An Eventful Year

I am happy to be able to report about the society's activities for the last year in this inaugural issue of our newsletter. We managed to have a very successful Congress in Melbourne in March 2020, just as many countries were starting to lock down for the Covid-19 pandemic.

"Towards making the Asian Pacific Hand Surgery community even more connected, cohesive, and vibrant." Fuminori Kanaya
SECRETARY GENERAL,
APFSSH

To Improve is to Change

First of all, I would like to congratulate the executive committee on the birth of the APFSSH Newsletter.

Journal of Hand Surgery, Asian-Pacific Volume is the official journal of the APFSSH. It was first published in 1996 as a biannual issue, became a triennial issue in 2005 and has been published 4 times a year since 2017.

"I think all the studies deserve to be published as long as they are well formatted and add value to existing literature " Goo Hyun Baek
EDITOR, JHS-AP

Certain journals do not accept case reports which decrease the impact factor significantly. However, impact factor cannot be the sole metric of journal quality. Techniques using expensive instrumentation or newer medical treatment may not be available in developing countries. Studies performed in the developing countries with poor infrastructure generally have greater difficulty in getting accepted.

I think all studies including retrospective case series or case reports, irrespective of whether they were performed in the developed or developing countries, deserve to be published as long as they are well formatted and add value to the existing literature. In this way, we can move forward together

Stay Safe. Stay Inspired.

Goo Hyun Baek, Editor-in-Chief, JHS-AP

ghbaek@snu.ac.kr

Bangladesh Society for Surgery of the Hand (BDSSH)

The war for liberation of Bangladesh ended in 1971 and ushered in a phase of growth of our health care system. It was initially focused on providing basic health needs and addressing war related injuries. Specialty care in Orthopaedic Surgery and Plastic Surgery began in 1975. The nationalization of the major industries led to an era of rapid industrialization with a resultant increasing incidence of hand injuries. The treatment outcomes were poor, and complications were high, as there were no hand specialists around.

In 1988, Professor Ramdew Ram Kairy underwent training in Hand Surgery at the National University Hospital, Singapore. Upon his return, he started the practice of Hand Surgery. In 2004, Professor Kairy met Dr. Raja Sabapathy and Professor Bhaskaranand Kumar at the annual meeting of the Indian Society for Surgery of the Hand at Gangtok. He was encouraged to start a society for Hand Surgery in Bangladesh.

Historic meeting at NITOR on 18 August 2005 to form BDSSH

Attended by Prof RR Kairy, Dr. Md. Abul Kalam, Dr Sk. Abbasuddin, Dr. Monowarul Islam, Dr. OFG Kibria, Dr Shaymol C Debnath, Dr. ASM Monirul Alam, Dr. Shah MH Rahman, and Dr. Sajedur Reza Faruquee

At a historic meeting on 18 August 2005 at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, the decision to form Bangladesh Society for Surgery of the Hand (BDSSH) was made. The objectives of BDSSH were:

• To promote and direct development of Hand Surgery in Bangladesh.
• To foster and coordinate education and research in Hand Surgery.
• To have trained manpower, arrange instructional hand courses and to send young surgeons abroad for training.
• To establish an independent specialty in future.

Our membership had also increased to 63 at that point. We became the youngest member of the APFSSH at the Cebu meeting in 2017 and our members now regularly attend meetings and have presented scientific papers in Australia, Germany, India, Thailand, Singapore and the United Kingdom. Despite Covid-19 pandemic, five surgeons attended the last APFSSH meeting in Melbourne in March 2020. The Bangladesh government has recognized Hand Surgery as a separate specialty. There are now 42 positions for Hand Surgeons at Government Medical Colleges across the nation. These include residents as well as professors. The Hand Surgery clinic at NITOR, now headed by Prof Jahangir, has been serving the nation since 2006. A Hand of BDSSH were formulated and approved by 27 members with Professor Kairy as founding President, Professor Abul Kalam as founding Vice-President and Dr. A S M Monirul Alam as founding Honorary Secretary. The logo of the society was designed by Dr. Shah MH Rahman, showing two hands of a surgeon in a functional position protecting the national emblem and aiding growth.

