Donnerstag, 25. November 2021

  • 08:00 – 08:45

    Registrierung

  • 08:00 – 18:30

    Posteraustellung SGH

    Sessions SGH/SSCM

    P1

    Measurement properties of the EQ-5D-5L questionnaire in patients after thumb CMC arthroplasty

    M. Marks1, C. Grobet1, L. Audigé1 (1Zürich)

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    Background: The EQ-5D-5L includes only 5 questions and is the most popular questionnaire to assess quality of life. However, its measurement properties in hand surgery are not well investigated, yet, and it is unknown if it is sensitive enough to detect changes after thumb carpometacarpal (CMC I) arthroplasty.

    Objective: The aim was to investigate the validity, responsiveness, minimal important difference (MID), minimal important change (MIC) and discriminative ability of the EQ-5D-5L utility index in patients after CMC I arthroplasty and to find out, whether the EQ-5D-5L would be a suitable instrument to measure quality of life in these patients, which is necessary e.g. for cost-utility analyses.

    Methods: In this prospective study, patients with CMC I osteoarthritis completed the EQ-5D-5L questionnaire before surgery and 6 months and 1 year after resection arthroplasty. In addition, they filled out the brief Michigan Hand Outcomes Questionnaire (brief MHQ) and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Construct validity (Pearson’s correlation coefficient, r), responsiveness (effect size), MID, MIC and floor and ceiling effects of the EQ-5D-5L were determined. To test discriminative ability, EQ-5D-5L utility indices of patients who were in a patient acceptable symptom state (PASS) or not at follow-up were compared using the Mann-Whitney U test.

    Results: We included 151 patients with a mean age of 65 years (SD 8). The mean baseline EQ-5D-5L utility index increased from 0.69 (SD 0.19) to 0.87 (SD 0.15) at 6 months and 0.88 (SD 0.11) at 1 year (p≤0.001). The EQ-5D-5L utility index correlated well with the brief MHQ (r=0.61) and the QuickDASH (r=-0.64). Responsiveness of the EQ-5D-5L utility index was high with an effect size of 1.3. The MID was 0.027 and the MIC ranged from 0.090 to 0.209, depending on the calculation method. Seventeen percent of the patients achieved the highest possible score (1.0) at one year, indicating a light ceiling effect. The EQ-5D-5L utility index differed significantly between patients being in a PASS versus patients who were not in a PASS.

    Conclusion: The EQ-5D-5L utility index shows good construct validity, responsiveness and discriminative ability in patients after CMC I arthroplasty. Despite the light ceiling effect, the EQ-5D-5L seems to be a suitable tool for quantifying quality of life in these patients, which is necessary to calculate quality-adjusted life years for cost-utility analyses.

    P2

    The topography of the Anconeus nerve: a donor for transfer to the axillary nerve

    M. Maniglio1, E. Zaidenberg2, E. Martinez2, C. R. Zaidenberg2 (1Lausanne; 2Buenos Aires AR)

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    Introduction

    The anconeus nerve is the longest branch of the radius proximal to the sulcus, which facilitates its connection to the axillary nerve in Brachial plexus lesions. This makes him suitable as a donor side for the neurotization to the axillary nerve. The aim of this study was to take a precise look on the Anconeus nerve, his origin and insertions of the muscular branches and to map the topographical course of this important branch of the radial nerve.

    Methods

    We followed the radial nerve in 15 fresh frozen elbows specimens distally until the anconeus nerves was discernable. This point was defined as the apparent origin and was recorded. The anconeus nerve was further traced distally up to its entry to the anconeus. A concomitant innervation or nerve branches to the medial head of triceps brachii were visualized. The relation between the topographic course of nerve in reference to clear anatomical landmarks, all of which can be palpated precurtain with ease (Tip of the olecranon, medial and lateral epicondyle, intercondylar line (ICL)) were assessed.

    Results

    The Anconeus nerve separated with an initial diameter of average 1.5mm (SD: 0.2) from the radial nerve at about 16.4 cm (SD: 1.5cm) proximal to the lateral epicondyle, on the postero-medial side of the humerus. The nerve run between the lateral and the medial head of the triceps muscle, before entering the medial head ad an average of 10.2cm (SD: 2.4 cm) proximal the intercondylar line (ICL) and running intramuscular until to the distal humerus. Exiting the muscle for a short distance, the nerve lies on the periosteum of the distal humerus and the dorso-lateral articular capsule of the elbow joint, before entering the anconeus muscle with an average diameter of 0.5 mm (SD:0.1mm)

    Two different types of Anconeus nerves were found: eight nerves innervate also the lateral head of the triceps and the other seven nerves only contribute two branches to his innervation.

    Conclusion

    Hand surgeons should, be aware of the course of the anconeus nerve, to know the option of this nerve as a valid donor side for the transfer to the axillary nerve. We want to underscore the critical passage of the nerve on the periost and the articular joint capsule, between the medial head of the triceps and the insertion into the anconeus nerve.

    N. anconeus in the region of the elbow in yellow
    the Anconeus nerve in the region of the distal humerus
    The course of the anconeus nerve in the humeral region

    P3

    Conservative Management versus Plating for Dorsally Displaced Distal Radius Fractures in the Elderly

    M. Maniglio1, M. Tahir2, N. Ahmed3, A. R. Jamali3, G. Mehboob3, S. Khan4, A. Faraz5 (1Lausanne; 2Stanmore GB; 3Karachi PK; 4Prescott GB; 5Leeds GB)

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    Introduction:

    Since the advent of the volar locking plate, the trend in the treatment of distal radius fractures (DRF) with dorsal displacement, in elderly patients, is towards the open reduction and internal fixation (ORIF) of unstable DRFs. However, the published literature is inconclusive and the choice of the best treatment is not certain. This randomized trial aims to compare the clinical, and radiological outcomes between plaster cast and volar plating for distal radius fractures in the elderly at 6 months, and 1-year.

    Material and Methods:

                A randomized trial was performed at a level 1 trauma centre between August 2016 and December 2019. The study included patients that were 60 years and above with an isolated, closed, unilateral, dorsally displaced DRF. Randomization into two groups (casting or plating) was based on a computer-generated algorithm stratified by age group and AO/OTA fracture type.

    The primary outcome was Patient Rated Wrist Evaluation (PRWE) score. Secondary clinical outcomes were active range of motion, grip strength, the Mayo’s wrist score and the quick Disability Arm, Shoulder, Hands scale. Patient’s satisfaction was evaluated with use of a SF-12 questionnaire and finally complications were recorded.

    Results:

    This pragmatic randomised controlled trial has shown that there is no significant difference in clinical outcomes of DRF at 6 and 12 months follow up when treated by cast immobilisation or plating. Although, the radiological parameters and the number of complications were significantly higher in the immobilisation group.

    Conclusion:

                To conclude, the results of the trial have shown that plating and casting are equally effective in achieving satisfactory patient reported and clinical outcomes at intermediate and final follow-up. Restoring patient satisfaction.

    P4

    Intraoperative stability of the first carpometacarpal joint

    P. Behm1, M. Marks1, S. Ferguson1, M. Brodbeck1, D. B. Herren1 (1Zürich)

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    Objective: There are no quantitative data on the intraoperative stability of the thumb carpometacarpal (CMC I) joint after trapeziectomy and the amount of added stability after tendon suspension and interposition (resection-suspension-interposition arthroplasty [RSI]). Therefore, our study objective was to measure CMC I joint stability during RSI. The contribution of the various surgical steps to stability was analysed and its relation to preoperative clinical and patient-reported measures was assessed.

    Methods: Preoperative pinch grip, thumb mobility (based on the Kapandji score) and hypermobility (using the Beighton score) were determined. In addition, patients completed the brief Michigan Hand Outcomes Questionnaire. During surgery and upon removal of the trapezium, the surgeon subjectively rated the degree of CMC I stability either as “stable”, “medium stable” or “unstable”. A measurement system with integrated force sensor was used to measure intraoperative CMC I stability. Briefly, a reposition forceps was attached to the base of the MC I and to a linear slide with integrated force sensor in a standardized pinch grip position. The thumb ray was displaced manually by 10 mm towards the scaphoid and the counteracting force measured over the entire displacement. Objective stability was determined as the maximal measured force after trapezium resection, tendon suspension and interposition.

    Results: We included 29 patients with a mean age of 70 years (±8.1). From the subjective surgeon ratings of stability, there were 13 (45%) thumbs considered as stable, seven as “medium stable”, and nine were considered unstable after trapeziectomy alone. These subjective ratings did not correlate with the objective stability measurement (r=0.28). In addition, none of the evaluated clinical or patient-reported variables correlated highly with the objective measurement. The objective intraoperative stability after trapeziectomy was 15.5 N (SD 5.4) and significantly increased to 18.7 N (SD 5.5) after suspension (p≤0.001). Stability only slightly increased after tendon interposition with an increase in force to 20.3 N (SD 6.7; p=0.124).

    Conclusions: The results of our study show that suspension contributes the most to thumb stability during RSI arthroplasty. Tendon interposition does not seem to have a significant additional effect regarding stability, at least immediately after surgery.

    P5

    Long-term follow-up after first dorsal extension osteotomy in early thumb carpometacarpal arthritis

    E. Coppo1, P. Honigmann1, D. Sutter1 (1Liestal)

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    Preliminary results

    Purpose: To evaluate the long-term outcomes and survival of first metacarpal extension osteotomy (Wilson osteotomy) for early thumb carpometacarpal (CMC) arthritis.

    Methods: Patients who underwent an extension osteotomy of the first metacarpal in our department between years 2013 and 2020 were identified. Demographics, complications, and reoperations were recorded. These patients will be enrolled for a follow-up examination in the outpatient clinic. The Patient Rated Wrist/Hand Evaluation (PRWHE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires will be submitted to each patient. Further clinical evaluation will include the following criteria: pain, palmar abduction of the thumb, carpometacarpal joint opposition of the thumb (Kapandji), range of motion of the metacarpophalangeal joint and strength. Progression of osteoarthritis will be evaluated on follow-up radiographs.

    Results: On retrospective analysis, 46 procedures in 39 patients (7 males and 32 females) were identified (mean age, 45.7 y, mean follow-up 11.6 months, range 3-36 months, 79.5% dominant hand). Analysis of patient records showed no cases of nonunion. 22 of 46 thumbs underwent removal of the osteosynthesis material (47.8%). In 36 out of 46 thumbs were reported little to no pain at last follow-up (78.2%). 10 patients reported persistence or progression of their symptoms. In 7 thumbs was observed a radiological progression of arthritis according to the Eaton-Littler classification (15.2%). All these patients were symptomatic and underwent or were recommended to a revision (overall 15.2% revision rate, either trapeziectomy or arthroplasty). 40 thumbs (87.0%) retained a Kapandji score for carpometacarpal joint opposition of 8 or more, full extension in CMC I was always achieved.

    Conclusions: Retrospective data suggests good pain relief with high patient satisfaction in short-to-mid term follow-up after first metacarpal extension osteotomy. A 15.2% progression rate of arthritis was observed, corresponding with the revision rate. These rates give reason to hope for good long-term results in first metacarpal extension osteotomy for early thumb carpometacarpal arthritis.

    P6

    Treatment of fracture dislocation of the proximal interphalangeal joint with a new external fixator

    C. Bouvet1, J. Y. Beaulieu2, K. Liu3, J. van Aaken2 (1Sierre; 2Genève; 3Beijing CN)

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    Background: Fracture dislocation of the proximal interphalangeal joint is a challenging situation, to face this situation the hand surgeon must be aware of all the surgical technic to deal with the joint instability. Management of the palmar comminution is a key process in the joint stability. Dynamic external fixator allows rapid motion to avoid joint stiffness. We describe the surgical technique and the clinical results of a new device: the Gexfinger®. It is an elastic dynamic external fixator which not only allows for motion of the PIP joint but also preserves elasticity of the ligaments and capsule during the distraction period

    Methods: This is a retrospective study, between 2017 to 2019 in 3 centers. We collected the clinical data from 26 patients who benefit from the Gexfinger®.The study was conducted in 3 centers in 2 countries.

    Results: For 26 patients, mean arc of motion of the PIP joint was 82° (60°-110°), for the DIP joint 65° (55°-80°). Grip strength in comparison with the contralateral side was 83%. All patients got back to work at a mean time of 7 weeks (2 to 12 weeks). We had 2 patients with PIP joint stiffness. Seven patients had only the external fixator, 15 patients benefited from additional screw 3 needed additional Kirschner wire and 1 patient benefit from screw and Kwire. The external fixator was left in place during 5,5 weeks. The mean follow-up was 8 months. Fifty-six percent of patients were very satisfied, 32% satisfied and 12% unsatisfied.

    Conclusions: For fracture dislocation of the PIP joint we advocate the use of a dynamic external fixator in association with ORIF using small screws to manage the palmar comminution and keeping the articulation congruent. Also this approach allows for rapid active motion of the joint.

     

     

     

    X-rays after external fixator removal ( 5 and 6) show good reduction and stability of the PIP joint.

