The Journal of hand surgery, European volume最新文献

{"title":"Economic benefits of WALANT anaesthesia in metacarpal and phalangeal fracture surgery.","authors":"Benjamin Trautz, Philipp Moog, Inessa Suhova, Jun Jiang, Oliver Schöffski, Hans-Guenther Machens, Haydar Kükrek","doi":"10.1177/17531934251409627","DOIUrl":"10.1177/17531934251409627","url":null,"abstract":"<p><strong>Introduction: </strong>The wide-awake-local-anaesthesia-no-tourniquet (WALANT) technique is increasingly used in hand surgery, avoiding general or regional anaesthesia and upper arm tourniquets. Clinical and economic benefits have been shown especially for trigger finger and carpal tunnel release; however, its impact on fracture treatment warrants evaluation.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective analysis of 921 metacarpal and phalangeal hand operations for fracture treatment, including both fixation and removal of metalwork. The operation time and cost of procedures performed under WALANT were compared with those using regional anaesthesia (RA) with brachial plexus block. Reimbursement for the procedures were compared with the cost.</p><p><strong>Results: </strong>The WALANT technique significantly reduced the operation time and treatment cost compared with RA. However, we found that the reimbursement structure did not fully cover the procedural expenses in either group. Despite this, WALANT reduced financial deficits, demonstrating superior cost-effectiveness.</p><p><strong>Conclusion: </strong>In addition to reducing operative time and overall procedural costs, WALANT decreased dependence on anaesthesia capacity, thereby improving the efficiency of surgical workflows. This approach also promotes a more sustainable model of healthcare delivery by minimizing resource consumption and simplifying logistics. Moreover, its cost-effectiveness may enhance the long-term economic feasibility of reimbursement and funding systems within modern healthcare structures.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"617-622"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand injuries following pager explosions in Lebanon: a single institution study.","authors":"Kaissar Yammine, Joeffroy Otayek, Chahine Assi","doi":"10.1177/17531934251387064","DOIUrl":"10.1177/17531934251387064","url":null,"abstract":"<p><p>The pager explosions in Lebanon yielded an unprecedented number of hand injuries. Forty-five patients (49 affected hands) presented with 123 amputations and 34 fractures. Emergency surgeries were mostly trimming of the stumps and immediate coverage with local skin flaps.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"643-644"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of amyloid deposits in synovium and flexor retinaculum, risk factors and asymptomatic cardiac involvement in patients with carpal tunnel syndrome.","authors":"Teruyasu Ohno, Shuzou Mihara, Masashi Morishige, Takeshi Nakamura","doi":"10.1177/17531934251398757","DOIUrl":"10.1177/17531934251398757","url":null,"abstract":"<p><strong>Introduction: </strong>Amyloid deposition in the tenosynovium and transverse carpal ligament, and particularly cardiac involvement, are rare in patients with carpal tunnel syndrome; however, the prevalence may be underreported. This prospective study assessed the prevalence of amyloid deposits in the synovium and transverse carpal ligament and whether dual-site sampling improved detection. Risk factors for a positive test and asymptomatic cardiac involvement were also investigated.</p><p><strong>Methods: </strong>In a prospective cohort of 100 consecutive patients undergoing carpal tunnel release, intraoperative biopsies were taken from the tenosynovium and the transverse carpal ligament and examined using Congo red and immunohistochemistry staining. Concordance between biopsy sites was assessed, and independent predictors for a positive test were evaluated by multivariable logistic regression. Amyloid-positive patients underwent cardiac assessments, including cardiac biomarkers and ^99mTc-pyrophosphate scintigraphy.</p><p><strong>Results: </strong>Amyloid deposition was present in 62 patients. Concordance between biopsy sites was 91%. Older age, male sex, bilateral carpal tunnel syndrome, multiple trigger fingers, and spinal stenosis independently predicted tissue amyloid. Asymptomatic cardiac amyloid deposition was identified in eight patients: three fulfilled criteria for cardiac amyloidosis and five demonstrated scintigraphic uptake with preserved function.</p><p><strong>Conclusion: </strong>Amyloid deposition in carpal tunnel syndrome was common in our study population, and subclinical cardiac involvement was not rare. Dual-site biopsy improved detection compared with the single-site sampling, and we recommend this routinely during carpal tunnel release. If not feasible, we recommend prioritizing older or male patients and those with bilateral carpal tunnel syndrome, multiple trigger fingers or spinal stenosis. Multiple trigger fingers may indicate a systemic process and high amyloid/cardiac risk.