Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.09.002
Haley F. Pate MD , David B. Fulton MD
Digital papillary adenocarcinoma is a rare cutaneous tumor of eccrine origin that often presents as a papule or nodule on the dorsal aspect of a finger. It is challenging to diagnose because of its rarity, its benign appearance, and the lack of specific clinical or histological features. Excision is recommended, given the malignant nature and variable recurrence rates with metastases well documented in the literature. We present a case of a 49-year-old man with a digital papillary adenocarcinoma on his right middle finger. We discuss this patient’s treatment course and the lack of standardized treatment guidelines. Further research is needed to establish evidence-based management strategies for digital papillary adenocarcinoma.
{"title":"Digital Papillary Adenocarcinoma: A Case Presentation and Literature Review","authors":"Haley F. Pate MD , David B. Fulton MD","doi":"10.1016/j.jhsg.2024.09.002","DOIUrl":"10.1016/j.jhsg.2024.09.002","url":null,"abstract":"<div><div>Digital papillary adenocarcinoma is a rare cutaneous tumor of eccrine origin that often presents as a papule or nodule on the dorsal aspect of a finger. It is challenging to diagnose because of its rarity, its benign appearance, and the lack of specific clinical or histological features. Excision is recommended, given the malignant nature and variable recurrence rates with metastases well documented in the literature. We present a case of a 49-year-old man with a digital papillary adenocarcinoma on his right middle finger. We discuss this patient’s treatment course and the lack of standardized treatment guidelines. Further research is needed to establish evidence-based management strategies for digital papillary adenocarcinoma.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 934-936"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706697","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.08.014
Michael J. McKernan MD , Miguel A. Diaz MS , Michael Kucharik MD , Nino Coutelle MD , Peter Simon PhD , Michael C. Doarn MD
Purpose
The purpose of this study was to evaluate the biomechanical properties of SutureTape as an alternative technique for arthrodesis of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthrodesis when compared with surgical steel wire.
Methods
A total of 32 fingers (index, long, ring, and small) from two matched pair cadaveric hands were used. K-wire and surgical steel wire were used for MCP and PIP joint arthrodesis of the control group (group I), whereas K-wire and SutureTape were used for the experimental group (group II). Each sample was potted in high strength resin and secured to a custom fixture mounted to a hydraulic test frame. Each sample underwent cantilever bending in four directions (flexion, extension, ulnar, and radial) at a rate of 0.01 mm/s until a maximum force of 10 N. Thereafter, ramp to failure in extension at a rate of 20 mm/min was performed. Metrics of interest were bending stiffness (N/mm), displacement (mm), and peak load to failure (N), along with failure modes.
Results
For MCP arthrodesis, during cantilever bending in flexion direction, surgical steel construct was found to be stiffer when compared with suture tape (P = .036) and have less displacement (P = .040). No significant differences were detected for stiffness or displacement in extension, ulnar, or radial bending. During the ramp to failure, no significant differences were found for force, stiffness, or displacement. For PIP arthrodesis, the only significant difference detected was for displacement during ulnar bending (P = .035).
Conclusions
For MCP and PIP arthrodesis, the biomechanical performance of the SutureTape arthrodesis was similar to that of the steel wire across all loading conditions except for flexion and ulnar loading.
Clinical relevance
The use of SutureTape for MCP and PIP joint arthrodesis may provide equivalent biomechanical performance to that of steel wire, making it a viable alternative clinically.
