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

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).

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).