Journal of Hand Surgery-American Volume最新文献

{"title":"Dr. Sterling Bunnell: From Son of the Gold Rush to Founding Father of Hand Surgery","authors":"Kevin J. Little MD","doi":"10.1016/j.jhsa.2026.04.002","DOIUrl":"10.1016/j.jhsa.2026.04.002","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1050-1051"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859708","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":"Thumb Fractures and Associated Injuries: An Evidence Based Review to Guide Treatment","authors":"Brian W. Yang MD,&nbsp;Robin N. Kamal MD MBA,&nbsp;Lauren M. Shapiro MD Ms","doi":"10.1016/j.jhsa.2026.02.001","DOIUrl":"10.1016/j.jhsa.2026.02.001","url":null,"abstract":"<div><div>Fractures of the thumb encompass a diverse spectrum of injury patterns, each requiring nuanced consideration of various treatment strategies. Associated conditions include injuries to the ulnar collateral ligament and radial collateral ligament of the metacarpophalangeal joint, which can significantly impact thumb stability and function. Although extra-articular fractures of the thumb metacarpal and phalanges are more tolerant of residual deformity due to compensatory movement of the carpometacarpal joint, intra-articular fractures, including Bennett and Rolando fractures, often benefit from surgical intervention to restore articular congruity. This review provides an updated analysis of the treatment and fixation options for thumb fractures and associated ligamentous injuries.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1034-1043"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488485","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":"A Biomechanical Cadaveric Comparison of Three Fixation Methods for Bennett Fractures","authors":"Seth A. Ahlquist MD,&nbsp;Erika Hookasian MS,&nbsp;Christopher R. Gajewski MD,&nbsp;Binglong Lee MBBS,&nbsp;David J. Graham MBBS,&nbsp;Brahman S. Sivakumar MBBS,&nbsp;Neil F. Jones MD,&nbsp;Edward Ebramzadeh PhD,&nbsp;Sophia N. Sangiorgio PhD","doi":"10.1016/j.jhsa.2025.10.021","DOIUrl":"10.1016/j.jhsa.2025.10.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Bennett fractures are inherently unstable intra-articular fractures of the first metacarpal base and are subject to multiple deforming forces. Suboptimal treatment can lead to fracture displacement, malunion, and post-traumatic arthritis of the carpometacarpal joint. The purpose of this study was to evaluate three fixation techniques for the stabilization of Bennett fractures. Our hypothesis was that screw fixation would be stiffer than the other methods.</div></div><div><h3>Methods</h3><div>Thirty fresh frozen cadaver hands were obtained. Bennett fractures were created by a fellowship-trained hand surgeon. Specimens were then randomized to fixation with one of three techniques: two 1.2 mm (0.047 in) Kirschner wires (K-wires), two 1.2 mm cortical lag screws, or a single 1.7 mm (0.067 in) headless compression screw with a minisuspensory cortical button construct (suture-button/screw). The specimens were loaded in displacement-controlled axial compression until failure. Radiographs were taken before and after testing to compare the final displacement and method of failure. Interfragmentary motion and applied load were recorded. The maximum force and relative motions of the first metacarpal and Bennett fragment were filtered and calculated.</div></div><div><h3>Results</h3><div>The median force to failure for screw, K-wire, and suture-button/screw were 166.6 N (38.9-590.3), 98.4 N (41.9-444.0), and 97.5 N (24.5-242.6), respectively, with no significant differences between constructs. Similarly, there were no significant differences in median displacement measured in three-dimensional space (5.7 mm (1.6-8.4), 5.7 mm (1.9-11.5), and 6.1 mm (3.9-17.9), respectively, or stiffness (37.2 N/mm (5.6-345.0), 22.8 N/mm (2.0-113.8), and 14.3 N/mm (5.5-285.9), respectively, between the groups.</div></div><div><h3>Conclusions</h3><div>All three methods of Bennett fracture fixation performed similarly at time zero in this <em>in vitro</em> biomechanical study.