Journal of Hand Surgery-American Volume最新文献

{"title":"Long-Term Outcomes of Radial Shortening Osteotomy for Kienböck Disease: Minimum 20-Year Follow-Up Study.","authors":"Tomoaki Suzuki, Yuichiro Matsui, Daisuke Momma, Takeshi Endo, Hirofumi Miyaji, Norimasa Iwasaki","doi":"10.1016/j.jhsa.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.018","url":null,"abstract":"<p><strong>Purpose: </strong>We have been performing radial shortening osteotomies for patients with negative ulnar variance and Lichtman stage 2 or higher Kienböck disease. Although we previously reported the results of this procedure 10 years after surgery, reports on follow-up beyond 10 years remain scarce. This study aimed to investigate the results of radial shortening osteotomy for Kienböck disease based on long-term clinical and radiographic outcomes for a minimum of 20 years after surgery.</p><p><strong>Methods: </strong>The cohort comprised seven patients with eight wrists treated between 1991 and 2002, whose average age at the time of surgery was 25.9 years (range: 17-44 years). The preoperative Lichtman classification was stage 3A in one wrist, 3B in five, and stage 4 in one; the mean preoperative ulnar variance was -2.2 mm (range: -1.0 to -3.5 mm). Changes in pain, range of motion, grip strength, modified Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and radiographs were evaluated from 10 years after surgery to the last follow-up at least 20 years after surgery.</p><p><strong>Results: </strong>Pain remained reduced in all patients at 20 years after surgery. Improvements in wrist extension and flexion observed 10 years after surgery were maintained at the last follow-up. Grip strength at 10 years after surgery was maintained at the last follow-up. The mean modified Mayo wrist score and the mean DASH score were maintained from 10 years after surgery to the last follow-up. Radiography showed no progression of lunate collapse in any case, although one case showed progression of degeneration in the radiocarpal joint and the distal radioulnar joint.</p><p><strong>Conclusions: </strong>Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after surgery.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152435","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":"Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases.","authors":"İsmail Bülent Özçelik, Muath Mamdouh Mahmod Al-Chalabi, Yücel Ağırdil, Berkan Mersa","doi":"10.1016/j.jhsa.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.027","url":null,"abstract":"<p><strong>Purpose: </strong>Radial club hand is a congenital malformation characterized by varying degrees of radial deviation and radial bone hypoplasia or absence. However, the optimal timing for corrective surgery remains a subject of debate. This study aimed to assess the impact of the timing of radial club surgery on functional outcomes.</p><p><strong>Methods: </strong>Eligibility for inclusion was limited to patients exhibiting type IIIb or type IV deformities according to the Bayne and Klug classification, who began hand therapy and splinting postnatally, and underwent all surgical interventions before 10 months of age. Regular assessments were conducted for a minimum of 2 years, and up to 6 years after intervention. Data, including demographics, surgical interventions, post-intervention ranges of motion, and complications, were collected retrospectively.</p><p><strong>Results: </strong>All 22 patients (34 hands) included in this study underwent surgical intervention before age 10 months. Our results demonstrated a mean preoperative hand-forearm angulation of 86.8° (range, 20°-150°) and a mean postoperative hand-forearm angulation of 3.8° (range, 0°-20°). The final range of motion showed a mean flexion of 84.3° (range, 70°-90°) in 30 hands, mean extension of 65.7° (range, 60°-70°) in 28 hands, mean ulnar deviation of 35.6° (range, 30°-40°) in 25 hands, and mean radial deviation of 17.4° (range, 15°-20°) in 27 hands. Skin necrosis occurred in 3 cases (9%).</p><p><strong>Conclusions: </strong>A comprehensive management approach immediately after birth, integrating exercises, splinting, and surgical correction before age 10 months is effective and safe.</p><p><strong>Type of study/level of evidence: </strong>Prognostic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152311","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":"Predicting Surgical Versus Nonsurgical Management of Acute Isolated Distal Radius Fractures in Patients Under Age 60 Using a Convolutional Neural Network.","authors":"Dionne Hsu, Jonathan Persitz, Atefeh Noori, Haochi Zhang, Pouria Mashouri, Rishi Shah, Andrea Chan, Amin Madani, Ryan Paul","doi":"10.1016/j.jhsa.