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Journal of Hand Surgery

Ezequiel Ernesto Zaidenberg, Efrain Farias Cisneros, Ryan Miller, Carlos Rodolfo Zaidenberg
Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted...
July 14, 2018: Journal of Hand Surgery
David R Sollaccio, Paul Navo, Alidad Ghiassi, Caley M Orr, Biren A Patel, Kristi L Lewton
PURPOSE: Hemi-hamate arthroplasty has been described as a viable treatment option for unstable proximal interphalangeal joint fracture-dislocations. The procedure uses a dorsal distal hamate osteochondral graft to recreate the injured volar middle phalanx (MP) proximal base. The purpose of this study was to evaluate the similarity in shape of these articular surfaces using quantitative 3-dimensional methods. METHODS: Three-dimensional virtual renderings were created from laser scans of the articular surfaces of the dorsal distal hamate and the volar MP bases of the index, middle, ring, and little fingers from cadaveric hands of 25 individuals...
July 14, 2018: Journal of Hand Surgery
John C Koshy, Bryce Bell
Infections are common in hand surgery and proper management is important to achieve optimal outcomes. Although most cases are not urgent, less common, severe infections such as flexor tenosynovitis and necrotizing fasciitis require urgent identification with both medical and surgical management. It is common for diagnoses to be missed or delayed because clinical and laboratory indicators are often variably present. Delayed identification and management can result in poor outcomes with permanent deficits. This article will provide a review of hand infections with a focus on identifying serious hand infections requiring urgent or emergent treatment, and distinguishing these from less urgent scenarios...
July 13, 2018: Journal of Hand Surgery
Christopher S Klifto, Sapan D Gandi, Anthony Sapienza
Bone grafting in the upper extremity is an important consideration in patients with injuries or conditions resulting in missing bone stock. A variety of indications can necessitate bone grafting in the upper extremity, including fractures with acute bone loss, nonunions, malunions, bony lesions, and bone loss after osteomyelitis. Selecting the appropriate bone graft option for the specific consideration is important to ensure optimal patient outcomes. Considerations such as donor site morbidity and the amount and characteristics of bone graft needed all weigh in the decision making regarding which type of bone graft to use...
July 3, 2018: Journal of Hand Surgery
Jacob M Wilson, Russell E Holzgrefe, Christopher A Staley, Mara L Schenker, Clifton G Meals
PURPOSE: Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures. METHODS: We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture...
July 3, 2018: Journal of Hand Surgery
Jill G Putnam, Sean M Mitchell, Ryan M DiGiovanni, Erin L Stockwell, Scott G Edwards
PURPOSE: Treatment of scaphoid nonunion with a segmental defect presents a challenging clinical problem. Various techniques have been proposed, often involving structural grafting with vascularized and nonvascularized bone. The authors hypothesize that satisfactory clinical and radiographic outcomes are possible with a relatively simplified technique of volar plate fixation with autogenous, purely cancellous graft. METHODS: The authors performed a retrospective review of 34 patients with scaphoid nonunions with segmental defects, treated with plate fixation and purely cancellous bone grafting...
June 27, 2018: Journal of Hand Surgery
Jeffrey G Stepan, Venkat Boddapati, Hayley A Sacks, Michael C Fu, Daniel A Osei, Duretti T Fufa
Diabetes mellitus (DM) is associated with the development of carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility. Despite descriptions of poorer response to nonsurgical treatment, previous studies have not shown increased complication rates in diabetic patients after hand surgery. Few studies, however, differentiate between insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. The purpose of this study was to evaluate the impact of insulin dependence on the postoperative risk profile of diabetic patients after hand surgery using a national database...
June 26, 2018: Journal of Hand Surgery
Melissa A Wright, Casey M Beleckas, Ryan P Calfee
PURPOSE: Social, mental, and physical health have a complex interrelationship with each influencing individuals' overall health experience. Social circumstances have been shown to influence symptom intensity and magnitude of disability for a variety of medical conditions. We tested the null hypothesis that social deprivation would not impact Patient-Reported Outcomes Measurement Information System (PROMIS) scores or objective health factors in patients presenting for treatment of carpal tunnel syndrome (CTS)...
June 23, 2018: Journal of Hand Surgery
Shashank Dwivedi, Andrew D Sobel, Manuel F DaSilva, Edward Akelman
Prolotherapy is a method of treatment of painful musculoskeletal conditions whereby a sclerosing agent is injected into an area of tendinosis or osteoarthritis to strengthen and repair painful connective tissue. It is a safe, effective, and relatively inexpensive nonsurgical treatment modality. This article provides a history of prolotherapy, discusses its proposed mechanisms of action, and provides a review of the existing literature on prolotherapy as a treatment for upper extremity pathologies, specifically, hand osteoarthritis, lateral epicondylitis, and rotator cuff disease...
June 23, 2018: Journal of Hand Surgery
Jared M Smith, Frederick W Werner, Brian J Harley
PURPOSE: To determine the 6 degrees of freedom forces and moments in the distal radius that occur during a pushup or other active wrist motions. METHODS: Eight fresh-frozen cadaveric wrists were moved through 6 physiological motions and held at 1 static pushup position while the force through the distal radius was measured with a 6 degrees of freedom load cell. Three levels of compressive force were applied at the pushup position. RESULTS: Active wrist motions caused axial forces up to 283 N and moments up to 0...
June 23, 2018: Journal of Hand Surgery
M C Jansen, S Evers, H P Slijper, K P de Haas, X Smit, S E Hovius, R W Selles
PURPOSE: Carpal tunnel release (CTR) is typically offered to symptomatic patients with electrophysiological abnormalities when night orthoses no longer prevent waking with numbness and preferably before there is any static numbness, weakness, or atrophy. The ability to predict the amount of symptom relief after CTR could be beneficial for managing patient expectations and, therefore, improve treatment satisfaction. Therefore, the aim of this study was to identify predictors for symptom relief after CTR and to determine their contribution to symptom relief at 6 months after surgery...
