Programme scientifique : Jeudi, 24 novembre

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08:45 – 09:15
Schadausaal
Sessions SSCM/SSRM

Ouverture conjointe

Maurizio Calcagni, Zürich , Patricia Kammermann, Bern , Stéphanie Rosca-Furrer, La Chaux-de-Fonds

  Gabrielle Obrist, Zürich

«Handzeichen – von der Qualität der Geste in der Kunst»

Gabrielle Obrist1 (1Zürich)

Details
09:30 – 10:30
Schadausaal
Sessions SSRM

Communications libres I

Fimke Donati, Locarno , Esther Bohli, Biel
FM60

Einfluss von Schmerz und Nervenverletzung auf das Ergebnis nach Beugesehnenverletzung (Zonen 1-2)

Vera Beckmann-Fries1, Maurizio Calcagni1, Lorena Schrepfer2, Alexandre Kaempfen2, Esther Vögelin3, Bernadette Tobler-Ammann3 (1Zürich; 2Basel; 3Bern)
Details

Introduction: Jusqu’à présent, peu d’études, ou des études contradictoires, ont été consacrées à l'influence de la douleur au repos (PAR*) et lors de la mobilisation (MEP**) ainsi que lors d’une lésion nerveuse supplémentaire sur le résultat du traitement après l’atteinte du tendon fléchisseur d’un doigt long. L’expérience pratique montre que ces deux paramètres peuvent avoir une influence sur le processus thérapeutique et, par conséquent, sur le résultat du traitement. 

Objectif: L’objectif de cette étude était de documenter (I) l’évolution de la PAR et de la MEP ainsi que (II) l’influence d’une lésion nerveuse supplémentaire. En outre, nous nous sommes intéressés à la mesure dans laquelle (III) la prise d’analgésiques, (IV) la mobilité active des doigts (aROM), (V) la capacité fonctionnelle autodéclarée (DASH) et (VI) la satisfaction étaient influencées par la PAR et la MEP et/ou par une lésion nerveuse supplémentaire.

Méthode: Les données de cette étude proviennent du registre suisse des tendons fléchisseurs qui ont été recueillies entre 2014 et 2020 durant les séances de thérapeutes de la main venant de trois hôpitaux universitaires. La douleur a été évaluée après 1, 2, 3, 6, 13, 26 et 52 semaines à l’aide de l'échelle visuelle analogique (EVA).

Résultats: Déjà lors de la semaine 1, les patients rapportaient une PAR nulle ou légère (avec lésion nerveuse, valeur moyenne 1.54, écart-type [2.10], sans : 1.46 [1.93]) et n’ont plus ressenti de douleur par la suite. La MEP était modérée à la semaine 1 (avec lésion nerveuse 3.22 [2.65], sans 3.27 [2.24]) et s'est réduite à une douleur légère après trois mois. Une lésion nerveuse supplémentaire n’a eu aucune influence statistiquement significative sur la PAR ou la MEP. 79% des patients avec une lésion nerveuse et 69% de l’ensemble des patients ont pris un traitement antidouleur au cours de la première semaine post-opératoire ; après 13 semaines, ils n’étaient plus qu’une minorité. Quand la MEP augmentait d’un point à la semaine 6, l’aROM diminuait en moyenne de 6.6°, en revanche elle était améliorée de 17.3° quand il n’y avait pas de lésion nerveuse. A la semaine 13, quand la MEP augmentait d'un point, le score au DASH était également plus haut de 2.1 points, mais était toutefois inférieur de 4.6 points quand il n’y avait aucune lésion nerveuse. La satisfaction des patients était significativement influencée par la MEP aux semaines 13 et 26 : une réduction d’un point entraînait une augmentation de 0.5 point sur l'échelle de satisfaction (0-10) aux semaines 13 et 26 et de 0.6 point à la semaine 52.

Pertinence pratique: La PAR n’a eu aucune influence significative sur les résultats du traitement. Par conséquent, son relevé en postopératoire ne peut pas être recommandé. En revanche, la MEP devrait être systématiquement recueillie et surveillée.

Note de la traductrice :

* pain at rest
** movement evoked pain

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FM61

Relative Motion Flexion: ein weiteres Beugesehnen-Nachbehandlungsschema - Top oder Flop?

Tamara Hauri1, Bernadette Tobler Ammann1, Esther Vögelin1 (1Bern)
Details

Contexte : L’application du schéma Relative Motion Extension (RME) a été établie pour le traitement post-opératoire d’une lésion d’un tendon extenseur en zones V-VI.

En 2020, une première série de cas avec l’utilisation du protocole de traitement en Relative Motion Flexion (RMF) après la suture d’un tendon fléchisseur en zones I-II a été publiée. Elle montrait des résultats prometteurs en termes de mobilité et les patients ne présentaient ni contracture en flexion PIP ni rupture. La publication d'une étude anatomique a permis d’en démontrer la faisabilité biomécanique.  

Objectif : L’objectif de cette présentation est de décrire le schéma RMF pour le traitement post-opératoire des lésions des tendons fléchisseurs en zones I-II et de l’accompagner des premiers résultats cliniques.

Méthodologie : Tout d’abord, le protocole de traitement a été élaboré d’après la littérature actuelle et résumé dans un guide d’instructions aux thérapeutes et un programme d’exercices à domicile. Ensuite, il a été cliniquement testé sur des patients appropriés souffrant d’une suture primaire d’un tendon fléchisseur en zones I-II. La fonction des doigts concernés a été mesurée après 6 et 13 semaines. La mobilité, la force de préhension, la satisfaction et les limitations quotidiennes ont été enregistrées. Les complications ont été documentées.

Résultats : Jusqu’à présent, quatre patients ont été traités d’après le schéma RMF. Il s’agissait de quatre hommes âgés en moyenne de 36 ans. Deux blessures étaient en zone I et deux en zone II. L’index et l’auriculaire étaient touchés deux fois chacun.

Après six semaines, les patients avaient un score d’amplitude de mouvement actif (TAM = flexion/extension PIP + flexion/extension DIP) de 85° et, après 13 semaines, de 117.5°. Le déficit d’extension de PIP s’est rétabli de 3.7° (6 semaines) à 0° (13 semaines). Les patients avaient un niveau de satisfaction à 8/10 après 13 semaines de traitement. Au même moment, les patients avaient récupéré 69% de la force de préhension, avec une moyenne de 31 kg, en comparaison avec la main non lésée. Le score au DASH était de 7.5 points après 13 semaines. Les patients ont bénéficié en moyenne de 13.5 séances de thérapie pendant les 13 premières semaines et de 14.5 séances jusqu’à la fin du traitement. Aucune rupture n'est à mentionner.

Pertinence pratique : Les premiers résultats cliniques concordent avec les expériences retrouvées dans la littérature. Grâce à l’utilisation précoce de la main concernée, le déficit d’extension de PIP ainsi que la force de préhension se sont déjà très bien rétablis après 13 semaines. Cela montre que le schéma RMF fonctionne, qu’il est sûr et « top » lors d’une lésion en zones I-II chez des patients sélectionnés avec soin.

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FM62

Conservative management of closed mallet finger injuries and creation of a dépliant for patients.

Claudia Moreyra Burga1 (1Locarno)
Details

Background Mallet finger is a traumatic injury of the extensor tendon in Zone 1. Closed injuries could be an extensor tendon tear or tendon avulsion with a bony fragment. Patients are unable to actively extended the distal interphalangeal joint (DIPJ). Conservative treatment is the most common choice. It involves full-time DIPJ immobilization using a static splint in slight hyperextension for about 6-8 weeks. Due to the long time frame, patients should receive comprehensive instructions to avoided complications, such as dorsal skin maceration, extensor lag and pain. The aim of this project is to create a dépliant for patients to avoid common complications and to summarize the recent treatment methods for hand therapists.

Methods A literature review was done on the current diagnosis, management and splinting of mallet finger injuries, focusing on a conservative approach.

Results Compliant patients were more likely to have a good outcome (i.e. 0°-10° extension deficit, full flexion, no pain) than noncompliant patients. Leaflets with comprehensive instructions could avoid skin complications. Nevertheless, they are not sufficient to improve patients’ compliance. Weekly follow-ups are required too. Custom-made thermoplastic splints were less likely to result in complications. Edema and patients’ age are correlated with an increase in extensor lag.

Conclusions For the creation of the flyer it is necessary to consider that patients may have difficulties understanding their medical condition and writing instructions. This could lead to poor results. Maintaining a weekly therapy session during the immobilization period can improve patients’ compliance. 

Khera, B., H., et al. (2021). An overview of mallet finger injuries, Acta Biomedica Atenei Parmensis, 92(5): 1-5. DOI: 10.23750/abm.v92i5.11731

O’Brien, L., J., & Bailey, M., J. (2011). Single blind, prospective, randomized controlled trial comparing dorsal aluminum and custom thermoplastic splints to stack splint for acute mallet finger, Archives of physical medicine and rehabilitation, 92:191-198. doi:10.1016/j.apmr.2010.10.035

Roh, Y., H., et al. (2016). Effects of health literacy on treatment outcome and satisfaction in patients with mallet finger injury, Journal of hand injury, 29: 459-464. http://dx.doi.org/10.1016/j.jht.2016.06.004

Salazar Botero, S., et al. (2016). Review of acute traumatic closed mallet finger injuries in adults, Archives of plastic surgery, 43: 134-144. http://dx.doi.org/10.5999/aps.2016.43.2.134

 

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FM63

Vibration- Die Lösung bei Verklebungen?

Eliane Hofman Wagner1, Tamara Hauri2 (1Bern; 2Zürich)
Details

Contexte: En 2017, la publication d’une étude traitait de l’utilisation des vibrations comme méthode thérapeutique en cas d’adhérences suite à la lésion d’un tendon fléchisseur en zone V. Lors d’un échange professionnel, deux exemples de patients dont les adhérences ont pu être traitées grâce à l’utilisation des vibrations dans leur travail nous sont venus à l’esprit. La question s’est posée de savoir si les vibrations étaient une méthode de traitement des adhérences qui, jusqu’à présent, n’a été que trop peu utilisée en thérapie de la main.

Objectif: L’objectif de cette étude de cas est de vérifier l’utilisation des vibrations sur les adhérences après une blessure de la main.

Méthodologie: Les patients présentant des adhérences suite à une blessure de la main ont utilisé des vibrations de 20-30 Hz pendant 5 minutes après avoir été autorisés à porter une charge complète. Les vibrations ont été appliquées en s’appuyant sur une plaque vibrante. Cette méthode a été répétée au cours de plusieurs séances de thérapie.

La mobilité a été mesurée avant et après le traitement. De plus, la mesure au Jamar a été enregistrée et les patients ont été questionnés sur l’utilisation de la méthode thérapeutique par vibrations.

Résultats: Jusqu’à présent, quatre patients ont été traités à l’aide des vibrations. L’expérience subjective des patients a été tout à fait positive. Ils ont fait état de cicatrices plus souples et d’une commande plus simple et plus directe.

Les résultats objectifs varient fortement. Chez deux patients, la mobilité s’est améliorée grâce à l’application des vibrations en combinaison avec d’autres méthodes thérapeutiques. Certains patients ont montré, directement après le traitement, une meilleure force de préhension. Les mesures au Jamar étaient 5% supérieures immédiatement après le traitement.

Chez deux patients présentant de très fortes adhérences, aucune amélioration de la mobilité n’a pu être mise en évidence. Les cicatrices étaient cependant clairement plus souples au cours du temps.

Pertinence pratique: L’effet des vibrations ne peut pas être démontré à travers cette série de cas. Cependant, quelques patients ont présenté des résultats positifs, ce qui montre l’importance d’une évaluation de cette méthode.

