HAND最新文献

Lipomas of the hand are uncommon accounting for only 1% to 3.8% of benign tumors of the hand. Moreover, in children, lipomas of the hand are extremely rare. A giant lipoma, ie, measuring greater than 5 cm, of the hand in the pediatric population is exceptionally uncommon. Lipomas of the hand can often be intermuscular, involving multiple compartments of the hand, presenting as an "infiltrating lipoma." Lipoma of the hand presents as a swelling with variable accompanying symptoms such as restricted movements and neurological complaints depending upon their size and site. Here, we discuss the presentation of a rare case of a giant, infiltrating lipoma in the hand of a 3-year-old child, its diagnosis and management.

Background: Syndactyly is the most common upper-extremity congenital condition, and cases can be associated with genetic syndromes or arise sporadically (nonsyndromic). The purpose of this investigation was to determine rates of both malignant and benign neoplasms among pediatric patients diagnosed with nonsyndromic syndactyly compared to matched controls.

Methods: The TriNetX US Collaborative database was queried using International Classification of Disease, 10th Revision codes to identify patients aged 10 years or younger diagnosed with syndactyly. Patient history of syndactyly was utilized to categorize patients into 2 cohorts. These cohorts were propensity-matched by age, sex, race, ethnicity, and congenital malformation syndromes. Subsequent rate of neoplasms was compared between patients with and without syndactyly.

Results: A total of 7478 patients aged 10 years or younger diagnosed with syndactyly were identified. After 1:1 propensity matching, both cohorts included 5461 patients. The rate of digestive malignancies was significantly higher int he syndactyly cohort than that in the control cohort. The rate of benign neoplasms was significant at >5 years follow-up duration (P = .016, 95% CI 0.001-0.005) but was not significant at 1 year or 1 to 5 years. Similarly, rate of any neoplasm was significant at >5 years follow-up duration (P = .013, 95% CI 0.001-0.005) but not at 1 year or 1 to 5 years.

Conclusions: Nonsyndromic syndactyly is associated with an increased rate of benign neoplasms and digestive malignancies. Further investigation is needed to better understand the relationship between the syndactyly phenotype and risk of malignancy.

Background: Many surgical techniques and devices are available to address thumb carpometacarpal (CMC) joint arthritis. To date, limited evidence exists regarding patient satisfaction, patient-reported outcomes, and revision-free survivorship of the Stablyx implant. We sought to examine these metrics for these implants against conventional CMC arthroplasty techniques.

Methods: Six hundred and thirty-one patients who underwent CMC arthroplasty were identified at our institution. Patients were contacted to obtain patient satisfaction scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and potential revision dates. Retrospective chart review was then performed on all 287 respondents. Respondents were placed into cohorts based on the arthroplasty surgical technique: (1) Stablyx (n = 53); (2) ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (n = 90); (3) abductor pollicis longus (APL) suspensionplasty (n = 71); and (4) TightRope suspensionplasty (n = 73). Minimum follow-up was 6 months with an average follow-up of 3.6 ± 2.2 years for the Stablyx cohort and 5.3 ± 2.8 years for all other CMC arthroplasty techniques (AOCAT). Patient demographics, including age, sex, smoking status, Eaton score, and operating surgeon, were also examined.

Results: Through multivariable modeling, higher revision rates were observed in patients who received Stablyx than those who underwent LRTI (control), APL suspensionplasty, or TightRope suspensionplasty. Dissatisfaction was greater in the Stablyx cohort (35%) than the AOCAT cohort (6.8%). No difference in QuickDASH scores were observed between groups.

Conclusions: Higher revision rates and lower patient satisfaction scores were seen in patients who underwent Stablyx CMC hemiarthroplasty compared with other arthroplasty techniques.

Background: Fractures of the scaphoid are the most common carpal bone fracture and have high rates of nonunion. Management of nonunions is crucial to preventing the predictable pattern of arthritis seen with scaphoid nonunion advanced collapse (SNAC). The medial femoral condyle (MFC) and trochlea (MFT) flaps have become a popular option for the management of recalcitrant nonunions. We analyzed our experience with outpatient free vascuarlized MFC/MFT flaps for management of scaphoid fractures and nonunions.

