Journal of Hand Surgery-American Volume最新文献_第4页

The Management of Upper-Extremity Xylazine-Associated Wounds 上肢木嗪相关伤口的处理。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2024.11.017

Parker Johnsen MD , Genoveffa R. Morway DO , Aaron Jackson MD , Sara Hope Buchner MD , Pietro Gentile MD , Asif M. Ilyas MD, MBA , Katharine Criner Woozley MD

Purpose

Xylazine has been associated with necrotic soft tissue wounds that have placed a challenging burden on patients who inject drugs in the Philadelphia region’s health care system over the last few years. An analysis of our initial experience is being presented to guide future treatment and directions for future research.

Methods

A retrospective review of 55 patients with patient-reported xylazine use and associated upper-extremity wounds at a single institution was performed. Patient demographics, treatments, and outcomes are presented.

Results

A large percentage of patients with xylazine-associated wounds were homeless (40%), had concomitant psychiatric diagnoses (26%), and had a history of tobacco use (84%). Comorbidities included 5% who were human immunodeficiency virus-positive and 67% who were hepatitis C virus-positive. The median number of hospital admissions per patient for xylazine-associated wounds was 3, with an average of 5.9 (range: 1–44 admissions). The median length of stay per hospital admission was 3 days, with an average of 5.3 days (range: 1–75). Among all included patients, 33 of 55 patients (60%) were treated nonoperatively with local wound care. Of the 22 patients who underwent surgery, there was a surgical complication rate of 59%, primarily related to continued wound issues, infections, and graft failures. The overall rate of patients who left the hospital against medical advice (AMA) was 49%. However, the mortality rate was 0%. Most surgical patients left AMA during their postoperative period hospital stay (64%) and demonstrated continued drug use per review of their hospital records (68%).

Conclusions

Patients presenting with xylazine-associated wounds have a high incidence of homelessness, psychiatric diagnoses, tobacco smoking, hepatitis C virus, and a predilection both toward leaving the hospital AMA and repeated drug use. These variables create inherent challenges to reconstructive surgery, yielding a subsequently high complication rate identified in most surgically managed patients.

Type of study/level of evidence

Therapeutic study IV.

目的：在过去的几年里，在费城地区的卫生保健系统中，Xylazine与坏死性软组织伤口有关，这给注射毒品的患者带来了挑战性的负担。目前正在对我们的初步经验进行分析，以指导未来的治疗和未来的研究方向。方法：回顾性分析同一医院55例报告使用噻嗪并伴有上肢创伤的患者。介绍了患者人口统计、治疗和结果。结果：很大比例的与氯嗪相关的伤口患者无家可归（40%），伴有精神疾病诊断（26%），有烟草使用史（84%）。合并症包括5%的人类免疫缺陷病毒阳性和67%的丙型肝炎病毒阳性。每位患者因xylazine相关伤口住院的中位数为3次，平均5.9次（范围：1-44次）。每次住院的中位住院时间为3天，平均为5.3天（范围：1-75天）。在所有纳入的患者中，55例患者中有33例（60%）采用局部伤口护理非手术治疗。在22例接受手术的患者中，手术并发症发生率为59%，主要与持续的伤口问题、感染和移植物失败有关。不遵医嘱（AMA）而离开医院的总比率为49%。然而，死亡率为0%。大多数手术患者在术后住院期间（64%）离开AMA，并且每次检查他们的医院记录（68%）都显示继续使用药物。结论：二甲肼相关伤口患者有较高的无家可归、精神疾病诊断、吸烟、丙型肝炎病毒、倾向于离开医院和反复用药的发生率。这些变量给重建手术带来了固有的挑战，在大多数手术治疗的患者中产生了随后的高并发症率。研究类型/证据水平：治疗性研究IV。

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引用次数: 0

Radiographic Characteristics of the Triphalangeal Thumb in Patients With Congenital Thumb Duplication: An Analysis of 383 Thumbs in 368 Children 368例小儿383根拇指的x线特征分析。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2024.11.004

JianPing Wu MD , Hai Zhao MD , ChenYang Li BD , YuanZhong Liu MD , Federico Canavese PhD , HongWen Xu PhD

Purpose

The purpose of this study was to evaluate the morphologic and radiographic characteristics of the triphalangeal thumb (TPT) in patients with congenital thumb duplication.

