Journal Of Hand And Microsurgery[JOURNAL]
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200 papers
Comparison of hand surgery certification exams in Europe and the United States using ChatGPT 4.0.
Hasan S, Ipaktchi K, Meyer N … +1 more , Liverneaux P
J Hand Microsurg · 2025 Jul · PMID 40475332 · Full text
UNLABELLED: Certification in hand surgery in Europe (EBHS) and the United States (HSE) requires a subspecialty examination. These exams differ in format, and practice exams, such as those published by the Journal of Hand...
UNLABELLED: Certification in hand surgery in Europe (EBHS) and the United States (HSE) requires a subspecialty examination. These exams differ in format, and practice exams, such as those published by the Journal of Hand Surgery (European Volume) and the ASSH, are used for preparation. This study aimed to compare the difficulty of the multiple-choice questions (MCQs) for the EBHS and HSE practice exams under the assumption that European MCQs are more challenging. ChatGPT 4.0 answered 94 MCQs (34 EBHS and 60 HSE practice exams) across five attempts. We excluded MCQs with visual aids. Performance was analyzed both quantitatively (overall and by section) and qualitatively. ChatGPT's scores improved after being provided with correct answers, from 59 % to 71 % for EBHS and 97 % for HSE practice exams by the 5th attempt. The European MCQs proved more difficult, with limited progress (<50 % accuracy up to the 5th attempt), while ChatGPT demonstrated better learning with the HSE questions. The complexity of the European MCQs raises questions about the harmonization of certification standards. ChatGPT can help standardize evaluations, though its performance remains inferior to that of humans. The findings confirm the hypothesis that EBHS MCQs are more challenging than the HSE practice exam. LEVEL OF EVIDENCE: Exploratory study, level of evidence IV.
Role of five-fingered hand in type IIIB thumb hypoplasia- an Asia-Pacific perspective.
Bhat AK, Pai G M, Acharya AM
J Hand Microsurg · 2025 Jul · PMID 40475331 · Full text
The management of type IIIB thumb hypoplasia in the Asia-Pacific region is predominantly shaped by cultural views, with numerous countries favouring a five-fingered hand. The article discusses the evolution of treatment...
The management of type IIIB thumb hypoplasia in the Asia-Pacific region is predominantly shaped by cultural views, with numerous countries favouring a five-fingered hand. The article discusses the evolution of treatment for type IIIB thumb hypoplasia with thumb preservation and reconstruction and the dilemma of excision and pollicization. Recent research has revealed the limitations of pollicization including joint instability and diminished grip strength. Moreover, several parents, particularly in the Asia-Pacific region, exhibit hesitancy towards thumb excision owing to cultural, psychological, or religious considerations, favouring the retention of a five-fingered hand. This has prompted continuous investigation into alternate techniques that preserve thumb stability while facilitating a functional five-fingered hand. Recent strategies have demonstrated encouraging outcomes comparable to conventional pollicization. In several instances, staged treatments are necessary to provide a five-fingered hand, although the reconstructed thumb may exhibit functional and developmental limits. This alternative procedure has demonstrated favourable functional and aesthetic benefits, with minimal donor morbidity, comparable to that of pollicization
"Median nerve hand": Replacing "T1 hand" in brachial plexus injuries.
Terrence Jose Jerome J
J Hand Microsurg · 2025 May · PMID 40458111 · Full text
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Fifth carpometacarpal arthritis management: A comparative cadaver study of two arthrodesis methods.
Aljasim O, Yener C, Demirkoparan M … +6 more , Vahabi A, Daştan AE, Küçük L, Özkayın N, Bilge O, Günay H
J Hand Microsurg · 2025 Jul · PMID 40433057 · Full text
Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand fu...
