Journal of Hand Surgery Global Online最新文献

{"title":"Impact on Families of Upper Extremity Surgical Treatment for Children with Cerebral Palsy","authors":"Sarah Romans MD ,&nbsp;Adam Mosa MD ,&nbsp;Lindley B. Wall MD, MSc","doi":"10.1016/j.jhsg.2025.100943","DOIUrl":"10.1016/j.jhsg.2025.100943","url":null,"abstract":"<div><h3>Purpose</h3><div>Upper-extremity surgery for children with cerebral palsy (CP) aims to address spasticity, improve function, and enhance quality of life. Although previous research has focused on functional outcomes, limited data exist regarding the broader impact of these surgeries on families. This study examines the psychosocial, functional, and familial impacts of upper-extremity surgery in CP patients, which in turn would to inform preoperative education and postoperative support strategies.</div></div><div><h3>Methods</h3><div>Parents/guardians of children with CP who underwent upper-extremity surgery at least 6 months prior were recruited. Participants completed the validated Impact on Family Scale survey and participated in semistructured interviews exploring family experiences. Thematic analysis of interview transcripts was performed, with intercoder reliability achieved through independent coding. Survey data were analyzed to identify common family impacts.</div></div><div><h3>Results</h3><div>Thirteen interviews were conducted (11 parents, two patients). Thematic analysis identified six overarching themes: (1) functional and mobility improvements, including range of motion; (2) independence in activities of daily living; (3) positive cosmetic impacts; (4) patient psychosocial outcomes, such as increased confidence and social engagement; (5) family-level psychosocial outcomes, including stress during recovery and the importance of external family support systems; and (6) interactions with the care team. Impact on Family Scale survey results had a mean score of 55.1 and revealed that psychosocial and financial burdens varied, with the highest agreement for statements emphasizing normalization of the child’s condition.</div></div><div><h3>Conclusions</h3><div>Upper-extremity surgery for CP has profound physical and psychosocial impacts on both patients and their families. Improvements in functional independence, confidence, and aesthetics were commonly observed; however, emotional challenges during recovery were notable. The findings underscore the importance of setting realistic expectations, providing robust preoperative education, and ensuring access to psychosocial support systems. Future studies should investigate longitudinal outcomes and interventions to better support families during the surgical journey.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100943"},"PeriodicalIF":0.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Clinical Research for Nerve Injuries (Nerve SPACE 2025)","authors":"Eliana B. Saltzman MD ,&nbsp;Daniel Y. Hong MD ,&nbsp;Roger Cornwall MD ,&nbsp;Heather L. Baltzer MD, MSc ,&nbsp;Thomas J. Wilson MD ,&nbsp;Jenny M. Dorich PhD, CHT ,&nbsp;Caroline Miller ,&nbsp;Avi M. Giladi MD, MS ,&nbsp;Paige M. Fox MD, PhD","doi":"10.1016/j.jhsg.2025.100939","DOIUrl":"10.1016/j.jhsg.2025.100939","url":null,"abstract":"<div><div>Because of the relative infancy of peripheral nerve injury research, there is a lack of standardization of nomenclature and language. The lack of consistency among researchers and publications leads to difficulties assessing outcomes and comparing across patients, surgeons, and interventions.</div></div><div><h3>Where Are We Now?</h3><div>Current efforts in nerve research are focused on determining appropriate-study outcomes and the validation of these for both physicians and patients to reflect the goals of care. Siloed efforts across multiple institutions and specialties limit progress.</div></div><div><h3>Where Do We Need to Go?</h3><div>Future efforts in peripheral nerve injury clinical research should focus on aligning multiple core outcome sets in a reproducible fashion across similar conditions while integrating the patient experience. As outcomes are being implemented, there is a need to measure them accurately using group consensus and technology to limit bias.</div></div><div><h3>How Do We Get There?</h3><div>Collaboration between experts through individual surgeons and societal efforts to align on a minimal core set of outcomes is paramount. Integration into the electronic medical record will increase the feasibility of surgeons to use these outcomes as both research and clinical tools.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100939"},"PeriodicalIF":0.