Journal of Hand and Microsurgery最新文献

{"title":"Epidemiology of ∗Upper Extremity Lacrosse Injuries presenting to the United States Emergency Departments during 2014-2023.","authors":"Carter Powell, Paul Pottanat, Colin Zieminski, Dane Daley, Charles Daly","doi":"10.1016/j.jham.2025.100281","DOIUrl":"10.1016/j.jham.2025.100281","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100281"},"PeriodicalIF":0.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259104","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":"WALANT vs. Brachial plexus block with tourniquet in zone 2 flexor tendon repair: An evidence-based comparison.","authors":"Sarath Radhakrishnapillai Sreedevi, Sabu Chaniveliyil Parameswaran, Helen Mary Titus, Lekshmi Malathi","doi":"10.1016/j.jham.2025.100280","DOIUrl":"10.1016/j.jham.2025.100280","url":null,"abstract":"<p><strong>Background: </strong>Zone 2 flexor tendon repair is traditionally performed using brachial plexus block, general anaesthesia, or local anaesthesia with a tourniquet. The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique, as the name implies, allows these procedures to be performed under local anaesthesia without a tourniquet. This study aims to evaluate the efficacy of WALANT in zone 2 flexor tendon repair, comparing it to brachial plexus block in terms of local anaesthetic drug requirement, pain management, surgical field visibility, postoperative outcomes, and patient satisfaction.</p><p><strong>Methodology: </strong>A prospective observational study was conducted with 24 patients in each group: one undergoing zone 2 flexor tendon repair under WALANT, and the other with brachial plexus block. The amount of local anaesthetic required, pain scores using the Visual Analog Scale (VAS), surgical field visibility using the Surgical Field Rating (SFR) scale, postoperative hospital stay, complications, and patient preferences were compared between the two groups.</p><p><strong>Results: </strong>The pain score during injection was significantly lower in the WALANT group (2.1 ± 0.3 vs 3.7 ± 0.8) whereas the perioperative and postoperative pain scores where similar in both groups. The average operative time (49.7 min vs. 53.2 min) and surgical field visibility (SFR grade 3-58.3 % vs 45.8 %) were comparable in both groups. The WALANT group had a significantly shorter postoperative hospital stay (18.16 h vs. 34.04 h). No complications were reported in the WALANT group, while one postoperative tendon rupture occurred in the brachial plexus block group. All WALANT patients opted the technique for future procedures, while 16.7 % of brachial plexus block patients did not prefer the same method again.</p><p><strong>Conclusion: </strong>WALANT offers several advantages over brachial plexus block, with similar surgical field visibility, intraoperative and postoperative pain control, without the discomfort of a tourniquet and with the added advantage of intraop testing of repair. It is a safe and effective alternative to brachial plexus block for zone 2 flexor tendon repair.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100280"},"PeriodicalIF":0.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676104","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":"Comparison of hand surgery certification exams in Europe and the United States using ChatGPT 4.0.","authors":"Salman Hasan, Kyros Ipaktchi, Nicolas Meyer, Philippe Liverneaux","doi":"10.1016/j.jham.2025.100258","DOIUrl":"10.1016/j.jham.2025.100258","url":null,"abstract":"<p><p>Certification in hand surgery in Europe (EBHS) and the United States (HSE) requires a subspecialty examination. These exams differ in format, and practice exams, such as those published by the Journal of Hand Surgery (European Volume) and the ASSH, are used for preparation. This study aimed to compare the difficulty of the multiple-choice questions (MCQs) for the EBHS and HSE practice exams under the assumption that European MCQs are more challenging. ChatGPT 4.0 answered 94 MCQs (34 EBHS and 60 HSE practice exams) across five attempts. We excluded MCQs with visual aids. Performance was analyzed both quantitatively (overall and by section) and qualitatively. ChatGPT's scores improved after being provided with correct answers, from 59 % to 71 % for EBHS and 97 % for HSE practice exams by the 5th attempt. The European MCQs proved more difficult, with limited progress (<50 % accuracy up to the 5th attempt), while ChatGPT demonstrated better learning with the HSE questions. The complexity of the European MCQs raises questions about the harmonization of certification standards. ChatGPT can help standardize evaluations, though its performance remains inferior to that of humans. The findings confirm the hypothesis that EBHS MCQs are more challenging than the HSE practice exam.