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Background: Sarcoma management guidelines in the extremities have been developed based on grouped averages, which are weighted toward lower extremity sarcomas. However, sarcomas in the forearm, wrist, hand, and fingers present unique management challenges given proximity to neurovascular structures and smaller presenting size. This study aims to describe the presenting characteristics of upper extremity sarcomas evaluated at our tertiary referral hospital from 2015 to 2022.

Methods: Pathology reports from 7888 upper extremity specimens were retrospectively reviewed, yielding 119 sarcoma entries belonging to 72 patients. Operative and clinic notes, pathology reports, and radiographic images were reviewed. Baseline demographic variables (age, sex, race) and tumor-specific characteristics were collected for all 72 patients. Survival characteristics (tumor recurrence, presence of metastasis) were collected for patients with a minimum of 6 months of follow-up.

Results: The most common upper extremity sarcomas were undifferentiated pleomorphic sarcoma (21/72, 29%) and myxofibrosarcoma (17/72, 24%). Sixteen of 44 patients (36%) developed metastasis, and 14 of 44 patients (32%) developed local recurrence. Eight of 16 patients who developed metastases presented with tumor sizes less than 5 cm, and 9 of 14 patients who developed recurrence presented with tumor sizes less than 5 cm. Size of tumor at presentation was neither statistically associated with metastasis (P = .82) nor with recurrence (P = .28).

Conclusions: Upper extremity sarcomas are a heterogeneous group of highly aggressive tumors. Current biopsy guidelines in sarcoma surveillance may not capture a majority of sarcomas in the upper extremity given the high frequency of small dimensions and indolent symptoms in even high-grade lesions.

Background: Successful trapeziometacarpal (TM) joint arthroplasty depends heavily on bone quality, particularly of the trapezium, where cup loosening remains a leading cause of implant failure. While dual-energy x-ray absorptiometry measures bone mineral density (BMD), it lacks regional specificity. Computed tomography (CT)-derived Hounsfield units (HU) offer quantitative, site-specific bone density estimation and may serve as a surrogate for BMD in preoperative planning. This study investigated the relationship between CT-derived HU values and tactilely perceived bone hardness of the trapezium to evaluate HU as a reliable predictor of bone quality.

Methods: Ten embalmed Body Donor hands were scanned using a Philips Spectral CT 7500 scanner. Bone segmentation and density analyses were conducted in 3D Slicer software, focusing on trabecular regions of the trapezium (proximal, ridge, and submetacarpal) and the first metacarpal (proximal, medial, and distal). Hounsfield unit values were converted to density (g/cm³) using validated equations. An experienced anatomist assessed trapezium hardness ("soft" or "hard") using bone forceps. Correlations between HU values, bone volume, and perceived hardness were analyzed using Pearson correlation coefficient.

Results: The mean trapezium HU was 354 (682.88 g/cm³), with regional trabecular variation: proximal 160.7 HU, ridge 286.5 HU, submetacarpal 241.7 HU. The first metacarpal demonstrated broader density variation (-285.8 to 228.8 HU). Hounsfield unit values correlated significantly with perceived hardness (r = .71, P = .02), whereas bone volume showed no correlation (r = .08, P = .82). Male trapezia displayed higher HU and density (472.7 ± 89.8 HU; 740.9 ± 44.0 g/cm³) than females (436.1 ± 87.2 HU; 723.0 ± 42.7 g/cm³).

Conclusions: Computed tomography-derived HU values strongly correlate with perceived bone hardness and provide an objective surrogate for assessing bone quality in TM joint arthroplasty. Incorporating preoperative HU assessment may guide implant selection and fixation strategies, reducing trapezium cup loosening and implant failure.

Background: Acutely performed proximal row carpectomy (PRC) is a viable alternative to open reduction internal fixation for perilunate and/or lunate dislocations, offering comparable outcomes with fewer postoperative complications. Studies report good motion, low complication, and reoperation rates. However, limited research exists on acute PRC for perilunate dislocations (PLDs), warranting further investigation into its functional outcomes.

Methods: A retrospective chart review was conducted on adult patients who underwent acute PRC for PLDs and perilunate fracture-dislocations (PLFDs) at a single institution (2010-2022). Inclusion criteria encompassed patients aged above 18 years with perilunate or lunate dislocation/fracture-dislocation treated with PRC within 21 days post-injury, among other criteria. Fourteen patients met our inclusion criteria. Patient-reported outcomes (PROs) were collected through phone surveys and final clinic visits, using Patient-Rated Wrist Evaluations (PRWEs), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), visual analog scale (VAS) pain scores, and return-to-work statuses. Surgical approaches, patient demographics, and injury characteristics were analyzed.

Results: In our cohort (average age 49.4 years), injuries were due to motor vehicle collisions (57%) and falls (43%). Proximal row carpectomy was performed within an average of 5.6 days post-injury, and patients were contacted an average of 68.0 months post-surgery. Return-to-work rates were favorable, with 35.7% returning without restrictions and 35.7% with restrictions. Patient-reported outcomes, encompassing VAS (1.31), QuickDASH (20.5), and PRWEs (24.5), demonstrated favorable results.

