Journal of Hand Surgery Global Online最新文献

{"title":"CMC Arthroplasty for Treatment of the Painful and Arthritic Thumb: A Review of Surgical Treatment Options with Preferred Technique","authors":"Jon E. Hammarstedt MD ,&nbsp;Yehuda A. Masturov BS ,&nbsp;Sebastian D. Arango MD ,&nbsp;Jacob Zeitlin MD ,&nbsp;Samuel H. Payne MD ,&nbsp;Mark S. Rekant MD","doi":"10.1016/j.jhsg.2025.100864","DOIUrl":"10.1016/j.jhsg.2025.100864","url":null,"abstract":"<div><div>Arthritis of the first carpometacarpal joint is a prevalent and often disabling condition for many older adults. The diagnosis is typically established through a comprehensive patient history, physical examination, and confirmatory radiographs. Nonsurgical management with splinting and anti-inflammatory medication has demonstrated effectiveness. Several surgical options have proven effectiveness for those who fail nonsurgical management. Surgical options include silicone implantation, resection arthroplasty, tendon interposition, ligament reconstruction, denervation, and joint implant arthroplasty. In the following review, we will elaborate upon the array of therapeutic approaches, culminating in the delineation of our preferred method.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100864"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384189","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":"Proof of Concept for Metacarpal Reconstruction Using a Custom 3-dimensional-Printed Titanium Implant: Design, Manufacturing, Surgical Technique, and Early Postoperative Outcomes","authors":"Ben Wesorick BSE ,&nbsp;Olabamibo Oke MD ,&nbsp;Nadine Elizabeth Withrow CST ,&nbsp;Daniel Herrera BS ,&nbsp;Tara Mann PhD ,&nbsp;Lexi Lewis BSE ,&nbsp;Nur Nurbhai DO","doi":"10.1016/j.jhsg.2025.100874","DOIUrl":"10.1016/j.jhsg.2025.100874","url":null,"abstract":"<div><div>This case report describes the use of a 3-dimensional-printed, custom titanium implant for the reconstruction of a complex post-traumatic metacarpal malunion. A 33-year-old woman with an open fracture of the right second metacarpal progressing to malunion from a motor vehicle accident underwent single-stage hand reconstruction using a custom implant. This report outlines preoperative planning, implant design, manufacturing, and surgical execution. Postoperative imaging confirmed appropriate implant positioning, soft tissue balancing, and deformity correction. The custom implant restored joint alignment and motion, resolving the preoperative fixed hyperextension contracture of the digit. At the 2-year follow-up, the implant demonstrated good incorporation without loosening and maintained digit function. This case demonstrates the unique application of a custom 3-dimensional-printed implant, from implant design through surgical execution, for complex hand reconstruction where alternative off-the-shelf options are not feasible, and highlights advantages in anatomical restoration and surgical precision in challenging patient populations.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100874"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420301","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":"Functional Outcomes of Miniplate/Screw Versus Suzuki Frame Fixation in Eaton Type III Middle Phalanx Base Fractures: A Case Series","authors":"Ekrem Özdemir MD ,&nbsp;Nasuhi Altay MD ,&nbsp;Fatih Emre Topsakal MD ,&nbsp;Mehmet Koçaslan MD ,&nbsp;Bilal Karabak MD ,&nbsp;Esra Demirel MD","doi":"10.1016/j.jhsg.2025.100866","DOIUrl":"10.1016/j.jhsg.2025.100866","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate and compare the surgical and functional outcomes of dynamic external fixation using the Suzuki frame versus volar miniplate fixation for intra-articular Eaton type III fractures at the base of the middle phalanx.</div></div><div><h3>Methods</h3><div>Thirty patients treated surgically between September 2022 and December 2023 were retrospectively analyzed. Group 1 (n = 15) underwent Suzuki frame application; group 2 (n = 15) received open reduction and internal fixation (ORIF) with a volar miniplate and screws. Operative time, complications, postoperative proximal interphalangeal joint range of motion, Visual Analog Scale, and Disabilities of the Arm, Shoulder, and Hand (<em>Quick</em>DASH) scores were compared. Statistical analysis included Student <em>t</em> tests, chi-square tests, effect size calculations, and minimal clinically important difference (MCID)-based clinical significance analysis, with <em>P</em> &lt; .05 significance threshold.</div></div><div><h3>Results</h3><div>Both groups achieved complete fracture union and a mean postoperative proximal interphalangeal range of motion of 90°. However, the Suzuki group demonstrated shorter operative times (27.1 vs 55.5 min), lower complication rates (6.6% vs 26.6%), reduced pain levels (Visual Analog Scale: 1 vs 2), and better functional recovery (<em>Quick</em>DASH: 2.3 vs 6.8). Disabilities of the Arm, Shoulder, and Hand scores showed statistically significant differences (Suzuki: 2.3 vs ORIF: 6.8, <em>P</em> = .040), but the 4.5-point difference fell below the established MCID threshold of 6.8 points. Visual Analog Scale pain scores also differed significantly (Suzuki: 1 vs ORIF: 2, <em>P</em> = .004), but the 1-point difference was below the MCID threshold of 1.6 points. Responder rate analysis showed similar proportions achieving clinically meaningful improvements (<em>Quick</em>DASH: 53.3% vs 46.7%, <em>P</em> = .742).