Journal of Hand Surgery-American Volume最新文献

{"title":"The Subdermal Approach for Harvesting Superficial Circumflex Iliac Artery-Based Pure Skin Perforator Flaps in Hand and Wrist Reconstruction","authors":"Xuwei Zhu MD ,&nbsp;Shi Li MD ,&nbsp;Ya Lv MD ,&nbsp;Jingquan Yang MD ,&nbsp;Feiya Zhou MD ,&nbsp;Tinggang Chu MD ,&nbsp;Kailiang Zhou PhD ,&nbsp;Jian Ding MD ,&nbsp;Yiheng Chen MD","doi":"10.1016/j.jhsa.2025.05.008","DOIUrl":"10.1016/j.jhsa.2025.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div>The pure skin perforator (PSP) flap technique offers a reliable solution for aesthetic limb reconstruction by reducing flap thickness to approximately 2 mm while preserving blood supply<span>. The subdermal approach simplifies flap harvesting, reducing surgical time and donor site morbidity. This study aimed to evaluate the clinical outcomes and feasibility of using the subdermal approach for harvesting superficial circumflex iliac artery (SCIA)-based PSP flaps in reconstructing hand and wrist defects.</span></div></div><div><h3>Methods</h3><div><span>This retrospective study included 11 patients with hand or wrist skin defects, who underwent SCIA-PSP flap reconstruction using the subdermal approach between March 2022 and February 2024. Flap design and harvesting were guided by preoperative high-frequency </span>ultrasonography<span>, with dissection at the subdermal plane using a surgical microscope. Postoperative care included monitoring flap viability and assessing aesthetic outcomes at 6 months using a five-point Likert scale.</span></div></div><div><h3>Results</h3><div>A total of 13 flaps were harvested, with two flaps harvested in cases 5 and 6, respectively. The flap sizes ranged from 11 to 98 cm² (mean: 47.5 cm²). Harvest times ranged from 37 to 140 minutes (mean: 70.1 minutes). Twelve flaps were successfully transferred, with one experiencing partial necrosis. Aesthetic outcomes at 6 months showed favorable results, with mean scores of 4.5 for overall aesthetic outcome and 4.7 for contour and texture match.</div></div><div><h3>Conclusions</h3><div>The subdermal approach for harvesting SCIA-PSP flaps is a feasible and effective technique for hand and wrist reconstruction, yielding excellent aesthetic results. Further research is needed to confirm its broader clinical applications.</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 9","pages":"Pages 1056-1065"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592974","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":"Collagen and Vascular Changes in the Scapholunate Ligament Following Injury: An Immunohistochemical Study","authors":"Oliver Miles MD, BBiom ,&nbsp;Stephen K. Tham MBBS ,&nbsp;Wayne Morrison MBBS, MD ,&nbsp;Eugene T. Ek MBBS, PhD ,&nbsp;Jason Palmer BSc ,&nbsp;David McCombe MBBS, MD","doi":"10.1016/j.jhsa.2024.10.011","DOIUrl":"10.1016/j.jhsa.2024.10.011","url":null,"abstract":"<div><h3>Purpose</h3><div>The scapholunate ligament (SLL) is the most frequently injured wrist ligament. The aim of this study was to investigate cellular and extracellular changes within the SLL following injury.</div></div><div><h3>Methods</h3><div>Fifteen SLLs were harvested, ranging between 39 days to 20 years from time of injury. These specimens were subject to immunohistochemical analysis to characterize their vascular and collagen constitution.</div></div><div><h3>Results</h3><div>Of the 15 ligaments, 4 were harvested &lt;3 months from injury, and 11 harvested &gt;3 months from injury. The mean type I collagen<span> density was 45.6% (25.2% to 55.9%) in all specimens. The mean type III collagen<span> density was 47% (38.2% to 51.8%) of the ligament area in specimens &lt;3 months after injury and 30.6% (13.3% to 44.1%) in those &gt;3 months after injury. Type III collagen density was highest in the volar subunit. Type I collagen decreased only minimally in specimens taken within 2 years of injury. The increase in the type I:III collagen ratio reflected the decline in type III collagen. Blood vessels were found in 13 of 15 specimens. Mean vessel density for all specimens was 1.3% (0% to 7.1%), with the highest density of 1.8% (0% to 10%) in the volar subunit. The vessel density decreased from 2.9% (1.3% to 4.3%) to 1.6% (0% to 10%) in the volar subunit in specimens harvested &gt;3 months after injury.</span></span></div></div><div><h3>Conclusions</h3><div>Mean type III collagen density decreased with time, most notably within the volar subunit. Mean type I collagen density held comparatively stable in ligaments taken within 2 years from injury. Blood vessels were detected in 87% of specimens, with the highest density in the volar subunit.