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Bridging the Nerve Gap: Techniques and Technology for Success in Peripheral Nerve Surgery 弥合神经鸿沟:成功实施周围神经手术的技术与科技
Q3 Medicine Pub Date : 2024-09-01 DOI: 10.1016/j.jhsg.2024.02.015
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引用次数: 0
Psychological Aspects of Nerve Gap Reconstruction: Addressing Patient Perspectives and Expectations 神经间隙重建的心理因素:应对患者的观点和期望
Q3 Medicine Pub Date : 2024-09-01 DOI: 10.1016/j.jhsg.2024.01.010

Purpose

Preoperative expectations play a major role in determining patient satisfaction after surgery. The aim of this study was to characterize patient’s preoperative expectations and postoperative perceptions of nerve gap repair surgery.

Methods

We conducted a search of Embase, Scopus, and Web of Science databases for peer-reviewed articles that studied patient expectations, perceptions, and impressions of nerve gap repair in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies related to lumbar plexus radiculopathy, reimplantation, or patient satisfaction scores without patient testimony were excluded. Primary and secondary outcomes were patient’s preoperative expectations and postoperative perceptions of nerve gap repair surgery, respectively.

Results

We included 11 studies evaluating a total of 462 patients. One study evaluated only patient expectations, six studies evaluated only patient perspectives, and four studies evaluated both. Patients were generally overly optimistic in their expectations of surgery. Postoperative satisfaction ranged from 82% to 86%, and 81% to 87% of patients would choose to undergo their surgery again knowing what they know now.

Conclusions

Patient expectations in nerve gap repair are optimistic, and at times unrealistic. Patient satisfaction with nerve gap repair is high and subject to influence from preoperative education and postoperative outcomes of functional and sensory recovery.

Clinical relevance

Surgeons should be aware that patient expectations of their postoperative outcomes can have substantial impacts on their perceived management and overall satisfaction. More emphasis should be placed on preoperative education and expectation management to optimize patient satisfaction.

目的 术前期望在决定患者术后满意度方面起着重要作用。本研究旨在描述患者对神经间隙修复手术的术前期望和术后感知。方法我们在 Embase、Scopus 和 Web of Science 数据库中检索了同行评议文章,这些文章根据《系统综述和元分析首选报告项目》指南研究了患者对神经间隙修复手术的期望、感知和印象。与腰丛神经根病、再植或无患者证词的患者满意度评分相关的研究均被排除在外。主要和次要结果分别为患者术前对神经间隙修复手术的期望和术后对神经间隙修复手术的看法。其中一项研究仅评估了患者的期望值,六项研究仅评估了患者的观点,四项研究同时评估了患者的期望值和观点。患者对手术的期望普遍过于乐观。术后满意度在 82% 到 86% 之间,81% 到 87% 的患者在了解现在的情况后会选择再次接受手术。患者对神经间隙修复术的满意度很高,但受术前教育以及术后功能和感觉恢复结果的影响。临床意义外科医生应该意识到,患者对术后结果的期望会对其感知管理和总体满意度产生重大影响。应更加重视术前教育和期望管理,以优化患者满意度。
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引用次数: 0
Development of Biomaterials for Addressing Upper Extremity Peripheral Nerve Gaps 开发用于解决上肢末梢神经间隙的生物材料
Q3 Medicine Pub Date : 2024-09-01 DOI: 10.1016/j.jhsg.2024.01.023

Peripheral nerve injuries within the upper extremities can lead to impaired function and reduced quality of life. Although autografts have traditionally served as the primary therapeutic approach to bridge nerve gaps, these present challenges related to donor site morbidity. This review delves into the realm of biomaterials tailored for addressing nerve gaps. Biomaterials, whether natural or synthetically derived, offer the potential not only to act as scaffolds for nerve regeneration but also to be enhanced with growth factors and agents that promote nerve recovery. The historical progression of these biomaterials as well as their current applications, advantages, inherent challenges, and future impact in the arena of regenerative medicine are discussed. By providing a comprehensive overview, we aim to shed light on the transformative potential of biomaterials in peripheral nerve repair and the path toward refining their efficacy in clinical settings.

