Journal of Hand and Microsurgery最新文献

{"title":"The osteocutaneous superficial circumflex iliac artery (SCIP) flap in extremity reconstruction.","authors":"Cédric Zubler, Mihai A Constantinescu, Ioana Lese, Radu Olariu","doi":"10.1016/j.jham.2025.100337","DOIUrl":"10.1016/j.jham.2025.100337","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable.</p><p><strong>Results: </strong>Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months.</p><p><strong>Conclusion: </strong>The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100337"},"PeriodicalIF":0.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875832","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":"Outcomes of the Starfish procedure using muscle transfer for independent digital control of a myoelectric prosthesis.","authors":"Keith M Nord, Casey M Sabbag, Sahitya K Denduluri, Bryan J Loeffler, R Glenn Gaston","doi":"10.1016/j.jham.2025.100333","DOIUrl":"10.1016/j.jham.2025.100333","url":null,"abstract":"<p><strong>Background: </strong>Surgical and technological advancements have revolutionized myoelectric prosthetic options for patients with upper extremity amputations, but partial hand amputations have remained a challenge. The Starfish procedure is a novel surgical technique that involves transferring intrinsic hand muscles to a subcutaneous location to allow immediate signal detection and independent digital control of a myoelectric prosthesis. We report the outcomes of our cohort of patients treated with this procedure.</p><p><strong>Methods: </strong>Twenty-one patients underwent the Starfish procedure between 2015 and 2021. All patients had a postoperative evaluation with an Ottobock Myoboy to determine if they had viable signals from interossei transfers. All patients completed a specialized survey for amputees, depression, and PTSD surveys.</p><p><strong>Results: </strong>All patients had recordable myoelectric signals at each muscle transfer. Three patients were lost to follow-up and three patients were multi-extremity amputees and therefore their DASH scores were not included given the confounding associated injuries thus 15 patients were available for outcomes data. 14 out of 15 remaining patients (93 %) obtained a myoelectric prosthesis. Patients reported using their prosthesis an average of 5.5 h per day and 5.5 days per week. The average DASH score prior to surgery was 67.9 and after surgery was 40.5 (p = 0.014). VAS Pain scores were 3.8 for residual limb pain and 2.7 for phantom pain. Mean follow-up was 2.1 years. 71 % of patients reported being \"extremely\" or \"very\" satisfied with the overall function of their prosthesis. The most common functional activities that the prosthesis allowed patients to perform include dressing, housework, meal preparation and eating. 73 % of previously working patients were able to return to employment.</p><p><strong>Conclusions: </strong>The Starfish procedure provides immediately detectable superficial myoelectric signals that allow intuitive and independent finger control. At 2-year follow up, patients have a high satisfaction rate, consistent myoelectric prosthetic use, improved DASH scores, and a high rate of return to work.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100333"},"PeriodicalIF":0.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849344","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":"Robotic-assisted technique in plastic and reconstructive surgery: Experience in Taiwan.","authors":"Yi-Chia Chen, Ming-Hsien Chung, Chieh-Kai Chang, Cheng-Yeu Wu, Yi-Ling Lin, Yueh-Chi Tsai, Chen-Te Lu, I-Chen Chen, Chih-Sheng Lai","doi":"10.1016/j.jham.2025.100332","DOIUrl":"10.1016/j.jham.2025.100332","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review summarizes Taiwan's pioneering experience with robotic-assisted techniques in this specialty, with an emphasis on clinical applications, educational models, and future directions.</p><p><strong>Methods: </strong>A narrative literature review was conducted focusing on robotic-assisted plastic and reconstructive surgery with relevance to Taiwanese clinical practice. Articles published between January 2000 and April 2024 were considered. Searches were performed in PubMed, Google Scholar, and Cochrane Library using the keywords: \"robotic surgery,\" \"plastic surgery,\" \"reconstructive surgery,\" \"Taiwan,\" and \"microsurgery.\" Inclusion criteria were: (1) studies involving robotic-assisted surgical techniques, (2) relevance to plastic and reconstructive surgery, (3) Taiwanese institutional or clinical context, and (4) availability of clinical or technical outcome data. Articles not published in English, lacking original data, or unrelated to the Taiwan context were excluded.</p><p><strong>Results: </strong>Robotic-assisted techniques were successfully applied in various reconstructive domains, notably in microsurgical anastomosis for free flap procedures, nerve transfers, and minimally invasive mastectomies. These approaches demonstrated favorable outcomes in terms of operative precision, reduced complications, and patient satisfaction. Taiwan's major medical centers, including Chang Gung Memorial Hospital and Taichung Veterans General Hospital, have been instrumental in driving these innovations. Furthermore, robotic training models facilitated the learning curve for microsurgeons and supported the integration of robotic platforms into surgical education.