Ali Engin Daştan, Omar Aljasim, Rüstem Celil, Yavuz Önel, Arman Vahabi
{"title":"A technical modification to avoid accidental graft drop during hemihamate osteochondral graft harvesting.","authors":"Ali Engin Daştan, Omar Aljasim, Rüstem Celil, Yavuz Önel, Arman Vahabi","doi":"10.1016/j.jham.2025.100301","DOIUrl":"10.1016/j.jham.2025.100301","url":null,"abstract":"<p><p>During graft harvesting for hemihamate arthroplasty, one potential intraoperative complication is accidental graft drop. In this technique, we present a technical modification designed to prevent inadvertent graft drop during the harvesting process. During hemihamate graft harvesting, after adequate exposure of hamate, dorsal cuts are made with a saw blade. Based on preference, a K-wire is placed dorsally into either the radial or ulnar half of the graft, taking into consideration its use as a guide for future screw placement. The wire is held by an assistant. The K-wire diameter is selected to correspond with the intended screw; in the authors' technique, a 1.0 mm K-wire is used as a guide when 1.2 mm screws are planned. The wire is advanced to an appropriate depth, ensuring it will not interfere with subsequent cuts made by saw or osteotome. The initial cut is made using a saw blade, and graft removal is completed with an osteotome. The pre-positioned K-wire prevents the graft from inadvertently falling. Once retrieved, the graft is shaped as needed, and drilling is completed through the K-wire entry point before definitive fixation is achieved using screws.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100301"},"PeriodicalIF":0.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660631","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":"Institutional perspectives on the routine use of Interrupted Horizontal Micro-Mattress (IHMM) suturing in microvascular anastomosis.","authors":"Subhendu Khan, Varun Saini, Sanujit Apurv Pawde","doi":"10.1016/j.jham.2025.100299","DOIUrl":"10.1016/j.jham.2025.100299","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100299"},"PeriodicalIF":0.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676083","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":"Remplissage with Bankart repair in \"on track\" lesions are safe, re-assuring, and without major complications - a comparative analysis among 80 patients.","authors":"Senthilvelan Rajagopalan, Karthikraj Kuberakani, Raghuram Sista, Baskar Krishnakanth, Girinivasan Chellamuthu, Sathish Muthu","doi":"10.1016/j.jham.2025.100302","DOIUrl":"10.1016/j.jham.2025.100302","url":null,"abstract":"<p><strong>Background: </strong>The current recommendation for remplissage is the 'Off Track' Hill-Sachs lesion. But it is a relatively safe procedure that might reduce the risk of redislocation even in on-track lesions. This study aims to compare and analyse the safety and functional outcomes of Bankart repair without (BR) and with remplissage (BRR) in patients with on-track Hill Sachs lesions without bone loss in the glenoid in a non-athletic population.</p><p><strong>Methods: </strong>This is a retrospective analysis of prospectively collected data in patients who underwent arthroscopic Bankart repair with and without remplissage for on-track Hill Sachs lesion. The outcome scores used were the Oxford and Rowe scores. External rotation deficit and incidence of posterior shoulder pain were noted. Redislocation and re-operation rates, and complications were analyzed.</p><p><strong>Results: </strong>We included 80 patients with a mean age of 28.8 (±7.3) years who underwent arthroscopic Bankart repair with (n = 24) and without remplissage (n = 56) for on-track Hill Sachs lesion. We found that both Oxford score (p < 0.001) and Rowe score (p < 0.001) were significantly higher in the BRR group compared to the BR group at 2-year follow-up. We noted comparable complications between the two groups.</p><p><strong>Conclusions: </strong>Routine utilization of remplissage for 'On Track' Hill Sachs lesion, along with Bankart repair, is safe and results in better functional outcomes and comparable complications. However, longer follow-up is needed to look out for any late complications associated with routine utilization.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100302"},"PeriodicalIF":0.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676088","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}
Mikko P Räisänen, Mikael S Hytönen, Yrjänä A Nietosvaara, Matti T Juntunen
{"title":"Managing complex hand, wrist, and forearm injuries with WALANT: A case-based technical report.","authors":"Mikko P Räisänen, Mikael S Hytönen, Yrjänä A Nietosvaara, Matti T Juntunen","doi":"10.1016/j.jham.2025.100295","DOIUrl":"10.1016/j.jham.2025.100295","url":null,"abstract":"<p><p>Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is an effective and increasingly utilised method of anaesthesia for the surgical treatment of injuries to the hand, wrist, and forearm. Despite its proven safety, efficacy, and cost-effectiveness, the adoption of WALANT has been limited, particularly in Western healthcare systems where general and regional anaesthesia predominate, especially in complex injuries. We report the application of WALANT in a variety of hand surgical procedures for the treatment of complex injuries ranging from complex fractures to multiple soft tissue injuries in adult patients. WALANT's benefits includes active intraoperative testing of the strength of tendon repairs and osteosynthesis which applies also to complex injuries. Additionally, nerve repairs can also be actively tested under WALANT, leading to more effective and safer postoperative rehabilitation. We anticipate that WALANT will soon see broader application even in more complex surgeries, extending to the surgical treatment of complex injuries around and above elbow.