</div></div><div><h3>Clinical relevance</h3><div>The results of the present study may be taken into consideration along with patient factors and fracture characteristics when treating Bennett fractures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 970.e1-970.e7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745759","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":"Influence of Dynamic Factors on Ulnar Impaction Syndrome: An Axial Compression Test Using Fresh-Frozen Cadavers","authors":"Kinshiro Nabeshima MD,&nbsp;Yusuke Matsuura MD, PhD,&nbsp;Takahiro Yamazaki MD, PhD,&nbsp;Aya Kanazuka MD, PhD,&nbsp;Seiji Ohtori MD, PhD,&nbsp;Takane Suzuki MD, PhD","doi":"10.1016/j.jhsa.2026.02.032","DOIUrl":"10.1016/j.jhsa.2026.02.032","url":null,"abstract":"<div><h3>Purpose</h3><div>The dynamic evaluation of ulnar impaction syndrome has recently garnered interest; however, its underlying mechanism remains unclear. This research aimed to analyze the dynamic ulnar impaction biomechanically during axial loading.</div></div><div><h3>Methods</h3><div>Ten fresh-frozen cadaveric upper limbs were tested. With the elbow at 90° flexion, forearm in neutral, and wrist at 0° flexion–extension, axial loads from 0 to 300 N were applied to the wrist. Posteroanterior radiographs were taken every 60 N (0, 60, 120, 180, 240, and 300 N). Ulnar variance was measured, and the relationship between the applied load and changes in variance was analyzed. Radiographs at 60 N and 300 N were overlaid to assess ulna displacement.</div></div><div><h3>Results</h3><div>Mean ulnar variance measured 1.70 mm at 0 N and increased to 3.00 mm at 300 N. There was a positive correlation between load and variance change (r = 0.67, <em>P</em> &lt; .001). The regression equation, Y (change in ulnar variance, mm) = 0.0044X (load, N), indicates an increase of approximately 0.44 mm for every 100 N of load. The ulna was displaced distally by 1.12 mm and radially by 0.81 mm, whereas the lunate moved proximally by 0.38 mm and toward the ulna by 0.43 mm.</div></div><div><h3>Conclusions</h3><div>Axial loading caused a linear increase in ulnar variance. The ulna and lunate shifted closer together, indicating a dynamic ulnar impaction.</div></div><div><h3>Clinical relevance</h3><div>These findings reinforce the biomechanical understanding of dynamic ulnar impaction and underscore the importance of considering load-dependent changes during assessment and treatment.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 960.e1-960.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610673","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":"Inside-out Volar Portal of Arthroscopy of Proximal Interphalangeal Joints: A Cadaver Study","authors":"Yuwei Liu MD, PhD,&nbsp;You Xie MD,&nbsp;Yangyang Hong MD,&nbsp;Jianquan Liu MD,&nbsp;Wencui Li MD,&nbsp;Zhe Zhao MD, PhD","doi":"10.1016/j.jhsa.2026.02.026","DOIUrl":"10.1016/j.jhsa.2026.02.026","url":null,"abstract":"<div><h3>Purpose</h3><div>The application of arthroscopy in the proximal interphalangeal joints can avoid scar development and joint contracture. However, conventional arthroscopic techniques are difficult to apply to the palmar side of the joint. This study aimed to explore the feasibility and safety of the inside-out volar portal arthroscopic technique for the proximal interphalangeal joint, elucidating a new portal technique for the inspection and treatment of small joints.</div></div><div><h3>Methods</h3><div>We performed the inside-out palmar portal arthroscopic technique on 10 cadavers. The distances between portals and important tissues were measured in both the extended (0°) and 90° flexed positions of the proximal interphalangeal joint.</div></div><div><h3>Results</h3><div>The full cohort demonstrated sufficient safety distances from portals to proper digital vessels and nerves, flexor digitorum tendons, and extensor digitorum tendons in all the fingers. Statistically significant differences were found in the distances to the ulnar interosseous vein, ulnar interosseous nerve, and ulnar flexor tendon among the four fingers. Specifically, the mean values were higher in the index and middle fingers compared to the ring and little fingers. Additionally, the measurements were similar between the ulnar and radial sides, suggesting that the inside-out volar portals can be established on either side of the proximal interphalangeal joint.</div></div><div><h3>Conclusions</h3><div>The findings demonstrate the feasibility of the inside-out volar portal arthroscopic technique. This study provides a new portal selection for proximal interphalangeal joint arthroscopy.