Session 12: Hand
Fredag den 25. oktober
11:00 – 12:00
Chairmen: Maiken Stilling / Anders Lorentzen
Hanne Gregersen, Mille Lybæk, Inger Lauge Johannesen, Pernille Leicht, Ulla Vig Nissen, Fin Biering-Sørensen
Clinic for spinal cord injuries, Copenhagen University Hospital, Glostrup Hospital; West Danish Center for spinal cord injuries, Viborg Hospital; Clinic for Orthopaedic Surgery, handsurgery section, Copenhagen University Hospital, Rigshospitalet
Background: All tetraplegia patients are offered an
evaluation and reconstructive surgery
of the upper extremity if it is possible.
Purpose / Aim of Study: Evaluate the satisfaction with upper
extremity reconstructive surgery in
spinal cord injured individuals with
Materials and Methods: Retrospective study with questionnaire
follow-up. 49 tetraplegic individuals
had 119 surgical procedures
performed to the upper extremities.
Seven had died and 42 were invited to
participate in the survey. 40 (95%;
median age 48 years at time of survey)
answered a questionnaire with a 5-
level Likert scale ranging from strongly
agree to strongly disagree regarding
satisfaction within 8 areas: 1) General
satisfaction; 2) Life impact; 3) Activity
of daily living (ADL); 4) Independence;
5) Appearance; 6) Reliability; 7)
Information; and 8) Postoperative
Findings / Results: The median time from first surgery till
survey was 13 years (range 2-36).
65% were C5-C6 spinal cord lesions;
64% had American Spinal Injury
Association Impairment Scale grade A.
The positive responses (sum of
strongly agree and agree): 76% for
general satisfaction, 84% for Life
impact, 73% for ADL, 53% for
independence, 66% for reliability, 78%
for information prior to surgery, and
65% for postoperative-therapy.
However, only 28% reported that they
were satisfied with the appearance of
their hand. There was a trend towards
an ability to perform more activities and
in particular more independence was
obtained when pinch/specific hand
surgery was performed compared to
triceps activation. Specifically easier in
drinking and eating was mentioned by
17, in particular by those with C6-C8
Conclusions: The overall satisfaction with upper
extremity surgery is high. It has a
positive impact on life in general, the
ability to perform ADL as well as an
increase in the level of independence.
Søren Larsen , Karina Liv Hansen, Tune Ipsen, Jens Lauritsen
Department of Orthopaedic Surgery, Odense University Hospital
Background: Dupuytren’s contracture (DC) is a
disorder that affect the palmar fascia
were a pretendinous cord with time
causes the finger to flex resulting in
impaired hand function.
Purpose / Aim of Study: The aim of this study was to evaluate
the efficacy of Xiapex® in the
treatment of DC at least 12 month after
The study was initiated following a
Minimal Health Technology
Materials and Methods: The study was a prospective study on
consecutive series of patients with DC
and flexion deformities of the
metacarpophalangeal and/or proximal
interphalangeal joint of >200 .
Primary end point was reduction in
contracture and improving hand
All patients gave informed consent.
Findings / Results: 194 patients were enrolled, 163 men
and 31 women, mean age 67 years
91% of the treated fingers are the 4.
and 5. finger.
At manipulation cord disruption
succeed in 87% of the patients at the
first attempt. Despite 31 % had
skindisruption no infections were
Mean DASH pre-injection was 17 [0-
52] and 12 months follow-up 9 [0-61].
In 1 case there had been a need for
further treatment of the Xiapex®
treated finger at 12 month
At 12 monts patient satisfaction was
Conclusions: Our results are promising and we find
Xiapex® a good treatment option for
DC-patients with a palpable cord.
The treatment is effective and with
acceptable recurrence at 12 months.
Janni Kjærgaard Thillemann, Theis Muncholm Thillemann, Bo Munk, Karsten Krøner
Department of Hand Surgery, Aarhus University Hospital; Ortopædkirurgisk Afdeling , Regional Hospital, Horsens
Background: Results after trapeziometacarpal (TMC) total
joint arthroplasty are divergent and recently
there has been many concerns regarding
the metal on metal (MoM) articulations.
Purpose / Aim of Study: The aim of this study was to evaluate the
short term results after Motec Basal Thumb
Joint Prosthesis with MoM articulation and
compare the results with patients who were
Materials and Methods: We retrospectively evaluated a
consecutive series of 42 Motec MoM
Prosthesis (40 patients, 33 women)
performed between 2009 and 2012.
Revision rates were calculated and
patients were divided in patients with the
prosthesis in situ and in patients who
had been revised with implant removal
and trapeziectomy. The two groups
were compared concerning Disability of
the Arm Shoulder and Hand (DASH)
score, pain on a numerical ranking scale
(NRS), serum chrome and cobalt
Findings / Results: After 4 years 17 (40%) of the 42
prostheses were revised. Revisions
were performed due to aseptic loosening
of the cup (9), pain (4), dislocation (3)
and deep infection (1).
