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Background: Flexor tendon injuries remain a challenge for hand surgeons. The constraints of the pulley system with the need for a strong repair require a delicate balance. Suture repair has been the gold standard. The 4-strand locked cruciate stitch is the technique of choice for many. This can be laborious and technically difficult. Tendon stapler devices (TSDs) aim to provide fast, strong, low-profile repairs. Industry data have shown stronger TSD repairs compared with suture repair techniques. We aim to further explore the relative strengths of TSD and 4-strand locked cruciate repairs in cadavers.

Methods: Twenty-four flexor tendons were used for 12 suture repairs and 12 TSD repairs. Four-strand locked cruciate repairs used 3-0 braided composite suture. The TSD repairs used CoNextions devices. Specimens were analyzed on a uniaxial load frame and distracted at 0.5 mm/s. Tension was recorded at 100 Hz. A camera system measured reference point positions at 10 Hz. Maximum tension and tension at 2-mm gap formation were recorded. Independent t-tests were used to compare groups, with significance noted by P < .05.

Results: Load to failure for the staple group and suture group were 70.6 ± 20.5 N and 49.9 ± 14.1 N, respectively. Load to 2-mm gap for the staple group and the suture group were 57.5 ± 21.1 N and 38.6 ± 13.7 N, respectively. Mean load to failure and load to 2-mm gap were significantly greater in the TSD group.

Conclusions: In this study, TSD repairs were stronger than the 4-strand locked cruciate suture repair. Further clinical studies and cost analyses are necessary to support their widespread use.

Ballistic peripheral nerve injuries (PNIs) are a distinct and complex form of nerve trauma caused by high-energy mechanisms and frequently accompanied by soft tissue and skeletal damage. Despite their prevalence in both military and civilian trauma, the literature on diagnosis, timing, treatment, and outcomes remains fragmented. We conducted a systematic review of PubMed, Embase, and Scopus (1975-2025) following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and included 27 studies with more than 2500 patients that reported original data on ballistic PNIs. Diagnostic approaches were inconsistent, with variable use of electrodiagnostics, imaging, and clinical assessment. The timing of diagnosis and surgery ranged from days to more than a year postinjury, and surgical strategies included neurolysis, direct repair, and nerve grafting. Outcome reporting was heterogeneous, with motor recovery often assessed using the Medical Research Council scale, while sensory and functional outcomes were less consistently measured and rarely evaluated with validated instruments. Across studies, many patients achieved partial motor recovery, but the lack of standardized diagnostic protocols and uniform outcome measures limited comparability. Overall, the evaluation and management of ballistic PNIs remain highly variable, underscoring the need for standardized diagnostic pathways and consistent, validated outcome reporting to guide future research and clinical care.

Background: The optimal surgical strategy for carpal tunnel release remains a subject of debate. This study compared the perioperative complication rates of endoscopic and open carpal tunnel release for the treatment of carpal tunnel syndrome in patients with nicotine dependence.

Methods: The TriNetX database was queried to conduct a retrospective cohort study, identifying a total of 22 435 open carpal tunnel releases and 4947 endoscopic carpal tunnel releases performed on patients with nicotine dependence. Short-term, 90-day complication rates were assessed across both cohorts, including hospital admissions, postoperative emergency department (ED) visits, infections, nerve injury, renal injury, and thrombotic events. Propensity score-matched analyses were performed to mitigate the risk of confounding.

Results: After adjusting for demographic and comorbidity variables, patients with nicotine dependence undergoing open carpal tunnel release had increased risk of postoperative admission (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9), ED visit (OR = 1.2, 95% CI = 1.1-1.4), median nerve injury (OR = 2.0, 95% CI = 1.0-4.7), and superficial infections (OR = 2.2, 95% CI = 1.7-2.8) compared with the endoscopic carpal tunnel release cohort.

Conclusion: Patients with nicotine dependence who undergo open carpal tunnel release experience higher 90-day perioperative complication rates compared with those receiving endoscopic carpal tunnel release. This effect persisted in both unmatched and matched analyses, suggesting an endoscopic technique may be preferable in patients with nicotine dependence due to lower short-term complication risk.

Background: Carpal tunnel syndrome (CTS) is a prevalent neuropathy in hand surgery that significantly affects people's quality of life. Frequently, patients conduct research online before seeking medical care. Large language models (LLMs) like ChatGPT are increasingly used for health information, yet concerns remain regarding the accuracy, readability, and complexity of their responses. Previous studies have assessed older ChatGPT models but have not comprehensively compared newer versions. The purpose of this study is to compare ChatGPT-4-generated, ChatGPT-4o-generated, and ChatGPT-o1-generated answers to common CTS-related patient questions.