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.015","url":null,"abstract":"<p><strong>Purpose: </strong>Distal radius fractures (DRFs) represent up to 20% of the fractures in the emergency department. Delays to surgery of more than 14 days are associated with poorer functional outcomes and increased health care utilization/costs. At our institution, the average time to surgery is more than 19 days because of the separation of surgical and nonsurgical care pathways and a lengthy referral process. To address this challenge, we aimed to create a convolutional neural network (CNN) capable of automating DRF x-ray analysis and triaging. We hypothesize that this model will accurately predict whether an acute isolated DRF fracture in a patient under the age of 60 years will be treated surgically or nonsurgically at our institution based on the radiographic input.</p><p><strong>Methods: </strong>We included 163 patients under the age of 60 years who presented to the emergency department between 2018 and 2023 with an acute isolated DRF and who were referred for clinical follow-up. Radiographs taken within 4 weeks of injury were collected in posterior-anterior and lateral views and then preprocessed for model training. The surgeons' decision to treat surgically or nonsurgically at our institution was the reference standard for assessing the model prediction accuracy.</p><p><strong>Results: </strong>We included 723 radiographic posterior-anterior and lateral pairs (385 surgical and 338 nonsurgical) for model training. The best-performing model (seven CNN layers, one fully connected layer, an image input size of 256 × 256 pixels, and a 1.5× weighting for volarly displaced fractures) achieved 88% accuracy and 100% sensitivity. Values for true positive (100%), true negative (72.7%), false positive (27.3%), and false negative (0%) were calculated.</p><p><strong>Conclusions: </strong>After training based on institution-specific indications, a CNN-based algorithm can predict with 88% accuracy whether treatment of an acute isolated DRF in a patient under the age of 60 years will be treated surgically or nonsurgically.</p><p><strong>Clinical relevance: </strong>By promptly identifying patients who would benefit from expedited surgical treatment pathways, this model can reduce times for referral.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144508","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":"Culturally Sensitive Care in Amputations: Recognition and Strategies.","authors":"Tiffany Tse, Annie Wang, Daniel Antflek, Christine Novak, Heather Baltzer","doi":"10.1016/j.jhsa.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.007","url":null,"abstract":"<p><p>The dignified disposal of limbs post-amputation is important to many cultural groups but is often not addressed. There is limited understanding from physicians and surgeons around the disposal process and its impact on patients, their beliefs, and their experiences within the health care system. In this overview, cultural and spiritual perspectives are reviewed and coupled with recommendations regarding the disposal and reclamation process. The current handling and management process of amputated parts is centered around hospital priorities. The beliefs and wishes of patients are not routinely considered, nor are the barriers to this adequately discussed. These implications affect groups with spiritual or cultural preferences that do not align with hospital standards, further exacerbating health inequity. This review provides information for health care providers surrounding the disposal of amputated parts to provide culturally sensitive and dignified approaches to patient care.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136604","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":"Comparison of Incremental Costs and Medicare Reimbursement for Intra- Versus Extra-Articular Distal Radius Fracture Surgery Using Time-Driven Activity-Based Costing.","authors":"T K Kevin Chan, David Portney, Tania Mamdouhi, Carol A Janney, Kevin C Chung","doi":"10.1016/j.jhsa.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.004","url":null,"abstract":"<p><strong>Purpose: </strong>Balancing surgical costs of care with reimbursements is important for the solvency of surgical practices and cost containment in the health care system. This study aimed to compare the day of surgery costs and incremental Medicare reimbursement for open reduction and internal fixation (ORIF) of intra-articular and extra-articular distal radius fractures (DRFs).