Journal of Hand Surgery-American Volume最新文献

{"title":"Can Dermofasciectomy for Dupuytren Disease be Performed Safely and Effectively Under Local Anesthesia with Adrenaline?","authors":"Richard J Goodall, Maria Chicco, Luke Geoghegan, Mark A Pickford","doi":"10.1016/j.jhsa.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.004","url":null,"abstract":"<p><strong>Purpose: </strong>Wide-awake local anesthesia no tourniquet (WALANT) surgery is well suited to dermofasciectomy for Dupuytren contracture because it permits active assessment of the central slip after disease excision; however, it is seldom performed. This study had two main aims: first, to describe our technique for dermofasciectomy under WALANT; second, to compare outcomes with dermofasciectomy performed under WALANT and regional anesthesia (RA).</p><p><strong>Methods: </strong>This retrospective cohort study included all patients treated with dermofasciectomy by the senior author in a single center between April 2020 and April 2024. Outcome data on disease characteristics, perioperative complications (eg, digital nerve/artery injury, digit loss, graft loss, cardiorespiratory complications related to anesthesia) and reoperation rates were compared between WALANT and RA groups.</p><p><strong>Results: </strong>Eighty-one digits in 61 patients underwent dermofasciectomy over the 5-year study period. Forty-two digits in 32 patients had dermofasciectomy under WALANT, and 39 digits in 29 patients under RA. The total surgical time was similar in both the RA and WALANT groups, as were the rates of digital nerve or artery injury, graft loss, postoperative infection, and reoperation. In the WALANT group, no operation required conversion to general anesthesia or RA, all patients went home on the same day as surgery, and there were no local anesthesia-related complications such as anesthetic toxicity or digital ischemia from local anesthetic with adrenaline.</p><p><strong>Conclusions: </strong>It is feasible to perform dermofasciectomy under WALANT.</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":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635004","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 Rate of Major Complications Following Distal Radial Fractures Treated With One Specific Volar Locking Plate: A Retrospective Study of 1,597 Consecutive Cases in 1,564 Patients.","authors":"Ole-Gunnar Olsen, Shifteh Omrani, Asgeir Amundsen, Jan Ragnar Haugstvedt, Kristian Samuelsson, Bengt Östman","doi":"10.1016/j.jhsa.2025.01.022","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.022","url":null,"abstract":"<p><strong>Purpose: </strong>Current knowledge of complication rates after volar plating of distal radius fractures mainly relies on studies of low to moderate numbers and various implants. This study sought to find the incidence of complications leading to reoperation in a sample of distal radius fractures treated with one specific volar locking plate (VLP).</p><p><strong>Methods: </strong>We retrospectively evaluated 1,597 distal radius fractures in 1,564 patients operated with a VLP from January 2011 to December 2017 for complications leading to a reoperation. We considered any reoperation a major complication, except for carpal tunnel syndrome surgery and removal of hardware not caused by intra- or extra-articular screw penetration. Postoperative information was assessed for a minimum of 5 years or until death.</p><p><strong>Results: </strong>The total complication rate was 7.5% (120 of the 1597 cases). Major complications accounted for 3.9% (n = 62) and minor complications 3.6% (n = 58). Implant extraction not attributed to screw penetration (n = 34, 2.1%) and postoperative carpal tunnel syndrome (n=24, 1.5%) were the most frequent. No flexor tendon ruptures occurred. There were four (0.3%) extensor pollicis longus ruptures but no other extensor tendon ruptures. Deep infections were rare, occurring in only four cases (0.3%).</p><p><strong>Conclusions: </strong>Treatment of unstable distal radius fractures with a VLP is associated with few major complications. Minor procedures, like carpal tunnel release, and removal of hardware without objective clinical or radiological indications, accounted for almost half of the reoperations.