Development and Validation of a Low-Cost Drilling Model.

Simulation models enable learners to have repeated practise at their own time, to master the psycho-motor and sensory acuity aspects of surgery and build their confidence in the procedure. The study aims to develop and evaluate the feasibility of a low-cost drilling model to train surgeons in the drilling task. The model targets three aspects of drilling - (1) Reduce plunge depth, (2) Ability to differentiate between bone and medullary canal and (3) Increase accuracy drilling in various angles.

Chicken Feet: A Model for Practising Locoregional Flaps of the Hand.

The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot model: fingertip volar V-Y advancement flap, four-flap and five-flap Z-plasty, cross-finger flap and first dorsal metacarpal artery (FDMA) flap. The study was performed in a surgical training laboratory on non-live chicken feet.

3D-printed Poly-Lactic Co-Glycolic Acid (PLGA) scaffolds in non-critical bone defects impede bone regeneration in rabbit tibia bone.

Background: An increasing number of bone graft materials are commercially available and vary in their composition, mechanism of action, costs, and indications.

Objective: A commercially available PLGA scaffold produced using 3D printing technology has been used to promote the preservation of the alveolar socket after tooth extraction. We examined its influence on bone regeneration in long bones of New Zealand White rabbits.

Pedicled Osteo-Onchyocutaneous Island Flap for Finger Macrodactyly: A Review of Literature.

We present a case of middle finger macrodactyly reconstructed in a single stage using multiple techniques. We elevated a pedicled osteo-onychocutaneous island flap, excised the remnant distal phalanx with a segment of 1 digital nerve and skin over the dorsum of the middle phalanx, performed epiphysiodesis and reduction of the middle phalanx as well as soft-tissue debulking, and inset the flap over the dorsum of the middle phalanx. Follow-up at 12 months revealed a satisfactory aesthetic and functional outcome.

Emergency Hand and Reconstructive Microsurgery in the COVID-19-Positive Patient.

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms.

Outcomes of Phalangeal Neck Fractures in a Pediatric Population.

Purpose: Displaced pediatric phalangeal neck fractures are regarded as unstable, and hence, surgical fixation is traditionally recommended. In our experience, some patients with displaced fractures treated nonsurgically healed with a good clinical outcome and no further displacement. We studied the outcome of displaced phalangeal neck fractures treated nonsurgically with attention to the change in fracture displacement over time and hypothesized that displaced phalangeal neck fractures can be treated nonsurgically with maintenance of acceptable radiological parameters.

Retrograde Flow Digital Artery Flaps.

Retrograde flow digital artery flaps are a versatile single-stage option for the coverage of fingertip and dorsal digit defects. There are technical challenges associated with pedicle dissection and preparation. Techniques vary predominantly in the vessel utilized (either the proper digital artery or its branches) and the incorporation of the digital nerve or its branches in the pedicle with subsequent neurorrhaphy.

Maximal advancement of homodigital neurovascular island flaps.

We investigated the maximal advancement of the homodigital neurovascular island flap with the digit in full extension and its correlation to the digital length. In 32 adult cadaveric digits, flaps measuring 1 × 1 cm were sequentially elevated to different dissection points. Dissection of the flap to the proximal interphalangeal joint crease, palmo-digital crease, division of adjacent digital artery and the superficial arch resulted in flap advancement of 8, 12, 15 and 18 mm, respectively.

Surmounting the Learning Curve of Core Suture Placement with Tendon Repair Simulator.

Background: Attaining competency in placement of core suture with adequate distance from juncture is a key skill for learners of tendon repair. Currently, this is most commonly practiced on animal models in wet laboratory environment. To improve accessibility and availability, we developed a tendon repair trainer that aims to guide learners in obtaining this key competency.

Post-Reduction Stability of the Proximal Interphalangeal Joint after Dorsal Fracture Dislocation-A Cadaveric Study.

Background: Proximal interphalangeal joint (PIPJ) dorsal fracture dislocations (DFD) are challenging injuries. Treatment aims to achieve stability of the PIPJ after reduction so that early motion can be initiated. We studied how increasing articular destruction would affect post reduction stability and investigate the amount of traction and PIPJ flexion needed to maintain the reduction.

Computer Aided Assessment in Microsurgical Training.

Background: Acquiring competence in microsurgical suturing is a basic requirement for any trainee aspiring to perform clinical microsurgery. New methods and simulation platform continue to evolve, but the assessment of the quality of microsurgical suturing is largely subjective. We present the concept of computer aided assessment of standardised microsurgical task, using a novel training platform.

Bone Marrow Derived Mesenchymal Stem Cell Augmentation of Rabbit Flexor Tendon Healing.

Background: This study investigated the effect of mesenchymal stem cell implantation on flexor tendon healing using a rabbit model of flexor tendon repair. Specifically, we compared the difference between autologous and allogeneic stem cells. The influence of cell number on the outcome of flexor tendon healing was also investigated.

Characteristics of Fingertip Injuries in Children in Singapore.

Fingertip injuries are common in children, with varying degrees of severity. However, there is limited epidemiological information in the literature. An understanding of the characteristics of these injuries can be used as a basis to prevent such injuries.

Effect of negative-pressure wound therapy on open fractures of the lower limb.

Introduction: Early debridement and coverage has long been regarded as the standard of care for open fractures of the lower limb, as infection is a serious complication. However, the best time for wound closure remains controversial. Negative-pressure wound therapy (NPWT) is thought to result in reduced flap infection and failure.

Causes and assessment of subacute and chronic wrist pain.

Wrist pain is a common presentation to the general practitioner and emergency department. Most cases are simple to treat, and pain frequently resolves with conservative treatment. However, there are certain conditions, such as scaphoid nonunion and Kienböck's disease, where delayed diagnosis and treatment can result in long-term deformity or disability.

General practitioners' knowledge of hand surgery in Singapore: a survey study.

Introduction: Hand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments.

Atypical Essex-Lopresti injury of the forearm: a case report.

The Essex-Lopresti injury of the forearm is difficult to diagnose. A missed diagnosis can lead to persistent pain and instability of the wrist. We report a 33-year-old man with a pre-existing cubital varus deformity who sustained an atypical Essex-Lopresti injury after a fall on his elbow.

Prevalence of carpal fracture in Singapore.

Purpose: To determine the prevalence of carpal fracture in Singapore, to compare demographic differences between isolated scaphoid and other carpal fractures, and to identify parameters associated with multiple carpal fractures.

Methods: A total of 149 patients with 162 carpal fractures seen at the National University Hospital in 2009 were enrolled into the study. We retrospectively reviewed their case records and radiographic studies.

Tissue engineering of flexor tendons: optimization of tenocyte proliferation using growth factor supplementation.

A significant problem in flexor tendon repair is the lack of suitable graft material for reconstruction. The ex vivo production of flexor tendon graft constructs requires the expansion of primary cells. Growth factors, such as platelet-derived growth factor-BB (PDGF-BB), insulin-like growth factor-1 (IGF-1), and basic fibroblast growth factor (bFGF), are known to promote tendon healing and tendon cell proliferation.

Combined fractures of the body and hook of hamate: a form of ulnar axial injury of the wrist.

Fractures of the hamate are rare, and usually associated with athletes. We describe an unusual form of the injury involving fractures of the hook as well as an intra-articular medial facet. It is likely to be a result of high velocity ulnar component of the axial injury.