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McEachan JE, Dahlin LB, Ng CY, Ring D, Ruettermann M. Round table discussion: the management of idiopathic cubital tunnel syndrome. J Hand Surg Eur Vol 2024:17531934241238942. [PMID: 38534139 DOI: 10.1177/17531934241238942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Idiopathic cubital tunnel syndrome is the second most common neuropathy in the upper limb. Best evidence regarding the surgical management of this condition has evolved from anterior or submuscular transposition as the former reference standard, to in situ simple release. Differences of opinion remain regarding the timing of surgery, type of surgery and adjunctive surgery. Four surgeons with Level 5 expertise were asked to answer specific questions regarding this condition.
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Affiliation(s)
- Jane E McEachan
- Fife Hand Clinic, Department of Orthopaedic Surgery, NHS Fife, UK
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Chye Yew Ng
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - David Ring
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Mike Ruettermann
- Department of Plastic Surgery, University of Groningen, Groningen, The Netherlands
- Institute for Hand and Plastic Surgery, Oldenburg, Germany
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Ruettermann M, Khoo SS. Re: Khoo SS, Guruseelan N, Gunasagaran J, Shamsul SA, Razak I, Ahmad TS. Reliability of WhatsApp images of plain radiographs to diagnose fractures of the hand and wrist. J Hand Surg Eur. 2023, 48: 419-25. J Hand Surg Eur Vol 2023; 48:1245-1246. [PMID: 37417002 DOI: 10.1177/17531934231186334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
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Ruettermann M. Nerve compression syndromes: what more can we learn? J Hand Surg Eur Vol 2023; 48:973-975. [PMID: 37934055 DOI: 10.1177/17531934231202410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University of Groningen, Groningen, The Netherlands
- Institute for Hand and Plastic Surgery, Oldenburg, Germany
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Ruettermann M, Broekstra DC, Groen GJ, Elting JW. Ultra-high-definition (22 MHz) ultrasound of the ulnar nerve: additional value and normative data. J Hand Surg Eur Vol 2023; 48:1036-1041. [PMID: 37125764 DOI: 10.1177/17531934231167751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We studied 30 healthy volunteers (60 arms), categorized into three age groups with equal numbers to verify if a 22 MHz compared with a 15 MHz ultrasound transducer has additional value for studying the intraneural architecture of the ulnar nerve throughout its course. At six sites, there were no differences in cross-sectional area measurements between the two transducers. With both, the cross-sectional area was significantly larger at the medial epicondyle compared with the other sites and smaller at the mid-forearm and Guyon's canal compared with the mid-upper arm. With higher age the cross-sectional area significantly increased. Significantly more fascicles were visible distal to the medial epicondyle compared with more proximal sites, as well as in men compared with women. Finally, higher body weight was related to a significantly smaller number of fascicles being seen. A 22 MHz transducer depicts more details of the intraneural architecture than a 15 MHz transducer. Our data can be used as normative data or reference values in analysing ulnar nerve pathology.Level of evidence: II.
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Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
- Institute for Hand and Plastic Surgery Oldenburg, Oldenburg, Germany
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Gerbrand J Groen
- Paincentre Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Jan Willem Elting
- Clinical Neurophysiology, Department of Neurology, University Medical Centre Groningen, University of Groningen, The Netherlands
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Hooper G, Ruettermann M. Reporting numerical values for sensory testing. J Hand Surg Eur Vol 2022; 47:1178-1180. [PMID: 36324237 PMCID: PMC9727111 DOI: 10.1177/17531934221132666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mike Ruettermann
- Editor, Journal of Hand Surgery (European Volume),University Medical Center Groningen – UMCG, Groningen, The Netherlands,HPC – Oldenburg, Institute for Hand- and Plastic Surgery, Oldenburg, Germany
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Ruettermann M. In Reply. Dtsch Arztebl Int 2022; 119:304-305. [PMID: 35912535 PMCID: PMC9450502 DOI: 10.3238/arztebl.m2022.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Mike Ruettermann
- *Department of Plastic Surgery University of Groningen University Medical Center Groningen The Netherlands
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Millrose M, Gesslein M, Ittermann T, Kim S, Vonderlind HC, Ruettermann M. Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review. EFORT Open Rev 2022; 7:49-58. [PMID: 35076414 PMCID: PMC8788152 DOI: 10.1530/eor-21-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results. Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies. A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring. All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.