{"title":"Biomechanical Comparison of Surgical Steel Wiring and Suture Tape Tension Band Techniques for Arthrodesis of the Metacarpophalangeal and Proximal Interphalangeal Joint","authors":"Michael J. McKernan MD , Miguel A. Diaz MS , Michael Kucharik MD , Nino Coutelle MD , Peter Simon PhD , Michael C. Doarn MD","doi":"10.1016/j.jhsg.2024.08.014","DOIUrl":"10.1016/j.jhsg.2024.08.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the biomechanical properties of SutureTape as an alternative technique for arthrodesis of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthrodesis when compared with surgical steel wire.</div></div><div><h3>Methods</h3><div>A total of 32 fingers (index, long, ring, and small) from two matched pair cadaveric hands were used. K-wire and surgical steel wire were used for MCP and PIP joint arthrodesis of the control group (group I), whereas K-wire and SutureTape were used for the experimental group (group II). Each sample was potted in high strength resin and secured to a custom fixture mounted to a hydraulic test frame. Each sample underwent cantilever bending in four directions (flexion, extension, ulnar, and radial) at a rate of 0.01 mm/s until a maximum force of 10 N. Thereafter, ramp to failure in extension at a rate of 20 mm/min was performed. Metrics of interest were bending stiffness (N/mm), displacement (mm), and peak load to failure (N), along with failure modes.</div></div><div><h3>Results</h3><div>For MCP arthrodesis, during cantilever bending in flexion direction, surgical steel construct was found to be stiffer when compared with suture tape (<em>P</em> = .036) and have less displacement (<em>P</em> = .040). No significant differences were detected for stiffness or displacement in extension, ulnar, or radial bending. During the ramp to failure, no significant differences were found for force, stiffness, or displacement. For PIP arthrodesis, the only significant difference detected was for displacement during ulnar bending (<em>P</em> = .035).</div></div><div><h3>Conclusions</h3><div>For MCP and PIP arthrodesis, the biomechanical performance of the SutureTape arthrodesis was similar to that of the steel wire across all loading conditions except for flexion and ulnar loading.</div></div><div><h3>Clinical relevance</h3><div>The use of SutureTape for MCP and PIP joint arthrodesis may provide equivalent biomechanical performance to that of steel wire, making it a viable alternative clinically.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 898-902"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707190","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.05.008
Jacqueline Van Gheem MD , Alexis Rounds MD , Taylor Blackwood DO , Cameron Cox BA , Evan J. Hernandez MBA , Desirae McKee MD , Brendan MacKay MD
Purpose
In the adult literature, allograft reconstruction of gapped peripheral nerve injuries has gained popularity over autologous nerve grafting. Allografts have demonstrated similar recovery while eliminating donor site morbidity. There is no well-defined incidence or treatment of such injuries in children. Our study explores the epidemiology and outcomes of traumatic pediatric peripheral nerve injuries treated with allograft.
Methods
This is a retrospective case series of a prospectively maintained database of all pediatric patients who underwent nerve allograft reconstruction at a Level I trauma center between September 2011 and July 2021.
Results
We identified 24 allograft nerve reconstructions in 18 patients, average age 12.9 years (range 1.5–17.0) and 78% male. Five patients (28%) were injured in a motor vehicle accident, and four were injured by sharp laceration, machinery, and blast injury (22%). The most injured nerve was digital (n = 10, 42%) followed by 8 (33%) ulnar, and 4 (17%) median. The average gap length was 30.3 ± 23.8 mm (range 4–87 mm). Fifteen nerves were repaired within 24 hours (63%). Average follow-up was 13.7 ± 14.5 months (range 1.6–46.8 months). At final follow-up, 9 (38%) had full sensory recovery, 6 (25%) protective sensation, 2 (8%) deep pressure, and 1 (4%) no sensation but a positive Tinel’s sign.
Conclusions
Allograft reconstruction is a viable option for the treatment of traumatic pediatric peripheral nerve injuries with gaps not amenable to direct repair.
