Journal of Hand Surgery Global Online最新文献

{"title":"Impact of Flexor Tendon Traction Tenolysis on Clinical Outcomes in Open A1 Pulley Release for Trigger Finger","authors":"Shalimar Abdullah BMBS, MS ,&nbsp;Syed Jeffrey Syed Ahmad Kabeer MBChB, MD ,&nbsp;Lim Chia Hua MD ,&nbsp;Jamari Sapuan MD, MS ,&nbsp;Parminder Singh Gill MBBS, MS ,&nbsp;Elaine Soh Zi Fan MBBS, MD","doi":"10.1016/j.jhsg.2024.09.010","DOIUrl":"10.1016/j.jhsg.2024.09.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to compare the postoperative clinical outcomes of open A1 pulley release with and without flexor tendon traction tenolysis. Outcomes assessed include finger range of motion, hand function (Disabilities of the Arm, Shoulder, and Hand [<em>Quick</em>DASH] score), complications (eg, digital nerve injury, superficial infection, and residual trigger finger), and surgery duration.</div></div><div><h3>Methods</h3><div>A prospective study was conducted from January 2018 to June 2019, involving patients with grade II–III trigger finger requiring surgical intervention. Patients were randomized into two groups: group I (open A1 pulley release with flexor tendon traction tenolysis) and group II (open A1 pulley release without flexor tendon traction tenolysis). Postoperative assessments were conducted at 2 weeks, 2 months, and 4 months, documenting finger range of motion, <em>Quick</em>DASH scores, complications, and surgery duration.</div></div><div><h3>Results</h3><div>A total of 50 patients met the selection criteria, with 46 completing the study. The majority were women, with an average age of 56 ± 9.6 years. The patients were predominantly diabetic with the condition affecting the left hand and middle finger and presenting as grade III trigger finger. Baseline characteristics, including age, gender (female/male), ethnicity, occupational status, diabetes status, and trigger finger severity, were comparable between the two groups. Preoperative <em>Quick</em>DASH scores were also similar. The mean preoperative finger range of motion at the metacarpophalangeal and proximal interphalangeal joint were lower in group I but were not statistically important. Patients in group I exhibited consistently better postoperative finger range of motion and <em>Quick</em>DASH scores compared to group II throughout the follow-up period. The difference was statistically important at the 2-week follow-up. Although group I continued to show better outcomes at 2 and 4 months, the differences were not statistically important. Surgery duration was importantly longer in group I (16.4 ± 5.7 minutes) compared to group II (11.43 ± 3.8 minutes). Two patients in group I experienced wound infections, which resolved with a week-long course of antibiotics.</div></div><div><h3>Conclusions</h3><div>Open A1 pulley release with flexor tendon traction tenolysis resulted in better early postoperative (2 weeks) finger flexion range of motion and <em>Quick</em>DASH scores, albeit with a longer surgery duration.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic Ib.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 56-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173009","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":"Pediatric Lunotriquetral Dissociation and Static Volar Intercalated Segmental Instability After Radial Neck Fracture","authors":"Lauren E. Tagliero MD ,&nbsp;William J. Shaughnessy MD ,&nbsp;Alexander Y. Shin MD","doi":"10.1016/j.jhsg.2024.09.005","DOIUrl":"10.1016/j.jhsg.2024.09.005","url":null,"abstract":"<div><div>Pediatric patients can pose challenges with regard to both diagnosis and obtaining an accurate history and physical examination, as well as in treatment strategies, as options become limited when physes remain open. This case report examines a 12-year-old boy who sustained a radial neck fracture after a ground-level fall. Although his elbow injury was treated appropriately, he developed wrist pain that progressed to static volar intercalated segmental instability deformity in the context of a carpal instability nondissociative wrist. A paucity of cases of pediatric patients with open physes and static volar intercalated segmental instability deformity exists. Adult treatment typically consists of some form of arthrodesis; however, this should be approached with caution in young patients. This case highlights the importance of careful wrist examination in all elbow injuries, as well as the challenges in surgical treatment options for pediatric patients.