HAND最新文献

Background: This study aimed to determine whether trapezium morphology, specifically trapezial inclination, is a risk factor for the failure of primary conservative or minimally invasive treatment for acute traumatic thumb carpometacarpal (CMC) joint dislocations in the relatively early period. We hypothesized that an elevated trapezial inclination would be associated with a higher rate of treatment failure.

Methods: We retrospectively reviewed patients treated for acute thumb CMC joint dislocations between 1976 and 2025 with closed reduction and subsequent immobilization or percutaneous pinning. Patients were classified into "failure" (recurrent dislocation or subsequent symptomatic subluxation) or "non-failure" groups. Trapezial inclination, measured on oblique hand radiographs, was compared between the groups using the Mann-Whitney U test.

Results: Fourteen patients met the inclusion criteria (7 failure, 7 non-failure). While demographics were not significantly different, the failure group demonstrated a significantly higher mean trapezial inclination (19.1° vs 8.7°; P = .0012). This significant difference persisted in a subgroup analysis that excluded associated Gedda type 3 Bennett fracture (P = .0318)Conclusions:Elevated trapezial inclination may predict the failure of primary conservative or minimally invasive treatment in the relatively early period for acute thumb CMC joint dislocation. Our findings suggest that patients with this steep trapezium may be poor candidates for conservative or minimally invasive management and should be considered for primary definitive surgery.

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for glycemic control, but their relationship with diabetes-related musculoskeletal conditions remains unclear. This study compared rates of carpal tunnel syndrome (CTS), carpal tunnel release (CTR), and CTR complications in patients with type 2 diabetes mellitus (T2DM) with and without GLP-1 RA use.

Methods: Adult T2DM patients were identified using the TriNetX database. The primary analysis compared patients with versus without GLP-1 RA use. The secondary analysis examined T2DM patients with CTS, stratified by GLP-1 RA exposure. The tertiary analysis included T2DM patients with GLP-1 RA use within 6 months before CTR versus controls without preoperative exposure. Cohorts were propensity-matched for demographics and comorbidities. Outcomes included CTS incidence (primary analysis), CTR incidence (secondary analysis), and 90-day postoperative complications (tertiary analysis).

Results: The primary analysis identified 555 267 matched pairs. Carpal tunnel syndrome incidence was 4.8% in GLP-1 RA users versus 5.5% in nonusers (relative risk [RR] 0.886, 95% confidence interval [CI] 0.872, 0.901). Conversely, GLP-1 RA use was associated with higher CTR prevalence (RR 1.138, 95% CI 1.104, 1.174). Postoperative complication rates, including infection, wound dehiscence, complex regional pain syndrome (CRPS), and stiffness, were comparable between groups.

Conclusions: Glucagon-like peptide-1 receptor agonist use was associated with reduced CTS incidence but higher CTR prevalence, without differences in postoperative complication rates. These findings suggest GLP-1 RAs may exert protective effects on musculoskeletal pathology and do not necessitate cessation before CTR.

Background: A Streamlined Care In Pediatric Hand Injuries (SCI-PHI) pathway was developed to reduce unnecessary follow-ups and improve health care resource utilization. This study aimed to investigate the post-implementation outcomes of patients treated with this previously developed SCI-PHI pathway.

Methods: Participants were contacted 12 months post-injury to complete a questionnaire, including a modified version of the Michigan Hand Questionnaire and the Patient-Reported Outcomes Measurement Information System upper extremity score.

Results: Ninety-four percent of patients had a pain-free return to activity, and 93% were satisfied with the appearance and function of their injured hand. Five patients (4%) had questions that were answered over the phone, and 5 patients (4%) requested follow-up with the surgical team. No patients required any intervention beyond reassurance. There was a consequent 27% reduction in visits.

Conclusions: The SCI-PHI pathway for children with simple hand injuries demonstrates good patient-reported outcomes and satisfaction. This has the potential to save significant resources for both families and the health care system.

Background: TDetection of distal radioulnar joint (DRUJ) instability has proven inconsistent despite numerous examination maneuvers. Computed tomography (CT) has been suggested as a modality for evaluating DRUJ instability; however, without stress across the DRUJ, it fails to reliably identify this. No study has simultaneously assessed stress CT with clinical stress maneuvers. As such, the purpose of this study was to compare both methods in stable and unstable wrists.

Methods: An arthrometer was developed to evaluate a clinical stress test of the DRUJ in various degrees of forearm rotation. In each forearm position, specimens were subjected to standardized volar and dorsal loads to simulate clinical stress to the DRUJ. Computed tomography images were acquired in each position with additional unstressed images. The triangular fibrocartilage complex (TFCC) was then sectioned to simulate DRUJ instability.

Results: Nine upper extremities were used. The arthrometer could detect a significant difference between sectioned and intact TFCCs in the supinated forearm position. A large proportion of the translation measured by the arthrometer was due to rotation within the clamps. In the unstressed state, CT analysis using the radioulnar ratio failed to show significant differences in DRUJ stability for any forearm orientation. By applying stress across the DRUJ, CT analysis of ulnar translation along the sigmoid notch showed significant differences between TFCC intact and sectioned wrists.

