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

Background: Radiological wrist parameters are used to evaluate the treatment of distal radius fractures. Accurately restoring the distal radius is essential for good functional outcomes, but the reference values used for the Thai population are based on Western databases. This study aims to determine the reference values for normal wrist parameters in the Thai population. Methods: Two orthopaedic hand surgeons analysed 200 posteroanterior (PA) and lateral wrist radiographs, measuring radial height, radial inclination, ulnar variance and volar tilt using the central reference point (CRP) as a reference, with comparisons between sex and wrist side. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC). Results: The mean values of wrist parameters were as follows: radial height, 10.7 ± 1.3 mm; radial inclination, 22.8° ± 2.4°; ulnar variance, -0.2 ± 1.2 mm and volar tilt, 13.5° ± 3.0°. All parameters had significant sex-based differences, with higher radial height in males and higher radial inclination, ulnar variance and volar tilt in females. No significant differences were found between the wrist sides. The interobserver reliability was excellent for radial inclination (ICC = 0.92) and ulnar variance (ICC = 0.93) and good for radial height (ICC = 0.90) and volar tilt (ICC = 0.79). Conclusions: Reference values were established for normal wrist parameters in the Thai population, with notable sex-based differences. The values are comparable to Western references except for volar tilt, which is higher in Thais. These findings can be applied in the treatment of distal radius fractures, the design of implants and the development of research or artificial intelligence databases. Level of Evidence: Level IV (Diagnostic).

Peripheral nerve injuries remain a significant clinical challenge due to suboptimal functional recovery, even with surgical intervention. This article critically reviews current adjunctive strategies aimed at enhancing outcomes after peripheral nerve repair. The modalities discussed include electrical stimulation, erythropoietin, tacrolimus, methylcobalamin, gene therapy and stem cell-based interventions. For each modality, we examine proposed mechanisms of action, quality of evidence and translational relevance. Special attention is given to differentiating findings from animal models and their applicability to clinical practice. Rather than highlighting speculative biological mechanisms, this review focusses on evaluating the clinical utility and limitations of each approach to guide evidence-based therapeutic decisions. Level of Evidence: Level V (Therapeutic).

Background: This study aimed to assess whether the presence of psychiatric co-morbidity impacts reoperation rates or the ability to complete routine follow-up after open reduction and internal fixation (ORIF) of distal radius fractures. Methods: A retrospective cohort study was performed of all patients who underwent distal radius ORIF with a volar locking plate between January 2012 and December 2016 at two Level I trauma centres. Presence of a psychiatric diagnosis at the time of injury was recorded. Bivariate analysis was utilised to compare patient characteristics, injury characteristics, reoperation rates and length of follow-up between those with and without psychiatric co-morbidity. Multivariable regression analysis was performed to identify whether psychiatric co-morbidity was predictive of reoperation or the ability to complete routine post-operative follow-up. Results: A total of 1,071 patients sustaining 1,110 distal radius fractures (39 bilateral injuries) met the inclusion criteria, of whom 338 patients (30.5%) had a psychiatric diagnosis at the time of injury. Bivariate analysis revealed a higher proportion of females in the psychiatric co-morbidity cohort (79% vs. 66%). There was no difference in reoperation rates (18% vs. 13%, p = 0.10) nor length of follow-up (12.8 months vs. 14.3 months, p = 0.67) between the psychiatric co-morbidity and control cohorts. Multivariable logistic regression revealed that the presence of psychiatric co-morbidity did not independently predict reoperation rate nor length of follow-up. Conclusions: The presence of psychiatric co-morbidity does not affect post-operative follow-up or need for revision surgery after distal radius ORIF. Level of Evidence: Level IV (Therapeutic).

Background: Psychosocial factors may play a role in the management of distal radius fractures (DRF). The purpose of this study was to explore how psychiatric history and socioeconomic status affect access to care, patient-reported outcomes (PROs) and complications after adult DRF. Methods: A retrospective cohort study of adult patients from 2005 to 2015 with a DRF was conducted. PROs were collected via DASH and VAS questionnaires. Socioeconomic status was inferred through insurance status and Area Deprivation Index (ADI) based upon the patient's ZIP code of residence. Complications and reoperations were collected. Statistical analysis consisted of generalised estimating equations (GEE) with a logistic link to account for repeated measures of individual subjects. Results: A total of 316 patients were studied. Psychiatric history was associated with increased time from injury to first clinic visit with a hand surgeon by a mean of 3.3 days, while time to surgery was increased with higher ADI percentile by a mean of 0.08 days per ADI percentile. Psychiatric history and higher ADI percentiles were associated with higher DASH scores by a mean of 8.9 points and 0.22 points per ADI percentile, respectively. VAS scores and complication or reoperation rates were not statistically affected by psychiatric history, insurance or ADI. Conclusions: Patients with a psychiatric history or those residing in a more socioeconomically disadvantaged neighbourhood have increased time to follow-up and surgery as well as worse DASH scores following DRF. Level of Evidence: Level III (Diagnostic).

