Journal of Hand and Microsurgery最新文献

Adverse reaction to metal debris (ARMD) consists of a spectrum of changes ranging from pure metallosis to aseptic lymphocytic vasculitis-associated lesion and granulomatous inflammation. Currently described ARMD cases are mainly limited to arthroplasty, typically total hip and knee arthroplasties in the lower limb and total wrist arthroplasty in the upper limb. Hypersensitivity to a metallic implant in fracture fixation is rare, and a severe form of metallosis has not been reported so far. In this paper, we present a case of ARMD occurring 10 years after the use of titanium implants for fracture fixation in the hand. Intra-operative findings, histopathological results, and a literature review on ARMD are also described.

Background  There is notable evidence that unhelpful thoughts (symptoms of anxiety and depression) increase symptom intensity among patients with trapeziometacarpal osteoarthritis (TMC OA). Surgeons may or may not be mindful of this line of evidence when interacting with patients. In a survey-based experiment, we randomized surgeons to be prompted about the psychosocial aspects of TMC OA. We aimed to measure the influence of mindfulness of mental health on treatment recommendations and willingness to discuss mental health interventions. Methods  We randomized 121 hand surgeons to read one of two paragraphs: (A) about biomedical treatment options for TMC OA, or (B) about the impact of mental and social aspects on TMC OA. Thereafter, surgeons were asked several questions about their opinions and treatment recommendations. Results  We found that prompting surgeons with information about the psychosocial aspects of TMC OA did not influence their attitudes or treatment recommendations. Most surgeons were willing to offer patients a workbook (92%) or psychologist referral (84%). Among the few surgeons declining to refer, their reasoning was "it would not be of any help" and "stigmatization." Conclusion  The observation that a paragraph to encourage mindfulness about the psychosocial aspects of TMC OA, which had no influence on surgeon opinions, suggests that awareness may not be a major factor accounting the relatively limited implementation of this evidence in practice to date. Surgeons seem aware of the importance of psychological influence and barriers may include availability, stigma, and a sense of futility. This is a diagnostic study that reflects level of evidence III.

Introduction  Studies have shown a link between patients' preoperative expectations and their postoperative satisfaction. However, limited studies exist concerning patient factors associated with higher preoperative expectations in the hand surgery population. This study analyzed preoperative expectation scores of patients undergoing hand surgery and aimed to determine associated patient characteristics. Materials and Methods  A total of 418 elective hand surgery patients aged 15 years and older enrolled in a prospectively collected orthopaedic registry from June 2015 to December 2018 were analyzed. Patients were administered preoperative questionnaires including six Patient-Reported Outcome Measurement Information System domains and other activity and pain scales. Expectation scores were measured using the six domains of the Musculoskeletal Outcomes Data Evaluation and Management System expectations questionnaire. Bivariate and multivariable analyses were conducted to identify independent predictors of higher expectations. Results  Overall, patients had high expectations (≥ 80.0) of their hand surgery. Higher mean expectation scores were seen with females, college graduates, better baseline health status, and fewer prior hand surgeries ( p  < 0.05 for all). No significant associations were found among the Common Procedural Terminology codes and expectations. Multivariable analysis confirmed that college degree ( p  = 0.023) and less pain ( p  = 0.008) were predictive of higher baseline expectations. Conclusion  In sum, more educated patients with less pain at baseline and better baseline health status have higher expectations of their hand surgery. Hand surgeons can use these results to help focus their preoperative counseling and expectation management.

