Journal of Hand Surgery-American Volume最新文献

{"title":"Long-Term Surgical Outcomes of Dorsal Capsulodesis and Three-Ligament Tenodesis in Midcarpal Instability: A Mean Follow-Up of 8 Years.","authors":"Isabel C Jongen, Niek J Nieuwdorp, Caroline A Hundepool, Amber Bouman, Sebastiaan Souer, Ruud W Selles, J Michiel Zuidam","doi":"10.1016/j.jhsa.2025.07.037","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.037","url":null,"abstract":"<p><strong>Purpose: </strong>The long-term effectiveness of surgical stabilization for midcarpal instability (MCI), or carpal instability nondissociative, is often debated due to concerns about the potential weakening of the reinforced ligaments or joint capsule over time. Ligament reconstruction techniques like three-ligament tenodesis (3LT) may offer more durable stabilization than the more common dorsal capsulodesis, given the intraosseous nature of stabilization. However, comparative long-term studies are lacking. This study aimed to evaluate the durability of surgical stabilization for nontraumatic MCI and compare the long-term outcomes of 3LT with dorsal capsulodesis.</p><p><strong>Methods: </strong>We included patients who underwent surgical stabilization for nontraumatic MCI with either dorsal capsulodesis or 3LT. Patient-reported pain and function were assessed using the patient-rated wrist evaluation (PRWE). Secondary outcomes included patient satisfaction and subsequent treatments. A linear mixed model was used to analyze PRWE scores across different time points during long-term follow-up and compare the outcomes between the two techniques.</p><p><strong>Results: </strong>We contacted 179 patients for long-term follow-up, including 143 patients treated with dorsal capsulodesis and 36 with 3LT, at a mean follow-up duration of 8 years (range: 2.7-12.4 years). Both techniques showed significantly improved PRWE function, pain, and total scores from intake to 12 months after surgery, with sustained results over long-term follow-up. At 3 months after surgery, dorsal capsulodesis demonstrated significantly better PRWE total and pain scores compared with 3LT. However, this difference was not observed at 12 months or during the long-term follow-up. There was no difference in patient satisfaction or subsequent treatment rates between both the treatment groups.</p><p><strong>Conclusions: </strong>Surgical stabilization provides durable, favorable outcomes for nontraumatic MCI, making it a reliable treatment option for patients who do not achieve sufficient relief from nonsurgical treatment. We prefer dorsal capsulodesis over the more invasive 3LT due to its quicker recovery and comparable, favorable long-term outcomes regarding pain, function, satisfaction, and subsequent treatment.</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":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103240","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":"Total Wrist Arthroplasty With Tantalum Coating: 20 Cases With a Mean Follow-Up of Six Years.","authors":"Daniel Reiser, Marcus Sagerfors, Kurt Pettersson, Per Wretenberg, Per Fischer","doi":"10.1016/j.jhsa.2025.07.040","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.040","url":null,"abstract":"<p><strong>Purpose: </strong>Despite improvements in total wrist arthroplasty (TWA) designs, periprosthetic osteolysis, and implant loosening are challenging issues. A new TWA implant design with a tantalum coating has been proposed to address these issues. This study reports the results of a pilot study of 20 cases operated on with the new TWA design.</p><p><strong>Methods: </strong>Of the 20 cases, 14 were primary TWAs and 6 were revision TWAs. Patients were assessed using visual analog scale pain scores, wrist range of motion, hand grip strength, and patient-reported outcome measures (PROMs) before surgery and 1, 2, and no later than 8 years after surgery. Radiographic examination was performed to assess any loosening of the TWA.</p><p><strong>Results: </strong>Of the 20 patients, 19, including 12 men and 7 women, came for postoperative follow-up at a mean of 6.5 years (5-8 years). Two reoperations were performed in two patients in the primary TWA group, compared with seven reoperations in six patients in the revision TWA group. Three of the reoperations were revision surgeries with conversion to radiocarpal arthrodesis, one in the primary TWA group and two in the revision TWA group. All three radiocarpal arthrodeses healed radiographically, but one of the patients underwent implant removal because of prominent hardware. Another patient in the revision TWA group had loosening of the articular head at the snap-fit mechanism and was offered revision surgery but declined further operative treatment. The radiographic examinations did not indicate implant loosening at the last follow-up. Range of motion, PROMs, and visual analog scale pain scores all improved at final follow-up.