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Osteoarthritis of the fingers and wrist, whether primary or secondary, is the most common degenerative disease. Its incidence is increasing due to the aging of the population. Most of the patients can be treated conservatively with good effect, but when conservative treatment fails, surgical intervention is considered. Essentially, there are 2 types of operations for this disease-radical (bone excision, arthrodesis, arthroplasty with an implant), and non-radical (joint denervation). Denervation of the joints has obvious advantages such as non-compromising the joint anatomy, preservation of range of motion, avoiding of an implant and low rate of complications. Denervation can be offered to younger patients, whatever their functional demands. Preservation of the bony anatomy does not preclude any further, more radical surgical interventions. This article presents a comprehensive information about methods of denervation of particular joints within the hand and their effectiveness in osteoarthritis. The current literature provides convincing evidence that denervation is a reliable and reproducible surgical technique for painful osteoarthritic conditions of the hand. It should be considered in patients presenting with painful joints which are still mobile, regardless the initial aetiology [ABSTRACT FROM AUTHOR]

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]

Carbon fiber reinforced plastics (CFRPs) are widely used in aerospace structures due to their high stiffness, strength and good fatigue properties. They are however vulnerable to loads perpendicular to their plane and, while impacted, can suffer significant internal damage decreasing their overall strength. Detecting and sizing such damage is an important task of the non-destructive inspection (NDI) methods. This study was conducted to detect and quantify damage in a set of six impacted even rectangular CFRP specimens designed from a MiG-29 vertical stabilizer’s skin. The inspection was done using the ultrasonic (UT) method (based on mobile scanner – MAUS V) and the pulsed infrared thermographic (IRT) method. Each specimen’s inside and outside (impacted) surface was inspected separately with IRT, while the outside surface was then inspected with UT. UT provided the most precise measurements of the damage area, while the IRT inspection of the outside surface (which would be accessible on a real aircraft structure) provided underestimated values due to the damage’s depth and geometry.

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]

Introduction: The assistance of anaesthesiologist is considered an inseparable part of most surgical procedures, with the exception of a small proportion of minor procedures performed under local anaesthesia. In hand surgery, a vast majority of procedures, even those lasting several hours, can be carried out under regional (brachial plexus block) or local (infiltration) anaesthesia. These can be delivered by the surgeons themselves, allowing the surgeries to be carried out without the assistance of anesthesiologists. Aim: The aim of this study was to analyze the efficacy and safety of presurgical anesthesia as delivered by surgeons without the assistance of anesthesiologists in the course of hand surgery procedures performed within the institution headed by the author of this article. Material and methods: The analysis was based on the records of anesthesia protocols filled out by the surgeons who delivered the anesthesia and who operated on the patients. The variables considered included the efficacy of anesthesia and the anesthesia-related adverse effects and complications. Results: Over a period of 13 years (2010--2022), a total of 24,703 surgeries were delivered; of these, 22,228 (91%) surgeries were carried out without anesthesiologists, with anesthesia being delivered by the surgeon him/herself. The efficacy of these procedures (local anasthesia and brachial plexus blocks combined) was 99%. A total of 631 (2.8%) anesthesia-related adverse reactions were recorded, most of them being transient, requiring immediate interventions and not leading to any serious sequelae. In only 17 cases (0.07%), adverse effects resulted in cancellation and rescheduling of the elective surgery. Conclusions: Pre-surgical anesthesia as delivered prior to hand surgery procedures by the surgeons without the assistance of anesthesiologists is effective and safe while being associated with numerous benefits for patients, surgeons and the health care system's budget. [ABSTRACT FROM AUTHOR]

Introduction: The results of some studies show that predictors of less favourable outcomes of surgery for carpal tunnel syndrome might include the presence of comorbidities, such as diabetes and thyroid gland diseases. The role of these factors has not been clearly determined, but in most trials the patients burdened with comorbidities conducive to CTS are excluded from the analysis. Aim: The aim of this study was to investigate the effect of concomitant diseases on the clinical profile and outcomes of surgery for carpal tunnel syndrome. Material and methods: The study group consisted of 1117 patients -- 909 women (81%) and 208 men (19%) -- at a mean age of 63 years. A total of 972 patients (87%) declared having at least one comorbidity, whereas 145 patients (13%) declared no comorbidities. The measurements were performed preoperatively and at 6 months postoperatively; they included pain intensity, total grip and key-pinch strength, digital sensibility and hand function with Levine's questionnaire. Results: At baseline, the patients with comorbidities had significantly worse digital sensiblility, weaker total grip strength and greater functional impairment of the hand, but only grip strength reached the minimal important difference (3.5 kg). Carpal tunnel release resulted in significant improvement in the tested variables for all patients, although the outcomes at 6 months were less favourable for those with comorbidities with regard to digital sensiblility, total grip and pinch strength and function of the hand. All these differences were statistically significant, but only grip strength reached the minimal important difference (2.9 kg). Conclusion: The results of this study show that comorbidities in patients suffering from CTS had a statistically and clinically significant negative effect only on the total grip strength pre- and postoperatively, and no significant effect on the outcome of surgery, which was satisfactory in all patients. [ABSTRACT FROM AUTHOR]

