Journal Of Hand And Microsurgery[JOURNAL]
Sun
200 papers
Impact of prompting on large language model performance: ChatGPT-4 performance on the 2023 hand surgery self-assessment examination.
Fiedler B, Barron OA, Hauck J … +4 more , Scioscia J, Phillips T, Ahmed AS, Mitchell S
J Hand Microsurg · 2025 Sep · PMID 40708759 · Full text
BACKGROUND: Large language models (LLMs) such as ChatGPT are artificial intelligence programs designed to interpret and respond to text based input These programs can improve output based on prompting and tailored prompt...
BACKGROUND: Large language models (LLMs) such as ChatGPT are artificial intelligence programs designed to interpret and respond to text based input These programs can improve output based on prompting and tailored prompt engineering. Multiple studies have assessed the ability of various LLMs to perform on medical exams at different levels of training. The newest version of ChatGPT, GPT-4, allows image recognition which is relevant for many questions on orthopedic surgery exams. Performance of GPT-4, and the potential for LLMs to learn from prior exams remains unclear. The present study analyzed ChatGPT-4 performance on the 2023 hand surgery Maintenance of Certification (MOC) Self-Assessment Examination (SAE) before and after prompting with 5 previous versions of the test. It was hypothesized that GPT-4 would pass the exam and improve performance after prompting. METHODS: GPT-4 was tested with all text and image-based questions from the 2023 hand surgery SAE. Video-based questions were excluded. GPT-4 was then provided with questions, answers, and explanations from 5 previous SAEs from 2014 to 2020 and retested on the 2023 SAE text and imaging questions. Responses from GPT-4 on prompted and unprompted tests were recorded and compared. RESULTS: Both prompted and unprompted versions of ChatGPT-4 exceeded SAE exam passing requirement of >50 % correct response rate. GPT-4 answered 67 % of all questions correctly unprompted and 71 % of all questions correctly after prompting (p = 0.51). Sub-analysis demonstrated GPT-4 answered 66 % of image-based questions correctly after prompting, compared to 56 % before prompting (p = 0.25). GPT-4 answered 75 % of text only questions correctly before prompting and 74 % correctly after prompting (p = 1.0). Fischer's exact test on total questions, image only, and text only showed no statistically significant differences between prompted and unprompted versions of GPT-4. CONCLUSION: GPT-4 demonstrated the ability to analyze orthopedic information, answer specialty-specific questions, and exceed the passing threshold of 50 % on the 2023 Hand Surgery Self-Assessment Exam. However, prompting GPT-4 with previous SAEs did not statistically significantly improve performance. With continued advancements in AI and deep learning, large language models may someday become resources in test simulation and knowledge checks in the realm of hand surgery.
Blauth and Manske classifications for thumb hypoplasia.
Takagi T
J Hand Microsurg · 2025 Sep · PMID 40703252 · Full text
Blauth's and Manske's classifications of thumb hypoplasia are widely known. Although both are used, confusion has arisen-particularly regarding the term "Blauth Type IIIB." Manske did not subdivide Blauth's Grade III; in...
Blauth's and Manske's classifications of thumb hypoplasia are widely known. Although both are used, confusion has arisen-particularly regarding the term "Blauth Type IIIB." Manske did not subdivide Blauth's Grade III; instead, he developed an independent classification system (Types I-V). Within this, Manske's Type III, defined as partial first metacarpal aplasia, was further divided into IIIA and IIIB. Blauth himself never used these subclassifications. In fact, Blauth's Grade II more closely corresponds to Manske's Type IIIA, and Blauth's Grade III to Manske's Type IIIB. Thus, the correct terminology is "Manske Type IIIB," not "Blauth Type IIIB," as the two systems are distinct. Since IIIA and IIIB imply different treatment strategies, they must be clearly distinguished. Surgeons must evaluate each case individually, as no classification is definitive, and future systems may better integrate both bony and soft tissue considerations.
Analyzing socioeconomic characteristics in brachial plexus birth injuries: A multicenter public health analysis.
Victoria R, Nathan KH, Devon O … +3 more , Mandana B, Erin M, Koehler SM
J Hand Microsurg · 2025 Sep · PMID 40703251 · Full text
PURPOSE: We aimed to examine and compare socioeconomic characteristics of infants with brachial plexus birth injury (BPBI) at two high-volume, distinct healthcare systems in the United States. METHODS: All patients diagn...
