Yuki Fujihara

A systematic review of different implants and approaches for proximal interphalangeal joint arthroplasty

Background: Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for proximal interphalangeal joint osteoarthritis, with an emphasis on different surgical approaches. Methods: The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for proximal interphalangeal joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty. Results: A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively. Conclusion: Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.

The Effect of Workers' Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis

Background: Patients who receive workers’ compensation often display worse surgical results, such as prolonged pain or reduced functional ability. The outcomes of surgery can be assessed using a variety of surveys, assessments, and measurements. It is unknown whether the confounding effect differs based on how results are measured. The aim of this study was to determine whether these variations exist. Methods: A search of full-length articles published between January 1, 1995, and December 31, 2015, was conducted using 3 online databases. The authors performed a systematic review and meta-analysis using unique inclusion criteria for each. Results: A total of 101 articles were included in the systematic review; 62 of them were retained for the meta-analysis. In the systematic review, 70 percent of studies found that patients receiving workers’ compensation had significantly worse postoperative results than uncompensated patients, whereas only 42 percent of studies that measured preoperative versus postoperative improvement were influenced by workers’ compensation. The meta-analysis found that uncompensated patients were more likely to experience improvement after surgery than patients receiving workers’ compensation (summary OR, 3.17; 95 percent CI, 2.47 to 4.08). A subgroup analysis demonstrated that functional measures, such as grip strength or nonunion, were least affected by workers’ compensation, compared with other outcome measures such as patient-reported outcomes questionnaires or time off work. Conclusion: Potential bias introduced by workers’ compensation can be mitigated by evaluating surgical treatment of work-related upper extremity disorders using preoperative versus postoperative improvement or functional measures.

Concomitant injuries affect prognosis in patients with central slip tear

Central slip tears often occur with concomitant hand injuries. However, the outcome of a central slip tear and the effect of concomitant injuries are rarely reported. We evaluated 67 fingers in 63 patients with central slip tears who underwent primary surgery in our hospital between April 2009 and June 2017. We performed multivariate analyses, with proximal interphalangeal (PIP) joint active range of motion (AROM) and existing extension lag greater than 10° as dependent variables and age, existence of concomitant fractures, skin defects, collateral ligament injuries, ruptured lateral bands, ruptured flexor tendons or vascular injury in the injured finger as independent variables. Concomitant injuries of tendons in the adjacent fingers were also independent variables. The average AROM of the PIP joint was 62°, and extension lag occurred in 34 fingers (51%). Patients aged > 40 years with fractures of the injured finger or flexor tendon injuries in an adjacent finger had low decreases in AROM (partial regression coefficient [95% confidence interval, CI]: -13.7 [43-66], -31.6 [30-57], -34.5 [32-60] and -33.5 [10-43]). Extensor tendon injuries in an adjacent finger caused significantly more extension lag in the PIP joint (odds ratio [95% CI]: 3.2 [1.0-9.6]). The present study indicated the negative impact of a tendon injury on adjacent fingers, a circumstance widely known as the quadriga phenomenon. Ultimately, we can use these prognostic factors in surgical repair planning, particularly when comparing treatments such as central slip reconstruction and primary arthrodesis.

Useful Plain Radiographic Findings in Diagnosis of Pediatric Olecranon Fracture Complicated With Proximal Radial Fracture.

ObjectiveThe aim of this study was to verify the use of initial plain radiographs, specifically the presence of a longitudinal crack on the olecranon, for diagnosing olecranon occult fractures in children. MethodsWe retrospectively reviewed all patients younger than 16 years who were diagnosed with proximal radial fractures treated at our hospital between April 1, 2006 and September 31, 2014. We included 22 patients (9 boys and 13 girls) with a mean age of 8.5 years. Three hand surgeons were blinded to each others results after examining all the initial radiographs of the injured elbows. To diagnose the fracture, we evaluated computed tomography scans in 9 cases and follow-up radiographs in the other 13 cases. Finally, we classified the fractured olecranon into 3 types: medial crack, posterior flat, and posterior crack. ResultsTwelve cases (54.5%) had associated olecranon fractures. According to the fracture type of the olecranon, 3 cases were a medial crack, 5 were a posterior flat, and 3 were a posterior crack. Each type of fracture had characteristic findings on plain radiographs. The mean value for sensitivity was 97.2% (range, 91.7%–100%), and the specificity was 90.0% (90.0%). ConclusionsOur data indicated that this easy, noninvasive use of plain radiographs for checking whether a longitudinal crack exists on the olecranon benefits the patient by preventing missed diagnoses of pediatric olecranon fractures.