Journal of Hand and Microsurgery最新文献

{"title":"Blauth and Manske classifications for thumb hypoplasia.","authors":"Takehiko Takagi","doi":"10.1016/j.jham.2025.100323","DOIUrl":"10.1016/j.jham.2025.100323","url":null,"abstract":"<p><p>Blauth's and Manske's classifications of thumb hypoplasia are widely known. Although both are used, confusion has arisen-particularly regarding the term \"Blauth Type IIIB.\" Manske did not subdivide Blauth's Grade III; instead, he developed an independent classification system (Types I-V). Within this, Manske's Type III, defined as partial first metacarpal aplasia, was further divided into IIIA and IIIB. Blauth himself never used these subclassifications. In fact, Blauth's Grade II more closely corresponds to Manske's Type IIIA, and Blauth's Grade III to Manske's Type IIIB. Thus, the correct terminology is \"Manske Type IIIB,\" not \"Blauth Type IIIB,\" as the two systems are distinct. Since IIIA and IIIB imply different treatment strategies, they must be clearly distinguished. Surgeons must evaluate each case individually, as no classification is definitive, and future systems may better integrate both bony and soft tissue considerations.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100323"},"PeriodicalIF":0.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700019","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":"An unusual presentation of thumb hypoplasia.","authors":"Soumen Das De","doi":"10.1016/j.jham.2025.100322","DOIUrl":"10.1016/j.jham.2025.100322","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100322"},"PeriodicalIF":0.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683345","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":"A systematic review of surgical management for open fractures of the distal phalanx: What is the evidence?","authors":"Omar El Sewify, Gabriel Bouhadana, Elisabeth Lorange, Marion Sylvain, Panu H Nordback, Soumen Das De, Johnny I Efanov","doi":"10.1016/j.jham.2025.100318","DOIUrl":"10.1016/j.jham.2025.100318","url":null,"abstract":"<p><strong>Purpose: </strong>Open fractures of the distal phalanx are common injuries with the potential for significant complications, yet standardized treatment guidelines remain lacking. Surgical debridement and antibiotic administration are crucial steps in the management of open fractures, but the optimal timing and combination of these interventions remain uncertain. This systematic review evaluates the impact of surgical debridement timing and antibiotic administration on complications, including infections, malunion and non-union, physeal closure disturbances, and nail deformities, with a focus on differences between adult and pediatric population.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, a comprehensive literature search of Medline, Embase, and Cochrane Library was conducted. Studies examining open distal phalanx fractures treated with surgical debridement, with or without antibiotics, were included. Pediatric (<18 years) and adult (≥18 years) populations were analyzed separately, and subgroup analyses were performed based on treatment timing. Statistical comparisons utilized chi-squared tests with significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 24 studies, including 915 fractures, were analyzed. The average patient age was 16.48 years, with males comprising 78.1 %. Early debridement (<24 h) was performed in 91.0 % of cases. Pediatric patients had significantly higher complication rates than adults, particularly for infections and malunion/non-union. Infections rates were lowest when debridement occurred within 8 h and increased significantly with delays beyond 24 h (p < 0.00001). Antibiotic administration with surgical debridement was associated with lower infection rates, particularly in pediatric patients. Among pediatric fractures treated with delayed debridement (>24 h), those receiving antibiotics alone had significantly lower infection rates than those receiving both debridement and antibiotics (p = 0.009), suggesting potential preselection bias. Malunion/non-union was more frequent in pediatric patients and strongly associated with delayed intervention (>24 h). Nail deformities were most commonly seen in debrided fractures, emphasizing the importance of meticulous surgical technique.</p><p><strong>Conclusions: </strong>Early surgical debridement (<8 h) as the preferred management strategy for open distal phalanx fractures, minimizing infection and complication rates. Delayed debridement (>24 h) significantly worsened outcomes, particularly in pediatric patients. Antibiotic administration reduced infection rates but was not a substitute for timely debridement. These findings highlight the need for standardized treatment protocols and further comparative studies to optimize management strategies across different age groups.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100318"},"PeriodicalIF":0.7,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676081","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 cardiac evaluation in elective non-cardiac surgery in India: Routine ECG, echocardiography, and angiography are not mandatory.","authors":"Narayanee Rajasekaran, Shivanand S Patil","doi":"10.1016/j.jham.2025.100321","DOIUrl":"10.1016/j.jham.2025.100321","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preoperative cardiac testing aims to identify patients at risk of perioperative cardiovascular complications, but indiscriminate use of tests like electrocardiograms (ECGs), echocardiography (ECHO), and even coronary angiography in low-risk patients often provides little benefit. International guidelines (2024 American College of Cardiology/American Heart Association and 2022 European Society of Cardiology) now emphasize a selective, risk-based approach rather than routine screening. In India, clinicians face pressure - including medicolegal concerns - to order extensive preoperative investigations. This article provides an evidence-based framework, from an Indian perspective, to guide when preoperative ECG, transthoracic echocardiography (TTE), or angiographic evaluation are truly warranted for elective non-cardiac surgeries, strongly emphasizing that these tests are &lt;b&gt;not mandatory&lt;/b&gt; in every case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative review was conducted, synthesizing recommendations from the 2024 ACC/AHA Guideline for perioperative cardiovascular evaluation and the 2022 ESC Guideline on non-cardiac surgery, along with key studies and Indian practice insights. We focused on guideline-directed indications for preoperative ECG and ECHO, highlighting