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Trends in Upper Extremity Saw Injuries From 2003 to 2022. 2003 年至 2022 年上肢锯伤的趋势。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-29 DOI: 10.1177/15589447241292658
Joseph G Monir, Jenny Nguyen, Thomas J McQuillan, Eric R Wagner

Purpose: Saws are a common source of upper extremity injury. There have been several commercial and government-mandated safety mechanisms designed to reduce the number of saw injuries. We aim to assess the trends in the incidence and impact of saw-related upper extremity injuries over the last 2 decades.

Methods: The National Electronic Injury Surveillance System database was queried from January 2003 to December 2022 for upper extremity injuries caused by saws. Summary statistics for primary body part injured and diagnosis were calculated. Linear regression was performed to evaluate trends in the number of injuries over time.

Results: An estimated 1.38 million injuries (weighted) presenting to emergency departments were reported from January 2003 to December 2022. Patients had a mean age of 50.5 ± 18.1. Digits (82.2%) accounted for most injuries, followed by hands (11.9%). The lower arm (3.4%), wrist (1.66%), shoulder (0.3%), elbow (0.2%), and upper arm (0.2%) accounted for fewer injuries. There was a downtrend in number of saw injuries over the study period (R = 0.83, R2 = 0.69, p < .001). Subgroup analysis showed decreases in number of injuries to fingers (R = -0.82, R2 = 0.67, p < .001) and wrists (R = -0.61, R2 = 0.37, p = .004). The most common diagnoses were lacerations (69.7%), fractures (12.6%), and amputations (9.9%).

Conclusions: Upper extremity saw injuries have significantly decreased over the last 20 years. The fingers and hands account for the vast majority of saw injuries, resulting most commonly in lacerations, fractures, and amputations.

Level of evidence: IV.

目的:锯是上肢受伤的常见原因。为了减少锯伤的发生,商业界和政府都制定了一些安全机制。我们旨在评估过去 20 年中与锯相关的上肢损伤的发生率和影响趋势:方法:从 2003 年 1 月到 2022 年 12 月,我们在国家电子伤害监测系统数据库中查询了由锯子造成的上肢伤害。计算了主要受伤部位和诊断的汇总统计数据。通过线性回归评估受伤人数随时间变化的趋势:结果:2003 年 1 月至 2022 年 12 月期间,急诊科报告的受伤人数(加权)估计为 138 万。患者的平均年龄为 50.5 ± 18.1 岁。大多数损伤发生在手指(82.2%),其次是手部(11.9%)。下臂(3.4%)、手腕(1.66%)、肩部(0.3%)、肘部(0.2%)和上臂(0.2%)受伤较少。在研究期间,锯伤的数量呈下降趋势(R = 0.83,R2 = 0.69,p p = .004)。最常见的诊断为撕裂伤(69.7%)、骨折(12.6%)和截肢(9.9%):结论:在过去 20 年中,上肢锯伤明显减少。结论:上肢锯伤在过去 20 年中明显减少,绝大多数锯伤发生在手指和手部,最常见的是撕裂伤、骨折和截肢:证据等级:IV。
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引用次数: 0
Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management. 手骨髓炎:文献系统综述及诊断和管理建议。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-27 DOI: 10.1177/15589447241284408
Dallan Dargan, Matthew Wyman, Mahir Bhoora, Dominic Ronan, Megan Baker, David Partridge, Jennifer Caddick, Victoria Giblin

Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty.Level of Evidence: IV.

手部骨髓炎的诊断和治疗都很复杂,有机会通过整理现有证据来改善护理。我们系统地检索了1990年至2022年间有关手骨髓炎的系列文献,以寻找诊断和治疗方面的证据,从而提出建议。21篇文献报道了至少5例成人手骨髓炎病例,共计666例。手术清创是治疗的核心,对于没有糖尿病、肾病或血管疾病的患者,在清创并消除相关败血症后,口服抗生素就足够了。根据机体的敏感性,建议使用 4 至 6 周的抗生素治疗,或在截肢后使用 2 周的抗生素治疗。延迟发病很常见,如果超过6个月,截肢率会很高。手部骨髓炎合并肾功能衰竭与全身并发症有关。重建方案包括抗生素洗脱垫片、骨合成或关节固定、血管化骨或脂肪、区域软组织覆盖和硅胶植入关节成形术:证据等级:IV。
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引用次数: 0
Static Stability of Elbow Interposition Arthroplasty Stabilized With Novel Ligament Reconstruction. 用新型韧带重建稳定肘关节置换术的静态稳定性
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-24 DOI: 10.1177/15589447241284669
Jeffrey S Chen, Colin H Beckwitt, Emerald D Robertson, Alexandria A Bosetti, Mark E Baratz, Robert A Kaufmann

Background: Outcomes of interposition arthroplasty for treatment of elbow arthritis are highly dependent on elbow stability. The purpose of this study was to determine whether interposition arthroplasty with a novel bidirectional ligament reconstruction technique could adequately restore the static stability of the native elbow.

