Journal of Hand Surgery-American Volume最新文献

{"title":"The Acute Burned Upper Extremity: Evolution of Practices and Management.","authors":"Sophia Salingaros, Abraham P Houng, Philip H Chang, Adam Jacoby","doi":"10.1016/j.jhsa.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.020","url":null,"abstract":"<p><p>Although limited to a small total surface area, burns to the hand can cause tremendous functional and social disability. The hand surgeon's reconstructive toolkit continues to evolve rapidly in light of improving burn mortality and technical advances. The surgeon should aim for the simplest reconstructive plan that facilitates early mobility and rehabilitation. Grafting (including the use of newer skin substitute agents), local and free flaps, and repair of underlying structures should prioritize key functional recovery over the complete range of motion. Multidisciplinary collaboration between the hand surgeon, burn team, and rehabilitation specialists is critical for achieving and maintaining optimal outcomes. In this review, we present an overview of the hand surgeon's role in assessment, acute surgical intervention, and postburn management for severe hand burns.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Metacarpal Head Morphology with Risk of Ulnar Collateral Ligament Rupture.","authors":"Ingmar W F Legerstee, Liliane A Freundt, Jayanth S Pratap, Jonathan Lans, Neal C Chen, Abhiram R Bhashyam","doi":"10.1016/j.jhsa.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.017","url":null,"abstract":"<p><strong>Purpose: </strong>A flat metacarpal head of the thumb is thought to predispose to ulnar collateral ligament ruptures because of limited range of motion. In this study, we quantitatively compared the roundness of the thumb metacarpal head in individuals with an ulnar collateral ligament rupture to the roundness in patients without any thumb pathology using conventional thumb metacarpophalangeal joint anteroposterior radiographs.</p><p><strong>Methods: </strong>Patient data were extracted from a single institutional system, including six urban hospitals in the United States. Eighty-two patients with a thumb ulnar collateral ligament rupture between January 2004 and December 2021 were identified and compared with 97 patients without any thumb pathology. The roundness of the thumb metacarpal head was calculated by dividing the length of the articular surface by the radius of the best-fit circle through the metacarpal head (a higher ratio corresponds to a rounder head).</p><p><strong>Results: </strong>The roundness ratios ranged between 0.47 and 1.95 across all 179 patients in the data set. The mean roundness ratio for uninjured patients was 1.12 (standard deviation [SD] 0.25) and did not differ significantly from that of the patients with ulnar collateral ligament rupture (1.16 [SD 0.26]).</p><p><strong>Conclusions: </strong>We found no difference in metacarpal head roundness between patients with a thumb ulnar collateral ligament rupture and healthy patients. This may suggest that a flat thumb metacarpal head is not associated with a traumatic thumb ulnar collateral ligament tear.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of an Intraoperative Real-Time Radiograph Counter on Radiation Exposure Events for Distal Radius Fracture Fixation: A Follow-Up Investigation.","authors":"Yagiz Ozdag, Mahmoud Mahmound, Yeshuwa Mayers, Jessica L Baylor, Alexander W Mettler, C Liam Dwyer, Joel C Klena, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.016","url":null,"abstract":"<p><strong>Purpose: </strong>Reducing fluoroscopic utilization in the operating room may aid in mitigating some radiation-related health consequences. The Hawthorne effect suggests that surgeons change their behavior during periods of observation. The purpose of this investigation was to evaluate changes in radiation emission with the use of a real-time, intraoperative radiograph counter during open reduction internal fixation of distal radius fractures.</p><p><strong>Methods: </strong>We reviewed a consecutive series of isolated open reduction and internal fixation of distal radius fractures within a single health care system. Three groups were created for comparison: a preintervention group without a radiograph counter, an intervention group with a counter, and a postintervention group where the counter was again removed. Baseline demographics and surgical characteristics were recorded. Reduction quality and radiation parameters were compared between the groups, which included radiation exposure events, fluoroscopy exposure times, and total radiation doses.</p><p><strong>Results: </strong>A total of 430 cases were performed by nine surgeons: 160 preintervention, 135 intervention, and 135 postintervention. The final radial inclination and volar tilt were similar between the groups. Statistically significant differences were noted between the groups with respect to radiation exposure events, exposure times, and total radiation doses (P < .05). For each of these variables, radiation emission was the highest in the preintervention group and decreased significantly in the intervention group. Although all emission/exposure variables subsequently increased in the postintervention group, these increases were not statistically significant.