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Compression Glove may Reduce Complications Secondary to Distal Radius Fractures
46.."3:10*/54 ∙ ∙
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Surgical reconstruction of SLAC wrist alters wrist kinematics and functional task performance. PRC resulted in improved performance and greater wrist motion during hammering when compared to 4CF. The preserved midcarpal surface in PRC may be responsible for the improved hammering performance. An objective understanding of functional outcomes following wrist reconstruction has implications for patient consent, surgical options, and postoperative rehabilitation.
3&'&3&/$&4 1. Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg [Am]. 1985 Jan; 10(1): 39-46. 2. Werner FW, Green JK, Short WH, Masaoka S. Scaphoid and lunate motion during a wrist dart throw motion. J Hand Surg [Am]. 2004 May; 29(3): 418-22. 3. Li ZM, Kuxhaus L, Fisk JA, Christophel TH. Coupling between wrist flexion-extension and radial-ulnar deviation. Clin Biomech (Bristol, Avon). 2005 Feb; 20(2): 177-83. 4. Syrkin G, Hillstrom HJ, Lenhoff M, Kraszewski A, Backus S, Wolff A, Wolfe SW 2009, Robustness of a Wrist Joint Coordinate system to forearm pronation-supination”, Proceedings of the XXIInd Congress of the International Society of Biomechanics, Cape Town, South Africa, July 5-9, 2009.
8 Grant support received from AFSH M Consulting fees with Extremity Medical, TriMed, Inc. (Wolfe) M Honoraria from TriMed, Inc., SBI (Wolfe) M Intellectual Property Rights/Patent Holder with KinematX Total Wrist
Arthroplasty, Extremity Medical, NJ (Wolfe) M Royalty support from TriMed, Inc, Elsevier, Inc. (Wolfe)
PAPER 36 'SJEBZ 4FQUFNCFS t1. $MJOJDBM1BQFS4FTTJPO"'4)'VOEFE1BQFST
Compression Glove may Reduce Complications Secondary to Distal Radius Fractures Level 1 Evidence 8 Michael S. Shuler, MD Ashley L. Cole, MPH Pat C. Monroe, OTR/L CHT Lauren C. Harris, OTR/L Jesica A. Chancey, OTR/L Margaret A. Robinson, BS
):105)&4*4 As many as one-third of distal radius fractures (DRF) result in complications. We hypothesize that a compression glove may prevent complications by reducing post-operative edema.
.&5)0%4 Figure 1. Angle-angle plot of a dart throw kinematic motion path (dashed line). Δθ represents the change in wrist angle from one time point to the next. The kinematic path length is the sum of these over the entire curvilinear path, Σ(Δθ). Coupling is the angle the principal axis (straight-line approximation, not shown) of the kinematic motion path makes with the horizontal.
Forty-eight subjects with unstable DRFs have been randomized in an ongoing trial to have a compression glove applied under their splint/cast immediately after surgery or receive no intervention. All patients are immobilized for five weeks. Follow-up evaluations are performed at two weeks, five weeks, three months, and six months from surgery. Outcomes collected include: Disabilities of the Arm, Shoulder and Hand (DASH) survey, pain scale, circumferential measurements taken at the wrist and mid-aspect of proximal phalanx of each digit, grip strength (beginning at five weeks), hand size (figure-of-eight method), finger flexion and extension, and evaluation for signs of carpal tunnel syndrome (CTS) and complex regional pain syndrome (CRPS). Circumferential measurements are adjusted using measurements of the contralateral side (injured minus contralateral). Significant differences between outcomes in the glove and control groups are tested using Wilcoxon rank sum test for continuous variables and Fisher's exact test for categorical variables.