BDSSHCON-06, NITOR, 25 Nov 2006

(L to R): Dr ASM Monirul Alam, Prof Siraj-ul-Islam, Prof Shamsuddin Ahmed, Prof RR Kairy

We started sending surgeons for specialty training abroad. Dr OFG Kibria went to Stanley Hospital (Chennai, India) in 2004 under Dr G Balakrishnan and I received my hand surgical training in 2006 at Ganga Hospital, (Coimbatore, India) under Dr Raja Sabapathy. Since then more than 25 surgeons received training at different centers overseas. The 1st national conference 'BDSSHCON-06' was held at NITOR on 25 November 2006. It was attended by 125 surgeons from Bangladesh and there were 27 podium presentations. The first AGM of BDSSH was held and the first executive committee was voted in.

'BDSSHCON' has been held annually since then and is attended by 150+ surgeons and includes a number of foreign faculty as well. Delegates from BDSSH joined the IFSSH congress at Sydney in 2007 and in 2008 at the delegates meeting at Lucerne, Bangladesh became the 50th member nation of IFSSH. Our membership had also increased to 63 at that point. We became the youngest member of the APFSSH at the Cebu meeting in 2017 and our members now regularly attend meetings and have presented scientific papers in Australia, Germany, India, Thailand, Singapore and the United Kingdom. Despite Covid-19 pandemic, five surgeons attended the last APFSSH meeting in Melbourne in March 2020.

The Bangladesh government has recognized Hand Surgery as a separate specialty. There are now 42 positions for Hand Surgeons at Government Medical Colleges across the nation. These include residents as well as professors. The Hand Surgery clinic at NITOR, now headed by Prof Jahangir, has been serving the nation since 2006.

Team Bangladesh @ IFSSH, Sydney, 2007

(L to R): Dr ASM Monirul Alam, Prof NK Datta, Prof Kh Abdul Awal, Prof MA Samad, Dr Md Abul Kalam, Prof RR Kairy

A Hand Surgery wing was started in 2017 at the Bangabandhu Sheikh Mujib Medical University, helmed by Prof KP Das. A postgraduate course in Hand Surgery was started at the Sheikh Hasina Institute of Burns and Plastic Surgery with a dedicated Hand Surgery Outpatient clinic. Hand Surgeons are practising in private sector also. Our membership has now risen to 101.

Bangladesh becoming 50th Member of IFSSH, Lucerne, 2008

(L to R): Prof RR Kairy, Dr S Raja Sabapathy, Dr ASM Monirul Alam, Dr Md Abul Kalam

Team Bangladesh @ APFSSH, Melbourne, 2020

(L to R): Dr Lata, Dr Wee Lam, Dr Sajedur Reza Faruquee, Dr Monsoor, Dr Sumi

Sajedur Reza Faruquee, Honorary Secretary, BDSSH

rocky_29th@yahoo.com

Management of Birth Brachial Plexus Injury Including Use of Distal Nerve Transfers.
Thatte MR, Nayak NS, Hiremath AS. J Hand Surg Asian Pac Vol. 2020;25(3):267-275.

Brachial plexus palsy at birth is a well recognized condition where early diagnosis and treatment can optimize outcomes and prevent late complications. Although most patients spontaneously recover from these injuries, a significant proportion of them do not. For this latter group of patients, there is only a limited window in which nerve surgery is helpful.

Time of Evaluation of Pain Catastrophizing after Surgery for Upper Extremity Motor Disorders. Hirata J, Inoue K. J Hand Surg Asian Pac Vol. 2021 Mar;26(1):41-46.

Pain is a common symptom and also influences outcomes following hand surgery. However, pain is variably experienced by different individuals. This can be explained by the fact that pain does not correlate perfectly with physiological insult or injury. Other factors, including cultural, interpersonal and cognitive aspects of the individual influence the pain experienced.

