Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2024.10.019
Sanjeev Kakar MD, FAOA , Sean Cantwell MD , Greg Couzens MD , Nick Smith MD , Mark Ross MD
Debate persists about the optimal surgical management of scapholunate dissociation. Many contemporary techniques address both the injured scapholunate ligament as well as the capsuloligamentous stabilizers necessary to prevent carpal instability and collapse. Here, we present a technique to reinforce or plicate the long radiolunate ligament, a critical stabilizer to the carpus. Arthroscopic-assisted long radiolunate ligament capsulodesis may be considered in the treatment algorithm for scapholunate dissociation.
{"title":"Minimally Invasive Radiolunate Imbrication Neutralization (MIRLIN) Procedure","authors":"Sanjeev Kakar MD, FAOA , Sean Cantwell MD , Greg Couzens MD , Nick Smith MD , Mark Ross MD","doi":"10.1016/j.jhsa.2024.10.019","DOIUrl":"10.1016/j.jhsa.2024.10.019","url":null,"abstract":"<div><div>Debate persists about the optimal surgical management of scapholunate dissociation. Many contemporary techniques address both the injured scapholunate ligament as well as the capsuloligamentous stabilizers necessary to prevent carpal instability and collapse. Here, we present a technique to reinforce or plicate the long radiolunate ligament, a critical stabilizer to the carpus. Arthroscopic-assisted long radiolunate ligament capsulodesis may be considered in the treatment algorithm for scapholunate dissociation.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 385.e1-385.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism.
Methods
We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism.
Results
The mean active flexion and extension of the PIP joint was 105° and −4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request.
Conclusions
The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints.
{"title":"The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint","authors":"Tatsuya Hara PhD , Toshikazu Kurahashi PhD , Yutaro Kuwahara MD , Masahiro Tatebe PhD , Takeshi Oguchi PhD , Shrio Urata MD","doi":"10.1016/j.jhsa.2023.09.004","DOIUrl":"10.1016/j.jhsa.2023.09.004","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism.</div></div><div><h3>Methods</h3><div>We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism.</div></div><div><h3>Results</h3><div>The mean active flexion and extension of the PIP joint was 105° and −4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request.</div></div><div><h3>Conclusions</h3><div>The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 381.e1-381.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2024.11.014
Merel J.-L. Berkhout MD, MA , Johannes G.G. Dobbe PhD , Paul W.M. Wilmer MD , Geert J. Streekstra PhD, MEng , Marco J.P.F. Ritt MD, PhD
Purpose
This observational pilot study investigated (1) carpal positioning in the neutral wrist pose, (2) the scapholunate (SL) rotation axis, (3) physiological SL motion, and (4) the SL distance after combined palmar and dorsal SL ligament reconstruction using quantitative four-dimensional computed tomography (4D-CT) imaging.
Methods
Six subjects were included, and 4D-CT images of both wrists were obtained. Kinematic parameters of the treated side were compared to those of the healthy contralateral side, which was used as the normal reference.
Results
Average follow-up was 18.3 months (range, 8–35). After surgery, an average residual rotational deviation of the scaphoid (10.0° flexion, 8.1° radial deviation, 7.1° pronation) and lunate (17.5° extension) at neutral position of the wrist was observed compared with the contralateral side. Scapholunate motion followed that of the healthy wrists, whereas SL motion of one untreated affected wrist deviated from normal. Scapholunate distance was on average 1.3 mm larger than in the healthy wrists during flexion-extension and radioulnar deviation.
Conclusions
Combined palmar and dorsal SL ligament reconstruction seems to restore wrist kinematics, although the neutral position of the scaphoid and lunate are not restored to normal.
Type of study/level of evidence
Therapeutic V.
