Journal of Hand Surgery Global Online最新文献_第5页

Trapeziometacarpal Arthrodesis With Tendon Interposition Resection Arthroplasty at the Scaphotrapeziotrapezoid Joint for Eaton Stage IV Trapeziometacarpal Osteoarthritis Eaton期IV型梯形腕骨关节炎的舟状斜方关节置换术联合肌腱间位切除关节成形术

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-14 DOI: 10.1016/j.jhsg.2025.100838

Masanori Hayashi MD, Ph.D , Hiroyuki Kato MD, PhD , Shigeharu Uchiyama MD, PhD , Hiroko Iwakawa MD, PhD , Yo Kitamura MD, PhD , Jun Takahashi MD, PhD

Purpose

Trapeziectomy and proximal trapezoid excision with ligament reconstruction and tendon interposition or suspensionplasty is the standard method for the treatment of Eaton stage IV trapeziometacarpal (TMC) osteoarthritis (OA). However, these procedures have potential risks, such as residual metacarpophalangeal (MCP) hyperextension and thumb shortening. The aim of this study was to present the surgical technique and clinical results of TMC arthrodesis with tendon interposition resection arthroplasty (TIRA) at the scaphotrapeziotrapezoid joint.

Methods

Thirteen hands of 10 patients with stage IV TMC OA underwent TMC arthrodesis with TIRA between 2014 and 2024, with a minimum follow-up of 12 months. Pre and postoperative visual analog scale score, quick disabilities of arm, shoulder, and hand score, patient-rated wrist evaluation score, grip strength, and side pinch strength were evaluated. Pre and postoperative radiographs were obtained to evaluate bone union, the angles of the MCP joint, and the capitolunate angle.

Results

The mean visual analog scale score decreased from 77 (SD: 13) before surgery to 10 (SD: 13) at follow-up. The mean disabilities of arm, shoulder, and hand score was 46 (SD: 17) before surgery and 22 (SD: 16) at the final follow-up. The mean patient-rated wrist evaluation score was 66 (SD: 21) before surgery and 15 (SD: 17) at the final follow-up. The mean side pinch was 2.7 kg (SD: 1.1) before surgery to 4.3 kg (SD: 1.2) at the final follow-up. Bone union at the TMC joint was achieved in all cases. The mean MCP joint angle was −20° (SD: 22°) before surgery and −4° (SD: 19°) at the final follow-up. The mean capitolunate angle was 0° (SD: 13°) before surgery and −2° (SD: 8°) at the final follow-up.

Conclusions

Compared with preoperative conditions, TMC arthrodesis with TIRA at the scaphotrapeziotrapezoid joint achieved satisfactory results with substantial improvement. This novel procedure could be used for stage IV TMC OA.

Type of study/level of evidence

Therapeutic IV.

目的：治疗Eatonⅳ期梯形骨关节炎（TMC）的标准方法是行近端梯形切除联合韧带重建和肌腱间置或悬吊成形术。然而，这些手术有潜在的风险，如残留的掌指骨（MCP）过伸和拇指缩短。本研究的目的是介绍TMC关节融合术联合肌腱间位切除关节成形术（TIRA）的手术技术和临床效果。方法2014 - 2024年间，10例IV期TMC OA患者13只手行TMC关节融合术，至少随访12个月。评估术前和术后视觉模拟量表评分、手臂、肩膀和手的快速残疾评分、患者评定的手腕评估评分、握力和侧捏力。术前和术后x线片评估骨愈合、MCP关节角度和头月角。结果两组患者视觉模拟量表平均评分由术前的77分（SD: 13）降至随访时的10分（SD: 13）。术前手臂、肩部和手部残疾平均评分为46 (SD: 17)，末次随访时为22 （SD: 16）。术前腕关节评分平均为66分（SD: 21），末次随访时为15分（SD: 17）。手术前平均侧夹为2.7 kg (SD: 1.1)，最终随访时为4.3 kg （SD: 1.2）。所有病例均实现TMC关节骨愈合。术前平均MCP关节角为- 20°（SD: 22°），最终随访时为- 4°（SD: 19°）。术前平均头月角为0°（SD: 13°），末次随访时为- 2°（SD: 8°）。结论与术前相比，TMC联合TIRA在舟方关节处进行关节融合术效果满意，改善明显。这种新方法可用于IV期TMC OA。研究类型/证据水平治疗性IV。

