Journal of Hand Surgery-American Volume最新文献_第9页

Reconstruction of Thumb and Index Flexion in High Median Nerve Paralysis Using a Single Radial Wrist Extensor Tendon Transfer 单桡腕伸肌腱移植重建高正中神经麻痹患者拇指和食指屈曲。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.10.016

Lahin M. Amlani MD , Nicholas Calotta MD , Sami Tuffaha MD , Jayme A. Bertelli MD, PhD

Purpose

Chronic paralysis of the flexor pollicis longus (FPL) and the index flexor digitorum profundus (FDP) is commonly treated with brachioradialis transfer to the FPL and side-to-side suturing of the index FDP to the FDPs of the ulnar digits. We report the clinical outcomes of nine patients in whom the extensor carpi radialis brevis (ECRB) or longus (ECRL) was transferred to both the FPL and index FDP.

Methods

We reviewed nine patients who underwent tendon transfer of the ECRB/L to both the FPL and index FDP. Postoperative assessments included strength grading of the FPL and index FDP using the Medical Research Council (MRC) scale, range of motion, and key pinch strength. The follow-up ranged from 4 to 58 months.

Results

Flexor pollicis longus and index FDP paralysis resulted from traumatic high median nerve injuries (n = 4), infraclavicular brachial plexus injuries (n = 3), Parsonage–Turner syndrome (n = 1), and neurofibromatosis type 2 (n = 1). All nine patients regained full thumb range of motion with MRC grade 4 strength. Seven patients achieved full active and passive range of motion of the index finger, although one required a secondary procedure to adjust index FDP tension. All patients had MRC grade 4 strength at the index distal interphalangeal joint. The mean key pinch strength was 3.4 kg, approximately 40% of the contralateral hand.

Conclusions

Tendon transfer of ECRB/L to both the FPL and index FDP is a viable surgical alternative for restoring thumb and index finger flexion.

Type of study/level of evidence

Therapeutic V.

目的：拇长屈肌（FPL）和指深屈肌指数（FDP）的慢性麻痹通常采用肱桡肌转移至拇深屈肌，并将指深屈肌指数与尺指深屈肌指数侧对侧缝合治疗。我们报告了9例桡侧腕短伸肌（ECRB）或长伸肌（ECRL）同时转移到FPL和指数FDP的患者的临床结果。方法：我们回顾了9例将ECRB/L肌腱转移到FPL和指数FDP的患者。术后评估包括使用医学研究委员会（MRC）量表对FPL和指数FDP进行强度分级、活动范围和关键捏紧强度。随访时间为4 ~ 58个月。结果：外伤性高正中神经损伤（n = 4）、锁骨下臂丛神经损伤（n = 3）、Parsonage-Turner综合征（n = 1）和2型神经纤维瘤病（n = 1）导致拇长屈肌和指数FDP麻痹。所有9名患者均恢复拇指活动范围，MRC 4级强度。7例患者实现了食指的完全主动和被动活动范围，尽管1例需要二次手术来调整食指FDP张力。所有患者在食指远端指间关节处的MRC强度均为4级。平均键捏强度为3.4 kg，约为对侧手的40%。结论：ECRB/L肌腱转移到FPL和食指FDP是恢复拇指和食指屈曲的可行手术选择。研究类型/证据水平：治疗性V。

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引用次数: 0

Clinical and Imaging Findings of Wrist Tuberculosis: A Study of 47 Patients 47例腕部结核的临床和影像学表现。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.05.015

Jia-Lu Wei MM , Yan Bi MM , Xu-Wen Fu BD , Min Qi BD , Ying Pu MM , Fang Xiao BD , Xiang Li MM , Xin-Hua Cun MM

Purpose

This study aimed to describe the clinical and imaging features of patients with wrist tuberculosis (TB) and to explore the importance of magnetic resonance imaging (MRI) in the evaluation and treatment of wrist TB.

Methods

The clinical and imaging data of 47 patients with wrist TB, diagnosed through a combination of pathological (microbiological culture, polymerase chain reaction, and histopathological examination) and clinical methods, were retrospectively analyzed. The demographic characteristics, clinical symptoms, laboratory tests, and imaging findings of these patients were recorded.

