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

Background: Cartilage injuries of the hand, wrist and elbow are common and may be managed by a variety of established procedures. While much literature has been devoted to cartilage injuries in the joints of the lower extremity, what data is available regarding treatment of similar injuries in the upper extremity is unknown. This systematic review assesses current procedures utilised to treat isolated cartilage injuries in the upper extremity and their outcomes. Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE was searched to identify articles that reported on cartilage procedures of the hand, wrist or elbow. Study demographic information, type of procedure and clinical outcomes (patient-reported outcome measures [PROMs], radiographic measures, return to play [if applicable], complications and follow-up) were collected and reported. Results: The initial search yielded 532 articles. Of these, 118 articles underwent full-text review; 47 articles were ultimately included and analysed. The majority of articles were Level IV evidence and reported on osteochondral autograft transplantation (OATS) in the elbow and hand. The remaining articles for the elbow reported on arthroscopic debridement with microfracture or drilling, arthroscopic debridement alone and core decompression. The remaining articles for the wrist reported on autologous chondrocyte implantation and arthroscopy. One hand article reported on periosteal autografting. Conclusions: The most significant improvements in PROMs, range of motion and return to play were reported for OATS procedures of the elbow, wrist and hand. Studies of a higher level of evidence are important to further standardise the treatment of cartilage injuries of the upper extremity. Level of Evidence: Level III (Therapeutic).

Background: Mallet fingers are common injuries with management often being guided by presence of fracture, joint subluxation, chronicity and patient requirements and surgeon preferences. The purpose of this study was to understand current trends of management of mallet finger injuries. Methods: This study surveyed an international group of English-speaking hand surgeons (n = 244) with different types of mallet finger injury patterns to assess current trends and identify any regional variations in practice. Results: Nonoperative management with extension splinting was the preferred treatment for soft tissue (93%) and congruent bony (87%) mallet finger injuries amongst surgeons from all regions. Similarly, most surgeons (76%) preferred operative treatment for incongruent bony injuries. The management of subtle joint subluxation was contentious with 36% recommending splinting and the rest opting for closed reduction and wiring or open reduction. Conclusions: While there is no consensus on treatment, surgeons seem to prefer nonoperative treatment for most soft tissue mallet injuries. Surgeon preference seems to dictate the management of bony mallet injuries especially with incongruent joints. Prospective randomised studies would be beneficial in providing evidence-based guidelines for management of this common injury. Level of Evidence: Level V (Therapeutic).

The articulation of the distal radioulnar joint (DRUJ) has minimal osseous constraint and relies on a number of other primary and secondary structures for stability and normal function. DRUJ instability is a challenging clinical problem, and osseous, chondral and ligamentous factors can all contribute to the pathology - often in combination. A thorough understanding of the aetiology, clinical presentation and imaging findings of DRUJ instability are important when determining the best management strategy. This review covers anatomy, kinematics, aetiology, imaging findings and surgical management of DRUJ instability for both acute and chronic presentations. Level of Evidence: Level V (Therapeutic).

Background: We hypothesised that the complication rate is correlated with the technique and the type of suture in all-inside transosseous flexor digitorum profundus (FDP) tendon repairs. Methods: A retrospective review of our database identified zone 1 injuries of FDP or flexor pollicis longus (FPL) that were repaired using the transosseous technique. In this method, two limbs of the nonabsorbable sutures are passed from volar to dorsal via transosseous tunnels and tied just proximal to the germinal matrix over the proximal aspect of the distal phalanx (dorsal to the terminal band). Demographics, operative details and complications were compiled. Results: Eleven patients met inclusion criteria with an average age of 35 years (range: 13-66) and an average follow-up of 7 months (range: 4-16). Sutures used included two Prolene, three Supramid and six FiberWires (Arthrex, USA). Three of these injuries were associated with distal phalanx fractures. Infection-like symptoms, including painful flare-ups of swelling of the eponychium, occurred in six patients (55%) in whom a braided suture was used, which included all three patients with Supramid and three patients with FiberWire (Arthrex, USA). Three of the patients experienced multiple episodes of painful swelling of the eponychium that were managed with antibiotics. Three patients (27%) experienced nail deformities. Eight (73%) of the eleven patients experienced complications, five requiring incision, drainage or subsequent suture removal. Conclusions: All-inside transosseous flexor tendon repair is correlated with a high complication rate mainly associated with suture abscess and nail deformity, with a high risk of needing additional intervention. We speculate that the braided sutures are more likely to cause recurrent symptoms of suture abscess. Although antibiotics may control the symptoms, the suture material should be occasionally removed in cases of recurrent suture abscesses. Level of Evidence: Level IV (Therapeutic).

Intravascular papillary endothelial hyperplasia, also known as Masson tumour, is a rare proliferative vascular lesion that can affect the hand. We report a patient who was operated on for a progressively enlarging soft tissue lump at the base of his thumb. Initially, it was thought to be a post-traumatic false aneurysm arising from a branch of the radial artery following blunt trauma. Subsequent histology revealed it to be a Masson tumour. We aim to highlight this rare pathology that can affect the hand and the diagnostic confusion we faced during the evaluation and management of this patient. Level of Evidence: Level V (Therapeutic).

