Journal of Hand Surgery-American Volume最新文献

{"title":"Serial Range of Motion and Grip Strength Measurements, Patient-Reported Outcomes, and Radiographic Thresholds Associated With Less Satisfactory Outcomes After Low-Energy Distal Radius Fracture in Women Aged 50 Years and Older","authors":"","doi":"10.1016/j.jhsa.2024.01.012","DOIUrl":"10.1016/j.jhsa.2024.01.012","url":null,"abstract":"<div><h3>Purpose</h3><p>To document the change of clinical (wrist motion and grip strength) measurements and Patient-Rated Wrist Evaluation (PRWE) scores at 9 weeks and 3, 6, and 12 months after distal radius fracture (DRF) in women 50 years and older with exclusively isolated, displaced, and low-energy DRFs treated by either closed and/or open reduction and to relate these outcomes to their radiographic results.</p></div><div><h3>Methods</h3><p>In this retrospective single-institution cohort study, patients’ post-DRF clinical measurements and PRWE scores were prospectively collected from December 2007 through September 2018 and stratified according to their final radiographic values of volar/dorsal tilt, ulnar variance, and radial inclination.</p></div><div><h3>Results</h3><p>Of the 1,319 women identified, 1,126 (85%) were treated nonsurgically, and 193 (15%) were treated operatively. At 12 months, patients averaged restoration (ratio of injured and uninjured sides’ values) of 96% pronation, 95% extension, 91% supination, 81% flexion, and 80% (77% nondominant, 85% dominant) grip strength. The mean PRWE score was 39.5 at week 9 and 14.4 at 12 months with 54% of patients scoring &lt;10 and 13% scoring zero. The mean volar/dorsal tilt, ulnar variance, and radial inclination values in those treated nonsurgically were 1.4° dorsal, +3.9 mm, and 18.0°, respectively. Analogous values in patients treated surgically were 6° volar, +2.6 mm, and 22°, respectively. Volar tilt ≥25°, dorsal tilt &gt;10°, ulnar variance &gt;+7.5 mm, and radial inclination ≤13° were thresholds beyond which motion and grip strength were reduced and/or PRWE scores increased. In general, older patients experienced more residual deformity and were less likely to have undergone surgery.</p></div><div><h3>Conclusions</h3><p>Generally, outcomes were satisfactory for patients with radiographic results within identified thresholds for acceptable fracture reduction. Outcomes were significantly less favorable for patients with radiographic results beyond these thresholds; for these patients, early surgical intervention should be considered. Low-energy DRFs should prompt bone density investigation.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic 2b.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0363502324000285/pdfft?md5=e83b13788601424059ecf1e93d2204af&pid=1-s2.0-S0363502324000285-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617670","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":"Trapezoidal Osteotomy for Treatment of Long-Standing Nonunion of Lateral Humeral Condyle Fracture With Cubitus Valgus Deformity","authors":"","doi":"10.1016/j.jhsa.2022.11.017","DOIUrl":"10.1016/j.jhsa.2022.11.017","url":null,"abstract":"<div><h3>Purpose</h3><p><span><span><span>Long-term nonunion<span> of the lateral humerus condyle fracture may lead to progressive cubitus </span></span>valgus, elbow pain and instability, and secondary ulnar </span>neuritis. A number of techniques of </span>osteotomy<span> are available for correction, but each has its disadvantages. The aim of this study was to present a technique of medial trapezoidal osteotomy for correcting nonunion of the lateral humeral condyle<span> with an elbow valgus deformity &gt;20°.</span></span></p></div><div><h3>Methods</h3><p><span>Eight patients (mean age, 7.5 years) with cubitus valgus, after neglected nonunion of a lateral humeral condyle fracture<span> of greater than 2 years duration, were treated with trapezoidal combined osteotomy. The mean interval from the lateral condylar fracture to surgery was 3.1 years. The osteotomy lines were marked on the bone with a </span></span>template<span> made before surgery. The lateral condyle and osteotomy site were fixed with K-wires, and the elbow joint was immobilized in a plaster brace. Pre- and postoperative carrying angles, range of motion, elbow function, and ulnar nerve<span> neuropathy were analyzed.</span></span></p></div><div><h3>Results</h3><p>The mean follow-up was 5.9 years. Union of the lateral condyle was achieved in all patients; 3 healed at 8 weeks, 2 healed at 9 weeks, 2 healed at 10 weeks, and 1 healed at 12 weeks. The mean carrying angle decreased from 30.1° before surgery to 5.8° after surgery. The surgery did not reduce the range of motion at the elbow. According to the Mayo Elbow Performance Score<span>, 6 patients had excellent elbow function, and 2 had good elbow function at the last follow-up. All preoperative ulnar nerve symptoms resolved. One patient had a mild surgical site infection. No other complications occurred.