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Background and purpose Soong classification is used to estimate volar locking plate prominence and evaluate the risk for flexor tendon ruptures after surgical treatment of distal radius fractures (DRFs). However, the scientific community has questioned the Soong classification due to lacking evidence. Therefore, this study aimed to evaluate the accuracy of Soong grading as a predictor for flexor tendon issues and plate removal. Patients and methods We performed a retrospective single-center review of adult distal radius fracture patients treated with a volar locking plate between 2009 and 2019. In total, 2779 patients were included in the study. The primary outcome was a flexor tendon issue (flexor tendon rupture, tendinitis, or flexor irritation), whereas plate removal was a secondary outcome. Using Soong grade 0 as a reference, we used univariable and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for flexor tendon issues and plate removal. Results In total, 756 (27%) patients were graded as Soong 0, 1679 (60%) Soong 1, and 344 (12%) Soong 2, respectively. There were 32 (1.2%) patients with flexor tendon issues, of which 4 were flexor tendon ruptures, 8 tendinitises, and 20 flexor irritations. The adjusted OR for flexor tendon issues was 4.4 (CI 1.1–39.7) for Soong grade 1 and 9.7 (CI 2.2–91.1) for Soong grade 2. The plate was removed from 167 (6.0%) patients. Soong grade 1 had a univariable OR of 1.8 (CI 1.2–2.8) for plate removal, and Soong grade 2 had an OR of 3.5. (CI 2.1–5.8), respectively. Conclusion Flexor tendon ruptures are rare complications after the volar plating of DRFs. A higher Soong grade is a risk factor for flexor tendon issues and plate removal. Trial registration The trial was retrospectively registered.

Background Trigger finger is a common hand disorder that limits finger range of motion and causes pain and snapping of the affected finger. Trigger finger is caused by an imbalance of the tendon sheath and the flexor tendon. The initial treatment is generally a local corticosteroid injection around the first annular (A1) pulley. However, it is not unusual that surgical release of the A1 pulley is required. Moreover, adverse events after local corticosteroid injection or operative treatment may occur. Platelet-rich plasma (PRP) has been shown to be safe and to reduce symptoms in different tendon pathologies, such as DeQuervain’s disease. However, the effects of PRP on trigger finger have not been studied. The aim of this single-center triple-blind randomized controlled trial is to study whether PRP is non-inferior to corticosteroid injection in treating trigger finger. The secondary outcome is to assess the safety and efficacy of PRP in comparison to placebo. Methods The trial is designed as a randomized, controlled, patient-, investigator-, and outcome assessor-blinded, single-center, three-armed 1:1:1 non-inferiority trial. The patients with clinical symptoms of trigger finger will be randomly assigned to treatment with PRP, corticosteroid, or normal saline injection. The primary outcome is Patient-Rated Wrist Evaluation and symptom resolution. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand; pain; grip strength; finger active range of motion; and complications. Appropriate statistical methods will be applied. Discussion We present a novel RCT study design on the use of PRP for the treatment of trigger finger compared to corticosteroid and normal saline injection. The results of the trial will indicate if PRP is appropriate for the treatment of trigger finger. Trial registration ClinicalTrials.gov NCT04167098 . Registered on November 18, 2019.

Background/Aim Enchondroma is the most common primary bone tumour of the hand. When surgery is indicated, curettage with or without void augmentation has been described. However, only few comparative studies exist. The aim of this study was to compare the outcomes of hand enchondromas treated with autologous bone graft (AG) and bioactive glass S53P4 (BAG). A retrospective comparative analysis was conducted among patients surgically treated for hand enchondromas at a tertiary referral centre during a 17-year period. A total of 190 patients (116 AG vs. 74 BAG) with 205 enchondromas were included. No statistically significant differences in outcome measures were observed. A reoperation was performed in five patients in the autologous bone-graft group; one patient presented a rare malignant transformation from enchondroma to chondrosarcoma after the primary operation. No reoperations were performed in the BAG group. Although AG is the gold standard for filling bony cavities, bone-graft retrieval can cause complications and postoperative pain. Our results suggest that S53P4 BAG is a safe and effective bone-graft material alternative for filling of enchondroma-evacuated cavities.

