Journal of Hand and Microsurgery最新文献

{"title":"Phalangeal and Metacarpal Fractures in Children: A 10-Year Comparison of Factors Affecting Functional Outcomes in 313 Patients.","authors":"Ailbhe L Kiely, Michelle Griffin, Faith Hyun Kyung Jeon, Grant S Nolan, Peter E Butler","doi":"10.1055/s-0041-1730885","DOIUrl":"10.1055/s-0041-1730885","url":null,"abstract":"<p><p><b>Introduction</b>  It is widely believed that fractures in children have excellent clinical outcomes due to their capacity to remodel. There are, however, certain fractures that require careful management to avoid long-lasting functional impairment. Functional outcomes following hand fractures in children are poorly studied. <b>Materials and Methods</b>  We performed a retrospective cohort study of consecutive children and adolescents who had operative treatment for metacarpal and phalangeal fractures (2008-2018). Tuft fractures and replantations were excluded. Functional outcomes were measured by total active motion (TAM) scoring, where a \"good\" outcome = TAM > 75%. Fractures were categorized by location, classification, and by the fixation they required. <b>Results</b>  Three hundred thirteen children were included. For proximal phalangeal fractures, those treated by manipulation under anesthesia, had a higher proportion of \"good\" functional outcomes than Kirschner-wire or open reduction internal fixation at discharge from hand therapy ( <i>p</i>  = 0.043). Middle phalanx fractures had excellent functional outcomes, with no difference between fixation methods ( <i>p</i>  = 0.81). For metacarpals, there was no statistically significant difference in functional outcomes across all managements ( <i>p</i>  = 0.134). Fractures in the thumb had poorer postoperative function at mean 7.26 weeks than those in the long fingers ( <i>p</i>  < 0.0001), and the data suggested a trend toward worse outcomes in the distal phalanx, pediatric Bennett fractures, Seymour fractures, and oblique fractures. <b>Conclusions</b>  Fractures in the thumb and phalangeal fractures that require percutaneous or open fixation may need closer early postoperative monitoring in children to optimize their potential for good function.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 2","pages":"124-132"},"PeriodicalIF":0.3,"publicationDate":"2021-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/3f/10-1055-s-0041-1730885.PMC10069998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9299930","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":"Running Interlocking Horizontal Mattress-A New Technique versus Modified Kessler in Extensor Tendon Injuries: A Comparative Study.","authors":"Rohit Shaju, Sunil Sharma, Kshiteej Dhull","doi":"10.1055/s-0041-1727297","DOIUrl":"10.1055/s-0041-1727297","url":null,"abstract":"<p><p><b>Introduction</b>  Pursuit for a new technique, which could be placed on flat extensor tendons and strong enough to withstand the tension forces of early mobilization to prevent stiffness, started few decades ago. We evaluated the new technique of tendon repair using running interlocking horizontal mattress (RIHM) sutures followed by early controlled motion protocol in traumatic extensor tendon injuries and compared it to modified Kessler technique. <b>Materials and Methods</b>  We conducted a prospective randomized interventional study of 18 months' duration, with 30 patients. A total of 103 tendons were repaired, of which 58 were repaired using modified Kessler technique and 45 were repaired using RIHM technique. Postoperatively, patients underwent the early controlled motion protocol and the results were evaluated using the criteria of Miller. <b>Results</b>  Majority of the patients had excellent results (53.3%) and 46.67% had good results in the RIHM group while most of the patients in modified Kessler group had only fair results (80%), and only 20% had good results while none had excellent results. <b>Conclusion</b>  RIHM suture is an easy-to-learn and effective technique for tendon repair with comparable operative duration and with better overall result than modified Kessler technique.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 1","pages":"59-66"},"PeriodicalIF":0.3,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904974/pdf/10-1055-s-0041-1727297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10685331","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":"Delayed Extensor Pollicis Longus Rupture after Distal Radius Fracture in a Pediatric Patient.","authors":"Nicholas Munaretto, Nicholas J Clark, Sanjeev Kakar","doi":"10.1055/s-0041-1727298","DOIUrl":"10.1055/s-0041-1727298","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"15 3","pages":"240-241"},"PeriodicalIF":0.3,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10306975/pdf/10-1055-s-0041-1727298.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736059","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":"Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome.","authors":"Nikolaos Karamanis, Georgia Stamatiou, Dionysia Vasdeki, Nikolaos Sakellaridis, Konstantinos C Xarchas, Sokratis Varitimidis, Zoe H Dailiana","doi":"10.1055/s-0040-1709087","DOIUrl":"10.1055/s-0040-1709087","url":null,"abstract":"<p><p><b>Introduction</b>  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. <b>Materials and Methods</b>  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. <b>Results</b>  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. <b>Conclusion</b>  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"95-100"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/bc/10-1055-s-0040-1709087.PMC8041500.