Journal of Hand Surgery Global Online最新文献_第8页

Enhancing Healing with Noncontact Low-Frequency Ultrasound in Fingertip Amputation Treatment: A Comparative Pilot Study 非接触低频超声在指尖截肢治疗中促进愈合：一项比较试点研究

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jhsg.2025.100843

Robert W. Gomez MD , Abbigail Walsh ppOTD , Kevin G. Valdes MS , Kristofer S. Matullo MD

Purpose

Acute traumatic fingertip amputations are common injuries. This study aimed to evaluate the efficacy of noncontact low-frequency ultrasound (NCLF-US) as adjunctive therapy for treatment of fingertip amputations.

Methods

A retrospective analysis was conducted on adult patients with an acute traumatic fingertip amputation without exposed bone between February 2022 and April 2023. Exclusions included vascular disease, active infection, surgical intervention, primary closure, or subsequent trauma. Patients received either NCLF-US therapy combined with local wound care or local wound care alone (LWCA). Data collected included age, sex assigned at birth, history of diabetes, and injury dimensions. Data were used to assess cohort demographics, injury characteristics, and clinical course. Nominal and continuous variables were analyzed using Fisher exact test and Student t test, respectively, with statistical significance set at P ≤ .05.

Results

Among 19 digits, nine were treated with NCLF-US, and ten received LWCA. There was no considerable difference between cohorts in terms of age, sex, or history of diabetes. The NCLF-US cohort presented with an average wound size of 434.7 mm² compared to the LWCA cohort at 123.0 mm². Total time to healing in the NCLF-US cohort was 34.4 days compared to 49.2 days in the LWCA cohort. Healing rates for NCLF-US were 0.112 days/mm² compared to LWCA at 1.038 days/mm².

Conclusions

The NCLF-US cohort exhibited larger initial fingertip amputations, while demonstrating a time to healing nine times faster than those treated solely with local wound care. These findings are encouraging and offer initial support for the consideration of NCLF-US as an adjunctive therapy for treatment of fingertip amputations.

Type of study/level of evidence

Therapeutic IV.

目的急性外伤性指尖截肢是常见的外伤。本研究旨在评价非接触式低频超声（NCLF-US）作为辅助治疗指尖截肢的疗效。方法回顾性分析2022年2月至2023年4月收治的成人急性外伤性指端无露骨截肢患者的临床资料。排除的病例包括血管疾病、活动性感染、手术干预、初次闭合或随后的创伤。患者接受NCLF-US治疗联合局部伤口护理或单独局部伤口护理（LWCA）。收集的数据包括年龄、出生性别、糖尿病史和损伤程度。数据用于评估队列人口统计、损伤特征和临床病程。名义变量和连续变量分别采用Fisher精确检验和Student t检验进行分析，P≤0.05为统计学显著性。结果19只手指中9只接受了NCLF-US治疗，10只接受了LWCA治疗。在年龄、性别或糖尿病史方面，各组之间没有显著差异。NCLF-US组的平均伤口大小为434.7 mm2，而LWCA组的平均伤口大小为123.0 mm2。NCLF-US组的总愈合时间为34.4天，而LWCA组的总愈合时间为49.2天。NCLF-US的愈合率为0.112天/mm2，而LWCA的愈合率为1.038天/mm2。结论：NCLF-US队列显示更大的初始指尖截肢，同时显示愈合时间比单纯局部伤口护理快9倍。这些发现令人鼓舞，并为考虑将NCLF-US作为指尖截肢治疗的辅助疗法提供了初步支持。研究类型/证据水平治疗性IV。

{"title":"Enhancing Healing with Noncontact Low-Frequency Ultrasound in Fingertip Amputation Treatment: A Comparative Pilot Study","authors":"Robert W. Gomez MD , Abbigail Walsh ppOTD , Kevin G. Valdes MS , Kristofer S. Matullo MD","doi":"10.1016/j.jhsg.2025.100843","DOIUrl":"10.1016/j.jhsg.2025.100843","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute traumatic fingertip amputations are common injuries. This study aimed to evaluate the efficacy of noncontact low-frequency ultrasound (NCLF-US) as adjunctive therapy for treatment of fingertip amputations.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on adult patients with an acute traumatic fingertip amputation without exposed bone between February 2022 and April 2023. Exclusions included vascular disease, active infection, surgical intervention, primary closure, or subsequent trauma. Patients received either NCLF-US therapy combined with local wound care or local wound care alone (LWCA). Data collected included age, sex assigned at birth, history of diabetes, and injury dimensions. Data were used to assess cohort demographics, injury characteristics, and clinical course. Nominal and continuous variables were analyzed using Fisher exact test and Student <em>t</em> test, respectively, with statistical significance set at <em>P</em> ≤ .05.</div></div><div><h3>Results</h3><div>Among 19 digits, nine were treated with NCLF-US, and ten received LWCA. There was no considerable difference between cohorts in terms of age, sex, or history of diabetes. The NCLF-US cohort presented with an average wound size of 434.7 mm<sup>2</sup> compared to the LWCA cohort at 123.0 mm<sup>2</sup>. Total time to healing in the NCLF-US cohort was 34.4 days compared to 49.2 days in the LWCA cohort. Healing rates for NCLF-US were 0.112 days/mm<sup>2</sup> compared to LWCA at 1.038 days/mm<sup>2</sup>.</div></div><div><h3>Conclusions</h3><div>The NCLF-US cohort exhibited larger initial fingertip amputations, while demonstrating a time to healing nine times faster than those treated solely with local wound care. These findings are encouraging and offer initial support for the consideration of NCLF-US as an adjunctive therapy for treatment of fingertip amputations.</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":"8 1","pages":"Article 100843"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420300","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

