The Journal of Hand Surgery最新文献_第2页

At What Time Interval After a Sharp Nerve Laceration Is Primary Nerve Repair No Longer Possible? 尖锐神经撕裂后的哪个时间段不再可能进行原发性神经修复？

The Journal of Hand Surgery

Pub Date : 2023-12-12 DOI: 10.1016/j.jhsa.2023.11.006

Nirbhay S. Jain, Meaghan L. Barr, Neil F. Jones

Purpose

The timeframe after a sharp nerve injury when nerve grafting becomes required remains unclear. A retrospective analysis was performed to determine the timeframe when primary repair of a sharp nerve laceration can no longer be performed and grafting becomes necessary.

Methods

All sharp nerve injuries in three regions of the hands and upper extremity—major nerves, common digital nerves, and proper digital nerves—treated between 2016 and 2021 were reviewed. Time from injury to repair, need for nerve grafting, length of graft, age, and associated injuries were collected and analyzed.

Results

A total of 313 nerve lacerations were included. Predictors of the need for grafting included time from injury to repair and level of injury. The odds ratio of time from injury in predicting the need for grafting was 1.04 for proper digital nerves, 1.05 for common digital nerves, and 1.18 for major nerves. Age and other injuries were not associated with increased rates of grafting. Only level of injury was associated with length of graft needed.

Conclusions

Patients with sharp major nerve injuries required grafting more frequently after several days from injury, whereas primary repair of common and proper digital nerves could be achieved up to two weeks or greater after injury. This suggests that the window for primary neurorrhaphy may be as short as two days after injury for major nerve injuries, much shorter than for common and proper digital nerve injuries.

Type of study/level of evidence

Prognostic IV.

目的尖锐神经损伤后需要进行神经移植的时间范围仍不明确。我们进行了一项回顾性分析，以确定当尖锐神经裂伤的初级修复不能再进行时，需要进行神经移植的时间范围。方法回顾了 2016 年至 2021 年间治疗的所有手部和上肢三个区域的尖锐神经损伤--主要神经、普通数字神经和适当数字神经。结果共纳入313例神经裂伤。需要移植神经的预测因素包括从受伤到修复的时间和受伤程度。从受伤到修复的时间预测需要移植的几率比为：正常数字神经 1.04，普通数字神经 1.05，主要神经 1.18。年龄和其他损伤与移植率的增加无关。结论尖锐的主要神经损伤患者在受伤数天后更需要进行移植手术，而普通和适当的数字神经的初级修复可在受伤后两周或更长时间内完成。研究类型/证据级别诊断IV.

{"title":"At What Time Interval After a Sharp Nerve Laceration Is Primary Nerve Repair No Longer Possible?","authors":"Nirbhay S. Jain, Meaghan L. Barr, Neil F. Jones","doi":"10.1016/j.jhsa.2023.11.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.11.006","url":null,"abstract":"<h3>Purpose</h3><p>The timeframe after a sharp nerve injury when nerve grafting becomes required remains unclear. A retrospective analysis was performed to determine the timeframe when primary repair of a sharp nerve laceration can no longer be performed and grafting becomes necessary.</p><h3>Methods</h3><p>All sharp nerve injuries in three regions of the hands and upper extremity—major nerves, common digital nerves, and proper digital nerves—treated between 2016 and 2021 were reviewed. Time from injury to repair, need for nerve grafting, length of graft, age, and associated injuries were collected and analyzed.</p><h3>Results</h3><p>A total of 313 nerve lacerations were included. Predictors of the need for grafting included time from injury to repair and level of injury. The odds ratio of time from injury in predicting the need for grafting was 1.04 for proper digital nerves, 1.05 for common digital nerves, and 1.18 for major nerves. Age and other injuries were not associated with increased rates of grafting. Only level of injury was associated with length of graft needed.</p><h3>Conclusions</h3><p>Patients with sharp major nerve injuries required grafting more frequently after several days from injury, whereas primary repair of common and proper digital nerves could be achieved up to two weeks or greater after injury. This suggests that the window for primary neurorrhaphy may be as short as two days after injury for major nerve injuries, much shorter than for common and proper digital nerve injuries.</p><h3>Type of study/level of evidence</h3><p>Prognostic IV.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138574178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Articular Surface Involvement With Retrograde Headless Screw Fixation of the Proximal Phalanx 近节指骨逆行无头螺钉固定术造成的关节面受累

The Journal of Hand Surgery

Pub Date : 2023-12-11 DOI: 10.1016/j.jhsa.2023.11.014

Sean Martin, E. Patrick Murray, Anthony Mitchell, Will Beucler, Robert Ablove

Purpose

Intramedullary (IM) screw fixation of proximal phalanx (P1) fractures is a treatment option increasing in popularity. This study aimed to quantify the articular surface loss after retrograde screw insertion and to determine the range of motion (ROM) of the proximal interphalangeal (PIP) joint while the defect in the P1 head is engaged with the base of the middle phalanx (P2).