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引用次数: 0

Limitations of Artificial Intelligence Generated Images for Hand Surgery Patient Education 人工智能生成图像在手外科患者教育中的局限性

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-10 DOI: 10.1016/j.jhsg.2025.100845

Jessica L. Duggan MD , Omar Mohamed MD , Euan Forrest BS , Jessica Guo , Tamara D. Rozental MD

Purpose

The role of artificial intelligence (AI) in medicine is rapidly evolving, with potential to improve both the clinician and patient experience. We sought to evaluate whether popular AI text-to-image generators could create anatomically accurate images of common hand surgery procedures. We hypothesized that the AI-generated images would not be adequate as patient education materials.

Methods

We queried five AI text-to-image generators: Craiyon, DALL-E, DeepSeek, Gemini, Midjourney, and Stable Diffusion. They were given the prompt, “Create an anatomically accurate image with labels of [Condition] surgical approach to be used as a visual aid for patient education,” with the following conditions inserted: carpal tunnel syndrome, Dupuytren contracture, trigger finger, thumb carpometacarpal arthritis, and de Quervain tenosynovitis. Images were then graded on legibility, detail and clarity, anatomical realism and accuracy, appropriate surgical site, and lack of fabricated anatomy. Images could score a maximum of 2 points per each criterion, with an assumed Control score of 10 points.

Results

A total of 1,500 images were generated and reviewed. When comparing total scores, all AI generators performed significantly lower than the Control, except for DALL-E’s images of Dupuytren contracture. For the image detail and clarity category, DALL-E, DeepSeek, Gemini, and Midjourney all scored similarly to the Control and each other. For the remaining criteria (legibility, anatomic realism, surgical site, fabricated anatomy), each of the AI generators scored significantly lower than the Control generator. In total, 99.8% of images contained at least some degree of fabricated anatomy. DALL-E consistently had the highest scores for each category, while Craiyon had the lowest.

Conclusions

Although the AI servers successfully produced highly detailed and visually engaging images, they failed to portray accurate anatomy and often included fictitious structures. Further work is needed to train and fine tune AI models to produce accurate and appropriate images.

Type of study/level of evidence

Therapeutic V.

人工智能（AI）在医学中的作用正在迅速发展，有可能改善临床医生和患者的体验。我们试图评估流行的人工智能文本到图像生成器是否可以创建普通手部手术过程的解剖学精确图像。我们假设人工智能生成的图像不足以作为患者教育材料。方法查询了5种人工智能文本到图像生成器：crayyon、DALL-E、DeepSeek、Gemini、Midjourney和Stable Diffusion。他们被要求“制作一幅解剖学上准确的图像，带有手术入路的标签，作为患者教育的视觉辅助工具”，其中插入了以下情况：腕管综合征、Dupuytren挛缩、扳机指、拇指腕掌关节炎和de Quervain腱鞘炎。然后对图像的易读性、细节和清晰度、解剖真实性和准确性、合适的手术部位以及缺乏伪造的解剖进行分级。每个标准的图像最多可得2分，假设控制得分为10分。结果共生成并评审图像1500张。当比较总分时，除了DALL-E的Dupuytren挛缩图像外，所有AI生成器的表现都明显低于对照组。在图像细节和清晰度方面，DALL-E、DeepSeek、Gemini和Midjourney的得分都与Control和彼此相似。对于其他标准（易读性、解剖真实性、手术部位、捏造的解剖结构），每个AI生成器的得分都明显低于Control生成器。总的来说，99.8%的图像至少含有某种程度的伪造解剖。DALL-E一直在每个类别中得分最高，而Craiyon得分最低。尽管人工智能服务器成功地生成了非常详细和视觉上引人入胜的图像，但它们无法描绘准确的解剖结构，并且经常包含虚构的结构。需要进一步的工作来训练和微调人工智能模型，以产生准确和适当的图像。研究类型/证据水平

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引用次数: 0

Scapholunate Ligament Injuries 舟月韧带损伤

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-10 DOI: 10.1016/j.jhsg.2025.100854

Joanne Y. Zhou MD , Riasoya Jodah MSc , Lauren P. Joseph MD , Jeffrey Yao MD

Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.

