HAND最新文献

{"title":"Matching Human Expertise: ChatGPT's Performance on Hand Surgery Examinations.","authors":"Zachary A Kirschenbaum, Yuri Han, Kiera L Vrindten, Hanbin Wang, Ron Cody, Brian M Katt, David Kirschenbaum","doi":"10.1177/15589447251322914","DOIUrl":"10.1177/15589447251322914","url":null,"abstract":"<p><strong>Background: </strong>The integration of artificial intelligence (AI) into health care witnessed significant advancements, particularly with AI-driven tools like ChatGPT. Initial evaluations indicated that ChatGPT 3.5 did not perform as well as humans on specialized hand surgery self-assessment examinations. The purpose of this study is to evaluate the performance of ChatGPT 4o on American Society for Surgery of the Hand (ASSH) self-assessment questions and whether using enhanced techniques such as better prompts and file search improve accuracy.</p><p><strong>Methods: </strong>Using data from the ASSH self-assessment examinations (2008-2013), we explored the impact of ChatGPT model version, prompt, and file search on the accuracy of AI-generated responses. We used OpenAI's application programming interface to automate question input and response scoring. Statistical analysis was conducted using one-way analysis of variance. KR-20 was used to assess the reliability of the test.</p><p><strong>Results: </strong>Results indicate that the latest AI models, particularly ChatGPT 4o with enhanced prompting and access to peer-reviewed literature, can achieve performance levels comparable to human examinees, particularly on text-based questions. ChatGPT 4o performed significantly better than ChatGPT 3.5 and showed marked improvement with better prompts and file search capabilities. The KR-20 for the 2013 examination was 0.946, indicating a very reliable test.</p><p><strong>Conclusions: </strong>These findings highlight AI's potential to support medical education and practice, demonstrating that ChatGPT can perform at a human-equivalent level on hand surgery self-assessment examinations. Our results suggest potential utility as a supplementary tool in educational settings and as a supportive resource in clinical practice.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251322914"},"PeriodicalIF":1.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Performance of Total Wrist Arthrodesis Plates With and Without Arthrodesis of the Carpometacarpal Joint.","authors":"David H Owen, Dongyang Wang, Xu Cong, Cameron Mowbray, Diana M Perriman, Chris J Roberts, Paul N Smith, Herwig Drobetz, David Ackland","doi":"10.1177/15589447231198263","DOIUrl":"10.1177/15589447231198263","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether total wrist arthrodesis (TWA) should be performed with or without arthrodesis of the carpometacarpal joint (CMCJ). The aim of this study is to compare CMCJ-spanning TWA plates using 3D printed wrist arthrodesis model with and without arthrodesis of the CMCJ.</p><p><strong>Methods: </strong>Total wrist arthrodesis plates mounted to 3D printed models were tested under a 4-N bending load at 4 Hz for 50 000 cycles, increased by 15% every 10 000 cycles until failure.</p><p><strong>Results: </strong>Plates with arthrodesis CMCJ were stiffer and failed at a significantly greater load and number of cycles than plates mounted to models without CMCJ arthrodesis. The Synthes stainless steel locking TWA plate performed better than the Trimed plate applied to the model without CMCJ arthrodesis and the Acumed plate applied to the model with CMCJ arthrodesis. Based on these findings, we recommend arthrodesis of the CMCJ in TWA.</p><p><strong>Conclusions: </strong>Incorporation of the CMCJ in TWA may protect against plate failure. If arthrodesis of the CMCJ is not performed, plate removal should be considered before breakage occurs.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"230-236"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41128045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity?","authors":"Michael G Livesey, Sandeep S Bains, Jonathan M Stern, Zhongming Chen, Jeremy A Dubin, Rubén Monárrez, Ethan A Remily, John V Ingari","doi":"10.1177/15589447231196905","DOIUrl":"10.1177/15589447231196905","url":null,"abstract":"<p><strong>Background: </strong>As legalization of cannabis spreads, an increasing number of patients who use cannabis are being seen in the clinical setting. This study examined the impact of cannabis and tobacco use on postoperative complications following open reduction and internal fixation (ORIF) of distal radius fractures.