</p><p><strong>Conclusions: </strong>The new TWA design gave improved PROMs, and the frequency of implant loosening was low. The number of revisions remains a concern, but most followed the revision TWA.</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":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Results of Treatment of Comminuted Olecranon Fracture With Free Articular Fragments Using the Embedded Subchondral K-Wire Fixation Along With Plate Fixation.","authors":"Jin Sung Park, Seung-Hyun Cho, Kyoung-Tae Min, Jae Hoon Lee, Jin Ho Kim, Goo Hyun Baek","doi":"10.1016/j.jhsa.2025.07.035","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.035","url":null,"abstract":"<p><strong>Purpose: </strong>Comminuted olecranon fractures with free articular fragments pose considerable surgical challenges because of anatomical complexity and instability of the fracture fragments. This study evaluated the functional and radiological outcomes of embedded subchondral K-wire fixation combined with plate fixation.</p><p><strong>Methods: </strong>A retrospective analysis of 14 patients (mean age ± SD: 43 ± 17 years; eight men and six women) treated between 2013 and 2022 was conducted. Inclusion criteria comprised patients diagnosed with comminuted olecranon fractures requiring surgical intervention using embedded subchondral K-wires and plate fixation. Outcomes were assessed using radiographic evaluations (Mayo classification and computed tomography imaging) and functional scores (Mayo Elbow Performance Score and range of motion).</p><p><strong>Results: </strong>All fractures achieved union by 20 weeks, with 42.9% united by 12 weeks and 85.7% by 15 weeks. Anatomic reduction was achieved in 64.3% of cases, whereas the remaining 35.7% had satisfactory reduction, defined as < 2 mm of articular stepoff with acceptable alignment. The average range of elbow motion at the final follow-up (mean ± SD: 21.3 ± 15.0 months) was 138.2° ± 9.7° flexion, -6.4° ± 6.6° extension, 80.4° ± 15.2° pronation, and 85.4° ± 12.2° supination. The mean Mayo elbow performance score was 95.4 ± 6.9. Complications included hardware irritation (35.7%) and one case each of post-traumatic arthritis and heterotopic ossification. Hardware removal was performed in 71.4% of patients. There were no cases of nonunion or implant failure.</p><p><strong>Conclusions: </strong>Embedded subchondral K-wire fixation with plate fixation effectively restores joint alignment and may reduce complications related to extension limitation and post-traumatic arthritis in comminuted olecranon fractures with free articular fragments. However, implant removal was frequently required.</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":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093095","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":"Bionic Reconstruction for the Nonfunctional, Painful Hand: Optimizing Pre/Intra/Postoperative Treatment Using Elective Transradial Amputation and Targeted Muscle Reinnervation/Regenerative Peripheral Nerve Interface.","authors":"Anirudh Kulkarni, John A Chao, Alta Fried, Ajul Shah","doi":"10.1016/j.jhsa.2025.07.024","DOIUrl":"10.1016/j.jhsa.2025.07.024","url":null,"abstract":"<p><p>The treatment of a nonfunctional, painful upper limb has historically been challenging. Bionic reconstruction, a technique that employs nerve and muscle transfers following an elective amputation to successfully facilitate prosthetic integration, overcomes the difficulties of previous treatment approaches. The biggest advantages conferred by a bionic reconstruction allow functional return of the injured limb in addition to mitigation of chronic pain. We describe a technique for elective transradial amputation using an all-fish-mouth technique that unites targeted muscle reinnervation with regenerative peripheral nerve interfaces for improved outcomes. In the implementation of the bionic reconstructive approach, a preoperative and postoperative multidisciplinary treatment approach is critical to optimize outcomes. We have outlined a novel comprehensive care protocol, including surgery, rehabilitation, prosthetics, and mental health treatment, to confer the success of the bionic technique.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066542","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":"Weight-Bearing Computed Tomography Analysis of Scapholunate Ligament Injury.","authors":"Brodie Ritchie, Justen Saini, Zoe E Mack, Alexandra Munn, Gurpreet Dhaliwal, Koren E Roach, Sarah L Manske, Neil J White","doi":"10.1016/j.jhsa.