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Injury Patterns, Imaging Findings, and Prognosis for Muscle Strength Recovery in Surgical Infraclavicular Brachial Plexus Injuries 锁骨下臂丛神经损伤手术中的损伤模式、成像结果和肌力恢复预后
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.012
Julia S. Retzky MD , Clara Straus BA , Anil Bhatia MD , Darryl B. Sneag MD , Ogonna K. Nwawka MD , Steve K. Lee MD

Purpose

Historically, infraclavicular brachial plexus injuries (IBPIs) were considered neuropraxic injuries that would improve with nonsurgical intervention. However, more recent studies suggest that these injuries may benefit from surgical intervention. The aims of this retrospective study were to (1) describe injury patterns and associated injuries of isolated, traumatic IBPIs, (2) evaluate the concordance of preoperative ultrasound and magnetic resonance neurography with surgical findings of patients who underwent surgical intervention for IBPIs, and (3) describe outcomes of surgical intervention for these injuries.

Methods

A total of 148 patients who underwent surgical intervention for traumatic injury to the IBP by one of three hand/upper-extremity fellowship-trained surgeons from 1995 to 2021 were included. Patients with supraclavicular brachial plexus injuries, stretch injuries, nonsurgical IBPIs, and brachial plexus dysfunction without traumatic injury were excluded.

Results

The most common cause of injury was motor vehicle accident (74%). Scapular fractures were associated with IBPI in 22% of patients. Isolated branch injuries were the most common (58.8%), of which isolated musculocutaneous nerve injury was the most frequent (40.6%). Preoperative ultrasound and magnetic resonance neurography were concordant with surgical findings in eight of nine and seven of nine patients, respectively. Nerve transfers were the most common intervention (46%). Muscle strength improved after surgery, with an increase from 1 to 5 points on the Medical Research Council scale at 14–50 months after surgery.

Conclusions

Infraclavicular brachial plexus injuries are associated with high-energy trauma and concomitant upper-extremity fractures. Ultrasound and magnetic resonance neurography are mostly concordant with surgical findings in patients undergoing surgical intervention for IBPIs. Prognosis for muscle recovery after surgery is good in patients with IBPIs.

Clinical relevance

Infraclavicular brachial plexus injuries can improve with surgical intervention.
目的从历史上看,锁骨下臂丛神经损伤(IBPIs)被认为是神经缺氧性损伤,通过非手术干预即可改善。然而,最近的研究表明,这些损伤可能会从手术干预中获益。这项回顾性研究的目的是:(1) 描述孤立性外伤性 IBPIs 的损伤模式和相关损伤;(2) 评估接受手术治疗的 IBPIs 患者的术前超声和磁共振神经影像学检查结果与手术结果的一致性;(3) 描述手术治疗这些损伤的结果。结果最常见的受伤原因是机动车事故(74%)。22%的患者肩胛骨骨折与IBPI有关。孤立的分支损伤最常见(58.8%),其中孤立的肌皮神经损伤最常见(40.6%)。术前超声波和磁共振神经成像与手术结果一致的患者分别占 9 人中的 8 人和 9 人中的 7 人。神经转移是最常见的干预措施(46%)。结论锁骨臂丛神经损伤与高能量创伤和并发上肢骨折有关。在接受手术治疗的 IBPI 患者中,超声和磁共振神经影像学检查与手术结果大多一致。IBPIs 患者术后肌肉恢复的预后良好。临床意义锁骨臂丛神经损伤可通过手术干预得到改善。
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引用次数: 0
Intra-articular Synovial Ganglion of the Wrist 腕关节内滑膜神经节
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.05.007
María Teresa Ramírez , Gustavo Molina , Cinzia Di Carlo , Vicente Fernández , Sebastian Von Unger , Nicolás Thumm , Philipp Anwandter , Gonzalo Morgan
Synovial ganglions, common soft tissue tumors of the hand and wrist, typically occur in the dorsal and volar aspects of the wrist, but intra-articular cases are rare. We present a case of a 27-year-old equestrian with persistent left wrist pain who was diagnosed with an intra-articular radiocarpal synovial ganglion after failed conservative management. Arthroscopic resection led to complete resolution of symptoms and functional recovery. This case highlights the diagnostic and therapeutic challenges posed by intra-articular synovial ganglions and underscores the efficacy of arthroscopic intervention in such cases. Although the literature on this specific presentation is scarce, our experience advocates for arthroscopic resection as an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures.
滑膜神经节是手部和腕部常见的软组织肿瘤,通常发生在腕部的背侧和外侧,但关节内病例很少见。我们介绍了一例 27 岁马术运动员的病例,患者左手腕持续疼痛,经保守治疗无效后被诊断为关节内放射性腕关节滑膜神经节。关节镜切除术后,症状完全缓解,功能也得到恢复。该病例凸显了关节内滑膜神经节给诊断和治疗带来的挑战,并强调了关节镜干预在此类病例中的疗效。虽然有关这种特殊表现的文献很少,但我们的经验表明,对于保守治疗无效的关节内滑膜神经节,关节镜切除术是一种有效的治疗策略。
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引用次数: 0
Sex Disparities Affecting Postoperative Outcomes After Total Elbow Arthroplasty 影响全肘关节置换术后效果的性别差异
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.010
Rohit Siddabattula BA , George Thomas MD , Urska Cvek ScD , Marjan Trutschl ScD , Edward Wu MD , Allison J. Rao MD

