Hand surgery & rehabilitation最新文献

Purpose: The purpose of this study is to evaluate the accuracy of a cold ablation robot-guided laser osteotome in pre-clinical cadaver tests, performing shortening and lengthening osteotomies on the ulna and radius.

Methods: The osteotomies were performed using CARLO®, a miniaturised ablation laser. A total of 12 corrective laser osteotomies were performed on the distal metaphysis of the radius and ulna. These were planned on a 3D CT model specific to each patient prior to surgery. Pre- and postoperative CT scans were taken to compare the virtual surgical planning with the postoperative results and to demonstrate the accuracy of the cutting path.

Results: Accuracy measurements of the actual cutting path compared to the planned cut showed a mean deviation of 2.11 ± 0.73 mm in the osteotomies of the radii and 1.66 ± 0.29 mm on the ulnae. After fixation the radii revealed an average lengthening of 4.36 ± 0.58 mm (planned: 4.00 mm), while radial inclination was corrected by 10.55 ° ±1.02 (planned: 10.00 °). The ulnae showed an average shortening of 3.05 ± 0.28 mm (planned: 3.00 mm).

Conclusion: First cadaveric tests showed promising results concerning the resulting corrections of one and two plane osteotomies in wrist and forearm surgery. Compared to previously published results on corrective osteotomies of the radius and ulna, the resulting corrections were highly precise, matching the accuracy of current techniques. Future steps are stability testing of the osteosynthesis followed by certification and first use in patients.

Level of evidence: Therapeutic, Level 5.

Background: The Sensory Collapse Test (SCT) is a clinical maneuver used in the assessment of peripheral nerve compression. Despite being widely described, its actual use and perceived impact in clinical practice remain unclear.

Objectives: To evaluate the current clinical use of the SCT, factors associated with its adoption, and its perceived influence on clinical decision-making among professionals involved in peripheral nerve care.

Methods: An international, web-based survey was conducted among clinicians involved in peripheral nerve surgery and hand therapy. The questionnaire assessed familiarity with the SCT, training background, frequency of use, confidence in its diagnostic value, and perceived impact on clinical decision-making. Descriptive statistics and comparative analyses were performed, including subgroup analyses and multivariable logistic regression to identify factors associated with SCT use.

Results: A total of 136 responses from 38 countries were analyzed. Most respondents were familiar with the SCT (86%), although its use varied: 55% reported frequent use and 11% reported never using the test. Formal training and greater professional experience were independently associated with SCT use (p < 0.05). Confidence was higher when the SCT was used as a complementary rather than a standalone diagnostic tool and correlated positively with frequency of use. Frequent users more commonly reported that the SCT influenced clinical decision-making, particularly regarding localization of nerve compression and surgical planning.

Conclusions: The SCT is widely recognized but inconsistently used. Its adoption is associated with training and experience, and it is generally perceived as a useful complementary tool. Further studies are needed to better define its diagnostic accuracy and clinical role.

Introduction: Pasteurella spp. are frequently implicated in animal-related hand infections, often presenting with severe local symptoms. Given their frequency and potential severity, we conducted a retrospective study to identify the incidence and risk factors for surgical revision and to evaluate long-term functional outcomes.

Methods: This single-center retrospective analytical study included patients operated on in a hand emergency center between November 2011 and June 2024. Eligible patients had deep structural involvement of the hand and intraoperative bacteriological samples positive for Pasteurella spp. Functional outcomes were assessed by telephone or videoconference. Univariate analysis was performed using chi-square or Fisher's exact tests, with odds ratios (ORs) calculated for each risk factor.

Results: 121 patients were included. The median interval between surgery and follow-up was 21 months (range 2-152). Fifteen patients (12.4%) required surgical revision. Significant risk factors for revision were diabetes (OR 3.9), septic arthritis (OR 4.0), initial management delay >72 h (OR 4.4), and age 45-65 years (OR 4.6). Functional assessment showed a significant reduction in total active motion of the long fingers and thumb compared with the contralateral side, while the Kapandji score was not significantly affected. Fourteen percent of patients reported mechanical pain and 26% neuropathic pain, although all resumed their usual activities satisfactorily.

