Journal of Hand Surgery Global Online最新文献

{"title":"The Use of Patient-Reported Outcomes in Clinical Practice: A National Survey of Hand Surgeons","authors":"Stephanie Choo MD ,&nbsp;Rown Parola MD ,&nbsp;Benjamin Kirby MD ,&nbsp;Daniel A. London MD","doi":"10.1016/j.jhsg.2024.09.009","DOIUrl":"10.1016/j.jhsg.2024.09.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-reported outcome measures (PROMs) use in practice could be limited secondary to logistical constraints and lack of consensus regarding PROMs’ clinical value. Therefore, the goals of this study are to determine (1) the use of PROMs by practicing hand surgeons, (2) which questionnaires are most used and the purpose for collection, and (3) the barriers to use.</div></div><div><h3>Methods</h3><div>A survey of American Society for Surgeons of the Hand members was conducted in May 2023. Demographic data of respondents, PROMs collected, and implementation and barriers to use were assessed. Associations between variables were determined by Fischer exact tests and logistic regression.</div></div><div><h3>Results</h3><div>A total of 419 surveys were completed from the 4,523 individuals contacted, representing a 9.3% response rate. Eighty-one percent (81%) were US/Canadian respondents, and 19% reported as other nationalities, with other nationalities reporting use of PROMs at a higher rate than US/Canadian respondents. Odds of PROM use were higher for academic, hybrid, and hospital employed respondents relative to those in private practice settings. The 247 (58%) respondents who did not use PROMs cited barriers including logistic or administrative concerns, uncertainty on application in practice, having no interest, and cost concerns. The most frequently used upper-extremity questionnaire among the 172 (42%) respondents using PROMs was the <em>Quick</em>DASH (Disabilities of the Arm, Shoulder, and Hand), which was used by 112 respondents (65.1%). Patient-reported outcome measures were collected for research/database purposes by 130 (76%) and monitoring routine clinical care by 103 (60%). Among those using PROMs for clinical care, 79 (77%) of respondents use PROMs for postoperative recovery monitoring and 52 (55%) for counseling regarding surgical expectations.</div></div><div><h3>Conclusions</h3><div>Patient-reported outcome measure use varies by practice setting, with most respondents not collecting PROMs. There remains large variability in the application of PROMs, and further research is needed to determine and demonstrate the value of PROMs in hand surgery for routine clinical care.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IIc.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 41-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143171926","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":"Leveraging ChatGPT to Produce Patient Education Materials for Common Hand Conditions","authors":"George Abdelmalek MD ,&nbsp;Harjot Uppal MBA ,&nbsp;Daniel Garcia BS ,&nbsp;Joseph Farshchian MD ,&nbsp;Arash Emami MD ,&nbsp;Andrew McGinniss MD","doi":"10.1016/j.jhsg.2024.10.002","DOIUrl":"10.1016/j.jhsg.2024.10.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Many adults in the United States possess basic or below basic health literacy skills, making it essential for patient education materials (PEMs) to be presented at or below a sixth-grade reading level. We evaluate the readability of PEMs generated by ChatGPT 3.5 and 4.0 for common hand conditions.</div></div><div><h3>Methods</h3><div>We used Chat Generative Pre-Trained Transformer (ChatGPT) 3.5 and 4.0 to generate PEMs for 50 common hand pathologies. Two consistent questions were asked to minimize variability: 1. “Please explain [Condition] to a patient at a sixth-grade reading level, including details on anatomy, symptoms, doctors' examination, and treatment (both surgical and nonsurgical).” 2. “Create a detailed patient information sheet for the general patient population at a sixth-grade reading level explaining [Condition], including points such as anatomy, symptoms, physical examination, and treatment (both surgical and nonsurgical).” Before asking the second question, a priming phase was conducted where ChatGPT 3.5 and 4.0 were presented with a text sample written at a sixth-grade reading level and informed that this was the desired output level. Multiple readability tests were used to evaluate the output, with a consensus reading level created from the results of all eight readability scores. Statistical analyses were performed using SAS 9.4.