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Background: Barbed suture allows for a knotless tenorrhaphy, which could provide an expedient method of flexor tendon repair while limiting cross-sectional area (CSA) following repair.

Methods: Fifty-one cadaveric flexor digitorum profundus tendons were procured based on an a priori sample size estimate. Specimens were randomized to either one of three 6-strand repair techniques (3-0 braided polyester Savage repair, 2-0 strength polypropylene barbed suture repair, and 4-0 looped nylon M-Tang repair). Length of time to complete each repair and cost of material was recorded. The long and short axes of the repair site were measured to calculate the CSA. An Instron loaded the constructs to 2-mm gapping and load to failure. Differences between long and short axes and CSA prior to tenotomy and post-tenorrhaphy were measured and compared for change.

Results: Repair time for the Savage technique was significantly longer and provided significantly greater loads to 2-mm gapping and failure. Material cost with the Savage repair was significantly less than repairs with the other materials, whereas material cost with the barbed suture was significantly less than the material cost of the M-Tang repair. There were no significant differences between the 3 groups regarding change in long axis, short axis, or CSA measurements after repair.

Conclusions: The Savage repair provided the greatest strength, with a lower suture cost, but a greater repair time. Barbed suture repair performed similar to the M-Tang repair at a lower material cost.

Background: Digital nerve injuries resulting in gaps not amendable to direct coaptation are frequently reconstructed utilizing conduits or processed nerve allograft (PNA). Concurrent flexor tendon repair necessitates the incorporation of a postoperative rehab protocol. The effects of this early mobilization on digital nerve regeneration following PNA or conduit reconstruction are not known.

Methods: Patient data collected during the RECON study included static 2-point discrimination (S2PD) and Semmes-Weinstein Monofilament testing following digital nerve reconstruction for gap defects of 5 to 25 mm with either PNA or conduits. Additional data included concurrent procedures such as flexor tendon repair and participation in rehab protocols. Outcomes were compared with respect to concurrent flexor tendon repair across all reconstruction techniques.

Results: A total of 182 enrollees were included in analysis. Of these, 67 patients suffered concomitant flexor tendon and digital nerve injuries. Thirty-five and 32 of these patients received PNA and collagen conduits for their nerve repairs, respectively. For the patients that underwent tendon repair, S2PD was 6.8 mm in the PNA group and 8.1 mm in the conduit group. S3 + or better was achieved following 65.7% of the PNA and 71.9% conduit reconstructions in the flexor tendon repair group. A significantly lower percentage of conduit repairs achieved American Society for Surgery of the Hand classification normal and fair in patients with tendon injuries (50%) versus those without tendon injury (73.3%) (P = .038).

Conclusions: Following digital nerve gap reconstruction in a large multi-center prospective, randomized trial, concurrent flexor tendon repair with early mobilization may have compromised conduit efficacy.

Clinical trial registry: NCT01809002.

Background: To improve the surgical procedure and rehabilitation after surgery, a better understanding of the biomechanical properties of the 3 ligament tenodesis (3LT) procedure is necessary.

Method: This study examined elongation in relation to flexion, and type of failure after 3LT using 10 anatomic specimens, each wrist undergoing 5 tests.

Results: At 80° flexion mean elongation of the flexor carpi radialis (FCR) tendon slip was 0.96 ± 0.38 mm. Mean elongation of the dorsal intercarpal complex (DIC) was 3.75 ± 0.91 mm at 80° flexion. Relative elongation at the FCR tendon slip was 4.1% and 33.4% at the DIC. In 2 tests (4%), sutures loosened at the proximal side of the DIC after 30° flexion. Ruptures of the radiotriquetral ligament, pull-outs of the bone anchor or FCR tendon ruptures were not observed.

Conclusion: This experiment suggests that following 3LT, the most elongation occurs at the DIC. Since instances of failure were noted at the proximal aspect of the DIC, if early active motion protocols are used, it is recommended to initiate wrist flexion with a limitation to 30° wrist flexion.

Preaxial polydactyly (PPD) is characterized by a supernumerary finger or duplication of digital parts on the radial aspect of the thumb. There is a wide phenotypic variety among presentations of PPD. Numerous classification systems have been created to categorize these phenotypes. Here, we present a rare case of PPD that does not fit into any of the known classification systems. The patient was born with a large nonosseous PPD. The patient was treated successfully with sharp excision, and pathology confirmed the diagnosis of a soft-tissue-only supernumerary digit containing unique features of vascular proliferation and subepidermal bullae. While this case is the only one of its kind, similar cases have been reported in the recent literature. Therefore, we should consider implementing this PPD phenotype into a classification system to guide patient counseling, clinical decision-making, and management.

