Journal of Hand Surgery-American Volume最新文献_第5页

Understanding Metacarpal Morphology and Practical Surgical Applications 了解掌骨形态及实际外科应用。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-06-24 DOI: 10.1016/j.jhsa.2025.05.007

Rhiana Rivas BS , Julie Mekhail MS , Ann Laurie Wells PhD , John J. Heifner MD , Gabriel Echegaray MD , Jorge Orbay MD , Deana Mercer MD

Purpose

Curved hand long bone morphology is understudied. Our study aimed to quantify the metacarpal dorsal and volar radius of curvature, canal and isthmus diameter, and compare the differences between the five metacarpals. A clear understanding of the radius of curvature (ROC) may help to better inform metacarpal biomechanical function, joint alignment, stability, and guide techniques that restore near-anatomical alignment during fracture fixation.

Methods

One hundred five computed tomography scans of cadaver hands were used to measure the volar and dorsal ROC, canal diameters, and isthmus dimensions of all metacarpals. Statistical analysis showed excellent interrater and intrarater reliability with intraclass correlation coefficients of 0.95 and 0.98, respectively.

Results

The volar ROC of each metacarpal was smaller, and therefore more curved, when compared with the dorsal surfaces for all metacarpals. The index and small finger metacarpals had the largest and smallest ROCs, respectively. The thumb metacarpal had the largest intramedullary diameter. The fourth metacarpal had the smallest intramedullary diameter. The index metacarpal was the longest.

Conclusions

The thumb and small finger metacarpals had the smallest volar radii of curvature, which may reflect the thumb and small fingers’ unique role in grasping movements and opposition. The dorsal surface is less curved with a large ROC in all metacarpals and therefore can be considered as relatively straight.

Clinical relevance

Based on our findings, we recommend surgeons use the nearly straight dorsal cortex as a guide when preparing and inserting intramedullary fixation. The volar metacarpal ROC varies between metacarpals and should be considered during fixation of fractures involving the volar surface. Restoring the anatomical arch may be important in optimizing intrinsic muscle function.

目的：对弯曲手长骨形态进行研究。我们的研究旨在量化掌骨的背侧和掌侧曲率半径、椎管和峡部直径，并比较五种掌骨之间的差异。对曲率半径（ROC）的清晰了解可能有助于更好地了解掌骨生物力学功能、关节对齐、稳定性以及在骨折固定过程中恢复接近解剖对齐的指导技术。方法：采用105张尸体手的计算机断层扫描，测量掌侧、背侧ROC、掌骨管径和峡部尺寸。统计分析表明，该方法具有良好的组间信度和组内信度，组内相关系数分别为0.95和0.98。结果：与所有掌骨背面相比，掌骨掌侧ROC更小，因此更弯曲。食指和小指掌骨的roc分别最大和最小。拇指掌骨髓内直径最大。第四掌骨髓内直径最小。索引掌骨最长。结论：拇指和小指掌骨掌侧曲率半径最小，这可能反映了拇指和小指在抓握和对立运动中的独特作用。背表面较少弯曲，所有掌骨的ROC较大，因此可以认为是相对直的。临床相关性：根据我们的研究结果，我们建议外科医生在准备和插入髓内固定时使用接近直的背侧皮质作为指导。掌侧掌骨的ROC随掌骨的不同而不同，在固定涉及掌面骨折时应予以考虑。恢复解剖弓可能是优化内在肌肉功能的重要因素。

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引用次数: 0

Radiographic Characteristics of Carpal Instability Associated With Scaphotrapeziotrapezoid Osteoarthritis 腕关节不稳合并舟状方椎体骨关节炎的影像学特征。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.jhsa.2025.11.018

Yasunori Hattori MD, PhD , Jun Sasaki MD , Sotetsu Sakamoto MD , Ian Magtoto MD , Ayumi Suzuki MD, PhD , Kazuteru Doi MD, PhD

Purpose

Scaphotrapeziotrapezoid osteoarthritis (STT-OA) may be related to the progression of carpal instability. This study analyzed the radiographic carpal indices in wrists with varying grades of STT-OA to investigate an association between the severity of STT-OA and the occurrence of dorsal intercalated segment instability (DISI), and to identify radiographic characteristics of carpal instability associated with STT-OA.