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.022","url":null,"abstract":"<p><strong>Purpose: </strong>Weight-bearing computed tomography allows for assessment of carpal alignment and stability under physiologic load conditions, which may allow for detection of subtle dynamic instabilities that may not be apparent in nonweight-bearing images. The purpose of this study was to evaluate carpal position under physiologic load in healthy and scapholunate interosseous ligament (SLIL)-injured wrists using weight-bearing computed tomography.</p><p><strong>Methods: </strong>Ten healthy controls and 10 participants with arthroscopy (Geisler III or IV) or magnetic resonance imaging-proven SLIL injury underwent computed tomography imaging in three positions: (1) nonweight-bearing neutral, (2) weight-bearing push-up bar (WBPUB) in a semiextended pronated grip position, and (3) weight-bearing in forced wrist extension. Radiographic parameters including scapholunate interval, capitate radius index, radiolunate angle, radioscaphoid angle, scapholunate angle, and dorsal scaphoid translation were performed by a senior resident and reviewed by consensus of three fellowship-trained hand surgeons.</p><p><strong>Results: </strong>In SLIL injury, the capitate radius index decreased significantly, whereas the scapholunate interval remained unchanged in weight-bearing positions. Scapholunate angle significantly decreased in weight-bearing positions in both groups, and there was no difference in scapholunate angle between SLIL injury and healthy wrists in either weight-bearing position. In WBPUB, SLIL-injured wrists had similar scaphoid flexion but increased lunate extension relative to healthy wrists, whereas in weight-bearing in forced wrist extension, they demonstrated similar lunate extension and decreased scaphoid flexion. In SLIL injury, dorsal scaphoid translation was eliminated in WBPUB.</p><p><strong>Conclusions: </strong>In SLIL injury, WBPUB demonstrated reduction of the scaphoid into the scaphoid facet, while both weight-bearing positions, WBPUB and forced wrist extension, demonstrated signficant reduction of the scapholunate angle.</p><p><strong>Clinical relevance: </strong>Application of load during x-ray or computed tomography imaging could be used to identify reduceable scapholunate ligament pathology prior to surgical reconstruction and may be used in the operating room to assist with obtaining anatomic scapholunate reduction.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055512","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":"Opioid-Free Pain Management Strategies for Patients on Oral Anticoagulation Undergoing Soft Tissue Hand Surgery.","authors":"Ellis M Berns, Thompson Zhuang, Hannah H Lee","doi":"10.1016/j.jhsa.2025.07.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.020","url":null,"abstract":"<p><p>Non-narcotic multimodal analgesia has become standard for patients undergoing soft tissue hand surgery. These regimens often include nonsteroidal anti-inflammatory drugs such as ketorolac and ibuprofen, which can elevate bleeding risks in patients on anticoagulation therapy. This review aims to (1) elucidate the physiology of coagulation in relation to nonsteroidal anti-inflammatory drugs and anticoagulants, (2) examine the current surgical literature on risks and benefits of limited-duration nonsteroidal anti-inflammatory drug use in anticoagulated patients, (3) identify viable pain management alternatives, and (4) highlight areas warranting further research in nonopioid analgesia for anticoagulated patients.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042397","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":"Over-the-Top Foveal Triangular Fibrocartilage Complex Repairs With Distal Radioulnar Joint Instability: A Biomechanical Study.","authors":"Parunyu Vilai, Andrew R Thoreson, Cheng-Yu Yin, Alexander W Hooke, Taylor P Trentadue, Kristin D Zhao, Sanjeev Kakar","doi":"10.1016/j.jhsa.2025.07.015","DOIUrl":"10.1016/j.jhsa.2025.07.015","url":null,"abstract":"<p><strong>Purpose: </strong>The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the distal radioulnar joint (DRUJ). Injury to the TFCC's foveal insertion can cause ulnar-sided wrist pain and DRUJ instability. The aim of this study was to assess DRUJ stability, as measured by volar-dorsal translation, after TFCC foveal repair using an arthroscopic \"over-the-top\" technique.