Journal of Hand Surgery-American Volume最新文献

英文中文

Comparison of Different Methods of Measuring Finger Range of Motion via Telehealth 远程医疗测量手指活动度不同方法的比较。

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.2023.03.018

Kory Bettencourt MS , Ingrid Parry MS , Miranda Yelvington MS , Sandra Taylor PhD , David Greenhalgh MD , Michelle A. James MD

Purpose

This study examined the accuracy and reliability of measuring total motion of the fingers via telehealth using the following three different methods: (1) goniometry, (2) visual estimation, and (3) electronic protractor. Measurements were compared with in-person measurement, which was assumed to be the reference standard.

Methods

Thirty clinicians measured finger range of motion from prerecorded videos of a mannequin hand with articulating fingers, which was posed in extension and flexion that simulated a telehealth visit, using a goniometer with results blinded to the clinician (blinded goniometry), visual estimation, and an electronic protractor, in random order. Total motion was calculated for each finger and for all four fingers in sum. The experience level, familiarity with measuring finger range of motion, and opinions of measurement difficulty were assessed.

Results

Measurement with the electronic protractor was the only method equivalent to the reference standard within 20°. Remote goniometer and visual estimation did not fall within the acceptable error margin of equivalence, and both underestimated total motion. Electronic protractor also had the highest interrater reliability (intraclass correlation [upper limit, lower limit], 0.95 [0.92, 0.95]); goniometry (intraclass correlation, 0.94 [0.91, 0.97]) was nearly identical, whereas visual estimation (intraclass correlation, 0.82 [0.74, 0.89]) was much lower. Clinicians’ experience and familiarity with range of motion measurements had no relationship with the findings. Clinicians reported visual estimation as the most difficult (80%) and electronic protractor as the easiest method (73%).

Conclusions

This study showed that traditional in-person forms of measurement underestimate finger range of motion via telehealth; a new computer-based method (ie, electronic protractor) was found to be more accurate.

Clinical Relevance

The use of an electronic protractor can be beneficial to clinicians measuring range of motion in patients virtually.

目的：探讨三种不同方法(1)测角法、(2)目测法和(3)电子量角器在远程医疗中测量手指总运动的准确性和可靠性。将测量值与现场测量值进行比较，并假设现场测量值为参考标准。方法：30名临床医生从预先录制的模拟远程医疗访问的具有关节手指的假人手的视频中测量手指的运动范围，该假人手摆出伸展和弯曲的姿势，使用对临床医生不知情的测角仪（盲测角仪），视觉估计和电子量角器，按随机顺序测量。计算每个手指和所有四个手指的总运动。评估经验水平、对测量手指活动度的熟悉程度和对测量难度的看法。结果：电子量角器是20°范围内唯一与参考标准相当的测量方法。遥测角仪和目视估计均未落在可接受的等效误差范围内，均低估了总运动。电子量角器的组间信度也最高（组内相关[上限，下限]，0.95 [0.92,0.95]）；角形测量（类内相关性，0.94[0.91,0.97]）几乎相同，而视觉估计（类内相关性，0.82[0.74,0.89]）要低得多。临床医生的经验和对运动范围测量的熟悉程度与结果无关。临床医生报告视觉估计是最困难的（80%），电子量角器是最简单的方法（73%）。结论：本研究表明，通过远程医疗，传统的面对面测量形式低估了手指的运动范围；人们发现以计算机为基础的新方法（即电子量角器）更为精确。临床相关性：使用电子量角器可以帮助临床医生测量患者的虚拟活动度。

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引用次数: 0

Limiting Levels of Fingertip Replantation Without Venous Anastomosis 无静脉吻合术指尖再植的限制水平。

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.2023.04.013

Tatsuya Hara PhD , Shigeru Kurimoto PhD , Toshikazu Kurahashi PhD , Yutaro Kuwahara MD , Hiroki Takeshige MD , Shiro Urata MD

Purpose

This study aimed to compare the success rates of fingertip replantation with and without venous anastomosis.

Methods

This retrospective study included 132 patients with 148 fingertip injuries who had undergone fingertip replantation (Ishikawa's classification I‒IV) between 2003 and 2020 at our hospital. Among them, 117 and 15 were men and women respectively, and their mean age was 43 years. There were 53, 44, and 51 fingertips with Ishikawa subzone II, III, and IV amputations respectively, and no cases were classified as Ishikawa subzone I. Venous anastomosis was performed on 64 fingertips (group A). This was not possible in the remaining 84 fingertips; thus, an external bleeding method was used (group B). Our external bleeding protocol consisted of 4-hourly skin pricks of the distal pulp with a 23-gauge needle for the first 5 days. The analyses included survival rates, hemoglobin levels (Hb), and blood transfusions administered.