</p><p><strong>Conclusions: </strong>Taiwan's experience underscores the feasibility and clinical value of robotic-assisted techniques in plastic and reconstructive surgery. Robotic platforms not only improve surgical outcomes but also expand the scope of reconstructive options. Ongoing research and educational efforts are crucial to optimizing technique standardization and surgeon training in this rapidly evolving field.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100332"},"PeriodicalIF":0.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838146","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 subacromial balloon spacer: Adhering to indications and clinical outcomes.","authors":"Peter Boufadel, Akshay Khanna, Joyce D Suarez, Ryan D Stadler, Mohamad Y Fares, Joseph A Abboud","doi":"10.1016/j.jham.2025.100330","DOIUrl":"10.1016/j.jham.2025.100330","url":null,"abstract":"<p><p>The subacromial balloon spacer has emerged as a viable treatment option for patients with massive, irreparable rotator cuff tears. Acting as a temporary interpositional device, the subacromial balloon reduces acromiohumeral impingement and redistributes forces across the shoulder, leading to pain relief and improved function. Achieving optimal outcomes requires adherence to appropriate surgical indications and the implementation of a structured postoperative rehabilitation protocol. This review provides a comprehensive overview of the subacromial balloon spacer's biomechanical function, clinical indications, surgical technique, postoperative rehabilitation, and outcomes from recent trials and meta-analyses. While short-term outcomes are promising, further large-scale, long-term studies are needed to refine its indications and define its role in shoulder surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100330"},"PeriodicalIF":0.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790260","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":"Letter regarding \"Modified double fascicular nerve transfer to restore elbow flexion in brachial plexus injuries - A series of 32 cases\".","authors":"Hui-Kuang Huang","doi":"10.1016/j.jham.2025.100328","DOIUrl":"10.1016/j.jham.2025.100328","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100328"},"PeriodicalIF":0.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761743","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":"Antenatal ultrasound cannot detect all congenital Anomalies: Clinical limitations, India-specific barriers, and medicolegal perspectives.","authors":"Ilayaraja Venkatachalam, Mohamed Siddique","doi":"10.1016/j.jham.2025.100331","DOIUrl":"10.1016/j.jham.2025.100331","url":null,"abstract":"<p><strong>Background: </strong>Antenatal ultrasound is central to prenatal screening, enabling early detection of many congenital anomalies. However, its diagnostic accuracy is limited, especially for subtle, complex, or late-onset fetal abnormalities. In India, additional systemic, infrastructural, and legal factors further restrict its effectiveness.</p><p><strong>Objectives: </strong>To review the diagnostic limitations of prenatal ultrasound, highlight India-specific barriers to anomaly detection, and examine medico-legal perspectives, including landmark court rulings on alleged negligence.</p><p><strong>Methods: </strong>This article synthesizes global and Indian data on anomaly detection rates, analyzes categories of commonly missed anomalies, and reviews relevant Indian legal cases, including Supreme Court judgments. The policy implications of the PCPNDT Act are also critically discussed.</p><p><strong>Results: </strong>Ultrasound detects 50-70 % of major anomalies in ideal settings, but many conditions-such as cardiac defects, skeletal dysplasias, orofacial defects ( Cleft lip, Cleft palate etc) and limb abnormalities-remain undiagnosed. India-specific challenges include operator variability, delayed antenatal care, equipment disparities, and regulatory hurdles under the PCPNDT Act. Indian courts consistently require expert testimony to establish negligence and have ruled in favor of clinicians when standard protocols were followed.</p><p><strong>Conclusion: </strong>Missed anomalies on antenatal ultrasound typically reflect known technical and systemic limitations, not medical negligence. Indian jurisprudence has set a clinician-protective precedent when standard care is provided. Counseling, documentation, and legal awareness remain key to mitigating risk. Policy reforms should promote ethical ultrasound use while safeguarding both patient access and provider protection.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100331"},"PeriodicalIF":0.