PURPOSE: We aimed to examine and compare socioeconomic characteristics of infants with brachial plexus birth injury (BPBI) at two high-volume, distinct healthcare systems in the United States. METHODS: All patients diagnosed with non-transient BPBI presenting between November 2021-November 2023 at either institution, New York City ("NY") or Los Angeles ("LA"), were included. To stratify based on socioeconomic background, Area Deprivation Index (ADI) and Child Opportunity Index (COI) were utilized. ADIs were presented in national percentiles (1-100 %) or state-normed deciles (1-10), with higher rankings indicating greater disadvantage. COI scores and quintiles were assigned using nationally-normed ZIP code-level data, with lower COI signifying lower childhood opportunity. Continuous variables underwent two-tailed, unpaired Mann-Whitney U and t-tests. Categorical variables underwent chi-square tests. The significance level was set at < 0.05. RESULTS: When comparing the LA (n = 92) and NY (n = 107) cohorts, the mean ADI scores were not significantly different: 24.5 % (SD 21.1) and 25.4 % (SD 13.5) respectively (p = 0.713). When comparing the COI scores, overall mean COI was significantly greater in LA (34.2, SD 26.9) compared to NY (17.3, SD 25.6; p < 0.001). While a significantly higher number of patients from NY than LA fell into categories of very low or low in education, social and economic, and overall COI, the distributions of these categories were more evenly spread across the LA cohort. CONCLUSION: Our findings underscore the importance of considering regional differences in patient populations when patients present with BPBI, as addressing such disparities may increase equitable access to treatment and optimize functional outcomes. Given the time-sensitive nature of BPBI care and implications of long-term disability if left under-treated, it is essential to allocate resources towards effectively treating BPBI in affected demographics, especially those experiencing resource deficits. By acknowledging geographic-specific differences in resource access among BPBI populations, physicians can develop targeted strategies to ensure equitable BPBI care.
An unusual presentation of thumb hypoplasia.
De SD
J Hand Microsurg · 2025 Sep · PMID 40692713 · Full text
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Thumb tip reconstruction for apical substance loss using a bipedunculated homodigital V-Y advancement FLAP: OUR experiences.
De Francesco F, Marchesini A, Mani O … +3 more , Zingaretti N, Parodi PC, Riccio M
J Hand Microsurg · 2025 Sep · PMID 40687302 · Full text
INTRODUCTION: The thumb plays a crucial role in hand biomechanics, particularly in fine and forceful grips. Due to its functional importance, trauma involving the thumb is frequent. In cases of pulp tissue loss, Moberg's...
INTRODUCTION: The thumb plays a crucial role in hand biomechanics, particularly in fine and forceful grips. Due to its functional importance, trauma involving the thumb is frequent. In cases of pulp tissue loss, Moberg's 1964 principles for functional thumb reconstruction remain a cornerstone in hand surgery. Among the available techniques, the bipedunculated V-Y advancement flap, described by D. Elliot in 1993, offers a reliable solution for preserving length, restoring sensation, ensuring grip stability, and maintaining an aesthetically acceptable outcome. MATERIALS AND METHODS: We retrospectively analyzed 54 cases of thumb tip reconstruction using the bipedunculated V-Y advancement flap for apical substance loss ranging from 1.0 to 2.5 cm in length. Patients had a mean follow-up of two and five years. Functional and aesthetic outcomes were assessed using the Pinch Test, Weber and Semmens Test, Vancouver Scar Scale, QuickDASH questionnaire and Fingertip Injury Outcome Score. : Our statistical analysis confirms the reliability and versatility of this flap. No major or minor complications were recorded. The flap effectively addressed transverse and oblique defects up to 1.5 cm, providing excellent functional and cosmetic results. CONCLUSIONS: This study validates the bipedunculated V-Y advancement flap as an effective technique for thumb tip reconstruction, emphasizing the importance of adhering to fundamental principles of digital reconstruction. The procedure ensures excellent functional outcomes and high patient satisfaction.
Uses of constraint-induced movement therapy (CIMT) in patients with brachial plexus birth injuries (BPBI).
Gotlieb-Horowitz M, Robbins V, Ferrante V … +3 more , DeRosa TM, Behbahani M, Koehler SM
J Hand Microsurg · 2025 Sep · PMID 40687301 · Full text
UNLABELLED: Constraint-induced movement therapy (CIMT) was originally implemented to address limb non-use in stroke recovery, and has more recently become a mainstay, evidence-based treatment approach to decrease develop...
