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The objective of this study was to quantify the lateral stability of healthy proximal interphalangeal (PIP) joints using a three-dimensional motion capture system and compare it to affected joints after surface replacement or silicone arthroplasty. Three study groups comprised healthy participants, patients with PIP joint osteoarthritis treated with a surface replacing implant (CapFlex-PIP) and those with a silicone arthroplasty. All participants were matched on gender and finger, and the two patient groups were also matched on length of follow-up. An optical tracking system was used to measure lateral stability. Radial and ulnar stability of the PIP joint was measured as the maximal lateral deviation angle of the middle phalanx under loads of 40 g, 90 g and 170g at 0°, 20° and 45° PIP joint flexion. Measurement reliability was evaluated with a test-retest trial [intraclass correlation coefficient (ICC)]. A total of 30 joints were assessed with 5 index and 5 middle fingers per test group. Lateral deviation increased proportionally with applied weight. Silicone arthroplasty joints had a higher median lateral deviation angle of 5.1° (range 0.7-7.9) than healthy [3.0° (0.5-11.0)] and surface replacement joints [3.3° (0.3-7.4)] at 45° flexion and under 170g load. Test-retest reliability was high with an ICC of 0.93. Lateral PIP joint stability is highly variable in both healthy participants and patients after PIP joint arthroplasty. PIP joint surface replacement arthroplasty tends to achieve better anatomical stability compared to flexible silicone implants.

Background Children with severe congenital heart disease (CHD) are a group of children at risk for neurodevelopmental impairments. Motor development is the first domain to show a delay during the first year of life and may significantly contribute to parental concerns, stress, and difficulties in early child-parent attachment. Thus, the aim of the study was to better understand the wishes and concerns of parents of children with CHD and explore their experience of their children’s neuromotor development in the first year of life. Methods In this qualitative study, fourteen families were recruited. Their children were aged 1–3 years and had undergone open heart surgery within the first 6 months of life. Semi-structured interviews were audio-recorded and transcribed. The data was explored within an expert group, and a qualitative content analysis was conducted using VERBI MAXQDA software 2020. The study was conducted in accordance with the COREQ checklist. Results Parents of children with CHD reported several burdens and needs. Parental burdens concerned the child’s motor development, their own physical and psychological strain, and difficulties in communication with healthcare professionals. The needs, parents reported included supporting their child’s motor development, a medical coordinator, and better communication between healthcare professionals and parents. During the first phase of their children’s illness, parents underwent a dynamic transitional phase and expressed the need to rely on themselves, to trust their children’s abilities, and to regain self-determination in order to strengthen their self-confidence. Conclusions It is essential to involve parents of children with CHD at an early stage of decision-making. Parents are experts in their children and appreciate medical information provided by healthcare professionals. Interprofessional teamwork, partnering with parents, and continuous support are crucial to providing the best possible care for children and their families. Family-centred early motor intervention for CHD children might counteract the effect of parental overprotection and improve children’s motor development and thus strengthen child-parent interaction. In future work, we aim to evaluate a family-centred early motor intervention for children with CHD developed on the basis of this qualitative study. Trial registration Not applicable.

We sought to investigate the reliability, validity, responsiveness, and interpretability of the German version of the Unite Rhumatologique des Affections de la Main (URAM) scale in patients with Dupuytren's disease. Patients with Dupuytren's disease were evaluated before receiving an injection of collagenase Clostridium histolyticum or undergoing surgical treatment and again 1 year later. Patients completed the URAM, the brief Michigan Hand Outcomes Questionnaire (brief MHQ), and the 5-level EuroQol version (EQ-5D-5L). Flexion contracture was measured. Internal consistency (Cronbach's alpha), construct validity (Spearman's correlation coefficient, r), responsiveness (effect size), and the minimally important change (MIC) and minimally important difference (MID) were determined. Confirmatory factor analysis was used to test the structural validity of the questionnaire. We included 231 patients (273 cases) with a mean age of 67 (SD, 9) years. Cronbach's alpha was 0.91. Correlations between the URAM and the brief MHQ, EQ-5D-5L and flexion contracture were r=-0.76, r=-0.46 and r=0.53, respectively. The URAM effect size was 0.96 and the MIC and MID were 6 and 7 points, respectively. The factor analysis revealed unidimensionality but indicated that one item (pick up small objects) could be removed. The German URAM has high reliability, good construct validity and excellent responsiveness. However, the questionnaire could be shortened by one item to increase its structural validity. We recommend using the URAM as a specific tool for evaluating the treatment effect in patients with Dupuytren's disease in daily practice and for research purposes.

Our aim was to determine the minimal important change and patient acceptable symptom state for pain and the brief Michigan Hand Outcomes Questionnaire in patients 1 year after proximal interphalangeaI joint arthroplasty. We analysed data of 100 patients from our prospective registry. The minimal important change and patient acceptable symptom state were determined with anchor-based methods, and patients with better or worse baseline status were examined. The minimal important change for pain at rest and during activities, and the brief Michigan Hand Outcomes Questionnaire was −1.2, −2.8 and 18, respectively, with corresponding patient acceptable symptom state values of 1.5, 2.5 and 64. Patients with higher baseline symptoms rated more severe postoperative symptoms as acceptable, whereas patients with lower baseline symptoms were only satisfied with a low level of pain and high level of hand function. The minimal important change and patient acceptable symptom state are useful estimates for patient outcomes and study results.Level of evidence: IV

Purpose The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ. Methods Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined. Results The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and – 0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points. Conclusions Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture. Clinical relevance The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment.

