Journal of Hand Surgery-American Volume最新文献

{"title":"Establishing the Patient-Acceptable Symptom State for the Numeric Rating Scale-Pain Score in a Postoperative Non–Shoulder Hand and Upper-Extremity Population","authors":"Joshua R. Daryoush MD ,&nbsp;Miranda J. Rogers MD, MS ,&nbsp;James C. Hubbard MD ,&nbsp;Jantz Arbon MD ,&nbsp;Chong Zhang MS ,&nbsp;Angela P. Presson PhD ,&nbsp;Brittany N. Garcia MD ,&nbsp;Nikolas H. Kazmers MD, MSE","doi":"10.1016/j.jhsa.2024.07.020","DOIUrl":"10.1016/j.jhsa.2024.07.020","url":null,"abstract":"<div><h3>Purpose</h3><div>The patient-acceptable symptom state (PASS) is a threshold score on a patient-reported outcome measurement beyond which patients consider themselves “well.” Our purpose was to establish the PASS for the numeric rating scale (NRS) for pain in a 1-year postoperative hand surgery population.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients undergoing non–shoulder upper-extremity surgery at a single, tertiary medical center identified over a 9-month period. At 1 year after surgery, NRS pain and responses to a pain-specific anchor question were collected. Patients were dichotomized based on achieving “PASS(+)” or failing to achieve “PASS(−)” an acceptable symptom state based upon their response to a pain-specific anchor question. Threshold values of a PASS(+) state were calculated for the NRS pain score using the following three methods: (1) mean score of PASS(+) patients, (2) Tubach method (75th percentile threshold for PASS(+) patients), and (3) the Youden index (receiver operating curve analysis to maximize sensitivity and specificity).</div></div><div><h3>Results</h3><div>Of 233 included patients, mean age was 54 years (±17), and 58% (n = 136) were women. Mean NRS pain scores differed between PASS(+) and PASS(−) patients (0.7 ± 1.2 vs 3.8 ± 2.7, respectively). PASS(−) patients were more likely to be non-White and have a diagnosed psychiatric comorbidity. Patient-acceptable symptom state estimates ranged from 0.73 to 2.1 for NRS pain, depending on the calculation method (0.73 for the mean score method, 1.0 for the Tubach method, and 2.1 for the Youden index). The area under the curve for the Youden index method was 0.86 consistent with excellent discrimination.</div></div><div><h3>Conclusions</h3><div>We propose the value of 2.1 to represent the PASS threshold for the NRS pain score in this population.</div></div><div><h3>Clinical relevance</h3><div>This PASS value should be used when interpreting NRS pain score outcomes at a population level. This threshold is expected to yield excellent discrimination for patient satisfaction when applied to a postoperative hand surgery population.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 10-18"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301280","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":"Risk Factors for Complications in Ulnar Shortening Osteotomies: A Multicenter Retrospective Review","authors":"Yiyang Zhang MD ,&nbsp;Ruby Grewal MD ,&nbsp;Martina Vergouwen BN ,&nbsp;Steve Lu MSc ,&nbsp;Neil White MD","doi":"10.1016/j.jhsa.2023.06.001","DOIUrl":"10.1016/j.jhsa.2023.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Ulnar shortening osteotomy<span><span><span> (USO) is commonly performed to alleviate pathologies causing ulnar-sided wrist pain. </span>Surgical complications include </span>nonunion and hardware removal, with rates up to 18% and 45%, respectively. The primary objective of the study was to report the overall complication rate of USO. The secondary objective was to identify risk factors for complications.</span></div></div><div><h3>Methods</h3><div>A retrospective multicenter cohort review was undertaken, including six Canadian cities over a 6-year period (January 2013–December 2018). Chart review was used to collect demographic data, surgical technique, implant used, and postoperative complications. Descriptive statistics of demographics and operative characteristics, including plate positioning, type of osteotomy, plate type, and ulnar variance (mm), were analyzed. Univariate analyses<span> were used to select predictor variables for nonunion and hardware removal. These predictor variables were then entered into an adjusted multivariable logistic regression model.</span></div></div><div><h3>Results</h3><div>A total of 361 USOs were performed. Mean age was 46 ± 16 years (60.7% men). The overall complication rate was 37.1%, hardware removal rate was 29.6%, and nonunion rate was 9.4%. There was a workers’ compensation claim associated with 21.6% of all complications, and it was a risk factor for both hardware removal (odds ratio [OR] = 3.81) and nonunion (OR = 2.88). Neither smoking nor diabetes was associated with complication rates. Seventy percent of plates were placed volarly, 25.5% dorsally, and 3.9% directly ulnar. Osteotomies were oblique in 83.7% of cases and transverse in 15.5%. Adjusted multivariate regression analysis revealed that younger age (OR = 0.98) was a risk factor for hardware removal and male sex (OR = 2.49) was a risk factor for nonunion. A surgical factor associated with hardware removal was direct ulnar plate placement (OR = 9.93). No surgical factors were associated with nonunions.