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

Protecting the Nerve Coaptation: Connector-Assisted Nerve Repair in Complex Injuries 保护神经适应：神经连接辅助修复复杂损伤

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-08-23 DOI: 10.1016/j.jhsg.2025.100816

Nesreen Zoghoul Alsmadi PhD , Curt Deister PhD , Peter Evans MD, PhD , Tamer Ghanem MD, PhD , Brandon Smetana MD , Deana Mercer MD

Purpose

This study evaluated differences in outcomes of peripheral nerve repair using connector-assisted repair (CAR) or direct repair (DR) in an injured soft tissue bed.

Methods

The sciatic nerve of the right leg in 20 male Lewis rats was exposed and transected. We simulated a traumatized wound bed by cauterizing the underlying muscle bed with a bipolar coagulator. Nerves were repaired with either DR or CAR using porcine small intestine submucosa conduits. At 6 weeks, adhesions were assessed semiquantitiatively, and the gastrocnemius wet muscle weight of each hind limb was recorded to evaluate muscle atrophy. Histology of the nerve was evaluated immediately distal to the nerve repair site. Data were analyzed for differences between repair methods.

Results

The DR group had a considerably higher area of foamy phagocytes and CD68-stained macrophages than that of the CAR group. There were considerably more blood vessels and axons in the CAR group than in the DR group. There were no differences between DR and CAR with respect to gastrocnemius muscle wet weight, extraneural adhesions, or intraneural collagen-to-cell ratio.

Conclusions

There was less area occupied by macrophages and foamy phagocytes in the CAR group, which was indicative of lower inflammatory response and resolving Wallerian degeneration. The CAR group also had more blood vessels and axons compared to that of the DR group, indicating more robust nerve regeneration. Gastrocnemius muscle weight between groups was similar, indicating that nerve regeneration was incomplete in both groups at the 6-week timepoint. These results highlight the potential benefits of CAR in protecting the nerve during the healing process.

Clinical relevance

This in vivo study evaluates histological changes in peripheral nerves during regeneration following transection with either CAR or DR.

目的：本研究评估神经连接辅助修复（CAR）和直接修复（DR）在损伤软组织床上修复周围神经的效果差异。方法对20只雄性Lewis大鼠右腿坐骨神经进行暴露和横断。我们通过用双极凝固器烧灼下面的肌肉床来模拟创伤的伤口床。采用猪小肠粘膜下导管行DR或CAR修复神经。6周时，半定量评估粘连情况，记录各后肢腓肠肌湿肌重量，评估肌肉萎缩情况。神经组织学立即评估远端神经修复部位。分析不同修复方法的数据差异。结果DR组泡沫吞噬细胞和cd68染色巨噬细胞面积明显高于CAR组。CAR组血管和轴突明显多于DR组。DR和CAR在腓肠肌湿重、神经外粘连或神经内胶原细胞比方面没有差异。结论CAR组巨噬细胞和泡沫吞噬细胞占据的面积更小，炎症反应较低，可缓解沃勒氏变性。与DR组相比，CAR组也有更多的血管和轴突，表明神经再生更强劲。两组腓肠肌重量相近，提示在6周时两组腓肠肌神经再生不完全。这些结果强调了CAR在愈合过程中保护神经的潜在益处。该体内研究评估了CAR或DR横断再生过程中周围神经的组织学变化。

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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 : 2025-11-01 Epub 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

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 : 2025-11-01 Epub 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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引用次数: 0

Evaluating Pedicled Groin Flap Reconstruction in Hand Degloving Injuries: A Retrospective Analysis 带蒂腹股沟皮瓣重建手部脱手套损伤的回顾性分析

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1016/j.jhsg.2025.100828

Saleh Abualhaj MD , Yazan S. Al-Zamer MD , Lina Al-Shadfan MD , Mosleh Abualhaj PhD , Ali aloun MD , Basel Joseph Massad MD

Purpose

This study aimed to evaluate the clinical outcomes of pedicled groin flap coverage in such injuries and identify factors associated with postoperative complications and flap viability.

Methods

A retrospective review of 23 patients who underwent pedicled groin flap reconstruction for finger or hand degloving injuries between 2015 and 2024 was conducted. Patient demographics, surgical details, complication rates, aesthetic outcomes, and functional recovery were analyzed.