Purpose

To investigate sex disparities in 30-day postoperative outcomes of total elbow arthroplasty.

Methods

The American College of Surgeons-National Surgical Quality Improvement Program files were queried for all patients who underwent a total elbow arthroplasty (TEA) between 2006 and 2020. Sex disparities in preoperative variables were studied using Fisher exact tests. Multivariate logistic regression models were used to determine the adjusted odds ratios (aOR) of postoperative outcomes for women in comparison with men.

Results

A total of 788 patients underwent a TEA in the period of 2006–2020. Of those, 180 were men, and 608 were women. We found an increase in TEAs performed each year with a predominance in females compared to males. Additionally, our work demonstrated increased statistically significant odds of a major adverse cardiac event (P < .0001), transfusions required (P < .0001), and return to the operating room (P < .0001) as postoperative outcomes in females compared to males following TEA. Finally, we found no statistically significant difference in mortality between the groups (P = 1).

Conclusions

Following a TEA, women had higher adjusted postoperative odds of experiencing a major adverse cardiac event, requiring transfusion, and return to the operating room. No significant differences were found in wound outcomes, pulmonary outcomes, venous thromboembolic outcomes, sepsis, and length of stay. Overall mortality rates were similar between the two groups. Our study warrants further evaluation of the root cause of sex disparities in TEA outcomes and methods to improve care delivery to reduce those disparities.

Type of study/level of evidence

Prognostic 2b.
目的 研究全肘关节置换术术后 30 天结果的性别差异。方法 查询美国外科医生学会-国家外科质量改进计划的档案,了解 2006 年至 2020 年间接受全肘关节置换术 (TEA) 的所有患者。使用费舍尔精确检验对术前变量的性别差异进行了研究。使用多变量逻辑回归模型确定了女性与男性术后结果的调整几率比(aOR)。其中 180 人为男性,608 人为女性。我们发现进行 TEA 的人数逐年增加,且女性多于男性。此外,我们的研究表明,与男性相比,女性在 TEA 术后发生重大心脏不良事件(P < .0001)、需要输血(P < .0001)和返回手术室(P < .0001)的几率均有显著统计学意义。结论TEA术后,女性发生重大心脏不良事件、需要输血和返回手术室的调整后几率更高。在伤口预后、肺部预后、静脉血栓栓塞预后、败血症和住院时间方面没有发现明显差异。两组的总死亡率相似。我们的研究值得进一步评估TEA结果性别差异的根本原因,以及改善护理服务以减少这些差异的方法。
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引用次数: 0
Fractional Dolphin Tenotomy for Boutonniere Deformity: A Cadaveric Study 分段式海豚腱切开术治疗布顿畸形:尸体研究
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.006
Karly Lorbeer MD , Andrew D. Allen MD , Alexander D. Jeffs MD , Emily Jewell MD , Nathaniel C. Adams BA , Eric Van Buren PhD , Feng-Chang Lin PhD , Reid W. Draeger MD

Purpose

Terminal extensor tenotomy or Dolphin tenotomy, is a described treatment for the management of distal interphalangeal (DIP) joint hyperextension in chronic boutonniere deformity. The purpose of this study was to investigate the effects of incremental partial Dolphin tenotomy in correcting boutonniere deformity, with a focus on evaluating the improvement in DIP joint hyperextension deformity and documenting the development of iatrogenic mallet finger.