</div></div><div><h3>Conclusions</h3><div>There are substantial rates of complications with USOs. Direct ulnar plate placement should be avoided. Patients should be thoroughly counseled on the risks of complications prior to proceeding with USO.</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 1","pages":"Pages 104.e1-104.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770154","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.2024.11.012","DOIUrl":"10.1016/j.jhsa.2024.11.012","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Page 26"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143240841","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":"Increasing Use of Musculoskeletal Ultrasound","authors":"John R. Fowler MD","doi":"10.1016/j.jhsa.2024.08.014","DOIUrl":"10.1016/j.jhsa.2024.08.014","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Page 76"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928718","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":"Prevalence and Associated Factors for Primary Osteoarthritis of the Scaphotrapeziotrapezoid, Radiocarpal, and Distal Radioulnar Joints in the Japanese General Elderly Population","authors":"Yo Kitamura MD ,&nbsp;Hiroyuki Kato MD, PhD ,&nbsp;Masanori Hayashi MD, PhD ,&nbsp;Shota Ikegami MD, PhD ,&nbsp;Fumihiro Isobe MD ,&nbsp;Jun Takahashi MD, PhD","doi":"10.1016/j.jhsa.2023.05.009","DOIUrl":"10.1016/j.jhsa.2023.05.009","url":null,"abstract":"<div><h3>Purpose</h3><div>The incidence and etiology of primary osteoarthritis<span> (OA) of the scaphotrapeziotrapezoid joint (STTJ), radiocarpal joint (RCJ), and distal radioulnar joint (DRUJ) remains unknown. The purpose of this study was to evaluate the prevalence and factors associated with primary wrist OA in a cross-sectional study of a basic resident registry.</span></div></div><div><h3>Methods</h3><div>A total of 1,297 residents between the ages of 50 and 89 years were randomly sampled from the registry of a Japanese town. A questionnaire was administered to all subjects, and each of them underwent radiographs of the bilateral hands, wrists, and elbows. STTJ, RCJ, and DRUJ radiographic osteoarthritis (ROA) were evaluated according to a previously described method. Associated factors for STTJ and DRUJ ROA were recorded. Associations between the incidence of ROA of the DRUJ, ulnar variance, and severity of elbow ROA were investigated.</div></div><div><h3>Results</h3><div>A total of 676 wrists (162 men and 176 women; mean age of 69.0 years) were investigated. The prevalence of STTJ, RCJ, and DRUJ ROA was 5.3%, 1.5%, and 21.2%, respectively. Factors associated with STTJ ROA were thumb carpometacarpal joint ROA, female sex, and increasing age. Factors associated with DRUJ ROA were elbow ROA, use of vibrating tools, increasing age, and positive ulnar variance. Prevalence of DRUJ ROA was 54.4% in wrists with severe-grade elbow ROA. Ulnar variance of the wrist in severe-grade elbow ROA was significantly larger than that in mild-grade or nonelbow ROA.</div></div><div><h3>Conclusions</h3><div>The prevalence of ROA was highest in the DRUJ, followed by the STTJ, and lowest in the RCJ. The occurrence of ROA of the STTJ and DRUJ was affected by the presence of ROA of the adjacent joint.</div></div><div><h3>Clinical relevance</h3><div>Primary DRUJ ROA occurs at a moderate frequency, similar to primary ROA of other extremity joints; however, primary STTJ and RCJ ROA is rare.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 103.e1-103.e10"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9827654","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":"Comparison of Early Versus Late Debridement Outcomes in the Management of Open Distal Radius Fractures","authors":"Daniel Nemirov MD ,&nbsp;Gleb Medvedev MD ,&nbsp;Myles Dworkin MD, MPH ,&nbsp;Michael Rivlin MD ,&nbsp;Pedro K. Beredjiklian MD ,&nbsp;Rick Tosti MD","doi":"10.1016/j.jhsa.2024.08.007","DOIUrl":"10.1016/j.jhsa.2024.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours.</div></div><div><h3>Methods</h3><div>A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years. Patient demographics, injury mechanism, and initial treatment were recorded. Fracture severity was graded by the Gustilo-Anderson classification. Comparisons were made between those treated surgically within and after 24 hours. Outcomes examined included infection, revision surgery, osteomyelitis, and nonunion.