Journal of Hand and Microsurgery最新文献

Purpose: Trapeziectomy has a particularly significant role in relieving pain in patients with trapeziometacarpal arthritis. With the advantage of arthroscopy combined with hematoma distraction, arthroscopic distal trapeziectomy can achieve good pain relief with minimum wound complications.

Aim: Evaluation of the clinical and functional results of arthroscopic distal trapeziectomy and hematoma distraction.

Patients and methods: The study included thirty patients with stage II and III trapeziometacarpal arthritis. The articular surface & subchondral bone were resected. Then the joint was distracted using percutaneous Kirschner wires. The mean follow-up period was about 20 months.

Results: There was a statistically significant difference in pre- and post-operative pain scores with slight improvement of tip & key pinch strength.

Conclusion: According to our study findings, arthroscopic distal trapeziectomy and hematoma distraction can be performed with significant improvements and satisfactory clinical and functional results in patients with stage II and III trapeziometacarpal arthritis.

Background: Fractures of the proximal humerus are prevalent among the elderly, often posing challenges in anatomical reconstruction and internal fixation. Precise anatomical knowledge tailored to specific populations is essential for optimal surgical outcomes. This study aims to quantitatively evaluate the anatomical characteristics of the proximal humerus in the Vietnamese population through multiplanar computed tomography (CT) and cadaveric measurements, and to determine the consistency between the two modalities.

Methods: A prospective descriptive study was conducted on 75 CT scans and 30 shoulder specimens from 15 fresh cadavers. Parameters measured included the neck-shaft angle, diameters of the humeral head (superior-inferior and anterior-posterior), width of the greater tuberosity, deltoid tuberosity index, and distances from the greater tuberosity to anatomical landmarks such as the lesser tuberosity, bicipital groove, and pectoralis major insertion.

Results: The average neck-shaft angle was 132.36° ± 2.44°, with most values within 130°-140°. The deltoid tuberosity index averaged 1.76 ± 0.20, exceeding thresholds reported in previous studies. No statistically significant differences were found between CT and cadaveric measurements across most parameters (p > 0.05). The anatomical measurements were found to be smaller than those reported in Western populations but comparable to other Asian populations.

Conclusion: The study confirms that CT imaging provides reliable and accurate morphometric data comparable to cadaveric dissection. Key anatomical landmarks such as the pectoralis major insertion, lesser tuberosity, and bicipital groove can serve as consistent intraoperative references for implant positioning in Vietnamese patients.

Purpose: Hand surgery decision-making requires integration of complex anatomical understanding, diverse patient-specific factors, and nuanced operative techniques. While artificial intelligence (AI), large language models (LLMs), and retrieval-augmented generation (RAG) models have advanced significantly in various fields, no AI-driven clinical decision support systems currently exist for hand surgery. A novel retrieval-enhanced AI large language model specifically tailored for hand surgery was developed, capable of effectively utilizing peer-reviewed published hand surgery literature for clinical decision support in real-time at point of care.

Methods: An AI clinical decision support system was developed integrating all available open-access 4510 peer-reviewed hand surgery publications from 2000 to 2024 identified through hand surgery-relevant keywords. Documents were processed using a hierarchical pipeline based on the RAPTOR methodology, which breaks down large texts into smaller segments to enhance accurate retrieval. The system was evaluated using 15 standardized clinical queries assessed using automated computational metrics for correctness and semantic similarity to source documents.

Results: The AI system demonstrated consistent performance with an average G-Eval correctness score of 0.79, SEM with an average similarity score of 0.75 (range: 0.54-0.86) and average maximum similarity score of 0.80 (range: 0.56-0.91), predominantly at moderate confidence levels. Generated recommendations were contextually appropriate and reliably linked to relevant hand surgery literature, providing accurate and clinically meaningful guidance.

Conclusion: The AI system, HandRAG, incorporating RAG and LLM approach offers potential benefits for evidence-based clinical decision support and education in hand surgery.

Background: The Jamar dynamometer is the gold standard to assess hand grip strength, but is expensive. The Camry dynamometer is relatively cost-effective. There is a dearth of literature on Camry's validation in healthy Indian adults, which is important to establish as hand grip is known to vary with age, gender and race.

Objectives: To establish the reliability and validity of the Camry dynamometer in comparison to the Jamar handheld dynamometer among healthy Indian adults in the age group of 20-59 years.

Methods: Following basic demographics, occupation and hand dominance, three trials of each dynamometer were performed in standardised positions for the non-dominant and dominant hand of each participant and the best value was recorded. A gap of 10 min was provided between the 2 dynamometers. Data was then recorded and analyzed.