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100295"},"PeriodicalIF":0.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676084","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":"Knacks and pitfalls for superficial circumflex iliac artery perforator flap.","authors":"Shigeki Ishibashi, Toko Miyazaki, Maya Kanasaki, Reiko Tsukuura, Chihiro Matsui, Nana Yamamoto, Takumi Yamamoto","doi":"10.1016/j.jham.2025.100296","DOIUrl":"10.1016/j.jham.2025.100296","url":null,"abstract":"<p><strong>Purpose: </strong>To review the utility of the Superficial Circumflex Iliac Artery Perforator (SCIP) flap for a wide range of defect reconstructions, emphasizing the groin's vascular anatomy, relevant anatomical variations, and recent advancements overcoming traditional groin flap limitations.</p><p><strong>Methods: </strong>Based on a literature review, anatomical knowledge, and clinical experience, this article summarizes the variations of the superficial circumflex iliac artery (SCIA), surgical techniques for SCIP flap harvesting, and the role of preoperative color Doppler ultrasound mapping for safe and efficient flap elevation.</p><p><strong>Results: </strong>The SCIA displays significant anatomical variations, necessitating thorough preoperative assessment for successful flap harvest. The perforator flap concept and supermicrosurgery have addressed the challenges of the traditional groin flap's short, small pedicle, making the SCIP flap a more reliable option. The SCIP flap offers remarkable versatility by potentially including multiple tissues-skin, fat, lymphatic vessels, lymph nodes, deep fascia, sartorius muscle, lateral femoral cutaneous nerve, and iliac bone-allowing its use as a chimeric flap for a broad spectrum of defects, ranging from simple to complex.</p><p><strong>Conclusions: </strong>With a comprehensive understanding of groin vascular anatomy and appropriate preoperative evaluation, including color Doppler ultrasound, the SCIP flap is a reliable and highly versatile reconstructive tool. Its ability to incorporate various tissues and minimal donor site morbidity, with scars concealable under clothing, make it an excellent choice for various reconstructive challenges.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100296"},"PeriodicalIF":0.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561463","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":"Anatomical morphometry of the proximal humerus in the Vietnamese population: A comparative study using multiplanar computed tomography and cadaveric dissection.","authors":"Thy Gia Anh Le, Nguyen Tri Phan, Phi Duong Nguyen","doi":"10.1016/j.jham.2025.100294","DOIUrl":"10.1016/j.jham.2025.100294","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the proximal humerus are prevalent among the elderly, often posing challenges in anatomical reconstruction and internal fixation. Precise anatomical knowledge tailored to specific populations is essential for optimal surgical outcomes. This study aims to quantitatively evaluate the anatomical characteristics of the proximal humerus in the Vietnamese population through multiplanar computed tomography (CT) and cadaveric measurements, and to determine the consistency between the two modalities.</p><p><strong>Methods: </strong>A prospective descriptive study was conducted on 75 CT scans and 30 shoulder specimens from 15 fresh cadavers. Parameters measured included the neck-shaft angle, diameters of the humeral head (superior-inferior and anterior-posterior), width of the greater tuberosity, deltoid tuberosity index, and distances from the greater tuberosity to anatomical landmarks such as the lesser tuberosity, bicipital groove, and pectoralis major insertion.</p><p><strong>Results: </strong>The average neck-shaft angle was 132.36° ± 2.44°, with most values within 130°-140°. The deltoid tuberosity index averaged 1.76 ± 0.20, exceeding thresholds reported in previous studies. No statistically significant differences were found between CT and cadaveric measurements across most parameters (p > 0.05). The anatomical measurements were found to be smaller than those reported in Western populations but comparable to other Asian populations.</p><p><strong>Conclusion: </strong>The study confirms that CT imaging provides reliable and accurate morphometric data comparable to cadaveric dissection. Key anatomical landmarks such as the pectoralis major insertion, lesser tuberosity, and bicipital groove can serve as consistent intraoperative references for implant positioning in Vietnamese patients.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100294"},"PeriodicalIF":0.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555294","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}
Rishub K Das, Brian C Drolet, Wesley P Thayer, Izabela A Galdyn
{"title":"National trends in bone supplement use and vitamin D deficiency - implications for upper extremity surgery.","authors":"Rishub K Das, Brian C Drolet, Wesley P Thayer, Izabela A Galdyn","doi":"10.1016/j.jham.2025.100298","DOIUrl":"10.1016/j.jham.2025.100298","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100298"},"PeriodicalIF":0.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555296","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}
Berk B Ozmen, Nishant Singh, Kavach Shah, Ibrahim Berber, Damanjit Singh, Eugene Pinsky, Antonio Rampazzo, Graham S Schwarz