Methods

We retrospectively reviewed 368 children with TPT duplication (n = 383). Data on age, sex, and laterality were obtained from medical records. The morphologic and radiographic characteristics of the TPT duplication were evaluated using plain radiographs.

Results

Of the 383 fingers, 322 (84%) had a TPT duplication on the radial side, 36 (10%), on the ulnar side, and 25 (7%) were bilateral. The mean age at the time of surgery of TPT duplication on the radial side (21 ± 11 months), on the ulnar side (25 ± 15 months), and in bilateral cases (27 ± 15 months) was not significantly different. The extra thumb was connected to the main thumb by a joint (75%), bone (18%), soft tissue (6%), and epiphysis (1%). There were 26 cases (7%) of abnormal hypertrophic epiphysis of the main thumb, all of which were located in the distal phalanx of the radial side of the TPT duplications. The thumb epiphyses in patients with TPT duplication appeared in the following order: distal phalanx (mean, 24 ± 14 months; range, 7–94 months), proximal phalanx (mean, 31 ± 18 months; range, 14–94 months), and metacarpal (mean, 34 ± 20 months; range, 13–94 months).

Conclusions

Triphalangeal thumb in patients with congenital thumb duplication is more common in boys, often duplicated at the level of the proximal phalanx, with the extra thumb articulated to the main thumb by a joint, often unilateral, and frequently radial and right-sided. The epiphysis of the TPT duplication ossifies sequentially from the distal phalanx to the metacarpal, and its onset is delayed in comparison to normal children.

Type of study/level of evidence

Diagnostic III.

目的：本研究的目的是评估先天性拇指重复患者三指指（TPT）的形态学和影像学特征。方法：对368例TPT重复患儿（n = 383）进行回顾性分析。年龄、性别和侧位数据来自医疗记录。使用x线平片评估TPT复制的形态学和影像学特征。结果：383个手指中，322个（84%）在桡侧有TPT重复，36个（10%）在尺侧，25个（7%）在双侧。桡骨侧（21±11个月）、尺侧（25±15个月）、双侧（27±15个月）TPT重复手术时的平均年龄差异无统计学意义。多余的拇指通过关节（75%）、骨骼（18%）、软组织（6%）和骨骺（1%）连接到主拇指。主拇指异常增生性骨骺26例（7%），均位于TPT双侧桡侧远端指骨。TPT重复患者拇指骺端依次出现：远端指骨(平均24±14个月；范围，7-94个月)，近端指骨(平均，31±18个月；范围，14-94个月)，掌骨(平均，34±20个月；范围：13-94个月)。结论：先天性拇指三指畸形多见于男孩，多发生在近端指骨水平，多指通过关节与主拇指关节连接，多为单侧，多为桡侧和右侧。TPT重复骨骺从远端指骨到掌骨依次骨化，与正常儿童相比，其发病延迟。研究类型/证据水平：诊断III。

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引用次数: 0

The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage 与战斗相关的肢体抢救中上肢神经损伤的范围和分布情况

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2023.09.008

Colin J. Harrington MD , Marissa E. Dearden MD , Patrick McGlone MD , Benjamin K. Potter MD , Scott M. Tintle MD , Jason M. Souza MD

Purpose

Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at <10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related limb salvage population.

Methods

We performed a retrospective review of all patients who underwent limb salvage procedures to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations.

Results

A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n = 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury.

Conclusions

Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible.

Type of study/level of evidence

Therapeutic IV.

目的继发于神经损伤的慢性疼痛和功能限制是高能量四肢创伤患者实现最佳康复的主要障碍。鉴于多发性创伤患者的骨骼和软组织管理面临挑战，伴随的神经损伤可能会被忽视或延迟处理。之前有文献报道，在高能量四肢创伤的情况下，周围神经损伤的发生率为 10%，而根据我们的经验，这些损伤的发生率要高得多。因此，我们试图确定与战斗相关的肢体救治人群中上肢周围神经损伤的发生率、疼痛后遗症和功能预后。方法我们对 2011 年 1 月至 2020 年 1 月期间在一家机构接受肢体救治手术的所有患者进行了回顾性审查，其中包括因与战斗相关的上肢创伤而接受皮瓣覆盖的患者。我们收集了患者人口统计学、围手术期并发症、神经损伤位置、手术干预、慢性疼痛以及患者主观报告的功能限制等方面的数据。结果共有45名患者在与战斗有关的创伤后接受了49个上肢的皮瓣手术。所有患者均为男性，中位年龄为 27 岁，96%（n = 47）的损伤是由爆炸机制造成的。49 例上肢中有 33 例（67%）伴有神经损伤。最常见的受伤神经是尺神经（51%），其次是正中神经（30%）和桡神经/骨间后神经（19%）。在 33 例神经损伤的肢体中，有 18 例（55%）接受了手术治疗。神经修复/重建是最常见的手术（67%），其次是靶向肌肉神经再支配（TMR，17%）。结论上肢周围神经损伤在高能量战斗相关创伤后很常见，慢性疼痛和功能受限的发生率很高。外科医生在进行包括皮瓣覆盖在内的肢体挽救手术时，应预计到相关的周围神经损伤，并在可行的情况下做好修复或重建损伤神经的准备。

