Journal of Hand Surgery Global Online最新文献

Biomechanical Comparison of Plate Versus Intramedullary Screw Fixation for Extra-Articular Metacarpal Base Fractures 钢板与髓内螺钉固定治疗关节外掌骨基部骨折的生物力学比较

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-15 DOI: 10.1016/j.jhsg.2025.100897

Majd Mzeihem MD , Dmitriy Peresada MD , Yeseop Park PhD , Jiries A. Fakhouri BS , Danil Rybalko MD , Mark H. Gonzalez MD, PhD , Farid Amirouche PhD

Purpose

Intramedullary (IM) screws are commonly used for metacarpal shaft and neck fractures, but their application in extra-articular metacarpal base fractures has not been thoroughly evaluated. This study aims to compare the biomechanical performance (load to failure) of IM screw fixation versus dorsal plate fixation for extra-articular fractures at the base of the metacarpal.

Methods

Twenty-four cadaveric metacarpals from 12 upper extremities were prepared and randomized to receive either IM screw fixation or dorsal plate fixation following a standardized transverse fracture near the base. All specimens were potted and tested using cantilever bending in a materials testing system. The primary outcome was ultimate load to failure; stiffness was evaluated as a secondary measure.

Results

Dorsal plate fixation demonstrated greater load to failure compared to IM screw fixation when all specimens were analyzed collectively. Subgroup analysis indicated this difference was more pronounced in the thumb metacarpals. In contrast, IM screw constructs consistently exhibited greater stiffness across all specimens, including both thumb and small finger metacarpals.

Conclusions

Dorsal plating offered greater resistance to fracture displacement, while IM screw fixation provided superior construct stiffness. Both fixation methods surpassed expected physiologic loading during hand use, indicating that either approach may be biomechanically acceptable depending on the clinical context.

Clinical relevance

The IM screws may serve as a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures. These findings may help guide surgical decision-making regarding fixation selection and promote individualized treatment strategies.

目的髓内螺钉常用于掌骨干部和颈部骨折，但其在掌骨关节外骨折中的应用尚未得到充分评价。本研究旨在比较IM螺钉固定与背侧钢板固定治疗掌骨基部关节外骨折的生物力学性能（负荷至失效）。方法选取12只上肢的24具尸体掌骨，随机接受近基底标准化横向骨折后的IM螺钉固定或背侧钢板固定。所有的试样都在材料测试系统中进行了盆栽和悬臂弯曲测试。主要结局是最终负荷失败；刚度作为次要指标进行评估。结果对所有标本进行综合分析时，与内钉固定相比，背侧钢板固定显示出更大的失效负荷。亚组分析表明，这种差异在拇指掌骨中更为明显。相比之下，IM螺钉结构在所有标本中均表现出更大的刚度，包括拇指和小指掌骨。结论背侧钢板具有更好的抗骨折移位能力，而内固定螺钉具有更好的结构刚度。两种固定方法都超过了手部使用时预期的生理负荷，这表明根据临床情况，两种方法在生物力学上都是可接受的。临床意义IM螺钉可作为一种生物力学上可行的替代背钢板治疗关节外掌骨基部骨折。这些发现可能有助于指导手术决策关于固定选择和促进个体化治疗策略。

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引用次数: 0

Reduced Pain and Edema Following Delayed Therapy for Flexor Tenolysis 屈肌肌腱松解延迟治疗后疼痛和水肿减轻

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-13 DOI: 10.1016/j.jhsg.2025.100895

Sarah Mart MS, OTR , Nancy M. Cannon OTR , Danielle Sparks DHS, OTR , Courtney D. Jensen PhD

Purpose

Traditionally, therapy has been initiated 1 day after surgery following flexor tenolysis to prevent the development of early adhesions. Pain and edema are limiting factors in the initial days after surgery and can interfere with the opportunity to effectively initiate a home therapy program. The purpose of this study was to demonstrate the safety and effectiveness of delaying the initiation of therapy to 3 days post-op following flexor tenolysis.