</p><p><strong>Conclusions: </strong>An intraoperative radiograph counter is associated with reduced fluoroscopic utilization during open reduction and internal fixation of distal radius fracture without reducing reduction quality. After the removal of the counter, nonsignificant increases were noted in all radiation parameters in the postintervention group, suggesting that the Hawthorne effect may be responsible for some of the reduced parameters in the intervention group.</p><p><strong>Clinical relevance: </strong>In addition to education and protective equipment, consistent use of an intraoperative radiograph counter may aid in improving occupational safety for upper-extremity surgeons.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Versus Nontraumatic Hand Digit Amputations: Neuroma Risk, Prevention Success, and Predictive Factors.","authors":"Mehmet Furkan Tunaboylu, Sai Cherukuri, Ali Gharibi Loron, Solene Nooli, Rou Wan, Kitty Wu, Steven L Moran","doi":"10.1016/j.jhsa.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.015","url":null,"abstract":"<p><strong>Purpose: </strong>Digital amputations can occur following trauma for a variety of reasons. The objective of the study was to evaluate the difference in neuroma rates between elective and emergent digital amputations and the factors contributing to persistent pain following amputation.</p><p><strong>Methods: </strong>A retrospective review of 907 patients treated with digital amputation from 2015 to 2023 met inclusion criteria. Demographic data, comorbidities, body mass index, workers' compensation cases, surgical data, digit (zone) injuries, and indications for surgery were noted. A total of 1,171 amputations were included.</p><p><strong>Results: </strong>At a median duration of follow-up of 2.6 months (interquartile range, 1.8-6.7), individuals who received elective procedures (n = 401) exhibited a neuroma rate of 4%, whereas those who underwent emergent surgeries (n = 506) had a neuroma rate of 3.2%. Patients were predominantly male (74%) with an average age of 52 years. Comorbidities were more frequent in patients who underwent elective surgeries. One hundred eleven patients had severe stump pain affecting their day-to-day lives, of which 32 (female, 28%) were diagnosed with a neuroma (mean follow-up: 18 months). In neuroma cases, 18 were treated with revision amputations, and 11 had nonsurgical treatments for their neuropathic symptoms. Other factors associated with pain following amputation included: proximal amputations (zones 4 and 5), middle finger amputations, alcohol abuse, tumors, rheumatoid arthritis, blast injury, crush injury, and multiple amputations in revision surgery.</p><p><strong>Conclusions: </strong>In this single institutional retrospective study, elective and emergent surgeries had comparable symptomatic neuroma rates. Factors predictive of pain following amputation included more proximal amputations, pre-existing alcohol use, inflammatory arthritis or vasculitis, and blast mechanism. These factors may be selected for patients best suited for prophylactic targeted muscle reinnervation or regenerative peripheral nerve interface surgeries at the time of amputation.</p><p><strong>Type of study/level of evidence: </strong>Prognostic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culp Midcarpal Reconstruction to Treat Palmar Midcarpal Instability.","authors":"Matthew W Parry, Randall W Culp","doi":"10.1016/j.jhsa.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.010","url":null,"abstract":"<p><p>Midcarpal instability (MCI) is an uncommon pathology of the wrist where impaired static and dynamic restraints of the carpals predispose the proximal carpal row to uncontrolled movements associated with a characteristic and painful \"clunk.\" Current non-operative strategies provide limited long-term benefit. Additionally, previously described surgical interventions are associated with limited mid- and long-term symptom resolution. Here, we describe a surgical technique for treating palmar MCI (PMCI) through autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy. Our surgical intervention for a rare condition has shown lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vivo Tracking of Amniotic Fluid Derived Stem Cells on Acellular Nerve Graft.","authors":"Xue Ma, Kaitlin Henry, Kelsey Healy, Tianyi David Luo, Thomas L Smith, Zhongyu Li","doi":"10.1016/j.jhsa.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.012","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to track amniotic fluid derived stem (AFS) cells that are seeded into nerve allografts, and to elucidate the potential mechanisms of their impact on the regenerating nerve.</p><p><strong>Methods: </strong>Amniotic fluid derived stem cells were labeled using supra-paramagnetic micrometer-sized iron oxide (MPIO) and assessed for viability. Cells were cultured in neurogenic induction media and evaluated for neurogenic growth factors. Differentiated cells were confirmed with reverse transcription-polymerase chain reaction for neurogenic lineage markers. MPIO labeled AFS cells were injected into an acellular nerve allograft (ANA) to repair sciatic nerve defects in rats. Labeled AFS cells were evaluated using magnetic resonance imaging (MRI) and the intensity of the MPIO regions in the ANA was quantified. Contiguous frozen sections were stained for iron to identify cells incorporated into the nerve graft.