جستجوی مقالات مرتبط با کلیدواژه « hand surgery » در نشریات گروه « پزشکی »

The aim of this study was to perform a bibliometric analysis to assess the number of articles published by Iranian researchers in the field of hand and microsurgery over the last four decades.

An online search was conducted using 685 keywords in the abstract/ title sections of articles, including carpal tunnel syndrome, wrist fractures, nerve injury and repair, skin flap and graft in the hand, congenital disorders in the hand and forearm, tumor in the hand and wrist, and infection in the hand and wrist. From February 1976 to May 2021, EndNote software version 8.1 was used to search articles in PubMed and Scopus databases. Articles in which at least one of the authors was affiliated with Iran were chosen. The name of the original institution, field of study, total number of publications, type of study, collaboration rate of Iranian hand surgeons for each year, and annual sharing of Iranian articles in journals with the highest cite scores in the field of hand and microsurgery were all examined in the present study.

The total number of publications in the field of hand and microsurgery was 632 (an average of 11 papers per year). Most of the Iranian hand and microsurgery papers were from the capital city, Tehran (38.09%). There was an increasing trend in the number of publications over the years, most which were about carpal tunnel syndrome (21.5%), tendon (9.8%), and nerve (9.6%). In total, 59.6% were descriptive articles, whereas the proportion of clinical trials was relatively small (22.3%).

Iranian hand microsurgeons have continued to increase their scientific output in hand microsurgery and related fields over the last 40 years. The quality of Iranian hand microsurgeons’ scientific output, both within and outside their discipline, has greatly improved; however, they still have a long way to go before becoming a hub of science.

The purpose of the present study is to report the incidence of operating room fires during hand surgical procedures. The clinic and OR electronic medical records of seven fellowship-trained orthopedic hand surgeons at a single, large practice were retrospectively reviewed. All upper extremity procedures performed between June 2014 to June 2019 in both hospital and surgery center settings were included in the review. Demographic data was collected. The incidence of operating room fires was determined. A total of 18,819 hand and upper extremity surgical procedures were included. There were 16,767 (89.1%) cases performed in a surgery center, while 2,052 (10.9%) of cases were performed in a hospital. There were 12,691 (67.4%) soft tissue procedures and 6,127 (32.6%) bony procedures performed. Chlorhexidine gluconate preparation solution was used in 9607 cases (51%). Chloraprep solution was used in 6280 cases (33.4%). Betadine was used in 2,932 cases (15.6%). One surgeon has monopolar electrocautery only available during cases. Five surgeons have bipolar available, and one has both mono and bipolar electrocautery available. There were no fires (0%) identified during the study period. The incidence of operating room fires during hand surgical procedures is extremely low. While hand surgeons can be reassured that the likelihood of an operating room fire is minimal, surgeons should not become complacent and should maintain a high level of vigilance to prevent these potentially devastating occurences. Level of evidence: IV

The prevalence of wide-awake hand surgery using local anesthesia has increased substantially. The fullinfluence of perioperative factors, namely operating room temperature, on patient comfort during these procedures ispresently underreported. One hundred and fifty-eight patients undergoing wide-awake hand surgery using local anesthesia wereprospectively enrolled. Surveys with visual analog scale (VAS) were administered after surgery to assess overallpatient comfort (OPC) and patient comfort with temperature (TPC). Operating room temperature at the initiation of theprocedure, surgery type, duration of surgery, tourniquet use and local anesthetic use were all recorded and their impacton patient comfort analyzed. The VAS used ranged from 1 (least comfortable) to 5 (most comfortable). Across all patients, the mean OPC was 4.7 (Range: 2 – 5, SD=0.6) and the mean TPC score was 4.7 (Range2 – 5, SD=0.6). There were weakly negative correlations between room temperature and VAS score for OPC (rs =-0.2,P=.038) and TPC (rs=-0.2, P=.051). The mean OPC score was lower with tourniquet use [4.6 (SD=0.7) versus 4.9(SD=0.4), P=.002]. Patient comfort during surgery using local anesthesia is not substantially affected by operating roomtemperature. Tourniquet use negatively impacts patient-reported comfort. Continued studies into the optimization ofpatient comfort during wide-awake hand surgery are warranted.Level of evidence: IV

