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Treatment of Mallet Finger - A Review

100%
Żyluk A., Piotuch B.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
243-250
2
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An Assessment of the Usefulness of Patient Evaluation Measure Questionnaire as an Outcome Measure after Carpal Tunnel Surgery

100%
Piotuch B., Żyluk A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 6
347-353
EN
Outcome assessment of carpal tunnel release has relied upon objective measurements including grip strength and sensory testing as well as subjective parameters such as relief from pain and improvement of hand function. The latter can be obtained by the use of standardized questionnaires.The aim of the study was to assess the usefulness of Patient Evaluation Measure (PEM) questionnaire as an outcome measure after carpal tunnel surgery.Material and methods. Fifty patients, 43 women and 7 men with an average age of 55 years with carpal tunnel syndrome received mini-invasive carpal tunnel release. Patients were examined before the operation, and at 1 and 6 months after, according the same protocol. They had measured a total grip and key-pinch strengths and sensation by the filament test. They completed also the PEM questionnaire. The following parameters of the questionnaire were determined: responsiveness, concurrent validity and internal consistency.Results. Over a half-year follow-up, the sensation improved statistically significantly during the first month after operation. Power of the hand decreased initially comparing to baseline values, following by further gradual increasing throughout the follow-up. PEM scores showed continuous improvement of the hand status at each assessment. The PEM questionnaire showed excellent responsiveness to change of considered parameters, comparing to baseline values. The PEM showed also high concurrent validity with total grip and pinch strengths, as well as with Sensory Index, but only at 6 months assessment. However, the PEM showed a discordance with total grip and key-pinch strength at 1 month assessment. The instrument showed excellent internal consistency.Conclusion. The PEM questionnaire is, with some exceptions, a good and useful instrument for outcome measurement after carpal tunnel treatment surgery.
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Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma

81%
Żyluk A., Mazur A., Piotuch B., Safranow K.
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vol. 85
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issue 12
699-705
EN
The aim of the study was to assess the reliability of neurological examination and other factors in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma (GCS 10-15). Material and methods. Over a one-year period, 227 patients: 145 male and 82 female, aged a mean of 51 years who sustained mild or moderate head trauma (GSC 10-15) were examined neurologically and had performed head CT scans. The neurological examination as a whole and each finding of the neurological examination were tested as predictors of the presence of traumatic abnormalities in the head CT scan. Results. Post-traumatic lesions in head CT scan were found in 109 patients (48%): skull fractures in 66 of these and brain injuries in 94; fifty-eight patients had skull fracture combined with brain injury. Seventeen patients required neurosurgical intervention (hematoma evacuation). Abnormal neurological examination showed the highest reliability in identifying patients with brain injuries in CT (sensitivity 87%, specificity 79%). Of single findings, gait abnormalities and consciousness disturbances, present in sober patients, were the strongest predictors of cerebral lesions. Likewise, abnormal neurological examination was the best indicator of skull fractures (sensitivity 77%, specificity 63%). Gait abnormalities and “racoon eyes” present in alcohol intoxicated patients were the strongest individual predictors of skull fractures. Conclusion. Results of our study show neurological abnormalities as the most reliable (although not 100% accurate) in identifying patients who are likely to have brain injuries and/or skull fracture following head trauma. Use of clinical decision rules may reduce the number of head CT scans performed “just in a case”.
4
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Early Results of Flexor Tendon Repair in Zone II With Modified, Four-Strand Strickland Technique

81%
Walaszek I., Żyluk A., Piotuch B.
Polish Journal of Surgery
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2008
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vol. 80
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issue 12
645-652
EN
New materials, techniques of tendon suture and methods of post-operative rehabilitation offer surgeons perspective of effective repair and excellent outcomes. Results of experimental studies show that multistrand tendon suture provides better mechanical properties than two-strand technique, however, clinical use in only 4 studies did not confirm its definitive superiority to traditional method of the repair.The aim of the study was the assessment of the outcomes of the treatment of flexor tendon repair by a modified, four-strand Stickland technique.Material and methods. Flexor tendons lacerations in 60 patients, all in Verdan's zone II, without associated bone fractures and impaired blood supply were repaired by a modified, four-strand Stickland technique. An active flexion and extension of the fingers in the range restricted by a splint was recommended immediately after operation. Early results were evaluated in 51 patients, 41 men and 10 women, in a mean age of 31 years, in whom 69 tendons were repaired in 69 digits. Follow-up at 2 and 6 weeks included examination of total active range of motion (AROM) of involved fingers, rupture rate and complications.Results. Failure of the repair occurred in 3 cases (6%), including one thumb, index and little finger, all between 2nd and 6th week after the operation. A mean AROM at 2 and 6 weeks was 38% and 58% of the normal value (270° for the finger and for 170° the thumb), respectively. In 13 digits (28%) AROM at 6 weeks was excellent, greater than 80%, but in 5 digits was poor, less than 20% of the normal value. The main cause of reduced AROM was incomplete extension of the digits, due to splint employment up to 6 weeks post-operatively.Conclusions. Early results obtained in the study fail to confirm greater endurance of four-strand repair over two-strand, what suggest rupture rate closed to given in the literature. An active range of motion achieved in the group was poorer than obtained after two-strand repair in other studies, but one can expect its improvement in the longer perspective.
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