Journal of Hand Surgery Global Online最新文献_第3页

Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon’s Practice and the Evidence 肩胛骨骨折和不愈合：基于调查的手外科医生实践与证据回顾

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.013

Jason A. Strelzow MD , W. Kelsey Snapp MD , Aviram M. Giladi MD, MS , Robert Wysocki MD , Charles C. Jehle MD

Purpose

The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership’s practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management.

Methods

Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs. The survey was divided into the following subtopics: minimally displaced scaphoid fracture, operative options for scaphoid fixation, and treatment of scaphoid nonunion.

Results

Of 9 EBP questions, only one was answered with the preferred response by >80% of surgeons. The remaining seven EBP questions had greater frequencies of less preferred responses. These questions concerned the current evidence for initial imaging options, optimal nonsurgical immobilization, percutaneous management, and the identification and treatment of nonunion. Of the PP questions, there were substantial differences of opinion on the choice of bone graft for nonunion, revisions, and patients with avascular necrosis. Nearly unanimous agreement was found for the use of headless compression screws for scaphoid fixation; however, the choice of approach for waist fixation was split between dorsal and volar percutaneous techniques and an open dorsal approach.

Conclusions

Scaphoid fracture and nonunion management continues to be an area of expanding evidence. There remain opportunities for our community to improve knowledge and familiarization with current evidence-based data. Many PPs areas demonstrated substantial agreement among the membership; however, there are areas of differences particularly graft choice, optimal approach for waist fixation, and postfixation protocols. Knowledge and familiarity with peer practices may help develop future areas of research and help to optimize patient care through a critically review and interpretation of the evidence.

Type of study/level of evidence

Economic/decision analyses V.

目的美国手外科学会循证实践委员会旨在评估会员的实践模式（PPs）以及对肩胛骨骨折和不愈合处理的循证原则的熟悉程度。方法采用协商一致生成的 25 个项目的在线调查，邀请美国手外科学会的所有会员于 2023 年 9 月通过电子邮件参与调查。调查采用两种问题类型，包括循证实践（EBP）和PPs。调查结果在 9 个 EBP 问题中，只有一个问题得到了 80% 外科医生的首选回答。其余 7 个 EBP 问题的首选回答率较低。这些问题涉及初始成像选择、最佳非手术固定、经皮处理以及非愈合的识别和治疗的现有证据。在PP问题中，对于非愈合、翻修和血管性坏死患者的植骨选择存在很大的意见分歧。在使用无头加压螺钉固定肩胛骨方面，大家几乎达成了一致意见；但在腰部固定的方法选择上，则存在背侧和外侧经皮技术与开放背侧方法之间的分歧。我们仍有机会增进对当前循证数据的了解和熟悉。在许多PPs领域，成员们的意见基本一致；但也存在分歧，尤其是移植物的选择、腰部固定的最佳方法以及固定后的方案。对同行做法的了解和熟悉有助于开发未来的研究领域，并通过对证据的严格审查和解释帮助优化患者护理。

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引用次数: 0

A Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet Versus General Anesthesia in Hand Fracture Fixation 手部骨折固定术中无止血带宽醒局部麻醉与全身麻醉比较的前瞻性研究

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.06.008

Shalimar Abdullah MS (Ortho), Dip Hand Surgery , Khairul Azmi bin Ghazali MBBS (Ortho & Traumatology) , Elaine Zi Fan Soh MBBS (Ortho & Traumatology) , Jamari Sapuan MD, MS (Ortho) , Parminder Singh Gill MBBS, MS (Ortho) , Chia Hua Lim MD (Ortho & Traumatology)

Purpose

Fixation of metacarpal or phalanx bone fractures is usually performed under general anesthesia (GA) or regional anesthesia and with the use of a tourniquet to minimize bleeding. However, the use of tourniquet causes pain and discomfort after surgery. Wide-awake local anesthesia no tourniquet (WALANT) enables the surgery to be performed with the patient fully awake and without a tourniquet, which allows intraoperative assessment of function during surgery. This study aims to compare the perioperative parameters and clinical outcomes between GA versus WALANT in hand fracture fixations.

Methods

Forty-eight patients with hand fractures were recruited over a period of 15 months. Twenty-one patients had undergone fracture fixation under GA, whereas another 27 patients had the surgery under WALANT. Parameters including vital signs (heart rate and systolic blood pressure), surgery duration, estimated blood loss, visual analog scale, and quick disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire were evaluated.

