Pub Date : 2025-12-24DOI: 10.1016/j.jhsg.2025.100905
Jordan T. Holler MD, MPH , Timothy P. Liu MD , Timothy A. Schaub MD
Pediatric lunate fractures are exceedingly rare, with limited evidence to guide management. We present the case of a 12-year-old boy who sustained bilateral wrist injuries with a displaced right lunate fracture after an electric bicycle fall. The fracture was reduced and fixed percutaneously with a headless compression screw. At 8 months, radiographs confirmed union and the patient had full, pain free wrist motion without evidence of osteonecrosis or instability. We propose that percutaneous compression screw fixation is a reasonable option for achieving reliable union in older pediatric patients with a sufficiently ossified carpus.
{"title":"Pediatric Lunate Fracture Treated With Percutaneous Screw Fixation","authors":"Jordan T. Holler MD, MPH , Timothy P. Liu MD , Timothy A. Schaub MD","doi":"10.1016/j.jhsg.2025.100905","DOIUrl":"10.1016/j.jhsg.2025.100905","url":null,"abstract":"<div><div>Pediatric lunate fractures are exceedingly rare, with limited evidence to guide management. We present the case of a 12-year-old boy who sustained bilateral wrist injuries with a displaced right lunate fracture after an electric bicycle fall. The fracture was reduced and fixed percutaneously with a headless compression screw. At 8 months, radiographs confirmed union and the patient had full, pain free wrist motion without evidence of osteonecrosis or instability. We propose that percutaneous compression screw fixation is a reasonable option for achieving reliable union in older pediatric patients with a sufficiently ossified carpus.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100905"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841101","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}
Hand rejuvenation procedures using dermal fillers are becoming increasingly popular as patients seek to restore dorsal hand volume and camouflage tendons and veins. Calcium hydroxyapatite is a commonly used filler that is inherently radiopaque and may produce imaging findings that mimic disease. We report the case of a 75-year-old woman who presented for follow-up of radiocarpal arthritis. Although her radiographs confirmed degenerative arthritis, they also demonstrated diffuse, clustered radiopaque foci in the dorsal soft tissues. These findings initially suggested metabolic or dystrophic calcification, but on further history, the patient disclosed recent cosmetic hand rejuvenation with calcium hydroxyapatite filler, establishing the true etiology. To our knowledge, the radiographic appearance of dermal filler in the hand has not been previously described. As the popularity of cosmetic hand rejuvenation continues to increase, both hand surgeons and radiologists should be aware of this phenomenon to prevent misdiagnosis and unnecessary diagnostic work-up.
{"title":"Radiographic Manifestation of Cosmetic Hand Rejuvenation With Calcium Hydroxyapatite","authors":"Alyssa Barré MD , Ahmed Al-Bayati MD , Chase Kluemper MD","doi":"10.1016/j.jhsg.2025.100902","DOIUrl":"10.1016/j.jhsg.2025.100902","url":null,"abstract":"<div><div>Hand rejuvenation procedures using dermal fillers are becoming increasingly popular as patients seek to restore dorsal hand volume and camouflage tendons and veins. Calcium hydroxyapatite is a commonly used filler that is inherently radiopaque and may produce imaging findings that mimic disease. We report the case of a 75-year-old woman who presented for follow-up of radiocarpal arthritis. Although her radiographs confirmed degenerative arthritis, they also demonstrated diffuse, clustered radiopaque foci in the dorsal soft tissues. These findings initially suggested metabolic or dystrophic calcification, but on further history, the patient disclosed recent cosmetic hand rejuvenation with calcium hydroxyapatite filler, establishing the true etiology. To our knowledge, the radiographic appearance of dermal filler in the hand has not been previously described. As the popularity of cosmetic hand rejuvenation continues to increase, both hand surgeons and radiologists should be aware of this phenomenon to prevent misdiagnosis and unnecessary diagnostic work-up.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100902"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841102","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 : 2025-12-24DOI: 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":"2025-12-24","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 : 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":"2025-12-24","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 : 2025-12-24DOI: 10.1016/j.jhsg.2025.100903
Walter I. Sussman DO , Erek W. Latzka MD , Jay Smith MD
Anomalous muscles of the forearm, including a reversed palmaris longus, may present as masses or median nerve compression syndromes, such as carpal tunnel syndrome. In both cases, ultrasound may be used as a first-line diagnostic test. This report presents a case of a reversed palmaris longus with sonographic findings and anatomic correlation. The diagnosis of these muscular anomalies, their relationship to compression syndromes, and implications for surgical planning are discussed.
