Journal of Hand and Microsurgery最新文献

{"title":"Older age is a predictor for hardware failure in open lower extremity fractures requiring free flap coverage.","authors":"Ramin Shekouhi, Syeda Hoorulain Ahmed, Harvey Chim","doi":"10.1016/j.jham.2025.100287","DOIUrl":"10.1016/j.jham.2025.100287","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in conjunction with open reduction and internal fixation (ORIF) and hardware placement. Secondary objectives were to determine incidence of fracture union and limb salvage. Finally, we sought to identify flap-related factors that might impact rates of infection, flap failure, and nonunion.</p><p><strong>Methods: </strong>A consecutive single-surgeon series was studied. Baseline patient characteristics, flap-related factors, incidence of hardware failure, amputation, and non-union were extracted and analyzed.</p><p><strong>Results: </strong>A total of 37 consecutive patients with a mean age of 38.9 ± 16.4 years were included, with a mean postoperative follow-up of 703.4 ± 459.6 days. There were 9 patients (24.3 %) with hardware failure and deep tissue infection. Time from injury to flap and time from last ORIF to flap were not significantly different between patients with hardware failure and those without. Flap type (muscle versus fasciocutaneous), smoking status, diabetes and body mass index were not associated with hardware failure. Multivariate regression analysis controlling for potential confounders showed that older age in patients was the only significant factor predicting hardware failure. Bone union was achieved in 29 (78.4 %) patients. Mean time from surgery to radiological signs of union was 329.3 ± 425.3 days.</p><p><strong>Conclusion: </strong>In patients requiring free flap reconstruction and ORIF for open tibial and ankle fractures, age was the only significant non-modifiable risk factor for hardware failure.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100287"},"PeriodicalIF":0.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318350","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":"Stabilization of the scapholunate interval with interference fit screws: How to do it safely.","authors":"Gustavo Luis Gomez Rodriguez, Nicolas Alejandro Irigoitia, Alvaro Muratore, Ahlam Arnaout, Gabriel Clembosky","doi":"10.1016/j.jham.2025.100288","DOIUrl":"10.1016/j.jham.2025.100288","url":null,"abstract":"<p><p>Scapholunate instability is a common wrist injury that significantly affects wrist function and biomechanics. This study compares three internal brace fixation methods for stabilizing the scapholunate interval in cadaveric models with a control group with intact ligaments (Group C): (1) internal brace without interference screw (Group N), (2) internal brace outside the interference screw (Group O), and (3) internal brace within the interference screw (Group I). The study aims to evaluate biomechanical stability, bone integrity, and osteolysis risk. Thirty-two cadaveric wrists were divided into four groups and subjected to biomechanical testing, including static, dynamic, and failure tests. Results showed that Group C exhibited a maximum failure load at 347.6 ± 21.4N; Group I exhibited the highest maximum failure load (319.4 N ± 28.7 N) and no recurrence of Dorsal Intercalated Segment Instability (DISI) during dynamic testing. Group N demonstrated the lowest biomechanical strength (118.5 N ± 15.3 N) and a 75 % DISI recurrence rate. Group O showed intermediate performance, with a maximum failure load of 221.7 N (±24.6 N) and a 37.5 % DISI recurrence rate. Imaging evaluation revealed that Group I had the least bone damage (2.1 % ± 0.9 %), while Group N had the most (24.8 % ± 2.3 %). The study concludes that placing the internal brace within the interference screw (Group I) offers superior biomechanical stability and bone protection, making it a promising technique for scapholunate stabilization. However, further clinical studies are needed to confirm these findings.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100288"},"PeriodicalIF":0.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318352","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":"Microsurgical resection of tenosynovial giant cell tumor in the digits microsurgery for digital GCT.","authors":"Keiichi Muramatsu, Yasuhiro Tani, Masaya Ueda, Daniela Kristina D Carolino, Hideaki Sugimoto","doi":"10.1016/j.jham.2025.100283","DOIUrl":"10.1016/j.jham.2025.100283","url":null,"abstract":"<p><strong>Background: </strong>Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. The utilization of the surgical microscope during resection of digital TGCTs appears to be beneficial for more detailed visualization. We presented the outcomes of microsurgical resection of TGCT and discussed how to prevent recurrence of TGCT.</p><p><strong>Methods: </strong>We reviewed 34 consecutive patients with TGCT cases operated by the single operator. The age at surgery ranged from 9 to 77 years, with an average of 48. The most common affected digit was the thumb (n = 13). In all cases, an operating microscope was utilized. The postoperative follow-up period was an average of 27.6 months.</p><p><strong>Results: </strong>Intraoperative findings with the use of a microscope revealed an unexpectedly large number of cases with continuity to the adjacent joints. In cases of joint invasion, the capsule was opened to directly visualize the inside of the joint, and intra-articular tumor was resected enbloc together with extra-articular components. The classification of the disease was mixed type in 17 digits, localized type in 17. Postoperative recurrence was found in only one case (2.9 %).