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 103-108"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173062","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":"Removal of Misplaced Intramedullary Nails for Proximal Phalanx and Metacarpal Fixation","authors":"Nirbhay S. Jain MD ,&nbsp;Teun Teunis MD, PhD","doi":"10.1016/j.jhsg.2024.10.007","DOIUrl":"10.1016/j.jhsg.2024.10.007","url":null,"abstract":"<div><div>Intramedullary nails for finger and metacarpal fracture fixation are gaining popularity. Given the increased usage, the number of adverse events will increase proportionally. In our practice, we have encountered several instances where we had to remove a previously placed intramedullary nail, for which there is no standard approach. This article describes our experience with removing intramedullary nails to benefit surgeons encountering similar situations.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 84-87"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173065","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":"Injury Patterns, Imaging Findings, and Prognosis for Muscle Strength Recovery in Surgical Infraclavicular Brachial Plexus Injuries","authors":"Julia S. Retzky MD ,&nbsp;Clara Straus BA ,&nbsp;Anil Bhatia MD ,&nbsp;Darryl B. Sneag MD ,&nbsp;Ogonna K. Nwawka MD ,&nbsp;Steve K. Lee MD","doi":"10.1016/j.jhsg.2024.08.012","DOIUrl":"10.1016/j.jhsg.2024.08.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Historically, infraclavicular brachial plexus injuries (IBPIs) were considered neuropraxic injuries that would improve with nonsurgical intervention. However, more recent studies suggest that these injuries may benefit from surgical intervention. The aims of this retrospective study were to (1) describe injury patterns and associated injuries of isolated, traumatic IBPIs, (2) evaluate the concordance of preoperative ultrasound and magnetic resonance neurography with surgical findings of patients who underwent surgical intervention for IBPIs, and (3) describe outcomes of surgical intervention for these injuries.</div></div><div><h3>Methods</h3><div>A total of 148 patients who underwent surgical intervention for traumatic injury to the IBP by one of three hand/upper-extremity fellowship-trained surgeons from 1995 to 2021 were included. Patients with supraclavicular brachial plexus injuries, stretch injuries, nonsurgical IBPIs, and brachial plexus dysfunction without traumatic injury were excluded.</div></div><div><h3>Results</h3><div>The most common cause of injury was motor vehicle accident (74%). Scapular fractures were associated with IBPI in 22% of patients. Isolated branch injuries were the most common (58.8%), of which isolated musculocutaneous nerve injury was the most frequent (40.6%). Preoperative ultrasound and magnetic resonance neurography were concordant with surgical findings in eight of nine and seven of nine patients, respectively. Nerve transfers were the most common intervention (46%). Muscle strength improved after surgery, with an increase from 1 to 5 points on the Medical Research Council scale at 14–50 months after surgery.</div></div><div><h3>Conclusions</h3><div>Infraclavicular brachial plexus injuries are associated with high-energy trauma and concomitant upper-extremity fractures. Ultrasound and magnetic resonance neurography are mostly concordant with surgical findings in patients undergoing surgical intervention for IBPIs. Prognosis for muscle recovery after surgery is good in patients with IBPIs.</div></div><div><h3>Clinical relevance</h3><div>Infraclavicular brachial plexus injuries can improve with surgical intervention.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 888-893"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706721","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":"Intra-articular Synovial Ganglion of the Wrist","authors":"María Teresa Ramírez ,&nbsp;Gustavo Molina ,&nbsp;Cinzia Di Carlo ,&nbsp;Vicente Fernández ,&nbsp;Sebastian Von Unger ,&nbsp;Nicolás Thumm ,&nbsp;Philipp Anwandter ,&nbsp;Gonzalo Morgan","doi":"10.1016/j.jhsg.2024.05.007","DOIUrl":"10.1016/j.jhsg.2024.05.007","url":null,"abstract":"<div><div>Synovial ganglions, common soft tissue tumors of the hand and wrist, typically occur in the dorsal and volar aspects of the wrist, but intra-articular cases are rare. We present a case of a 27-year-old equestrian with persistent left wrist pain who was diagnosed with an intra-articular radiocarpal synovial ganglion after failed conservative management. Arthroscopic resection led to complete resolution of symptoms and functional recovery. This case highlights the diagnostic and therapeutic challenges posed by intra-articular synovial ganglions and underscores the efficacy of arthroscopic intervention in such cases. Although the literature on this specific presentation is scarce, our experience advocates for arthroscopic resection as an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 911-914"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706699","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":"Sex Disparities Affecting Postoperative Outcomes After Total Elbow Arthroplasty","authors":"Rohit Siddabattula BA ,&nbsp;George Thomas MD ,&nbsp;Urska Cvek ScD ,&nbsp;Marjan Trutschl ScD ,&nbsp;Edward Wu MD ,&nbsp;Allison J. Rao MD","doi":"10.1016/j.jhsg.2024.06.010","DOIUrl":"10.1016/j.jhsg.2024.06.