Journal of Hand Surgery-American Volume最新文献_第7页

Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture 重复胶原酶治疗双膝挛缩的疗效。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2023.03.026

Joseph M. Legato MD , Meera K. Gill DO , Nino A. Coutelle MD , Jason A. Nydick DO

Purpose

Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment.

Methods

A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection.

Results

Forty-five patients with an average duration of 30 months (range, 6–73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group.

Conclusions

Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events.

Type of study/level of evidence

Therapeutic IV.

目的：注射溶组织梭菌胶原酶是一种有效且耐受性良好的非手术治疗手部Dupuytren挛缩的方法。本研究的目的是确定先前接受过胶原酶治疗的患者注射胶原酶的疗效和不良事件发生率。方法：回顾性分析2009 - 2019年同一医院3名研修手外科医师接受胶原酶注射治疗Dupuytren挛缩的332例患者的资料。45例患者59个关节因同一指复发性挛缩而接受重复胶原酶治疗。记录治疗前和治疗后掌指关节和近端指间关节屈曲挛缩，并将完全矫正定义为：结果：45例患者首次和重复胶原酶治疗的平均持续时间为30个月（范围6-73个月）。第一次注射胶原酶后平均改善45°±24°（掌指关节39°，近指关节50°），第二次注射后平均改善43°±23°（掌指关节41°，近指关节44°）。虽然在首次注射（80%）和重复注射（73%）之间观察到相似的完全矫正率和皮肤撕裂率（初次注射32.2%，重复注射30.5%），但后者的不良事件发生率高3倍（初次注射3.4%，重复注射10.2%）。结论：胶原酶治疗可有效矫正全屈曲挛缩。对先前治疗过的手指进行重复胶原酶治疗可获得相似的畸形矫正和完全矫正率，但不良事件发生率较高。研究类型/证据水平：治疗性IV。

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引用次数: 0

Effect of Screw Length in Volar Plating for Intra-Articular Distal Radius Fractures: A Biomechanical Study 关节内桡骨远端骨折沃尔钢板固定中螺钉长度的影响：生物力学研究

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2024.07.019

Thomas S. Hong MD, MS , Daniel J. Lee MD , Babak Jahani PhD , Kaitlyn S. Broz MD, MS , Donald A. Aboytes MS , Simon Tang PhD , Stephen DeMartini BS , David M. Brogan MD, MSc

Purpose

The purpose of this study was to compare the effect of varying screw lengths on load to failure and retention of the dorsal ulnar corner fragment after fixation of comminuted intra-articular distal radius fractures in a cadaveric model.

Methods

Twenty-four fresh frozen cadaveric forearms were subjected to a standardized distal radius osteotomy to mimic an intra-articular fracture pattern. Dual X-ray absorptiometry scans were performed to ensure minimal variability in bone density. All fractures were fixed with a volar locking plate and distal locking screws. Three different lengths of distal locking screws were used in each group of eight specimens to simulate the clinical decision of different distal screw lengths. The screw lengths tested were bicortical, 100% of the width of the bone but unicortical, and 75% of the width of the bone and unicortical. All specimens were preconditioned with cyclic axial loading and then axially loaded using matching acrylic resin molds to clinical failure and fragment displacement as detected by a motion analysis system. Retention or loss of the dorsal ulnar corner fragment during loading was recorded as a binary variable.

Results

Between the three groups, there were no statistically significant differences in precycling stiffness, postcycling stiffness, load at 2 mm displacement of the dorsal ulnar corner, or force at failure. The group with 75% length screws had a significantly higher loss of reduction of the dorsal ulnar corner (86%) compared with the other groups (0%).

Conclusions

Varying screw lengths did not affect the stiffness or overall loads to failure of axially loaded specimens. However, the 75% length screws did not reliably secure the dorsal ulnar corner fragments. Although this did not significantly affect the overall load to failure of the construct, displacement of this fragment may have implications for rotation of the forearm through the distal radioulnar joint.

Clinical relevance

Surgeons should consider the utilization of full-length unicortical locking screws to ensure adequate fixation of the dorsal ulnar corner.

