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Journal of Hand Surgery

Joshua W Hustedt, Andrew Chung, Daniel D Bohl, Neil Olmscheid, Scott Edwards
PURPOSE: The clinical decision to replant an amputated digit is driven primarily by surgical indication. However, the extent to which patient comorbidity should play into this decision is less well defined. This study was designed to determine the effect of patient comorbidities on the success, risk, and cost of digital replantation. METHODS: All amputation injuries and digital replantation procedures captured by the National Inpatient Sample during 2001 to 2012 were identified...
October 17, 2016: Journal of Hand Surgery
Brian H Cohen, Michael P Gaspar, Alan H Daniels, Edward Akelman, Patrick M Kane
Double crush syndrome (DCS), as it is classically defined, is a clinical condition composed of neurological dysfunction due to compressive pathology at multiple sites along a single peripheral nerve. The traditional definition of DCS is narrow in scope because many systemic pathologic processes, such as diabetes mellitus, drug-induced neuropathy, vascular disease and autoimmune neuronal damage, can have deleterious effects on nerve function. Multifocal neuropathy is a more appropriate term describing the multiple etiologies (including compressive lesions) that may synergistically contribute to nerve dysfunction and clinical symptoms...
October 14, 2016: Journal of Hand Surgery
Anita Sadhu, Ryan P Calfee, Andre Guthrie, Lindley B Wall
PURPOSE: To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared with primary LRTI. METHODS: This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of 2 years' follow-up were eligible. All patients completed an in-office study evaluation...
October 14, 2016: Journal of Hand Surgery
Sezai Özkan, Jos J Mellema, Adam Nazzal, Sang-Gil Lee, David Ring
PURPOSE: Information gathering is a key component of shared decision making and has a measurable effect on treatment decisions. Access to health information might improve quality of care in hand surgery. Our purpose was to identify socio-demographic, condition-related, and psychosocial factors associated with online information-seeking behavior in patients with hand and upper-extremity conditions. METHODS: From June 2015 to February 2016, we enrolled 134 patients with an upper-extremity condition who presented to an outpatient hand surgery office at an urban level I trauma center in this cross-sectional study...
October 14, 2016: Journal of Hand Surgery
Deepak N Bhatia
Distal biceps tendon (DBT) ruptures are infrequent injuries that result in pain, weakness, and cosmetic deformity. Severe retraction of the ruptured DBT can occur at the time of injury, or in chronic neglected ruptures, and surgical exposure is performed using a single incision or a 2-incision technique. The technique presented here describes an endoscopic approach using 3 portals that provide access to the retracted DBT, biceps sheath, and radial tuberosity. Preoperative sonographic localization of the retracted DBT and neurovascular structures is used to guide portal placement...
October 12, 2016: Journal of Hand Surgery
Ian L Valerio, Zachary Masters, Jonathan G Seavey, George C Balazs, Derek Ipsen, Scott M Tintle
PURPOSE: To assess the outcomes of treatment with a dermal regeneration template (DRT) in a cohort of combat casualties with severe upper extremity injuries. METHODS: Records of all active duty military patients treated with DRT at our institution between November 2009 and July 2013 were screened. Inclusion criteria were upper extremity open wounds sustained during combat, requiring split-thickness or full-thickness skin grafting for closure. The primary outcome measure was wound healing after the first attempt at definitive treatment (defined as the first application of split-thickness or full-thickness skin graft)...
October 12, 2016: Journal of Hand Surgery
Danielle J Casagrande, Randal P Morris, Nikoletta L Carayannopoulos, William L Buford
PURPOSE: Increased ulnar variance has been shown to lead to diminished load borne by the distal radius. The purpose of this study was to determine the correlations among ulnar variance, bone mineral density, and load to failure at the distal radius. METHODS: Posteroanterior radiographs and computed tomographic scans were taken of 12 cadaveric forearms in neutral rotation. Ulnar variance was measured for each wrist by the method of perpendiculars. Measurements of cortical, trabecular, and combined bone density were made at the distal radius...
October 1, 2016: Journal of Hand Surgery
Hassan Alnaeem, Salah Aldekhayel, Johnathan Kanevsky, Omar Fouda Neel
PURPOSE: The optimal management of undisplaced scaphoid fractures remains controversial. A systematic review was conducted to assess the outcomes of acute, undisplaced scaphoid fractures managed with cast immobilization versus percutaneous or miniopen screw fixation in terms of time to return to work (RTW), time to union, and morbidity. METHODS: PubMed MEDLINE, Ovid MEDLINE, EMBASE, SCOPUS, and Cochrane electronic databases were searched over the period 1974 to 2015...
October 1, 2016: Journal of Hand Surgery
Nikunj N Trivedi, Matthew R Cohn, Samir K Trehan, Aaron Daluiski
PURPOSE: Fractures of the proximal ulna are common injuries in the elderly population. These fractures can be managed nonsurgically or with open reduction internal fixation (ORIF). Whereas nonsurgical management may lead to a relative loss of elbow extension and to nonunion, ORIF carries a risk of complications. Although complications specific to the orthopedic intervention have been reported, few studies have identified postoperative systemic complications in this higher-risk group. The purposes of this study were to determine the rate of systemic complications in patients undergoing surgical fixation of proximal ulna fractures and to determine risk factors for complications...
September 23, 2016: Journal of Hand Surgery
Jessie Janowski, Caitlyn Coady, Louis W Catalano
The treatment of scaphoid nonunion and malunions has undergone a considerable transition since the 1960 modification of Matti's technique by Russe.(1) We present a review of articles with clear data on union rates and functional status to review the current methods of treatment for scaphoid nonunion and malunion.
