Journal of Hand Surgery Global Online最新文献

{"title":"Efficient Replantation: Techniques, Tricks, and Secondary Procedures for Improved Functional Outcomes","authors":"Deborah B. Martins MD ,&nbsp;Ogi Solaja MD ,&nbsp;Gregory Buncke MD","doi":"10.1016/j.jhsg.2024.07.010","DOIUrl":"10.1016/j.jhsg.2024.07.010","url":null,"abstract":"<div><div>Successful digit replantation is dependent on multiple factors, including patient demographics, comorbidities, the mechanism of injury, and the skill and experience of the surgical team and microsurgery center. Although patient and injury characteristics cannot be controlled, the microsurgeon can incorporate specific techniques to improve efficiency and optimize outcomes. Replantation can be tedious, and minimizing surgeon fatigue is important. This article aims to review strategies and tricks to increase efficiency and success in digit replantation, while also reviewing postreplant rehabilitation and secondary surgeries to optimize hand function.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 331-339"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620930","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 Effect of Arm Abduction and Forearm Muscle Activation on Kinematics During Elbow Flexion","authors":"Tyler J. Wilps MD ,&nbsp;Robert A. Kaufmann MD ,&nbsp;James W. Gorenflo MS ,&nbsp;Satoshi Yamakawa PhD ,&nbsp;Richard E. Debski PhD","doi":"10.1016/j.jhsg.2024.11.006","DOIUrl":"10.1016/j.jhsg.2024.11.006","url":null,"abstract":"<div><h3>Purpose</h3><div>As the elbow flexes with the arm at the side (0° humerothoracic abduction, HTA), it loses its valgus carrying angle. When the arm is abducted to 90° HTA, a varus torque tensions the lateral ligaments. Our purpose was to quantify the effect of abduction on elbow kinematics during active motion and the effect of lateral forearm muscle activation. We hypothesized that arm abduction would increase elbow varus angulation throughout flexion, and lateral forearm muscle activation would decrease varus angulation.</div></div><div><h3>Methods</h3><div>A dynamic elbow testing apparatus was employed in six human cadaver arms at two levels of arm abduction, 0° and 90° HTA. Six electromechanical actuators simulated muscle action, whereas joint position was measured to quantify the relationship between the forearm and humerus as the elbow was actively flexed.</div></div><div><h3>Results</h3><div>All elbows maintained greater varus angle with the arm at 90° HTA compared with 0° HTA, significant at 60° flexion, 4.3° versus 3.4°, 90° flexion, 8.0° versus 6.8°, and 120° flexion, 10.5° versus 8.9°. The abducted elbow demonstrated less varus angle when the lateral stabilizers were activated. A significant difference was found at 30° flexion, 0.9 versus 1.5, 60° flexion, 3.8 versus 4.3, and 90° flexion, 7.6 versus 8.0.</div></div><div><h3>Conclusions</h3><div>Elbow joint coronal plane kinematics were influenced by abduction of the arm to 90° HTA, and greater elbow varus angles were found throughout flexion when compared with the arm at side position (0° HTA). In addition, activation of lateral forearm muscles (90° HTA + Lat Stab) decreased elbow varus angulation throughout flexion.</div></div><div><h3>Clinical relevance</h3><div>Understanding the effect of varus torque on elbow biomechanics and the degree to which these effects are countered through dynamic stabilization may assist in arthroplasty and ligamentous reconstruction designs.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 146-151"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621065","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":"Carpal Tunnel Release with Ultrasound Guidance Versus Open and Mini-Open Carpal Tunnel Release: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Seper Ekhtiari MD, MSc ,&nbsp;Mark Phillips PhD ,&nbsp;Dalraj Dhillon BSc ,&nbsp;Ali Shahabinezhad MD ,&nbsp;Conner McMains MD ,&nbsp;Bill Dzwierzynski MD ,&nbsp;Mohit Bhandari MD, PhD","doi":"10.1016/j.jhsg.2024.04.001","DOIUrl":"10.1016/j.jhsg.2024.04.