Methods

10 patients undergoing flexor tenolysis initiated therapy at 3 days post-op. Pain, edema, and range of motion were measured at baseline, day 3 post-op, day 12 ± 2, and weeks 3, 4, 8, and 12. Functional limitations and level of anxiety were assessed at the initial post-op visit, as well as week 4 and week 12.

Results

Most range of motion improvements occurred in the first 2–3 weeks. Mean total active motion of the interphalangeal joints increased from 64.0° ± 24.9° at baseline to 142.5° ± 24.6° at 3 weeks post-op. Differences in interphalangeal joint total active motion were significant between baseline and 3 weeks, and these improvements were maintained through the 8-week follow-up visit. At 8 weeks post-op, five patients had excellent results, three had good, and two had fair, according to the Original Strickland Classification system.

Conclusions

Early and effective management of pain and edema is critical to ensuring a positive outcome. Patients with less initial postoperative edema had better range of motion at 3 weeks post-op. Results were maintained through 8 weeks, and the patients required fewer therapy visits. Delaying the initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results and is safe for clinical practice.

Clinical relevance

This case series demonstrates that delaying initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results. Delaying therapy can mitigate the ill effects of surgery and allow reduction of pain and edema for improved range of motion and overall outcome.

传统上，治疗是在屈肌腱松解术后1天开始，以防止早期粘连的发展。疼痛和水肿是手术后最初几天的限制因素，可能会干扰有效启动家庭治疗计划的机会。本研究的目的是证明将屈肌腱松解术后3天开始治疗的安全性和有效性。方法10例屈曲肌腱松解术患者于术后3天开始治疗。在基线、术后第3天、第12±2天以及第3、4、8和12周时测量疼痛、水肿和活动范围。功能限制和焦虑水平在最初的术后访问以及第4周和第12周进行评估。结果大多数活动范围改善发生在前2-3周。术后3周，指间关节的平均总活动度从基线时的64.0°±24.9°增加到142.5°±24.6°。在基线和3周期间，指间关节总主动运动的差异是显著的，并且这些改善在8周的随访中保持不变。术后8周，根据原思特里克兰德分类系统，5例患者预后良好，3例预后良好，2例预后一般。结论疼痛和水肿的早期有效治疗是确保患者预后良好的关键。术后水肿较少的患者术后3周活动范围较好。结果维持了8周，患者需要的治疗次数减少了。将屈曲肌腱松解术后3天延迟开始治疗可以产生良好的效果，并且对临床实践是安全的。临床相关性：本病例系列表明，屈肌腱松解术后3天延迟开始治疗可以产生良好的效果。延迟治疗可以减轻手术的不良影响，减轻疼痛和水肿，改善活动范围和整体结果。

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引用次数: 0

Association Between Worker’s Compensation Status and Outcomes for Surgical Treatment of Lateral Epicondylitis 外上髁炎手术治疗的工人补偿状况与预后的关系

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-13 DOI: 10.1016/j.jhsg.2025.100873

Asher B. Mirvish BA , John R. Fowler MD

Purpose

Evaluate for variation between patients undergoing surgery for lateral epicondylitis (LE) with and without worker’s compensation (WC) coverage.

Methods

A retrospective review was performed on patients, identified by Current Procedural Terminology codes, who underwent LE surgery between 2008 and 2020. Following exclusions, there were 293 operative patients for LE, 34 of whom had WC coverage. Outcomes consisted of comparing before surgery and postoperative pain level reported by patient feedback during consultations, ability to perform job duties, and retaining employment. This study also assessed clinical workflow via time to surgery. Positive outcomes included having resolution or improvement in symptoms after surgery, returning to employment completely, and the ability to perform job duties appropriately. Negative outcomes included unchanged or worsened pain, incomplete return to work, loss of employment, and revisions. Patients were evaluated after surgery at approximately 2-week, 6-week, and 3-month milestones.