</p><p><strong>Conclusion: </strong>Microsurgery may be a beneficial tool for TGCT resection, but there have been only few reports. Invasive TGCT into the volar plate or infiltrating into the bone near the tendon attachment are well visualized and could be more certainly resected. The recurrence rate after microscopic TGCT resection was only 2.9 %, which is probably the lowest rate in the previously reported literature. Microsurgery allows sufficient visualization of the TGCT invasion and is useful for dissection of digital nerves and arteries.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100283"},"PeriodicalIF":0.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286788","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 skin reconstruction of the hand with an artificial dermal substitute in a traumatic setting.","authors":"Morgane Dorniol, Marie Pouedras, Victor Lestienne, Francois Labbe, Marc Leroy, Camilo Chaves","doi":"10.1016/j.jham.2025.100286","DOIUrl":"10.1016/j.jham.2025.100286","url":null,"abstract":"<p><strong>Background: </strong>Tissue coverage of the hand in a traumatic setting is challenging given the limited treatments available, the functional issues and the risk of amputation in case of failure. Artificial dermal substitutes have been used in reconstructive surgery for decades but their indications and results in hand surgery need to be further evaluated. The aim of our study was to evaluate skin reconstruction of the hand with an artificial dermal substitute in a traumatic setting.</p><p><strong>Methods: </strong>We retrospectively reviewed patients suffering from traumatic hand wounds defect with neurovascular, and/or osseous, and/or tendinous exposure. Patients underwent reconstruction with an artificial dermal substitute between 2017 and 2020 in a hand-trauma and reimplantation center. Primary outcomes included the success of the dermal substitute and the surgical revisions dues to failure. Patient satisfaction, QuickDASH and Vancouver scar scale (VSS) were also evaluated.</p><p><strong>Results: </strong>Thirteen cases were retrieved. The average follow-up length was 22 months. Average age was 56,5 years. The mean surface to be covered was 7.9 cm². In eleven patients (85 %) the dermal substitute successfully covered the required surface. Two patients (15 %) required revision, one for finger ray amputation and another for revision of the dermal substitute. Seventy-seven percent of patient were satisfied, the mean QuickDASH was 30.7, and the VSS 6.3.</p><p><strong>Conclusion: </strong>Dermal substitutes allow skin coverage of traumatized hand particularly when used in first instance immediately after the trauma. They offer good quality scars and good functional results.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100286"},"PeriodicalIF":0.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318351","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":"Sliding volar hinge osteotomy for correction of extra-articular distal radius malunion with excessive radial shortening.","authors":"Ian Jason Magtoto, Jieying Xu, Nicholas Matthias Zhi Wei Tan, Sreedharan Sechachalam","doi":"10.1016/j.jham.2025.100285","DOIUrl":"10.1016/j.jham.2025.100285","url":null,"abstract":"<p><p>Distal Radius Malunion may occur with closed treatment and may result in various complications including stiffness and decrease in grip strength. Several techniques for correction of malunion have been devised and may broadly be classified into either hinge or distraction osteotomies. We present a \"Volar Sliding Hinge Osteotomy\" technique for correction of extra articular distal radius malunion, even with excessive radial shortening, without the use of distant bone grafts. The outcomes of three consecutive patients who underwent the procedure were also documented. Our technique may present as a good alternative to radial distraction or ulnar shortening osteotomies in correction of extra articular distal radius malunions with significant radial shortening.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100285"},"PeriodicalIF":0.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303210","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":"Application of 3D printing for customised treatment of upper limb disorders.","authors":"Saurabh Kumar Gupta, Navaneeth Holla, Satyam Suwas, Kaushik Chatterjee, Sathya Vamsi Krishna","doi":"10.1016/j.jham.2025.100284","DOIUrl":"10.1016/j.jham.2025.100284","url":null,"abstract":"<p><strong>Purpose: </strong>Three-dimensional (3D) technology is rapidly emerging as a valuable tool in the medical and healthcare industry, particularly for performing corrective osteotomies in upper limb extremities. This study involved patients with impaired upper limb function who underwent corrective osteotomies using a computer-assisted 3D surgical planning process with 3D-printed, patient-specific plates. The biomechanical performance of these 3D-printed, patient-specific plates was enhanced while maintaining crucial properties such as corrosion resistance and biocompatibility, ensuring their safety for clinical application in humans. The surgical outcomes were analyzed by visualizing bone healing, and an evaluation was conducted to assess the success of these methodologies by comparing the clinical outcomes achieved with those planned during the surgical planning phase.