Journal of Hand Surgery Global Online最新文献

Comparison of Surgical Techniques and Joint Injections for Base of Thumb Osteoarthritis: A Systematic Review

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.12.005

Saiuj Bhat MD, BPhil (Hons) , Lewis Weeda MD, MPH , Ishith Seth MD, MS , Warren M. Rozen MD, PhD

Purpose

To perform an updated systematic review investigating the various surgical and injection interventions for thumb carpometacarpal (CMC) joint arthritis.

Methods

A systematic literature search was conducted in MEDLINE, Embase, Web of Science, and Cochrane databases from inception to April 2024 to identify prospective, randomized studies comparing surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months. Reference lists of previous reviews were screened to identify additional publications. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference) because of marked heterogeneity of data and inadequate statistical power. Cochrane’s risk of bias 2 tool assessed the quality of included studies.

Results

Seventeen studies encompassing 1,166 thumbs were included in this review. Fourteen studies compared surgical interventions, whereas three studies compared various intra-articular injections. Five studies had a low risk of bias, eight had a moderate risk of bias, and four had a high risk of bias. Regarding primary outcomes, there was no difference in function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis. Arthrodesis was associated with a higher complication rate compared with trapeziectomy. Platelet-rich plasma injections had improved pain, function, and patient satisfaction outcomes compared with corticosteroid injections.

Conclusions

No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Platelet-rich plasma injections may be a useful alternative to corticosteroids in first CMC osteoarthritis.

Type of study/level of evidence

Therapeutic IB.

{"title":"Comparison of Surgical Techniques and Joint Injections for Base of Thumb Osteoarthritis: A Systematic Review","authors":"Saiuj Bhat MD, BPhil (Hons) , Lewis Weeda MD, MPH , Ishith Seth MD, MS , Warren M. Rozen MD, PhD","doi":"10.1016/j.jhsg.2024.12.005","DOIUrl":"10.1016/j.jhsg.2024.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To perform an updated systematic review investigating the various surgical and injection interventions for thumb carpometacarpal (CMC) joint arthritis.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in MEDLINE, Embase, Web of Science, and Cochrane databases from inception to April 2024 to identify prospective, randomized studies comparing surgical and/or minimally invasive interventions for thumb CMC joint osteoarthritis with a minimum follow-up of 12 months. Reference lists of previous reviews were screened to identify additional publications. Qualitative analysis was performed for primary and secondary outcomes based on the direction of effect (statistically higher, lower, or no difference) because of marked heterogeneity of data and inadequate statistical power. Cochrane’s risk of bias 2 tool assessed the quality of included studies.</div></div><div><h3>Results</h3><div>Seventeen studies encompassing 1,166 thumbs were included in this review. Fourteen studies compared surgical interventions, whereas three studies compared various intra-articular injections. Five studies had a low risk of bias, eight had a moderate risk of bias, and four had a high risk of bias. Regarding primary outcomes, there was no difference in function between trapeziectomy and arthroplasty, key pinch strength between partial and total trapeziectomy, and pain and function between trapeziectomy and arthrodesis. Arthrodesis was associated with a higher complication rate compared with trapeziectomy. Platelet-rich plasma injections had improved pain, function, and patient satisfaction outcomes compared with corticosteroid injections.</div></div><div><h3>Conclusions</h3><div>No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. Platelet-rich plasma injections may be a useful alternative to corticosteroids in first CMC osteoarthritis.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IB.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 212-218"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620994","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

Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.10.008

Zohair S. Zaidi MD , Océane Mauffrey , Alexander D. Jeffs MD , Andrew D. Allen MD , Patricia K. Wellborn MD , Sarah E. Obudzinski MD , G. Aman Luther MD

Purpose

Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.

Methods

A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018–2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.

Results

Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.

Conclusions

Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.

Level of Evidence

Prognostic IIIa.