{"title":"Scapholunate Kinematics After Combined Palmar and Dorsal Ligament Reconstruction: A Quantitative Evaluation Using Four-Dimensional Computed Tomography","authors":"Merel J.-L. Berkhout MD, MA , Johannes G.G. Dobbe PhD , Paul W.M. Wilmer MD , Geert J. Streekstra PhD, MEng , Marco J.P.F. Ritt MD, PhD","doi":"10.1016/j.jhsa.2024.11.014","DOIUrl":"10.1016/j.jhsa.2024.11.014","url":null,"abstract":"<div><h3>Purpose</h3><div>This observational pilot study investigated (1) carpal positioning in the neutral wrist pose, (2) the scapholunate (SL) rotation axis, (3) physiological SL motion, and (4) the SL distance after combined palmar and dorsal SL ligament reconstruction using quantitative four-dimensional computed tomography (4D-CT) imaging.</div></div><div><h3>Methods</h3><div>Six subjects were included, and 4D-CT images of both wrists were obtained. Kinematic parameters of the treated side were compared to those of the healthy contralateral side, which was used as the normal reference.</div></div><div><h3>Results</h3><div>Average follow-up was 18.3 months (range, 8–35). After surgery, an average residual rotational deviation of the scaphoid (10.0° flexion, 8.1° radial deviation, 7.1° pronation) and lunate (17.5° extension) at neutral position of the wrist was observed compared with the contralateral side. Scapholunate motion followed that of the healthy wrists, whereas SL motion of one untreated affected wrist deviated from normal. Scapholunate distance was on average 1.3 mm larger than in the healthy wrists during flexion-extension and radioulnar deviation.</div></div><div><h3>Conclusions</h3><div>Combined palmar and dorsal SL ligament reconstruction seems to restore wrist kinematics, although the neutral position of the scaphoid and lunate are not restored to normal.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 320-330"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2023.09.006
Abraham Bankole MD , Raul Tejada BSA , David Ring MD, PhD , Sina Ramtin MD
Purpose
Pain after minor hand surgery can be misinterpreted as a problem. The sense that something may be wrong intensifies the pain. Some surgeons anticipate these feelings and call patients the evening or day after surgery to guide them through the recovery process. A study of routine, next day, postoperative phone calls can help determine the frequency of concerns and associated factors. We asked: 1) What factors are associated with concern the day after office hand surgery? 2) What factors are associated with pain intensity, satisfaction with care, and patient’s perceived recovery trajectory the day after office hand surgery?
Methods
In a cross-sectional study, 82 patients who had office hand and upper extremity surgery completed a survey recording age, gender, insurance, income level, measures of symptoms of depression and anxiety, a measure of catastrophic thinking regarding pain, 10-point ordinal ratings of pain intensity and satisfaction with care, whether the patient was concerned about their hand (yes or no) and whether they felt their recovery was on track (yes or no).
Results
Ten patients (12%) were concerned about their hand. In bivariate analysis, concern the day after surgery was associated with greater catastrophic thinking and male gender. Greater pain intensity was associated with greater catastrophic thinking. There was insufficient variation in satisfaction or a sense that recovery was on track for a meaningful analysis.
Conclusions
The finding that concerns were common the day after minor office hand surgery supports the practice of contacting patients for support and helping to reorient unhelpful catastrophic thoughts.