</p><p><strong>Methods: </strong>Using time data and supply costs at a single, large academic health center, we used a time-driven activity-based costing analysis to calculate the total day of surgery costs for ORIF of DRFs for the three current procedural terminology (CPT) codes 25607, 25608, and 25609, representing the spectrum of extra-articular to comminuted intra-articular fractures. We included patients with age >65 years with an isolated closed DRF. We compared the total costs of care during surgery with the incremental Medicare reimbursements for DRF ORIF.</p><p><strong>Results: </strong>We identified 193 DRFs, including 46 extra-articular DRFs (CPT 25607), 57 two-part intra-articular DRFs (CPT 25608), and 90 intra-articular DRFs ≥ 3 fragments (CPT 25609). Significant differences in the total day of surgery costs were observed between comminuted intra-articular DRF versus two-part intra-articular and extra-articular DRFs. Specifically, CPT 25609 cost $2147.63 more than CPT 25607 but was reimbursed an incremental average of $406.65 by Medicare, yielding a negative earnings difference of $1740.98. Additionally, CPT 25609 was more costly than CPT 25608 by a mean of $1620.54, yet was reimbursed an incremental average of $286.83. The net negative earnings difference was $1333.71. The largest contributions to the total day of surgery costs were the operating room and materials for all DRF surgeries.</p><p><strong>Conclusions: </strong>The current time-driven activity-based costing analysis indicates that complex, comminuted intra-articular DRF ORIF is undervalued by Medicare.</p><p><strong>Clinical relevance: </strong>The results may justify higher reimbursements for complex DRFs, although practicing surgeons should continue to lower the costs of care by efficiently performing ORIF and judiciously using implants.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129358","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":"Wrist Extension Reconstruction Using Distal Anterior Interosseous to Extensor Carpi Radialis Brevis Nerve Transfer in Brachial Plexus Injuries.","authors":"Harvey Chim, Sami H Tuffaha, Johnny Chuieng-Yi Lu","doi":"10.1016/j.jhsa.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.010","url":null,"abstract":"<p><strong>Purpose: </strong>Reconstruction of wrist extension in C5-C8 root brachial plexus injuries (BPIs) is challenging, because of limited nerve and tendon donors. The purpose of this study was to report outcomes relating to the pronator quadratus branch of the anterior interosseous nerve (AIN) to extensor carpi radialis brevis (ECRB) nerve transfer from three BP surgeons.</p><p><strong>Methods: </strong>Ten patients with C5-C8 BPI underwent AIN to ECRB nerve transfer. The mean age of the patients was 30.5 ± 15.9 years. All patients were men. The mean time to nerve surgery following initial injury was 4.5 ± 1.2 months. In all patients, wrist extension was absent at baseline. All patients had a minimum follow-up of 12 months (mean: 28.1 months) after surgery.</p><p><strong>Results: </strong>Seven of 10 patients achieved Medical Research Council (M) grading system 4 wrist extension. In these patients, mean time to M2 was 12.7 ± 10.1 months, and mean time to M4 was 19.9 ± 10.0 months. The three patients who did not achieve M4 wrist extension had double fascicular transfer and relied strongly on the \"Oberlin effect\" where wrist flexion was required to initiate and achieve antigravity elbow flexion. Additionally, the three patients who did not achieve M4 wrist extension also had longer recovery to achieve antigravity (M3) elbow flexion, all presenting with poorer ability to initiate and achieve elbow flexion independent of the Oberlin effect. None of the patients had loss of forearm pronation after AIN to ECRB nerve transfer.</p><p><strong>Conclusions: </strong>The AIN to ECRB nerve transfer can effectively reconstruct wrist extension in BPI patients with C5-C8 root injuries. Single fascicular transfer with the ulnar nerve as a donor and avoidance of multiple muscle targets for reinnervation from the median nerve may result in more consistent recovery through this nerve transfer.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136606","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":"Arterial Perfusion of the Medial Femoral Trochlea Flap Examined by Micro-Computed Tomography Angiography.","authors":"Andrew I Abadeer, Austin Hembd, Daina Brooks, James P Higgins, Aviram M Giladi, Valeriy Shubinets","doi":"10.1016/j.jhsa.