ulnar styloid fixation is generally unnecessary, and surgical
decision-making should prioritize DRUJ assessment to optimize outcomes
while minimizing operative morbidity.

the extremities were in greater evidence. These injuries are characterized by high-energy and comminuted fractures, vascular damage and important soft tissue loss. More recently, in the Global War Against Terrorism, reports from the United States Navy Medical Corps revealed an incidence of 58 to 88% of firearm injuries, with 23 to 39% of fractures in more than 56,000 patients (2). The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. The amputation rate of American soldiers in World War II was 35.8% after repair and , On per rectal examination anterior rectal wall was indented by the vaginal mass and rectal mucosa was free. Left pulses of the superior left limb were absent with clinical signs of the beginning of ischemia.

A prospective audit of 140 median, radial and ulnar blocks, given for 70 hand operations is described. The surgery was completed successfully in every patient. A further injection of local anaesthetic was required in 13 operations. Four patients experienced severe tourniquet pain. The results of the audit have shown that if a careful technique is used, a wide range of minor hand operations can be performed under regional nerve block.

Many fingertip injuries in childhood involve the nail bed. Deformities of the nail are a frequent result of failure to repair the nail bed at the time of injury. Secondary correction of nail deformities seldom achieves good results. We present the results of our experience in the management of 19 children with 22 injuries involving the nail bed. All achieved normal nail growth and the overall result of the repair was good in 91%. Complications were few and parental satisfaction with the management was high. Every effort should be made to perform a meticulous primary repair of all nail bed injuries.

Ankle fusion that is operated on severe ankle arthritis has its weakness in that normal walking is impossible, even though the result is pretty good. As a alternative choice, total ankle replacement pursues the longer survivorship with material improvement. However, it is not yet known how much range of motion is possible after the replacement, or how it has changed overtime. Therefore, we need an analyzation for that. Materials and Methods: A retrospective review of sixty-seven patients undergoing STAR total ankle replacement at our institution between 1998 and 2002 was conducted. Of those, twenty-six (39%) had complete sets of full dorsiflexion and plantar flexion lateral radiographs both between "immediate" postop and at a minimum of 2-years follow-up and no revision procedure during that time. The mean age of these patients was 63.2 years when the surgery was done; the etiology of arthrosis was 21(81%) post-traumatic/degenerative, 4 rheumatoid and 1 psoriatic. Results: Average "immediate" ankle range of motion was 15.9°, and total foot (non-ankle) motion was 20.6°. At one, two, and three years the average ankle and total foot ranges of motion were 17.4°, 17.6°, 15.6° and 21.0°, 22.0°, 21.2° respectively. Statistically there was no significant difference between "immediate" postop motion and one to three years postop (all p>0.05). The range of motion after the STAR total ankle replacement is maintained from the "immediate" postoperative range of motion, but not increased, in the 1-3 year post replacement period.

ARTICLE DETAILS Background: Thumb tip injuries involving soft tissue loss and bone exposure represent a reconstructive challenge due to the need to preserve digital length, restore sensibility, and maintain pinch function. The Moberg flap (bilateral volar neurovascular advancement flap) is a classic reconstructive option that provides sensate glabrous skin and durable coverage for selected distal defects. Case Report: We present the case of a 25-year-old male patient with a transverse right thumb tip injury classified as Allen type III, secondary to an avulsion mechanism, with a 1.5 × 2.0 cm defect and distal bone exposure. Reconstruction was performed using a Moberg flap, achieving complete defect coverage without additional bone shortening. Postoperative management included early mobilization and a progressive rehabilitation protocol. Results: The flap demonstrated complete survival with adequate preservation of digital length and favorable clinical evolution. Follow-up revealed recovery of sensibility, preserved joint mobility, and progressive functional reintegration, with no evidence of necrosis, significant joint stiffness, or major complications. Conclusion: The Moberg flap remains a reliable and effective reconstructive technique for Allen type III thumb tip injuries with bone exposure. Proper indication and meticulous surgical execution allow for satisfactory functional outcomes, reinforcing its role as a first-line option for distal thumb reconstruction.