Methods: Six frequently asked CTS questions were queried of each LLM. Responses were independently graded by 2 board-certified hand surgeons using evidence-based guidelines. Lexical diversity was assessed using the Measure of Textual Lexical Diversity, and readability was evaluated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and Simple Measure of Gobbledygook. Analysis of variance or Kruskal-Wallis with post hoc tests were conducted to compare LLMs and questions.

Results: All 3 ChatGPT models averaged 93% accuracy with no significant differences between them, though a significant difference in accuracy was observed between questions 3 and 5. Readability scores between models varied significantly, with ChatGPT-4o generating the most readable responses and ChatGPT-o1 producing the most complex answers.

Conclusions: While LLMs had similar accuracy, ChatGPT-4o offered the most patient-friendly content. Furthermore, the readability of all models remains above the recommended level for the general population. Future work should explore whether fine-tuning or advancements in model design can enhance accessibility for a broader audience.

Background: This study evaluated the efficacy of woodcast (WC) versus thermoplastic (TP) splints for postoperative immobilization following carpometacarpal (CMC) joint suspensionplasty. The hypothesis was that WC splints would provide improved efficacy and compliance compared with TP splints, while also reducing waste generation.

Methods: A prospective, randomized controlled trial enrolled 26 patients, all older than 18 years old, undergoing CMC joint suspensionplasty. Participants were randomized to receive postoperative splinting with either a WC or TP splint. Exclusion criteria included additional procedures on the same arm or surgeon-determined unsuitability. Outcomes assessed included patient comfort, compliance, satisfaction, complication rates, and quantity of waste material generated by each splint type.

Results: The TP group demonstrated higher splint compliance and fewer splint-related complications than the WC group. Both groups reported similar satisfaction concerning their splints and overall treatment. However, the WC group generated significantly less waste (3.14 ± 1.38 g) compared with the TP group (20.88 ± 9.64 g), an 85% reduction. Functional outcome scores (Quick Disabilities of Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, visual analog scale) were similar between groups at all time points.

Conclusions: Thermoplastic splinting resulted in greater compliance and fewer complications but generated substantially more waste than WC splinting. As both splint types yielded comparable functional outcomes, the choice of splinting material should account for therapist expertise and health care waste considerations. The findings support exploring alternative biodegradable splint materials that support waste management without compromising patient care.Randomized Controlled Trial: ClinicalTrials.gov ID: NCT06876350.

Despite increasing clinical interest, there has yet to be a systematic evaluation of the literature regarding hyperselective neurectomy (HSN) for upper limb spasticity. In this study, we assess the results of HSN on spasticity reduction, muscle strength preservation, and range of motion (ROM). Nine studies were included from Ovid MEDLINE, Embase, and Scopus, detailing the outcomes of 253 HSNs targeting the shoulder, elbow, forearm (pronators), wrist, and digits. Hyperselective neurectomy demonstrated reductions in spastic tone while preserving or modestly improving strength and ROM in both agonist and antagonist muscle groups. Slight recurrence of spasticity was frequently reported among studies with longitudinal follow-up, but this did not reach statistical significance. Interpretation of results is constrained by heterogeneity in surgical technique, follow-up duration, patient characteristics, and outcome measures. Future studies should aim to standardize fascicle resection thresholds, report uniform outcome metrics, and extend follow-up duration to identify optimal surgical strategies, evaluate the risk of delayed recurrence, and identify patient subgroups most likely to benefit from HSN.

Background: Carpal tunnel release (CTR) is one of the most commonly performed hand surgeries, with both open and endoscopic techniques widely used. This study analyzes US historical trends in CTR utilization among Medicare beneficiaries and projects future procedural volumes through 2040.

Methods: Medicare Part B National Summary data from 2000 to 2022 were used to estimate annual procedural volumes for open (Current Procedural Terminology [CPT] 64721) and endoscopic (CPT 29848) CTR. Adjustments were made to account for the increasing proportion of Medicare Advantage enrollees. Four forecasting models-log-linear, Poisson regression, negative binomial regression, and auto-regressive integrated moving average (ARIMA)-were applied. Model performance was evaluated using mean absolute error and root mean square error, with ARIMA selected for its superior predictive accuracy.

Results: From 2000 to 2022, the annual volume of open CTR increased by 180%, while endoscopic CTR grew by 959%. Auto-regressive integrated moving average projections indicate that open CTR will continue to grow at an average annual rate of 2.0%, reaching an estimated 424 271 procedures by 2040. Endoscopic CTR is projected to increase at a faster rate of 2.42% annually, with a forecasted volume of 184 723 by 2040. Despite this growth, open CTR is expected to remain the predominant approach.