Methods: Static varus and valgus elbow stability was tested in 7 cadaver elbows with intact ligaments and capsule at 5 flexion angles (0°, 30°, 60°, 90°, and 120°). At each angle, the distance between fixed reference points across the elbow was measured both medially and laterally. The elbows were then destabilized and an interposition arthroplasty with ligament reconstruction was performed. Static elbow stability was reassessed by comparing postoperative deflection measurements with those of the native state. Graft slippage or loosening was visually assessed following testing.

Results: Interposition arthroplasty was performed in 7 cadaver specimens. Following ligament reconstruction, specimens reproduced the flexion angle-dependent static stability of native elbows to both varus and valgus stress. The greatest deflection changes between native elbows and elbows after interposition arthroplasty were 2.7% (P = .13) medially and 2.3% (P = .42) laterally, which were not significant. There was no loosening or slippage of either the interposition graft or the ligament reconstruction grafts.

Conclusions: Cadaveric elbow specimens underwent interposition arthroplasty with a novel technique for bidirectional ligament reconstruction. Static stability was maintained at varying degrees of elbow flexion, comparable to that of the native elbow. Interposition and ligament reconstruction grafts maintained secure fixation following static biomechanical testing.

背景:关节间置换术治疗肘关节炎的效果在很大程度上取决于肘关节的稳定性。本研究的目的是确定采用新型双向韧带重建技术的置换关节成形术能否充分恢复原生肘关节的静态稳定性:方法:在7个韧带和关节囊完好的尸体肘关节中,测试了5个屈曲角度(0°、30°、60°、90°和120°)下肘关节的静态内翻和外翻稳定性。在每个角度下,测量肘部内侧和外侧固定参考点之间的距离。然后对肘部进行失稳处理,并进行带韧带重建的关节间置换术。通过比较术后挠度测量值与原始状态的挠度测量值,重新评估肘关节的静态稳定性。测试后目测评估移植物的滑动或松动情况:结果:对 7 个尸体标本进行了关节置换术。韧带重建后,标本再现了原生肘关节在屈曲和外翻应力下与屈曲角度相关的静态稳定性。原生肘关节和关节间置换术后肘关节的最大挠度变化分别为内侧2.7%(P = 0.13)和外侧2.3%(P = 0.42),但变化不大。间位移植物和韧带重建移植物均无松动或滑脱:结论:尸体肘关节标本采用双向韧带重建的新技术进行了置换关节成形术。在不同程度的肘关节屈曲时,都能保持静态稳定性,与原生肘关节的稳定性相当。在进行静态生物力学测试后,置换和韧带重建移植物保持了安全的固定。
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引用次数: 0
Cannabis-Related Disorders Are Associated with Increased Early Postoperative Opioid Prescriptions and Delayed Emergency Department Visits Following Open Carpal Tunnel Release. 大麻相关疾病与开放性腕管松解术后早期阿片类药物处方增加和急诊就诊延迟有关。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-21 DOI: 10.1177/15589447241284788
Kirstin A Humble, Sohrab K Vatsia, Peter F Monahan, Kenneth F Taylor

Background: The effect of cannabis on pain management following open carpal tunnel release (CTR) surgery is unknown. The purpose of this study is to compare outcomes for patients with cannabis-related disorder (CRD) undergoing open CTR to a propensity-matched cohort of patients without CRD (no cannabis-related disorder [NCRD]).

Methods: The TriNetX Research Network was queried to identify patients undergoing primary open CTR between January 2010 and December 2022. Patients with CRD were propensity matched to a NCRD cohort in a 1:1 ratio based on 7 characteristics. Rates of postoperative opioid prescriptions, emergency department (ED) services, and outpatient appointments were reported at 0-2, 2-6, and 6-12 weeks postoperatively.

Results: A total of 925 CRD patients were propensity matched to 925 NCRD patients undergoing open CTR. Within 0-2 weeks postoperatively, CRD patients received significantly greater rates of opioid prescriptions compared to NCRD patients (30.9% and 25.6%, P = .011). No cannabis-related disorder (NCRD) patients presented for outpatient follow-up at significantly higher rates than CRD patients within 6 weeks postoperatively. CRD patients presented to the ED at significantly higher rates between 6 and 12 weeks postoperatively (11.0% vs. 8.0%, respectively, P = .027).

Conclusions: Cannabis-related disorder (CRD) is associated with lower rates of outpatient follow-up but higher rates of postoperative opioid prescriptions and ED presentations following open CTR compared to a propensity-matched cohort of NCRD patients.

