Journal of Hand Surgery-American Volume最新文献

{"title":"Incidence and Presentation of Periprosthetic Joint Infection After Primary Metacarpophalangeal and Proximal Interphalangeal Arthroplasty","authors":"Adam T. Schluttenhofer BS ,&nbsp;Matthew M. Rode MS ,&nbsp;Marco Rizzo MD ,&nbsp;Peter M. Murray MD","doi":"10.1016/j.jhsa.2024.12.008","DOIUrl":"10.1016/j.jhsa.2024.12.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Periprosthetic joint infection (PJI) is a devastating complication that has been extensively investigated in large joint arthroplasty. However, this has been inconsistently reported after metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthroplasty. The objective of the study was to report the presentation and treatment of patients with PJI after MCP or PIP joint arthroplasty.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of 1418 primary MCP or PIP arthroplasties in 642 patients with a minimum of 180 days of follow-up (mean 9.0 years) at a single institution from 1991 to 2020. We also analyzed the association of patient (body mass index, smoking, diabetes, and immunocompromised status) and surgical (digit, implant, operative time, and reoperation) factors with infection.</div></div><div><h3>Results</h3><div>There were six joints, all in separate patients, that developed PJI (0.4%). The median time to PJI was 91.5 days. Of the six patients with PJI, five had no systemic symptoms and a normal leukocyte count. The most common cultured organism was <em>Staphylococcus aureus</em>. PJI was most commonly treated with hardware removal and antibiotics.</div></div><div><h3>Conclusions</h3><div>PJI is uncommon after MCP or PIP arthroplasties. It commonly presents without systemic symptoms or leukocyte count and is most frequently caused by <em>Staphylococcus aureus</em>. More studies are needed to identify the optimal diagnostic criteria, treatment, and preventive strategies of PJI of the MCP and PIP joints.</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 433-441"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025379","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":"Radiographic Comparison of Forearm Symmetry in Healthy Individuals and Its Importance in the Diagnosis of Longitudinal Radioulnar Dissociation","authors":"Christopher M. Jones MD ,&nbsp;Genoveffa R. Morway DO ,&nbsp;Christina J. Gutowski MD ,&nbsp;Kurosh Darvish PhD","doi":"10.1016/j.jhsa.2023.10.008","DOIUrl":"10.1016/j.jhsa.2023.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Longitudinal radioulnar dissociation (LRD) is an injury often missed upon initial presentation. A recent study examined a radiographic screening test in cadavers that showed increased interosseous distance when the interosseous ligament (IOL) was divided. For this test to be clinically useful, it is necessary for uninjured forearms to have similar interosseous spaces. The purpose of this study was to determine the typical differences between right and left interosseous spaces of healthy individuals.</div></div><div><h3>Methods</h3><div><span>Anterior-posterior x-rays of bilateral forearms in maximum supination<span> of 28 surgical residents with no history of injury were obtained. These images were uploaded into a picture archiving and communication system and then digitized. The length of the radius was measured (X</span></span>_r). The maximum interosseous distance (D_max<span>) between the radius and ulna as well as the interosseous distance at a location 0.3 X</span>_r<span> from the distal radioulnar joint was measured. The right and left arm distances were compared. Also, an outlier analysis was used to evaluate forearm rotational asymmetry between right and left arms.</span></div></div><div><h3>Results</h3><div>The outlier analysis revealed two sets of forearm x-rays were rotationally different compared to the rest of the group due to asymmetric arm positioning; these data were excluded from the analysis. The average difference in D_max was 1.7 mm (standard deviation [SD] 1.5) between right and left arms, and this was found at a position of 0.28 X_r on average. The difference in interosseous distance measured at a fixed location 0.3 X_r was 1.6 mm (SD 1.5). No significant difference was found between the paired right and left arms for D_max or at 0.3 X_r.</div></div><div><h3>Conclusions</h3><div>There does not appear to be any significant difference between the maximum interosseous distance of right and left arms in healthy individuals. Therefore, analyzing bilateral forearm x-rays may be a simple LRD screening test.</div></div><div><h3>Clinical relevance</h3><div>Understanding the degree of normal variation in the forearm bone spacing might inform evaluation of abnormal forearm bone alignment resulting from LRD.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 505.e1-505.