Journal of Hand and Microsurgery最新文献

{"title":"Fifth carpometacarpal arthritis management: A comparative cadaver study of two arthrodesis methods.","authors":"Omar Aljasim, Can Yener, Mesut Demirkoparan, Arman Vahabi, Ali Engin Daştan, Levent Küçük, Nadir Özkayın, Okan Bilge, Hüseyin Günay","doi":"10.1016/j.jham.2025.100256","DOIUrl":"10.1016/j.jham.2025.100256","url":null,"abstract":"<p><p>Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand function, significantly limiting the patient's ability to perform daily activities. Surgical interventions for post-traumatic osteoarthritis of the fifth CMC joint include arthrodesis and arthroplasty, with the Dubert technique combining elements of both approaches. This study aimed to compare the effects of Dubert arthrodesis and traditional fifth metacarpal (MC)-hamate arthrodesis on the flexion-extension range of motion of the fifth MC. An in vitro study was conducted using twelve cadaveric forearm specimens. The specimens were divided into two groups: Group 1 underwent Dubert arthrodesis, and Group 2 underwent fifth MC-hamate arthrodesis. Preoperative and postoperative evaluations were performed using computed tomography (CT) scans to measure the flexion-extension range of motion of the fifth MC. Twelve specimens, with a mean age of 53 years (range: 41-60 years), were analyzed. No significant difference in preoperative flexion-extension motion was observed between the groups. Both groups exhibited a significant reduction in flexion-extension motion following arthrodesis. However, no significant difference in postoperative flexion-extension motion was observed between the groups. Neither Dubert arthrodesis nor fifth MC-hamate arthrodesis preserved the physiological flexion-extension motion of the fifth MC. Biomechanical analysis showed no significant advantage of one technique over the other. The Dubert arthrodesis procedure was technically demanding, with inadequate resection potentially leading to residual symptoms. Further comparative clinical studies are required to confirm these findings and determine the optimal surgical approach for managing fifth MC arthritis.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100256"},"PeriodicalIF":0.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162725","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":"Advancing emergency upper extremity care: A pilot study of ChatGPT's potential role in diagnosing and managing hand and wrist trauma.","authors":"Evan Rothchild, Geena Jung, Christopher Aiello, Neil Tanna, Joseph A Ricci","doi":"10.1016/j.jham.2025.100260","DOIUrl":"10.1016/j.jham.2025.100260","url":null,"abstract":"<p><strong>Purpose: </strong>Hand and wrist trauma is a frequent cause of emergency room (ER) visits. However, hospitals often lack immediate hand specialist coverage. This study aims to evaluate the efficacy of Artificial Intelligence (AI) platforms like ChatGPT in aiding in the diagnosis and patient management of upper extremity trauma.</p><p><strong>Methods: </strong>Ten clinical vignettes depicting common hand and wrist emergency clinical situations were created by the senior author to represent a broad range of common upper extremity injuries. These were presented to plastic surgery residents and ChatGPT (version 4.0). The responder was tasked to provide a diagnosis, ER management, and definitive treatment plans for each vignette. Responses were collected and scored by two attending plastic surgeons, blinded to the source, on a scale of 0 (poor) to 30 (excellent). Univariate and linear regression models were utilized for analysis.</p><p><strong>Results: </strong>A total of 16 resident responses (9 junior and 7 senior) and 16 ChatGPT responses were collected for each of the 10 clinical scenarios. ChatGPT had significantly higher total average scores (mean = 26.6 vs. 22.7, p < 0.05) and ER management scores (mean = 9.9 vs. 6.7, p < 0.05) when compared to residents. We did not find any notable differences in diagnosis or definitive treatment scores between residents and ChatGPT responses. However, the study was not sufficiently powered to detect smaller effect sizes in these areas. No apparent correlations between scores and resident year of training were observed.</p><p><strong>Conclusions: </strong>ChatGPT provided clinically accurate diagnosis and management plans for upper extremity trauma. Implementing AI in trauma management has the potential to improve the management of hand and wrist trauma in emergency settings by serving as a diagnostic and clinical reference tool for emergency medical providers. However, their integration into clinical practice should be carefully evaluated and focused on complementing, and not replacing, traditional consults. Ultimately, these tools could alleviate the burden placed on ERs and limit reliance on hand consults.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100260"},"PeriodicalIF":0.