The Journal of Hand Surgery最新文献

{"title":"Articular Surface Involvement With Retrograde Headless Screw Fixation of the Proximal Phalanx","authors":"Sean Martin, E. Patrick Murray, Anthony Mitchell, Will Beucler, Robert Ablove","doi":"10.1016/j.jhsa.2023.11.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.11.014","url":null,"abstract":"<h3>Purpose</h3><p><span>Intramedullary (IM) screw fixation of proximal phalanx<span> (P1) fractures is a treatment option increasing in popularity. This study aimed to quantify the </span></span>articular surface<span> loss after retrograde screw insertion and to determine the range of motion (ROM) of the proximal interphalangeal (PIP) joint while the defect in the P1 head is engaged with the base of the middle phalanx (P2).</span></p><h3>Methods</h3><p>Twelve fresh frozen cadaver hand specimens were analyzed for prefixation ROM of the PIP joint. A retrograde screw was placed using a percutaneous technique under fluoroscopic guidance. Following screw insertion, specimens were dissected to determine size of the extensor mechanism defect, evaluate the lateral bands with passive ROM of the PIP joint, and determine the angle at which the dorsal aspect of P2 ceases to engage with the defect and the amount of articular surface loss. The percentage of articular surface loss was calculated using a digital image software program.</p><h3>Results</h3><p>The angle at which P2 ceased to engage with the articular surface defect was an average of 36.8° of PIP joint flexion. In full PIP joint flexion, the average extensor mechanism defect was 8.8%. The average total articular surface loss was 4.4% across all digits.</p><h3>Conclusion</h3><p>Percutaneous retrograde P1 intramedullary screw fixation results in minimal damage to the extensor mechanism and articular surface. The arc during which the defect in the head of P1 engages the base of the P2 is almost entirely outside the functional ROM of the PIP joint.</p><h3>Clinical relevance</h3><p>Quantifying the amount of articular surface loss through the P1 head and extensor apparatus damage in IM screw fixation can inform surgeons of the consequences of this technique. This study supports the use of a retrograde intramedullary screw as a safe option for fixation of P1 fractures.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study","authors":"Rodrigo Gutiérrez-Monclus, Héctor Gutiérrez-Espinoza, Felipe Araya-Quintanilla, Carlos Gutierrez-Novoa, Paúl Cordero-Barzallo, Alfonso Rodríguez-Baeza, Ángel Ferreres-Claramunt, Marc García-Elias","doi":"10.1016/j.jhsa.2023.11.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.11.015","url":null,"abstract":"<h3>Purpose</h3><p>The aim of the study was to use cadaveric models to assess the effect of loading the forearm muscles in different forearm rotations, with or without disruption to the stabilizing components, on the intra-articular pressure of the distal radioulnar joint (DRUJ).</p><h3>Methods</h3><p><span>Ten forearms with no severe osteoarthritis<span> or injury to the DRUJ stabilizers were used. They were placed in a vertical support, and pressure sensors measured pressure within the DRUJ in 5 forearm rotations (neutral, pronation, </span></span>supination<span>, extension, and flexion) under the following 6 conditions: 1) no loading; 2) loading (at 1/5 of the load per cross-sectional area) with no disruption; 3) loading with disruption of the triangular fibrocartilage complex (TFCC); 4) loading with disruption of the TFCC and ulnar ligaments (ULs); 5) loading with disruption of the TFCC, ULs and interosseous membrane (IM); and 6) loading with disruption of the TFCC, ULs, IM, and pronator quadratus (PQ).</span></p><h3>Results</h3><p>Under the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, the highest intra-articular pressures were recorded in supination. Compared with the no-load condition, pressure was greater in the no disruption-loaded condition with a mean difference (MD) of 1.57 kg/cm² in a neutral position. In flexion, pressure was greater with a disrupted TFCC (MD, 4.3 kg/cm²). In supination, pressure was only greater with a disrupted TFCC (MD, 3.3 kg/cm²), and pressure decreased in the other disruption conditions. The pressures recorded did not differ from the no disruption-no load condition in pronation or extension.</p><h3>Conclusions</h3><p>Pressures within the DRUJ changed with forearm rotations. In the no disruption-no load, no disruption-loaded, and disrupted TFCC conditions, intra-articular pressure was highest in supination. In flexion and supination with load and disruption of stabilizers, intra-articular pressure only increased significantly in the disrupted TFCC condition compared with no load.</p><h3>Clinical Relevance</h3><p>Based on our findings, exercises in supination should be avoided during the first phase of rehabilitation of TFCC injuries given the increased pressure on the DRUJ.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial Nerve Repair in a Dog Model: Effect of Local and Systemic Administration of Erythropoietin","authors":"Mostafa M. Alsayed, Mahmoud F. Ahmed, Mohamed A. Hashem, Ahmed I. Maaty, Mohamed K. El-Kherbetawy, Mohsen M. Hassan, Asser A. Sallam","doi":"10.1016/j.jhsa.2023.10.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2023.10.018","url":null,"abstract":"<h3>Purpose</h3><p><span>This study aimed to assess the effectiveness of erythropoietin<span> (EPO) as a novel treatment for </span></span>peripheral nerve<span> injury after surgical repair of an induced tibial nerve injury in dogs.</span></p><h3>Methods</h3><p>Mongrel dogs (<em>n</em><span> = 27) were randomly divided into three equal groups. A complete tibial nerve injury was induced and repaired directly by stay sutures<span> and the local application of 1 mL fibrin glue<span> (control group). In the “systemic” group, 20,000 IU of EPO were given subcutaneously immediately after surgery and on the first and second days after surgery. In the “local” group, EPO was mixed with fibrin glue at 1,000 IU/mL. Lameness score, compound muscle action potential of the tibial nerve, and serum biochemical and histopathological examinations were performed to evaluate the treated dogs over the study period (12 weeks).</span></span></span></p><h3>Results</h3><p>EPO significantly improved the lameness score and compound muscle action potential in both the systemic and local groups. After 12 weeks, systemic and local groups showed earlier improvement in lameness, reaching scores of −1 and 0, respectively, in comparison with the control group, which did not reach a score of −1. The histological study revealed a normal architecture of the nerve bundles within connective tissue. The axons were aligned in a regular pattern, whereas the control group had disrupted and degenerated nerve axons with large gaps in between.</p><h3>Conclusions</h3><p>EPO has an accelerating healing effect after tibial nerve surgical repair. Local EPO mimics systemic EPO treatment without systemic adverse effects. These findings indicated that EPO has a potential role in tibial nerve recovery and nerve regeneration.</p><h3>Clinical relevance</h3><p>The findings of the present experimental study supported the beneficial effects of systemic and local EPO when combined with peripheral nerve surgical repair, potentially improving functional outcomes and enhancing faster recovery.</p>","PeriodicalId":501629,"journal":{"name":"The Journal of Hand Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}