Journal of Hand Surgery Global Online最新文献

{"title":"Beyond Amputation: Functional Restoration after Upper-Extremity Limb Loss","authors":"Jonathan T. Bricker MD ,&nbsp;Kazimir R. Bagdady BS ,&nbsp;Lindsay E. Janes MD ,&nbsp;Jason M. Souza MD ,&nbsp;Gregory A. Dumanian MD ,&nbsp;Jason H. Ko MD, MBA","doi":"10.1016/j.jhsg.2025.01.008","DOIUrl":"10.1016/j.jhsg.2025.01.008","url":null,"abstract":"<div><div>Several factors have contributed to poor quality of life outcomes for upper-extremity amputees. In recent decades, the advancements in both surgical procedures and prosthetics have been aimed at both improving the function and quality of life of amputees. Targeted muscle reinnervation, regenerative peripheral nerve interfaces, agonist–antagonist myoneural interfaces, free tissue transfers, and limb transplantation are chief among the surgical options available for improved sensorimotor function in residual and prosthetic limbs. New technologies such as cuff electrodes, intraneural filaments, and various osseointegrated prosthesis systems are used either alone or in concert with these operative techniques. Procedural and technological advancements will continue to push the limits of functional restoration after upper-extremity limb loss.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 368-375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620410","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":"Squamous Cell Carcinoma of the Nail Unit: A Case Report","authors":"Vanessa R. Richardson MD ,&nbsp;Cole D. Tessendorf MS3 ,&nbsp;Elizabeth Helsper MD ,&nbsp;Andrew Erie MD ,&nbsp;Victoria Durkin MD ,&nbsp;Robert Van Demark Jr. MD","doi":"10.1016/j.jhsg.2024.10.011","DOIUrl":"10.1016/j.jhsg.2024.10.011","url":null,"abstract":"<div><div>We report an 83-year-old woman who presented to her primary care provider with pain and swelling of her left thumb distal phalanx for 1 week. Initial imaging was benign. The patient underwent treatment for presumed soft tissue infection with 2 separate oral antibiotic courses. An intralesional corticosteroid injection did not provide relief and repeat radiographs showed a destructive lesion to the tuft of the distal phalanx. Advanced imaging showed bony destruction and biopsy revealed invasive squamous cell carcinoma involving the nail plate with bony invasion. Amputation through the interphalangeal joint of the left thumb was conducted with disease-free margins. The patient currently is following with oncology for clinical surveillance. Given this entity's rarity, either persistent or recurrent nail unit disease must be investigated thoroughly with early referral to a surgical hand specialist as appropriate.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 232-237"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620932","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":"Retrospective Analysis of Functional Outcome of Distal Fingertip Replants Without Heparin","authors":"N. Jithendran MS, MCh ,&nbsp;J. Terrence Jose Jerome FRCS(G), European Diploma Hand Surgery","doi":"10.1016/j.jhsg.2024.02.018","DOIUrl":"10.1016/j.jhsg.2024.02.018","url":null,"abstract":"<div><h3>Purpose</h3><div>This study reviews distal fingertip replants without heparin, aiming to assess their functional outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed all patients who underwent distal fingertip replants in two specialized hand surgery center over 7 years (2016–2023). Patient demographics, injury mechanism, ischemia time, complications, and functional outcomes were analyzed. The functional outcomes were assessed using the Fingertip Injuries Outcome Score.</div></div><div><h3>Results</h3><div>A total of 30 patients underwent distal fingertip replantation without heparin during the study period. The mean age was 31 years (range, 8–56 years). Machine cut avulsion (23 cases) was the common injury. The mean ischemia time was 7.4 hours. Twenty-five distal replants survived. Fingertip Injuries Outcome Scores categorized outcomes as excellent (n = 10), good (n = 10), fair (n = 5), and poor (n = 5). Complications included shortening (n = 5), nail dystrophy (n = 1), and cold intolerance (n = 1).</div></div><div><h3>Conclusion</h3><div>This study suggests favorable functional outcomes for distal fingertip replants without heparin. No significant complications were observed, suggesting that heparin may not be necessary for all cases. Further research is needed for more explicit guidelines on heparin use in fingertip 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 272-276"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043975","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":"Artificial Intelligence in Surgical Coding: Evaluating Large Language Models for Current Procedural Terminology Accuracy in Hand Surgery","authors":"Emily L. Isch MD ,&nbsp;Jamie Lee BA ,&nbsp;D. Mitchell Self MD ,&nbsp;Abhijeet Sambangi BS ,&nbsp;Theodore E. Habarth-Morales BS, 1LT ,&nbsp;John Vaile BS ,&nbsp;EJ Caterson MD, PhD","doi":"10.1016/j.jhsg.2024.11.013","DOIUrl":"10.1016/j.jhsg.2024.11.013","url":null,"abstract":"<div><h3>Purpose</h3><div>The advent of large language models (LLMs) like ChatGPT has introduced notable advancements in various surgical disciplines. These developments have led to an increased interest in the use of LLMs for Current Procedural Terminology (CPT) coding in surgery. With CPT coding being a complex and time-consuming process, often exacerbated by the scarcity of professional coders, there is a pressing need for innovative solutions to enhance coding efficiency and accuracy.