Pub Date : 2026-03-01Epub Date: 2026-01-23DOI: 10.1016/j.jhsg.2025.100889
J.J.E. Delahaije MSc , J. van Boxtel MSc , S.F.A. Raupp MSc , E.L.W.G. van Haren MSc
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.
{"title":"Perineural Lipoma of the Ulnar Nerve Within the Cubital Tunnel: A Brief Review of the Literature","authors":"J.J.E. Delahaije MSc , J. van Boxtel MSc , S.F.A. Raupp MSc , 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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.jhsg.2025.100921
Sandro Castro Adeodato MD, MSc , Nathalia Sundin Palmeira de Oliveira MD, PhD , André Luiz de Campos Pessoa MD, PhD , Moyses Messias Souza de Sant’Anna MSc, PhD , Bernardo Couto Neto MSc, PhD , Liszt Palmeira de Oliveira MSc, PhD
Purpose
This anatomical study aimed to describe, quantify, and topographically correlate the insertions of the dorsal scapholunate complex (DSLC) components, specifically the dorsal scapholunate interosseous ligament (dSLIL), dorsal radiocarpal (DRC), dorsal intercarpal (DIC), and dorsal capsuloligamentous scapholunate septum (DCSS), with each other and in relation to lunate morphology (types I and II).
Methods
Twenty-seven cadaveric wrists (23 formalin fixed and 4 fresh frozen) were systematically dissected. Measurements of width and thickness for dSLIL, DRC, DIC, and DCSS insertions were performed using a 0.05-mm precision caliper. Lunate morphology was classified (Viegas type I or II). Statistical analysis included descriptive statistics, independent samples t tests or Mann-Whitney U tests for intergroup comparisons, and paired-sample tests for dSLIL insertion site differences.
Results
DRC width at the lunate insertion was significantly greater in type II lunates compared to type I (P < .001, Cohen’s d = –1.647). No other DSLC component measurements differed significantly between lunate types. The dSLIL showed no notably difference in dimensions between its scaphoid and lunate insertions. Topographically, the scaphoid apex was identified as a consistent insertion site for dSLIL and DIC, with the DCSS located anterior and slightly ulnar to it.
Conclusions
This study provides a detailed morphological characterization of the DSLC components and their topographical relationships. Key findings include a more robust DRC at the lunate insertion in type II lunates and consistent insertion patterns of dSLIL and DIC at the scaphoid apex.
Clinical relevance
The observed robustness of the DRC in type II lunates suggests a potential protective effect against dorsal intercalated segment instability collapse. The precise anatomical data regarding DSLC component insertions offer crucial guidance for improving arthroscopic diagnostic accuracy and refining surgical reconstruction techniques for scapholunate instability.
目的：本解剖学研究旨在描述、量化舟月骨背复合体（DSLC）组成部分的插入，特别是舟月骨背骨间韧带（dSLIL）、桡腕背（DRC）、腕背间韧带（DIC）和舟月骨背囊寡聚隔膜（DCSS）彼此之间以及与月骨形态（I型和II型）相关的插入，并在地形上进行关联。方法系统解剖27例尸体手腕（23例福尔马林固定，4例新鲜冷冻）。使用0.05 mm精密卡尺测量dSLIL、DRC、DIC和dcs插入物的宽度和厚度。月骨形态分为Viegas I型和II型。统计分析包括描述性统计、组间比较的独立样本t检验或Mann-Whitney U检验、dSLIL插入位点差异的成对样本检验。结果II型月骨插入处drc宽度明显大于I型月骨插入处（P < 0.001, Cohen’s d = -1.647）。其他DSLC成分测量在月骨类型之间没有显著差异。dSLIL在舟状骨和月状骨插入处的尺寸无显著差异。地形学上，舟状骨尖端被确定为dSLIL和DIC的一致插入点，DCSS位于其前方，略尺侧。结论本研究提供了DSLC组分的详细形态表征及其地形关系。主要发现包括II型月骨的月骨止点处有更强健的DRC，舟状骨尖端处dSLIL和DIC的植入模式一致。观察到的II型月骨DRC的稳健性表明其对背插节段不稳定性塌陷具有潜在的保护作用。关于DSLC假体插入的精确解剖数据为提高关节镜诊断准确性和改进舟月骨不稳定的手术重建技术提供了重要指导。
