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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: Cold intolerance following digital nerve injury burdens patients significantly. To better understand how cold intolerance evolves in the setting of digital nerve injuries, a sub-analysis of a trial comparing conduit-based (CONDUIT) and processed nerve allograft (PNA) repairs was conducted. It was hypothesized that PNA repairs would alleviate cold intolerance more effectively, especially for longer nerve gaps.

Methods: A multicenter trial across 20 US-based medical centers was undertaken of patients 18- to 69-year-old presenting with 5 to 25 mm digital nerve gaps within 24 weeks of injury. Patients were randomized (1:1) to PNA or collagen CONDUIT repairs. Cold Intolerance Symptom Severity (CISS) scores and sensory function testers were assessed at first patient visit (FPV), 1-, 3-, 6-, 9-, and 12-months post-surgery, with patients and assessors blinded to treatment.

Results: In total, 220 patients were enrolled, with 183 patients included in final analysis with ≥6 months follow-up. At the last evaluable visit (LEV), mean CISS score decreased from FPV for both PNA (from 31.2 ± 27 to 20.8 ± 19) and CONDUIT (from 31.2 ± 30 to 25.9 ± 24). On sub-analysis, more patients converted from severe/extremely severe cold intolerance to mild cold intolerance for PNA compared with CONDUIT at 1 month and LEV (P < 0.05). The CISS scores correlated significantly with sensory function testing.

Conclusions: Although no correlation was demonstrated with nerve gap size, digital nerve gap repaired with PNA had significantly improved cold tolerance outcomes for patients with more severe cold intolerance at FPV relative to nerves repaired with CONDUIT.

Background: This study aims to evaluate the readability, quality, and reliability of online resources about peripheral nerve surgeries to determine if they meet recommended literacy standards.

Methods: We analyzed a total of 137 peripheral nerve surgery website by performing a Google search using the search terms "nerve transfer," "nerve repair," "nerve graft," "nerve decompression," "neurolysis," "targeted muscle reinnervation," "regenerative peripheral nerve interface," and "vascularized denervated muscle target." The reading level of the website text was assessed using Simple Measures of Gobbledygook, Flesch-Kincaid, and Gunning Fog. Quality was evaluated using the DISCERN Instrument. Reliability was determined using the Journal of American Medical Association Benchmark Criteria.

Results: All the websites exceeded the sixth-grade reading level, with median readability scores corresponding to a high school reading level or above. Conceptually harder peripheral nerve surgeries such as targeted muscle reinnervation and regenerative peripheral nerve interface websites were generally written at a significantly higher reading level than conceptually easier surgeries such as nerve repair and nerve graft. The median quality of the websites was rated as poor, and the median reliability of the websites was rated as low.

Conclusions: The findings indicate that the current peripheral nerve surgery websites texts do not adhere to recommended reading levels and are constructed with poor quality and low reliability. This potentially hinders patients understanding and utilization of peripheral nerve surgeries, suggesting a need for standardized guidelines to enhance the accessibility of medical information online.

Background: Injuries sustained from dog leashes often result in visits to hand surgeons. This study presents an analysis of dog-leash-related upper-extremity injuries at a single orthopedic practice, including treatment options for these injuries, and guidance for prevention.

Methods: We identified all outpatients who presented to a hand surgeon at a single institution from 2016 to 2021 following an upper-extremity injury related to a dog leash. Charts were reviewed and demographics, injury description and mechanism, and details of treatment were recorded.

Results: We identified 443 patients that presented for a dog-leash-related injury. The average time from injury to outpatient visit was 23 days. Surgery occurred following injury in 96 patients (21.6%). The most common injury locations were the ring finger, followed by the wrist, third finger, and fifth finger. Interphalangeal joint sprain was the most common injury type followed by phalangeal fracture. The majority of injuries were caused by the extremity catching in the leash while being pulled (337, 75.9%). Among the 96 patients requiring surgery, open reduction and internal fixation was the most commonly performed procedure followed by closed reduction with percutaneous pinning. For patients not requiring surgery (348, 78.4%), splinting or bracing was the most common treatment recommended.

Conclusion: The majority of dog-leash injuries were caused by the patient's extremity catching in the leash as it was pulled, resulting in interphalangeal joint injures and phalanx fractures. The most common treatment required for these patients was nonoperative.

Recent literature has emphasized the role of hand surgeons in screening patients with carpal tunnel syndrome (CTS) for amyloidosis by performing a carpal tunnel synovial biopsy during open carpal tunnel release (CTR). This has led to misconceptions about the diagnostic utility of synovial biopsy and the clinical evaluation of suspected amyloidosis. Controversy over carpal tunnel biopsy is exacerbated by minimally invasive advances in CTR procedures. This current perspective aims to determine the role of carpal tunnel synovial biopsy in amyloidosis and provide an update for hand surgeons regarding the nuances of amyloidosis. We conclude that carpal tunnel synovial biopsy should not be performed without CTS symptoms but only in patients meeting criteria for open CTR such as in those with severe symptoms which have failed nonoperative treatment and minimally invasive procedures are contraindicated. A screening approach for amyloidosis is proposed in patients presenting with CTS symptoms. Despite advances in the understanding, treatment, and diagnosis of amyloidosis, there remains a need for accurate, specific, and sensitive diagnostic tests.

Introduction: The treatment for Kienböck disease varies widely based on the status of the lunate. To date, there is no consensus regarding the optimal treatment for patients with coronal plane fractures of the lunate, or Lichtman Stage IIIC. Therefore, the purpose of this study was to assess whether coronal plane fractures of the lunate in Kienböck disease healed after surgical intervention, and to determine the outcomes after surgical fixation of the lunate compared with treatment with salvage procedures.

