Journal of Hand and Microsurgery最新文献

Semi-constrained total distal radioulnar joint (DRUJ) arthroplasty with Aptis-Scheker implant has demonstrated excellent results in patients with end-stage rheumatoid arthritis (RA) of the wrist. However, clinical success of the Scheker implant in restoring range of motion may be limited in patients with concomitant degenerative disease at the proximal radioulnar joint and radiocapitellar joint, which work in tandem with the DRUJ to allow pronosupination of the forearm. Among treatment options for elbow arthritis, standalone radial head arthroplasty remains poorly studied in the context of RA, despite being used widely in trauma patients. Here, we illustrate the surgical technique for combined total DRUJ arthroplasty with a Scheker implant and radial head arthroplasty to treat long-standing, refractory RA, at the wrist and elbow joints, with excellent results at 1-year follow-up.

Objectives: This study compared Collagenase Clostridium Histolyticum (CCH) injection and limited fasciectomy (LF) in terms of early post-interventional soft tissue conditions and patient burden, evaluated by visit frequency to surgeons and hand therapists, complications, and reintervention rates.

Materials and methods: Consecutive patients undergoing CCH injection or LF as first-line treatment for Dupuytren's disease over 15 years were assessed. Propensity score matching minimized selection bias. The primary outcome was the assessment of early post-interventional (between 2 and 8 weeks) soft tissue condition using a novel Soft Tissue Score with points assigned for documented swelling, hyperemia, induration, and tenderness. Secondary outcomes included the number of surgeon and hand therapy visits, as well as the complication and reintervention rates in a subgroup of patients followed for at least 4 months.

Results: After propensity score matching, two treatment groups of 26 patients each were formed (CCH vs. LF group). There were no significant differences in baseline characteristics and correction of flexion contracture between the two treatment groups. The early postinterventional Soft Tissue Score was significantly worse in the LF group than in the CCH group (mean 1.35 vs. 0.65 points, MD 0.7, 95 % CI [0.2, 1.2], p = 0.022). The number of surgeon and hand therapy visits was significantly higher in the LF group (mean 4.7 vs. 1.9 visits, MD 2.8, 95 % CI [1.8, 3.8], p < 0.001 and mean 10.5 vs. 4.3 visits, MD 6.2, 95 % CI [0.7, 11.7], p = 0.036, respectively). The rate of mild and severe complications was comparable in both groups. While the reintervention rate was significantly higher in the CCH group, the occurrence of multiple reinterventions was comparable.

Conclusion: The results of this study suggest that CCH injections lead to less complicated wound healing requiring less intensive surgeon and hand therapy aftercare than LF. CCH represents a valuable addition to Dupuytren's disease treatment, allowing for repeated use in severe, complex, or recurrent cases without increasing procedure-related risks while offering versatility for combination with minimally invasive surgery.

Endoscopic carpal tunnel release (ECTR) has advanced considerably since its introduction, providing a minimally invasive alternative to traditional open surgery for carpal tunnel syndrome. This review traces the history of ECTR, highlighting key advancements in techniques and variations. We compare the anatomical visualization between endoscopic and open approaches, particularly regarding nerve and tendon preservation. The role of Wide Awake Local Anaesthesia No Tourniquet (WALANT) in ECTR is discussed, with a focus on its benefits in reducing postoperative pain and recovery time. Additionally, we present our approach to bilateral ECTR, illustrated through pictorial representations, demonstrating the advantages of this technique. We conclude that bilateral ECTR not only accelerates overall recovery but also has the potential to reduce overall healthcare costs.

Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand function, significantly limiting the patient's ability to perform daily activities. Surgical interventions for post-traumatic osteoarthritis of the fifth CMC joint include arthrodesis and arthroplasty, with the Dubert technique combining elements of both approaches. This study aimed to compare the effects of Dubert arthrodesis and traditional fifth metacarpal (MC)-hamate arthrodesis on the flexion-extension range of motion of the fifth MC. An in vitro study was conducted using twelve cadaveric forearm specimens. The specimens were divided into two groups: Group 1 underwent Dubert arthrodesis, and Group 2 underwent fifth MC-hamate arthrodesis. Preoperative and postoperative evaluations were performed using computed tomography (CT) scans to measure the flexion-extension range of motion of the fifth MC. Twelve specimens, with a mean age of 53 years (range: 41-60 years), were analyzed. No significant difference in preoperative flexion-extension motion was observed between the groups. Both groups exhibited a significant reduction in flexion-extension motion following arthrodesis. However, no significant difference in postoperative flexion-extension motion was observed between the groups. Neither Dubert arthrodesis nor fifth MC-hamate arthrodesis preserved the physiological flexion-extension motion of the fifth MC. Biomechanical analysis showed no significant advantage of one technique over the other. The Dubert arthrodesis procedure was technically demanding, with inadequate resection potentially leading to residual symptoms. Further comparative clinical studies are required to confirm these findings and determine the optimal surgical approach for managing fifth MC arthritis.