{"title":"Factors Associated With Concerns the Day After Office Hand Surgery","authors":"Abraham Bankole MD , Raul Tejada BSA , David Ring MD, PhD , Sina Ramtin MD","doi":"10.1016/j.jhsa.2023.09.006","DOIUrl":"10.1016/j.jhsa.2023.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Pain after minor hand surgery can be misinterpreted as a problem. The sense that something may be wrong intensifies the pain. Some surgeons anticipate these feelings and call patients the evening or day after surgery to guide them through the recovery process. A study of routine, next day, postoperative phone calls can help determine the frequency of concerns and associated factors. We asked: 1) What factors are associated with concern the day after office hand surgery? 2) What factors are associated with pain intensity, satisfaction with care, and patient’s perceived recovery trajectory the day after office hand surgery?</div></div><div><h3>Methods</h3><div>In a cross-sectional study, 82 patients who had office hand and upper extremity surgery completed a survey recording age, gender, insurance, income level, measures of symptoms of depression and anxiety, a measure of catastrophic thinking regarding pain, 10-point ordinal ratings of pain intensity and satisfaction with care, whether the patient was concerned about their hand (yes or no) and whether they felt their recovery was on track (yes or no).</div></div><div><h3>Results</h3><div>Ten patients (12%) were concerned about their hand. In bivariate analysis, concern the day after surgery was associated with greater catastrophic thinking and male gender. Greater pain intensity was associated with greater catastrophic thinking. There was insufficient variation in satisfaction or a sense that recovery was on track for a meaningful analysis.</div></div><div><h3>Conclusions</h3><div>The finding that concerns were common the day after minor office hand surgery supports the practice of contacting patients for support and helping to reorient unhelpful catastrophic thoughts.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 383.e1-383.e5"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2024.12.002
Scott D. Lifchez MD, FACS
{"title":"Surgical Treatment of Thumb Basal Joint Arthritis: From Eaton’s Tendon Interposition to Denervation","authors":"Scott D. Lifchez MD, FACS","doi":"10.1016/j.jhsa.2024.12.002","DOIUrl":"10.1016/j.jhsa.2024.12.002","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 350-351"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2024.12.004
Soun Sheen MD , David Speach MD , Courtney M.C. Jones MPH, PhD , Mattie E. Raiford MD , Warren C. Hammert MD
Purpose
Our goal was to determine the association between the severity of electrodiagnostic (EDX) studies with the cross-sectional area (CSA) of the ulnar nerve at the cubital tunnel using diagnostic ultrasound. Based on our clinical experience, we hypothesized there would not be a positive correlation between the severity of EDX and ulnar nerve CSA.
Methods
This was a retrospective analysis of patients 18 years or older evaluated from May 1, 2020, to June 31, 2021, referred for an upper limb EDX and neuromuscular ultrasound to evaluate for an upper limb neuropathy. History, physical examination, ultrasound imaging (ulnar nerve at elbow), and EDX were reviewed. Patients were excluded for age under 18 years or concomitant upper limb radiculopathy. Baseline sample characteristics were analyzed, including age, race, sex, ethnicity, body mass index (normal, overweight, obese, or morbid obesity), and smoking status.
Results
Of 1,043 patients, there were more females than males (634 vs 409) with an average age (SD) of 54.0 (15.5). Most of the patients were White (863) compared to Black (113) and other races (67). The average CSA of the ulnar nerve at the elbow increased with increased severity based on EDX results. There was a significant association between increasing severity on EDX and the increased nerve CSA at the elbow.
Conclusions
We found a positive association between the EDX severity and the CSA of the ulnar nerve on diagnostic ultrasound at the cubital tunnel. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow.
Type of study/level of evidence
Prognostic II.
