Journal Of Hand And Microsurgery[JOURNAL]
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200 papers
A case report of microsurgical penile replantation: Engaging multi-disciplinary expertise to optimise patient outcomes.
Geary E, Francis E, Menzies D … +3 more , Lennon G, Morrison CM, Dolan RT
J Hand Microsurg · 2025 Mar · PMID 39882353 · Full text
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Rethinking brachial plexus birth palsy: Beyond physician blame.
Jerome JTJ, Leechavengvongs S, Malungpaishrope K … +1 more , Kuppusamy T
J Hand Microsurg · 2025 Jan · PMID 39876958 · Full text
Brachial plexus birth palsy, a devastating injury affecting newborns, has long been a source of contention and misunderstanding. This article aims to dispel the myth that healthcare providers are solely responsible for t...
Brachial plexus birth palsy, a devastating injury affecting newborns, has long been a source of contention and misunderstanding. This article aims to dispel the myth that healthcare providers are solely responsible for these injuries, presenting evidence that highlights the complex interplay of maternal, fetal, and biological factors in their causation. By shifting the narrative away from blame and towards a more comprehensive understanding, we can foster a more supportive and informed approach to childbirth.
A systematic review of systematic reviews comparing simple trapeziectomy versus trapeziectomy with ligament reconstruction and tendon interposition for trapeziometacarpal osteoarthritis.
Fang E, Behroozian T, Thoma A
J Hand Microsurg · 2025 Jan · PMID 39876957 · Full text
BACKGROUND: The outcomes of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal (TMC) osteoarthritis have been compared in several systematic...
BACKGROUND: The outcomes of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal (TMC) osteoarthritis have been compared in several systematic reviews (SRs) with conflicting results across the various outcomes studied. Despite a lack of conclusions regarding the superiority of one treatment versus the other, LRTI remains the most popular surgical option. This raises the questions of whether published SRs are of high methodological quality, and whether discordant conclusions can be attributed to differences in methodologic quality. To answer these, a SR of SRs comparing T vs LRTI was conducted. METHODS: A search of MEDLINE, EMBASE, and the Cochrane Database of SRs was performed from 1946 to September 18, 2023. SRs directly comparing T vs LRTI for TMC osteoarthritis were selected for inclusion. Methodological characteristics, results and conclusions of the selected SRs were extracted. Outcomes and conclusions were assessed for disagreement in the context of methodological differences. Quality of the included reviews was assessed using the AMSTAR 2 tool. RESULTS: Seven SRs, published between 2004 and 2022, were included. Based on AMSTAR 2 criteria, all seven SRs received a quality rating of "critically low" due to weaknesses in more than one critical domain. The most frequent weaknesses in critical domains included: failure to indicate that the review followed an protocol (5 of 7 SRs), failure to provide a list of excluded studies and justification for each (5 of 7 SRs), failure to account for risk of bias from primary studies when discussing results (4 of 7 SRs), and failure to justify methods used for meta-analysis (4 of 5 meta-analyses). CONCLUSIONS: SRs comparing T vs LRTI have had methodological or reporting flaws which limit confidence in results. Future SRs should ensure a rigorous methodology is followed and clearly reported in the publication.
Evaluating the diagnostic utility of the flexion-compression test for carpal tunnel syndrome.
Denduluri SK, Ford S, Odum S … +3 more , Geary MB, Gaston RG, Loeffler BJ
J Hand Microsurg · 2025 Jan · PMID 39876956 · Full text
BACKGROUND: We sought to determine the diagnostic utility of the flexion-compression (F-C) test for carpal tunnel syndrome (CTS). Using electrodiagnostic testing as the gold standard, we hypothesized that the F-C test wo...
