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

The aetiology of carpal tunnel syndrome is often idiopathic, and it is seldom caused by a space-occupying lesion. Herein, we report our experience with a case of parosteal lipoma causing carpal tunnel syndrome. A 66-year-old woman with a history of hyperthyroidism and hypertension presented with numbness and pain on the ulnar side of the left index finger without any triggers. A positive Tinel sign in the left carpal tunnel and presence of a space-occupying lesion with fat concentration extending from the carpal tunnel to the central subcutaneous palmar region on computed tomography led to the diagnosis of carpal tunnel syndrome due to lipoma. Subsequently, carpal tunnel release, tumour resection and median nerve dissection were performed. At 1 year and 3 months postoperatively, the disease course was good, without recurrence or sensory disturbance. Although rare, carpal tunnel syndrome may be caused by a space-occupying parosteal lipoma. Level of Evidence: Level V (Therapeutic).

Background: Targeted muscle reinnervation (TMR) is an emerging surgical technique that reroutes severed peripheral nerves to nearby motor targets to prevent symptomatic neuroma formation and reduce amputation-related pain. This case series evaluates the effectiveness of TMR in managing symptomatic neuromas following digit and hand amputations and reports postoperative outcomes and complications. Methods: Seventeen patients with traumatic or surgical digit/hand amputations distal to the wrist crease presenting with symptomatic neuromas were prospectively enrolled between August 2021 and August 2023. Patients underwent either primary TMR at the time of amputation or secondary TMR following neuroma formation. Surgical technique involved microsurgical coaptation of transected sensory nerves to adjacent motor entry points under loupe or microscopic magnification. Outcomes assessed included operative time, pain recurrence, phantom limb pain (PLP), narcotic usage and upper limb function measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Primary TMR was performed in 13 patients and secondary TMR in 4 patients. The mean operative time was approximately 90 minutes. All nerve transfers maintained a sensory-to-motor diameter ratio of less than 2:1. Postoperative neuroma-related pain occurred in only one patient due to a slipped suture, which was successfully revised. PLP was reported in three patients, resolving within 2 months in all cases. Narcotic and neuromodulator medication use was required transiently in three patients, with complete cessation achieved by 2 months postoperatively. The mean DASH score was 21 ± 8, indicating mild overall disability and good overall hand function. Conclusions: TMR demonstrates significant promise as an effective intervention to reduce symptomatic neuroma formation and associated pain following digit and hand amputation. Successful implementation requires detailed knowledge of hand microsurgical anatomy and expertise in nerve coaptation techniques. Further studies with larger cohorts and longer follow-up are warranted to validate these findings and optimise patient selection. Level of Evidence: Level IV (Therapeutic).

Background: It is important to prevent delayed union after surgical treatment for acute scaphoid fractures; however, risk factors remain to be elucidated. We investigated the risk factors for delayed union in cases of scaphoid fractures with surgical treatment at our hospital. Methods: We enrolled 29 patients with scaphoid fracture who underwent percutaneous screw fixation at Juntendo University Hospital between January 2015 and February 2024. Patients were divided into a U group consisting of those who achieved bone union at 6 months after surgery, and a D group consisting of those who had delayed union. The evaluation items were: age, smoking, occupation, fracture type (Herbert classification, Schernberg classification), duration from injury to surgery, displacement measurement preoperative intrascaphoid angle (ISA), postoperative ISA, preoperative scapholunate angle (SLA) and postoperative SLA. Results: Delayed union was observed in eight cases. Bivariate analysis showed that duration from injury to surgery, displacement measurement, preoperative ISA and preoperative SLA were significantly associated with delayed union (p = 0.002, p = 0.006, p < 0.001 and p = 0.008, respectively). Furthermore, we found a significant positive correlation between preoperative ISA and the duration from injury to surgery, and between preoperative ISA and preoperative SLA. Conclusions: Delayed union was associated with duration from injury to surgery, humpback deformity and instability between the scaphoid and lunate. While the factors were statistically correlated, both are important clinical considerations for surgeons. Level of Evidence: Level III (Therapeutic).

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).

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).

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: 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: 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: 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.