BACKGROUND: Early and accurate diagnosis is critical to preserve function and reduce healthcare costs in patients with hand and wrist injury. As such, artificial intelligence (AI) models have been developed for the purpose of diagnosing fractures through imaging. The purpose of this systematic review and meta-analysis was to determine the accuracy of AI models in identifying hand and wrist fractures and dislocations.
METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagnostic Test Accuracy guidelines, Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to October 10, 2023. Studies were included if they utilized an AI model (index test) for detecting hand and wrist fractures and dislocations in pediatric (<18 years) or adult (>18 years) patients through any radiologic imaging, with the reference standard established through image review by a medical expert. Results were synthesized through bivariate analysis. Risk of bias was assessed using the QUADAS-2 tool. This study was registered with PROSPERO (CRD42023486475). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS: A systematic review identified 36 studies. Most studies assessed wrist fractures (27.90%) through radiograph imaging (94.44%), with radiologists serving as the reference standard (66.67%). AI models demonstrated area under the curve (0.946), positive likelihood ratio (7.690; 95% confidence interval, 6.400-9.190), and negative likelihood ratio (0.112; 0.0848-0.145) in diagnosing hand and wrist fractures and dislocations. Examining only studies characterized by a low risk of bias, sensitivity analysis did not reveal any difference from the overall results. Overall certainty of evidence was moderate.
CONCLUSIONS: In demonstrating the accuracy of AI models in hand and wrist fracture and dislocation diagnosis, we have demonstrated that the potential use of AI in diagnosing hand and wrist fractures is promising.
METHODS: Level III. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND: The reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications.
METHODS: From June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases.
RESULTS: Altogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps.
CONCLUSIONS: The free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.

Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction.

Reconstruction of bony defects is challenging. Most cases can be solved by means of nonvascularized bone grafts, either corticocancellous or cancellous. However, when the defect is long, there is a combined soft tissue defect, infection, a poor scarred bed, and when a piece of cartilage needs to be included, a vascularized bone graft is preferred. This article features a review of the most useful flaps for small and long defects in the hand and upper limb.

UNASSIGNED: The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality.
UNASSIGNED: To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries.
UNASSIGNED: A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated.
UNASSIGNED: After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates.
UNASSIGNED: Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.
UNASSIGNED: El enfoque propioceptivo puede mejorar de manera efectiva la fuerza, la movilidad, la reducción del edema y la disminución del dolor; lo que a su vez tiene un impacto positivo en la funcionalidad.
UNASSIGNED: Identificar las estrategias de rehabilitación propioceptiva reportadas en la literatura, en adultos con lesiones traumáticas de muñeca.
UNASSIGNED: Se efectuó una revisión de alcance siguiendo los parámetros de la estrategia Prisma ScR. Se incluyeron investigaciones con pacientes adultos, diagnóstico de lesión postraumática de muñeca, que utilizaron rehabilitación propioceptiva. Se evaluó el dolor, la funcionalidad, la fuerza, los rangos de movilidad articular y el edema.
UNASSIGNED: Se incluyeron seis artículos, que involucraron 125 pacientes al aplicar los criterios de exclusión. Se han generado protocolos de rehabilitación basados en facilitación neuromuscular propioceptiva y el uso de herramientas sensoriomotoras que promueven la recuperación de la muñeca. Además, se han establecido otros abordajes como la imaginería motora, que genera un trabajo de identificación y organización del movimiento, mejorando el dolor y la función manual. Faltan seguimientos de mayor tiempo, estandarización de los instrumentos utilizados durante la intervención propioceptiva y aumentar la población observada para generar una recomendación de intervención temprana y estimaciones entre el costo y el beneficio.
UNASSIGNED: La rehabilitación propioceptiva ha demostrado beneficios en la recuperación del miembro inferior y la cadera o espalda. Para la rehabilitación de las lesiones traumáticas de muñeca, es un pendiente de la investigación. La información bien descrita y los diseños de buena calidad son necesarios para proponer rutinariamente esta estrategia en la clínica.