{"title":"The Reversed Palmaris Longus: Sonographic Findings and Anatomical Correlation With Implications for Carpal Tunnel Syndrome Diagnosis and Management","authors":"Walter I. Sussman DO , Erek W. Latzka MD , Jay Smith MD","doi":"10.1016/j.jhsg.2025.100903","DOIUrl":"10.1016/j.jhsg.2025.100903","url":null,"abstract":"<div><div>Anomalous muscles of the forearm, including a reversed palmaris longus, may present as masses or median nerve compression syndromes, such as carpal tunnel syndrome. In both cases, ultrasound may be used as a first-line diagnostic test. This report presents a case of a reversed palmaris longus with sonographic findings and anatomic correlation. The diagnosis of these muscular anomalies, their relationship to compression syndromes, and implications for surgical planning are discussed.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100903"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841103","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 : 2025-12-15DOI: 10.1016/j.jhsg.2025.100897
Majd Mzeihem MD , Dmitriy Peresada MD , Yeseop Park PhD , Jiries A. Fakhouri BS , Danil Rybalko MD , Mark H. Gonzalez MD, PhD , Farid Amirouche PhD
Purpose
Intramedullary (IM) screws are commonly used for metacarpal shaft and neck fractures, but their application in extra-articular metacarpal base fractures has not been thoroughly evaluated. This study aims to compare the biomechanical performance (load to failure) of IM screw fixation versus dorsal plate fixation for extra-articular fractures at the base of the metacarpal.
Methods
Twenty-four cadaveric metacarpals from 12 upper extremities were prepared and randomized to receive either IM screw fixation or dorsal plate fixation following a standardized transverse fracture near the base. All specimens were potted and tested using cantilever bending in a materials testing system. The primary outcome was ultimate load to failure; stiffness was evaluated as a secondary measure.
Results
Dorsal plate fixation demonstrated greater load to failure compared to IM screw fixation when all specimens were analyzed collectively. Subgroup analysis indicated this difference was more pronounced in the thumb metacarpals. In contrast, IM screw constructs consistently exhibited greater stiffness across all specimens, including both thumb and small finger metacarpals.
Conclusions
Dorsal plating offered greater resistance to fracture displacement, while IM screw fixation provided superior construct stiffness. Both fixation methods surpassed expected physiologic loading during hand use, indicating that either approach may be biomechanically acceptable depending on the clinical context.
Clinical relevance
The IM screws may serve as a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures. These findings may help guide surgical decision-making regarding fixation selection and promote individualized treatment strategies.
{"title":"Biomechanical Comparison of Plate Versus Intramedullary Screw Fixation for Extra-Articular Metacarpal Base Fractures","authors":"Majd Mzeihem MD , Dmitriy Peresada MD , Yeseop Park PhD , Jiries A. Fakhouri BS , Danil Rybalko MD , Mark H. Gonzalez MD, PhD , Farid Amirouche PhD","doi":"10.1016/j.jhsg.2025.100897","DOIUrl":"10.1016/j.jhsg.2025.100897","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary (IM) screws are commonly used for metacarpal shaft and neck fractures, but their application in extra-articular metacarpal base fractures has not been thoroughly evaluated. This study aims to compare the biomechanical performance (load to failure) of IM screw fixation versus dorsal plate fixation for extra-articular fractures at the base of the metacarpal.</div></div><div><h3>Methods</h3><div>Twenty-four cadaveric metacarpals from 12 upper extremities were prepared and randomized to receive either IM screw fixation or dorsal plate fixation following a standardized transverse fracture near the base. All specimens were potted and tested using cantilever bending in a materials testing system. The primary outcome was ultimate load to failure; stiffness was evaluated as a secondary measure.</div></div><div><h3>Results</h3><div>Dorsal plate fixation demonstrated greater load to failure compared to IM screw fixation when all specimens were analyzed collectively. Subgroup analysis indicated this difference was more pronounced in the thumb metacarpals. In contrast, IM screw constructs consistently exhibited greater stiffness across all specimens, including both thumb and small finger metacarpals.</div></div><div><h3>Conclusions</h3><div>Dorsal plating offered greater resistance to fracture displacement, while IM screw fixation provided superior construct stiffness. Both fixation methods surpassed expected physiologic loading during hand use, indicating that either approach may be biomechanically acceptable depending on the clinical context.</div></div><div><h3>Clinical relevance</h3><div>The IM screws may serve as a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures. These findings may help guide surgical decision-making regarding fixation selection and promote individualized treatment strategies.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100897"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791663","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 : 2025-12-13DOI: 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":"2025-12-13","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 : 2025-12-13DOI: 10.1016/j.jhsg.2025.100873
Asher B. Mirvish BA , John R. Fowler MD
Purpose
Evaluate for variation between patients undergoing surgery for lateral epicondylitis (LE) with and without worker’s compensation (WC) coverage.