    P7

    Arthroskopisch assistierte Behandlung von perilunären Luxationen

    P. Boucke1, D. Merky1, C. Surke1, S. Hirsiger1, E. Vögelin1 (1Bern)

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    E: Chirurgisch werden verletzte Bänder und Frakturen bei perilunäre Verletzungen über einen offenen dorsalen und ggf. palmaren Zugang versorgt. Die Methode ist invasiv und hat oft eine erhebliche Bewegungseinschränkung zur Folge. Wobei sich diese, eben so wie die Faustschlusskraft in der Literatur bei einem follow-up >1 Jahr bei ca. 73%, respektive 76% der Gegenseite einpendeln. In den letzten Jahren wurden gute Resultate von rein arthroskopisch versorgten perilunären Luxationen publiziert. Vorwiegend stammen diese Arbeiten aus Asien, nur sehr wenige aus Europa. Wir gehen davon aus, dass die arthroskopische unterstützte Reposition zu einer geringeren Beeinträchtigung der Durchblutung und Narbenbildung führt, sodass unser Fokus seit einem Jahr auf der arthroskopischen Behandlung liegt.

    M: Bei der arthroskopischen Versorgung erfolgt eine Inspektion der Verletzungen und ein Débridement der verletzten Bänder. Allfällige Frakturen werden perkutan versorgt und der Carpus mit perkutanen Kirschnerdrähten transfixiert. Postoperativ erfolgt eine Ruhigstellung im Scaphoidgips für mind. 8 Wochen. Nach anschliessender radiologischer Verlaufskontrolle werden die Drähte entfernt und mit Handtherapie begonnen. Weitere Kontrollen erfolgen 3 und 6 Monate postoperativ. Bestimmt wird der Bewegungsumfang in Flexion/Extension sowie Radial-/Ulnardeviation und die Faustschlusskraft, jeweils in % der Gegenseite.

    R: In unserem Institut wurden seit September 2019 9 Patienten mit einer perilunären Luxation oder Luxationsfraktur behandelt. Darunter waren 2 minor arc Verletzungen (je 1x Mayfield Stadium 3&4) sowie 7 greater arc Luxationen, (6x Mayfield Stadium 3, 1x Stadium 4). Radiologisch zeigte sich ein guter Verlauf ohne vergrösserten SL Abstand oder zunehmende DISI Fehlstellung der proximalen Reihe verglichen zu den intraoperativen Aufnahmen. Dabei verbesserten sich die Flexion/Extension bis 6 Monate postoperativ von 66.8% auf 72.8%, die Faustschlusskraft von 54% auf 59%, wobei wir dies dem im Vgl. zur Literatur sehr kurzen follow-up zuschreiben. Der follow up betrug 3-9 Monate. Verzögerte Knochenheilung oder Pseudarthrosen traten in der Periode nicht auf.

    D: Die vorläufigen Resultate der arthroskopischen Behandlung von perilunären Luxationen sind vielversprechend – die Patienten weisen eine günstige Heilung und im Seitenvergleich eine gute Bewegungsamplitude auf. Vorläufig konnte keine Verbreiterung des SL-Intervalles oder rasch progrediente Radiokarpalarthrose festgestellt werden.

    P8

    Parosteal ossifying lipoma in the supinator muscle : about one case

    L. Deghayli1, C. Bouvet1, N. Balagué1, P. Zaugg1 (1Sierre)

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    Case description: A right-handed patient presented with a slow-growing mass on the lateral side of her left elbow. She was referred to us due to paresthesia along the territory of the sensory branch of the radial nerve. The radiological workup reveals an ossifying mass within the supinator muscle with a peripheral fat density, suggesting an parosteal ossifying lipoma (see image) and we proceed with a surgical resection. 

    An antero-lateral approach along the supinator muscle allowed for en-bloc resection of the mass followed by neurolysis of the radial nerve and its sensory branch. The postoperative clinical course was favorable with the complete resolution of the paresthesia along the radial nerve. Pathology results confirmed the diagnosis of an paraosteal ossifying lipoma.

    Discussion: Although lipomas represent by far the most common mesenchymal neoplasm, the parosteal lipoma is a rare entity often described in the literature as case reports. They are benign soft tissue tumors that can mimic malignancy like liposarcomas and that often present late as they are usually asymptomatic unless they compress adjacent structures, like in our case. They have been reported to occur most commonly in the femur, the tibia, the humerus and the radius. To our knowledge, there are no known cases of this pathology being found in the supinator muscle.

    X-ray, CT scan and MRI showing the intra-muscular lipoma

    P9

    Sequenzielle Lappen in der Handchirurgie – Innovation oder nur Spielerei ?

    C. Fritz1, E. Fritsche1 (1Luzern)

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    Einleitung

    Eine der Möglichkeiten in der Lappenchirurgie zur Defektdeckung ist das Decken des Hebedefektes eines ersten Lappens mit einer zweiten Lappenplastik, die «sequential flaps method». Kann diese Methode auch in der Handchirurgie angewendet werden und ist sie auch sinnvoll oder doch nur «fancy-flap-surgery» ?

     

    Methode und Material

    Wir stellen 3 Fälle vor, bei welchen diese Technik angewendet worden ist. In einem Fall wird der Hebedefekt eines dorsalen Intermetacarpalelappens mit einem distal gestielten Interosseus anterior Lappen gedeckt. In einem zweiten Fall wird ein Perforator-Lappen des Grundgliedes eines Langfingers dorsal mit einem Intermetacarpale-Lappen gedeckt und in einem weiteren Fall wird der Hebedefekt eines Interosseous-anterior Lappens mit einem Interosseous-posterior Perforator-Lappen gedeckt.

    Resultate

    Alle 3 bezw. 6 Lappenplastiken sind sauber und ohne Komplikationen eingeheilt. Durch die «sequential-flap method» konnte verhindert werden, dass die Hebedefekt einer ersten Lappenplastik unter zu grosser Spannung verschlossen werden mussten bezw. dass keine Transplantate benötigt wurden, um Hebedefekte zu verschliessen.

    Zusammenfassung

    Die « Folge-Lappen-Technik» (um einen allerdings nicht offiziellen Terminus in deutscher Sprache zu wählen) ist durchaus auch in der Handchirurgie anwendbar und sinnvoll. Die guten funktionellen Ergebnisse müssen in Relation zu dem «Mehr» an Narben gesetzt werden. Diese Technik sollte allen Handchirurgen geläufig sein und ihre Indikation gehört zum Rüstzeug des Handchirurgen.

    P10

    Kienböck disease after radius core decompression: correlates the radiological and clinical outcome?

    M. Maniglio1, E. Zaidenberg2, S. Roner3, N. Habib4, G. Gallucci2, P. de Carli2 (1Lausanne; 2Buenos Aires AR; 3Chur; 4Lugano)

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    Introduction

    For the treatment of Kienböck’s disease with distal radius core decompression, significant improvement in functional activity, motion and reduction of pain has been reported. However, in spite of these good clinical results, a radiological progression in a certain degree in the long-term follow-up is possible. Is there a negative correlation between the clinical improvement of the patients and the? Our study aims to figure out the correlation between the clinical improvement in Mayo wrist score and the radiological progression in the Lichtman classification in patients treated with core decompression for Kienböck’s disease.

    Methods

    24 patients (mean age: 38y; 10 women) treated with core decompression for Kienböck’s disease were included in this retrospective study. In 9 patients the dominant side was affected. The mean follow-up was 9.7 years (range, 3-18 years).

    Clinical evaluation included preoperative and postoperative pain recorded using the visual analog scale, the active range of motion of the wrist in flexion and extension and the grip strength.

    Subjective and objective clinical outcomes were assessed with help of the modified Mayo wrist score. We performed statistical correlation testing with the Spearman test.

    Results

    At end of follow-up 9 had an excellent result, 13 had a good and two a fair result. This was an average improvement of two levels in the Mayo classification. The pain was reduced by average 5.1 points in the VAS. The radiologic progression in the Lichtman classification was seen in 9 patients (five patients of one level, three patients of two and one patient of three levels).   The Spearman correlation coefficient wasn’t significant: he was -0.056 between Mayo and Lichtman classification and 0.161 between VAS and Lichtman classification.

    Discussion

    Our results suggest, that there isn’t a clear correlation between the clinical and radiological outcome of patients after a distal radius core decompression in a middle to long-term follow-up. A radiological progression seems possible in the years after treatment, but patients keeps a satisfactory clinical outcome. In natural course of the Kienböck’s disease in elderly patients similar results were found by Taniguchi et al.


    Conclusion

    The clinical outcomes seem not to suffer in spite of a radiological progression in the Lichtman classification of patients treated with core decompression for Kienböck’s disease.

    P11

    Is core decompression an effective treatment for Kienböck’s disease in middle-aged patients?

    M. Maniglio1, E. Zaidenberg2, G. Thürig3, E. Gautier3, J. Boretto2, P. de Carli2 (1Lausanne; 2Buenos Aires AR; 3Fribourg)

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    Introduction

    For the treatment of Kienböck’s disease, the distal radius core decompression provides the surgeon with a biologic-based technique that does not alter the anatomy of the radiocarpal, ulnocarpal, or radioulnar joints. Significant improvement in functional activity, motion and reduction of pain has been reported with this technique. However, a biological healing technique also needs a good healing potential. Since the regeneration potential deteriorates with the advancing age of a patient, we asked following question: Is a higher age associated with a poorer outcome and maybe a contraindication to this technic? Our study aims to compare the outcomes of patients with Kienböck’s disease, under and over 45 years old, treated with core decompression.

     

    Material and Methods

    36 patients treated with core decompression for Kienböck’s disease were included in this retrospective study. Patient were allocated to two cohorts according to their age at surgery. 22 patients (8 women) under 45 years old (mean: 28 y) were compared with 14 patients (8 women) 45 years old or older (mean: 52 y). The mean follow-up was 7 years (range, 1-18 years).

    Clinical evaluation included preoperative and postoperative pain recorded using the visual analog scale, the active range of motion of the wrist in flexion and extension and the grip strength.

    Subjective and objective clinical outcomes were assessed with help of the modified Mayo wrist score. We performed statistical comparisons using t-tests for parametric and the Mann-Whitney test for non-parametric data. Significance was set at less than .05.

     

     

    Results

    Preoperatively the mean VAS was 6.8 (range: 5-10) in patient under 45 years old and 5.6 (range,3-10) in patients over 45 years old. At the final follow-up the average VAS was 1.7 (range: 0-8) and 1.2 (range: 0-6) respectively. The improvement from preoperative to the end of the follow-up was significant in both groups (<45 years: p<0.001; >=45 years: p=0.003).

    However, the difference between both age groups was neither significant preoperatively (p=0.075) nor postoperatively (p=0.445).

    Also, in the other postoperative measurements (ROM, grip strength and Mayo score) there wasn’t any significant difference. However, from preoperative to postoperative the grip strength increased significantly in the younger age group (71% to 77%), but the increase of grip strength wasn’t significant in patients over 45 years old (72% to 80%).

     

    Discussion

    In this study a cohort of patients over 45 years old treated with core decompression for Kienböck’s disease were compared with a younger cohort. Similar clinical outcomes were showed, no matter to which age group patient belonged. Our results suggest that the radius core decompression is a simple, less invasive procedure that demonstrated favorable results also in a middle-aged patient cohort between 45 and 61 years old.

     

    Conclusion

    Core decompression should be considered as an important surgical alternative, also in middle-aged patients older than the “typical patient” with Kienböck’s disease.

    P12

    Evaluation of Patient Satisfaction after Implantation of a Carpometacarpal Prothesis from 2017-2021

    L. Dietrich1, I. Berner1, E. Blumer1, A. Behrndt1, C. Zimmermann1, U. Genewein1 (1Rheinfelden)

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    Background: Rhizarthrosis is a common degenerative disease of the aging population with increasing incidence. For years, trapezectomy was considered the undisputed gold standard for advanced rhizarthrosis. Advances in prosthetics made the innovative carpometacarpal (CMC) prosthesis available as an alternative. This surgical technique has been approved in Switzerland, but so far long-term results are still lacking. From our point of view, patient satisfaction postoperatively is of utmost importance.

     

    Methods: Our clinic received approval for implantation of CMC prostheses in 2016. Since January 2017, 99 prostheses type ARPE were implanted. All 86 patients were included in the study. 13 (15.1%) patients have bilateral prosthesis. Patients were predominantly female (68.7%) with an average age of 70 years (39-83). The study includes 7 patients with known diabetes (8.1%) and 46 active smokers (53.5%). The ratio between the dominant and non-dominant upper extremity was 51:48. Complications occurred in 11 (12.8%) patients (luxation and/or ischemia). 6 patients underwent trapezectomy after implantation of a prosthesis. Satisfaction was defined as the sum of freedom from pain and functionality in daily life. We applied a standardized follow-up assessment. On a visual linear-analogue scale (VAS) from 0 (totally dissatisfied) to 10 (totally satisfied), patients rated their satisfaction with the prosthesis. All patients were asked whether they would have the procedure performed on the opposite hand or a hypothetical third hand.

     

    Results: The satisfaction of the patients is at a mean value of 8.91 on VAS from 0 to 10. The 6 patients with trapeziectomy during the course of the study reported an average satisfaction of 6.5. Overall, 78 (90.7%) would undergo the surgery again if the opposite hand was affected, or on a hypothetical third hand. Compared with trapeziectomy, quicker postoperative recovery is shown in terms of pain duration and occupational therapy.