BACKGROUND: We sought to determine the diagnostic utility of the flexion-compression (F-C) test for carpal tunnel syndrome (CTS). Using electrodiagnostic testing as the gold standard, we hypothesized that the F-C test would be a better diagnostic test for CTS as compared to the wrist flexion (Phalen's) or palmar compression (Durkan's) tests alone. METHODS: We studied patients who presented with and without CTS symptoms, designated as study and control group patients, respectively. At the first clinic visit, all patients were evaluated using the CTS-6 score, and then the Phalen's, Durkan's, and F-C tests in a random order. Patients in the study group were then sent for electrodiagnostic testing. RESULTS: 162 patients were included after power analysis, 81 each in the study and control groups. Among study group patients with electrodiagnostic evidence of CTS, the positive likelihood ratio (LR+) of the Phalen's test (1.29) was higher than the Durkan's (1.06) and F-C (0.95) tests, though less than the CTS-6 score (1.64). Performing any physical exam test in conjunction with the CTS-6 score was not more useful than the CTS-6 alone. As expected, all three physical exam maneuvers were more likely to be positive among study patients compared to control patients. CONCLUSIONS: None of the physical exam maneuvers were highly predictive of electrophysiologically-positive CTS. The CTS-6 score alone better predicts electrodiagnostic evidence of CTS than physical exam, though it only very slightly increases the post-test probability of disease. Formal electrodiagnostic testing remains important in diagnosing CTS when compared to physical exam maneuvers and CTS-6.
Vascularised Composite Allotransplantation - A guide to optimal dissemination of scientific outputs.
Hehir CM, Dowling GP, Calpin GG … +5 more , O'Connor M, Kelly L, Honeyman CS, Stark HL, Dolan RT
J Hand Microsurg · 2025 Jan · PMID 39876955 · Full text
PURPOSE: The impact of academic research is not just important within the clinical domain but within society as a whole. Altmetric Attention Score (AAS) offers a means of assessing how scholarly outputs are interacted wi...
PURPOSE: The impact of academic research is not just important within the clinical domain but within society as a whole. Altmetric Attention Score (AAS) offers a means of assessing how scholarly outputs are interacted with online. Vascularised Composite Allotransplantation (VCA) is a modern but rapidly evolving topic which encompasses a broad range of complex and clinically significant surgical interventions. Primarily VCA is utilised in the reconstruction of complex, composite tissue defects, including limb and face transplantation. There is also a growing interest in the role of VCA as an early means of real-time immuno-monitoring, in sentinel skin flap transplant (SSF). MATERIALS & METHODS: In July 2024, a search was conducted using the database using the search term 'vascular-composite' AND 'allograft' OR 'allotransplant'. A simultaneous literature search was carried out using Web of Science (WoS) database utilising the same search terms with extraction of traditional citation-based metrics as well as relevant ' and ' subject headings. Corresponding citation-based metrics were extracted utilising . Data was compiled and analysed using a linear regression model with level of significance set at p < 0.05. RESULTS: The Top 100 (T100) performing articles relating to VCA displayed a mean Altmetric Attention Score (AAS) of 3.31. All T100 papers were published in the English language. Sixty percent (n = 60) of T100 papers were published in Q1 Journals. News outlet mentions (r = 6.95), blog mentions (r = 6.20), and mentions (r = 0.52) demonstrated the greatest positive impact on AAS upon application of a linear regression model (p < 0.05). CONCLUSION: Altmetric Scores offer a means of appraising the impact of research outputs in both academic and societal domains. Such modern metrics are useful in evolving topics such as VCA as AAS is not dependent on citation counts. Publishing of outputs in high quartile, open access journals with timely utilisation of news and social media outlets should be utilised by researchers aiming to maximise dissemination of research outputs in the field of VCA.
Comparison of WALANT and general anaesthesia for trapeziectomy and abductor pollicis longus hammock ligamentoplasty.
Demi R KR, Karademi R F, Ayhan E … +2 more , Baş CE, Ersan Ö
J Hand Microsurg · 2025 Jan · PMID 39876954 · Full text
BACKGROUND: Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available...