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate sex disparities in 30-day postoperative outcomes of total elbow arthroplasty.</div></div><div><h3>Methods</h3><div>The American College of Surgeons-National Surgical Quality Improvement Program files were queried for all patients who underwent a total elbow arthroplasty (TEA) between 2006 and 2020. Sex disparities in preoperative variables were studied using Fisher exact tests. Multivariate logistic regression models were used to determine the adjusted odds ratios (aOR) of postoperative outcomes for women in comparison with men.</div></div><div><h3>Results</h3><div>A total of 788 patients underwent a TEA in the period of 2006–2020. Of those, 180 were men, and 608 were women. We found an increase in TEAs performed each year with a predominance in females compared to males. Additionally, our work demonstrated increased statistically significant odds of a major adverse cardiac event (<em>P</em> &lt; .0001), transfusions required (<em>P</em> &lt; .0001), and return to the operating room (<em>P</em> &lt; .0001) as postoperative outcomes in females compared to males following TEA. Finally, we found no statistically significant difference in mortality between the groups (<em>P</em> = 1).</div></div><div><h3>Conclusions</h3><div>Following a TEA, women had higher adjusted postoperative odds of experiencing a major adverse cardiac event, requiring transfusion, and return to the operating room. No significant differences were found in wound outcomes, pulmonary outcomes, venous thromboembolic outcomes, sepsis, and length of stay. Overall mortality rates were similar between the two groups. Our study warrants further evaluation of the root cause of sex disparities in TEA outcomes and methods to improve care delivery to reduce those disparities.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic 2b.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 818-822"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707115","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":"Fractional Dolphin Tenotomy for Boutonniere Deformity: A Cadaveric Study","authors":"Karly Lorbeer MD ,&nbsp;Andrew D. Allen MD ,&nbsp;Alexander D. Jeffs MD ,&nbsp;Emily Jewell MD ,&nbsp;Nathaniel C. Adams BA ,&nbsp;Eric Van Buren PhD ,&nbsp;Feng-Chang Lin PhD ,&nbsp;Reid W. Draeger MD","doi":"10.1016/j.jhsg.2024.08.006","DOIUrl":"10.1016/j.jhsg.2024.08.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Terminal extensor tenotomy or Dolphin tenotomy, is a described treatment for the management of distal interphalangeal (DIP) joint hyperextension in chronic boutonniere deformity. The purpose of this study was to investigate the effects of incremental partial Dolphin tenotomy in correcting boutonniere deformity, with a focus on evaluating the improvement in DIP joint hyperextension deformity and documenting the development of iatrogenic mallet finger.</div></div><div><h3>Methods</h3><div>Thirty-eight fingers from 10 cadaveric hands were used. We created a boutonniere deformity in each digit by transecting the central slip and repairing it with a 3-mm gap. We performed incremental fractional terminal extensor tenotomy by detaching one-third, one-half, two-thirds, and complete transection. The positions of the proximal interphalangeal (PIP) and DIP joints were measured in the extended position following each subsequent tenotomy.</div></div><div><h3>Results</h3><div>The model produced an average DIP joint hyperextension deformity of −15 ± 1°. The DIP joint position sequentially improved with one-third (−11 ± 1°), one-half (−9 ± 1°), and two-thirds (−5 ± 1°) tenotomy. Complete tenotomy resulted in an average 25° extensor lag. There was no significant improvement in PIP joint flexion deformity with any degree of fractional tenotomy (<em>P</em> &gt; 0.05), and only mild improvement after complete tenotomy (48 ± 2° to 41 ± 2°, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Fractional terminal extensor tenotomy demonstrated incremental improvement in DIP joint hyperextension deformity with increasing degree of tenotomy performed. There were no cases of iatrogenic mallet finger with fractional tenotomy involving up to two-thirds of the tendon.