Journal of Hand, Upper Limb, and Microsurgery

Letter from Editor

Marquee Kenny Tumbelaka, MD. — Fri, 02 May 2025 00:00:00 +0700

If you’ve been keeping an eye in thenews,
over the past few years, the scientific
publishing landscape in Indonesia has been
rocked by troubling controversies—ranging
from the unethical buying and selling of
professorial titles to unauthorized use of
authors’ names. These practices have shifted
academic publications as tools for climbing
the ranks, securing promotions, collecting
fancy titles—straying far from their noble
purpose.

Point of Perspective

Marquee Kenny Tumbelaka, MD. — Fri, 02 May 2025 00:00:00 +0700

Orthopaedic, surgery and hand
surgery are highly complex and often time
consuming specialties. Orthopaedic surgery
involves bones, joints, ligaments, tendons,
and muscles, all critical for mobility. While,
hand surgery is even more intricate because
of the density of small structures like tiny
bones, tendons, nerves, and blood vessels in
a compact space.

OPEN REDUCTION AND FIXATION WITH CORACOID OSTEOTOMY FOR A COMPLICATED PROXIMAL HUMERUS FRACTURE-DISLOCATION: A CASE REPORT

Fri, 02 May 2025 00:00:00 +0700

Introduction: Proximal humerus fracture dislocation presents a debilitating problem with poor outcome due to the high risk of avascular necrosis and the necessity for further arthroplasty in the future. Many studies report various surgical techniques from minimally invasive to classic open procedures for the management of proximal humerus fracture dislocation.

Objective: The aim of study is to discuss the surgical management of complicated proximal humerus fracture dislocation.

Case Presentation: We present a 44-year-old female with severe Neer 4 parts proximal humerus fracture and anterior humeral head dislocation following a high-energy motor vehicle injury. Open reduction and plate screw fixation is performed successfully with aid from coracoid osteotomy. Humeral head dislocation is firstly reduced into the glenoid. Coracoid osteotomy provides better visualization and a larger surgical field. Postoperative follow-up shows a satisfactory functional arm without any signs of early avascular necrosis.

Discussion: Despite the initial intention to perform a shoulder arthroplasty, intraoperative evaluation allows a better perspective and encourages head-preserving reconstruction with a more convenient plate and screw fixation. Coracoid osteotomy is a pivotal procedure in this surgery. It exposes many important structures in the anterior deltopectoral approach.

Conclusion: Open surgery with a properly undertaken coracoid osteotomy approach presents beneficial support for managing such a complicated case of proximal humerus fracture-dislocation.

FUNCTIONAL OUTCOME OF MEDIAN NERVE FASCICLE TRANSFER TO MUSCULOCUTANEOUS NERVE FASCICLE FOR RESTORATION OF ELBOW FLEXION IN BRACHIAL PLEXUS INJURY: A CASE REPORT

Alsyahrin Manggala Putra Sarif — Fri, 02 May 2025 00:00:00 +0700

Abstract

Introduction. Nerve transfer procedures are increasingly performed for repair of brachial plexus injury (BPI). The procedure essentially involves the coaption of a proximal foreign nerve to the distal denervated nerve to reinnervate the latter by the donated axons.

Objective: This retrospective observational study evaluated the outcome of the nerve transfer on bicipital power in patients with trunk C5 to T1 root level injuries operated on before 6 months of injury

Case presentation. A 20-year-old male with right incomplete traumatic brachial plexus injury post ganglionic type with discontinuity in root to divisions of C5-T1 already performed median nerve motor fascicle transferred onto the nerve to biceps. Initial elbow power strength was M0 assessed by the Medical Research Council (MRC) prior the surgery and elbow flexion revealing biceps contraction against gravity and resistance (M4 on MRC) after single fascicular nerve transfer surgery. We performed neurolysis to explore the presence of nerve and we found no contraction of phrenic nerve, disrupted integrity proximal part of trunk C5, partially lost of trunk C6 cover by fibrotic tissue, and intact of trunk C7. An internal neurolysis of the median nerve is performed to separate the individual fascicles. One fascicle from median nerve determined by combined motor action potentials (CMAP) to contain the greatest percentage of wrist flexor innervation is cut distally. Nylon 10-0 is used to anastomose the median fascicle to the biceps branch of the musculocutaneous nerve.

Discussion. In restoration of elbow flexion, we prefer to use median nerve transfer onto musculocutaneus nerve because preoperative clinical finding initial muscle strength of median nerve is better than ulnar nerve in MRC scale and its confirm intraoperatively with muscle stimulator device that reveal similar. After 6 months follow up the patient achieved elbow flexion strength MRC grade 4, prior the surgery elbow flexion strength MRC grade 0. Nat et al. found that for cases of functional deficit in elbow flexion, median nerve transfer to the musculocutaneous nerve has proven to be an effective treatment for the functional loss with combined C5–6 brachial plexus root avulsions. Sungpet et al. conclude that transfer of one fascicle of the median nerve to the motor branch of the biceps muscle appears to be reliable, without further impairment of the donor site at final follow-up examination

Conclusion. Median nerve fascicle transfer onto musculocutaneus nerve resulted in a significant improvement in elbow flexion strength and should be considered an effective, and in many cases preferable, alternative to ulnar nerve fascicle transfer.

The Accuracy of Ultrasonography Diagnostic Tests in Carpal Tunnel Syndrome (Electromiography-Nerve Conduction Velocity As Gold Standard)

Fri, 02 May 2025 00:00:00 +0700

Introduction: Carpal Tunnel Syndrome is a collection of symptoms (pain in the median nerve distribution, numbness, tingling to motor weakness or muscle atrophy) due to ischemic compression of the median nerve. This causes a decrease in quality of life and disrupts work. EMG-NCV is a gold standard diagnostic tool with high sensitivity and specificity, but it is uncomfortable, high costs and an inadequate number of devices.

Methods: The authors consider the use of ultrasound with a specificity of 86.8% and a sensitivity of 77.6%, providing more convenience, lower cost, a greater number of devices available. Moreover, some literature explains that ultrasound can diagnose CTS earlier. Thus, the author conducted diagnostic test research with a cross-sectional design. The research sample underwent ultrasound and EMG-NCV examination, then receiver operating characteristic analysis was carried out to obtain cut-off point and analyze sensitivity, specificity and accuracy.

Results: The results of this study showed that mid-carpal CSA on ultrasound with a cut point of 12.5 mm2 could be used to predict the diagnosis of CTS with a sensitivity of 78% and a specificity of 52.4% with a predictive power of 74.7%. In addition, each clinical grade is related to the ultrasound grade and EMG-NCV. So ultrasound can confirm the diagnosis of CTS and can be applied in all healthcare facilities that have ultrasound so that the distribution of diagnosis of patients with CTS can be more even and make health services easier and faster.

Conclusion: It can be concluded that the ultrasound test (Mid-Carpal CSA) is sensitive, non-specific and accurate in diagnosing carpal tunnel syndrome. And, from this research, ultrasound can determine the severity of carpal tunnel syndrome. However, researchers recommend that this research be continued with a larger sample size to be more representative in determining the severity of carpal tunnel syndrome from an ultrasound examination.