Journal of Hand Surgery-Asian-Pacific Volume最新文献

{"title":"Pyogenic Flexor Tenosynovitis: Modern Management Strategies and the Iatrogenic and Cognitive Drivers of Delayed Intervention.","authors":"Yuki Fujihara, Nasa Fujihara","doi":"10.1142/S2424835526500566","DOIUrl":"https://doi.org/10.1142/S2424835526500566","url":null,"abstract":"<p><p>Pyogenic flexor tenosynovitis (PFT) remains one of the most challenging hand infections, capable of causing undesired subsequent events including severe functional loss and amputation. While Kanavel cardinal signs have historically guided diagnosis, recent evidence suggests they lack the specificity required for modern clinical decision-making. This review evaluates the current landscape of PFT management, comparing the efficacy of conservative antibiotic therapy against surgical intervention. We analyse large-scale data regarding prognosis, highlighting that treatment delays - often driven by cognitive biases such as loss aversion - significantly worsen outcomes. We propose an updated treatment algorithm that incorporates diagnostic aspiration to rule out mimics and mandates a strict 12- to 24-hour limit for conservative trials. Furthermore, we discuss the evolution of surgical techniques from open drainage to closed catheter irrigation and Continuous Local Antibiotic Perfusion (CLAP) for severe cases. Surgeons must view PFT not merely as an infection, but as a 'compartment syndrome' of the tendon sheath requiring urgent decompression to prevent irreversible sequelae. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186009","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":"Using Colour Doppler Ultrasound for Flap Planning in the Hand and Upper Extremity.","authors":"Harvey Chim","doi":"10.1142/S2424835526300045","DOIUrl":"https://doi.org/10.1142/S2424835526300045","url":null,"abstract":"<p><p>Conventional techniques for planning perforator flaps rely on anatomical landmarks and handheld Doppler. Handheld Doppler can be unreliable in localising perforators, with false positive signals from the axial vessel or perforators that terminate in the muscle. Additionally, the loudness of the audible signal on Doppler does not correlate with the presence or size of the perforator. Advanced imaging modalities offer a more accurate tool for preoperative perforator mapping. These include ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Colour Doppler ultrasound (CDU) is available in most operating rooms, with the advantages of no added cost, lack of radiation and no requirement for intravenous contrast. Location and characteristics of perforators can be accurately mapped preoperatively, allowing for rapid and efficient flap harvest. Additionally, accurate preoperative perforator localisation with CDU allows elevation of thin and superthin flaps, which allow a better 'like-for-like' reconstruction in the hand and upper extremity. In this article, the technique of CDU for flap planning is discussed together with illustrative cases. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167677","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":"Distal Scaphoid Resection with Suspensionplasty Using the Mini-TightRope^TM for Scaphotrapeziotrapezoid Osteoarthritis: A Case Series.","authors":"Takanobu Higashi, Atsuyuki Inui, Yutaka Mifune, Ryosuke Kuroda","doi":"10.1142/S2424835526500554","DOIUrl":"https://doi.org/10.1142/S2424835526500554","url":null,"abstract":"<p><p><b>Background:</b> Distal scaphoid resection (DSR) with suspensionplasty using the Mini-TightRope™ has not previously been reported for isolated scaphotrapeziotrapezoid (STT) osteoarthritis. The aim of this study is to report outcomes of DSR using the Mini-TightRope™ for STT arthritis. <b>Methods:</b> We retrospectively evaluated four female patients (four wrists; mean age: 71 years) who underwent this procedure between 2018 and 2020, with a mean follow-up of 72 months. Clinical and radiographic outcomes, including pain (visual analogue scale [VAS]), grip strength, DASH-JSSH scores, trapezial subsidence and dorsal intercalated segment instability (DISI), were assessed. <b>Results:</b> The mean VAS improved from 6.0 to 1.0 and the DASH-JSSH score from 59.0 to 19.5. Grip strength was 13.9 kg (97% of the contralateral side), and the trapezial height was well maintained with minimal subsidence. DISI developed in all patients (mean radiolunate angle: 9.3°-32.7°) but remained asymptomatic, and no complications or revisions occurred. <b>Conclusions:</b> This simple, tissue-preserving technique provided satisfactory outcomes for isolated STT osteoarthritis. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169078","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":"Normative Data and Development of a Five-Grade Classification for Pinch Strength in Healthy Japanese Adults.","authors":"Kentaro Chino, Kazunari Tomita","doi":"10.1142/S2424835526500578","DOIUrl":"https://doi.org/10.1142/S2424835526500578","url":null,"abstract":"<p><p><b>Background:</b> Pulp pinch is the most frequently used grasping pattern amongst two-finger pinches; however, normative data on pulp pinch strength based on a large Japanese population have not been reported. The utility of such normative data would be enhanced by presenting five-grade classifications in addition to the mean and standard deviation (SD). Therefore, the objective of this study was to present normative data and establish sex-specific five-grade classifications for pulp pinch strength in healthy Japanese adults. <b>Methods:</b> A total of 514 healthy Japanese adults (337 men and 177 women) participated in this study. Maximal voluntary pulp pinch strength between the thumb and index finger of both the dominant and nondominant hands, as well as between the thumb and middle finger of the dominant hand, was measured using a muscle strength tester equipped with a pinch force sensor. Based on the deviation score [= 50 + ((measured value - mean) / SD) × 10], pinch strength was classified into five grades as follows: grade 5, deviation score ≥ 65; grade 4, deviation score ≥ 55 and < 65; grade 3, deviation score ≥ 45 and < 55; grade 2, deviation score ≥ 35 and < 45 and grade 1, deviation score < 35. <b>Results:</b> As normative data for pinch strength in healthy Japanese adults, the mean ± SD values of pulp pinch strength for each condition were calculated separately for men and women. Five-grade classifications were established for each pinch condition in men and women. <b>Conclusions:</b> Normative data and sex-specific five-grade classifications for pulp pinch strength in healthy Japanese adults were successfully developed and may serve as normative reference values for assessing patients with hand pathologies and evaluating pinch strength recovery. <b>Level of Evidence:</b> Level III (Diagnostic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169072","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":"New Mixed-Reality Navigation System for Cup Positioning in Trapeziometacarpal Arthroplasty: An In Vitro Validation Study.","authors":"David Mayorga-Naranjo, Carmen García-Espert, Cristina Ramírez-Fuentes, Alfonso Valverde-Navarro, Joan Ferràs-Tarragó","doi":"10.1142/S2424835526500542","DOIUrl":"https://doi.org/10.1142/S2424835526500542","url":null,"abstract":"<p><p><b>Background:</b> To describe and validate a novel mixed-reality (MR) navigation system for cup positioning in trapeziometacarpal arthroplasty and to assess its accuracy and reproducibility compared with the conventional freehand technique. <b>Methods:</b> A trackerless holographic navigation software for Microsoft HoloLens 2 was developed to provide real-time holographic feedback of anteversion and inclination during guidewire insertion. Two in vitro studies were performed. First, geometric trapezoidal models (<i>n</i> = 80) were used, in which an orthopaedic resident and an expert hand surgeon inserted Kirschner wires freehand and with navigation. Second, anatomical trapezium bio-models (<i>n</i> = 20) were used, with an expert surgeon performing freehand (<i>n</i> = 10) and navigated (<i>n</i> = 10) insertions. Postoperative CT quantified angular deviation from planned targets. Results were analysed using Student's <i>t</i>-test and Bartlett's test. <b>Results:</b> In geometric models, the pooled total mean absolute error was 6.99° (SD = 4.92°, 95% CI 3.47-10.52) for the freehand technique and 0.65° (SD = 0.26°, 95% CI 0.47-0.84) for MR guidance, with a mean paired difference of 6.34° favouring navigation (<i>p</i> = 0.002). Anteversion and inclination errors were significantly lower, and variability was reduced (Bartlett <i>p</i> < 0.01). No significant differences were observed between operators under MR guidance. In anatomical bio-models, MR guidance significantly reduced the overall mean angular error from 9.10° to 0.68° (<i>p</i> = 0.0004), while both anteversion and inclination errors were also significantly lower than with the conventional freehand technique. <b>Conclusions:</b> In this in vitro study, MR navigation substantially improves the accuracy and reproducibility of guidewire placement for trapeziometacarpal cup positioning compared with the freehand technique, while reducing variability and operator dependence. Clinical studies are required to determine its impact on intraoperative workflow and patient outcomes.