</p><p><strong>Methods: </strong>After obtaining institutional biospecimens approval, eight fresh-frozen cadavers were procured. Distal radioulnar joint instability was defined as an increase in sagittal translation of the distal ulna relative to the radius. A custom biomechanical testing protocol was implemented, which involved applying a linear translation to the radius and measuring both the applied force and bone displacement in the dorsal-volar direction. The stability of the DRUJ was tested with an intact foveal insertion and ulnar styloid insertion, after release of the entire TFCC foveal insertion and transection of the superficial TFCC attachment to the ulnar styloid, and then after the \"over-the-top\" technique repair with three different suture configurations. Distal radioulnar joint stability was assessed in the following three wrist positions: neutral, 60° pronation, and 60° supination using both translation and stability improvement as outcomes.</p><p><strong>Results: </strong>Distal radioulnar joint translation increased between the intact and injured conditions in neutral, pronation, and supination. Suture repair improved DRUJ translation compared with the injured state. Percent stability improvement, calculated relative to the injured condition, was higher across all repair groups. A single suture repair restored approximately half the stability relative to the injured condition, whereas the three-suture repair demonstrated the greatest improvement in DRUJ stability.</p><p><strong>Conclusions: </strong>\"Over-the-top\" TFCC foveal repairs can enhance postoperative DRUJ stability.</p><p><strong>Clinical relevance: </strong>\"Over-the-top\" TFCC foveal repair using three sutures provides the greatest improvement in DRUJ stability in a cadaveric model. These findings may help guide surgical decision-making regarding the optimal number of sutures needed to restore DRUJ stability following foveal TFCC injuries.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055558","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":"Decreasing Trend in Medicare Physician Reimbursements for Flap and Microvascular Surgery Procedures From 2002 to 2023.","authors":"Aaron B Lavi, Paul G Mastrokostas, Leonidas E Mastrokostas, Bruce B Zhang, Scott Liu, Katherine M Connors, Jennifer Hashem","doi":"10.1016/j.jhsa.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.027","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate how major US health care policy changes have influenced long-term Medicare reimbursement trends for upper-extremity flap and microvascular procedures from 2002 to 2023.</p><p><strong>Methods: </strong>Reimbursement data for 28 common flap and microvascular procedures were extracted from the Medicare Physician Fee Schedule database using Current Procedural Terminology codes. Adjustments for inflation were made using the Consumer Price Index. Statistical analyses included descriptive evaluations, trend analyses, and compound annual growth rate calculations. Sensitivity analyses were performed across four policy-relevant time periods.</p><p><strong>Results: </strong>From 2002 to 2023, inflation-adjusted Medicare reimbursement amounts for flap and microvascular procedures declined by an average of 36.9%. The compound annual growth rate was -2.3%, and inflation-adjusted reimbursements saw a sharper decline of 4.5% annually. Work relative value units increased modestly by 7.2%, whereas facility and malpractice relative value units increased by 15.9% and 95.7%, respectively. The steepest declines in reimbursement occurred during the COVID-19 pandemic (2020-2023), with an average decrease of 17.1%. Linear regression analyses revealed statistically significant downward trends for all procedures.</p><p><strong>Conclusions: </strong>Medicare reimbursement amounts for upper-extremity flap and microvascular procedures have not kept pace with inflation, reflecting a broader trend of declining economic viability in surgical subspecialties.</p><p><strong>Clinical relevance: </strong>This trend may exacerbate disparities in health care access, as physicians face increasing financial pressures. Policymakers must address these challenges to ensure sustainable compensation and equitable care for patients. Future research should explore strategies to mitigate the impact of declining reimbursement rates on patient care and provider practice patterns.