Journal of Hand Surgery-American Volume最新文献

{"title":"Letter Regarding “Clinical Classification Versus MRI Patterns of Injury in Brachial Plexus Birth Injury”","authors":"Brian Pettitt MD, Alejandro J. Friedman MA, Steven M. Koehler MD","doi":"10.1016/j.jhsa.2026.01.006","DOIUrl":"10.1016/j.jhsa.2026.01.006","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Page 1001"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859705","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":"Arthrodesis Versus Trapeziectomy for Thumb Carpometacarpal Joint Arthritis with Metacarpophalangeal Joint Hyperextension","authors":"Tomoki Matsuo MD, PhD,&nbsp;Masao Nishiwaki MD, PhD,&nbsp;Masato Okazaki MD, PhD,&nbsp;Yasuhiro Kiyota MD, PhD,&nbsp;Taku Suzuki MD, PhD,&nbsp;Takuji Iwamoto MD, PhD,&nbsp;Kenichi Tazaki MD, PhD","doi":"10.1016/j.jhsa.2026.03.016","DOIUrl":"10.1016/j.jhsa.2026.03.016","url":null,"abstract":"<div><h3>Purpose</h3><div>Thumb carpometacarpal (CMC) joint arthritis often presents with metacarpophalangeal (MCP) joint hyperextension. Although CMC joint arthrodesis and trapeziectomy are established treatments, their effects on MCP joint hyperextension and functional outcomes stratified by MCP joint status remain unclear. We assessed correction of MCP joint hyperextension and functional improvement according to preoperative MCP joint status after CMC joint arthrodesis or trapeziectomy and compared outcomes between procedures in patients with preoperative MCP joint hyperextension.</div></div><div><h3>Methods</h3><div>Patients with CMC joint arthritis who underwent arthrodesis or trapeziectomy with suspensionplasty between 2012 and 2024 were retrospectively reviewed. Radiographic MCP joint and CMC joint angles and functional outcomes, including grip strength, key pinch strength, Kapandji score, visual analog scale for pain, and Quick Disabilities of the Arm, Shoulder, and Hand, were evaluated. Thumbs were categorized into preoperative MCP joint hyperextension (&lt; −20°) and nonhyperextension (≥ −20°) groups. Changes from preoperative assessment to final follow-up were assessed within each group for each surgical procedure, and outcomes were compared between procedures in the MCP joint hyperextension subgroup.</div></div><div><h3>Results</h3><div>Eighty-four thumbs (arthrodesis: 42 and trapeziectomy: 42) were analyzed with a mean follow-up of 28 ± 19 months. Arthrodesis corrected MCP joint hyperextension by addressing CMC joint flexion deformity, while maintaining thumb opposition. Trapeziectomy did not reliably correct MCP joint hyperextension and, in the MCP joint nonhyperextension group, increased MCP joint extension. Functional improvement was observed in all subgroups except the trapeziectomy group with MCP joint hyperextension, which showed no notable improvement in grip or pinch strength. In the MCP joint hyperextension group, unadjusted comparisons demonstrated greater final pinch strength after arthrodesis and no reoperations after trapeziectomy, with comparable functional scores. After multivariable adjustment, surgical procedure was not independently associated with final pinch strength.</div></div><div><h3>Conclusions</h3><div>Arthrodesis corrected MCP joint hyperextension, whereas trapeziectomy did not. For CMC joint arthritis with MCP joint hyperextension, decision making between arthrodesis and trapeziectomy should balance alignment correction, anticipated strength, and reoperation risk, guided by patients’ priorities and expectations.</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 956.e1-956.e12"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960430","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 Metacarpophalangeal Hyperextension in Patients Undergoing Basilar Thumb Joint Suspensionplasty: Are Preoperative Passive Measurements Predictive of Failure?","authors":"Brandon Smetana MD,&nbsp;Drew Wrightson BS,&nbsp;Ryan Harold MD,&nbsp;Peter Henning MD,&nbsp;Gregory Merrell MD","doi":"10.1016/j.jhsa.2026.05.002","DOIUrl":"10.1016/j.jhsa.2026.05.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether a 30° passive metacarpophalangeal (MCP) joint hyperextension threshold was associated with postoperative mechanical and patient-reported outcomes when leaving MCP joint hyperextension unaddressed after performing trapeziectomy with suspensionplasty.</div></div><div><h3>Methods</h3><div>This prospective observational study evaluated adults with symptomatic thumb carpometacarpal osteoarthritis and passive MCP joint hyperextension ≥10° who underwent trapezial resection and suspensionplasty without concurrent MCP joint stabilization. Patients were stratified by baseline passive MCP joint hyperextension: &lt;30° and ≥30°, with measurements obtained before surgery and at 12 months after surgery. The primary outcome was the between-group difference in change over time for MCP joint position during key pinch. Secondary outcomes included between-group differences in change over time for MCP joint position during jar and cap grasp; carpometacarpal joint position during key pinch, jar grasp, and cap grasp; grip and pinch strength; first-second metacarpal angle; trapezial space ratio; and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.</div></div><div><h3>Results</h3><div>We did not observe a statistically significant difference between groups in change over time for the primary outcome of MCP joint position during key pinch, or for secondary dynamic MCP joint and carpometacarpal joint outcomes, with most patients positioning the MCP joint in flexion. We also did not detect a difference in change over time between groups for pinch and grip strength, first-second metacarpal angle, trapezial space ratio, or DASH scores.