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David Ring - One of the best experts on this subject based on the ideXlab platform.
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reoperation after combined Injury of the index Finger repair versus immediate amputation
Journal of Hand Surgery (European Volume), 2016Co-Authors: Suzanne C Wilkens, Paul T Ogink, Femke M A P Claessen, Ali Moradi, David RingAbstract:Purpose To identify factors associated with unplanned reoperation of severely injured index Fingers and to address the number of amputations after initial repair. Methods In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index Finger Injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation. Results Among 114 patients with combined Injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and 8 after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for Fingers other than the index Finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair. Conclusions Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined Injury of the index Finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple Fingers. Effective shared decision making is particularly important in this setting given that 1 in 5 repaired index Fingers were eventually amputated. Type of study/level of evidence Therapeutic IV.
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the influence of job satisfaction burnout pain and worker s compensation status on disability after Finger injuries
Journal of Hand Surgery (European Volume), 2012Co-Authors: John Kadzielski, Arjan G J Bot, David RingAbstract:Purpose Motivation, job satisfaction, burnout, and secondary gain are factors that can influence return to work and disability after orthopedic injuries. The current study evaluated the separate effects of job satisfaction, burnout, and secondary gain on arm-specific disability after a Finger Injury. Methods Ninety-three employed patients with Finger injuries were enrolled in this prospective study, and 51 completed the follow-up. Burnout (measured with Shirom-Melamed's Burnout Measure), job satisfaction (measured with the Job Descriptive Index questionnaire), and demographics were assessed at the initial visit. After 6 months, arm-specific disability was measured with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and general health status was measured with the Short Form-36 (SF-36) survey, mental component summary (MCS) and physical component summary (PCS). Results In the 51 patients with complete follow-up, the mean DASH score was 12, the mean SF-36 PCS was 48, the mean SF-36 MCS was 49, and the mean pain rating was 2.1. In multivariable analysis, pain and worker's compensation status explained 52% of the variability in DASH scores (pain alone accounted for 49%); pain accounted for 14% of the variability in SF-36 PCS scores; and worker's compensation accounted for 11% of the variation in the SF-36 MCS scores. Conclusions The majority of variation in the SF-36 PCS and MCS scores remained unaccounted for by the models, but pain and worker's compensation were more important than job burnout or job satisfaction. Pain and worker's compensation were also significant predictors of the DASH. Clinical relevance Worker's compensation and pain were more important than job satisfaction and burnout in explaining variations in arm-specific disability in patients with Finger injuries. Type of study/level of evidence Prognostic II.
Yong Huang - One of the best experts on this subject based on the ideXlab platform.
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pullout wire fixation together with distal interphalangeal joint kirschner wire stabilization for acute combined tendon and bone double level mallet Finger Injury
Journal of Hand Surgery (European Volume), 2015Co-Authors: Xu Zhang, X Shao, Yong HuangAbstract:This article describes a previously unclassified type of combined tendon/bone mallet Finger. This supplements the conventional Doyle classification. The article also describes the technique for surgical treatment of such mallet Fingers, which involves the use of a pullout wire with K-wire stabilization of the distal interphalangeal joint.
Suzanne C Wilkens - One of the best experts on this subject based on the ideXlab platform.
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symptomatic neuroma following initial amputation for traumatic digital amputation
Journal of Hand Surgery (European Volume), 2017Co-Authors: Margot A Vlot, Suzanne C Wilkens, Neal C Chen, Kyle R EberlinAbstract:Purpose We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation. Methods We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development. Results Of 1,083 patients, 71 (6.6%) developed a symptomatic neuroma. Mean time to diagnosis was 6.4 months. A total of 47 patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index Finger Injury and avulsion Injury mechanism were significantly associated with a higher risk for symptomatic neuroma. Conclusions Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation and more than half of these patients will undergo revision surgery for neuroma, with a mean time to operative intervention of 11 months. Type of study/level of evidence Prognostic II.
