Hand surgery & rehabilitation最新文献

Introduction: Rollover hand injuries are uncommon but potentially devastating lesions. While typically described as dorsal injuries, cases involving the palmar side are rare. There are two different mechanisms of rollover hand injuries: the "grabbing" or the "hanging out" mechanism. The aim of this case-report was to describe a particularly severe pattern of rollover hand injury with palmar side injuries following the "grabbing" mechanism.

Case-report: Three males patients sustained severe stage 3 lesions according to Coulet's classification following dune-buggy accidents with a "grabbing" mechanism. All cases exhibited combined dorsal and palmar injuries with bone, vascular, and tendinous involvement. Infectious complications were frequent, requiring serial debridement and flap coverage using posterior interosseous or groin flaps. One patient required a trans-metacarpal amputation due to ischemia. At a median follow-up of 21 months, all surviving digits demonstrated satisfactory healing and function, despite persistent intrinsic muscle paralysis.

Conclusion: Buggy-specific hand injuries have so far been grouped under injuries caused by "rollover" mechanisms, involving vehicle overturning. However, the distinct mechanism of these injuries, which is linked to the presence of a safety cage, is more likely to result in palmar injuries with severe vascular damage.

Level of evidence: IV.

A rupture of the distal insertion of the flexor digitorum profundus tendon is a serious avulsion that typically occurs when gripping a jersey. It is commonly known as the "Jersey Finger" or "Rugby Finger" in French literature. This injury, which primarily affects the ring finger (in 80% of cases), requires urgent diagnosis for optimal surgical management. Although rugby has seen a decrease in incidence thanks to advances in equipment, we present two cases that occurred in professional soccer, raising the question of whether the epidemiology of this pathology is changing. This discussion extends to the need for jerseys and refereeing rules to evolve to prevent this injury.

Introduction: Patients have become increasingly reliant on the internet to seek health-related information (HRI). The newfound popularity of artificial intelligence (AI) search engines has created interest in their ability to provide HRI. This study aimed to quantify and compare the readability of carpal tunnel syndrome (CTS) HRI from the American Academy of Orthopaedic Surgeons OrthoInfo and AI search engines.

Methods: Six prompts were developed using the OrthoInfo page on CTS. These prompts were entered to ChatGPT-4 and Google Gemini 2.0 Flash to generate AI responses. The readability of this information was calculated using the Flesch-Kincaid Reading Ease Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, FORCAST Readability Formula, Gunning Fog index, and Simple Measure of Gobbledygook Index. Statistical testing was performed using the Kruskal-Wallis nonparametric One-Way Analysis of Variance test.

Results: The mean grade level readability score across all platforms, questions, and testing metrics was 12.6. No significant differences were observed between the overall mean grade level readability scores of OrthoInfo, ChatGPT, and Gemini, nor were they observed for any specific prompt. The only significant differences were found using the Flesch-Kincaid Grade Level test, for which ChatGPT had the lowest scores.

Conclusion: The readability of carpal tunnel syndrome health-related information from OrthoInfo, ChatGPT, and Gemini is similar. Physicians should advise patients to continue using OrthoInfo as a primary source of carpal tunnel syndrome information, although artificial intelligence search engines are useful to supplement when patient concerns require more tailored responses. Notably, no text included in this study was at recommended reading level thresholds.

Purpose: This study sought to determine the incidence of Neuralgic Amyotrophy (NA) in the United States of America's health system, most common presenting symptoms, time from symptom onset and time from initial presentation to diagnosis, number and specialty of clinicians seen prior to diagnosis, and specialty of diagnosing clinician.

Methods: A retrospective chart review study was conducted to identify all patients diagnosed with ICD-10 G54.5 from September 1, 2016 - December 31, 2023.