Methods

We retrospectively measured carpal indices in 135 wrists with STT-OA (Crosby’s classification grade 2, 62; grade 3, 73). Carpal indices measured included radiolunate (RL), radioscaphoid (RS), scapholunate (SL), and lunocapitate (LC) angles and SL distance. We compared the values of these carpal indices and the occurrence of DISI between the STT-OA grade 2 and grade 3 groups. We evaluated the presence of radiographic OA in other joints. In the wrists with DISI, we further investigated the relationship between the RL angle and other carpal angles.

Results

The RL and RS angles of grade 3 patients with STT-OA were smaller than those of grade 2 patients. The LC angle of grade 3 was greater than that of grade 2. DISI was identified in 3 grade 2 wrists (5%), and 44 grade 3 wrists (60%). None of the wrists had an SL angle >70°, a widened SL distance (>3mm), or radiographic OA in the RS joint. In the 47 wrists with DISI, there was a negative correlation between RL and LC angles, and positive correlation between RL and RS angles.

Conclusions

We found an association between the severity of STT-OA and occurrence of DISI, and identified unique characteristics of this carpal instability, which include an extended position of the scaphoid, a normal SL angle, and no development of RS-OA.

Type of study/level of evidence

Differential diagnosis/symptom prevalence study IV.

目的：舟状梯形骨关节炎（STT-OA）可能与腕关节不稳定的进展有关。本研究分析了不同级别STT-OA腕关节的x线片腕关节指数，以探讨STT-OA严重程度与背侧插入节段不稳定（DISI）发生之间的关系，并确定STT-OA相关腕关节不稳定的x线片特征。方法：我们回顾性地测量了135例STT-OA患者腕关节指数（Crosby分级2,62；分级3,73）。腕指数测量包括桡月骨（RL）、桡舟骨（RS）、舟月骨（SL）和月头骨（LC）角度和SL距离。我们比较了STT-OA 2级组和3级组腕关节指数和DISI的发生情况。我们评估了其他关节的骨关节炎影像学表现。在DISI腕关节中，我们进一步研究了RL角和其他腕角之间的关系。结果：STT-OA 3级患者的RL和RS角均小于2级患者。3级的LC角大于2级。2级手腕3例（5%），3级手腕44例（60%）。所有腕关节均无左旋角70°，左旋距离增宽3mm， RS关节无骨性关节炎。在47例DISI腕关节中，RL与LC角呈负相关，RL与RS角呈正相关。结论：我们发现STT-OA的严重程度与DISI的发生之间存在关联，并确定了这种腕不稳定的独特特征，包括舟状骨位置延伸，正常的SL角，没有RS-OA的发展。研究类型/证据水平：鉴别诊断/症状流行研究IV。

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引用次数: 0

Ulnar Shortening With Rotational Osteotomy of the Distal Facing Sigmoid Notch for Ulnar Carpal Abutment Syndrome 尺骨短缩与乙状突切迹远端旋转截骨治疗尺腕基台综合征。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-06-28 DOI: 10.1016/j.jhsa.2025.05.004

Zach Zhang MD , Edward H. Liu MD , Eugene T. Ek MBBS, PhD , Stephen K. Tham MBBS

Purpose

Pediatric distal radius fractures with epiphyseal growth arrest can lead to ulnar positive variance and ulnar carpal abutment. In these cases, where there is an associated distally facing sigmoid (or reverse oblique sigmoid, Tolat type III), an ulna shortening osteotomy can result in incongruity of the distal radioulnar joint (DRUJ). We present a series of patients with a distally facing sigmoid who had undergone an ulna shortening osteotomy and sigmoid notch rotational osteotomy to treat the ulnar carpal abutment and adjust for the incongruity of the DRUJ.

Methods

A review of patients who had undergone sigmoid notch rotational osteotomy with ulna shortening osteotomy was performed. All patients had a history of pediatric distal radius fracture, ulnar abutment syndrome, and Tolat type III DRUJ. Data on clinical history, postoperative physical examination, visual analog scale score, Disabilities of Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and plain radiographs of both the operated and unaffected wrists were collected.

Results

Of the 6 patients treated, 4 were available for follow-up, with an age range of 13–23 years. The mean follow-up period was 99 months (range: 66–168 months). The mean follow-up value for visual analog score pain score was 0.5. Physical examination demonstrated a similar range of motion and grip strength of both the operated and unaffected wrists. Plain film radiography confirmed union of all osteotomy sites and reversal of the sigmoid notch angle, matching the ulnar seat angle.

Conclusions

Ulna shortening with sigmoid notch rotationplasty is an effective option to relieve the symptoms from ulnar carpal abutment associated with a distally facing sigmoid.