Results

The mean age of the patients was 53.9 ± 15.3 years, and the time from the onset of the patient’s symptoms to the diagnosis of wrist TB was 16.2 ± 25.6 months. The main clinical manifestations included wrist pain (100%), wrist swelling (97.9%), and limited wrist joint movement (89.4%). According to the X-ray findings, wrist TB was classified into the synovitis stage (stage I, n = 22; 46.8%) and the bone erosion/destruction stage (stage II, n = 25; 53.2%). The MRI manifestations included bone destruction (87.2%) and synovitis (100%), and other manifestations included joint space narrowing (44.7%), tendon sheath involvement (66.0%), abscess formation (42.6%), and rice body formation (12.8%). Early bone destruction, not seen on plain radiographs (46.8%), was detected by MRI examination. There was an increase in the proportions of dorsal soft tissue abscesses and distal radioulnar joint abscesses detected by MRI examination in stage II patients compared with stage I patients.

Conclusions

MRI can serve as an important adjunct in the diagnosis of wrist TB, offering valuable insights into bone, joint, and soft tissue involvement that may not be visible on plain radiographs.

Type of study/level of evidence

Diagnostic IV.

目的：本研究旨在描述腕部结核（TB）患者的临床和影像学特征，探讨磁共振成像（MRI）在腕部结核评估和治疗中的重要性。方法：回顾性分析47例经病理（微生物培养、聚合酶链反应、组织病理学检查）和临床相结合诊断的腕部结核患者的临床和影像学资料。记录这些患者的人口学特征、临床症状、实验室检查和影像学表现。结果：患者平均年龄为53.9±15.3岁，从患者出现症状到诊断为腕部结核的时间为16.2±25.6个月。主要临床表现为腕部疼痛（100%）、腕部肿胀（97.9%）、腕关节活动受限（89.4%）。根据x线表现，腕部结核分为滑膜炎期(I期，n = 22；46.8%)和骨侵蚀/破坏阶段(II期，n = 25；53.2%)。MRI表现为骨破坏（87.2%）、滑膜炎（100%），其他表现为关节间隙狭窄（44.7%）、肌腱鞘受累（66.0%）、脓肿形成（42.6%）、米体形成（12.8%）。早期骨破坏，平片未见（46.8%），可通过MRI检查发现。与I期患者相比，II期患者MRI检查中发现的背侧软组织脓肿和尺桡关节远端脓肿的比例增加。结论：MRI可以作为腕部结核诊断的重要辅助手段，对骨、关节和软组织受累情况提供有价值的见解，这些在x线平片上可能看不到。研究类型/证据水平：诊断IV。

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引用次数: 0

Controversies in the Management of Proximal Humerus Fractures 肱骨近端骨折治疗的争议。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.07.009

Nicholas Brule MD , Yagiz Ozdag MD , Louis C. Grandizio DO

Proximal humerus fractures (PHFs) are frequently encountered by upper-extremity surgeons. Despite recent advances in both surgical techniques and implant designs, numerous management controversies exist that are primarily centered on indications for operative treatment as well as the decision to use fixation techniques or arthroplasty in the management of these injuries in older patients. The introduction and widespread adoption of reverse total shoulder arthroplasty in the management of three- and four-part PHFs represents a paradigm shift with respect to operative treatment options. This review discusses modern management controversies surrounding adult PHFs, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions for management by incorporating results of recent randomized controlled trials assessing treatment outcomes following management of PHFs.

肱骨近端骨折（phf）是上肢外科医生经常遇到的。尽管近年来手术技术和植入物设计都取得了进展，但仍存在许多管理上的争议，这些争议主要集中在手术治疗的指征以及在老年患者中使用固定技术或关节置换术来处理这些损伤。在治疗三节段和四节段phf中引入和广泛采用反向全肩关节置换术代表了手术治疗选择的范式转变。这篇综述讨论了围绕成人phf的现代管理争议，包括手术指征、髓内钉和辅助固定的作用，以及反向全肩关节置换术的时机和技术，通过结合最近评估phf管理后治疗结果的随机对照试验的结果，帮助外科医生做出基于证据的管理决策。

引用次数: 0

Treatment of Severe Dupuytren Disease in Two Steps: Progressive Distraction With External Fixator and Percutaneous Needle Fasciotomy 两步治疗严重双胎病：外固定器渐进式牵张和经皮筋膜针切开术。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.02.002

Massimo Corain MD , Umberto Lavagnolo MD

Purpose

Severe Dupuytren disease (DD) remains a surgical challenge. Several minimally invasive treatment methods exist, including the use of a distractible angular external fixator (DAEF) followed by collagenase injection. The purpose of this study was to investigate the combination of DAEF followed by percutaneous needle fasciotomy (PNF) in patients with advanced stage of DD.