上肢周围神经损伤可导致功能受损和生活质量下降。虽然自体移植一直是弥合神经间隙的主要治疗方法,但自体移植也面临着与供体部位发病率相关的挑战。本综述将深入探讨专为解决神经间隙问题而定制的生物材料领域。生物材料,无论是天然的还是人工合成的,不仅具有作为神经再生支架的潜力,而且还能通过生长因子和促进神经恢复的药物来增强其功能。本文讨论了这些生物材料的历史发展及其在再生医学领域的当前应用、优势、固有挑战和未来影响。通过全面概述,我们旨在阐明生物材料在周围神经修复中的变革潜力,以及在临床环境中完善其功效的途径。
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引用次数: 0
ChatGPT-4 Can Help Hand Surgeons Communicate Better With Patients: Comment ChatGPT-4 可以帮助手外科医生更好地与患者沟通:评论
Q3 Medicine Pub Date : 2024-09-01 DOI: 10.1016/j.jhsg.2024.06.001
Hinpetch Daungsupawong PhD , Viroj Wiwanitkit MD
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引用次数: 0
The Experience of the Virtual Interview Process for Hand Fellowship Program Directors 手部研究金项目主任虚拟面试过程的体验
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.04.009
Rohun Gupta MD , Isabel Silva BS , Isabel Herzog BA , Peter K. Firouzbakht MD , Joseph Weisberger MD , Michael M. Vosbikian MD , Brian A. Mailey MD, FACS

Purpose

Due to the Coronavirus Disease-19 pandemic, the fellowship application process has transitioned from in-person interviews to virtual interviews. Although several studies have assessed the impact of Coronavirus Disease-19 on residency and fellowship interviews, fewer studies have investigated the program director’s perspective. Therefore, the aim of this study was to assess the experience of virtual interviews on hand fellowship program directors and understand some of the important factors that may make an applicant more competitive.

Methods

A 21-question survey was conducted through Google Forms and distributed through a standardized email to hand fellowship program directors and coordinators. Questions used a 5-point Likert scale with the opportunity for respondents to answer some questions in a free-response format. Statistical analysis was conducted with significance assigned to P values < .05.

Results

Ninety-three surveys were distributed, of which 35 responses were obtained, corresponding to a 37.6% survey response rate. Program directors reported that they tended to place more emphasis on applicant’s curriculum vitae, calls from colleagues, and applicants that they had previously met. In addition, program directors felt that applicants were able to accurately represent themselves through the virtual format. Finally, most program directors stated that they were highly likely to continue to offer virtual interviews.

Conclusions

With several parenting organizations and program directors affirming that they are comfortable with proceeding with virtual interviews, it is essential for hand fellowship applicants to understand what factors program directors may perceive as more important. It is possible that the virtual interview process may effectively achieve suitable matches between applicants and institutions.

Type of study/level of evidence

Decision analysis IIIb.

目的由于 Coronavirus Disease-19 大流行,研究金申请流程已从面对面面试过渡到虚拟面试。虽然已有多项研究评估了 Coronavirus Disease-19 对住院医师和研究员面试的影响,但从项目主任的角度进行调查的研究较少。因此,本研究旨在评估虚拟面试对手部研究员项目主任的影响,并了解可能使申请人更具竞争力的一些重要因素。方法 通过谷歌表格进行了一项包含 21 个问题的调查,并通过标准化电子邮件分发给手部研究员项目主任和协调员。问题采用 5 点李克特量表,受访者可以自由回答一些问题。结果共发放了 93 份调查问卷,收到 35 份回复,回复率为 37.6%。项目主任表示,他们倾向于更重视申请人的简历、同事的来电以及他们以前见过的申请人。此外,项目主任认为申请人能够通过虚拟形式准确地表达自己。最后,大多数项目主任表示,他们很有可能继续提供虚拟面试。结论随着一些养育机构和项目主任确认他们对继续进行虚拟面试感到满意,了解项目主任可能认为哪些因素更重要对奖学金申请人来说至关重要。研究类型/证据等级决策分析 IIIb.
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引用次数: 0
Enhancing Hand Fracture Care: A Prospective Study of Artificial Intelligence Application With ChatGPT 加强手部骨折护理:人工智能应用与 ChatGPT 的前瞻性研究
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.03.014
Connor John Atkinson MD , Ishith Seth MD , Marc Adam Seifman MD , Warren Matthew Rozen MD , Roberto Cuomo MD

Purpose

The integration of artificial intelligence and machine learning technologies into the medical field has brought about remarkable advancements, particularly in the domain of clinical decision support systems. However, it is uncertain how they will perform as clinical decision-makers.

