November 2016 www.ifssh.info VOLUME 6 | ISSUE 4 | NUMBER 24 | NOVEMBER 2016 ezine IFSSH 50 YEARS ON: TIME TO DO SOME STOCK-TAKING SCIENTIFIC COMMITTEE: CONGENITAL CONDITIONS ifsshCONNECTING OUR GLOBAL HAND SURGERY FAMILY

AN EXERCISE PROGRAM FOR THE RECONSTRUCTION OF THE CENTRAL BAND OF THE CHRONICALLY PAINFUL WRIST RADIOULNAR INTEROSSEOUS MEMBRANE USING A LENGTH ADJUSTABLE BONE TENDON-BONE GRAFT

1 www.ifssh.info November 2016 www.ifssh.info VOLUME 6 | ISSUE 4 | NUMBER 24 | NOVEMBER 2016

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Journal of Hand and Microsurgery Editor-in-Chief: J. Terence Jose Jerome 2017/Volume 9/3 issues p.a./ISSN 0974-3227 contents Americas Individuals: starting at $73 (contact [email protected])Institutions: 20% OFF starting at $385 (contact [email protected]) for new subscribers Europe, Africa, Asia, Australia, New Zealand Individuals: starting at €38 (contact [email protected])Institutions: starting at €342 (contact [email protected]) 1 COVER 21 MEMBER SOCIETY UPDATES (Please add shipping charges: €31.00) Anatomical drawings by Prof. Eduardo A • German Society for Surgery of the Hand Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka Zancolli- see page 14 • Hellenic Society for Surgery of the Hand For subscription rates in INR, please contact [email protected] • The Hong Kong Society for Surgery of the Subscribe at www.thieme.com/jham 4 EDITORIAL Hand Ulrich Mennen - IFSSH 50 Years on: • Indian Society for Surgery of the Hand Time to do some stock-taking 25 LETTER TO THE EDITOR Journal of Wrist Surgery 6 SECRETARY-GENERAL REPORT Alexander Zolotov Editor-in-Chief: T. Nakamura Message from the outgoing IFSSH Secretary 2017/Volume 6/4 issues p.a./ISSN 2163-3916 General, Marc Garcia-Elias 27 PEARLS OF WISDOM Americas Marc Garcia-Elias - Reconstruction of the Individuals: starting at $160 (contact [email protected]) 8 IFSSH SCIENTIFIC COMMITTEE central band of the radioulnar interosseous 20% OFF Institutions: starting at $598 (contact [email protected]) for new Europe, Africa, Asia, Australia, New Zealand Congenital Conditions membrane using a length adjustable bone subscribers Individuals: starting at €125 (contact [email protected])Institutions: tendon-bone graft starting at €453 (contact [email protected]) 12 OBITUARY (Please add shipping charges: €43.00) • Ayan Gulgonen 28 JOURNAL HIGHLIGHTS Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka For subscription rates in INR, please contact [email protected] • Journal of Hand Surgery (European)

Subscribe at www.thieme.com/jws 14 PIONEER PROFILES • Journal of Hand Surgery (American) • Eduardo A Zancolli • Journal of Hand Surgery (Asian-Pacific) • Jacques Michon • Journal of Hand Therapy • Journal of Wrist Surgery 16 HAND THERAPY • Hand Clinics An exercise program for the chronically painful wrist 30 UPCOMING EVENTS

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094_JHAMJWS_IFSSH_Ad.indd 1 10/24/2016 11:40:00 AM EDITORIAL www.ifssh.info November 2016

IFSSH 50 Years on: Time to do some stock-taking

In 1966, eight Hand Surgeons came congresses. This mutual relationship the title of “Giants of Hand Surgery” together in Chicago representing eight has been beneficial to both the surgeons and “Pioneers of Hand Surgery”. These Societies to establish a group to share, and therapists. names are listed on the IFSSH website. encourage, debate and learn from each other. This is still the prime aim of One of the major aims of the IFSSH is The IFSSH Charter was thoroughly what has now developed into a huge to produce Scientific Reports, which overhauled, and brought up to date. international family of 56 Member reflect a balanced and “state of the art” The financial auditing has become Societies, forming the International account of various hand related topics. ‘professional’ to comply with the Federation of Societies for Surgery of The last 40 can be accessed from the stringent regulations of the Illinois, the Hand (IFSSH) It is therefore prudent IFSSH website (ifssh.info) and have also USA tax laws, where the IFSSH is now to reflect on what has been achieved been published in the IFSSH Ezine. officially registered as a not-for-profit over these last 50 years. organisation. The IFSSH Ezine is published every The history of the IFSSH up to now The IFSSH is governed by the Delegates 3 months and is the international has been scrutinised for relevant and of its Society Members. The day-to-day communication medium of the important documents which are now running of this Federation is done by IFSSH. Subscription is free of charge digitalised and thus made much more the Executive Council (President, Past- ([email protected]). It is full of relevant accessible. This mammoth task was President, Secretary-General, Secretary- information, including helpful tips and undertaken by Frank Burke whom we Elect, President Elect, Members-at- advice from the Hand Therapist, as well owe special thanks. large and Historian) and is assisted by as what’s happening in our Member the Administrator. Societies. Members are encouraged to The “World of Hand Surgery and Hand The first of the triennial Congresses was use this magazine to share information Therapy” has become internationally held in Rotterdam, The Netherlands in and ideas. interconnected, readily accessible and 1980. Last month we have celebrated freely available. Our Hand Family is the half centenary of our Federation Educational sponsorships have been more vibrant than ever, and is growing at at the 13th Congress in Buenos Aires, introduced in the form of the Kleinert a healthy pace. Hope you enjoy reading Argentina. The Organisers under the Visiting Professor, financial support this issue of the Ezine! chairmanship of Eduardo Zancolli must for deserving surgeons and therapists be congratulated on a very successful to IFSSH Congresses, financial and memorable event! (In this issue sponsorships for courses, workshops, we have compiled a few images of the educational material, fellowships and combined IFSSH-IFSHT Congress) projects, etc. Applications are welcomed, indeed encouraged from members of The IFSSH Congresses have not only Member Societies. grown over the years, but have integrated The IFSSH has also recognised Prof Ulrich Mennen with the Federation of Societies for exceptional contribution to hand surgery Editor, IFSSH Ezine Past-President, IFSSH Hand Therapy (IFSHT) since the last 10 by individuals by honouring them with 4 5 SECRETARY-GENERAL REPORT www.ifssh.info November 2016 SECRETARY-GENERAL REPORT

General: Daniel Nagle, from USA; As I said in my first Newsletter, ezine Message from the outgoing 5) Secretary-General Elect: Goo three years ago, our mission is not Hyun Baek, from South Korea; to accumulate honors and awards,

CONNECTING OUR GLOBAL HAND SURGERY FAMILY 6) Historian: David Warwick, but to increase and spread the ifssh from United Kingdom, and 7) knowledge of surgery of the hand IFSSH Secretary-General, Member-at-Large: Raja Sabapathy throughout the globe. Let this goal (from India). A full report of the guide our steps through the next IFSSH DISCLAIMER: Delegates’ Council Meeting will be three years. The IFSSH ezine is the provided in an upcoming IFSSH official mouthpiece of the Dr. Marc Garcia-Elias Ezine. Yours sincerely, International Federation of Societies for Surgery of the Dear friends: between the young and the more the British option. Well done ! I’ll never forget the Congress of Marc Garcia-Elias Hand. The IFSSH does not experienced, between the Eastern Buenos Aires. Not only because Secretary-General, IFSSH endorse the commercial Eleven months ago, on my way and the Western societies. The Another important moment of the of a carefully planned scientific Email: [email protected] advertising in this back home from the customary social program had been planned Council of Delegates was when and social program, but also publication, nor the content inspection of the facilities to please everyone: the flying president of the ExCo, on behalf because it was there where, having or views of the contributors that would hold our congress hands over the crowded Faena of the Assembly, welcomed two ended my three-year term as to the publication. in Argentina, I wrote; “..the Arts Center, the Tango show at new members from Mexico: the Secretary-General, the Assembly Subscription to the IFSSH determination of the organizing the Alvear Palace, the Closing “Asociación Mexicana de Cirugía of Delegates trusted me with my ezine is free of charge and committee in hosting this event Banquet at the Yacht Club Puerto de la Mano A.C.” and the “Sociedad new assignment as President-elect. the ezine is distributed on a is unparalleled. I am sure that Madero.... what a colorful set of Mexicana de Cirugía de la Mano What a big honor! I feel grateful quarterly basis. nobody will leave Buenos Aires great moments to treasure. The y Microcirugía S.C.”. Personally, for this. Needless to say, I’ll do my unchanged”. I was right! The people, the venue, the city, the I am delighted to see my brother best to cope effectively with what Should you be interested to organizers have done an excellent country, all contributed to classify Mexicans joining our organization. our new President asks me to. No advertise in this publication, job, and the meeting has been one this meeting as one of the best. They are not only fun people to be matter what! Welcome President please contact the Editor: of the most enjoyable, interesting, Thank you, Eduardo Zancolli. What with, but also wise professionals to Szabo! [email protected] and easy going IFSSH congresses I you and your team have achieved learn from. IFSSH EZINE have ever attended. Unforgettable! is extraordinary. Congratulations! But before closing this letter, let me EDITORIAL TEAM: Electing the IFSSH Executive say a few words about the out going EDITOR: As Secretary-General of the IFSSH, October 27th 2016 was an Committee for 2016-2019 was President, Prof. Michael Tonkin. Professor Ulrich Mennen I went to Buenos Aires with a important day for those who had another highlight of the Council of In my opinion, he has endured (Past President of the IFSSH) long list of matters to supervise, been preparing bids to organize Delegates. None of the propositions one of the most difficult terms in issues to discuss, and decisions to the 15th Congress of the IFSSH made by Prof. Ulrich Mennen, the history of the IFSSH. Yet, he DEPUTY EDITOR: make. Five days later, no longer in 2022. They all had done their Chairman of the Nominating has proved to be a gentleman, a Professor Michael Tonkin worried, I returned home fully best to attract the sympathy of Committee was dismissed by the diplomat, an excellent analyzer, (Immediate Past President of satisfied. The scientific program the members of the Council of Assembly. For the next three years, and an effective and intelligent the IFSSH) had been balanced, carefully Delegates with a right to vote. In the IFSSH Executive Committee leader from whom I learned a lot. chosen to cover all aspects of our the end, and without hesitation, the will be formed by: 1) President: I’ll never forget his words when, not GRAPHIC DESIGNER: specialty. The benefits of mutual Council expressed unequivocally Zsolt Szabo, from Hungary; 2) long ago I went through a difficult Tamrin Hansen interaction between surgeons and its preference: the meeting will be President Elect: Marc Garcia- time in my life. Thank you, my therapists had been, once again, held in London. Not surprisingly, Elias, from Spain; 3) Immediate President. The long applause you TO SUBSCRIBE GO TO: demonstrated. There have been the word “Brexit” was seldom Past President: Michael Tonkin, got at the closing ceremony was www.ifssh.info/ezine.html fruitful and rewarding discussions pronounced by the defendants of from Australia; 4) Secretary- well deserved. 6 7 IFSSH SCIENTIFIC COMMITTEE REPORT www.ifssh.info November 2016 IFSSH SCIENTIFIC COMMITTEE REPORT

been associated with macrodactyly IFSSH Scientific Committee on leading to speculation that there is an underlying diagnosis causing the dysregulation of growth. The development of genome wide Congenital Conditions parallel sequencing has allowed comparison of DNA from involved Chair: Scott Oishi (USA) and uninvolved tissues. This has COMMITTEE: CHRIS STUTZ (USA), STEVEN HOVIUS (NETHERLANDS), GOO HYUN BAEK (KOREA) led to the identification of a number KERBY OBERG (USA), EMIKO HORII (JAPAN) of somatic mutations, occurring in the post-zygotic early embryo, REPORT SUBMITTED OCTOBER 2015 and causing mosaicism in growth regulation.

