Journal of Hand Surgery-American Volume最新文献

{"title":"Long-Term Functional and Radiological Results in Tonkin Type 3B Thumb Hypoplasia Treated With Nonvascularized Toe Phalanx Transfer as an Alternative to Pollicization","authors":"Anil K. Bhat MS(Ortho), DNB(Ortho) ,&nbsp;Ashwath M. Acharya MS, FNB ,&nbsp;Mithun Pai G MS, FNB","doi":"10.1016/j.jhsa.2024.06.011","DOIUrl":"10.1016/j.jhsa.2024.06.011","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Parents of children with hypoplastic thumbs often reject the option of pollicization for various reasons and enquire about alternate choices. Our study aimed to assess the outcome in children who underwent nonvascularized toe phalanx transfer for Tonkin type 3B thumb </span>hypoplasia and compare it with a similar cohort of children treated with pollicization.</div></div><div><h3>Methods</h3><div>At an average follow-up of 7 years for toe phalanx transfer and 6 years of pollicization, five children from each group were tested for thumb length, stability of the first carpometacarpal (CMC) joint, mobility, opposition, and donor-site morbidity. Parents were asked to report improvements in function and appearance. All cases were Tonkin type 3B thumb hypoplasia.</div></div><div><h3>Results</h3><div><span>The CMC joint was found to be stable in all children, and the Kapandji score was 6 in 3 children and 5 in 2 children with toe phalanx transfer compared to 9 in all children with pollicization. The average palmar abduction was 24°, and the average radial abduction was 36° in the toe phalanx transfer group compared to 40° and 45°, respectively, in children with pollicization. The average thumb length was 50.8% of the index finger's<span> proximal phalanx<span> in the toe phalanx group compared to 60 % in the pollicization group. The mean visual analog scale scores for the thumb's function and appearance were 6.8 and 6.4, respectively, compared to 9.2 and 8.8, respectively, in the pollicization group. No resorption was noted in the donor phalanx at a mean follow-up of 7 years with no donor-site morbidity other than mild shortening of the </span></span></span>toes.</div></div><div><h3>Conclusions</h3><div>We noted increased palmar abduction and radial abduction in the pollicization group. No resorption was noted in the donor toe phalanx at the longest follow-up of 9 years. Toe phalanx can be considered an alternative for those children in whom a five-finger hand is a priority.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1269.e1-1269.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114901","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":"Looped Penrose Drainages of Acute Hand Infections in Vulnerable Populations","authors":"Jane N. Ewing BS ,&nbsp;Yoshiko Toyoda MD ,&nbsp;Mehdi S. Lemdani BA ,&nbsp;John R. Vaile BS ,&nbsp;Elizabeth Malphrus MD, MPP ,&nbsp;Zachary Gala MD ,&nbsp;Chris Amro MD ,&nbsp;Robyn B. Broach PhD ,&nbsp;Benjamin Chang MD","doi":"10.1016/j.jhsa.2024.11.015","DOIUrl":"10.1016/j.jhsa.2024.11.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute hand infections (AHIs) remain a challenge for hand surgeons and represent a condition for which clinical outcomes are considerably affected by social barriers. We previously described the looped Penrose drainage technique, where a drain is sutured to itself in a loop and the outflow tract of egress is maintained, thus obviating the need for large incisions, wound closure, or repeat packing, thereby reducing the follow-up burden. In the face of escalating numbers of socioeconomically vulnerable patients, especially in urban settings, we aimed to characterize the clinical features and outcomes of this technique in an urban population of patients with AHI.</div></div><div><h3>Methods</h3><div>A review of all surgical irrigations of AHI by a single, fellowship-trained hand surgeon at an urban hospital from 2013 through 2021 was performed. Patient demographics, procedure details, and postprocedure outcomes were analyzed.</div></div><div><h3>Results</h3><div><span><span>Fifty-three patients (average age, 48.6 years) with AHI underwent surgical irrigations with the looped Penrose drainage technique. The majority of patients were Black (50.9%). Approximately 81.1% of the patients received public insurance, 22.6% were unemployed, 35.9% had annual incomes &lt;$40,000, and 17% experienced homelessness. Overall, 34% were lost to follow-up with the Penrose still intact, including 78% of those who were homeless. Most of the cases occurred on the hand, with involvement of the deep spaces (24.5%), tenosynovitis (39.3%), and bone (1.9%). </span>Recurrent infection (1.9%) and abscess formation (5.7%) led to one </span>reoperation<span> (1.9%). There were no amputations or readmissions, and all postoperative emergency department visits (7.1%) were discharged.</span></div></div><div><h3>Conclusions</h3><div>The looped Penrose technique is a simple and less invasive alternative to traditional incision and drainage with packing and serves as an effective single-episode intervention strategy for AHIs, particularly in patients with complex social challenges because of the ease of wound management and low rates of readmission and reoperation.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1274.e1-1274.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016623","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":"Resource Utilization and Cost Associated With Hand Trauma: An Analysis Outside of the Surgical Global Period","authors":"Muhammad Harirah MD ,&nbsp;Berkay Basagaoglu MD ,&nbsp;Monal Depani MD ,&nbsp;Pui Man (Pamela) Chan MPH ,&nbsp;Jialiang Liu PhD ,&nbsp;Donghan M. Yang PhD ,&nbsp;Jessica I. Billig MD, MSc","doi":"10.1016/j.jhsa.2025.06.017","DOIUrl":"10.1016/j.jhsa.2025.06.