Journal of Hand Surgery-American Volume最新文献

Deliberate self-harm (DSH), including self-injurious behavior and nonsuicidal self-injury, presents substantial challenges to health care providers because of its prevalence, association with psychiatric conditions, and potential progression to suicide.^1,2 Hand surgeons are often among the first subspecialists to encounter these patients, particularly in emergency and outpatient settings, where upper-extremity injuries are common. This article explores the critical role of hand surgeons in identifying, managing, and preventing DSH-related injuries, emphasizing a multidisciplinary approach. Early recognition of DSH is vital, as many patients display subtle signs, such as scars on the upper extremities or discrepancies in reported injury mechanisms. Suicide screening tools, such as the Ask Suicide Screening Questions toolkit, enable rapid and effective identification of at risk individuals to guide subsequent care. In the emergency setting, hand surgeons must balance surgical intervention with the need for psychiatric evaluation, leveraging a multidisciplinary team to address underlying mental health conditions. Similarly, in outpatient clinics, hand surgeons have a unique opportunity to screen for DSH, initiate mental health referrals, and establish follow-up care with the help of existing clinical staff and social workers. Addressing misconceptions, such as the belief that discussing suicide may "implant" the idea or that surgical intervention reinforces self-harm for the average patient, is essential to improving care pathways. These misconceptions also deter hand surgeons from asking about DSH and suicidal thoughts. By expanding their role to include mental health considerations, hand surgeons can reduce recurrence rates, improve functional outcomes, and potentially save lives. We provide a comprehensive framework for integrating suicide prevention strategies and mental health resources into hand surgery practice, underscoring the critical impact of hand surgeons in managing this vulnerable patient population.

Purpose: There is a lack of comprehensive data concerning the prevalence of surgically treated peripheral nerve injuries (PNIs) and associated financial burden within the United States. Our purpose was to determine incidence of operatively managed major mixed upper-extremity PNIs and to quantify direct payments for PNI surgical intervention.

Methods: We analyzed administrative data from the Merative MarketScan Commercial Database and the Multi-State Medicaid Database from 2016 to 2022, focusing on adults aged 18-64 with surgically managed PNIs. Incidence, demographics, and direct payments within the first year postsurgery were examined. We used descriptive statistics to summarize payment data and the Mann-Kendall test to assess trends in annual incidence rates from 2016 to 2022.

Results: There were 5,735 patients and 2,917 patients in the commercial and Medicaid databases, respectively, who met inclusion criteria. The incidence of surgically managed PNIs in the commercial insurance population remained relatively stable, averaging 3.73 per 100,000 individuals annually. In the Medicaid population, incidence increased from 2.8 to 4.4 per 100,000 insured individuals between 2016 and 2022. Among patients with 365 days of continuous enrollment, mean total payments over 1 year were $31,840.55 in the commercial data set and $27,517.00 in the Medicaid data set. At 30, 90, and 180 days, mean total payments were $16,759.69, $20,367.30, and $24,537.40 for commercially insured patients as well as $10,443.09, $13,892.63, and $17,536.23 for Medicaid patients, respectively; these payments represent interval-specific averages, not cumulative payments.

Conclusions: The incidence of surgically treated PNIs is stable in the commercially insured but is rising in the Medicaid-insured population. Of the patients who remained insured in the year after injury, there were ongoing direct payments, highlighting the persistent claims-based financial footprint associated with PNI. These estimates reflect only direct payments and do not assess cost-effectiveness or broader societal costs but serve as a foundation for future investigations.

Type of study/level of evidence: Economic/Decision Analysis IV.

Purpose: Bennett fractures are inherently unstable intra-articular fractures of the first metacarpal base and are subject to multiple deforming forces. Suboptimal treatment can lead to fracture displacement, malunion, and post-traumatic arthritis of the carpometacarpal joint. The purpose of this study was to evaluate three fixation techniques for the stabilization of Bennett fractures. Our hypothesis was that screw fixation would be stiffer than the other methods.

Methods: Thirty fresh frozen cadaver hands were obtained. Bennett fractures were created by a fellowship-trained hand surgeon. Specimens were then randomized to fixation with one of three techniques: two 1.2 mm (0.047 in) Kirschner wires (K-wires), two 1.2 mm cortical lag screws, or a single 1.7 mm (0.067 in) headless compression screw with a minisuspensory cortical button construct (suture-button/screw). The specimens were loaded in displacement-controlled axial compression until failure. Radiographs were taken before and after testing to compare the final displacement and method of failure. Interfragmentary motion and applied load were recorded. The maximum force and relative motions of the first metacarpal and Bennett fragment were filtered and calculated.

Results: The median force to failure for screw, K-wire, and suture-button/screw were 166.6 N (38.9-590.3), 98.4 N (41.9-444.0), and 97.5 N (24.5-242.6), respectively, with no significant differences between constructs. Similarly, there were no significant differences in median displacement measured in three-dimensional space (5.7 mm (1.6-8.4), 5.7 mm (1.9-11.5), and 6.1 mm (3.9-17.9), respectively, or stiffness (37.2 N/mm (5.6-345.0), 22.8 N/mm (2.0-113.8), and 14.3 N/mm (5.5-285.9), respectively, between the groups.

Conclusions: All three methods of Bennett fracture fixation performed similarly at time zero in this in vitro biomechanical study.

Clinical relevance: The results of the present study may be taken into consideration along with patient factors and fracture characteristics when treating Bennett fractures.