</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165752","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":"A Simple Slotted Guide for Instrument Passage in Wrist Arthroscopy.","authors":"Ren-Guo Xie","doi":"10.1142/S2424835526970106","DOIUrl":"https://doi.org/10.1142/S2424835526970106","url":null,"abstract":"<p><p>Wrist arthroscopy is increasingly used for the diagnosis and treatment of wrist pathology. However, the limited joint space and small arthroscopic portals make repeated insertion of instruments challenging and may result in soft-tissue trauma or creation of a false passage. Commercially available cannulas are generally unsuitable for wrist arthroscopy. We describe a simple technique using a segment of tubing from a disposable intravenous infusion set. A longitudinal slot is created in the tube, which is passed through the wrist joint to form a ring-shaped guide between two arthroscopic portals. The slotted design facilitates repeated instrument passage while allowing instruments to disengage from the guide for unrestricted intra-articular manipulation. This is a simple, inexpensive technique that requires no specialised equipment and may facilitate instrument passage during wrist arthroscopy. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170231","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":"Simulation-Based Corrective Osteotomy with Predicted Postoperative Forearm Rotation for Distal Radioulnar Joint Instability.","authors":"Kunihiro Oka, Satoshi Miyamura, Hiroyuki Tanaka","doi":"10.1142/S2424835526500530","DOIUrl":"https://doi.org/10.1142/S2424835526500530","url":null,"abstract":"<p><p><b>Background:</b> Distal radioulnar joint (DRUJ) instability associated with forearm bone deformity is difficult to treat because residual osseous malalignment may impair forearm rotation even after triangular fibrocartilage complex (TFCC) reconstruction. This study evaluated the clinical usefulness of preoperative three-dimensional (3D) computer simulation and patient-matched instruments (PMIs) for corrective osteotomy in deformity-related DRUJ instability. <b>Methods:</b> Three patients with chronic DRUJ instability associated with forearm bone deformity underwent corrective osteotomy based on 3D computer simulation and PMI-assisted surgery. Preoperative simulation was used to determine osteotomy planes, correction angles, and postoperative forearm rotation. Patient-matched surgical guides and plates were manufactured according to the simulation. Corrective osteotomy was combined with TFCC repair or reconstruction. Clinical outcomes were evaluated based on pain, range of motion, grip strength, redislocation and Modified Mayo Wrist Score (MMWS). <b>Results:</b> Bone union was achieved in all patients within 6 months. Postoperative radiographs demonstrated correction of osseous deformity and reduction of the DRUJ. Forearm rotational limitation improved in all cases with fixed dislocation, and dynamic instability resolved in the remaining case. Wrist pain disappeared in all patients, and grip strength and MMWS improved without major complications. <b>Conclusions:</b> Preoperative 3D computer simulation and PMI-assisted corrective osteotomy enabled accurate restoration of osseous alignment and forearm rotation in deformity-related DRUJ instability. Combining corrective osteotomy with TFCC repair or reconstruction may provide stable and functional outcomes. <b>Level of Evidence:</b> Level IV (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170753","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":"Readability, CPT Billing Accuracy and Diagnostic Coding Performance of ChatGPT Models in Hand Surgery.","authors":"Sohail R Daulat, Romir P Parmar, Tyler T Brady, Jude Kolodisner, Jae Won Song, Cameron Roth","doi":"10.1142/S242483552650058X","DOIUrl":"https://doi.org/10.1142/S242483552650058X","url":null,"abstract":"<p><p><b>Background:</b> Large language models (LLMs) like ChatGPT show their potential use in healthcare. However, limited research has been conducted on how effective these models are in hand surgery. Therefore, the purpose of this study is to compare ChatGPT-4, ChatGPT-4o and ChatGPT-o1 across patient education, billing and diagnostic coding in hand surgery. <b>Methods:</b> LLMs were tested using standardised prompts for five common hand conditions: distal radius fractures, trigger finger, carpal tunnel syndrome, cubital tunnel syndrome and ganglion cysts. Three tasks were evaluated: (1) patient education (15 frequently asked questions), (2) CPT code prediction and recognition of a supplied correct