3&46-54
Table 1 v Speaker has nothing of financial value to disclose
Treatment groups were statistically similar with respect to gender, age, pain and fracture classification at baseline. Two weeks postoperatively, pain, functionality, and flexibility were similar between the two groups; however, subjects in the glove group were
31
significantly less swollen compared to controls, as evidenced by smaller adjusted hand size and circumferential measurements (table 1). Five weeks post-operatively, subjects in the glove group reported significantly less pain than controls (glove: mean=1.3, SD=1.2; control: mean=3.6, SD=2.2; p=0.0008). DASH scores of glove subjects were lower than controls, indicating greater functionality (glove: mean=36.9, SD=21.2; control: mean=51.2, SD=21.2; p=0.05). Furthermore, a significantly larger proportion of patients in the glove group had regained full flexion, compared to controls (13 (81%) gloves versus 8 (40%) controls, p=0.02). Glove subjects continued to experience less swelling compared to controls (table 1). Among controls, four patients have been diagnosed with post-traumatic CTS and three with CRPS, compared to none of the glove subjects.
46.."3:10*/54 ∙ ∙
∙
In a study of 48 DRFs, application of a compression glove after surgical stabilization significantly reduced post-operative edema. While no statistically significant differences were observed two weeks post-operatively, subjects who wore a compression glove reported less pain, improved functionality, and demonstrated greater flexibility than control subjects at five weeks. Based on preliminary results, glove subjects may have lower incidence of CTS and CRPS than patients who do not wear a compression glove.
Figure 1. Outcome measurements of 48 subjects with unstable distal radius fractures, taken two weeks and five weeks post-operatively 2 weeks
Characteristic
Hand size (cm)
Glove group (N=27)
Control group (N=21)
Mean (SD)
Mean (SD)
0.2 (1.1)
1.8 (1.4)
1.4 (0.6) 0.1 (0.3) 0.2 (0.4) 0.1 (0.5) 0.2 (0.4) N/A 3.1 (2.4) 60.0 (20.3) N (%)
1.8 (0.5) 0.4 (0.4) 0.5 (0.5) 0.4 (0.5) 0.3 (0.3) N/A 3.0 (2.2) 60.3 (23.1) N (%)
Flexion5 Full Partial Extension6 Full Partial
8 (38.1) 13 (61.9)
11 (44.0) 14 (56.0)
20 (95.2) 1 (4.8)
23 (88.5) 3 (11.5)
'SJEBZ 4FQUFNCFS t1. $MJOJDBM1BQFS4FTTJPO"'4)'VOEFE1BQFST
Bioactive Sutures Lead to Improved Strength of Rat Achilles Tendon Repairs in vivo Not a clinical study 8Jeffrey Yao, MD Tatiana Korotkova, BS Colin Woon, MD Don Y. Park, MD Anthony Behn, PhD Robert Lane Smith, PhD
M
):105)&4*4 We previously demonstrated sutures coated with bioactive substrates and pluripotent stem cells may deliver the cells to tendon repair sites. These cells remain metabolically active and proliferate following passage into the tendon. We sought to determine if these cell-seeded “bioactive” sutures may accelerate tendon healing and enhance early repair strength and in a rat model.
5 weeks Glove group (N=20)
Control group (N=17)
Mean (SD)
Mean (SD)
<0.0001
-0.04 (1.1)
1.6 (1.6)
0.002
0.01 0.009 0.05 0.02 0.10
0.7 (0.5) -0.2 (0.3) -0.1 (0.3) -0.1 (0.3) -0.02 (0.3) 22.4 (12.1) 1.4 (1.2) 36.9 (21.2) N (%)
1.1 (1.0) 0.5 (0.5) 0.5 (0.5) 0.6 (0.5) 0.5 (0.4) 19.5 (11.3) 3.6 (2.2) 51.15 (21.2) N (%)
0.08 <0.0001 0.0003 <0.0001 0.0005 0.34 0.0008 0.05
0.77
13 (81.3) 3 (18.8)
8 (40.0) 12 (60.0)
0.02
0.62
16 (100.0) 0 (0.0)
16 (80.0) 4 (20.0)
0.11
p-value1
p-value1
Circumferential Measurements2,3 (cm) Wrist 1st finger 2nd finger 3rd finger 4th finger Grip strength2 (kg) Pain Scale (0-10) DASH4
PAPER 37
0.97 0.71
Abbreviations: SD, standard deviation; DASH, Disabilities of the Arm, Shoulder and Hand survey Statistically significant p-values are shown in bold 1 p-values from Wilcoxon rank sum test (continuous variables) and Fisher’s exact test (categorical variables) 2 Adjusted for contralateral side measurements (injured minus contralateral) 3 Data missing on 1 control at 2 weeks 4 Data missing on 2 glove subjects at 2 weeks and 1 glove subject at 5 weeks 5 Data missing on 2 control subjects at 2 weeks and 1 glove subject at 5 weeks 6 Data missing on 1 control subject at 2 weeks and 1 glove subject at 5 weeks
