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

Background: Managing ulnar wrist pain without ulnar plus variance presents a clinical challenge. This study aimed to compare the causes of symptom onset and surgical outcomes between arthroscopic triangular fibrocartilage complex (TFCC) repair and ulnar shortening osteotomy (USO) and analyse factors influencing pain reduction following arthroscopic TFCC repair. Methods: Twenty-four patients without ulnar plus variance who underwent either arthroscopic TFCC repair or USO at our institution were retrospectively reviewed. Demographic data, symptom onset causes, time from onset to surgery, pre- and postoperative range of motion (ROM), grip strength ratio (injured to uninjured wrist), numeric pain rating scale (NRS), change in NRS and Hand20 scores were compared between the two treatment groups. For TFCC repair, correlations were investigated between NRS change and time from onset to surgery and between NRS change and age. Results: Of 24 patients, 14 underwent arthroscopic TFCC repair and 10 underwent USO. Only two patients in the USO group had no clear onset trigger, whereas most had identifiable triggers. Both groups showed no significant differences in pre- and postoperative ROM, grip strength ratio, NRS and Hand20 score. The change in NRS was significantly greater in the USO group (p = 0.049). For the TFCC repair group, NRS change was significantly negatively correlated with age (Spearman's rank correlation coefficient -0.603, p = 0.029). Conclusions: Our findings indicate that patients without ulnar plus variance who experience symptom onset including trauma often have an underlying degenerative component as well as instability. USO provides significant pain relief in such cases. Arthroscopic TFCC repair was effective in young patients in whom instability was the primary cause of pain and age was associated with pain reduction rather than time from onset to surgery. Effective treatment strategies for ulnar wrist pain without ulnar plus variance should consider both age and wrist arthroscopy findings to optimise outcomes. Level of Evidence: Level IV (Therapeutic).

Background: In 50 years since mobile phones were invented, their number has surpassed the global population, with India being the second-largest user after China. Although the lithium-ion battery failure rate is 1 in 10 million, high production increases related injuries. This study presents a series of hand injuries caused by mobile phone battery explosions at a tertiary care centre in central India. Methods: A retrospective audit was conducted at our institute from January 2020 to March 2024. Medical records were reviewed for demographics, clinical history, management and postoperative complications. Hand function was assessed at a minimum of 6 months post-op using the Michigan Hand Outcomes Questionnaire (MHQ). Spearman's correlation test was used for statistical analysis using Jamovi Statistical software. Results: Twelve patients (mean age: 24.8 years, range: 8-55) with lower and middle socioeconomic backgrounds were included. Paediatric cases resulted from playing with discarded batteries, while adult cases occurred during charging. Nine (75%) patients had dominant hand involvement, one (8%) had a non-dominant hand injury and two (17%) had bilateral injuries. Injuries were classified as mild (three patients, 25%), moderate (two patients, 16%) and severe (seven patients, 58%). MHQ scores averaged 80.7 for mild, 68.5 for moderate and 52.9 for severe injuries. Statistical analysis showed an inverse correlation between injury severity and hand function (rho = -0.809, p < 0.005). Conclusions: Mobile phone battery explosions pose a growing health hazard, causing severe trauma. Most cases are preventable through proper disposal of electronic waste and discarded batteries. Awareness and adherence to safe practices are essential for reducing such injuries. Level of Evidence: Level IV (Therapeutic).

Restoration of elbow extension is seldom considered in the reconstructive plan for patients with extensive brachial plexus injury because of the scarcity of the nerve and tendon transfer options. However, restoring elbow extension could increase the outreach of hand and give better control of the elbow flexion. We propose a new technique for restoring elbow extension using the readily available contralateral lower trapezius (CLT). By extending the CLT with a fascia lata graft and transferring it to the triceps, we were able to restore elbow extension. In all four patients who underwent this procedure, anti-gravity (Grade-3) elbow extension was reliably achieved. Patients reported improved ability to reach for objects below shoulder level and expressed greater stability while handling a two-wheeler. This technique offers an effective method of restoring elbow extension in instances where the conventional ipsilateral donor muscles are not available for transfer. Level of Evidence: Level V (Therapeutic).