Level of evidence: Cohort Study; Level III.

背景:大麻对开放性腕管松解术(CTR)术后疼痛控制的影响尚不清楚。本研究的目的是比较接受开放式腕管松解术的大麻相关障碍(CRD)患者与无CRD(无大麻相关障碍 [NCRD])患者的倾向匹配队列的疗效:方法:通过查询 TriNetX 研究网络,确定 2010 年 1 月至 2022 年 12 月间接受初级开放式 CTR 治疗的患者。根据 7 个特征,将 CRD 患者与 NCRD 患者按 1:1 的比例进行倾向匹配。报告了术后0-2周、2-6周和6-12周的阿片类药物处方率、急诊科(ED)服务率和门诊预约率:共有 925 名 CRD 患者与 925 名接受开放式 CTR 的 NCRD 患者进行了倾向匹配。术后 0-2 周内,CRD 患者获得阿片类药物处方的比例明显高于 NCRD 患者(30.9% 和 25.6%,P = .011)。术后 6 周内,无大麻相关障碍(NCRD)患者到门诊复诊的比例明显高于 CRD 患者。CRD患者在术后6周和12周内到急诊室就诊的比例明显更高(分别为11.0%和8.0%,P = .027):大麻相关障碍(CRD)与较低的门诊随访率有关,但与倾向匹配的 NCRD 患者队列相比,开放性 CTR 术后阿片类药物处方率和 ED 就诊率较高:队列研究;III级。
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引用次数: 0
Characteristics of Patients Utilizing Telemedicine in Hand and Upper-Extremity Surgery. 手部和上肢手术中使用远程医疗的患者特征。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1177/15589447241285048
Oluleke Falade, Maria A Munsch, Luke Latario, John R Fowler

Background: The impact of social determinants of health on patients' access to medical care and health outcomes is increasingly recognized. Telemedicine's rapid and widespread adoption altered the delivery of care. This study describes the characteristics of patients undergoing telemedicine visits with hand surgeons, without COVID-19 pandemic-related restrictions.

Methods: All telemedicine encounters for 4 hand surgeons at a single institution between September 2022 and September 2023 were retrospectively reviewed. Patient demographics were recorded as well as the encounter type. The distance of the patients' residential address and the area deprivation index (ADI) were recorded.

Results: Sixty patient encounters were recorded. Forty-seven percent were male and 53% were female, 5 (8.3%) were new patients, 44 (73.3%) were established patients, and 11 (18.3%) were postoperative. The mean age was 43, and the mean and median distances from the clinic were 72 and 18 miles, respectively. Forty-three patients (72%) were from high ADI residences. Upon comparison of low ADI (0-50th percentile) and high ADI (50th-100th percentile) patients, no statistically significant differences in age, sex, distance from clinic, or encounter type were found.

Conclusions: Telemedicine in hand surgery at this single institution is most frequently used for follow-up encounter types in patients living in high ADI communities, far from clinic sites. Low or high ADI did not correlate with seasonal changes in the use of telemedicine, encounter type, or patient demographics. Telemedicine may improve patient access to hand surgery follow-up care. This may particularly benefit patients facing geographic and economic challenges to healthcare access.

Level of evidence: Prognostic Level IV.

