Nadine Hollevoet

Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club

This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.

Excision of the Trapezium for Osteoarthritis of the Trapeziometacarpal Joint of the Thumb

We assessed the results of 86 trapeziectomies in 83 patients. Simple excision of the trapezium was performed in 54 thumbs. This was combined with shortening of the abductor pollicis longus tendon in 14 thumbs and with soft-tissue interposition and/or ligamentous reconstruction in 17 thumbs. 88% of the patients were satisfied with the result, 76% had relief of pain and 74% had no functional disability. The subjective results achieved with the three different techniques were similar. Clinical assessment of 57 thumbs revealed no statistical difference in web span, thumb adductionflexion, key pinch and grip strength between the three operative procedures, nor in comparison with the non-operated contralateral hand.

Thumb carpometacarpal joint total arthroplasty: a systematic review:

Thumb carpometacarpal joint total arthroplasty has been undertaken for many years. The proponents believe the short-term outcomes are better than trapeziectomy and its variants, but the longer term complications are often higher. This systematic review of all peer reviewed articles on thumb carpometacarpal joint total arthroplasty for osteoarthritis shows that there are reports of many implants. Some are no longer available. The reported outcomes are very variable: for some there are good long-term outcomes to beyond 10 years; for others there are unacceptably high early rates of failure. Overall the published evidence does not show that total arthroplasty is better than trapeziectomy and its variants yet there is a higher complication rate and significant extra cost of using an implant. Future research needs to compare total arthroplasty with trapeziectomy to assess short term results where the arthroplasties may be better, long-term outcomes and the healthcare and personal costs so that surgeons and patients can make fully informed choices about the treatment of symptomatic thumb carpometacarpal joint osteoarthritis.

Tibial Ultrasound Velocity in Women With Wrist Fracture

The aim of the study was to determine whether cortical midtibial speed of sound (Soundscan 2000, Myriad Ultrasound Systems, Israel) was able to discriminate women who sustained a fracture of the distal radius from normal women and to compare the performance of tibial speed of sound with dual-energy X-ray absorptiometry (DXA) of the distal radius, hip, and lumbar spine. The study population consisted of 40 women with a wrist fracture and 41 healthy age-matched controls. Tibial ultrasound velocity correlated with bone mineral density of the distal forearm (rS = 0.64, p < 0.001), the hip (rS = 0.46, p < 0.001), and the lumbar spine (rS = 0.51, p < 0.001). The mean speed of sound value at the mid-tibia of the wrist fracture patients (3873 m/s) was lower than that of the controls (3913 m/s), but the difference was not statistically significant (p = 0.12). All DXA values were significantly lower in fracture cases. Receiver operating curve analysis showed that mid-tibial ultrasound velocity was less effective than DXA of the distal forearm to discriminate wrist fracture patients from age-matched controls.

Muscle fibres crossing the line of incision used in carpal tunnel decompression

Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel decompression can be a source of confusion, particularly for the less experienced surgeon. We investigated how frequently muscle fibres crossed the line of incision on the palmar surface of the flexor retinaculum at carpal tunnel decompression in 143 hands, and dissected 103 cadaver hands to study the origin and insertion of these muscle fibres. The line of incision was defined as a longitudinal line between thenar and hypothenar eminences along the third web space, with the wrist in neutral radioulnar deviation and the fingers in extension. Muscle fibres crossing the line of incision were absent in 50% of the operated hands, 2–10 mm wide in 39% and more than 10 mm wide in 11%. In the cadaver hands the proportions were similar at 50%, 35% and 15%, respectively. The fibres were extensions of the thenar and hypothenar muscles and did not appear to represent a separate anomalous muscle.

The role of imaging in isolated benign peripheral nerve tumors : a practical review for surgeons

The diagnosis of nerve tumor(s) must be suspected in all cases of tumefaction or pain on the path of a nerve exacerbated by percussion. Solitary nerve tumors are primarily schwannomas, but other rare tumors may be present such as intraneural ganglion cysts of controversial origin. Preservation of nerve continuity is the underlying goal for any surgical procedure, irrespective of the type of tumor. Therapeutic outcomes are closely linked to tumor resectability; in most patients, the resectability of the tumor, its type and benignity can be predicted based on medical imaging. Comparison with the clinical examination and case-based reasoning is crucial. Consequently, the aim of this review was to examine the role of imaging in isolated benign peripheral nerve tumors, and provide the surgeon with a practical guide for its application in predicting the nature and resectability of nerve tumors.

Tennis elbow : associated psychological factors

BACKGROUND The etiology of tennis elbow is multifactorial. Overuse of the wrist extensors along with anatomic factors, such as flexibility problems, aging, and poor blood circulation, may play a role. This study investigated whether patients with tennis elbow have a different psychological profile compared with healthy controls. METHODS Patients with clinical signs of tennis elbow, consulting at the Ghent University Hospital between September 2015 and January 2017, were offered a paper-and-pencil questionnaire about Big Five personality traits, perfectionism, anxiety, depression, work satisfaction, and working conditions. Healthy controls in the same risk group were offered the same questionnaires. RESULTS We recruited 69 patients (35 men, 34 women) and 100 controls (44 men, 56 women). Tennis elbow patients scored significantly lower on the personality traits extraversion and agreeableness. Men, in particular, scored significantly higher on perfectionism and were more likely to develop an anxiety disorder or a depression. Concerning work, patients indicated a significantly higher workload (especially men) and a significantly lower autonomy (especially women). Female patients also indicated less contact with colleagues. However, work satisfaction was relatively high in both groups. CONCLUSION The results suggest that there is a relationship between complaints related to tennis elbow and psychological characteristics.

