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

Background: Diaphyseal ulna shortening osteotomy (USO) is an accepted treatment for multiple ulnar sided wrist pathologies. Recently, a number of specifically designed compression plates for USO have become available. The purpose of the study was to assess the outcomes of an ulnar osteotomy compression plate system for USO across multiple centres. Methods: A multicentre cohort study was conducted on USO performed for a variety of ulnar-sided wrist pathologies using a USO compression system. Radiographic, clinical and subjective outcomes were assessed postoperatively and compared between aetiologies. Results: A total of 174 USOs were performed with union achieved in 170 osteotomies. Overall satisfaction was high and 83.2% returned to work. And 31.6% of patients required plate removal. Conclusions: The use of a specific USO compression plate provides a reasonable option for USO with similar results across multiple sites. High union rates can be achieved. However, the incidence of plate removal was high and remains a potential concern warranting further study. Level of Evidence: Level IV (Therapeutic).

Surgical treatment of Kienböck disease remains controversial and depends on patient age, activity and disease stage. We report an 18-year-old female badminton player who presented with wrist pain, limited motion and decreased grip strength. Imaging revealed a displaced coronal lunate fracture, with the palmar fragment locked against the volar rim of the radius, consistent with Lichtman Stage IIIC and Bain grade 2b. MRI showed low signal intensity, suggesting compromised vascularity. Arthroscopy confirmed intact cartilage except at the fracture site. Lunate reconstruction using the Kuhlmann technique with a vascularised bone graft was performed, and the scaphoid was temporarily fixed to the radius to offload the lunate. At 2-year follow-up, despite the development of radiolunate osteoarthritis, the patient showed significant improvement in pain, grip strength and wrist motion. This case highlights that although disease progression may continue, joint-preserving reconstruction can achieve favourable functional outcomes in young, active patients. Level of Evidence: Level V (Therapeutic).

Background: Scaphoid non-union is a challenging condition that can lead to chronic wrist pain, decreased range of motion (ROM) and functional impairment. One promising approach involves the use of costo-osteochondral rib autografts, offering a non-vascularised and structurally supportive environment for bone regeneration. This systematic review aims to evaluate the current evidence regarding the management of non-salvageable scaphoid proximal poles and non-union using rib costo-osteochondral autografts. Methods: A comprehensive search of electronic databases was conducted. Data extraction was performed independently by two authors. The primary outcomes were ROM, grip strength, pain, functional outcomes and complications. Results: A total of six studies were identified that met the inclusion criteria. A total of 101 patients had undergone scaphoid costo-osteochondral autografting with a rib donor. Postoperative active ROM arc had a mean of 112° (range: 78°-125°), with grip strength mean of 34 kg (range: 22-50 kg). Various functional outcome measures were reported, such as the QuickDASH, Patient Rated Wrist Evaluation (PRWE) and Visual Analogue Scale (VAS), with overall improvement noted for function and pain. Complications were reported in 10% of cases, including four donor site complications. Conclusions: The available literature supports the use of costo-osteochondral rib autografts to treat the non-salvageable proximal scaphoid, with short-term improvement in ROM and function. However, given the heterogeneity of the included studies and the limited number of high-quality randomised controlled trials, further research is needed to establish the optimal graft selection for scaphoid AVN or non-union. Level of Evidence: Level III (Therapeutic).

Background: Brachial plexus (BP) injuries are a known complication of shoulder dislocation, yet optimal management strategies remain unclear. This systematic review aims to evaluate the outcomes and treatment approaches for BP injuries following shoulder dislocation. Methods: A systematic review was conducted according to PRISMA guidelines across four databases: PubMed/MEDLINE, Embase, Scopus and Web of Science. Eligible studies included human subjects with BP injuries following shoulder dislocation. Data extraction and risk of bias (ROB) assessment were independently performed by two reviewers. Due to heterogeneity amongst the studies, a meta-analysis was not conducted. Results: Out of 2,060 initial studies, 9 met the inclusion criteria, encompassing a total of 255 patients (256 limbs) with a mean age of 55.9 ± 16.0 years. Of these, 193 (75.7%) had BP injuries post dislocation. Conservative management was the most common treatment (149 cases, 67.4%), followed by neurolysis ± nerve transfer (44 cases, 19.9%) and nerve repair (28 cases, 12.7%). Amongst 133 patients with reported BP injury patterns, the posterior cord was most frequently involved (38.3%). Sensory and motor recovery was observed in 51.6% and 45.2% of patients respectively, with 60.4% of patients achieving MRC grade ≥ 4 in studies that reported this metric. The mean follow-up period was 28.4 months. Conclusions: BP injuries following shoulder dislocation are uncommon but clinically significant. Conservative treatment remains the predominant approach, though surgical interventions may offer improved functional recovery in selected cases. Level of Evidence: Level III (Therapeutic).

