The Journal of hand surgery, European volume最新文献

The use of metalwork, such as screws and plates, is common in orthopaedic trauma surgery, with a recent trend towards individually packed metalwork owing to concerns about sterilization efficacy and traceability. Despite this, there is no clinical evidence proving clinical risk from repeat sterilization of metalworks used in orthopaedic trauma of either increased infection rates or loosening or implant failure. On the contrary, the use of individually packed metalworks presents several practical challenges, including higher costs, increased risks of contamination, longer operative times and a larger carbon footprint. This review underscores the need for further validation of individually packed metalwork in orthopaedic trauma surgery.

The study evaluates the forced small finger abduction test for assessing the strength of intrinsic muscles innervated by the ulnar nerve. The test was performed on healthy and ulnar neuropathy patients. Results demonstrate its ability to detect intrinsic weakness, which may enhance diagnosis of ulnar neuropathy.

Treatment of distal radial fractures that include small anterior rim fragments can be difficult. We retrospectively reviewed 19 patients in whom an anterior rim plate with locking screws was used. After a median follow-up of 18 months (range 6-32; interquartile range (IQR) 14, 26), the median wrist flexion and extension arc was 70° (range 50-80; IQR 60, 70), the median grip strength was 80% of the contralateral side (range 52-104; IQR 77, 88), the median visual analogue scale score for pain was 0 (range 0-5; IQR 0, 1), the median disabilities of the arm, shoulder and hand score was 2 (range 0-59; IQR 0, 11) and the median modified Mayo wrist score was 80 (range 35-100; IQR 75, 85). Two patients exhibited loss of reduction; one was treated conservatively and the other underwent revision surgery. Our findings support anterior rim plates as a treatment option for anterior rim fractures if they are properly placed.Level of evidence: IV.

We previously introduced the modified Wassel-Flatt classification to overcome the limitation of the traditional classification for radial polydactyly. This study aimed to evaluate this modified classification in terms of surgical planning and clinical outcomes using the Japanese Society for Surgery of the Hand scoring system. A retrospective review of 211 patients with 223 thumbs treated for radial polydactyly between October 2017 and November 2022 was conducted. Patients were classified using the modified Wassel-Flatt classification, which further differentiated between hypoplastic proximal (HP) and hypoplastic distal (HD) types. The results indicated that simple excision was feasible only for the HP type, while the HD type and non-hypoplastic types required more complex procedures. In addition, hypoplastic types generally had better outcomes, with the HP type achieving better appearance scores than the HD type. Comparisons among non-hypoplastic types revealed no significant differences. The modified Wassel-Flatt classification appears to enhance surgical planning and predict clinical outcomes effectively.Level of evidence: IV.

This systematic review aimed to analyse the factors associated with intrinsic neonatal limb ischaemia (INLI), its causes and its management. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, and 115 articles were identified for analysis. For INLI detected at birth, most newborns presented with upper limb ischaemia (72%), with thrombus being the most common cause (66%). Higher rates of positive outcomes were observed when INLI was treated with medical management alone, although this could reflect a less severe manifestation. The data did not demonstrate any causative factors for the development of INLI. Depending on the timing of the in-utero insult and the degree of tissue involvement and loss, different primary interventions may be selected for management. A classification system is proposed to help guide the choice of management, in which the different clinical manifestations of INLI are divided into four grades.

In this article, we examine the pros and cons of textbook vs. journal articles. We suggest that textbooks serve as an essential knowledge provider for colleagues, especially at their entry level, but to advance clinical and academic capability, journal articles remain an important and unreplaceable tool for continuous professional development. Currently multi-author review articles provide one of the best sources of information, providing recommendations that are authoritative yet balanced. We explored if there are options to combine the best of both these platforms of information.

We retrospectively reviewed the outcome of triple nerve transfer, including reinnervation of brachioradialis and double nerve transfer surgery in C5-C6 traumatic brachial plexus injuries.Level of evidence: IV.

We present a short report discussing our first-hand experience using a modification of the improvised syringe-barrel external-fixator for hand fractures and its practical advantages in stabilising single bone fixation.