Fractures of the proximal interphalangeal (PIP) joint with fragment displacement should be promptly repaired after injury, though this does not ensure the return of pre-injury finger function. This article presents the case of a 29-year-old patient who sustained an injury to the fourth finger of his right hand, resulting in an open fracture of the distal and shaft of the proximal phalanx involving the PIP joint and partial damage to the finger extensor mechanism. Immediately post injury, the fracture was realigned and stabilized with Kirschner wires (K-wires). Three years later, due to post-traumatic degenerative disease, the patient required further surgical intervention and was diagnosed with type III according to the modified Kellgren and Lawrence scale. The decision was made to perform a partial arthroplasty of the PIP joint. The implantation of the PIP prosthesis in a patient with post-traumatic degenerative disease can restore the correct range of flexion movement, realign the fourth digit, and eliminate pain. However, this treatment method may pose a risk of a slight limitation in the range of extension motion in the joint.

UNASSIGNED: To investigate the effectiveness of the perforator-based propeller flaps (PPFs) based on digital artery (DA) and dorsal metacarpal artery (DMA) in repairing hand wounds.
UNASSIGNED: The clinical data of 45 patients with hand wounds between January 2018 and March 2023 were retrospectively analyzed. There were 27 males and 18 females with an average age of 41.2 years (range, 14-72 years). The causes of injury included twist injury in 15 cases, crush injury in 19 cases, and cut injury in 11 cases. The injured parts included 32 cases of digits, 10 cases of dorsal hand, and 3 cases of palmar hand, all of which had tendon, joint, and bone exposure. The time from injury to operation ranged from 2 to 8 hours (mean, 4.3 hours). The wound sizes after debridement ranged from 1.8 cm×1.0 cm to 5.0 cm×3.5 cm. Twenty-eight cases were repaired by the PPFs based on DA and 17 cases were repaired by the PPFs based on DMA. The flap size ranged from 2.5 cm×1.1 cm to 8.5 cm×4.0 cm. The defects of the donor sites in 14 patients were closed directly and the defects in the left 31 patients were resurfaced with free full-thickness skin graft from the proximal medial forearm.
UNASSIGNED: All the flaps survived after operation. Two cases of the PPF based on DA and 1 case of the PPF based on DMA underwent partially blisters at the distal end and healed after dressing change. The incisions in the donor site healed by first intention and the skin grafts survived. All patients were followed up 10-33 months, with a mean of 15.4 months. At last follow-up, the static two-point discrimination of the PPFs based on DA and DMA were 4-14 mm and 8-20 mm with the averages of 8.1 mm and 13.3 mm, respectively. According to the Michigan Hand Outcomes Questionnaire, 20 patients were very satisfied with the appearance of the PPF based on DA and 8 patients were satisfied; 8 patients were very satisfied with the appearance of the PPF based on DMA and 9 patients were satisfied. Based on the Vancouver Scar Scale (VSS), the appearance scores of the donor site of the PPFs based on DA and DMA were 2-7 and 4-9, with the averages of 4.2 and 6.1, respectively.
UNASSIGNED: The two kinds of PPFs are reliable in blood supply and easy to harvest, which provide a good method for emergency repair of small and medium area wounds in the hand.
UNASSIGNED: 探讨应用指动脉及掌背动脉穿支蒂螺旋桨皮瓣修复手部创面的临床疗效。.
UNASSIGNED: 回顾分析2018年1月—2023年3月收治的45例手部创面患者临床资料。男27例，女18例；年龄14～72岁，平均41.2岁。致伤原因：绞伤15例，压砸伤19例，切割伤11例。受伤部位：手指32例，手背10例，手掌3例；均存在肌腱、关节及骨外露。受伤至手术时间2～8 h，平均4.3 h。清创后创面范围为1.8 cm×1.0 cm～5.0 cm×3.5 cm。采用指动脉穿支蒂螺旋桨皮瓣修复28例，掌背动脉穿支蒂螺旋桨皮瓣修复17例；皮瓣切取范围为2.5 cm×1.1 cm～8.5 cm×4.0 cm。14例供区直接缝合，31例取前臂近端内侧全厚游离皮片植皮修复。.
UNASSIGNED: 术后45例皮瓣全部成活，其中2例指动脉穿支蒂螺旋桨皮瓣及1例掌背动脉穿支蒂螺旋桨皮瓣远端肿胀并出现水疱，经换药处理后愈合。供区切口Ⅰ期愈合，植皮均成活。患者均获随访，随访时间10～33个月，平均15.4个月。末次随访时，指动脉穿支蒂螺旋桨皮瓣静态两点辨别觉为4～14 mm，平均8.1 mm；掌背动脉穿支蒂螺旋桨皮瓣为8～20 mm，平均13.3 mm。按照Michigan手部功能问卷评定标准，指动脉穿支蒂螺旋桨皮瓣患者对皮瓣外观非常满意20例，满意8例；掌背动脉穿支蒂螺旋桨皮瓣患者对皮瓣外观非常满意8例，满意9例。参照温哥华瘢痕量表（VSS），指动脉穿支蒂螺旋桨皮瓣患者供区外观评分为2～7分，平均4.2分；掌背动脉穿支蒂螺旋桨皮瓣为4～9分，平均6.1分。.
UNASSIGNED: 两种穿支蒂螺旋桨皮瓣血供可靠，切取简便，为急诊修复手部中、小面积创面提供了较好的治疗方法。.