</div></div><div><h3>Clinical relevance</h3><div>The SLL displays a collagen profile similar to other ligaments with favorable healing capacity. The volar subunit possessed a collagen ratio and vessel density that may suggest its acute repair and inclusion in reconstructive techniques has merit.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 9","pages":"Pages 1134.e1-1134.e9"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734453","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":"Long-Term Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction","authors":"Monica M. Shoji MD ,&nbsp;Carly Q. Kingston BS ,&nbsp;Nithin Lankipalle BS ,&nbsp;Aviram M. Giladi MD, MS ,&nbsp;James P. Higgins MD","doi":"10.1016/j.jhsa.2025.05.003","DOIUrl":"10.1016/j.jhsa.2025.05.003","url":null,"abstract":"<div><h3>Purpose</h3><div><span>The long-term outcomes of the medial femoral trochlea (MFT) osteochondral free flap for proximal pole scaphoid </span>nonunion (SNU) reconstruction are unknown. The primary purpose of this study was to evaluate the upper and lower extremity patient-reported outcomes (PROs) of MFT for SNU reconstruction at a follow-up of &gt;9 years.</div></div><div><h3>Methods</h3><div>Patients who underwent MFT for SNU reconstruction by the senior author &gt;9 years ago were contacted to complete PRO questionnaires. Upper-extremity outcomes were reported with the Quick Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em><span><span>DASH), Patient-Rated Wrist Evaluation (PRWE), and Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE). Knee outcomes were reported with the International Knee Documentation scale, Knee Injury and Osteoarthritis Outcome Score, Kujala Anterior Knee Pain scale, and </span>Western Ontario and McMaster Universities Osteoarthritis Index scales; scores were compared with normative data or established patient-acceptable symptom state thresholds to provide context. Long-term radiographic evaluation of scapholunate and radiolunate angles and revised carpal height ratio was also performed.</span></div></div><div><h3>Results</h3><div>Eleven of 12 patients completed PROs. The mean follow-up time was 10.2 years (range: 9.2–11.7). Bony union was achieved in all cases. The mean long-term <em>Quick</em>DASH was 4.5 ± 5.8, PRWE total 7.8 ± 9.1, and PROMIS UE 55.8 ± 6.1—all similar to normative population scores. The mean International Knee Documentation score was 91.2 ± 15.9 and Western Ontario and McMaster Universities Osteoarthritis Index score 96.0 ± 11.2; both comparable with normative data. The Kujala and Knee Injury and Osteoarthritis Outcome Scores reflected good postoperative knee function and minimal pain. None demonstrated radiographic evidence of radioscaphoid arthritis. There was no difference between preoperative and postoperative average scapholunate or radiolunate angle. Postoperative revised carpal height ratio (1.6) was similar to preoperative (1.5).</div></div><div><h3>Conclusions</h3><div>Medial femoral trochlea reconstruction for difficult, recalcitrant scaphoid proximal pole nonunion provides satisfactory, sustained long-term upper-extremity outcomes and stable radiographs with minimal donor-site morbidity.</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 9","pages":"Pages 1043-1049"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531182","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":"Nonsurgical Treatment Versus Intramedullary Fixation of Displaced Metacarpal Shaft Fractures","authors":"Alexander D. Jeffs MD ,&nbsp;Andrew D. Allen MD ,&nbsp;Zohair S. Zaidi MD ,&nbsp;Stephen M. Himmelberg MD ,&nbsp;Nicholas C. Bank MD ,&nbsp;Sarah C. Conlon MD ,&nbsp;Nathaniel C. Adams BA ,&nbsp;Patricia K. Wellborn MD ,&nbsp;Charles A. Baumann MD ,&nbsp;G. Aman Luther MD","doi":"10.1016/j.jhsa.2025.05.012","DOIUrl":"10.1016/j.jhsa.2025.05.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Retrograde intramedullary headless compression screw (IMHS) fixation offers potential advantages over traditional surgical treatment of metacarpal shaft fractures. The purpose of this study was to compare the rates of recovery of short-term functional outcomes for displaced metacarpal shaft fractures treated nonsurgically and those treated using a minimally invasive intramedullary screw technique. We hypothesized that IMHS fixation would lead to earlier return of function with equivalent outcomes at final follow-up.