首页 > 最新文献

HAND最新文献

英文 中文
Six-Week Radiographic Follow-up Does Not Change Management for Nonoperatively Treated Extraarticular Metacarpal Shaft Fractures. 对非手术治疗的掌骨关节外骨折进行六周的放射学随访不会改变治疗方法。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-24 DOI: 10.1177/15589447231170249
Zachary Crawford, Robert B Ponce, Michael Moore, Adam Schumaier, Phillip Ross, Peter Stern

Background: Metacarpal fractures are common and account for over 30% of all hand fractures. Previous literature has shown similar outcomes between operative and nonoperative management of metacarpal shaft fractures. There is little information regarding the natural history of conservatively managed metacarpal shaft fractures and changes in management based on follow-up radiographs.

Methods: A retrospective chart review was performed on all patients who presented to a single institution with an extraarticular metacarpal shaft or base fracture between 2015 and 2019.

Results: Thirty-one patients with 37 metacarpal fractures were included for review: average age 41 years, male 48%, right hand dominant 91%, and average follow-up duration 7.3 weeks. At follow-up, a change of 2.4° in angulation (P = .0005) and a change in shortening of 0.1 mm (P = .0386) were noted over the 6-week time interval. No fractures had malrotation at presentation, and none developed malrotation during the follow-up period.

Conclusions: Recent systematic reviews and meta-analysis have suggested that metacarpal fractures treated nonoperatively had similar outcomes to surgical fixation at 12 months of follow-up. We found that extraarticular metacarpal shaft fractures that do not meet operative indications at the initial visit should be expected to heal reliably with minimal change in angulation and shortening over time. The transition to removable brace or no brace at the 2-week follow-up is likely sufficient, and additional follow-up is not necessary and will reduce cost.

Level of evidence: Level III.

背景介绍掌骨骨折很常见,占所有手部骨折的 30% 以上。以往的文献显示,手术和非手术治疗掌骨骨折的结果相似。有关保守治疗掌骨骨折的自然病史以及根据随访X光片改变治疗方法的信息很少:方法:对2015年至2019年期间在一家机构就诊的所有关节外掌骨干或基底骨折患者进行回顾性病历审查:31名患者共涉及37处掌骨骨折,平均年龄41岁,男性占48%,右手占优势91%,平均随访时间7.3周。随访发现,在 6 周的时间间隔内,成角变化为 2.4°(P = 0.0005),缩短变化为 0.1 mm(P = 0.0386)。没有骨折在出现时发生错位,也没有骨折在随访期间发生错位:最近的系统综述和荟萃分析表明,掌骨骨折非手术治疗在随访12个月后的效果与手术固定相似。我们发现,初次就诊时不符合手术指征的关节外掌骨干骨折应能可靠愈合,随着时间的推移,其成角和缩短的变化也应最小。在两周的随访中,过渡到可移动支架或不使用支架可能就足够了,无需进行额外的随访,而且还能降低成本:证据等级:三级。
{"title":"Six-Week Radiographic Follow-up Does Not Change Management for Nonoperatively Treated Extraarticular Metacarpal Shaft Fractures.","authors":"Zachary Crawford, Robert B Ponce, Michael Moore, Adam Schumaier, Phillip Ross, Peter Stern","doi":"10.1177/15589447231170249","DOIUrl":"10.1177/15589447231170249","url":null,"abstract":"<p><strong>Background: </strong>Metacarpal fractures are common and account for over 30% of all hand fractures. Previous literature has shown similar outcomes between operative and nonoperative management of metacarpal shaft fractures. There is little information regarding the natural history of conservatively managed metacarpal shaft fractures and changes in management based on follow-up radiographs.</p><p><strong>Methods: </strong>A retrospective chart review was performed on all patients who presented to a single institution with an extraarticular metacarpal shaft or base fracture between 2015 and 2019.</p><p><strong>Results: </strong>Thirty-one patients with 37 metacarpal fractures were included for review: average age 41 years, male 48%, right hand dominant 91%, and average follow-up duration 7.3 weeks. At follow-up, a change of 2.4° in angulation (<i>P</i> = .0005) and a change in shortening of 0.1 mm (<i>P</i> = .0386) were noted over the 6-week time interval. No fractures had malrotation at presentation, and none developed malrotation during the follow-up period.</p><p><strong>Conclusions: </strong>Recent systematic reviews and meta-analysis have suggested that metacarpal fractures treated nonoperatively had similar outcomes to surgical fixation at 12 months of follow-up. We found that extraarticular metacarpal shaft fractures that do not meet operative indications at the initial visit should be expected to heal reliably with minimal change in angulation and shortening over time. The transition to removable brace or no brace at the 2-week follow-up is likely sufficient, and additional follow-up is not necessary and will reduce cost.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9516772","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
Anatomical Variations of the First Dorsal Compartment in de Quervain Tenosynovitis. 杜氏腱鞘炎第一背室的解剖变异
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-19 DOI: 10.1177/15589447231164746
Christina Liu, Stephen Moye, Philip Blazar, Brandon E Earp, Dafang Zhang

Background: De Quervain tenosynovitis of the wrist is a common pathology. The primary aim of this study is to determine the prevalence of extensor pollicis brevis and abductor pollicis longus (APL) anatomical variations in association with de Quervain tenosynovitis. The secondary aim was to compare additional patient-specific factors associated with de Quervain tenosynovitis.