目的：我们的目的是确定电诊断（EDX）研究的严重程度与肘管处尺神经横截面积（CSA）之间的关系。根据我们的临床经验，我们假设EDX的严重程度与尺神经CSA之间没有正相关。方法：回顾性分析2020年5月1日至2021年6月31日期间接受上肢EDX和神经肌肉超声检查以评估上肢神经病变的18岁及以上患者。回顾病史、体格检查、超声成像（肘部尺神经）和EDX。排除年龄在18岁以下或伴有上肢神经根病的患者。分析基线样本特征，包括年龄、种族、性别、民族、体重指数（正常、超重、肥胖或病态肥胖）和吸烟状况。结果：1043例患者中，女性多于男性（634 vs 409），平均年龄（SD）为54.0（15.5）。多数患者为白人（863），黑人（113）和其他种族（67）。根据EDX结果，肘部尺神经的平均CSA随着严重程度的增加而增加。EDX严重程度的增加与肘部神经CSA的增加之间存在显著关联。结论：我们发现EDX的严重程度与肘管超声诊断的尺神经CSA呈正相关。随着肘部尺神经病变严重程度的增加，肘部尺神经的CSA也相应增加。研究类型/证据水平：预后II。
{"title":"Association of Ultrasound and Electrodiagnostic Studies in Patients Evaluated for Ulnar Neuropathy","authors":"Soun Sheen MD , David Speach MD , Courtney M.C. Jones MPH, PhD , Mattie E. Raiford MD , Warren C. Hammert MD","doi":"10.1016/j.jhsa.2024.12.004","DOIUrl":"10.1016/j.jhsa.2024.12.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Our goal was to determine the association between the severity of electrodiagnostic (EDX) studies with the cross-sectional area (CSA) of the ulnar nerve at the cubital tunnel using diagnostic ultrasound. Based on our clinical experience, we hypothesized there would not be a positive correlation between the severity of EDX and ulnar nerve CSA.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients 18 years or older evaluated from May 1, 2020, to June 31, 2021, referred for an upper limb EDX and neuromuscular ultrasound to evaluate for an upper limb neuropathy. History, physical examination, ultrasound imaging (ulnar nerve at elbow), and EDX were reviewed. Patients were excluded for age under 18 years or concomitant upper limb radiculopathy. Baseline sample characteristics were analyzed, including age, race, sex, ethnicity, body mass index (normal, overweight, obese, or morbid obesity), and smoking status.</div></div><div><h3>Results</h3><div>Of 1,043 patients, there were more females than males (634 vs 409) with an average age (SD) of 54.0 (15.5). Most of the patients were White (863) compared to Black (113) and other races (67). The average CSA of the ulnar nerve at the elbow increased with increased severity based on EDX results. There was a significant association between increasing severity on EDX and the increased nerve CSA at the elbow.</div></div><div><h3>Conclusions</h3><div>We found a positive association between the EDX severity and the CSA of the ulnar nerve on diagnostic ultrasound at the cubital tunnel. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 259-264"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2024.08.016
Nikhil Gopal MBBS , Abhijith Anil MBBS, MS , Meera Gopal MBBS , Anil K. Bhat MBBS, MS
Purpose
Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs.
Methods
We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications.
Results
Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups.
Conclusions
Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study’s limitations.
Type of study/level of evidence
Therapy/Prevention, Etiology/Harm II.
目的：使用 Kirschner 钢丝进行经皮固定和使用外侧锁定钢板进行切开复位内固定是治疗桡骨远端骨折（DRF）最常用的手术技术。由于这两种技术的优越性尚未确定，我们旨在开展一项最新的系统性综述，对这两种技术进行比较，以优化不稳定桡骨远端骨折的治疗：我们进行了全面的文献检索，以确定对使用 Kirschner 钢丝治疗和使用外侧锁定钢板治疗的 DRFs 固定效果进行比较的研究。仅纳入了随机对照试验（RCT）。修订后的 Cochrane 偏倚风险工具用于评估 RCT 的方法学质量。仅对三项或三项以上随机对照试验在相同时间点使用相同指标报告的结果指标进行了 Meta 分析。评估的结果包括手臂、肩部和手部残疾（DASH）评分、握力、腕部活动范围和放射学结果。我们还评估了患者评定的腕部评估（PRWE）评分和并发症的发生率：荟萃分析共纳入了 14 项研究，2226 名患者。在所有时间点上，钢板组的 DASH 评分都明显较低。在随访一年以上时，PRWE结果更倾向于固定组。两组在放射学结果或并发症发生率方面无明显差异：结论：尽管在术后1年，钢板组的功能结果略好于K线组，但K线组仍然是一个可行的替代方案。由于所纳入的研究性临床试验存在固有的差异性，因此应谨慎解释所报告的差异。要在所有年龄组和骨折类型中推广我们的结果，就必须进行具有严格纳入标准和标准术后方案的高质量研究，以克服我们研究的局限性：治疗/预防，病因/危害 II.