</div></div><div><h3>Clinical relevance</h3><div>Clinical application of fractional terminal extensor tenotomy may be an effective treatment option for patients with chronic boutonniere deformity in whom PIP joint deformity is mild and DIP joint hyperextension accounts for the primary functional deficit. Fractional tenotomy may allow the surgeon to tailor the degree of correction to the existing preoperative deformity.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 870-874"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706718","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":"Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases","authors":"Tan Chern Yang Harmony MD ,&nbsp;Matthew Pina MD ,&nbsp;Tuna Ozyurekoglu MD ,&nbsp;Elkin J. Galvis MD","doi":"10.1016/j.jhsg.2024.06.012","DOIUrl":"10.1016/j.jhsg.2024.06.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This case series presents four cases of periprosthetic ulna fractures following Aptis distal radioulnar joint (DRUJ) arthroplasty to elucidate clinical characteristics, contributing factors, management challenges, and short-term outcomes following this rare complication and to propose prevention and optimal treatment strategies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 239 Aptis DRUJ prostheses implanted between 2012 and 2022 at a single institution. We identified four cases of periprosthetic ulna fractures and assessed demographics, surgical indications, time to fracture, mechanism of injury, radiographic findings, treatment modalities, associated complications, and outcomes.</div></div><div><h3>Results</h3><div>The incidence of periprosthetic ulna fractures was 1.7%. All patients had prior surgery on the same extremity. Fractures occurred within 11 months of DRUJ arthroplasty, with varied mechanisms of injury, including one after a fall, another with heavy lifting, and the remaining two unprovoked. Postoperative radiographs revealed eccentric stem position and endosteal impingement in all cases. According to the Unified Classification System for periprosthetic fractures, three were classified as B1 type, and one was B2 type at diagnosis. Open reduction and internal fixation reliably achieved union at an average of 7 months with acceptable function.</div></div><div><h3>Conclusion</h3><div>Intraoperative technical pitfalls may contribute to periprosthetic ulna fractures during the early postoperative period. Consideration should also be given to anatomical variations and ulna shaft morphometry. Nonsurgical treatment yielded unsatisfactory results, whereas fractures without gross stem loosening treated with open reduction and internal fixation and autologous bone grafting resulted in reliable fracture union, suggesting a limited role for conservative treatment. Based on principles of periprosthetic fracture treatment in other locations, fractures with gross stem loosening may be best managed with implant exchange, with or without supplemental open reduction and internal fixation; however, more evidence is needed to guide the treatment of this rare complication of DRUJ arthroplasty.</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":"6 6","pages":"Pages 823-829"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707116","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":"Can Machine Learning Identify Patients Who are Appropriate for Outpatient Open Reduction and Internal Fixation of Distal Radius Fractures?","authors":"Alexander L. Hornung MD ,&nbsp;Samuel S. Rudisill MD ,&nbsp;Shelby Smith MD ,&nbsp;John T. Streepy MS ,&nbsp;Xavier C. Simcock MD","doi":"10.1016/j.jhsg.2024.06.002","DOIUrl":"10.1016/j.jhsg.2024.06.002","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to identify which patients were “unsafe” for outpatient surgery patients and determine the most predictive demographic and clinical factors contributing to postoperative risk following open reduction internal fixation for distal radius fractures.