Journal of Hand Surgery RSS feed: Current Issue. The Journal of Hand Surgery publishes original, peer-reviewed articles related to the diagnosis , treatment , and pathophysiology of diseases and conditions of the upper extremity ; these include both clinical and basic science studies, along with case reports. Special features include Clinical Perspective and History of Hand Surgery articles, Comprehensive Review manuscripts, and Surgical Technique articles that provide an overview of hand surgery, technical aspects of surgery, and current controversial topics. Beginning in January 2006, the Journal of Hand Surgery will incorporate the Journal of the American Society for Surgery of the Hand . Benefits to authors We also provide many author benefits, such as free PDFs, a liberal copyright policy, special discounts on Elsevier publications and much more. Please click here for more information on our author services . Please see our Guide for Authors for information on article submission. If you require any further information or help, please visit our support pages: http://support.elsevier.com http://www.jhandsurg.org/?rss=yesElsevier Inc.en © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. Journal of Hand Surgery0363-5023385May 2013 © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jhandsurg.org/article/PIIS0363502313001354/abstract?rss=yes Purpose: Brachial plexus pain is thought to be generated not by avulsed roots but rather by nonavulsed roots, because avulsed roots could not transmit action potentials to central nerves. The aim of this study was to evaluate pain-related behavior and the extent of glial activation in a model of brachial plexus avulsion (BPA). Methods: We used 24 male Wistar rats. For rats in the BPA group, the C8–T1 roots were avulsed from the spinal cord at the level of the lower trunk (n = 10). Rats in a sham-surgery group had a similar surgery without the root avulsion (n = 7). Rats in an untreated group had no surgery (n = 7). Mechanical hyperalgesia of the forelimb plantar surfaces corresponding to C6 and C7 dermatomes was evaluated using a Semmes-Weinstein monofilament test every third day for 3 weeks (n = 15). Activation of astrocytes and microglia was examined immunohistochemically using anti-glia fibrillary acidic protein and anti-Iba1 antibodies 3 days after surgery (n = 9). Results: When compared with rats in the sham-surgery and naive control groups, rats in the BPA group displayed significant mechanical hyperalgesia in the dermatome innervated by uninjured nerves both ipsilaterally and contralaterally and continuing through day 21. Iba1-immunoreactive microglia and glia fibrillary acidic protein–immunoreactive astrocytes were significantly activated on the ipsilateral side in the BPA group from levels C3 to T3 compared with the sham-surgery and untreated groups of rats. Conclusions: Activation of glia at uninjured levels of the dorsal horn may facilitate pain transmission following BPA injury. Consequently, spared spinal glial cells may represent therapeutic targets for treatment of pain related to BPA injury. Clinical relevance: Our findings may indicate why neuropathic pain is so frequent and intense following BPA injury. Activation of Astrocytes and Microglia in the C3–T4 Dorsal Horn by Lower Trunk Avulsion in a Rat Model of Neuropathic PainRyutaro Iwasaki, Yusuke Matsuura, Seiji Ohtori, Takane Suzuki, Kazuki Kuniyoshi, Kazuhisa Takahashi10.1016/j.jhsa.2013.01.034Journal of Hand Surgery 38, 5 (2013)2013-03-26Journal of Hand Surgery2013-03-26385S0363-5023(13)X0005-XScientific Articles841846http://www.jhandsurg.org/article/PIIS0363502313002323/abstract?rss=yes Purpose: Nerve repair after a segmental defect injury remains a challenge for surgeons. Fibrin glue can be used to expedite surgical procedures and maintain proper nerve spatial orientation to potentially optimize recovery, yet surgeons hesitate to use it owing to concerns about fibrin's inhibiting regeneration and increasing scar formation. The purpose of these experiments was to evaluate whether fibrin glue impedes nerve regeneration. Methods: A critical-size defect of 10 mm was created in 32 Sprague-Dawley rats with 4 different forms of repair: a collagen type-I conduit (n = 8), a collagen type-I conduit filled with fibrin glue (n = 8), an autologous nerve graft (n=8), and an autologous nerve graft with fibrin glue (n = 8). Behavioral tests, including sciatic functional indices, were used to evaluate functional recovery. Neurophysiology, immunohistochemistry, and nerve morphometry were used to critically analyze nerve regeneration. Results: Multiple outcome parameters for nerve regeneration, remyelination, behavior, and electrophysiology were used to determine that the addition of fibrin did not influence recovery for the autograft groups. Similarly, within the conduit group, behavioral tests showed comparable functional recovery and indistinguishable results in compound motor action potential and nerve morphometry. Immunohistochemistry revealed identical degrees of Wallerian degeneration and scarring between conduit groups. Conclusions: The addition of fibrin to either the conduit or the autograft group did not result in any meaningful differences in recovery. Our data demonstrate that fibrin glue does not impede nerve regeneration or functional recovery after surgical repair of a segmental nerve defect in a rat model. Clinical relevance: The clinical use of fibrin glue as an adjunct with peripheral nerve repair may be considered safe because it does not impair nerve regeneration with critical size defects in an animal model. The Effects of Adjuvant Fibrin Sealant on the Surgical Repair of Segmental Nerve Defects in an Animal ModelGregory Rafijah, Andrew Jay Bowen, Christina Dolores, Ryan Vitali, Tahseen Mozaffar, Ranjan Gupta10.1016/j.jhsa.2013.01.044Journal of Hand Surgery 38, 5 (2013)2013-04-04Journal of Hand Surgery2013-04-04385S0363-5023(13)X0005-XScientific Articles847855http://www.jhandsurg.org/article/PIIS0363502313002347/abstract?rss=yes Purpose: It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery. Methods: Using a web-based survey, hand surgeons recommended surgical or nonsurgical treatment for patients in 2 different scenarios. Six elements of the first scenario (symptoms, circumstances, mindset, diagnosis, objective testing, and expectations) had 2 possibilities that were each independently and randomly assigned to each rater. For the second scenario, 2 different scenarios were randomly assigned to each rater. Multivariable logistic regression sought factors associated with a recommendation for surgery. Results: A total of 186 surgeons of the Science of Variation Group completed a survey regarding recommendation of surgery for 2 different patients based on clinical scenarios. Recommendations for surgery did not vary significantly according to provider characteristics. For the various elements in scenario 1, recommendation for surgery was more