舟月骨间韧带（SLIL）复合体的损伤可导致可预测的腕骨不协调运动级联，从而导致桡腕退行性变。急性创伤冲击和重复运动都可能导致sll不足。为了进行适当的诊断和治疗，需要彻底了解SLIL的解剖结构。在此，我们回顾舟月骨韧带的解剖、预防策略、诊断方法、非手术和手术治疗以及结果。对于sll损伤的每个阶段存在无数的治疗选择，治疗应该是患者和医生之间的公开讨论。

引用次数: 0

Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up 缝合线-钮扣悬吊成形术治疗拇指手掌骨关节炎的长期疗效：至少10年随访

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-10 DOI: 10.1016/j.jhsg.2025.100855

Jordan Lachnish MD , Ashley L. Titan MD , Subhro Sen MD , Jeffrey Yao MD

Purpose

Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years.

Methods

We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.

Results

The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0–40.9) at the long-term follow-up, compared with 26.2 (range: 4.5–75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement.

Conclusions

Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis.

Type of study/level of evidence

Therapeutic IV.

目的联合椎体切除和缝合-按钮悬吊成形术（SBS）是治疗拇指腕掌骨关节炎（CMC）的一种常见且成熟的手术方法。尽管短期和中期随访研究显示，患者保持了良好的活动范围和力量，但缺乏长期数据。我们研究的目的是评估接受SBS手术治疗拇指CMC关节炎患者的长期预后，随访期至少为10年。方法对17例接受SBS手术治疗拇指CMC关节炎至少10年的患者进行评价。我们测量了握力和捏紧力、活动范围和梯形空间高度，并将其与术后常规3个月随访时测量的相应值进行比较。所有患者都另外完成了手臂、肩膀和手的快速残疾问卷。结果女性11例，男性6例，平均年龄60.3±6.4岁，术后平均随访137.4±11.4个月。在长期随访中，手臂、肩部和手部的平均快速残疾评分为9分（范围：0-40.9），而术后3个月的评分为26.2分（范围：4.5-75）。握力和捏力分别为术后3个月值的116%和111%。桡骨外展和掌外展分别占术后3个月价值的98%和94%。Kapandji得分等于或高于先前记录的得分。斜位的平均高度为术后测量的69%。结论我们的研究结果表明，接受SBS手术治疗拇指CMC骨关节炎的患者，尽管随着时间的推移有一些放射学上的下沉，但通过保持良好的主观和客观结果，获得了良好的长期预后。这些结果表明SBS是一种有效和持久的长期治疗拇指CMC骨关节炎的技术。研究类型/证据水平治疗性IV。

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引用次数: 0

The Utility of Plain Radiography in Flexor Tendon and Digital Nerve Lacerations of the Hand x线平片在手部屈肌腱和指神经撕裂伤中的应用

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-10 DOI: 10.1016/j.jhsg.2025.100849

Ralph Hsiao MD, MSc , Carmen Ng MD, MSc , Alexander Morzycki MD, MSc , Matthew W.T. Curran MD, MSc , Hollie A. Power MD

Purpose

Physical examination during hand lacerations may sufficiently identify flexor tendon and digital nerve injuries, but radiographs are often acquired to rule out fracture, dislocation, or foreign body. This study examines the impact of plain radiography in the management of patients with isolated sharp injuries of the hand.

Methods

We retrospectively reviewed consecutive adult patients with flexor tendon and/or digital nerve lacerations who presented during 2019-2021 to a tertiary referral urgent care hand clinic. Charts were reviewed to determine the presence of bony injury or foreign body and whether radiographic evaluation affected clinical management. Comparisons were made among patients with varying mechanisms.

Results

One hundred eighty-five patients met inclusion criteria, with the mechanisms of sharp laceration (83.2%), saw injury (11.9%), and crush injury (4.9%). All patients with saw and crush injuries received radiographs compared with 45.5% in the sharp laceration group. Bony injuries and/or foreign bodies were found in 63.6% and 66.7% of cases in the saw and crush groups, respectively. In comparison, no patients with sharp lacerations had a bony injury, and one patient had a foreign body from glass shattering that was removed in the emergency department.

Conclusions

Our results suggest that the utility of plain radiography in sharp lacerations may be limited to clinical contexts in which a retained foreign body is suspected. We recommend only selective use of radiography in isolated sharp lacerations of the hand; however, radiographs regularly altered management in injuries because of saw and crush mechanisms and would be warranted in these settings.