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel release (CTR) can be performed using several techniques, including traditional open CTR, mini-open CTR, endoscopic CTR (ECTR), and CTR with ultrasound guidance (CTR-US). Carpal tunnel release with ultrasound guidance allows the procedure to be performed through a small, nonpalmar incision while maintaining visualization of critical anatomy and may confer benefits in terms of early recovery and incision-related complications. The objective of this study was to compare CTR-US with traditional open or mini-open CTR based on evidence from randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>The electronic databases Embase and MEDLINE were searched from inception to November 2022. Randomized controlled trials comparing CTR-US with traditional open or mini-open CTR were eligible for inclusion. Studies were assessed for eligibility from title and abstract followed by a full-text review. The main outcomes of interest were return to normal activity or return to work, patient-reported functional scores, and complications.</div></div><div><h3>Results</h3><div>Three RCTs were eligible for inclusion with a total of 221 patients randomized. Meta-analysis demonstrated that compared with open CTR patients, patients treated with CTR-US had significantly higher functional scores at 3 months (standardized mean difference: −0.91, 95% confidence interval (CI): −1.38 to −0.44, <em>P</em> &lt; .01) and faster return to normal activities (mean difference: −20.8 days, 95% CI: −21.77 to −19.73). There was no significant difference in complication rates between the two groups (odds ratio: 0.80, 95% CI: 0.04–15.10, <em>P</em> = .07). No domains were deemed to be at high risk of bias in any study.</div></div><div><h3>Conclusions</h3><div>Based on the available evidence, CTR-US is a safe and effective surgical option for treating carpal tunnel syndrome with a similar risk profile to open CTR. Data suggest that patients who receive CTR-US have improved functional outcomes and faster return to work or normal activities. Future RCTs with larger sample sizes are needed to corroborate these benefits and demonstrate long-term outcomes of CTR-US.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 121-126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620413","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":"Current Principles in the Management of a Mangled Hand","authors":"Martina Macrì MD ,&nbsp;Pierfrancesco Pugliese MD ,&nbsp;Graziano Accardo MD ,&nbsp;Alice Clemente MD ,&nbsp;Valentina Cecconato MD ,&nbsp;Simona Odella MD ,&nbsp;Pierluigi Tos MD, PhD","doi":"10.1016/j.jhsg.2024.07.009","DOIUrl":"10.1016/j.jhsg.2024.07.009","url":null,"abstract":"<div><div>Mangled upper-extremity injuries can have devastating consequences for the patient. The goal of treatment was to recreate a functional hand with a minimum of three sensitive and opposable fingers to achieve an acceptable quality of life. Early management of injuries is critical to treatment success. Initial assessment begins in the emergency department where the injury is quantified and the amputated segments are evaluated, particularly the possibility of replanting them or using them as spare parts as tissue bank. In the operating room, careful debridement is essential for any reconstruction. Despite advances in reconstructive techniques, the management of these injuries is a challenge for the surgeon. The main treatment guidelines and a step-by-step approach to the mangled hand are presented to achieve acceptable results.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 326-330"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620929","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":"Free-Functioning Muscle Transfers After Major Upper Limb Replantation","authors":"Pedro C. Cavadas MD, PhD ,&nbsp;Tina M.Y. Lee MBBS","doi":"10.1016/j.jhsg.2024.07.008","DOIUrl":"10.1016/j.jhsg.2024.07.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Major upper limb replantation surgery is a complex undertaking that often requires secondary reconstructive procedures to improve function. The loss of critical functional muscle groups in the forearm was once considered a relative contraindication for replantation. The advent of free-functioning muscle transfers (FFMTs) has expanded the boundaries for replantation. In this study, we seeked to review the indications, surgical considerations, and outcomes of the use of FFMTs after major upper limb replantation.</div></div><div><h3>Methods</h3><div>In this retrospective study, we included patients who underwent replantation surgery for amputations at or proximal to the forearm and subsequent FFMTs for reconstruction of motor function.</div></div><div><h3>Results</h3><div>A total of 16 patients received 20 FFMTs between the period of 1998 and 2022. These were all used to reconstruct finger flexion or finger extension or both. All patients underwent secondary procedures to further augment functional outcomes after FFMT surgery.