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Chronic refractory complex regional pain syndrome (CRPS) is the severest form of this condition characterised by acute pain, other painful phenomena (hyperpathia, allodynia), severe functional impairment of the affected extremity and non-responsiveness to standard treatments. This paper presents a case of a 40-year-old man suffering from this form of CRPS, in whom all treatment options, including non-standard appeared ineffective. The patient suffered from intractable pain and a completely disabled extremity was considered by him a burden, additionally affecting his daily living. After a review of the literature and informing the patient about the potential benefits and the potential risk of failure of surgery, at the request of the patient an amputation of the upper extremity was performed at the level of 1/3 distal arm. The postoperative course was uneventful, but amputation did not result in cessation of the pain which persisted in the residual limb. The presented case shows that limb amputation for chronic refractory CRPS may not give expected beneficial effect. [ABSTRACT FROM AUTHOR]

The number and variety of different classifications that have been proposed for assessing the severity of Dupuytren's disease (DD) and for evaluating the results of surgery for DD indicate that there is no single perfect tool for assessing this disease. Despite the multiplicity of these scales, there is no consensus on the best method of grading the severity of this disease and on the most accurate outcome measure after treatment. This review article presents scales for assessing the severity and outcomes of surgery for DD based on the current literature. Several different classifications are presented, such as assessment of the degree of contracture, assessment of hand function, histologic evaluation, and so-called "complex scales". Each of these classifications has its advantages, but each also has weaknesses. This article provides a comprehensive and critical review of these instruments. Of all the scales and outcome measures reviewed in this article, these so-called "patient-oriented outcome measures" probably best reflect patients' perceptions of their outcomes after treatment. Therefore, these instruments seem to be more accurate and effective than other outcome measures in assessing the severity of DD and evaluating the results of treatment. However, the selection of the ideal outcome measure remains a task for future research. [ABSTRACT FROM AUTHOR]

Introduction: Hand fractures are the most common fractures of the upper extremity. Following the outbreak of war in Ukraine, approx. 1.5 million Ukrainians fled to Poland. Many of these individuals quickly integrated into Polish society and found employment, often in manual labor. The objective of this study was to analyze the spectrum of hand fractures recorded in the emergency department of a tertiary hospital and compare the incidence of hand fractures among Polish and Ukrainian patients before (2020) and after (2022) the outbreak of the war in Ukraine. Materials and methods: The study utilized records from the database of the Emergency Department SPSK 1 in Szczecin from 2020 and 2022, representing the year before and the year of Russia's invasion of Ukraine. Results: A total of 344 hand fractures were recorded in 2020 and 437 in 2022. In both periods, the most common injuries were finger and metacarpal fractures, accounting for 74% (2020) and 72% (2022) of all fractures. In 2020, 12 Ukrainians were registered, representing 3.5% of all patients that year, while in 2022, there were 44 Ukrainians, representing 10% of all patients (statistically significant, p = 0.0004). The number of work-related fractures was significantly higher among Ukrainians than among Poles, in both 2020 (6% vs. 58%) and 2022 (8% vs. 61%; statistically significant, p = 0.0001). Conclusion: The higher incidence of hand injuries among Ukrainians may be due to less attention to work safety compared to Poles and the fact that they often work outside their trained professions, which increases the risk of injury. [ABSTRACT FROM AUTHOR]

The fibrous flexor tendon sheath is a relatively thick structure surrounding both flexor tendons (superficial and profundus) along the finger and distal part of the metacarpus. It consists of circumferentially and obliquely passing bands, so-called 'pulleys'. The flexor tendon fibrous sheath with its pulley system plays an important role in the proper gliding of the tendons by maintaining them close to the bone of phalanges during full finger flexion, and its major defects manifest by impaired flexion of the finger because the tendon bowstringing. There is no commonly accepted opinion about the range of pulley release which is safe and would not cause bowstringing. The article presents current recommendations about the safe range of release of pulleys during repair of the flexor tendons which essentially allows longer incisions than was suggested previously. The priority is the undisturbed gliding of repaired tendon along the finger and avoiding catching the repair at edge of the pulley, which would result in a reduction of the finger's range of motion. [ABSTRACT FROM AUTHOR]

