Journal of Hand Surgery-American Volume最新文献

{"title":"Assessment of Ulnar Carpal Translocation and Carpal Alignment After Volar Plate Fixation With Vascularized Bone Graft for Scaphoid Waist Fracture Nonunions.","authors":"Yonghoon Lee, Anthony Martin, Aouod Agenor, Seth D Dodds","doi":"10.1016/j.jhsa.2024.06.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.06.009","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple fixation methods with or without vascularized graft have been described to treat scaphoid nonunions. This study aimed to assess the incidence of carpal malalignment and the degree of ulnar carpal translocation after scaphoid volar plate fixation with pedicled vascularized bone graft in scaphoid waist nonunions with humpback deformity.</p><p><strong>Methods: </strong>A retrospective cohort study of individuals with recalcitrant scaphoid fracture nonunion treated with volar scaphoid plating and vascularized bone graft was analyzed. All patients had radiographs with the wrist at neutral with clinical follow-up of at least 3 months after surgery. Ulnar subluxation of the carpus was assessed by the change in lunate uncovering and carpal-radial distance before and after surgery.</p><p><strong>Results: </strong>Seventeen patients were included for analysis. Average age was 26 years with an average follow-up interval of 11.0 months. After surgery, 16 patients (94.1%) had fracture union. Between preoperative and initial postoperative imaging, there was an increase in lunate uncovering (mean difference: 8.8%; 95% confidence interval, 4.6% to 13.1%) and carpal-radial distance (mean difference: 3.3% ulnar shift; 95% confidence interval, 1.1% to 5.4%). After surgery, there was minimal change in lunate uncovering and carpal-radial distance from immediately after surgery to final follow-up.</p><p><strong>Conclusions: </strong>Preoperative lunate uncovering was lower than normal values, suggesting an abnormal radial shift of the carpus with a collapsed scaphoid. Postoperative lunate uncovering was similar to normal values, reflecting an ulnar shift of the carpus after operative intervention.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891029","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":"Computer-Generated Radiographic Measurements of Distal Radius Fractures: Does It Help With Decision Making?","authors":"","doi":"10.1016/j.jhsa.2022.09.015","DOIUrl":"10.1016/j.jhsa.2022.09.015","url":null,"abstract":"<div><h3>Purpose</h3><p>Operative management of distal radius fractures (DRFs) has become increasingly common. Age, activity levels, and comorbid conditions are major factors influencing the treatment decision, although operative indications are still controversial. Radiographic parameters (RPs), such as radial inclination, dorsal tilt, and articular step-off, can provide objective support for effective decision making. However, manual measurement of RPs may be imprecise and subject to inconsistency. To address this problem, we developed custom software of an algorithm to automatically detect and compute 6 common RPs associated with DRF in anteroposterior and lateral radiographs. The aim in this study was to assess the effect of this software on radiographic interobserver variability among orthopedic surgeons. Our hypothesis was that precise and consistent measurement of RPs will improve radiographic interpretation variability among surgeons and, consequently, may aid in clinical decision making.</p></div><div><h3>Methods</h3><p>Thirty-five radiograph series of DRFs were presented to 9 fellowship-trained hand and orthopedic trauma<span> surgeons. Each case was presented with basic clinical information, together with plain anteroposterior and lateral radiographs. One of the 2 possible treatment options was selected: casting or open reduction with a locking plate. The survey was repeated 3 weeks later, this time with computer-generated RP measurements. Data were analyzed for interobserver and intraobserver variability for both surveys, and the interclass coefficient, kappa value, was calculated.</span></p></div><div><h3>Results</h3><p>The interobserver reliability (interclass coefficient value) improved from poor to moderate, 0.35 to 0.50, with the provided RP. The average intraobserver interclass coefficient was 0.68. When participants were assessed separately according to their subspecialties (trauma and hand), improved interobserver variability was found as well.</p></div><div><h3>Conclusions</h3><p>Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs.</p></div><div><h3>Clinical relevance</h3><p>Orthopedic surgeons’ consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40667372","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":"Patient and Caregiver Impressions of the Impact of Madelung Deformity: A CoULD Registry Analysis","authors":"","doi":"10.1016/j.jhsa.2024.01.019","DOIUrl":"10.1016/j.jhsa.2024.01.019","url":null,"abstract":"<div><h3>Purpose</h3><p>This study seeks to investigate demographics of patients with Madelung deformity<span><span> in a large, geographically diverse sample and understand patient and caregiver perceptions of the impact of this condition. We hypothesized that patients with untreated Madelung deformity have greater pain and lower function compared to the normal population but are less affected than the chosen control group, namely, patients with proximal radioulnar </span>synostosis (PRUS).</span></p></div><div><h3>Methods</h3><p>This retrospective study queried the Congenital Upper Limb Differences (CoULD) Registry, a multicenter registry of patients treated in tertiary care pediatric hospitals. We searched patients enrolled as of July 2022 and identified 3,980 total patients and 66 (1.7%) with a diagnosis of Madelung deformity. We reviewed demographics and Patient-Reported Outcomes Measurement Information System (PROMIS; peer relations, depressive symptoms, pain interference, and upper extremity function domains) scores at time of enrollment. We used a matched cohort comparison with propensity scoring for 50 patients with Madelung deformity and 50 patients with PRUS (control cohort).