     

    Conclusion: Our study shows that the satisfaction of patients after implantation of a CMC prothesis is very high (8.91 on VAS). In particular, the fact that the vast majority (90.7%) would choose surgery again on the opposite hand or on a hypothetical third hand shows the great potential of this technique. Furthermore, trapeziectomy is still possible after implantation of a prosthesis. These results support the innovative technique and explain the worldwide increase in implantations. Long-term results remain to be seen.

    P13

    A functional assessment score for congenital hypoplastic thumbs

    K. Mende1, M. A. Tonkin2 (1Basel; 2Sydney AU)

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    Background: For surgical reconstruction of congenital hypoplastic thumbs surgical techniques vary and the empirical evidence that allows for evaluation of the results is scarce. Uncontrolled, retrospective, descriptive studies with a low level of evidence are available. These vary considerably in terms of inclusion criteria, study populations, and the use of grading systems. Furthermore, the lack of standardized outcome measures prohibits a comparison of the results by means of meta-analyses and there’s a lack of standardized guidelines.

    Methods: Based on our results from previous studies we developed a score that measures the specific anatomical anomalies as described in the Blauth grading, which is applicable in the very young and non-cooperative patient as well as in the older and cooperative one and allows for comparison of pre- and post-operative functional status as well as the results from different studies.

    Results: A 5-category score based on the anatomical variations of the width of the first web (W), intrinsic function/ anomalies- ability to oppose (I), metacarpophalangeal (MP) joint stability (M), extrinsic function/ anomalies (E), CMC joint/ first metacarpal base (C), shown with the acronym WIMEC is proposed. The anatomical deficiencies in each category are scored from 5 (normal thumb) to 0 (absent thumb). To these anatomical variations are added three further assessment categories- MP joint mobility, strength of pinch, strength of grip, which are applicable for a more global functional assessment in cooperative patients. The full acronym becomes WIMMECSS. Strength and motion measurements are compared to the normal contra-lateral hand when possible, or with age-related normative values.

    Conclusion: The thumb hypoplasia score (WIMEC) allows for an objective assessment and comparison of the pre- and postoperative status of hypoplastic thumbs, taking into consideration the anatomical deficiencies as described by Blauth, including intra-operative findings independently of the patients age and cooperation, and may therefore be used to evaluate the improvement gained from surgical reconstruction. The extended score (WIMMECSS) allows for evaluation and comparison of different techniques, for instance in the assessment of two types of opposition plasty, which may be used for comparison of results from different surgical units. The establishment of a multi-centre trial to determine the validity and any alteration in weighting of parameters is intended.

    P14

    Suicide Attempt – Cardioplegic Solution - Migraine Surgery: Comprehensive care for a Hand Amputation

    J. Bürgin1, A. Gohritz1, D. J. Schaefer1, K. Mende1 (1Basel)

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    Introduction: Hand macro-amputations require immediate treatment in a specialized centre by a trained team of microsurgeons. However, the success of the operation and its long-term outcome may not only depend on the replantation itself, but sometimes also need additional peri- and postoperative measures beyond anastomotic expertise, as presented in this exceptional case.

    Case report: A 67-year-old male patient attempted to commit suicide because of chronic hemi-lateral occipital head-aches. Treatment was severely delayed for about 6 hours after the injury as the patient had hidden himself and the amputated hand in the forest. To prevent reperfusion injury, the hand had to be flushed by cardio-plegic solution and kept cold between admittance to the emergency department until the patient arrived in the operation room and vascular anastomosis could be started. The replantation could be completed after 7 hours, no postoperative complications occurred.

    After several successful blocks of the left greater occipital nerve, in a second operation bilateral surgical nerve decompression in the neck was performed 17 months later. This revealed a severe greater occipital nerve entrapment by scar tissue on the symptomatic side, presumably due to work-related heavy loading and carrying on the left neck and shoulder for decades.

    At 19-month after the replantation, the patient has regained a very useful hand function with good opening and strong grip which even enabled him to resume his original work as a plumber. Regarding the unbearable head-ache which made him suicidal, he is completely free of symptoms.

    Conclusion: This case shows that beyond surgical performance during a macro-replantation, a holistic view and comprehensive treatment of the individual is important to achieve a successful long-term outcome.

    P15

    Stability of the distal radioulnar joint with and without activation of forearm muscles

    A. Weber1, L. Reissner1, S. Friedl1, A. Schweizer1 (1Zürich)

    Show text

    INTRODUCTION

    The distal radioulnar joint (DRUJ) is not only crucial for the rotational movement in the forearm but also for power and load transfer. Torque movements and other activities that stress the wrist lead to physiological dorsovolar shift in the DRUJ complex.

    Several studies have investigated this shift, and typical values (utilizing ultrasonography) were previously described. The primary aim of the present study was to examine the effect of the ulnar forearm muscles activation on DRUJ stability in healthy individuals. The primary outcome, therefore, was to measure the difference in dorsovolar ulna head translation in relation to the distal radius with and without activation of the ulnar forearm muscles (Flexor Carpi Ulnaris (FCU) and Extensor Carpi Ulnaris (ECU)).

     

    METHODS

    This study is a single-center, prospective, cohort study of otherwise healthy individuals (≥ 18 years, without history (or evidence) of pathology related to the DRUJ complex) who underwent a single examination and testing at our Institution. The study is powered to detect significant differences with N = 32 subjects. Enrollment began (April 2021) and is expected to conclude by August 2021.

    The dorsovolar ulnar head translation in relation to the distal radius was measured in a transverse plane through the ulnar head and Lister tubercle. Measurements were carried out in the resting position and while the hand was actively pressed onto a surface (5 kg), with and without activation of the ulnar forearm muscles. Concurrently, an electromyogram was used to measure the FCU and ECU muscle activation.

     

    RESULTS

    Preliminary data on subjects (n = 4) thus far indicates an average total dorsovolar translation of wrists without muscle activation of 2.4 mm (SD = 0.95 mm). While ulnar forearm muscles were activated, the translation was only 0.8 mm (SD = 0.71 mm) on average. Muscle activation was monitored electrophysiologically, while the proportion of muscle activity (ECU vs. FCU) was similar (Root Mean Square = 153 mV vs. 151 mV).

     

    DISCUSSION

    Overall, our preliminary results indicate that ulnar translation with the activity of the ulnar forearm muscles is diminished by two-thirds compared to ulnar translation without the activity of these muscles. As such, ECU/FCU activation serve as additional secondary stabilizers of the DRUJ complex. This finding may be important as physicians discuss different treatment approaches for patients presenting with DRUJ instability.

  • 08:30 – 18:00

    Posteraustellung SGHR

    Sessions SGHR/SSRM

    P40

    Postoperative rehabilitation following CMC dual mobility prosthesis: a case study

    A. Viola1, R. Stojmenova2, L. Priora1, I. Tami3 (1Mendrisio; 2Giubiasco; 3Gravesano)

    Show text

    Introduction

    Carpometacarpal (CMC) osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women and is a challenge for therapists.

    If conservative treatment failed, many different surgical techniques could be proposed for this degenerative arthritis. Trapeziectomy with or without legamentoplasty is a gold standard treatment, instead total joint replacement with dual mobility prosthesis is relatively recent.

    There are many studies about rehabilitation after trapeziectomy, but in literature we cannot find studies about rehabilitation regime after CMC prosthesis.

    Case presentation report

    A 44-years old woman with osteoarthritis of the first CMC joint (stage II, Eaton-Littler classification) started a conservative treatment with custom made splint for the night and joint protection education. The aim was to stabilizing the joint through muscle strengthening and gesture re-education.

    Patient was been operated with a CMC dual mobility prothesis on the right hand (Touch, by Kerimed).

    First day after surgery, early active motion protocol was started without any immobilization.

    A CMC neoprene splint was worn for 6 weeks day and night.

    1-2 weeks edema and wounds were managed, a gently active mobilization of the thumb started in all directions and pain-free. The patient was taught for home exercise in opposition, flexion, extension, adduction and abduction of the thumb and has been educated how to perform light activities of daily living.

    3-6 weeks scar massage was begun, active and passive mobilization was performed to improve functional ROM.

    For 6 weeks, no traction of the thumb and strength exercises to avoid prosthesis dislocations.

    After 6 weeks, strengthening exercises was began, especially intrinsic and extrinsic thumb muscles.

    Conclusion

    In young women with osteoarthritis of the thumb, early mobilization seems to be an effective rehabilitation treatment after dual mobility CMC prosthesis.

    Early return to activities of daily living, no pain, good pinch, fast strength recovery was indicated by the patient as characteristics of this rehabilitation.

    Bibliography

    Badia A., Total Joint Arthroplasty in the Treatment of Advanced Stages of Thumb Carpometacarpal Joint Osteoarthritis, J Hand Surg, 2006

    Froschauer S., Total Arthroplastic with Ivory Prosthesis versus resection-suspension arthroplasty: a retrospective cohort study on 82 carpometacarpal-I osteoarthritis patients over 4 years, Europ. J of Medical Research, 2020

    P41

    Bruner or Brunner? The Man Behind the Zig-Zag Incisions

    E. Kulakli- Inceleme1, K. T. Danuser2, E. Fritsche1 (1Luzern; 2Zug)

    Show text

    Introduction

    Finding the answer to Julian Minassian Bruner – or was it Brunner? His name is

    mentioned almost daily in a routine workday of a hand surgeon and his zig zag incision

    is a gold standard for the approach on the palmar side of the digits. But since decades

    there has been an uncertainty about the way of writing Mr. Bruner’s last name.

    Methods

    To find the answer to this special and honorable name we had to go through the family

    tree of Mr. Bruner’s ancestors. It is difficult to find data about the family tree of MD

    Julian Minassian Bruner. But we found a book, “Our American Ancestors”, written by

    Henry Lane Bruner and Elisabeth Bruner Taylor, the uncle and aunt of Julian M.

    Bruner, written in 1943. Obviously, they themselves already were curious about their

    family’s origin.

    Conclusion

    Literally - as sure as written in stone – the name of MD Julian M. Bruner is written with

    one “N”. But looking at his family tree the origin of the name goes back to the

    beginning of the 18th century with its roots in Germany. Johann Jacob Brun(n)er,

    tracing Julian’s ancestors back seven generations, was born in Schifferstadt,Ludwigshafen, a town in the area of Rheinland-Pfalz in Germany and was the first

    member to reach America. It was also the first member in the family tree where

    documents have been found with the name Bruner written with two “N”s.

    So - if someone nowadays writes the “Bruner Incision” with two N’s, they now at least

    have a justification for their misspelling and rely on the origin of the name. But in

    honor of MD Julian Minassian Bruner we suggest to simply follow his will, as it is

    written on his grave, and continue writing “Bruner” with one “N”.

    P42

    ROLE OF GRADED MOTOR IMAGERY IN PREVENTING CRPS AFTER SURGERY FOR DISTAL RADIUS FRACTURE

    S. Pagella1, A. Viola2, L. Priora1, F. Ferrario1, M. G. Fioretti1, I. Tami1 (1Gravesano; 2Mendrisio)

    Show text

    Introduction: pain management is essential in the early stages of rehabilitation after surgery for distal radius fractures (DRF). Patients often are afraid to move the operated wrist, mainly because of pain. This might result in prolonged immobilization, resulting in stiffness and impaired function of the affected limb with devastating impact on working and social life. Pain becomes chronic in about 41.9% of the cases.It has been proved that pain in CRPS is associated with a reorganization of the primary sensory cortex with  an alteration of the somatotopic cortical representation and loss of ability to integrate stimuli with spatial representation and discrimination between the affected and the healthy side. Motor performance is also compromised. Fortunately, these changes are not irreversible.The clinical application of these studies has seen the development of specific treatments that have as their objective the reduction of pain through a cortical reorganization and Graded  Motor Imagery (GMI) is one of those. GMI is a form of brain training aimed to reduce pain and improved performance. It uses three stage approach: left-right discrimination, imaged movements and mirror therapy. We present a prospective and randomized study aimed to explore the ability of GMI to significantly reduce the incidence of CRPS in patient with DRF, after surgery. 

    Methods: We enrolled 60 consecutive patients with 60 DRF and we divided them in two groups. The allocation into these groups was randomized.In group A patients were treated in accordance with our standard protocol for DRF. In group B patients were treated with our standard protocol but also with GMI. We evaluated for statistical comparison all patients at 8 weeks postoperatively focusing on  pain,Patient Rated Wrist Evaluation (PRWE), Brief Pain Inventory (BPI), McGill Pain Questionnaire MPQ. and function (ROM). We also recorded the presence of diagnostic criteria for CRPS.

    Results:the number of simple medium severe or complicated fractures was similar between the 2 groups. At the last follow up patients in group B showed better results then patients in group A.  This difference was not significant.  There were 5 cases of CRPS in group A (without GMI).

    Conclusions:our study suggests that GMI might implement standard rehabilitation protocols after surgery for DRS.  GMI seems to have  a protective effect against CRPS.

