Journal of Hand Surgery-American Volume最新文献

{"title":"Upper-Extremity Compartment Syndrome: Comparison of Substance-Related Found Down and Acute Trauma Mechanisms.","authors":"Etka Kurucan, Bradley Wiekrykas, Alec Talsania, Gabriel Alonso, Joseph Thoder, Mark Solarz","doi":"10.1016/j.jhsa.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.021","url":null,"abstract":"<p><strong>Purpose: </strong>Upper-extremity compartment syndrome can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma, in recent years, opioid and substance-related overdose has led to a rise in patients with \"found down\" compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism.</p><p><strong>Methods: </strong>A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups.</p><p><strong>Results: </strong>Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with rhabdomyolysis and kidney injury requiring hemodialysis.</p><p><strong>Conclusions: </strong>Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of rhabdomyolysis and acute kidney injury requiring hemodialysis.</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":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082176","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 Association Between Distal Screw and Articular Subsidence in the Open Treatment of Intra-articular Distal Radius Fractures.","authors":"Clinton J Ulmer, Luke Verlinsky, Ritu Agarwal, Richard Hum, Sean Sequeira, Connor A Armstrong, Brandon L Driggs, Kavya K Sanghavi, Aviram M Giladi, Ryan A Rose","doi":"10.1016/j.jhsa.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.016","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the association between volar plate screw position and postoperative radiographic outcomes in the open treatment of comminuted intra-articular distal radius fractures (DRFs). We hypothesized that increased distance from distal screws to subchondral bone is associated with early loss of reduction and articular subsidence.</p><p><strong>Methods: </strong>We performed a two-center retrospective review over 10 years (2013-2023) for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C3 DRF treated with open reduction and volar locking plate fixation. We measured the distance from the distal screw to the subchondral bone (STSB), ulnar variance (UV), and volar tilt (VT) on initial postfixation and 6-week postoperative nonstandardized wrist radiographs, as well as second metacarpal cortical percentage (2MCP) on initial radiographs. Plate positioning was categorized using the Soong classification, and instability was graded using the Lafontaine criteria. Immediate after surgery and 6-week follow-up radiographic measurements were compared. Multivariable logistic regression models were used to evaluate factors associated with loss of UV and VT.</p><p><strong>Results: </strong>Initially, 540 patients were identified, with 178 remaining after exclusion. We found a statistically significant difference in median STSB distance between the immediate postoperative period (2.8 mm) and the 6-week follow-up (2.0 mm). A significant difference between immediate and 6-week postoperative UV was also present. After adjusting for appropriate covariates (age, initial 2MCP, and Lafontaine's criteria for instability), patients with initial STSB >3 mm had increased odds of an increase in UV >2 mm compared to patients with <3 mm STSB. Bone density (2MCP), perioperative Soong classification, and instability were not associated with UV change.</p><p><strong>Conclusions: </strong>In this two-center retrospective cohort of comminuted intra-articular DRFs, we found that placing the distal row of screws greater than 3mm from subchondral bone was associated with increased odds of worsening UV.</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":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082170","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":"Predictors of Syndromic Association in Ulnar Polydactyly: Analysis of a Multicenter Congenital Hand Differences Registry in the United States.","authors":"Thomas McQuillan, Hannah Antonellis, Lindley Wall, Suzanne Steinman, Angela Wang, Kim Bjorklund, Mary Claire Manske, Deborah Bohn, Apurva Shah, Andrea Bauer","doi":"10.1016/j.jhsa.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.019","url":null,"abstract":"<p><strong>Purpose: </strong>Ulnar polydactyly is one of the most common congenital hand differences in the United States. Prior literature suggests that those with type B (rudimentary) extra digits, patients and caregivers that identify as Black race or skin color, and those with a strong family history of polydactyly are less frequently associated with concomitant genetic syndromes. As race is a social construct, not a biological one, there is a need to quantify the degree of association of other clinical variables with syndromes for risk stratification and testing.</p><p><strong>Methods: </strong>Data from the Congenital Upper Limb Difference (CoULD) Registry were collected and reviewed, involving 10 tertiary hand centers in the United States. Demographic characteristics, morphology, and laterality were analyzed for to their relationship with syndromic and nonsyndromic forms of ulnar polydactyly.</p><p><strong>Results: </strong>Three hundred thirty-four patients (42% female and 63% bilateral) were included in the cohort. Patients with type A (fully formed) polydactyly had an associated syndrome in 21% of cases, compared to 2% of type B ulnar polydactyly. Black patients were less likely to have an associated syndrome than non-Black patients, but with a less strong association than type B morphology. Patients without any family history of upper limb difference were more likely to have an associated syndrome. Bilateral cases were not associated with a syndrome.