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"550-556"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and cost savings of non-theatre carpal tunnel release: observational analysis of administrative data for England.","authors":"Abid Ali Khan, Katy McErlain, Nikhita Nikhita, Aligha Purushothaman, Stella Vig, Tim Wr Briggs, William K Gray","doi":"10.1177/17531934261415787","DOIUrl":"10.1177/17531934261415787","url":null,"abstract":"<p><strong>Introduction: </strong>Carpal tunnel release (CTR) surgery is typically performed in resource-intensive operating theatres. Transitioning CTR to procedure or clinic rooms may reduce costs, waiting times and environmental impact. This study evaluated the clinical safety and financial savings associated with CTR surgery performed outside traditional theatre settings.</p><p><strong>Methods: </strong>An observational, retrospective analysis was conducted using Hospital Episode Statistics data from England between April 2017 and September 2024, comparing patients undergoing CTR in trusts predominantly using non-theatre settings with those trusts predominantly using operating theatres. Primary outcomes were emergency readmission within 30 days and ipsilateral repeat surgery within 1 year. Logistic regression models adjusted for age, sex, socioeconomic deprivation, frailty and year of surgery. The financial implications associated with this move away from theatres were analysed using structured interviews and national procurement prices.</p><p><strong>Results: </strong>In total, 5748 patients (four hospital trusts) were included in the non-theatre group and 223,463 patients (137 hospital trusts) were in the operating theatre group. Carpal tunnel release performed by trusts routinely performing it outside theatres was not associated with higher risk of repeat ipsilateral surgery within 1 year or 30-day all-cause emergency readmission. Non-theatre settings reduced cost per procedure by around 40%.</p><p><strong>Conclusions: </strong>Carpal tunnel release surgery performed in non-theatre settings was not associated with higher rates of 30-day all-cause emergency readmissions or 12-month revision rates. Estimated financial costs were substantially lower for out-of-theatre CTR based on data for two trusts routinely performing CTR out of theatre. Wider adoption of this model could enhance operational efficiency.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"557-565"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the value of hand surgery through mapping algorithms.","authors":"Luke Geoghegan, Conrad J Harrison, Shehan Hettiaratchy, Jeremy N Rodrigues","doi":"10.1177/17531934251408719","DOIUrl":"10.1177/17531934251408719","url":null,"abstract":"<p><strong>Introduction: </strong>Health state utility values describe the desirability of health states and are needed to calculate quality-adjusted life years. Traditionally, they are derived using generic measures such as the EuroQol 5-Dimension scale. No hand-specific measures can be used to derive them. This study aimed to develop and evaluate mapping algorithms to estimate the EuroQol 5-Dimension utility index from the Patient Evaluation Measure.</p><p><strong>Methods: </strong>Matched Patient Evaluation Measures and EuroQol 5-Dimension 5-Level data from 2043 patients were used to develop mapping algorithms. Transfer-to-utility models were developed and assessed through a 1000-fold bootstrap validation.</p><p><strong>Results: </strong>We present a range of mapping algorithms to derive health state utility values from the Patient Evaluation Measure, a commonly used hand-specific Patient Reported Outcome Measure (PROM). The population-level prediction error of our best performing models was clinically relevant.</p><p><strong>Conclusions: </strong>This suggests that mapping hand-specific PROMs on to generic preference-based measures may not be appropriate.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"604-610"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there evidence of metal-on-metal bearing failure in modern total wrist arthroplasty?","authors":"Daniel J Brown, Thomas J Joyce","doi":"10.1177/17531934261420064","DOIUrl":"10.1177/17531934261420064","url":null,"abstract":"<p><p>Given the well-publicised issues around metal-on-metal (MOM) hip replacements there has been a great deal of scrutiny around the same bearing when used in total wrist arthroplasty (TWA). There are several case series and reports in the literature of metallosis following MOM TWA which have implicated the MOM bearing as the cause of the issue with some authors advocating that the MOM bearing should be avoided. As the MOM version of one of the current TWA is widely used, this potentially represents a problem. This article discusses the issues of MOM articulations as they relate to both hip and wrist replacements and critically analyses the literature to see if there is indeed any evidence of issues with MOM bearings in modern TWA. While metallosis has been reported in TWA, frequently this has been due to failure of the polyethylene bearing or unintended impingement between arthroplasty components. In such cases, titanium debris has been released and, while not benign, such debris lacks the known toxicity associated with the cobalt and chromium of MoM hips. These findings, together with those from explant analysis of MOM articulations, suggest that metallosis seen with the MOM TWA is extra-articular in origin and there is no evidence to suggest an issue with the bearing itself.