Results

Wide-awake local anesthesia no tourniquet group had significantly higher systolic blood pressure values and higher estimated blood less than GA group. Wide-awake local anesthesia no tourniquet group also documented shorter surgical time compared with GA group, but the difference was not significant. In terms of clinical outcomes, WALANT group recorded significantly lower visual analog scale score at 2 hours and 2 weeks postsurgery. However, WALANT has a comparable QuickDASH score with GA group except at 3 months postsurgery.

Conclusions

Wide-awake local anesthesia no tourniquet surgery for hand fracture fixation provides a similar analgesic effect and comparable QuickDASH score except at 3 months postsurgery compared with GA.

Type of study/level of evidence

Therapeutic IIb.

目的掌骨或指骨骨折固定术通常在全身麻醉（GA）或区域麻醉下进行，并使用止血带以减少出血。然而，使用止血带会导致术后疼痛和不适。不使用止血带的宽清醒局部麻醉（WALANT）可在患者完全清醒的情况下进行手术，且无需使用止血带，从而可在术中对手术功能进行评估。本研究旨在比较 GA 与 WALANT 在手部骨折固定术中的围手术期参数和临床结果。21名患者在GA下进行了骨折固定，27名患者在WALANT下进行了手术。评估的参数包括生命体征（心率和收缩压）、手术时间、估计失血量、视觉模拟量表以及手臂、肩部和手部快速残疾（QuickDASH）问卷。宽醒局部麻醉无止血带组的手术时间也比一般麻醉组短，但差异不显著。在临床结果方面，WALANT 组在术后 2 小时和 2 周的视觉模拟量表评分明显较低。结论手部骨折固定的宽醒局部麻醉无止血带手术与GA相比，具有相似的镇痛效果和可比的QuickDASH评分（术后3个月除外）。

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引用次数: 0

A Comprehensive Review of Topography and Axon Counts in Upper-Extremity Peripheral Nerves: A Guide for Neurotization 上肢末梢神经拓扑和轴突数量综合评述：神经化指南

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.002

Ethan Paulin MD , Evan C. Bowen BS , Shireen Dogar DO , Muntazim Mukit MD , Michael S. Lebhar MD , Laura I. Galarza MD , Shelley R. Edwards BS , Marc E. Walker MD, MBA

Purpose

Currently, no comprehensive database detailing topography and axon counts exists. This study aims to review the axon counts and topography of the major peripheral motor nerves of the upper extremity to allow for optimal surgical planning for peripheral nerve reconstruction via neurotization.

Methods

Peer-reviewed journal articles were identified through PubMed, ScienceDirect, Google Scholar, and CENTRAL. Studies were included for review based upon the identification of the described topography or axon count of any upper-extremity peripheral motor nerve. Animal research, laboratory studies, and unpublished studies were excluded from our review. A total of 43 studies were identified, and 38 of these met the inclusion criteria. Statistical analysis was performed to determine axon count averages for all upper extremity motor nerves identified in the included studies.

Results

Thirty-eight studies were reviewed, giving insights into the topography and axon counts of the major peripheral nerves of the upper extremity, including the brachial plexus and its terminal branches as well as common donor nerves such as the spinal accessory nerve and intercostal nerves. Studies showed considerable variability in reported axon counts.

Conclusions

Existing data were relatively weak and included several case reports and series. Taking this into consideration, we posit that there is a need for further studies of upper-extremity nerve axon counts that include large study populations and more consistent methods of nerve specimen analysis.

Clinical relevance

Understanding the topographical anatomy of donor and recipient nerves, as well as appropriately matching the motor axon counts for each donor and recipient, is helpful in upper-extremity nerve reconstruction.

目的目前还没有详细记录地形和轴突数量的综合数据库。本研究旨在回顾上肢主要外周运动神经的轴突数和地形，以便通过神经化实现外周神经重建的最佳手术规划。方法通过 PubMed、ScienceDirect、Google Scholar 和 CENTRAL 查找同行评审的期刊文章。根据对任何上肢周围运动神经的地形或轴突数量的鉴定，将研究纳入审查范围。动物研究、实验室研究和未发表的研究不在我们的审查范围之内。共确定了 43 项研究，其中 38 项符合纳入标准。我们对这些研究进行了统计分析，以确定纳入研究中所有上肢运动神经的轴突数平均值。结果我们对 38 项研究进行了综述，深入了解了上肢主要外周神经的地形和轴突数，包括臂丛神经及其末端分支，以及脊髓附属神经和肋间神经等常见供体神经。结论现有数据相对薄弱，包括一些病例报告和系列研究。考虑到这一点，我们认为有必要对上肢神经轴突计数进行进一步研究，研究应包括大量研究人群和更一致的神经标本分析方法。临床意义了解供体和受体神经的地形解剖，并适当匹配每个供体和受体的运动神经轴突计数，有助于上肢神经重建。

