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International Guest Hand Society Poster Abstract Book International Guest Hand Society Japanese Society for Surgery of the Hand Poster Abstract Book 71st Annual Meeting of the American Society For Surgery Of The Hand Guest Society Poster 01: Plasma microRNA-155 is a Potential Biomarker of Acute Rejection after Hind Limb Transplantation in Rats AUTHORS Hiroki Oda, MD Ryosuke Ikeguchi, MD, PhD Soichi Ohta, MD, PhD Yukitoshi Kaizawa, MD Hirofumi Yurie, MD Shuichi Matsuda, MD, PhD The authors of this poster have nothing of financial value to disclose. CURRICULUM TOPIC - Hand and Wrist Reconstruction PURPOSE/CATEGORY - Basic Science LEVEL OF EVIDENCE: N/A HYPOTHESIS The development of immunosuppressive regimens has resulted in many cases of successful hand transplantations being performed throughout the world. However acute and chronic rejection remains a major problem. Visual skin inspection and histological evaluations are used to assess rejection of hand transplants, however, these methods are largely subjective. Recently, microRNAs (miRNAs) have been recognized as minimally invasive biomarkers of various diseases, including acute rejection after organ transplantation. We hypothesized that some miRNAs are differentially expressed and can be biomarkers in acute rejection of limb transplantations. METHODS Six male Brown-Norway rats (RT1-n), weighting 210–290 g, were used as donors. Eleven male Lewis rats (RT1-l), weighting 230–330 g, were used as the recipients. The hind limbs of the donor rats were transplanted orthotopically to recipient rats. We administered 1 mg/kg per day FK506 by intramuscular injection for 7 days beginning on the day of transplantation. Skin changes were noted daily. Skin biopsies were obtained from the transplanted hind limb at 7, 10, and 14 days post-transplant. Thin sections of the skin were prepared, stained with Hematoxylin and eosin, and assessed using a grading system for skin rejection, according to Büttemeyer. Plasma samples were obtained before transplantation and at 7, 10, and 14 days post-transplant. miRNAs were isolated from the plasma, reverse transcribed to cDNA and measured using real time polymerase chain reaction. miRNAs were analyzed using the delta-delta Ct method with spike-in of ath-miRNA-159a to normalize miRNA levels. These data were statistically analyzed using student’s t test and the differences were considered significant at P < .05. RESULTS Skin changes occurred at a mean of 11.1 days post-transplant. Skin biopsies at 7 and 10 days post-transplant showed incomplete histological rejection classified as grade 0-1. Whereas, most skin biopsies at 14 days post-transplant showed histological rejection classified as grade 3. We found that plasma miRNA-155 was significantly up-regulated at 10 and 14 days post-transplant, compared with that at 7 days post-transplant (P = 0.040 and P = 0.026, respectively). No significant changes were found in plasma expression of miRNA-182, and miRNA-451 post- operatively. SUMMARY POINTS Expression of miRNA-155 was upregulated at 10 and 14 days post-transplant compared with that at 7 days post-transplant. The up-regulation of the plasma miRNA-155 was detected before the observation of complete rejection in visual skin inspection or histological assessment. Plasma miR-155 represents a potential biomarker of acute rejection after vascularized composite tissue allotransplantation. FIGURES Guest Society Poster 02: Total Wrist Arthrodesis with the Wrist Fusion Rod for Patients with Rheumatoid Arthritis AUTHORS Kenji Onuma, MD, PhD Koji Sukegawa, MD, PhD Kentaro Uchida, PhD Naonobu Takahira, MD, PhD Akimasa Kobayashi, MD, PhD Masashi Takaso, MD. PhD The authors of this poster have nothing of financial value to disclose. CURRICULUM TOPIC - Hand and Wrist Reconstruction PURPOSE/CATEGORY - Surgical Technique LEVEL OF EVIDENCE: Level 4 HYPOTHESIS The Wrist Fusion Rod (WFR) is a relatively new instrument designed by Dr. Ishikawa for total wrist fusion of the rheumatoid wrist(Reference 1). We retrospectively reviewed the short term surgical outcome of wrist fusion using WFR in our hospital. METHODS Six wrists of four patients with severely distracted rheumatoid wrists categorized as Larsen IV or V underwent total wrist fusion using WFR (Figure 1). Clinical outcome was assessed using a numeric rating scale (NRS) of pain (NRSP) and satisfaction (NFSS) level. We also assessed bony fusion, correction of palmar subluxation and ulnar shift, rod bending angle, wrist fusion angle and complications from radiographs. RESULTS On NRS assessment, mean NRSP at pre- and post-operation were 8.0 and 1.0, respectively, and mean NRSS was 8.2 (Table 1). These results indicate that wrist fusion by this procedure significantly reduced pain and that the results were satisfactory. All wrists achieved