Journal of Hand Surgery-American Volume最新文献

{"title":"The Displaced Fleck Sign: Description of a Radiographic Finding Consistent with Grade III Thumb Ulnar Collateral Ligament Tears with Stener Lesions","authors":"Joshua R. Daryoush MD ,&nbsp;Hernan Roca MD ,&nbsp;Brittany N. Garcia MD ,&nbsp;Nikolas H. Kazmers MD, MSE","doi":"10.1016/j.jhsa.2024.12.003","DOIUrl":"10.1016/j.jhsa.2024.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>Controversy exists regarding the optimal imaging modality (magnetic resonance imaging, ultrasound, stress radiographs) for identification of patients with grossly unstable thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) injuries or Stener lesions. We characterize a radiographic sign for this purpose. The “displaced fleck sign” is a small </span>avulsion fracture from the ulnar </span>proximal phalanx<span> base that is displaced proximal to the MCP joint line.</span></div></div><div><h3>Methods</h3><div>Patients with thumb UCL injuries evaluated by hand surgeons were identified at a single, tertiary institution. Patients who were skeletally immature, had chronic injuries (&gt;3 months old), and those with MCP arthritis were excluded. Two attending hand surgeons independently reviewed radiographs to identify the displaced fleck sign. Presence/absence of a Stener lesion was extracted from operative notes.</div></div><div><h3>Results</h3><div>Of 228 patients, 17 (7.5%) had a positive displaced fleck sign. Excellent interobserver reliability was observed (κ = 0.94). All 17 (100%) demonstrated gross instability with no end point in clinic, and all underwent surgical repair. Grade III ruptures were noted for all. Specifically, 14 (94.1%) had a Stener lesion, and one patient (7%) had a bony avulsion from the metacarpal. The displaced fleck sign had a positive predictive value of 100% for Grade III rupture and 94.1% for a Stener lesion.</div></div><div><h3>Conclusions</h3><div>Presence of a displaced fleck sign has implications for offering surgery to patients with thumb UCL injuries because of a high likelihood of a Stener lesion. When present, surgeons may consider proceeding with surgical repair without additional imaging and associated follow-up visits.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1276.e1-1276.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016632","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":"Biomechanical Comparison of Volar Plate Repair Versus Volar Plate Repair With Suture Tape Augmentation at the Finger Proximal Interphalangeal Joint","authors":"David Wright MD ,&nbsp;Carol Lee MD ,&nbsp;Steven S. Shin MD ,&nbsp;Michelle H. McGarry MS ,&nbsp;Thay Q. Lee PhD","doi":"10.1016/j.jhsa.2024.11.005","DOIUrl":"10.1016/j.jhsa.2024.11.005","url":null,"abstract":"<div><h3>Purpose</h3><div><span>The purpose of this study was to perform a biomechanical comparison of volar plate repair alone versus volar plate repair with suture tape augmentation in a </span>hyperextension laxity injury model at the proximal interphalangeal (PIP) joint.</div></div><div><h3>Methods</h3><div>Ten matched cadaveric fingers were obtained from five cadavers (average age, 59 ± 7 years). The specimens underwent 5 and 10 N·cm of extension load at the PIP joint to measure the laxity of the intact joint. Next, an injury model was created by incising the proximal volar plate and loading the specimen on a testing machine to 30° of hyperextension; laxity testing was repeated. Within each matched pair, one side was used for volar plate repair, and the contralateral side was used for volar plate repair with suture tape augmentation. Laxity measurements were repeated. The specimens were then loaded from 2 to 5 N·cm for 30 cycles, and then loaded to failure.</div></div><div><h3>Results</h3><div>In both groups, extension angle significantly increased following PIP joint injury. Both repair groups significantly decreased extension angle compared with injury. Specimens that underwent volar plate repair with suture tape augmentation demonstrated significantly increased stiffness at 10, 20, and 30 cycles compared with volar plate repair alone (3.4, 3.5, and 3.6 N·cm/° vs 2.5, 2.5, and 2.6 N·cm/°, respectively), a higher yield load (16.7 vs 12.4 N·cm), and ultimate load (25.9 vs 19.1 N·cm) and absorbed more energy at ultimate load (4.1 vs 2.6 N·cm).