ARTICLE DETAILS Background: Soft-tissue defects of the hand and wrist represent a reconstructive challenge due to the need for thin, pliable coverage that preserves function and aesthetics. The distally based posterior interosseous artery (PIA) flap offers a reliable regional option without sacrificing a major arterial axis. Objective: To evaluate clinical outcomes, complications, and technical refinements associated with the use of the distally based posterior interosseous artery flap for reconstruction of hand and wrist defects. Methods: A retrospective review was conducted on patients who underwent reconstruction with a distally based PIA flap for traumatic or post-surgical defects of the hand and wrist. Demographic data, defect characteristics, flap dimensions, survival rates, and postoperative complications were analyzed. Results: The flap demonstrated a high rate of complete survival, with partial distal necrosis occurring in a minority of early cases. Mild venous congestion was observed initially but did not compromise final outcomes. Incorporation of additional subcutaneous tissue and superficial venous structures appeared to reduce venous complications. Donor-site morbidity was low, although split-thickness skin grafting occasionally resulted in aesthetic dissatisfaction. Conclusions: The distally based posterior interosseous artery flap is a dependable and versatile option for coverage of selected hand and wrist defects. Proper preoperative planning and meticulous dissection are essential to minimize complications, particularly venous congestion and issues related to anatomical variation.

Artículo de Investigación. El trauma severo de extremidades constituye uno de los mayores desafíos en cirugía plástica y reconstructiva, ya que exige una toma de decisiones que trasciende la restauración anatómica y se orienta hacia la recuperación funcional y psicosocial a largo plazo. Esta revisión analiza la evidencia relacionada con el salvamento de la extremidad y la amputación, las estrategias de tiempo reconstructivo, las técnicas microquirúrgicas y basadas en perforantes, así como las medidas de resultados reportados por los pacientes (PROMs), con énfasis en desempeño funcional, adaptación psicológica y calidad de vida. Los datos comparativos sugieren que los resultados funcionales globales a largo plazo pueden converger entre salvamento y amputación bajo determinadas condiciones, aunque las trayectorias de recuperación y la carga terapéutica difieren. La cobertura temprana definitiva se ha asociado con mejor control local de la herida cuando es fisiológicamente viable, mientras que los enfoques escalonados alineados con los principios de control de daños son fundamentales en pacientes inestables. Los avances en colgajos libres, colgajos perforantes y reconstrucción de extremidad superior han ampliado las capacidades técnicas; sin embargo, la recuperación duradera depende del acceso a rehabilitación, el manejo de complicaciones y la evaluación centrada en el paciente. La investigación basada en PROMs destaca que la función física, la participación social, la carga sintomática y el bienestar emocional son dominios esenciales en la valoración de resultados. Las trayectorias a largo plazo muestran discapacidad persistente en un subgrupo de pacientes, aun cuando se observe adaptación parcial de la calidad de vida con el tiempo. Desde una perspectiva internacional, incluyendo contextos latinoamericanos como México, Colombia y Ecuador, las decisiones reconstructivas deben integrar la capacidad del sistema de salud y las realidades socioeconómicas. Por lo tanto, la cirugía reconstructiva en trauma debe entenderse como un proceso restaurativo longitudinal orientado a preservar autonomía, dignidad y participación significativa en la vida. Trauma de extremidades, cirugía plástica reconstructiva, salvamento de extremidad, amputación, microcirugía, colgajos perforantes, resultados funcionales, resultados reportados por el paciente, calidad de vida, adaptación psicológica, ortopedia de control de daños, discapacidad a largo plazo Severe extremity trauma represents a critical challenge in reconstructive plastic surgery, requiring decision-making that extends beyond anatomical restoration toward long-term functional and psychosocial recovery. This review analyzes the evidence surrounding limb salvage and amputation, reconstructive timing strategies, microsurgical and perforator-based techniques, and patient-reported outcome measures (PROMs), with emphasis on functional performance, psychological adaptation, and quality of life. Comparative data suggest that long-term global functional outcomes between salvage and amputation may converge under specific conditions, although recovery pathways and treatment burdens differ. Early definitive coverage has been associated with improved local wound control when physiologically feasible, whereas staged approaches aligned with damage control principles remain essential in unstable patients. Advances in free flaps, perforator flaps, and upper-extremity reconstruction have expanded technical capabilities, yet durable recovery depends on rehabilitation access, complication management, and patient-centered evaluation. PROM-based research underscores that physical function, social participation, symptom burden, and emotional well-being are central domains in outcome assessment. Long-term trajectories reveal persistent disability in a subset of patients despite partial quality-of-life adaptation over time. From an international perspective, including Latin American contexts such as Mexico, Colombia, and Ecuador, reconstructive decisions must integrate healthcare system capacity and socioeconomic realities. Reconstructive surgery after trauma, therefore, must be interpreted as a longitudinal restorative process aimed at preserving autonomy, dignity, and meaningful life participation rather than solely achieving anatomical survival.