Results

Of the 34 WC cases, 12 (35%) had a negative outcome, whether persistent pain, reassignment to permanent and stationary employment, or loss of employment. Twenty percent of WC patients versus 3.5% of non-worker’s compensation (NWC) patients had unchanged symptoms. Twenty-five percent of WC patients returned to modified duty versus 7.3% of NWC. Two WC patients and one NWC patient lost their jobs. Patients on WC were more likely to have delays in time to surgery than NWC patients. Postoperative documentation reflected persistent epicondylitis as the reason for failure of complete return to work. By the 3-month postoperative consultation, 3% of patients without WC (NWC) had negative outcomes, whereas 20% of WC patients had a negative outcome. By the final consultation, 92% of NWC patients returned to work full duty, whereas 68% of WC patients were able to return to work full duty.

Conclusions

Overall, only approximately two-thirds of patients undergoing LE surgery under a WC claim returned to work within 3 months of surgery, compared to 92% without a WC claim. WC patients had more frequent delays in time to surgery versus NWC patients.

Type of study/level of evidence

Prognostic IV.

目的评估有和没有工人赔偿（WC）覆盖的外上髁炎（LE）手术患者之间的差异。方法回顾性分析2008年至2020年期间接受LE手术的患者。排除后，共有293例LE手术患者，其中34例有WC覆盖。结果包括比较术前和术后患者在会诊期间反馈的疼痛水平、履行工作职责的能力和保留工作。本研究还通过手术时间评估了临床工作流程。积极的结果包括手术后症状的缓解或改善，完全恢复工作，以及适当履行工作职责的能力。负面结果包括疼痛未改变或恶化、不完全恢复工作、失业和修订。患者在术后大约2周、6周和3个月进行评估。结果在34例WC病例中，12例（35%）出现了负面结果，无论是持续疼痛，重新分配到永久和固定工作，还是失去工作。20%的WC患者与3.5%的非工伤补偿（NWC）患者的症状没有变化。25%的WC患者恢复了改良工作，而NWC患者的这一比例为7.3%。两名WC患者和一名NWC患者失去了工作。使用WC的患者比使用NWC的患者更有可能延迟手术时间。术后文件反映持续性上髁炎是不能完全恢复工作的原因。术后3个月，无WC （NWC）患者中有3%出现阴性结果，而WC患者中有20%出现阴性结果。在最后的咨询中，92%的NWC患者返回全职工作，而68%的WC患者能够返回全职工作。总的来说，只有大约三分之二的有WC索赔的LE手术患者在手术后3个月内恢复工作，而没有WC索赔的患者为92%。WC患者比NWC患者更频繁延迟手术时间。研究类型/证据水平

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引用次数: 0

Proximal Ulna Adamantinoma 尺骨近端金刚瘤

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-05 DOI: 10.1016/j.jhsg.2025.100899

Liam H. Wong MD , Rosanna Wustrack MD , Nicolas Lee MD , Leah Demetri MD

Adamantinoma is a rare, malignant tumor that is typically seen in the tibia but has been reported in all long bones. We present the case of a woman who presented as a teenager with a pathologic fracture of the proximal ulna that was initially diagnosed as osteofibrous dysplasia and treated with internal fixation. After the lesion was identified in adulthood as adamantinoma, she was converted to a one-bone forearm procedure as a salvage treatment.

金刚烷瘤是一种罕见的恶性肿瘤，通常见于胫骨，但在所有长骨中都有报道。我们提出的情况下，一名妇女谁提出了作为一个十几岁的病理性骨折的近尺，最初诊断为骨纤维结构不良和治疗内固定。成年后病变被确定为金刚瘤，她被转换为单骨前臂手术作为抢救治疗。

引用次数: 0

Where Are the Hand Surgeons? Examining the Socioeconomic and Geographic Gaps in Patients’ Access to Care in the United States 手外科医生在哪里？研究美国患者获得护理的社会经济和地理差距

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-05 DOI: 10.1016/j.jhsg.2025.100898

Roshan V. Patel BS , Gnaneswar Chundi BS , David Mothy BS , Aayush Mehta BS , Tamara D. Rozental MD , Monica M. Shoji MD

Purpose

The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.

Methods

We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.

Results

A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.

Conclusions

There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.

Level of Evidence

Cross-sectional study, III.