Background: Denervation of the carpometacarpal (CMC) joint has been described as a treatment to decrease pain and increase function for patients with base-of-thumb osteoarthritis. However, few short- to mid-term outcome studies have been conducted.

Methods: A prospective clinical trial was conducted on patients who received CMC denervation at our institution. Preoperative and postoperative evaluations were conducted on patients including evaluation of pain with the visual analogue score (VAS), functional outcomes via the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcome measure, quality of life with the EuroQol-5D (EQ-5D), and need for revision to CMC suspension arthroplasty.

Results: Eighty-seven CMC denervation procedures were performed in 77 patients. The average age of the study population was 66 years, with a range of 35 to 89 years. The median follow-up time was 2.8 years, with a range of 1.5 to 4 years. VAS pain scores improved from an average of 7.2 to 2.1, QuickDASH scores improved from 54.8 to 31.2, and EQ-5D scores improved from 0.40 to 0.68. Eighty-seven percent of patients reported improved hand function following denervation, and patients reported a 72% reduction in pain. Three of 87 (3.4%) denervation procedures were revised to a CMC arthroplasty procedure.

Conclusion: Carpometacarpal denervation appears to provide pain reduction and improvement in function and quality of life in short- to mid-term follow-up with a low need for revision to arthroplasty. A vast majority of patients saw improvement in hand function. Carpometacarpal denervation may offer lasting pain relief with quick return of function for patients suffering from base-of-thumb osteoarthritis.

A child was born with duplication of the right upper limb, including 2 humeri, radii, and a mirror hand. The child also had multiple cardiac anomalies that required early surgeries. Surgical removal of the supernumerary limb was successfully performed without complications. Due to the rarity of polymelia, this case highlights the importance of individualized and multidisciplinary approaches. It also emphasizes the role of detailed surgical planning, continuous follow-up, and psychological support in optimizing outcomes and quality of life.

Background: Currently, there is no consensus on the optimal surgical technique for scaphoid nonunion (arthroscopic vs open surgery). Open bone grafting is likely to result in better carpal alignment than arthroscopic bone grafting, but the clinical relevance of this issue is unclear. The aim of this retrospective study is to compare the clinical and radiological outcomes of arthroscopic versus open surgery for scaphoid nonunion.

Methods: A retrospective case-control study was conducted, assessing patients who underwent surgery for scaphoid nonunion between October 2015 and March 2023. Inclusion criteria were age over 18 years and no preexisting degenerative disease or severe concomitant injuries that would prevent standardized follow-up treatment. We compared range of motion, grip strength, complication rates, and reoperation rates. Based on radiological data, consolidation, incidence of posttraumatic osteoarthritis of the wrist, and changes in the length of the scaphoid axis and position in the carpus were assessed.

Results: After exclusion and matching, 42 of a total of 55 patients were included for comparative data analysis (22 in the arthroscopic and 20 in the open treatment group). Baseline patient characteristics were comparable in both groups. The mean operating time averaged 157 minutes (SD 19.74) for open surgery versus 151 minutes (SD 42.95) for arthroscopic approaches. There were no statistically significant differences between the two groups regarding wrist range of motion and grip strength at 3- and 12-month follow-up. The incidence of posttraumatic wrist osteoarthritis, complication and reoperation rates were comparable. Regarding consolidation, there was a statistically significant higher radiological consolidation rate after 3 months in the arthroscopic group compared to the open approach. Consolidation rates leveled out at the 12-month follow-up.

Discussion: The arthroscopic procedure demonstrates a valid alternative to the open method with comparable postoperative subjective outcomes (especially pain) and similarly satisfactory range of motion as well as strength measurements. Surgical time can be reduced using the arthroscopic approach, albeit an initial steep learning curve must be considered. Arthroscopic reconstructions are usually less painful and may be performed as an outpatient basis.

Conclusion: This study supports the use of arthroscopic reconstruction of scaphoid pseudarthrosis as it marks a time-efficient alternative to the current gold standard open approach without loss of function and faster time to consolidation.