Methods

Thirty-eight fingers from 10 cadaveric hands were used. We created a boutonniere deformity in each digit by transecting the central slip and repairing it with a 3-mm gap. We performed incremental fractional terminal extensor tenotomy by detaching one-third, one-half, two-thirds, and complete transection. The positions of the proximal interphalangeal (PIP) and DIP joints were measured in the extended position following each subsequent tenotomy.

Results

The model produced an average DIP joint hyperextension deformity of −15 ± 1°. The DIP joint position sequentially improved with one-third (−11 ± 1°), one-half (−9 ± 1°), and two-thirds (−5 ± 1°) tenotomy. Complete tenotomy resulted in an average 25° extensor lag. There was no significant improvement in PIP joint flexion deformity with any degree of fractional tenotomy (P > 0.05), and only mild improvement after complete tenotomy (48 ± 2° to 41 ± 2°, P < 0.05).

Conclusions

Fractional terminal extensor tenotomy demonstrated incremental improvement in DIP joint hyperextension deformity with increasing degree of tenotomy performed. There were no cases of iatrogenic mallet finger with fractional tenotomy involving up to two-thirds of the tendon.

Clinical relevance

Clinical application of fractional terminal extensor tenotomy may be an effective treatment option for patients with chronic boutonniere deformity in whom PIP joint deformity is mild and DIP joint hyperextension accounts for the primary functional deficit. Fractional tenotomy may allow the surgeon to tailor the degree of correction to the existing preoperative deformity.
目的末端伸肌腱膜切开术或Dolphin腱膜切开术是一种用于治疗慢性拇指畸形中远端指间关节(DIP)过度伸展的治疗方法。本研究的目的是研究渐进式部分 Dolphin 腱切开术在矫正拇指畸形中的效果,重点是评估 DIP 关节过度伸展畸形的改善情况,并记录先天性槌状指的发生情况。我们通过横断中央滑脱并用 3 毫米的间隙进行修复,在每个指头上创建了拇指畸形。我们通过分离三分之一、二分之一、三分之二和完全横断的方式,对末端伸肌腱鞘进行了递增式分段切除。结果该模型产生的平均DIP关节过伸畸形为-15 ± 1°。在进行三分之一(-11 ± 1°)、二分之一(-9 ± 1°)和三分之二(-5 ± 1°)韧带切除术后,DIP关节位置依次得到改善。完全腱膜切除术导致平均 25° 的外展滞后。任何程度的点阵式腱膜切开术对 PIP 关节屈曲畸形均无明显改善(P> 0.05),完全腱膜切开术后仅有轻微改善(从 48 ± 2° 到 41 ± 2°,P< 0.05)。临床意义对于PIP关节畸形轻微、DIP关节过度伸展为主要功能障碍的慢性拇指畸形患者,临床应用点状末端伸肌腱膜切开术可能是一种有效的治疗选择。分段式腱膜切除术可让外科医生根据术前存在的畸形情况来调整矫正程度。
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引用次数: 0
Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases Aptis 桡肘远端关节置换术后的假体周围尺骨骨折:四例系列病例
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.012
Tan Chern Yang Harmony MD , Matthew Pina MD , Tuna Ozyurekoglu MD , Elkin J. Galvis MD

Purpose

This case series presents four cases of periprosthetic ulna fractures following Aptis distal radioulnar joint (DRUJ) arthroplasty to elucidate clinical characteristics, contributing factors, management challenges, and short-term outcomes following this rare complication and to propose prevention and optimal treatment strategies.

Methods

We conducted a retrospective review of 239 Aptis DRUJ prostheses implanted between 2012 and 2022 at a single institution. We identified four cases of periprosthetic ulna fractures and assessed demographics, surgical indications, time to fracture, mechanism of injury, radiographic findings, treatment modalities, associated complications, and outcomes.