目的本研究的目的是评估目前全美手外科医生的地理分布，并描述患者获得医疗服务的差异。方法我们使用美国整形外科学会、美国手外科协会和美国手外科学会的数据库和Doximity来定位截至2024年12月在美国接受过整形外科和普外科培训的手外科医生。收集了美国各县实践地点的详细信息和相应的社会经济信息。各县分为有手外科医生的和没有手外科医生的。地理和社会经济细节进行了比较。结果共发现2733名手外科医生。这些外科医生主要在大都市和富裕地区执业。加州、纽约、佛罗里达和宾夕法尼亚的手外科医生最多。哥伦比亚特区、罗德岛州、康涅狄格州、新罕布什尔州和佛蒙特州的人均外科医生比例最高。从地理上看，西部的手外科医生数量最少，而南部的手外科医生数量最多。只有18.3%的美国县至少有一名手外科医生，其中32.9%的县只有一名。有手外科医生的县比没有手外科医生的县收入中位数更高，贫困率更低，失业率更高。结论手外科医师的地理分布有明显差异。西部和经济落后地区似乎面临严重短缺。为了解决这些短缺问题，需要采取诸如增加医学教育以增加对手外科的兴趣，增加指导机会以及激励服务不足地区的实践等策略。远程医疗和农村培训方案也可以在增加偏远地区获得护理的机会方面发挥重要作用。证据水平：横断面研究，III。

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引用次数: 0

Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection 手部的婴儿纤维肉瘤：用现代靶向口服化疗和保守手术切除保肢治疗

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-05 DOI: 10.1016/j.jhsg.2025.100887

John R. Vaile MD , John A. Tipps BA , Rachel Hurley MD, PhD , Sarah L. Struble MD , Brooke E. Allen BS , Lea F. Surrey MD , Laura S. Finn MD , Frank M. Balis MD , Theodore W. Laetsch MD , Shaun D. Mendenhall MD

Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its NTRK fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.

婴儿纤维肉瘤是一种局部侵袭性肿瘤，传统上需要化疗和根治性切除或截肢。最近，利用其NTRK融合癌基因的新辅助治疗已被用于减少手术切除的范围。然而，形态学相似的婴儿纤维肉瘤样肿瘤的治疗尚未得到很好的描述。我们报告一例间变性淋巴瘤激酶驱动的手部婴儿纤维肉瘤样肿瘤，采用多模式，肢体保留方法进行治疗。一例妊娠35周的新生儿在其左手掌侧出现血管性肿块。间变性淋巴瘤激酶抑制剂lorlatinib的新辅助治疗导致肿瘤显著消退，使得保守手术切除和保留手部成为可能。随访2年，患者继续接受氯拉替尼治疗，无复发，尽管有中度瘢痕挛缩，但手部功能良好。本病例强调了新辅助治疗联合切除治疗婴儿纤维肉瘤样肿瘤的疗效。

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引用次数: 0

Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options 辐射诱发的臂丛病：目前的认识、诊断和治疗方案

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-05 DOI: 10.1016/j.jhsg.2025.100896

Alex G. Lambi MD, PhD, FACS , Tomas Holy MD , Ryan E. Tomlinson PhD , Mary F. Barbe PhD, FAAA, FASBMR

Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.

放射诱发的臂丛病（RIBP）是在肺癌、胸壁、头颈、乳房和腋窝周围接受放射治疗的癌症的可怕并发症。它可以发生在早发（短暂）或晚发（慢性）的方式。诊断包括排除新的或复发的压迫性肿瘤过程，并且在很大程度上依赖于患者的症状，没有经过良好验证的客观评分系统。治疗选择仍然有限，因为在预防或阻止疾病进展方面没有取得重大进展。本文就RIBP的发病背景、病理生理及诊断作一综述。除了手术治疗方案，非手术方式，往往是主要的症状管理，讨论。最后，强调了目前治疗RIBP的挑战，重点是针对潜在的罪魁祸首-辐射诱导的纤维化。

引用次数: 0

Temporary Dorsal Staple Fixation of Scapholunate Interosseous Ligament Repair and Reconstruction 舟月骨间韧带修复与重建的临时背侧钉固定

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-05 DOI: 10.1016/j.jhsg.2025.100891

Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD

There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.