Methods

Twelve fresh frozen cadaver hand specimens were analyzed for prefixation ROM of the PIP joint. A retrograde screw was placed using a percutaneous technique under fluoroscopic guidance. Following screw insertion, specimens were dissected to determine size of the extensor mechanism defect, evaluate the lateral bands with passive ROM of the PIP joint, and determine the angle at which the dorsal aspect of P2 ceases to engage with the defect and the amount of articular surface loss. The percentage of articular surface loss was calculated using a digital image software program.

Results

The angle at which P2 ceased to engage with the articular surface defect was an average of 36.8° of PIP joint flexion. In full PIP joint flexion, the average extensor mechanism defect was 8.8%. The average total articular surface loss was 4.4% across all digits.

Conclusion

Percutaneous retrograde P1 intramedullary screw fixation results in minimal damage to the extensor mechanism and articular surface. The arc during which the defect in the head of P1 engages the base of the P2 is almost entirely outside the functional ROM of the PIP joint.

Clinical relevance

Quantifying the amount of articular surface loss through the P1 head and extensor apparatus damage in IM screw fixation can inform surgeons of the consequences of this technique. This study supports the use of a retrograde intramedullary screw as a safe option for fixation of P1 fractures.

目的髓内（IM）螺钉固定近端指骨（P1）骨折是一种越来越受欢迎的治疗方法。本研究旨在量化逆行螺钉插入后的关节面损失，并确定当 P1 头缺损与中节指骨 (P2) 基部接合时近端指骨 (PIP) 关节的活动范围 (ROM)。在透视引导下采用经皮技术置入逆行螺钉。插入螺钉后，对标本进行解剖，以确定伸肌机制缺损的大小，评估PIP关节被动ROM的侧带，并确定P2背侧停止与缺损接合的角度以及关节面缺损的程度。结果 P2与关节面缺损停止接触的角度为PIP关节屈曲36.8°的平均值。PIP 关节完全屈曲时，伸肌机制缺损平均为 8.8%。结论经皮逆行 P1 髓内螺钉固定对伸肌机制和关节面的损伤极小。P1 头部缺损与 P2 底部啮合的弧度几乎完全超出了 PIP 关节的功能 ROM。临床意义通过髓内螺钉固定中 P1 头部和伸肌装置损伤的关节面损失量进行量化，可以让外科医生了解这种技术的后果。这项研究支持使用逆行髓内螺钉作为固定 P1 骨折的安全选择。

{"title":"Articular Surface Involvement With Retrograde Headless Screw Fixation of the Proximal Phalanx","authors":"Sean Martin, E. Patrick Murray, Anthony Mitchell, Will Beucler, Robert Ablove","doi":"10.1016/j.jhsa.2023.11.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.11.014","url":null,"abstract":"<h3>Purpose</h3><p><span>Intramedullary (IM) screw fixation of proximal phalanx<span> (P1) fractures is a treatment option increasing in popularity. This study aimed to quantify the </span></span>articular surface<span> loss after retrograde screw insertion and to determine the range of motion (ROM) of the proximal interphalangeal (PIP) joint while the defect in the P1 head is engaged with the base of the middle phalanx (P2).</span></p><h3>Methods</h3><p>Twelve fresh frozen cadaver hand specimens were analyzed for prefixation ROM of the PIP joint. A retrograde screw was placed using a percutaneous technique under fluoroscopic guidance. Following screw insertion, specimens were dissected to determine size of the extensor mechanism defect, evaluate the lateral bands with passive ROM of the PIP joint, and determine the angle at which the dorsal aspect of P2 ceases to engage with the defect and the amount of articular surface loss. The percentage of articular surface loss was calculated using a digital image software program.</p><h3>Results</h3><p>The angle at which P2 ceased to engage with the articular surface defect was an average of 36.8° of PIP joint flexion. In full PIP joint flexion, the average extensor mechanism defect was 8.8%. The average total articular surface loss was 4.4% across all digits.</p><h3>Conclusion</h3><p>Percutaneous retrograde P1 intramedullary screw fixation results in minimal damage to the extensor mechanism and articular surface. The arc during which the defect in the head of P1 engages the base of the P2 is almost entirely outside the functional ROM of the PIP joint.</p><h3>Clinical relevance</h3><p>Quantifying the amount of articular surface loss through the P1 head and extensor apparatus damage in IM screw fixation can inform surgeons of the consequences of this technique. This study supports the use of a retrograde intramedullary screw as a safe option for fixation of P1 fractures.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intra-articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study 桡骨远端关节的关节内压力：生物力学研究