{"title":"The Dorsal Scapholunate Ligament Complex: Anatomical Description and Correlation with Lunate Morphology","authors":"Sandro Castro Adeodato MD, MSc , Nathalia Sundin Palmeira de Oliveira MD, PhD , André Luiz de Campos Pessoa MD, PhD , Moyses Messias Souza de Sant’Anna MSc, PhD , Bernardo Couto Neto MSc, PhD , Liszt Palmeira de Oliveira MSc, PhD","doi":"10.1016/j.jhsg.2025.100921","DOIUrl":"10.1016/j.jhsg.2025.100921","url":null,"abstract":"<div><h3>Purpose</h3><div>This anatomical study aimed to describe, quantify, and topographically correlate the insertions of the dorsal scapholunate complex (DSLC) components, specifically the dorsal scapholunate interosseous ligament (dSLIL), dorsal radiocarpal (DRC), dorsal intercarpal (DIC), and dorsal capsuloligamentous scapholunate septum (DCSS), with each other and in relation to lunate morphology (types I and II).</div></div><div><h3>Methods</h3><div>Twenty-seven cadaveric wrists (23 formalin fixed and 4 fresh frozen) were systematically dissected. Measurements of width and thickness for dSLIL, DRC, DIC, and DCSS insertions were performed using a 0.05-mm precision caliper. Lunate morphology was classified (Viegas type I or II). Statistical analysis included descriptive statistics, independent samples <em>t</em> tests or Mann-Whitney U tests for intergroup comparisons, and paired-sample tests for dSLIL insertion site differences.</div></div><div><h3>Results</h3><div>DRC width at the lunate insertion was significantly greater in type II lunates compared to type I (<em>P</em> < .001, Cohen’s d = –1.647). No other DSLC component measurements differed significantly between lunate types. The dSLIL showed no notably difference in dimensions between its scaphoid and lunate insertions. Topographically, the scaphoid apex was identified as a consistent insertion site for dSLIL and DIC, with the DCSS located anterior and slightly ulnar to it.</div></div><div><h3>Conclusions</h3><div>This study provides a detailed morphological characterization of the DSLC components and their topographical relationships. Key findings include a more robust DRC at the lunate insertion in type II lunates and consistent insertion patterns of dSLIL and DIC at the scaphoid apex.</div></div><div><h3>Clinical relevance</h3><div>The observed robustness of the DRC in type II lunates suggests a potential protective effect against dorsal intercalated segment instability collapse. The precise anatomical data regarding DSLC component insertions offer crucial guidance for improving arthroscopic diagnostic accuracy and refining surgical reconstruction techniques for scapholunate instability.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100921"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977647","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 : 2026-03-01Epub Date: 2025-12-13DOI: 10.1016/j.jhsg.2025.100895
Sarah Mart MS, OTR , Nancy M. Cannon OTR , Danielle Sparks DHS, OTR , Courtney D. Jensen PhD
Purpose
Traditionally, therapy has been initiated 1 day after surgery following flexor tenolysis to prevent the development of early adhesions. Pain and edema are limiting factors in the initial days after surgery and can interfere with the opportunity to effectively initiate a home therapy program. The purpose of this study was to demonstrate the safety and effectiveness of delaying the initiation of therapy to 3 days post-op following flexor tenolysis.
Methods
10 patients undergoing flexor tenolysis initiated therapy at 3 days post-op. Pain, edema, and range of motion were measured at baseline, day 3 post-op, day 12 ± 2, and weeks 3, 4, 8, and 12. Functional limitations and level of anxiety were assessed at the initial post-op visit, as well as week 4 and week 12.
