Journal of Hand Surgery-Asian-Pacific Volume最新文献

Background: Our objective is to compare clinical, radiographic and complication-related outcomes between two non-autologous implants - Mini TightRope^® and Microlink™ - used in suspensionplasty following open trapeziectomy for thumb carpometacarpal joint arthritis. Methods: We retrospectively analysed 77 patients (41 Mini TightRope^®, 36 Microlink™) treated between 2017 and 2021 with a minimum follow-up of 36 months. All surgeries were performed by the same experienced hand surgeon using a standardised open technique. Pre- and postoperative assessments included Quick Disabilities of the Arm, Shoulder and Hand (QDASH), visual analogue scale (VAS; rest and effort), Kapandji score, grip and pinch strength, thumb range of motion (ROM), patient satisfaction and radiographic evaluation for metacarpal subsidence. Complications and reoperations were recorded and compared. Results: Both groups demonstrated significant clinical improvement, with no statistically significant differences in functional scores, ROM, strength, pain or satisfaction. Implant-related complications differed notably: four Mini TightRope^® patients (9.8%) required implant removal due to discomfort, and one experienced a transient sensory neurapraxia, yielding a total complication rate of 12.2%. In the Microlink™ group, only one patient (2.8%) experienced a similar neurapraxia, and no implant removals or reoperations were needed. No subsidence was observed in either group. Conclusions: Both implants were clinically effective, but the Microlink™ device was associated with a lower complication rate and no removals. These findings suggest that all-suture implants may offer improved soft-tissue compatibility. This is the first clinical report on Microlink™, and its mid-term results appear comparable to those of the more established Mini TightRope^®. Further prospective studies are warranted to assess long-term outcomes. Level of Evidence: Level III (Therapeutic).

An aneurysmal bone cyst (ABC) is classified as a benign osteoclastic giant cell-rich tumour. We report a case of a 48-year-old male patient with a solid variant ABC involving the trapezoid bone. We chose to fill the defect with bone cement after curettage. At the 12-month follow-up, the patient remained recurrence-free with satisfactory hand function. Carpal bone tumours are rare and typically benign, with malignant and metastatic lesions being extremely uncommon. We were unable to find any other reports of a solid variant ABC in the trapezoid bone. This case highlights the importance of histopathological and genetic analyses to achieve a definitive diagnosis of solid variant ABCs in atypical presentations. Level of Evidence: Level V (Therapeutic).

Background: Emergency department (ED) utilisation after surgery is a potentially preventable complication and a focus of health system improvement programmes. Understanding whether mean area income is a risk factor for increased ED utilisation can guide how resources are deployed to reduce unnecessary utilisation. In this study, we tested whether there is an association between mean area income and ED utilisation after hand surgery. Methods: Using a national administrative claims database, we performed a retrospective cohort study of patients who underwent common upper-extremity surgeries. We evaluated ED utilisation within 7 and 30 days after surgery and subdivided the number of ED visits by region and by procedure. We performed multivariable logistic regression to evaluate the association between mean area income and the odds of an ED visit. Results: We identified 2,123,692 patients; 1,851,113 (87%) underwent elective upper extremity surgeries, and 272,579 (13%) underwent distal radius fracture fixation. Overall, compared to patients from areas with income ≥ $65,000, those from areas with income < $65,000 had a higher incidence of any ED utilisation at both 7 and 30 days postoperatively. In multivariable analyses, each $10,000 increase in mean area income was associated with a decrease in odds of an ED visit by 5%-6% at both 7 and 30 days postoperatively. Conclusions: Mean area income has a progressive, inverse association with ED utilisation after both elective upper extremity and distal radius fracture surgery. Mean area income is a contextual factor that can be used to identify and support patients at risk of postoperative ED utilisation. Level of Evidence: Level III (Prognostic).