BACKGROUND: Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available for TMC joint surgery, including wide-awake local anaesthesia no tourniquet (WALANT), regional anaesthesia, and general anaesthesia (GA). The aim of this study was to compare the clinical outcomes of trapeziectomy and abductor pollicis longus hammock ligamentoplasty performed under WALANT versus GA. METHODS: This retrospective study included 22 patients who underwent surgery for TMC OA between 2017 and 2019. Patients' pre- and post-operative pain intensity, grip and pinch strength, and functional scores were compared. Pain intensity was assessed 1 h after surgery, while overall outcome measures were evaluated one year post-operatively. RESULTS: The results showed that patients who underwent WALANT had significantly lower pain intensity 1 h postoperatively compared to those who received GA. Both groups experienced a reduction in pain, improvement in grip strength, and functional scores after at one year, with no significant differences between them. No significant differences were found between the GA and WALANT groups in terms of postoperative VAS scores, grip strength, and functional scores. CONCLUSIONS: We recommend WALANT for trapeziectomy and APL hammock ligamentoplasty due to its effectiveness in reducing early post-operative pain and achieving functional outcomes comparable to those of GA.
Clinical results of carpal tunnel Re-release revision surgery and synovial wrap for recurrent carpal tunnel syndrome.
Kimura M, Ikeguchi R, Noguchi T … +7 more , Nankaku M, Yamawaki R, Yoshimoto K, Sakamoto D, Iwai T, Fujita K, Matsuda S
J Hand Microsurg · 2025 Jan · PMID 39876953 · Full text
INTRODUCTION: Carpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision sur...
INTRODUCTION: Carpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up. PATIENTS AND METHODS: A retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm × 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up. RESULTS: All patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 ± 10.3, 19.3 ± 12.7, respectively) were significantly lower than those recorded before surgery (76.5 ± 11.1, 52.4 ± 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up. CONCLUSION: Carpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.
Cross intrinsic transfer for ulnar drift in the rheumatoid hand under wide awake local anesthesia No tourniquet - Surgical technique.
Jerome JTJ
J Hand Microsurg · 2025 Jan · PMID 39876952 · Full text
This article introduces a surgical technique for cross-intrinsic transfers (CIT) to correct ulnar drift in rheumatoid hands performed under wide-awake local anesthesia no tourniquet (WALANT). This approach allows real-ti...
This article introduces a surgical technique for cross-intrinsic transfers (CIT) to correct ulnar drift in rheumatoid hands performed under wide-awake local anesthesia no tourniquet (WALANT). This approach allows real-time adjustment of tendon transfer tension and active patient participation in hand movements and deformity correction during the procedure. It can be combined with other surgeries such as prosthetic replacement arthroplasties of the MCP joints. The technique was applied to six patients, resulting in a significant reduction of ulnar deviation from an average of 70° preoperatively to 8° postoperatively. All patients reported high satisfaction with good outcomes.
Using machine and deep learning to predict short-term complications following trigger digit release surgery.
Shah RM, Khazanchi R, Bajaj A … +3 more , Rana K, Saklecha A, Wolf JM
J Hand Microsurg · 2025 Jan · PMID 39876951 · Full text
BACKGROUND: Trigger finger is a common disorder of the hand characterized by pain and locking of the digits during flexion or extension. In cases refractory to nonoperative management, surgical release of the A1 pulley c...