Results

The overall survival rate was 90.5% (134 of 148). In group A, survival was achieved in 92.3%, 100%, and 94.3% of those with subzones II, III, and IV amputations, respectively. In group B, survival was achieved in 100%, 82.1%, and 62.5% of those with subzones II, III, and IV, respectively. Subzone IV in group B showed a significantly lower rate of replantation success. In groups A and B, the preoperative and 7-day postoperative Hb levels were 14.5 g/dL and 14.6 g/dL, and 11.3 g/dL, and 11.6 g/dL, respectively. In addition, blood transfusion was required for five patients (7.9%) in group A and six patients (7.9%) in group B. Thus, the Hb levels and blood transfusion administered were similar between the two groups.

Conclusions

Subzone IV is an important threshold for artery-only replantation. Furthermore, our external bleeding protocol is a safe and effective method.

Type of study/level of evidence

Therapeutic IV.

目的：比较静脉吻合术与非静脉吻合术指尖再植的成功率。方法：回顾性分析我院2003年至2020年收治的132例148例指尖损伤患者（Ishikawa分类I-IV型）再植术。其中男性117人，女性15人，平均年龄43岁。分别有53、44、51个指尖存在Ishikawa II亚区、III亚区和IV亚区截肢，没有一例属于Ishikawa i亚区。A组64个指尖进行了静脉吻合，其余84个指尖无法进行静脉吻合；因此，采用外出血方法（B组）。我们的外出血方案包括在前5天用23号针每4小时穿刺远端牙髓。分析包括存活率、血红蛋白水平（Hb）和输血量。结果：总生存率为90.5%（134 / 148）。A组II区、III区和IV区截肢患者的生存率分别为92.3%、100%和94.3%。B组II、III和IV亚区患者的生存率分别为100%、82.1%和62.5%。B组IV区再植成功率明显降低。A组和B组术前和术后7天Hb水平分别为14.5 g/dL和14.6 g/dL， 11.3 g/dL和11.6 g/dL。此外，A组有5例（7.9%）患者需要输血，b组有6例（7.9%）患者需要输血。因此，两组之间的Hb水平和输血量相似。结论：IV区是单纯动脉再植的重要阈值。此外，我们的体外出血方案是一种安全有效的方法。研究类型/证据水平：治疗性IV。

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引用次数: 0

Short-Term Patient Outcomes After Placement of an Internal Joint Stabilizer for Terrible Triad Injuries: A Multicenter Study 一项多中心研究：置入内关节稳定器治疗可怕三联征损伤后的短期疗效。

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.2023.04.003

Daniel A. London MD, MS , Erica Umpierrez MD , Gabrielle Notorgiacomo BS , Phillip R. Ross MD , Michael Wigton MD , John D. Wyrick MD , Reed W. Hoyer MD

Purpose

The purpose of this study was to assess the functional and patient-reported outcomes after the use of the internal joint stabilizer (IJS) for unstable terrible triad injuries. Specifically, we sought to determine our complication rate and the impact of complications on patient outcomes.

Methods

We identified all patients who had an IJS placed as a supplemental fixation for a terrible triad injury at two urban, level 1 academic medical centers. We reviewed these patients’ charts for demographic information, complication profiles, postoperative range of motion (ROM), and pain-level data. We also collected the QuickDASH and Patient-Rated Elbow Evaluation (PREE) scores. Descriptive statistics were reported. Final visit data were compared between patients who returned to the OR for a complication and those who did not.

Results

From 2018 to 2020, 29 patients had an IJS placed for a terrible triad injury. The median final follow-up was 6.3 months after surgery (IQR: 6.2 months). There were 38 complications in 19 patients (65.5%) that required 12 patients to return to the OR (41.3%) for procedures beyond simple IJS removal. There were no significant differences in the ROM between patients who returned to the OR for a complication and those who did not. QuickDASH and PREE scores were greater (indicating more disability) in patients who had a complication that required a secondary surgical procedure.

Conclusions

Patients who receive an IJS incur a high rate of complications. When patients sustain complications that require secondary surgeries, their ultimate functional outcome scores worsen.