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-Of-Pocket Expenses of Carpal Tunnel Release","authors":"Derrick W. Williams MD, MBA ,&nbsp;Philip Blazar MD ,&nbsp;Kyra A. Benavent BS ,&nbsp;Laura Byrne BS ,&nbsp;Brandon E. Earp MD ,&nbsp;Dafang Zhang MD","doi":"10.1016/j.jhsg.2025.100846","DOIUrl":"10.1016/j.jhsg.2025.100846","url":null,"abstract":"<div><h3>Purpose</h3><div>Out-of-pocket charges (OOPCs) are growing faster than the total cost of care. Carpal tunnel release (CTR) is performed in variable surgical settings under different anesthetic protocols. OOPC of CTR may impact patient choice and patient perception of the value of their insurance. The primary objective of this study was to identify factors associated with OOPC after CTR.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients who underwent CTR between January 1, 2019, and November 4, 2022 by three hand surgeons at a tertiary referral center in the Northeast United States. The final cohort comprised 808 patients. OOPC was defined as surgical and anesthesia fees billed to the patient for CTR surgery following primary and secondary insurance payment. Multivariable logistic regression analysis was performed to identify explanatory variables independently associated with our response variables.</div></div><div><h3>Results</h3><div>The mean age of the final cohort was 61.7 years, with 66% women, 79% White, and 100% insured. The multivariable logistic regression analysis showed protective factors against OOPC after CTR included Hispanic ethnicity and diabetes mellitus. Risk factors for having OOPC included no secondary insurance, procedure in a minor procedure room, and out-of-state residence.</div></div><div><h3>Conclusions</h3><div>As overall health care costs balloon, patients are bearing more financial responsibility for care. Our results may aid surgeons in shared decision-making discussions about modifiable surgical choices such as surgical setting and anesthesia choice.</div><div><em>Type of study/level of evidence</em>: Economic Analysis IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100846"},"PeriodicalIF":0.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural Lipoma of the Ulnar Nerve Within the Cubital Tunnel: A Brief Review of the Literature","authors":"J.J.E. Delahaije MSc ,&nbsp;J. van Boxtel MSc ,&nbsp;S.F.A. Raupp MSc ,&nbsp;E.L.W.G. van Haren MSc","doi":"10.1016/j.jhsg.2025.100889","DOIUrl":"10.1016/j.jhsg.2025.100889","url":null,"abstract":"<div><div>This study presents a case of a patient with a 6-month history of progressively worsening paresthesia, numbness, weakness, and shooting pain in the ulnar nerve distribution of the left hand. Ultrasound measurements showed an enlarged cross-sectional area of the ulnar nerve, confirming the diagnosis, and an isoechogenic and homogenous mass alongside the ulnar nerve. An open cubital tunnel release was performed for ulnar nerve decompression. Intraoperatively, a perineural lipoma was identified within the cubital tunnel and subsequently confirmed by histopathological analysis. Soft tissue lipomas rarely cause symptomatic compressive neuropathy. Although other space-occupying lesions within the cubital tunnel are well-documented in the literature, a perineural lipoma causing extrinsic ulnar nerve compression has not been previously reported. After surgery, shooting pain resolved, sensation normalized in digits four and five, and hand strength gradually improved. Therefore, we report the first case of a perineural lipoma extrinsically causing ulnar nerve compression in the cubital tunnel.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100889"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personality and Perception: A Qualitative Investigation of Factors That Shape Mentorship Satisfaction Among Hand Surgery Fellows","authors":"Colby Newson MD ,&nbsp;Steven Kozusko MD ,&nbsp;Ava Chappell MD ,&nbsp;Kacy J. Peek MD ,&nbsp;A. Bobby Chhabra MD ,&nbsp;Brent R. DeGeorge Jr. MD, PhD","doi":"10.1016/j.jhsg.2025.100922","DOIUrl":"10.1016/j.jhsg.2025.100922","url":null,"abstract":"<div><h3>Purpose</h3><div>Mentorship is critical to the professional and personal development of surgical trainees, influencing clinical competence and career advancement. Although mentorship during residency has been widely studied, little is known about mentorship experiences during hand surgery fellowship, a brief and high stakes training period requiring rapid relationship formation. This study explored mentorship experiences and satisfaction among hand surgery fellows and to assess how personality traits, demographics, and program factors influence mentorship quality.