</p><p><strong>Level of evidence: </strong>Exploratory study, level of evidence IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100258"},"PeriodicalIF":0.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235428","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":"Use of compression screw in a metacarpal head Fracture: The \"lollipop\" technique.","authors":"Ricardo Kaempf de Oliveira, Paula Fischer, Victor Trivino, Lucian Lior Marcovici, Pedro J Delgado","doi":"10.1016/j.jham.2025.100276","DOIUrl":"10.1016/j.jham.2025.100276","url":null,"abstract":"<p><p>Only 4 % of metacarpal fractures affect the distal articular region. In the literature, some studies have ended up causing confusion by mixing up extraarticular neck fractures with subcapital fractures, a term that should only be used to define transverse articular fractures of the head that are distal to the origin of the collateral ligament. Due to the need for anatomical reduction, displaced metacarpal head fractures must be reduced and fixed, mostly by open surgery. Recently, the use of intramedullary fixation has become the method of choice in the treatment of transverse metacarpal diaphyseal and neck fractures. Having this in mind, we describe the so-called \"lollipop\" technique for the treatment of subcapital metacarpal fractures, in which a cortical mini-fragment screw is inserted through the head by intramedullary retrograde fixation in the diaphysis, leaving the final assembly in the shape of the candy. By using minimal fixation, the already impaired vascularity of the head articular fragments is protected, providing enough rigid stability for the fracture to heal in an anatomical position and allowing early mobility.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100276"},"PeriodicalIF":0.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327186","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":"Rehabilitation outcomes in traumatic brachial plexus Injury: Occupational therapy perspective.","authors":"Tejal Talankar, Shilpshree Palsule","doi":"10.1016/j.jham.2025.100277","DOIUrl":"10.1016/j.jham.2025.100277","url":null,"abstract":"<p><strong>Background: </strong>Traumatic Brachial Plexus Injury (TBPI) results in significant motor and sensory impairments, impacting daily function, employment, and psychological well-being. While surgical interventions aim to restore function, outcomes remain variable, necessitating comprehensive rehabilitation. Occupational Therapy (OT) plays a crucial role in optimizing upper limb function, addressing psychosocial concerns, and enhancing quality of life. However, limited research exists on its specific impact, particularly in the Indian context.</p><p><strong>Objective: </strong>This study aimed to evaluate the functional outcomes of OT interventions in adult TBPI patients, assessing their impact on muscle strength, sensation, range of motion, functional performance, and quality of life.</p><p><strong>Methods: </strong>A prospective longitudinal observational study was conducted at the Occupational Therapy Department of a tertiary healthcare center in Mumbai, India. 33 patients were recruited, with 31 completing the study. Functional outcomes were assessed at baseline and at 3, 6, 9, and 12 months post-intervention using muscle power assessment, sensory evaluation, range of motion, the Brachial Assessment Tool (BrAT), Disabilities of the Arm, Shoulder, and Hand (DASH) score, WHOQOL-BREF, and the Modified Mallet Score.</p><p><strong>Results: </strong>Significant improvements were observed in muscle power (p = 0.0001), sensation (p = 0.0001). The BrAT score showed significant improvement across all time points, particularly in conservatively managed patients (p < 0.01). DASH scores demonstrated a significant reduction over 12 months (p = 0.0001), with upper plexus injuries showing better recovery than global plexus injuries. WHOQOL-BREF scores improved significantly in physical, psychological, and social domains (p < 0.05). Correlation analysis revealed a strong negative correlation between DASH and BrAT scores (R = -0.84, p = 0.0001) and a moderate positive correlation between BrAT and WHOQOL-BREF (Physical R = 0.57, Psychological R = 0.58, p = 0.0001).</p><p><strong>Conclusion: </strong>Occupational Therapy significantly enhances functional recovery, independence in daily activities, and psychosocial well-being in TBPI patients. Conservatively managed patients showed greater functional gains compared to surgically managed patients. These findings highlight the critical role of OT in TBPI rehabilitation and the need for standardized OT protocols to improve patient outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100277"},"PeriodicalIF":0.