背景:人们日益认识到健康的社会决定因素对患者获得医疗服务和健康结果的影响。远程医疗的迅速普及改变了医疗服务的提供。本研究描述了在没有 COVID-19 大流行相关限制的情况下接受手外科医生远程医疗会诊的患者特征:方法:回顾性审查了 2022 年 9 月至 2023 年 9 月期间某机构 4 名手外科医生的所有远程医疗就诊情况。记录了患者的人口统计学特征以及就诊类型。记录了患者住址的距离和地区贫困指数(ADI):共记录了 60 次就诊。其中 47% 为男性,53% 为女性,5 人(8.3%)为新患者,44 人(73.3%)为老患者,11 人(18.3%)为术后患者。平均年龄为 43 岁,距离诊所的平均距离和中位距离分别为 72 英里和 18 英里。43 名患者(72%)来自高 ADI 居住地。对低 ADI(0-50 百分位数)和高 ADI(50-100 百分位数)患者进行比较后发现,他们在年龄、性别、诊所距离或就诊类型方面没有明显的统计学差异:结论:在这所医疗机构中,手外科远程医疗最常用于远离诊所的高 ADI 社区患者的随访就诊类型。低或高 ADI 与远程医疗的使用、就诊类型或患者人口统计学方面的季节性变化无关。远程医疗可改善患者获得手外科后续护理的机会。这对面临地理和经济挑战的患者尤为有利:预后IV级。
{"title":"Characteristics of Patients Utilizing Telemedicine in Hand and Upper-Extremity Surgery.","authors":"Oluleke Falade, Maria A Munsch, Luke Latario, John R Fowler","doi":"10.1177/15589447241285048","DOIUrl":"https://doi.org/10.1177/15589447241285048","url":null,"abstract":"<p><strong>Background: </strong>The impact of social determinants of health on patients' access to medical care and health outcomes is increasingly recognized. Telemedicine's rapid and widespread adoption altered the delivery of care. This study describes the characteristics of patients undergoing telemedicine visits with hand surgeons, without COVID-19 pandemic-related restrictions.</p><p><strong>Methods: </strong>All telemedicine encounters for 4 hand surgeons at a single institution between September 2022 and September 2023 were retrospectively reviewed. Patient demographics were recorded as well as the encounter type. The distance of the patients' residential address and the area deprivation index (ADI) were recorded.</p><p><strong>Results: </strong>Sixty patient encounters were recorded. Forty-seven percent were male and 53% were female, 5 (8.3%) were new patients, 44 (73.3%) were established patients, and 11 (18.3%) were postoperative. The mean age was 43, and the mean and median distances from the clinic were 72 and 18 miles, respectively. Forty-three patients (72%) were from high ADI residences. Upon comparison of low ADI (0-50th percentile) and high ADI (50th-100th percentile) patients, no statistically significant differences in age, sex, distance from clinic, or encounter type were found.</p><p><strong>Conclusions: </strong>Telemedicine in hand surgery at this single institution is most frequently used for follow-up encounter types in patients living in high ADI communities, far from clinic sites. Low or high ADI did not correlate with seasonal changes in the use of telemedicine, encounter type, or patient demographics. Telemedicine may improve patient access to hand surgery follow-up care. This may particularly benefit patients facing geographic and economic challenges to healthcare access.</p><p><strong>Level of evidence: </strong>Prognostic Level IV.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Most Carpal Tunnel Releases Address Moderate or Severe Median Neuropathy. 大多数腕管松解术可解决中度或严重的正中神经病变。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1177/15589447241284776
Niels Brinkman, Calvin Chandler, David Ring, Gregg Vagner, Lee Reichel

Background: The role of surgery in normal or very mild median neuropathy can be questioned given that surgery in the absence of pathophysiology may offer only nonspecific effects that can be achieved without surgery, which raises ethical concerns. It's also important to avoid misdiagnosis: given that mild median neuropathy is prevalent and generally well-accommodated, notable symptoms from mild median neuropathy can signal unhelpful thoughts and feelings of distress that are a more pressing health priority.

Methods: We identified 38 studies that categorized electrodiagnostic (EDX) measured median neuropathy severity among people being evaluated for carpal tunnel syndrome. We converted the different EDX grades used into one general grading classification. The Kruskal-Wallis test was used to compare the ratio of moderate/severe to mild/normal EDX findings between tests ordered by a surgeon or a nonoperative clinician.

Results: The median (interquartile range) ratio of moderate/severe to mild/normal EDX findings of median neuropathy at the carpal tunnel was 1.2 (0.91 to 1.8) among tests ordered by nonoperative clinicians and 3.3 (1.5 to 5.3) among tests ordered by surgeons (P = .0023). Only 4.1% of the patients who had EDX testing ordered by a surgeon had no measurable neuropathy. There were zero patients with normal EDX findings in 10 of the 17 (59%) studies in surgeon practices and in 10 of the 21 (48%) in the practices of nonoperative clinicians.

Conclusions: The observation that in case series documenting EDX severities of median neuropathy, surgeons are mostly treating and operating on moderate to severe pathophysiology, emphasizes that while mild median neuropathy is highly prevalent it is uncommonly considered for surgery.

Level of evidence: Level II, Prognostic study.

