The Journal of hand surgery, European volume最新文献

This study compared the clinical outcomes of tibial-sided digital artery pedicled flap from the second toe versus full-thickness skin grafting to repair great toe defects after wrap-around flap transfers. The pedicled flap resulted in better pain scores and aesthetic outcomes.

The latest generation of wrist arthroplasties provides good clinical function and pain relief with an acceptable revision/reoperation rate. The procedure is complex and technically demanding, both for the surgeon and the patient. The available implants (with the exception of one) have not been developed or refined in the last decade, which reduces the versatility and ability to adapt to specific patient anatomy, to manage implant/treatment problems and to perform successful revisions. Medical device regulation in Europe has led to a halt in development and a reduction in available implants for niche products such as wrist arthroplasty. To improve long-term outcomes after implantation, surgeons should refine and review their skills, implement improvements, avoid complications reported by experienced colleagues, and expect a learning curve and follow-up surgery. The author reviews the pitfalls and requirements of modern wrist arthroplasty.

The distribution of motion between the radiocarpal and midcarpal joints in scapholunate instability is poorly understood. This has potential implications in predicting degenerative changes and in selecting salvage procedures. We studied 19 healthy wrists and 19 wrists with scapholunate instability using dynamic computed tomography during wrist extension to flexion and ulnar to radial deviation. Radiocarpal and midcarpal kinematics of the scaphoid and the lunate were computed. In scapholunate instability, in the radial column, there was increased motion in the radiocarpal joint when the wrist was radially deviating beyond 10° or moving from 70° to 40° extension. In both groups, the capitolunate joint was the dominant articulation in the central column. In scapholunate instability, there was significantly more capitolunate motion during 70° to 30° extension. These changes may predict the development of radioscaphoid arthritis and enable identifying a kinematically abnormal wrist. The motion distribution in scapholunate instability was abnormal beyond 10° of radial deviation and between 70° and 40° of wrist extension.Level of evidence: III.

Osteoarthritis of the wrist presents complex surgical challenges. A wide variety of surgical options are available when conservative management fails to provide adequate pain relief. Despite advancements in management, such as modifications of partial wrist arthrodesis techniques and increasing use of total wrist replacements, in most scenarios there is no single preferred option. The surgeon's role is crucial in assessing the patient and creating a bespoke treatment strategy that will provide an optimal outcome. This article presents an approach to management of the degenerate wrist based on current evidence.

Osteoarthritis of the scaphotrapeziotrapezoidal joint is frequent but often pain-free or well tolerated with non-surgical treatment. Surgical options are numerous and none seems to have clear evidence of superiority. In addition to well-established procedures, such as scaphotrapeziotrapezoidal joint arthrodesis, distal scaphoid resection and trapeziectomy, more recent surgical techniques have been reported. These include scaphotrapeziotrapezoidal arthroplasty and arthroscopic treatment. This article provides an overview of the procedures and their outcomes that can be proposed for isolated scaphotrapeziotrapezoidal joint osteoarthritis and when combined with symptomatic osteoarthritis of the thumb carpometacarpal joint or of the radiocarpal and midcarpal joints.

This study describes the patterns and prevalence of advanced osteoarthritis of the wrist. Bilateral wrist radiographs of 1327 patients over the age of 40 years were reviewed. Osteoarthritis was present in 228 (17%) patients (368 wrists). One wrist was affected in 88 (39%) patients and both wrists in 140 (61%). A total of 27 different patterns of wrist osteoarthritis were found. The most common pattern was isolated osteoarthritis of the scaphotrapeziotrapezoidal joint (217 wrists, 59%), followed by isolated osteoarthritis of the radioscaphoid joint (45 wrists, 12%). In 251 (68%) wrists, advanced osteoarthritis was present only in the midcarpal joint, including the scaphotrapeziotrapezoidal joint. In 115 (31%) wrists, advanced arthritis was present in the radiocarpal joint or in both the mid- and radiocarpal joints. This suggests that advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought.Level of evidence: IV.

The aim of the study was to investigate the repair strength and the biocompatibility of Alaska pollock-derived gelatin (ApGltn) sheet for nerve repair. Cadaveric digital nerves were repaired with double suture, single suture + ApGltn sheet, single suture + fibrin glue, single suture, ApGltn sheet and fibrin. Maximum failure loads were measured (20 nerves each). Rat sciatic nerves were repaired with double suture, single suture + ApGltn sheet, single suture, ApGltn sheet, fibrin glue and resection (10 nerves each). Macroscopic appearance, muscle weight and histopathological findings were examined 8 weeks postoperatively. The mean failure load of ApGltn sheet (0.39 N) was significantly higher than that of a fibrin (0.05 N), and that of single suture + ApGltn sheet (1.32 N) was significantly higher than that of a single suture alone (0.97 N). Functional and histological assessments showed similar nerve recovery among the suture, ApGltn and fibrin groups. ApGltn sheet has potential for clinical application as an alternative to fibrin.

Total wrist arthrodesis can be used to treat symptomatic end-stage wrist osteoarthritis after failed conservative treatment. It can also be considered the last-resort option when partial fusion, proximal row carpectomy, denervation or prosthetic arthroplasty is unsuccessful. Currently anatomic pre-contoured low-profile plates with angle stable screws are available with or without inclusion of the carpometacarpal joints. Generally, patients are satisfied after total wrist arthrodesis, although they are not always pain-free, even when wrist flexion and extension remain limited or absent. Complications and reoperations occur frequently, most often due to incomplete bone fusion or hardware-related problems. It is still not known which type of implant is best for degenerative osteoarthritis and if the carpometacarpal joint should be included in the arthrodesis. Future prospective randomized trials may shed more insights on these questions.