.&5)0%4 Bone marrow-derived stem cells (bMSCs) were harvested from Sprague-Dawley rat femora. 4-0 Ethibond sutures used for repairs in the experimental group were precoated with intercellular cell adhesion molecule 1 (ICAM-1) and poly-L-lysine, and seeded with 4 x 106 PKH26 fluorescent-dye labeled bMSCs. The presence of viable cells on these sutures was confirmed with fluorescent microscopy. Control group 4-0 Ethibond sutures used for repairs were not otherwise treated. Utilizing a matched-paired design, bilateral Sprague-Dawley rat achilles tendons were transected and each side was randomized to be repaired by either experimental (cell-coated), or control (non-coated) sutures (4-strand) by a blinded surgeon. Postoperatively, both hindlimbs were casted in equinus. All tendons were harvested at 4, 7, 10, 14 and 28 days and subjected to biomechanical assessment using an Instron MTS for ultimate failure load. Student's t-test was used to compare failure loads, with significance set at p < 0.05. Additional tendons were assessed histologically for the presence of PKH26-labeled (implanted) cells at repair sites.
3&46-54 8 Grant support received from American Foundation for Surgery of the Hand (AFSH) Clinical Research Grant 2010.
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Histology revealed the presence of PKH26-labeled cells at repair sites at all time points (Figure 1). Biomechanical testing revealed significantly superior repair strength in tendons repaired with experimental sutures compared to control at 7 days (11.6 ± 4.1N vs 6.5 ± 3.4N; p<0.01, Figure 2).
v Speaker has nothing of financial value to disclose
∙
Surgical reconstruction of SLAC wrist alters wrist kinematics and functional task performance. PRC resulted in improved performance and greater wrist motion during hammering when compared to 4CF. The preserved midcarpal surface in PRC may be responsible for the improved hammering performance. An objective understanding of functional outcomes following wrist reconstruction has implications for patient consent, surgical options, and postoperative rehabilitation.
3&'&3&/$&4 1. Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg [Am]. 1985 Jan; 10(1): 39-46. 2. Werner FW, Green JK, Short WH, Masaoka S. Scaphoid and lunate motion during a wrist dart throw motion. J Hand Surg [Am]. 2004 May; 29(3): 418-22. 3. Li ZM, Kuxhaus L, Fisk JA, Christophel TH. Coupling between wrist flexion-extension and radial-ulnar deviation. Clin Biomech (Bristol, Avon). 2005 Feb; 20(2): 177-83. 4. Syrkin G, Hillstrom HJ, Lenhoff M, Kraszewski A, Backus S, Wolff A, Wolfe SW 2009, Robustness of a Wrist Joint Coordinate system to forearm pronation-supination”, Proceedings of the XXIInd Congress of the International Society of Biomechanics, Cape Town, South Africa, July 5-9, 2009.
8 Grant support received from AFSH M Consulting fees with Extremity Medical, TriMed, Inc. (Wolfe) M Honoraria from TriMed, Inc., SBI (Wolfe) M Intellectual Property Rights/Patent Holder with KinematX Total Wrist
Arthroplasty, Extremity Medical, NJ (Wolfe) M Royalty support from TriMed, Inc, Elsevier, Inc. (Wolfe)
PAPER 36 'SJEBZ 4FQUFNCFS t1. $MJOJDBM1BQFS4FTTJPO"'4)'VOEFE1BQFST
Compression Glove may Reduce Complications Secondary to Distal Radius Fractures Level 1 Evidence 8 Michael S. Shuler, MD Ashley L. Cole, MPH Pat C. Monroe, OTR/L CHT Lauren C. Harris, OTR/L Jesica A. Chancey, OTR/L Margaret A. Robinson, BS
):105)&4*4 As many as one-third of distal radius fractures (DRF) result in complications. We hypothesize that a compression glove may prevent complications by reducing post-operative edema.