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引用次数: 0

Inter- and Intraobserver Reliability for the Computed Tomography Scan Assessment of Union After Surgery for Scaphoid Fractures and Nonunion 肩胛骨骨折和未愈合手术后计算机断层扫描评估愈合的观察者间和观察者内可靠性

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.005

Morten Kjær MD , Dimitar Ivanov Radev MD , Robert Gvozdenovic MD, PhD

Purpose

Assessment of scaphoid union after operative treatment might be associated with uncertainty, disagreement, and misinterpretation. Union is defined as consolidation on three of four X-ray views. Computed tomography (CT) scans are increasingly used to evaluate union of scaphoid fractures and nonunion. It allows multiplanar assessment of the scaphoid. Reliability in CT scan assessment of union after operative intervention is limited. We hypothesized that inter- and intraobserver reliability of the CT scan assessment of union after operative treatment for scaphoid fracture and nonunion are substantial and better in fracture cases.

Methods

An institutional search identified 230 patients with operative intervention. According to the sample size, we randomly selected 60 patients (30 fractures and 30 nonunion), with age above 18 years and CT scans 6–26 weeks after surgery, when uncertainty about healing status is most pronounced. Three observers evaluated the CT scans on two occasions 6 weeks apart. Observers classified the scaphoid into two categories: No/partial/full union and >/<50% union.

Results

Interrater agreement in no/partial/full union was overall substantial, substantial in fractures, and moderate for nonunion cases. Interobserver agreement for >/<50% union was overall moderate and moderate for both fractures and nonunion groups. The interrater agreement of no/partial/full union with CT scans ≥12 weeks after surgery was substantial versus fair for the cases below. Intrarater agreement was overall better in cases with CT scans ≥12 weeks postoperative versus earlier.

Conclusions

CT scans show substantial agreement in the assessment of no/partial/full union after operative intervention, although the presence of metal artifacts and bone grafts potentially impair visibility among observers. The agreement was better in scaphoid fractures. CT scan assessment of >/<50% union is with overall moderate agreement. Inter- and intrarater agreement is improved when CT scans are taken 12 weeks or later after operative treatment, blinded to the clinical information.

Level of Evidence

Diagnostic, III.

目的手术治疗后对肩胛骨结合的评估可能存在不确定性、分歧和误读。在四个 X 光切面中，有三个切面出现骨结合即为骨结合。计算机断层扫描（CT）越来越多地用于评估肩胛骨骨折的愈合和未愈合情况。它可以对肩胛骨进行多平面评估。CT 扫描评估手术干预后骨结合的可靠性有限。我们假设，肩胛骨骨折和不愈合手术治疗后，CT 扫描评估结合的观察者间和观察者内可靠性都很高，而且骨折病例的可靠性更高。根据样本量，我们随机选取了 60 例患者（30 例骨折和 30 例不愈合），年龄均在 18 岁以上，CT 扫描时间为术后 6-26 周，此时愈合状况的不确定性最为明显。三名观察者两次评估 CT 扫描结果，每次间隔 6 周。观察者将肩胛骨分为两类：结果无/部分/完全愈合的观察者之间的一致性总体上很高，骨折的观察者之间的一致性很高，非愈合病例的观察者之间的一致性一般。50%结合的观察者之间的一致性总体为中等，骨折和未愈合组的观察者之间的一致性为中等。术后≥12周的CT扫描结果显示，无/部分/完全愈合的观察者之间的一致性很高，而以下病例的一致性尚可。结论 CT 扫描显示，尽管金属伪影和植骨的存在可能会影响观察者之间的可视性，但在评估手术干预后无/部分/完全愈合方面，观察者之间的一致性很高。肩胛骨骨折的一致性更好。CT扫描对50%愈合的评估总体上具有中等程度的一致性。如果在手术治疗后12周或更晚的时间进行CT扫描，并对临床信息进行盲测，则可提高观察者之间和观察者内部的一致性。

