Journal of Hand Surgery-American Volume最新文献

{"title":"Benefits of Sensory Nerve Transfers and Risks of Using the Superficial Radial Nerve as a Donor","authors":"Yamaan S. Saadeh MD ,&nbsp;Martijn J. Malessy PhD, MD","doi":"10.1016/j.jhsa.2024.09.027","DOIUrl":"10.1016/j.jhsa.2024.09.027","url":null,"abstract":"<div><div>Nerve transfers have re-emerged in the past several decades as a powerful tool for restoration of neurological function and are an essential part of peripheral nerve surgical practice. There is extensive literature describing outcomes from nerve transfers for the restoration of motor nerve function and describing the complication profile. Recently, interest and use of nerve transfers for restoration of sensation has increased. In this review, we highlight the limitations of the current literature on outcomes from sensory nerve transfers and showcase potential complications from their use, particularly related to use of the superficial branch of the radial nerve as a donor sensory nerve.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 368-372"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683622","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":"Claims Database Research in Hand Surgery: From Data to Bedside","authors":"Thompson Zhuang MD, MBA ,&nbsp;Lauren M. Shapiro MD, MS ,&nbsp;Robin N. Kamal MD, MBA, MS","doi":"10.1016/j.jhsa.2024.10.004","DOIUrl":"10.1016/j.jhsa.2024.10.004","url":null,"abstract":"<div><div>The widespread availability of administrative claims data has unlocked opportunities to answer challenging clinical questions in hand surgery, overcoming the limitations of traditional data sets. Researchers are taking advantage of claims data sets to obtain samples from broader segments of the population and achieve statistical power that was previously unattainable. Therefore, a basic understanding of claims database research is quickly becoming an invaluable tool in the surgeon’s toolkit, enabling the performance of ground-breaking research and the critical evaluation of data-driven results to inform clinical practice. We provide an overview of methodological approaches to claims data analysis for hand surgery and a roadmap for analyzing and interpreting these studies in clinical practice.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 352-361"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712031","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 Area-Level Deprivation on the Severity of Cubital Tunnel Syndrome on Presentation to a Hand Surgeon","authors":"Rimel N. Mwamba BA ,&nbsp;Jeffrey G. Stepan MD, MSc","doi":"10.1016/j.jhsa.2024.11.007","DOIUrl":"10.1016/j.jhsa.2024.11.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Cubital tunnel syndrome (CuTS) is the second most common upper-extremity neuropathy and can cause debilitating symptoms. Patients presenting to care with severe CuTS can be left with permanent weakness and numbness despite treatment. The aim of this study was to examine the relationship between area-level deprivation and the severity of CuTS on presentation to a hand surgeon.</div></div><div><h3>Methods</h3><div>We retrospectively identified 369 patients who were diagnosed with CuTS at a new patient visit between January 2017 and December 2021. We queried the electronic health record to assess the severity of CuTS using the McGowan grade. We used patient addresses to determine the national percentile of area-level deprivation for each patient. Bivariate analyses were used to determine if sociodemographic factors were associated with CuTS severity on presentation or rates of surgical intervention.</div></div><div><h3>Results</h3><div>In bivariate analysis, patients with higher levels of area-level deprivation had more severe CuTS. Those who were older, were men, and had public insurance were also found to have more severe CuTS. Secondary analysis revealed that patients with higher levels of deprivation were more likely to receive nerve conduction testing. No sociodemographic factors were associated with whether patients received surgical intervention or in time from presentation to surgery.</div></div><div><h3>Conclusions</h3><div>Patients from marginalized backgrounds present to hand surgeons with more severe CuTS disease.</div></div><div><h3>Clinical relevance</h3><div>Delayed presentation can lead to worse outcomes in CuTS. Understanding barriers to earlier presentation in more deprived locations and certain patient populations can help develop solutions to address these disparities.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 292-298"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830844","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 Instructions","authors":"","doi":"10.1016/S0363-5023(25)00052-8","DOIUrl":"10.1016/S0363-5023(25)00052-8","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Page A12"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529342","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.2025.01.026","DOIUrl":"10.1016/j.jhsa.2025.01.026","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Page 310"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529355","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":"Comparative Outcomes of Anterior and Posterior Plating for Distal-Third Humerus Shaft Fractures","authors":"Yuya Shimamoto MD ,&nbsp;Katsuhiro Tokutake MD, PhD ,&nbsp;Yasuhiko Takegami MD, PhD ,&nbsp;Yuta Asami MD ,&nbsp;Ken Sato MD ,&nbsp;Hiroki Ueno MD ,&nbsp;Takahiko Nakano MD ,&nbsp;Sei Fujii MD ,&nbsp;Nobuyuki Okui MD, PhD ,&nbsp;Shiro Imagama MD, PhD","doi":"10.1016/j.jhsa.2023.07.014","DOIUrl":"10.1016/j.jhsa.2023.07.014","url":null,"abstract":"<div><h3>Purpose</h3><div>When treating distal-third humerus shaft fractures<span> (HSFs) surgically, the optimal approach for plating is controversial. We conducted a retrospective multicenter study to investigate and compare the clinical outcomes of anterior and posterior plating in distal-third HSFs and the incidence of complications including iatrogenic radial nerve palsy.