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38889999","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":"Factors Associated with Increased Risk of Recurrence following Treatment of Trigger Finger with Corticosteroid Injection.","authors":"Frederik Flensted, Claus Hjorth Jensen, Henrik Daugaard, Jens-Christian Vedel, Rasmus Wejnold Jørgensen","doi":"10.1055/s-0040-1719228","DOIUrl":"10.1055/s-0040-1719228","url":null,"abstract":"<p><p><b>Introduction</b>  The aim of the study was to estimate recurrence rates, time to recurrence, and predisposing factors for recurrence of trigger finger when treated with corticosteroid (CS) injection as primary treatment. <b>Materials and Methods</b>  In a retrospective chart review, we identified primary trigger fingers treated with CS injection as primary treatment. Affected hand and finger, recurrence, time to recurrence, duration of symptoms, secondary treatment type, and comorbidities were recorded. A total of 539 patients were included with a mean follow-up of 47.6 months <b>Results</b>  In total, 330/539 (61%) recurrences were registered. Mean time to recurrence was 312 days. Increased risk of recurrence was seen after treatment of the third finger (relative risk [RR]: 1.22; 95% confidence interval [CI]: 1.06-1.39). Several comorbidities were associated with increased risk of recurrence: carpal tunnel syndrome (RR: 1.27; 95% CI: 1.07-1.52), thyroid disease (RR: 1.45; 95% CI: 1.15-1.83), or shoulder diseases (RR: 1.58; 95% CI: 1.36-1.83). <b>Conclusion</b>  We found a recurrence rate after primary treatment of CS injection for trigger finger of 61%. Most recurrences happened within 2 years and we found treatment of third finger, carpal tunnel syndrome, shoulder, or thyroid disease to be associated with an increased risk of recurrence of symptoms.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"109-113"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/f5/10-1055-s-0040-1719228.PMC8041498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38890001","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":"Polyethylene Glycol Fusion of Nerve Injuries: Review of the Technique and Clinical Applicability.","authors":"Duncan S Van Nest, David M Kahan, Asif M Ilyas","doi":"10.1055/s-0040-1718651","DOIUrl":"10.1055/s-0040-1718651","url":null,"abstract":"<p><p>Traumatic peripheral nerve injuries present a particular challenge to hand surgeons as mechanisms of nerve-healing pose serious limitations to achieving complete functional recovery. The loss of distal axonal segments through Wallerian degeneration results in the loss of neuromuscular junctions and irreversible muscle atrophy. Current methods of repair depend on the outgrowth of proximal nerve fibers following direct end-to-end repair or gap repair techniques. Investigational techniques in nerve repair using polyethylene glycol (PEG) nerve fusion have been shown to bypass Wallerian degeneration by immediately restoring nerve axonal continuity, thus resulting in a rapid and more complete functional recovery. The purpose of this article is to review the current literature surrounding this novel technique for traumatic nerve repair, paying particular attention to the underlying physiology of nerve healing and the current applications of PEG fusion in the laboratory and clinical setting. This article also serves to identify areas of future investigation to further establish validity and feasibility and encourage the translation of PEG fusion into clinical use.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"49-54"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/19/10-1055-s-0040-1718651.PMC8041495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38884572","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":"Thirty-Day Outcomes following Upper Extremity Flap Reconstruction.","authors":"Thomas Wright, Daniel Donato, Jacob Veith, David Magno-Padron, Jayant Agarwal","doi":"10.1055/s-0040-1715557","DOIUrl":"10.1055/s-0040-1715557","url":null,"abstract":"<p><p><b>Introduction</b>  Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications. <b>Materials and Methods</b>  The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications. <b>Results</b>  On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations. <b>Conclusion</b>  There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"101-108"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f2/15/10-1055-s-0040-1715557.PMC8041497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38890000","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":"Trapeziectomy and Abductor Pollicis Longus Suspensionplasty Combined with Extensor Pollicis Brevis Tenodesis for Management of Thumb Basal Joint Osteoarthritis and Metacarpophalangeal Hyperextension.","authors":"Mohamed Maklad, Ravi Mallina, Tommy R Lindau","doi":"10.1055/s-0040-1713584","DOIUrl":"10.1055/s-0040-1713584","url":null,"abstract":"<p><p>Metacarpal joint hyperextension is common cause of postoperative dissatisfaction after trapeziectomy in the management of basal thumb osteoarthritis. The senior author uses this technique to address this biomechanical problem at the time of trapeziectomy.