Methods: This retrospective study included 172 patients with de Quervain tenosynovitis who underwent first dorsal compartment release and 179 patients with thumb carpometacarpal (CMC) arthritis who underwent thumb CMC arthroplasty between August 1, 2007, and May 1, 2022. The CMC group was chosen as the control group because the study surgeons perform APL suspensionplasty as the primary procedure for thumb CMC arthritis, allowing for a comparison group without de Quervain tenosynovitis. Exclusion criteria included patients undergoing revision surgery, patients undergoing thumb CMC procedure other than APL suspensionplasty, and patients with both CMC and first dorsal compartment diagnoses. Demographics, clinical variables, and intraoperative findings were collected through retrospective chart reviews.

Results: Patients in the de Quervain tenosynovitis group tended to be younger (51 years, range: 23-92 years vs 63 years, range: 28-85 years), women (86.1% vs 77.1%), and more commonly of African American or black race (15.7% vs 3.9%) and Asian race (5.2% vs 0%). There was a higher prevalence of tendon subcompartments (79.1% vs 64.2%), but fewer number of APL slips (38.3% vs 20.7% 2 or fewer slips) seen in the de Quervain tenosynovitis group.

Conclusion: Anatomical variation exists between patients with and without de Quervain tenosynovitis. The presence of tendon subcompartments but not an increased number of tendon slips is associated with de Quervain tenosynovitis.

背景:腕部的杜氏腱鞘炎是一种常见病。本研究的主要目的是确定伸拇肌和内收肌(APL)解剖变异与杜氏腱鞘炎的相关性。次要目的是比较与杜氏腱鞘炎相关的其他患者特异性因素:这项回顾性研究纳入了2007年8月1日至2022年5月1日期间接受第一背室松解术的172例德-夸因腱鞘炎患者和接受拇指CMC关节成形术的179例拇指腕掌(CMC)关节炎患者。之所以选择CMC组作为对照组,是因为该研究的外科医生将APL悬吊成形术作为治疗拇指CMC关节炎的主要手术,这样就可以将没有患上杜氏腱鞘炎的患者作为对比组。排除标准包括接受翻修手术的患者、接受 APL 悬吊成形术以外的拇指 CMC 手术的患者,以及同时诊断为 CMC 和第一背室的患者。通过回顾性病历审查收集了患者的人口统计学特征、临床变量和术中发现:结果显示:杜氏腱鞘炎组患者的年龄更小(51岁,范围:23-92岁 vs 63岁,范围:28-85岁),女性(86.1% vs 77.1%),非裔美国人或黑人(15.7% vs 3.9%)和亚裔(5.2% vs 0%)更多。在杜氏腱鞘炎组中,肌腱亚节的发病率较高(79.1% vs 64.2%),但APL滑脱的数量较少(38.3% vs 20.7% 2个或更少):结论:患有和未患有杜氏腱鞘炎的患者在解剖学上存在差异。结论:患有和未患有杜氏腱鞘炎的患者在解剖结构上存在差异,肌腱亚分区的存在与杜氏腱鞘炎有关,但肌腱滑脱数量的增加与杜氏腱鞘炎无关。
{"title":"Anatomical Variations of the First Dorsal Compartment in de Quervain Tenosynovitis.","authors":"Christina Liu, Stephen Moye, Philip Blazar, Brandon E Earp, Dafang Zhang","doi":"10.1177/15589447231164746","DOIUrl":"10.1177/15589447231164746","url":null,"abstract":"<p><strong>Background: </strong>De Quervain tenosynovitis of the wrist is a common pathology. The primary aim of this study is to determine the prevalence of extensor pollicis brevis and abductor pollicis longus (APL) anatomical variations in association with de Quervain tenosynovitis. The secondary aim was to compare additional patient-specific factors associated with de Quervain tenosynovitis.</p><p><strong>Methods: </strong>This retrospective study included 172 patients with de Quervain tenosynovitis who underwent first dorsal compartment release and 179 patients with thumb carpometacarpal (CMC) arthritis who underwent thumb CMC arthroplasty between August 1, 2007, and May 1, 2022. The CMC group was chosen as the control group because the study surgeons perform APL suspensionplasty as the primary procedure for thumb CMC arthritis, allowing for a comparison group without de Quervain tenosynovitis. Exclusion criteria included patients undergoing revision surgery, patients undergoing thumb CMC procedure other than APL suspensionplasty, and patients with both CMC and first dorsal compartment diagnoses. Demographics, clinical variables, and intraoperative findings were collected through retrospective chart reviews.</p><p><strong>Results: </strong>Patients in the de Quervain tenosynovitis group tended to be younger (51 years, range: 23-92 years vs 63 years, range: 28-85 years), women (86.1% vs 77.1%), and more commonly of African American or black race (15.7% vs 3.9%) and Asian race (5.2% vs 0%). There was a higher prevalence of tendon subcompartments (79.1% vs 64.2%), but fewer number of APL slips (38.3% vs 20.7% 2 or fewer slips) seen in the de Quervain tenosynovitis group.</p><p><strong>Conclusion: </strong>Anatomical variation exists between patients with and without de Quervain tenosynovitis. The presence of tendon subcompartments but not an increased number of tendon slips is associated with de Quervain tenosynovitis.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9440761","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
Area Deprivation Index Is Not Associated With the Severity of Carpal Tunnel Syndrome. 地区贫困指数与腕管综合征的严重程度无关。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-26 DOI: 10.1177/15589447231167591
Nicholas F Aloi, Haris Rahman, John R Fowler

Background: While living in a socially disadvantaged neighborhood is linked with numerous health outcomes, its effect on patient-reported outcome scores and diagnostic measures in carpal tunnel syndrome (CTS) is not fully understood. This study examines the effect of neighborhood socioeconomic deprivation on CTS severity as measured by the Boston Carpal Tunnel Questionnaire (BCTQ), 6-item Carpal Tunnel Symptoms Scale (CTS-6), and diagnostic testing modalities.