{"title":"A Comparison Between Volar Locking Plates and Percutaneous Pinning in the Treatment of Distal Radius Fractures: A Systematic Review","authors":"Nikhil Gopal MBBS , Abhijith Anil MBBS, MS , Meera Gopal MBBS , Anil K. Bhat MBBS, MS","doi":"10.1016/j.jhsa.2024.08.016","DOIUrl":"10.1016/j.jhsa.2024.08.016","url":null,"abstract":"<div><h3>Purpose</h3><div>Percutaneous fixation with Kirschner wires and open reduction and internal fixation with volar locking plates are the most common surgical techniques for managing distal radius fractures (DRFs). As the superiority of either technique is yet to be established, we aimed to conduct an updated systematic review to compare these techniques for the optimal management of unstable DRFs.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive literature search to identify studies comparing fixation outcomes for DRFs between groups treated with Kirschner wires and those treated with volar locking plates. Only randomized controlled trials (RCTs) were included. The revised Cochrane risk-of-bias tool was used to assess the methodological quality of RCTs. Meta-analyses were performed only on outcome measures that were reported at the same time points using the same metrics across three or more RCTs. Evaluated outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, wrist range of motion, and radiological outcomes. We also assessed the Patient-Rated Wrist Evaluation (PRWE) score and incidence of complications.</div></div><div><h3>Results</h3><div>Fourteen RCTs with 2,226 patients were included in the meta-analysis. DASH scores were significantly lower in the plating group at all time points. PRWE outcomes favored the plating group at follow-ups greater than 1 year. There were no significant differences in radiological outcomes or incidence of complications between the two groups.</div></div><div><h3>Conclusions</h3><div>Although the plating group provided marginally better functional outcomes at 1 year after surgery, the K-wire group remained a viable alternative. The reported differences should be interpreted cautiously because of the inherent variability of the included RCTs. High-quality RCTs with strict inclusion criteria and standard postoperative protocols are essential to generalize our results across all age groups and fracture types to overcome our study’s limitations.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapy/Prevention, Etiology/Harm II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 265-273"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2025.01.027
{"title":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2025.01.027","DOIUrl":"10.1016/j.jhsa.2025.01.027","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Page 362"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to examine the surgical outcomes of double free muscle transfer (DFMT) performed in patients with complete brachial plexus injury (BPI).
Methods
We retrospectively analyzed the outcomes of DFMT for 12 patients with complete BPI who were followed up for more than 2 years after the final muscle transplantation. Their mean age was 29 years (range, 18–41). Three patients underwent contralateral C7 nerve root transfer before the DFMT. The range of motion (ROM) of the shoulder, elbow, and fingers was measured. Patient-reported outcome measures, including Disability of the Shoulder, Arm, and Hand (DASH) scores and visual analog scale (VAS) scores for pain, were also examined.
Results
The mean shoulder ROM against gravity was 22° ± 8° in abduction and 33° ± 5° in flexion. Seven patients underwent phrenic nerve (PhN) transfer to the suprascapular nerves, and five exhibited asymptomatic lung impairment on spirography more than 2 years after PhN transfer. The mean elbow ROM against gravity was 111° ± 9° in flexion and –32° ± 7° in extension. All patients obtained elbow flexion >90° against a 0.5-kg weight. All patients obtained touch sensation and two recognized warm and cold sensations in the affected palm. The mean total active motion of the affected fingers was 44° ± 11°. All patients exhibited hook function of the hands. The mean preoperative and postoperative DASH scores were 70.3 ± 13.4 and 51.8 ± 15.9, respectively. The mean pain VAS score was 28 ± 31 at the final follow-up.
Conclusions
Double free muscle transfer provided patients with complete brachial plexus palsy with good elbow flexion and hand hook functions.
