HAND最新文献

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.

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.

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.

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.

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.

Background: Modern crossbow is a popular weapon used throughout the United States for outdoor recreation. Crossbow mechanics place the hand and digits at significant risk of injury while shooting or handling these weapons; however, injury patterns have been poorly documented. In this study, the authors use a national database to assess patterns of crossbow-related injuries of the hand and digits.

Methods: A retrospective review of the National Electronic Injury Surveillance System database was conducted to identify crossbow-related hand and digit injuries over the past 10 years. Demographic data, injury timing, anatomical injury location, specific injury diagnosis, and disposition data were collected.

Results: A total of 15 460 crossbow-related hand injuries were identified between 2011 and 2021. A strong temporal relationship was identified, with 89% of injuries occurring between the months of August and December. Male patients sustained most injuries (>85%). Body areas injured were the digits (93.2%) and the hand (5.7%). The most common injuries were laceration (n = 7520, 48.6%), fracture (n = 4442, 28.7%), amputation (n = 1341, 8.7%), and contusion/abrasion (n = 957, 6.2%). More than 50% of cases involved injury to the thumb, with approximately 750 thumb amputations recorded during the time period examined.

Conclusions: This study is the first to document the patterns of hand and digit injuries associated with crossbow use on a national scale. These findings have important implications for public health awareness campaigns targeting hunters and support the designation of crossbow "safety wings" as a mandatory feature of crossbow design.

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.

Background: We sought to determine the risk factors for the development of de Quervain tenosynovitis after distal radius fractures. Our hypothesis is that longer periods of immobilization and higher-energy fracture patterns will correlate with the development of de Quervain tenosynovitis.

Methods: This is a 10-year retrospective study of 1451 consecutive patients with distal radius fractures presenting to a large academic institution. The incidence and relative risk of de Quervain tenosynovitis within 1 year of sustaining a distal radius fracture were analyzed.

Results: In total, 41 patients developed posttraumatic de Quervain tenosynovitis at an average time of 6.5 months. In the operative cohort, the incidence was 2.2%, and that of the nonoperative group was 3.8%. Among all affected patients, 78% admitted to strenuous, overuse activities or careers. Compared with the unaffected cohort, the de Quervain tenosynovitis group was more likely to be female and black with similar age and body mass index. The traumatic cohort was less likely to respond to corticosteroid injections. A separate extensor pollicis brevis (EPB) sheath was noted in all patients requiring surgical release.

Conclusions: Patients with a nonoperative distal radius fracture were 4.2 times more likely to develop de Quervain's than the general population, and those treated operatively were 2.4 times more likely. These patients were more likely to be female, black, and engage in strenuous overuse activities or careers. They demonstrated higher-energy fracture patterns and worse response to corticosteroid injections, more frequently requiring surgical decompression. Among those requiring surgery, patients were 2.5 times more likely to have a separate EPB sheath than those with atraumatic Quervain's.

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.

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.