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Hand injuries constitute approximately 20% of emergency department visits. Some of these injuries may require surgical care and extended follow-up outside of the global surgery period to obtain the best functional outcomes. However, little is known regarding national estimates of health care utilization outside of the global period and the characteristics and associated expenses of these services.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, population-based analysis of patients using the Merative MarketScan Research Database between 2019 and 2022 for “treatment intense” hand trauma including distal radius fracture surgical treatment, flexor tendon repair, and replantation/revascularization. We evaluated health care utilization from 90 days to 1 year after the index operation and the associated payments and out-of-pocket expenses.</div></div><div><h3>Results</h3><div>There was a total of 20,141 patients identified from the database. Between 90 days and 1 year after the index procedure, 1,361 (6.8%) patients had at least one utilization visit while 18,780 (93.2%) patients had no utilization visits. This resulted in mean total payments of $934.31 for care from 91 to 365 days after the index operation, whereas mean out-of-pocket expenses were $89.89. Patients with at least one utilization visit were more likely to be older (51 vs 50 years), have a median household income between &lt;40,000 to 60,000, and underwent treatment for a distal radius fracture or replantation. Additionally, flexor tendon repair was associated with a decreased adjusted mean of total insurance payments (odds ratio [OR], 0.57 [0.42–0.81]), compared to distal radius fracture fixation.</div></div><div><h3>Conclusions</h3><div>Hand traumatic injuries are resource-intensive and may require treatment outside the global period to obtain the best functional outcomes. Findings from this study provide national estimates of the health care utilization outside of the global period and the associated costs to the health care systems and patients.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1165-1173"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857077","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":"A Nationwide Study on Price Transparency and Variables Affecting the Cost of Common Hand Procedures","authors":"Alexandra Polovneff MD ,&nbsp;Aishu Ramamurthi MD ,&nbsp;Brian Conway MD, MS ,&nbsp;Nicolas Koerber BS ,&nbsp;Gwendolyn Hoben MD, PhD ,&nbsp;Sergey Tarima PhD ,&nbsp;Kate Krucoff MD","doi":"10.1016/j.jhsa.2025.07.006","DOIUrl":"10.1016/j.jhsa.2025.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To help patients make better-informed health care decisions and decrease overall health care expenditures, the Centers for Medicare and Medicaid Services established a price transparency law in 2021 requiring hospitals to publish price data. We investigated hospital compliance rates with price reporting, price variation for common hand surgery procedures, and the influence of hospital factors on price.</div></div><div><h3>Methods</h3><div>Common Procedure Terminology (CPT) codes for 14 common hand procedures were searched in the Turquoise Health database for prices published by hospitals nationwide from March 2023 to August 2023. Hospital details were collected, and univariate and multivariable analyses assessed the relationship between hospital factors and price for each CPT code.</div></div><div><h3>Results</h3><div>A total of 769,349 contracted rates from 3,700 different hospitals were analyzed from 14 hand surgery CPT codes. The greatest price variation was seen with surgical treatment for Dupuytren disease, and the smallest price variation was seen with lesion excision. Multivariable analysis of hospital factors demonstrated geographic region, private ownership, and safety net status most affected price, whereas Medicare’s hospital rating, status as an academic center, hospital bed size, and compliance with the price transparency law did not consistently influence price. Higher prices were found for hospitals in the Northwest and West regions, privately owned health care institutions, nonsafety net hospitals, and hospitals in urban settings.</div></div><div><h3>Conclusions</h3><div>Since Centers for Medicare and Medicaid Services legislation enactment, there is continued variation in price transparency and cost of common hand surgery procedures, regardless of hospital ranking.</div></div><div><h3>Clinical relevance</h3><div>The lack of transparency may place patients at a disadvantage, particularly when seeking a physician and hospital system for elective surgeries.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1198-1206"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139513","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":"A Changing Landscape in Surgical Treatment of Basilar Thumb Arthritis: Is the Rate of Denervation Increasing?","authors":"Daniel A. Portney MD ,&nbsp;Cody P. Lee MD ,&nbsp;Jennifer Moriatis Wolf MD, PhD ,&nbsp;Jason A. Strelzow MD ,&nbsp;Jeffrey G. Stepan MD, MSc","doi":"10.1016/j.jhsa.2024.12.007","DOIUrl":"10.1016/j.jhsa.2024.12.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to assess the evolving landscape of surgical interventions for basilar thumb arthritis.