Methods: This was a retrospective analysis of patients who presented to the hand clinic at a single hospital system with symptoms consistent with CTS. Ultrasound cross-sectional area (CSA) of the median nerve, CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ, and the Area Deprivation Index (ADI) national rank percentile were collected. Patients were grouped into 4 quartiles based on their ADI national percentile. Analyses of variance (ANOVAs) were conducted to test for statistical differences between the 4 quartiles based on the average values of median nerve CSA, CTS-6, SSS, and FSS score. The bottom quartile was compared with the upper 75% of the sample (26th-100th percentile) and to the upper quartile via Student t test. Statistical significance was set at P < .05.

Results: Analyses of variance revealed no statistically significant differences between the 4 quartiles for either median nerve CSA, CTS-6, SSS, or FSS. When comparing the bottom quartile with the upper 75% of the sample and the upper quartile, no significant statistical differences were identified.

Conclusions: No relationships were found between social deprivation (ADI) and patient-reported outcomes, CTS-6 scores, or median nerve CSA.

背景:虽然生活在社会处境不利的社区与许多健康结果有关,但其对患者报告的结果评分和腕管综合征(CTS)诊断措施的影响尚未完全明了。本研究通过波士顿腕管问卷(BCTQ)、6 项腕管症状量表(CTS-6)和诊断测试方式,探讨了邻里社会经济贫困对 CTS 严重程度的影响:这是一项回顾性分析,对象是在一家医院手部门诊就诊、症状与 CTS 一致的患者。收集了正中神经超声横截面积(CSA)、CTS-6、BCTQ症状严重程度量表(SSS)和功能状态量表(FSS)以及地区贫困指数(ADI)全国百分位数。根据 ADI 全国百分位数将患者分为 4 个四分位组。根据正中神经CSA、CTS-6、SSS和FSS评分的平均值进行方差分析(ANOVA),以检验4个四分位组之间的统计差异。通过学生 t 检验将下四分位数与上 75% 的样本(第 26-100 百分位数)和上四分位数进行比较。统计显著性以 P < .05 为标准:方差分析显示,正中神经 CSA、CTS-6、SSS 或 FSS 在 4 个四分位数之间均无显著统计学差异。在将下四分位数与上 75% 的样本和上四分位数进行比较时,也未发现明显的统计学差异:结论:未发现社会贫困(ADI)与患者报告的结果、CTS-6评分或正中神经CSA之间存在关系。
{"title":"Area Deprivation Index Is Not Associated With the Severity of Carpal Tunnel Syndrome.","authors":"Nicholas F Aloi, Haris Rahman, John R Fowler","doi":"10.1177/15589447231167591","DOIUrl":"10.1177/15589447231167591","url":null,"abstract":"<p><strong>Background: </strong>While living in a socially disadvantaged neighborhood is linked with numerous health outcomes, its effect on patient-reported outcome scores and diagnostic measures in carpal tunnel syndrome (CTS) is not fully understood. This study examines the effect of neighborhood socioeconomic deprivation on CTS severity as measured by the Boston Carpal Tunnel Questionnaire (BCTQ), 6-item Carpal Tunnel Symptoms Scale (CTS-6), and diagnostic testing modalities.</p><p><strong>Methods: </strong>This was a retrospective analysis of patients who presented to the hand clinic at a single hospital system with symptoms consistent with CTS. Ultrasound cross-sectional area (CSA) of the median nerve, CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ, and the Area Deprivation Index (ADI) national rank percentile were collected. Patients were grouped into 4 quartiles based on their ADI national percentile. Analyses of variance (ANOVAs) were conducted to test for statistical differences between the 4 quartiles based on the average values of median nerve CSA, CTS-6, SSS, and FSS score. The bottom quartile was compared with the upper 75% of the sample (26th-100th percentile) and to the upper quartile via Student <i>t</i> test. Statistical significance was set at <i>P</i> < .05.</p><p><strong>Results: </strong>Analyses of variance revealed no statistically significant differences between the 4 quartiles for either median nerve CSA, CTS-6, SSS, or FSS. When comparing the bottom quartile with the upper 75% of the sample and the upper quartile, no significant statistical differences were identified.</p><p><strong>Conclusions: </strong>No relationships were found between social deprivation (ADI) and patient-reported outcomes, CTS-6 scores, or median nerve CSA.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9405604","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
Improved Outcomes in Operative Management of Concomitant Distal Radius and Scaphoid Fractures. 改善桡骨远端和肩胛骨同时骨折的手术治疗效果。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-12 DOI: 10.1177/15589447231163943
Luke Verlinsky, Clinton Ulmer, Alec Rose, Christina Brady, Ryan Rose

Background: This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management.

