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

Background: While functional and patient-reported outcomes are similar for closed reduction percutaneous pinning (CRPP) and open reduction internal fixation (ORIF) of phalanx fractures, controversy exists regarding optimal fixation choice. In this study, we tested the null hypotheses that there is no difference in (1) percentage of patients undergoing secondary procedures within 2 years, (2) therapy utilisation and (3) total costs following CRPP and ORIF of phalanx fractures. Methods: Using an administrative claims database, we identified patients undergoing CRPP or ORIF of phalanx fractures from 2011 to 2020. Secondary procedures assessed within 2 years after CRPP or ORIF included phalanx osteotomy, tenolysis, irrigation and debridement, metacarpophalangeal joint arthrodesis and interphalangeal joint arthrodesis or arthroplasty. We calculated therapy utilisation at 6-month intervals after surgery and total cost of care at 90 days post-procedure. Multivariable logistic regression models were used to evaluate the association between choice of surgical fixation and incidence of secondary procedures, adjusting for age, sex, region, insurance and Elixhauser comorbidity index. Results: The composite incidence of secondary procedures was 3.1% after CRPP and 4.7% after ORIF (p < 0.001). Within 2 years after CRPP, fewer patients had tenolysis (odds ratio [OR] = 0.57 [95% confidence interval (CI): 0.52-0.63]), interphalangeal joint arthrodesis (OR = 0.51 [95% CI: 0.41-0.62]) or interphalangeal joint arthroplasty procedures (OR = 0.58 [95% CI: 0.38-0.87]). Patients who underwent CRPP had increased therapy utilisation, but similar 90-day total cost of care. Conclusions: CRPP for phalanx fractures is associated with a lower incidence of subsequent procedures compared to ORIF. Further studies are needed to compare CRPP with ORIF for phalanx fractures while accounting for specific fracture patterns as confounders, which was a limitation of this study. Level of Evidence: Level III (Therapeutic).

Background: Palmar midcarpal instability (PMCI) is often neglected in diagnosis and lacks a gold standard treatment. It is primarily associated with dorsal radiocarpal (DRC) ligament insufficiency. We used a combined approach of arthroscopic thermal capsular shrinkage and open DRC ligament suture tensioning for symptomatic PMCI and present our outcomes. Methods: From 2018 to 2022, nine PMCI patients (mean age: 32 years) underwent this treatment. The mean symptom duration was 15.3 months, with a mean follow-up of 16.8 months. Outcomes were measured by wrist ROM, grip strength, VAS for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and modified Mayo Wrist scores. Results: All patients showed significant improvement in pain, grip strength and function, with maintained radiocarpal stability at final follow-up. Although wrist ROM showed mild limitation after surgery, all patients returned to their previous work and activities. Conclusions: This approach may provide an effective and less aggressive treatment for PMCI. Level of Evidence: Level IV (Therapeutic).

The author's approach to a patient with CRPS is presented. The key is to classify the patient into any of the following groups: wrong diagnosis, psychogenic-dystonic hand, nerve injury (complex regional pain syndrome [CRPS] 2), flare reaction (FR) and the remaining would comprise the real CRPS 1 patient. The first three do not represent any mysterious condition, but require addressing the underlying problem, while a FR - a minor form of CRPS 1 - is, for the most, self-resolved by physical therapy. The remaining group, i.e. the true CRPS 1 case, have a condition known as irritative carpal tunnel syndrome (ICTS): release of the transverse carpal ligament yields a 94% cure rate. Even though the treatment is the same, carpal tunnel syndrome (CTS) and ICTS are very different conditions. In summary, there is a paradigm shift in handling CRPS patients. Further research to understand the pathophysiology and the failures is needed. Level of Evidence: Level V (Therapeutic).

Comminuted intra-articular fractures of the metacarpophalangeal joint (MCPJ) of the thumb are difficult to treat because of challenges with anatomical fixation. The pins and rubbers traction system (PRTS), described by Suzuki et al., is a minimally invasive technique that enables early range-of-motion training while maintaining joint congruency. PRTS exhibits advantages relative to other dynamic external fixation techniques due to its simplicity, low cost and compact design. It has been used mainly in treating primarily proximal interphalangeal joint (IPJ) fractures. We present two patients where we used a PRTS for comminuted intra-articular fractures of the thumb MCPJ with good outcomes. We temporarily pinned the carpometacarpal joint (CMCJ) in maximum abduction to avoid skin irritation from the ulnar aspect of the axial traction wire in thumb adduction. Level of Evidence: Level V (Therapeutic).

Neuropathic pain in root avulsion brachial plexus injury (BPI) is severe and unrelenting. Routine analgesics and other described methods often provide inadequate pain relief. We report a patient with neuropathic pain following C₈T₁ root avulsion injury, which was successfully managed with end-to-side ulnar sensory branch transfer to the median nerve. Postoperatively, there was a marked reduction in pain score as determined by visual analogue score (VAS) and a marked improvement in the daily sleep interference scale (DSIS). This option may be considered in patients with severe neuropathic pain in lower root avulsion injury in BPI. Level of Evidence: Level V (Therapeutic).