Conclusions: Carpal tunnel release utilization has increased substantially in the United States, with endoscopic techniques growing at a faster rate than open CTR. Despite this trend, open CTR is projected to remain the predominant approach. Future research should assess the economic impact, patient-reported outcomes, and factors influencing the adoption of each technique.

Introduction: Carpal instability related to scapholunate ligament injury can manifest as an increased scapholunate (SL) interval and/or angle. Radiocarpal arthrosis is expected with chronic carpal instability due to an imbalance of normal joint loading. This study seeks to quantify the effect of an increased SL interval and angle on joint loading properties.

Methods: Radioscaphoid (RS) and radiolunate (RL) contact area and pressure were collected in 13 cadaveric specimens tested under the following conditions (#): normal SL interval and SL angle (1), increased interval only (2), increased angle only (3), and both increased interval and angle (4).

Results: Compared with condition 1, RS contact area decreased by 21%, 49%, and 33% in conditions 2, 3, and 4, respectively, and RL contact area increased by 0.3%, 55%, and 36%. Compared with condition 1, RS pressure increased by 167%, 207%, and 185% in conditions 2, 3, and 4, respectively, and RL pressure decreased by 13% in condition 2 and increased by 27% and 76% in conditions 3 and 4, respectively.

Conclusions: Radioscaphoid and RL joint loading properties change with an increased SL interval and angle. An increased SL angle alters radiocarpal joint loading to a greater extent than an increased SL interval. As a result, an increased SL angle likely has a more significant impact on the development of carpal arthrosis.

Background: Cold therapy devices (CTDs) have been shown to provide analgesia, reduce swelling, and improve outcomes following orthopedic procedures. However, comparative data on postoperative narcotic use and pain control between CTDs and traditional ice packs remain limited. This study evaluates patient satisfaction and opioid use among those using CTDs after carpometacarpal (CMC) arthroplasty or distal radius open reduction internal fixation (ORIF).

Methods: A prospective analysis was conducted on 124 patients who underwent hand surgery by a single fellowship-trained surgeon between June 2023 and February 2025. A total of 92 patients who underwent CMC arthroplasty or distal radius ORIF were included. Patient-reported outcomes on pain relief, cryotherapy use adherence, and opioid usage were compared between CTD users and those using traditional ice packs.

Results: In CMC arthroplasty patients, CTD users reported significantly higher pain relief scores (9.56/10 vs 3.42/10, P < .001) and greater adherence (>3 sessions/day: 94.4% vs 36.8%, P < .001) than ice pack users. Similar patterns were observed in distal radius ORIF patients, with higher CTD usage at both 3 and 7 days postoperatively (96% vs 11% and 88% vs 11%, respectively; P < .001). In distal radius ORIF patients, CTD users demonstrated a significant increase in 6-week Single Assessment Numeric Evaluation (SANE) score. No significant difference in oxycodone consumption was observed between groups for either procedure.

Conclusion: CTD use following CMC arthroplasty and distal radius ORIF is associated with improved pain relief and adherence with cryotherapy. Although opioid use did not differ significantly, CTDs show promise as an adjunct for postoperative pain management in hand and wrist surgery.

Background: This study aimed to determine whether deaf patients experience barriers to orthopedic care compared with hearing patients through evaluating time to appointment, appointment denial rates, and interpreter availability.

Methods: Researchers called 132 randomly selected US orthopedic offices to request appointments for fictitious patients with distal radius fractures. Each office was called twice on the same weekday over different weeks-once for a hearing patient and once for a deaf patient communicating in American Sign Language (ASL). The primary outcome was time to appointment. Secondary analysis included provider type, ASL interpreter availability, interpreter modality, and requests for family interpretation. Differences in time to appointment with P values were determined using Wilcoxon signed-rank, Mann-Whitney U, and Kruskal-Wallis tests.

Results: Data from 132 clinics (63 academic and 69 community/private practices) were analyzed. The time to appointment for patients across all regions, practices, and providers was 3.9 days. Deaf patients experienced significantly longer wait times for physician appointments (4.96 vs 3.32 days, P value: .0031). When considering all providers (physicians, nurse practitioners, and physician associates), deaf patients did not wait significantly longer (4.43 vs 3.38 days, P value: .06). Most offices (81.8%) offered interpreters, with academic institutions more likely to guarantee ASL interpretation (95.5%) than community/private practices (68.2%). Some offices (17.9%) requested family members interpret instead.

Conclusions: Distal radius fractures are common, and evidence suggests prompt care results in better outcomes and quicker return-to-work time. This study demonstrates statistically but not necessarily clinically significant delays for deaf patients seeking surgical appointments with MDs and reliance on ad hoc interpreters.