Journal of Hand Surgery - June 2022 - S259

Abstract
S259
The Original Arc displayed the highest reproducibility
in four observers, reaching substantial agreement in
three. The Line method consistently performed the
worst compared to the other methods. The PA and
Line were reported to be the easiest to perform by
the observers, with the more senior consultants preferring
the Lateral View.
Conclusions: The Original Arc showed the highest
levels of reliability and reproducibility in this study,
although the reliability is still low at 0.41. The novel
measurement method does not justify the additional
complexity or time taken given it has less agreement
than the Original Arc. Further adaptations and
improvements need to be made to improve the reliability
and reproducibility of these measurements for
clinical practice, including a comparison of the
displacement measured compared to the true
displacement.
A-1370 Methods of Assessing Intra-Articular
Displacement in Distal Radius Fractures
George Philip Esworthy1, Nick A Johnson2,3, Pip Divall4
and Joseph J Dias2
1University of Leicester, Leicester, UK
2Academic Team of Musculoskeletal Surgery, University
Hospitals of Leicester NHS Trust, Leicester, UK
3Pulvertaft Hand Centre, Derby, UK
4Education Centre Library, Glenfield Hospital, University
Hospitals of Leicester NHS Trust, Leicester, UK
Objective: Summarise measurement methods currently
used within clinical practice, their development
and evaluate their performance particularly
for reliability and reproducibility. Assess the imaging
modalities currently utilised and their effectiveness.
Methods: A systematic review was performed to
identify different methods of intra-articular fracture
measurement. All relevant citations and a conference
presentation known to the research group
were reviewed.
Results: Four methods currently exist within clinical
practice, all on radiograph. The first described by
Kreder et al. in 1996 uses the long axis of the
radius as a reference point on a PA view. Cole
et al. developed this further in 1997, naming it the
Longitudinal Method using the fracture site and the
long axis as reference points on the PA and lateral
views. They also introduced the Arc Method on the
lateral view. This was updated in 2018 by Johnson
et al. who proposed a Modified Arc Method on the
lateral view, which is currently untested. The
Longitudinal and Arc methods were shown to have
near perfect correlation when using the same predefined
points, with the Longitudinal showing high
levels of reproducibility and varying levels of reliability
when used with modern equipment. CT has been
shown to be more detailed than radiograph, showing
greater displacement and often changing treatment
plans but should be reserved for complicated cases.
Especially given the widespread availability, low cost
and radiation of radiographs in comparison to CT.
Conclusions: The Longitudinal and Arc methods have
remained unchanged since 1997 with only the
untested Modified Arc proposed since. Of these the
Longitudinal is the most accepted and tested method
currently used in clinical practice. There is a lack of
evidence comparing measurement methods and
using modern techniques. Further research is
required to establish which method is most appropriate
for clinical practice.
A-1371 MSAP flap as gliding nerve tissue transfer:
anatomical study and clinical application
Pierfrancesco Pugliese1,2, Francesco De Francesco2,
Andrea Campodonico2, Pier Paolo Pangrazi2,
Andrea Antonini3 and Michele Riccio2
1Plastic and Reconstructive Surgery, Department of
Surgical, Oncological and Oral Sciences, University of
Palermo, Palermo, Italy
2Department of Reconstructive and Hand Surgery, AOU
" Ospedali Riuniti " , Ancona, Italy
3Department of Infectious Disease and Septic Orthopedics,
S. Corona Hospital, Pietra Ligure, Italy
Objective: Nerve recovery after a complex upper
limb trauma is affected by many factors and a
poorly vascularized bed is often the cause of failure
and perineural scar. Many techniques have been
devised to avoid this problem. The objective of this
study was to investigate the possibility to transfer a
nerve with its surrounding viable sliding tissue.
Methods: An anatomic study on 8 latex-injected
specimens was performed to investigate the possibility
to raise a medial sural artery perforator (MSAP)
flap including the sural nerve within its vascularized
sheath. The flap was then clinically applied in a case
of complex hand-wrist trauma raising the sural
nerve with its proximal tibial and peroneal components
to restore metacarpal nerves on the ulnare
side of the hand.
Results: Specimens analysis showed visible direct
nerve vascularization was in 57% of legs (8 out of
14). In 43% a vascular network was visible in the
fascia layer. No vascular anomalies were found.
Patient's 12 months follow up showed an improving
nerve function both clinically and electromyographically
without any problem due to nerve adherence.
Journal of Hand Surgery - June 2022

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