Background: Complications of thumb basal joint arthritis surgery include surgical wound pain and cheiralgia paresthetica through involvement of the radial nerve superficial branch (RNSB). The aim of this study is to compare the risk of nerve injury between anterolateral and dorsal approaches to the first carpometacarpal joint (1CMCJ) by measuring the distance between the incisions and RNSB, recording crosses between them, and evaluating the density of skin nerve endings at incision sites.

Methods: In this descriptive study of 20 cryopreserved cadaver specimens, the anatomical distribution of the RNSB and its relationship with 1CMCJ anterolateral and dorsal approaches were determined by macro-dissection, and histomorphological analysis and digital imaging were used to measure cutaneous nerve ending density at the 1CMCJ and incision sites.

Results: In comparison to dorsal approach, the minimum distance from the RNSB was significantly shorter (1.30 ± 1.94 mm vs 3.70 ± 2.71 mm), and the total number (16.60 ± 8.50 vs 9.97 ± 7.51) and density (2.00 ± 0.83 vs 1.29 ± 0.77 mm²) of nerve endings were significantly higher with anterolateral approach. With the anterolateral approach, more nerve structures were observed in the distal versus proximal section of the incision, although the difference was only close-to-significant.

Conclusion: The incision is closer to the RNSB pathway with Wagner's anterolateral approach than with Gervis' dorsal approach, crossing with nerve branches in 50% of cases. The density of nerves is higher in the skin overlying the anterolateral versus dorsal aspect of the carpometacarpal joint. The risk of neuropathic wound pain after 1CMCJ surgery could be higher with the anterolateral approach, which should therefore be avoided.

Background: Thumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that causes pain and dysfunction, particularly in middle-aged and elderly individuals. Arthrodesis offers reliable pain relief and joint stability but is associated with a risk of pseudarthrosis depending on the fixation method. This study aimed to evaluate the clinical outcomes of thumb CMC arthrodesis using a headless compression screw (HCS) and locking plate with autologous bone grafting.

Methods: This retrospective case series included 17 patients (17 hands) who underwent thumb CMC arthrodesis between 2020 and 2022. The procedure involved curettage of the joint surface, bone grafting, fixation with an HCS, and dorsal locking plate. Postoperative outcomes were assessed using bone union rate, time to union, visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Kapandji score, grip strength, and pinch strength. All parameters were evaluated preoperatively and at 1-year follow-up.

Results: All patients achieved radiographic union (100%) with a mean time to union of 10.5 weeks. Median VAS improved from 70 to 6, and DASH score improved from 39.8 to 11.2. Kapandji score remained unchanged. Grip strength showed mixed results, with a median decrease but mean increase. Lateral-pinch and tip-pinch strengths improved significantly. No major complications such as pseudarthrosis or hardware failure were observed.

Conclusion: Thumb CMC arthrodesis using HCS, locking plate, and autologous bone grafting results in high union rates and substantial pain relief, offering a reliable technique particularly suited for patients with compromised bone quality.

Background: In 2020, collagenase clostridium histolyticum (CCH) was withdrawn from markets in Europe, Asia, and Australia for Dupuytren's contracture (DC). The impact of this withdrawal on US treatment patterns remains unclear. This study evaluates national trends in DC management across Medicare and Medicaid populations.

Methods: Using data from the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary, all DC-related procedure claims from 2012 to 2022 were identified using Current Procedural Terminology (CPT) codes for open partial palmar fasciotomy (26045), open fasciectomy (26121, 26123, 26125), percutaneous needle aponeurotomy (26040), and collagenase injection (20527). Claims were analyzed by year, provider type, and place of service, normalized per 100 000 total claims.

Results: Between 2012 and 2022, 189 142 procedures were recorded. Overall intervention rates increased by 36%, from 35.87 to 49.10 per 100 000 claims. Collagenase injections rose 269%, while open fasciotomy declined 26%. Open fasciectomy remained the dominant treatment, accounting for over 60% of procedures. Notably, fasciectomy with digital release (26123, 26125) increased, while isolated palmar fasciectomy (26121) decreased. Office-based procedures rose from 14% to 21%, while ambulatory surgical centers remained most common (46% in 2022). Orthopedic surgeons were the leading providers, though hand specialists saw the largest proportional increase.

Conclusion: Unlike international trends, US collagenase use continued to rise through 2022. Open fasciectomy remained primary, with a shift toward minimally invasive treatments and outpatient settings. Hand specialists are increasingly involved, though orthopedic surgeons lead in volume. These findings reflect evolving care models and highlight the need for continued monitoring of provider patterns and access to DC treatment.