Results

The incidence of periprosthetic ulna fractures was 1.7%. All patients had prior surgery on the same extremity. Fractures occurred within 11 months of DRUJ arthroplasty, with varied mechanisms of injury, including one after a fall, another with heavy lifting, and the remaining two unprovoked. Postoperative radiographs revealed eccentric stem position and endosteal impingement in all cases. According to the Unified Classification System for periprosthetic fractures, three were classified as B1 type, and one was B2 type at diagnosis. Open reduction and internal fixation reliably achieved union at an average of 7 months with acceptable function.

Conclusion

Intraoperative technical pitfalls may contribute to periprosthetic ulna fractures during the early postoperative period. Consideration should also be given to anatomical variations and ulna shaft morphometry. Nonsurgical treatment yielded unsatisfactory results, whereas fractures without gross stem loosening treated with open reduction and internal fixation and autologous bone grafting resulted in reliable fracture union, suggesting a limited role for conservative treatment. Based on principles of periprosthetic fracture treatment in other locations, fractures with gross stem loosening may be best managed with implant exchange, with or without supplemental open reduction and internal fixation; however, more evidence is needed to guide the treatment of this rare complication of DRUJ arthroplasty.

Type of study/level of evidence

Therapeutic IV.
目的 本病例系列介绍了四例 Aptis 放射锁骨远端关节 (DRUJ) 人工关节置换术后发生的假体周围尺骨骨折病例,以阐明这种罕见并发症的临床特征、诱因、管理挑战和短期疗效,并提出预防和最佳治疗策略。我们确定了四例假体周围尺骨骨折病例,并评估了人口统计学、手术适应症、骨折时间、损伤机制、放射学检查结果、治疗方式、相关并发症和预后。所有患者都曾在同一肢体上接受过手术。骨折发生在DRUJ关节置换术后的11个月内,损伤机制各不相同,其中一名患者是摔倒后骨折,另一名患者是提重物时骨折,其余两名患者是无诱因骨折。术后X光片显示,所有病例都存在骨干偏心位置和骨膜内撞击。根据假体周围骨折统一分类系统,确诊时有三例属于B1型,一例属于B2型。结论术中的技术误区可能会在术后早期导致假体周围尺骨骨折。结论:术中的技术误区可能会导致术后早期的假体周围尺骨骨折,同时也应考虑解剖变异和尺骨轴的形态。非手术治疗的结果并不令人满意,而通过切开复位、内固定和自体骨移植治疗无严重骨干松动的骨折,可实现可靠的骨折结合,这表明保守治疗的作用有限。根据其他部位假体周围骨折的治疗原则,有骨干严重松动的骨折可能最好采用假体置换术,并辅以或不辅以切开复位和内固定术;然而,还需要更多证据来指导这种DRUJ关节成形术罕见并发症的治疗。
{"title":"Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases","authors":"Tan Chern Yang Harmony MD ,&nbsp;Matthew Pina MD ,&nbsp;Tuna Ozyurekoglu MD ,&nbsp;Elkin J. Galvis MD","doi":"10.1016/j.jhsg.2024.06.012","DOIUrl":"10.1016/j.jhsg.2024.06.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This case series presents four cases of periprosthetic ulna fractures following Aptis distal radioulnar joint (DRUJ) arthroplasty to elucidate clinical characteristics, contributing factors, management challenges, and short-term outcomes following this rare complication and to propose prevention and optimal treatment strategies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 239 Aptis DRUJ prostheses implanted between 2012 and 2022 at a single institution. We identified four cases of periprosthetic ulna fractures and assessed demographics, surgical indications, time to fracture, mechanism of injury, radiographic findings, treatment modalities, associated complications, and outcomes.</div></div><div><h3>Results</h3><div>The incidence of periprosthetic ulna fractures was 1.7%. All patients had prior surgery on the same extremity. Fractures occurred within 11 months of DRUJ arthroplasty, with varied mechanisms of injury, including one after a fall, another with heavy lifting, and the remaining two unprovoked. Postoperative radiographs revealed eccentric stem position and endosteal impingement in all cases. According to the Unified Classification System for periprosthetic fractures, three were classified as B1 type, and one was B2 type at diagnosis. Open reduction and internal fixation reliably achieved union at an average of 7 months with acceptable function.</div></div><div><h3>Conclusion</h3><div>Intraoperative technical pitfalls may contribute to periprosthetic ulna fractures during the early postoperative period. Consideration should also be given to anatomical variations and ulna shaft morphometry. Nonsurgical treatment yielded unsatisfactory results, whereas fractures without gross stem loosening treated with open reduction and internal fixation and autologous bone grafting resulted in reliable fracture union, suggesting a limited role for conservative treatment. Based on principles of periprosthetic fracture treatment in other locations, fractures with gross stem loosening may be best managed with implant exchange, with or without supplemental open reduction and internal fixation; however, more evidence is needed to guide the treatment of this rare complication of DRUJ arthroplasty.</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":"6 6","pages":"Pages 823-829"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707116","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
Can Machine Learning Identify Patients Who are Appropriate for Outpatient Open Reduction and Internal Fixation of Distal Radius Fractures? 机器学习能否识别适合桡骨远端骨折门诊开放复位内固定术的患者?
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.002
Alexander L. Hornung MD , Samuel S. Rudisill MD , Shelby Smith MD , John T. Streepy MS , Xavier C. Simcock MD

