Journal Of Hand And Microsurgery[JOURNAL]
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200 papers
Giant cell tumor - Hamate.
Kumar B, Vijayan S, Shanmuganathan SS
J Hand Microsurg · 2025 Nov · PMID 41049762 · Full text
Giant cell tumor, a benign, but locally aggressive primary bone tumor usually occurs in the ends of long bones and some flat bones. Its occurrence in the carpal bones is rare and has varied characteristics compared to ot...
Giant cell tumor, a benign, but locally aggressive primary bone tumor usually occurs in the ends of long bones and some flat bones. Its occurrence in the carpal bones is rare and has varied characteristics compared to other locations. We report the case of a 17-year-old girl diagnosed with giant cell tumor of the hamate, who was managed with excision and reconstruction with acrylic bone cement and went on to have a reasonably good outcome without recurrence. We discuss the clinico-radiological, histopathological and treatment modalities of giant cell tumors in the carpal bones.
Quantifying the environmental and economic impact of telephone follow-up in hand surgery: A single surgeon's experience.
Fawdry RA, Stapleton O, Wardle E … +2 more , Sook C, Kocheta A
J Hand Microsurg · 2025 Nov · PMID 41036213 · Full text
INTRODUCTION: The National Health Service (NHS) in England generates approximately 24.9 million tonnes of carbon dioxide annually. Achieving net-zero emissions requires contributions from all clinical specialties. Orthop...
INTRODUCTION: The National Health Service (NHS) in England generates approximately 24.9 million tonnes of carbon dioxide annually. Achieving net-zero emissions requires contributions from all clinical specialties. Orthopaedics, as a high-emission specialty, has a critical role to play in this transition. The COVID-19 pandemic catalysed the widespread adoption of telephone consultations, which have demonstrated patient satisfaction, favourable clinical outcomes, and potential environmental benefits. This study evaluated the environmental and economic impact of a single surgeon's shift to telephone follow-up appointments. MATERIALS AND METHODS: Patients who received telephone follow-up consultations between March 2020 and March 2023 in one surgeon's clinic were retrospectively identified. Case notes were reviewed to determine diagnosis, treatment type, and need for further in-person follow-up. Travel distances were estimated based on patient addresses, and deprivation scores were calculated using postcode-linked indices. RESULTS: A total of 118 telephone consultations were identified; six patients were excluded due to missing address data. Of the remaining 112, 37.5 % had carpal tunnel syndrome, 62 % followed surgical intervention, and 25 % followed injection. Secondary in-person follow-up was required in 26 % of cases, with no significant difference between postoperative and post-injection patients (p = 0.59). The intervention resulted in an estimated 1284 miles of travel avoided and a saving of 0.33 tonnes of CO emissions. Notably, 39.3 % of patients were from the most socioeconomically deprived quintile. DISCUSSION: This study demonstrates that even a modest change in outpatient follow-up practices by a single clinician can yield measurable environmental benefits. Savings in patient expenses were found, particularly among those from disadvantaged backgrounds. If implemented across the NHS, such changes have the potential to significantly reduce emissions without compromising patient care and reduce direct costs to patients.
Volar locked plating versus dorsal bridge plating for complete articular (AO/OTA type 23C) distal radius fractures.
Carroll TJ, Dondapati A, Lander R … +5 more , Rodenhouse A, Patel U, Hammert WC, Gonzalez R, Ketonis C
J Hand Microsurg · 2025 Nov · PMID 41036212 · Full text
BACKGROUND: Volar locked plating (VLP) and dorsal bridge plating (DBP) are both appropriate surgical strategies for the treatment of complete articular distal radius fractures (DRFs), however, direct comparisons between...