Clinical relevance

This study supports the judicious use of radiography in simple sharp lacerations of the volar hand.

目的手部撕裂伤时的体格检查可以充分识别屈肌腱和指神经损伤，但通常需要x线片来排除骨折、脱位或异物。本研究探讨了平片在治疗孤立的手部尖锐损伤患者中的作用。方法回顾性分析2019-2021年在三级转诊急诊手部诊所就诊的连续成年屈肌腱和/或指神经撕裂患者。检查图表以确定骨损伤或异物的存在，以及影像学评估是否影响临床处理。在不同机制的患者中进行比较。结果185例患者符合入选标准，机制分别为锐裂伤（83.2%）、锯伤（11.9%）和挤压伤（4.9%）。所有锯伤和挤压伤患者均接受x线片检查，而锐裂伤组为45.5%。锯组和挤压组分别有63.6%和66.7%的病例出现骨损伤和/或异物。相比之下，没有尖锐撕裂伤的患者有骨损伤，一名患者有玻璃碎片的异物，在急诊室被移除。结论x线平片在尖锐裂伤诊断中的应用仅限于怀疑有异物残留的临床情况。我们建议在手部孤立的尖锐撕裂伤中只选择性地使用x线摄影；然而，由于锯断和压伤机制，x线摄影经常改变对损伤的处理，在这些情况下是有必要的。本研究支持在掌侧单纯性尖锐撕裂伤中明智地使用x线摄影。

{"title":"The Utility of Plain Radiography in Flexor Tendon and Digital Nerve Lacerations of the Hand","authors":"Ralph Hsiao MD, MSc , Carmen Ng MD, MSc , Alexander Morzycki MD, MSc , Matthew W.T. Curran MD, MSc , Hollie A. Power MD","doi":"10.1016/j.jhsg.2025.100849","DOIUrl":"10.1016/j.jhsg.2025.100849","url":null,"abstract":"<div><h3>Purpose</h3><div>Physical examination during hand lacerations may sufficiently identify flexor tendon and digital nerve injuries, but radiographs are often acquired to rule out fracture, dislocation, or foreign body. This study examines the impact of plain radiography in the management of patients with isolated sharp injuries of the hand.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive adult patients with flexor tendon and/or digital nerve lacerations who presented during 2019-2021 to a tertiary referral urgent care hand clinic. Charts were reviewed to determine the presence of bony injury or foreign body and whether radiographic evaluation affected clinical management. Comparisons were made among patients with varying mechanisms.</div></div><div><h3>Results</h3><div>One hundred eighty-five patients met inclusion criteria, with the mechanisms of sharp laceration (83.2%), saw injury (11.9%), and crush injury (4.9%). All patients with saw and crush injuries received radiographs compared with 45.5% in the sharp laceration group. Bony injuries and/or foreign bodies were found in 63.6% and 66.7% of cases in the saw and crush groups, respectively. In comparison, no patients with sharp lacerations had a bony injury, and one patient had a foreign body from glass shattering that was removed in the emergency department.</div></div><div><h3>Conclusions</h3><div>Our results suggest that the utility of plain radiography in sharp lacerations may be limited to clinical contexts in which a retained foreign body is suspected. We recommend only selective use of radiography in isolated sharp lacerations of the hand; however, radiographs regularly altered management in injuries because of saw and crush mechanisms and would be warranted in these settings.</div></div><div><h3>Clinical relevance</h3><div>This study supports the judicious use of radiography in simple sharp lacerations of the volar hand.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100849"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postoperative Ketorolac Use and the Odds of a Nonunion in Operatively Treated Scaphoid Fractures 手术治疗舟状骨骨折术后使用酮罗拉酸和骨不连的几率

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-09 DOI: 10.1016/j.jhsg.2025.100848

Alexander D. Jeffs MD , Océane Mauffrey BS , Nicholas C. Bank MD , Stephen J. Perle BS , Sonja A. Samant MD , Stephen M. Himmelberg MD , Gregory M. Knoll MD , J. Megan M. Patterson MD , Reid W. Draeger MD

Purpose

Ketorolac is a potent nonsteroidal anti-inflammatory drug that is beneficial in the ambulatory hand surgery setting. Reluctance exists in the use of nonsteroidal anti-inflammatory drugs, such as ketorolac, after operative treatment of fractures at high risk for nonunion, such as scaphoid fractures. We hypothesized that postoperative ketorolac administration within 5 days of operative treatment for a scaphoid fracture would coincide with a higher rate of nonunion than no postoperative ketorolac administration.