Osteoarthritis of the fifth carpometacarpal (CMC) joint is an uncommon yet challenging complication following fracture-dislocation injuries. This condition results in chronic pain, restricted motion, and impaired hand function, significantly limiting the patient's ability to perform daily activities. Surgical interventions for post-traumatic osteoarthritis of the fifth CMC joint include arthrodesis and arthroplasty, with the Dubert technique combining elements of both approaches. This study aimed to compare the effects of Dubert arthrodesis and traditional fifth metacarpal (MC)-hamate arthrodesis on the flexion-extension range of motion of the fifth MC. An in vitro study was conducted using twelve cadaveric forearm specimens. The specimens were divided into two groups: Group 1 underwent Dubert arthrodesis, and Group 2 underwent fifth MC-hamate arthrodesis. Preoperative and postoperative evaluations were performed using computed tomography (CT) scans to measure the flexion-extension range of motion of the fifth MC. Twelve specimens, with a mean age of 53 years (range: 41-60 years), were analyzed. No significant difference in preoperative flexion-extension motion was observed between the groups. Both groups exhibited a significant reduction in flexion-extension motion following arthrodesis. However, no significant difference in postoperative flexion-extension motion was observed between the groups. Neither Dubert arthrodesis nor fifth MC-hamate arthrodesis preserved the physiological flexion-extension motion of the fifth MC. Biomechanical analysis showed no significant advantage of one technique over the other. The Dubert arthrodesis procedure was technically demanding, with inadequate resection potentially leading to residual symptoms. Further comparative clinical studies are required to confirm these findings and determine the optimal surgical approach for managing fifth MC arthritis.
Rehabilitation outcomes in traumatic brachial plexus Injury: Occupational therapy perspective.
Talankar T, Palsule S
J Hand Microsurg · 2025 Jul · PMID 40417711 · Full text
BACKGROUND: Traumatic Brachial Plexus Injury (TBPI) results in significant motor and sensory impairments, impacting daily function, employment, and psychological well-being. While surgical interventions aim to restore fu...
BACKGROUND: Traumatic Brachial Plexus Injury (TBPI) results in significant motor and sensory impairments, impacting daily function, employment, and psychological well-being. While surgical interventions aim to restore function, outcomes remain variable, necessitating comprehensive rehabilitation. Occupational Therapy (OT) plays a crucial role in optimizing upper limb function, addressing psychosocial concerns, and enhancing quality of life. However, limited research exists on its specific impact, particularly in the Indian context. OBJECTIVE: This study aimed to evaluate the functional outcomes of OT interventions in adult TBPI patients, assessing their impact on muscle strength, sensation, range of motion, functional performance, and quality of life. METHODS: A prospective longitudinal observational study was conducted at the Occupational Therapy Department of a tertiary healthcare center in Mumbai, India. 33 patients were recruited, with 31 completing the study. Functional outcomes were assessed at baseline and at 3, 6, 9, and 12 months post-intervention using muscle power assessment, sensory evaluation, range of motion, the Brachial Assessment Tool (BrAT), Disabilities of the Arm, Shoulder, and Hand (DASH) score, WHOQOL-BREF, and the Modified Mallet Score. RESULTS: Significant improvements were observed in muscle power (p = 0.0001), sensation (p = 0.0001). The BrAT score showed significant improvement across all time points, particularly in conservatively managed patients (p < 0.01). DASH scores demonstrated a significant reduction over 12 months (p = 0.0001), with upper plexus injuries showing better recovery than global plexus injuries. WHOQOL-BREF scores improved significantly in physical, psychological, and social domains (p < 0.05). Correlation analysis revealed a strong negative correlation between DASH and BrAT scores (R = -0.84, p = 0.0001) and a moderate positive correlation between BrAT and WHOQOL-BREF (Physical R = 0.57, Psychological R = 0.58, p = 0.0001). CONCLUSION: Occupational Therapy significantly enhances functional recovery, independence in daily activities, and psychosocial well-being in TBPI patients. Conservatively managed patients showed greater functional gains compared to surgically managed patients. These findings highlight the critical role of OT in TBPI rehabilitation and the need for standardized OT protocols to improve patient outcomes.
Combined semi-constrained total distal radioulnar joint (DRUJ) arthroplasty and radial head arthroplasty for severe, concomitant rheumatoid disease of the wrist and elbow joints.