</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":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607172","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":"Development of an Amyloidosis Risk Score for Positive Tenosynovial Biopsy at Carpal Tunnel Release.","authors":"Dafang Zhang, Brandon E Earp, Kyra A Benavent, Yuchiao Chang, Sarah Cuddy, George S M Dyer, Rodney H Falk, Jeffrey N Katz, Richard N Mitchell, Robert F Padera, Philip Blazar","doi":"10.1016/j.jhsa.2025.01.028","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.028","url":null,"abstract":"<p><strong>Purpose: </strong>Tenosynovial biopsy at the time of carpal tunnel release affords a unique opportunity for the early diagnosis of amyloidosis. We aimed to build a risk score to stratify patients likely to have undiagnosed amyloidosis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 320 adult patients with carpal tunnel syndrome undergoing carpal tunnel release. Patients underwent tenosynovial biopsy at the time of surgery. The primary outcome measure was a positive biopsy for amyloid deposition as assessed by Congo red and sulfated Alcian blue staining. We generated a risk score by assigning points to each variable independently associated with a positive biopsy in a logistic regression model, with weights proportional to parameter estimates (log odds ratio).</p><p><strong>Results: </strong>The cohort mean age was 63 years, and 65% were female. Forty-nine out of 320 subjects (15.3%) had positive tenosynovial biopsies for amyloidosis. In the logistic regression model, independent predictors of a positive biopsy included age 70 to 79 years (odds ratio [OR] 14.6, 95% confidence interval [CI] 1.83-115.7) and age ≥ 80 years (OR 33.9, 95% CI 4.1-279.3) compared with age < 50 years, male sex (OR 2.6, 95% CI 1.3-5.3), and history of trigger digit (OR 2.4, 95% CI 1.2-4.9). We assigned weights proportional to the log odds ratios from the logistic model to generate a summary amyloidosis risk score based on age, sex, and history of trigger digit. A score of 0 corresponds to 2.5% risk and 6 to 75% risk.</p><p><strong>Conclusions: </strong>The likelihood of a positive biopsy for amyloidosis is independently associated with older age, male sex, and history of trigger digit.</p><p><strong>Clinical relevance: </strong>A routine biopsy strategy maximizes sensitivity for the early detection of amyloidosis with a 15% positive biopsy rate. We furthermore present a risk score for a selective biopsy strategies with associated sensitivities and specificities.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588266","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":"Prophylactic Antibiotics for Uncomplicated Upper-Extremity Lacerations: A Retrospective Cohort Study of Private Insurance Claims.","authors":"Cecil S Qiu, Gabriel Yohe, Eliana Schaefer, Gongliang Zhang, Oluseyi Aliu, Aviram M Giladi","doi":"10.1016/j.jhsa.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.030","url":null,"abstract":"<p><strong>Purpose: </strong>Despite limited evidence for their effectiveness, antibiotics are frequently prescribed after uncomplicated upper-extremity lacerations. We analyzed rates of prophylactic antibiotic prescriptions and risk factors for infection after upper-extremity lacerations that were acutely repaired in emergency departments (ED).</p><p><strong>Methods: </strong>Using the IBM MarketScan Commercial Claims and Encounters database, we conducted a retrospective cohort study of adult patients with uncomplicated upper-extremity lacerations repaired in the ED between 2010 and 2020. In addition to univariate analyses, multivariable models were used to predict the likelihood of antibiotic prescriptions and to assess their independent relationship to infections.</p><p><strong>Results: </strong>We identified 249,261 patients with upper-extremity lacerations repaired in the ED. Of these, 147,964 lacerations (59.4%) were shorter than 2.5 cm, and 224,581 (90.1%) were coded as simple repairs. Prophylactic antibiotics were given to 49,609 (19.9%). Overall, the 30-day infection rate was 2.1%. Individuals who underwent complex repair were more likely to fill antibiotic prescriptions compared with those undergoing simple repair (40.2% vs 18.2%), but no clinically meaningful difference in subsequent infections was observed (1.9% vs 2.0%). We performed a least absolute shrinkage and selection operator regression that predicted antibiotic prescriptions with moderate discrimination (area under the curve = 0.67). A propensity-score balanced logistic regression found that antibiotics were independently associated with greater odds of infection (odds ratio = 1.31, 95% confidence interval: 1.23-1.41).