Journal of Hand Surgery-American Volume最新文献

{"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}

{"title":"The Use of Musculoskeletal Ultrasound for Diagnosis of Peripheral Nerve Compression Syndromes","authors":"John R. Fowler MD","doi":"10.1016/j.jhsa.2024.11.009","DOIUrl":"10.1016/j.jhsa.2024.11.009","url":null,"abstract":"<div><div>Musculoskeletal ultrasound has emerged as a reasonable alternative to electrodiagnostic studies in the diagnostic work-up of carpal tunnel syndrome, cubital tunnel syndrome, and other peripheral nerve compression syndromes. Chronic nerve compression results in nerve edema, which can be measured using ultrasound and reported as increased cross-sectional area. If the cross-sectional area exceeds predetermined cutoffs, a diagnosis can be made. The purpose of this review was to summarize the literature regarding the use of ultrasound for the diagnosis of peripheral nerve compression syndromes.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 481-490"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814991","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":"Does Perioperative Antibiotic Administration Decrease the Incidence of Prosthetic Joint Infection in Patients Undergoing Elective Soft Tissue Hand Surgery?","authors":"Kelsey Young MD ,&nbsp;Thompson Zhuang MD, MBA ,&nbsp;Sophia Mavrommatis BS ,&nbsp;Mitchell Hallman MD ,&nbsp;Viviana Serra-Lopez MD ,&nbsp;Ellis Berns MD ,&nbsp;Andrew D. Sobel MD","doi":"10.1016/j.jhsa.2025.01.002","DOIUrl":"10.1016/j.jhsa.2025.01.002","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of prophylactic antibiotics in patients with existing total hip or knee arthroplasty undergoing elective hand surgery has not been studied. We tested the null hypothesis that perioperative antibiotic administration is not associated with the incidence of prosthetic joint infection (PJI) in patients undergoing elective, soft tissue hand surgery.</div></div><div><h3>Methods</h3><div>We used a large, national administrative claims database to identify patients with existing total hip or knee arthroplasty undergoing soft tissue hand surgery (carpal tunnel release, de Quervain release, trigger finger release, limited palmar fasciectomy, ganglion or mucoid cyst removal, or soft tissue mass removal). Antibiotic prophylaxis was defined as the same day administration of intravenous cefazolin, vancomycin, or clindamycin. Patients receiving antibiotics were propensity score-matched in a 1:1 ratio to those who did not, accounting for age, sex, geographic region, insurance plan, subsequent surgeries, and the presence of comorbid diabetes mellitus, rheumatoid arthritis, myocardial infarction, congestive heart failure, chronic kidney disease, human immunodeficiency virus infection, chronic kidney disease, malignancy, obesity, or tobacco use. Residual differences between matched cohorts were adjusted for using multivariable logistic regression. The primary outcome was the incidence of PJI within 6, 9, and 12 months after hand surgery.</div></div><div><h3>Results</h3><div>The overall incidence of PJI was 0.8% (166/21,582) within 12 months after hand surgery. There was no difference in the incidence of PJI between patients who received antibiotic prophylaxis and those who did not at 6 (0.3% vs 0.5%), 9 (0.6% vs 0.7%), or 12 months (0.7% vs 0.8%) after hand surgery. These findings were unchanged after adjusting for residual confounding. Surgical site infection within 3 months after hand surgery was also not associated with PJI at 6, 9, or 12 months.</div></div><div><h3>Conclusions</h3><div>We found no association between prophylactic antibiotic administration in patients with prior total hip or knee arthroplasty undergoing soft tissue hand surgery and the incidence of PJI at 6, 9, and 12 months after surgery.</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 459-465"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366508","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":"Altered Ulnar Variance With Full-Body Weight-Bearing During Handstands With Upper Extremity Weight-Bearing CT","authors":"Joseph A. Buckwalter V MD, PhD ,&nbsp;Noah M. Scigliano BS ,&nbsp;Ignacio Garcia Fleury MD ,&nbsp;Nicole A.D. Watson PhD ,&nbsp;Kevin N. Dibbern PhD ,&nbsp;Natalie A. Glass PhD ,&nbsp;Jessica E. Goetz PhD","doi":"10.1016/j.jhsa.2023.09.010","DOIUrl":"10.1016/j.jhsa.2023.09.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Ulnar variance (UV) is a radiographic measurement relating the articular surface<span><span> heights of the distal radius and ulna. Abnormal UV increases the risk for wrist pathology; however, it only provides a static measurement of an inherently dynamic bony relationship that changes with wrist position and loading. The purpose of this study was to investigate how full-body weight-bearing affects UV using weight-bearing </span>computed tomography (WBCT).