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.008","url":null,"abstract":"<p><strong>Purpose: </strong>The medial femoral trochlea (MFT) flap is a source of vascularized articular cartilage that has most commonly been used for reconstruction of proximal pole scaphoid nonunions and lunate osteonecrosis in Kienbock disease. This study aimed to describe the arterial perfusion of the MFT.</p><p><strong>Methods: </strong>Selective injection of the descending genicular artery (DGA) was performed with radiopaque dye in eight cadaveric lower extremities. Micro-computed tomography was performed on the medial femoral condyle including the MFT segment, with digital analysis quantifying vessel location and internal diameter within the territory of the MFT flap.</p><p><strong>Results: </strong>All specimens had adequate perfusion up to the MFT from the transverse branch of the DGA. The transverse branch and longitudinal branches of the DGA were of similar caliber (0.45 ± 0.19 and 0.49 ± 0.29 mm, respectively). The segment of bone and cartilage included in MFT harvest had an average of 5.9 ± 1.2 terminal periosteal vessels and 2.8 ± 1.9 nutrient vessels. The greatest number of nutrient vessels to the MFT were contained within 6.3 ± 2.19 mm from the cartilage margin. More nutrient vessels were found penetrating the cortex on the proximal aspect of the trochlea. The nutrient vessels demonstrated a consistent pattern of perfusion penetrating the cortex and coursing perpendicular to the surface of the femur.</p><p><strong>Conclusions: </strong>The MFT flap is reliably perfused by the transverse branch of the DGA with a rich supply of periosteal and nutrient vessels adjacent to cartilage. These vessels often collateralize with terminal vessels of the longitudinal branch. Periosteal and nutrient vessels to the flap are within 6.3 mm from the edge of the cartilage, which translates to a safe margin for osteotomy/flap harvest.</p><p><strong>Clinical relevance: </strong>Understanding MFT microperfusion guides optimal flap harvest by maximizing the capture of osseous perforators.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129218","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":"Spinal Accessory Nerve Versus Intercostal Nerves in Gracilis Free-Functioning Muscle Transfer for Elbow Flexion in Adult Brachial Plexus Patients.","authors":"Sandesh G Bhat, Allen T Bishop, Robert J Spinner, Kenton R Kaufman, Alexander Y Shin","doi":"10.1016/j.jhsa.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.005","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brachial plexus injury may cause either partial or complete loss of arm function. Surgical reconstruction of elbow flexion using a gracilis free-functioning muscle transfer (FFMT) may be necessary. The donor nerve, which could be the spinal accessory nerve (SAN) or intercostal nerves (ICN), can affect the final muscle strength, but little is known about how they affect voluntary neuromuscular control. This study aimed to examine the differences in voluntary neuromuscular control of the FFMT gracilis reinnervated by either SAN or ICN using biomechanical measures.</p><p><strong>Methods: </strong>Patients with a gracilis FFMT for elbow flexion innervated with SAN or ICN (2-3 motor nerves) were studied. The voluntary control of their gracilis-produced elbow flexion was evaluated on a previously validated apparatus. Subjects were instructed to produce a predefined torque relative to their maximum elbow flexion torque. Objective measures of neuromuscular control, including elbow flexor contraction latency, relaxation latency, and duration of successfully achieved demanded torque, were studied.</p><p><strong>Results: </strong>Twenty-two subjects were identified, 12 with SAN and 10 with ICN as the donor nerve to reinnervate the FFMT gracilis muscle for elbow flexion. The SAN group displayed a similar ability to contract and a better ability to relax elbow flexion produced by the gracilis muscle compared with the ICN group. The SAN group also demonstrated better modulation in their hold times with an increase in torque demand compared with the ICN group.</p><p><strong>Conclusions: </strong>This study demonstrated the superior neuromuscular control of SAN over ICN for control.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121407","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":"Three-Dimensional Orientation of the Radial Neck Axis Angulation: Implications for Radial Head Replacement.","authors":"Ausberto R Velasquez Garcia, Adam J Wentworth, Hiroki Nishikawa, Shawn W O'Driscoll","doi":"10.1016/j.jhsa.