Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102124
Chul Ki Goorens , Kjell Van Royen , Laurens Van Melkebeke , Jean François Goubau , Jean-Michel Cognet
Periprosthetic complications after trapeziometacarpal arthroplasty mostly require revision surgery to restore function. An unstable cup in the trapezium is typically surgically managed by trapeziectomy. This report highlights a possible alternative to maintain the implant by reconstruction of the trapezium with corticocancellous autograft.
{"title":"Reconstruction of the trapezium with structural bone graft in trapeziometacarpal joint arthroplasty with cup instability","authors":"Chul Ki Goorens , Kjell Van Royen , Laurens Van Melkebeke , Jean François Goubau , Jean-Michel Cognet","doi":"10.1016/j.hansur.2025.102124","DOIUrl":"10.1016/j.hansur.2025.102124","url":null,"abstract":"<div><div>Periprosthetic complications after trapeziometacarpal arthroplasty mostly require revision surgery to restore function. An unstable cup in the trapezium is typically surgically managed by trapeziectomy. This report highlights a possible alternative to maintain the implant by reconstruction of the trapezium with corticocancellous autograft.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102124"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102095
Roberto Tedeschi
{"title":"Breaking the cycle: Addressing the drucebo effect in hand rehabilitation","authors":"Roberto Tedeschi","doi":"10.1016/j.hansur.2025.102095","DOIUrl":"10.1016/j.hansur.2025.102095","url":null,"abstract":"","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102095"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102082
Christopher A. White, Jamie L. Kator, Hannah S. Rhee, Thomas Boucher, Rachel Glenn, Amanda Walsh, Jaehon M. Kim
Background
Patients are increasingly turning to the internet, and recently artificial intelligence engines (e.g., ChatGPT), for answers to common medical questions. Regarding orthopedic hand surgery, recent literature has focused on ChatGPT’s ability to answer patient frequently asked questions (FAQs) regarding subjects such as carpal tunnel syndrome, distal radius fractures, and more. The present study seeks to determine how accurately ChatGPT can answer patient FAQs surrounding simple fracture patterns such as fifth metacarpal neck fractures.
Methods
Internet queries were used to identify the ten most FAQs regarding boxer’s fractures based on information from five trusted healthcare institutions. These ten questions were posed to ChatGPT 4.0, and the chatbot’s responses were recorded. Two fellowship trained orthopedic hand surgeons and one orthopedic hand surgery fellow then graded ChatGPT’s responses on an alphabetical grading scale (i.e., A–F); additional commentary was then provided for each response. Descriptive statistics were used to report question, grader, and overall ChatGPT response grades.
Results
ChatGPT achieved a cumulative grade of a B, indicating that the chatbot can provide adequate responses with only minor need for clarification when answering FAQs for boxer’s fractures. Individual graders provided comparable overall grades of B, B, and B+ respectively. ChatGPT deferred to a medical professional in 7/10 responses. General questions were graded at an A−. Management questions were graded at a C+.
Conclusion
Overall, with a grade of B, ChatGPT 4.0 provides adequate-to- complete responses as it pertains to patient FAQs surrounding boxer’s fractures.