</div></div><div><h3>Conclusions</h3><div>Suture tape augmentation increased construct stiffness, yield load, load to failure, and ultimate load in this biomechanical study and may offer additional support in volar plate repair for chronic PIP joint hyperextension laxity.</div></div><div><h3>Clinical relevance</h3><div>This finding lends support to using suture tape as an augment to produce a stronger PIP joint repair, potentially leading to an expedited recovery and earlier return to activities.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1273.e1-1273.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814988","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":"Defining the Zone of Acute Peripheral Nerve Injury Using Fluorescence Lifetime Imaging in a Crush Injury Sheep Model","authors":"Dattesh R. Dave MD, MSc ,&nbsp;Alba Alfonso Garcia PhD ,&nbsp;Lisanne Kraft MSc ,&nbsp;Laura Marcu PhD ,&nbsp;Clifford T. Pereira MD","doi":"10.1016/j.jhsa.2024.11.020","DOIUrl":"10.1016/j.jhsa.2024.11.020","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Current technologies to define the zone of acute peripheral nerve injury intraoperatively are limited by surgical experience, time, cumbersome </span>electrodiagnostic<span> equipment, and interpreter reliability. In this pilot study, we evaluated a real-time, label-free optical technique for intraoperative nerve injury imaging. We hypothesize that fluorescence lifetime imaging (FLIm) will detect a difference between the time-resolved fluorescence signatures for acute crush injuries<span> versus uninjured segments of peripheral nerves in sheep.</span></span></div></div><div><h3>Methods</h3><div><span>Label-free FLIm uses ultraviolet laser pulses to excite endogenous tissue fluorophores and detect their fluorescent decay over time, generating real-time tissue-specific signatures. A crush injury was produced in eight peripheral nerves of two sheep. A hand-held </span>FLIm instrument<span> captured the time-resolved fluorescence signatures of injured and uninjured nerve segments across three spectral emission channels (390/40 nm, 470/28 nm, and 540/50 nm). The average FLIm parameters (ie, lifetime and intensity ratios) for injured and uninjured nerve segments were compared. We used linear discriminant analysis to differentiate between crushed and uninjured nerve segments.</span></div></div><div><h3>Results</h3><div>A total of 23,692 point measurements were collected from eight crushed peripheral nerves of two sheep. Histology confirmed the zone of injury. Average lifetime at 470 nm and 540 nm were significantly different between crushed and uninjured sheep nerve segments. The linear discriminant analysis differentiated between crushed and uninjured areas of eight nerve segments with 92% sensitivity, 85% specificity, and 88% accuracy.</div></div><div><h3>Conclusions</h3><div>In this pilot study, FLIm detected differing average lifetime values for crushed versus uninjured sheep peripheral nerves with high sensitivity, specificity, and accuracy.</div></div><div><h3>Clinical relevance</h3><div>With further investigation, FLIm may guide the peripheral nerve surgeon to the precise zone of injury for reconstruction.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1277.e1-1277.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933706","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":"Patient- and Provider-Perceived Barriers to Reconstructive Surgery for Patients With Upper Limb Spasticity","authors":"Sean R. Cantwell MD ,&nbsp;Peter C. Rhee DO, MSc","doi":"10.1016/j.jhsa.2024.11.019","DOIUrl":"10.1016/j.jhsa.2024.11.019","url":null,"abstract":"<div><h3>Purpose</h3><div>The benefits of upper-extremity reconstructive surgery for patients with spastic deformities are well documented, but a small portion of eligible patients undergo surgery. We sought to determine perceptions of upper-extremity reconstructive surgery among brain injury patients and nonsurgical providers to identify potential barriers to surgical evaluation.</div></div><div><h3>Methods</h3><div>Electronic medical records at a referral center were reviewed for patients diagnosed with upper limb spasticity following brain injury. A patient-specific survey was distributed by email to all eligible patients. An anonymous provider-specific electronic survey was distributed to the members of United States–based professional societies that routinely provide nonsurgical medical care to patients with spasticity.