</div></div><div><h3>Results</h3><div>ChatGPT 4.0 successfully produced 28% of its responses at the appropriate reading level following the priming phase, compared to none by ChatGPT 3.5. ChatGPT 4.0 showed superior performance across all readability metrics.</div></div><div><h3>Conclusions</h3><div>ChatGPT 4.0 is a more effective tool than ChatGPT 3.5 for generating PEMs at a sixth-grade reading level for common hand conditions.</div></div><div><h3>Clinical relevance</h3><div>The results suggest that Artificial Intelligence could significantly enhance patient education and health literacy with further refinement.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 37-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173006","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":"Operative Versus Nonoperative Management of Pyogenic Flexor Tenosynovitis: An Analysis of the National Readmissions Database","authors":"Justin D. Sawyer MD ,&nbsp;Justin Davis MD ,&nbsp;Steven Scaife MS ,&nbsp;Michael W. Neumeister MD ,&nbsp;Timothy H.F. Daugherty MD","doi":"10.1016/j.jhsg.2024.08.017","DOIUrl":"10.1016/j.jhsg.2024.08.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to use a national database to determine if either surgical or nonsurgical management of pyogenic flexor tenosynovitis (PFT) led to specific superior outcomes.</div></div><div><h3>Methods</h3><div>International Classification of Diseases, Tenth Revision codes were used to identify patients admitted with PFT from the National Readmissions Database for the years 2016–2019. All patients had been admitted initially and treated with either surgical or nonsurgical management. Baseline characteristics were determined, and in those who were readmitted, the top 10 diagnoses of 90-day readmissions were identified. Risk factors for readmission were identified using a regression analysis. Ninety-day readmission rates, amputation rates, and length of stay between the groups were compared, as these are outcomes that can be reviewed from the database.</div></div><div><h3>Results</h3><div>The overall 90-day readmission rate was 13.25%. Infectious complications from the original diagnosis of PFT were the leading causes of readmission. Variables associated with 90-day readmission were higher Charlson comorbidity index, hypertension, Medicaid insurance, longer initial length of hospital stay, tobacco use, and nonsurgical management. Ninety-day readmission rates and amputation rates were higher in the nonsurgical group.</div></div><div><h3>Conclusions</h3><div>In patients with PFT, surgical intervention may prevent hospital readmissions and reduce the likelihood of amputation. Readmission is more likely in patients with more medical comorbidities, tobacco users, and lower socioeconomic status.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IIC.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 9-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173001","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":"Postoperative Complications After Operative Treatment of Open Versus Closed Distal Radius Fractures: A Propensity Score Matched Analysis","authors":"R. Cole Schmidt MD ,&nbsp;Conor N. O’Neill MD ,&nbsp;Zakkary J. Walterscheid MD ,&nbsp;James R. Satalich MD ,&nbsp;Jonathan Isaacs MD","doi":"10.1016/j.jhsg.2024.09.006","DOIUrl":"10.1016/j.jhsg.2024.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary objective was to use a large sample size to compare 30-day infection rates and other perioperative outcomes between operatively treated open and closed distal radius fractures.</div></div><div><h3>Methods</h3><div>Patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent open reduction and internal fixation of a distal radius fracture between 2008 and 2018 were identified using Current Procedural Terminology codes and stratified into open (OF) and closed fractures (CF). A 10:1 (CF:OF) nearest neighbor propensity score matching was used to address demographic differences. Infection rate and other outcomes were compared between groups.</div></div><div><h3>Results</h3><div>A total 17,536 CF and 401 OF were treated by open reduction and internal fixation. After matching, baseline demographics were not statistically different (<em>P</em> &gt; .05). There was a statistically significant increase in deep surgical site infections between OF and CF (0.2% vs 0.02%, <em>P</em> &lt; .05). The OF cohort had a higher rate of significant adverse events (7.2% vs 1.6%, <em>P</em> &lt; .05), return to the operating room (3.5% vs 0.9%, <em>P</em> &lt; .05), mean length of stay (1.8 vs 0.7 days, <em>P</em> &lt; .05), and operative time (90.8 vs 73.7 minutes, <em>P</em> &lt; .05), but no difference in time from admission to the operating room (0.4 vs 0.3 days).