舟月骨间韧带损伤有多种治疗方法，包括修复和重建。这些技术的共同点是通过临时放置克氏针（k -丝）在舟月骨和有时舟头骨关节上提供固定来保护修复或重建。使用k -针有多种潜在的缺点，包括可能干扰修复或重建，通过k -针时舟月骨关节分散，偶尔需要多次通过以正确放置，导致骨内应力上升，以及意外的k -针并发症，包括断裂、移位和感染。我们描述了在舟月骨关节处使用背侧部分插入镍钛诺钉作为一种改进的技术，用于暂时固定关节。使用短钉可以压缩舟月骨间隙，在插入时直接可见，并且能够避免干扰舟月骨间韧带的修复或重建。除了描述我们的手术技术外，我们还提供了我们在患者中使用该技术的经验总结和案例说明。

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引用次数: 0

Reevaluating Pediatric Nailbed Injuries: Are We Overtreating Simple Cases? 重新评估小儿钉伤：我们是否过度治疗简单病例？

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-04 DOI: 10.1016/j.jhsg.2025.100880

Evelyn Reed MD , Catherine Bautista MD , Mackenzie French MD , Alexandra Vitale BS , Candace Winterton BM, MM , Joanna Chen MD , Devin Eddington MS , Christopher Goodenough MD

Purpose

Pediatric fingertip injuries involving the nailbed are extremely common; however, there is no consensus on treatment protocols. The practice of repairing simple nailbed laceration injuries may result in overtreatment. The aim of this study was to identify variables that could predict which patients with nailbed lacerations might achieve equivalent outcomes with fewer procedural interventions.

Methods

A retrospective chart review was conducted at a single children’s hospital. Patients aged 0–18 years with nailbed injuries were included if they had an x-ray at the time of injury, at least one follow-up appointment, and no Seymour or Salter-Harris fractures. Descriptive statistics were generated. chi-square and Fisher exact tests were used to analyze categorical variables, and the Kruskal-Wallis test was used to analyze continuous variables.

Results

Two hundred thirty-nine patients were included in the study, accounting for 255 nailbed injuries. One hundred thirty-two were men (55%), 107 were women (45%), and the mean age at the time of injury was 6.1 years. The median follow-up was 15.1 days. One hundred eighty-two patients (71%) sustained a distal phalanx fracture. Outcomes were analyzed by the type of nailbed repair (removal and repair, trephination, and conservative). The analysis demonstrated no differences in infection rates among treatment groups: nailbed repair (3%), trephination (0%), and conservative (2.9%), and no difference in complication rates (0.5%, 0%, and 2.9%, respectively).

Conclusions

For simple nailbed injuries, patients had consistently good early outcomes irrespective of the intervention. Further study into long-term outcomes and a prospective investigation into conservative treatment of uncomplicated nailbed injuries are warranted.

Clinical relevance

These findings may alter practice management in the treatment of simple nailbed injuries. Simple nailbed injuries may be treated conservatively with similar rates of complication, thereby reducing the necessity for subspecialist involvement in these injuries, pediatric procedural sedations, and emergency room length of stay.

目的：小儿指尖损伤累及指甲极为常见；然而，在治疗方案上没有达成共识。单纯性指甲撕裂伤的修复可能会导致过度治疗。本研究的目的是确定变量，这些变量可以预测哪些指甲裂伤患者在较少的手术干预下可能达到相同的结果。方法对某儿童医院进行回顾性调查。年龄0-18岁的指甲损伤患者，如果在受伤时有x光片，至少有一次随访预约，并且没有西摩或索尔特-哈里斯骨折，则纳入研究。生成描述性统计数据。分类变量分析采用卡方检验和Fisher精确检验，连续变量分析采用Kruskal-Wallis检验。结果共纳入239例患者，其中钉伤255例。男性132例（55%），女性107例（45%），损伤时平均年龄6.1岁。中位随访时间为15.1天。182例（71%）患者发生远端指骨骨折。结果按钉内修复类型（拔除修复、钻孔和保守）进行分析。分析显示，不同治疗组之间的感染率无差异：钉钉修复（3%）、环钻（0%）和保守（2.9%），并发症发生率无差异（分别为0.5%、0%和2.9%）。结论对于单纯性钉伤，无论采取何种干预措施，患者的早期预后均良好。进一步研究长期结果和前瞻性调查保守治疗无并发症的钉伤是必要的。这些发现可能会改变治疗单纯性钉伤的实践管理。简单的钉伤可以保守治疗，并发症发生率相似，从而减少了亚专科介入治疗这些损伤的必要性，减少了儿科手术镇静和急诊室住院时间。