目的：本研究的目的是在尸体模型中比较不同螺钉长度对粉碎性关节内桡骨远端骨折固定后失败载荷和尺骨背角碎片保留的影响：对 24 具新鲜冷冻的尸体前臂进行标准化桡骨远端截骨，以模拟关节内骨折模式。进行双 X 射线吸收扫描以确保骨密度变化最小。所有骨折均使用外侧锁定钢板和远端锁定螺钉固定。每组八个样本中使用了三种不同长度的远端锁定螺钉，以模拟不同远端螺钉长度的临床决定。测试的螺钉长度分别为双皮质、100% 骨宽但单皮质以及 75% 骨宽但单皮质。所有试样均以循环轴向加载进行预处理，然后使用匹配的丙烯酸树脂模具进行轴向加载，以达到临床失效和运动分析系统检测到的片段位移。加载过程中尺侧背角碎片的保留或脱落被记录为二元变量：三组之间在循环前刚度、循环后刚度、尺骨背角位移 2 毫米时的载荷或失效时的力方面没有统计学意义上的显著差异。与其他组（0%）相比，使用 75% 长度螺钉组的尺骨背角缩减率（86%）明显更高：结论：不同的螺钉长度不会影响轴向加载试样的刚度或失效时的总载荷。然而，长度为 75% 的螺钉并不能可靠地固定背侧尺骨角碎片。虽然这对结构的整体破坏载荷没有明显影响，但该片段的移位可能会影响前臂通过桡骨远端关节的旋转：外科医生应考虑使用全长单皮质锁定螺钉，以确保充分固定尺骨背角：生物力学研究

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引用次数: 0

Surgical Outcomes of Percutaneous Pinning and Open Locking Plating in Patients With Intra-Articular Fractures of the Base of the Fifth Metacarpal 经皮钉钉和开放锁定钢板治疗第五掌骨底关节内骨折的手术效果。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2023.03.024

Jung Il Lee MD, PhD , Jong Woong Park MD, PhD , Yong Jin You MD , Young Hoon Jo MD, PhD , Ki-Chul Park MD, PhD

Purpose

The purpose of the study was to demonstrate the results of surgical treatment, including percutaneous K-wire fixation after closed reduction (CRKF) or locking plate fixation after open reduction (ORPF), in patients with intra-articular fractures of the base of the fifth metacarpal.

Methods

We retrospectively reviewed data of 29 patients who received surgical treatment for closed, intra-articular fractures of the base of the fifth metacarpal and were followed up for at least 1 year after surgery. Sixteen of the 29 patients underwent CRKF, whereas 13 patients underwent ORPF. Attempts were made to address intra-articular step-off with closed reduction in all the patients; however, if inadequate, ORPF was performed. Clinical outcomes were evaluated using Disabilities of the Arm, Shoulder, and Hand scores, visual analog scale pain scores, the total active motion (TAM) of the little finger, and grip strength. Osseous union and posttraumatic arthritis of the fifth carpometacarpal joint were also evaluated.

Results

K-wire fixation after closed reduction was performed for 13 simple fractures and 3 comminuted fractures; ORPF was performed for 6 simple fractures and 7 comminuted fractures. All the patients had satisfactory subjective outcomes with over 90% grip strength compared with that on the contralateral side and nearly full TAM. All the patients in both the groups achieved osseous union. There were five cases of grade 1 posttraumatic arthritis after CRKF and seven cases of grade 1 posttraumatic arthritis after ORPF.

Conclusions

Surgical treatment provided satisfactory results in patients with intra-articular fractures of the base of the fifth metacarpal treated with either CRKF or ORPF. Our data showed that the patients who underwent CPKF had good results, and those who underwent ORPF after attempt failure of close reduction also had good results. Our experience suggests that ORPF can be a backup plan when CRKF cannot be accomplished in a satisfactory way.

Type of study/level of evidence

Therapeutic IV.