</p><p><strong>Methods: </strong>A national, all-payer database was queried to identify patients who underwent ORIF of a distal radius fracture between 2015 and 2020 (n = 970 747). Patients were stratified into the following groups: (1) tobacco use (n = 86 941), (2) cannabis use (n = 898), (3) tobacco and cannabis use (n = 9842), and (4) neither tobacco nor cannabis use (\"control\", 747 892). Multivariable logistic regression was used to identify risk factors for infection, nonunion, and malunion within the first postoperative year.</p><p><strong>Results: </strong>Concomitant use of tobacco and cannabis was associated with a higher rate of nonunion (5.0%) compared to tobacco or cannabis use alone (<i>P</i> < .001). Multivariate analysis identified cannabis-only use (odds ratio [OR] 1.25), tobacco-only use (OR 2.17), and concurrent tobacco and cannabis use (OR 1.78) as risk factors for infection within the first postoperative year. Similarly, cannabis-only use (OR 1.47), tobacco-only use (OR 1.92), and concurrent tobacco and cannabis use (OR 2.52) were associated with an increased risk of malunion.</p><p><strong>Conclusions: </strong>Cannabis use is associated with an elevated risk of infection and malunion following operative management of a distal radius fracture. Concomitant use of cannabis and tobacco poses an elevated risk of nonunion and malunion compared to tobacco use alone.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"263-268"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41126184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic-Assisted Treatment of Bennett Fractures: A Potentially Advantageous Operative Procedure?","authors":"Carlos Eduardo Torres Fuentes, Julian David Meneses Argalle, Carol Andrea Romero León","doi":"10.1177/15589447231211602","DOIUrl":"10.1177/15589447231211602","url":null,"abstract":"<p><strong>Background: </strong>Articular fractures of the base of the first metacarpal (Bennett fractures) have been studied for years to determine the best method of reduction and fixation. This study aims to show the application of the percutaneous reduction and internal fixation technique with cannulated screws and arthroscopic assistance in articular fractures of the base of the first metacarpal.</p><p><strong>Methods: </strong>Descriptive cohort study in a series of 30 patients, the first cohort in our country and the largest series published so far, in which 8 patients presented with type 2A fracture and 19 patients with type 2B of the Torres-Becerra classification underwent the mentioned technique under direct vision and control of the articular reduction by arthroscopy evaluating the intraoperative characteristics of the articular surface, stability of de reduction and fixation. Assessment of functional and rehabilitation results with a minimum postoperative follow-up of 6 to 12 months.</p><p><strong>Results: </strong>The senior author has used this technique with consistent clinical outcomes to improve reduction and fixation of intra-articular base fractures of first metacarpal bone (Bennett), reducing the articular step-off and gapping permitting an early rehabilitation progress with satisfactory functional results.</p><p><strong>Conclusions: </strong>We can suggest that this surgical method for the treatment of Bennett fractures may offer multiple advantages: adequate debridement of the trapeziometacarpal joint, direct visualization of the articular surface during reduction, achieving greater precision in fixation with minimum morbidity, imperceptible incisions and scars, shorter surgical time, and fewer associated complications.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"218-223"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Trends in Pediatric Trigger Thumb Among Hand Surgeons, Pediatric Orthopedic Surgeons, and Pediatric Hand Surgeons.","authors":"Ashley E MacConnell, Theodore L Schoenfeldt, Christine A Bowman, Alicia M January, Felicity G Fishman","doi":"10.1177/15589447231210925","DOIUrl":"10.1177/15589447231210925","url":null,"abstract":"<p><strong>Background: </strong>The appropriate initial management of pediatric trigger thumb (PTT) remains controversial. Some providers advocate for prolonged nonoperative management, whereas others may offer surgical release to provide a reliable and expedient resolution. The goal of this study was to elucidate the practice patterns of surgeons with different fellowship training who treat patients with PTT. We hypothesized that an association between surgeon specialty training and treatment algorithm would be identified.</p><p><strong>Methods: </strong>A cross-sectional survey was sent to mailing lists of 3 professional organizations whose members represent most providers caring for pediatric hand patients. Respondents were asked their training background and treatment recommendations for several clinical scenarios. Responses were compared across subspecialties.