Five Essential Principles for First Web Space Reconstruction in the Burned Hand.

Background: Burn injuries commonly affect the hand, and the development of adduction contractures of the first web space is frequent and deleterious, both functionally and aesthetically. Many corrective techniques and algorithmic approaches have been described to treat this problem, but there is no consensus on the optimal management.

Methods: A retrospective review at a single high-volume pediatric burn center was undertaken to evaluate the clinical course of these patients.

Evaluation of the Seesaw Test as New Diagnostic Test for Thumb CMC Osteoarthritis.

Background: The seesaw test consists of flexion and extension of the thumb metacarpal on the trapezium, with continuous axial pressure to keep the metacarpal base reduced in the carpometacarpal (CMC) joint. We aim to evaluate this maneuver compared with the grind test.

Methods: We prospectively enrolled 80 participants from March 2017 to March 2018 at a single institution, excluding those who had previous thumb surgery or pathology.

Patient Transfer for Hand and Upper Extremity Injuries: Diagnostic Accuracy at the Time of Referral.

Background: Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral.

Methods: Adult patients transferred from outside facilities to the authors' Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified.

Postoperative Dorsal Proximal Interphalangeal Joint Subluxation in Volar Base Middle Phalanx Fractures.

 This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis.  We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.

Reoperation After Operative Fixation of Proximal Interphalangeal Joint Fractures.

The purpose of this study was to determine the reoperation rate and what factors are associated with reoperation of proximal interphalangeal (PIP) joint fractures. We identified 161 surgically treated PIP joint fractures between 2004 and 2015 at 2 academic medical systems. Demographic, injury, radiographic, and treatment data that might be associated with reoperation were collected.

Do Patient Preferences Influence Surgeon Recommendations for Treatment?

Background: When the best treatment option is uncertain, a patient's preference based on personal values should be the source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation in treatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patient preferences.

Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operative treatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.

Longitudinal Microsurgery Laboratory Training during Hand Surgery Fellowship.

Background:  Laboratory training courses have traditionally offered an attractive method to learn microsurgery in a low-risk environment. However, courses are often limited by cost, accessibility, and their one-time, nonlongitudinal nature. Our aims were to (1) describe our institution's microsurgical training course for hand surgery fellows, which is longitudinal and integrated within our fellowship curriculum and (2) investigate how this course affects the microsurgical confidence and competence of trainees throughout their fellowship year.

Diagnostic Criteria for Symptomatic Neuroma.

Introduction: After nerve injury, disorganized or incomplete nerve regeneration may result in a neuroma. The true incidence of symptomatic neuroma is unknown, and the diagnosis has traditionally been made based on patient history, symptoms, physical examination, and the anatomic location of pain, along with response to diagnostic injection. There are no formally accepted criteria for a diagnosis of neuroma.

Variation in Nonsurgical Treatment Recommendations for Common Upper Extremity Conditions.

Background: In orthopaedic surgery, there is known surgeon-to-surgeon variation in recommendations for surgery. Variation in recommendations for nonsurgical treatment of common upper extremity conditions for which surgery is discretionary remains unclear.

Methods: One hundred eighty-three surgeons were included after completing six questions on six scenarios of upper extremity conditions regarding nonsurgical treatment recommendations.

Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial.

Purpose: Decision aids increase patient participation in decision making and reduce decision conflict. The goal of this study was to evaluate the effect of a decision aid prior to the appointment, upon decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the decision aid over time.

Secondary Surgery following Initial Replantation/Revascularization or Completion Amputation in the Hand or Digits.

Background: The authors studied the rate of secondary surgery following replantation/revascularization or completion amputation in patients with traumatic upper extremity injuries. The authors hypothesized that there are no factors associated with secondary surgery after initial treatment and that travel distance to the authors' hospital does not influence the number of secondary operations.

Methods: A multi-institutional retrospective study was performed including patients presenting from 2006 to 2014.

Is Physician Empathy Associated With Differences in Pain and Functional Limitations After a Hand Surgeon Visit?

Background: In prior work we demonstrated that patient-rated physician empathy was the strongest driver of patient satisfaction after a visit to an orthopaedic hand surgeon. Data from the primary care setting suggest a positive association between physician empathy and clinical outcomes, including symptoms of the common cold. It is possible that an empathic encounter could make immediate and measureable changes in a patient's mindset, symptoms, and functional limitations.