</div></div><div><h3>Methods</h3><div>This observational study evaluated the effectiveness of five publicly available large language models—Perplexity.AI, Bard, BingAI, ChatGPT 3.5, and ChatGPT 4.0—in accurately identifying CPT codes for hand surgery procedures. A consistent query format was employed to test each model, ensuring the inclusion of detailed procedure components where necessary. The responses were classified as correct, partially correct, or incorrect based on their alignment with established CPT coding for the specified procedures.</div></div><div><h3>Results</h3><div>In the evaluation of artificial intelligence (AI) model performance on simple procedures, Perplexity.AI achieved the highest number of correct outcomes (15), followed by Bard and Bing AI (14 each). ChatGPT 4 and ChatGPT 3.5 yielded 8 and 7 correct outcomes, respectively. For complex procedures, Perplexity.AI and Bard each had three correct outcomes, whereas ChatGPT models had none. Bing AI had the highest number of partially correct outcomes (5). There were significant associations between AI models and performance outcomes for both simple and complex procedures.</div></div><div><h3>Conclusions</h3><div>This study highlights the feasibility and potential benefits of integrating LLMs into the CPT coding process for hand surgery. The findings advocate for further refinement and training of AI models to improve their accuracy and practicality, suggesting a future where AI-assisted coding could become a standard component of surgical workflows, aligning with the ongoing digital transformation in health care.</div></div><div><h3>Type of study/level of evidence</h3><div>Observational, IIIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 181-185"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621070","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":"“Callus Bending Technique” Following Gradual Bone Lengthening for Functional Reconstruction in Cases of Phalangeal Loss Due to Digital Amputation: Two Case Reports","authors":"Hiroyuki Gotani MD, PhD","doi":"10.1016/j.jhsg.2024.07.005","DOIUrl":"10.1016/j.jhsg.2024.07.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to introduce the “Callus bending technique” following gradual bone lengthening for functional reconstruction. We report cases of segmental phalangeal loss with replanted incomplete amputation and distal finger amputation.</div></div><div><h3>Methods</h3><div>Herein, we report two cases to introduce the “callus bending technique”: one in which the “callus bending technique” was adopted after gradual bone lengthening for amputated digital stumps, and the other, a case of incomplete digital amputation, in which defects in the replanted middle phalanges were filled by distraction lengthening of the proximal phalanx, followed by use of the callus bending technique.</div></div><div><h3>Results</h3><div>The patients could almost touch their palms with the tips of their injured fingers when they flexed their metacarpophalangeal joint of the digit fully. When he extended the metacarpophalangeal joint of the injured fingers fully, the hand looked almost natural, and he could push a table. For the patient with incomplete digital amputation, the distal interphalangeal joint was also reconstructed using the joint surfaces of the distal and proximal phalanges.</div></div><div><h3>Conclusions</h3><div>Both patients were satisfied with both the functional and cosmetic improvement of their fingers and returned to their work as carpenters. In both cases, an external fixator, the Ilizarov minifixator, was used, as it affords relatively great flexibility.</div></div><div><h3>Clinical relevance</h3><div>Adoption of this technique involves the use of multiple surgical procedures, but it eventually yields reasonable cosmetic and functional results. We propose the use of this technique as the technique of choice for amputated fingers or severe bone loss due to trauma.