Background: Fassler Type D fingertip injuries represent a significant reconstructive challenge as they involve bone exposure and compromise of the nail complex. The redesigned V-Y flap offers a simple, safe, and functional alternative for small to moderate defects, providing low morbidity and preserving length, sensitivity, and aesthetics. Objective: To present a clinical case reconstructed using a redesigned V-Y flap and a nail splint, highlighting the technique, clinical outcomes, and contemporary applicability. Methods: We described the case of a 35-year-old male with a Fassler D-Type fingertip injury to the fourth finger. The defect measured 10 mm x 0.8 mm with distal phalanx bone exposure. An andvancing V-Y flap was performed, modifying the incision with an oblique cut being preferred, and subsequent release of the septa to maximize tension-free displacement. A synthetic nail splint was made with polypropylene and fixed with sutures. Results: Complete coverage and restoration of tissue continuity were achieved under local anesthesia. Follow-up at 4 weeks demonstrated preservation of digital length and sensory recovery with two-point discrimination, restoring both aesthetics and functionality of the fingertip. Conclusions: The redesigned V-Y flap is a reliable and reproducible option for distal reconstructions with bone exposure, particularly in resource-limited settings.

Anatomic variants of the muscles of the hand have important clinical implications. We report a case of bilateral extensor digitorum brevis manus (EDBM), a rare muscle found on the dorsum of the wrist and hand in an adult female formalin-fixed cadaver. In both hands the muscle inserted proximally in the dorsal surface of the distal radius and finished inserting in the common extensor tendon of the middle finger. The anatomic and clinical implications of this variant are discussed here.

Introduction Traumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons’ tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. The aim of our study was to compare the functional results after secondary procedures by administering the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire to patients who had successful upper limb replantation and revascularization. Materials and methods This prospective observational study involved 40 patients who had a partial or complete amputation of the upper limb and underwent secondary procedures to correct function after successful replantation and revascularization surgery. The patients’ functional outcomes after various secondary procedures were recorded using the QuickDASH questionnaire. Results The mean QuickDASH score for thumb...

BACKGROUND For decades design and development of TWA has been accompanied by quite a few failures, so that it has been rejected by most surgeons until today. The difficult and complex anatomy of the wrist led to different ways of development and often ended in an impasse. Compared to knee and hip arthroplasties which could be conceived and developed further, a consistent method could not be applied. But in the last years some new concepts have established themselves, so that TWA is now not only applied in individual cases. The indications could be expanded and standardised. PATIENTS/MATERIAL AND METHODS At the Hand-Center Lingen more than 400 TWAs have been performed since 2005. This article describes the mid-term results (5 years since operation) of TWA in 162 patients. 41 % suffered from rheumatoid arthritis, the remaining diseases consisted of osteoarthritis, post-traumatic arthritis and osteoarthritis following distal radius fracture, scaphoid non-union, scapholunate dissociatio...

