Journal of Hand and Microsurgery最新文献

{"title":"Failed carpal tunnel decompression surgery; A retrospective observational magnetic resonance imaging analysis.","authors":"Sabina A R Barbur, Tahlia J J Kerridge, Simon B M MacLean","doi":"10.1016/j.jham.2025.100360","DOIUrl":"10.1016/j.jham.2025.100360","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100360"},"PeriodicalIF":0.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12556183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393940","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":"Evaluation of the results of combined free vascularized fibular graft and pasteurized tumor segment for the reconstruction of intercalary femoral defects following tumor resection.","authors":"Islam Mohamed Abdelmaksoud, Mohammad Hasan Ahmad, Awad Rafalla Elmalky, Ahmed Elsayed Semaya, Mahmoud Kamal","doi":"10.1016/j.jham.2025.100359","DOIUrl":"10.1016/j.jham.2025.100359","url":null,"abstract":"<p><strong>Introduction: </strong>the reconstruction of intercalary femoral defects after tumour resection is challenging. We have evaluated the clinical, functional, and oncological results of using free vascularized fibular graft combined with preserved pasteurized tumour segment.</p><p><strong>Materials: </strong>this study was retrospective in nature and included 12 patients [eight males and four females]. The mean age was 21.3 years ± 11.3. The diagnoses of the patients were osteosarcoma (Five cases) and Ewing's sarcoma (seven cases). The resection was wide local excision, and the defect was reconstructed using combined free vascularized fibular graft and pasteurized tumour segment.</p><p><strong>Results: </strong>the mean time to union was 7.1 ± 1.9 months while the mean time to full weight bearing was 12 ± 1.8 months. The mean size of skeletal defect was 17.7 cm ± 1.92. The mean duration of surgery was 12.1 h ± 1.88. Nonunion occurred in four cases, stress fractures occurred in two cases and metal failure occurred in one case.</p><p><strong>Conclusion: </strong>the combined technique of using free vascularized fibular graft and pasteurized tumour segment for intercalary femoral defects following tumour resection is a valuable technique with accepted complications and good results.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100359"},"PeriodicalIF":0.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12597259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490590","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 shield multicentre collaborative: A study of hand surgeons' intraoperative radiation exposure and techniques to limit dosing.","authors":"Iulia Marinescu, Cian M Hehir, Ferdia Browne, Sean Curran, Khairun Izlinda Abdul Jalil, Aoife O'Brien, Angela Canas-Martinez, Robert Woods, Claire Stenson, Nicholas Stratford, Linda Kelly, Paul Sullivan, Marlese Dempsey, Christine Quinlan, Laura Kearney, Kenneth Joyce, Roisin T Dolan","doi":"10.1016/j.jham.2025.100355","DOIUrl":"10.1016/j.jham.2025.100355","url":null,"abstract":"<p><strong>Purpose: </strong>Fluoroscopic radiographic imaging is indispensable in modern hand surgery. Challenges in positioning patient digits during complex hand injury assessments can result in direct radiation exposure to operating staff. The adverse health risks associated with radiation exposure, including malignancy, are well documented and demand clear risk reduction strategies. The EURATOM 2013/59 directive provides guidance on reducing occupational exposure under the 'as low as reasonably achievable' (ALARA) principle. This study aims to assess the prevalence of non-patient (surgeon) anatomy in intra-operative radiographs and outline prevention strategies to optimise radiation safety practices for hand surgeons.</p><p><strong>Methods: </strong>A national multi-centre audit of direct occupational hand surgeon radiation exposure was performed. Intra-operative radiographic images obtained during hand surgery cases across six plastic and reconstructive surgery centres were retrospectively reviewed. The primary outcome was the presence of non-patient (surgeon) anatomy in intra-operative radiographic images. Secondary outcomes include timing of surgery (working hours vs. out-of-hours), procedure type and surgeon seniority (consultant vs. trainee).</p><p><strong>Results: </strong>A total of 852 hand trauma procedures performed across the six national centres across a three-year period were included. Non-patient digits were present in intra-operative radiographs in 51.7 % of cases (range, 22.3-78.3 %). The most common procedure was fracture reduction and k-wire fixation (n = 515, 60.4 %). There was significant variance between the surgical units in the rate of non-patient anatomy captured, indicating inter-hospital differences in radiation safety practice adherence. Twenty-two percent of procedures were performed out-of-hours. There was no significant relationship between radiation exposure and procedure timing or surgeon seniority.