</span></p></div><div><h3>Conclusions</h3><p>Medial trapezoidal osteotomy appears to be an effective method for treating nonunion of lateral humeral epicondyle fracture with cubitus valgus deformity.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic V.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10546330","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":"Complications in the 2-Year Postoperative Period Following Pediatric Syndactyly Release","authors":"","doi":"10.1016/j.jhsa.2022.10.017","DOIUrl":"10.1016/j.jhsa.2022.10.017","url":null,"abstract":"<div><h3>Purpose</h3><p><span>Syndactyly surgical release is one of the most common congenital hand surgeries performed by </span>pediatric<span> hand surgeons. The purpose of our study was to evaluate the complications associated with syndactyly release and determine factors that correlate with higher complication rates within the 2-year postoperative period.</span></p></div><div><h3>Methods</h3><p>A retrospective chart review was completed for patients who underwent syndactyly release at a single pediatric center between 2005 and 2018. Patients were included if they had a diagnosis of syndactyly and underwent surgical release, and excluded for a diagnosis of cleft hand, incomplete surgical documentation, surgery performed at an outside institution, or follow-up care that did not extend beyond the first postoperative visit. Complications were classified using the Clavien-Dindo (CD) system.</p></div><div><h3>Results</h3><p>Fifty-nine patients met the inclusion criteria, which included 143 webs released in 85 surgeries. A total of 27 complications occurred for the 85 surgeries performed. The severity of complications was CD grade I or II in 23% of surgeries, most commonly unplanned cast changes, and CD grade III in 8% of surgeries. No CD grade IV or V complications occurred. The CD grade III complications included 6 reoperations. The complication rate was higher when performing &gt;1 syndactyly release per surgery. It also was higher for patients undergoing &gt;1 surgical event. Rates of complication per surgery were similar between patients with multiple surgeries compared with those with a single surgery. Concomitant diagnoses and complexity of syndactyly was not associated with a higher complication rate.</p></div><div><h3>Conclusions</h3><p>Syndactyly release was associated with a complication rate of 31% per surgical event with 44% of these complications related to unplanned cast changes and 8% of complications that required admission or reoperation. Risk factors for complications following syndactyly release include &gt;1web operated on per surgery and undergoing &gt;1 surgical event.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognosis IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10411680","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 Outcomes of Surgical Repair for Partial Distal Biceps Tendon Tears","authors":"","doi":"10.1016/j.jhsa.2022.11.015","DOIUrl":"10.1016/j.jhsa.2022.11.015","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to describe the outcomes of patients treated with surgical repair of partial tears of the distal biceps tendon.</p></div><div><h3>Methods</h3><p><span>The study was a retrospective review of repairs of partial tears of the distal biceps tendon performed by multiple surgeons from January 1, 2015 to October 15, 2020. Inclusion criteria consisted of preoperative magnetic resonance imaging indicative of distal biceps pathology without a complete tear and surgical treatment with intraoperative confirmation of a partial tear. The presence of preceding trauma, duration of symptoms, and postoperative complications were documented. Patients were contacted for outcome assessment using the Quick Disabilities of the Arm, Shoulder, and Hand (</span><em>Quick</em>DASH) and Patient-Reported Elbow Evaluation outcome measures. Clinical outcomes were obtained from 56 of 74 (76%) eligible patients with an average follow-up of 46 months (range: 15–85 months).</p></div><div><h3>Results</h3><p>After surgery, the median <em>Quick</em>DASH was 2.3 (interquartile range, 0–9.7), and the median Patient-Reported Elbow Evaluation score was 1 (interquartile range, 0–12). Postoperative <em>Quick</em><span><span>DASH scores were significantly lower than the preoperative scores. Known traumas preceding the symptoms and duration of symptoms before surgery were not significantly associated with the outcome. Of all eligible patients, 30 complications were reported in 25 (34%) patients and included 2 reruptures, 2 cases of heterotopic ossification, 1 deep infection, 1 case of implant irritation, 21 neuropraxias, and 3 hematomas. Five (7%) patients underwent 6 </span>reoperations<span> including 1 revision for a rerupture, 1 irrigation and debridement<span>, 2 heterotopic ossification excisions, 1 hematoma evacuation, and 1 implant removal.