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09:30 – 10:30
Lachensaal 1
Sessions SSCM

Communications libres I A

Quality and Assessment

Sebastian Günkel, Solothurn, Dominique Merky, Bern
FM1

Lebensqualität und Arbeitsbedingungen von Schweizer Handchirurg:innen – eine nationale Befragung

Léna Dietrich1, Tatjana Pastor1, Esther Vögelin1 (1Bern)
Details

Einleitung. Die qualitativ hochstehende Versorgung von Patient:innen in der Handchirurgie ist alltägliches Bestreben. Doch wie steht es um die Lebensqualität der Handchirurg:innen, die diese hohe Qualität tagtäglich gewährleisten. Ziel dieser Arbeit ist es, die Lebensqualität und die Arbeitsbedingungen von Schweizer Handchirurg:innen zu evaluieren.

Methodik. Wir etablierten eine nationale Befragung. Die Umfrage wurde durch die Schweizerische Gesellschaft für Handchirurgie und die Vereinigung der Jungen Handchirurg:innen via E-Mail versendet. Via Zugangslink konnte online der standardisierte Fragebogen anonym ausgefüllt werden. Kernthematik waren Arbeitsumstände, Lebensqualität und die Zufriedenheit mit dem Beruf sowie Aspekte des Privatlebens. Die Daten wurden als uni- und multivariable Modelle ausgewertet.

Resultate. Es konnten ca. 250 Handchirurg:innen angeschrieben werden. Mit 110 vollständig ausgefüllten Fragebögen ergab sich eine Rücklaufquote von 44%. Die Befragten sind überwiegend männlich (58%). 93% aller Befragten sind in einer Partnerschaft, 71% haben Kinder und 9% sind Raucher:innen. 43% geben an, dass sie 4-7 Tage pro Monat Bereitschaftsdienst haben. Demgegenüber stehen 9%, die nie Bereitschaftsdienst haben. Die wöchentlichen Arbeitsstunden und Dienste haben einen negativen Einfluss auf die Lebensqualität. Mehr als 50% der Befragten fühlen sich auch während den Ferien/Freizeit durch den Beruf gestresst. 88% fühlen sich durch das Umfeld verstanden und unterstützt. 85% haben das Gefühl, dass die Arbeit private Beziehungen beeinflusst. 83% würden erneut die Fachrichtung Handchirurgie wählen.

Schlussfolgerung. Die Lebensqualität von Schweizer Handchirurg:innen ist im Allgemeinen überwiegend sehr gut. Dennoch ist der Beruf Handchirurg:in in der Schweiz stressig und beeinträchtigt die Lebensqualität. Die Rate an chronischer Erschöpfung, Burnout und Depression ist ähnlich hoch wie in der Literatur für andere chirurgische Fächer angegeben. Die Mehrheit der Befragten gibt an, dass eine Stelle an einem Akutspital für Handchirurgie durch weniger Dienste und/oder eine bessere Entschädigung der Arbeitszeit und der Dienste für sie attraktiver würde.

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FM2

How do scientific registries improve quality in hand surgery?

Sara Neumeister1, Daniel B. Herren1, Stephan Schindele1, Miriam Marks1 (1Zürich)
Details

Background: Despite the recognition of the importance of routine measurement of clinical outcomes in healthcare, the implementation remains a challenge. This article describes the framework by which the authors have created and implemented multiple registers for the routine measurement of patient outcomes in hand surgery. In addition, we discuss how this highly automated data collection infrastructure promotes a high coverage rate and provides an essential foundation for meaningful scientific data analyses and publications.  

Methods: In the registries, baseline data as well as clinical and patient-reported outcomes are documented at 6 weeks, 3 months, 1, 2, 5, and 10 years postoperatively. For this purpose, the secure and web-based application REDCap (Research Electronic Data Capture) is used, supported by a database for the routine monitoring created on Filemaker Pro Advanced, which is automatically and periodically updated with new data from the clinic information system. Data collection and completeness of data is dealt with by the study assistant, while the research assistant is responsible for data management. In addition, the participation of the surgeons as well as the secretaries is essential. Both the setup of the registers as well as the data analysis are approved by the Cantonal Ethics Committee. All patients with an arthroplasty of the proximal interphalangeal (PIP), the metacarpophalangeal (MCP) or thumb carpometacarpal (CMC I) joint and patients with an individual patient-specific implant (IPS) for corrective osteotomy are recorded in separate scientific registries.

Results: The coverage rate of all our registries is 100%, meaning that no patient was missed. Our biggest and oldest registry covering PIP joint arthroplasties includes 743 patients. We may report a follow-up rate two and five years postoperatively of 96% and 95%, respectively. The registry containing 236 CMC I prostheses also shows a follow-up rate of 96% one year and 93% two years postoperatively. Furthermore, this collection of scientific data has led to the publication of more than 15 peer-reviewed articles in international journals since the start of the registries.

Conclusion: Although the maintenance of registries requires resources and manpower, the recording of essential clinical data in registries serves as a strong foundation for scientific publications, for the improvement of the quality of patient care as well as to tackle various scientific questions.  

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FM3

Increasing patient service in hand surgery through video consultation

Sara Neumeister1, Caroline Krefter1, Daniel B. Herren1, Stephan Schindele1, Miriam Marks1 (1Zürich)
Details

Introduction: While video consultation is widely accepted and integrated in the service of many health care providers, no studies have yet been conducted regarding patient satisfaction with video consultation in hand surgery. The aim of this project was to evaluate patient satisfaction with video consultations in elective hand surgery using a self-developed patient questionnaire.

 

Methods: All patients attending video consultation by a hand surgery consultant since March 2022 were included in this study. Patients were offered video consultation either for the initial assessment of unspecific hand complaints or as a postoperative follow-up in case the patients were free of any complications. After the video consultation, patients received a survey in which they noted sociodemographic data and rated their experience and satisfaction with the video consultation.

 

Results: Until May 2022, 37 patients with a mean age of 53 years (range 17-81) were included. Patients had different education levels ranging from vocational training to doctoral degrees. Eighteen patients had a first consultation and 19 a postoperative follow-up. The most frequent reasons for attending video consultation were recommendation of the surgeon (n=16), travel time savings (n=10) or reduced waiting time until the first appointment (n=10). Most frequent diagnoses of the postoperative consultations were total joint replacement arthroplasties (n=4), carpal tunnel release (n=3) and joint arthrodeses (n=3). Of all patients 95% (n=35) were satisfied or very satisfied with the video consultation in general. While 31 patients would consider a video consultation again, 4 patients would prefer an in-clinic appointment. Two patients were dissatisfied, one because the symptoms could not be clarified completely, the other criticized the video and sound quality. Furthermore, both had a foreign language as their mother tongue.

 

Discussion: Video consultation in hand surgery seems to be a valuable additional offer to in-clinic appointments, given that the internet speed and the video and audio quality are sufficient. The service is appreciated by patients for time savings and less waiting time. Patients were satisfied with this procedure regardless of their age or education. However, for patients who are not native speakers, a video consultation might not be optimal. The project is on-going, and data of more patients will be presented.  

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FM4

In vivo Motion Analysis of Translational Motion of the Proximal Radioulnar Joint in Forearm Rotation

Andreas Weber1, Andreas Schweizer2 (1Zürich; 28008 Zürich)
Details

INTRODUCTION

It is well known that pronation and supination of the forearm leads to a physiological dorso-palmar shift in the distal radioulnar joint (DRUJ). However, little is known about the translational movement in the proximal radioulnar joint (PRUJ) during pronation and supination.

Therefore, the primary objectives of this study are to demonstrate the existence of an anterior-posterior translation in the PRUJ, its degree, and directionality during forearm rotation based on an in vivo motion analysis.

 

METHODS

This study recruited 15 healthy adult volunteers with no reported history of pathology that might affect the rotational movement of the forearm. Each participant underwent an ultra-low dose computed tomography (ULD-CT) of both forearms in neutral position, pronation, and supination. Bilateral 3-dimensional surface models of the radius and ulna were generated from the ULD-CT slides by segmentation of the bones in the image data. The models were then superimposed on each other, the axis of rotation was determined, and the degree of dorso-palmar translation of the radial head center was measured.

 

RESULTS

Fifteen volunteers (7 females, 8 males) with a mean age of 34 years (Range: 26-55 years old) were included in the study. Study participants were right-handed in 73% (11/15) and left-handed in 27% (4/15). In all participants, an anterior translation of the radius in the PRUJ during supination was found and posterior translation during pronation was observed. The mean anterior-posterior shift was 2.5 mm (Range: 0.4 mm – 4.4 mm) on the right side and 2.6 mm (Range: 0.9 mm – 5.5 mm) on the left side.

 

DISCUSSION & CONCLUSION

Overall, our results indicate that an anterior-posterior translation during forearm rotation exists in the proximal radioulnar joint (PRUJ) with a posterior shift of the radial head in pronation and an anterior shift in supination.

These in vivo analyzed findings contradict the previous studies describing translational motion in the PRUJ. This finding re-defines specific aspects of the complex spatial relationship between the radius and ulna during forearm rotation.

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FM5

How can registry data be further leveraged and what are the benefits for doctors and patients?

Michael Oyewale1, Daniel B. Herren1, Stephan Schindele1, Miriam Marks1 (1Zürich)
Details

Background: Despite the many clinical registries in healthcare, only a fraction of the data is effectively being used to improve clinical processes and outcomes in many cases. We describe the framework by which registries can be further used to support decision-making or patient-doctor communication during consultations.

Methods: Patient-reported data is collected using the secure and web-based application REDCap (Research Electronic Data Capture) with which questionnaires can automatically be distributed to patients. Patient-reported and clinical outcomes are documented preoperatively, on the day of surgery, and 6 weeks, 3 months and 1, 2, 5, and 10 years postoperatively.

REDCap data along with demographic and clinical data from the clinic information system is forwarded to a data warehouse, which serves as a rich data source for various research activities or clinimetrics. Moreover, the data is integrated into the workflow of health professionals via a visualization platform built on Microsoft PowerBI, allowing clinicians to have direct access to individual patient outcomes during consultations.

Results: Over 12 years, 4 registries of the hand surgery departments have been regularly managed at our clinic. Approximately 3000 questionnaires have been filled out by patients for over 1'000 surgeries. Last year, the coverage rate of all registries was 100%, meaning that no patient that should have been recorded was missed across all our registries.

Currently, for patients with implant arthroplasty at the first carpometacarpal joint, our hand surgeons have the possibility to visualize individual patient data in relation to the patient's cohort (Figure 1). Besides expanding this functionality to all registries, we are currently working on implementing decision-support tools such as e.g., goal-setting instruments, prediction models or clinical alert systems into the same platform.

Conclusion: By visualizing individual outcome data relative to other patients, both the patient and the clinician are provided with a reference to discuss treatments and their outcomes. Future developments intend to further improve clinical care and aid doctors in their decision-making.

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FM6

Is hand therapy dispensable after fixing P1 fractures – plate versus screw osteosynthesis?

Kaspars Silins1, Luzian Haug1, Esther Vögelin1 (1Bern)
Details

Introduction

Proximal phalangeal fractures (P1) account for approximately 10% of all fractures. Displaced and unstable fractures require a surgical treatment. During the healing period, adhesions between the fractured bone and the adjacent soft tissue contribute for limited total active range of motion (TAM). Hand therapy is important after operative treatment of fractures to counteract stiffness of the joints. We compare the clinical results of plate osteosynthesis versus intramedullary screw osteosynthesis applying a rehabilitation protocol.