Fuller Z, Gupta A, Herzog I … +4 more , Weisberger J, Ahmed IH, Vosbikian MM, Ignatiuk A
J Hand Microsurg · 2025 Jul · PMID 40417710 · Full text
Semi-constrained total distal radioulnar joint (DRUJ) arthroplasty with Aptis-Scheker implant has demonstrated excellent results in patients with end-stage rheumatoid arthritis (RA) of the wrist. However, clinical succes...
Semi-constrained total distal radioulnar joint (DRUJ) arthroplasty with Aptis-Scheker implant has demonstrated excellent results in patients with end-stage rheumatoid arthritis (RA) of the wrist. However, clinical success of the Scheker implant in restoring range of motion may be limited in patients with concomitant degenerative disease at the proximal radioulnar joint and radiocapitellar joint, which work in tandem with the DRUJ to allow pronosupination of the forearm. Among treatment options for elbow arthritis, standalone radial head arthroplasty remains poorly studied in the context of RA, despite being used widely in trauma patients. Here, we illustrate the surgical technique for combined total DRUJ arthroplasty with a Scheker implant and radial head arthroplasty to treat long-standing, refractory RA, at the wrist and elbow joints, with excellent results at 1-year follow-up.
Early postinterventional clinical implications of Collagenase Clostridium Histolyticum injection versus limited fasciectomy for Dupuytren's disease.
Liechti R, Bernhard J, Merky DN … +2 more , Sutter D, Vögelin E
J Hand Microsurg · 2025 Jul · PMID 40417709 · Full text
OBJECTIVES: This study compared Collagenase Clostridium Histolyticum (CCH) injection and limited fasciectomy (LF) in terms of early post-interventional soft tissue conditions and patient burden, evaluated by visit freque...
OBJECTIVES: This study compared Collagenase Clostridium Histolyticum (CCH) injection and limited fasciectomy (LF) in terms of early post-interventional soft tissue conditions and patient burden, evaluated by visit frequency to surgeons and hand therapists, complications, and reintervention rates. MATERIALS AND METHODS: Consecutive patients undergoing CCH injection or LF as first-line treatment for Dupuytren's disease over 15 years were assessed. Propensity score matching minimized selection bias. The primary outcome was the assessment of early post-interventional (between 2 and 8 weeks) soft tissue condition using a novel Soft Tissue Score with points assigned for documented swelling, hyperemia, induration, and tenderness. Secondary outcomes included the number of surgeon and hand therapy visits, as well as the complication and reintervention rates in a subgroup of patients followed for at least 4 months. RESULTS: After propensity score matching, two treatment groups of 26 patients each were formed (CCH vs. LF group). There were no significant differences in baseline characteristics and correction of flexion contracture between the two treatment groups. The early postinterventional Soft Tissue Score was significantly worse in the LF group than in the CCH group (mean 1.35 vs. 0.65 points, MD 0.7, 95 % CI [0.2, 1.2], p = 0.022). The number of surgeon and hand therapy visits was significantly higher in the LF group (mean 4.7 vs. 1.9 visits, MD 2.8, 95 % CI [1.8, 3.8], p < 0.001 and mean 10.5 vs. 4.3 visits, MD 6.2, 95 % CI [0.7, 11.7], p = 0.036, respectively). The rate of mild and severe complications was comparable in both groups. While the reintervention rate was significantly higher in the CCH group, the occurrence of multiple reinterventions was comparable. CONCLUSION: The results of this study suggest that CCH injections lead to less complicated wound healing requiring less intensive surgeon and hand therapy aftercare than LF. CCH represents a valuable addition to Dupuytren's disease treatment, allowing for repeated use in severe, complex, or recurrent cases without increasing procedure-related risks while offering versatility for combination with minimally invasive surgery.
Integrating artificial intelligence into orthopedics: Opportunities, challenges, and future directions.
Vaishya R, Sibal A, Kar S … +1 more , Reddy S
J Hand Microsurg · 2025 Jul · PMID 40395968 · Full text
PURPOSE: Artificial intelligence (AI) is transforming orthopedics by improving diagnostic accuracy, optimizing surgical planning, and personalizing treatment approaches. This review evaluates the applications of AI in or...
