Hand Surgery & Rehabilitation最新文献

Emerging advances in immersive virtual reality incorporating optical hand-tracking present promising potential for application in orthopedic hand therapy. The system is designed to analyze hand movements, enabling users to “use” their hands virtually in any fabricated setting. This article, supplemented with videos, examines practical applications of immersive virtual reality in routine hand therapy and provides a scientific presentation of the interaction of immersive virtual reality with our physiological and neurological systems. Indications for immersive virtual reality use, critical evaluations and recommendations are comprehensively discussed. Immersive virtual reality has the potential to evolve into a standard treatment modality in orthopedic hand therapy.

Introduction

Since the introduction of the non-vascularized bone graft by Matti and Russe, followed by vascularized grafts and more recently by free vascularized bone grafts, the choice of technique in scaphoid non-union has been controversial. The purpose of the present study was to address the following questions in an umbrella review: Do union rates differ between techniques? Is there any evidence that one technique is superior to another?

Methods

An umbrella review conducted during September 2023 month included systematic reviews and meta-analyses. The primary criterion was mean union rate according to technique. The secondary criterion was indication according to type of non-union. The PubMed, Cochrane, and MEDLINE databases were searched using a predefined methodology according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA version 2020). The quality of the systematic reviews included was evaluated by the “Assessing the Methodological Quality of Systematic Reviews” instrument (AMSTAR 2).

Results

Nine studies (systematic reviews or meta-analyses) were included. Quality ranged between low and high. A Table was constructed to summarize the qualitative findings of each article. There was no significant difference in union rates between vascularized and non-vascularized bone grafts in 8 of the 9 studies: vascularized bone graft, 84–92%; non-vascularized bone graft, 80–88%. One study found higher union rates with vascularized bone graft (RR 1.1; 95% CI 1.0–1.2; P = 0.02), but no significant difference in functional results. However, vascularized bone graft was more effective in case of avascular necrosis of the proximal pole (74–88% union for vascularized bone graft vs. 47–62% for non-vascularized bone graft) and in revision cases, while non-vascularized bone graft showed fewer failures in case of humpback deformity and/or dorsal intercalated segment instability (IRR 0.7 ± 0.09; P = 0.01).

Conclusions

This umbrella review provides an overview for management of scaphoid non-union. There were no significant global differences between techniques. Thus, various factors need to be considered when selecting the appropriate technique.

Objectives

The choice of surgical technique for aponeurectomy in Dupuytren’s disease is controversial due to varying outcomes and complication rates. The Malingue plasty has shown mathematical and mechanical advantages, but long-term efficacy and results compared to other techniques have never been reported.

This study aimed to evaluate the long-term functional, esthetic and recurrence outcomes of Malingue plasty in Dupuytren's disease.

Material and methods

The study included patients who underwent aponeurectomy with Malingue plasty performed by a highly experienced surgeon between January 2014 and December 2016, with a minimum follow-up of 5 years. Preoperative records were analyzed. At follow-up, extension lag was analyzed in each joint (metacarpophalangeal, proximal interphalangeal and distal interphalangeal) in each operated finger, as well as signs of recurrence or extension of the disease. Function and esthetics were assessed using the QuickDASH (Disabilities of the Arm, Shoulder and Hand) questionnaire and the Michigan Hand Outcomes Questionnaire.

Results

Out of 107 eligible patients, 55 were included in the study after exclusions and loss to follow-up. Three patients required revision surgery for recurrence during follow-up. All preoperative deformities of the proximal interphalangeal and metacarpophalangeal joints were corrected postoperatively, and no intraoperative or postoperative complications occurred. Mean extension deficit at follow-up was 18.1 °. Only the little finger showed significant loss of correction (p = 0.02). Mean QuickDASH score was 13.2 and the overall Michigan Hand Outcomes Questionnaire score was 91.8%. Recurrence affected 50% of patients according to the Leclercq criteria and 27.5% according to the Felici criteria.

