Journal of Hand Surgery Global Online最新文献

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

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

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

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

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

{"title":"Achilles Allograft in the Upper Extremity: A Systematic Review","authors":"Mahmoud Mahmoud MBBS ,&nbsp;Sanjum Singh MD ,&nbsp;Yagiz Ozdag MD ,&nbsp;Ryan Kempski BA ,&nbsp;Louis C. Grandizio DO","doi":"10.1016/j.jhsg.2025.100929","DOIUrl":"10.1016/j.jhsg.2025.100929","url":null,"abstract":"<div><h3>Purpose</h3><div>Achillies tendon allografts (ATAs) are used in a variety of upper-extremity reconstructive procedures. The purpose of this study was to systematically review the existing literature on the complications, reoperation rates and outcomes associated with the use of ATAs in upper-extremity reconstructions.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic review was conducted of studies published between January 1990 and August 2024. Eligible studies included adult patients who underwent shoulder, elbow and wrist tendon reconstruction using ATAs to provide insight into the overall performance of ATA reconstruction in the upper extremity. Studies which did not report complications and/or functional outcomes were excluded. Retrospective, prospective, and randomized controlled trials were included, whereas cadaveric, biomechanical, and nonhuman studies were excluded.</div></div><div><h3>Results</h3><div>A total of 23 studies comprising 408 cases met inclusion criteria. The most common indications for ATA use were distal biceps reconstruction (26%), irreparable rotator cuff tears (24%) and failed distal ulna resection (20%). The overall complication rate was 19%, with graft-related failure (43%) and infection (20%) as the most frequent complications. Reoperation was required in 10% of cases; predominantly because of graft failure (42%) and deep infection (29%). Despite these complications, patient-reported outcomes were favorable, with a mean postoperative-visual analog scale score of two and a Mayo Elbow Performance Score of 88, indicating substantial pain relief and functional improvement.</div></div><div><h3>Conclusions</h3><div>ATAs in upper-extremity reconstructive procedures appear to result in low levels of postoperative pain and improvements in function. However, overall complication and reoperations rates following ATA use were 19% and 10%, respectively.</div></div><div><h3>Clinical relevance</h3><div>ATA is advantageous in the sense that it can be used for a variety of shoulder, elbow, and wrist procedures; however, surgeons need to carefully weigh the benefits of decreased donor-site morbidity against the relatively high rates of complications.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100929"},"PeriodicalIF":0.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Dorsal Scapholunate Ligament Complex: Anatomical Description and Correlation with Lunate Morphology","authors":"Sandro Castro Adeodato MD, MSc ,&nbsp;Nathalia Sundin Palmeira de Oliveira MD, PhD ,&nbsp;André Luiz de Campos Pessoa MD, PhD ,&nbsp;Moyses Messias Souza de Sant’Anna MSc, PhD ,&nbsp;Bernardo Couto Neto MSc, PhD ,&nbsp;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> &lt; .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":"2026-01-13","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}