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引用次数: 0

Vascularized Cartilage: Development of a New Technique of Microsurgical Joint Reconstruction 血管化软骨：开发显微外科关节重建新技术

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2024.11.008

James P. Higgins MD

The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a researcher dedicated to advancing patient care in the field of hand surgery. The purpose of this article is to summarize the progression of our research focused on achieving joint preservation using autogenous vascularized cartilage transfer.

引用次数: 0

Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2025.01.018

Richard G. Eaton M.D. , Steven Z. Glickel M.D. , J. William Littler M.D.

Arthrosis of the trapeziometacarpal joint of the thumb is a predictable sequelae of ligament laxity. A new technique of tendon interposition arthroplasty with ligament reconstruction using the flexor carpi radialis tendon for a painful arthritic trapeziometacarpal joint of the thumb is described. Twenty-one patients had 25 operative procedures; 14 were women and seven were men. All of the patients presented with intractable pain, crepitus, and varying degrees of laxity of the basal joint. Pinch strength was diminished. Follow-up averaged 37 1/2 months. After surgery, 91.7% of patients had good to excellent results, and 56% were completely pain free. Range of motion and grip and pinch strengths were equal on the operated and unoperated sides.

引用次数: 0

Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty 女性手掌骨置换术合并掌指骨融合术患者与未手术侧或手掌骨置换术患者的远期疗效比较。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2023.09.002

Carissa C. Dock BS , Rebecca Stone McGaver MS, ATC , Clare K. McCarthy MD

Purpose

Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only.

Methods

This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients.

Results

Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2–16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups.

Conclusion

Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs.

Type of study/level of evidence

Therapeutic IV.

目的：腕掌骨关节炎（OA）患者常表现为掌指（MP）过度伸展和/或鱼际萎缩。本研究假设，对于患有中度至重度鱼际萎缩、MP过度伸展>30°或MP关节炎的患者，在CMC关节成形术（CMCA）时进行的MP融合（MPF）将具有更大的长期握力，并改善手臂的快速残疾，与未手术侧或仅患有CMCA的患者相比，肩手（QuickDASH）评分来自术前值。方法：本研究对接受CMCA或CMCA/MPF的患者的长期结果进行了回顾性审查。在基线夹量表上测量QuickDASH评分、疼痛视觉模拟量表（VAS）和每个拇指的平均三个夹量读数，并对右手患者的手优势进行校正。结果：53名女性患者，70个拇指接受了手术。平均年龄67.2岁。共有29个CMCA和41个CMCA/MPF。平均随访时间为6.3年（2-16.9年）。在最近的随访中，CMCA/MPF的平均夹持力（11.3磅）明显强于CMCA（8.0磅）和腕掌骨关节炎拇指（8.9磅）。接受CMCA和CMCOA拇指的患者之间的握力没有显著差异（分别为8.0磅和8.9磅）。术前QuickDASH在CMCA/MPF组中表现出较差的功能（55.8 vs 36.5）。在最新的随访中，QuickDASH和VAS在CMC A/MPF（10.5和0.66）组和CMC A（18.5和0.52）组中显示出相似的值。结论：长期结果表明，与接受CMCA或未经治疗的腕掌骨关节炎拇指患者相比，接受CMCA/MPF的患者的QuickDASH评分有更大的改善。研究类型/证据水平：治疗IV。

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引用次数: 0

Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis 关节融合术与韧带重建和肌腱介入治疗拇指掌关节关节炎：系统回顾和荟萃分析。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2024.10.018

Chul-Ho Kim MD, PhD , Dong-Hoon Lee MD , Jae-Sung Lee MD, PhD , Hyoung-Seok Jung MD, PhD

Purpose

Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions.