{"title":"Endoscopic Carpal Tunnel Release after Prior Distal Radius Fixation: Clinical Outcomes and Intraoperative Findings","authors":"Zohair S. Zaidi MD , Océane Mauffrey , Alexander D. Jeffs MD , Andrew D. Allen MD , Patricia K. Wellborn MD , Sarah E. Obudzinski MD , G. Aman Luther MD","doi":"10.1016/j.jhsg.2024.10.008","DOIUrl":"10.1016/j.jhsg.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Open carpal tunnel release (OCTR) after distal radius fractures is well described; however, the use of endoscopic carpal tunnel release (ECTR) in the setting of prior distal radius fixation is less clear. We report clinical outcomes and intraoperative findings of patients with carpal tunnel syndrome following prior ipsilateral distal radius fixation who underwent subsequent ECTR.</div></div><div><h3>Methods</h3><div>A retrospective cohort of patients who had undergone prior ipsilateral distal radius fixation and ECTR for ipsilateral carpal tunnel syndrome (CTS) from 2018–2023 was collected at a single institution. All patients had electrodiagnostic evidence of CTS and scored positive on the CTS-6 Questionnaire. All patients underwent ECTR within 1 year of their initial distal radius fixation. Patients with carpal tunnel release at the time of initial distal radius surgery were excluded. Postoperative outcomes included 5-point Likert scale questionnaires regarding overall satisfaction and improvement in symptoms. Intraoperative findings were noted for all patients. Complications including nerve injury, conversion to OCTR, and need for revision surgery were documented. Patients were followed for 1 year after surgery.</div></div><div><h3>Results</h3><div>Twenty-two patients with electrodiagnostic evidence confirmed CTS were identified following prior distal radius fixation. Average time from initial distal radius surgery to carpal tunnel release was 3.2 months. Scarring of the median nerve (MN) to the flexor retinaculum was noted in seven patients and hemosiderin deposition along the MN was noted in four patients. Likert scale questionairre demonstrated 95% symptom improvement and 95% patient satisfaction. There were no injuries to the palmar cutaneous branch, recurrent motor branch, third common digital nerve, or MN. No patients required conversion to OCTR or revision within the 1-year follow-up.</div></div><div><h3>Conclusions</h3><div>Endoscopic carpal tunnel release provides reliable outcomes for patients with CTS after prior distal radius fixation with low complication rates and high patient satisfaction.</div></div><div><h3>Level of Evidence</h3><div>Prognostic IIIa.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 135-138"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621063","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

Biomechanical Evaluation of Novel Tendon Coaptation Technique: A Potential Application for Tendon Transfers

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.11.007

Devin W. Collins DO , Miguel A. Diaz MS , Nino Coutelle MD , Mariel McLaughlin MD , Damir Pamic BS , Peter Simon PhD , Michael C. Doarn MD

Purpose

The purpose of this study was to evaluate the biomechanical performance and time to completion of the Pulvertaft weave technique, the CoNextions tendon repair system only, and a combination of single Pulvertaft weave with the CoNextions repair.

Methods

A total of 22 cadaveric hands were dissected, and the extensor pollicis longus tendons were harvested and divided into the following three groups: (1) Pulvertaft weave, (2) Pulvertaft weave + CoNextions, and (3) CoNextions. Each sample underwent axial loading in a cyclical fashion, followed by ramp to failure. Metrics of interest were suture time, displacement, stiffness, ultimate failure load, and failure mechanism were recorded.

Results

Time required to instrument each configuration was significantly different across all groups; CoNextions group was the fastest. For cyclic loading, no significant differences in elongation were detected between the groups. The displacement at ultimate failure load, on average, for the Pulvertaft (10.6 mm) and the Pulvertaft and CoNextions combination (10.2 mm) were not significantly different compared with CoNextions (6.5 mm). The stiffness during cyclic loading was similar between the Pulvertaft (38.8 N/mm) and the Pulvertaft and CoNextions combination (36.7 N/mm), and both were found to be significantly stiffer compared with the CoNextions (28.0 N/mm). During the ramp to failure, no significant differences in stiffness were detected. The Pulvertaft had the largest ultimate failure load at 67.5 N.

Conclusions

The Pulvertaft weave and CoNextions tendon repair device demonstrated similar performance to traditional Pulvertaft tendon weave. The combination technique is faster than the traditional tendon weave and displayed improved performance compared with CoNextions repair alone.

Clinical relevance

The combined use of novel tendon repair with a single tendon weave allows for faster tendon coaptation and equivalent strength as a Pulvertaft weave.

