Journal of Hand and Microsurgery最新文献

Kienbock's Disease is a rare disease with insidious clinical symptoms and characteristic features on imaging. However, the clinical and radiological findings are similar to many other pathologies affecting the lunate. We present a precise definition of the Kienbock's wrist, and an overview of other pathologies affecting the lunate. Better understanding of the clinical, radiological and arthroscopic findings of these diseases, allows accurate diagnosis and effective management strategy.

Thumb hypoplasia, a congenital malformation characterized by an underdeveloped or absent thumb, presents significant functional and aesthetic challenges. In Vietnam, a low-middle income developing country, the management of thumb hypoplasia is shaped by limited resources, geographic disparities, and reliance on international collaborations. This article reviews the current state of diagnosis, surgical treatment, and rehabilitation of thumb hypoplasia in Vietnam, with a focus on the unique challenges faced by healthcare providers in resource-constrained settings. The role of international experts, including Dr. Terry Light, Dr. Takehiko Takagi, Dr. Alain Gilbert, and Dr. Philippe Valenti, is emphasized for their contributions in shaping advanced surgical techniques and mentoring local surgeons. We also discuss the critical involvement of the Vietnam Pediatric Orthopaedic Association (VPOA) in promoting pediatric orthopedic care. Future recommendations include expanding access to specialized care, improving surgical training, decentralizing services to rural areas, and encouraging the publication of local research to foster global collaboration. By addressing these areas, Vietnam can continue to enhance outcomes for children affected by thumb hypoplasia.

Purpose: Index finger pollicization is a surgical technique used for Blauth Types IIIB and IV thumb hypoplasia reconstruction. Traditionally, index finger pollicization techniques have not addressed management of the rudimentary thumb/pouce flottant; with no improvements made to the thenar eminence, it often remains flat and hypoplastic. This case series aims to contribute to the body of literature supporting the technique of index finger pollicization with use of the pouce flottant to create a vascularized adipofascial flap for reconstruction of the thenar eminence.

Methods: From 2018 to 2024, a single surgeon performed a modified index finger pollicization technique on seven patients with Blauth Type IIIB and IV thumb hypoplasia. The skin incision technique incorporates the vascular pedicle to the pouce flottant to allow for creation of a vascularized adipofascial flap. This approach utilizes the soft tissue components of the remnant thumb to reconstruct the thenar eminence with a filet flap derived from portions of the typically discarded hypoplastic thumb. Cosmetic and functional outcomes were evaluated by the surgeon, the occupational therapist and the patients' parents. Functional outcomes assessed include evaluation of thumb opposition, stability, and pinch.

Results: The use of an adipofascial flap from the rudimentary thumb provided sufficient bulk to improve the appearance of the thenar eminence and hand without complications. All patients achieved satisfactory cosmetic results. All the parents were satisfied with the appearance of the hand. Two patients initially showed disfavor to utilizing the newly created thumb and restraint therapy was successfully employed to encourage use of the new thumb. The thenar eminence was maintained at latest follow-up for all patients. At one-year follow-up, all seven patients demonstrated opposition, strong pinch, flexion, and extension with continued satisfactory cosmetic results.

Conclusion: For patients with Type IIIB and IV thumb hypoplasia, soft tissue components of the remnant thumb/pouce flottant can be used as an adipofascial flap to improve the cosmetic result of pollicization. All patients demonstrated satisfactory functional and cosmetic results with improved appearance of the thenar eminence. The technique was reproducible, suggesting its implementation should be incorporated into standard practice for treatment of Types IIIB and IV thumb hypoplasia.

Since 1997, arthroscopic bone grafting has offered hand surgeons a solution to the riddle of scaphoid fracture nonunion. The intended merit of an arthroscopic approach for scaphoid fracture nonunion management lies in its minimal invasiveness, which preserves the tenuous vascularity of the scaphoid, poses minimal disturbance to carpal ligaments, and allows comprehensive evaluation in diagnostic uncertainty. What does the evidence tell us about its outcomes and limitations compared to open techniques? Level III evidence suggests that arthroscopic bone graft yields similar union rates and potentially earlier time to union compared to open bone graft, at an average union rate of 96 % and union time of 13.5 weeks. It offers a universal solution to scaphoid fracture nonunion, with similar union rate and time achieved regardless of smoking, chronicity, proximal fracture or avascular necrosis. Radiological correction of humpback deformity and dorsal intercalated segment instability (DISI) may be inferior compared to an open technique, but correction to within normal range is still possible. Hence, it's long term clinical implication remains unclear. Perhaps the only true contraindications to arthroscopic bone grafting are proximal pole fragmentation due to unsalvageable necrosis, or advanced scaphoid nonunion advanced collapse (SNAC). While it is easy to get lost in the debate of biology and the necessity of vascularized bone graft, ultimately, fracture healing is multifactorial and surgeons must not neglect the mechanical importance of well placed instrumentation.

In Germany and other European countries, pollicization is still indicated for thumb hypoplasia Manske type IIIB, IV and V. The one-stage procedure is well established and only the details have been refined over the years. In experienced hands, it is a safe operation with few complications. European surgeons focus on overall function combined with the best possible appearance when treating congenital malformations. With pollicization, we can create a thumb that looks and works like a thumb, that can spread, pinch and grasp objects. The function of a Manske type IV with pollicization is better than that of a thumb reconstruction. The European centres for congenital malformations prefer pollicization of the index finger for Manske type IIIB due to good function, growth and having experienced disappointing results after reconstruction with an avascular toe phalanx transfer. The benefit of the complex reconstruction technique with a vascularized hemimetatarsal has not yet been demonstrated. For a fair comparison, we need more data on adult patients with a long follow-up and using the same evaluation scores to determine the correlation between function, appearance, and health-related quality of life in both techniques.

