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Journal of Hand Surgery

Joseph J Ruzbarsky, Sariah Khormaee, Aaron Daluiski
PURPOSE: Randomized controlled trials (RCTs) are the gold standard for comparing clinical interventions. Statistical significance as reported via a P value has been used to determine if a difference between clinical interventions exists in an RCT. However, P values do not clearly convey information about the robustness of a study's conclusions. An emerging metric, called the fragility index (the number of subjects who would need to change outcome category to raise the P value above the ...
November 9, 2018: Journal of Hand Surgery
Lennart M Steenbeek, Marieke M Dreise, Paul M N Werker
PURPOSE: The aim of this study was to analyze the durability of the treatment results of the thumb and first web contractures in Dupuytren disease with collagenase Clostridium histolyticum. METHODS: Twelve patients (14 hands) were followed for an average of 35 months (range, 24-42 months). Two patients (3 hands) were excluded, yielding 11 hands available for assessment. Nondurability was defined as a worsening of at least 20° of passive extension deficit at a treated joint or any decrease greater than 5 mm in intermetacarpal head distance, both relative to 30 days after injection or as intervention to correct new/worsening contracture...
November 9, 2018: Journal of Hand Surgery
River M Elliott, Suresh K Nayar, Aviram M Giladi, Christopher L Forthman, Brent G Parks, Kenneth R Means
PURPOSE: The purpose of this study was to determine the relationship between hemihamate graft size and proximal interphalangeal (PIP) joint flexion in a biomechanical fracture-dislocation model. METHODS: We simulated middle finger PIP fracture-dislocations in 5 cadaver hands by resecting 50% of the palmar articular surface of the middle phalanx (P2) base. Fluoroscopy was used to confirm dorsal subluxation of the middle phalanx base after resection. A 10-mm osteochondral hamate graft was contoured to reconstruct the volar lip of the middle phalanx and was progressively downsized by 2-mm increments for each trial...
November 9, 2018: Journal of Hand Surgery
Christina M Webber, Alexander Y Shin, Kenton R Kaufman
Assessment of upper extremity function either before or after surgical treatment has been a rapidly evolving field. A reproducible, accurate, and valid assessment tool provides the ability to compare surgical interventions, evaluate physical therapy regimens, and assess novel assistive and restorative technologies. The purpose of this article is to detail the various upper extremity assessment tools and introduce the concept of real-world data acquisition of upper extremity function.
November 9, 2018: Journal of Hand Surgery
Joseph Said, Kaela Frizzell, Juliana Heimur, Amir Kachooei, Pedro Beredjiklian, Michael Rivlin
PURPOSE: To determine the minimum incision size needed using an open cubital tunnel technique to obtain equivalent visualization comparable with an endoscopic technique. METHODS: Visualization was assessed in 10 fresh-frozen cadavers with a 2-cm incision, using percutaneous needle localization with the endoscopic system. The most proximal and distal extent of the field of view was marked. Next, an open cubital tunnel release was performed on each cadaver specimen...
November 9, 2018: Journal of Hand Surgery
Jenny Saving, Anders Enocson, Sari Ponzer, Cecilia Mellstrand Navarro
PURPOSE: To determine if a volar locking plate (VLP) is superior to external fixation (EF) 3 years after surgery for unstable, dorsally displaced, distal radius fractures caused by low-energy injury in patients 50 to 74 years of age. METHODS: During 2009 to 2013, 140 patients with an unstable dorsally displaced distal radius fracture were randomized to either VLP or EF. One hundred eighteen patients (EF 56, VLP 62) were available for a 3-year follow-up. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand score (DASH) at 3 years...
November 9, 2018: Journal of Hand Surgery
Christine B Novak, Yue Li, Herbert P von Schroeder, Dimitri J Anastakis, Steven J McCabe
PURPOSE: This study evaluated the effect of forearm or hand warming versus bare hand conditions to improve cold-induced symptoms and skin temperatures in hand trauma patients. METHODS: Adults with symptoms of cold intolerance at least 3 months following hand trauma and age-/sex-matched controls were included. Testing sessions (bare hand, hand warming, forearm warming) were completed in a climate laboratory with continuous temperature monitoring. Outcomes included physical findings (skin temperature) and self-report symptoms (thermal comfort, pain)...
November 9, 2018: Journal of Hand Surgery
Dafang Zhang, Jamie Collins, Brandon E Earp, Philip Blazar
PURPOSE: Carpal tunnel syndrome and trigger finger (TF) frequently present concomitantly; some studies suggest that carpal tunnel release (CTR) is a risk factor for the development of ipsilateral TF in the postoperative period. The primary objective of this study was to elucidate the relationship between CTR and the subsequent development of TF. METHODS: A retrospective study was conducted of 1,386 hands in 1,140 patients who underwent primary CTR at a tertiary referral center from July 2008 to June 2013...
November 5, 2018: Journal of Hand Surgery
Seung Hoo Lee, Jung Eun Lee, Ki Ho Lee, Sung Hee Pyo, Min Bom Kim, Young Ho Lee
PURPOSE: We suggest a method to achieve anatomical reduction in mallet finger fractures that are insufficiently treated by the 2-extension block wire technique. METHODS: We performed a retrospective review of 18 patients who were found to have an irreducible dorsal fragment and distal interphalangeal joint incongruence owing to rotation of the dorsal fragment in the sagittal plane. In these cases, we additionally employed a dorsal counterforce technique to supplement the 2-extension block technique...
November 5, 2018: Journal of Hand Surgery
Gershon Zinger, Khaled Abu Dalu, Alexander Bregman, Genady Yudkevich
Ruptures of the extensor pollicis longus (EPL) tendon are known to occur primarily from local mechanical causes at Lister's tubercle. Other reasons for ruptures have been proposed including local steroid or even distant steroid injections that might have weakened the tendon, leading to rupture. There have been rare cases in the literature that describe ruptures without any known causes. Here, we describe a case with no known risk factors and with a spontaneous EPL rupture on one side and subclinical tendinopathy on the other...