Results

The cohort had a mean age of 27.9 years, with a male predominance (73.9%) and a high smoking rate (73.9%). Most defects involved the fingers (87%), with a mean defect size of 30.6 cm² and a mean flap size of 72.0 cm². The mean wound healing time was 32.5 days, and the average hospital stay was 3.6 days. Flap success was achieved in 91.3% of the cases. Postoperative complications occurred in 34.8% of the patients, including partial flap necrosis (26.1%), wound dehiscence (13.0%), and infection (4.3%). Intraoperative venous congestion was observed in 39.1% of the cases and was more frequent among patients who developed complications (P = .001). Other variables showing statistically significant differences between patients with and without complications included smoking status (P = .037), additional procedures performed (P = .037), and smaller defect dimensions (P = .011 for width; P = .032 for size). Aesthetic outcomes were rated as good or neutral in over 90% of the cases. Functionally, 91.3% of the patients experienced minimal-to-mild disability, with a mean QuickDASH score of 18.1 (SD = 14.1). Patients with complications had higher disability scores (mean: 27.9 vs 12.9; P = .012).

Conclusions

Groin flap reconstruction remains a reliable and accessible option for managing hand degloving injuries, particularly in resource-limited settings, offering acceptable functional and aesthetic outcomes despite a relatively high rate of secondary procedures.

Type of study/level of evidence

Therapeutic III.

目的评价带蒂腹股沟皮瓣复盖治疗此类损伤的临床效果，探讨影响术后并发症及皮瓣存活的相关因素。方法回顾性分析2015年至2024年23例手指或手部脱手套损伤行带蒂腹股沟皮瓣重建术的病例。分析了患者人口统计学、手术细节、并发症发生率、美学结果和功能恢复情况。结果该队列平均年龄27.9岁，男性占73.9%，吸烟率较高（73.9%）。大多数缺损涉及手指（87%），平均缺损面积为30.6 cm2，平均皮瓣面积为72.0 cm2。平均创面愈合时间32.5 d，平均住院时间3.6 d。皮瓣移植成功率为91.3%。术后并发症发生率为34.8%，其中皮瓣部分坏死（26.1%）、创面裂开（13.0%）、感染（4.3%）。39.1%的患者术中出现静脉充血，在出现并发症的患者中更为常见（P = 0.001）。其他在有和没有并发症的患者之间显示有统计学意义差异的变量包括吸烟状况（P = 0.037）、额外的手术（P = 0.037）和较小的缺陷尺寸（宽度P = 0.011，大小P = 0.032）。在超过90%的病例中，美学结果被评为良好或中性。在功能上，91.3%的患者经历了轻微至轻度残疾，平均QuickDASH评分为18.1 （SD = 14.1）。并发症患者的残疾评分较高（平均：27.9比12.9;P = 0.012）。结论腹股沟皮瓣重建仍然是处理手部脱手套损伤的一种可靠和可获得的选择，特别是在资源有限的情况下，尽管二次手术的比例相对较高，但它提供了可接受的功能和美观结果。研究类型/证据水平：治疗性

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引用次数: 0

Surgical Treatments for Scapholunate Ligament Injuries and Development of Arthritis in the Wrist: A Systematic Review 腕关节舟月骨韧带损伤和关节炎发展的外科治疗：系统综述

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-09-13 DOI: 10.1016/j.jhsg.2025.100827

Eiden Lami MS , Jack Kramer BA , Majd Mzeihem MD , Farid Amirouche PhD

Purpose

The scapholunate ligament (SLL) is the most injured carpal ligament; however, surgeons do not agree on the best management. Several studies have reported on the after surgery functional outcomes of different surgical techniques, with varying results. However, there is little literature on the development of arthritis in the context of a SLL injury. The goal of this review was to examine the current literature to investigate the relationship between an SLL injury and the development of arthritis in the wrist and hand.

Methods

We performed a systematic literature review on surgical treatments for SLL injuries. This review included 37 studies that met the inclusion criteria for treatment outcomes and arthritis development. We reported both demographic and radiological results, which included arthritis prevalence and pattern. Methodological quality was assessed using the Downs and Black checklist.

Results

In total, 784 injured wrists were analyzed across the 37 studies, and postoperative arthritis occurrences across treatment types were as follows, capsulodesis (10.6%), tenodesis (13.6%), ligamentoplasty (14.6%), bone-ligament-bone (31.5%), and debridement (5.3%), with scapholunate advanced collapse III being the most common arthritic pattern. The mean age of patients was 39.8 years. The delay between injury and treatment averaged 13.2 months.