Background : The purpose of this study is to illustrate whether the electro-cauterization and transient tourniquet enhanced e ciency of local anesthesia with epinephrine in surgery of metacarpal fractures. Methods : Forty-four consecutive cases of metacarpal fractures with estimated major operative time more than 30 minutes were enrolled. Local anesthesia with epinephrine, electro-cauterization and transient tourniquet were performed. Data regarding anesthesia effect, bleeding in the surgical eld (with in ating and de ating tourniquet), time when patient felt uncomfortable with tourniquet, inspection of the surgical outcome, and some other surgical tricks were collected and evaluated. Results : All patients felt no pain for whole surgical period in the surgical eld. Time when patient felt uncomfortable with tourniquet was about 16 minutes. Mean tourniquet time was about 29 minutes. There was no or less bleeding in the surgical eld for whole surgical period. The anatomical structures, such as nerve, tendon and vessel can be easily distinguished and dissected. Outcome of repair and reconstruction could be examined with instructed movement. Postoperative inspection showed no symptom of in ammation. Conclusions : Local anesthesia with epinephrine, electro-cauterization and transient tourniquet for major hand surgery can save time and obtain wide-awake effect, which would satisfy both doctors and patients.

Background: Fracture-Related Infection (FRI) is a major postoperative complication of closed proximal femur fracture surgery. Glycated haemoglobin (HbA1c) among Type 2 Diabetes Mellitus (T2DM) has been found to be a good predictor of infection in elective orthopaedics, but its prognostic usefulness in acute fracture surgery remains uncertain. Materials and Methods: This retrospective analytical cross-sectional study comprised 91 T2DM patients who underwent surgery for closed proximal femur fractures at a medical college hospital between July 2022 and December 2024. Preoperative HbA1c levels measured within two weeks before surgery was linked to infection outcomes over a minimum five-month follow-up period. Clinical, analytical, microbiological, and radiographic criteria were employed to determine the infection. Data were evaluated using chi-square tests, t-tests, odds ratios, and multivariate logistic regression with ROC curve analysis to determine the optimal HbA1c threshold. Results: The average HbA1c was 8.13 ± 2.25%, with a mean age of 58.7 ± 8.6 years. Among 91 study patients, 12 had FRI, i.e., the infection rate was 13% (95% Confidence Interval; 7% to 21.9%). Staphylococcus species (75%) were the primary cause of FRI. Compared to the non-infected patients (7.8 ± 2.1%; t = 3.489, p-value 0.003; mean difference 2.4, 95% CI: 0.9-3.8), the patients with infection had a significantly higher mean HbA1c (10.2 ± 2.2%). Infection rates were 4.5% (1) for patients with HbA1c <6.5%, 6.3% (2) for patients with 6.5-7.5% and 24.3% (9) for those with HbA1c >7.5% (p-value 0.03). According to ROC analysis, an optimum HbA1c cutoff of 9.5% predicted infection with 75% sensitivity and 78.5% specificity, yielding an AUC of 0.764 (95% confidence interval: 0.613-0.915, p-value of 0.003). Age, gender, fracture type, comorbidities, and body mass index had no significant correlation with infection. Conclusion: In surgically treated closed proximal femur fractures among T2DM patients, elevated perioperative HbA1c is an independent predictor of postoperative FRI. For infection risk stratification in trauma settings, an HbA1c threshold of ≥9.5% provides moderate diagnostic accuracy. Optimising glycaemic levels prior to surgery could lower the risk of infection among T2DM patients.

Aims & Objective. To assess the incidence and rate of implant removal among orthopedic patients, its indications, and the effect of COVID-19 pandemic. Material & Method: A retrospective study was done during the period from October 2017 to October 2020 included all patients admitted for removal of orthopedic implants. Results: One-hundred eleven patients with a mean age of 28 ± 10.9 years were included in this study. Most (83.8%) were males. The incidence rate of removal was 20.2%. The mean period between implant fixation and removal was 26 ± 20 months. Lower limb fractures constituted 85.6% of cases with about half of them as foot and ankle fractures. The most frequently presented fractures were femur and tibia (33.3% and 21.6%, respectively), while the most frequently removed implants were plate and screws (43.2%). Only 8.9% of surgeries were indicated for removal, and only 4.5% of all patients suffered post-removal complications. Conclusion: Non indicated implant removal occurs at a significantly high rate in Saudi Arabia. No real indications for such a procedure were found in the majority of patients. COVID-19 control strategies caused a significant decrease in this high rate.

