Journal of Clinical Medicine

Research

13 pages, 2655 KiB

Open AccessArticle

Clinical Outcomes and Failure Rate of Triangular Fibrocartilage Complex Foveal Repair Were Comparable between Arthroscopic and Open Techniques

by Shin Woo Lee, Jung Jun Hong, Seung-Yong Sung, Tae-Hoon Park and Ji-Sup Kim

J. Clin. Med. 2024, 13(10), 2766; https://doi.org/10.3390/jcm13102766 - 8 May 2024

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Abstract

Background: This study compared clinical outcomes between arthroscopic and open repair of triangular fibrocartilage complex (TFCC) foveal tears in chronic distal radioulnar joint (DRUJ) instability patients. Methods: A total of 79 patients who had gone through foveal repair of TFCC using arthroscopic technique [...] Read more.

Background: This study compared clinical outcomes between arthroscopic and open repair of triangular fibrocartilage complex (TFCC) foveal tears in chronic distal radioulnar joint (DRUJ) instability patients. Methods: A total of 79 patients who had gone through foveal repair of TFCC using arthroscopic technique (n = 35) or open technique (n = 44) between 2016 and 2020 were retrospectively analyzed. The visual analog scale (VAS) score for pain, active range of motion (ROM), grip strength, Mayo Modified Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and Patient-Rated Wrist Evaluation (PRWE) score at 2-4-6-12-24 months postoperatively were compared between two groups. Results: Two years after the operation, clinical parameters (VAS, MMWS, DASH, and PRWE), grip strength, and ROM showed significant advancement in the two groups in comparison to their values measured preoperatively (p < 0.001). Nonetheless, we could not identify any statistically significant differences in the above clinical factors between the two groups. The arthroscopic group showed a better flexion–extension arc at 2 months and supination–pronation arc at 2 and 4 months than the open group (p < 0.001). There were no significant differences between the two groups at 2 years postoperatively. Ten patients (12.6%) had recurrent instability (three in the arthroscopic group and seven in the open group, p = 0.499). Similarly, both groups showed no significant difference in the return to work period. Conclusions: Arthroscopic foveal repair of TFCC provided similarly favorable outcomes and early recovery of pain and ROM compared to open repair. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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11 pages, 874 KiB

Open AccessArticle

How Preoperative Closed Reduction and Time to Surgery Impact Postoperative Palmar Inclination in Distal Radius Fractures

by Frank Beyer, Johannes Oppermann, Tobias Prasse, Lars Peter Müller, Peer Eysel and Jan Bredow

J. Clin. Med. 2024, 13(8), 2316; https://doi.org/10.3390/jcm13082316 - 17 Apr 2024

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Abstract

Background: The anatomical reconstruction of the wrist is the aim when treating distal radius fractures. Current literature on the importance of preoperative reduction in fractures that are treated operatively is limited. Methods: This study investigated the effect of the preoperative closed reduction of [...] Read more.

Background: The anatomical reconstruction of the wrist is the aim when treating distal radius fractures. Current literature on the importance of preoperative reduction in fractures that are treated operatively is limited. Methods: This study investigated the effect of the preoperative closed reduction of distal radius fractures on the day of trauma and the time to surgery on postoperative palmar inclination. A total of eighty patients (48 females and 32 males, mean age 55.6 years) were studied retrospectively. All patients were treated with an open reduction and internal fixation. The palmar inclination angle was measured using X-rays by two investigators, and the interobservers and pre- and post-reduction parameters were compared. Results: When the surgical management of closed distal radius fractures is required, neither initial repositioning nor a delay of up to 14 days to the surgical treatment influences postoperative palmar inclination. Conclusions: The significance of preoperative reduction of distal radius fractures without neurovascular or extensive soft tissue damage is limited and is not leading to improved outcomes. When surgery is about to be performed, surgeons should carefully consider if reduction is really vital preoperatively. Level of evidence: III. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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9 pages, 1246 KiB

Open AccessArticle

The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study

by Taichi Saito, Ryo Nakamichi, Ryuichi Nakahara, Keiichiro Nishida and Toshifumi Ozaki

J. Clin. Med. 2023, 12(22), 7187; https://doi.org/10.3390/jcm12227187 - 20 Nov 2023

Cited by 1 | Viewed by 768

Abstract

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger [...] Read more.