Vertical locking of the thumb metacarpophalangeal joint (MCPJ) is a very rare condition characterised by a flexion deformity at the MCPJ, accompanied by preserved interphalangeal joint motion. Most reported cases are associated with trauma in young adults, and degenerative causes, especially in the thumb, have not been documented. We present a case of a 52-year-old woman with a several-year history of intermittent locking of the left thumb in flexion, initially self-reducible, later requiring passive release. Intraoperatively, a volar osteophyte from the metacarpal head was noted, with the sesamoid displaced centrally and becoming mechanically trapped on the bony prominence during flexion. The osteophyte was carefully excised, resulting in immediate resolution of the locking. Degenerative locking of the thumb MCPJ is rare and may present insidiously. Awareness of underlying osteophyte impingement on the sesamoid complex is essential. Open surgical intervention with preservation of key anatomical structures leads to good functional outcomes. Level of Evidence: Level V (Therapeutic).

Background: The purpose of this study was to compare Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) and PROMIS Pain Interference (PI) scores before and after carpal tunnel release (CTR) between patients who underwent preoperative electrodiagnostic studies (EDS) and those who did not. Methods: This study was performed retrospectively. A total of 84 patients who underwent an endoscopic or open CTR in 2022 were retrospectively identified and divided based on those who did (n = 42) and did not (n = 42) receive preoperative EDS prior to CTR. Patients who did not receive EDS underwent preoperative CTS-6 or ultrasound. Results: No significant differences were found in pre- and postoperative PROMIS PI and UE scores between the EDS and non-EDS groups. Conclusions: With continued emphasis on reducing health care expenditure in orthopaedics, our findings suggest that preoperative EDS may not influence postoperative outcomes in CTR, and alternative diagnostic assessments, such as CTS-6 or ultrasound, may be considered when EDS is unavailable or unnecessary. Level of Evidence: Level III (Therapeutic).

Background: Thumb metacarpophalangeal (MCP) collateral ligament injuries are common and can be debilitating, with prolonged recovery and functional limitation of the injured hand. The aim of this study is to identify potential demographic differences between patients treated operatively and nonoperatively and identify trends in the surgical management of thumb MCP ligament injuries in New York (NY) State. Methods: Using the Statewide Planning and Research Cooperative System (SPARCS) database and relevant diagnosis codes, 18,171 patients diagnosed from 2010 through 2020 in NY State were identified. Demographic information, including age, sex, race and insurance type, was collected. Comparisons between the operative and nonoperative groups were performed using t-tests or Chi-squared tests as appropriate. The change in percentage of injuries treated operatively, as well as the effects of age, sex, race and insurance type on odds of undergoing surgery, were evaluated using linear regression analysis. Statistical significance was set at p < 0.05. Results: From 2010 to 2020, there were 18,230 collateral ligament injuries. The percentage of injuries treated operatively increased over the study period, with a minimum of 25.7% in 2011 and a maximum of 35.8% in 2017. Compared to patients with Medicaid insurance, patients were significantly more likely to be treated surgically if they had private insurance (OR = 4.15, 95% CI [3.64, 4.75], p < 0.001), worker's compensation (OR = 5.28, 95% CI [4.50, 6.20], p < 0.001) or Medicare (OR = 2.73, 95% CI [2.28, 3.26], p < 0.001). Black and Hispanic patients were less likely to undergo operative management than white patients (OR = 0.52, 95% CI [0.47, 0.58] and OR = 0.45, 95% CI [0.40, 0.51], p < 0.001). Conclusions: Demographic factors, including private insurance, workers' compensation and race, appeared to impact the likelihood of undergoing surgical management. Clinicians must be cognisant of potential demographic biases when making treatment decisions. Level of Evidence: Level IV (Therapeutic).