</p><p><strong>Conclusions: </strong>Infections after acute repairs of upper-extremity lacerations were rare. One in five patients received prophylactic antibiotics, a lower prescribing rate than previously reported. Receiving antibiotics was associated with an increased odds of infection after controlling for multiple demographic and clinical variables, but a causal relationship cannot be established from these data. We did not find evidence that supports routine use of prophylactic antibiotics to prevent infections in uncomplicated upper-extremity lacerations.</p><p><strong>Type of study/level of evidence: </strong>Therapy/Prevention IIb.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588269","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":"Three-Dimensional In Vivo Kinematic Analysis of Kienböck Disease Treated with Arthroscopic Lunate Excision.","authors":"Sitthiphong Suwannaphisit, Shohei Omokawa, Akio Iida, Kenji Kawamura, Hideo Hasegawa, Yasuhito Tanaka","doi":"10.1016/j.jhsa.2025.01.024","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.024","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment options for advanced stage Kienböck disease primarily involve lunate excision, either in the context of proximal row carpectomy or in association with partial wrist fusion. This study aimed to investigate the in vivo three-dimensional carpal kinematics following arthroscopic lunate excision.</p><p><strong>Methods: </strong>We analyzed carpal translation and rotation of the affected wrist in five patients who underwent arthroscopic lunate excision for stage IIIC Kienböck disease. Our dynamic computed tomography image-based analysis focused on determining the centroid position of the scaphoid, triquetrum, and capitate and measuring the rotational angles of each carpal bone relative to the radius. These postoperative measurements data were compared with those derived from five healthy subjects. Furthermore, the joint contact area was visualized to assess the congruity of the radiocarpal and midcarpal joints.</p><p><strong>Results: </strong>Wrists in which the lunate was arthroscopically excised were found to have significantly different carpal kinematics compared to normal subjects. Specifically, scaphoid-triquetrum, ulno-triquetrum, and radio-capitate distances decreased during ulnar and radial deviation. After surgery, the scaphoid tended to be limited in its extension, presenting a flexed position. Lunate-excised wrists demonstrated no apparent deviation of the contact area in the radioscaphoid or midcarpal joint.</p><p><strong>Conclusions: </strong>Although postarthroscopic lunate excision alters normal carpal kinematics, the joint congruity is maintained in the short-term.</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":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588288","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 Epitendinous-First Repair of Flexor Digitorum Profundus in Zone II on Gapping and Load-To-Failure in a Cadaveric Simulated Active Motion Model.","authors":"Joseph Catapano, Pooyan Abbasi, Kavya K Sanghavi, Ryan D Katz, James P Higgins, Aviram M Giladi, Kenneth R Means","doi":"10.1016/j.jhsa.2025.01.029","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.029","url":null,"abstract":"<p><strong>Purpose: </strong>Surgeons routinely use epitendinous suturing to augment zone II flexor digitorum profundus (FDP) repairs. We sought to determine whether completing epitendinous suturing first, with proposed improved repair alignment and core-suture tensioning, facilitates durability for cyclic and load-to-failure testing in a cadaver model.</p><p><strong>Methods: </strong>In fresh, matched-pair human cadaver hands, we sharply cut all FDPs transversely in zone II. A single surgeon repaired each FDP with a running-locking epitendinous technique using 6-0 polypropylene suture and locking cruciate 8-strand core technique with 4-0 looped multi-strand polyethylene/braided polyester suture. For each matched pair, the surgeon completed the epitendinous repair first in one FDP (n = 12) and for the other FDP they completed the core repair first (n = 12). Using a computer-controlled system attached to the finger flexors and extensors, we simulated active range of motion from full extension to 5 mm short of tip-to-palm flexion at 0.2 Hz for 2,000 cycles, replicating a 6-week protocol. We measured repair gapping at predetermined cycle timepoints. We explanted FDPs with repairs that had not failed by 2,000 cycles and loaded them to repair failure on a materials testing machine at 1 mm/s. We defined failure as gapping >2 mm throughout the study. Our primary outcome was residual repair load-to-failure after cyclic testing.