Background: Patients with dorsal fracture dislocations of the proximal interphalangeal joint (PIPJ) may have significant functional impairment. This study aims to present the outcomes of open reduction and internal fixation (ORIF) in patients who presented late with dorsal fracture dislocations of the PIPJ and to evaluate factors affecting the outcomes. Methods: This retrospective study included patients who presented late with a dorsal PIPJ fracture dislocation and underwent ORIF. The outcome measures included active arc of motion (AAOM) of the PIPJ and distal interphalangeal joint (DIPJ), grip strength, Quick disabilities of the arm, shoulder and hand (Q-DASH), Ishida and Ikuta scores. The outcomes data was statistically analysed to determine association of outcomes with the finger involved, mechanism of injury, presence of concomitant injury, delay between injury and surgery, percentage of the articular surface involved, presence of comminution of the volar lip and involvement of proximal phalanx head. Results: The mean surgical delay was 58 days. The average articular surface involvement was 58%. The PIPJ AAOM improved by 72°, with a 10° mean flexion deformity, an average Q-DASH score of 4.8 and grip strength at 84% of the non-operated hand. Eleven patients achieved excellent Ishida and Ikuta scores, two good and four fair-to-poor. Surgical delay had no significant impact (p > 0.05), but less-comminuted fractures and non-cricket injuries showed better recovery (p < 0.05). Concomitant injuries and proximal phalanx head involvement correlated with higher disability scores, lower grip strength and poorer functional outcomes (p < 0.05). Conclusions: ORIF is a viable, joint-preserving surgical option that can be considered in delayed cases up to 2 months. This technique retains the native osteochondral fragments. The surgical approach allows one to convert to hemi-hamate arthroplasty (HHA) as an alternative procedure in the same setting when fracture is not amenable for reconstruction. Level of Evidence: Level IV (Therapeutic).

Background: Contralateral C7 (CC7) is an important donor nerve for reconstruction in global brachial plexus palsy. In 2013, Shu Feng Wang introduced the direct repair of lower trunk (LT) to CC7. The outcomes of hand recovery reported in the study was significantly better than the traditional techniques. We did a retrospective analysis of 11 consecutive adult patients who underwent reconstruction for pan-brachial plexus injury by repair of the CC7 to LT along with other extraplexal nerve transfers. Methods: Patients were evaluated for motor recovery of flexion and extension at elbow, wrist and digits (Modified medical research council [MRC] grading). They were also evaluated for cortical plasticity and complications, if any. Results: Eleven consecutive patients underwent CC7 to LT transfer during the study duration. The mean follow-up period was 85 ±11.39 months (range: 69-105 months). Two out of the eight patients with a CC7 transfer to MCN regained M4 elbow flexion, while one regained M3 function. The remaining five did not recover elbow flexion. Two patients who had an ICN to MCN transfer regained M4 elbow flexion. Four out of 11 patients regained >M3+ wrist and finger flexion. Out of the four patients with a CC7 to LT, none recovered any elbow extension. Out of the seven patients who underwent a phrenic to PDLT transfer, six regained M3+ elbow extension. Out of the seven patients with phrenic to PDLT transfer, none regained any wrist or finger extension. Conclusions: Outcome in terms of composite motor recovery of hand is better that other reconstructive techniques but falls short of qualifying as a functionally useful hand. Elbow flexion recovery is inferior when compared to other extraplexal nerve transfers. Neuropathic pain is reduced. There is restoration of protective sensation in both ulnar and median nerve territory. Level of Evidence: Level IV (Therapeutic).