Macrodactyly Update Macrodactyly has traditionally Macrodactyly most often is Through eloquent genetic Figure 3. PI3K-AKT Pathway and associated clinical overgrowth disorders. been considered a specific confined to a single anatomic sequencing reported by multiple Used with permission from Keppler-Noreuil et al. PIK3CA-Related Overgrowth diagnosis characterized by region or limb, but cases of more authors, including Rios et al.1, Spectrum (PROS): Diagnostic and Testing Eligibility Criteria, Differential enlarged digits in the hand or foot than one site of involvement the genetic abnormality was Diagnosis, and Evaluation. Am J Med Genet A. 2015 Feb; 0(2):287-295. that is present at birth and does not have been reported. The level of found to be a gain-of-function undergo malignant degeneration. involvement may vary from the mutation in PIK3CA pathway Involvement of a “nerve territory”, distal part of a single digit to an (Phosphatidylinositol-4,5- hemimegalencephaly and others. classification, where macrodactyly most commonly the median entire hand/foot or limb. All the Bisphosphate 3-Kinase). Because Interestingly, Luks et al.3 have is placed into the general category nerve in the hand, had been tissues in the involved area are it is a postzygotic mutation some recently reported that PIK3CA of dysplasia, and then subdivided noted. Enlargement of the thumb, abnormal. Osseous structures cells carry the mutation while mutations are present in most into hypertrophy or tumorous index, and middle fingers in some enlarge and joints become others do not. DNA sequencing isolated lymphatic malformations conditions, with further delineation combination is usually associated stiffened and hyperostotic. Angular of affected tissue will show this as well as conditions in which depending on amount of upper limb with a lipofibromatous hamartoma deformity of the digits is caused PIK3CA mutation, while DNA lymphatic malformations are a involved.4 of the median nerve. (Figure 1) by asymmetric growth of the sequencing of unaffected areas in component. Similarly, enlargement of the ulnar open physes. The enlargement in the same individual will not. PIK3CA, along with mTOR and AKT, digits can be present when the the typical case of macrodactyly The clinical presentation of a constitute a signaling pathway ulnar nerve is involved. (Figure 2) remains in its original distribution The most recent, significant PIK3CA mutation/mosaicism would shown in Figure 3. This pathway over the growth of the child. The advance in our understanding is then depend on the location, timing is involved with the regulation condition may be relatively static, the discovery that macrodactyly and specific tissue in which the of growth, protein synthesis and growing in proportion to the child, is a part of a spectrum of mutation occurred. It appears to cellular proliferation. Mutations or may demonstrate progressive overgrowth disorders related now be appropriate to refer to all within this pathway have been enlargement out of proportion to PIK3CA mutations. PIK3CA- these conditions as “overgrowth” found in various cancers, and to the size and growth rate of Related Overgrowth Spectrum conditions, and sub-divide them treatment for the malignancies the child. When the abnormal (PROS)2 includes macrodystrophic further according to phenotypic now is focused at blocking the tissues grow progressively and lipomatosis, CLOVES (Congenital presentation and tissue involved. mTOR receptors. This has led extend proximally into uninvolved Lipomatous Overgrowth, Vascular This has already been done in to the development of targeted Figure 1. Median nerve distribution Figure 2. Ulnar nerve distribution areas, the condition is termed malformation, Epidermal nevi, the new IFSSH Classification chemotherapeutic agents with macrodactyly; Lipofibromatous macrodactyly. macrodystrophia lipomatosa. Spinal/skeletal anomalies) of Congenital Anomalies, the encouraging results in the cancer hamartoma of the median nerve. Other overgrowth conditions have (Figures 3-4), as well as OMT(Oberg Manske Tonkin) world.5 8 9 IFSSH SCIENTIFIC COMMITTEE REPORT www.ifssh.info November 2016 IFSSH SCIENTIFIC COMMITTEE REPORT

PROS conditions are non- hypertension, anemia/ 4. Tonkin MA, Tolerton SK, et al. malignant, although many have thrombocytopenia, peripheral Classification of congenital extensive associated morbidity edema, creatinine elevation, and anomalies of the hand and (Figure 4A-D). It is hoped that the potential hard tissue malignancy. upper limb: Development and same mTOR blocking strategy used Long-term follow-up is mandatory. assessment of a new system. in cancer treatment can control or In the next few years hopefully JHS (A) 2013; 38(9): 1845-53 modulate the growth abnormality we will have more information 5. Xia P, Xu X. PIK3CA/ Akt/ mTOR in children with PROS. Treatment regarding ideal candidates and signaling pathway in cancer will not reverse the condition, Figure 4D. PROS-Macrodystrophia length of treatment. stem cells: from basic research and must be administered over a Lipomatosa to clinical application. Am J prolonged period of time, with no Surgical treatment of patients with Cancer Res 2015; 5(5): 1602-1609 clear endpoint. upper limb macrodactyly includes 6. Lackner H, Karastaneva options such as ray amputation, A, et al. Sirolimus for the de-bulking procedures, and treatment of children with macrodactyly epiphysiodesis depending on the various complicated vascular is a part of a clinical findings. In patients with anomalies. Eur J Ped 2015; “ mild to moderate enlargement (epub ahead of print) spectrum of de-bulking +/- epiphysiodesis can 7. Margolin J, Soni H, et al. be a reasonable option; however in Medical therapy for pediatric Figure 4A. PROS - macrodactyly overgrowth patients with extremely large index vascular anomalies. Sem Pl and/or middle fingers with very Figure 6. Treatment algorithm. Used with permission from Gluck J & Ezaki M. Surg 2014; 28(2): 79-86 disorders little use ray amputation is a good Surgical Treatment of Macrodactyly. J Hand Surg Am. 2015;40(7):1461-1468. 8. Gluck J, Ezaki M. Surgical alternative as multiple de-bulkings treatment of macrodactyly. related to and epiphysiodeses procedures Summary References JHS(A) 2015; 40(7): 1461-1468 are unlikely to improve function or Somatic mutations resulting in 1. Rios J, Paria N et al. Somatic PIK3CA cosmetic appearance. (Figure 5) A limb overgrowth can present as gain-of function mutations recent publication by Gluck and macrodactyly alone or involve the in PIK3CA in patients with mutations Ezaki8 has outlined a reasonable whole upper or lower limb as well macrodactyly. Human Figure 4B. PROS – CLOVES algorithm for the treatment of these as many types of different tissue. molecular Gen 2013; 22(3): 444- Clinical trials have begun utilizing” patients. (Figure 6) DNA sequencing has identified 451 these medications to treat the most mutations along the PI3K-AKT 2. Keppler-Noreuil K, Rios J, et severe conditions, with promising signaling pathway as the culprit al. PIK3CA-related overgrowth results.6,7 At our institution we in the affected tissue. Treatment spectrum (PROS): Diagnostic have treated several patients with can involve observation, surgery and testing eligibility criteria, large vascular components with for de-bulking/ amputation, and/or differential diagnosis, and mTOR blocking agents, and have chemotherapeutic agents for mTOR evaluation. Am J Med Genet A been likewise encouraged with the blockade. Hopefully in the near 2015; 0(2): 287-295 short-term results. However, at future we will be able to identify the 3. Luks V, Kamitaki N, et al. this time it is unclear exactly which appropriate time and place for each Lymphatic and other vascular patients can benefit from treatment. type of intervention. malformative/ overgrowth Side effects and morbidity include disorders are caused by somatic Figure 4C. PROS- Muscular mucositis, hypercholesterolemia/ mutations in PIK3CA. Journal Hemihypertrophy hypertriglyceridemia, dyspnea, Figure 5. of Ped 2015; 166: 1048-54 10 11 OBITUARY www.ifssh.info November 2016 Cadaveric Human Specimens for your Medical Research, Training or Educational Needs

When it comes to medical research, development and surgical training, experts agree that the use of human tissue is far safer and superior to textbooks, computer simulations or artificial substitutes. In the field of hand surgery, many advancements, including the world’s first pediatric bilateral hand transplant, can be attributed to hours of research, training and practice using cadaver tissue.

Where do hand surgeons and medical facilities Ayan Gulgonen find fresh tissue for research and training? They work with organizations like Science Care, one of the 1937 - 2016 world’s largest non-transplant tissue banks with 5-accredited locations spread across the U.S. Science Care is capable of Ayan Gulgonen, a mentor and pioneer in the field of Hand Surgery and Microsurgery together. Between shipping custom procured tissue anywhere in the world. Science Care tissue has been used by numerous hand surgeons and Hand Surgery and Microsurgery in Turkey, passed away 1978 and 1980, Professor Gulgonen accomplished training facilities across the globe, helping to impact on August 25, 2016. The international family of hand many “firsts” in Turkish Microsurgery, including the successful surgical outcomes. surgeons and microsurgeons feel the personal loss of a first replantation of 5 digits, toe-to-thumb transfer, great friend and colleague, and the medical world a loss replantation of upper and lower extremity, among Whatever your tissue needs are, Science Care of a true giant in the field. others. Professor Gulgonen was also a renowned can help. We offer: teacher, having trained numerous surgeons in hand • Safe, well documented source of human tissue specimens. Ayan Gulgonen was trained in general surgery at the and microsurgery, establishing national symposiums – Tissue can be requested and supplied in multiple forms: whole Geissen-Evangelisches Hospital and then worked as an on advanced techniques in hand and microsurgery. bodies, extremities, internal organs, skin, FDA panels and more. “Oberarzt” at Unfall-Krankenhaus in Vienna, as well as In recognition of his efforts, Dr. Gulgonen received the • Customized methods of tissue procurement, preparation in Zofingen-Berzirkisspal in Switzerland. He returned “Eczcibasi Science Award” in 1979, and the “Medical and preservation are available to match your study and to Turkey in 1969, where he was faculty and division Sciences Award” by the Istanbul Medical Chamber in program goals. chief of the Emergency Department at the Hacettepe 1994. • A complete medical and social history of the donor with University. In 1972, he completed his hand surgery each human tissue specimen. fellowship at Columbia University. After serving as Great surgeons are remembered by generations because • Specially packaged specimens with worldwide shipping. a faculty member at the Department of Plastic and of their wisdom and actions that altered the course of Reconstructive Surgery at Gulhane Miltary Medical history. Professor Gulgonen changed medical history in How can YOU utilize cadaveric specimens for Academy (1974-1975), Professor Gulgonen joined the Turkey with his actions and perseverance to strive for your research, training and educational needs? faculty of Medicine at Istanbul University. In 1978, he excellence. Gulgonen also had the humility and passion pursued additional microsurgery training at Hopital that makes him a true giant. Call or Email us today: Jeanne D’Arc in France. Upon Dr. Gulgonen’s return to [email protected] | 844 825 3480 Turkey, he established the first hand and microsurgery A few words and good-bye to my friend Ayan; a man, who From Outside the U.S., call: 1 602 288 0047 group in the country. In 1980, he presented his thesis by nature was polite and pleasant. He was a humble man on “Finger Replantations” and earned professorship at of few words who had a vision and the courage to try to Visit us Online: http://research.sciencecare.com the Marmara University. He served as the chief of hand achieve the most from the often-meagre opportunities. surgery at VKV American Hospital, and was active in Ayan was a surgeon of great strength and perseverance, training fellows until his retirement in 2010. who believed that it was worth the effort to strive for excellence, even when things seemed impossible. Ayan Professor Gulgonen was one of the founders of the lived his life well. Turkish and Hand and Upper Extremity Surgery Society in 1977. In the history of the society, Dr. Gulgonen is Panayotis N. Soucacos, MD, FACS considered the man who initiated the application of 12 13 PIONEER PROFILES www.ifssh.info November 2016 PIONEER PROFILES