</div></div><div><h3>Methods</h3><div>A mixed-methods study was conducted across 10 US hand surgery fellowship programs with Institutional Review Board approval. Participants completed an online questionnaire assessing demographics, fellowship characteristics, mentorship satisfaction, and personality traits. Semistructured interviews were conducted, transcribed, and analyzed using inductive content analysis to identify common themes. Quantitative data were analyzed using descriptive statistics, Pearson correlations, and analysis of variance with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 10 fellows from 10 programs participated. Fellows valued personal mentor attributes (eg, altruism, honesty, patience) over relational and professional qualities and rated shared demographics as least important. Mentorship satisfaction showed nonsignificant trends: higher satisfaction among fellows who rated themselves as more emotionally stable and lower satisfaction among those scoring higher in openness to experience. Program structure showed similar trends, with greater satisfaction reported by fellows with more mentors and fewer cofellows. Qualitative analysis identified seven themes: (1) ideal mentor qualities, (2) organic relationship building, (3) mutual investment and communication, (4) diverse mentor expertise, (5) demographics and representation, (6) sponsorship beyond mentorship, and (7) dealing with time and other challenges.</div></div><div><h3>Conclusions</h3><div>Hand surgery fellows reported overall positive mentorship experiences and emphasized personal qualities over demographic similarity. Although quantitative associations were limited by sample size, trends suggest that personality traits and program structure may influence mentorship satisfaction. Recognizing these dynamics may help fellowship directors identify trainees at risk for poor mentorship alignment and implement early, targeted support within the 1-year fellowship’s limited timeframe.</div></div><div><h3>Type of study/level of evidence</h3><div>Differential diagnosis/symptom prevalence study IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100922"},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity Score-Matched Comparison of Ultrasound-Guided Versus Open Carpal Tunnel Release: Three-Month Outcomes From the MISSION Registry","authors":"Victor M. Marwin MD, MBA ,&nbsp;Christopher J. Lincoski MD ,&nbsp;Johnny T. Nelson MD ,&nbsp;James F. Watt DO ,&nbsp;Amy T. Moeller MD ,&nbsp;Paul E. Perry MD ,&nbsp;Nicholas A. Bontempo MD ,&nbsp;Steven R. Niedermeier MD ,&nbsp;Larry E. Miller PhD, PStat ,&nbsp;Kyle J. Moyles MD, MBA","doi":"10.1016/j.jhsg.2025.100931","DOIUrl":"10.1016/j.jhsg.2025.100931","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of the study was to compare the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR) in real-world clinical settings.</div></div><div><h3>Methods</h3><div>Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0–10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching.</div></div><div><h3>Results</h3><div>A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: −0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: −0.16 points), and pain severity (group difference: −0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%).</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon’s judgment.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100931"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant Use and Risk of Reoperation After Distal Radius Open Reduction and Internal Fixation: A Propensity Score-Matched Cohort Study","authors":"Firdavs Kurbanov BS ,&nbsp;Christopher Dussik MD ,&nbsp;Amy Phan MD ,&nbsp;Zion Rouege BS ,&nbsp;Danielle Wilbur MD ,&nbsp;Constantinos Ketonis MD, PhD","doi":"10.1016/j.jhsg.2025.100930","DOIUrl":"10.1016/j.jhsg.2025.100930","url":null,"abstract":"<div><h3>Purpose</h3><div>Antidepressant use is common and has been linked to impaired bone remodeling, but its effect on fracture healing after fixation remains unclear. The purpose of this study was to examine whether selective serotonin reuptake inhibitors (SSRIs) and, separately, agents that modulate serotonergic signaling but are not SSRIs (non-SSRI serotonergic antidepressants) were associated with unplanned return to the operating room (RTOR) after open reduction and internal fixation (ORIF) of distal radius fractures.