</div></div><div><h3>Conclusions</h3><div>Free-functioning muscle transfers serve as a useful reconstructive tool for restoration of motor function following major upper limb replantation.</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 2","pages":"Pages 319-325"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620928","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":"Surgical Technique: “Perforate and Fill” Technique of Bone Grafting for Scaphoid Fracture Fixation","authors":"Mehek Gupta MBBS ,&nbsp;Heng Qi Hui Bernice MBBS, MRCS ,&nbsp;Mala Satkunanantham MRCS, MMed ,&nbsp;Tina Munn Yi Lee MRCS, FAMS ,&nbsp;Xu Jieying MRCS, FRCS ,&nbsp;Lam-Chuan Teoh MMed, FRCS","doi":"10.1016/j.jhsg.2024.12.007","DOIUrl":"10.1016/j.jhsg.2024.12.007","url":null,"abstract":"<div><h3>Purpose</h3><div>We introduce the “Perforate and Fill” technique for bone grafting of scaphoid fracture with delayed union and nonunion, which preserves the cartilage shell and does not break open the fibrous nonunion. This article describes the technique and reports the experience in 11 scaphoid fractures.</div></div><div><h3>Methods</h3><div>The records of 11 patients whose scaphoid fractures were managed surgically with this bone grating technique from our institution from July 2017 to June 2024 were reviewed retrospectively. Patient and fracture factors, radiographic measurements of bone defect, postoperative films, and subjective and objective outcomes were considered.</div></div><div><h3>Results</h3><div>The radiographic union of the fracture ranges from 36 to 110 days (an average of 68 days). In the last follow-up review, the affected wrists were pain free in all cases, and they were able to resume their premorbid status of vocation and resumed all physical activities. In nine cases, their total wrist motion (including flexion, extension, radial, and ulnar deviation) measured 130° to 195° (an average of 172° and 93% of the opposite wrists). In these nine cases, their grip strengths measured 28–50 kg (an average of 31.5 kg and is 97% of the opposite hand).</div></div><div><h3>Conclusions</h3><div>In conclusion, in treatment of scaphoid fracture delayed union and nonunion, the “Perforate and Fill” technique of bone grafting is a good alternative to the conventional wedge grafting technique. The advantage of keeping the intact cohesive union of cartilage shell and a less-invasive approach may contribute to the success of the fracture union in our 11 cases using this technique.</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 2","pages":"Pages 219-224"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620995","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":"A Patient-Specific Three-Dimensional-Printed Surgical Guide for Dorsal Scaphoid Fracture Fixation: A Comparative Cadaver Study","authors":"Grayson A. Wagner MS ,&nbsp;Alyssa Glennon BS ,&nbsp;Johannes M. Sieberer MS ,&nbsp;Steven M. Tommasini PhD ,&nbsp;Lisa L. Lattanza MD","doi":"10.1016/j.jhsg.2024.11.008","DOIUrl":"10.1016/j.jhsg.2024.11.008","url":null,"abstract":"<div><h3>Purpose</h3><div>This study proposes a patient-specific three-dimensional (3D)-printed surgical guide designed for scaphoid fracture fixation through a limited dorsal approach.</div></div><div><h3>Methods</h3><div>Computed tomography scans of five cadaveric wrists were modeled in 3D segmentation software and cannulated screw guidewire trajectory was planned. Custom 3D-printed surgical guides for guidewire insertion were designed for each scaphoid. Guidewire placement was performed with and without the surgical guide through a dorsal approach. Postoperative scans were overlaid with the planned trajectory and compared. Five variables were measured: angular deviation, distance between entry points, distance between exit points, embedded guidewire length, and number of attempts.</div></div><div><h3>Results</h3><div>Mean angular deviation from the planned trajectory was 10.80 ± 6.72° for the guided and 14.08 ± 4.65° for the freehand group. The offset between entry and exit for the guided group was 2.22 ± 1.04 and 3.52 ± 2.80 mm and for the freehand group 2.95 ± 1.31 and 4.91 ± 2.37 mm, respectively. The mean length for the guided group was 23.25 ± 3.33 mm and 23.31 ± 3.07 mm for the freehand group. All guided cases took one attempt and the freehanded cases 2.0 ± 1.0 attempts. A significant positive correlation was found between trajectory and exit. No significance between groups was found between any of the measured variables. A minimum sample size of 28 was determined for follow-up studies.