HAND最新文献

Hypothenar hammer syndrome (HHS) is a rare condition typically seen in patients with repetitive trauma to the hand. Multiple treatment options are available, and these range from conservative options to surgery, depending on severity of symptoms. There is an abundance of case reports reporting on HHS, with limited large studies reporting patency findings and patient-reported outcome measures (PROM). The main objective of this study was to review long-term patency rates and PROMs in HHS patients undergoing surgical intervention with a focus on vein graft repair, arterial graft repair, and direct repair without a graft. A total of 1399 publications were screened, and 14 were included (patency rates papers n = 13; PROM papers n = 5). The pooled patency rates were 65% for vein grafts (with a yearly rate decline of 4.4%; P = .243), 100% for the arterial grafts (4 studies; n = 23; mean follow-up 40.8 months), and 67% for the direct repair group. Longitudinal patency rates were higher with arterial grafts than with vein grafts (β = 0.36, P = .001). Pooled Disabilities of the Arm, Shoulder, and Hand (DASH) scores were comparable between vein grafts and direct repair (10.9 vs. 11.5; P = .958). In summary, there is a downward yearly trend in patency rates of vein grafts. Compared to vein grafts, arterial grafts have higher long-term patency rates. Vein grafts and direct repair, however, yield promising postoperative function and pain as assessed via DASH and Visual Analog Scale (VAS) scores.

Distal radius fractures are among the most frequent injuries treated in orthopedic surgery. Volar locking plates have become the preferred fixation method, offering fixed-angle stability and lower risk of extensor tendon injury compared with dorsal plating. However, in certain complex fracture patterns, volar plating alone may not provide sufficient stability. In such cases, alternative fixation strategies-such as dorsal plating, fragment-specific fixation, or spanning constructs-may be necessary. Understanding the biomechanical challenges and appropriate surgical solutions is key to optimizing outcomes in distal radius fractures beyond standard volar fixation. This review highlights fracture types where volar fixation may be insufficient and presents alternative strategies tailored to each fracture pattern.

Background: Sterile Alpha and TIR Motif Containing 1 (SARM1) is the central executioner of Wallerian degeneration (WD) following axonal injury, with its inhibition having been shown to delay WD. However, little is known about its effect on functional recovery after nerve transection and repair. This study aimed to evaluate whether recovery after nerve transection and delayed repair is enhanced in an SARM1 knockout (KO) model.

Methods: A total of 16 SARM1 KO and 16 wild-type (WT) Lewis rats underwent sciatic nerve transection, followed by repair at 4 days with functional analysis at either 2 or 6 weeks. Primary outcome measures included muscle tetanic force, compound nerve action potential (CNAP) amplitude and latency, and sciatic function index (SFI). Both SARM1 KO and WT groups were compared using independent t tests with a priori level of significance of P ≤ .05.

Results: The SARM1 KO rats displayed significantly lower tibialis anterior (1.43 ± 0.98 N vs 2.56 ± 1.43 N, P = .016) and gastrocnemius (2.35 ± 0.64 N vs 4.48 ± 1.32 N, P = .002) muscle strength at 6 weeks. There were no differences in CNAP amplitudes or latencies at 2 or 6 weeks after delayed repair compared with WT. There was no difference in SFI between SARM1 KO and WT groups at 2 or 6 weeks after repair.

Conclusions: The SARM1 KO impeded recovery of muscle strength after nerve transection and delayed repair. Knockout rodents also appeared to have increased scarring, reflective of poor axonal regeneration. Further work should aim to better understand the inhibitory effects of SARM1 deletion and its role in nerve regeneration.

Background: Lateral antebrachial cutaneous nerve neuropathy (LABCN) is a known complication following distal biceps tendon repair; however, potential risk factors leading to this are not well described. This retrospective study of distal biceps repairs seeks to determine associations between patient demographics, surgical technique, and injury characteristics associated with postoperative LABCN.

Methods: A retrospective chart review was performed on 275 patients with partial- or full-thickness biceps tendon ruptures who underwent operative repair. Patient characteristics were recorded including utilization of tobacco, alcohol, age, and body mass index, along with surgical factors including tourniquet time, approach, prior shoulder surgery, and tendon repair techniques. Lateral antebrachial cutaneous nerve neuropathy was identified by description of "numbness, tingling, burning, or decreased sensation" at postoperative visits. Chi-square and t tests were used to analyze differences in LABCN development rate for the listed variables.