{"title":"Can ChatGPT 4.0 reliably answer patient frequently asked questions about boxer’s fractures?","authors":"Christopher A. White, Jamie L. Kator, Hannah S. Rhee, Thomas Boucher, Rachel Glenn, Amanda Walsh, Jaehon M. Kim","doi":"10.1016/j.hansur.2025.102082","DOIUrl":"10.1016/j.hansur.2025.102082","url":null,"abstract":"<div><h3>Background</h3><div>Patients are increasingly turning to the internet, and recently artificial intelligence engines (e.g., ChatGPT), for answers to common medical questions. Regarding orthopedic hand surgery, recent literature has focused on ChatGPT’s ability to answer patient frequently asked questions (FAQs) regarding subjects such as carpal tunnel syndrome, distal radius fractures, and more. The present study seeks to determine how accurately ChatGPT can answer patient FAQs surrounding simple fracture patterns such as fifth metacarpal neck fractures.</div></div><div><h3>Methods</h3><div>Internet queries were used to identify the ten most FAQs regarding boxer’s fractures based on information from five trusted healthcare institutions. These ten questions were posed to ChatGPT 4.0, and the chatbot’s responses were recorded. Two fellowship trained orthopedic hand surgeons and one orthopedic hand surgery fellow then graded ChatGPT’s responses on an alphabetical grading scale (i.e., A–F); additional commentary was then provided for each response. Descriptive statistics were used to report question, grader, and overall ChatGPT response grades.</div></div><div><h3>Results</h3><div>ChatGPT achieved a cumulative grade of a B, indicating that the chatbot can provide adequate responses with only minor need for clarification when answering FAQs for boxer’s fractures. Individual graders provided comparable overall grades of B, B, and B+ respectively. ChatGPT deferred to a medical professional in 7/10 responses. General questions were graded at an A−. Management questions were graded at a C+.</div></div><div><h3>Conclusion</h3><div>Overall, with a grade of B, ChatGPT 4.0 provides adequate-to- complete responses as it pertains to patient FAQs surrounding boxer’s fractures.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102082"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102110
Pascal Ledoux
Introduction
The combination of a trapeziometacarpal prosthesis and a metacarpophalangeal arthrodesis of the thumb was formally contraindicated by JY de la Caffinière. This is a landmark notion, but no theoretical, experimental or clinical study has confirmed it. Combined indications for arthrodesis and trapeziometacarpal prosthesis are rare. Isolated arthrodesis is more common. In both cases, it is important to avoid overloading the trapeziometacarpal joint.
Aim
The aim of this study is to verify whether metacarpophalangeal arthrodesis really does increase the load on the trapeziometacarpal joint, taking into account bone shortening and the angle at which the arthrodesis is performed. The second aim is to review the literature on series of metacarpophalangeal thumb arthrodeses.
Material & Methods: We used a previously developed 2-dimensional mathematical model to calculate stresses at the trapeziometacarpal joint during a key pinch grip. We calculated stresses at constant thumb column lenght, and after 6 and 8 mm shortening to account for the bone resection required to perform arthrodesis. We also tested several levels of flexion between the metacarpal and the first phalanx in the arthrodesis situation.
Results
All other parameters being equal, we found a 118% increase in trapeziometacarpal stress after metacarpophalangeal arthrodesis. When arthrodesis is performed at 25 ° of flexion, the trapeziometacarpal stress level is comparable to the physiological situation.
Conclusions
Arthrodesis does not increase trapeziometacarpal stress when performed at 25 ° flexion. Under these conditions, metacarpophalangeal arthrodesis does not increase the risk of trapeziometacarpal osteoarthritis, and is compatible with a trapeziometacarpal prosthesis.
{"title":"Does thumb metacarpophalangeal arthrodesis increase trapeziometacarpal loading?","authors":"Pascal Ledoux","doi":"10.1016/j.hansur.2025.102110","DOIUrl":"10.1016/j.hansur.2025.102110","url":null,"abstract":"<div><h3>Introduction</h3><div>The combination of a trapeziometacarpal prosthesis and a metacarpophalangeal arthrodesis of the thumb was formally contraindicated by JY de la Caffinière. This is a landmark notion, but no theoretical, experimental or clinical study has confirmed it. Combined indications for arthrodesis and trapeziometacarpal prosthesis are rare. Isolated arthrodesis is more common. In both cases, it is important to avoid overloading the trapeziometacarpal joint.</div></div><div><h3>Aim</h3><div>The aim of this study is to verify whether metacarpophalangeal arthrodesis really does increase the load on the trapeziometacarpal joint, taking into account bone shortening and the angle at which the arthrodesis is performed. The second aim is to review the literature on series of metacarpophalangeal thumb arthrodeses.</div><div>Material & Methods: We used a previously developed 2-dimensional mathematical model to calculate stresses at the trapeziometacarpal joint during a key pinch grip. We calculated stresses at constant thumb column lenght, and after 6 and 8 mm shortening to account for the bone resection required to perform arthrodesis. We also tested several levels of flexion between the metacarpal and the first phalanx in the arthrodesis situation.</div></div><div><h3>Results</h3><div>All other parameters being equal, we found a 118% increase in trapeziometacarpal stress after metacarpophalangeal arthrodesis. When arthrodesis is performed at 25 ° of flexion, the trapeziometacarpal stress level is comparable to the physiological situation.</div></div><div><h3>Conclusions</h3><div>Arthrodesis does not increase trapeziometacarpal stress when performed at 25 ° flexion. Under these conditions, metacarpophalangeal arthrodesis does not increase the risk of trapeziometacarpal osteoarthritis, and is compatible with a trapeziometacarpal prosthesis.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102110"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102127
Stuart Cannell, Louis Charles Castel, Thomas Gregory, Romain Allard
The use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) is well documented in elective surgery but remains understudied in emergency hand surgery. The emergency setting presents distinct challenges, including preoperative pain, patient stress, and inflamed or damaged soft tissue. This study aims to evaluate the efficacy and safety of the WALANT procedure for soft tissue and bone surgery in acute hand and wrist injuries. A prospective cohort study was conducted, involving 245 hand injuries in 207 patients. Pain scores during injection were 3.7/10 for wounds and 3.8/10 for bone procedures. Pain scores during surgery were 1.6 for wounds and 2.8 for bone procedures. Over 96% of patients reported being satisfied or very satisfied with the procedure. No complications were observed. These results suggest that WALANT is a safe and well-tolerated technique for emergency hand surgery, yielding high patient satisfaction.
