Journal of Hand Surgery - June 2022 - S255

Abstract
S255
A-1344 Acellularized Nerve Allografts and Conduits
for Peripheral Nerves in Sensory, Mixed and Motor
Nervereconstruction: Outcomes from a single
center after implementing these procedures
Kiran Anderson and Rasmus Wejnold Rasmussen
Handsurgery Clinic, Gentofte University Hospital,
Copenhagen, Denmark
Objective: After implementing the use of processed
nerve allografts and conduits (AvanceVR
Nerve Graft,
AxoGen, Inc.) for nerve reconstruction in 2017 and
onward we wanted to evaluate the outcome.
Methods: We have thus far had 51 individual nerve
injuries with this type of nerve reconstruction.
Sufficient data was available for 42 injuries (32 sensory,
9 mixed, and 1 motor nerves). The mean age
was 4416 (12-72). Data collected at follow up
included visual analog scale (VAS) pain scores at
rest and at function, static two point discrimination
(S2-PD) and defined as meaningful with values
<15mm, Semmes Weinstein Monofilament
Examination (SMWE), grading of cold intolerance
and hyperaestesia from 0-3 of perceived problems
from pain or discomfort of normal touch when
using the hand (0¼hinders function, 1¼disturbing,
2¼moderate, 3¼none/minor problems), grip
strength, pinch strength and The Disabilities of the
Arm, Shoulder and Hand score (Quick-DASH), all
though not all the mentioned data were collected
for every patient.
Results: The mean time of the last follow up was 250
days147 (84-550). the mean VAS scores were
1,292,6 (0-8) at rest and 2,753,4 (0-10) at function.
S2-PD with 14/22 (66,7%) patients having meaningful
S2-PD. SWME with 65,2% with protective sensation.
Grip strength of injured hand with a mean of
22,6 KgF11 (2-48) and pinch strength with a mean
of 5 KgF2,2 (0-8). Cold intolerance showing 0%
with grade 0 and 69,6% with grade 3, and hyperaestesia
with 4,5% with grade 0 and 63,6% with grade
3 function. Q-DASH with a median of 1822,2 (0-73).
No difference in functional outcome was found
between allografts and conduits. Two patients developed
neuromas in connection with the allograft. One
has had revision surgery with a new allograft and one
with removing the allograft and burrying the proximal
nerve end in adjacent muscle. Two other
patients have not had satisfying functional outcomes
and have had tendon transfers to restore function
(one motor and one mixed nerve).
Conclusion: Thus far the results are good but not as
good as other studies alike. This study is ongoing and
continuation will allow for the enrollment of additional
subjects and longer term follow up.
A-1345 Plate choice in " very distal " radius
fractures. Our current approach
M Bertolini, E Mijno, M Cicirello, M Ferrero, G Pontiglio
and B Battiston
Hand Surgery and Microsurgery Department C.T.O., Citta`
della Salute e della Scienza, Turin, Italy
Objective: Marginal articular fractures of the distal
radius are defined by the presence of a fragment of
the intermediate column less than or equal to
15mm in size. This kind of fracture require a fragment-specific
fixation. For this, several types of
low-profile, fragment-specific plates have been
developed. In our Hand Surgery and microsurgery
Department in Turin, starting from 2010, we thought
if it was possible to choose what type of plate was
more suitable for each specific kind of very distal
fracture. We have therefore established a cut-off
for the use of the different plates. For fractures
with a distal fragment between 15 and 8mm we
used " standard " plates (Synthes Variable Angle
LCP 2.4); with fragments smaller than 8mm we
used Medartis FPL plates; with fragments smaller
than 5mm we used Medartis plates with hooks or
hooks alone. The aim of the study was to evaluate
the limit of synthesis with conventional plates with
variable angular stability in marginal fractures.
Methods: From December 2010 to January 2018, 325
articular fractures of the distal radius were studied
with CT to measure the size of the central column
fragment. 152 fractures were classified as " very distal "
articular fractures and treated with volar plate.
Following our cut-off to decide which plate to use, we
treated 87 fractures with Synthes VA Hand plate,
40 fractures with Medartis FPL plate, 7 with
Medartis hooks/hook plate, others treated with
mixed fixation or external fixation. The functional
results were evaluated using the PRWE score and
the Mayo wrist score, with a mean follow-up of
18 months. Reassessment of patients during the
COVID-19 pandemic was possible with the help of
telemedicine (sending clinical images and video
with a smartphone).
Results: We had no late infectious complications
occurred. There was 1 case of delayed consolidation;
1 case subsequently required a RSL arthrodesis; in 3
patients we had to remove the plate after fracture
healing; 32 patients were lost to follow-up. The
mean Mayo score of patients treated with Synthes
VA plates was 78.2 and PRWE 10, of those treated
with Medartis FLP plates was 81.8 and PRWE 5.34
and of those treated with plate with hooks or only
with hooks was 75 and PRWE 16.3.
Journal of Hand Surgery - June 2022

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