Hand surgery & rehabilitation最新文献

Lateral epicondylitis is a very common form of tendinosis that may heal spontaneously. Diagnosis is mainly clinical. Treatment is usually non-operative. However, if conservative treatment fails, open or arthroscopic tenotomy of the epicondylar muscles may be an option. Ultrasound-guided percutaneous tenotomy may now be performed on the common epicondylar tendon close to the enthesis, with a success rate close to that of conventional surgery. For several years now, we have used a slightly different technique, involving ultrasound-guided fasciotomy of the extensor digitorum communis and extensor carpi radialis brevis muscles at the level of the radiohumeral joint. It may be performed under local anesthesia in the office. Ultrasound-guided hydro-dissection of the fascia is essential to facilitate the procedure and easily visualize the various anatomical structures. Fasciotomy can be performed with an ophthalmology scalpel, surgical knife or curved needle. This procedure is similar to arthroscopic techniques, but is significantly less expensive and with lower carbon footprint. It is safe and effective when a surgeon with experience in ultrasound-guided procedures performs it.

Objective: We present long-term results for the Pyrocardan®, a pyrocarbon trapeziometacarpal interposition implant used for the treatment of osteoarthritis of the thumb.

Methods: Between March 2009 and May 2013, 199 arthroplasties were performed in a single hand center, in 184 patients by 6 hand surgeons. 107 implants were followed up for a mean 137 months (range, 120-168 months). 82 patients (89 implants) were lost to follow-up.

Results: Median age was 57 years, with 15 patients (14.2%) aged ≤50 years. At last follow-up, functional scores were significantly improved compared to preoperative data: pain rating, 0.4/10 versus 7.2/10; Patient-Rated Wrist/Hand Evaluation, 4/100 versus 61/100; Quick Disabilities of the Arm, Shoulder and Hand, 9/100 versus 54/100. Range of motion and strength were comparable to the contralateral side. Radiographic analysis showed that 82% of implants were correctly positioned. No implant dislocation was observed. There were 6 re-operations, 5 of which in the short term. Overall implant survival was 94.3%, with 44.7% loss to follow-up.

Conclusion: Pyrocardan® interposition arthroplasty is a valid alternative for the treatment of osteoarthritis of the thumb.

Level of evidence: IV.

Introduction: ChatGPT has been increasingly utilized to create, simplify, and revise hand surgery patient education materials. While significant research has examined the quality and readability of ChatGPT-derived hand surgery patient education, the patient perspective has not previously been evaluated. This study compared patient reported clarity and readability grades as well as patient preferences for carpal tunnel surgery educational information from medical education websites and ChatGPT.

Methods: Patients without a history of carpal tunnel release surgery at two orthopaedic hand surgery outpatient clinics were asked to complete an anonymous survey which gathered demographic information and included a blinded educational passage on carpal tunnel release surgery from ChatGPT, WebMD, or Mayo Clinic. Patients graded the blinded passages regarding clarity, readability, length, likeliness to recommend to others, and overall satisfaction with the education material.

Results: There were no significant differences in clarity (p = 0.682),readability (p = 0.328), or likeliness to recommend to others (p = 0.106) between the different educational sources. When stratified by age, younger patients (under 55) were more likely to recommend Mayo Clinic over other resources (p = 0.002). When further stratified to include only those who reported previously using websites for healthcare information, patients tended to have a higher likelihood of recommending Mayo Clinic compared to other sources, but this was not a statistically significant difference.

Conclusions: There were no differences in clarity, readability, or preference ratings between patient education materials that were produced by ChatGPT, WebMD and Mayo Clinic. However, while ChatGPT-generated materials are comparable in quality based on patient ratings, younger patients may still favor well-established sources for medical education. This information regarding patient preferences provides valuable insights for hand surgeons when selecting suitable educational resources for their patients.

Introduction: Surgical treatment of ulnar tunnel syndrome is controversial, with no consensus on the ideal procedure. Nevertheless, in-situ decompression seems to provide faster recovery with less morbidity than neurolysis-transposition. The aim of this retrospective study was to validate a new percutaneous technique using ultrasonography.

Methods: A retrospective 2-center study included 40 patients with McGowan stage 1 or 2 ulnar nerve entrapment at the elbow treated by a new limited ultrasound-guided percutaneous technique. Patients with McGowan stage 3, osteoarthritis at the elbow or instability were excluded. The study endpoint was clinical success of the percutaneous technique using ultrasonography for release of ulnar nerve entrapment at the elbow. The secondary endpoint was time to recovery.

Results: All 40 patients showed clinical improvement, with the resolution of acroparesthesia symptoms. No recurrences were observed at 13 months' follow-up. There were no cases of neurological complications, ulnar nerve instability or infection. Patients were able to return to work rapidly, with an average absence of 3.5 weeks.

Discussion: Numerous studies questioned the value of ulnar nerve transposition associated with release in the early stages. No significant difference was found between in-situ decompression and transposition; however, more complications were observed in patients with transposition.

