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

Background: Partial wrist arthrodesis (PWA) is a salvage procedure used in advanced wrist arthritis and has traditionally been performed via an open dorsal approach. In recent years, surgeons have moved towards arthroscopic fusions to minimise soft tissue damage and preserve vascular supply, increase union rates and hasten recovery. The purpose of this study is to synthesise the current literature on the outcomes of arthroscopic PWA. Methods: A systematic review was performed to survey the literature regarding outcomes of PWA. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. Data collected included patient demographics, operation time and technique, complications and postoperative patient outcomes in the form of patient-rated surveys, grip strength, range of motion and the pain visual analogue scale (VAS). Results: Twelve studies were eligible for inclusion, with a total of 191 patients. 94% of patients achieved union, with a mean time to fusion of 12.5 weeks. VAS, Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist scores were significantly improved after the procedure, and complication rates were comparable to open procedures. Range of motion varied greatly across studies, due to heterogeneity in carpal intervals fused. Conclusions: Arthroscopic PWA is a safe and effective procedure in the treatment of advanced arthritis of the wrist. Further comparative studies would be useful in assessing benefits of arthroscopic arthrodesis over an open approach. Level of Evidence: Level III (Therapeutic).

Background: Carpal tunnel syndrome (CTS) due to amyloid deposition was reported to precede fatal cardiac amyloidosis by several years. Although nerve conduction study (NCS) supports CTS diagnosis, the incidence of positive amyloid deposition in electrophysiologically proven CTS is unclear. Methods: We retrospectively analysed the demographic data including age, gender, bilateral hand involvement, amyloid deposition and NCS results, of 111 consecutive CTS patients with postoperative symptom improvement (mean 71.1 years old, male/female ratio: 44/67) who simultaneously underwent carpal tunnel release (CTR) and biopsy for amyloid deposition. Results: Electrophysiologically proven CTS patients were 102 (91.9%) out of 111 patients. Amyloid deposition was detected in 62 hands (55.9%), of which 51 were transthyretin amyloid. The NCS severity was associated with a higher prevalence of positive amyloid deposition (p < 0.01). The NCS severity also showed an increased trend between reported risk factors for positive amyloid deposition such as older age, male gender and bilateral hand symptoms (p < 0.01). Conclusions: The prevalence of positive amyloid deposition was higher than previous reports in this study. Abnormal NCS findings in CTS, such as an increased distal motor latency (DML) of abductor pollicis brevis compound muscle action potentials (APB-CMAP) or absent APB-CMAP, may help to increase the pre-test probability of amyloid deposition in tenosynovial biopsy. Level of Evidence: Level IV (Diagnostic Study).

Background: De Quervain (DQ) tenosynovitis is a frequent source of wrist pain amongst middle-aged adults. Steroid injections are recommended after conservative methods fail, despite unclear mechanisms. The effectiveness of platelet-rich plasma (PRP) for DQ is not well-studied. To address this gap, we conducted a randomised controlled trial comparing the efficacy of PRP and corticosteroid (CS) injections for treating DQ. Methods: This prospective, randomised and open-label trial was conducted at a tertiary care hospital in India. Adult patients aged 18-60 were randomly assigned to receive either ultrasound-guided triamcinolone acetonide injections or autologous PRP in the first extensor compartment. Outcomes were measured at baseline and at 1, 4 and 12 weeks using the VAS and quick disabilities of arm, shoulder and hand (QuickDASH) questionnaires. Results: Eighty-six age- and sex-matched patients, with an average disease duration of 14 weeks in both groups, were enrolled. Both the CS and PRP groups demonstrated a significant reduction in pain scores and improvement in functions at 1, 4 and 12 weeks. However, between the groups, the degree of improvement in pain was more in CS group at 1 week and similar improvements between the groups at 4 and 12 weeks. Regarding hand function, the CS group exhibited notable at 1 and 4 weeks based on the QuickDASH scale. Yet, by the 12th week, hand function improvements were comparable between both groups. Conclusions: This study suggests that PRP is equivalent to CS in reducing pain in DQ tenosynovitis. Hand function improved more significantly in the CS group at 1 and 4 weeks post-injection. Both PRP and CS are safe and equally effective treatments for DQ. Level of Evidence: Level I (Therapeutic).