EDUARDO A ZANCOLLI, JACQUES MICHON MD, (1921-1989)

This influenced him to initiate Orthopaedics and Traumatology, The need to manage the injured Jacques Michon was also one of the Orthopaedic Service at the the Argentine and South hand better was further influenced the founding fathers of the Société Rehabilitation Centre of Buenos American Societies for Surgery of and encourage by same minded Française de la Main (French Aires where special emphasis was the Hand and the Society of Hip colleagues such as Marc Iselin in Society for Surgery of the Hand) given to paralytic deformities of and Knee Surgery. He is Honorary Paris, Pierre Colson in Lyon, Herbert in 1963. He was president of this the upper limb. A strong group of Member of the Hand Societies Seddon in London, Claude Verdan Society from 1972-1973, and also orthopaedic and hand surgeons of the following countries: in Lausanne, William Littler and president of the French Society for were formed and worked with him Argentina, USA, Australia, Spain, James Smith in New York. Plastic and Reconstructive Surgery at this facility for more than 20 South Africa, Great Britain, Chile, in 1980. Michon was member years. A number of publications Costa Rica, Venezuela, Uruguay, Prof Michon was one of the and honorary member of various on the spastic hand, tetraplegic and Brazil. first surgeons in Europe to international societies. upper limb and congenital use the microscope for nerve Dr Zancolli trained at the malformations evolved from their Prof. Zancolli has taught Jacques Michon was born on 22 reconstructive surgery, when he Jacques Michon was still active in Finochietto School of Surgery, experiences. He is especially hand surgery at the National January 1921 in Nancy, France. He returned from a stint in the USA in his Clinic days before he passed Rawson Hospital, in Argentina known for the two textbooks on Rehabilitation Centre and at the was the eldest of four sons. Their 1963. away on 9 March 1989. Although and at the Campbell Clinic in the hand: one on the “Structural Medical School of Buenos Aires. father was professor of Medicine, his personality was characterised Memphis, Tennessee where he and Dynamic bases of Hand He has lectured world-wide and this influenced him to study In 1970 he established the surgical by a humble and quiet demeanour, studied orthopaedic surgery Surgery” and a massive “Atlas of through series of conferences, medicine. The Second World War service in the Hôpital Jeanne d’Arc he had an intense desire and for 6 months under H Boyd, M J Surgical Anatomy of the Hand”. courses and surgical programs saw him serving in the Military in Nancy, France, with special exceptional energy to improve Steward, R Knight, J S Speed and and was Visiting Professor at in Algeria from 1945 to 1946. In emphases on the reconstructive healthcare to the injured hand H Smith. He also visited the Hand Prof. Zancolli is Honorary Harvard, Cornell, Irvine and 1948 he completed his medical aspect of injured upper limbs. patient. Service of Michael Mason, Harvey Professor at the Medical School of Stanford Universities. The studies, and became a trainee Some of his students included S. Allen and Summer Koch at the Buenos Aires, and at the Córdoba majority of hand surgeons in under Professor Chalnot. In 1955 he Claude Guibert, Guy Foucher and The IFSSH, at its sixth international Passavant Memorial Hospital of University in Argentina. He was Argentina have received training graduated as a surgeon and became Michel Merle, who caught on to this congress in Helsinki, Finland, 3-7 Chicago. He studied scoliosis Professor of Orthopaedics and from him in hand and orthopaedic “Professeur agrégé” in 1958. “new speciality” and propagated the July 1995, honoured Prof Jacques and arthritic hand surgery at the Traumatology at the Medical surgery. importance of excellent primary Michon with the title “Pioneer of Hospital for Special Surgery in School of Buenos Aires and at Professor Michon’s interest in care for the injured hand. Hand Surgery”. New York with J Cobb and L R UCES Medical School in Buenos At the sixth IFSSH Congress in traumatology was influenced by Straub. Aires. He is the ninth member Helsinki, Finland, July 1995, Prof. Robert Merle D’Aubigné at the This then led to the establishment elected to the National Academy Eduardo A Zancolli was honoured Hôpital Cochin, as well as by of the “Confédération Européenne Dr Zancolli visited the of Medicine and is also a member as a “Pioneer of Hand Surgery” Daniel Morel-Fatio at the Hôpital des Services d’Urgences de la Rehabilitation Center of Warm of the Academy of Medicine of Vaugirard. During this time he Main” by Jacques Michon, R Vilain, Springs, Georgia in 1950, where Córdoba. He was also honoured as realised that the injured hand was G Foucher and M Merle. Presently he observed tendon transfers Honorary President of the 13th a neglected part of both, Plastic there are some 30 such centres of and reconstructive procedures Prof. Zancolli is Past-President IFSSH Congress in Buenos Aires, and Reconstructive Surgery, and excellence in Europe. for hip and spine deformities. of the Argentine Society of Argentina, in October 2016. Surgical Traumatology. 14 15 HAND THERAPY www.ifssh.info November 2016 HAND THERAPY

pattern. This compensatory strengthening of the musculoskeletal An exercise program for the movement pattern is the system aims to correct these physiological reaction to a temporary persistent compensatory motor change in peripheral feedback. If the patterns. In our experience this pain disappears, the adaptation will approach may offer long-term pain not be necessary anymore and the relief. chronically painful original motor strategy is resumed. But what happens when the pain THE EXERCISE PROGRAM exists long enough to induce a The exercise program covers 12 Figure 3: Lateral view of the neutral wrist revision of the programming rules? weeks of intensive training. In the wrist position The compensatory movement first sessions, the emphasis lies experience these methods do not strategy is composed. Immediately pattern will be upgraded as the new on a thorough perception of the [Figure 2 & 3]. result in a satisfactory long-term after the planned movement is standard motor strategy. Even when rationale and goal of the treatment The program consists of exercises pain relief. Therefore, we have been effectuated, feedback information the original pain has disappeared, and instructions for home exercises. that focus on different aspects of treating these patients since 1992 from the peripheral effector organs the ‘compensatory’ movement It is really important that although our motor system. Some exercises with an exercise program that is will contribute to the continuous pattern will continue. pain may be present, the patient focus on strength, others more not primarily focused on the pain adaptation of the motor strategy. is encouraged to start with active on wrist stability, proprioception, but on functional re-education and This process is continuously exercises. The use of a supporting coordination or mobility. During strengthening of the musculoskeletal changing the strategy until it is wrist brace is cut down as much therapy sessions the attention will system. This article discusses the optimally adjusted to the peripheral as possible. In the beginning the be alternately focused on a different rationale, the exercise program and body and the environment. The therapist helps the patient to become aspect of the motor system but the some study results. result is a customised movement aware of their wrist positioning, integration of all aspects should Annemieke Videler, PT, PhD pattern that satisfies the primary compensatory movements and pain always be kept in mind. If we train, THE RATIONALE intention2. Repeated adaptation provoking activities. Furthermore, a for example, muscle strength, Physiotherapist / hand therapist If the major complaint of the patient of the same strategy will, at some lot of feedback is given about having proprioception and coordination Hand & Wrist Center Amsterdam with a chronic wrist disorder is pain, point, require a revision of the ‘motor a neutral position of the wrist during will, of cause, also be part of the Weerdestein 106a why start exercising? The exercise programming rules’ that will make Figure 1: Circle of chronic wrist pain especially load bearing activities exercise. The course of the program 1083 GN Amsterdam program that is developed in our the adaptation unnecessary and is not fixed. Different aspects require The Netherlands clinic is based on the idea that thus create a more efficient motor It is our hypothesis that even if Figure 2: Frontal view of the neutral attention for a longer or shorter the pain is maintained by subtle strategy1,3. For example, a definite there is no objective pathology in wrist position period, earlier or later in the program Physical examination and overload mechanisms in the wrist change in the peripheral effector the wrist (any more), chronic pain imaging of chronic wrist pain is due to persisting compensatory organ, such as the amputation of a can very well be maintained by a well-documented challenge. movement patterns. A movement finger, will lead to adaptation of the such a persisting compensatory Nevertheless, an objective diagnosis pattern is the visual result of a ‘motor programming rules’ for all movement pattern. In a joint as that directly explains the pain series of complex information actions that involved that finger 2, 3. complex as the wrist a subtle often remains elusive. These non- processing1. The intention to This model of dynamic motor change in movement pattern can specific chronic wrist pain patients perform a movement activates programming can be used to lead towards loss of strength and are regularly referred to a physio-/ a motor-planning process that approach chronic wrist pain from a functional instability which in term hand therapist. Immobilisation, combines acquired abstract different point of view. What if the leads to disproportional loading of avoiding excessive wrist load, steroid ‘motor programming rules’ with feedback information contains pain? the musculoskeletal system and pain injections and various physical a selection of a multitude of Pain will also serve as input and the [Figure 1]. therapy methods predominantly perceptive, proprioceptive and motor strategy will adapt to this pain focus on the pain itself. In our cognitive input. An initial motor with a compensatory movement Functional re-education and 16 17 HAND THERAPY www.ifssh.info November 2016 HAND THERAPY

adjusted to the individual patient. and inform the patient about the results of this study showed that of the questionnaires 24 patients VAS and a good (=low) score on the Strength and co-ordination exercises involvement of the upper extremity, patients moved significantly less were excluded from the study. PRWHE. Spearman rank correlation aim to achieve a good qualitative especially the affected wrist, during fluently compared to the healthy Twenty-three of these patients did coefficient (rs=-0.7, p<0.0001). control of movement and functional daily activities. Variation in training matched controls. And even more not complete the exercise program stability. Especially the long by using different materials and interesting, the same disturbance and one patient had surgery after Before treatment with the exercise extrinsic muscles of the hand should changing in posture are absolutely in fine motor control was found a second opinion. The remaining program 20 patients (33%) were not be trained as active stabilisers of necessary for optimal functional at the contra lateral, non-painful 60 patients had all completed the able to work at all because of their the wrist. The exercises are as much results.1,2 This requires creativity and wrist.5 These results support our exercise program and had not wrist pain and depended totally on as possible in the pain-free range. Figure 6: Dynamic exercises with a motivation from the therapist and view that chronic wrist pain can received any further treatment since health insurance. Five patients were Initially the focus is on positioning dumbbell patient. disturb cerebral motor programming then. These were 51 women and 9 partially disabled because of their and stabilising the wrist during maintaining the circle of pain. men with a mean age of 24 years old. wrist pain and only 23 patients were upper extremity movement. During It takes a lot of time and effort from The follow-up ranges from 2 to 50 able to work in their own profession the therapy sessions the patient the patient to regain a functional To evaluate the effect of the program months with a mean of 17 months. without adjustment. The remaining works towards extending the pain- and stable motor pattern in the a retrospective pilot study was The data from the visual analogue 12 patients were unemployed or free range with increased loading wrist. With the help of the therapist performed among 100 patients scale for pain relief (VAS) could be students. At the time of evaluation and complexity of movements. Some a patient should try to become aware who were referred to follow the separated into three groups. The there was a decrease in job examples of exercises are given of wrist positioning, compensatory program. The patients were selected largest group of 29 patients (48%) disablement by 21% and 38 patients movements and pain provoking from the outpatient clinic of the were very satisfied with the pain (63%) were completely able to work in activities during daily activities department of plastic, reconstructive relief (score 7-10 on the VAS). Sixteen their own profession without being Figure 7: Manipulating heavier and work. Obviously a clear and hand surgery. All patients had patients scored the maximum restricted by their wrist pain. objects in the hand understanding of the rationale of a pain history of the wrist of more possible satisfaction (score 10 on the program, a good motivation and than six months’ duration and no VAS = 27%). An intermediate group creativity are essential for both the objective cause for the pain nor of 13 patients (22%) did have some therapist and the patient. any indications to justify further benefit from the therapy and were examination. The questionnaire equally satisfied with the gained patients Figure 4: Training of extrinsic muscles STUDY RESULTS consisted of questions related to pain relief (score 4-6 on the VAS). with a with handgrip We have performed a couple of the time and duration that the However, there is also a group of “ studies to support the rationale of exercise program was followed, 18 patients (30%) that did not have our exercise program and to evaluate a visual analogue scale to assess long term pain relief at all (score chronically its effect. The first studies were set patient satisfaction on pain relief, 0-3 on the VAS). The results from non-specific Figure 8: Stabilization of the wrist in up to investigate if motor function the PRWHE for the rating of wrist the PRWHE ranged from 0 to 100. A pro- and supination movements is indeed different in chronic wrist pain and disability questions about total wrist score of zero means that painful pain patients compared to healthy recreational activities, job history the patient experiences no pain or subjects. Furthermore, we wanted to and ability to work. disability at all and a score of 100 wrist can be The exercises should be as functional study if there is a centrally disturbed means extreme pain and complete as possible and directed at the motor programming in these Eighty-four completed disablement. The data in our study successfully problematic actions of the patient. patients. In this study fine motor questionnaires (84%) were returned. show an equal spread between score Figure 5: Stabilisation of the patient’s With the optimisation of mobility function between 18 patients and The 16 questionnaires that were 0 and 90. However, the same three treated with wrist while the therapist gives and strength and the gradually 20 healthy controls of the same age not returned were sent to patients groups could be identified when isometric resistance in different increasing stability and complexity and gender was studied.4 All subjects who had moved to an unknown these data were compared with the an exercise directions of movement it is possible to work performed a writing task and fluency address (11%) or to patients who results of the VAS. A statistically towards these problematic activities. of movement was analysed using were not willing to participate in significant correlation was shown program below [Figures 4-8]. It is also important to advise a customized computer setup. The the study (5%). Following analysis between a good (=high) score on the ” 18 19 HAND THERAPY www.ifssh.info November 2016 MEMBER SOCIETY UPDATES