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引用次数: 0

Electrodiagnostic Testing Predicts Postdecompression Outcomes in Patients With Cubital Tunnel Syndrome 电诊断测试预测腓骨隧道综合征患者减压后的疗效

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.013

Kevin R. Cuneo BS , Thomas J. McQuillan MD , Constance M. Sullivan BS, BA , Hayden L. Cooke BS , Sabryn A. Kapp BS , Eric R. Wagner MD, MSc , Michael B. Gottschalk MD

Purpose

Electrodiagnostic (EDX) testing is commonly used in conjunction with symptoms and physical examination findings to diagnose cubital tunnel syndrome (CuTS). The purpose of this study was to investigate the relationship between preoperative EDX diagnosis and the degree of Disabilities of the Arm, Shoulder, and Hand (QuickDASH) improvement after surgery within the CuTS patient population.

Methods

A retrospective review was designed to analyze patients from a single institution who underwent a cubital tunnel release. Patients who had preoperative EDX testing, as well as preoperative and 3-month postoperative QuickDASH scores were eligible for inclusion. These patients were divided into two groups, EDX-positive or EDX-negative, based on the findings of their EDX testing for CuTS. Demographics, preoperative QuickDASH, postoperative QuickDASH, and changes in QuickDASH were compared between the two groups.

Results

Fifty-seven patients were included—34 EDX-positive and 23 EDX-negative. The EDX-negative cohort had higher preoperative QuickDASH scores, which approached but did not reach significance (P = .06). Both groups had significant improvement in QuickDASH following cubital tunnel release (P = .021, P < .01). Patients with EDX-negative testing had a significantly greater improvement in QuickDASH from before surgery to 3 months after surgery (25 points vs 11, P < .01).

Conclusions

Patients who underwent cubital tunnel release had a significant short-term improvement in their QuickDASH scores, regardless of EDX diagnosis. However, negative preoperative EDX studies in the setting of strong clinical suspicion of CuTS do not exclude diagnosis and may in fact be a positive, rather than a negative, predictive factor for short-term postoperative functional improvement.

Type of study/level of evidence

Prognostic IV.

目的电诊断（EDX）测试通常与症状和体格检查结果相结合，用于诊断肘隧道综合征（CuTS）。本研究旨在调查术前 EDX 诊断与 CuTS 患者术后手臂、肩部和手部残疾（QuickDASH）改善程度之间的关系。术前进行过 EDX 检测以及术前和术后 3 个月进行过 QuickDASH 评分的患者均符合纳入条件。根据 CuTS EDX 检测结果，这些患者被分为 EDX 阳性和 EDX 阴性两组。两组患者的人口统计学、术前 QuickDASH、术后 QuickDASH 和 QuickDASH 变化情况进行了比较。EDX阴性组的术前QuickDASH评分较高，接近但未达到显著性（P = .06）。肘隧道松解术后，两组患者的 QuickDASH 均有明显改善（P = .021, P < .01）。结论无论EDX诊断结果如何，接受肘隧道松解术的患者的QuickDASH评分在短期内都有明显改善。然而，在临床强烈怀疑 CuTS 的情况下，术前 EDX 检查结果呈阴性并不能排除诊断，事实上，这可能是术后短期功能改善的一个积极而非消极的预测因素。

{"title":"Electrodiagnostic Testing Predicts Postdecompression Outcomes in Patients With Cubital Tunnel Syndrome","authors":"Kevin R. Cuneo BS , Thomas J. McQuillan MD , Constance M. Sullivan BS, BA , Hayden L. Cooke BS , Sabryn A. Kapp BS , Eric R. Wagner MD, MSc , Michael B. Gottschalk MD","doi":"10.1016/j.jhsg.2024.08.013","DOIUrl":"10.1016/j.jhsg.2024.08.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Electrodiagnostic (EDX) testing is commonly used in conjunction with symptoms and physical examination findings to diagnose cubital tunnel syndrome (CuTS). The purpose of this study was to investigate the relationship between preoperative EDX diagnosis and the degree of Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH) improvement after surgery within the CuTS patient population.</div></div><div><h3>Methods</h3><div>A retrospective review was designed to analyze patients from a single institution who underwent a cubital tunnel release. Patients who had preoperative EDX testing, as well as preoperative and 3-month postoperative <em>Quick</em>DASH scores were eligible for inclusion. These patients were divided into two groups, EDX-positive or EDX-negative, based on the findings of their EDX testing for CuTS. Demographics, preoperative <em>Quick</em>DASH, postoperative <em>Quick</em>DASH, and changes in <em>Quick</em>DASH were compared between the two groups.</div></div><div><h3>Results</h3><div>Fifty-seven patients were included—34 EDX-positive and 23 EDX-negative. The EDX-negative cohort had higher preoperative <em>Quick</em>DASH scores, which approached but did not reach significance (<em>P</em> = .06). Both groups had significant improvement in <em>Quick</em>DASH following cubital tunnel release (<em>P</em> = .021, <em>P</em> < .01). Patients with EDX-negative testing had a significantly greater improvement in <em>Quick</em>DASH from before surgery to 3 months after surgery (25 points vs 11, <em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>Patients who underwent cubital tunnel release had a significant short-term improvement in their <em>Quick</em>DASH scores, regardless of EDX diagnosis. However, negative preoperative EDX studies in the setting of strong clinical suspicion of CuTS do not exclude diagnosis and may in fact be a positive, rather than a negative, predictive factor for short-term postoperative functional improvement.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 779-783"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706768","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