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761742","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":"Cold intolerance following microsurgical replantation of finger amputations: A retrospective cohort study.","authors":"Makoto Shiraishi, Mitsunaga Narushima, Chihena Hansini Banda, Yuta Moriwaki, Satoshi Miyamoto, Yuri Miyazaki, Mayu Okuyama, Kirito Kojima, Chizuki Kondo, Kosuke Yamagata, Kohei Mitsui, Kohei Hashimoto, Kento Hosomi, Ryohei Ishiura, Masakazu Kurita, Isao Koshima","doi":"10.1016/j.jham.2025.100327","DOIUrl":"10.1016/j.jham.2025.100327","url":null,"abstract":"<p><strong>Purpose: </strong>Cold intolerance following finger amputation is a major postoperative complication. Although current evidence suggests decreased blood flow to digital peripheral vessels may be associated with cold intolerance, the underlying mechanism remains controversial. This study aimed to investigate the relationship between skin perfusion in affected fingers and the presence of cold intolerance.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to evaluate patients who underwent finger replantation at two centers between 2008 and 2020. Demographic data were collected, and at least one of the following evaluative methods was used: the Semmes-Weinstein monofilament test (SW test), moving two-point discrimination (M2PD), contrast-enhanced computed tomography, or thermography.</p><p><strong>Results: </strong>A total of 41 amputated fingers in 20 patients were assessed, with a mean follow-up period of 18.7 ± 12.1 months. Most injuries were located in Tamai zone 4 (n = 18, 43.9 %), followed by zone 1 (n = 9, 22.0 %), zone 2 (n = 9, 22.0 %), and zone 3 (n = 5, 12.2 %). The most common injury type was crush (n = 24, 58.5 %), followed by guillotine (n = 13, 31.7 %) and crush-avulsion (n = 4, 9.7 %). A significant difference was observed in the SW test (p = .047) and average vessel diameter (p = .047) between patients with and without cold intolerance.</p><p><strong>Conclusions: </strong>Narrowed blood vessels and impaired SW test scores are associated with cold intolerance after finger replantation. Nerve injury may potentially contribute to abnormal vasoconstriction. Further studies are needed to elucidate the underlying mechanisms of cold intolerance.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100327"},"PeriodicalIF":0.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745417","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 'teres major first' approach for deltoid reinnervation in brachial plexus injuries with shoulder fracture-dislocations.","authors":"Prem S Bhandari","doi":"10.1016/j.jham.2025.100329","DOIUrl":"10.1016/j.jham.2025.100329","url":null,"abstract":"<p><strong>Background: </strong>In upper brachial plexus (C5-C6) avulsion injuries, deltoid reinnervation via radial-to-axillary nerve transfer is standard. However, fracture-dislocations around the shoulder complicate surgical exposure due to fibrosis and distorted anatomy.</p><p><strong>Methods: </strong>Fifteen male patients (mean age: 26.1 years) with C5-C6 avulsion injuries and concomitant shoulder fractures were treated between October 2019 and April 2022 using a modified posterior approach. The \"teres major first\" technique utilized the inferior border of the teres major muscle as a consistent landmark to identify and mobilize the long head triceps branch and anterior axillary nerve. A vertical slit in the teres major tendon improved access and allowed tension-free coaptation. All patients also received spinal accessory to suprascapular nerve transfers, and partial ulnar and/or median nerve transfers for elbow flexion restoration.</p><p><strong>Results: </strong>All patients had fibrous adhesions in the quadrangular space, and 3 had distal axillary nerve injuries. The teres major landmark enabled safe dissection in all cases. Twelve of 15 patients achieved deltoid reinnervation with active shoulder abduction between 110° and 170° (mean 156°; MRC grade III-IV). Three patients (2 with proximal humerus fractures and 1 with lateral clavicle fracture with coracoclavicular disruption) showed limited recovery (70°-80° abduction). Triceps donor site weakness (MRC grade ≥3 in 14/15) was tolerated well, and full elbow flexion was restored in all patients. EMG evidence of reinnervation appeared by week 21 (deltoid) and week 23 (infraspinatus), with improvement in active shoulder abduction from week 27 onward.</p><p><strong>Conclusion: </strong>The \"teres major first\" approach enables rapid and safe identification of target nerves in brachial plexus injuries complicated by shoulder fractures and dislocations. This technique minimizes dissection in fibrotic areas, ensures tension-free repair, and achieves reliable functional outcomes. However this study is limited by the relatively small sample size and a reduced statistical power.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100329"},"PeriodicalIF":0.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733803","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":"Impact of prompting on large language model performance: ChatGPT-4 performance on the 2023 hand surgery self-assessment examination.","authors":"Benjamin Fiedler, Olivia A Barron, Jeffrey Hauck, Jacob Scioscia, Todd Phillips, Adil S Ahmed, Scott Mitchell","doi":"10.1016/j.jham.2025.100326","DOIUrl":"10.1016/j.jham.2025.100326","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) such as ChatGPT are artificial intelligence programs designed to interpret and respond to text based input These programs can improve output based on prompting and tailored prompt engineering. Multiple studies have assessed the ability of various LLMs to perform on medical exams at different levels of training. The newest version of ChatGPT, GPT-4, allows image recognition which is relevant for many questions on orthopedic surgery exams. Performance of GPT-4, and the potential for LLMs to learn from prior exams remains unclear. The present study analyzed ChatGPT-4 performance on the 2023 hand surgery Maintenance of Certification (MOC) Self-Assessment Examination (SAE) before and after prompting with 5 previous versions of the test. It was hypothesized that GPT-4 would pass the exam and improve performance after prompting.