The Journal of Hand Surgery - European Volume - April 2018 - 3

BSSH Spring meeting abstracts
Proximal Replantation: Challenges and Outcomes in
Limited Resources Hospitals in Developing
Countries
Mr Hazem Alfeky, Professor Essam Taman,
Dr Ahmed Omran, Dr Mohammed Swilam and
Dr Mohammed Elshahat
Whiston Hospital
Time in programme: Thursday 3rd May 2018 09:33

Aim: Proximal hand and forearm amputations are
devastating injuries. With thehigh rate of these injuries in developing countries and their limited
resources, there are more challenges in the replantation procedures compared to the UK. these are
primarily the cost of the procedure and the postoperative rehabilitation.Besides, prediction of the
outcomeis always uncertain due to multi factorial
risk factors including the mode of injury, level of
amputation, presence of contamination and the
extent of the damage to the neuro-vascular tree,
general patient status and co-morbidities.
Patients and methods: We present our experience of
a series of 17 post traumatic proximal hand and forearm replantations over a 5-year period in 2 major
trauma centres in Egypt. All patients were operated
on in the same theatre environment, received the
same postoperative rehabilitation. Follow up ranged
between 16 to64 months (Average: 20).
Results: All the 17 cases were successful.Mean age
was36.4. Operative time in total 18.5 hours. Average
number of secondary procedures is 4.6 procedures.
2case developed wound healing problems and tendon
rupture and required extra procedures. Overall
patient satisfaction was excellent.
Conclusion: Proximal hand and forearm replantation
is awarding procedure. Effictivenessthroughout the
whole procedure can cut down the costs while keeping high standard of care. It requires well trained
MDT as well as patient willingness to achieve desired
outcomes.

Limb Hypoplasia in Obstetric Branchial Plexus
Injuries - A Longitudinal Study
Miss Taj Tomouk, Mr Henk Giele, Mr George Wheble and
Mr Simon Maciburko
Royal Free Hospital
Time in programme: Thursday 3rd May 2018 09:40

Aims: Upper limb hypoplasia in obstetric brachial
plexus injury (OBPI) is not well documented. This
study evaluates the degree of upper limb hypoplasia

S3
with extent of plexus injury and surgical intervention
as well as the inter-rater reliability of the Mallet
score classification.
Methods: A retrospective review of OBPI patient case
notes between 1998 and 2017. Data comprised
patient demographics, Narakas grade, whether primary nerve or shoulder surgery was performed, and
measurements of both upper limbs. True and apparent arm lengths were compared and mean percentage differences were calculated between the affected
and contralateral upper limbs. Two blinded observers graded patient photographs using the modified
Mallet score.
Results: A total of 62 patients were identified and
underwent 209 sets of measurements during the
study period, two thirds of whom had sequential
measurements. The majority of the cohort were
females with right sided injuries and a Narakas
grade of 1. Approximately one third had primary
nerve surgery while almost double (60.7%) underwent a shoulder procedure.
Mean percentage differences between the affected
and contralateral upper limbs across the cohort
were 9.3% for clavicular length, 7.8% apparent arm
length, 7.3% humeral length, 5.9% forearm length,
5.7% hand circumference and 7.8% scapular length.
The two raters chose the same Mallet score in
approximately three quarters of cases.
Conclusions: This study shows that OBPI leads to
quantifiable hypoplasia of the upper limb, and that
the Mallet score is a reliable tool for assessment.
To our knowledge this is the longest longitudinal
study to quantify upper limb hypoplasia secondary
to OBPI.

Evolution of Combination Therapy for Upper Limb
Spasticity Management: 1500 Limbs Report
Mr Hazem Alfeky and Mr Paul Mcarhur
Alder Hey Children Hospital
Time in programme Thursday 3rd May 2018 09:47

Aims: Upper limb spasticity is a major long-term
complication of stroke, cerebral palsy and head
injury. Historically managed by physiotherapy/earlyactive rehabilitation the introduction of focal botulinum toxin injections has assisted with the therapy
and improved outcomes. However the need to repeat
the injections and the onset of muscle fibrosis are
known considerations. Spasticity modifying surgery,
including neurectomy, Tendon transfer / lengthening
and Arthrodesis, does constitute a large part of the
armamentarium upper limb that surgeons have to



Table of Contents for the Digital Edition of The Journal of Hand Surgery - European Volume - April 2018

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The Journal of Hand Surgery - European Volume - April 2018 - Cover3
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