Mean follow-up was 2.2 years (range
1.2-3.8) and 2.1 years (range 1.3-3.8)
for the prosthesis and the revision group,
respectively. The DASH score was
comparable between groups (p= 0.77).
Pain at rest and in activity was
comparable between groups. The
frequency of patients with serum chrome
and cobalt levels above 10 nmol/L was
comparable between the two groups
(p=0.28). DASH scores were
significantly higher in patients with
elevated serum chrome and cobalt.
Conclusions: The revision rate after TMC prosthesis in this
study is disappointing. However, DASH
scores after revision with implant removal
and trapeziectomy are acceptable. In this
study elevated chrome and cobalt levels
was associated with at higher dash score
but not associated with revision.
Lasse E. Rasmussen, Søren Larsen, Kim L Mikkelsen
Orthopaedic Surgery, Unit for Handsurgery, Odense University Hospital; Danish Patient Insurance Association ,
Background: The use of an arterial tourniquet may be
associated with reversible and irreversible
damage during limb surgery. Such damage
may result in a financial compensation in
Denmark. Currently limited scientific
evidence is available regarding the
outcome from the use of the arterial
tourniquet in limb surgery. Yet in Denmark,
damage from the arterial tourniquet is
among the compensation claim cases with
the highest level of recognition.
Purpose / Aim of Study: Thus, the cases in the Danish Patient
Insurance Association for compensation
claims from the damage due to the use of
an arterial tourniquet in were investigated.
Materials and Methods: Data were extracted from cases in the
Danish Patient Insurance Association for
compensation claims in the years 1998 –
2010, where patients with an
acknowledged tourniquet injury were
registered. Injury resulting in 5% damage-
level or more triggered a compensation
payment, otherwise not.
Findings / Results: In the time-period a total of 69 patients had
there case recognized, resulting in a total
payment of 10.89 million. Danish kroner.
The cases were distributed among 35 men,
and 34 women (age 0-77 years).
Causes of injury (listed in order of
(1) Long tourniquet time n = 20
(2) Defective equipment n = 15
(3) Direct tissue crush n = 9
(4) “Unknown” n = 9
(5) "Unusual" complications n = 6
(6) Bleeding n = 5
(7) Tourniquet in vascular disease n = 4
(8) Skin damage n = 4
Conclusions: Surprisingly, the proportion of injuries that
could not be predicted totals a maximum of
35%. The remaining could potentially be
avoided. Thus it is encouraged that the
surgeon ensures that the equipment is
properly maintained, that the shortest
possible duration of ischemia is ensured,
and that the lowest possible tourniquet
pressure is applied.
Sys Hasslund, Hanne Gissel, Carl Christian Danielsen, Mette Koefoed, Lars Aagaard, Kjeld Søballe
Orthopedics, Aarhus University Hospital; Biomedicin, Aarhus Universitet
Background: Flexor tendon injury and repair are
complicated by formation of fibrotic
adhesion. Despite decades of research in
this field our understanding of the biological
mechanisms of tendon healing and adhesion
formation remains incomplete. Previously we
have developed a model of murine flexor
tendon repair. Using this model we have
already demonstrated that Gdf5 gene
delivery via viral vectors loaded on freeze-
dried allografts significantly reduced tendon
Purpose / Aim of Study: In this study we wanted to develop a non-
viral method for tendon gene therapy, and
via gene delivery of Vegf or Gh to modify the
tendon healing response.
Materials and Methods: The study was performed on our murine
model. We used electroporation for non-viral
gene delivery. To evaluate gene delivery, a
marker gene (Luc) and an in vivo imagine
system was used. In order to test the effect
of the active genes functional tests of tendon
adhesions and tensile strength were
Findings / Results: We used electroporation for non-viral gene
delivery of a marker gene. In a kinetics
study we compared this novel method of
tendon gene therapy with the previously
used viral method. Remarkably we found
that the marker gene was expressed as
early as two hours after gene delivery by
electroporation. The onset of gene
expression in the viral vector group did not
start until day 3. The last part of this study,
delivery of the functional genes Gh or Vegf
and assessment of the effect on the
biomechanical properties is still ongoing.
Conclusions: Electroporation can be used as a non-viral
method of gene delivery. The preliminary
results from the biomechanical testing of the
mice electroporated with Vegf or Gh vs.
control have been encouraging. Tendon
healing has previously been modified by
local gene delivery by others and us.
Pernille Leicht, Ellen Thomsen Rasmussen, Lisbeth Villemoes Sørensen, Stig Jensen
Ortopædkirurgisk klinik, Håndkirurgisk sektion, Rigshospitalet; Klinik for ergo og fysioterapi, Rigshospitalet; , Sahva
Background: Amputation of a spastic, paralysed arm
after a stroke and prosthetic supply
afterwards is unusual and to our
knowledge not described previously.