</p><p><strong>Conclusions: </strong>A high frequency of genetic syndromes was found in patients with type A polydactyly (21%), and these patients were much more likely to have a genetic syndrome than those with rudimentary (type B) digits. Given this strong association with multiorgan genetic syndromes the authors recommend consultation with a genetics specialist for patients with type A ulnar polydactyly for early screening, diagnosis, treatment, and counseling for families.</p><p><strong>Type of study/level of evidence: </strong>Prognostic II.</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":"144082168","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 CTS-2T: An Assessment of a Modified, Telephone-Based Version of the CTS-6 in the Evaluation of Carpal Tunnel Syndrome.","authors":"Brandon H Smith, Jessica L Koshinski, Yagiz Ozdag, Mahmoud Mahmoud, Victoria C Garcia, C Liam Dwyer, Joel C Klena, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.011","url":null,"abstract":"<p><strong>Purpose: </strong>Preconsultation electrodiagnostic studies (EDS) are used frequently by hand surgeons. However, EDS can increase health care expenditures and delay access to subspeciality care. Our purpose was to assess the validity of a modified, telephone-based versions of the CTS-6 (the \"CTS-3T\" and \"CTS-2T\") in determining a preconsultation diagnosis of carpal tunnel syndrome (CTS).</p><p><strong>Methods: </strong>Adult patients scheduled via telephone for an outpatient upper extremity visit were administered the telephone screening instrument by a clinic scheduler. Patients were asked the 2 history components of the CTS-6 (subjective numbness and nocturnal symptoms) and instructed on how to perform the Phalen test. Points assigned to individual phone questions were the same as in the CTS-6. The CTS-6 data from a prior study were used to determine diagnostic thresholds for phone instruments. The 2-item CTS-2T consisted of both history questions and the 3-item CTS-3T also included the Phalen test. Following telephone administration by a clinic scheduler, 1 of 3 hand surgeons administered the CTS-6 during clinic, which served as the reference standard. Sensitivity (Sn), specificity (Sp) and agreement (Cohen's κ) for the CTS-2T and 3T were calculated.</p><p><strong>Results: </strong>A total of 178 patients were included and 36% had CTS based on the results of the CTS-6. The CTS-2T had a Sn/Sp of 78%/88% whereas for the CTS-3T it was 77%/83%, respectively. Agreement between schedulers and surgeons for diagnosis of CTS was moderate (κ = 0.59; 95% confidence interval, 0.47-0.71) for CTS-3T and substantial for CTS-2T (κ = 0.68; 95% confidence interval, 0.54-0.77). Agreement for the Phalen test was the lowest of the 3 items (κ = 0.18, slight).</p><p><strong>Conclusions: </strong>The CTS-2T demonstrated a Sn/Sp of 78%/88% with substantial agreement for the diagnosis of CTS. With high Sn/Sp, surgeons who routinely require preconsultations EDS should consider incorporating the CTS-2T into scheduling pathways, as this telephone screening instrument can accurately identify patients with suspected CTS.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057398","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":"Evaluating the Association Between Health Literacy and Patient-Reported Outcome Measures After Distal Radius Fracture.","authors":"Katherine R Miclau, Jeffrey W Kwong, Emma Tapp, Ashley Mulakaluri, Lauren M Shapiro","doi":"10.1016/j.jhsa.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.022","url":null,"abstract":"<p><strong>Purpose: </strong>Patient-reported outcome measures (PROMs) are used to assess patients' outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF.</p><p><strong>Methods: </strong>This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted.</p><p><strong>Results: </strong>Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs.</p><p><strong>Conclusions: </strong>Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores.</p><p><strong>Type of study/level of evidence: </strong>Prognosis IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040611","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":"Changes in Distal Radioulnar Joint Stability With Metaphyseal Versus Diaphyseal Ulnar Shortening Osteotomies: A Biomechanical Investigation.","authors":"Alex Doermann, Mark Smith, Ben Loflin, Stephen Schlecht, Jeffrey Greenberg, Nicholas Crosby","doi":"10.1016/j.jhsa.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.015","url":null,"abstract":"<p><strong>Purpose: </strong>Diaphyseal ulnar shortening osteotomy (DUSO) is the gold standard operative treatment to address positive ulnar variance in the setting of ulnocarpal impaction syndrome. However, an alternative technique, the distal metaphyseal ulnar shortening osteotomy (DMUSO), has been described with good initial results. Previous biomechanical investigations have shown increased stiffness of the distal radioulnar (DRU) joint after DUSO, but the effect of DMUSO on DRU joint stiffness has not been studied. The primary aim of the study was to compare DRU joint motion after DMUSO compared to DUSO. The hypothesis was that there is no difference in stiffness of the DRU joint after DMUSO compared to DUSO.