Methods: A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion.

Results: In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction).

Conclusions: This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures.

背景:本研究旨在调查桡骨远端和肩胛骨同时骨折的特征,并确定手术和非手术治疗的结果差异:本研究旨在调查桡骨远端和肩胛骨同时骨折的特征,并确定手术和非手术治疗的结果差异:方法:对一级创伤中心数据库中15年(2007-2022年)内成人桡骨远端和肩胛骨同时骨折的病例进行回顾性检索。共对 31 例病例的损伤机制、骨折处理方法、桡骨远端骨折 AO 基金会/骨科创伤协会分类、肩胛骨骨折分类、肩胛骨放射学结合时间、活动时间和其他人口统计学特征进行了回顾。我们完成了一项多变量统计分析,比较了这些患者肩胛骨骨折手术治疗与保守治疗的结果。结果:结果:共审查了 22 例手术固定肩胛骨的病例和 9 例非手术治疗肩胛骨的病例。手术组中有一例未愈合。对肩胛骨骨折进行手术治疗可显著缩短活动时间(2周后复位)和影像学结合时间(8周后复位):这项研究表明,在同时发生桡骨远端骨折的情况下,对肩胛骨骨折进行手术治疗可缩短影像学结合时间和临床活动时间。这表明,对于适合手术且希望尽早恢复活动的患者来说,手术治疗是理想的选择。不过,也应考虑保守治疗,因为非手术治疗在肩胛骨或桡骨远端骨折的愈合率方面没有统计学差异。
{"title":"Improved Outcomes in Operative Management of Concomitant Distal Radius and Scaphoid Fractures.","authors":"Luke Verlinsky, Clinton Ulmer, Alec Rose, Christina Brady, Ryan Rose","doi":"10.1177/15589447231163943","DOIUrl":"10.1177/15589447231163943","url":null,"abstract":"<p><strong>Background: </strong>This study aims to investigate the characteristics of concomitant distal radius and scaphoid fractures and determine outcome differences of operative and nonoperative management.</p><p><strong>Methods: </strong>A retrospective search of a level-1 trauma center's database over a 15-year period (2007-2022) for concomitant distal radius and scaphoid fractures in adult patients was completed. In all, 31 cases were reviewed for mechanism of injury, method of fracture management, distal radius fracture AO Foundation/Orthopaedic Trauma Association classification, scaphoid fracture classification, time to radiographic scaphoid union, time to motion, and other demographics. A multivariate statistical analysis was completed comparing outcomes in operative versus conservative management of the scaphoid fracture in these patients. Outcomes were defined as time to radiographic union and time to motion.</p><p><strong>Results: </strong>In all, 22 cases of operative fixation of the scaphoid and 9 cases of nonoperative management of the scaphoid were reviewed. One case of nonunion was identified in the operative group. Operative management of scaphoid fractures resulted in a statistically significant reduction in time to motion (2-week reduction) and time to radiographic union (8-week reduction).</p><p><strong>Conclusions: </strong>This study demonstrates that operative management of scaphoid fractures in the setting of a concomitant distal radius fracture reduces the time to radiographic union and time to clinical motion. This suggests that operative management is ideal in patients who are good candidates for surgery and desire earlier return of motion. However, conservative management should be considered, as nonoperative care showed no statistical difference regarding union rates of scaphoid or distal radius fractures.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9283357","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
Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic. 非住院选修科:大流行病期间仅局部麻醉手术的经验。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-03 DOI: 10.1177/15589447231158810
Edward Jeans, Sumedh Talwalkar, Tadesse Gebrye, Gillian Yeowell, Francis Fatoye, Mike Hayton

Background: The second COVID-19 wave severely limited access to elective surgery.

Methods: Between December 2020 and May 2021, 530 patients underwent a procedure in the elective ambulatory unit (EAU), a walk-in and walk-out model of surgery, and we used a prepandemic cohort of day-case patients for comparison.

Results: We have had no confirmed cases of COVID-19 transmission on-site. The infection rate for EAU and day-case units for carpal tunnel decompression was 1.36% and 2%, respectively, and this difference was not significant, P = .696. Patient satisfaction was excellent at 9.8 of 10. The waiting time from primary care referral to carpal tunnel decompression was cut from 36 weeks to 12 weeks during the study period. Significant benefit in efficiency and cost saving was also found.

Conclusion: Elective ambulatory unit provides a template to perform high-volume low-complexity hand and wrist surgery in a safe, efficient, and cost-effective manner.

