Journal of Hand and Microsurgery最新文献

{"title":"Safety and efficacy of platelet-rich plasma injections in basal thumb osteoarthritis; should we offer it or not?","authors":"Omar El Sewify, Shaishav Datta, Jack Legler, Marion Sylvain, Andre Cheah, Johnny I Efanov","doi":"10.1016/j.jham.2025.100223","DOIUrl":"10.1016/j.jham.2025.100223","url":null,"abstract":"<p><p>Nonsurgical therapeutic approaches for thumb carpometacarpal (CMC) osteoarthritis (OA) often offer only inconsistent symptom relief and fail to restore hand function. Intra-articular platelet-rich plasma (PRP) injections have recently emerged as a promising alternative, with encouraging outcomes in knees and hips. This systematic review and meta-analysis aims to highlight the safety and efficacy of PRP injections in thumb CMC OA. A systematic review was completed using Medline, Embase, and Cochrane. Primary outcomes focused on patients with basal thumb osteoarthritis treated with intra-articular PRP injections. Patient characteristics, product administration, functional outcomes and complications were analyzed as means of central tendency. A meta-analysis was performed focusing on pain relief and improvement in hand function. Seven articles were included, comprising 115 patients with an average age of 62.6 years, predominantly female (67.0 %). Patients received an average of 1.4 PRP injections per joint, with an average follow-up of 14.1 months. Control groups were administered corticosteroids, normal saline, and hyaluronic acid. All PRP-treated patients resumed their prior activities of daily living with a satisfaction rate at 73.7 % (n = 76). Statistically significant pain reduction (n = 98) and improvement in pinch strength were reported, while no statistically significant improvement in grip strength was observed (n = 39). No adverse events occurred, with only one complication (a palmar wrist ganglion) reported. Intra-articular PRP injections in thumb CMC OA yields favorable outcomes for pain relief and hand function without major complications. However, procedural and data heterogeneity affect reliability. Further randomized controlled trials comparing PRP and cortisone injections are needed.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100223"},"PeriodicalIF":0.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543650","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":"Revision reverse shoulder arthroplasty: Current concepts for the glenoid.","authors":"Abhay Mathur, Viraj Deshpande, Napat Intarachumnun, Patrick Saunders, Hafiz F Kassam","doi":"10.1016/j.jham.2025.100226","DOIUrl":"10.1016/j.jham.2025.100226","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100226"},"PeriodicalIF":0.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493764","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":"Anatomic versus reverse shoulder replacement: Are we asking the right questions and what are the answers?","authors":"Kathleen A Leinweber, Adam R Bowler, Declan R Diestel, Miranda McDonald-Stahl, Kiet Le, Jacob M Kirsch, Andrew Jawa","doi":"10.1016/j.jham.2025.100225","DOIUrl":"10.1016/j.jham.2025.100225","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100225"},"PeriodicalIF":0.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504766","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":"Navigating the future: A comprehensive review of technology in shoulder arthroplasty.","authors":"J Ryan Hill, Garrett R Jackson, William To, Benjamin Zmistowski, Aghdas Movassaghi, Vani J Sabesan","doi":"10.1016/j.jham.2025.100224","DOIUrl":"10.1016/j.jham.2025.100224","url":null,"abstract":"<p><p>The volume of shoulder arthroplasty (SA) procedures has increased significantly in recent years, outpacing the growth of hip and knee arthroplasty. As a relatively young area in orthopedics, shoulder arthroplasty offers many opportunities for innovation, often borrowing from established practices in other subspecialties. Degenerative shoulder pathology presents unique challenges that can be difficult to adequately address with conventional reconstructive methods alone. Currently, three-dimensional preoperative planning is the most widely utilized technology in shoulder arthroplasty. Implementation of patient-specific instrumentation is increasing, primarily for patients with severe deformity. Computer-assisted navigation, widely used in hip and knee reconstruction, is gaining traction. These technologies have demonstrated increased accuracy and precision in correcting glenoid deformity and implant positioning, which are known to influence the long-term performance of SA. However, studies specifically evaluating the long-term clinical benefits of these innovations are lacking. In the near future, the application of robotic and immersive technologies like augmented reality for SA demonstrates promise for enhancing the surgeon's ability to address glenoid deformity intraoperatively. These advancements provide exciting opportunities to transform the field of shoulder arthroplasty, yet they must be critically evaluated for their cost and impact to outcomes clinical cohorts with long-term follow-up.