A case of severe streptococcal phlegmon of the right upper extremity with subsequent necrosis of both hands and feet in a young, homeless alcoholic man is reported. The disease developed after a minor injury to the hand, and it progressed rapidly, resulting in the involvement of the whole hand and sepsis over 2 days. After admission, antibiotic and anticoagulant therapy was immediately administered, followed by wide surgical incisions on the hand and forearm. Nonetheless, over the course of 3 days, ischemia of the affected hand developed, followed by ischemia of the contralateral hand and both feet the next day. The treatment employed was not effective, and the patient eventually died on the fifth day after admission. [ABSTRACT FROM AUTHOR]

Introduction: Anesthesiologist's assistance is considered an inseparable part of most surgical procedures, except for minor operations performed under local anesthesia. In hand surgery, most of the operations can be performed under regional (brachial plexus block) or local (infiltration) anesthesia. These procedures can be carried out by the surgeons themselves, which allows them to operate without the assistance of an anesthesiologist. The objective of this study was an analysis of the efficacy and safety of anesthesia to operations in hand surgery performed by surgeons, without the assistance of anesthesiologists. Materials and Methods: This analysis was based on records of anesthesia protocols completed by the surgeons who performed the procedure and who operated on the patients. The following variables were considered: efficacy of anesthesia, adverse effects associated with anesthesia and complications. Results: Over a 10-year period (2013-2022), a total of 16,583 procedures were performed, of which 5638 (34%) were carried out under anesthesia by surgeons, without the assistance of anesthesiologists. The efficacy of these procedures (local and brachial plexus blocks) was 98%. A total of 203 (3.6%) anesthesia-related events were noted, most of which were transient, requiring emergency intervention and without serious consequences. In only 12 cases (0.02%) adverse effects led to cancellation and postponement of the planned operation. Conclusion: Anesthesia for operations in hand surgery performed by surgeons themselves and without the assistance of anesthesiologists is effective and safe and is associated with numerous benefits for patients, surgeons, and the budget of the medical care system. [ABSTRACT FROM AUTHOR]

Strangulation of the vermiform appendix into the femoral hernia sac (de Garengeot hernia) is very rare. This article presents a case of a 63-year-old woman with this kind of hernia which contained a strangulated tumour of the appendix. The patient presented to the hospital with a 3-day-long history of a palpable lump in the right groin. She had no other significant complaints, but USG imaging showed suspicion of the strangulated femoral hernia containing a bowel. The patient was operated on. As the tumour was not suitable to remove via groin incision, laparotomy was performed, followed by a release of the appendix with the tumour and their resection together with a fragment of the caecum. The postoperative course was uneventful, and histological examination showed appendiceal mucinous neoplasm with high-grade dysplasia. After oncological consultation, the patient underwent prophylactic right hemicolectomy. [ABSTRACT FROM AUTHOR]

Ganglion cysts are the most common benign soft tissue tumors of the hand and wrist. They are usually found on the wrist, more often on the dorsal side. Very rarely, these cysts can be located in the nerves, tendons, and bones (the intraneural, intratendinous, and bony ganglions, respectively). In this article, we report a case of a ganglion cyst localized in the extensor communis tendon of the index finger in a 54-year-old woman. The nature of the lesion was discovered intraoperatively; it was then resected. The postoperative course was uneventful and the patient recovered within 4 weeks. Histologic examination revealed that the cyst wall consisted of fibrous tissue with signs of degeneration and no epithelial lining. [ABSTRACT FROM AUTHOR]