Methods

This prospective observational study evaluated the outcomes of 52 patients (56 DAEF implanted) with DD in stages III–IV according to the Tubiana classification, who underwent progressive extension on the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints through the application of DAEF followed by PNF in the palm and proximal phalangeal volar side. A postoperative splint was applied. Patients were evaluated at 1-year follow-up by measuring the angle of extension deficit, pain, and the Disability of the Arm, Shoulder, and Hand (DASH) score.

Results

The distraction lasted 21.9 ± 3.8 days (minimum 16 days, maximum 29 days). Considering the average pretreatment deficit (MP 94° ± 29°, PIP 67° ± 28°), a statistically significant improvement in PIP joint extension was observed after the DAEF treatment (MP 90° ± 28°, PIP 12° ± 19°) and of the MP joint extension after the PNF procedure (MP 29° ± 21°, PIP 11° ± 18°). The DAEF distraction was not painful (numeric rating scale 1.6 ± 1.2). The correction angle achieved was maintained at the 1-year postprocedure follow-up (MP 11° ± 12°, PIP 12° ± 15°). Compared with the average pretreatment DASH score (80.2 ± 11.7 points), a statistically significant improvement was found at 6 months (9.7 ± 6.7 points). No complications were reported.

Conclusions

Progressive distraction with DAEF followed by PNF was effective in patients with advanced-stage DD.

Type of study/level of evidence

Therapeutic IV.

目的：重度Dupuytren病（DD）仍然是一个外科挑战。目前存在几种微创治疗方法，包括使用可分散的角度外固定架（DAEF），然后注射胶原酶。本研究的目的是探讨DAEF联合经皮针筋膜切开术（PNF）在晚期dd患者中的应用。本前瞻性观察研究评估了52例（56例植入DAEF） III-IV期DD患者（根据Tubiana分类）的结果，这些患者通过应用DAEF，然后在手掌和近端指骨掌侧进行PNF，在掌指关节（MP）和近端指间关节（PIP）上渐进式伸展。术后使用夹板。在1年的随访中，通过测量伸展缺损角度、疼痛和臂、肩和手的残疾（DASH）评分来评估患者。结果：牵张时间为21.9±3.8 d，最短16 d，最长29 d。考虑到平均预处理缺陷（MP 94°±29°，PIP 67°±28°），DAEF治疗后PIP关节伸展（MP 90°±28°，PIP 12°±19°）和PNF治疗后MP关节伸展（MP 29°±21°，PIP 11°±18°）有统计学意义的改善。DAEF牵张无疼痛感（数值评定量表1.6±1.2）。术后随访1年，矫正角度保持不变（MP 11°±12°，PIP 12°±15°）。与治疗前平均DASH评分（80.2±11.7分）比较，6个月时总分（9.7±6.7分）有统计学意义的改善。无并发症报道。结论：渐进式牵张联合DAEF加PNF治疗晚期dd患者有效。

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引用次数: 0

Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases 手术时机对桡骨棒手功能结局的影响：Bayne-Klug IIIb/IV型病例的回顾性研究。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.03.027

İsmail Bülent Özçelik MD , Muath Mamdouh Mahmod Al-Chalabi MD , Yücel Ağırdil MD , Berkan Mersa MD

Purpose

Radial club hand is a congenital malformation characterized by varying degrees of radial deviation and radial bone hypoplasia or absence. However, the optimal timing for corrective surgery remains a subject of debate. This study aimed to assess the impact of the timing of radial club surgery on functional outcomes.

Methods

Eligibility for inclusion was limited to patients exhibiting type IIIb or type IV deformities according to the Bayne and Klug classification, who began hand therapy and splinting postnatally, and underwent all surgical interventions before 10 months of age. Regular assessments were conducted for a minimum of 2 years, and up to 6 years after intervention. Data, including demographics, surgical interventions, post-intervention ranges of motion, and complications, were collected retrospectively.