Purpose The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft). Methods We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded. Results We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46–56) to 83 (95% CI, 78–87) and 53 (95% CI, 47–58) to 76 (95% CI, 69–84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient. Conclusions The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon. Type of study/level of evidence Therapeutic I.

L’essai propose de suivre le fil des débats autour de l’Immaculée Conception dans les pays germaniques à partir du Concile de Bâle jusqu’au début du xvie siècle.Le décret du Concile en faveur de cette doctrine (1439) avait ranimé un désaccord déjà ancien entre les ordres mendiants et particulièrement entre les Franciscains et les Dominicains au sujet de la Vierge immaculée. Les deux traités défendant ce privilège (1444/1445) écrits par l’ancien évêque de Constance, Otto d’Hachberg, sont un premier témoignage de ce conflit en Allemagne. Dès l’avènement du pape franciscain Sixte IV (1471-1484), les disputations publiques et les polémiques littéraires au sujet de l’Immaculée Conception se multiplient. Le point culminant de cette controverse arrive au moment du procès contre le dominicain Wigand Wirt à Rome où l’accusé se voit contraint en 1512 de révoquer ses écrits diffamatoires. L’isolement croissant de l’ordre dominicain dans ce débat semble être aussi la conséquence du thomisme rigide des dominicains observants en Italie et en Allemagne. Ainsi les frères observants de la province de « Teutonie » suivent-ils de près l’opinion de leur confrère Vincent Bandelli de la congrégation observante de Lombardie, déclarant la foi en l’Immaculée Conception comme hérétique. Bien que la bulle Grave nimis (1482) interdise aux partis opposés de se dénoncer mutuellement comme hérétiques, les observants allemands ne manquent pas de faire usage de cette arme, ce qui provoque l’alliance de leurs adversaires (Carmes, Chartreux, Augustiniens, Bénédictins et cercles humanistes de toute couleur) dans le camp des franciscains de l’Observance. L’analyse des traités et des circonstances de cette querelle met donc en lumière les tensions et les constellations intellectuelles du discours religieux dans les décennies avant la Réforme protestante où le raisonnement théologique fait place à la polémique et où l’imprimerie permet d’atteindre un public en dehors du cloître et de l’université. Ainsi les gravures en bois de la Vierge Immaculée trouvent-elles leur place aussi bien dans la campagne des humanistes strasbourgeois autour de Sébastien Brand que dans les illustrations du récit satirique du franciscain Thomas Murner, relatant les différents épisodes de l’affaire Jetzer à Berne.This essay proposes to follow the thread of arguments around the Immaculate Conception in Germany from the end of the Council of Basel till the early 16th century. The decision of the Council of Basel in favour of this doctrine (1439) had the effect to stir up the old dispute among the mendicant orders and especially among Dominicans and Franciscans on behalf of the Immaculate Conception. The two treaties of Otto of Hachberg, former bishop of Constance, defending the Virgin Immaculate (1444/1445), are a first testimony of this conflict in Germany. Starting with the pontificate of the Franciscan pope Sixtus IV (1471-1484) the amount of disputes and literary controversies multiplied. They came to a peak in 1512, when the Dominican Wigand Wirt was on trial in Rome for his defamatory statements and forced to revoke his utterances. The fact that the Dominican Order became increasingly isolated in this matter seems also to be a consequence of the strength of Thomism among the observant friars in Italy and Germany. Although the papal bull Grave nimis (1482) had forbidden both parts of this debate to denounce each other as heretics, the German Dominicans made often use of this weapon, thus provoking an dangerous alliance of defenders of the Immaculate Conception bringing together the observant Franciscans, the Carmelites, the Carthusians, the Augustinians and Benedictines with different circles of humanists. The analysis of the treaties and contexts of this controversy throw a sharp light upon the tensions and intellectual constellations of the religious discourse during the last decades before the outbreak of the Reformation where theological reflection had to give way to polemic and where the art of printing provided the means to reach a public outside the monasteries and universities. The use of printed images of the Immaculate Virgin played therefore an important role in the campaign of the humanistic circle of Sebastian Brand as well as printed illustrations of the “Jetzer affair” in the satirical chronicle of the Franciscan Thomas Murner.

In seiner Vita der hl. Elisabeth von Thuringen schildert der Zisterzienser Casarius von Heisterbach [1], wie Elisabeth nach dem Tod ihres Mannes und ihrer Ubersiedlung nach Marburg endlich die ihr gemase Lebensform gefunden hatte, namlich wie Martha fur Kranke und Arme sorgen zu durfen und sich gleichzeitig wie Maria der Kontemplation hinzugeben: Ibat etiam beata Elyzabeth frequentius cum ancillis suis ad domos pauperum, secum deferri faciens panes, carnes, farinam et alia victualia, que indigentibus competebant, que omnia propria manu distribuii. Quorum vestes et lectos diligenter inspiciebat et domum rediens orationi insistebat. Non enim propter ministerium Marthe deserere voluit quietem Marie (Huyskens, S. 376).