Purpose: Hand and wrist trauma is a frequent cause of emergency room (ER) visits. However, hospitals often lack immediate hand specialist coverage. This study aims to evaluate the efficacy of Artificial Intelligence (AI) platforms like ChatGPT in aiding in the diagnosis and patient management of upper extremity trauma.

Methods: Ten clinical vignettes depicting common hand and wrist emergency clinical situations were created by the senior author to represent a broad range of common upper extremity injuries. These were presented to plastic surgery residents and ChatGPT (version 4.0). The responder was tasked to provide a diagnosis, ER management, and definitive treatment plans for each vignette. Responses were collected and scored by two attending plastic surgeons, blinded to the source, on a scale of 0 (poor) to 30 (excellent). Univariate and linear regression models were utilized for analysis.

Results: A total of 16 resident responses (9 junior and 7 senior) and 16 ChatGPT responses were collected for each of the 10 clinical scenarios. ChatGPT had significantly higher total average scores (mean = 26.6 vs. 22.7, p < 0.05) and ER management scores (mean = 9.9 vs. 6.7, p < 0.05) when compared to residents. We did not find any notable differences in diagnosis or definitive treatment scores between residents and ChatGPT responses. However, the study was not sufficiently powered to detect smaller effect sizes in these areas. No apparent correlations between scores and resident year of training were observed.

Conclusions: ChatGPT provided clinically accurate diagnosis and management plans for upper extremity trauma. Implementing AI in trauma management has the potential to improve the management of hand and wrist trauma in emergency settings by serving as a diagnostic and clinical reference tool for emergency medical providers. However, their integration into clinical practice should be carefully evaluated and focused on complementing, and not replacing, traditional consults. Ultimately, these tools could alleviate the burden placed on ERs and limit reliance on hand consults.

Purpose: Artificial intelligence (AI) is transforming orthopedics by improving diagnostic accuracy, optimizing surgical planning, and personalizing treatment approaches. This review evaluates the applications of AI in orthopedics, focusing on its impact on patient care, the efficacy of AI methodologies, and challenges in integrating these technologies into clinical practice.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar for articles published up to 28^th February 2025. Inclusion criteria included studies addressing AI applications in orthopedics, while non-peer-reviewed and non-English publications were excluded. Data extraction focused on AI technologies, applications, outcomes, and the advantages or limitations of AI integration.

Results: Findings demonstrate AI's effectiveness in areas such as fracture detection and treatment planning, mainly through machine learning and deep learning. AI has improved outcomes in joint reconstruction, spine surgery, and rehabilitation. However, challenges such as data standardization and clinical validation remain.

Conclusion: The review highlights AI's potential to revolutionize orthopedic practice, emphasizing the need for ongoing research to overcome barriers to adoption. Future directions should prioritize multi-center clinical trials, enhanced data protocols, and stakeholder collaboration to ensure ethical and effective AI implementation, ultimately improving patient outcomes and care delivery.

Introduction: Recently introduced image processing capabilities of AI models, which are accessible to a broad audience, may contribute to progress in medical research. Inspection and physical examination are important components of hand injury assessment, but they have inherent limitations in accuracy. The purpose of this study was to compare the structures identified as damaged during physical examination with those predicted by an AI model, utilizing its image processing capability. We hypothesized that the AI tool would demonstrate a level of accuracy comparable to that of physical examination in predicting injured structures.

Methods: We retrospectively reviewed the files of patients with hand and forearm injuries related to the volar aspect from January 2024 to July 2024. After exclusions, a total of 30 patients were included in the final analyses. Structures suspected to be damaged based on the initial evaluation and those identified as injured during surgery were documented through chart review. For the same patients, the AI tool (ChatGPT-4.0) was utilized to predict injured structures from clinical photos obtained during the initial examination. We examined the correlation and overlap between the structures identified as injured during the initial clinical examination and those predicted by the AI tool, as well as the correlation and overlap between the structures predicted by the AI tool and those confirmed as injured during surgical procedures.