Results

All 22 patients (34 hands) included in this study underwent surgical intervention before age 10 months. Our results demonstrated a mean preoperative hand-forearm angulation of 86.8° (range, 20°–150°) and a mean postoperative hand-forearm angulation of 3.8° (range, 0°–20°). The final range of motion showed a mean flexion of 84.3° (range, 70°–90°) in 30 hands, mean extension of 65.7° (range, 60°–70°) in 28 hands, mean ulnar deviation of 35.6° (range, 30°–40°) in 25 hands, and mean radial deviation of 17.4° (range, 15°–20°) in 27 hands. Skin necrosis occurred in 3 cases (9%).

Conclusions

A comprehensive management approach immediately after birth, integrating exercises, splinting, and surgical correction before age 10 months is effective and safe.

Type of study/level of evidence

Prognostic IV.

目的：桡骨棒手是一种先天性畸形，其特征是不同程度的桡骨偏离和桡骨发育不全或缺失。然而，矫正手术的最佳时机仍然是争论的主题。本研究旨在评估桡骨钉手术时机对功能预后的影响。方法：入选资格仅限于根据Bayne和Klug分类表现为IIIb型或IV型畸形的患者，这些患者在出生后开始手部治疗和夹板，并在10个月前接受了所有手术干预。在干预后至少2年，最多6年进行定期评估。回顾性收集数据，包括人口统计学、手术干预、干预后活动范围和并发症。结果：本组22例患者（34只手）均于10月龄前接受手术治疗。我们的结果显示，术前手-前臂平均成角为86.8°（范围，20°-150°），术后手-前臂平均成角为3.8°（范围，0°-20°）。最终活动范围显示，30只手平均屈曲84.3°（范围，70°-90°），28只手平均伸直65.7°（范围，60°-70°），25只手平均尺侧偏差35.6°（范围，30°-40°），27只手平均径向偏差17.4°（范围，15°-20°）。皮肤坏死3例（9%）。结论：出生后立即采取综合管理方法，结合运动、夹板和10个月前的手术矫正是有效和安全的。研究类型/证据水平：预后IV。

{"title":"Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases","authors":"İsmail Bülent Özçelik MD , Muath Mamdouh Mahmod Al-Chalabi MD , Yücel Ağırdil MD , Berkan Mersa MD","doi":"10.1016/j.jhsa.2025.03.027","DOIUrl":"10.1016/j.jhsa.2025.03.027","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Radial club hand is a congenital malformation<span> characterized by varying degrees of radial deviation and radial bone </span></span>hypoplasia or absence. However, the optimal timing for corrective surgery remains a subject of debate. This study aimed to assess the impact of the timing of radial club surgery on functional outcomes.</div></div><div><h3>Methods</h3><div>Eligibility for inclusion was limited to patients exhibiting type IIIb or type IV deformities according to the Bayne and Klug classification, who began hand therapy and splinting postnatally, and underwent all surgical interventions before 10 months of age. Regular assessments were conducted for a minimum of 2 years, and up to 6 years after intervention. Data, including demographics, surgical interventions, post-intervention ranges of motion, and complications, were collected retrospectively.</div></div><div><h3>Results</h3><div><span>All 22 patients (34 hands) included in this study underwent surgical intervention before age 10 months. Our results demonstrated a mean preoperative hand-forearm angulation<span> of 86.8° (range, 20°–150°) and a mean postoperative hand-forearm angulation of 3.8° (range, 0°–20°). The final range of motion showed a mean flexion of 84.3° (range, 70°–90°) in 30 hands, mean extension of 65.7° (range, 60°–70°) in 28 hands, mean ulnar deviation of 35.6° (range, 30°–40°) in 25 hands, and mean radial deviation of 17.4° (range, 15°–20°) in 27 hands. </span></span>Skin necrosis occurred in 3 cases (9%).</div></div><div><h3>Conclusions</h3><div>A comprehensive management approach immediately after birth, integrating exercises, splinting, and surgical correction before age 10 months is effective and safe.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 72.e1-72.e7"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152311","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

Frictional Analysis of Pulley Reconstruction Techniques: A Biomechanical Cadaveric Study 滑轮重建技术的摩擦分析：生物力学尸体研究。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.04.020

Gilad Rotem MD , Emma Badowski MASc , David Sahai BSc , G. Daniel G. Langohr MASc, PhD , Assaf Kadar MD

Purpose

To evaluate the friction between a flexor tendon and different A2 pulley reconstruction techniques using a biomechanical model, and to compare the efficacy of a novel A1 pulley reconstruction to traditional techniques, including palmaris longus (PL) and extensor retinaculum (ER) reconstructions, as well as the native A2 pulley.

