Journal of Hand and Microsurgery最新文献

Background: Elbow flexion restoration is one of the most important objectives of brachial plexus surgery in upper root injuries. Many authors have shown very good results with double fascicular nerve transfers and it has become the mainstay of nerve transfers for elbow flexion restoration. We present the results of a modified version of this double fascicular transfer.

Methods: A retrospective study of 32 patients who underwent the modified double fascicular nerve transfer(i.e median n to n to biceps and ulnar n to n to brachialis) was done. The average duration for delay in surgery from the time of injury was 5.6 months. The average age of the patients was 35.84. The average follow up of the patients was 39.3months.

Results: All patients had M0 or M1 power preoperatively. Eight patients had M3 power and 22 patients had M4 or M4+ power post operatively. Two patients did not recover meaningful elbow flexion. The results were similar to the original double fascicular nerve transfer for elbow flexion.

Conclusion: The modified version of the double fascicular nerve transfer is as reliable and produces similar results to the original double fascicular transfer. The theoretical advantages include the ease of doing the operation - (i) The n to biceps and median n are closer. (ii) The length of the n to brachialis allows it to be swung across the arm to reach the more posterior and medial ulnar nerve.

Anatomy is vital for integrating basic science with clinical practice, particularly for surgeons specializing in hand, orthopedic, and plastic surgery. Traditional teaching methods often lack the hands-on experience needed for a thorough understanding. To address this issue, the Italian Society of Hand Surgery (SICM) designed a course focused on cadaveric dissection aimed at enhancing anatomical knowledge and surgical skills. This study assessed the perceptions and knowledge gains of medical residents and specialists in a 4-day intensive course, which included 21 h of dissections, 9 h of video demonstrations, and 4 h of lectures. Participants were evaluated through pre- and post-course exams and a survey using a five-point Likert scale. Out of 280 participants, post-course scores improved significantly (mean increase of 11.14 points, p < 0.00001), with 85 % finding the practical dissection approach most effective. The course was particularly beneficial for those with lower initial scores, indicating the need for tailored instruction for varying specialties.

Nonsurgical therapeutic approaches for thumb carpometacarpal (CMC) osteoarthritis (OA) often offer only inconsistent symptom relief and fail to restore hand function. Intra-articular platelet-rich plasma (PRP) injections have recently emerged as a promising alternative, with encouraging outcomes in knees and hips. This systematic review and meta-analysis aims to highlight the safety and efficacy of PRP injections in thumb CMC OA. A systematic review was completed using Medline, Embase, and Cochrane. Primary outcomes focused on patients with basal thumb osteoarthritis treated with intra-articular PRP injections. Patient characteristics, product administration, functional outcomes and complications were analyzed as means of central tendency. A meta-analysis was performed focusing on pain relief and improvement in hand function. Seven articles were included, comprising 115 patients with an average age of 62.6 years, predominantly female (67.0 %). Patients received an average of 1.4 PRP injections per joint, with an average follow-up of 14.1 months. Control groups were administered corticosteroids, normal saline, and hyaluronic acid. All PRP-treated patients resumed their prior activities of daily living with a satisfaction rate at 73.7 % (n = 76). Statistically significant pain reduction (n = 98) and improvement in pinch strength were reported, while no statistically significant improvement in grip strength was observed (n = 39). No adverse events occurred, with only one complication (a palmar wrist ganglion) reported. Intra-articular PRP injections in thumb CMC OA yields favorable outcomes for pain relief and hand function without major complications. However, procedural and data heterogeneity affect reliability. Further randomized controlled trials comparing PRP and cortisone injections are needed.