Type of study/level of evidence

Therapeutic IV.

目的：本研究的目的是评估使用内关节稳定器（IJS）治疗不稳定可怕三联征损伤后的功能和患者报告的结果。具体来说，我们试图确定我们的并发症发生率和并发症对患者预后的影响。方法：我们确定了所有在两个城市一级学术医疗中心接受IJS作为可怕三联征损伤补充固定的患者。我们回顾了这些患者的图表，包括人口统计信息、并发症概况、术后活动范围（ROM）和疼痛水平数据。我们还收集了QuickDASH和患者肘部评分（PREE）评分。进行描述性统计。将因并发症而返回手术室的患者和未因并发症而返回手术室的患者的最终就诊数据进行比较。结果：2018年至2020年，29例患者因可怕的三联征损伤而放置IJS。中位最终随访时间为术后6.3个月（IQR: 6.2个月）。19例患者（65.5%）中有38例并发症，需要12例患者（41.3%）返回手术室进行简单的IJS切除手术。在因并发症而返回手术室的患者和未返回手术室的患者之间，ROM没有显著差异。在有并发症需要二次手术的患者中，QuickDASH和PREE评分更高（表明更多的残疾）。结论：接受IJS的患者并发症发生率高。当患者出现并发症需要二次手术时，其最终功能结局评分会恶化。研究类型/证据水平：治疗性IV。

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引用次数: 0

Range of Motion Following Flexor Tendon Repair: Comparing Active Flexion and Extension With Passive Flexion Using Rubber Bands Followed by Active Extension 屈肌腱修复后的活动范围：比较主动屈伸与使用橡皮筋被动屈伸，然后再进行主动伸展。

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.2024.08.003

Markus Renberg MD , Jonas Svingen PT, PhD , Marianne Arner MD, PhD , Simon Farnebo MD, PhD

Purpose

This study aimed to compare the outcome in terms of range of motion between early active flexion and extension (early active motion, [EAM]) and passive flexion using rubber bands followed by active extension (sometimes referred to as a Kleinert regimen) after flexor tendon repair in zones 1 and 2.

Methods

Data were collected from the Swedish national health care registry for hand surgery (HAKIR). Rehabilitation regimens were decided by the preference of each caregiver. At 3 months, 828 digits (656 EAM and 172 passive flexion) and at 12 months, 448 digits (373 EAM and 75 passive flexion) were available for analysis. Thumbs were analyzed separately.

Results

No notable difference in total active motion was found between the groups at 12 months of follow-up.

Conclusions

This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols.

Type of study/level of evidence

Therapeutic IV.

目的：本研究旨在比较屈肌腱修复术后1区和2区早期主动屈伸（早期主动运动）和使用橡皮筋被动屈伸后主动伸展（有时称为Kleinert疗法）在运动范围方面的效果：数据收集自瑞典全国手部手术医疗登记处（HAKIR）。康复方案由每位护理人员自行决定。3个月时有828个手指（656个EAM和172个被动屈曲），12个月时有448个手指（373个EAM和75个被动屈曲）可供分析。对拇指进行了单独分析：结果：随访 12 个月时，两组在总主动运动方面没有发现明显差异：这项大型登记研究支持这样的假设，即与被动运动方案相比，EAM 康复可能不会带来更好的长期运动范围：治疗 IV.

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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.2024.10.013

引用次数: 0

Delivery of Hand Care to Patients With High Anxiety Burden 为高度焦虑的患者提供手部护理。

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.2024.08.005

Caellagh D. Catley BA , Sarah C. Romans BS , Abby L. Cheng MD, MPHS , Ryan P. Calfee MD, MSc

Purpose

To determine whether patients presenting with Patient-Reported Outcome Measurement Information System (PROMIS) anxiety scores at >95th percentile of the US population undergo elective hand surgery at rates different from patients with less anxiety. Secondarily, we aimed to assess surgeon notation of these patients’ emotional states and incidences of postoperative complications.

Methods

This single-center retrospective cohort study analyzed data from new adult patients presenting for hand care between January 2019 and December 2020. Patients with initial PROMIS anxiety scores ≥70 were identified as the high anxiety burden (HAB) group. For each patient with HAB presenting with carpal tunnel syndrome, trigger finger, and distal radius fractures (n = 45), three controls were matched (n = 135). After matching, bivariate statistical analysis compared outcome variables of interest between patient groups. Sentiment analysis was used to explore if patient anxiety was realized and considered in surgical decision making.