</div></div><div><h3>Methods</h3><div>Adult patients (aged ≥18 years) who presented with distal radius fracture and underwent open reduction internal fixation were identified using the American College of Surgeons National Surgical Quality Improvement Program database for years 2016 to 2021. Patients who were deemed “unsafe” therefore contraindicated for outpatient open reduction internal fixation of distal radius fracture if they required admission (length of stay of one or more days) or experienced any complication or required readmission within 7 days of the index operation. The model with optimal performance was determined according to area under the curve on the receiver operating characteristic curve and overall accuracy. Additional model metrics were also evaluated, and predictive factors (ie, features) that were most important to model derivation were identified.</div></div><div><h3>Results</h3><div>A total of 2,020 eligible patients underwent open reduction and internal fixation for distal radius fractures. The majority (78.6%) were women, with a mean age of 57.5 ± 16.0 years. Of these patients, 21.5% experienced short-term adverse events. Gradient boosting was the optimal model for predicting patients who were “unsafe” for outpatient surgery, with key features including International Classification of Diseases, 10th Revision code, preoperative white blood cell count, age, body mass index, and Hispanic ethnicity.</div></div><div><h3>Conclusions</h3><div>Using machine learning techniques, a predictive model was developed, which demonstrated good discrimination and excellent performance in predicting which patients were “unsafe” for outpatient operative fixation of distal radius fracture. Findings of this study highlight the predictive value of artificial intelligence and machine learning for the purposes of preoperative risk stratification as well as its potential to better inform shared decision making and guide personalized fracture care.</div></div><div><h3>Level of evidence/type of study</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 808-813"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707196","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":"Reporting Clinical Outcomes in Hand Surgery Randomized Controlled Trials: A Systematic Review Using Wide-Awake Local Anesthesia No Tourniquet Studies as a Model","authors":"Jad Lawand MS ,&nbsp;Ashraf Hantouly MS, MD ,&nbsp;Fadi Bouri MD ,&nbsp;Mohammad Muneer MD ,&nbsp;Elisabet Hagert MD, PhD","doi":"10.1016/j.jhsg.2024.08.007","DOIUrl":"10.1016/j.jhsg.2024.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to comprehensively evaluate clinical outcome reporting in hand surgery randomized controlled trials (RCTs), using wide-awake local anesthesia no tourniquet (WALANT) studies as a model.</div></div><div><h3>Methods</h3><div>This International Prospective Register of Systematic Reviews-registered systematic review (CRD42023461653) adheres to preferred reporting items for systematic reviews and meta-analysis guidelines, focusing on RCTs evaluating WALANT in hand and upper limb surgery. A systematic search across five databases was conducted to include all eligible articles from inception until search date (April 1, 2023). Inclusion criteria encompassed WALANT RCTs in upper limb surgery, with exclusion criteria addressing non-RCTs and non-English studies. Data extraction covered study characteristics, patient demographics, procedures performed, and outcomes reported. The revised Cochrane risk-of-bias tool for randomized trials was employed for quality assessment.</div></div><div><h3>Results</h3><div>The search identified 304 articles—after screening, 11 were included for analysis, encompassing 889 patients in WALANT RCTs. Technical outcomes were most reported (73%), whereas functional was least commonly reported (36%). The analysis encompassed a heterogeneous patient cohort, with an average follow-up period of 41.3 days. Challenges in standardizing functional outcomes and patient-reported outcomes were identified. The Cochrane risk-of-bias tool for randomized trials indicated an overall low risk, affirming the methodological rigor of the included studies.</div></div><div><h3>Conclusions</h3><div>A significant diversity in outcome reporting and assessment tools was identified, emphasizing the challenges in standardization and outcome reporting across RCTs. Although technical outcomes were prevalent, patient-reported and functional outcomes were often lacking. The study underscores the need for further research standardization to optimize patient care and advance evidence-based decision making, as variability in outcomes reporting hinders the ability to draw consistent conclusions and comparisons across studies.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapy/Prevention, Etiology/Harm IA.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"6 6","pages":"Pages 875-881"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706719","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}