likely for patients who were self-employed and continued to work and who had objective electrodiagnostic abnormalities. For the 2 vignettes used in scenario 2, a recommendation for surgery was associated with abnormal electrophysiology. Conclusions: The findings of this study suggest that—at least in a survey setting—surgeons prefer to offer peripheral nerve decompression to patients with abnormal electrophysiology, particularly those with effective coping strategies. Clinical relevance: The role of objective verification of pathophysiology is debated, but it is an influential factor in recommendations for hand surgery. Variation in Recommendation for Surgical Treatment for Compressive NeuropathyMichiel G.H. Hageman, Stephanie J.E. Becker, Arjan G.J. Bot, Thierry Guitton, David Ring, Science of Variation Group10.1016/j.jhsa.2013.02.008Journal of Hand Surgery 38, 5 (2013)2013-04-05Journal of Hand Surgery2013-04-05385S0363-5023(13)X0005-XScientific Articles856862http://www.jhandsurg.org/article/PIIS0363502313001317/abstract?rss=yes Purpose: To compare the clinical outcome between secondary trapezial excision after failed total trapeziometacarpal joint replacement and primary trapeziectomy. Methods: Between October 2003 and July 2008, we performed 16 revision procedures in our institution because of failed trapeziometacarpal joint replacements. Of these patients, 15 were followed up. We compared clinical outcomes between this group and 15 patients treated with primary trapeziectomy in a matched-pair analysis. The matching criteria were sex, age, and time from surgery. The mean follow-up period was 48 months. We evaluated mobility (radial and palmar abduction, opposition, and Kapandji score), grip strength, and patient self-assessment (pain; satisfaction; Disabilities of the Arm, Shoulder, and Hand score; and activity restriction). Results: According to most of the clinical evaluation methods (range of motion and Kapandji score) and subjective assessments (pain; Disabilities of the Arm, Shoulder, and Hand), outcome did not differ considerably between the 2 study groups. In particular, the results of strength testing were not significantly different between groups. Conclusions: The present study showed that the outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. Although it shows high revision rates in the literature, trapeziometacarpal total joint arthroplasty might be a treatment option. In the case of failure, the outcome of secondary trapeziectomy is comparable to that of primary trapeziectomy. Type of study/level of evidence: Therapeutic III. Outcome Comparison of Primary Trapeziectomy Versus Secondary Trapeziectomy Following Failed Total Trapeziometacarpal Joint ReplacementBalázs Kaszap, Wolfgang Daecke, Martin Jung10.1016/j.jhsa.2013.01.030Journal of Hand Surgery 38, 5 (2013)2013-03-26Journal of Hand Surgery2013-03-26385S0363-5023(13)X0005-XScientific Articles863871.e3http://www.jhandsurg.org/article/PIIS0363502313001330/abstract?rss=yes Purpose: To use computed tomography to determine whether factors could be identified to predict union for acute scaphoid fractures treated nonoperatively. Methods: We used a radiology database at a tertiary care center to identify scaphoid computed tomography scans performed between 2004 and 2010. We noted fracture location, fracture orientation, translation between fragments, humpback deformity, comminution, cysts, and sclerosis. We determined the associations between imaging variables on union rates and time to achieve union with casting alone in a cohort of 219 patients (mean age, 31 y; 83% males). Results: Most fractures were scaphoid waist fractures (173 of 219; 79%), of which 178 (81% of total group) were nondisplaced. There were 28 proximal pole fractures (13%) and 18 distal pole fractures (8%). The overall union rate was 95% (207 of 219). The odds of developing a nonunion were increased in fractures with translation (odds ratio, 3.4) or with a humpback deformity (odds ratio, 6.9). The presence of sclerosis or cysts did not correlate with union rates. There was no statistical association between successful union and fracture location, although, given the small number of proximal pole fractures, we were underpowered for this finding. Time to union was longer for proximal pole fractures (113 d) versus distal pole (53 d) and waist fractures (65 d) and for fractures with sclerosis (166 vs 67 d) or comminution (103 vs 66 d). Conclusions: We were able to identify a number of features that contributed to risk of nonunion or delayed union based on computed tomography scan. Factors such as fracture translation, comminution, and humpback were related to a higher risk of scaphoid nonunion. Factors such as sclerosis, comminution, translation, and location in the proximal pole were associated with longer times to union. These variables were independently significant in increasing the time required to achieve union and were shown to have an overall additive effect. Type of study/level of evidence: Prognostic II. Use of Computed Tomography to Predict Union and Time to Union in Acute Scaphoid Fractures Treated NonoperativelyRuby Grewal, Nina Suh, Joy C. MacDermid10.1016/j.jhsa.2013.01.032Journal of Hand Surgery 38, 5 (2013)2013-03-26Journal of Hand Surgery2013-03-26385S0363-5023(13)X0005-XScientific Articles872877http://www.jhandsurg.org/article/PIIS0363502313000841/abstract?rss=yes Purpose: To assess the long-term efficacy of scaphocapitate arthrodesis for treatment of chronic scapholunate instability in high-demand patients. Methods: We retrospectively analyzed the clinical and radiographic results of 20 manual workers who underwent scaphocapitate arthrodesis for chronic scapholunate instability at a mean follow-up of 10 years (range, 1–23 y). We measured range of motion and grip strength; pain on a scale of 0 to 5; Quick Disabilities of the Arm, Shoulder, and Hand score; and ability to return to work. We assessed radiographs for union, carpal height and alignment, signs of ulnar translation or radiocarpal arthritis, and hardware problems. Results: At most recent follow-up, the arc of motion averaged 87° for flexion-extension and 41° for the radioulnar deviation. The postoperative average maximum grip strength was 21 kg, which was 60% of the opposite, normal wrist. Pain was significantly reduced. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 19, and the return-to-work rate was 90%. Radiographic analysis showed union in all patients, improvement of carpal height and scaphoid angle, no evidence of ulnar translation, and a 30% rate of radiocarpal osteoarthritis. Conclusions: This report of long-term results demonstrates the efficacy of scaphocapitate limited carpal arthrodesis for the treatment of chronic rotatory subluxation of the scaphoid. We conclude that continued use of this procedure is warranted. Type of study/level of evidence: Therapeutic IV. Scaphocapitate Arthrodesis for Treatment of Scapholunate Instability in Manual WorkersMatthias Luegmair, Philippe Saffar10.1016/j.jhsa.2013.01.013Journal of Hand Surgery 38, 5 (2013)2013-03-13Journal of Hand Surgery2013-03-13385S0363-5023(13)X0005-XScientific Articles878886http://www.jhandsurg.org/article/PIIS0363502313002815/abstract?rss=yes Purpose: To examine the long-term results of the modified Brunelli tenodesis using a strip of the flexor carpi radialis tendon as a ligament substitute to maintain reduced rotatory subluxation of the scaphoid for scapholunate instability. Methods: Between 1995 and 1998, 10 patients with scapholunate instability underwent the modified Brunelli procedure. We reviewed 8 patients with static instability with a mean follow-up of 13.8 years (range, 12–15 y). The mean age of patients was 40 years at the time of surgery. The mean period from the injury to surgical treatment was 4 months. Results: The functional outcome according to Green and O'Brien was excellent or good in 7 of 8 patients. Postoperative Disabilities of the Arm, Shoulder, and Hand and modified Mayo scores averaged 9 and 83, respectively. At final follow-up, average total wrist motion and grip strength were 85% of the opposite normal side. Of the 8 patients, 6 were pain free; 1 patient had slight and occasional pain, and another had chronic pain. On radiographs, the average preoperative scapholunate gap was 5.1 mm. It was corrected to 2.4 mm at surgery and was 2.8 mm at final follow-up. The average scapholunate angle was 72° preoperatively, 46° postoperatively, and 63° at final follow-up. We observed degenerative osteoarthritis in 1 case. Conclusions: Because the number of cases is small, only a few conclusions can be made. At final follow-up there was a certain loss of scapholunate reduction. The fact that we observed arthritic changes in only 1 of 8 cases suggests that carpal stability obtained by this procedure is probably sufficient to obtain good functional long-term results. Long-term studies with more cases are required to evaluate this method, which has shown encouraging results in the present study. Type of study/level of evidence: Therapeutic IV. Treatment of Static Scapholunate Instability With Modified Brunelli Tenodesis: Results Over 10 YearsFrank Nienstedt10.1016/j.jhsa.2013.02.022Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles887892http://www.jhandsurg.org/article/PIIS0363502313001342/abstract?rss=yes Purpose: Controversy exists as to whether a proximal row carpectomy (PRC) is a better procedure than scaphoid excision with 4-corner arthrodesis for preserving motion in the painful posttraumatic arthritic wrist. The purpose of this study was to determine how the kinematics and tendon forces of the wrist are altered after PRC and 4-corner arthrodesis. Methods: We tested 6 fresh cadaver forearms for the extremes of wrist motion and then used a wrist simulator to move them through 4 cyclic dynamic wrist motions, during which time we continuously recorded the tendon forces. We repeated the extremes of wrist motion measurements and the dynamic motions after scaphoid excision with 4-corner arthrodesis, and then again after PRC. We analyzed extremes of wrist motion and the peak tendon forces required for each dynamic motion using a repeated measures analysis of variance. Results: Wrist extremes of motion significantly decreased after both the PRC and 4-corner arthrodesis compared with the intact wrist. Wrist flexion decreased on average 13° after 4-corner arthrodesis and 12° after PRC. Extension decreased 20° after 4-corner arthrodesis and 12° after PRC. Four-corner arthrodesis significantly decreased wrist ulnar deviation from the intact wrist. Four-corner arthrodesis allowed more radial deviation but less ulnar deviation than the PRC. The average peak tendon force was significantly greater after 4-corner arthrodesis than after PRC for the extensor carpi ulnaris during wrist flexion-extension, circumduction, and dart throw motions. The peak forces were significantly greater after 4-corner arthrodesis than in the intact wrist for the extensor carpi ulnaris during the dart throw motion and for the flexor carpi ulnaris during the circumduction motion. The peak extensor carpi radialis brevis force after PRC was significantly less than in the intact wrist. Conclusions: The measured wrist extremes of motion decreased after both 4-corner arthrodesis and PRC. Larger peak tendon forces were required to achieve identical wrist motions with the 4-corner arthrodesis compared with the intact wrist. We observed smaller forces for the PRC. Clinical relevance: These results may help explain why PRC shows early clinical improvement, yet may lead to degenerative arthritis. 4-Corner Arthrodesis and Proximal Row Carpectomy: A Biomechanical Comparison of Wrist Motion and Tendon ForcesDaniel P. DeBottis, Frederick W. Werner, Levi G. Sutton, Brian J. Harley10.1016/j.jhsa.2013.01.033Journal of Hand Surgery 38, 5 (2013)2013-03-25Journal of Hand Surgery2013-03-25385S0363-5023(13)X0005-XScientific Articles893898http://www.jhandsurg.org/article/PIIS0363502313002396/abstract?rss=yes Purpose: To compare clinical outcomes of wrist arthrodesis and total wrist arthroplasty in the treatment of pancarpal posttraumatic arthritis. We hypothesized that arthroplasty would demonstrate better clinical outcomes than wrist arthrodesis. Methods: We performed a retrospective review of 22 patients treated (15 arthrodeses and 7 arthroplasties) for pancarpal posttraumatic arthritis. We measured clinical outcomes with the visual analog pain scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; the Patient-Rated Wrist Evaluation; and a study-specific questionnaire. Postoperative complications were recorded from chart review. Results: Mean follow-up was 68 months for arthrodesis and 56 months for arthroplasty. The mean visual analog scale pain score was 2 for each group. The mean Disabilities of the Arm, Shoulder, and Hand score was 38 for the arthrodesis group and 29 for the arthroplasty group. The mean Patient-Rated Wrist Evaluation was 73 for the arthrodesis group and 31 for the arthroplasty group. The results from the study-specific questionnaire revealed that the majority of patients in both groups were satisfied. Complication rates were similar in both groups. Conclusions: Total wrist arthroplasty as an alternative to arthrodesis for the treatment of pancarpal posttraumatic arthritis may offer improved functional outcomes. Type of study/level of evidence: Therapeutic III. Clinical Outcomes of Arthrodesis and Arthroplasty for the Treatment of Posttraumatic Wrist ArthritisJason A. Nydick, James F. Watt, Michael J. Garcia, Bailee D. Williams, Alfred V. Hess10.1016/j.jhsa.2013.02.013Journal of Hand Surgery 38, 5 (2013)2013-04-05Journal of Hand Surgery2013-04-05385S0363-5023(13)X0005-XScientific Articles899903http://www.jhandsurg.org/article/PIIS0363502313002360/abstract?rss=yes Purpose: Vascularized bone grafting (VBG) is one of the therapeutic approaches for treating