Journal of Hand and Microsurgery最新文献

{"title":"Ultrasound imaging: Enhancing the diagnosis of carpal tunnel syndrome.","authors":"Depraetere Lander, Hans Lowyck, Arne Decramer, Bert Vanmierlo","doi":"10.1016/j.jham.2024.100173","DOIUrl":"10.1016/j.jham.2024.100173","url":null,"abstract":"<p><p>Broader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability to uncover hidden anomalies and assist in surgical planning.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100173"},"PeriodicalIF":0.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060925","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 comparison study of 90-day readmission and emergency department visitation after outpatient versus inpatient pediatric pollicization surgery.","authors":"Julia C Mastracci, Eliana B Saltzman, Kirby W Bonvillain, Katherine D Drexelius, Julie C Woodside, R Christopher Chadderdon, Peter M Waters, R Glenn Gaston","doi":"10.1016/j.jham.2024.100176","DOIUrl":"10.1016/j.jham.2024.100176","url":null,"abstract":"<p><strong>Introduction: </strong>Transition to outpatient surgery has grown with an emphasis on delivery of safe, high-quality medical care. The purpose of this study is to compare 90-day emergency department (ED) visits, readmissions, and complications between patients undergoing outpatient versus inpatient pollicization surgery.</p><p><strong>Methods: </strong>A single institution database was queried for primary thumb pollicization from 2010 to 2022 in patients under 18 years of age. Standard demographic data, comorbidities, surgical information, and discharge disposition were collected. Primary outcome measures were complications including ED visits, unplanned reoperations and hospital readmissions within 90-days of index procedure.</p><p><strong>Results: </strong>Twenty-seven patients underwent pollicization surgery. Twenty patients were outpatient surgery while 7 had postoperative hospital admission, defined as an overnight hospital stay. The outpatient cohort had no major postoperative complications including no ED visits, reoperations or readmissions within 90 days of index procedure. One outpatient experienced swelling around bilateral thumb pin sites without infection or vascular compromise. One inpatient represented to the ED within 90 days of surgery for bilateral hand cellulitis.All patients with ASA I classification were performed outpatient. Three of 7 inpatients (43 %) had congenital heart disease versus 5 of the 20 (25 %) outpatients. There was a trend that inpatients were younger than the outpatient cohort (19 vs. 33 months). The average length of procedure in the inpatient cohort was significantly longer than the outpatient cohort (237 vs. 173 min). Pollicizations performed between 2017 and 2022 were more likely to be outpatient than those performed between 2010 and 2016.</p><p><strong>Conclusion: </strong>On properly selected patients, outpatient pollicization appears to be a safe option. Patients with longer operative times were more likely to require postoperative hospital admission. Over the study years evaluated at our institution, pollicization procedures were more likely to be performed outpatient, reflecting an evolution of our practice.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100176"},"PeriodicalIF":0.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060759","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":"Evaluating the diagnostic utility of the flexion-compression test for carpal tunnel syndrome.","authors":"Sahitya K Denduluri, Samuel Ford, Susan Odum, Michael B Geary, R Glenn Gaston, Bryan J Loeffler","doi":"10.1016/j.jham.2024.100172","DOIUrl":"10.1016/j.jham.2024.100172","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine the diagnostic utility of the flexion-compression (F-C) test for carpal tunnel syndrome (CTS). Using electrodiagnostic testing as the gold standard, we hypothesized that the F-C test would be a better diagnostic test for CTS as compared to the wrist flexion (Phalen's) or palmar compression (Durkan's) tests alone.</p><p><strong>Methods: </strong>We studied patients who presented with and without CTS symptoms, designated as study and control group patients, respectively. At the first clinic visit, all patients were evaluated using the CTS-6 score, and then the Phalen's, Durkan's, and F-C tests in a random order. Patients in the study group were then sent for electrodiagnostic testing.</p><p><strong>Results: </strong>162 patients were included after power analysis, 81 each in the study and control groups. Among study group patients with electrodiagnostic evidence of CTS, the positive likelihood ratio (LR+) of the Phalen's test (1.29) was higher than the Durkan's (1.06) and F-C (0.95) tests, though less than the CTS-6 score (1.64). Performing any physical exam test in conjunction with the CTS-6 score was not more useful than the CTS-6 alone. As expected, all three physical exam maneuvers were more likely to be positive among study patients compared to control patients.</p><p><strong>Conclusions: </strong>None of the physical exam maneuvers were highly predictive of electrophysiologically-positive CTS. The CTS-6 score alone better predicts electrodiagnostic evidence of CTS than physical exam, though it only very slightly increases the post-test probability of disease. Formal electrodiagnostic testing remains important in diagnosing CTS when compared to physical exam maneuvers and CTS-6.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100172"},"PeriodicalIF":0.