The volume of shoulder arthroplasty (SA) procedures has increased significantly in recent years, outpacing the growth of hip and knee arthroplasty. As a relatively young area in orthopedics, shoulder arthroplasty offers many opportunities for innovation, often borrowing from established practices in other subspecialties. Degenerative shoulder pathology presents unique challenges that can be difficult to adequately address with conventional reconstructive methods alone. Currently, three-dimensional preoperative planning is the most widely utilized technology in shoulder arthroplasty. Implementation of patient-specific instrumentation is increasing, primarily for patients with severe deformity. Computer-assisted navigation, widely used in hip and knee reconstruction, is gaining traction. These technologies have demonstrated increased accuracy and precision in correcting glenoid deformity and implant positioning, which are known to influence the long-term performance of SA. However, studies specifically evaluating the long-term clinical benefits of these innovations are lacking. In the near future, the application of robotic and immersive technologies like augmented reality for SA demonstrates promise for enhancing the surgeon's ability to address glenoid deformity intraoperatively. These advancements provide exciting opportunities to transform the field of shoulder arthroplasty, yet they must be critically evaluated for their cost and impact to outcomes clinical cohorts with long-term follow-up.

Level of evidence: Level V; Narrative Review.

Fasciectomy is a surgical procedure frequently used for the treatment of Dupuytren's disease. The WALANT (Wide-Awake Local Anesthesia No-Tourniquet) anesthesia technique has gained popularity for its advantages over general anesthesia, such as risk reduction and cost savings. However, one of the main challenges is pain management and anesthetic efficacy during surgery. This study aims to evaluate the feasibility of this technique in pain management, patient experience, and cost savings in surgery for Dupuytren's disease. Prospective study that included patients treated surgically for Dupuytren's disease under WALANT anesthesia. Clinical history, number of affected fingers, and joint contracture were recorded, classifying them according to Tubiana. Anesthesia consisted of a mixture of 20 ml of 2 % lidocaine with epinephrine, 20 ml of 0.5 % bupivacaine, and 40 ml of saline solution, administered by ulnar nerve block and over the area of the cord to be resected, without using a hemostatic cuff. Variables such as pain during infiltration and surgical procedure, anxiety, surgery time, postoperative range of motion, and incidence of complications and recurrences were evaluated. The data were analyzed using descriptive methods and statistical analysis. 17 patients were prospectively evaluated. 64.7 % of patients managed to recover a full range of motion in the first four postoperative weeks, while 35.2 % had a partial range. Immediate complications were minimal, with only 5.8 % of patients developing local infections or minor hematomas, successfully resolved with conservative treatment. The recurrence rate was 11.7 % at six months. A cost analysis showed that the use of WALANT resulted in a cost saving of 60.6 % compared to general or regional anesthesia, making the technique an attractive option in healthcare systems with limited resources. The study reveals that the WALANT anesthetic technique for surgery for Dupuytren's disease provides effective pain management both during the injection and during the surgical procedure. This technique facilitates a relatively quick and comfortable recovery, offering an overall positive experience for patients. results suggest that WALANT may be an effective and precise option for the surgical procedure in Dupuytren's disease, with advantages in terms of pain control, cost savings, and favorable postoperative outcomes. Furthermore, it allows surgeons and patients to obtain immediate feedback on the dynamic outcome of cord release, which may improve subsequent dissection and rehabilitation.

Introduction: Nail-bed grafting is an accepted treatment for nail-bed defects of the fingernail. This study summarizes and analyses recent data on the outcomes associated with nail-bed grafting for nail-bed injuries at varying degrees of severity.

Materials and methods: A literature search was conducted in the electronic databases(PubMed, MEDINE, EMBASE, SCOPUS) to extract articles published from March 1985 to March 2023. Studies reporting data on nail-bed injury treated with full or split thickness nail-bed grafting was included in the study. Extracted data consisted of demographic data, surgical technique, follow-up, outcomes and complications.

Results: A total of 107 articles were identified, of which 6 studies were eligible for final inclusion comprising a total of 84 patients. The average age of patients was 28.87 years. The mean length of follow-up was 17 months. 2 studies reported excellent outcome in 12 patients as per Zook's criteria. The first nail appeared 3 weeks to 4 months after the surgery. 4 studies mentioned use of nail splint after the surgery reflecting the current practice trends. No major complications were reported in the studies.

Conclusion: Nail-bed grafting can be a safe, effective technique for the treatment of nail-bed injuries in immediate and delayed setting. Results of nail-bed grafting indicate satisfactory outcome in carefully selected cohort of nail-bed injury patients.LEVEL OF EVIDENCE.V.