</p><p><strong>Conclusions: </strong>Hand surgeons are frequently exposed to excess intra-operative radiation. Radiation safety training, strict adherence to intra-operative radiation safety protocol, formal radiation safety education, and use of innovative surgical equipment, may help reduce the rates of radiation exposure in hand surgery.</p><p><strong>Type of study: </strong>Differential diagnosis/symptom prevalence study.</p><p><strong>Level of evidence: </strong>2c.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100355"},"PeriodicalIF":0.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12550140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379287","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 unlocked hand: A surgical-rehabilitative paradigm for post-stroke spasticity.","authors":"Vaikunthan Rajaratnam, Usama Farghaly Omar, Amr Eisa, Shalimar Abdullah, J Terrence Jose Jerome","doi":"10.1016/j.jham.2025.100349","DOIUrl":"10.1016/j.jham.2025.100349","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100349"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565473","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":"Arthroscopic treatment of carpal boss: Description of an intra-articular technique.","authors":"Fernando Corella, Ricardo Kaempf de Oliveira, Paula Fischer, Montserrat Ocampos Hernández","doi":"10.1016/j.jham.2025.100352","DOIUrl":"10.1016/j.jham.2025.100352","url":null,"abstract":"<p><strong>Introduction: </strong>Carpal Boss is a bony protuberance located on the dorsal region of the wrist, at the base of the carpometacarpal joint of the second and third rays. It is a lesion of uncertain origin and, when associated with osteophytes and osteoarthritis, may be linked by a congenital change due to the presence of an accessory bone (<i>os styloideum</i>), which causes a change in biomechanics, thus creating instability. In symptomatic patients, surgery may be indicated and consists of resecting the sclerotic bony prominence in layers until all degenerative tissue is removed, finding healthy cancellous bone and cartilage.</p><p><strong>Purpose: </strong>to describe arthroscopic surgical access portals for the treatment of carpal boss.</p><p><strong>Material and methods: </strong>The intra-articular arthroscopic treatment of the carpal boss that is accessed through the midcarpal joint, associated with the use of one or two additional portals that are strategically located radially and ulnarly to the carpometacarpal joint and the extensor carpi radialis longus tendon.</p><p><strong>Results: </strong>These portals provide direct access to the carpal boss and allow the surgeon to maneuver the instruments with precision while avoiding injury to critical structures.</p><p><strong>Conclusion: </strong>This technique lets complete and safe resection of the carpal boss, allowing the surfaces of the second and third metacarpals and the trapezoid to be flattened to create a smooth, level contour. In addition, when compared to open techniques, it provides a wide and direct view of the region with less soft tissue damage, cosmetic advantages and rapid recovery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100352"},"PeriodicalIF":0.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349090","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":"Tremors associated with peripheral nerve entrapments of the upper limb.","authors":"Thomas Apard, Jean-Paul Brutus, Benjamin Ferembach, Alison Tayor, Elisabet Hagert","doi":"10.1016/j.jham.2025.100353","DOIUrl":"10.1016/j.jham.2025.100353","url":null,"abstract":"<p><p>Peripherally-induced movement disorder (PIMD) is a group of conditions manifested by involuntary movements or other motor abnormalities that are induced by or emerge in the context of injury to the peripheral nervous system. Peripheral nerve entrapment (PNE) in the upper extremities is common and their clinical signs are very well known by hand surgeons. Only 3 cases of tremor with PNE have already been reported (one in 1986 and two very recently). The aim of this multicentric retrospective study is to report clinical cases of tremors caused by PNE and to analyze their clinical findings and treatment. 17 patients was referred to 5 hand centers for tremors of their hand after being examined by a neurologist clinically and electrophysiologically. The clinical examination showed simple, double or multiple crush nerve entrapment at the upper limb (elbow was involved for all of them except one). The treatment was conservative (myofascial manipulation and taping) for 8 patients and surgical (wide awake nerve release) for 9 others after failure of conservative treatments. The tremors disappeared for all of them. Our study showed upper limb peripheral nerve entrapment can be a cause of tremor of the hand in rare but misdiagnosed situations. We suggest that tremor induced by peripheral nerve entrapment can be a new type of tremor classified in the PIMD group. Hand physiotherapist and surgeons must be questioned by medical doctors who take care of tremors (family doctors, neurologists …) and so, be awared of that etiology.