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Affiliation(s)
- Michael Millrose
- 1Department of Trauma Surgery and Sports Medicine, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
- 2Department of Orthopaedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
| | - Markus Gesslein
- 2Department of Orthopaedics and Traumatology, Paracelsus Medical University, Nuremberg, Germany
| | - Till Ittermann
- 3Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany
| | - Simon Kim
- 4Department of Trauma and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | | | - Mike Ruettermann
- 6Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 7Institute for Hand- and Plastic Surgery, Oldenburg, Germany
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Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PMN. Dupuytren's Disease–Etiology and Treatment. Dtsch Arztebl Int 2021; 118:781-788. [PMID: 34702442 DOI: 10.3238/arztebl.m2021.0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
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E H Boeckstyns M, Hems T, Hooper G, Lam W, Ruettermann M, Bo Tang J. Publication ethics: maintaining sound academic standards. J Hand Surg Eur Vol 2021; 46:925-927. [PMID: 34622683 DOI: 10.1177/17531934211050872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Tim Hems
- Editor, The Journal of Hand Surgery (European Volume)
| | | | - Wee Lam
- Editor, The Journal of Hand Surgery (European Volume)
| | | | - Jin Bo Tang
- Editor-in-Chief, The Journal of Hand Surgery (European Volume)
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Hermann RM, Trillmann A, Becker JN, Kaltenborn A, Nitsche M, Ruettermann M. Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study. Med Sci (Basel) 2021; 9:medsci9040066. [PMID: 34842775 PMCID: PMC8628986 DOI: 10.3390/medsci9040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.
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Affiliation(s)
- Robert Michael Hermann
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 26655 Westerstede, Germany;
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 49511 Hannover, Germany;
- Correspondence:
| | - Annika Trillmann
- Department of Anaesthesia, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany;
| | - Jan-Niklas Becker
- Department of Radiotherapy and Special Oncology, Hannover Medical School, 49511 Hannover, Germany;
| | - Alexander Kaltenborn
- Department of Trauma and Orthopaedic Surgery, Section for Plastic, Reconstructive and Hand Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany; (A.K.); (M.R.)
| | - Mirko Nitsche
- Center for Radiotherapy and Radiooncology Bremen and Westerstede, 26655 Westerstede, Germany;
- Radiotherapy, Karl-Lennert-Krebscentrum, Universität Kiel, 24105 Kiel, Germany
| | - Mike Ruettermann
- Department of Trauma and Orthopaedic Surgery, Section for Plastic, Reconstructive and Hand Surgery, Federal Armed Forces Hospital Westerstede, 26655 Westerstede, Germany; (A.K.); (M.R.)
- HPC-Institute for Hand and Plastic Surgery, 26122 Oldenburg, Germany
- University Medical Center Groningen, Department of Plastic Surgery, University of Groningen, 9713 Groningen, The Netherlands
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Lam WL, Ruettermann M. Challenging surgical dogmas in hand surgery. J Hand Surg Eur Vol 2021; 46:3-4. [PMID: 33325319 DOI: 10.1177/1753193420975674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
The current evidence for treatment of primary idiopathic cubital tunnel syndrome favours an in situ release. However, anterior transposition of the ulnar nerve remains a popular procedure in recurrent cubital tunnel syndrome. For more than 20 years, I have performed an extended in situ release only, and achieved similar or better results than with nerve transposition. In performing a systematic review of the evidence for surgery for recurrent cubital tunnel syndrome, I could only include 16 out of 296 studies regarding treatment of recurrent cases of cubital tunnel syndrome. A meta-analysis was not possible, due to selection bias and disparity of outcome measurements of the studies. However, I could not find robust evidence that supports the need of an anterior transposition of the ulnar nerve in recurrent cubital tunnel syndrome over an in situ decompression. My own experience of an extended in situ release with complete neurolysis with reasonable outcomes, in combination with the lack of literature support of anterior transposition in recurrent cases, have led me to the consideration that this dogma should be revised.