</p><p><strong>Level of evidence: </strong>Level V; Narrative Review.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100224"},"PeriodicalIF":0.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765278","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":"Walant in upper limb surgery- a three year experience from a tertiary institute.","authors":"Peerzada Umar Farooq Baba, Onkar Santoshkumar Kulkarni, Altaf Rasool, Mohsin Mir, Haroon Rashid Zargar, Yasir Mir, Raheeb Ahmad Shah, Eknath Jayapalan, Avinash Gundavarappu, Junaid Khurshid, Adil Bashir Sheikh, Adil Hafeez Wani","doi":"10.1016/j.jham.2025.100222","DOIUrl":"10.1016/j.jham.2025.100222","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100222"},"PeriodicalIF":0.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543677","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":"Experience in the surgical treatment of Dupuytren's disease using WALANT anesthesia.","authors":"María Solange Ferraguti, Gabriel Morano","doi":"10.1016/j.jham.2025.100218","DOIUrl":"10.1016/j.jham.2025.100218","url":null,"abstract":"<p><p>Fasciectomy is a surgical procedure frequently used for the treatment of Dupuytren's disease. The WALANT (Wide-Awake Local Anesthesia No-Tourniquet) anesthesia technique has gained popularity for its advantages over general anesthesia, such as risk reduction and cost savings. However, one of the main challenges is pain management and anesthetic efficacy during surgery. This study aims to evaluate the feasibility of this technique in pain management, patient experience, and cost savings in surgery for Dupuytren's disease. Prospective study that included patients treated surgically for Dupuytren's disease under WALANT anesthesia. Clinical history, number of affected fingers, and joint contracture were recorded, classifying them according to Tubiana. Anesthesia consisted of a mixture of 20 ml of 2 % lidocaine with epinephrine, 20 ml of 0.5 % bupivacaine, and 40 ml of saline solution, administered by ulnar nerve block and over the area of the cord to be resected, without using a hemostatic cuff. Variables such as pain during infiltration and surgical procedure, anxiety, surgery time, postoperative range of motion, and incidence of complications and recurrences were evaluated. The data were analyzed using descriptive methods and statistical analysis. 17 patients were prospectively evaluated. 64.7 % of patients managed to recover a full range of motion in the first four postoperative weeks, while 35.2 % had a partial range. Immediate complications were minimal, with only 5.8 % of patients developing local infections or minor hematomas, successfully resolved with conservative treatment. The recurrence rate was 11.7 % at six months. A cost analysis showed that the use of WALANT resulted in a cost saving of 60.6 % compared to general or regional anesthesia, making the technique an attractive option in healthcare systems with limited resources. The study reveals that the WALANT anesthetic technique for surgery for Dupuytren's disease provides effective pain management both during the injection and during the surgical procedure. This technique facilitates a relatively quick and comfortable recovery, offering an overall positive experience for patients. results suggest that WALANT may be an effective and precise option for the surgical procedure in Dupuytren's disease, with advantages in terms of pain control, cost savings, and favorable postoperative outcomes. Furthermore, it allows surgeons and patients to obtain immediate feedback on the dynamic outcome of cord release, which may improve subsequent dissection and rehabilitation.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100218"},"PeriodicalIF":0.