The Journal of hand surgery, European volume最新文献

We present six cases of post-traumatic osteoarthritis of proximal interphalangeal joint with swan neck deformity and ulnar deviation treated by surface replacement arthroplasty and soft tissue reconstruction using the radial slip of flexor digitorum superficialis tendon.

Early palmar carpal instability with proximal row collapse into flexion after a distal radial fracture is rarely reported. Fracture reduction alone may not restore alignment, whereas dorsal capsuloligamentous reinforcement may achieve stability, underscoring the importance of early recognition and combined treatment.Level of evidence: V.

Introduction: The aim of the study was to compare a radiocarpal approach with or without a midcarpal exploration to determine outcomes and incidence of recurrences following arthroscopic excision of dorsal wrist ganglions.

Methods: This retrospective study included 39 patients who underwent arthroscopic excision of dorsal wrist ganglions with a radiocarpal approach alone and 32 patients who received radiocarpal excision with midcarpal exploration. Outcomes assessed at 1 year follow-up included Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, pain relief, patient satisfaction, complications and recurrence. Pre- and postoperative MRI images were used to classify the ganglions into four types based on their origin and location. Postoperative MRI was performed in cases of suspected recurrence.

Results: One year postoperatively, QuickDASH scores, pain relief and patient satisfaction were similar in both groups. Complications were minimal and comparable between groups. Recurrence occurred in seven patients in the radiocarpal excision group and in one patient who underwent radiocarpal excision with midcarpal exploration. Magnetic resonance imaging analysis of the eight recurrences revealed five type 2 lesions (midcarpal), one type 3 lesion (radiocarpal) and two type 4 lesions (combined radiocarpal and midcarpal), indicating that seven of eight recurrences involved the midcarpal joint.

Conclusion: Routine midcarpal joint exploration during arthroscopic excision of dorsal wrist ganglions appeared to reduce recurrence at 1 year without negatively impacting patient outcomes.

Level of evidence: III.

Introduction: This systematic review aimed to investigate the use of single-photon emission computed tomography/computed tomography (SPECT/CT) in diagnosing and managing hand and wrist disorders, especially hand and wrist pain of unknown aetiology.

Methods: A systematic review of the Embase, MEDLINE and Cochrane databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Author experiences with SPECT/CT and, where available, sensitivity and specificity data were analysed.

Results: The search yielded 3546 records, of which 3477 were excluded, leaving 69 for full-text analysis. Fourteen studies were eligible for inclusion. Overall, SPECT/CT demonstrated sensitivities and specificities in the ranges 0.6-0.83 and 0.9-0.1 for non-specific hand and wrist pain (n = 6), 0.75-1.0 and 0.82-0.93 for osseous disorders (n = 5) and 0.72-1.0 and 0.65-0.82 for rheumatic disorders (n = 3). For hand and wrist disorders, SPECT/CT demonstrated comparable sensitivity and specificity to magnetic resonance imaging (MRI), but greater diagnostic accuracy than routine imaging modalities. In cases where the pathology was subtle or ambiguous, SPECT/CT could help confirm the diagnosis, estimate the severity of the condition and identify clinically relevant anatomy.

Conclusion: Although SPECT/CT has comparable diagnostic accuracy to other cross-sectional imaging modalities, such as MRI, the additional information it provides influences surgical management in only a minority of cases. Its substantial radiation exposure may prevent SPECT/CT from being used routinely, but it can be an effective problem-solving tool in cases where the diagnosis remains unclear despite prior imaging.

Conflicts of interest (COI) are pervasive in hand surgery, where clinical practice, research, and education intersect with industry. Beyond financial ties, COIs can be research-related, personal, social media-associated and royalty-based, influencing implant choice, study outcomes and educational content. Evidence shows that inaccurate disclosures remain common, with up to 81% of authors failing to report COIs correctly, while social media and mentorship reveal hidden biases. These conflicts risk undermining scientific integrity and patient trust. Mitigation requires a multi-level approach: full transparency in disclosures, adherence to social media guidelines, distancing from decision-making roles when conflicts exist, institutional COI registries, standardized journal policies and unbiased selection for conferences and leadership positions. Fostering a culture of integrity ensures collaboration with the industry and helps to advance innovation without compromising ethics or patient care.

Introduction: With widespread implementation of rehabilitation by early active motion, preventing both early gap formation and failure are essential in flexor tendon repair. We studied the effect of various six-strand Tsuge techniques on early gap formation and strength in flexor tendon repair.

Methods: Thirty porcine flexor digitorum profundus tendons were divided into three groups: the conventional six-strand Tsuge technique (the Tsuge normal group) and two modified versions, the Tsuge cross and Tsuge cross short groups, in which two of three sutures were crossed with different purchase lengths. Fatigue strength (newtons × cycles) was determined using cyclic tensile testing on the repaired tendons with gradually increasing loads. The load (newtons) and number of tensile testing cycles when a 2 mm gap or failure occurred at the repair site were recorded.