</span></span></span></p></div><div><h3>Conclusions</h3><p>The results suggest that the repair of partial distal biceps tendon tears is a viable treatment option with significant improvement in <em>Quick</em>DASH. There was no significant relationship between the postoperative outcome and duration of symptoms or known traumas preceding the symptoms.</p></div><div><h3>Type of study/level of evidence</h3><p>Therapeutic IV.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10856524","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":"Helping Surgeons’ Hands: A Biomechanical Evaluation of Ergonomic Instruments","authors":"","doi":"10.1016/j.jhsa.2022.12.006","DOIUrl":"10.1016/j.jhsa.2022.12.006","url":null,"abstract":"<div><h3>Purpose</h3><p>“Ergonomic” is a common descriptor for a desk or computer workspace but is a term rarely used to describe a surgical instrument. Instead, surgeons spend many hours in inconvenient positions, often using instruments that are not ergonomic. Improving the ergonomics of surgical instruments may decrease the required force for simple tasks and allow for more efficient surgery.</p></div><div><h3>Methods</h3><p>To evaluate the impact of ergonomic surgical instruments, the authors developed ergonomic screwdriver handles. The shape and size of these handles were engineered using previous dental studies and 3-dimensional modeling to create an ideal handle for specific glove sizes. Participants were recruited to test 3 different ergonomic handle sizes against a standard screwdriver while assessing digital peak force, digital contact area, and participant preference. Ten participants (3 women) with glove sizes ranging from 6 to 8 were evaluated.</p></div><div><h3>Results</h3><p>Ergonomic screwdriver handles sized for glove sizes 6 and 7 required significantly less thumb peak force than the standard screwdriver for all participants (702 N for glove size 6 and 567 N for glove size 7 ergonomic screwdrivers, vs 1780 N for “one size fits all” standard screwdriver). Participants consistently preferred screwdrivers that required lower thumb and index finger forces. All ergonomic handles required lower thumb and index finger force. Eighty percent of participants preferred a screwdriver modeled within 1 glove size of their own.</p></div><div><h3>Conclusions</h3><p>Improved ergonomic handles require less force and are preferred by surgeons.</p></div><div><h3>Clinical relevance</h3><p>The significant decrease in thumb peak force for glove sizes 6 and 7 suggests that there is room for ergonomic improvement in instruments, especially for surgeons with smaller hands. Manufacturing ergonomic screwdriver handles and using the evolving convenience of 3-dimensional printing may help to develop a more comfortable work environment for surgeons.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10663724","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":"Surgical Hand Antisepsis: Environmental and Cost Impact in Hand Surgery","authors":"","doi":"10.1016/j.jhsa.2024.04.003","DOIUrl":"10.1016/j.jhsa.2024.04.003","url":null,"abstract":"<div><p><span>Health care systems, including operating rooms, are a considerable contributor to environmental waste. Given ongoing concerns regarding water scarcity in the United States and worldwide, action to reduce water utilization should be taken. Traditional water-based hand scrubbing wastes an estimated 11 L of water per scrub. Waterless hand rubbing with an alcohol-based solution has been shown to be as effective as traditional water-based hand scrubbing in surgical hand antisepsis and in preventing </span>surgical site infections. Furthermore, alcohol-based rubbing results in less waste and reduced costs when compared with water-based hand scrubbing. The hand surgery operating room, including minor procedure rooms, serves as an opportunity to decrease water use and reduce the environmental impact of our field. Waterless alcohol-based hand rubbing for antisepsis may also be an opportunity to save money and provide value-based care to our patients.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141096926","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 Social Determinants of Health and Distal Radius Fracture Outcomes","authors":"","doi":"10.1016/j.jhsa.2024.04.009","DOIUrl":"10.1016/j.jhsa.2024.04.009","url":null,"abstract":"<div><h3>Purpose</h3><p><span>The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of </span>distal radius fractures<span><span> and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with </span>postoperative complications.