OBJECTIVE: Tuberculosis of the upper extremity, while rare, is still a problem in the Philippines. Included in the primary aim of TB treatment is cure of the patient and restoration of quality of life and productivity. The purpose of this paper is to describe a series of patients treated for Tuberculosis of the upper extremity in the context of level of function and possible factors contributing to disability.
METHOD: Records of the University of the Philippines-Philippine General Hospital Department of Orthopaedics were reviewed to recruit adult patients treated for Tuberculosis of the upper extremity from 2009-2013. Patients who consented were asked to answer a Disability of Arm, Shoulder and Hand questionnaire (DASH) validated for Filipinos.
RESULTS: Fifteen (15) patients presenting with conditions ranging from synovitis to arthritis, treated medically and surgically, were evaluated for function at least 6 months after treatment. The average disability for strenuous activities. Patients reported minimal limitations in doing activities of daily living.
CONCLUSION: Patients treated for Tuberculosis of the upper extremity still present with relatively low levels of disability. Activities of daily living were generally performed without problems but activities requiring exertion were consistently reported as a difficult task for most participants.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Tuberculosis-therapy,therapeutics ; Upper Extremity ; Orthopedic Procedures ; Synovitis ; Arthritis ; Tuberculosis

BACKGROUND: Clinical research has been part of the orthopedic residents' training program over the past 27 years of the Department of Orthopedics, Philippine General Hospital. The purpose of the present study was to determine the levels of evidence in the researches done by orthopedic residents in training from January 1983 to December 2010.

METHODS: The authors reviewed all completed research performed by the department's orthopedic residents in training from January 1983 to December 31, 2010. The exclusion criteria for the study were as follows: review articles, research articles whose full texts were not available and those research articles in which consultants were primary authors. The research articles were scored according to the level of evidence proposed by the Journal of Bone and Joint Surgery (American Volume), and were categorized according to decade: 1980s, 1990s, and 2000s. 

RESULTS: A total of 24 research articles were retrieved and reviewed. There were no Level I studies performed in the department by the residents since 1983. There was a significant increase in the number of Level II and Level III studies from the 1980s to the 2000s (p=0.0001). The Hand Section had the highest number of Level II studies 8.6% (3 out of 35) while the Adult Section had the highest number of Level III studies at 21% (11 out of 53). The Pediatric Section had the highest number of Level IV studies at 91% (30 out of 33).

CONCLUSION: The level of evidence in research conducted by the orthopedic residents in training of the Department of Orthopedics, Philippine General Hospital has improved significantly in the past 27 years.

Human ; Adult ; Child ; United States ; Orthopedics ; Consultants ; Hospitals, General ; Philippines ; Orthopedic Procedures ; Biomedical Research ; Hand

BACKGROUND: Infection after flexor tendon repair in the hand is uncommon but may cause debilitating problems if not prevented. In centers where delayed presentation after injury happens often, early bacterial colonization is assumed and an initial debridement is indicated ensuring a clean environment for subsequent repair. Preference for the type of initial debridement differ from surgeon to surgeon.

OBJECTIVE: This paper aims to compare limited and extensive initial debridement in preventing post-operative infection in patients treated more than 24 hours after open tendon injury.

METHODS: A retrospective review of records for demographics, the type of debridement and occurrence of infection was performed. Statistical comparison of proportions of post-operative infection was done.

RESULTS: Of thirty-one records included, twenty-four patients underwent extensive debridement while 7 had limited. Two patients from each group developed infections resulting to 8.3 % infection in the extensive group and 28.6 % in the limited group. The difference is not statistically significant.

CONCLUSION: The trend for a higher infection rate in the limited group supports the need for aggressive debridement in managing delayed presenting patients with open tendon injuries. While the non-significant difference potentially supports the less cumbersome option, a better powered study is recommended to confirm.

Human ; Male ; Female ; Adult ; Debridement ; Tendon Injuries ; Tendons ; Hand ; Surgeons ; Demography

We report an innovative approach to reconstructing the defect after excision of giant tumor cell (GCT) involving the entire first metacarpal. Reconstruction was performed using non-vascularized fibular autograft fused at the metacarpo-phalangeal (MP) joint and soft tissue arthroplasty using ligament reconstruction and tendon interposition (LRTI) at the carpo-metacarpal (CMC) joint of the thumb.

Two years after the procedure, the CMC joint had functional pain-free motion and radiographs showed fusion of the MP joint. The patient did not present with any major complication and was satisfied with the outcome of the procedure.

Human ; Female ; Young Adult ; Thumb ; Metacarpal Bones ; Autografts ; Metacarpophalangeal Joint ; Arthroplasty ; Tendons ; Finger Phalanges ; Ligaments ; Pain

Reconstruction of chronic boutonniere deformity remains to be a challenging procedure especially when combined with other debilitating injuries in the same extremity. The balance to properly tension the reconstruction with active motion is often prevented by the need to perform the procedure under sedation of block to tolerate the use of tourniquet. We present a case of a young patient who successfully underwent restoration of active proximal interphalangeal (PIP) extension with a Palmaris longus graft while wide awake under local anesthesia and no tourniquet (WALANT) before subsequently having nerve transfers for upper type brachial plexus injury.

BACKGROUND: Reconstruction for congenital hand anomalies, if indicated, is generally recommended during early childhood to optimize function before formal education starts and minimize the psychosocial impact. There have been limited reports on these conditions persisting beyond the recommended age for surgery. OBJECTIVE: The research aimed to explore the common reasons why patients consult for late surgery and determine the baseline function of the patients prior to reconstructive surgery using the Filipino Disability of Arm Shoulder and Hand (Fil-DASH). METHODS: An observational, chart review of cases from 2013-2021 was done. The reasons and indications were extracted from the history and Fil-DASH scores were recorded with available data. The results were presented using summary statistics and tabulation of qualitative data. RESULTS: Twenty-five hands in 20 patients underwent reconstruction of congenital anomalies persisting beyond childhood. The most common indication for surgery was concerns regarding work opportunities. Hope for a better function, cosmesis, social pressure and hygiene were the other reasons mentioned. Most of the patients did not complain of significant problems in doing activities of daily living. This was supported by their Fil-DASH scores and employment status prior to surgery. CONCLUSION In this population, the indications to request for reconstruction of congenital anomalies beyond childhood were not necessarily due to loss of function but to increase opportunities for employment, improved appearance and hope for increased function. The results may aid in the understanding of the natural history of congenital hand anomalies and guide the physicians with more specific advice for parents with children presenting with these conditions.