Background: Autologous fat grafting (AFG) is increasingly explored beyond cosmetic applications, with interest in its regenerative potential for hand conditions such as cutaneous systemic sclerosis, thumb base osteoarthritis, Dupuytren contracture, burn scars, trauma and congenital hand deformities. This systematic review evaluates the therapeutic efficacy, techniques and outcomes associated with AFG across pathological hand conditions. Methods: A systematic literature search was conducted in July 2023 using PubMed, Ovid MEDLINE, Embase and Web of Science. Studies were included if they involved autologous fat or stromal vascular fraction (SVF) grafting for therapeutic purposes in hand conditions. Risk of bias (RoB) was assessed using RoB 2.0 for randomised controlled trials (RCTs) and the MINORS tool for non-RCTs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Results: Twenty-five studies were included (8 RCTs, 17 non-RCTs), involving a total of 909 patients. Conditions studied included systemic sclerosis (n = 7 studies), thumb base osteoarthritis (n = 7), Dupuytren contracture (n = 6), burn-related scars (n = 2), hand trauma (n = 2) and congenital deformities (n = 2). AFG was most consistently associated with improvements in pain (visual analogue scale [VAS]), joint mobility (range of motion) and functional scores such as the Cochin Hand Function Scale (CHFS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Michigan Hand Questionnaire (MHQ), particularly in systemic sclerosis and thumb base osteoarthritis. Findings in Dupuytren's contracture were mixed, with observational studies reporting early improvements but RCTs showing higher recurrence rates. Outcomes for burn scars, trauma and congenital deformities were less consistent. Techniques for fat harvesting, processing and injection varied widely. Conclusions: AFG shows therapeutic potential across several hand conditions, with the strongest current evidence supporting its use in systemic sclerosis and thumb base osteoarthritis. However, significant methodological heterogeneity and limited high-level evidence remain. Further robust, standardised RCTs are needed to clarify indications, optimise techniques and assess long-term outcomes. Level of Evidence: Level III (Therapeutic).

Background: We designed a new non-locking six-strand suture technique (Li-Wee) as an evolution of our previous work. The aim of this study is to biomechanically compare repairs using this technique with FiberWire^® 4-0 versus Prolene^® 4-0. Methods: Thirty porcine flexor tendons were harvested for the experiments. A transverse cut was made in the middle of the tendons to allow for tendon repair. Repairs were made equally by using the Li-Wee technique with FiberWire^® 4-0 and Prolene^® 4-0. The ultimate tensile strength (UTS), load to 2 mm gap force, stiffness and repair times were measured under static testing. Furthermore, cyclic testing was performed on five specimens with the circumferential epitendinous suture from each repair group to evaluate their gap formation under cyclic loadings and final UTS. Results: The mean UTS of repairs using FiberWire^® was 81.3 ± 10.3 N while repairs done with Prolene^® was 66.7 ± 8.3 N under static testing, and 98.7 ± 4.9 N for repairs using FiberWire^® and 68.3 ± 10.4 N for repairs using Prolene^® under cyclic testing. Comparing FiberWire^® and Prolene^® repairs, the load to 2 mm gap force was 37.6 ± 8.4 N and 31.0 ± 10.9 N; stiffness was 6.5 ± 0.9 N/m and 8.1 ± 1.0 N/m; repair times were 466 ± 45 s and 465 ± 62 s, respectively. A statistically significant difference was found between groups for UTS under both static and cyclic testing, as well as stiffness. Conclusions: This study has shown that six-strand non-locking Li-Wee flexor tendon repair using FiberWire^® offers satisfactory repair strength, adequate stiffness and 2 mm gap force.

Background: Carpometacarpal-1 joint osteoarthritis (CMC-1 OA) is a common degenerative hand condition that significantly impairs hand function and quality of life, with autologous fat grafting (AFG) emerging as a promising treatment option. This study aims to conduct a systematic review of the outcomes of the use of AFG for CMC-1 OA. Methods: A comprehensive literature search was conducted across various databases. Ten relevant studies were identified, analysed and assessed for risk of bias (ROB) using the Cochrane Systematic Review RCT ROB assessment tool, Evidence Project ROB tool and the Joanna Briggs Institute Critical Appraisal Checklist. Results: The review included one RCT, two prospective comparative studies, four prospective non-comparator studies and three case series. Post-AFG, pain decreased by an average of 4.5 points on the visual analogue scale. Patient-reported outcomes improved by 60% in Arm, Shoulder and Hand Disability scores. Pinch grip and grip strength results varied, with only two studies showing significant improvements. Patient satisfaction was high: 83% would recommend the treatment, and 73% would undergo it again. Surgical revision rates fluctuated, peaking at 38.7% over 5 years. Conclusions: AFG shows promise as a lasting treatment for CMC-1 OA, providing significant pain relief and improved hand function. However, more studies on objective outcomes are necessary to establish its efficacy. Level of Evidence: Level III (Therapeutic).