.&5)0%4 Figure 1. Angle-angle plot of a dart throw kinematic motion path (dashed line). Δθ represents the change in wrist angle from one time point to the next. The kinematic path length is the sum of these over the entire curvilinear path, Σ(Δθ). Coupling is the angle the principal axis (straight-line approximation, not shown) of the kinematic motion path makes with the horizontal.
Forty-eight subjects with unstable DRFs have been randomized in an ongoing trial to have a compression glove applied under their splint/cast immediately after surgery or receive no intervention. All patients are immobilized for five weeks. Follow-up evaluations are performed at two weeks, five weeks, three months, and six months from surgery. Outcomes collected include: Disabilities of the Arm, Shoulder and Hand (DASH) survey, pain scale, circumferential measurements taken at the wrist and mid-aspect of proximal phalanx of each digit, grip strength (beginning at five weeks), hand size (figure-of-eight method), finger flexion and extension, and evaluation for signs of carpal tunnel syndrome (CTS) and complex regional pain syndrome (CRPS). Circumferential measurements are adjusted using measurements of the contralateral side (injured minus contralateral). Significant differences between outcomes in the glove and control groups are tested using Wilcoxon rank sum test for continuous variables and Fisher's exact test for categorical variables.
3&46-54
Table 1 v Speaker has nothing of financial value to disclose
Treatment groups were statistically similar with respect to gender, age, pain and fracture classification at baseline. Two weeks postoperatively, pain, functionality, and flexibility were similar between the two groups; however, subjects in the glove group were
31
significantly less swollen compared to controls, as evidenced by smaller adjusted hand size and circumferential measurements (table 1). Five weeks post-operatively, subjects in the glove group reported significantly less pain than controls (glove: mean=1.3, SD=1.2; control: mean=3.6, SD=2.2; p=0.0008). DASH scores of glove subjects were lower than controls, indicating greater functionality (glove: mean=36.9, SD=21.2; control: mean=51.2, SD=21.2; p=0.05). Furthermore, a significantly larger proportion of patients in the glove group had regained full flexion, compared to controls (13 (81%) gloves versus 8 (40%) controls, p=0.02). Glove subjects continued to experience less swelling compared to controls (table 1). Among controls, four patients have been diagnosed with post-traumatic CTS and three with CRPS, compared to none of the glove subjects.
46.."3:10*/54 ∙ ∙
∙
In a study of 48 DRFs, application of a compression glove after surgical stabilization significantly reduced post-operative edema. While no statistically significant differences were observed two weeks post-operatively, subjects who wore a compression glove reported less pain, improved functionality, and demonstrated greater flexibility than control subjects at five weeks. Based on preliminary results, glove subjects may have lower incidence of CTS and CRPS than patients who do not wear a compression glove.
Figure 1. Outcome measurements of 48 subjects with unstable distal radius fractures, taken two weeks and five weeks post-operatively 2 weeks
Characteristic
Hand size (cm)
Glove group (N=27)
Control group (N=21)
Mean (SD)
Mean (SD)
0.2 (1.1)
1.8 (1.4)
1.4 (0.6) 0.1 (0.3) 0.2 (0.4) 0.1 (0.5) 0.2 (0.4) N/A 3.1 (2.4) 60.0 (20.3) N (%)
1.8 (0.5) 0.4 (0.4) 0.5 (0.5) 0.4 (0.5) 0.3 (0.3) N/A 3.0 (2.2) 60.3 (23.1) N (%)
Flexion5 Full Partial Extension6 Full Partial
8 (38.1) 13 (61.9)
11 (44.0) 14 (56.0)
20 (95.2) 1 (4.8)
23 (88.5) 3 (11.5)
'SJEBZ 4FQUFNCFS t1. $MJOJDBM1BQFS4FTTJPO"'4)'VOEFE1BQFST
Bioactive Sutures Lead to Improved Strength of Rat Achilles Tendon Repairs in vivo Not a clinical study 8Jeffrey Yao, MD Tatiana Korotkova, BS Colin Woon, MD Don Y. Park, MD Anthony Behn, PhD Robert Lane Smith, PhD
M
):105)&4*4 We previously demonstrated sutures coated with bioactive substrates and pluripotent stem cells may deliver the cells to tendon repair sites. These cells remain metabolically active and proliferate following passage into the tendon. We sought to determine if these cell-seeded “bioactive” sutures may accelerate tendon healing and enhance early repair strength and in a rat model.