</p><p><strong>Methods: </strong>GPT-4 was tested with all text and image-based questions from the 2023 hand surgery SAE. Video-based questions were excluded. GPT-4 was then provided with questions, answers, and explanations from 5 previous SAEs from 2014 to 2020 and retested on the 2023 SAE text and imaging questions. Responses from GPT-4 on prompted and unprompted tests were recorded and compared.</p><p><strong>Results: </strong>Both prompted and unprompted versions of ChatGPT-4 exceeded SAE exam passing requirement of >50 % correct response rate. GPT-4 answered 67 % of all questions correctly unprompted and 71 % of all questions correctly after prompting (p = 0.51). Sub-analysis demonstrated GPT-4 answered 66 % of image-based questions correctly after prompting, compared to 56 % before prompting (p = 0.25). GPT-4 answered 75 % of text only questions correctly before prompting and 74 % correctly after prompting (p = 1.0). Fischer's exact test on total questions, image only, and text only showed no statistically significant differences between prompted and unprompted versions of GPT-4.</p><p><strong>Conclusion: </strong>GPT-4 demonstrated the ability to analyze orthopedic information, answer specialty-specific questions, and exceed the passing threshold of 50 % on the 2023 Hand Surgery Self-Assessment Exam. However, prompting GPT-4 with previous SAEs did not statistically significantly improve performance. With continued advancements in AI and deep learning, large language models may someday become resources in test simulation and knowledge checks in the realm of hand surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100326"},"PeriodicalIF":0.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709364","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":"Analyzing socioeconomic characteristics in brachial plexus birth injuries: A multicenter public health analysis.","authors":"Robbins Victoria, Khabyeh-Hasbani Nathan, O'Brien Devon, Behbahani Mandana, Meisel Erin, Steven M Koehler","doi":"10.1016/j.jham.2025.100325","DOIUrl":"10.1016/j.jham.2025.100325","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to examine and compare socioeconomic characteristics of infants with brachial plexus birth injury (BPBI) at two high-volume, distinct healthcare systems in the United States.</p><p><strong>Methods: </strong>All patients diagnosed with non-transient BPBI presenting between November 2021-November 2023 at either institution, New York City (\"NY\") or Los Angeles (\"LA\"), were included. To stratify based on socioeconomic background, Area Deprivation Index (ADI) and Child Opportunity Index (COI) were utilized. ADIs were presented in national percentiles (1-100 %) or state-normed deciles (1-10), with higher rankings indicating greater disadvantage. COI scores and quintiles were assigned using nationally-normed ZIP code-level data, with lower COI signifying lower childhood opportunity. Continuous variables underwent two-tailed, unpaired Mann-Whitney U and t-tests. Categorical variables underwent chi-square tests. The significance level was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>When comparing the LA (n = 92) and NY (n = 107) cohorts, the mean ADI scores were not significantly different: 24.5 % (SD 21.1) and 25.4 % (SD 13.5) respectively (p = 0.713). When comparing the COI scores, overall mean COI was significantly greater in LA (34.2, SD 26.9) compared to NY (17.3, SD 25.6; p < 0.001). While a significantly higher number of patients from NY than LA fell into categories of very low or low in education, social and economic, and overall COI, the distributions of these categories were more evenly spread across the LA cohort.</p><p><strong>Conclusion: </strong>Our findings underscore the importance of considering regional differences in patient populations when patients present with BPBI, as addressing such disparities may increase equitable access to treatment and optimize functional outcomes. Given the time-sensitive nature of BPBI care and implications of long-term disability if left under-treated, it is essential to allocate resources towards effectively treating BPBI in affected demographics, especially those experiencing resource deficits. By acknowledging geographic-specific differences in resource access among BPBI populations, physicians can develop targeted strategies to ensure equitable BPBI care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100325"},"PeriodicalIF":0.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700018","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}