</span></div></div><div><h3>Methods</h3><div>We identified 116 patients from our multicenter trauma database who were diagnosed as having distal-third HSFs and who underwent surgical treatment, including intramedullary nailing<span> between 2011 and 2020. We analyzed 50 cases treated in one of two ways: open reduction internal fixation with anterior plating (group A: 20 cases) and open reduction internal fixation with posterior plating (group P: 30 cases).</span></div></div><div><h3>Results</h3><div>The findings were similar in terms of operation time, estimated bleeding, and clinical and radiographic outcomes between the groups. Postoperative radial nerve palsy occurred only in group P (4 cases) and never in group A.</div></div><div><h3>Conclusions</h3><div>The results of this study suggest that the anterior approach is a safe and effective method for treating distal-third HSFs with satisfactory outcomes.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 375.e1-375.e8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10161829","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":"Neonatal Limb Compartment Syndrome: A Comprehensive Review","authors":"Ibrahim Cherry MD ,&nbsp;Diane Franck MD ,&nbsp;Frederic Urbain MD","doi":"10.1016/j.jhsa.2023.08.013","DOIUrl":"10.1016/j.jhsa.2023.08.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Neonatal limb compartment syndrome (NLCS) is a rare and potentially limb-threatening condition defined as an increased pressure within a confined limb compartment. Clinicians may fail to distinguish NLCS from other mimicking conditions. Misdiagnosis is possible due to a low index of suspicion for this condition, which may delay appropriate and urgent treatment. A comprehensive review of the available literature was performed to explore common themes in NLCS and identify gaps in the evidence to guide future studies.</div></div><div><h3>Methods</h3><div>A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French. Studies were selected by two independent reviewers who extracted descriptive data including the delivery history and complications, the timing of diagnosis, the location of the lesion, and the management strategy.</div></div><div><h3>Results</h3><div><span><span><span>A total of 43 reports describing 86 cases of neonatal compartment syndrome were published between 1980 and 2021. The male-to-female ratio was 6:7. Compartment syndrome was mainly located in the upper extremity (95.3%). Clinical features including swelling (41%), sentinel skin lesion (94.2%), extremity </span>cyanosis (89.5%), and necrotic fingers (7%) were observed. The treatment strategy was either </span>surgical decompression<span> (32.6%) or nonsurgical management (68.6%). Sequelae occurred at a rate of 16.6%, 81.3%, and 75.9% after early </span></span>fasciotomy (&lt; 24 hours), late fasciotomy, and nonsurgical management, respectively.</div></div><div><h3>Conclusions</h3><div>Sentinel skin lesions and flaccid paralysis<span> are the most observed clinical features and represent key clues for diagnosis. Neither radiography, Doppler ultrasound, nor magnetic resonance imaging has demonstrated any advantage in guiding the appropriate management of NLCS and may delay appropriate treatment. Despite nonsurgical management and late fasciotomy (&gt; 24 hours) being the most described treatments, the lowest rate of sequelae was observed when decompression was performed within the first 24 hours.</span></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 3","pages":"Pages 379.e1-379.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Kinematic Analysis of Wrist and Carpal Function Using Four-Dimensional Computed Tomography Technology: A Dynamic Perspective","authors":"Elizabeth Norman B. Eng ,&nbsp;Manisha R. Mistry MD, MSc ,&nbsp;Emily Lalone PhD ,&nbsp;Nina Suh MD, MSc","doi":"10.1016/j.jhsa.2023.07.011","DOIUrl":"10.1016/j.jhsa.2023.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>An emerging imaging modality, four-dimensional computed tomography, can provide dynamic evaluation of carpal motion, which allows for a better understanding of how the carpals work together to achieve range of motion. The objective of this work was to examine kinematic motion of the carpus through a flexion/extension arc of motion using four-dimensional computed tomography.</div></div><div><h3>Methods</h3><div>A convenience sample of 20 uninjured participants underwent a four-dimensional computed tomography scanning protocol through a complete arc of flexion/extension motion. Kinematic changes in motion were quantified using helical axes motion data for each carpal. Rotation angles were compared between bones to identify differences in kinematic motion between bones.</div></div><div><h3>Results</h3><div>The bones within the proximal carpal row, the lunate, scaphoid, and triquetrum, rotate significantly to differing magnitudes at the ends of motion (40° of flexion and 40° of extension). The scaphoid rotates to the highest magnitude, followed by the triquetrum, and lastly, the lunate. The distal carpal row bones rotate to similar magnitudes throughout the entire range of motion.