Type of study/level of evidence

Therapeutic V.

目的：小儿桡骨远端骨折伴骨骺生长停止可导致尺侧阳性变异和尺侧腕基台。在这些病例中，如果存在相关的远端乙状骨（或反斜乙状骨，Tolat III型），尺骨缩短截骨术可导致远端尺桡关节（DRUJ）不一致。我们报告了一系列的远端乙状结肠患者，他们接受了尺骨缩短截骨术和乙状结肠切迹旋转截骨术来治疗尺腕基并调整DRUJ的不一致。方法：回顾性分析乙状结肠切迹旋转截骨联合尺骨缩短截骨术的临床资料。所有患者均有小儿桡骨远端骨折、尺基综合征和Tolat III型DRUJ病史。收集患者的临床病史、术后体格检查、视觉模拟量表评分、手臂、肩部和手部残疾、患者腕部评估以及手术和未手术腕部的x线平片资料。结果：6例患者中，4例可随访，年龄13 ~ 23岁。平均随访99个月（66 ~ 168个月）。视觉模拟评分疼痛评分的平均随访值为0.5。体格检查显示手术和未受影响的手腕的活动范围和握力相似。平片证实所有截骨部位愈合，乙状窦切迹角反转，与尺座角吻合。结论：尺骨短缩联合乙状窦切迹旋转成形术是一种有效的治疗方法，可以缓解尺腕基与远端乙状窦相关的症状。研究类型/证据水平：治疗性V。

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引用次数: 0

Factors Associated With Levels of Pain Intensity in Patients With Intermittent Paresthesia 间歇性感觉异常患者疼痛强度水平的相关因素

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-08-20 DOI: 10.1016/j.jhsa.2025.05.019

George E. Sayegh BS , Rafael Cordero MD , Drew Aronoff BS , Amin Razi MD , David Ring MD, PhD , Lee Reichel MD , Niels Brinkman MD

Purpose

Distorted thinking (worst-case thoughts, fear of painful movement) and feelings of distress (worry/despair) are important and modifiable aspects of human illness. It is possible that a more intense experience of intermittent paresthesia of the fingers, interpreted as “pain,” might be associated with higher levels of misinterpretation and distress regarding sensations. In patients seeking specialist care for intermittent paresthesia of the fingers, we asked what factors are associated with general and nighttime “pain” intensity, as well as levels of incapability.

Methods

In a cross-sectional study, 142 adult patients with symptoms of intermittent paresthesia of the fingers completed a survey, including measures of unhelpful thoughts and feelings of distress regarding symptoms, symptoms of depression, an 11-point ordinal rating of pain intensity, and a measure of upper extremity-specific capability. Bivariate, linear regression, and cluster analyses sought factors associated with greater pain intensity and level of incapability.

Results

Greater general and night pain intensity, and greater levels of incapability, were all associated with higher levels of distress regarding symptoms.

Conclusions

Among patients with intermittent paresthesia of the fingers, relatively notable levels of pain intensity and incapability are associated with modifiable mindset factors.

Clinical relevance

When clinicians notice a patient experiencing or describing paresthesia as pain, it can signal them to guide patients to a healthy understanding of compressive neuropathy.

目的：扭曲的思维（最坏的情况，对痛苦运动的恐惧）和痛苦的感觉（担心/绝望）是人类疾病的重要和可改变的方面。可能更强烈的手指间歇性感觉异常，被解释为“疼痛”，可能与更高程度的误解和对感觉的痛苦有关。在因手指间歇性感觉异常而寻求专科护理的患者中，我们询问了与一般和夜间“疼痛”强度以及丧失能力程度相关的因素。方法：在一项横断面研究中，142名有间歇性手指感觉异常症状的成年患者完成了一项调查，包括与症状有关的无用想法和痛苦感觉的测量、抑郁症状、疼痛强度的11分顺序评分和上肢特定能力的测量。双变量、线性回归和聚类分析寻找与更大的疼痛强度和丧失能力水平相关的因素。结果：更大的全身疼痛和夜间疼痛强度，以及更大程度的丧失行为能力，都与症状相关的更高程度的痛苦有关。结论：在间歇性手指感觉异常患者中，相对显著的疼痛强度和丧失能力水平与可改变的心态因素相关。临床相关性：当临床医生注意到患者经历或描述感觉异常为疼痛时，可以向他们发出信号，指导患者对压缩性神经病变有一个健康的认识。

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引用次数: 0

A Comprehensive Surgical Approach for Congenital Clasped Thumb: Introduction of a Modified Index Finger Rotation Flap 综合手术治疗先天性拇指夹扣：改良食指旋转皮瓣的介绍。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-10-08 DOI: 10.1016/j.jhsa.2025.08.010

Papat Sriswadpong MD , Xiaofang Shen MD

Purpose

This study evaluated the outcomes of reconstructive techniques combined with a modified index finger rotation flap for complex congenital clasped thumbs, focusing on functional improvement, aesthetic results, and donor site morbidity.

