Journal of Hand Surgery - June 2022 - S367

Abstract
S367
A-1701 TOxin for Treating Raynaud's Conditions in
Hands (The TORCH Study)
Ellen Geary1,2, Peter Doran2, Kealan Blake1,
Sinead Holden2, Patrick Murray2,3, Helen Campion2 and
Roisin Dolan1
1Department of Plastic & Reconstructive Surgery,
St Vincent's University Hospital, Co Dublin, Ireland
2UCD Clinical Research Centre, University College Dublin,
Ireland
3Department of Pharmacology, University College Dublin,
Ireland
Introduction: Raynaud's condition of the hands is a
complex disorder resulting in inappropriate constriction
or insufficient dilation in microcirculation which
can have a debilitating impact on a patient's quality of
life. Raynaud's disease unresponsive to medical
therapy is a significant problem for patients but a
potential breakthrough in treatment could be found
in botulinum toxin type-A. Aims We aim to assess the
efficacy of botulinum toxin type A to treat patients
living with Raynaud's conditions. Secondarily we
aim for this data to provide guidance for clinicians
using botulinum toxin type A in the treatment of
Raynaud's condition of the hands. Methodology:
Study Design and Setting This is a multicentre trial
and so patients with symptomatic Raynaud's condition
resistant after one treatment be selected from
Rheumatological Sclerosis Clinics. Participants will
be enrolled after ethical approval in September 2021.
Interventions Participants will receive botulinum
toxin type A in one randomly selected hand and sterile
saline in the opposite hand. Injections will be performed
by two hand surgeons using a 3mL syringe
and a 30-gauge needle through the dorsal surface
into the intercostal webspaces between each metacarpal.
Hands in the experimental group will receive
50 units of botulinum toxin type A in total, reconstituted
in 2mL of sterile saline. Hands in the control
group will receive 2mL of sterile saline in total as a
placebo. Data collection In-person follow up will be
conducted at week 6 and week 12 post-injection.
In-person visits will include non-invasive laser
Doppler Imagining, digital pulse pressure and thermal
camera imaging. Patient-reported outcomes will
be collated for each hand, using instrumental validated
in other upper extremity and hand conditions
(The disability of the arms, shoulders and
hands (DASH) score, visual analogue scale (VAS),
Raynaud's Condition Score). Clinical characteristics
related to the patient's Raynaud's disease severity
will be tabulated from a prospective database maintained
by the SVUH Plastic & Reconstructive Surgery
team, this will include history of oedema, colour
change, pain and frequency of vasospasm.
Results: So Far TORCH Pilot Study A pilot study was
undertaken at SVUH to assess the efficacy of botulinum
toxin type- A treatment before proposing a
clinical trial. This pilot study demonstrated that
according to patient reports there was a 70% reduction
in vasospastic attacks. Patients also reported
significant improvements in daily function due to a
reduction in oedema, an increased range of motion
and significant healing of digital ulcers. The average
VAS pain score pre-treatment score was 7, the average
score 2 weeks post-injection was 5 and at
6 weeks. Suspected Outcomes We suspect that the
use of botulinum toxin type-A will improve the quality
of life for participants living with Raynaud's condition.
We aim to achieve this by reducing the symptoms
of Raynaud's disease such as healing of digital
ulcers and reduction in digital oedema, thereby
increasing function in the hand.
Conclusion: In conclusion, this study aims to demonstrate
the potential benefits of botulinum toxin type A
as a treatment for Raynaud's condition of the hands.
Pilot patient testimonial: " You gave me hope, and my
life back. "
A-1702 Single surgery technique to treat lesser arc
perilunate injuries
Alexander Bolt and Nicholas Riley
Nuffield Orthopaedic Centre, Oxford, UK
Background: Perilunate injuries are a challenging
entity with a multi-centre study showing that even
when treated within a week 56% develop posttraumatic
arthritis and 71% have unsatisfactory
radiographs at long term follow up. Traditionally,
the carpal dislocation element of these injuries is
managed with open reduction and temporary stabilisation
with k-wires. This necessitates prolonged cast
immobilisation and secondary surgery for wire
removal. The use of k-wires also exposes the patient
to the risk of pin site infection which can have
catastrophic consequences. We describe a new technique
to stabilise acute traumatic lesser arc
perilunate injuries. This technique avoids the complications
of temporary k-wire stabilisation, secondary
surgery and allows earlier range of motion in injuries
that have a notoriously poor prognosis.
Methods: In the presence of acute lesser arc perilunate
injuries we perform a technique based on the
oval ring theory of carpal stability. We use four
3.5mm Arthrex SwiveLock anchors and the internal
brace with an ECRB tendon graft to reconstruct the
scapholunate and lunotriquetral ligaments with
Journal of Hand Surgery - June 2022

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