Hand surgery & rehabilitation最新文献

Introduction: This study aims to assess the rates of return to work and sports participation following arthroscopic bone grafting for severe scaphoid nonunion.

Patients and methods: We conducted a retrospective analysis of patients treated for scaphoid nonunion from 2017 to 2024, with a minimum follow-up of one year. All patients underwent arthroscopic repair utilizing an olecranon bone graft and antegrade screw fixation. Employment status and sports participation prior to the diagnosis of nonunion were documented and evaluated at final follow-up.

Results: A total of 21 patients met the inclusion criteria. Before the diagnosis of scaphoid nonunion, 18 patients (85.7%) were employed, with 2 (11.1%) not returning to work. Seventeen patients (80.9%) participated in sports prior to nonunion. At the final follow-up, one patient (5.8%) was unable to resume sports, while two patients (11.7%) modified their activities due to ongoing wrist discomfort during pre-injury sports.

Conclusion: The arthroscopic management of scaphoid nonunion resulted in significant functional recovery, with an 88.9% return-to-work rate and a 94.2% return-to-sport rate.

Level of evidence: IV.

Achieving tension-free end-to-end sutures is crucial for optimal nerve recovery; however, it presents significant challenges in the contralateral C7 nerve transfer (cC7 transfer) procedure for patients with hemiplegic arms. This paper presents a modified surgical technique for cC7 transfer, featuring an aesthetically pleasing incision design. Key steps of the technique include precise incision planning, careful exposure and identification of the brachial plexus, meticulous tracing of the cC7 nerve, protection of the phrenic nerve and vertebral vessels, and the creation of a prevertebral space to facilitate the nerve transfer. We illustrate this method step by step in a hemiplegic patient. In conclusion, our approach offers a safe and effective strategy for performing modified contralateral C7 transfer surgery, ensuring tension-free end-to-end sutures for improved patient outcomes.

Objectives: The "psychopathological hand" or "psychogenic hand", long regarded as a clinical curiosity, remains underdiagnosed today and is sometimes confused with other hand conditions. The aim of this article is to reframe the psychopathological hand syndrome within the field of functional neurological disorders, in order to clarify its clinical, pathophysiological and therapeutic specificities.

Methods: A narrative review of the literature was conducted using international medical databases and reference works in functional neurology, psychiatry and hand surgery. The main data were synthesized along four axes: historical aspects, diagnostic and clinical criteria, comorbidities and pathophysiological models, therapeutic strategies and organization of care.

Results: Functional neurological disorders of the hand are characterized by anatomo-clinical inconsistencies, symptom variability, and frequent presentations such as functional dystonias, tremors, paresis or atypical pain. They occur in a context of vulnerability due to early trauma, heightened bodily vigilance, and psychiatric or somatic comorbidities. From a neurofunctional perspective, they reflect a disorganization of the networks of agency, interoception and emotion. Treatment is based on a positive diagnosis announcement, recovery by combined action, psychotherapeutic support and multidisciplinary coordination.

Conclusion: The psychopathological hand constitutes a localized manifestation of a functional neurological disorder and should no longer be regarded as a marginal entity. Its recognition as a specific functional disorder helps to avoid inappropriate treatments and paves the way for integrated care strategies and a better structuring of specialized pathways.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Anterograde ultrasound-guided carpal tunnel release is now a widely adopted technique. However, identifying the distal limit of the transverse carpal ligament (TCL) on a longitudinal view remains challenging. This study investigates whether the 'V'-shaped structure seen on longitudinal ultrasound can serve as a reliable landmark for complete TCL release.

Materials and methods: Ten fresh cadaveric upper limbs were examined. Four anatomical landmarks were identified and marked under ultrasound guidance, including the distal end of the 'V'-shaped structure seen on longitudinal view. An ultrasound-guided anterograde release of the transverse carpal ligament was then performed, advancing the instrument to the distal end of the V-shaped sonographic image. A final anatomical dissection verified the correspondence between ultrasound landmarks and underlying structures, particularly the superficial palmar arch.

