X-ref For other Roundups in this issue that cross-reference with Wrist & Hand see: Children’s orthopaedics Roundup 4.
Who is satisfied after fasciectomy?
As surgeons, we have a moral obligation to consider custodianship of scarce healthcare resources; treatment for cosmetic reasons alone may well not be justified. However, the flip side to that coin is that we also have to be aware that patient satisfaction is becoming recognised as an important an outcome as more objective doctor-orientated measures such as range of movement. Dupuytren’s contracture is one of those diseases in which decision making is increasingly difficult with patient expectations rather high and the evidence sometimes somewhat equivocal as to who will benefit, and who won’t, from fasciectomy. A study team in Rotterdam and Hilversum (The Netherlands)1 set out to establish what the predictors are of patient satisfaction following fasciectomy. They undertook an analysis of 194 patients, all of whom completed the Michigan Hand Outcomes Questionnaire (MHQ), and collated a range of demographic and disease-specific factors. They performed a multivariate analysis, and the factors predictive of the satisfaction outcome question on the MHQ were the post-operative residual contracture, complications, a better pre-operative functional score and male gender. The bottom line appears to be that if you want your Dupuytren’s patients to be satisfied then the key is contracture correction and absence of complications; appearance was the strongest predictor of patient satisfaction. Patients really do care about cosmesis and so should we if we want satisfied patients.
Arthroscopic resection of occult dorsal wrist ganglia
We should always try to treat conditions in simpler and safer ways, with quicker post-operative recovery. Whilst larger ganglia are often asymptomatic, smaller “occult” ganglia can be very painful, especially when present on the dorsal aspect. The ganglia can be ‘nipped’ between the capitate and dorsal rim of the radius on hyperextension, leading to symptoms. The difficulty with …