PURPOSE: Artificial intelligence (AI) is transforming orthopedics by improving diagnostic accuracy, optimizing surgical planning, and personalizing treatment approaches. This review evaluates the applications of AI in orthopedics, focusing on its impact on patient care, the efficacy of AI methodologies, and challenges in integrating these technologies into clinical practice. METHODS: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar for articles published up to 28 February 2025. Inclusion criteria included studies addressing AI applications in orthopedics, while non-peer-reviewed and non-English publications were excluded. Data extraction focused on AI technologies, applications, outcomes, and the advantages or limitations of AI integration. RESULTS: Findings demonstrate AI's effectiveness in areas such as fracture detection and treatment planning, mainly through machine learning and deep learning. AI has improved outcomes in joint reconstruction, spine surgery, and rehabilitation. However, challenges such as data standardization and clinical validation remain. CONCLUSION: The review highlights AI's potential to revolutionize orthopedic practice, emphasizing the need for ongoing research to overcome barriers to adoption. Future directions should prioritize multi-center clinical trials, enhanced data protocols, and stakeholder collaboration to ensure ethical and effective AI implementation, ultimately improving patient outcomes and care delivery.
Wide-awake local anaesthesia in bilateral endoscopic carpal tunnel release Surgery: An efficient ergonomic approach.
Kong SYZ, Rin HY, Chew DEM … +1 more , Kang YC
J Hand Microsurg · 2025 Jul · PMID 40376120 · Full text
Endoscopic carpal tunnel release (ECTR) has advanced considerably since its introduction, providing a minimally invasive alternative to traditional open surgery for carpal tunnel syndrome. This review traces the history...
Endoscopic carpal tunnel release (ECTR) has advanced considerably since its introduction, providing a minimally invasive alternative to traditional open surgery for carpal tunnel syndrome. This review traces the history of ECTR, highlighting key advancements in techniques and variations. We compare the anatomical visualization between endoscopic and open approaches, particularly regarding nerve and tendon preservation. The role of Wide Awake Local Anaesthesia No Tourniquet (WALANT) in ECTR is discussed, with a focus on its benefits in reducing postoperative pain and recovery time. Additionally, we present our approach to bilateral ECTR, illustrated through pictorial representations, demonstrating the advantages of this technique. We conclude that bilateral ECTR not only accelerates overall recovery but also has the potential to reduce overall healthcare costs.
Advancing emergency upper extremity care: A pilot study of ChatGPT's potential role in diagnosing and managing hand and wrist trauma.
Rothchild E, Jung G, Aiello C … +2 more , Tanna N, Ricci JA
J Hand Microsurg · 2025 Jul · PMID 40352662 · Full text
PURPOSE: Hand and wrist trauma is a frequent cause of emergency room (ER) visits. However, hospitals often lack immediate hand specialist coverage. This study aims to evaluate the efficacy of Artificial Intelligence (AI)...
PURPOSE: Hand and wrist trauma is a frequent cause of emergency room (ER) visits. However, hospitals often lack immediate hand specialist coverage. This study aims to evaluate the efficacy of Artificial Intelligence (AI) platforms like ChatGPT in aiding in the diagnosis and patient management of upper extremity trauma. METHODS: Ten clinical vignettes depicting common hand and wrist emergency clinical situations were created by the senior author to represent a broad range of common upper extremity injuries. These were presented to plastic surgery residents and ChatGPT (version 4.0). The responder was tasked to provide a diagnosis, ER management, and definitive treatment plans for each vignette. Responses were collected and scored by two attending plastic surgeons, blinded to the source, on a scale of 0 (poor) to 30 (excellent). Univariate and linear regression models were utilized for analysis. RESULTS: A total of 16 resident responses (9 junior and 7 senior) and 16 ChatGPT responses were collected for each of the 10 clinical scenarios. ChatGPT had significantly higher total average scores (mean = 26.6 vs. 22.7, p < 0.05) and ER management scores (mean = 9.9 vs. 6.7, p < 0.05) when compared to residents. We did not find any notable differences in diagnosis or definitive treatment scores between residents and ChatGPT responses. However, the study was not sufficiently powered to detect smaller effect sizes in these areas. No apparent correlations between scores and resident year of training were observed. CONCLUSIONS: ChatGPT provided clinically accurate diagnosis and management plans for upper extremity trauma. Implementing AI in trauma management has the potential to improve the management of hand and wrist trauma in emergency settings by serving as a diagnostic and clinical reference tool for emergency medical providers. However, their integration into clinical practice should be carefully evaluated and focused on complementing, and not replacing, traditional consults. Ultimately, these tools could alleviate the burden placed on ERs and limit reliance on hand consults.