{"title":"Treatment of Complete Brachial Plexus Injuries Using Double Free Muscle Transfer","authors":"Ryosuke Kakinoki MD, PhD , Kazuhiro Ohtani MD, PhD , Souichi Ohta MD, PhD , Ryosuke Ikeguchi MD, PhD , Masao Akagi MD, PhD , Koji Goto MD, PhD","doi":"10.1016/j.jhsa.2023.09.005","DOIUrl":"10.1016/j.jhsa.2023.09.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to examine the surgical outcomes of double free muscle transfer (DFMT) performed in patients with complete brachial plexus injury (BPI).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the outcomes of DFMT for 12 patients with complete BPI who were followed up for more than 2 years after the final muscle transplantation. Their mean age was 29 years (range, 18–41). Three patients underwent contralateral C7 nerve root transfer before the DFMT. The range of motion (ROM) of the shoulder, elbow, and fingers was measured. Patient-reported outcome measures, including Disability of the Shoulder, Arm, and Hand (DASH) scores and visual analog scale (VAS) scores for pain, were also examined.</div></div><div><h3>Results</h3><div>The mean shoulder ROM against gravity was 22° ± 8° in abduction and 33° ± 5° in flexion. Seven patients underwent phrenic nerve (PhN) transfer to the suprascapular nerves, and five exhibited asymptomatic lung impairment on spirography more than 2 years after PhN transfer. The mean elbow ROM against gravity was 111° ± 9° in flexion and –32° ± 7° in extension. All patients obtained elbow flexion >90° against a 0.5-kg weight. All patients obtained touch sensation and two recognized warm and cold sensations in the affected palm. The mean total active motion of the affected fingers was 44° ± 11°. All patients exhibited hook function of the hands. The mean preoperative and postoperative DASH scores were 70.3 ± 13.4 and 51.8 ± 15.9, respectively. The mean pain VAS score was 28 ± 31 at the final follow-up.</div></div><div><h3>Conclusions</h3><div>Double free muscle transfer provided patients with complete brachial plexus palsy with good elbow flexion and hand hook functions.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 382.e1-382.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jhsa.2023.08.004
Daniel Reiser MD, PhD , Per Fischer MD, PhD , Kurt Pettersson MD, PhD , Per Wretenberg MD, PhD , Marcus Sagerfors MD, PhD
Purpose
Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.
Methods
Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.
Results
In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.
Conclusions
The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.
{"title":"Total Wrist Arthroplasty With a New Design: 20 Cases With 8-Year Follow-Up","authors":"Daniel Reiser MD, PhD , Per Fischer MD, PhD , Kurt Pettersson MD, PhD , Per Wretenberg MD, PhD , Marcus Sagerfors MD, PhD","doi":"10.1016/j.jhsa.2023.08.004","DOIUrl":"10.1016/j.jhsa.2023.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Total wrist arthroplasty (TWA) is an established motion-preserving alternative to arthrodesis in the treatment of wrist arthritis, but post-TWA complications requiring additional surgery remain an issue. A new TWA design has been proposed. The purpose of this study was to report the outcome of a cohort study of 20 patients who underwent surgery using the new TWA design.</div></div><div><h3>Methods</h3><div>Patients were assessed before surgery and at 1, 2, and 8 years after surgery for visual analog scale (VAS) pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs). Radiographic examination was conducted for evidence of prosthetic loosening. Reasons for revision were analyzed.</div></div><div><h3>Results</h3><div>In total, 24 reoperations were performed, including 12 revisions in 6 patients. Patient-reported outcome measures improved significantly at the 2-year follow-up compared with preoperative values. Hand grip strength, wrist extension, and VAS pain scores improved significantly at the 2-year follow-up. No radiographic loosening of the components was observed, but backing out of the carpal screws was noted in 16 of the 20 cases.</div></div><div><h3>Conclusions</h3><div>The new TWA resulted in improved VAS pain scores, PROMs, wrist extension, and hand grip strength. The high frequency of reoperation is a concern, and modification of the implant is needed.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 377.e1-377.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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