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143916","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":"Role of five-fingered hand in type IIIB thumb hypoplasia- an Asia-Pacific perspective.","authors":"Anil K Bhat, Mithun Pai G, Ashwath M Acharya","doi":"10.1016/j.jham.2025.100278","DOIUrl":"10.1016/j.jham.2025.100278","url":null,"abstract":"<p><p>The management of type IIIB thumb hypoplasia in the Asia-Pacific region is predominantly shaped by cultural views, with numerous countries favouring a five-fingered hand. The article discusses the evolution of treatment for type IIIB thumb hypoplasia with thumb preservation and reconstruction and the dilemma of excision and pollicization. Recent research has revealed the limitations of pollicization including joint instability and diminished grip strength. Moreover, several parents, particularly in the Asia-Pacific region, exhibit hesitancy towards thumb excision owing to cultural, psychological, or religious considerations, favouring the retention of a five-fingered hand. This has prompted continuous investigation into alternate techniques that preserve thumb stability while facilitating a functional five-fingered hand. Recent strategies have demonstrated encouraging outcomes comparable to conventional pollicization. In several instances, staged treatments are necessary to provide a five-fingered hand, although the reconstructed thumb may exhibit functional and developmental limits. This alternative procedure has demonstrated favourable functional and aesthetic benefits, with minimal donor morbidity, comparable to that of pollicization<b>.</b></p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100278"},"PeriodicalIF":0.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235429","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":"Combined semi-constrained total distal radioulnar joint (DRUJ) arthroplasty and radial head arthroplasty for severe, concomitant rheumatoid disease of the wrist and elbow joints.","authors":"Zachary Fuller, Arjun Gupta, Isabel Herzog, Joseph Weisberger, Irfan H Ahmed, Michael M Vosbikian, Ashley Ignatiuk","doi":"10.1016/j.jham.2025.100275","DOIUrl":"10.1016/j.jham.2025.100275","url":null,"abstract":"<p><p>Semi-constrained total distal radioulnar joint (DRUJ) arthroplasty with Aptis-Scheker implant has demonstrated excellent results in patients with end-stage rheumatoid arthritis (RA) of the wrist. However, clinical success of the Scheker implant in restoring range of motion may be limited in patients with concomitant degenerative disease at the proximal radioulnar joint and radiocapitellar joint, which work in tandem with the DRUJ to allow pronosupination of the forearm. Among treatment options for elbow arthritis, standalone radial head arthroplasty remains poorly studied in the context of RA, despite being used widely in trauma patients. Here, we illustrate the surgical technique for combined total DRUJ arthroplasty with a Scheker implant and radial head arthroplasty to treat long-standing, refractory RA, at the wrist and elbow joints, with excellent results at 1-year follow-up.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100275"},"PeriodicalIF":0.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143913","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":"Early postinterventional clinical implications of Collagenase Clostridium Histolyticum injection versus limited fasciectomy for Dupuytren's disease.","authors":"Rémy Liechti, Julia Bernhard, Dominique Nellie Merky, Damian Sutter, Esther Vögelin","doi":"10.1016/j.jham.2025.100268","DOIUrl":"10.1016/j.jham.2025.100268","url":null,"abstract":"<p><strong>Objectives: </strong>This study compared Collagenase Clostridium Histolyticum (CCH) injection and limited fasciectomy (LF) in terms of early post-interventional soft tissue conditions and patient burden, evaluated by visit frequency to surgeons and hand therapists, complications, and reintervention rates.</p><p><strong>Materials and methods: </strong>Consecutive patients undergoing CCH injection or LF as first-line treatment for Dupuytren's disease over 15 years were assessed. Propensity score matching minimized selection bias. The primary outcome was the assessment of early post-interventional (between 2 and 8 weeks) soft tissue condition using a novel Soft Tissue Score with points assigned for documented swelling, hyperemia, induration, and tenderness. Secondary outcomes included the number of surgeon and hand therapy visits, as well as the complication and reintervention rates in a subgroup of patients followed for at least 4 months.