</div></div><div><h3>Conclusion</h3><div>Despite achieving statistical significance, MCID-based analysis confirmed that the Suzuki frame and ORIF miniplate fixation techniques yield clinically equivalent outcomes in hand surgery. This finding underscores that treatment selection should not be driven by statistical superiority but rather by surgeon expertise, fracture-specific characteristics, patient-centered preferences, and health care resource considerations. Such an equivalence-based perspective provides a more meaningful framework for evidence-based, individualized, and cost-effective decision making in clinical practice.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100866"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420289","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":"Carpometacarpal Osteoarthritis Is Associated With an Increased Risk of Carpal Tunnel Syndrome","authors":"Blaire Peterson VanderWeele MD ,&nbsp;Lindsey Peng BS ,&nbsp;Benjamin Fitch BS ,&nbsp;Travis Kotzur BS ,&nbsp;Mallory Ogburn MD ,&nbsp;Ryan Rose MD ,&nbsp;Christina Brady MD","doi":"10.1016/j.jhsg.2025.100867","DOIUrl":"10.1016/j.jhsg.2025.100867","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpometacarpal (CMC) osteoarthritis (OA) of the thumb finger is the most common joint OA in the upper extremity to require surgery. This study aims to assess the impact of CMC OA on the management of carpal tunnel syndrome (CTS) as well as outcomes following carpal tunnel release (CTR) surgery.</div></div><div><h3>Methods</h3><div>This retrospective matched cohort study used data from the TriNetX Research Network. Patients without CTS and with an ambulatory visit between 2017 and 2018 were identified; using International Classification of Diseases (ICD)-10 codes, those with CMC OA were matched to a control cohort of those without it, and they were followed for 5 years to assess the development of CTS. Patients with CTS and CMC OA were then matched to a control cohort of patients with CTS and no diagnosis of CMC OA. Progression to therapy within three years was assessed; interventions were identified using Current Procedural Terminology (CPT) codes. Subanalysis of a secondarily matched cohort of patients undergoing CTR, with and without CMC OA, assessed 2-year postoperative outcomes.</div></div><div><h3>Results</h3><div>A total of 31,075 patients were matched, and those with CMC OA were more likely to develop CTS. Of patients with CTS, those with CMC OA were more likely to receive corticosteroid injection and operative management than those without CMC OA. Secondary analysis of matched cohorts of 15,431 patients who underwent CTR demonstrated those with CMC OA had higher odds of postoperative opioid prescription, postoperative infection, postoperative EMG, and repeat CTR within one year than the cohort without CMC OA.</div></div><div><h3>Conclusions</h3><div>Patients with CMC OA were more likely to develop CTS, receive corticosteroid injections, and undergo CTR. Among patients who underwent CTR, patients with CMC OA were more likely to have worse outcomes.</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 1","pages":"Article 100867"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420376","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":"Cost Effectiveness of Hand Postaxial Polydactyly Type B Excision in the Office Versus Operating Room","authors":"Manisha Banala BBA ,&nbsp;Sarah L. Struble MD ,&nbsp;Holly Cordray BS ,&nbsp;Benjamin Chang MD ,&nbsp;Apurva S. Shah MD, MBA ,&nbsp;Eliza Buttrick BA ,&nbsp;John R. Vaile MD ,&nbsp;Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2025.100865","DOIUrl":"10.1016/j.jhsg.2025.100865","url":null,"abstract":"<div><h3>Purpose</h3><div>Postaxial polydactyly type B of the hand can be excised in the office with local anesthesia or in the operating room under general anesthesia. Existing studies have not described the cost difference between these treatments. We compared charges, reimbursements, and outcomes of office and operating room excision.</div></div><div><h3>Methods</h3><div>All cases of postaxial polydactyly type B excision at a children’s hospital from fiscal year 2018–2023 were included. Independent <em>t</em> tests and Fisher exact tests were performed to compare the charges and outcomes of office and operating room excisions. Random-effects models were used to compare differences in reimbursements since these data were obtained as summary statistics (mean [SD]) by fiscal year.</div></div><div><h3>Results</h3><div>Of 620 total patients, 30 (4.8%) underwent operating room excisions (22 bilateral and 8 unilateral), and 590 (95%) had office excisions (346 bilateral and 244 unilateral). Average total charges were 78% and 84% less for bilateral and unilateral excisions, respectively, in the office than in the operating room. Insurance companies paid $7800 more for bilateral operating room excisions and $7600 more for unilateral operating room excisions. Surgeons received $2300 more for bilateral operating room excisions and $1300 more for unilateral operating room excisions. The treatment strategy did not impact outcomes.</div></div><div><h3>Conclusions</h3><div>Given the cost efficacy and safety of office excision, operating room excision should be limited to patient-specific factors requiring general anesthesia.