Outcomes of Metacarpal Fracture Fixation With Intramedullary Nails

Annals of Plastic Surgery · 2025-06-01

BACKGROUND: Metacarpal fractures are the third most common upper extremity fracture and the second most common hand fracture, resulting in significant disability. This systematic review evaluates the clinical outcomes associated with using intramedullary nails to treat metacarpal fractures. METHODS: A qualitative analysis was conducted to analyze summative data and calculate proportions for dichotomous variables and mean and standard deviation for continuous variables. RESULTS: Seventeen studies involving 761 patients and 815 metacarpal fractures were included. Postoperative recovery of grip strength averaged 89.3% ± 7.7% compared to the unaffected hand. Significant improvement in angulation was noted, decreasing from a preoperative mean of 40.0° ± 9.1° to 11.5° ± 4.3° postoperatively. The mean metacarpal shortening was 2.0 ± 0.8 mm following surgery. The average time to fracture union was 7.3 ± 2.4 weeks, with a mean return-to-work time of 8.1 ± 1.4 weeks. Postoperative functional outcomes were favorable, with mean Disabilities of the Arm, Shoulder and Hand and QuickDASH scores of 4.0 ± 3.6 and 3.9 ± 3.2, respectively. The average postsurgical visual analog scale pain score was 1.1 ± 0.4. The mean postoperative total active arc of motion was 248.6° ± 11.9°. CONCLUSION: Intramedullary nailing provides favorable outcomes in the fixation of metacarpal fractures, with significant improvements in grip strength, angulation, and functional recovery.

D153. Patient Reported Outcomes After Surgical Treatment for Neurogenic Thoracic Outlet Syndrome With At Least 1 Year Follow-up

Plastic & Reconstructive Surgery Global Open · 2025-05-01

PURPOSE: Neurogenic thoracic outlet syndrome (NTOS) is an uncommon condition with limited consensus on best methods for diagnosis and treatment. METHODS: Forty-four consecutive patients who underwent surgery for NTOS were reviewed. Patients were contacted at least one year postoperatively and assessed using standardized patient-reported outcome measures (PROMs), including Visual Analog Scale (VAS) for pain, Patient Satisfaction Scale (PSS), Derkash classification, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ), and Cervical Brachial Symptom Questionnaire (CBSQ). Data were analyzed using t-tests and linear regression models. RESULTS: The NTOS site of involvement was supraclavicular (SC) in 12 (27.3%) patients, infraclavicular (IC) in 16 (36.4%), and both (SC and IC) in 16 (36.4%). A distal compression site was treated in 20 (45.5%) patients. Overall success rate as assessed through Derkash classification was 87.5%. Mean postoperative VAS score (2.6±3.2) was significantly improved from preoperative VAS score (8.0±2.9). Mean postoperative DASH, MHQ and CBSQ scores were 32.8±21.8, 68.1±26.5 and 39.2±32.6, respectively. Worse postoperative VAS scores were significantly (p<0.05) correlated with poorer outcomes (Derkash, DASH, MHQ and CBSQ scores). Multiple linear regression analysis showed that surgical delay was the most significant factor for a higher mean postoperative VAS pain score. CONCLUSION: Surgical delay for NTOS was associated with higher postoperative VAS pain scores suggesting that earlier surgical intervention in patients diagnosed with NTOS following recommended guidelines, may be beneficial. Higher VAS scores were significantly correlated with poorer postoperative mid-term outcomes as assessed through the DASH, MHQ, CBSQ scores, and Derkash classification.

Machine learning can aid in the differential diagnosis of neurogenic thoracic outlet syndrome and carpal tunnel syndrome

Journal of Plastic Reconstructive & Aesthetic Surgery · 2025-09-05 · 1 citations

Management and Outcomes of Brachial Plexus Injuries after Shoulder Dislocation: A Systematic Review

The Journal of Hand Surgery (Asian-Pacific Volume) · 2025-09-24

Background: Brachial plexus (BP) injuries are a known complication of shoulder dislocation, yet optimal management strategies remain unclear. This systematic review aims to evaluate the outcomes and treatment approaches for BP injuries following shoulder dislocation. Methods: A systematic review was conducted according to PRISMA guidelines across four databases: PubMed/MEDLINE, Embase, Scopus and Web of Science. Eligible studies included human subjects with BP injuries following shoulder dislocation. Data extraction and risk of bias (ROB) assessment were independently performed by two reviewers. Due to heterogeneity amongst the studies, a meta-analysis was not conducted. Results: Out of 2,060 initial studies, 9 met the inclusion criteria, encompassing a total of 255 patients (256 limbs) with a mean age of 55.9 ± 16.0 years. Of these, 193 (75.7%) had BP injuries post dislocation. Conservative management was the most common treatment (149 cases, 67.4%), followed by neurolysis ± nerve transfer (44 cases, 19.9%) and nerve repair (28 cases, 12.7%). Amongst 133 patients with reported BP injury patterns, the posterior cord was most frequently involved (38.3%). Sensory and motor recovery was observed in 51.6% and 45.2% of patients respectively, with 60.4% of patients achieving MRC grade ≥ 4 in studies that reported this metric. The mean follow-up period was 28.4 months. Conclusions: BP injuries following shoulder dislocation are uncommon but clinically significant. Conservative treatment remains the predominant approach, though surgical interventions may offer improved functional recovery in selected cases. Level of Evidence: Level III (Therapeutic)

