The Journal of hand surgery, European volume最新文献

Introduction: Mucopolysaccharidosis type I is a rare metabolic disorder characterized by the accumulation of glycosaminoglycans, leading to musculoskeletal disorders such as carpal tunnel syndrome. This retrospective cohort study was performed to determine the prevalence and timing of the development of carpal tunnel syndrome, assess the efficacy of surgery on recurrence and the effect of haematopoietic stem cell transplantation in resolving accumulated degradation products.

Methods: Thirty-three mucopolysaccharidosis type I patients, born between 2001 and 2023, were included in this study. They received annual screening and treatment at our specialist hospital. Patient demographics, clinical symptoms of carpal tunnel syndrome pre- and post-carpal tunnel release and histopathological sections of the flexor retinaculum were collected. Regression analyses were conducted to assess cumulative risks and determine hazard ratios and survival curves were plotted.

Results: Twenty-seven of 33 mucopolysaccharidosis type I patients, with a median age at the latest follow-up of 13 years (IQR 7.7 to 18.3), were diagnosed with carpal tunnel syndrome on electrophysiological tests or ultrasound at a median age of 3.6 years (IQR 2.8 to 5.2). Only a few patients exhibited clinical symptoms. Twenty-one patients underwent carpal tunnel release and 13 patients experienced recurrence. The highest risk of developing carpal tunnel syndrome was within the first 6 years of life. Eight of the 11 patients accumulated degradation products within lysosomes despite successful haematopoietic stem cell transplantation.

Conclusions: In this study, 27 mucopolysaccharidosis type I patients were diagnosed with carpal tunnel syndrome, showing a high-risk window from 0 to 6 years of age. Recurrence of carpal tunnel syndrome after carpal tunnel release surgery was common, occurring in 61.9% of patients.

Level of evidence: III.

We describe an intraoperative test to show extensor carpi ulnaris tendon instability in the ulnar sulcus.Level of evidence: V.

Corrective osteotomy for a malunited distal radial fracture (DRF) can be challenging. Three-dimensional printing techniques can be used to produce patient specific implants (PSIs). Theoretically, this technique improves accuracy of reconstruction and therefore patient-related outcomes. The aim of this retrospective cohort study was to compare pre- and postoperative patient-rated functional and radiological outcomes following corrective osteotomy of 47 malunited DRFs with PSIs. The primary outcome was the difference in Patient-Rated Wrist Hand Evaluation score (PRWHE). The median PRWHE improved from 68 (IQR: 60 to 77) to 17 (IQR: 7 to 30) after a median follow-up of 15 months in 32 patients. The mean preoperative dorsal tilt of -15° (SD: -8), improved to 7° (SD: 7) palmar tilt postoperatively in 46 patients. Preoperatively, 28 patients exhibited radiocarpal malalignment, which decreased to five postoperatively. Corrective osteotomy of a malunited DRF with a PSI can lead to improved PRWHE, range of motion and radiological outcomes.Level of evidence: IV.

The aim of this study was to explore the pattern of eye dominance in individuals with congenital transverse absences between humeral and metacarpal levels. Eighty-one patients were included with a median age of 25 years (interquartile range 15 to 35; range 6-71). The left-right laterality of limb absence was 27:54. Eighty-one per cent of left-hand-dominant (absent right hand) patients were left-eye dominant (compared with 57% of normal left-handers); 83% of right-hand-dominant (absent left hand) patients were right-eye dominant (compared with 66% normal right-handers). Patients were more likely to be right-eye dominant than left-eye dominant (odds ratio 22.4; 95% confidence interval: 7.0 to 85.8; p < 0.001). This study suggests a possible link between eye dominance and unilateral congenital upper limb transverse deficiency which may have implications for future rehabilitation techniques and prothesis design.Level of evidence: III.

We report a case of restoration of elbow extension after C6-T1 brachial plexus injury using nerve transfer of the teres minor motor branch to the long head of the triceps muscle.Level of evidence: V.

We studied the safety and cost of repeated local steroid injections for carpal tunnel syndrome. Medical records of patients treated by injection between 2016-2017 were retrospectively reviewed for 5 years. Two-hundred and twenty-one patients were included. The number of injections, the reason for surgery and any complications were recorded. A regression analysis was done for predictors of carpal tunnel release. The costs of the treatments were calculated. The mean number of injections was 2.3 (SD2.3; range 1-26). Two patients reported severe pain after the first injection. Thirty per cent of wrists proceeded to carpal tunnel release. Persistent and worsening symptoms were the main reasons for surgery. No intraoperative complications were noted. Patients who underwent release had a longer duration of symptoms and a higher percentage of thenar atrophy. The acquisition of nerve conduction studies was the only significant predictor for release. Cost analysis revealed that giving up to four injections before surgery reduced overall cost. Repeated injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release.Level of evidence: III.

Introduction: The optimal timing for distal radial fracture fixation remains controversial. Most previous studies have dichotomized timing into early or delayed categories, potentially obscuring the true effect of delay. This study investigated surgical timing as a continuous variable to determine its influence on radiographic alignment.

Methods: In a retrospective multicentre cohort study, we reviewed 691 surgically treated distal radial fractures across four Swedish hospitals. Radiographic parameters assessed included dorsal tilt (primary outcome), radial inclination, ulnar variance, intra-articular step, coronal shift and anterior apposition. Logistic regression was used to analyse overall acceptable alignment, while linear regression was used for dorsal tilt. Models were adjusted for age and sex. Interobserver reliability was evaluated with intraclass correlation coefficients.

Results: The mean patient age was 61 years, and 80% of the cohort were female. Each additional day delay to surgery increased the risk of unacceptable alignment by 6%, corresponding to a twofold risk increase with a 2 week delay. Dorsal tilt worsened linearly by approximately 0.34° per day, accumulating to nearly 5° after 2 weeks. Male sex was associated with significantly greater dorsal tilt (mean difference >2°) and reduced correction compared with females. Interclass correlation coefficients demonstrated excellent reliability for dorsal tilt (0.952) and radial inclination (0.947), and moderate reliability for ulnar variance (0.748) and coronal shift (0.611).

Conclusion: A linear relationship was identified between surgical delay and declining radiographic outcomes, highlighting that each day's delay progressively compromises fracture alignment. These findings emphasize the importance of prompt surgical intervention for distal radial fractures to achieve optimal radiographic results.

Level of evidence: III.