Surgery of the hand in patients with systemic sclerosis: outcomes and considerations.
Bibliographic record
Abstract
OBJECTIVE: To assess the current status of hand surgery in patients who have systemic sclerosis (SSc) and to elucidate special issues of surgery in this patient group. METHODS: A systematic review of English language original studies of surgical procedures of the hand in patients with SSc was performed using Medline, PreMedline, Embase, and Web of Science, from 1975 to March 15, 2004. RESULTS: Thirty-four studies were reviewed: 5 describing surgical procedures on joints, 13 on calcinosis removal, and 20 on digital sympathectomy. When the hand is affected by advanced contracture and deformity due to scleroderma, a nominal measured improvement in position and function may lead to a substantial improvement in the patient's adaptive ability to perform certain activities of daily living. A major concern is the potential for postoperative digital ischemia secondary to vascular involvement, as most of these patients exhibit blood vessel wall changes and Raynaud's phenomenon. Surgical wounds generally heal well following fusion of the proximal interphalangeal (PIP) or distal interphalangeal joint. Correction of severe flexion contractures of the PIP joint improves function and may reduce the frequency of dorsal skin ulceration. Recurrent digital tip ulceration occurs in 31.8-71.4% (median 45.2%) of scleroderma patients, reported to progress to gangrene and autoamputation in 14-29% of cases. Microsurgical revascularization of the hand, digital arterial reconstruction, and peripheral sympathectomy may improve digital vascular perfusion, heal digital ulcers, and relieve pain. Subcutaneous calcifications occur in 8.9-73.1% (median 44.1%) of SSc patients, most commonly at the fingertip, causing pain, functional impairment, and ulceration. Calcinosis can be partially removed with a high-speed burr or carbon dioxide laser. CONCLUSION: The goals of surgery for advanced SSc affecting the hand are limited and include pain relief through sympathectomy and increased perfusion, repositioning the digit, providing a functional position of fusion, and modest mobilization through resection arthroplasty.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".