advanced Kienböck disease; however, few reports on long-term outcomes are available for this technique. The purpose of this study is to evaluate long-term results by following up patients with stage III Kienböck disease for more than 10 years after VBG. Methods: The study included 18 patients with advanced Kienböck disease (Lichtman stage IIIA, n = 10; stage IIIB, n = 8) who received VBG between 1996 and 2001 and were followed up for at least 10 years. Eleven patients received transplantation from the metacarpal base and 7 patients from the distal radius. Radial shortening and capitate shortening were performed in 5 and 2 stage IIIB patients, respectively. Results: The mean follow-up period was 12 years, 3 months. Based on the Mayo Modified Wrist Score, clinical results were excellent in 8 patients, good in 7 patients, and fair in 3 patients. The Stahl index and carpal height ratio were not improved in stage IIIA patients who received bone graft alone, whereas significant improvement was observed in stage IIIB patients who received shortening, as well. Conclusions: Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment. Type of study/level of evidence: Therapeutic III. Long-Term Results of Vascularized Bone Graft for Stage III Kienböck DiseaseHiroyoshi Fujiwara, Ryo Oda, Shinsuke Morisaki, Kazuya Ikoma, Toshikazu Kubo10.1016/j.jhsa.2013.02.010Journal of Hand Surgery 38, 5 (2013)2013-04-05Journal of Hand Surgery2013-04-05385S0363-5023(13)X0005-XScientific Articles904908http://www.jhandsurg.org/article/PIIS0363502313002839/abstract?rss=yes Purpose: To assess the clinical outcome and accuracy of prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a plastic bone model manufactured by preoperative computer simulation. Methods: Nine consecutive patients underwent computed tomography (CT)-based 3-dimensional corrective osteotomy for malunited upper extremity fractures. There were 4 cubitus varus deformities, 1 cubitus valgus deformity, and 4 forearm diaphyseal malunions. We constructed a computer model of the affected bones using the CT data and simulated the 3-dimensional deformity correction on a computer. A real-sized plastic model of the corrected bone was manufactured by rapid prototyping. We used a metal plate, prebent to fit the plastic bone model, in the actual surgery. Patients were evaluated after an average follow-up of 22 months (range, 14–36 mo). We retrospectively collected radiographic and clinical data at the most recent follow-up and compared them with preoperative data. We also performed CT after surgery and evaluated the error in corrective osteotomy as the difference between preoperative simulation and postoperative bone model. Results: The range of forearm rotation and grip strength in patients with forearm malunions improved after corrective osteotomies of the radius and ulna. Wrist pain, which 2 patients with forearm malunion had experienced before surgery, disappeared or decreased substantially after surgery. Radiographic examination indicated that preoperative angular deformities were nearly nonexistent after all corrective osteotomies. Three-dimensional errors in the corrective osteotomy using a prebent plate, as evaluated by CT data, were less than 3 mm and 2°. Conclusions: Prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a 3-dimensionally corrected, real-sized plastic bone model prepared by preoperative computer simulation is a precise and relatively easily performed technique that results in satisfactory clinical outcome. Type of study/level of evidence: Therapeutic IV. 3-Dimensional Prebent Plate Fixation in Corrective Osteotomy of Malunited Upper Extremity Fractures Using a Real-Sized Plastic Bone Model Prepared by Preoperative Computer SimulationToshiyuki Kataoka, Kunihiro Oka, Junichi Miyake, Shinsuke Omori, Hiroyuki Tanaka, Tsuyoshi Murase10.1016/j.jhsa.2013.02.024Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles909919http://www.jhandsurg.org/article/PIIS0363502313001305/abstract?rss=yes Purpose: Open reduction and internal fixation of distal radius fractures often necessitates release of the brachioradialis from the radial styloid. However, this common procedure has the potential to decrease elbow flexion strength. To determine the potential morbidity associated with brachioradialis release, we measured the change in elbow torque as a function of incremental release of the brachioradialis insertion footprint. Methods: In 5 upper extremity cadaveric specimens, we systematically released the brachioradialis tendon from the radius and measured the resultant effect on brachioradialis elbow flexion torque. We defined release distance as the distance between the release point and the tip of the radial styloid. Results: Brachioradialis elbow flexion torque dropped to 95%, 90%, and 86% of its original value at release distances of 27, 46, and 52 mm, respectively. Importantly, brachioradialis torque remained above 80% of its original value at release distances up to 7 cm. Conclusions: Our data demonstrate that release of the brachioradialis tendon from its insertion has minor effects on its ability to transmit force to the distal radius. Clinical relevance: These data imply that release of the distal brachioradialis tendon during distal radius open reduction internal fixation can be performed without meaningful functional consequences to elbow flexion torque. Even at large release distances, overall elbow flexion torque loss after brachioradialis release would be expected to be less than 5% because of the much larger contributions of the biceps and brachialis. Use of the brachioradialis as a tendon transfer donor should not be limited by concerns of elbow flexion loss, and the tendon could be considered as an autograft donor. Functional Consequence of Distal Brachioradialis Tendon Release: A Biomechanical StudyTimothy F. Tirrell, Orrin I. Franko, Siddharth Bhola, Eric R. Hentzen, Reid A. Abrams, Richard L. Lieber10.1016/j.jhsa.2013.01.029Journal of Hand Surgery 38, 5 (2013)2013-03-25Journal of Hand Surgery2013-03-25385S0363-5023(13)X0005-XScientific Articles920926http://www.jhandsurg.org/article/PIIS0363502313002827/abstract?rss=yes Purpose: Distal radius fractures are the most commonly treated fracture, and their management remains complex. We aimed to evaluate the presence of publication bias in the literature on distal radius fracture management and to identify specific study variables that may influence the reporting of positive outcomes. Methods: We conducted a systematic review on all available journal articles to find primary articles reporting on the management of distal radius fractures. Data collected included the direction of study outcome (positive, neutral, and negative) and various study characteristics including sample size, geographic origin of the study, clinical setting, study design, type of treatment, analysis for statistical significance, evaluation of wrist function, presence of subjective outcome measures, mean