背景: 第二次 COVID-19 浪潮严重限制了择期手术的机会:第二轮COVID-19严重限制了患者接受择期手术:2020年12月至2021年5月期间,530名患者在非住院择期手术室(EAU)接受了手术,这是一种即入即出的手术模式:结果:我们没有发现 COVID-19 现场传播的确诊病例。腕管减压术的EAU和日间病房感染率分别为1.36%和2%,差异不显著,P = .696。患者满意度为 9.8 分(满分为 10 分)。研究期间,从初级保健转诊到腕管减压术的等待时间从 36 周缩短至 12 周。研究还发现,在提高效率和节约成本方面也取得了显著成效:选择性门诊部提供了一个模板,可以安全、高效、经济地实施高产量、低复杂度的手部和腕部手术。
{"title":"Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic.","authors":"Edward Jeans, Sumedh Talwalkar, Tadesse Gebrye, Gillian Yeowell, Francis Fatoye, Mike Hayton","doi":"10.1177/15589447231158810","DOIUrl":"10.1177/15589447231158810","url":null,"abstract":"<p><strong>Background: </strong>The second COVID-19 wave severely limited access to elective surgery.</p><p><strong>Methods: </strong>Between December 2020 and May 2021, 530 patients underwent a procedure in the elective ambulatory unit (EAU), a walk-in and walk-out model of surgery, and we used a prepandemic cohort of day-case patients for comparison.</p><p><strong>Results: </strong>We have had no confirmed cases of COVID-19 transmission on-site. The infection rate for EAU and day-case units for carpal tunnel decompression was 1.36% and 2%, respectively, and this difference was not significant, <i>P</i> = .696. Patient satisfaction was excellent at 9.8 of 10. The waiting time from primary care referral to carpal tunnel decompression was cut from 36 weeks to 12 weeks during the study period. Significant benefit in efficiency and cost saving was also found.</p><p><strong>Conclusion: </strong>Elective ambulatory unit provides a template to perform high-volume low-complexity hand and wrist surgery in a safe, efficient, and cost-effective manner.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10071184/pdf/10.1177_15589447231158810.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9324038","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
The Scratch-Collapse Test: A Systematic Review and Statistical Analysis. 划痕-塌陷测试:系统回顾与统计分析
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-24 DOI: 10.1177/15589447231174483
Nirbhay S Jain, Brian Zukotynski, Meaghan L Barr, Abigail Cortez, Prosper Benhaim

Background: The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a controversial point in the literature in regard to its exact clinical application. We performed a systematic review and statistical analysis to provide statistical data on SCT outcomes and elucidate its role in diagnosing compressive conditions.

Methods: We performed a systematic review of the literature according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. We extracted data of patients with outcomes on the SCT (yes/no) and on an accepted gold standard examination (electrodiagnostic studies). These data were analyzed using a statistical software program to generate the sensitivity and specificity values of the pooled data, as well as kappa agreement statistics.

Results: For patients with carpal tunnel, cubital tunnel, peroneal, and pronator compressive neuropathies, the overall sensitivity of the SCT was 38%, and the specificity was 94%, with the kappa statistic approximately 0.4. Sensitivity and specificity values were higher for cubital tunnel syndrome and peroneal compression syndrome but lower for carpal tunnel syndrome. Pronator syndrome was also examined, but the data were inadequate for analysis.

Conclusions: The SCT is a useful adjunct in the armament of diagnostic tools for the hand surgeon. Given its low sensitivity and high specificity, SCT should be used as a confirmatory test, rather than as a diagnostic screening test. More analyses are needed to identify subtler applications.

背景:划痕-塌陷试验(SCT)是一种用于诊断压迫性神经病的刺激性手法。尽管有多项研究支持其使用,但 SCT 在文献中的确切临床应用仍存在争议。我们进行了一项系统性回顾和统计分析,以提供有关 SCT 结果的统计数据,并阐明其在诊断压迫性疾病中的作用:我们根据《系统综述和荟萃分析首选报告指南》对文献进行了系统综述。我们提取了在 SCT(是/否)和公认的金标准检查(电诊断研究)中有结果的患者数据。我们使用统计软件程序对这些数据进行了分析,以生成汇总数据的灵敏度和特异性值以及卡帕一致性统计:对于腕管、肘管、腓肠肌和代指压迫性神经病患者,SCT 的总体灵敏度为 38%,特异度为 94%,卡帕统计量约为 0.4。肘隧道综合征和腓肠肌压迫综合征的敏感性和特异性值较高,而腕隧道综合征的敏感性和特异性值较低。此外,还对腓肠肌综合征进行了检查,但数据不足以进行分析:结论:SCT 是手外科医生诊断工具中一个有用的辅助工具。鉴于其灵敏度低、特异性高,SCT 应被用作确诊试验,而不是诊断筛查试验。需要进行更多的分析,以确定更微妙的应用。
{"title":"The Scratch-Collapse Test: A Systematic Review and Statistical Analysis.","authors":"Nirbhay S Jain, Brian Zukotynski, Meaghan L Barr, Abigail Cortez, Prosper Benhaim","doi":"10.1177/15589447231174483","DOIUrl":"10.1177/15589447231174483","url":null,"abstract":"<p><strong>Background: </strong>The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a controversial point in the literature in regard to its exact clinical application. We performed a systematic review and statistical analysis to provide statistical data on SCT outcomes and elucidate its role in diagnosing compressive conditions.</p><p><strong>Methods: </strong>We performed a systematic review of the literature according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. We extracted data of patients with outcomes on the SCT (yes/no) and on an accepted gold standard examination (electrodiagnostic studies). These data were analyzed using a statistical software program to generate the sensitivity and specificity values of the pooled data, as well as kappa agreement statistics.</p><p><strong>Results: </strong>For patients with carpal tunnel, cubital tunnel, peroneal, and pronator compressive neuropathies, the overall sensitivity of the SCT was 38%, and the specificity was 94%, with the kappa statistic approximately 0.4. Sensitivity and specificity values were higher for cubital tunnel syndrome and peroneal compression syndrome but lower for carpal tunnel syndrome. Pronator syndrome was also examined, but the data were inadequate for analysis.</p><p><strong>Conclusions: </strong>The SCT is a useful adjunct in the armament of diagnostic tools for the hand surgeon. Given its low sensitivity and high specificity, SCT should be used as a confirmatory test, rather than as a diagnostic screening test. More analyses are needed to identify subtler applications.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881672","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
Readability of Online Patient Education Materials for Congenital Hand Differences. 先天性手部差异在线患者教育材料的可读性。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-02 DOI: 10.1177/15589447231168907
Alexander J Baldwin

Background: The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences.