</div></div><div><h3>Conclusions</h3><div>In our prospective assessment, we did not detect an association between preoperative measures of ≥30° passive MCP joint hyperextension and 12-month dynamic mechanics, strength, radiographic measures, or DASH scores after trapeziectomy with suspensionplasty. Dynamic measures may complement passive thresholds to characterize MCP joint behavior. Larger studies are needed to define the true role of MCP joint stabilization for trapeziectomy with suspensionplasty, as this study may have been underpowered to detect smaller effects.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic 2b</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 957.e1-957.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165647","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":"Response to the Letter on “Postoperative Displacement of the Dorsal Ulnar Fragment After Volar Locking Plate Fixation: Risk Factors and Clinical Prediction Tool”","authors":"Jiaqing Ji MD,&nbsp;Jian Fan MD","doi":"10.1016/j.jhsa.2026.05.014","DOIUrl":"10.1016/j.jhsa.2026.05.014","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Page 973"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148861759","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":"Rotational Stability of One Versus Two Intramedullary Screws for Proximal Phalanx Fractures: A Biomechanical Study","authors":"Rae Tarapore MD,&nbsp;Andrew O’Brien MD,&nbsp;Zakkary Walterscheid MD,&nbsp;Manaswini Chennoju MS,&nbsp;Pooyan Abbasi MS,&nbsp;Kenneth R. Means Jr. MD,&nbsp;Aviram M. Giladi MD, MS","doi":"10.1016/j.jhsa.2026.01.011","DOIUrl":"10.1016/j.jhsa.2026.01.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary screws in single- or double-screw configurations are increasingly used for proximal phalanx (P1) fractures. Our purpose was to assess the biomechanical rotational stability of antegrade one- versus two-screw constructs in the fixation of simulated transverse mid-diaphyseal P1 fractures.</div></div><div><h3>Methods</h3><div>We used matched pairs of fresh-frozen cadaver upper extremities. We harvested the P1s of all fingers and made transverse mid-diaphyseal osteotomies. Across each matched pair, we alternated between one- and two-screw antegrade fixation constructs on matched P1s. We placed one-screw constructs centrally in the P1s, ensuring appropriate sizing fit within each canal. We placed two-screw constructs in either a “V” or “lambda” configuration as able, such that the distal threads of both were distal to each simulated fracture. We secured each P1 in a material testing system frame and rotated the distal fragment relative to the proximal fragment at 2 degrees/second. Our primary outcome was the difference in group-level torque (Nm) required to produce 15 degrees of malrotation for each fixation group.</div></div><div><h3>Results</h3><div>We tested nine matched pairs of simulated P1 fractures, fixing one of each with a single intramedullary screw and the other with two screws. There was no statistically significant difference between one- and two-screw constructs in mean torque required to generate 15 degrees of malrotation at the simulated fracture site (0.16 and 0.26 Nm, respectively, <em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Properly fitted antegrade one- and two-screw intramedullary constructs for transverse mid-diaphyseal P1 fractures have similar biomechanical rotational stability.</div></div><div><h3>Clinical relevance</h3><div>For rotational stability in the fixation of transverse P1 fractures, there is no advantage to using a two-screw construct over a one-screw construct.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 963-968"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214995","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":"Erratum.","authors":"","doi":"10.1016/j.jhsa.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.002","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842232","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":"Learning Curve Analysis of Dual-Mobility Trapeziometacarpal Arthroplasty: A Single-Surgeon Series With 2-Year Follow-up.","authors":"Stefan M Froschauer, Tobias Gotterbarm, Matthias Holzbauer","doi":"10.1016/j.jhsa.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.015","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the learning curve of dual-mobility trapeziometacarpal arthroplasty using cumulative sum (CUSUM) analysis based on surgical time and clinical outcomes (complications and revisions) and report 2-year outcomes.</p><p><strong>Methods: </strong>This prospective single-surgeon case series included patients undergoing dual-mobility trapeziometacarpal joint arthroplasty between September 2018 and January 2023. Of 125 arthroplasties in 109 patients, 12 cases with concomitant procedures were excluded, leaving 113 arthroplasties in 99 patients for analysis. Consecutive cases were analyzed using CUSUM analysis based on surgical time and outcome-based end points, including complications and revisions. Clinical outcomes included pain; Disabilities of the Arm, Shoulder and Hand score; key pinch strength; range of motion; and satisfaction. Reoperations and revision procedures were recorded.</p><p><strong>Results: </strong>Mean patient age was 60 ± 9 years, and 81% were women. The median surgical time was 51 minutes (IQR 18). The surgical time CUSUM analysis peaked at case 28, indicating stabilization of surgical efficiency. All clinical outcomes showed significant postoperative improvement (P ≤ .001). Thirty-one complications (27%) were recorded; most were tendon-related or soft tissue-related. Eight (7%) were classified as attributable to suboptimal surgical technique. Eleven reoperations (10%) and four revision surgeries (4%) were performed. Outcome-based CUSUM analyses showed threshold crossings for overall complications and the subgroup of complications attributable to suboptimal surgical technique, whereas revision procedures remained within acceptable limits. Kaplan-Meier analysis demonstrated revision-free survival at 2 years of 0.973 (95% CI, 0.943-1.000).