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543735","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":"Nail bed grafting for the treatment of nail-complex injuries: A systematic review.","authors":"Amit Kumar Vyas, Sayantani Misra","doi":"10.1016/j.jham.2025.100219","DOIUrl":"10.1016/j.jham.2025.100219","url":null,"abstract":"<p><strong>Introduction: </strong>Nail-bed grafting is an accepted treatment for nail-bed defects of the fingernail. This study summarizes and analyses recent data on the outcomes associated with nail-bed grafting for nail-bed injuries at varying degrees of severity.</p><p><strong>Materials and methods: </strong>A literature search was conducted in the electronic databases(PubMed, MEDINE, EMBASE, SCOPUS) to extract articles published from March 1985 to March 2023. Studies reporting data on nail-bed injury treated with full or split thickness nail-bed grafting was included in the study. Extracted data consisted of demographic data, surgical technique, follow-up, outcomes and complications.</p><p><strong>Results: </strong>A total of 107 articles were identified, of which 6 studies were eligible for final inclusion comprising a total of 84 patients. The average age of patients was 28.87 years. The mean length of follow-up was 17 months. 2 studies reported excellent outcome in 12 patients as per Zook's criteria. The first nail appeared 3 weeks to 4 months after the surgery. 4 studies mentioned use of nail splint after the surgery reflecting the current practice trends. No major complications were reported in the studies.</p><p><strong>Conclusion: </strong>Nail-bed grafting can be a safe, effective technique for the treatment of nail-bed injuries in immediate and delayed setting. Results of nail-bed grafting indicate satisfactory outcome in carefully selected cohort of nail-bed injury patients.LEVEL OF EVIDENCE.V.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 2","pages":"100219"},"PeriodicalIF":0.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411213","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":"Role of Interrupted Horizontal Micromattress suturing for size discrepancies in free flap vessel anastomosis.","authors":"Gaurav Chaturvedi, Abhinav Singh, Ved Prakash Rao Cheruvu, Ashish Kumar Gupta, Manal Mohd Khan, Kanika Suhag","doi":"10.1016/j.jham.2025.100216","DOIUrl":"10.1016/j.jham.2025.100216","url":null,"abstract":"<p><strong>Aim: </strong>The study aimed to evaluate the effectiveness of the interrupted horizontal micro mattress suturing technique in anastomosing size-mismatched vessels during free flap surgeries.</p><p><strong>Material & method: </strong>The study included patients who underwent free flap surgery and encountered size disparities in vessels intraoperatively. The technique was applied to 24 patients with 28 mismatched blood vessels. Interrupted horizontal micro-mattress sutures were utilized to adjust the diameter mismatch between incongruent vessels. Each suture aimed to reduce the diameter of the larger vessel in comparison to the smaller vessel.</p><p><strong>Results: </strong>During free flap surgeries, the technique was successfully applied across various body regions, from head to toe. Out of the 28 vessels where anastomosis was performed using this technique, two patients experienced thrombosis. This technique enabled anastomosis of vessels with a size mismatched ratio up to 2:1.</p><p><strong>Conclusion: </strong>The interrupted micro mattress suturing technique proves to be a straightforward, secure, and dependable for addressing vessel size discrepancy up to 2:1. An additional benefit of this technique is its ability to circumvent the need for end-to-side repair, enhancing its utility in eversion of margins of repaired blood vessels and practicality in free flap surgeries.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 2","pages":"100216"},"PeriodicalIF":0.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411214","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.","authors":"Krishna D Unadkat, Isra Abdulwadood, Annika N Hiredesai, Carina P Howlett, Laura E Geldmaker, Shelley S Noland","doi":"10.1016/j.jham.2025.100217","DOIUrl":"10.1016/j.jham.2025.100217","url":null,"abstract":"<p><strong>Background: </strong>With advancements in artificial intelligence, patients increasingly turn to generative AI models like ChatGPT for medical advice. This study explores the utility of ChatGPT 4.0 (GPT-4.0), the most recent version of ChatGPT, as an interim diagnostician for common hand conditions. Secondarily, the study evaluates the terminology GPT-4.0 associates with each condition by assessing its ability to generate condition-specific questions from a patient's perspective.