Methods

Eight fresh-frozen cadaver digits were tested in a biomechanical model. The coefficient of friction was measured for native A2, A1 pulley reconstruction, PL, and ER techniques using validated mechanical testing protocols. Friction coefficients were compared at two contact angles to assess differences in gliding resistance.

Results

The A1 pulley reconstruction demonstrated friction coefficients comparable to the native A2 pulley, significantly lower than those observed with PL and ER reconstructions. Statistical analysis confirmed the influence of reconstruction technique on friction coefficients, with the A1 reconstruction achieving the most favorable results.

Conclusions

The novel A1 pulley reconstruction closely replicates the biomechanical properties of the native A2 pulley, offering reduced friction and potentially improved postoperative outcomes compared to traditional techniques. This supports the “like for like” approach in pulley reconstruction to optimize tendon function.

Clinical relevance

This study evaluates the frictional characteristics of various A2 pulley reconstruction techniques, providing insights that may influence surgical decisions and improve patient outcomes in tendon repair procedures.

目的：利用生物力学模型评估屈肌腱和不同A2滑轮重建技术之间的摩擦，并比较新型A1滑轮重建技术与传统技术的疗效，包括掌长肌（PL）和伸肌支持带（ER）重建，以及原生A2滑轮。方法：对8个新鲜冷冻尸体手指进行生物力学实验。采用经过验证的力学测试方案，测量了原生A2、A1滑轮重建、PL和ER技术的摩擦系数。比较两种接触角下的摩擦系数，以评估滑动阻力的差异。结果：A1皮带轮重建的摩擦系数与原生A2皮带轮相当，显著低于PL和ER重建的摩擦系数。统计分析证实了重建技术对摩擦系数的影响，其中A1重建效果最为理想。结论：与传统技术相比，新型A1滑轮重建与原有A2滑轮的生物力学特性非常相似，减少了摩擦，可能改善了术后效果。这支持滑轮重建中的“同类”方法来优化肌腱功能。临床相关性：本研究评估了各种A2滑轮重建技术的摩擦特性，提供了可能影响手术决策和改善患者肌腱修复手术结果的见解。

{"title":"Frictional Analysis of Pulley Reconstruction Techniques: A Biomechanical Cadaveric Study","authors":"Gilad Rotem MD , Emma Badowski MASc , David Sahai BSc , G. Daniel G. Langohr MASc, PhD , Assaf Kadar MD","doi":"10.1016/j.jhsa.2025.04.020","DOIUrl":"10.1016/j.jhsa.2025.04.020","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the friction between a flexor tendon<span> and different A2 pulley reconstruction techniques using a biomechanical model, and to compare the efficacy of a novel A1 pulley reconstruction to traditional techniques, including palmaris longus (PL) and extensor retinaculum (ER) reconstructions, as well as the native A2 pulley.</span></div></div><div><h3>Methods</h3><div><span>Eight fresh-frozen cadaver digits were tested in a biomechanical model. The coefficient of friction was measured for native A2, A1 pulley reconstruction, PL, and ER techniques using validated mechanical testing protocols. </span>Friction coefficients were compared at two contact angles to assess differences in gliding resistance.</div></div><div><h3>Results</h3><div>The A1 pulley reconstruction demonstrated friction coefficients comparable to the native A2 pulley, significantly lower than those observed with PL and ER reconstructions. Statistical analysis confirmed the influence of reconstruction technique on friction coefficients, with the A1 reconstruction achieving the most favorable results.</div></div><div><h3>Conclusions</h3><div>The novel A1 pulley reconstruction closely replicates the biomechanical properties of the native A2 pulley, offering reduced friction and potentially improved postoperative outcomes compared to traditional techniques. This supports the “like for like” approach in pulley reconstruction to optimize tendon function.</div></div><div><h3>Clinical relevance</h3><div>This study evaluates the frictional characteristics of various A2 pulley reconstruction techniques, providing insights that may influence surgical decisions and improve patient outcomes in tendon repair procedures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 91.e1-91.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499395","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

