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Background: 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: Wide-awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room. Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across 8 age groups was analyzed using a Cochran-Armitage test in R. Results: The overall infection rate was 6.2% (n = 59). All infections were superficial. Carpal tunnel had the highest number of infections (n = 25), followed by trigger finger (n = 8), and the combination trigger finger with carpal tunnel (n = 7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again. Conclusion: Wide-awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

Background: Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures.

Methods: We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain.

Results: We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, "I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion," which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains.

Conclusion: Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

Background: Patients face increasing financial toxicity (FT), defined as emotional distress due to the cost of medical treatment. However, little is known regarding FT in the context of upper extremity trauma.

Methods: We surveyed patients who sustained traumatic finger amputation (October 21, 2011-January 1, 2021). We collected patient-reported financial distress using the Comprehensive Score for Financial Toxicity (COST-11), where a lower score indicates worse FT. We also collected data of patients' perceptions regarding the costs of their treatment. We used linear regression to assess patient-level characteristics associated with FT as measured by the COST-11 score.

Results: Of the 191 eligible patients, 46 patients completed the survey (response rate of 24%). A total of 41 respondents (89%) received an initial treatment of revision amputation, with the remaining patients receiving a semi-occlusive dressing. Patients with commercial insurance had significantly lower COST-11 scores (ie, worse FT) than patients with Medicare (β = 7.5, 95% CI: 0.5 to 14.5) and Worker's Compensation (β = 8.7, 95% CI: 1.8 to 15.6). Patients who were single/never married had significantly worse FT (β = -11.3, 95% CI: -18.7 to -3.9). Approximately 35% (n = 16) reported that the costs were higher than expected. More than a third of patients (39%) reported decreasing spending on basic items, such as food, at least once since surgery.

Conclusion: Patients face FT when obtaining surgery following traumatic finger amputation. Variation in the FT is associated with type of insurance and marriage status, highlighting how underinsurance and social support likely affect the overall economic well-being of patients.

Background: The Linburg-Comstock (LC) anomaly is a common tendinous connection between the flexor pollicis longus and flexor digitorum profundus (FDP), most frequently to the FDP of the index finger. The purpose of this study was to obtain epidemiologic data on the LC anomaly in a healthy, ethnically diverse population and to study the effect of the LC anomaly on grip strength, tip pinch strength, key pinch strength, and chuck pinch strength.

Methods: We examined 500 healthy subjects (292 females and 208 males) bilaterally for the presence of the LC anomaly. Each subject had their grip strength, tip pinch strength, key pinch strength, and chuck pinch strength measured bilaterally using a dynamometer for grip strength and a pinch meter for all pinch strength measurements.

Results: The LC anomaly was present in 213 of the 500 subjects (43%). One hundred one subjects (47%) had a unilateral presentation, and 112 (53%) subjects had a bilateral presentation. The LC anomaly was associated with a weaker tip pinch strength. When examining the LC anomaly among different ethnic groups, the highest prevalence was found in the Hispanic (57%) population followed by Caucasian (50%), Asian (41%), and African American (31%) populations.

Conclusions: The LC anomaly has different prevalence according to ethnicity, with a higher prevalence in the Hispanic and Caucasian populations and a lower overall prevalence in the African American populations. The LC anomaly can also result in weaker tip pinch strength.

Background: The treatment of distal radius fractures may require manipulation of the fracture assisted by finger traction, causing pain both at the fracture site and at the fingers. The usual type of anesthesia used does not anesthetize the fingers.

Methods: We conducted a prospective cohort study with two groups, hematoma block (HB) and hematoma with associated median nerve block (MHB). Characteristic variables of the patients were collected. The main variable for the analysis was pain, measured using the Visual Analogical Scale (VAS). It was measured prior to the injection (VAS1), during fracture reduction (VAS2), and 30 minutes after the injection (VAS3) in both groups.

Results: The study included a total of 140 fractures (70 anesthetized with HB), 78% were women. There were no significant differences in the variables age, sex, Elixhauser index. and need for surgery between the groups. In the HB group, the VAS means were VAS1 5.23 cm (SD 2.31), VAS2 5.80 cm (SD 2.52), and VAS3 1.89 cm (SD 1.94); while in the MHB group, VAS1 5.13 cm (SD 2.36), VAS2 3.15 cm (SD 1.70), and VAS3 1.09 cm (SD 1.38). Area of greatest pain during fracture reduction in the HB group was finger traction in 78% cases (p < .05), while in the MHB group it was the manipulation of the fracture site in 71% cases (p < .05).