Methods

A retrospective cohort was obtained from the TriNetX database. Patients ≥18 years old who underwent operative treatment of a scaphoid fracture from 2013 to 2023 were included. Patients with open fractures, prior nonunion, and infection were excluded. Cohorts were defined based on postoperative ketorolac use within 5 days of surgery. After propensity score matching, nonunion and nonunion revision surgery rates were determined and compared with odds ratios (ORs) and 95% CIs. Statistical significance was reported as an alpha error of < .05.

Results

A total of 2,063 matched patients (1,044 ketorolac; 1,019 no ketorolac) were compared. No considerable differences in nonunion rate and nonunion revision surgery rate were observed between the ketorolac and no ketorolac groups (4.3% vs 3.9%; OR, 1.102 [95% CI, 0.714–1.703] and 1.0% vs 1.5%; OR, 0.655 [95% CI, 0.302–1.417]).

Conclusions

Postoperative ketorolac use within 5 days of operative treatment does not considerably increase the rate of nonunion or nonunion revision surgery in operatively treated scaphoid fractures.

Type of study/level of evidence

Therapeutic III

目的：酮咯酸是一种有效的非甾体抗炎药，在门诊手外科环境中是有益的。对于舟状骨骨折等易发生骨不连的骨折，手术治疗后不愿使用非甾体类抗炎药，如酮罗拉酸。我们假设舟状骨骨折术后5天内给予酮罗拉酸治疗与术后未给予酮罗拉酸相比，骨不愈合的发生率更高。方法从TriNetX数据库中获得回顾性队列。纳入2013年至2023年接受舟状骨骨折手术治疗的≥18岁患者。排除开放性骨折、既往骨不连和感染的患者。根据术后5天内酮罗拉酸的使用情况来定义队列。倾向评分匹配后，确定骨不连和骨不连翻修手术率，并比较优势比（ORs）和95% ci。报告的alpha误差为<； 05，具有统计学意义。结果共有2063例匹配患者（服用酮咯酸1044例，未服用酮咯酸1019例）进行比较。酮洛酸组和无酮洛酸组的骨不连率和骨不连翻修手术率无显著差异（4.3% vs 3.9%； OR为1.102 [95% CI, 0.714-1.703]； OR为1.0% vs 1.5%； OR为0.655 [95% CI, 0.402 - 1.417]）。结论术中舟状骨骨折术后5天内应用酮罗拉酸对骨不愈合及骨不愈合修复手术的发生率无显著影响。研究类型/证据水平：治疗性

{"title":"Postoperative Ketorolac Use and the Odds of a Nonunion in Operatively Treated Scaphoid Fractures","authors":"Alexander D. Jeffs MD , Océane Mauffrey BS , Nicholas C. Bank MD , Stephen J. Perle BS , Sonja A. Samant MD , Stephen M. Himmelberg MD , Gregory M. Knoll MD , J. Megan M. Patterson MD , Reid W. Draeger MD","doi":"10.1016/j.jhsg.2025.100848","DOIUrl":"10.1016/j.jhsg.2025.100848","url":null,"abstract":"<div><h3>Purpose</h3><div>Ketorolac is a potent nonsteroidal anti-inflammatory drug that is beneficial in the ambulatory hand surgery setting. Reluctance exists in the use of nonsteroidal anti-inflammatory drugs, such as ketorolac, after operative treatment of fractures at high risk for nonunion, such as scaphoid fractures. We hypothesized that postoperative ketorolac administration within 5 days of operative treatment for a scaphoid fracture would coincide with a higher rate of nonunion than no postoperative ketorolac administration.</div></div><div><h3>Methods</h3><div>A retrospective cohort was obtained from the TriNetX database. Patients ≥18 years old who underwent operative treatment of a scaphoid fracture from 2013 to 2023 were included. Patients with open fractures, prior nonunion, and infection were excluded. Cohorts were defined based on postoperative ketorolac use within 5 days of surgery. After propensity score matching, nonunion and nonunion revision surgery rates were determined and compared with odds ratios (ORs) and 95% CIs. Statistical significance was reported as an alpha error of < .05.</div></div><div><h3>Results</h3><div>A total of 2,063 matched patients (1,044 ketorolac; 1,019 no ketorolac) were compared. No considerable differences in nonunion rate and nonunion revision surgery rate were observed between the ketorolac and no ketorolac groups (4.3% vs 3.9%; OR, 1.102 [95% CI, 0.714–1.703] and 1.0% vs 1.5%; OR, 0.655 [95% CI, 0.302–1.417]).</div></div><div><h3>Conclusions</h3><div>Postoperative ketorolac use within 5 days of operative treatment does not considerably increase the rate of nonunion or nonunion revision surgery in operatively treated scaphoid fractures.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100848"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biohacking and Chip Implantation in the Human Hand: An Introduction 生物黑客和芯片植入人手：介绍