 

Materials and methods

Between February 2017 and March 2020, 29 patients with 31 comparable fractures of the proximal phalanx that were treated either with a plate (14) or with minimal invasive cannulated compression screw (17). The mean age of the patients was 46 years (16-82).  All the patients received a rehabilitation-protocol with initial splinting, followed by early active mobilization. The number of sessions were documented. Total active range of motion (TAM), work disability, Pain, strength, and QuickDASH score were assessed. Level of significance was set at p<0.05. A power analysis was performed with power target of 0.8.

 

Results

All patients attended hand therapy postoperatively. The screw group attended an average of 10 sessions compared to the plate group with 21 sessions (p=0.02, power 0.94). The TAM was 41° worse in the plate group prior to the plate removal compared to screw group with a TAM of 205° versus 246° (p=0.02, power 0.99). After plate removal the TAM in the plate group was 227° with a difference of 22° (205°) not reaching statistical significance (p=0.32, power 0.38). The extension lag difference of 13° between both groups prior to plate removal and 12° after plate removal was statistically significant (p=0.01/p=0.03, power 0.99).

In the screw group, sick leave was 5.6 weeks compared to 9.9 weeks in the plate group (p=0.05, power 0.97). There were no statistically significant differences in pain, strength and QuickDASH score.

 

Conclusion

Hand therapy is important after surgery of proximal phalangeal fractures. The chosen method of fixation, plays a significant role in the outcome of the TAM and the amount of needed hand therapy sessions.

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FM7

3D motion analysis of the wrist and finger joints in rock climbing

Micha Schneeberger1, Gabriella Fischer1, Andreas Petter1, Maurizio Calcagni1, Andreas Schweizer1, Lisa Reissner1 (1Zürich)
Details

Purpose: This study aimed to describe the joint movements during rock climbing using an optoelectronic motion capture system and to investigate the practicability of this method.

Methods: One higher elite, eight elite and two advanced level rock climbers performed climbing moves on handholds instrumented with self-developed load cells collecting kinetic data, that were used to determine the holding phase. An optoelectronic motion capture system (VICON®) simultaneously recorded the movements of the finger joints and wrists. Measurements were performed for three common grip positions in rock climbing (crimp, half-crimp and open-hand grip). Kinematic data was analysed using Matlab®.

Results: Marker visibility was best for the open-hand grip and for the more proximal joints. During the holding phase, mean left ring finger proximal and distal interphalangeal (PIP, DIP) joint angles were 86° (SD 2.3°) and -16° (SD 1.9°) for the crimp grip, 66° (SD 2.1°) and -7° (SD 1.8°) for the half-crimp grip and 27° (SD 3.8°) and 19° (SD 3.3°) for the open-hand grip, respectively. The wrist joint was extended between -37° (crimp) and -10° (open hand). During the holding phase, joints moved within a range of maximally 14° for the crimp and the open-hand grip and 12° for the half-crimp grip task. Two different open-hand grip methods could be observed, with the ring finger PIP joint angle either below 15° or above, ranging from 20 to 78°.

Conclusion: Despite challenging marker visibility in some task, the optoelectronic motion capture system proofed to be a practicable tool for 3D motion analysis of the hands during rock climbing. The obtained joint angles were in line with general descriptions in previous studies. Joint angles did not vary considerably during the holding phase but remained stable. This allows direct force transmission on the wall when pulling on a handhold. Eccentric finger joint motion during high loads, notably a risk factor for finger flexor pulley injuries, was not observed. It presumably only occurs unintentionally during an unexpected load rise on the hand. The two open-hand grip methods most likely differed in whether the little finger was used or not, leading to more flexed or extended middle and ring fingers. As loads on pulleys are lower with less flexed PIP joints, instruction not to use the little finger for the open-hand grip might be important after pulley rupture.

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09:30 – 10:30
Lachensaal 2
Sessions SSCM

Communications libres I B

Bone and Joint

Flavien Mauler, Genf , David Jann, Thun
FM8

Thumb carpometacarpal implant arthroplasty: Does the success continue in the mid-term?

Vanessa Reischenböck1, Miriam Marks1, Sara Neumeister1, Stephan Schindele1, Daniel Herren1 (1Zürich)
Details

Objective: The aim was to analyse the outcomes 2 years after thumb carpometacarpal (CMC I) implant arthroplasty with the focus on revisions and complications.

Methods: Patients treated with an implant arthroplasty (Touch®, KeriMedical, Switzerland) who were prospectively documented in a registry were included. Revisions up to 2 years postoperatively and complications were recorded. Before surgery and 2 years thereafter, all patients had their hand function assessed with the brief MHQ (score 0-100) and rated their pain during daily activities on a Numeric Rating Scale (NRS; 0-10). Key pinch strength was measured with a pinch gauge. Two-year implant survival was estimated using the Kaplan–Meier method. We used a two-sided t-test to analyse for differences between baseline and 2 years.

Results: Currently, we have 232 CMC I implants in our registry, 67 of whom were operated on 2 years ago or earlier and were therefore suitable for this analysis. Three out of these 67 implants had to be revised 14-24 months after implantation, leading to an estimated 2-years survival rate of 95% (95% Confidence interval [CI]: 84% to 98%). The reason for revision was cup loosening in one case, mispositioning of the cup in another case and impingement due to suboptimal cup positioning and a too short head/neck component in the third case. Further complications that required additional conservative therapy and/or steroid injection and/or soft-tissue surgery include tendovaginitis de Quervain (n=2), tendovaginitis stenosans at the operated thumb (n=2), connective tissue nodule at the EPL tendon (n=1), intraoperative trapezium fracture (n=1) and thumb stiffness (n=1).

At two years, 54 patients were available for follow-up. The brief MHQ score increased from mean 46 (CI:42-51) at baseline to 87 (CI:83-92) at 2 years (p≤0.001) and pain during activities decreased from 7.2 (CI:6.8-7.7) to 1.4 (CI:0.8-1.9) at 2 years (p≤0.001). Key pinch strength was 4.8kg before surgery and 7.2kg at final follow-up (p≤0.001).

Conclusions: The 2-year survival rate of 95% of the Touch® implant is acceptable and better than for other CMC I implants reported in the literature. A careful surgical technique, especially in the placement of the cup in the trapezium, is needed and the learning curve of the surgeon has to be considered.

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FM9

Thumb carpometacarpal implant arthroplasty: The fast track back to work

Nora Huber1, Miriam Marks1, Sara Neumeister1, Stephan Schindele1, Daniel Herren1 (1Zürich)
Details

Objective: The aim was to investigate if patients treated with a thumb carpometacarpal (CMC I) implant arthroplasty recover significantly faster than patients after resection-suspension-interposition (RSI) arthroplasty, regarding the number of days they went back to work.

Methods: This study comprised two cohorts: (1) Patients treated with an implant arthroplasty (Touch®, KeriMedical, Switzerland) who were prospectively documented in a registry and (2) RSI patients from a previous clinical trial. Before surgery, 3 months and 1 year thereafter, all patients noted the number of days until they returned to work post-surgery. Hand function was assessed with the brief MHQ (score 0-100) and pain during daily activities was measured on a Numeric Rating Scale (NRS; 0-10). Key pinch strength was measured with a pinch gauge.

Results: In the implant group, 125 patients with a mean age of 63 (±8) years were available and their 1-year outcomes were compared to 127 RSI patients with a mean age of 65 years (±9). In the implant group, 70 patients were employed and 39 in the RSI group. After implant arthroplasty, patients returned to work after a mean time of 44 days (95% confidence interval [CI]:27-61), which was significantly faster than the mean time of 68 days (CI:41-96) for the RSI group (p≤0.05). Moreover, patients with an implant had a significantly better 3-month postoperative brief MHQ score (83, CI:80-86) than those after RSI (69, CI:65-72) (p≤0.001, figure 1). Pain at 3 months was also significantly lower in the implant than RSI group (1.9 (CI:1.6-2.3) versus 3.2 (CI:2.9-3.6), p≤0.001). Key pinch at three months was significantly higher in the implant than RSI group (6.9kg (CI:6.3-7.6) versus 3.1kg (CI:2.8-3.4), p≤0.001). At one year, patients in both groups had similar outcomes, except for key pinch, that was still significantly higher in the implant group.

Conclusion: Patients after CMC I implant arthroplasty return almost twice as fast to work and also show significantly faster recovery of hand function than patients after RSI. One year after the surgery, there is only a difference between both groups in strength but not in the other outcomes.

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FM10

Lessons learned after 80 Touch trapeziometacarpal prosthesis

Elvira Bodmer1, Urs Hug1 (1Luzern)
Details

Introduction

Despite the satisfactory outcomes of RSI-Arthroplasty, the Touch prosthesis has become an excellent alternative in recent years. Due to their double mobility concept, the third generation prostheses show significantly better 5-year results than the second generation prostheses. The aim of this study was to retrospectively analyse not our results but our complications in order to assess our learning curve and its consequences in a hand surgery teaching unit.

Methods

We are using Touch prosthesis since 2019. To date (May 2022), 80 patients have been operated on by two surgeons. We have recorded our complications in a retrospective analysis. On the basis of clinician and patient reported outcomes, postoperative X-rays and the prosthesis components used, we have tried to identify technical challenges and to draw learning effects from them. We used the spherical cup in 76 % of cases.

Results

We analysed 80 Touch prosthesis in 76 patients. Mean age was 62 years, 16 men and 60 women. A total of 6 complications (4.8%) were detected in 6 different patients: 2 cup dislocations, 2 instabilities of the metacarpo-phalangeal (MCP) joint, 1 ossification and 1 de Quervain’s tenosynovitis. All 6 patients had to be reoperated: 2 re-positionings of the cup, 2 MCP fusions, 1 resection of the ossification and change to a bigger size of the neck and finally 1 synovectomy in the first extensor compartment.

Conclusion

Five out of 6 complications (83%) were among the first 19 patients (24%). The 2 cup dislocations were due to incorrect cup placement and/or insufficient resection of trapezium osteophytes. Periarticular ossification in 1 thumb caused stiffening of the prosthesis and was probably caused by insufficient resection of trapezial and metacarpal osteophytes. Persistent MCP joint instability after any procedure at the osteoarthritic trapeziometacarpal joint is a common problem in literature. It’s debatable if this entity should be called “complication”. In literature, de Quervain’s tenosynovitis following Touch prosthesis is well described. In our series it was only once a real problem, so we don’t see the need to address first extensor compartment routinely.

In conclusion, our lessons learned are:

- complete resection of hemicircular capsule and complete release of metacarpal base to get enough mobility for cup positioning

- proper resection of osteophytes

- invest enough time for optimal cup positioning

- use of machine drill for conical cup if possible

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FM11

Is it useful to replace the PIP joint at the index finger? Analysis of prospective 5-year outcomes

Xenia Startseva1, Miriam Marks1, Michael Oyewale1, Stephan Schindele1, Daniel Herren1 (1Zürich)
Details

Objective: The aim was to compare the 5-year outcomes between surface-replacing implants at the proximal interphalangeal (PIP) joint of the index finger versus the same implants at the PIP joints of the other fingers. Our primary hypothesis was that patients with an index finger PIP implant would not have a higher revision rate 5 years after surgery compared to patients with PIP implants at the other fingers.

Methods: Based on our prospective registry, patients who received a single PIP surface replacing arthroplasty (CapFlex-PIP) and had a 5-year follow up were included in this analysis. Revisions and complications were recorded. Active range of motion (ROM) of the PIP joint and deviations from the longitudinal finger axis were measured. Before surgery and at follow-up, patients completed the brief Michigan Hand Questionnaire (MHQ) and rated their pain during daily activities on a Numeric Rating Scale (0-10). Between-group differences in revision rates were calculated with a Fisher's exact test and differences in the other outcomes using the Mann-Whitney U test.