The Journal of Hand Surgery

Pub Date : 2023-12-08 DOI: 10.1016/j.jhsa.2023.11.015

Rodrigo Gutiérrez-Monclus, Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla, Carlos Gutierrez-Novoa, Paúl Cordero-Barzallo, Alfonso Rodríguez-Baeza, Ángel Ferreres-Claramunt, Marc García-Elias

Purpose

The aim of the study was to use cadaveric models to assess the effect of loading the forearm muscles in different forearm rotations, with or without disruption to the stabilizing components, on the intra-articular pressure of the distal radioulnar joint (DRUJ).

Methods

Ten forearms with no severe osteoarthritis or injury to the DRUJ stabilizers were used. They were placed in a vertical support, and pressure sensors measured pressure within the DRUJ in 5 forearm rotations (neutral, pronation, supination, extension, and flexion) under the following 6 conditions: 1) no loading; 2) loading (at 1/5 of the load per cross-sectional area) with no disruption; 3) loading with disruption of the triangular fibrocartilage complex (TFCC); 4) loading with disruption of the TFCC and ulnar ligaments (ULs); 5) loading with disruption of the TFCC, ULs and interosseous membrane (IM); and 6) loading with disruption of the TFCC, ULs, IM, and pronator quadratus (PQ).

Results

Under the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, the highest intra-articular pressures were recorded in supination. Compared with the no-load condition, pressure was greater in the no disruption-loaded condition with a mean difference (MD) of 1.57 kg/cm² in a neutral position. In flexion, pressure was greater with a disrupted TFCC (MD, 4.3 kg/cm²). In supination, pressure was only greater with a disrupted TFCC (MD, 3.3 kg/cm²), and pressure decreased in the other disruption conditions. The pressures recorded did not differ from the no disruption-no load condition in pronation or extension.

Conclusions

Pressures within the DRUJ changed with forearm rotations. In the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, intra-articular pressure was highest in supination. In flexion and supination with load and disruption of stabilizers, intra-articular pressure only increased significantly in the disrupted TFCC condition compared with no load.

Clinical Relevance

Based on our findings, exercises in supination should be avoided during the first phase of rehabilitation of TFCC injuries given the increased pressure on the DRUJ.

目的该研究的目的是使用尸体模型评估在稳定部件受损或未受损的情况下，在不同的前臂旋转中对前臂肌肉加载对桡尺关节远端（DRUJ）关节内压力的影响。他们被放置在一个垂直支架上，压力传感器在以下 6 种条件下测量 5 个前臂旋转（中立、前倾、上举、伸展和屈曲）过程中 DRUJ 内的压力：1）无负载；2）负载（每横截面积负载的 1/5）且无中断；3）负载且三角纤维软骨复合体 (TFCC)中断；4）负载且三角纤维软骨复合体和尺韧带 (UL) 中断；5）负载且三角纤维软骨复合体、尺韧带和骨间膜 (IM) 中断；以及 6）负载且三角纤维软骨复合体、尺韧带、骨间膜和旋前肌 (PQ) 中断。结果在无破坏-无加载、无破坏-加载和破坏 TFCC 的条件下，上举时记录到的关节内压力最高。与无负载条件相比，无中断负载条件下的压力更大，中立位时的平均差（MD）为 1.57 kg/cm2。屈曲时，TFCC断裂的压力更大（MD，4.3 kg/cm2）。在仰卧位时，只有TFCC断裂时压力较大（MD，3.3 kg/cm2），其他断裂情况下压力均有所下降。结论 DRUJ 内的压力随前臂旋转而变化。在无中断无负荷、无中断负荷和中断 TFCC 条件下，关节内压力在仰卧时最高。根据我们的研究结果，在 TFCC 损伤康复的第一阶段，应避免上举运动，因为 DRUJ 所承受的压力会增加。