Conclusions: Clinical examination maneuvers and arthrometers are observing a rotational component that occurs due to the inability to directly clamp the underlying bone, whereas stress CT is more accurate for quantifying underlying bony translation. Unstressed CT analysis did not identify instability.

Background: The scaphoid height-to-length (H/L) ratio assesses reduction quality, with lower values indicating better anatomic restoration and reduced malunion risk. We hypothesized that dorsal percutaneous fixation of acute, unstable distal oblique fractures yields a lower postoperative H/L ratio compared with volar fixation.

Methods: We retrospectively reviewed all Herbert B1 fractures treated with percutaneous screw fixation at a single, tertiary referral center over 10 years. Dorsal and volar approaches followed standardized protocols, with guidewire placement under fluoroscopy and headless compression screw fixation. Postoperative computed tomography (CT) assessed the H/L ratio, intrascaphoid angle (ISA), and dorsal cortical angle (DCA), reformatted along the long axis of the scaphoid. Demographics, injury/operative characteristics, CT-based metrics, and clinical outcomes were compared between approaches.

Results: A total of 18 patients met inclusion criteria (dorsal n = 10, volar n = 8), with an average follow-up of 7.3 months. The cohorts did not significantly differ in demographic, injury, or operative covariates. Computed tomography assessment showed similar ISA and DCA, but a lower H/L ratio in the dorsal approach cohort (0.64 vs 0.70, P = .040). While functional outcomes were mostly comparable, dorsal approach patients reported lower Disability of the Arm, Shoulder, and Hand scores at final follow-up (17.7 vs 45.5, P = .019). Two of the 18 patients developed nonunion; both were treated via a dorsal approach.

Conclusions: A dorsal approach may achieve more anatomic reduction in percutaneous screw fixation of distal oblique scaphoid fractures, though it remains unclear whether the approach has any meaningful, relative influence on functional outcome and bone union.

Background: Peripheral nerve injuries (PNIs) are a significant cause of global disability, often leading to lifelong sensory and motor deficits. Increasing efforts to unveil the psychosocial implications of such injuries is being made. The aim of this study was to determine the impact of preoperatively diagnosed mental health disorder (MHD), specifically major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD), on short-term outcomes following PNI repair.

Methods: A large, retrospective cohort, using the TriNetX Collaborative Global Network database queried on April 9, 2025, was used to identify patients undergoing PNI repair with preoperative MHD diagnoses. Propensity matching was performed, allowing analysis of 30-day and 90-day postoperative outcomes in patients with MHD along with subgroup analysis of those diagnosed with MDD, GAD, or PTSD.

Results: Mental health disorder (n = 2521), MDD (n = 1107), GAD (n = 996), and PTSD (n = 938) groups were found to have increased emergency department use and hospital readmission postoperatively. Patients with MHD were less likely to attend outpatient follow-up in clinic or use occupational therapy services. Complications and opioid consumptions were similar among all groups.

Conclusions: Following PNI repair, patients with pre-existing MHD demonstrated increased hospital resource utilization and decreased outpatient follow-up despite similar complication and opioid use rates. The need for a comprehensive, multifaceted approach to optimize treatment outcomes following PNI, specifically those with concomitant MHD, is obviated by the findings in this study.

Background: The purpose of this study is to compare outcomes in patients with isolated unrepairable scapholunate (SL) injuries treated with the reduction and association of the scaphoid and lunate (RASL) screw technique versus suture anchors with an internal brace (IB).

Methods: Patients treated with either the RASL screw or IB technique for a complete, nonrepairable SL injury were identified. Radiographic and clinical data were recorded preoperatively, immediate postoperatively, and at final follow-up. Patients were then contacted via telephone survey, and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) questionnaire was administered. Patients with less than 6 months of follow-up were excluded.

Results: Twenty-five patients (19 men, 6 women) with an average age of 43 (range = 23-66) years were identified (RASL = 14 and IB = 11). There were no differences between groups in radiographic parameters or range of motion at final follow-up, except for a smaller SL gap at final follow-up in RASL patients (1.5 vs 2.4 mm, P = .03). Four patients in the RASL (29%) group required additional procedures for screw removal secondary to screw breakage (n = 1) or screw migration/loosening (n = 3). One patient in the IB group had complete failure/diastasis postoperatively, and 36% (4/11) of patients had osteolysis at final follow-up. At final follow-up, qDASH was 26 versus 31 in the IB versus RASL groups (P = .79).

Conclusions: Both RASL and IB have similar postoperative outcomes when treating SL injuries. It is important to note complications of screw breakage/loosening associated with RASL and recurrent diastasis/gapping and high rate of osteolysis with IB, although this has an unknown clinical significance.