目的：本研究的目的是展示手术治疗的结果，包括经皮闭合复位后k针固定（CRKF）或切开复位后锁定钢板固定（ORPF），治疗第五掌骨底关节内骨折患者。方法：回顾性分析29例第5掌骨基部闭合性关节内骨折患者的手术治疗资料，术后随访至少1年。29例患者中有16例接受了CRKF，而13例接受了ORPF。所有患者均尝试通过闭合复位来解决关节内步脱问题；但是，如果不充分，则进行ORPF。临床结果采用手臂、肩部和手部残疾评分、视觉模拟疼痛评分、小指总主动运动（TAM）和握力进行评估。骨愈合和第五腕关节创伤后关节炎也进行了评估。结果：单纯骨折13例，粉碎性骨折3例，行闭合复位后k针固定；6例单纯性骨折，7例粉碎性骨折行ORPF。所有患者主观结果满意，握力比对侧超过90%，TAM接近满。两组患者均实现骨愈合。CRKF术后1级创伤后关节炎5例，ORPF术后1级创伤后关节炎7例。结论：采用CRKF或ORPF治疗第五掌骨底关节内骨折均可获得满意的手术治疗效果。我们的数据显示，行CPKF的患者有良好的效果，在闭合复位失败后行ORPF的患者也有良好的效果。我们的经验表明，当CRKF不能以令人满意的方式完成时，ORPF可以作为备用计划。研究类型/证据水平：治疗性IV。

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引用次数: 0

Surgical Management of Tophaceous Gout in the Upper Limb 上肢痛风的外科治疗。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2023.04.015

Daniel A. Espinel MD , Diana C. Martínez MD , María Á. Gómez MD , David F. Duque MD , Paula A. Torres MD , Juliana V. Rincón MD

Purpose

Gouty tophi are a clinical manifestation of hyperuricemia in advanced stages. They can produce pain, functional limitation, and severe deformities. Patients with severe symptoms require short-term symptomatic solutions that standard medical management is not able to provide. The objective of this study was to present the results obtained with the surgical management of tophaceous gout in the upper limb, as well as present a detailed characterization of the disease in the upper limb.

Methods

Databases of the hand surgery service of a quaternary care hospital were reviewed to identify patients aged >18 years old undergoing tophi resection in the upper limbs between 2014 and 2020. Medical history records were reviewed retrospectively, and the relevant data were extracted to establish demographic profile, clinical presentation, anatomic distribution, postoperative outcomes, and additional procedures required.

Results

The most frequent symptom was pain (83%), followed by limited range of motion (56%), deformity (50%), and daily living/occupational activity limitation (28%). The main indications for surgical management were the presence of deformity, pain, and/or limited range of motion. The most frequently affected anatomic sites were the metacarpophalangeal joints, followed by the elbows, proximal interphalangeal joints, and proximal phalanges. The postoperative complication rate was 28%. The most common complications were operative site infections and wound dehiscence. Decreased pain was associated with surgical resection. Additional procedures, such as extensor tenorrhaphy and local flaps, were required in 47.2% of patients.

Conclusion

Surgical resection of tophi can decrease pain. Although surgery is associated with a high rate of complications, most are minor.

Type of study/level of evidence

Therapeutic IV.

目的：痛风痛风是高尿酸血症晚期的临床表现。它们会造成疼痛、功能限制和严重的畸形。症状严重的患者需要短期的对症治疗，这是标准医疗管理无法提供的。本研究的目的是介绍手术治疗上肢痛风的结果，以及上肢疾病的详细特征。方法：回顾性分析某四级护理医院手外科数据库，收集2014 ~ 2020年收治的年龄在bb0 ~ 18岁的上肢tophi切除术患者。回顾性回顾病史记录，并提取相关数据，以确定人口统计学特征、临床表现、解剖分布、术后结果和所需的其他手术。结果：最常见的症状是疼痛（83%），其次是活动范围受限（56%）、畸形（50%）和日常生活/职业活动受限（28%）。手术治疗的主要指征是存在畸形、疼痛和/或活动范围受限。最常受影响的解剖部位是掌指关节，其次是肘部、近端指间关节和近端指骨。术后并发症发生率为28%。最常见的并发症是手术部位感染和伤口裂开。疼痛减轻与手术切除有关。47.2%的患者需要额外的手术，如伸肌腱束缝合和局部皮瓣。结论：手术切除痛风石可减轻疼痛。虽然手术并发症的发生率很高，但大多数都是轻微的。研究类型/证据水平：治疗性IV。