{"title":"Case Series of Traumatic Peripheral Nerve Injuries in Pediatric Patients Treated with Allograft Repair","authors":"Jacqueline Van Gheem MD , Alexis Rounds MD , Taylor Blackwood DO , Cameron Cox BA , Evan J. Hernandez MBA , Desirae McKee MD , Brendan MacKay MD","doi":"10.1016/j.jhsg.2024.05.008","DOIUrl":"10.1016/j.jhsg.2024.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div>In the adult literature, allograft reconstruction of gapped peripheral nerve injuries has gained popularity over autologous nerve grafting. Allografts have demonstrated similar recovery while eliminating donor site morbidity. There is no well-defined incidence or treatment of such injuries in children. Our study explores the epidemiology and outcomes of traumatic pediatric peripheral nerve injuries treated with allograft.</div></div><div><h3>Methods</h3><div>This is a retrospective case series of a prospectively maintained database of all pediatric patients who underwent nerve allograft reconstruction at a Level I trauma center between September 2011 and July 2021.</div></div><div><h3>Results</h3><div>We identified 24 allograft nerve reconstructions in 18 patients, average age 12.9 years (range 1.5–17.0) and 78% male. Five patients (28%) were injured in a motor vehicle accident, and four were injured by sharp laceration, machinery, and blast injury (22%). The most injured nerve was digital (n = 10, 42%) followed by 8 (33%) ulnar, and 4 (17%) median. The average gap length was 30.3 ± 23.8 mm (range 4–87 mm). Fifteen nerves were repaired within 24 hours (63%). Average follow-up was 13.7 ± 14.5 months (range 1.6–46.8 months). At final follow-up, 9 (38%) had full sensory recovery, 6 (25%) protective sensation, 2 (8%) deep pressure, and 1 (4%) no sensation but a positive Tinel’s sign.</div></div><div><h3>Conclusions</h3><div>Allograft reconstruction is a viable option for the treatment of traumatic pediatric peripheral nerve injuries with gaps not amenable to direct repair.</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 801-807"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706724","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.08.011
Tiffany N. Bridges DO , Adam S. Kohring DO , Alexis A. Kasper BS , Amir R. Kachooei MD, PhD , Rick Tosti MD , Michael Rivlin MD
Purpose
Compressive neuropathies such as carpal tunnel and cubital tunnel syndrome can lead to sensation loss, muscle weakness, joint contractures, and disrupted sleep. The interplay between these conditions and the effect on patients’ intimacy is unknown. The purpose of this study was to examine sexual function before and after surgery in patients undergoing carpal tunnel release or cubital tunnel release.
Methods
All patients 18 years or older who underwent unilateral or bilateral carpal tunnel release and/or cubital tunnel release, performed either open or endoscopically, between January 2021 and August 2022, were retrospectively identified. An anonymous 21-question survey assessing pre- and post-operative sexual function was sent electronically to patients who were between 3 months and 2 years postprocedure.
Results
A total of 47% of respondents reported that their upper extremity symptoms disrupted their sexual activity. Before surgery, various challenges were reported: paresthesia (84%), pain (61%), reduced strength (53%), and reduced motion (40%). A total of 65% of patients changed positions before surgery, most frequently by avoiding weight-bearing (79%) and using the affected arm (55%). After surgery, 61% reported an easier time engaging in sexual activity, which was most frequently attributed to diminished paresthesia (69%) and pain (67%). A total of 73% of patients resumed sexual activities within 3 weeks of surgery. Ultimately, 32% of patients were more satisfied with their sexual function after surgery.
Conclusions
Sexual function is intimately tied to the physical and mental health of individuals. Surgical release improves sexual function and satisfaction.
Type of study/level of evidence
Retrospective Case–Control Cohort, Therapeutic III.
{"title":"When Numbness and Tingling Play a Role—Sexual Function in Compressive Neuropathy","authors":"Tiffany N. Bridges DO , Adam S. Kohring DO , Alexis A. Kasper BS , Amir R. Kachooei MD, PhD , Rick Tosti MD , Michael Rivlin MD","doi":"10.1016/j.jhsg.2024.08.011","DOIUrl":"10.1016/j.jhsg.2024.08.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Compressive neuropathies such as carpal tunnel and cubital tunnel syndrome can lead to sensation loss, muscle weakness, joint contractures, and disrupted sleep. The interplay between these conditions and the effect on patients’ intimacy is unknown. The purpose of this study was to examine sexual function before and after surgery in patients undergoing carpal tunnel release or cubital tunnel release.</div></div><div><h3>Methods</h3><div>All patients 18 years or older who underwent unilateral or bilateral carpal tunnel release and/or cubital tunnel release, performed either open or endoscopically, between January 2021 and August 2022, were retrospectively identified. An anonymous 21-question survey assessing pre- and post-operative sexual function was sent electronically to patients who were between 3 months and 2 years postprocedure.</div></div><div><h3>Results</h3><div>A total of 47% of respondents reported that their upper extremity symptoms disrupted their sexual activity. Before surgery, various challenges were reported: paresthesia (84%), pain (61%), reduced strength (53%), and reduced motion (40%). A total of 65% of patients changed positions before surgery, most frequently by avoiding weight-bearing (79%) and using the affected arm (55%). After surgery, 61% reported an easier time engaging in sexual activity, which was most frequently attributed to diminished paresthesia (69%) and pain (67%). A total of 73% of patients resumed sexual activities within 3 weeks of surgery. Ultimately, 32% of patients were more satisfied with their sexual function after surgery.</div></div><div><h3>Conclusions</h3><div>Sexual function is intimately tied to the physical and mental health of individuals. Surgical release improves sexual function and satisfaction.</div></div><div><h3>Type of study/level of evidence</h3><div>Retrospective Case–Control Cohort, Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 796-800"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707195","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.07.011