Introduction: The technique of reduction and fixation of distal radial fractures consisting in the introduction of K-wires between bone fragments ("intrafocal technique") was firstly described by French orthopedic surgeon dr. Adalbert Kapandji in 1967. This method allows a reduction of the fracture using the K-wire as a "lever", which elevates displaced bone fragments and places it on site. The objective of this article is the presentation of the Kapandji technique and the results of the treatment of distal radial fractures operated on at the authors' institution. Materials and methods: A total of 187 patients, 151 women 6 months after surgery, according to standard protocol. Results: The mean wrist total arch of motion (dorsal + palmar flexion) was 93°, grip strength of 17.2 kG and the quickDASH score 21 points. All these variables reflect the overall good function of the affected hand. Meaningful secondary displacements were noted in only 5 patients (2.6%). In general, the results obtained by the patients were satisfactory. The results of our study show that using the Kapandji technique for the treatment of distal radial fractures resulted in satisfactory clinical outcomes and relatively rare complications. [ABSTRACT FROM AUTHOR]

Vascular-derived tumours localized in the upper extremity are relatively commonly encountered, particularly in children. They are divided into 2 groups: vascular-derived neoplasms and vascular malformations. These 2 groups differ in several aspects, although their clinical presentation may be similar. Haemangiomas constitute the greatest group of benign vascular current information on the classification, aetiology, diagnostic, symptomatology, methods, and outcomes of treatment of vascular-derived tumours localized in the upper extremity. It may be useful in diagnosing and managing these conditions. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb. Mechanical compression and local ischemia of the median nerve result in paresthesia, pain, and sensory and motoric disturbances. There are some aspects of the disease that suggest the potential role of genetic predispositions. This article presents a review of the literature about the significance of genetic factors in the etiology of CTS. It discusses the effect of selected gene mutations on constitutional and anthropometric features which may predispose to CTS. These genes are involved in the organization of an extracellular matrix architecture, as well as in bone, cartilage, and tendons development pathways. Therefore they may be potentially responsible for the observed relationship between anthropometric/constitutional factors and CTS. The findings from the studies provide reliable information on the association between genetic risk factors and the development of CTS. [ABSTRACT FROM AUTHOR]

Excessive hand injuries are not uncommon in hand surgeon’s practice. They are usually caused by various devices such as circular saws, grinders, millers, presses, conveyers, and agricultural machines. This article reports a case of mutilating injury to the entire upper extremity as a result of crush and burn of IV degree. The right upper extremity of a farmer who attempted to unblock the mechanism of a straw-press was pulled inside the machine. Despite resistance against the pulling force, the extremity was drawn inside the machine up to the elbow, where the cog-wheels started to glide on the exposed bones of the forearm and arm. The farmer first attempted to cut off the extremity with the pocket knife, following by firing the straw inside the press to draw somebody’s attention to his dramatic situation. Eventually, a person who passed by on the road nearby noticed the smoke flying out of the machine, came to the victim, and called for help. Despite the excessive injury of the entire upper limb and bleeding, the condition of the patient on admission was good. The extremity from the level of mid-arm was crushed, whittled, and burned, and the only option was the amputation at the proximal arm level. The post-operative course was uneventful. [ABSTRACT FROM AUTHOR]

Introduction: Immune thrombocytopenia (IT) is an acquired immune-mediated disease characterized by a decrease in platelet count due to antiplatelet autoantibody-mediated increased platelet destruction. Platelets which are "labelled" by autoantibodies are recognized and destroyed first of all in the spleen, and, therefore, splenectomy is one of the treatment options, particularly in cases refractory to conservative treatment. The objective of this study was to determine long-term outcomes of splenectomy in the treatment of IT in adult patients. Materials and methods: Eleven patients, 7 men and 4 women with a mean age of 43 years and IT lasting 30 months on average underwent splenectomy. Indication to surgery was failed conservative steroid therapy in all patients. Outcomes of surgery were assessed in 9 patients on average 5 years following the surgery. Results: In all patients, good response to the treatment was obtained (remission). None of the patients continued therapy against the disease and all had platelet count at the follow-up higher than 100 G/L. No serious complications were observed. Conclusion: Splenectomy is an effective and relatively safe, second-line treatment of IT, in cases in which conservative therapy fails. [ABSTRACT FROM AUTHOR]