</p></div><div><h3>Results</h3><p>Patients with Madelung deformity presented at an average age of 13.1 years (± 2.1 years). Ninety-eight percent were female, and 82% were White. Seventy-four percent had distal radius-only deformity. Upper extremity PROMIS scores in both the Madelung deformity and the PRUS groups were significantly “worse” than normal, confirming our hypothesis. The Madelung deformity and PRUS cohort scores were not consistently different from one another. PROMIS scores from all other domains, including pain interference, were similar to, or better than normal for both groups, disproving the second part of our hypothesis.</p></div><div><h3>Conclusions</h3><p>Patients with Madelung deformity averaged 13 years of age and were nearly all female, and the majority had only distal involvement of the radius. Patients with Madelung deformity had lower function based on PROMIS scores, similar to the control cohort, whereas all other PROMIS measures were similar to or better when compared to normal values. Pain interference scores in both cohorts were lower than normal values. Patients with Madelung deformity have decreased function, similar to the comparative cohort of patients with PRUS, but do not present with increased pain.</p></div><div><h3>Type of study/level of evidence</h3><p>Symptom Prevalence III.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013725","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":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2024.06.004","DOIUrl":"10.1016/j.jhsa.2024.06.004","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961903","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 Volar Midline Longitudinal Groove of the Middle Phalanx: An Anatomic Study and Clinical Implications","authors":"","doi":"10.1016/j.jhsa.2022.10.004","DOIUrl":"10.1016/j.jhsa.2022.10.004","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To investigate the volar anatomy of the </span>middle phalanges of the hand; in particular, to define the presence and depth of a volar midline longitudinal groove.</p></div><div><h3>Methods</h3><p>Measurements were performed at 5 equidistant points along the shafts of 60 skeletonized middle phalanges from 15 cadaveric hands. The thickness at the midline of each phalanx was subtracted from the maximal dorsovolar thickness to indicate the presence or absence of a groove at each point. The phalanges were also evaluated by computed tomography to confirm the presence of a volar groove and to rule out morphological abnormalities.</p></div><div><h3>Results</h3><p>A volar groove was confirmed in all 60 phalanges. The groove had an average depth of 0.4 mm and was found to be deepest at the mid-phalangeal shaft. The groove reached a depth of greater than 1 mm in 23% of the phalanges. The middle phalanges of the middle and ring digits consistently revealed deeper grooves than those found in the index and little fingers. Computed tomography confirmed the presence of a volar groove and showed no morphological abnormalities.</p></div><div><h3>Conclusions</h3><p>A midline volar longitudinal groove is present in the middle phalanges, is most pronounced in the mid-phalangeal shaft, and is the deepest in the middle and ring fingers.</p></div><div><h3>Clinical relevance</h3><p>Surgeons should be cognizant of the volar longitudinal groove when inserting screws from dorsal to volar during the fixation of middle phalangeal fractures<span>. Lateral intraoperative fluoroscopy may not reveal excessive screw penetration because of the presence of ridges on either side of the groove. Particular care should be taken at the mid-phalangeal level of the middle phalanges of the middle and ring fingers.</span></p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40473814","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 Effect of Proximal Row Carpectomy and Trapeziectomy on First Ray Stability: A Cadaveric Study","authors":"","doi":"10.1016/j.jhsa.2023.06.013","DOIUrl":"10.1016/j.jhsa.2023.06.013","url":null,"abstract":"<div><h3>Purpose</h3><p>Wrist and thumb pathology can coexist leading to potential indications for proximal row carpectomy (PRC) and trapeziectomy. In this setting, the axial stability of the first ray is not known. We sought to evaluate axial subsidence of the first metacarpal in cadavers following trapeziectomy and trapeziectomy with PRC to determine the mechanical effects of the procedures performed concurrently.</p></div><div><h3>Methods</h3><p>Eleven fresh-frozen cadaveric distal forearm specimens were used in this study. The specimens were fixed in cement and mounted to a material test system frame. A predetermined force (20 N) was applied to the thumb metacarpal to simulate forces observed with lateral pinch. Axial displacement of the thumb metacarpal was measured. The application of force was repeated following trapeziectomy on each hand and then again following PRC. Analysis was performed to compare thumb metacarpal subsidence of the 3 groups: native, trapeziectomy, and trapeziectomy with PRC.</p></div><div><h3>Results</h3><p>Before trapeziectomy, native cadaver specimens had an average of 5.1 ± 1.9 mm of thumb metacarpal subsidence under the material test system load (20 N), compared to 16.2 ± 3.4 mm following trapeziectomy, and 25.0 ± 5.5 mm for trapeziectomy with PRC.</p></div><div><h3>Conclusion</h3><p>We observed a significant increase in thumb metacarpal subsidence following concurrent trapeziectomy with PRC when compared to trapeziectomy alone. Our results suggest that performing both operations together would lead to a substantial risk of first ray subsidence.