The Journal of hand surgery, European volume最新文献

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.

Introduction: Macrodactyly of the hand is an uncommon anomaly. There are few studies looking at late presentation or adults with macrodactyly. This study specifically aims to describe the presentation and surgical management of adult macrodactyly and to compare these findings with those in children, highlighting the distinct challenges associated with late presentation.

Methods: This is a retrospective study of 13 adults (18 years or older) and 19 children with macrodactyly of the upper limb who underwent surgery in a 13 year period. Clinical features including radiographic findings, number and types of surgeries were compared between adults and children.

Results: Common reasons for presentation in adulthood were carpal tunnel syndrome and functional impairment. Radiographs of adults showed exostoses, arthritis, bony fusions and angulation deformities. The mean number of surgeries that children underwent was almost double that of adults. The average number of debulking procedures per patient was significantly more in children including soft tissue resection, osteotomy and reconstructive surgeries. Amputations were slightly more common in adults. Carpal tunnel syndrome or trigger fingers were seen only in adults.

Conclusion: Adults and paediatric patients with macrodactyly seek treatment for different reasons. Presentation in childhood often results in multiple debulking stages or reconstructive attempts. In adults, surgery is often for improving function and usually single staged. Untreated, long-term progression of joint changes can lead to pain and disability. Recognition of these symptoms can guide treatment in older patients or prevent age-related changes in younger populations.

Level of evidence: IV.

There is significant interest in research on the pathology, natural history and treatment of brachial plexus birth injury. This article comments on a few newly published papers in the Journal of Hand Surgery (European Volume) to highlight updates and new research. Classification of brachial plexus birth injury remains challenging. Intraoperative findings from a recent article allow the introduction of a new classification based on findings during surgical exploration, providing a more precise description of the extent and severity of injury. The classification correlates well with pre- and postoperative function and should allow more accurate comparisons of treatment outcomes. Knowledge of the natural history of brachial plexus birth injury can help guide management decisions, such as the proportion of patients who will spontaneously recover active shoulder abduction. In another recent article, almost all cases regained 90° or more abduction, indicating a good chance of a satisfactory function. However, in contrast to other studies, recovery of elbow flexion at age 4 months did not predict outcome. Shoulder external rotation is an important movement which often recovers poorly after brachial plexus birth injury. A third article reported no difference in long-term outcomes of nerve grafting or transfer for restoration of shoulder external rotation. Overall, about a third of children did not regain active external rotation, indicating the difficulties restoring this movement. These studies contribute to improving management of brachial plexus birth injury, but more investigation of both the natural history and treatment outcomes is needed.

Introduction: The aim of the study was to understand finger proximal interphalangeal joint (PIPJ) dislocations better by reviewing the demographics and biomechanics of a cohort of PIPJ dislocations.

Methods: All cases of PIPJ dislocations presenting to our emergency department or neighbouring minor injury units over a 2 year period were reviewed. We recorded demographics, mechanism of injury, direction of the dislocation radiologically, concomitant injuries and rates of follow-up (FU).

Results: There were 74 dislocations in 74 adults with a median age of 46 (range 14-87) years. Fifty-six (76%) were men and 18 (24%) were women. The dislocations were ulnar more than radial: little finger (43%), ring finger (34%), middle finger (15%) and index finger (8%). Amongst all 74 dislocations, 36 (49%) were dorso-ulnar, 30 (41%) dorsal, five (7%) ulnar, two volar and one dorso-radial. Six dislocations were open. Five of these were dorsal dislocations and five affected the index (three) and middle (two) fingers. The median number of FU appointments was two (range 0-21).

Conclusion: Our findings suggest that PIPJ dislocations commonly affect two distinct populations: young men suffering little finger dislocations during sport and older patients sustaining middle finger dislocations after falling. Open dislocations are predominantly dorsal dislocations of the index and middle fingers. FU rates are very variable but suggest 20% of cases have prolonged symptoms.

Level of evidence: IV.