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

Background: Palmar midcarpal instability (PMCI) is often neglected in diagnosis and lacks a gold standard treatment. It is primarily associated with dorsal radiocarpal (DRC) ligament insufficiency. We used a combined approach of arthroscopic thermal capsular shrinkage and open DRC ligament suture tensioning for symptomatic PMCI and present our outcomes. Methods: From 2018 to 2022, nine PMCI patients (mean age: 32 years) underwent this treatment. The mean symptom duration was 15.3 months, with a mean follow-up of 16.8 months. Outcomes were measured by wrist ROM, grip strength, VAS for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and modified Mayo Wrist scores. Results: All patients showed significant improvement in pain, grip strength and function, with maintained radiocarpal stability at final follow-up. Although wrist ROM showed mild limitation after surgery, all patients returned to their previous work and activities. Conclusions: This approach may provide an effective and less aggressive treatment for PMCI. Level of Evidence: Level IV (Therapeutic).

Comminuted intra-articular fractures of the metacarpophalangeal joint (MCPJ) of the thumb are difficult to treat because of challenges with anatomical fixation. The pins and rubbers traction system (PRTS), described by Suzuki et al., is a minimally invasive technique that enables early range-of-motion training while maintaining joint congruency. PRTS exhibits advantages relative to other dynamic external fixation techniques due to its simplicity, low cost and compact design. It has been used mainly in treating primarily proximal interphalangeal joint (IPJ) fractures. We present two patients where we used a PRTS for comminuted intra-articular fractures of the thumb MCPJ with good outcomes. We temporarily pinned the carpometacarpal joint (CMCJ) in maximum abduction to avoid skin irritation from the ulnar aspect of the axial traction wire in thumb adduction. Level of Evidence: Level V (Therapeutic).

Neuropathic pain in root avulsion brachial plexus injury (BPI) is severe and unrelenting. Routine analgesics and other described methods often provide inadequate pain relief. We report a patient with neuropathic pain following C₈T₁ root avulsion injury, which was successfully managed with end-to-side ulnar sensory branch transfer to the median nerve. Postoperatively, there was a marked reduction in pain score as determined by visual analogue score (VAS) and a marked improvement in the daily sleep interference scale (DSIS). This option may be considered in patients with severe neuropathic pain in lower root avulsion injury in BPI. Level of Evidence: Level V (Therapeutic).

Conventional prosthetic sockets can be uncomfortable and restrictive to elbow flexion when fitted on short forearm stumps due to their high trimline. We report improved patient experience after switching to a locking silicone-liner socket in conjunction with a lightweight aesthetic prosthesis in two congenital transradial amputees with short stumps who were previously dissatisfied with their conventional prosthesis. To reduce weight, the forearm section of the prosthesis was constructed using a lightweight design. Seven of eight attributes, namely aesthetics, comfort, suspension, ease of donning/doffing, weight, range of motion, skin issues and overall satisfaction, were rated by both patients as having improved versus their conventional prosthesis, with no change reported regarding issues of the skin. Our experience suggests that transradial amputees with short stumps who had problems with conventional fittings due to socket impingement and prosthesis weight may benefit from an approach combining a locking-pin liner suspension with a lightweight prosthesis. Level of Evidence: Level V (Therapeutic).

Background: Distal radius fractures (DRFs) are a common injury with fracture parameters guiding surgical treatment. Palmar plating is the most common method of fixation in patients needing surgical fixation. However, in fractures with a complete or nearly intact volar cortex, reduction of the fracture fragments may be challenging with the palmar approach. We use a novel Z-osteotomy technique to address this issue and report on our outcomes. Methods: This is a retrospective review of all patients where a volar Z-osteotomy technique was used. We assessed pre-, intra- and postoperative radiographic parameters, fracture union and final wrist range of motion of all patients. Results: Twelve DRFs in 11 patients were analysed. All fractures were successfully plated palmarly with volar tilt 9-14 (average: 11.3) and all achieved fracture union. This was maintained in the final radiographs with good clinical wrist range of motion. Conclusions: The volar Z-osteotomy technique described allows surgeons to achieve anatomical reduction of volar tilt in DRFs where the volar cortex is intact with good clinical and radiological outcomes. Level of Evidence: Level IV (Therapeutic).

Background: This study aimed to identify the risk factors associated with re-displacement or collapse of distal radius fractures treated using volar locking plates in older adults. Methods: We conducted a retrospective analysis of 131 patients aged ≥65 years with distal radius fractures who underwent volar locking plate fixation. The collapse was classified into three categories: 'radial collapse' was determined as the top decile of patients with the greatest decrease in radial inclination; 'dorsal collapse' was defined by volar tilt angle on lateral or 25° tilted lateral views and 'height collapse' by radial height. To identify the factors related to these three types of collapses, we compared the clinical and radiological parameters between the wrists with each type of collapsed and non-collapsed wrists. Results: Dorsal collapse had no significant associated factors and radial collapse had osteoporosis as a significant different factor. The height collapse group was associated with older age, had a higher prevalence of high-energy injury mechanisms and a limited range of flexion-extension at final follow-up and larger distance between the articular surface and distal screws. Conclusions: The volar locking plate may effectively prevent three types of collapses. Height collapse group included patients with increased age, high-energy injury mechanisms and limited range of flexion-extension at the time of final follow-up. To prevent collapse, the longest possible distal screws must be inserted just beneath the subchondral bone. Level of Evidence: Level IV (Therapeutic).