Hourglass-like constriction (HGC) of the nerve is a rare cause of nerve palsy and has been reported for many nerves. We were unable to find previous reports of concomitant constriction of the suprascapular and axillary nerve in literature. Our patient was a young male with shoulder paralysis of 7-months duration. On exploration we found two HGCs of the suprascapular and axillary nerves. A neurolysis of the suprascapular nerve was carried out. The axillary nerve constriction was deemed to be severe and a nerve transfer using the branch innervating the medial head of the triceps motor was done. Patient recovered excellent shoulder function at 1-year post-surgery. Awareness about this rare occurrence will prevent poor outcome from addressing the constriction at only one site. Nerve surgery should be considered for patients who do not show any improvement in 6 months. Level of Evidence: Level IV (Therapeutic).

Background: Distal radius fractures (DRFs) are a common injury with fracture parameters guiding surgical treatment. Palmar plating is the most common method of fixation in patients needing surgical fixation. However, in fractures with a complete or nearly intact volar cortex, reduction of the fracture fragments may be challenging with the palmar approach. We use a novel Z-osteotomy technique to address this issue and report on our outcomes. Methods: This is a retrospective review of all patients where a volar Z-osteotomy technique was used. We assessed pre-, intra- and postoperative radiographic parameters, fracture union and final wrist range of motion of all patients. Results: Twelve DRFs in 11 patients were analysed. All fractures were successfully plated palmarly with volar tilt 9-14 (average: 11.3) and all achieved fracture union. This was maintained in the final radiographs with good clinical wrist range of motion. Conclusions: The volar Z-osteotomy technique described allows surgeons to achieve anatomical reduction of volar tilt in DRFs where the volar cortex is intact with good clinical and radiological outcomes. Level of Evidence: Level IV (Therapeutic).

Conventional prosthetic sockets can be uncomfortable and restrictive to elbow flexion when fitted on short forearm stumps due to their high trimline. We report improved patient experience after switching to a locking silicone-liner socket in conjunction with a lightweight aesthetic prosthesis in two congenital transradial amputees with short stumps who were previously dissatisfied with their conventional prosthesis. To reduce weight, the forearm section of the prosthesis was constructed using a lightweight design. Seven of eight attributes, namely aesthetics, comfort, suspension, ease of donning/doffing, weight, range of motion, skin issues and overall satisfaction, were rated by both patients as having improved versus their conventional prosthesis, with no change reported regarding issues of the skin. Our experience suggests that transradial amputees with short stumps who had problems with conventional fittings due to socket impingement and prosthesis weight may benefit from an approach combining a locking-pin liner suspension with a lightweight prosthesis. Level of Evidence: Level V (Therapeutic).

Background: This study aimed to identify the risk factors associated with re-displacement or collapse of distal radius fractures treated using volar locking plates in older adults. Methods: We conducted a retrospective analysis of 131 patients aged ≥65 years with distal radius fractures who underwent volar locking plate fixation. The collapse was classified into three categories: 'radial collapse' was determined as the top decile of patients with the greatest decrease in radial inclination; 'dorsal collapse' was defined by volar tilt angle on lateral or 25° tilted lateral views and 'height collapse' by radial height. To identify the factors related to these three types of collapses, we compared the clinical and radiological parameters between the wrists with each type of collapsed and non-collapsed wrists. Results: Dorsal collapse had no significant associated factors and radial collapse had osteoporosis as a significant different factor. The height collapse group was associated with older age, had a higher prevalence of high-energy injury mechanisms and a limited range of flexion-extension at final follow-up and larger distance between the articular surface and distal screws. Conclusions: The volar locking plate may effectively prevent three types of collapses. Height collapse group included patients with increased age, high-energy injury mechanisms and limited range of flexion-extension at the time of final follow-up. To prevent collapse, the longest possible distal screws must be inserted just beneath the subchondral bone. Level of Evidence: Level IV (Therapeutic).

Background: Radial head fractures with comminution and displacement present challenges in achieving optimal treatment outcomes in the long term. This study aims to evaluate the long-term effects of radial head excision (RHE) in patients with Mason type 3 fractures. Methods: We conducted a retrospective study of patients with a Mason type 3 radial head fracture who underwent primary RHE between January 2010 and January 2020. The primary outcome was the Mayo elbow performance score (MEPS). Additionally, joint stability and arthritis, and the carrying angle were recorded for each patient. Results: In total, 61 patients (21; 34% female) with a follow-up range of 3-13 years were examined. The mean (SD) total MEPS was 91.8 (9.2). The results were excellent for 46, good for 12 and fair for 3 patients. A model of total MEPS adjusted for sex, age and follow-up time showed a significant effect of patient age on treatment success (p < 0.001). Thirteen patients (21%) showed elbow instability. Six individuals had increased valgus laxity. The mean carrying angle was 19° (range: 11°-27°) on the injured side and 9° (4°-15°) on the uninjured side, t(120) = 12.608, p < 0.001. Overall, 37 patients had degenerative changes in the operative elbow. Conclusions: Benefits of RHE persist for a long time with predominantly excellent elbow function and minimal complications. An increase in the carrying angle, joint instability and degenerative changes are to be expected. Patient age at the time of the surgery can affect treatment outcomes. Level of Evidence: Level IV (Therapeutic).