</p><p><strong>Results: </strong>One core-first repair failed during cyclic testing. Gapping during cyclic testing and residual median loads-to-failure between epitendinous-first and core-first repairs were similar (98 N vs 91 N, respectively). Median repair times were also similar between groups (15.3 min vs 13.4 min, respectively).</p><p><strong>Conclusions: </strong>For transverse Zone II FDP lacerations, the order of epitendinous and core-suture placement does not appear to substantially affect repair residual strength after cyclic loading.</p><p><strong>Clinical relevance: </strong>Regarding repair durability for clean, transverse zone II FDP lacerations, surgeons can place epitendinous and core sutures in their preferred sequence.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588283","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":"Clinical Effectiveness of an Orthosis After Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture.","authors":"Craig Dent, Nino Coutelle, Meera Gill, Peter Simon, Michael Doarn, Jason Nydick","doi":"10.1016/j.jhsa.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.023","url":null,"abstract":"<p><strong>Purpose: </strong>Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment.</p><p><strong>Methods: </strong>The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded.</p><p><strong>Results: </strong>There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least \"Most of the Time\" at 1 month and 52% at least \"Half of the Time\" at 4 months.</p><p><strong>Conclusions: </strong>Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures.</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":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568858","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":"Fully Threaded Versus Partially Threaded Intramedullary Headless Compression Screw Fixation for Proximal Third Fractures of the Proximal Phalanx: A Biomechanical Study.","authors":"Bert Vanmierlo, Bruno Vandekerckhove, Leen Popleu, Bert O Eijnde, Joris Duerinckx, Jean F Goubau","doi":"10.1016/j.jhsa.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.01.006","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the maximal elastic force and deformation resistance of two commonly used headless compression screw systems, a fully threaded 2.5 mm screw and a partially threaded screw of the same dimensions, in a cadaveric model of a human transverse proximal third fracture of the proximal phalanx.</p><p><strong>Methods: </strong>Six fresh frozen cadavers were used, and the proximal phalanges of the index, long, and ring fingers of both hands were dissected. A proximal third transverse osteotomy was created, and screws were inserted in an antegrade direction. The three-point bending load-to-failure test measured the maximal elastic force and deformation resistance of each bone-screw construct.</p><p><strong>Results: </strong>The fully threaded screw demonstrated a maximal elastic force of 121 N and a deformation resistance of 134 N/mm. The partially threaded screw showed superior performance with a maximal elastic force of 165 N and deformation resistance of 166 N/mm. The bone-screw construct with the fully threaded screw had a mean maximal elastic force of 155.2 N compared to 101.8 N in the construct with the partially threaded screw. Deformation resistance was 145.2 N/mm for fully threaded screws and 98.6 N/mm for partially threaded screws.</p><p><strong>Conclusions: </strong>Fully threaded intramedullary headless compression screw fixation provides superior maximal elastic force and deformation resistance compared to partially threaded intramedullary headless compression screw fixation in transverse proximal third fractures of the proximal phalanx.</p><p><strong>Clinical relevance: </strong>The findings indicate that fully threaded intramedullary headless compression screw fixation may offer enhanced stability for treating proximal third fractures of the proximal phalanx, potentially leading to better patient outcomes through earlier mobilization and reduced complications compared to partially threaded screws.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544499","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":"Assessing the Effect of Time From Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease","authors":"Purushottam Nagarkar MD ,&nbsp;Nirbhay S. Jain MD ,&nbsp;Meaghan L. Barr MD ,&nbsp;Cathy Tang MD ,&nbsp;Dong Lee BS ,&nbsp;Irene Chang BA ,&nbsp;Michael R. Delong MD ,&nbsp;Prosper Benhaim MD","doi":"10.1016/j.jhsa.2023.07.015","DOIUrl":"10.1016/j.jhsa.2023.07.015","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Dupuytren disease<span> can be managed with an injection of collagenase </span></span><em>Clostridium histolyticum</em> enzyme followed by manual manipulation. Although the recommended time from injection to manipulation is 24–72 hours, patient and physician schedules may not accommodate this time frame. Therefore, we sought to study the impact of time from injection to manipulation on outcomes and complications of collagenase injection.