Challenges in Hand and Upper Limb Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 January 2024) | Viewed by 9748

Special Issue Editor

Associate Professor, Department of Pediatric Orthopaedics and Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisinger-Strasse 109, A-1130 Vienna, Austria
Interests: paediatric and adult hand surgery; paediatric orthopaedics

Special Issue Information

Dear Colleagues,

The human hand is a highly sophisticated yet fascinating organ, whose pathologic affection can cause severe morbidity. While children can be born with a variety of congenital hand differences, the spectrum of hand disorders ranges from trauma and posttraumatic deformities to infection, neurologic hand problems (e.g., caused by cerebral palsy, brachial plexus injury) and overuse and arthritis-related issues. The present Special Issue aims to summarize the current understanding of hand and upper limb disorders “from the cradle to the grave”. As such, this Special Issue´s articles aim to summarize advances that are relevant to different aspects of hand surgery in children and adults. The multidisciplinary approach that is often needed to adequately address these problems will offer healthcare professionals insight into its complexity, provide understanding, and promote strategies. Submissions for this Special Issue should therefore involve original research articles, systematic reviews, unique case reports and nonsystematic (narrative) reviews on the different aspects of hand and upper limb surgery, including its aetiology/genetics, diagnosis (clinical tests, arthroscopy, radiology), and surgical and nonoperative care, regardless of the medical discipline. We look forward to receiving your scientific work, which will help to improve patient care for the young and old in this interesting discipline.

Dr. Sebastian Farr
Guest Editor

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Keywords

  • congenital hand difference
  • OMT classification
  • osteoarthritis
  • rheumatoid arthritis
  • carpal instability
  • wrist pain
  • wrist arthroscopy

Published Papers (6 papers)