{"title":"Biomechanical Evaluation of Novel Tendon Coaptation Technique: A Potential Application for Tendon Transfers","authors":"Devin W. Collins DO , Miguel A. Diaz MS , Nino Coutelle MD , Mariel McLaughlin MD , Damir Pamic BS , Peter Simon PhD , Michael C. Doarn MD","doi":"10.1016/j.jhsg.2024.11.007","DOIUrl":"10.1016/j.jhsg.2024.11.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the biomechanical performance and time to completion of the Pulvertaft weave technique, the CoNextions tendon repair system only, and a combination of single Pulvertaft weave with the CoNextions repair.</div></div><div><h3>Methods</h3><div>A total of 22 cadaveric hands were dissected, and the extensor pollicis longus tendons were harvested and divided into the following three groups: (1) Pulvertaft weave, (2) Pulvertaft weave + CoNextions, and (3) CoNextions. Each sample underwent axial loading in a cyclical fashion, followed by ramp to failure. Metrics of interest were suture time, displacement, stiffness, ultimate failure load, and failure mechanism were recorded.</div></div><div><h3>Results</h3><div>Time required to instrument each configuration was significantly different across all groups; CoNextions group was the fastest. For cyclic loading, no significant differences in elongation were detected between the groups. The displacement at ultimate failure load, on average, for the Pulvertaft (10.6 mm) and the Pulvertaft and CoNextions combination (10.2 mm) were not significantly different compared with CoNextions (6.5 mm). The stiffness during cyclic loading was similar between the Pulvertaft (38.8 N/mm) and the Pulvertaft and CoNextions combination (36.7 N/mm), and both were found to be significantly stiffer compared with the CoNextions (28.0 N/mm). During the ramp to failure, no significant differences in stiffness were detected. The Pulvertaft had the largest ultimate failure load at 67.5 N.</div></div><div><h3>Conclusions</h3><div>The Pulvertaft weave and CoNextions tendon repair device demonstrated similar performance to traditional Pulvertaft tendon weave. The combination technique is faster than the traditional tendon weave and displayed improved performance compared with CoNextions repair alone.</div></div><div><h3>Clinical relevance</h3><div>The combined use of novel tendon repair with a single tendon weave allows for faster tendon coaptation and equivalent strength as a Pulvertaft weave.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 152-157"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621066","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

Perceptions of Patient and Surgeon Marijuana Use: A Survey Study of Upper-Extremity Patients

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.11.010

Andrew Cross MD , Mahmoud Mahmoud MBBS , Yagiz Ozdag MD , Jessica L. Koshinski BS , Victoria C. Garcia PhD , C. Liam Dwyer MD , Joel C. Klena MD , Louis C. Grandizio DO

Purpose

The Drug Enforcement Agency has categorized marijuana as a schedule 1 substance. In states where marijuana is legal, health care systems and licensing boards restrict usage by health care professionals outside of work, unlike alcohol. Considering the paucity of evidence with respect to clinical efficacy and the legal ambiguity associated with marijuana, the purpose of this investigation was to quantify patient perceptions of marijuana use. We sought to evaluate patient perceptions of potential marijuana use by physicians, compared with other substances such as alcohol and nicotine.

Methods

Four hundred thirteen anonymous, 19-question surveys were administered to upper-extremity patients at a single institution. Surveys included demographics, the Brief Marijuana Effect Expectancies Questionnaire, and questions analyzing willingness to discuss/use marijuana as part of treatment. Patients were asked to answer the following using a five-point Likert scale: “I am comfortable with my doctor using the following substances outside of work.” A binary logistic regression model was constructed to assess the significance of patient demographics associated with perceptions of physician marijuana usage.

Results

A total of 388 (94%) surveys were included. Forty percent of respondents had used marijuana. Forty percent were open to using marijuana as part of a treatment plan. Sixty-four percent agreed that they were comfortable with their doctor using alcohol outside of work compared with 47% for recreational marijuana. Demographic factors and personal history of marijuana use were not associated with perceptions of potential physician use.

Conclusions

Patient perceptions of marijuana use are variable. More patients were comfortable with their physician using marijuana outside of work than not. Patients were as comfortable with their physicians using medical marijuana as they were with nicotine.

Clinical relevance

As federal and state laws surrounding marijuana use change, understanding patient perceptions of potential physician use may play a role in determining health system and licensing board policies.