</div></div><div><h3>Conclusions</h3><div>There was a statistically but probably not clinically impactful increase in 30-day deep surgical site infections in OF compared to CF. Patients with OF had significantly longer operative times and length of stay, and more often returned to the OR. This suggests that many OF patients do not carry a clinically increased short-term risk of infection when compared to CF patients.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic, Level III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 29-32"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173004","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":"Total Metacarpal Reconstruction with Fascia-Wrapped Fibular Graft Following Ewing Tumor Resection in a Growing Patient","authors":"Samer Abdel Al MD ,&nbsp;Muhamad A. Al-Qawasmi MD ,&nbsp;Muntaser Abu Shokor MD ,&nbsp;Hamza M. Khalaf MD ,&nbsp;Mohammad A. Alattar PT","doi":"10.1016/j.jhsg.2024.09.003","DOIUrl":"10.1016/j.jhsg.2024.09.003","url":null,"abstract":"<div><div>Ewing tumor, a rare bone tumor, exceptionally affects the hand. We report a unique case of this tumor in the fourth metacarpal of a young patient. Reconstructing a digit after complete metacarpal removal because of sarcoma resection is a complex challenge, especially in growing individuals. We employed a novel technique involving a nonvascularized fibular autograft wrapped in fascia and intricate soft tissue reconstruction for proximal phalanx growth. The patient’s function remained satisfactory for more than 2-year follow-up.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 98-102"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173061","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":"Evaluation of Chat Generative Pre-trained Transformer and Microsoft Copilot Performance on the American Society of Surgery of the Hand Self-Assessment Examinations","authors":"Taylor R. Rakauskas BS ,&nbsp;Antonio Da Costa BS ,&nbsp;Camberly Moriconi BS ,&nbsp;Gurnoor Gill BA ,&nbsp;Jeffrey W. Kwong MD MS ,&nbsp;Nicolas Lee MD","doi":"10.1016/j.jhsg.2024.10.001","DOIUrl":"10.1016/j.jhsg.2024.10.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Artificial intelligence advancements have the potential to transform medical education and patient care. The increasing popularity of large language models has raised important questions regarding their accuracy and agreement with human users. The purpose of this study was to evaluate the performance of Chat Generative Pre-Trained Transformer (ChatGPT), versions 3.5 and 4, as well as Microsoft Copilot, which is powered by ChatGPT-4, on self-assessment examination questions for hand surgery and compare results between versions.</div></div><div><h3>Methods</h3><div>Input included 1,000 questions across 5 years (2015–2019) of self-assessment examinations provided by the American Society of Surgery of the Hand. The primary outcomes included correctness, the percentage concordance relative to other users, and whether an additional prompt was required. Secondary outcomes included accuracy according to question type and difficulty.</div></div><div><h3>Results</h3><div>All question formats including image-based questions were used for the analysis. ChatGPT-3.5 correctly answered 51.6% and ChatGPT-4 correctly answered 63.4%, which was a statistically significant difference. Microsoft Copilot correctly answered 59.9% and outperformed ChatGPT-3.5 but scored significantly lower than ChatGPT-4. However, ChatGPT-3.5 sided with an average of 72.2% users when correct and 62.1% when incorrect, compared to an average of 67.0% and 53.2% users, respectively, for ChatGPT-4. Microsoft Copilot sided with an average of 79.7% users when correct and 52.1% when incorrect. The highest scoring subject was <em>Miscellaneous</em>, and the lowest scoring subject was <em>Neuromuscular</em> in all versions.</div></div><div><h3>Conclusions</h3><div>In this study, ChatGPT-4 and Microsoft Copilot perform better on the hand surgery subspecialty examinations than did ChatGPT-3.5. Microsoft Copilot was more accurate than ChatGPT3.5 but less accurate than ChatGPT4. The ChatGPT-4 and Microsoft Copilot were able to “pass” the 2015–2019 American Society for Surgery of the Hand self-assessment examinations.