</span></p></div><div><h3>Methods</h3><p><span>Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and </span>environmental factors<span>. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates.</span></p></div><div><h3>Results</h3><p><span>After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07–3.29]), infection (OR: 2.37 [95% CI: 2.12–2.66]), </span>wound dehiscence<span> (OR: 2.06 [95% CI: 1.72–2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15–1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08–1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07–1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications.</span></p></div><div><h3>Conclusions</h3><p><span>Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the </span>perioperative period.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognosis II.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460843","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":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2024.07.013","DOIUrl":"10.1016/j.jhsa.2024.07.013","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128820","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 Validity and Responsiveness of the Patient-Specific Functional Scale in Patients With First Carpometacarpal Osteoarthritis","authors":"","doi":"10.1016/j.jhsa.2024.04.006","DOIUrl":"10.1016/j.jhsa.2024.04.006","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis.</p></div><div><h3>Methods</h3><p>Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent <em>t</em> tests to discriminate between satisfied and dissatisfied patients.</p></div><div><h3>Results</h3><p>We classified 98% of the PSFS items in the International Classification of Function “activities” and “participation” domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46–0.68) and 0.47 (0.35–0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up.</p></div><div><h3>Conclusions</h3><p>The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire.</p></div><div><h3>Clinical relevance</h3><p>The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0363502324001977/pdfft?md5=c731f41f1d4ce501c42620ebbd6c504f&pid=1-s2.0-S0363502324001977-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460845","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":"Clinical Outcomes After Definitive Treatment of Soft Tissue Sarcoma of the Hand: A Retrospective Cohort Study of 109 Patients","authors":"","doi":"10.1016/j.jhsa.2024.05.003","DOIUrl":"10.1016/j.jhsa.2024.05.003","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to provide updated data on oncologic outcomes following definitive surgical treatment of soft tissue sarcoma of the hand in a cohort of 109 patients, as well as to characterize risk factors for poor oncologic and functional outcomes.</p></div><div><h3>Methods</h3><p>We analyzed data from 109 consecutive patients who had definitive surgical treatment for soft tissue sarcoma<span> of the hand performed between 1996 and 2019 by a single surgeon at a sarcoma center. Primary outcomes included functional outcome (assessed by Musculoskeletal Tumor Society scores), disease-free survival (DFS), and overall survival (OS). We compiled descriptive data and used a multivariable linear model to identify factors associated with functional outcomes. Kaplan-Meier methods were used to estimate 5- and 10-year DFS and OS.</span></p></div><div><h3>Results</h3><p>Patients had a median age of 36 years at presentation. Median follow-up was 6.1 years among patients alive at the end of follow-up. The median Musculoskeletal Tumor Society score was 29; functional outcome was worse among patients with high-grade tumors or complications. Among the 107 patients who became disease-free, there were four local recurrences (one with metastasis), six distant recurrences, and one death without recurrence. All local recurrences were deep tumors (two myxofibrosarcoma and two myxoinflammatory fibrosarcoma). Estimated 5- and 10-year DFS rates were 89% (95% confidence interval [CI]: 83% to 96%) and 88% (95% CI: 80% to 95%). There were seven deaths, and the estimated 5- and 10-year OS rates were 95% (95% CI: 90% to 100%) and 92% (95% CI: 84% to 100%). Larger tumor size and higher stage at diagnosis were associated with shorter DFS and OS in univariable analyses; low event rates precluded multivariable analysis of survival.</p></div><div><h3>Conclusions</h3><p>Aggressive disease-specific surgical and multidisciplinary treatment can yield long DFS and OS, and good functional outcomes. However, complications and high-grade tumors are associated with worse functional scores.</p></div><div><h3>Type of study/level of evidence</h3><p>Prognostic II.</p></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460818","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}