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017165","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":"Integrating artificial intelligence into orthopedics: Opportunities, challenges, and future directions.","authors":"Raju Vaishya, Anupam Sibal, Sujoy Kar, Sangita Reddy","doi":"10.1016/j.jham.2025.100257","DOIUrl":"10.1016/j.jham.2025.100257","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI) is transforming orthopedics by improving diagnostic accuracy, optimizing surgical planning, and personalizing treatment approaches. This review evaluates the applications of AI in orthopedics, focusing on its impact on patient care, the efficacy of AI methodologies, and challenges in integrating these technologies into clinical practice.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar for articles published up to 28^th February 2025. Inclusion criteria included studies addressing AI applications in orthopedics, while non-peer-reviewed and non-English publications were excluded. Data extraction focused on AI technologies, applications, outcomes, and the advantages or limitations of AI integration.</p><p><strong>Results: </strong>Findings demonstrate AI's effectiveness in areas such as fracture detection and treatment planning, mainly through machine learning and deep learning. AI has improved outcomes in joint reconstruction, spine surgery, and rehabilitation. However, challenges such as data standardization and clinical validation remain.</p><p><strong>Conclusion: </strong>The review highlights AI's potential to revolutionize orthopedic practice, emphasizing the need for ongoing research to overcome barriers to adoption. Future directions should prioritize multi-center clinical trials, enhanced data protocols, and stakeholder collaboration to ensure ethical and effective AI implementation, ultimately improving patient outcomes and care delivery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100257"},"PeriodicalIF":0.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112298","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 role of artificial intelligence in predicting injured structures based on clinical images of lacerations in the volar aspect of the hand and forearm.","authors":"Arman Vahabi, Ali Engin Daştan, Hüseyin Günay","doi":"10.1016/j.jham.2025.100255","DOIUrl":"10.1016/j.jham.2025.100255","url":null,"abstract":"<p><strong>Introduction: </strong>Recently introduced image processing capabilities of AI models, which are accessible to a broad audience, may contribute to progress in medical research. Inspection and physical examination are important components of hand injury assessment, but they have inherent limitations in accuracy. The purpose of this study was to compare the structures identified as damaged during physical examination with those predicted by an AI model, utilizing its image processing capability. We hypothesized that the AI tool would demonstrate a level of accuracy comparable to that of physical examination in predicting injured structures.</p><p><strong>Methods: </strong>We retrospectively reviewed the files of patients with hand and forearm injuries related to the volar aspect from January 2024 to July 2024. After exclusions, a total of 30 patients were included in the final analyses. Structures suspected to be damaged based on the initial evaluation and those identified as injured during surgery were documented through chart review. For the same patients, the AI tool (ChatGPT-4.0) was utilized to predict injured structures from clinical photos obtained during the initial examination. We examined the correlation and overlap between the structures identified as injured during the initial clinical examination and those predicted by the AI tool, as well as the correlation and overlap between the structures predicted by the AI tool and those confirmed as injured during surgical procedures.</p><p><strong>Results: </strong>The sensitivity of the physical examination was found to be 66.0 % (95 % CI: 57.5 %-73.7 %), while the specificity was 98,7 % (95 % CI: 97,6 % to 99,4 %). The sensitivity of the AI tool was found to be 61.7 % (95 % CI: 53.1 %-69.8 %), while the specificity was 82.4 % (95 % CI: 79.4 %-85.2 %).</p><p><strong>Conclusion: </strong>In its current form, AI demonstrates limited yet promising potential as an adjunctive tool in the clinical evaluation of flexor-side injuries of the hand and forearm.</p><p><strong>Level of evidence: </strong>III, Diagnostic study.