Hand surgery & rehabilitation最新文献

Background: Numerous patient-reported outcome measures are used to assess thumb and hand function, but none are specific to the trapeziometacarpal (TMC) joint. The purpose of this study was to describe and validate a TMC-specific patient-reported outcome measure: the Buffalo Score.

Methods: The Buffalo Score was compared with validated functional scores (QuickDASH, Kapandji score, Trapeziometacarpal Arthrosis Symptoms Disability (TASD) questionnaire) and with objective hand measurements (lateral pinch strength and subjective strength evaluation by number of paper folds a patient can do). Ninety-two patients with complete datasets after TMC prosthetic surgery were analyzed. Internal validity was assessed through correlations with subjective functional scores, and external validity through correlations with objective measurements.

Results: The Buffalo Score showed a very strong positive correlation with the TASD (r = 0.895, p < 0.001) and a strong positive correlation with the QuickDASH (r = 0.776, p < 0.001). A significant negative correlation was found with the Kapandji score (r = -0.530, p < 0.001). Correlations with objective measurements were weak and non-significant (pinch strength: r = -0.148, p = 0.215; number of folds: r = -0.116, p = 0.331). Pinch strength and number of folds were strongly correlated with each other (r = 0.938).

Conclusion: The Buffalo Score exhibits strong construct validity when compared to established subjective functional scores, effectively capturing patient-perceived functional impairment of the thumb column. However, it does not consistently predict objective pinch strength, which should be evaluated independently. Overall, the Buffalo Score serves as a straightforward and valuable tool for clinical and postoperative assessment of trapeziometacarpal pathology.

Background: Rhizarthrosis is a frequent degenerative condition and a major source of pain and functional impairment. While several surgical options are available, international practice remains heterogeneous, and contemporary nationwide data describing temporal trends in France are limited.

Objective: To describe nationwide trends in the surgical management of rhizarthrosis in France over a 16-year period using exhaustive medico-administrative data, and to compare these trends with surgeons' declared practices.

Methods: A retrospective nationwide analysis was conducted using the French hospital discharge database from 2009 to 2024. Surgical procedures were identified using codes as proxies for trapeziometacarpal arthroplasty, trapeziectomy, extension osteotomy, and arthrodesis. Annual volumes and incidence rates were calculated. These population-level data were compared with results from two nationwide surveys conducted among members of the French Society for Surgery of the Hand in 2018 and 2025.

Results: The total number of surgical procedures increased from 7,564 in 2009 to 20,406 in 2024, with incidence rising from 11.8 to 29.8 procedures per 100,000 inhabitants. Trapeziometacarpal arthroplasty became the dominant technique, accounting for 75.1% of procedures in 2024. Survey data showed a parallel shift in surgeons' practices, with the proportion reporting a predominance of arthroplasty increasing from 52.5% in 2018 to 85.9% in 2025. Implant activity became increasingly concentrated among high-volume surgeons, and total joint arthroplasty largely replaced interposition implants.

Conclusion: Over the past two decades, surgical practice in France has undergone a profound shift, with trapeziometacarpal arthroplasty progressively supplanting trapeziectomy as the reference surgical strategy for rhizarthrosis. These findings highlight the need for procedure-specific coding and a nationwide registry to ensure long-term surveillance of implant outcomes.

Level of evidence: IV (Retrospective epidemiological study).

Background: Extensor tendon injuries in the dorsal hand are prevalent due to the superficial location of the tendons and limited surrounding soft tissue. Early active mobilization (EAM) protocols are increasingly being adopted; however, comparative data with traditional immobilization methods remain scarce.

Purpose: This study aims to compare the short-term functional outcomes and return-to-work times between EAM and immobilization following zone 5-6 extensor tendon repairs.

Study design: A retrospective cohort study.

Methods: We analyzed twenty-six patients with isolated zone 5-6 extensor tendon injuries (EAM: n = 12; immobilization: n = 14). Range of motion was assessed using a goniometer, while grip strength was measured with a hand dynamometer. Data on return-to-work times and physiotherapy sessions were collected. Statistical analyses included parametric and non-parametric tests, effect sizes (Cohen's d), and interaction analyses based on occupation type and dominant hand involvement. A post-hoc power analysis was performed for total active motion.

Results: The EAM group exhibited significantly higher values for metacarpophalangeal, distal interphalangeal, and total active motion at discharge compared to the immobilization group (p = 0.035, p = 0.001, p = 0.007), with large effect sizes. However, there were no significant differences in grip strength, return-to-work times, or the number of physiotherapy sessions (p > 0.05). Additionally, occupation type and hand dominance did not significantly influence return-to-work outcomes. The post-hoc power for total active motion was calculated at 91.2%. Importantly, no tendon ruptures were reported.