painless wrist stability with bony fusion of the radiocarpal joint. Surgery corrected both the palmar subluxation and ulnar shift in all cases. Two radiographic complications were observed, rod fracture and a radiolucent band in a proximal metacarpal bone in one case each. Both complications might have occurred as a result of instability of the third carpometacarpal joint, but neither influenced clinical outcome. Wrist fusion angle was smaller than rod bending angle at final observation. SUMMARY POINTS Wrist fusion using the WFR is one option for treatment of the severely distracted rheumatoid wrist. Our experience suggests the need to assess the stability of third carpometacarpal joint before surgery, and to fuse this joint if indicated. Surgeons should note that the bending angle of the intramedullary rod does not directly form the wrist fusion angle, in contrast to the case with a dorsal wrist fusion plate. REFERENCES 1. Ishikawa H. Total wrist arthrodesis (in Japanese). Arthritis -undoukishikkan to rinsho. 2007; 5: 88-97. FIGURES Guest Society Poster 03: Metacarpophalangeal Joint Arthroplasty Using Flexible Hinge Toe Implant for the Deformity of the Rheumatoid Thumb AUTHORS Tetsuya Nemoto, MD, PhD Hajime Ishikawa, MD, PhD Asami Abe, MD, PhD Katsunori Inagaki, MD, PhD Youichi Toyoshima, MD, PhD The authors of this poster have nothing of financial value to disclose. CURRICULUM TOPIC - Hand and Wrist Reconstruction PURPOSE/CATEGORY - Surgical Technique LEVEL OF EVIDENCE: Level 4 HYPOTHESIS The boutonniere deformity of the thumb is the most common deformity of rheumatoid thumb and it accounts for 50 to 74% of the involved thumbs. Metacarpophalangeal(MP) joint arthroplasty is indicated for the deteriorated MP joint with preserved soft tissue stability. Feldon introduced to use flexible hinge toe implant for the MP joint reconstruction because of its better mechanical strength compared to finger joint implant (Reference 1). We hypothesized rheumatoid thumb reconstruction using flexible hinge toe implant would improve the clinical outcomes and radiological findings. METHODS Swanson implant arthroplasty for at the thumb MP joint was performed on the 68 cases (male 11, female 57) between November 2006 and December 2014. The average age was 64 yrs. old and the average follow-up period was 3 yrs. The duration of the rheumatoid arthritis at the time of surgery was 22 years. Combined with this MP joint arthroplasty, arthrodesis at the IP joint in 20 thumbs, capsulodesis at the IP joint in 3 thumbs and suspensionplasty at the CM joint (Thompson) in one thumb were performed. Radiological assessments were performed in 56 cases, clinical evaluation was performed in 47 cases. We assessed range of motion, grip power, side pinch power, general health using visual analog scale (VAS) and DAS28-CRP. Wilcoxon rank sum test was used as a statistical analysis. RESULTS A painless motion and stability was provided to the thumb in most of the patients. In the radiological assessment, the pre- and the postoperative flexion angles at the MP joint were 45 and 17 degrees, and extension angles at the IP joint were 44 and -1 degree(s). In the clinical assessment, the average range of motion was 21 degrees, with 44 degree in flexion and -23 degrees in extension. The average grip strength changed from 117 to 125 mmHg (p=0.775) and the average side pinch power changed 1.5 to 2.1kgw (0.047). The patients were satisfied with their appearance of the thumb. General health using VAS improved from 41 to 29 (0.019) and DAS28-CRP was decreased 3.3 to 2.4(p=0.00). In one case, postoperative infection occurred and implant was removal of required. Joint stability and prehension pattern improved by arthrodesis or capsulodesis. SUMMARY POINTS By the rheumatoid thumb surgery, deformity was corrected and hand function improved. The ratio of implant failure was lower than that in the previous reports (Reference 2). REFERENCES 1. Feldon P, Millender LH, Nalebuff: Rheumatoid arthritis in the hand and wrist. Operative Hand Surgery, pp 1587-1690, Churchill Livingstone, New York, 1993. 2. Bieber EJ, Weiland AJ, Volnec-Dowling S. Silicone rubber implant arthroplasty of the metacarpal-phalangeal joints for rheumatoid arthritis. J Bone Joint Surg Am 1986;68:206-9 Guest Society Poster 04: Selection of Tendon Transfer or Tendon Graft on Wide-awake Tendon Reconstruction with Evaluation of Muscle Degenerative Disorder Using Active Muscle-tendon Excursion AUTHORS Mineyuki Zukawa, MD Ryusuke Osada Tomoatsu Kimura The authors of this poster have nothing of financial value to disclose. CURRICULUM TOPIC - Hand and Wrist Reconstruction PURPOSE/CATEGORY - Surgical Technique LEVEL OF EVIDENCE: Level 4 HYPOTHESIS Selection of tendon transfer or tendon graft in the tendon reconstruction depends on potential
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