{"title":"Perceptions of Patient and Surgeon Marijuana Use: A Survey Study of Upper-Extremity Patients","authors":"Andrew Cross MD , Mahmoud Mahmoud MBBS , Yagiz Ozdag MD , Jessica L. Koshinski BS , Victoria C. Garcia PhD , C. Liam Dwyer MD , Joel C. Klena MD , Louis C. Grandizio DO","doi":"10.1016/j.jhsg.2024.11.010","DOIUrl":"10.1016/j.jhsg.2024.11.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The Drug Enforcement Agency has categorized marijuana as a schedule 1 substance. In states where marijuana is legal, health care systems and licensing boards restrict usage by health care professionals outside of work, unlike alcohol. Considering the paucity of evidence with respect to clinical efficacy and the legal ambiguity associated with marijuana, the purpose of this investigation was to quantify patient perceptions of marijuana use. We sought to evaluate patient perceptions of potential marijuana use by physicians, compared with other substances such as alcohol and nicotine.</div></div><div><h3>Methods</h3><div>Four hundred thirteen anonymous, 19-question surveys were administered to upper-extremity patients at a single institution. Surveys included demographics, the Brief Marijuana Effect Expectancies Questionnaire, and questions analyzing willingness to discuss/use marijuana as part of treatment. Patients were asked to answer the following using a five-point Likert scale: “<em>I am comfortable with my doctor using the following substances outside of work</em>.” A binary logistic regression model was constructed to assess the significance of patient demographics associated with perceptions of physician marijuana usage.</div></div><div><h3>Results</h3><div>A total of 388 (94%) surveys were included. Forty percent of respondents had used marijuana. Forty percent were open to using marijuana as part of a treatment plan. Sixty-four percent agreed that they were comfortable with their doctor using alcohol outside of work compared with 47% for recreational marijuana. Demographic factors and personal history of marijuana use were not associated with perceptions of potential physician use.</div></div><div><h3>Conclusions</h3><div>Patient perceptions of marijuana use are variable. More patients were comfortable with their physician using marijuana outside of work than not. Patients were as comfortable with their physicians using medical marijuana as they were with nicotine.</div></div><div><h3>Clinical relevance</h3><div>As federal and state laws surrounding marijuana use change, understanding patient perceptions of potential physician use may play a role in determining health system and licensing board policies.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 167-172"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621068","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

Nail Bed Reconstruction Using Synthetic Matrix: A Case Series

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.10.006

Devin C. Potter MD , Caleb A. LaVigne MD , Haley D. Puckett MD , Gary M. Lourie MD

Injuries to fingertips are one of the most common hand injuries treated in medical settings. Traditional treatment options often have disadvantages, such as increased risk of infection, high cost, and donor-site morbidity. Here, we discuss two cases of fingertip injuries with associated nail bed damage where we used NovoSorb® biodegradable temporizing matrix as a successful alternative treatment compared to skin grafts and acellular dermal matrices.

引用次数: 0

Viability and Functional Prognosis in Mangled Hand Casualties Depending on Their Etiological Factors. A Study of 31 Cases

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.06.014

Ioannis A. Ignatiadis MD , Vasiliki A. Tsiampa MD , Pavlos Altsitzioglou MD , Emmanouil G. Daskalakis MD , Dimitrios K. Arapoglou MD , Andreas F. Mavrogenis MD

Purpose

Mangled hands refer to disfiguring severe injuries that affect many anatomical components. These injuries are evaluated using various scoring systems. In addition to these ratings, we need to include critical aspects relating to the patient, such as the trauma origin, prognosis, and procedure. We examined the significance of accident etiology in assessing trauma and predicting outcomes, as well as their value in guiding decisions for trauma treatment.

Methods

Thirty-one patients, from 6 to 73 years, have been treated for upper limb compound injuries at our hospital between 2004 and 2009. We registered 10 blast injuries, 10 work accidents, six motor vehicle accidents, and five gunshot injuries. The severity, anatomy, topography, and type assessment method was used to evaluate the prognosis on viability and functionality. Additionally, we studied the influence of the etiological factor on injury prognosis. The functional results have been assessed by the manual muscle testing grading system, whereas the results of the limb usefulness have been evaluated by Disabilities of Arm, Shoulder and Hand (DASH) score test (patients’ self-questionnaire).