Methods

A retrospective review of nine patients (10 thumbs) who underwent modified index finger rotational flap reconstruction with Z-plasty donor site closure between 2022 and 2024 was conducted. Variables collected included patient demographics, preoperative first intermetacarpal angle, and postoperative outcomes, which included active radial and palmar abduction, metacarpophalangeal joint extension, donor site morbidity, and scar quality assessed using the patient and observer scar assessment scale.

Results

The mean age at surgery was 6 years and 5 months (range: 15–167 months), with an average follow-up of 12.7 months (range: 6–30 months). All patients healed without complications (eg, infection, flap necrosis, or revision). The mean preoperative intermetacarpal angle was 17.5°, consistent with moderate first web space contracture. At the final follow-up, the mean active radial abduction was 49.3°, and the mean palmar abduction was 50.6°. Full metacarpophalangeal joint extension of the thumb was achieved without extensor lag. No proximal interphalangeal joint flexion contracture or extensor lag of the index finger was observed. Scar quality outcomes were favorable, with all parents reporting satisfaction with both functional and aesthetic results.

Conclusions

The modified index rotation flap is an effective technique for reconstructing congenital clasped thumbs, offering improved functional and aesthetic outcomes with minimal donor site morbidity. It addresses palmar skin deficiency and first web space contracture, making it valuable for managing complex clasped thumb deformities.

Type of study/level of evidence

Therapeutic V.

目的：本研究评估重建技术结合改良的食指旋转皮瓣治疗复杂先天性夹住拇指的结果，重点关注功能改善、美学结果和供区发病率。方法：回顾性分析2022年至2024年间9例（10个拇指）行改良食指旋转皮瓣z形成形术关闭供区。收集的变量包括患者人口统计学、术前第一掌间角和术后结局，包括桡骨和掌骨活动外展、掌指关节伸展、供体部位发病率，以及使用患者和观察者疤痕评估量表评估的疤痕质量。结果：手术时平均年龄6岁5个月（15-167个月），平均随访12.7个月（6-30个月）。所有患者均无并发症（如感染、皮瓣坏死或翻修）。术前平均掌间角为17.5°，符合中度第一指间间隙挛缩。在最后的随访中，平均桡骨外展为49.3°，手掌外展为50.6°。拇指掌指关节完全伸展无伸肌迟滞。未见近端指间关节屈曲挛缩或食指伸肌迟滞。疤痕质量结果良好，所有家长都报告对功能和美学结果满意。结论：改良的食指旋转皮瓣是重建先天性拇指夹持的有效技术，在最小的供区发病率的情况下，改善了功能和美观。它解决了手掌皮肤缺陷和第一网空间挛缩，使其对管理复杂的拇指畸形有价值。研究类型/证据水平：治疗性V。

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引用次数: 0

Correlation and Optimal Cutoff Value of the Japanese Society for Surgery of the Hand Score for Postoperative Satisfaction in Radial Polydactyly: A Retrospective Cohort Study 桡侧多指畸形日本手外科学会术后满意度评分的相关性及最佳截止值：一项回顾性队列研究。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-10-07 DOI: 10.1016/j.jhsa.2025.08.014

Won Sun Lee MD , Young Ho Shin MD, PhD , Jae Kwang Kim MD, PhD

Purpose

The purpose of this study was to assess the correlation between the Japanese Society for Surgery of the Hand (JSSH) score and parental satisfaction in patients with radial polydactyly and to identify the optimal JSSH score that correlates with parental satisfaction.

Methods

A retrospective study was conducted on 144 patients (144 thumbs) who underwent surgery for radial polydactyly between October 2017 and September 2023. Patients were classified according to the modified Wassel–Flatt classification, excluding hypoplastic types. Postoperative outcomes were evaluated using the JSSH scoring system, totaling 20 points distributed across functional, appearance, and subjective parameters. Parental satisfaction regarding function and appearance was assessed using a five-point Likert scale. Spearman's rank correlation assessed the relationship between the JSSH score and parental satisfaction, and receiver operating characteristic curve analysis was used to determine the optimal cutoff value of the JSSH score corresponding to parental satisfaction.

