Journal of Hand Surgery Global Online最新文献

{"title":"Proximal Ulna Adamantinoma","authors":"Liam H. Wong MD ,&nbsp;Rosanna Wustrack MD ,&nbsp;Nicolas Lee MD ,&nbsp;Leah Demetri MD","doi":"10.1016/j.jhsg.2025.100899","DOIUrl":"10.1016/j.jhsg.2025.100899","url":null,"abstract":"<div><div>Adamantinoma is a rare, malignant tumor that is typically seen in the tibia but has been reported in all long bones. We present the case of a woman who presented as a teenager with a pathologic fracture of the proximal ulna that was initially diagnosed as osteofibrous dysplasia and treated with internal fixation. After the lesion was identified in adulthood as adamantinoma, she was converted to a one-bone forearm procedure as a salvage treatment.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100899"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Effectiveness of Hand Postaxial Polydactyly Type B Excision in the Office Versus Operating Room","authors":"Manisha Banala BBA ,&nbsp;Sarah L. Struble MD ,&nbsp;Holly Cordray BS ,&nbsp;Benjamin Chang MD ,&nbsp;Apurva S. Shah MD, MBA ,&nbsp;Eliza Buttrick BA ,&nbsp;John R. Vaile MD ,&nbsp;Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2025.100865","DOIUrl":"10.1016/j.jhsg.2025.100865","url":null,"abstract":"<div><h3>Purpose</h3><div>Postaxial polydactyly type B of the hand can be excised in the office with local anesthesia or in the operating room under general anesthesia. Existing studies have not described the cost difference between these treatments. We compared charges, reimbursements, and outcomes of office and operating room excision.</div></div><div><h3>Methods</h3><div>All cases of postaxial polydactyly type B excision at a children’s hospital from fiscal year 2018–2023 were included. Independent <em>t</em> tests and Fisher exact tests were performed to compare the charges and outcomes of office and operating room excisions. Random-effects models were used to compare differences in reimbursements since these data were obtained as summary statistics (mean [SD]) by fiscal year.</div></div><div><h3>Results</h3><div>Of 620 total patients, 30 (4.8%) underwent operating room excisions (22 bilateral and 8 unilateral), and 590 (95%) had office excisions (346 bilateral and 244 unilateral). Average total charges were 78% and 84% less for bilateral and unilateral excisions, respectively, in the office than in the operating room. Insurance companies paid $7800 more for bilateral operating room excisions and $7600 more for unilateral operating room excisions. Surgeons received $2300 more for bilateral operating room excisions and $1300 more for unilateral operating room excisions. The treatment strategy did not impact outcomes.</div></div><div><h3>Conclusions</h3><div>Given the cost efficacy and safety of office excision, operating room excision should be limited to patient-specific factors requiring general anesthesia.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100865"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpometacarpal Osteoarthritis Is Associated With an Increased Risk of Carpal Tunnel Syndrome","authors":"Blaire Peterson VanderWeele MD ,&nbsp;Lindsey Peng BS ,&nbsp;Benjamin Fitch BS ,&nbsp;Travis Kotzur BS ,&nbsp;Mallory Ogburn MD ,&nbsp;Ryan Rose MD ,&nbsp;Christina Brady MD","doi":"10.1016/j.jhsg.2025.100867","DOIUrl":"10.1016/j.jhsg.2025.100867","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpometacarpal (CMC) osteoarthritis (OA) of the thumb finger is the most common joint OA in the upper extremity to require surgery. This study aims to assess the impact of CMC OA on the management of carpal tunnel syndrome (CTS) as well as outcomes following carpal tunnel release (CTR) surgery.</div></div><div><h3>Methods</h3><div>This retrospective matched cohort study used data from the TriNetX Research Network. Patients without CTS and with an ambulatory visit between 2017 and 2018 were identified; using International Classification of Diseases (ICD)-10 codes, those with CMC OA were matched to a control cohort of those without it, and they were followed for 5 years to assess the development of CTS. Patients with CTS and CMC OA were then matched to a control cohort of patients with CTS and no diagnosis of CMC OA. Progression to therapy within three years was assessed; interventions were identified using Current Procedural Terminology (CPT) codes. Subanalysis of a secondarily matched cohort of patients undergoing CTR, with and without CMC OA, assessed 2-year postoperative outcomes.</div></div><div><h3>Results</h3><div>A total of 31,075 patients were matched, and those with CMC OA were more likely to develop CTS. Of patients with CTS, those with CMC OA were more likely to receive corticosteroid injection and operative management than those without CMC OA. Secondary analysis of matched cohorts of 15,431 patients who underwent CTR demonstrated those with CMC OA had higher odds of postoperative opioid prescription, postoperative infection, postoperative EMG, and repeat CTR within one year than the cohort without CMC OA.</div></div><div><h3>Conclusions</h3><div>Patients with CMC OA were more likely to develop CTS, receive corticosteroid injections, and undergo CTR. Among patients who underwent CTR, patients with CMC OA were more likely to have worse outcomes.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic, IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100867"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpal Tunnel Release Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials","authors":"Saksham Pruthi BS ,&nbsp;Justin Rehder BS ,&nbsp;Matthew Toedt BS ,&nbsp;Raymond Okeke MD ,&nbsp;Brian Mailey MD","doi":"10.1016/j.jhsg.2024.08.016","DOIUrl":"10.1016/j.jhsg.2024.08.016","url":null,"abstract":"<div><h3>Purpose</h3><div>The management of postoperative pain after carpal tunnel release (CTR) has evolved over the years. This article reviews various approaches to pain management in the literature.</div></div><div><h3>Methods</h3><div>An electronic search was conducted using PubMed, Google Scholar, and SCOPUS for studies on CTR pain management using either preoperative, perioperative, or postoperative tools. Only randomized controlled trials were included in the narrative review. Articles included in the study evaluated patients diagnosed with carpal tunnel syndrome, underwent CTR, and had preoperative, perioperative, or postoperative intervention evaluated as a primary end point. Duration and quantity of opioids, and patient-reported pain scales, such as the visual analog scale, were calculated and compared.