{"title":"Development of a novel artificial intelligence clinical decision support tool for hand surgery: HandRAG.","authors":"Berk B Ozmen, Nishant Singh, Kavach Shah, Ibrahim Berber, Damanjit Singh, Eugene Pinsky, Antonio Rampazzo, Graham S Schwarz","doi":"10.1016/j.jham.2025.100293","DOIUrl":"10.1016/j.jham.2025.100293","url":null,"abstract":"<p><strong>Purpose: </strong>Hand surgery decision-making requires integration of complex anatomical understanding, diverse patient-specific factors, and nuanced operative techniques. While artificial intelligence (AI), large language models (LLMs), and retrieval-augmented generation (RAG) models have advanced significantly in various fields, no AI-driven clinical decision support systems currently exist for hand surgery. A novel retrieval-enhanced AI large language model specifically tailored for hand surgery was developed, capable of effectively utilizing peer-reviewed published hand surgery literature for clinical decision support in real-time at point of care.</p><p><strong>Methods: </strong>An AI clinical decision support system was developed integrating all available open-access 4510 peer-reviewed hand surgery publications from 2000 to 2024 identified through hand surgery-relevant keywords. Documents were processed using a hierarchical pipeline based on the RAPTOR methodology, which breaks down large texts into smaller segments to enhance accurate retrieval. The system was evaluated using 15 standardized clinical queries assessed using automated computational metrics for correctness and semantic similarity to source documents.</p><p><strong>Results: </strong>The AI system demonstrated consistent performance with an average G-Eval correctness score of 0.79, SEM with an average similarity score of 0.75 (range: 0.54-0.86) and average maximum similarity score of 0.80 (range: 0.56-0.91), predominantly at moderate confidence levels. Generated recommendations were contextually appropriate and reliably linked to relevant hand surgery literature, providing accurate and clinically meaningful guidance.</p><p><strong>Conclusion: </strong>The AI system, HandRAG, incorporating RAG and LLM approach offers potential benefits for evidence-based clinical decision support and education in hand surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100293"},"PeriodicalIF":0.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555295","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}
Rae Tarapore, Sierra Lindsey, Anand M Murthi, Ryan A Hoffman
{"title":"Advances in shoulder surgical education. What are the realities?","authors":"Rae Tarapore, Sierra Lindsey, Anand M Murthi, Ryan A Hoffman","doi":"10.1016/j.jham.2025.100290","DOIUrl":"10.1016/j.jham.2025.100290","url":null,"abstract":"<p><p>There has been a robust increase in innovations seen in education in the field of shoulder and elbow surgery over the past few years. This is evident through the introduction of new technologies, teaching techniques, and online platforms. Of particular significance is the introduction of augmented reality (AR), mixed reality (MR), and virtual reality (VR). Furthermore, the expansion of online platforms, offering online attendance to courses, conferences, and video libraries (AAOS OVT, vumedi) allow for enhanced exposure and education to orthopedic topics and surgical procedures. These have expanded learning from conventional in person training and conferences to a newer age digital presence. This review aims to provide an overview towards advancements in educational opportunities in shoulder and elbow surgery both to the surgeon, and trainees.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100290"},"PeriodicalIF":0.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676082","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":"Reliability and validity of Camry dynamometer for isometric hand grip strength measurement in healthy Indian adults.","authors":"Vrushali Panhale, Raveena Kini, Shreya Kothale","doi":"10.1016/j.jham.2025.100291","DOIUrl":"10.1016/j.jham.2025.100291","url":null,"abstract":"<p><strong>Background: </strong>The Jamar dynamometer is the gold standard to assess hand grip strength, but is expensive. The Camry dynamometer is relatively cost-effective. There is a dearth of literature on Camry's validation in healthy Indian adults, which is important to establish as hand grip is known to vary with age, gender and race.</p><p><strong>Objectives: </strong>To establish the reliability and validity of the Camry dynamometer in comparison to the Jamar handheld dynamometer among healthy Indian adults in the age group of 20-59 years.</p><p><strong>Methods: </strong>Following basic demographics, occupation and hand dominance, three trials of each dynamometer were performed in standardised positions for the non-dominant and dominant hand of each participant and the best value was recorded. A gap of 10 min was provided between the 2 dynamometers. Data was then recorded and analyzed.</p><p><strong>Results: </strong>120 participants were recruited, with an equal males and females. The mean isometric hand grip strength for the non-dominant hand was 26.71 ± 9.29 kgf, and for the dominant hand was 27.66 ± 9.12 kgf using the Camry hand-held dynamometer, while it was 26.43 ± 9.07 kgf for the non-dominant and 27.37 ± 9.26 kgf for the dominant side using the Jamar Hand Held dynamometer. Data was further analyzed with age and gender stratification. The Camry hand-held device had excellent reliability (ICC>0.97) and good validity with Pearson's correlation index of 0.97 (p < 0.05) for the dominant hand and 0.99 (p < 0.05) for the nondominant hand, and Bland-Altman's graphics showing more than 90 % of measures within confidence limits.</p><p><strong>Conclusion: </strong>Camry digital dynamometer is a reliable and valid device to measure isometric handgrip strength in healthy Indian adults compared to the Jamar hydraulic handgrip dynamometer.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100291"},"PeriodicalIF":0.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530303","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}