    P43

    Skier’s thumb treatment with new orthosis and early mobilization

    R. Stojmenova1, S. G. Rech2, T. Giesen3 (1Giubiasco; 2Lugano; 3Gravesano-Lugano)

    Show text

    Thumb ulnar collateral ligament (UCL) injuries are very common [1]. Conservative and post-operative regimes include immobilization of the metacarpophalangeal (MCP) joint for 10 days to 6 weeks [1-2], but, arguably, controlled early active motion stimulates healing of ligaments and avoid stiffness [3].

    We treated 6 cases of UCL injuries (5 conservative, 1 post-operative) over a period of 2 months with a modified splint that allows early mobilization by protecting the torn ligament.

    There were 3 women and 3 men with an average age of 42 years (range 29-52). One male patient was operated. We immobilized the MCP joint in a hand based splint (Figure 1) for 2 weeks. We then modified the splint by replacing the palmar block at the MCP joint with a velcro encouraging flexion of the MCP joint (Figure 2) for 4 weeks. The splint was still protecting radial and ulnar deviation while compensative flexion of the trapeziometacarpal joint was inhibited. The velcro was only removed during the exercises and light activities.

    All patients eventually healed with good stability of the MCP joint; 90% of MCP flexion and Kapandji score of at least 9 was recovered at 8 weeks post injuries in all cases. Average Key Pinch was at 93% (range 5,5-10) at 8 weeks. This new regime seems to be safe with a fast recovery.

     

    References:

    1. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 2010;20(2): 106-112.
    2. Harley BJ, Werner FW, Green JK. A biomechanical modeling of injury, repair, and rehabilitation of ulnar collateral ligament injuries of the thumb. J Hand Surg 2004;29(5);915-920.
    3. Michaud EJ, Flinn S, Seity WH Jr. Treatment of grade III thumb metacarpophalangeal ulnar collateral ligament injuries with early controlled motion using a hinged splint. J Hand Ther. 2010;23(1);77-82.

    P44

    Das erste Lebensjahr eines Kindes mit Arthrogryposis multiplex congenita aus Sicht der Ergotherapie

    M. von Gunten1, A. Ringeisen1 (1Bern)

    Show text

    Hintergrund

    Arthrogryposis multiplex congenita [AMC] ist eine seltene Erkrankung mit angeborenen Gelenkkontrakturen, die unter anderem die oberen Extremitäten betreffen. Das erste Lebensjahr ist entscheidend, um Verbesserungen im Bereich der Körperstrukturen und –funktionen zu erzielen (Oishi et al., 2019). Durch die reduzierten Bewegungsfähigkeiten haben Neugeborene Mühe, ihre Arme zu heben und Gegenstände zu erkunden (Babik et al., 2020).

    Ziel dieses Fallberichtes ist es, die ergotherapeutischen Massnahmen zur Unterstützung der Handlungsfähigkeit sowie Ergebnisse  im ersten Lebensjahr eines Kindes mit AMC in den verschiedenen Bereichen der International Classification of Functioning, Disability and Health [ICF] vorzustellen. Zudem sollen Faktoren aufgezeigt werden, welche die Rehabilitation begünstigt und erschwert haben.

    Fallbeschreibung

    Die Interventionen beinhalteten unter anderem Schienenversorgungen, Mobilisation, Taping, Elektrostimulation, Adaptationen von Spielzeug sowie Beratung der Bezugspersonen. Das Mädchen besuchte die Ergotherapie ein- bis zweimal pro Woche.  Die wichtigsten Ergebnisse waren eine Verbesserung der Gelenksbeweglichkeit sowie ein vermehrtes Nutzen der Hände zum Erkunden, Bewegen und Greifen von Gegenständen. Der Verlauf wird mit Bildmaterial und Verlaufsbeurteilungen dargestellt werden.

    Begünstigende Faktoren waren eine vertrauensvolle Beziehung zwischen der Mutter und den Therapeut*innen und der interdisziplinäre Austausch. Erschwerend war das häufige starke und anhaltende Weinen des Mädchens, die Notwendigkeit, die Schienen häufig anzupassen und die limitierte Studienlage.

    Schlussfolgerungen

    Die Ergotherapie sollte früh begonnen werden und alle Komponenten der ICF berücksichtigen. Somit können Körperstrukturen und –Funktionen verbessert und die Eigenaktivität erhöht werden. Ein interdisziplinärer Austausch ist wichtig, um bei diesem komplexen Krankheitsbild Schwerpunkte zu definieren.

     

    Babik, I., Cunha, A. B., & Lobo, M. A. (2020). Assistive and Rehabilitative Effects of the Playskin Lift TM Exoskeletal Garment on Reaching and Object Exploration in Children With Arthrogryposis. Am. Jour. of Occ. Ther., 75(1), 7501205110p1.

    Oishi, S., Agranovich, O., Zlotolow, D., Wall, L., Stutz, C., Pajardi, G., Novelli, C., Abdel Ghani, H., Jester, A., Vuillermin, C., James, M., Manske, M. C., & Beckwith, T. (2019). Treatment and outcomes of arthrogryposis in the upper extremity. Am. Jour. of Med. Gen. Part C: Seminars in Medical Genetics, 181(3), 363–371.

    P45

    New Desing for Scapula Winger's brace

    S. Pagella1, F. Ferrario1, A. Viola2, T. Giesen1 (1Gravesano; 2Mendrisio)

    Show text

    Introduction: The most common causa of winging scapula (WS) is a close trauma to the long thoracic nerve and subsequent palsy of the serratus muscle.Initial treatment is mostly conservative, and includes the use of a splint designed to hold the scapula reduced on the chest wall. A reduced scapula, reduces pain and improves upper limb function while waiting for the serratus muscle to recover. If the palsy of the serratus persists, surgery is indicated. After surgery a similar splint is indicated. In literature it is longtime debated the difficulty in creating an equally effective and comfortable brace for WS. We present a new design for scapula winging splint we used in 4 patients pre and post operatively after long thoracic persistent nerve palsy. Methods: From June 2018 to February 2021 we treated 4 patients with post traumatic long thoracic palsy and consequent painful WS. The patients were all females with an average age 53 y.o. (range 23-76). All patients sustained a closed blunt trauma to the long thoracic nerve. All patients presented to our service with a long standing post traumatic scapula (>1 year). A WS splint was tailored before the operation and tested for 2 weeks before surgery. All patients underwent a transfer of the sterno-costal head of the pectoralis muscle to the tip of the scapula. Materials: a plate for the scapula area of thermoplastic material. Non-adhesive loop (NLV) Velcro, adhesive hook Velcro (AHV), Adhesive Padding, Soft velvet ending strip black. The thermoplastic material was molded directly on the patient's scapula. We introduced a border above the collarbone to strengthen the upper portion of the splint. We found how a perfect match of the lower part of the splint with the lower edge of the scapula is essential in maintaining the scapula reduced. The splint was was the completed with NLV and AHV very tight around the thorax just under the armpits and the breast. Original padding patterns were used around the lower part of the splint, posteriorly, were the most discomfort has been usually described. Splint was worn constantly above a normal t-shirt and removed carefully only to change clothes. Results: All patients recovered with the WS resolved and no residual pain. Al patients tolerated the splint adequately for all the pre and post operatively period.We think our modifications to the WS splint could be of use in this very specific pathology.

    Martti V. et al, 2015

    Marin R., 1998 

  • 08:45 – 09:15

    Gartensaal 1 A-C

    Gemeinsame Eröffnung

    U. Hug, Luzern (CH) / P. Kammermann, Bern (CH) / S. Rosca-Furrer, La-Chaux-de-Fonds (CH)

    Joint Sessions

    Deutsch

    Lassen Sie sich überraschen!

  • 09:30 – 10:30

    Gartensaal 1 A-C

    Freie Mitteilungen I A

    J. Beaulieu, Genève (CH) / T. Franz, Uster (CH)

    Sessions SGH/SSCM

    FM1

    To operate or not to operate: When is it best to perform a PIP arthroplasty?

    M. Marks1, M. Oyewale1, B. Steiger1, S. Neumeister1, S. Schindele1, D. B. Herren1 (1Zürich)

    Show text

    Background: There is an ongoing discussion about the optimal timing of surgery for patients with proximal interphalangeal (PIP) joint osteoarthritis (OA). It would be useful to know at which level of preoperative symptoms patients should be operated on to achieve the potentially best postoperative result.

    Objective: The objective of this study was to define clinically relevant preoperative thresholds at which patients with PIP joint OA have the greatest chance to achieve a minimal important change (MIC) and a patient acceptable symptom state (PASS) one year after surgery.

    Methods: Data from our prospective registry including patients with PIP joint OA who underwent arthroplasty for this condition and who had a 1-year follow-up were analysed. Patients were examined before and 1.5, 3, and 12 months after surgery. They indicated pain on a numeric rating scale (0-10) and completed the brief Michigan Hand Questionnaire (MHQ, 0-100). Active range of motion (ROM) of the affected PIP joint was measured. Radial rays (index and middle finger) and ulnar rays (ring and little finger) were analysed separately. The preoperative thresholds, which are predictive to achieve the MIC and PASS, were determined using receiver operating characteristics (ROC) curves.

    Results: We included 214 patients with 263 fingers and a mean age of 68 (±10) years. Patients have the highest chance to achieve a MIC and PASS, if they are operated with preoperative pain at rest between 2.5 and 6.5, pain during activities of about 6.5, a brief MHQ score of about 42, ROM between 46° and 49° (radial rays), and ROM of 46° to 63° (ulnar rays). Within these reference values, patients have the greatest chance of achieving a subjectively relevant change and an acceptable symptom state.

    Conclusion: The determined thresholds may help the surgeon in the preoperative decision-making process to decide for or against a surgical intervention and to explain the probability of achieving sufficient postoperative symptom relief to the patient. The findings substantiate our experience of patients being operated on too early or too late in the course of the disease.

    FM2

    Thumb interphalangeal joint replacement with a surface replacing implant: a prospective study

    S. Schindele1, M. Marks1, D. B. Herren1 (1Zürich)

    Show text

    Objective: The objective of this study was to evaluate the 1-year patient-reported and clinical outcomes of thumb interphalangeal (IP) joint arthroplasty using a surface replacing implant (CapFlex-PIP, KLS Martin, Germany).

    Methods: In this prospective pilot study, we included patients who received a CapFlex-PIP implant at the thumb IP joint. Patients rated their satisfaction with the treatment outcome on a 5-point Likert scale. They completed the brief Michigan Hand Outcomes Questionnaire (MHQ) and rated their pain on a numeric rating scale (0-10). Range of motion (ROM) of the thumb IP joint and key pinch were measured.

    Results: Twelve patients with a median age of 67 years (range 53-80 years) were included. The brief MHQ increased from median 41 points before surgery to 50 at 1 year. Pain decreased from median 5.5 before surgery to 1.0 at 1 year. Total range of IP joint motion was 40° at 1 year. Key pinch increased form median 4kg before surgery to 5gk one year later. Seven patients were satisfied and five were unsatisfied with the treatment outcome at 1 year. Among the unsatisfied patients were heavy manual workers and one patient with severe systemic lupus erythematosus. One dislocated implant was revised to an arthrodesis.

    Conclusion: Based on the inconsistent results, we conclude that thumb IP arthroplasty with a surface gliding implant is rarely indicated, but could be an alternative for patients attaching great importance on mobility and precision tasks. For patients who either have high demands for a powerful pinch grip, the high physical demands of a manual job or a rheumatoid disease, thumb IP joint arthrodesis should be preferred.

    FM3

    Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty

    D. B. Herren1, N. Fuchs1, S. Schindele1, M. Marks1 (1Zürich)

    Show text

    Objective: There a no clear guidelines advocating how patients with residual symptoms after thumb carpometacarpal (CMC I) resection arthroplasty should be treated further. The aims of our study were to (1) investigate the medium-term results of CMC I revision interventions, and (2) define a revision concept including diagnostic recommendations for different residual symptoms after resection arthroplasty.

    Methods: Patients who had undergone primary trapeziectomy with or without tendon suspension and interposition followed by at least one revision surgery more than 12 months before were invited for a clinical follow-up examination. Patients completed the brief Michigan Hand Outcomes Questionnaire (MHQ) and rated pain on a numeric rating scale (0-10).

    Results: Twenty-four patients with 25 affected thumbs were examined on average 5.5 years after their last revision surgery. Mean pain at rest was 1.6 (SD 2.0), pain during daily activities was 2.7 (SD 2.7) and the brief MHQ score was 63 (SD 19). Seventeen patients (68%) indicated that their thumb was better than before primary surgery. The four relevant subgroups encompassing the reasons for revision were (Figure 1): Impingement of the MC I (main reason), scaphotrapezoidal (ST) arthritis, flexor carpi radialis tendinitis and problems caused by other joints.

    Conclusion: Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary resection arthroplasty. Our revision algorithm suggests that the main reason for revision — symptomatic impingement of the MC I — should be first treated with a steroid infiltration. If symptoms persist, a computer tomography examination is recommended to confirm and localise these problems. In most cases, the two corresponding bones causing the impingement give rise to marks in the form of either sclerosis, abrasion, or cystic bone changes. Upon confirmation, a resection of the MC I base and ST joint is recommended. An existing interposition should be revised, or a new interposition should be used preferably with an autologous tendon or alternately with an allograft.

    Figure 1: Revision algorithm for assessing and treating residual problems after resection arthroplasty

    FM4

    To resect or suture the capsule in thumb carpometacarpal joint implant arthroplasty?

