The Biomechanical Stability of a Single Headless Compression Screw Construct to Fix Scaphoid Waist Fractures.

Background: Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures.

Questions/purposes: (1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation?

Methods: In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist.

A retrospective comparison of absorbable versus non-absorbable sutures for elective hand surgery wound closures.

Background: Suture selection in elective hand surgery closures has traditionally been non-absorbable sutures (NAS) rather than absorbable sutures (AS). The goal of this study was to evaluate absorbable versus non-absorbable closures of various primary elective hand procedures. Our group hypothesized that no differences in major short-term outcomes would exist.

When Numbness and Tingling Play a Role-Sexual Function in Compressive Neuropathy.

Purpose: Compressive neuropathies such as carpal tunnel and cubital tunnel syndrome can lead to sensation loss, muscle weakness, joint contractures, and disrupted sleep. The interplay between these conditions and the effect on patients' intimacy is unknown. The purpose of this study was to examine sexual function before and after surgery in patients undergoing carpal tunnel release or cubital tunnel release.

Cutting-Edge Approaches for Nerve Debridement Prior to Repair.

Peripheral nerve injuries can be devastating. Although neuropraxic and some axonotmesis injuries will recover spontaneously, nerve repair or reconstruction is required to restore function in high-grade axonotmesis or neurotmesis injuries. The first step of nerve repair or reconstruction is adequate nerve debridement with removal of necrotic and fibrous tissues.

Comparison of Early Versus Late Debridement Outcomes in the Management of Open Distal Radius Fractures.

Purpose: The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours.

Methods: A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years.

Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis.

Background: The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy.

Methods: A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year.

A quality and readability comparison of artificial intelligence and popular health website education materials for common hand surgery procedures.

Introduction: ChatGPT and its application in producing patient education materials for orthopedic hand disorders has not been extensively studied. This study evaluated the quality and readability of educational information pertaining to common hand surgeries from patient education websites and information produced by ChatGPT.

Methods: Patient education information for four hand surgeries (carpal tunnel release, trigger finger release, Dupuytren's contracture, and ganglion cyst surgery) was extracted from ChatGPT (at a scientific and fourth-grade reading level), WebMD, and Mayo Clinic.

A novel classification of intraoperative ulnar nerve instability to aid transposition surgery.

Hypothesis: The purpose of this study was to compare inter- and intraobserver agreement of a novel intraoperative subluxation classification for patients undergoing ulnar nerve surgery at the elbow. We hypothesize there will be strong inter- and intraobserver agreement of the 4-category classification system, and reviewers will have substantial confidence while reviewing the classification system.

Methods: Four blinded fellowship-trained orthopedic hand surgeons reviewed 25 videos in total on 2 separate viewings, 21 days apart.

Extensor tendon transfer for fracture-related extensor pollicis longus rupture: Long-term outcome case series.

Background: Spontaneous rupture of the extensor pollicis longus (EPL) tendon following both nonoperative and operative treatment of distal radius fractures has been well described.

Purpose: The purpose of this study was to assess long-term outcomes of extensor indicis proprius to EPL tendon transfers for patients following distal radius fracture and EPL tendon repair.

Study Design: Retrospective case series focusing on long-term clinical outcomes.

Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery.

 Patients acutely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have increased risk for postsurgical pulmonary complications and mortality, particularly with general anesthesia. Surgery is often delayed to mitigate risk; however, excessive delays may result in morbidity. Optimal criteria for delaying surgery in patients with or without symptoms are unknown.

Technique for Minimally Invasive, Arthroscopic-assisted Distal Radius Fracture Fixation.

Distal radius fractures are common injuries that often require surgical intervention. Commonly, these fractures are fixed using open reduction internal fixation with plating and screws. This often requires a more extensive soft tissue dissection and exposure.

All-Inside Versus Outside-in Repair of Triangular Fibrocartilage Complex Peripheral Tears.

Purpose: Triangular fibrocartilage complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown in prior case series. The purpose of this study was to compare two methods of arthroscopic peripheral TFCC repair: all-inside vertical mattress and outside-in horizontal mattress.

Finger Necrosis After Cutaneous Wart Intralesional Injection with Candida albicans Antigen: A Case Report.

Case: A 25-year-old man presented 18 hours after Candida albicans antigen injection into a left index finger cutaneous wart by his dermatologist. He experienced a rapid-onset inflammatory response, which was indistinguishable from gangrenous infection. Urgent incision and drainage was performed; however, no purulent collection was noted and no organism isolated.