The results of the questionnaire REFERENCES “Exercise Therapy for Chronic showed that patients with a 1. Mulder Th. A process-oriented Wrist Pain” chronically non-specific painful model of human motor The booklet elaborates on the Member Society Updates wrist can be successfully treated behaviour: toward a theory- issues of chronic wrist pain and on with an exercise program. based rehabilitation approach. the rationale behind treatment with Further study will be necessary Phys Ther 1991;71:157-164. our exercise program. The content GERMAN SOCIETY FOR SURGERY OF THE at the hand and forearm. We were honored to to understand why some patients 2. Mulder Th. Spinal Cord and structure of the exercise HAND have William (Bill) Cooney, the former head of the improve and others do not. In a Dysfunction, Vol.II Intervention program is thoroughly discussed department for hand surgery at the Mayo Clinic, to prospective longitudinal study, it and treatment. 1990;187-209, and many examples of exercises The German Society for Surgery of the Hand (Deutsche present the Buck-Gramcko lecture. may be possible to identify criteria Oxford University Press. (with drawings) are given. An Gesellschaft für Handchirurgie = DGH) has a busy that will select patients with a 3. Merzenich MM, Jenkins WM. exercise program that focuses on time. With the annual meeting in October 2015 in In October 2016 there will be a further combined high potential to benefit from this Reorganization of cortical the correction of impaired motor Ludwigsburg we started a series of combined meetings meeting of the DGH and the Italian Society for Hand program. representations of the hand skills is important in many chronic with other national societies for surgery of the hand, Surgery, this time taking place in Palermo, Sicily, Italy. following alterations of skin wrist problems. In patients with which will culminate in 2019 with the IFSSH meeting The annual meeting 2017 of the DGH will be in Munich Our exercise program has been inputs induced by nerve injury, midcarpal instability, for example, in Berlin. In Ludwigsburg we hosted the Italian with the British Hand Society as the guest society, and published in a Dutch booklet skin island transfers and the exercise program is perfect Society for Surgery of the Hand. The meeting was very in 2018 we will welcome our colleagues from the Swiss and has been used successfully experience. J Hand Ther 1993; for improving the function and successful with a total of more than 700 participants. Society for Surgery of the Hand in Mannheim. for many years. It has now been 6:89-104. usability of the wrist. The meeting ended with an excursion through the translated into English: “Exercise 4. Smeulders MJC, Kreulen M, This booklet contains of 44 vineyards around Ludwigsburg and a wine tasting. The DGH has at the moment 905 members. We all Therapy for Chronic Wrist Pain”. Bos KE. Fine motor assessment pages, is written for physio- and look forward to welcoming hand surgeons and hand The booklet elaborates on the in chronic wrist pain: the role occupational therapists and should In January 2016 the DGH was the guest society at the therapists from all over the world to Berlin in 2019. issues of chronic wrist pain and on of adapted motor control. Clin be seen as a guide in the treatment annual meeting of the American Association for Hand the rationale behind treatment with Rehabil 2001; 15:133-141. of patients with chronic wrist pain. Surgery (AAHS) in Scottsdale. Prof. Dr. Karl-Josef Prommersberger our exercise program. The content 5. Smeulders MJC, Kreulen M, We hope that this guide will inspire In May 2016 the DGH was invited to join the IFSSH delegate of the DGH and structure of the exercise Hage JJ, et al. Motor Control you to use our vision as a potential Meeting of the Chinese Society for Surgery of the program is thoroughly discussed impairment of the contralateral approach in your treatment of this Hand in Qingdao. 23 German hand surgeons used and many examples of exercises wrist in patients with unilateral category of patients. Many positive the opportunity to visit Qingdao, to meet Chinese (with drawings) are given. An chronic wrist pain. Am J Phys responses have been received since colleagues, who were in Germany over the last decade exercise program that focuses on Med Rehabil 2002; 81:177-181. the publication of the first edition. as visiting fellows, and to taste beer from the world- the correction of impaired motor famous “Tsingtao” Brewery, which was founded in 1903 skills is important in many chronic The cost of the booklet is 15 euros by Germans. wrist problems. In patients with (~$21) + postage costs Michael Sauerbier (Congress president of the annual DGH mid-carpal instability, for example, If you`re interested in purchasing In September 2016 we were able to return the invitation meeting in Frankfurt), Nicola Borisch (President of the the exercise program is perfect the booklet please send an email to and had the AAHS as our guest society at the annual DGH) with Bill Cooney, the Buck-Gramcko lecturer, and for improving the function and Annemieke ([email protected]) so DGH meeting in Frankfurt. The meeting was very Ulrich Lanz, Pioneer of Hand Surgery usability of the wrist. she can arrange your order. well attended with a total of nearly 800 participants from Germany, USA, Austria, and Switzerland. The day before the meeting was a day-long live surgery workshop at the Department for Plastic, Hand and Reconstructive Surgery at the BG Trauma Center in Frankfurt. Main topics at the symposium were microsurgical reconstruction after severe hand The delegation of the DGH visiting the meeting of the injuries, wide awake surgery, and malignant tumors Chinese Society for Handsurgery in Qingdao 20 21 MEMBER SOCIETY UPDATES www.ifssh.info November 2016 MEMBER SOCIETY UPDATES

HELLENIC SOCIETY FOR SURGERY OF THE know and like history. Larissa is a very nice city which HAND is attractive for everybody to visit and not only for The Indian Hand Society fondly remembered the scientific reasons. contributions of Dr Robert Acland who passed away The Hellenic (Greek) Society for Surgery of the Hand recently. ISSH ever remains in debt to Dr. Acland who and Upper Extremity holds its Annual Meeting for the Our Associations invite you to attend the Meeting and graciously transferred the copyright of his popular year 2016, in Larissa from December 1 to December 3. It enjoy a wonderful time in Larissa. ‘Red book’, the Practice Manual of Microsurgery; the will be the 22nd Consecutive Combined Meeting with latest edition was published with Dr Raja Sabapathy the Hellenic Society of Reconstructive Microsurgery. joining as co author. The proceeds has helped the ISSH THE HONG KONG SOCIETY FOR SURGERY to institute the Dr. Acland International Travelling Surgery of the Hand in Greece has a significant OF THE HAND Fellowship, a mid career award for an Indian Surgeon tradition long before the establishment of the to take up a 3 weeks study tour abroad. official Associations for the Surgery of the Hand On 18 March 2016, the 2016-2018 Council of the Hong and Reconstructive Microsurgery. Soon after this Kong Society of Surgery of the Hand (HKSSH) had INDIAN SOCIETY FOR SURGERY OF THE The next meeting of the ISSH will be in Mumbai establishment, the combined annual meetings took been elected. Our current council includes experience HAND on 21st, 22nd & 23rd September, 2017 under the place with great success helping especially residents as well as young and energetic members. We aim at chairmanship of Dr. Pankaj Ahire (http://isshcon2017. and young surgeons to be acquainted with the practice promoting hand surgery among the surgeons and the The 2016 Annual meeting of the ISSH was held com/ ) and secrets of Hand Surgery. Six national and allied health personnel. Our council members are: between the 15th to 17th September, 2016 at Ranchi, Prof Richard Gelbermann and Prof James Bertelli will international Hand Surgery workshops and seminars the state capital of Jharkand. It is a developing state be guest orators and this is held with the Singapore were organized in Greece in 2016 providing a high level President: Dr CHAN, Ping-Tak of India, rich in minerals. The site was chosen as Society for Surgery of the Hand as the Guest Society. training in more than 200 young surgeons. Vice-President: Dr LAU Yan-Kit per the policy of the ISSH, whereby once every 3 or 4 Dr Ravi Gupta of Chandigarh and Dr. Rajendra Nehete President-Elect: Dr WONG, Hin-Keung years we reach out to an area where the meeting has of Nashik are the current President and Secretary of This year the convention will take place in Larissa, at Secretary: Dr KOO, Siu-Cheong Jeffrey Justin never been held. It gives the opportunity to the local the society. the facilities of the Medical School of the University Treasurer: Dr WAN, Siu-Ho surgeons to project Hand surgery in the region. The of Thessaly. The Scientific Program will cover Council Member: Dr IP, Wing-Yuk; Dr CHOW, Ching-San organizing team led by Dr. Anant Sinha took on the many topics of Hand Surgery including trauma, challenge very well. Presently Ranchi is more known osteoarthritis, instability, soft tissue coverage, tendon as the hometown of the Captain of the Indian Cricket transfers and congenital abnormalities. The most Team Mr. Dhoni. In line with that the whole meeting known and experienced Greek Hand Surgeons will be was held at the Cricket Club. The club did have participate in the Meeting and present their work. good rooms and it provided a good ambience for the visitors since the halls and the lobby was studded with International participation this year will be photographs and memorabilia of great cricketers and (L-R) Dr. Rajendra Nehere, Secretary, Dr. Prakash Kotwal, outstanding. Four distinguished colleagues and matches. The organizers had opened up the stadium President,ISSH and the Prof. Venkataswami Orator Dr. renowned Surgeons will honor the Meeting with their for the delegates to play before the dinner. It was a rare Goo Hyun Baek presence and lectures. These are Drs Dean Sotereanos opportunity for everyone to be at the flood lit stadium and Mark Baratz from the USA, Dr Marko Bubasirevic Our society is formed in 1986 by a group of enthusiastic and even our overseas visitors had a great time. from Serbia and Dr Alexandru Georgescu from pioneers, including Prof PC Leung and Prof SP Chow. Romania. Their expertise in the fields of Hand Surgery This year, we are celebrating the 30th Anniversary of The theme of the meeting was “Back to Basics”. ISSH and Microsurgery and also their teaching experience our society. A symposium will be held on 12 Nov 2016 has two orations named after the doyens of Indian will contribute to a high scientific level of the Meeting. to denote our celebration. The theme is “continuing Hand Surgery, Pro. R. Venkataswami and Prof. BB the legacy, committed to the future”. We are looking Joshi. The Venkataswami oration was delivered by Larissa is the place where Hippocrates, the father of forward for this memorable event. Esther; Dr YAU, Prof Goo Hyun Baek from Korea and the BB Joshi Dr. Martin Boyer facilitated by the Organising Chairman of Medicine, lived his last years, died, and was buried. Leung-Kai Edmund oration was delivered by Prof Martin Boyer of the the Congress His tomb is a significant monument for people who Washington University, USA. 22 23 www.ifssh.info November 2016 LETTER TO THE EDITOR