Conclusions

Our systematic review highlights the variability in arthritis patterns following SLL injuries and underscores the lack of consensus regarding management strategies. We observed the highest rates of arthritis using the bone-ligament-bone method and the lowest rates using the debridement technique.

Type of study/level of evidence

Therapeutic IIA.

目的舟月骨韧带（SLL）是损伤最严重的腕韧带；然而，外科医生对最佳治疗方法意见不一。一些研究报道了不同手术技术的术后功能结果，结果不同。然而，在SLL损伤的背景下，很少有关于关节炎发展的文献。本综述的目的是检查当前的文献，以研究SLL损伤与手腕和手部关节炎发展之间的关系。方法对SLL损伤的外科治疗进行系统的文献回顾。本综述纳入了37项符合治疗结果和关节炎发展纳入标准的研究。我们报告了人口统计学和放射学结果，包括关节炎的患病率和类型。使用Downs和Black检查表评估方法学质量。结果37项研究共分析了784例手腕损伤，不同治疗类型的术后关节炎发生率分别为：关节囊固定术（10.6%）、肌腱固定术（13.6%）、韧带成形术（14.6%）、骨-韧带-骨（31.5%）和清创术（5.3%），舟月骨晚期塌陷III型是最常见的关节炎类型。患者平均年龄39.8岁。从受伤到治疗的平均延迟时间为13.2个月。我们的系统综述强调了SLL损伤后关节炎模式的可变性，并强调了在治疗策略方面缺乏共识。我们观察到使用骨-韧带-骨方法的关节炎发病率最高，而使用清创技术的关节炎发病率最低。研究类型/证据水平：治疗性IIA。

{"title":"Surgical Treatments for Scapholunate Ligament Injuries and Development of Arthritis in the Wrist: A Systematic Review","authors":"Eiden Lami MS , Jack Kramer BA , Majd Mzeihem MD , Farid Amirouche PhD","doi":"10.1016/j.jhsg.2025.100827","DOIUrl":"10.1016/j.jhsg.2025.100827","url":null,"abstract":"<div><h3>Purpose</h3><div>The scapholunate ligament (SLL) is the most injured carpal ligament; however, surgeons do not agree on the best management. Several studies have reported on the after surgery functional outcomes of different surgical techniques, with varying results. However, there is little literature on the development of arthritis in the context of a SLL injury. The goal of this review was to examine the current literature to investigate the relationship between an SLL injury and the development of arthritis in the wrist and hand.</div></div><div><h3>Methods</h3><div>We performed a systematic literature review on surgical treatments for SLL injuries. This review included 37 studies that met the inclusion criteria for treatment outcomes and arthritis development. We reported both demographic and radiological results, which included arthritis prevalence and pattern. Methodological quality was assessed using the Downs and Black checklist.</div></div><div><h3>Results</h3><div>In total, 784 injured wrists were analyzed across the 37 studies, and postoperative arthritis occurrences across treatment types were as follows, capsulodesis (10.6%), tenodesis (13.6%), ligamentoplasty (14.6%), bone-ligament-bone (31.5%), and debridement (5.3%), with scapholunate advanced collapse III being the most common arthritic pattern. The mean age of patients was 39.8 years. The delay between injury and treatment averaged 13.2 months.</div></div><div><h3>Conclusions</h3><div>Our systematic review highlights the variability in arthritis patterns following SLL injuries and underscores the lack of consensus regarding management strategies. We observed the highest rates of arthritis using the bone-ligament-bone method and the lowest rates using the debridement technique.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IIA.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100827"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044848","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

Development and Application of the WFS-175: A Novel Multidimensional Score for Wrist Function WFS-175的开发与应用：一种新的腕部功能多维评分方法

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-08-30 DOI: 10.1016/j.jhsg.2025.100819

Sang Anh Nguyen MD , Doanh Quoc Tran PhD

Purpose

We present a novel protocol for wrist function assessment that integrates both objective factors (range of motion and grip strength) and subjective domains (pain, motor function, and quality of life) into the composite Wrist Function Score - 175 (WFS-175) score.