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100255"},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039279","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":"Distal ulnar neck fracture displacement with forearm rotation: A biomechanical cadaveric study.","authors":"Camelia Qian Ying Tang, Sean Han Sheng Lai, Amit Kumarsing Ramruttun, Siaw Meng Chou, Alphonsus Khin Sze Chong, Sreedharan Sechachalam","doi":"10.1016/j.jham.2025.100254","DOIUrl":"10.1016/j.jham.2025.100254","url":null,"abstract":"<p><p>Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement in isolated distal ulnar fractures, specifically AO Muller Q2 and Biyani Type I fracture pattern, during forearm pronosupination.6 fresh frozen cadaveric upper limbs amputated at mid-humerus were used. Soft tissues including proximal and distal radioulnar joints were carefully preserved. Specimens were inspected grossly and radiographically for absence of pathologies. Radiocarpal and midcarpal pinning was performed to facilitate quantification of forearm rotation. 2 markers were each placed proximal and distal to fracture site to quantify fracture displacement. 3-dimensional positional data was recorded using an optoelectronic system (Vicon MX motion capture system).Distance between the 2 markers increased in the proximodistal and radioulnar axis, and decreased in the dorsovolar axis when the forearm was rotated from neutral to 100° pronation. The inverse was observed during supination. Mean aggregate fracture site displacement increased to 9.17 ± 2.78 mm at 100° pronation. Statistically significant increase in aggregate fracture site displacement was observed from 60° pronation onwards. At 100° supination, the aggregate fracture site displacement was 4.58 ± 8.62 mm. When supinating from neutral to 100°, fracture displacement did not increase significantly.</p><p><strong>Results: </strong>from this study suggest that distal ulnar fractures are potentially stable, particularly in supination. However, unrestricted forearm pronation with inadequate immobilisation might still cause further fracture displacement. Further studies are required to assess distal ulnar fracture stability in vivo before treatment guidelines can be established.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100254"},"PeriodicalIF":0.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990784","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":"ChatGPT 4.0's efficacy in the self-diagnosis of non-traumatic hand conditions: Correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.jham.2025.100253","DOIUrl":"10.1016/j.jham.2025.100253","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100253"},"PeriodicalIF":0.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001334","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":"Exploring reconstructive alternatives to pollicization for modified Blauth type IIIB-V congenital thumb hypoplasia: A systematic review.","authors":"Anish Raman, John A Tipps, John R Vaile, Shaun D Mendenhall","doi":"10.1016/j.jham.2025.100251","DOIUrl":"10.1016/j.jham.2025.100251","url":null,"abstract":"<p><strong>Background: </strong>Although pollicization remains the traditional treatment strategy for modified Blauth type IIIB-V grade congenital thumb hypoplasia, many patients and parents express interest in alternative reconstructive approaches that maintain a five-digit hand. The aim of this study was to provide a summary of these alternative techniques and to assess for differences in their outcomes, with the hypothesis that techniques featuring vascularized bone grafts would have fewer instances of bone resorption or nonunion relative to non-vascularized techniques.</p><p><strong>Methods: </strong>A systematic literature review was conducted in PubMed, Embase, and CINAHL using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the reconstruction of modified Blauth type IIIB-V hypoplastic thumbs were included. Chi squared tests (or Fisher exact tests where appropriate) were performed to compare aggregate complication data.</p><p><strong>Results: </strong>Twenty-four articles met inclusion criteria, yielding 207 patients with 210 thumbs undergoing reconstruction. Mean patient age at surgery was 3.4 years, while the mean follow-up time was 4.2 years. 203 of the 207 patients underwent reconstruction using one of five techniques: PIPJ/MTPJ transfer, hemi-metatarsal transfer, toe and metatarsal transfer, iliac crest transfer, and toe phalanx transfer. PIPJ and MTPJ transfers were the most performed procedures (n = 54, 26 %). Vascularized grafts were used in 89 cases (43 %), while non-vascularized grafts comprised 114 cases (55 %). Rates of bone resorption and nonunion were higher in non-vascularized grafts, though not significantly so (n = 203, p = 0.19). Conversely, donor site complications were significantly higher in vascularized bone grafting techniques (n = 203, p = 0.0056). The most frequently reported outcome measures were Kapandji scores (46 %) and key pinch strength (46 %). Kapandji scores had a weighted mean of 5.6 (range 3.1-6.7).