Results
Most range of motion improvements occurred in the first 2–3 weeks. Mean total active motion of the interphalangeal joints increased from 64.0° ± 24.9° at baseline to 142.5° ± 24.6° at 3 weeks post-op. Differences in interphalangeal joint total active motion were significant between baseline and 3 weeks, and these improvements were maintained through the 8-week follow-up visit. At 8 weeks post-op, five patients had excellent results, three had good, and two had fair, according to the Original Strickland Classification system.
Conclusions
Early and effective management of pain and edema is critical to ensuring a positive outcome. Patients with less initial postoperative edema had better range of motion at 3 weeks post-op. Results were maintained through 8 weeks, and the patients required fewer therapy visits. Delaying the initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results and is safe for clinical practice.
Clinical relevance
This case series demonstrates that delaying initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results. Delaying therapy can mitigate the ill effects of surgery and allow reduction of pain and edema for improved range of motion and overall outcome.
{"title":"Reduced Pain and Edema Following Delayed Therapy for Flexor Tenolysis","authors":"Sarah Mart MS, OTR , Nancy M. Cannon OTR , Danielle Sparks DHS, OTR , Courtney D. Jensen PhD","doi":"10.1016/j.jhsg.2025.100895","DOIUrl":"10.1016/j.jhsg.2025.100895","url":null,"abstract":"<div><h3>Purpose</h3><div>Traditionally, therapy has been initiated 1 day after surgery following flexor tenolysis to prevent the development of early adhesions. Pain and edema are limiting factors in the initial days after surgery and can interfere with the opportunity to effectively initiate a home therapy program. The purpose of this study was to demonstrate the safety and effectiveness of delaying the initiation of therapy to 3 days post-op following flexor tenolysis.</div></div><div><h3>Methods</h3><div>10 patients undergoing flexor tenolysis initiated therapy at 3 days post-op. Pain, edema, and range of motion were measured at baseline, day 3 post-op, day 12 ± 2, and weeks 3, 4, 8, and 12. Functional limitations and level of anxiety were assessed at the initial post-op visit, as well as week 4 and week 12.</div></div><div><h3>Results</h3><div>Most range of motion improvements occurred in the first 2–3 weeks. Mean total active motion of the interphalangeal joints increased from 64.0° ± 24.9° at baseline to 142.5° ± 24.6° at 3 weeks post-op. Differences in interphalangeal joint total active motion were significant between baseline and 3 weeks, and these improvements were maintained through the 8-week follow-up visit. At 8 weeks post-op, five patients had excellent results, three had good, and two had fair, according to the Original Strickland Classification system.</div></div><div><h3>Conclusions</h3><div>Early and effective management of pain and edema is critical to ensuring a positive outcome. Patients with less initial postoperative edema had better range of motion at 3 weeks post-op. Results were maintained through 8 weeks, and the patients required fewer therapy visits. Delaying the initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results and is safe for clinical practice.</div></div><div><h3>Clinical relevance</h3><div>This case series demonstrates that delaying initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results. Delaying therapy can mitigate the ill effects of surgery and allow reduction of pain and edema for improved range of motion and overall outcome.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100895"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739081","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 : 2026-03-01Epub Date: 2026-01-24DOI: 10.1016/j.jhsg.2025.100943
Sarah Romans MD , Adam Mosa MD , Lindley B. Wall MD, MSc
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
{"title":"Impact on Families of Upper Extremity Surgical Treatment for Children with Cerebral Palsy","authors":"Sarah Romans MD , Adam Mosa MD , 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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-01-22DOI: 10.1016/j.jhsg.2025.100922
Colby Newson MD , Steven Kozusko MD , Ava Chappell MD , Kacy J. Peek MD , A. Bobby Chhabra MD , Brent R. DeGeorge Jr. MD, PhD
Purpose
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.
Methods
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 P < .05.
Results
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.
Conclusions
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.
Type of study/level of evidence
Differential diagnosis/symptom prevalence study IV.