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-07 DOI: 10.1016/j.jhsg.2025.100853

Ward Eerens MD , Pieter Caekebeke MD, PhD , Joris Duerinckx MD PhD

Biohacking is a term used to describe people making changes to their bodies to improve their well-being. This includes the implantation of radiofrequency identification implants. This technology for wireless communication is already incorporated into our daily lives as in the use of contactless payment and badges to open doors. Since the first radiofrequency identification implantation in a human in 1998, the possibilities of this technology have dramatically increased, and the number of persons that have been chipped is growing. The hand seems to be the most popular body part to implant these chips because it can easily be positioned close to a reader. Currently, implantation is typically not performed in a medical environment. However, implantation of these devices in humans can result in complications, such as infection and tendon attrition, and the relevant safety implications have not been extensively studied. The scope of this review was to inform the hand surgeon community about the existence of these implants, why they are used, and to open the debate about the possible future role of the hand surgeon in safely implanting these devices and dealing with possible complications.

生物黑客是一个术语，用来描述人们改变自己的身体来改善他们的健康。这包括射频识别植入物的植入。这种无线通信技术已经融入了我们的日常生活，如使用非接触式支付和徽章开门。自从1998年第一次射频识别植入人体以来，这项技术的可能性急剧增加，植入芯片的人数也在不断增加。手似乎是植入这些芯片最受欢迎的身体部位，因为它可以很容易地靠近阅读器。目前，植入通常不在医疗环境中进行。然而，在人类中植入这些装置会导致并发症，如感染和肌腱磨损，相关的安全性影响尚未得到广泛研究。这篇综述的范围是告知手外科医生这些植入物的存在，为什么要使用它们，并就手外科医生在安全植入这些装置和处理可能的并发症方面可能发挥的作用展开辩论。

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引用次数: 0

Underutilization of Hand Corticosteroid Injections and Arthroplasty for Minority Demographics 少数民族人口统计数据中手部皮质类固醇注射和关节成形术的利用不足

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-06 DOI: 10.1016/j.jhsg.2025.100837

Christopher M. Dussik MD , Amy Phan MD , Akhil Dondapati MD , Jeffrey Coombs MD , Danielle Wilbur MD , Ronald Gonzalez DO , Constantinos Ketonis MD, PhD

Purpose

The management of hand osteoarthritis is a cornerstone of hand surgery practice. Corticosteroid injections and surgical interventions form the mainstay of treatment for those patients with symptoms recalcitrant to less-invasive measures. Health care disparities have been increasingly recognized, particularly regarding variations in pain management. This study aimed to determine whether such disparities exist across different racial and ethnic groups in the treatment of hand osteoarthritis.

Methods

We used the TriNetX database to evaluate patients diagnosed with hand osteoarthritis between January 1, 2010 and December 31, 2024. Diagnostic and billing codes were used to identify patients, assess overall health care utilization postdiagnosis, and gauge the use of corticosteroid injections and surgical intervention across different demographics. Outcomes were stratified based on racial and ethnic identification. Matching was performed to mitigate risk for confounding. Odds ratios were used to describe differences in the probability of receiving treatment across groups of interest.