</div></div><div><h3>Clinical relevance</h3><div>Surgical techniques for the proximal interphalangeal should consider the pathology of palmar structures to ensure optimal treatment. This study suggests that the inside-out volar portal arthroscopy of the proximal interphalangeal joint is a feasible technique for joint diseases.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 961.e1-961.e7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719004","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":"Choosing Local Flaps Versus Occlusive Dressings in Fingertip Amputations: A Systematic Review and Meta-Analysis With Proposed Algorithm","authors":"Kasra Rahmati BS,&nbsp;Nirbhay S. Jain MD,&nbsp;Rashed Alananzeh BS,&nbsp;Lauren E. Wessel MD","doi":"10.1016/j.jhsa.2026.02.029","DOIUrl":"10.1016/j.jhsa.2026.02.029","url":null,"abstract":"<div><h3>Purpose</h3><div>Fingertip amputations present a reconstructive challenge because of the varying degrees of tissue loss, bony exposure, and functional impact. Often, providers must decide between occlusive dressings and local flap reconstruction. This systematic review aims to analyze outcomes of both treatment modalities to determine the benefits and risks of each.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies directly comparing occlusive dressings and local flap reconstruction in fingertip injuries were included. A total of 220 studies were identified. After screening, three studies met the inclusion criteria.</div></div><div><h3>Results</h3><div>A total of 142 patients with 143 affected digits were found. Of the interventions, 72 cases (50%) were managed with occlusive dressings, whereas 71 cases (50%) underwent soft tissue reconstruction with flap coverage. Symptomatic neuroma formation was higher in the flap group (11%) as compared to local wound care (1%), especially with significant bone exposure (16%). Joint stiffness was also higher in the flap cohort (24%) than the dressing cohort (8%). Nail deformities and infections were equivalent in both treatment arms.</div></div><div><h3>Conclusions</h3><div>Although flap reconstruction offers immediate wound closure, it is associated with a higher incidence of formation of symptomatic neuromas and joint stiffness compared to occlusive dressings. Conversely, occlusive dressings provide a lower complication profile while maintaining comparable outcomes in nail deformities. These findings underscore the importance of balancing the benefits of rapid functional recovery against the potential risks of surgical complications.</div></div><div><h3>Type of study/Level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1027.e1-1027.e7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635125","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 One- and Two-knot Techniques in Eight-Strand Flexor Tendon Repair Using Looped Sutures: A Biomechanical Study in a Porcine Model","authors":"Hideomi Takami MD,&nbsp;Hideyuki Ota MD, PhD,&nbsp;Satoshi Niwa MD,&nbsp;Hoyu Cho MD, PhD,&nbsp;Tomoyuki Tamemoto MD,&nbsp;Kazuki Uchibori MD","doi":"10.1016/j.jhsa.2026.05.015","DOIUrl":"10.1016/j.jhsa.2026.05.015","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to compare the biomechanical properties of one-knot and two-knot configurations in eight-strand flexor tendon repair using looped sutures. The influence of knot-tying strategy on gap resistance and ultimate failure strength was evaluated using a standardized porcine Achilles tendon model.</div></div><div><h3>Methods</h3><div>Sixteen fresh porcine Achilles tendons were transected and randomly assigned to one-knot or two-knot repair groups (n = 8 per group). Repairs were performed using an eight-strand core suture technique with a single 4-0 looped suture-based on a modified Adelaide repair. Biomechanical testing was conducted using a digital force gauge to measure the tensile force required to produce 1-, 2-, and 3-mm gap formations and ultimate failure load. Failure modes were visually assessed and categorized into three categories: suture breakage, knot failure, or suture pull-out.</div></div><div><h3>Results</h3><div>The one-knot group demonstrated significantly higher tensile forces required for 1-mm (12.4 ± 4.5 N vs 6.8 ± 2.8 N, <em>P</em> = .011), 2-mm (20.4 ± 7.5 N vs 10.3 ± 3.8 N, <em>P</em> = .004), and 3-mm (28.0 ± 9.2 N vs 17.0 ± 5.4 N, <em>P</em> = .011) gap formation compared to the two-knot group. Mean ultimate failure load was 100.1 ± 11.5 N in the one-knot group and 91.1 ± 13.7 N in the two-knot group, with no significant difference between them (<em>P</em> = .175). Knot failure was predominant in the one-knot group (7 of 8), whereas suture breakage was the primary failure mode in the two-knot group (7 of 8).