Methods

We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates.

Results

Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD], −0.05; 95% CI, −0.40 to 0.30; P = .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI, −1.12 to 2.17; P = .53), and grip strength (SMD, −0.67; 95% CI, −1.85 to 0.51; P = .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32–0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00–32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11–3.91; I² = 0%) compared with the LRTI group.

Conclusions

Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI.

Type of study/level of evidence

Therapeutic II.

目的：关节融合术、韧带重建和肌腱插入术（LRTI）是治疗拇指腕掌骨关节炎（CMC）的常用方法。虽然LRTI是最常见的手术治疗，但CMC关节融合术因其报道的优势而被采用。本系统综述和荟萃分析比较了CMC关节融合术和LRTI之间的差异，以便更好地为外科医生和患者做出治疗决策提供信息。方法：我们检索MEDLINE、Embase和Cochrane图书馆，检索截至2023年8月27日发表的直接比较关节融合术与LRTI治疗拇指CMC关节关节炎的研究。集合分析比较视觉模拟量表；手臂，肩膀和手的快速残疾得分；握力;键夹紧强度；手术率;以及术后并发症的发生率。结果：六项研究共纳入285个拇指，其中分别有141个和155个拇指进行了关节融合术和LRTI。视觉模拟量表(标准均差[SMD]， -0.05；95% CI, -0.40 ~ 0.30；P = 0.78)，手臂、肩部和手部快速残疾评分(SMD, 0.53；95% CI, -1.12 ~ 2.17；P = 0.53)，握力(SMD, -0.67；95% CI, -1.85 ~ 0.51；P = 0.27)，两组间无差异。关节融合术组的关键夹紧强度(SMD, 0.61；95% CI, 0.32-0.90)，再手术率(优势比，8.02；95% CI, 2.00-32.16)和术后并发症发生率(优势比，2.08；95% ci, 1.11-3.91；I2 = 0%)与LRTI组比较。结论：与LRTI相比，手掌骨融合术与更好的关键捏力相关。然而，在功能评分和握力方面没有观察到显著差异。关节融合术患者的再手术率和术后并发症发生率高于LRTI患者。因此，虽然关节融合术对于对捏压强度要求较高的患者可能是一种更好的手术，但与LRTI相比，外科医生也应考虑到较高的并发症。研究类型/证据水平：治疗性II。

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引用次数: 0

Tendon Force and Range of Motion Changes After In Vitro Total Wrist Replacement 体外全腕置换术后肌腱力和活动范围的变化。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-03-01 DOI: 10.1016/j.jhsa.2024.11.011

Gaurav G. Mookerjee MD , Frederick W. Werner MME , Walter H. Short MD

Purpose

The purpose of this study was to determine if there were differences in the tendon forces needed to cause wrist motion and in the passive range of wrist motion following total wrist replacement (TWR) using a contemporary arthroplasty design.

Methods

Eight fresh frozen cadaver arms were moved through five different wrist motions using a wrist joint simulator before and after the insertion of a TWR. Changes in the peak tendon forces and wrist range of motion were compared.

Results

During each of the five wrist motions following TWR, there were significant increases in the extensor tendon forces. Most notably, the force in the extensor carpi radialis longus more than doubled in four motions. Also, the range of motion significantly decreased in flexion (average 18 degrees, range of 23 to −5 [one wrist had an increase in flexion]), extension (average 23 degrees, range of 4-32), and radial deviation (average 19 degrees, range of 29 to −2 [one wrist had an increase in radial deviation]) following TWR. The hand and carpus shifted distally following the insertion of a wrist implant (average of 8.5 mm; range of 3.6–18.0).

Conclusions

Wrist tendon forces increased with TWR insertion, even with a fourth-generation design. Positioning of the implant or differences in the biomechanical properties of the implant compared with the intact specimen may have been factors in the reduced range of motion and distal movement of the carpus. The difficulties of implanting a prosthesis that allows normal kinematics may also play a role in these results.

Clinical relevance

Despite the marked improvements in recent TWR designs, additional design and surgical technique modifications are needed to further reduce the tendon forces required to move a wrist following TWR and increase its range of motion.