Identifying High Direct Variable Costs of Open Carpal Tunnel Release Patients Using Time-Driven Activity-Based Costing.

Purpose: To improve value in health care delivery, a deeper understanding of the cost drivers in hand surgery is necessary. Time-driven activity-based costing (TDABC) more accurately reflects true resource use compared with traditional accounting methods. This study used TDABC to explore the facility cost of carpal tunnel release and identify preoperative characteristics of high-cost patients.

Reliability of Assessing Distal Radius Fractures on a Smartphone Versus PACS.

Background: Communication between health care providers is becoming more intertwined with technology. During the pandemic, telehealth strategies grew exponentially. Remote viewing of imaging on a smartphone may offer efficient communication; however, the reliability of injury assessment when compared with traditional methods is not known.

Arthroscopic Trapeziectomy.

Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate mobilization in order to expedite return to function. Herein I present a step by step method of arthroscopic total trapeziectomy without suspensionplasty.

Wide Awake Local Anesthesia No Tourniquet Endoscopic Cubital Tunnel Release.

As demands for faster return to function, improvement in surgical scarring, and minimal disruption to personal schedule have increased, so also have the demands increased for minimally invasive procedures under the wide awake, local anesthetic, no tourniquet method. However, owing to the subcutaneous yet constrained position of the ulnar nerve at the elbow, wide-awake endoscopic cubital tunnel release has remained a technical challenge. We describe a 2-stage local anesthetic injection method that safely introduces local anesthetic within the cubital tunnel and simultaneously achieves comfort, sufficient visualization, and the ability to decompress multiple compression sites through a minimal incision.

Surveying the Use and Perceptions of Wrist Arthroscopy Among Upper Extremity Surgeons.

This study describes current trends in the skill acquisition and practice patterns for wrist arthroscopy among upper extremity surgeons. A survey was sent to the membership of the American Association for Hand Surgery (AAHS). A total of 104 responses were available for analysis.

Managing Challenges in Thumb Carpometacarpal Arthritis.

Thumb carpometacarpal osteoarthritis is commonly encountered and multifactorial in etiology, and its management is based on the radiographic stage and surgeon preference. A variety of management strategies exist including ligament reconstruction, arthroscopic débridement, extension osteotomy, open versus arthroscopic total and partial trapeziectomy with or without interposition and/or suspensionplasty, arthrodesis, and total or hemi implant arthroplasty. A review of the literature shows each of these management strategies to be effective in pain relief, but no one procedure has been shown to be superior despite theoretic benefits to preserving trapezial height.

Tension Band Wiring in Upper Extremity Surgery.

Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces. The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies.

Antibiotic Management and Antibiotic Resistance in Hand Infections.

The rates of methicillin-resistant infections in the hand and upper extremity approach 50% in many facilities. In addition, multidrug resistance is beginning to include clindamycin. This article discusses the history, prevalence, and treatment of both community-acquired and health care-associated methicillin-resistant Staphylococcus aureus in regard to hand infections.

Contralateral Heterotopic Thumb-to-Thumb Replantation With Free Ulnar Forearm Fasciocutaneous Flap and Targeted Muscle Reinnervation.

Mangling hand injuries can be difficult to manage owing to the severity and heterogeneity of the injuries. Outcomes after reconstruction of unique injuries are less well-known but provide valuable insight. We present an unusual spare parts reconstruction of a bilateral upper-extremity mangling injury treated with a heterotopic thumb-to-thumb replantation, an acute forearm fasciocutaneous free flap, and targeted muscle reinnervation.

Fragment-Specific Fixation in Distal Radius Fractures.

Purpose Of Review: Fragment-specific fixation can be a useful tool in treating distal radius fractures. In order to best utilize these techniques, surgeons require an understanding of the normal anatomy, fracture patterns, approaches, and fixation strategies.

Recent Findings: Fragment-specific fixation may be appropriate for certain fracture patterns particularly when monoblock plating techniques are not sufficient.

A Novel Technique for Correcting Radial Length and Translation in Distal Radius Fractures.

We describe a novel technique in correcting distal radius fractures deformed with significant shortening or coronal plane translation in both the acute or chronic setting. The technique involves using a modified push-pull device to assist the surgeon in correcting length and/or translation of the articular block without the use additional hardware outside of the volar plate.