<b>Level of Evidence:</b><b>V</b>.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"647-652"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital replantation in adults: a French survey of postoperative practices.","authors":"Marie Protais, Antoine Barczewski, Yves Le Bellec","doi":"10.1177/17531934251369278","DOIUrl":"10.1177/17531934251369278","url":null,"abstract":"<p><p>This survey of 136 microsurgeons in France reveals substantial variation in postoperative protocols for digital replantation. Anaesthesia, pharmacological management, monitoring and rehabilitation practices diverge widely, highlighting the need for standardized national guidelines to optimize outcomes and ensure procedural consistency.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"630-632"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pollicization for congenital thumb malformations: a retrospective study of 24 patients with a 9 year mean follow-up.","authors":"Gauthier Desrousseaux, Aurélie Mézel, Marc Saab","doi":"10.1177/17531934251375812","DOIUrl":"10.1177/17531934251375812","url":null,"abstract":"<p><p>This study assessed clinical and functional outcomes after pollicization for congenital thumb malformations in 24 patients. Most achieved good functional scores, although grip and key pinch strength were reduced. Outcomes were poorer in patients with associated comorbidities.<b>Level of evidence:</b> IV.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"633-635"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyethylene liner fracture in dual-mobility trapeziometacarpal joint prosthesis: Report of 17 cases.","authors":"Joris Duerinckx, Miriam Marks, Daniel B Herren","doi":"10.1177/17531934251383007","DOIUrl":"10.1177/17531934251383007","url":null,"abstract":"<p><p>We report 17 polyethylene liner fractures in 15 patients with dual mobility trapeziometacarpal joint prostheses who were primarily active males with high key pinch strength. Treatment involved head and liner exchange or trapeziectomy, depending on implant damage severity.<b>Evidence level:</b> V.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"639-642"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpal tunnel syndrome in mucopolysaccharidosis type I: clinical, surgical and histopathological findings.","authors":"Boudewijn A W van Binsbergen, Joris A van Dongen, Linda Vriend, Stephan H Goedee, Peter M van Hasselt, Aebele B Mink van der Molen","doi":"10.1177/17531934261416366","DOIUrl":"10.1177/17531934261416366","url":null,"abstract":"<p><strong>Introduction: </strong>Mucopolysaccharidosis type I is a rare metabolic disorder characterized by the accumulation of glycosaminoglycans, leading to musculoskeletal disorders such as carpal tunnel syndrome. This retrospective cohort study was performed to determine the prevalence and timing of the development of carpal tunnel syndrome, assess the efficacy of surgery on recurrence and the effect of haematopoietic stem cell transplantation in resolving accumulated degradation products.</p><p><strong>Methods: </strong>Thirty-three mucopolysaccharidosis type I patients, born between 2001 and 2023, were included in this study. They received annual screening and treatment at our specialist hospital. Patient demographics, clinical symptoms of carpal tunnel syndrome pre- and post-carpal tunnel release and histopathological sections of the flexor retinaculum were collected. Regression analyses were conducted to assess cumulative risks and determine hazard ratios and survival curves were plotted.</p><p><strong>Results: </strong>Twenty-seven of 33 mucopolysaccharidosis type I patients, with a median age at the latest follow-up of 13 years (IQR 7.7 to 18.3), were diagnosed with carpal tunnel syndrome on electrophysiological tests or ultrasound at a median age of 3.6 years (IQR 2.8 to 5.2). Only a few patients exhibited clinical symptoms. Twenty-one patients underwent carpal tunnel release and 13 patients experienced recurrence. The highest risk of developing carpal tunnel syndrome was within the first 6 years of life. Eight of the 11 patients accumulated degradation products within lysosomes despite successful haematopoietic stem cell transplantation.</p><p><strong>Conclusions: </strong>In this study, 27 mucopolysaccharidosis type I patients were diagnosed with carpal tunnel syndrome, showing a high-risk window from 0 to 6 years of age. Recurrence of carpal tunnel syndrome after carpal tunnel release surgery was common, occurring in 61.9% of patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94237,"journal":{"name":"The Journal of hand surgery, European volume","volume":" ","pages":"566-575"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}