</p><p><strong>Methods: </strong>Five common hand conditions were identified: trigger finger (TF), Dupuytren's Contracture (DC), carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DQT), and thumb carpometacarpal osteoarthritis (CMC). GPT-4.0 was queried with author-generated questions. The frequency of correct diagnoses, differential diagnoses, and recommendations were recorded. Chi-squared and pairwise Fisher's exact tests were used to compare response accuracy between conditions. GPT-4.0 was prompted to produce its own questions. Common terms in responses were recorded.</p><p><strong>Results: </strong>GPT-4.0's diagnostic accuracy significantly differed between conditions (p < 0.005). While GPT-4.0 diagnosed CTS, TF, DQT, and DC with >95 % accuracy, 60 % (n = 15) of CMC queries were correctly diagnosed. Additionally, there were significant differences in providing of differential diagnoses (p < 0.005), diagnostic tests (p < 0.005), and risk factors (p < 0.05). GPT-4.0 recommended visiting a healthcare provider for 97 % (n = 121) of the questions. Analysis of ChatGPT-generated questions showed four of the ten most used terms were shared between DQT and CMC.</p><p><strong>Conclusions: </strong>The results suggest that GPT-4.0 has potential preliminary diagnostic utility. Future studies should further investigate factors that improve or worsen AI's diagnostic power and consider the implications of patient utilization.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 3","pages":"100217"},"PeriodicalIF":0.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504768","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":"Cost analysis of carpal tunnel release with local anesthesia vs sedation. A survey of the Argentinian Association of Hand Surgery.","authors":"Facundo Delgado, Francisco Príncipe, Verónica Andrea Alfie, Mariano Oscar Abrego, Fernando Holc, Pedro Bronenberg Victoria, Jorge Guillermo Boretto, Ignacio Rellan","doi":"10.1016/j.jham.2025.100215","DOIUrl":"10.1016/j.jham.2025.100215","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a conventional operating room (OR) with sedation. Additionally, we aimed to assess the anesthetic preferences of the Argentine Association of Hand and Upper Limb Reconstructive Surgery (AACM) members regarding CTR.</p><p><strong>Material and methods: </strong>This cross-sectional, single-center study involved analyzing specific hospital costs associated with each anesthesia technique in both surgical settings. A report was obtained from the OR chief of our institution. Additionally, an anonymous survey was conducted among certified and main AACM members, gathering data on: (1) practice location, (2) preferred anesthesia type for CTR and reasons for not using WALANT/AL-T regularly, (3) years of practice, (4) preferred CTR surgical technique, and (5) willingness to change anesthesia preference if offered differential fees.</p><p><strong>Results: </strong>Performing CTR with WALANT and AL-T in a procedure room resulted in cost savings of 64 % and 65 %, respectively, compared to sedation in a conventional OR. The average duration for CTR, including cleaning and turnover time, was 34 min (±3) for WALANT, 33 min (±4) for AL-T, and 55 min (±8) for sedation in a conventional operating room.Out of 226 AACM members, 95 (42 %) responded to the survey. Among them, 42 % practiced in Buenos Aires (CABA), and only 35 % preferred using local anesthesia for CTR (16 % WALANT, 19 % AL-T). Nearly half (49 %) had over 16 years of experience. All respondents favored open or mini-approach techniques for CTR. Those who did not use WALANT or AL-T cited discomfort with patient interaction and perceived lack of benefits as reasons. However, 31 % indicated they would change their anesthesia preference if offered differential fees.</p><p><strong>Conclusions: </strong>CTR with WALANT or AL-T in a procedure room reduces costs by over 65 % compared to sedation in a conventional OR. Despite cost benefits, sedation remains the predominant practice in Argentina, hindered by a lack of consensus and institutional incentives.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 2","pages":"100215"},"PeriodicalIF":0.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080808","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}