CPT code from de-identified operative notes, and (3) ICD-10 code prediction from clinical vignettes (HPI, physical exam and imaging). Readability was assessed using the SMOG Index, Flesch-Kincaid Grade Level and Flesch Reading Ease. Accuracy for billing and diagnostic tasks was measured using F1 scores. Repeated-measures and group-level statistical analyses were performed using Friedman, Wilcoxon signed-rank, Kruskal-Wallis and Dunn tests with Holm-corrected post hoc comparisons, as appropriate. <b>Results:</b> ChatGPT-o1 generated significantly more complex responses than ChatGPT-4 and ChatGPT-4o (adjusted <i>p</i> < 0.001), while responses to surgical questions were significantly more difficult to read than diagnostic questions (SMOG: adjusted <i>p</i> = 0.001; FRE: adjusted <i>p</i> = 0.024). All models achieved near-perfect accuracy in detecting CPT codes. At the three-character ICD category level, ChatGPT-o1 outperformed ChatGPT-4o (adjusted <i>p</i> = 0.001). At the four-character ICD subcategory level, ChatGPT-o1 outperformed both ChatGPT-4 and ChatGPT-4o (adjusted <i>p</i> < 0.001 for both). For exact ICD-10 code prediction, ChatGPT-4o and ChatGPT-o1 both outperformed ChatGPT-4 (adjusted <i>p</i> < 0.001), while ChatGPT-4o and ChatGPT-o1 did not significantly differ (adjusted <i>p</i> = 0.995). Diagnostic accuracy improved with the addition of physical examination and imaging information. <b>Conclusions:</b> Even though LLMs struggled with predicting billing codes and exact ICD-10 codes, they performed better at recognizing supplied correct billing codes and identifying broader diagnostic groupings. All models produced educational content above the recommended reading level. These findings highlight both the promise and limitations of LLMs in hand surgery. <b>Level of Evidence:</b> Level V (Diagnostic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167679","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":"Use of a da Vinci Xi Robot for an Oberlin Transfer - A Preliminary Report and Technical Considerations.","authors":"Raja Tiwari, Manju R, Rishi Nayyar, Maneesh Singhal","doi":"10.1142/S2424835526970118","DOIUrl":"https://doi.org/10.1142/S2424835526970118","url":null,"abstract":"<p><p>A minimally invasive Oberlin transfer was performed using the da Vinci Xi robot in four patients with upper brachial plexus injury. This technical note describes the technique, detailing patient selection, robotic setup, anaesthesia considerations, port placement and key intraoperative steps. In three of four patients, the procedure was completed in a minimally invasive fashion; one patient required conversion to an open approach due to impaired visualisation from diffuse oozing in a scarred surgical field. Postoperative recovery was uneventful in all patients with no complications or donor morbidity. Although outcome analysis was beyond the scope of this technical note, all patients demonstrated recovery of biceps (Medical Research Council (MRC) grade ≥ 4) at 12-month follow-up. Patients in whom the minimally invasive procedure was completed had shorter scars. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167533","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":"Digital Acro-osteolysis Revealing Hajdu-Cheney Syndrome in an Elderly Patient: A Case Report.","authors":"Antonio García-Jiménez, Lluis Pomerol, Eulàlia Armengol","doi":"10.1142/S2424835526720136","DOIUrl":"10.1142/S2424835526720136","url":null,"abstract":"<p><p>Hajdu-Cheney syndrome (HCS) is a rare genetic connective tissue disorder characterised by progressive acro-osteolysis of the distal phalanges, pseudo-clubbing, joint hyperlaxity and generalised osteoporosis. We report the case of an 85-year-old woman presenting with infectious dactylitis of the third finger of the right hand, in whom radiographs revealed distal osteolysis in several digits. After excluding infectious, inflammatory and metabolic causes, genetic testing confirmed a heterozygous NOTCH2 mutation consistent with HCS. This case highlights the importance of recognising the characteristic radiographic and clinical findings in the hand, since its presentation may mimic rheumatologic or infectious conditions. Awareness of this entity allows accurate diagnosis, avoidance of unnecessary surgical interventions and optimised functional and preventive management. <b>Level of Evidence:</b> Level V (Therapeutic).</p>","PeriodicalId":51689,"journal":{"name":"Journal of Hand Surgery-Asian-Pacific Volume","volume":" ","pages":"543-547"},"PeriodicalIF":0.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882285","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}