Functionally, the thumb is the most important digit of the hand, allowing for numerous precise movements used in daily life. The thumb is a key factor in our ability to have a prehensile hand, the cornerstone of human evolution. The prehensile hand provides a variety of fine movements allowing for grasp, pinch, and the manipulation of objects. However, children with congenital anomaly of the hand, specifically thumb hypoplasia, have suboptimal thumb functioning. Depending on the severity of thumb hypoplasia, children may have hypoplastic or absent structures and joint instability. Many surgeons, including our practice, opt for early intervention to reconstruct the prehensile hand prior to developmental thumb use. Treatment of mild hypoplasia (types IIa, IIb, and IIIa) focuses on restoring thumb function and prehension, deepening the thumb-index webspace, and stabilizing the metacarpophalangeal joint. Herein we focus on our approach to creating a prehensile hand whilst specifically utilizing the abductor digiti minimi transfer.

Purpose: Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to procedural complexity and lack of microsurgical availability. While FFMT is well described for brachial plexus injury and facial trauma, its application in Volkmann's ischemic contracture (VIC) is underexplored, with variable operative timelines and postoperative outcomes.

Methods: Following PRISMA-ScR guidelines, PubMed and Ovid electronic databases were searched using the following keywords: "Volkmann," "compartment syndrome," "muscle transfer," "muscle transplantation," and/or "reconstruction." Studies were imported into Covidence, and screening was performed by two independent reviewers. Patient characteristics, surgery information, and postoperative clinical data were extracted.

Results: The scoping review included 21 studies. In total, 163 FFMTs for VIC were performed, most commonly using the gracilis muscle (64.4 %) for finger flexion deficits (91.4 %). Nerve selection was variably reported, with the anterior interosseus nerve (AIN) used most frequently. Grip strength, range of motion, and total active motion were the most frequently utilized outcome measures. FFMT success rates were high (96 %), and 34.6 % of all-comers experienced tendon or muscle adhesions that required subsequent tenolysis or adhesiolysis. Several studies recommended early exploration within 3 weeks, and FFMT within 6 months of the initial injury; however, successful FFMT cases were reported up to 20 years post-injury.

Conclusions: FFMT remains a viable option for VIC treatment, with a 96 % success rate. There is a relatively high incidence of tendon or muscle adhesions (34.6 %) that require secondary procedures.

Purpose: Osteoarthritis (OA) of the first carpometacarpal (CMC) joint, or basilar thumb arthritis, is the most common symptomatic hand arthritis, leading to significant healthcare costs. This study analyzed trends in managing basilar thumb arthritis and determined approaches linked to favorable outcomes to guide future treatments.

Methods: This retrospective cohort study queried the TriNetX United States Collaborative Network from 2013 to 2023. Patients with primary OA of the first CMC joint were identified using International Classification of Diseases-10 codes, and surgical interventions were classified using Current Procedural Terminology codes. Patients were stratified by surgical status and age groups (18-59 years and 60 years or older). Baseline demographic characteristics, risk factors, and mortality rates were compared between surgical and non-surgical cohorts. The incidence and prevalence of surgical interventions for basilar thumb arthritis were also determined.

Results: The study included 213,881 patients with primary basilar thumb arthritis (12,923 in the operative group and 195,820 in the non-operative cohort). Obesity (BMI 30-39), nicotine dependence, and Type 2 diabetes mellitus were more prevalent in the operative group (p < 0.01). The non-operative cohort had a lower average BMI (20-29, p = 0.04). Surgery incidence rose from 0.13 % in 2013 to 1.13 % by 2023, while prevalence increased from 0.45 % to 5.93 %. The matched odds ratios were 0.652 for 1-year, 0.763 for 3-year, and 0.818 for 5-year mortality.

Conclusions: Management of basilar thumb arthritis is shifting towards more surgical interventions. Identifying optimal patient profiles for surgery will refine management strategies for this condition.

Background: Fingertip amputations can be managed using a number of surgical and nonsurgical techniques including semi-occlusive dressings.

Aim: The aim of this systematic review is to assess the efficacy and safety of semi-occlusive dressings for fingertip amputations.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The following databases were searched: Medline, Embase and CINAHL. The primary outcomes included healing rate and time to epithelialization. Secondary outcomes included patient satisfaction, finger range of motion (ROM), patient reported outcome measures (PROMs), fingertip sensitivity, need for surgical intervention and complications.

Results: A total of 15 studies met the inclusion criteria with a total of 611 fingertip amputations. The mean overall healing rate was 97.4 % and the mean time to complete epithelialization was 30 days. Ninety three percent of patients achieved full ROM. A 96.5 % of patients reported being either satisfied or very satisfied with their outcome. Mean time to return to work was 22.3 days. Complications were reported in 31 % of patients, most of which were considered minor. Only 1.5 % of patients required surgical intervention.

Conclusion: Semi-occlusive dressing therapy is a safe and effective treatment modality for patients with fingertip amputations without bone exposure. Further comparative studies are needed to outline the role and protocols of semi-occlusive dressings in fingertip amputations.