Wrist and Hand Melorheostosis: Case Report With Surgical Consideration 腕部和手部骨质疏松症：一例手术考虑

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-06-18 DOI: 10.1016/j.jhsg.2024.11.005

Hussain Algawahmed MD, FRCSC , Abdulaziz Fahad Altammami MD

Melorheostosis is a rare, sporadic, benign bone disorder with an unclear cause. We present a case report of a 34-year-old man with chronic deformity secondary to melorheostosis. He complained of deformity and limited range of motion affecting his functionality. Surgical debulking of the sclerotic lesion was performed. The clinical outcome was satisfactory with no signs of recurrence at 9-months follow-up.

黑骨化症是一种罕见的、散发的、良性的骨骼疾病，病因不明。我们提出一个病例报告，34岁的男子慢性畸形继发于骨质疏松症。他抱怨畸形和活动范围有限影响了他的功能。对硬化病变进行手术切除。临床结果令人满意，随访9个月无复发迹象。

引用次数: 0

Carpal Tunnel Release: A Four-Specialty Comparison Demonstrating Equal Clinical and Economic Efficacy 腕管松解术：四专科对比显示同等的临床和经济效果

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-10-31 DOI: 10.1016/j.jhsg.2025.100863

Andy M. Liu BS , Vikranth Mirle MD , Cody Lee MD , Jennifer Moriatis Wolf MD, PhD , Jason Strelzow MD

Purpose

Carpal tunnel release (CTR), the most common hand surgery procedure in the United States, is routinely performed by orthopedic surgeons, neurosurgeons, plastic surgeons, and general surgeons. There is limited literature comparing clinical costs and research utilization among specialties. This study sought to determine treatment utilization, variations in cases, and cost trends among orthopedic, plastic, general, and neurosurgeons.

Methods

A national insurance database was queried for patients who underwent open or endoscopic CTR between the years 2007 and 2022. Four cohorts based on provider specialty, orthopedic, plastic, general, and neurosurgery, were matched using the following factors: age, sex, diabetes, obesity, tobacco use, location of procedure, and Elixhauser Comorbidity Index. Average cost by specialty was then calculated and compared. Rates of therapy within 3 months after surgery and EMG and nerve conduction velocity studies within 3 months before the procedure were also compared.

Results

The matched cohorts consisted of 13,107 patients each. Plastic surgeons and neurosurgeons had the highest average cost ($2,923.29 and $2,922.58), followed by orthopedic surgeons ($2,765.95), with general surgeons having the lowest cost ($2,607.02). Rates of preoperative EMG and nerve conduction studies were highest with neurosurgeons (28.5%), followed by orthopedics and plastics (22.6% and 23.4%, respectively), with general surgeons ordering the fewest (19.7%). For complications, general surgeons and neurosurgeons had a small but statistically higher infection rate (0.8%, 0.7% respectively) compared with orthopedic and plastic surgeons (0.5%, 0.5%).

Conclusions

The current study demonstrates that overall orthopedic, plastic, neurosurgery, and general surgeons perform CTRs with similar overall costs and with similar postoperative complications.

Type of study/level of evidence

Economic/decision analysis III.

腕管松解术（CTR）是美国最常见的手部手术，骨科医生、神经外科医生、整形外科医生和普通外科医生都经常进行。比较各专科的临床费用和研究利用的文献有限。本研究旨在确定骨科、整形外科、普通外科和神经外科的治疗利用率、病例变化和费用趋势。方法在国家保险数据库中查询2007年至2022年间接受开放式或内窥镜CTR的患者。四个基于提供者专业的队列，骨科、整形、普通和神经外科，使用以下因素进行匹配：年龄、性别、糖尿病、肥胖、吸烟、手术地点和Elixhauser合并症指数。然后计算和比较各专业的平均成本。手术后3个月内的治疗率和手术前3个月内的肌电图和神经传导速度研究也进行了比较。结果匹配队列包括13107例患者。整形外科医生和神经外科医生的平均费用最高（分别为2923.29美元和2922.58美元），其次是整形外科医生（2765.95美元），普通外科医生的费用最低（2607.02美元）。神经外科医生的术前肌电图和神经传导检查率最高（28.5%），其次是骨科和整形外科（分别为22.6%和23.4%），普通外科医生的订货量最少（19.7%）。在并发症方面，普通外科医生和神经外科医生的感染率（分别为0.8%和0.7%）略高于骨科和整形外科医生（分别为0.5%和0.5%）。目前的研究表明，骨科、整形外科、神经外科和普通外科医生进行的CTRs的总成本和术后并发症相似。研究类型/证据水平经济/决策分析