{"title":"Intra-articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study","authors":"Rodrigo Gutiérrez-Monclus, Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla, Carlos Gutierrez-Novoa, Paúl Cordero-Barzallo, Alfonso Rodríguez-Baeza, Ángel Ferreres-Claramunt, Marc García-Elias","doi":"10.1016/j.jhsa.2023.11.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.11.015","url":null,"abstract":"<h3>Purpose</h3><p>The aim of the study was to use cadaveric models to assess the effect of loading the forearm muscles in different forearm rotations, with or without disruption to the stabilizing components, on the intra-articular pressure of the distal radioulnar joint (DRUJ).</p><h3>Methods</h3><p><span>Ten forearms with no severe osteoarthritis<span> or injury to the DRUJ stabilizers were used. They were placed in a vertical support, and pressure sensors measured pressure within the DRUJ in 5 forearm rotations (neutral, pronation, </span></span>supination<span>, extension, and flexion) under the following 6 conditions: 1) no loading; 2) loading (at 1/5 of the load per cross-sectional area) with no disruption; 3) loading with disruption of the triangular fibrocartilage complex (TFCC); 4) loading with disruption of the TFCC and ulnar ligaments (ULs); 5) loading with disruption of the TFCC, ULs and interosseous membrane (IM); and 6) loading with disruption of the TFCC, ULs, IM, and pronator quadratus (PQ).</span></p><h3>Results</h3><p>Under the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, the highest intra-articular pressures were recorded in supination. Compared with the no-load condition, pressure was greater in the no disruption-loaded condition with a mean difference (MD) of 1.57 kg/cm<sup>2</sup> in a neutral position. In flexion, pressure was greater with a disrupted TFCC (MD, 4.3 kg/cm<sup>2</sup>). In supination, pressure was only greater with a disrupted TFCC (MD, 3.3 kg/cm<sup>2</sup>), and pressure decreased in the other disruption conditions. The pressures recorded did not differ from the no disruption-no load condition in pronation or extension.</p><h3>Conclusions</h3><p>Pressures within the DRUJ changed with forearm rotations. In the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, intra-articular pressure was highest in supination. In flexion and supination with load and disruption of stabilizers, intra-articular pressure only increased significantly in the disrupted TFCC condition compared with no load.</p><h3>Clinical Relevance</h3><p>Based on our findings, exercises in supination should be avoided during the first phase of rehabilitation of TFCC injuries given the increased pressure on the DRUJ.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neonatal Limb Compartment Syndrome: A Comprehensive Review 新生儿肢室综合征：全面回顾

The Journal of Hand Surgery

Pub Date : 2023-12-08 DOI: 10.1016/j.jhsa.2023.08.013

Ibrahim Cherry, Diane Franck, Frederic Urbain

Purpose

Neonatal limb compartment syndrome (NLCS) is a rare and potentially limb-threatening condition defined as an increased pressure within a confined limb compartment. Clinicians may fail to distinguish NLCS from other mimicking conditions. Misdiagnosis is possible due to a low index of suspicion for this condition, which may delay appropriate and urgent treatment. A comprehensive review of the available literature was performed to explore common themes in NLCS and identify gaps in the evidence to guide future studies.

Methods

A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French. Studies were selected by two independent reviewers who extracted descriptive data including the delivery history and complications, the timing of diagnosis, the location of the lesion, and the management strategy.

Results

A total of 43 reports describing 86 cases of neonatal compartment syndrome were published between 1980 and 2021. The male-to-female ratio was 6:7. Compartment syndrome was mainly located in the upper extremity (95.3%). Clinical features including swelling (41%), sentinel skin lesion (94.2%), extremity cyanosis (89.5%), and necrotic fingers (7%) were observed. The treatment strategy was either surgical decompression (32.6%) or nonsurgical management (68.6%). Sequelae occurred at a rate of 16.6%, 81.3%, and 75.9% after early fasciotomy (< 24 hours), late fasciotomy, and nonsurgical management, respectively.

Conclusions

Sentinel skin lesions and flaccid paralysis are the most observed clinical features and represent key clues for diagnosis. Neither radiography, Doppler ultrasound, nor magnetic resonance imaging has demonstrated any advantage in guiding the appropriate management of NLCS and may delay appropriate treatment. Despite nonsurgical management and late fasciotomy (> 24 hours) being the most described treatments, the lowest rate of sequelae was observed when decompression was performed within the first 24 hours.

Type of study/level of evidence

Therapeutic V.

