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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.

Background: The study aims to classify complications of open reduction and internal fixation (ORIF) of distal radius fractures, to determine risk factors of complications, and to validate a Clavien-Dindo scale modified for distal radius ORIF (mCD-DR).

Methods: Patients undergoing distal radius ORIF at a single institution were retrospectively reviewed. Demographics, comorbidities, surgery length, and complications were collected. Complications were graded using the mCD-DR: Grade 1 is deviation from standard postoperative requirements, grade 2 requires additional pharmacologic management or monitoring, grade 3 requires procedural intervention, grade 4 includes life-threatening medical problems, and grade 5 is death. Two reviewers blindly graded complications, and agreement was determined using Cohen kappa coefficient. Logistic regression assessed predictors of complications.

Results: A total of 160 patients were included: 112 (70.0%) women and 48 (30.0%) men. Sixty patients (37.5%) experienced a total of 67 complications. There were 25 (33.3%) grade 1, 12 (16.0%) grade 2, and 38 (50.7%) grade 3 complications. The most common complications were removal of hardware (22.7%), wrist injections (17.3%), and hand or wrist stiffness (9.3%). Blinded grading demonstrated near-perfect intra- and interrater agreement, with kappa coefficients of 0.95 to 0.97 and 0.87 to 0.95, respectively. Regression analysis revealed that longer surgeries, moderate Charlson Comorbidity Index, above-median age, and use of general anesthesia were predictive of complications.

Conclusion: The mCD-DR identified an overall complication rate of 37.5% following distal radius ORIF, with grade 3 complications being the most common. Near-perfect agreement was observed among raters, demonstrating the reliability of the scale for classifying complications following distal radius ORIF.

Background: We present a series of cases in which the induced membrane technique (IMT) was used to treat segmental bone defects from trauma and chronic infection nonunion in the hand and upper extremity. The aims of the study were to present the rates of union and complications using this technique.

Methods: Our institutional database was queried between 2012 and 2018. Patients who met the inclusion criteria with segmental defects either from acute trauma or chronic infection nonunion were included in the study. A retrospective review of their charts was performed documenting patient demographics, size of bone defect, time to union, mechanism of injury, and postoperative complications.

Results: A total of 13 patients met the inclusion criteria, and their individual charts and operative notes were reviewed. Eleven patients had acute traumatic bone loss, and the remaining 2 patients were treated for postoperative chronic infection nonunion as confirmed with positive cultures taken at the nonunion site. Rate of union after the index procedure was 84.6%, and average time to union was 14 weeks. The mean bone defect length was 2.73 cm. 46.1% of patients had soft tissue defects and complications requiring additional procedures for soft tissue coverage.

Conclusion: The IMT is an alternative means of treating segmental bone defects in the upper extremity but can present with challenges resulting in persistent nonunion and complications with soft tissue reconstruction.

Background: The recent trend in administering postoperative oral corticosteroids has proven effective in alleviating pain and improving surgical outcomes for hand and upper extremity procedures. However, concerns persist regarding potential infection risks despite a lack of supporting evidence in the current literature. We propose that a 6-day regimen of low-dose postoperative oral corticosteroids is safe and does not increase the likelihood of surgical site infections (SSIs) in adult upper extremity surgeries.

Methods: A retrospective study of all adult patients who underwent clean, upper extremity surgery, including both soft tissue and hardware implantation cases, between November 2021 and November 2023, performed at a single institution were included in the study. Primary outcome measures were diagnosis of SSI by 14 days and 30 days. Categorical variables were compared using χ² tests, and continuous variables were compared using Wilcoxon rank-sum tests. A P value less than .05 was considered statistically significant.

Results: A total of 813 cases were included for analysis-196 received a 6-day course of postoperative oral steroids (methylprednisolone) and 617 did not. Both groups had similar SSI rates of 4.1% and 3.1%, respectively, with no statistical differences between the groups at any postoperative time. Subgroup analysis of patients diagnosed with an SSI identified no statistically different demographic factors or medical comorbidities when comparing patients who received postoperative oral corticosteroids versus those who did not.

Conclusions: Low-dose, postoperative oral steroid use following adult upper extremity surgery is safe and does not increase the risk of SSI. Further investigations with prospective studies on postoperative oral corticosteroids would prove advantageous.

Background: Revisionary digital amputations are often performed after partial or full traumatic digital amputation to minimize complications while preserving as much length and functionality as possible. Many surgeons attempt revisionary procedures swiftly after initial injury. The aim of this study was to investigate the effects of time from injury to surgery on rate of complications and reoperation in revisionary traumatic digital amputations.