BACKGROUND: The neurocutaneous flap was developed based on the understanding that every superficial cutaneous nerve includes vessels, also known as vasa nervorum or paraneural vessels, which run around and inside the nerves and deliver blood to the skin above. A cutaneous perforator connected to paraneural vessels that vascularize the skin and nerves is referred to as a neurocutaneous perforator. The lateral antebrachial cutaneous nerve (LACN), the most dependable blood supply from the primary underlying veins of the neurocutaneous flap, is the subject of this study.
METHODS: We reviewed the results of 30 flap coverage procedures in 10 children. The applied flap was based distally along the radial aspect of the hand and wrist. The pivot point of the flap was located dorsally. This study considered patients with posttraumatic tissue loss, vital structure exposure, or hand contractures with an LACN flap. There was a case-by-case assessment.
RESULTS: Thirteen male patients were included; their ages ranged from 6 to 65 years. Demographic data, preoperative cause of trauma, and postoperative complications were collected. Statistically significant improvements were observed after flap healing.
CONCLUSIONS: The LACN flap is a more versatile flap with less morbidity than other alternative flaps for coverage of soft tissue defect restoration around the hand, wrist, and distal forearm.

Background  Kite string injuries (manja cut injuries), particularly those caused by Chinese manja, are new culprit of emergencies especially in the month of January in Maharashtra region. These injuries commonly affect the neck, face, hands, and legs, especially among individuals traveling on two wheelers. The visibility challenge, where the kite\'s thread is difficult to see, further exacerbates the risk. Materials and Methods  We have studied 10 cases of manja cut injuries presented to a tertiary care center in Nagpur during the last 2 years. Result  A total of 10 patients reported kite string-related injuries to our department over a period of 2 years. All patients were male. The majority of patients presented in the younger age group with the mean age of presentation was 25 years. Majority of the patients had injuries in zone 2 of the hand. Conclusion  Kite flying is a traditional festival celebrated in the month of January in Gujarat and Maharashtra for years. However, the introduction of Chinese or nylon manja has led to serious injuries and fate, affecting not only kite flyers but also bystanders, animals, and birds. This study seeks to highlight the harmful consequences of Chinese manja and deceptive appearance of manja giving false impression of simple lacerated wound which could be just a tip of the iceberg.

The study included 40 patients of both genders who underwent skin transplantation after a hand injury. The study aims to evaluate the oxidative stress parameters in patients\' blood and serum levels of galectin-3 in order to investigate gender differences pre- and post- skin transplantation. The results of the study suggest a significant increase in superoxide anion radical levels, catalase activity, and reduced glutathione levels in females before skin transplantation. The surgical treatment caused significant increase in superoxide anion radical and hydrogen peroxide levels as prooxidants in males, while superoxide dismutase and catalase activity were also increased 7 days after the procedure. In females, superoxide anion radical and TBARS levels increased after surgical procedure as well as the activity of catalase. Regarding galectin-3 levels, a significant interaction between gender and time was observed (gender×time; p=0.000). Correlation analysis of different oxidative stress markers with gal-3 revealed the existence of a significant negative correlation of superoxide anion radical, catalase, and reduced glutathione with gal-3, but only in female patients. It can be concluded that OS as well as galectin-3 play important roles at least in the first 7 days of the postoperative period.