Pain catastrophizing occurs when a patient engages in cognitive activities which exaggerates the actual or anticipated pain, i.e. the patient approaches pain with a negative mental set. The level of pain catastrophizing is typically measured using a questionnaire and has been shown to predict pain outcomes, including intensity of post-surgical pain, response and misuse of opioids and persistent surgical pain. Pain catastrophizing has been shown to predict finger stiffness, grip strength and range of motion following distal radius fractures as well as lower patient satisfaction after carpal tunnel release.

However, the level of pain catastrophizing is affected by the pain a patient is experiencing. So the timing of evaluation may be important. This work addresses this question by studying changes in pain in the early post-operative period and their corresponding pain catastrophizing scores using a commonly used scale. They studied this in a range of upper extremity surgery ranging from finger fractures to rotator cuff surgery.

Their findings suggest that scale scores at 2-weeks post-op best predicts pain and Hand 20(a Japanese Hand Outcomes questionnaire) at 8 weeks. As the authors acknowledge, the limited scope of the surgeries performed and exclusion of patients with severe pain (which is not qualified or explained in their paper), limits the generalizability of their findings.

Alphonsus Chong, Deputy Editor, JHS-AP

alfchong@gmail.com

Diversity at the Australian Hand Surgery Society 2021

The Australian Hand Surgery Society (AHSS) recently held the most diverse, albeit “virtual” Annual Scientific Meeting (ASM) in its history. The four outstanding guest speakers (below) were of diverse background and gender, the moderators were almost 50% female and there was strong representation of women among the speakers in the program. In addition, the 2021 AHSS ASM included the first ever diversity session.

Perhaps the most powerful statement of AHSS’s dedication to gender equity is that 9 of the 17 (53%) Post Fellowship Education & Training (PFET) graduates in Hand Surgery to date are female. AHSS has strongly committed to diversity in hand surgery in its adopted Ethics Guidelines: "AHSS is committed to diversity and gender equality in healthcare and to removing any practices that hinder that commitment. The AHSS strives to implement this commitment through its policies, practices, and inclusive culture. It is an expectation that every individual who attends the AHSS ASM is respected and treated equally regardless of their cultural background, gender, role or particular circumstance."

What is the science supporting the AHSS decision to support diversity? There is overwhelming evidence that diversity of the healthcare workforce is critical for healthcare equity. Hand surgery must reflect the composition of the community we serve in order to provide the best care– not only the women, but our indigenous and under-represented minority (URM) communities. There is increasing data in orthopaedics and other specialties showing the healthcare inequity that results from workforces that lack diversity. A man is between 3 and 22 times more likely to be offered a knee replacement than a woman with the same symptoms.

The outcomes for orthopaedic trauma and arthroplasty are much poorer in URM patients in wealthy nations. A recent study of over a million births in Florida show that the survival rate of black infants increased by 50% when they were treated by a black doctor. Diversity in healthcare can be the difference not only between access to surgical treatment & poorer outcomes, but in some specialties it can mean the difference between life and death. What are the evidence-based strategies to increase the inclusion of women and URM in hand surgery? The strategies include creating visible role models; mentoring; mitigating bias in our selection process and appointments to leadership roles; and increasing flexibility in training for everyone. This requires commitment from the leadership and initiatives to support parenting, particularly during training. The nation with the highest percentage of women in surgery is Estonia and it is no coincidence that is also has the best parental leave and child support policies in the OECD.

Diversity is powerful. Diverse organisations attract the top talent (as they select from a larger pool of candidates), they are more innovative and they make better decisions. They are even more profitable. As the past chair of the Australian Orthopaedic Association Orthopaedic Women’s Link, I became curious about diversity initiatives beyond Australia. The network snowballed and the result has been the formation of the International Orthopaedic Diversity Alliance (IODA) – a collaboration to advance diversity in orthopaedics representing all six continents.