Presenteeism and Absenteeism Before and After Carpal Tunnel Release or Open Reduction and Internal Fixation for Distal Radius Fracture 腕管松解术或桡骨远端骨折切开复位内固定术前后的出勤率和缺勤率

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.009

David N. Bernstein MD, PhD , Alexy Ilchuk BA , Monica M. Shoji MD , Carl M. Harper MD , Tamara D. Rozental MD

Purpose

The use of a person’s hands is crucial to their ability to succeed at work. Hand pathologies can impact work success by increasing absenteeism (ie, not being able to go to work) and presenteeism (ie, being able to work but in a reduced capacity). In this study, we quantified employed patients’ presenteeism and absenteeism following carpal tunnel release or surgical fixation of a distal radius fracture (DRF).

Methods

In this prospective cohort study, 91 patients (carpal tunnel syndrome [CTS]: n = 62; DRF: n = 29) from June 2022 to December 2023 were included. Baseline patient characteristics and patient-reported outcome measures (PROMs) were collected. Presenteeism and absenteeism were calculated using the World Health Organization’s Health and Work Performance Questionnaire. Questionnaires were sought before surgery and at 3 and 6 months after surgery. Clinical improvement was determined using minimal clinically important difference (MCID) cutoff range estimates. The employee value of lost work was calculated as a percentage of the average patient in each group before surgery and at 6 months after surgery.

Results

The average change in PROMs scores from before to after surgery at 6 months surpassed the low-end MCID estimates for all functional and pain-related PROMs. For patients undergoing surgery for CTS and DRF, retained employee value rose from 85.6% to 130.2% (ie, worked more than expected) and 52.7% to 56.9%, respectively.

Conclusions

Patients undergoing surgery for CTS or DRF have clinically appreciable improvement in functional and pain symptoms by 6 months after surgery. However, by 6 months after surgery, carpal tunnel release results in greater than complete employee value recovery, compared with surgical fixation of DRFs in which greater than 40% of the employee value remains lost after surgery. These findings can assist with preoperative expectation setting.

Type of study/level of evidence

Prognostic II.

目的手的使用对一个人能否成功工作至关重要。手部病变会增加缺勤率（即无法上班）和旷工率（即能够上班但工作能力下降），从而影响工作的成功率。在这项研究中，我们量化了就业患者在腕管松解术或桡骨远端骨折（DRF）手术固定后的旷工和缺勤情况。方法在这项前瞻性队列研究中，纳入了 2022 年 6 月至 2023 年 12 月期间的 91 名患者（腕管综合征 [CTS]：n = 62；DRF：n = 29）。研究收集了患者的基线特征和患者报告的结果指标（PROMs）。采用世界卫生组织的健康和工作表现问卷计算出缺勤率和旷工率。在手术前、手术后 3 个月和 6 个月进行问卷调查。采用最小临床意义差异（MCID）临界范围估算法确定临床改善情况。结果在所有功能和疼痛相关的PROMs中，手术前和手术后6个月PROMs评分的平均变化超过了MCID估计值的低端。结论接受 CTS 或 DRF 手术的患者在术后 6 个月时，其功能和疼痛症状在临床上有明显改善。然而，与 DRF 手术固定相比，腕管松解术后 6 个月，员工价值的恢复超过了完全恢复，而 DRF 手术固定术后，员工价值的损失超过了 40%。这些发现有助于术前期望值的设定。