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 292-299"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620925","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":"Thirty-Eight-Year Follow-Up After Multiple Toe-to-Hand Transfers","authors":"M. Kristine Carbullido MD ,&nbsp;Emily E. Zona BS ,&nbsp;Sarah M. Thornton BA ,&nbsp;Pradeep Attaluri MD, MBA ,&nbsp;Peter J. Wirth MD ,&nbsp;Ellen C. Shaffrey MD ,&nbsp;Venkat K. Rao MD, MBA","doi":"10.1016/j.jhsg.2024.11.012","DOIUrl":"10.1016/j.jhsg.2024.11.012","url":null,"abstract":"<div><div>Replantation of damaged digits is the preferred treatment for traumatic pediatric hand injuries, but, when replantation is not feasible, second toe-to-hand transfers have been reported since the 1960s as a reconstructive method. This case report discusses a 38-year follow-up of a pediatric patient who underwent bilateral second toe-to-hand transfer after a riding lawn mower accident resulted in traumatic amputations of her right index through little fingers. At follow-up, the patient’s hand was assessed for functionality, including range of motion, grip strength, and sensation. The Disabilities of the Arm, Shoulder, and Hand score was 0/100, and 2-point discrimination was 7 mm, indicating high functionality and quality of life. No donor site complications were reported, and the patient actively participated in sports and recreational activities. This case demonstrates that toe-to-hand transplants can restore significant hand function with minimal complications.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 242-245"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620412","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 Firework Injury of the Thumb: Injury Pattern and Treatment Algorithm","authors":"David Cardenas BS ,&nbsp;Muhammad Harirah MD ,&nbsp;Anca Dogaroiu MS ,&nbsp;Brandon Bruce BS ,&nbsp;Andrei Odobescu MD, PhD ,&nbsp;Douglas Sammer MD ,&nbsp;Andrew Y. Zhang MD","doi":"10.1016/j.jhsg.2024.04.012","DOIUrl":"10.1016/j.jhsg.2024.04.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Firework blast trauma most commonly affects the hands and occurs along a spectrum of severity ranging from minor burns to mangling injuries. This study presents a retrospective chart review of patients surgically treated for upper-extremity firework injuries at a major metropolitan level-l trauma center with a focus on injuries involving the thumb. A detailed treatment algorithm is proposed based on patterns of injuries with an additional two illustrative cases.</div></div><div><h3>Methods</h3><div>Patients who underwent surgical management for firework-related hand injuries at a level-1 trauma center between January 2009 and December 2023 were retrospectively reviewed for demography, injury pattern, and treatment. Two cases involving the thumb and first web space injuries were selected for the case series. General descriptive statistics were performed.</div></div><div><h3>Results</h3><div>Seventy-four patients who sustained severe firework blast injuries to the hand were reviewed. Thumb injuries were treated in 59 patients (80%). A majority of these, 52 patients involved both the thumb and the first web space (88%). A wide range of surgical treatments were employed, and often, several different techniques were used for the case. Amputation (60%, n = 45) was performed most frequently, followed by skin grafting (36%, n = 27) and primary closure (32%, n = 24). Local and free flaps were performed in 35% (n = 26) of the cases.</div></div><div><h3>Conclusions</h3><div>A majority of surgical firework injuries to the hand involve the thumb and first web space. It is paramount to preserve or restore length, sensation, mobility of the thumb, and a supple first web space. Proximal thumb injuries tend to require more aggressive treatment of the first web space. In case of devastating proximal injuries involving the carpometacarpal joint, creating a stable and well-positioned sensate post is acceptable. We propose a treatment algorithm for the management of thumb and first web space blast injuries.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IIIB.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 284-291"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279637","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":"Spaghetti Wrist Injury: Past, Present, and Future","authors":"Matei Ileana Rodica MD, PhD ,&nbsp;Ciura-Capota Irina MD, PhD ,&nbsp;Olariu Octavian ,&nbsp;Alexandru Georgescu MD, PhD","doi":"10.1016/j.jhsg.2024.02.016","DOIUrl":"10.1016/j.jhsg.2024.02.016","url":null,"abstract":"<div><div>This study will present our experience in treating “spaghetti wrist,” a complex injury of the distal forearm, with laceration of tendons, nerve(s), artery(es), and soft tissues. Also, we will present a review of the literature summarizing preoperative preparations, surgical and rehabilitation therapy, and immediate and delayed postoperative outcomes. The patients had complex injuries located in the distal 1/3 of the forearm, regardless of the physical etiologic agent, encompassing breach of the deep antebrachial fascia, at least one nerve, tendons, and, in some cases, arteries, along with single or multiple skin lacerations. The surgical procedure included surgical debridement, fasciotomy, decompression incisions, neurorrhaphy, tenorrhaphy, arteriorrhaphy, and soft tissue coverage protected by active/passive drainage. Depending on the anatomical structures reconstructed, the rehabilitation protocol was personalized, initially with dorsal immobilization in a plaster cast, followed by, as early as possible, passive and then active mobilization, under a single hand therapist’s control. Following prompt surgical intervention and adjusted personalized rehabilitation protocol, the results of even this type of challenging cases can be successful. The earlier the rehabilitation protocol was initiated, the better the results were. Patient adherence to the complex algorithm of treatment was also one of the most important prognostic aspects. What happens after the healing is another important aspect because the most devastating chronic complications, nervous deficits, must be evaluated and treated using modern possibilities.