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reoperation after combined Injury of the index Finger repair versus immediate amputation
Journal of Hand Surgery (European Volume), 2016Co-Authors: Suzanne C Wilkens, Paul T Ogink, Femke M A P Claessen, Ali Moradi, David RingAbstract:Purpose To identify factors associated with unplanned reoperation of severely injured index Fingers and to address the number of amputations after initial repair. Methods In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index Finger Injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation. Results Among 114 patients with combined Injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and 8 after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for Fingers other than the index Finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair. Conclusions Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined Injury of the index Finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple Fingers. Effective shared decision making is particularly important in this setting given that 1 in 5 repaired index Fingers were eventually amputated. Type of study/level of evidence Therapeutic IV.
Alexander M Spiess - One of the best experts on this subject based on the ideXlab platform.
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small Finger osteocutaneous fillet flap for reconstruction in ring Finger trauma
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Brodie Parent, Liliana Camison, Guilherme Barreiro, Alexander M SpiessAbstract:Finger amputations are common injuries which result in significant long-term morbidity and loss of function. In this report, we describe a creative operative solution for a 21-year-old man who was in a motorcycle crash and sustained severely comminuted open fractures of the left small and ring Fingers with severe crush Injury and soft tissue avulsion. Of the tissues and bones in the small Finger, only the distal half of the proximal phalanx remained intact and was vascularized via the remaining ulnar neurovascular bundle. In the ring Finger, the extensor mechanism and ulnar neurovascular bundle were avulsed and the distal half of the proximal phalanx was absent, but the flexor tendons were intact. A small Finger ray amputation was performed. Then, using an osteocutaneous fillet flap based on the ulnar neurovascular bundle from the small Finger, the bony gap and soft tissue deficits in the ring Finger were reconstructed. The ring Finger extensor tendon was then reconstructed. Subsequently, the patient had evidence of bony union on follow-up X-rays and he had a sensate filet flap over the ulnar aspect of the ring Finger. This case demonstrates the creative use of a "spare-parts" osteocutaneous fillet flap in the reconstruction of a traumatic Finger Injury. This example highlights the importance of assessing all available reconstructive options to avoid the morbidity of a Finger amputation.
Wade R Smith - One of the best experts on this subject based on the ideXlab platform.
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replantation versus revision of amputated Fingers in patients air transported to a level 1 trauma center
Journal of Hand Surgery (European Volume), 2010Co-Authors: Kagan Ozer, William Kramer, Syed Gillani, Allison E Williams, Wade R SmithAbstract:Purpose To assess the rate of replantation versus revision of amputated Fingers in patients air-transported to a tertiary care hand trauma center. Methods We included 40 consecutive subjects (70 digits) who were transported via air after digit(s) amputation distal to the metacarpophalangeal joint. The primary outcome measure was type of surgery (attempted replantation vs revision of the amputation). Data were collected prospectively. Results We identified 3 groups of patients. In group 1 (15 patients, 23 digits), replantation of one or more digits was attempted. In group 2 (6 patients, 8 digits), replantation was not elected. In group 3 (19 patients, 39 digits), no digits were suitable for replantation. The mean age was 36.2 years (range, 5–69 years) and mean time of transport was 5.15 hours (range, 1–24 hours). Mechanisms of Finger Injury were crush (n = 34), followed by clean cut (n = 15), avulsion/crush (n = 15), and gunshot (n = 6). No significant differences were found between groups for age or time elapsed from Injury to hospital arrival. Most patients (n = 25; 65%) transported via air did not undergo replantation surgery. Injury characteristics (n = 18 patients, 72%) were the main reason not to replant. The most common reason for the refusal of replantation was inability to return to work immediately. The most common reasons for surgeon's decision to not to replant were single digit amputations proximal to flexor digitorum superficialis attachment (7 patients), and crush/avulsion type injuries (7 patients), followed by health status and age (5 patients). Conclusions This study shows that a considerable portion of patients transported via air do not undergo replantation surgery. Further studies are needed to establish whether this is an overused service.