Methods

The protocol consists of three main steps: (1) data collection, which involves measuring the wrist range of motion in six directions using a goniometer and grip strength, including maximum strength, endurance, and recovery, using a Jamar dynamometer, alongside concurrent subjective assessment with a standardized questionnaire; (2) standardization of all data onto a unified scoring scale, applying a linear formula to calculate the total WFS-175 score (maximum 175 points), with the following components: range of motion (30 points), grip strength (40 points), pain (25 points), motor function (40 points), and quality of life (40 points); and (3) input of results into the AppSheet/Google Sheets system, which provides automated calculation, storage, reporting, and graphical visualization for longitudinal tracking of functional recovery.

Results

This protocol yields a standardized assessment form that enables precise calculation of the WFS-175 score. It integrates muscular endurance and recovery measures and fully digitalizes the workflow.

Conclusions

Initial applications show that the WFS-175 score effectively evaluates wrist function and tracks recovery over time. For example, a postoperative patient scored 164/175, indicating excellent recovery.

Clinical relevance

The WFS-175 protocol offers a novel and digital-ready solution for standardized wrist function assessment. By combining objective and subjective measures in one scoring system, it enhances sensitivity and supports clinical decision making in modern rehabilitation.

目的：我们提出了一种新的腕功能评估方案，该方案将客观因素（活动范围和握力）和主观因素（疼痛、运动功能和生活质量）整合到综合腕功能评分-175 （WFS-175）评分中。方法该方案包括三个主要步骤：(1)数据收集，包括使用角计测量腕部在六个方向的运动范围和握力，包括最大力量，耐力和恢复，使用Jamar测力仪，同时使用标准化问卷进行主观评估；(2)将所有数据标准化到统一的评分量表上，应用线性公式计算WFS-175总分（最高175分），其中运动范围（30分）、握力（40分）、疼痛（25分）、运动功能（40分）、生活质量（40分）；(3)将结果输入AppSheet/谷歌Sheets系统，该系统提供自动计算、存储、报告和图形可视化，用于功能恢复的纵向跟踪。结果该方案产生了一个标准化的评估表格，可以精确计算WFS-175评分。它整合了肌肉耐力和恢复措施，并将工作流程完全数字化。初步应用表明，WFS-175评分可有效评估腕关节功能，并随时间跟踪腕关节恢复情况。例如，术后患者得分为164/175，表明恢复良好。临床相关性WFS-175方案为标准化腕功能评估提供了一种新颖的数字化解决方案。将客观指标和主观指标结合在一个评分系统中，提高了敏感性，为现代康复的临床决策提供了支持。

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引用次数: 0

Suture Button Fixation for Regan-Morrey Type II Coronoid Fracture of Anterior and Posterior Monteggia Fracture: A Report of Two Cases 缝线扣固定治疗Regan-Morrey型冠状骨折前后蒙特吉亚骨折2例报告

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.jhsg.2025.100834

Shiro Yoshida MD, PhD , Mitsuhiro Matsuura MD , Yusuke Ogrura MD, PhD , Taiki Nishimura MD, PhD , Koji Hiraoka MD, PhD

This report details two cases of Monteggia fracture-dislocations that were successfully managed using the TightRope suture button technique via the posterior approach. The first case involved a 26-year-old man with type IID posterior Monteggia fracture-dislocation. Treatments included coronoid stabilization, radial head replacement, and variable-angle elbow plate placement. Seventeen months after the injury, his elbow motion ranged from 15° to 115°, with 50° supination and 10° pronation. In the second case, a 50-year-old woman with type IID anterior olecranon fracture-dislocation achieved elbow motion from 10° to 125° at 12 months after injury, with 80° supination and 70° pronation following similar fixation. Both patients underwent surgery using a global posterior approach. TightRope fixation was used for coronoid tip fragments, whereas locking plates were used for proximal ulnar and olecranon fractures. This method eliminates the need for an anterior incision and allows open reduction internal fixation through a single incision.

