Journal of Hand Surgery Global Online最新文献_第9页

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

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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。

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引用次数: 0

Digital Doses: Virtual Reality Use for Perioperative Pain and Anxiety in Patients Undergoing Hand Surgery 数字剂量：虚拟现实用于手部手术患者围手术期疼痛和焦虑

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-09-23 DOI: 10.1016/j.jhsg.2025.100830

Angel X. Xiao MD, MSE , Brian Chen BS , Christopher Chiong BA , Nicholas H. Lee , Igor Immerman MD , Sakura Kinjo MD

Purpose

Virtual reality (VR) is increasingly recognized as a complementary tool to address pain and anxiety. We conducted a randomized controlled trial to evaluate the effectiveness of VR for the management of pain and anxiety in patients undergoing minor hand surgery.

Methods

Patients undergoing outpatient hand surgery were randomized to VR or control groups. In addition to the standard anesthetic protocol, the VR group received a VR experience as part of their preoperative care. Patient anxiety and pain scores were collected using the Numerical Visual Analog Anxiety Scale and Numerical Rating Scale, respectively. In addition, we recorded changes in patient hemodynamics and any additional medication doses required to manage pain or anxiety.

Results

Forty-one patients (21 VR and 20 control) were enrolled. There were no differences in reported pain or anxiety scores before, during, or after surgery. There was no difference in vital signs or recovery times. Patients in the VR groups received less additional midazolam (0.4 mg vs 1.2 mg) and fentanyl (10 mcg vs 27.4 mcg) compared with patients in the control group. In a multivariable model, VR use remained the only significant predictor for no required midazolam. Eighty-five percent of patients believed that the use of VR positively impacted their surgical experience. As a result of the VR experience, 78% believed that their anxiety decreased and 61.1% believed that their pain decreased.

Conclusions

Although patient pain and anxiety levels between the VR and non-VR groups were similar, the VR group required significantly less midazolam and fentanyl. Moreover, VR use was the only predictor of not requiring midazolam administration during surgery. Patient satisfaction was high with VR usage. VR implementation during minor hand surgery is a viable option to improve patient experience.

Type of study/Level of evidence

Therapeutic IIB.

目的虚拟现实（VR）越来越被认为是解决疼痛和焦虑的辅助工具。我们进行了一项随机对照试验，以评估VR治疗手部小手术患者疼痛和焦虑的有效性。方法门诊手部手术患者随机分为VR组和对照组。除了标准麻醉方案外，VR组还接受了VR体验作为术前护理的一部分。分别使用数值视觉模拟焦虑量表和数值评定量表收集患者焦虑和疼痛评分。此外，我们还记录了患者血流动力学的变化以及控制疼痛或焦虑所需的任何额外药物剂量。结果共纳入41例患者，其中虚拟现实患者21例，对照组20例。在手术前、手术中或手术后报告的疼痛或焦虑评分没有差异。两组在生命体征和恢复时间上没有差异。与对照组患者相比，VR组患者额外接受的咪达唑仑（0.4 mg vs 1.2 mg）和芬太尼（10 mcg vs 27.4 mcg）较少。在多变量模型中，VR使用仍然是不需要咪达唑仑的唯一重要预测因素。85%的患者认为VR的使用对他们的手术体验产生了积极的影响。由于VR体验，78%的人认为他们的焦虑减轻了，61.1%的人认为他们的疼痛减轻了。结论虽然VR组和非VR组患者的疼痛和焦虑水平相似，但VR组对咪达唑仑和芬太尼的需求明显减少。此外，VR的使用是手术期间不需要咪达唑仑的唯一预测因素。患者对VR的使用满意度很高。在小手手术中实施虚拟现实技术是改善患者体验的可行选择。研究类型/证据水平：治疗性IIB。

