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Journal of Hand Surgery

C Liam Dwyer, Maximillian Soong, Alice Hunter, Jesse Dashe, Eric Tolo, N George Kasparyan
PURPOSE: We investigated whether written guidelines for surgeons and educational handouts for patients regarding safe and effective opioid use after hand surgery could reduce prescription sizes while achieving high patient satisfaction and a low refill rate. METHODS: All patients undergoing isolated carpal tunnel release or distal radius volar locked plating in a hand surgery group practice during a 6-month period were prospectively enrolled. Surgeons prescribed analgesics at their own discretion based on written guidelines...
March 12, 2018: Journal of Hand Surgery
Michael P Gaspar, Genevieve Landes, Farinaz Safavi, A Lee Osterman
Accidental needlestick injuries are common in laboratory and health care workers. Injection of atypical pathogens, such as those encountered in the animal laboratory setting, may pose considerable problems at the site of inoculation. We present the case of an otherwise healthy laboratory worker who accidentally self-injected Freund complete adjuvant with heat-killed Mycobacterium tuberculosis into her hand, requiring multiple debridement operations over a prolonged treatment course.
March 8, 2018: Journal of Hand Surgery
Ji Hun Park, Dongmin Kim, Heesu Park, Inwon Jung, Inchan Youn, Jong Woong Park
PURPOSE: This study examined the influence of triangular fibrocartilage complex (TFCC) deep fiber tears on wrist proprioception. METHODS: The study involved 48 subjects: 24 with deep fiber TFCC tears and 24 with healthy wrists. A specially created sensor measured wrist proprioception in 3 axes of movement. Absolute differences between target and subject-reproduced angles were compared in injured and healthy wrists and in injured and contralateral patient wrists...
March 6, 2018: Journal of Hand Surgery
Francisco Del Piñal, Eduardo Moraleda, Jaime S Rúas, Ana Rodriguez-Vega, Alexis Studer
PURPOSE: To present a new arthroscopic method for treating supination losses. METHODS: Six patients (15-71 y) were eligible for this study. All had a history of trauma to the wrist more than 6 months previously. Five of them had sustained a distal radius fracture: 3 had been treated with a volar plate (1 of them for an extra-articular malunion), 1 with an external fixator and K-wires, and 1 had been treated in a cast. One of these patients underwent a further operation for correcting an intra-articular malunion...
March 6, 2018: Journal of Hand Surgery
Ricardo Kaempf de Oliveira, Pedro José Delgado, Samuel Ribak, Jayme Augusto Bertelli, Fabiano da Silva Marques
A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure was performed. Complete bone healing was achieved. Ten years later, an excellent functional result was maintained, with a pain-free wrist, an acceptable wrist joint range of motion, as well as a favorable aesthetic appearance...
March 3, 2018: Journal of Hand Surgery
Abdo Bachoura, Eric J Yakish, John D Lubahn
PURPOSE: To evaluate the survival and long-term outcomes of thumb metacarpal extension osteotomy for early carpometacarpal (CMC) arthritis. METHODS: Patients who underwent a thumb extension osteotomy between years 2000 and 2011 were identified. Patient demographics, complications, and reoperations were recorded. The Kaplan-Meier survival analysis was used with subsequent CMC surgery defined as failure. Patients who had undergone surgery 10 years or more before the study date underwent radiographic assessment, grip and pinch strength testing, and completed the Patient Rated Wrist/Hand Evaluation (PRWHE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires...
March 1, 2018: Journal of Hand Surgery
Sheriff D Akinleye, Maya Deza Culbertson, Giacomo Cappelleti, Nicholas Richardson, Jack Choueka
PURPOSE: Transecting the extensor pollicis longus (EPL) tendon and rerouting it through the first extensor compartment is an established technique for treating thumb-in-palm deformity (TIPD). An alternative technique that approximates the trajectory of the first extensor compartment without violating the compartment or transecting the EPL tendon can be accomplished by creating an artificial sheath from the extensor retinaculum to radialize the tendon glide path. This study compares this extracompartmental (EC) EPL transposition to the established, intracompartmental (IC) transposition by evaluating, in a cadaver model, the extent of thumb extension in both techniques...