背景:手术治疗正常或非常轻微的正中神经病变的作用可能会受到质疑,因为在没有病理生理学依据的情况下进行手术治疗可能只会产生非特异性效果,而这些效果无需手术即可实现,这就引起了伦理方面的关注。同样重要的是要避免误诊:鉴于轻度正中神经病变很普遍,而且一般都能得到很好的治疗,轻度正中神经病变引起的显著症状可能预示着无益的想法和痛苦的感觉,而这才是更紧迫的健康问题:我们确定了 38 项研究,这些研究对接受腕管综合征评估的人群中通过电诊断(EDX)测量的正中神经病变严重程度进行了分类。我们将所使用的不同 EDX 等级转换为一个通用的分级分类。我们使用 Kruskal-Wallis 检验来比较由外科医生或非手术临床医生进行的检查中,中度/严重 EDX 结果与轻度/正常 EDX 结果的比率:在非手术临床医生所做的检查中,腕管正中神经病变的中度/重度与轻度/正常 EDX 检查结果的中位数(四分位数间距)比率为 1.2(0.91 至 1.8),而在外科医生所做的检查中,中度/重度与轻度/正常 EDX 检查结果的中位数(四分位数间距)比率为 3.3(1.5 至 5.3)(P = .0023)。在外科医生要求进行 EDX 检测的患者中,只有 4.1% 的患者没有可测量的神经病变。在外科医生执业的 17 项研究中,有 10 项(59%)的 EDX 结果为零,而在非手术临床医生执业的 21 项研究中,有 10 项(48%)的 EDX 结果为零:在记录正中神经病变 EDX 严重程度的病例系列中,外科医生大多针对中度至重度病理生理学进行治疗和手术,这一观察结果强调,虽然轻度正中神经病变非常普遍,但很少考虑进行手术治疗:二级,预后研究。
{"title":"Most Carpal Tunnel Releases Address Moderate or Severe Median Neuropathy.","authors":"Niels Brinkman, Calvin Chandler, David Ring, Gregg Vagner, Lee Reichel","doi":"10.1177/15589447241284776","DOIUrl":"https://doi.org/10.1177/15589447241284776","url":null,"abstract":"<p><strong>Background: </strong>The role of surgery in normal or very mild median neuropathy can be questioned given that surgery in the absence of pathophysiology may offer only nonspecific effects that can be achieved without surgery, which raises ethical concerns. It's also important to avoid misdiagnosis: given that mild median neuropathy is prevalent and generally well-accommodated, notable symptoms from mild median neuropathy can signal unhelpful thoughts and feelings of distress that are a more pressing health priority.</p><p><strong>Methods: </strong>We identified 38 studies that categorized electrodiagnostic (EDX) measured median neuropathy severity among people being evaluated for carpal tunnel syndrome. We converted the different EDX grades used into one general grading classification. The Kruskal-Wallis test was used to compare the ratio of moderate/severe to mild/normal EDX findings between tests ordered by a surgeon or a nonoperative clinician.</p><p><strong>Results: </strong>The median (interquartile range) ratio of moderate/severe to mild/normal EDX findings of median neuropathy at the carpal tunnel was 1.2 (0.91 to 1.8) among tests ordered by nonoperative clinicians and 3.3 (1.5 to 5.3) among tests ordered by surgeons (<i>P</i> = .0023). Only 4.1% of the patients who had EDX testing ordered by a surgeon had no measurable neuropathy. There were zero patients with normal EDX findings in 10 of the 17 (59%) studies in surgeon practices and in 10 of the 21 (48%) in the practices of nonoperative clinicians.</p><p><strong>Conclusions: </strong>The observation that in case series documenting EDX severities of median neuropathy, surgeons are mostly treating and operating on moderate to severe pathophysiology, emphasizes that while mild median neuropathy is highly prevalent it is uncommonly considered for surgery.</p><p><strong>Level of evidence: </strong>Level II, Prognostic study.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Utilization and Effectiveness of Pectoralis Minor Tenotomy in the Surgical Management of Neurogenic Thoracic Outlet Syndrome. 小胸肌腱膜切开术在神经源性胸廓出口综合征外科治疗中的应用和效果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1177/15589447241286240
Gayan De Silva, J Westley Ohman, Karen M Henderson, Danita M Goestenkors, Richard D Meyer, Robert W Thompson

Background: Uncertainty exists concerning the optimal utilization and effectiveness of pectoralis minor tenotomy (PMT) in neurogenic thoracic outlet syndrome (NTOS).

Methods: Between January 2020 and July 2023, 355 patients with NTOS underwent primary surgical treatment. Prospectively collected data were analyzed retrospectively.

Results: Overall mean patient age was 35.9 ± 1.9 years, 76% were female, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at presentation was 60.3 ± 3.2, reflecting substantial disability. Surgical treatment was based on localized tenderness/symptoms to palpation, with 322 (91%) undergoing combined supraclavicular decompression and PMT (SCD + PMT) and 33 (9%) selected for isolated PMT when findings were solely confined to the subcoracoid space. Mean operative time (29 ± 5 vs 164 ± 9 min, P < .01) and hospital stay (0.3 ± 0.1 vs 4.0 ± 0.2 days, P < .01) were both lower after isolated PMT, with no significant differences in postoperative complications or rehospitalization. During follow-up of 26.7 ± 1.5 months, QuickDASH scores declined by 41.2% ± 2.3% (P < .0001) and patient-rated outcomes were excellent in 34%, good in 41%, fair in 22%, and poor in 4%. Fewer patients had poor-rated outcomes after SCD + PMT (2%) than after isolated PMT (19%) (P < .01). Recurrent symptoms requiring supraclavicular reoperation occurred in 16 patients after SCD + PMT (5%) and in 5 patients after isolated PMT (15%) (P < .05).