    V. Reischenböck1, M. Oyewale1, M. Marks1, S. Schindele1, D. B. Herren1 (1Zürich)

    Show text

    Background: To further facilitate the rehabilitation and enhance range of motion (ROM) of the thumb carpometacarpal (CMC) joint, it has been suggested to perform capsular resection in total joint arthroplasties instead of traditional capsular repair.
    Objective: We aimed to compare the effects of CMC I arthroplasty with capsular resection (CR) versus capsular suture (CS) on patients operated with the Touch® (KeriMedical) CMC I total arthroplasty.
    Methods: Patients with a Touch® CMC implant that are prospectively recorded in our registry complete the brief Michigan Hand Outcomes Questionnaire (brief MHQ; score 0-100), report their pain levels at rest (Numeric Rating Scale; 0-10), and have their thumb opposition (Kapandji score) and key pinch strength assessed. Statistical analyses include t-tests to compare within- and between group differences and a linear regression model to adjust for baseline status if baseline data differed between the groups (e.g. key pinch and pain).
    Results: 66 patients with a follow-up of at least one year underwent an implant arthroplasty for CMC I osteoarthritis. In 39 patients the capsule was resected and in 27 patients it was sutured. The brief MHQ scores increased from 45 (±14) at baseline to 85 (±18; p≤0.05) after one year in the CR group and from 47 (±14) to 76 (±21; p≤0.05) in the CS group. The Kapandji scores increased from 8.6 (±1.9) to 9.9 (±0.3, p<0.05) in the CR group and from 8.5 (±2.6) to 9.4 (±1.4) in the CS group. These results were significantly better in the CR group. The linear regression model analysis, on the other hand, showed no significant influence of the group allocation on the increase in pinch strength from 5kg (±3) before surgery to 7kg (±4; p≤0.05) in the CR group and from 4kg (±2.5) to 6kg (±2; p≤0.05) in the CS group. Similar findings were observed for pain levels.
    In each group, one implant had to be revised and converted to a resection-suspension-interposition arthroplasty. A causal relationship between the handling of the capsule and these complications is unlikely.
    Conclusion: These findings confirm that patients recover well after the implantation of the Touch® CMC I total arthroplasty for CMC I osteoarthritis. Capsular resection shows promising results by indicating better overall hand function, although improvement of pain and pinch strength after one year shows no significant between group differences.

    FM5

    Analysis of CMC I joint kinematics using 4D-CT imaging in vivo - an observational study

    A. Gübeli1, M. Keller1, I. Dobbe2, P. Honigmann1 (1Liestal; 2Amsterdam NL)

    Show text

    Background: Four-dimensional computer tomography (4D-CT) imaging is spreading in the medical field and has recently reached the field of hand surgery. Analysis of the thumb carpometacarpal (CMC I) joint using this technique however is limited to a few feasability studies or studies with a very small amount of volunteers.1-2 Our aim is to visualize the CMC I joint kinematics and change of articular surface contact area during motion using dynamic distance mapping.

     

    Method: We conducted a 4D-CT scan of a cadaver CMC I joint to test the imaging protocol and estimate the radiation dose.

    20 volunteers without symptoms at the thumb CMC joint were recruited for this study. They were trained to perform a thumb opposition and retropulsion movement by a hand surgeon smoothly over a period of 10 seconds.

    4D-CT scans were performed at a temporal resolution of 5 frames per second, resulting in 50 frames for each movement (10 seconds of movement duration). The effective radiation dose of one 4D-CT scan with the duration of 10 seconds was approximately 0.176 mSv.

    The trapeziometacarpal joint surface was divided into a grid and the distance between the articular surfaces of the metacarpal bone and the trapezium during motion was calculated for each square of the grid, resulting in a coloured pattern visualizing the contact area of the joint (Fig. 1).  

     

    Results and conclusion: We were able to optimize the visualization and understanding of CMC I joint kinematics, discovering CMC I joint phenotypes and possible causes for the development of CMC I joint osteoarthritis. Compared to earlier studies on this topic, we analysed thumb opposition motion in vivo with real 4D-CT imaging compared to 3D-CT scans at static endpoints and the analysis was conducted in higher resolution using absolute distance for the proximity calculation.

     

    References: 

    1. Goto et al. In vivo pilot study evaluating the thumb carpometacarpal joint during circumduction. Clin Orthop Relat Res. 2014;472(4):1106–13.

    2. Wang et al. Quantitative analysis of in-vivo thumb carpometacarpal joint kinematics using four-dimensional computed tomography. J Hand Surg Eur Vol. 2018;43(10):1088–97.

    Fig. 1 Color mapping of the articular surface distance (in millimeters) in the CMC I joint during thumb opposition

    FM6

    Radiographic landmarks for centering the trapezial cup in trapeziometacarpal joint arthroplasty

    L. Auberson1, L. Athlani2, J. Y. Beaulieu1 (1Genève; 2Nancy FR)

    Show text

    Introduction : Trapeziometacarpal (TMC) total joint arthroplasty is a surgical option to treat TMC osteoarthritis that have not responded to conservative treatment. Generally, clinical results are good with significant pain reduction and functional thumb range of motion. However, one of the main complications is cup loosening. Various authors highlighted the importance of correct cup positioning to minimize the risk of loosening. They suggest the importance of having a satisfactory bone support on each side of the cup allowing a high osteointegration. Thereby, some of them propose that the prosthetic cup in the trapezium should be placed in the center of the distal articular surface of the trapezium. We hypothesize that the center of the distal articular surface of the trapezium does not match with the middle of the trapezium width. Based on radiographs, we sought to evaluate those two radiographic landmarks with an aim to identify the most reliable solution for centering the trapezial component.
    Material and method : We performed a retrospective review of standard anteroposterior and lateral x-rays of the thumb from 80 patients. On the frontal x-rays, we measured the distal articular surface of the trapezius and the width of the trapezius. We compared the respective midpoints of these two distances, as radiographic centering marks for the positioning of a 9 mm cup (corresponding to the diameter of the trapezial cup of the Touch® implant (KeriMedical)). We measured the distance between the radial end of each segment and the radial edge of the trapezium, which corresponded to the radial residual bone distances after positioning of the cup.
    Résultats : Differences between the both radial residual bone distances were assessed using Student's t-test. The width of the trapezius had a significantly higher mean value than the distal articular surface of the trapezius (p < 0.01), and their midpoints did not match. Thus, after positioning the simulated 9 mm diameter of the prosthetic cup, centered on each midpoints, the radial residual bone distance was up to 33% greater using the width of the trapezoid (p < 0.01).
    Discussion : Our study suggests that the middle of the trapezium width is the most reliable radiographic landmark for centering the trapezial prothetic cup in the total joint arthroplasty by preserving better bone stock on the radial side without depleting the ulnary side, thus reducing the risk of cup loosening.
        

    FM7

    Hand motion analysis of functional tasks – repeatability and marker visibility

    G. Fischer1, L. Reissner1, R. List1, D. Jermann1, M. Calcagni1 (1Zürich)

    Show text

    Objective: The aim of this study was to demonstrate the feasibility of simultaneously measuring all finger joints, the wrist and the radio-ulnar joint during daily activities using a 3D motion capture system. Main interest was in verifying good marker visibility and quantifying repeatability of angular motion patterns during functional tasks.

    Method: Twenty healthy volunteers were recorded with a motion capture system during eight functional activities: opening a jar, a bottle and yoghurt, writing, typing, lifting a 1kg, 3kg and a small object. 46 skin markers were used to collect kinematic data of the hand, forearm, thumb and fingers simultaneously. Each task was repeated five times.

    The visibility of the markers was reported as a percentage over the entire duration of the task. The intra- and inter-subject standard deviation (SD) between the angle curves was used as a measure of repeatability.

    Results: Overall marker visibility was 97%, with markers for calculation of wrist, thumb and MCP kinematics achieving high visibility of over 99%, elbow and PIP >95% and DIP only 88.5%.

    The averaged intra- and inter-subject SD over all tasks and joints was 4.9° and 10.2° respectively.

    Conclusion: Overall, good data quality was achieved, thus confirming the feasibility of assessing hand kinematics during daily activities. However, in some tasks visibility of the markers for DIP3-5 joints was limited.

    The movements were repeatable within a subject, but relatively large inter-individual differences were found. The tasks varied regarding repeatability, e.g. writing was the most repeatable activity within subjects (3.2°), but large differences between subjects were found for this task (11.7°). Using a heavier dumbbell weight (3kg vs. 1 kg) increased the repeatability of finger kinematics. Future studies should investigate the impact of the load on repeatability.

    The angular motion patterns of healthy volunteers showed a relatively large inter-subject normal range. With the aim of quantitatively measuring hand function, future studies will investigate whether and to what extent patients' movement patterns and functional constraints can be distinguished from these normal values.

    Inter- and intra-subject repeatability.png
  • 09:30 – 10:30

    Gartensaal 2

    Freie Mitteilungen I

    P. Chèvre, Bern (CH) / E. Marthaler, Biel (CH)

    Sessions SGHR/SSRM

    FM60

    COVID und wie ein Handtherapie Kurs in Sri Lanka trotzdem stattfand!

    B. Loos1, S. Ewald1 (1Zürich)

    Show text

    Einleitung

    Ein bereits geplanter Handtherapie-Kurs für TherapeutInnen in Sri Lanka (SL) kann wegen der Corona Pandemie nicht stattfinden - was nun? Abblasen oder gibt es Alternativen? Vorausgesetzt die TeilnehmerInnen (TN) in SL verfügen über Internetzugang sollte es möglich sein, Grundlagen der Handtherapie online zu vermitteln. Nach Rücksprache mit unserer lokalen Partnerin in SL sehen wir in der Möglichkeit eines online Kurses eine neue Herausforderung.

     

    Methode

    Eine online Umfrage, die wir an interessierte TherapeutInnen in SL verteilen liessen, gab uns Überblick über ihren Wissensstand. Schliesslich fand die Weiterbildung mit 24 TN über Zoom statt und beinhaltete 6 online Sessions à 2 Std. verteilt auf 3.5 Mt.

    Unterrichtet wurde mit PowerPoint Präsentationen, Fragerunden, Videosequenzen und praktischen Übungen. Zwischen den Unterrichtseinheiten wurden die TN aufgefordert in Gruppen Aufgaben zu bearbeiten und diese einzureichen. Ein online Learning-center wurde auf der Plattform groupspaces.com für diesen Kurs eingerichtet.

     

    Ziele

    Am Ende des Kurses:

    • haben die TN Grundkenntnisse in Handtherapie.
    • steht den TN eine Auswahl an selbsterarbeiteten Befundungs- und Patienteninformationsblättern zur Verfügung, die für den Klinikalltag in SL nützlich sind.
    • bildet sich ein Netzwerk unter den TherapeutInnen und der Wissensaustausch und die Zusammenarbeit werden gefördert.

     

    Schlussfolgerung

    Wir stellten fest, dass der online Kurs mit gestaffelten Unterrichtssequenzen Vorteile gegenüber dem Blockunterricht hat. Die TN hatten Zeit, das Gelernte zu verarbeiten und in der Praxis erste Erfahrungen damit zu sammeln, sowie die Aufgaben für ihren Arbeitsalltag relevant zu gestalten. Als Instruktorinnen konnten wir durch die Aufgaben einen Eindruck gewinnen über den Wissensstand und wie das neue Wissen appliziert wurde. Dementsprechend war es uns möglich, den Inhalt des Kurses und unsere Instruktionsstrategien fortlaufend anzupassen. Wir konnten den Lerneffekt beobachten. Das positive Feedback der TN ermutigte und bestätigte uns, dass ein online Handtherapie-Kurs effektiv durchgeführt werden kann.

    In 2021 wurde die Gruppe mit TN aus Banglasdesh erweitert, und der online Kurs wurde mit Referentinnen aus fünf Länder fortgesetzt.

    Ein online Handtherapie-Kurs ist kostengünstig für alle Parteien, umweltfreundlich, fördert die Entwicklung der Handtherapie vor Ort und kann trotz Pandemie stattfinden.

    FM61

    Défi en rééducation de la main: l’observance au traitement

    Revue des besoins du patient et thérapeute

    L. Kiener1 (1Nidau)

    Show text

    Motivation du travail

    L’observance en rééducation de la main est un défi : si le patient participe activement à la thérapie et suit les recommandations sur une base volontaire, il y a significativement plus de chance qu’il soit rapidement peu ou pas gêné dans les activités de la vie quotidienne. De plus, les coûts du système de santé peuvent être largement réduits. La rééducation de la main se différencie d’autres domaines par certains de ses objectifs à court terme comme par exemple après suture de tendon : l’observance au traitement ne peut pas attendre. Les risques de conséquences négatives pour la main apparaissent en quelques jours, voire en quelques heures.

    Ce travail a pour objectif de proposer un modèle pour la pratique pour que les thérapeutes de la main aient l'opportunité de percevoir leurs besoins et ceux du patient par rapport à l'observance au traitement.

     

    Méthodologie

    Par une revue de la littérature, les besoins des patients et des thérapeutes en matière d'observance au traitement ont été recherchés et structurés grâce au Multidimensional Adherence Model (MAM) développé par l'Organisation mondiale de la santé (OMS). Les résultats ont ensuite été rassemblés dans un modèle créé par l’auteur.