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592743","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":"Gap Resistance and Tensile Strength of a Q Suture Technique During Curved Loading: An Ex Vivo Porcine Flexor Tendon Study","authors":"Si Wei Xu BM ,&nbsp;Wei Feng Mao PhD ,&nbsp;Ya Fang Wu MD","doi":"10.1016/j.jhsa.2023.10.007","DOIUrl":"10.1016/j.jhsa.2023.10.007","url":null,"abstract":"<div><h3>Purpose</h3><div><span>This study aimed to determine the mechanical properties of the double Q suture technique in angular motion and to compare the gap formation associated with </span>tendon repairs during curved and linear loading.</div></div><div><h3>Methods</h3><div>Eighty porcine flexor tendons<span> were repaired with one of two 4-strand sutures: double Q suture or double modified Kessler plus peripheral running sutures. The repaired tendons were cyclically loaded sequentially against a pulley with a radius of 2.0, 1.5, and 1.0 cm or linearly without any pulleys. The number of tendons that formed an initial or 2-mm gap at the repair site during cyclic loading, the gap size between tendon ends when cyclic loading ended, and the ultimate strength were recorded.</span></div></div><div><h3>Results</h3><div>The gap at the repair site formed gradually from the dorsal to volar aspect during curved loading. No double Q repairs, but half of the double Kessler plus running suture repairs, formed an initial or 2-mm gap on the volar aspect during curved loading. The double Q group had a significantly smaller gap size on the dorsal aspect than the double Kessler plus running suture group at all three radii of curvature. The ultimate strength was similar between the two groups. There were no significant differences in linear motion between these two repairs.</div></div><div><h3>Conclusions</h3><div>The double Q suture is superior to the conventional 4-strand tendon core suture plus running peripheral sutures in gap resistance in angular motion. This study provides insight into the formation of an unbalanced gap on the dorsal and volar aspects of tendon repair during curved loading.</div></div><div><h3>Clinical Relevance</h3><div>The double Q suture provides a simple and efficient option for flexor tendon repair considering the high risk of gap formation on the dorsal aspects of the tendon repair in angular motion.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 504.e1-504.e9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400405","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 Nonunion After Distal Phalangeal Fractures of the Hand","authors":"Christin Kammerhofer MD ,&nbsp;Andreas Weber MD ,&nbsp;Céline S. Bratschi MD ,&nbsp;Claudia Meuli-Simmen MD ,&nbsp;Jan A. Plock MD ,&nbsp;Flavien Mauler MD","doi":"10.1016/j.jhsa.2023.10.003","DOIUrl":"10.1016/j.jhsa.2023.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the risk factors for distal phalanx fracture nonunion.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all adult patients treated for distal phalanx fractures at our institution between January 2015 and December 2019 with a minimum one-year follow-up period for potential risk factors. The absence of consolidation signs on follow-up radiographs at least 12 months after trauma was defined as nonunion.</div></div><div><h3>Results</h3><div>This study included 124 patients with 143 fractures available for follow-up. Nonunion was diagnosed in 19 patients, 18 of whom initially presented with an open fracture<span>. On the day of the injury, 17 patients with open fractures presented to the hospital. In 16 nonunion cases, the traumatic mechanism was a crush injury. All nonunions occurred in tuft fractures, and none required revision surgery at the follow-up visit.</span></div></div><div><h3>Conclusions</h3><div>Our findings suggest that tuft involvement in open fractures is the main risk factor for nonunion of distal phalangeal fractures. However, after a minimum of 1 year of follow-up, none of the tuft nonunions required revision surgery.</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 501.e1-501.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720633","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":"Immunohistochemical Investigation of Mechanoreceptors Within the Injured Scapholunate Ligament","authors":"Oliver Miles MD, MSurg ,&nbsp;Stephen Tham MBBS ,&nbsp;Wayne Morrison MBBS, MD ,&nbsp;Eugene Ek MBBS, PhD ,&nbsp;Jason Palmer BSc (Hons) ,&nbsp;David McCombe MBBS, MD","doi":"10.1016/j.jhsa.2023.10.002","DOIUrl":"10.1016/j.jhsa.2023.10.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Scapholunate ligaments (SLLs) play a well-established role in maintaining carpal alignment and kinematics, and are innervated with sensory mechanoreceptors located within the ligaments. They are involved in the afferent arc of dynamic wrist stability. The aim of this study was to describe the changes in these mechanoreceptor populations in injured SLLs.