Results

The JSSH score demonstrated a significant correlation with overall parental satisfaction. The optimal cutoff value for predicting parental satisfaction was determined to be 18.5, with an area under the receiver operating characteristic curve of 0.82. The effect size between satisfied and unsatisfied parents was 1.26. Parents reported significantly lower satisfaction with appearance outcomes compared with functional outcomes. Notably, the appearance parameter of the JSSH score showed a weak correlation with appearance satisfaction, along with limited discriminative ability and a small effect size.

Conclusions

We noted a significant correlation between JSSH score and parental satisfaction in patients with radial polydactyly and established an optimal cutoff value of 18.5 points.

Clinical relevance

Future development of a scoring system that better integrates both functional and aesthetic considerations (social function) could enhance the evaluation and management of patients with polydactyly.

目的：本研究的目的是评估桡侧多指畸形患者日本手外科学会（JSSH）评分与父母满意度的相关性，并确定与父母满意度相关的最佳JSSH评分。方法：对2017年10月至2023年9月接受桡侧多指畸形手术的144例患者（144个拇指）进行回顾性研究。根据改良的Wassel-Flatt分类对患者进行分类，不包括发育不良类型。使用JSSH评分系统评估术后结果，共20分，分布在功能、外观和主观参数上。父母对功能和外观的满意度采用五点李克特量表进行评估。采用Spearman秩相关法评价JSSH评分与父母满意度之间的关系，采用被试工作特征曲线分析确定JSSH评分与父母满意度对应的最佳截断值。结果：JSSH评分与家长整体满意度有显著相关。预测父母满意度的最佳截断值为18.5，受试者工作特征曲线下面积为0.82。满意父母与不满意父母之间的效应量为1.26。与功能结果相比，父母对外观结果的满意度明显较低。值得注意的是，JSSH评分的外观参数与外观满意度的相关性较弱，且判别能力有限，效应量较小。结论：我们注意到桡侧多指畸形患者的JSSH评分与父母满意度有显著相关性，并建立了最佳临界值18.5分。临床意义：未来发展一种更好地结合功能和美学考虑（社会功能）的评分系统，可以加强对多指畸形患者的评估和管理。

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引用次数: 0

Reducing Health Care’s Carbon Footprint: The Environmental Impact of Telephone Clinic Visits for Hand Surgery 减少医疗保健的碳足迹：电话诊所就诊对手外科的环境影响。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-08-07 DOI: 10.1016/j.jhsa.2025.06.010

Jagmeet S. Arora MD , Reid W. Smith BA , Allen Green BS , Vincent R. Hentz MD , Catherine Curtin MD , Paige M. Fox MD, PhD

Purpose

The health care sector contributes substantially to global greenhouse gas emissions. Telehealth presents an opportunity for reducing health care–associated emissions and patient transportation burden. This study analyzed the environmental and clinical outcomes of telephone encounters conducted at a Veterans Affairs Medical Center Hand Clinic between June 2022 and June 2023. We hypothesized that telehealth would reduce carbon emissions while maintaining effective patient care.

Methods

We conducted a retrospective review of 416 telephone encounters involving 295 patients. Patient demographics, travel distances, and emissions data were collected. Carbon dioxide (CO₂) emissions and gasoline savings were calculated based on avoided travel distances. Encounters were categorized as telephone-managed (concerns addressed via telephone) or telephone-facilitated escalation of care (recommendation for in-person follow-up).

Results

Of the encounters evaluated, 88.1% were telephone-managed, and 11.9% identified the need for an in-person evaluation. The study demonstrated a reduction in travel-related CO₂ emissions (51,920 kg total, 54 kg per encounter) and gasoline savings (5841 gallons), with a median driving distance saved of 129.9 miles per encounter. The environmental impact of telehealth was equivalent to recycling 2258 bags of waste or growing 866 tree seedlings for 10 years. Moreover, telephone encounters saved patients over 2180 hours of travel time and $29,847 in gasoline costs.

Conclusions

Most telephone encounters were successfully managed without further intervention, whereas a subset appropriately resulted in an in-person evaluation. These findings highlight the value of telehealth in supporting clinical decision-making and demonstrate its potential to reduce travel distance, time, and fuel consumption, particularly for patients living far from specialty care.