Results

After matching, patients with HAB averaged baseline PROMIS scores in every assessed domain that were ≥1 SD worse than unaffected patients. Patients with HAB and control patients were offered surgery at a comparable rate (58% vs 47%). Among those offered surgery, patients with HAB were less likely to undergo surgery (73% vs 92%). Postoperative complications occurred more frequently in the patients with HAB (32% vs 8%). Sentiment analysis of office notes revealed that the patients with HAB had their emotional state explicitly noted more often (40% vs 24%), but the majority of patients with HAB did not have this addressed in records.

Conclusions

Patients with HAB both underwent surgery offered less frequently and when undergoing surgery, experienced more complications. Surgeons are likely to miss opportunities to positively influence extreme patient anxiety as most patients with HAB were treated without mention of their emotional state. Future investigations should explore whether preoperative anxiety alleviation could diminish these disparities.

Type of study/level of evidence

Symptom Prevalence III.

目的：确定患者报告结果测量信息系统（PROMIS）焦虑评分大于美国人口第95百分位数的患者接受手部择期手术的比例是否与焦虑程度较低的患者不同。其次，我们旨在评估外科医生对这些患者情绪状态的记录以及术后并发症的发生率：这项单中心回顾性队列研究分析了 2019 年 1 月至 2020 年 12 月期间前来接受手部护理的成年新患者的数据。初始 PROMIS 焦虑评分≥70 分的患者被确定为高焦虑负担（HAB）组。对于每名患有腕管综合征、扳机指和桡骨远端骨折的 HAB 患者（n = 45），匹配三名对照组患者（n = 135）。配对后，进行双变量统计分析，比较患者组之间的相关结果变量。情感分析用于探究患者的焦虑是否已被意识到并在手术决策中得到考虑：匹配后，HAB 患者在每个评估领域的平均 PROMIS 基线得分比未受影响的患者差≥1 SD。HAB患者和对照组患者获得手术治疗的比例相当（58% vs 47%）。在接受手术的患者中，HAB 患者接受手术的几率较低（73% 对 92%）。HAB 患者的术后并发症发生率更高（32% 对 8% ）。对诊室记录的情感分析显示，HAB 患者的情绪状态被明确记录的比例更高（40% 对 24%），但大多数 HAB 患者的记录中并没有提及这一点：结论：HAB 患者接受手术的频率较低，而且在接受手术时并发症较多。由于大多数 HAB 患者在接受治疗时都没有提及自己的情绪状态，因此外科医生很可能会错失对患者极度焦虑产生积极影响的机会。未来的研究应探讨减轻术前焦虑是否能减少这些差异：症状发生率 III.

{"title":"Delivery of Hand Care to Patients With High Anxiety Burden","authors":"Caellagh D. Catley BA , Sarah C. Romans BS , Abby L. Cheng MD, MPHS , Ryan P. Calfee MD, MSc","doi":"10.1016/j.jhsa.2024.08.005","DOIUrl":"10.1016/j.jhsa.2024.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether patients presenting with Patient-Reported Outcome Measurement Information System (PROMIS) anxiety scores at >95th percentile of the US population undergo elective hand surgery at rates different from patients with less anxiety. Secondarily, we aimed to assess surgeon notation of these patients’ emotional states and incidences of postoperative complications.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study analyzed data from new adult patients presenting for hand care between January 2019 and December 2020. Patients with initial PROMIS anxiety scores ≥70 were identified as the high anxiety burden (HAB) group. For each patient with HAB presenting with carpal tunnel syndrome, trigger finger, and distal radius fractures (n = 45), three controls were matched (n = 135). After matching, bivariate statistical analysis compared outcome variables of interest between patient groups. Sentiment analysis was used to explore if patient anxiety was realized and considered in surgical decision making.</div></div><div><h3>Results</h3><div>After matching, patients with HAB averaged baseline PROMIS scores in every assessed domain that were ≥1 SD worse than unaffected patients. Patients with HAB and control patients were offered surgery at a comparable rate (58% vs 47%). Among those offered surgery, patients with HAB were less likely to undergo surgery (73% vs 92%). Postoperative complications occurred more frequently in the patients with HAB (32% vs 8%). Sentiment analysis of office notes revealed that the patients with HAB had their emotional state explicitly noted more often (40% vs 24%), but the majority of patients with HAB did not have this addressed in records.</div></div><div><h3>Conclusions</h3><div>Patients with HAB both underwent surgery offered less frequently and when undergoing surgery, experienced more complications. Surgeons are likely to miss opportunities to positively influence extreme patient anxiety as most patients with HAB were treated without mention of their emotional state. Future investigations should explore whether preoperative anxiety alleviation could diminish these disparities.</div></div><div><h3>Type of study/level of evidence</h3><div>Symptom Prevalence III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"49 12","pages":"Pages 1212-1218"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301277","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}