Dr Kristy Weber

Past President AAOS

Jennifer Green, Diversity Champion, APFSSH

jennifer.green1312@gmail.com

International Federation of Societies for Surgery of the Hand

The main change is the decision taken by the delegates to retain the triennial mode of congresses while moving on to a mode of leadership change once in two years. In addition, there will be an increase of the Member-at-large position to five from the present one. A regional distribution has been planned as per the number of member societies and number of members. One each from North and South America, two from Europe and one from the Asian-Pacific region will be selected. Elections for these posts will happen during the London Congress. We hope to have a meeting of the delegates of the member nations probably in the last week of June or first week of July to explain to the delegates the changes and the opportunities that will open up. Please ensure that your national delegate participates in this important meeting. Another matter of importance to the Asian-Pacific region is that it is a chance for the region to host the IFSSH 2028. The venue will be voted during the London Congress in June 2022. The timelines for submitting the bid process will be announced after the next delegates meeting. Meanwhile if your country wishes to bid, please get ready to welcome the world to your place by getting ready with an attractive bid.

IFSSH has a wonderful e-magazine called EZine and it is the 10th year since its publication. Past President Ulrich Mennon has steered it well over these 10 years. Please visit the IFSSH website www.ifssh.info to read the back numbers of the EZine and also to know the news and notes.

This year has been like no other due to the pandemic. While we all hoped that we will be free in 2021, the target still eludes us. I am sure it will soon be fine. Meanwhile be safe and we look forward to seeing you in London from June 6-10, 2022 for the next IFSSH congress. The team led by David Shewring and Jonathan Hobby are working very hard to provide us a congress to remember.

Asian-Pacific Federation of Societies for Hand Therapy (APFSHT)

APFSHT Executive Committee Group Photo @ Cebu 2017

Hand Therapist Delegates from Hong Kong, Singapore, Malaysia and Bangladesh @ Melbourne 2020

Anderson to put forth an enriching programme for the hand therapists. Hand therapists from twenty over countries congregated and engaged enthusiastically with current updates in hand therapy and hand surgery topics. Shortly after the 2020 APFSHT congress, we have several exciting events in the pipeline. Currently, we are working along with IFSHT under the lead of Nicola Goldsmith, in planning for the 12th IFSHT Congress 2022 in London. Meantime, we are also gearing up for the next APFSSH/APFSHT Congress in Singapore in 2023

If you are interested to know more about APFSHT, our members and our ongoing activities, please find us on our website. We look forward to many eventful regional and international meetings with the Asian-Pacific Hand surgery community.

Hercy Li, Immediate Past President, APFSHT

hercyli@gmail.com

Australian Hand Surgery Society (AHSS)

We are now immunising the population. It is proving to be a challenge to get a sufficient quantity of vaccines and vaccines that people trust and feel comfortable using. Each state in Australia has fared differently and adopted slightly different approaches.

The impact on myself as a surgeon in Western Australia is that I cannot leave Australia without government permission and on return I will face two weeks of mandatory quarantine in a selected hotel. The problem with hotel quarantine is that it is still possible to get infected while in quarantine because the airflow is not appropriate for a quarantine situation. People have acquired the virus while in quarantine. We are coming to the realisation that this virus is something we will live with and that it will impact our economy in terms of debt. We have had social policies to keep people employed and keep small businesses open. This is an expense that will need to be repaid in the future. I believe that Australians have been remarkably fortunate in the way Covid has impacted our population. We feel very sad to see the impact of Covid on other countries.

Jeffrey Ecker, President, AHSS

jeff@ecker.com.au

Indian Society for Surgery of the Hand (ISSH)

Parag Lad conducted the CME on OrthoTV platform and had a collective viewership of more than 6000. Nilesh Satbhai’s efforts with the 'webinar series' brought in stalwarts of Hand Surgery from across the globe to our screens. The first edition of IWS (ISSH Webinar Series) had eighteen, 90 minute heart-to-heart talks. IWS-1 is available on ISSH website for the members and on The MediTube for the non-members.