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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10 pages, 1329 KiB

Open AccessArticle

Enchondroma Detection from Hand Radiographs with an Interactive Deep Learning Segmentation Tool—A Feasibility Study

by Turkka Tapio Anttila, Samuli Aspinen, Georgios Pierides, Ville Haapamäki, Minna Katariina Laitinen and Jorma Ryhänen

J. Clin. Med. 2023, 12(22), 7129; https://doi.org/10.3390/jcm12227129 - 16 Nov 2023

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Abstract

Enchondromas are common benign bone tumors, usually presenting in the hand. They can cause symptoms such as swelling and pain but often go un-noticed. If the tumor expands, it can diminish the bone cortices and predispose the bone to fracture. Diagnosis is based [...] Read more.

Enchondromas are common benign bone tumors, usually presenting in the hand. They can cause symptoms such as swelling and pain but often go un-noticed. If the tumor expands, it can diminish the bone cortices and predispose the bone to fracture. Diagnosis is based on clinical investigation and radiographic imaging. Despite their typical appearance on radiographs, they can primarily be misdiagnosed or go totally unrecognized in the acute trauma setting. Earlier applications of deep learning models to image classification and pattern recognition suggest that this technique may also be utilized in detecting enchondroma in hand radiographs. We trained a deep learning model with 414 enchondroma radiographs to detect enchondroma from hand radiographs. A separate test set of 131 radiographs (47% with an enchondroma) was used to assess the performance of the trained deep learning model. Enchondroma annotation by three clinical experts served as our ground truth in assessing the deep learning model’s performance. Our deep learning model detected 56 enchondromas from the 62 enchondroma radiographs. The area under receiver operator curve was 0.95. The F1 score for area statistical overlapping was 69.5%. Our deep learning model may be a useful tool for radiograph screening and raising suspicion of enchondroma. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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8 pages, 1870 KiB

Open AccessArticle

Ulnar-Sided Sclerosis of the Lunate Does Not Affect Outcomes in Patients Undergoing Volar Locking Plate Fixation for Distal Radius Fracture

by Jong-Hun Baek, Jae-Hoon Lee and Ki-Hyeok Ku

J. Clin. Med. 2023, 12(18), 6003; https://doi.org/10.3390/jcm12186003 - 16 Sep 2023

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Abstract

Background and aim: Radial shortening after distal radius fracture causes ulnar impaction, and a mild reduction loss of radial height occurs even after volar locking plate fixation. This study aimed to determine whether preoperative ulnar-sided sclerosis affects clinical outcomes after volar locking plate [...] Read more.

Background and aim: Radial shortening after distal radius fracture causes ulnar impaction, and a mild reduction loss of radial height occurs even after volar locking plate fixation. This study aimed to determine whether preoperative ulnar-sided sclerosis affects clinical outcomes after volar locking plate fixation for distal radius fracture (DRF). Method: Among 369 patients who underwent volar locking plate fixation for DRF, 18 with preoperative ulnar-sided sclerosis of the lunate were included in Group A and compared to a 1:4 age-, sex- and fracture-pattern-matched cohort without sclerosis (72 patients, Group B). The visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and grip strength were assessed as clinical outcomes. Ulnar variance (UV), radial inclination, radial length, and volar tilt at two weeks after surgery and the final follow-up were measured as radiographic outcomes. Results: The mean VAS and DASH scores and grip strength did not differ between the two groups. The mean UV at two weeks after surgery and the last follow-up was significantly higher in Group A. The mean changes in UV were +0.62 mm in Group A and +0.48 mm in Group B. There were no significant intergroup differences. Neither UV nor its changes showed any association with DASH and VAS scores. Conclusions: Preoperative ulnar-sided sclerosis of the lunate did not affect clinical outcomes after volar locking plate fixation, even if UV increased postoperatively. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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10 pages, 2182 KiB

Open AccessArticle

Intra-Articular Ultrasonography Probe for Minimally Invasive Upper Extremity Arthroscopic Surgery: A Phantom Study

by Shintaro Oyama, Nobuo Niimi, Masato Mori and Hitoshi Hirata

J. Clin. Med. 2023, 12(17), 5727; https://doi.org/10.3390/jcm12175727 - 2 Sep 2023

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Abstract

Background: Upper extremity arthroscopic surgery is a highly technique-dependent procedure that requires the surgeon to assess difficult cartilage conditions and manage the risk of iatrogenic damage to nerves and vessels adjacent to the joint capsule in a confined joint space, and a device [...] Read more.

