The Journal of hand surgery, European volume最新文献

Early repair of flexor tendon injuries is ideal, but delays are common. We studied the outcomes of flexor tendon repairs delayed from 5 days to 6 months and carried out under wide-awake local anaesthesia with no tourniquet (WALANT). Twenty-four patients (29 fingers) who underwent primary flexor tendon repair on zone II using a four- to six-strand core suture technique, followed by controlled early active motion therapy. Clinical assessments, including total active motion (TAM) and Disabilities of the Arm, Shoulder and Hand, were made 6, 8 and 12 weeks after operation. All outcomes improved significantly over time. At the final assessment, 93% of fingers showed excellent TAM outcomes. Extension deficit was between 5° and 20° in eight of 26 fingers. The results of this study suggest that delayed primary flexor tendon repair under WALANT can achieve excellent functional outcomes, although longer follow-up is needed for extension deficit recovery.Level of evidence: IV.

The impact of preoperative structured instructions by a hand therapist on recovery after carpal tunnel and trigger finger releases was assessed in 87 patients. No significant differences in recovery, satisfaction, or outcomes were found, suggesting limited benefit.

Parsonage-Turner Syndrome after COVID-19 infection or vaccination is rare. Motor, sensory deficits and neuropathic pain may result from inflammation and compression around the brachial plexus. Early surgical intervention in patients with significant motor deficits may result in improved outcomes.

This bibliometric analysis aimed to define important topics and developments across wide awake local anaesthesia no tourniquet (WALANT) hand surgery, an innovative ambulatory technique that gained popularity during the COVID-19 pandemic. Articles were searched and screened using the Web of Science core collection database. VOSviewer 1.6.18 and bibliometrix were used for analysis. In the initial search 419 articles were found. Between 1990 and 2023, 333 writers contributed to the top 100 most-cited articles published. The country with the highest number of published articles (20%) was Canada, followed by the USA (18%) and China (12%). Most articles were published in Plastic and Reconstructive Surgery (15%), Hand Clinics (14%) and the European and American volumes of The Journal of Hand Surgery (9% each). Eighty-two percent of articles had a Level of Evidence of III or V. High-quality randomized controlled trials and systematic reviews of WALANT are needed to broaden and enhance clinical practice and research.Level of evidence: V.

We compared the outcomes of two groups of patients with scaphoid nonunion treated with arthroscopic cancellous bone grafting. In group 1, K-wires were introduced beforehand and in group 2 after debridement and packing bone grafts in the nonunion site. Our hypothesis was that the percentage of unions would be higher in group 2. We conducted a retrospective, single-centre comparative study of two consecutive series of patients. Seventeen patients in group 1 were operated between 2011 and 2015 and 25 patients in group 2 between 2015 and 2022. At 3 months, there was already a significant difference in consolidation, with three fractures united in group 1 and 21 in group 2. At 6 months, 10 patients (59%) united in group 1 and 24 (96%) in group 2. Debridement of the nonunion site without K-wires in place may allow a more thorough debridement and extensive filling of the defect with bone graft. If an arthroscopic technique is used for scaphoid nonunion, we do not recommend prior fixation with K-wires.Level of evidence: III.

This review paper provides a summary of the evidence for non-surgical and surgical management of thumb base osteoarthritis and suggests guidelines through Clinical Practice Recommendations including Good Practice Points and a Patient Flow Algorithm. The guidelines were developed through systematic reviews in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence. A stepwise approach is recommended with initial non-invasive treatment consisting of a comprehensive and multimodal package of supported self-management. Splints should be additionally considered for those who have not responded to a self-management package alone. Intra-articular corticosteroid injections should be considered in those who have not responded to non-invasive treatment. If symptoms fail to resolve, surgery should be considered. Additional procedures such as interposition or ligament reconstruction do not appear to confer any benefit over excision of the trapezium alone.

Nineteen patients presenting with a secondary metacarpal fracture after a previously fractured little metacarpal were retrospectively reviewed. The new injury was more likely to be at the original fracture site in patients with shaft fractures than those with neck fractures.Level of evidence: IV.

This study evaluates the outcomes of arthroscopic triangular fibrocartilage complex (TFCC) foveal reattachment using an inside-out suture passing through the TFCC at specific ulnocarpal anatomical landmarks to grasp the radioulnar ligaments. Thirty-eight patients with a mean age of 36 years (range 19-54), diagnosed with TFCC injury with distal radioulnar joint (DRUJ) instability, underwent arthroscopic inside-out TFCC foveal reattachment using designated suture sites. At a mean follow-up of 32 months (range 26-44), pain score, range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Modified Mayo Wrist Score all showed significant improvement after surgery. The DRUJ stability was restored and the minimal clinically important difference threshold for the DASH score was achieved in all patients. Arthroscopic TFCC foveal reattachment using the inside-out technique at specific ulnocarpal anatomical landmarks provided reliable outcomes and could be considered as another straightforward procedure for treating TFCC injuries with DRUJ instability.Level of evidence: IV.

Digital transformation through extended reality (xR)-comprising virtual, augmented, mixed, and substitutional reality-has become an integral part of the future of clinical and surgical practice. xR technologies facilitate advanced surgical planning, training, therapies and education, reshaping both personal and institutional healthcare. This paper examines the potential changes that xR has introduced into the field of hand surgery, exploring how xR enhances patient-centric care, increases medical service efficiency and revolutionizes surgical training, planning and therapeutic interventions. Key areas such as surgical assistance, telemedicine, therapies and rehabilitation, medical training and education, and improving patient understanding are highlighted. By synthesizing the current literature, this narrative review articulates the theoretical and practical implications of xR, offering insights into its transformative potential and supporting continuous educational advancement in medical practice.

This study assessed the nationwide incidence of Kienböck's Disease, and operations performed for Kienböck's Disease from the Care Register for Health Care in Finland 1996-2022. The mean annual total standardized incidence rate per million person-years was 9.60 (95% CI: 9.10-10.11) and for men and women, 10.38 (95% CI: 9.63-11.13) and 8.78 (95% CI: 8.10-9.45), respectively. The incidence rate was highest for 50-59-year-olds, at 15.49. Compared with women, the incidence rate for men was higher across all age groups up to 60-69 years. Altogether, 44% of the patients were operated on, and 19% of them had multiple operations. Partial arthrodesis was the most performed procedure and salvage procedures covered 62% of all operations. Our findings provide comprehensive new evidence about Kienböck's Disease distribution across Finland's population and offer insights into the burden caused by operations.Level of evidence: III.