{"title":"Is WALANT anesthesia safe and comfortable in emergency hand surgery?","authors":"Stuart Cannell, Louis Charles Castel, Thomas Gregory, Romain Allard","doi":"10.1016/j.hansur.2025.102127","DOIUrl":"10.1016/j.hansur.2025.102127","url":null,"abstract":"<div><div>The use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) is well documented in elective surgery but remains understudied in emergency hand surgery. The emergency setting presents distinct challenges, including preoperative pain, patient stress, and inflamed or damaged soft tissue. This study aims to evaluate the efficacy and safety of the WALANT procedure for soft tissue and bone surgery in acute hand and wrist injuries. A prospective cohort study was conducted, involving 245 hand injuries in 207 patients. Pain scores during injection were 3.7/10 for wounds and 3.8/10 for bone procedures. Pain scores during surgery were 1.6 for wounds and 2.8 for bone procedures. Over 96% of patients reported being satisfied or very satisfied with the procedure. No complications were observed. These results suggest that WALANT is a safe and well-tolerated technique for emergency hand surgery, yielding high patient satisfaction.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102127"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102125
Daniel Zobrist, Andreas Schweizer, Lisa Reissner
Malunion of the distal radius with dorsal angulation reduces stability of the distal radioulnar joint. The aim of the study was to sonographically quantify the stability of the distal radioulnar joint in 20 patients following corrective osteotomy of the distal radius and to investigate the subjective and clinical results preoperatively, three and twelve months postoperatively. Sonographically measured dorsovolar ulnar head translation relative to the distal radius was significantly higher (3.6 mm) preoperatively compared to 2.9 mm three months postoperatively. Twelve months postoperatively the result was 3.2 mm, equal to the contralateral side (3.2 mm). Pain, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations, wrist flexion, radial and ulnar inclination, grip strength and pronation and supination torque improved significantly. Corrective osteotomy of the distal radius shows good subjective and clinical results and improves sonographically measured distal radioulnar joint stability.
Level of evidence
III.