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 259-265"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697792","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":"Delayed Repair of Recurrent Motor Branch Injury after Carpal Tunnel Release","authors":"Anna L. Lundeen MD ,&nbsp;Edward J. Wu MD","doi":"10.1016/j.jhsg.2024.11.009","DOIUrl":"10.1016/j.jhsg.2024.11.009","url":null,"abstract":"<div><div>Iatrogenic injury to the recurrent motor branch of the median nerve is an uncommon but severe complication following carpal tunnel release. Surgeons should be aware of the anatomical variations of this branch, particularly with the advent of smaller incisions and endoscopic techniques. Here, we present the case of a 60-year-old woman whose recurrent motor branch injury was not identified until 2 years following her index procedure. She underwent a successful primary repair 25 months after her initial injury, with notable improvements in thumb function, strength, and return of thenar muscle bulk beginning 2 months after surgery and continuing through last follow-up at 7 months. Our patient’s outcome suggests that repair of a severed recurrent motor branch remains a viable option 2 years after initial injury and that functional improvement and thenar muscle reinnervation can occur even after considerable time has elapsed.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 238-241"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620997","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":"Wrist Kinetics Post-Scapholunate Dissociation: Experimental and Computational Analysis of Scapholunate Interosseous Ligament Injury","authors":"Sunjung Kim PhD ,&nbsp;Wedam Nyaaba PhD ,&nbsp;Majd Mzeihem MD ,&nbsp;Alfonso Mejia MD, MPH ,&nbsp;Mark Gonzalez MD, PhD ,&nbsp;Farid Amirouche PhD","doi":"10.1016/j.jhsg.2024.11.011","DOIUrl":"10.1016/j.jhsg.2024.11.011","url":null,"abstract":"<div><h3>Purpose</h3><div>The scapholunate ligament, linking the scaphoid and lunate bones, is crucial for wrist stability and motion. An injury to this ligament disrupts wrist biomechanics, leading to compromised functionality and a higher risk of osteoarthritis.</div></div><div><h3>Methods</h3><div>Eight wrist specimens were used on a custom rig to study the effects of scapholunate ligament injury. The rig stabilized the hand while allowing controlled finger flexion. Sensors measured contact pressure, and motion sensors tracked scaphoid and lunate movements. Forces simulated finger flexion, and a finite element analysis model replicated wrist kinematics and pressure distribution.</div></div><div><h3>Results</h3><div>Scaphoid and lunate movement significantly varied with ligament condition, showing increased scapholunate distance in distal-proximal directions and decreased in medial-lateral directions for full tears. Lunate angles shifted from flexion to extension with fully torn ligaments, whereas the scaphoid shifted from extension to flexion. Proximal movement was noted for all groups, with significant differences in the partial tear group. A significant lateral deviation of the scaphoid and lunate was found when the ligament was damaged.</div><div>An increase in radioscaphoid contact area was noted in the presence of a ligament tear; however, statistical significance was not established. Conversely, only finger pressure exhibited a statistically significant decrease in the presence of an scapholunate ligament tear.</div><div>The findings, confirmed by finite element analysis and experiments, accurately replicated scaphoid and lunate movements, with peak radiocarpal pressure significantly differing between intact and fully torn ligaments.</div></div><div><h3>Conclusions</h3><div>Scapholunate ligament damage alters wrist stability, affecting bone movement and angles, leading to radial deviation and proximal displacement of the scaphoid and lunate bones.</div></div><div><h3>Clinical relevance</h3><div>Chronic untreated conditions may lead to early arthritis. Experimental results, validated through finite element analysis, suggest potential utility in clinical decision-making and treatment selection.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 173-180"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621069","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}