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Objective and research design This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. Results The whole sample model ( N  = 745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression ( β  = .10) and its indirect effect on carer depression through cognitive fusion ( β  = .15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across 3 countries, while the direct path was no longer significant in Spanish and UK samples. Conclusion These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.

We report our experience with the use of a vascularized ulnar periosteal pedicled flap to treat forearm nonunion in children. Seven children underwent surgical treatment of radial diaphysis nonunion with this technique. The mean duration of nonunion prior to the flap was 9 months. Significant postoperative improvements were observed in pain severity (mean visual analogue scale score of 0.6), Quick Disabilities of the Arm, Shoulder, and Hand (mean score of 7.1) and grip strength (89% higher than preoperative status). Union was achieved in all patients, with a mean time to union of 3 months. One patient developed distal radioulnar synostosis as a postoperative complication. A vascularized ulnar periosteal pedicled flap is a reliable and versatile technique for treating forearm nonunion in children, associated with both good outcomes and low donor morbidity. Level of evidence: IV.

Purpose: An endoscopic-assisted approach for Sprengel deformity has been previously reported. Our objective was to assess outcomes of the endoscopic Woodward procedure in a series of patients., Methods: Retrospective analysis was performed of children with a Sprengel deformity treated between November 2014 and February 2018. Recorded data were demographic, pre- and postoperative active shoulder elevation and deformity severity according to Cavendish., Results: A total of 12 children (four girls and eight boys, ten right-sided/two left-sided) with a mean age of nine years two months (3 years 5 months to 16 years 1 month) and mean follow-up 19.8 months (10 to 48) were assessed. Nine children were classified as Cavendish Grade III and three as grade IV, respectively. Mean preoperative active shoulder forward elevation was 100.8° (70° to 120°), while postoperatively it increased to 149.2° (100° to 170°). Mean preoperative scapular high difference was 4.5 cm (2.8 to 5.2), while postoperatively it was 1.33 cm (0 to 2.8)., Conclusion: The endoscopic assisted Woodward procedure is an effective technique. Further comparative studies will ascertain advantages in functional and cosmetic results compared to the standard Woodward procedure., Level of Evidence: Therapeutic study, Level IV., (Copyright © 2021, The author(s).)

Background: The development of trigger digit after carpal tunnel syndrome release surgery has been widely reported. Lluch described reconstruction of the flexor retinaculum in elongated position to prevent such complication. Methods: We conducted a retrospective review to determine whether patients who undergo reconstruction in elongated position of the flexor retinaculum have a lower incidence of trigger digit postoperatively. In total, 1050 patients were included, 865 of whom had undergone traditional carpal tunnel release and 185 flexor retinaculum reconstruction. Results: No differences were found in the incidence of trigger digit after surgery (8.7% of the patients who underwent traditional release vs 11.9% in the reconstruction group). Neither difference was found when comparing mean time with the development of trigger digit. Conclusions: In the absence of randomized long-term studies comparing traditional release and reconstruction in elongated position after carpal tunnel release, given our results, we see no reason to favor reconstruction over standard carpal tunnel release as a means to prevent postoperative triggering of digits.

Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.

Background: While most intervention studies conducted with dementia family caregivers have focused on depressive symptoms as the main outcome, no study has analyzed the effects of an intervention on comorbid clinical presentations of depressive and anxious symptomatology., Objective: The aim of this study was to examine the association between clinical depressive and anxious symptomatology at baseline and treatment responses of dementia family caregivers using samples from two randomized intervention trials with the same pre-post design., Methods: Specifically, the effects on depressive and anxious comorbidity of three intervention conditions (Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and a control group (CG)) were analyzed. Participants were 130 dementia family caregivers. In addition to sociodemographic variables, depressive and anxious symptomatology were measured., Results: Caregivers with clinical depressive and anxiety comorbid symptoms at baseline recovered less well from depressive symptoms after CBT (45.45%) and ACT (47.72%) interventions than caregivers with non-comorbidity (100% recovery in both treatments). No significant association between comorbidity and treatment responses on depression was found for the control group. Regarding anxiety, among participants with comorbidity at baseline, 36.36% of caregivers in CBT and 30.9 % in the ACT group recovered from anxiety symptoms after treatment, compared to 6.45% in the control group. Similar results were obtained regarding those caregivers who recovered both from clinical depressive and anxiety symptoms and showed comorbidity at baseline., Conclusion: Caregivers that show comorbid depressive and anxiety symptoms at baseline may benefit less from interventions than caregivers who do not show comorbidity.

The purpose of the study was to evaluate clinical and radiological outcomes of extra-articular fractures involving the base of the thumb metacarpal treated with fixation using a retrograde intramedullary cannulated headless screw. A review of prospectively collected data was conducted on a consecutive series of 13 patients, treated with headless screw fixation for acute displaced fractures. All workers resumed full duties, while non-workers returned to unlimited leisure activities within a mean of 42 days. At 3 months follow-up, all range of motion measurements in the treated and untreated thumb were similar. Mean visual analogue pain score was 0.8 at rest and 1.4 during exercise and mean Quick Disabilities of the Arm, Shoulder, and Hand score was 5. All patients achieved radiographic union by 8 weeks. We conclude that the intramedullary headless screw fixation is safe and reliable for base of thumb metacarpal fractures, allowing for early postoperative motion and good functional recovery. Level of evidence: IV.

We undertook a retrospective study to evaluate minimal 8-year outcomes of 46 trapeziometacarpal joints (46 patients) treated with pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis in two different hand surgery units. The mean follow-up interval was 9.5 years (average 113 months with a range 97-144 months). The study showed that pyrocarbon interpositional arthroplasty provided pain relief and high patient satisfaction. All patients experienced a reduction in the DASH score, with an average change of 30 points. The visual analogue scale score, the Kapandji score, and key pinch also showed remarkable improvement. The PyroDisk implant exhibited good longevity, with good implant survival. A review of the literature revealed that the functional outcomes after implant surgery are not superior to more common techniques, such as trapeziectomy with or without ligamentoplasty. Therefore, this is a reliable surgery but may not have added benefits over simpler surgical treatments. This implant could have a role, perhaps in a select group of young patients, as a time-procuring procedure. Level of evidence: IV.

Background: A very uncommon pattern of thumb duplication consists of an ulnar-side floating thumb and a radial-side distally hypoplastic thumb., Methods: We report the case of a 15-month-old child with this type of thumb duplication on his right hand treated with an on-top-plasty technique. The ulnar-side segment was pedicled and transferred to the lateral thumb, which was distally resected., Results: A well-aligned and widely mobile thumb with a wide first web and an excellent cosmetic appearance was exhibited 10 years after surgery., Conclusions: On-top-plasty technique might be amenable to reconstruct certain atypical thumb duplications.