Results: The sensitivity of the physical examination was found to be 66.0 % (95 % CI: 57.5 %-73.7 %), while the specificity was 98,7 % (95 % CI: 97,6 % to 99,4 %). The sensitivity of the AI tool was found to be 61.7 % (95 % CI: 53.1 %-69.8 %), while the specificity was 82.4 % (95 % CI: 79.4 %-85.2 %).

Conclusion: In its current form, AI demonstrates limited yet promising potential as an adjunctive tool in the clinical evaluation of flexor-side injuries of the hand and forearm.

Level of evidence: III, Diagnostic study.

Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement in isolated distal ulnar fractures, specifically AO Muller Q2 and Biyani Type I fracture pattern, during forearm pronosupination.6 fresh frozen cadaveric upper limbs amputated at mid-humerus were used. Soft tissues including proximal and distal radioulnar joints were carefully preserved. Specimens were inspected grossly and radiographically for absence of pathologies. Radiocarpal and midcarpal pinning was performed to facilitate quantification of forearm rotation. 2 markers were each placed proximal and distal to fracture site to quantify fracture displacement. 3-dimensional positional data was recorded using an optoelectronic system (Vicon MX motion capture system).Distance between the 2 markers increased in the proximodistal and radioulnar axis, and decreased in the dorsovolar axis when the forearm was rotated from neutral to 100° pronation. The inverse was observed during supination. Mean aggregate fracture site displacement increased to 9.17 ± 2.78 mm at 100° pronation. Statistically significant increase in aggregate fracture site displacement was observed from 60° pronation onwards. At 100° supination, the aggregate fracture site displacement was 4.58 ± 8.62 mm. When supinating from neutral to 100°, fracture displacement did not increase significantly.

Results: from this study suggest that distal ulnar fractures are potentially stable, particularly in supination. However, unrestricted forearm pronation with inadequate immobilisation might still cause further fracture displacement. Further studies are required to assess distal ulnar fracture stability in vivo before treatment guidelines can be established.

Background: Although pollicization remains the traditional treatment strategy for modified Blauth type IIIB-V grade congenital thumb hypoplasia, many patients and parents express interest in alternative reconstructive approaches that maintain a five-digit hand. The aim of this study was to provide a summary of these alternative techniques and to assess for differences in their outcomes, with the hypothesis that techniques featuring vascularized bone grafts would have fewer instances of bone resorption or nonunion relative to non-vascularized techniques.

Methods: A systematic literature review was conducted in PubMed, Embase, and CINAHL using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the reconstruction of modified Blauth type IIIB-V hypoplastic thumbs were included. Chi squared tests (or Fisher exact tests where appropriate) were performed to compare aggregate complication data.

Results: Twenty-four articles met inclusion criteria, yielding 207 patients with 210 thumbs undergoing reconstruction. Mean patient age at surgery was 3.4 years, while the mean follow-up time was 4.2 years. 203 of the 207 patients underwent reconstruction using one of five techniques: PIPJ/MTPJ transfer, hemi-metatarsal transfer, toe and metatarsal transfer, iliac crest transfer, and toe phalanx transfer. PIPJ and MTPJ transfers were the most performed procedures (n = 54, 26 %). Vascularized grafts were used in 89 cases (43 %), while non-vascularized grafts comprised 114 cases (55 %). Rates of bone resorption and nonunion were higher in non-vascularized grafts, though not significantly so (n = 203, p = 0.19). Conversely, donor site complications were significantly higher in vascularized bone grafting techniques (n = 203, p = 0.0056). The most frequently reported outcome measures were Kapandji scores (46 %) and key pinch strength (46 %). Kapandji scores had a weighted mean of 5.6 (range 3.1-6.7).

Conclusion: A variety of alternative techniques exist for reconstructing severely hypoplastic thumbs, though no technique demonstrates clear superiority. Vascularized grafts trend towards a lower bone resorption/nonunion rate relative to non-vascularized grafts, though there is evidence of heightened risks of donor site complications when taking vascularized bone grafts from the foot. Objective outcome measures showed variability across studies limiting comparisons between techniques.