BACKGROUND: Trigger finger is a common disorder of the hand characterized by pain and locking of the digits during flexion or extension. In cases refractory to nonoperative management, surgical release of the A1 pulley can be performed. This study evaluates the ability of machine learning (ML) techniques to predict short-term complications following trigger digit release surgery. METHODS: A retrospective study was conducted using data for trigger digit release from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) years 2005-2020. Outcomes of interest were 30-day complications and 30-day return to the operating room. Three ML algorithms were evaluated - a Random Forest (RF), Elastic-Net Regression (ENet), and Extreme Gradient Boosted Tree (XGBoost), along with a deep learning Neural Network (NN). Feature importance analysis was performed in the highest performing model for each outcome to identify predictors with the greatest contributions. RESULTS: We included a total of 1209 cases of trigger digit release. The best algorithm for predicting wound complications was the RF, with an AUC of 0.64 ± 0.04. The XGBoost algorithm was best performing for medical complications (AUC: 0.70 ± 0.06) and reoperations (AUC: 0.60 ± 0.07). All three models had performance significantly above the AUC benchmark of 0.50 ± 0.00. On our feature importance analysis, age was distinctively the highest contributing predictor of wound complications. CONCLUSIONS: Machine learning can be successfully used for risk stratification in surgical patients. Moving forwards, it is imperative for hand surgeons to continue evaluating applications of ML in the field.
A framework for optimizing postoperative scars: A Therapist's perspective.
Taylor A, Harvey EG, Jose Jerome JT
J Hand Microsurg · 2025 Jan · PMID 39876950 · Full text
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Treatment of distal femur aseptic nonunion after lateral locking plate fixation: Results of medial custom made plating and free fibula flap transfer using CAD-CAM technology.
Ramella V, Canton G, Dussi M … +9 more , Formentin C, Scamacca V, Bagnacani F, Belinda T, Spazzapan L, Troisi L, Grezar L, Papa G, Murena L
J Hand Microsurg · 2025 Jan · PMID 39876949 · Full text
BACKGROUND: Aim of the present paper is to report the preliminary results of CAD-CAM (Computer-Aided Design - Computer-Aided Manufacturing) technology application to distal femur nonunion treatment with free fibula flap,...
BACKGROUND: Aim of the present paper is to report the preliminary results of CAD-CAM (Computer-Aided Design - Computer-Aided Manufacturing) technology application to distal femur nonunion treatment with free fibula flap, custom made medial plating and maintenance of a stable lateral locking plate. METHODS: Two cases of distal femur nonunion that occurred after lateral locking plating were treated and prospectively followed-up. Surgical planning followed the same preoperative protocol adopted for mandibular CAD-CAM reconstruction. Wide cutting sections were planned to obtain radical debridement. The tailored custom-made plate, a 3D rendering of bone defect and the cutting guides were produced and sterilized. Surgical intervention was conducted by steps (medial approach, bone resection, recipient vessels isolation, fibula harvesting and cutting, plate-fibula construct assembly, microvascular anastomosis, final fixation). RESULTS: The mean follow-up was 13 (12-15) months. Bone union was achieved in both cases at mean 3.1 months. Full weight bearing without referred pain or discomfort was reached in both cases at mean 8,5 months (range 7-10). No complications occurred. CONCLUSIONS: CAD-CAM technology proved to be useful and reliable in custom made medial plating combined with free fibula transfer for the treatment of distal femur nonunion after lateral locking plating. TRIAL REGISTRATION: none.
A retrospective comparison of absorbable versus non-absorbable sutures for elective hand surgery wound closures.
Nemirov D, Dentcheva E, Thurmond T … +3 more , Bachoura A, Hirsch D, Tosti R
J Hand Microsurg · 2025 Jan · PMID 39876948 · Full text
BACKGROUND: Suture selection in elective hand surgery closures has traditionally been non-absorbable sutures (NAS) rather than absorbable sutures (AS). The goal of this study was to evaluate absorbable versus non-absorba...