Arthroscopic bone grafting in scaphoid fracture nonunion: Is it a universal solution?
Li MKL, Ho PC, Tse WL … +2 more , Mak MC, Koo JJSC
J Hand Microsurg · 2025 Jul · PMID 40343106 · Full text
Since 1997, arthroscopic bone grafting has offered hand surgeons a solution to the riddle of scaphoid fracture nonunion. The intended merit of an arthroscopic approach for scaphoid fracture nonunion management lies in it...
Since 1997, arthroscopic bone grafting has offered hand surgeons a solution to the riddle of scaphoid fracture nonunion. The intended merit of an arthroscopic approach for scaphoid fracture nonunion management lies in its minimal invasiveness, which preserves the tenuous vascularity of the scaphoid, poses minimal disturbance to carpal ligaments, and allows comprehensive evaluation in diagnostic uncertainty. What does the evidence tell us about its outcomes and limitations compared to open techniques? Level III evidence suggests that arthroscopic bone graft yields similar union rates and potentially earlier time to union compared to open bone graft, at an average union rate of 96 % and union time of 13.5 weeks. It offers a universal solution to scaphoid fracture nonunion, with similar union rate and time achieved regardless of smoking, chronicity, proximal fracture or avascular necrosis. Radiological correction of humpback deformity and dorsal intercalated segment instability (DISI) may be inferior compared to an open technique, but correction to within normal range is still possible. Hence, it's long term clinical implication remains unclear. Perhaps the only true contraindications to arthroscopic bone grafting are proximal pole fragmentation due to unsalvageable necrosis, or advanced scaphoid nonunion advanced collapse (SNAC). While it is easy to get lost in the debate of biology and the necessity of vascularized bone graft, ultimately, fracture healing is multifactorial and surgeons must not neglect the mechanical importance of well placed instrumentation.
The role of artificial intelligence in predicting injured structures based on clinical images of lacerations in the volar aspect of the hand and forearm.
Vahabi A, Daştan AE, Günay H
J Hand Microsurg · 2025 Jul · PMID 40290855 · Full text
INTRODUCTION: Recently introduced image processing capabilities of AI models, which are accessible to a broad audience, may contribute to progress in medical research. Inspection and physical examination are important co...
INTRODUCTION: Recently introduced image processing capabilities of AI models, which are accessible to a broad audience, may contribute to progress in medical research. Inspection and physical examination are important components of hand injury assessment, but they have inherent limitations in accuracy. The purpose of this study was to compare the structures identified as damaged during physical examination with those predicted by an AI model, utilizing its image processing capability. We hypothesized that the AI tool would demonstrate a level of accuracy comparable to that of physical examination in predicting injured structures. METHODS: We retrospectively reviewed the files of patients with hand and forearm injuries related to the volar aspect from January 2024 to July 2024. After exclusions, a total of 30 patients were included in the final analyses. Structures suspected to be damaged based on the initial evaluation and those identified as injured during surgery were documented through chart review. For the same patients, the AI tool (ChatGPT-4.0) was utilized to predict injured structures from clinical photos obtained during the initial examination. We examined the correlation and overlap between the structures identified as injured during the initial clinical examination and those predicted by the AI tool, as well as the correlation and overlap between the structures predicted by the AI tool and those confirmed as injured during surgical procedures. RESULTS: The sensitivity of the physical examination was found to be 66.0 % (95 % CI: 57.5 %-73.7 %), while the specificity was 98,7 % (95 % CI: 97,6 % to 99,4 %). The sensitivity of the AI tool was found to be 61.7 % (95 % CI: 53.1 %-69.8 %), while the specificity was 82.4 % (95 % CI: 79.4 %-85.2 %). CONCLUSION: In its current form, AI demonstrates limited yet promising potential as an adjunctive tool in the clinical evaluation of flexor-side injuries of the hand and forearm. LEVEL OF EVIDENCE: III, Diagnostic study.