</p><p><strong>Conclusion: </strong>A variety of alternative techniques exist for reconstructing severely hypoplastic thumbs, though no technique demonstrates clear superiority. Vascularized grafts trend towards a lower bone resorption/nonunion rate relative to non-vascularized grafts, though there is evidence of heightened risks of donor site complications when taking vascularized bone grafts from the foot. Objective outcome measures showed variability across studies limiting comparisons between techniques.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100251"},"PeriodicalIF":0.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005481","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 new solution for the bilateral severe thumb hypoplasia.","authors":"Yu Chen, Chunhua Yin, Xiaofang Shen","doi":"10.1016/j.jham.2025.100246","DOIUrl":"10.1016/j.jham.2025.100246","url":null,"abstract":"<p><p>Thumb hypoplasia is a manifestation of radial longitudinal dysplasia, ranging from a slight decrease in thumb size to complete absence of the thumb. It has been suggested that distinct treatment approaches be used for various categories of hypoplastic thumb. However, due to cultural preferences in Eastern countries, some parents frequently look for alternative surgical treatments to achieve an aesthetically \"normal\" hand. We describe the surgical technique used in a young boy born with the bilateral severe thumb hypoplasia, a left hand Blauth Ⅳ thumb and a right hand Blauth ⅢB thumb. Thumb reconstruction was done in two stages, and the results were good in terms of both appearance and functionality. This method maximized thumb function as well as the parents' expectations.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100246"},"PeriodicalIF":0.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024140","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":"Review and algorithmic management of the anatomical variations of the medial sural artery perforator flap.","authors":"Jennifer An-Jou Lin, Joachim N Meuli, Juan Carlos Ignacio Larsson, Mohamed Abdelrahman, Kiron Koshy, Tommy Nai-Jen Chang","doi":"10.1016/j.jham.2025.100252","DOIUrl":"10.1016/j.jham.2025.100252","url":null,"abstract":"<p><strong>Background: </strong>Perforator variations in the calf region can be found during medial sural artery perforator (MSAP) flap harvest. This article reviews the perforator anatomy of the posterior calf and proposes an algorithmic approach to MSAP flap harvest when there are no favorable perforators, based on the author's experience and literature review.</p><p><strong>Material and methods: </strong>The PubMed database was searched for anatomic and/or clinical studies describing the perforator anatomy of the posterior calf. Clinical studies reporting the use of alternative flaps for cases in which perforator anatomy was unfavorable were also analyzed. We summarized the study's characteristics and identified the main anatomical challenges faced during flap harvest. We present our algorithm to address these situations, illustrated with three cases in which perforator variations were found intraoperatively and/or difficulties were encountered during MSAP flap harvest.</p><p><strong>Results: </strong>The anatomical studies from the literature review showed a mean of 3.2 ± 0.8 (1-7) perforators in the posterior calf. The presence of MSAPs and lateral sural artery perforators (LSAPs) have been reported to be 97.2 % and 62.5 % respectively. The mean number of MSAPs was 1.8 ± 0.32 while LSAPs were 1.3 ± 0.3, favoring a medial dominance. Perforators from MSA and LSA were found at a similar distance below the popliteal crease and from the mid-calf. Our clinical experience showed that MSAPs found anterior to the incision can still be used and even as a chimeric flap. Posterior tibial artery perforator flaps can also be harvested from the same anterior incision. Direct septal perforators from the MSA represent a newly identified anatomical variation. An algorithmic approach is presented for managing MSAP intra-operative perforator variations.</p><p><strong>Conclusion: </strong>The proposed approach of MSAP flap harvest can provide a useful guide for the microsurgeon to raise alternative flaps in the posterior calf region. We advocate an anterior approach that also gives access to perforators of the sural artery itself and posterior tibial artery perforators. These back-up flaps provide similar tissue characteristics and potential for head and neck and extremity composite tissue reconstruction.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100252"},"PeriodicalIF":0.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049954","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":"Decision making in Thumb Hypoplasia - Our perspective.","authors":"Samuel C Raj Pallapati, D R Kathir Joyson, Sasi P Kiran, Binu Prathap Thomas","doi":"10.1016/j.jham.2025.100250","DOIUrl":"10.1016/j.jham.2025.100250","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100250"},"PeriodicalIF":0.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054327","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}