BACKGROUND: Suture selection in elective hand surgery closures has traditionally been non-absorbable sutures (NAS) rather than absorbable sutures (AS). The goal of this study was to evaluate absorbable versus non-absorbable closures of various primary elective hand procedures. Our group hypothesized that no differences in major short-term outcomes would exist. METHODS: A retrospective review of 867 patients was conducted. Patients were identified using Current Procedural Terminology (CPT) codes specific to surgical cases from forearm to fingertip. Patients undergoing emergent trauma operations or debridement for infection were excluded. Two experimental groups were evaluated: one in which surgical wound closures were performed with non-absorbable suture (nylon) vs one in which closures were performed with absorbable suture (monocryl). Outcomes measured were wound dehiscence, need for postoperative antibiotics, 30-day general complications, and reoperations within 60 days. RESULTS: A total of 867 patients were investigated in this study. The AS cohort consisted of 455 patients whereas the NAS group contained 412. No significant differences were noted between the AS and NAS groups with regards to age, gender, or diabetes. Postoperatively, there was no significant difference in rates of dehiscence, infections, or antibiotic prescription. Furthermore, rates of 30-day complications (1.36 % vs 1.47 %; p = 1.000), 60-day complications (0.68 % vs 2.19 %; p = 0.113) and reoperation (1.13 % versus 1.46 %; p = 0.903) were similar between the AS and NAS cohorts. CONCLUSION: Wound closure in hand surgery using absorbable suture appears to have comparable outcomes with non-absorbable suture. LEVEL OF EVIDENCE: 3.
Outcomes of wrist denervation and core decompression of the radius for Kienbock's disease.
Forrester LA, Tedesco LJ, Geiger B … +1 more , Strauch RJ
J Hand Microsurg · 2025 Jan · PMID 39876947 · Full text
BACKGROUND: The definitive treatment of Kienbock's disease has yet to be determined. Wrist denervation combined with core decompression of the radius has not been previously studied as a combined treatment for Kienbock's...
BACKGROUND: The definitive treatment of Kienbock's disease has yet to be determined. Wrist denervation combined with core decompression of the radius has not been previously studied as a combined treatment for Kienbock's disease. PURPOSE: The purpose of this study was to assess the efficacy of simultaneous wrist denervation and core decompression of the radius in the treatment of Kienbock's disease. METHODS: All patients with Kienbock's disease who were treated with simultaneous core decompression of the radius and wrist denervation by a single surgeon at a single institution from 2012 to 2022 were contacted for this study. Demographic, clinical and radiographic data were collected retrospectively. Quick DASH and Upper Extremity PROMIS scores were collected prospectively. RESULTS: Ten patients met inclusion criteria. Mean age at time of surgery was 31 years old. One patient was Lichtman stage 2, 5 patients were stage 3a, and 4 patients were stage 3 b. Patient reported outcomes were collected at a mean of 5.1 years since surgery (7 month-10.3 years). The mean Upper Extremity Promise T-score was 49 (median 52; age >/ = 40, normal 51.2 ± 8.2; age <40, normal 55.9 ± 6.6) and the mean Quick DASH score was 13 (median 7; normal 0-20). Nine of 10 patients reported they were satisfied with the procedure, and 100 % of patients said they would choose to have the procedure again. CONCLUSIONS: Patients with Lichtman stage 2, 3a and 3 b Kienbock's disease treated with simultaneous core decompression and wrist denervation reported minimal to no disability at 5 years after surgery. All patients in this study reported they would choose to have the surgery again to treat their Kienbock's disease.
The long-term functional outcome of the mangled upper extremity intricate management. A single center experience.
Athanaselis ED, Mylonas T, Konstantinou E … +3 more , Hantes M, Karachalios T, Varitimidis S
J Hand Microsurg · 2025 Jan · PMID 39876946 · Full text
PURPOSE: Severe injury of multiple anatomical structures of the upper extremity can be caused by an extremely violent mechanism during labor and motor vehicle accidents, gunshots and explosions. The mangled upper extremi...
