Journal of Hand Surgery-American Volume最新文献

{"title":"Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair.","authors":"David Cardenas, Anca Dogaroiu, Muhammad Harirah, Andrew Y Zhang, Andrei Odobescu, Douglas M Sammer","doi":"10.1016/j.jhsa.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.11.021","url":null,"abstract":"<p><strong>Purpose: </strong>The epitendinous suture is a critical part of flexor tendon repair. In addition to smoothing the repair site, it augments repair strength and increases gap resistance. This study aimed to determine whether increasing the number of passes or increasing suture caliber would improve the strength (primary outcome), 2 mm gap resistance, or stiffness of a simple running epitendinous suture.</p><p><strong>Methods: </strong>A total of 30 flexor pollicis longus (FPL), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) tendons were harvested from three cadavers, and transverse tendon lacerations were produced. Tendons were repaired with only an epitendinous suture (no core suture) in three groups: 6-0 Prolene with six passes, 5-0 Prolene with six passes, or 5-0 Prolene with six passes. Epitendinous repair strength was tested using a materials testing machine.</p><p><strong>Results: </strong>The use of eight passes had significantly greater ultimate tensile strength than six passes (21 +/- 7 N vs 14 +/- 5 N). Although 5-0 suture had a higher average ultimate tensile strength than 6-0 suture, this difference was not statistically significant (14 N +/- 5 vs 10 N +/- 3). Failure mode for all groups was most often suture tear-through.</p><p><strong>Conclusions: </strong>A simple epitendinous suture using eight passes provides almost 50% more epitendinous repair strength and greater 2 mm gap resistance than six passes when using 5-0 Prolene.</p><p><strong>Clinical relevance: </strong>When performing a simple running epitendinous repair to augment a core flexor tendon repair, the surgeon should consider the additional strength and gap resistance provided by eight passes compared to six.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190318","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.2024.12.020","DOIUrl":"10.1016/j.jhsa.2024.12.020","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Page 215"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298432","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":"MRI for Scaphoid Nonunion: Utilization Rates, Factors Associated With Utilization, and Subsequent Vascularized Bone Graft Use","authors":"Lauren M. Shapiro MD, MS ,&nbsp;Emily A. Schultz BS ,&nbsp;Jessica Welch BS ,&nbsp;Thompson Zhuang MD, MBA ,&nbsp;Robin N. Kamal MD, MBA","doi":"10.1016/j.jhsa.2024.10.008","DOIUrl":"10.1016/j.jhsa.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of magnetic resonance imaging (MRI) for evaluation of scaphoid nonunion may be an example of low-value imaging for the treatment of scaphoid nonunion. The purpose of this study was to investigate variation in MRI use for scaphoid nonunion, the association of MRI with a vascularized bone graft (VBG) and to develop consensus on MRI use for scaphoid nonunion.</div></div><div><h3>Methods</h3><div>We identified patients &gt;18 years of age who underwent scaphoid nonunion surgery between 2010 and 2019 using a claims database. Patients who had, and did not have, an MRI within 90 days prior to their diagnosis of scaphoid nonunion were included and a multivariable analysis was performed to evaluate variation in MRI and VBG use. Subsequently, a literature review was performed, and a preliminary consensus statement was developed pertaining to the routine use of MRI for scaphoid nonunion. A consortium of nine hand surgeons evaluated the importance, feasibility, usability, and scientific acceptability of the statement through a modified RAND Coroporation/University of California, Los Angeles Delphi. Panelists evaluated the statement in two voting rounds with an intervening face-to-face discussion.</div></div><div><h3>Results</h3><div>We identified 1,324 eligible patients with surgical repair of a scaphoid nonunion. Two hundred and sixty-three (19.9%) underwent an MRI within 90 days prior to surgery. Differences in age, insurance type, and comorbidity burden existed between patients who received MRI and those who did not. The MRI cohort was more likely to receive VBG (10.6%) compared to those without an MRI (4.7%). Panelists agreed on the voting domains of the consensus statement and therefore the statement, “There is no benefit of routine MRI/MRA in the treatment of scaphoid nonunion with or without presumed avascular necrosis,” was considered valid.</div></div><div><h3>Conclusions</h3><div>MRI use within 90 days of surgical repair of scaphoid nonunion varies, is associated with greater rates of VBG use, and may represent low-value imaging given the lack of sufficient evidence on this topic.</div></div><div><h3>Clinical relevance</h3><div>As MRI use for scaphoid nonunion varies and may represent low-value imaging, a validated consensus statement may help guide the evaluation of patients with scaphoid nonunion.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 182-187"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774884","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":"Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?","authors":"Daniel A. Portney MD ,&nbsp;Quinn A. Stillson BS ,&nbsp;Jason A. Strelzow MD ,&nbsp;Jennifer Moriatis Wolf MD, PhD","doi":"10.1016/j.jhsa.2023.05.019","DOIUrl":"10.1016/j.jhsa.2023.05.