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10 pages, 1390 KiB  
Article
Comparative Analysis of Treatment Outcomes: Modified Ulnar Gutter Slab vs. Sugar Tong Slab for Distal Radioulnar Joint Instability Following Triangular Fibrocartilage Complex Repair
by Tulyapruek Tawonsawatruk, Pheeraphat Phoophiboon, Thepparat Kanchanathepsak and Panithan Tuntiyatorn
J. Clin. Med. 2023, 12(20), 6574; https://doi.org/10.3390/jcm12206574 - 17 Oct 2023
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Abstract
The standard treatment for distal radioulnar joint (DRUJ) instability involves repairing the triangular fibrocartilage complex (TFCC) and immobilizing the joint with a sugar tong slab, but this can cause elbow stiffness. To address this, a modified ulnar gutter slab was designed to enhance [...] Read more.
The standard treatment for distal radioulnar joint (DRUJ) instability involves repairing the triangular fibrocartilage complex (TFCC) and immobilizing the joint with a sugar tong slab, but this can cause elbow stiffness. To address this, a modified ulnar gutter slab was designed to enhance elbow mobility during immobilization. A prospective randomized controlled trial was conducted on 23 DRUJ instability patients who underwent arthroscopic TFCC repair. Two post-operative splinting techniques were compared: the modified ulnar gutter slab and the sugar tong slab. The assessment included the Disabilities of Arm, Shoulder, and Hand (DASH) score; elbow, forearm, and wrist range of motion (ROM); post-operative DRUJ stability; and complications. DASH scores at 4 and 6 weeks were not significantly different. However, the modified ulnar gutter slab improved elbow extension range of motion at 4 weeks (extension lag: 20.0 vs. 6.5 in the sugar tong group) (p = 0.011). Post-operative DRUJ stability was comparable between the two groups. Notably, one patient in the sugar tong slab group experienced complex regional pain syndrome (CRPS). The modified ulnar gutter slab offers a post-operative alternative after TFCC repair. It effectively immobilizes forearm and wrist motion while enhancing elbow mobility, potentially reducing post-operative elbow stiffness. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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10 pages, 6716 KiB  
Article
An Alternative Treatment Option for Blauth III B Thumb Hypoplasia—Thumb Stabilization with Iliac Crest Bone Graft and Intermetacarpal Arthrodesis
by Simon Oeckenpöhler, Martin Franz Langer, Anna Wichmann, Johannes Glasbrenner and Oliver Riesenbeck
J. Clin. Med. 2023, 12(18), 5977; https://doi.org/10.3390/jcm12185977 - 15 Sep 2023
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Abstract
Thumb hypoplasia modified Blauth III B is usually treated by pollicization or, less commonly, by toe transfer. Both procedures always result in the resection of a body part, but with good cosmesis and acceptable function. We describe an intermetacarpal I/II arthrodesis with autologous [...] Read more.
Thumb hypoplasia modified Blauth III B is usually treated by pollicization or, less commonly, by toe transfer. Both procedures always result in the resection of a body part, but with good cosmesis and acceptable function. We describe an intermetacarpal I/II arthrodesis with autologous bone graft augmentation to lengthen and stabilize the loose thumb. Clinical data were collected from nine patients, median age at surgery 3 years 8 months, with more than 7 years of follow-up. The results showed a grip strength on the Jamar dynamometer of approximately 61% of the unoperated hand. The Quick-DASH score was 11. The reconstructed thumb was 0.8 cm thinner and 1.9 cm shorter. Overall satisfaction on the VAS, with an average of 1.5 out of 10, is excellent with a partially usable thumb on a hand with five rays. The described procedure is a reliable treatment option with satisfactory results. In addition, none of the patients lost pincer grip between the second and third digit, but their thumb gained new function. Especially in environments where physical integrity has a high value, thumb construction instead of replacement could be considered. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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12 pages, 1859 KiB  
Article
Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints
by Chung-Chia Chang, Sung-Yen Lin, Chun-Kuan Lu, Jesse B. Jupiter, Yin-Chih Fu and Wen-Chih Liu
J. Clin. Med. 2023, 12(14), 4760; https://doi.org/10.3390/jcm12144760 - 18 Jul 2023
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Abstract
This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included [...] Read more.
This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0–10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3–56.8) were included in this study. The median follow-up period was 6.5 years (range of 5–11 years). The median numeric pain scale improved from 5 (IQR: 4.3–6.0) preoperatively to 0 (IQR 0–0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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10 pages, 500 KiB  
Article
Conservative and Surgical Treatment of Osteochondromas in Children, Particularly with or without Surgical Lengthening of the Ulna
by Julie Mercier, Reto Bernasconi, Christina Steiger, Alexandre Kaempfen and Andreas H. Krieg
J. Clin. Med. 2023, 12(13), 4273; https://doi.org/10.3390/jcm12134273 - 26 Jun 2023
Cited by 1 | Viewed by 923
Abstract
Prevention of rotatory impairment and radial head dislocation in the forearm is an important aspect when treating children with osteochondromas. Various studies tried to determine the best treatment, describing different surgical techniques. No consensus has been reached yet. This retrospective study compares the [...] Read more.
