Cold hypersensitivity after hand injuries. A prospective 7-year follow-up

Abstract

We studied changes in cold hypersensitivity from 3 to 7 years following severe hand injuries. Data was collected using postal questionnaires 7 years after injury in 71 patients who had participated in a 3-year follow-up from the time of injury. There was no change in cold sensitivity measured using the McCabe Cold Sensitivity Severity scale (CSS) from 3 to 7 years after injury. However, there was a trend toward decreased severity measured using a five-level scale of self-reported cold hypersensitivity. Compared to the 3-year follow-up, fewer respondents rated their condition as severe and two patients had recovered from their cold hypersensitivity at the 7-year follow-up. Furthermore, 21 (30%) of the respondents stated a decrease in cold hypersensitivity during the last 2 years. Limitations in cold associated activities and the importance of being less limited in leisure activities (NRS 0-10) did not change between the two follow-ups. In conclusion, the CSS-scores did not change from 3 to 7 years after injury. Several patients experienced improvements in cold hypersensitivity, but few recovered completely from the condition.     

Multisystem disorder and limb girdle muscular dystrophy caused by LMNA p.R28W mutation

Primary laminopathies caused by mutations in the LMNA gene typically display an extremely pleiotropic clinical presentation including cardiac, muscular and metabolic phenotypes. Additionally, many atypical laminopathies have been described combining features of two or more of the distinctive disorders or syndromes associated with LMNA mutations. We report on a 46-year-old female patient with a heterozygous p.R28W LMNA mutation, who presented with a novel clinical phenotype comprising severe limb-girdle muscular dystrophy, pronounced partial lipodystrophy, cardiac conduction defect, polycystic ovary disease and a metabolic syndrome with insulin-resistant diabetes mellitus and hypertriglyceridemia. On examination, her 23-year old daughter solely showed early signs of a LGMD phenotype.     

“S”形截骨术用于肢体延长的疗效及并发症观察

目的：观察“S”形截骨术在肢体延长中的应用疗效及常见并发症。方法选择我院2011年1月至2014年12月收治的行肢体延长术患者79例作为研究对象,按随机数表法分为观察组(n=40)和对照组(n=39)。观察组采取“S”形截骨术,对照组采取横行截骨术,比较两组的治疗情况（延长长度、延长幅度、牵伸时间）、术后恢复情况（外固定时间、骨愈合时间、骨愈合指数）、并发症发生情况（轴线偏移、疤痕挛缩、延迟愈合、筋膜室综合征、关节僵硬、针道感染）。结果观察组患者的肢体延长长度与延长幅度分别为(7.8±1.3) cm、(21.8±3.3)%,对照组患者分别为(8.2±1.6) cm、(22.1±4.2)%,两组比较差异均无统计学意义(P>0.05);观察组患者的牵拉时间为(111.4±20.1) d,明显短于对照组的(140.2±23.7) d,差异有统计学意义(P<0.05);观察组患者的外固定时间、骨愈合时间及骨愈合指数分别为(158.3±30.4) d、(347.5±46.1) d、(46.6±5.1) d/cm,均低于对照组(179.1±38.8) d、(379.4±43.9) d、(59.8±20.1) d/cm,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为17.5%(7/40),低于对照组的38.5%(15/39),差异有统计学意义(P<0.05)。结论应用“S”形截骨术进行肢体延长在取得满意肢体延长幅度基础上还可缩短牵拉时间、加快骨愈合速度,骨愈合指数低、术后并发症少,具有较高的临床应用价值。     

Lower limb immobilization is associated with increased corticospinal excitability

Temporary immobilization of the leg serves as a useful model for the brain’s adaptive responses to casting, long-term confinement to bed rest and possibly to trauma. As part of a larger program using TMS to investigate changes associated with bed rest, we sought to determine whether casting of the leg causes brain excitability changes measurable with TMS, and the time course of resolution of these changes. In this study, eight adults wore a full leg cast for 10 days. TMS measures of motor cortex excitability were gathered before the cast was placed, and then immediately after cast removal, and 24 and 48 h later. A control group did not wear a cast and underwent the same TMS sessions. Significant excitability changes occurred and peaked at 24 h post cast removal in the TMS experimental group but not the non-casted group.     