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100353"},"PeriodicalIF":0.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281267","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":"Volar locked plating versus dorsal bridge plating for complete articular (AO/OTA type 23C) distal radius fractures.","authors":"Thomas J Carroll, Akhil Dondapati, Richard Lander, Andrew Rodenhouse, Urvi Patel, Warren C Hammert, Ronald Gonzalez, Constantinos Ketonis","doi":"10.1016/j.jham.2025.100350","DOIUrl":"10.1016/j.jham.2025.100350","url":null,"abstract":"<p><strong>Background: </strong>Volar locked plating (VLP) and dorsal bridge plating (DBP) are both appropriate surgical strategies for the treatment of complete articular distal radius fractures (DRFs), however, direct comparisons between these fixation methods in this injury pattern is lacking.</p><p><strong>Purpose: </strong>The purpose of this study was to compare functional, radiographic, and patient-reported outcomes, for complete articular (AO/OTA 23C) DRFs treated with VLP versus dorsal bridge plating DBP.</p><p><strong>Methods: </strong>This was a retrospective cohort study that included patients aged 18-90 years old who underwent VLP or DBP fixation for AO/OTA 23C DRFs. Polytraumatized patients and those undergoing revision surgery were excluded. Wrist range of motion (ROM) and radiographic outcome measures were collected at 6-month follow-up. PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) were obtained at each follow-up. Surgical complications and patient demographic data were recorded.</p><p><strong>Results: </strong>After propensity matching, 1069 VLP patients were matched to 214 DBP individuals, rendering all demographic variables examined comparable. DBP patients had higher rates of delayed union(2.0 % vs. 4.2 %; p < 0.05) and tendon rupture (0.5 % vs. 3.3 %; p < 0.05), but similar rates of revision surgery, malunion, and infection at 6-months. Multivariate analysis demonstrated greater wrist flexion, extension, radial and ulnar deviation, supination, protonation, grip strength, PROMIS UE, and PROMIS PF among the VLP group compared to DBP (p < 0.05). VLP patients also demonstrated greater radial height and radial inclination, less articular step-off, and decreased volar tilt (p < 0.05).</p><p><strong>Conclusions: </strong>VLP was associated with greater ROM, grip strength, PROMIS UE and PF, improved radial height, radial inclination, and less articular step-off and volar tilt at 6-month follow-up compared to DBP. DBP patients also demonstrated higher rates of delayed union and tendon rupture but similar complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic III.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100350"},"PeriodicalIF":0.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207803","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":"Quantifying the environmental and economic impact of telephone follow-up in hand surgery: A single surgeon's experience.","authors":"R A Fawdry, O Stapleton, E Wardle, C Sook, A Kocheta","doi":"10.1016/j.jham.2025.100351","DOIUrl":"10.1016/j.jham.2025.100351","url":null,"abstract":"<p><strong>Introduction: </strong>The National Health Service (NHS) in England generates approximately 24.9 million tonnes of carbon dioxide annually. Achieving net-zero emissions requires contributions from all clinical specialties. Orthopaedics, as a high-emission specialty, has a critical role to play in this transition. The COVID-19 pandemic catalysed the widespread adoption of telephone consultations, which have demonstrated patient satisfaction, favourable clinical outcomes, and potential environmental benefits. This study evaluated the environmental and economic impact of a single surgeon's shift to telephone follow-up appointments.</p><p><strong>Materials and methods: </strong>Patients who received telephone follow-up consultations between March 2020 and March 2023 in one surgeon's clinic were retrospectively identified. Case notes were reviewed to determine diagnosis, treatment type, and need for further in-person follow-up. Travel distances were estimated based on patient addresses, and deprivation scores were calculated using postcode-linked indices.