Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100899
Liam H. Wong MD , Rosanna Wustrack MD , Nicolas Lee MD , Leah Demetri MD
Adamantinoma is a rare, malignant tumor that is typically seen in the tibia but has been reported in all long bones. We present the case of a woman who presented as a teenager with a pathologic fracture of the proximal ulna that was initially diagnosed as osteofibrous dysplasia and treated with internal fixation. After the lesion was identified in adulthood as adamantinoma, she was converted to a one-bone forearm procedure as a salvage treatment.
{"title":"Proximal Ulna Adamantinoma","authors":"Liam H. Wong MD , Rosanna Wustrack MD , Nicolas Lee MD , Leah Demetri MD","doi":"10.1016/j.jhsg.2025.100899","DOIUrl":"10.1016/j.jhsg.2025.100899","url":null,"abstract":"<div><div>Adamantinoma is a rare, malignant tumor that is typically seen in the tibia but has been reported in all long bones. We present the case of a woman who presented as a teenager with a pathologic fracture of the proximal ulna that was initially diagnosed as osteofibrous dysplasia and treated with internal fixation. After the lesion was identified in adulthood as adamantinoma, she was converted to a one-bone forearm procedure as a salvage treatment.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100899"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690934","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}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100898
Roshan V. Patel BS , Gnaneswar Chundi BS , David Mothy BS , Aayush Mehta BS , Tamara D. Rozental MD , Monica M. Shoji MD
Purpose
The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.
Methods
We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.
Results
A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.
Conclusions
There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.
{"title":"Where Are the Hand Surgeons? Examining the Socioeconomic and Geographic Gaps in Patients’ Access to Care in the United States","authors":"Roshan V. Patel BS , Gnaneswar Chundi BS , David Mothy BS , Aayush Mehta BS , Tamara D. Rozental MD , Monica M. Shoji MD","doi":"10.1016/j.jhsg.2025.100898","DOIUrl":"10.1016/j.jhsg.2025.100898","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.</div></div><div><h3>Methods</h3><div>We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.</div></div><div><h3>Results</h3><div>A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.</div></div><div><h3>Conclusions</h3><div>There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.</div></div><div><h3>Level of Evidence</h3><div>Cross-sectional study, III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100898"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690937","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}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100887
John R. Vaile MD , John A. Tipps BA , Rachel Hurley MD, PhD , Sarah L. Struble MD , Brooke E. Allen BS , Lea F. Surrey MD , Laura S. Finn MD , Frank M. Balis MD , Theodore W. Laetsch MD , Shaun D. Mendenhall MD
Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its NTRK fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.
{"title":"Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection","authors":"John R. Vaile MD , John A. Tipps BA , Rachel Hurley MD, PhD , Sarah L. Struble MD , Brooke E. Allen BS , Lea F. Surrey MD , Laura S. Finn MD , Frank M. Balis MD , Theodore W. Laetsch MD , Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2025.100887","DOIUrl":"10.1016/j.jhsg.2025.100887","url":null,"abstract":"<div><div>Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its <em>NTRK</em> fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100887"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690821","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}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100896
Alex G. Lambi MD, PhD, FACS , Tomas Holy MD , Ryan E. Tomlinson PhD , Mary F. Barbe PhD, FAAA, FASBMR
Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.
{"title":"Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options","authors":"Alex G. Lambi MD, PhD, FACS , Tomas Holy MD , Ryan E. Tomlinson PhD , Mary F. Barbe PhD, FAAA, FASBMR","doi":"10.1016/j.jhsg.2025.100896","DOIUrl":"10.1016/j.jhsg.2025.100896","url":null,"abstract":"<div><div>Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100896"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690935","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}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100891
Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD
There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.
{"title":"Temporary Dorsal Staple Fixation of Scapholunate Interosseous Ligament Repair and Reconstruction","authors":"Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD","doi":"10.1016/j.jhsg.2025.100891","DOIUrl":"10.1016/j.jhsg.2025.100891","url":null,"abstract":"<div><div>There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100891"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690823","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}
Pub Date : 2025-12-04DOI: 10.1016/j.jhsg.2025.100880
Evelyn Reed MD , Catherine Bautista MD , Mackenzie French MD , Alexandra Vitale BS , Candace Winterton BM, MM , Joanna Chen MD , Devin Eddington MS , Christopher Goodenough MD
Purpose
Pediatric fingertip injuries involving the nailbed are extremely common; however, there is no consensus on treatment protocols. The practice of repairing simple nailbed laceration injuries may result in overtreatment. The aim of this study was to identify variables that could predict which patients with nailbed lacerations might achieve equivalent outcomes with fewer procedural interventions.