Class III recommendations (tests not recommended) versus scenarios where testing is appropriate. Evidence from randomized trials (e.g., CARP trial) and observational cohorts was reviewed to assess outcome impact of routine testing. Consideration was given to India-specific factors such as higher prevalence of cardiovascular disease and defensive medical practices. The findings were distilled into a decision algorithm and summary tables stratified by surgical risk and patient factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Routine preoperative ECG or ECHO in asymptomatic patients undergoing low-risk surgery (expected &lt;1 % 30-day Major Adverse Cardiac event risk) is not recommended (Class III, no benefit). The 2022 ESC guidelines do not recommend ECG even for intermediate risk surgeries in those who are asymptomatic and do not have pre existing heart disease (Class III). Unnecessary testing in low-risk situations did not improve outcomes and can lead to delays. For intermediate- or high-risk surgeries, a baseline ECG is reasonable, especially in patients with known cardiovascular disease (ACC/AHA Class IIa; ESC Class I). However, even for intermediate risk surgeries, an ECG is &lt;b&gt;not mandatory&lt;/b&gt; if the patient is asymptomatic and has good functional capacity and has no pre existing heart disease, aligning with 2024 ACC AHA and 2022 ESC guidance (Class III for low-risk patients) and a judicious approach. Preoperative TTE is indicated (Class I) for patients with active cardiac symptoms - for example, new or worsening heart failure signs, or a murmur suggestive of significant valvular disease. Patients with known cardiac dysfunction should have TTE only if there is a c","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100321"},"PeriodicalIF":0.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676087","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":"Thumb tip reconstruction for apical substance loss using a bipedunculated homodigital V-Y advancement FLAP: OUR experiences.","authors":"Francesco De Francesco, Andrea Marchesini, Olimpia Mani, Nicola Zingaretti, Pier Camillo Parodi, Michele Riccio","doi":"10.1016/j.jham.2025.100319","DOIUrl":"10.1016/j.jham.2025.100319","url":null,"abstract":"<p><strong>Introduction: </strong>The thumb plays a crucial role in hand biomechanics, particularly in fine and forceful grips. Due to its functional importance, trauma involving the thumb is frequent. In cases of pulp tissue loss, Moberg's 1964 principles for functional thumb reconstruction remain a cornerstone in hand surgery. Among the available techniques, the bipedunculated V-Y advancement flap, described by D. Elliot in 1993, offers a reliable solution for preserving length, restoring sensation, ensuring grip stability, and maintaining an aesthetically acceptable outcome.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 54 cases of thumb tip reconstruction using the bipedunculated V-Y advancement flap for apical substance loss ranging from 1.0 to 2.5 cm in length. Patients had a mean follow-up of two and five years. Functional and aesthetic outcomes were assessed using the Pinch Test, Weber and Semmens Test, Vancouver Scar Scale, QuickDASH questionnaire and Fingertip Injury Outcome Score. <i>Results</i>: Our statistical analysis confirms the reliability and versatility of this flap. No major or minor complications were recorded. The flap effectively addressed transverse and oblique defects up to 1.5 cm, providing excellent functional and cosmetic results.</p><p><strong>Conclusions: </strong>This study validates the bipedunculated V-Y advancement flap as an effective technique for thumb tip reconstruction, emphasizing the importance of adhering to fundamental principles of digital reconstruction. The procedure ensures excellent functional outcomes and high patient satisfaction.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100319"},"PeriodicalIF":0.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676089","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":"Association Between Area Deprivation Index and Narcotic Prescriptions, Wound Complications, and Reoperation Rates after Soft Tissue Hand and Wrist Surgery.","authors":"Arman Tabarestani, Marco Foreman, Oluwaferanmi Dada, Kevin A Hao, Keegan M Hones, Anton Khlopas, Jongmin Kim, Thomas W Wright","doi":"10.1016/j.jham.2025.100300","DOIUrl":"10.1016/j.jham.2025.100300","url":null,"abstract":"<p><strong>Background: </strong>The area deprivation index (ADI) is an outcome metric that quantifies socioeconomic status by stratifying neighborhoods based on zip code. The purpose of this study was to investigate the effect of national ADI rank on the amount of narcotics prescribed, wound complications, and reoperations after routine hand or wrist surgery.</p><p><strong>Methods: </strong>We conducted a retrospective review of adult patients undergoing routine hand or wrist soft tissue surgery between 2013 and 2022. Patients were included if they underwent routine hand or wrist surgeries. Patients were excluded for having concomitant lacerations, penetrating injuries, or fractures. Multivariable logistic regression was performed to determine whether national ADI is associated with the amount of narcotics prescribed, the incidence of wound complications, and reoperation rates after routine hand and wrist procedures independent of covariates.</p><p><strong>Results: </strong>We included 1389 patients. The mean age was 55 years and 65 % were female. The average national ADI rank was 65.6. The largest ADI decile group that was categorized was in the 70-79 rank (consistent with a highly economically disadvantaged group), with the national median being set at 50. Wound complications occurred in 2.9 % of patients (n = 40) and reoperations occurred in 2.5 % of patients (n = 35). Multivariable regression determined that national ADI rank was not associated with a difference in the amount of narcotics prescribed (P = .141), wound complications (P = .599), or reoperation rates (P = .141).</p><p><strong>Conclusions: </strong>National ADI rank was not associated with a significant difference in the amount of narcotics prescribed, wound complications, or reoperation rates.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100300"},"PeriodicalIF":0.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576608","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":"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":"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}

{"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":"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}