Acute Compartment Syndrome of the Upper Extremity 上肢急性筋膜室综合征。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.07.021

Anjum F. Shaikh BA , Philip E. Blazar MD , Brandon E. Earp MD , Dafang Zhang MD

Acute compartment syndrome of the upper extremity is a rare but serious condition of elevated intracompartmental pressures leading to tissue ischemia. Prompt diagnosis and emergent fasciotomy are critical to optimize patient outcomes, and delays to care can result in myonecrosis, contracture, and limb dysfunction. Acute compartment syndrome of the upper extremity most commonly occurs in the forearm but may also affect the arm and the hand. Upper-extremity acute compartment syndrome most commonly occurs following trauma, but nontraumatic etiologies include prolonged decubitus position, bleeding conditions, and reperfusion injury after critical limb ischemia. This review article will provide a general overview of acute compartment syndrome of the upper extremity with specific sections on the prevalence, treatment, and outcomes for each anatomic location. This review will also address management options and current controversies, including the treatment of delayed presentation or missed compartment syndrome as well as discuss recent advancements in diagnosis and management.

上肢急性室室综合征是一种罕见但严重的情况，升高的室内压力导致组织缺血。及时诊断和紧急筋膜切开术对优化患者预后至关重要，延误护理可导致肌坏死、挛缩和肢体功能障碍。上肢急性筋膜室综合征最常见于前臂，但也可能影响手臂和手。上肢急性筋膜室综合征最常发生在创伤后，但非创伤性病因包括长时间的卧位、出血情况和严重肢体缺血后的再灌注损伤。这篇综述文章将提供上肢急性筋膜室综合征的总体概述，并具体介绍每个解剖部位的患病率、治疗和结果。本综述还将讨论管理方案和当前的争议，包括延迟表现或遗漏的筋膜室综合征的治疗，以及讨论诊断和管理的最新进展。

引用次数: 0

Clinical and Patient-Reported Outcomes After Ligament Reconstruction for Traumatic Thumb Carpometacarpal Instability 外伤性拇指腕掌骨不稳韧带重建的临床和患者报告结果。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.09.015

Niek J. Nieuwdorp MSc , Isabel C. Jongen MD , Caroline A. Hundepool MD, PhD , Mark J.W. van der Oest MD, PhD , Thybout M. Moojen MD, PhD , Ruud W. Selles PhD

Purpose

The effectiveness of ligament reconstruction for chronic traumatic thumb carpometacarpal (CMC) instability is debated because of concerns of trauma-induced cartilage damage affecting postoperative results. This study aimed to assess patient- and clinician-reported outcomes of ligament reconstruction in these patients.

Methods

This study included patients with chronic traumatic CMC instability undergoing various ligament reconstruction techniques. The visual analog scale (range 0–100) for pain and the Michigan Hand Outcome Questionnaire (MHQ, range 0–100) scores at intake were compared to those at 3 and 12 months and at long-term follow-up. Secondary outcomes included grip and pinch strength, range of motion, complications, and patient satisfaction. A linear mixed model was used to analyze which variables influence postoperative MHQ pain scores.

Results

Forty-three patients were included with a mean follow-up of 8 years (range, 3.2–12.5). The visual analog scale pain score significantly improved from 60 (95% CI, 53–67) at intake to 26 (95% CI, 18–33) at 12 months, remaining consistent over long-term follow-up. The MHQ total, pain, and function scores also improved considerably. All thumbs were stable after surgery with preserved range of motion. Grip and pinch strength notably improved. One patient progressed to osteoarthritis during follow-up. The dorsal ligament reconstruction technique was a predictor of worse postoperative MHQ pain scores.

Conclusions

Patient- and clinician-reported outcomes considerably improved postsurgery, affirming ligament reconstruction as a viable treatment for chronic traumatic CMC instability. The dorsal ligament reconstruction technique should be approached with caution.

Type of study/level of evidence

Therapeutic IV.

