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The present meta-analysis demonstrated that preoperative administration of EPO in pediatric craniosynostosis surgery decreased the proportion of patients requiring ABT. In addition, the volume of transfusion was reduced in patients who received EPO. Future randomized studies are needed to establish the cost-effectiveness of routine preoperative EPO administration in craniosynostosis surgery.

Anastomosing soft tissue free flaps to the common or proper digital artery, and the volar or dorsal digital vein is a safe and effective approach with numerous advantages that should be considered in the reconstruction of soft tissue defects of the hand. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:21-25, 2018.

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Background Open dorsal metacarpophalangeal joint dislocations are rare. We report the case of a 62-year-old man who fell from a height of 10 m onto his left outstretched hand and presented to us with four open dorsal metacarpophalangeal joint dislocations. We review the literature and present our case to elucidate the best treatment protocol for open dorsal metacarpophalangeal joint dislocations. Methods A systematic review was conducted using MEDLINE, Embase, and PubMed from 1946 to present. Publications were found using key terms and crossreferencing. Detail on patient demographic, presentation, mechanism of injury, injury management, and outcome were collected. Results A total of 102 articles of metacarpophalangeal joint dislocation (excluding thumb dislocations) were identified. Of these, only four were of open dorsal metacarpophalangeal joint dislocation involving the four long fingers. Open dislocation of the metacarpophalangeal joint in these studies showed no hand predominance, nor association with hand dominance. Conclusion Open dorsal metacarpophalangeal joint dislocations of the four long fingers are unusual. Based on the available case reports and our experience, we suggest addressing this injury intraoperatively with minimal delay. Most cases will be associated with volar plate injury, and we encourage its repair with figure-of-eight stitches. Postoperatively, we suggest a dorsal blocking splint for 2 weeks followed by occupational therapy consisting of passive and active range of motion (ROM) exercises and adjunctive therapies to control edema and optimize scar tissue. Inadequate management of such injuries could be highly detrimental to hand function.

Purpose: No study in the literature compares different external distractors for PIPJ injury. We compared a device described by Suzuki et al and another by Hynes & Giddins in non-injured cadaveric fingers. Main outcome measures were articular space and PIPJ flexion resistance.Methods: Thirty-two Thiel embalmed fingers were used. The elastics based model was performed with 3 and 5 elastics per side (3E and 5E); the 2-pin model used no elastics (2P). Articular distraction of each device was measured using x-ray imaging. The force required to flex the PIP joint to 45˚ and 90˚ in each group was measured with a dynamometer.Main findings: The articular distraction was statistically significant for all groups. The difference in articular distraction was significant in the AP view between groups 3E and 2P, and 5E and 2P. Flexion forces were only significant between group 5E and 2P at 90˚ flexion, but resistance was notably higher in group 2P than in groups 3E and 5E. Group 2P was more difficult to engage and often disengaged in flexion compared to groups 3E and 5E.Conclusion: All devices achieved significant articular distraction (>99% in AP) but optimal distraction has not been clinically determined and may depend on each unique fracture, hence a variable distraction device may be optimal. The 3E and 5E models can be adjusted for distraction by adding the sufficient elastics to reduce individual fractures. The increased resistance to PIP flexion found in the 2P model may limit post-op mobilization, but clinical correlation is needed.

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