Journal of Hand Surgery-American Volume最新文献

{"title":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2025.02.023","DOIUrl":"10.1016/j.jhsa.2025.02.023","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Page 490"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738548","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":"Wide-Awake Local Anesthesia No Tourniquet Surgery for Zone VII Extensor Tendon Reconstruction: Stages in Active Range of Motion From Intraoperative to Final Recovery","authors":"Ryusuke Osada MD, PhD ,&nbsp;Mineyuki Zukawa MD, PhD ,&nbsp;Tatsurou Hirokawa MD ,&nbsp;Miku Inagaki OTR ,&nbsp;Yoshiharu Kawaguchi MD, PhD","doi":"10.1016/j.jhsa.2023.09.014","DOIUrl":"10.1016/j.jhsa.2023.09.014","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated chronological changes in active range of motion (ROM) of the metacarpophalangeal (MCP) joint after zone VII extensor tendon reconstruction<span> with wide-awake local anesthesia no tourniquet (WALANT) surgery.</span></div></div><div><h3>Methods</h3><div><span>Reconstruction of the extensor tendons ruptured in zone VII of 82 fingers in 40 patients was performed using WALANT techniques. The mean patient age was 71.3 years. During surgery, we evaluated passive stretch distance and active contraction distance of the ruptured musculocutaneous unit. The sum of passive stretch distance and active contraction distance was defined as total excursion. In cases with total excursion ≥30 mm, we selected bridge tendon grafting for tendon reconstruction. In cases with total excursion &lt;30 mm, end-to-side </span>tendon transfer was performed. Active ROM of the MCP joint was measured before surgery; during surgery; 1, 3, and 5 months after surgery, and at the final follow-up.</div></div><div><h3>Results</h3><div>Extension lag of the MCP joint was 49.2° before surgery, improving to 2.9° during surgery, deteriorating to 18.7° at 1-month, and improving again to 15.6° at 3-months, 13.6° at 5-months, and 10.5° at the final follow-up. Meanwhile, the active flexion angle of the MCP was 87.9° before surgery, 87.3° during surgery, 67.6° at 1-month, 76.0° at 3-months, 79.7° at 5-months, and 81.0° at the final follow-up. Extension and flexion angles at each time point remained nearly constant regardless of whether tendon grafting or tendon transfer was used.</div></div><div><h3>Conclusions</h3><div>Extensor tendon reconstruction using WALANT surgery allowed intraoperative measurement of active ROM, confirming near-complete extension and flexion after reconstruction. The changes in ROM of the MCP joint during follow-up are an approximate indication of the progression of postoperative recovery.</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 4","pages":"Pages 500.e1-500.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400333","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":"Replication of Coupled Movements of the Wrist: A Cadaveric Study of Total Wrist Arthroplasty","authors":"Joanna Glanville MBiolSci ,&nbsp;Karl T. Bates MPhil, PhD ,&nbsp;Natan Silver MBChB ,&nbsp;Dileep Karthikappallil MBChB ,&nbsp;Sebastiano Fichera MSc, PhD ,&nbsp;Daniel J. Brown MBChB","doi":"10.1016/j.jhsa.2024.12.006","DOIUrl":"10.1016/j.jhsa.2024.12.006","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to determine how well the active range of motion and the forces required to achieve motions are maintained following cadaveric implantation of the ball-and-socket style total wrist arthroplasty (TWA).</div></div><div><h3>Methods</h3><div>An active wrist motion simulator was used to produce flexion, extension, radioulnar deviation, dart-thrower’s motion, and circumduction in 14 fresh-frozen cadaveric wrists before and after TWA. Identical tendon displacements were applied to five major wrist flexors and extensors to control motion presurgery and postsurgery. Motion trials were recorded using biplanar video fluoroscopy and digitally reconstructed with 6 degrees of freedom using x-ray reconstruction of moving morphology. Wrist angles were subsequently measured with respect to an anatomically based radial coordinate system. Forces applied to the five actuated tendons were recorded by the simulator throughout all motion trials. Maximum wrist angles, dart-thrower’s motion plane orientation, circumduction ellipse parameters, and peak tendon forces in pre-TWA and post-TWA conditions were compared.</div></div><div><h3>Results</h3><div>There were no significant differences in maximal flexion, extension, radial, or ulnar deviation angles when comparing preoperative anatomic wrists with the same wrist following implantation of the TWA. Orientation of dart-thrower’s motion planes and circumduction ellipses with respect to the sagittal plane increased after cadaveric surgery, whereas the area of the circumduction ellipses remained similar. Tendon forces were similar in anatomic and TWA wrists apart from flexor forces, which decreased in flexion in TWA wrists.</div></div><div><h3>Conclusions</h3><div>In our cadaveric setup, the TWA was able to recreate functional motion patterns without significantly increased tendon forces.</div></div><div><h3>Clinical relevance</h3><div>The results of this study support the assertion that a ball-and-socket style TWA can provide a postoperative range of motion adequate to perform activities of daily living.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 424-432"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Radius Fracture in the Setting of Human Immunodeficiency Virus: Management and Adverse Events","authors":"Helia C. Hosseini MS ,&nbsp;Alexander J. Kammien BS ,&nbsp;Karen Bach MD ,&nbsp;Omar Allam MD ,&nbsp;Jonathan N. Grauer MD ,&nbsp;David L. Colen MD","doi":"10.1016/j.jhsa.2024.12.017","DOIUrl":"10.1016/j.jhsa.2024.