Comparative outcomes of total wrist arthrodesis for salvage of failed total wrist arthroplasty and primary wrist arthrodesis

A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes. Level of evidence: III

Goldwater After Trump

The “Goldwater rule,” a policy adopted by the American Psychiatry Association (APA) in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until the election of Donald Trump in 2016. Since that time, a significant number of psychiatrists have either violated or criticized the rule openly. This paper argues that whatever the initial merits of the rule, the prohibition has since been rendered obsolete by the combined lack of professional consensus supporting the policy, absence of a meaningful enforcement mechanism, and the credible statements of non-APA members in the mental health professions regarding public figures.

The Key Pinch Stress Radiograph to Evaluate Dorsal Subluxation in the Basilar Thumb Joint

The basilar thumb joint is the joint second most commonly affected by osteoarthritis (OA) in the hand. Evaluation of dorsal subluxation of the thumb during a functional task such as key pinch could help assess OA risk. The objectives of this study were to determine the best imaging angle for measuring thumb dorsal subluxation during key pinch and to compare subluxation to corresponding OA grades on the Eaton-Glickel, Outerbridge, and ICRS scales. Eleven cadavers cadveric forearm specimens were rigged to simulate key pinch. A mobile c-arm captured AP view images of the hand, and rotating in 5° increments toward the ulnar aspect of the arm up to 60°. Dorsal subluxation was measured on each image and compared to determine which angle captured maximum subluxation. The resulting best imaging angle was used for comparisons between dorsal subluxation of the thumb and OA grades for the basilar thumb joint. The max subluxation was in the AP view for most specimens. There was a significant correlation between subluxation and the Eaton-Glickel grade (p=0.003, R2 = 0.779), but not with either Outerbridge grades (p=0.8018) or ICRS grades (p=0.7001). Dorsal Our results indicate that dorsal thumb subluxation during key pinch should be measured in the A-P view of the forearm/handhand view. Dorsal thumb subluxation during key pinch had a significant correlation with the Eaton-Glickel radiographic measure of OA but not with more accurate visual classifications of OA.

Validation of a Malay Version of the Patient-Rated Wrist Hand Evaluation (PRWHE-MV)

INTRODUCTION: The Patient-Rated Wrist Hand Evaluation (PRWHE) is a widely used measure of patient[1]reported disability, pain and appearance related to both hand and wrist disorders. It has been adapted cross[1]culturally worldwide but not in Malaysia. We performed a translation and cross-cultural adaptation of the PRWHE into a Malay version (PRWHE-MV) with assessed reliability and validity in patients presented with hand and/or wrist disorders. MATERIAL AND METHODS: PRWHE-MV was developed via translation and resolution of cultural discrepancies. A total of 83 patients (38 men, 45 women) with the mean age of 38 (SD 14) years and hand and/or wrist disorders completed both PRWHE-MV and the Malay version of Quick DASH during their first orthopaedic hand clinic follow up, and a second PRWHE-MV at 48 hours later. Intraclass Correlation Coefficient (ICC) was used to assess test-retest reliability of the PRWHE-MV while Cronbach’s alpha was calculated to assess the internal consistency. We tested the validity of PRWHE-MV against the Malay version of Quick DASH by calculating the nonparametric Spearman’s correlation coefficient between these two measures. RESULTS: There was no major cultural problems during the forward and backward translation of PRWHE, except for a minor change owing to cultural discrepancy in toilet hygiene. The Cronbach alpha PRWHE-MV was 0.978 (SEM = 5.5) at baseline and 0.979 (SEM = 5.35) at the second assessment. For the test-retest reliability, ICC was 0.99. There was a strong direct correlation between the scores for the PRWHE-MV and the Quick DASH (r = 0.916, p< 0.001). A majority of patients considered hand appearance somewhat important and were bothered in the past week. Their main concerns were gaining back normal hand function and subsequently returning to work. CONCLUSION: The PRWHE-MV showed high internal consistency, test-retest reliability and good validity in patients with hand and/or wrist disorders.

Effect of mCIMT with and without interval on hand in patient suffering from stroke

Introduction. Paresis of hand has severe impact on the life of the stroke patients. Modified constrained induced movement therapy (mCIMT) can be used to treat the involved limb of the patient. It involves constraining of functional hand and increasing the activity of paretic hand which overcomes the “learned disuse” that develops following stroke but the constraining also creates difficulties for the patient and reduces his/her compliance to the treatment. Hence this trial aims to study the effect of mCIMT with and without interval to see if providing relaxation in between the treatment would be able to produce similar effect as mCIMT without interval protocol. Matgerial and methods. 44 patients were recruited in the study and were divided in to three groups: mCIMT without interval (n = 18), mCIMT with interval (n = 16) and control group (n = 10). Participants in three groups were examined for pain and functionality of hand through Patient rated wrist hand evaluation score and Box and Block test at pre and post intervention. The intervention was given for 6 days/week for two weeks. Therapy time was 2 hours and constrain was for 6 hours a day. Clinical trial registration number -CTRI/2019/12/022547. Results. No baseline differences were found in between the three groups. There was significant increase in box and block test score and significant decrease in PRWHE score in pre and post treatment readings for with and without interval mCIMT but non-significant changes in PRWHE score and box and block test were seen in control group. Conclusion. Both interval and without interval mCIMT was effective. Interval mCIMT was seen to be more comfortable than without interval mCIMT for the patient.

Strategy for Application of Support Object for Fall Prevention in the Elderly Based on Balance Recovery Characteristics

This research proposes a strategy for applying support objects—equipment, tools, and even furniture/environment from which humans can receive reaction force through their hands—for fall prevention in the elderly. This paper presents an assessment example of support objects based on balance recovery characteristics and a discussion regarding their application according to the assessment results. The balance recovery characteristics depend on the direction in which reaction force can be obtained based on the shape of the support object and direction in which the force is easily exerted on the hand. Evaluation indices for assessing the height and shape of nonportable support objects and determining a position of the tip on the ground of a cane, a typical portable support object, in the anterior direction are briefly introduced based on the authors’ previous works. The strategy for the application of support objects utilizing the evaluation indices is proposed; better use of support objects, their locations, new-shaped ones, and support devices with a new design concept are discussed and introduced based on the values of the calculated indices according to the type/usage of the support objects.