目的新生儿肢体隔室综合征（NLCS）是一种罕见的可能危及肢体的疾病，其定义为受限肢体隔室内压力增高。临床医生可能无法将新生儿肢室综合征与其他类似疾病区分开来。由于对这种疾病的怀疑指数较低，因此可能会误诊，从而延误适当的紧急治疗。我们对现有文献进行了全面回顾，以探讨 NLCS 的共同主题，并找出证据方面的不足，为今后的研究提供指导。方法我们在 PubMed、Scopus 和 Google Scholar 电子数据库中进行了文献检索，以确定英文或法文的原创文章和综述。两名独立审稿人对研究进行筛选，并提取描述性数据，包括分娩史和并发症、诊断时间、病变位置和处理策略。男女比例为 6:7。室间隔综合征主要发生在上肢（95.3%）。临床特征包括肿胀（41%）、前哨皮肤损伤（94.2%）、四肢发绀（89.5%）和坏死手指（7%）。治疗策略为手术减压（32.6%）或非手术治疗（68.6%）。早期筋膜切开术（24 小时）、晚期筋膜切开术和非手术治疗的后遗症发生率分别为 16.6%、81.3% 和 75.9%。放射学、多普勒超声和磁共振成像在指导 NLCS 的适当治疗方面均未显示出任何优势，可能会延误适当的治疗。尽管非手术治疗和晚期筋膜切开术（24 小时）是描述最多的治疗方法，但在最初 24 小时内进行减压时，后遗症发生率最低。

{"title":"Neonatal Limb Compartment Syndrome: A Comprehensive Review","authors":"Ibrahim Cherry, Diane Franck, Frederic Urbain","doi":"10.1016/j.jhsa.2023.08.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.08.013","url":null,"abstract":"<h3>Purpose</h3><p>Neonatal limb compartment syndrome<span> (NLCS) is a rare and potentially limb-threatening condition defined as an increased pressure within a confined limb compartment. Clinicians may fail to distinguish NLCS from other mimicking conditions. Misdiagnosis is possible due to a low index of suspicion for this condition, which may delay appropriate and urgent treatment. A comprehensive review of the available literature was performed to explore common themes in NLCS and identify gaps in the evidence to guide future studies.</span></p><h3>Methods</h3><p>A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French. Studies were selected by two independent reviewers who extracted descriptive data including the delivery history and complications, the timing of diagnosis, the location of the lesion, and the management strategy.</p><h3>Results</h3><p><span><span>A total of 43 reports describing 86 cases of neonatal compartment syndrome were published between 1980 and 2021. The male-to-female ratio was 6:7. Compartment syndrome was mainly located in the upper extremity (95.3%). Clinical features including swelling (41%), sentinel skin lesion (94.2%), extremity </span>cyanosis (89.5%), and necrotic fingers (7%) were observed. The treatment strategy was either </span>surgical decompression<span> (32.6%) or nonsurgical management (68.6%). Sequelae<span> occurred at a rate of 16.6%, 81.3%, and 75.9% after early fasciotomy (< 24 hours), late fasciotomy, and nonsurgical management, respectively.</span></span></p><h3>Conclusions</h3><p><span>Sentinel skin lesions and flaccid paralysis are the most observed clinical features and represent key clues for diagnosis. Neither radiography, </span>Doppler ultrasound, nor magnetic resonance imaging has demonstrated any advantage in guiding the appropriate management of NLCS and may delay appropriate treatment. Despite nonsurgical management and late fasciotomy (> 24 hours) being the most described treatments, the lowest rate of sequelae was observed when decompression was performed within the first 24 hours.</p><h3>Type of study/level of evidence</h3><p>Therapeutic V.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients 实体器官移植受者桡骨远端骨折的预后

The Journal of Hand Surgery

Pub Date : 2023-12-08 DOI: 10.1016/j.jhsa.2023.10.009

Christopher R. Gajewski, Kevin Y. Chen, Nirbhay S. Jain, Neil F. Jones

Purpose

Distal radius fractures (DRFs) are one of the most common conditions that musculoskeletal providers treat. As the frequency of solid organ transplants (SOT) increases, these providers are often called upon to manage DRFs in these patients. These patients are at increased risk for osteopenia and osteoporosis, given the altered bone metabolism after SOT and frequent use of glucocorticoid and immunosuppressive medications. This study aimed to examine both surgical and nonsurgical treatment outcomes of DRFs in the SOT population and the prevalence of decreased bone mineral density.

Methods

A retrospective review of patients treated at a single institution who had previously undergone SOT and subsequently sustained DRF between 2013 and 2022 was completed. Patients were excluded for incomplete documentation and treatment initiation at an outside institution. Demographic variables, clinical outcomes, organ transplant, steroid use, and second metacarpal cortical percentage were collected for both groups. A telephone survey with the QuickDASH questionnaire was conducted for all available patients.

Results

A total of 34 DRFs in 33 patients were included in the analysis. Of these, 15 fractures in 14 patients underwent surgical intervention, and 19 fractures in 19 patients were managed nonsurgically. The following three adverse events were observed in the patients managed operatively: hardware failure, postoperative carpal tunnel syndrome, and tendon irritation. No reported treatment complications were recorded in the patients managed nonsurgically. Of the 33 included patients, 32 had radiographic evidence of decreased bone mineral density and five were receiving treatment for osteoporosis.