BACKGROUND: Volar locked plating (VLP) and dorsal bridge plating (DBP) are both appropriate surgical strategies for the treatment of complete articular distal radius fractures (DRFs), however, direct comparisons between these fixation methods in this injury pattern is lacking. PURPOSE: The purpose of this study was to compare functional, radiographic, and patient-reported outcomes, for complete articular (AO/OTA 23C) DRFs treated with VLP versus dorsal bridge plating DBP. METHODS: This was a retrospective cohort study that included patients aged 18-90 years old who underwent VLP or DBP fixation for AO/OTA 23C DRFs. Polytraumatized patients and those undergoing revision surgery were excluded. Wrist range of motion (ROM) and radiographic outcome measures were collected at 6-month follow-up. PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) were obtained at each follow-up. Surgical complications and patient demographic data were recorded. RESULTS: After propensity matching, 1069 VLP patients were matched to 214 DBP individuals, rendering all demographic variables examined comparable. DBP patients had higher rates of delayed union(2.0 % vs. 4.2 %; p < 0.05) and tendon rupture (0.5 % vs. 3.3 %; p < 0.05), but similar rates of revision surgery, malunion, and infection at 6-months. Multivariate analysis demonstrated greater wrist flexion, extension, radial and ulnar deviation, supination, protonation, grip strength, PROMIS UE, and PROMIS PF among the VLP group compared to DBP (p < 0.05). VLP patients also demonstrated greater radial height and radial inclination, less articular step-off, and decreased volar tilt (p < 0.05). CONCLUSIONS: VLP was associated with greater ROM, grip strength, PROMIS UE and PF, improved radial height, radial inclination, and less articular step-off and volar tilt at 6-month follow-up compared to DBP. DBP patients also demonstrated higher rates of delayed union and tendon rupture but similar complication rates. LEVEL OF EVIDENCE: Therapeutic III.
The TFCC table lift test: A clinical tool for detecting palmer 1B TFCC lesions.
Marcovici LL, Greco A, Chiossi B … +4 more , Muscatiello AL, Tandioy-Delgado FA, Molayem I, Pagnotta A
J Hand Microsurg · 2025 Nov · PMID 40979303 · Full text
BACKGROUND: Ulnar-sided wrist pain, frequently linked to triangular fibrocartilage complex (TFCC) injuries, poses a diagnostic challenge due to the limited sensitivity and specificity of standard clinical tests. Although...
BACKGROUND: Ulnar-sided wrist pain, frequently linked to triangular fibrocartilage complex (TFCC) injuries, poses a diagnostic challenge due to the limited sensitivity and specificity of standard clinical tests. Although wrist arthroscopy remains the diagnostic gold standard, a reliable clinical tool is needed to better identify peripheral TFCC lesions (Palmer 1B). This study introduces and validates the "TFCC Table Lift Test" (TTL test), a novel exam aimed at improving clinical detection of Palmer 1B TFCC injuries. The primary goal was to correlate TTL test scores with arthroscopic findings, using the Atzei classification to subcategorize lesions and assess the test's diagnostic utility. MATERIALS & METHODS: We conducted a retrospective case-control study involving 314 patients with unilateral chronic ulnar-sided wrist pain who underwent wrist arthroscopy from January 2016 to December 2023. All patients performed the TTL test during preoperative assessment, which involved lifting a flat surface with fingertips while the wrist was in full supination and extension. Pain intensity was scored using a Visual Analogue Scale (VAS, 0-10) and compared to the unaffected side. Exclusion criteria included bilateral pain, previous wrist surgery, or other wrist disorders. Arthroscopy confirmed or excluded Palmer 1B TFCC lesions and subclassified them using the Atzei system. TTL scores were statistically analyzed for diagnostic correlation. RESULTS: Of 314 patients, 213 (Group 1) were arthroscopically diagnosed with Palmer 1B TFCC lesions: 136 were Atzei Class 1, 75 Class 2, and 2 Class 3. The remaining 101 patients (Group 2) had other wrist conditions. All Group 1 patients had TTL scores >5, with severity reflected in increasing mean scores (Class 1: 6.52; Class 2: 8.15; Class 3: 9.0). All but three patients in Group 2 had scores <3. The TTL test showed 100 % sensitivity, 97.03 % specificity, 98.6 % positive predictive value, and 100 % negative predictive value. ROC analysis yielded an AUC of 0.999; the optimal threshold was VAS >5. CONCLUSION: The TTL test is a simple, reproducible, and accurate clinical tool for detecting Palmer 1B TFCC lesions. A TTL score >5 strongly correlates with arthroscopic findings and reflects lesion severity, making it a valuable adjunct in the evaluation of ulnar-sided wrist pain.