</div></div><div><h3>Results</h3><div>A total of 230 cases met the inclusion criteria. The cohorts of early and delayed surgical intervention were similar with regard to preoperative demographics. The most common mechanism of injury was motor vehicle accident. Approximately 40% of cases were graded as type I, 40% as type II, and 20% as type III. Mean time to debridement in the group treated after 24 hours was 5 days. A mean postoperative follow-up of greater than 6 months was obtained in both cohorts. Similar outcomes were found between cohorts with respect to postoperative infection, revision surgery, osteomyelitis, and nonunion.</div></div><div><h3>Conclusions</h3><div>Similar outcomes with regards to infection, revision, osteomyelitis, and nonunion were found between open distal radius fractures treated emergently versus those managed in a delayed fashion. Patient- and injury-specific factors are important in dictating care.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IIB.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 19-25"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332633","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":"Arthroscopic Capitate Partial Resection for Kienböck Disease: Postoperative Outcomes","authors":"Sitthiphong Suwannaphisit MD ,&nbsp;Hideo Hasegawa MD, PhD ,&nbsp;Kenji Kawamura MD, PhD ,&nbsp;Shohei Omokawa MD, PhD","doi":"10.1016/j.jhsa.2024.07.023","DOIUrl":"10.1016/j.jhsa.2024.07.023","url":null,"abstract":"<div><div>Partial capitate shortening osteotomy represents a feasible surgical approach to reduce load distribution to the lunate in Kienböck disease, with preservation of the scaphoid-capitate articular surface. A surgical procedure, presented here, entails arthroscopic partial resection of the proximal capitate articular surface to alleviate pressure on the lunate.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 105.e1-105.e5"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583563","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":"All-Inside Versus Outside-in Repair of Triangular Fibrocartilage Complex Peripheral Tears","authors":"Lilah Fones MD ,&nbsp;Keegan P. Cole MD ,&nbsp;Moody Kwok MD ,&nbsp;Greg G. Gallant MD, MBA ,&nbsp;Rick Tosti MD","doi":"10.1016/j.jhsa.2023.05.004","DOIUrl":"10.1016/j.jhsa.2023.05.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Triangular fibrocartilage<span><span> complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to </span>vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown in prior case series. The purpose of this study was to compare two methods of arthroscopic peripheral TFCC repair: all-inside vertical mattress and outside-in horizontal mattress.</span></div></div><div><h3>Methods</h3><div><span><span><span>A 5-year retrospective review was performed on patients treated from 2016 to 2021 with wrist arthroscopy and TFCC repair for Palmer 1B tears. Patients with ulnar extrinsic ligament repair, distal </span>radioulnar joint instability, concomitant ulnar shortening </span>osteotomy<span>, and extensor carpi ulnaris instability were excluded. Patient therapy and office visit records were reviewed. Outcomes including Quick Disabilities of the Arm, Shoulder, and Hand (</span></span><em>Quick</em>DASH); range of motion; grip strength; immobilization time; complications; and need for revision procedures were compared.</div></div><div><h3>Results</h3><div>Fifty-two patients were included in the study, 32 in the outside-in group and 20 in the all-inside group. The average follow-up length was 24.8 weeks, with similar range of motion and strength in both groups. The average postoperative <em>Quick</em>DASH score was 13 in the outside-in group and 9 in the all-inside group at 43.5 months, compared with the preoperative <em>Quick</em>DASH scores of 47 and 50, respectively. Mean immobilization time was longer for outside-in than for all-inside (5.25 vs 2.0 weeks, respectively).</div></div><div><h3>Conclusions</h3><div>All-inside arthroscopic peripheral TFCC repair showed range of motion, grip strength, complications, revisions, and postoperative improvement in <em>Quick</em>DASH scores similar to those with the outside-in technique.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV; retrospective comparative study.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Pages 96.e1-96.e6"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683925","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 Journal of Hand Surgery Begins its 50th Year","authors":"Brent Graham MD, FRCSC","doi":"10.1016/j.jhsa.2024.09.010","DOIUrl":"10.1016/j.jhsa.2024.09.010","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Page 1"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632854","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.2024.11.013","DOIUrl":"10.1016/j.jhsa.2024.11.013","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 1","pages":"Page 87"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143240760","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}