Conclusions: Pectoralis minor tenotomy (PMT) has an important role in surgical treatment of NTOS, mainly as an adjunct in combination with SCD. While highly selected patients can do well after isolated PMT as a short outpatient procedure with rapid recovery, there is a greater potential for poor outcomes and supraclavicular reoperation than after SCD + PMT.

背景:关于神经源性胸廓出口综合征(NTOS)胸小肌腱膜切开术(PMT)的最佳利用和有效性存在不确定性:胸小肌腱膜切开术(PMT)在神经源性胸廓出口综合征(NTOS)中的最佳应用和有效性存在不确定性:2020年1月至2023年7月期间,355名NTOS患者接受了初级手术治疗。对前瞻性收集的数据进行回顾性分析:患者总平均年龄为(35.9 ± 1.9)岁,76%为女性,发病时手臂、肩部和手部快速残疾(QuickDASH)评分为(60.3 ± 3.2)分,反映出严重残疾。手术治疗以局部压痛/触诊症状为依据,322例(91%)患者接受了锁骨上减压和PMT联合手术(SCD + PMT),33例(9%)患者在检查结果仅局限于肩胛下间隙时接受了单独的PMT手术。平均手术时间(29±5 分钟 vs 164±9 分钟,P P P P P 结论:胸肌小肌腱鞘切除术(PMT)在 NTOS 的手术治疗中发挥着重要作用,主要是作为 SCD 的辅助手段。虽然经过严格筛选的患者可以在门诊进行短时间的单独小腱膜切除术,并能快速恢复,但与 SCD + 小腱膜切除术相比,更有可能出现不良后果和锁骨上再次手术。
{"title":"Utilization and Effectiveness of Pectoralis Minor Tenotomy in the Surgical Management of Neurogenic Thoracic Outlet Syndrome.","authors":"Gayan De Silva, J Westley Ohman, Karen M Henderson, Danita M Goestenkors, Richard D Meyer, Robert W Thompson","doi":"10.1177/15589447241286240","DOIUrl":"https://doi.org/10.1177/15589447241286240","url":null,"abstract":"<p><strong>Background: </strong>Uncertainty exists concerning the optimal utilization and effectiveness of pectoralis minor tenotomy (PMT) in neurogenic thoracic outlet syndrome (NTOS).</p><p><strong>Methods: </strong>Between January 2020 and July 2023, 355 patients with NTOS underwent primary surgical treatment. Prospectively collected data were analyzed retrospectively.</p><p><strong>Results: </strong>Overall mean patient age was 35.9 ± 1.9 years, 76% were female, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at presentation was 60.3 ± 3.2, reflecting substantial disability. Surgical treatment was based on localized tenderness/symptoms to palpation, with 322 (91%) undergoing combined supraclavicular decompression and PMT (SCD + PMT) and 33 (9%) selected for isolated PMT when findings were solely confined to the subcoracoid space. Mean operative time (29 ± 5 vs 164 ± 9 min, <i>P</i> < .01) and hospital stay (0.3 ± 0.1 vs 4.0 ± 0.2 days, <i>P</i> < .01) were both lower after isolated PMT, with no significant differences in postoperative complications or rehospitalization. During follow-up of 26.7 ± 1.5 months, QuickDASH scores declined by 41.2% ± 2.3% (<i>P</i> < .0001) and patient-rated outcomes were excellent in 34%, good in 41%, fair in 22%, and poor in 4%. Fewer patients had poor-rated outcomes after SCD + PMT (2%) than after isolated PMT (19%) (<i>P</i> < .01). Recurrent symptoms requiring supraclavicular reoperation occurred in 16 patients after SCD + PMT (5%) and in 5 patients after isolated PMT (15%) (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Pectoralis minor tenotomy (PMT) has an important role in surgical treatment of NTOS, mainly as an adjunct in combination with SCD. While highly selected patients can do well after isolated PMT as a short outpatient procedure with rapid recovery, there is a greater potential for poor outcomes and supraclavicular reoperation than after SCD + PMT.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dorsal and Volar Approaches for Proximal Interphalangeal Joint Replacement: Comparing Outcomes Through Systematic Review and Meta-Analysis. 近端指间关节置换术的背侧和侧方入路:通过系统回顾和 Meta 分析比较结果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1177/15589447241284670
Gagandeep Mahi, Eric Ansong, Eugene Gan, Sasan Dehbozorgi, Han Hong Chong

Background: The 2 primary surgical approaches for proximal interphalangeal joint (PIPJ) arthroplasty, dorsal or volar, have been extensively described in the literature. However, the ongoing debate regarding which approach offers superior results or is associated with fewer complications persists. This systematic review aims to compare the outcomes of PIPJ arthroplasty between the dorsal and volar approaches.