February 27, 2018: Journal of Hand Surgery
Anita Dijksterhuis, Emmi Friedeman, Brigitte van der Heijden
Squamous cell carcinoma of the nail unit (SCCNU) is often misdiagnosed and improperly treated because it mimics a number of other conditions. This review details current knowledge of anatomy, pathophysiology, clinical presentation, diagnosis, and treatment of SCCNU. A heightened clinical awareness is critical to treating SCCNU and preventing development of advanced disease at which time amputation is needed and metastasis may occur. Physicians should consider SCCNU in each case of a nail abnormality unresponsive to topical treatment...
February 24, 2018: Journal of Hand Surgery
Christopher J Dy, Benjamin Aunins, David M Brogan
The physiological limitations of neural regeneration make peripheral nerve surgery challenging to both the surgeon and the patient. Presence of nerve gaps and local wound factors may all influence outcome, suggesting that barriers to reduce perineural scarring, minimize fibrosis, and avoid ischemia would be beneficial. To examine the evidence supporting their use, we reviewed the autologous and commercially-available options for barriers against scarring around a nerve. Numerous clinical case series demonstrated the effectiveness and safety of local/rotational flaps and autologous vein wrapping when used in the presence of recurrent compressive neuropathy...
February 24, 2018: Journal of Hand Surgery
Anthony L Logli, Brian J Bear, Edric G Schwartz, Kenneth J Korcek, Brian J Foster
PURPOSE: To determine if any significant differences exist in patient-reported or clinical outcomes among 3 different postoperative orthotic regimens: no orthosis, removable orthosis, and plaster nonremovable orthosis-following miniopen carpal tunnel release (CTR) surgery for symptomatic isolated carpal tunnel syndrome. METHODS: A total of 249 patients received a miniopen CTR and were subsequently randomized into 1 of 3 orthotic regimens: 80, no orthosis; 83, removable orthosis; and 86, nonremovable orthosis-to be removed at the first postoperative visit 10 to 14 days later...
February 24, 2018: Journal of Hand Surgery
Jeffrey Kutsikovich, Gregory Merrell
PURPOSE: To determine the accuracy of ultrasound-guided (UG) injections compared with anatomic landmark-guided (AL) injections in the first dorsal compartment (FDC) with the hypothesis that ultrasound guidance would increase the accuracy of injection. METHODS: We randomized 43 above-elbow cadaveric specimens to receive latex dye injections into the FDC via a UG or AL technique. If ultrasound imaging identified a septated FDC, the needle was redirected and a portion of the dye was injected around the extensor pollicis brevis (EPB) tendon...
February 23, 2018: Journal of Hand Surgery
Eric Quan Pang, Nathan Douglass, Anthony Behn, Matthew Winterton, Michael J Rainbow, Robin N Kamal
PURPOSE: The ideal material for reconstruction of the scapholunate interosseous ligament (SLIL) should replicate the mechanical properties of the native SLIL to recreate normal kinematics and prevent posttraumatic arthritis. The purpose of our study was to evaluate the cyclic torsional and tensile properties of the native SLIL and load to failure tensile properties of the dorsal SLIL. METHODS: The SLIL bone complex was resected from 10 fresh-frozen cadavers. The scaphoid and lunate were secured in polymethylmethacrylate and mounted on a test machine that incorporated an x-y stage and universal joint, which permitted translations perpendicular to the rotation/pull axis as well as nonaxial angulations...
February 17, 2018: Journal of Hand Surgery
Patrick B Morrissey, Ryan Myers, Daniel Houskamp, Leo T Kroonen
PURPOSE: Ulnohumeral arthroplasty, also known as the Outerbridge-Kashiwagi procedure, was popularized after reports of successful results in 1978, and has long been a means of management for ulnohumeral arthritis. However, there are concerns over the loss of integrity of the distal humerus as a result of fenestration. The purpose of this study was to examine the relationship between the size of fenestration and fracture risk. METHODS: Using a validated fourth-generation sawbones model, load to failure and site of fracture were investigated following incrementally increasing distal humeral fenestration sizes...
