Journal of Hand Surgery-European Volume最新文献

Thumb amputations affect 50% of hand functionality. Common solutions consist of microsurgical treatments or silicone vacuum prosthesis. Not all patients are eligible for microsurgical treatment and the use of vacuum prosthesis is often discouraged because of their instability. On the contrary, osseointegrated prosthesis provide stable retention and osseoperception. This cadaveric study evaluated the process of a patient-matched osseointegrated prosthesis for the treatment of thumb amputees. Computed tomography (CT) medical images reconstruction provided information on metacarpal stump, used as input for the parametric screw design. Preoperative planning guided the surgeons in the surgery: postoperative placement confirmed the accuracy of the preoperative planning. Surgeons were directly involved in the implant design to meet their requirements and patient needs. Implants were inserted into cadaveric specimens in one-stage surgery. A similar process can be adopted and exploited for the treatment of different levels of thumb amputations and long finger amputations.

Level of evidence: IV.

This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss (n = 323, 62%), followed by motor deficits (n = 294, 56%) and neuropathic pain (n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage (n = 108, 6%), followed by neurolysis alone (n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.

In this prospective, randomized comparative study in patients with distal radial fractures, we aimed to determine whether surgical repair of the superficial head after anterior locking plate fixation of the radius improves clinical or functional outcomes or both, and distal radioulnar joint stability. One hundred patients were randomized to undergo distal radial fixation with or without repair of the superficial head. Twenty-one patients were lost to follow-up, leaving a final sample of 79 patients. No differences were observed between the groups in functional scores or complication after operation. Surgical repair of the superficial head of the pronator quadratus muscle after osteosynthesis with an anterior locking plate for distal radial fractures does not appear to substantially contribute to preserving distal radioulnar joint stability or improving the consolidation process.Level of evidence: II.

Anterior locking plate fixation of the distal radius is a common procedure with reliable results. Failure of fixation is sometimes seen. The aim of the present study was to identify the reasons for failure. In total, 517 cases met the study inclusion criteria. Of them, 23 cases had failure of fixation (4.4%). Failure analysis generated qualitative data. Subsequent thematic analysis identified the primary mode of failure and contributing factors. Primary modes were identified as failure to support all key fracture fragments (n = 20), wrong choice of implant (n = 1), failure of union (n = 1) and poor bone quality (n = 1). Contributing factors were errors in plate positioning, fracture reduction, implant selection and screw configuration, as well as fracture pattern complexity and poor bone quality. Most failed fixations had a primary mode and two or three contributing factors. Overall anterior plating is reliable with a low rate of surgical failure. Knowledge of failure modes will aid operative planning and prevent failure.Level of evidence: V.

The aim of this study was to assess bone healing and secondary fracture displacement after corrective osteotomy of the distal radius without any cortical contact using palmar locking plates without bone grafting. Between 2009 and 2021, 11 palmar corrective osteotomies of extra-articular malunited distal radius fractures and palmar plate fixations without the use of bone grafts and without cortical contact, were assessed. All patients showed complete osseous restoration and significant improvement in all radiographic parameters. Except for one patient, there were no secondary dislocations or loss of reduction in the postoperative follow-up. Bone grafts may not be mandatory for bone healing and prevention of secondary fracture displacement after palmar corrective osteotomy without cortical contact and fixation with palmar locking plate.Level of evidence: IV.