Background: Surgeons use anatomical landmarks like the scaphoid tubercle, pisiform, trapezial tubercle and hook of hamate, along with Kaplan cardinal line (KCL) to avoid injury to the recurrent motor branch (RMB) of the median nerve during carpal tunnel release. The presence of transverse muscle fibres (TMF) overlying the transverse carpal ligament (TCL) may suggest proximity of the RMB, but their anatomical relationship is unclear. In this study, we evaluated the accuracy of anatomical landmarks to the RMB, TMF origin and insertion, and examined the relationship between TMF presence and RMB running patterns. Methods: We dissected 30 hands from 16 fresh-frozen cadavers. After marking the superficial landmarks, we made a skin incision to confirm the presence of TMF and examined their origins and insertions. We then opened the carpal tunnel, dissected the RMB and recorded each position on a coordinate system using a fluoroscopic imaging system. Results: TMF were observed in 18 hands (60%): 13 were continuous with the abductor pollicis brevis (APB), 2 were continuous with the superficial head of the flexor pollicis brevis (FPB) and 3 were continuous with both. The bifurcation point of the RMB was significantly located 4.5 mm ulnar and 7.5 mm proximal to the superficial landmark at the median. The RMB was classified according to Poisel classification: 24 (80%) were of the extraligamentous type, 4 (13%) of the transligamentous type, 1 (3%) of the preligamentous type and 1 (3%) of the subligamentous type. Amongst these, the transligamentous/preligamentous/subligamentous types are at high risk for RMB injury during TCL incision. No significant association existed between TMF presence and these high-risk RMB types.. Conclusions: The actual RMB may be located ulnar and proximal to the superficial landmark, indicating that surgeons should be cautious about RMB damage even in the absence of TMF.

Background: Decellularised nerve transplantation has limited therapeutic efficacy for peripheral nerve injuries. In this study, we tested the hypothesis that nerve regeneration can be promoted by increasing blood circulation to the decellularised nerve through the surrounding blood-flow environment. Methods: We transplanted 20 mm decellularised nerves into sciatic nerve defects in Sprague-Dawley rats (female, 12 weeks old). In the intramuscular group, the decellularised nerve was implanted into the biceps femoris muscle and covered with the muscle to provide blood circulation. In the avascular group, the decellularised nerve was sutured to the sciatic nerve and the surrounding nerve bed was cauterised to create a non-bleeding field. In the intramuscular without repair group, the decellularised nerve was implanted in the biceps femoris muscle, but not sutured to the sciatic nerve. Axonal elongation and angiogenesis were evaluated immunohistochemically using anti-neurofilament, anti-S100 and anti-CD31 antibodies in sagittal and transverse sections of the nerve 3 weeks later. Results: In the intramuscular group, the number of neurofilaments per unit area and S100 were higher than those in the other groups (p < 0.05). CD31 staining was predominant in the intramuscular group. Axial images of the nerves confirmed the localisation of CD31-positive cells, and positive cells were found in the centre of the decellularised nerves in the intramuscular group. Conclusions: Decellularised nerve grafts wrapped with vascular-rich tissue promoted nerve regeneration by enhancing angiogenesis in transplanted nerve grafts and preventing ischemia in the centre of the nerve graft.