Perception of limb orientation in the vertical plane depends on center of mass rather than inertial eigenvectors

We performed two experiments to test the hypothesis that the perception of limb orientation depends on inertial eigenvectors (e _i ) against the alternative hypothesis that it depends on the center of mass vector (CM). Whereas e _i constrains the dynamic torques involved in angular rotation, CM constrains the static torque necessary to keep the limb aloft in the gravitational field. Hence, possible effects of e _i and CM on kinesthetic judgments must be related to the dynamic and static torques, respectively, involved in moving and positioning a limb. In the first experiment, blindfolded participants matched, with upper arms supported, the orientation of their forearms while the forearms’ e _i and CM were manipulated relative to the elbow. The manipulation of the vector CM alone induced a matching bias, as did the combined manipulation of e _i and CM, whereas the manipulation of e _i alone did not. In the second experiment, participants positioned their unseen and unsupported right arm at an indicated spatial configuration while e _i and CM of the right forearm were manipulated as in Experiment 1. As in the first experiment, forearm positioning was affected by the independent manipulation of CM and the combined manipulation of e _i and CM, but not by the independent variation of e _i . Moreover, none of the manipulations affected upper arm positioning. These results refute the claim that the perception of limb orientation (in the vertical plane) is based on e _i and demonstrate, for the first time, the implication of a limb segment’s CM in the perception of its orientation. This research was supported in part by The Netherlands Organization for Scientific Research (NWO) Grant 402-01-040.     

Comparing limb proprioception and oculomotor signals during hand-guided saccades

We previously showed that saccades tend to overshoot briefly flashed targets that were manually displaced in the dark (Ren et al. 2006). However it was not clear if the overshoot originated from a sensory error in measuring hand displacement or from a premotor error in saccade programming, because gaze and hand position started at the same central position. Here, we tested between these hypotheses by dissociating the initial eye and hand position. Five hand/target positions (center, far, near, right, left) on a frontally-placed horizontal surface were used in four paradigms: Center or Peripheral Eye-hand Association (CA or PA, both gaze and right hand started from the center or a same peripheral location) and Hand or Eye Dissociation (HD or ED, hand or gaze started from one of three non-target peripheral locations). Subjects never received any visual feedback about the final target location and the subjects’ hand displacement. In the CA paradigm, subjects showed the same overshoot that we showed previously. However, changing both initial eye and hand positions relative to the final target (PA) affected the pattern, significantly altering the directions of overshoots. Changing only the initial position of hand (HD) did not have this effect, whereas changing only initial eye position (ED) had the same effect as the PA condition (CA ≈ HD, PA ≈ ED). Furthermore, multiple regression analysis showed that the direction of the ideal saccade contributed significantly to the endpoint direction error, not the direction of the hand path. These results suggest that these errors do not primarily arise from misestimates of the hand trajectory, but rather from a process of comparing the initial eye position and the limb proprioceptive signal during saccade programming.     

No effect of preoperative ulceration on outcomes of tibiotalocalcaneal arthrodesis

BackgroundTibiotalocalcaneal (TTC) arthrodesis is a commonly performed operation for complex hindfoot pathology, but the effect of preoperative ulceration on TTC outcomes has been debated. This study aims to examine infection rates in patients undergoing TTC arthrodesis with internal fixation with and without concomitant hindfoot ulceration.MethodsWe conducted a retrospective review of 31 patients who underwent a TTC arthrodesis between June 2016 and February 2021 with a fellowship-trained foot and ankle surgeon at an academic medical center. Nine (29.0%) patients had preoperative ulceration. Mean follow-up duration was 1.49 (range, 0.51–4.28) years. Other data collected included demographics, comorbidities, surgical approach, fixation method, and complication and reoperation rates.ResultsThere was no difference in overall complication (ulcer [U]=66.7%, no ulcer [NU]=50.0%; p = .397), infection (U=33.3%, NU=31.8%; p = .935), or reoperation (U=55.6%, NU=27.3%; p = .135) rates between groups.ConclusionsTTC arthrodesis with internal fixation appears to be a reasonable treatment method for patients with a preoperative ulcer.