Abdullah AlShenaiber BHSc , Shaishav Datta HBSc, MD , Adam J. Mosa MD, MSc , Paul A. Binhammer MD, MSc , Edsel B. Ing MD, MPH, PhD
Purpose
Tools using artificial intelligence may help reduce missed or delayed diagnoses and improve patient care in hand surgery. This study aimed to compare and evaluate the performance of two natural language processing programs, Isabel and ChatGPT-4, in diagnosing hand and peripheral nerve injuries from a set of clinical vignettes.
Methods
Cases from a virtual library of hand surgery case reports with no history of trauma or previous surgery were included in this study. The clinical details (age, sex, symptoms, signs, and medical history) of 16 hand cases were entered into Isabel and ChatGPT-4 to generate top 10 differential diagnosis lists. Isabel and ChatGPT-4’s inclusion and median rank of the correct diagnosis within each list were compared. Two hand surgeons were then provided each list and asked to independently evaluate the performance of the two systems.
Results
Isabel correctly identified 7/16 (44%) cases with a median rank of two (interquartile range = 3). ChatGPT-4 correctly identified 14/16 (88%) of cases with a median rank of one (interquartile range = 1). Physicians one and two, respectively, preferred the lists generated by ChatGPT-4 in 12/16 (75%) and 13/16 (81%) of cases and had no preference in 2/16 (13%) cases.
Conclusions
ChatGPT-4 had significantly greater diagnostic accuracy within our sample (P < .05) and generated higher quality differential diagnoses than Isabel. Isabel produced several inappropriate and imprecise differential diagnoses.
Clinical relevance
Despite large language models’ potential utility in generating medical diagnoses, physicians must continue to exercise high caution and use their clinical judgment when making diagnostic decisions.
{"title":"Large Language Models in the Diagnosis of Hand and Peripheral Nerve Injuries: An Evaluation of ChatGPT and the Isabel Differential Diagnosis Generator","authors":"Abdullah AlShenaiber BHSc , Shaishav Datta HBSc, MD , Adam J. Mosa MD, MSc , Paul A. Binhammer MD, MSc , Edsel B. Ing MD, MPH, PhD","doi":"10.1016/j.jhsg.2024.07.011","DOIUrl":"10.1016/j.jhsg.2024.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Tools using artificial intelligence may help reduce missed or delayed diagnoses and improve patient care in hand surgery. This study aimed to compare and evaluate the performance of two natural language processing programs, Isabel and ChatGPT-4, in diagnosing hand and peripheral nerve injuries from a set of clinical vignettes.</div></div><div><h3>Methods</h3><div>Cases from a virtual library of hand surgery case reports with no history of trauma or previous surgery were included in this study. The clinical details (age, sex, symptoms, signs, and medical history) of 16 hand cases were entered into Isabel and ChatGPT-4 to generate top 10 differential diagnosis lists. Isabel and ChatGPT-4’s inclusion and median rank of the correct diagnosis within each list were compared. Two hand surgeons were then provided each list and asked to independently evaluate the performance of the two systems.</div></div><div><h3>Results</h3><div>Isabel correctly identified 7/16 (44%) cases with a median rank of two (interquartile range = 3). ChatGPT-4 correctly identified 14/16 (88%) of cases with a median rank of one (interquartile range = 1). Physicians one and two, respectively, preferred the lists generated by ChatGPT-4 in 12/16 (75%) and 13/16 (81%) of cases and had no preference in 2/16 (13%) cases.</div></div><div><h3>Conclusions</h3><div>ChatGPT-4 had significantly greater diagnostic accuracy within our sample (<em>P</em> < .05) and generated higher quality differential diagnoses than Isabel. Isabel produced several inappropriate and imprecise differential diagnoses.</div></div><div><h3>Clinical relevance</h3><div>Despite large language models’ potential utility in generating medical diagnoses, physicians must continue to exercise high caution and use their clinical judgment when making diagnostic decisions.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 847-854"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706769","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.08.010
Michael G. Flood MD , Rebecca Tananbaum BA , Tyler J. Tantillo DO , Marci D. Jones MD
In this case report, we present a novel occurrence of acute hepatitis 2 weeks after local bupivacaine injection for wide awake, local anesthesia, no tourniquet carpal tunnel release. Laboratory and biopsy analysis confirmed cholestatic, drug-induced hepatitis that was successfully managed with conservative treatment. With a paucity of potential bupivacaine-induced hepatitis cases reported within the literature, the importance of broad differential diagnosis, meticulous medication reconciliation, and consideration of this rare complication should not be understated by the astute hand surgeon.