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.023","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the 3-dimensional (3D) orientation of the radial neck axis with respect to the forearm rotation axis and explore its theoretical implications for radial head prosthetic replacement.</p><p><strong>Methods: </strong>Computed tomography scans of the forearm of healthy individuals were used to construct 3D bone models defining the relationship between the forearm rotation and radial neck axes (FRANA). These models were adjusted to achieve neutral forearm rotation. A comprehensive method for measuring FRANA in 3D was developed, and the results were compared with those of clinical simulated 2-dimensional (2D) projections.</p><p><strong>Results: </strong>In 20 patients, the 3D FRANA angle averaged 5.1° (SD: 2.2°, 95% confidence intervals [CI]: 4.1-6.2°) consistently oriented toward the palmar side. This was strongly correlated (r = 0.87) with 2D measurements in the anterior view with the forearm in neutral rotation (mean: 4.5°, SD: 2.3°, 95% CI: 3.5°-5.6°), but not with the measurements in the lateral view (mean: -0.1°, SD: 2.5°, 95% CI: -1.3° to 1.0°). Angular measurements in the anterior view were strong predictors of 3D FRANA (R² = 0.8).</p><p><strong>Conclusions: </strong>The axis of the radial neck does not line up precisely with the axis of forearm rotation but points to a location that is approximately 2 cm palmar to the fovea of the distal ulna. Significant differences were found between 3D and 2D lateral measurements, which highlights the benefits of computer-assisted modeling for analyzing proximal radial geometry.</p><p><strong>Clinical relevance: </strong>With the forearm in neutral rotation, the proximal radial canal is aligned with the axis of forearm rotation in the sagittal plane but points to a mean of 5° palmarly in the coronal plane. This information can be used to optimize the radial neck cut and direction of canal preparation prior to prosthesis insertion.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121410","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 Emerging Therapies and Declining Physician Reimbursement on Dupuytren Disease Treatment: A 21-Year Review.","authors":"Evan H Richman, Dylan Rakowski, Alexander Lauder","doi":"10.1016/j.jhsa.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.013","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the trends in treatment and physician reimbursement for Dupuytren contracture (DC) within the Medicare population over a 21-year period, with a focus on how the introduction of collagenase clostridium histolyticum (CCH) has affected treatment patterns. Additionally, this study examines public interest in DC treatments through Google search trends.</p><p><strong>Methods: </strong>Medicare Part B data from 2000 to 2021 were analyzed to assess procedure volumes, charges, and reimbursements using Current Procedural Terminology codes for percutaneous needle fasciotomy (PNF), open fasciectomy, and CCH injection. Inflation-adjusted reimbursement rates were calculated. Google Trends data from 2012 to 2023 were analyzed to assess public interest in DC and its treatments.</p><p><strong>Results: </strong>From 2000 to 2021, DC treatment volumes increased by 468%, with CCH becoming the most widely used treatment, accounting for 61% of all procedures in 2021. PNF increased by 468%, whereas open fasciectomy decreased by 39%. Reimbursement for all DC treatments declined by 18% after inflation adjustment, with the greatest decline in PNF (32%) and the smallest in CCH (5%). Public interest, as measured by Google Trends, demonstrated a 525% increase in searches related to DC, with a 1,033% rise for CCH.</p><p><strong>Conclusions: </strong>The introduction of CCH has led to a considerable increase in the treatment of DC, possibly driven in part by rising public awareness of emerging therapies. Furthermore, the declining reimbursement rates for all procedures underscore the financial challenges faced by clinicians, particularly given the high cost of treatments like CCH.</p><p><strong>Clinical relevance: </strong>The growing use of CCH as the dominant treatment for DC underscores how marketing and public awareness may influence treatment practices. Physicians have a responsibility to understand these influences, ensuring that treatment decisions are guided by clinical efficacy and cost-effectiveness while managing patient expectations and prioritizing long-term outcomes over trends driven by marketing.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082173","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}