The Journal of hand surgery, European volume最新文献

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).

This study investigated the complications and fusion angles of patients treated for thumb metacarpophalangeal dysfunction with intramedullary locking screws using a fixed-angle device. There were 36 procedures. All joints fused appropriately with a mean fusion angle of 25°, with two complications.Level of evidence: IV.

Introduction: We assessed the long-term quality of life, cosmesis and pain after childhood syndactyly separation.

Methods: A retrospective review identified 155 patients (⩾10-year follow-up) of whom 76 participated with a median follow-up period of 18.2 years (IQR 12.4 to 38.3). Patient-reported outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, EuroQol-5 Dimension-5 Level, and visual analogue scales (0-10) for function, cosmesis and pain.

Results: Uncomplicated cases had significantly better patient reported outcomes (0 vs. 11.4 and 1.0 vs. 0.89; p < 0.01), and higher functional scores (9.0 vs. 7.0, p < 0.05) and cosmetic scores (8.2 vs. 7.0, p > 0.05). Complicated cases presented with more cold intolerance (58 vs. 14%, p < 0.01). Pain scores were similar in both groups, with 16-18% reporting some pain in the past week.

Conclusion: Syndactyly reconstruction yields satisfactory subjective long-term outcomes. Complicated cases had poorer function and more cold sensitivity but remained overall favorable.

Level of evidence: IV.

This study compared open decompression and the hypothenar fat pad flap for recurrent carpal tunnel syndrome. Both techniques led to significant improvements in pain (Visual Analog Scale), the DN4 neuropathic pain questionnaire and QuickDASH scores, with no statistically significant differences between the groups at a long-term 10-year follow-up.

We used an artificial intelligence-based model to estimate finger range of movement from video recordings. The mean bias was 11° (standard deviation 34°), with an interclass correlation coefficient of 0.95, indicating high reproducibility.

Introduction: The aim of this study was to review the published literature to assess whether adult distal radial fractures were more common on the left side than the right, and more common on the non-dominant or dominant side.

Methods: A structured literature review was performed using a predefined search. There were 1726 papers possibly related to dominance and 1571 related to laterality. After screening of the abstracts, 41 papers relating to hand dominance and 144 to laterality were retrieved for full text analysis. Studies reporting adult patients, over 250 fractures and providing data on laterality or hand dominance were included.

Results: There were 10 papers fulfilling the inclusion criteria. Three were from national databases providing 92% of the cases. Overall there were 47,959 distal radial fractures of which 26,534 (55.3%) occurred on the left and 21,425 (44.7%) occurred on the right (p < 0.0001). Of 1738 distal radial fractures where hand dominance was reported, 935 (53.8%) were on the side of the non-dominant hand and 803 (46.2%) on the side of the dominant hand (p < 0.0001).

Conclusion: Distal radial fractures occur significantly more often on the left side and to the non-dominant hand. This is confirmed in the limited data on side of injury in studies of fracture fixation and with the data on implant purchasing patterns for institutions. Why there is this difference is unclear, but may relate to fall mechanics, protective reflexes or subtle differences in bone density. These results may help validate randomization in clinical trials.

Level of evidence: V.

Cases of complete brachial plexus birth injury are likely to result in severe limitation of upper limb function and are challenging to manage. There is little high-level evidence to guide management of these children. Surgical exploration and microsurgical repair of the plexus is often recommended when facilities are available. Three expert brachial plexus surgeons were asked to answer specific questions regarding outcomes of non-operative management, their surgical strategies, the indications for contralateral C7 nerve root transfer, outcomes of surgical reconstruction and evidence for operative nerve surgery and improvement in hand function. The responses are presented and discussed.

We describe a rare case using an ulnar polydactyly with an anterolateral thigh flow-through flap to reconstruct an amputated thumb.