The results of functional treatment, without immobilization, in 7 patients with stable fractures of the metacarpal bones and phalanges is reported. Each patient was instructed to make a full flexion and extension of all fingers in 1 block (fingers kept close each other). No immobilization was used. The results were assessed at 1 month and 3 months from the beginning of therapy. All patients achieved consolidation of their fractures confirmed radiologically at 3 months. All patients achieved full finger movement and very good function of the hand. No change of treatment into operative was necessary. The results of this study demonstrate that the treatment of stable fractures of the metacarpal bones and phalanges according to the presented "functional" protocol is safe, well tolerated by the patients and gives good outcomes. [ABSTRACT FROM AUTHOR]

The diagnosis of complex regional pain syndrome (CRPS) is made on clinical grounds, based on the presence of several symptoms and signs that are relatively easy to find when recording the patient's history and in the clinical examination. It is not as easy, however, to quantify these features. Maintaining objectivity is desired in clinical practice, and is particularly important in research studies. Complex regional pain syndrome causes a functional impairment of the affected extremities and limits daily living activity in the patients. An objective measurement of these limitations is also desired. In this paper we present methods used in contemporary research on CRPS, attempting to objec-tivize features that are primarily subjective, such as pain and level of impairment. The methods of assessment of these variables are useful in studies on the impact of the disease on patient functioning in daily living. They are also important in a complex assessment of the results of treatment of the condition. [ABSTRACT FROM AUTHOR]

Haemangiomas are fairly common tumours encountered in the upper extremity. They are composed of non-homogenous groups of lesions of arteriosus, venous or lymphatic origin. The results of surgical treatment of haemangiomas in the upper extremities of 19 patients, 11 women and 8 men, at a mean age of 46 years are presented. Eleven patients (58%) had lesions localized in the digits, 6 (32%)) in the wrist or metacarpus and 2 (10%)) in the forearm or arm. The duration of the disease until operation was 6 years on average. The most common motivation to undergo surgery was cosmetic concern. The follow-up assessment was performed in a form of a phone interview for all patients, at a mean of 4 years after the operation. No serious postoperative complications were observed. Four patients were not satisfied with the appearance of the postoperative scar, 1 reported sensory disturbances in the operated finger and another had reduced grip strength of the operated hand. One case (5%) of a recurrence of the lesion was noted, at 1 year after the operation. [ABSTRACT FROM AUTHOR]

Glomus tumours are rare, benign lesions of vascular origin. In the hand, they frequently localize in the distal phalanges and under the nail plate. Most tumours are symptomatic with characteristic features such as spontaneous pain at the end of the digit exacerbated at exposure to the cold, and trigger point tenderness. This study presents results of the operative treatment of 18 patients, 12 women and 6 men, at a mean age of 38 years with glomus tumours in the hand. Most of them (n = 16) were localized in the distal phalanges, 8 of which were subungual. The follow-up assessment was performed in the form of a phone interview at a mean of 4.2 years following surgery. All patients declared pain relief almost immediately after the tumour's resection. Problems reported by the patients at the follow-up were inaesthetic scars, occasional pain in the operated digit at weather changes, and mild tenderness at the operation site. Three cases of recurrence were noted. These results show that operative treatment of glomus tumours is effective, provides fast relief of troublesome symptoms and is associated with a moderate risk of recurrence. [ABSTRACT FROM AUTHOR]