Hand Posturing Is a Nonverbal Indicator of Catastrophic Thinking for Finger, Hand, or Wrist Injury.

Background: Prior research documents that greater psychologic distress (anxiety/depression) and less effective coping strategies (catastrophic thinking, kinesophobia) are associated with greater pain intensity and greater limitations. Recognition and acknowledgment of verbal and nonverbal indicators of psychologic factors might raise opportunities for improved psychologic health. There is evidence that specific patient words and phrases indicate greater catastrophic thinking.

A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis.

Arthroscopic management of thumb carpometacarpal (CMC) osteoarthrosis (OA) is an approach that has unclear results. We performed a systematic review encompassing three electronic databases up to May 2016 for studies describing arthroscopic-assisted techniques for thumb CMC OA. Meta-analyses of visual analogue scores (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength and pinch strength before and after arthroscopy were performed for ten included non-randomized cohort studies comprising 294 patients.

Symptomatic Neuroma Following Initial Amputation for Traumatic Digital Amputation.

Purpose: We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation.

Methods: We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.

Patients Transferred for Upper Extremity Amputation: Participation of Regional Trauma Centers.

Purpose: Level-I trauma centers are required to provide hand and microsurgery capability at all times. We examined transfers to our center to better understand distant patient referrals and, indirectly, study referrals in our region.

Methods: Records were reviewed from 2010 to 2015 to evaluate patients transferred to our level-I institution for upper extremity amputation.

Factors Associated With Radiographic Trapeziometacarpal Arthrosis in Patients Not Seeking Care for This Condition.

Background: A common adage among hand surgeons is that the symptoms of trapeziometacarpal (TMC) arthrosis vary among patients independent of the radiographic severity. We studied factors associated with radiographic severity of TMC arthrosis, thumb pain, thumb-specific disability, pinch strength, and grip strength in patients not seeking care for TMC arthrosis. Our primary null hypothesis was that there are no factors independently associated with radiographic severity of TMC arthrosis according to the Eaton classification among patients not seeking care for TMC arthrosis.

Gradual Onset Diseases: Misperception of Disease Onset.

Purpose: Gradual onset diseases (eg, carpal tunnel syndrome, cubital tunnel syndrome, and trapeziometacarpal arthrosis) tend to go unnoticed for years. When a slowly progressive disease transitions from asymptomatic to symptomatic, it may seem like an acute event. The primary aim of this study was to determine the percentage of patients who perceive the slowly progressive disease as having started within 1 year.

QuickDASH Score Is Associated With Treatment Choice in Patients With Trapeziometacarpal Arthrosis.

Background: Trapeziometacarpal (TMC) arthrosis has a variety of treatment options, including nonoperative (eg, education, splint, injection) and operative management. Symptoms and limitations vary greatly among patients. The purpose of this study was to determine an association of symptoms and limitations, quantified using the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, with treatment choice in patients newly diagnosed with TMC arthrosis.

The Incidence of Arthroplasty After Initial Arthroscopy for Trapeziometacarpal Arthrosis.

Background: It remains unclear how many patients undergo secondary surgery after initial arthroscopy for trapeziometacarpal (TMC) arthrosis. We studied the factors related to secondary TMC arthroplasty after TMC arthroscopy. We also examined secondary questions of: (1) what percentage of patients underwent secondary TMC arthroplasty; and (2) how much time elapsed from initial arthroscopy to arthroplasty.

Unplanned Reoperation After Trapeziometacarpal Arthroplasty: Rate, Reasons, and Risk Factors.

Background: Trapeziometacarpal (TMC) arthritis is an expected part of ageing to which most patients adapt well. Patients who do not adapt to TMC arthritis may be offered operative treatment. The factors associated with reoperation after TMC arthroplasty are incompletely understood.

Reoperation After Combined Injury of the Index Finger: Repair Versus Immediate Amputation.

Purpose: To identify factors associated with unplanned reoperation of severely injured index fingers and to address the number of amputations after initial repair.

Methods: In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index finger injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up.