{"title":"Stability of the distal radioulnar joint before and after corrective osteotomy of the distal radius","authors":"Daniel Zobrist, Andreas Schweizer, Lisa Reissner","doi":"10.1016/j.hansur.2025.102125","DOIUrl":"10.1016/j.hansur.2025.102125","url":null,"abstract":"<div><div>Malunion of the distal radius with dorsal angulation reduces stability of the distal radioulnar joint. The aim of the study was to sonographically quantify the stability of the distal radioulnar joint in 20 patients following corrective osteotomy of the distal radius and to investigate the subjective and clinical results preoperatively, three and twelve months postoperatively. Sonographically measured dorsovolar ulnar head translation relative to the distal radius was significantly higher (3.6 mm) preoperatively compared to 2.9 mm three months postoperatively. Twelve months postoperatively the result was 3.2 mm, equal to the contralateral side (3.2 mm). Pain, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Reported Wrist Evaluations, wrist flexion, radial and ulnar inclination, grip strength and pronation and supination torque improved significantly. Corrective osteotomy of the distal radius shows good subjective and clinical results and improves sonographically measured distal radioulnar joint stability.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102125"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102083
Susanne Rein , Elisabet Hagert
An ulnar nerve (UN) palsy is devastating for hand function, resulting in an intrinsic minus position or claw hand with a loss of pinch grip. Distal nerve transfers facilitate faster reinnervation of hand intrinsic muscles in cases of proximal ulnar nerve lesions. The traditional anterior interosseous nerve (AIN) to UN motor transfer is commonly used, however, this still leads to long reinnervation times for the distal intrinsic muscles, important for the thumb to index pinch grip. This study investigated the feasibility of a more distal nerve transfer, from the median thenar to the deep branch of the UN (DBUN), in six cadaveric hands. A separate branch of the median nerve to the superficial head of flexor pollicis brevis (sFPB) arose distally of the thenar branch from the common digital nerve of the thumb shortly before the bifurcation of the ulnar palmar digital nerve to the thumb in all specimens, with a mean distance to the thenar branch of 8.3 ± 5.3 mm. The sFPB motor branch had a mean length of 11.5 ± 1.5 mm. The mean distance between the division of the dorsal cutaneous branch of the UN, where the AIN to UN motor transfer is usually performed, and the transfer between the sFPB branch to the DBUN was 132 ± 11 mm. A distal nerve transfer between the median innervated motor branch to the sFPB to the DBUN shortens the reinnervation distance for the first dorsal interosseous, the adductor pollicis, and the deep head of the FPB muscles, which is a prerequisite for restoration of the pinch grip.
{"title":"Nerve transfer of the median flexor pollicis brevis branch to the deep branch of the ulnar nerve for ulnar nerve palsy: a cadaveric feasibility study","authors":"Susanne Rein , Elisabet Hagert","doi":"10.1016/j.hansur.2025.102083","DOIUrl":"10.1016/j.hansur.2025.102083","url":null,"abstract":"<div><div>An ulnar nerve (UN) palsy is devastating for hand function, resulting in an intrinsic minus position or claw hand with a loss of pinch grip. Distal nerve transfers facilitate faster reinnervation of hand intrinsic muscles in cases of proximal ulnar nerve lesions. The traditional anterior interosseous nerve (AIN) to UN motor transfer is commonly used, however, this still leads to long reinnervation times for the distal intrinsic muscles, important for the thumb to index pinch grip. This study investigated the feasibility of a more distal nerve transfer, from the median thenar to the deep branch of the UN (DBUN), in six cadaveric hands. A separate branch of the median nerve to the superficial head of flexor pollicis brevis (sFPB) arose distally of the thenar branch from the common digital nerve of the thumb shortly before the bifurcation of the ulnar palmar digital nerve to the thumb in all specimens, with a mean distance to the thenar branch of 8.3 ± 5.3 mm. The sFPB motor branch had a mean length of 11.5 ± 1.5 mm. The mean distance between the division of the dorsal cutaneous branch of the UN, where the AIN to UN motor transfer is usually performed, and the transfer between the sFPB branch to the DBUN was 132 ± 11 mm. A distal nerve transfer between the median innervated motor branch to the sFPB to the DBUN shortens the reinnervation distance for the first dorsal interosseous, the adductor pollicis, and the deep head of the FPB muscles, which is a prerequisite for restoration of the pinch grip.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102083"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102093
Ranaivoson Manitra O.I. , Manassé Herijaona R. , Anesy Anselme A.C. , Lazasoa S.D. , Bozon Olivier , Daoulas Thomas
We report a case of CAF in the hand of a young adult woman. This patient’s age exceeded the usual range for CAF. While surgical excision led to fifth digit stiffness and bowstringing, further diagnostic delays could have resulted in much worse outcomes due to tumor invasion of the tendons. This case suggests reevaluating the upper age limit for diagnosis and considering CAF in adults with suggestive clinical features.