Background: Radial head fractures with comminution and displacement present challenges in achieving optimal treatment outcomes in the long term. This study aims to evaluate the long-term effects of radial head excision (RHE) in patients with Mason type 3 fractures. Methods: We conducted a retrospective study of patients with a Mason type 3 radial head fracture who underwent primary RHE between January 2010 and January 2020. The primary outcome was the Mayo elbow performance score (MEPS). Additionally, joint stability and arthritis, and the carrying angle were recorded for each patient. Results: In total, 61 patients (21; 34% female) with a follow-up range of 3-13 years were examined. The mean (SD) total MEPS was 91.8 (9.2). The results were excellent for 46, good for 12 and fair for 3 patients. A model of total MEPS adjusted for sex, age and follow-up time showed a significant effect of patient age on treatment success (p < 0.001). Thirteen patients (21%) showed elbow instability. Six individuals had increased valgus laxity. The mean carrying angle was 19° (range: 11°-27°) on the injured side and 9° (4°-15°) on the uninjured side, t(120) = 12.608, p < 0.001. Overall, 37 patients had degenerative changes in the operative elbow. Conclusions: Benefits of RHE persist for a long time with predominantly excellent elbow function and minimal complications. An increase in the carrying angle, joint instability and degenerative changes are to be expected. Patient age at the time of the surgery can affect treatment outcomes. Level of Evidence: Level IV (Therapeutic).

Background: The off-label use of gabapentinoids for carpal tunnel syndrome (CTS) is increasing despite limited evidence of efficacy and known risks of adverse effects. This systematic review and meta-analysis aimed to synthesise the evidence of the benefits and harms of oral gabapentinoids in treating CTS. Methods: We searched Medline and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT). Based on the search results, we formed three comparisons assessing the effect of oral gabapentinoid interventions against (1) placebo (primary comparison), (2) open label no-treatment (with co-interventions in both arms) or (3) splinting. The primary outcome was symptom severity. The secondary outcomes were pain, function, clinical improvement, health-related quality of life, adverse effects and need for surgery. We adhered to the Cochrane and GRADE methodology throughout conducting this systematic review and meta-analysis. Results: Gabapentinoids probably do not improve CTS symptoms (moderate certainty) compared with placebo. The benefit was 0.08 points better (95% confidence interval [CI] 0.33 better to 0.17 worse; two studies, 286 randomised participants) expressed on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (1-5 points, lower is better; minimal clinically important difference [MCID] 1.14 points) with gabapentinoids at 8 weeks. Secondary comparison to no treatment aligned with this finding. Gabapentinoids probably cause more fatigue (risk ratio [RR] 1.67 [95% CI 1.06-2.63]) and may cause more dizziness (RR 1.96 [95% CI 0.93-4.13]) compared to placebo. When compared to no-treatment at short term, gabapentinoids may provide minor benefits for pain but not for hand function. Conclusions: Current evidence does not support the use of oral gabapentinoids for CTS. There were no clinically important benefits in symptom relief when compared to placebo or no-treatment, and gabapentinoids caused adverse effects, particularly fatigue and maybe also dizziness. Level of Evidence: Level II (Therapeutic).

Background: Thumb carpometacarpal (CMC) arthritis is a painful and debilitating condition, which in severe cases may be treated by surgery. Previous studies have emphasised the importance of rehabilitation following surgery to achieve optimal results. This study aimed to investigate whether intensive hand therapy is effective in improving hand functions after arthroscopic partial trapeziectomy with suture-button (SB) suspensionplasty in patients with thumb CMC arthritis. Methods: This was a retrospective observational study that used non-randomised historical controls. Patients who underwent arthroscopic partial trapeziectomy with SB suspensionplasty were divided into two groups according to whether they had postoperative hand therapy or not (hand therapy group, n = 12; no hand therapy group, n = 11). CMC joint pain, range of motion (ROM), grip and pinch strength in the operative side and Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score were compared before surgery and at the final follow-up for each group. Results: CMC joint pain, ROM and QuickDASH scores significantly improved following surgery, in both groups. Conversely, postoperative grip and pinch strength only increased significantly in the hand therapy group (grip strength: effect size = 0.36, pinch strength: effect size = 0.44). Conclusions: This study demonstrates that early-stage intensive hand therapy is an effective intervention after arthroscopic partial trapeziectomy with SB suspensionplasty, specifically for improving grip and pinch strength. Level of Evidence: Level III (Therapeutic).