Aviram M. Giladi

Trend of recovery after simple decompression for treatment of ulnar neuropathy at the elbow.

Background: Although numerous studies have investigated long-term outcomes after surgical treatment of ulnar neuropathy at the elbow with simple decompression, no study has evaluated the trend of postoperative recovery. The authors assessed timing of recovery after simple decompression for ulnar neuropathy at the elbow. Methods: The five-center Surgery of the Ulnar Nerve Study Group prospectively recruited 58 consecutive subjects with ulnar neuropathy at the elbow and treated them with simple decompression. Patients were evaluated preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patient-rated outcomes questionnaires included the Michigan Hand Questionnaire; the Disabilities of the Arm, Shoulder and Hand questionnaire; and the Carpal Tunnel Questionnaire. Functional tests used were grip strength, key pinch strength, two-point discrimination, and Semmes-Weinstein monofilament testing. Postoperative improvement was assessed at each time point to establish the trend of recovery in reaching a plateau. Results: Significant patient-reported symptomatic and functional recovery occurred over the first 6 weeks postoperatively as represented by improvements in questionnaire scores. Symptomatic recovery occurred earlier than functional recovery as measured by sensory and strength testing and the work domain of the Michigan Hand Questionnaire. Improvement in patient-reported outcomes continued and reached a plateau at 3 months, whereas measured strength and sensory recovery continued over 12 months. Conclusion: The greatest clinical improvement after simple decompression for ulnar neuropathy at the elbow, according to questionnaire scores, occurs in the first 6 weeks postoperatively and reaches a plateau by 3 months. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Measuring outcomes and determining long-term disability after revision amputation for treatment of traumatic finger and thumb amputation injuries

Background: Disability ratings after finger amputations are based on anatomical injury according to the American Medical Association’s Guides to the Evaluation of Permanent Impairment. These ratings determine disability and compensation, without considering validated outcomes measures. The authors hypothesize that patient-reported outcomes reflect function and health-related quality of life after traumatic finger amputations, and that Guides scoring does not accurately rate postamputation disability. Methods: Patients were classified by amputation: single finger, thumb, multifinger, or multifinger plus thumb. Eighty-four patients completed functional tests, the Jebsen-Taylor Hand Function Test, and patient-reported outcomes [Brief Michigan Hand Questionnaire (MHQ), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Short Form-36 health-related quality-of-life questionnaire). Patients were given disability scores according to the Guides. Pearson correlations between outcomes metrics were calculated, and linear regression evaluated associations between amputation group, Guides score, and outcomes measures. Results: The Brief MHQ and Quick DASH questionnaires had significant correlation with functional tests, the Jebsen-Taylor test, and the physical component summary of Short Form-36. Only the Brief MHQ correlated with the mental component summary of the Short Form-36 (r = 0.29, p = 0.02). The Guides score only correlated with the Jebsen-Taylor test (r = 0.47, p < 0.001). Regression results indicate that the Brief MHQ, Quick DASH, and Guides score predict Jebsen-Taylor test score; however, amputation group and Guides score do not predict patient-reported outcomes. Conclusions: The American Medical Association Guides score represents anatomical and functional outcomes without addressing mental health and other components of disability. As a result, Guides scoring is inadequate for determining postamputation disability. In evaluating composite amputation outcomes, Brief Michigan Hand Questionnaire outperformed other metrics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Procedure 2 – Fasciotomy for Compartment Syndrome of the Hand and Forearm

• Compartment syndrome—when pressure within a fibroosseous space increases to a level that results in a decreased perfusion gradient across tissues • Reperfusion after prolonged ischemia time, including tourniquet, wraps, casts, compression, and others • Crush injury with resultant edema, causing increased pressure in the closed muscle space • Other high-risk causes of compartment syndrome: injection injury, extravasation injury, electrical injury, penetrating trauma, circumferential burns, snake or insect bites • Certain injection injuries (air, water, other hydrophilic liquids) can potentially be observed depending on volume, clinical presentation, etc. • Injection of paint or other oil-based liquid requires early decompression and additional exploration/debridement as needed. These injection injuries tend to develop ischemia as well as deep space infections and worsen rather than improve with time (Fig. 2.1A and B).

Anatomical Variation of the Radial Artery Associated With Clinically Significant Ischemia

PURPOSE The purpose of this retrospective review was to investigate the incidence of radial artery anatomical variations in patients with clinically significant distal upper extremity (UE) ischemia. Available anatomical studies report that high takeoff of the radial artery occurs in up to 15% of the population. We hypothesized that there is a higher incidence of high origin of the radial artery in patients with clinically significant ischemia compared with the reported frequency in the general population. METHODS We performed a retrospective review of all patients who underwent UE angiography for clinically significant hand and digital ischemia in our institution from 2012 to 2016. Data collected included patient age, sex, comorbidities, and modality of treatment. RESULTS Twenty-six angiograms were performed for UE ischemia meeting inclusion criteria. Eight patients had Raynaud disease or scleroderma. Ten patients (38%) had high radial artery takeoff with radial artery origin proximal to the antecubital fossa. The need for surgical intervention was similar in patients with normal anatomy and those with high takeoff of the radial artery. CONCLUSIONS Incidence of high radial artery takeoff was found more frequently in patients with distal UE ischemia requiring angiogram than in reported population data. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.

Abstract P76: Characterization of Factors Leading to Heterotopic Ossification in Adult Burn Injury Using a Large Multi-Institutional Burn Database

www.PRSJournal.com 41 Fday, M ay 15 METHODS: The population studied included 63 patients who received upper extremity surgery at a week-long hand surgery mission to Honduras in March 2013. Before receiving surgery, participants completed the pre-operative Quality Improvement Survey, QuickDASH, and SF12. Three months post-operatively, participants completed the post-operative Satisfaction Survey, QuickDASH, and SF12. Linear correlations of patient characteristics with QuickDASH and SF12 outcome, along with linear correlations of additional outcome measurements with QuickDASH and SF12 outcome, were performed in Stata.