Lunate pathology mimicking Kienbock's Disease; defining the disease and exploring differentials.
MacLean SBM, Bain GI
J Hand Microsurg · 2025 Sep · PMID 40977900 · Full text
Kienbock's Disease is a rare disease with insidious clinical symptoms and characteristic features on imaging. However, the clinical and radiological findings are similar to many other pathologies affecting the lunate. We...
Kienbock's Disease is a rare disease with insidious clinical symptoms and characteristic features on imaging. However, the clinical and radiological findings are similar to many other pathologies affecting the lunate. We present a precise definition of the Kienbock's wrist, and an overview of other pathologies affecting the lunate. Better understanding of the clinical, radiological and arthroscopic findings of these diseases, allows accurate diagnosis and effective management strategy.
Information, communication, and education (ICE) and the eye of social media in peripheral nerve surgery.
Terrence Jose Jerome J, Leis A, Mana Saffari T … +1 more , Ross D
J Hand Microsurg · 2025 Jul · PMID 40949113 · Full text
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Is AI an advanced intelligence, artificial intelligence, or annoying intelligence in hand and microsurgery?
Terrence Jose Jerome J
J Hand Microsurg · 2025 Sep · PMID 40896790 · Full text
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Challenges and complications of trans-osseous carpal tenodesis for scapholunate ligament tears.
Räisänen MP, Smith NC, Del Piñal F
J Hand Microsurg · 2025 Nov · PMID 40895176 · Full text
Scapholunate (SL) instability remains a challenging condition with significant possibility of implications for wrist function and long-term outcomes. This review explores the limitations and complications of current tran...
Scapholunate (SL) instability remains a challenging condition with significant possibility of implications for wrist function and long-term outcomes. This review explores the limitations and complications of current trans-osseous scapholunate ligament (SLL) reconstruction techniques, focusing on isometric reconstruction challenges and complications, for example osteonecrosis, tunnel fractures, graft failure, and iatrogenic extrinsic ligament injuries. Through biomechanical analysis and clinical case reviews, we demonstrate that the conventional three-ligament tenodesis (3LT) scaphoid tunnel has high risk of resulting in a non-isometric volar scapho-trapezial (vST) ligament reconstruction, potentially exacerbating carpal instability. Additionally, trans-osseous techniques have risk of osteonecrosis and fracture, which can accelerate degenerative changes and necessitating salvage procedures. This paper will additionally highlight concerns regarding tendon graft viability, anchor failure, and the critical role of extrinsic ligaments in SL stability. It will also be shown that modular arthroscopic approaches, which focus on selective ligament repair, may provide better outcomes with fewer complications and lower morbidity compared to traditional reconstructions. Future advancements probably should prioritise preserving bone vascularity and minimising iatrogenic injury, guiding surgeons toward safer and more effective treatment strategies.
Hand reconstruction with multi-pedicled anterolateral thigh flap.
Sơn TT, Nghĩa PT, Việt Dung PT … +3 more , Hồng Thuý TT, Nam ĐP, Acartürk TO
J Hand Microsurg · 2025 Nov · PMID 40895175 · Full text
Complex hand defects that involve multiple components present significant challenges for reconstructive surgery. The Anterolateral Thigh (ALT) flap is one of the most versatile options in reconstructive microsurgery, off...