Background  Distal radius fractures (DRF) are the second most common fragility fracture experienced by the elderly, and surgical management constitutes an appreciable sum of Medicare expenditure for upper extremity surgery. Using Medicare data from 2012 to 2017, our primary aim was to describe temporal changes in surgical treatment, physician payment, and patient charges for DRF fixation. Methods  We examined surgical volumes and retrospective patient charge (services billed by surgeon) and surgeon payment (professional fee) data from 2012 to 2017 for four DRF surgeries: closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF) of extra-articular fractures, ORIF of intra-articular (IA) (2-fragment) fractures, and ORIF of IA (> 3 fragments) fractures. The reimbursement ratio was defined and calculated as the ratio of charges to payment. Rates were adjusted for inflation using the annual consumer-price index. Results  For these four surgeries from 2012 to 2017, total patient charges grew by 64% from $117 to 193 million, while surgeon payment grew by 42% from $30 to 42 million. CRPP cases fell by 47%, while ORIF increased by 17, 14, and 45% for extra-articular, IA (2-fragment), and IA (> 3 fragments) surgeries, respectively. After adjusting for inflation, payment to physicians increased by more than or equal to 16% for all procedures except for CRPP, which fell by 2%. Charges during this same period increased from 13 to 38%. Reimbursement ratios declined from -9.2% to -13% for each procedure. Conclusion  From 2012 to 2017, while charges have outpaced surgeon payment, payment has outpaced inflation for all forms of distal radius ORIF, aside from CRPP. There has been a continued sharp decline of CRPP. Level of Evidence is III, economic.

Coverage of posttraumatic and chronic wounds at the distal leg is a difficult problem due to limited soft tissue available for local flaps. The sural flap is a versatile and effective method for reconstruction in this area since it does not need a significant amount of time or assistance to complete. Improving the survival of these flaps is critically dependent on understanding the basics of flap circulation and why recent modifications were introduced. This review will serve as a much-needed comprehensive analysis of these topics for surgeons looking to increase the reliability of their sural flaps.

We report a case of chronic scapholunate ligament insufficiency in a patient with scaphocapitate coalition. After more than 4 years of mild symptoms, there was no radiological evidence of progression to scapholunate advanced collapse in spite of minimal load-bearing repetitive physical activities undertaken by the patient as a professional guitarist. We believe that scaphocapitate coalition could contribute to mitigate the progression to scapholunate advanced collapse by preventing abnormal flexion of the scaphoid once the ligament is not competent anymore. The biomechanical and surgical implications of this type of carpal coalition are also discussed.

Objectives  Flap surgery using a wide awake local anesthesia no tourniquet (WALANT) technique has historically been avoided because of technical challenges and concerns regarding the vasoconstriction caused by the necessary injection of epinephrine alongside the local anesthetic. The objective of our work was to evaluate the viability of the hand flaps performed using a WALANT technique compared with those performed under regional with a tourniquet. Materials and Methods  Seventy-four patients were enrolled in a prospective comparative single-center study and subsequently divided into two groups: 36 patients in the locoregional anesthesia group and 38 patients in the WALANT group. Flap viability was evaluated on day 2 and day 10 using predetermined criteria. Results  We did not find any significant difference in outcomes assessed for flap viability between the two groups postoperatively. Conclusion  There was no evidence to suggest that vascularization of the flaps was compromised by the injection of epinephrine. The WALANT technique may, therefore, potentially be able to be safely deployed within this population.

Objective  Since 1958, more than 50 postresidency fellowship programs in hand surgery have been introduced within the United States. Ongoing changes in health care and medical education necessitate the evaluation of these fellowships. The purpose of this study is to identify trends in operative experience over time regarding procedure volume, surgery type, and anatomic region. Materials and Methods  National Accreditation Council for Graduate Medical Education (ACGME) case logs of graduating orthopaedic hand surgery fellows were evaluated for years 2011 to 2019. Procedures were grouped according to ACGME-defined categories for hand surgery. The mean number of procedures per fellow in each category was trended over time using a Mann-Kendall test. Results  All 1,257 fellows were included. The mean number of procedures completed annually by each fellow increased from 797.6 in 2011 to 945.6 in 2019 ( p  < 0.01). Over the course of the study period, there were increases in the number of "soft tissue," "fracture," and "nerve" procedures ( p  < 0.001), while the number of "congenital" procedures decreased ( p  < 0.05). Additionally, small but statistically significant increases were found in "amputation," "Dupuytren's," and "decompression of tendon sheath/synovectomy/ganglions" procedures ( p <  0.01). Conclusion  There has been an increase in the number of procedures performed by orthopaedic hand surgery fellows over the past decade. This appears to be due to the increase in nerve, fracture, and soft tissue categories, and there has been a decrease in the number of congenital cases completed. These data confirm that the operative experiences for most hand surgery fellows are robust and growing over time.