Clinical relevance

Telephone encounters offer a means of managing hand conditions and postoperative care remotely, reducing travel burdens and environmental impact while still facilitating timely in-person evaluations when necessary.

目的：卫生保健部门对全球温室气体排放的贡献很大。远程保健为减少与保健有关的排放和病人运输负担提供了机会。该研究分析了2022年6月至2023年6月期间在退伍军人事务医疗中心手部诊所进行的电话接触的环境和临床结果。我们假设，远程医疗将减少碳排放，同时保持有效的病人护理。方法：我们对295名患者的416次电话就诊进行回顾性分析。收集了患者人口统计、出行距离和排放数据。二氧化碳（CO2）排放量和汽油节省是根据避免的旅行距离计算的。就诊被分类为电话管理（通过电话解决问题）或电话促进的护理升级（建议面对面随访）。结果：在评估的接触中，88.1%是电话管理的，11.9%确定需要亲自评估。该研究表明，与旅行相关的二氧化碳排放量减少了51,920公斤，每次相遇54公斤)，汽油节省了5841加仑，每次相遇的平均驾驶距离节省了129.9英里。远程保健的环境影响相当于回收2258袋废物或在10年内种植866棵树苗。此外，电话会诊为病人节省了超过2180小时的旅行时间和29,847美元的汽油费用。结论：大多数电话接触在没有进一步干预的情况下成功管理，而一小部分适当地导致了面对面的评估。这些发现突出了远程医疗在支持临床决策方面的价值，并证明了其减少旅行距离、时间和燃料消耗的潜力，特别是对于远离专业护理的患者。临床意义：电话会诊提供了一种远程管理手部状况和术后护理的手段，减少了旅行负担和对环境的影响，同时在必要时仍有助于及时进行现场评估。

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引用次数: 0

Pediatric Finger Fractures: Preventing Big Problems After Small Fractures 小儿手指骨折：小骨折后预防大问题。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-10-08 DOI: 10.1016/j.jhsa.2025.08.015

Gopal R. Lalchandani MD , Aaron Berger MD, PhD , Nicole S. Schroeder MD , Andrea S. Bauer MD

Pediatric finger fractures are among the most common injuries of the hand. Although most can be treated nonsurgically with good results, a small subset benefits from intervention. The purpose of this review was to provide an update on potentially problematic pediatric phalanx fractures. We will review common finger fractures unique to pediatric patients, classifications, surgical indications, and treatment options for chronic presentations.

小儿手指骨折是手部最常见的损伤之一。尽管大多数患者可以通过非手术治疗获得良好的效果，但也有一小部分患者可以从干预中获益。本综述的目的是提供潜在问题儿童指骨骨折的最新情况。我们将回顾常见的手指骨折独特的儿科患者，分类，手术指征，和治疗方案的慢性表现。

引用次数: 0

Do Patients Older Than 40 Years with Work Claims for Unilateral Wrist Symptoms Have Symmetric, Bilateral MRI Signal Changes That Do Not Correspond with Symptoms? 40岁以上有单侧腕关节症状的患者是否有不符合症状的对称、双侧MRI信号改变？

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.jhsa.2025.11.012

Emily H. Jaarsma MD , David Ring MD, PhD , Melissa D. Tonn MD, MBA , Niels Brinkman BS

Purpose

New symptoms from established idiopathic or senescent pathophysiology are often misinterpreted as an injury (damage to tissues by an external force). Misinterpretation of age-related imaging abnormalities as damage from an external force introduces potential for overdiagnosis, overtreatment, overprotection, and misplacement of a condition under work insurance. Evidence from the shoulder and knee suggests that awareness of the bilateral nature of many idiopathic and senescent pathophysiologies can limit erroneous diagnosis of traumatic pathophysiology.

Methods

Sixty-four scrutinized work injury claims with unilateral wrist symptoms underwent bilateral wrist magnetic resonance imaging (MRI) as part of routine care. The radiologist’s interpretation of the MRIs was reviewed. Abnormalities were documented for each side and rated as either corresponding with or incidental to the location of the symptoms. We analyzed factors associated with MRI abnormalities present in the symptomatic wrist alone.