September 23, 2016: Journal of Hand Surgery
Gaurav Aman Luther, Praveen Murthy, Philip E Blazar
PURPOSE: As health care costs continue to rise, providers must increasingly identify and implement cost-effective practice measures without sacrificing quality of care. Corticosteroid injections are an established treatment for trigger finger; however, numerous clinical trials have documented the limited efficacy of these injections in the diabetic population. Furthermore, the most cost-effective treatment strategy for diabetic trigger finger has not been determined. The purpose of this study was to perform a decision analysis to identify the least costly strategy for effective treatment of diabetic trigger finger using existing evidence in the literature...
September 23, 2016: Journal of Hand Surgery
Michaela Huber, Markus Loibl, Christoph Eder, Richard Kujat, Michael Nerlich, Sebastian Gehmert
PURPOSE: This cadaver study investigated the temperature profile in the wrist joint and distal radioulnar joint (DRUJ) during radiofrequency energy (RFE) application for triangular fibrocartilage complex resection. METHODS: An arthroscopic partial resection of the triangular fibrocartilage complex using monopolar and bipolar RFE was simulated in 14 cadaver limbs. The temperature was recorded simultaneously in the DRUJ and at 6 other anatomic locations of the wrist during RFE application...
September 20, 2016: Journal of Hand Surgery
Mihir J Desai, Charles A Daly, John G Seiler, Walter H Wray, David S Ruch, Fraser J Leversedge
PURPOSE: Loss of active shoulder abduction after brachial plexus or isolated axillary nerve injury is associated with a severe functional deficit. The purpose of this 2-center study was to retrospectively evaluate restoration of shoulder abduction after transfer of a radial nerve branch to the axillary nerve for patients after brachial plexus or axillary nerve injury. METHODS: Patients who underwent transfer of a radial nerve branch to the anterior branch of the axillary nerve between 2004 and 2014 were reviewed...
September 20, 2016: Journal of Hand Surgery
George C Balazs, Theodora C Dworak, Jordan Tropf, George P Nanos, Scott M Tintle
PURPOSE: To identify the incidence and demographic factors associated with volar wrist ganglia in both military and civilian beneficiary populations. METHODS: The U.S. Department of Defense Management Analysis and Reporting Tool (M2) accesses a comprehensive database of all health care visits by military personnel and their dependents. Because there is no specific code for ganglions of the wrist, the database was searched for all military personnel and civilian beneficiaries with an International Classification of Diseases, 9th Revision, diagnosis of 727...
September 20, 2016: Journal of Hand Surgery
Jouni Havulinna, Jarkko Jokihaara, Pasi Paavilainen, Olli V Leppänen
Coronal plane fracture of lunate in Kienböck disease is a challenging problem with no proven treatment. We present a technique for the treatment. A vascularized bone graft from the distal radius employing the fourth and fifth extracompartmental artery pedicles is used as a mechanical support in order to enable fracture union. The technical pearls and pitfalls are described and a clinical case is presented.
September 20, 2016: Journal of Hand Surgery
Parham Daneshvar, Ryan Willing, Markian Pahuta, Ruby Grewal, Graham J W King
PURPOSE: Using a novel technique, we assess and describe the distal radioulnar joint (DRUJ) anatomy. The purpose of this study was to provide the anatomic dimensions of the DRUJ and to evaluate contralateral symmetry. METHODS: Computed tomography images of 100 cadaveric forearms were obtained. Three-dimensional models of the radius and ulna were generated and evaluated using 3-dimensional modeling software. Measurements of the radius of curvature of the sigmoid notch (SN) and ulnar head (UH), as well as the length of the SN and volar and dorsal lips were performed in the axial and coronal sequences...
September 20, 2016: Journal of Hand Surgery
Adam D Glener, Brad Gandolfi, Mihir J Desai, David S Ruch
Congenital radial head dislocations are rare, and presentation with late complications is even less common. We present a case of a patient who presented with symptoms and findings of proximal median nerve compression secondary to large osteophytes associated with untreated congenital radial head dislocations.
September 20, 2016: Journal of Hand Surgery
Georgia-Alexandra Spyropoulou, Leonidas Pavlidis, Panagiotis Mylothridis, Thomas Zaraboukas, Efterpi Demiri
Dupuytren disease in children younger than 10 years is rare and only 8 histologically proven cases have been reported. A histologically proven Dupuytren disease in a 10-year-old with an uncommon clinical presentation as a nodule on the radial side of the middle phalanx of the little finger is documented. Dupuytren's disease should be in the differential diagnosis in cases of nodules and contractures in the palm and fingers of children.
September 18, 2016: Journal of Hand Surgery
David E Ruchelsman, Mark A Vitale
Acute extensor carpi ulnaris (ECU) subsheath injury and chronic subsheath insufficiency may result in symptomatic ECU instability at the level of the distal ulna osseous sulcus. Associated ulnocarpal (ie, triangular fibrocartilage complex) and ECU intrinsic tendinopathic changes may accompany subsheath pathologies and require concomitant treatment. Surgical treatment is indicated in refractory cases despite nonoperative treatment and may consist of repair of the torn edge of the ECU subsheath or, more frequently, reconstruction utilizing a radially based extensor retinacular sling...
September 18, 2016: Journal of Hand Surgery
Pieter Caekebeke, Nicolas Vermeersch, Joris Duerinckx, Roger van Riet
PURPOSE: One of the options to repair a ruptured distal biceps tendon to the radial tuberosity is by means of a transosseous cortical button. Although excellent functional outcomes have been reported, no studies have been performed to quantify the effect of the transosseous fixation technique on the radius. Our study evaluated the clinical outcome and radiological outcome of this technique. The main goal of this study was to evaluate the radiographic evolution of the bone tunnel in the radius...
September 18, 2016: Journal of Hand Surgery
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