</p><p><strong>Results: </strong>A total of 118 telephone consultations were identified; six patients were excluded due to missing address data. Of the remaining 112, 37.5 % had carpal tunnel syndrome, 62 % followed surgical intervention, and 25 % followed injection. Secondary in-person follow-up was required in 26 % of cases, with no significant difference between postoperative and post-injection patients (p = 0.59). The intervention resulted in an estimated 1284 miles of travel avoided and a saving of 0.33 tonnes of CO₂ emissions. Notably, 39.3 % of patients were from the most socioeconomically deprived quintile.</p><p><strong>Discussion: </strong>This study demonstrates that even a modest change in outpatient follow-up practices by a single clinician can yield measurable environmental benefits. Savings in patient expenses were found, particularly among those from disadvantaged backgrounds. If implemented across the NHS, such changes have the potential to significantly reduce emissions without compromising patient care and reduce direct costs to patients.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100351"},"PeriodicalIF":0.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208130","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 TFCC table lift test: A clinical tool for detecting palmer 1B TFCC lesions.","authors":"Lucian Lior Marcovici, Alessandro Greco, Beatrice Chiossi, Antonio Luca Muscatiello, Fabio Andrés Tandioy-Delgado, Iakov Molayem, Alessia Pagnotta","doi":"10.1016/j.jham.2025.100348","DOIUrl":"10.1016/j.jham.2025.100348","url":null,"abstract":"<p><strong>Background: </strong>Ulnar-sided wrist pain, frequently linked to triangular fibrocartilage complex (TFCC) injuries, poses a diagnostic challenge due to the limited sensitivity and specificity of standard clinical tests. Although wrist arthroscopy remains the diagnostic gold standard, a reliable clinical tool is needed to better identify peripheral TFCC lesions (Palmer 1B). This study introduces and validates the \"TFCC Table Lift Test\" (TTL test), a novel exam aimed at improving clinical detection of Palmer 1B TFCC injuries. The primary goal was to correlate TTL test scores with arthroscopic findings, using the Atzei classification to subcategorize lesions and assess the test's diagnostic utility.</p><p><strong>Materials & methods: </strong>We conducted a retrospective case-control study involving 314 patients with unilateral chronic ulnar-sided wrist pain who underwent wrist arthroscopy from January 2016 to December 2023. All patients performed the TTL test during preoperative assessment, which involved lifting a flat surface with fingertips while the wrist was in full supination and extension. Pain intensity was scored using a Visual Analogue Scale (VAS, 0-10) and compared to the unaffected side. Exclusion criteria included bilateral pain, previous wrist surgery, or other wrist disorders. Arthroscopy confirmed or excluded Palmer 1B TFCC lesions and subclassified them using the Atzei system. TTL scores were statistically analyzed for diagnostic correlation.</p><p><strong>Results: </strong>Of 314 patients, 213 (Group 1) were arthroscopically diagnosed with Palmer 1B TFCC lesions: 136 were Atzei Class 1, 75 Class 2, and 2 Class 3. The remaining 101 patients (Group 2) had other wrist conditions. All Group 1 patients had TTL scores >5, with severity reflected in increasing mean scores (Class 1: 6.52; Class 2: 8.15; Class 3: 9.0). All but three patients in Group 2 had scores <3. The TTL test showed 100 % sensitivity, 97.03 % specificity, 98.6 % positive predictive value, and 100 % negative predictive value. ROC analysis yielded an AUC of 0.999; the optimal threshold was VAS >5.</p><p><strong>Conclusion: </strong>The TTL test is a simple, reproducible, and accurate clinical tool for detecting Palmer 1B TFCC lesions. A TTL score >5 strongly correlates with arthroscopic findings and reflects lesion severity, making it a valuable adjunct in the evaluation of ulnar-sided wrist pain.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100348"},"PeriodicalIF":0.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114708","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":"Giant cell tumor - Hamate.","authors":"Bhaskaranand Kumar, Sandeep Vijayan, Saktthi S Shanmuganathan","doi":"10.1016/j.jham.2025.100340","DOIUrl":"10.1016/j.jham.2025.100340","url":null,"abstract":"<p><p>Giant cell tumor, a benign, but locally aggressive primary bone tumor usually occurs in the ends of long bones and some flat bones. Its occurrence in the carpal bones is rare and has varied characteristics compared to other locations. We report the case of a 17-year-old girl diagnosed with giant cell tumor of the hamate, who was managed with excision and reconstruction with acrylic bone cement and went on to have a reasonably good outcome without recurrence. We discuss the clinico-radiological, histopathological and treatment modalities of giant cell tumors in the carpal bones.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100340"},"PeriodicalIF":0.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233727","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}