Results: Forty-four patients with an arthroplasty of the index finger and 37 patients with an arthroplasty at the other PIP joints were evaluated. The 5-year revision rate did not differ significantly between groups and was 6.5% for the index finger and 2% for the other fingers (p=0.38). Preserved PIP joint range of motion (ROM) after 5 years was 46° (SD 25) for the index finger and 54° (SD 25) for the other fingers (p=0.18). The brief MHQ score at 5 years was 68 (±16) for the index finger group and 76 (±16) for the other fingers (p≤0.05). However, this difference is not clinically meaningful, as it is below the minimal important difference. There was no significant difference in pain after 5 years between groups. Longitudinal axis deviations were more frequent the index finger group before surgery, but this proportion was similar to the other finger group after 5 years.

Conclusion: Five years after surface replacing arthroplasty, patients with an index finger arthroplasty show similar outcomes to patients with arthroplasties of the other PIP joints. Therefore, we recommend PIP joint arthroplasty at the index finger, but a surface replacing implant with its increased intrinsic stability should be used.

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FM12

Positioning of a surface replacing implant in the PIP joint: Reliability and relation to outcomes

Elvira Bodmer1, Fabrizio Fiumedinisi1, Miriam Marks2, Sara Neumeister2, Daniel Herren2, Stephan Schindele2 (1Luzern; 2Zürich)
Details

Introduction

Despite the satisfactory outcomes of proximal interphalangeal (PIP) joint surface replacing implants, we know too little about the correct positioning of the individual implant components and their effect on the surgical outcome. Furthermore, there are no standardized radiological assesments available to quantify the implant position. The aims of this study were to define radiological measurements to quantify the position of the CapFlex-PIP implant, to test the reliability of these measurements and to explore, if the implant position influences the outcomes one year after surgery.

 

Methods

We used data from our prospective CapFlex registry and selected two groups of patients: Group 1 included patients with the best total active range of motion (ROM) of the PIP joint 1 year after surgery and group 2 included patients with the worst ROM after one year. Two independent raters took 7 different measures to quantify the position of the proximal and distal components in relation to the proximal and middle phalanges on radiographs. Interrater reliability of these measures was calculated with the intraclass correlation coefficient (ICC). Correlation between the radiographic measures and ROM, the brief Michigan Hand Outcomes Questionnaire (MHQ) and pain were determined using Spearman's correlation coefficient.

 

Results

We analysed the radiographs of 63 fingers. Interrater reliability of the 7 different measures was poor to moderate indicated by ICC values between 0.34 and 0.69. The radiographic measures did not correlate with ROM, brief MHQ or pain, shown by correlation coefficients between 0.00 and 0.29. There was no difference in the radiographic measures between patients with the best and worst ROM, except for the deviation of the axis of the proximal component. Patients with the best ROM at 1 year showed an angle of mean 67° (SD 13) and patients with the worst ROM showed an angle of 71° (SD 18) (p≤0.05). However, the difference of 4° does not seem to be relevant and could be attributed to measurement error.

 

Conclusion

A correlation between the implant position and the 1-year outcomes could not be detected, which might be either due to the inaccurate radiological measures, unstandardized X-rays or because there is actually no correlation between the implant positioning and functional outcomes. Despite the lack of evidence for a correlation, we still recommend a precise intraoperative component positioning, because at least it has no negative influence on the outcome.

 

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FM13

Are printed titanium plates useful for corrective osteotomies of the distal radius and forearm?

Michael Brodbeck1, Miriam Marks2, Michael Oyewale2, Daniel Herren2, Stephan Schindele2 (1St. Gallen; 2Zürich)
Details

Objective: To evaluate the one-year postoperative clinical and patient-reported outcomes in patients who had a 3D-planned corrective osteotomy because of malunion of distal radius and forearm shaft using a printed anatomical patient-tailored titanium plate and to determine the feasibility and effectiveness of this methodology.

Methods: Simulation in computer-assisted preoperative planning of corrective osteotomy results in three-dimensional printed surgical guides, surgical models, and in this series additional anatomically customized printed plates for application at the distal radius and forearm. Patients with malunions of the distal radius or forearm who underwent fixation with such custom-made plates were documented in our registry. Grip strength and range of motion assessments were made preoperatively (baseline) as well as at 6 weeks, 3 and 12 months. Additionally, patients rated their wrist-related pain and disability using the Patient-Rated Wrist Evaluation (PRWE).

Results: Fourteen patients with a median age of 56 years underwent corrective osteotomy and had a 1-year follow-up. All osteotomies showed osseous consolidation and no severe adverse events were reported.  The median baseline PRWE score improved from 47 to 7 after one year. Baseline flexion-extension arc of motion of the wrist increased from 90° to 130° at one year and pronation-supination arc of motion of the wrist increased from 135° to 160°. Differences in radiological measurements for palmar and radial inclination as well as for ulnar variance between the affected and contralateral wrists were reduced with the osteotomy. In one case of a young patient, the plate was removed around 11 months after the osteotomy.

Conclusions: Today 3D-simulation and printed individual guides for correction of forearm malunions is a well proofed method and different systems are available. Printed patient-tailored and anatomically customized plates for stable fixation in each patient is a new option and described only in case reports. The advantage compared to standard implants lies in the more accurate placement of printed plates on the deformed bone, especially in the diaphyseal forearm and in correction of intraarticular deformities, where anatomical landmarks for the correct placement of the implant are technically difficult to determine.

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FM14

Peroperative morbidities of distal radius fracture treated by locking plate in elderly population

Bérénice Moutinot1, Cindy Bouvet2, Olivier Mares3, Ivana Sojevic2, Jean-Yves Beaulieu2 (1Lausanne; 2Genève; 3Nimes FR)
Details

PEROPERATIVE MORBIDITIES IN DISTAL RADIUS FRACTURES TREATED BY LOCKINGPLATE IN THE SUPER ELDERLY POPULATION: A RETROSPECTIVE STUDY

 

Purpose

Nowadays there is no consensus concerning distal radius fracture treatment in the super elderly population. The aim of this study was to evaluate the operative morbidities and requirement of rehabilitation care after a distal radius fracture treated by locking plate among patients 85 years old and above.

 

Methods

A retrospective study of all patients 85 years old and above who underwent open treatment by locking plate for a distal radius fracture from January 2013 to December 2018 in a level 1 trauma center was conducted. The occurrence of minor complications (tendinopathy, neuropathy, carpal tunnel syndrome and infections), major complications (Complex Regional Pain Syndrome (CRPS), pseudarthrosis, loss of reduction, intra-articular screw and displacement of the osteosynthesis material) and need for any revision surgeries were recorded. The need and timing for rehabilitation care were also observed. A nested case control study was performed to evaluate predictive factors associated with the need for rehabilitation care.

 

Results

The mean global complication rate among the 185 patients included was 17 % (n=26) with 7.6 % (n=12) showing minor complications and 8.9% (n=14) showing major complications.

In-patient rehabilitation care was required for one third of the patients (n=59) and 7% (n=11) were definitely placed in nursing home. The place of residence before the fracture, the ASA score and the type of anesthesia were associated with rehabilitation need.

 

 

Conclusions

Overall, age does not put patient at higher risk for post-operative complication as comparative literature find the same complications rate for younger patients. Nevertheless, given the frequent requirement for rehabilitation, further consideration must be given.

 

Level of evidence: IV

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FM16

First-in-human application of the new silk fibroin nerve conduit SilkBridge®: preliminary results

Maurizio Calcagni1, Raphael Labèr1, Nora Huber1, Giulia Bassani2, Giuliano Freddi2, Antonio Alessandrino2, Florian Früh1 (1Zürich; 2Lomazzo (CO) IT)
Details

Introduction

Nerve gap reconstruction remains a challenge in modern peripheral surgery. Many different techniques have been proposed in the past, any of them as effective as autologous nerve grafts, especially on in defects longer than 20mm. Silk fibroin has been already used in the past to manufacture nerve conduits showing promising features: cell attachment and guidance, slow resorption, limited inflammatory reaction. However, many problems remained with an unfavourable balance between mechanical stability and biological properties.

SilkBridge®, a novel hybrid three-layered tube based on silk fibroin (obtained from the silk of the Bombyx mori) was developed with optimized characteristics for peripheral nerve regeneration. The device has two nanofibers electrospun layers (inner and outer), and an intermediate textile one. The preclinical studies demonstrated a high mechanical stability and the capability to sustain neurite growth and improve length and myelinization. The aim of this pilot study is to assess efficacy and safety in a first-in-human trial.

Patients and methods

Following the requests of Swissmedic, finger nerve defects up to 26mm in four patients were repaired with the new device and followed up for twelve months. After surgery the patients were controlled regularly with clinical tests (MHQ, pain VAS, 2-point discrimination) and ultrasound examination.

Results

Four patients were included, with a finger nerve defects 12-26mm long. At 12 months follow-up all patients showed a very good sensation recovery with a static 2-point discrimination of 7-12mm, moving 2-PD of 5-10mm, MHQ 98 points, patient satisfaction (PGIC scale) of 6-7/7. The ultrasound morphology of the device was conserved in three patients, while in one case, a patient  treated for a painful neuroma, an initial swelling over the implant was observed without any clinical correlation. The same patient reported some residual pain under load, not preventing him to return to a manual work. All other patients were completely pain free. No further local or general complications were recorded.

Discussion

The device performed very well in vivo, allowing for a complete functional recovery in all patients without complications. In one case, after an initial swelling, the healing was uneventful.

In conclusion the new hybrid, multi-layered silk fibroin device SilkBridge® is safe and effective in the reconstruction of peripheral nerve defects. The study will continue with the inclusion of more patients.

 

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10:30 – 11:00
Pause

Pause café

11:00 – 12:30
Lachensaal 1
Sessions SSRM

Communications libres II

Aline Wermelinger, Luzern , Ursula Osterwalder, Baden
FM64

What happens when the median nerve doesn’t glide anymore: a case report

Susanna Pagella1, Francesca Ferrario1, Mario, Gaetano Fioretti1, Thomas Giesen1 (1Lugano)
Details

Background

Carpal tunnel syndrome (CTS) is the most common compression lesion of peripheral nerves. It is often treated by release of the flexor retinaculum, which may completely relieve the symptoms. Although such treatment is considered successul, there are patients with persistent or recurrent symptoms. Based on timing, persistence (less than 6 months) relief symptons was often related to incomplete release of the transverse carpal ligament. Recurrent symptoms are caused by perineural or intraneural fibrosis.

 Method

A 45-year-old woman, housewife, with a CTS diagnosed in her right hand reporting hiperparesthesia and iposensitivity of the first three fingers after only two months following an open release surgery in another hospital in October 2019. No therapy was performed after surgery. Two years after CTS release, the patient came to our clinic with symptoms of: severe local hyperesthesia, positive Tinel sign on the median nerve at the CT, VAS score of 4-5 at rest and 8 during ADL. Immediately a neurolysis of the median nerve in the CT with an adipose-fascial flap covering from by hypothenaric eminence was planned. To avoid another nerve entrapment in the scar tissue, after the safe heal of the flap, several nerve gliding exercises was performed.

Discussion

The entrapment of the nerve in the scar imprisons the nerve in the surrounding tissues, impeding it from gliding and compressing the nerve again prevents complete healing and the improvement of the symptoms. Promoting an early mobilisation and nerve gliding exercises, even after the 2nd surgery improved the patient's pain and symptoms.

Conclusion

The most common cause of recurring symptoms after a period of symptom relief is due to scar formation in the carpal tunnel post-operatively .Prolonged immobilization, forming of postoperative haematomas or inadequate rehabilitation such as the absence of nerve gliding promotion leave perineural scar tissue forming and the consequent damage: “the nerve tethering”.

The limit of this study is that is a case report. Immobilisation was the main cause of the patient's problems. We asked if it reasonable to immobilize the wrist after the surgery and when it is reccomended to start the nerve gliding exercises.