{"title":"Digital Doses: Virtual Reality Use for Perioperative Pain and Anxiety in Patients Undergoing Hand Surgery","authors":"Angel X. Xiao MD, MSE , Brian Chen BS , Christopher Chiong BA , Nicholas H. Lee , Igor Immerman MD , Sakura Kinjo MD","doi":"10.1016/j.jhsg.2025.100830","DOIUrl":"10.1016/j.jhsg.2025.100830","url":null,"abstract":"<div><h3>Purpose</h3><div>Virtual reality (VR) is increasingly recognized as a complementary tool to address pain and anxiety. We conducted a randomized controlled trial to evaluate the effectiveness of VR for the management of pain and anxiety in patients undergoing minor hand surgery.</div></div><div><h3>Methods</h3><div>Patients undergoing outpatient hand surgery were randomized to VR or control groups. In addition to the standard anesthetic protocol, the VR group received a VR experience as part of their preoperative care. Patient anxiety and pain scores were collected using the Numerical Visual Analog Anxiety Scale and Numerical Rating Scale, respectively. In addition, we recorded changes in patient hemodynamics and any additional medication doses required to manage pain or anxiety.</div></div><div><h3>Results</h3><div>Forty-one patients (21 VR and 20 control) were enrolled. There were no differences in reported pain or anxiety scores before, during, or after surgery. There was no difference in vital signs or recovery times. Patients in the VR groups received less additional midazolam (0.4 mg vs 1.2 mg) and fentanyl (10 mcg vs 27.4 mcg) compared with patients in the control group. In a multivariable model, VR use remained the only significant predictor for no required midazolam. Eighty-five percent of patients believed that the use of VR positively impacted their surgical experience. As a result of the VR experience, 78% believed that their anxiety decreased and 61.1% believed that their pain decreased.</div></div><div><h3>Conclusions</h3><div>Although patient pain and anxiety levels between the VR and non-VR groups were similar, the VR group required significantly less midazolam and fentanyl. Moreover, VR use was the only predictor of not requiring midazolam administration during surgery. Patient satisfaction was high with VR usage. VR implementation during minor hand surgery is a viable option to improve patient experience.</div></div><div><h3>Type of study/Level of evidence</h3><div>Therapeutic IIB.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100830"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105551","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 : 2025-09-20 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

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引用次数: 0

Extensor Retinaculum Capsulorrhaphy and Suture Repair for Ulnocarpal and Distal Radioulnar Joint Instability: One-Year Results 伸肌视网膜带包膜缝合修复尺腕关节和远尺桡关节不稳：一年的结果

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-09-19 DOI: 10.1016/j.jhsg.2025.100806

Nicholas I. Pilla MD , R. Cole Turner MD , Daniella R. Mora BS , Alex Mafdali MD , Fady Attalla BS , Liannys Capote BS , Md Ashfaq Ahmed MS, PhD , E. Anne Ouellette MD, MBA

Purpose

Persistent ulnar-sided wrist pain, often because of triangular fibrocartilage complex (TFCC) tears, can lead to instability of the distal radioulnar joint (DRUJ) and the ulnocarpal joint (UCJ). Although the TFCC's role in stabilizing the DRUJ is well established, its contribution to UCJ stability has gained increasing recognition. This study evaluates the clinical outcomes of combined Herbert Sling and suture repair for (UCJ) instability secondary to TFCC tears.

Methods

Eighty-eight patients (91 wrists) with TFCC tears and UCJ instability, unresponsive to nonsurgical management, underwent combined Herbert sling (HS) and suture repair. The HS technique stabilizes both the DRUJ and UCJ by advancing an extensor retinaculum flap to the radius. Suture repair for the TFCC was performed using a commercially available all-inside-repair device. Postoperative care involved immobilization followed by structured rehabilitation. Outcomes were assessed at 6 months and 1 year and included visual analog scale pain scores, range of motion, and supination test results.

Results

Visual analog scale pain scores improved considerably from 4.5 before surgery to 1.1 at 6 months, with sustained improvement at 1 year. The flexion-extension arc decreased from 133° before surgery to 113° at 6 months but returned to 135° at 1 year. The pronation-supination arc decreased slightly from 177° to 171° at 6 months, with full recovery by 1 year. Supination testing showed a considerable improvement in UCJ stability, with 92% of wrists stable at 6 months and 87% stable at 1 year. Four wrists experienced recurrent instability between 6 months and 1 year.

Conclusions

The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. This technique provides a promising approach to the treatment of ulnocarpal instability while minimizing tissue disruption.

Type of study/level of evidence

Therapeutic IV.

