Hand Surgery

Purpose To evaluate long-term efficacy and safety of collagenase clostridium histolyticum (CCH) after the third year of a 5-year nontreatment follow-up study, Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study.

Between January 2000 and July 2009, five adults who had suffered bilateral traumatic below-elbow amputations, received bilateral hand-forearm allografts performed by the Lyon team. We report the functional benefits achieved over a mean follow-up period of 7.6 years (range 4–13 years), up to December 31st, 2013. Clinical measurement is hampered by the lack of specific validated assessment tools, obliging us to use non-specific standardized evaluation means. Our assessment shows that the restoration of motion, strength, and sensibility are fair. Functional results (Carroll upper extremity function test, 400-point test, Activities of daily living) are good, as well as quality of life evaluation (RAND-36). Subjective and overall results explored with questionnaires – Disabilities of the Arm Shoulder and Hand (DASH), Hand Transplantation Score System (HTSS), are very good. Improvement was seen to continue during the first three years, and then tend to become stable. Continued efforts should be directed at designing comprehensive, condition-specific, reliable outcome measurement tools. Continuous monitoring and evaluation of patients is required to assess the long-term risk-benefit balance.

Study Design: Retrospective cohort study.
Introduction: Somatosensory rehabilitation is a standardized method of evaluation and conservative treatment of painful disorders of vibrotactile sensation, including the mechanical allodynia and burning pain of complex regional pain syndrome (CRPS).
Purpose of the Study: The purpose of this study was to examine the effectiveness of somatosensory rehabilitation for reducing allodynia in persons with CRPS of 1 upper limb in a retrospective consecutive cohort of patients.
Methods: An independent chart review of all client records (May 2004-August 2015) in the Somatosensory Rehabilitation Centre (Fribourg, Switzerland) identified 48 persons meeting the Budapest criteria for CRPS of 1 limb who had undergone assessment and treatment. Outcomes of interest were the French version of the McGill Pain Questionnaire (Questionnaire de la Douleur St-Antoine [QDSA]), total area of
allodynia as recorded by mapping the area of skin where a 15-g monofilament was perceived as painful, and the allodynia threshold (minimum pressure required to elicit pain within the allodynic territory).
Results: This cohort was primarily women (70%), with a mean age of 45 years (range: 18-74). Mean duration of burning pain was 31 months (range: 1 week-27.5 years), and baseline QDSA core was 48. The average primary area of allodynia was 66 cm2 (range: 2.6-320), and the most common allodynia threshold was 4.0 g. The average duration of treatment was 81 days. At cessation of treatment, the average QDSA score was 20 (effect size Cohen’s d ¼ 1.64). Allodynia completely resolved in 27 persons (56% of the total sample where only 58% completed treatment).
Discussion: This uncontrolled retrospective study suggests that somatosensory rehabilitation may be an effective treatment with a large effect size for reducing the allodynia and painful sensations associated with CRPS of the upper limb. More work is in progress to provide estimates of reliability and validity for the measurement tools for allodynia employed by this method.
Level of Evidence: 2c.