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Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
- Institute for Hand- and Plastic Surgery, University of Groningen, Oldenburg, Germany
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Ruettermann M. Changing surgical treatments of thumb carpometacarpal osteoarthritis. J Hand Surg Eur Vol 2020; 45:533-535. [PMID: 32281453 PMCID: PMC7787559 DOI: 10.1177/1753193420915800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- HPC, Oldenburg, Institute for Hand- and Plastic Surgery, Oldenburg, Germany
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Affiliation(s)
- Mike Ruettermann
- University Medical Center Groningen, UMCG, Groningen, The Netherlands,HPC, Oldenburg Institute for Hand- and Plastic Surgery, Oldenburg, Germany,
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Abstract
A total of seven patients (six men and one woman) with a defect in the Achilles tendon and overlying soft tissue underwent reconstruction using either a composite radial forearm flap (n = 3) or an anterolateral thigh flap (n = 4). The Achilles tendons were reconstructed using chimeric palmaris longus (n = 2) or tensor fascia lata (n = 2) flaps or transfer of the flexor hallucis longus tendon (n = 3). Surgical parameters such as the rate of complications and the time between the initial repair and flap surgery were analysed. Function was measured objectively by recording the circumference of the calf, the isometric strength of the plantar flexors and the range of movement of the ankle. The Achilles tendon Total Rupture Score (ATRS) questionnaire was used as a patient-reported outcome measure. Most patients had undergone several previous operations to the Achilles tendon prior to flap surgery. The mean time to flap surgery was 14.3 months (2.1 to 40.7). At a mean follow-up of 32.3 months (12.1 to 59.6) the circumference of the calf on the operated lower limb was reduced by a mean of 1.9 cm (sd 0.74) compared with the contralateral limb (p = 0.042). The mean strength of the plantar flexors on the operated lower limb was reduced to 88.9% of that of the contralateral limb (p = 0.043). There was no significant difference in the range of movement between the two sides (p = 0.317). The mean ATRS score was 72 points (sd 20.0). One patient who had an initial successful reconstruction developed a skin defect of the composite flap 12 months after free flap surgery and this resulted in recurrent infections, culminating in transtibial amputation 44 months after reconstruction. These otherwise indicate that reconstruction of the Achilles tendon combined with flap cover results in a successful and functional reconstruction. Cite this article: Bone Joint J 2015;97-B:215–20.
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Affiliation(s)
- J. Soons
- Medical Spectrum Twente, Enschede, The Netherlands
| | | | | | | | - P. K. Bos
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - O. T. Zöphel
- Medical Spectrum Twente, Enschede, The Netherlands
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Bolster MAJ, Zöphel OT, van den Heuvel ER, Ruettermann M. Cubital tunnel syndrome: a comparison of an endoscopic technique with a minimal invasive open technique. J Hand Surg Eur Vol 2014; 39:621-5. [PMID: 23877730 DOI: 10.1177/1753193413498547] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Both open and endoscopic methods for ulnar nerve decompression have been described. The purpose of this study is to compare the 6-month results of a minimal invasive open technique with an endoscopic technique. We treated 60 patients with unilateral ulnar neuropathy at the elbow, employing both techniques. Six months postoperative we found no differences in treatment effect on pain and disability scores between both groups, but both techniques resulted in an early postoperative relief of symptoms and good patient satisfaction.
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Affiliation(s)
- M A J Bolster
- Department of Plastic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - O T Zöphel
- Department of Plastic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M Ruettermann
- Department of Plastic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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Bolster M, Schipper C, Van Sterkenburg S, Ruettermann M, Reijnen M. Single interrupted sutures compared with Donati sutures after open carpal tunnel release: A prospective randomised trial. J Plast Surg Hand Surg 2013; 47:289-91. [DOI: 10.3109/2000656x.2012.762006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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