Conclusion: This study identified four risk factors for emergency surgical revision in Pasteurella spp. hand infections. Functional outcomes demonstrated significant reductions in total active motion of the fingers, with a notable prevalence of residual neuropathic (26.4%) and mechanical pain (14%). Tailoring management to these factors may improve outcomes, pending confirmation by multivariate analysis.

Metacarpal defects following ballistic hand injuries are a devastating complication that can compromise hand function. Autologous bone grafting is the gold standard treatment of these osseous defects, most commonly utilizing the anterior iliac crest as the donor site. Alternatively, use of corticocancellous bone graft from the proximal ulna has been described, although with mixed clinical outcomes. Additionally, the upper limit of defect that can be repaired with this technique remains unknown. Herein we described the case a patient who sustained a partial extensor tendon injury and significant fourth metacarpal defect following ballistic injury who was subsequently treated with open reduction and internal fixation of the fourth metacarpal using a 2.5 cm corticocancellous bone graft harvested from the ipsilateral proximal ulna, in conjunction with primary extensor tendon repair. The patient achieved successful radiographic union of the corticocancellous graft and appropriate filling of the donor site with restoration of digit flexion and extension.

Introduction: Artificial intelligence (AI) has become increasingly tested for improving fracture detection. This scoping review evaluates how AI can improve human performance in detecting traumatic wrist fractures.

Methods: A scoping review was conducted to identify studies comparing AI and human performance for wrist fracture detection. Nine resources were searched, including key databases Embase, MEDLINE, and SCOPUS. Studies which did not include AI being used as an assistant were excluded.

Results: Nine studies were included in the review, where AI models demonstrated sensitivity from 83% to 97.7%, specificity from 77% to 96%, negative predictive value (NPV) from 89% to 90%, and positive predictive value (PPV) from 83% to 92%. Human performance demonstrated sensitivity from 58% to 94%, specificity from 77% to 97%, a NPV from 62% to 87%, and a PPV from 74% to 93%. When AI was used as a diagnostic aid, combined performance generally improved across all studies. Sensitivity gains ranged from 3% to 19%, with greater improvements among less experienced readers. Specificity changed between -4% to 11% when AI was used as a diagnostic aid. NPV and PPV changed from 6% to 13% and -5% to 7% when AI was used as a diagnostic aid, respectively.

Conclusion: Models using AI improved sensitivity and negative predictive value across all readers, while some readers had a reduced specificity or positive predictive value when using AI. Overall, AI has demonstrated promising results in traumatic wrist fracture detection when used as an assistant to support diagnosis.

Introduction: The purpose of this study was to retrospectively analyze the clinical features and surgical outcomes of a distinct subgroup of patients who underwent sequential bilateral ulnar shortening osteotomy with arthroscopic triangular fibrocartilage complex (TFCC) foveal repair for ulnar impaction syndrome (UIS) associated with distal radioulnar joint (DRUJ) instability, with a particular focus on the development of contralateral symptoms following initial unilateral surgery.

Methods: A retrospective review was conducted of 26 patients who underwent bilateral ulnar shortening osteotomy with TFCC foveal repair between 2015 and 2022, with at least 2 years of follow-up for each wrist. The inclusion criteria were radiologically positive ulnar variance (≥3 mm), arthroscopic evidence of lunate chondromalacia, definitive foveal TFCC detachment, and DRUJ instability in both wrists.

Results: In 88% of the patients, the initial surgery was performed on the dominant side with the mean age of 34.08 years. All preoperative statuses improved at the final follow-up. Subsequent surgeries were conducted on the contralateral side with a mean interval of 15.7 months. At follow-up, significant improvement from the preoperative status was observed, while the contralateral surgery group showed less preoperative deterioration in grip strength, VAS, MMWS, and DASH scores than at the initial surgery. However, both groups showed comparable improvements in all outcome measures at the final follow-up.

Conclusion: Sequential bilateral ulnar shortening osteotomy with TFCC foveal repair yielded consistently favorable outcomes, regardless of surgical side or baseline functional deficit. The interval between surgeries and the absence of a history of trauma suggest that contralateral pathology may develop in the context of degenerative changes, potentially influenced by compensatory overuse during postoperative recovery.

Level of evidence: Level IV, retrospective case series.

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.