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

Background: Patient-reported outcome measures (PROMs) are questionnaires used to evaluate a patient's functional status, examine outcomes and inform clinical decisions. PROMs have been primarily developed with English-speaking populations and should be validated in the patient population in whom they are being applied. As present, the validity of commonly utilised distal radius fracture (DRF) PROMs in patients who speak Japanese is unknown. The purpose was to evaluate the validity and psychometric properties of common DRF PROMs in the Japanese population. Methods: A systematic review was conducted to identify published literature on Japanese DRF PROMs, using a comprehensive search strategy based on previous literature. Methodologic quality of PROM adaptation and validation was evaluated using instruments: Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures, Quality Criteria for Psychometric Properties of Health Status Questionnaire, and the Consensus-based Standards for the Selection of Health Measurement Instruments Checklist for Cross-Cultural Validity. The level of evidence was then calculated based on the above methodologic quality. Results: Three studies met the inclusion criteria. Amongst them, three PROMs were reported: the Disability of Arm, Shoulder and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE) and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH). None of the three studies followed all six processes for adaptation, nor assessed all measurement properties. No study demonstrated the completion of more than 7 of the 15 aspects of cross-cultural validity. The PRWE, DASH and QuickDASH all had limited evidence to support the domains of measurement properties evaluating the level of evidence. Conclusions: There is a gap in validated PROMs for Japanese patients with DRFs. As such, commonly utilised PROMs should be adapted and validated or cross-walked to Japanese-specific instruments to ensure reliability, validity and cultural equivalence before widespread use. Level of Evidence: Level III (Diagnostic Studies scale).

Brachial plexus injuries (BPIs) are burdensome to patients. These often involve the axillary nerve, which may lead to pseudo-subluxation of the humeral head because of deltoid atony. While advances in nerve reconstruction have improved outcomes, these procedures still have markedly high failure rates, which may lead to persistent pain, dysfunction and poor satisfaction. We present a case of a 51-year-old male with a traumatic BPI in the context of a motorcycle accident who experienced pseudo-subluxation of his humeral head and later underwent surgical reconstruction for his BPI. Despite a lack of improvement in deltoid functional strength, the pseudo-subluxation resolved, and the patient's pain decreased. This may suggest benefits to surgical reinnervation of the deltoid, even if recovery of strength is not achieved. Level of Evidence: Level V (Therapeutic).

Background: This study aimed to examine the correlation between the angle created by the block pin and the fracture line, and the adequacy of reduction in the lateral radiographs of patients with mallet fractures who underwent the extension block pin technique. Methods: The study comprised 31 patients with mallet fractures who had extension block pin treatment. Measurements were taken on the patients' postoperative radiographs to determine the angles between the fracture line and the block pin, as well as the joint gap and dorsal gap values. The measurements were conducted three times by three different researchers. The sufficient reduction group consisted of individuals whose total joint and dorsal gaps were equal to or less than 1 millimetre. Those with greater gaps were included in the insufficient reduction group. Statistical analysis was conducted using the mean values of the measurements obtained by the researchers. Results: The three researchers had a strong correlation in their measurements (ICC: 0.85, Pearson score: 0.001). Despite observing a lower angle in the sufficient reduction group (n = 12, mean angle = 10.8°) compared to the insufficient reduction group (n = 19, mean angle = 18.6°), no statistically significant difference was observed between the two groups (p > 0.05). Conclusions: It is possible to measure the angle between the fracture line and the block pin in a reliable and repeatable manner. We did not discover any statistically significant differences between the sufficient and insufficient reduction groups. Hence, we believe that it is worthwhile to evaluate our hypothesis in broader patient cohorts. Level of Evidence: Level IV (Therapeutic).

Background: Restoring the volar lip of the middle phalanx is key to regaining concentric joint gliding after dorsal proximal interphalangeal (PIP) joint fracture-dislocations, but no reliable radiographic assessment currently exists. This study introduces volar tilt as a new radiographic measure. Methods: We evaluated 27 dorsal PIP fracture-dislocations in 25 patients, analysing clinical outcomes, osteoarthritis (OA) and volar tilt on lateral radiographs at injury, after extension block pinning and at 16-year follow-up. Results: Initial volar tilt averaged 22°, improving to 12° after extension block pinning and 9° at follow-up, while adjacent uninjured fingers averaged -2°. Increased residual volar tilt was associated with pain and volar tilt ≥10° revealed significantly poorer Patient-Rated Wrist/Hand Evaluation scores and increased radiographic OA. Conclusions: Volar tilt reflects subluxation in both acute and chronic dorsal PIP joint fracture-dislocations and predicts better long-term outcomes and less radiological OA when properly restored. Level of Evidence: Level IV (Therapeutic).