Methods: A retrospective review of a 2-surgeon approach to outpatient MFC/MFT flap reconstruction of scaphoid nonunions without postoperative flap monitoring was performed. Baseline demographic details, injury history, preoperative and postoperative radiographic analysis, operative details, and postoperative union were collected. Patients were discharged either on the day of surgery or the follow morning.

Results: Ten patients met inclusion criteria. Four patients had involvement of the proximal pole and received an MFT as opposed to an MFC. Eight patients were discharged on the day of surgery, and the remaining 2 were discharged on the first postoperative day. Nine patients (90%) showed postoperative union on imaging, with no residual dorsal intercalated segment instability deformity.

Conclusions: Vascularized bone grafting with a free MFC/MFT for management of recalcitrant scaphoid nonunion can be successfully and safely performed without postoperative monitoring in an outpatient surgery center setting. This series is the first to report on ambulatory free MFC/MFT flap reconstruction, and to our knowledge, it is the second in the literature to describe free vascularized tissue transfer of any kind performed with same-day discharge.

Level of evidence: Level IV, Therapeutic.

Background: Perilunate/lunate injuries are frequently misdiagnosed. We hypothesize that utilization of a machine learning algorithm can improve human detection of perilunate/lunate dislocations.

Methods: Participants from emergency medicine, hand surgery, and radiology were asked to evaluate 30 lateral wrist radiographs for the presence of a perilunate/lunate dislocation with and without the use of a machine learning algorithm, which was used to label the lunate. Human performance with and without the machine learning tool was evaluated using sensitivity, specificity, accuracy, and F1 score.

Results: A total of 137 participants were recruited, with 55 respondents from emergency medicine, 33 from radiology, and 49 from hand surgery. Thirty-nine participants were attending physicians or fellows, and 98 were residents. Use of the machine learning tool improved specificity from 88% to 94%, accuracy from 89% to 93%, and F1 score from 0.89 to 0.92. When stratified by training level, attending physicians and fellows had an improvement in specificity from 93% to 97%. For residents, use of the machine learning tool resulted in improved accuracy from 86% to 91% and specificity from 86% to 93%. The performance of surgery and radiology residents improved when assisted by the tool to achieve similar accuracy to attendings, and their assisted diagnostic performance reaches levels similar to that of the fully automated artificial intelligence tool.

Conclusions: Use of a machine learning tool improves resident accuracy for radiographic detection of perilunate dislocations, and improves specificity for all training levels. This may help to decrease misdiagnosis of perilunate dislocations, particularly when subspecialist evaluation is delayed.

Background: Aggressive digital papillary adenocarcinoma (ADPA) is a rare skin adnexal tumor with a predilection for the hand. The presentation, treatment, and outcomes of ADPA remain poorly defined due to the scarcity of reports and low-level evidence of published findings.

Methods: We performed a meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines with the intent to provide hand surgeons a better understanding of the diagnosis and treatment of the disease. Three additional cases of ADPA from our institution were combined with the results from the systematic review.

Results: A total of 238 cases were included in the meta-analysis. Most ADPAs were painful, evolving, and less than 2 cm in size. Regional sentinel lymph node biopsies were performed in 55 patients, of which 25.5% were positive. Overall cohort recurrence and distant metastasis rates were 24.3% and 18.1%, respectively. Patients who obtained clear margins within 6 months of diagnosis had significantly lower rates of recurrence, metastasis, and mortality (P < .001, P = .04, P = .003, respectively). There were no differences in recurrence or metastasis rates in those who obtained clear margins by excision or amputation (P = .27 and P = .07, respectively). In patients who died from disease (6.0%), 5.0 years was the average time to death.

Conclusions: Aggressive digital papillary adenocarcinoma should be included in the differential diagnosis of hand lesions with unusual presentations or lack of response to other therapies. Clear margins should be obtained within 6 months of diagnosis, and routine surveillance should be provided by an oncologic physician familiar with ADPA as these tumors have high recurrence rates.