{"title":"Possible Bupivacaine Induced Hepatitis Following Wide Awake, Local Anesthesia, No Tourniquet Carpal Tunnel Surgery: A Case Report","authors":"Michael G. Flood MD , Rebecca Tananbaum BA , Tyler J. Tantillo DO , Marci D. Jones MD","doi":"10.1016/j.jhsg.2024.08.010","DOIUrl":"10.1016/j.jhsg.2024.08.010","url":null,"abstract":"<div><div>In this case report, we present a novel occurrence of acute hepatitis 2 weeks after local bupivacaine injection for wide awake, local anesthesia, no tourniquet carpal tunnel release. Laboratory and biopsy analysis confirmed cholestatic, drug-induced hepatitis that was successfully managed with conservative treatment. With a paucity of potential bupivacaine-induced hepatitis cases reported within the literature, the importance of broad differential diagnosis, meticulous medication reconciliation, and consideration of this rare complication should not be understated by the astute hand surgeon.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 931-933"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706696","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.08.015
Robert Kalapos MD , Mollie Manley MD
This surgical technique article describes the anatomic C scapholunate reconstruction technique. It is indicated for complete acute or chronic scapholunate ligament dissociation. The technique addresses severe scapholunate interval gapping, ulnar translocation of the lunate, and rotational/dorsal intercalated segment instability. The C-shaped ligament is cradled from dorsal to volar using a symmetric four anchor/synthetic tape construct through a single dorsal incision and hyperflexion of the wrist. It does not require any volar incision/approach, as previously described techniques, and also avoids vascular disruption of the scaphoid ridge. An athlete patient case with illustration is also presented, who was treated with anatomic C scapholunate reconstruction on one wrist and all-dorsal scapholunate reconstruction on the other wrist. The two wrists are compared, and postoperative management with technique pearls and pitfalls are described.