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Thumb carpometacarpal (CMC) osteoarthritis<span> (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis.</span></div></div><div><h3>Methods</h3><div>We queried a national insurance dataset for all patients with an International Classification of Diseases<span>, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment.</span></div></div><div><h3>Results</h3><div>After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3).</div></div><div><h3>Conclusions</h3><div>We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy treatment.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 234.e1-234.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9889992","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":"2024 ASSH Presidential Address: Making Space","authors":"Steven L. Moran MD","doi":"10.1016/j.jhsa.2024.11.003","DOIUrl":"10.1016/j.jhsa.2024.11.003","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 123-129"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256482","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":"Reliability and Validity of the Ten Test for the Assessment of Digit Sensation.","authors":"Yagiz Ozdag, Jessica L Koshinski, Anil Akoon, Victoria C Garcia, C Liam Dwyer, Joel C Klena, Louis C Grandizio","doi":"10.1016/j.jhsa.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.12.015","url":null,"abstract":"<p><strong>Purpose: </strong>The ten test (TT) is a sensory assessment used to quantify the sensation of each digit. Because it does not require additional equipment, it may have utility in telemedicine. Our purpose was to evaluate the validity and reliability of the TT.</p><p><strong>Methods: </strong>Adult patients with nontrauma upper-extremity complaints were evaluated within an academic outpatient clinic. Two examiner groups (hand surgeons [group 1] and residents/physician assistants [group 2]) administered the TT and static two-point discrimination (2PD). Hand surgeons were blinded to the results obtained by the initial examiners. The TT is administered by having the patient define an area of normal sensation with their uninvolved index finger and then rate digital sensation against the involved hand on a 1-10 scale, with 10 defined as perfectly normal sensation. A cut-point analysis was employed, and both sensory assessments were categorized as either normal (2PD ≤5 mm, TT ≥9) or abnormal sensation for the entire median-nerve distribution and individual digit level. Agreement statistics including sensitivity (Sn) and specificity (Sp) were calculated for the TT, using static 2PD as the reference standard. Interrater reliability was compared between the groups of examiners.</p><p><strong>Results: </strong>A total of 201 patients (1,005 digits) were examined. The Sn/Sp for the TT was 53%/84% and 54%/85% at the digit-level and median-nerve distribution level, respectively. Interrater reliability for the TT between the groups of examiners was substantial at the digit level (κ = 0.68, SE = 0.02).</p><p><strong>Conclusions: </strong>The Sn/Sp for the TT was 53%/84% when using static 2PD as the reference standard. Interrater reliability for TT was substantial (κ = 0.68). The TT can serve as an alternative to other sensory assessments that require instrumentation. As telemedicine programs continue to evolve within upper-extremity surgery, the TT may be a useful tool with virtual applications.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic I.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191073","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":"Conversion of Total Wrist Arthrodesis to a Total Wrist Arthroplasty: Twelve Patients Followed for 7 (2–16) Years","authors":"Ole Reigstad MD, PhD ,&nbsp;Trygve Holm-Glad MD ,&nbsp;Johanne Korslund MD ,&nbsp;Geir Gjelsten BS ,&nbsp;Rasmus Thorkildsen MD, PhD ,&nbsp;Magne Røkkum MD","doi":"10.1016/j.jhsa.2024.10.007","DOIUrl":"10.1016/j.jhsa.2024.10.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Total wrist arthroplasty has become a viable alternative to arthrodesis. Wrist arthrodesis is not necessarily the final surgery for many of the patients because some patients never accept the residual pain and reduced function that accompanies a stiff wrist. The purpose of this study was to evaluate the clinical performance (pain, function, and satisfaction) of rearticulation, as well as the complications and reoperations of the procedure in a prospective unselected case series of patients.</div></div><div><h3>Methods</h3><div>Twelve (7 men) patients with a mean age of 53 (42–67) years were converted to a total wrist arthroplasty at a mean of 8 (3–17) years after wrist arthrodesis. The patients had undergone 53 wrist surgeries prior to rearticulation.</div></div><div><h3>Results</h3><div>One wrist with a periprosthetic fracture of the ulna and a loose distal radioulnar joint arthroplasty that had been removed during the conversion was finally fused a second time. At follow-up 7 (2–16) years after conversion, increased wrist active range of motion (0°–98°), supination (75°–85°), reduced Patient-Rated Wrist Evaluation score (56–30), and reduced visual analog scale pain scores were found. All arthroplasties were radiologically stable, well-fixed and osseointegrated. None regretted the surgery knowing the outcome.</div></div><div><h3>Conclusions</h3><div>Conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants.</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 2","pages":"Pages 173-181"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734659","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 Instructions","authors":"","doi":"10.1016/S0363-5023(24)00661-0","DOIUrl":"10.1016/S0363-5023(24)00661-0","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Page A12"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298362","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":"Epidemiology of Congenital Upper-Limb Anomalies in Southern Taiwan Based on the Updated Oberg, Manske, and Tonkin Classification: A Series of 1,335 Anomalies in 1,188 Patients","authors":"Jui-Po Yeh MD ,&nbsp;Pao-Jen Kuo MD ,&nbsp;Tsan-Shiun Lin MD ,&nbsp;Yuan-Cheng Chiang MD","doi":"10.1016/j.jhsa.2023.05.016","DOIUrl":"10.1016/j.jhsa.2023.05.016","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to investigate the relative frequency of congenital upper-limb anomalies (CULAs) in southern Taiwan using the 2020-updated the Oberg, Manske, and Tonkin (OMT) classification system and evaluate the practicality of the new classification system.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with CULAs from 1987 to 2021 at a referral center in southern Taiwan. All patients were analyzed based on medical records<span>, photographs, and radiographs, and the anomalies were classified according to the 2020 OMT classification system.</span></div></div><div><h3>Results</h3><div><span><span><span><span>A total of 1,188 patients with 1,335 CULAs were retrospectively reviewed. The results demonstrated that the most common type of CULA was malformations (1,092 cases), followed by </span>dysplasias (144 cases), syndromes (51 cases), and deformations (48 cases). Among the malformations, radial </span>polydactyly was the most common anomaly (732 cases), followed by simple </span>syndactyly (66 cases). Among the dysplasias, </span>camptodactyly<span><span> was the most common anomaly (52 cases), followed by thumb-in-palm deformity (45 cases) and vascular tumors (17 cases). In the deformations, </span>constriction ring<span> sequence accounted for all cases. Poland syndrome (21 cases) occurred most often in the category of syndromes.</span></span></div></div><div><h3>Conclusions</h3><div>The results of this study show that radial polydactyly (732 cases, 55%) is the most common CULA in southern Taiwan, followed by simple syndactyly (66 cases, 5%) and then camptodactyly (52 cases, 4%).</div></div><div><h3>Clinical relevance</h3><div>The OMT classification system is reasonably practical for precise classification of CULAs and enables easy comparison of studies over different time periods. However, continually updating the OMT classification system is required to better categorize the highly variable presentations of CULAs.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 231.e1-231.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9889989","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":"Proximity of the Ulnar Neurovascular Structures in Endoscopic Carpal Tunnel Release Surgery: A Cadaveric Study","authors":"Bryan A. Hozack MD ,&nbsp;Benjamin R. Campbell MD ,&nbsp;Justin M. Kistler MD ,&nbsp;Jonas L. Matzon MD ,&nbsp;Christopher M. Jones MD ,&nbsp;Michael Rivlin MD","doi":"10.1016/j.jhsa.2023.06.019","DOIUrl":"10.1016/j.jhsa.2023.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the proximity of the ulnar neurovascular structures to the endoscopic blade during endoscopic carpal tunnel release (CTR).</div></div><div><h3>Methods</h3><div>Ten fresh-frozen cadaver hands were used to perform endoscopic CTR using devices from two manufacturers. The skin was excised from the palm, and the endoscopic carpal tunnel blade was deployed at the distal edge of the transverse carpal ligament (TCL). The blade’s proximity to the ulnar neurovascular bundle, deep ulnar motor branch, superficial palmar arch, and median nerve was recorded. Following release of the TCL, the device was turned ulnar to the maximal extent to determine if direct injury to the ulnar neurovascular bundle was possible.</div></div><div><h3>Results</h3><div>The average longitudinal distance from the end of the TCL to the superficial palmar arch was 13.3 mm (range, 8.4–20.9) and to the ulnar motor branch was 10.8 mm (range, 4.0–15.0). The average transverse distance from the end of the TCL to the ulnar neurovascular bundle was 5.9 mm (range, 3.1–7.8) and to the median nerve was 3.3 mm (range, 0–6.5). In two of our specimens, the median nerve subluxated volarly over the cutting device. When placing the blade at the distal edge of the TCL, injury to the deep motor branch of the ulnar nerve, ulnar neurovascular bundle, or superficial palmar arch was not possible in any specimens using the tested devices, even when turning the blade directly toward these structures.</div></div><div><h3>Conclusions</h3><div>There is a low likelihood of direct injury to the ulnar neurovascular bundle during endoscopic CTR.</div></div><div><h3>Clinical relevance</h3><div>These results suggest that injury to the ulnar neurovascular bundle is unlikely during endoscopic CTR if the distal aspect of the transverse carpal ligament can be clearly identified prior to release. Control of the median nerve is also important to prevent subluxation over the cutting device.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 2","pages":"Pages 237.e1-237.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9921084","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}