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

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.

Background: Camitz opponensplasty is a widely used reconstruction procedure for severe carpal tunnel syndrome. However, it has several drawbacks, including poor pronation during thumb opposition and a tendency for flexion at the thumb metacarpophalangeal (MP) joint. We developed a novel procedure to overcome these issues while preserving its advantages. Methods: Our procedure involves mini open carpal tunnel release (KnifeLight) and the transfer of the palmaris longus (PL) tendon to the rerouted extensor pollicis brevis (EPB) tendon using the distal part of the PL tendon as a pulley. We assessed sensory and motor function recovery up to 12 weeks postoperatively, and changes in subjective symptoms, satisfaction with surgery and presence of pulley loosening after 1 year. Results: In 47 hands, palmar abduction of the thumb improved from an average of 32° preoperatively to 45° at 4 weeks postoperatively, and tip pinching between the thumb and index finger recovered in all patients by 8 weeks postoperatively. Furthermore, within 4-8 weeks postoperatively, all patients showed improvement in pinching and grasping, enhancing hand function in activities of daily living (ADL). Self-evaluation of surgery in patients followed for more than 1 year was generally favorable. None of the patients who were directly evaluated showed any deviation of the EPB tendon at the pulley. Conclusions: Our technique is a potential alternative to the Camitz procedure as it retains the advantages of the Camitz procedure while overcoming its drawbacks. Level of Evidence: Level IV (Therapeutic).

Enchondromatosis secondary to Ollier disease (OD) is rare, with secondary chondrosarcomas (CS) accounting for only 1% of malignant osseous tumours. This is one of only two reports documenting four enchondromas of different bones of the same hand developing malignant transformation, with long-term follow-up. This is a 72-year-old female with histologically proven CS from multiple enchondromas of the index finger metacarpal and proximal phalanx, and middle finger proximal and middle phalanges. Six years following curettage and bone grafting, she showed no recurrence or metastases from CS. While CS of the hand behaves aggressively, they rarely metastasise and show good 5-year survival rates. Due to good prognosis, function-sparing surgical options are acceptable over amputation, accompanied by close surveillance. Level of Evidence: Level V (Therapeutic).

Background: Distal radius fractures are the most common fractures in the upper extremity. Volar plate fixation is a commonly performed surgical procedure for this fracture. Flexor tendon rupture is a serious postoperative complication due to attrition between the plate and tendon. This study aimed to analyse the factors associated with the time from surgery to tendon rupture, classify plate position and determine the incidence of flexor tendon rupture in relation to plate position. Methods: This multicentre retrospective study included 28 patients (24 women) with flexor tendon rupture following volar plate surgery for distal radius fractures. Plate positions were classified into four types based on plain radiographs. They were distal position (DP), dorsal angulation (DA), screw protrusion (SP) and proximal position (PP). The associations between the time to rupture and factors, including patient backgrounds and radiological parameters, were examined. Results: Thirty-five flexor tendons ruptured. All cases included Soong grade 1 or 2 plate prominence. The average time to tendon rupture was 101.5 months (SD 60.2, range: 1.1-202.1). No factors were significantly associated with time to rupture. Flexor tendon ruptures were associated with DA in 17 ruptures, DP in 11, SP in 6 and PP in 2. SP was observed in the non-locking system only. Conclusions: Attention must be paid to the possibility of tendon rupture in patients with Soong grade 1 or 2. The risk of flexor tendon rupture was highest in patients with prominent plates due to DA. Level of Evidence: Level IV (Therapeutic).

Background: While early research identified features of volar locking plate design and placement as risk factors for flexor tendinopathy, temporal trends in rates of flexor tendinopathy have not been characterised despite the use of newer generations of volar plates and increased awareness of these risk factors. In this study, we tested the null hypothesis that there is no temporal trend in the incidence of flexor tendinopathy after surgical fixation of distal radius fractures. Methods: Using a national administrative claims database, we identified adults undergoing surgical fixation of isolated, closed distal radius fractures from 2011 to 2020. Patients were grouped by the quarter of the year they underwent surgery. We measured the incidence of flexor tendinopathy, malunion, nonunion and hardware removal at 1 and 2 years after the index procedure. We used a linear regression model to evaluate the association between time (per quarter) and the incidence of each complication. Results: We included 196,194 patients who underwent surgical fixation of distal radius fractures. With respect to 1-year outcomes, the incidence of flexor tendinopathy decreased by 0.6% per quarter, malunion increased by 0.8% per quarter, nonunion decreased by 2.1% per quarter and hardware removal increased by 0.5% per quarter. With respect to 2-year outcomes, the incidence of flexor tendinopathy decreased by 0.6% per quarter, malunion increased by 0.5% per quarter, nonunion decreased by 2.6% per quarter and hardware removal increased by 0.4% per quarter. Conclusions: The incidence of flexor tendinopathy after distal radius fracture fixation decreased from 2011 to 2020, which may reflect developments in volar plate design, improvements in implant selection and/or increased surgeon awareness of the risk of flexor tendinopathy. Further studies are needed to evaluate the aetiology of this trend. Level of Evidence: Level III (Therapeutic).