</span></div></div><div><h3>Methods</h3><div>Ten gymnasts completed two 45-second scans inside a WBCT machine while performing a handstand on a flat platform (H) and parallettes (P). A non–weight-bearing CT scan was collected to match clinical practice (N). Differences in UV between weight-bearing conditions were evaluated separately for dominant and nondominant sides, and then, UV was compared between weight-bearing conditions on pooled dominant/nondominant data.</div></div><div><h3>Results</h3><div>Pooled analyses comparing weight-bearing conditions revealed a significant increase in UV for H versus N (0.58 mm) and P versus N (1.00 mm), but no significant change in UV for H versus P (0.43 mm). Significant differences in UV were detected for H versus N, P versus N, and H versus P for dominant and nondominant extremities. The change from N to H was significantly greater in the dominant versus nondominant side, but greater in the nondominant side from N to P.</div></div><div><h3>Conclusions</h3><div>Ulnar variance changed with the application of load and position of the wrist. Differences in UV were found between dominant and nondominant extremities.</div></div><div><h3>Clinical relevance</h3><div><span>Upper extremity loading patterns are affected by hand dominance as defined by a cartwheel and suggest skeletal consequences from repetitive load on a dominantly used wrist. Although statistically significant, subtle changes detected in this investigational study do not necessarily bear clinical significance. Future WBCT research can lead to improved </span>diagnostic measures for wrist pathologies affected by active loading and rotational wrist behavior.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 498.e1-498.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720630","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.2025.02.022","DOIUrl":"10.1016/j.jhsa.2025.02.022","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Page 450"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738546","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":"Autonomic Component of Carpal Tunnel Syndrome","authors":"Ahmadreza Afshar MD ,&nbsp;Ali Tabrizi MD ,&nbsp;Mohammad Javad Shariyate MD","doi":"10.1016/j.jhsa.2024.11.018","DOIUrl":"10.1016/j.jhsa.2024.11.018","url":null,"abstract":"<div><div>Carpal tunnel syndrome (CTS) is the most common compression neuropathy. The median nerve contains sensory, motor, and sympathetic fibers. Involvement of the different fibers of the median nerve in CTS may vary; hence, one of the sensory, motor, or autonomic dysfunctions may be dominant. Autonomic fibers of the median nerve consist of postganglionic sympathetic vasomotor and sudomotor fibers. An incomplete interruption of the axoplasmic flow may provoke a reflex that increases the sympathetic activity, leading to sweating, Raynaud phenomenon, and paleness of fingers. A complete sympathetic axoplasmic flow disruption blocks the sympathetic activity that leads to vasodilation, and the affected area in the hand is believed to be swollen, warmer, pinker, and dryer than the rest of the limb. In advanced and severe autonomic dysfunction, the fingertips may ulcerate, and nail growth changes may occur. Carpal tunnel syndrome diagnosis is a constellation of symptoms and signs; however, there has been limited attention to the autonomic component of CTS. Regeneration and reinnervation capacity of thin unmyelinated sympathetic fibers after compression and axonal degeneration is poor. Ignoring the important role of the autonomic component of CTS may lead to persistent symptoms and unsuccessful CTS surgery. Early carpal tunnel release in patients with autonomic findings is indicated and may provide improved outcomes.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 491-496"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738549","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":"Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients","authors":"Christopher R. Gajewski MD ,&nbsp;Kevin Y. Chen BA ,&nbsp;Nirbhay S. Jain MD ,&nbsp;Neil F. Jones MD","doi":"10.1016/j.jhsa.2023.10.009","DOIUrl":"10.1016/j.jhsa.2023.10.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Distal radius fractures<span> (DRFs) are one of the most common conditions that musculoskeletal providers treat. As the frequency of solid organ transplants (SOT) increases, these providers are often called upon to manage DRFs in these patients. These patients are at increased risk for osteopenia<span><span> and osteoporosis<span>, given the altered bone metabolism after SOT and frequent use of </span></span>glucocorticoid<span> and immunosuppressive medications. This study aimed to examine both surgical and nonsurgical treatment outcomes of DRFs in the SOT population and the prevalence of decreased bone mineral density.