Results: Sixty-three of 275 (22.9%) patients were identified as having some form of LABCN postoperatively. Age, body mass index, and tourniquet time were not correlated with LABCN (P > .05). The 2-incision technique and the use of corkscrew anchor fixation correlated with lower LABCN rates (P < .05). Chronic biceps rupture, partial thickness tear, and history of prior ipsilateral shoulder surgery correlated with higher LABCN rates (P > .05).

Conclusions: Multiple factors affect the risk of LABCN after distal biceps repair. Patient-related factors do not appear to be associated with increased risk, except in cases where patients have a history of shoulder surgery or chronic distal biceps rupture. Surgical factors such as approach and method of tendon fixation demonstrate differences in the rate of postoperative LABCN.

Background: Sarcoma management guidelines in the extremities have been developed based on grouped averages, which are weighted toward lower extremity sarcomas. However, sarcomas in the forearm, wrist, hand, and fingers present unique management challenges given proximity to neurovascular structures and smaller presenting size. This study aims to describe the presenting characteristics of upper extremity sarcomas evaluated at our tertiary referral hospital from 2015 to 2022.

Methods: Pathology reports from 7888 upper extremity specimens were retrospectively reviewed, yielding 119 sarcoma entries belonging to 72 patients. Operative and clinic notes, pathology reports, and radiographic images were reviewed. Baseline demographic variables (age, sex, race) and tumor-specific characteristics were collected for all 72 patients. Survival characteristics (tumor recurrence, presence of metastasis) were collected for patients with a minimum of 6 months of follow-up.

Results: The most common upper extremity sarcomas were undifferentiated pleomorphic sarcoma (21/72, 29%) and myxofibrosarcoma (17/72, 24%). Sixteen of 44 patients (36%) developed metastasis, and 14 of 44 patients (32%) developed local recurrence. Eight of 16 patients who developed metastases presented with tumor sizes less than 5 cm, and 9 of 14 patients who developed recurrence presented with tumor sizes less than 5 cm. Size of tumor at presentation was neither statistically associated with metastasis (P = .82) nor with recurrence (P = .28).

Conclusions: Upper extremity sarcomas are a heterogeneous group of highly aggressive tumors. Current biopsy guidelines in sarcoma surveillance may not capture a majority of sarcomas in the upper extremity given the high frequency of small dimensions and indolent symptoms in even high-grade lesions.

Background: Successful trapeziometacarpal (TM) joint arthroplasty depends heavily on bone quality, particularly of the trapezium, where cup loosening remains a leading cause of implant failure. While dual-energy x-ray absorptiometry measures bone mineral density (BMD), it lacks regional specificity. Computed tomography (CT)-derived Hounsfield units (HU) offer quantitative, site-specific bone density estimation and may serve as a surrogate for BMD in preoperative planning. This study investigated the relationship between CT-derived HU values and tactilely perceived bone hardness of the trapezium to evaluate HU as a reliable predictor of bone quality.

Methods: Ten embalmed Body Donor hands were scanned using a Philips Spectral CT 7500 scanner. Bone segmentation and density analyses were conducted in 3D Slicer software, focusing on trabecular regions of the trapezium (proximal, ridge, and submetacarpal) and the first metacarpal (proximal, medial, and distal). Hounsfield unit values were converted to density (g/cm³) using validated equations. An experienced anatomist assessed trapezium hardness ("soft" or "hard") using bone forceps. Correlations between HU values, bone volume, and perceived hardness were analyzed using Pearson correlation coefficient.

Results: The mean trapezium HU was 354 (682.88 g/cm³), with regional trabecular variation: proximal 160.7 HU, ridge 286.5 HU, submetacarpal 241.7 HU. The first metacarpal demonstrated broader density variation (-285.8 to 228.8 HU). Hounsfield unit values correlated significantly with perceived hardness (r = .71, P = .02), whereas bone volume showed no correlation (r = .08, P = .82). Male trapezia displayed higher HU and density (472.7 ± 89.8 HU; 740.9 ± 44.0 g/cm³) than females (436.1 ± 87.2 HU; 723.0 ± 42.7 g/cm³).

Conclusions: Computed tomography-derived HU values strongly correlate with perceived bone hardness and provide an objective surrogate for assessing bone quality in TM joint arthroplasty. Incorporating preoperative HU assessment may guide implant selection and fixation strategies, reducing trapezium cup loosening and implant failure.

Background: Acutely performed proximal row carpectomy (PRC) is a viable alternative to open reduction internal fixation for perilunate and/or lunate dislocations, offering comparable outcomes with fewer postoperative complications. Studies report good motion, low complication, and reoperation rates. However, limited research exists on acute PRC for perilunate dislocations (PLDs), warranting further investigation into its functional outcomes.