Conclusion

Although Malingue plasty did not improve the recurrence rate in Dupuytren's disease compared with other techniques, its advantages in terms of functional improvement and complications make it an interesting surgical option.

Introduction

The proximal regions of the brachial plexus (roots, trunks) are more susceptible to permanent damage due to stretch injuries than the distal regions (cords, terminal branches). A better description of brachial plexus mechanical behavior is necessary to better understand deformation mechanisms in stretch injury.

The purpose of this study was to model the biomechanical behavior of each portion of the brachial plexus (roots, trunks, cords, peripheral nerves) in a cadaveric model and report differences in elastic modulus, maximum stress and maximum strain.

Methods

Eight cadaveric plexi, divided into 47 segments according to regions of interest, underwent cyclical uniaxial tensile tests, using a BOSE® Electroforce® 3330 and INSTRON® 5969 material testing machines, to obtain the stress and strain histories of each specimen.

Maximum stress, maximum strain and elastic modulus were extracted from the load–displacement and stress–strain curves.

Statistical analyses used 1-way ANOVA with post-hoc Tukey HSD (Honestly Significant Difference) and Mann-Whitney tests.

Results

Mean elastic modulus was 8.65 MPa for roots, 8.82 MPa for trunks, 22.44 MPa for cords, and 26.43 MPa for peripheral nerves. Differences in elastic modulus and in maximum stress were statistically significant (p < 0.001) between proximal (roots, trunks) and distal (cords, peripheral nerves) specimens.

Conclusions

Proximal structures demonstrated significantly smaller elastic modulus and maximum stress than distal structures. These data confirm the greater fragility of proximal regions of the brachial plexus.

Introduction

Despite the progress in microsurgery in recent decades, neurovascular bundle defects during ring finger injuries still pose challenges for the surgeon. Usually, a reversed venous graft and a non-vascularized nerve graft are utilized to reconstruct this defect. One of the most common challenges encountered when using a venous graft is the caliber mismatch between the graft and the digital arterial ends. The use of an arterialized nerve graft (neurovascular graft) is poorly described and could represent an attractive reconstructive option.

Case presentation

We present the case of a 36-year-old manual worker, a non-smoker, with no significant medical or surgical comorbidities, who presented a ring avulsion type trauma, leading to the amputation of the third left finger at the distal interphalangeal joint and avulsion of the circumferential skin at the level of the middle and proximal phalanges (Urbaniak III).

The patient presented a neurovascular bundle defect of 3 cm, reconstructed by the vascularized posterior interosseous nerve graft along the distal perforator of the dorsal branch of the anterior interosseous artery serving both as an interpositional arterial conduit and as a nerve graft. The results of postoperative nerve regeneration at three years are satisfactory, with the patient demonstrating a two-point discrimination measured at 6 mm.

Conclusion

Simultaneous digital artery and nerve reconstruction using a neurovascular flap is very appealing to the hand surgeon as it offers several advantages over traditional methods, particularly the ideal diameter match between the digital arteries and the distal perforator of the dorsal branch of the anterior interosseous artery.

Metal hypersensitivity is a rare and often underestimated complication, as shown by the small number of published studies, particularly concerning the upper limbs and the hand. However, the increase in the annual number of trapeziometacarpal arthroplasties underlines the importance of better understanding of this problem.

We performed a study based on data from the revision of trapeziometacarpal prostheses to assess the incidence of this complication and to define a sequence of radiological changes to detect metal hypersensitivity.

This single-center retrospective study included 37 patients operated on between January 2014 and November 2023 for revision of trapeziometacarpal prosthesis. Ten (27%) had no clearly identified cause of failure.