</div></div><div><h3>Methods</h3><div>Injured SLLs were collected from human wrists at the time of SLL reconstruction or limited wrist fusion, where the ligament remnants would otherwise be discarded. These specimens were formalin-fixed and paraffin-embedded for immunohistochemical analysis to identify mechanoreceptors, which were then classified by type and location within the ligament.</div></div><div><h3>Results</h3><div>A total of 15 ligaments were collected, with the interval from injury ranging from 39 days–20 years. Eleven ligaments were collected less than one year after injury, and four ligaments were collected two years or more after injury. A total of 66 mechanoreceptors were identified, with 50 mechanoreceptors identified in nine of the 11 specimens collected less than one year after injury. In this group, 54% of the mechanoreceptors resided in the volar subunit, 20% in the dorsal subunit, and 26% in the proximal subunit. Two of the four specimens collected two years or later after injury contained mechanoreceptors, all of which were located in the dorsal subunit. Increasing time from injury demonstrated a decline in mechanoreceptor numbers within the volar subunit.</div></div><div><h3>Conclusions</h3><div>Mechanoreceptors were consistently located in the SLL, particularly in the volar subunit of specimens collected less than one year after injury.</div></div><div><h3>Clinical relevance</h3><div>Ligament reconstruction techniques aim to primarily reconstitute the biomechanical function of the disrupted SLL; however, re-establishing the afferent proprioceptive capacity of the SLL may be a secondary objective. This suggests the need to consider the reconstruction of its volar subunit particularly in those managed within one year of injury.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 499.e1-499.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479371","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 Recovery of Spastic Finger Flexion Using Hyperselective Neurectomy: A Case Series","authors":"Mohammadreza Emamhadi MD ,&nbsp;Mohammad Haghani Dogahe MD ,&nbsp;Amirreza Emamhad MD","doi":"10.1016/j.jhsa.2023.10.004","DOIUrl":"10.1016/j.jhsa.2023.10.004","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Hyperselective neurectomy<span> (HSN) is an advanced peripheral nerve </span></span>ablation procedure<span><span><span> that can relieve spasticity and enhance the quality of life in patients with spasticity following </span>upper motor neuron<span> injuries. The main advantage of HSN is that it can treat spasticity as well as preserve hand function. Thus, HSN may be the procedure of choice in patients with spastic functional hands. In this study, we present the surgical technique and results of HSN of the flexor </span></span>digitorum superficialis (FDS) in the setting of spastic finger flexion.</span></div></div><div><h3>Methods</h3><div>HSN of the FDS was performed on 18 patients with functional hands. We employed the Peraut and House categorizations to evaluate pain reduction and improvement of hand function, respectively.</div></div><div><h3>Results</h3><div>The patients exhibited marked improvement in finger spasticity following HSN. Finger function was preserved, and all patients demonstrated improved hand function, as evidenced by an increase in the House Score from 0 to 2 before surgery to a range of 4 to 8 after the intervention. All patients experienced relief from pain.</div></div><div><h3>Conclusions</h3><div>HSN of the FDS branch is a technique that should be considered to reduce finger flexor spasticity and preserve finger flexion function.</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 502.e1-502.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557180","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 Mangled Digit Severity Score: Determining Salvageability of Severe Digital Injuries","authors":"Anna Luan MD, MS ,&nbsp;Jeffrey Friedrich MD, MC ,&nbsp;Aviram Giladi MD, MS ,&nbsp;Suhail K. Mithani MD ,&nbsp;Peter Rhee DO, MS ,&nbsp;Bauback Safa MD ,&nbsp;Adam Strohl MD ,&nbsp;Kyle R. Eberlin MD","doi":"10.1016/j.jhsa.2024.12.014","DOIUrl":"10.1016/j.jhsa.2024.12.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The assessment, prognostication, and decision-making for mangled digital injuries can be challenging, even for experienced surgeons. This study aimed to develop a Mangled Digit Severity Score (MDSS) to predict whether a mangled digit should be salvaged.