{"title":"Surgical Management of Tophaceous Gout in the Upper Limb","authors":"Daniel A. Espinel MD , Diana C. Martínez MD , María Á. Gómez MD , David F. Duque MD , Paula A. Torres MD , Juliana V. Rincón MD","doi":"10.1016/j.jhsa.2023.04.015","DOIUrl":"10.1016/j.jhsa.2023.04.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Gouty tophi<span> are a clinical manifestation of hyperuricemia in advanced stages. They can produce pain, functional limitation, and severe deformities. Patients with severe symptoms require short-term symptomatic solutions that standard medical management is not able to provide. The objective of this study was to present the results obtained with the surgical management of tophaceous gout in the upper limb, as well as present a detailed characterization of the disease in the upper limb.</span></div></div><div><h3>Methods</h3><div>Databases of the hand surgery service of a quaternary care hospital were reviewed to identify patients aged >18 years old undergoing tophi resection in the upper limbs between 2014 and 2020. Medical history records were reviewed retrospectively, and the relevant data were extracted to establish demographic profile, clinical presentation, anatomic distribution, postoperative outcomes, and additional procedures required.</div></div><div><h3>Results</h3><div><span><span><span>The most frequent symptom was pain (83%), followed by limited range of motion (56%), deformity (50%), and daily living/occupational activity limitation (28%). The main indications for surgical management were the presence of deformity, pain, and/or limited range of motion. The most frequently affected anatomic sites were the metacarpophalangeal joints, followed by the elbows, </span>proximal interphalangeal joints<span>, and proximal phalanges. The </span></span>postoperative complication rate was 28%. The most common complications were operative site infections and </span>wound dehiscence. Decreased pain was associated with surgical resection. Additional procedures, such as extensor tenorrhaphy and local flaps, were required in 47.2% of patients.</div></div><div><h3>Conclusion</h3><div>Surgical resection of tophi can decrease pain. Although surgery is associated with a high rate of complications, most are minor.</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":"49 12","pages":"Pages 1275.e1-1275.e10"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9596380","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

Factors Affecting Outcomes After Free Functional Gracilis Muscle Transfer for Elbow Flexion in Brachial Plexus Injury: A Systematic Review and Meta-Analysis 影响臂丛神经损伤患者肘关节屈曲功能性腓肠肌游离转移术后疗效的因素：系统回顾与元分析》。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2024.07.012

Syeda Hoorulain Ahmed MBBS , Ramin Shekouhi MD , Yousef M. Husseiny BS , Eddy Rios BS , Maryam Sohooli MD , Harvey Chim MD

Purpose

Free functional gracilis transfer (FFGT) is a useful option for reconstruction of elbow flexion following brachial plexus injury presenting late or with poor outcomes from previous nerve surgery. In this systematic review and meta-analysis, we aimed to investigate variables associated with superior outcomes. The efficacy of single versus double FFGT, where the first FFGT is performed to restore elbow flexion, and the choice of donor nerve for neurotization were evaluated.

Methods

A meta-analysis was conducted, including studies that provided postoperative Medical Research Council (MRC) grade for elbow flexion, Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores, quantitative elbow flexion strength, and range of motion. A random effects meta-regression analysis was performed to identify factors associated with improved outcomes.