</div></div><div><h3>Methods</h3><div>We performed a retrospective, propensity score-matched cohort study using TriNetX, a global federated research network that aggregates deidentified electronic health record data from large health care organizations. Adults who underwent surgery within 14 days of distal radius fracture diagnosis were included and the ORIF date served as the index. Two mutually exclusive exposure comparisons were analyzed: SSRI users versus nonusers and non-SSRI serotonergic users (serotonin-norepinephrine reuptake inhibitors), tricyclic antidepressants, serotonergic monoamine oxidase inhibitors, vortioxetine, or vilazodone versus nonusers, defined by ≥2 prescriptions in the 180 days preindex. Cohorts were balanced using 1:1 greedy nearest-neighbor propensity-score matching (caliper 0.10). The primary outcome was unplanned RTOR 30–365 days postindex, defined as nonunion repair or repeat fixation. We estimated absolute risk differences, risk ratios (RRs), and Cox hazard ratios (HRs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>After matching, 2,657 SSRI users and 2,197 non-SSRI serotonergic users were compared with equal numbers of nonusers. Unplanned RTOR occurred in 47 (1.8%) SSRI users versus 20 (0.8%) nonusers (ARD 1.0%, RR 2.35, HR 2.25; 95% CI 1.33–3.79). Non-SSRI serotonergic users had 52 events (2.4%) versus 14 (0.6%) in nonusers (ARD 1.7%, RR 3.71, HR 3.62; 95% CI 2.01–6.54). Findings were consistent across absolute risk comparisons and time-to-event analyses.</div></div><div><h3>Conclusions</h3><div>Preoperative antidepressant exposure to SSRIs or non-SSRI serotonergic agents was associated with a small but clinically relevant increase in unplanned reoperation after distal radius ORIF.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100930"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Dupuytren Contracture Recurrence After Surgery With Collagenase Clostridium Histolyticum: A Retrospective Multicenter Series","authors":"Clayton A. Peimer MD ,&nbsp;Marie A. Badalamente PhD ,&nbsp;Philip Blazar MD ,&nbsp;Keith A. Denkler MD ,&nbsp;William Dzwierzynski MD ,&nbsp;Mark Elzik MD ,&nbsp;F. Thomas D. Kaplan MD ,&nbsp;Jason A. Nydick DO ,&nbsp;Gary M. Pess MD ,&nbsp;James Verheyden MD ,&nbsp;Mark A. Vitale MD ,&nbsp;Jeffrey Andrews MS ,&nbsp;Qinfang Xiang PhD ,&nbsp;David Hurley MD ,&nbsp;Lawrence C. Hurst MD","doi":"10.1016/j.jhsg.2025.100919","DOIUrl":"10.1016/j.jhsg.2025.100919","url":null,"abstract":"<div><h3>Purpose</h3><div>Dupuytren contracture (DC) is a fibroproliferative disorder characterized by collagen deposition in the palmar fascia. Treatment options include collagenase clostridium histolyticum (CCH) injection and surgery; however, DC frequently recurs after primary therapy. We hypothesized that CCH treatment could be effective and well tolerated for the treatment of contracture recurrence for patients unwilling to undergo reoperation or at high risk for complications.</div></div><div><h3>Methods</h3><div>This Phase 4, multicenter, noninterventional, retrospective study analyzed medical records from 10 clinical centers in the US. Patients were treated with CCH for DC recurrence ≥6 months after previously successful surgical correction performed between January 1, 2010, and August 15, 2020. Primary end points were the measured joint contracture change from baseline, at first and last clinical evaluation within 12 months of CCH treatment of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. Secondary end points were “clinical success” (percentage of joints with reduction in contracture to 0° to 5°) and adverse events.</div></div><div><h3>Results</h3><div>Of 113 patients screened, 101 were analyzed (mean age, 64.1 years; 75% men). Median time to DC recurrence was 36.0 months. A total of 144 treated joints were analyzed (MP, <em>n</em> = 64; PIP, <em>n</em> = 75; unspecified, <em>n</em> = 5). Overall mean (SD) baseline contracture was 52° (21°) (MP, 43° [19°]; PIP, 61° [20°]). Mean (SD) improvement of contracture from baseline at last evaluation was 38° (21°) for all joints (MP, 36° [17°]; PIP, 41° [24°]), with 58% of joints having clinical success (MP, 75%; PIP, 43%). All skin tears (20 events in 19% of patients) resolved spontaneously, with 50% resolving in ≤21 days; there was one flexor profundus rupture that did not require secondary reconstruction.</div></div><div><h3>Conclusions</h3><div>This retrospective analysis indicates that CCH treatment is an effective and well tolerated nonsurgical option for recurrent postsurgical contracture, with results comparable to patients without prior surgery.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100919"},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Area Deprivation Index and the Time to Presentation of Scaphoid Fractures","authors":"Aidan M. Lynch BS, MS ,&nbsp;Muhammad H. Hamdan BS ,&nbsp;Jordan Bauer MD ,&nbsp;Rohan V. Rajan BS ,&nbsp;Rajendra Singh BS ,&nbsp;Joel V. Ferreira MD ,&nbsp;Anthony Parrino MD ,&nbsp;Craig M. Rodner MD","doi":"10.1016/j.jhsg.2025.100932","DOIUrl":"10.1016/j.jhsg.2025.100932","url":null,"abstract":"<div><h3>Purpose</h3><div>Scaphoid fractures are the most common carpal fractures and are prone to nonunion because of their retrograde blood supply. Delayed diagnosis or treatment increases the risk of nonunion and progression to scaphoid nonunion advanced collapse. Social determinants of health, measured by the area deprivation index (ADI), may contribute to such delays. This study examines the association between ADI, time to presentation, and the presence of nonunion at initial evaluation.