Osteoarthritis (OA) at the trapeziometacarpal joint (TMC) is common. However, no published data on the TMC-OA surgery incidence exist. The aim of this study was to evaluate the incidence and trends of TMC-OA surgical treatment. A nationwide hospital discharge register-based study was conducted among patients surgically treated for TMC-OA in Finland between 1997 and 2019. A total of 8,728 surgeries were performed. The annual surgery incidence increased 10-fold from 1997 to 2019. The incidence was higher in women and increased the most in the age groups of 50-59 and 60-69 years. TMC resection arthroplasty with or without ligament reconstruction and/or tendon interposition accounted for 91% of all surgeries. The increase in the surgical procedure rates is substantial. It is not explained by advancements in surgical treatment or by the ageing population. The indications for surgery appear to have become broader.

Urethral defects are normally reconstructed using a patient's own genital tissue; however, in severe cases, additional grafts are needed. We studied the suitability of poly( l -lactide-co-ɛ-caprolactone) (PLCL) and poly(trimethylene carbonate) (PTMC) membranes for urethral reconstruction in vivo . Further, the compatibility of the materials was evaluated in vitro with human urothelial cells (hUCs). The attachment and viability of hUCs and the expression of different urothelial cell markers (cytokeratin 7, 8, 19, and uroplakin Ia, Ib, and III) were studied after in vitro cell culture on PLCL and PTMC. For the in vivo study, 32 rabbits were divided into the PLCL ( n  = 15), PTMC ( n  = 15), and control or sham surgery ( n  = 2) groups. An oval urethral defect 1 × 2 cm in size was surgically excised and replaced with a PLCL or a PTMC membrane or urethral mucosa in sham surgery group. The rabbits were followed for 2, 4, and 16 weeks. After the follow-up, urethrography was performed to check the patency of the urethra. The defect area was excised for histological examination, where the epithelial integrity and structure, inflammation, and fibrosis were observed. There was no notable difference on hUCs attachment on PLCL and PTMC membranes after 1 day of cell seeding, further, the majority of hUCs were viable and maintained their urothelial phenotype on both biomaterials. Postoperatively, animals recovered well, and no severe strictures were discovered by urethrography. In histological examination, the urothelial integrity and structure developed toward a normal urothelium with only mild signs of fibrosis or inflammation. According to these results, PLCL and PTMC are both suitable for reconstructing urethral defects. There were no explicit differences between the PLCL and PTMC membranes. However, PTMC membranes were more flexible, easier to suture and shape, and developed significant epithelial integrity.

Background: We have experimental data indicating that the pancreas is easily damaged by any intervention. The present study compared the effects of suture diameter, number of needle passes and suture tightness on rat pancreas. Methods: Under anesthesia, rat pancreas was sutured either with one loose stitch of 6-0 polydioxanone (PDS II) or 3-0 PDS II, with 5 passes of loose running 6-0 PDS II, or with 6-0 PDS II loop tightened to 0.6 or 1.2 N. Amylase activity and pancreatic tissue histology at the suturing site and farther away, were evaluated 1, 3, 7 and 21 days postoperatively. Results: Each suturing exposure and the sham-operation induced temporary amylase activity elevation on day 1 when compared with the baseline. In histology, 3-0 suture, 5 needle passes and 1.2-newton loop induced more damage than 6-0 suture, single needle pass and 0.6-newton loop, respectively. Similar but milder changes were observed in samples from the remote site. Conclusions: The pancreas reacts to suturing with widespread injury response resembling that of acute pancreatitis. In attempting to reduce suturing-induced widespread injury, as few and thin sutures and as loose suture tightness as possible should be used. Although these findings may seem obvious, they have not previously been proven in terms of histology.