</div></div><div><h3>Results</h3><div>During the study period between 2015 and 2022, 10 randomized controlled trials met the inclusion criteria. Of these, studies were analyzed as either preoperative, perioperative, or postoperative means of managing pain. When these techniques were compared with opioid usage, no notable differences were found in pain ratings between patients who were given opioids for pain management compared with those provided with these nonopioid pain management options.</div></div><div><h3>Conclusions</h3><div>This review highlights the effectiveness of various preoperative, perioperative, and postoperative interventions for pain management after CTR. Although opioids are the current standard for pain management after CTR, our study highlights interventions that are as effective, if not more so, as opioids at lowering pain scores with this procedure.</div></div><div><h3>Clinical relevance</h3><div>The success of the studied alternatives in reducing pain outcomes for CTR can help mitigate the number of opioids prescribed to patients for the procedure. Given the current opioid epidemic plaguing the nation, understanding the efficacy of all other nonaddictive alternatives for pain management with CTR is imperative.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100642"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Are the Hand Surgeons? Examining the Socioeconomic and Geographic Gaps in Patients’ Access to Care in the United States","authors":"Roshan V. Patel BS ,&nbsp;Gnaneswar Chundi BS ,&nbsp;David Mothy BS ,&nbsp;Aayush Mehta BS ,&nbsp;Tamara D. Rozental MD ,&nbsp;Monica M. Shoji MD","doi":"10.1016/j.jhsg.2025.100898","DOIUrl":"10.1016/j.jhsg.2025.100898","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.</div></div><div><h3>Methods</h3><div>We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.</div></div><div><h3>Results</h3><div>A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.</div></div><div><h3>Conclusions</h3><div>There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.</div></div><div><h3>Level of Evidence</h3><div>Cross-sectional study, III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100898"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintaining Stability in Metacarpal Ray Amputations: A Novel Technique Using Cortical Suspensory Button Fixation","authors":"Taylor Anthony DO ,&nbsp;William Fang DO ,&nbsp;Reily Cannon BS ,&nbsp;Nicole Infantino MS ,&nbsp;Joseph Meter DO ,&nbsp;MS. Andrew J. Bronstein MD ,&nbsp;Olivia J. Wang MD","doi":"10.1016/j.jhsg.2025.100869","DOIUrl":"10.1016/j.jhsg.2025.100869","url":null,"abstract":"<div><div>Maintaining stability and function in the hand after major traumatic injury remains a significant challenge for surgeons. Ray resection has shown promise in quality of life in patients with dysfunctional digits resulting from prior trauma, ischemia, malignancy, infection, and congenital abnormalities. Ray resection may serve as a viable salvage procedure for persistent digit dysfunction following unsuccessful preservation of the digit. We present the case of a 42-year-old man manual laborer who sustained a zone 3 flexor tendon laceration in the long-finger. Over several years, multiple tendon repairs and revision attempts were unsuccessful. Ultimately, the patient underwent long-finger ray resection at the metacarpal base, with cortical suspensory button fixation applied to the adjacent metacarpals. After surgery, the patient regained hand function and reported excellent satisfaction with the outcome.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100869"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “A Comparison of Artificial Intelligence Platforms in the Utility of Answering Frequently Asked Questions About Carpal Tunnel Syndrome”","authors":"Amnuay Kleebayoon PhD ,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.jhsg.2025.100884","DOIUrl":"10.1016/j.jhsg.2025.100884","url":null,"abstract":"","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100884"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection","authors":"John R. Vaile MD ,&nbsp;John A. Tipps BA ,&nbsp;Rachel Hurley MD, PhD ,&nbsp;Sarah L. Struble MD ,&nbsp;Brooke E. Allen BS ,&nbsp;Lea F. Surrey MD ,&nbsp;Laura S. Finn MD ,&nbsp;Frank M. Balis MD ,&nbsp;Theodore W. Laetsch MD ,&nbsp;Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2025.100887","DOIUrl":"10.1016/j.jhsg.2025.100887","url":null,"abstract":"<div><div>Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its <em>NTRK</em> fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100887"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopy Versus Open Arthrotomy for Septic Arthritis of the Wrist: A Nationwide Inpatient Sample Analysis of 1,065 Cases","authors":"Gabriel Hanna MD ,&nbsp;Robert Dalcortivo MD ,&nbsp;Michael Vosbikian MD ,&nbsp;Irfan H. Ahmed MD ,&nbsp;Michael M. Abdou MD ,&nbsp;Eli Bryk MD ,&nbsp;Robert Pae MD","doi":"10.1016/j.jhsg.2025.100885","DOIUrl":"10.1016/j.jhsg.2025.100885","url":null,"abstract":"<div><h3>Purpose</h3><div>Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures.</div></div><div><h3>Methods</h3><div>The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student’s <em>t</em>- test.</div></div><div><h3>Results</h3><div>A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0–15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80–1.80) or surgical (OR, 0.87; 95% CI, 0.65–1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0).</div></div><div><h3>Conclusions</h3><div>Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100885"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options","authors":"Alex G. Lambi MD, PhD, FACS ,&nbsp;Tomas Holy MD ,&nbsp;Ryan E. Tomlinson PhD ,&nbsp;Mary F. Barbe PhD, FAAA, FASBMR","doi":"10.1016/j.jhsg.2025.100896","DOIUrl":"10.1016/j.jhsg.2025.100896","url":null,"abstract":"<div><div>Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100896"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}