</div></div><div><h3>Methods</h3><div>An anonymous questionnaire was sent to 67 hand surgeons at seven hand trauma centers as an initial survey panel. Participants were provided a list of factors influencing outcomes following a mangled digit injury and were asked to assign weights from 0–10 for each factor reflecting its relative importance in determining likelihood of functional salvage versus failure or secondary amputation. Using a modified Delphi method, iterative questionnaire rounds then were performed with seven expert panelists and consensus established. The final ratings were used to develop a weighted scoring system to assess mangled digits. A retrospective single-center review was conducted to validate the scoring system. The sensitivity and specificity for amputation at different MDSS prognostic thresholds were evaluated, and a receiver operating characteristic curve and area under the curve were calculated.</div></div><div><h3>Results</h3><div>From initial surgeon responses (36/67 response rate) and two subsequent rating rounds, consensus was achieved on 14 factors, including crush/avulsion mechanism, intraarticular fracture, and zone II flexor tendon injury. Final weights for all factors ranged between 3–9. Among 54 mangled digits reviewed, digits that were salvaged had a significantly lower MDSS than those that underwent amputation. The MDSS demonstrated an area under the curve of 0.87. At a threshold of 35, the MDSS achieved a sensitivity of 60% and specificity of 88% in predicting amputation.</div></div><div><h3>Conclusions</h3><div>The MDSS was developed through a consensus of experts and is a useful tool for identifying mangled digits that may not be salvageable.</div></div><div><h3>Clinical relevance</h3><div>The MDSS provides a structured framework for the assessment of severely injured digits with a prognostic guideline for amputation or salvage.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 407-415"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082289","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":"Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: Anatomical study and report of four cases","authors":"C. Oberlin MD,&nbsp;D. Béal MD,&nbsp;S. Leechavengvongs MD,&nbsp;A. Salon,&nbsp;M.C. Dauge MD,&nbsp;J.J. Sarcy MD","doi":"10.1016/j.jhsa.2025.01.019","DOIUrl":"10.1016/j.jhsa.2025.01.019","url":null,"abstract":"<div><div>Four patients with C5–C6 root avulsion after brachial plexus injury were treated with a transfer of part of a normal functioning nerve in the arm to the motor nerve of the biceps. Ten percent of the bulk of the ulnar nerve was harvested for a suture directly to the motor nerve of the biceps with no significant impairment of hand function.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 4","pages":"Pages 473-478"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738547","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":"Skin Cancer of the Hand: Current Management and New Horizons.","authors":"Peyton H Terry, Yoshiko Toyoda, Ines C Lin","doi":"10.1016/j.jhsa.2025.02.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.019","url":null,"abstract":"<p><p>Skin cancer is the most common malignancy of the upper extremity. As such, hand surgeons must be facile with their evaluation and initial management, for these malignancies may present as mimickers of other conditions. This article reviews essential knowledge regarding the diagnosis, management, and prognosis of melanoma and nonmelanoma cutaneous malignancies of the upper extremity. We also discuss recent advances and promising clinical and translational research.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744396","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 Acute Burned Upper Extremity: Evolution of Practices and Management.","authors":"Sophia Salingaros, Abraham P Houng, Philip H Chang, Adam Jacoby","doi":"10.1016/j.jhsa.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.02.020","url":null,"abstract":"<p><p>Although limited to a small total surface area, burns to the hand can cause tremendous functional and social disability. The hand surgeon's reconstructive toolkit continues to evolve rapidly in light of improving burn mortality and technical advances. The surgeon should aim for the simplest reconstructive plan that facilitates early mobility and rehabilitation. Grafting (including the use of newer skin substitute agents), local and free flaps, and repair of underlying structures should prioritize key functional recovery over the complete range of motion. Multidisciplinary collaboration between the hand surgeon, burn team, and rehabilitation specialists is critical for achieving and maintaining optimal outcomes. In this review, we present an overview of the hand surgeon's role in assessment, acute surgical intervention, and postburn management for severe hand burns.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733255","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}