follow-up time, adequacy of reduction, complications, mean patient age, and the presence of any extramural funding. Results: We reviewed 215 journal articles and found that 70% of articles reported positive outcomes, 25% reported neutral outcomes, and 5% reported negative outcomes. Funnel plot analysis suggested the presence of publication bias depicted by the asymmetric distribution of studies. In addition, we found statistically significant differences between study outcomes with respect to treatment type, presence of external funding, reduction adequacy, hand/wrist functional assessment, and patient questionnaires for subjective assessment. Conclusions: Publication bias likely exists in the literature for distal radius fracture management. Several study characteristics influence the reporting of positive outcomes, but whether the presence of these characteristics portends a greater chance of publication remains unclear. A standardized approach to measure and track results may improve evidence-based outcomes. Type of study/level of evidence: Therapeutic III. Analysis of Publication Bias in the Literature for Distal Radius FractureIan C. Sando, Sunitha Malay, Kevin C. Chung10.1016/j.jhsa.2013.02.023Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles927934.e5http://www.jhandsurg.org/article/PIIS0363502312018400/abstract?rss=yes Purpose: Wrist arthrodesis after resection of a giant cell tumor of the distal radius can be performed using a vascularized free fibular transfer (VFFT) or a nonvascularized structural iliac crest transfer (NICT). The purpose of this study was to compare the union times, functional outcomes, and complications after these procedures. Methods: We identified 27 patients at 2 centers: 14 underwent VFFT, and 13 NICT. The 2 groups were comparable for age, sex, and tumor grade. We assessed functional outcomes of the wrist with the Toronto Extremity Salvage Score, Musculoskeletal Tumor Society 1987 and 1993 scores, and Disabilities of the Arm, Shoulder, and Hand scores. Results: Two local recurrences occurred in the VFFT group and 1 in the NICT group. The VFFT group had 3 patients who had already undergone or were planning to undergo surgery for improved appearance, hardware removal, or tendon release. In the NICT group, 2 infections required debridement, one of which went on to free fibular transfer, but there were no reoperations for nonunion or donor site morbidity. The surgical time was significantly shorter for NICT. Functional scores showed no differences between groups on any of the parameters studied for the upper limb. Conclusions: Both VFFT and NICT were effective surgical techniques for wrist fusion after distal radial resection for giant cell tumor. Vascularized free fibular transfer should be considered when a major skin defect is anticipated, because it allows the inclusion of a vascularized skin paddle, or when the osseous defect is too long (> 10 cm) for NICT. We were unable to demonstrate a difference in upper limb functional scores between VFFT and NICT. Because the surgical time is significantly shorter and the reoperation rate is lower for NICT, we recommend NICT whenever possible. Type of study/level of evidence: Therapeutic III. Functional Results Following Vascularized Versus Nonvascularized Bone Grafts for Wrist Arthrodesis Following Excision of Giant Cell TumorsPaul W. Clarkson, Kelly Sandford, Amy E. Phillips, Theresa J.C. Pazionis, Anthony Griffin, Jay S. Wunder, Peter C. Ferguson, Bassam A. Masri, Thomas Goetz10.1016/j.jhsa.2012.12.026Journal of Hand Surgery 38, 5 (2013)2013-03-01Journal of Hand Surgery2013-03-01385S0363-5023(13)X0005-XScientific Articles935940.e1http://www.jhandsurg.org/article/PIIS0363502313002359/abstract?rss=yes Purpose: To report the clinical results of a free gracilis muscle transfer to finger and thumb extensors reinnervated by supinator muscle motor branches in patients with longstanding C7-T1 root avulsion. Methods: Between January 2010 and January 2011, 3 young adult patients with traumatic C7-T1 brachial plexus palsies had gracilis transfer to the thumb and finger extensors at a mean of 38 months after injury. The muscle flap was connected to radial vessels and comitant veins and to nerve branches supplying the supinator muscle. Results: All patients had recovery of active thumb and finger extension, scoring M3 and M4 on the Medical Research Council scale, respectively, at a mean of 12 months after surgery. Conclusions: Reconstruction of finger and thumb extension in lower-type brachial plexus injuries is a challenging problem that is most commonly addressed with an extensor tenodesis technique, which depends on wrist flexion. Free gracilis transfer innervated by nerve branches to the supinator provided the restoration of thumb and finger extension independent of wrist flexion. Clinical relevance: For those patients with lower brachial root injury more than a year old, transfer of a free functional gracilis muscle is an alternative for the reconstruction of thumb and finger extension. Type of study/level of evidence: Therapeutic IV. Free Gracilis Transfer Reinnervated by the Nerve to the Supinator for the Reconstruction of Finger and Thumb Extension in Longstanding C7-T1 Brachial Plexus Root AvulsionFrancisco Soldado, Jayme Bertelli10.1016/j.jhsa.2013.02.009Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles941946http://www.jhandsurg.org/article/PIIS0363502313002402/abstract?rss=yes Purpose: Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injury. Methods: We replanted 33 fingers on 33 patients (age, 15–54 y) with complete ring avulsion amputation injuries. Twenty-eight amputations were distal to the insertion of the flexor digitorum superficialis, and 5 were complete degloving injuries with intact tendons. Vascular transpositions and vein grafts were used, and in all cases, only 1 of the digital nerves was repaired. Results: The 29 successful cases were tracked over an average follow-up of 89 months. The average total active motion of the reconstructed finger was 185°. Sensibility evaluated by static 2-point discrimination varied from 9 to 15 mm and by moving 2-point discrimination from 8 to 15 mm. Five patients complained of cold intolerance. Conclusions: Resection of the avulsed digital artery and vein is the most crucial part of the procedure.Vessels reconstruction can be performed using various methods, but vessel transfers from the middle finger appear to be the most reliable solution. The outcome of the cases demonstrates that replantation should be attempted. Type of study/level of evidence: Therapeutic IV. Results of Replantation of 33 Ring Avulsion AmputationsRoberto Adani, Elisabetta Pataia, Luigi Tarallo, Raffaele Mugnai10.1016/j.jhsa.2013.02.014Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles947956http://www.jhandsurg.org/article/PIIS036350231300230X/abstract?rss=yes Purpose: To investigate in vivo 3-dimensional kinematics in elbow osteoarthritis. We hypothesized