     

    Résultats

    Les patients et les thérapeutes ont des besoins qui dépendent de nombreux facteurs en relation avec l’observance. Le temps, les compétences pédagogiques et les compétences en communication sont les principaux besoins des thérapeutes. Les patients ont besoin eux aussi de temps, d’être informés de manière claire et grâce à différents supports ainsi que d’être motivés pour le traitement.

     

    Discussion et conclusion

    Les thérapeutes de la main doivent garder une vue d'ensemble et une ouverture sur les différents facteurs et besoins relatifs à l’observance dans le but de préparer une stratégie ou une intervention optimale de traitement. Le modèle créé pour ce travail est un support proposé aux thérapeutes pour identifier leurs propres besoins ainsi que ceux des patients en matière d’observance et d’élaborer une stratégie d’action pour le traitement.

    Les résultats de ce travail comportent certaines limitations. La principale étant le fait que les données recueillies sur le thème des besoins en rapport avec l’observance sont généralement des auto-questionnaires. Le comportement des interrogés peut changer s’ils savent qu’ils sont interrogés sur le sujet.

    FM62

    Behaviour Change? Alte und neue Evidenz anhand eines Klientenbeispiels aufgezeigt

    B. Aegler1, C. Wildhaber-Phillips1 (1Zürich)

    Show text

    Klienten mit Handverletzungen oder Handerkrankungen durchlaufen für eine erfolgreiche Rehabilitation mehrere Verhaltensveränderungen. Meist geht es in der akuten Phase um ein Umlernen der Tätigkeiten damit die verletzte Hand geschont werden kann, um dann in der Rehaphase die betroffene Hand im Alltag und bei der Arbeit langsam wieder zu integrieren und aufzutrainieren. Wie können Therapeuten ihre Klienten dabei optimal unterstützen?

    Solche Verhaltensänderungen wurden in den 80 Jahren mit dem Transtheoretischen Modell (TTM) beschrieben. Es erklärt dabei die 6 Phasen der Verhaltensänderung. Schwarzer entwickelte etwas später das Health Action Process Modell (HAPA), das den Intention-Behaviour-Gap ins Zentrum setzt. Beide Modelle besagen, dass die Herausforderung das Überwinden der Intention zur Aktion ist. Neueste Ansätze wie «Tiny Habits» von BJ Fogg 2019, basieren vermehrt auch auf Neuroendokrinischer Forschung. Hier werden weitere Aspekte zur Erleichterung dieses Gaps aufgezeigt, wie z.B. mittels gezieltem Triggern von Hormonen eine Verhaltensveränderung im Alltag leichter gelingt. In diesem Vortrag sollen die Stärken der einzelnen Modelle, sowie das neueste biologische Wissen der Hormonforschung, auf dem «Tiny Habits» basiert, erläutert und an einem Klientenbeispiel (Geigenspielerin) eine mögliche Umsetzung in die Therapie dargestellt werden.

     

    Referenzen:

    • Prochaska, J. O. & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of therapy. Psychotherapy: Theory, Research, and Practice, 19, 267-288
    • Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. In R. Schwarzer (Ed.), Self-efficacy: Thought control of action (pp. 217-243). Washington, DC: Hemisphere.
    • Fogg B.J. (2020) Tiny Habits: The Small Changes That Change Everything Virgin Books London

    FM63

    "Du und ich" – Gemeinsam therapieren wir die Hand

    Die therapeutische Beziehung in der Handtherapie

    A. Schmid1 (1Thun)

    Show text

    Wir wollen alle, dass der Patient nicht so geht wie er gekommen ist. Nicht nach einer Behandlungssequenz und schon gar nicht beim Abschluss der Therapie. Patient und Therapeut möchten beide die grösstmögliche Funktion der Hand wiedererlangen – Mit einer guten Zusammenarbeit schlagen wir einen sehr wichtigen und effizienten Weg ein. Die Frage nach der bestmöglichen, effizientesten Therapie bleibt unser ständiger Begleiter. Welche Faktoren beeinflussen die Veränderung?

    Lambert (1999) hat in der Psychotherapie untersucht, welche Faktoren bei den Klienten Veränderung bewirken. Als ich kürzlich diesem Modell begegnet bin, hat es mich inspiriert und motiviert mehr darüber zu wissen. Selbst wenn die therapeutische Beziehung in der Handtherapie etwas weniger als die von Lambert beschriebenen 40% beträgt, so ist diese bestimmt auch in der Handtherapie von grosser Bedeutung.

    Taylor et al. (2009) machten eine randomisierte Umfrage von unter Ergotherapeuten in Amerika zur Selbstwirksamkeit «Use of Self» respektive den Gewohnheiten/Einstellungen und Erfahrungen im Hinblick auf die therapeutische Beziehung. Mehr als 80% der Therapeuten glauben, dass die therapeutische Intervention der eigenen Person das wichtigste Mittel für die Therapieergebnisse darstellt. Entsprechend sollte beim «Clinical Reasoning» immer die eigene Person einbezogen werden. Die meisten gaben an, dass sie häufig bis immer positive Gefühle gegenüber ihren Patienten haben – was eine ideale Voraussetzung für eine erfolgreiche Therapie ist. Jedoch waren die meisten Therapeuten der Ansicht, dass sie nicht ausreichend ausgebildet waren und nicht über ausreichende Kenntnisse verfügen.

    Immer wieder melden sich bei uns Patienten und wünschen nach Jahren eine erneute Therapie bei der bisherigen Therapeutin. Manchmal haben sie eine entsprechende personengebundene Empfehlung von einer Freundin erhalten. Es ist ihnen wichtig, wer sie behandelt.

    Dies als eines von vielen Beispielen aus der Praxis, welches die Wichtigkeit der therapeutischen Beziehung im Alltag zeigt.

    Basierend auf den Ergebnissen aus Studien und anhand von Erfahrungen aus der Praxis möchte ich zusammen mit den Kongressteilnehmern die Aufmerksamkeit und die Begeisterung nicht nur auf die Hand, sondern vielmehr auf den Menschen und die therapeutische Beziehung richten.

    Taylor, R. R., et al. (2009). "Therapeutic use of self: a nationwide survey of practitioners' attitudes and experiences." Am J Occup Ther 63(2): 198-207.

    Grafik influencers of Change.png
  • 09:30 – 10:30

    Vortragssaal 2

    Freie Mitteilungen I B

    Bones

    A. Schweizer, Zürich (CH) / M. Häfeli, Chur (CH)

    Sessions SGH/SSCM

    FM8

    The spanning plate as an internal fixator in distal radius fractures – a prospective cohort study

    R. Liechti1, R. Babst1, U. Hug1, B. C. Link1, B. van de Wall1, M. Knobe1, F. Beeres1 (1Luzern)

    Show text

    Objective

    Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation at a level I trauma centre in central Switzerland.

    Patients and Methods

    All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. Post-operative assessments included radiological, functional, and patient-rated outcomes at a minimum of 12 months follow-up.

    Results

    In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. The mean follow-up time was 14.5 months (range 12-24 months). SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion.

    Conclusion

    The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable bail out treatment option for complex DRFs in selected patients.

    FM9

    Total wrist Implant in complex distal radius fractures in the elderly

    I. Tami1, C. Mesoraca2, T. Giesen1 (1Gravesano; 2Neuchatel)

    Show text

    Introduction: Complex distal radius fractures with severe comminution and dislocation, reppesent a challenge for the hand surgeon, especially in the elderly. An osteoporotic bone on top, might be a critical factor influencing the stability of the fixation, often leading to questionable results. We present our primary experience with the immediate implantation of Motec total wrist implant in severely comminuted and displaced distal radius fractures in the elderly.

    Materials and Methods:

    From January 2020 to February 2021 we treated 7 distal radius fractures with a Motec total wrist implant. All patients were female with an average age of 79 years old (range 75-89). All sustained a distal radius fractures classified as C2 or C3. One patients had  a fracture classified as C2 but with a large depressed and damaged area to the radius cartilage. There were 5 right wrist and 2 left. All patients were active and independent with no major health problem. One patient was diabetic.

    Results: At 6 months follow up ( range 3-12) all patients recovered well. Prono-supination was substantially maintained and painfree in all cases. Average wrist extension was 42° (range 35°-60°) while average flexion was 50° ( 40°-70°). Jamar in position 2 gave an average strength of 78% of the controlateral wrist ( range 62%-85%). VAS was 1 (range 0-3) at rest. VAS under wrist load was 2 ( range 1-4). Maximum load observed was of 5 Kilograms. No major complications were observed. On patient required 4 months to fully recover wrist extension. In general wrist extension was the most difficult movement to recover. 

    Conclusion: As already largely accepted for other joints in the body, difficult fracture of the distal radius might benefit from an immediate total joint arthroplasty. The Motec implant seems to offer a reliable solution. Further studies and longer follow up might be required to better define indications.

     

    DISCLOSURE: No financial conflict of interest to disclose

    FM10

    Surgical Fixation Techniques in Four-Corner Fusion of the Wrist: A Systematic Review of 1103 Cases

    O. Andronic1, R. Labèr1, P. Kriechling1, D. Karczewski2, A. Flury1, L. Nagy1, A. Schweizer1 (1Zürich; 2Berlin DE)

    Show text

    Background: Four corner fusion (4CF) is a known treatment option for degenerative wrist conditions. Different techniques may be used and there is no general consensus on best implant. As such, it was the purpose of the current systematic review to compare fusion rates and outcomes depending on the fixation technique.

    Methods: The systematic review was registered in the international prospective register of systematic reviews (PROSPERO): CRD42020164301. It followed the PRISMA guidelines. Original articles were screened using the following databases: CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE and Web of Science Core Collection. Studies reporting on outcome for four-corner fusion surgery were included. Studies with a minimum Level IV of evidence were considered eligible. Quality assessment was performed using the MINORS (Methodological Index for Non-Randomized Studies) criteria.

    Results:  29 studies met the inclusion criteria, for a total of 1103 wrists. The mean age was 41.8 years (range 19-83). Mean follow-up overall was 43.5 months (range 24-146 months). Fusion weighted rates of 97% for K-wires, 94% for locking plates and 98% for non-locking plates. Reoperations occurred in 135 (12%) of all 1103 cases. Least reoperations occurred using K-wire fixation (10.4%) as opposed to locking plates (14.2%) or non-locking plates (11.7%).

    Conclusion: Satisfactory fusion rates can be achieved independent of the fixation technique used in 4-corner arthrodesis. In terms of reoperations, K-wires showed an overall lower reoperation rate compared to other techniques. 

    FM11

    Clinical, Radiological and Patient-Rated Outcome Comparison between Partial and Total Ulnar Head Implants

    L. Estermann1, L. Reissner1, A. Schweizer1, L. Nagy1 (1Zürich)

    Show text

    Introduction: Painlessness, motion and joint stability are crucial for a well-functioning distal radioulnar joint. The same requirements apply to the ulnar head prosthesis. The aim of this study was to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants.

    Material and Methods: 22 patients with 23 implants were available with a mean follow up time of 7 years after distal radioulnar joint arthroplasty. Patient-rated outcome measures by visual analog scale, PRWE and DASH questionnaire, range of motion measurements, radiographic examination and grip strength as well as pronation and supination torque were assessed.  Additionally, sonography was performed to quantify the instability of distal radioulnar joint.

    Results: Patients showed a low level of pain at rest and under load, a median DASH score and PRWE of 12 after implantation of a partial ulnar head prothesis, 20 and 22 after implantation of a total ulnar head prosthesis, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison to the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength as well as supination and pronation torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. The sonographically assessed instability of the distal radioulnar joint did not show any significant differences between the prostheses.

    FM12

    3D planned reconstruction of the distal radioulnar joint congruency of severe ulna minus variance

    L. Reissner1, L. Estermann1, A. Schweizer1 (1Zürich)

    Show text

    Introduction:

    Dysplasia of the distal radioulnar joint (DRUJ) and posttraumatic conditions may lead to symptomatic ulna minus variance. Until now, there is no evidence for treatment of ulnar dysplasia Swanson Grade I. By recent developments in computer-assisted surgery, the use of patient-specific instruments (PSI) has been described as a reliable method to accurately correct even complex malunions of the forearm. With a 3D planned radius corrective osteotomy a better DRUJ congruency could be achieved. The primary objective of this study is to describe our treatment approach to restore a congruent DRUJ. Furthermore, we analyzed postoperative pain, hand function, range of motion and grip strength.

    Method:

    All patients with a severe ulna minus who received a PSI guided osteotomy of the radius with a minimal follow up of 6 months were included. Based on three-dimensional computed tomography imaging data PSI were planned and produced to guide the osteotomy and further osteosynthesis. Subjective assessment was based on a visual analogue scale (VAS) for pain, DASH and PRWE score. Range of motion (ROM) and grip strength data were extracted from the documentation of the last follow up examination. Ulna variance values were measured by means of the method of perpendiculars.