Conclusion: Early active mobilization following zone 5-6 extensor tendon repair significantly enhances short-term range of motion without increasing complication rates. Grip strength and return-to-work outcomes remain comparable to those observed with immobilization. These findings advocate for early active mobilization as a safe and effective rehabilitation approach.

Purpose: To evaluate the short-term safety and clinical effectiveness of arthroscopic-assisted reduction with percutaneous proximal-row stabilization performed without intrinsic ligament repair for acute perilunate injuries.

Methods: Patients with acute, isolated perilunate injuries treated by a single surgeon between 2021 and 2025 were prospectively enrolled. All underwent arthroscopic-assisted reduction and percutaneous proximal-row stabilization without intrinsic ligament repair. Clinical evaluation included objective functional assessment and patient-reported outcome measures. Radiographic analysis included measurement of the scapholunate interval, scapholunate, radiolunate and radioscaphoid angles, dorsal scaphoid translation, fracture union, and presence of degenerative changes.

Results: Ten male patients (36 ± 14 years) were treated at a mean of 5 ± 3 days post-injury; 40% presented with median neuropathy. Eight injuries were Mayfield stage III and two stage IV, with five fracture-dislocation patterns. At a mean 14-month follow-up, patients demonstrated favorable early outcomes (Disabilities of the Arm, Shoulder and Hand score 7 ± 10, Modified Mayo Wrist Score 89 ± 7, Patient-Rated Wrist Evaluation 14.6 ± 15.1, and Visual Analog Scale pain score 0.4 ± 1), near-symmetric motion and grip strength, and maintained radiographic alignment (mean scapholunate gap 2.3 ± 0.8 mm). All fractures united, there were no post-operative complications, and all manual laborers returned to unrestricted work at 28 ± 16 weeks.

Conclusion: Arthroscopic-assisted reduction and percutaneous proximal-row fixation without ligament repair appears feasible and safe, yielding excellent short-term functional and radiographic outcomes with minimal morbidity. Larger studies with longer follow-up are needed to determine long-term durability.

Prospective case series: Level IV.

Purpose: To systematically review the clinical presentation, imaging findings, arthroscopic characteristics, and treatment outcomes of dorsal wrist capsular impingement, a distinct cause of chronic dorsal wrist pain.

Methods: A review was performed in accordance with PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, and CINAHL were searched from inception to January 11, 2026. Eligible studies included patients diagnosed with dorsal wrist capsular impingement. Data were synthesized narratively.

Results: Six studies comprising 231 patients (233 wrists) met inclusion criteria. Age ranged from 27 to 42 years, and 53% of patients were male (122/231). Follow-up ranged from 6 to 42 months. All patients presented with dorsal-central wrist pain (231/231, 100%). Extension-provoked pain was reported in 177 wrists (77%) and in all patients in the five studies describing this symptom. MRI findings were inconsistently reported and demonstrated limited correlation with intraoperative pathology. Across four studies, hypertrophied or redundant dorsal capsular tissue interposed within the radiocarpal joint was identified in all evaluated wrists (66/66, 100%). Following arthroscopic debridement, most treated wrists demonstrated postoperative pain reduction. QuickDASH scores improved across studies, decreasing from approximately 33-49 preoperatively to 4.8-17 at 3-12 months postoperatively. Recurrence was uncommon (2 wrists, 1%), and complications were rare.

Conclusion: Dorsal wrist capsular impingement presents with chronic, extension-provoked dorsal-central wrist pain, often despite nondiagnostic imaging. Arthroscopy may aid diagnosis and management, with reported intraoperative findings and symptomatic improvement in selected patients. Current evidence is limited to small retrospective studies, and prospective research is needed to better define diagnostic criteria and outcomes.

Background: Focal chondral lesions of the wrist and hand are an underrecognized source of pain and functional limitation in athletes. Their management remains challenging due to the limited healing capacity of hyaline cartilage, the biomechanical demands of small joints, and the lack of standardized treatment algorithms. Arthroscopy allows accurate diagnosis and targeted treatment with minimal morbidity, while biologic augmentation using autologous adipose-derived products has emerged as a potential adjunct to improve clinical outcomes.

Objective: To evaluate the clinical outcomes of arthroscopic debridement combined with intra- and peri-articular injection of autologous microfragmented adipose tissue in professional athletes affected by focal chondral lesions of the wrist and hand.