Background: Neglected dorsal subluxation of the proximal interphalangeal joint (PIPJ) results in significant compromise of hand function. Operations like volar plate arthroplasty, hemihamate arthroplasty and joint fusions have been described to treat them. However, all are open procedures and technically demanding. Dynamic external fixation has been used as a treatment for acute injuries. There is a paucity of literature on the use of static external fixation in the treatment of neglected PIPJ fracture subluxations. We describe the outcomes of the use of static external fixation followed by splinting and therapy for this injury. Methods: Six adults who had chronic dorsal subluxations of the PIPJ with a minimum chronicity of 5 weeks from the injury were included in the study. All of them underwent application of joint-spanning external fixation followed by acute single-step intraoperative distraction. The apparatus was removed at 5 weeks, followed by splinting and therapy. Outcomes recorded were pain scores, total active motion (TAM) and Quick DASH score. Results: The mean age of patients was 30 years. The mean time from injury to surgery was 4.2 months. The mean preoperative VAS was 3.66, and the postoperative VAS was 1.83. The mean TAM improved from 131.6° to 253°. The mean Q-DASH score was 6.41. Conclusions: Static PIPJ distraction using an external fixator followed by splinting and therapy gives good results in neglected dorsal PIPJ fracture subluxations. Level of Evidence: Level IV (Therapeutic).

Fractional tendon lengthening (FTL) is a technique to release certain contractures of various musculotendinous units of the upper and lower limb. It is traditionally done as an open procedure in the operating room under varying types of anaesthesia. A 19-year-old female with an isolated middle finger flexor digitorum superficialis (FDS) contracture who underwent ultrasound-guided percutaneous FTL under wide awake local anaesthesia, without a tourniquet, is presented. This alternative FTL technique allows for a percutaneous approach, which can be done in the clinic under local anaesthesia with possibly comparable outcomes to the standard open approach. Level of Evidence: Level V (Therapeutic).

Background: Wrist arthroscopy is widely used to assess the intactness of ligaments, including the scapholunate ligament (SLL), as it allows direct visualisation and palpation. However, arthroscopy is invasive and costly, while traditional imaging modalities, such as X-rays and MRI, often miss ligament injuries due to their static nature. A promising alternative is four-dimensional computed tomography (4DCT), which allows dynamic, non-invasive visualisation of wrist motion in real time. This study evaluates the diagnostic potential of 4DCT for detecting SLL tears by comparing its findings with arthroscopy and open surgery. Methods: Twenty-one patients with suspected SLL tears underwent 4DCT imaging, with independent reviews by two radiologists. The motion cycles of extension-flexion and radial-ulnar deviation were analysed. Arthroscopy was performed within a few weeks after the scan. Patients with Geissler grade III or IV tears underwent surgical reconstruction. The qualitative assessments of the SLL by radiologists and surgeons were compared, while the kinematic parameters of the injured and contralateral wrists were analysed using a linear mixed model. Results: Radiologists' 4DCT evaluations corresponded with arthroscopy or surgical findings in 14 of 21 patients (67%). Patients with total SLL tears showed greater scapholunate distance and scapholunate angle during all wrist movements compared with uninjured wrists. Notably, 4DCT showed greater diagnostic agreement with surgical findings than arthroscopy alone. Conclusions: These findings demonstrate the potential role of 4DCT in diagnosing SLL tears. Further research should focus on optimising the acquisition and analysis of the 4DCT scan and refining 4DCT parameters to distinguish partial from total SLL tears. Level of Evidence: Level III (Therapeutic).

The scaphoid is the most injured carpal bone, with an incidence of 12 per 100,000 per annum in the United Kingdom (UK). Fractures of the scaphoid can be challenging to diagnose, both clinically and radiographically, and have a propensity to fail to unite or develop necrosis. There is debate regarding whether to manage acute fractures conservatively or offer early surgical fixation. The poor predictive value of initial examination and plain imaging not only results in missed fractures but also, conversely, in a fivefold overtreatment, which has subsequent significant socioeconomic consequences. It is estimated that between 1995 and 2010, claims relating to the mismanagement of scaphoid fractures cost the National Health Service in the UK £3.5 million. This review will focus on two main controversies in the diagnosis and treatment of scaphoid fractures: how to manage a symptomatic patient with a negative X-ray and which fractures warrant acute surgical fixation? Level of Evidence: Level V (Therapeutic).