Background: Suspension arthroplasty using the abductor pollicis longus (APL) tendon for advanced thumb carpometacarpal (CMC) arthrosis is known as the hammock method. We retrospectively investigated the short-term results of a previous attempt to use this method combined with the Mini TightRope^® to improve CMC joint stability. Methods: We included 22 hands of 19 patients (4 men and 15 women; mean age: 61.7 years) with primary advanced thumb CMC arthrosis who underwent this procedure during the past 4 years. All patients had Eaton stages II-IV thumb CMC arthritis. The Mini TightRope^® was inserted before APL tendon fixation to the metacarpal bone. After a 2-week immobilisation, the patients were permitted unrestricted hand usage. We assessed the grip and pinch strength; radial and volar abduction angles; the quick disabilities of the arm, shoulder and hand (quick DASH), hand 20 and Kapandji scores; trapezial height before surgery and at the final follow-up; postoperative complications and operative time. Results: The mean follow-up was 24.2 months, and the mean operative time was 58.1 minutes. The grip, tip pinch and side pinch strengths increased postoperatively. Additionally, the radial and volar abduction angles improved. The Kapandji, quick DASH and hand 20 scores showed improvements. The mean trapezial height was 8.4 mm preoperatively and 6.4 mm at the final follow-up. Postoperative complications included superficial radial neuropathy (n = 3), thumb flexor tendinitis (n = 2) and flexor carpi radialis (FCR) tendinitis (n = 3). Conclusions: The hammock method combined with the Mini TightRope^® shows good short-term results. Level of Evidence: Level IV (Therapeutic).

Background: Ruptures of the distal biceps brachii tendon (DBT) have only a few published reports in Asia. In this study, we report on the diagnosis and surgical outcomes of six acute traumatic cases surgically treated using a new internal fixation instrument, PushLock^® Knotless Suture Anchor. Methods: In the past 3 years, we treated six patients with DBT rupture. All were males, aged 39-67 years at the time of surgery. Three patients had complete rupture of both the long and short head and three patients had only rupture of the long head. The ruptured DBT tendon was tightly fixed to the anatomical insertion in the radial tuberosity by use of a 2.9 mm PushLock^® Knotless Suture Anchor. Results: All patients had recovered to MMT 5 in elbow flexion post-operatively and there was no limitation of ROM in elbow or forearm. The DASH score significantly improved from a mean of 28.5 points to 17.5. One patient had a transient complaint of numbness in the area of the superficial radial nerve. Conclusions: Even if the long head of DBT is injured alone, pain and consequent elbow flexion weakness will occur. Repair of the injured tendon should be considered even for partial rupture of DBT, especially in manual workers. The SutureTape and 2.9 mm PushLock^® Knotless Suture Anchor are new internal fixation instruments, and their usefulness for repair of ruptured DBT has not been reported yet. In this case series, excellent outcomes were obtained. Pain relief and recovery of muscle strength were achieved early after surgery. Our technique is simple, safe and reliable for surgical repair of the ruptured DBT. Level of Evidence: Level IV (Therapeutic).

Free flaps have become the standard of treatment for complex tissue defects following trauma or oncological resection. At times, there is a lack of available recipient vessels near the defect. Classically, this problem has been circumvented with the use of vein grafts, either as interpositional grafts or arteriovenous (AV) loops. Other solutions include the use of bridging flaps, or, more recently, interpositional composite AV bundles (ICAVB). This is a relatively new technique with few publications in the literature. In this article, we share our experience of 18 successful ICAVB cases and discuss the indications, choice of donor and technical tips for the execution of this technique. Level of Evidence: Level V (Therapeutic).

Background: Numerous medical questionnaires exist to assess the quality of life in patients with carpal tunnel syndrome (CTS). However, most of these instruments are available exclusively in English. Therefore, we decided to translate and culturally adapt the Six-Item CTS Symptoms Scale (CTS-6 SS) into Persian. This questionnaire was selected because it offers a subjective evaluation with a concise set of questions. Methods: The translation followed the World Health Organization's four-step protocol, including forward and backward translation, expert panel review and pre-testing. The cultural adaptation involved a multidisciplinary team ensuring relevance and comprehensibility for Iranian patients. The questionnaire's validity and reliability were assessed. The questionnaire was revised and then administered to 60 randomly selected patients diagnosed with CTS. Results: The translated CTS-6 demonstrated high comprehension and completion rates. The adaptation process addressed cultural nuances and ensured the scale's effectiveness in the Iranian context. Cronbach's α was computed at 0.903 to evaluate internal consistency. The test-retest data for the CTS-6 showed a normal distribution. Conclusions: The Persian version of the CTS-6 is a reliable and efficient tool for assessing CTS symptoms, facilitating accurate diagnosis and treatment in Persian-speaking populations. The brevity and clarity of the questionnaire enhance patient compliance and the reliability of collected data. Level of Evidence: Level IV (Diagnostic).