No abstract

Background: Thumb polydactyly is one of the commonest congenital hand differences. Traditional surgeon-based outcome scores capture outcomes mainly on bodily structure and function. Outcomes on the long-term well-being of the patients in the domains of activity and participation are not fully studied. Methods: Forty-eight thumbs in forty-five Chinese patients with radial polydactyly underwent surgical treatment at or before 3 years old were recruited. Mean follow-up was 11.6 years. Surgical outcomes were collected and compared to the normal opposite thumb. The results were compiled into the Japanese Society for Surgery of the Hand (JSSH) score, Cheng score and Tada score. Patients’ activity involving hands were assessed by both objective tools and patient-reported outcome measure while their health-related quality of life (HRQoL) was assessed by Patient- and Parent-reported Pediatric Quality of Life Inventory (PedsQL). Correlations between outcomes were analysed. Results: Overall, both parents and patients themselves reported good quality of life with mean score of 86.6% and 92.1% respectively in PedsQL. The combined surgical scores ranged from 52% good or excellent results using JSSH score to 100% good result using Cheng score. None of the outcomes on bodily structure and function showed positive correlation with patient’s well-being. Negative correlation was noted in total passive range of movement, active movement and Cheng score. All patients reported no activity restriction. Writing test did not show significant slowing. The operated hands had significantly poorer fine motor dexterity than normal. No significant correlation is noted between activity outcomes and PedsQL. Conclusions: Outcomes on bodily structure, function and activity showed little correlation with patients’ well-being after thumb polydactyly correction. It should be careful in using or analysing patient/parent-reported outcome measures on HRQoL as outcome assessment of surgical treatment of radial polydactyly.

Objective: Dissolution velocity of monosodium urate (MSU) crystal during urate-lowering therapy (ULT) had been inadequately studied. By using dual-energy computed tomography (DECT), which allows accurate assessment of MSU load, we analyze relationship between serum urate (SU) and volumetric reduction rate of MSU and develop a model that predicts dissolution time. Methods: Baseline and follow-up DECTs were performed under a standard ULT protocol. Monthly dissolution rates were calculated by simple and compound methods. Correlations with average SU were compared and analyzed. Best-fit regression model was identified. MSU dissolution times were plotted against SU at different endpoints. Results: In 29 tophaceous gout patients, MSU volume reduced from baseline 10.94 ± 10.59 cm 3 to 2.87 ± 5.27 cm 3 on follow-up (p ¼ .00). Dissolution rate had a stronger correlation with SU if calculated by compound method (Pearson's correlation coefficient r¼ À0.77, p ¼ .00) and was independent of baseline MSU load. The ensuing dissolution model was logarithmic and explained real-life scenarios. When SU > 0.43 mmol/l, dissolution time approached infinity. It improved to 10-19 months at SU ¼ 0.24 mmol/l. When SU approximated zero (as with pegloticase), dissolution flattened and still took 4-8 months. Conclusion: MSU dissolution is better described as a logarithmic function of SU, which explains, predicts, and facilitates understanding of the dissolution process.

Background: Multiple Hereditary Exostoses with distal ulnar exostosis often results in forearm deformity and functional restrictions. Literature reported variable outcomes and frequent complications with an aggressive approach of ulna lengthening. The role of distal ulnar exostosis excision remained uncertain with contradictory effect in restoring growth. Our study aimed to report our outcome of simple excision and compare with the reported results in literature. Method: Retrospective review was carried out in patients with distal ulnar exostoses excision who were operated from 2003 to 2011. Patients with less than 3 years of follow-up, radial head dislocation or subluxation, or within 3 years of skeletal maturity were excluded. Clinical outcome including range of forearm rotation was documented. Radiological outcomes including radial articular angle, carpal slip, ulnar variance and radial bowing were measured. The results were analysed statistically and compared with literature. Results: Five cases were included in our study. All had excision of exostosis, and one case had additional ulnar lengthening. Mean age of operation was 10.4 years. Mean follow-up time was 72 months. Improvement was shown in the range of pronation, radial articular angle, carpal slip and ulnar variance, in the cases with simple excision alone. Improvements were mostly achieved at the first postoperative year. However, for the case with concomitant lengthening, ulna shortened relatively with growth, and complications were reported. This phenomenon is in keeping with the literature finding. Conclusion: Simple excision of distal ulnar exostosis improves forearm rotation and provides some restoration of growth in skeletally immature patients with Masada type I deformity.