VOL 10 NO 4 | Oct 2016 SPOTLIGHT ON IFSHT MEMBER SOCIETY: 2013-2016 IFSHT ACCOMPLISHMENTS Letter to the Editor FINLAND Much of the work of the IFSHT Executive Commit- The Finnish Hand Therapy Society has 289 members, tee (EXCO) has been accomplished through regular two thirds of whom are OTs and the remaining one Skype meetings. These past three years have seen Alexander Zolotov third are PTs. This year’s biggest society event was đƫ Substantial upgrades to the IFSHT website the 26th Scandinavian Hand Society Congress, March đƫ Survey of member countries 31-April 3 in Levi, Lapland which was organized to- đƫ Significant improvements to the treasurer’s ac- gether with the Finnish Society for Surgery of the counting processes Thank you very much for the last issue of the IFSSH Ezine (August 2016, #23) đƫ Increase in member countries from 41 to 50 Hand. The therapists’ program consisted of focus sessions đƫ Establishment of regular communication through the IFSHT Facebook page, Hand Therapy Con- For several years the Ezine has become a friend nections E-Newsletter and the IFSSH Ezine. and a teacher for hand surgeons around the world. I Sarah Ewald, our outgoing President, has represented appreciate your contribution a great deal. IFSHT at the American, Brazilian, Asia-Pacific and Eu- ropean hand conferences. To prepare for the Triennial Congress in Buenos Aires she has worked tirelessly I sincerely regret the passing of Kenya Tsuge. Actually, with Birgitta Rosén to develop the scientific program, Kenya Tsuge was my pen friend and “distant” teacher for and with Beatriz Inés Piso, local organizing committee chairperson, to ensure the success of the congress. a long time. In the 80’s I have known about his original Ursula Wendling, has served two terms as IFSHT Sec- loop tendon suture technique and sent him a letter with retary General to coordinate IFSHT communication plenty of questions concerning the practical details. I 11th and keep everyone organized. IFSHT, a totally volunteer organization, appreciates received an answer from this famous Japanese surgeon the contribution of the EXCO and all volunteers. very soon. It was a parcel with copies of Tsuge’s articles, At the Levi congress; Back row L to R: Pia Nahi, Elina Kanninen (Vice a chapter from the author’s surgical atlas, as well as President), Virpi Natt (President), Sari Marjala (Secretary), Tiina Mar- IFSSH EZINE several boxes with original loop needles. Kenya Tsuge jala (Treasurer), and front row from L to R: Annu Voipio (IFSHT delegate), The IFSHT contribution to the July 2016 IFSSH Ezine Saara Raatikainen, Mira Sillanpää, Anna Piironen. Piia Pajunen is absent. (http://www.ifssh.info/ezine.html) is a discussion by shared his knowledge and experience generously. He Birgitta Rosén and helped me with advice in complicated clinical cases, on new insights in neuroscience and pain mechanisms Pernilla Vikström and was interested in my articles about using his as well as the role of fascia in upper limb pain. The about timing of sen- participants also deepened their understanding of sory re-learning in tendon suture technique which I published in Russian peripheral neuropathies, the central changes related clinical practice fol- and international journals. Professor Tsuge was proud to them, and the clinical means to measure them. The lowing nerve repair. that his method was spread around the world. information was brought together through learning This thorough de-

how to interpret functional and sensory assessments scription of their sen- and base clinical practice on the results. sory relearning model Michael Tonkin (IFSSH President) formulated the chief purposes of the IFSSH in the last issue of the Ezine. One Other courses this year will be basic splinting courses is a valuable resource of them is to promote the free and full exchange of knowledge, to improve and widen the opportunities for study in Helsinki and Oulu as well as a course on evaluation for the hand therapist and observation of Hand Surgery in the various countries. According to that, Kenya Tsuge was a real Pioneer of the of the hand for junior therapists in Jyväskylä at the clinician. IFSHT is end of the year. The Finnish Hand Therapy Society keen to have clinically Hand Surgery. publishes an electronic journal on its website four Imagery exercises from the sensory re-learn- relevant and interest- times a year. ing articles to contrib- ing model. Below is the letter from 2004, in which Kenya Tsuge made a pencil drawing of his suture technique. This drawing ute to the IFSSH Ezine. KNOW WHAT IS GOING ON AT THE Please write to [email protected] if you has historical significance and can be of interest to readers of the Ezine. would like to contribute, or if you have a topic to sug- 2016 IFSHT CONGRESS gest. If you are unable to join us in Buenos Aires, Best regards, follow us on our IFSHT Facebook page Alexander Zolotov, to keep up with the scientific and social Vladivostok events at the Congress. For hand therapy educational events, go to “National/ International Education Events” under “Education” at www.IFSHT.org. www.drzolotov.com

24 11th Triennial IFSHT Congress | Berlin, Germany | May 20-24, 2019 25 PEARLS OF WISDOM www.ifssh.info November 2016 PEARLS OF WISDOM

proportion of load that leaves the forearm through Treatment of an Essex-Lopresti injury is not for the ulna (across the trochlea) or through the radial the novice in upper limb surgery. It requires an head (across the capitellum) varies substantially experienced surgeon with good understanding depending on a number of factors (Farr et al., 2015). of the pathoanatomy of the forearm. This is not a If the axial load gets into the forearm while the elbow forgiving injury that tolerates suboptimal surgery. is forced in valgus, the radiocapitellar joint carries Lack of surgical determination is not acceptable most of that load, and the IOM remains undisturbed. either. All components of the injury need to be By contrast, if the elbow is stressed in varus, the properly addressed: the TFCC detachment needs to trochlea gets most of that axial load. In between the be fixed or reconstructed, the radial head must be two extremes, the amount of force transferred from anatomically restored or substituted by an implant, the radius into the ulna, and from there into the and the continuity of the IOM must be somehow humerus, varies considerably as long as the IOM is re-established (Figure 2B)(Adams et al., 2010). In the Pearls of wisdom intact. (Figure 1). In the absence of a competent IOM, presence of longitudinal radioulnar instability, radial both TFCC and the radial head become overloaded in head excision is a harmful procedure to be avoided all elbow positions. If these two structures are also at all costs: it makes things worse. Distal radioulnar Marc Garcia-Elias damaged, the radius becomes grossly unstable, and resection arthroplasties (Darrach, Kapandji-Sauvé,..) migrates proximally, unable to move or carry load are not adequate either: they also tend to further normally (Figure 2A). Certainly, the Essex-Lopresti destabilize the joint (McGlinn et al., 2013). This Reconstruction of the central band of the radioulnar dislocation of the radius relative to the fixed ulna injury is not a forgiving condition. article will not discuss the overall treatment of the interosseous membrane using a length adjustable (Essex-Lopresti, 1951). Known as the “Essex-Lopresti Essex-Lopresti injury nor the wide range of options bone-tendon-bone graft injury”, this condition is one of the most difficult that exist to reconstruct the radial head. This paper forearm derangements to treat, and one of the most will concentrate only on how to restore function of On June 15th, 1951, the untimely death of the British disabling, if missed or underestimated (McGlinn et the disrupted IOM. Orthopaedic Surgeon Peter Gordon Essex-Lopresti al., 2013). put an end to a remarkable career (McGlinn et al., Reconstruction of the radioulnar IOM 2013). Trained in Orthopaedic Surgery at the London To understand and treat this condition, it is useful No matter how recent the injury is, a disrupted Hospital, he worked at the Birmingham Accident reviewing some kinetic concepts. The so-called IOM seldom can be repaired (McGlinn, 2013). The Hospital where he earned an excellent reputation “forearm articulation” is a polyarticular, load bearing tissue is usually torn through its mid-substance, the as orthopaedic surgeon and prolific investigator. structure composed of two slightly curved bones ends being thin, irregularly retracted, and difficult On May 1951, few months before passing away, (radius and ulna), linked by two trochoid (pivot- to access. To overcome this problem, different he was awarded a Hunterian Professorship at the like) articulations (proximal and distal radioulnar reconstructive alternatives have been suggested. Royal College of Surgeons in recognition of the huge joints) interposed between the two segments of Figure 1 Figure 2 Some authors propose reconstructing the central amount of work done on the diagnosis and treatment the elbow joint (radiocapitellar and ulnotrochlear) band of the IOM using a palmaris longus tendon of the fractures of the Os Calcis. Oddly enough, his and the two segments of the wrist (radiocarpal and For this combination of injuries to appear, there is a autograft (Tejwanj et al., 2005), others recommend name would not be remembered for that enormous ulnocarpal). From a kinetic perspective, a normal need for: 1) a longitudinal shear stress large enough a pronator teres rerouting technique (Chloros et contribution. His name would be forever linked to forearm articulation is the one that is able perform as to disrupt the different bundles of the IOM, 2) al., 2008), and others advocate the use of allografts a 3-pages long article in which he described, for full pronosupination under load, that is, while the a substantial torque, most often hyperpronation, (Miller et al., 2016). Technically demanding, none the first time, one of the most challenging fracture- hand carries substantial amount of weight (Garcia- causing a distal radioulnar dislocation, and 3) of these reconstructions have proved if they will dislocations of the forearm: an injury characterized Elias M., 2008). an axial radiocapitellar compression stress plus pass the test of time. Another problem is how to by the presence of an unstable radial head fracture, Forces transferred across the forearm are not evenly valgus of the elbow causing an unstable radial ensure solid graft fixation onto the thick cortices of a complete disruption of the radioulnar interosseous distributed among its different articulations. In head fracture. Fortunately, such a combination of radius and ulna. To enhance healing, some authors membrane (IOM), a detachment or disruption of normal conditions, most centripetal forces generated factors is infrequent, and so it is that combination of recommend securing a bone-patellar tendon-bone the triangular fibrocartilage complex (TFCC), and a in the hand enter the forearm through the radius. The injuries. autograft with screws onto the decorticated origin 26 27 PEARLS OF WISDOM www.ifssh.info November 2016 PEARLS OF WISDOM

