HAND最新文献

Proximal phalangeal fractures occur at a higher frequency than other phalanges, but the optimal management of these injuries remains subject to debate. The use of intramedullary screw (IMS) fixation has gained popularity over the last decade and aims to minimize extensor apparatus violation whilst providing adequate construct stability to allow early motion and rehabilitation. This systematic review aims to provide an updated analysis of patient- and clinician-reported outcome measures following fracture fixation using IMS in the proximal phalanx. A literature search was conducted using PubMed, Ovid Medline, Embase, and the Cochrane Controlled Register of Trials, yielding 16 studies with 204 fractures for inclusion. A mean total active motion of 237°, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score of 3.58, and DASH score of 2.65 was revealed by pooled analysis of the included studies. A total complication rate of 6.4% was reported, including screw prominence, fracture displacement, infection, and flexion contracture. This updated systematic review finds good functional outcomes and a low complication rate following the use of IMS fixation for proximal phalangeal fractures.

Background: Corticosteroid injections are a first-line treatment of trigger finger and de Quervain's tenosynovitis. Little research has evaluated preinjection patient-reported outcomes as a predictive factor for treatment success following corticosteroid injection. We hypothesized that patients with less pretreatment impairment would demonstrate greater post-treatment improvement than patients whose function was more severely impaired.

Methods: We retrospectively reviewed prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) scores in patients undergoing corticosteroid injection for trigger finger or de Quervain's tenosynovitis from 2017 to 2023. Independent variables were patient baseline characteristics, comorbidities, and baseline PROMIS UE. The primary outcome was treatment success between 30 days and 12 weeks, defined as achieving the minimal clinically important difference for PROMIS UE without undergoing surgery.

Results: In total, 240 trigger finger and 74 de Quervain's tenosynovitis patients (N = 314) were analyzed. Following injection, 63 (20.1%) patients achieved treatment success, 86 (27.4%) underwent surgical release, and 165 (52.5%) did not significantly improve function or undergo surgery. Each 1-point increase in baseline PROMIS UE was associated with 10% lower odds of treatment success (P < .001). Among nonoperative patients, each 1-point increase in baseline PROMIS UE was associated with a 0.51-point decrease in PROMIS UE score (P < .001) and diabetes was associated with a 2.74-point decrease in PROMIS UE after injection (P = .44).

Conclusion: Corticosteroid injection provides meaningful improvement for a subset of trigger finger and de Quervain's tenosynovitis patients. Corticosteroid injection remains a first-line treatment for trigger finger and de Quervain's tenosynovitis patients, especially for those with more severe functional impairment.

We report a unique case of carpal reconstruction for capitate deficiency in a child. The patient is a 15-year-old girl who had a destructive giant cell tumor involving the capitate and hamate. To the author's knowledge, this is the first case in which Achilles tendon interposition allograft was utilized to fill the bony void left behind by capitate and partial hamate excision. Arthrodesis was used as an adjunct for stabilizing the second and third proximal metacarpals. This resulted in a great functional and radiographic outcome with 7-year follow-up. In conclusion, when treating a carpal defect from capitate deficiency, if excision of the bone in its entirety is indicated, consideration for tendon allograft as an interposition graft may be given.

Medial epicondyle fractures account for 11% to 20% of pediatric elbow fractures. While most are managed conservatively, ulnar nerve palsy, present in up to 16% of cases, is an accepted indication for surgical treatment. Neurologic symptoms may begin in a delayed fashion and, in rare cases, persist or progress despite surgical intervention. In adults, distal nerve transfers such as anterior interosseous nerve (AIN) to ulnar motor branch transfer have demonstrated promising outcomes, but their role in pediatric patients remains limited. We report the case of a 13-year-old, right-handed gymnast who developed delayed progressive ulnar nerve palsy after a nondisplaced right medial epicondyle fracture managed conservatively. Despite undergoing anterior ulnar nerve transposition at 8 months after injury, she exhibited persistent motor and sensory deficits, with a QuickDASH score of 90.6. At 31 months after the injury, she underwent further surgery, with ulnar nerve decompression and submuscular transposition, ulnar nerve decompression at Guyon's canal, and supercharged end-to-side (SETS) AIN-to-ulnar motor nerve transfer. Eight months postoperatively, she showed substantial recovery of hand strength, fine motor coordination, and ulnar nerve-mediated sensation. At 4-year follow-up, QuickDASH score was 6.8, indicating near-complete functional recovery. To our knowledge, this is the first reported pediatric case of SETS AIN-to-ulnar motor nerve transfer after failed decompression of the ulnar nerve, following a late ulnar nerve palsy complicating a medial epicondyle fracture of the humerus. Distal nerve transfer may offer a viable strategy for enhancing intrinsic hand function in a pediatric chronic ulnar neuropathy, even beyond the conventional reinnervation window.