</p><p><strong>Results: </strong>Of the respondents, 444 completed a fellowship in hand surgery, 167 completed a pediatric orthopedic fellowship, and 155 completed an additional congenital hand fellowship. Providers with hand fellowship training were more likely to offer surgical intervention as a first-line treatment for a 3-year-old patient with a flexible trigger thumb than those who completed a pediatric orthopedic fellowship (<i>P</i> = .001), and more likely to offer surgical intervention to a 3-year-old patient with an intermittent (<i>P</i> = .007), painful (<i>P</i> = .015), or locked (<i>P</i> = .012) trigger thumb than those providers who completed additional training in congenital hand surgery. No statistically significant differences in practice patterns were appreciated for children aged 6 and 18 months.</p><p><strong>Conclusion: </strong>Variability was appreciated in practice patterns for initial treatment recommendation for a patient presenting with PTT. Subspecialty training does appear to affect treatment recommendations for clinical scenarios involving a 3-year-old patient with PTT, although this trend is not observed when treating younger patients.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"213-217"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Denervation of the Thumb Carpometacarpal Joint: A New Technique.","authors":"Hayman Lui, Sanjeev Kakar","doi":"10.1177/15589447231200646","DOIUrl":"10.1177/15589447231200646","url":null,"abstract":"<p><strong>Background: </strong>To report the clinical outcomes of partial denervation for the treatment of basilar thumb joint arthritis.</p><p><strong>Methods: </strong>Patients who underwent partial denervation of the basilar thumb joint for osteoarthritis from a single center between 2019 and 2021 were recruited into the study. This involved a technique that involved cauterization of the joint capsule and its innervation through the branches of the superficial radial, palmar cutaneous branch of the median, lateral antebrachial, and ulnar nerves. Patients were followed up postoperatively to record clinical (grip strength, thumb apposition and opposition pinch grip strength, Kapandji score) and patient-reported outcomes (visual analogue scale [VAS], Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Patient-reported Wrist Evaluation [PRWE]).</p><p><strong>Results: </strong>Twelve patients (15 carpometacarpal joints; 9 female and 3 male patients) underwent a partial denervation of the thumb (Eaton stage 3-4). The mean age at the time of surgery was 63 ± 5 years (range 56-72). The mean clinical follow-up duration was 23 ± 11 months (range 9-42 months), and functional score follow-up duration was 27 ± 7 months (range 14-42 months). At the latest clinical follow, VAS score, Kapandji score, grip strength, and thumb apposition/opposition pinch strength all improved significantly (<i>P</i> < .05). The mean QuickDASH score was 30 ± 16, and PRWE score was 32 ± 17. Patients who had unilateral partial thumb denervation demonstrated greater improvement in grip strength than patients who had bilateral partial thumb denervation procedures (<i>P</i> = .01).</p><p><strong>Conclusion: </strong>In this clinical case series, our method of basilar thumb joint partial denervation has been effective in improving clinical outcomes and reducing pain due to osteoarthritis.</p><p><strong>Level of evidence: </strong>IV, case series.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"224-229"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54228900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contralateral Arm Pain as a Sign of Distress Regarding Symptoms.","authors":"Floor A Davids, Jose C Padilla, David Ring, Gregg A Vagner, Lee M Reichel, Sina Ramtin","doi":"10.1177/15589447231216145","DOIUrl":"10.1177/15589447231216145","url":null,"abstract":"<p><strong>Background: </strong>Pain intensity and magnitude of incapability are associated with common unhelpful thoughts about symptoms such as catastrophic thinking and kinesiophobia. To determine whether reports of pain in the upper limb contralateral to a non-trauma condition were associated with unhelpful thoughts, we measured the relationship between pain intensity in the opposite limb and levels of unhelpful thinking.