目的：本研究的目的是确定采用现代关节置换术设计的全腕置换术（TWR）后，引起腕关节运动所需的肌腱力和腕关节被动运动范围是否存在差异。方法：采用腕部关节模拟器对8具新鲜冰冻尸体手臂进行5种不同的腕部运动。比较峰值肌腱力和手腕活动范围的变化。结果：在TWR后的五次手腕运动中，伸肌腱力均显著增加。最值得注意的是，桡侧腕长伸肌的力量在四次运动中增加了一倍以上。此外，TWR后的屈曲（平均18度，范围为23至-5[一只手腕的屈曲增加]），伸展（平均23度，范围为4-32）和径向偏差（平均19度，范围为29至-2[一只手腕的径向偏差增加]）的活动范围显着减少。腕部植入后，手和腕骨向远端移位(平均8.5 mm；范围3.6-18.0)。结论：腕部肌腱受力随着TWR植入而增加，即使是第四代设计。植入物的位置或与完整标本相比，植入物的生物力学特性的差异可能是腕骨活动范围缩小和远端活动的因素。植入允许正常运动的假体的困难也可能在这些结果中起作用。临床相关性：尽管最近的TWR设计有了明显的改进，但需要进一步的设计和手术技术修改，以进一步减少TWR后腕关节活动所需的肌腱力，并增加其活动范围。

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引用次数: 0

Tetraplegic Hand Reconstruction Using Double Nerve Transfers for All Finger Flexion: Motor Grading and Hand Functional Tests.

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-02-26 DOI: 10.1016/j.jhsa.2025.01.012

Jirachart Kraisarin, Kanit Sananpanich, Siam Tongprasert, Wachiraporn Wittayanin, Phichayut Phinyo

Purpose: To evaluate motor grading and hand functional outcomes of restoring tetraplegic hands using single-stage multiple nerve transfers, including double nerve transfers, for finger flexion.

Methods: Patients with tetraplegia who had single-stage multiple nerve transfers between January 2016 and December 2021 were included in the study. We evaluated the patients using muscle grading, the International Spinal Cord Injury Upper Extremity basic data set, the Toronto Rehabilitation Institute-Hand Function Test, the Spinal Cord Independent Measure III, and the Spinal Cord Ability Ruler.

Results: During the research study period, 7 patients with tetraplegia underwent a total of 41 nerve branch transfers for upper-extremity motor reanimation, including 6 posterior deltoid to the long head of the triceps, 11 supinator to the posterior interosseous nerve, 11 extensor carpi radialis brevis to the flexor digitorum profundus of the ulnar nerve, 9 brachialis to the anterior interosseous nerve, 2 pronator teres to the anterior interosseous nerve, 1 extensor carpi radialis brevis to the anterior interosseous nerve, and 1 pronator teres to the flexor digitorum profundus component controlled by the ulnar nerve. Following the nerve transfers, the motor grade, and functional tests of each limb showed improvement. The brachialis to anterior interosseous nerve transfer improved more slowly than the other nerve transfers, and two of those transfers only resulted in grade 1 thumb and index flexor strength, with the latter requiring tendon transfer.

Conclusions: Single-stage multiple nerve transfers can increase the function of the hand in patients with tetraplegia. In C6 and C7 patients with tetraplegia who have two good donors, double nerve transfers to the anterior interosseous nerve and flexor digitorum profundus branch controlled by the ulnar nerve can restore flexion in all fingers. The brachialis to the anterior interosseous nerve transfer requires a longer recovery time than the other transfers and has a lower success rate.

Type of study/level of evidence: Therapeutic V.

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引用次数: 0

Quick Response and Management of Patients During a Mass Casualty Incident: Experiences After 2023 Türkiye Earthquake.

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2025-02-21 DOI: 10.1016/j.jhsa.2025.01.014

Ömer Faruk Yıkılmaz, Furkan Temizayak, Rıdvan Çit, Özden Baz, Engin Çetinkaya, Burak Yaşar, Ramazan Erkin Ünlü

A devastating series of earthquakes hit Kahramanmaraş, Türkiye on February 6, 2023, affecting 14 million people. A true mass casualty incident, these earthquakes reminded us of the importance of being ready and able to address the consequences. Our clinic is a central referral center so during the first few days we had to treat hundreds of patients transferred to us with compartment syndrome in the upper extremities, finger amputations, tissue defects, and infected open wounds. Every member of our team showed tremendous effort and selfless nature to attend to the extreme number of patients in a limited time. We share our experiences during this trying time so that should a mass casualty incident occur again, a hand surgeon anywhere in the world can anticipate the aftereffect and respond adequately and quickly.

引用次数: 0