5 weeks Glove group (N=20)
Control group (N=17)
Mean (SD)
Mean (SD)
<0.0001
-0.04 (1.1)
1.6 (1.6)
0.002
0.01 0.009 0.05 0.02 0.10
0.7 (0.5) -0.2 (0.3) -0.1 (0.3) -0.1 (0.3) -0.02 (0.3) 22.4 (12.1) 1.4 (1.2) 36.9 (21.2) N (%)
1.1 (1.0) 0.5 (0.5) 0.5 (0.5) 0.6 (0.5) 0.5 (0.4) 19.5 (11.3) 3.6 (2.2) 51.15 (21.2) N (%)
0.08 <0.0001 0.0003 <0.0001 0.0005 0.34 0.0008 0.05
0.77
13 (81.3) 3 (18.8)
8 (40.0) 12 (60.0)
0.02
0.62
16 (100.0) 0 (0.0)
16 (80.0) 4 (20.0)
0.11
p-value1
p-value1
Circumferential Measurements2,3 (cm) Wrist 1st finger 2nd finger 3rd finger 4th finger Grip strength2 (kg) Pain Scale (0-10) DASH4
PAPER 37
0.97 0.71
Abbreviations: SD, standard deviation; DASH, Disabilities of the Arm, Shoulder and Hand survey Statistically significant p-values are shown in bold 1 p-values from Wilcoxon rank sum test (continuous variables) and Fisher’s exact test (categorical variables) 2 Adjusted for contralateral side measurements (injured minus contralateral) 3 Data missing on 1 control at 2 weeks 4 Data missing on 2 glove subjects at 2 weeks and 1 glove subject at 5 weeks 5 Data missing on 2 control subjects at 2 weeks and 1 glove subject at 5 weeks 6 Data missing on 1 control subject at 2 weeks and 1 glove subject at 5 weeks
.&5)0%4 Bone marrow-derived stem cells (bMSCs) were harvested from Sprague-Dawley rat femora. 4-0 Ethibond sutures used for repairs in the experimental group were precoated with intercellular cell adhesion molecule 1 (ICAM-1) and poly-L-lysine, and seeded with 4 x 106 PKH26 fluorescent-dye labeled bMSCs. The presence of viable cells on these sutures was confirmed with fluorescent microscopy. Control group 4-0 Ethibond sutures used for repairs were not otherwise treated. Utilizing a matched-paired design, bilateral Sprague-Dawley rat achilles tendons were transected and each side was randomized to be repaired by either experimental (cell-coated), or control (non-coated) sutures (4-strand) by a blinded surgeon. Postoperatively, both hindlimbs were casted in equinus. All tendons were harvested at 4, 7, 10, 14 and 28 days and subjected to biomechanical assessment using an Instron MTS for ultimate failure load. Student's t-test was used to compare failure loads, with significance set at p < 0.05. Additional tendons were assessed histologically for the presence of PKH26-labeled (implanted) cells at repair sites.
3&46-54 8 Grant support received from American Foundation for Surgery of the Hand (AFSH) Clinical Research Grant 2010.
32
Histology revealed the presence of PKH26-labeled cells at repair sites at all time points (Figure 1). Biomechanical testing revealed significantly superior repair strength in tendons repaired with experimental sutures compared to control at 7 days (11.6 ± 4.1N vs 6.5 ± 3.4N; p<0.01, Figure 2).
v Speaker has nothing of financial value to disclose