</p><p><strong>Conclusions: </strong>CUSUM analysis showed that surgical efficiency stabilized after approximately 28 cases; however, complications, including those related to suboptimal technique, persisted throughout the series and exceeded predefined thresholds. Thus, improved efficiency does not equate to technical mastery. Although 2-year outcomes and implant survival were favorable, these findings must be balanced against the observed complication burden. Although tendon-related complications are generally manageable, technique-related complications may be reduced through structured training and meticulous surgical execution.</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":2.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834797","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":"Modern Concepts in the Etiology and Pathogenesis of Kienbock Disease.","authors":"Simon B M MacLean, Gregory I Bain","doi":"10.1016/j.jhsa.2026.07.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.013","url":null,"abstract":"<p><p>Our understanding of Kienbock disease has evolved significantly over the last decade with advances in the study of basic science and advanced imaging. Some patients are predisposed to the disease, and the evolution of the disease may be influenced by the patient's demographic. Both biomechanical and biological factors play a significant role. The morphology of the wrist and lunate influence loading mechanics through the central column. Both arterial and venous factors are important in the development of ischemia and the onset of a compartment syndrome of bone. Stability of the wrist plays a role. The disease affects the ligaments within and between the carpus and radius through synovitis or avulsion, and disruption of these can leading to collapse of the lunate and carpus. Better understanding of the disease pathogenesis will improve our ability to strategize surgical management.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834828","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":"Assessment Strategies for First Web Space Contracture.","authors":"Erin A Miller, Chelsea C Boe, Christopher S Crowe","doi":"10.1016/j.jhsa.2026.07.012","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.012","url":null,"abstract":"<p><p>First web space contracture is a common and potentially debilitating condition that impairs thumb positioning and compromises pinch and grasp. The complex, three-dimensional anatomy of the web space and the intricate biomechanics of the thumb contribute to substantial variability in both assessment methods and treatment strategies. At present, there is no universally accepted framework for defining, classifying, or measuring outcomes in first web space contracture. This review aims to synthesize current strategies for assessment and outcome evaluation, highlighting their limitations and areas of inconsistency. By clarifying existing methodologies and identifying gaps in the literature, this article aims to provide a foundation for more standardized, clinically meaningful evaluation and management of first web space contracture.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834751","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":"Reverse Total Wrist Arthroplasty: New Design and Biomechanical Advantages.","authors":"Elizabeth Norman-Puim, Emily Lalone, Assaf Kadar, G Daniel G Langohr, Nina Suh","doi":"10.1016/j.jhsa.2026.06.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.06.005","url":null,"abstract":"<p><strong>Purpose: </strong>Although fourth generation total wrist arthroplasties (TWAs) have improved implant longevity compared to earlier generations, high failure rates persist. This study aimed to assess how a shift in the center of rotation will affect kinematic outcomes of the joint. This has been accomplished through a TWA redesign, known as the reverse total wrist arthroplasty (RTWA).</p><p><strong>Methods: </strong>Eight cadaveric specimens (75.1 ± 10.9 years, 8 men) were implanted with both a custom load sensing TWA and a novel redesigned RTWA. For both reconstructed states, the specimens were mounted and actuated through flexion-extension (FE) and radial-ulnar deviation (RUD) using an active motion simulator. Muscle forces and articular loading patterns were recorded in both states for comparison of the implant designs. Statistical analysis completed showed RUD motion was underpowered and are therefore presented as exploratory and descriptive because of limited power.</p><p><strong>Results: </strong>In general, during both FE and RUD the RTWA required a lower magnitude of force from the muscles compared to the TWA state. Throughout FE, four of the five muscles examined required less force after RTWA implantation. Through RUD, three of five required less force. In addition, through both ranges of motion the carpal component joint loading was decreased in all wrist positions (41.6 ± 8.6% and 38.1 ± 7.1% for extension and flexion motion, respectively) after implantation of the RTWA compared to the TWA.</p><p><strong>Conclusions: </strong>The redesigned RTWA performed well compared to a standard TWA implant and there was a noted decrease in both the muscle forces and joint loading following RTWA implantation.</p><p><strong>Clinical relevance: </strong>The new RTWA design may have the potential to reduce the magnitude of force required by muscles to actuate the joint and reduce the high loading patterns within the distal carpal component that are noted after implantation of TWA implants.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814825","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}