Bibliography

Revision of Carpal tunnel Surgery, Stahs Pripotnev, Susan E. Mackinnon

Effectiveness of Nerve Gliding Exerciseson Carpal Tunnel Syndrome: ASystematic Review Ruth Ballestero-Pérez,et al

 

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FM65

«Die blinde Hand» - Evidenzbasiertes Behandlungsschema für sensible Ausfälle an der Hand

Deborah Bürcher1 (1Brig)
Details

Motivation: Les lésions nerveuses périphériques affectent durablement les patients dans leur vie quotidienne. Une main sans sensibilité est souvent une main sans fonction (Lundborg et al., 2007). Jusqu’à présent, les ergothérapeutes de l’hôpital de Brigue travaillaient sans approche uniforme. Le développement d’un protocole de traitement devait permettre d’améliorer la qualité du traitement.

Question: Quelles sont les recommandations d’action basées sur des preuves, applicables quotidiennement et qui améliorent la sensibilité de la main après une section ou une compression nerveuse périphérique ? 

Méthodologie: Une revue de littérature systématique a été menée en janvier 2022. La littérature pertinente a été repérée dans différentes banques de données (Pubmed, Cochrane Library, OTseeker). Parmi celle-ci, quatre RCT et une revue systématique répondaient aux critères d’inclusion et d’exclusion.

Résultats: Après une section (partielle) d’un nerf périphérique, des modifications dans le cortex somatosensoriel déterminent le résultat. Les mécanismes de plasticité du cerveau peuvent être utilisés à des fins thérapeutiques (Björkman, 2013). Les patients doivent apprendre à interpréter le « nouveau langage de la main » pour surmonter les difficultés rencontrées dans les activités du quotidien (Cederlund et al., 2010). Pour obtenir les meilleurs résultats possibles, l’entraînement de la sensibilité doit être adapté aux phases de régénération. Dans la phase 1 (pas de réinnervation), la représentation corticale doit être maintenue. Dans la phase 2 (innervation partielle), la localisation, la différenciation et l’identification du toucher sont entraînées (Lundborg et al., 2007). Plus la rééducation sensorielle est débutée rapidement, meilleurs sont les résultats. Un niveau de preuve élevé a été établi pour la thérapie du miroir lors de la phase 1. En cas d’une compression nerveuse, de faibles preuves ont été données pour la rééducation sensorielle lors de la phase 2.  

Pertinence pratique: Un protocole de traitement a été créé sur des preuves scientifiques. Il contient des propositions d’exercices pour les phrases 1 et 2 qui permettent une procédure uniforme mais néanmoins individualisable.

Björkman, A. (2013). Cerebral Reorganization after Nerve Injury. Federation of European Societies for Surgery of the Hand. Instructional Courses 2013 (L.B. Dahlin & G. Leblebicioglu, Hrgs.), 81-92. Palme Publications

Cederlund, R., Thorén-Jönsson, A. L., & Dahlin, L. B. (2010). Coping strategies in daily occupations 3 months after a severe or major hand injury. Occupational Therapy International, 17(1), 1–9. https://doi.org/10.1002/oti.287

Lundborg, G., & Rosén, B. (2007). Hand function after nerve repair. Acta Physiologica, 189(2), 207–217. https://doi.org/10.1111/j.1748-1716.2006.01653.x

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FM66

Erfassung der Sensibilität nach peripherer Nervennaht

Sarah Zindel1 (1Luzern)
Details

Introduction: Un feedback sensoriel adéquat est fondamental pour la fonction de la main (Jerosch-Herold, 2020). Après la section d’un nerf périphérique, l’évaluation de la sensibilité est une partie importante de l’anamnèse. Selon Jerosch-Herold (2020), cette évaluation nous fournit des informations pour planifier le traitement et examiner son déroulement. Afin de trouver les évaluations appropriées pour sa propre institution, il est important de connaître leurs critères de qualité comme la fiabilité, la validité et l’objectivité et d’évaluer leurs avantages cliniques en termes d’acceptabilité, de faisabilité et de coûts (Fonseca et al., 2018; Jerosch-Herold, 2005).

Objectif: L’objectif de ce travail dans le cadre du CAS en thérapie de la main est l’élaboration de lignes directrices pour l’évaluation de la sensibilité après une suture nerveuse. Les lignes directrices doivent assurer une collecte de données de la sensibilité uniformisée au sein de l’institution et l’application correcte de l’évaluation. Cette dernière sert de base au traitement et doit en garantir sa qualité.

Méthode: Une recherche de littérature à ce sujet a servi de base pour évaluer les critères de qualité des évaluations après une suture nerveuse. Dans un second temps, les évaluations jugées standardisées ont été placées dans le contexte de l’institution pour faire une sélection. Des directives et des instructions d’utilisation ont été rédigées.

Résultats: Sur la base des premiers résultats, les directives incluront le Ten Test, le test des monofilaments de Semmes Weinstein ainsi que le Shape-texture-identification Test (STI2). Des détails à ce propos seront présentés lors de la conférence. 

Bibliographie

Fonseca, M. D. C., Elui, V. M. C., Lalone, E., da Silva, N. C., Barbosa, R. I., Marcolino, A. M., Ricci, F. P. F. M., & MacDermid, J. C. (2018). Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties. Systematic Reviews, 7(1). https://doi.org/10.1186/s13643-018-0836-0

Jerosch-Herold, C. (2005). Assessment of Sensibility after Nerve Injury and Repair: A Systematic Review of Evidence for Validity, Reliability and Responsiveness of Tests. Journal of Hand Surgery, 30(3), 252–264. https://doi.org/10.1016/j.jhsb.2004.12.006

Jerosch-Herold, C. (2020). Sensibility Testing. In T. M. Skriven, A. L. Ostermann, J. M. Fedorczyk, P. C. Amadio, S. B. Feldscher, & E. K. Shin (Eds.), Rehabilitation of the Hand and Upper Extremity (7th ed., Vol. 1, pp. 125–141). Elsevier.

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FM67

Konservative Behandlungsmöglichkeiten bei einem Neurom Was sagt die Literatur - was zeigt die Praxis?

Ulla Jörn Good1, Brigitte Blum1 (1Zürich)
Details

Le traitement d’un névrome est devenu plus diversifié grâce aux progrès de la recherche neurophysiologique et aux développements techniques. Que pouvons-nous en tirer dans la pratique ?

Les névromes peuvent apparaître après une section ou une lésion nerveuse périphérique. Les symptômes possibles comprennent une activité nerveuse spontanée malgré l’absence de stimulus externe, une hypo et une hypersensibilité ainsi qu’une allodynie. Le bourgeonnement axonal et l'altération de la production de divers canaux ioniques ne sont que deux des changements possibles en cas d’une lésion du système nerveux périphérique (Lui Y, Kao DS, 2021).

Les mesures de traitement suivantes sont listées dans la littérature pour le traitement conservateur d’un névrome : médication, stimulation électrique transcutanée TENS, programme d’imagerie motrice PIM, réalité virtuelle, réalité augmentée, vibrations, stimulation magnétique transcrânienne TMS et réhabilitation somatosensorielle® (Spicher et al 2006, Hoffman 2020 et al, Lui Y& Kao DS 2021).

Notre expérience montre qu’après l’élimination d’une allodynie et la rééducation de la sensibilité qui s’ensuit, le traitement d’un névrome peut également être nécessaire. L’objectif est de réduire le déclenchement des sensations désagréables lors d’un contact avec le névrome et d’obtenir ainsi le meilleur usage fonctionnel du membre.

Cette présentation a pour objectif de montrer les possibilités actuellement disponibles dans la littérature et dans la pratique pour détecter et traiter un névrome. La détection et le traitement d’un névrome grâce à un appareil à vibrations (Vibralgic 5, YsY Medical) ainsi que la désensibilisation tactile, le PIM et le TENS se sont avérés efficaces dans notre pratique.

Spicher C, Derange B, Mathis F, La désactivation des signes d'irradiation provoquée: Une nouvelle technique de rééducation sensitive pour traiter les douleurs chroniques, Ergotherapies 22 (2006): 13-18

Hoffmann HG, Boe DA, Rombokas E et al, Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain, Journal of Hand Therapy 33 (2020): 254-62

Liu Y, Kao DS, Nonsurgical Approaches to Neuroma Management, Hand Clin 37 (2021): 323-33

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FM68

Treatment of the Ulnar Collateral Ligament of the Thumb with a Modified Splint

Rosana Stojmenova1, Silvano G. Rech2, Thomas Giesen3 (1Giubiasco; 2Lugano; 3Gravesano)
Details

Thumb ulnar collateral ligament (UCL) injuries of the metacarpal phalangeal (MCP) joint can be treated with conservative or operative treatment, according to the severity of the lesion and the presence of a Stener lesion.  

Conservative regimes for grade 1 and 2 lesions and post-operative rehabilitation regimes usually include immobilization of the MCP joint up to 6 weeks. Early active motion in such lesions could stimulate healing of ligaments and avoid stiffness of the MCP joint. In literature few authors have already published variations of the classic short thumb spica splint, but the proposed splints were relatively complicated to fabricate. We present our further experience with 25 consecutive cases of UCL lesions treated with a hand-based splint, including the MCP joint, and an extremely simple modification that allows early mobilization of the MCP joint while protecting the UCL.

From January 2021 to May 2022, we treated conservatively 15 cases of grade 2 UCL injuries and 10 cases of surgically repaired ligaments. There were 12 women and 13 men with an average age of 39 years (range 15-58). Patients that underwent surgery for ligament repair were 4 male and 6 females. There were 14 right thumb and 11 left thumbs. There were 16 dominant hands.

In both groups, conservative and post-operative patients, the rehabilitation protocols, and the modified splint were identical. We immobilized the MCP joint in a hand-based splint including the MCP joint for 2 weeks. We then modified the splint by replacing the palmar block at the MCP joint with a removable Velcro, starting active and passive flexion of the MCP joint for 4 more weeks. The splint was still protecting radial and ulnar deviation of the MCP joint, while compensative flexion of the trapezium-metacarpal joint was inhibited.    

Results: all patients were followed-up for 6 months. All ligaments eventually healed with good stability of the MCP joint.

92 % of contralateral MCP Flexion was recovered already at 12 weeks. Kapandji score was equal to the contralateral in 80% of patients at 12 weeks. Average K-pinch was 96% of the contralateral (range 2-11,5 KG) at 12 weeks. Pain was rated with the visual analogic scale (VAS) as 1.6 (range 0-5) at 12 weeks. Patients treated conservatively recovered faster.

Conclusion: The proposed modification for conservative or surgically treated UCL lesions seems to be safe with a fast recovery of a pain free motion and strength of the thumb.

en
FM69

Behandlungsqualität trotz Personalmangel – wie geht das?

Esther Bohli1 (1Biel)
Details

Comment pouvons-nous garantir la prise en charge, l’attention portée et les résultats chez les patients en thérapie de la main malgré un manque de personnel ?

Comment gérons-nous les différentes attentes du patient, du médecin et du thérapeute en matière de traitement ?

Quelles sont les valeurs qui nous guident dans cette démarche – et en sommes-nous conscients ?

Qu’est-ce qui est raisonnable pour le personnel, qu’est-ce qui ne l’est pas ?

Existe-t-il des critères, un soutien, des possibilités pour « tenir le coup » ?

Nous montrerons, à l’aide des quatre principes bio-éthiques, que la décision pour ou contre une intervention en rééducation de la main peut être réfléchie. Lors d’un dilemme ou d’un conflit d’intérêt, il vaut également la peine de repenser son propre travail en fonction d’autres possibilités, de rendre les frontières transparentes et de trouver ainsi une qualité de traitement qui soit différente mais qui reste encore malgré tout hautement qualitative.

