Sunday, April 27, 2014

Recent Publications, April 2014

I have been asked to regularly add to my blog recent publications which are important for children with congenital hand anomalies.  Here are 3 publications from the last few months.  These 3 publications are all in in the Journal of Hand Surgery.

Transverse Bone in Cleft Hand  This manuscript details our findings in comparing two groups of patients with cleft hand- those with or without a sideways bone (transverse bone).

Holt Oram Syndrome  This manuscript is a short review on a common syndrome which may affect children with Radial Longitudinal Deficiency (RLD).

Soft Tissue Distraction Before Centralization in RLD  This final manuscript discusses our findings in treating patients with RLD with centralization.  Specifically, we compared two groups of patients- those treated with and without a fixator prior to centralization.

A great scientific article has a couple of key components.  First, it includes a large number of patients. Second, there is a long follow- up time.  Specifically, this means  more than 5 or more than 10 years between surgery (or first visit) and last visit.  And finally, patients are ideally thoroughly assessed before treatment to allow a great comparison to after treatment.  There are many other components to consider but these 3 are key and are a particular challenge in the field of congenital hand surgery.

Publications on patients born with hand anomalies has always been a challenge.  First, even in busy centers like ours, the # of patients seen is limited.  Second, accurate record keeping and good data collection takes time and requires the cooperation of patients, families, and therapists.  It requires regular follow- up visits and good communication.  And third, kids change as they grow and comparing function before and after a surgery is difficult given the fact that kids grow and mature naturally (meaning with or without surgery).   A larger hand and a more mature child will naturally function better than a younger child- the challenge is to figure out what role surgery plays in the improvement over time.

The three papers above all add to our understanding of challenging problems.  The most straightforward is on Holt Oram Syndrome.  This is a review of the important features of this problem. The other two look at relatively large numbers of kids with 2 rare problems (cleft hand and RLD). Both papers use 2 groups of patients to allow comparisons of different features and different treatments.


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