Degenerative changes of the distal interphalangeal (DIP) joint are often managed surgically with arthrodesis or silicone implant arthroplasty when conservative treatments fail. Conventional approaches for silicone implant arthroplasty require division of the extensor tendon, leading to prolonged immobilisation and potential extension lag. We introduce a novel palmar flexor tendon splitting approach. This approach allows silicone implant arthroplasty while preserving the extensor mechanism, eliminating the need for post-surgical immobilisation and permitting early range of motion exercise. We performed silicone implant arthroplasty using this approach on 16 fingers in 12 patients and followed up for more than 3 months. There was no flexor tendon rupture or nerve injury, and the mean DIP range of motion was 28.3°, with an extension lag of 11°. Postoperative wound healing was excellent in this approach, with no delayed healing or maceration. This approach is simple and eliminates postoperative immobilisation and has the potential to reduce extension lag.

The objective of this study was to assess functional, quality of life, and satisfaction outcomes of a hand surgery short-term surgical mission (STSM) to Honduras, and determine whether patient demographics and surgery characteristics during a surgical mission correlate with outcome. A total of 63 patients who received upper extremity surgery at a week-long hand surgery STSM to Honduras in March 2013 participated in the study. A before-after study design was used. Before receiving surgery, participants completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and the Short Form 12 Health Survey version 2 (SF12v2). Four months postoperatively, participants completed the QuickDASH, SF12v2, and Satisfaction Survey. The mean QuickDASH score significantly improved preoperatively to postoperatively. Demographics measures of age, sex, education, and income did not correlate with QuickDASH scores. Preoperative QuickDASH statistically significantly correlated w...

Hand amputation at the wrist level is severely disabling, especially when
bilateral. It is paramount to restore the hand function to the best possible level for the
patient’s daily living activities, as well as optimal social and occupational rehabilitation.
There are various options for restoration of function after amputation at wrist and
distal forearm levels including Krukenberg’s operation, variations of toe transfers, hand
allotransplantation, and prosthesis. Krukenberg’s procedure and the reconstruction
using toe transfer like Vilkki’s procedure or two-toe transfers, restore only the pinch.
Hand allotransplantation, although it gives excellent function, has limitations due to
the complications of immunosuppression. Functional hand prosthesis, though superior
in cosmetic appearance, have again limitations in function, and the cost is prohibitive
for most patients in our country.
Materials and Methods We present the unique case of a bilateral hand amputation at
the wrist level reconstructed with three toes and free anterolateral thigh (ALT) flap in a
single-stage surgery for each hand. In two stages, the patient had six toes transferred to
both hands.
Result All transferred toes and all three free (two ALT and one thoracodorsal artery
perforator) flaps survived completely. Three-finger grip (tripod pinch) was thus
restored in each hand. The hook grip was also restored well by the reconstructed
two fingers. Within 3 months after surgery, the patient could perform all activities of
daily living. He resumed his original job with some modification of his work within
6 months postinjury.
Conclusion Hand reconstruction using three toes and a free flap is an excellent option
for functional restoration for amputation at the wrist and distal forearm level. It allows
an early return to function and good social and professional integration of the patient.
This procedure is a potential alternative to expensive prosthesis and allotransplantation
for a bilateral hand amputation.

Introduction: During the 19 th and 20 th centuries, the Wars were the cause of many amputations among military and civilians. Despite the absence of armed conflict in our country, we notice a high frequency of major amputations in our activity. Objective: The aim of this work was to study the causes of major amputations observed in our practice in order to develop preventive measures. Materials and Method: This was a descriptive retrospective study over a 6-year period, from January 1, 2008 to December 31, 2014. The following parameters were studied: epidemiological aspects (age according to WHO age groups and gender of patients), type of amputation, level of amputation and causes. Results: Two hundred and fifty-two patients were included. The distribution of amputations by cause and age group showed two distinct entities: The forms of the young subject where there was a predominance of tumour and traumatic causes; and the forms of the elderly person caused by vascular infections and conditions. Infections were the main cause of amputation in both sexes. Conclusion: The causes of major limb amputations vary according to age and limb: tumor and trauma in young people and for the upper limb, infectious and vascular in the elderly and for the lower limb.