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008574","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":"Shear Wave Elastography for the Assessment of Thenar Muscle Elasticity in Trapeziometacarpal Osteoarthritis: A Cross-Sectional Study.","authors":"Feray Karademir, Adalet Elçin Yıldız, Kadir Mutlu Hayran, İbrahim Faruk Adıgüzel, Özlem Ülger, Tüzün Fırat","doi":"10.1016/j.jhsa.2025.07.007","DOIUrl":"10.1016/j.jhsa.2025.07.007","url":null,"abstract":"<p><strong>Purpose: </strong>Although recent studies have emphasized the importance of the adductor pollicis (AdP) and first dorsal interosseous (FDI) muscles in maintaining trapeziometacarpal (TMC) joint function, the viscoelastic properties of these muscles in the presence of TMC osteoarthritis (OA) remain unclear. This study aimed to investigate differences in the elasticity of the AdP and FDI muscles in patients with TMC OA, thereby contributing to the understanding of muscular changes associated with the disease.</p><p><strong>Methods: </strong>Eighteen patients with TMC OA (29 thumbs) and 13 age- and sex-matched asymptomatic controls (26 thumbs) were included. The elasticity of the AdP and FDI muscles was measured using shear wave elastography (SWE). Data were analyzed using a linear mixed-effects model to assess differences between the groups.</p><p><strong>Results: </strong>SWE values of the AdP muscle were notably higher in patients with TMC OA compared with controls, whereas no notable difference was found in the FDI muscle.</p><p><strong>Conclusions: </strong>SWE provides a quantitative and real-time method for assessing the thenar muscle elasticity and detecting changes in the AdP muscle in TMC OA. Our findings suggest that shear wave elastography may be a promising tool for investigating biomechanical mechanisms involved in the pathogenesis of TMC OA.</p><p><strong>Clinical relevance: </strong>SWE may inform clinical decision-making by identifying changes in the viscoelastic properties of the thenar muscles, which could support the assessment of muscle-targeted interventions in TMC OA.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979390","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 Effect of Forearm Shortening on Finger Flexion: A Biomechanical Study","authors":"Timothy Daugherty MD ,&nbsp;Justin Sawyer MD ,&nbsp;Thomas Gillin BS ,&nbsp;Pooyan Abbasi MS ,&nbsp;Gabriel Yohe MS ,&nbsp;James P. Higgins MD ,&nbsp;Kenneth R. Means Jr. MD","doi":"10.1016/j.jhsa.2024.09.005","DOIUrl":"10.1016/j.jhsa.2024.09.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Surgeons may shorten the forearm for many indications. We quantified the impact of shortening on finger flexion with a cadaver model.</div></div><div><h3>Methods</h3><div><span><span>Ten fresh cadaver proximal forearms were pinned to a static block. We pinned each distal forearm/hand to a block that could unlock, slide, and relock on a mounting track. This block allowed wrist-neutral or 30-degree extension. With the sliding block locked, we removed the central 10 cm of the radius/ulna. We placed sutures in the </span>proximal end of each flexor </span>digitorum<span> profundus (FDP). After pretensioning, we simulated near-maximum baseline FDP muscle-generating force by applying 100 N via a load cell at the proximal sutures. We then anchored the load cell system proximally to set the initial length-tension relationship for simulating near-maximum baseline muscle-generating force. We called subsequent load cell readings the simulated muscle force (SMF) and pressure sensor readings between fingertips and the palm the tip-to-palm force (TPF). We shortened the forearm in 1 cm increments with the distal sliding-locking block. At each increment, we recorded SMF and TPF in the wrist-neutral position. Once a specimen lost measurable TPF, we applied 30 degrees wrist extension until again losing TPF.</span></div></div><div><h3>Results</h3><div>Incremental forearm shortening was associated with exponential decreases in each FDP’s SMF and TPF. In wrist-neutral, 3 cm mean shortening had a loss of 99% and 98% SMF and TPF, respectively. Wrist extension marginally improved SMF and TPF up to 4 cm mean shortening, where both lost 99%. Loss of any fingertip touchdown occurred after a mean shortening of 4.9 cm in wrist-neutral and 5.3 cm in 30 degrees wrist extension.</div></div><div><h3>Conclusions</h3><div>Mean forearm shortening of 3 or 4 cm had a near-complete loss of FDP SMF and TPF in wrist-neutral/wrist extension, respectively. With ∼5 cm shortening, there was a complete loss of fingertip touchdown.</div></div><div><h3>Clinical relevance</h3><div>Surgeons should consider the influence of forearm shortening on the FDPs and contemplate flexor tendon shortening or alternative reconstructions as indicated.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 9","pages":"Pages 1126.e1-1126.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481276","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}