</div></div><div><h3>Methods</h3><div>We identified patients between 2017 and 2022 with a displaced metacarpal shaft fracture treated nonsurgically or with IMHS. We included patients aged 18–65 years with a minimum 12 week follow up. We excluded open fractures<span><span> and those presenting &gt;1 week from injury. We documented radiographic displacement, grip strength, visual analog scale pain scores, total active motion (TAM), return to work (RTW), time to union, complications, and treatment cost. We performed a </span>linear regression analysis to compare outcomes over time and survival curves for RTW.</span></div></div><div><h3>Results</h3><div><span>Ninety-nine patients with 109 fractures were included. Intramedullary headless compression screw fixation demonstrated less radiographic shortening (2.4 vs 5.1 mm) and angulation at 12 weeks (2</span><strong>°</strong> vs 30<strong>°</strong>) compared with nonsurgical management. There was significantly faster normalization of grip strength in the IMHS group during the first 6 weeks. At 12 weeks, there was no significant difference between the IMHS and nonsurgical groups in TAM, pain, or grip strength. The IMHS group had faster return to light (1.2 vs 2.1 weeks) and heavy-duty work (3.1 vs 6.1 weeks). Average direct cost was $1,413 and $2,452 for nonsurgical and IMHS patients, respectively.</div></div><div><h3>Conclusions</h3><div>The IMHS group demonstrated earlier return of grip strength and RTW compared with nonsurgical treatment. Intramedullary headless compression screw fixation improved radiographic parameters at 12 weeks without a difference in TAM, grip strength, or visual analog scale pain scores. The direct cost was higher by $1,039 with IMHS fixation.</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 9","pages":"Pages 1066-1074"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585652","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)00430-7","DOIUrl":"10.1016/S0363-5023(25)00430-7","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 9","pages":"Page A14"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922218","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":"Description of Specific Portals for Extensor Carpi Ulnaris Tenoscopy: Anatomical Safety Study","authors":"Elisa de Torres-de Torres MD ,&nbsp;Fernando Corella MD, PhD ,&nbsp;Ricardo Kaempf de Oliveira MD ,&nbsp;Montserrat Ocampos Hernández MD, PhD ,&nbsp;Miguel Ángel Corella ,&nbsp;María Teresa Vázquez-Osorio MD, PhD","doi":"10.1016/j.jhsa.2024.10.005","DOIUrl":"10.1016/j.jhsa.2024.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this study was to describe potential working portals positioned directly over the extensor carpi<span> ulnaris (ECU) tendon and assess their safety in relation to the dorsal branch of the ulnar nerve (DBUN).</span></div></div><div><h3>Methods</h3><div>A descriptive anatomical study was conducted on 15 fresh human cadaver upper limbs. Five distinct portals over the ECU were examined, and the shortest distances from these portals to the DBUN were measured. Additionally, three distances from two portals and the ulnar styloid to the point where the DBUN crosses the ECU tendon were assessed.</div></div><div><h3>Results</h3><div>The measurements of the distance to the DBUN from the portal at the level of the ulnocarpal joint (UCJ) from the proximal ECU (PECU) portal and from the portals located two and three centimeters proximal to the PECU indicate that no distances fell within the high-risk category (less than 3.5 mm). Measuring from the portal at the level of the UCJ to the DBUN, only one specimen fell within the medium-risk range (3.5–4.5 mm). However, in the rest of the previously described portals, all measurements corresponded to a low-risk range (more than 4.5 mm). The measurements from the distal ECU (DECU) portal to the DBUN revealed that 4 of 15 specimens had a distance less than 3.5 mm (high-risk range), whereas 2 of 15 fell within the medium-risk range.</div></div><div><h3>Conclusions</h3><div>Proximal portals are safer and present a lower risk of nerve injury. Three distinct zones have been defined along the ECU based on their safety characteristics. The “green zone” is the safest area, situated 1 cm proximal to the 6R portal. The “yellow zone” encompasses the area extending from 1 cm proximal to 0.5 cm distal to the 6R portal. Finally, the “red zone” is located 0.5 cm distal to the 6R portal.</div></div><div><h3>Clinical relevance</h3><div>For arthroscopic procedures involving the ECU, additional portals may be necessary. This anatomical study may be valuable in developing and implementing surgical techniques tailored for ECU pathology.