    Results:

    10 patients with a mean age of 23 years received corrective osteotomies of the radius in order to address their ulna minus variance. The follow up examination took place on average 3.1 years after surgery (range 9 months - 5.7 years). On the VAS scale, the pain was 0 without load in five patients and 2-4 in the other five patients. In addition, DASH score was 24 and PRWE score 30. The mean active ROM of pronation and supination was 78/0/84° preoperative and 75/0/82° postoperative. The grip strength increased from mean 24 kg preoperative to 34 kg postoperative. The mean ulna variance was before surgery minus 6.2 mm (SD 2.7) and postoperative minus 0.5mm (SD 0.6).

    Conclusion:

    Our technique, based on 3D bone modelling and application of PSI, permitted to perform a precise osteotomy, that would have otherwise been difficult to treat using any of the few procedures described in the literature to date. Most patients showed nearly unchanged range of motion and an improved grip strength postoperative with no or moderate pain during rest and activity. We recommend 3D planned radius corrective osteotomy as an approach to manage symptomatic ulna minus variance.

     

    FM13

    Morphometrie der distalen Ulna im Hinblick auf das Prothesendesign

    P. Furrer1, L. Nagy1, A. Schweizer1, L. Reissner1 (1Zürich)

    Show text

    Soll bei der prothetischen Versorgung des distalen Radio-Ulnar-Gelenkes (DRUG) lediglich der Ulnakopf im Sinne einer Ulnakopf-Hemiprothese (UKHP) ersetzt werden, sollte das Implantat die ursprüngliche Anatomie weitestmöglich reproduzieren. Hierfür haben wir die, für das Design einer UKHP relevante Geometrie der distalen Ulna untersucht.

     

    40 Computertomogramme von gesunden Ulnae wurden segmentiert und in einem 3-D Programm bearbeitet: 4 Chirurgen haben in die distalen 7 cm der Markhöhle einen in der Grösse angepassten Zylinder, analog einem Prothesenschaft, eingepasst. Ein zweiter grössenvariabler paralleler Zylinder wurde um den gelenkbildenden Teil des Ulnakopfes angelegt. Gemessen wurden die Radii der beiden Zylinder sowie der Versatz der beiden Zylinderachsen bezüglich Abstand und Richtung.

     

    Der Radius der distalen Markhöhle betrug im Mittel (SD): 7.92mm (0.74); des Ulnakopfes: 2.89mm (0.42). Der Abstand der beiden Zylinderachsen war: 3.89mm (0.78); die Richtung des Offset: 8.63° Supination (15.28). Die Messungen der genannten Variablen waren sehr konsistent mit einer Interrater-Reliabilität von 0.93; 0.88; 0.82 und 0.90. Die Grössen der beiden Zylinder korrelierten statistisch signifikant zu 0.622 (Pearson).

     

    Eine möglichst anatomiegetreue UKHP sollte einen wesentlichen Versatz zwischen der Prothesen-Schaft-Achse und dem Prothesen-Kopf aufweisen. Dies dürfte eine Voraussetzung darstellen für die korrekte Spannung der ligamentären Stabilisatoren des DRUG: Der diversen Anteile der membrana interossea und im Fall einer partiellen Hemiprothese auch des belassenen TFC. Dies ist bei den erhältlichen UKHP’s nicht der Fall und womöglich die Ursache der häufigsten Komplikation – der DRUG-Instabilität.

    FM14

    SUPEXOR: implementing the ICHOM Hand and Wrist Conditions set in Switzerland

    M. Calcagni1, M. E. Gunning1 (1Zürich)

    Show text

    Introduction

    One of the biggest challenges of modern health systems is to truly put patients first. That requires measuring performance, listening to patients’ opinions and improving outcome and patients’ experience. In Switzerland there is no system to register outcomes measurements of treatments for hand and wrist conditions. Outcome measurements can control and improve treatment quality, catalyze communication and decision making between physicians and patients and build a research database, to be used for comparative research, health technology assessment and benchmarking between institutions.

    Aim of this project is to establish an outcomes registry in a pilot group of Swiss hand surgery institutions and to set the basis for a potential upscale at national level.

    Methods

    In 2020-2021, four Swiss hospitals built an outcomes registry based on existing software of Dutch medical engineers, using the newly developed Standard set for hand and wrist conditions by the International Consortium for Health Outcomes Measurement. Patients are risk stratified and divided over five tracks according to the type of problem to allow for optimal analysis. Treatment outcomes of hand and wrist conditions are entered by surgeons, therapists and patients in a multi-language registry to serve the needs of all stakeholders.

    Results

    The registry went live in the last quarter of 2020 and over 300 patients have been registered so far. It is too early to evaluate results and measure impact on patient care, but the first experience is positive. Semi-automatic track assignment and automatic emails are features that reduce clinician’s burden. Patient’s compliance has been growing during the first months of clinical use of the registry.

    Conclusion

    Establishing a quality registry is a big endeavor with risks and pitfalls, but with careful planning and a professional team it can be mastered successfully. The most important and challenging, is to convince and motivate physicians to engage in this project, not seeing it as a threat, but rather as an opportunity for improvement. Quality control, pay per performance and benchmarking are becoming reality and for physicians it is fundamental to stay on the cutting edge of these developments, keep the lead and advocate for themselves and their patients. Quality can only be improved if it is measured in a meaningful manner. In an outcomes registry, data are collected in a structured way, building value for all stakeholders involved.

  • 10:30 – 11:00

    Kaffeepause

  • 11:00 – 11:15

    Gartensaal 1 A-C

    Report Forschungsfonds

    M. Calcagni, Zürich (CH)

    Sessions SGH/SSCM

    Deutsch

    L1 Report

    S. Hirsiger, Bern (CH)

  • 11:00 – 12:30

    Gartensaal 2

    Freie Mitteilungen II

    B. Tobler, Bern (CH) / J. Busskamp, Basel (CH)

    Sessions SGHR/SSRM

    FM64

    Heimprogrammvideos in der Handtherapie – ein Schritt in die Zukunft

    D. Kuster1, K. de Cillia2 (1Zürich; 2Altstätten)

    Show text

    Heimprogramme sind ein essentieller Bestandteil für den Erfolg einer Behandlung in der Handtherapie und deren Instruktion ist eine wichtige Aufgabe der Therapeutinnen und Therapeuten. Verschiedene Faktoren wie Verständnisprobleme oder zu wenig Hilfestellungen für Patientinnen und Patienten können diesen Prozess erschweren.

    Der heutige technische Fortschritt und die gesellschaftlichen Veränderungen eröffnen neue Möglichkeiten. Auch im Gesundheitswesen werden wir immer öfters mit neuen Technologien konfrontiert. Das Medium Video wird in der Literatur häufig diskutiert. In der Handtherapie wird dem Einsatz von Videoanleitungen für Heimprogramm-Übungen grosses Potential zugeschrieben1.

    Die Suche nach Möglichkeiten, den Prozess der Instruktion von Heimprogramm-Übungen zu optimieren, hat uns als Handtherapeutinnen beschäftigt. Die Internetrecherche nach geeigneten Videoanleitungen, die unseren Anforderungen entsprechen, blieb erfolglos. Es gibt wenige Instruktionsvideos, welche von erfahrenen Handtherapeutinnen und Handtherapeuten produziert werden2.

    Im Rahmen des CAS Handtherapie haben wir literaturbasierte Guidelines zur Herstellung von Heimprogramm-Videos erarbeitet. Anhand dieser produzierten wir sechs Videos mit unterschiedlichen Übungen und setzten sie in der Praxis ein. Durch diesen Prozess konnten wertvolle Erfahrungen mit dem Medium Video gesammelt werden. Die Rückmeldungen der Patientinnen und Patienten und der Teammitglieder sowie unsere eigenen Erkenntnisse regten uns zum Reflektieren der Art und des Inhalts der Instruktion an. Infolgedessen haben wir die Produktion adaptiert und ein weiteres, umfassenderes Video erstellt.

    In der Präsentation möchten wir den Einsatz von Videoanleitungen in der Handtherapie dem Publikum näherbringen und unsere Erfahrungen dazu aufzeigen. Wir sind überzeugt, dass Videoanleitungen für Heimprogramm-Übungen zukünftig Erleichterung im Praxisalltag bringen werden.

    1 Ouegnin, A. & Valdes, K. (2019). Client preferences and perceptions regarding a written home exercise program or video self-modeling: A cross-sectional study. Journal of Hand Therapy. Published online January 21, 2019. DOI: https://doi.org/10.1016/j.jht.2018.09.006.

    2 Villafañe, J. H., Cantero-Tellez, R., Valdes, K., Usuelli, F. G. & Berjano, P. (2018). Educational Quality of YouTube Videos in Thumb Exercises for Carpometacarpal Osteoarthritis: A Search on Current Practice. Hand, 13(6), 715-719.

    FM65

    Home exercise program modalities in carpal tunnel release rehabilitation: handout or smartphone?

    P. Lorenzo1, S. Rosana2, F. Gaetano1, T. Ivan3 (1Mendrisio; 2Giubiasco; 3Gravesano)

    Show text

    Background

    It is common practice to recommend home exercise program after carpal tunnel release surgery. Usually, these exercises have been delivered in the way of written handouts with pictures. However, the possibilities offered by the use of the smartphones, can be valuable for both, therapists and patients. It is outstanding to discover the best modality, to maximise patient’s compliance in order to ensure the best outcome. The aim of this study is to investigate the patients’ preference between written handouts with pictures and videos recorded using their smartphone.

    Methods

    A cross-sectional study is conducted on patients who access at the rehabilitation facility after carpal tunnel release surgery. The day after surgery patients receive the written handout plus the instructions to record the same exercises using their personal smartphone. The patient is asked to perform the exercises one day in accordance to the written instructions and the day after by watching the videos recorded by themselves the first day. Concluded 10 days of program, a satisfaction evaluation form is delivered. No validated instruments have been found in the peer reviewed literature, therefore, it is necessary to create a standardized assessment tool. Regarding the evaluation scale set-up, the principles of customer satisfaction is used, especially the “Servqual” approach. The following domains are investigated: usefulness, comprehensibility, feasibility and motivation.

    Discussion

    The study is in progress with the currently inclusion of 25 patients. The data collection is expected by the end of August 2021 with the total enrolment of 30 patients. The data will be processed to find out which of the two modalities scored the highest value on the 4 items. It will then be possible to cross demographic data with preferences. Preliminary data shows that the smartphone application can be valuable in increasing adherence to the home exercise program.

    References

    Ouegnin A, Valdes K. Client preferences and perceptions regarding a written home exercise program or video self-modeling: A cross-sectional study. J Hand Ther. Jan-Mar 2020;33(1):67-72.

    Cole T, Robinson L, Romero L, O’Brien L. Effectiveness of interventions to improve therapy adherence in people with upper limb conditions: A systematic review. J Hand Ther. Apr-Jun 2019;32(2):175-183.

    Asuboteng P, McCleary K, Swan J. SERVQUAL revisited : a critical review of service quality. Journal Of Services Marketing. Dec 1996;10(6):62-81.

    FM66

    Nervengleitübungen als Heimprogramm

    E. Vola1, F. Flütsch1 (1Chur)

    Show text

    Wir haben festgestellt, dass die Instruktion von Nervengleitübungen in unserem Team unterschiedlich gehandhabt wird und unsere Heimprogrammblätter für Patienten keine Steigerungsmöglichkeiten enthalten. Im Rahmen unserer CAS-Arbeit haben wir die Blätter überarbeitet mit dem Ziel, für den N. medianus, den N. ulnaris sowie den N. radialis Übungen zu haben, welche Steigerungsmöglichkeiten enthalten. Zudem wollten wir das Team schulen, damit alle die Übungen einheitlich instruieren.

     

    Ausgehend von der Literatur und der Anatomie haben wir erarbeitet, wie die Nerven gleiten, bei welcher Bewegung die verschiedenen Nerven unter Spannung kommen und in welcher sie entlastet werden. Zudem wollten wir wissen, wann diese Übungen angezeigt sind und welche Kontraindikationen es gibt.

     

    Möglichkeiten für Übungen sind Slider und Tensioner. Slider sind Übungen, die Gleitbewe­gungen der Nerven gegenüber dem Umgebungsgewebe erzeugen, ohne viel Spannung oder Kompression aufzubauen (Shacklock, 2008). Beim Tensioner werden die Gelenke so positioniert, dass die Spannung auf den Nerv zunimmt.

     

    Lohkamp et al. (2018) empfehlen bei den Übungen am weitesten entfernt von der betroffenen Stelle zu beginnen, mit zweiseitigen Slidern über einseitige Slider hin zu einseitigen Tensioner und weiter zu zweiseitigen Tensioner.

     

    Aufgrund der unzähligen Möglichkeiten an Übungen haben wir uns für eine schematische Darstellung entschieden. Entstanden sind für die drei Nerven N. medianus, N. ulnaris und N. radialis je ein Blatt mit Slidern, die in ihrer Intensität aufeinander aufbauen. Für die Tensioner haben wir ein Blatt konzipiert, auf welchem die Bewegungsübungen problembezogen eingezeichnet werden können.

     

    Literaturverzeichnis:

    Lohkamp, M., Small, K., & Herrington, L. (2018). Neurodynamik (1. Aufl.). München: Elsevier.

    Shacklock, M. (2008). Angewandte Neurodynamik (1. Aufl.). München: Elsevier.