{"title":"Cellular Bone Matrix for the Treatment of Considerable Bone Loss in Two Metacarpal Fractures","authors":"Serge Andreou MD, MS,&nbsp;Ameen Suhrawardy MD,&nbsp;Pranav Khambete MD,&nbsp;Andrew Tsai MD","doi":"10.1016/j.jhsg.2025.100924","DOIUrl":"10.1016/j.jhsg.2025.100924","url":null,"abstract":"<div><div>High-energy mechanisms that lead to hand fractures can create substantial bony defects that are not amenable to traditional treatments. Management options include autograft, allograft, and bone graft substitutes such as calcium sulfate/phosphate cements, which provide good results when used appropriately however each strategy has limitations. Cellular bone matrices (CBMs) are newer graft substitutes designed to supply osteogenic cells along with scaffold and inductive factors. We present a case series of metacarpal fractures with considerable ballistic-related defects treated with CBM augmentation. Two male patients (mean age 32 years) sustained second metacarpal fractures from high-caliber ballistic injury and were followed for 19 months. One required later tenolysis and dorsal capsulotomy for stiffness. Both demonstrated full radiographic union and CBM incorporation on computed tomography. This series shows excellent radiographic outcomes using CBM for metacarpal defects. Although further study is needed, to our knowledge, this is the first published evidence supporting CBM as an effective option for these injuries.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100924"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Proximal Humerus Surgery: Does Regional Anesthesia Usage Matter?","authors":"Bill Young BS,&nbsp;Amy L. Ladd MD","doi":"10.1016/j.jhsg.2025.100920","DOIUrl":"10.1016/j.jhsg.2025.100920","url":null,"abstract":"<div><h3>Purpose</h3><div>Regional anesthesia is commonly used for intraoperative pain control during proximal humerus fracture surgery. We hypothesized that patients undergoing proximal humerus fracture surgery who received regional anesthesia would have increased postoperative emergency department (ED) utilization, increased perioperative opioid prescriptions, and greater incidence of persistent postoperative opioid prescriptions compared with those who received general anesthesia.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients ≥18 years of age with a closed proximal humerus fracture undergoing either open reduction internal fixation (ORIF) or shoulder arthroplasty within 21 days of the fracture. We used International Classification of Diseases (ICD) 9/10 codes to identify patients using an administrative claims database. We categorized and then propensity-score matched patients based on receipt of regional anesthesia during surgery. Our first outcome was any instance of an ED visit within 7 and 30 days after surgery. Secondary outcomes included perioperative opioid prescriptions and the incidence of persistent opioid prescriptions. Multivariable regression models were used to assess the risk of an ED visit or persistent opioid usage based on the receipt of intraoperative regional anesthesia, adjusting for demographics and comorbidities.</div></div><div><h3>Results</h3><div>In total, 10,580 (33.3%) ORIF patients and 3,299 (33.6%) shoulder arthroplasty patients received regional anesthesia during surgery. Regional anesthesia was associated with an increased 7-day ED visit incidence compared to no regional anesthesia receipt for ORIF patients (3.3% vs 2.3%) and shoulder arthroplasty patients (2.7% vs 1.9%) (<em>P</em> &lt; .001 for both). In the 30-day postoperative window, regional anesthesia was associated with an increased incidence of an ED visit for ORIF patients (7.1% vs 5.8%) and shoulder arthroplasty patients (6.6% vs 5.2%) (<em>P</em> &lt; .001 for both). Regional anesthesia was also associated with greater perioperative opioid prescriptions across both surgeries (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>Further research should explore interventions for proximal humerus fracture surgery patients who receive regional anesthesia to reduce potentially preventable ED visits and opioid-related adverse events.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100920"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary Threaded Nail Versus Dorsal Plate and Screw Fixation of Comminuted Metacarpal Shaft Fractures: A Cadaveric Biomechanical Study","authors":"Andrew D. Allen MD ,&nbsp;Alexander D. Jeffs MD ,&nbsp;Yukun Zhang PhD ,&nbsp;Stephen M. Himmelberg MD ,&nbsp;Zohair S. Zaidi MD ,&nbsp;Nathaniel C. Adams BA ,&nbsp;Bradley J. Lauck BA ,&nbsp;Matthew Fisher PhD ,&nbsp;J. Megan M. Patterson MD ,&nbsp;Reid W. Draeger MD","doi":"10.1016/j.jhsg.2025.100925","DOIUrl":"10.1016/j.jhsg.2025.100925","url":null,"abstract":"<div><h3>Purpose</h3><div>Indications are expanding for the use of intramedullary threaded nail (IMTN) fixation in metacarpal fractures. We hypothesized that IMTN fixation would have superior bending stiffness compared to dorsal plate and screw fixation and provide sufficient stability to withstand cyclic loading comparable with early range of motion.</div></div><div><h3>Methods</h3><div>Index, long, ring, and small finger metacarpals were harvested from matched pair cadaveric hands. A midshaft 1.75 mm transverse gap was created to simulate a comminuted fracture. Specimens were randomized into two groups for fixation with either a retrograde IMTN or dorsal plate and screws. Specimens underwent three-point bend testing with an Instron. Each specimen was cyclically loaded at 70 N for 2,000 cycles (composite grasp), followed by 120 N for 2,000 cycles (tip pinch). Specimens were then loaded to failure. Outcomes included cycles to failure, bending stiffness, peak load to failure, and location of failure.</div></div><div><h3>Results</h3><div>Bending stiffness was significantly greater in the IMTN group compared to the plate group (136.71 ± 24.19 N/mm vs 39.89 ± 14.08 N/mm). Peak load to failure was greater in the plate group, but this difference was not statistically significant (365.33 ± 79.85 N vs 598.11 ± 372.76 N). During the cyclic loading phases, all specimens in the IMTN group completed the 70 N and 120 N loading phases without failure. In the plate group, two of nine specimens progressed to catastrophic failure during the 120 N cyclic loading phase.</div></div><div><h3>Conclusions</h3><div>In a comminuted metacarpal shaft fracture model, IMTN fixation had significantly greater bending stiffness and more consistent load to failure characteristics compared to dorsal plate and screw fixation.</div></div><div><h3>Clinical relevance</h3><div>IMTN fixation provided sufficient stability in comminuted metacarpal shaft fractures to withstand cyclic forces consistent with early range of motion, whereas dorsal plate and screw fixation demonstrated more variable results.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100925"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977648","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}