Methods

This prospective cohort study evaluates the potential of incorporating ChatGPT-4 plus into the management of subcapital fifth metacarpal fractures. The treatment recommendations provided by ChatGPT-4 plus were compared with those of the two control groups—the attending clinic plastic surgeon and an independent expert panel. The primary outcome measures, operative or conservative, were compared between the groups. Intraclass correlation of 0.61 infers moderate reliability in the consistency of recommended management plans across all groups.

Results

Key predictors for opting for operative management, regardless of the decision-maker, included clinical signs of scissoring, extension deficit, and radiographic evidence of intra-articular extension.

Conclusions

These findings support the potential for artificial intelligence applications in enhancing diagnostic and treatment decisions.

Type of study/level of evidence

Therapeutic IV.

目的人工智能和机器学习技术融入医疗领域带来了显著的进步,尤其是在临床决策支持系统领域。本前瞻性队列研究评估了将 ChatGPT-4 plus 纳入第五掌骨下骨折治疗的潜力。将 ChatGPT-4 plus 提供的治疗建议与两个对照组(整形外科主治医生和独立专家小组)的治疗建议进行了比较。两组的主要结果指标(手术或保守治疗)进行了比较。结果无论决策者是谁,选择手术治疗的主要预测因素包括剪切的临床表现、伸展障碍和关节内伸展的影像学证据。结论这些发现支持了人工智能应用在提高诊断和治疗决策方面的潜力。
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引用次数: 0
Understanding Changing Demographic and Treatment Trends of Distal Radius Fractures: A TriNetX Database Contemporary Analysis of 32,912 Patients 了解桡骨远端骨折不断变化的人口统计学和治疗趋势:对 32,912 名患者进行的 TriNetX 数据库当代分析
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.01.005

Purpose

Distal radius fractures (DRF) are among the most commonly encountered fractures. The population of the United States is rapidly growing, aging, and diversifying. This study was undertaken to better understand current incidences and treatment trends across all ages, gender, and races to inform resource allocation and to potentially address treatment inequities.

Methods

The TriNetX US Collaborative Network was queried for all patients diagnosed with DRFs from 2017 to 2022. Cohorts were defined by inclusion and exclusion of Current Procedural Terminology procedure codes and categorized into operative and nonsurgical groups. Statistical analysis was performed to determine differences in management among demographic groups across the 6-year time period.

Results

Incidence rates of operative intervention for DRF increased from 19.6% in 2017 to 23.6% in 2022. Incidence rates of operative intervention increased from 21.7% to 25.2% for females and from 15.3% to 19.7% for males. A bimodal distribution was observed in females with more fractures occurring in the pediatric and geriatric ages, but this distribution was not observed in males. All demographic groups had an overall higher incidence of nonsurgical intervention. Patients aged 40–64 years were more likely to undergo operative intervention than patients 18–39 years. Females were more likely to undergo operative intervention than males. White patients were more likely to undergo operative intervention than Black patients and Asian patients.

Conclusions

The incidence of DRFs continues to climb, as does their rate of operative management. The classic bimodal distribution was observed in females, but not males. However, differences in management of DRFs were also observed across different demographic groups with ongoing racial disparities. Future consideration should be taken into optimizing treatment disparities relative to demographic status.

Type of Study/Level of Evidence

Prognosis IV.