Results

A total of 896,636 patients diagnosed with hand osteoarthritis were identified. Non-Hispanic White patients had nearly twice the odds of undergoing corticosteroid injections and demonstrated consistently higher rates of surgical treatment compared with minority populations across unmatched analyses. After matching for demographic and comorbidity variables, these disparities largely persisted despite similar overall health care utilization.

Conclusions

Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis. Similarly, these groups undergo surgical management at considerably lower rates. These findings highlight the persistent disparities in treatment faced by underrepresented groups and underscore the critical importance of considering social determinants of health in the management of upper extremity conditions.

Type of study/level of evidence

Prognosis IIC.

目的手骨关节炎的治疗是手外科实践的基石。皮质类固醇注射和手术干预是对那些症状难以采取微创措施的患者的主要治疗方法。人们日益认识到保健方面的差异，特别是在疼痛管理方面的差异。本研究旨在确定这种差异是否存在于不同种族和民族的治疗手骨关节炎。方法使用TriNetX数据库对2010年1月1日至2024年12月31日诊断为手骨关节炎的患者进行评估。诊断和计费代码用于识别患者，评估诊断后的总体医疗保健利用率，并衡量不同人口统计学中皮质类固醇注射和手术干预的使用情况。结果根据种族和民族认同进行分层。进行匹配以降低混淆的风险。比值比用于描述各组间接受治疗概率的差异。结果共鉴定出896636例手部骨关节炎患者。非西班牙裔白人患者接受皮质类固醇注射的几率几乎是少数族裔患者的两倍，并且与少数族裔人群相比，他们的手术治疗率始终较高。在匹配了人口统计学和合并症变量后，尽管总体医疗保健利用率相似，但这些差异在很大程度上仍然存在。结论少数民族接受皮质类固醇注射治疗手骨关节炎的几率较低。同样，这些群体接受手术治疗的比率也相当低。这些发现突出了代表性不足的群体在治疗方面持续存在的差异，并强调了在上肢疾病管理中考虑健康的社会决定因素的至关重要性。研究类型/证据水平预后IIC。

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引用次数: 0

Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex 关节镜辅助修复三角形纤维软骨复合体

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-06 DOI: 10.1016/j.jhsg.2025.100857

Joanne Y. Zhou MD , Hubert Tuyishime BA , Jeffrey Yao MD

Triangular fibrocartilage complex (TFCC) injuries are a common cause of ulnar-sided wrist pain and may progress to persistent pain, instability of the distal radioulnar joint, and arthritis if left untreated. Diagnosis and management of these injuries requires a nuanced understanding of features pertinent to the clinical presentation, imaging, and arthroscopic findings for accurate management. Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. In this review, we discuss the anatomy of the TFCC, history and examination of ulnar-sided pathology, imaging findings, classification schemes, and surgical techniques for treatment of TFCC injuries. We also touch on pearls and pitfalls of the techniques, complications, and results of treatment.

三角形纤维软骨复合体（TFCC）损伤是尺侧腕关节疼痛的常见原因，如果不及时治疗，可能会发展为持续疼痛、远端尺桡关节不稳定和关节炎。这些损伤的诊断和治疗需要细致入微地了解与临床表现、影像学和关节镜检查结果相关的特征，以便进行准确的治疗。关节镜辅助修复技术已经彻底改变了手术管理，提供了详细的可视化，并促进了微创技术对TFCC损伤和相关病理的修复。在这篇综述中，我们讨论了TFCC的解剖、病史和尺侧病理检查、影像学表现、分类方案和治疗TFCC损伤的手术技术。我们也触及珍珠和陷阱的技术，并发症和治疗的结果。

引用次数: 0

Flexor Carpi Radialis Tendinitis to Rupture: A Case Series and Algorithm 桡侧腕屈肌腱炎至断裂：一个病例系列和算法

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-10-06 DOI: 10.1016/j.jhsg.2025.100859

James D. Spratt MD , Ashley Mehl MD , Gary M. Lourie MD

Purpose

Flexor carpi radialis (FCR) tendinitis is an uncommon but important cause of volar radial wrist pain that can be a diagnostic and therapeutic challenge. We present a series of patients with FCR tendinitis managed successfully with an algorithm developed by the senior author.