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引用次数: 0

Arthroscopy Versus Open Arthrotomy for Septic Arthritis of the Wrist: A Nationwide Inpatient Sample Analysis of 1,065 Cases 关节镜与开放关节切开术治疗脓毒性手腕关节炎：全国1065例住院患者样本分析

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-12-04 DOI: 10.1016/j.jhsg.2025.100885

Gabriel Hanna MD , Robert Dalcortivo MD , Michael Vosbikian MD , Irfan H. Ahmed MD , Michael M. Abdou MD , Eli Bryk MD , Robert Pae MD

Purpose

Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures.

Methods

The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student’s t- test.

Results

A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0–15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80–1.80) or surgical (OR, 0.87; 95% CI, 0.65–1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0).

Conclusions

Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates.

Type of study/level of evidence

Prognostic III.

目的：脓毒性手腕关节炎是一种罕见的疾病，但它可以导致严重的发病率。脓毒性手腕关节炎的住院结果在关节镜治疗与开放关节切开术治疗的患者中存在有限的数据。我们研究的目的是比较这两种手术的再手术率和住院并发症。方法采用全国住院患者样本数据库，对2002年至2012年美国18岁及以上诊断为脓毒性手腕关节炎的患者进行识别。脓毒性关节炎病例根据治疗方式进行分类，包括关节镜治疗和关节切开术治疗的患者进行统计分析。在多因素logistic回归分析中调整年龄、性别、种族和合并症后，比较住院结果，包括再手术率、外科和内科并发症。使用学生t检验比较平均费用和住院时间。结果1065例化脓性手腕关节炎患者采用关节镜治疗（516例）或切开关节治疗（549例）。经关节镜治疗的患者再手术率更高（48.6% vs 8.7%）。通过多因素分析，接受关节镜治疗的患者更有可能接受重复关节镜手术（比值放射[OR]， 10.4; 95% CI, 7.0-15.3），尽管他们在发生内科并发症（OR, 1.20; 95% CI, 0.80-1.80）或外科并发症（OR, 0.87; 95% CI, 0.65-1.16）的风险方面没有差异。关节镜和关节切开术在住院时间（6.29±5.0 vs 6.26±4.5）和住院费用（33,563.4±30,296.3 vs 34,422.6±31,362.0）方面也没有差异。结论骨科医生在关节镜下处理脓毒性手腕关节炎患者时应注意再手术率的增加，并应与手术候选人讨论这一潜在风险。研究类型/证据水平预后

{"title":"Arthroscopy Versus Open Arthrotomy for Septic Arthritis of the Wrist: A Nationwide Inpatient Sample Analysis of 1,065 Cases","authors":"Gabriel Hanna MD , Robert Dalcortivo MD , Michael Vosbikian MD , Irfan H. Ahmed MD , Michael M. Abdou MD , Eli Bryk MD , Robert Pae MD","doi":"10.1016/j.jhsg.2025.100885","DOIUrl":"10.1016/j.jhsg.2025.100885","url":null,"abstract":"<div><h3>Purpose</h3><div>Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures.</div></div><div><h3>Methods</h3><div>The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student’s <em>t</em>- test.</div></div><div><h3>Results</h3><div>A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0–15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80–1.80) or surgical (OR, 0.87; 95% CI, 0.65–1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0).</div></div><div><h3>Conclusions</h3><div>Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100885"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690939","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}

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