Pub Date : 2024-11-01Epub Date: 2023-05-26DOI: 10.1177/15589447231174045
Chelsea C Boe, Scott Telfer, Stephen Kennedy
Background: Intramedullary headless screw fixation is increasingly used for fixation of proximal phalanx fractures. However, the impact of screw entry defects on joint contact pressures is not well defined and may have implications for arthrosis. The objective of this cadaveric biomechanical study was to assess joint contact pressures at the metacarpophalangeal (MCP) joint before and after passage of 2 sizes of antegrade intramedullary fixation.
Methods: Seven fresh frozen cadaver specimens without arthritis or deformity were included in this study. Antegrade intramedullary screw fixation of proximal phalanx fracture was simulated using an intra-articular technique. Flexible pressure sensors were inserted into the MCP joints and cyclic loading was performed. Peak contact pressures were determined and averaged across loading cycles for each finger in the native state, with 2.4- and 3.5-mm drill defects in line with the medullary canal.
Results: Peak pressure increased with the size of the drill hole defect. Contact pressure increases were greater in extension, with peak contact pressures increased by 24% for the 2.4-mm defect and 52% for the 3.5-mm defect. Increase in peak contact pressure was statistically significant with a 3.5-mm articular defect. Contact pressures were not consistently increased for the 2.4-mm defect. Testing in flexion of 45° resulted in reduced contact pressure for these defects.
Conclusions: Our study demonstrates that antegrade intramedullary fixation of proximal phalanx fractures can increase MCP joint peak contact pressures, particularly in an extended joint position. Effect increases with defect size. This has implications for the management of proximal phalanx fractures using this technique.
{"title":"Intra-Articular Antegrade Intramedullary Screw Fixation for Proximal Phalanx Fractures: Impact of Articular Surface Defects on Joint Contact Pressures.","authors":"Chelsea C Boe, Scott Telfer, Stephen Kennedy","doi":"10.1177/15589447231174045","DOIUrl":"10.1177/15589447231174045","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary headless screw fixation is increasingly used for fixation of proximal phalanx fractures. However, the impact of screw entry defects on joint contact pressures is not well defined and may have implications for arthrosis. The objective of this cadaveric biomechanical study was to assess joint contact pressures at the metacarpophalangeal (MCP) joint before and after passage of 2 sizes of antegrade intramedullary fixation.</p><p><strong>Methods: </strong>Seven fresh frozen cadaver specimens without arthritis or deformity were included in this study. Antegrade intramedullary screw fixation of proximal phalanx fracture was simulated using an intra-articular technique. Flexible pressure sensors were inserted into the MCP joints and cyclic loading was performed. Peak contact pressures were determined and averaged across loading cycles for each finger in the native state, with 2.4- and 3.5-mm drill defects in line with the medullary canal.</p><p><strong>Results: </strong>Peak pressure increased with the size of the drill hole defect. Contact pressure increases were greater in extension, with peak contact pressures increased by 24% for the 2.4-mm defect and 52% for the 3.5-mm defect. Increase in peak contact pressure was statistically significant with a 3.5-mm articular defect. Contact pressures were not consistently increased for the 2.4-mm defect. Testing in flexion of 45° resulted in reduced contact pressure for these defects.</p><p><strong>Conclusions: </strong>Our study demonstrates that antegrade intramedullary fixation of proximal phalanx fractures can increase MCP joint peak contact pressures, particularly in an extended joint position. Effect increases with defect size. This has implications for the management of proximal phalanx fractures using this technique.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1308-1313"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9515133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis.
Methods: The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up.
Results: Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up.
Conclusions: Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.
{"title":"Interposition Arthroplasty versus Dual Cup Mobility Prosthesis in Treatment of Trapeziometacarpal Joint Osteoarthritis: A Prospective Randomized Study.","authors":"Matteo Guzzini, Leopoldo Arioli, Alessandro Annibaldi, Stefano Pecchia, Francesca Latini, Andrea Ferretti","doi":"10.1177/15589447231185584","DOIUrl":"10.1177/15589447231185584","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis.</p><p><strong>Methods: </strong>The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up.</p><p><strong>Results: </strong>Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up.</p><p><strong>Conclusions: </strong>Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1260-1268"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-01-10DOI: 10.1177/15589447231221171
Marco Fresa, Laura Bruschi, Sarah Grognuz, Joachim Meuli, Laurent Wehrli, Lucia Mazzolai
Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.