Conclusions: The study demonstrates that the use of hematoma with associated median nerve block decreases pain perception in patients with distal radius fracture that needs closed reduction, when compared to HB alone.

Background: Reconstructive options for high radial nerve injuries include tendon transfer (TT) and nerve transfer (NT), each with distinct advantages and limitations. This prospective, randomized clinical trial compared the outcomes of TT and NT in 21 patients with isolated radial nerve injuries.

Methods: Patients were randomly assigned to the NT group (11 patients) or the TT group (10 patients). Nerve transfer involved transferring the distal anterior interosseous nerve to the extensor carpi radialis brevis motor branch and the flexor carpi radialis motor branch to the posterior interosseous nerve. Tendon transfer used the Boyes tendon transfer technique.

Results: At an average follow-up of 20 months for NT and 15 months for TT, NT resulted in significantly better wrist flexion (51° vs 27°), wrist extension (54° vs 34°), metacarpophalangeal hyperextension (15° vs 8°), and thumb radial abduction (44° vs 37°). Nerve transfer also resulted in significantly higher muscle power grades for finger and thumb extension, with higher proportions of patients achieving grades M4+ and M5. Both groups showed significant improvements in Disabilities of the Arm, Shoulder, and Hand scores and grip strength, but with no significant differences between both groups. Tendon transfer offered faster functional recovery (4.30 ± 1.49 months) compared with NT (5.72 ± 1.34 months).

Conclusions: Nerve transfer provided better long-term muscle strength and range of motion, while TT allowed quicker rehabilitation. The choice between NT and TT should consider individual patient factors, balancing early functional recovery with long-term outcomes. Further studies with larger cohorts are recommended to validate these results and refine treatment guidelines.

Background: Carpal tunnel syndrome is common, and carpal tunnel syndrome-6 (CTS-6) is a validated diagnostic tool; however, its weighted scoring limits rapid use. We evaluated a simplified quick carpal tunnel syndrome-6 (QCTS-6) for diagnostic accuracy.

Methods: Carpal tunnel releases performed at a tertiary care center (January 2017-August 2024) were retrospectively identified. Preoperative presence or absence of the components of the CTS-6 were reviewed and assigned the corresponding number of points. For the QCTS-6 scoring system, 0 or 1 point was assigned for a total score out of 6. Preoperative electromyography (EMG)/nerve conduction study (NCS) results were collected when available. Descriptive statistics, Spearman's Rho correlations, and diagnostic ratio tests were performed.

Results: A total of 1143 patients met the inclusion criteria. There was a strong positive relationship between the CTS-6 and QCTS-6 scores for the overall cohort (r = 0.976). Patients with QCTS-6 score of 3 or more exhibited the presence of all questionnaire components and severe EMG/NCS findings at higher rates, with 98.2% of them having CTS-6 scores greater than 12. Diagnostic ratio testing identified numbness in the median nerve territory, nocturnal numbness, and loss of 2-point discrimination as the most balanced predictive factors.

Conclusions: The QCTS-6 scoring system can be a valid alternative to the traditional CTS-6. Owing to its uniform scoring, it can allow for efficient workup without necessitating EMG/NCS. A score of 3 or more may serve as a sensitive cutoff for carpal tunnel syndrome.

Background: Currently, there is limited literature that highlights the rate of reoperation or requiring additional corticosteroid injections following surgical trigger finger release. This study determined the incidence of additional corticosteroid injection or reoperation of the same digit in patients who underwent trigger finger release. Risk factors for requiring subsequent treatment in the same digit following trigger finger release were also identified.

Methods: This retrospective cohort study evaluated patients who underwent primary trigger finger release from 2015 to 2017. The incidence of further treatment with either steroid injection or reoperation of the same digit following trigger finger release was determined. Multivariate regression was performed to identify independent risk factors for requiring further treatment with injection or surgery.

Results: In total, 2.68% of patients required further treatment with either surgery or injection in the same digit following initial surgical release. Specifically, 0.76% of patients underwent reoperation while 1.92% required an additional injection. Multivariate regression demonstrated that releasing the index, middle, or multiple fingers during the initial trigger finger release was predictive of requiring further treatment.

Conclusions: The incidence of reoperation following trigger finger release is less than 1% of patients, which supports previous research. We also established the rate of injection in the same digit following surgery to be 1.92%. This study may provide valuable information for surgeons when communicating with patients about the necessity of additional treatment following trigger finger release. In addition, it can help patients understand the outcomes of surgical management for severe trigger finger symptoms.