</p></div><div><h3>Clinical relevance</h3><p>When treating concurrent basilar thumb and wrist arthritis, it may be more effective to stage the procedures or use a form of thumb metacarpal suspension or arthrodesis.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931900","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":"Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex","authors":"","doi":"10.1016/j.jhsa.2022.10.010","DOIUrl":"10.1016/j.jhsa.2022.10.010","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid </span>osteotomy, and to assess its clinical results.</p></div><div><h3>Methods</h3><p><span><span>We reviewed 12 patients with distal radioulnar joint<span> (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments<span>. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor </span></span></span>carpi<span> ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ </span></span>subluxation, and any hardware-related problems.</p></div><div><h3>Results</h3><p>Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity<span><span>, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the </span>ulnar nerve.</span></p></div><div><h3>Conclusions</h3><p>Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40473813","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":"Advances in the Treatment of Hand and Wrist Injuries in the Elite Athlete","authors":"","doi":"10.1016/j.jhsa.2024.03.018","DOIUrl":"10.1016/j.jhsa.2024.03.018","url":null,"abstract":"<div><p><span>Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, </span>thumb ulnar collateral ligament<span> tears, and scaphoid fractures<span> are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete.</span></span></p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077434","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":"What Is a Surgical Site Infection After Carpal Tunnel Release?","authors":"","doi":"10.1016/j.jhsa.2023.12.014","DOIUrl":"10.1016/j.jhsa.2023.12.014","url":null,"abstract":"<div><h3>Purpose</h3><p>Considerable variation exists in the literature on published rates of surgical site infection (SSI) after carpal tunnel release, ranging over 20-fold, from 0.28% to 6.4%. The reason for this variability is unknown.</p></div><div><h3>Methods</h3><p><span>A retrospective review was conducted on 748 open carpal tunnel releases performed under wide-awake local anesthetic no tourniquet in an in-office procedure room. The following three different definitions of infection were used for analysis: definition A: prescription of an oral antibiotic; Definition B: SSI definition by the Centers for Disease Control and Prevention; Definition C: infection that required </span>reoperation.</p></div><div><h3>Results</h3><p>Infection rate by definition A was 8.9% (67/748), by definition B was 2.3% (17/748), and by definition C was 0.4% (3/748), resulting in a 22-fold range.</p></div><div><h3>Conclusions</h3><p>The infection rate after carpal tunnel release is heavily influenced by the definition of SSI. The definition of SSI needs to be considered when making comparisons, either in research or quality assurance/quality improvement applications.</p></div><div><h3>Clinical relevance</h3><p>When analyzing SSI rates, the exact definition of infection must be ascertained to accurately compare an individual’s practice or institutional data to the literature.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652249","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":"Complications After Volar Locking Plate Fixation of Distal Radius Fractures: A Retrospective Study of 822 Patients","authors":"","doi":"10.1016/j.jhsa.2022.11.012","DOIUrl":"10.1016/j.jhsa.2022.11.012","url":null,"abstract":"<div><h3>Purpose</h3><p><span>With the current routine use of volar locking plates as the preferred surgical treatment option for </span>distal radius fractures<span>, the purpose of this study was to investigate the incidence of postoperative complications following surgery and, second, investigate the correlation between demographic factors and the risk of complications.</span></p></div><div><h3>Methods</h3><p>We retrospectively reviewed all patients who had been surgically treated for a distal radius fracture with open reduction and internal fixation using volar plating and screws during a 3-year period. Relevant demographic information and all postoperative complications of the 822 patients eligible for inclusion were recorded, with a mean follow-up time of 2.8 years.</p></div><div><h3>Results</h3><p>We identified an overall complication rate of 12.3% (101 of the 822 patients), with 4.8% defined as experiencing major complications and 7.5% defined as experiencing minor complications. The most frequent were complications that led to hardware removal, observed in 2.7% (n = 22) of the patients; wound-related problems that did not require surgical revision, observed in 2.2% (n = 18) of the patients; and carpal tunnel syndrome<span>, observed in 1.9% (n = 16) of the patients. Binary logistic regression modeling showed no correlation between demographic factors and the risk of complications.</span></p></div><div><h3>Conclusions</h3><p>In conclusion, a low overall complication rate of 12.3% was found. Further, 4.8% of the patients experienced a major complication and 7.5% of the patients experienced a minor complication following open reduction and internal fixation using volar plating of distal radius fractures. Age, sex, fracture type, and time from trauma to surgery were not found to be associated with an increased risk of postoperative complications.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognostic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617247","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}