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 9","pages":"Pages 1132.e1-1132.e7"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683633","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":"Revision Carpal Tunnel Release with Endoscopic Technique: Clinical Outcomes and Intraoperative Findings","authors":"Patricia K. Wellborn MD ,&nbsp;Alexander D. Jeffs MD ,&nbsp;Andrew D. Allen MD ,&nbsp;Zohair S. Zaidi MD ,&nbsp;G. Aman Luther MD","doi":"10.1016/j.jhsa.2024.10.016","DOIUrl":"10.1016/j.jhsa.2024.10.016","url":null,"abstract":"<div><h3>Purpose</h3><div>The standard treatment for recurrent carpal tunnel syndrome (CTS) has been open revision. We hypothesize that endoscopic carpal tunnel release can be used successfully in the revision setting.</div></div><div><h3>Methods</h3><div>We identified patients between 2018–2023 who underwent revision carpal tunnel release (CTR). All patients underwent prior open or mini-open CTR (OCTR). All had electrodiagnostically proven CTS and CTS-6 scores &gt;12. Those with suspected or documented nerve injury after primary CTR were excluded. Patient-reported outcomes, including visual analog scale pain scores and 5-point Likert-style rating of symptom improvement, were collected.</div></div><div><h3>Results</h3><div>Thirty patients were identified: 22 with recurrent and 8 with persistent CTS. Average time from index surgery was 110 months in recurrent and 18 months in persistent CTS cases. Twenty-five patients had prior mini-open CTR, and five underwent traditional-open CTR. Intraoperative findings included incomplete release (<em>n</em><span> = 4), median nerve (MN) adhesions to skin (</span><em>n</em> = 1) or flexor retinaculum (<em>n</em> = 4), inadequate visualization of the MN (<em>n</em> = 5) and no documented findings (<em>n</em><span> = 17). Five of 30 patients (16%) were converted from endoscopic to open release procedures intraoperatively. All conversions occurred in patients with prior traditional-open CTR and incisions crossing the wrist flexion crease. At 6-month follow-up, average visual analog pain scores improved from 7 to 2 after revision endoscopic release and from 7 to 3 in cases in which conversion from endoscopic to open release was required. Of the patients, 92% in the revision endoscopic group and 60% in the conversion group had symptom improvement (5-point Likert score ≥3 at final follow-up).</span></div></div><div><h3>Conclusions</h3><div>Revision endoscopic carpal tunnel release can be performed successfully after primary mini-open CTR. A prior traditional OCTR with an incision crossing the wrist crease is more likely to require conversion to open release. A lower proportion of patients converted to OCTR have postoperative symptom improvement than those treated with revision endoscopic release.</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 9","pages":"Pages 1075-1080"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848244","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":"Biscapular Protraction Force and Excursion in Adult Patients With Traumatic Brachial Plexus Injuries: A Comparative Study.","authors":"Ellen Y Lee, Andrew W Nelson, Brandon P Sampson, Nicholas Pulos, Robert J Spinner, Alexander Y Shin","doi":"10.1016/j.jhsa.2025.07.032","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.032","url":null,"abstract":"<p><strong>Purpose: </strong>Traditional body-powered upper limb prostheses use a Bowden cable to translate shoulder and residual upper limb movements into forces that control the terminal device. The necessary force and excursion required to use a traditional body-powered prosthesis in patients with traumatic brachial plexus injuries (BPI) has yet to be ascertained. This study compared the force and excursion generated during biscapular protraction in adults with traumatic BPI compared to healthy volunteers.</p><p><strong>Methods: </strong>Thirty nonamputee volunteers, divided into BPI and uninjured control groups and matched for age and sex, were recruited, consented, and comprised the study's cohort. Biscapular protraction force and excursion were measured using a figure-of-8 harness simulating body-powered prosthesis control. Age, sex, anatomical dimensions, and cohorts were compared to determine their potential effects on force and excursion.</p><p><strong>Results: </strong>The control group demonstrated significantly higher force (4.2 vs 1.0 kg) and excursion (52.6 vs 16.7 mm) than the BPI group. After adjusting for age, sex, and anatomical dimensions, the differences remained.</p><p><strong>Conclusions: </strong>Complete BPI patients demonstrated considerably diminished biscapular force and excursion compared to healthy volunteers. These differences illustrate the potential challenges in use of body-powered prostheses in patients with BPI. Patients with BPI may require alternative strategies to exploit contralateral scapular motion to enable use of terminal devices.