</div></div><div><h3>Methods</h3><div>Using a national insurance claims database spanning from 2016 to 2022, patients undergoing surgical treatment for thumb carpometacarpal (CMC) arthritis were identified through International Classification of Disease<span><span> 10 and Current Procedural Terminology codes. The incidence of each type of surgical procedure was collected and normalized to the 2016 level. The total percentage change in incidence and </span>linear regression<span> trendline was calculated over the 7-year period. Multiple variable logistic regression<span> assessed factors associated with thumb CMC denervation.</span></span></span></div></div><div><h3>Results</h3><div>Among 64,281 surgically treated patients, trapeziectomy with interposition arthroplasty<span> was the most common (83.8%). Although thumb CMC denervation was the least common surgery and accounted for only 1.0% of all surgery, the incidence of denervation increased over the study period from 0.47 to 1.30 per 1,000,000, alongside a 41% rise in trapeziectomy alone. Regression analysis revealed male sex, Western US region, and concomitant carpal tunnel syndrome as associated factors for thumb CMC denervation.</span></div></div><div><h3>Conclusions</h3><div>The study indicates a notable shift in surgical approaches for basilar thumb arthritis. Although CMC denervation was the least commonly performed basal joint surgery, there was an increase in denervation procedures from 2016 to 2022. Denervation was not associated with patient age and was most strongly associated with male sex.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1280.e1-1280.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366347","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":"Comparing the Palmar Radiocarpal Artery Vascularized Bone Graft with Alternatives for Unstable Scaphoid Nonunions: A Retrospective Analysis","authors":"Louis-Philippe Baisi MD ,&nbsp;Marc-Antoine Ricard MD ,&nbsp;Melanie Dodd-Moher MHK ,&nbsp;Taryn Hodgdon MD ,&nbsp;Manisha Mistry MD, MSc ,&nbsp;Braden Gammon MD, MSc","doi":"10.1016/j.jhsa.2024.11.022","DOIUrl":"10.1016/j.jhsa.2024.11.022","url":null,"abstract":"<div><h3>Purpose</h3><div>We compared the radiographic union and magnitude of humpback deformity correction when using different vascularized bone grafts (VBGs) and nonvascularized bone grafts (NVBGs) in the treatment of unstable scaphoid nonunions (USNUs).</div></div><div><h3>Methods</h3><div>This was a retrospective radiographic review of 93 patients with an USNU treated between 2013 and 2022 at a single center by a single surgeon. Inclusion criteria included skeletally mature patients with radiographic evidence of an USNU resulting from failure of either nonsurgical or operative treatment. There were three treatment groups. Two groups were treated with either a palmar radiocarpal artery (PRCA) VBG or a 1,2 intercompartmental supraretinacular (1,2 IC-SRA) VBG. The third group comprised patients who were treated with a heterogeneous mix of NVBGs. Patients were followed radiographically at regular intervals until they were deemed healed or underwent a salvage procedure because of treatment failure. Measurements of carpal and scaphoid alignment were then repeated on the final imaging series and compared to preoperative measurements.</div></div><div><h3>Results</h3><div>Ninety patients were included in the final analysis. PRCA VBG had the highest radiographic union rate, followed by 1,2 IC-SRA VBG and finally NVBGs. PRCA VBG had a significantly higher rate of union than NVBGs. Scapholunate angle change and scaphoid length change were greatest with PRCA VBG. These differences were statistically significant for the former when compared with 1,2 IC-SRA VBG and NVBGs and for the latter when compared with the 1,2 IC-SRA VBG in both univariate and multivariable analyses.</div></div><div><h3>Conclusions</h3><div>PRCA VBG had the highest radiographic union rate compared with alternative grafts as well as providing the greatest degree of humpback deformity correction in the treatment of USNUs.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1279.e1-1279.e9"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043410","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.2025.09.002","DOIUrl":"10.1016/j.jhsa.2025.09.002","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Page 1259"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204151","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":"Response to Commentary on “Skin Cancer of the Hand: Current Management and New Horizons”","authors":"Peyton H. Terry MD ,&nbsp;Yoshiko Toyoda MD ,&nbsp;Ines C. Lin MD, MSEd","doi":"10.1016/j.jhsa.2025.07.029","DOIUrl":"10.1016/j.jhsa.2025.07.029","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1161-1164"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204241","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":"Letter to the Editor Regarding “The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability”","authors":"Ge Xiong MD, PhD ,&nbsp;Yuan Zheng MD ,&nbsp;Jiangchao Zhang MD","doi":"10.1016/j.jhsa.2025.07.012","DOIUrl":"10.1016/j.jhsa.2025.07.012","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Page e13"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204489","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 Practice Guidelines","authors":"Brent Graham MD, FRCSC","doi":"10.1016/j.jhsa.2025.07.031","DOIUrl":"10.1016/j.jhsa.2025.07.031","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1153-1154"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204495","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}