Journal of Hand Surgery-American Volume最新文献

{"title":"Cartilage Cap in Scaphoid Nonunions: An Indication of Stability and Biology?","authors":"Frank Vazquez, Joanne Y Zhou, Kier M Blevins, Musab Gulzar, Constance Sullivan, Nina Suh, Michael B Gottschalk, Eric R Wagner","doi":"10.1016/j.jhsa.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.019","url":null,"abstract":"<p><strong>Purpose: </strong>Scaphoid nonunion management is controversial and is dependent upon many factors without a clear algorithm. Traditionally, open approaches involved corticocancellous, vascularized, or nonvascularized structural bone grafting with internal fixation. Recent arthroscopic techniques have improved the ability to assess the stability of fractures and the need for bone grafting while preserving blood supply. We present our experience with arthroscopic-assisted scaphoid nonunion repairs that were discovered to have an intact cartilage cap at the nonunion site and thus were treated with screw fixation alone.</p><p><strong>Methods: </strong>A retrospective review of patients diagnosed with scaphoid nonunion (defined as the lack of union on computed tomography at 6 months postinjury or no change on interval computed tomography scans at least 3 months apart) was performed. Nine patients-noted to have an intact cartilage cap, defined as continuous cartilage as viewed from the midcarpal and radiocarpal portals, without mobility at the fracture site on probing-were included. All underwent percutaneous screw fixation without fracture debridement. Time to union, range of motion, and patient-reported outcome measures were collected retrospectively.</p><p><strong>Results: </strong>Nine patients aged 16-33 years, with a median follow-up of 35 months (range: 2-74), were included. The mean radiographic displacement was 2 mm, and no fractures had a humpback deformity or dorsal intercalated segmental instability. There was a 100% union rate. At the final follow-up, patient-reported outcome measures demonstrated overall improvement across the cohort. No complications were observed.</p><p><strong>Conclusions: </strong>Scaphoid nonunions with minimal displacement, maintained mechanical malignment of the carpus, and an intact cartilage cap represent a stable pattern that can be treated by restoring mechanical stability. Thus, if a cartilage cap is found to be intact, arthroscopic-assisted percutaneous screw fixation results in bony union, favorable outcomes, with minimal pain and excellent patient-reported outcomes.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979307","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":"Controversies in the Management of Proximal Humerus Fractures.","authors":"Nicholas Brule, Yagiz Ozdag, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.009","url":null,"abstract":"<p><p>Proximal humerus fractures (PHFs) are frequently encountered by upper-extremity surgeons. Despite recent advances in both surgical techniques and implant designs, numerous management controversies exist that are primarily centered on indications for operative treatment as well as the decision to use fixation techniques or arthroplasty in the management of these injuries in older patients. The introduction and widespread adoption of reverse total shoulder arthroplasty in the management of three- and four-part PHFs represents a paradigm shift with respect to operative treatment options. This review discusses modern management controversies surrounding adult PHFs, including surgical indications, the role of intramedullary nailing and supplemental fixation, as well as timing and techniques for reverse total shoulder arthroplasty to assist surgeons in making evidence-based decisions for management by incorporating results of recent randomized controlled trials assessing treatment outcomes following management of PHFs.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979370","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":"Efficacy of Ice Application After Hand Surgery.","authors":"Matthew C Henn, Charles Marik, Karlee Lau, Omar Nazir, Adam Mirarchi","doi":"10.1016/j.jhsa.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.06.016","url":null,"abstract":"<p><strong>Purpose: </strong>After-surgery use of ice is largely empirical, with limited data on actual effectiveness. This study evaluated the impact of ice on skin temperature changes under plaster splints after hand and wrist surgery. We hypothesize that applying ice packs over splints in the early postoperative period will not considerably affect skin heat exposure because of the exothermic reaction of the cast material curing.</p><p><strong>Methods: </strong>This prospective, randomized clinical study involved patients placed in volar resting wrist or thumb spica splints after surgery. Temperature probes recorded skin temperatures near the incision for 60 minutes. Ice was applied based on randomization. Total heat capacity and temperature exposure were calculated for each group.</p><p><strong>Results: </strong>One-hundred-nineteen subjects (58 ice group and 61 control group) were included. Ice led to a mean temperature decrease of 1.19 °C near the incision, whereas in the control group, temperature increased by 0.987 °C. The control group's temperature did not return to baseline within 60 minutes, whereas the ice group reached baseline temperatures 40 minutes after splinting and decreased to an average minimum of 31.4 °C. The ice group experienced a mean heat capacity decrease of 2,030 calories, whereas the control group saw an increase of 1,520 calories.</p><p><strong>Conclusions: </strong>Our findings support that ice significantly reduces skin temperature under splinted wrists.</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":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979352","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":"Factors Associated With Levels of Pain Intensity in Patients With Intermittent Paresthesia.","authors":"George E Sayegh, Rafael Cordero, Drew Aronoff, Amin Razi, David Ring, Lee Reichel, Niels Brinkman","doi":"10.1016/j.jhsa.