Results

Thirty-seven studies, with 1,607 patients, were analyzed. Single FFGT was reported in 34 studies (n = 1,398), and double FFGT was reported in 10 studies (n = 209). The mean follow-up duration was 37.3 ± 21.1 months. Following single FFGT, 75.4% and 48.9% achieved MRC grades ≥3 and ≥4, respectively. Following double FFGT, 100% achieved an MRC grade ≥3 and 62.7% ≥4. The likelihood of achieving M3 and M4 was significantly greater for double FFGT. Overall, FFGT innervated by the spinal accessory nerve had significantly better recovery of MRC grade ≥3. When comparing only single and double FFGT innervated by spinal accessory nerve, there was no significant difference in recovery of elbow flexion. The meta-regression analysis showed a significant negative correlation between the patient’s age and the probability of achieving an MRC grade of ≥3 and 4.

Conclusions

In the overall analysis encompassing all innervating nerves, double FFGT was superior to single FFGT. Subgroup analysis of single and double FFGT innervated by the spinal accessory nerve showed no significant difference. Increasing age was a significant risk factor for poorer outcomes.

Type of study/level of evidence

Therapeutic IV.

目的：游离功能性腕弓转移术（FFGT）是臂丛神经损伤后重建肘关节屈曲的一种有效方法，这种损伤出现较晚或之前的神经手术效果不佳。在本系统综述和荟萃分析中，我们旨在研究与卓越疗效相关的变量。我们评估了单路 FFGT 与双路 FFGT 的疗效（其中第一路 FFGT 是为恢复肘关节屈曲而进行的），以及神经化供体神经的选择：方法：我们进行了一项荟萃分析，其中包括提供术后肘关节屈曲度、手臂、肩部和手部残疾等级、视觉模拟量表评分、肘关节屈曲定量力量和活动范围的医学研究委员会（MRC）研究。研究人员进行了随机效应元回归分析，以确定与疗效改善相关的因素：共分析了 37 项研究，1,607 名患者。34项研究（n = 1,398）报道了单次FFGT，10项研究（n = 209）报道了双次FFGT。平均随访时间为 37.3 ± 21.1 个月。单次 FFGT 后，分别有 75.4% 和 48.9% 的患者达到 MRC 分级≥3 级和≥4 级。双 FFGT 后，100% 达到 MRC 分级≥3，62.7% ≥4。双 FFGT 达到 M3 和 M4 的可能性明显更大。总体而言，由脊神经附属神经支配的 FFGT 在 MRC 等级≥3 级的恢复情况明显更好。如果仅比较脊髓附属神经支配的单FFGT和双FFGT，则肘关节屈曲的恢复没有明显差异。元回归分析显示，患者的年龄与MRC分级≥3级和4级的概率呈显著负相关：结论：在包括所有支配神经的总体分析中，双FFGT优于单FFGT。对脊柱附属神经支配的单层和双层 FFGT 进行分组分析，结果显示两者无明显差异。年龄的增长是导致疗效不佳的重要风险因素：治疗 IV。

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引用次数: 0

Automating Patient-Reported Outcome Measures Following Hand Surgery. 手部手术后患者报告结果的自动化测量。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 Epub Date: 2023-05-29 DOI: 10.1016/j.jhsa.2023.04.007

Fady Y Hijji, Daniel A London, Andrew D Schneider, Garrhett G Via, Orrin I Franko

Purpose: The purpose of this study was to assess the overall response rate of patients receiving electronic patient-reported outcome measures (ePROMs) following hand surgery and to determine the patient characteristics associated with responding.

Methods: A Health Insurance Portability and Accountability Act-compliant, web-based system was developed to automatically distribute ePROMs to patients undergoing hand surgery at five institutions with 22 surgeons. Patients who were at least 18 years old were eligible. The PROMs used were the visual analog scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). After surgery, ePROMs along with a satisfaction questionnaire were electronically sent three, six, 12, 24, and 52 weeks after surgery.

Results: A total of 6458 patients were eligible. Of these, 80% were enrolled voluntarily. Among these, 70% completed ePROMs for at least one postoperative time point, whereas 30% did not complete any. Among responders, 28% completed all five time points, whereas 72% completed four or fewer time points. Incomplete responders were more likely to be insured by workers' compensation when compared to complete responders. Incomplete responders exhibited higher baseline QuickDASH scores and similar baseline VAS compared to complete responders. During the follow-up, incomplete responders demonstrated worse VAS and QuickDASH scores at all time points. Finally, in comparison with complete responders, incomplete responders were less likely to be satisfied with their surgery at all time points.

