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IGHS Poster 01: History of the Australian Hand Surgery Society

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IGHS Poster 01: History of the Australian Hand Surgery Society IGHS Poster 01: History of the Australian Hand Surgery Society Category: Other Keyword: Other Not a clinical study ♦ Michael Tonkin, MD ♦ Richard Honner, MD Hypothesis: The Australian Hand Club was established in 1972, following discussion between members of the New South Wales Hand Surgery Association and the plastic surgeons of Melbourne under the direction of Sir Benjamin Rank, who became the first President. The other elected Office Bearers were: President Elect - Alan McJannet Secretary - Frank Harvey Treasurer - Richard Honner Committee Members - Peter Millroy, Don Robinson, Bernard O’Brien In 1990 the name was changed to the Australian Hand Surgery Society. This now has 159 active members, 18 overseas members, 28 honorary members and 9 provisional members. The current Board consists of: President - Randall Sach President Elect - David Stabler Ex-officio President - Stephen Coleman Secretary - Philip Griffin Treasurer - Douglass Wheen Executive Committee - Anthony Beard, David McCombe, Jeffrey Ecker An Annual Scientific Meeting with overseas Guest Professors is conducted each year, often associated with a separate two day program in hand surgery for Registrars on surgical training schemes in Australia and New Zealand. The AHSS also convenes hand surgery programmes for the Annual Scientific Meetings of the Australian Orthopaedic Association and the Royal Australasian College of Surgeons. Combined meetings with other hand surgery societies have been held, including with New Zealand, Singapore and most recently with the ASSH in Kauai, USA, March 2012. The AHSS became a member of the International Federation of Societies for Surgery of the Hand (IFSSH) in 1977 and was a founding member of the Asia-Pacific Federation of Societies for Surgery of the Hand (APFSSH) in 1997. We were the host society for the IFSSH Congress in Sydney in March 2007. A number of Australian hand surgeons have been recognised as IFSSH Pioneers in Hand Surgery – Sir Benjamin Rank, Sir Sidney Sunderland, Bernard O’Brien, John Hueston and Bruce Conolly. Bernard O'Brien was the IFSSH President from 1979-83. Michael Tonkin takes up the position of IFSSH President in 2013. Wayne Morrison, Michael Tonkin and W. Bruce Conolly have been appointed to Presidency of the APFSSH. These, and many others, have contributed to Australia’s status in the international world of hand surgery. ♦ Nothing of financial value to disclose IGHS Poster 02: A New Surgical Approach to Dupuytren’s Disease Category: Other Keyword: Hand Level 4 Evidence ♦ Ian A. Edmunds, Dr Hypothesis: Modern surgical approaches to Dupuytren’s disease usually involve straight incisions with Z-plasty closure, Bruner incisions (1), broad Y-V incisions (2,3) or a combination of the above. There are some problems and restrictions with these approaches. The disadvantage of a straight line incision is that one is committed to using skin grafts or Z-plasties because primary closure would result in a longitudinal scar contracture. With Bruner incisions, lengthening of the wound by use of advancement flaps is not possible and it is difficult to use skin grafts or the McCash open-wound technique (4) because the addition of transverse incisions makes the flap tips too narrow and susceptible to necrosis. With Bruner and broad Y-V flaps, the flaps are large and difficult to raise without buttonholing, access to retrovascular disease can be difficult, and the scar corner at the basal digital crease tends to hypertrophy because the lateral extent of this scar is limited by the web, which is volar to the mid-axial line.We present a new approach to Dupuytren’s surgery which overcomes some of the problems seen with traditional approaches. Methods: This approach is simple but allows full exposure and accommodates all options for closure. It comprises transverse incisions at the skin creases of the digit joined by oblique incisions at 45º. The transverse incisions can be extended to the mid-axial line for improved exposure and skin release and to lateralize the apices of the scar. After excision of the disease and correction of the contracture the wound can be assessed and closed primarily, with advancement flaps or skin grafts, or left partially open. Results: This study includes surgery on 105 rays in 75 patients with excellent results in 80 rays, good results in 20 rays, fair results in four rays and a poor result in one ray. There was only one significant complication. Summary: There are problems with traditional surgical approaches to Dupuytren's disease This new approach overcomes those problems and is simple, universal, flexible and gives good exposure It allows complete excision of the disease and complete correction of the contractures It allows all alternatives in closure, and allows these to be assessed and implemnented after excision of the disease, rather than being committed to one technique from the outset. References: 1. Bruner, JM. The zigzag volar-digital incision for flexor-tendon surgery. Plast. Reconstr. Surg. 1967, 40: 571. 