Complex hand defects that involve multiple components present significant challenges for reconstructive surgery. The Anterolateral Thigh (ALT) flap is one of the most versatile options in reconstructive microsurgery, offering numerous advantages. Variations in ALT anatomy enable the creation of different types of multi-pedicle flaps, which aid in addressing complex injuries. This study involved 116 patients treated with the ALT flap for hand lesions, with a focus on 20 patients who received multipedicle flaps for complex hand defects. Among these, ten patients were treated with adipocutaneous multi-pedicled flaps for the coverage of defects, while the remaining ten patients received a combination of adipocutaneous and FL multi-pedicled flaps, which enabled both the covering of the skin and the reconstruction of the extensor tendon. Prior to thinning, the average thickness of the flaps was measured at 21 mm, which was subsequently reduced to an average of 6.5 mm following the thinning procedure. The overall survival rate of the flaps was 97.5 %, and two patients required defatting after one year. Patient satisfaction regarding both functional and aesthetic outcomes was reported to be high. Multi-pedicle flaps that incorporate two skin islands or combinations of skin islands and FL flaps have proven to be highly effective for complex, multi-unit hand reconstruction. The success of this technique is influenced by various factors, including the types and number of perforators, the composition of the flap, the methods used for thinning, and the specific arrangement of flaps tailored to each defect.
The vascularized iliac crest bone graft: An often forgotten long bone alternative-Now remembered a half-century later.
Hallock GG
J Hand Microsurg · 2025 Nov · PMID 40842556 · Full text
PURPOSE: For long bone large segmental defects, and especially for the tibia, the vascularized fibula osseous flap has been proven around the world to be the ideal and reliable solution. Yet if congenital, traumatic, onc...
PURPOSE: For long bone large segmental defects, and especially for the tibia, the vascularized fibula osseous flap has been proven around the world to be the ideal and reliable solution. Yet if congenital, traumatic, oncologic, anatomical anomalies or even aesthetic reasons preclude this choice, a second tier alternative that is also reliable need be considered. METHOD: A unique 40 year follow-up for an infected non-union of a right tibia fracture, initially slated for limb amputation, was instead salvaged using a vascularized iliac crest bone graft [VICBG]. An updated focus on this event, the evolution of the VICBG surgical anatomy, and a concise description of a pragmatic dissection approach for this flap harvest is intended. RESULT: A composite free groin flap and vascularized iliac crest bone graft pedicled by the deep circumflex iliac vessels proved to be a reasonable solution for a concomitant large lower limb soft tissue deficiency and tibial segmental defect. Now for more than 40 years the patient has retained a functional limb with no restrictions in ambulatory prowess. CONCLUSION: Over the past half-century, numerous donor sites for vascularized bone grafts have been identified. Some are primarily cortical, some cancellous; some tubular, some convoluted; some minute, some gargantuan; some rarely used, some often. Depending on the circumstances, a vascularized iliac crest bone graft can be a potential alternative where here demonstrated extremely long term success can be expected. This alternative should not be overlooked as a potential solution for what otherwise can be a demanding dilemma.
The osteocutaneous superficial circumflex iliac artery (SCIP) flap in extremity reconstruction.
Zubler C, Constantinescu MA, Lese I … +1 more , Olariu R
J Hand Microsurg · 2025 Nov · PMID 40821010 · Full text
INTRODUCTION: Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perfo...
INTRODUCTION: Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes. METHODS: A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable. RESULTS: Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months. CONCLUSION: The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.
Effect of end-to-side anterior interosseous nerve transfer in proximal ulnar nerve injuries: A comparative study.
Yoğun Y, Bezirgan U, Ertan MB … +3 more , Kıratlıoğlu Y, Nergizal OT, Armangil M
J Hand Microsurg · 2025 Nov · PMID 40814395 · Full text
BACKGROUND: Few studies have described the efficacy of end-to-side (ETS) nerve transfer for high ulnar nerve injuries. This study aimed to compare the intrinsic functional outcomes of patients who underwent ETS nerve tra...