目的桡骨远端骨折(DRF)是最常见的骨折之一。美国人口正在迅速增长、老龄化和多样化。本研究旨在更好地了解目前各年龄段、性别和种族的发病率和治疗趋势,以便为资源分配提供信息,并潜在地解决治疗不公平的问题。方法查询 TriNetX 美国协作网络中 2017 年至 2022 年诊断为 DRF 的所有患者。通过纳入和排除《现行手术术语》(Current Procedural Terminology)手术代码来定义队列,并将其分为手术组和非手术组。结果DRF的手术干预发生率从2017年的19.6%上升到2022年的23.6%。女性的手术干预发生率从 21.7% 上升至 25.2%,男性的手术干预发生率从 15.3% 上升至 19.7%。女性的骨折发生率呈双峰分布,更多的骨折发生在儿童和老年阶段,而男性则没有这种分布。所有人口组别中,非手术干预的总体发生率都较高。与 18-39 岁的患者相比,40-64 岁的患者更有可能接受手术干预。女性比男性更有可能接受手术干预。白人患者比黑人患者和亚裔患者更有可能接受手术干预。女性中出现了典型的双峰分布,而男性则没有。然而,在不同的人口群体中,DRFs 的处理也存在差异,种族差异仍在持续。未来应考虑优化与人口状况相关的治疗差异。
{"title":"Understanding Changing Demographic and Treatment Trends of Distal Radius Fractures: A TriNetX Database Contemporary Analysis of 32,912 Patients","authors":"","doi":"10.1016/j.jhsg.2024.01.005","DOIUrl":"10.1016/j.jhsg.2024.01.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Distal radius fractures (DRF) are among the most commonly encountered fractures. The population of the United States is rapidly growing, aging, and diversifying. This study was undertaken to better understand current incidences and treatment trends across all ages, gender, and races to inform resource allocation and to potentially address treatment inequities.</p></div><div><h3>Methods</h3><p>The TriNetX US Collaborative Network was queried for all patients diagnosed with DRFs from 2017 to 2022. Cohorts were defined by inclusion and exclusion of Current Procedural Terminology procedure codes and categorized into operative and nonsurgical groups. Statistical analysis was performed to determine differences in management among demographic groups across the 6-year time period.</p></div><div><h3>Results</h3><p>Incidence rates of operative intervention for DRF increased from 19.6% in 2017 to 23.6% in 2022. Incidence rates of operative intervention increased from 21.7% to 25.2% for females and from 15.3% to 19.7% for males. A bimodal distribution was observed in females with more fractures occurring in the pediatric and geriatric ages, but this distribution was not observed in males. All demographic groups had an overall higher incidence of nonsurgical intervention. Patients aged 40–64 years were more likely to undergo operative intervention than patients 18–39 years. Females were more likely to undergo operative intervention than males. White patients were more likely to undergo operative intervention than Black patients and Asian patients.</p></div><div><h3>Conclusions</h3><p>The incidence of DRFs continues to climb, as does their rate of operative management. The classic bimodal distribution was observed in females, but not males. However, differences in management of DRFs were also observed across different demographic groups with ongoing racial disparities. Future consideration should be taken into optimizing treatment disparities relative to demographic status.</p></div><div><h3>Type of Study/Level of Evidence</h3><p>Prognosis IV.</p></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 4","pages":"Pages 477-483"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589514124000148/pdfft?md5=5d77117db3df98f252e17873d85db03c&pid=1-s2.0-S2589514124000148-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomechanical Analysis of a New Odd-Numbered Strand Suture Technique for Early Active Mobilization After Primary Flexor Tendon Repair 用于初级屈肌腱修复术后早期主动活动的奇数股缝合新技术的生物力学分析
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.02.013

Purpose

The placement of multistrand sutures during flexor tendon repair is complex and challenging. We developed a new, simpler, nine-strand suture, which we term the Tajima nines. The Tajima nines repair method is a new odd-numbered strand tendon technique.

Methods

Fourteen porcine flexor tendons were transected and repaired using the Tajima nines repair method, without placement of peripheral sutures. This technique is a modification of the Lim and Tsai repair method; it uses a 4-0 monofilament nylon, 3-strand line, and two needles. The repaired tendons were tested for linear, noncyclic, load-to-failure tensile strength. The initial gap, 2-mm gap-formation force, and ultimate strength were measured.

Results

The initial gap-formation force was 27.9 ± 7.5 newtons (N), the 2-mm gap-formation force was 39.2 ± 4.7 N, and the ultimate strength was 76.7 ± 17.2 N. Eight, three, and three of the 14 tendons repaired using the Tajima nines method demonstrated failure because of thread breakage, knot failure, and suture pull-out, respectively.

Conclusions

This biomechanical study demonstrated that Tajima nines repair was associated with particularly high initial tension at the repair site; there were minor variations in the initial load and 2-mm gap-formation load. Our results suggest that Tajima nines repair with peripheral suturing allows the repaired flexor tendon to tolerate the stresses encountered during early active mobilization.

Clinical relevance

This simple nine-strand technique will be particularly useful for inexperienced surgeons who perform early active mobilization after primary flexor tendon repair because the technique is a modification of the Lim and Tsai repair method using a triple strand instead of a double strand.