2. King EW. Bass DM. Watson HK. Treatment of Dupuytren's contracture by extensive fasciectomy through multiple Y-V--plasty incisions: short-term evaluation of 170 consecutive operations. J Hand Surg Am. 1979, 4(3): 234-41. 3. Tubiana R, Leclercq C, Hurst LC et al. Dupuytren’s Disease, 1st Edn. London, Martin Dunitz, 2000: 2-3, 132, 139, 140. 4. McCash, CR. The open palm technique in Dupuytren’s contracture. Br. J. Plast. Surg. 1964, 17: 271. ♦ Nothing of financial value to disclose IGHS Poster 03: Hand Surgery On Anticoagulated Patients – A Prospective Study of 121 Operations Category: Other Keyword: Hand Level 4 Evidence ♦ Ian A. Edmunds, Dr Hypothesis: Many patients requiring hand surgery are taking long term anticoagulant/antiplatelet medication. The management of these patients presents some challenges to the hand surgeon, especially since there has been increasing concern, expressed anecdotally, in the literature and in the courts, that stopping or altering a patient’s anticoagulation exposes the patient to an increased risk of a thrombotic event (1,2,3). There have been papers published reporting the safety of hand, skin, eye and dental surgery on patients taking anticoagulants, usually warfarin (4,5,6,7). Other studies have attempted to develop algorithms to aid the surgeon in making decisions regarding anticoagulation2. Despite this, there is a lack of large prospective studies addressing the management of patients on anticoagulation therapy who undergo hand surgery. The aim of this study is to prospectively study the results of hand surgery in patients taking warfarin, clopidogrel (Plavix/Iscover) alone and clopidogrel with aspirin. Methods: The study design was to perform hand surgery without ceasing patients’ anticoagulation medication, whether that medication be warfarin, clopidogrel alone or clopidogrel with aspirin. All trauma and elective patients were to be included. The one proviso was that, for patient taking warfarin, the International Normalised Ratio (INR) was not greater than 3.0 for elective cases. Patients were to be reviewed post-operatively, at ten days and thence as needed. A log of complications was to be kept. Results: In total, there were 107 patients who had 121 operations between December 2005 and August 2008. There were 57 operations on 51 patients taking warfarin with an average INR of 2.26 (range 1.4 – 3.2). There were 40 operations on 36 patients taking clopidogrel alone and 24 operations on 20 patients taking clopidogrel and aspirin.There was only one major complication, which occurred in a patient taking clopidogrel, which was a post-operative haematoma developed which required evacuation the following day. Summary: Long term anticoagulation is common. Stopping anticoagulation therapy risks thrombotic complications. It is safe to perform hand surgery on patients taking warfarin (INR < 3.0), or clopidogrel with or without aspirin. References: 1. Blacker DJ, Wijdicks EFM, McClelland RL, Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy, Neurology 61:964–968, 2003. 2. Chassot PG, Delabays A, Spahn DR, Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction, British Journal of Anaesthesia 99:316–328, 2007. 3. Ferrari E, Benhamou M, Cerboni P, Marcel B, Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis, Journal of the American College of Cardiology 45: 456–459, 2005. 4. Morris A, Elder MJ, Warfarin therapy and cataract surgery, Clinical and Experimental Ophthalmology 28:419–422, 2000. 5. Wahl MJ, Dental surgery in anticoagulated patients, Archives of Internal Medicine 158:1610–1616, 1998. 6. Alcalay J, Cutaneous surgery in patients receiving warfarin therapy, Dermatological Surgery and Oncology 27:756–758, 2001. 7. Wallace DL, Latimer MD, Belcher HJ, Stopping warfarin therapy is unnecessary for hand surgery, Journal of Hand Surgery 29B:203–205, 2004. ♦ Nothing of financial value to disclose IGHS Poster 04: Simplified Technique for Navigated Central Screw Placement in Fractured Scaphoids Utilizing Ultra Low Dose Computed Tomography Category: Fractures and Dislocations Keyword: Wrist Level 4 Evidence ♦ Brad Gilpin, MBBS ♦ Greg Couzens, MD ♦ Ross Crawford, PhD Hypothesis: The study hypothesis was that use of a navigation system with pre-operative ultra low dose CT imaging and a dorsal percutaneous operative technique would result in accurate and reproducible central screw placement in cadaver scaphoids. Methods: Two cadaver wrists underwent navigation assisted scaphoid surgery (NASS) at the Queensland University of Technology Medical Engineering Research Facility. Cadaver wrists were secured to a custom built radio-lucent splint prior to undergoing pre-operative ultra low dose CT. A novel dorsal percutaneous operative technique was employed. Accuracy of screw placement as compared to the ideal screw trajectory was measured on post-operative CT. Parametric t-tests were used to determine whether there was a significant difference when comparing the actual screw positioning with the ideal trajectory path down the centre of the scaphoid bone. Significance was measured against an alpha value of 0.05.
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