Hand Surgery

To evaluate the subjective satisfaction of brachial plexus injury (BPI) patients after surgery based on the medical outcomes study 36-item short form health survey (SF-36) and to correlate their SF-36 scores with upper extremity functions. Four items were assessed statistically for 30 patients: SF-36 scores after BPI surgery were compared with Japanese standard scores; the correlation between SF-36 scores and objective joint functions; difference in SF-36 scores between each type of BPI; and influence of each joint function on the SF-36 scores. The SF-36 subscale: PF — physical functioning, RP — role-physical, BP — bodily pain, and the summary score PCS — physical component summary, were significantly inferior to the Japanese standard scores. SF-36 is more sensitive to shoulder joint function than to elbow and finger joint functions. Little correlation was found between SF-36 scores and objective evaluations of joint functions. Greater effort is needed to improve the quality of life (QOL) of BPI patients. This study showed that SF-36 is not sensitive enough to evaluate regional conditions. A region- or site-specific questionnaire is required to evaluate upper extremity surgery.

Several years ago, while attending a Philippines Orthopaedic Association (PDA) Annual Convention, held at the Westin Philippine Plaza Hotel, Manila in December, I had the opportunity to meet with Professor Yoshikazu Ikuta, a well-known microsurgery and hand surgeon from Japan and one of the foreign guest speakers. I had been invited to work with him at the Armed Forces of the Philippines (AFP) Medical Center on the case of a high ranking general of the AFP, with a hand contracture disability problem. The case was referred to him by Dr. Evaristo Sanchez, Chief of Orthopaedics and the Commanding General of the AFP Medical Center. He had been pre-scheduled for surgery the next day, a Sunday morning, the day before Prof. Ikuta was due to return to Japan.

After a brief examination and evaluation of the generals affected hand, in the operating room with Prof. Ikuta, just before he was placed under general anaesthesia, we performed the operation together.

The operation did not involve microsurgery. The procedures done were multiple combined Bunnell-Zancolli pulley advancements and MP-joint volar capsulorraphies plus flexor tendon releases in the volar forearm, which although quite extensive, were only palliative, to minimise and improve on the contracture deformities, in preparation for a final re-evaluation for possible later, more definitive tendon transfers for hand function.

However, I never received any further information regarding the results of our surgery.

Recently, I have been honoured and invited again by Prof. Ikuta, presently the Editor-in-Chief of the Hand Surgery Journal (Asian Volume), this time to write the history of hand surgery in the Philippines and add to it, "Highlights in my experience at the National Orthopaedic Hospital, Mandaluyong, and the Our Lady of Lourdes Hospital, Manila", the last portion of which is on paralytic disabilities of the Hand.

I am deeply grateful to Prof. Ikuta for giving me this honour and opportunity to present the total experience, favourable and unfavourable, of a hand surgeon from a developing country, like the Philippines. Furthermore, this would afford me also, the chance to be able to make known to readers of this now prestigious journal, the philosophical thoughts which led me to unwittingly originate or come up with and develop a few of my own "Long Tendon Rerouting Procedures" which may possibly and hopefully merit as this author's title contribution to surgery of the hands.

There are two parts to this paper. In the first part we report 18 cases of bilateral scapho-trapezio-trapezoid osteoarthrosis associated with uni- or bilateral scapholunate dissociation. This case series was followed prospectively using repeat clinical assessments and radiographs. We were able to document the progression of both the clinical manifestations and radiographic features of the scapholunate dissociation in these patients. In the second part of the paper we compared the radiographic indices of scapholunate dissociation seen in our series, that is, the scapholunate angle and interval, with those of a control group over time, to determine if there was a significant difference. The control group differed from our series principally by being devoid of any clinical or radiographic evidence of scapho-trapezio-trapezoid osteoarthrosis. We found that our case series already had some radiographic evidence of scapholunate attrition at presentation and that at follow-up the scapholunate dissociation became more pronounced both clinically and radiographically relative to the controls. The authors propose a theory to explain the association and temporal relationship between the two conditions.

We report an infant who developed arthritis with osteochondral destruction in a hand after being stung by bees. The clinical findings resembled those reported as "beekeeper's arthropathy", but the radiological findings were more severe. Histology of the resected specimen revealed fibrous granulation tissue with infiltration of inflammation cells.

This is the first reported case of non-traumatic, acute bilateral forearm compartment syndrome. Despite a delay of over 24 hours until surgical decompression and 50% muscle fibre necrosis in the histopathological examination, the clinical outcome was excellent after fasciotomy, delayed primary wound closure and early institution of a range of motion exercise programme. The literature on non-traumatic causes of compartment syndrome is reviewed.

A nine-year-old boy fell on his outstretched hand and was diagnosed with simultaneous fractures of the scaphoid and the capitate. The patient was treated conservatively with a cast for two months. Fracture of the capitate healed, however, fracture of the scaphoid resulted in non-union. We treated scaphoid non-union with an iliac bone graft and internal fixation. Three years after surgery, the patient had neither complaints nor complications and union of the scaphoid was confirmed on the radiographs.

A minimal invasive technique for finger flexor pulley is described. The technique is compared biomechanically to a "single loop" tendon graft technique using a cadaveric model.

The purpose of this study was to evaluate the safety and efficiency of transdermal anaesthesia using eutectic mixture of lidocaine and prilocaine (EMLA) in patients undergoing percutaneous trigger finger release and to compare it with lidocaine infiltration.

In this prospective, randomised study percutaneous release of the A1 annular pulley was performed to treat stenosing tenosynovitis (trigger finger syndrome) in 50 patients (50 fingers). The procedure was performed either under transdermal anaesthesia using EMLA applied transcutaneously 120 minutes prior to the operation (Group A, n = 25) or using local infiltration anaesthesia using lidocaine (Group B, n = 25). Pain experienced during administration of anaesthesia and during the operation was assessed using a 10-point Visual Analogue Pain Scale (VAPS), while all patients rated the effectiveness of anaesthesia with a 5-point scale.

There were no significant differences between the two groups in the VAPS during the operation (1.33 ± 0.52 versus 1.59 ± 0.87) and the satisfaction scores (4.6 ± 0.2 versus 4.4 ± 0.3). The VAPS score during the administration of anaesthesia was statistically significantly less in the EMLA group (0 versus 5.96 ± 2.41). All patients were satisfied with the final result of the operation.

Percutaneous trigger finger release can be performed as an office procedure with the use of EMLA avoiding the use of injectable local infiltration anaesthesia.