Results

Seventeen cases involved major vascular lesions that required emergency reconstruction or amputation. Our findings indicate that cases with blast injuries managed by partial or total amputations or using flaps to close stumps had poor prognoses. For cases with work-related injuries, we performed revascularization or flaps where the likelihood of saving the limbs was deemed higher than the potential risks of postoperative complications. In cases with gunshot injuries, despite the low overall functioning seen, our primary approach was to repair rather than amputating because of the potential feasibility of achieving viability.

Conclusions

Further investigation is needed to determine if the cause of trauma has an important impact on trauma evaluation scores and predicting trauma outcomes, furthermore, helping decision making in emergencies.

Type of study/level of evidence

Prognosis IIa.

{"title":"Viability and Functional Prognosis in Mangled Hand Casualties Depending on Their Etiological Factors. A Study of 31 Cases","authors":"Ioannis A. Ignatiadis MD , Vasiliki A. Tsiampa MD , Pavlos Altsitzioglou MD , Emmanouil G. Daskalakis MD , Dimitrios K. Arapoglou MD , Andreas F. Mavrogenis MD","doi":"10.1016/j.jhsg.2024.06.014","DOIUrl":"10.1016/j.jhsg.2024.06.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Mangled hands refer to disfiguring severe injuries that affect many anatomical components. These injuries are evaluated using various scoring systems. In addition to these ratings, we need to include critical aspects relating to the patient, such as the trauma origin, prognosis, and procedure. We examined the significance of accident etiology in assessing trauma and predicting outcomes, as well as their value in guiding decisions for trauma treatment.</div></div><div><h3>Methods</h3><div>Thirty-one patients, from 6 to 73 years, have been treated for upper limb compound injuries at our hospital between 2004 and 2009. We registered 10 blast injuries, 10 work accidents, six motor vehicle accidents, and five gunshot injuries. The severity, anatomy, topography, and type assessment method was used to evaluate the prognosis on viability and functionality. Additionally, we studied the influence of the etiological factor on injury prognosis. The functional results have been assessed by the manual muscle testing grading system, whereas the results of the limb usefulness have been evaluated by Disabilities of Arm, Shoulder and Hand (DASH) score test (patients’ self-questionnaire).</div></div><div><h3>Results</h3><div>Seventeen cases involved major vascular lesions that required emergency reconstruction or amputation. Our findings indicate that cases with blast injuries managed by partial or total amputations or using flaps to close stumps had poor prognoses. For cases with work-related injuries, we performed revascularization or flaps where the likelihood of saving the limbs was deemed higher than the potential risks of postoperative complications. In cases with gunshot injuries, despite the low overall functioning seen, our primary approach was to repair rather than amputating because of the potential feasibility of achieving viability.</div></div><div><h3>Conclusions</h3><div>Further investigation is needed to determine if the cause of trauma has an important impact on trauma evaluation scores and predicting trauma outcomes, furthermore, helping decision making in emergencies.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IIa.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 300-313"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620926","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

Venous Flap Coverage of the Mangled Hand

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.05.012

Anca Dogaroiu MS , Berkay Başağaoğlu MD , Andrew Y. Zhang MD , Douglas Sammer MD , Bauback Safa MD, MBA , Andrei Odobescu MD, PhD

Mangled upper-extremity injuries represent composite tissue injuries that threaten the viability or function of the limb. Successful reconstruction is critical to both the patient’s mental and physical well-being, and early soft tissue coverage is necessary to best facilitate this. Since first described by Nakayama almost four decades ago, venous flaps have remained underused in microsurgery. Here, we discuss the advantages of venous flaps in mangled upper-extremity soft tissue coverage, including their thin, pliable nature with easily accessible donor sites, short dissection, and overall procedure times. We outline surgical techniques to facilitate successful tissue transfer and identify common pitfalls.

引用次数: 0

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation 手部复杂损伤后手指截肢后遗症的流式手术

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.02.017

Alexandru Valentin Georgescu MD, PhD , Alma-Andreea Corpodean MD , Octavian David Olariu PhD , Ileana Rodica Matei MD, PhD

Purpose

Complex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem.

