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Background: TDetection of distal radioulnar joint (DRUJ) instability has proven inconsistent despite numerous examination maneuvers. Computed tomography (CT) has been suggested as a modality for evaluating DRUJ instability; however, without stress across the DRUJ, it fails to reliably identify this. No study has simultaneously assessed stress CT with clinical stress maneuvers. As such, the purpose of this study was to compare both methods in stable and unstable wrists.

Methods: An arthrometer was developed to evaluate a clinical stress test of the DRUJ in various degrees of forearm rotation. In each forearm position, specimens were subjected to standardized volar and dorsal loads to simulate clinical stress to the DRUJ. Computed tomography images were acquired in each position with additional unstressed images. The triangular fibrocartilage complex (TFCC) was then sectioned to simulate DRUJ instability.

Results: Nine upper extremities were used. The arthrometer could detect a significant difference between sectioned and intact TFCCs in the supinated forearm position. A large proportion of the translation measured by the arthrometer was due to rotation within the clamps. In the unstressed state, CT analysis using the radioulnar ratio failed to show significant differences in DRUJ stability for any forearm orientation. By applying stress across the DRUJ, CT analysis of ulnar translation along the sigmoid notch showed significant differences between TFCC intact and sectioned wrists.

Conclusions: Clinical examination maneuvers and arthrometers are observing a rotational component that occurs due to the inability to directly clamp the underlying bone, whereas stress CT is more accurate for quantifying underlying bony translation. Unstressed CT analysis did not identify instability.

Background: The scaphoid height-to-length (H/L) ratio assesses reduction quality, with lower values indicating better anatomic restoration and reduced malunion risk. We hypothesized that dorsal percutaneous fixation of acute, unstable distal oblique fractures yields a lower postoperative H/L ratio compared with volar fixation.

Methods: We retrospectively reviewed all Herbert B1 fractures treated with percutaneous screw fixation at a single, tertiary referral center over 10 years. Dorsal and volar approaches followed standardized protocols, with guidewire placement under fluoroscopy and headless compression screw fixation. Postoperative computed tomography (CT) assessed the H/L ratio, intrascaphoid angle (ISA), and dorsal cortical angle (DCA), reformatted along the long axis of the scaphoid. Demographics, injury/operative characteristics, CT-based metrics, and clinical outcomes were compared between approaches.

Results: A total of 18 patients met inclusion criteria (dorsal n = 10, volar n = 8), with an average follow-up of 7.3 months. The cohorts did not significantly differ in demographic, injury, or operative covariates. Computed tomography assessment showed similar ISA and DCA, but a lower H/L ratio in the dorsal approach cohort (0.64 vs 0.70, P = .040). While functional outcomes were mostly comparable, dorsal approach patients reported lower Disability of the Arm, Shoulder, and Hand scores at final follow-up (17.7 vs 45.5, P = .019). Two of the 18 patients developed nonunion; both were treated via a dorsal approach.

Conclusions: A dorsal approach may achieve more anatomic reduction in percutaneous screw fixation of distal oblique scaphoid fractures, though it remains unclear whether the approach has any meaningful, relative influence on functional outcome and bone union.

Background: Peripheral nerve injuries (PNIs) are a significant cause of global disability, often leading to lifelong sensory and motor deficits. Increasing efforts to unveil the psychosocial implications of such injuries is being made. The aim of this study was to determine the impact of preoperatively diagnosed mental health disorder (MHD), specifically major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD), on short-term outcomes following PNI repair.

Methods: A large, retrospective cohort, using the TriNetX Collaborative Global Network database queried on April 9, 2025, was used to identify patients undergoing PNI repair with preoperative MHD diagnoses. Propensity matching was performed, allowing analysis of 30-day and 90-day postoperative outcomes in patients with MHD along with subgroup analysis of those diagnosed with MDD, GAD, or PTSD.

Results: Mental health disorder (n = 2521), MDD (n = 1107), GAD (n = 996), and PTSD (n = 938) groups were found to have increased emergency department use and hospital readmission postoperatively. Patients with MHD were less likely to attend outpatient follow-up in clinic or use occupational therapy services. Complications and opioid consumptions were similar among all groups.

Conclusions: Following PNI repair, patients with pre-existing MHD demonstrated increased hospital resource utilization and decreased outpatient follow-up despite similar complication and opioid use rates. The need for a comprehensive, multifaceted approach to optimize treatment outcomes following PNI, specifically those with concomitant MHD, is obviated by the findings in this study.

Background: The purpose of this study is to compare outcomes in patients with isolated unrepairable scapholunate (SL) injuries treated with the reduction and association of the scaphoid and lunate (RASL) screw technique versus suture anchors with an internal brace (IB).

Methods: Patients treated with either the RASL screw or IB technique for a complete, nonrepairable SL injury were identified. Radiographic and clinical data were recorded preoperatively, immediate postoperatively, and at final follow-up. Patients were then contacted via telephone survey, and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) questionnaire was administered. Patients with less than 6 months of follow-up were excluded.

Results: Twenty-five patients (19 men, 6 women) with an average age of 43 (range = 23-66) years were identified (RASL = 14 and IB = 11). There were no differences between groups in radiographic parameters or range of motion at final follow-up, except for a smaller SL gap at final follow-up in RASL patients (1.5 vs 2.4 mm, P = .03). Four patients in the RASL (29%) group required additional procedures for screw removal secondary to screw breakage (n = 1) or screw migration/loosening (n = 3). One patient in the IB group had complete failure/diastasis postoperatively, and 36% (4/11) of patients had osteolysis at final follow-up. At final follow-up, qDASH was 26 versus 31 in the IB versus RASL groups (P = .79).