</p><p><strong>Methods: </strong>Twelve fresh frozen cadaveric specimens were used; six underwent DUSO, and six underwent DMUSO. A custom jig was designed and used to apply a volar and dorsal force to the distal ulnar shaft while stabilizing the carpus. Each specimen was tested before and after osteotomy in neutral rotation, 60° of forearm pronation, and 60° of forearm supination. DRU joint translation and stiffness were then compared between DUSO and DMUSO.</p><p><strong>Results: </strong>In neutral forearm rotation, there was a significant decrease in translation of the ulna after DUSO compared to DMUSO in both volar and dorsal directions. In supination, there was a significant decrease in translation of the ulna with a volar force after DUSO compared to DMUSO. No significant differences were seen in pronation.</p><p><strong>Conclusions: </strong>The results demonstrate that compared to DUSO, the DRU joints has more translation after DMUSO with the forearm in neutral and supination.</p><p><strong>Clinical relevance: </strong>The authors recommend consideration of using a DUSO if there is preoperative DRU joint laxity and, alternatively, a DMUSO if no instability exists. More studies may be helpful comparing the techniques, including in vivo applications.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043070","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":"Machine Learning for Hand Surgeons: Emerging Clinical Applications.","authors":"Jacob Zeitlin, Tristan B Weir, Andrew J Miller","doi":"10.1016/j.jhsa.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.018","url":null,"abstract":"<p><p>Machine learning (ML) is transforming medicine and holds substantial potential in hand surgery to manage complex conditions, predict surgical outcomes, and optimize resources. Emerging ML applications in hand surgery include diagnostic imaging interpretation, risk stratification, outcome prediction, and practice management. For example, ML algorithms predict patient outcomes after procedures such as carpal tunnel release and optimize surgical scheduling to reduce wait times. We emphasize the importance of appraising ML research quality, using previously published guidelines to evaluate predictive models. We address challenges such as data quality and bias, the \"black box\" nature of some models, legal and ethical concerns, limited generalizability across populations, and the risk of disproportionate benefits favoring well-studied groups. To advance ML in hand surgery, surgeons should collaborate to generate diverse, high-quality data sets, reducing bias and improving generalizability. Developing transparent, explainable algorithms will enhance clinician trust and understanding. Furthermore, integrating ML into clinical workflows through decision support tools will facilitate evidence-based, individualized care. By engaging with these technologies, hand surgeons can help shape the future of the specialty, leading to better patient outcomes and optimized resource utilization.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029440","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":"Are Preoperative Corticosteroid Injections in Large or Intermediate Joints Associated with Surgical Site Infection After Soft Tissue Hand Surgery? A Retrospective Database Analysis.","authors":"Thompson Zhuang, Ellis M Berns, Mitchell Hallman, Hannah H Lee","doi":"10.1016/j.jhsa.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.020","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, we asked the following question: Is intra-articular corticosteroid injection at a distant site prior to hand surgery associated with an increased risk of (1) surgical site infection, (2) reoperation for infection, or (3) wound dehiscence?</p><p><strong>Methods: </strong>Using a national administrative claims database, we identified adult patients undergoing carpal tunnel, trigger finger, or DeQuervain release. Patients were divided into four cohorts: intra-articular corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery or no injection within 90 days prior to surgery. Large and intermediate joints were considered. We measured surgical site infection incidence, reoperation, and wound dehiscence within 90 days after surgery. We created multivariable logistic regression models to evaluate the association between preoperative corticosteroid injection and each outcome, adjusting for age, sex, region, insurance plan, Elixhauser comorbidities, and history of tobacco use.</p><p><strong>Results: </strong>Receiving a large-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with surgical site infection or reoperation. Receiving a large-joint corticosteroid injection between 0 and 30 days before surgery was associated with a slightly higher incidence of wound dehiscence compared to no injection (0.5% vs 0.4%). Receiving an intermediate-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with the incidence of surgical site infection, reoperation, or wound dehiscence. In patients with diabetes, receiving a corticosteroid injection within 90 days before surgery in a large or intermediate joint was not associated with an increased risk of surgical site infection, reoperation, or wound dehiscence.</p><p><strong>Conclusions: </strong>Corticosteroid injections into large- and intermediate-sized joints can be safely administered before hand surgery from a surgical site infection perspective, including in patients with diabetes.