{"title":"Presenteeism and Absenteeism Before and After Carpal Tunnel Release or Open Reduction and Internal Fixation for Distal Radius Fracture","authors":"David N. Bernstein MD, PhD , Alexy Ilchuk BA , Monica M. Shoji MD , Carl M. Harper MD , Tamara D. Rozental MD","doi":"10.1016/j.jhsg.2024.08.009","DOIUrl":"10.1016/j.jhsg.2024.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of a person’s hands is crucial to their ability to succeed at work. Hand pathologies can impact work success by increasing absenteeism (ie, not being able to go to work) and presenteeism (ie, being able to work but in a reduced capacity). In this study, we quantified employed patients’ presenteeism and absenteeism following carpal tunnel release or surgical fixation of a distal radius fracture (DRF).</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 91 patients (carpal tunnel syndrome [CTS]: n = 62; DRF: n = 29) from June 2022 to December 2023 were included. Baseline patient characteristics and patient-reported outcome measures (PROMs) were collected. Presenteeism and absenteeism were calculated using the World Health Organization’s Health and Work Performance Questionnaire. Questionnaires were sought before surgery and at 3 and 6 months after surgery. Clinical improvement was determined using minimal clinically important difference (MCID) cutoff range estimates. The employee value of lost work was calculated as a percentage of the average patient in each group before surgery and at 6 months after surgery.</div></div><div><h3>Results</h3><div>The average change in PROMs scores from before to after surgery at 6 months surpassed the low-end MCID estimates for all functional and pain-related PROMs. For patients undergoing surgery for CTS and DRF, retained employee value rose from 85.6% to 130.2% (ie, worked more than expected) and 52.7% to 56.9%, respectively.</div></div><div><h3>Conclusions</h3><div>Patients undergoing surgery for CTS or DRF have clinically appreciable improvement in functional and pain symptoms by 6 months after surgery. However, by 6 months after surgery, carpal tunnel release results in greater than complete employee value recovery, compared with surgical fixation of DRFs in which greater than 40% of the employee value remains lost after surgery. These findings can assist with preoperative expectation setting.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 882-887"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706720","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

Bilateral Hemi-Hamate Autograft for Two Proximal Interphalangeal Joint Fracture Dislocations: A Case Report 双侧半驼峰自体移植物治疗两个近端指间关节骨折脱位：病例报告

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.07.001

Levonti Ohanisian MD , Michael P. Kucharik MD , Kathryn S. King MD , Tantien Nguyen BS , Michael Doarn MD

A 27-year-old man sustained right ring and little finger proximal interphalangeal joint fracture dislocations. He subsequently underwent bilateral hemi-hamate autograft to treat these intra-articular injuries. The patient was followed periodically and demonstrated return of normal grip strength and radiographic union of the hemi-hamate reconstruction arthroplasties. This is the first reported case of a patient who underwent bilateral hamates as donor grafts for two proximal interphalangeal joint fracture dislocations. When patients present with multiple unrepairable proximal interphalangeal joint fracture dislocations, surgeons can consider bilateral hemi-hamate reconstruction arthroplasty as a consideration to restore normal function.

一名 27 岁男子的右手无名指和小指近端指间关节骨折脱位。随后，他接受了双侧半髋关节自体移植手术来治疗这些关节内损伤。对该患者进行了定期随访，结果表明其握力恢复正常，半髋关节再造假体也在影像学上与关节结合。这是首例接受双侧腘绳肌作为供体移植治疗两个近端指间关节骨折脱位的患者。当患者出现多处无法修复的近端指间关节骨折脱位时，外科医生可以考虑采用双侧半髋关节重建关节置换术来恢复患者的正常功能。

引用次数: 0

Trends in Digit Replantation and Revision Amputation in the United States From 2009 to 2019 2009 年至 2019 年美国 Digit Replantation 和 Revision Amputation 的趋势

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.07.012

Joseph G. Monir MD , Hayden Cooke BS , Olivia Jagiella-Lodise BS , Thomas McQuillan MD , Eric Wagner MD , Nicole A. Zelenski MD

Purpose

Digit amputations can be managed either with replantation or revision amputation. The advent and refinement of microsurgical techniques allowed for the reliable success of replantation. Despite this, rates of digit replantation have been decreasing over the past several decades. A paucity of data exists on recent trends. The authors hypothesize that rates of both replantation and revision amputation will continue to downtrend.