Methods: The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook Index (SMOG). To account for the potential effect of each condition's name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s.

Results: The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly (P < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample t test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI (P = .009) and median grade metrics (P = .048). A 1-way analysis of variance revealed no influence of condition or source on readability.

Conclusion: Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition's name.

背景:本研究旨在评估有关先天性手部差异的在线患者教育材料(PEM)的可读性:本研究旨在评估有关先天性手部差异的在线患者教育材料(PEMs)的可读性:方法:针对 10 种疾病(多指畸形、联合actyly、扳机指/拇指、clinodactyly、camptodactyly、symbrachydactyly、拇指发育不良、桡骨发育不良、还原缺损和羊膜带综合征),对排名前 10 位的英文在线患者教育材料进行了汇编,并按来源和国家进行了分类。使用 5 种工具对可读性进行评估:弗莱施阅读容易程度评分(FRES)、弗莱施-金凯德等级水平(FKGL)、贡宁雾指数(GFI)、科尔曼-利亚指数(CLI)和简单拗口指数(SMOG)。为了考虑上述公式中每个条件的名称可能产生的影响,在用单音节词替换名称后重复进行了分析:100 份 PEM 的平均可读性得分分别为:FRES 56.3(目标值≥80)、FKGL 8.8、GFI 11.5、CLI 10.9 和 SMOG 8.6,等级得分中位数为 9.8(目标值≤6.9)。调整后,所有可读性得分均有显著提高(P < .001)。调整后的得分分别为 FRES 63.8、FKGL 7.8、GFI 10.7、CLI 9.1 和 SMOG 8.0,等级分中位数为 8.6。只有 1 个网页使用所有工具达到了目标水平。出版国(美国和英国)的双样本 t 检验表明,使用调整前 CLI(P = .009)和等级指标中位数(P = .048),来自英国的 PEM 更容易阅读。单因素方差分析显示,条件或来源对可读性没有影响:大多数关于先天性手部差异的在线 PEM 的书写水平都高于建议的六年级阅读水平,即使调整了条件名称的影响也是如此。
{"title":"Readability of Online Patient Education Materials for Congenital Hand Differences.","authors":"Alexander J Baldwin","doi":"10.1177/15589447231168907","DOIUrl":"10.1177/15589447231168907","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences.</p><p><strong>Methods: </strong>The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook Index (SMOG). To account for the potential effect of each condition's name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s.</p><p><strong>Results: </strong>The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly (<i>P</i> < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample <i>t</i> test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI (<i>P</i> = .009) and median grade metrics (<i>P</i> = .048). A 1-way analysis of variance revealed no influence of condition or source on readability.</p><p><strong>Conclusion: </strong>Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition's name.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9456749","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
Stener-Like Lesions in the Hand: A Qualitative Review. 手部斯特纳样病变:定性综述。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-05-22 DOI: 10.1177/15589447231171655
Tiffany A Smith, Brian Bueno, Joseph V Phelan, Divya Anand, David Kirschenbaum, Brian M Katt

A Stener-like lesion is defined as the interposition of the sagittal band between the torn collateral ligament of the metacarpophalangeal (MCP) joint of a finger and its origin or insertion. Owing to the rarity of this injury, standardized protocols on the diagnosis and care of these injuries are not currently available. PubMed Central and Google Scholar were searched for published studies from 1962 to 2022. Inclusion criteria admitted any injury of the MCP joints of any nonthumb fingers involving a torn collateral ligament with sagittal band injury that trapped the collateral ligament. Eight studies were ultimately included in our analysis and contained 11 cases of Stener-like lesions. Eight of the 11 cases presented radial collateral ligament injury to the ring and little fingers. All 11 cases presented showed that detailed physical examination was a primary step in diagnosis of these lesions. Metacarpophalangeal joint laxity was present in all cases reported. Imaging-aided diagnosis was used in majority of the cases presented and included arthrography, ultrasound, or magnetic resonance imaging. All cases presented in this review were managed surgically. Following surgical repair, a majority of authors opted to use immobilization techniques immediately postoperatively. As awareness of this injury pattern increases, a standardized treatment algorithm may develop.