Conclusions

Management of DRFs in SOT patients is challenging, given their increased medical complexity. Decreased bone mineral density was nearly universal and undertreated in this patient population. Most of these patients in both groups had good or excellent functional outcomes with both surgical and nonsurgical management. Additionally, surgery was well tolerated with no reported anesthesia complications, wound-healing issues, or infections.

Type of study/level of evidence

Therapeutic IV.

目的桡骨远端骨折（DRF）是肌肉骨骼医疗人员最常治疗的疾病之一。随着实体器官移植（SOT）的频率增加，这些医疗机构经常需要处理这些患者的桡骨桡侧骨折。由于 SOT 术后骨代谢发生改变以及糖皮质激素和免疫抑制剂的频繁使用，这些患者患骨质疏松和骨质疏松症的风险增加。本研究旨在检查 SOT 患者中 DRF 的手术和非手术治疗效果以及骨矿物质密度下降的发生率。方法对 2013 年至 2022 年期间在一家机构接受过 SOT 治疗且随后出现 DRF 的患者进行回顾性研究。因记录不完整或在外部机构开始治疗的患者被排除在外。收集了两组患者的人口统计学变量、临床结果、器官移植、类固醇使用和第二掌骨皮质百分比。对所有可用患者进行了QuickDASH问卷电话调查。其中，14 名患者的 15 处骨折接受了手术治疗，19 名患者的 19 处骨折接受了非手术治疗。在接受手术治疗的患者中观察到以下三种不良事件：硬件故障、术后腕管综合征和肌腱刺激。在非手术治疗的患者中，没有治疗并发症的报告。在纳入的 33 名患者中，32 人有骨矿密度降低的影像学证据，5 人正在接受骨质疏松症治疗。在这一患者群体中，骨矿密度降低几乎是普遍现象，而且治疗不足。两组患者中的大多数在手术和非手术治疗后都取得了良好或卓越的功能效果。此外，手术耐受性良好，无麻醉并发症、伤口愈合问题或感染报告。

{"title":"Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients","authors":"Christopher R. Gajewski, Kevin Y. Chen, Nirbhay S. Jain, Neil F. Jones","doi":"10.1016/j.jhsa.2023.10.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.10.009","url":null,"abstract":"<h3>Purpose</h3><p><span>Distal radius fractures<span><span> (DRFs) are one of the most common conditions that musculoskeletal providers treat. As the frequency of solid organ transplants (SOT) increases, these providers are often called upon to manage DRFs in these patients. These patients are at increased risk for osteopenia<span> and osteoporosis, given the altered </span></span>bone metabolism after SOT and frequent use of </span></span>glucocorticoid<span> and immunosuppressive<span> medications. This study aimed to examine both surgical and nonsurgical treatment outcomes of DRFs in the SOT population and the prevalence of decreased bone mineral density.</span></span></p><h3>Methods</h3><p><span>A retrospective review of patients treated at a single institution who had previously undergone SOT and subsequently sustained DRF between 2013 and 2022 was completed. Patients were excluded for incomplete documentation and treatment initiation at an outside institution. Demographic variables, clinical outcomes, organ transplant, steroid use, and second metacarpal cortical percentage were collected for both groups. A telephone survey with the </span><em>Quick</em><span>DASH questionnaire was conducted for all available patients.</span></p><h3>Results</h3><p>A total of 34 DRFs in 33 patients were included in the analysis. Of these, 15 fractures in 14 patients underwent surgical intervention, and 19 fractures in 19 patients were managed nonsurgically. The following three adverse events were observed in the patients managed operatively: hardware failure, postoperative carpal tunnel syndrome<span>, and tendon irritation. No reported treatment complications were recorded in the patients managed nonsurgically. Of the 33 included patients, 32 had radiographic evidence of decreased bone mineral density and five were receiving treatment for osteoporosis.</span></p><h3>Conclusions</h3><p>Management of DRFs in SOT patients is challenging, given their increased medical complexity. Decreased bone mineral density was nearly universal and undertreated in this patient population. Most of these patients in both groups had good or excellent functional outcomes with both surgical and nonsurgical management. Additionally, surgery was well tolerated with no reported anesthesia complications, wound-healing issues, or infections.</p><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Recovery of Spastic Finger Flexion Using Hyperselective Neurectomy: A Case Series 利用分散神经切除术实现痉挛性手指屈伸的临床康复：病例系列

The Journal of Hand Surgery

Pub Date : 2023-12-08 DOI: 10.1016/j.jhsa.2023.10.004

Mohammadreza Emamhadi, Mohammad Haghani Dogahe, Amirreza Emamhad

Purpose

Hyperselective neurectomy (HSN) is an advanced peripheral nerve ablation procedure that can relieve spasticity and enhance the quality of life in patients with spasticity following upper motor neuron injuries. The main advantage of HSN is that it can treat spasticity as well as preserve hand function. Thus, HSN may be the procedure of choice in patients with spastic functional hands. In this study, we present the surgical technique and results of HSN of the flexor digitorum superficialis (FDS) in the setting of spastic finger flexion.