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.05.019","url":null,"abstract":"<p><strong>Purpose: </strong>Distorted thinking (worst-case thoughts, fear of painful movement) and feelings of distress (worry/despair) are important and modifiable aspects of human illness. It is possible that a more intense experience of intermittent paresthesia of the fingers, interpreted as \"pain,\" might be associated with higher levels of misinterpretation and distress regarding sensations. In patients seeking specialist care for intermittent paresthesia of the fingers, we asked what factors are associated with general and nighttime \"pain\" intensity, as well as levels of incapability.</p><p><strong>Methods: </strong>In a cross-sectional study, 142 adult patients with symptoms of intermittent paresthesia of the fingers completed a survey, including measures of unhelpful thoughts and feelings of distress regarding symptoms, symptoms of depression, an 11-point ordinal rating of pain intensity, and a measure of upper extremity-specific capability. Bivariate, linear regression, and cluster analyses sought factors associated with greater pain intensity and level of incapability.</p><p><strong>Results: </strong>Greater general and night pain intensity, and greater levels of incapability, were all associated with higher levels of distress regarding symptoms.</p><p><strong>Conclusions: </strong>Among patients with intermittent paresthesia of the fingers, relatively notable levels of pain intensity and incapability are associated with modifiable mindset factors.</p><p><strong>Clinical relevance: </strong>When clinicians notice a patient experiencing or describing paresthesia as pain, it can signal them to guide patients to a healthy understanding of compressive neuropathy.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979380","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 Strategies for Distal Radioulnar Joint Instability: Current State and a Need for Improved Tools.","authors":"Michele Christy, David J Wright, Charles A Goldfarb","doi":"10.1016/j.jhsa.2025.06.021","DOIUrl":"10.1016/j.jhsa.2025.06.021","url":null,"abstract":"<p><p>The distal radioulnar joint (DRUJ) plays a crucial role in wrist and forearm motion by facilitating pronation and supination while transmitting forces between the ulna and carpus. The stability of the DRUJ is dependent on both bony and soft tissue structures; however, because of the variability in joint congruence during wrist motion, soft tissue stabilizers are more critical for maintaining stability. The primary static soft tissue stabilizer of the DRUJ is the triangular fibrocartilage complex. Various clinical tests, such as the ballottement test, ulnar fovea sign, and press test, are commonly used to assess DRUJ stability. However, these tests are often considered subjective, exhibiting variable reliability and reproducibility. Although imaging techniques such as radiography, computed tomography, and magnetic resonance imaging have been employed, they present challenges related to cost, accessibility, patient tolerance, radiation exposure, and inability to detect dynamic instability at the DRUJ. Additionally, although ultrasound shows some promise in detecting dynamic instability, it remains highly operator-dependent, especially for evaluation of the DRUJ. Future efforts to develop reliable and quantifiable methods for analyzing DRUJ instability are essential for improving the management and treatment of this condition.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876893","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":"Age-Related Effects on Peripheral Nerve Regeneration.","authors":"Ken M Porche, Robert J Spinner, Allen T Bishop, Nicholas Pulos, AlexanderY Shin","doi":"10.1016/j.jhsa.2025.07.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.013","url":null,"abstract":"<p><p>Age considerably influences peripheral nerve regeneration, affecting outcomes after surgical repair of nerve injuries, particularly brachial plexus injuries. Historically, older patients were considered poor candidates for nerve reconstruction because of diminished regenerative capacity and reduced functional recovery. However, advances in surgical techniques, especially the use of nerve transfers, have led to meaningful functional improvements in patients >50 years of age. This review summarizes the current understanding of how aging affects nerve regeneration at cellular, molecular, and functional levels and provides evidence-based recommendations for managing brachial plexus injuries in older adults. Optimal outcomes in older patients are associated with early surgical intervention, strategic use of nerve transfers to shorten regeneration distances, and realistic patient expectations. Surgeons should consider age-related biological constraints while recognizing opportunities for considerable functional restoration using modern reconstructive strategies.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859948","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":"Pectoralis Minor Transfer for Internal Rotation Reconstruction in Brachial Plexus Birth Injuries.","authors":"Jayme A Bertelli, Ismaray de Avila Díaz, Fernando Levaro, Juliana Andrea Rojas Neira, Francisco Soldado","doi":"10.1016/j.jhsa.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.011","url":null,"abstract":"<p><strong>Purpose: </strong>A subset of patients with brachial plexus birth injuries experiences a loss of internal rotation, resulting either from neurological paralysis, as a complication of surgical procedures intended to restore external rotation, or because of contractures of the external rotators. Although humeral internal rotation osteotomy can address this deficit, it often results in compromised external rotation. To mitigate this drawback, in supple shoulders, we investigated the pectoralis minor tendon transfer to the subscapularis footprint as an alternative.</p><p><strong>Methods: </strong>Five patients with active internal rotation deficits, but a supple shoulder joint, secondary to brachial plexus birth injuries, underwent pectoralis minor tendon transfer to the lesser tuberosity of the humerus via a deltopectoral approach. Pre- and postoperative evaluations measured shoulder rotation with the shoulder adducted and the elbow flexed at 90°. Postoperative follow-up ranged from 9 to 14 months.