ISSH & British Society for Surgery of the Hand (BSSH) conducted a joint CME in March 2021 led by Praveen Bhardwaj (ISSH) and Sumedh Talwalkar (BSSH). Our annual conference that was to be held in Chennai in August 2020 has been rescheduled to August 2021 as a virtual conference with BSSH as Guest society. As we improve our activities on digital platforms, we hope and await the post pandemic normalcy

Pankaj Ahire, Secretary, ISSH

secretary@issh.org

Malaysian Society for Surgery of the Hand (MSSH)

We managed to organise our 16th Annual Scientific meeting together with the Malaysian Hand Therapist Society. It was held virtually from the 25th -27th of March 2021. Simultaneous tendon workshops in 7 different centres throughout our country were held on the first day. We had 15-20 participants for each tendon workshop and 192 doctors and 76 hand therapists for the virtual meeting. The meeting recordings have been posted on YouTube for your viewing ( Day 1 / Day 2 ).

President MSSH, Dr Iskander at UKM Tendon Worksop

We will be hosting the 2nd Combined ASEAN Hand Meeting from 3rd-5th September 2021 at the world famous KLCC. This will be a hybrid meeting as we understand there may be travel constraints. We are in the midst of confirming a cadaver workshop for flap dissection and a saw bone workshop for internal and external fixators. There is a logo design competition for the ASEAN Hand Society. We would love for you to join us especially if you are from the ASEAN region. Please look for updates at our Facebook page and website.

Ruban Sivanoli, Honorary Secretary, MSSH

rubansivanoli@gmail.com

Association of Hand Surgeons of the Philippines (AHSP)

During these difficult and uncertain times, we have organized webinar lecture series, with different orthopaedic training institutions nationwide and the Philippine Orthopaedic Association (POA). The society also launched its website "handsurgeons.ph" in order to facilitate online booking of appointments, and finding nearby hand surgeons based on patients' location.

Upper Extremity Workhorse Free Flaps ASSH Webinar Emmanuel Estrella

(Past President, AHSP)

Raymar Sibonga, Member, AHSP

raymar_sibonga@yahoo.com

Singapore Society for Hand Surgery (SSHS)

The Symposia on Advances in Reconstructive Microsurgery on 31 Jan 2021 included presentations from Prof Yuan-Kun Tu (Taiwan), Prof Sang-Hyun Woo (Korea), Prof Joon-Pio Hong (Korea) and Prof Zeng-Tao Wang (China).

SSHS organized a Resident Review Series for Hand, Orthopaedics and Plastic Surgery resdents over a virtual platform on a weekly basis from 30 May to 18 July 2020 (8 sessions).

Faculty and Participants @ SSHS Virtual Meeting January 2021

The society also conducted 3 online teaching sessions for Hand Surgery trainees in 2020/2021

The SSHS Travelling Fellowship was suspended in 2020. The 6th Congress of the Asia Pacific Wrist Association scheduled for 2020 will be held along with the APFFSH meeting in 2023. SSHS intends to hold a joint meeting with the British Society for Surgery of the Hand from 11-13 February 2022 in Singapore. Further updates will be posted on the society's web page. Our society has 81 members.

Robert Yap, Secretary, SSHS

robertyap@yahoo.com

Korean Society for Surgery of the Hand (KSSH)

1^st KSSH Webinar Symposium 2021

The number of attendees were more than we expected, reflecting the desire to continue learning and sharing knowledge in hand surgery. We found this platform was welcomed by our younger members who appreciated the time and energy saved compared to inperson meetings. We are planning to continue this bimonthly webinar.

The annual congress of the KSSH is planned for November 5-7, 2021 with Kwang Seog Kim (Chonnam National University) as Chairman and Jong Woong Park (Korea University) as President. We sincerely hope all members of the APFSSH stay healthy and happy through this difficult period.

Hyun Sik Gong, Scientific Committee Chair,KSSH

hsgong@snu.ac.kr