Brisbane Hand & Upper Limb Research Institute

This study was performed to determine whether an arthroscopic dorsal peripheral triangular fibrocartilage complex (TFCC) repair can stabilize symptomatic distal radioulnar joint (DRUJ) instability in patients with a positive hook test, an intact foveal insertion, and a dorsal peripheral detachment of the TFCC. All patients who had an isolated arthroscopic dorsal peripheral TFCC repair performed by the primary author between August 2018 and April 2023 were included in the study. Functional measures of range of motion (ROM), gross grip, lateral pinch, force plate, pronation strength, supination strength, visual analogue scale (VAS) at rest, VAS on use, patient rated wrist evaluation (PRWE), and disabilities of the arm, shoulder, and hand (DASH) were recorded pre- and postoperatively. For this study 31 patients met the inclusion criteria. Measures taken at a mean of 13.8 months post-surgery demonstrated improvement in all functional parameters, with the exception of ulnar deviation and pronation which remained unchanged. Resolution of symptomatic DRUJ instability was documented in all cases. There were no cases of recurrent instability. There were no complications. Arthroscopic dorsal TFCC repair can successfully resolve symptomatic DRUJ instability in patients with a positive hook test, a dorsal peripheral detachment of the TFCC, and an intact foveal insertion. Level IV.

Background Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. Purposes This paper underscores the necessity of developing evidence-based clinical guidelines for UIS to guide clinicians in their diagnostic and therapeutic approaches. Materials and Methods In collaboration with the Asian Pacific Wrist Association, a team of experts from various fields within the Hand Surgery Department at Huashan Hospital has collectively formulated the "Clinical Practice Guidelines for Ulnar Impaction Syndrome (2024)" (hereinafter referred to as the "Guidelines"). The development process adhered to the guidelines outlined in the World Health Organization's handbook for guideline development. Results Ten key questions and 21 recommendations are formed. The Guidelines provide recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues. Conclusions The collaborative effort aims to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals affected by UIS, with these recommendations intended to serve as a valuable reference for healthcare professionals.

3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition. These implants are generally designed as titanium scaffolds that encourage bony incorporation at the host implant junction both proximal and distal. These scaffolds are typically considered a cellular solid, with high porosity that also promotes bone ingrowth directly into the substance of the body of the implant. Titanium scaffolds of this type have become a useful treatment alternative for large segmental bone defects around the knee, especially distal femoral defects. These are often adult patients with local or systemic compromise, or instead they may be too young to be considered candidates for reconstruction using a megaprosthesis. The process requires careful evaluation of individual patients, then matching that patient with the best treatment option, while recognizing the expectations and demands specific to that particular patient. Several cases are presented here to illustrate the variety of indications that can be successfully addressed with this technology, highlighting the quality of the clinical outcome that can be achieved despite the complexity of the pathology encountered.

'PD Warrior' (PDW) is a popular exercise programme for Parkinson disease; however, there are no published studies on the outcomes of the programme. To investigate short-term functional and quality of life (QoL) outcomes after the PDW 10-week programme in a pilot study of individuals with early Parkinson Disease (PD). Twenty individuals with PD (Hoehn & Yahr 1-3) attending a hospital outpatient clinic were recruited into the PDW 10-week programme, comprising a weekly 1-h supervised class complemented by an individualised daily home exercise programme. Participants had the following assessments at baseline and after completion of the programme: Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part III, timed up-and-go (TUG), 10-m walk test (10mWT), 6-min walking test (6MWT), balance tests, fine motor skills, 7-day Parkinson KinetiGraph (PKG) and PDQ-39 QoL scale. Seventeen individuals completed the programme. Significant improvements were observed in MDS-UPDRS motor score (P = 0.019, d = 0.68, MCID 7); 6MWT distance (P < 0.001, d = 1.16); walking time during motor or cognitive dual tasking (P = 0.006, d = 0.77; P = 0.005, d = 0.79, respectively); and the PDQ-39 emotional well-being subdomain (P = 0.009; MCID 4.2); as well as improvements trending to significance in bradykinesia (P = 0.025, d = 0.73), 10mWT walking time (P = 0.023, d = 0.61) and borderline improvement in balance (P = 0.056, d = 0.50). The outcomes of this study support the efficacy of the PDW programme in individuals with early PD and provide justification for future trials and investigation of its effects.

Strontium 90 (Sr-90) has been commonly used in the radiation treatment of pterygia of the eye. A radioactive plaque is placed in an applicator onto the surface of the eyeball for a specific length of time to achieve a desired dose. Dose is usually calculated using source activity and decay, as well as the distance from it to the surface of the eye. However, this assumes a flat eye surface. This investigation used 3D printing to produce an anthropomorphic eyeball phantom on which to perform dosimetry measurements for two different applicator sizes. These doses were compared to planar geometry measurements and a dose difference found. While planar geometry measurements are useful for routine quality assurance, measurements of the effects of the curved surface on dose calculations can provide valuable clinical information.

We investigated the surface electromyogram response of six forearm muscles to falls onto the outstretched hand. The extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, abductor pollicis longus, flexor carpi radialis and flexor carpi ulnaris muscles were sampled from eight volunteers who underwent ten self-initiated falls. All muscles initiated prior to impact. Co-contraction is the most obvious surface electromyogram feature. The predominant response is in the radial deviators. The surface electromyogram timing we recorded would appear to be a complex anticipatory response to falling modified by the effect on the forearm muscles following impact. The mitigation of the force of impact is probably more importantly through shoulder abduction and extension and elbow flexion rather than action of the forearm muscles.