that normal kinematics is preserved in an osteoarthritic elbow with a normal radiocapitellar joint (OAN). Conversely, we hypothesized that an osteoarthritic elbow with radiocapitellar degenerative changes (OAD) would show an abnormal kinematics pattern. Furthermore, the differences in osteophyte formation between groups may affect elbow kinematics. Methods: We examined 7 normal elbows, 7 OAN elbows, and 9 OAD elbows. We investigated 3-dimensional kinematics using computed tomography registration techniques. The osteophyte location was determined using 3-dimensional bone models generated from computed tomography data. Results: The kinematics is different in OAN and OAD elbows. In the OAN group, the ulna changed by 11° from a valgus to a varus position during elbow flexion and demonstrated a 4° change in the axis of elbow motion, similar to that in normal elbows. Osteophytes formed medially on the olecranon fossa. In the OAD group, the ulna changed by 4° varus during flexion from the 90° position, but only by 2° valgus during elbow extension from 90°. The change in the axis of elbow motion was 9°. Additional osteophytes formed on the anteromedial and lateral trochlea, lateral olecranon fossa, and medial olecranon of the ulnotrochlear joint, and on the radiocapitellar joint. Conclusions: Normal kinematics was preserved in the OAN group. The OAD group demonstrated marked changes in the direction of elbow motion in the extension range, and the valgus motion pattern during extension was decreased. Clinical relevance: The results of the current study provide a good starting point for further research into the nature of arthritic progression in the elbow joint and the role of debridement arthroplasty. Kinematic Changes in Elbow Osteoarthritis: In Vivo and 3-Dimensional Analysis Using Computed Tomographic DataJunichi Miyake, Kozo Shimada, Hisao Moritomo, Toshiyuki Kataoka, Tsuyoshi Murase, Kazuomi Sugamoto10.1016/j.jhsa.2013.02.006Journal of Hand Surgery 38, 5 (2013)2013-04-04Journal of Hand Surgery2013-04-04385S0363-5023(13)X0005-XScientific Articles957964http://www.jhandsurg.org/article/PIIS0363502313002840/abstract?rss=yes Purpose: To determine function and complications after reverse total shoulder arthroplasty (RTSA) in obese patients compared with a control group of nonobese patients. Methods: Between 2005 and 2011, we performed 76 RTSAs in 17 obese, 36 overweight, and 23 normal weight patients, based on World Health Organization body mass index classification. We reviewed the charts for age, sex, body mass index, date of surgery, type of implant, type of incision, length of stay, comorbidities, surgical time, blood loss, American Society of Anesthesiologists score, shoulder motion, scapular notching, and postoperative complications. Complications and outcomes were analyzed and compared between groups. Results: Reverse total shoulder arthroplasty in obese patients was associated with significant improvement in range of motion. Complication rate was significantly greater in the obese group (35%), compared with 4% in the normal weight group. We found no significant differences between scapular notching, surgical time, length of hospitalization, humeral component loosening, postoperative abduction, forward flexion, internal and external rotation, pain relief, or instability between groups. Conclusions: Our results show that obese patients have significant improvement in motion after RTSA but are at an increased risk for complication. Obesity is not a contraindication to RTSA, but obese patients need to understand fully the increased risk of complication with RTSA. Type of study/level of evidence: Therapeutic III. Reverse Total Shoulder Arthroplasty in Obese PatientsJohn D. Beck, Kaan S. Irgit, Cassondra M. Andreychik, Patrick J. Maloney, Xiaoqin Tang, G. Dean Harter10.1016/j.jhsa.2013.02.025Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles965970http://www.jhandsurg.org/article/PIIS0363502313002426/abstract?rss=yes Purpose: Open carpal tunnel decompression under local anesthesia is routinely done by many surgeons. However, patients complain of pain during the injection of local anesthesia. This prospective, double-blind, randomized study was to compare the pain visual analog scale (VAS) scores of local anesthesia using lidocaine with and without sodium bicarbonate in patients with bilateral carpal tunnel syndrome. Methods: Twenty-five patients underwent bilateral simultaneous carpal tunnel decompression. All had topical anesthetic cream applied on the palm and wrist before the lidocaine block. In a randomized manner, half of the hands were blocked with nonbuffered lidocaine and half were blocked with buffered lidocaine. Pain was evaluated on a VAS score. Results: The mean pain VAS score in the hand with buffered lidocaine was 4.6 ± 1.5 and 6.5 ± 1.5 for the hand with nonbuffered lidocaine. After adjustment for individual threshold of the pain, the mean pain VAS score changed into 4.6 ± 1.3 with buffered lidocaine and 6.6 ± 1.7 without buffered lidocaine. Conclusions: In open carpal tunnel surgery, the use of buffered lidocaine for local anesthesia reduces the anesthetic pain effectively. Type of study/level of evidence: Therapeutic I. The Effect of Buffered Lidocaine in Local Anesthesia: A Prospective, Randomized, Double-Blind StudyHyuk Jin Lee, Young Jae Cho, Hyun Sik Gong, Seung Hwan Rhee, Hyun Soo Park, Goo Hyun Baek10.1016/j.jhsa.2013.02.016Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles971975http://www.jhandsurg.org/article/PIIS0363502313002293/abstract?rss=yes Purpose: To present the outcomes after one-bone forearm (OBF) surgery for chronic posttraumatic forearm and distal radioulnar joint instability. Methods: We conducted a retrospective chart review to study patients who underwent OBF surgery because of a traumatic etiology. We collected patient demographics, surgical technique, preoperative and postoperative range of motion, final grip strength, and complications from the medical records. Patients were asked to complete the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, a 0- to 10-point pain scale, and a 0- to 10-point treatment satisfaction scale. Results: There were 5 male and 5 female patients, with a mean age of 32 years at the time of OBF surgery (range, 17–44 y). The mean number of procedures before OBF surgery was 3.6 (range, 2–7); 4 patients had undergone a Darrach procedure and 3 patients had undergone a Sauvé-Kapandji procedure. The median clinical follow-up duration was 6 years (range, 1–17 y). Wrist and elbow range of motion did not change remarkably before and after surgery. Of 8 primary OBF surgeries, 3 resulted in nonunion. Of 10 patients, 4 experienced painful impingement of the remaining proximal radius on adjacent bone and soft tissue and required a total of 7 procedures after OBF surgery. The median follow-up duration for patient-rated outcomes was 10 years (range, 5–21 y; n = 7). The median Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 