</div></div><div><h3>Methods</h3><div>We performed a review of 309 patients who underwent an injection of collagenase <em>Clostridium histolyticum</em><span> for Dupuytren disease with manipulation at two, five, or seven days after injection. We compared preinjection and postinjection contracture angles as well as frequency of skin tears and tendon ruptures.</span></div></div><div><h3>Results</h3><div>Of the 309 patients, 207 underwent manipulation at two days, 32 at five days, and 70 at seven days. Patients had similar preinjection contracture angles. All patients demonstrated improvement in contracture after manipulation. Rates of skin tears and tendon ruptures were similar in all three groups. Significant predictors of complications included number of cords injected and history of previous collagenase injection, but not history of previous Dupuytren diagnosis.</div></div><div><h3>Conclusions</h3><div>Although collagenase injection for Dupuytren disease is typically performed with plans for manipulation at 24–72 hours, postinjection manipulation could be performed as late as seven days without adversely affecting the frequency of skin and tendon complications.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 376.e1-376.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10426939","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 Elbow Flexion On Valgus Carrying Angle","authors":"Tyler John Wilps MD ,&nbsp;Calvin K. Chan MS ,&nbsp;Satoshi Yamakawa PhD ,&nbsp;Keishi Takaba MD ,&nbsp;Satoshi Takeuchi MD ,&nbsp;Robert A. Kaufmann MD ,&nbsp;Richard E. Debski PhD","doi":"10.1016/j.jhsa.2023.07.010","DOIUrl":"10.1016/j.jhsa.2023.07.010","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to examine the effect of flexion on valgus carrying angle in the human elbow using a dynamic elbow testing apparatus.</div></div><div><h3>Methods</h3><div>Active elbow motion was simulated in seven cadaveric upper extremities. Six electromechanical actuators simulated muscle action, while 6 degrees-of-freedom joint<span> motion was measured with an optical tracking system to quantify the kinematics of the ulna<span> with respect to the humerus as the elbow was flexed at the side position. Repeatability of the testing apparatus was assessed in a single elbow over five flexion-extension cycles. The varus angle change of each elbow was compared at different flexion angles with the arm at 0° of humerothoracic abduction or dependent arm position.</span></span></div></div><div><h3>Results</h3><div>The testing apparatus achieved excellent kinematic repeatability (intraclass correlation coefficient, &gt;0.95) throughout flexion and extension. All elbows decreased their valgus carrying angle during flexion from 0° to 90° when the arm was maintained at 0° of humerothoracic abduction. Elbows underwent significant total varus angle change from full extension of 3.9° ± 3.4° (<em>P</em> = .007), 7.3° ± 5.2° (<em>P</em> = .01), and 8.9° ± 7.1° (<em>P</em> = .02) at 60°, 90°, and 120° of flexion, respectively. No significant varus angle change was observed between 0° and 30° of flexion (<em>P</em> = .66), 60° and 120° of flexion (<em>P</em> = .06), and 90° and 120° of flexion (<em>P</em> = .19).</div></div><div><h3>Conclusions</h3><div>The dynamic elbow testing apparatus characterized a decrease of valgus carrying angle during elbow flexion and found that most varus angle changes occurred between 30° and 90° of flexion. All specimens underwent varus angle change until at least 90° of flexion.</div></div><div><h3>Clinical relevance</h3><div>Our model establishes the anatomic decrease in valgus angle by flexion angle <em>in vitro</em><span> and can serve as a baseline for testing motion profiles of arthroplasty designs and ligamentous reconstruction in the dependent arm position. Future investigations should focus on characterizing motion profile change as the arm is abducted away from the body.</span></div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 373.e1-373.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10014344","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}