Results: The distal end of the 'V'-shaped structure was consistently located distal to Kaplan's line and trapezium-hook of hamate line. It averaged 6.8 mm from the superficial palmar arch. In 5 of 10 cases, this distance was ≤5 mm, and in one case, the section came into contact with the superficial palmar arch without causing injury.

Conclusion: The 'V'-shaped structure extends beyond the anatomical limits of the carpal tunnel. Despite its proximity to the superficial palmar arch, no vascular injury occurred. These findings support the need for continuous ultrasound guidance and highlight that the 'V' sign does not represent the true distal limit of the carpal tunnel. Larger in vivo studies are required to confirm these results and establish consistent longitudinal ultrasound landmarks for safe carpal tunnel release.

Purpose: This study evaluated the accuracy of leading AI models, ChatGPT-4o and Gemini 1.5 Pro, in providing management recommendations for CTS in patient scenarios against American Academy of Orthopedic Surgery (AAOS) guidelines.

Methods: Treatment ratings for CTS patient scenarios from the AAOS Appropriate Use Criteria for Management of Carpal Tunnel Syndrome Pathology were compared with ratings provided by ChatGPT and Gemini 1.5 Pro using a scale from 1 to 9, with discrepancies in treatment rating calculated by contrasting scores with AAOS ratings. Spearman correlations and paired t-tests (α < .05) were conducted to assess consensus, while heatmaps were employed to display the findings.

Results: A total of 810 paired scores were generated across 135 patient scenarios. Compared to AAOS guidelines, ChatGPT-4o under-recommended steroid injection (mean error -2.7 ± 1.2; P < .001) and carpal tunnel release (mean error -1.8 ± 1.7; P < .001) while over-recommending electrodiagnostic studies (mean error 4.5 ± 3.8; P < .001). Gemini 1.5 Pro demonstrated a similar pattern, under-recommending steroid injection (mean error -2.4 ± 1.4; P < .001) and carpal tunnel release (mean error -1.8 ± 1.3; P < .001) but showing a less pronounced over-recommendation for electrodiagnostic studies (mean error 3.7 ± 3.2; P < .001). Gemini 1.5 Pro outperformed ChatGPT-4o in alignment with AAOS guidelines, with a stronger Spearman correlation (Rho = 0.782 vs. 0.53, P < 0.001).

Conclusions: Gemini 1.5 Pro showed a stronger overall alignment with AAOS guidelines, indicating a more refined diagnostic approach. Ultimately, these platforms are bound by the limitations of algorithmic biases, posing a risk for misdiagnosis.

Level of evidence: Level III - Non-Experimental Study.

Closed traumatic ruptures of the finger flexor tendon pulleys are common injuries in sport climbers. In cases of complete rupture, surgical repair using graft material is the current standard to restore pulley function. Although these techniques provide good outcomes, recovery often exceeds six months and graft-related morbidity may occur. Surprisingly, the option of direct suture repair has been little explored, despite its potential advantages. We retrospectively reviewed six cases of isolated closed traumatic pulley rupture and two cases of multiple pulley ruptures treated by direct suture combined with early active postoperative rehabilitation. Postoperative outcomes were assessed using the Buck-Gramcko score and by comparing the postoperative climbing level with the preinjury level. Tendon-bone distance, functional impairment, and hand strength were also evaluated. Ultrasound examination of the repaired pulley was performed in three patients at three years postoperatively. Patients recovered their preinjury climbing level after a mean of 5.8 months (range, 3-8 months), a shorter timeframe than that typically reported after graft-based reconstruction. Ultrasound confirmed pulley continuity and adequate mechanical behavior in the three examined patients. All injured fingers achieved an excellent Buck-Gramcko score. Hand strength was comparable to preoperative measurements, functional complaints were minimal, and tendon-bone distance remained within normal limits. These encouraging clinical results suggest that direct suture repair of flexor tendon pulley ruptures in high-level climbers may represent a valuable alternative to graft-based reconstruction, enabling a faster return to climbing with minimal morbidity.