斯特纳样损伤的定义是手指掌指关节(MCP)撕裂的副韧带与其起源或插入点之间的矢状带间隙。由于这种损伤非常罕见,目前还没有关于这种损伤的标准化诊断和护理方案。我们在 PubMed Central 和 Google Scholar 上搜索了 1962 年至 2022 年发表的研究。纳入标准包括任何涉及副韧带撕裂的非拇指MCP关节损伤,以及困住副韧带的矢状带损伤。我们的分析最终纳入了八项研究,其中包含 11 例斯特纳样病变。在这 11 个病例中,有 8 个病例的桡侧副韧带损伤发生在无名指和小指上。所有 11 个病例都表明,详细的体格检查是诊断这些病变的首要步骤。报告的所有病例均存在掌指关节松弛。大多数病例均采用影像辅助诊断,包括关节造影、超声波或磁共振成像。本综述中介绍的所有病例均采用手术治疗。手术修复后,大多数作者选择在术后立即使用固定技术。随着人们对这种损伤模式认识的提高,可能会形成一种标准化的治疗算法。
{"title":"Stener-Like Lesions in the Hand: A Qualitative Review.","authors":"Tiffany A Smith, Brian Bueno, Joseph V Phelan, Divya Anand, David Kirschenbaum, Brian M Katt","doi":"10.1177/15589447231171655","DOIUrl":"10.1177/15589447231171655","url":null,"abstract":"<p><p>A Stener-like lesion is defined as the interposition of the sagittal band between the torn collateral ligament of the metacarpophalangeal (MCP) joint of a finger and its origin or insertion. Owing to the rarity of this injury, standardized protocols on the diagnosis and care of these injuries are not currently available. PubMed Central and Google Scholar were searched for published studies from 1962 to 2022. Inclusion criteria admitted any injury of the MCP joints of any nonthumb fingers involving a torn collateral ligament with sagittal band injury that trapped the collateral ligament. Eight studies were ultimately included in our analysis and contained 11 cases of Stener-like lesions. Eight of the 11 cases presented radial collateral ligament injury to the ring and little fingers. All 11 cases presented showed that detailed physical examination was a primary step in diagnosis of these lesions. Metacarpophalangeal joint laxity was present in all cases reported. Imaging-aided diagnosis was used in majority of the cases presented and included arthrography, ultrasound, or magnetic resonance imaging. All cases presented in this review were managed surgically. Following surgical repair, a majority of authors opted to use immobilization techniques immediately postoperatively. As awareness of this injury pattern increases, a standardized treatment algorithm may develop.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9853335","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
Necrotizing Sweet Syndrome of the Hand and Forearm in the Immediate Postoperative Period: Case Report. 术后即刻手前臂坏死性Sweet综合征1例报告。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-11-09 DOI: 10.1177/15589447231207978
Andrew M Hresko, Brent B Pickrell, Carl M Harper

Necrotizing soft tissue infection (NSTI) is a feared and potentially morbid postoperative complication requiring prompt surgical intervention. Cutaneous conditions that mimic NSTI have been reported and rarely occur in the postoperative period. Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a dermatologic condition characterized by fever, neutrophil-predominant leukocytosis, and painful skin lesions. Necrotizing Sweet syndrome (NSS) is an aggressive variant that causes a clinical appearance of localized skin necrosis and histologic evidence of necrotic foci extending to the deep aspects of the soft tissues and involving fascia and/or skeletal muscle. Necrotizing Sweet syndrome can be easily mistaken for NSTI. Contrary to infection, Sweet syndrome and NSS are worsened by surgical intervention due to the phenomenon of pathergy and readily respond to corticosteroid treatment. We present the case of a 54-year-old woman who developed NSS following an uncomplicated fasciectomy for Dupuytren disease.

坏死性软组织感染(NSTI)是一种令人担忧的潜在病态术后并发症,需要及时手术干预。据报道,类似NSTI的皮肤状况很少发生在术后。Sweet综合征,也称为急性发热性中性粒细胞性皮肤病,是一种以发热、中性粒细胞为主的白细胞增多和疼痛性皮肤病变为特征的皮肤病。坏死性Sweet综合征(NSS)是一种侵袭性变体,可导致局部皮肤坏死的临床表现和坏死灶延伸至软组织深层并涉及筋膜和/或骨骼肌的组织学证据。坏死性Sweet综合征很容易被误认为是NSTI。与感染相反,Sweet综合征和NSS由于能量不足的现象而通过手术干预恶化,并且容易对皮质类固醇治疗产生反应。我们报告了一例54岁的女性,她在Dupuytren病的简单筋膜切除术后发展为NSS。
{"title":"Necrotizing Sweet Syndrome of the Hand and Forearm in the Immediate Postoperative Period: Case Report.","authors":"Andrew M Hresko, Brent B Pickrell, Carl M Harper","doi":"10.1177/15589447231207978","DOIUrl":"10.1177/15589447231207978","url":null,"abstract":"<p><p>Necrotizing soft tissue infection (NSTI) is a feared and potentially morbid postoperative complication requiring prompt surgical intervention. Cutaneous conditions that mimic NSTI have been reported and rarely occur in the postoperative period. Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a dermatologic condition characterized by fever, neutrophil-predominant leukocytosis, and painful skin lesions. Necrotizing Sweet syndrome (NSS) is an aggressive variant that causes a clinical appearance of localized skin necrosis and histologic evidence of necrotic foci extending to the deep aspects of the soft tissues and involving fascia and/or skeletal muscle. Necrotizing Sweet syndrome can be easily mistaken for NSTI. Contrary to infection, Sweet syndrome and NSS are worsened by surgical intervention due to the phenomenon of pathergy and readily respond to corticosteroid treatment. We present the case of a 54-year-old woman who developed NSS following an uncomplicated fasciectomy for Dupuytren disease.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72014048","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
The Iatrogenic Injury Potential of Self-adherent, Elastic Bandages in Finger Injuries. 手指受伤时自粘弹力绷带可能造成的先天性损伤。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-01 Epub Date: 2023-04-13 DOI: 10.1177/15589447231160208
Henry H Yu, Jason Nadeau, Jenna Powell, Charles Fox, Alexander Lauder, Kyros Ipaktchi