Conclusions: This study provides novel insights into the outcomes of acute PRC for perilunate and lunate dislocations, expanding on limited existing literature. It highlights PRC as a viable intervention for PLDs and PLFDs, demonstrated by substantial return-to-work rates and positive PROs.

Background: Regaining hand and upper extremity function is a functional priority for patients with cervical spinal cord injuries (SCI). Despite the high demand for upper extremity reconstruction (UER) to restore function, the utilization of these procedures remains low. This study evaluates the incidence and timing of UER in patients with cervical SCI.

Methods: The TriNetX Research Network was queried to identify patients with cervical SCI. Then, we identified patients who underwent procedures to restore motor function (nerve transfer, tendon transfer, tenodesis, or arthrodesis) and procedures to treat spasticity and contractures (neurectomy, tendon lengthening, or tenotomy) using International Classification of Diseases, 10th Revision, Current Procedural Terminology, and Systematized Nomenclature of Medicine codes. Baseline characteristics were compared between patients who received UER and those who did not. Propensity score-matched analysis was used to compare UER rates between sex and racial groups.

Results: Among 117 401 patients with SCI, only 0.8% of those with cervical SCI underwent UER, with higher utilization among patients with low cervical (C5-C8) and complete injuries. Tendon and joint procedures were more commonly performed than nerve procedures for both motor restoration and spasticity management. Nerve transfers were typically performed earlier post-injury than tendon procedures. Patients who received UER were significantly younger and more likely to have complete SCI, higher rates of psychiatric comorbidities, and lower prevalence of diabetes than those who did not undergo UER. Although overall UER rates did not differ significantly by sex, male and White patients were more likely to receive nerve-related procedures.

Conclusions: Less than 1% of cervical SCI patients underwent any form of upper extremity reconstructive procedures. Significantly more tendon procedures were performed compared with nerve procedures to both treat spasticity and restore motor function. Patients of White race and male gender were more likely to receive nerve-related UER procedures.

Background: The optimal surgical approach for Preiser disease, a rare avascular necrosis of the scaphoid, remains unclear. Our institution employs a stage-based strategy: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early disease (Herbert classification stages 1-2) and proximal row carpectomy (PRC) for advanced disease (stages 3-4). This study evaluates this stage-based surgical approach.

Methods: We retrospectively analyzed 8 patients (mean age: 60.6 years) who underwent surgical treatment for Preiser disease between 2000 and 2019. Preoperative evaluation included Herbert and Kalainov classifications. Outcome measures included the range of motion (ROM), grip strength (GS), pain (numeric rating scale [NRS] score), Modified Mayo Wrist Score (MMWS), and radiological parameters. Mean follow-up was 50 months.

Results: Five patients had stage 2, 1 had stage 3, and 2 had stage 4 disease. Seven patients were treated according to our strategy; 1 stage 4 patient deviated. In those treated per protocol, the VBG/CRWO group (n = 5) and the PRC group (n = 2) showed improvements across all clinical outcomes. Despite clinical gains, radiographic disease progression occurred in 4 of the 5 patients in the VBG/CRWO group. The patient treated outside the standard approach experienced clinical deterioration and developed dorsal intercalated segment instability deformity.

Conclusion: Our stage-based surgical strategy for Preiser disease yields favorable clinical outcomes. While radiographic progression may occur regardless of treatment, clinical improvements are generally maintained when procedures are appropriately selected based on disease stage.

Background: There is no clear consensus regarding optimal surgical management of Bennett fractures of the thumb carpometacarpal joint. We aimed to assess the initial displacement of such fractures and directly compare the stability of 2 different Kirschner-wire (K-wire) fixation constructs, hypothesizing that both constructs would confer substantial stability and that a pin crossing the fracture site would be more resistant to subsidence at the joint than suspensory fixation alone.

Methods: Bennett fractures were recreated using a sagittal saw in 8 paired fresh-frozen cadaveric specimens. Axial subsidence was then measured under a 100 N load of applied force. Specimens were then assigned to one of two 0.064" K-wire fixation methods: (1) an intermetacarpal suspensory method with 2 parallel K-wires between the diaphyses of the first and second metacarpals; and (2) an interfragmentary pin directly spanning the fracture site at the base of the first metacarpal with a second suspensory intermetacarpal pin. Specimens were then tested with cyclic loading to 25 N, 50 N, and 100 N. Axial subsidence between the two fragments was measured followed by paired statistical analysis.

Results: The average axial subsidence of the fractures prior to fixation was 3.1 mm. There was less subsidence for the fracture-spanning fixation at 25 N and 50 N compared to suspensory fixation (P = .0156 and P = .0078, respectively) but no difference at 100 N (P = .37).

Conclusion: Bennett fractures without fixation demonstrate clinically significant step off greater than 2 mm indicating a benefit from operative fixation. Both percutaneous K-wire fixation methods conferred acceptable stability, with interfragmentary fixation providing increased stability at lower loads.