PURPOSE: Severe injury of multiple anatomical structures of the upper extremity can be caused by an extremely violent mechanism during labor and motor vehicle accidents, gunshots and explosions. The mangled upper extremity consists of trauma of at least 3 of 4 tissue types: connective tissue (skin, subcutaneous tissue, tendons, muscles), vessels, nerves, and bones. The purpose of this study is to evaluate the medium and long-term results of the limb salvage management of those injuries in our department. METHODS: Sixty-seven patients with multi-injured upper limb were operated in our department between 2014 and 2022 and evaluated with clinical examination and questionnaires (PROMs) on an outpatient basis at a mean follow up of 7.4 years. Patients' demographics, the injured anatomic structures and the surgical interventions needed, were recorded. RESULTS: The overall outcome, configured by functional scores was quite acceptable concerning injuries' severity. Nineteen patients (29 %) underwent more than one operation, 2-point discrimination test was impaired in 30 % of the patients who had an injured nerve and total loss of regional sensation was diagnosed in 2 patients. Primary amputation was necessary in 8 % of the patients. CONCLUSIONS: Even though the mangled upper extremity refers to a severe injury with often poor postoperative results and high rates of amputations, a thorough evaluation and management by expert hand surgeons is essential for maximizing the possible outcomes.
Safety and efficacy of outpatient versus inpatient adult brachial plexus surgery.
Drexelius KD, Saltzman EB, Bonvillain KW … +6 more , Mastracci JC, Gachigi KK, Lewis DR, Waters PM, Loeffler BJ, Gaston RG
J Hand Microsurg · 2025 Jan · PMID 39876945 · Full text
PURPOSE: Outpatient orthopedic surgery is becoming more common as a method of providing safe and cost-effective medical care. The purpose of this study was to compare outcomes between adult patients undergoing outpatient...
PURPOSE: Outpatient orthopedic surgery is becoming more common as a method of providing safe and cost-effective medical care. The purpose of this study was to compare outcomes between adult patients undergoing outpatient versus inpatient brachial plexus surgery. METHODS: A single institution database was queried for patients with brachial plexus injuries undergoing brachial plexus exploration with or without concomitant reconstructive procedures from 2010 to 2022. Outcome measures included 90-day major and minor complications, as well as longer term pain scores and reoperation rates. Multivariate analysis was performed to compare outcomes between the cohorts. RESULTS: In a group of 51 adult patients, 36 (70.6 %) were admitted for at least one night following surgery and 15 (29.4 %) underwent outpatient surgery. The cohorts were similar with respect to demographics. When compared to brachial plexus procedures performed between 2010 and 2016, those performed between 2017 and 2022 were 67 % more likely to be outpatient (OR 0.33; p = 0.11). The overall major complication rate during the 90-day episode of care was 11.8 % (n = 6), all of which occurred in the inpatient cohort There was no significant difference in minor complication rate. 90-day reoperation rate due to complications was 2.8 % in the inpatient cohort and 0.0 % in the outpatient cohort. CONCLUSION: No prior study has assessed the safety of brachial plexus exploration and reconstruction in an outpatient setting. This study demonstrates that outpatient brachial plexus surgery is a safe option for properly selected patients. Procedures were more often performed outpatient in recent years, reflecting a continuing evolution of our practice.
A comparison study of 90-day readmission and emergency department visitation after outpatient versus inpatient pediatric pollicization surgery.
Mastracci JC, Saltzman EB, Bonvillain KW … +5 more , Drexelius KD, Woodside JC, Chadderdon RC, Waters PM, Gaston RG
J Hand Microsurg · 2025 Jan · PMID 39876944 · Full text
INTRODUCTION: Transition to outpatient surgery has grown with an emphasis on delivery of safe, high-quality medical care. The purpose of this study is to compare 90-day emergency department (ED) visits, readmissions, and...