UNLABELLED: Constraint-induced movement therapy (CIMT) was originally implemented to address limb non-use in stroke recovery, and has more recently become a mainstay, evidence-based treatment approach to decrease developmental disregard in children. In addition to combating developmental disregard in the BPBI patient with residual deficit(s), CIMT can be applied in various ways across diverse cases in brachial plexus practice, including post-surgical use to aid in the activation of nerve transfers and/or tendon transfers. The timing, dosage, and setting of CIMT will vary depending on the patient's case and individual needs. This paper highlights how the individuality of CIMT implementation, when tailored to each patient's developmental stage and specific needs and circumstances outside of the clinic, contributes to its success. Rather than presenting the routine use of CIMT for BPBI developmental disregard, sample cases are presented to outline the variety of uses for CIMT in the surgical BPBI patient. Practical tips and clinical strategies are provided to support other clinicians in effectively incorporating CIMT in their care of children in this vulnerable population. LEVEL OF EVIDENCE: IV.
Institutional perspectives on the routine use of Interrupted Horizontal Micro-Mattress (IHMM) suturing in microvascular anastomosis.
Khan S, Saini V, Apurv Pawde S
J Hand Microsurg · 2025 Sep · PMID 40687300 · Full text
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A systematic review of surgical management for open fractures of the distal phalanx: What is the evidence?
El Sewify O, Bouhadana G, Lorange E … +4 more , Sylvain M, Nordback PH, Das De S, Efanov JI
J Hand Microsurg · 2025 Sep · PMID 40687299 · Full text
PURPOSE: Open fractures of the distal phalanx are common injuries with the potential for significant complications, yet standardized treatment guidelines remain lacking. Surgical debridement and antibiotic administration...
PURPOSE: Open fractures of the distal phalanx are common injuries with the potential for significant complications, yet standardized treatment guidelines remain lacking. Surgical debridement and antibiotic administration are crucial steps in the management of open fractures, but the optimal timing and combination of these interventions remain uncertain. This systematic review evaluates the impact of surgical debridement timing and antibiotic administration on complications, including infections, malunion and non-union, physeal closure disturbances, and nail deformities, with a focus on differences between adult and pediatric population. METHODS: Following PRISMA 2020 guidelines, a comprehensive literature search of Medline, Embase, and Cochrane Library was conducted. Studies examining open distal phalanx fractures treated with surgical debridement, with or without antibiotics, were included. Pediatric (<18 years) and adult (≥18 years) populations were analyzed separately, and subgroup analyses were performed based on treatment timing. Statistical comparisons utilized chi-squared tests with significance set at p < 0.05. RESULTS: A total of 24 studies, including 915 fractures, were analyzed. The average patient age was 16.48 years, with males comprising 78.1 %. Early debridement (<24 h) was performed in 91.0 % of cases. Pediatric patients had significantly higher complication rates than adults, particularly for infections and malunion/non-union. Infections rates were lowest when debridement occurred within 8 h and increased significantly with delays beyond 24 h (p < 0.00001). Antibiotic administration with surgical debridement was associated with lower infection rates, particularly in pediatric patients. Among pediatric fractures treated with delayed debridement (>24 h), those receiving antibiotics alone had significantly lower infection rates than those receiving both debridement and antibiotics (p = 0.009), suggesting potential preselection bias. Malunion/non-union was more frequent in pediatric patients and strongly associated with delayed intervention (>24 h). Nail deformities were most commonly seen in debrided fractures, emphasizing the importance of meticulous surgical technique. CONCLUSIONS: Early surgical debridement (<8 h) as the preferred management strategy for open distal phalanx fractures, minimizing infection and complication rates. Delayed debridement (>24 h) significantly worsened outcomes, particularly in pediatric patients. Antibiotic administration reduced infection rates but was not a substitute for timely debridement. These findings highlight the need for standardized treatment protocols and further comparative studies to optimize management strategies across different age groups.
Managing complex hand, wrist, and forearm injuries with WALANT: A case-based technical report.
Räisänen MP, Hytönen MS, Nietosvaara YA … +1 more , Juntunen MT
J Hand Microsurg · 2025 Sep · PMID 40687298 · Full text
Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is an effective and increasingly utilised method of anaesthesia for the surgical treatment of injuries to the hand, wrist, and forearm. Despite its proven safety, effic...
Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is an effective and increasingly utilised method of anaesthesia for the surgical treatment of injuries to the hand, wrist, and forearm. Despite its proven safety, efficacy, and cost-effectiveness, the adoption of WALANT has been limited, particularly in Western healthcare systems where general and regional anaesthesia predominate, especially in complex injuries. We report the application of WALANT in a variety of hand surgical procedures for the treatment of complex injuries ranging from complex fractures to multiple soft tissue injuries in adult patients. WALANT's benefits includes active intraoperative testing of the strength of tendon repairs and osteosynthesis which applies also to complex injuries. Additionally, nerve repairs can also be actively tested under WALANT, leading to more effective and safer postoperative rehabilitation. We anticipate that WALANT will soon see broader application even in more complex surgeries, extending to the surgical treatment of complex injuries around and above elbow.
Pedicled adipofascial flaps for treatment and prophylaxis of neurodesis and neuromas in continuity of the upper extremity: A case series of 22 patients.
Asensio Ramos S, Sánchez-Del Hoyo R, García Bernal FJ
J Hand Microsurg · 2025 Sep · PMID 40687297 · Full text
INTRODUCTION AND OBJECTIVES: Trauma to a peripheral nerve can lead to neuromas in continuity and perineural adhesions or fibrosis (neurodesis), causing pain and functional impairment. We present a retrospective study reg...
INTRODUCTION AND OBJECTIVES: Trauma to a peripheral nerve can lead to neuromas in continuity and perineural adhesions or fibrosis (neurodesis), causing pain and functional impairment. We present a retrospective study regarding our experience in managing these types of injuries using pedicled adipofascial flaps. MATERIAL AND METHODS: We present a series of twenty-two patients treated between 2012 and 2023 for neurodesis or neuromas in continuity in the upper limb, performing external neurolysis and twenty-three adipofascial flaps. The affected nerves were the median nerve (n = 22) and the superficial branch of the radial nerve (n = 1). The ulnar artery perforator adipofascial flap was used in ten cases, the hypothenar fat pad flap in ten cases and the radial artery perforator adipofascial flap in three cases. Pain outcomes were measured using the Visual Analog Scale (VAS) pre and postoperatively, and a statistical analysis of the data was performed. STROBE guidelines were followed. RESULTS: The average pain VAS scores pre and postoperatively were 7.13 and 2.3, respectively, representing a statistically significant improvement (p < 0.001). No statistically significant differences were found based on the type of flap used (p = 0.38) or the patients' age (p = 0.47). Complications included one surgical wound dehiscence of the donor site of an ulnar flap and another one in the recipient site (n = 2). CONCLUSION: Adipofascial flaps are a useful therapeutic option for managing neuromas in continuity and neurodesis of peripheral nerves in the upper extremity, achieving a significant reduction in pain.
Advances in shoulder surgical education. What are the realities?
Tarapore R, Lindsey S, Murthi AM … +1 more , Hoffman RA
J Hand Microsurg · 2025 Sep · PMID 40687296 · Full text
There has been a robust increase in innovations seen in education in the field of shoulder and elbow surgery over the past few years. This is evident through the introduction of new technologies, teaching techniques, and...
There has been a robust increase in innovations seen in education in the field of shoulder and elbow surgery over the past few years. This is evident through the introduction of new technologies, teaching techniques, and online platforms. Of particular significance is the introduction of augmented reality (AR), mixed reality (MR), and virtual reality (VR). Furthermore, the expansion of online platforms, offering online attendance to courses, conferences, and video libraries (AAOS OVT, vumedi) allow for enhanced exposure and education to orthopedic topics and surgical procedures. These have expanded learning from conventional in person training and conferences to a newer age digital presence. This review aims to provide an overview towards advancements in educational opportunities in shoulder and elbow surgery both to the surgeon, and trainees.
WALANT vs. Brachial plexus block with tourniquet in zone 2 flexor tendon repair: An evidence-based comparison.
Sreedevi SR, Parameswaran SC, Titus HM … +1 more , Malathi L
J Hand Microsurg · 2025 Sep · PMID 40687295 · Full text
BACKGROUND: Zone 2 flexor tendon repair is traditionally performed using brachial plexus block, general anaesthesia, or local anaesthesia with a tourniquet. The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) techniq...