{"title":"Carpal Tunnel Release: A Four-Specialty Comparison Demonstrating Equal Clinical and Economic Efficacy","authors":"Andy M. Liu BS , Vikranth Mirle MD , Cody Lee MD , Jennifer Moriatis Wolf MD, PhD , Jason Strelzow MD","doi":"10.1016/j.jhsg.2025.100863","DOIUrl":"10.1016/j.jhsg.2025.100863","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel release (CTR), the most common hand surgery procedure in the United States, is routinely performed by orthopedic surgeons, neurosurgeons, plastic surgeons, and general surgeons. There is limited literature comparing clinical costs and research utilization among specialties. This study sought to determine treatment utilization, variations in cases, and cost trends among orthopedic, plastic, general, and neurosurgeons.</div></div><div><h3>Methods</h3><div>A national insurance database was queried for patients who underwent open or endoscopic CTR between the years 2007 and 2022. Four cohorts based on provider specialty, orthopedic, plastic, general, and neurosurgery, were matched using the following factors: age, sex, diabetes, obesity, tobacco use, location of procedure, and Elixhauser Comorbidity Index. Average cost by specialty was then calculated and compared. Rates of therapy within 3 months after surgery and EMG and nerve conduction velocity studies within 3 months before the procedure were also compared.</div></div><div><h3>Results</h3><div>The matched cohorts consisted of 13,107 patients each. Plastic surgeons and neurosurgeons had the highest average cost ($2,923.29 and $2,922.58), followed by orthopedic surgeons ($2,765.95), with general surgeons having the lowest cost ($2,607.02). Rates of preoperative EMG and nerve conduction studies were highest with neurosurgeons (28.5%), followed by orthopedics and plastics (22.6% and 23.4%, respectively), with general surgeons ordering the fewest (19.7%). For complications, general surgeons and neurosurgeons had a small but statistically higher infection rate (0.8%, 0.7% respectively) compared with orthopedic and plastic surgeons (0.5%, 0.5%).</div></div><div><h3>Conclusions</h3><div>The current study demonstrates that overall orthopedic, plastic, neurosurgery, and general surgeons perform CTRs with similar overall costs and with similar postoperative complications.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic/decision analysis III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100863"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420299","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

Influence of Sociodemographic Factors on Patient Completion of Patient-Reported Outcome Measures in Hand Surgery Patients 社会人口学因素对手外科患者完成患者报告结果测量的影响

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jhsg.2025.100872

Ezra Goodrich MD , Tobin Smith BA , Mithil Gudi BS , Nebiyat M. Girma MPH , Carl Wilson MS , Charles S. Day MD, MBA

Purpose

Patient-reported outcome measures (PROMs) are standardized surveys that assess health outcomes, symptoms, functional status, and quality of life. Although prior studies have evaluated completion and/or participation across orthopedic subspecialties, no current studies have examined both completion and participation outcomes specifically in hand surgery. This study investigates the association between sociodemographic factors and PROM completion and participation in hand surgery patients.

Methods

A retrospective review was conducted of patients who underwent carpal tunnel release, trigger finger release, or both by an orthopedic hand surgeon at an academic center between 2020 and 2024. Demographic variables, area deprivation index, and PROM participation and completion were recorded. Participation was defined as completing at least one pre- and one postoperative survey, and completion was defined as completing all pre- and postoperative surveys. Univariable and multivariable logistic regression were used to identify factors associated with PROM completion and participation.

Results

In total, 406 patients were included for review. Black patients had lower rates of survey completion, and both Asian and Black patients demonstrated reduced participation of PROM surveys. Furthermore, patients from minority backgrounds and patients residing in areas with greater sociodemographic disadvantage were less likely to complete and participate in PROM surveys. Additionally, increasing age was also associated with decreased likelihood of both survey completion and participation.

Conclusions

This study found PROM completion and participation rates to be lower among hand surgery patients of Black race, racial/ethnic minorities, higher area deprivation index score, and older age. However, only participation rates were lower for Asian race and those with active smoking status. These findings support similar studies in other orthopedic subspecialties and support the need for equitable PROMs collection to better represent patients across all sociodemographic backgrounds.

Type of study/level of evidence

Prognostic III.

目的：患者报告结果测量（PROMs）是评估健康结果、症状、功能状态和生活质量的标准化调查。虽然先前的研究已经评估了骨科亚专科的完成度和/或参与程度，但目前还没有研究专门调查手部手术的完成度和参与程度。本研究旨在探讨社会人口学因素与手部手术患者胎膜早破及参与的关系。方法回顾性分析某学术中心骨科手外科医师于2020 - 2024年间行腕管松解术、扳机指松解术或两者兼有的患者。记录人口统计变量、面积剥夺指数、PROM参与和完成情况。参与定义为完成至少一项术前和术后调查，完成定义为完成所有术前和术后调查。使用单变量和多变量逻辑回归来确定与PROM完成和参与相关的因素。结果共纳入406例患者。黑人患者的调查完成率较低，亚洲人和黑人患者都表现出较少参与PROM调查。此外，来自少数民族背景的患者和居住在社会人口劣势较大地区的患者完成和参与PROM调查的可能性较小。此外，年龄的增长也与调查完成和参与的可能性降低有关。结论本研究发现黑人、少数民族、区域剥夺指数评分较高、年龄较大的手外科患者的PROM完成率和参与率较低。然而，只有亚洲人种和积极吸烟的人的参与率较低。这些发现支持了其他骨科亚专科的类似研究，并支持公平收集prom以更好地代表所有社会人口背景的患者的必要性。研究类型/证据水平预后