{"title":"Personality and Perception: A Qualitative Investigation of Factors That Shape Mentorship Satisfaction Among Hand Surgery Fellows","authors":"Colby Newson MD , Steven Kozusko MD , Ava Chappell MD , Kacy J. Peek MD , A. Bobby Chhabra MD , 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> < .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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2025-12-24DOI: 10.1016/j.jhsg.2025.100900
Shyam Sundar Sah MD , Abhishek Kumbhalwar PhD
{"title":"Comment on “Outcomes of Thumb Metacarpophalangeal Joint Arthrodesis Using the XMCP Intramedullary Interlocking Device”","authors":"Shyam Sundar Sah MD , Abhishek Kumbhalwar PhD","doi":"10.1016/j.jhsg.2025.100900","DOIUrl":"10.1016/j.jhsg.2025.100900","url":null,"abstract":"","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100900"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841033","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 : 2026-03-01Epub Date: 2025-12-24DOI: 10.1016/j.jhsg.2025.100910
Sang Anh Nguyen MD, MSc , Anh Hoang Dang MD, PhD , Doanh Quoc Tran MD, PhD
Purpose
To evaluate the reliability, clinical utility, and prognostic value of distal radius fracture (DRF) classification systems and to translate current evidence into a decision-oriented framework for everyday care.
Methods
We conducted a PRISMA-guided narrative review with structured searches of PubMed and Scopus (January 2010 to September 2025). Eligible adult studies assessed at least one DRF classification (eg, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone, IDEAL) and reported reliability, clinical utility (treatment selection, complications/reoperation), or prognostic associations (patient-reported outcome measures, radiographic restoration). Study selection, extraction, and risk of bias assessment followed predefined procedures; data were synthesized thematically by imaging modality, rater expertise, and category granularity.
Results
Interobserver agreement was typically fair–moderate on radiographs; computed tomography yielded modest improvements. Increasing granularity (more categories/subcategories) consistently reduced κ/intraclass correlation coefficient, while a brief rater calibration session improved agreement. Across studies linking taxonomy to care, classification alone rarely changed management once radiographic thresholds of instability (shortening, tilt, intra-articular step-off) and patient factors (age/bone quality, functional demand) were applied. Prognostic associations between subtype and patient-reported outcome measures were inconsistent after adjustment for reduction quality. We operationalize these findings via reliability, morphology, age of bone, patient demands, yielding actionable pathways with explicit quality targets: restoration of radial height and tilt, intra-articular step-off ≤2 mm, and early motion.
Conclusions
The DRF classifications remain valuable as a shared language and research scaffold, but their stand-alone reliability and prognostic power are limited. A pragmatic, reliability, morphology, age of bone, patient demands, yielding actionable pathway-based approach integrates classification with instability thresholds and patient factors to support auditable, evidence-based decisions.
Type of study/level of evidence
Therapeutic V.
