The Journal of hand surgery, European volume最新文献

Wrist arthroscopic procedures using ulnar wrist portals, such as the 6-ulnar and direct foveal portals, have a risk of injuring the dorsal sensory branch of the ulnar nerve. This study investigated the anatomy of the dorsal sensory branch of the ulnar nerve and its positional changes during supination, neutral rotation and pronation at specific landmarks to find an optimal forearm position to minimize the risk of iatrogenic nerve injury during arthroscopy. The concept of 'nerve density' was introduced to quantify the likelihood of encountering the dorsal sensory branch of the ulnar nerve within different sectors, correlating to the risk of nerve injury. Our findings indicate that the sectors containing the 6-ulnar and direct foveal portals showed very low risk (≤5% risk) in supination and neutral rotation, but moderate risk (30-60% risk) in pronation. These results suggest that maintaining the forearm in neutral rotation or supination reduces the risk of injury to the dorsal sensory branch of the ulnar nerve during procedures that use these portals.Level of evidence: IV.

Six patients treated by hyperselective neurectomy were assessed using preoperative dynamic electromyography and intraoperative force measurements. Patients with lower preoperative biceps dynamic electromyography activation had significantly reduced force production at operation, suggesting that these findings could guide and improve procedure selection.Level of evidence: IV.

We present a case of a 63-year-old woman with an infected metacarpophalangeal arthroplasty, treated with an articulating cement spacer over a K-wire framework. This technique maintained joint movement during the management of the infection, leading to a positive functional outcome.Level of evidence: V.

In this insightful and personal biographical article, Professor Vilkki recounted his journey from surgical problem to surgical solution. This was an invited article as part of the 2025 FESSH/JHSE Special Issue on 'Technology and Innovation'. Professor Vilkki attributed his achievements to the influence of mentors, the importance of cadaveric dissections and long years of clinical experience.

Recessive dystrophic epidermolysis bullosa causes blistering and scarring of the hands, resulting in contractures fused web spaces and altered function. The aim of this study was to present the short- and mid-term clinical and functional results of a large case series of patients who underwent surgery for recessive dystrophic epidermolysis bullosa-related pseudosyndactyly. The study included 75 hands in 39 children (21 boys, 18 girls) with a mean age of 8 years (range, 4-15) and minimum follow-up of 1 year. Children were assessed with the Birmingham Epidermolysis Bullosa Severity Score Sheet and the ABILHAND-Kids questionnaire before operation and at final follow-up. There were varying degrees of recurrent scarring in all the hands by 24 months after operation. The ABILHAND-Kids questionnaire showed a significant improvement in ability to perform 17 of 21 tasks. In conclusion, despite recurrence that may develop in the short and mid term, surgical release can provide significant improvements in hand function.Level of Evidence: IV.

We evaluated thumb pronation angles in patients with trapeziometacarpal joint osteoarthritis. Patients with a significantly decreased pronation angle showed a moderate correlation with the Eaton-Littler classification. Weakness of opponens pollicis function is associated with the development of trapeziometacarpal joint osteoarthritis.Level of evidence: III.

We compared 3-D-printed patient-specific implants (PSIs) with standard palmar locking plates for radiological accuracy after extra-articular corrective osteotomy for malunited distal radial fractures. Eleven patients were operated on with a PSI. Additionally, a plastic printed model of each patient was operated on with a standard plate in vitro. Three months postoperatively, radial alignment in patients and models was compared with the preoperative ideal planning using CT scans. Patients with PSIs showed smaller rotational deviations (median 7°) compared with standard plate models (9°). Deviations in the direction of translation, radial inclination, palmar tilt, radial height and ulnar variance were also smaller or similar with the PSI compared with the standard plates. The preoperative grip strength with a median of 8 kg and a Patient-Rated Wrist Evaluation score of 44 improved to 23 kg and 3 points, respectively, at a median follow-up of 13.5 months. Our results indicate superior radial alignment after PSI compared with standard plates, but the clinical relevance of these findings needs to be investigated.Level of evidence: IV.

This is a prospective case review on 100 MatOrtho proximal interphalangeal joint arthroplasties in 50 patients with previously published 2-year outcomes. We report the outcomes at a minimum of 10-years' follow-up. Sixty-three implants in 29 patients were available for analysis. The visual analogue scale score for pain revealed a significant improvement of pain at 10 years (mean 0.7, SD 1.3) compared with preoperatively (mean 4.3, SD 0.8) and at 2 years (mean 1.1, SD 1.8). There was no statistically significant improvement at 10 years compared with preoperatively in the mean grip strength (10, SD 6.7), range of motion (27°, SD 20.1,), patient evaluation measure score (43, SD 22), Quick Disabilities of the Arm, Shoulder and Hand (38, SD 23) and Michigan Hand Outcome Questionnaire (65, SD 9,), but all patients remained satisfied with the surgery. Survivorship was 82% at 10 years. We conclude that this implant is suitable to use mainly for pain relief.Level of Evidence: IV.

This study aims to investigate surgical outcomes in elderly patients aged over 60 years old, with brachial plexus injury, undergoing nerve reconstruction using nerve grafts and/or nerve transfers for shoulder and elbow function. Twenty-two patients met the inclusion criteria. Postoperative median shoulder abduction was 35° in the single nerve transfer group (n = 12) and less than 20° in the single nerve grafting group (n = 2). Patients over 65 tended to have poorer outcomes. For elbow flexion strength, a higher proportion of patients in the nerve transfer group (11/12 cases) achieved M3 or greater elbow flexion compared with the nerve grafting group (3/7 cases). Elbow extension also improved in the reconstructive group (9/13 cases). Given these findings, elbow flexion reconstruction is the first priority, while shoulder abduction, showing poor results, should not consume excessive neurotizers. Elbow extension is the second priority, achievable through nerve reconstruction.Level of evidence: IV.

A scarf osteotomy was used to manage a malunited metacarpal fracture, allowing simultaneous correction of both shortening and angulation.