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060902","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":"Using machine and deep learning to predict short-term complications following trigger digit release surgery.","authors":"Rohan M Shah, Rushmin Khazanchi, Anitesh Bajaj, Krishi Rana, Anjay Saklecha, Jennifer Moriatis Wolf","doi":"10.1016/j.jham.2024.100171","DOIUrl":"10.1016/j.jham.2024.100171","url":null,"abstract":"<p><strong>Background: </strong>Trigger finger is a common disorder of the hand characterized by pain and locking of the digits during flexion or extension. In cases refractory to nonoperative management, surgical release of the A1 pulley can be performed. This study evaluates the ability of machine learning (ML) techniques to predict short-term complications following trigger digit release surgery.</p><p><strong>Methods: </strong>A retrospective study was conducted using data for trigger digit release from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) years 2005-2020. Outcomes of interest were 30-day complications and 30-day return to the operating room. Three ML algorithms were evaluated - a Random Forest (RF), Elastic-Net Regression (ENet), and Extreme Gradient Boosted Tree (XGBoost), along with a deep learning Neural Network (NN). Feature importance analysis was performed in the highest performing model for each outcome to identify predictors with the greatest contributions.</p><p><strong>Results: </strong>We included a total of 1209 cases of trigger digit release. The best algorithm for predicting wound complications was the RF, with an AUC of 0.64 ± 0.04. The XGBoost algorithm was best performing for medical complications (AUC: 0.70 ± 0.06) and reoperations (AUC: 0.60 ± 0.07). All three models had performance significantly above the AUC benchmark of 0.50 ± 0.00. On our feature importance analysis, age was distinctively the highest contributing predictor of wound complications.</p><p><strong>Conclusions: </strong>Machine learning can be successfully used for risk stratification in surgical patients. Moving forwards, it is imperative for hand surgeons to continue evaluating applications of ML in the field.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100171"},"PeriodicalIF":0.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060930","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 framework for optimizing postoperative scars: A Therapist's perspective.","authors":"Alison Taylor, Elizabeth G Harvey, J Terrence Jose Jerome","doi":"10.1016/j.jham.2024.100163","DOIUrl":"10.1016/j.jham.2024.100163","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100163"},"PeriodicalIF":0.3,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060760","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 repair of multiple pulley injuries with proximal interphalangeal joint contracture under WALANT.","authors":"Ana Carreño, Laia Sabate Cequier, Anna Domingo Trepat, Nuria Carnicero, Daniel Martín Barreda","doi":"10.1016/j.jham.2024.100170","DOIUrl":"10.1016/j.jham.2024.100170","url":null,"abstract":"<p><p>Flexor tendon pulley reconstruction in patients with multiple pulley ruptures and proximal interphalangeal joint contracture after closed injuries is relatively uncommon. The paucity of evidence in the literature supporting one technique can make these surgical decisions and surgeries challenging. This article presents the surgical technique we use for treatment of the proximal interphalangeal joint stiffness and pulley reconstruction at the same time, using wide-awake local anesthesia with no tourniquet (WALANT). The clear advantage of this anesthetic technique for this procedure is the ability to directly verify the contracture release and tendon's gliding through the reconstructed pulley system during the patient's active mobilization, allowing the surgeon to make adjustments during the surgery and educating the patient on the postoperative therapy.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 2","pages":"100170"},"PeriodicalIF":0.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334104","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":"Treatment of distal femur aseptic nonunion after lateral locking plate fixation: Results of medial custom made plating and free fibula flap transfer using CAD-CAM technology.","authors":"Vittorio Ramella, Gianluca Canton, Micol Dussi, Cristina Formentin, Veronica Scamacca, Filippo Bagnacani, Trobec Belinda, Luca Spazzapan, Luigi Troisi, Laura Grezar, Giovanni Papa, Luigi Murena","doi":"10.1016/j.jham.2024.100169","DOIUrl":"10.1016/j.jham.2024.100169","url":null,"abstract":"<p><strong>Background: </strong>Aim of the present paper is to report the preliminary results of CAD-CAM (Computer-Aided Design - Computer-Aided Manufacturing) technology application to distal femur nonunion treatment with free fibula flap, custom made medial plating and maintenance of a stable lateral locking plate.</p><p><strong>Methods: </strong>Two cases of distal femur nonunion that occurred after lateral locking plating were treated and prospectively followed-up. Surgical planning followed the same preoperative protocol adopted for mandibular CAD-CAM reconstruction. Wide cutting sections were planned to obtain radical debridement. The tailored custom-made plate, a 3D rendering of bone defect and the cutting guides were produced and sterilized. Surgical intervention was conducted by steps (medial approach, bone resection, recipient vessels isolation, fibula harvesting and cutting, plate-fibula construct assembly, microvascular anastomosis, final fixation).</p><p><strong>Results: </strong>The mean follow-up was 13 (12-15) months. Bone union was achieved in both cases at mean 3.1 months. Full weight bearing without referred pain or discomfort was reached in both cases at mean 8,5 months (range 7-10). No complications occurred.