目的评估桡骨远端骨折（DRF）分类系统的可靠性、临床应用和预后价值，并将现有证据转化为日常护理的决策导向框架。方法采用prisma引导的叙述性综述，对PubMed和Scopus进行结构化检索（2010年1月至2025年9月）。符合条件的成人研究评估了至少一种DRF分类（例如，Arbeitsgemeinschaft f r Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone， IDEAL）并报告了可靠性、临床效用（治疗选择、并发症/再手术）或预后相关性（患者报告的结果测量、放射学恢复）。研究选择、提取和偏倚风险评估遵循预先确定的程序；数据按成像方式、专家知识和分类粒度进行主题合成。结果观察者间在x线片上的一致性一般为中等偏下；计算机断层扫描取得了适度的改善。增加粒度（更多的类别/子类别）持续降低κ/类内相关系数，而简短的分级校准会话提高了一致性。在将分类学与护理联系起来的研究中，一旦应用不稳定性的放射学阈值（缩短、倾斜、关节内踏步）和患者因素（年龄/骨质量、功能需求），单独分类很少改变管理。在调整复位质量后，亚型和患者报告的结果测量之间的预后关联不一致。我们通过可靠性、形态学、骨龄、患者需求来操作这些发现，得出具有明确质量目标的可操作路径：恢复桡骨高度和倾斜、关节内台阶≤2mm和早期运动。结论DRF分类作为一种共享语言和研究框架仍有价值，但其单独的可靠性和预后能力有限。实用、可靠、形态学、骨龄、患者需求、产生可操作的基于通路的方法将分类与不稳定性阈值和患者因素相结合，以支持可审计的、基于证据的决策。研究类型/证据水平
{"title":"Distal Radius Fracture Classifications in Real Life: Reliability and How They Change Treatment","authors":"Sang Anh Nguyen MD, MSc , Anh Hoang Dang MD, PhD , Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100910","DOIUrl":"10.1016/j.jhsg.2025.100910","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the reliability, clinical utility, and prognostic value of distal radius fracture (DRF) classification systems and to translate current evidence into a decision-oriented framework for everyday care.</div></div><div><h3>Methods</h3><div>We conducted a PRISMA-guided narrative review with structured searches of PubMed and Scopus (January 2010 to September 2025). Eligible adult studies assessed at least one DRF classification (eg, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone, IDEAL) and reported reliability, clinical utility (treatment selection, complications/reoperation), or prognostic associations (patient-reported outcome measures, radiographic restoration). Study selection, extraction, and risk of bias assessment followed predefined procedures; data were synthesized thematically by imaging modality, rater expertise, and category granularity.</div></div><div><h3>Results</h3><div>Interobserver agreement was typically fair–moderate on radiographs; computed tomography yielded modest improvements. Increasing granularity (more categories/subcategories) consistently reduced κ/intraclass correlation coefficient, while a brief rater calibration session improved agreement. Across studies linking taxonomy to care, classification alone rarely changed management once radiographic thresholds of instability (shortening, tilt, intra-articular step-off) and patient factors (age/bone quality, functional demand) were applied. Prognostic associations between subtype and patient-reported outcome measures were inconsistent after adjustment for reduction quality. We operationalize these findings via reliability, morphology, age of bone, patient demands, yielding actionable pathways with explicit quality targets: restoration of radial height and tilt, intra-articular step-off ≤2 mm, and early motion.</div></div><div><h3>Conclusions</h3><div>The DRF classifications remain valuable as a shared language and research scaffold, but their stand-alone reliability and prognostic power are limited. A pragmatic, reliability, morphology, age of bone, patient demands, yielding actionable pathway-based approach integrates classification with instability thresholds and patient factors to support auditable, evidence-based decisions.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100910"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841031","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 : 2026-03-01Epub Date: 2026-01-12DOI: 10.1016/j.jhsg.2025.100927
Christy Zheng BS, MS , Leah Demetri MD , Philip Blazar MD , Brandon E. Earp MD , Dafang Zhang MD
Purpose
Patient-reported outcome measures (PROMs) are widely used in hand surgery to assess symptom severity prior to surgical intervention; however, little is known about how food insecurity, an important social determinant of health, influences these scores. We aimed to measure the correlation between county-level food insecurity and baseline PROMs in a cohort of patients undergoing carpal tunnel release (CTR) for idiopathic carpal tunnel syndrome (CTS).
Methods
Baseline PROMs were prospectively collected in 114 patients with electrodiagnostic study, ultrasound, or CTS-6 confirmed CTS treated with CTR at a single tertiary referral center. Feeding America’s Map the Meal Gap Dataset was used to identify county-level food-insecurity rate, average meal cost, and percent eligible for Supplemental Nutritional Assistance Program. Correlations between food-insecurity parameters and PROMs were assessed using correlation coefficients; bivariate analyses of continuous explanatory variables were performed using linear regression.
