Hand surgery & rehabilitation最新文献

Background: Wrist dislocations are rare injuries that present substantial diagnostic challenges, yet large-scale epidemiological data on injury mechanisms and trends are limited. This study characterizes wrist dislocation epidemiology using nationally representative emergency department data from 2004 to 2023.

Methods: A retrospective analysis was performed using the National Electronic Injury Surveillance System (NEISS) database to estimate national wrist dislocation trends. Cases were identified by diagnosis and body part codes. Demographics, mechanisms, and annual incidence were examined. Trends were assessed using linear regression; group differences were assessed using Odds Ratios (OR) and Injury Proportion Ratios (IPR).

Results: Among 21,237 estimated cases (3.42/1,000,000 population), males accounted for 64.2% of dislocations, with a 4.38/1,000,000 incidence vs. 2.40/1,000,000 in females (p < 0.001). Peak incidence was among ages 25-44 years (17.49 per 1,000,000 US population; male-to-female [M:F] IPR 3.59). Females demonstrated bimodal vulnerability: <5 years (IPR 1.85) and ≥65 years (IPR 1.52). Athletic dislocations (19.7%) mainly involved males in football (16.0%) and snowboarding (12.8%). Non-athletic dislocations (80.3%) disproportionately affected females (OR 3.02) and individuals ≥50 years (OR 4.68), with home environments posing elevated risks (female OR 2.22).

Conclusions: This national analysis characterizes wrist dislocation epidemiology, revealing a stable incidence despite rising sports participation. Key demographic disparities were identified, including high-risk groups of young males (15-24) and females at bimodal age peaks (<5 and ≥65 years). This descriptive epidemiological analysis provides a foundational baseline to inform future clinical research on management and outcomes within these specific populations.

Background: Pyrocarbon and silicone implants are the two main options for metacarpophalangeal (MCP) joint arthroplasty, but their comparative functional outcomes and long-term survivorship remain debated. Evidence is scattered across heterogeneous study designs, and no recent meta-analysis has directly compared both implant types.

Purpose: To compare functional outcomes and implant survival between pyrocarbon and silicone MCP joint arthroplasty.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Embase, and Cochrane Library were searched from inception to July 2024. Studies reporting postoperative outcomes after silicone or pyrocarbon MCP arthroplasty were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale (with adapted criteria for single-group pre-post designs). Random-effects models were used due to anticipated heterogeneity. Functional outcomes (arc of motion, flexion, extension lag, DASH score, VAS pain) and implant survival (5- and 10-year) were pooled. Sources of heterogeneity were qualitatively explored.

Results: Twelve studies (1,023 implants) were included: 535 silicone and 488 pyrocarbon. Pooled analyses showed no significant differences between silicone and pyrocarbon implants for postoperative flexion, total arc of motion, or extension lag. DASH scores favored silicone implants, with significantly lower postoperative disability; however, the magnitude of this difference did not exceed the reported minimal clinically important difference. Five-year survival was high for both groups (silicone 82-97%, pyrocarbon 82-97%). Ten-year survival ranged from 70-89% for silicone and 81-88% for pyrocarbon. Considerable heterogeneity was present across several pooled analyses, related mainly to study design variability.

Conclusion: Both silicone and pyrocarbon MCP arthroplasties provide comparable improvements in pain, function, and medium-term survival. Differences in range of motion favor silicone, while long-term survivorship appears similar. Due to substantial heterogeneity and predominance of non-comparative studies, these findings should be interpreted with caution.

Level of evidence: III (based on retrospective comparative studies).

Rotational instability following revision silicone arthroplasty of the proximal interphalangeal joint is rare and difficult to manage, especially in young patients with hyperlaxity. This paper sets out a novel surgical technique for recurrent prosthesis rotation. The technique consists of a transosseous fixation through both phalanges.

Objective: Scapholunate ligament injuries lead to wrist pain exacerbated by hyperextension and a reduction in strength, posing challenges for military personnel who require high physical fitness for sports and heavy lifting. This study primarily aimed to assess return-to-work rates using the REFA physical workload scale (Reichsausschuss Für Arbeitszeitermittlung) and return-to-sport following isolated arthroscopic posterior capsuloplasty. Secondary objectives included evaluating pain during forced hyperextension, functional assessments, range of motion, and radiological outcomes.

Material and method: A prospective monocentric study was conducted involving military patients who underwent isolated arthroscopic posterior capsuloplasty of the wrist between 2019 and 2024, utilizing the technique originally described by Mathoulin.

Results: Nineteen wrists were treated: seven at EWAS stage 3B, six at stage 3C, five at stage 4, and one at stage 5. One patient was lost to follow-up. With a mean follow-up duration of 24 months, all patients returned to work at a physical workload equal to or exceeding their pre-injury capacity, while all but one resumed sport at pre-injury levels. QuickDASH and PRWE scores averaged 8.5 and 14.3, respectively, at the final follow-up. Pain during hyperextension significantly decreased from 6.6 to 2.6 on a 10-point scale. Flexion decreased by 10 degrees; however, extension remained unchanged, and no significant radiological changes were observed.

Conclusion: Arthroscopic posterior capsuloligamentous repair results in high rates of return to work involving heavy lifting and sports participation, even in advanced scapholunate injuries (EWAS scores 3C or 4). Postoperative functional wrist scores are remarkably satisfactory.

Level of evidence: Prospective study.

Level iii:

Objectives: The trapeziometacarpal (TMC) joint is a puzzling joint with complex kinematics. Historically, instability and subluxation of the TMC joint are quantified by measurements as trapezial tilt, dorsal subluxation angle and radial subluxation ratio on two dimensional radiographs. These measurements are influenced by different factors such as radiographic incidence and position of the thumb relative to the hand. The recent introduction of four dimensional (4D) CT allows analysis of joint kinematics during an in vivo motion. The aim of this study was to analyze the congruency of the TMC joint during an active opposition and retropulsion movement using 4D CT.

Patients and methods: A total of 10 healthy volunteers were included and their TMC joint kinematics were studied during a retropulsion-opposition-retropulsion movement. Trapezial tilt, dorsal subluxation angle and radial subluxation ratio were measured for every patient during this active motion.

Results: Trapezial tilt evolved from 124 in retropulsion to 120 degrees in opposition and evolved from 120 degrees in opposition to 124 degrees in retropulsion. Dorsal subluxation angle evolved from 68 degrees in retropulsion to 45 degrees in opposition and evolved from 44 degrees in opposition to 68 degrees in retropulsion. Radial subluxation ratio evolved from 20% in retropulsion to 20% in opposition and evolved from 19% in opposition to 20% in retropulsion.

Conclusion: Trapezial tilt and dorsal subluxation decreases with opposition, whereas radial subluxation remains constant. Future research could use this model to investigate the influence of hyperlaxity and osteoarthritis on TMC joint kinematics and joint congruency.