Conclusions: This study demonstrates that automated email-based ePROM systems may be an effective method for survey distribution. Particularly for simple, outpatient surgeries, this study illustrates the potential for clinical use of the data obtained from these systems.

Clinical relevance: Patient-reported outcome measures continue to have an expanding role in health care with the rise of valued-based systems. Electronic PROMs are a relatively unexplored medium that may offer a viable alternative to more effectively collecting these valuable patient metrics.

目的：本研究的目的是评估手部手术后接受电子患者报告结果测量（ePROMs）的患者的总体反应率，并确定与反应相关的患者特征。方法：根据《健康保险流通与责任法案》（Health Insurance Portability and Accountability act）的要求，开发了一个基于网络的系统，为5家机构22名外科医生的手部手术患者自动分发eprom。年满18岁的患者才符合条件。采用视觉模拟量表（VAS）评估疼痛和手臂、肩膀和手的快速残疾（QuickDASH）。术后3周、6周、12周、24周和52周，电子发送eprom和满意度问卷。结果：共有6458例患者符合条件。其中80%是自愿参加的。其中，70%的患者在术后至少一个时间点完成了eprom，而30%的患者没有完成任何eprom。在应答者中，28%的人完成了所有五个时间点，而72%的人完成了四个或更少的时间点。与完全应答者相比，不完全应答者更有可能被工人赔偿保险。与完全应答者相比，不完全应答者表现出更高的基线QuickDASH评分和相似的基线VAS。在随访期间，不完全应答者在所有时间点都表现出较差的VAS和QuickDASH评分。最后，与完全应答者相比，不完全应答者在所有时间点对手术的满意度都较低。结论：本研究表明，基于电子邮件的自动化ePROM系统可能是调查分发的有效方法。特别是对于简单的门诊手术，这项研究说明了从这些系统中获得的数据在临床应用的潜力。临床相关性：随着以价值为基础的系统的兴起，患者报告的结果测量继续在卫生保健中发挥越来越大的作用。电子prom是一种相对未开发的媒介，它可能为更有效地收集这些有价值的患者指标提供可行的替代方案。

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引用次数: 0

JOURNAL CME QUESTIONS

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2024.10.012

引用次数: 0

Patient-Perceived Outcomes of Recovery After Trigger Digit Release 触发手指释放后患者感知的恢复结果。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2023.03.016

Philip E. Blazar MD , Dafang Zhang MD , Jessica K. Bryant MD , Kyra A. Benavent BS , Caleb M. Yeung MD , Brandon E. Earp MD

Purpose

Trigger finger release (TFR) is one of the most commonly performed hand surgeries; nevertheless, the time until patients subjectively feel recovered has not been well documented. The limited literature on patient perceptions of recovery after any type of surgery has described that patients and surgeons may have differing views on the time until full recovery. Our primary study question was to determine how long it takes for patients to subjectively feel fully recovered after TFR.

Methods

In this prospective study, patients who underwent isolated TFR completed questionnaires before surgery and at multiple time points following surgery until they reported full recovery. Patients completed visual analog scale (VAS) pain scores and QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and were asked if they felt fully recovered at 4 weeks, 6 weeks, and 3, 6, 9, and 12 months.

Results

The average time to self-reported full recovery was 6.2 months (SD 2.6), and the median time to self-reported full recovery was 6 months (IQR 4 months). At 12 months, four out of 50 patients (8%) did not feel fully recovered. QuickDASH and VAS pain scores improved significantly from preoperative assessment to final follow-up. All patients reported improvement in both VAS pain scores and QuickDASH scores greater than the minimal clinically important difference between 6 weeks and 3 months after surgery. Higher preoperative VAS and QuickDASH scores were associated with failure to fully recover by 12 months after surgery.

Conclusions

The length of time after surgery until patients felt fully recovered after isolated TFR is longer than the senior authors’ expectations. This suggests that patients and surgeons may consider distinctly different parameters when discussing recovery. Surgeons should be aware of this discrepancy when discussing recovery after surgery.