</span></span></span></div></div><div><h3>Methods</h3><div>A retrospective review of patients treated at a single institution who had previously undergone SOT and subsequently sustained DRF between 2013 and 2022 was completed. Patients were excluded for incomplete documentation and treatment initiation at an outside institution. Demographic variables, clinical outcomes, organ transplant, steroid use, and second metacarpal cortical percentage were collected for both groups. A telephone survey with the <em>Quick</em><span>DASH questionnaire was conducted for all available patients.</span></div></div><div><h3>Results</h3><div>A total of 34 DRFs in 33 patients were included in the analysis. Of these, 15 fractures in 14 patients underwent surgical intervention, and 19 fractures in 19 patients were managed nonsurgically. The following three adverse events were observed in the patients managed operatively: hardware failure, postoperative carpal tunnel syndrome, and tendon irritation. No reported treatment complications were recorded in the patients managed nonsurgically. Of the 33 included patients, 32 had radiographic evidence of decreased bone mineral density and five were receiving treatment for osteoporosis.</div></div><div><h3>Conclusions</h3><div>Management of DRFs in SOT patients is challenging, given their increased medical complexity. Decreased bone mineral density was nearly universal and undertreated in this patient population. Most of these patients in both groups had good or excellent functional outcomes with both surgical and nonsurgical management. Additionally, surgery was well tolerated with no reported anesthesia complications, wound-healing issues, or infections.</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 506.e1-506.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557179","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":"Union and Complication Rates After Total Wrist Arthrodesis: A Systematic Review and Meta-Analysis","authors":"David H. Owen MBBS ,&nbsp;Joshua W. Booth BSc, MD ,&nbsp;Paul A. Agius BA, MSc ,&nbsp;Diana M. Perriman BSc(Physio), PhD ,&nbsp;Paul N. Smith MBBS ,&nbsp;Chris J. Roberts MBBS","doi":"10.1016/j.jhsa.2023.10.011","DOIUrl":"10.1016/j.jhsa.2023.10.011","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Total wrist arthrodesis (TWA) has been performed using various techniques. We aimed to provide pooled prevalence estimates of union and complications of TWA by technique. A secondary aim was to provide estimates of union and complication rates by treatment of the </span>carpometacarpal joint (CMCJ) in TWA using plates. Given the widespread adoption of wrist arthrodesis plates (WAP), we hypothesized that these implants would result in higher union and lower complication rates. We also hypothesized that TWA with CMCJ arthrodesis would improve these outcomes.</div></div><div><h3>Methods</h3><div>Online databases including PubMed, Medline, Embase, and Cochrane were searched. Studies reporting union and/or complication rates of 10 or more TWA performed with a similar technique (analyzed as bone graft only, bone graft with minimal fixation, intramedullary, augmented intramedullary, plate, WAP, and other) were included. Studies with fewer than 10 TWA, studies reporting TWA where union or complications could not be analyzed separately, and studies without union and complication rates were excluded. Data extraction was performed independently by two English-speaking reviewers with a translator where required. Pooled prevalence estimates were made using a random-effects meta-analysis model and presented as a percent prevalence with 95% confidence and prediction intervals.</div></div><div><h3>Results</h3><div>One hundred and thirty-six studies with a total of 3,517 patients and 3,969 TWA were analyzed. No differences in union and complication prevalence were observed between TWA techniques and in TWA with different treatments of the CMCJ using plates and WAP.</div></div><div><h3>Conclusion</h3><div>Using meta-analysis, we found no difference in union and complication prevalence between TWA techniques and TWA with different treatments of the CMCJ with plates and WAP. It must be acknowledged that this research included low-quality studies with high heterogeneity, and confidence in the precision of the estimates is low.