Journal of Hand and Microsurgery最新文献

{"title":"Changing trends in peripheral nerve repair: A two-decade TriNetX analysis of grafting techniques and the ascendancy of allografts.","authors":"Tyler Reinoso, Emerson Rowe, David Kirby, Sina Ramtin, Asif M Ilyas","doi":"10.1016/j.jham.2025.100395","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100395","url":null,"abstract":"<p><strong>Background: </strong>Various modalities exist for repairing transected nerves not amenable to primary repair; including, autograft, vein graft, conduit, and allograft. The study was hypothesis was that there is increasing utilization of allografts for peripheral nerve repairs.</p><p><strong>Materials & methods: </strong>The TriNetX Research Network was queried from 2002 to 2022 for all patients undergoing peripheral nerve repair. Demographic information, usage patterns, and comorbidities associated with different grafting methods by CPT were extracted and analyzed.</p><p><strong>Results: </strong>Out of 33,262 patients undergoing peripheral nerve repair, 31,756 with available demographic data were identified and included. Primary repair cases totaled 17,159, followed by conduit (n = 9282), allograft (n = 3582), autograft (n = 2886), and vein autograft (n = 353). Noting that a cpt for an allograft was introduced in 2017, a logistical regression analysis was performed to further sub-analyze allograft usage. The utilization of allografts significantly increased in 2021-2022 compared to 2019-2020, with an odds ratio (OR) of 1.4 (95 % confidence interval [CI]: 1.1-1.7; P = 0.001), indicating a greater increase compared to autograft utilization during the same interval. The mean per-year rate of change (range) between 2017 and 2022 for nerve allograft, conduit, autograft and vein autograft was +93.4 (+16.5 to +176.5), +6.3 (-37 to +45), -1.4 (-7.5 to +7.5), and +2 (-2.5 to +6.5), respectively.</p><p><strong>Conclusion: </strong>This study presents a twenty-year analysis of the changing trends in nerve repair and grafting techniques employed by nerve surgeons. Conduit repair has remained a major grafting technique used among surgeons. However, since its introduction, nerve allograft repair demonstrates a consistent positive upward trend in usage within the last 6 years, In contrast, autograft usage has decreased while vein graft usage is least common with a less relevant change in usage. These trends suggest an increasing preference for allograft, potentially displacing other nerve grafting methods, including autografting.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100395"},"PeriodicalIF":0.5,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890427","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":"Comparative efficacy and safety of endoscopic, open, and mini-open techniques for carpal tunnel release: A meta-analysis.","authors":"Marc Boutros, Guy Awad, Jean-Pierre Saad, Kamal Bou Hamdan, Maya Bou Hamdan, Bassem Elhassan","doi":"10.1016/j.jham.2025.100392","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100392","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. In addition to traditional open carpal tunnel release (OCTR), endoscopic (ECTR) and mini-open (MOCTR) approaches have been developed as minimally invasive alternatives. However, comparative evidence regarding their clinical efficacy and safety remains inconsistent.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were performed according to PRISMA guidelines, including 44 comparative studies (38 comparing ECTR vs OCTR and 6 comparing ECTR vs MOCTR) involving adult patients with idiopathic CTS. Outcomes extracted included pain (VAS), functional scores (BCTQ-SSS, BCTQ-FSS, DASH), grip and pinch strength, sensory symptoms, and complications such as pillar pain, nerve injury, opioid use, and revision CTR.</p><p><strong>Results: </strong>Across all functional measures (DASH, BCTQ-FSS, BCTQ-SSS), pain, and sensory outcomes, pooled analyses demonstrated no statistically significant differences between ECTR, OCTR, and MOCTR. Grip and pinch strength were also comparable, indicating equivalent long-term motor recovery. Postoperative VAS pain scores did not differ significantly between ECTR and OCTR (p = 0.10). Nerve injury also showed no significant difference between techniques in the random-effects model (p = 0.56). Opioid prescription rates were similar across groups. Notably, ECTR demonstrated a significantly lower revision CTR rate compared with OCTR (risk ratio = 0.46, 95 % CI 0.29-0.73; p = 0.0009).</p><p><strong>Conclusion: </strong>Open, mini-open, and endoscopic carpal tunnel release techniques provide comparable outcomes in pain relief, functional recovery, strength, sensory symptoms, and overall safety for idiopathic CTS. Although revision CTR occurred less frequently after ECTR in the pooled analysis, the clinical significance of this difference remains uncertain. Technique selection should therefore be individualized based on surgeon expertise, patient priorities, and resource availability.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100392"},"PeriodicalIF":0.5,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890497","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":"Do it right the first time; implementation of three-dimensional technology for bone defect reconstruction in upper extremity surgery.","authors":"Hedayatullah Esmati, Tim de Jong, Kim Y Jochem, Vincent M A Stirler, Rob F M van Doremalen, Hinne A Rakhorst","doi":"10.1016/j.jham.2025.100390","DOIUrl":"10.1016/j.jham.2025.100390","url":null,"abstract":"<p><p>Three-dimensional (3D) technology has rapidly evolved from an innovative concept into an essential surgical tool. The increasing availability of high-resolution imaging, affordable 3D printers and user-friendly software has accelerated the integration of 3D technology into clinical practice, including upper extremity surgery. Despite the growing interest, many surgeons remain uncertain about how to practically implement this technique in clinical workflows. This review illustrates the clinical use of 3D technology in upper extremity bone defect reconstruction. We highlight both the preoperative and intraoperative applications of 3D technology, illustrated by detailed case examples. We also provide a practical guideline to support clinicians in adopting 3D technology as part of their routine surgical practice.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100390"},"PeriodicalIF":0.