Methods

A retrospective review of patients treated for FCR tendinitis at a hand practice was performed. The percent of the FCR rupture, determined with magnetic resonance imaging (MRI) and intraoperative confirmation, determined specific treatment. Patients with <50% rupture on MRI were treated conservatively. Surgery was indicated if this failed to yield relief or MRI suggested >50% rupture. On intraoperative examination, patients with <50% rupture underwent tenosynovectomy and excision of trapezial osteophytes. Patients with >50% rupture underwent an FCR-sacrificing procedure. Patient-reported outcomes, including severity of pain with activities of daily living and ability to return to previous levels of activity, were obtained.

Results

Sixteen patients were treated for FCR tendinitis. Five were treated conservatively, with complete relief of symptoms and return to full activity without sequelae in three of five cases. Four of the 11 surgical patients were found to have <50% of tendon rupture and underwent an FCR-sparing procedure. The remaining seven patients had >50% tendon involvement, which required an FCR-sacrificing procedure. All surgical patients achieved satisfactory results in both functional and clinical outcomes.

Conclusions

This series demonstrates acceptable patient outcomes using the described FCR algorithm, using 50% FCR involvement as a benchmark.

Type of study/level of evidence

Level IV.

目的桡侧腕屈肌（FCR）肌腱炎是掌侧桡腕关节疼痛的一种罕见但重要的病因，是一种诊断和治疗上的挑战。我们提出了一系列患者与FCR肌腱炎成功管理的算法开发的资深作者。方法回顾性分析我院收治的FCR肌腱炎患者资料。FCR破裂的百分比，通过磁共振成像（MRI）和术中确认来确定具体的治疗方法。MRI显示50%破裂的患者采用保守治疗。如果不能缓解或MRI提示50%破裂，则需要手术。术中检查，50%破裂的患者行腱鞘切除术和斜骨赘切除术。50%破裂的患者接受fcr牺牲手术。获得患者报告的结果，包括疼痛的严重程度与日常生活活动和恢复到先前活动水平的能力。结果16例患者接受FCR肌腱炎治疗。5例接受保守治疗，5例中3例症状完全缓解，完全恢复活动，无后遗症。11例手术患者中有4例发现有50%的肌腱断裂，并进行了fcr保留手术。其余7例患者有50%的肌腱受累，需要牺牲fcr手术。所有手术患者在功能和临床结果方面均取得满意的结果。本系列研究表明，使用所描述的FCR算法，以50%的FCR受累为基准，患者的预后是可接受的。研究类型/证据水平四级。

{"title":"Flexor Carpi Radialis Tendinitis to Rupture: A Case Series and Algorithm","authors":"James D. Spratt MD , Ashley Mehl MD , Gary M. Lourie MD","doi":"10.1016/j.jhsg.2025.100859","DOIUrl":"10.1016/j.jhsg.2025.100859","url":null,"abstract":"<div><h3>Purpose</h3><div>Flexor carpi radialis (FCR) tendinitis is an uncommon but important cause of volar radial wrist pain that can be a diagnostic and therapeutic challenge. We present a series of patients with FCR tendinitis managed successfully with an algorithm developed by the senior author.</div></div><div><h3>Methods</h3><div>A retrospective review of patients treated for FCR tendinitis at a hand practice was performed. The percent of the FCR rupture, determined with magnetic resonance imaging (MRI) and intraoperative confirmation, determined specific treatment. Patients with <50% rupture on MRI were treated conservatively. Surgery was indicated if this failed to yield relief or MRI suggested >50% rupture. On intraoperative examination, patients with <50% rupture underwent tenosynovectomy and excision of trapezial osteophytes. Patients with >50% rupture underwent an FCR-sacrificing procedure. Patient-reported outcomes, including severity of pain with activities of daily living and ability to return to previous levels of activity, were obtained.</div></div><div><h3>Results</h3><div>Sixteen patients were treated for FCR tendinitis. Five were treated conservatively, with complete relief of symptoms and return to full activity without sequelae in three of five cases. Four of the 11 surgical patients were found to have <50% of tendon rupture and underwent an FCR-sparing procedure. The remaining seven patients had >50% tendon involvement, which required an FCR-sacrificing procedure. All surgical patients achieved satisfactory results in both functional and clinical outcomes.</div></div><div><h3>Conclusions</h3><div>This series demonstrates acceptable patient outcomes using the described FCR algorithm, using 50% FCR involvement as a benchmark.</div></div><div><h3>Type of study/level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100859"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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