BACKGROUND: Few studies have described the efficacy of end-to-side (ETS) nerve transfer for high ulnar nerve injuries. This study aimed to compare the intrinsic functional outcomes of patients who underwent ETS nerve transfer for proximal ulnar nerve transection injuries and those of patients who did not. MATERIALS AND METHODS: We retrospectively evaluated 15 patients who underwent primary repair of proximal ulnar nerve injuries. Patients were divided into groups based on whether ETS nerve transfer was performed. Postoperative intrinsic atrophy, clawing, ability cross finger Froment sign, Wartenberg sign, and Disabilities of Arm, Shoulder, and Hand (DASH) scores were evaluated and compared between groups. Additionally, two-point discrimination, grip strength, pinch strength, and intrinsic muscle strength of the hand were evaluated and compared between groups. RESULTS: Nine patients comprised the ulnar nerve repair (UNR) group and six patients comprised the UNR with SETS (UNR + ETS) group. No significant differences in intrinsic atrophy, clawing, ability to cross finger, Froment sign, Wartenberg sign, and DASH scores were observed between groups. No significant differences in the strength of the abductor digiti minimi, grip strength, pinch strength, and two-point discrimination were observed between groups. A statistically significant difference only in the strength of the first dorsal interosseous muscle was observed between groups. CONCLUSION: Our comparative study showed little or no benefit of ETS-AIN transfer for high ulnar nerve injuries.
Outcomes of the Starfish procedure using muscle transfer for independent digital control of a myoelectric prosthesis.
Nord KM, Sabbag CM, Denduluri SK … +2 more , Loeffler BJ, Gaston RG
J Hand Microsurg · 2025 Nov · PMID 40809317 · Full text
BACKGROUND: Surgical and technological advancements have revolutionized myoelectric prosthetic options for patients with upper extremity amputations, but partial hand amputations have remained a challenge. The Starfish p...
BACKGROUND: Surgical and technological advancements have revolutionized myoelectric prosthetic options for patients with upper extremity amputations, but partial hand amputations have remained a challenge. The Starfish procedure is a novel surgical technique that involves transferring intrinsic hand muscles to a subcutaneous location to allow immediate signal detection and independent digital control of a myoelectric prosthesis. We report the outcomes of our cohort of patients treated with this procedure. METHODS: Twenty-one patients underwent the Starfish procedure between 2015 and 2021. All patients had a postoperative evaluation with an Ottobock Myoboy to determine if they had viable signals from interossei transfers. All patients completed a specialized survey for amputees, depression, and PTSD surveys. RESULTS: All patients had recordable myoelectric signals at each muscle transfer. Three patients were lost to follow-up and three patients were multi-extremity amputees and therefore their DASH scores were not included given the confounding associated injuries thus 15 patients were available for outcomes data. 14 out of 15 remaining patients (93 %) obtained a myoelectric prosthesis. Patients reported using their prosthesis an average of 5.5 h per day and 5.5 days per week. The average DASH score prior to surgery was 67.9 and after surgery was 40.5 (p = 0.014). VAS Pain scores were 3.8 for residual limb pain and 2.7 for phantom pain. Mean follow-up was 2.1 years. 71 % of patients reported being "extremely" or "very" satisfied with the overall function of their prosthesis. The most common functional activities that the prosthesis allowed patients to perform include dressing, housework, meal preparation and eating. 73 % of previously working patients were able to return to employment. CONCLUSIONS: The Starfish procedure provides immediately detectable superficial myoelectric signals that allow intuitive and independent finger control. At 2-year follow up, patients have a high satisfaction rate, consistent myoelectric prosthetic use, improved DASH scores, and a high rate of return to work.
Robotic-assisted technique in plastic and reconstructive surgery: Experience in Taiwan.
Chen YC, Chung MH, Chang CK … +6 more , Wu CY, Lin YL, Tsai YC, Lu CT, Chen IC, Lai CS
J Hand Microsurg · 2025 Nov · PMID 40800240 · Full text
BACKGROUND: Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review s...
