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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 16.4 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 16.4 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 16.4 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。
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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 16.4 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。
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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 16.4 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":"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":" ","pages":"15589447241286240"},"PeriodicalIF":16.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463886","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}
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 16.4 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。
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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 16.4 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 16.4 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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引用次数: 0
Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures. 外科医生与临床实践指南的一致性:桡骨远端骨折治疗的定性分析。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-06 DOI: 10.1177/15589447241277843
Emily A Schultz, Sara L Eppler, Lauren M Shapiro, Robin N Kamal

Background: Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures.

Methods: We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain.

Results: We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, "I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion," which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains.

Conclusion: Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

背景:临床实践指南(CPG)的制定旨在指导医生提供一致的高质量护理。尽管桡骨远端骨折的治疗有循证指南,但之前的研究表明,许多患者接受的治疗与 CPG 并不一致。我们试图探索桡骨远端骨折治疗与指南保持一致的障碍和促进因素:我们对治疗桡骨远端骨折的外科医生进行了有目的性的半结构访谈。我们的访谈指南以理论领域框架(TDF)为基础。我们对访谈内容进行了转录,并在 14 个 TDF 领域内采用演绎分析法对访谈内容进行了编码。类似编码所依据的信念陈述被用来描述与指南一致的护理的障碍和促进因素。我们对内容进行了分析,以统计每个 TDF 领域的频率:我们采访了 14 名外科医生。最常见的 TDF 领域是关于后果的信念(110 个)、知识(49 个)和社会影响(29 个)。代表与 CPGs 一致的障碍的信念陈述包括:"当 CPGs 与我的专业意见不同时,我更有可能偏离 CPGs",该陈述被归类为有关后果的信念。在 TDF 领域中,每个主题都有类似的信念陈述:结论:桡骨远端骨折患者的决策制定受到后果信念、知识和社会影响的驱动。在其他领域解决这些信念的策略,如在进一步结构化的共同决策过程中纳入患者因素、开发实施工具包作为 CPG 开发过程的一部分,以及实施支付计划,可能会改善 CPG 的一致性。
{"title":"Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures.","authors":"Emily A Schultz, Sara L Eppler, Lauren M Shapiro, Robin N Kamal","doi":"10.1177/15589447241277843","DOIUrl":"https://doi.org/10.1177/15589447241277843","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures.</p><p><strong>Methods: </strong>We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain.</p><p><strong>Results: </strong>We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, \"I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion,\" which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains.</p><p><strong>Conclusion: </strong>Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241277843"},"PeriodicalIF":1.8,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380687","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
The Effect of Patient-Reported Allergies on Patient-Reported Outcomes in Carpal Tunnel Release. 患者自述的过敏症对腕管松解术患者自述结果的影响
IF 16.4 Q2 ORTHOPEDICS Pub Date : 2024-10-05 DOI: 10.1177/15589447241284304
Anthony Mitchell, Sean Martin, Mohammad N Haider, Alexander Kovacs, Jacob Mogerman, Robert Ablove

Background: Patient-reported allergies have been shown to be a risk factor for poor surgical outcomes in a variety of orthopedic procedures. The relationship between patient-reported allergies and outcomes in carpal tunnel surgery remains unclear.

Methods: A retrospective electronic medical chart review was conducted on 390 patients who underwent primary carpal tunnel releases, without concomitant procedures, who completed preoperative and postoperative Quick Disabilities of Arm, Shoulder, and Hand or Patient-Rated Wrist Evaluation scores, with a minimum of 1-year follow-up. Patient demographic data and patient-reported outcome measures were collected. Patients were grouped based on the number of allergies reported (≤3 allergies or ≥4 allergies), and statistical analysis was performed.

Results: Three hundred and ninety patients were included in the analysis (347 patients [89.0%] with ≤3 allergies; 43 patients [11.0%] with ≥4 allergies). Patients were predominantly female (n = 243, 62.3%), and the median age at surgery was 61 years. Patients with ≥4 allergies were more likely to be female (88.4% vs 59.1%), older (64.3 years vs 60.3 years), and more likely to be taking psychotropic medication (51.2% vs 28.2%). No differences were seen in patient-reported outcomes at any time point preoperatively or postoperatively, with both groups showing similar postoperative improvement.

Conclusions: Patients with a high number of reported allergies have similar improvement in patient-reported outcomes following carpal tunnel release as low-allergy cohorts.

背景:在各种骨科手术中,患者报告的过敏症已被证明是手术效果不佳的风险因素。患者报告的过敏症与腕管手术结果之间的关系仍不清楚:我们对 390 例接受腕管松解术的患者进行了回顾性电子病历审查,这些患者在术前和术后完成了 "手臂、肩部和手部快速残疾评估 "或 "患者评定腕部评估 "评分,并接受了至少 1 年的随访。我们收集了患者的人口统计学数据和患者报告的结果指标。根据报告的过敏症数量(≤3 种过敏症或≥4 种过敏症)对患者进行分组,并进行统计分析:共有 390 名患者参与分析(347 名患者[89.0%]过敏症≤3 种;43 名患者[11.0%]过敏症≥4 种)。患者以女性为主(n = 243,62.3%),手术时的中位年龄为 61 岁。过敏症≥4 种的患者中女性比例更高(88.4% 对 59.1%),年龄更大(64.3 岁对 60.3 岁),服用精神药物的比例更高(51.2% 对 28.2%)。术前和术后任何时间点的患者报告结果均无差异,两组患者的术后改善情况相似:结论:报告有大量过敏症的患者在腕管松解术后的患者报告结果改善程度与低过敏症组相似。
{"title":"The Effect of Patient-Reported Allergies on Patient-Reported Outcomes in Carpal Tunnel Release.","authors":"Anthony Mitchell, Sean Martin, Mohammad N Haider, Alexander Kovacs, Jacob Mogerman, Robert Ablove","doi":"10.1177/15589447241284304","DOIUrl":"10.1177/15589447241284304","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported allergies have been shown to be a risk factor for poor surgical outcomes in a variety of orthopedic procedures. The relationship between patient-reported allergies and outcomes in carpal tunnel surgery remains unclear.</p><p><strong>Methods: </strong>A retrospective electronic medical chart review was conducted on 390 patients who underwent primary carpal tunnel releases, without concomitant procedures, who completed preoperative and postoperative Quick Disabilities of Arm, Shoulder, and Hand or Patient-Rated Wrist Evaluation scores, with a minimum of 1-year follow-up. Patient demographic data and patient-reported outcome measures were collected. Patients were grouped based on the number of allergies reported (≤3 allergies or ≥4 allergies), and statistical analysis was performed.</p><p><strong>Results: </strong>Three hundred and ninety patients were included in the analysis (347 patients [89.0%] with ≤3 allergies; 43 patients [11.0%] with ≥4 allergies). Patients were predominantly female (n = 243, 62.3%), and the median age at surgery was 61 years. Patients with ≥4 allergies were more likely to be female (88.4% vs 59.1%), older (64.3 years vs 60.3 years), and more likely to be taking psychotropic medication (51.2% vs 28.2%). No differences were seen in patient-reported outcomes at any time point preoperatively or postoperatively, with both groups showing similar postoperative improvement.</p><p><strong>Conclusions: </strong>Patients with a high number of reported allergies have similar improvement in patient-reported outcomes following carpal tunnel release as low-allergy cohorts.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447241284304"},"PeriodicalIF":16.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377789","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}
引用次数: 0
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