Background: Spinal cord injury (SCI) often results in upper extremity paralysis, significantly limiting independence and quality of life. Surgical interventions, including nerve and tendon transfers, offer the potential to restore critical functions such as hand grasp and elbow extension. However, the utilisation of these techniques remains limited despite promising outcomes. As such, this study aimed to systematically review the literature on the clinical outcomes of nerve and tendon transfers for upper extremity reconstruction in patients with cervical SCI. Methods: A systematic search was conducted in PubMed/Medline, Scopus, Embase and Web of Science following PRISMA guidelines. Studies reporting quantitative outcomes following nerve or tendon transfer in SCI patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale, and descriptive synthesis was performed due to heterogeneity. Results: Thirty studies met the inclusion criteria: 15 focussed on nerve transfers (208 patients, 319 limbs) and 15 on tendon transfers (360 patients, 447 limbs). The most common nerve transfers were brachialis to the anterior interosseous nerve (AIN) and supinator to the posterior interosseous nerve (PIN). Tendon transfers most frequently included extensor carpi radialis longus (ECRL) to flexor digitorum profundus (FDP) and brachioradialis (BR) to flexor pollicis longus (FPL). Both techniques demonstrated significant functional gains, with nerve transfers associated with more natural biomechanics and tendon transfers with greater strength. Early rehabilitation appeared to enhance outcomes. Conclusions: Both nerve and tendon transfer techniques can substantially improve upper limb function in patients with cervical SCI. Level of Evidence: Level III (Therapeutic).

The extensor indicis proprius (EIP) is commonly used as a donor for tendon transfers. It normally inserts on the ulnar aspect of the extensor hood with the extensor digitorum communis (EDC) to the index finger inserting on the radial aspect. Anatomical studies have reported variations in EIP anatomy with a 1%-1.5% incidence of EIP insertion onto the radial aspect of the extensor hood. In our experience with 60 EIP transfers over 18 years, we found the EIP to insert onto the radial aspect of the extensor hood in three patients (5%). This is higher than what has been reported in the literature. We confirm the EDC by identifying the juncturae tendinae connecting the index and long finger EDC. We review relevant literature and suggest technical tips to avoid accidentally harvesting the wrong tendon. Level of Evidence: Level V (Therapeutic).

Background: This study aimed to investigate whether the use of artificial bone substitutes during volar locking plate (VLP) fixation for intra-articular comminuted distal radius fractures in elderly women improves radiographic and clinical outcomes. Methods: A retrospective study was conducted on female patients aged ≥65 years with intra-articular comminuted distal radius fractures (AO/OTA types B3, C2 and C3) treated with VLPs between 2018 and 2022. Patients were categorised into groups based on the use of β-tricalcium phosphate (β-TCP) as a bone substitute. A propensity score (PS) matched comparison utilising inverse probability of treatment weight was conducted comparing patients receiving standard versus β-TCP augmentation during fixation. Clinical and radiographic outcomes were evaluated. The screw-joint surface distance was assessed as a radiographic parameter indicative of optimal distal screw positioning adjacent to the subchondral bone. Results: The mean follow-up period was 9.9 months (range: 6-35 months). After PS matching, each group included 35 patients with comparable baseline characteristics. The screw-joint surface distance was significantly lower in the bone substitute group, indicating closer distal screw placement. However, at final follow-up, no significant differences were observed between the groups in radiographic or clinical outcomes. These results were consistent in inverse probability of treatment weighting (IPTW)-adjusted regression analysis. Conclusions: Closer placement of screws near the joint was observed in the bone substitute group, possibly reflecting improved intraoperative stability, but was not significantly associated with the prevention of postoperative correction loss or other clinical outcomes. Since clinical outcomes were similarly good regardless of its usage, artificial bone substitute may not be necessary for low-energy comminuted intra-articular fractures in elderly women. Further studies are warranted to determine its potential benefit in cases involving severe metaphyseal voids or joint instability. Level of Evidence: Level III (Therapeutic).

