The Journal of Hand Surgery最新文献

英文中文

The Effects of Radial Longitudinal Deficiency on Long-Term Use of the Thumb in Pediatric Patients Following Index Pollicization. 桡骨纵向缺损对小儿拇指截骨术后长期使用拇指的影响

The Journal of Hand Surgery

Pub Date : 2024-04-01 DOI: 10.1016/j.jhsa.2024.02.010

Paula A. Pino, Aida K. Sarcon, Rou Wan, Wendy A. Tomhave, Ann E. Van Heest, Steven L. Moran

引用次数: 0

Radial Collateral Ligament Laxity of Thumb Metacarpophalangeal Joint Following Trapeziometacarpal Arthrodesis. 拇指掌指关节的桡侧副韧带松弛（肩胛骨掌指关节切除术后

The Journal of Hand Surgery

Pub Date : 2024-04-01 DOI: 10.1016/j.jhsa.2024.03.006

Y. Hattori, Vijayendrasingh Gour, S. Sakamoto, Jun Sasaki, Kota Hayashi, K. Doi

引用次数: 0

Opponensplasty With Abductor Pollicis Brevis Rerouting for Types II and IIIA Hypoplastic Thumbs. 针对 II 型和 IIIA 型拇指发育不良的拇指外展成形术和拇指内收肌重塑术。

The Journal of Hand Surgery

Pub Date : 2024-04-01 DOI: 10.1016/j.jhsa.2024.02.006

Sakura Yamaguchi, T. Takagi, A. Seki, S. Takayama

引用次数: 0

Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study. 类风湿性关节炎患者全腕关节置换术的临床疗效：最短 10 年随访研究。

The Journal of Hand Surgery

Pub Date : 2024-04-01 DOI: 10.1016/j.jhsa.2024.03.002

Yuichiro Matsui, Akio Minami, Makoto Kondo, Jyunichi Ishikawa, M. Motomiya, D. Kawamura, Norimasa Iwasaki

引用次数: 0

The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability. 远端斜带对桡骨远端关节稳定性的贡献

The Journal of Hand Surgery

Pub Date : 2024-04-01 DOI: 10.1016/j.jhsa.2024.03.001

J. Orbay, Brandon Gardner, J. Heifner, Anthony Martin, Deana M. Mercer

引用次数: 0

Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures 髓内压缩螺钉固定治疗中指骨骨折

The Journal of Hand Surgery

Pub Date : 2024-02-02 DOI: 10.1016/j.jhsa.2023.12.011

Adam R. George, Hagen Abbot, Luke McCarron, David J. Graham, Brahman S. Sivakumar

Purpose

This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures.

Methods

A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature.

Results

Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort.

Conclusion

Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores.

Type of study/level of evidence

Therapeutic IV.

目的本研究旨在评估髓内加压螺钉固定治疗关节外中指骨骨折的中短期临床和患者报告结果。方法对 2020 年 1 月至 2023 年 3 月间接受中指骨骨折固定治疗的 20 例患者（共 23 个骨折指骨）进行了一系列回顾性研究。结果髓内螺钉固定是治疗关节外中指骨骨折的可行方案。结论髓内螺钉固定是治疗关节外中指骨骨折的可行方案，术后活动范围大，恢复功能的时间长，并发症发生率高，疼痛评分低。

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引用次数: 0

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries 通过踝肌转移矫正或预防桡骨和骨间后神经损伤的腕部桡侧偏斜

The Journal of Hand Surgery

Pub Date : 2024-01-12 DOI: 10.1016/j.jhsa.2023.11.025

Jayme A. Bertelli, Harsh R. Shah, Christopher S. Crowe

Purpose

Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon.

Methods

Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity.

Results

Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability.

Conclusions

Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis.

Type of study/level of evidence

Therapeutic V.

目的在桡神经麻痹的病例中，为恢复腕关节伸展而进行肌腱转移时可能会出现腕关节桡侧偏斜的并发症。在后骨间神经（PIN）损伤的情况下，这是因为桡长伸肌完好和尺侧伸肌（ECU）瘫痪造成的不平衡。因桡神经麻痹而将代趾（PT）转移到桡侧伸肌（ECRB）后，也可能出现这种畸形。为了解决腕部桡侧偏斜问题，我们建议将由 ECU 和尺侧屈肌（FCU）之间的肌间隔膜延伸的 anconeus 肌肉转移到 ECU 肌腱上。方法通过尺骨上的切口，在骨膜水平切除 ECU 和 FCU 之间的肌间隔膜，并将其留在anconeus 近端。然后从尺骨上松解蚁骨肌，并在最大张力下将肌间隔延伸部分缝合到 ECU 肌腱上。有两名患者因桡神经损伤进行了桡骨肌腱转移术（PT-ECRB）后，为纠正慢性腕关节桡偏，以及两名 PIN 麻痹患者进行了踝肌转移术。有四名患者在进行标准肌腱转移治疗桡神经麻痹的同时还进行了肌腱转移，以防止腕关节桡偏畸形。有 PIN 病变的患者以及在桡神经肌腱转移的同时进行了脐肌腱转移的患者都能主动进行尺侧偏位。没有患者出现肘关节伸展无力、疼痛或不稳定。结论通过肌间隔膜延伸的肱骨肌转移是解决PIN神经病变或桡神经麻痹患者PT至ECRB肌腱转移后腕关节桡侧偏位的可行替代方案。