Background: Upper extremity arthroscopic surgery is a highly technique-dependent procedure that requires the surgeon to assess difficult cartilage conditions and manage the risk of iatrogenic damage to nerves and vessels adjacent to the joint capsule in a confined joint space, and a device that can safely assist in this procedure has been in demand. Methods: In this study, we developed a small intra-articular ultrasound (AUS) probe for upper extremity joint surgery, evaluated its safety using underwater sound field measurement, and tested its visualization with a phantom in which nerves and blood vessels were embedded. Results: Sound field measurement experiments confirmed the biological safety of the AUS probe’s output, while confirming that sufficient output power level performance was obtained as an ultrasound measurement probe. In addition, images of blood vessels and nerves were reconstructed discriminatively using A-mode imaging of the agar phantom. Conclusions: This study provides proof-of-concept of the AUS probe in upper extremity surgery. Further studies are needed to obtain approval for use in future medical devices. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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Review

Jump to: Research, Other

11 pages, 4476 KiB

Open AccessReview

Management of Scar Contractures of the Hand—Our Therapeutic Strategy and Challenges

by Hoyu Cho, Shimpei Ono and Kevin C. Chung

J. Clin. Med. 2024, 13(5), 1516; https://doi.org/10.3390/jcm13051516 - 6 Mar 2024

Viewed by 787

Abstract

The essence of treating scar contractures lies in covering the skin deficit after releasing the contractures, typically using flaps or skin grafts. However, the specific characteristics of scar contractures, such as their location, shape, and size, vary among patients, which makes surgical planning [...] Read more.

The essence of treating scar contractures lies in covering the skin deficit after releasing the contractures, typically using flaps or skin grafts. However, the specific characteristics of scar contractures, such as their location, shape, and size, vary among patients, which makes surgical planning challenging. To achieve excellent outcomes in the treatment of scar contractures, we have developed a dimensional classification system for these contractures. This system categorizes them into four types: type 1 (superficial linear), type 2-d (deep linear), type 2-s (planar scar contractures confined to the superficial layer), and type 3 (planar scar contractures that reach the deep layer, i.e., three-dimensional scar contractures). Additionally, three factors should be considered when determining surgical approaches: the size of the defect, the availability of healthy skin around the defect, and the blood circulation in the defect bed. Type 1 and type 2-d are linear scars; thus, the scar is excised and sutured in a straight line, and the contracture is released using z-plasty or its modified methods. For type 2-s, after releasing the scar contracture band, local flaps are indicated for small defects, pedicled perforator flaps for medium defects, and free flaps and distant flaps for large defects. Type 2-s has good blood circulation in the defect bed, so full-thickness skin grafting is also a suitable option regardless of the defect’s size. In type 3, releasing the deep scar contracture will expose important structures with poor blood circulation, such as tendons, joints, and bones. Thus, a surgical plan using flaps, rather than skin grafts, is recommended. A severity classification and treatment strategy for scar contractures have not yet been established. By objectively classifying and quantifying scar contractures, we believe that better treatment outcomes can be achieved. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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Other

Jump to: Research, Review

15 pages, 356 KiB

Open AccessSystematic Review

Clinical, Radiologic, and Functional Outcomes following Bone Grafting for Metacarpal Non-Unions: A Systematic Review

by Omar El Sewify, Jad Abi-Rafeh, Jack Legler, Shayan Karimi, Aslan Baradaran and Johnny I. Efanov

J. Clin. Med. 2024, 13(4), 1148; https://doi.org/10.3390/jcm13041148 - 18 Feb 2024

Viewed by 550

Abstract

Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt [...] Read more.

Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. Methods: A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. Results: Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. Conclusions: Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management. Full article

(This article belongs to the Special Issue Hand and Wrist Surgery: Challenges and New Perspectives)

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