For these 10 patients, we analyzed clinical data and postoperative X-rays. In the 11 revision arthroplasties, 2 patients had no symptoms or radiographic signs suggestive of allergy. Six patients had a-posteriori diagnosis established by allergy testing, which also identified 2 additional patients, for a total of 8 patients (21% of the initial cohort). In these cases, there was systematic metaphyseal osteolysis of the first metacarpal between 15 days and 1 month after implantation. Clinically, most patients had an asymptomatic period of 2 weeks to 1 month before onset of symptoms and osteolysis, often accompanied by local inflammation.

This study found a reproducible pattern of progression, characterized by the appearance of radiographic signs of osteolysis in the first month, followed by clinical deterioration. Although this course is strongly suggestive of a metal hypersensitivity, it is crucial not to exclude the possibility of an infectious cause, which should always be considered.

Introduction

Peripheral nerves consist of axons and connective tissue. The amount of connective tissue in peripheral nerves such as the brachial plexus varies proximally to distally. The proximal regions of the brachial plexus are more susceptible to stretch injuries than the distal regions. A description of the mechanical behavior of the peripheral nerve components is necessary to better understand the deformation mechanisms during stretch injuries.

The purpose of this study was to model the biomechanical behavior of each component of the peripheral nerves (fascicles, connective tissue) in a cadaveric model and report differences in elastic modulus, maximum stress and maximum strain.

Methods

Forty-six specimens of fascicles and epi-perineurium were subjected to cyclical uniaxial tensile tests to obtain the stress and strain histories of each specimen, using a BOSE® Electroforce® 3330 and INSTRON® 5969 materials testing machines.

Maximum stress, maximum strain and elastic modulus were extracted from the load–displacement and stress–strain curves, and analyzed using Mann-Whitney tests.

Results

Mean elastic modulus was 6.34 MPa for fascicles, and 32.1 MPa for connective tissue. The differences in elastic modulus and maximum stress between fascicles and connective tissue were statistically significant (p < 0.001).

Conclusions

Peripheral nerve connective tissue showed significantly higher elastic modulus and maximum stress than fascicles. These data confirm the greater fragility of axons compared to connective tissue, suggesting that the greater susceptibility to stretch injury in proximal regions of the brachial plexus might be related to the smaller amount of connective tissue.

Background

Type-2 diabetes influences the course and severity of hand infections.

Methods

We prospectively examined glucose metabolism in 90 patients with hand infection, distinguishing between normal, prediabetic and diabetic states. HbA1c-levels were evaluated prior to surgery. Patients with normal levels took an oral glucose tolerance test and those diagnosed with prediabetes were retested after the infection subsided. Hospital stay, number of surgical interventions and inflammatory markers were examined per group.

Results

Sixty-two patients (68.8%) had abnormal glucose metabolism: 17 (18.9%) with history of diabetes and 11 (12.2%) newly diagnosed. Prediabetes was observed in 34 patients (37.8%). At follow-up, prediabetes and diabetes were diagnosed in 7 cases each, and physiological glucose metabolism was observed in 3 patients. For the 11 patients unable to undergo a second oral glucose tolerance test, detailed phone calls confirmed absence of diabetes. C-reactive protein levels were significantly elevated in diabetic patients compared to those with normal glucose metabolism (p = 0.001) or prediabetes (p = 0.034). Patients with history of diabetes were significantly older than those with normal glucose tolerance (p = 0.001) or prediabetes (p = 0.017). There were no significant intergroup differences in thrombocyte count, length of hospital stay, interval from injury to admission or the number surgical interventions.

Conclusion

Glucose metabolism should be assessed in patients with hand infections and reassessed after the infection has subsided in prediabetic cases.

Objectives

De Quervain’s tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain’s tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy.

Methods

We reviewed a series of 331 trapeziometacarpal prostheses.

Results

There were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain’s tendinitis and those who did not. However, the frequency of De Quervain’s tendinitis was much higher after arthroplasty than trapeziectomy.

Conclusions

We believe that the preoperative frequency of De Quervain’s tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis.

Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.