{"title":"Influence of Sociodemographic Factors on Patient Completion of Patient-Reported Outcome Measures in Hand Surgery Patients","authors":"Ezra Goodrich MD , Tobin Smith BA , Mithil Gudi BS , Nebiyat M. Girma MPH , Carl Wilson MS , Charles S. Day MD, MBA","doi":"10.1016/j.jhsg.2025.100872","DOIUrl":"10.1016/j.jhsg.2025.100872","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-reported outcome measures (PROMs) are standardized surveys that assess health outcomes, symptoms, functional status, and quality of life. Although prior studies have evaluated completion and/or participation across orthopedic subspecialties, no current studies have examined both completion and participation outcomes specifically in hand surgery. This study investigates the association between sociodemographic factors and PROM completion and participation in hand surgery patients.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of patients who underwent carpal tunnel release, trigger finger release, or both by an orthopedic hand surgeon at an academic center between 2020 and 2024. Demographic variables, area deprivation index, and PROM participation and completion were recorded. Participation was defined as completing at least one pre- and one postoperative survey, and completion was defined as completing all pre- and postoperative surveys. Univariable and multivariable logistic regression were used to identify factors associated with PROM completion and participation.</div></div><div><h3>Results</h3><div>In total, 406 patients were included for review. Black patients had lower rates of survey completion, and both Asian and Black patients demonstrated reduced participation of PROM surveys. Furthermore, patients from minority backgrounds and patients residing in areas with greater sociodemographic disadvantage were less likely to complete and participate in PROM surveys. Additionally, increasing age was also associated with decreased likelihood of both survey completion and participation.</div></div><div><h3>Conclusions</h3><div>This study found PROM completion and participation rates to be lower among hand surgery patients of Black race, racial/ethnic minorities, higher area deprivation index score, and older age. However, only participation rates were lower for Asian race and those with active smoking status. These findings support similar studies in other orthopedic subspecialties and support the need for equitable PROMs collection to better represent patients across all sociodemographic backgrounds.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100872"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420385","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

Anatomic Structures at Risk With Antegrade Intramedullary Fixation of the First Metacarpal Using Three Start Points: Is There A Safe Zone? 使用三个起始点顺行髓内固定第一掌骨会危及解剖结构：是否存在安全区域？

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-11-08 DOI: 10.1016/j.jhsg.2025.100850

Mason H. Adams DO , Thomas B. Lynch MD , Daniel D. Homeier MD , David J. Wilson MD , Jantz J. Arbon MD , Taylor J. Bates MD

Purpose

Intramedullary fixation of extraarticular first metacarpal fractures using a percutaneous technique may risk injury to important anatomic structures. The purpose of this study is to evaluate potential safe zones for antegrade implant entry of the first metacarpal and describe the anatomical structures at risk.

Methods

Ten cadaveric hands were used to evaluate three start points located at the first metacarpal base: volar-radial, dorsal-radial, and dorsal-ulnar. A fluoroscopic imaging system was used to guide percutaneous placement of 0.8 mm × 100 mm guidewires and 2.0 mm diameter screws. After screw placement the guidewires were left in place and soft tissues were dissected to identify at risk anatomic structures.

Results

The identified structures at risk were the radial artery, superficial branch of the radial nerve (SBRN), extensor pollicis longus (EPL) tendon, abductor pollicis longus (APL) tendon, and extensor pollicis brevis (EPB) tendon. A volar-radial start point risks injury to the APL tendon (8.3 ± 5.4 mm). A dorsal-radial start point risks injury to the SBRN (2.2 ± 3.4 mm), APL (1.4 ± 1.8 mm), and EPB (1.2 ± 2.1 mm) tendons. A dorsal-ulnar start point risks injury to the SBRN (5 ± 4.2 mm), radial artery (3.5 ± 3.1 mm), and EPL tendon (3.5 ± 2.4 mm).

Conclusions

Dorsal-radial and dorsal-ulnar start points risk injuring critical anatomic structures: radial artery, SBRN, EPL, APL, and EPB. A volar-radial start point may risk injury to the APL tendon but presents the lowest risk of injury to neurovascular structures.

Clinical relevance

This study identifies key anatomic structures at risk associated with three common percutaneous entry points. The volar-radial start point demonstrated the lowest risk to neurovascular structures and may represent a safe approach for percutaneous intramedullary fixation.