</p><p><strong>Results: </strong>Proliferation rate and morphology between the control and MPIO-labeled cells demonstrated similar patterns. AFS cells differentiated toward Schwann-like cells after being cultured in neurogenic induction media. nerve growth factor (NGF) and neurofilament light chain gene expression were elevated by 202.60 ± 1.89 and 30.62 ± 1.99 times, respectively, compared with control. Cytokine quantification analysis showed significantly increased brain-derived neurotrophic factor, β-NGF, β-fibroblast growth factor, glial cell-derived neurotrophic factor, nerve growth factor receptor, neurotrophin-4, and tumor growth factor β production. 7-Tesla MRI demonstrated MPIO labeling with a strong decrease in the T2-weighted signal. The average normalized hypointense region volume was similar between groups postinjury. Cell integration into ANA was confirmed by iron staining.</p><p><strong>Conclusions: </strong>AFS cells remained viable after labeling with MPIO and can be used to augment nerve repair by seeding onto ANAs. Cytokine analysis suggests a paracrine-mediated effect of AFS cells on nerve repair following injury. MRI can effectively track the AFS cells longitudinally in the rat model up to 4 weeks postimplantation.</p><p><strong>Clinical relevance: </strong>The study provides translational evidence on using MRI for tracking AFS cells in the decellularized nerve allografts for nerve repair and regeneration.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue Concentrations of Vancomycin Achieved by Regional Perfusion Versus Intravenous Prophylaxis in Upper Extremity Surgery: A Randomized Controlled Trial.","authors":"Nathaniel B Hinckley, Molly C Klanderman, Kevin J Renfree","doi":"10.1016/j.jhsa.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>Prior studies on intraosseous administration of vancomycin in the lower extremity have demonstrated higher tissue drug concentrations using lower doses compared with systemic intravenous administration. Our purpose was to quantify and compare vancomycin concentrations in bone and soft tissue of the hand and wrist after regional perfusion and after systemic administration.</p><p><strong>Methods: </strong>Twenty patients undergoing an upper extremity reconstructive procedure requiring removal of bone were randomized to regional intravenous perfusion of vancomycin (125 mg in 50 mL normal saline) or systemic intravenous administration of vancomycin (1 g). Samples of subcutaneous fat and bone were collected 5-10 minutes after skin incision and 20-25 minutes after skin incision, and fat was collected at closure. The primary outcome was the difference in bone and fat tissue concentrations between groups. The secondary outcome was complications related to the method of delivery of vancomycin in each group.</p><p><strong>Results: </strong>Mean tissue concentrations in fat at each time point were 114.9 μg/g (range, 25.0-333.8), 117.2 μg/g (range, 57.1-220.3), and 150.1 μg/g (range, 4.6-386.4) in the regional perfusion group and 3.9 μg/g (range, 1.5-8.4), 5.2 μg/g (range, 1.6-18.6), and 4.5 μg/g (range, 1.4-8.1) in the systemic group, respectively. Mean bone concentrations were 107.0 μg/g (range, 27.4-269.1) and 117.4 μg/g (range, 57.1-220.3) in the regional perfusion group and 13.0 μg/g (range, 6.1-20.3) (P = .002) and 14.9 μg/g (range, 8.7-22.9) in the systemic group, respectively. A fitted linear mixed model showed the average tissue concentration was 109 μg/g higher in the regional group compared with systemic administration. There were no complications requiring reoperation in either group within the 12-week follow-up period.</p><p><strong>Conclusions: </strong>Regional intravenous perfusion of vancomycin in the upper extremity achieves higher levels of antibiotic concentration than systemic intravenous administration of a much greater dose. These preliminary results warrant further evaluation of this method for the prevention and treatment of infections in the upper extremity.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readability of the Most Commonly Used Patient-Reported Outcome Measures in Hand Surgery.","authors":"Harjot Uppal, Daniel Garcia, George Abdelmalek, Joseph Farshchian, Nikhil Sahai, Arash Emami, Andrew McGinniss","doi":"10.1016/j.jhsa.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.011","url":null,"abstract":"<p><strong>Purpose: </strong>Patient-reported outcome measures (PROMs) assess surgical outcomes and patient perspectives on function, symptoms, and quality of life. The readability of patient-reported outcome measures is crucial for ensuring patients can understand and accurately complete them. The National Institutes of Health and American Medical Association recommend that patient materials be written at or below a sixth-grade reading level. We aimed to evaluate whether PROMs identified in the hand literature meet these recommended reading standards.</p><p><strong>Methods: </strong>We conducted a readability analysis of 22 PROMs referenced in the hand literature. Readability was assessed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. Scores were obtained using an online readability calculator. Patient-reported outcome measures meeting a FRES ≥ 80 or SMOG ˂ 7 were considered at a sixth-grade reading level or lower, per the National Institutes of Health and American Medical Association guidelines.