Anal and rectal injuries are rather uncommon in surgical practice. They are mainly caused at traffic accidents, sexual assaults, harmful voluntary, and eccentric sexual activities, or medical measures. Spectrum of these injuries is wide -- from minor wounds of anodermy or rectal mucosa, until rectal tears penetrated the peritoneal cavity. A case of an accidental, intraperitoneal injury of the rectum caused by a wooden broomstick is presented. The range of trauma was diagnosed based on computed tomography imaging of the abdomen and treatment consisted in the resection of the damaged fragment of the rectum followed by end colostomy. The post-operative course was uneventful. The authors emphasize the necessity of a careful evaluation of these injuries, because any delay in the treatment may result in serious, even fatal complications. [ABSTRACT FROM AUTHOR]

Introduction: Benign tumours of the hand and upper limb are frequently seen by hand surgeons. The literature in this field is relatively rich, however there are several issues which are not referenced in the literature or are subject to divergent opinions. These concerns complaints caused by the tumours. The objective of this study was to investigate the distribution, symptomatology and histological analysis of benign tumours within the upper extremity. Materials and methods: The study group consisted of 346 patients – 234 women (68%) and 112 men (32%) at a mean age of 53 years who were operated on in the authors’ institution between 2015–2018. The criteria of inclusion were as follows: the presence of a tumour in the upper extremity which was not a ganglion cyst or malignant tumour, and available results of histopathological examination of the resected tumour. Results: Most lesions – 231 (67%) were localized in the digits, followed by the metacarpus – 46 (13.3%). The size of most of the tumours – 204 (59%) was 0.6–2 cm. The tumours were present for a mean duration of 2.6 years before surgical excision. For most patients, an unaesthetic appearance of the hand was the primary problem. Most of the tumours – 248 (72%), were symptomatic by means of pain at compression or caused mild dysfunction. In the study group, most tumours were giant-cell tumours of the tendon sheath – 96 (27.7%), lipomas – 44 (12.7%) and rheumatoid nodules – 30 (8.7%). [ABSTRACT FROM AUTHOR]

Rheumatoid nodules are common extra-articular manifestations of rheumatoid arthritis (RA). It is estimated that 35–40% of patients diagnosed with RA have got nodules localised in various body regions. Rheumatoid nodules constitute a fairly common problem in the hand surgeon’s practice. This study presents the results of operative treatment of 30 patients with rheumatoid nodules in the upper limb – 21 women and 9 men with a mean age of 51 years. Only 6 of the 30 patients (20%) had RA diagnosed prior to surgery. All but 1 nodules were localised on the hands. The follow-up assessment was performed in a form of a phone interview on average 1.5 years following the surgery. All patients declared satisfaction with the results of the treatment, 5 (17%) had a slight pain in the postoperative scar, and 6 (20%) complained about the esthetic effect. Two cases (7%) of recurrence at the operation site were noted. The results of this study indicate a good effect of surgery and justify this approach to rheumatoid nodules in hands. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome is the most common compressive neuropathy in the upper limb. Morbidity is approx. 4 times higher in women than in men. Clinical observations suggest that the sex and age of patients influence a preoperative reduction of grip and pinch strengths as well the range of improvement in these variables postoperatively. The objective of the study was to investigate this issue. Materials and methods: The study group consisted of 1,117 patients, 909 women (81%) and 208 men (19%) at a mean age of 63 years. Each patient had been tested for total grip strength, pinch strength and completed the functional part of the Levine questionnaire which evaluates the severity of dysfunction caused by the disease. Results: Preoperatively, men had almost a double-fold total grip and pinch strength compared to women, whereas women had greater, but clinically irrelevant, hand dysfunction. The total grip and pinch strengths were statistically and clinically significantly lower in patients >80 years old. Postoperative improvement of the power and function of the hand was similar in women and men. Patients in different age groups achieved similar improvement of the power and function of the hand postoperatively, except in the oldest group (>80 years old) in which the improvement was smallest. Conclusion: In the course of carpal tunnel syndrome, reduction of the power and function of the hand are similar in women and in men, as well as in different age ranges, except for the oldest patients in which dysfunction is the greatest. Surgery results in similar improvement of power and function of the hand in both sexes and in different age groups, except for the oldest patients, who show the least improvement. [ABSTRACT FROM AUTHOR]