</div></div><div><h3>Conclusions</h3><div>The use of a custom surgical guide improved guidewire placement in four of five specimens when compared with a freehand approach. Specifically, the trajectory was closer to the planned trajectory. All guidewire placements were clinically acceptable. Therefore, we consider the use of this surgical guide for the dorsal approach feasible to be used in clinical practice.</div></div><div><h3>Clinical relevance</h3><div>This device could be used to treat nondisplaced scaphoid fractures. The use of a custom surgical guide could allow for accurate and efficient screw placement as well as reduced operating time and fluoroscopy exposure.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 158-166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621067","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":"Versatility of Vascularized Fibular Graft in Forearm Bone Loss: From Initial Treatment to Secondary Nonunion Treatment","authors":"Bruno Battiston MD, PhD ,&nbsp;Francesca Fissore MD ,&nbsp;Elisabetta Mijno MD ,&nbsp;Davide Ciclamini MD","doi":"10.1016/j.jhsg.2024.08.004","DOIUrl":"10.1016/j.jhsg.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Managing mangled forearms poses a considerable challenge for hand surgeons. The vascularized fibular graft (VFG) is a commonly used technique for addressing this complex issue. This retrospective study aims to assess the outcomes of advanced treatment for complex forearm bone loss necessitating microsurgical treatment with a vascularized fibula flap.</div></div><div><h3>Methods</h3><div>Patients treated with VFG between January 2010 and December 2022 were included in this analysis. Physical and radiographic evaluations were performed for all patients, and they completed patient-reported outcome measures such as the disability of the arm, shoulder, and hand scores, Mayo Wrist scores, and visual analog scale pain (VAS-Pain) scores for both the recipient and donor sites. Patients treated with one-bone forearm (OBF) reconstruction were also assessed using the outcome score of the OBF according to Peterson.</div></div><div><h3>Results</h3><div>A total of 26 cases were treated with VFG for forearm bone defect reconstruction (13 for primary treatment and 13 for secondary treatment of nonunion). Vascularized fibular graft was employed to create a OBF in four cases, a double barrel in three cases, and an osteocutaneous composite flap in nine cases. The average bone defect measured 81 ± 3.4 mm (range: 50–150 mm). Bone healing was achieved at an average of 8.3 ± 5.5 months (range: 4–15 months), with nonunion at one docking point observed in eight cases necessitating revision. At the follow-up end point, patients reported an average disability of the arm, shoulder, and hand score of 13.5%, a Mayo Wrist score of 80%, and a VAS-Pain score of 3/10. The VAS-Pain outcome at the donor site was rated at 4/10. One-bone forearm’s mean score was 7/10.</div></div><div><h3>Conclusions</h3><div>Vascularized fibular graft stands as a viable option for mangled forearm reconstruction. Whether through the double barrel technique or as an osteocutaneous composite graft, VFG allows for the simultaneous reconstruction of both forearm bones and associated soft tissue injuries.</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 2","pages":"Pages 356-361"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620408","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":"Are PROMIS and Legacy Patient-Reported Outcome Measures Correlated for Patients Undergoing Carpal Tunnel Release?","authors":"Leah Demetri MD ,&nbsp;Philip Blazar MD ,&nbsp;Brandon E. Earp MD ,&nbsp;Dafang Zhang MD","doi":"10.1016/j.jhsg.2024.12.002","DOIUrl":"10.1016/j.jhsg.2024.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Long-established patient-reported outcome measures (PROMs), such as the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the <em>Quick</em>DASH, have been used traditionally to measure baseline symptoms and treatment effects before and after carpal tunnel release (CTR), but more recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been used increasingly in the CTR patient population. We aimed to measure the correlation between legacy and PROMIS PROMs for baseline pain and function in a cohort of patients undergoing CTR for idiopathic carpal tunnel syndrome (CTS).