目的经皮髓内固定第一掌骨关节外骨折有损伤重要解剖结构的危险。本研究的目的是评估第一掌骨顺行植入的潜在安全区域，并描述存在风险的解剖结构。方法用10只尸体手评价位于第一掌骨基部的三个起始点：掌桡、桡背、尺背。使用透视成像系统引导经皮放置0.8 mm × 100 mm导丝和2.0 mm直径的螺钉。螺钉置入后，将导丝留在原位，解剖软组织以确定有危险的解剖结构。结果确定的危险结构为桡动脉、桡神经浅支（SBRN）、拇长伸肌腱（EPL）、拇长外展肌腱（APL）和拇短伸肌腱（EPB）。掌桡起始点有损伤APL肌腱的风险（8.3±5.4 mm）。背桡起始点有损伤SBRN（2.2±3.4 mm）、APL（1.4±1.8 mm）和EPB（1.2±2.1 mm）肌腱的风险。背尺起始点有损伤SBRN（5±4.2 mm）、桡动脉（3.5±3.1 mm）和EPL肌腱（3.5±2.4 mm）的风险。结论背桡和背尺起始点有损伤关键解剖结构的风险：桡动脉、SBRN、EPL、APL和EPB。掌桡起始点可能有损伤APL肌腱的风险，但对神经血管结构的损伤风险最低。临床相关性本研究确定了与三个常见经皮穿刺点相关的关键解剖结构的危险。掌侧桡侧起始点对神经血管结构的风险最低，可能是经皮髓内固定的安全方法。

{"title":"Anatomic Structures at Risk With Antegrade Intramedullary Fixation of the First Metacarpal Using Three Start Points: Is There A Safe Zone?","authors":"Mason H. Adams DO , Thomas B. Lynch MD , Daniel D. Homeier MD , David J. Wilson MD , Jantz J. Arbon MD , Taylor J. Bates MD","doi":"10.1016/j.jhsg.2025.100850","DOIUrl":"10.1016/j.jhsg.2025.100850","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary fixation of extraarticular first metacarpal fractures using a percutaneous technique may risk injury to important anatomic structures. The purpose of this study is to evaluate potential safe zones for antegrade implant entry of the first metacarpal and describe the anatomical structures at risk.</div></div><div><h3>Methods</h3><div>Ten cadaveric hands were used to evaluate three start points located at the first metacarpal base: volar-radial, dorsal-radial, and dorsal-ulnar. A fluoroscopic imaging system was used to guide percutaneous placement of 0.8 mm × 100 mm guidewires and 2.0 mm diameter screws. After screw placement the guidewires were left in place and soft tissues were dissected to identify at risk anatomic structures.</div></div><div><h3>Results</h3><div>The identified structures at risk were the radial artery, superficial branch of the radial nerve (SBRN), extensor pollicis longus (EPL) tendon, abductor pollicis longus (APL) tendon, and extensor pollicis brevis (EPB) tendon. A volar-radial start point risks injury to the APL tendon (8.3 ± 5.4 mm). A dorsal-radial start point risks injury to the SBRN (2.2 ± 3.4 mm), APL (1.4 ± 1.8 mm), and EPB (1.2 ± 2.1 mm) tendons. A dorsal-ulnar start point risks injury to the SBRN (5 ± 4.2 mm), radial artery (3.5 ± 3.1 mm), and EPL tendon (3.5 ± 2.4 mm).</div></div><div><h3>Conclusions</h3><div>Dorsal-radial and dorsal-ulnar start points risk injuring critical anatomic structures: radial artery, SBRN, EPL, APL, and EPB. A volar-radial start point may risk injury to the APL tendon but presents the lowest risk of injury to neurovascular structures.</div></div><div><h3>Clinical relevance</h3><div>This study identifies key anatomic structures at risk associated with three common percutaneous entry points. The volar-radial start point demonstrated the lowest risk to neurovascular structures and may represent a safe approach for percutaneous intramedullary fixation.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100850"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526465","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

Temporary Dorsal Staple Fixation of Scapholunate Interosseous Ligament Repair and Reconstruction 舟月骨间韧带修复与重建的临时背侧钉固定

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 10.1016/j.jhsg.2025.100891

Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD

There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.

舟月骨间韧带损伤有多种治疗方法，包括修复和重建。这些技术的共同点是通过临时放置克氏针（k -丝）在舟月骨和有时舟头骨关节上提供固定来保护修复或重建。使用k -针有多种潜在的缺点，包括可能干扰修复或重建，通过k -针时舟月骨关节分散，偶尔需要多次通过以正确放置，导致骨内应力上升，以及意外的k -针并发症，包括断裂、移位和感染。我们描述了在舟月骨关节处使用背侧部分插入镍钛诺钉作为一种改进的技术，用于暂时固定关节。使用短钉可以压缩舟月骨间隙，在插入时直接可见，并且能够避免干扰舟月骨间韧带的修复或重建。除了描述我们的手术技术外，我们还提供了我们在患者中使用该技术的经验总结和案例说明。

{"title":"Temporary Dorsal Staple Fixation of Scapholunate Interosseous Ligament Repair and Reconstruction","authors":"Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD","doi":"10.1016/j.jhsg.2025.100891","DOIUrl":"10.1016/j.jhsg.2025.100891","url":null,"abstract":"<div><div>There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100891"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690823","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

Association Between Insurance Status and Recommendation for Surgery for Distal Radius Fractures 保险状况与桡骨远端骨折手术建议的关系

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.jhsg.2025.100890

Emma T. Smolev MD , Rafa Rahman MD, MPH , Amy Z. Lu BS , Jarred Chow BS , Rosie McColgan MD , Jeremy Abolade MD , Sanjum Singh MD , Isabel Wolfe MD , Troy B. Amen MD, MBA , Duretti T. Fufa MD

Purpose

Disparities continue to impact patient care within orthopedics. Distal radius fractures (DRFs) are extremely common, with variability in surgical indications allowing for potential treatment disparities. The study sought to determine whether (1) insurance status and (2) geographic socioeconomic disadvantage is associated with surgeon treatment recommendation for dorsally angulated DRF.

