Catálogo de publicaciones - revistas

<jats:sec><jats:title>Background</jats:title><jats:p> Flexor digitorum superficialis (FDS) hemitenodesis is a common procedure to treat swan neck deformity (SND). We hypothesize that this surgical technique is a biomechanically effective way to reduce strain in the volar plate at the proximal interphalangeal joint (PIPJ). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Fifteen digits from 5 cadaveric specimens were tested using a novel in vitro active finger motion simulator under 4 finger conditions: intact, SND, FDS hemitenodesis, and FDS hemitenodesis with distal interphalangeal (DIP) joint fusion. Tensile loads in FDS and flexor digitorum profundus (FDP) and joint ranges of motion were measured by electromagnetic tracking. In addition, strain gauges were inserted under the volar plate to measure strain during PIPJ hyperextension. Results were analyzed using 1-way repeated-measures analysis of variance tests. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The SND condition increased volar plate strain by 176% ± 25% ( P &lt; .001) compared with the intact condition. The FDS hemitenodesis repair relieved more than 50% of the SND strain, restoring it to within no statistical difference from intact. The DIP fusion further reduced strain with no further statistical significance. At full flexion, FDS and FDP tendon loads diverged as a function of the test condition ( P &lt; .001). With the FDS hemitenodesis, the FDP load increased by 2.1 ± 1.5 N from the SND condition ( P &lt; .001), whereas the FDS load decreased by 1.3 ± 1.3 N ( P = .012). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The FDS hemitenodesis repair restored strains to within 3.0 milli-strain of the intact condition with no significant difference. Application of DIP fusion did not further protect the PIPJ from increased hyperextension and further exacerbated the imbalance of flexor tendon loads. </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> The objective of this study was to understand the frequency and types of complications, and the associated postoperative outcomes within the first 5 years of practice after hand and upper extremity surgery fellowship. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This was a retrospective observational study of all patients seen and surgically treated by a single surgeon at a single institution from August 2014 to September 2019. This corresponded to the first 5 years of practice after fellowship. Data collected included patient demographics, perioperative data, complication type, and outcome of the complication (better/same/worse than preoperative status). Complications were classified using the Clavien-Dindo system and a unique, self-derived system. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> In total, 3301 surgeries were performed during the first 5 years of practice. The overall complication rate was 7.9% (261 complications from 239 patients). The 30-day complication rate was 5.2% (171/3301). Eleven (4.2%) of the 261 complications occurred intraoperatively. The total number of complications significantly declined during the first 5 years of practice as follows: 74, 71, 46, 37, and 33 ( P = .010, R<jats:sup>2</jats:sup> = .92). Hand and wrist were the most frequent anatomic locations involved and bone pathology was the predominant indication. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The overall surgical complication rate for hand and upper extremity surgery was 7.9%, with a 30-day complication rate of 5.2% (171/3301). The rate of complications after fellowship declined over the first 5 years of independent practice. Superficial infections were the most common complication. More than 90% of patients ultimately improved after addressing the complication. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> IV </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> The Soong classification grades the prominence of volar locking plates used to treat distal radius fractures in relation to the volar rim. The basis of the classification scheme is that increasing plate prominence over the volar rim and distal radius watershed zone is associated with increased likelihood of flexor tendon irritation and need for plate removal. However, recent studies report mixed results on the predictive value of the Soong classification for these outcomes. We hypothesized that the decreased predictive accuracy of Soong classification is due to misclassification between Soong grades secondary to a suboptimal correlation between the Soong classification on radiographs (XRs) and computed tomography (CT). </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Fifty volarly displaced distal radius fractures treated with a volar locking plate in the international and publicly available ICUC database were reviewed. All cases with a postoperative XR and CT were included. Soong classification of the volar locking plate in relation to the volar ulnar rim was determined on both XR and CT by 2 independent, fellowship-trained hand surgeons using CT imaging as the gold standard. The distribution of Soong grades on XR and CT was compared using Pearson’s χ<jats:sup>2</jats:sup> test, and correlation was calculated using the Matthews correlation coefficient (MCC). A multi-class confusion matrix was used to calculate each grade’s positive predictive value (PPV). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> We found an MCC of 0.65, indicating only moderate correlation between the 2 modalities. Per individual Soong grade, the PPV was the highest for grade 2 (0.96), with lower PPVs for grade 0 (0.63) and grade 1 (0.60). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The distribution of Soong grades was significantly different when using XR versus CT ( P &lt; .001). </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Oxford Centre for Evidence-Based Medicine, diagnostic, level 2b </jats:p></jats:sec>