</p><p><strong>Clinical relevance: </strong>Patients with complete BPI exhibit considerably reduced biscapular force and excursion compared to healthy individuals, limiting their potential to operate body-powered prostheses.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979339","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 40-Year Retrospective Evaluation of Vascularized Bone Grafting for Kienböck Disease.","authors":"Jess D Rames, Andrew F Emanuels, Mehmet F Tunaboylu, Steven L Moran","doi":"10.1016/j.jhsa.2025.07.025","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.025","url":null,"abstract":"<p><strong>Purpose: </strong>Kienböck disease is characterized by lunate osteonecrosis with progressive carpal collapse. The relative benefit of revascularization compared to other surgical options remains uncertain. The purpose of this investigation was to compare long-term radiographic, functional, and patient-reported outcomes of revascularization techniques to alternative surgical procedures for the treatment of early- and late-stage Kienböck disease.</p><p><strong>Methods: </strong>A retrospective cohort of patients who underwent surgery for Kienböck disease from 1976 to 2023 was identified. Only patients with at least 24 months of follow-up were included in the study. The patients were grouped by index surgical procedure and disease severity: early-stage defined as Lichtman stage I-IIIA and late-stage defined as stage IIIB-IV. Demographic, functional, and radiographic data; postoperative Disability of the Shoulder, Arm and Hand (DASH) scores; and postoperative Patient-Rated Wrist Evaluation (PRWE) scores were obtained. Patient outcomes were compared between the different surgical techniques, accounting for disease severity. Hazard ratio and survival analyses were performed to evaluate predictors of unplanned return to the operating room or conversion to a salvage procedure after revascularization.</p><p><strong>Results: </strong>A total of 195 patients were included in the primary analysis. Compared to other procedures, patients undergoing revascularization were younger. Additionally, patients undergoing revascularization or offloading procedures had lower proportions of late-stage disease. For patients with early-stage disease, wrist range of motion, relative grip strength, and postoperative Stahl indices were comparable or higher after revascularization and DASH scores were comparable or lower than other procedures. Patients undergoing revascularization and joint leveling procedures had similar rates of reoperation, which were higher than those seen with scaphocapitate fusion or proximal row carpectomy.</p><p><strong>Conclusions: </strong>In early-stage Kienböck disease, revascularization procedures resulted in comparable or better patient-reported scores than other interventions. There were no benefits noted for revascularization over other procedures in late-stage disease. Revascularization should be reserved for patients with early-stage disease.</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":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979255","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":"Acute Compartment Syndrome of the Upper Extremity.","authors":"Anjum F Shaikh, Philip E Blazar, Brandon E Earp, Dafang Zhang","doi":"10.1016/j.jhsa.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.07.021","url":null,"abstract":"<p><p>Acute compartment syndrome of the upper extremity is a rare but serious condition of elevated intracompartmental pressures leading to tissue ischemia. Prompt diagnosis and emergent fasciotomy are critical to optimize patient outcomes, and delays to care can result in myonecrosis, contracture, and limb dysfunction. Acute compartment syndrome of the upper extremity most commonly occurs in the forearm but may also affect the arm and the hand. Upper-extremity acute compartment syndrome most commonly occurs following trauma, but nontraumatic etiologies include prolonged decubitus position, bleeding conditions, and reperfusion injury after critical limb ischemia. This review article will provide a general overview of acute compartment syndrome of the upper extremity with specific sections on the prevalence, treatment, and outcomes for each anatomic location. This review will also address management options and current controversies, including the treatment of delayed presentation or missed compartment syndrome as well as discuss recent advancements in diagnosis and management.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979293","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}