Purpose

This study aimed to identify which patients were “unsafe” for outpatient surgery patients and determine the most predictive demographic and clinical factors contributing to postoperative risk following open reduction internal fixation for distal radius fractures.

Methods

Adult patients (aged ≥18 years) who presented with distal radius fracture and underwent open reduction internal fixation were identified using the American College of Surgeons National Surgical Quality Improvement Program database for years 2016 to 2021. Patients who were deemed “unsafe” therefore contraindicated for outpatient open reduction internal fixation of distal radius fracture if they required admission (length of stay of one or more days) or experienced any complication or required readmission within 7 days of the index operation. The model with optimal performance was determined according to area under the curve on the receiver operating characteristic curve and overall accuracy. Additional model metrics were also evaluated, and predictive factors (ie, features) that were most important to model derivation were identified.

Results

A total of 2,020 eligible patients underwent open reduction and internal fixation for distal radius fractures. The majority (78.6%) were women, with a mean age of 57.5 ± 16.0 years. Of these patients, 21.5% experienced short-term adverse events. Gradient boosting was the optimal model for predicting patients who were “unsafe” for outpatient surgery, with key features including International Classification of Diseases, 10th Revision code, preoperative white blood cell count, age, body mass index, and Hispanic ethnicity.

Conclusions

Using machine learning techniques, a predictive model was developed, which demonstrated good discrimination and excellent performance in predicting which patients were “unsafe” for outpatient operative fixation of distal radius fracture. Findings of this study highlight the predictive value of artificial intelligence and machine learning for the purposes of preoperative risk stratification as well as its potential to better inform shared decision making and guide personalized fracture care.