and insertion sites of the two diaphyses (Adams et with a corticocancellous non-articular portion of the two ends of the grafts are tightly pulled, side-by- References al., 2010). Unfortunately, improving graft fixation the base of the third metacarpal (Figure 3). Two side, in opposite directions, several non absorbable 1. Adams JE, Culp RW, Osterman AL. Interosseous does not answer all the questions. There is a need small incisions, proximal and distal, are necessary sutures are placed, uniting the two hemi-tendons membrane reconstruction for the Essex-Lopresti for a bone-tendon-bone graft matching the length to do so. Once removed from the distal incision, the into one solid bone-tendon-bone graft, mimicking injury. J Hand Surg Am. 2010; 35:129-136. of the original IOM. It is important to ensure that bone-tendon graft is divided longitudinally into two the original central band of the IOM (Figure 4C) 2. Chandler JW, Stabile KJ, Pfaeffle HJ, et the obliquity of the graft is anatomically correct. symmetrical hemitendons, each keeping a portion al. Anatomic parameters for planning of How much tension is to be applied to the graft to of corticocancellous bone from the base of the third interosseous ligament reconstruction using mimic the normal situation?. What follows is a metacarpal. computer-assisted techniques. J Hand Surg Am. description of a technique that we have developed in 2003; 28:111-116. an attempt to solve these problems. Unfortunately, To prepare the two tunnels that will accommodate 3. Chloros GD, Wiesler ER, Stabile KJ, et al. our experience with the technique is limited, and the graft, two skin incisions are needed: an 8 cm Reconstruction of Essex-Lopresti injury of the although our early results are more convincing than longitudinal incision along the ulnar border of the forearm: technical note. J Hand Surg Am. 2008; with previously used techniques, caution is still ulna, and a 2 cm lateral incision along the radius. 33:124-130. recommended According to the anatomical studies by Chandler et 4. Essex-Lopresti P. Fractures of the radial head al. (2003), and later validated by Noda et al. (2009), with distal radio-ulnar dislocation; report of two Surgical technique the insertion site of the central band is located cases. J Bone Joint Surg Br. 1951; 33B:244-247. As stated above, reconstructing the central band of on its lateral edge (the one facing the radius) at 5. Farr LD, Werner FW, McGrattan ML, et al. the IOM is only one step, usually the last one, in the the junction of the middle and distal third of the Anatomy and biomechanics of the forearm process of fixing all what needs to be fixed in an bone. The insertion site of the radius is about 2 cm interosseous membrane. J Hand Surg Am. 2015; Essex-Lopresti injury. We do not start reconstructing proximal to the middle of the bone, on the ridge that 40:1145-1151. the IOM until the radial head has been restored, faces the ulna. If the two (radial and ulnar) insertion 6. Garcia-Elias M, Lluch AL, Ferreres A, et al. the TFCC reattached, and the reduction of the two sites have been correctly identified, the angle Transverse loaded pronosupination test. J Hand forearm bones has been neutralized at about 45º formed by the main axis of the ulna and a virtual line Surg Eur Vol. 2008; 33:765-767. supination with a 2 mm K-wire across the two bones. connecting these two insertion sites must be about Figure 4 7. McGlinn EP, Sebastin SJ, Chung KC. A historical 25 degrees. perspective on the Essex-Lopresti injury. J Hand This part of the operation begins by obtaining The post-operative regime is characterized by a Surg Am. 2013; 38:1599-1606. a bone-tendon graft. An Achilles’ bone-tendon Once the two insertion sites have been identified, prolonged immobilization. The arm is kept in an 8. Miller AJ, Naik TU, Seigerman DA, et al. Anatomic allograft is an option, another is to use the Extensor and marked on the surface of the bone with a sterile above elbow plaster cast, elbow at right angle, Interosseus Membrane reconstruction utilizing Carpi Radialis Brevis (ECRB) harvested together marker, one K-wire is obliquely inserted into the forearm at 45 degrees supination (fixed by the wire). the biceps button and screw tenodesis for Essex- ulna, entering the bone through its medial edge, The radioulnar neutralization K-wire is removed at 4 Lopresti Injuries. Tech Hand Up Extrem Surg. from distal to proximal at an angle of approximately weeks, and a posterior long arm splint is maintained 2016; 20:6-13. 25 degrees. The wire must exit where the marker for 6 more weeks, followed by intensive upper limb 9. Noda K, Goto A, Murase T, et al. Interosseous indicates it was the ulnar origin of the IOM. A second re-education. membrane of the forearm: an anatomical study of wire, inserted from proximal to distal across the ligament attachment locations. J Hand Surg Am. lateral border of the radius, with the same obliquity 2009; 34: 415-422. as the first one, and exiting medially at the radial 10. Tejwani SG, Markolf KL, Benhaim P. Graft IOM insertion site. These wires are used to guide reconstruction of the interosseous membrane a 2,7 mm cannulated drill across the bone, and a in conjunction with metallic radial head second 4,5 mm drill to enlarge the outer end of the replacement: a cadaveric study.J Hand Surg Am. two tunnels as to create a chamber to hold the bony 2005; 30: 335-342. portion of the two hemi-bone-tendon grafts. The grafts are then passed across the two tunnels to Figure 3 emerge in the interosseous space. (Figure 4B). While 28 29 JOURNAL HIGHLIGHTS www.ifssh.info November 2016 JOURNAL HIGHLIGHTS

JOURNAL OF HAND l Clinical results of releasing the K. J. Shin, l Distal transfers as a primary JOURNAL OF HAND l A Population-Based Analysis SURGERY EUROPEAN entire A2 pulley after flexor tendon S. H. Lee, treatment in obstetric brachial SURGERY AMERICAN of Time to Surgery and Travel (VOLUME OCTOBER 2016 # 41) repair in zone 2C K. S. Koh, plexus palsy: a series of 20 cases (SEPTEMBER 2016 VOL 41 Distances for Brachial Plexus K. Moriya, W. C. Song B. A. Ghanghurde, ISSUE 9) Surgery l Editorial: Errors in surgery T. Yoshizu, R. Mehta, Christopher J. Dy, Grey Giddins N. Tsubokawa, l A cadaveric study of the K. M. Ladkat, l Comparison of Treatment Jack Baty, H. Narisawa, distribution pattern of the B. B. Raut, Outcome After Collagenase and Mohammed J. Saeed, l Predictors of outcome after K. Hara, cutaneous sensory fibres of the M. R. Thatte Needle Fasciotomy for Dupuytren Margaret A. Olsen, primary flexor tendon repair in Y. Maki distal palm of the hand. Contracture: A Randomized, Single- Daniel A. Osei zone 1, 2 and 3 R. Filfilan, l Intraneural lipoma of the Blinded, Clinical Trial With a 1-Year I. Z. Rigo and l Commentaries on Clinical A. Kinsella, posterior interosseous nerve Follow-Up l Trapeziometacarpal Arthrodesis M. Røkkum results of releasing the entire A2 L. Yong, D. Yamamoto, Joakim Strömberg, or Trapeziectomy with Ligament pulley after flexor tendon repair in D. M. Davidson D. Yamauchi, Allan Ibsen-Sörensen, Reconstruction in Primary l Asymmetric six-strand zone 2C. K. Moriya, T. Yoshizu, N. H. Tsuchiya Jan Fridén Trapeziometacarpal Osteoarthritis: core sutures enhance tendon Tsubokawa, H. Narisawa, K. Hara l Assessment of the structures A 5-Year Follow-Up fatigue strength and the optimal and Y. Maki. J Hand Surg Eur. 2016, at risk during wrist arthroscopy: l Incidence of flexor tendon fraying l Treatment of Infected Forearm Kim R. Spekreijse, asymmetry 41: 822–28. a cadaveric study and systematic found during A1 pulley release Nonunions With Large Complete Ruud W. Selles, N. Kozono, David Elliot, review operation for trigger finger Segmental Defects Using Bulk Muhammed A. Kedilioglu, T. Okada, Donald H. Lalonde, G. Shyamalan, J. Lee, Allograft and Intramedullary Harm P. Slijper, N. Takeuchi, Jin Bo Tang R. W. Jordan, S.-H. Lee, Fixation Reinier Feitz, M. Hanada, P. K. Kimani, S. S. Eun Jason A. Davis, Steven E. Hovius, T. Shimoto, l Suture configurations and P. A. Liverneaux, Andrew Choo, Guus M. Vermeulen Y. Iwamoto biomechanical properties of flexor C. Mathoulin l Intraneural perineurioma of the Daniel P. O’Connor, tendon repairs by 16 hand surgeons digital nerve: a case report Mark R. Brinker l Defining the Indications of l A knotless bidirectional- in Finland l The risk to the cutaneous nerve N. J. Visser, Pedicled Groin and Abdominal barbed tendon repair is inferior to O. V. Leppänen, branches in the anterior (Wagner) H. Bril, l Ulnar Distraction Osteogenesis Flaps in Hand Reconstruction in conventional 4-strand repairs in L. Linnanmäki, and snuff-box approaches to the J. van Loon in the Treatment of Forearm the Current Microsurgery Era cyclic loading J. Havulinna, trapezium: a cadaveric study Deformities in Children With Mohammad M. Al-Qattan, F. P. O’Brien III, H. Göransson K. Mohamed, l Spontaneous recovery of a case Multiple Hereditary Exostoses Ahmed M. Al-Qattan B. G. Parks, L. Y. Yong, with suspected hourglass-like Stephen Refsland, M. A. Tsai, l Cross-sectional area of the ulnar D. M. Davidson fascicular constriction and anterior Scott H. Kozin, l Defining and Measuring Patient and K. R. Means, Jr nerve after decompression at the interosseous nerve palsy Dan A. Zlotolow Satisfaction cubital tunnel l Recovery of upper extremity T. Sunagawa, Brent Graham l Biomechanical investigation of S. Duetzmann, function following endoscopically Y. Nakashima, l Measurement Properties of the ‘figure of 8’ flexor tendon repair K. G. Krishnan, assisted contralateral C7 transfer R. Shinomiya Brief Michigan Hand Outcomes l Dorsal Approach Decreases techniques F. Staub, for obstetrical brachial plexus Questionnaire in Patients With Operative Time for Complex A. K. Agrawal, J.-S. Kang, injury Dupuytren Contracture Metacarpophalangeal Dislocations I. S. Mat Jais, V. Seifert, G. Leblebicioglu, Martina Wehrli, Cathryn J. Vadala, E. M. Chew, G. Marquardt C. Ayhan, Stefanie Hensler, Christina M. Ward A. K. T. Yam, T. Firat, Stephan Schindele, S. C. Tay l Anatomy of the deep branch of A. Uzumcugil, Daniel B. Herren, Surgical Treatment of Displaced the ulnar nerve M. Yorubulut, Miriam Marks Midshaft Clavicle Fractures: Y. C. Gil, M. N. Doral Precontoured Plates Versus 30 31 JOURNAL HIGHLIGHTS www.ifssh.info November 2016 JOURNAL HIGHLIGHTS