</div></div><div><h3>Results</h3><div>Forty-three of 143 patients (30%) responded to the survey. All subjects underwent initial nonsurgical management for their spastic upper limbs, but only 19% (n = 8) underwent subsequent reconstructive upper-extremity surgery. Hesitancy to undergo surgery was primarily related to “uncertainty regarding its benefits” and “fear of worsened postoperative function.” Thirty-seven medical providers responded to the survey. Seventy-six percent (n = 28) saw more than 10 patients afflicted with spasticity annually, but 83% referred fewer than 10 patients for surgical evaluation. Barriers to referral included “uncertainty regarding procedure effectiveness” (58%), “concerns regarding insurance approval” (56%), “uncertainty whether a patient is a surgical candidate” (53%), and “no relationship with an upper extremity surgeon” (39%) for referral.</div></div><div><h3>Conclusions</h3><div>Surgery is infrequently performed among brain injury patients with spastic upper limb deformities. Patients report unfamiliarity with surgical options and concerns regarding surgical risks and benefits. Nonsurgical providers describe uncertainty regarding surgical efficacy and candidacy and underdeveloped referral networks.</div></div><div><h3>Clinical relevance</h3><div>Surgical treatment of upper-extremity spasticity following brain injury is infrequently provided to eligible patients. Patient and provider perceptions of upper-extremity reconstructive surgery may help identify the factors that underlie the relative infrequency of surgical treatment and suggest opportunities to optimize the delivery of surgical care.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1275.e1-1275.e11"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916276","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 the Procedure Room for Wide-Awake Local Anesthesia, No Tourniquet Hand Surgery in “High-Risk” Patients","authors":"Jordan Cook Serotte MD ,&nbsp;Kevin Chen BA ,&nbsp;Jennifer Moriatis Wolf MD, PhD ,&nbsp;Megan Conti Mica MD","doi":"10.1016/j.jhsa.2024.10.017","DOIUrl":"10.1016/j.jhsa.2024.10.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To study if patients who would be deemed high-risk individuals by traditional classifications of American Society of Anesthesiologists (ASA) or the updated guidelines of ASA Practice Advisory (ASAPA) can safely undergo surgery under wide-awake local anesthesia, no tourniquet in a procedure room setting without any increased risks of complications.</div></div><div><h3>Methods</h3><div><span>We analyzed 436 surgeries performed in our procedure room over a 4-year period. No medical comorbidities precluded a patient from surgery within the procedure room, and no preoperative clearance was required. All patients were risk-stratified based on two classifications systems: ASA and ASAPA recommendations. Complications were documented. Patients were categorized into a </span>surgical site infection (SSI) cohort and a non-SSI cohort. Mann–Whitney Wilcoxon and chi-square analyses were used to detect differences between cohorts.</div></div><div><h3>Results</h3><div><span>The prevalence of SSI was six out of 437 (1.4%). Our total complication rate (mass recurrence, need for additional surgery, etc.) was 12 out of 425 (2.7%). The number of patients within each risk classification was similar. Patient characteristics were similar on the basis of age, </span>body mass index<span>, smoking status, or presence of diabetes. The ASA or ASAPA classification did not show a relationship to complications. Additionally, no patients were transferred to the emergency department or admitted overnight after their procedures.</span></div></div><div><h3>Conclusions</h3><div>Our study demonstrated a complication rate of 2.7% for hand surgery procedures performed in the procedure room setting. Using standardized measures of anesthetic risk related to comorbidities, this study showed that there was no increase in complications for high-risk patients who had surgeries performed in the procedure room.