Sporadic Schwannomatosis: A Systematic Review Following the 2005 Consensus Statement

Abstract Aims To identify the frequency of reports of sporadic schwannomatosis, the types of patients affected, and the nerves affected. Patients and Methods We identified all case reports and case series that reported on patients with sporadic schwannomatosis according to established criteria. Results The initial search yielded 1,597 studies, of which 15 were included. A total of 38 of 55 individuals met the inclusion criteria. The mean age of the patients was 48 years; 41% were male. Thirty‐three patients had peripheral nerve tumors, and 17 had spinal tumors. Twelve had tumors in both locations. Tumor distribution was unilateral in 25 of 30 cases (83.3%) and segmental (limited to one limb or five or fewer contiguous segments of the spine) in 28 of 38 cases (73.7%). Conclusion This systematic review quantified the number of individuals who meet the criteria for sporadic schwannomatosis and better described this population to facilitate the classification of neurofibromatosis in regard to the 2005 consensus statement. Unilateral or segmental distribution of nerve tumors are key aspects when dealing with multiple noncutaneous schwannomas without involvement of the vestibular nerve.

Foreign body reaction after trapeziectomy and Dacron interposition.

The purpose of this study was to evaluate patients who were treated with trapeziectomy and Dacron interposition in our hospital and to describe the incidence of foreign body reactions. Between 2004 and 2010, 10 women with trapeziometacarpal osteoarthritis underwent Dacron interpositional arthroplasty. One patient had surgery in both hands. Implants were removed in two patients, 5 and 8 years postoperatively. Histological analysis confirmed the presence of a foreign body reaction with giant cells in both cases. At a mean follow-up of 9 years, seven patients with the implant still in place were available for review and clinical examination. Mean DASH score was 32 and mean VAS for pain and satisfaction was 1.6 and 8.8, respectively. Mean grip strength was 11.4kg and mean key pinch strength was 1.5kg. Recent radiographs were available in nine hands. Seven out of nine hands had radiological signs of a foreign body reaction with bone erosion. A severe reaction occurred in three patients. We no longer use the Dacron implant and recommend careful monitoring of all patients in whom this implant has been used.

Outcome of Ulnar Shorting Osteotomy

Introduction: Ulnar shortening is a treatment option for ulnar wrist pain. Most frequently, this procedure is performed for ulnocarpal impingement, but it may also be useful in patients with persistent ulnar wrist pain after a sprain. The aim of the study was to assess outcome of patients who were operated on in our hospital with a diaphysial ulnar shortening osteotomy; to look for complications; and to find out if results were influenced by factors such as age, gender, hand dominance, smoking, type of osteotomy (horizontal or oblique), and length of follow-up; and whether or not a trauma was involved. Methods: Between 2006 and 2014, 37 out of 46 patients who were operated on in our hospital were available for evaluation with a mean follow-up of 54 months (range, 7-69). Mean age at the time of surgery was 39 years (range, 15-69), 24 were women, in 19 the dominant hand was involved, 15 were smokers, and in 28 a horizontal and in 9 an oblique osteotomy was performed. In 18 a trauma was involved, and in 14 there was an associated fracture of the radius or ulna. In all patients, Disability of Arm Shoulder and Hand (DASH) questionnaire, patient rated wrist hand evaluation (PRWE), visual analogue scale (VAS) for pain, satisfaction, and complications could be assessed, and in 25 grip strength and range of motion were determined. Statistical analyses (Mann-Whitney U test, independent samples t test) were performed to find out which factors had an influence on the outcome. Multiple regression analysis was done to assess influences on the DASH score. Results: Mean DASH was 22 (range, 0-75) and mean PRWE score 33 (range, 0-90). Mean VAS for pain was 2.6 (range, 0-7.8). Thirty patients were satisfied and 7 would not undergo the same operation again. In 17 the plate and screws had to be removed. In 3 cases with a horizontal osteotomy, a second operation had to be performed for nonunion. Two of them were smokers. Mean grip strength was 84%, mean wrist flexion 84%, extension 75%, pronation 85%, and supination 86% of the contralateral side. PRWE and DASH scores were significantly better in smokers. PRWE was significantly worse in posttraumatic ulnocarpal impaction syndrome. Multiple regression analysis showed a significantly better DASH score in smokers, in patients operated on the nondominant side and with a longer follow-up. Discussion and Conclusion: Ulnar shortening may not be able to solve ulnar wrist pain in all patients as one fifth was not satisfied. Complications should not be underestimated. Reoperations were needed in half of patients. Outcomes were better in idiopathic ulnocarpal impaction. In posttraumatic cases, ligamentous lesions may also play a role in causing ulnar wrist pain. Results were better when the follow-up was longer which may indicate that recovery after ulnar shortening may take long time or that patients may have adapted their activities. In contrast to other studies, outcome scores in the present study were better in smokers, but 2 of the 3 patients with nonunion were smokers.