Methods
A retrospective review was performed on patients, identified by Current Procedural Terminology codes, who underwent LE surgery between 2008 and 2020. Following exclusions, there were 293 operative patients for LE, 34 of whom had WC coverage. Outcomes consisted of comparing before surgery and postoperative pain level reported by patient feedback during consultations, ability to perform job duties, and retaining employment. This study also assessed clinical workflow via time to surgery. Positive outcomes included having resolution or improvement in symptoms after surgery, returning to employment completely, and the ability to perform job duties appropriately. Negative outcomes included unchanged or worsened pain, incomplete return to work, loss of employment, and revisions. Patients were evaluated after surgery at approximately 2-week, 6-week, and 3-month milestones.
Results
Of the 34 WC cases, 12 (35%) had a negative outcome, whether persistent pain, reassignment to permanent and stationary employment, or loss of employment. Twenty percent of WC patients versus 3.5% of non-worker’s compensation (NWC) patients had unchanged symptoms. Twenty-five percent of WC patients returned to modified duty versus 7.3% of NWC. Two WC patients and one NWC patient lost their jobs. Patients on WC were more likely to have delays in time to surgery than NWC patients. Postoperative documentation reflected persistent epicondylitis as the reason for failure of complete return to work. By the 3-month postoperative consultation, 3% of patients without WC (NWC) had negative outcomes, whereas 20% of WC patients had a negative outcome. By the final consultation, 92% of NWC patients returned to work full duty, whereas 68% of WC patients were able to return to work full duty.
Conclusions
Overall, only approximately two-thirds of patients undergoing LE surgery under a WC claim returned to work within 3 months of surgery, compared to 92% without a WC claim. WC patients had more frequent delays in time to surgery versus NWC patients.
{"title":"Association Between Worker’s Compensation Status and Outcomes for Surgical Treatment of Lateral Epicondylitis","authors":"Asher B. Mirvish BA , John R. Fowler MD","doi":"10.1016/j.jhsg.2025.100873","DOIUrl":"10.1016/j.jhsg.2025.100873","url":null,"abstract":"<div><h3>Purpose</h3><div>Evaluate for variation between patients undergoing surgery for lateral epicondylitis (LE) with and without worker’s compensation (WC) coverage.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on patients, identified by Current Procedural Terminology codes, who underwent LE surgery between 2008 and 2020. Following exclusions, there were 293 operative patients for LE, 34 of whom had WC coverage. Outcomes consisted of comparing before surgery and postoperative pain level reported by patient feedback during consultations, ability to perform job duties, and retaining employment. This study also assessed clinical workflow via time to surgery. Positive outcomes included having resolution or improvement in symptoms after surgery, returning to employment completely, and the ability to perform job duties appropriately. Negative outcomes included unchanged or worsened pain, incomplete return to work, loss of employment, and revisions. Patients were evaluated after surgery at approximately 2-week, 6-week, and 3-month milestones.</div></div><div><h3>Results</h3><div>Of the 34 WC cases, 12 (35%) had a negative outcome, whether persistent pain, reassignment to permanent and stationary employment, or loss of employment. Twenty percent of WC patients versus 3.5% of non-worker’s compensation (NWC) patients had unchanged symptoms. Twenty-five percent of WC patients returned to modified duty versus 7.3% of NWC. Two WC patients and one NWC patient lost their jobs. Patients on WC were more likely to have delays in time to surgery than NWC patients. Postoperative documentation reflected persistent epicondylitis as the reason for failure of complete return to work. By the 3-month postoperative consultation, 3% of patients without WC (NWC) had negative outcomes, whereas 20% of WC patients had a negative outcome. By the final consultation, 92% of NWC patients returned to work full duty, whereas 68% of WC patients were able to return to work full duty.</div></div><div><h3>Conclusions</h3><div>Overall, only approximately two-thirds of patients undergoing LE surgery under a WC claim returned to work within 3 months of surgery, compared to 92% without a WC claim. WC patients had more frequent delays in time to surgery versus NWC patients.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100873"},"PeriodicalIF":0.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738978","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.2025.100899
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.
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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}
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