The currently used flexor tendon repair techniques and methods of postoperative rehabilitation differ significantly from those used as recently as 10-15 years ago. The repair techniques have evolved from 2-strand sutures (the Kessler suture) in the direction of the much stronger 4-strand and 6-strand sutures (the Adelaide and Savage sutures), reducing the risk of failure of the repair and allowing for more extensive rehabilitation. Rehabilitation regimes have also changed so as to be more comfortable for patients compared to previous protocols and to facilitate the achievement of better functional outcomes of the treatment. This study presents the updated trends in the management of flexor tendon injuries within the digits, with regard to the operative technique and postoperative rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Introduction: Dupuytren’s disease is a common fibrotic disorder of the palmar aponeurosis characterized by the formation of nodules and cords, as well as development of progressive flexion deformities in the digits, leading to functional impairment. Surgical excision of the affected aponeurosis remains the most common treatment. Quite a few new information appeared about epidemiology, pathogenesis and particularly treatment of the disorder. Aim: The aim of this study is an updated review of scientific data in this topic. Results: Results of epidemiologic studies showed that Dupuytren’s disease is not so uncommon in Asian and African population as it was earlier believed. An important role of genetic factors on development of the disease in a proportion of patients was demonstrated, however, it did not translate neither to the treatment nor to the prognosis. The most changes concerned the management of Dupuytren’s disease. A positive effect of steroids injections into the nodules and cords for inhibition of the disease in early stages was shown. In the advanced stages, a standard technique of partial fasciectomy was partly replaced by mini-invasive methods such as needle fasciotomy and collagenase Clostirdium hystolyticum injections. Unexpected withdrawal of collagenase from the market in 2020 resulted in considerable limitation of the availability of this treatment. Conclusion: It seems that updated knowledge on Dupuytren’s disease may be interested and useful for surgeons involved in management of the disorder. [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]

Most aircraft launchers exhibit a rapid acceleration of the launching aircraft, often exceeding ten times the acceleration due to gravity. However, only magnetic launchers offer flexible control over the propulsion force of the launcher cart, enabling precise control over the aircraft's acceleration and speed during its movement on the launcher. Consequently, extensive research is being conducted on magnetic launchers to ensure the repeatability of launch parameters, protect against aircraft overloads, and ensure operator safety. This article describes the process of modeling and analyzing the dynamical properties of a launch cart of an innovative prototype launcher, which employs a passive magnetic suspension with high-temperature superconductors, developed under the GABRIEL project. The developed mathematical model of the magnetic catapult cart was employed to conduct numerical studies of the longitudinal and lateral movement of the cart, as well as the configuration of the UAV–cart system during UAV takeoff under variable atmospheric conditions. An essential aspect of the research involved experimentally determining the magnetic levitation force generated by the superconductors as a function of the gap. The results obtained demonstrate that the analyzed catapult design enables safe UAV takeoff. External factors and potential vibrations resulting from uneven mass distribution in the UAV–cart system are effectively balanced by the magnetic forces arising from the Meissner effect and the flux pinning phenomenon. The primary advantage of the magnetic levitation catapult, in comparison to commercial catapults, lies in its ability to provide a reduced and consistent acceleration throughout the entire takeoff process. [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]

This article is focused on the research concerning the calculation of the durability of electrical machines installed in the electrical system of M-28 and C-130 Hercules aircraft. The article presents a method of predicting the service life of aircraft commutator machines, which are the primary source of electrical energy. The result of the research was the determination of the durability of bearings and coils of electrical machines operated on aircraft based on a flight profile analysis. It is problematic to directly measure the wear of bearings and windings of an electric machine on the aircraft. Their usage can be determined from the relation between their wear and the ambient temperature. This research can be used in practice to plan maintenance work on the analyzed aircrafts. [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]