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Daniel Herren

  • Finger joints are of the most common site of osteoarthritis and include the DIP, PIP and the thumb saddle joint.

  • Joint arthroplasty provides the best functional outcome for painful destroyed PIP joints, including the index finger.

  • Adequate bone stock and functional tendons are required for a successful PIP joint replacement

  • Fixed swan-neck and boutonnière deformity are better served with PIP arthrodesis rather than arthroplasty.

  • Silicone implants are the gold standard in terms of implant choice. Newer two-component joints may have potential to correct lateral deformities and improve lateral stability.

  • Different surgical approaches are used for PIP joint implant arthroplasty according to the needs and the experience of the surgeon.

  • Post-operative rehabilitation is as critical as the surgical procedure. Early protected motion is a treatment goal.

  • Revision and exchange PIP arthroplasty may successfully be used to treat chronic pain, but will not correct deformity.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180042

Dimitrios A. Flevas, Sophia Syngouna, Emmanouel Fandridis, Sotirios Tsiodras, and Andreas F. Mavrogenis

  • Infections of the hand are common entities that are frequently encountered by orthopaedic surgeons and primary care physicians.

  • A high clinical suspicion and a thorough medical history with information about the social and working history of the patients, correct identification of the type and cause of the infection, and prompt initiation of appropriate treatment by the infectious diseases physicians and orthopaedic surgeons are required.

  • Late diagnosis and inappropriate treatment may be a significant cause of morbidity for the hand and mortality for the patients. This article reviews the clinical spectrum and microbiology of the most common infections of the hand, and discusses the current concepts for their treatment. The aim is to increase the awareness of the treating physicians of the diagnosis and management of infections in the hand.

Cite this article: EFORT Open Rev 2019;4:183-193. DOI: 10.1302/2058-5241.4.180082

Rita Grazina, Sérgio Teixeira, Renato Ramos, Henrique Sousa, Andreia Ferreira, and Rui Lemos

  • Dupuytren’s disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength.

  • It is a benign disorder but can cause high morbidity by limiting daily activities.

  • Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease.

  • Treatment is not yet uniform around the world and still varies with the surgeon’s experience and preference.

  • In this review, the authors review the pathogenesis and treatment options for Dupuytren’s disease in an attempt to summarize the current state of the art.

Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.

Jonny K. Andersson

  • Injuries to the scapholunate joint are the most common cause of carpal instability.

  • An isolated injury to the scapholunate ligament may progress to abnormal joint mechanics and degenerative cartilage changes.

  • Treatment for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalising carpal kinematics.

  • Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis of the injury, as a proper ligament repair is recommended within four to six weeks after trauma.

  • In this review, anatomy, diagnosis and treatment of scapholunate ligament injury and carpal instability are discussed. Recommendations for treatment based on the stage and classification of injury and the degree of instability and arthritic changes are proposed.

Cite this article: EFORT Open Rev 2017;2:382–393. DOI: 10.1302/2058-5241.2.170016

Lars Henrik Frich and Morten Schultz Larsen

  • The glenoid fossa is involved in approximately 10% of all scapular fractures.

  • Glenoid fossa incongruity is surprisingly well tolerated.

  • Surgery is recommended when 20% or more of the anterior glenoid fossa is involved.

  • Glenoid rim fractures often lead to chronic shoulder instability.

  • Unstable glenoid neck fractures need surgical treatment and stable fractures can be treated conservatively.

  • CT examination with 3D reformations of the glenoid fossa has improved insight into fracture morphology and fracture patterns and is very helpful for clinical decision makers.

Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160082. Originally published online at

Lars B. Dahlin and Mikael Wiberg

  • A nerve injury has a profound impact on the patient’s daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems.

  • To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome.

  • Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i.e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon.

  • The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound.

  • To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques.

  • The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.

Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160071. Originally published online at

Massimo Ceruso, Sandra Pfanner, and Christian Carulli

  • Until the late 1980s, proximal interphalangeal (PIP) joint reconstruction had been almost exclusively performed by the use of monobloc silicone spacers and associated with acceptable to good clinical outcomes.

  • More recently, new materials such as metal-on-polyethylene and pyrocarbon implants were proposed, associated with good short-term and mid-term results.

  • Pyrocarbon is a biologically inert and biocompatible material with a low tendency to wear. PIP pyrolytic implants are characterised by a graphite core, visible on radiographs and covered by a radiolucent outer layer of pyrocarbon.

  • New surgical techniques and better patient selection with tailored rehabilitative protocols, associated with the knowledge arising from the long-term experience with pyrocarbon implants, has demonstrated noteworthy clinical outcomes over the years, as demonstrated by recent studies.

Cite this article: EFORT Open Rev 2017;2:21–27. DOI: 10.1302/2058-5241.2.160041

Maurizio Calcagni and Thomas Giesen

  • A severely painful, dysfunctional, or destroyed distal radio-ulnar joint (DRUJ) can be reconstructed by fusion, interposition of soft tissue, or by arthroplasty using prostheses.

  • The objective of this study was to review the literature on implants and evaluate their effectiveness in terms of pain relief, range of motion and longevity.

  • A search was carried out using protocols and well-defined criteria in PubMed, the Cochrane Library and by screening reference lists. The review was conducted according to PRISMA guidelines.

  • Of the 27 publications reporting on nine different implants, we excluded reports with less than five cases and silastic replacements of the ulna head. Eighteen publications describing a total of five implants were selected for analysis. Nine of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.

  • It seems that DRUJ implants have good potential to improve function through pain reduction; an improvement was observed in 17 series, although it was significant in only seven series.

  • Instability is not uncommon with ulna head-only implants, but they cause fewer clinical problems and re-interventions than might be expected.

  • The risk of deep infection is small with the available implants.

  • Overall implant survival in papers with at least five years’ follow-up is 95%, with a slightly better longevity of 98% for the constrained implants.

  • Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.

Cite this article: Calcagni M, Giesen T. Distal radioulnar joint arthroplasty with implants: a systematic review. EFORT Open Rev 2016;1:191-196. DOI: 10.1302/2058-5241.1.160008.

Marianne Arner

  • The Scandinavian National Healthcare Quality Registries (NQRs) have brought about considerable improvements since their introduction in the 1970s.

  • One such registry – HAKIR (‘hand surgery’) – was established in 2010 and was likely the first NQR for hand surgery.

  • Patient-reported outcome and reoperations due to post-operative complications are registered in HAKIR, as well as hand function in selected groups of surgical procedures.

  • Creating simple logistics for collecting data and careful planning are important factors when establishing a new NQR.

  • Continuous surveillance of data validity and coverage are crucial for success.

  • With perseverance, large databases for clinical research can be created, along with the establishment of national multi-professional collaboration in healthcare improvement work.

Cite this article: Arner, M. Developing a national quality registry for hand surgery: challenges and opportunities. EFORT Open Rev 2016;1:100-106. DOI: 10.1302/2058-5241.1.000045.

Patrick Houvet

  • Partial wrist fusion is a useful technique for the treatment of such specific carpal disorders as arthritis, Kienböck’s disease, midcarpal instability, scaphoid nonunion, etc.

  • Many techniques have been described by removing arthritic joint surfaces and transfering load, using, for bone fixation, K-wires, screws, staples, and more recently dedicated plates.

  • The goal of this procedure is to maximise wrist motion and strength while minimizing or eliminating pain.

  • The purpose of this article is to discuss the most commonly used combination of intercarpal arthrodeses, to clarify the indications for each fusion, to describe the appropriate surgical technique for each fusion, and to provide an overview of results and current concepts.

Cite this article: Houvet, P. Intercarpal fusions: indications, treatment options and techniques. EFORT Open Rev 2016;1:45-51. DOI: 10.1302/2058-5241.1.000019.