There is still some debate regarding the most proper anesthetic technique in minor hand surgeries. Wehypothesized that both the WALANT and forearm tourniquet Bier block methods provide effective anesthesia in minorhand surgeries without significant difference. A total of 85 patients consented to participate in this study and were randomized into WALANT and singletourniquet forearm Bier block groups. In WALANT group, patients received adrenaline-contained lidocaine withouttourniquet while lidocaine was administered accordingly after applying a forearm tourniquet in Bier group. Due todifference in intervention methods, the study was non-blinded. Need for additional analgesia during surgery, visualanalogue scale (VAS) for pain intensity during operation and an hour later, amount of bleeding and active handmovements were evaluated and recorded. The need for analgesia and severity of pain (VAS) during surgery and one hour later were significantly lessin WALANT group, whereas the amount of bleeding was less in Bier block group. The ability to move hand and fingersduring the operation was the same in both groups. Both WALANT and single cuff forearm tourniquet Bier block are effective methods in minor hand surgeries,however, forearm Bier block provides less analgesia and pain control with a drier field than WALANT method.Level of evidence: I

Isolated fractures of the trapezoid are very rare. Of all of the fractures of the carpus, the most common happens for the scaphoid, which represents 68.2% of all carpal fractures. In contrast, trapezoid fractures represent 0.4% of all carpal injuries. We present a rare case of a trapezoid fracture associated with a scaphoid fracture that was successfully treated with percutaneous fixation with a headless cannulated compression screw and the patient had a full functional recovery.

There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to theperception that this exposure will improve their professional “marketability” in a subspecialty they perceive as havinghigher compensation. Using Medicare data, we investigated the most common surgeries from these fields and determinedwhich have the highest compensation [work relative value unit (wRVU), payment, charge, and reimbursement(payment-to-charge percentage] rates per operative time. We then determined whether the overall non-weightedand weighted (by surgical frequency/volume) compensation rates of shoulder/elbow surgery are greater than thatof hand surgery. Among 30 shoulder/elbow procedures, arthroplasty and arthroscopic rotator cuff repair had the highest paymentand wRVU assignments. Among 83 hand procedures, upper-extremity flaps, carpal stabilization, distal radius openreduction internal fixation (ORIF), both-bone ORIF, and interposition arthroplasty had the greatest wRVU assignmentswith correspondingly high payments. A non-weighted comparison of the two subspecialties showed that hand surgeryhas a higher mean payment/min ($10.46±3.22 vs. $7.52±2.89), charge/min ($51.02±17.11 vs. $41.96±11.32), andreimbursement (21±4.7% vs. 18±5.1%) compared with shoulder/elbow surgery (all, P<0.01). Non-weighted meanwRVUs/min were similar (0.12±0.03 vs. 0.13±0.03, P = 0.12). When weighted by procedure frequency, hand surgeryhad greater wRVUs/min (0.15±0.036 vs. 0.13±0.032), payments/min ($14.17±4.50 vs. $6.97±2.26), charges/min($75.68±30.47 vs. $42.61±7.83), and reimbursement (20±5.0% vs. 17±6.0%) (all, P<0.01). According to Medicare compensation, and when weighted by procedure frequency, hand proceduresare associated with greater overall mean wRVUs/min, payments/min, charges/min, and reimbursement compared withshoulder and elbow procedures. Hand-surgery fellowship applicants should be aware that subspecialty compensationis complex in nature but should seek shoulder/elbow elective experience to acquire an additional surgical skill-set asopposed to primarily monetary reason.Level of evidence: III