Methods

This study retrospectively reviewed four cases that underwent single or multiple fingers’ reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented.

Results

All the patients were men, aged between 21 and 45 years (median age: 31.75). One of them injured the left-dominant hand, and the other three their right-dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range: 3–36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (second and fourth), and one patient had three fingers amputated (second, third, and fourth). In the first patient, a true flow-through flap and a second toe transfer were done, and in the other three patients, multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients.

Conclusions

Toe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods is very useful, especially in cases with few vascular resources.

Type of study/level of evidence

Therapeutic IV.

{"title":"Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation","authors":"Alexandru Valentin Georgescu MD, PhD , Alma-Andreea Corpodean MD , Octavian David Olariu PhD , Ileana Rodica Matei MD, PhD","doi":"10.1016/j.jhsg.2024.02.017","DOIUrl":"10.1016/j.jhsg.2024.02.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Complex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed four cases that underwent single or multiple fingers’ reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented.</div></div><div><h3>Results</h3><div>All the patients were men, aged between 21 and 45 years (median age: 31.75). One of them injured the left-dominant hand, and the other three their right-dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range: 3–36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (second and fourth), and one patient had three fingers amputated (second, third, and fourth). In the first patient, a true flow-through flap and a second toe transfer were done, and in the other three patients, multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients.</div></div><div><h3>Conclusions</h3><div>Toe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods is very useful, especially in cases with few vascular resources.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 266-271"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050730","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

Operative Treatment of Non-Thumb Carpometacarpal Joint Fracture Dislocations

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.11.003

Thomas J. Berault MD , Emilio A. Ihde BS , George C. Balazs MD , Aaron A. Olsen DO , Andrew D. Henebry MD

Purpose

To investigate the functional outcomes and complications of operatively managed carpometacarpal (CMC) fracture dislocations, excluding the thumb, in a young, active population.

Methods

A retrospective chart review of all patients undergoing surgical treatment for CMC joint injuries at a single institution over a 6-year period was performed. Patients were excluded if they had a first CMC joint injury, were under 18 years old, or had incomplete documentation. Injury radiographs were categorized as simple/extra-articular, partial articular, and complete articular. Electronic health records were searched for demographic information, mechanism, associated injuries, time to surgery, time to union, time to return to full-activity, complications, and need for revision surgery. QuickDASH (Disabilities of Arm, Shoulder, and Hand) and Patient-Reported Wrist Evaluation scores were collected at final follow-up.

Results

A total of 160 patients were included in the study, of which 89% were male. Punching was the most common mechanism of injury. Combined fourth and fifth CMC fracture dislocations and isolated fifth CMC fracture dislocations encompassed 90% of the injury patterns seen. Combined fourth and fifth CMC joint injuries had an associated distal carpal row fracture 54% of the time. There was a 29% complication rate. Complications related to K-wires made up 55% of the total complications. Final follow-up was obtained on 45/160 patients (28%). The median final QuickDASH score was 11.4 (range, 0–45.5), with 65% of patients meeting the patient acceptable symptomatic state. Median Patient-Reported Wrist Evaluation score of 18.5 (range, 0–67.5) with 76% meeting the patient acceptable symptomatic state. Among the 133 active-duty military patients included, 79/133 (59%) remained on active-duty at a median of 3.3 years after surgery.

Conclusions

Despite relatively high surgical complication rates, operative management of CMC fracture dislocations results in good-to-excellent functional outcomes.

Type of study/level of evidence

Differential diagnosis/system prevalence study III.

