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Introduction: Ganglia are the commonest cause of swellings of the hand and wrist; the documented success of outcomes varies considerably. There is little published data to help predict patients likely to benefit from each treatment modality. We sought to identify factors predicting success of each intervention to provide an evidence basis to inform referral criteria and treatment decisions. Materials and Methods: A retrospective series of 140 serial patients referred with confirmed hand and wrist ganglia between June 2005 and January 2011 was studied to a minimum of 12-month follow-up to determine predictors of successful treatment. Treatment was deemed to be successful if the patient did not develop recurrence. Analysis was completed for predictors of successful treatment at presentation; examining gender, presence of pain, duration of symptoms, anatomic location and treatment modality. Results: Treatment success rate following aspiration was 34% for wrist and 58% for finger ganglia and for surgical excision 7% for wrist and 4% for finger ganglia. Surgical excision was significantly more successful than aspiration (p < 0.01). Duration of symptoms greater than one year was significantly associated with increased recurrence rates (relative risk 2.33, p < 0.05) and male sex was associated with lower recurrence (relative risk: 0.54, p = 0.14). Subgroup analysis of different varieties of soft tissue ganglia did not show any statistically significant factors predictive of recurrence, although both painless presentation and male sex were of borderline significance. Discussion and Conclusions: Duration of symptoms less than one year and male sex can be used to identify patients likely to benefit from interventional treatments and guide treatment decisions. Surgical excision was significantly more successful than aspiration (p < 0.01).

Background: Radial head dislocation in patients with multiple hereditary exostoses (MHE) is associated with loss of function and cosmetic problems. The treatment of the deformity with radial head dislocation is difficult and the timing of surgical intervention is important. The aim of this study was to evaluate the factors predictive of radial head dislocation in patients with MHE.

Methods: Patients diagnosed with forearm deformity due to MHE between 1995 and 2021 were retrospectively evaluated. Radiographic parameters including radial bow (RB), ulnar bow (UB), total radial bow (TRB), total ulnar bow (TUB), percent ulnar length (PUL), ulnar shortening (US), radial articular angle (RAA), modified Masada classification and irregularity of proximal radioulnar joint (PRUJ) of the dislocated group (group D), that is subluxation or dislocation of the radial head, and the located group (group L) were compared.

Results: A total of 18 patients and 25 limbs (5 girls and 13 boys) with a mean age of 10.5 years were included. There were significant differences in TUB (22.8° ± 5.6° vs. 10.7° ± 6.5°), PUL (97.5% ± 5.5% vs. 108.2% ± 7.7%) between group D and group L (p < 0.05). Moreover, irregularity of PRUJ on radiographs was more in group D (p < 0.05).

Conclusions: It is possible that appropriate radiographic assessment in relation to radial head dislocation may prevent delayed surgical treatment of forearm deformities in MHE.

Level of Evidence: Level IV (Diagnostic)

The epidemiology of diabetic foot infections and the predictive factors for limb loss were evaluated in a cohort of 100 diabetics treated at the National University Hospital (NUH) during the period January to June 2005. The mean age of study population was 59.8 years. Ethnically there was a significant increased representation in Malays along with a significant decreased representation in Chinese. All had type 2 diabetes. The common infections included abscess (32%), wet gangrene (29%) and infected ulcers (19%); 13 patients were treated conservatively. The major amputation rate (below and above knee amputations) was 28%; 48% had monomicrobial and 52% polymicrobial infections. The most common pathogens in both infectious were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeroginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictivefactors for limb loss were ages about 60 years, gangrene, ABI < 0.8, monomicrobial infections, WBC ≥ 15.0 × 10⁹/L, ESR ≥ 100 mm/hr, CRP ≥ 15.0 mg/dL, Hb ≤ 10.0 g/dL and Cr ≥ 150 μmol/L. With stepwise logistic regression, only gangrene, ABI < 0.8, WBC ≥; 15.0 × 10⁹/L and Hb ≤ 10.0g/dL were significant.

Major amputation resulting from a diabetic foot problem poses not only serious emotional burden but also serious mortality issues. Indeed amputation leads to loss of life. It is therefore imperative to avoid limb loss at all costs. This requires all diabetics to undergo annual foot screening and foot care to address the “foot at risk” promptly. Several research workers have studied the role of various factors as predictive factors for limb loss. The authors compare and discuss their results in evaluating predictive factors in a cohort of 202 diabetics with those of other co-workers.

With univariate analysis, predictive factors were found to be age above 60, co-morbidities like stroke and ischaemic heart disease, complications of diabetes including nephropathy, peripheral vascular disease and sensory neuropathy HbA1C level > 7%, ankle brachial index (ABI) < 0.8, foot problems such as gangrene and infection and pathogens such as MRSA and Staphylococcus aureus. With stepwise logistic regression, only peripheral vascular disease and infection were found to be significant.

Major lower limb amputation is the most dreadful complication of diabetic foot. A review on Hong Kong Chinese diabetics with ulcerated feet has identified ulcer depth, peripheral vascular insufficiency, old age and hypoalbuminemia to be factors associated with major amputation. An infected ulcer, neuropathy, anaemia and low lymphocyte count are frequently observed in this group of amputees. Amputation has a seasonal variation and is more commonly performed in summer. Establishing a dedicated clinic for this group of patients can lead to a dramatic decrease in amputation. Input from different disciplines is of vital importance to its success.