Patient Reported Outcomes After Surgical Treatment for Neurogenic Thoracic Outlet Syndrome with At Least 1 Year Follow Up

Plastic & Reconstructive Surgery Global Open · 2025-06-01

BACKGROUND: Neurogenic Thoracic Outlet Syndrome (NTOS) is a rare condition with limited disease-specific care teams across multiple specialties. This poses a challenge to standardization of surgical management. As such outcomes are limited with regards to conservative, rib sparring, supraclavicular (SC) and infraclavicular (IC) decompression. This study aims to assess functional and patient-reported outcomes following surgical decompression for NTOS. METHODS: Forty-four consecutive patients who underwent surgery for NTOS were reviewed. Patients were contacted at least one year postoperatively and assessed using standardized patient reported outcome measures (PROMs), including Visual Analog Scale (VAS) for pain, Patient Satisfaction Scale (PSS), Derkash classification, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcomes Questionnaire (MHQ), and Cervical Brachial Symptom Questionnaire (CBSQ). Data was analyzed using t-tests and linear regression models. RESULTS: The NTOS site of involvement was SC in 12 (27.3%) patients, IC in 16 (36.4%), and both (SC & IC) in 16 (36.4%). A distal compression site was treated in 20 (45.5%) patients. Overall success rate, as assessed through Derkash classification, was 87.5%. Mean postoperative VAS score (2.6±3.2) was significantly improved from preoperative VAS score (8.0±2.9). Mean postoperative DASH, MHQ, and CBSQ scores were 32.8±21.8, 68.1±26.5 and 39.2±32.6, respectively. Postoperative VAS scores were significantly (p<0.05) correlated with worse Derkash classification, DASH, MHQ, and CBSQ scores. Multiple linear regression analysis showed that a longer duration of symptoms before surgery was the most significant factor for a higher mean postoperative VAS pain score. CONCLUSIONS: Longer time to surgery was associated with higher postoperative VAS pain scores, suggesting that earlier surgical intervention in NTOS patients may be beneficial. Higher VAS scores were significantly correlated with poorer postoperative mid-term outcomes as assessed through the DASH, MHQ, CBSQ scores, and Derkash classification.

Mental health status and quality of life is not improved in amputees following targeted muscle reinnervation

Journal of Plastic Reconstructive & Aesthetic Surgery · 2025-03-12 · 1 citations

Utility of the scratch collapse test for diagnosis of neurogenic thoracic outlet syndrome: Patient-reported outcomes after surgical treatment with at least 1 year follow-up

Journal of Plastic Reconstructive & Aesthetic Surgery · 2025-07-28 · 2 citations

Older age is a predictor for hardware failure in open lower extremity fractures requiring free flap coverage

Journal of Hand and Microsurgery · 2025-05-23

Reconstruction of Massive Ventral Hernias with Free Latissimus Dorsi Flap: Mid-Term Patient Reported Outcomes Analysis

Plastic & Reconstructive Surgery Global Open · 2025-06-01

Impact of Surgical Refusal on Overall Survival in Patients With Melanoma: A Comprehensive Analysis

Anticancer Research · 2025-03-01 · 3 citations

<h3>Background/Aim:</h3> Surgery is the primary treatment for melanoma, but some patients refuse it, potentially affecting survival. This study examines demographic and clinical factors associated with surgery refusal to inform targeted interventions. <h3>Patients and Methods:</h3> We conducted a retrospective cohort study using the National Cancer Database (NCDB) to analyze factors linked to surgery refusal in melanoma patients. Demographic, clinical, and treatment characteristics were compared using Pearson Chi-square and Wilcoxon Rank Sum tests. <h3>Results:</h3> Among 1,048,575 melanoma patients considered for surgery, 605 (0.1%) refused. Those who refused were older (mean age 75.8 years), had more comorbidities, and were more likely to be racial minorities or socioeconomically disadvantaged (<i>p</i>&lt;0.001). Survival analysis showed a lower overall survival rate in the refusal group, with 66.0% alive at follow-up compared to 78.3% in the non-refusal group. <h3>Conclusion:</h3> Surgery refusal in melanoma patients is associated with advanced age, frailty, and socioeconomic disadvantages, including racial minority status and lower income. Addressing these barriers may improve treatment acceptance and survival outcomes.