Background: Distal radius fractures (DRFs) are a common orthopedic injury. Patient-reported outcomes (PROs) and achievement of the minimum clinically important difference (MCID) provide insight into functional recovery. The purpose of this study was to evaluate the impact of patient characteristics, particularly anxiety, on PROs and MCID achievement following DRF.

Methods: All adult patients undergoing primary operative fixation of a DRF at a single health system between 2018 and 2023 were identified. Exclusions included polytrauma, fixation besides a volar locking plate, or missing PROs at baseline or any postoperative follow-up. The Patient-Rated Wrist Evaluation (PRWE) was collected preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. An anchor-based MCID was calculated using a general health question.

Results: Seventy-eight patients were included (87.2% female, average age 62.4 ± 12.5 years). Fifty-nine patients (75.6%) had intraarticular fractures. Depression was more common in the anxiety cohort (68.4% vs 20.3%, P < .001). The MCID thresholds at 3 and 6 months were 57.7 and 61.8, respectively. Patients with anxiety had lower MCID achievement at 6 months (31.6% vs 59.3%, P = .035) and smaller PRWE improvements (P = .002). The PRWE scores at 6 weeks and 3 months were moderately correlated with 6-month scores (r = .51, r = .58, respectively), and 3-month changes were strongly correlated with 6-month changes (r = .73)Conclusions:Anxiety was associated with smaller improvements in PRWE scores and reduced MCID achievement, highlighting the importance of addressing mental health in postoperative care. Early PRWE scores were moderately predictive of 6-month scores, suggesting that patients with limited early improvement may benefit from targeted interventions to optimize long-term recovery.

Background: TSymptomatic thumb carpometacarpal arthritis refractory to nonoperative treatment often results in carpometacarpal arthroplasty surgery. Postoperative therapy facilitates functional recovery, but there may be barriers that can affect recovery and final outcomes. This study identified socioeconomic or functional factors influencing therapy attendance after surgery and patient outcomes.

Methods: Patients at a single academic institution from 2014 to 2024 with carpometacarpal osteoarthritis undergoing carpometacarpal arthroplasty surgery were reviewed. Demographics, postoperative clinic and therapy visits, Patient-Reported Outcomes Measurement Information System scores, and Quick Disabilities of the Arm, Shoulder, and Hand scores were tallied. Bivariate analysis compared patients attending 5 or more therapy sessions with those who did not. Area of deprivation was used to divide patients for analysis.

Results: A total of 1259 patients were eligible for inclusion, with 1078 (85.6%) attending hand therapy for 4 [2, 7] sessions over 7.4 [3.6, 12.1] weeks. Socioeconomically disadvantaged patients had fewer therapy visits but no worse functional outcomes. Patients engaging in consistent therapy reported worse pain interference, physical function, and upper extremity function at 6 weeks relative to those attending fewer sessions (all P < .05). Function nearly equalized at 3 months, and at 6 months, consistent therapy patients achieved more favorable Pain Interference and Physical Function scores (P < .05).

Conclusion: Patients with carpometacarpal osteoarthritis exhibit high therapy attendance following surgery. Socioeconomically disadvantaged patients attended fewer therapy sessions but had comparable functional outcomes. Patients with poorer functional scores at 6 weeks tended to attend therapy longitudinally. At latest follow-up however, their function exceeded non-participants. Therapy attendance is influenced by socioeconomic factors and natural functional recovery.

Background: Triangular fibrocartilage complex (TFCC) injuries are common in athletes and may lead to substantial pain and functional limitations. This study characterizes TFCC injuries in athletes, particularly those involved in racquet sports. We also report on treatment patterns, patient outcomes, and risk factors for TFCC injury.

Methods: Patients with soft tissue injuries of the wrist at our institution in the last 9 years were screened for diagnosis of TFCC injury associated with racquet sports. Patients were excluded if there was no record of treatment or follow-up after diagnosis. Retrospective chart review was performed to collect data on demographics, injury and treatment specifics, return to baseline activity (RTBA) time after initiating treatment, and complications.

Results: Of 700 patients diagnosed with TFCC injury, 23.1% sustained injury during sports. Twenty-five (15.4%) were playing a racquet sport, most commonly tennis (n = 21). Five patients were excluded according to exclusion criteria. Fifty-five percent of the included patients were men, adolescents, and played their sport competitively. Seventy-five percent injured their dominant wrist, with 35% sustaining an ulnar-sided tear. Fifteen patients were treated nonoperatively through wrist immobilization and therapy. Of the 5 surgically treated patients, 4 underwent arthroscopic debridement while 1 underwent open repair. Seventeen patients (12 nonoperative and all surgical) were able to RTBA (average time: 134 days), of which only one had pain recurrence.

Conclusions: Triangular fibrocartilage complex injuries disproportionately affect tennis players but favorably resolved from nonoperative treatment in 73.3% of cases and from surgery in all cases. Prior TFCC pathology and age above 50 were associated with no RTBA.