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引用次数: 0

The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage 与战斗相关的肢体抢救中上肢神经损伤的范围和分布情况

The Journal of Hand Surgery

Pub Date : 2024-01-12 DOI: 10.1016/j.jhsa.2023.09.008

Colin J. Harrington, Marissa E. Dearden, Patrick McGlone, Benjamin K. Potter, Scott M. Tintle, Jason M. Souza

Purpose

Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at <10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related limb salvage population.

Methods

We performed a retrospective review of all patients who underwent limb salvage procedures to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations.

Results

A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n = 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury.

Conclusions

Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible.

Type of study/level of evidence

Therapeutic IV.

目的继发于神经损伤的慢性疼痛和功能限制是高能量四肢创伤患者实现最佳康复的主要障碍。鉴于多发性创伤患者的骨骼和软组织管理面临挑战，伴随的神经损伤可能会被忽视或延迟处理。之前有文献报道，在高能量四肢创伤的情况下，周围神经损伤的发生率为 10%，而根据我们的经验，这些损伤的发生率要高得多。因此，我们试图确定与战斗相关的肢体救治人群中上肢周围神经损伤的发生率、疼痛后遗症和功能预后。方法我们对 2011 年 1 月至 2020 年 1 月期间在一家机构接受肢体救治手术的所有患者进行了回顾性审查，其中包括因与战斗相关的上肢创伤而接受皮瓣覆盖的患者。我们收集了患者人口统计学、围手术期并发症、神经损伤位置、手术干预、慢性疼痛以及患者主观报告的功能限制等方面的数据。结果共有45名患者在与战斗有关的创伤后接受了49个上肢的皮瓣手术。所有患者均为男性，中位年龄为 27 岁，96%（n = 47）的损伤是由爆炸机制造成的。49 例上肢中有 33 例（67%）伴有神经损伤。最常见的受伤神经是尺神经（51%），其次是正中神经（30%）和桡神经/骨间后神经（19%）。在 33 例神经损伤的肢体中，有 18 例（55%）接受了手术治疗。神经修复/重建是最常见的手术（67%），其次是靶向肌肉神经再支配（TMR，17%）。结论上肢周围神经损伤在高能量战斗相关创伤后很常见，慢性疼痛和功能受限的发生率很高。外科医生在进行包括皮瓣覆盖在内的肢体挽救手术时，应预计到相关的周围神经损伤，并在可行的情况下做好修复或重建损伤神经的准备。

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引用次数: 0

Complications and Unplanned Reoperation After Thumb Metacarpophalangeal Arthrodesis 拇指掌指关节置换术后的并发症和意外再手术

The Journal of Hand Surgery

Pub Date : 2024-01-03 DOI: 10.1016/j.jhsa.2023.11.024

Ingmar W.F. Legerstee, Oscar Y. Shen, Kevin Kooi, Yannick A.J. Hoftiezer, Kyle R. Eberlin, Neal C. Chen

Purpose

Arthrodesis of the metacarpophalangeal (MCP) joint of the thumb is a common procedure to treat arthritis or instability. Studies reporting hardware complications and nonunion rates after thumb MCP joint arthrodesis report on small sample sizes. We aimed to describe the hardware complication rate, the nonunion rate, and the number of thumbs that achieve union among patients undergoing thumb MCP joint arthrodesis.

Methods

A database spanning 5 urban hospitals in a single metropolitan region in the United States was searched for patients who underwent thumb MCP joint arthrodesis between January 1, 2004 and January 1, 2020. After reviewing patient records, we identified 122 thumbs that underwent MCP joint arthrodesis and had a minimum follow-up of 90 days. The primary outcome was unplanned reoperation after hardware complications and nonunion. Second, the number of thumbs that achieved radiographic union was reported for the tension band and screw fixation arthrodesis group.

Results

Twenty-two (18%) out of 122 thumbs had hardware complications after thumb MCP joint arthrodesis, and 11 (9%) out of 122 thumbs developed a nonunion. Patients who underwent screw fixation arthrodesis had no events of hardware complications and subsequent hardware removal. The nonunion rate was 9/65 (14%) in the tension band arthrodesis group and 2 (4%) of 45 in the screw fixation arthrodesis group. Of the thumbs that had available radiographs to assess the healing of the arthrodesis, 34 (81%) of 42 were radiographically united in the tension band arthrodesis group and 29 (91%) of 32 in the screw fixation group.