</div></div><div><h3>Clinical Relevance</h3><div>While holding promise within medical education, caution should be used with large language models as more detailed evaluation of consistency is needed. Future studies should explore how these models perform across multiple trials and contexts to truly assess their reliability.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 23-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173003","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":"Inexperienced Evaluator Identification of Hand Ischemia Via Video Processed with Pigment-Enhancing Technology","authors":"Max Horowitz BS ,&nbsp;Aygul Iskandarova MD ,&nbsp;Gabriel Yohe MS ,&nbsp;Shihab Rahman BS ,&nbsp;Nicholas Durr PhD ,&nbsp;Aviram M. Giladi MD, MS","doi":"10.1016/j.jhsg.2024.11.002","DOIUrl":"10.1016/j.jhsg.2024.11.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Eulerian video magnification (EVM)+waveform is a novel video processing software that enhances visualization of tissue perfusion and has been shown to improve hand surgeon identification of ischemia via video alone. The purpose of this study is to determine whether EVM+waveform technology will support improved accuracy in identifying hand ischemia for less experienced persons, regardless of the evaluator’s health care experience or the melanin content of the hand in the video.</div></div><div><h3>Methods</h3><div>Healthy volunteers were recruited for us to record videos of their hands both perfused and under tourniquet-induced ischemia. Videos were processed with EVM+waveform and inserted into a 26-question survey. There were two types of questions presented in each survey. One format showed a video processed with EVM+waveform, and the respondent was asked if the hand was ischemic, perfused, or if they were unsure. The second format presented two side-by-side videos, one ischemic and one perfused. Both were processed with EVM+waveform, and the respondent had to choose which was ischemic. Respondents included both medical and non-medical professionals none of whom had experience with hand surgery.</div></div><div><h3>Results</h3><div>A total of 64 survey responses were recorded. The EVM+waveform technology significantly improved accuracy in determining ischemia regardless of the respondent’s health care experience. Respondents were divided into medical doctorate (MD; n = 15) and non-MD (n = 49) groups. Both groups demonstrated significant improvement in determining ischemia when using EVM+waveform. Within the non-MD cohort, accuracy percentages significantly improved across Fitzpatrick types IV, V, and VI. Within the MD cohort, accuracy percentages significantly improved across Fitzpatrick types III, V, and VI.</div></div><div><h3>Conclusions</h3><div>These findings further establish EVM+waveform as an effective modality for identifying ischemia via video alone, as it enhanced performance for inexperienced evaluators. EVM+waveform is effective for assessing various skin types, especially those with higher skin melanin content.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic, IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 72-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173056","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":"Metacarpophalangeal Joint Salvage Following Gunshot Wounds: A Case Series And Literature Review","authors":"Reece A. Moore MD ,&nbsp;Jacob Franke MD ,&nbsp;Matthew Fahrenkopf MD","doi":"10.1016/j.jhsg.2024.11.004","DOIUrl":"10.1016/j.jhsg.2024.11.004","url":null,"abstract":"<div><div>Metacarpophalangeal (MCP) joint arthroplasty may be considered for patients with destructive gunshot wound (GSW) injuries. We present a review of two patients who sustained a low-velocity GSW of the hand with involvement of an MCP joint requiring MCP joint salvage using arthroplasty. Differing arthroplasty methods were used for each patient including pyrocarbon hemiarthroplasty and silicone arthroplasty. For pyrocarbon hemiarthroplasty, total arc of motion at 9 months after surgery for the MCP, proximal interphalangeal, and distal interphalangeal joints were 70º, 110º, and 80º, respectively. For silicone arthroplasty, total arc of motion at 9 months after surgery for the MCP, proximal interphalangeal, and distal interphalangeal joints were 85º, 120º, and 80º, respectively. Both patients returned to work without restrictions and were without chronic pain at the last follow-up 9 months from salvage surgery. The application of pyrocarbon or silicone arthroplasty for GSWs is a viable option for joint salvage in this population.