Traumatic dislocation of the thumb carpometacarpal (CMC) joint is relatively rare. Although there are scattered reports of such dislocations, they are all in the dorsoradial direction. We report a very rare case of an ulnar dislocation of the CMC joint of the thumb. The patient fell while on a motorcycle and was presented with an ulnar dislocation of the CMC joint of the left thumb. Manual reduction failed to provide stability, and surgery was performed. The CMC joint was temporarily wired, and the posterior oblique ligament and dorsoradial ligament were repaired with a suture anchor. One year after surgery, the CMC joint was stable and pain-free.

Background: Social determinants of health greatly influence medical outcomes. The Area Deprivation Index (ADI) assesses socioeconomic disparities. This study evaluates the impact of geographic socioeconomic disadvantage on the time to scaphoid open reduction and internal fixation (ORIF).

Methods: A retrospective chart review from 2012 to 2023 analyzed time to surgery (TTS) with 21- and 28-day cutoffs (TTS₂₁ and TTS₂₈). Patients were categorized into highest (ADI_high) and lowest (ADI_low) national ADI quartiles. Logistic regression and proportional hazards models were built to determine whether ADI status affected time to surgery. The impact of age, sex, race, ethnicity, insurance status, and medical comorbidities on TTS was also assessed.

Results: Among 116 patients (83% male, 17% female), the average TTS was 20.8 ± 27.1 days. For TTS₂₁, mean TTS_≤21 was 8.9 ± 5.2 days versus TTS_>21 was 52.1 ± 35.3 days (P < .05). For TTS₂₈, mean TTS_≤28 was 10.5 ± 6.9 days versus TTS_>28 was 62.7 ± 36.6 days (P < .05). ADI_low and ADI_high quartiles had 30 patients each, with average TTS of 23.1 ± 34.3 and 19.3 ± 25.0 days, respectively, with no significant difference (P = .18).

Conclusion: Significant surgical delays occur when scaphoid ORIF is performed after 21- or 28-day post-injury. Although geographic disadvantage was not identified as a risk in this study due to small sample size, future studies could help clarify the utility in ADI integration into electronic records to identify at-risk patients for more timely surgical intervention.

Background: Chronic scapholunate instability can be treated with the all-dorsal scapholunate augmented reconstruction This study examined the mid-term outcome of a multicentre series of this technique.

Methods: Patients with chronic symptomatic scapholunate instability that underwent surgical treatment were included. Patients with wrist arthritis were excluded. Assessment consisted of clinical (range of motion, grip strength, pain), functional (Disabilities of the Arm, Shoulder and Hand [DASH] score; Patient-Related Wrist Evaluation [PRWE] score and patient satisfaction), and radiographic measurements (scapholunate distance, scapholunate angle, radiolunate angle, capitolunate angle, dorsal scaphoid translation, and drill hole diameter).

Results: Eighteen consecutive patients were included. The mean age was 44.4 years, and the mean follow-up was 4.2 years, with a minimum of 2 years. Five patients (27.8%) were unavailable for final follow-up due to revision surgery caused by recurrent symptomatic instability. Compared to the contralateral side, the mean postoperative flexion was 60.6%, extension 66.5%, and grip strength 62.0%. Postoperatively, the mean visual analogue scale pain score was 2.5, mean DASH score 17.9, and mean PRWE score 26.0. Postoperative radiographic parameters did not differ significantly from preoperative values. However, an increased dorsal scaphoid translation and scapholunate and capitolunate angle were observed in the cohort requiring revision. Postoperatively, 59% of drill holes significantly increased in size during follow-up. Radiographic bone collapse of the scaphoid or lunate was observed in 3 patients (16.8%).

Conclusions: Our mid-term study showed a high overall failure rate of 44.4% for the all-dorsal scapholunate augmented reconstruction. Failure occurred more in patients with higher degrees of scapholunate instability. The remaining patients had good clinical and functional outcomes.

Rigid plaster casting and functional bracing are the 2 most commonly used methods for conservative immobilization in Colles fractures. Despite their widespread use, the optimal approach remains debated. A systematic literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar up to April 2025. Six randomized controlled trials involving 697 adult patients were included. Assessed outcomes included Visual Analogue Scale pain scores, modified Gartland and Werley functional scores, grip strength measured as a percentage of the uninjured side, modified Lidström anatomical scores, dorsal angulation, and complication rates including re-manipulation, nerve injury, complex regional pain syndrome (CRPS), upper limb dystrophy, swelling, and other adverse events. Pain scores were similar between groups at 2 and 6 weeks. Functional outcomes favored the bracing group, with significantly better scores at 12 weeks, and grip strength was also higher at 6 weeks. Bracing was associated with significantly better anatomical outcomes, as evidenced by lower dorsal angulation and better modified Lidström scores at 6 weeks, along with similar re-manipulation rates between 1 and 2 weeks post-treatment. Complication rates, including nerve injuries, CRPS, and upper limb dystrophy, were also similar between groups, with the exception of a higher incidence of hand and finger swelling in the bracing group. Taken together, functional bracing offers modest but clinically relevant advantages over plaster casting in conservatively managing Colles fractures, promoting earlier recovery and better alignment without added risk. These findings support its use in selected adults.