这篇外科技术文章介绍了解剖学 C 肩胛骨重建技术。它适用于完全性急性或慢性肩胛韧带离断。该技术可解决严重的肩胛骨间隙、月骨尺侧移位和旋转/背侧夹节不稳的问题。通过单个背侧切口和腕关节过度屈曲，使用对称的四锚/合成带结构从背侧到外侧对C形韧带进行支撑。与之前描述的技术相比，这种方法不需要任何外侧切口/入路，也避免了对肩胛骨脊的血管破坏。图中还展示了一个运动员病例，该运动员的一只手腕采用了解剖C型肩胛骨重建术，另一只手腕采用了全背侧肩胛骨重建术。对这两个腕部进行了比较，并介绍了术后管理以及技术要点和误区。
{"title":"Anatomic C Scapholunate Reconstruction Technique: For Complete Dissociation of the Scapholunate Interval","authors":"Robert Kalapos MD , Mollie Manley MD","doi":"10.1016/j.jhsg.2024.08.015","DOIUrl":"10.1016/j.jhsg.2024.08.015","url":null,"abstract":"<div><div>This surgical technique article describes the anatomic C scapholunate reconstruction technique. It is indicated for complete acute or chronic scapholunate ligament dissociation. The technique addresses severe scapholunate interval gapping, ulnar translocation of the lunate, and rotational/dorsal intercalated segment instability. The C-shaped ligament is cradled from dorsal to volar using a symmetric four anchor/synthetic tape construct through a single dorsal incision and hyperflexion of the wrist. It does not require any volar incision/approach, as previously described techniques, and also avoids vascular disruption of the scaphoid ridge. An athlete patient case with illustration is also presented, who was treated with anatomic C scapholunate reconstruction on one wrist and all-dorsal scapholunate reconstruction on the other wrist. The two wrists are compared, and postoperative management with technique pearls and pitfalls are described.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 903-909"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707191","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}
Peripheral nerve neuromas may present significant therapeutic challenges especially when neuromas in continuity are scar-tethered to adjacent vital structures. We report a case of a patient who presented with delayed neurotmesis of median and ulnar nerves in the arm while extensive scarring of the median nerve was found in close proximity to the repaired brachial artery. For the surgical restoration of the continuity of the median nerve, the scarred segment was left in situ to avoid reinjury of the brachial artery and a “fly-over” nerve grafting technique with sural nerve autografts was employed.
{"title":"Treating a Scar-Tethered Median Nerve Neuroma in Continuity With a Fly-Over Nerve Grafting Technique","authors":"Eleni Karagergou MD, PhD , Emmanouil Pantelidis MD , Dimitrios Kitridis MD , Panagiotis Givissis MD, PhD","doi":"10.1016/j.jhsg.2024.08.001","DOIUrl":"10.1016/j.jhsg.2024.08.001","url":null,"abstract":"<div><div>Peripheral nerve neuromas may present significant therapeutic challenges especially when neuromas in continuity are scar-tethered to adjacent vital structures. We report a case of a patient who presented with delayed neurotmesis of median and ulnar nerves in the arm while extensive scarring of the median nerve was found in close proximity to the repaired brachial artery. For the surgical restoration of the continuity of the median nerve, the scarred segment was left in situ to avoid reinjury of the brachial artery and a “fly-over” nerve grafting technique with sural nerve autografts was employed.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 924-926"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707194","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.07.014
David A. Rivetti MD, MS , Maria A. Munsch MD , Jeffrey C. Wera MD , Duc M. Nguyen MD , John R. Fowler MD
Purpose
Thumb carpometacarpal (CMC) arthritis is the most common arthritis of the hand, with most studies demonstrating little difference in outcomes between various surgical treatment techniques. However, trapeziectomy, followed by ligament reconstruction and tendon interposition (LRTI), remains the technique of choice among hand surgeons in the United States. In 2009, suture suspensionplasty (SS) was first described as a less invasive alternative to LRTI. The purpose of this study was to compare surgical details as well as patient-reported and radiographic outcomes between SS and LRTI for thumb CMC arthroplasty.
Methods
Following Institutional Review Board approval, 111 extremities were retrospectively identified in 104 patients who underwent carpometacarpal arthroplasty. Two age-matched cohorts were developed for patients having undergone LRTI (n = 58) or SS (n = 53) by one of three fellowship-trained hand surgeons. Tourniquet times were compared, and outcome measures included first metacarpal scaphoid space (FMSS) measured on 2-week postoperative radiographs, as well as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and pain score on a 10-point visual analog scale (VAS) from the preoperative visit as well as at 2 weeks, 6 weeks, and 3 months following surgery.
Results
There were no demographic differences between the two cohorts. There was no statistical difference between cohorts in VAS scores at any point in time. The SS cohort reported better QuickDASH scores at the 6-week postoperative visit; otherwise, QuickDASH scores did not differ between cohorts. The SS technique had shorter tourniquet times, and patients had less radiographic subsidence as evidenced by larger postoperative FMSS.
Conclusions
The SS arthroplasty technique demonstrated comparable early clinical results to LRTI. Furthermore, SS arthroplasty, which alleviates the need for tendon transfers and additional incisions with LRTI, had shorter tourniquet time, with less subsidence of the first metacarpal in the first 2 weeks.