Methods

HSN of the FDS was performed on 18 patients with functional hands. We employed the Peraut and House categorizations to evaluate pain reduction and improvement of hand function, respectively.

Results

The patients exhibited marked improvement in finger spasticity following HSN. Finger function was preserved, and all patients demonstrated improved hand function, as evidenced by an increase in the House Score from 0 to 2 before surgery to a range of 4 to 8 after the intervention. All patients experienced relief from pain.

Conclusions

HSN of the FDS branch is a technique that should be considered to reduce finger flexor spasticity and preserve finger flexion function.

Type of study/level of evidence

Therapeutic IV.

目的非选择性神经切除术（HSN）是一种先进的周围神经消融术，可以缓解上运动神经元损伤后痉挛患者的痉挛症状，提高其生活质量。HSN 的主要优点是既能治疗痉挛，又能保留手部功能。因此，HSN 可能是痉挛性功能手患者的首选手术。在本研究中，我们介绍了在手指痉挛性屈曲的情况下对屈指肌浅肌（FDS）进行 HSN 的手术技巧和结果。我们采用 Peraut 和 House 分类法分别评估疼痛减轻情况和手部功能改善情况。手指功能得以保留，所有患者的手部功能都得到了改善，House 评分从术前的 0 到 2 分提高到干预后的 4 到 8 分。所有患者的疼痛都得到了缓解。结论FDS分支的HSN是一种可减轻手指屈曲痉挛并保留手指屈曲功能的技术，值得考虑。

{"title":"Clinical Recovery of Spastic Finger Flexion Using Hyperselective Neurectomy: A Case Series","authors":"Mohammadreza Emamhadi, Mohammad Haghani Dogahe, Amirreza Emamhad","doi":"10.1016/j.jhsa.2023.10.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.10.004","url":null,"abstract":"<h3>Purpose</h3><p><span><span>Hyperselective neurectomy (HSN) is an advanced </span>peripheral nerve<span> ablation procedure that can relieve spasticity and enhance the </span></span>quality of life<span><span> in patients with spasticity following upper motor neuron injuries. The main advantage of HSN is that it can treat spasticity as well as preserve hand function. Thus, HSN may be the procedure of choice in patients with spastic functional hands. In this study, we present the surgical technique and results of HSN of the flexor </span>digitorum superficialis (FDS) in the setting of spastic finger flexion.</span></p><h3>Methods</h3><p>HSN of the FDS was performed on 18 patients with functional hands. We employed the Peraut and House categorizations to evaluate pain reduction and improvement of hand function, respectively.</p><h3>Results</h3><p>The patients exhibited marked improvement in finger spasticity following HSN. Finger function was preserved, and all patients demonstrated improved hand function, as evidenced by an increase in the House Score from 0 to 2 before surgery to a range of 4 to 8 after the intervention. All patients experienced relief from pain.</p><h3>Conclusions</h3><p>HSN of the FDS branch is a technique that should be considered to reduce finger flexor spasticity and preserve finger flexion function.</p><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tibial Nerve Repair in a Dog Model: Effect of Local and Systemic Administration of Erythropoietin 狗模型中的胫神经修复：局部和全身应用促红细胞生成素的效果

The Journal of Hand Surgery

Pub Date : 2023-12-07 DOI: 10.1016/j.jhsa.2023.10.018

Mostafa M. Alsayed, Mahmoud F. Ahmed, Mohamed A. Hashem, Ahmed I. Maaty, Mohamed K. El-Kherbetawy, Mohsen M. Hassan, Asser A. Sallam

Purpose

This study aimed to assess the effectiveness of erythropoietin (EPO) as a novel treatment for peripheral nerve injury after surgical repair of an induced tibial nerve injury in dogs.

Methods

Mongrel dogs (n = 27) were randomly divided into three equal groups. A complete tibial nerve injury was induced and repaired directly by stay sutures and the local application of 1 mL fibrin glue (control group). In the “systemic” group, 20,000 IU of EPO were given subcutaneously immediately after surgery and on the first and second days after surgery. In the “local” group, EPO was mixed with fibrin glue at 1,000 IU/mL. Lameness score, compound muscle action potential of the tibial nerve, and serum biochemical and histopathological examinations were performed to evaluate the treated dogs over the study period (12 weeks).

