Search

Background: There is no current consensus on which of the two most common flexor digitorum profundus (FDP) avulsion repair constructs, via suture button pullout (SBP) or suture anchor (SA), is biomechanically superior. Our purpose was to compare these repair methods via systematic review and meta-analysis of available literature. Methods: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of PubMed, the Cochrane library, and Embase. We only included studies with direct comparison data for both techniques. We performed a meta-analysis comparing the reported biomechanical results using pooled data for initial repair stiffness (N/mm), gap formation (mm), and ultimate load to failure (N). Results: Seven studies met inclusion criteria, including a total of 201 cadaveric specimens. Four studies reported initial construct stiffness, with pooled analysis showing superiority for SA repairs (P <.05). Four studies evaluated gap formation, with pooled analysis demonstrating less gapping with SA repair (P <.05). Mean gap formation was 2.4 (±1.4) mm and 3.9 (±2.0) mm for the SA and SBP groups, respectively. All 7 studies assessed load to failure, with pooled analysis revealing no significant difference between groups (P >.05). We lacked statistical power to determine equivalence between techniques for load to failure. Both groups had failure values significantly lower than the native FDP. Conclusions: Via meta-analysis, there was increased initial construct stiffness and less gap formation for SA compared to SBP for FDP reinsertion, with no significant differences for ultimate failure load. [ABSTRACT FROM AUTHOR]

Background: Free fibula flap (FFF) and medial femoral condyle (MFC) flap are commonly used for upper extremity osseous reconstruction, yet donor-site morbidity has never been systematically compared. Methods: Patients who underwent an FFF or MFC for upper extremity extra-carpal osseous reconstruction at 3 academic hand centers were retrospectively identified. Only patients who underwent reconstruction for a defect in which either flap type is routinely used or has been described in the literature were deemed eligible. Patients who agreed to participate were asked to complete the Lower Extremity Functional Scale (LEFS) and Lower Limb Core Scale (LLCS). The reported population norm median score of LEFS is 77 points. The LLCS population norm mean score is 90.52 points. Results: Twenty-one patients (10 MFC, 11 FFF) were enrolled. The median LEFS score for patients after MFC was 76 (interquartile range [IQR], 49-80) points and 75 (IQR, 56-79) points after FFF. The median LLCS score for patients after MFC was 96.4 (IQR, 87.9-100) points and 100 (IQR, 91-100) points after FFF. Median LEFS scores were slightly below the population norm, whereas median LLCS scores were above the norm for both FFF and MFC. All patients stated they would have the surgery again and that any dysfunction or pain in the leg was justified by the benefit in the arm. Conclusions: When considering whether to use an MFC or FFF for upper extremity reconstruction, both flap types appear to result in modest and comparable donor-site morbidity. [ABSTRACT FROM AUTHOR]

Background: This article will describe the development of a low-cost 3D-printed medical phantom of the arm with a distal radius fracture (DRF) to facilitate training of reduction and splinting techniques. The phantom incorporates tactile responses and visual stimuli from fluoroscopy to assist skill acquisition in a clinical setting. This provides feedback to trainees to help them develop competency and knowledge before providing care to patients., Methods: Phantoms were developed through advice and feedback from fellowship-trained hand surgeons and orthopaedic senior and junior residents. Phantoms were then pilot tested during a surgical skills examination, with residents having minimal previous exposure to distal radial reduction techniques. Residents were evaluated on procedure speed and accuracy by attending surgeons using the objective structured assessment of technical skills. Residents then completed a written knowledge examination about relevant requirements of DRF management and feedback on their opinion of the exercise using the Likert scale., Results: Residents who passed the hands-on examination also scored higher on the written examination. All residents reported that the phantom was beneficial and motivating as part of their overall training., Discussion: Real-time feedback using a phantom limb and fluoroscopic imaging, in conjunction with guidance from surgeons, allows residents to learn and practice DRF reduction and splinting techniques. These educational exercises are relatively low-cost and remove the risk of potential harm to patients during early skill acquisition. This training method may be a predictor of surgical performance in addition to providing assessment of background knowledge. Additional training sessions will be required to determine the effect of repeat exposure to residents' proficiency and comprehension., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)