Methods

IBM Watson Health Marketscan Commercial Claims and Encounters and Medicare Supplemental databases were queried for digit replantation and revision amputations from 2009 to 2019. National volumes and incidences were estimated by combining these data with population data from the United States Census Bureau Public Use Microdata Sample. Linear regression was performed to evaluate trends. Subgroup analysis was performed for both volume and incidence to elucidate the role of age, sex, and geographical location.

Results

Between 2009 and 2019, there were an estimated 2,207 digit replantations and 53,810 digit revision amputations. The volume of replantations decreased by 42.2%, and the incidence of replantations decreased by 46.3%. The volume of revision amputations decreased by 16.2%, and the incidence of revision amputations decreased by 22.2%. Men were the majority of both groups, accounting for 75.6% of replantations and 83.6% of amputations. The replantation-to-amputation ratio decreased from 0.057 to 0.039 (−31.0%).

Conclusions

Both digit replantations and revision amputations continued to decline over the decade from 2009 to 2019. The downtrend in replantations outpaced the downtrend in revision amputations, resulting in a decreased replantation-to-amputation ratio.

Type of study/level of evidence

Therapeutic IV.

目的数字截肢可以通过再植或翻修截肢来处理。显微外科技术的出现和完善使再植手术获得了可靠的成功。尽管如此，在过去的几十年中，手指再植的比例一直在下降。有关近期趋势的数据很少。作者假设，再植和翻修截肢率将继续呈下降趋势。方法查询了 IBM Watson Health Marketscan Commercial Claims and Encounters 和 Medicare Supplemental 数据库，以了解 2009 年至 2019 年的指骨再植和翻修截肢情况。通过将这些数据与美国人口普查局公共使用微数据样本中的人口数据相结合，估算出了全国的截肢量和发病率。为评估趋势进行了线性回归。对数量和发病率进行了分组分析，以阐明年龄、性别和地理位置的作用。结果2009年至2019年间，估计有2207例指骨再植术和53810例指骨翻修截肢术。再植数量减少了 42.2%，再植发生率减少了 46.3%。翻修截肢的数量减少了 16.2%，翻修截肢的发生率减少了 22.2%。两组患者中男性居多，占再植手术的 75.6%，占截肢手术的 83.6%。再植与截肢的比率从 0.057 降至 0.039（-31.0%）。结论从 2009 年到 2019 年的十年间，数字再植和修正截肢都在持续下降。再植的下降趋势超过了翻修截肢的下降趋势，导致再植与截肢的比率下降。

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引用次数: 0

Impact of Social Deprivation on Cubital Tunnel Syndrome Treatment Timeline 社会贫困对肘管综合征治疗时间表的影响

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.08.019

Akhil Dondapati MD , Janet Ngoc Tran BA , Callista Zaronias BA , Cody C. Fowler MD , Thomas J. Carroll MD , Bilal Mahmood MD

Purpose

The purpose of this study was to establish the impact of area deprivation index (ADI) on treatment timelines of patients with cubital tunnel syndrome (CuTS). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery.

Methods

This is a retrospective study of patients diagnosed with CuTS who underwent surgical intervention at a single academic institution. Variables including age, sex, body mass index, ADI, electrodiagnostic (EDX) severity classification, and time elapsed between treatment milestones were obtained. Treatment milestones included time elapsed between initial presentation to hand surgery and EDX studies, and surgery. Analysis included univariate χ² tests and analysis of variance, as well as multivariate linear and logistic regressions.

Results

Six hundred and fifty-three patients were divided by ADI national percentiles from the least to most deprived tertiles. Univariate analysis found no differences in care timelines across ADI tertiles. Multivariate analysis revealed a nonsignificant trend toward higher ADI predicting longer time from presentation to surgery. Moderate EDX rating correlated with increased time from presentation to surgery. Mild EDX ratings correlate with increased time from EDX studies to surgery. Age was a significant predictor of decreased time between initial presentation and surgery and between EDX and surgery. Completion of EDX studies prior to presentation significantly decreased time to surgery.

Conclusions

Social deprivation does not significantly correlate with delays in the treatment timeline for CuTS. Increased age was significantly correlated with shorter treatment timelines, which may reflect differences in physicians’ approaches to patients of different ages. Electrodiagnostic testing obtained prior to initial presentation expedited care following presentation to hand clinic. However, this could reflect either an overall delay in care (if EDX were obtained because of a delay from referral to presentation) or truly expedited care.

Type of study/level of evidence

Prognostic II.

