The Journal of hand surgery, European volume最新文献

Introduction: We studied the relationship between the dorsal tilt of the distal radius and midcarpal alignment, specifically the capitolunate angle, in patients with distal radials fractures or malunion.

Methods: We retrospectively reviewed 47 patients diagnosed with distal radial fractures or malunions between January 2000 and October 2025. Radiographic variables, including dorsal tilt, radiolunate angle and capitolunate angle, were measured on standard lateral radiographs. The effective radiolunate flexion (ERLF) angle was calculated to classify cases into those with adaptive midcarpal malalignment (Type 1: ERLF ⩽ 25°) and those with pathological radiocarpal malalignment (Type 2: ERLF > 25°). In Type 1 cases, correlation and regression analyses between dorsal tilt and capitolunate angles were carried out.

Results: Of the 47 included cases, 39 were classified as Type 1 and eight as Type 2. A weak positive correlation was found between dorsal tilt and capitolunate angle in Type 1 cases (r = 0.43). The regression equation was y = 0.50x + 0.69 (R² = 0.21), indicating that increased dorsal tilt was associated with increased midcarpal flexion.

Conclusions: Midcarpal alignment in distal radial fractures and malunions demonstrates a measurable relationship with dorsal tilt of the radius. Our study supports the concept that an extra-articular dorsal tilt deformity of the distal radius can induce a corresponding adaptive malalignment at the midcarpal level.

Level of evidence: IV.

Introduction: Trapeziometacarpal joint stability during pinch depends on the balance between the opponens pollicis and the first dorsal interosseous muscles, which control pronation and supination of the first metacarpal, respectively. Disruption of this muscular balance may contribute to joint instability in patients with trapeziometacarpal osteoarthritis, although the mechanisms underlying movement pattern changes in these patients remain unclear. This study aimed to quantitatively compare thumb rotation patterns during tip pinch between patients with trapeziometacarpal osteoarthtits and healthy individuals.

Methods: The thumb rotation angle during tip pinch was measured in 36 hands of 27 patients with trapeziometacarpal osteoarthritis and 19 hands of 11 healthy controls using a three-axis gyroscope equipped with a three-axis accelerometer fixed to the dorsum of the thumb metacarpal. The pronation/supination angle was recorded as the rotation around the long axis of the gyroscope.

Results: The trapeziometacarpal osteoarthritis group demonstrated a lower median change in pronation angle during pinch (2.6°) compared with the control group (3.7°) (p = 0.014). The frequency of the thumb supination during pinch was higher in the trapeziometacarpal osteoarthritis group (25%) than in the control group (8.8 %) (p = 0.013). Pronation angles were moderately and negatively associated with the Eaton-Littler and Kellgren-Lawrence classifications for osteoarthritis.

Conclusions: Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis. The findings may influence targeted rehabilitation interventions to improve dynamic stabilization of trapeziometacarpal joint.

Level of evidence: III.

Introduction: This prospective, one-group, interventional study assessed 5 year survival and outcomes after partial wrist denervation for painful wrist osteoarthritis. The primary outcome was the proportion of patients who did not require further surgery (survival rate). Secondary outcomes included patient-reported measures, objective function and radiographic progression.

Methods: Sixty consecutive patients who underwent neurectomy of the posterior and anterior interosseous nerves between 2018 and 2020 were included. Survival was analysed using Kaplan-Meier and Cox regression. Patient-reported outcomes, strength and range of motion were assessed at baseline, 1 year and 5 years using generalized estimating equations. Radiographs were reviewed at baseline and 5 years later.

Results: At 1 and 5 years, the survival probabilities were estimated to be 73 and 57%, respectively. In patients who did not require additional surgery, DASH improved by 15 points, Patient-reported Wrist Evaluation by 23 points, pain at rest by 2 points and pain on load by 3 points. No significant changes were observed in the European Quality of Life Three Dimensions or objective function. Radiographic progression was observed in 21% of patients.

Conclusion: In summary, less than half of the patients underwent revision surgery within 5 years and those who did not require further procedures experienced significant improvements in patient-reported outcomes. Additional studies are required to confirm these findings and investigate who may benefit from partial wrist denervation.

Level of evidence: III.

Treatment of trapeziometacarpal joint osteoarthritis with a dual-mobility prosthesis offered a quick convalescence and return to work (median 51 days) in patients ranging between 40 and 67 years of age. No significant difference was found between office workers and labourers.

Introduction: Distal radial fractures are the most common fractures in adults. Maltreatment of distal radial fractures can result in pain and disability. The most common complications and maltreatment after distal radial fractures are malunion, tendon injury, infection and nerve injury. The Swedish Patient Insurance Company (LÖF) indemnifies approximately 90% of all healthcare providers in Sweden. The aim of this study was to assess maltreated distal radius fractures using data from the LÖF-register in combination with data from the Swedish Fracture Register.

Method: All insurance claims relating to patient-reported maltreatment of distal radial fractures in adults in Sweden, as well as data from the Swedish Fracture Register regarding fracture type and patient-reported outcome measures during the period 2011-2021 were analysed.