Level of evidence/type of study

Prognostic IV.
本研究旨在确定哪些患者对门诊手术患者来说是 "不安全 "的,并确定导致桡骨远端骨折切开复位内固定术后风险的最具预测性的人口统计学和临床因素。方法使用美国外科学院国家外科质量改进计划数据库(2016 年至 2021 年)确定桡骨远端骨折并接受切开复位内固定术的成人患者(年龄≥18 岁)。如果患者需要入院治疗(住院时间为 1 天或 1 天以上),或出现任何并发症,或在指数手术后 7 天内需要再次入院治疗,则被视为 "不安全",因此禁止在门诊接受桡骨远端骨折切开复位内固定术。根据接收者操作特征曲线下的面积和总体准确性,确定了性能最佳的模型。结果共有 2020 名符合条件的患者接受了桡骨远端骨折切开复位内固定术。大多数(78.6%)患者为女性,平均年龄为(57.5 ± 16.0)岁。其中,21.5%的患者出现了短期不良反应。梯度提升法是预测门诊手术 "不安全 "患者的最佳模型,其主要特征包括国际疾病分类第 10 版代码、术前白细胞计数、年龄、体重指数和西班牙裔。这项研究的结果凸显了人工智能和机器学习在术前风险分层方面的预测价值,以及更好地为共同决策提供信息和指导个性化骨折护理的潜力。
{"title":"Can Machine Learning Identify Patients Who are Appropriate for Outpatient Open Reduction and Internal Fixation of Distal Radius Fractures?","authors":"Alexander L. Hornung MD ,&nbsp;Samuel S. Rudisill MD ,&nbsp;Shelby Smith MD ,&nbsp;John T. Streepy MS ,&nbsp;Xavier C. Simcock MD","doi":"10.1016/j.jhsg.2024.06.002","DOIUrl":"10.1016/j.jhsg.2024.06.002","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to identify which patients were “unsafe” for outpatient surgery patients and determine the most predictive demographic and clinical factors contributing to postoperative risk following open reduction internal fixation for distal radius fractures.</div></div><div><h3>Methods</h3><div>Adult patients (aged ≥18 years) who presented with distal radius fracture and underwent open reduction internal fixation were identified using the American College of Surgeons National Surgical Quality Improvement Program database for years 2016 to 2021. Patients who were deemed “unsafe” therefore contraindicated for outpatient open reduction internal fixation of distal radius fracture if they required admission (length of stay of one or more days) or experienced any complication or required readmission within 7 days of the index operation. The model with optimal performance was determined according to area under the curve on the receiver operating characteristic curve and overall accuracy. Additional model metrics were also evaluated, and predictive factors (ie, features) that were most important to model derivation were identified.</div></div><div><h3>Results</h3><div>A total of 2,020 eligible patients underwent open reduction and internal fixation for distal radius fractures. The majority (78.6%) were women, with a mean age of 57.5 ± 16.0 years. Of these patients, 21.5% experienced short-term adverse events. Gradient boosting was the optimal model for predicting patients who were “unsafe” for outpatient surgery, with key features including International Classification of Diseases, 10th Revision code, preoperative white blood cell count, age, body mass index, and Hispanic ethnicity.</div></div><div><h3>Conclusions</h3><div>Using machine learning techniques, a predictive model was developed, which demonstrated good discrimination and excellent performance in predicting which patients were “unsafe” for outpatient operative fixation of distal radius fracture. Findings of this study highlight the predictive value of artificial intelligence and machine learning for the purposes of preoperative risk stratification as well as its potential to better inform shared decision making and guide personalized fracture care.</div></div><div><h3>Level of evidence/type of study</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 808-813"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707196","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
Reporting Clinical Outcomes in Hand Surgery Randomized Controlled Trials: A Systematic Review Using Wide-Awake Local Anesthesia No Tourniquet Studies as a Model 报告手外科随机对照试验的临床结果:以宽醒局部麻醉无止血带研究为模型的系统性综述
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.007
Jad Lawand MS , Ashraf Hantouly MS, MD , Fadi Bouri MD , Mohammad Muneer MD , Elisabet Hagert MD, PhD

Purpose

The purpose of this study was to comprehensively evaluate clinical outcome reporting in hand surgery randomized controlled trials (RCTs), using wide-awake local anesthesia no tourniquet (WALANT) studies as a model.

Methods

This International Prospective Register of Systematic Reviews-registered systematic review (CRD42023461653) adheres to preferred reporting items for systematic reviews and meta-analysis guidelines, focusing on RCTs evaluating WALANT in hand and upper limb surgery. A systematic search across five databases was conducted to include all eligible articles from inception until search date (April 1, 2023). Inclusion criteria encompassed WALANT RCTs in upper limb surgery, with exclusion criteria addressing non-RCTs and non-English studies. Data extraction covered study characteristics, patient demographics, procedures performed, and outcomes reported. The revised Cochrane risk-of-bias tool for randomized trials was employed for quality assessment.

Results

The search identified 304 articles—after screening, 11 were included for analysis, encompassing 889 patients in WALANT RCTs. Technical outcomes were most reported (73%), whereas functional was least commonly reported (36%). The analysis encompassed a heterogeneous patient cohort, with an average follow-up period of 41.3 days. Challenges in standardizing functional outcomes and patient-reported outcomes were identified. The Cochrane risk-of-bias tool for randomized trials indicated an overall low risk, affirming the methodological rigor of the included studies.