Sur la base d’une étude de la Haute école spécialisée bernoise, les adaptations utiles pour une équipe en rééducation de la main seront présentées. En prenant comme exemple sa propre pratique, l'efficacité de ces adaptations sera examinée de manière critique.

Bibliographie :

Arn, Ch., Weidmann-Hügle T: Ethikwissen für Fachpersonen, (2009), EMH-Verlag Basel.

Beauchamp, T.L.; Childress, J.F: (2001): Principles of Biomedical Ethics 5th. Ed. New York, Oxford, Oxford University Press.

Gantschnig B.E, Ballmer TH, Aegler B: Assessments in der Handtherapie: wie wählen
wir gute für die Praxis und/oder Forschung aus? (2019), Zeitschrift pro manu SGHR S. 17 – 19.

Peter, K.A. (2019) STRAIN – Work-related stress among health professionals in Switzerland STRAIN Resultate auf einen Blick.

Peter, K. A. (2021). Rahmenbedingungen im Gesundheitswesen optimieren - nationale Interventionsstudie. Frequenz, 2021(05), 15-18.

Baumann-Hölzle, R. (2008): Das Modell «7 Schritte ethischer Entscheidungsfindung». Praxisordner Dialkog Ethik. EMH-Verlag. Basel

de
11:00 – 11:15
Schadausaal
Sessions SSCM

Report Forschungsfonds

Florian Früh, Aarau

Report Forschungsfonds
Biomechanical strength of partially united scaphoid fractures - a finite element study

Esin Rothenfluh1 (1Zürich)
11:00 – 12:30
Workshop-Raum 1
Sessions SSRM

Atelier A

Julie Dziwornu, Biel

Attelle articulée de coude dite «robocop

Claire Girard1 (1Genf)

Avec le soutien de Cuiro SA, Lausanne et Orthopartner AG, Niederlenz

Lors de cet atelier vous apprendrez à confectionner une attelle articulée de coude, réalisée dans le but de limiter une pronation/ supination tout en gardant une flexion/extension contrôlée.

Details

Lors de cet atelier vous apprendrez à confectionner une attelle articulée de coude, réalisée dans le but de limiter une pronation/ supination tout en gardant une flexion/extension contrôlée.

Durant cet atelier, nous expliquerons pour quelles pathologies cette attelle est indiquée. Nous montrerons comment la fabriquer à l'aide d’une fiche explicative qui indiquera la durée de port recommandé ainsi que les différentes évolutions. Nous guiderons les participants tout au long de la confection de leur propre attelle.

11:15 – 12:30
Schadausaal
Sessions SSCM/SSRM

Session principale I

Mind the gap - Enhancing the quality of sensory and mixed-motor nerve gap reconstructions

Florian Früh, Aarau , Vera Beckmann-Fries, Zürich

When and how I use autograft

Esther Vögelin1 (1Bern)
en

When and how I use allograft

Bauback Safa1 (1San Francisco US)
en

Sensory/pain rehabilitation

Marianne von Haller1 (1Basel)
en

Motor rehabilitation

Agnes Sturma1 (1Wien AT)
en

Experimental nerve grafts

Florian Früh1 (1Aarau)
en

Case discussion

Details

- Pure sensory digital
- Hand therapy case I
- Motor hand
- Mixed motor forearm
- Hand therapy case II
- Mixed motor humerus
- Hand therapy case III

Followed by conclusions from the chairs.

12:30 – 13:45
Pause

Déjeuner - rencontre dans l'exposition

12:45 – 13:30
Lachensaal 1
Symposium

Symposium de midi 1

Welchen Nutzen haben patientenspezifische Implantate zur Behandlung von komplexen Defektsituationen?

Stephan Schindele, Zürich

Einführung in die 3D Planung

Stephan Schindele1 (1Zürich)
de

Patientenspezifische Rekonstruktion des distalen Radius

Stephan Schindele1 (1Zürich)
de

Patientenspezifische Unterarm Rekonstruktion – Fall Präsentation

Elvira Bodmer1 (1Zug)

Experience with IPS in Forearm, Metacarpal & Scaphoid malunion

Niels Schep1 (1Rotterdam NL)
en
13:45 – 15:00
Lachensaal 1
Sessions SSRM

Communications libres III

Susanna Pagella, Mendrisio , Marie Ange Schneiders, Lausanne
FM70

Recherche de la littérature sur l’efficacité des principes de protection articulaire

Cyndia Di Biase1 (1Delémont)
Details

Dans la thérapie de la main, nous enseignons les principes de protection articulaire aux patients présentant de l’arthrose des mains. Ce concept est couramment utilisé pour améliorer et/ou maintenir la fonction des articulations de la main (Stamm et al., 2002). Il a été développé comme une intervention d’auto-efficacité qui vise à améliorer la perception qu'ont les clients du contrôle de leur état physique, psychologique, de leurs activités quotidiennes, de leur rôle et de leur participation sociale. L'objectif est d'éduquer les clients à la modification des méthodes de travail,  l'utilisation d'une mécanique articulaire et corporelle appropriée par l'application de principes ergonomiques, l'utilisation de moyens auxiliaires et la modification des performances et des environnements (Bobos et al., 2018). 

Le but de cette recherche de la littérature est de connaître les différentes approches de principes de protection articulaire dans les bases de données et de savoir leurs efficacités afin de mieux accompagner les patients dans leur pathologie.

La méthodologie de recherche de la littérature s'est effectuée dans 5 bases de données : PubMed, COCHRANE, Google Scholar, PEDro et OTseeker de janvier 2009 à mars 2020; avec des articles niveau 1 : Meta-analyse, Randomised Control Trials, Systematic Review; les mots-clés sont : joint protection, hand therapy, osteoarthritis, arthritis, effectiveness, treatment. Une analyse, une synthèse et un résumé des méthodes ont été listés.

Les 24 études consultées démontrent que : une approche psycho-éducative et d’autogestion, un enseignement individualisé et centré sur le client, des principes de respect de la douleur articulaire et d’économie d’énergie ainsi qu'une combinaison de plusieurs moyens de traitement s'avèrent efficaces. Cependant, il n'existe pas de consensus sur la manière de traiter l'arthrose et il est difficile de connaître si les principes de protection articulaire ont une preuve significative sur la gestion de la maladie. 

L’efficacité de la protection articulaire a des évidences faibles à modérées. Pour l’augmenter, elle doit être associée avec différentes interventions, avoir une approche bio-psycho-sociale orientée sur les forces et les ressources et non sur les déficiences et le handicap afin de mieux gérer la douleur, la raideur et les capacités fonctionnelles (Niedermann et al., 2010).

fr
FM71

Metacarpophalangeal extension blocking splint for the treatment of thumb CMC arthritis

Rosana Stojmenova1, Lorenzo Priora2, Thomas Giesen3 (1Giubiasco; 2Mendrisio; 3Gravesano)
Details

With regards to carpometacarpal (CMC) arthritis of the thumb, the efficacy of thumb splinting is still unclear and there is lack of overwhelming evidence. Recent studies have demonstrated the role and the importance of metacarpophalangeal (MCP) joint hyperextension in the pathogenesis and clinical progression of CMC arthritis. In cases of early disease and in cases of advanced disease with the patients not willing to undergo surgery, we proposed a splinting regime including an MCP joint extension blocking thermoplastic splint for the day and a night long rigid splint for thumb and wrist.

Over a period of 6 months, we treated with a new splinting regime and without other means of therapy 17 consecutive thumbs with CMC arthritis in 15 patients. There were all women with an average age of 54,9 years (range 30-74). There were 11 right thumb and 6 left thumbs. There were 11 dominant hands. The radiological stage of CMC arthritis (Litter et al. classification) was stage 1 in 6 thumbs, stage 2 in 6 thumbs and stage 3 in 5 thumbs. Nine patients were manual workers.

We partially immobilized the MCP joint during the day with a simple extension blocking thermoplastic splint with the MCP joint hold at 10°-30° degrees of flexion according to the mobility of the joint. The splint was fabricated in a way that active MCP flexion was still possible. The splint had to be worn constantly and removed only for personal hygiene.

We evaluated pain at rest and during light and heavy activities; subjective outcome with the Michigan Hand Questionnaire (MHQ); personal satisfaction of the patients regarding the comfort of the MCP extension blocking splint. K-pinch and t Jamar in position 2; the Kapandji score;

Results: 13 patients were satisfied with the treatment and the comfort of the MCP extension blocking splint. The VAS during light and heavy activities and the MHQ was statistically significant improved. K pinch and Jamar values did not show any significant variation.

Kapandji score was equal to the contralateral thumb in all cases and did not change over time.

Conclusion: an extension blocking splint for the MCP joint seems to be beneficial for the treatment of pain in early and advanced CMC arthritis. The splint seems to be very practical and simple to use in daily activities and at work, including manual work.

en
FM72

A conservative treatment protocol and a home exercise program to treat the de Quervain’s syndrome

Anna Donati1 (1Broglio)
Details

De Quervain affects active people who overload thumb and wrist movements by causing pain and limitation in the functional use of the hand. In addition to there being no conservative treatments clearly supported by the literature, there is confusion in the terminology.
What conservative interventions supported by the literature can be proposed to a patient suffering from de Quervain? What exercises can he perform independently at home to improve his condition?
A literature review was performed in order to give an answer to the previous questions, as well as to understand the pathophysiology of tendinopathies and the possible treatments.
In order to treat de Quervain effectively, the tendon healing process must be recognised adn understood. Treatments with higher level of evidence are infiltration and rest in orthoses. Lower level evidence supports patient education, eccentric training, stretching and physical modalities. Multiple treatments are more effective than a single treatment. Evaluations and treatments are summarized in the protocol. Exercises for home training are described in words and with a photograph in a paper.
The knowledge of physiology and the effects of the treatments have allow the therapist to work in a more targeted and effective.

 

Abi-Rafeh, J., Kazan, R., Safran, T., & Thibaudeau, S. (2020). Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm. Plastic & Reconstructive Surgery, 146(1), 105–126

Cavaleri, R., Schabrun, S. M., Te, M., & Chipchase, L. S. (2016). Hand therapy versus corticosteroid injections in the treatment of de Quervain’s disease: A systematic review and meta-analysis. Journal of Hand Therapy29(1), 3–11

Huisstede, B. M., Coert, J. H., Fridén, J., & Hoogvliet, P. (2014). Consensus on a Multidisciplinary Treatment Guideline for de Quervain Disease: Results From the European HANDGUIDE Study. Physical Therapy94(8), 1095–1110

Lipman, K., Wang, C., Ting, K., Soo, C., & Zheng, Z. (2018). Tendinopathy: injury, repair, and current exploration. Drug Design, Development and TherapyVolume 12, 591–603

Murtaugh, B., & M. Ihm, J. (2013). Eccentric Training for the Treatment of Tendinopathies. Current Sports Medicine Reports12(3), 175–182

Sartorio F., Garzonio F., Vercelli S., Bravini E, Ruella C., Maglio R., Cisari C., Ferriero G. (2016). Trattamenti conservativi nelle tendinopatie agli arti superiori in ambito occupazionale: revisione narrativa. La medicina del lavoro. 107

en
FM73

Elaboration d'une fiche thérapeutique lors d'arthrose de la méta-carpophalangienne du pouce

Barbara Roland1 (1Miège)
Details

Das Trapezium-Metakarpal-Gelenk ist das am dritthäufigsten von Arthrose betroffene Gelenk. 54-67% der Bevölkerung ab 55 Jahren leiden darunter (Beasley Jeanine & al 2017); der Anteil steigt mit zunehmendem Alter proportional an. Die Prävention der Osteoarthrose ist von erheblicher sozioökonomischer Bedeutung, da 80% der Bevölkerung über 79 Jahre alt werden (Stamm T. A. et al., 2002), und die OA einen Einfluss auf die Lebensqualität hinsichtlich Mobilität, Wohlbefinden und Zufriedenheit (O'Brien V. et al., 2012) hat, je nach Schmerzen und Funktionseinschränkungen (Beasley J. et al., 2017). Die Vermittlung von Übungen ist eines der drei Mittel, die in der konservativen Behandlung beschrieben werden (O'Brien V. et al., 2012). Ziel ist es, dem Patienten ein Hilfsmittel an die Hand zu geben, das er zu Hause anwenden kann, um seine Mobilität zu verbessern und Schmerzen zu verringern.