Methods

This retrospective cohort study used institutional data from 2016 to 2021 to assess associations between patient demographics and socioeconomic variables of interest, including geographic socioeconomic disadvantage (Area Deprivation Index), insurance status, and likelihood of operative recommendation. Multivariable logistic regression adjusted for potential confounders including fracture severity based on degree of dorsal angulation (mild, ≥0° and ≤10°; moderate, >10° and <20°; severe ≥20°), radial inclination, ulnar variance, presence of an ulnar styloid fracture, sex, age, and Elixhauser Comorbidity score (α = 0.05).

Results

In total, 891 patients were included, with a mean age of 55 years (range 18–62), 78% women (n = 699), and 79.4% White non-Hispanic (n = 707), 2.9% Black non-Hispanic (n = 26), 6.9% Hispanic (n = 61), and 10.9% Other (n = 97). In total, 31% (n=280) of all patients presented with mild DRF, 29% (n = 258) moderate, and 40% (n = 353) severe. Overall, 77% (n = 688) of patients were recommended surgery, and 74% (n = 660) underwent operative management. Public health insurance was associated with lower likelihood of recommendation for surgery. There was no significant difference in treatment recommendation based on Area Deprivation Index.

Conclusions

Public health insurance was found to be significantly associated with lower likelihood of recommendation for DRF surgery, even after controlling for fracture severity and individual-level confounding variables. This suggests variability in DRF management based on individual patient factors.

Type of study/level of evidence

Prognostic III

目的：差异继续影响骨科患者护理。桡骨远端骨折（DRFs）非常常见，手术指征的差异允许潜在的治疗差异。该研究试图确定(1)保险状况和(2)地理社会经济劣势是否与外科医生对背侧成角DRF的治疗建议有关。方法本回顾性队列研究使用2016年至2021年的机构数据来评估患者人口统计学与感兴趣的社会经济变量之间的关系，包括地理社会经济劣势（区域剥夺指数）、保险状况和推荐手术的可能性。多变量logistic回归校正了潜在的混杂因素，包括骨折严重程度，基于背角程度（轻度，≥0°和≤10°；中度，>；10°和<；20°；严重≥20°）、桡骨倾角、尺侧变异、尺茎样骨骨折、性别、年龄和Elixhauser合并症评分（α = 0.05）。结果共纳入891例患者，平均年龄55岁（18-62岁），78%为女性（n = 699）， 79.4%为非西班牙裔白人（n = 707）， 2.9%为非西班牙裔黑人（n = 26）， 6.9%为西班牙裔（n = 61）， 10.9%为其他（n = 97）。总的来说，31% （n=280）的患者表现为轻度DRF， 29% （n= 258）为中度DRF， 40% （n= 353）为重度DRF。总体而言，77% （n = 688）的患者推荐手术治疗，74% （n = 660）的患者接受手术治疗。公共健康保险与推荐手术的可能性较低相关。基于面积剥夺指数的治疗推荐无显著性差异。结论公共健康保险与推荐DRF手术的可能性降低显著相关，即使在控制骨折严重程度和个体水平混杂变量后也是如此。这表明DRF的管理因患者个体因素而异。研究类型/证据水平预后

{"title":"Association Between Insurance Status and Recommendation for Surgery for Distal Radius Fractures","authors":"Emma T. Smolev MD , Rafa Rahman MD, MPH , Amy Z. Lu BS , Jarred Chow BS , Rosie McColgan MD , Jeremy Abolade MD , Sanjum Singh MD , Isabel Wolfe MD , Troy B. Amen MD, MBA , Duretti T. Fufa MD","doi":"10.1016/j.jhsg.2025.100890","DOIUrl":"10.1016/j.jhsg.2025.100890","url":null,"abstract":"<div><h3>Purpose</h3><div>Disparities continue to impact patient care within orthopedics. Distal radius fractures (DRFs) are extremely common, with variability in surgical indications allowing for potential treatment disparities. The study sought to determine whether (1) insurance status and (2) geographic socioeconomic disadvantage is associated with surgeon treatment recommendation for dorsally angulated DRF.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used institutional data from 2016 to 2021 to assess associations between patient demographics and socioeconomic variables of interest, including geographic socioeconomic disadvantage (Area Deprivation Index), insurance status, and likelihood of operative recommendation. Multivariable logistic regression adjusted for potential confounders including fracture severity based on degree of dorsal angulation (mild, ≥0° and ≤10°; moderate, >10° and <20°; severe ≥20°), radial inclination, ulnar variance, presence of an ulnar styloid fracture, sex, age, and Elixhauser Comorbidity score (α = 0.05).</div></div><div><h3>Results</h3><div>In total, 891 patients were included, with a mean age of 55 years (range 18–62), 78% women (n = 699), and 79.4% White non-Hispanic (n = 707), 2.9% Black non-Hispanic (n = 26), 6.9% Hispanic (n = 61), and 10.9% Other (n = 97). In total, 31% (n=280) of all patients presented with mild DRF, 29% (n = 258) moderate, and 40% (n = 353) severe. Overall, 77% (n = 688) of patients were recommended surgery, and 74% (n = 660) underwent operative management. Public health insurance was associated with lower likelihood of recommendation for surgery. There was no significant difference in treatment recommendation based on Area Deprivation Index.</div></div><div><h3>Conclusions</h3><div>Public health insurance was found to be significantly associated with lower likelihood of recommendation for DRF surgery, even after controlling for fracture severity and individual-level confounding variables. This suggests variability in DRF management based on individual patient factors.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100890"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576949","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

Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly 老年人桡骨远端骨折伴桡骨远端关节脱位的发生频率和预后

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.jhsg.2025.100882

Manami Ishimatsu MD , Takashi Oda MD, PhD , Yuka Yamanaka MSc , Katsunori Takahashi MD, PhD , Shuto Hamada MD, PhD , Takuro Wada MD, PhD

Purpose

Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.

Methods

We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.

Results

A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.

Conclusions

The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.

Type of study/level of evidence

Therapeutic IV.

目的：尽管远端尺桡关节脱位或半脱位很少与桡骨远端骨折共存，但老年人三角形纤维软骨复合体（TFCC）的补充修复必要性仍存在争议。我们研究了老年患者桡骨远端骨折合并DRUJ脱位的TFCC再附着的频率和手术效果。方法回顾性分析65岁及以上接受桡骨远端骨折内固定治疗的患者。评估损伤时DRUJ的骨折类型和脱位或半脱位。6个月后从医疗记录中检索疼痛、活动范围、握力、改良梅奥手腕评分和手臂、肩部和手部残疾（DASH）评分。所有病例被分为三组，以比较脱位、半脱位和非脱位的临床结果。结果共纳入173例腕关节，其中年龄77.8岁，男性12例，女性159例。2例（1.2%）和3例（1.7%）腕关节分别出现DRUJ脱位和半脱位，5例腕关节均出现Arbeitsgemeinschaft f型骨合成骨折（AO） A3型桡骨远端骨折。这两例脱位均表现为桡骨内固定后尺头掌侧脱位复发，涉及使用骨锚修复TFCC。腕部伸展和握力较差；然而，脱位组的疼痛和DASH评分优于半脱位组和非脱位组。结论老年患者桡骨骨折合并DRUJ脱位/半脱位的发生率较低。如果桡骨内固定后DRUJ仍然不稳定，一期TFCC再附着可以预期良好的结果，即使在老年患者中也是如此。研究类型/证据水平治疗性IV。

{"title":"Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly","authors":"Manami Ishimatsu MD , Takashi Oda MD, PhD , Yuka Yamanaka MSc , Katsunori Takahashi MD, PhD , Shuto Hamada MD, PhD , Takuro Wada MD, PhD","doi":"10.1016/j.jhsg.2025.100882","DOIUrl":"10.1016/j.jhsg.2025.100882","url":null,"abstract":"<div><h3>Purpose</h3><div>Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.</div></div><div><h3>Results</h3><div>A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.</div></div><div><h3>Conclusions</h3><div>The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.</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":"8 1","pages":"Article 100882"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576883","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

A Comparison of Artificial Intelligence Platforms in the Utility of Answering Frequently Asked Questions About Carpal Tunnel Syndrome: A Cross-Sectional Study 人工智能平台在回答腕管综合征常见问题中的效用比较：一项横断面研究

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.jhsg.2025.100831

Calista Stevens BA , Mehreen Pasha BS , Dashun Liu MS , Andrew Block MD , Anthony Parrino MD , Craig Rodner MD

Purpose

The rise of artificial intelligence (AI) in health care comes with increasing concerns about the use and integrity of the information it generates. Chat Generative Pre-Trained Transformer (ChatGPT) 3.5, Google Gemini, and Bing Copilot are free AI chatbot platforms that may be used for answering medical questions and disseminating medical information. Given that carpal tunnel syndrome accounts for 90% of all neuropathies, it is important to understand the accuracy of the information patients may be receiving. The purpose of this study is to determine the use and accuracy of responses generated by ChatGPT, Google Gemini, and Bing Copilot in answering frequently asked questions about carpal tunnel syndrome.

Methods

Two independent authors scored responses using the DISCERN tool. DISCERN consists of 15 questions assessing health information on a five-point scale, with total scores ranging from 15 to 75 points. Then, a two-factor analysis of variance was conducted, with scorer and chatbot type as the factors.

Results

One-way analysis of variance revealed no significant difference in DISCERN scores among the three chatbots. The chatbots each scored in the “fair” range, with means of 45 for ChatGPT, 48 for Bing Copilot, and 46 for Google Gemini. The average Journal of the American Medical Association score for ChatGPT and Google Gemini surpassed that of Bing Copilot, with averages of 2.3, 2.3, and 1.8, respectively.

