BACKGROUND

To compare biomechanical strength of the Pulvertaft (PT) weave and the side-to-side (STS) tendon repair techniques.

METHODS

We conducted a comprehensive literature search using PubMed, MEDLINE and Cochrane library from inception to November 2020. All studies comparing the PT weave and STS were included. Methodological quality and assessment of risk of bias were assessed by two independent researchers. Publication bias was assessed using a funnel plot and confirmed by the Begg’s and Egger’s test. The random effects mode was used due to both statistical and clinical heterogeneity among studies.

RESULTS

The initial search resulted in 624 articles; however, after a thorough review, only six studies were selected for inclusion in the meta-analysis and systematic review. We were able to pool findings for maximum load and load to failure. By definition, maximum load is the peak force achieved in tensile testing while load to failure is the first negative inflection of force during the failure test. For maximum load, results showed that there was no evidence that the two tendon repair techniques were significantly different (SMD = –0.84, z = 0.88, p = 0.379, 95% CI = –2.72 – 1.04). However, there was significantly high heterogeneity detected among the included studies (Q=21.10, p = 0.001, I2 = 90.50%, τ2 = 2.47). For load to failure, results indicated that the load to failure was statistically higher in the side-to-side approach (SMD = 1.36, z = 5.26, p = 0.001, 95% CI = 0.85 – 1.86) than the PT approach. It is also notable that a small, non-significant heterogeneity was detected among the included studies (Q=3.66, p = 0.300, I2 = 18.10%, τ2 = 0.05).

CONCLUSION

STS is stronger than PT weave in terms of load to failure but comparable in terms of maximum load. STS is a possible alternative to PT weave for tendons in need of grafting.

Human ; Tendons

Metacarpal fractures are one of the more common fractures of the hand, with the fifth metacarpal neck fractures, commonly referred to as boxer’s fractures, comprising around 20% of all hand fractures. Currently, a variety of surgical treatment methods may be used for management, such as wire or plate fixations. Although these methods provide stable reduction, they are limited by higher costs and their invasive nature. Therefore, boxer's fractures have traditionally been treated conservatively with cast or splint immobilization, with these methods showing good functional outcomes. Recently, however, there have been studies showing similar results with the use of protected early mobilization with the use of soft wraps and buddy taping.

This study aims to compare the patient-reported functional outcomes of treating undisplaced fifth metacarpal neck fractures with protected early mobilization using buddy taping versus cast/splint immobilization with the use of the Shortened Disability of the Arm, Shoulder and Hand Score (quickDASH). This study will be conducted with a comprehensive literature search from PubMed, Cochrane Library, Embase, Google Scholar and ScienceDirect from inception to October 2022. All randomized control trials comparing protected early mobilization with buddy taping and cast/splint immobilization of the fifth metacarpal neck fractures will be included.

A 57-year-old female presented with a history of a progressively enlarging palmar mass over three years, with associated numbness over the median nerve distribution and difficulty in gripping due to dimensions of the mass. Physical examination revealed a 4 x 5 cm, movable, non-tender mass over the thenar eminence and a 2 x 1 cm movable, non-tender mass over the center of the palm. Tinel’s sign was positive over the mass and the carpal tunnel.

Excision of the mass was performed under intravenous regional anesthesia. A curvilinear incision made from the thenar crease distally to the midline of the wrist overlying the carpal tunnel, proximally. Dissection was carried down to the transverse carpal ligament which was transected to allow visualization of the mass and its attachment to the median nerve.

The mass described in this present case report shares characteristics from cases in previously published literature. Its gross appearance was highly indicative of a lipoma and its close relationship with the median nerve suggested an epineural origin. Magnetic resonance imaging revealed a well-defined lesion, suggesting a mass that was more likely to be excised, potentially leading to better neurologic outcomes.

Intraneural lipomas (within the epineurium) are rare soft-tissue tumors that predominantly occur in the hand and forearm. Most cases reported involve the median nerve, followed by the radial nerve, posterior interosseus nerve and more rarely the brachial plexus. Compression of peripheral nerves by benign adipose tumors is infrequently reported in literature, with most publications restricted to case reports or series of a few patients. To the author’s knowledge, this is the first article describing an intraneural lipoma in the Filipino population.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Carpal Tunnel Syndrome ; Peripheral Nerves

Dupuytren’s disease (DD) is a heritable, benign, chronic fibroproliferative process which affects the connective tissue of the palmar fascia. DD is rare among Asians with a prevalence of 0.004 to 0.032 percent. There are only 74 cases of DD among Asians identified in literature, and there are no published cases from the Philippines. We discuss a rare case of DD in a 60-year-old male Filipino presenting with bilateral loss of range of motion of the middle, ring, and little finger of both hands.
Dupuytren Contracture|asian