INTRODUCTION: Transition to outpatient surgery has grown with an emphasis on delivery of safe, high-quality medical care. The purpose of this study is to compare 90-day emergency department (ED) visits, readmissions, and complications between patients undergoing outpatient versus inpatient pollicization surgery. METHODS: A single institution database was queried for primary thumb pollicization from 2010 to 2022 in patients under 18 years of age. Standard demographic data, comorbidities, surgical information, and discharge disposition were collected. Primary outcome measures were complications including ED visits, unplanned reoperations and hospital readmissions within 90-days of index procedure. RESULTS: Twenty-seven patients underwent pollicization surgery. Twenty patients were outpatient surgery while 7 had postoperative hospital admission, defined as an overnight hospital stay. The outpatient cohort had no major postoperative complications including no ED visits, reoperations or readmissions within 90 days of index procedure. One outpatient experienced swelling around bilateral thumb pin sites without infection or vascular compromise. One inpatient represented to the ED within 90 days of surgery for bilateral hand cellulitis.All patients with ASA I classification were performed outpatient. Three of 7 inpatients (43 %) had congenital heart disease versus 5 of the 20 (25 %) outpatients. There was a trend that inpatients were younger than the outpatient cohort (19 vs. 33 months). The average length of procedure in the inpatient cohort was significantly longer than the outpatient cohort (237 vs. 173 min). Pollicizations performed between 2017 and 2022 were more likely to be outpatient than those performed between 2010 and 2016. CONCLUSION: On properly selected patients, outpatient pollicization appears to be a safe option. Patients with longer operative times were more likely to require postoperative hospital admission. Over the study years evaluated at our institution, pollicization procedures were more likely to be performed outpatient, reflecting an evolution of our practice. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
Ultrasound imaging: Enhancing the diagnosis of carpal tunnel syndrome.
Lander D, Lowyck H, Decramer A … +1 more , Vanmierlo B
J Hand Microsurg · 2025 Jan · PMID 39876943 · Full text
Broader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability t...
Broader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability to uncover hidden anomalies and assist in surgical planning.
Lunate prosthetic arthroplasty for the treatment of Kienbock's disease: A systematic review.
Vaghela KR, Selby A, Heras-Palou C … +1 more , Johnson N
J Hand Microsurg · 2025 Mar · PMID 39866368 · Full text
PURPOSE: Prosthetic replacement of the fragmented, collapsed and unreconstructable lunate is a treatment option in Kienbock's disease. The objective of this study is to assess the effectiveness, safety and outcomes of pr...
PURPOSE: Prosthetic replacement of the fragmented, collapsed and unreconstructable lunate is a treatment option in Kienbock's disease. The objective of this study is to assess the effectiveness, safety and outcomes of prosthetic lunate arthroplasty for the treatment of Kienbock's disease. METHODS: We conducted a PRISMA-P compliant systematic review PROSPERO (CRD 42021283996) searching Cochrane, Medline, PubMed and Embase databases for the outcomes of prosthetic lunate arthroplasty. Primary outcomes were patient reported outcome measures, complications and re-operations. Secondary outcomes were pain, grip strength and range of motion. RESULTS: 1093 citations were identified of which 42 studies met the inclusion criteria. Five types of prosthetic lunate arthroplasty were identified including silicone, pyrocarbon, acrylic, metal and 3D printed lunates. Swanson silicone lunates (n = 70) had a 78.5 % complication and 21.4 % re-operation rate at long-term (275.5 months) follow-up with high silicone synovitis incidence. High performance silicone lunates (n = 47) had a 63.8 % complication and 14.8 % re-operation rate at medium term (52.2 months) follow-up. Acrylic lunates (n = 14) had a complication rate of 14.2 % and re-operation rate of 7.1 % at long-term (169.4 months) follow-up. Metal lunates (n = 41) had a 7.3 % complication and re-operation rate at medium-term (120 months) follow-up. Anatomic design Pyrocarbon lunates (n = 13) with medium-term (30.3 months) follow-up had a 23 % complication rate and a 15.3 % re-operation rate with high implant dislocation incidence. 3D-Printed lunates (n = 7) with short-term (14.4 months) follow-up had no complications. CONCLUSIONS: The role of lunate prosthetic arthroplasty in the treatment of Kienbock's disease remains uncertain. Early silicone implants had unacceptably high complication and revision rates and their use has been discontinued as a result. Modern materials such as pyrocarbon and bespoke 3D printed designs remain unproven in the long-term and the challenges of maintaining implant stability remain.
