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The Journal of Hand Surgery, European... May 2024There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates... (Meta-Analysis)
Meta-Analysis
There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.
Topics: Humans; Collateral Ligament, Ulnar; Thumb; Bone Wires; Rupture; Hand Strength; Range of Motion, Articular; Suture Anchors; Treatment Outcome; Ulnar Collateral Ligament Reconstruction
PubMed: 38488512
DOI: 10.1177/17531934241235556 -
Long-term results of index finger pollicization for congenital thumb anomalies: a systematic review.The Journal of Hand Surgery, European... Jul 2024This systematic review analyses the literature for long-term outcomes of index finger pollicization. This review includes all seven studies that reported outcomes of...
This systematic review analyses the literature for long-term outcomes of index finger pollicization. This review includes all seven studies that reported outcomes of index finger pollicization for congenital thumb aplasia or hypoplasia for qualitative review. The seven studies included 108 index finger pollicizations with 54% male children. The studies did not describe the preoperative quality and function of the transposed index finger. Grip strength was in the range of 52%-76% of the contralateral hand. Lateral pinch and key grip strength were also approximately 50% of the contralateral hand. The main drawback of the collective literature is the lack of homogeneity of results and a standardized protocol for reporting postoperative outcomes. These factors need to be addressed to compare the long-term results of pollicizations accurately.
Topics: Humans; Thumb; Fingers; Hand Strength; Hand Deformities, Congenital; Hand Deformities
PubMed: 37987671
DOI: 10.1177/17531934231212392 -
The Journal of Hand Surgery Jun 2024As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand,... (Meta-Analysis)
Meta-Analysis
Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
PURPOSE
As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA.
METHODS
A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded.
RESULTS
The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma.
CONCLUSIONS
Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic II.
Topics: Humans; Injections, Intra-Articular; Osteoarthritis; Randomized Controlled Trials as Topic; Trapezium Bone; Adrenal Cortex Hormones; Carpometacarpal Joints; Hyaluronic Acid; Hand Strength; Treatment Outcome
PubMed: 38530683
DOI: 10.1016/j.jhsa.2024.02.001 -
British Medical Bulletin Jun 2018Trapeziometacarpal arthritis is a common and disabling condition. There is no evidence in the literature of superiority of one surgical procedure over others. Several...
INTRODUCTION
Trapeziometacarpal arthritis is a common and disabling condition. There is no evidence in the literature of superiority of one surgical procedure over others. Several prosthetic implants have been introduced to preserve joint mobility.
SOURCED OF DATA
We searched the on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'artelon', 'thumb', 'carpometacarpal', 'trapeziometacarpal' and 'rhizoarthrosis'; 11 studies were identified.
AREAS OF AGREEMENT
The use of Artelon implant is not recommended because of its high revision rate and worse outcomes compared to conventional techniques.
AREAS OF CONTROVERSY
Inert materials subjected to compressive and shearing forces could produce debris and subsequent inflammatory response. There is debate in the published scientific literature regarding the role of preoperative antibiotic profilaxis and post-surgery inflammatory response.
GROWING POINTS
Standard techniques such as trapeziectomy alone or combined with interposition or suspensionplasty offer effective treatment for thumb basal joint arthritis.
AREAS TIMELY FOR DEVELOPING RESEARCH
Several prosthetic implants show promising results in terms of pain relief and functional request, but there is a need of long-term randomized controlled trials to demonstrate their equivalence, and eventually superiority, compared to standard techniques.
Topics: Arthroplasty, Replacement, Finger; Carpometacarpal Joints; Humans; Osteoarthritis; Pinch Strength; Randomized Controlled Trials as Topic; Range of Motion, Articular; Thumb; Trapezium Bone; Treatment Outcome
PubMed: 29659726
DOI: 10.1093/bmb/ldy012