Methods: This was a retrospective chart review of all patients undergoing revisionary digital amputation for initial traumatic amputation at a single hospital from January 1, 2007 to December 31, 2021. Demographics, comorbidities, surgical details, complications, and time from injury to surgery were collected. Five-factor modified fragility index scores were also computed for each patient. Primary outcomes of interest included complications and need for additional procedures. Secondary outcomes of interest included development of neuroma, phantom limb, and referral to a long-term pain specialist.

Results: A total of 97 patients were identified as meeting all inclusion criteria. The average time to surgery was 14.4 days. Body mass index, comorbidities, and time to surgery were not associated with increased risk of complication. Increasing time to surgery was not significantly associated with increased risk of complications, development of neuroma, phantom limb, or a referral to long-term pain service. The only factors which were significantly associated with reoperation were absence of diabetes and hypertension.

Conclusion: Increasing time to surgery after initial injury was not significantly associated with increased risk of complications or reoperation. Surgeons should consider this when assessing urgency of surgery in patients after traumatic digital amputation.

The diagnosis and optimal management of radial tunnel syndrome (RTS) is controversial with little consensus among the many possible pathophysiological mechanisms and surgical approaches. Thus, we performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on studies reporting outcomes of surgical treatment for RTS. PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases were queried. Patient demographics, surgical approach, intraoperative findings, postoperative patient-reported outcomes, and complications were recorded and synthesized. We included 11 studies comprising 401 upper extremities (381 patients). Of the included forearms, 54% (n = 155) were approached dorsally, and 46% (n = 130) were approached volarly. Studies that utilized a dorsal approach between the extensor carpi radialis brevis and extensor digitorum communis had the most favorable Roles and Maudsley scores and patient satisfaction when compared with volar approaches. However, volar approaches identified a greater number of constrictions at the arcade of Frohse (19% vs 7%) when compared with dorsal approaches. Wide variability of surgical approaches used for treatment of RTS is present in the literature. Compared with volar approaches, dorsal approaches are associated with favorable reported outcomes. However, in RTS secondary to vascular constriction, volar approaches may be better suited for release.

Diagnostic suspicion of Chiari I malformations (CM-I) can be challenging in the pediatric population due to highly variable neurologic symptoms and cognitive immaturity impairing symptom identification. Especially in an atypical presentation without obvious central neurological abnormalities, the diagnosis can often be missed. We present a case of a left-hand-dominant 14-year-old boy presenting to an orthopedic hand clinic with right-hand weakness, tingling, and impaired grip strength. The medical history was notable for mild scoliosis and acute lymphoblastic leukemia in remission treated with chemotherapy. The patient denied headaches, neck pain, or balance dysfunction on initial presentation. Neurodiagnostic studies were consistent with C7 and C8 radiculopathies, and magnetic resonance imaging of the brain and entire spine revealed herniation of the cerebellar tonsils with expansive syrinx extending into the lower thoracic spine. After successful posterior fossa decompression, upper extremity strength and hand clawing improved, which was corroborated with postoperative imaging. The patient met his physical therapy goals 6 months after surgery. A thorough history and neurologic examination are essential for earlier detection of pediatric CM-I and a favorable prognosis, particularly in patients with an unclear neurologic cause.

Background: Although it is well established that antibiotic prophylaxis is not needed in soft tissue upper extremity cases, there is still no definitive consensus when hardware implantation is involved. We hypothesize that antibiotic prophylaxis is not necessary and there is no difference in postoperative surgical site infection rates regardless of preoperative antibiotic administration.

Methods: A retrospective cohort analysis was performed on upper extremity surgical cases with hardware implantation performed at a single institution amongst 5 hand surgeons between November 2021 and November 2023. Implants included plates, screws, Kirschner wires, and suture anchors. Primary outcome measures were diagnosis of surgical site infection by 14 and 30 days postoperatively. Secondary outcomes included the type of management used to treat infection. Categorical variables were compared using Fisher exact test, and continuous variables were compared using Wilcoxon rank-sum test.

Results: A total of 232 patients were included for analysis-152 received antibiotic prophylaxis and 80 did not. There were no differences between the 2 groups in terms of demographic factors, comorbidities, or smoking status. There was no difference in infection rates between the group who received antibiotic prophylaxis and the group who did not. Infection rate in the antibiotic prophylaxis group was 4.6% and in the sans antibiotics group was 2.5%. All infections were treated with antibiotics, and there were no differences in the rates of operative washout and hardware removal between the 2 groups.

Conclusions: Antibiotic prophylaxis is not necessary in upper extremity surgical cases even when implantation of hardware is involved.

Background: Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement.

Methods: The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution's central sterilization processing (CSP) department.

Results: Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2).

Conclusions: Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.