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Previous research has highlighted the elevated fracture risk among patients with human immunodeficiency virus (HIV). The current study assesses the association between HIV and the management and adverse events of distal radius fractures.</div></div><div><h3>Methods</h3><div>Patients with a distal radius fracture from 2016 to 2022 were identified in a national administrative database. Patients were stratified by HIV status, and antiretroviral therapy (ART) use was identified. Fracture treatment modality (open or closed) was determined, and adverse events were identified within 1 year of fracture. Treatment modality and adverse events were compared using logistic regression and chi-square tests, respectively.</div></div><div><h3>Results</h3><div>Among 396,544 patients with a distal radius fracture, 2,392 had HIV. HIV status was not associated with treatment modality. For patients with closed treatment, those with HIV had greater rates of malunion or nonunion and wrist arthritis. For patients with open treatment, HIV was also associated with greater incidence of malunion or nonunion. When stratifying by ART status, patients not on ART were less likely to undergo open treatment, whereas those with ART underwent open treatment at similar rates to HIV-negative patients. Compared with the HIV-negative cohort, those with HIV, and on ART were significantly more likely to sustain malunion or nonunion following closed treatment.</div></div><div><h3>Conclusions</h3><div>Patients with HIV are at increased risk for fracture, and they are more likely to experience adverse events following both closed and open management of distal radius fractures. Surgeons should pay close attention to bone healing in patients with HIV, and future research should investigate the causes of these adverse events and assess their modifiable risk factors.</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 4","pages":"Pages 451-458"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082188","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 MD ,&nbsp;Jessica L. Koshinski BS ,&nbsp;Anil Akoon MD, MBA ,&nbsp;Victoria C. Garcia PhD, MPH ,&nbsp;C. Liam Dwyer MD ,&nbsp;Joel C. Klena MD ,&nbsp;Louis C. Grandizio DO","doi":"10.1016/j.jhsa.2024.12.015","DOIUrl":"10.1016/j.jhsa.2024.12.015","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic I.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 442-450"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","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":"Journal CME Instructions","authors":"","doi":"10.1016/S0363-5023(25)00118-2","DOIUrl":"10.1016/S0363-5023(25)00118-2","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Page A14"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738534","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":"Solid Waste and Associated Environmental Impact of WALANT Carpal Tunnel Release Performed Across Three Clinical Settings","authors":"Audrey Le MD ,&nbsp;Stephen Douglas BS ,&nbsp;Jordan Baker MS ,&nbsp;David Megee MD ,&nbsp;Matthew Drake MD ,&nbsp;Charles C. Jehle MD","doi":"10.1016/j.jhsa.2025.01.003","DOIUrl":"10.1016/j.jhsa.2025.01.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel release (CTR) remains the most common hand and wrist surgery in the United States, with an estimated 500,000 procedures per year. The introduction of wide-awake local anesthetic, no tourniquet (WALANT) technique and use of a minor sterile field has allowed CTR procedures to be performed in a clinic setting. Our study aimed to quantify the solid waste and related emissions associated with WALANT CTR procedures performed in a hospital operating room, ambulatory surgical center, and clinic.</div></div><div><h3>Methods</h3><div>All WALANT unilateral CTRs performed by three fellowship-trained hand surgeons from the same hospital system were prospectively studied over a 6-month period. Data gathered were surgical venue (hospital operating room, ambulatory surgical center (ASC), or clinic) and weight of solid waste produced by material type. The carbon emissions associated with the production and disposal of this waste were calculated using emissions factors from the UK Government’s Department for Energy Security and Net Zero.</div></div><div><h3>Results</h3><div>Over 43 cases, there were significant differences in solid waste production. The average waste generated was 4.6 kg in the hospital operating room, 2.6 kg in the ASC, and 0.7 kg in the clinic. Similarly, greenhouse gas emissions, denoted in equivalent amount of CO₂ (kgCO₂-eq) varied by site, with the operating room emitting 41.6 kg of CO2eq, the ASC 26.0 kg, and the clinic 8.3 kg on average.</div></div><div><h3>Conclusions</h3><div>Our research considers the environmental impact of the same procedure performed in different settings. Under our institution’s current policies, the clinic setting is the most sustainable venue to perform CTR. This supports and replicates previous studies at other institutions.</div></div><div><h3>Clinical relevance</h3><div>Limiting the environmental impact of surgery is possible. Moving common hand surgeries such as CTR to the clinic may be a more efficient way to achieve improvements in environmental impact than changing hospital or ASC policies.