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

Background: In 2025, South Korea's society is facing the transition into a hyper-ageing society. The effectiveness and functional outcome between surgical operation and conservative treatment of distal radial fractures in the elderly have been consistently debated. The aim of this study is to present the outcomes of surgical fixation for comminuted distal radial fractures in hyper-aged patients aged 75 years or older. Methods: This is a retrospective study of all patients aged 75 years or older who underwent surgical fixation of distal radial fractures in the period from January 2011 to December 2021 with a minimum follow-up of at least 3 months. Data collected included sex, age, residence status, economically active population, osteoporosis, AO/OTA fracture classification and use of bone graft. Functional outcomes were evaluated with Mayo wrist score system (MWSS) and radiologic outcomes between preoperative, postoperative and unaffected sides of each patient was measured. Results: The study included 38 patients (35 females) with a median age of 79.7 years (range: 75-92). MWSS at postoperative 6 months showed that 30 patients (78.9%) expressed excellent or good outcomes. Postoperative parameters indicated radial height 6.90 mm (4.82-9.08), radial inclination 15.5° (13.0°-19.9°) and volar tilt 10.8° (7.2°-14.5°). These values were significantly different compared with preoperative values. We identified with McNemar's test that in all time periods (2 weeks, 1 month and 3 months), there were no significant difference in the proportion of acceptable reduction in all parameters. Conclusions: Although treatment of distal radial fractures in the elderly is still controversial, operative treatment showed significantly improved functional and radiological outcomes and showed possibilities to reduce socioeconomic burden and to aid in early functional restoration and aesthetic deformity correction. Level of Evidence: Level IV (Therapeutic).

Background: The off-label use of gabapentinoids for carpal tunnel syndrome (CTS) is increasing despite limited evidence of efficacy and known risks of adverse effects. This systematic review and meta-analysis aimed to synthesise the evidence of the benefits and harms of oral gabapentinoids in treating CTS. Methods: We searched Medline and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT). Based on the search results, we formed three comparisons assessing the effect of oral gabapentinoid interventions against (1) placebo (primary comparison), (2) open label no-treatment (with co-interventions in both arms) or (3) splinting. The primary outcome was symptom severity. The secondary outcomes were pain, function, clinical improvement, health-related quality of life, adverse effects and need for surgery. We adhered to the Cochrane and GRADE methodology throughout conducting this systematic review and meta-analysis. Results: Gabapentinoids probably do not improve CTS symptoms (moderate certainty) compared with placebo. The benefit was 0.08 points better (95% confidence interval [CI] 0.33 better to 0.17 worse; two studies, 286 randomised participants) expressed on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (1-5 points, lower is better; minimal clinically important difference [MCID] 1.14 points) with gabapentinoids at 8 weeks. Secondary comparison to no treatment aligned with this finding. Gabapentinoids probably cause more fatigue (risk ratio [RR] 1.67 [95% CI 1.06-2.63]) and may cause more dizziness (RR 1.96 [95% CI 0.93-4.13]) compared to placebo. When compared to no-treatment at short term, gabapentinoids may provide minor benefits for pain but not for hand function. Conclusions: Current evidence does not support the use of oral gabapentinoids for CTS. There were no clinically important benefits in symptom relief when compared to placebo or no-treatment, and gabapentinoids caused adverse effects, particularly fatigue and maybe also dizziness. Level of Evidence: Level II (Therapeutic).