本报告详细介绍了两例Monteggia骨折脱位的病例，均通过后路使用TightRope缝合按钮技术成功治疗。第一个病例涉及一名26岁的男性IID型后孟氏骨折脱位。治疗包括冠状突稳定、桡骨头置换术和可变角度肘关节钢板置入。伤后17个月，患者肘关节活动范围15°至115°，旋后50°，旋前10°。在第二个病例中，一名患有IID型前鹰口骨折脱位的50岁女性在受伤后12个月肘关节活动从10°到125°，在类似的固定后肘关节旋后80°和旋前70°。两例患者均采用全后路手术。冠突尖端骨折采用钢丝固定，尺骨近端和鹰嘴骨折采用锁定钢板固定。该方法不需要前切口，允许通过单个切口切开复位内固定。

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引用次数: 0

Early Removal of Dorsal Spanning Plate With Supplemental Distal Radius Fixation: Safety and Efficacy 早期拔除背侧跨越钢板辅助桡骨远端固定：安全性和有效性

Q3 Medicine

Journal of Hand Surgery Global Online

Pub Date : 2025-11-01 Epub Date: 2025-09-16 DOI: 10.1016/j.jhsg.2025.100825

Bishoy N. Saad DO , Ian S. Hong MD , Nicole D. Campbell MBS , Christian G. Zapf BS , Mallery Zeiman BS , Frank A. Liporace MD , Richard S. Yoon MD , Nicole Montero-Lopez MD

Purpose

The purpose of the study was to evaluate the safety and efficacy of early dorsal spanning plate (DSP) removal at 6–9 weeks in the management of distal radius fractures.

Methods

A retrospective review of adult patients (≥18years) treated with DSP with or without supplemental volar plate fixation for unstable distal radius fractures between January 2019 and December 2022 was conducted. Inclusion criteria included DSP removal 6–9 weeks after surgery and a minimum of the 12-month follow-up. Patients were excluded if they had previous ipsilateral hand, wrist, or forearm surgery or incomplete records. Demographics, perioperative details, and radiographic measurements were collected (before surgery, immediate after surgery, immediately following DSP removal, and at the most recent follow-up). Functional outcomes were assessed using the quick disabilities of the arm, shoulder, and hand questionnaire.

Results

Seventeen patients were included (mean age: 53.3 ± 21.7 years, body mass index: 27.1 ± 4.2 kg/m²). The average time to DSP removal was 6.97 ± 1.1weeks. The 2R3C3.2 AO/OTA classification was the most commonly observed fracture pattern (59%). Radiographic assessments indicated sustained anatomic alignment and fracture healing. The mean short-term quick disabilities of the arm, shoulder, and hand score was 18.9, indicating mild disability. Complications within 90 days and at the 1-year follow-up were observed in 18% and 29% of the patients, respectively, predominantly because of paresthesia and superficial wound issues.

Conclusions

This study confirmed the safety and efficacy of DSP removal at 6–9 weeks, with clinical outcomes comparable with traditional 12-week to 16-week timelines. Future studies could evaluate whether earlier plate retrieval allows for an accelerated rehabilitation protocol, an earlier return-to-work timeline, as well as its potential in reducing postoperative stiffness.

Type of study/level of evidence

Therapeutic IV.

目的评价6-9周早期背侧跨越钢板（DSP）取出治疗桡骨远端骨折的安全性和有效性。方法回顾性分析2019年1月至2022年12月期间，采用DSP治疗不稳定桡骨远端骨折的成人患者（≥18岁），并辅以掌侧钢板固定。纳入标准包括术后6-9周去除DSP，至少随访12个月。既往有同侧手、腕、前臂手术史或记录不完整者排除。收集人口统计学、围手术期细节和放射学测量数据（术前、术后、去除DSP后和最近随访时）。使用手臂、肩膀和手的快速残疾问卷评估功能结果。结果纳入17例患者，平均年龄53.3±21.7岁，体重指数27.1±4.2 kg/m2。去除DSP的平均时间为6.97±1.1周。2R3C3.2 AO/OTA分类是最常见的骨折类型（59%）。x线评估显示持续的解剖排列和骨折愈合。手臂、肩部和手部的平均短期快速残疾得分为18.9，为轻度残疾。在90天和1年随访中分别有18%和29%的患者出现并发症，主要是由于感觉异常和浅表伤口问题。本研究证实了在6-9周时去除DSP的安全性和有效性，其临床结果与传统的12- 16周时间线相当。未来的研究可以评估早期钢板取出是否允许加速康复方案，更早的恢复工作时间，以及它在减少术后僵硬方面的潜力。研究类型/证据水平治疗性IV。

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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 : 2025-11-01 Epub 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

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 : 2025-11-01 Epub 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