Frage: Kann ein Programm an eigenständigen Übungen hilfreich sein, um die Beweglichkeit des Daumens langfristig zu erhalten/verbessern und zur Schmerzlinderung beizutragen?

Methodik: Die Suche wurde in PubMed und Google Scholar durchgeführt. Die verwendeten Suchbegriffe waren: osteoarthritis, thumb joint, prevention, conservative treatment, hand exercises. Eine weitere Auswahl wurde durch den Vergleich der aufgeführten Quellen getroffen.

Ergebnisse: Die Durchführung täglicher Übungen verringert Schmerzen und Behinderungen des Daumens, erhöht die Kraft (Stamm T. A. et al., 2002) und die Mobilität (Beasley J. 2012) als Ergänzung zu Therapien, Schienen und der Verwendung von entsprechenden Hilfsmitteln.

Literaturverzeichnis

Beasley Jeanine (2012). Osteoarthritis and rheumatoid Arthritis : Conservative Therapeutic managment Journal of Hand Therapy 25 : 163-171
Beasley J., Ward L., Knipper-Fischer K., Hughes K., Lunsford D., Leiras C. (2017). Conservative therapeutic intervention for osteoarthritic finger joints : a systematic review. Journal of Hand Therapy 32 : 153-164
O’Brien V. H., Giveans R. M. (2012). Effects of a dynamic stability approch in conservative intervention of the carpometacarpal joint of the thumb : a retrospective study. Journal of Hand Therapy 26: 44-52
Stamm T.A., Machold K. P., Smolen J. S., Fischer S., Redlich K., Graninger W., Ebner W., Erlacher L. (2002). Joint protection and home hand exercises improve Hand Function in Patients With Hand Osteoarthritis: a Randomized Controlled Trial. Arthritis Care & research 47: 44-49
Wilder F.V., J.P. Barrett and E.J. Farina (2006). Brief report Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritis and cartilage 14, 953-957.

fr
FM74

Prise en charge de la main brûlée en rééducation

Céline Minguely1 (1Grandsivaz)
Details

Introduction

Nos mains nous permettent d’interagir continuellement avec notre environnement. Grâce à elles, nous pouvons saisir et déplacer des objets, accomplir la plupart de nos activités et nous protéger face aux agressions. De ce fait, les mains sont l’une des zones les plus fréquemment touchées lors de brûlures qu’elles soient thermiques, électriques ou encore chimiques.

Une brûlure s’étendant sur la face dorsale de la main ainsi que dans la paume représente uniquement 3 pourcents de la surface corporelle totale touchée mais peut provoquer une perte de fonction conséquente pour la personne brûlée (Roger & Simpson, 2011). C’est l’un des trois endroits du corps le plus à risque de cicatrisation pathologique. A cause des spécificités anatomiques et de la complexité des structures, le risque d’une cicatrisation hypertrophique amenant à des rétractions, des déformations et donc une atteinte fonctionnelle est importante (Richard et al., 2009). L’aspect esthétique n’est pas à négliger non plus car les mains ont un rôle majeur dans la communication et la sphère sociale de la personne.

Objectif

Présentation de la prise en charge d’une main brûlée en rééducation à l’aide de 2 exemples de cas.

Méthode

Une revue de littérature a été menée sur le traitement en rééducation de la main brûlée. La prise en charge ainsi que le résultat de la revue de littérature seront illustré à travers la présentation de cas cliniques.

Résultats et implication

La rééducation de la main brûlée doit être initiée aussi rapidement que possible. Le contrôle de l’œdème, le maintien de la mobilité et la prévention des déformations et contractures sont les buts principaux en phase aigüe. Cela nécessite une prise en charge spécialisée et ciblée afin d’avoir un résultat optimal et satisfaisant.

 

Littérature mentionnée dans le résumé

Richard, R., Baryza, M.J., Carr, J.A., Dewey, W.S., Dougherty, M.E., Forbes-Duchart, L., Franzen, B.J., Healey, T., Lester M.E., Li, S.K., Moore, M., Nakamura, D., Nedelec, B., Niszczak, J., Parry, I.S., Quick, C.D., Serghiou, M., Ward, R.S., & Ware, L. (2009). Burn rehabilitation and research: proceedings of a consensus summit. Journal of Burn Care & Research, 30(4), 543-573. doi: 10.1097/BCR.0b013e3181adcd93

Roger, L., & Simpson M. D. (2011). Management of Burns of the Upper Extremity. In T. M. Skirven, A. L. Osterman, J. M. Fedorczyk, & P. C. Amadio (Eds), Rehabilitation of the Hand and Upper Extremity (pp. 302-316). Elsevier Mosby.

 

fr
13:45 – 15:00
Schadausaal
Sessions SSCM/SSRM

Session principale II

Reconstructive versus joint replacement surgery on the distal radio-ulnar joint

Thomas Giesen, Gravesano , Tamara Hauri, Bern

Introduction: An overview on bilogical DRUJ reconstructions

Thomas Giesen1 (1Gravesano)

DRUJ: From TFCC reconstruction to implant arthroplasty

Luis Scheker1 (1Louisville US)
en

Implants overview and new perspectives

Lisa Reissner1 (1Zürich)
en

DRUJ- Hand Therapy Essentials

Mel Eissens1 (1Winterthur)
en

Discussion & Panel

en
13:45 – 14:45
Lachensaal 2
Sessions SSCM

Communications libres II

Nerves

Silvia Schibli, Nottwil , Alexandre Kämpfen, Basel
FM15

Respecting the Window of Opportunity for Nerve Transfers – Experience from Tetrahand Surgery

Armin Pallaver1, Sabrina Koch-Borner1, Jan Fridén1, Silvia Schibli1 (1Nottwil)
Details

Introduction

Despite better knowledge of the pathophysiological processes activated after nerve injury, timing of nerve transfers remains difficult. After 12-18 months, the Wallerian degeneration results in irreversible muscle atrophy and fibrosis and the axon tubes will be stenotic, and consequently, poor outcome of nerve transfer can be expected. As primary nerve reconstruction is the standard initial treatment for peripheral nerve injuries in most cases, a dilemma arises between waiting for nerve regeneration and performing a nerve transfer. In tetrahand surgery, we face lesions of the upper (UMN) and lower motor neuron (LMN) at the level of the spinal cord injury. Lesions of the LMN cause the same type of  pathophysiologic changes as injuries of peripheral motor nerves. The timing of a nerve transfer in these patients is crucial to provide a good outcome.

Methods

We retrospectively analyzed 32 tetraplegic persons treated with nerve transfer of supinator motor branches to interosseus posterior nerve. Damage of the LMN was preoperatively assessed by motor point mapping examination of Extensor digitorum communis (EDC) at week 2,4, and 8 after spinal cord injury. Muscle strength of EDC was graded according to MRC (Medical Research Council Scale) at 6, 12 and 24 months postoperatively.

 

Results

16 patients showed preoperatively damaged LMN, 16 had an intact LMN. Surgery was performed 13 months (range 8-24) post injury. Among patients with damaged LMN of EDC, 8 were operated later than 6 months post injury (range 10.0 - 16.7 months). These patients achieved significant lower strength grades of EDC than those operated within 6 months post injury (MRC ≥ 3 12.5% and MRC ≥ 3 50% respectively, p-value = 0.016).

Conclusion

Our data confirm inferior results after nerve transfer in patients with LMN damage when operated more than 6 months post injury. Thus, respecting the window of opportunity is critical for success of nerve transfer surgery. The duration of axonal outgrowth to reach the target muscle should also be included in this calculation. Patients with peripheral motor nerve injuries with missing signs of reinnervation after first treatment or expected poor outcome may benefit from early nerve transfer.

de
FM17

Bone marrow adipose tissue – unrecognized regulator of thumb carpometacarpal osteoarthritis?

Mauro Maniglio1, Thomas Hügle1, Jeroen Geurts1 (1Lausanne)
Details

Background: Subchondral bone and the marrow adipose tissue (BMAT) contained therein, undergo elevated turnover and remodelling during progression of osteoarthritis (OA). Previously regarded as inert filler cells, marrow adipocytes have recently been identified as crucial regulators of bone homeostasis and energy metabolism. In this study, we sought to characterize BMAT tissue morphology in thumb carpometacarpal (CMC1) OA.

Methods: Resection specimens were harvested from 14 consecutive patients (median age: 62, range 26-71, 9 female) undergoing total joint arthroplasty or trapezectomy for thumb CMC1 OA (Eaton Litter stage 1 (N=1); stage 2 (N=1), stage 3 (10), stage 4 (2). Neutral lipids (triglycerides) and cell nuclei were visualized in 1mm thick tissue sections using whole mount staining with Oil red O and Hoechst.  Specimens were evaluated by fluorescence stereomicroscopy.

Results: Ten out of fourteen tissue samples displayed moderate to severe articular cartilage degeneration along osteosclerosis of the subjacent subchondral cortical and trabecular bone. Four specimens with mild articular degeneration showed a homogeneous distribution of marrow adipocyte size and neutral lipid staining patterns. Nuclear staining revealed a relatively low cell abundance both in between adipocytes and at the subchondral trabecular bone surface (Fig 1a). In contrast, specimens with osteochondral pathology displayed striking differences in BMAT morphology. Adipocyte size distribution was heterogeneous and zones of high bone turnover and formation contained fewer and smaller adipocytes. Oil red O staining indicated a relative reduction of neutral lipid content in adipocytes, suggesting altered lipid metabolism. High cell abundance was observed around adipocytes as well as at trabecular bone surface, indicating elevated remodelling of both bone and marrow adipose tissues (Figure 1b).   

Conclusion: These findings demonstrate that BMAT changes associate with pathological bone formation in thumb CMC1 OA. We hypothesize that bone marrow adipocyte dysfunction is a factor that alter the energy metabolism in bone and finally leads to the typically changes in OA. It isn’t merely a consequence of it. These changes may be induced by obesity, thereby providing a novel mechanism for explaining the association between obesity and hand OA.

de
FM18

Sonographic Ratio for Carpal Tunnel Syndrome

Nora Schlimme1, Stefanie Hirsiger1, Esther Vögelin1 (1Bern)
Details

HYPOTHESIS

The use of multiple measurements and ratios of the circumferential surface area (CSA) of the median nerve by Ultrasonography (US) along its course through the carpal tunnel improves diagnostic power for carpal tunnel syndrome (CTS) compared to single values.

METHODS

Prospective study on 50 patients and 51 controls. All participants were interviewed and examined by the same hand surgeon and completed DASH Scores and Boston Carpal Tunnel Questionnaire. Ultrasound was performed by 2 independent examiners with measurement of the median nerve at the forearm, inlet, tunnel and outlet of the carpal tunnel. All patients (not controls) had nerve conduction studies. Statistical analysis was performed using chi-squared and Student's t-tests for patient characteristics, linear regression for measurements, logistic regression for diagnostic accuracy and Receiver operating characteristic curves for diagnostic performance. Inter-observer reliability was computed by Bland-Altman plots and Intra-class correlation coefficients (ICC).