Methods: A comprehensive search of multiple databases was conducted, and studies meeting predetermined criteria were included. Data extraction, assessment of bias risk, and statistical analysis were performed to compare treatment modalities. Outcome measures included range of motion (ROM), patient-reported outcome measures (PROMs), revisions, and reported complications.

Results: Among 368 screened articles, 5 studies involving 302 patients (310 implants) were eligible for final review. No significant differences were observed between the 2 approaches regarding postoperative ROM (mean difference [MD] 2.24; 95% confidence interval [CI] -3.83, 8.32; P = .47) and PROMs (standardized mean difference [SMD] 0.18; 95% CI -0.12, 0.48; P = .25). Complication rates, including revision/fusion, persistent pain, stiffness, infection, and dislocation, did not significantly differ between the approaches. Notably, dorsal approach was associated with higher risk of swan-neck deformity (9 out of 82 implants), while no such cases were reported in the volar approach (0 out of 101 implants).

Conclusion: Despite limitations and heterogeneity in the literature, both dorsal and volar approaches for PIPJ arthroplasty appear to yield equivalent outcomes for patients.

Level of evidence: II, therapeutic.

背景:文献中广泛介绍了近端指间关节(PIPJ)关节成形术的两种主要手术方法,即背侧或外侧。然而,关于哪种方法效果更好或并发症更少的争论仍在继续。本系统性综述旨在比较背侧和伏侧两种 PIPJ 关节置换术的效果:方法:对多个数据库进行了全面检索,并纳入了符合预定标准的研究。进行数据提取、偏倚风险评估和统计分析,以比较治疗方式。结果测量包括活动范围(ROM)、患者报告的结果测量(PROMs)、翻修率和报告的并发症:在筛选出的 368 篇文章中,有 5 项研究符合最终审查条件,涉及 302 名患者(310 个植入物)。在术后 ROM(平均差 [MD] 2.24;95% 置信区间 [CI]-3.83,8.32;P = .47)和 PROMs(标准化平均差 [SMD] 0.18;95% 置信区间 [CI]-0.12,0.48;P = .25)方面,未观察到两种方法之间存在明显差异。两种方法的并发症发生率,包括翻修/融合、持续疼痛、僵硬、感染和脱位,没有明显差异。值得注意的是,背侧入路与较高的天鹅颈畸形风险相关(82 例植入物中有 9 例),而侧入路则无此类病例报告(101 例植入物中有 0 例):结论:尽管文献中存在局限性和异质性,但背侧和伏侧两种方法进行PIPJ关节置换术似乎能为患者带来同等的疗效:证据等级:II,治疗。
{"title":"Dorsal and Volar Approaches for Proximal Interphalangeal Joint Replacement: Comparing Outcomes Through Systematic Review and Meta-Analysis.","authors":"Gagandeep Mahi, Eric Ansong, Eugene Gan, Sasan Dehbozorgi, Han Hong Chong","doi":"10.1177/15589447241284670","DOIUrl":"https://doi.org/10.1177/15589447241284670","url":null,"abstract":"<p><strong>Background: </strong>The 2 primary surgical approaches for proximal interphalangeal joint (PIPJ) arthroplasty, dorsal or volar, have been extensively described in the literature. However, the ongoing debate regarding which approach offers superior results or is associated with fewer complications persists. This systematic review aims to compare the outcomes of PIPJ arthroplasty between the dorsal and volar approaches.</p><p><strong>Methods: </strong>A comprehensive search of multiple databases was conducted, and studies meeting predetermined criteria were included. Data extraction, assessment of bias risk, and statistical analysis were performed to compare treatment modalities. Outcome measures included range of motion (ROM), patient-reported outcome measures (PROMs), revisions, and reported complications.</p><p><strong>Results: </strong>Among 368 screened articles, 5 studies involving 302 patients (310 implants) were eligible for final review. No significant differences were observed between the 2 approaches regarding postoperative ROM (mean difference [MD] 2.24; 95% confidence interval [CI] -3.83, 8.32; <i>P</i> = .47) and PROMs (standardized mean difference [SMD] 0.18; 95% CI -0.12, 0.48; <i>P</i> = .25). Complication rates, including revision/fusion, persistent pain, stiffness, infection, and dislocation, did not significantly differ between the approaches. Notably, dorsal approach was associated with higher risk of swan-neck deformity (9 out of 82 implants), while no such cases were reported in the volar approach (0 out of 101 implants).</p><p><strong>Conclusion: </strong>Despite limitations and heterogeneity in the literature, both dorsal and volar approaches for PIPJ arthroplasty appear to yield equivalent outcomes for patients.</p><p><strong>Level of evidence: </strong>II, therapeutic.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anatomical Variation of the Recurrent Motor Branch of the Median Nerve. 正中神经回流运动支的解剖变异。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-18 DOI: 10.1177/15589447241284411
Kowsar A Ahmed, Sami H Tuffaha

