Hand surgery & rehabilitation最新文献

We describe a new ligament reconstruction of the distal interosseous membrane to treat chronic distal radioulnar joint instability without osteoarthritis and report the results of a series of four cases. This ligamentoplasty appears to be a technically simple and effective joint stabilization procedure to contend posterior-anterior ulnar head instability. Level of evidence IV.

Despite its increasing popularity, total wrist arthroplasty (TWA) remains a treatment option that is often viewed critically and is still rarely used in patients with partial or complete osteoarthritis of the wrist. TWA is an appropriate alternative to total or partial wrist fusion, particularly for active patients with a high need for function. As the number of cases continues to increase, procedure-specific complications are becoming more common. In this report, we present a 61-year-old female Caucasian patient with increasing wrist pain after TWA performed at another institution in 2016. Metallosis was suspected after clinical and radiographic examination and was confirmed intraoperatively and by histopathological analysis. Surgical management included removal of the pseudocapsule and replacement of the mobile parts of the implant. At 12 weeks post-operatively, the patient still reported limited range of motion but a significant reduction in pain. This is one of the few reports to date of metallosis following TWA, particularly with a metal-on-polymer joint. The possibility of metallosis should always be considered, especially in cases of delayed onset of pain and reduced range of motion after TWA, to ensure appropriate management.

Surgical site infection is a serious complication of fracture surgery that often requires antibiotic treatment, implant removal, and wound debridement. Antibiotic prophylaxis is one of the measures taken to reduce the risk of surgical site infection. Other factors influencing the risk of infection include leaving the ends of the K-wires protruding through the skin vs. buried under the skin, operating under full sterility vs. field sterility in the operating room, or the burden of comorbidities. The purpose of this study was to review the current literature on antibiotic prophylaxis and other factors that influence the risk of infection during surgery for hand and distal radial fractures. We also reviewed the literature on potential adverse effects and costs of antibiotic prophylaxis. Results. Three studies and one systematic review were identified for the operative treatment of closed hand and distal radius fractures, none of which supported the routine use of antibiotic prophylaxis. For leaving the ends of K-wires exposed versus burying them under the skin, two articles were found. One reported an increased risk of surgical site infection when K-wires are left exposed, and the other reported that it does not matter. Three studies reported harmful and adverse effects of unnecessary use of antibiotic prophylaxis. Two studies reported an increased risk of surgical site infection in patients with comorbidities, compromised immunity, smoking, and alcohol use. The routine use of antibiotic prophylaxis generates significant costs that can be avoided if it is used as recommended by evidence-based medicine. Conclusion. The authors believe that this review may have many beneficial effects for patients and the health care system, such as: preventing bacterial resistance, increasing the efficacy of antibiotics in true infections, reducing the risk of adverse reactions, and reducing health care costs.

Background: Wrist fractures are among the most common upper extremity injuries. Despite their prevalence and significant societal and healthcare costs, long-term epidemiological data on national wrist fracture trends remain limited.

Methods: This retrospective study analyzed data from the National Electronic Injury Surveillance System (NEISS) and U.S. Census data to evaluate national trends in wrist fractures from 2004 to 2023. Utilizing weighted sampling techniques, incidence rates were calculated, and demographic patterns, causes, and differences between athletic and non-athletic injuries were assessed. Statistical analyses included regression models, chi-square tests, and injury proportion ratios (IPR).

Results: Over the twenty-year study period, there were a reported 106,929 wrist fractures, representing 4,040,516 cases nationwide (95% CI: 3,414,316-4,666,716). The incidence declined significantly over the study period from 78.04 per 100,000 person-years in 2004 to 60.27 in 2023 (p < 0.05), representing a 22.7% decrease in overall wrist fracture incidence rates. Males aged 5-14 years showed the highest fracture rate (238.2 per 100,000), primarily driven by sports-related injuries such as bicycling, football, and skateboarding. Conversely, females aged ≥65 years had the highest risk of non-athletic fractures, often due to falls on stairs or floors. Nearly half (47.96%) of all wrist fractures were sports-related, with males three times more likely than females to sustain such injuries (OR: 3.05, p < 0.001).

Conclusion: This comprehensive analysis of wrist fracture trends over two decades reveals a significant decline in overall incidence, with notable demographic patterns. These findings underscore the importance of targeted prevention strategies, such as improving safety measures in youth sports and enhancing fall prevention programs for older adults, while highlighting the need for continued research to inform effective prevention and treatment strategies.