Background: The use of a self-adherent, elastic bandage is a practical way to dress finger injuries. Multiple reports describe iatrogenic injuries from elastic bandages, ranging from skin necrosis to finger gangrene, necessitating amputations. This study investigated whether elastic bandages can compromise digital perfusion by occluding arterial blood flow in healthy volunteers and evaluated the utility of pulse oximetry as a monitoring tool for digital perfusion. A technique for safe bandage application is proposed.

Methods: A commercially available elastic bandage was wrapped around the index finger of 20 healthy volunteers at varying degrees of stretch. Digital perfusion measurements were carried out using photoelectric pulse transduction, laser Doppler flowmetry, and pulse oximetry. Intracompartmental pressure measurements were recorded using a separate in vitro experimental model.

Results: Elastic bandages applied at maximum stretch did not change digital brachial index or pulse oximetry values, suggesting arterial blood flow was preserved distal to the bandage. Intracompartmental pressure measurements at maximum stretch remained below the systolic digital pressure. In contrast, superficial dermal perfusion fell to 32% of normal as measured by laser Doppler flow, at 100% bandage stretch.

Conclusion: This study suggests a risk for iatrogenic injury when using elastic bandages for finger dressings. While arterial inflow was never compromised, pressures were high enough to occlude superficial venous outflow, which may begin at 20% bandage stretch. Pulse oximetry failed to detect changes distal to applied dressings, and we do not recommend it to detect digital vascular compromise in this setting.

背景:使用自粘弹力绷带包扎手指损伤是一种实用的方法。多份报告描述了弹力绷带造成的先天性损伤,从皮肤坏死到手指坏疽,导致必须截肢。本研究调查了弹性绷带是否会通过阻断健康志愿者的动脉血流而影响数字血流灌注,并评估了脉搏血氧仪作为数字血流灌注监测工具的实用性。本文提出了一种安全使用绷带的技术:方法:在 20 名健康志愿者的食指上缠绕不同拉伸程度的市售弹力绷带。使用光电脉冲传导、激光多普勒血流测量仪和脉搏血氧仪进行数字灌注测量。使用单独的体外实验模型记录了瓣膜内压力测量结果:结果:在最大拉伸状态下使用弹性绷带不会改变数字肱动脉指数或脉搏氧饱和度值,表明绷带远端动脉血流保持不变。最大拉伸时的椎间隙内压测量值仍低于数字收缩压。相反,根据激光多普勒血流测量,在绷带拉伸100%时,真皮浅层的血流灌注下降到正常值的32%:这项研究表明,使用弹力绷带包扎手指存在先天性损伤的风险。虽然动脉血流从未受到影响,但压力高到足以堵塞浅静脉流出,这可能从绷带拉伸 20% 开始。脉搏血氧仪无法检测到敷料远端的变化,因此我们不建议在这种情况下使用脉搏血氧仪检测数字血管受损情况。
{"title":"The Iatrogenic Injury Potential of Self-adherent, Elastic Bandages in Finger Injuries.","authors":"Henry H Yu, Jason Nadeau, Jenna Powell, Charles Fox, Alexander Lauder, Kyros Ipaktchi","doi":"10.1177/15589447231160208","DOIUrl":"10.1177/15589447231160208","url":null,"abstract":"<p><strong>Background: </strong>The use of a self-adherent, elastic bandage is a practical way to dress finger injuries. Multiple reports describe iatrogenic injuries from elastic bandages, ranging from skin necrosis to finger gangrene, necessitating amputations. This study investigated whether elastic bandages can compromise digital perfusion by occluding arterial blood flow in healthy volunteers and evaluated the utility of pulse oximetry as a monitoring tool for digital perfusion. A technique for safe bandage application is proposed.</p><p><strong>Methods: </strong>A commercially available elastic bandage was wrapped around the index finger of 20 healthy volunteers at varying degrees of stretch. Digital perfusion measurements were carried out using photoelectric pulse transduction, laser Doppler flowmetry, and pulse oximetry. Intracompartmental pressure measurements were recorded using a separate in vitro experimental model.</p><p><strong>Results: </strong>Elastic bandages applied at maximum stretch did not change digital brachial index or pulse oximetry values, suggesting arterial blood flow was preserved distal to the bandage. Intracompartmental pressure measurements at maximum stretch remained below the systolic digital pressure. In contrast, superficial dermal perfusion fell to 32% of normal as measured by laser Doppler flow, at 100% bandage stretch.</p><p><strong>Conclusion: </strong>This study suggests a risk for iatrogenic injury when using elastic bandages for finger dressings. While arterial inflow was never compromised, pressures were high enough to occlude superficial venous outflow, which may begin at 20% bandage stretch. Pulse oximetry failed to detect changes distal to applied dressings, and we do not recommend it to detect digital vascular compromise in this setting.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663378","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
期刊
HAND
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1