Background: Osteoarthritis (OA) of the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints frequently occurs in the same digit. Although PIP implant arthroplasty and DIP arthrodesis are well-established procedures, evidence on their combined application is limited. This study aimed to assess whether performing simultaneous DIP arthrodesis and PIP implant arthroplasty influences the outcomes of PIP implant arthroplasty, compared with performing PIP implant arthroplasty alone. Methods: We retrospectively analysed 18 fingers in 15 patients who underwent simultaneous DIP arthrodesis and PIP surface implant arthroplasty (PIP + DIP group) and compared them with 106 fingers treated with PIP implant arthroplasty alone (PIP-only group). DIP arthrodesis was performed using a dorsal approach with cannulated headless screws or Kirschner wire fixation. PIP arthroplasty was performed using an extensor tendon split approach with the Self-Locking Finger Joint System (Nakashima Healthforce Co., Ltd., Okayama, Japan). Outcome measures included the visual analogue scale (VAS) score for pain; active range of motion (ROM) of the metacarpophalangeal (MP), PIP and DIP joints, and radiographic evaluation of DIP joint union. Results: All fingers in the PIP + DIP group achieved bony union at the DIP joint. Both groups showed significant postoperative improvements in VAS scores and ROM of the MP and PIP joints. A significant reduction in DIP joint ROM was observed. After adjustment for preoperative variables, no significant differences were observed between groups in postoperative VAS scores (2.2 and 0.9 in the PIP + DIP and PIP-only groups, respectively) or PIP joint ROM (67° and 65.3° in the PIP + DIP and PIP-only groups, respectively). Conclusions: Simultaneous DIP arthrodesis and PIP surface implant arthroplasty provided effective pain relief and short-term PIP joint mobility comparable to PIP arthroplasty alone. This combined approach may be a viable surgical option for patients with coexisting DIP and PIP joint OA. Level of Evidence: Level IV (Therapeutic).

Background: Stiffness based on tendon adhesions after operative treatment of hand fractures remains a relevant complication, for which tenolysis may be needed. This systematic review aims to analyse the incidence of tenolysis after surgical hand fracture treatment and related clinical outcomes. Methods: The review was performed according to the PRISMA guidelines. CINAHL, Cochrane Central Register of Controlled Trials/Clinical Answers/Database of Systematic Reviews, Embase, PubMed and Web of Science were searched for articles until 31 December 2024, using keywords. Studies were included in the case of patients aged 16 years or older, who have undergone tenolysis for flexor and/or extensor tendon adhesions after surgical treatment of phalangeal and/or metacarpal fractures. The outcomes were the incidence of tenolysis and total active motion, passive and/or active range of motion (P/AROM) and lag of motion post-tenolysis. The included articles were assessed for methodological quality and risk of bias using the Critical Appraisal Skills Programme checklists, the Joanna Briggs Institute critical appraisal tools and the National Institutes of Health quality assessment tools. Results: Eight out of 160 studies were included. These studies reported an incidence of tenolysis of surgically treated phalangeal fractures varying from 4% to 32%. Only the study of Wong et al. statistically analysed the AROM of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint pre- to post-tenolysis, showing a significant improvement of the AROM of the PIP joint (p = 0.012). However, based on the quality assessment, the included articles have poor to fair quality. Conclusions: Based on these studies, no definite conclusions concerning the incidence and clinical effect of tenolysis in terms of improvement of MCP-, PIP- and DIP-joint motion can be drawn. Due to the lower quality of these studies, future high-quality research with prospective registration is needed. Level of Evidence: Level IV (Therapeutic).

This report describes a rare case of irreducible closed volar subluxation of the distal interphalangeal (DIP) joint of the small finger following a sports injury. Closed reduction failed, leading to open surgery, which revealed ulnar condyle entrapment between a partially torn extensor tendon and volarly displaced oblique retinacular ligament (ORL). Flexing the proximal interphalangeal (PIP) joint to 90° while extending the DIP joint relaxed the ORL, enabling dorsal repositioning and successful reduction. Awareness of this mechanism may help hand surgeons achieve effective reduction. Level of Evidence: Level V (Therapeutic).