Results
Mean age was 61.6 ± 12.7 years. A total of 57.9% were women, and 93.9% were White. In total, 14.9% and 19.3% of our cohort reside in Massachusetts counties falling within the upper quartile and upper half of food-insecurity rates, respectively. No significant correlations were found between food-insecurity variables and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Younger age was associated with worse Boston Carpal Tunnel Questionnaire–Symptom Severity Scale scores and PROMIS Pain Interference scores.
Conclusions
We found no evidence that patients with food insecurity present with greater symptom severity at time of CTR.
{"title":"The Effect of County-Level Food Insecurity on Baseline Patient-Reported Outcome Measures in Patients Undergoing Carpal Tunnel Release","authors":"Christy Zheng BS, MS , Leah Demetri MD , Philip Blazar MD , Brandon E. Earp MD , Dafang Zhang MD","doi":"10.1016/j.jhsg.2025.100927","DOIUrl":"10.1016/j.jhsg.2025.100927","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-reported outcome measures (PROMs) are widely used in hand surgery to assess symptom severity prior to surgical intervention; however, little is known about how food insecurity, an important social determinant of health, influences these scores. We aimed to measure the correlation between county-level food insecurity and baseline PROMs in a cohort of patients undergoing carpal tunnel release (CTR) for idiopathic carpal tunnel syndrome (CTS).</div></div><div><h3>Methods</h3><div>Baseline PROMs were prospectively collected in 114 patients with electrodiagnostic study, ultrasound, or CTS-6 confirmed CTS treated with CTR at a single tertiary referral center. Feeding America’s Map the Meal Gap Dataset was used to identify county-level food-insecurity rate, average meal cost, and percent eligible for Supplemental Nutritional Assistance Program. Correlations between food-insecurity parameters and PROMs were assessed using correlation coefficients; bivariate analyses of continuous explanatory variables were performed using linear regression.</div></div><div><h3>Results</h3><div>Mean age was 61.6 ± 12.7 years. A total of 57.9% were women, and 93.9% were White. In total, 14.9% and 19.3% of our cohort reside in Massachusetts counties falling within the upper quartile and upper half of food-insecurity rates, respectively. No significant correlations were found between food-insecurity variables and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Younger age was associated with worse Boston Carpal Tunnel Questionnaire–Symptom Severity Scale scores and PROMIS Pain Interference scores.</div></div><div><h3>Conclusions</h3><div>We found no evidence that patients with food insecurity present with greater symptom severity at time of CTR.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100927"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977644","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 : 2026-03-01Epub Date: 2026-01-24DOI: 10.1016/j.jhsg.2025.100939
Eliana B. Saltzman MD , Daniel Y. Hong MD , Roger Cornwall MD , Heather L. Baltzer MD, MSc , Thomas J. Wilson MD , Jenny M. Dorich PhD, CHT , Caroline Miller , Avi M. Giladi MD, MS , Paige M. Fox MD, PhD
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.
Where Are We Now?
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.
Where Do We Need to Go?
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.
How Do We Get There?
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.
{"title":"Challenges in Clinical Research for Nerve Injuries (Nerve SPACE 2025)","authors":"Eliana B. Saltzman MD , Daniel Y. Hong MD , Roger Cornwall MD , Heather L. Baltzer MD, MSc , Thomas J. Wilson MD , Jenny M. Dorich PhD, CHT , Caroline Miller , Avi M. Giladi MD, MS , 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":"2026-03-01","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}
Pub Date : 2026-03-01Epub Date: 2026-01-24DOI: 10.1016/j.jhsg.2025.100846
Derrick W. Williams MD, MBA , Philip Blazar MD , Kyra A. Benavent BS , Laura Byrne BS , Brandon E. Earp MD , Dafang Zhang MD
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Type of study/level of evidence: Economic Analysis IV.
{"title":"Out-Of-Pocket Expenses of Carpal Tunnel Release","authors":"Derrick W. Williams MD, MBA , Philip Blazar MD , Kyra A. Benavent BS , Laura Byrne BS , Brandon E. Earp MD , 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":"2026-03-01","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}
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