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: In carpal tunnel syndrome (CTS), pain and sensory disturbance are the main symptoms, but thumb palmar abduction (TPA) paralysis cannot be ignored as a concurrent symptom. The reliable quantitative measurement of TPA power was not established. The purpose of this study was to report on the reliability of TPA strength measurements by the hand-held dynamometry (HHD) in large samples of CTS and its superiority over other tests, including grip, pinch powers, TPA angles and manual muscle testing, in terms of clinical progress indicators. Methods: We examined the relative and absolute reliabilities of the perioperative TPA strength measured by HHD (HHD-TPA) in 566 participants with CTS and the correlation coefficient between the HHD-TPA and other clinical tests. Results: The reliability of the HHD-TPA was intraclass correlation coefficients: 97% or higher. The Bland-Altman absolute reliability showed a random pattern of bias, and the minimal detectable changes (MDC) of the inter-rater and intra-rater reliabilities indicated 9.0 N and 7.0 N individually. The HHD-TPA showed statistically significant recoveries between perioperative stages; however, the mean difference larger than the MDC was recognised only between the preoperative and 12-month postoperative stages by intra-rater comparison. More individual patients showed recovery of HHD-TPA beyond the MDC when the same examiner continuously measured HHD-TPA than when multiple examiners continuously measured HHD-TPA. Grip strength and pinch strength measurements showed a strong correlation with HHD-TPA and did not show statistically significant improvement during the perioperative period. Conclusions: HHD-TPA is the most reliable method for quantifying muscle strength in the perioperative course of TPA force in CTS. HHD-TPA is a more reliable assessment of CTS motor recovery when measured consistently for each patient by the same hand therapist. Level of Evidence: Level IV (Diagnostic).

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).

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).

Background: To investigate the impact of antithrombotic drug continuation or interruption on postoperative outcomes in patients with carpal tunnel syndrome (CTS) who undergo endoscopic carpal tunnel release (ECTR). Methods: This prospective, randomised, open-label, parallel group trial was conducted between December 2016 and October 2022 of CTS patients on antithrombotic medications who underwent ECTR. The 65 participants were randomly assigned to either maintain antithrombotic therapy (continuation group, 34 patients) or suspend it (interruption group, 31 patients). The primary outcome was a version of the CTS Instrument developed by the Japanese Society for Surgery of the Hand (CTSI-JSSH). Secondary outcomes were the Semmes-Weinstein Monofilament Test (SW), swelling (determined by measuring the circumferences of the middle finger, wrist and hand), visual analogue scale (VAS) for pain, VAS for swelling evaluated independently by patients and doctors and complications. CTSI-JSSH was administered before surgery and 3 months after. SW was conducted before surgery and at 1 and 3 months after. Swelling was objectively measured before surgery and at 2 weeks and 1 month after. Both pain and swelling VAS scores were recorded at 2 weeks and 1 month postoperatively. Complications were evaluated up to 3 months postoperatively. Results: Results on the symptom severity scale (SSS) of the CTSI-JSSH were significantly better in the interruption group at 3 months after surgery. VAS swelling assessed by both patients and doctors was significantly lower in the interruption group. There were no complications in either group. Conclusions: The interruption group had better outcomes on the SSS and postoperative subjective swelling, with no cardiovascular events. For patients taking antithrombosis medication, short-term ECTR outcomes improve when its use is temporarily suspended. Level of Evidence: Level II (Therapeutic).

Background: Partial wrist arthrodesis (PWA) is a salvage procedure used in advanced wrist arthritis and has traditionally been performed via an open dorsal approach. In recent years, surgeons have moved towards arthroscopic fusions to minimise soft tissue damage and preserve vascular supply, increase union rates and hasten recovery. The purpose of this study is to synthesise the current literature on the outcomes of arthroscopic PWA. Methods: A systematic review was performed to survey the literature regarding outcomes of PWA. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. Data collected included patient demographics, operation time and technique, complications and postoperative patient outcomes in the form of patient-rated surveys, grip strength, range of motion and the pain visual analogue scale (VAS). Results: Twelve studies were eligible for inclusion, with a total of 191 patients. 94% of patients achieved union, with a mean time to fusion of 12.5 weeks. VAS, Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist scores were significantly improved after the procedure, and complication rates were comparable to open procedures. Range of motion varied greatly across studies, due to heterogeneity in carpal intervals fused. Conclusions: Arthroscopic PWA is a safe and effective procedure in the treatment of advanced arthritis of the wrist. Further comparative studies would be useful in assessing benefits of arthroscopic arthrodesis over an open approach. Level of Evidence: Level III (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).