</div></div><div><h3>Methods</h3><div>Baseline PROMs were collected prospectively in 86 patients with electrodiagnostically confirmed CTS treated with CTR at a single tertiary referral center. The legacy PROMs used were the BCTQ and the <em>Quick</em>DASH. The PROMIS instruments used were computer adaptive test versions of the PROMIS Pain Interference (PI), Upper Extremity (UE), and Physical Function (PF). Given normal distributions, correlation between PROMs was assessed using the Pearson correlation coefficient.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 59.7 years, and 56% were women. When assessing pain, the BCTQ – Symptom Severity Scale (SSS) was correlated moderately with PROMIS – PI (ρ = 0.59). When assessing function, the BCTQ – Functional Status Scale (FSS) was strongly inversely correlated with PROMIS – UE (ρ = −0.71) and moderately inversely correlated with PROMIS – PF (ρ = −0.58). The <em>Quick</em>DASH was strongly inversely correlated with PROMIS – UE (ρ = −0.75) and moderately inversely correlated with PROMIS – PF (ρ = −0.62). Finally, when comparing the two legacy PROMs for function, the BCTQ – FSS was strongly correlated with <em>Quick</em>DASH (ρ = 0.88).</div></div><div><h3>Conclusions</h3><div>We demonstrated at least moderate correlation between legacy and PROMIS outcome measures of baseline pain and function in CTS patients.</div></div><div><h3>Clinical Relevance</h3><div>Our findings support the use of either legacy or PROMIS outcome measures for this patient population.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 196-202"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620991","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":"Safety and Efficacy of Low-Dose Triamcinolone Injection without Injection Frequency Limitation for Trigger Finger","authors":"Jo Watanabe MD, PhD ,&nbsp;Yusuke Matsuura MD, PhD ,&nbsp;Takahiro Yamazaki MD, PhD ,&nbsp;Toshiyuki Yamada MD, PhD ,&nbsp;Seiji Ohtori MD, PhD","doi":"10.1016/j.jhsg.2025.01.005","DOIUrl":"10.1016/j.jhsg.2025.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Triamcinolone tendon sheath injection is a useful nonsurgical treatment for trigger finger; however, complications, such as tendon rupture, and infections caused by excessive administration, have been reported. Considering the complication risk, we inject 4 mg triamcinolone into the tendon sheath without limitation on the number of injections at intervals of at least 1 month. This study aimed to retrospectively examine the results of triamcinolone tendon sheath injections for trigger finger at multiple facilities.</div></div><div><h3>Methods</h3><div>The participants included patients with trigger finger who visited four facilities between April 2009 and October 2021, received at least one triamcinolone tendon sheath injection, and could be evaluated for effectiveness. Patients with a follow-up period of &lt;3 months from the initial injection, and pediatric patients aged &lt;16 years old were excluded. Quinnell’s severity classification, number of injections per finger, interval of injections (when performed ≥2 times), complications, proportion of diabetes, hemoglobin A1c (HbA1c) levels, and proportion that required surgery were collected.</div></div><div><h3>Results</h3><div>Overall, 356 cases and 715 fingers were included (men, 260 fingers; women, 455 fingers). The mean age of the participants was 64.9 years (17–92 years), and the mean number of affected fingers per person was 1.9 (1–7 fingers). The median follow-up period was 27 (3–134) months. According to Quinnell’s severity classification, 234, 274, 126, and 50 fingers were classified as grade 1, 2, 3, and 4, respectively. The average number of injections per finger was 3.3. The mean interval between injections was 6.3 months. Complications, such as tendon rupture, or infection, were not observed. The rate of diabetes was 22.4%, and the median HbA1c value was 7.2%. In total, 9.8% of all patients required surgery.</div></div><div><h3>Conclusions</h3><div>No complications were observed for 4 mg triamcinolone injections when administered at intervals of at least 1 month.</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 2","pages":"Pages 225-231"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620996","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}