目的持续的尺侧腕关节疼痛，通常是由于三角形纤维软骨复合体（TFCC）撕裂，可导致远端尺桡关节（DRUJ）和尺腕关节（UCJ）的不稳定。虽然TFCC在稳定DRUJ方面的作用已经确立，但它对UCJ稳定性的贡献已经得到越来越多的认可。本研究评估Herbert Sling联合缝合修复TFCC撕裂后（UCJ）不稳定的临床效果。方法88例（91例）TFCC撕裂合并UCJ不稳定，对非手术治疗无反应，采用Herbert sling （HS）联合缝合修复。HS技术通过向桡骨推进伸肌支持带皮瓣来稳定下胫腓关节和下胫腓关节。TFCC的缝合修复使用市售的全内修复装置进行。术后护理包括固定和有组织的康复。结果在6个月和1年时进行评估，包括视觉模拟量表疼痛评分、活动范围和旋后试验结果。结果视觉模拟疼痛评分从术前的4.5分显著提高到6个月时的1.1分，并持续改善至1年。屈伸弧度从术前的133°下降到6个月时的113°，但1年后又恢复到135°。6个月时旋前-旋后弧度从177°略微下降到171°，1年完全恢复。旋后试验显示UCJ稳定性有显著改善，92%的患者在6个月时腕关节稳定，87%的患者在1年时腕关节稳定。4个手腕在6个月至1年内反复出现不稳定。结论HS联合缝合修复可有效恢复tfcc相关性尺腕关节不稳定患者的DRUJ和UCJ的稳定性，显著减轻疼痛并保持活动范围。该技术为治疗尺腕不稳定提供了一种很有前途的方法，同时最大限度地减少了组织破坏。研究类型/证据水平治疗性IV。

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引用次数: 0

Reliability of Provocative Maneuvers for Hand Pathologies: Concordance Between Nonspecialist and Specialist Assessments in a General Clinic Setting 刺激手法对手部疾病的可靠性：在普通诊所设置非专科和专科评估之间的一致性

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-09-19 DOI: 10.1016/j.jhsg.2025.100824

Clay B. Thames BA , Evan Bowen BS , Greg Vance BE , Bradley Hathaway BA , Kacy Benedict MD , Mark Dodson MD , Marc Walker MD

Purpose

Provocative maneuvers are frequently employed by hand surgeons to evaluate common hand pathologies. Although prior studies have evaluated the efficacy of individual maneuvers independently, to date, no studies have been performed evaluating the concordance between nonsurgeon-administered Tinel, Eichhoff, Finkelstein, and carpometacarpal Grind test and attending hand surgeon diagnoses in a general hand clinic population.

Methods

A prospective cohort study was performed on new patients presenting to the hand clinic. All four provocative maneuvers were performed on each patient. Positive versus negative results were recorded by a student and compared with the final clinical diagnoses by fellowship-trained, board-certified hand surgeons retrospectively. Descriptive statistics and χ² analysis were performed.

Results

A total of 93 patients were enrolled in the study. The concordance between the nonsurgeon examination and the hand surgeon examination was analyzed. Analyses showed that Tinel test, Grind test, and Eichhoff test were meaningfully associated with their respective hand pathologies, whereas Finkelstein test was not. Among the tests evaluated, the Grind test showed the greatest concordance, and the Tinel test offered high concordance while also limiting false-positive examinations, even between a nonsurgeon and a hand specialist.

Conclusions

This prospective study revealed varied concordance among maneuvers. The Grind test, Tinel test, and Eichhoff test demonstrated efficacy in identifying carpometacarpal arthritis, carpal tunnel syndrome, and de Quervain tenosynovitis, respectively. Although these tests were not designed for screening, these maneuvers may support early hypothesis generation when evaluating undifferentiated upper-extremity complaints in the clinic.

Type of study/level of evidence

Diagnostic IIb.

目的手外科医生经常使用挑衅性动作来评估常见的手部病变。虽然先前的研究已经独立评估了个体操作的有效性，但迄今为止，还没有研究评估非手术治疗的Tinel， Eichhoff， Finkelstein和carpometacarpal Grind测试与一般手部门诊人群的主治手外科医生诊断之间的一致性。方法采用前瞻性队列研究对初诊手部门诊的患者进行分析。所有四种刺激动作都在每位患者身上进行。阳性和阴性结果由一名学生记录下来，并与最终临床诊断结果进行回顾性比较。进行描述性统计和χ2分析。结果共纳入93例患者。分析了非外科检查与手外科检查的一致性。分析显示，Tinel检验、Grind检验和Eichhoff检验与各自的手部病理有显著相关，而Finkelstein检验则无显著相关。在评估的测试中，Grind测试显示出最大的一致性，而Tinel测试提供了高一致性，同时也限制了假阳性检查，即使在非外科医生和手部专家之间也是如此。结论本前瞻性研究揭示了不同动作之间的一致性。Grind试验、Tinel试验和Eichhoff试验分别证明了识别腕掌关节炎、腕管综合征和de Quervain腱鞘炎的有效性。虽然这些测试不是为筛查而设计的，但这些操作可以在临床评估未分化上肢疾患时支持早期假设生成。研究类型/证据水平