目的：韧带重建治疗慢性外伤性拇指腕掌骨（CMC）不稳定的有效性存在争议，因为担心创伤性软骨损伤会影响术后结果。本研究旨在评估患者和临床报告的这些患者韧带重建的结果。方法：本研究包括慢性外伤性CMC不稳患者，采用各种韧带重建技术。将入院时疼痛的视觉模拟量表（范围0-100）和密歇根手部结局问卷（MHQ，范围0-100）评分与3个月、12个月和长期随访时的评分进行比较。次要结局包括握力和握力、活动范围、并发症和患者满意度。采用线性混合模型分析影响术后MHQ疼痛评分的变量。结果：纳入43例患者，平均随访8年（范围3.2-12.5）。视觉模拟疼痛评分从摄入时的60分（95% CI, 53-67）显著改善到12个月时的26分（95% CI, 18-33），在长期随访中保持一致。MHQ总分、疼痛和功能评分也显著提高。术后所有拇指均稳定，活动范围保留。握力和捏力明显提高。1例患者在随访期间进展为骨关节炎。背韧带重建技术是术后MHQ疼痛评分较差的预测因子。结论：患者和医生报告的术后结果显著改善，证实韧带重建是慢性外伤性CMC不稳定的可行治疗方法。背韧带重建技术应谨慎处理。研究类型/证据水平：治疗性IV。

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引用次数: 0

Three-Dimensional Orientation of the Radial Neck Axis Angulation: Implications for Radial Head Replacement 桡骨颈轴角的三维定位：桡骨头置换术的意义。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.03.023

Ausberto R. Velasquez Garcia MD , Adam J. Wentworth MS , Hiroki Nishikawa MD, PhD , Shawn W. O’Driscoll MD, PhD

Purpose

The purpose of this study was to determine the 3-dimensional (3D) orientation of the radial neck axis with respect to the forearm rotation axis and explore its theoretical implications for radial head prosthetic replacement.

Methods

Computed tomography scans of the forearm of healthy individuals were used to construct 3D bone models defining the relationship between the forearm rotation and radial neck axes (FRANA). These models were adjusted to achieve neutral forearm rotation. A comprehensive method for measuring FRANA in 3D was developed, and the results were compared with those of clinical simulated 2-dimensional (2D) projections.

Results

In 20 patients, the 3D FRANA angle averaged 5.1° (SD: 2.2°, 95% confidence intervals [CI]: 4.1–6.2°) consistently oriented toward the palmar side. This was strongly correlated (r = 0.87) with 2D measurements in the anterior view with the forearm in neutral rotation (mean: 4.5°, SD: 2.3°, 95% CI: 3.5°–5.6°), but not with the measurements in the lateral view (mean: −0.1°, SD: 2.5°, 95% CI: −1.3° to 1.0°). Angular measurements in the anterior view were strong predictors of 3D FRANA (R² = 0.8).

Conclusions

The axis of the radial neck does not line up precisely with the axis of forearm rotation but points to a location that is approximately 2 cm palmar to the fovea of the distal ulna. Significant differences were found between 3D and 2D lateral measurements, which highlights the benefits of computer-assisted modeling for analyzing proximal radial geometry.

Clinical relevance

With the forearm in neutral rotation, the proximal radial canal is aligned with the axis of forearm rotation in the sagittal plane but points to a mean of 5° palmarly in the coronal plane. This information can be used to optimize the radial neck cut and direction of canal preparation prior to prosthesis insertion.

目的：本研究的目的是确定桡骨颈轴相对于前臂旋转轴的三维方向，并探讨其在桡骨头假体置换术中的理论意义。方法：使用健康个体前臂的计算机断层扫描构建三维骨模型，定义前臂旋转与桡骨颈轴（fra）之间的关系。调整这些模型以实现前臂中性旋转。建立了一种综合的三维测量方法，并将结果与临床模拟二维（2D）投影结果进行了比较。结果：20例患者的3D FRANA角度平均为5.1°（SD: 2.2°，95%可信区间[CI]: 4.1-6.2°），始终指向掌侧。这与前臂中立旋转时的前位2D测量值（平均值：4.5°，SD: 2.3°，95% CI: 3.5°-5.6°）密切相关（r = 0.87），但与侧位测量值无关（平均值：-0.1°，SD: 2.5°，95% CI: -1.3°至1.0°）。前视图角度测量是3D FRANA的强预测因子（R2 = 0.8）。结论：桡骨颈轴与前臂旋转轴并不完全对齐，而是指向尺骨远端中央凹掌侧约2cm处。在三维和二维横向测量之间发现了显著差异，这突出了计算机辅助建模在分析近端径向几何形状方面的优势。临床意义：前臂处于中性旋转时，桡骨近端管在矢状面与前臂旋转轴对齐，但在冠状面平均指向掌侧5°。该信息可用于优化植入假体前桡骨颈切口和根管准备方向。