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"114-118"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/ef/10-1055-s-0040-1713584.PMC8041503.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38890002","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":"Psychiatric Disease after Isolated Traumatic Upper Extremity Amputation.","authors":"Shirley Shue, Yuewei Wu-Fienberg, Kyle J Chepla","doi":"10.1055/s-0040-1701156","DOIUrl":"10.1055/s-0040-1701156","url":null,"abstract":"<p><p><b>Introduction</b>  Psychiatric disease after traumatic limb loss impacts rehabilitation, prosthesis use, and quality of life. The purpose of this study was to evaluate the prevalence of psychiatric disease in civilians after isolated, traumatic upper extremity amputation and determine if any risk factors are associated with developing psychiatric disease. <b>Materials and Methods</b>  Demographics, time since injury, mechanism of injury, amputation level, hand affected (dominant vs. nondominant), Bureau of Workers' Compensation (BWC) status, and prosthesis use were retrospectively reviewed for all patients treated from 2012 to 2017. For patients with an International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnosed psychiatric disease, the diagnosis and length of treatment were recorded. Patients were grouped by presence or absence of psychiatric diagnosis and data analysis was performed using descriptive statistics, Fisher's exact test, and relative risk. <b>Results</b>  Forty-six patients met the inclusion criteria. Thirty-one patients (67.4%) had at least one diagnosed psychiatric condition. Major depressive disorder was the most common ( <i>n</i> = 14), followed by posttraumatic stress disorder ( <i>n</i> = 11), adjustment disorder ( <i>n</i> = 11), anxiety ( <i>n</i> = 6), and panic disorder ( <i>n</i> = 2). No statistically significant correlation was seen between psychiatric illness and gender, age at the time of injury, time since injury, current employment status, BWC status, hand injured (dominant vs. nondominant), prosthetic use, or level of amputation. <b>Conclusion</b>  The rates of depression and anxiety after traumatic upper limb loss in the civilian population are similar to reported rates after combat injury. While we were unable to identify a statistically significant association with any of the studied variables, upper extremity surgeons should be aware of the high prevalence of psychiatric disease after traumatic upper extremity amputation.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"75-80"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/d8/10-1055-s-0040-1701156.PMC8041502.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38884002","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":"Bennett's Fracture Repair-Which Method Results in the Best Functional Outcome? A Retrospective Cohort Analysis and Systematic Literature Review of Patient-Reported Functional Outcomes.","authors":"Benjamin Langridge, Michelle Griffin, Mo Akhavani, Peter E Butler","doi":"10.1055/s-0040-1703412","DOIUrl":"10.1055/s-0040-1703412","url":null,"abstract":"<p><p>Surgical fixation of Bennett's fracture of the thumb is critical to prevent functional impairment; however, there is no consensus on the optimal fixation method. We performed an 11-year retrospective cohort analysis and a systematic literature review to determine long-term patient-reported outcomes following Bennett's fracture fixation. Retrospective cohort analysis identified 49 patients treated with Kirschner (K)-wire fixation, 85% returned to unrestricted movement during hand therapy. Forty-seven patients (96%) completed the disabilities of the arm, shoulder, and hand (DASH) questionnaires at a mean of 5.55 years from injury, with a mean score of 7.75. Systematic literature review identified 14 studies with a cumulative 541 patients. Fixation included open or percutaneous methods utilizing K-wires, tension band wiring, lag screws, T-Plates, external fixation, and arthroscopic screw fixation. Functional outcomes reported included DASH, quickDASH (qDASH), and visual analogue scores. Superficial wound infection occurred in 4 to 8% of percutaneous K-wire fixation. Open reduction internal fixation (ORIF) methods were associated with a 4 to 20% rate of reintervention and 5 to 28% rate of persistent paresthesia. Closed reduction with percutaneous K-wire fixation should be the first choice surgical method, given excellent, long-term functional outcomes, and low risk of complications. ORIF should be utilized where closed reduction is not achievable; however, the current evidence does not support one method of ORIF above another.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"13 2","pages":"81-88"},"PeriodicalIF":0.3,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/3c/10-1055-s-0040-1703412.PMC8041494.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38884003","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}