Top 75 most-cited articles in hand microsurgery: A bibliometric and visualised analysis.
Wong ZY, Adegboye O, Damavandi P … +5 more , Faderani R, Kanapathy M, Miranda BH, Nikkhah D, Mosahebi A
J Hand Microsurg · 2025 Mar · PMID 39866367 · Full text
INTRODUCTION: Hand microsurgery is an important advancement of the speciality that has improved outcomes in hand trauma and hand surgical conditions. This bibliometric analysis aims to identify the 75 most cited hand mic...
INTRODUCTION: Hand microsurgery is an important advancement of the speciality that has improved outcomes in hand trauma and hand surgical conditions. This bibliometric analysis aims to identify the 75 most cited hand microsurgery articles and explore their relevance to contemporary practice. METHODS: The Web of Science core collection database was used to screen and identify the top 75 most-cited articles relevant to hand microsurgery. VOSviewer 1.6.18 and CiteSpace 6.2.R4 software were used to analyse and visualise occurrences, authorship, countries, institutions, journals, keywords, and Evidence Level (Oxford Centre for Evidence-Based Medicine). RESULTS: The initial search identified 3024 articles. The top 75 most-cited articles were published between 1980 and 2018, with contributions from 291 authors. Professor Fu Chang Wei from Chang Gung Memorial Hospital, Taiwan, was the most prolific author. Articles originated from 14 countries, with the United States leading (29.3 %), followed by Taiwan (14.6 %), Italy (8.0 %), and Germany (8.0 %). The 75 most-cited articles were published in 22 journals, led by , followed by the and . A total of 345 keywords were analysed, with "Hand," "Defects," "Reconstruction," and "Regeneration" being the most frequent. Level of Evidence 4 was most common (40 %), followed by Levels 3 (25 %) and 5 (24 %). CONCLUSIONS: The top 75 most-cited hand microsurgery articles influence current surgical practice and teaching material. Understanding specific surgical techniques in hand microsurgery and examining their outcomes will benefit patients, surgeons, researchers and policymakers alike.
Evaluation of tension-band osteosynthesis for cubitus varus deformity in pediatric patients: A retrospective review.
Minh Phan MD, Light TR, Van Phan T … +1 more , Nguyen PD
J Hand Microsurg · 2025 Mar · PMID 39866366 · Full text
PURPOSE: This study aims to evaluate the effectiveness and safety of lateral closing wedge osteotomy with tension-band wire fixation for correcting cubitus varus deformity in pediatric patients. The primary objective was...
PURPOSE: This study aims to evaluate the effectiveness and safety of lateral closing wedge osteotomy with tension-band wire fixation for correcting cubitus varus deformity in pediatric patients. The primary objective was to assess the bone union rate, functional outcomes, and potential complications associated with this surgical approach. METHODS: We conducted a retrospective review of 104 pediatric cases (ages 7-15) with post-traumatic cubitus varus deformity treated between January 2018 and December 2019 at the Pediatric Orthopedic Department. The surgical technique involved a lateral closing wedge osteotomy with fixation achieved using an 8-figure tension-band wire on the lateral column of the distal humerus. Follow-up assessments were conducted for bone union, correction stability, range of motion, and any post-surgical complications. RESULTS: Out of 104 cases, 63 involved left elbows and 41 right elbows, with an average patient age of 8.12 years. The deformity was severe (>30° varus) in 33.65 % of cases. Successful correction and bone union were achieved in 100 % of cases, with an average follow-up duration of 8 months (range: 3-20 months). Complications included minor recurrence in two cases due to early post-operative trauma, limited range of motion in three cases, K-wire protrusion in three cases, and infection in two cases. Functional outcomes rated as excellent in 94.2 % of cases and good in 5.8 %. CONCLUSION: Lateral closing wedge osteotomy with tension-band wire fixation is a reliable technique for correcting pediatric cubitus varus deformity, offering stable fixation, high success rates in bone healing, and favorable functional outcomes with minimal complications.
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