Background: Supracondylar humerus fractures are the most common type of elbow fracture in children, with a variety of complications such as cubitus varus deformity. The most important goal of the initial treatment is to avoid complicated deformities. In the present study, we investigated cubitus varus deformity and discussed the ideal initial treatment for supracondylar humerus fractures. Methods: There were 58 conservative cases (26 girls and 32 boys) and 115 operative cases (40 girls and 75 boys) with supracondylar humerus fractures. We evaluated the correlation between the following factors on injury in the conservative cases: Gartland classification, presence of comminuted medial fractures, medial shift length, anterior spike length, age, sex, affected side (as explanatory variables) and the factors of cubitus varus deformity as response variables by using the linear regression model for multivariable analysis. Moreover, we evaluated the changes in displacement after the operation in the operative cases, adding the presence of medial pins and the number of pins as explanatory variables. Results: Injury severity (Gartland classification) was a significant factor for cubitus varus deformity. The presence of comminuted bone fragments on the medial side, anterior spike length, age, sex and affected side were not significant factors of cubitus varus deformity. However, medial displacement on injury was a significant factor of both cubitus varus deformity. In the operative case study, medial displacement was a significant factor in cubitus varus deformity. The presence of comminuted bone fragments on the medial side, number of pins and age were also significant factors for cubitus varus deformities. Conclusions: The present study concluded that it is important to perform accurate reduction and fixation, with special attention to medial shift and medial comminuted fragments to avoid cubitus varus deformity. Level of Evidence: Level IV (Therapeutic).

Globally, surgical exposure for the trainee has become challenging due to changes in shift patterns, increasing medicolegal issues and the recognition of burnout. Simulation models are a crucial adjunct for the development of arthroscopic skills and open procedures. Advanced anatomically precise 3D-printed wrist models are used in our workshops. The models have pathological lesions within, allowing a range of arthroscopic and open procedures to be performed. Pathology can be ordered on-demand. Arthroscopic and open procedures can be performed, including fracture fixation and arthroplasty. For effective teaching, we use a lab-based environment with basic arthroscopic and open equipment and implants available. We use a specific structure in which to teach trainees, including pre-course material, videos, demonstrations, practice and feedback. Advanced surgical training models for wrist surgery allow for safe, repetitive surgical training to allow the trainee to accelerate their learning curve. Level of Evidence: Level V (Therapeutic).

Synovial osteochondromatosis is a relatively rare condition of the hand. We present a rare case of a locked finger in a paediatric patient with synovial osteochondromatosis, in which a tumourous lesion was continuous with the flexor tendon and trapped proximal to the A1 pulley. After resection of the tumour and synovium, no recurrence was observed over a 6-month follow-up period. Synovial osteochondromatosis in the hand or fingers can lead to swelling and limited range of motion; however, symptom progression is usually slow. Moreover, it is uncommon for an extra-articular tumour to cause a sudden onset of locking symptoms without prior warning signs. Comprehensive excision of the synovium is essential, and ongoing observation for recurrence is necessary during follow-up. Level of Evidence: Level V (Therapeutic).

Background: Synovial chondromatosis is a condition that rarely occurs in the hand and wrist. Recurrence and malignant transformation are two potential complications of the disease. We set out to retrospectively review 35 years of practice within our sarcoma and tertiary hand unit and identify recurrence or malignant transformation. Methods: This is a retrospective analysis of patients with synovial chondromatosis seen at our sarcoma and tertiary hand unit for the past 35 years. Incidence of recurrence or malignant transformation was noted. Where possible, patients were clinically and radiologically reviewed with range of motion, grip strength and patient evaluation measures obtained. Results: Of 12 patients presenting to the practice, seven patients were followed up and, of these, two demonstrated recurrences. The recurrence was diagnosed based on patient-reported symptoms, clinical examination and the requisition of further imaging. Of the five who could not be followed up, two demonstrated recurrence and one had malignant transformation with a low-grade chondrosarcoma on histology. Conclusions: While a rare disease, we demonstrated recurrence within our small case series. Fusion to obliterate the joint is an option in the management of recurrence. For the diagnostically challenging, genetic testing may be beneficial, though genetic rearrangements are not seen in all cases. All patients should be counselled on symptoms to watch for as a small proportion may experience recurrence and a small percentage may undergo malignant transformation. Level of Evidence: Level IV (Therapeutic).