{"title":"Suture Suspensionplasty Compared With Ligament Reconstruction and Tendon Interposition for Surgical Treatment of Thumb Carpometacarpal Arthritis","authors":"David A. Rivetti MD, MS , Maria A. Munsch MD , Jeffrey C. Wera MD , Duc M. Nguyen MD , John R. Fowler MD","doi":"10.1016/j.jhsg.2024.07.014","DOIUrl":"10.1016/j.jhsg.2024.07.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Thumb carpometacarpal (CMC) arthritis is the most common arthritis of the hand, with most studies demonstrating little difference in outcomes between various surgical treatment techniques. However, trapeziectomy, followed by ligament reconstruction and tendon interposition (LRTI), remains the technique of choice among hand surgeons in the United States. In 2009, suture suspensionplasty (SS) was first described as a less invasive alternative to LRTI. The purpose of this study was to compare surgical details as well as patient-reported and radiographic outcomes between SS and LRTI for thumb CMC arthroplasty.</div></div><div><h3>Methods</h3><div>Following Institutional Review Board approval, 111 extremities were retrospectively identified in 104 patients who underwent carpometacarpal arthroplasty. Two age-matched cohorts were developed for patients having undergone LRTI (n = 58) or SS (n = 53) by one of three fellowship-trained hand surgeons. Tourniquet times were compared, and outcome measures included first metacarpal scaphoid space (FMSS) measured on 2-week postoperative radiographs, as well as Quick Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH) score and pain score on a 10-point visual analog scale (VAS) from the preoperative visit as well as at 2 weeks, 6 weeks, and 3 months following surgery.</div></div><div><h3>Results</h3><div>There were no demographic differences between the two cohorts. There was no statistical difference between cohorts in VAS scores at any point in time. The SS cohort reported better <em>Quick</em>DASH scores at the 6-week postoperative visit; otherwise, <em>Quick</em>DASH scores did not differ between cohorts. The SS technique had shorter tourniquet times, and patients had less radiographic subsidence as evidenced by larger postoperative FMSS.</div></div><div><h3>Conclusions</h3><div>The SS arthroplasty technique demonstrated comparable early clinical results to LRTI. Furthermore, SS arthroplasty, which alleviates the need for tendon transfers and additional incisions with LRTI, had shorter tourniquet time, with less subsidence of the first metacarpal in the first 2 weeks.</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 861-864"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706716","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jhsg.2024.07.004
Mitchell C. Harris MD , Ryan J. Bickley MD , Pooyan Abbasi MSc , Gabriel J. Yohe MS , Kenneth R. Means MD , Scott M. Tintle MD , Aviram M. Giladi MD, MS
Purpose
Osteoporotic patients are at risk of peri-implant fractures after distal radius fixation. A unicortical screw in the proximal hole of the plate can theoretically decrease stress riser formation by eliminating the hole in the far bone cortex. This construct has been proposed in orthopedic literature to prevent peri-implant fractures but has not been tested in an osteoporotic distal radius model.
Methods
Eleven paired cadaver radii were harvested and plated with four-hole titanium volar distal radius plates. No osteotomies were created. The fixation constructs were identical except that group A used a bicortical proximal locking screw and group B used a unicortical proximal locking screw. Bone mineral density was estimated using radiographic measurements. The samples were potted and tested for four-point bending stiffness, torsion stiffness, and load to failure.
Results
Between the bicortical and unicortical screw groups, there was no significant difference in four-point bending stiffness (110.8 vs 106.2 N/mm, apex volar bending; 105.4 vs 107.1 N/mm, apex dorsal bending) or torsional stiffness (430.6 vs 427.6 N-mm/degree, internal rotation; 430.8 vs 429.7 N-mm/degree, external rotation). There was also no significant difference in load to failure with apex dorsal four-point bending (795.3 vs 770.0 N).
Conclusions
This study shows that a healed osteoporotic distal radius volar plate construct with a proximal unicortical locking screw is not statistically different from a bicortical screw in stiffness or load to failure in apex dorsal bending. Although a unicortical locking screw has been proposed as a mechanism to prevent stress risers at the proximal aspect of the distal radius plate, this study suggests no significant difference when compared with a bicortical locking screw.