Type of study/level of evidence

Prognostic II.

目的：扳机指松解术（TFR）是最常用的手部手术之一；然而，直到病人主观感觉恢复的时间没有很好的记录。关于任何类型手术后患者对恢复的看法的有限文献描述了患者和外科医生可能对完全恢复的时间有不同的看法。我们的主要研究问题是确定患者在TFR后主观感觉完全恢复需要多长时间。方法：在这项前瞻性研究中，接受孤立性TFR的患者在手术前和术后多个时间点完成问卷调查，直到他们报告完全康复。患者完成视觉模拟量表（VAS）疼痛评分和QuickDASH（手臂、肩膀和手的残疾），并询问他们在4周、6周、3、6、9和12个月时是否感觉完全恢复。结果：自报告完全恢复的平均时间为6.2个月（SD 2.6），自报告完全恢复的中位时间为6个月（IQR 4个月）。12个月时，50名患者中有4名（8%）感觉没有完全康复。从术前评估到最终随访，QuickDASH和VAS疼痛评分均有显著改善。手术后6周和3个月，所有患者报告的VAS疼痛评分和QuickDASH评分的改善大于最小的临床重要差异。术前VAS和QuickDASH评分较高与术后12个月未能完全恢复相关。结论：孤立性TFR术后患者感觉完全恢复的时间比资深作者预期的要长。这表明患者和外科医生在讨论恢复时可能考虑明显不同的参数。外科医生在讨论术后恢复时应该注意到这种差异。研究类型/证据水平：预后II。

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引用次数: 0

Diagnosis and Management of Hand Infections 手部感染诊断与管理的当前概念》（Current Concepts in Diagnosis and Management of Hand Infections）。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2024.09.001

Ethan Song MD , Jessica Seidelman MD, MPH , Warren Hammert MD, DDS , Eliana Saltzman MD

Hand and upper-extremity infections span a broad spectrum of presentations for the hand surgeon, primary care provider, and emergency medicine practitioner. As many hand infections arise from penetrating trauma, knowledge of the offending pathogen, location, and mode of spread allows the clinician to determine the appropriate intervention. Along with a thorough history and physical examination, patient factors such as age, occupation, medical comorbidities, and surgical history should be noted. Timely diagnosis and appropriate management allow for optimal recovery and outcomes. In this article, we describe the ongoing debate regarding the timing and influence of preoperative antibiotics on culture yield, timing of debridement for open fractures as it relates to infection risk, and strategies for obtaining adequate cultures to guide antibiotic therapy for complex infections such as periprosthetic joint and hardware infections. Given the changing epidemiological landscape and increased rates of antibiotic resistance, it is critical to promote antibiotic stewardship. We provide updated treatment recommendations and antibiotic profiles for the treatment of common hand infections. Finally, we discuss newer technologies such as next-generation sequencing and development of promising diagnostic and treatment strategies that will enhance the hand surgeon’s ability to treat complex hand infections.

手部和上肢感染对于手外科医生、初级保健提供者和急诊医生来说是一种广泛的病症。由于许多手部感染都是由穿透性创伤引起的，因此了解病原体、感染部位和传播方式有助于临床医生确定适当的干预措施。在全面了解病史和体格检查的同时，还应注意患者的年龄、职业、合并症和手术史等因素。及时的诊断和适当的治疗可使患者获得最佳的康复和预后。在这篇文章中，我们介绍了目前关于术前使用抗生素的时机及其对培养率的影响、开放性骨折清创时机与感染风险的关系，以及获得充分培养以指导复杂感染（如假体周围关节和硬件感染）抗生素治疗的策略等方面的争论。鉴于流行病学形势的变化和抗生素耐药性的增加，推广抗生素管理至关重要。我们提供了治疗常见手部感染的最新治疗建议和抗生素简介。最后，我们讨论了下一代测序等更新的技术，以及有望提高手外科医生治疗复杂手部感染能力的诊断和治疗策略的发展。