Noncontoured Plates Ricardo J. Bello, JOURNAL OF HAND l Oligodactyly with Thumb Grafting Through the Distal l Reasons for Implant Removal Ao Rongguang, Ryan D. Katz, Brent G. Parks, SURGERY ASIAN- Goo Hyun Baek, Insertion Hole of a Fully Threaded after Distal Radius Fractures Jian Zhen, Kenneth R. Means Jr. PACIFIC Jihyeung Kim Headless Screw Audrey Tan, Zhou Jianhua, (VOL 21, NO 03) Souichi Ohta, Alphonsus Chong Shi Jifei, l Correction of Volar l Open Finger Fractures: Incidence, Ryosuke Ikeguchi, Jiang Xinhua, Subluxation Deformities of the l Decision-making and Patterns of Injury and the Influence Takashi Noguchi, l Closed Rupture of the Flexor Yu Baoqing Metacarpophalangeal Joints Management of Ulnar Polydactyly of Social Deprivation Yukitoshi Kaizawa, Tendon Secondary to Sclerosis of Following a Distal Radius Fracture of the Newborn: Outcomes and Raymond E. Anakwe, Hiroki Oda, the Hook of the Hamate: A Report of l Morphology and Mobility of the in a Patient With Systemic Lupus Satisfaction Scott D. Middleton, Hirofumi Yurie, Two Cases Reconstructed Basilar Joint of the Erythematosus Salem Samra, Kate E. Bugler, Shuichi Matsuda Hiroshi Yamazaki, Pollicized Index Finger Sreedharan Sechachalam, Debra Bourne, Andrew D. Duckworth, Shigeharu Uchiyama, Clotilde Strugarek-Lecoanet, Qi Hui Bernice Heng Joel Beckett, Margaret M. McQueen, l Surfing Behind a Boat: Quality Masato Hosaka, Jérémie Chevrollier, Michael Matthew, Charles M. Court Brown and Reliability of Online Resources Hiroyuki Kato Nicolas Pauchard, l Intraneural Nodular Fasciitis in a J. Grant Thomson on Scaphoid Fractures Alain Blum, Child: A Case Report and Review of l Reconstruction of Attritional Mujtaba Nassiri, l Osteoid Osteoma of Distal François Dap, the Literature l Preoperative Surgical Discussion Rupture of Flexor Tendons with Osama Mohamed, Phalanx of Middle Finger—A Gilles Dautel Kohei Kanaya, and Information Retention by Fascia Lata Graft Following Distal Arvids Berzins, Diagnostic Dilemma Kousuke Iba, Patients Radius Fracture Malunion Yasser Aljabi, Bharat Durgia, l Postoperative Growth in Radial Toshihiko Yamashita, David E. Feiner, A.K. Bhat, Talat Mahmood, Anuj Jain, Polydactyly: A Clinical Study Takuro Wada, Ghazi M. Rayan A.M. Acharya, Shojaeddin Chenouri, Shekhar Agarwal Long Wang, Tadashi Hasegawa N. Soni Paul O’Grady Xianyao Tao, l Comparison of Wrist Motion and lRecent Advances in Immediate Weiyang Gao, Grip Strength in a Normal Chinese l Arthroscopic Trans-osseous l Does Graft on Flap Method Toe-to-Hand Transfer Jian Ding, l The Simplified Posterior and Caucasian Population Suture of Peripheral Triangular Work on Sequela of Fingertip Sang-Hyun Woo, Zongwei Zhou, Interosseous Flap Yan Yan Kwok, Fibrocartilage Complex Tear Amputation? Myung-Jae Yoo, Xiaoliang Feng Pedro C. Cavadas, Pak-Cheong Ho, Midum Jegal, Kazufumi Sano, Jung-Wook Paeng Alessandro Thione, Carlos Rubí Guy Feldman, Kang Heo, Satoru Ozeki l Estimating Scaphoid Lengths Eugene Lo, Erik Wells, Jong Pil Kim l Recurrent Hypothenar Hammer Using Anatomical Measurements in l A Scapholunate Ligament– Ronit Wollstein l Ulnar Nerve Injury after Flexor Syndrome: A Case Report the Wrist Sparing Technique Utilizing l The Holevich Flap Revisited: A Tendon Grafting Nicholas S. Adams, Paul W.L. ten Berg, the Medial Femoral Condyle l Recurrent Primary Synovial Comparison with the Foucher Flap, Michael John McCleave Ronald D. Ford Johannes G.G. Dobbe, Corticocancellous Free Flap to Sarcoma of Median Nerve: A Case Case Series Geert Meermans, Reconstruct Scaphoid Nonunions Report and Literature Review Luciano Ruiz Torres, l You’ve Got to Hand It to Them: l Flexor Carpi Radialis to Palmaris Simon D. Strackee, With Proximal Pole Avascular A.K. Bhat, Luiz Sorrenti Assessing Final Year Medical Longus Tendon Transfer for Frederik Verstreken, Necrosis K.N. Jayakrishnan, Students Knowledge of Hand Spontaneous Rupture of the Flexor Geert J. Streekstra Nikolas H. Kazmers, A.M. Acharya l Prognostic Factors Affecting the Anatomy and Pathology Carpi Radialis Tendon—A Review Stephanie Thibaudeau, Clinical Outcome of Septic Arthritis Cormac Weekes Joyce, of an Uncommon Finding and l Changes in Wrist Motion L. Scott Levin l Report of the 10th Asia-Pacific of the Shoulder Shazrinizam Shaharan, Surgical Technique for Operative After Simulated Scapholunate Federation of Societies for Surgery Chul-Hyun Cho, Kate Lawlor, Correction Arthrodesis: A Cadaveric Study l Pollicization of the Second of the Hand Congress (Organising Geon-Myeong Oh Melanie Elizabeth Burke, Jonathan Winkworth Shearin, Kevin D. Han, Metacarpal Based on Dorsal Chair and Scientific Chair) Michael John Kerin, Brian Walters, Jaehon M. Kim, Metacarpal Arteries Roohi Sharifah A., l Percutaneous Fixation for Jack Laurence Kelly S. Steven Yang Michael V. DeFazio, Kagan Ozer Shalimar Abdullah Scaphoid Nonunion with Bone 32 33 JOURNAL HIGHLIGHTS www.ifssh.info November 2016 JOURNAL HIGHLIGHTS

l Tips and Tricks in Mallet Fracture l Post-Reduction Stability of the JOURNAL OF HAND l Development and reliability Rochelle Mendonca, interphalangeal joint extension Fixation Proximal Interphalangeal Joint THERAPY of a Turkish version of the Short Peter Dalley Lonita Mak, Yuin Cheng Chin, after Dorsal Fracture Dislocation—A (JULY-SEPTEMBER 2016 VOL 29, Form-Joint Protection Behavior Lorna D. Aitkens, Tun-Lin Foo Cadaveric Study ISSUE3) Assessment (JPBA-S) l Coaching of patients with an Christine B. Novak Andre Eu-Jin Cheah, Eda Tonga, isolated minimally displaced l Recent Update in the Diagnosis Tun-Lin Foo, l The case for better case reports…. Songul Atasavun Uysal, fracture of the radial head l The Use of Patient-centered and Treatment of Bone Frailty Janice Chin-Yi Liao, Joy C. MacDermid Sedef Karayazgan, immediately increases range of Outcome Measures by Hand in Patients with a Distal Radius Min He, Mutlu Hayran, motion Therapists: A Practice Survey Fracture Alphonsus Khin-Sze Chong l Thirty years of hand therapy: The Tülin Düger Teun Teunis, K. Valdes, Young Ho Shin, 2014 practice analysis Emily R. Thornton, L.A. Algar, Hyun Sik Gong l Simultaneous Volar Dislocation JoAnn L. Keller, l Reproducibility: Reliability and Thierry G. Guitton, B. Connors, of Distal Interphalangeal Joint Carla M. Caro, agreement of short version of Ana-Maria Vranceanu, L. Cyr, D. Dickman, l Causes of Flexor Tendon Repair and Volar Fracture-Subluxation of Mary P. Dimick, Western Ontario Rotator Cuff Index David Ring A. Lucado, Failures in Two Common Repair Proximal Interphalangeal Joint of Keri Landrieu, (Short-WORC) in patients with N. Naughton Techniques: A Cadaver Study Little Finger: A New Mechanism of Lynnlee Fullenwider, rotator cuff disorders l Clinical Relevance Commentary Raakhi Mistry, Injury J. Martin Walsh Neha Dewan, in Response to: Coaching of l What is the Optimum Outcome Michael John McCleave, Kamran Mozaffarian, Joy C. MacDermid, patients with and isolated Tool for Assessing the Upper John Codrington Abdollah Bayatpour, l Effect of manual therapy and Norma MacIntyre, minimally displaced fracture of the Limb. A Comparison of 10 Different Amir Reza Vosoughi neurodynamic techniques vs Ruby Grewal radial head immediately increases Outcome Tools l Answer to Dr Ruiz Letter on ultrasound and laser on 2PD in range of motion C.P. Gabel “The Holevich Flap Revisited: A patients with CTS: A randomized l The inter-rater reliability of the Susan Blackmore Comparison with the Foucher Flap, controlled trial modified finger goniometer for l Case Report: The casting motion l Development of a New Patient- Case Series” Tomasz Wolny, measuring forearm rotation to mobilize stiffness technique for reported Outcome to Measure Jose Couceiro Edward Saulicz, Mike Szekeres, rehabilitation after a crush and Functioning and Quality of Life for Paweł Linek, Joy C. MacDermid, degloving injury of the hand People With Dupuytren Contracture l Post-Operative Contracture Andrzej Myśliwiec, Trevor Birmingham, Robyn Midgley N.J. Forget, of the Proximal Interphalangeal Mariola Saulicz Ruby Grewal P.G. Harris, Joint after Surface Replacement l Therapeutic taping for soft J. Higgins, Arthroplasty Using a Volar l A scoping review of applications l Adherence behavior in an acute tissue–based digit malrotation M. Rivard Approach and outcomes of traction orthoses pediatric hand trauma population: Kimberly A. Masker Ken Shirakawa, and constructs for the management A pilot study of parental report of l The Dash and Quick-Dash: Based Masahiko Shirota of intra-articular fractures and adherence levels and influencing l An alternative fabrication on Consensus Findings for Internal fracture dislocations in the hand factors method of the dart thrower’s motion Consistency and Factor Structure l The Influence of Injected Tara L. Packham, Pamela D. Ball, Tanya Cole, orthosis (also known as the dart – Are They Suitable and Valid Volume on Discomfort During Joy C. MacDermid, Ann Underhill, orthosis) Outcome Measures for the Upper Administration of Digital Block James R. Bain, Sue Kennedy Deborah A. Schwartz Limb? Solveig Ballo, Arianna DalCin C.P. Gabel, A. Cuesta Tonje Hjelseng, l The effectiveness of orthoses l The challenge of the mallet Lena Flatlandsmo Tangen, l Validation of Duruöz Hand Index in the conservative management orthosis: A simple solution l Experiences of Individuals in Janne Svindal Lundbom, in patients with tetraplegia of thumb CMC joint osteoarthritis: Daniel Harte Upper Extremity Rehabilitation Trine Skarsvåg, Tugce Ozekli Misirlioglu, An analysis of functional pinch With Incongruence Between Their Vilhjalmur Finsen Halil Unalan, strength l Mallet finger injuries—A Quickdash and Groc Scores: A Safak Sahir Karamehmetoglu Marie-Lyne Grenier, new method to maintain distal Phenomenological Study 34 35 JOURNAL HIGHLIGHTS www.ifssh.info November 2016 JOURNAL HIGHLIGHTS