目的在屈肌腱修复过程中,多股缝合线的放置既复杂又具有挑战性。我们开发了一种新的、更简单的九股缝合线,我们称之为田岛九股缝合线。田岛九股缝合线修复法是一种新型奇数股肌腱技术。方法采用田岛九股缝合线修复法横断和修复 14 条猪屈肌腱,无需放置外围缝合线。该技术是对 Lim 和 Tsai 修复方法的改进;它使用 4-0 单丝尼龙、3 股线和两根针。对修复后的肌腱进行了线性、非循环、加载至断裂拉伸强度测试。结果初始间隙形成力为 27.9 ± 7.5 牛顿(N),2 毫米间隙形成力为 39.2 ± 4.7 牛顿(N),极限强度为 76.7 ± 17.2 牛顿(N)。在使用田岛九针法修复的 14 条肌腱中,分别有 8 条、3 条和 3 条因断线、打结失败和缝线拉出而出现失败。我们的研究结果表明,田岛九针修复术采用周边缝合,可使修复后的屈肌腱承受早期主动活动时所遇到的应力。临床意义这种简单的九针技术对于没有经验的外科医生来说特别有用,因为他们在进行初级屈肌腱修复术后要进行早期主动活动,而这种技术是对 Lim 和 Tsai 修复方法的一种改进,使用的是三针而不是双针。
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引用次数: 0
Pediatric Hand Surgery Training: A Spectrum of Educational Resources 小儿手外科培训:各种教育资源
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.04.004

Treatment of children with upper-extremity trauma, congenital hand differences, cerebral palsy, and brachial plexus birth injuries requires specialized training, given the spectrum of pathology and complexities of treating an individual who is still developing. Although a limited number of dedicated pediatric hand surgery fellowships are available, mastering the large breadth of the field should ideally begin early in training and may take several different pathways. The authors seek to provide a comprehensive list of resources for trainees interested in pediatric hand surgery, including training opportunities, educational tools, and networking organizations. By shining a light on these pediatric hand surgery resources, we hope to encourage future trainees to plan ahead, so that they are well-prepared for the care of children with complex upper limb reconstructive needs.

治疗患有上肢创伤、先天性手部差异、脑瘫和臂丛神经产伤的儿童需要专门的培训,因为病理范围广,而且治疗仍在发育中的个体非常复杂。虽然专门的小儿手外科研究员名额有限,但掌握这一领域的广泛知识最好在培训初期就开始,而且可能会有几种不同的途径。作者试图为对小儿手外科感兴趣的学员提供一份全面的资源清单,包括培训机会、教育工具和网络组织。我们希望通过介绍这些小儿手外科资源,鼓励未来的受训者未雨绸缪,为治疗有复杂上肢重建需求的儿童做好充分准备。
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引用次数: 0
Acral Metastasis to the Hand as the Primary Presentation of Malignancy 作为恶性肿瘤主要表现的手部尖锐湿疣转移
Q3 Medicine Pub Date : 2024-07-01 DOI: 10.1016/j.jhsg.2024.04.006

Metastatic hand tumors are uncommon but important to include in the differential diagnosis for hand masses. In this study, we report the case of a patient presenting initially with hand pain and swelling with no other pertinent medical history except for an extensive smoking history. Subsequent mass biopsy and work-up revealed metastatic lung cancer. Acral metastases to the hand as the first manifestation of a primary tumor are a rare but debilitating condition with a poor prognosis. Hand surgeons must remain aware of the potential for metastatic hand tumors in patients without known malignancy and advocate for the prompt initiation of multidisciplinary care and treatment to maximize patient outcomes.

转移性手部肿瘤并不常见,但必须纳入手部肿块的鉴别诊断中。在本研究中,我们报告了一例最初因手部疼痛和肿胀而就诊的患者,患者除有大量吸烟史外,无其他相关病史。随后的肿块活检和检查发现了转移性肺癌。作为原发肿瘤首发表现的手部骨转移是一种罕见但预后较差的致残性疾病。手外科医生必须时刻警惕未发现恶性肿瘤的患者出现手部转移性肿瘤的可能性,并倡导及时启动多学科护理和治疗,以最大限度地改善患者的预后。
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引用次数: 0
期刊
Journal of Hand Surgery Global Online
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