BACKGROUND: Zone 2 flexor tendon repair is traditionally performed using brachial plexus block, general anaesthesia, or local anaesthesia with a tourniquet. The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique, as the name implies, allows these procedures to be performed under local anaesthesia without a tourniquet. This study aims to evaluate the efficacy of WALANT in zone 2 flexor tendon repair, comparing it to brachial plexus block in terms of local anaesthetic drug requirement, pain management, surgical field visibility, postoperative outcomes, and patient satisfaction. METHODOLOGY: A prospective observational study was conducted with 24 patients in each group: one undergoing zone 2 flexor tendon repair under WALANT, and the other with brachial plexus block. The amount of local anaesthetic required, pain scores using the Visual Analog Scale (VAS), surgical field visibility using the Surgical Field Rating (SFR) scale, postoperative hospital stay, complications, and patient preferences were compared between the two groups. RESULTS: The pain score during injection was significantly lower in the WALANT group (2.1 ± 0.3 vs 3.7 ± 0.8) whereas the perioperative and postoperative pain scores where similar in both groups. The average operative time (49.7 min vs. 53.2 min) and surgical field visibility (SFR grade 3-58.3 % vs 45.8 %) were comparable in both groups. The WALANT group had a significantly shorter postoperative hospital stay (18.16 h vs. 34.04 h). No complications were reported in the WALANT group, while one postoperative tendon rupture occurred in the brachial plexus block group. All WALANT patients opted the technique for future procedures, while 16.7 % of brachial plexus block patients did not prefer the same method again. CONCLUSION: WALANT offers several advantages over brachial plexus block, with similar surgical field visibility, intraoperative and postoperative pain control, without the discomfort of a tourniquet and with the added advantage of intraop testing of repair. It is a safe and effective alternative to brachial plexus block for zone 2 flexor tendon repair.
Remplissage with Bankart repair in "on track" lesions are safe, re-assuring, and without major complications - a comparative analysis among 80 patients.
Rajagopalan S, Kuberakani K, Sista R … +3 more , Krishnakanth B, Chellamuthu G, Muthu S
J Hand Microsurg · 2025 Sep · PMID 40687294 · Full text
BACKGROUND: The current recommendation for remplissage is the 'Off Track' Hill-Sachs lesion. But it is a relatively safe procedure that might reduce the risk of redislocation even in on-track lesions. This study aims to...
BACKGROUND: The current recommendation for remplissage is the 'Off Track' Hill-Sachs lesion. But it is a relatively safe procedure that might reduce the risk of redislocation even in on-track lesions. This study aims to compare and analyse the safety and functional outcomes of Bankart repair without (BR) and with remplissage (BRR) in patients with on-track Hill Sachs lesions without bone loss in the glenoid in a non-athletic population. METHODS: This is a retrospective analysis of prospectively collected data in patients who underwent arthroscopic Bankart repair with and without remplissage for on-track Hill Sachs lesion. The outcome scores used were the Oxford and Rowe scores. External rotation deficit and incidence of posterior shoulder pain were noted. Redislocation and re-operation rates, and complications were analyzed. RESULTS: We included 80 patients with a mean age of 28.8 (±7.3) years who underwent arthroscopic Bankart repair with (n = 24) and without remplissage (n = 56) for on-track Hill Sachs lesion. We found that both Oxford score (p < 0.001) and Rowe score (p < 0.001) were significantly higher in the BRR group compared to the BR group at 2-year follow-up. We noted comparable complications between the two groups. CONCLUSIONS: Routine utilization of remplissage for 'On Track' Hill Sachs lesion, along with Bankart repair, is safe and results in better functional outcomes and comparable complications. However, longer follow-up is needed to look out for any late complications associated with routine utilization.
Preoperative cardiac evaluation in elective non-cardiac surgery in India: Routine ECG, echocardiography, and angiography are not mandatory.
Rajasekaran N, Patil SS
J Hand Microsurg · 2025 Sep · PMID 40687293 · Full text
BACKGROUND: Preoperative cardiac testing aims to identify patients at risk of perioperative cardiovascular complications, but indiscriminate use of tests like electrocardiograms (ECGs), echocardiography (ECHO), and even...