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769332","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":"Maltreated and misdiagnosed finger fractures: a malpractice claim analysis from the Swedish national patient insurance register 2011-2021.","authors":"Jonny K Andersson, Amanda Davidsson, Marcus Sagerfors","doi":"10.1016/j.jham.2025.100382","DOIUrl":"10.1016/j.jham.2025.100382","url":null,"abstract":"<p><p>Finger fractures are among the most common fractures of the upper limb. The number and cost of maltreated and misdiagnosed finger fractures in Sweden is unknown. The aim was to study the number, complications, causes, and cost of maltreated and misdiagnosed finger fractures, 2011-2021, in Sweden.Claims matching the prespecified ICD-10-SE codes S62.6-7 (finger fractures) and T92.2 (sequelae after finger fracture) during the 2011-2021 timeframe were identified. The data were extracted from the Swedish National Patient Insurance Company Register and analyzed in terms of epidemiology and cost.Of the 1621 assessed cases, 384 reported maltreated and misdiagnosed finger fractures were found. The mean age was 41 years (range 2-88). Thirty-one percent of the healthcare-related injuries occurred in emergency care, primarily due to maltreatment leading to malunion after non-operative treatment. Thirty-six percent of healthcare-related injuries occurred in specialist departments, mostly due to malunion after surgical intervention. In primary care, the leading cause was misdiagnosis, often due to inadequate examination and lack of X-ray examination. The total aggregated direct and indirect costs amounted to SEK 25 557 200 (USD 2 505 608, Euro 2 165 864, Yen 424 249 520).</p><p><strong>Conclusion: </strong>Finger fractures affect people of all ages and can lead to significant socioeconomic and medical invalidity. Maltreated fractures mainly occur in emergency care (due to malunion after immobilization) and specialist care (due to malunion after surgery). Misdiagnosed fractures were more common in primary care. A suggestion for claims prevention would be improved physician education, updated guidelines regarding the use of X-rays, seeking specialist opinions in uncertain cases, evaluating surgical technique, and optimizing postoperative care could probably help reduce the number of these injuries.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100382"},"PeriodicalIF":0.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649653","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":"Wide awake anesthesia has awakened us widely.","authors":"Xavier Gueffier, J Terrence Jose Jerome","doi":"10.1016/j.jham.2025.100362","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100362","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100362"},"PeriodicalIF":0.5,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285612","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":"Advancements in the differential diagnosis for spindle cell lipoma.","authors":"Jiro Ichikawa, Tomonori Kawasaki, Masanori Wako, Kouhei Mitsui, Kojiro Onohara","doi":"10.1016/j.jham.2025.100364","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100364","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100364"},"PeriodicalIF":0.5,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12605259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514646","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":"Companian Editorial Letter.","authors":"Donald H Lalonde","doi":"10.1016/j.jham.2025.100361","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100361","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100361"},"PeriodicalIF":0.5,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285551","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":"Corrigendum to \"Stabilization of the scapholunate interval with interference fit screws: How to do it safely\" [J Hand Microsurg 17 (4) (2025) 100288].","authors":"Gustavo Luis Gomez Rodriguez, Nicolas Alejandro Irigoitia, Alvaro Muratore, Arnaout Ahlam, Gabriel Clembosky","doi":"10.1016/j.jham.2025.100363","DOIUrl":"10.1016/j.jham.2025.100363","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.jham.2025.100288.].</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100363"},"PeriodicalIF":0.5,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483322","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 \"clover FLAP\": A one-stage local flap for dorsal fingertip and nail bed reconstruction.","authors":"Pier Paolo Pangrazi, Francesco De Francesco, Michele Riccio","doi":"10.1016/j.jham.2025.100357","DOIUrl":"10.1016/j.jham.2025.100357","url":null,"abstract":"<p><strong>Background: </strong>Fingertip and nail bed injuries represent complex reconstructive challenges in hand surgery, requiring restoration of both function and aesthetics. The nail unit's intricate anatomy-comprising the matrix, bed, and surrounding tissues-necessitates precise surgical techniques to prevent long-term deformities and sensory deficits. This study presents and evaluates the \"clover flap,\" a novel homodigital advancement technique designed for dorsal fingertip injuries involving partial or complete nail bed loss.</p><p><strong>Methods: </strong>In this retrospective cohort study, 63 patients with dorsal fingertip defects were treated between 2005 and 2023 using the clover flap at a primary referral center. The flap involves volar V-Y advancements redirected dorsally in a trifoliate configuration, allowing one-stage coverage without grafts. Outcomes were assessed using standardized clinical, functional, and aesthetic metrics including Quick-DASH, 2PD, POSAS, FIOS, and OFNAS scores.</p><p><strong>Results: </strong>No complete flap necrosis occurred. Nail deformities were limited to 17.5 % of cases, with minimal donor site morbidity. Patients achieved a mean Quick-DASH score of 14.6, 2PD of 7.3 mm, and an active ROM of 224°. Grip and pinch strength recovered to 79 % and 81 % of the contralateral side, respectively. Aesthetic outcomes were favorable, with an OFNAS of 4.5 and FIOS of 11.3. Multivariate analysis confirmed functional and cosmetic stability over time, regardless of complication presence.</p><p><strong>Conclusion: </strong>The clover flap offers a reliable, one-stage reconstructive option for dorsal fingertip injuries, combining high functional recovery with excellent nail bed and scar aesthetics. Its design preserves nail matrix integrity, avoids microsurgery, and is particularly suitable in acute care settings.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100357"},"PeriodicalIF":0.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483332","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":"Treatment options for bilateral fibrolipomatous hamartoma of the median nerve.","authors":"Arne Decramer, Bert Vanmierlo, Bart Billet","doi":"10.1016/j.jham.2025.100358","DOIUrl":"10.1016/j.jham.2025.100358","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100358"},"PeriodicalIF":0.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12596205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490610","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}