BACKGROUND: Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review summarizes Taiwan's pioneering experience with robotic-assisted techniques in this specialty, with an emphasis on clinical applications, educational models, and future directions. METHODS: A narrative literature review was conducted focusing on robotic-assisted plastic and reconstructive surgery with relevance to Taiwanese clinical practice. Articles published between January 2000 and April 2024 were considered. Searches were performed in PubMed, Google Scholar, and Cochrane Library using the keywords: "robotic surgery," "plastic surgery," "reconstructive surgery," "Taiwan," and "microsurgery." Inclusion criteria were: (1) studies involving robotic-assisted surgical techniques, (2) relevance to plastic and reconstructive surgery, (3) Taiwanese institutional or clinical context, and (4) availability of clinical or technical outcome data. Articles not published in English, lacking original data, or unrelated to the Taiwan context were excluded. RESULTS: Robotic-assisted techniques were successfully applied in various reconstructive domains, notably in microsurgical anastomosis for free flap procedures, nerve transfers, and minimally invasive mastectomies. These approaches demonstrated favorable outcomes in terms of operative precision, reduced complications, and patient satisfaction. Taiwan's major medical centers, including Chang Gung Memorial Hospital and Taichung Veterans General Hospital, have been instrumental in driving these innovations. Furthermore, robotic training models facilitated the learning curve for microsurgeons and supported the integration of robotic platforms into surgical education. CONCLUSIONS: Taiwan's experience underscores the feasibility and clinical value of robotic-assisted techniques in plastic and reconstructive surgery. Robotic platforms not only improve surgical outcomes but also expand the scope of reconstructive options. Ongoing research and educational efforts are crucial to optimizing technique standardization and surgeon training in this rapidly evolving field.
The subacromial balloon spacer: Adhering to indications and clinical outcomes.
Boufadel P, Khanna A, Suarez JD … +3 more , Stadler RD, Fares MY, Abboud JA
J Hand Microsurg · 2025 Sep · PMID 40766774 · Full text
The subacromial balloon spacer has emerged as a viable treatment option for patients with massive, irreparable rotator cuff tears. Acting as a temporary interpositional device, the subacromial balloon reduces acromiohume...
The subacromial balloon spacer has emerged as a viable treatment option for patients with massive, irreparable rotator cuff tears. Acting as a temporary interpositional device, the subacromial balloon reduces acromiohumeral impingement and redistributes forces across the shoulder, leading to pain relief and improved function. Achieving optimal outcomes requires adherence to appropriate surgical indications and the implementation of a structured postoperative rehabilitation protocol. This review provides a comprehensive overview of the subacromial balloon spacer's biomechanical function, clinical indications, surgical technique, postoperative rehabilitation, and outcomes from recent trials and meta-analyses. While short-term outcomes are promising, further large-scale, long-term studies are needed to refine its indications and define its role in shoulder surgery.
Letter regarding "Modified double fascicular nerve transfer to restore elbow flexion in brachial plexus injuries - A series of 32 cases".
Huang HK
J Hand Microsurg · 2025 Sep · PMID 40746436 · Full text
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Antenatal ultrasound cannot detect all congenital Anomalies: Clinical limitations, India-specific barriers, and medicolegal perspectives.
Venkatachalam I, Siddique M
J Hand Microsurg · 2025 Sep · PMID 40746435 · Full text
BACKGROUND: Antenatal ultrasound is central to prenatal screening, enabling early detection of many congenital anomalies. However, its diagnostic accuracy is limited, especially for subtle, complex, or late-onset fetal a...