Agenesis, functional deficiency and the common type of the flexor digitorum superficialis of the little finger: A meta-analysis Age´ne´sie, de´ficit fonctionnel, et variations anatomiques les plus courantes du flexor digitorum superficialis de l'auriculaire : une me´ta-analyse Agenesis, functional deficiency and the common type of the flexor digitorum superficialis of the little finger are reported in the literature to be highly variable with significant discrepancy between clinical and cadaveric frequencies. The aim of this systematic review was to generate overall clinical and cadaveric weighted frequencies, along with ancestry-based, side-based, sex-based and laterality-based frequencies. A systematic literature search identified 34 studies including 12,213 forearms/hands that met the inclusion criteria. Functional deficit of the FDS tendon of the little finger was significantly more prevalent among Iranian and Caucasian populations as compared to Indian, East African and Chinese populations. The weighted ''clinical'' frequency of functional absence of the FDS tendon of the little finger was 7.45%, while prevalence of the common type was 37.5%. The weighted ''cadaveric'' prevalence of muscle absence of the FDS-5 in the forearm was 2.5% while tendon absence in the hands was nil. An expanded examination technique proved to be the most accurate test for FDS function. In case of injury, inadequate knowledge of different connections or substitutions of the FDS-5 could lead to a total loss of flexion of the little finger. These findings support the hypothesis of a dual origin of the FDS-5 where the muscle portion originates in the forearm, while the tendon portion originates in the hand. C 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved. R E ´ S U M E ´ L'agé né sie, le dé ficit fonctionnel et les variations anatomiques les plus courantes du flexor digitorum superficialis de l'auriculaire (FDS-5) sont rapporté s dans la litté rature avec une grande variabilité et une divergence significative entre les fré quences cliniques et cadavé riques. Le but de cette revue systé matique e ´ tait de gé né rer des valeurs pondé ré es de fré quence clinique et cadavé rique avec celles basé es sur l'ethnicité , le côté , le sexe et la laté ralité. Une recherche systé matique dans la litté rature a identifié 34 e ´ tudes, comprenant 12.213 avant-bras et mains, et remplissant les critè res d'inclusion. Le dé ficit fonctionnel du tendon du FDS-5 e ´ tait significativement plus fré quent parmi les populations iraniennes et caucasiennes que parmi les populations indiennes, chinoise et de l'Afrique de l'Est. La fré quence clinique pondé ré e de l'absence fonctionnelle du tendon du FDS-5 e ´ tait de 7,45 % tandis que celle du type commun e ´ tait calculé e a ` 37,5 %. La pré valence cadavé rique pondé ré e de l'absence du muscle FDS-5 a ` l'avant-bras e ´ tait de 2,5 % et celle de son tendon a ` la main e ´ tait de 0 %. La technique de G Model HANSUR-198; No. of Pages 9 Please cite this article in press as: Yammine K, Eric´M. Agenesis, functional deficiency and the common type of the flexor digitorum superficialis of the little finger: A meta-analysis. Hand Surg Rehab (2018), https://doi.

Minimal important changes and differences describe the smallest changes and differences between individuals that are relevant to patients following treatment. Minimal important differences may vary between conditions, treatments and lengths of follow-up, and can be calculated in different ways. Minimal important differences for elective hand surgery were reviewed. A total of 99 minimal important differences were identified in 29 articles. The conditions, treatments, outcome measures used and follow-up periods are discussed. The Disabilities of the Arm, Shoulder and Hand had the most estimates of minimal important differences, but these varied. The methods used in the included studies were reviewed and appraised. Most minimal important differences were calculated using retrospective anchors. Future research directions in this area are suggested.

HOXD13, the most 5 gene of the HOXD cluster, encodes a homeodomain transcription factor with important functions in limb patterning and growth. Heterozygous mutations of human HOXD13, encoding polyalanine expansions or frameshifts, are believed to act by dominant negative or haploinsufficiency mechanisms and are predominantly associated with synpolydactyly phenotypes. Here, we describe two mutations of HOXD13 (923CrG encoding Ser308Cys and 940ArC encoding Ile314Leu) that cause missense substitutions within the homeodomain. Both are associated with distinctive limb phenotypes in which brachydactyly of specific metacarpals, metatarsals, and phalangeal bones is the most constant feature, exhibiting overlap with brachydactyly types D and E. We investigated the binding of synthetic mutant proteins to double-stranded DNA targets in vitro. No consistent differences were found for the Ser308Cys mutation compared with the wild type, but the Ile314Leu mutation (which resides at the 47th position of the homeodomain) exhibited increased affinity for a target containing the core recognition sequence 5 -TTAC-3 but decreased affinity for a 5 -TTAT-3 target. Molecular modeling of the Ile314Leu mutation indicates that this mixed gain and loss of affinity may be accounted for by the relative positions of methyl groups in the amino acid side chain and target base.