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引用次数: 0

Revision Surgery Following Primary Reconstruction for Hand Syndactyly 手部畸形初次重建后的翻修手术

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/j.jhsa.2024.08.012

Zoe E. Belardo BA , Emily M. Graham MD , Meagan Pehnke MS , Benjamin Chang MD , Shaun D. Mendenhall MD , Sayaka Mori BA , Apurva S. Shah MD, MBA

Purpose

Web creep and scar contracture are established complications of syndactyly reconstruction; however, few reports characterize risk factors for revision surgery. The purpose of this investigation was to examine the rate and risk factors of reoperation for congenital hand syndactyly.

Methods

Patients undergoing syndactyly reconstruction from 2007 to 2021 at a single children’s hospital were reviewed. Cases with less than 1 year of follow-up were excluded. Demographic, surgical, and outcomes data were recorded by each web space to account for mixed treatments.

Results

In total, 514 web spaces in 231 children were reviewed with a mean follow-up of 6.0 years after primary reconstruction; 66 (12.8%) web spaces in 51 (22.1%) children underwent revision. The most common procedures were web space deepening due to web creep (57.9% of cases) and digital scar contracture release (45.6%); these were augmented in a minority (17.5%) of cases by other aesthetic/functional procedures. Revisions occurred at a median of 1.7 years after primary reconstruction. First web spaces (thumb–index finger) were most frequently reoperated (33.3%). On multivariable analysis, first web space involvement, complete syndactyly, and complications after the primary reconstruction significantly increased odds of revision. Age at primary reconstruction was not a significant predictor. Following revision, 10.5% of cases had recurrent web creep, and 14.0% had recurrent scar contracture. Eight (1.6%) web spaces in seven (3.0%) children required multiple revisions.

Conclusions

Approximately 13% of syndactyly reconstructions (22% of patients) require reoperation. Most revisions occur within 4 years of primary reconstruction. Complete syndactyly, complications after the primary reconstruction, and first web space involvement increase the risk of revision; age at primary reconstruction is not a risk factor. Revision outcomes mirror the index procedure, with 10% to 14% of revised web spaces experiencing recurrent web creep or contracture.

Type of study/level of evidence

Therapeutic IV.

目的：蹼蠕变和瘢痕挛缩是并指畸形重建的既定并发症；然而，很少有报道描述翻修手术的风险因素。本调查旨在研究先天性手畸形再手术的比例和风险因素：方法：对 2007 年至 2021 年期间在一家儿童医院接受并指畸形重建手术的患者进行回顾性研究。随访时间不足一年的病例被排除在外。每个网络空间都记录了人口统计学、手术和结果数据，以考虑混合治疗的情况：共对 231 名儿童的 514 个蹼间隙进行了回顾性研究，初次重建后的平均随访时间为 6.0 年；51 名儿童（22.1%）的 66 个蹼间隙（12.8%）进行了翻修。最常见的手术是因蹼蠕变而进行的蹼间隙加深（57.9%的病例）和数字瘢痕挛缩松解（45.6%）；少数病例（17.5%）通过其他美学/功能性手术增加了蹼间隙。翻修发生在初次重建后的中位 1.7 年。第一蹼间隙（拇指-食指）最常发生再次手术（33.3%）。在多变量分析中，第一蹼间隙受累、完全联合畸形和初次重建后的并发症会显著增加翻修的几率。初次重建时的年龄不是重要的预测因素。翻修后，10.5%的病例出现复发性蹼间隙蠕变，14.0%的病例出现复发性瘢痕挛缩。7名儿童（3.0%）中的8个（1.6%）蹼间隙需要多次翻修：结论：约有13%的联合畸形重建手术（22%的患者）需要再次手术。大多数翻修手术发生在初次重建后的 4 年内。完全性联合畸形、初次重建后的并发症和第一蹼间隙受累会增加翻修的风险；初次重建时的年龄不是风险因素。翻修手术的结果与指数手术相同，10%到14%的翻修蹼间隙会出现复发性蹼蠕动或挛缩：治疗四级。

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引用次数: 0