Prevention of rotatory impairment and radial head dislocation in the forearm is an important aspect when treating children with osteochondromas. Various studies tried to determine the best treatment, describing different surgical techniques. No consensus has been reached yet. This retrospective study compares the treatment outcome of patients with osteochondroma of the radius and ulna after surgical or conservative treatment. Seventeen forearms treated over a period of 20 years were analysed. Outcome parameters were the prospectively collected clinical data and the radiological findings: “relative shortening” of ulna/radius, the “radial articular angle” (RAA) and the “carpal slip” (CS). Our study shows an improvement of the range of motion and cosmetic appearance of the forearm after an operative procedure, with or without bone lengthening. We observed an increase in wrist and elbow mobility with a decrease in pain scores and a confirmed high cosmetic satisfaction in almost 70% of the patients after bone lengthening and up to 85% after simple excision. For patients suffering from functional impairment or pain, an operative approach is beneficial. Multiple and repetitive osteochondroma excisions are recommended during growth to prevent deformity and rotatory motion restriction. Lengthening procedures require a careful indication. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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12 pages, 8753 KiB  
Article
Guided Growth for the Treatment of Cubitus Varus in Children: Medium- to Long-Term Results
by Sergio Martínez-Álvarez, María Galán-Olleros, Javier Alonso-Hernández, Isabel Vara-Patudo, Carlos Miranda-Gorozarri and Ángel Palazón-Quevedo
J. Clin. Med. 2023, 12(7), 2632; https://doi.org/10.3390/jcm12072632 - 31 Mar 2023
Cited by 1 | Viewed by 3250
Abstract
Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate [...] Read more.
Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate system between 2008 and 2018, with a minimum 4-year follow-up. We collected demographic, fracture-related, pre- and postoperative clinical (carrying angle (CA), ROM), and radiological data (humeral-ulnar angle (HUA), Baumann angle (BA), shaft-condylar angle (SCA), lateral capitellohumeral angle (LCHA)), as well as data on complications and satisfaction at last follow-up. Fifteen patients were included, with a median follow-up of 81 (64–103) months. All the variables had improved significantly as follows: CA −16 (−18 to −9)°, HUA −16 (−19 to −12)°, BA −11 (−17 to −7)°, SCA 7.5 (3.3 to 13.8)°, LCHA −4.8 (−6.8 to 0.6), flexion 10 (0 to 24)°, and extension 10 (0 to 10)°. The annual correction rate in terms of HUA was 2.41° (1.9 to 3.2). There were 5 cases of aseptic screw loosening, 4 of them requiring replacement, without relation to age at surgery (p = 0.324). Most patients (86.67%) were satisfied, and a relationship was found with younger age at surgery (p = 0.037). In conclusion, preliminary results show that LDHH with the eight-Plate system is an effective technique for mild to moderate cubitus varus deformity correction in children. Patients should be advised of the relatively long duration of implant retention and the possibility of reoperation for screw replacement or implant removal. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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10 pages, 4047 KiB  
Case Report
Vascularized Growth Plate Transfer in Paediatric Ulna Non-Union: Operative Technique and Review of the Literature
by Nisha M. Grünberger, Amelie Klein, Marina Barandun, Dirk J. Schaefer, Andreas H. Krieg and Alexandre Kaempfen
J. Clin. Med. 2023, 12(15), 4981; https://doi.org/10.3390/jcm12154981 - 28 Jul 2023
Viewed by 729
Abstract
Congenital pseudarthrosis of forearm fractures is rare and is strongly associated with neurofibromatosis type 1 (NF1). Our case report illustrates the progression of a non-union of the ulna after minor trauma in a twelve-year-old boy, newly diagnosed with NF1, and presents the technique [...] Read more.
Congenital pseudarthrosis of forearm fractures is rare and is strongly associated with neurofibromatosis type 1 (NF1). Our case report illustrates the progression of a non-union of the ulna after minor trauma in a twelve-year-old boy, newly diagnosed with NF1, and presents the technique of microsurgical bone reconstruction, including the growth plate. More than seven years after the first operation, follow-up presents a favorable outcome with a pain-free patient and unrestricted function of the forearm after a secondary correction of the remaining radial bowing. This treatment is discussed with a comprehensive review of the current literature on ulnar congenital pseudarthrosis in PubMed and Google Scholar and free fibular growth plate transfer in PubMed and Google Scholar. Nine publications reporting on 20 cases of congenital ulnar non-unions were identified. With this reconstructive option, favorable outcomes were achieved in all cases with the union after primary surgery and complications requiring further surgeries in nine cases. The benefit of vascularized growth plate bone transfer in congenital ulna non-union seems to be significant compared to other therapies such as open reduction internal fixation (ORIF), non-vascularized bone grafts, or one-bone-forearms and beneficial when growth reconstruction is needed. Other techniques might be necessary to improve insufficient long-term results. Full article
(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)
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