</p><p><strong>Methods: </strong>In a cross-sectional study, 152 new and return patients seeking care of an upper-limb musculoskeletal condition completed measures of upper-extremity-specific magnitude of capability, pain intensity of the involved and contralateral arms, unhelpful thoughts regarding symptoms, symptoms of distress regarding symptoms, and general symptoms of depression. Factors associated with contralateral and ipsilateral pain intensity and upper-extremity-specific magnitude of capability were assessed using multivariable statistics.</p><p><strong>Results: </strong>In bivariate analysis, contralateral arm pain was associated with symptoms of distress regarding pain, but not in multivariable analysis. Accounting for potential confounding in negative binominal regression analysis, greater pain intensity of the affected side was independently associated with greater feelings of distress regarding symptoms and no prior surgery. Greater upper-extremity-specific capability was independently associated with less distress regarding symptoms, married/partnered, men, and no prior surgery.</p><p><strong>Conclusions: </strong>The observation that greater pain intensity in the opposite arm was associated with greater distress regarding symptoms suggests that, in combination with other verbal and non-verbal signs of distress, patient concerns about pain in the contralateral limb can help direct patients and surgeons to evidence-based care strategies for alleviating stress regarding symptoms.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"312-318"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the Clinical Efficacy of Wide-Awake Local Anesthesia Without Tourniquet: A Trial Sequential Analysis.","authors":"Pedro Romeiro, Catarina Rodriguez Silva","doi":"10.1177/15589447241284305","DOIUrl":"10.1177/15589447241284305","url":null,"abstract":"","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"334"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triceps Tendon Reattachment Using Mini Plates and Screws After Failure of Olecranon Avulsion Fracture Fixation in Osteoporotic Bone: A Case Report.","authors":"Nicholas B Pohl, Parker L Brush, James Russo, Sebastian I Fras, Pedro K Beredjiklian, Daniel J Fletcher","doi":"10.1177/15589447241238373","DOIUrl":"10.1177/15589447241238373","url":null,"abstract":"<p><p>This is a case report of an 85-year-old woman with osteopenia who underwent olecranon avulsion fracture repair with supplemental triceps tendon repair following a fall on an outstretched arm. The initial procedure failed due to osteoporotic bone quality and an atraumatic disruption of the olecranon fracture fixation. The patient subsequently underwent further surgical intervention with an olecranon avulsion fracture excision and a novel triceps tendon repair technique using plate augmentation and fiber tape. Surgeons may consider this novel approach as an initial treatment for elderly patients with osteopenia or osteoporosis undergoing olecranon avulsion fracture fixation, to prevent the failure and consequent revision surgery.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"NP1-NP5"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 3D-Printed Custom Elbow Prosthesis for Salvage Treatment of Complex Intra-Articular Distal Humerus Fracture Malunion.","authors":"Tommy Pan, Kevin T Monahan, Athan G Zavras, Michael J Reynolds, Michael Weiser, Jon E Hammarstedt, Edward R Westrick","doi":"10.1177/15589447241257642","DOIUrl":"10.1177/15589447241257642","url":null,"abstract":"<p><p>Intra-articular fractures of the distal humerus are complex injuries that often require surgery with the goal of restoring elbow range-of-motion and function. Open reduction and internal fixation has been the preferred surgical modality; however, restoration of the medial and/or lateral columns can be complicated in fractures involving a major loss of the articular surface and bony structure. Over the past decade, 3-dimensional (3D) printing has made significant advances in the field of orthopedic surgery, specifically in guiding surgeon preoperative planning. Recently, the incorporation of 3D-printing has proven to provide a safe and reliable construct for the restoration of anatomy in complex trauma cases. We present a 47-year-old woman who sustained a complex, intra-articular distal humerus fracture with associated shearing of the capitellum that went onto malunion. Patient was treated with a patient-specific 3D-printed custom elbow prosthesis with excellent outcomes. Our goal was to shed light on the use of 3D-printing technology as a viable salvage option in treating complex, intra-articular distal humeral fractures associated with lateral condylar damage that subsequently went onto malunion.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"NP6-NP12"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}