目的本研究旨在确定地区贫困指数（ADI）对肘管综合征（CuTS）患者治疗时间的影响。我们假设，社会贫困程度的增加将与从发病到手术的护理里程碑之间的时间增加相关。方法这是一项回顾性研究，研究对象是在一家学术机构接受手术治疗的确诊 CuTS 患者。获得的变量包括年龄、性别、体重指数、ADI、电诊断（EDX）严重程度分类以及治疗里程碑之间的时间间隔。治疗里程碑包括从初次就诊到接受手外科手术、EDX检查和手术之间的时间间隔。分析包括单变量χ2检验和方差分析，以及多变量线性回归和逻辑回归。单变量分析发现，不同 ADI 百分位数的护理时间没有差异。多变量分析显示，ADI越高，预示从发病到手术的时间越长，但这一趋势并不明显。中度 EDX 评级与从发病到手术的时间延长相关。轻度 EDX 评级与从 EDX 研究到手术的时间延长相关。年龄是最初发病到手术以及 EDX 到手术之间时间缩短的重要预测因素。结论社会贫困与 CuTS 治疗时间的延迟无明显相关性。年龄的增加与治疗时间的缩短明显相关，这可能反映了医生对不同年龄患者的治疗方法存在差异。初次就诊前进行的电诊断测试可加快手部诊所的治疗速度。然而，这可能反映了治疗的整体延迟（如果从转诊到就诊的延迟导致了电诊断检查的获得），也可能反映了真正的加速治疗。

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引用次数: 0

Upper-Extremity Injuries in a Level 1 Trauma Center Following Border Wall Height Increase 边境墙增高后一级创伤中心的上肢损伤情况

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2024-11-01 DOI: 10.1016/j.jhsg.2024.07.002

Emma Williams BA , Vivian Hu MD , Cooper Haaland BS , Meera Reghunathan MD , Laura N. Haines MD , Jay J. Doucet MD , Todd W. Costantini MD , Katharine M. Hinchcliff MD

Purpose

From 2018–2019, the height of over 400 miles of southern border wall was raised to 30 feet. Our aim was to evaluate the impact of the increase in border wall height on upper-extremity injuries sustained via barrier fall.

Methods

A retrospective review of patients admitted with upper-extremity injuries sustained via border wall fall between January 2015 and December 2022 at a Level 1 trauma center serving the United States-Mexico border. Patients admitted between 2015–2018 were included in the preincrease group, and those admitted between 2019–2022 were included in the postincrease group. Demographic data, injury severity metrics, fracture characteristics, operative treatments, hospital charges, and lengths of stay were compared.

Results

In total, 110 patients were identified, with 16 preincrease and 94 postincrease. Following the barrier height increase, patients had higher injury severity scores. Radial fractures were most common pre- and postincrease and accounted for nearly one-third of all fractures. Postincrease upper-extremity trauma patients required more operative events (2.15 ± 2.10 vs 1.44 ± 0.73 preincrease). The average cost for each patient’s hospital stay also quadrupled after the increase in wall height ($397,632 ± $1,057,574 vs $98,978 ± $84,169 preincrease).

Conclusions

The increase in overall injury severity and costly inpatient treatment of upper-extremity injuries among patients who fell from the border following construction has placed additional stress on an already strained health care system.

Level of Evidence

Differential Diagnosis/Symptom Prevalence Study, IV.

目的从2018年至2019年，400多英里的南部边境墙的高度提高到了30英尺。我们的目的是评估边境墙高度的增加对因障碍物坠落而造成的上肢损伤的影响。方法回顾性分析美国-墨西哥边境一家一级创伤中心在 2015 年 1 月至 2022 年 12 月期间收治的因边境墙坠落而造成上肢损伤的患者。2015-2018年间入院的患者被纳入增加前组，2019-2022年间入院的患者被纳入增加后组。对人口统计学数据、受伤严重程度指标、骨折特征、手术治疗、住院费用和住院时间进行了比较。结果共确定了 110 名患者，其中增高前 16 人，增高后 94 人。障碍物增高后，患者的受伤严重程度评分较高。桡骨骨折在增高前和增高后最为常见，占所有骨折的近三分之一。增高后的上肢创伤患者需要更多的手术治疗（2.15 ± 2.10 vs 1.44 ± 0.73）。结论施工后从边界跌落的患者上肢受伤的总体严重程度和昂贵的住院治疗费用增加，给本已紧张的医疗保健系统带来了额外的压力。

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引用次数: 0