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Background: Scapholunate advanced collapse (SLAC) is the most common pattern of wrist arthritis. Sparse data exist regarding the SLAC wrist pattern of arthritis. This study aimed to document the epidemiology of advanced SLAC in terms of patients’ sociodemographics and possible association with trauma. Methods: Sixty-one patients with severe SLAC wrist were included. Baseline sociodemographic characteristics were reviewed. To evaluate the relationship to injury, this group of cases was compared with a control group of 61 patients with first carpometacarpal osteoarthritis (CMC OA). The following data were collected for both groups: age, gender, history of traumatic injury, history of manual labor, duration of symptoms, and dominant hand involvement. Pearson chi-square tests for categorical variables and independent samples t test for continuous variables were performed to determine differences between groups. Results: Patients with SLAC wrist were more likely to be male (80.3% vs 31.1%; p

Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.

Background The purpose of this study was to evaluate the prevalence of cold sensitivity in patients with hand- and wrist-related diagnoses. Methods We included English-speaking adults who were more than 1 month following hand injury or onset of symptoms. Patients were asked if exposure to cold air or water provoked cold-related symptoms and to rank symptom severity (scale 0–10). Statistical analyses evaluated the relationships between the cold sensitivity and independent variables (age, gender, history of trauma, and time from injury/symptoms). Results There were 197 patients (mean age 49± 16 years): 98 trauma and 99 non-trauma cases. Cold-induced symptoms were reported by 34 %, with 10 % reporting severe symptoms. Exposure to cold air is the most common catalyst; mean severity score was 6.7±2.2. Those with traumatic injuries compared to non-trauma diagnoses reported significantly more cold-induced symptoms ( p=.04). Using backward linear regression, the significant predictors of cold symptom severity were trauma ( p=.004) and time since onset ( p=.003). Including only the trauma patients in the regression model, the significant predictor was time since injury ( p=.005). Conclusions Cold-induced symptoms are reported by more than 30 % of hand-related diagnoses, and exposure to cold air was the most commonly reported trigger. The significant predictors of cold-induced symptoms are traumatic injuries and longer time from injury. This study provides evidence of the common problem of cold sensitivity in patients with hand pathology. Level of Evidence: Prognostic Level II

Introduction In a published cost analysis of the management of flexor sheath ganglia, it was found that two attempts at aspiration, followed by surgical removal for those who failed, was the least costly alternative. We used this report as a template to create a model of the management that could be used in decision analysis. Method Using the published cohort study as a guide, a decision tree and Markov model of the management of flexor sheath ganglia were created. Results When compared to the results of a large cohort of patients reported in the literature, we accurately modeled the management of flexor sheath ganglia using both approaches. Discussion Creating a model of the management of a disease provides the opportunity to understand and explore questions efficiently and inexpensively. Many disorders of the upper extremity have commonality in their management, making the modeling approach attractive and potentially very valuable. This simple example illustrates two common methods used and is important because it builds confidence in the method by accurately modeling actual clinical experience.