BACKGROUND: Preoperative cardiac testing aims to identify patients at risk of perioperative cardiovascular complications, but indiscriminate use of tests like electrocardiograms (ECGs), echocardiography (ECHO), and even coronary angiography in low-risk patients often provides little benefit. International guidelines (2024 American College of Cardiology/American Heart Association and 2022 European Society of Cardiology) now emphasize a selective, risk-based approach rather than routine screening. In India, clinicians face pressure - including medicolegal concerns - to order extensive preoperative investigations. This article provides an evidence-based framework, from an Indian perspective, to guide when preoperative ECG, transthoracic echocardiography (TTE), or angiographic evaluation are truly warranted for elective non-cardiac surgeries, strongly emphasizing that these tests are in every case. METHODS: A narrative review was conducted, synthesizing recommendations from the 2024 ACC/AHA Guideline for perioperative cardiovascular evaluation and the 2022 ESC Guideline on non-cardiac surgery, along with key studies and Indian practice insights. We focused on guideline-directed indications for preoperative ECG and ECHO, highlighting Class III recommendations (tests not recommended) versus scenarios where testing is appropriate. Evidence from randomized trials (e.g., CARP trial) and observational cohorts was reviewed to assess outcome impact of routine testing. Consideration was given to India-specific factors such as higher prevalence of cardiovascular disease and defensive medical practices. The findings were distilled into a decision algorithm and summary tables stratified by surgical risk and patient factors. RESULTS: Routine preoperative ECG or ECHO in asymptomatic patients undergoing low-risk surgery (expected <1 % 30-day Major Adverse Cardiac event risk) is not recommended (Class III, no benefit). The 2022 ESC guidelines do not recommend ECG even for intermediate risk surgeries in those who are asymptomatic and do not have pre existing heart disease (Class III). Unnecessary testing in low-risk situations did not improve outcomes and can lead to delays. For intermediate- or high-risk surgeries, a baseline ECG is reasonable, especially in patients with known cardiovascular disease (ACC/AHA Class IIa; ESC Class I). However, even for intermediate risk surgeries, an ECG is if the patient is asymptomatic and has good functional capacity and has no pre existing heart disease, aligning with 2024 ACC AHA and 2022 ESC guidance (Class III for low-risk patients) and a judicious approach. Preoperative TTE is indicated (Class I) for patients with active cardiac symptoms - for example, new or worsening heart failure signs, or a murmur suggestive of significant valvular disease. Patients with known cardiac dysfunction should have TTE only if there is a change in clinical status or if no recent assessment is available (Class IIa). In patients with poor or unknown functional capacity (<4 METs [metabolic equivalents]) facing high-risk surgery, further cardiac evaluation is warranted: Importantly, in the absence of symptoms or clinical risk factors, neither ECHO nor stress testing should be done routinely. Routine coronary angiography or CT angiography is not indicated as a screening tool in asymptomatic patients - it is reserved for those with high-risk findings or active cardiac conditions (Class III for routine use). We developed a stepwise algorithm to guide selective testing, which can be integrated into hospital standard operating procedures (SOPs). CONCLUSION: Not all patients require extensive cardiac work-up before surgery. An evidence-based, selective strategy can safely optimize care: preoperative ECG and ECHO are performed only when clinical indicators suggest necessity, rather than as routine for every case. This approach is supported by current guidelines and outcome studies and maximizes patient safety and resource utilization. In the Indian medicolegal context, adhering to such guideline-driven protocols establishes a clear standard of care, protecting clinicians who avoid unnecessary tests. By documenting rationale for selective testing (or omission of testing) per accepted guidelines, doctors can shield themselves from medicolegal accusations, while focusing on truly at-risk patients. Ultimately, a targeted preoperative cardiac evaluation strategy ensures high-value care - doing the right test for the right patient - and prevents over-testing that is not mandatory for low-risk scenarios.
Median nerve entrapment in a callus fracture following an elastic stable intramedullary nailing for treatment of pediatric both-bone forearm shaft fracture: A case report and literature review.
Houvet P, Bourcheix L
J Hand Microsurg · 2025 Sep · PMID 40687292 · Full text
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Use of the trans-scaphoid portal for the arthroscopic treatment of scaphoid nonunion in the middle third with flexion deformity: technique description and patient series.
Kaempf R, Fischer P, Arnaout A … +2 more , Marchovich LL, Delgado PJ
J Hand Microsurg · 2025 Sep · PMID 40687291 · Full text
Nonunion is one of the main complications associated with scaphoid fractures. Over the past decades, the use of arthroscopy in the treatment of scaphoid nonunion has proven to be a valuable technique, even in cases prese...
