Journal of Hand Surgery-American Volume最新文献

{"title":"Mixture of Lidocaine and Ropivacaine as a Local Anesthetic in WALANT Surgery: A Prospective Randomized Study.","authors":"Yann Gricourt, Bob-Valery Occean, Amélie Favrelle, Thierry Chevallier, Olivier Mares, Philippe Cuvillon","doi":"10.1016/j.jhsa.2025.03.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.010","url":null,"abstract":"<p><strong>Purpose: </strong>With lidocaine, the wide awake local anesthesia no tourniquet (WALANT) technique provides effective anesthesia. However, analgesia is also short with this technique (3 hours). This study analyzed pain relief and quality of recovery when ropivacaine (a long-acting local anesthetic, 8-12 hours) was added to lidocaine.</p><p><strong>Methods: </strong>This prospective, double-blinded randomized study included patients scheduled for distal upper limb surgery under WALANT. Patients were randomly assigned to a group: the lidocaine group (20 mL of 1% lidocaine at 1:100,000 epinephrine) or the lidocaine-ropivacaine group (18 mL of 1% lidocaine at 1:100,000 epinephrine and 2 mL of 0.75% ropivacaine). The primary end point was the postoperative Quality of Recovery (QoR)-40 score at Day 2. Secondary end points were the pain score for the first 7 days postsurgery, rescue analgesia, adverse medical and surgical events, and chronic pain at 3 months.</p><p><strong>Results: </strong>Over the study period, 91 patients were randomized. The QoR score was 187 (182-190) in the lidocaine group and 186 (180-188) for lidocaine-ropivacaine group. The median duration of analgesia was 8 (4-12) hours for the lidocaine group and 8 (4-10) hours for the lidocaine-ropivacaine group. No difference was observed between groups regarding rescue analgesia, pain score, adverse events, or incidence of chronic pain at 3 months.</p><p><strong>Conclusions: </strong>Adding ropivacaine to lidocaine for WALANT did not improve patient recovery after surgery.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic Ib.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058628","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":"Unicortical Versus Bicortical Screws for Dorsal Plate Fixation of Phalangeal Fractures.","authors":"Brahman Shankar Sivakumar, Lianne Bissell, Mark Hile, Elizabeth Clarke","doi":"10.1016/j.jhsa.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.009","url":null,"abstract":"<p><strong>Purpose: </strong>To compare unicortical and bicortical screw fixation for dorsal plating of extra-articular proximal phalangeal fractures.</p><p><strong>Methods: </strong>Midshaft osteotomies were performed on 21 cadaveric proximal phalanges. The phalanges were fixed via dorsal plating using either unicortical or bicortical locking screws and subjected to a three-point bending test. Cyclical loading was performed, increasing displacement by 0.4 mm every block of five cycles, until construct failure. Clinical failure was defined as 2 mm of displacement. Data collected included maximal force at failure, force at clinical failure, number of cycles to failure, and displacement to failure.</p><p><strong>Results: </strong>Similar values were noted in maximal force at clinical failure and biomechanical failure, number of cycles to failure, and displacement to failure between phalanges fixed using unicortical or bicortical locking screws.</p><p><strong>Conclusions: </strong>Both unicortical and bicortical locking screws provide sufficient stability to facilitate early motion without risk of clinically relevant displacement during plate fixation of midshaft proximal phalangeal fractures.</p><p><strong>Clinical relevance: </strong>Unicortical dorsal plate-screw constructs should be considered, where appropriate, to prevent tendon injury or complications.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019146","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":"Recurrent Treatments After Percutaneous Needle Fasciotomy for Dupuytren Contracture-A Retrospective Cohort Study.","authors":"Laura Houstrup Matthiesen, Simon Toftgaard Skov, Jeppe Lange","doi":"10.1016/j.jhsa.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.004","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to estimate the risk of recurrent treatment after percutaneous needle fasciotomy (PNF) for Dupuytren contracture, defined as any subsequent treatment in a previously PNF-treated finger.</p><p><strong>Methods: </strong>This is a registry-based follow-up study on PNF-treated patients at Silkeborg Regional Hospital between 2007 and 2015. The first PNF procedure within the study period was defined as the index procedure. Succeeding data relative to the PNF index procedure were extracted at a national level by the Danish National Patient Registry and the Danish Civil Registration System in 2018 to identify all possible recurrent treatments. The registries lack information about which specific hand and finger were treated. A review of medical records was performed to validate whether it was a recurrent treatment of the PNF index procedure. As access to medical records was limited to Silkeborg Regional Hospital, data validation was only feasible for patients treated in Silkeborg during the follow-up period (subcohort X). To compensate for the lack of complete data validation, we estimated the best- and worst-case scenarios of recurrent treatments in the total cohort.