BACKGROUND: Antenatal ultrasound is central to prenatal screening, enabling early detection of many congenital anomalies. However, its diagnostic accuracy is limited, especially for subtle, complex, or late-onset fetal abnormalities. In India, additional systemic, infrastructural, and legal factors further restrict its effectiveness. OBJECTIVES: To review the diagnostic limitations of prenatal ultrasound, highlight India-specific barriers to anomaly detection, and examine medico-legal perspectives, including landmark court rulings on alleged negligence. METHODS: This article synthesizes global and Indian data on anomaly detection rates, analyzes categories of commonly missed anomalies, and reviews relevant Indian legal cases, including Supreme Court judgments. The policy implications of the PCPNDT Act are also critically discussed. RESULTS: Ultrasound detects 50-70 % of major anomalies in ideal settings, but many conditions-such as cardiac defects, skeletal dysplasias, orofacial defects ( Cleft lip, Cleft palate etc) and limb abnormalities-remain undiagnosed. India-specific challenges include operator variability, delayed antenatal care, equipment disparities, and regulatory hurdles under the PCPNDT Act. Indian courts consistently require expert testimony to establish negligence and have ruled in favor of clinicians when standard protocols were followed. CONCLUSION: Missed anomalies on antenatal ultrasound typically reflect known technical and systemic limitations, not medical negligence. Indian jurisprudence has set a clinician-protective precedent when standard care is provided. Counseling, documentation, and legal awareness remain key to mitigating risk. Policy reforms should promote ethical ultrasound use while safeguarding both patient access and provider protection.
Cold intolerance following microsurgical replantation of finger amputations: A retrospective cohort study.
Shiraishi M, Narushima M, Banda CH … +13 more , Moriwaki Y, Miyamoto S, Miyazaki Y, Okuyama M, Kojima K, Kondo C, Yamagata K, Mitsui K, Hashimoto K, Hosomi K, Ishiura R, Kurita M, Koshima I
J Hand Microsurg · 2025 Sep · PMID 40735244 · Full text
PURPOSE: Cold intolerance following finger amputation is a major postoperative complication. Although current evidence suggests decreased blood flow to digital peripheral vessels may be associated with cold intolerance,...
PURPOSE: Cold intolerance following finger amputation is a major postoperative complication. Although current evidence suggests decreased blood flow to digital peripheral vessels may be associated with cold intolerance, the underlying mechanism remains controversial. This study aimed to investigate the relationship between skin perfusion in affected fingers and the presence of cold intolerance. METHODS: A retrospective cohort study was conducted to evaluate patients who underwent finger replantation at two centers between 2008 and 2020. Demographic data were collected, and at least one of the following evaluative methods was used: the Semmes-Weinstein monofilament test (SW test), moving two-point discrimination (M2PD), contrast-enhanced computed tomography, or thermography. RESULTS: A total of 41 amputated fingers in 20 patients were assessed, with a mean follow-up period of 18.7 ± 12.1 months. Most injuries were located in Tamai zone 4 (n = 18, 43.9 %), followed by zone 1 (n = 9, 22.0 %), zone 2 (n = 9, 22.0 %), and zone 3 (n = 5, 12.2 %). The most common injury type was crush (n = 24, 58.5 %), followed by guillotine (n = 13, 31.7 %) and crush-avulsion (n = 4, 9.7 %). A significant difference was observed in the SW test (p = .047) and average vessel diameter (p = .047) between patients with and without cold intolerance. CONCLUSIONS: Narrowed blood vessels and impaired SW test scores are associated with cold intolerance after finger replantation. Nerve injury may potentially contribute to abnormal vasoconstriction. Further studies are needed to elucidate the underlying mechanisms of cold intolerance.
The 'teres major first' approach for deltoid reinnervation in brachial plexus injuries with shoulder fracture-dislocations.
Bhandari PS
J Hand Microsurg · 2025 Sep · PMID 40727242 · Full text
BACKGROUND: In upper brachial plexus (C5-C6) avulsion injuries, deltoid reinnervation via radial-to-axillary nerve transfer is standard. However, fracture-dislocations around the shoulder complicate surgical exposure due...