Background: Carpal tunnel syndrome (CTS), which is frequently encountered in orthopaedic practice, is an early symptom of wild-type transthyretin amyloidosis (ATTRwt). ATTRwt has a high misdiagnosis rate, making early detection difficult, which in turn delays treatment and results in a poor prognosis. Therefore, we herein investigated whether the early diagnosis of CTS leads to the early detection and treatment of ATTRwt, ultimately improving its prognosis. Methods: This study included 42 patients diagnosed with ATTRwt (34 males, 8 females; mean age: 77.7 years). We investigated the presence of a history of CTS, the affected side, the duration from the CTS diagnosis to ATTRwt confirmation, the number of deaths and the number of referrals from orthopaedic surgeons to cardiologists. Results: A history of CTS was present in 26 cases, with 15 being bilateral CTS. The average duration from the CTS diagnosis to ATTRwt confirmation was 6.4 years. Four patients died, and there were no referrals from orthopaedic surgeons to cardiologists. Conclusions: The present results showed that 61.9% of patients diagnosed with ATTRwt had a history of CTS, suggesting that CTS is a predictive factor for ATTRwt. However, the average duration from the CTS diagnosis to ATTRwt confirmation was 6.4 years, indicating a significant delay. One reason for this delay is that orthopaedic surgeons may not be aware of the relationship between CTS and ATTRwt, as suggested by the result showing no referrals from orthopaedic surgeons to cardiologists. Level of Evidence: Level IV (Diagnostic).

Background: Given the increasing prevalence of cannabis use, it is critical to understand its association with postoperative complications. We investigated association between cannabis use and complications after metacarpal fracture fixation. Methods: We identified 80,787 patients from a US insurance claims database who underwent metacarpal fracture fixation from 2010 to 2022; 5,043 (6.7%) had diagnosed cannabis use disorder, dependence or addiction. Cannabis users were compared with patients with history of tobacco use and those with no history of using either substance ('control group'). Propensity matching was used to control for age, sex and Charlson Comorbidity Index (CCI) value. Demographic and comorbidity profiles, 90-day medical complications and 6-month surgical complications were compared using chi-squared tests (α = 0.05). Results: Compared with the control group, cannabis users had a higher incidence of acute kidney injury, cardiac arrest, deep venous thrombosis, hypoglycemia, myocardial infarction, pneumonia, sepsis, stroke and urinary tract infection (all, p < 0.01) within 90 days after surgery. After matching the cannabis and control groups, the cannabis group had a higher incidence of nerve injury (p < 0.01), fracture nonunion (p = 0.04) and fracture malunion (p = 0.002). Compared with tobacco users, cannabis users had a lower incidence of pneumonia (p = 0.002), urinary tract infection (p < 0.01) and hypoglycemia (p = 0.03) within 90 days. Conclusions: Compared with patients who had no history of drug use, cannabis users had a higher incidence of several medical and surgical complications. Compared with tobacco users, cannabis users had a lower incidence of some medical complications. These differences underscore the need for tailored perioperative care strategies for cannabis users. Level of Evidence: Level III (Therapeutic).

Background: Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus (BP). Surgical intervention is pursued when conservative treatments fail. The present study aimed to investigate the mid-term functional outcomes of patients with nTOS who underwent first rib resection (FRR) compared to rib-sparing scalenectomy (RSS) using standardised patient-reported outcome measures (PROMs). Methods: The PROMs used included the Visual Analogue Scale (VAS), Patient Satisfaction Scale (PSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ) and Cervical Brachial Symptom Questionnaire (CBSQ). Statistical analyses compared outcomes between the RSS and FRR groups, with regression models accounting for confounding factors. Results: This study included 20 patients with supraclavicular nTOS, with a mean age of 42.5 ± 13.1 years and a mean BMI of 28.1 ± 5.5. There were 11 females (55.0%) and 9 males (45.0%). Mean postoperative follow-up before PROMs was 29.3 ± 13.9 months. The overall mean DASH, CBSQ and MHQ scores were 50.1 ± 34.1, 45.0 ± 42.1 and 59.8 ± 23.6, respectively. A significant positive correlation was observed between the Derkash score and time from symptom onset to surgery. Comparing FRR (n = 10) and RSS (n = 10), the DASH score was significantly higher in the FRR group (66.8 ± 36.2) compared to the RSS group (33.4 ± 22.9). No other significant differences in PROMs were found between the FRR and RSS groups. Conclusion: RSS and FRR were both effective in improving symptoms in nTOS, with RSS having a significantly lower DASH score postoperatively. Level of Evidence: Level III (Therapeutic).