Background: Primary neuroma excision and autografting are the gold-standard surgical treatments for brachial plexus birth injury (BPBI). With the rising popularity of distal nerve transfers, it is more frequently utilised to manage BPBI. However, distal transfers for BPBI remain under investigation. We reviewed the updated evidence for nerve transfers compared to nerve grafting as a primary approach for shoulder and elbow reconstruction in Narakas I and II neonatal brachial plexus palsy. Methods: A systematic review of the literature was performed according to the PRISMA guidelines. PubMed and Cochrane Central Register of Controlled Trials were searched using the search terms: ([{brachial plexus} AND {neonatal OR obstetric}] AND [graft OR grafting]) AND (transfer OR transfers). Results: Most studies did not specify the indications for grafting versus nerve transfer. Some suggested indications for nerve transfer surgery in BPBI include late presentations and nerve root avulsions. There was significantly greater improvement in shoulder external rotation postoperatively in the nerve transfer group compared to the nerve grafting group. There was no significant difference between the nerve transfer and nerve grafting groups for shoulder flexion, abduction and total active movement scale score. Patients undergoing nerve grafting were more likely to undergo a secondary shoulder stabilising procedure, though this was not statistically significant. Conclusion: The current literature shows that there appears to be little difference in functional outcomes between nerve grafting and nerve transfers. Level of Evidence: Level III (Therapeutic).

Background: Congenital syndactyly is one of the most common congenital hand anomalies (1 in 3,000 live births). The ideal surgical technique must rebuild a satisfactory web space, restore digit abduction and avoid secondary contracture. The dorsal omega flap reduces the need for skin graft, thereby reducing web creep and contracture. There is a gap in literature on patient reported outcomes regarding the dorsal omega flap. We conducted a cross-sectional study to assess the outcomes patients operated with this technique. The aim of this study is to assess quality of life using Patient Reported Outcome Measures Information Systems (PROMIS^®) (upper extremity parent proxy short form) and to assess scar of dorsal omega flap subjectively using Visual analogue scale (VAS) and objectively using Vancouver Scar Score (VSS) and Withey score. Methods: Fifty-one children underwent congenital syndactyly correction between 2015 and 2021 at our institute. Seventeen children (45 webs) could be contacted for outpatient visit. Thirty-seven webs had undergone the dorsal omega flap. Withey's score and VSS for objective assessment of web and VAS for subjective scar assessment by parents. Parents were also administered the PROMIS^® (upper extremity parent proxy short form). The data analysis was performed using SPSS software (v22). Results: Patients who underwent surgery at least 4 years ago reported a higher median VSS (35) compared to those less than 4 years post-surgery (30). VAS and VSS showed improvement with time elapsed since surgery (ANOVA test), which was significant at p < 0.05. Median PROMIS^® score is lower in patients who had a graft used for coverage. But this was not significant statistically. The use of graft or the lack of it did not affect median VSS. Conclusions: PROMIS^® scores improve over time. The use of graft was associated with lower PROMIS^® scores. Older scars were of significantly better quality than more recent scars. Level of Evidence: Level IV (Therapeutic).

Birth brachial plexus palsy (BBPP) can lead to significant functional impairment of the upper limb, particularly affecting hand function. Despite advancements in primary nerve reconstruction, many patients require secondary procedures to optimise hand use. This study evaluates surgical strategies aimed at restoring hand function in BBPP, emphasising the timing of intervention, nerve transfer options and reconstructive techniques. A comprehensive review of direct root transfers, secondary tendon transfers, along with an analysis of sensory re-education and long-term functional outcomes. Early nerve reconstruction, particularly nerve transfers to the lower trunk or medial cord, demonstrated superior functional recovery when performed within the critical period of motor endplate viability. Secondary tendon and free muscle transfers proved beneficial in patients with persistent deficits, particularly for enhancing grasp, pinch and intrinsic hand function. Sensory recovery remained a key determinant of overall hand utility, with targeted nerve transfers improving protective sensation. Optimising hand function in BBPP requires a multimodal approach tailored to each patient's residual deficits. Early nerve surgery provides the best potential for meaningful recovery, while secondary procedures play a crucial role in refining outcomes. Understanding the interplay between motor and sensory recovery is essential for achieving the best functional restoration. Level of Evidence: Level V (Therapeutic).