BACKGROUND: In upper brachial plexus (C5-C6) avulsion injuries, deltoid reinnervation via radial-to-axillary nerve transfer is standard. However, fracture-dislocations around the shoulder complicate surgical exposure due to fibrosis and distorted anatomy. METHODS: Fifteen male patients (mean age: 26.1 years) with C5-C6 avulsion injuries and concomitant shoulder fractures were treated between October 2019 and April 2022 using a modified posterior approach. The "teres major first" technique utilized the inferior border of the teres major muscle as a consistent landmark to identify and mobilize the long head triceps branch and anterior axillary nerve. A vertical slit in the teres major tendon improved access and allowed tension-free coaptation. All patients also received spinal accessory to suprascapular nerve transfers, and partial ulnar and/or median nerve transfers for elbow flexion restoration. RESULTS: All patients had fibrous adhesions in the quadrangular space, and 3 had distal axillary nerve injuries. The teres major landmark enabled safe dissection in all cases. Twelve of 15 patients achieved deltoid reinnervation with active shoulder abduction between 110° and 170° (mean 156°; MRC grade III-IV). Three patients (2 with proximal humerus fractures and 1 with lateral clavicle fracture with coracoclavicular disruption) showed limited recovery (70°-80° abduction). Triceps donor site weakness (MRC grade ≥3 in 14/15) was tolerated well, and full elbow flexion was restored in all patients. EMG evidence of reinnervation appeared by week 21 (deltoid) and week 23 (infraspinatus), with improvement in active shoulder abduction from week 27 onward. CONCLUSION: The "teres major first" approach enables rapid and safe identification of target nerves in brachial plexus injuries complicated by shoulder fractures and dislocations. This technique minimizes dissection in fibrotic areas, ensures tension-free repair, and achieves reliable functional outcomes. However this study is limited by the relatively small sample size and a reduced statistical power.
Complex regional pain syndrome of wrist and hand following distal radius fracture: A long-term follow-up study: 16 years (range 10-22 years).
Kulkarni RS, Prakash KA, Kulkarni SR
J Hand Microsurg · 2025 Sep · PMID 40708760 · Full text
PURPOSE: The objective of this longitudinal prospective research on distal radius fractures was to identify and analyse impairments resulting from complex regional pain syndrome at long term follow up. MATERIAL AND METHO...
PURPOSE: The objective of this longitudinal prospective research on distal radius fractures was to identify and analyse impairments resulting from complex regional pain syndrome at long term follow up. MATERIAL AND METHODS: The clinical and radiological assessment was performed up to 16 weeks then at 6, 9, 12 months following distal radius fracture for 62 patients of diagnosed complex regional pain syndrome and were treated between 2000 and 2011 at one institute. All patients were invited for re-examination at final long term follow up and the clinical assessment which was performed after an average of 16 years (range 10 years-22 years). Out of the 62 patients 44 (70.9 %) attended for this long term clinical follow up. Women constituted 11 (25.0 %). The main outcome measures were the impairments assessed by standard physical examination, pain, grip strength, vasomotor instability and finger mobility. The mean duration of treatment was 274.4 ± 24.2 days. RESULTS: The mean interval between distal radius fracture, inciting event and the diagnosis complex regional pain syndrome was 2.3 (range 1-5) months. At long term follow-up the pain and tenderness were present in 41 (93.2 %) and 36 (81.8 %) patients, this association was highly significant (chi-square = 29.3, P < 0.001). The prevalence of vasomotor instability was high, in 37 (84.1 %) patients. Grip strength was significantly lower on the affected fracture side than normal hand (57.4 ± 8.2 against 148.2 ± 12.4 mm of Hg, P < 0.001). There was a strong association between all three manifestations of sensory, motor and autonomic features in this study report (p < 0.001. CONCLUSION: Pain along with loss of full fist muscle strength and restricted activities of daily living were the most evident factors leading to perceived disabilities, at long term follow-up of 16 (range-10 to 22) years after the onset of complex regional pain syndrome. Pain was the most important factor contributing to handicap. This study supports with strong evidence for long term loss of productive effort with prolonged treatment period having most unpredictable functional impairment.
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