Results

EPO significantly improved the lameness score and compound muscle action potential in both the systemic and local groups. After 12 weeks, systemic and local groups showed earlier improvement in lameness, reaching scores of −1 and 0, respectively, in comparison with the control group, which did not reach a score of −1. The histological study revealed a normal architecture of the nerve bundles within connective tissue. The axons were aligned in a regular pattern, whereas the control group had disrupted and degenerated nerve axons with large gaps in between.

Conclusions

EPO has an accelerating healing effect after tibial nerve surgical repair. Local EPO mimics systemic EPO treatment without systemic adverse effects. These findings indicated that EPO has a potential role in tibial nerve recovery and nerve regeneration.

Clinical relevance

The findings of the present experimental study supported the beneficial effects of systemic and local EPO when combined with peripheral nerve surgical repair, potentially improving functional outcomes and enhancing faster recovery.

目的本研究旨在评估促红细胞生成素（EPO）作为一种新的治疗方法对犬胫神经损伤手术修复后周围神经损伤的有效性。方法将杂种犬（n = 27）随机分为三个等量组。诱发完全性胫神经损伤后，直接进行留置缝合修复，并在局部涂抹 1 mL 纤维蛋白胶（对照组）。在 "全身 "组，术后立即皮下注射 20,000 IU EPO，术后第一天和第二天也是如此。在 "局部 "组中，EPO 与纤维蛋白胶混合，浓度为 1,000 IU/毫升。在研究期间（12 周），对接受治疗的狗进行了跛行评分、胫神经复合肌肉动作电位以及血清生化和组织病理学检查。12 周后，全身组和局部组的跛行改善较早，分别达到-1 分和 0 分，而对照组没有达到-1 分。组织学研究显示，结缔组织内的神经束结构正常。结论 EPO 在胫神经手术修复后具有加速愈合的作用。局部 EPO 可模拟全身性 EPO 治疗，但无全身性不良反应。临床意义本实验研究的结果表明，全身和局部 EPO 与周围神经手术修复相结合可产生有益的效果，从而改善功能预后，加快康复速度。

{"title":"Tibial Nerve Repair in a Dog Model: Effect of Local and Systemic Administration of Erythropoietin","authors":"Mostafa M. Alsayed, Mahmoud F. Ahmed, Mohamed A. Hashem, Ahmed I. Maaty, Mohamed K. El-Kherbetawy, Mohsen M. Hassan, Asser A. Sallam","doi":"10.1016/j.jhsa.2023.10.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.10.018","url":null,"abstract":"<h3>Purpose</h3><p><span>This study aimed to assess the effectiveness of erythropoietin<span> (EPO) as a novel treatment for </span></span>peripheral nerve<span> injury after surgical repair of an induced tibial nerve injury in dogs.</span></p><h3>Methods</h3><p>Mongrel dogs (<em>n</em><span> = 27) were randomly divided into three equal groups. A complete tibial nerve injury was induced and repaired directly by stay sutures<span> and the local application of 1 mL fibrin glue<span> (control group). In the “systemic” group, 20,000 IU of EPO were given subcutaneously immediately after surgery and on the first and second days after surgery. In the “local” group, EPO was mixed with fibrin glue at 1,000 IU/mL. Lameness score, compound muscle action potential of the tibial nerve, and serum biochemical and histopathological examinations were performed to evaluate the treated dogs over the study period (12 weeks).</span></span></span></p><h3>Results</h3><p>EPO significantly improved the lameness score and compound muscle action potential in both the systemic and local groups. After 12 weeks, systemic and local groups showed earlier improvement in lameness, reaching scores of −1 and 0, respectively, in comparison with the control group, which did not reach a score of −1. The histological study revealed a normal architecture of the nerve bundles within connective tissue. The axons were aligned in a regular pattern, whereas the control group had disrupted and degenerated nerve axons with large gaps in between.</p><h3>Conclusions</h3><p>EPO has an accelerating healing effect after tibial nerve surgical repair. Local EPO mimics systemic EPO treatment without systemic adverse effects. These findings indicated that EPO has a potential role in tibial nerve recovery and nerve regeneration.</p><h3>Clinical relevance</h3><p>The findings of the present experimental study supported the beneficial effects of systemic and local EPO when combined with peripheral nerve surgical repair, potentially improving functional outcomes and enhancing faster recovery.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0