Results: 153 patients with NA diagnoses from 2016-2023 were included. The average incidence of NA in the United States of America's healthcare system was 1.77/100,000 per year. The most common chief concern upon presentation was shoulder pain, (n = 57, 37.2%) and the most common secondary or tertiary concern was shoulder weakness (n = 41, 26.7%). Average time from symptom onset to diagnosis was 101.3 days (SD = 155.4; median = 51 days), and from initial presentation to diagnosis was 78.1 days (SD = 145.6; median = 28 days). Sixty-three patients (41.2%) presented to one other clinician with similar symptoms prior to diagnosis, 37 (24.2%) saw two clinicians, 16 (10.5%) saw three, and 7 (4.6%) saw four or more clinicians. Patients most often initially presented to a family medicine, primary care, or urgent care clinician (n = 61, 39.9%). The most common specialties of diagnosing clinicians were orthopaedic surgery (100 diagnoses, 65.4%), neurology (23 diagnoses, 15%) and neurosurgery (15 diagnoses, 10%).

Conclusion: Diagnosis of neuralgic amyotrophy is historically rare, but the incidence may be higher than previously thought. Neuralgic amyotrophy is a debilitating disorder that is often initially unrecognized, ultimately leading to a months-long delay in diagnosis. Over 80% of patients were seen by at least one other clinician before diagnosis, and orthopaedic clinicians were most likely to make the diagnosis.

Clinical relevance: Maintaining a high clinical suspicion while recognizing the common presenting symptoms along with onset and evolution of symptoms would help facilitate timely referral to specialists trained in identifying and managing neuralgic amyotrophy, prevent unnecessary and unproductive appointments preceding the diagnosis, and allow earlier initiation of treatment.

Level of evidence: Diagnostic Type IV.

Osteoarthritis (OA) is a leading cause of disability, with diagnosis and management limited by inter-observer variability and the absence of individualized therapeutic strategies. This review critically examines recent applications of artificial intelligence (AI) in OA diagnosis, treatment planning, rehabilitation, and drug discovery, with a particular focus on clinically relevant imaging-based and predictive models. We synthesize evidence from radiographic and MRI-based AI systems used for disease grading, progression prediction, and surgical outcome forecasting, highlighting their performance, limitations, and translational barriers. Particular emphasis is placed on how AI-generated outputs can inform clinical decision-making, including treatment selection and rehabilitation monitoring. Current challenges related to dataset bias, external validation, and workflow integration are discussed using concrete examples from published studies. Finally, we outline future directions aimed at improving clinical utility through explainable AI, multi-modal data integration, and prospective validation. This focused synthesis underscores both the promise and the practical constraints of AI-driven osteoarthritis care.

Purpose: The relationship between glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and trigger finger (TF) remains unknown. This study aims to compare rates of TF, TF release, and complications of TF release between diabetic patients with and without a history of GLP-1 RA use.

Methods: This study utilized the TriNetX database to identify adult patients with Type II diabetes mellitus. The primary analysis included patients with and without a history of GLP-1 RA use. The secondary analysis included patients with a history of TF separated by the presence or absence of GLP-1 RA use, respectively. The tertiary analysis included patients with and without a history of GLP-1 RA use within the 6 months prior to TF release. Cohorts were propensity-matched 1:1 based on demographic characteristics and medical comorbidities. The primary outcome was the incidence of TF; the secondary outcome was the incidence of TF release. Tertiary outcomes included postoperative complications within 90 days of surgery.

Results: GLP-1 RA use was associated with a significant reduction in the prevalence of trigger finger. In contrast, GLP-1 RA users demonstrated a higher prevalence of TF release and similar rates of surgical site infection, joint stiffness, wound dehiscence, and abscess irrigation and debridement following operative release.

Conclusions: Glucagon-like peptide-1 receptor agonist use in patients with type 2 diabetes mellitus is associated with a reduction in the prevalence of trigger finger without an elevation in complication risk following surgical release. Interestingly, we also observed increased prevalence of trigger finger release among glucagon-like peptide-1 receptor agonist users.

Introduction: Non-tobacco nicotine dependence (NTND) from products like e-cigarettes and pouches is rapidly rising. Studies have shown that tobacco can negatively impact outcomes following carpal tunnel release (CTR), but literature focusing specifically on NTND is sparse. As such, the purpose of this study was to compare outcomes following CTR between patients with versus without a history of NTND.