Background: We aimed to evaluate the difference in health utility outcome measures between trapeziectomy and total joint arthroplasty (TJA) in the surgical management of basal thumb osteoarthritis (BTOA). Methods: Data obtained from the UK Hand Registry for all trapeziectomies (± ligament reconstruction and tendon interposition) and total joint arthroplasties for BTOA, including patient-reported outcome measures (PROMs) EQ5D and PEM part 2 scores, at baseline, 3 months, 6 months, 1 year and 2 years postoperatively. EQ5D scores were converted to index values, and PEM part 2 scores were calculated to allow comparison with baseline scores and to generate delta values at each time point. Mann-Whitney U tests were used to determine statistical differences. Results: A total of 948 procedures identified (710 trapeziectomy; 238 TJA), 76% female. More PROMs were collected for trapeziectomy patients at all timepoints (267 EQ5D and 262 PEM-2 at baseline; 27 EQ5D and 26 PEM-2 at 2 years) than for TJA patients (98 EQ5D and 111 PEM-2 at baseline; 8 EQ5D and 18 PEM-2 at 2 years). PEM-2 was significantly improved in the TJA group at 3 months (p = 0.047) and 6 months (p = 0.012); there was no significant difference at subsequent follow-up (1 year, p = 0.611; 2 years, p = 0.438). There was no significant difference in EQ5D identified between trapeziectomy and TJA at any time point (3 months, p = 0.056; 6 months, p = 0.059; 1 year, p = 0.222; 2 years, p = 0.250). Conclusions: TJA appears to offer a faster return of hand function, as measured by PEM-2, when compared with trapeziectomy, though this clinical improvement is not sustained beyond 6 months from this registry data. We identified no significant difference in EQ5D between the two procedures at any time point, though both groups improved from baseline. Greater engagement with the UKHR from surgeons and patients might help to reduce attrition and improve longer-term outcomes reporting. Level of Evidence: Level III (Therapeutic).

Introduction: Surgical decompression remains the gold standard for managing severe carpal tunnel syndrome (CTS). However, perioperative pain and incomplete symptom resolution persist in some patients. Alpha-lipoic acid (ALA), a neuroprotective antioxidant, has shown potential benefits in neuropathic conditions. This retrospective study evaluates the clinical and electrophysiological effects of ALA as an adjunctive therapy in CTS management. Methods: We retrospectively analysed 164 patients with electrodiagnostically confirmed CTS who underwent open surgical decompression. Patients were divided into three groups: Group A (surgery only), Group B (surgery plus postoperative ALA) and Group C (pre- and postoperative ALA). Outcomes were assessed using the visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), analgesic consumption and nerve conduction studies, with follow-up at 6 weeks, 6 months and 12 months. Results: ALA-treated patients showed statistically significant improvements in VAS scores, BCTQ subscales and analgesic consumption compared to controls. Only the group receiving both pre- and postoperative ALA achieved clinically meaningful improvements, exceeding the established MCID thresholds for both symptom severity (0.76 points) and functional status (0.32 points). Electrophysiological parameters, such as motor conduction velocity, also improved more in ALA-treated groups. Conclusions: Adjunctive use of ALA in CTS surgery was associated with statistically significant, yet clinically modest, improvements in pain, function and electrophysiology. These findings support further investigation of ALA as a low-risk, potentially beneficial coadjuvant in CTS treatment protocols. Level of Evidence: Level III (Therapeutic).

Background: The first metacarpal extension osteotomy (FMEO) is an effective surgical procedure for thumb carpometacarpal (CMC) arthritis, but a dedicated fixation implant was not yet available. The Shamoji plate is a newly developed anatomical locking implant for FMEO. We report the short-term postoperative results of FMEO using the Shamoji plate in patients with early to moderate stage of CMC arthritis of the thumb. Methods: We reviewed 17 thumbs in 17 patients who underwent FMEO using the Shamoji plate. At the initial time of diagnosis, all cases were classified as Eaton stage 2 of CMC joint arthritis. The postoperative follow-up period ranged from 5 to 18 months, with an average of 10.1 months. An L-sized Shamoji plate (30 mm, six locking screws and one cortical screw) with a 30° bend was used most. Postoperatively, active range-of-motion exercises started the following day after surgery. Clinical outcomes and realignment of CMC joint on plain radiograph and computed tomography were evaluated. Results: An average operation time was 52 minutes. Plain radiographs showed early bone union in all patients with an average time of 3.3 months. Visual analogue scale, tip pinch strength and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score were significantly improved postoperatively. The flexion angle of the metacarpophalangeal joint decreased approximately 10°. The metacarpals were dorsally realigned 23°-25° after FMEO. The dorsal subluxation angle and % subluxation were significantly improved, indicating a significant improvement in malalignment of the CMC joint. Conclusions: The Shamoji plate is a sufficient internal fixation implant with good short-term results in terms of osteotomy angle, bone healing, pain relief, functional recovery and realignment of the CMC joint. FMEO by use of Shamoji plate is expected to provide reliable clinical outcomes for patients with the CMC joint arthritis in Eaton stage 2. Level of Evidence: Level IV (Therapeutic).