Results: 120 participants were recruited, with an equal males and females. The mean isometric hand grip strength for the non-dominant hand was 26.71 ± 9.29 kgf, and for the dominant hand was 27.66 ± 9.12 kgf using the Camry hand-held dynamometer, while it was 26.43 ± 9.07 kgf for the non-dominant and 27.37 ± 9.26 kgf for the dominant side using the Jamar Hand Held dynamometer. Data was further analyzed with age and gender stratification. The Camry hand-held device had excellent reliability (ICC>0.97) and good validity with Pearson's correlation index of 0.97 (p < 0.05) for the dominant hand and 0.99 (p < 0.05) for the nondominant hand, and Bland-Altman's graphics showing more than 90 % of measures within confidence limits.

Conclusion: Camry digital dynamometer is a reliable and valid device to measure isometric handgrip strength in healthy Indian adults compared to the Jamar hydraulic handgrip dynamometer.

Background: The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in conjunction with open reduction and internal fixation (ORIF) and hardware placement. Secondary objectives were to determine incidence of fracture union and limb salvage. Finally, we sought to identify flap-related factors that might impact rates of infection, flap failure, and nonunion.

Methods: A consecutive single-surgeon series was studied. Baseline patient characteristics, flap-related factors, incidence of hardware failure, amputation, and non-union were extracted and analyzed.

Results: A total of 37 consecutive patients with a mean age of 38.9 ± 16.4 years were included, with a mean postoperative follow-up of 703.4 ± 459.6 days. There were 9 patients (24.3 %) with hardware failure and deep tissue infection. Time from injury to flap and time from last ORIF to flap were not significantly different between patients with hardware failure and those without. Flap type (muscle versus fasciocutaneous), smoking status, diabetes and body mass index were not associated with hardware failure. Multivariate regression analysis controlling for potential confounders showed that older age in patients was the only significant factor predicting hardware failure. Bone union was achieved in 29 (78.4 %) patients. Mean time from surgery to radiological signs of union was 329.3 ± 425.3 days.

Conclusion: In patients requiring free flap reconstruction and ORIF for open tibial and ankle fractures, age was the only significant non-modifiable risk factor for hardware failure.

Scapholunate instability is a common wrist injury that significantly affects wrist function and biomechanics. This study compares three internal brace fixation methods for stabilizing the scapholunate interval in cadaveric models with a control group with intact ligaments (Group C): (1) internal brace without interference screw (Group N), (2) internal brace outside the interference screw (Group O), and (3) internal brace within the interference screw (Group I). The study aims to evaluate biomechanical stability, bone integrity, and osteolysis risk. Thirty-two cadaveric wrists were divided into four groups and subjected to biomechanical testing, including static, dynamic, and failure tests. Results showed that Group C exhibited a maximum failure load at 347.6 ± 21.4N; Group I exhibited the highest maximum failure load (319.4 N ± 28.7 N) and no recurrence of Dorsal Intercalated Segment Instability (DISI) during dynamic testing. Group N demonstrated the lowest biomechanical strength (118.5 N ± 15.3 N) and a 75 % DISI recurrence rate. Group O showed intermediate performance, with a maximum failure load of 221.7 N (±24.6 N) and a 37.5 % DISI recurrence rate. Imaging evaluation revealed that Group I had the least bone damage (2.1 % ± 0.9 %), while Group N had the most (24.8 % ± 2.3 %). The study concludes that placing the internal brace within the interference screw (Group I) offers superior biomechanical stability and bone protection, making it a promising technique for scapholunate stabilization. However, further clinical studies are needed to confirm these findings.

Background: Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. The utilization of the surgical microscope during resection of digital TGCTs appears to be beneficial for more detailed visualization. We presented the outcomes of microsurgical resection of TGCT and discussed how to prevent recurrence of TGCT.

Methods: We reviewed 34 consecutive patients with TGCT cases operated by the single operator. The age at surgery ranged from 9 to 77 years, with an average of 48. The most common affected digit was the thumb (n = 13). In all cases, an operating microscope was utilized. The postoperative follow-up period was an average of 27.6 months.

Results: Intraoperative findings with the use of a microscope revealed an unexpectedly large number of cases with continuity to the adjacent joints. In cases of joint invasion, the capsule was opened to directly visualize the inside of the joint, and intra-articular tumor was resected enbloc together with extra-articular components. The classification of the disease was mixed type in 17 digits, localized type in 17. Postoperative recurrence was found in only one case (2.9 %).

Conclusion: Microsurgery may be a beneficial tool for TGCT resection, but there have been only few reports. Invasive TGCT into the volar plate or infiltrating into the bone near the tendon attachment are well visualized and could be more certainly resected. The recurrence rate after microscopic TGCT resection was only 2.9 %, which is probably the lowest rate in the previously reported literature. Microsurgery allows sufficient visualization of the TGCT invasion and is useful for dissection of digital nerves and arteries.