</div></div><div><h3>Conclusions</h3><div>The one-knot configuration provided superior gap resistance compared to the two-knot configuration in looped suture-based eight-strand flexor tendon repair. Both techniques achieved high ultimate failure strength.</div></div><div><h3>Clinical relevance</h3><div>In flexor tendon repairs using looped sutures, the one-knot configuration may offer improved mechanical stability during the early rehabilitation phase, potentially reducing the risk of gapping and adhesion formation.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1018.e1-1018.e7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354693","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":"Letter to the Editor: Postoperative Displacement of the Dorsal Ulnar Fragment After Volar Locking Plate Fixation: Risk Factors and Clinical Prediction Tool","authors":"Ge Xiong MD, PhD,&nbsp;Almina Mubarak MD","doi":"10.1016/j.jhsa.2026.05.005","DOIUrl":"10.1016/j.jhsa.2026.05.005","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Page 972"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859117","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":"Innovator’s Corner: Vascularized Bone Flaps for Carpal Reconstruction—Challenging Dogma","authors":"Harvey Chim MD,&nbsp;James P. Higgins MD","doi":"10.1016/j.jhsa.2026.05.018","DOIUrl":"10.1016/j.jhsa.2026.05.018","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1044-1049"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859707","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":"Ten Years of a Novel Telemedicine System for Management of Statewide Hand Trauma Decreases EMS Transfer Rate and Health Care Costs in Arkansas","authors":"Katherine Montoya MD,&nbsp;Amy Schexnayder BS,&nbsp;Austin Porter DrPH, MPH,&nbsp;Theresa Wyrick MD","doi":"10.1016/j.jhsa.2025.12.015","DOIUrl":"10.1016/j.jhsa.2025.12.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Hand trauma is a challenge to triage and manage, especially in rural states, because of the relative paucity of fellowship-trained hand surgeons and equipped treatment centers. Since the establishment of the Arkansas Hand Trauma Telemedicine Program (AHTTP) in 2014, early data suggest a successful reduction in hospital transfers for hand trauma. The purpose of this economic and decision analysis study was to perform a comprehensive, longer-term analysis describing trends in emergency medical service (EMS) transfer rate for hand trauma in Arkansas in relation to the establishment of AHTTP. Secondary end points included estimated health care cost savings and geographic distribution of consults.</div></div><div><h3>Methods</h3><div>Data from all AHTTP encounters were used to conduct trend analyses in program utilization and interfacility transfers from 2013 to 2023. Cost savings were estimated based on Arkansas Medicare fee schedules. Consult origins were mapped to observe geographic distribution.</div></div><div><h3>Results</h3><div>The AHTTP facilitated 7,260 remote hand trauma consults in its first decade. The rate of EMS ground transfer for consults placed via the AHTTP considerably decreased from 44.9% to 33.2% during the study period and as low as 28.8% in 2022. Transfer rates were markedly lower compared with prior to the system’s inception when the EMS transfer rate for hand trauma was 72.6%. The incidence of air ambulance fell from a maximum of 31 in 2016 to three in 2021. An estimated 2,519 EMS ground and 156 EMS air transfers were saved, roughly correlating to a cost savings of $12,200,000. A geographically diverse distribution of consults was observed.</div></div><div><h3>Conclusions</h3><div>The AHTTP has notably decreased the overall rate of transfer for management of hand trauma across Arkansas, including EMS ground and air transfer, saving patients and taxpayers an estimated $12.2M and increasing availability of local emergency medical resources.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic and decision analysis, IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1019-1026"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133570","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}