Patients and methods: This prospective single-center case series included six professional athletes (5 men, 1 woman; mean age 26.3 years) treated between June 2020 and April 2022. A total of nine joints were addressed (3 radiocarpal and 6 metacarpophalangeal). All patients underwent standardized wrist or hand arthroscopy followed by intra- and peri-articular injection of autologous microfragmented adipose tissue processed using a closed mechanical system. Chondral lesions were graded according to the International Cartilage Repair Society classification. Clinical outcomes included pain (visual analog scale, VAS), upper-limb function (QuickDASH), and joint range of motion (ROM), assessed preoperatively and during follow-up. Nonparametric statistical analysis was performed.

Results: At a mean follow-up of 17.5 ± 8.2 months (range, 8-30 months), all patients demonstrated clinically meaningful improvement in pain, function, and joint mobility. Mean VAS scores decreased from 7.2 to 1.5, and QuickDASH scores improved from 36.9 to 8.2. Joint ROM increased across all planes. All athletes returned to their pre-injury competitive level, and activities of daily living were fully resumed within a mean of 4.8 months. No procedure-related complications or reoperations were observed.

Conclusion: Arthroscopic debridement combined with autologous microfragmented adipose tissue injection appears to be a safe and feasible joint-preserving option for the management of focal chondral lesions of the wrist and hand in professional athletes. The observed clinical improvements represent a preliminary signal of benefit and support further investigation in larger comparative studies.

Background: Fibromyalgia is a centralized pain disorder associated with inferior postoperative outcomes across multiple surgical disciplines. Its impact on outcomes following carpal tunnel release (CTR) was yet to be studied. This study compared postoperative outcomes after CTR in patients with fibromyalgia and matched controls.

Methods: A retrospective matched cohort study was performed including adult patients who underwent open CTR between 2010 and 2024. Patients with fibromyalgia were matched 1:1 with controls without fibromyalgia based on age, sex, hand dominance, preoperative CTS-6 score, preoperative pain intensity, and follow-up duration. Outcomes included postoperative Numeric Pain Rating Scale (NPRS) scores, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), early postoperative pain, long-term pain (NPRS ≥ 5), pain improvement, and patient satisfaction.

Results: Twenty-seven patients with fibromyalgia were matched to 27 controls. Baseline characteristics did not differ between the groups. Patients with fibromyalgia demonstrated higher postoperative pain (NPRS 3.6 vs 1.8; p = 0.02), worse symptom severity and function (BCTQ-SSS 2.2 vs 1.5; p = 0.004; BCTQ-FSS 2.8 vs 1.8; p = 0.002), and higher rates of both a painful early postoperative period (44.4% vs 7.4%; p = 0.002) and residual long-term pain (48% vs 15%; p = 0.008). Despite this, both groups experienced significant postoperative pain reduction (p < 0.001), with no significant difference in pain improvement rate and magnitude or patient satisfaction. The magnitude of within-group postoperative pain improvement in both cohorts exceeded the minimal clinically important difference.

Conclusion: Fibromyalgia is associated with higher postoperative pain and worse patient-reported outcomes after CTR but does not preclude clinically meaningful improvement. CTR remains effective in patients with fibromyalgia, although surgeons should counsel patients regarding a potentially more painful postoperative course and higher rates of residual symptoms.

Introduction: Fractures of the first metacarpal base with partial involvement of the joint surface, known as Bennett fractures, are unstable due to static and dynamic forces. If closed reduction remains unsuccessful, an open procedure is indicated. The fracture is usually exposed via a radiopalmar approach according to Wagner to the trapeziometacarpal (TMC) joint with detachment of the thenar muscles. An alternative,muscle-sparing dorsal approach to the TMC joint and its long-term results in the treatment of Bennett fractures are described.

Patients and methods: Over a period of 15 years, a total of 53 patients with Bennett fractures were reduced via a dorsal approach and fixed with screw osteosynthesis. In a follow-up examination, the mobility and the strength development of the hand were compared with the healthy contralateral side. Subjective symptoms were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the German Thumb Disability Examination (TDX-G) questionnaire.

Results: 8.2 years (±4.6; 2.2-16.7) after the accident, 33 patients (35.6 years ±16.5) were available for follow-up examination. Radial and palmar abduction were significantly reduced by 5% and 6%, respectively. No other significant measurable differences were found. The DASH score and TDX-G score were 4.6 and 5.7, respectively. A total of 4 complications occurred.

Conclusion: The dorsal, muscle-sparing approach to the TMC joint is an alternative to the radiopalmar approach for the treatment of Bennett fractures. In the long term, patients are little restricted in their everyday lives despite significant measurable restrictions in movement.