Methods
A retrospective chart review was conducted at a single children’s hospital. Patients aged 0–18 years with nailbed injuries were included if they had an x-ray at the time of injury, at least one follow-up appointment, and no Seymour or Salter-Harris fractures. Descriptive statistics were generated. chi-square and Fisher exact tests were used to analyze categorical variables, and the Kruskal-Wallis test was used to analyze continuous variables.
Results
Two hundred thirty-nine patients were included in the study, accounting for 255 nailbed injuries. One hundred thirty-two were men (55%), 107 were women (45%), and the mean age at the time of injury was 6.1 years. The median follow-up was 15.1 days. One hundred eighty-two patients (71%) sustained a distal phalanx fracture. Outcomes were analyzed by the type of nailbed repair (removal and repair, trephination, and conservative). The analysis demonstrated no differences in infection rates among treatment groups: nailbed repair (3%), trephination (0%), and conservative (2.9%), and no difference in complication rates (0.5%, 0%, and 2.9%, respectively).
Conclusions
For simple nailbed injuries, patients had consistently good early outcomes irrespective of the intervention. Further study into long-term outcomes and a prospective investigation into conservative treatment of uncomplicated nailbed injuries are warranted.
Clinical relevance
These findings may alter practice management in the treatment of simple nailbed injuries. Simple nailbed injuries may be treated conservatively with similar rates of complication, thereby reducing the necessity for subspecialist involvement in these injuries, pediatric procedural sedations, and emergency room length of stay.
{"title":"Reevaluating Pediatric Nailbed Injuries: Are We Overtreating Simple Cases?","authors":"Evelyn Reed MD , Catherine Bautista MD , Mackenzie French MD , Alexandra Vitale BS , Candace Winterton BM, MM , Joanna Chen MD , Devin Eddington MS , Christopher Goodenough MD","doi":"10.1016/j.jhsg.2025.100880","DOIUrl":"10.1016/j.jhsg.2025.100880","url":null,"abstract":"<div><h3>Purpose</h3><div>Pediatric fingertip injuries involving the nailbed are extremely common; however, there is no consensus on treatment protocols. The practice of repairing simple nailbed laceration injuries may result in overtreatment. The aim of this study was to identify variables that could predict which patients with nailbed lacerations might achieve equivalent outcomes with fewer procedural interventions.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a single children’s hospital. Patients aged 0–18 years with nailbed injuries were included if they had an x-ray at the time of injury, at least one follow-up appointment, and no Seymour or Salter-Harris fractures. Descriptive statistics were generated. chi-square and Fisher exact tests were used to analyze categorical variables, and the Kruskal-Wallis test was used to analyze continuous variables.</div></div><div><h3>Results</h3><div>Two hundred thirty-nine patients were included in the study, accounting for 255 nailbed injuries. One hundred thirty-two were men (55%), 107 were women (45%), and the mean age at the time of injury was 6.1 years. The median follow-up was 15.1 days. One hundred eighty-two patients (71%) sustained a distal phalanx fracture. Outcomes were analyzed by the type of nailbed repair (removal and repair, trephination, and conservative). The analysis demonstrated no differences in infection rates among treatment groups: nailbed repair (3%), trephination (0%), and conservative (2.9%), and no difference in complication rates (0.5%, 0%, and 2.9%, respectively).</div></div><div><h3>Conclusions</h3><div>For simple nailbed injuries, patients had consistently good early outcomes irrespective of the intervention. Further study into long-term outcomes and a prospective investigation into conservative treatment of uncomplicated nailbed injuries are warranted.</div></div><div><h3>Clinical relevance</h3><div>These findings may alter practice management in the treatment of simple nailbed injuries. Simple nailbed injuries may be treated conservatively with similar rates of complication, thereby reducing the necessity for subspecialist involvement in these injuries, pediatric procedural sedations, and emergency room length of stay.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100880"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690936","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}
Pub Date : 2025-12-04DOI: 10.1016/j.jhsg.2025.100885
Gabriel Hanna MD , Robert Dalcortivo MD , Michael Vosbikian MD , Irfan H. Ahmed MD , Michael M. Abdou MD , Eli Bryk MD , Robert Pae MD
Purpose
Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures.
Methods
The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student’s t- test.
