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

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).

Background: There is currently no consensus regarding optimal treatment strategies for treating radiocarpal arthritis. The purpose of this prospective study was to compare preoperative and postoperative wrist range of motion (ROM), residual pain, grip and pinch strength, functional results and fusion rates after radioscapholunate (RSL) fusion using a volarly placed plate. Methods: This single-centre prospective study was conducted from January 2022 to December 2024. This study included nine patients (six males and three females) with post-traumatic arthritis after a distal radius fracture who underwent RSL fusion using a volarly placed plate. Pre- and postoperative functional results were measured using pinch strength, grip power, Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue pain score (VAS). Results: Fusion was achieved for all patients with no complications. Significant improvements in grip and pinch strength were noted from 6 months onwards (p < 0.05), with patients having 91% recovery of their grip strength as compared to their healthy hand. Fusion was also able to provide significant pain relief with functional improvements of upper extremities (preoperative: 74.3 ± 11.3; postoperative 1 year: 5.0 ± 4.7) from 3 months postoperatively (p < 0.05). Regarding wrist ROM, significant improvements in wrist pronation, supination were noted from 3 months preoperatively (p < 0.05). Degree of radial (preoperative: 8.9° ± 3.5°; 3 months: 5.0° ± 4.4°; 6 months: 9.6° ± 2.9°; 1 year: 11.2° ± 2.3°) and ulnar deviation had gradual improvements from 6 months onwards. No significant differences between preoperative and postoperative flexion and extension were noted. Conclusion: RSL fusion using a volarly placed plate is a reliable surgical option for managing post-traumatic radiocarpal joint arthritis following a distal radius fracture with good clinical, functional and radiological outcomes. Level of Evidence: Level III (Therapeutic).

Background: The cross-finger flap is a reliable technique for soft tissue reconstruction in finger injuries, providing pliable tissue and anatomical security. However, donor finger morbidity remains a concern. This retrospective cohort study evaluated donor-site outcomes, focussing on functional recovery and patient-reported measures. Methods: This retrospective cohort study included 30 patients who underwent cross-finger flap surgery, predominantly males (80%) aged 21-40 years, mostly manual labourers with workplace-related injuries. The index finger was most injured (48%), while the middle finger served as the primary donor (66.6%). Assessments included donor finger pain, total active motion (TAM), pinch strength, aesthetic outcomes and complications. Statistical analysis compared donor and control fingers to evaluate functional recovery and patient satisfaction. Results: Patient satisfaction was high (96.7%), with minimal donor site pain (93%). A significant reduction in TAM was observed in donor fingers compared to controls (p = 0.029). Maximal pinch strength showed no significant difference (p = 0.415). Complications included hyperpigmentation (20%) and partial graft loss (10%) and hypertrophic scar (3%). Conclusion: The cross-finger flap remains an effective reconstructive option with high patient satisfaction. However, donor finger morbidity, particularly reduced TAM, underscores the need for structured postoperative rehabilitation. Early flap division and supervised physiotherapy may optimise functional recovery. Study limitations include sample size, but these findings demonstrate the procedure's viability for soft tissue reconstruction. Level of Evidence: Level IV (Therapeutic).

Background: Percutaneous screw placement can treat nondisplaced or scaphoid waist fractures. Screws positioned in areas of highest trabecular density improve fracture stability and bone healing. This study aims to compare the density of six segments of the intact scaphoid bone to facilitate optimal screw positioning. Methods: This study compared the density of six segments of the scaphoid bone in 214 intact scans using the 3D Quantitative Imaging (3DQI) Platform. The scaphoid was divided into proximal, middle and distal regions, each with radial and ulnar segments. Densities were measured in Hounsfield units (HU) and compared using a mixed effects model. Results: The proximal pole had the highest density (proximal radial 551 ± 115 HU; proximal ulnar 546 ± 116 HU), followed by the middle, with the distal pole having the lowest density. The proximal segments were significantly denser than the middle and distal segments. Conclusion: Our study suggests a more ulnar starting point in the distal pole for retrograde percutaneous screw placement, to maximise engagement of the highest trabecular bone density. For the antegrade approach, the proximal pole demonstrates consistently uniform density, permitting screw placement based on fracture plane; however, if possible, the ulnar segment of the distal pole should be engaged.