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 466-472"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing the Foundation for Success With Nerve Transfers","authors":"Amy M. Moore MD","doi":"10.1016/j.jhsa.2025.01.013","DOIUrl":"10.1016/j.jhsa.2025.01.013","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 479-480"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544496","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":"Time-Dependent Change in Carpal Tunnel Cross-Sectional Area and Transverse Carpal Ligament Thickness Using Serial Magnetic Resonance Imaging Studies—An Anatomical Study","authors":"Nathaniel B. Hinckley DO ,&nbsp;Jordan R. Pollock MBA ,&nbsp;Laura Beckman OT ,&nbsp;Nan Zhang BS ,&nbsp;Michael G. Fox MD ,&nbsp;Samuel J. Fahrenholtz PhD ,&nbsp;Kevin J. Renfree MD","doi":"10.1016/j.jhsa.2023.10.010","DOIUrl":"10.1016/j.jhsa.2023.10.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Idiopathic carpal tunnel syndrome<span><span> (CTS) is a common compressive neuropathy. Aging and female sex are </span>risk factors, but the reasons are unclear. The purpose of this study was to evaluate whether identifiable radiographic changes resulting in a decrease in carpal tunnel area (CTA) over time exist.</span></div></div><div><h3>Methods</h3><div>A database search of a multicenter, academic, tertiary institution from 1998 to 2021 identified 433 patients with serial wrist magnetic resonance images (MRI) at least 5 years apart. Fifty-six met the inclusion criteria with adequate films to measure CTA and transverse carpal ligament (TCL) thickness at the same slice location—the carpal tunnel inlet, hook of the hamate, and carpal tunnel outlet—independently by two observers who were blinded to each other’s measurements. Rates for the change in CTA and TCL thickness were calculated at all three locations.</div></div><div><h3>Results</h3><div>Thickness of the TCL increased, whereas that of the CTA decreased over time. Inlet CTA decreased by 0.9 mm² per year (95% CI: 0.34–1.5), outlet CTA decreased by 1.8 mm² per year (95% CI: 1.2–2.5), and CTA at the hook of the hamate decreased by 1.6 mm² per year (95% CI: 1.0–2.0 per year). The TCL thickened by 0.02 mm per year at all three sections. Taller patients had a decreased rate of CTA loss.</div></div><div><h3>Conclusions</h3><div>In this select cohort, TCL thickened and CTA decreased with time. TCL thickening accounted for about half of the variation in CTA, suggesting that this is a possible contributor to this change. Hypertrophy of the carpal tunnel floor may account for the remaining variation in CTA. The question of whether these results are reliable and generalizable to the general population, or a major influence in the pathophysiology of CTS, is unknown.</div></div><div><h3>Clinical relevance</h3><div>Small decreases in CTA and thickening of the TCL occur with aging. Whether this is a contributing factor in the development of CTS requires further study.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 507.e1-507.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464423","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":"Risk Factors for Failure of Nonsurgical Management of Ulnar Shaft Fractures","authors":"Carew C. Giberson-Chen MD ,&nbsp;Cassandra M. Chruscielski BS ,&nbsp;Dafang Zhang MD ,&nbsp;Philip E. Blazar MD ,&nbsp;Brandon Earp MD","doi":"10.1016/j.jhsa.2023.09.009","DOIUrl":"10.1016/j.jhsa.2023.09.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Isolated ulnar shaft fractures are frequently managed nonsurgically. However, rates of nonsurgical treatment failure remain substantial, and risk factors for the failure of nonsurgical management are not well described. This study investigated radiographic and patient-specific risk factors for the failure of nonsurgical management of isolated ulnar shaft fractures.</div></div><div><h3>Methods</h3><div>A retrospective review of patients with ulnar shaft fractures initially treated nonsurgically was performed at two tertiary referral centers over a 19-year period from 2001 to 2020. Patient- and injury-related variables, surgical interventions, and plain radiographic measurements were recorded. The outcome of interest was failure of nonsurgical management, defined as failure to achieve fracture union nonsurgically within 3 months of injury.</div></div><div><h3>Results</h3><div><span>One hundred fifty four patients initially treated nonsurgically for isolated ulnar shaft fractures were included. Twenty six patients (17%) experienced failure of nonsurgical management; these included five nonunions, 16 delayed unions, and 10 conversions to surgical management. Patients who experienced failure of nonsurgical management had a higher prevalence of diabetes mellitus, a higher employment rate, and fractures with higher initial median posteroanterior and lateral translations, fracture gap, and </span>angulation; 83% of the patients with an initial fracture gap of ≥4 mm and 41% of the patients with an initial fracture angulation of &gt;10° failed nonsurgical management.</div></div><div><h3>Conclusions</h3><div>Although most ulnar shaft fractures heal successfully with nonsurgical management, a substantial percentage of these fractures do not. Patients who are currently working, have diabetes mellitus, or have fractures with an initial fracture gap of ≥4 mm or an initial fracture angulation of &gt; 10° may be more likely to fail nonsurgical treatment, although additional studies with larger sample sizes are needed to confirm these associations.</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 4","pages":"Pages 497.e1-497.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720632","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}