Results
A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0–15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80–1.80) or surgical (OR, 0.87; 95% CI, 0.65–1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0).
Conclusions
Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates.
Type of study/level of evidence
Prognostic III.
目的：脓毒性手腕关节炎是一种罕见的疾病，但它可以导致严重的发病率。脓毒性手腕关节炎的住院结果在关节镜治疗与开放关节切开术治疗的患者中存在有限的数据。我们研究的目的是比较这两种手术的再手术率和住院并发症。方法采用全国住院患者样本数据库，对2002年至2012年美国18岁及以上诊断为脓毒性手腕关节炎的患者进行识别。脓毒性关节炎病例根据治疗方式进行分类，包括关节镜治疗和关节切开术治疗的患者进行统计分析。在多因素logistic回归分析中调整年龄、性别、种族和合并症后，比较住院结果，包括再手术率、外科和内科并发症。使用学生t检验比较平均费用和住院时间。结果1065例化脓性手腕关节炎患者采用关节镜治疗（516例）或切开关节治疗（549例）。经关节镜治疗的患者再手术率更高（48.6% vs 8.7%）。通过多因素分析，接受关节镜治疗的患者更有可能接受重复关节镜手术（比值放射[OR]， 10.4; 95% CI, 7.0-15.3），尽管他们在发生内科并发症（OR, 1.20; 95% CI, 0.80-1.80）或外科并发症（OR, 0.87; 95% CI, 0.65-1.16）的风险方面没有差异。关节镜和关节切开术在住院时间（6.29±5.0 vs 6.26±4.5）和住院费用（33,563.4±30,296.3 vs 34,422.6±31,362.0）方面也没有差异。结论骨科医生在关节镜下处理脓毒性手腕关节炎患者时应注意再手术率的增加，并应与手术候选人讨论这一潜在风险。研究类型/证据水平预后
{"title":"Arthroscopy Versus Open Arthrotomy for Septic Arthritis of the Wrist: A Nationwide Inpatient Sample Analysis of 1,065 Cases","authors":"Gabriel Hanna MD , Robert Dalcortivo MD , Michael Vosbikian MD , Irfan H. Ahmed MD , Michael M. Abdou MD , Eli Bryk MD , Robert Pae MD","doi":"10.1016/j.jhsg.2025.100885","DOIUrl":"10.1016/j.jhsg.2025.100885","url":null,"abstract":"<div><h3>Purpose</h3><div>Septic arthritis of the wrist is an uncommon condition, but one that can result in substantial morbidity. Limited data exist on the inpatient outcomes of septic arthritis of the wrist among patients treated using arthroscopy versus open arthrotomy. The purpose of our study was to compare the reoperation rates and inpatient complications between these two procedures.</div></div><div><h3>Methods</h3><div>The Nationwide Inpatient Sample database was used to identify patients 18 years old and older with a diagnosis of septic arthritis of the wrist in the United States from 2002 to 2012. Septic arthritis cases were classified based on the treatment modality, and patients who were treated either arthroscopically or using arthrotomy were included in statistical analysis. Hospitalization outcomes, including reoperation rates and surgical and medical complications were compared after adjusting for age, sex, race, and comorbidities in multivariate logistic regression analysis. Mean costs and length of stay were compared using the Student’s <em>t</em>- test.</div></div><div><h3>Results</h3><div>A total of 1,065 patients with septic arthritis of the wrist were treated either arthroscopically (n = 516) or by open arthrotomy (n = 549). Patients who were treated arthroscopically had higher reoperation rates (48.6% vs 8.7%). Using multivariate analysis, patients who were treated arthroscopically were more likely to undergo repeat arthroscopic procedures (odds radio [OR], 10.4; 95% CI,7.0–15.3), although they were not different in terms of the risk of development of medical (OR, 1.20; 95% CI, 0.80–1.80) or surgical (OR, 0.87; 95% CI, 0.65–1.16) complications. Arthroscopy and arthrotomy also did not differ in terms of length of stay (6.29 ± 5.0 vs 6.26 ± 4.5) and inpatient hospital charges (33,563.4 ± 30,296.3 vs 34,422.6 ± 31,362.0).</div></div><div><h3>Conclusions</h3><div>Orthopedic surgeons should be aware of the increased rate of reoperation when managing patients with septic arthritis of the wrist arthroscopically and should discuss this potential risk with surgical candidates.</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 1","pages":"Article 100885"},"PeriodicalIF":0.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690939","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}
Pub Date : 2025-11-21DOI: 10.1016/j.jhsg.2025.100881
Elise S. McKenna , Nathaniel Co , Hanna Brancaccio , Blane Soper , Aryan Borole , Yuri Han , David Kirschenbaum MD , Brian M. Katt MD
Purpose
Trigger finger is a common hand condition often managed conservatively with splinting, which reduces pain and improves function by immobilizing the affected digit. Splinting is a viable alternative for patients wishing to avoid corticosteroid injections or surgery. Short-term studies suggest it effectively relieves symptoms; however, adherence can be challenging. This systematic review evaluates the short-term efficacy of splinting for trigger finger and aims to identify the most effective splint.