Background: In patients with a zone 1 flexor digitorum profundus (FDP) avulsion fracture, we suture the FDP tendon to the A5 or A4 pulley using an absorbable suture as an adjunct to standard surgical fixation. This minimises the proximal retraction force of the tendon during the early postoperative period. The aim of this study is to report the clinical outcomes of this approach. Methods: This is a retrospective study of all patients who underwent this technique over a 2-year period between January 2020 and December 2022. Patients aged 18-65 with isolated zone 1 FDP avulsion fracture and who complied with physical therapy and follow-up protocols were included. Demographic information, injury details, surgical methods and postoperative outcomes, including range of motion (ROM), Strickland score, grip strength and Quick disabilities of hand, shoulder and arm (Quick-DASH) score were measured. Results: Eight patients (three females, five males; average age 45.75) were included. Injuries occurred in the ring finger (3) and little finger (5), with sports-related injuries being the most common cause (4). Surgical methods varied, including K-wire, pull-out techniques and combinations of these techniques. At 1-year follow-up, the average active ROM was 87.5° ± 10.9° in the proximal interphalangeal (PIP) joint and 46.9° ± 11.5° in the distal interphalangeal (DIP) joint. Strickland score was excellent in two patients, good in four and fair in two. Grip strength averaged 78.12% of the contralateral side. Quick-DASH scores averaged 14.6 ± 6.8. No tendon ruptures or implant failures were observed. Conclusions: The absence of rupture and satisfactory functional outcomes suggest that this technique is a viable option for treating zone 1 FDP avulsion fracture. Further studies with larger sample sizes and longer follow-up periods are warranted. Level of Evidence: Level IV (Therapeutic).

Distal radioulnar joint (DRUJ) instability following distal radius fracture (DRF) is an increasingly recognised entity, particularly with recent advances in the management of DRF. This review aims to provide a comprehensive appraisal of DRUJ anatomy, methods of assessing instability and current treatment strategies. Both non-operative and operative modalities are considered. In the acute setting, surgical management primarily involves open reduction and internal fixation (ORIF) of the distal radius, which can restore DRUJ stability through correction of translation and distraction of the distal fragment. Management of concomitant injuries, such as ulnar styloid fractures and triangular fibrocartilage complex (TFCC) tears, are also addressed, particularly in cases where instability persists following DRF fixation. In the chronic setting, DRUJ instability is categorised according to underlying pathology: bony abnormalities (including distal radius malunion and ulnar styloid nonunion) and soft-tissue insufficiency (notably TFCC tears). Finally, attention is drawn to associated conditions - such as DRUJ subluxation and stiffness - which may complicate management or remain underrecognised in clinical practice. Level of Evidence: Level V (Therapeutic).

Acquired digital fibrokeratoma (ADFK) is a rare benign tumour that can be difficult to diagnose when unusually large or atypical in presentation. We report a man in his 50s with a slowly enlarging lesion on the fifth toe that reached 30 mm over 2 years. MRI revealed a well-circumscribed soft tissue mass with homogeneous, low-signal intensity internally on T1- and T2-weighted images, without features of malignancy. Excisional biopsy confirmed ADFK, and the postoperative defect was reconstructed with a reverse digitolateral flap. After a year, there was no recurrence and both functional and cosmetic outcomes were favourable. This case represents an exceptionally rare presentation of giant ADFK and highlights the importance of preoperative imaging for accurate diagnosis and systematic treatment planning. Level of Evidence: Level V (Therapeutic).

Background: Malunions of the distal radius are the commonest complication of distal radius fractures and can be debilitating. A corrective osteotomy seeks to restore the patient's anatomy, with advances in technology permitting the use of patient-specific technology to accurately achieve this goal. This study compares the biomechanical properties of these systems, against standard implants, with the hypothesis that improved biomechanical properties may translate into improved functional and clinical outcomes for these patients. Methods: Ten artificial, identical, 3D-printed right distal radii were randomised. Five samples were fixed using a standard distal radial locking plate, with a pre-determined osteotomy site using planning software (control group). The remaining five samples were prepared using a 3D-printed jig, prior to fixation with a patient-specific distal radius locking plate (intervention group). A further five general distal radius sawbones were prepared and fixed using standard techniques, using the same pre-determined osteotomy level and degree of correction as the other groups (baseline group). The specimens were cyclically loaded for 2,000 cycles. Primary outcome was interfragmentary motion at the osteotomy site, with secondary outcome measures of stiffness of the construct and failure. Results: We found a statistically significant difference in motion when comparing the intervention and control groups, at both 80 N and 250 N of load (80 N: 88 µm, p < 0.001; 250 N: 316 µm, p < 0.001). The difference between the control and baseline groups was not found to be statistically significant (80 N: p = 0.13; 250 N: p = 0.088). The patient-specific implant was found to be the stiffest construct of the three specimens, and this difference was statistically significant. Conclusions: Our study shows increased mechanical stability in patient-specific implants, which may support earlier rehabilitation of patients. However, this study has highlighted a need for high-quality clinical research, to investigate how this data translates into the clinical, functional and union outcomes for these patients.