Nonunion is one of the main complications associated with scaphoid fractures. Over the past decades, the use of arthroscopy in the treatment of scaphoid nonunion has proven to be a valuable technique, even in cases presenting deformity and carpal instability. This approach facilitates rapid consolidation while minimizing damage to the joint capsule and ligaments, thereby preserving the already compromised vascular supply of the scaphoid. Due to their simpler anatomy, dorsal portals are commonly employed in wrist arthroscopy, reducing the risk of injury to neurovascular structures during joint access. Initial descriptions of arthroscopic treatment for scaphoid nonunion (SNU) used only dorsal portals throughout the procedure. However, correcting the scaphoid's flexion deformity caused the dorsal cortex to close and created a defect in the volar portion, introducing a technical challenge. Herein, we describe a novel access portal to assist in the arthroscopic treatment of mid-third scaphoid nonunion, which we have termed the trans-scaphoid portal. Located volar and distal to portal 1/2, just volar to the first extensor tendon compartment, it allows direct lateral access to the nonunion site. We used this portal in 10 patients with excellent results, observing that it simplified the correction of the scaphoid flexion deformity and allowed for direct placement of the bone graft in the volar region. The trans-scaphoid portal was developed to overcome the limitations of dorsal portals, enabling safe and straightforward debridement of the lesion, correction of deformity, and easier graft placement into the volar defect.
A technical modification to avoid accidental graft drop during hemihamate osteochondral graft harvesting.
Daştan AE, Aljasim O, Celil R … +2 more , Önel Y, Vahabi A
J Hand Microsurg · 2025 Sep · PMID 40677304 · Full text
During graft harvesting for hemihamate arthroplasty, one potential intraoperative complication is accidental graft drop. In this technique, we present a technical modification designed to prevent inadvertent graft drop d...
During graft harvesting for hemihamate arthroplasty, one potential intraoperative complication is accidental graft drop. In this technique, we present a technical modification designed to prevent inadvertent graft drop during the harvesting process. During hemihamate graft harvesting, after adequate exposure of hamate, dorsal cuts are made with a saw blade. Based on preference, a K-wire is placed dorsally into either the radial or ulnar half of the graft, taking into consideration its use as a guide for future screw placement. The wire is held by an assistant. The K-wire diameter is selected to correspond with the intended screw; in the authors' technique, a 1.0 mm K-wire is used as a guide when 1.2 mm screws are planned. The wire is advanced to an appropriate depth, ensuring it will not interfere with subsequent cuts made by saw or osteotome. The initial cut is made using a saw blade, and graft removal is completed with an osteotome. The pre-positioned K-wire prevents the graft from inadvertently falling. Once retrieved, the graft is shaped as needed, and drilling is completed through the K-wire entry point before definitive fixation is achieved using screws.
Long-term outcomes of arthroscopic radial styloidectomy for the treatment of radioscaphoid impingement, including SLAC and SNAC wrists.
d'Ailly PN, Waaijer L, Goslings JC … +2 more , Rahimtoola ZO, Schep NWL
J Hand Microsurg · 2025 Sep · PMID 40620864 · Full text
INTRODUCTION: This study aimed to evaluate the patient-reported outcomes following arthroscopic radial styloidectomy (ARS) in patients with symptomatic radioscaphoid impingement (RSI). MATERIALS AND METHODS: All arthrosc...
INTRODUCTION: This study aimed to evaluate the patient-reported outcomes following arthroscopic radial styloidectomy (ARS) in patients with symptomatic radioscaphoid impingement (RSI). MATERIALS AND METHODS: All arthroscopically treated patients with symptomatic RSI were retrospectively included. Arthroscopy was performed using four portals (3-4, 6 R, MC-U and MC-R) and the radial styloid was removed with a burr. Primary outcome was wrist function measured with the Patient-Rated Wrist Evaluation (PRWE) score with a minimal follow-up of two years. Secondary outcomes were Numeric Rating Scale (NRS) for pain, complications, secondary surgery, patients satisfaction and lost workdays. RESULTS: Seventeen RSI patients were included with a median age of 47 years: four with scapholunate advanced collapse, six with scaphoid nonunion advanced collapse, four with a healed scaphoid fracture and three with a radial styloid fracture nonunion. Follow-up assessments were performed at 22 months and 59 months. The median PRWE score was 8 and the median NRS was 0, which both showed continuous improvement until the final follow-up. Among the two complications were hypertrophic scar tissue and a septic arthritis which was treated with arthroscopic drainage and antibiotics. Four patients required secondary surgery, which included repeated ARS, open radial styloidectomy, posterior interosseous nerve neurectomy and wrist arthroplasty. Out of the 17 patients, 15 reported satisfaction with the treatment. The median number of lost workdays was eight. CONCLUSION: We conclude that ARS results in good long-term patient-reported outcomes with an acceptable risk of complications and need for secondary surgery. ARS should be considered before opting for more invasive procedures. EVIDENCE LEVEL: IV therapeutic.