Microsurgery is a form of surgery performed with the assistance of a magnifying device such as a microscope or loupe. It is not considered a distinct specialty but a competency required for different surgical specialties. The study presents an undergraduate training model designed in the authors' institution and is directed towards medical students in their clinical years. It consists of 30 practical learning hours of how to conduct various microsurgical procedures. These took place during 15 three-hour classes (2 h under the microscope per lesson), held once a week. The simulation model used in this training was a chicken thigh and instrumentation consisted of surgical training microscopes and professional microinstruments. Effectiveness of the training was assessed through the observation of acquired skills and the so called "6-stiches test". Other simulation models used in microsurgical training and other methods of evaluating the acquired proficiency were discussed. The results show that the proposed 30 h of undergraduate, facultative microsurgical training is effective in ensuring participating students acquire basic and advanced microsurgical skills, competence and confidence. The curriculum was designed to allow students to participate in training during the evening, away from other duties, so as not to burden them too much. [ABSTRACT FROM AUTHOR]

Penetrating injuries of the forearm are relatively frequently seen in hand surgeon's practice. They are typically caused by a knife or other sharp tool which drives deeply into the forearm muscles and frequently damages nerves or vessels. In this paper, we report a case of a young man with a forearm wound in which a piece of glass on the palmar side passed through the muscles and the interosseous membrane to the dorsal side and caused extensor tendons injury. The glass object was seen in the X-ray. The wound was inspected in the operating theatre and injured tendons were repaired. The postoperative course was uneventful. This case shows that surgeon must be very cautious in assessing penetrating injuries due to the possibility of damage to structures localized beyond the entry wound. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the upper limb. Morbidity is approx. 4 times higher in women than in men. Clinical observations suggest that the course of the disease, including the severity of symptoms, varies depending on the sex and age of the patients. The objective of the study was to investigate this issue. Materials and methods: The study group consisted of 1,117 patients, 909 women (81%) and 208 men (19%) with a mean age of 59 years. Each patient declared their subjective perception of pain intensity using the Numeric Rank Scale (NRS) and completed the Levine questionnaire which evaluates the severity of symptoms caused by the disease. Results: A mean pain intensity in the NRS (6.3 vs. 5.4) and in the symptoms judged by the Levine questionnaire (3.1 vs. 2.9) were statistically significantly higher in women than in men, although these differences were borderline regarding clinical significance. A comparison of variables in the age groups (from <40 to >80 years) showed no statistically or clinically significant differences: for NRS 5.8-6.5 and for the Levine symptom score 3.0-3.2. Conclusion: Women suffering from CTS experience slightly more intensive pain than men, but this has no clinical significance. The age of the patients has no impact on experience of complaints caused by the syndrome. [ABSTRACT FROM AUTHOR]

Unlike in other parts of the digestive tract, the localization of a haemorrhage site in the small intestine is difficult. In the case of massive bleeding and the need for an urgent operation, localization of the area or site of bleeding in the small bowel may be challenging for the surgeon. The authors report a method of finding sites of bleeding using a laparoscope in a patient with massive gastrointestinal bleeding. Endoscopic diagnostics were inconclusive and an angio-CT revealed bleeding in the small bowel in the left middle-abdomen. Emergency laparotomy was performed with enterotomy and an inspection of the suspected part of the intestine with a laparoscope. Three sites of bleeding were found, of which one with active bleeding was ligated. Additionally, the small intestine parts over the bleeding sites were devascularized by ligation of arterial branches supporting them. This resulted in the bleeding stopping and the patient eventually recovering. The authors believe that the presented technique may be helpful in intraoperative localization of bleeding sites in the small bowel. [ABSTRACT FROM AUTHOR]