Background: Currently, there is no recommended standard set of outcomes to report in Dupuytren disease treatment studies, nor are there guidelines on how the outcomes themselves should be reported. This study aimed to elicit the most salient issues for patients living with and undergoing treatment for Dupuytren disease, as well as for the hand surgeons, occupational therapists, and physical therapists caring for these patients.

Methods: A qualitative, interpretive description study employing one-on-one semi-structured interviews was conducted. Ten surgeons, 12 occupational and physical therapists, and 10 patients were interviewed.

Results: Priorities related to Dupuytren disease treatment and recovery differed by stakeholder group. Surgeons prioritized range of motion, recovery time, and recurrence. Physical and occupational therapists frequently mentioned range of motion, grip strength, activities of daily living, return to meaningful activities, wound healing, edema, lack of sensation, and pain as important treatment outcomes. Patients described extension deficit, activities of daily living, holding objects, and lack of sensation.

Conclusions: Through the present study, we have identified outcomes of high importance to patients, hand surgeons, occupational therapists, and physical therapists. These results can be used to inform the development of a core outcome set for Dupuytren contracture.

Background: Achieving bony union in scaphoid nonunion fractures is challenging. Various bone grafts have been studied using headless compression screws (HCS) fixation. However, the impact of bone graft choice on bone healing with volar locking plates (VLP) use is less clear. This study evaluates osseous bridging using packed cancellous grafting versus corticocancellous grafting when used during scaphoid waist nonunion repair with volar plating.

Methods: A retrospective case series was performed of 22 consecutive patients with a scaphoid waist fracture nonunions that were treated with VLP fixation and bone autografts. Inclusion criteria required ≥90-day follow-up clinical examination and postoperative computed tomography (CT) scan. Graft types included corticocancellous or packed cancellous autograft harvested from the radius or iliac crest. Amount of bone healing and presence of residual dorsal intercalated segmental instability were determined by 3 fellowship-trained hand surgeons.

Results: Twenty-two patients with scaphoid fracture nonunions that met study inclusion criteria were evaluated. Postoperative CT scan showed osseous bridging in 95% (21/22) of patients. Despite less time between surgery and the final follow-up CT scan (102.7 ± 59 days for packed cancellous autografts vs 133.6 ± 73 days for corticocancellous autografts), the packed cancellous autograft group displayed higher osseous bridging percentages compared with the corticocancellous graft (80.7% ± 17% vs 47.8% ± 35%, P = .013).

Conclusion: Nearly all patients displayed osseous bridging on postoperative CT scan with VLP and autograft use. However, study findings suggest that packed cancellous autograft use displayed more robust early healing.

Background: Managing open distal radius fractures (DRFs) poses challenges. While preventing surgical site infection (SSI) involves prompt antibiotic administration and thorough irrigation and debridement, the impact of urgent intervention on reducing postoperative infection rates is debated. We hypothesize that timing of surgery does not significantly affect the incidence of SSI in open DRF treated within or after 24 hours from time of injury.

Methods: We retrospectively analyzed the American College of Surgeons Trauma Quality Improvement Program from 2011 to 2021. We focused on outcome variables, including superficial SSI and deep SSI or osteomyelitis. To evaluate the relationship between time to operative intervention and SSI rates, we employed least absolute shrinkage and selection operator and multivariate regression models, adjusting for patient-specific factors and injury severity.

Results: A total of 14 486 patients were included. Regression modeling demonstrated a 23% increase in the odds of deep SSI with each 1-day delay in surgery (P = .010). However, no association was found between time to surgery and superficial SSI (odds ratio [OR] = 0.96, P = .768). Injury severity score (ISS) was associated with increased odds of superficial SSI (OR = 1.06, P < .001) and deep SSI (OR = 1.06, P < .001) while diabetes (OR = 3.56, P = .013) was significantly associated with increased rates of superficial SSI.

Conclusions: Extended time to surgery correlates with a modest rise in deep SSI incidence in open DRF. However, there was no heightened risk of superficial SSI in patients with delayed surgery. Polytrauma, alcohol use disorder, and diabetes were linked to elevated SSI rates in open DRF.