{"title":"Calcifying aponeurotic fibroma of the hand in an adult","authors":"Ranaivoson Manitra O.I. , Manassé Herijaona R. , Anesy Anselme A.C. , Lazasoa S.D. , Bozon Olivier , Daoulas Thomas","doi":"10.1016/j.hansur.2025.102093","DOIUrl":"10.1016/j.hansur.2025.102093","url":null,"abstract":"<div><div>We report a case of CAF in the hand of a young adult woman. This patient’s age exceeded the usual range for CAF. While surgical excision led to fifth digit stiffness and bowstringing, further diagnostic delays could have resulted in much worse outcomes due to tumor invasion of the tendons. This case suggests reevaluating the upper age limit for diagnosis and considering CAF in adults with suggestive clinical features.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102093"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102109
Maxence Liot , Dominique Le Nen
Proximal phalanx condylar lesions are well known injuries. Total condylar defect, however, is an exceptional therapeutic challenge. We report the case of a 19-year-old male who sustained complex hand trauma following a circular saw accident, including a lesion that destroyed the entire lateral condyle of the middle finger’s proximal phalanx. A custom-made non-vascularized composite graft taken from the second toe proved to be a viable option for reconstruction not only of the condyle but also of the lateral ligaments and part of the extensor system. At 1-year follow-up, results were very satisfactory, and the patient had resumed his work as a carpenter 6 months after surgery.
{"title":"Custom-made non-vascularized toe-to-finger graft for proximal phalanx condyle reconstruction","authors":"Maxence Liot , Dominique Le Nen","doi":"10.1016/j.hansur.2025.102109","DOIUrl":"10.1016/j.hansur.2025.102109","url":null,"abstract":"<div><div>Proximal phalanx condylar lesions are well known injuries. Total condylar defect, however, is an exceptional therapeutic challenge. We report the case of a 19-year-old male who sustained complex hand trauma following a circular saw accident, including a lesion that destroyed the entire lateral condyle of the middle finger’s proximal phalanx. A custom-made non-vascularized composite graft taken from the second toe proved to be a viable option for reconstruction not only of the condyle but also of the lateral ligaments and part of the extensor system. At 1-year follow-up, results were very satisfactory, and the patient had resumed his work as a carpenter 6 months after surgery.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102109"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hansur.2025.102114
Géraldine Lautenbach , Andreas Schweizer , Tobias Götschi , Raffael Labèr
A total of 124 scaphoid nonunion surgical procedures performed between 2002 and 2020 were analyzed to investigate the potential impact of delayed diagnosis on time to union. The primary outcome was the correlation between the time from injury to surgery and the time to union. Secondary outcomes included identifying risk factors for delayed union and persistent nonunion following scaphoid nonunion surgery.
The analysis revealed that time to union was similar for surgeries performed between 6 months and over 2 years post-injury. However, nonunion persisted in 12 cases, five of which involved surgeries conducted more than 2 years after the injury. Further investigation into secondary outcomes showed that fractures in the proximal third of the scaphoid took 1.4–1.5 times longer to unite compared to fractures in the middle and distal thirds. Additionally, fractures without trabecular bone required approximately twice as long to heal.
In conclusion, surgical intervention performed between 6 months and over 2 years after injury generally offers a favorable outcome for healing. However, when surgery is delayed beyond 2 years, the risk of persistent nonunion increases.
{"title":"The role of surgical timing in 124 scaphoid nonunion surgical procedures","authors":"Géraldine Lautenbach , Andreas Schweizer , Tobias Götschi , Raffael Labèr","doi":"10.1016/j.hansur.2025.102114","DOIUrl":"10.1016/j.hansur.2025.102114","url":null,"abstract":"<div><div>A total of 124 scaphoid nonunion surgical procedures performed between 2002 and 2020 were analyzed to investigate the potential impact of delayed diagnosis on time to union. The primary outcome was the correlation between the time from injury to surgery and the time to union. Secondary outcomes included identifying risk factors for delayed union and persistent nonunion following scaphoid nonunion surgery.</div><div>The analysis revealed that time to union was similar for surgeries performed between 6 months and over 2 years post-injury. However, nonunion persisted in 12 cases, five of which involved surgeries conducted more than 2 years after the injury. Further investigation into secondary outcomes showed that fractures in the proximal third of the scaphoid took 1.4–1.5 times longer to unite compared to fractures in the middle and distal thirds. Additionally, fractures without trabecular bone required approximately twice as long to heal.</div><div>In conclusion, surgical intervention performed between 6 months and over 2 years after injury generally offers a favorable outcome for healing. However, when surgery is delayed beyond 2 years, the risk of persistent nonunion increases.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102114"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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