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引用次数: 0

More Than Epineurium Deep: Characterizing Peripheral Nerve Damage Using High-Resolution Micro-Computed Tomography for Simulated Peripheral Nerve Lacerations 超过神经外膜深度：模拟周围神经撕裂的高分辨率显微计算机断层扫描表征周围神经损伤

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-09-18 DOI: 10.1016/j.jhsg.2025.100833

Rasa Zhukauskas MD , Brandon S. Smetana MD , Adam B. Strohl MD , Sunishka M. Wimalawansa MD, MBA , Eitan Melamed MD , Amy M. Moore MD , Fraser J. Leversedge MD , Youssra Marjoua MD , Bauback Safa MD

Purpose

Nerve damage because of acute traumatic lacerations is challenging to assess and is typically evaluated using loupes or an operating microscope. However, defining the zone of injury clinically is limited to evaluating the epineurium and/or transected nerve ends for visible injury, with tactile changes corresponding with nerve damage not evident in the acute setting. During surgical nerve repair or reconstruction, adequate debridement of the damaged tissue is essential, as fascicular health influences the regenerative potential of the nerve. This study used a novel high-resolution imaging method to characterize the extent of nerve damage resulting from 3 common mechanisms of traumatic lacerations.

Methods

Twelve human upper extremity cadaveric specimens were used to simulate common injuries using a knife, broken glass, or table saw in flexor tendon zones II or V. The distance of nerve damage measured from the transected end was visually estimated by experienced peripheral nerve surgeons under loupe magnification. The length of nerve damage was measured radiographically using micro-computed tomography and then compared with visually estimated damage.

Results

Radiographic image analysis revealed fascicular disruption extending proximally and distally from the transection, which was underestimated by visual assessment 9.5 mm on average in knife injuries, 7.8 mm in broken glass injuries, and 12.1 mm in table saw injuries. The extent of radiographic damage was similar in proximal and distal nerves, and in knife and broken glass lacerations, but most extensive in table saw lacerations.

Conclusions

Nerve damage was greatest in table saw lacerations. Radiographic imaging showed fascicular damage extending beyond the surgeon’s visual assessment of epineural damage, indicating that the internal damage to nerves from traumatic lacerations was underappreciated by surgeons. The impact this underestimated damage has on regenerative potential of an injured nerve requires further investigation.

Type of study/Level of evidence

Diagnostic V.

目的：急性创伤性撕裂伤引起的神经损伤很难评估，通常使用镜或手术显微镜进行评估。然而，临床上对损伤区域的界定仅限于评估神经外膜和/或横断的神经末梢的可见损伤，与神经损伤相对应的触觉变化在急性情况下并不明显。在外科神经修复或重建过程中，对受损组织进行充分的清创是必不可少的，因为神经束的健康影响神经的再生潜能。本研究使用一种新的高分辨率成像方法来表征三种常见机制造成的创伤性撕裂伤的神经损伤程度。方法采用12例人体上肢尸体标本，用刀、碎玻璃或台锯在屈肌腱II区或v区模拟常见损伤，由经验丰富的周围神经外科医生在放大镜下目测神经损伤与横断端的距离。神经损伤的长度用显微计算机断层摄影测量，然后与视觉估计的损伤进行比较。结果x线图像分析显示束状断裂从横断面向近端和远端延伸，刀伤平均低估了9.5 mm，碎玻璃伤平均低估了7.8 mm，表锯伤平均低估了12.1 mm。近端和远端神经、刀伤和碎玻璃伤的x线损伤程度相似，但台锯伤最广泛。结论表锯伤以神经损伤最严重。放射成像显示神经束损伤超出了外科医生对神经外损伤的视觉评估，表明外伤性撕裂伤对神经的内部损伤没有得到外科医生的重视。这种被低估的损伤对受损神经再生潜能的影响需要进一步研究。研究类型/证据水平

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