Methods: A retrospective review of 36 patients with Lichtman IIIC Kienböck disease was conducted. Patients were classified into lunate reconstruction (vascularized bone graft [VBG] or non-VBG) or salvage procedures (proximal row carpectomy [PRC] or limited fusion). Preoperative and postoperative visual analog scale (VAS) pain, range of motion, grip strength, and Mayo Wrist Score (MWS) were analyzed. Radiographs and computed tomographic scans were reviewed for Lichtman stage, fracture location, union, modified carpal height ratio, Stahl index, and radioscaphoid angle.

Results: Thirteen patients underwent lunate reconstruction, 13 underwent limited fusion, and 10 underwent PRC. The overall union rate was 45% after lunate reconstruction, with average time to union of 7 months. There were no differences in union rates between VBG and non-VBG. All 3 groups experienced improvement in their postoperative grip strength and MWS. There were no statistically significant differences in preoperative to postoperative changes in clinical outcome measures between the 3 cohorts; however, when we compared lunate reconstruction with all patients who underwent salvage procedures (limited carpal fusion and PRC), we noted the latter had improved functional outcomes (P = .019). Four patients (31%) in the reconstruction cohort and 2 patients (8%) in the limited carpal fusion group required reoperation at latest follow-up.

Conclusions: Union rate of coronal plane fractures in Kienböck disease remains variable. While the proportion of patients requiring reoperation was higher in the reconstruction group, all groups of patients experienced improvement in their clinical outcomes, without a significant difference between cohorts.

Background: Peripheral nerve injuries (PNI) range from mild neurapraxia to severe transection, leading to significant morbidity. Despite their impact, the societal implications of PNI in the United States are not well understood. This study aims to systematically review the literature on PNI epidemiology in the United States. We hypothesize that this review will reveal significant gaps in the understanding of PNI incidence, demographics, and economic impact.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we queried the literature for studies on PNI that reported at least one of the following: incidence rates, demographics, affected nerve distribution, injury mechanisms, surgical intervention rates, and associated direct costs. Exclusion criteria included non-English publications, abstracts, conference proceedings, reviews, or editorials, studies published before 2000, non-US studies, or studies focusing solely on digital nerves or plexus injuries.

Results: Fifteen studies met the inclusion criteria. Data indicate a higher incidence of upper extremity nerve injuries compared with lower extremity injuries. The literature lacks comprehensive reporting on surgical intervention rates, with no recent data since 2013. There is a notable absence of nationwide epidemiological data on PNI mechanisms and recent cost data, with most information over a decade old and primarily focused on inpatient costs, neglecting outpatient visits, physical therapy, and medication expenses.

Conclusion: The epidemiological data on PNI are limited and outdated, highlighting the need for further research. Future studies should focus on recent trends in PNI incidence, injury mechanisms, and financial burden, including comprehensive reporting on surgical interventions, to inform strategies aimed at improving patient outcomes and health care resource allocation.

Reconstruction of metacarpal hands remains a challenging problem for hand surgeons. In this case report, we present a middle-aged female patient with bilateral Wei Type IIB metacarpal hands secondary to severe burn injuries following a motor vehicle accident. The patient underwent a 2-stage reconstruction with big, second, and third toes transfer in each hand to restore tripod pinch. Long-term follow-up demonstrated excellent functional outcomes, with independence with all activities of daily living and minimal donor site morbidity. This is the first report of a 2-stage 6 toe-to-hand transfer in a patient with bilateral metacarpal hands. Approaching this patient's reconstruction in only 2 stages allowed for a successful outcome with fewer operations and less surgical morbidity.

Background: The purpose of this study is to analyze the relationship between discharge opioids after operative treatment of carpometacarpal (CMC) arthritis and patient-reported outcomes (PROs) over a 6-month episode of care.

Methods: A total of 172 patients met inclusion criteria for this study. Patient-reported outcomes including patient-reported wrist/hand evaluation (PRWHE), single assessment numeric evaluation, and PRO measurement information system (PROMIS) global-10 questionnaires were collected prospectively and stored in an electronic data capture system until review for the purpose of this study. Morphine milligram equivalents (MMEs) were calculated using a Centers for Disease Control and Prevention-published opioid conversion table.

Results: Of the 172 patients who met inclusion criteria for this study, 121 (70.4%) were female. The average patient age on the day of procedure was 63.6 ± 7.4 years. All patients received a prescription pain medication upon discharge with an average of 191.3 MMEs (range: 40.00-800.00 MMEs) prescribed per patient. Overall, there was no correlation between the amount of pain medication prescribed in MMEs and change in PROs between baseline, 6-weeks, 3-months, and 6-months (r < .14).

Discussion: Surgeons should feel confident limiting postoperative opioid prescription for patients after CMC arthroplasty without jeopardizing outcomes.

Background: This study aimed to evaluate and compare the outcomes of proximal row carpectomy (PRC) with interposition arthroplasty using dorsal wrist capsule interposition, lateral meniscus allograft, or dermal allograft in patients with lunate facet/capitate degeneration.

Methods: Patients who underwent PRC with interposition arthroplasty between 2010 and 2022 at a single institution were identified. Preoperative and postoperative visual analog scale (VAS) pain, functional outcomes, and complications were recorded.

Results: Twenty-one patients (11 dorsal capsule, 6 meniscus, 4 dermal matrix) were identified with a mean follow-up of 65.8 months. Postoperative pain and functional outcome scores significantly improved. The mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 20.3. In total, 89.5% of patients returned to work, including 75% of manual laborers.

Conclusions: No significant differences were found between dorsal capsular flap versus allograft groups. Proximal row carpectomy with interposition arthroplasty is an effective motion-sparing procedure for patients with proximal capitate and/or lunate fossa arthritis, improving pain and function.