Results

MRI signal abnormalities were detected in 97% (n = 62) of symptomatic wrists and 91% (n = 58) of asymptomatic wrists, with an average of three abnormal findings per wrist. Signal abnormalities of the articular disc and extensor carpi ulnaris tendon were present in 64% and 45% percent of wrists and they were bilateral in 85% and 72% of patients, respectively. MRI findings were considered incidental to the symptoms in 95% (n = 61) of patients. In 55% (n = 35) of the cohort, symptoms were attributed to idiopathic or senescent pathophysiology and in 41% (n = 26) symptoms were considered nonspecific (no pathophysiological explanation). A trip and fall injury mechanism was the only variable associated with the presence of an abnormal MRI signal in the symptomatic wrist alone.

Conclusions

Occupational injury claimants with unilateral wrist symptoms tend to have symmetric MRI signal changes that do not correspond with symptoms, suggesting that new symptoms from idiopathic or degenerative conditions are far more common than traumatic pathophysiology.

Type of study/level of evidence

Diagnostic IV.

目的：来自已确定的特发性或衰老病理生理学的新症状常被误解为损伤（外力对组织的损伤）。将与年龄相关的影像学异常误解为外力造成的损伤，可能会导致过度诊断、过度治疗、过度保护和工作保险条件的错误定位。来自肩部和膝关节的证据表明，意识到许多特发性和衰老性病理生理的双侧性质可以限制创伤性病理生理的错误诊断。方法：64例有单侧手腕症状的工伤索赔患者接受了双侧手腕磁共振成像（MRI）作为常规护理的一部分。回顾放射科医生对核磁共振成像的解释。记录了每侧的异常情况，并将其评为与症状位置相对应或附带的。我们分析了与有症状腕关节MRI异常相关的因素。结果：97% （n = 62）有症状腕关节MRI信号异常，91% （n = 58）无症状腕关节MRI信号异常，平均每个腕关节3个异常。关节盘和尺侧腕伸肌腱的信号异常分别出现在64%和45%的腕部，分别出现在85%和72%的患者的双侧。95% （n = 61）的患者认为MRI表现与症状无关。在55% （n = 35）的队列中，症状归因于特发性或衰老的病理生理，41% （n = 26）的症状被认为是非特异性的（没有病理生理解释）。在有症状的腕关节中，绊倒和跌倒损伤机制是唯一与异常MRI信号相关的变量。结论：伴有单侧腕关节症状的工伤索赔人往往有不符合症状的对称MRI信号改变，提示特发性或退行性疾病引起的新症状远比创伤性病理生理更常见。研究类型/证据水平：诊断IV。

{"title":"Do Patients Older Than 40 Years with Work Claims for Unilateral Wrist Symptoms Have Symmetric, Bilateral MRI Signal Changes That Do Not Correspond with Symptoms?","authors":"Emily H. Jaarsma MD , David Ring MD, PhD , Melissa D. Tonn MD, MBA , Niels Brinkman BS","doi":"10.1016/j.jhsa.2025.11.012","DOIUrl":"10.1016/j.jhsa.2025.11.012","url":null,"abstract":"<div><h3>Purpose</h3><div>New symptoms from established idiopathic or senescent pathophysiology are often misinterpreted as an injury (damage to tissues by an external force). Misinterpretation of age-related imaging abnormalities as damage from an external force introduces potential for overdiagnosis, overtreatment, overprotection, and misplacement of a condition under work insurance. Evidence from the shoulder and knee suggests that awareness of the bilateral nature of many idiopathic and senescent pathophysiologies can limit erroneous diagnosis of traumatic pathophysiology.</div></div><div><h3>Methods</h3><div>Sixty-four scrutinized work injury claims with unilateral wrist symptoms underwent bilateral wrist magnetic resonance imaging (MRI) as part of routine care. The radiologist’s interpretation of the MRIs was reviewed. Abnormalities were documented for each side and rated as either corresponding with or incidental to the location of the symptoms. We analyzed factors associated with MRI abnormalities present in the symptomatic wrist alone.</div></div><div><h3>Results</h3><div>MRI signal abnormalities were detected in 97% (n = 62) of symptomatic wrists and 91% (n = 58) of asymptomatic wrists, with an average of three abnormal findings per wrist. Signal abnormalities of the articular disc and extensor carpi ulnaris tendon were present in 64% and 45% percent of wrists and they were bilateral in 85% and 72% of patients, respectively. MRI findings were considered incidental to the symptoms in 95% (n = 61) of patients. In 55% (n = 35) of the cohort, symptoms were attributed to idiopathic or senescent pathophysiology and in 41% (n = 26) symptoms were considered nonspecific (no pathophysiological explanation). A trip and fall injury mechanism was the only variable associated with the presence of an abnormal MRI signal in the symptomatic wrist alone.</div></div><div><h3>Conclusions</h3><div>Occupational injury claimants with unilateral wrist symptoms tend to have symmetric MRI signal changes that do not correspond with symptoms, suggesting that new symptoms from idiopathic or degenerative conditions are far more common than traumatic pathophysiology.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 3","pages":"Pages 313-320"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088229","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}