Results: Fatigue strength at 2 mm gap formation was significantly greater in the Tsuge cross and Tsuge cross short techniques than in the Tsuge normal technique. Fatigue strength at failure was significantly greater with the Tsuge cross short technique than with the Tsuge normal technique. Detailed analysis suggested that gap prevention using the Tsuge cross and Tsuge cross short techniques may be caused by tendon tightening by cross suturing.

Conclusion: The Tsuge cross and Tsuge cross short suture techniques prevent gap formation, which could hinder tendon healing during early active motion rehabilitation. The Tsuge cross short technique demonstrated a lower failure rate compared with the Tsuge normal technique; nevertheless, both the Tsuge cross and Tsuge cross short techniques had sufficient strength for early active motion.

Introduction: Scapholunate ligament injury may cause carpal instability leading to pain, dysfunction and risk of scapholunate advanced collapse (SLAC) if untreated. Chronic dissociation is challenging to manage, with no clear reference standard reconstruction technique. This study aimed to evaluate the outcomes of scapholunate ligament reconstruction using an extensor carpi radialis brevis autograft and internal brace augmentation.

Methods: We prospectively enrolled 12 patients with symptomatic chronic scapholunate (SL) dissociation treated between 2020 and 2024. Clinical outcomes included a visual analogue scale for pain, Mayo Wrist Score, QuickDASH, grip strength, range of motion and patient satisfaction. Radiographic outcomes included scapholunate gap, scapholunate angle and carpal height ratio. Patients were followed for a mean of 27.1 months.

Results: The median pain visual analogue score improved from 7 preoperatively to 2 at final follow-up (p < 0.001). QuickDASH decreased from 43 to 6 (p < 0.001), and Mayo score improved from 37 to 75 (p < 0.001). Grip strength increased from 35 to 40.8 kg (p < 0.001), approaching values of the contralateral hand. Radiographs showed reduction of the SL gap and correction of SL angle to near-normal values, with no loss of carpal height. No patient showed progression of SLAC during the study period. All patients returned to pre-injury work or sport.

Conclusion: Scapholunate reconstruction using extensor carpi radialis brevis autograft with internal brace augmentation provides reliable mid-term outcomes, restoring stability, function and strength. This technique proved effective even in patients with early degenerative changes, offering postoperative satisfaction and potentially delaying arthritis progression.

Level of evidence: IV.

Introduction: The Narakas classification of brachial plexus birth injuries has been widely used but its validity for intraoperative classification of lower root injuries (C8-T1) is debated. This study introduces a new intraoperative classification and assesses its correlation with muscle function before and after operative repair of the brachial plexus.

Methods: The study reviewed 162 primary brachial plexus explorations over 19 years. Based on intraoperative findings, patients were categorized by injury patterns, A (C5-C6), B (C5-C7), C (C5-C8) and D (C5-T1), followed by the number of root avulsions. Preoperative and postoperative active movement scale scores, along with intraoperative findings, were compared in assessing lower root involvement.

Results: Ten cases were classified as injury type A, 42 as type B, 14 as type C, and 96 as D. Of 682 injured nerve roots, 189 were avulsed. With a mean follow-up of 5.4 years, the median preoperative total active movement scale score was 39 (IQR 24 to 54) and improved to 55 (IQR 44.25 to 70) at final postoperative follow-up. There was a decline in pre- and postoperative scores with increasing injury severity from A to D. Significant differences were observed between injury subtypes based on number of avulsions, notably in the injury D subgroup (p < 0.001). Horner's syndrome did not significantly impact final postoperative active movement scale scores after adjusting for injury types.

Conclusions: An intraoperative classification that specifies roots involved may better capture variability of brachial plexus birth injuries than the established Narakas system and align more closely with functional recovery. These findings emphasize the importance of intraoperative assessment to guide surgical decision-making.

Level of evidence: IV.

We present a 46-year-old man with pain in his left hand caused by entrapment of a bifid median nerve by an accessory belly of the flexor digitorum superficialis muscle in the midforearm. A literature review found this case to be novel.

Introduction: This study investigated the association between capitate morphology and the success rates of non-vascularized bone graft (NVBG) and vascularized bone graft (VBG) operations for scaphoid nonunion.

Methods: We retrospectively analysed 213 patients with established scaphoid non-union who underwent either non-vascularized bone graft (n = 75) or vascularized bone graft (n = 138). We analysed risk factors, including demographics, medical history, implant type, previous surgery, bone graft donor site and capitate morphology for their association with treatment outcome. We also assessed the relationship between capitate and scaphoid morphology in the uninjured wrists of 31 patients.

Results: The overall success rate was 81% for NVBG and 86% for VBG, with no significant difference. For NVBG, Type II capitate, age 40 or older and tobacco use were significant risk factors for failure. For VBG, only previous surgery was a significant risk factor. In uninjured wrists, a Type II capitate was associated with a significantly thinner scaphoid waist and a lower waist index than a Type I capitate.

Conclusion: Our study introduces a new radiographic classification of capitate morphology and establishes its significant association with scaphoid morphology. Beyond traditional factors, capitate morphology can help to assess scaphoid morphology and potentially infer vascularity, aiding the selection of the most appropriate bone graft type for treating scaphoid non-union.

Level of evidence: III.