</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 508.e1-508.e12"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479374","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":"Preserved Finger Flexion in Brachial Plexus Total Lesion: A Study of 16 Cases Among 989 Surgical Patients","authors":"Jayme A. Bertelli MD, PhD ,&nbsp;Christopher S. Crowe MD ,&nbsp;Mohammed Tahir MD, MSc ,&nbsp;Marco F. Ghizoni MD, MSc","doi":"10.1016/j.jhsa.2024.11.025","DOIUrl":"10.1016/j.jhsa.2024.11.025","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachial plexus traction injuries have conventionally been categorized as involving the C5–C6, C5–C7, C5–T1, and C8–T1 roots. In this article, we report a distinct clinical presentation of brachial plexus injury characterized by intact finger flexion with signs of complete brachial plexus injury.</div></div><div><h3>Methods</h3><div>From 2010 to 2022, 989 patients who sustained brachial plexus injuries were examined and underwent surgery. Prior to surgery, brachial plexus computed tomography myelography was obtained. A total of 16 patients (1.6%) with preserved finger flexion and panplexus injury were identified. Upper root exploration and spinal accessory to suprascapular nerve transfer were performed as indicated. Transfer of median nerve fascicles to the biceps motor branch was used to reconstruct elbow flexion in 11 cases, whereas fascicles from the ulnar nerve were transferred in two. Two patients underwent C5 root grafting to the musculocutaneous nerve. In one case, intercostal to musculocutaneous nerve transfer was performed. Twelve patients had adequate follow-up (average, 18.5 months).</div></div><div><h3>Results</h3><div>Horner sign and imaging studies demonstrating C8 and T1 root avulsion were noted in all cases. Finger flexion was partially preserved in all patients with variable involvement of the intrinsic muscles of the hand. Little finger flexor digitorum profundus and flexor carpi ulnaris were always paralyzed. After surgery, an average shoulder abduction of 60° was achieved, whereas elbow flexion recovered in 11 of 12 patients (91.7%), M4 in seven cases, and M3 in four cases. Four of 13 patients (28.6%) who underwent nerve transfer using the median nerve as a donor exhibited a reduction in finger flexion strength or a loss of motion.</div></div><div><h3>Conclusions</h3><div>This study demonstrates a distinct clinical presentation of brachial plexus trauma, characterized by preserved finger flexion despite complete plexus injury.</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 416-423"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738535","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 Impact of Venous Reconstruction on Finger Replantation Success Rates Based on Level of Injury","authors":"Vinay Rao MD, MPH ,&nbsp;Victoria A. Zeyl BA ,&nbsp;Luke Soliman MTS ,&nbsp;Nikhil Sobti MD ,&nbsp;Reena A. Bhatt MD ,&nbsp;Scott T. Schmidt MD, MBA ,&nbsp;Loree K. Kalliainen MD, MA","doi":"10.1016/j.jhsa.2023.10.012","DOIUrl":"10.1016/j.jhsa.2023.10.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The requirement for anatomic venous reconstruction<span><span> in digit replantation is an ongoing area of research. In this study, we evaluated our institutional experience to study whether replantation success is affected by the presence or absence of </span>vein repair, stratified by the level of injury.</span></div></div><div><h3>Methods</h3><div>A retrospective review was performed at an urban, level-1 trauma center of all single-digit replantations performed in adults from 2012 to 2021. Patient demographics, injury mechanism, level of injury, whether a vein was repaired, and replant survival were recorded.</div></div><div><h3>Results</h3><div>Sixty-seven single replanted digits were included. Patients were, on average, 38 years old, and 94% were men. The most common mechanism of injury was a sharp laceration (81%). The overall survival rates for all replantations were 68.7% (46/67) and 60% (12/20) for distal finger replantation. Patients with digital replantations at Tamai zone III or more proximal exhibited a 1.8 times increase in survival rates when one vein was repaired versus zero veins (84.4% vs 46.7%). Patients with digital replantations at Tamai zones I and II exhibited similar survival rates.</div></div><div><h3>Conclusions</h3><div><span>Replantations at or proximal to the middle phalanx should be repaired with at least one artery and vein to maximize the chance for success. However, for distal finger replantations, artery-only replantation is a viable option when </span>vein anastomosis is not achievable.</div></div><div><h3>Typo 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 509.e1-509.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479373","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}