</p><p><strong>Results: </strong>All patients demonstrated improvement in internal rotation, with an average gain of 88°. After surgery, four patients were able to touch their abdominal flanks, whereas one patient, because of passive limitations, required wrist flexion to achieve this. External rotation was preserved in all cases.</p><p><strong>Conclusions: </strong>Pectoralis minor tendon transfer presents a viable alternative for addressing internal rotation deficits while preserving external rotation. Its unique anatomy and innervation, derived from the lower roots of the brachial plexus, make it particularly well-suited for these cases.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859949","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":"Signs of Systemic Illness in the Hand.","authors":"Anna Green, Robert J Goitz","doi":"10.1016/j.jhsa.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.06.019","url":null,"abstract":"<p><p>Many systemic illnesses have characteristic signs that are apparent in the hand. Although these findings themselves may be subtle or benign, the potential underlying illnesses can have considerable and detrimental effects to the patient involved if left untreated. It is important for hand surgeons to be able recognize these signs, understand the associated conditions, and refer the patients to the appropriate specialty provider for work-up and treatment to manage the consequences of the systemic illness. The purpose of this review is to provide an update on notable clinical signs in the hand that could indicate an untreated systemic condition that all hand surgeons should be cognizant of to ensure early referral for treatment and improve the health of our patients.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857078","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 Diagnostic Value of the Scapholunate C-Sign: A New Tool for Detecting Through-and-Through Scapholunate Interosseous Ligament Injuries.","authors":"Parunyu Vilai, Sanjeev Kakar","doi":"10.1016/j.jhsa.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.06.011","url":null,"abstract":"<p><strong>Purpose: </strong>Currently, there is a lack of a validated clinical sign to accurately detect through-and-through or complete injuries to both the dorsal and volar scapholunate interosseous ligament. The aim of this study was to evaluate the validity of a clinical sign for detecting this condition.</p><p><strong>Methods: </strong>This study included 28 patients with suspected high-grade tears of the scapholunate interosseous ligament who underwent the C-sign maneuver. Each patient received a comprehensive evaluation, including a history, physical examination, magnetic resonance imaging interpretations by a musculoskeletal radiologist, and wrist arthroscopy. The diagnostic performance of the C-sign was assessed by calculating its sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, and overall accuracy, using wrist arthroscopy as the reference standard.</p><p><strong>Results: </strong>The C-sign, which includes both a characteristic patient reported symptom and a corresponding physical examination finding, demonstrated high sensitivity and specificity (86% and 83%, respectively) when present together. The positive likelihood ratio for the C-sign was 5.18, and the negative likelihood ratio was 0.16. The overall diagnostic accuracy was 85.7%. The diagnostic performance decreased when only one component of the C-sign was considered alone.</p><p><strong>Conclusions: </strong>The scapholunate C-sign is a valuable clinical indicator, demonstrating good diagnostic accuracy in detecting high-grade, through-and-through scapholunate interosseous ligament injuries that may warrant surgical intervention.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857079","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":"Geographic Disparities in Access to Certified Hand Therapists in the United States.","authors":"Emily E Hecox, Anna G Boydstun, Hannah G Talbot, Shelley R Edwards, Luke Anderson, Katherine C Benedict, Marc E Walker","doi":"10.1016/j.jhsa.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.05.013","url":null,"abstract":"<p><strong>Purpose: </strong>Access to a certified hand therapist (CHT) enhances postoperative functional outcomes and reduces morbidity in complex hand surgery and in traumatic injuries that necessitate targeted rehabilitation. However, CHTs are unequally distributed across regions, resulting in access disparities. This study investigated the accessibility of CHT services in the United States by analyzing physical proximity to CHTs and estimated associated personal ground transportation costs.</p><p><strong>Methods: </strong>County-level distances to the nearest CHT were mapped and evaluated. Transportation costs were calculated using 2024 US Internal Revenue Service standard mileage rates ($0.67 per mile [$0.42/km]). Counties, selected as the geographic unit because of national data availability, were classified as Urban (1-3) or Rural (4-9) based on 2023 Rural-Urban Continuum Codes (RUCCs). Independent t tests compared travel distance in rural and urban counties. Multivariable analyses were performed to evaluate the association of RUCC with distance to nearest CHT.</p><p><strong>Results: </strong>Distance traveled to nearest CHT provider and travel costs differed significantly between urban and rural counties. On average, individuals in rural counties must travel 38.75 miles (cost of $26.00) to reach a CHT, compared with 13.55 miles (cost of $9.10) for those in urban areas. Rural-Urban Continuum Code is a predictor of travel distance, with each increase in RUCC corresponding to a 4.77-mile increase in travel.</p><p><strong>Conclusions: </strong>Geographic disparities exist in access to CHTs across the United States, creating potential barriers to optimal rehabilitation outcomes.</p><p><strong>Clinical relevance: </strong>Limited access to CHTs places a substantial physical and potential economic burden on patients given the frequency and duration of rehabilitation. Further investigation into sociodemographic factors may help identify actionable solutions to improve equitable access nationwide.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838591","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}