77, the median pain score was 7, and the median satisfaction score was 7. Conclusions: In our experience, complications after OBF surgery are common. Although wrist and elbow range of motion were spared, pain persisted and functional outcomes were poor. One-bone forearm surgery is our last resort for a chronically painful and unstable forearm. Type of study/level of evidence: Therapeutic IV. Complications Following One-Bone Forearm Surgery for Posttraumatic Forearm and Distal Radioulnar Joint InstabilitySidney M. Jacoby, Abdo Bachoura, Eliseo V. DiPrinzio, Randall W. Culp, A. Lee Osterman10.1016/j.jhsa.2013.02.005Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XScientific Articles976982.e1http://www.jhandsurg.org/article/PIIS0363502313002281/abstract?rss=yes Purpose: To create a current reading list of the hand surgery articles most commonly cited in the last 20-plus years. Methods: Using the Web of Science Citation Index Search, we searched “hand” and “wrist” in the orthopedic, surgery, and sport sciences research areas. We then reviewed the articles and chose the 50 most commonly cited articles related to hand surgery. Articles were categorized as clinical or basic science. Clinical articles were subcategorized as either therapeutic, prognostic, diagnostic, or economic/decision analysis and assigned a level of evidence rating. We calculated the number of citations per year (citation density). Results: The total number of citations for the top 50 articles ranged from 92 to 317. Citation density ranged from 4 to 24 (average, 9.7). Of the 50 articles, 39 were clinical (78%), whereas the remainder were basic science. Clinical articles were most commonly therapeutic (25 of 39; 64%), followed by diagnostic (11 of 39; 28%) and prognostic (3 of 39; 8%). There were no economic/decision analysis–type articles. The most common level of evidence was level IV, which made up 38% of the list (19 of 50 articles). The second most common was level I, which represented 20% of the list (10 of 50 articles). A total of 70% of the articles (35 of 50) were published between 1990 and 1999, and the remainder of the articles were published after 1999. Fifty percent of the articles appeared in the Journal of Hand Surgery, American volume. Conclusions: Many of the articles found on our list have shaped the way we practice hand surgery today. We hope that this report and the articles it names can help residents and fellows study current hand surgery and its evolution over the past 20 years. Type of study/level of evidence: Economic and decision analyses IV. The Most Cited Articles in Hand Surgery Over the Past 20-Plus Years: A Modern-Day Reading ListPhilip To, Cameron T. Atkinson, Donald H. Lee, Nick D. Pappas10.1016/j.jhsa.2013.02.004Journal of Hand Surgery 38, 5 (2013)2013-04-04Journal of Hand Surgery2013-04-04385S0363-5023(13)X0005-XScientific Articles983987http://www.jhandsurg.org/article/PIIS0363502313002803/abstract?rss=yesi (j.d.l.) first met Dieter Buck-Gramcko in spring 1981 at a comprehensive review course on hand surgery in Louisville, Kentucky. I was about halfway through my fellowship and was fortunate enough to be allowed to attend some of the course. It was immediately apparent to me that Dieter loved to teach. His lectures were clear, concise, and to the point. To a hand fellow starving for as much knowledge about pediatric hand surgery as could be crammed into a short period of time, Buck-Gramcko became a key teacher and surgeon from whom I could learn a great deal. Fellows in Louisville at that time who were there for a year were allowed a month's travel, and a number of fellows, including myself and Curt Steyers, chose to spend time with Dieter in Hamburg, Germany. We were privileged to work with him in his clinic, where he examined children from all over Europe, the Middle East, and Asia with congenital upper extremity problems. We observed Buck-Gramcko in his clinical practice dealing with patients from the German Health Service, his private practice, and his practice at the Kinderkrankenhaus (pediatric hospital). The German Health Service obviously made allowances for the care of children from anywhere in the world in need of Buck-Gramcko's care.First Hand: Dieter Buck-GramckoReimer Hoffmann, John D. Lubahn10.1016/j.jhsa.2013.02.021Journal of Hand Surgery 38, 5 (2013)2013-04-08Journal of Hand Surgery2013-04-08385S0363-5023(13)X0005-XA Touch of Humanity988990http://www.jhandsurg.org/article/PIIS0363502313004991/abstract?rss=yesJournal CME Instructions10.1016/S0363-5023(13)00499-1Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-X991991http://www.jhandsurg.org/article/PIIS0363502313000713/abstract?rss=yesA 45-year-old engineer and recreational racquetball player reports the gradual onset of elbow soreness over the past 6 to 8 weeks. She has pain with raking and lifting her laptop. Examination demonstrates tenderness over the lateral epicondyle and pain with resisted wrist extension. She has mild tenderness over the proximal extensors. Her primary care physician recommended an elbow strap, oral nonsteroidal anti-inflammatory medication, and wrist extensor strengthening exercises supervised by a therapist, but these have not helped. A colleague at work told her about platelet-rich plasma (PRP) injections and she is hoping that this will cure the problem.Autologous Blood and Platelet-Rich Plasma Injections for Enthesopathy of the Extensor Carpi Radialis Brevis OriginJenna Bernstein, Jennifer Moriatis Wolf10.1016/j.jhsa.2013.01.001Journal of Hand Surgery 38, 5 (2013)2013-03-01Journal of Hand Surgery2013-03-01385S0363-5023(13)X0005-XEvidence-Based Medicine992994http://www.jhandsurg.org/article/PIIS0363502313001603/abstract?rss=yesThe Review Section of JHS will contain at least 3 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details.Management of Radial Nerve Palsy Associated With Humerus FractureJohn Prodromo, Robert J. Goitz10.1016/j.jhsa.2013.02.003Journal of Hand Surgery 38, 5 (2013)2013-04-05Journal of Hand Surgery2013-04-05385S0363-5023(13)X0005-XEvidence-Based Medicine995998http://www.jhandsurg.org/article/PIIS0363502313002980/abstract?rss=yesJournal CME Questions10.1016/j.jhsa.2013.03.003Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XEvidence-Based Medicine998998http://www.jhandsurg.org/article/PIIS036350231300289X/abstract?rss=yes Arthrodesis of a painful and destroyed wrist is one of the key operations in patients with rheumatoid arthritis. Clayton is given credit for the first description of an operative technique of wrist arthrodesis by means of an intramedullary Steinmann pin. Mannerfelt popularized this technique by using a Rush pin and additional fixation with staples. The aim of the present article is to give a detailed description of the operative technique used in our hospital. Over a period of 13 years, 104 modified Clayton-Mannerfelt arthrodeses were performed in 87 patients with rheumatoid arthritis. Ninety-three