Distal ulnar neck fracture displacement with forearm rotation: A biomechanical cadaveric study.
Tang CQY, Lai SHS, Ramruttun AK … +3 more , Chou SM, Chong AKS, Sechachalam S
J Hand Microsurg · 2025 Jul · PMID 40290854 · Full text
UNLABELLED: Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement i...
UNLABELLED: Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement in isolated distal ulnar fractures, specifically AO Muller Q2 and Biyani Type I fracture pattern, during forearm pronosupination.6 fresh frozen cadaveric upper limbs amputated at mid-humerus were used. Soft tissues including proximal and distal radioulnar joints were carefully preserved. Specimens were inspected grossly and radiographically for absence of pathologies. Radiocarpal and midcarpal pinning was performed to facilitate quantification of forearm rotation. 2 markers were each placed proximal and distal to fracture site to quantify fracture displacement. 3-dimensional positional data was recorded using an optoelectronic system (Vicon MX motion capture system).Distance between the 2 markers increased in the proximodistal and radioulnar axis, and decreased in the dorsovolar axis when the forearm was rotated from neutral to 100° pronation. The inverse was observed during supination. Mean aggregate fracture site displacement increased to 9.17 ± 2.78 mm at 100° pronation. Statistically significant increase in aggregate fracture site displacement was observed from 60° pronation onwards. At 100° supination, the aggregate fracture site displacement was 4.58 ± 8.62 mm. When supinating from neutral to 100°, fracture displacement did not increase significantly. RESULTS: from this study suggest that distal ulnar fractures are potentially stable, particularly in supination. However, unrestricted forearm pronation with inadequate immobilisation might still cause further fracture displacement. Further studies are required to assess distal ulnar fracture stability in vivo before treatment guidelines can be established.
Review and algorithmic management of the anatomical variations of the medial sural artery perforator flap.
An-Jou Lin J, Meuli JN, Ignacio Larsson JC … +3 more , Abdelrahman M, Koshy K, Nai-Jen Chang T
J Hand Microsurg · 2025 May · PMID 40290208 · Full text
BACKGROUND: Perforator variations in the calf region can be found during medial sural artery perforator (MSAP) flap harvest. This article reviews the perforator anatomy of the posterior calf and proposes an algorithmic a...
BACKGROUND: Perforator variations in the calf region can be found during medial sural artery perforator (MSAP) flap harvest. This article reviews the perforator anatomy of the posterior calf and proposes an algorithmic approach to MSAP flap harvest when there are no favorable perforators, based on the author's experience and literature review. MATERIAL AND METHODS: The PubMed database was searched for anatomic and/or clinical studies describing the perforator anatomy of the posterior calf. Clinical studies reporting the use of alternative flaps for cases in which perforator anatomy was unfavorable were also analyzed. We summarized the study's characteristics and identified the main anatomical challenges faced during flap harvest. We present our algorithm to address these situations, illustrated with three cases in which perforator variations were found intraoperatively and/or difficulties were encountered during MSAP flap harvest. RESULTS: The anatomical studies from the literature review showed a mean of 3.2 ± 0.8 (1-7) perforators in the posterior calf. The presence of MSAPs and lateral sural artery perforators (LSAPs) have been reported to be 97.2 % and 62.5 % respectively. The mean number of MSAPs was 1.8 ± 0.32 while LSAPs were 1.3 ± 0.3, favoring a medial dominance. Perforators from MSA and LSA were found at a similar distance below the popliteal crease and from the mid-calf. Our clinical experience showed that MSAPs found anterior to the incision can still be used and even as a chimeric flap. Posterior tibial artery perforator flaps can also be harvested from the same anterior incision. Direct septal perforators from the MSA represent a newly identified anatomical variation. An algorithmic approach is presented for managing MSAP intra-operative perforator variations. CONCLUSION: The proposed approach of MSAP flap harvest can provide a useful guide for the microsurgeon to raise alternative flaps in the posterior calf region. We advocate an anterior approach that also gives access to perforators of the sural artery itself and posterior tibial artery perforators. These back-up flaps provide similar tissue characteristics and potential for head and neck and extremity composite tissue reconstruction.