Clinical relevance
There is no significant biomechanical advantage to unicortical over bicortical locking screws in the proximal hole of a distal radius plate to prevent diaphyseal peri-implant fractures in osteoporotic patients.
目的骨质疏松患者在桡骨远端固定术后有发生假体周围骨折的风险。理论上，在钢板近端孔中使用单皮质螺钉可以消除远端骨皮质中的孔，从而减少应力骤增的形成。这种结构在骨科文献中被提出来预防假体周围骨折，但尚未在骨质疏松的桡骨远端模型中进行过测试。未进行截骨。除A组使用双皮质近端锁定螺钉、B组使用单皮质近端锁定螺钉外，其他固定结构完全相同。骨矿物质密度通过射线测量进行估算。结果双皮质螺钉组和单皮质螺钉组的四点弯曲刚度没有显著差异（110.8 N/mm vs 106.2 N/mm）。8 vs 106.2 N/mm，顶点外侧弯曲；105.4 vs 107.1 N/mm，顶点背侧弯曲）或扭转刚度（430.6 vs 427.6 N-mm/度，内旋；430.8 vs 429.7 N-mm/度，外旋）无显著差异。结论本研究表明，痊愈的骨质疏松桡骨远端沃尔钢板在近端使用单皮质锁定螺钉与双皮质螺钉在顶点背侧弯曲的刚度或失效载荷方面没有统计学差异。临床意义在桡骨远端钢板近端孔中使用单皮质锁定螺钉与双皮质锁定螺钉相比，在防止骨质疏松症患者骺端植入物周围骨折方面，单皮质锁定螺钉在生物力学上没有明显优势。
{"title":"Unicortical Versus Bicortical Proximal Locking Screw for Prevention of Peri-Implant Fracture: A Biomechanical Analysis of an Osteoporotic Distal Radius Model","authors":"Mitchell C. Harris MD , Ryan J. Bickley MD , Pooyan Abbasi MSc , Gabriel J. Yohe MS , Kenneth R. Means MD , Scott M. Tintle MD , Aviram M. Giladi MD, MS","doi":"10.1016/j.jhsg.2024.07.004","DOIUrl":"10.1016/j.jhsg.2024.07.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Osteoporotic patients are at risk of peri-implant fractures after distal radius fixation. A unicortical screw in the proximal hole of the plate can theoretically decrease stress riser formation by eliminating the hole in the far bone cortex. This construct has been proposed in orthopedic literature to prevent peri-implant fractures but has not been tested in an osteoporotic distal radius model.</div></div><div><h3>Methods</h3><div>Eleven paired cadaver radii were harvested and plated with four-hole titanium volar distal radius plates. No osteotomies were created. The fixation constructs were identical except that group A used a bicortical proximal locking screw and group B used a unicortical proximal locking screw. Bone mineral density was estimated using radiographic measurements. The samples were potted and tested for four-point bending stiffness, torsion stiffness, and load to failure.</div></div><div><h3>Results</h3><div>Between the bicortical and unicortical screw groups, there was no significant difference in four-point bending stiffness (110.8 vs 106.2 N/mm, apex volar bending; 105.4 vs 107.1 N/mm, apex dorsal bending) or torsional stiffness (430.6 vs 427.6 N-mm/degree, internal rotation; 430.8 vs 429.7 N-mm/degree, external rotation). There was also no significant difference in load to failure with apex dorsal four-point bending (795.3 vs 770.0 N).</div></div><div><h3>Conclusions</h3><div>This study shows that a healed osteoporotic distal radius volar plate construct with a proximal unicortical locking screw is not statistically different from a bicortical screw in stiffness or load to failure in apex dorsal bending. Although a unicortical locking screw has been proposed as a mechanism to prevent stress risers at the proximal aspect of the distal radius plate, this study suggests no significant difference when compared with a bicortical locking screw.</div></div><div><h3>Clinical relevance</h3><div>There is no significant biomechanical advantage to unicortical over bicortical locking screws in the proximal hole of a distal radius plate to prevent diaphyseal peri-implant fractures in osteoporotic patients.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 842-846"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706771","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}
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