     

    FM67

    Die patientenspezifische Funktionsskala (PSFS) – ein wertvolles Assessment für die Handtherapie

    M. von Haller1 (1Zürich)

    Show text

    Einleitung: Der Einbezug der Perspektive des Patienten ist ein wichtiger Bestandteil einer klientenzentrierten Befundaufnahme und Behandlung (1). Die patientenspezifische Funktionsskala (PSFS) erfasst individuelle funktionelle Einschränkungen anhand von Aktivitäten, die vom Patienten definiert werden (2).

    Ziel: Evaluation der psychometrischen Eigenschaften der PSFS bei handtherapeutischen Patienten und Aufzeigen von Einsatzmöglichkeiten der PSFS in der Handtherapie.

    Methode: Systematische Literatursuche in medizinischen Datenbanken und Fallbeispiele aus der Praxis.

    Resultate: In den 9 inkludierten Studien zeigt die PSFS eine gute Reliabilität, Validität und Änderungssensitivität bei Patienten mit Verletzungen oder Erkrankungen der oberen Extremitäten, wie z.B. Morbus Dupuytren oder periphere Nervenverletzungen (3-5). Sie ist ein klientenzentriertes Instrument, das benutzerfreundlich und wenig zeitaufwendig ist, und auch für die individuelle Zielsetzung und Behandlungsplanung eingesetzt werden kann (6).

    Diskussion: Trotz guter psychometrischer Eigenschaften wird mehr Evidenz für den Einsatz der PSFS in der Handtherapie benötigt, insbesondere bezüglich einzelner Diagnosen und ihrer Anwendung in der Forschung.

     

    1. Bren L. The importance of patient-reported outcomes... it’s all about the patients. FDA Consumer. 2006 Dec 11;40(6):26–32.
    2. Stratford P, Gill C, Westaway M, Binkley J. Assessing Disability and Change on Individual Patients: A Report of a Patient Specific Measure. Physiotherapy Canada. 1995 Oct;47(4):258–63.
    3. Rosengren J, Brodin N. Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis. Journal of Hand Therapy. 2013 Jan;26(1):53–61.
    4. van Kooij YE, Poelstra R, Porsius JT, Slijper HP, Warwick D, Selles RW. Content validity and responsiveness of the Patient-Specific Functional Scale in patients with Dupuytren’s disease. Journal of Hand Therapy. 2020 Apr;S0894113020300405.
    5. Wright HH, O’Brien V, Valdes K, Koczan B, MacDermid J, Moore E, et al. Relationship of the Patient-Specific Functional Scale to commonly used clinical measures in hand osteoarthritis. Journal of Hand Therapy. 2017 Oct;30(4):538–45.
    6. Jolles BM, Buchbinder R, Beaton DE. A study compared nine patient-specific indices for musculoskeletal disorders. Journal of Clinical Epidemiology. 2005 Aug;58(8):791–801.

    FM68

    Eine Beugesehnen-Datenbank – Follow-up zu einem multizentrischen Forschungsprojekt

    V. Beckmann-Fries1, L. Schrepfer2, L. Hemelaers2, E. Oberfeld3, M. Calcagni1, B. Tobler-Ammann3 (1Zürich; 2Basel; 3Bern)

    Show text

    Einleitung: Im Jahr 2013 war eine Besprechung von Handtherapie Abteilungen aus drei Universitätsspitälern zur Nachbehandlung nach Beugesehnennaht der Auslöser, um ein gemeinsames Nachbehandlungsprotokoll zu definieren. Dies war der Start für eine intensive Zusammenarbeit mit dem Ziel, die Behandlungsergebnisse nach dieser Verletzung standardisiert zu erfassen, zu dokumentieren und analysieren.

    Ziel: Durch die Zusammenarbeit dreier grosser Kliniken in relativ kurzer Zeit über eine genügend grosse Anzahl Beugesehnendaten zu verfügen, um Aussagen über das Behandlungsergebnis und entsprechende Anpassungen in der Nachbehandlung machen zu können.

    Methode: In allen drei Handtherapien Abteilungen werden bei Patienten nach einer Beugesehnenverletzung klinische Messungen zu klar vorgegebenen Zeitpunkten durchgeführt. Für die gemeinsame Erfassung der Daten wurde eine Datenbank (REDCap) eingerichtet. Diese ermöglicht jederzeit allen Kliniken, unabhängig vom Standort, den Zugriff auf ihre Daten.

    Resultate: Diese Studie läuft seit 2014 und soll bis 2025 weitergeführt werden. Aktuell befinden sich die Daten von 308 Patienten mit 343 verletzten Langfingern und Daumen im Datenpool. 202 Männer (65.6%) konnten eingeschlossen werden, der Altersdurchschnitt aller Patienten liegt bei 36.6 Jahren (SD 13.6). Am häufigsten erfolgte die Verletzung in Zone 2 (n=205), gefolgt von Zone 1 (n=90) und Zone 3 (n=48). Bei 56.0% (n=192) aller verletzten Langfinger und Daumen wurde auch ein Digitalnerv chirurgisch versorgt. 96.1% (n=296) der Patienten wurden mit einer langen dorsalen Schiene versorgt, 3.9% (n=12) erhielten eine «Manchester Short Splint». Bei einem komplikationsfreien Verlauf (ohne Ruptur, CRPS oder Tenolyse) dauerte die Handtherapie durchschnittlich 19.1 Wochen (SD 9.3). Wurde später eine Tenolyse durchgeführt, lag die Therapiedauer bei 23.3 Wochen (SD 13.2) und bei einem begleitenden CRPS bei 29.7 Wochen (SD 10.0).

    Praxisrelevanz: Es ist wichtig, Ergebnismessungen nach Verletzungen oder bei Erkrankungen an der Hand standardisiert und zu vorgegebenen Zeitpunkten zu erfassen (Selles et al. 2020). Dies erlaubt eine qualitativ hochwertige Überprüfung des Behandlungsergebnisses, bietet die Grundlage für Verbesserung und ist eine Chance für einen fokussierten Austausch zum Thema.

    Selles RW, Wouters RM, Poelstra R, et al. Routine Health Outcome Measurement: Development, Design, and Implementation of the Hand and Wrist Cohort. Plast Reconstr Surg. 2020;146(2):343-354.

    FM69

    The consensus Wrist Index (CWI), an Outcome Tool for Interdisciplinary Use 

    S. G. Ewald1, E. Vögelin2, R. Wollstein3 (1Zürich; 2Bern; 3New York US)

    Show text

    Introduction: The consensus wrist index (CWI) is an interdisciplinary outcomes visualization tool relevant for surgeons and therapists. It was developed following an interdisciplinary wrist outcome meeting in 2018. Following the second revision in 2019, it has been available to clinicians for use in practice.

    Method / Aims: The CWI combines existing and established assessments to create an overall picture of the patient’s functional situation. It includes objective measurements: grip strength and range of motion, and patient-rated outcome measures: Patient-Specific Functional Scale (PSFS), Patient Rated Wrist and Hand Evaluation (PRWHE), the Single Answer Numeric Evaluation (SANE), and the work module of the Michigan Hand Questionnaire (MHQ).  Following data collection, the data is input into an excel file. All data points are equally weighted and visualized on a spider diagram, which can accommodate 3 points in time. It takes about 10 minutes to input data into the Excel file and generate the resulting graphic. Case examples demonstrating the use of the tool in practice will be discussed.

    Conclusion: The CWI is a new tool that can assist clinicians and patients in the visualization of multiple aspects of a wrist condition. The tool goes beyond objective measurements and incorporates patients’ specific priorities and needs to gain a comprehensive picture of the situation. It generates a visual representation of outcomes; this is advantageous as multiple domains are viewed in a single diagram. The CWI provides a foundation for discussing the status, progress, and possible further interventions with patients and other clinicians. It can be utilized, in patients with injuries that are treated conservatively to monitor progress, prior to surgery to measure pre- /post-surgical outcomes or following surgery to track progress.  A feasibility study is underway, and we would welcome input from clinicians that have used the CWI in their clinical practice.

    Example of CWI
  • 11:15 – 12:30

    Gartensaal 1 A-C

    Hauptsession I

    In sport, everything revolves around the hand…

    I. Tami, Gravesano-Lugano (CH) / T. Hauri, Bern/Zürich (CH)

    Joint Sessions

    JS1

    English

    Introduction

    I. Tami, Gravesano-Lugano (CH) / T. Hauri, Bern/Zürich (CH)

    JS2

    English

    Managing athletes in fighting sports

    L. Pegoli, Milano (IT)

    JS3

    English

    Teamwork in managing athletes

    G. Matera, Milan (IT)

    JS4

    English

    Complex bilateral wrist injuries in mountain biker: case report

    R. Lucchetti, Rimini (IT)

    JS5

    English

    Resistance training in rehabilitation

    S. Küng, Zürich (CH)

    English

    Discussion and take home message

    L. Pegoli, Milano (IT) / I. Tami, Gravesano-Lugano (CH) / T. Hauri, Bern/Zürich (CH)

  • 12:30 – 13:45

    Stehlunch – Begegnung in der Ausstellung

  • 12:45 – 13:30

    Gartensaal 1 A-C

    Mittags-Symposium 1

    Diversität – eine handchirurgische Annäherung

    Vernetzung im World Café

    Symposium

  • 12:45 – 13:30

    Gartensaal 2

    Mittags-Symposium 2

    NanoScope

    Dr. med. Mischa Wiegand, Facharzt für Chirurgie FMH, Handchirurgie FMH

    Symposium

  • 13:30 – 15:00

    Vortragssaal 2

    Workshop 1

    P. Kammermann, Bern (CH) / I. Cianci, Affoltern am Albis (CH)

    Sessions SGHR/SSRM

    WS1

    Deutsch

    Sugar Tong Schiene für TFCC Verletzungen – unser Schienenmodell

    T. Hauri, Bern/Zürich (CH) / M. Löffel, Zürich (CH)

    Mit freundlicher Unterstützung: 3M (Schweiz) GmbH, Rüschlikon / Orthopartner AG, Niederlenz

    Show full description

    Es gibt verschiedene Schienenarten für die Behandlung von TFCC Verletzungen. Alle haben das Ziel die Pronation und Supination des Vorderarms zu verhindern oder limitieren. Eine mögliche Schiene dabei ist die Sugar Tong Schiene. Unsere Sugar Tong Schiene ist leicht modifiziert und wird aus Scotchcast hergestellt. Die Schiene wird von unseren Patienten gut toleriert.

    In unserem Workshop geben wir einen kurzen Überblick über verschiedene Schienenmodelle für die Behandlung von TFCC Verletzungen und zeigen unser Model. Wir demonstrieren die Herstellung dieser Schiene und leiten die Teilnehmer an eine eigene Schiene herzustellen (siehe Bild unten)

  • 13:45 – 15:00

    Gartensaal 1 A-C

    Hauptsession II

    Tetrahand surgery

    S. Koch-Borner, Nottwil (CH) / S. Schibli, Nottwil (CH)

    Joint Sessions

    JS6

    English

    Mobility and stability

    J. Fridén, Nottwil (CH)

    JS7

    Deutsch

    Muscle excitability – refined diagnostics

    S. Koch-Borner, Nottwil (CH)

    JS8

    Deutsch

    Grasp and release - advanced surgical options

    S. Schibli, Nottwil (CH)

    JS9

    Deutsch

    Motor relearning strategies

    K. Schmuck, Nottwil (CH)

    JS10

    Deutsch

    Patient perspective

    A. Pallaver, Nottwil (CH)

    JS11

    Deutsch

    Across boundaries

    S. Schibli, Nottwil (CH)

  • 15:00 – 15:15

    Kurze Pause ohne Verpflegung

  • 15:15 – 15:25

    Gartensaal 1 A-C

    Report Claude Verdan travelling fellowship

    N. Zechmann-Müller, Winterthur (CH)

    Sessions SGH/SSCM

    Deutsch

    L2 Report

    C. Bouvet, Genève (CH)

  • 15:25 – 16:30

    Gartensaal 1 A-C

    Special Session

    Ohne Passion – keine Veränderung

    E. Bodmer, Luzern (CH) / C. Struchen, Luzern (CH)

    Joint Sessions

    JS12

    Deutsch

    Einführungsreferat: 4 Generationen – wie beeinflusst der Wertewandel die Handchirurgie und die Ergotherapie

    E. Bodmer, Luzern (CH) / C. Struchen, Luzern (CH)

    JS13

    Deutsch

    Neue Generationen – veraltete Strukturen

    F. Höpflinger, Horgen (CH)

    JS14

    Deutsch

    Passion Gleichstellung als Motor der Veränderung

    S. Banos, München (DE)

    JS15

    Deutsch

    «No news, good news» war gestern: warum Generation Y eine neue Führungskommunikation braucht

    S. Heuss, Olten (CH)

    Deutsch

    Diskussion

  • 16:30 – 17:00

    Kaffeepause

  • 17:00 – 18:30

    Gartensaal 1 A-C

    Mitgliederversammlung SGH

    Sessions SGH/SSCM

  • 17:00 – 18:30

    Gartensaal 2

    Mitgliederversammlung SGHR

    Sessions SGHR/SSRM

  • 19:30 – 22:00

    Gemeinsamer Festabend