Conclusions

ChatGPT, Google Gemini, and Bing Copilot platforms generated relatively reliable answers for potential patient questions about carpal tunnel syndrome. However, users should continue to be aware of the shortcomings of the information provided, given the lack of citations, potential for misconstrued information, and perpetuated biases that inherently come with using such platforms. Future studies should explore the response quality for less common orthopedic pathologies and assess patient perceptions of response readability to determine the value of AI as a patient resource across the medical field.

Type of study/level of evidence

Cross-sectional study V

随着人工智能（AI）在医疗保健领域的兴起，人们越来越关注其产生的信息的使用和完整性。ChatGPT 3.5、谷歌Gemini和Bing Copilot是免费的人工智能聊天机器人平台，可用于回答医疗问题和传播医疗信息。鉴于腕管综合征占所有神经病变的90%，了解患者可能接收到的信息的准确性是很重要的。本研究的目的是确定ChatGPT、谷歌Gemini和Bing Copilot在回答有关腕管综合征的常见问题时所产生的反应的使用和准确性。方法两位独立作者使用DISCERN工具对回答进行评分。辨别由15个问题组成，以五分制评估健康信息，总分从15到75分不等。然后，以得分者和聊天机器人类型为影响因素，进行双因素方差分析。结果单因素方差分析显示，三种聊天机器人在DISCERN得分上无显著差异。每个聊天机器人的得分都在“公平”范围内，ChatGPT得分为45分，Bing副驾驶得分为48分，b谷歌双子座得分为46分。ChatGPT和谷歌Gemini在《美国医学协会杂志》（Journal of American Medical Association）上的平均得分分别为2.3、2.3和1.8，超过了Bing Copilot。结论schatgpt、谷歌Gemini和Bing Copilot平台为潜在患者关于腕管综合征的问题提供了相对可靠的答案。然而，用户应该继续意识到所提供信息的缺点，因为缺乏引用，信息可能被误解，以及使用此类平台固有的长期偏见。未来的研究应该探索不太常见的骨科病理的反应质量，并评估患者对反应可读性的看法，以确定人工智能作为整个医疗领域患者资源的价值。研究类型/证据水平横断面研究

{"title":"A Comparison of Artificial Intelligence Platforms in the Utility of Answering Frequently Asked Questions About Carpal Tunnel Syndrome: A Cross-Sectional Study","authors":"Calista Stevens BA , Mehreen Pasha BS , Dashun Liu MS , Andrew Block MD , Anthony Parrino MD , Craig Rodner MD","doi":"10.1016/j.jhsg.2025.100831","DOIUrl":"10.1016/j.jhsg.2025.100831","url":null,"abstract":"<div><h3>Purpose</h3><div>The rise of artificial intelligence (AI) in health care comes with increasing concerns about the use and integrity of the information it generates. Chat Generative Pre-Trained Transformer (ChatGPT) 3.5, Google Gemini, and Bing Copilot are free AI chatbot platforms that may be used for answering medical questions and disseminating medical information. Given that carpal tunnel syndrome accounts for 90% of all neuropathies, it is important to understand the accuracy of the information patients may be receiving. The purpose of this study is to determine the use and accuracy of responses generated by ChatGPT, Google Gemini, and Bing Copilot in answering frequently asked questions about carpal tunnel syndrome.</div></div><div><h3>Methods</h3><div>Two independent authors scored responses using the DISCERN tool. DISCERN consists of 15 questions assessing health information on a five-point scale, with total scores ranging from 15 to 75 points. Then, a two-factor analysis of variance was conducted, with scorer and chatbot type as the factors.</div></div><div><h3>Results</h3><div>One-way analysis of variance revealed no significant difference in DISCERN scores among the three chatbots. The chatbots each scored in the “fair” range, with means of 45 for ChatGPT, 48 for Bing Copilot, and 46 for Google Gemini. The average Journal of the American Medical Association score for ChatGPT and Google Gemini surpassed that of Bing Copilot, with averages of 2.3, 2.3, and 1.8, respectively.</div></div><div><h3>Conclusions</h3><div>ChatGPT, Google Gemini, and Bing Copilot platforms generated relatively reliable answers for potential patient questions about carpal tunnel syndrome. However, users should continue to be aware of the shortcomings of the information provided, given the lack of citations, potential for misconstrued information, and perpetuated biases that inherently come with using such platforms. Future studies should explore the response quality for less common orthopedic pathologies and assess patient perceptions of response readability to determine the value of AI as a patient resource across the medical field.</div></div><div><h3>Type of study/level of evidence</h3><div>Cross-sectional study V</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100831"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095981","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

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 : 2025-11-01 Epub 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。

{"title":"Underutilization of Hand Corticosteroid Injections and Arthroplasty for Minority Demographics","authors":"Christopher M. Dussik MD , Amy Phan MD , Akhil Dondapati MD , Jeffrey Coombs MD , Danielle Wilbur MD , Ronald Gonzalez DO , Constantinos Ketonis MD, PhD","doi":"10.1016/j.jhsg.2025.100837","DOIUrl":"10.1016/j.jhsg.2025.100837","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IIC.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100837"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265304","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