RESULTS

Mean age was 59 years for patients and 57.5 for controls. Boston and DASH-Scores were significantly worse in CTS patients (p<0.0001). All four CSA values as well as the two ratios of Inlet/Tunnel and Outlet/Tunnel differed significantly between controls and patients (p<0.0001). The latter two ratios showed the highest adjusted odds ratios for predicting CTS of all measurements. Of the four single values, the CSAinlet had the best performance (AUC 0.79) with an optimized cut-off of 11.75mm2 (Sensitivity 0.78, Specificity 0.70). The inlet and outlet ratios performed even better (AUC 0.93 and 0.90). The optimized cut-offs were 1.25 (Sensitivity 0.80, Specificity 0.92) for the Inlet and 1.45 (Sensitivity 0.80, Specificity 0.85) for the Outlet ratio. Inter-obsserver reliability showed limits of correlation of about 5mm2 for the CSA at forearm, inlet, tunnel and about 8mm2 at the outlet, whereas examiner 2 measured slightly higher values. ICC (95%CI) was generally high, with better values for single CSA than for ratios.

SUMMARY

The use of ratios instead of a single value of circumferential surface area measurement improves diagnostic power of US and we thus recommend their clinical use for the diagnosis of carpal tunnel syndrome. The optimized cut-offs were 1.25 for the Inlet ratio and 1.45 for the Outlet ratio. If using a single measurement, the inlet CSA had the best performance with the cut-off of 11.75mm2.

de
FM19

Percutaneous sonographically guided carpal tunnel release : short term clinical outcome

Fabian Moungondo1, Georgia Antoniou1, Frédéric Schuind1 (1Brussels BE)
Details

Introduction

Percutaneous sonographically guided carpal tunnel release is a new procedure with promising advantages over classic open or endoscopic release. Thanks to the sonography control the procedure should be safer and percutaneous modality should have the benefits of limited post-operative pain and shorter recovery time.

The aim of the present study is to assess clinical short term results of this surgical technique.

Materials and Methods

Medical data from patients with carpal tunnel syndrome, confirmed by electromyography, operated by the same surgeon using the percutaneous sonography method between July 2017 an April 2021 were retrospectively reviewed. Follow–up appointments were set at 14 days, 1 month, 3 months, 6 months and 9 months at which measurement of grip and pinch strength were systematically performed. Additionally, the presence of Tinel, Phalen and Durkan signs as well as pillar pain were systematically assessed. Odds ratios were calculated with x2 test, while continuous variables means were compared with one-way ANOVA.

Results

A total of 278 patients were included in this study with a mean age of 56.5 y.o. All surgeries were performed under local anesthesia. The mean duration of each procedure was 13 minutes (range 4-32minutes). No major complication like nerve, artery nor tendon iatrogenic lesion, and no post-operative infection were observed. A hundred and seventy patients were operated unilaterally while 67 patients were treated on both sides with the same method. At 14 days a significant decrease (p<0.001) in the grip (mean= 44.49%) and pinch strengths (mean= 35.9%) were recorded. Both values returned to their prior to surgery levels at 6 months (mean reduction G-0.7%; P-6.9%) and increased at 9 months post-surgery for the grip strength (mean reduction G-10.4%; P-0.8%). Tinel, Phalen and Durkan signs disappeared within the first three months post-operatively. Pillar pain appeared immediately post-surgery in 65.7% of patients and was persisting in 21.4% of patient at 6 months.

Discussion and conclusions

Percutaneous sonographically guided carpal tunnel release is a safe and effective procedure. Even if the procedure is minimally invasive, post operative functional limitations like decreased grip and pinch strength and pillar pain are observed in a significant proportion of patients. Prospective randomized comparative studies should be performed to better assess the functional advantages of this technique over the classical open procedure.

en
FM20

Cognitive nerve transfers to restore hand function in spastic hemiplegia

Olga Politikou1, Anna Bösendorfer1, Agnes Sturma1, Gottfried Kranz1, Richard Lieber2, Oskar Aszmann1 (1Wien AT; 2Chicago US)
Details

Objective: Stroke is nowadays a leading cause of disability with devastating sequelae. Upper limb spasticity is one of them. Nevertheless, not all the muscles are equally affected, as some may turn spastic or paretic and other remain intact. This unique pathophysiological mosaic dictates a precise therapeutic plan. Existing spasticity treatment has significant drawbacks due to its unspecific targeting and short duration. A causal, life-lasting treatment, precisely adapted to every single patient's needs and to disease pattern, is currently missing. Hyperselective muscle denervation and subsequent cognitive reinnervation with appropriate unaffected donor nerves may break the pathological spastic circuit and provide volitional muscle control. We performed cognitive nerve transfers to spastic muscles of stroke patients and prospectively investigated their effects on clinical and functional level.

Methods: To provide volitional muscle control of finger flexors and wrist/fingers extensors we transferred the branch to brachialis muscle to the anterior interosseous nerve and the branch to the lateral head of triceps to the deep branch of radial nerve in a total of five hemiplegic patients. As spastic forearm pronation was always present, we additionally cognitively reinnervated the pronator teres muscle with a branch to the pectoralis major muscle using a nerve graft. Supplementary surgical steps as tendon lengthening and hyperselective neurotomies were performed as needed. Nerve donors had been always carefully selected, provided they could be volitionally recruited and de-recruited and had a minimum M4 strength. Clinical and functional outcomes are evaluated 6 and 12 months after surgery.

Results: At 6-month follow-up, all patients had improved DASH and CAHAI scores and modified Ashworth scale revealed no abnormality in muscle tone and resistance to passive stretch. Muscle activity of the newly reinnervated muscles could be observed only electrophysiologically with surface electromyography. The 12-month follow-up is still ongoing.

Conclusion: A novel concept for treatment of upper limb spasticity after stroke that allows patients to regain volitional muscle control has been now established. Cognitive muscle reinnervation through selective nerve transfers reduces spasticity and offers the possibility for permanent biological restoration of hand function.

en
FM21

Stiffness and finger kinematics after intra-articular PIP joint fractures

Gabriella Fischer1, Esin Rothenfluh1, Dominic Hirter1, Bill Taylor1, Maurizio Calcagni1 (1Zürich)
Details

Objective:

Posttraumatic stiffness of the proximal interphalangeal (PIP) joint is very common and can severely affect hand function. Despite its potentially high impact, joint stiffness is usually not assessed quantitatively in clinical settings. The aim of this study was to measure joint stiffness in patients after treatment of intra-articular PIP fractures and to assess the relationship between joint stiffness and daily function.

Methods

Ten patients with intra-articular PIP joint fractures and a minimum follow-up time of 2 years were included. The stiffness of the PIP joint of the affected digit was measured using a newly developed finger stiffness measurement device (FSMD). It measures the torque required for a predefined movement sequence, while the finger is fixed in the device and passively moved by an actuator.

In addition, 3D motion analysis was used to record kinematics of all finger joints during maximal flexion-extension movements and when grasping four different objects: 1.5l bottle (empty and full) and dumbbell (1kg and 3kg). Maximum range of motion (ROM) and joint stiffness were compared between affected and healthy side using paired t-tests.

Results:

Average stiffness of the PIP joint was 0.0028Nm and 0.0024Nm for the affected finger and the healthy contralateral PIP joint (p=0.01). One patient with swan-neck deformity had to be excluded as the finger could not be positioned correctly in the FSMD.

Mean ROM in the affected PIP joints (77°) was significantly reduced (p=0.0005) compared to the ROM of the healthy PIP (108°). In the functional tasks, PIP ROM for gripping bottles and dumbbells ranged from 23-36° and 52-71°, respectively. ROM of the affected PIP was significantly reduced when gripping a full/empty bottle (p<0.03) and a 3kg dumbbell (p=0.03).

Conclusion
The application of the new FSMD was shown to be successful in most cases. The applied force of the FSMD was easily tolerated by all patients without causing pain or discomfort. Patients after intra-articular fractures showed a reduced maximal ROM as well as an increased joint stiffness in the affected PIP. Despite not requiring the full ROM of the joint in the functional tasks, there was still reduced PIP motion compared to the healthy side.

Measurements of joint stiffness complements standard clinical outcome assessment. The influence of increased stiffness on hand function with regards to intra- and inter-digital coordination and different treatment modalities will be further investigated.

de
15:00 – 15:15
Pause

Pause courte sans repas

15:15 – 16:30
Schadausaal
Sessions SSCM/SSRM

Session principale III

Big Data and quality control in hand surgery and therapy

Maurizio Calcagni, Zürich , Bernadette Tobler-Ammann, Bern

Real World Data based research. How Outcome Registry based clinical research works and what can be reached.

Ruud Selles1 (1Rotterdam NL)
en

How to implement registries in our practice and how does research on outcomes help us to treat patients?

Steven Hovius1 (1Rotterdam NL)
en

Implant registries: Benefits and challenges of long-term follow-up

Miriam Marks1 (1Zürich)
en

Establishing an outcome registry in hand surgery. Experiences learned from SupExOR at the USZ.

Myrna Gunning1, Maurizio Calcagni1 (1Zürich)
en

Discussion

15:15 – 16:30
Lachensaal 1
Sessions SSCM

Polit-Podium

Inflation und Arzttarife

Pius Gyger, Zürich , Urs Hug, Luzern
Details

Inflation und Arzttarife

Dr. med. Urs Stoffel, Mitglied des FMH-Zentralvorstandes
Wolfram Strüwe, Leiter Gesundheitspolitik Helsana
PD Dr. med. Boris Czermak, Handchirurg
Felix Schneuwly, Head of Public Affairs Comparis
Dr. med. Josef Widler, Präsident Zürcher Ärztegesellschaft

15:15 – 16:30
Workshop-Raum 1
Sessions SSRM

Atelier C

Livia Andrey, Biel

Die 360° Manschette: Mehr Extension, Flexion, Supination und Pronation in einem. Zeit- und kosteneffiziente Quengelmanschette aus NRX

Anja Walter1, Rebecca Glanzmann1 (1Sursee)

Avec le soutien de Rehatec AG, Allschwil.

La mobilité du poignet a une très grande importance lors de chaque utilisation du bras et de la main. A quelle fréquence sommes-nous confrontés, en thérapie, à un manque de mobilité du poignet ?

Details

La mobilité du poignet a une très grande importance lors de chaque utilisation du bras et de la main. A quelle fréquence sommes-nous confrontés, en thérapie, à un manque de mobilité du poignet ? A quelle direction l’attelle dynamique doit-elle être consacrée en premier ? Extension, flexion, pronation ou supination ? Nous pouvons confectionner une attelle différente pour chaque direction de mouvement. Cela demande beaucoup de temps et est coûteux. Nous avons la solution pour obtenir une grande qualité en un minimum de temps!

Dans notre atelier, nous montrerons comment fabriquer, à partir de straps en néoprène et de chutes d’attelles, une manchette simple mais très efficace pour améliorer la mobilité en extension, en flexion, en supination ET en pronation. Une fois taillée sur mesure, la manchette peut être mise en place par le patient très facilement et rapidement, d’une seule main. Elle est très bien tolérée par nos patients et nous recevons de nombreux commentaires positifs. Le matériau est bon marché et peut être utilisé pour diverses attelles. Nous présenterons brièvement d’autres possibilités d’utilisation comme par exemple une manchette pour le pouce, une attelle de flexion dynamique MCP/PIP, une syndactylie, etc.

16:30 – 17:00
Pause

Pause café

17:00 – 18:30
Schadausaal
Sessions SSCM

Réunion des membres SSCM

17:00 – 18:30
Lachensaal 1
Sessions SSRM

Réunion des membres SSRM

De 19:30
Alte Reithalle Thun

Soirée de fête conjointe