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

A 42-year-old man suffered an avulsion amputation of his right middle finger. He had undergone several surgeries since the age of 24, including amputation plasty and implantation of the injured nerve into fat and bone, but had difficulty returning to work due to persistent severe pain. He underwent nerve capping with an artificial nerve conduit at a university hospital, and his symptoms improved slightly, but immediately flared up again. Therefore, he was referred to our hospital and was treated with a blocking splint in addition to resection of the traumatic neuroma, covering with an artificial nerve conduit and wrapping with an adiposal flap. The lumen of the conduit was observed without collapse until it was resorbed, and he returned to work without pain 10 months after surgery. The blocking splint to an angle that preserves the lumen of the conduit was useful for artificial nerve surgery near the joint. Level of Evidence: Level V (Therapeutic).

Background: Amputated neuromas, a common consequence of peripheral nerve injury, can cause significant pain and may impair daily life. Herein, we conducted a retrospective study on patients who underwent a nerve-capping technique using the bioabsorbable nerve conduit Renerve®, with a minimum follow-up period of 6 months. Methods: We conducted a retrospective study to assess patients with amputation neuromas of the finger or palm who underwent surgical treatment using the capping technique with the Renerve® conduit between October 2018 and September 2022. The data on demographics, operative details, pre- and postoperative evaluations (visual analogue scale [VAS] pain scores and Tinel sign) and complications were analysed. Results: Seven patients (seven nerves) with a median age of 51 years (three men and four women) were assessed. The median follow-up duration was 15 months. Renerve® conduits of varying sizes (1.0-2.3 mm) and lengths (15-25 mm) were used. The median duration until surgery was 195 days. After the procedure, VAS pain scores significantly decreased from a baseline of 53.1 mm to 5.7 mm at the 6-month follow-up. Tinel sign persisted in four patients, and no postoperative complications occurred. Conclusions: Our study demonstrates the clinical usefulness of the Renerve® conduit as a nerve-capping technique for amputation neuroma. Considering the limited availability of real-world data on Renerve® conduits for nerve capping, our findings provide valuable insights for clinical practitioners. Level of Evidence: Level IV (Therapeutic).

Background: Due to the rapid evolution of generative artificial intelligence (AI) and its implications on patient education, there is a pressing need to evaluate AI responses to patients' medical questions. This study assessed the quality and usability of responses received from two prominent AI platforms to common patient-centric hand and wrist surgery questions. Methods: Twelve commonly encountered hand and wrist surgery patient questions were inputted twice into both Gemini and ChatGPT, generating 48 responses. Each response underwent a content analysis, followed by assessment for quality and usability with three scoring tools: DISCERN, Suitability Assessment of Materials (SAM) and the AI Response Metric (AIRM). Statistical analyses compared the features and scores of the outputs when stratified by platform, question type and response order. Results: Responses earned mean overall scores of 55.7 ('good'), 57.2% ('adequate') and 4.4 for DISCERN, SAM and AIRM, respectively. No responses provided citations. Wrist question responses had significantly higher DISCERN (p < 0.01) and AIRM (p = 0.02) scores compared to hand responses. Second responses had significantly higher AIRM (p < 0.01), but similar DISCERN (p = 0.76) and SAM (p = 0.11), scores compared to the first responses. Gemini's DISCERN (p = 0.04) and SAM (p < 0.01) scores were significantly higher than ChatGPT's corresponding metrics. Conclusions: Although responses are generally 'good' and 'adequate', there is variable quality with respect to platform used, type of question and response order. Given the diversity of publicly available AI platforms, it is important to understand the quality and usability of information patients may encounter during their search for answers to common hand and wrist surgery questions. Level of Evidence: Level IV (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).

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).

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).

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).

Background: Native joint septic arthritis (NJSA) of the hand is poorly studied. Management guidelines are extrapolated from large joint infections despite differences in epidemiology, anatomy and aetiology. Limited evidence suggests shorter courses of antibiotics can achieve outcomes comparable to longer courses. The aim of our study is to characterise the presentation, management and outcomes of NJSA of the hand in an adult cohort from Southeast Queensland (SEQ) and determine if the route or duration of antibiotics affected the outcome. Our cohort was compared to those in the literature to determine if already published data could be applicable to our population. Methods: A coding based retrospective cohort of adult patients between 2016 and 2022 were assessed. The cohort was divided into short/long course antibiotics and primarily intravenous/oral route for outcome comparison. Results: Seventy-four patients were included with a joint culture positive rate of 75%. The most common aetiology of infection was direct trauma and the most common pathogen was Staphylococcus aureus. Resolution was achieved in 86% of patients after 1-year follow-up, with a median antibiotic duration of 14 days, and 48% had non-infectious sequelae. Failure to achieve resolution was associated with females and taking immunosuppressants. No significant difference was detected when analysed for primary route or duration of antibiotics. Conclusions: There was no difference in the rate of resolution attributable to the route or duration of antibiotics. We demonstrated comparability between our cohorts' demographics, management and outcomes with those in the literature. Based on the findings in our study, noting the retrospective nature and small cohort, the authors conclude for uncomplicated NJSA of the hand, a total antibiotic duration of 14 days in addition to early surgical intervention is likely to be successful in most patients. Level of Evidence: Level III (Therapeutic).

Peripheral nerve injuries (PNI) present substantial challenges due to variability in injury severity and limited regenerative capabilities. Historically, PNI research has focussed on measures such as subjective surgeon outcome grading, two-point discrimination (2PD) and the Medical Research Council (MRC) grading system. While these methods have use, there are also limitations related to subjectivity and sensitivity. Electrophysiological studies, including electromyography (EMG) and nerve conduction studies (NCS), provide detailed insights but are invasive and resource intensive. Currently, the landscape of outcome measurements in PNI research is diverse, incorporating a mix of surgeon-scored, patient-reported and objective measures. Advancements in wearable devices and motion-tracking technologies offer the potential for continuous, real-time monitoring of patient recovery. These innovations can provide a more comprehensive and objective view of functional recovery, moving beyond the limitations of periodic clinical assessments. The primary limitation in current PNI research is the lack of standardisation in outcome measures and the arbitrary timing of assessments. This variability complicates data interpretation and comparative effectiveness research. Standardising the selection and timing of outcome measures is crucial for enhancing the reliability of research findings and facilitating collaborative studies. Level of Evidence: Level V (Diagnostic).