Methods
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered with the International Prospective Register of Systematic Reviews Registry. Six medical databases were queried, and studies screened using predetermined inclusion criteria. Relevant data were extracted and analyzed.
Results
Thirteen studies met criteria, investigating various blocking orthoses worn for 6 to 12 weeks. Splinting consistently reduced pain, stopped triggering, and improved function over the short term (within 1 year), with success rates up to 97%, comparable to corticosteroid injections but without risks like skin atrophy or infection. Regardless of splint type, splinting was most effective when worn 24 hours a day. Although the metacarpophalangeal joint blocking orthoses was the most studied orthotic, the proximal interphalangeal joint blocking orthoses (PIP-BO) outperformed the metacarpophalangeal joint blocking orthoses , providing more effective pain reduction and better functional outcome. Patients found the PIP-BO to be more comfortable and aesthetic, leading to greater wear time.
Conclusions
Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement. Although adherence may be challenging for some patients, splinting remains a valuable option for those seeking noninvasive management. PIP-BOs superior functional outcomes, patient satisfaction, and cost-effectiveness, leads our study to recommend a PIP-BO worn continuously for at least 6 weeks, if splinting is chosen as a first-line treatment. Further research is needed to explore long-term outcomes and standardize splinting approaches for broader clinical application.
{"title":"Efficacy of Splinting in Managing Adult Trigger Finger: A Systematic Review of Short-Term Outcomes","authors":"Elise S. McKenna , Nathaniel Co , Hanna Brancaccio , Blane Soper , Aryan Borole , Yuri Han , David Kirschenbaum MD , Brian M. Katt MD","doi":"10.1016/j.jhsg.2025.100881","DOIUrl":"10.1016/j.jhsg.2025.100881","url":null,"abstract":"<div><h3>Purpose</h3><div>Trigger finger is a common hand condition often managed conservatively with splinting, which reduces pain and improves function by immobilizing the affected digit. Splinting is a viable alternative for patients wishing to avoid corticosteroid injections or surgery. Short-term studies suggest it effectively relieves symptoms; however, adherence can be challenging. This systematic review evaluates the short-term efficacy of splinting for trigger finger and aims to identify the most effective splint.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered with the International Prospective Register of Systematic Reviews Registry. Six medical databases were queried, and studies screened using predetermined inclusion criteria. Relevant data were extracted and analyzed.</div></div><div><h3>Results</h3><div>Thirteen studies met criteria, investigating various blocking orthoses worn for 6 to 12 weeks. Splinting consistently reduced pain, stopped triggering, and improved function over the short term (within 1 year), with success rates up to 97%, comparable to corticosteroid injections but without risks like skin atrophy or infection. Regardless of splint type, splinting was most effective when worn 24 hours a day. Although the metacarpophalangeal joint blocking orthoses was the most studied orthotic, the proximal interphalangeal joint blocking orthoses (PIP-BO) outperformed the metacarpophalangeal joint blocking orthoses , providing more effective pain reduction and better functional outcome. Patients found the PIP-BO to be more comfortable and aesthetic, leading to greater wear time.</div></div><div><h3>Conclusions</h3><div>Splinting is an effective short-term conservative treatment for trigger finger, offering symptom relief and functional improvement. Although adherence may be challenging for some patients, splinting remains a valuable option for those seeking noninvasive management. PIP-BOs superior functional outcomes, patient satisfaction, and cost-effectiveness, leads our study to recommend a PIP-BO worn continuously for at least 6 weeks, if splinting is chosen as a first-line treatment. Further research is needed to explore long-term outcomes and standardize splinting approaches for broader clinical application.</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 1","pages":"Article 100881"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576948","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}
Pub Date : 2025-11-21DOI: 10.1016/j.jhsg.2025.100888
Dominic Alessio MD , Veronica Ortolan BA , Molly Harrod PhD , Erika D. Sears MD, MS
Purpose
Some variation in presurgical care is inevitable, yet it represents an understudied opportunity to improve the value and standardization of care leading up to surgery. This study aimed to explore differences in patients’ presurgical experiences and better understand the factors associated with this variation in care.
