Journal of Hand and Microsurgery最新文献

{"title":"Challenges for Women in Hand Surgery: Our Perspective.","authors":"Julia A V Nuelle, Sonya P Agnew, Felicity G Fishman","doi":"10.1055/s-0042-1744209","DOIUrl":"10.1055/s-0042-1744209","url":null,"abstract":"<p><p>Over recent decades, the prevalence of women in surgical subspecialties has increased. There has been a significant rise in the percentage of women entering integrated plastic surgery programs and an increase, albeit smaller, in women entering orthopedic surgery training programs. Although female membership in the American Society for Surgery of the Hand has steadily increased, women remain in the vast minority within this professional society and many others within the field of hand surgery. In addition to underrepresentation in positions of leadership, women face challenges such as imposter syndrome, bullying, unfavorable work structure for work-family balance, macro and micro-aggressions, and lack of mentors at a higher rate than their male colleagues. As awareness rises of the additional challenges that women in hand surgery face, we must directly address them to improve equity within our subspecialty.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"258-260"},"PeriodicalIF":0.3,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495207/pdf/10-1055-s-0042-1744209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244496","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":"Surgical Anatomy and Exercises Using the Chicken Thigh Sciatic Nerve for Microsurgery Training.","authors":"Alphonsus K S Chong, Lan Anh T Le, Amitabha Lahiri, Khadijah Yusoff, George W Yip, Feng Pan, Wendy Teo, Janice C Y Liao, Jin Xi Lim","doi":"10.1055/s-0042-1749444","DOIUrl":"10.1055/s-0042-1749444","url":null,"abstract":"<p><p><b>Introduction</b>  Vessel repair in a chicken thigh is commonly used in microsurgery training model. The sciatic nerve is closely associated with the vessels and has been used for training nerve coaptation, which has different technical considerations from vessel anastomosis. We describe in detail the relevant surgical anatomy and training exercises that can be used with this model. <b>Methods</b>  With 32 fresh store-bought chicken thighs, 16 were used to analyze the gross and histological features of the sciatic nerve, and 16 were intended to create and perform training models. <b>Results</b>  The average visible length of the nerve in the thigh was 51 mm (standard deviation [SD] 2.57 mm). The average diameter of the nerve was 2 mm (SD 0.33 mm) and was largest at its proximal end (3.21 mm, SD 0.27 mm). The nerve consistently branched into two along the chicken thigh, with more branching subsequently. This simulation model is appropriate not only for the classical end-to-end epineural suture, but also for advanced exercises, in terms of longitudinal fasciculus dissection, mismatched size nerve transfer, injured nerve preparation, and vein conduit technique. Dyeing of nerve fascicles enhanced the visibility of nerve surface quality. <b>Conclusion</b>  The sciatic nerve in the chicken thigh is a suitable and accessible model for microsurgery training. The branching and fascicular patterns of the nerve lends itself well to both novice training and advanced simulation. We have incorporated this model into our training curricula.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 5","pages":"365-370"},"PeriodicalIF":0.3,"publicationDate":"2022-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049526","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 Development and Validation of Data Elements and Process Steps for an Electronic Health Record for Hand Surgery Outreach Trips.","authors":"Lauren M Shapiro, James Chang, Paige M Fox, Scott Kozin, Kevin C Chung, George S M Dyer, Duretti Fufa, Fraser Leversedge, Julie Katarincic, Robin Kamal","doi":"10.1055/s-0042-1749465","DOIUrl":"10.1055/s-0042-1749465","url":null,"abstract":"<p><p><b>Background</b>  The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips. <b>Methods</b>  We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step. <b>Results</b>  In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs. <b>Conclusion</b>  This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 5","pages":"358-364"},"PeriodicalIF":0.3,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049438","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":"Variations in Treatment and Costs for Distal Radius Fractures in Patients Over 55 Years of Age: A Population-Based Study.","authors":"Lauren M Shapiro, Michelle Xiao, Thompson Zhuang, David S Ruch, Marc J Richard, Robin N Kamal","doi":"10.1055/s-0042-1749460","DOIUrl":"10.1055/s-0042-1749460","url":null,"abstract":"<p><p><b>Objective</b>  To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction. <b>Methods</b>  We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost. <b>Results</b>  The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93-0.95]; <i>p</i>  < 0.01). The southern United States had the highest percentage of patients initially managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090 vs. $2,209 ± 5,940; <i>p</i>  < 0.01). <b>Conclusion</b>  The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 5","pages":"351-357"},"PeriodicalIF":0.3,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049439","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":"Flexor Tendon Pulley Injuries: A Systematic Review of the Literature and Current Treatment Options.","authors":"Stefano Artiaco, Francesco Bosco, Alessandro Lusso, Luigi Luca Cioffi, Bruno Battiston, Alessandro Massè","doi":"10.1055/s-0042-1749420","DOIUrl":"10.1055/s-0042-1749420","url":null,"abstract":"<p><p>Closed injuries of the finger flexor pulley system are rare among the general population, and most of them occur during rock climbing. During the last few decades, scientific interest on this topic has increased. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The research was limited from January 2000 to March 2022. PubMed and Scopus databases were investigated for full-text articles published in English, French, and Italian using the following MeSH terms: ([pulley rupture] OR [finger pulley lesion]) AND ([injur*] OR [ruptur*] OR [damage] OR [trauma*]). Initial screening results identified 461 studies, among which 172 were included after including additional records identified through other sources and excluding repeated studies. Finally, four clinical studies were included in the analysis. The methodological quality of the articles was evaluated through the methodological index for nonrandomized studies (MINORS) score. Our search identified four studies that enrolled a total of 189 patients, of whom 164 were male and 25 were female. We finally examined 154 patients with a total of 208 pulleys damaged. Except for the thumb, all fingers were involved. Depending on the type of flexor pulley injury, graded with Schöffl classification, 69 patients underwent a surgical procedure, whereas 85 patients were treated conservatively. Closed finger pulleys injury occurred in rock climbers and non - rock climbers. All patients had excellent results on the Buck-Gramcko score regardless of the return to sports activity. Considering the overall outcomes of the reviewed articles, functional results were satisfactory in both conservative and surgical treatment. Moreover, in grade 3 and 4, surgical results were positive regardless of the specific technique used for finger pulley reconstruction. Only minor complications were reported. Closed flexor tendon pulley injuries require a careful clinical and imaging examination to confirm the diagnosis. In most cases, positive clinical results can be achieved with either conservative or surgical therapy.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"247-252"},"PeriodicalIF":0.3,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495204/pdf/10-1055-s-0042-1749420.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295042","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":"International Residents' Perspectives on Education and Challenges in Microsurgery Training.","authors":"Camelia Qian Ying Tang, Benedicta Seeli S, Clelia Rugiero, Rocío Belén Perez Heredia, Marie Kearns, Tony C T Huang, Mahmoud Mohamed Shaker, Johannes Glasbrenner, Turan Mehdizade, Nikhil Panse, Eric Santamaria, Charly Chen, J Terrence Jose Jerome","doi":"10.1055/s-0042-1744211","DOIUrl":"10.1055/s-0042-1744211","url":null,"abstract":"<p><p><b>Objective</b>  Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. <b>Methods</b>  The <i>Journal of Hand and Microsurgery</i> leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. <b>Results</b>  Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. <b>Conclusion</b>  Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents. <b>Level of Evidence</b>  Level V.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"295-298"},"PeriodicalIF":0.3,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495202/pdf/10-1055-s-0042-1744211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295043","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":"Metallosis Following Titanium Implant Use in the Hand: A Case Report and Review of Current Literature.","authors":"Camelia Qian Ying Tang, Khoon Leong Chuah, Lam Chuan Teoh","doi":"10.1055/s-0042-1748762","DOIUrl":"10.1055/s-0042-1748762","url":null,"abstract":"<p><p>Adverse reaction to metal debris (ARMD) consists of a spectrum of changes ranging from pure metallosis to aseptic lymphocytic vasculitis-associated lesion and granulomatous inflammation. Currently described ARMD cases are mainly limited to arthroplasty, typically total hip and knee arthroplasties in the lower limb and total wrist arthroplasty in the upper limb. Hypersensitivity to a metallic implant in fracture fixation is rare, and a severe form of metallosis has not been reported so far. In this paper, we present a case of ARMD occurring 10 years after the use of titanium implants for fracture fixation in the hand. Intra-operative findings, histopathological results, and a literature review on ARMD are also described.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"318-321"},"PeriodicalIF":0.3,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495208/pdf/10-1055-s-0042-1748762.