Collagenase Clostridium histolyticum (CCH; Xiaflex) is an established nonsurgical therapy for Dupuytren contracture. Although adverse effects such as edema, ecchymosis, and skin tears are common, vascular injury is rare and pseudoaneurysm formation has not been previously described. Clinical evaluation and operative management of a patient who developed a digital artery pseudoaneurysm after CCH injection and manipulation were reviewed. A 66-year-old man developed a pulsatile swelling on the volar-radial aspect of the small finger 1 week after manipulation. Duplex ultrasound demonstrated a 1.8 × 1.5 × 1.9 cm partially thrombosed pseudoaneurysm with a 1.2 × 0.5 × 1.0 cm patent lumen arising from the radial digital artery. Surgical exploration revealed the artery entering the pseudoaneurysm with the digital nerve displaced centrally. The diseased arterial segment was excised and clipped proximally and distally. Digital perfusion remained intact and recovery was uneventful. Digital artery pseudoaneurysm is a potential, previously unreported complication of CCH injection for Dupuytren contracture. New or pulsatile swelling after manipulation should prompt vascular imaging to exclude this diagnosis.

Background: Suture anchors in Zone I flexor tendon repairs risk dorsal cortex penetration and nail bed disruption. Preoperative measurements guide safe anchor-drill selection, yet the accuracy of radiograph-based measurements and optimal safety thresholds remain unclear. This study quantified distal phalanx depths, verified radiograph measurements with computed tomography (CT) scans, and assessed compatibility with commercially available anchor systems.

Methods: Thirty adult subjects (120 digits) with paired lateral radiographs and CT scans of the same hand were retrospectively reviewed. Oblique and perpendicular depths at the distal phalanx base were measured independently by 2 reviewers on both imaging modalities and statistically analyzed. Safe depth thresholds were calculated and compared with specifications for 5 commercially available anchor systems. Male and female digits were compared.

Results: Radiographs slightly overestimated CT (mean bias ≤ 0.6 mm) but showed a largely linear and predictable relationship. Maximum safe depths ranged from 3.8 mm in the little finger to 4.9 mm in the index, increasing to 4.6 to 5.9 mm with oblique drilling. Several anchor systems exceeded these limits, particularly in ring and little fingers.

Conclusions: Digital radiographs provide sufficiently accurate measurements for most clinical scenarios with the use of a modest safety margin. Distal phalanx size varies by digit and gender, warranting added caution in female patients and in ring and little fingers. Our findings support routine consideration of retrograde oblique drilling techniques to optimize bone purchase and reduce the risk of dorsal cortex penetration.

Background: Cubital tunnel syndrome (CuTS) is a common peripheral neuropathy often exacerbated by trauma or anatomical disruption. Cervical radiculopathy has been proposed as a proximal risk factor via the double crush mechanism, but its role in post-traumatic CuTS following distal humerus fracture (DHF) remains underexplored.

Methods: A retrospective cohort study was conducted using the PearlDiver database (165 million patients). Patients with DHF were stratified by the presence of pre-existing cervical radiculopathy. Incidence rates of cubital tunnel syndrome diagnosis (CuTSD) and cubital tunnel release surgery (CuTRS) were compared using bivariate and multivariate logistic regression, adjusting for demographics, comorbidities, fracture type, and management approach.

Results: Patients with cervical radiculopathy had a significantly higher incidence of CuTSD after DHF (9.6% vs 5.14%; odds ratio, 1.95, 95% confidence interval, 1.71-2.23) and modestly elevated CuTRS rates (3.75% vs 3.18%). Cervical radiculopathy remained an independent predictor of both outcomes after adjusting for confounders. Predictors such as rheumatoid arthritis and prior nerve injury were significant, whereas fibromyalgia, diabetic neuropathy, and systemic lupus erythematosus were not. The predictive effect was stronger for diagnosis than for surgical intervention.

Conclusion: Cervical radiculopathy is an independent risk factor for developing CuTSD following DHF and may influence symptom perception more than surgical decision-making. These findings support the double crush hypothesis and highlight the need for heightened vigilance in managing DHF in patients with cervical radiculopathy. Prospective studies are warranted to validate these associations and refine treatment algorithms.