Association Between Area Deprivation Index and Narcotic Prescriptions, Wound Complications, and Reoperation Rates after Soft Tissue Hand and Wrist Surgery.
Tabarestani A, Foreman M, Dada O … +5 more , Hao KA, Hones KM, Khlopas A, Kim J, Wright TW
J Hand Microsurg · 2025 Sep · PMID 40620863 · Full text
BACKGROUND: The area deprivation index (ADI) is an outcome metric that quantifies socioeconomic status by stratifying neighborhoods based on zip code. The purpose of this study was to investigate the effect of national A...
BACKGROUND: The area deprivation index (ADI) is an outcome metric that quantifies socioeconomic status by stratifying neighborhoods based on zip code. The purpose of this study was to investigate the effect of national ADI rank on the amount of narcotics prescribed, wound complications, and reoperations after routine hand or wrist surgery. METHODS: We conducted a retrospective review of adult patients undergoing routine hand or wrist soft tissue surgery between 2013 and 2022. Patients were included if they underwent routine hand or wrist surgeries. Patients were excluded for having concomitant lacerations, penetrating injuries, or fractures. Multivariable logistic regression was performed to determine whether national ADI is associated with the amount of narcotics prescribed, the incidence of wound complications, and reoperation rates after routine hand and wrist procedures independent of covariates. RESULTS: We included 1389 patients. The mean age was 55 years and 65 % were female. The average national ADI rank was 65.6. The largest ADI decile group that was categorized was in the 70-79 rank (consistent with a highly economically disadvantaged group), with the national median being set at 50. Wound complications occurred in 2.9 % of patients (n = 40) and reoperations occurred in 2.5 % of patients (n = 35). Multivariable regression determined that national ADI rank was not associated with a difference in the amount of narcotics prescribed (P = .141), wound complications (P = .599), or reoperation rates (P = .141). CONCLUSIONS: National ADI rank was not associated with a significant difference in the amount of narcotics prescribed, wound complications, or reoperation rates.
Knacks and pitfalls for superficial circumflex iliac artery perforator flap.
Ishibashi S, Miyazaki T, Kanasaki M … +4 more , Tsukuura R, Matsui C, Yamamoto N, Yamamoto T
J Hand Microsurg · 2025 Sep · PMID 40612916 · Full text
PURPOSE: To review the utility of the Superficial Circumflex Iliac Artery Perforator (SCIP) flap for a wide range of defect reconstructions, emphasizing the groin's vascular anatomy, relevant anatomical variations, and r...
PURPOSE: To review the utility of the Superficial Circumflex Iliac Artery Perforator (SCIP) flap for a wide range of defect reconstructions, emphasizing the groin's vascular anatomy, relevant anatomical variations, and recent advancements overcoming traditional groin flap limitations. METHODS: Based on a literature review, anatomical knowledge, and clinical experience, this article summarizes the variations of the superficial circumflex iliac artery (SCIA), surgical techniques for SCIP flap harvesting, and the role of preoperative color Doppler ultrasound mapping for safe and efficient flap elevation. RESULTS: The SCIA displays significant anatomical variations, necessitating thorough preoperative assessment for successful flap harvest. The perforator flap concept and supermicrosurgery have addressed the challenges of the traditional groin flap's short, small pedicle, making the SCIP flap a more reliable option. The SCIP flap offers remarkable versatility by potentially including multiple tissues-skin, fat, lymphatic vessels, lymph nodes, deep fascia, sartorius muscle, lateral femoral cutaneous nerve, and iliac bone-allowing its use as a chimeric flap for a broad spectrum of defects, ranging from simple to complex. CONCLUSIONS: With a comprehensive understanding of groin vascular anatomy and appropriate preoperative evaluation, including color Doppler ultrasound, the SCIP flap is a reliable and highly versatile reconstructive tool. Its ability to incorporate various tissues and minimal donor site morbidity, with scars concealable under clothing, make it an excellent choice for various reconstructive challenges.
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