</p><p><strong>Results: </strong>A total of 2,257 unique patients (3,331 PNF-treated fingers) were identified. Of those, 1,724 (76%) patients (2,511 [75%] fingers) were included in subcohort X. In subcohort X, 28% had received a recurrent treatment at a median follow-up time of 6.8 (interquartile range [IQR], 4.6-9.3; min-max, 1.0-11.7) years. In the total cohort, recurrent treatments were estimated to be between 21% and 46% at a median follow-up time of 7.2 (IQR, 4.9-9.5; min-max, 1.0-11.7) years.</p><p><strong>Conclusions: </strong>This study provides information about recurrent treatments after PNF in a large Scandinavian cohort, which was estimated to be between 21% and 46% at a median follow-up time of 7.2 (IQR, 4.9-9.5; min-max, 1.0-11.7) years.</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":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053690","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":"Transforming Myofibroblasts Into Lipid-Filled Cells to Treat Dupuytren Disease.","authors":"Mary E Ziegler, Melinda Lem, Jacklyn Melkonian, Tania Nasrollahi, Helia Rahimian, Abtin Shams, Nikhil Prabhakar, Seyedeh Saina Saifzadeh, Amalvin Fritz, Amber Leis, Alan Widgerow","doi":"10.1016/j.jhsa.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.005","url":null,"abstract":"<p><strong>Purpose: </strong>Transforming myofibroblasts (MFs) into adipocyte-like cells may be a viable option for treating Dupuytren disease. Human Dupuytren MFs (DMFs) and adipose-derived stem cells (ASCs) cocultured in the presence of platelet-rich plasma (PRP) reprogrammed into lipid-laden cells. This treatment also reduced fibrosis markers in vivo. We aimed to determine whether this treatment transformed DMFs into adipocyte-like cells in vivo and characterize the PRP factors contributing to this transformation.</p><p><strong>Methods: </strong>Dupuytren MFs and normal human dermal fibroblasts were transplanted into the forepaws of rats (Rowett Nude [rnu/rnu]). Two months later, the paws were treated with saline, ASCs + PRP, or Clostridium histolyticum (clinical comparison) once a week for three treatments. The paw tissue was harvested 1 week after each treatment and subjected to Masson trichrome staining, collagen I and III, α-smooth muscle actin (SMA), and perilipin detection by immunohistochemistry. Dupuytren MFs were cocultured with ASCs and PRP or insulin-like growth factor I (IGF-I) or IGF-I-depleted PRP. In addition, the IGF-I receptor was inhibited. Oil Red O or boron-dipyrromethene detected lipid-laden cells.</p><p><strong>Results: </strong>Rodent paws implanted with DMFs showed enhanced α-SMA expression, imbalanced collagen III:I ratio, and reduced adipocytes compared with normal human dermal fibroblasts. After treatment with ASCs + PRP, DMF paws demonstrated reduced α-SMA, a balanced collagen III:I ratio, and a replenishment of adipocytes. Dupuytren MFs treated with ASCs + IGF-I transformed into adipocyte-like cells in vitro, which was validated by IGF-I-depletion and IGF-I receptor inhibition.</p><p><strong>Conclusions: </strong>Adipose-derived stem cells + PRP reduce fibrosis markers and induce adipocyte renewal in vivo. As a PRP component, IGF-I works with ASCs to transform DMFs into adipocyte-like cells in vitro.</p><p><strong>Clinical relevance: </strong>Identifying an active factor in PRP that synergizes with ASCs to transform DMFs into adipocyte-like cells may contribute to finding a novel therapeutic for Dupuytren disease. Such a treatment may allow for less-extensive surgical intervention coupled with therapeutic injection to reduce the recurrence of Dupuytren disease.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058630","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":"Assessment of Cartilaginous and Tendinous Lesions Following Intramedullary Compression Screw Fixation of Middle Phalangeal Fractures: A Cadaveric Study.","authors":"Michael Strong, Conor Honeywill, Elizabeth Clarke, David Graham, Brahman Sivakumar","doi":"10.1016/j.jhsa.2025.02.025","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.025","url":null,"abstract":"<p><strong>Purpose: </strong>Phalangeal fractures are undergoing surgical intervention more frequently and can be stabilized via a range of modalities. Intramedullary screw (IMS) fixation has become popular in the management of metacarpal and phalangeal fractures, with promising short- to medium-term results. Violation of articular cartilage and the terminal extensor tendon is a concern when IMS fixation is used in the middle phalanx. The aim of this study was to assess the cartilaginous and soft tissue footprint resulting from retrograde IMS insertion in the middle phalanx.</p><p><strong>Methods: </strong>Ten cadaveric hands underwent radiographic guided insertion of 1.7 and 2.2 mm diameter headless compression screws. The width of the extensor tendon lesion and the surface area of the surface defect within the articular cartilage were both measured using digital processing software.