E. Smith-Forbes, on Zone II Flexor Pollicis Longus P. Kurtz, l Beyond the Research: An l The Effect of a Foam Roller l The Upper Limb Functional D.M. Howell, Tendon Tension in a Human B. Koczan, Accelerated Rehabilitation Protocol Stretch on the Flexibility of the Index (ULFI) – A Review of R. Morgan, Cadaver Model S. Moore for Patients With Distal Radius Pectoralis Minor Published Validation Studies Show K. Clark, P.O. Rappaport, Fracture Treated With Open D.W. Witt, Improved Clinimetric Properties S. Hall, A.R. Thoreson, l The First Dorsal Interosseus: A Reduction Internal Fixation Using L. Mulligan, and Recommends a Simple Format J. Willoughby, T. Yang, Dynamic Stabilizer of the Radially Volar Locking Plate, A Retrospective N. Talbott Change H. Armstrong, R.L. Reisdorf, Subluxed Thumb Carpometacarpal Review and Comparison of C.P. Gabel G. Pitts, K. An, Joint? Outcomes With a Surgeon Directed l Figure-of-eight Measurements T.L. Uhl P.C. Amadio C. McGee, Independent Exercise Program Show High Reliability in A Clinical l Clinically Effective Conservative V. O’Brien, K. Waterbury, Setting in Assessing Edema in Treatments for Lateral l Determining Validity of Measures l Pilot Study Comparing Two Early S. Van Nortwick, J. Husband, Patients With Hand Injuries Epicondylitis: A Retrospective of Pain and Perceived Effort of Active Motion (EAM) Regimens for J. Adams, N. Callinan, E.S. Lewis, Study Women With Hand Osteoarthritis Surgically Repaired Flexor Tendons, A. Van Heest M. Reams M. Jones, C. Leiras, During a Jar Opening Task Zone I–IV, Wrist Synergistic EAM R. DeMasi, K. Collins, C. McGee, vs. Modified Belfast Static Wrist l Psychometric Properties of l Range of Motion Outcomes of an N. Tabor, A. Jordan, N. Affeldt, EAM. Assessments of Scars and Scarring: Alternative Protocol for Clostridium A. Howley A. Petersen, S. Braski, G. Horsfall A Systematic Review Histoliticum Collagenease Injection D. Lunsford, M. Kloke, T.L. Packham, and Occupational Therapy l Evaluation of Technology Use as T. Phillips, K. Stokke, l Analysis of Factors Influencing S. Mehta, A. Heathfield, a Contributor to Injury in Musicians: J. Beasley K. Thomason Outcomes of Full and Partial Hand S. Iacob, K. Dupre, A Pilot Study Multi-articulating Prostheses V. Patel, M. Cooper M. Rosel, K. Goldie Staines, l Advancements in Partial Hand l Minimal Clinical Important L. Whelan, J. Beasley, E. Collins, Prostheses: A Case Study Difference of the Quick Disabilities N. Wagner l How Can Joint Protection C. Leiras, R. Young, L. Whelan of the Arm Shoulder and Hand Apply to Grocery Shopping?; M. Mead F. Brooks (Quickdash) for Post-surgical Distal l Sonographic Measurements of An Evaluation to Determine the l Effects of a Dynamic Orthosis Radius Fractures Humeral Head Displacement During Optimal Handle Diameter of l Comparison of the Validity l A Systematic Literature Review: and a Home Exercise Program in an E. Smith-Forbes, Posterior Shoulder Mobilizations Shopping Carts. of Goniometer and Visual Conservative Management of Individual With Claw Deformity D.M. Howell, N. Talbott, K. Nottelmann, Assessments of Angular Joint Trigger Finger G.Q. Sousa, J. Willoughby, D. Witt F. Woods, Positions of The Hand and Wrist T. Ostrander, M. Macedo G. Pitts, M. Pittsley, K. McVeigh, M. Materi, T.L. Uhl l A Scoping Review of Applications J. Beasley, P. Murray, C.C. Ivy, l Effect of Restricted Motion on and Outcomes of Traction Splinting B. Ashby, M. Heckman, S. Smith Performance During Wrist Specific l Effects of Surgical Treatment for Management of Intra-articular K. Anderson J. Peterson Functional Tasks of Neuromas on Patient-rated Fractures and Fracture Dislocations l Effective Conservative A. Wolff, A. Kraszewski, Psychosocial Factors in the Hand l Concurrent Validity of l Adherence to a Home Exercise Treatments for De Quervain’s L. Tran, M. Gibbons, D. Wojtkiewicz, T.L. Packham, Goniometric and 3D Motion Program After Signing a Contract Tenosynovitis: A Retrospective C. Henn, H. Hillstrom, L. Domeshek, P. Ball, Capture Measurements of the Hand C.A. Murphy Study S.W. Wolfe L. Osvaldo, J. MacDermid, and Their Effects on a Model of D. Lunsford, C. Novak, J. Bain, Finger Functionality for Clinical l Forearm Positioning and Its C. Dolislager, S. Mackinnon A. DalCin Assessment Functional Implications B. Krenselewski, S. Leitkam, T.R. Bush, K. MacDonald, K. Oosting, l Effect of Wrist and Inter- l Effects of Cross-education J. Beasley, S.J. Chinchalkar, J. Beasley, phalangeal Thumb Movement Training on Grip Strength J. Buschman J. Pipicelli T. Phillips, C. Leiras 36 37 JOURNAL HIGHLIGHTS www.ifssh.info November 2016 JOURNAL HIGHLIGHTS

JOURNAL OF WRIST l Dorsal or Volar Plate Fixation l Bilateral Complete Osseous HAND CLINICS l Ulnar Nerve Tendon Transfers SURGERY of the Distal Radius: Does the Coalition of the Capitate and (AUGUST 2016 VOL 32 ISSUE 3) for Pinch (AUGUST 2016 VOL 5 ISSUE 3) Complication Rate Help Us to Trapezoid Shane Cook, Choose? Alexander B. Christ, l An Update on Upper Extremity R. Glenn Gaston, l Interosseous Membrane and D.J.G. Disseldorp, Andrew S. Maertens, Tendon Transfers Gary M. Lourie Its Effect on the Distal Radioulnar P.F.W. Hannemann, Andrew J. Weiland R. Glenn Gaston Joint M. Poeze, l Tendon Transfers for Combined David J. Slutsky P.R.G. Brink lMultiple Volar Carpometacarpal l Principles of Tendon Transfer Peripheral Nerve Injuries Dislocations: Case Report/Review of Danielle Wilbur, Christopher A. Makarewich, l Management of the Essex- l Trends in the Utilization of Total the Literature Warren C. Hammert Douglas T. Hutchinson Lopresti Injury Wrist Arthroplasty versus Wrist Robert A.Cates, Andrew P. Matson, Fusion for Treatment of Advanced Peter C. Rhee, l Biomechanics of Tendon l Tendon Transfers for Tetraplegia David SAndrew P. Ruch, Wrist Arthritis Sanjeev Kakar Transfers Michael S. Bednar Eitan Melamed, Andrew Livermore, l Suture-Button Reconstruction of Bryan Marascalchi, l Single-Incision Carpal Tunnel Jonathan L. Tueting l Free Flap Functional Muscle the Interosseous Membrane Richard M. Hinds, Release and Distal Radius Open Transfers Clifton G Meals, Marco Rizzo, Reduction and Internal Fixation: A l Restoration of Shoulder Function Ryan M. Garcia, Christopher L Forthman, John T. Capo Cadaveric Study Chelsea C. Boe, David S. Ruch Keith A. Segalman Michael P. Gaspar, Bassem T. Elhassan l Distal Radius Hemiarthroplasty Blane A. Sessions, l Tendon Transfers in l Central Band Interosseous Brian D. Adams, Bryan S. Dudoussat, l Restoration of Elbow Flexion the Rheumatoid Hand for Membrane Reconstruction For Ericka A. Lawler, Patrick M. Kane Bryan J. Loeffler, Reconstruction Forearm Longitudinal Instability Taften L. Kuhl Daniel R. Lewis Michael Brody O’Sullivan, Julie E. Adams, Hardeep Singh, Randall W. Culp, l Three-Dimensional Carpal l Radial Nerve Tendon Transfers Jennifer Moriatis Wolf A. Lee Osterman Kinematics after Carpal Tunnel Andre Eu-Jin Cheah, Release Jennifer Etcheson, Jeffrey Yao l Tendon Transfers for the l Interosseous Membrane of the Jonathan R. Schiller, Hypoplastic Thumb Forearm Jeffrey J. Brooks, l High Median Nerve Injuries Lindley B. Wall, Robert Matthias, P. Kaveh Mansuripur, Jonathan Isaacs, Charles A. Goldfarb Thomas W. Wright Joseph A. Gil, Obinna Ugwu-Oju Edward Akelman l Cerebral Palsy Tendon Transfers: l Coronal Fractures of the l Low Median Nerve Transfers Flexor Carpi Ulnaris to Extensor Scaphoid: A Review l Arthroscopic Resection of (Opponensplasty) Carpi Radialis Brevis and Extensor David J. Slutsky, Distal Pole of the Scaphoid for Robert Christopher Chadderdon, Pollicis Longus Reroutement Guillaume Herzberg, Scaphotrapeziotrapezoid Joint R. Glenn Gaston Anchal Bansal, Alexander Y. Shin, Arthritis: Comparison between Lindley B. Wall, Geert A. Buijze, Simple Resection and Implant l A Comprehensive Guide on Charles A. Goldfarb David C. Ring, Interposition Restoring Grasp Using Tendon Chaitanya S. Mudgal, L. Pegoli, Transfer Procedures for Ulnar Yuen-Fai Leung, Alessandro Pozzi, Nerve Palsy Christian Dumontier G. Pivato, Rafael J. Diaz-Garcia, R. Luchetti Kevin C. Chung 38 39 UPCOMING EVENTS www.ifssh.info November 2016 UPCOMING EVENTS

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2017 Prelim. Program Avail_Hand Journal.indd 1 6/22/2016 9:43:24 PM UPCOMING EVENTS www.ifssh.info November 2016 UPCOMING EVENTS ALL HANDS ON DECK DOI:10.1177/1758998316657933 Farewell Symposium Steven Hovius Executive Committee (Ex.Com) During the Council Meeting in Santander the main issue discussed was the Combined Triennial congress of the European Federation for Societies of Hand Surgery (FESSH) and the European Federation for Save the date: Societies of Hand Therapy (EFSHT). Rotterdam, December 16, 2016

EFSHT Executive Committee President 2016–2018 Saara Raatikainen, Finland Faculty: The theme will be Evidenced Based Hand Surgery and Therapy. The President-elect 2016–2018 therapists’ program, including focus sessions and workshops, will be held Ali Kitis, Turkey Tim Davis over the first day and a half, whereas the remaining Friday afternoon and Saturday morning are entirely for combined sessions with the Past-president 2016–2018 surgeons. Updates and new information will be posted on the EFSHT Turid Aasheim, Norway Facebook, Twitter and LinkedIN accounts when available. Henk Giele Or just check the website: http://www.EUROHAND2017.com. Treasurer 2006–2017 Glykeria Gounaropoulou, Greece The Executive Committee of the EFSHT has a new president-elect Mr. Ali Kitis, from Turkey. He will be shadowing our new president Saara Secretary 2015–2018 Rolf Habenicht Raatikainen. The EFSHT expresses great gratitude to Mrs. Gabriela Paul De Buck, Belgium Versuemer for her work on the Executive Committee, her initiative and help in developing a stronger structure for EFSHT. Education Committee Roma Bhopal, UK (Chair) Veronique van der Zypen, Switzerland Stefan Hofer Education Committee (EC) Nikki Burr, UK Jolanda ten Brinke, The Netherlands The biggest news to celebrate this year are that six more countries have Rose Luciano, Italy Roger Khouri formulated their national certification processes with help from the EC as required. They are Austria, Belgium, France, Italy, Portugal and Scientific Committee Spain. Congratulations to all these countries on reaching this Bernadette Ammann, Switzerland milestone! Eleven out of nineteen member countries now have Ursula Wendling-Hosch, Switzerland national certification. This is very exciting as national societies have Lucelle van de Ven-Stevens, the Netherlands Caroline Leclercq looked at the ECHT and formalized their national certification processes to fit in with the ECHT. Applicants who eventually wish to apply for the ECHT have a clear pathway. The EC are keen to support the rest of Website Committee the EFSHT member countries to develop their national certification too Paul De Buck, Belgium Viçenc Pensola Izard, Spain Scott Oishi and we would urge you to get in touch for any help needed. Estelle Kronn, Ireland

As the number of new European Certified Hand Therapist is increasing Nomination Committee Paul Smith we will in the future publish them on our social media accounts. Soteria Poulis, Greece Paul de Buck, Belgium Claude Lelardic, France

Michael Tonkin , EFSHT

www.esserstichting.nl/esser-course Hand Therapy Vol. 21 No. 3, September 2016

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Downloaded from hth.sagepub.com at South African Society on September 8, 2016 UPCOMING EVENTS www.ifssh.info November 2016 UPCOMING EVENTS

44 45 www.ifssh.info 4th European Symposium on Pediatric Hand Surgery and Rehabilitation

Paris 2017 Thursday & Friday June 15-16

First Announcement

46 www.PediatricHand.com