Conclusions

A significant diversity in outcome reporting and assessment tools was identified, emphasizing the challenges in standardization and outcome reporting across RCTs. Although technical outcomes were prevalent, patient-reported and functional outcomes were often lacking. The study underscores the need for further research standardization to optimize patient care and advance evidence-based decision making, as variability in outcomes reporting hinders the ability to draw consistent conclusions and comparisons across studies.

Type of study/level of evidence

Therapy/Prevention, Etiology/Harm IA.
本研究的目的是以宽醒局部麻醉无止血带(WALANT)研究为模型,全面评估手外科随机对照试验(RCT)的临床结果报告。方法本国际前瞻性系统综述注册系统综述(CRD42023461653)遵循系统综述和荟萃分析指南的首选报告项目,重点关注手部和上肢手术中评估WALANT的RCT。该研究在五个数据库中进行了系统检索,以纳入从开始到检索日期(2023 年 4 月 1 日)的所有符合条件的文章。纳入标准包括上肢手术中的 WALANT RCT,排除标准为非 RCT 和非英语研究。数据提取涵盖研究特点、患者人口统计学特征、所实施的手术以及所报告的结果。结果检索发现了 304 篇文章,经过筛选,纳入了 11 篇文章进行分析,涵盖了 WALANT RCT 中的 889 名患者。技术性结果的报道最多(73%),而功能性结果的报道最少(36%)。分析涵盖了不同类型的患者群,平均随访时间为 41.3 天。研究发现了功能性结果和患者报告结果标准化方面的挑战。科克伦随机试验偏倚风险工具显示总体风险较低,这肯定了纳入研究在方法上的严谨性。虽然技术性结果很普遍,但往往缺乏患者报告的功能性结果。这项研究强调了进一步实现研究标准化的必要性,以优化患者护理和推进循证决策,因为结果报告的差异阻碍了得出一致结论和对不同研究进行比较的能力。
{"title":"Reporting Clinical Outcomes in Hand Surgery Randomized Controlled Trials: A Systematic Review Using Wide-Awake Local Anesthesia No Tourniquet Studies as a Model","authors":"Jad Lawand MS ,&nbsp;Ashraf Hantouly MS, MD ,&nbsp;Fadi Bouri MD ,&nbsp;Mohammad Muneer MD ,&nbsp;Elisabet Hagert MD, PhD","doi":"10.1016/j.jhsg.2024.08.007","DOIUrl":"10.1016/j.jhsg.2024.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to comprehensively evaluate clinical outcome reporting in hand surgery randomized controlled trials (RCTs), using wide-awake local anesthesia no tourniquet (WALANT) studies as a model.</div></div><div><h3>Methods</h3><div>This International Prospective Register of Systematic Reviews-registered systematic review (CRD42023461653) adheres to preferred reporting items for systematic reviews and meta-analysis guidelines, focusing on RCTs evaluating WALANT in hand and upper limb surgery. A systematic search across five databases was conducted to include all eligible articles from inception until search date (April 1, 2023). Inclusion criteria encompassed WALANT RCTs in upper limb surgery, with exclusion criteria addressing non-RCTs and non-English studies. Data extraction covered study characteristics, patient demographics, procedures performed, and outcomes reported. The revised Cochrane risk-of-bias tool for randomized trials was employed for quality assessment.</div></div><div><h3>Results</h3><div>The search identified 304 articles—after screening, 11 were included for analysis, encompassing 889 patients in WALANT RCTs. Technical outcomes were most reported (73%), whereas functional was least commonly reported (36%). The analysis encompassed a heterogeneous patient cohort, with an average follow-up period of 41.3 days. Challenges in standardizing functional outcomes and patient-reported outcomes were identified. The Cochrane risk-of-bias tool for randomized trials indicated an overall low risk, affirming the methodological rigor of the included studies.</div></div><div><h3>Conclusions</h3><div>A significant diversity in outcome reporting and assessment tools was identified, emphasizing the challenges in standardization and outcome reporting across RCTs. Although technical outcomes were prevalent, patient-reported and functional outcomes were often lacking. The study underscores the need for further research standardization to optimize patient care and advance evidence-based decision making, as variability in outcomes reporting hinders the ability to draw consistent conclusions and comparisons across studies.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapy/Prevention, Etiology/Harm IA.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 875-881"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706719","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 Diagnosis and Treatment of Cardiac Amyloidosis by Screening Biopsy During Trigger Finger Release 在扳机指松解过程中通过筛查活检早期诊断和治疗心脏淀粉样变性