Background: Recovery from peripheral nerve injuries (PNI) is influenced by a range of biological, social, and clinical factors. However, the relative contributions of these domains to sensory recovery remain unclear. The objective of this study is to evaluate the predictive value of biological, social, and injury/surgical factors on sensory recovery after PNI, using logistic regression modelsMethods:A retrospective review of 169 patients who underwent upper extremity peripheral nerve reconstruction between May 2013 and May 2023 was conducted. Functional sensory recovery was measured using static 2-point discrimination (2pD) at 6 months postsurgery. Predictor variables were categorized into 3 domains: biological (eg, age and comorbidities), social (eg, insurance status and formal rehabilitation participation), and surgical (eg, nerve injured, gap length, and timing to surgery). Separate logistic regression models were developed for each domain, followed by a combined model incorporating all variables. Model performance was assessed using accuracy, area under the receiver operating characteristic (ROC) curve (AUC), and confusion matrix analysis.

Results: The Injury/Surgical model yielded the highest standalone accuracy (82.4%) and ROC AUC (0.85) among domain-specific models. The Combined model demonstrated superior overall performance with an ROC AUC of 0.92 and accuracy of 85.3%. Key predictive features included age, gap length, injury-to-evaluation interval, formal occupational therapy participation, Area Deprivation Index, current smoker, and history of alcohol use.

Conclusions: Recovery from PNI is most strongly influenced by injury-specific and surgical characteristics. However, the integration of social and biological factors can enhance predictive performance. Multidimensional modeling frameworks may inform preoperative counseling, surgical planning, and postoperative care.

Background: Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint often lead to stiffness, pain, and post-traumatic osteoarthritis (PTOA). This study evaluated long-term clinical outcomes and radiographic PTOA following surgical treatment of unstable PIP fracture-dislocations.

Methods: We conducted a retrospective cohort study of 25 patients (27 fingers) treated with extension block pinning for unstable dorsal PIP fracture-dislocations between 2000 and 2009. Follow-ups in 2010 and 2021 assessed active range of motion (AROM) in PIP and distal interphalangeal (DIP) joints, grip strength, and pain. Postoperative radiographs were analyzed for articular surface involvement and step-off. Post-traumatic osteoarthritis was graded using Kellgren-Lawrence, Kallman, and Osteoarthritis Research Society International scales by 3 blinded hand surgeons, with intraobserver and interobserver reliability assessed.

Results: Over a follow-up of up to 16 years, PIP AROM remained stable. Patients aged ≥45 had reduced PIP AROM and more frequent pain. Greater pain was also seen in those with >0.5 mm articular step-off or advanced radiographic osteoarthritis (OA). Osteoarthritis progression was associated with reduced PIP AROM and residual step-off. The Kallman scale showed the most significant OA progression, especially with ≥50% joint surface involvement. Osteoarthritis grading showed substantial intraobserver and interobserver reliability.

Conclusion: Long-term function after extension block pinning of dorsal PIP joint fracture-dislocations remained, though age over 45 years and residual step-off predicted reduced AROM, pain, and OA progression.

Background: Trigger finger surgery typically has a successful outcome, also in patients with diabetes mellitus (DM). However, the impact of glycemic control on long-term outcomes after open trigger finger release (OTFR) remains unclear. This study examines whether high hemoglobin A1c (HbA1c) levels affect patient-reported outcome (PRO) following OTFR in individuals with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Methods: Data from 2010 to 2020 were sourced from the Swedish national quality register for hand surgery (HAKIR) and cross-linked with the Swedish National Diabetes Register. Adults ≥18 years undergoing OTFR were included. Patient-reported outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and HAKIR Questionnaire-8 (HQ-8) questionnaires (evaluating stiffness, pain, and satisfaction) preoperatively and at 3 and 12 months postsurgery. Participants were stratified into tertiles based on mean HbA1c: "optimal control" (≤48 mmol/mol), "acceptable control" (48.1-64 mmol/mol), and "poor control" (>64 mmol/mol). Linear mixed model regression, adjusted for sex, age, DM duration, smoking, mean arterial pressure, body mass index, and physical activity, analyzed outcomes over time, using "acceptable control" group as reference. To adjust for multiple comparisons, a Bonferroni correction was used.

Results: In total, 496 individuals with T1DM and 869 individuals with T2DM underwent OTFR and were registered in HAKIR. Of these, 53% (n = 710) answered at least 1 questionnaire. There was no difference in QuickDASH nor the studied HQ-8 between the different HbA1c groups at 12 months, neither in individuals with T1DM nor T2DM.

Conclusion: Poor glycemic control was not associated with worse PRO 12 months after OTFR. Thus, for long-term outcome, preoperative HbA1c testing does not seem to be necessary.