</p><p><strong>Patients and methods: </strong>Eight cases involving malunions and deformities were treated using patient-specific bone plates fabricated through metal additive manufacturing. Preoperative computed tomography (CT) scans were used to generate virtual bone models for surgical planning. Normal/anatomical bone alignment was achieved by mirroring the contralateral healthy bone and projecting it onto the affective bone model. Surgical guides and patient-specific bone implants were then designed. These implants underwent an innovative cyclic heat treatment to optimize their strength and ductility for enhanced biomechanical performance.</p><p><strong>Results: </strong>The final outcomes for the patients were assessed using functional scoring and radiographs. The 3D-printed surgical guides facilitated accurate osteotomy angulation and precise positioning of drilled holes, ensuring optimal placement of customised, mechanically enhanced bone plates. All patients demonstrated improved DASH scores and experienced reduced or no pain after healing.</p><p><strong>Conclusions: </strong>This study demonstrates the success of personalized treatment for upper limb disorders using 3D-printed, patient-specific plates, which showed improved biomechanical performance after tailored heat treatment. This method of preparing patient-specific implants offers a safe and highly effective approach to treating malunions and deformities in the upper limbs with reduced surgical time.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100284"},"PeriodicalIF":0.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276239","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":"Lateral plate fixation for middle phalangeal fractures.","authors":"Louis Choon Kit Wong, Abby Choke, Sze Ryn Chung, Yong Chiang Kang","doi":"10.1016/j.jham.2025.100282","DOIUrl":"10.1016/j.jham.2025.100282","url":null,"abstract":"<p><p>Plate osteosynthesis is a core modality commonly employed for rigid surgical fixation of middle phalangeal fractures. It is conventionally done via a dorsal extensor-splitting approach, which bears the risk of plate irritation and adhesion formation with the extensor apparatus that can lead to significant postoperative stiffness. While utilizing a lateral surgical approach may avoid this issue, literature on it remains scarce within the context of middle phalangeal fractures. Here, we outline our extensor-sparing technique of lateral plate fixation in middle phalangeal fractures. We demonstrate that it is a feasible and safe method for rigid surgical fixation with favorable clinical outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100282"},"PeriodicalIF":0.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286787","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":"Clinical experiences and surgical techniques of the dorsal ulnar artery perforator free flap in reconstruction of medium-sized defects of the digits.","authors":"Celestial Xin Lu Wong, Jia Lin Sophie Xie, Sreedharan Sechachalam, Jian Hao Kevin Wong, Munn Yi Tina Lee","doi":"10.1016/j.jham.2025.100279","DOIUrl":"10.1016/j.jham.2025.100279","url":null,"abstract":"<p><strong>Introduction: </strong>Our study aims to share our surgical experiences in utilising the dorsoulnar artery perforator-based (DUAP) free flap for reconstruction of medium-sized defects of the digits.</p><p><strong>Methods: </strong>Five patients, from 2014 to 2022, all of whom sustained critical defects of the digit(s), either due to trauma or infection, underwent resurfacing with an ipsilateral DUAP free flap. The size of the defects ranged from 2.5 to 3.5 cm in width and 3.5 to 7 cm in length. The main outcomes included active range of movement, sensory recovery of the flap, and time to return to work.</p><p><strong>Results and techniques: </strong>All five patients demonstrated favourable outcomes following reconstruction of medium-sized digital defects using the DUAP free flap. The patients were followed up for an average of 5 months postoperatively. There were no cases of partial or complete flap failure, and none of the cases required re-exploration of anastomoses. Flap neurotisation was performed in selected cases using either end-to-end or end-to-side neurorrhaphy, achieving a 2-point discrimination of up to 7 mm at 10 weeks postoperatively. All donor sites had healed well and demonstrated good final wrist range of movement, even when flaps extended into the ulnar wrist crease. Technicial refinements included adjusting the flap position to accommodate longer pedicle lengths for defects with short recipient vessels or a wider zone of injury, using a cuff of the main ulnar artery for anastomosis in cases of vessel size mismatch, and using either the dorsal digital vein or superficial dorsal hand vein to mitigate venous congestion.End-to-side (ETS) neurotization was performed in one of the cases, which allowed for preservation of thumb sensation.</p><p><strong>Conclusion: </strong>The DUAP free flap is reliable and consistently reproducible and serves as a good option for reconstruction of medium-sized defects of the digit. It provides satisfactory functional and aesthetic outcomes, minimal donor site morbidity and the potential for sensory restoration through end-to-end and end-to-side neurotisation. Our experience supports the application of this flap beyond pulp defects, especially when selected technical modifications are employed to address the individual anatomical challenges and optimze outcomes.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100279"},"PeriodicalIF":0.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303209","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":"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}