Methods: A retrospective chart review was conducted on adult patients who underwent acute PRC for PLDs and perilunate fracture-dislocations (PLFDs) at a single institution (2010-2022). Inclusion criteria encompassed patients aged above 18 years with perilunate or lunate dislocation/fracture-dislocation treated with PRC within 21 days post-injury, among other criteria. Fourteen patients met our inclusion criteria. Patient-reported outcomes (PROs) were collected through phone surveys and final clinic visits, using Patient-Rated Wrist Evaluations (PRWEs), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), visual analog scale (VAS) pain scores, and return-to-work statuses. Surgical approaches, patient demographics, and injury characteristics were analyzed.

Results: In our cohort (average age 49.4 years), injuries were due to motor vehicle collisions (57%) and falls (43%). Proximal row carpectomy was performed within an average of 5.6 days post-injury, and patients were contacted an average of 68.0 months post-surgery. Return-to-work rates were favorable, with 35.7% returning without restrictions and 35.7% with restrictions. Patient-reported outcomes, encompassing VAS (1.31), QuickDASH (20.5), and PRWEs (24.5), demonstrated favorable results.

Conclusions: This study provides novel insights into the outcomes of acute PRC for perilunate and lunate dislocations, expanding on limited existing literature. It highlights PRC as a viable intervention for PLDs and PLFDs, demonstrated by substantial return-to-work rates and positive PROs.

Background: Regaining hand and upper extremity function is a functional priority for patients with cervical spinal cord injuries (SCI). Despite the high demand for upper extremity reconstruction (UER) to restore function, the utilization of these procedures remains low. This study evaluates the incidence and timing of UER in patients with cervical SCI.

Methods: The TriNetX Research Network was queried to identify patients with cervical SCI. Then, we identified patients who underwent procedures to restore motor function (nerve transfer, tendon transfer, tenodesis, or arthrodesis) and procedures to treat spasticity and contractures (neurectomy, tendon lengthening, or tenotomy) using International Classification of Diseases, 10th Revision, Current Procedural Terminology, and Systematized Nomenclature of Medicine codes. Baseline characteristics were compared between patients who received UER and those who did not. Propensity score-matched analysis was used to compare UER rates between sex and racial groups.

Results: Among 117 401 patients with SCI, only 0.8% of those with cervical SCI underwent UER, with higher utilization among patients with low cervical (C5-C8) and complete injuries. Tendon and joint procedures were more commonly performed than nerve procedures for both motor restoration and spasticity management. Nerve transfers were typically performed earlier post-injury than tendon procedures. Patients who received UER were significantly younger and more likely to have complete SCI, higher rates of psychiatric comorbidities, and lower prevalence of diabetes than those who did not undergo UER. Although overall UER rates did not differ significantly by sex, male and White patients were more likely to receive nerve-related procedures.

Conclusions: Less than 1% of cervical SCI patients underwent any form of upper extremity reconstructive procedures. Significantly more tendon procedures were performed compared with nerve procedures to both treat spasticity and restore motor function. Patients of White race and male gender were more likely to receive nerve-related UER procedures.

Background: The optimal surgical approach for Preiser disease, a rare avascular necrosis of the scaphoid, remains unclear. Our institution employs a stage-based strategy: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early disease (Herbert classification stages 1-2) and proximal row carpectomy (PRC) for advanced disease (stages 3-4). This study evaluates this stage-based surgical approach.

Methods: We retrospectively analyzed 8 patients (mean age: 60.6 years) who underwent surgical treatment for Preiser disease between 2000 and 2019. Preoperative evaluation included Herbert and Kalainov classifications. Outcome measures included the range of motion (ROM), grip strength (GS), pain (numeric rating scale [NRS] score), Modified Mayo Wrist Score (MMWS), and radiological parameters. Mean follow-up was 50 months.

Results: Five patients had stage 2, 1 had stage 3, and 2 had stage 4 disease. Seven patients were treated according to our strategy; 1 stage 4 patient deviated. In those treated per protocol, the VBG/CRWO group (n = 5) and the PRC group (n = 2) showed improvements across all clinical outcomes. Despite clinical gains, radiographic disease progression occurred in 4 of the 5 patients in the VBG/CRWO group. The patient treated outside the standard approach experienced clinical deterioration and developed dorsal intercalated segment instability deformity.

Conclusion: Our stage-based surgical strategy for Preiser disease yields favorable clinical outcomes. While radiographic progression may occur regardless of treatment, clinical improvements are generally maintained when procedures are appropriately selected based on disease stage.