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 117-120"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173059","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":"Single-Stage Coverage of Exposed Critical Structures With Intact Decellularized Fish Skin and Simultaneous Epidermal Autograft Application: The “Sandwich” Technique","authors":"Katherine C. Benedict MD,&nbsp;John M. Sullivan MD,&nbsp;Laura I. Galarza MD,&nbsp;Marc E. Walker MD, MBA","doi":"10.1016/j.jhsg.2024.09.008","DOIUrl":"10.1016/j.jhsg.2024.09.008","url":null,"abstract":"<div><div>Coverage of exposed tendon and bone in upper-extremity injuries presents a reconstructive challenge, often requiring staged procedures or complex microsurgical reconstruction techniques. We present a case series using a single-stage approach with intact decellularized fish skin graft laminated with a simultaneous split-thickness skin autograft. This technique aims to reduce the number of surgeries and decrease time to complete healing. Two cases are reported: a dog-bite forearm injury with exposed extensor tendons devoid of peritenon and a work-related crush injury of the hand with exposed metacarpal fracture. Following definitive debridement, both cases ultimately achieved successful wound healing with simultaneous placement of decellularized fish skin graft laminated with split-thickness skin autograft without further interventions.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173063","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":"Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study","authors":"Michael B. Gehring MD ,&nbsp;Brandon Wolfe BA ,&nbsp;Riley Kahan BS ,&nbsp;Stephanie D. Malliaris MD ,&nbsp;Kia M. Washington MD ,&nbsp;Matthew D. Folchert MD ,&nbsp;Kyros Ipaktchi MD ,&nbsp;Mark A. Greyson MD ,&nbsp;Alexander Lauder MD ,&nbsp;Matthew L. Iorio MD","doi":"10.1016/j.jhsg.2024.08.020","DOIUrl":"10.1016/j.jhsg.2024.08.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary fixation (IMF) has emerged as an effective treatment for metacarpal fractures. Benefits include stable fixation that allows early postoperative rehabilitation and high fracture union rates, without increased complications. Both headless compression screws and intramedullary threaded noncompressive nails have been described for this purpose; however, prospective outcomes reporting are lacking. This study assessed the outcomes of metacarpal fractures treated with IMF including patient-reported outcomes, grip strength, total active motion, and complications.</div></div><div><h3>Methods</h3><div>A prospective multicenter trial enrolled consecutive patients with closed, extra-articular metacarpal fractures treated with IMF. Radiographic healing was assessed at each postoperative visit and patient-reported outcomes included pain scores, <em>Quick</em>DASH (Disabilities of the Arm, Shoulder, and Hand), and Short Form Survey scores. Grip strength, goniometric motion measurements, and complications were also obtained.</div></div><div><h3>Results</h3><div>One-hundred-one fractures were treated in 82 patients with an average age of 33 years and mean follow-up of 69 days. Most patients were male (70%), nonlaborers (72%), and nonsmokers (74%). <em>Quick</em>DASH scores improved by 40 points, with a final mean of 17 following metacarpal IMF. Short Form Survey components of physical component score and mental component score at final follow-up were 55.95 and 48.74, respectively. Final average grip strength was 15 kg and total active motion was 228º. The average total active motion of the closed reduction cohort (249°) was significantly higher than the open cohort (210°) at final follow-up (<em>P</em> &lt; 0.05). Four complications (3.9%) occurred, including one hardware failure, two proximal screw migrations, and one metacarpophalangeal joint contracture, with three of these patients requiring revision surgery.</div></div><div><h3>Conclusions</h3><div>Intramedullary fixation is a reliable technique for treatment of extra-articular metacarpal fractures with satisfactory patient-reported outcomes, excellent strength and motion, and a low complication rate. Intramedullary fixation should be considered for closed, extra-articular metacarpal fractures.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 48-55"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173007","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}