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Hand Surgery Journal Digest

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Hand Surgery Journal Digest

Mr Mark Phillips reviews the latest Hand surgery literature so you don’t have to.

  • The Bone and Joint Journal April 2016 page 519

This paper by D A Lees and others compares elevation of the arm vs exsanguination before tourniquet inflation. It demonstrates that there is a clear preference for exsanguination in terms of patient reported pain during the procedure

  • The American Journal Hand Surgery March 2016

On page 348 there is an analysis of the effectiveness of collagenase for Dupuytren’s disease of the thumb and 1st web space. Good results were obtained with significant improvement in almost all patients. The follow-up was only 6 months.

On page 367 there is a report on practice trends and probability of surgery based on the number of steroid injections for common hand conditions. The conditions looked at were: carpal tunnel syndrome, trigger finger, and DeQuervain’s Tenosynovitis (dQT). This was a review of a quarter of a million patients. Surgery was avoided in 17% of patients with carpal tunnel syndrome, 57% of patients with trigger finger, and 73% with dQT. About 70% of patients only had one injection before their operation with carpal tunnel syndrome, 58% with trigger finger, and is 67% with dQT. The predicted probability of surgery after carpal tunnel syndrome patients who received 2 injections was 44%. For trigger finger it was 26% after 2 injections and for dQT it was 17%

On page 404 there is a systematic review and meta-analysis of the management of distal radius fractures in the elderly. It seems that the current literature does not support the theory that operative management can provide better clinical outcomes for elderly patients with distal radius fractures.

  • The European Journal of Hand Surgery May 2016

There is a review of the need for prophylactic antibiotics in open distal phalanx fractures. This is a systematic review and meta-analysis. 353 fractures were included. There were no reported cases of osteomyelitis despite 164 fractures not receiving antibiotics. The conclusion is that prophylactic antibiotics are not required.