引用次数: 0

Outcome of Trapeziectomy and Ligament Reconstruction and Tendon Interposition for Patients Aged Less Than 56 Years: A Retrospective Study With a Minimum 5-Year Follow-Up 年龄小于 56 岁患者的梯形切除术和韧带重建及肌腱间置术的效果：至少随访 5 年的回顾性研究。

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.2024.07.024

Iman Hameed MD , Ellen Tomkinson BSc , Omer Slevin MD , David McCombe MBBS, MD , Anthony C. Berger MBBS , Stephen K. Tham MBBS

Purpose

The purpose of this study was to determine the long-term consequences of trapeziectomy and ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal osteoarthritis in patients aged less than 56 years.

Methods

A retrospective study was performed to investigate the outcome of trapeziectomy and LRTI with a follow-up period of greater than 5 years in patients aged less than 56 years at the time of surgery. Patients completed the Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a 10-point visual analog score for pain (VAS). Objective assessments included thumb opposition, palmar and radial abduction angles, and grip, lateral key, and thumb tip pinch strengths. Radiographic assessments of the thumb carpometacarpal joint were performed in three planes, and the trapezial space and trapezial space to metacarpal height ratios were calculated.

Results

Between January 2005 and December 2017, 105 patients were treated. Forty-eight patients with 58 thumbs returned for review. The mean patient age at the time of surgery was 52.5 years, and 96% of the patients were women. The mean follow-up period from surgery was 11 years. The mean VAS score was 1. A significant association was found between younger age at the time of surgery and increased proximal migration of the metacarpal, between high VAS pain scores and high PRWE and DASH scores, weak grip, lateral key pinch and thumb tip pinch strength, and Kapandji score, and between the follow-up period and increasing VAS pain, PRWE, and DASH scores.

Conclusions

Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. The benefits of surgery should be balanced against the deterioration in the outcome measures of DASH and PRWE and increasing VAS scores with increasing intervals from surgery.

Type of study/level evidence

Therapeutic IV.

目的：本研究旨在确定年龄小于 56 岁的患者接受梯形骨切除术和韧带重建及肌腱插置术（LRTI）治疗梯形掌骨性关节炎的长期后果：我们进行了一项回顾性研究，调查了手术时年龄小于 56 岁的患者接受梯形骨切除术和韧带重建及肌腱间置术后超过 5 年的随访结果。患者完成了 "手臂、肩部和手部残疾"（DASH）、"患者评定腕部评估"（PRWE）和10点疼痛视觉模拟评分（VAS）。客观评估包括拇指对位、掌侧和桡侧外展角、握力、侧键和拇指尖捏力。对拇指腕掌关节的三个平面进行了放射学评估，并计算了腕掌间隙和腕掌间隙与掌骨高度比：2005年1月至2017年12月，105名患者接受了治疗。有 48 名患者的 58 个拇指返回接受复查。手术时患者的平均年龄为52.5岁，96%的患者为女性。手术后的平均随访时间为 11 年。结果发现，手术时年龄较小与掌骨近端移位增加之间、VAS疼痛评分较高与PRWE和DASH评分、握力减弱、侧键捏力和拇指尖捏力以及Kapandji评分之间、随访时间与VAS疼痛、PRWE和DASH评分增加之间存在显著关联：对于年龄小于 56 岁的患者来说，斜方肌切除术和 LRTI 是有效的手术方法。结论：对于 56 岁以下的患者，椎弓根切除术和 LRTI 是有效的手术，但手术的益处应与 DASH 和 PRWE 结果指标的恶化以及随着手术间隔的延长而增加的 VAS 评分相平衡：治疗 IV.

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引用次数: 0

2024 ASSH MEMBERS IN MEMORIAM

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.2024.11.001

引用次数: 0

2024 Consultant Reviewers

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.2024.11.002

引用次数: 0

Journal CME Instructions

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2024-12-01 DOI: 10.1016/S0363-5023(24)00539-2

引用次数: 0

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