June 23, 2018: Journal of Hand Surgery
William L Wang, Kristin Buterbaugh, Tiffany R Kadow, Robert J Goitz, John R Fowler
PURPOSE: Nerve conduction studies (NCS), CTS-6, Wainner, Kamath, and Lo are diagnostic tests that are used to diagnose carpal tunnel syndrome (CTS). To our knowledge, no study has compared the sensitivity and specificity of these 5 tests with one another. The purpose of this study is to compare NCS, CTS-6, Wainner, Kamath, and Lo using clinical diagnosis by a hand fellowship-trained orthopedic surgeon as reference standard. METHODS: A hand fellowship-trained surgeon completed the CTS-6, Wainner, Kamath, and Lo diagnostic tools...
June 20, 2018: Journal of Hand Surgery
Nicole M Sgromolo, Mickey S Cho, Joseph T Gower, Peter C Rhee
PURPOSE: Treating dorsal wrist pain of unknown etiology provides a challenge to the most experienced hand surgeon. Therefore, we conducted a study aimed to determine outcomes of patients undergoing a posterior interosseous nerve (PIN) or anterior/posterior interosseous nerve (AIN/PIN) neurectomy for wrist pain without a known cause, in patients who responded to preoperative injection. METHODS: A retrospective chart review was performed of all active duty patients undergoing isolated PIN or AIN/PIN neurectomy for idiopathic dorsal wrist pain with a documented response to preoperative injection between December 2011 and April 2017...
June 20, 2018: Journal of Hand Surgery
Stephanie A Russo, Carolyn M Killelea, Dan A Zlotolow, Scott H Kozin, Luisa M Rodriguez, Ross S Chafetz, James G Richards
PURPOSE: To quantify the effects of scapular stabilization on scapulothoracic and glenohumeral (GH) stretching. METHODS: Motion capture data during external rotation and abduction with and without scapular stabilization were collected and analyzed for 26 children with brachial plexus birth palsy. These positions were performed by an experienced occupational therapist and by the child's caretaker. Scapulothoracic and GH joint angular displacements were compared between stretches with no stabilization, stabilization performed by the therapist, and stabilization performed by the caretaker...
June 19, 2018: Journal of Hand Surgery
Juliaan R M van Rappard, Tijmen de Jong, Willy A Hummel, Marco J P F Ritt, Chantal M Mouës
PURPOSE: During mini C-arm fluoroscopy, both the patient and surgical team are exposed to scatter radiation. The objective of this study was to quantify body, thyroid, and hand radiation exposure to surgeon and assistant during intraoperative use of flat panel mini C-arm fluoroscopy in hand and wrist surgical procedures. METHODS: Over 5 months, the surgeon's and assistant's radiation exposure was recorded during all osseous hand and wrist surgical procedures. Whole-body and thyroid radiation exposure were measured with 2 types of dosimeters: a photon thermoluminescence detector and a RaySafe i2 real-time dosimeter...
June 19, 2018: Journal of Hand Surgery
Stephen Michael Crowe Ernst, David P Green, James M Saucedo
Scaphoid fracture nonunion can often lead to pain, arthrosis, and disability. While typically the result of delayed diagnosis or inadequate treatment, it can sometimes occur even if the initial care was timely and appropriate. Whereas early recognition of acute fractures allows for nonoperative management, nonunions frequently require surgical treatment. Traditionally, this has involved open debridement and bone grafting. However, some publications suggest that certain stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting...
June 19, 2018: Journal of Hand Surgery
Bhavuk Garg, Vikrant Manhas, Anand Vardhan, Deep Narayan Srivastava, Chandan J Das, Deepti Vibha, Vivek Gupta, Rajesh Malhotra, Prakash Kotwal
PURPOSE: To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. METHODS: A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery...
June 19, 2018: Journal of Hand Surgery
Jayme Augusto Bertelli
PURPOSE: To report the clinical outcomes of elbow flexion reconstruction using a reverse free gracilis muscle flap plus Steindler flexorplasty in patients with previously failed reconstruction of extended upper-type brachial plexus paralysis. METHODS: Twenty-four male patients were reoperated upon an average of 45 months (SD, ± 45 months) after brachial plexus repair. The gracilis tendon was secured to the acromion, and the muscle belly was sutured to the biceps distal tendon...
June 19, 2018: Journal of Hand Surgery
Sami H Tuffaha, Amy Quan, Shar Hashemi, Pranay Parikh, Devin M O'Brien-Coon, Justin M Broyles, A Lee Dellon, Scott D Lifchez
PURPOSE: To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis. METHODS: Cadaveric dissections were performed in 10 fresh upper extremities to better define the innervation patterns to the CMC joint and guide the surgical approach for CMC joint denervation. Histologic confirmation of candidate nerves was performed with hematoxylin and eosin staining...
June 19, 2018: Journal of Hand Surgery
Daniel E Hess, Patricia Drace, Michael J Franco, A Bobby Chhabra
Carpometacarpal (CMC) arthroplasty surgery, although modifications have occurred over time, continues to be commonly performed and has provided patients with their desired pain relief and return of function. The complications of primary surgery, although relatively rare, can present in various clinical ways. An understanding of the underlying anatomy, pathology of coexisting conditions, and specific techniques used in the primary surgery is required to make the best recommendation for a patient with residual pain following primary CMC arthroplasty...
June 19, 2018: Journal of Hand Surgery
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