The Journal of hand surgery, European volume最新文献

We compared the outcomes of two groups of patients with scaphoid nonunion treated with arthroscopic cancellous bone grafting. In group 1, K-wires were introduced beforehand and in group 2 after debridement and packing bone grafts in the nonunion site. Our hypothesis was that the percentage of unions would be higher in group 2. We conducted a retrospective, single-centre comparative study of two consecutive series of patients. Seventeen patients in group 1 were operated between 2011 and 2015 and 25 patients in group 2 between 2015 and 2022. At 3 months, there was already a significant difference in consolidation, with three fractures united in group 1 and 21 in group 2. At 6 months, 10 patients (59%) united in group 1 and 24 (96%) in group 2. Debridement of the nonunion site without K-wires in place may allow a more thorough debridement and extensive filling of the defect with bone graft. If an arthroscopic technique is used for scaphoid nonunion, we do not recommend prior fixation with K-wires.Level of evidence: III.

This review paper provides a summary of the evidence for non-surgical and surgical management of thumb base osteoarthritis and suggests guidelines through Clinical Practice Recommendations including Good Practice Points and a Patient Flow Algorithm. The guidelines were developed through systematic reviews in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence. A stepwise approach is recommended with initial non-invasive treatment consisting of a comprehensive and multimodal package of supported self-management. Splints should be additionally considered for those who have not responded to a self-management package alone. Intra-articular corticosteroid injections should be considered in those who have not responded to non-invasive treatment. If symptoms fail to resolve, surgery should be considered. Additional procedures such as interposition or ligament reconstruction do not appear to confer any benefit over excision of the trapezium alone.

This study evaluates the outcomes of arthroscopic triangular fibrocartilage complex (TFCC) foveal reattachment using an inside-out suture passing through the TFCC at specific ulnocarpal anatomical landmarks to grasp the radioulnar ligaments. Thirty-eight patients with a mean age of 36 years (range 19-54), diagnosed with TFCC injury with distal radioulnar joint (DRUJ) instability, underwent arthroscopic inside-out TFCC foveal reattachment using designated suture sites. At a mean follow-up of 32 months (range 26-44), pain score, range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Modified Mayo Wrist Score all showed significant improvement after surgery. The DRUJ stability was restored and the minimal clinically important difference threshold for the DASH score was achieved in all patients. Arthroscopic TFCC foveal reattachment using the inside-out technique at specific ulnocarpal anatomical landmarks provided reliable outcomes and could be considered as another straightforward procedure for treating TFCC injuries with DRUJ instability.Level of evidence: IV.

Nineteen patients presenting with a secondary metacarpal fracture after a previously fractured little metacarpal were retrospectively reviewed. The new injury was more likely to be at the original fracture site in patients with shaft fractures than those with neck fractures.Level of evidence: IV.

Digital transformation through extended reality (xR)-comprising virtual, augmented, mixed, and substitutional reality-has become an integral part of the future of clinical and surgical practice. xR technologies facilitate advanced surgical planning, training, therapies and education, reshaping both personal and institutional healthcare. This paper examines the potential changes that xR has introduced into the field of hand surgery, exploring how xR enhances patient-centric care, increases medical service efficiency and revolutionizes surgical training, planning and therapeutic interventions. Key areas such as surgical assistance, telemedicine, therapies and rehabilitation, medical training and education, and improving patient understanding are highlighted. By synthesizing the current literature, this narrative review articulates the theoretical and practical implications of xR, offering insights into its transformative potential and supporting continuous educational advancement in medical practice.

This study assessed the nationwide incidence of Kienböck's Disease, and operations performed for Kienböck's Disease from the Care Register for Health Care in Finland 1996-2022. The mean annual total standardized incidence rate per million person-years was 9.60 (95% CI: 9.10-10.11) and for men and women, 10.38 (95% CI: 9.63-11.13) and 8.78 (95% CI: 8.10-9.45), respectively. The incidence rate was highest for 50-59-year-olds, at 15.49. Compared with women, the incidence rate for men was higher across all age groups up to 60-69 years. Altogether, 44% of the patients were operated on, and 19% of them had multiple operations. Partial arthrodesis was the most performed procedure and salvage procedures covered 62% of all operations. Our findings provide comprehensive new evidence about Kienböck's Disease distribution across Finland's population and offer insights into the burden caused by operations.Level of evidence: III.

This article explores the background to the concept of levels of evidence and their role in promoting the principles of evidence-based medicine within hand surgery. The Journal of Hand Surgery (European Volume) requires allocation of a level of evidence to each full-length clinical research article. The system employed by the Journal is described, together with discussion of limitations and difficulties in application. Most articles published on hand surgery still have a low level of evidence. Insights and editorial perspectives on various types of research study and the classification of evidence levels are included. Clinical importance of articles and the need to encourage innovation as opposed to high levels of evidence are also discussed.

This study aimed to establish whether virtual reality can reduce patient anxiety and improve surgical satisfaction during wide-awake local anaesthetic no tourniquet hand procedures. Previously validated questionnaires were used to assess subjective anxiety and patient satisfaction. Objective anxiety was determined using patient blood pressure and heart rate measured four times during the procedure. The median difference in intra-operative minus pre-operative diastolic blood pressure was significantly lower in the virtual reality group compared with the control group (p = 0.003). There was a significant decrease in heart rate from pre-operative to post-operative within the virtual reality group (p < 0.001). No differences were observed in subjective anxiety or surgical satisfaction between the groups. Virtual reality can benefit wide-awake patients during hand procedures, particularly where patient preference exists.Level of evidence: Level I, Randomized Controlled Trial.

This paper discusses the current literature surrounding the potential use of artificial intelligence and machine learning models in the diagnosis of acute obvious and occult scaphoid fractures. Current studies have notable methodological flaws and are at high risk of bias, precluding meaningful comparisons with clinician performance (the current reference standard). Specific areas should be addressed in future studies to help advance the meaningful and clinical use of artificial intelligence for radiograph interpretation.

In a series of 271 consecutive duplicated thumbs, an angular, hypertrophied epiphysis was detected in 13 thumbs. We propose a revised version of the radial polydactyly classification that includes this pattern as a separate type from triphalangeal thumb.