</p><p><strong>Type of study/level of evidence: </strong>Prognosis II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055939","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":"National Trends of Surgical Interventions for Thumb Carpometacarpal Arthritis From 2010 to 2022.","authors":"Wesley Day, Albert Rancu, Andrea Halim, Michael J Gouzoulis, Peter Y Joo, Jonathan N Grauer","doi":"10.1016/j.jhsa.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.014","url":null,"abstract":"<p><strong>Purpose: </strong>Thumb carpometacarpal arthritis is a common condition for which several surgical options are used: trapeziectomy with ligament reconstruction and tendon interposition (LRTI), other nonprosthetic arthroplasties without tendon transfer (eg, suture button suspensionplasty), trapeziectomy alone, arthrodesis, and prosthetic arthroplasty. The current study used a large, national, multi-insurance database to characterize utilization and factors associated with these surgical options over the years.</p><p><strong>Methods: </strong>All adult patients who underwent one of the above-noted procedures were identified from 2010 to October 2022 using PearlDiver database. Patient characteristics were abstracted including clinical (age, sex, Elixhauser Comorbidity Index) and nonclinical (insurance plan, and geographic region) variables. Characteristics were compared with multivariable logistic regression to assess whether each influenced the odds of undergoing one procedure versus the others. Relative utilization of the different surgeries was assessed over the years of the study and changes in patient characteristics over time were compared with univariate linear regression.</p><p><strong>Results: </strong>Of 160,387 patients identified, LRTI was performed for 97,595 (60.8%), other nonprosthetic arthroplasty for 46,371 (28.9%), trapeziectomy alone for 11,353 (7.1%), arthrodesis for 3,245 (2.0%), and prosthetic arthroplasty for 1,823 (1.1%). Various clinical and nonclinical variables were independently predictive of the surgery performed, the strongest being geographic region in which the surgery was performed. From 2010 to 2022, relative utilization, when compared with all other cohorts, only increased for nonprosthetic non-LRTI arthroplasty (from 27.1% to 35.7%, an absolute increase of 31.5%). Fewer cases of LRTI, trapeziectomy, arthrodesis, and prosthetic arthroplasty were performed (absolute decreases of 8.2%, 16.8%, 52.0%, and 44.9%, respectively).</p><p><strong>Conclusions: </strong>Of surgical options to address thumb carpometacarpal arthritis, LRTI still predominates, but nonprosthetic arthroplasty was the only cohort increasing in utilization over the years. Both patient clinical and nonclinical factors were associated with receiving one surgical modality over the others.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060142","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":"Correction of Congenital Ring-Little Finger Metacarpal Synostosis Through Simultaneous Interpositional Allograft Bone After Split Osteotomy of the Synostosis Site and Distraction Lengthening of the Fifth Metacarpal","authors":"Ji Sup Hwang MD ,&nbsp;Sang Beom Ma MD ,&nbsp;Jihyeung Kim MD, PhD ,&nbsp;Goo Hyun Baek MD, PhD","doi":"10.1016/j.jhsa.2023.12.009","DOIUrl":"10.1016/j.jhsa.2023.12.009","url":null,"abstract":"<div><h3>Purpose</h3><div><span>We attempted a technique for patients with congenital ring-little finger metacarpal synostosis<span> involving simultaneous interpositional allograft bone after split </span></span>osteotomy<span> of the synostosis site and distraction lengthening of the fifth metacarpal along with correction of the metacarpal joint abduction contracture. The purpose of this study was to describe the surgical technique and its outcomes.</span></div></div><div><h3>Methods</h3><div><span>We reviewed the medical records of children with congenital ring-little finger metacarpal synostosis treated surgically at our institute. Eight hands of six children with an average age of 5.0 (range, 1.7–9.3) years were treated by simultaneous interpositional allograft bone after split osteotomy, distraction lengthening, and </span>tenotomy of abductor digiti minimi. We measured the metacarpal head-to-capitate area ratios from serial radiographs and analyzed them according to age. We also measured the change in the intermetacarpal angle (IMA) and metacarpal length ratio during an average of 8.1 (range, 1.4–16.8) years of follow-up. These changes were compared with changes in seven hands of five children with an average age of 8.1 (range, 1.5–15.6) years treated by the same method, but without a distraction lengthening of the fifth metacarpal and followed up for an of average 12.1 (range, 4.1–19.8) years, as a control group.</div></div><div><h3>Results</h3><div>Abnormal metacarpal head-to-capitate area ratio before surgery was normalized in all patients within the first 2 years after surgery. The IMA change averaged 39.8°, and the metacarpal length ratio changed by 17%. The control group showed an average IMA change of 36.6° and metacarpal length ratio change of 6%.</div></div><div><h3>Conclusions</h3><div>Simultaneous interpositional allograft bone after split osteotomy of the synostosis site and distraction lengthening of the fifth metacarpal with correction of metacarpal joint abduction contracture can restore the radiographic parameters in congenital ring-little finger metacarpal synostosis. The normalized ossification of the fifth metacarpal head indicates that the surgical procedure is probably safe.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 5","pages":"Pages 623.e1-623.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572061","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}