</p><p><strong>Results: </strong>Using the 1.7 mm screw, the mean lesion involved 12.1% of the width of the extensor tendon and 1.8% of the total articular surface. Using the 2.2 mm screw, the mean lesion involved 20.4% of the width of the extensor tendon and 3.5% of the total articular surface.</p><p><strong>Conclusions: </strong>The use of retrograde intramedullary screw fixation in the middle phalanx results in minimal violation of the articular cartilage and terminal extensor tendon.</p><p><strong>Clinical relevance: </strong>This study finds minimal disruption of the articular cartilage and terminal extensor tendon when intramedullary screws are inserted into middle phalanges in a retrograde fashion. When combined with promising early- to mid-term clinical outcomes, these findings render intramedullary screw fixation a suitable therapeutic option in this cohort.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009591","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 Hand Surgeon's Role in the Management of Upper-Extremity Arteriovenous Malformation: A Review of the Literature.","authors":"Edward S Mojica, Amir Taghinia, Joseph Upton, Omri Ayalon","doi":"10.1016/j.jhsa.2025.02.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.021","url":null,"abstract":"<p><p>The diagnosis and treatment of fast-flow arteriovenous malformations with or without dynamic arteriovenous fistulae in the upper limb can be both frustrating and daunting for the hand surgeon. The clinical presentation can vary from an incidental finding to a pulsating mass, threatening the entirety of the upper extremity and precipitating cardiac failure secondary to diverging vasculature. Non-operative treatment is appropriate for the small, minimally symptomatic mass. However, considerable controversy remains regarding the management of symptomatic lesions, specifically regarding the utility of embolization or sclerotherapy and the aggressiveness of surgical resection, concepts that are dependent primarily on both the size and location of the lesion. Although classification schemes exist, which attempt to stratify the severity of the lesion encountered by the upper-extremity surgeon, they make no attempt to categorize its location based on clinical relevance. Therefore, our purpose was to review the etiology, clinical presentation, and management of arteriovenous malformations in the upper limb and to refine the present classification to include present treatment options for this uncommonly encountered pathology.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812944","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":"New Classification System for Radially Deviated Thumb Polydactyly.","authors":"Kaiying Shen, Yuezhou Wang, Yufeng Wang, Yabin Hu, Yunlan Xu","doi":"10.1016/j.jhsa.2025.02.024","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.024","url":null,"abstract":"<p><strong>Purpose: </strong>Radially deviated thumb polydactyly (RDTP) is a risk factor for secondary deformities but lacks comprehensive characterization. We developed a new classification system for RDTP based on the preoperative radiographic appearance that should inform surgical approaches: (1) D-shaped, (2) bell-shaped, (3) radial-concave phalanges, and (4) asymmetric Wassel III-like.</p><p><strong>Methods: </strong>Radially deviated thumb polydactyly patients evaluated from January 2015 to December 2021 were classified into four types based on their preoperative radiographs. Reliability of the classification was assessed, and patient demographics, radiographic measurements, and intraoperative findings were retrospectively reviewed.</p><p><strong>Results: </strong>Twenty-nine patients with RDTP (29 affected thumbs) were included and classified as follows: type I (n = 9), type II (n = 10), type III (n = 8), and type IV (n = 2). The interobserver and intraobserver kappa values for the classification system were 0.928 and 0.963, respectively.</p><p><strong>Conclusions: </strong>Our proposed RDTP classification system is reliable and may offer surgical guidance for the treatment of patients with RDTP.</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":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804885","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":"Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release.","authors":"Nicholas B Pohl, Parker L Brush, Jory P Parson, Patrick Fitzgerald, Alex Charlton, Pedro K Beredjiklian, Daniel J Fletcher","doi":"10.1016/j.jhsa.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.009","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the incidence of subsequent treatment of trigger finger in the same or additional digits after the initial trigger finger release, as well as identify patient characteristics associated with the need for subsequent treatment.</p><p><strong>Methods: </strong>This study retrospectively analyzed 1,715 patients with a trigger finger who underwent surgical release from 2015 to 2017. Bivariate analysis was performed to determine the percentage of patients requiring further trigger finger treatment by either steroid injection or operative release. Patient factors were then compared in those who did and did not undergo subsequent treatment. Cox proportional hazards models and survival analysis were performed to identify patient characteristics associated with requiring subsequent treatment, injection, and surgery.