</p><p><strong>Results: </strong>Across all PROMs, the average FRES was 66 ± 12, and the average SMOG Index was 8 ± 1, corresponding to approximately an eighth- to ninth-grade reading level. Three PROMs met the target readability thresholds: Patient-Reported Outcome Measurement Information System-Physical Function Upper Extremity, Patient Evaluation Measure, and the 6-item Carpal Tunnel Syndrome Symptom Scale. Several PROMs, including the Southampton Dupuytren's Scoring Scheme, Hand Assessment Tool, and Manual Ability Measure 16, demonstrated relatively low readability scores.</p><p><strong>Conclusions: </strong>Most PROMs mentioned in the hand literature exceeded the recommended sixth-grade reading level, potentially affecting patient comprehension and data accuracy. Although improving readability may enhance patient understanding, altering PROM wording is not straightforward and may require extensive revalidation because changes risk affecting validity and reliability, underscoring the complexity of revising PROMs.</p><p><strong>Clinical relevance: </strong>These findings highlight the importance of raising awareness about PROM readability issues. Recognizing these readability challenges may encourage researchers, developers, and journal editors to consider recommended guidelines when proposing, modifying, or evaluating these measures.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Pain During Carpal Tunnel Release Performed by Experienced Surgeons: A Prospective Randomized Trial Comparing WALANT with Local Anesthesia and Tourniquet.","authors":"Ignacio Rellán, Nicolas Martin Molho, Agustín Guillermo Donndorff, Gerardo Luis Gallucci, Miguel Angel Ayerza, Jorge Guillermo Boretto","doi":"10.1016/j.jhsa.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.001","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the intraoperative pain in carpal tunnel decompression (CTD) using lidocaine + epinephrine (wide awake local anesthesia no tourniquet [WALANT]) versus local anesthesia (lidocaine) and tourniquet (LA-T).</p><p><strong>Methods: </strong>Patients with a diagnosis of carpal tunnel syndrome (CTS) and meeting the indications for surgical treatment were enrolled in a prospective, randomized, controlled study. Patients were randomized to two different local anesthetic techniques: WALANT and LA-T. All patients were operated on by a fellowship-trained hand surgeon not blinded to the intervention. After surgery, patients completed a questionnaire evaluating intraoperative pain using a visual analog scale. The minimal clinically important difference was assumed to be 2 points.</p><p><strong>Results: </strong>A total of 69 patients were enrolled, including 35 in the WALANT arm and 34 in the LA-T arm. All patients completed the questionnaire and complied with the prescribed follow-ups up to 28 days after surgery. Intraoperative pain was 1 point (interquartile range [IQR], 0-2) in the WALANT group and 2 points (IQR, 1-4) in the LA-T technique. Although this difference was statistically significant, it was not considered clinically relevant because it did not reach the minimal clinically important difference.</p><p><strong>Conclusions: </strong>Carpal tunnel decompression performed under WALANT presents similar intraoperative pain scores compared to the LA-T technique when performed by an experienced surgeon. Our findings may not apply to other procedures that could potentially have a longer duration.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Severe Dupuytren Disease in Two Steps: Progressive Distraction With External Fixator and Percutaneous Needle Fasciotomy.","authors":"Massimo Corain, Umberto Lavagnolo","doi":"10.1016/j.jhsa.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.002","url":null,"abstract":"<p><strong>Purpose: </strong>Severe Dupuytren disease (DD) remains a surgical challenge. Several minimally invasive treatment methods exist, including the use of a distractible angular external fixator (DAEF) followed by collagenase injection. The purpose of this study was to investigate the combination of DAEF followed by percutaneous needle fasciotomy (PNF) in patients with advanced stage of DD.</p><p><strong>Methods: </strong>This prospective observational study evaluated the outcomes of 52 patients (56 DAEF implanted) with DD in stages III-IV according to the Tubiana classification, who underwent progressive extension on the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints through the application of DAEF followed by PNF in the palm and proximal phalangeal volar side. A postoperative splint was applied. Patients were evaluated at 1-year follow-up by measuring the angle of extension deficit, pain, and the Disability of the Arm, Shoulder, and Hand (DASH) score.</p><p><strong>Results: </strong>The distraction lasted 21.9 ± 3.8 days (minimum 16 days, maximum 29 days). Considering the average pretreatment deficit (MP 94° ± 29°, PIP 67° ± 28°), a statistically significant improvement in PIP joint extension was observed after the DAEF treatment (MP 90° ± 28°, PIP 12° ± 19°) and of the MP joint extension after the PNF procedure (MP 29° ± 21°, PIP 11° ± 18°). The DAEF distraction was not painful (numeric rating scale 1.6 ± 1.2). The correction angle achieved was maintained at the 1-year postprocedure follow-up (MP 11° ± 12°, PIP 12° ± 15°). Compared with the average pretreatment DASH score (80.2 ± 11.7 points), a statistically significant improvement was found at 6 months (9.7 ± 6.7 points). No complications were reported.</p><p><strong>Conclusions: </strong>Progressive distraction with DAEF followed by PNF was effective in patients with advanced-stage DD.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}