</p><p><strong>Conclusions: </strong>CAD-CAM technology proved to be useful and reliable in custom made medial plating combined with free fibula transfer for the treatment of distal femur nonunion after lateral locking plating.</p><p><strong>Trial registration: </strong>none.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100169"},"PeriodicalIF":0.3,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060921","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":"Outcomes of wrist denervation and core decompression of the radius for Kienbock's disease.","authors":"Lynn Ann Forrester, Liana J Tedesco, Bryanna Geiger, Robert J Strauch","doi":"10.1016/j.jham.2024.100168","DOIUrl":"10.1016/j.jham.2024.100168","url":null,"abstract":"<p><strong>Background: </strong>The definitive treatment of Kienbock's disease has yet to be determined. Wrist denervation combined with core decompression of the radius has not been previously studied as a combined treatment for Kienbock's disease.</p><p><strong>Purpose: </strong>The purpose of this study was to assess the efficacy of simultaneous wrist denervation and core decompression of the radius in the treatment of Kienbock's disease.</p><p><strong>Methods: </strong>All patients with Kienbock's disease who were treated with simultaneous core decompression of the radius and wrist denervation by a single surgeon at a single institution from 2012 to 2022 were contacted for this study. Demographic, clinical and radiographic data were collected retrospectively. Quick DASH and Upper Extremity PROMIS scores were collected prospectively.</p><p><strong>Results: </strong>Ten patients met inclusion criteria. Mean age at time of surgery was 31 years old. One patient was Lichtman stage 2, 5 patients were stage 3a, and 4 patients were stage 3 b. Patient reported outcomes were collected at a mean of 5.1 years since surgery (7 month-10.3 years). The mean Upper Extremity Promise T-score was 49 (median 52; age >/ = 40, normal 51.2 ± 8.2; age <40, normal 55.9 ± 6.6) and the mean Quick DASH score was 13 (median 7; normal 0-20). Nine of 10 patients reported they were satisfied with the procedure, and 100 % of patients said they would choose to have the procedure again.</p><p><strong>Conclusions: </strong>Patients with Lichtman stage 2, 3a and 3 b Kienbock's disease treated with simultaneous core decompression and wrist denervation reported minimal to no disability at 5 years after surgery. All patients in this study reported they would choose to have the surgery again to treat their Kienbock's disease.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100168"},"PeriodicalIF":0.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060906","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 long-term functional outcome of the mangled upper extremity intricate management. A single center experience.","authors":"Efstratios D Athanaselis, Theodoros Mylonas, Efstathios Konstantinou, Michael Hantes, Theofilos Karachalios, Sokratis Varitimidis","doi":"10.1016/j.jham.2024.100167","DOIUrl":"10.1016/j.jham.2024.100167","url":null,"abstract":"<p><strong>Purpose: </strong>Severe injury of multiple anatomical structures of the upper extremity can be caused by an extremely violent mechanism during labor and motor vehicle accidents, gunshots and explosions. The mangled upper extremity consists of trauma of at least 3 of 4 tissue types: connective tissue (skin, subcutaneous tissue, tendons, muscles), vessels, nerves, and bones. The purpose of this study is to evaluate the medium and long-term results of the limb salvage management of those injuries in our department.</p><p><strong>Methods: </strong>Sixty-seven patients with multi-injured upper limb were operated in our department between 2014 and 2022 and evaluated with clinical examination and questionnaires (PROMs) on an outpatient basis at a mean follow up of 7.4 years. Patients' demographics, the injured anatomic structures and the surgical interventions needed, were recorded.</p><p><strong>Results: </strong>The overall outcome, configured by functional scores was quite acceptable concerning injuries' severity. Nineteen patients (29 %) underwent more than one operation, 2-point discrimination test was impaired in 30 % of the patients who had an injured nerve and total loss of regional sensation was diagnosed in 2 patients. Primary amputation was necessary in 8 % of the patients.</p><p><strong>Conclusions: </strong>Even though the mangled upper extremity refers to a severe injury with often poor postoperative results and high rates of amputations, a thorough evaluation and management by expert hand surgeons is essential for maximizing the possible outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100167"},"PeriodicalIF":0.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060917","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":"Rethinking brachial plexus birth palsy: Beyond physician blame.","authors":"J Terrence Jose Jerome, Somsak Leechavengvongs, Kanchai Malungpaishrope, Thirumagal Kuppusamy","doi":"10.1016/j.jham.2024.100166","DOIUrl":"10.1016/j.jham.2024.100166","url":null,"abstract":"<p><p>Brachial plexus birth palsy, a devastating injury affecting newborns, has long been a source of contention and misunderstanding. This article aims to dispel the myth that healthcare providers are solely responsible for these injuries, presenting evidence that highlights the complex interplay of maternal, fetal, and biological factors in their causation. By shifting the narrative away from blame and towards a more comprehensive understanding, we can foster a more supportive and informed approach to childbirth.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100166"},"PeriodicalIF":0.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060908","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}