wrists were reviewed clinically and radiographically. The patients had high fusion rates and a reliable reduction in preoperative pain, with a low rate of complications. The pin technique is more versatile than standard wrist arthrodesis plates, and the wrist can be positioned according to the needs of the patient. This technique seems to be a good alternative to conventional wrist arthrodesis using an arthrodesis plate in wrists destroyed by rheumatoid arthritis, even in situations with difficult bone stock. In most cases, it is not necessary to remove the hardware. The Modified Clayton-Mannerfelt Arthrodesis of the Wrist in Rheumatoid Arthritis: Operative Technique and Report on 93 CasesSebastian Kluge, Stephan Schindele, Thomas Henkel, Daniel Herren10.1016/j.jhsa.2013.02.029Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XSurgical Technique9991005http://www.jhandsurg.org/article/PIIS0363502313002906/abstract?rss=yes Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7–10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period. Alternative Method for Thumb Reconstruction. Combination of 2 Techniques: Metacarpal Lengthening and Mini Wraparound TransferRoberto Adani, Massimo Corain, Luigi Tarallo, Francesco Fiacchi10.1016/j.jhsa.2013.02.030Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XSurgical Technique10061011http://www.jhandsurg.org/article/PIIS0363502313002384/abstract?rss=yesThe Review Section of JHS will contain at least 3 clinically relevant articles selected by the editor to be offered for CME in each issue. For CME credit, the participant must read the articles in print or online and correctly answer all related questions through an online examination. The questions on the test are designed to make the reader think and will occasionally require the reader to go back and scrutinize the article for details.Management of the Hand in Systemic SclerosisPaige Fox, Lorinda Chung, James Chang10.1016/j.jhsa.2013.02.012Journal of Hand Surgery 38, 5 (2013)2013-04-05Journal of Hand Surgery2013-04-05385S0363-5023(13)X0005-XIn Brief10121016http://www.jhandsurg.org/article/PIIS0363502313002992/abstract?rss=yesJournal CME Questions10.1016/j.jhsa.2013.03.004Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XIn Brief10171017http://www.jhandsurg.org/article/PIIS0363502313000981/abstract?rss=yesWhen radiographs are normal in a young adult patient with snuffbox tenderness after a fall, we turn to more sophisticated radiological examination to rule out a fracture of the scaphoid. But each examination can miss a fracture or suggest a fracture when one is not present. There is no test that is both reliable and accurate in the diagnosis of a scaphoid fracture among patients with a suspected fracture. Both patients and health providers crave certainty, but we can only estimate the probability of a scaphoid fracture in this context.Latent Class AnalysisValentin Neuhaus, David C. Ring10.1016/j.jhsa.2013.01.024Journal of Hand Surgery 38, 5 (2013)2013-03-08Journal of Hand Surgery2013-03-08385S0363-5023(13)X0005-XIn Brief10181020http://www.jhandsurg.org/article/PIIS0363502313002438/abstract?rss=yes Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases. We present a review of hand fracture management, with special attention paid to advances since 2008. The history and mechanisms of these fractures are discussed, as are treatment options and common complications. Early mobilization of the fractured hand is emphasized because soft tissue recovery may be more problematic than that of bone. Hand Fractures: A Review of Current Treatment StrategiesClifton Meals, Roy Meals10.1016/j.jhsa.2013.02.017Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XCurrent Concepts10211031http://www.jhandsurg.org/article/PIIS0363502313003006/abstract?rss=yesJournal CME Questions10.1016/j.jhsa.2013.03.005Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XCurrent Concepts10311031http://www.jhandsurg.org/article/PIIS0363502313002864/abstract?rss=yes Traumatic bone loss in hand surgery is challenging for the patient as well as the doctor. Whereas the patient is threatened with a possible amputation or severe disability, the hand surgeon focuses on reconstruction, restoration of the function, bony union, and appearance of the injured hand. Both are confronted with a long-standing and staged treatment coupled with a high risk of complications. This review encompasses the classifications and treatment options of bone loss in hands. The optimal treatment is still prevention of the trauma itself. Bone Loss in the HandValentin Neuhaus, Ladislav Nagy, Jesse B. Jupiter10.1016/j.jhsa.2013.02.026Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XCurrent Concepts10321039http://www.jhandsurg.org/article/PIIS0363502313004425/abstract?rss=yes Don L. Eyler, MD, former ASSH President, died in Byrdstown, Tennessee, on January 19, 2013, a few weeks shy of his 95th birthday. He was a wonderfully friendly, approachable, and sympathetic person, traits that were quickly realized by virtually anyone he met. He had an insatiable curiosity and a huge fund of knowledge about many subjects.Don L. Eyler, MDFrank E. Jones, David S. Jones10.1016/j.jhsa.2013.03.053Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XIn Memoriam10401041http://www.jhandsurg.org/article/PIIS0363502313002311/abstract?rss=yes There is an old adage that without knowledge of history, there can be no future. No truer is this than in the field of surgery. Nicholas Tinley is an Honorary Surgeon at Brigham and Women's Hospital and Francis D. Moore Distinguished Professor of Surgery at Harvard Medical School. In Invasion of the Body: Revolutions in Surgery, he provides a rich discourse of surgery over the past century and describes innovations that have transformed the field. Set on the stage of Brigham and Women's Hospital, where he was trained, Tilney's vivid cast of patients, surgeons, students, and researchers creates a captivating story such that one can almost envision oneself entwined in the tale.Kerry-Ann Stewart10.1016/j.jhsa.2013.01.043Journal of Hand Surgery 38, 5 (2013)2013-04-04Journal of Hand Surgery2013-04-04385S0363-5023(13)X0005-XBook Review10421043http://www.jhandsurg.org/article/PIIS0363502313004565/abstract?rss=yesMasthead10.1016/S0363-5023(13)00456-5Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XFrontmatterA2A2http://www.jhandsurg.org/article/PIIS0363502313004577/abstract?rss=yesEditorial Board10.1016/S0363-5023(13)00457-7Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XFrontmatterA4A4http://www.jhandsurg.org/article/PIIS0363502313004589/abstract?rss=yesTable of Contents10.1016/S0363-5023(13)00458-9Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XFrontmatterA7A7http://www.jhandsurg.org/article/PIIS0363502313004590/abstract?rss=yesInstructions to Authors10.1016/S0363-5023(13)00459-0Journal of Hand Surgery 38, 5 (2013)2013-05-01Journal of Hand Surgery2013-05-01385S0363-5023(13)X0005-XFrontmatterA16A20