Radial nerve entrapment at the lateral intermuscular septum in the distal upper arm can cause debilitating pain and functional impairment. The nerve passes from the dorsal to the volar compartment through the LIS, approximately 8-10 cm proximal to the lateral epicondyle, making it susceptible to compression. Clinical signs include wrist drop, localized pain, and weakness in wrist and finger extension, often seen in manual laborers and athletes. A minimally invasive, ultrasound-guided, percutaneous technique using local anesthesia and no tourniquet allows precise nerve decompression while preserving function. Hydrodissection under Doppler ultrasound ensures safety and avoids complications such as nerve palsy. This approach minimizes tissue disruption compared to traditional open decompression. Despite promising results, the technique remains under-researched, with no large-scale clinical trials available. Prospective studies with long-term follow-up are essential to establish the efficacy of this innovative, patient-centered technique.

Ultrasound-guided surgery is a new trend resulting from the introduction of high-frequency linear probes and higher-quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasound is, of course, essential. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the use of the wide awake and local anesthesia with no tourniquet (WALANT) technique in the outpatient setting. The purpose of this article is to report our experience with retrograde percutaneous ultrasound-guided techniques.

The purpose of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for lacertus syndrome, i.e., median nerve entrapment at the elbow. Using the Walant technique (wide awake local anesthesia and no tourniquet), the entry point is made with a 19G needle to introduce the hook distally from the distal border of the lacertus fibrosus. The hook is then slid along the pronator teres fascia to the proximal border of the lacertus fibrosus. The cut is ultrasound-guided from proximal to distal. The cut is effective when the back of the force is observed in the 3 targeted muscles (flexor carpi radialis, flexor pollicis longus and flexor digitorum profundus). This minimally invasive surgical procedure is efficient in terms of lacertus fibrosus sectioning. Real-time ultrasound monitoring may improve safety. The technique could be considered as a new ultrasound-guided alternative to open surgery. When performed superficially to the pronator teres muscle under WALANT anesthesia and percutaneously, ultrasound-guided lacertus fibrosus release may be an effective treatment for lacertus syndrome in the interventional ultrasound unit.

Objectives: Post-burn neuropathy is a little-known pathology. However, the nerve is the most sensitive organ to burns, especially electrical burns. Carpal tunnel syndrome is the most common mononeuropathy worldwide and the most common post-burn neuropathy. The aim of this study is to evaluate, through a review of the literature, the specificities of the management of mononeuropathy of the median nerve at the wrist occurring at a distance from the burn injury.

Methods: A comprehensive search of the literature was conducted using the Cochrane Library, PubMed, and EMBASE. We included all articles that mentioned nerve injury associated with burns and excluded those that did not address the median nerve or in which the median nerve was the subject of early release. For each study, we compared diagnostic methods and patient management elements. We propose to associate to this review the case of a 23-year-old male victim of an electrical burn who developed a carpal tunnel at a distance from his burn. The patient underwent surgery and was evaluated 1 mo and 6 mo after surgery using grip strength, Weber's two-point discrimination test, QuickDASH, and BCTSQ questionnaires. An electromyogram was performed preoperatively and 6 mo postoperatively.

Results: Thirteen articles met the inclusion criteria and were reviewed. The majority of these involved electrical and thermal burns, with TBSA ranging from 2% to 65%. The affected population was young (36.7 years) and predominantly male. The mean hospital stay was 59.1 days, compared with 137.5 days for diagnosis delay. Diagnostic electromyography was not always performed. No study used ultrasound or MRI to look for an etiology other than burns in the development of carpal tunnel syndrome. All studies that reported symptom improvement after treatment did not use a functional score. In our case, grip strength on the operated side improved moderately. Discriminative sensation was restored. QuickDASH and BCTSQ scores were initially poor and improved very modestly after surgery. Electromyography showed recovery of sensory conduction but no recovery of motor conduction.

Conclusion: Carpal tunnel syndrome can have significant functional consequences in burn patients because it is often overlooked and treated late. Early clinical and electromyographic diagnosis is essential to ensure surgical management before irreversible intra-neural injury occurs. Ultrasound could be useful for the early detection of signs of median nerve injury at the wrist when electromyography is not possible, and to verify the absence of another associated etiology in the development of carpal tunnel syndrome after burns. We propose a decision algorithm for the management of carpal tunnel syndrome associated with burns.

Level of evidence: IV.