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1272.e1-1272.e9"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873426","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":"Phocomelia Re-Examined Using the CoULD Registry","authors":"Lindley B. Wall MD, MSc ,&nbsp;Sarah Ishamuddin BS ,&nbsp;Suzanne Steinman MD ,&nbsp;Carley Vuillermin MD ,&nbsp;Charles A. Goldfarb MD ,&nbsp;CoULD Study Group","doi":"10.1016/j.jhsa.2025.08.006","DOIUrl":"10.1016/j.jhsa.2025.08.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Phocomelia is an intercalary segmental dysplasia of the upper limb, a distinct entity from longitudinal deficiencies. Nearly 20 years ago, more severely dysplastic limbs initially thought to be phocomelia were able to be reclassified as more severe forms of longitudinal dysplasia. This study sought to evaluate current phocomelia cases to identify if these represented true phocomelia.</div></div><div><h3>Methods</h3><div>Using the Congenital Upper Limb Differences Registry, all cases of phocomelia were evaluated to consider the phocomelia diagnosis. Twenty patients were included for assessment, in whom 23 extremities were classified as phocomelia. Three extremities had clavicle dysplasia and were not included in the final assessment. The radiographs, clinical images, and medical histories were examined to assess the limb diagnosis. Patients with Type V ulnar or radial longitudinal dysplasia were also evaluated to ensure no possible mis-classification.</div></div><div><h3>Results</h3><div>All extremities could be reclassified as either ulnar longitudinal dysplasia (ULD) or radial longitudinal dysplasia (RLD), with 18 ULD and 5 RLD. No true case of phocomelia was identified in this cohort. Extremities with more severe dysplasia than type V classifications were able to be classified using associated syndromes, contralateral limb diagnosis, lower limb involvement, bony morphology, and hand/digit patterning.</div></div><div><h3>Conclusions</h3><div>True phocomelia is rare and most severely dysplastic limbs can be classified as ULD or RLD with specific guidelines, which is critical in clinical care, in assessing for additional medical comorbidities, and for family counseling.</div></div><div><h3>Clinical relevance</h3><div>Patients with presumed diagnosis of phocomelia should be critically reassessed, using other patient characteristics (syndrome diagnosis, lower limb involvement, etc.), for RLD or ULD to ensure necessary medical testing is completed.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1224-1231"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014508","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":"Commentary on “Motion-Preserving Procedures in the Treatment of Scapholunate Advanced Collapse Wrist”","authors":"Eric R. Wagner MD, MSE","doi":"10.1016/j.jhsa.2025.06.014","DOIUrl":"10.1016/j.jhsa.2025.06.014","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1238-1240"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204150","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":"Commentary on Mental and Physical Health Disparities in Patients With Carpal Tunnel Syndrome Living With High Levels of Social Deprivation","authors":"Lauren M. Shapiro MD, MS","doi":"10.1016/j.jhsa.2025.07.003","DOIUrl":"10.1016/j.jhsa.2025.07.003","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1250-1252"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor Regarding “The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability”","authors":"Jorge Orbay MD ,&nbsp;Brandon Gardner MD, PhD","doi":"10.1016/j.jhsa.2025.07.010","DOIUrl":"10.1016/j.jhsa.2025.07.010","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Page e15"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204490","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":"Commentary on “Skin Cancer of the Hand: Current Management and New Horizons”","authors":"Claire E. Reynolds BA ,&nbsp;Andrew B. Fay BS ,&nbsp;Chandler W. Rundle MD ,&nbsp;Bryan T. Carroll MD, PhD ,&nbsp;Jeremy S. Bordeaux MD, MPH","doi":"10.1016/j.jhsa.2025.07.030","DOIUrl":"10.1016/j.jhsa.2025.07.030","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 10","pages":"Pages 1155-1160"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145204496","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}