{"title":"Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case.","authors":"Marco Fresa, Laura Bruschi, Sarah Grognuz, Joachim Meuli, Laurent Wehrli, Lucia Mazzolai","doi":"10.1177/15589447231221171","DOIUrl":"10.1177/15589447231221171","url":null,"abstract":"<p><p>Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"NP7-NP12"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2023-07-15DOI: 10.1177/15589447231184896
Vanessa Choi Yin Wong, Darius Balumuka, Young Ji Tuen, Marija Bucevska, Rebecca Courtemanche, Kim Durlacher, Doria Bellows, Sally Hynes, Cynthia Verchere
Background: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.
Methods: The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed.
Results: Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function.
Conclusions: We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.
{"title":"How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb's Type) Birth Injuries.","authors":"Vanessa Choi Yin Wong, Darius Balumuka, Young Ji Tuen, Marija Bucevska, Rebecca Courtemanche, Kim Durlacher, Doria Bellows, Sally Hynes, Cynthia Verchere","doi":"10.1177/15589447231184896","DOIUrl":"10.1177/15589447231184896","url":null,"abstract":"<p><strong>Background: </strong>For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.</p><p><strong>Methods: </strong>The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed.</p><p><strong>Results: </strong>Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function.</p><p><strong>Conclusions: </strong>We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1195-1205"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2023-06-02DOI: 10.1177/15589447231175513
Rachel C Lister, Henry C Bradford, Alex Joo, Catherine W Carr, Anna Delancy, Aparajit Naram, Douglas M Rothkopf, John V Shufflebarger
Background: Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture.
Methods: We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis.
Results: We identified 29 articles that met the inclusion criterion.
Conclusions: A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment.
背景:背侧第三节伸肌(EPL)断裂和腱鞘炎通常与类风湿性关节炎病史或桡骨远端骨折有关。然而,文献表明还有其他多种潜在因素可能导致看似自发性的断裂:我们按照《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)的指导原则进行了系统综述。检索包括与肌腱损伤、肌腱病、手部手术、肌腱转移和注射有关的标题和关键词,这些内容发表在报告和研究中。由两名独立审稿人根据预先确定的纳入和排除标准,通过标题和摘要对引文进行筛选,并由第三名审稿人解决差异问题。符合条件的文章必须满足以下纳入标准:描述自发性EPL断裂或第三背室腱鞘炎的病例。排除标准为任何桡骨远端骨折或类风湿性关节炎病史:结果:我们共发现了 29 篇符合纳入标准的文章:结论:无数的前驱事件或诱发因素最终导致了第三节EPL断裂或腱鞘炎。所描述的重建方法包括初次修复、肌腱移植和肌腱转移技术;所有方法的效果普遍良好。这些结果凸显了该肌腱固有的脆弱性,并支持在发生背侧第三室腱鞘炎时尽早松解 EPL 肌腱的历史性建议。
{"title":"Spontaneous Rupture of the Extensor Pollicis Longus Tendon: A Systematic Review.","authors":"Rachel C Lister, Henry C Bradford, Alex Joo, Catherine W Carr, Anna Delancy, Aparajit Naram, Douglas M Rothkopf, John V Shufflebarger","doi":"10.1177/15589447231175513","DOIUrl":"10.1177/15589447231175513","url":null,"abstract":"<p><strong>Background: </strong>Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture.</p><p><strong>Methods: </strong>We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis.</p><p><strong>Results: </strong>We identified 29 articles that met the inclusion criterion.</p><p><strong>Conclusions: </strong>A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1314-1320"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9563358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15589447241284811
Alexis J Zimbulis, Vincent V G An, Michael Symes, Liron S Duraku, R Glenn Gaston, Kyle R Eberlin, Brahman Sivakumar
Background: Chronic pain remains a significant challenge for individuals following limb amputation, with incidence of painful neuromas, phantom limb pain (PLP), and residual limb pain (RLP). Targeted muscle reinnervation (TMR) is a surgical technique designed to restore motor control information lost during amputation by redirecting residual nerves to new muscle targets. This systematic review and meta-analysis aims to compare patient-reported and functional outcomes following amputation with either TMR or standard neurological treatment (SNT). The study also includes an examination of primary versus secondary TMR and explores outcomes in highly comorbid patient populations.
Methods: A search of central databases was performed, and meta-analysis was completed on extracted data where possible.
Results: Eleven studies were identified. Results indicate a significant reduction in PLP and RLP in patients undergoing TMR compared to SNT using various pain scores. TMR also demonstrates improved functional outcomes and decreased opioid use. Furthermore, results indicated patients who underwent TMR at the time of amputation (primary TMR) had improved pain scores compared with those who had TMR performed later (secondary TMR).
Conclusions: The review emphasizes the benefits of TMR as a valuable surgical adjunct for amputee patients, while also highlighting the need for further research, especially in comorbid populations.