The patient-rated wrist evaluation (PRWE) score is one of the most common clinical instruments used as an outcome measurement tool for distal radius fractures and other upper extremity conditions. The purpose of this study was to translate the PRWE into its Persian version and to evaluate its validity and reliability in patients with upper extremity conditions.
One hundred and fourthly one adult patients with upper extremity conditions participated in this ethical board approved study from August 2015 to May 2016. After translating the original version of the PRWE into Persian, all patients filled out the PRWE in addition to the VAS (Visual analogue scale) and DASH questionnaires. For evaluating reliability, after three days the researchers called back some of the patients who did not receive treatment or any changes in symptoms and asked them to complete the PRWE retest (104 patients).
Cronbach’s alpha was calculated as high as 0.934, implying very reliable internal consistency. After each item deletion, the Cronbach’s alpha was still constant (range: 0.926 to 0.936). Intraclass correlation coefficient was 0.952 and this showed excellent test-retest reliability. The correlation coefficient between the PRWE and DASH scores was strong. Multivariable analysis showed an association between the PRWE and years educated.
Our study has shown that the Persian version of the PRWE is valid and reliable for patients with upper extremity conditions.

As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.
One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9).
On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.
Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.

Hand surgery literature is full of disease names and terms. Some of them are misnomers, which are misleading to physicians outside the specialty. Therefore, we decided to collect all misnomers and provide them via this paper. Considering development of sciences in future, perhaps avoidance from new misnomers is impossible, but awareness of this fact, lead us to be more ingenious in interpretation. On the other hand, we believe this collection would be interesting for most specialists in hand surgery and as well informative for others.

Fast and holistic access to the patients’ clinical record is a major requirement of modern medical decision support systems (DSS). While electronic health records (EHRs) have replaced the traditional paper-based records in most healthcare organization, the data entry into these systems remains largely manual. Speech recognition technology promises substitution of the more convenient speech-based data entry with currently laborious manual method, in the near future. Developing effective speech recognition systems (SRS) require availability of standardized vocabulary databases. This study was aimed at developing a medical speech recognition database for reconstructive hand surgery based on the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). All codes related to hand problems were extracted from ICD-10. A sample of 2051 diagnosis codes was randomly selected from the patients’ records. The operation report paper sheets were transformed to electronic records. For each term, the SNOMED-CT was browsed to find the preferred synonym, using CliniClue® Xplore Software. For some words with several number of synonyms, the preference of reconstructive surgery specialists were asked using a researcher-made questionnaire. Ultimately, the preferred words was substituted throughout each document and used for developing a database of standard nomenclature. The developed database was used in speech-based recording clinical data in reconstructive hand surgery operating room and accuracy of 81% in correct recording of clinical data was observed. Therefore, development of standard medical nomenclature databases can facilitate accurate electronic recording of medical data and reduce the associated labor and cost posed by current manual method.

Trans-scaphoid perilunate fracture-dislocation and perilunate dislocations are among uncommon injuries, most commonly seen in young patients due to high energy trauma. The treatment can be achieved either surgically by open reduction and internal fixation or closed reduction and casting. To compare surgical versus non-operative results of treatment of trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocation, we collected the data of 34 patients who were treated at least 5 years before our study, twenty of whom were treated surgically and fourteen were treated nonsurgical. We compared clinical and radiological findings in two groups. Functional outcome was assessed by Mayo wrist score for each patient. The surgically treated patients had much higher Mayo wrist scores, 85 and 87.78 for perilunate dislocation and trans-scaphoid perilunate fracture-dislocation respectively, while 71 and 71.11 in non-surgically treated group respectively. Wrist range of motion was also more favorable in operative group (55 flexion - 54.28 extension for trans-scaphoid perilunate fracture-dislocation and 50 flexion, 51.66 extension for perilunate dislocations)than non-operative group(48.5 flexion, 48.1 extension for trans-scaphoid fracture-dislocations and 48.1 flexion, 50 extension for perilunate dislocation). The radiographic changes showed arthritic changes but those changes did not significantly interfered with functional outcome and wrist scores. Regarding our better clinical results after early open reduction and internal fixation for these injuries, we can suggest the operativetreatment of these complicated hand injuries.

Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair. Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group). The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day). The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03). According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01). There was not any case of re-tear or need to re-operate in the intervention and control groups. Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.