Conclusion: Overall, this new ultrasound-guided percutaneous technique for ulnar nerve entrapment was safe. It allowed rapid recovery with effective symptom relief while limiting the risk of complications and time off work.

New surgical techniques for the treatment of scaphoid non-union, developed in the last two decades, now enable a healing rate of 80-90%. However, no consensus exists for the surgical treatment of non-union. On the other hand, regenerative medicine techniques have enriched the therapeutic armamentarium for non-union, especially in the lower limbs, with the use of autologous concentrated bone marrow injection using autologous osteogenic precursors to create a favorable microenvironment for bone healing. This technique has the advantages of being inexpensive, easily accessible and applicable in scaphoid non-union as a biological adjuvant to surgery, to improve both healing times and rates. We report 6-month clinical results for the first patient receiving autologous concentrated bone marrow injection associated to scaphoid screw fixation in our center.

We carried out a cadaver study using 10 fresh-frozen adult legs and hands to explore technical feasibility and reproducibility of the free Medial Sural Artery Perforator flap and its applicability for covering soft tissue defects in the hand. A mean of 2 cutaneous perforators (1-4) were found. Each flap had a pedicle composed of a main perforator that arose from the medial sural artery. Distance between the middle of the popliteal fossa and the emergence of the main perforator was 10 ± 1.9 cm. The pedicle length was 13 ± 1.6 cm. It included an artery (diameter: 2.5 ± 0.6 mm) and a vein (diameter: 3.2 ± 1.2 mm). Skin paddle thickness was 8.5 ± 1.9 mm. Using an 10 × 8 cm skin paddle, it was always possible to cover the entire palmar and dorsal sides of the hand. Our findings suggest that this free flap is a reliable and reproducible option for large cutaneous defects of the hand, offering an effective alternative to conventional flaps. LEVEL OF EVIDENCE: IV.

Introduction: Destruction of the metacarpophalangeal joint can result in disabling pain and stiffness. Several therapeutic options are available, including pyrocarbon interposition implants. The primary endpoint of this study was assessment of clinical and radiographic outcomes in 34 patients treated with HAPY® pyrocarbon interposition implants (Tornier, Grenoble, France) with a minimum follow-up of 3 years. The secondary endpoint was to assess complications and the need for revision surgery.

Materials and methods: Thirty-four patients (61 implants) who underwent metacarpophalangeal arthroplasty with the HAPY® implant were reviewed with a minimum follow-up of 3 years. The etiology was inflammatory (rheumatoid arthritis) in 18 cases (37 implants), primary osteoarthritis in 16 (21 implants), and post-traumatic in 3 (3 implants). Preoperative data comprised age, gender, operated finger, etiology (inflammatory, primary or post-traumatic), digital chain mobility, pain assessment on visual analog scale, grip strength on a standardized handheld dynamometer, and functional scores including QuickDASH and the Patient-Rated Wrist/Hand Evaluation. Immediate postoperative radiographs (anteroposterior, lateral and oblique views) centered on the metacarpophalangeal joint were compared with those at last follow-up. Metacarpal and phalangeal implant subsidence were assessed.

Results: At a mean follow-up of 71.5 months, pain score was reduced by a mean 5.4 points: 6.4/10 versus 1/10 (p < 0.001). The mean active range of motion in flexion-extension showed a significant improvement of 27°: 42.9 ° versus 70 ° (p < 0.001). The QuickDASH and Patient-Rated Wrist/Hand Evaluation functional scores significantly improved by a mean 26.7 points (50.6 ± 20.1 versus 23.9 ± 25 (p < 0.001)) and 32.8 points (53.58 ± 21.6 versus 20.77 ± 22.1 (p < 0.001)), respectively. Comparison between pre- and post-operative grip strength did not show a significant difference. 94% of patients reported being satisfied with the procedure, while 6% were dissatisfied or very dissatisfied. One of the dissatisfied patients developed type 1 complex regional pain syndrome, while the other had persistent pain and stiffness. Mean implant subsidence in the metacarpal was 0.48 mm ± 4.2 mm, and in the first phalanx 3.6 mm ± 9.6 mm. One patient (2.9%) experienced implant dislocation in the immediate postoperative period. No further implant dislocations were observed during follow-up.

Discussion: The HAPY® interpositional implant provided good clinical and radiographic outcomes for the management of long finger arthritis, offering functional results and improvement in range of motion, comparable to other series. The HAPY® interpositional implant has the advantage of being non-constrained and maximizing bone stock.

Total joint arthroplasty is a promising surgical treatment for painful thumb trapeziometacarpal osteoarthritis. Strict surgical technique is essential to achieve a reliably good outcome. Preoperative radiographic evaluation before surgery and intraoperative fluoroscopy during surgery are valuable means of optimizing implant positioning. This article provides an overview of how to perform proper radiographic evaluation for trapeziometacarpal arthroplasty, and discusses radiographic guidelines for correct implant placement and how to use them during surgery.