The Journal of hand surgery, European volume最新文献

We present the results of 137 nerve transfers in 56 limbs (35 participants, 21 bilateral) with special reference to the International Classification for Surgery of the Hand in Tetraplegia, as outcomes for Groups 0 and 1 are rarely reported. These participants were assessed for a minimum of 20 (median 36) months after operation. Medical Research Council grades and strength measurements showed that for Group 0, reconstruction of useful wrist extension was achieved in six out of eight limbs. Reanimation of finger and thumb flexion in this group remains difficult and in only one out of four limbs was prehensile function achieved. Limbs in Group 1 had functional results for finger extension and grip. Outcomes of nerve transfers for the other groups and for triceps reanimation were comparable with previous reports. We believe that nerve transfers in patients with high level tetraplegia are underused but could bring valuable improvement.Level of evidence: IV.

Introduction: The centre of rotation (COR) of the Motec^® ball-and-socket total wrist arthroplasty (TWA) lies at the centre of the head, and is determined by the position of the cup and thus the radial implant. The ideal position for the COR is not known.

Methods: The effect of the longitudinal position of the COR on performance of the wrist was studied using custom-made articular components in a cadaveric wrist model controlled by an active wrist motion simulator. Analysis of the standard surgical technique and clinical corroboration of postoperative radiographs were also performed.

Results: The ideal position for the COR is 8 mm distal to the point where the long axis of the radius meets the distal articular surface (the RCS) and 95% of optimal movement and efficiency can be achieved within 3.3 mm of that point. The standard surgical technique results in the COR being positioned7mm distal to the RCS. Clinical corroboration, in 40 well-functioning Motec^® wrists, confirmed the COR was within the range where the implant could be expected to achieve at least 95% of preoperative movement and efficiency.

Conclusion: Moving the COR of a Motec^® TWA affects movement and efficiency. Flexion and extension are more affected than other movements. Performance of the wrist deteriorates with more proximal and distal positions; however excellent results can be obtained over a relatively wide area.The standard surgical technique reliable places the COR of the Motec^® TWA in a position where optimal movement and efficiency can be expected.

Scaphotrapeziotrapezoid arthrodesis is a controversial surgical procedure for wrist disorders and its biomechanical effect remains unclear. This study investigated scaphotrapeziotrapezoid fusion based on a previously validated whole-wrist finite element model to simulate arthrodesis by creating a unified bone complex from the three bones (scaphoid, trapezium and trapezoid) in the joint. The model was analysed under physiological grasping loads to examine axial load distributions and articular contact pressures at the radioscaphoid and radiolunate interfaces. The fused complex becomes a major load-bearing structure, while radiocarpal contact pressures at both the radioscaphoid and radiolunate interfaces show reductions compared with the intact model. This altered load distribution pattern suggests significant biomechanical adaptations after the procedure and supports its use for scapholunate instability and the treatment of Kienböck's disease.

Introduction: The acquisition and maintenance of knowledge is a continuous process which extends throughout clinical practice. Hand surgeons draw on a wide range of educational resources, but preferences and reading habits are not well described. This study aimed to identify how hand surgeons access and prioritize information for learning and decision-making.

Methods: An anonymous, cross-sectional online survey was distributed by the Young European Hand Surgeons Committee and Federation of European Societies for the Surgery of the Hand (FESSH) Office to hand surgeons across Europe. The 28 item questionnaire covered demographics, preferred learning resources, reading habits and multimedia use. Continuous variables were presented as means. Group comparisons used chi-square testing.

Results: A total of 95 responses were analysed (mean age 37.7 years; 78% under 40; 60% specialists). Textbooks were the most frequently used resource for learning unfamiliar topics (49%) and preparing for operations (44%), followed by senior colleagues and journals. For staying up-to-date, online journals (39%) and webinars (13%) were preferred. The Journal of Hand Surgery (European Volume) was the most frequently read journal (59%), and Green's Operative Hand Surgery was the leading textbook (89%). Residents relied more on online resources such as Orthobullets (61%) than specialists (25%) (p = 0.0013), while specialists more often subscribed to journals and followed new issues regularly.

Conclusion: Hand surgeons combine traditional and digital resources for learning. Textbooks, journals and mentorship remain central, but digital tools are increasingly used. These findings offer a valuable insight into educational resource use across different stages of training.

The tube posterior tibial artery flow-through free flap technique is proposed for salvaging upper limbs with severely contaminated or infected soft tissue defects and major arterial injuries. Between January 2016 and February 2024, six patients were treated using this method. This is a two-stage approach involving initial restoration of blood supply via a tube posterior tibial artery flow-through free flap, followed by delayed soft tissue coverage utilizing the unfolded tube flap after a series of wound debridements and vacuum sealing drainage treatments. All upper limbs and flaps completely survived. At the 2-year follow-up, the grip and pinch strength of the injured hands reached 37% (range 29-72%）and 31% (range 12-42%) of the contralateral sides, respectively. The mean Disabilities of the Arm, Shoulder, and Hand score was 60 (range 53-67). This study demonstrates the feasibility and efficacy of the tube posterior tibial artery flow-through free flap technique in complex upper limb salvage cases.Level of evidence: IV.

Background: This article aims to summarize the current recommended methods, guidelines and consensus among a panel of international experts meeting at the 16th Congress of the International Federations for Societies for Surgery of the Hand in 2025 and discussion prior to or after the congress in the tendon study group.Primary flexor tendon repair:The updated guidelines and consensus emphasize (1) the use of strong and solid repair methods and true early active flexion in all flexor tendon repairs in zone 2, and also in zones 3-5, (2) no traditional running peripheral sutures when a six-strand repair is used, (3) not placing the knots between two tendon stumps, as the knots are foreign bodies and (4) abandoning place-and-hold exercise after surgery. Outcomes from the surgical units of these authors are reported to support these guidelines.Secondary flexor tendon reconstruction:This article also summarizes guidelines relating to secondary reconstruction of the flexor tendons. We collectively suggest one-stage tendon grafting for the patients without a lengthy destruction of the pulleys - that is - not needing pulley reconstruction. Staged tendon grafting should be reserved for patients who require pulley reconstruction in the first stage. Early active motion can be used after such one-stage tendon grafting procedures.

Conclusions: Despite significant advances in flexor tendon repair and reconstruction, the drive towards perfection continues. The authors draw attention to outcomes obtained across the globe in recent years and highlight critical areas and pertinent technical points that the readers may use to improve their outcomes.

We conducted a systematic review of the definition of a scaphoid fracture on MRI scans, examining 58 studies of patients with suspected scaphoid fractures. Nearly half the studies did not report any definition or measurement of fracture. Among those that did, 29 out of 33 studies (88%) described a linear fracture shape, 13 out of 33 studies (39%) reported the extent of the fracture across the scaphoid and none specified the fracture line orientation. Of the 25 studies describing fractures using at least one of the shape and extent groupings, 12 (48%) regarded a linear signal through the cortex as a fracture, five (20%) regarded a linear intramedullary signal in isolation as a fracture and eight (32%) regarded a diffuse intramedullary signal in isolation as a fracture. This review highlights the need for a consensus definition of scaphoid fractures on MRI scans to assess the reliability and diagnostic performance of MRI scans for diagnosing true scaphoid fractures, as well as their potential harms and benefits.Systematic Review (Level III).