Results: Of the total of 1393 claims relating to distal radial fractures during the study period, the frequency of reported maltreatment claims was 1.4%. Eighty-two per cent of the claimants were female and the median age was 60 years. Malunion was the most common overall complication, carpal tunnel syndrome was the most common nerve-related complication and extensor pollicis longus tendon rupture following anterior plating was the most common tendon-related complication. Sixty-four per cent of the claims were accepted and reimbursed. The total direct cost for maltreated distal radial fractures was €4,980,000.

Conclusion: Reducing the number of symptomatic malunions, ensuring correct anterior plate placement and identifying other critical steps in treatment would likely improve patient safety and decrease the additional financial burden for the society.

Level of evidence: IV.

Introduction: Focal fibrocartilaginous dysplasia is a rare, benign bone lesion that causes lateral angulation deformity of long bones in children, predominantly affecting the proximal tibia and distal femur. This study aims to present a case series of clinodactyly caused by focal fibrocartilaginous dysplasia in the phalanges and summarize its clinical and imaging features.

Methods: Twenty cases (29 phalanges) were retrospectively reviewed. The diagnosis was confirmed radiographically in all patients. Clinical and imaging data, including age at presentation, gender, clinical presentation, affected site, clinical course and deformity angle were collected.

Results: The cohort comprised 15 boys and five girls, with lateral angulation deformity as the predominant clinical manifestation. The mean age at presentation was 61 (range 6-132) months. Both hands were involved in seven patients. The involved phalanges included seven proximal and 22 middle phalanges. The median follow-up was 24 (range 12-60) months. Sixteen patients were followed up without intervention, with a deformity angle of 21° (SD 8°) at first presentation and 21° (SD 8°) at the last follow-up. Four patients received corrective osteotomy for aesthetic concerns, reducing the deformity from 30° (SD 14°) preoperatively to 5° (SD 2°) at the latest follow-up. No recurrence or progression was observed.

Conclusion: Phalangeal focal fibrocartilaginous dysplasia is an important cause of clinodactyly. The deformity remains stable without functional impairment. Surgical intervention is considered when patients' parents seek to address aesthetic concerns.

Level of evidence: IV.

Introduction: Rotational malunion of forearm fractures may severely impair pronosupination. Accurate preoperative assessment of torsional deformities is therefore critical, yet no standardized technique exists to quantify axial rotation of the radius and ulna, and the validity of using the contralateral limb as a reference remains uncertain. This study aimed to develop a simple, reproducible CT-based method for measuring forearm torsion and to determine side-to-side anatomical symmetry in normal individuals.

Methods: A manual measurement technique based on cross-sectional two-dimensional CT images was applied to 30 normal right forearms by two independent observers. Torsion angles were calculated between defined proximal and distal axes of the radius and ulna. Inter- and intraobserver reliability was assessed using Pearson correlation. To analyse bilateral symmetry, automated measurements were obtained from 490 paired radii and 451 paired ulnae from the three-dimensional CT scans obtained from the Stryker Orthopaedic Modeling and Analytics imaging database of healthy volunteers. Measurements were performed using consistent bony landmarks.

Results: The two-dimensional CT scan method demonstrated excellent reproducibility for radial torsion (interobserver r = 0.89; intraobserver r = 0.95) as well as for ulnar torsion, using the radial notch as a proximal landmark (Pearson co-efficient r = 0.81 and r = 0.93). In three-dimensional CT scan analysis, right-left torsion differences were <15° in 98% of radii and 91% of ulnae, with correlation coefficients of 0.6-0.8 across measurements.

Conclusion: The measurements based on standard axial slices of two-dimensional CT scans provide a reliable and clinically feasible tool to quantify forearm torsion. In over 90% of individuals, the contralateral limb may serve as a valid reference, supporting its routine use in preoperative planning of corrective derotational osteotomies for forearm malunion.

Level of evidence: III.

Introduction: Traditional single-stage tendon transfer procedures in patients with tetraplegia are designed to restore active pinch and grasp function. However, digital extension is usually achieved by wrist tenodesis. More recently, nerve transfer has allowed potential restoration of digital extension. This matched observational pilot study compares clinical outcomes after traditional tendon transfers vs. a study group using two-stage using combined nerve and tendon transfer.

Methods: Eighteen patients in the traditional tendon transfer control group and 18 patients in the combined nerve and tendon transfer group using a supinator branches to posterior interosseous nerve (S-PIN) transfer were compared. Primary outcomes include hand opening capacity, using the cylinder test. Secondary outcomes include muscle strength, first web space opening, grip and pinch strength, grasp and release ability, and activity performance.

Results: Analyses indicated that adding a nerve transfer allowed more patients to achieve normal one-handed hand opening, although this difference was not statistically significant. Secondary outcomes revealed superior grasp and release ability and pinch opening in the study group; however, there were no notable differences in grip strength and activity performance between the groups.

Conclusions: Adding a S-PIN nerve transfer appears to enhance grasp function in the tetraplegic limb when combined with established tendon transfer techniques. For individuals with tetraplegia, the capacity to use single hand grips is particularly significant, as it allows the other arm to stabilize and compensate for limited core balance. More participants with a longer follow-up are needed to fully demonstrate the superiority of combined nerve and tendon procedures.

Level of evidence: III.