Exploring reconstructive alternatives to pollicization for modified Blauth type IIIB-V congenital thumb hypoplasia: A systematic review.
Raman A, Tipps JA, Vaile JR … +1 more , Mendenhall SD
J Hand Microsurg · 2025 May · PMID 40248000 · Full text
BACKGROUND: Although pollicization remains the traditional treatment strategy for modified Blauth type IIIB-V grade congenital thumb hypoplasia, many patients and parents express interest in alternative reconstructive ap...
BACKGROUND: Although pollicization remains the traditional treatment strategy for modified Blauth type IIIB-V grade congenital thumb hypoplasia, many patients and parents express interest in alternative reconstructive approaches that maintain a five-digit hand. The aim of this study was to provide a summary of these alternative techniques and to assess for differences in their outcomes, with the hypothesis that techniques featuring vascularized bone grafts would have fewer instances of bone resorption or nonunion relative to non-vascularized techniques. METHODS: A systematic literature review was conducted in PubMed, Embase, and CINAHL using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the reconstruction of modified Blauth type IIIB-V hypoplastic thumbs were included. Chi squared tests (or Fisher exact tests where appropriate) were performed to compare aggregate complication data. RESULTS: Twenty-four articles met inclusion criteria, yielding 207 patients with 210 thumbs undergoing reconstruction. Mean patient age at surgery was 3.4 years, while the mean follow-up time was 4.2 years. 203 of the 207 patients underwent reconstruction using one of five techniques: PIPJ/MTPJ transfer, hemi-metatarsal transfer, toe and metatarsal transfer, iliac crest transfer, and toe phalanx transfer. PIPJ and MTPJ transfers were the most performed procedures (n = 54, 26 %). Vascularized grafts were used in 89 cases (43 %), while non-vascularized grafts comprised 114 cases (55 %). Rates of bone resorption and nonunion were higher in non-vascularized grafts, though not significantly so (n = 203, p = 0.19). Conversely, donor site complications were significantly higher in vascularized bone grafting techniques (n = 203, p = 0.0056). The most frequently reported outcome measures were Kapandji scores (46 %) and key pinch strength (46 %). Kapandji scores had a weighted mean of 5.6 (range 3.1-6.7). CONCLUSION: A variety of alternative techniques exist for reconstructing severely hypoplastic thumbs, though no technique demonstrates clear superiority. Vascularized grafts trend towards a lower bone resorption/nonunion rate relative to non-vascularized grafts, though there is evidence of heightened risks of donor site complications when taking vascularized bone grafts from the foot. Objective outcome measures showed variability across studies limiting comparisons between techniques.
The new solution for the bilateral severe thumb hypoplasia.
Chen Y, Yin C, Shen X
J Hand Microsurg · 2025 May · PMID 40242185 · Full text
Thumb hypoplasia is a manifestation of radial longitudinal dysplasia, ranging from a slight decrease in thumb size to complete absence of the thumb. It has been suggested that distinct treatment approaches be used for va...
Thumb hypoplasia is a manifestation of radial longitudinal dysplasia, ranging from a slight decrease in thumb size to complete absence of the thumb. It has been suggested that distinct treatment approaches be used for various categories of hypoplastic thumb. However, due to cultural preferences in Eastern countries, some parents frequently look for alternative surgical treatments to achieve an aesthetically "normal" hand. We describe the surgical technique used in a young boy born with the bilateral severe thumb hypoplasia, a left hand Blauth Ⅳ thumb and a right hand Blauth ⅢB thumb. Thumb reconstruction was done in two stages, and the results were good in terms of both appearance and functionality. This method maximized thumb function as well as the parents' expectations.