October 30, 2018: Journal of Hand Surgery
Jayme Augusto Bertelli, Francisco Soldado, Alfonso Rodrígues-Baeza, Marcos Flávio Ghizoni
PURPOSE: With ulnar nerve injuries, paralysis of the first dorsal interosseous (FDI) and the adductor pollicis (ADP) muscles weakens pinch. The likelihood that these muscles will be reinnervated following ulnar nerve repair around the elbow is very low. To overcome this obstacle, we propose a more distal repair: transferring the opponens pollicis motor branch (OPB) to the terminal division of the deep branch of the ulnar nerve (TDDBUN). METHODS: We dissected 10 embalmed hands to study the anatomy of the thenar branches of the median nerve and TDDBUN...
October 23, 2018: Journal of Hand Surgery
Laura Y Lu, Nicole Sheikholeslami, Aaron Alokozai, Sara L Eppler, Robin N Kamal
PURPOSE: Trust is foundational to the patient-physician relationship. However, there is limited information on the patient characteristics and behaviors that are related to patient trust. We investigated whether the time patients spend researching their physician and/or symptoms before a clinic visit was correlated with patient trust in their hand surgeon. METHODS: We conducted a prospective study of new patients (n = 134) who presented to a hand surgery clinic...
October 23, 2018: Journal of Hand Surgery
Hasan Utkan Aydin, Christiana Savvidou, Tuna Ozyurekoglu
PURPOSE: The homodigital dorsolateral flap (HDF) was described to treat various types of pulp and fingertip defects. The aim of this study was to analyze the intermediate-term function after fingertip reconstruction with HDF and compare these results with the cross-finger flap. METHODS: We analyzed a retrospective cohort of 25 patients. The HDF group consisted of 16 patients (18 fingertip defects) with a mean age of 44 years (range, 16-63 y). The cross-finger flap group consisted of 9 patients (10 fingertip defects) with a mean age of 33 years (range, 16-47 y)...
October 23, 2018: Journal of Hand Surgery
Wendy A Tomhave, Kathleen M Kollitz, Steven L Moran
PURPOSE: The Thumb Grasp and Pinch (T-GAP) assessment quantifies functional hand use in children with congenital thumb hypoplasia by categorizing grasp and thumb use patterns during assessment activities that encourage a variety of grasp and pinch styles. This study aims to demonstrate interrater and intrarater reliability results of the T-GAP. METHODS: A retrospective review was performed of children who had undergone index finger pollicization for congenital thumb hypoplasia and subsequent evaluation with videotaping of the T-GAP assessment...
October 23, 2018: Journal of Hand Surgery
Brandon S Smetana, Jue Cao, Gregory A Merrell, Jeffrey A Greenberg
PURPOSE: To investigate the ideal suture material to test strain at nerve repair sites. Based on nerve strain tolerance, we aimed to determine which suture reliably failed by an average of 5% and a maximum of 8% strain when loaded to failure. METHODS: The median nerve of 19 cadavers was exposed in the distal forearm, transected proximally, and attached to a spring gauge. It was marked 5 cm on either side of its midpoint to measure strain. A laceration was created at its midpoint...
October 23, 2018: Journal of Hand Surgery
Brad T Hyatt, Douglas P Hanel, James M Saucedo
Bridge plate fixation has traditionally been described for the treatment of high-energy distal radius fractures with extensive comminution, associated instability, and polytrauma with the need for immediate upper extremity assisted weight bearing. Certain patient populations who may similarly benefit from such effective and expedient stabilization include patients with multiple comorbidities who may have lower-energy fractures, poor bone quality, and a baseline reliance on ambulatory assist devices. This article reviews treatment considerations for distal radius fractures in low-demand patients and explores the rationale and technique of bridge plate fixation in this population...
October 23, 2018: Journal of Hand Surgery
R Randall McKnight, Steve K Lee, R Glenn Gaston
PURPOSE: Nitinol memory compression staples are a recent addition to carpal bone fixation. Compared with traditional staples, they have been shown to have superior compression at the far cortex relative to standard and traditional compression staples. The purpose of this study was to (1) determine the effective leg length of different nitinol staples, (2) confirm the effect of 1 versus 2 staples on biomechanical compression, and (3) determine the effect of troughing (countersinking the staple into bone) the bone on staple biomechanical properties...
October 18, 2018: Journal of Hand Surgery
Sergi Barrera-Ochoa, Gerardo Mendez-Sanchez, Xavier Mir-Bullo, Jorge Knörr, Jayme Augusto Bertelli, Francisco Soldado
PURPOSE: To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). MATERIALS AND METHODS: Twelve patients younger than 18 years with scaphoid nonunion, who underwent a VTMPF procedure without bone grafting, were included for this prospective cohort study, at a mean follow-up of 10.2 months. Patients were operated on by 3 different hand surgeons at 3 hand surgery institutions...
October 18, 2018: Journal of Hand Surgery
Esther Fernández Tormos, Fernando Corella Montoya, María Ángeles Martínez Izquierdo, Beatriz Sánchez-Artola, Borja Limousin Aranzabal, Ricardo Larraínzar-Garijo
Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb...
October 18, 2018: Journal of Hand Surgery
Brent R DeGeorge, Richard A Berger, Alexander Y Shin
PURPOSE: Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wounds, although documented, have not been the primary focus of prior reports. This study investigated short- to medium-term soft tissue complications after DRUJ semiconstrained implant arthroplasty...
October 18, 2018: Journal of Hand Surgery
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