</div></div><div><h3>Conclusions</h3><div>This work describes the kinematics of the carpals throughout dynamic <em>in vivo</em> flexion and extension.</div></div><div><h3>Clinical relevance</h3><div>This study adds to an understanding of wrist mechanics and the possible clinical implications of pathological deviation from baseline kinematics.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 374.e1-374.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10025100","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":"The Management of Upper-Extremity Xylazine-Associated Wounds","authors":"Parker Johnsen MD ,&nbsp;Genoveffa R. Morway DO ,&nbsp;Aaron Jackson MD ,&nbsp;Sara Hope Buchner MD ,&nbsp;Pietro Gentile MD ,&nbsp;Asif M. Ilyas MD, MBA ,&nbsp;Katharine Criner Woozley MD","doi":"10.1016/j.jhsa.2024.11.017","DOIUrl":"10.1016/j.jhsa.2024.11.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Xylazine has been associated with necrotic soft tissue wounds that have placed a challenging burden on patients who inject drugs in the Philadelphia region’s health care system over the last few years. An analysis of our initial experience is being presented to guide future treatment and directions for future research.</div></div><div><h3>Methods</h3><div>A retrospective review of 55 patients with patient-reported xylazine use and associated upper-extremity wounds at a single institution was performed. Patient demographics, treatments, and outcomes are presented.</div></div><div><h3>Results</h3><div>A large percentage of patients with xylazine-associated wounds were homeless (40%), had concomitant psychiatric diagnoses (26%), and had a history of tobacco use (84%). Comorbidities included 5% who were human immunodeficiency virus-positive and 67% who were hepatitis C virus-positive. The median number of hospital admissions per patient for xylazine-associated wounds was 3, with an average of 5.9 (range: 1–44 admissions). The median length of stay per hospital admission was 3 days, with an average of 5.3 days (range: 1–75). Among all included patients, 33 of 55 patients (60%) were treated nonoperatively with local wound care. Of the 22 patients who underwent surgery, there was a surgical complication rate of 59%, primarily related to continued wound issues, infections, and graft failures. The overall rate of patients who left the hospital against medical advice (AMA) was 49%. However, the mortality rate was 0%. Most surgical patients left AMA during their postoperative period hospital stay (64%) and demonstrated continued drug use per review of their hospital records (68%).</div></div><div><h3>Conclusions</h3><div>Patients presenting with xylazine-associated wounds have a high incidence of homelessness, psychiatric diagnoses, tobacco smoking, hepatitis C virus, and a predilection both toward leaving the hospital AMA and repeated drug use. These variables create inherent challenges to reconstructive surgery, yielding a subsequently high complication rate identified in most surgically managed patients.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic study IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 331-339"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016640","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":"Radiographic Characteristics of the Triphalangeal Thumb in Patients With Congenital Thumb Duplication: An Analysis of 383 Thumbs in 368 Children","authors":"JianPing Wu MD ,&nbsp;Hai Zhao MD ,&nbsp;ChenYang Li BD ,&nbsp;YuanZhong Liu MD ,&nbsp;Federico Canavese PhD ,&nbsp;HongWen Xu PhD","doi":"10.1016/j.jhsa.2024.11.004","DOIUrl":"10.1016/j.jhsa.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the morphologic and radiographic characteristics of the triphalangeal thumb (TPT) in patients with congenital thumb duplication.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 368 children with TPT duplication (n = 383). Data on age, sex, and laterality were obtained from medical records. The morphologic and radiographic characteristics of the TPT duplication were evaluated using plain radiographs.</div></div><div><h3>Results</h3><div>Of the 383 fingers, 322 (84%) had a TPT duplication on the radial side, 36 (10%), on the ulnar side, and 25 (7%) were bilateral. The mean age at the time of surgery of TPT duplication on the radial side (21 ± 11 months), on the ulnar side (25 ± 15 months), and in bilateral cases (27 ± 15 months) was not significantly different. The extra thumb was connected to the main thumb by a joint (75%), bone (18%), soft tissue (6%), and epiphysis (1%). There were 26 cases (7%) of abnormal hypertrophic epiphysis of the main thumb, all of which were located in the distal phalanx of the radial side of the TPT duplications. The thumb epiphyses in patients with TPT duplication appeared in the following order: distal phalanx (mean, 24 ± 14 months; range, 7–94 months), proximal phalanx (mean, 31 ± 18 months; range, 14–94 months), and metacarpal (mean, 34 ± 20 months; range, 13–94 months).</div></div><div><h3>Conclusions</h3><div>Triphalangeal thumb in patients with congenital thumb duplication is more common in boys, often duplicated at the level of the proximal phalanx, with the extra thumb articulated to the main thumb by a joint, often unilateral, and frequently radial and right-sided. The epiphysis of the TPT duplication ossifies sequentially from the distal phalanx to the metacarpal, and its onset is delayed in comparison to normal children.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 3","pages":"Pages 274-281"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814990","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}