Methods: The TriNetX database was queried to identify patients over 18 years old who underwent primary CTR. Patients were stratified based on their history of NTND. Cohorts underwent propensity score matching in a 1:1 ratio using demographics, medical comorbidities, and substance use. The following outcomes were collected: 1) post-operative complications, surgical complications, and healthcare utilization within 90 days, 2) opioid use within 2 years, and 3) revision CTR within 2 years.

Results: Within 90 days, patients with NTND (n = 9,811), compared to those without (n = 9,811), had significantly higher rates of healthcare utilization, including emergency department visits (p < 0.001), and post-operative complications, like pneumonia (OR: 1.372, p = 0.036) and wound complications (OR: 1.501, p = 0.005). There were no differences in surgical complications. More patients with NTND were prescribed opioids at all time points within 2 years of CTR (all p < 0.001). There were no differences in revision surgery rates.

Conclusion: Non-tobacco nicotine dependence is associated with higher rates of healthcare utilization, medical complications, and opioid use following carpal tunnel release. Increased clinical awareness, targeted patient counseling, and pre-operative optimization may be warranted for this growing population.

Purpose: Perilunate dislocations and fracture-dislocations are severe wrist injuries, frequently caused by high-energy trauma, that can lead to long-term complications if not promptly addressed. While early open reduction and internal fixation (ORIF) is the standard treatment for acute injuries, the optimal management of late presentations remains controversial. This study aims to compare the clinical outcomes of proximal row carpectomy (PRC) with those of ORIF in patients with late-presenting perilunate injuries.

Methods: This retrospective comparative study analyzed data from three hand trauma centers in Italy. Patients with perilunate injuries presenting more than four weeks post-injury were included and treated with either PRC or ORIF. Clinical outcomes, including Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores, pain scores according to a Visual Analog Scale (VAS), wrist range of motion, and grip strength, were assessed pre-operatively and at 3, 6, and 12 months post-operatively. Patient allocation was non-randomized and based on surgeon judgment and intra-operative findings RESULTS: Twenty-seven patients were included (11 PRC, 16 ORIF). Both procedures resulted in significant improvements in pain and function. At 3 months, PRC showed lower disability and pain scores compared with ORIF (DASH 34.1 vs 43.1; VAS 2.18 vs 3.06). At 12 months, outcomes were comparable, with greater wrist flexion after PRC (49.1 ° vs 44.1 °) and greater grip strength after ORIF (28.1 vs 23.6 kg).

Conclusion: In late-presenting perilunate injuries, PRC is a viable surgical option, offering faster early recovery and comparable long-term outcomes to ORIF. While ORIF may provide superior grip strength, PRC is advantageous for early pain relief and flexion recovery.

Background: Ultrasound-guided carpal tunnel release (CTR-US) has emerged as a reliable and minimally invasive alternative to open or endoscopic surgery. However, the variability of techniques and the absence of a standardized framework may increase the risk of iatrogenic complications, particularly during the learning curve.

Purpose: To describe the CLEAR procedure, a five-step structured method designed to ensure safety, reproducibility, and educational consistency in ultrasound-guided median nerve release at the carpal tunnel.

Methods: The CLEAR procedure synthesizes current anatomical, technical, and interventional imaging data into five core principles: C - Critical anatomical awareness, building a precise mental map of the carpal tunnel anatomy before starting. L - Locate with ultrasound, to define a patient-specific safe zone. E - Equip with the appropriate device, selecting a blade that provides constant visualization and reproducible mechanics. A - Always visualize the blade, ensuring continuous ultrasound control during ligament section. R - Rule out bleeding, with final Doppler verification performed without a tourniquet.

Results: This codified sequence standardizes the operative workflow, reducing operator-dependent variability. Continuous ultrasound visualization and final Doppler control significantly minimize iatrogenic events and postoperative hematomas.

Conclusion: The CLEAR procedure provides a pragmatic, safety-oriented pedagogical framework for CTR-US. It articulates the principle that no step is complete until safety has been verified. Prospective evaluation of CLEAR versus usual care is warranted.