Purpose / Aim of Study: Amputation of a spastic paralysed arm
and prosthetic substitution may open
opportunities for better quality of life
and better physical function in patients
after right hemisphere stroke.
Materials and Methods: Eight years after a severe right
hemisphere stroke a man age 63 was
referred to orthopaedic surgery clinic
for evaluation of possible amputation
of his paralysed and spastic left arm.
He wanted to replace his left useless
arm with a prosthetic arm to be able to
accomplish ’two hand activities’. To
make sure he would be able to use a
prosthetic arm his ability was assessed
by neurologist, neuropsychologist and
a temporary artificial arm was
produced by prosthetist and tested
under supervision of occupational
therapist. Subsequent his left arm was
amputated 10 cm proximal to the
elbow, prosthetic arm produced and he
was trained in using it.
Findings / Results: The amputation had a positive impact
on patient’s body balance, ADL
activities, mood, and sleep. A year
after amputation he used his prosthetic
arm daily in ’two hand activities’,
Conclusions: Prosthetic substitution of a spastic
paralysed arm after a stroke can
improve patients function and well-
Jessica Agneta Nilsson, Hans-Eric Rosberg
General practitioner, Gøtzsche & Johnsen, Hørsholm, Copenhagen Denmark; Hand Surgery, Skåne University Hospital, Malmö
Background: A fracture of the proximal interphalangeal
(PIP) joint at the base of the middle phalanx is
rare, but is a challenge to treat.
Posttraumatic osteoarthritis is a known
complication causing impaired hand function
Purpose / Aim of Study: The aim of the present retrospective study
was to evaluate characteristics and
outcome of complex PIP joint fractures
treated by the pins and rubbers traction
Materials and Methods: Medical records of 42 patients, with
fractures treated with a PRTS in 1999 -
2010, were reviewed, and followed up by
questionnaires (QuickDASH, CISS, self-
composed questionnaire). The fractures
were divided into three types of fractures:
volar lip, dorsal lip and pilon fractures.
Findings / Results: The volar lip fracture was most frequent
(26/42; dorsal lip 3/42; pilon 13/42). Most
fractures were sport related (19/42;
45%) and males predominated (M:F ratio
1.8). All fractures united. Infection
occurred in 17/41 (41%) cases.
Radiological signs of posttraumatic
osteoarthritis were found in 25/41 (61%)
patients. In 18/42 patients, where an
objective evaluation was performed,
66% of contralateral total active range of
motion (TAM), 93% grip strength and
100% pinch strength were achieved. The
volar lip fracture had the best outcome
according to the self-reported
QuickDASH and CISS score and regained
77% of contralateral TAM.
Conclusions: Fractures of the PIP joint in the middle
phalanx can be treated with the PRTS, but
reduced mobility, grip strength, infection and
osteoarthritis are seen. The device is well
tolerated by the patients, easy to apply and
with ready accessible materials for the
Charlotte Schultz, Martin Andersen, Vendel Jensen Ninna, Niels H. Søe, Henning Bliddahl
Department of Hand Surgery, Gentofte Hospital; Biopharmaceuticals Research Unit, Novo Nordisk, Måløv; The Parker Institute, Frederiksberg Hospital
Background: Smaller equipment has made
arthroscopy of small joints (MCP and PIP
joints) possible. Only few articles have
been published on this subject. Different
techniques and portals have been
described. In two articles the technique
was developed and used on cadavers.
The clinical uses for needle arthroscopy
have not been fully determined and it
remains to be shown that the objective
findings correlate with the
histopathological changes in the joints.
Purpose / Aim of Study: To describe and to evaluate the
technique and portals used in small joint
arthroscopy and to assess the
possibility of objectively determining the
degree of synovitis and obtaining
biopsies of a sufficient size and quality
from small joints with a needle
Materials and Methods: 6 MCP joints, 3 PIP joints and 2 IP joints
from 10 RA patients were biopsied and
synvectomised by needle arthroscopy.
All needle arthroscopies were
performed by the same hand surgeon.
The overall histopathological synovitis
score (Krenn) was compared to the
synovitis score as seen with the needle
arthroscope. The sample size was
measured as well and tested for ability
of detecting lining for histopathological
purposes in the biopsy.
Findings / Results: All samples were of a sufficient size
(average 3.07 mm2) however the
success rate of including the lining was
only 0.58. Synovitis as seen by the
surgeon was predictive of synovitis
determined by a histopathological
Conclusions: Our results indicate that it is possible to
determine synovitis in small joints with a
needle arthroscope and to get biopsies
of a good size with a fair chance of
including the lining in the samples taken.