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.07.013
Ella Gibson MD , Imo A. Ebong MD, MS , Morgan A. Darrow MD , Ge Xiong MD, PhD , Angelo B. Lipira MD, MA , Ravi F. Sood MD, MS
Patients undergoing trigger release surgery are known to be at increased risk of amyloidosis and heart failure, and therefore, amyloidosis screening during trigger release surgery may facilitate early diagnosis and treatment of cardiac amyloidosis. However, the reported prevalence of amyloid on biopsies taken during trigger release surgery has varied widely, and no biopsy-positive patients in prior studies have been diagnosed with occult cardiac amyloidosis or started on disease-modifying therapy. We review the existing literature on this topic and present a case of a patient with cardiac amyloidosis diagnosed from a biopsy taken during trigger release surgery and subsequently started on disease-modifying therapy. This case supports the potential role of amyloidosis screening during trigger release and highlights the benefits of collaboration between hand surgeons and amyloidosis specialists in multidisciplinary amyloidosis programs.
众所周知,接受触发释放手术的患者罹患淀粉样变性和心力衰竭的风险会增加,因此,在触发释放手术期间进行淀粉样变性筛查可能有助于早期诊断和治疗心脏淀粉样变性。然而,据报道,触发释放手术期间活检组织中淀粉样蛋白的患病率差异很大,在之前的研究中,没有活检阳性患者被诊断为隐匿性心脏淀粉样变性或开始接受疾病调节治疗。我们回顾了有关这一主题的现有文献,并介绍了一例在触发释放手术中通过活检确诊为心脏淀粉样变性并随后开始接受疾病调节治疗的患者。该病例支持在触发释放手术中进行淀粉样变性筛查的潜在作用,并强调了手外科医生和淀粉样变性专家在多学科淀粉样变性项目中合作的益处。
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引用次数: 0
Letter Regarding “Xylazine-Associated Wounds of the Upper Extremity: Evaluation and Algorithmic Surgical Strategy” 关于 "上肢与赛拉嗪相关的伤口:评估和手术策略算法"
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.011
Tristan B. Weir MD , Adam B. Strohl MD , Andrew J. Miller MD
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引用次数: 0
Hook of Hamate Regrowth After Surgical Excision: A Report of Two Cases 手术切除后锤骨再生的钩状突起:两个病例的报告
Q3 Medicine Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.008
Michele Christy MD , Charles A. Goldfarb MD , Douglas Carlan MD
Two high-level baseball players sustained a hook of hamate fracture while batting and were treated with excision of the fragment. Both players returned to play, and both had repeat fractures through a regenerated hook. This phenomenon of hook of hamate regeneration has not been well described in the literature. In conclusion, hook of hamate regeneration can occur after fracture fragment excision. The incidence and risk of this sequela as well as its association with surgical technique is uncertain.
两名高水平棒球运动员在击球时发生了钩状腿骨骨折,他们接受了切除碎片的治疗。两名球员都重返赛场,但都因钩突再生而再次发生骨折。文献中对这种钩突再生现象的描述并不详尽。总之,切除骨折片后可能会出现钩突再生。这种后遗症的发生率和风险及其与手术技术的关系尚不确定。
{"title":"Hook of Hamate Regrowth After Surgical Excision: A Report of Two Cases","authors":"Michele Christy MD ,&nbsp;Charles A. Goldfarb MD ,&nbsp;Douglas Carlan MD","doi":"10.1016/j.jhsg.2024.08.008","DOIUrl":"10.1016/j.jhsg.2024.08.008","url":null,"abstract":"<div><div>Two high-level baseball players sustained a hook of hamate fracture while batting and were treated with excision of the fragment. Both players returned to play, and both had repeat fractures through a regenerated hook. This phenomenon of hook of hamate regeneration has not been well described in the literature. In conclusion, hook of hamate regeneration can occur after fracture fragment excision. The incidence and risk of this sequela as well as its association with surgical technique is uncertain.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 927-930"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Hand Surgery Global Online
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