引用次数: 0

Recurrent Treatments After Percutaneous Needle Fasciotomy for Dupuytren Contracture—A Retrospective Cohort Study 经皮针筋膜切开术治疗双胎肌挛缩的复发治疗：回顾性队列研究。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-03-01 Epub Date: 2025-04-16 DOI: 10.1016/j.jhsa.2025.03.004

Laura Houstrup Matthiesen MS , Simon Toftgaard Skov MD, PhD , Jeppe Lange MD, PhD

Purpose

The purpose of this study was to estimate the risk of recurrent treatment after percutaneous needle fasciotomy (PNF) for Dupuytren contracture, defined as any subsequent treatment in a previously PNF-treated finger.

Methods

This is a registry-based follow-up study on PNF-treated patients at Silkeborg Regional Hospital between 2007 and 2015. The first PNF procedure within the study period was defined as the index procedure. Succeeding data relative to the PNF index procedure were extracted at a national level by the Danish National Patient Registry and the Danish Civil Registration System in 2018 to identify all possible recurrent treatments. The registries lack information about which specific hand and finger were treated. A review of medical records was performed to validate whether it was a recurrent treatment of the PNF index procedure. As access to medical records was limited to Silkeborg Regional Hospital, data validation was only feasible for patients treated in Silkeborg during the follow-up period (subcohort X). To compensate for the lack of complete data validation, we estimated the best- and worst-case scenarios of recurrent treatments in the total cohort.

Results

A total of 2,257 unique patients (3,331 PNF-treated fingers) were identified. Of those, 1,724 (76%) patients (2,511 [75%] fingers) were included in subcohort X. In subcohort X, 28% had received a recurrent treatment at a median follow-up time of 6.8 (interquartile range [IQR], 4.6–9.3; min–max, 1.0–11.7) years. In the total cohort, recurrent treatments were estimated to be between 21% and 46% at a median follow-up time of 7.2 (IQR, 4.9–9.5; min–max, 1.0–11.7) years.

Conclusions

This study provides information about recurrent treatments after PNF in a large Scandinavian cohort, which was estimated to be between 21% and 46% at a median follow-up time of 7.2 (IQR, 4.9–9.5; min–max, 1.0–11.7) years.

Type of study/level of evidence

Therapeutic IV.

目的：本研究的目的是评估经皮针筋膜切开术（PNF）治疗Dupuytren挛缩后复发治疗的风险，定义为先前经PNF治疗的手指的任何后续治疗。方法：这是一项基于登记的随访研究，研究对象是2007年至2015年在Silkeborg地区医院接受pnf治疗的患者。研究期间的第一个PNF程序被定义为索引程序。2018年，丹麦国家患者登记处和丹麦民事登记系统在全国范围内提取了与PNF指数程序相关的后续数据，以确定所有可能的复发治疗。登记处缺乏具体哪只手和哪根手指接受了治疗的信息。对医疗记录进行了审查，以验证这是否是PNF指数手术的复发性治疗。由于医疗记录的获取仅限于Silkeborg地区医院，数据验证仅适用于随访期间在Silkeborg接受治疗的患者（亚队列X）。为了弥补缺乏完整的数据验证，我们估计了整个队列中复发治疗的最佳和最坏情况。结果：共鉴定出2257例独特患者（3331例经pnf治疗的手指）。其中，1724例（76%）患者（2511例（75%）指）被纳入亚队列X。在亚队列X中，28%的患者在中位随访时间为6.8(四分位间距[IQR]， 4.6-9.3；最小顶薪，1.0-11.7)年。在整个队列中，估计复发治疗在中位随访时间7.2 (IQR, 4.9-9.5；最小顶薪，1.0-11.7)年。结论：本研究提供了斯堪的纳维亚大型队列中PNF后复发治疗的信息，中位随访时间为7.2 (IQR, 4.9-9.5；最小顶薪，1.0-11.7)年。研究类型/证据水平：治疗性IV。

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引用次数: 0