Dupuytren disease (DD) has been described since the 17th century, but its true aetiology remains a mystery. The treatment of DD largely involves addressing the end stage of a complex fibroproliferative pathway, specifically, the cords. In recent years, there has been a shift to less radical approaches, with an increased adoption of percutaneous needle aponeurotomy (PNA) or collagenase. However, the difficulty in comparing outcomes across various treatments is likely to persist due to limitations in evaluating the effectiveness of those treatments. Patient-reported outcome measures may not accurately reflect disease severity or treatment success; objective measures might not correlate well with subjective improvements and treating all joints with equal weight is unrealistic. Additionally, the inherent difficulties of blinding in studies comparing surgical and percutaneous techniques, along with heterogeneity of the affected population, further complicate outcome assessment. There are interesting developments in the basic science arena resulting in a deeper understanding of the signalling pathways driving DD. Targeting molecular targets early in the signalling pathway may hold the key to preventing pathological contractures in Dupuytren patients. Level of Evidence: Level V (Therapeutic).

The clenched fist deformity (CFD) in adult patients with upper motor neuron syndrome (UMNS), typically due to a brain or spinal cord injury, can develop from an imbalance of the extrinsic finger flexors relative to the extensors. This brings the fingers into a flexed posture across the metacarpophalangeal (MCP) and interphalangeal (IP) joints and places the fingertips close to or in contact with the palm. The intrinsic musculature of the hand also plays a contributing role to the flexion deformity across the MCP joints whose contribution to the deformity can be masked by the extrinsic flexors. Severity of the CFD is patient specific and ranges over a spectrum dependent upon the involved muscle groups and underlying spasticity, myostatic contracture and/or joint contractures. In addition to markedly decreasing function, patients and caretakers may struggle with hygiene in the hand and even develop wounds within the palm. Surgical correction of the CFD can be classified as procedures implemented for muscles with (functional) or without (non-functional) volitional motor control. Techniques encompass muscle-tendon lengthening, tenotomies, tendon transfers, muscle origin release (slides), joint capsule and/or ligament releases. A comprehensive review of the surgical approach to correcting the CFD for the hand with and without volitional motor control in the fingers will be presented. Level of Evidence: Level V (Therapeutic).

Background: The prognosis of Kienböck disease (KD) depends upon the extent of damage to the articular surface of the lunate and its adjacent articulations. Arthroscopy offers valuable information for management and decision-making by revealing the status of the articular surface, which radiographs cannot visualise. Methods: This study on KD assessed 10 patients, correlating radiographic and arthroscopic evaluations to enhance diagnostic accuracy and determine the decision-making, which may result in improved functional outcomes for patients. Results: Findings have shown that arthroscopy often reveals critical details not visible by imaging, influencing surgical planning. Notably, the management plan changed in 50% of the cases following arthroscopic assessment in our series. The radiological evaluations indicated changes in the lunate, carpal collapse and instability angles, while wrist arthroscopy offered further insights into cartilage damage, lunate fracture and ligament integrity. Additionally, wrist arthroscopic evaluations facilitated minimally invasive procedures, such as scapho-capitate fusion through a mini-incision, potentially resulting in a shorter recovery time and a decreased risk of complications relative to the conventional dorsal approach, thereby providing a much more satisfactory functional outcome. Conclusion: The study concludes that combining radiographic and arthroscopic data enhances comprehensive diagnostic accuracy and guides precise surgical intervention in KD. Level of Evidence: Level IV (Therapeutic).

Background: In mutilated hand reconstruction, the choice between index or little finger as the sole ulnar post to oppose a functional thumb remains controversial. This study objectively compares functional outcomes between these two configurations in basic two-digit hand. Methods: This retrospective study (2013-2020) evaluated 11 patients with a functional two-digit hand. Inclusion criteria included an uninjured thumb and the presence of only one uninjured digit serving as an ulnar post, either little finger (group 1) or index (group 2), characterised by good web space, sensate perception, painlessness and the ability to oppose each other in movement. Assessments included pinch and grip strength measurements, Jebsen-Taylor Hand Function Test (JHFT) and disabilities of arm, shoulder and hand (DASH) score. Non-parametric tests (Mann-Whitney U) compared continuous variables with significance at p < 0.05. Results: Objective testing revealed superior function in group 2 patients (index finger ulnar post) patients versus group 1 patients (JHFT: 1.39 vs. 1.91 minutes; grip: 4 vs. 1.2 kg; pinch: 2.5 vs. 0.4 kg). DASH scores favoured group 2 patients (25.2 vs. 37.4), though not statistically significant (p = 0.144). Conclusions: Our findings challenge traditional ulnar-digit preference, demonstrating the index finger provides significantly better strength and functional outcomes as the ulnar post in basic two-digit hands. These results support prioritising radial-digit reconstruction when the first web space is uncompromised, though individual patient factors and occupational demands should be considered. Level of Evidence: Level III (Therapeutic).