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引用次数: 0

The Optimal Donor Site From the Foot as a Nonvascularized Osteochondral Graft for the Reconstruction of Lunate Facet Defects in Distal Radius Intra-Articular Fracture: A Computed Tomography and Cadaveric Study 足部无血管化骨软骨移植重建桡骨远端关节内骨折月骨小面缺损的最佳供体部位：计算机断层扫描和尸体研究。

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume

Pub Date : 2026-01-01 DOI: 10.1016/j.jhsa.2025.04.014

Marianne Therese S. Feng MD , Seo-Jun Lee MD , Jae Jun Nam MD, PhD , Im Joo Rhyu MD, PhD , In Cheul Choi MD, PhD , Jong Woong Park MD, PhD

Purpose

This study aimed to identify the best donor sites for a nonvascularized osteochondral graft from the foot to reconstruct lunate facet defects in malunited distal radius fractures.

Methods

Fifty-six wrist computed tomography (CT) scans, obtained from scaphoid fracture patients, assessed the lunate facet’s articular surface for dorsal and volar width, dorsovolar length, and concavity depth. Additionally, 60 foot CT scans, obtained from calcaneus fracture patients, assessed the second and third metatarsals and cuneiforms for dorsal and plantar width, dorsoplantar length, concavity/convexity, inflection point, and articular cartilage thickness. A cadaver study of 20 feet recorded the same parameters along with cartilage thickness using ultrasound and further examined the accessory fibular and tibial facets of the four bones.

Results

The lunate facet measured 11.4 mm dorsally, 13.9 mm volarly, and 17.4 mm long with a 3 mm concavity. The sizes of dorsal and plantar width and dorsoplantar length of articular surfaces of all four foot bones were large enough for lunate facet reconstruction. The second metatarsal and second cuneiform showed concave and convex surfaces in 100% of the cases, respectively. The third metatarsal was concave in 21.7% and convex in 78.3% of the cases. The third cuneiform was concave in 78.3% and convex in 21.7% of the cases. The cadaver study confirmed similar results, with cartilage thickness ranging from 0.5 to 0.7 mm. The dorsofibular accessory facet was oval and larger on the base of the third metatarsal.

Conclusions

The third metatarsal base and third cuneiform are the best donor sites for lunate facet reconstruction. A convex donor site is suboptimal for reconstructing the concave lunate facet; therefore, a preoperative CT scan is mandatory for identifying an appropriate concave donor site.

Clinical relevance

The study recommends the third metatarsal base or third cuneiform for lunate facet reconstruction in distal radius fractures.

目的：本研究旨在为桡骨远端骨折不愈合患者进行足部无血管化骨软骨移植重建月骨小面缺损的最佳供体部位。方法：对舟状骨骨折患者进行56次腕关节CT扫描，评估月骨小面关节面背侧和掌侧宽度、掌侧长度和凹陷深度。此外，从跟骨骨折患者获得的60英尺CT扫描，评估了第二和第三跖骨和楔状骨的背和足底宽度、背跖长度、凹凸度、拐点和关节软骨厚度。一项20英尺的尸体研究使用超声波记录了相同的参数以及软骨厚度，并进一步检查了四块骨头的副腓骨和胫骨面。结果：月骨突背侧为11.4 mm，掌侧为13.9 mm，长17.4 mm，凹度为3mm。4块足骨关节面背、足底宽度和背、足底长度的大小均足以进行月骨小关节面重建。第二跖骨和第二楔形骨均有凹面和凸面，发生率为100%。第三跖骨凹陷21.7%，凸出78.3%。第三楔形骨凹的占78.3%，凸的占21.7%。尸体研究证实了类似的结果，软骨厚度在0.5到0.7毫米之间。腓骨背侧副关节面为椭圆形，在第三跖骨基部较大。结论：第三跖底和第三楔状骨是月骨小关节重建的最佳供体。对于重建凹月骨小面，凸供体是次优的；因此，术前CT扫描是必要的，以确定合适的凹供体部位。临床相关性：该研究推荐在桡骨远端骨折的月骨面重建中使用第三跖骨基底或第三楔状骨。

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