Decision making in Thumb Hypoplasia - Our perspective.
Raj Pallapati SC, Kathir Joyson DR, Kiran SP … +1 more , Thomas BP
J Hand Microsurg · 2025 May · PMID 40236765 · Full text
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Current surgical outcomes of free functional muscle transfer for Volkmann's ischemic contracture: A scoping review.
Vaile JR, Tipps JA, Struble SL … +3 more , Patel NK, Kota A, Mendenhall SD
J Hand Microsurg · 2025 May · PMID 40236764 · Full text
PURPOSE: Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to proc...
PURPOSE: Free functional muscle transfer (FFMT) is a versatile surgical option for restoring function in cases of acute trauma, ischemic contracture, or tumor resection. FFMT is often considered a last resort due to procedural complexity and lack of microsurgical availability. While FFMT is well described for brachial plexus injury and facial trauma, its application in Volkmann's ischemic contracture (VIC) is underexplored, with variable operative timelines and postoperative outcomes. METHODS: Following PRISMA-ScR guidelines, PubMed and Ovid electronic databases were searched using the following keywords: "Volkmann," "compartment syndrome," "muscle transfer," "muscle transplantation," and/or "reconstruction." Studies were imported into Covidence, and screening was performed by two independent reviewers. Patient characteristics, surgery information, and postoperative clinical data were extracted. RESULTS: The scoping review included 21 studies. In total, 163 FFMTs for VIC were performed, most commonly using the gracilis muscle (64.4 %) for finger flexion deficits (91.4 %). Nerve selection was variably reported, with the anterior interosseus nerve (AIN) used most frequently. Grip strength, range of motion, and total active motion were the most frequently utilized outcome measures. FFMT success rates were high (96 %), and 34.6 % of all-comers experienced tendon or muscle adhesions that required subsequent tenolysis or adhesiolysis. Several studies recommended early exploration within 3 weeks, and FFMT within 6 months of the initial injury; however, successful FFMT cases were reported up to 20 years post-injury. CONCLUSIONS: FFMT remains a viable option for VIC treatment, with a 96 % success rate. There is a relatively high incidence of tendon or muscle adhesions (34.6 %) that require secondary procedures.
ChatGPT 4.0's efficacy in the self-diagnosis of non-traumatic hand conditions: Correspondence.
Daungsupawong H, Wiwanitkit V
J Hand Microsurg · 2025 May · PMID 40224955 · Full text
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Management of thumb hypoplasia in Vietnam: Challenges in a developing country and future directions.
Nguyen PD, Takagi T, Light TR … +7 more , Truong DQ, Dinh Vo NQ, Vo TC, Le TN, Doan HD, Truong KT, Minh Phan MD
J Hand Microsurg · 2025 May · PMID 40224954 · Full text
Thumb hypoplasia, a congenital malformation characterized by an underdeveloped or absent thumb, presents significant functional and aesthetic challenges. In Vietnam, a low-middle income developing country, the management...
Thumb hypoplasia, a congenital malformation characterized by an underdeveloped or absent thumb, presents significant functional and aesthetic challenges. In Vietnam, a low-middle income developing country, the management of thumb hypoplasia is shaped by limited resources, geographic disparities, and reliance on international collaborations. This article reviews the current state of diagnosis, surgical treatment, and rehabilitation of thumb hypoplasia in Vietnam, with a focus on the unique challenges faced by healthcare providers in resource-constrained settings. The role of international experts, including Dr. Terry Light, Dr. Takehiko Takagi, Dr. Alain Gilbert, and Dr. Philippe Valenti, is emphasized for their contributions in shaping advanced surgical techniques and mentoring local surgeons. We also discuss the critical involvement of the Vietnam Pediatric Orthopaedic Association (VPOA) in promoting pediatric orthopedic care. Future recommendations include expanding access to specialized care, improving surgical training, decentralizing services to rural areas, and encouraging the publication of local research to foster global collaboration. By addressing these areas, Vietnam can continue to enhance outcomes for children affected by thumb hypoplasia.
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