</p><p><strong>Results: </strong>After propensity score matching, two treatment groups of 26 patients each were formed (CCH vs. LF group). There were no significant differences in baseline characteristics and correction of flexion contracture between the two treatment groups. The early postinterventional Soft Tissue Score was significantly worse in the LF group than in the CCH group (mean 1.35 vs. 0.65 points, MD 0.7, 95 % CI [0.2, 1.2], p = 0.022). The number of surgeon and hand therapy visits was significantly higher in the LF group (mean 4.7 vs. 1.9 visits, MD 2.8, 95 % CI [1.8, 3.8], p < 0.001 and mean 10.5 vs. 4.3 visits, MD 6.2, 95 % CI [0.7, 11.7], p = 0.036, respectively). The rate of mild and severe complications was comparable in both groups. While the reintervention rate was significantly higher in the CCH group, the occurrence of multiple reinterventions was comparable.</p><p><strong>Conclusion: </strong>The results of this study suggest that CCH injections lead to less complicated wound healing requiring less intensive surgeon and hand therapy aftercare than LF. CCH represents a valuable addition to Dupuytren's disease treatment, allowing for repeated use in severe, complex, or recurrent cases without increasing procedure-related risks while offering versatility for combination with minimally invasive surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100268"},"PeriodicalIF":0.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143915","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":"Fifth carpometacarpal arthritis management: A comparative cadaver study of two arthrodesis methods.","authors":"Omar Aljasim, Can Yener, Mesut Demirkoparan, Arman Vahabi, Ali Engin Daştan, Levent Küçük, Nadir Özkayın, Okan Bilge, Hüseyin Günay","doi":"10.1016/j.jham.2025.100256","DOIUrl":"10.1016/j.jham.2025.100256","url":null,"abstract":"<p><p>Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand function, significantly limiting the patient's ability to perform daily activities. Surgical interventions for post-traumatic osteoarthritis of the fifth CMC joint include arthrodesis and arthroplasty, with the Dubert technique combining elements of both approaches. This study aimed to compare the effects of Dubert arthrodesis and traditional fifth metacarpal (MC)-hamate arthrodesis on the flexion-extension range of motion of the fifth MC. An in vitro study was conducted using twelve cadaveric forearm specimens. The specimens were divided into two groups: Group 1 underwent Dubert arthrodesis, and Group 2 underwent fifth MC-hamate arthrodesis. Preoperative and postoperative evaluations were performed using computed tomography (CT) scans to measure the flexion-extension range of motion of the fifth MC. Twelve specimens, with a mean age of 53 years (range: 41-60 years), were analyzed. No significant difference in preoperative flexion-extension motion was observed between the groups. Both groups exhibited a significant reduction in flexion-extension motion following arthrodesis. However, no significant difference in postoperative flexion-extension motion was observed between the groups. Neither Dubert arthrodesis nor fifth MC-hamate arthrodesis preserved the physiological flexion-extension motion of the fifth MC. Biomechanical analysis showed no significant advantage of one technique over the other. The Dubert arthrodesis procedure was technically demanding, with inadequate resection potentially leading to residual symptoms. Further comparative clinical studies are required to confirm these findings and determine the optimal surgical approach for managing fifth MC arthritis.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100256"},"PeriodicalIF":0.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162725","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 local anaesthesia in bilateral endoscopic carpal tunnel release Surgery: An efficient ergonomic approach.","authors":"Sean Yao Zu Kong, Hong Yu Rin, Darryl Ee Ming Chew, Yong Chiang Kang","doi":"10.1016/j.jham.2025.100261","DOIUrl":"10.1016/j.jham.2025.100261","url":null,"abstract":"<p><p>Endoscopic carpal tunnel release (ECTR) has advanced considerably since its introduction, providing a minimally invasive alternative to traditional open surgery for carpal tunnel syndrome. This review traces the history of ECTR, highlighting key advancements in techniques and variations. We compare the anatomical visualization between endoscopic and open approaches, particularly regarding nerve and tendon preservation. The role of Wide Awake Local Anaesthesia No Tourniquet (WALANT) in ECTR is discussed, with a focus on its benefits in reducing postoperative pain and recovery time. Additionally, we present our approach to bilateral ECTR, illustrated through pictorial representations, demonstrating the advantages of this technique. We conclude that bilateral ECTR not only accelerates overall recovery but also has the potential to reduce overall healthcare costs.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100261"},"PeriodicalIF":0.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080519","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}