The recurrent motor branch (RMB) of the median nerve has commonly thought to originate proximal to the terminal digital branches, although its anatomical course and number may vary. We report a rare variation of the RMB that arose from the second common palmar digital nerve. The median nerve bifurcated into the first and second common palmar digital nerves distal to the transverse carpal ligament, with the RMB dividing from the second common palmar digital nerve and traveling retrograde to enter the abductor pollicis brevis muscle. This high origin variation may be at increased risk of injury during procedures of the hand.

正中神经的运动回流支(RMB)通常被认为起源于末端数字分支的近端,尽管其解剖走向和数量可能有所不同。我们报告了一种罕见的正中神经运动回流支变异,该运动回流支起源于掌侧第二总数字神经。正中神经在腕横韧带远端分叉为第一和第二掌侧数字总神经,人民币从第二掌侧数字总神经分出,逆行进入外展肌。这种高起源变异可能会增加在手部手术中受伤的风险。
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引用次数: 0
Prevalence and Effect of Cannabinoids in Pain Management for Hand Pathologies. 手部病变疼痛治疗中大麻素的使用率和效果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-11 DOI: 10.1177/15589447241284275
Marc G Sleiman, Andrew Straszewski, Jeffrey G Stepan, Megan Conti Mica

Background: Cannabinoids are a diverse group of compounds under investigation for various medical purposes, including analgesia. Given the evolving landscape of cannabinoid use, we aimed to analyze their prevalence and effect in pain management among urban orthopedic hand patients.

Methods: An electronic survey was administered to 122 new patients presenting to the orthopedic hand clinic of a major urban academic hospital. Demographic data, numerical rating scale pain scores, cannabinoid usage, and other concomitant pain regimens were recorded.

Results: Approximately half of the new patients were dissatisfied with current pain management for their hand pathology. Prescription (Rx) and over-the-counter (OTC) pain medications were used by 58% (71/122) of patients, while cannabinoids were used by 15% (18/122) of patients. Compared with pre-usage pain scores, both cannabinoids and Rx/OTC medications induced significant reductions in pain associated with patients' hand pathologies (Cannabinoid: Δ4.4, P = .002; Rx/OTC: Δ3.0, P < .001). Cannabinoids induced a larger analgesic effect, but this difference was not statistically or clinically significant (P = .06). Subjectively, cannabinoid users either preferred their cannabinoid over Rx/OTC medications or liked both equally. Opioid use was higher among cannabinoid users (22.2% vs 12.5%), although this was not statistically significant (P = .28).

Conclusion: Approximately 15% of new urban hand patients use cannabinoids for pain control, and these compounds have similar analgesic efficacy in hand pathologies as Rx/OTC medications. Cannabinoids are equally liked or preferred relative to traditional medications in this cohort, and they may play an important role in pain management for hand patients.

背景:大麻素是一类多种多样的化合物,正在被研究用于各种医疗目的,包括镇痛。鉴于大麻素的使用情况不断变化,我们旨在分析其在城市手部矫形患者疼痛治疗中的使用率和效果:我们对一家大型城市学术医院手部骨科诊所的 122 名新患者进行了电子调查。调查记录了人口统计学数据、数字评级疼痛量表评分、大麻素使用情况以及其他伴随疼痛治疗方案:结果:约有一半的新患者对目前治疗手部病变的疼痛疗法不满意。58%(71/122)的患者使用处方(Rx)和非处方(OTC)止痛药,15%(18/122)的患者使用大麻素。与使用前的疼痛评分相比,大麻素和处方药/非处方药均可显著减轻患者手部病变引起的疼痛(大麻素:Δ4.4,P = .002;处方药/非处方药:Δ3.0,P < .001)。大麻素诱导的镇痛效果更大,但这种差异在统计或临床上并不显著(P = .06)。从主观上看,大麻素使用者要么更喜欢大麻素而不是 Rx/OTC 药物,要么两者同样喜欢。大麻素使用者使用阿片类药物的比例较高(22.2% 对 12.5%),但这一比例在统计学上并不显著(P = .28):大约 15%的新城市手部患者使用大麻类药物控制疼痛,这些化合物对手部病症的镇痛效果与 Rx/OTC 药物相似。在这一群体中,大麻素与传统药物相比同样受到喜爱或偏爱,它们可能会在手部患者的疼痛治疗中发挥重要作用。
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