Conclusions: Both RASL and IB have similar postoperative outcomes when treating SL injuries. It is important to note complications of screw breakage/loosening associated with RASL and recurrent diastasis/gapping and high rate of osteolysis with IB, although this has an unknown clinical significance.

Background: Distal radius fractures (DRFs) are a common orthopedic injury. Patient-reported outcomes (PROs) and achievement of the minimum clinically important difference (MCID) provide insight into functional recovery. The purpose of this study was to evaluate the impact of patient characteristics, particularly anxiety, on PROs and MCID achievement following DRF.

Methods: All adult patients undergoing primary operative fixation of a DRF at a single health system between 2018 and 2023 were identified. Exclusions included polytrauma, fixation besides a volar locking plate, or missing PROs at baseline or any postoperative follow-up. The Patient-Rated Wrist Evaluation (PRWE) was collected preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. An anchor-based MCID was calculated using a general health question.

Results: Seventy-eight patients were included (87.2% female, average age 62.4 ± 12.5 years). Fifty-nine patients (75.6%) had intraarticular fractures. Depression was more common in the anxiety cohort (68.4% vs 20.3%, P < .001). The MCID thresholds at 3 and 6 months were 57.7 and 61.8, respectively. Patients with anxiety had lower MCID achievement at 6 months (31.6% vs 59.3%, P = .035) and smaller PRWE improvements (P = .002). The PRWE scores at 6 weeks and 3 months were moderately correlated with 6-month scores (r = .51, r = .58, respectively), and 3-month changes were strongly correlated with 6-month changes (r = .73)Conclusions:Anxiety was associated with smaller improvements in PRWE scores and reduced MCID achievement, highlighting the importance of addressing mental health in postoperative care. Early PRWE scores were moderately predictive of 6-month scores, suggesting that patients with limited early improvement may benefit from targeted interventions to optimize long-term recovery.

Background: TSymptomatic thumb carpometacarpal arthritis refractory to nonoperative treatment often results in carpometacarpal arthroplasty surgery. Postoperative therapy facilitates functional recovery, but there may be barriers that can affect recovery and final outcomes. This study identified socioeconomic or functional factors influencing therapy attendance after surgery and patient outcomes.

Methods: Patients at a single academic institution from 2014 to 2024 with carpometacarpal osteoarthritis undergoing carpometacarpal arthroplasty surgery were reviewed. Demographics, postoperative clinic and therapy visits, Patient-Reported Outcomes Measurement Information System scores, and Quick Disabilities of the Arm, Shoulder, and Hand scores were tallied. Bivariate analysis compared patients attending 5 or more therapy sessions with those who did not. Area of deprivation was used to divide patients for analysis.

Results: A total of 1259 patients were eligible for inclusion, with 1078 (85.6%) attending hand therapy for 4 [2, 7] sessions over 7.4 [3.6, 12.1] weeks. Socioeconomically disadvantaged patients had fewer therapy visits but no worse functional outcomes. Patients engaging in consistent therapy reported worse pain interference, physical function, and upper extremity function at 6 weeks relative to those attending fewer sessions (all P < .05). Function nearly equalized at 3 months, and at 6 months, consistent therapy patients achieved more favorable Pain Interference and Physical Function scores (P < .05).

Conclusion: Patients with carpometacarpal osteoarthritis exhibit high therapy attendance following surgery. Socioeconomically disadvantaged patients attended fewer therapy sessions but had comparable functional outcomes. Patients with poorer functional scores at 6 weeks tended to attend therapy longitudinally. At latest follow-up however, their function exceeded non-participants. Therapy attendance is influenced by socioeconomic factors and natural functional recovery.

Background: Triangular fibrocartilage complex (TFCC) injuries are common in athletes and may lead to substantial pain and functional limitations. This study characterizes TFCC injuries in athletes, particularly those involved in racquet sports. We also report on treatment patterns, patient outcomes, and risk factors for TFCC injury.

Methods: Patients with soft tissue injuries of the wrist at our institution in the last 9 years were screened for diagnosis of TFCC injury associated with racquet sports. Patients were excluded if there was no record of treatment or follow-up after diagnosis. Retrospective chart review was performed to collect data on demographics, injury and treatment specifics, return to baseline activity (RTBA) time after initiating treatment, and complications.

Results: Of 700 patients diagnosed with TFCC injury, 23.1% sustained injury during sports. Twenty-five (15.4%) were playing a racquet sport, most commonly tennis (n = 21). Five patients were excluded according to exclusion criteria. Fifty-five percent of the included patients were men, adolescents, and played their sport competitively. Seventy-five percent injured their dominant wrist, with 35% sustaining an ulnar-sided tear. Fifteen patients were treated nonoperatively through wrist immobilization and therapy. Of the 5 surgically treated patients, 4 underwent arthroscopic debridement while 1 underwent open repair. Seventeen patients (12 nonoperative and all surgical) were able to RTBA (average time: 134 days), of which only one had pain recurrence.

Conclusions: Triangular fibrocartilage complex injuries disproportionately affect tennis players but favorably resolved from nonoperative treatment in 73.3% of cases and from surgery in all cases. Prior TFCC pathology and age above 50 were associated with no RTBA.

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.