Conclusions

Our data suggest that screw fixation has fewer hardware complications and a lower reoperation rate than tension band arthrodesis.

Type of study/level of evidence

Prognosis IV.

目的拇指掌指关节（MCP）的关节置换术是治疗关节炎或不稳定的常见手术。有关拇指 MCP 关节置换术后硬件并发症和不愈合率的研究报告样本量较小。我们的目的是描述接受拇指 MCP 关节置换术的患者的硬件并发症发生率、不愈合率以及实现愈合的拇指数量。方法在美国一个大都会地区的 5 家城市医院的数据库中搜索了 2004 年 1 月 1 日至 2020 年 1 月 1 日期间接受拇指 MCP 关节置换术的患者。在查阅患者病历后，我们确定了 122 名接受过 MCP 关节置换术且随访至少 90 天的拇指患者。主要结果是硬件并发症和不愈合后的非计划再手术。其次，报告了张力带和螺钉固定关节置换术组获得放射学结合的拇指数量。结果122个拇指中有22个（18%）在拇指MCP关节置换术后出现了硬件并发症，122个拇指中有11个（9%）出现了不愈合。接受螺钉固定关节置换术的患者没有出现硬件并发症和随后的硬件移除事件。张力带关节置换术组的不愈合率为9/65（14%），螺钉固定关节置换术组的不愈合率为2/45（4%）。结论我们的数据表明，与张力带关节置换术相比，螺钉固定术的硬件并发症更少，再次手术率更低。

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引用次数: 0

Biomechanical Comparison of Fixation of Metacarpal Shaft Fractures With Intramedullary Threaded Nail and Dorsal Plate 髓内螺纹钉和背板固定掌骨骨折的生物力学比较

The Journal of Hand Surgery

Pub Date : 2023-12-15 DOI: 10.1016/j.jhsa.2023.11.011

Luigi Piarulli, Mehrangiz Taheri, Sorin Siegler, Christopher M. Jones

Purpose

The purpose of this study was to investigate the mechanical properties of metacarpal long oblique and transverse shaft fractures stabilized by threaded intramedullary nails and dorsal plates and screws.

Methods

Transverse and oblique midshaft osteotomies were created in 28 paired left and right metacarpal bones from four fresh frozen cadavers. Each matched pair was fixed with one 4.5-mm threaded intramedullary nail and one 2.0-mm dorsal stainless-steel plate and a screw construct. The bones were secured at the proximal end, by a 3-D–printed customized jig, to a tensile testing machine and were loaded through a Kevlar wire tensioned over the metacarpal head, simulating muscle/tendon loading during grip. Loading to failure was performed, and the applied force and failure mode were recorded.

Results

Oblique fractures fixed with nails failed at a greater force than those fixed with dorsal plates (183 ± 50 N vs 130 ± 40 N). Transverse fractures showed comparable strength between the nail (215 ± 33 N) and the plate (183 ± 64 N). Plate failure modes included three diverse types of bone fracture and yielding deformation of the plate. Intramedullary nail failure modes included yielding of the nail, bone fracture without nail yielding, and relative rotation between the two sections of the bone.

Conclusions

Fixation of oblique and transverse metacarpal shaft fractures using a 4.5-mm threaded intramedullary nail in a simulated grip test model showed similar or greater strength than a 2.0-mm dorsal plate and screw construct.

Clinical relevance

Threaded intramedullary nail fixation of metacarpal shaft fractures may be an appropriate alternative to plate fixation in these fracture patterns.

研究目的：本研究旨在探讨用螺纹髓内钉和背侧钢板及螺钉稳定的掌骨长斜轴和横轴骨折的机械性能。方法：在四具新鲜冷冻尸体的 28 根成对左右掌骨上进行横轴和斜中轴截骨。每对配对骨骼都用一枚 4.5 毫米螺纹髓内钉和一枚 2.0 毫米背侧不锈钢钢板及螺钉固定。骨骼的近端通过 3-D 打印的定制夹具固定在拉伸试验机上，并通过凯夫拉尔线在掌骨头部张紧加载，模拟握持过程中的肌肉/肌腱加载。结果用钉子固定的斜形骨折比用背板固定的骨折在更大的力量下断裂（183 ± 50 N vs 130 ± 40 N）。横向骨折显示，钉子（215 ± 33 N）和钢板（183 ± 64 N）的强度相当。钢板失效模式包括三种不同类型的骨折和钢板屈服变形。髓内钉的失效模式包括髓内钉屈服、无髓内钉屈服的骨骨折以及两段骨之间的相对旋转。在模拟抓握试验模型中使用 4.5 毫米螺纹髓内钉固定掌骨斜向和横向骨折，其强度与 2.0 毫米背侧钢板和螺钉结构相似或更高。

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