</p><p><strong>Results: </strong>Overall, 690 (40.2%) patients required subsequent treatment with either steroid injection or surgical release in either the same or an additional finger. Four hundred sixty patients (26.8%) underwent at least one subsequent injection, with 36 (2.1%) of these on the same finger. Additionally, 230 (13.4%) patients received at least one subsequent first annular pulley release, with 14 (0.8%) on the same finger as the initial release. Cox proportional hazards models showed patients with a higher comorbidly burden and current smoking status were more likely to receive subsequent treatment. Higher body mass index and greater comorbidity burden were also associated with requiring subsequent surgery. Additionally, current smokers or patients with a greater comorbidity burden had a higher risk of requiring subsequent treatment in an additional digit not initially released.</p><p><strong>Conclusions: </strong>Subsequent release or injection in the same or another digit was common following an initial trigger finger release. Patient characteristics such as higher body mass index and greater comorbidity burden were associated with requiring subsequent surgery, and smoking status as well as comorbidity burden were associated with subsequent treatment in an additional digit not initially released.</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":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812927","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":"Atraumatic Disorders of the Pediatric Spinal Cord and Brachial Plexus.","authors":"David S Liu, Anna Rothenberg, Andrea S Bauer","doi":"10.1016/j.jhsa.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.006","url":null,"abstract":"<p><p>While brachial plexus birth injury is a relatively common condition with an incidence of approximately 1.5 in 1,000 live births, pediatric nonobstetric brachial plexus injuries are more rare. Among nonobstetric causes of brachial plexus dysfunction, trauma is the most common, while other etiologies include thoracic outlet syndrome, acute flaccid myelitis, Parsonage-Turner syndrome, and various oncologic etiologies. The presentation and pattern of injury of each patient is unique despite having the commonality of a brachial plexus injury. As such, treatment algorithms can be complex, and outcomes unpredictable. The aim of this review is to provide a basis of information on which a clinician can appropriately manage pediatric or adolescent patients with brachial plexus injuries of various etiologies.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789425","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":"Interfragmentary Screws Versus Intramedullary Implants For Proximal Phalanx Fractures: A Biomechanical Study in Matched Hands.","authors":"Thomas McQuillan, John Kopriva, Daniel Thompson, Jason Shah, John Seiler, Eric Wagner, Nina Suh","doi":"10.1016/j.jhsa.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.008","url":null,"abstract":"<p><strong>Purpose: </strong>Displaced proximal phalanx fractures are common injuries that often require surgical intervention. Intramedullary screw (IMS) fixation has recently gained popularity as a minimally invasive approach, but the relative resistance to fracture displacement when undergoing early motion is unknown. The purpose of this study was to determine whether the stability of IMS fixation is comparable or superior to the stability of interfragmentary screws for oblique fractures.</p><p><strong>Methods: </strong>Twenty-four matched cadaveric specimens were cut to produce standardized 60° oblique fractures and then randomized to stabilization with a 2.4-mm IMS or two 1.5-mm interfragmentary cortical screws. Specimens were loaded at 20 N for 2,000 cycles to simulate flexor tendon range of motion and were then loaded to failure, where failure was defined as 3 mm of movement from initial position.</p><p><strong>Results: </strong>After 2,000 cycles of 20 N loading, the cortical screws averaged significantly less movement than the IMS screws, with movements of 0.7 mm and 1.3 mm, respectively. When loaded to failure, the cortical screws withstood slightly higher forces than the IMS, averaging 79.8 N and 65.4 N, respectively. Under cyclic loading, 1 cortical screw specimen and 2 IMS specimens failed before reaching the completion point of 2,000 cycles.</p><p><strong>Conclusions: </strong>Two orthogonal interfragmentary screws demonstrate less displacement than the IMS after cyclic loading of oblique proximal phalanx fractures under physiologic loads. Two bicortical interfragmentary screws are a robust option for long-oblique fractures and may tolerate an early motion protocol.</p><p><strong>Clinical relevance: </strong>This study suggests that interfragmentary screws provide robust fixation of long-oblique proximal phalanx fractures. Given the initial displacement of intramedullary screws, further research should assess the role of canal fill, fracture morphology, and screw configuration on the selection of internal fixation strategy.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789426","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}