Methods
This qualitative study involved semistructured interviews with 24 patients receiving care for carpal tunnel syndrome at Veterans Affairs health care facilities, which had been previously stratified by levels of presurgical delay and resource utilization in a prior quantitative study. Interview transcripts were coded via thematic analysis to form an in-depth picture of veterans’ experiences and perspectives between these sites.
Results
Veterans at high delay/utilization sites more often described long-standing and severe symptoms which disrupted their quality of life, and were more likely to attempt alternative self-treatments. Once care had been established, these veterans reported variable and less well-defined pathways from diagnosis to treatment relative to low delay/utilization sites. Veterans across all sites expressed a desire for timely treatment and definitive outcomes.
Conclusions
Patients place high importance on efficient and timely presurgical care. However, there is noted variation in patient-reported experiences of their presurgical care correlating with previously quantified differences in the facilities at which these patients were treated. This variance in patient experience could be due to inconsistencies in provider–patient relationships and communication, care coordination, and lack of standardized pathways for diagnostic testing, referral, or ultimate treatment. Optimizing the presurgical interval and associated treatment pathways could have major impact on the lived experience of patients during presurgical care and may help providers and health systems better understand targets for future quality improvement initiatives.
{"title":"Patient Experience of Presurgical Care for Carpal Tunnel Syndrome Across Treatment Sites in the Veterans Affairs Health System: A Qualitative Analysis","authors":"Dominic Alessio MD , Veronica Ortolan BA , Molly Harrod PhD , Erika D. Sears MD, MS","doi":"10.1016/j.jhsg.2025.100888","DOIUrl":"10.1016/j.jhsg.2025.100888","url":null,"abstract":"<div><h3>Purpose</h3><div>Some variation in presurgical care is inevitable, yet it represents an understudied opportunity to improve the value and standardization of care leading up to surgery. This study aimed to explore differences in patients’ presurgical experiences and better understand the factors associated with this variation in care.</div></div><div><h3>Methods</h3><div>This qualitative study involved semistructured interviews with 24 patients receiving care for carpal tunnel syndrome at Veterans Affairs health care facilities, which had been previously stratified by levels of presurgical delay and resource utilization in a prior quantitative study. Interview transcripts were coded via thematic analysis to form an in-depth picture of veterans’ experiences and perspectives between these sites.</div></div><div><h3>Results</h3><div>Veterans at high delay/utilization sites more often described long-standing and severe symptoms which disrupted their quality of life, and were more likely to attempt alternative self-treatments. Once care had been established, these veterans reported variable and less well-defined pathways from diagnosis to treatment relative to low delay/utilization sites. Veterans across all sites expressed a desire for timely treatment and definitive outcomes.</div></div><div><h3>Conclusions</h3><div>Patients place high importance on efficient and timely presurgical care. However, there is noted variation in patient-reported experiences of their presurgical care correlating with previously quantified differences in the facilities at which these patients were treated. This variance in patient experience could be due to inconsistencies in provider–patient relationships and communication, care coordination, and lack of standardized pathways for diagnostic testing, referral, or ultimate treatment. Optimizing the presurgical interval and associated treatment pathways could have major impact on the lived experience of patients during presurgical care and may help providers and health systems better understand targets for future quality improvement initiatives.</div></div><div><h3>Type of study/level of evidence</h3><div>Not graded (qualitative).</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100888"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576882","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}
Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.
Methods
We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.
Results
A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.
Conclusions
The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.
{"title":"Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly","authors":"Manami Ishimatsu MD , Takashi Oda MD, PhD , Yuka Yamanaka MSc , Katsunori Takahashi MD, PhD , Shuto Hamada MD, PhD , Takuro Wada MD, PhD","doi":"10.1016/j.jhsg.2025.100882","DOIUrl":"10.1016/j.jhsg.2025.100882","url":null,"abstract":"<div><h3>Purpose</h3><div>Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.</div></div><div><h3>Results</h3><div>A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.</div></div><div><h3>Conclusions</h3><div>The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.</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 1","pages":"Article 100882"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576883","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号