</div></div><div><h3>Methods</h3><div>A retrospective chart review identified 168 patients with suspected scaphoid fractures between January 1, 2018 and June 30, 2025. State-level ADI scores were grouped into the following terciles: least-deprived (LDT), intermediately deprived (IDT), and most deprived (MDT). Patients presenting more than 5 years after injury or without confirmed fractures were excluded, leaving a total of 107 patients. Independent <em>t</em> tests compared the mean time from injury to presentation across ADI terciles, χ² tests compared the nonunion rates at presentation, and binomial regression assessed whether ADI predicted scaphoid nonunion.</div></div><div><h3>Results</h3><div>The mean time from injury to presentation increased with deprivation: LDT = 16.9 ± 23.5 days, IDT = 55.1 ± 97.9 days, and MDT = 173.5 ± 364.5 days. Both MDT and IDT patients presented significantly later than LDT patients (<em>P</em> = .0146 and <em>P</em> = .0315, respectively) and had a higher prevalence of nonunion at presentation (<em>P</em> = .025). The ADI independently predicted scaphoid nonunion, with each unit increase in state ADI associated with 23.8% higher odds of nonunion (<em>P</em> = .029).</div></div><div><h3>Conclusions</h3><div>Patients from socioeconomically deprived communities experienced significantly longer delays in presentation for scaphoid fractures and a higher incidence of nonunion, which may increase the risk of long-term complications such as scaphoid nonunion advanced collapse wrist arthritis. These findings highlight the importance of addressing neighborhood-level disparities to increase access to treatment in time-sensitive injuries such as scaphoid fractures.</div></div><div><h3>Type of study/level of evidence</h3><div>Prevalence IIIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100932"},"PeriodicalIF":0.0,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of Articular Surface Involvement During Intramedullary Fixation of the Phalanges","authors":"Julie Mekhail MS,&nbsp;Rhiana Rivas BS,&nbsp;Carolyn A. Ardizzone MD,&nbsp;Jordan P. Pearce MD,&nbsp;Nikalus G. Skipp BS,&nbsp;Deana M. Mercer MD","doi":"10.1016/j.jhsg.2025.100928","DOIUrl":"10.1016/j.jhsg.2025.100928","url":null,"abstract":"<div><h3>Purpose</h3><div>Phalangeal fractures of the hand are the second most common upper-extremity fracture in the United States. Numerous studies have reported on the biomechanical efficacy of intramedullary (IM) hand nail fixation of the phalanges and increased utilization of IM hand nails. During IM fixation, the nail often penetrates the articular cartilage during insertion. This study seeks to quantify the percentage of cartilage involvement created by anterograde and retrograde intramedullary fixation of proximal and middle phalangeal fractures with 3.0 mm and 3.5 mm IM threaded hand nails.</div></div><div><h3>Methods</h3><div>Thirty-two frozen fingers were studied from eight cadaveric hands. Four different techniques for nail placement were used: (1) retrograde across an unflexed distal interphalangeal joint, (2) retrograde across a flexed distal interphalangeal joint into the middle phalanx, (3) retrograde through a flexed proximal interphalangeal joint into the proximal phalanx, and 4) antegrade through the metacarpal phalangeal joint into the proximal phalanx. Clinical photographs and fluoroscopy images were taken for each specimen, and the articular cartilage damage was quantified using Image J software.</div></div><div><h3>Results</h3><div>The average articular involvement using intramedullary hand nails for phalangeal fixation was less than 10% of the articular surface regardless of nail placement technique and nail size (mean range 3.56% to 9.73%). The damaged area was always greater with the 3.5 mm than the 3.0 mm nails.</div></div><div><h3>Conclusions</h3><div>Our results are consistent with the literature. Our study is unique in that we compare the different methods of hand nail insertion and the different diameter hand nails and evaluate the degree of articular surface involvement in an approach that has not been tested on cadaveric models. Phalanx fracture fixation with intramedullary hand nails may be beneficial, as it has acceptable joint cartilage damage based on our study data.</div></div><div><h3>Type of study/level of evidence</h3><div>Bench research/laboratory study V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100928"},"PeriodicalIF":0.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}