{"title":"Targeted Muscle Reinnervation Compared to Standard Peripheral Nerve Management Following Amputation: A Systematic Review and Meta-Analysis.","authors":"Alexis J Zimbulis, Vincent V G An, Michael Symes, Liron S Duraku, R Glenn Gaston, Kyle R Eberlin, Brahman Sivakumar","doi":"10.1177/15589447241284811","DOIUrl":"10.1177/15589447241284811","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain remains a significant challenge for individuals following limb amputation, with incidence of painful neuromas, phantom limb pain (PLP), and residual limb pain (RLP). Targeted muscle reinnervation (TMR) is a surgical technique designed to restore motor control information lost during amputation by redirecting residual nerves to new muscle targets. This systematic review and meta-analysis aims to compare patient-reported and functional outcomes following amputation with either TMR or standard neurological treatment (SNT). The study also includes an examination of primary versus secondary TMR and explores outcomes in highly comorbid patient populations.</p><p><strong>Methods: </strong>A search of central databases was performed, and meta-analysis was completed on extracted data where possible.</p><p><strong>Results: </strong>Eleven studies were identified. Results indicate a significant reduction in PLP and RLP in patients undergoing TMR compared to SNT using various pain scores. TMR also demonstrates improved functional outcomes and decreased opioid use. Furthermore, results indicated patients who underwent TMR at the time of amputation (primary TMR) had improved pain scores compared with those who had TMR performed later (secondary TMR).</p><p><strong>Conclusions: </strong>The review emphasizes the benefits of TMR as a valuable surgical adjunct for amputee patients, while also highlighting the need for further research, especially in comorbid populations.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241284811"},"PeriodicalIF":16.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15589447241284783
Charlotte L E Laane, Floris V Raasveld, Huub H de Klerk, Daniel T Weigel, Jayanth S Pratap, Neal C Chen, Kyle R Eberlin
Background: Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius.
Methods: The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female.
Results: As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle.
Conclusions: Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures.
{"title":"Anatomy of Lister's Tubercle: Implications for Volar Locked Plating of the Distal Radius.","authors":"Charlotte L E Laane, Floris V Raasveld, Huub H de Klerk, Daniel T Weigel, Jayanth S Pratap, Neal C Chen, Kyle R Eberlin","doi":"10.1177/15589447241284783","DOIUrl":"10.1177/15589447241284783","url":null,"abstract":"<p><strong>Background: </strong>Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius.</p><p><strong>Methods: </strong>The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female.</p><p><strong>Results: </strong>As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle.</p><p><strong>Conclusions: </strong>Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures.</p><p><strong>Level of evidence: </strong>IV-Therapeutic.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241284783"},"PeriodicalIF":16.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/15589447241284791
Jenna M Godfrey, John Benda, Won Jin Choi, Jason D Tavakolian, Erin C Owen
Background: The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting.
Methods: This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR.
Results: Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile.
Conclusions: Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.
{"title":"Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia.","authors":"Jenna M Godfrey, John Benda, Won Jin Choi, Jason D Tavakolian, Erin C Owen","doi":"10.1177/15589447241284791","DOIUrl":"10.1177/15589447241284791","url":null,"abstract":"<p><strong>Background: </strong>The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting.</p><p><strong>Methods: </strong>This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR.</p><p><strong>Results: </strong>Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile.</p><p><strong>Conclusions: </strong>Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241284791"},"PeriodicalIF":16.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 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.
{"title":"Trends in Upper Extremity Saw Injuries From 2003 to 2022.","authors":"Joseph G Monir, Jenny Nguyen, Thomas J McQuillan, Eric R Wagner","doi":"10.1177/15589447241292658","DOIUrl":"10.1177/15589447241292658","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, <i>p</i> < .001). Subgroup analysis showed decreases in number of injuries to fingers (R = -0.82, R2 = 0.67, <i>p</i> < .001) and wrists (R = -0.61, R2 = 0.37, <i>p</i> = .004). The most common diagnoses were lacerations (69.7%), fractures (12.6%), and amputations (9.9%).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241292658"},"PeriodicalIF":16.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-27DOI: 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.
{"title":"Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management.","authors":"Dallan Dargan, Matthew Wyman, Mahir Bhoora, Dominic Ronan, Megan Baker, David Partridge, Jennifer Caddick, Victoria Giblin","doi":"10.1177/15589447241284408","DOIUrl":"10.1177/15589447241284408","url":null,"abstract":"<p><p>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.<b>Level of Evidence:</b> IV.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241284408"},"PeriodicalIF":16.4,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}