February 16, 2018: Journal of Hand Surgery
Charmaine Baxter, Thomas A Miller, Douglas C Ross, Christopher Doherty
Cervical spondylotic amyotrophy is characterized by severe, proximal upper extremity weakness including an inability to abduct the shoulder and flex the elbow. Treatment using both medical and surgical decompression approaches has produced variable results. This paper reports the use of nerve transfers (spinal accessory to suprascapular, flexor carpi ulnaris fascicle of ulnar to biceps motor branch, radial nerve branch to triceps to axillary) to restore shoulder and elbow function in a case of unilateral cervical spondylotic amyotrophy involving C5 and C6 myotomes...
February 16, 2018: Journal of Hand Surgery
Ronnie L Shammas, Nathan Mela, Scott Wallace, Betty C Tong, Joel Huber, Suhail K Mithani
PURPOSE: We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure. METHODS: Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture...
February 15, 2018: Journal of Hand Surgery
Peter Axelsson, Johan Kärrholm
PURPOSE: To determine the repeatability and validity of new methods designed to objectively measure forearm torque and lifting strength in a clinical setting. METHODS: Twenty-eight healthy volunteers, 19 women and 9 men, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. Two raters tested each participant on 3 occasions in the standing position. One of the raters also examined 15 subjects, 3 times, for forearm torque in the seated position and for lifting strength and forearm torque by the Work Simulator II, Baltimore Therapeutic Equipment (BTE II)...
February 14, 2018: Journal of Hand Surgery
Taiichi Matsumoto, Ryosuke Kakinoki, Ryosuke Ikeguchi, Souichi Ohta, Masao Akagi, Shuichi Matsuda
PURPOSE: To report the outcomes of patients with stage III Kienböck disease treated by vascularized bone graft (VBG) followed by temporary scaphocapitate (SC) fixation, a minimum of 2 years after surgery. METHODS: Twenty-six patients (mean age, 35 years) with stage III Kienböck disease (16 with stage IIIA and 10 with stage IIIB), treated with VBG followed by SC fixation for 4 months, were retrospectively followed for at least 2 years (range, 24-121 months; mean, 61...
February 14, 2018: Journal of Hand Surgery
Peter Axelsson, Per Fredrikson, Anders Nilsson, Jonny K Andersson, Johan Kärrholm
PURPOSE: To establish reference values for new methods designed to quantitatively measure forearm torque and lifting strength and to compare these values with grip strength. METHODS: A total of 499 volunteers, 262 males and 237 females, aged 15 to 85 (mean, 44) years, were tested for lifting strength and forearm torque with the Kern and Baseline dynamometers. These individuals were also tested for grip strength with a Jamar dynamometer. Standardized procedures were used and information about sex, height, weight, hand dominance, and whether their work involved high or low manual strain was collected...
February 10, 2018: Journal of Hand Surgery
Ki Won Lee, Joo Yul Bae, Dong-Kyo Seo, Sang Bum Kim, Hyun Il Lee
PURPOSE: This study aimed to establish normal values for wrist carpal alignment measured by 3-dimensional computed tomography (CT) and to show the inter- and intraobserver reliability of this measurement compared with simple radiography. METHODS: The study utilized 3-dimensional CT and simple radiography of wrist joints in 30 asymptomatic volunteers. The wrist position was standardized using a custom-designed positioning device. Three independent observers measured carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radiocapitate angle, radius-third metacarpal angle, scapholunate angle, lunocapitate angle, and lunate-third metacarpal angle...
February 7, 2018: Journal of Hand Surgery
Jennifer Moriatis Wolf, Isam Atroshi, Caddie Zhou, Jon Karlsson, Martin Englund
PURPOSE: Patients undergoing surgery for thumb carpometacarpal (CMC1) osteoarthritis often require sick leave owing to postoperative immobilization, pain, and decreased function. Our goal was to evaluate the amount of sick leave after surgery for 2 common CMC1 arthroplasty procedures. METHODS: Using registry data from the Skåne region of southern Sweden, cross-linked with employment data showing person-specific sick leave, 2 cohorts of CMC1 surgical patients, between ages 40 and 59 years, were examined...
February 7, 2018: Journal of Hand Surgery
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