{"title":"Operative Treatment of Non-Thumb Carpometacarpal Joint Fracture Dislocations","authors":"Thomas J. Berault MD , Emilio A. Ihde BS , George C. Balazs MD , Aaron A. Olsen DO , Andrew D. Henebry MD","doi":"10.1016/j.jhsg.2024.11.003","DOIUrl":"10.1016/j.jhsg.2024.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the functional outcomes and complications of operatively managed carpometacarpal (CMC) fracture dislocations, excluding the thumb, in a young, active population.</div></div><div><h3>Methods</h3><div>A retrospective chart review of all patients undergoing surgical treatment for CMC joint injuries at a single institution over a 6-year period was performed. Patients were excluded if they had a first CMC joint injury, were under 18 years old, or had incomplete documentation. Injury radiographs were categorized as simple/extra-articular, partial articular, and complete articular. Electronic health records were searched for demographic information, mechanism, associated injuries, time to surgery, time to union, time to return to full-activity, complications, and need for revision surgery. <em>Quick</em>DASH (Disabilities of Arm, Shoulder, and Hand) and Patient-Reported Wrist Evaluation scores were collected at final follow-up.</div></div><div><h3>Results</h3><div>A total of 160 patients were included in the study, of which 89% were male. Punching was the most common mechanism of injury. Combined fourth and fifth CMC fracture dislocations and isolated fifth CMC fracture dislocations encompassed 90% of the injury patterns seen. Combined fourth and fifth CMC joint injuries had an associated distal carpal row fracture 54% of the time. There was a 29% complication rate. Complications related to K-wires made up 55% of the total complications. Final follow-up was obtained on 45/160 patients (28%). The median final <em>Quick</em>DASH score was 11.4 (range, 0–45.5), with 65% of patients meeting the patient acceptable symptomatic state. Median Patient-Reported Wrist Evaluation score of 18.5 (range, 0–67.5) with 76% meeting the patient acceptable symptomatic state. Among the 133 active-duty military patients included, 79/133 (59%) remained on active-duty at a median of 3.3 years after surgery.</div></div><div><h3>Conclusions</h3><div>Despite relatively high surgical complication rates, operative management of CMC fracture dislocations results in good-to-excellent functional outcomes.</div></div><div><h3>Type of study/level of evidence</h3><div>Differential diagnosis/system prevalence study III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 139-145"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621064","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

Early Surgical Decompression for the Treatment of Hourglass-Like Constriction of the Posterior Interosseus Nerve

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsg.2024.12.008

Nathan Redlich MD , Matan Ozery MD , Adam Haydel MD , Charles Cush BS , Rasheed Ahmad MD

Posterior interosseous nerve (PIN) syndrome refers to a rare compressive neuropathy of the PIN resulting in motor dysfunction of the forearm extensor compartment. Often, surgical exploration will reveal extrinsic structures that mechanically compress the nerve. Less frequently, PIN syndrome has been reported with a visible hourglass-like constriction and no identifiable causative adjacent structures. In our report, we describe an adolescent patient with PIN syndrome and associated hourglass-like constriction of the PIN. For diagnosis, we used physical examination, preoperative imaging, nerve studies, and intraoperative findings. To monitor recovery, we performed serial neurological examinations and documented patient-reported functional outcomes. The patient underwent early surgical decompression (< 6 weeks from presentation). Complete resolution of pain was reported 2 weeks after surgery. Complete resolution of wrist extension motor function occurred at 28 weeks after surgery. We demonstrate effective pain relief and complete motor recovery with early surgical release in this adolescent high-level athlete.

{"title":"Early Surgical Decompression for the Treatment of Hourglass-Like Constriction of the Posterior Interosseus Nerve","authors":"Nathan Redlich MD , Matan Ozery MD , Adam Haydel MD , Charles Cush BS , Rasheed Ahmad MD","doi":"10.1016/j.jhsg.2024.12.008","DOIUrl":"10.1016/j.jhsg.2024.12.008","url":null,"abstract":"<div><div>Posterior interosseous nerve (PIN) syndrome refers to a rare compressive neuropathy of the PIN resulting in motor dysfunction of the forearm extensor compartment. Often, surgical exploration will reveal extrinsic structures that mechanically compress the nerve. Less frequently, PIN syndrome has been reported with a visible hourglass-like constriction and no identifiable causative adjacent structures. In our report, we describe an adolescent patient with PIN syndrome and associated hourglass-like constriction of the PIN. For diagnosis, we used physical examination, preoperative imaging, nerve studies, and intraoperative findings. To monitor recovery, we performed serial neurological examinations and documented patient-reported functional outcomes. The patient underwent early surgical decompression (< 6 weeks from presentation). Complete resolution of pain was reported 2 weeks after surgery. Complete resolution of wrist extension motor function occurred at 28 weeks after surgery. We demonstrate effective pain relief and complete motor recovery with early surgical release in this adolescent high-level athlete.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 246-248"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620922","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