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244498","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":"Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis.","authors":"Janna S E Ottenhoff, David Ring, Aebele B Mink van der Molen, J Henk Coert, Teun Teunis","doi":"10.1055/s-0042-1748879","DOIUrl":"10.1055/s-0042-1748879","url":null,"abstract":"<p><p><b>Background</b>  There is notable evidence that unhelpful thoughts (symptoms of anxiety and depression) increase symptom intensity among patients with trapeziometacarpal osteoarthritis (TMC OA). Surgeons may or may not be mindful of this line of evidence when interacting with patients. In a survey-based experiment, we randomized surgeons to be prompted about the psychosocial aspects of TMC OA. We aimed to measure the influence of mindfulness of mental health on treatment recommendations and willingness to discuss mental health interventions. <b>Methods</b>  We randomized 121 hand surgeons to read one of two paragraphs: (A) about biomedical treatment options for TMC OA, or (B) about the impact of mental and social aspects on TMC OA. Thereafter, surgeons were asked several questions about their opinions and treatment recommendations. <b>Results</b>  We found that prompting surgeons with information about the psychosocial aspects of TMC OA did not influence their attitudes or treatment recommendations. Most surgeons were willing to offer patients a workbook (92%) or psychologist referral (84%). Among the few surgeons declining to refer, their reasoning was \"it would not be of any help\" and \"stigmatization.\" <b>Conclusion</b>  The observation that a paragraph to encourage mindfulness about the psychosocial aspects of TMC OA, which had no influence on surgeon opinions, suggests that awareness may not be a major factor accounting the relatively limited implementation of this evidence in practice to date. Surgeons seem aware of the importance of psychological influence and barriers may include availability, stigma, and a sense of futility. This is a diagnostic study that reflects level of evidence III.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"14 4","pages":"315-321"},"PeriodicalIF":0.3,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9666062/pdf/10-1055-s-0042-1748879.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9600294","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":"Preoperative Expectations in Hand Surgery Patients.","authors":"Patrick M J Sajak, Samir Kaveeshwar, Ali Aneizi, Alexander Hahn, Cameran I Burt, Dominic J Ventimiglia, Kali N Stevens, Ngozi M Akabudike, Raymond A Pensy, R Frank Henn Iii","doi":"10.1055/s-0042-1748782","DOIUrl":"10.1055/s-0042-1748782","url":null,"abstract":"<p><p><b>Introduction</b>  Studies have shown a link between patients' preoperative expectations and their postoperative satisfaction. However, limited studies exist concerning patient factors associated with higher preoperative expectations in the hand surgery population. This study analyzed preoperative expectation scores of patients undergoing hand surgery and aimed to determine associated patient characteristics. <b>Materials and Methods</b>  A total of 418 elective hand surgery patients aged 15 years and older enrolled in a prospectively collected orthopaedic registry from June 2015 to December 2018 were analyzed. Patients were administered preoperative questionnaires including six Patient-Reported Outcome Measurement Information System domains and other activity and pain scales. Expectation scores were measured using the six domains of the Musculoskeletal Outcomes Data Evaluation and Management System expectations questionnaire. Bivariate and multivariable analyses were conducted to identify independent predictors of higher expectations. <b>Results</b>  Overall, patients had high expectations (≥ 80.0) of their hand surgery. Higher mean expectation scores were seen with females, college graduates, better baseline health status, and fewer prior hand surgeries ( <i>p</i>  < 0.05 for all). No significant associations were found among the Common Procedural Terminology codes and expectations. Multivariable analysis confirmed that college degree ( <i>p</i>  = 0.023) and less pain ( <i>p</i>  = 0.008) were predictive of higher baseline expectations. <b>Conclusion</b>  In sum, more educated patients with less pain at baseline and better baseline health status have higher expectations of their hand surgery. Hand surgeons can use these results to help focus their preoperative counseling and expectation management.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"299-307"},"PeriodicalIF":0.3,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495209/pdf/10-1055-s-0042-1748782.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295038","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":"Variation in the Index Finger Vascular Pedicle in a Case of Congenital Hypoplasia of the Thumb.","authors":"Harsh R Shah, Eldy Pereira, Amita Hiremath, Mukund R Thatte","doi":"10.1055/s-0042-1748765","DOIUrl":"10.1055/s-0042-1748765","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 4","pages":"322-324"},"PeriodicalIF":0.3,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495213/pdf/10-1055-s-0042-1748765.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242945","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}