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100865"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420384","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":"Maintaining Stability in Metacarpal Ray Amputations: A Novel Technique Using Cortical Suspensory Button Fixation","authors":"Taylor Anthony DO ,&nbsp;William Fang DO ,&nbsp;Reily Cannon BS ,&nbsp;Nicole Infantino MS ,&nbsp;Joseph Meter DO ,&nbsp;MS. Andrew J. Bronstein MD ,&nbsp;Olivia J. Wang MD","doi":"10.1016/j.jhsg.2025.100869","DOIUrl":"10.1016/j.jhsg.2025.100869","url":null,"abstract":"<div><div>Maintaining stability and function in the hand after major traumatic injury remains a significant challenge for surgeons. Ray resection has shown promise in quality of life in patients with dysfunctional digits resulting from prior trauma, ischemia, malignancy, infection, and congenital abnormalities. Ray resection may serve as a viable salvage procedure for persistent digit dysfunction following unsuccessful preservation of the digit. We present the case of a 42-year-old man manual laborer who sustained a zone 3 flexor tendon laceration in the long-finger. Over several years, multiple tendon repairs and revision attempts were unsuccessful. Ultimately, the patient underwent long-finger ray resection at the metacarpal base, with cortical suspensory button fixation applied to the adjacent metacarpals. After surgery, the patient regained hand function and reported excellent satisfaction with the outcome.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100869"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420245","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":"Enhancing Healing with Noncontact Low-Frequency Ultrasound in Fingertip Amputation Treatment: A Comparative Pilot Study","authors":"Robert W. Gomez MD ,&nbsp;Abbigail Walsh ppOTD ,&nbsp;Kevin G. Valdes MS ,&nbsp;Kristofer S. Matullo MD","doi":"10.1016/j.jhsg.2025.100843","DOIUrl":"10.1016/j.jhsg.2025.100843","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute traumatic fingertip amputations are common injuries. This study aimed to evaluate the efficacy of noncontact low-frequency ultrasound (NCLF-US) as adjunctive therapy for treatment of fingertip amputations.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on adult patients with an acute traumatic fingertip amputation without exposed bone between February 2022 and April 2023. Exclusions included vascular disease, active infection, surgical intervention, primary closure, or subsequent trauma. Patients received either NCLF-US therapy combined with local wound care or local wound care alone (LWCA). Data collected included age, sex assigned at birth, history of diabetes, and injury dimensions. Data were used to assess cohort demographics, injury characteristics, and clinical course. Nominal and continuous variables were analyzed using Fisher exact test and Student <em>t</em> test, respectively, with statistical significance set at <em>P</em> ≤ .05.</div></div><div><h3>Results</h3><div>Among 19 digits, nine were treated with NCLF-US, and ten received LWCA. There was no considerable difference between cohorts in terms of age, sex, or history of diabetes. The NCLF-US cohort presented with an average wound size of 434.7 mm² compared to the LWCA cohort at 123.0 mm². Total time to healing in the NCLF-US cohort was 34.4 days compared to 49.2 days in the LWCA cohort. Healing rates for NCLF-US were 0.112 days/mm² compared to LWCA at 1.038 days/mm².</div></div><div><h3>Conclusions</h3><div>The NCLF-US cohort exhibited larger initial fingertip amputations, while demonstrating a time to healing nine times faster than those treated solely with local wound care. These findings are encouraging and offer initial support for the consideration of NCLF-US as an adjunctive therapy for treatment of fingertip amputations.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100843"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420300","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":"Influence of Sociodemographic Factors on Patient Completion of Patient-Reported Outcome Measures in Hand Surgery Patients","authors":"Ezra Goodrich MD ,&nbsp;Tobin Smith BA ,&nbsp;Mithil Gudi BS ,&nbsp;Nebiyat M. Girma MPH ,&nbsp;Carl Wilson MS ,&nbsp;Charles S. Day MD, MBA","doi":"10.1016/j.jhsg.2025.100872","DOIUrl":"10.1016/j.jhsg.2025.100872","url":null,"abstract":"<div><h3>Purpose</h3><div>Patient-reported outcome measures (PROMs) are standardized surveys that assess health outcomes, symptoms, functional status, and quality of life. Although prior studies have evaluated completion and/or participation across orthopedic subspecialties, no current studies have examined both completion and participation outcomes specifically in hand surgery. This study investigates the association between sociodemographic factors and PROM completion and participation in hand surgery patients.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of patients who underwent carpal tunnel release, trigger finger release, or both by an orthopedic hand surgeon at an academic center between 2020 and 2024. Demographic variables, area deprivation index, and PROM participation and completion were recorded. Participation was defined as completing at least one pre- and one postoperative survey, and completion was defined as completing all pre- and postoperative surveys. Univariable and multivariable logistic regression were used to identify factors associated with PROM completion and participation.</div></div><div><h3>Results</h3><div>In total, 406 patients were included for review. Black patients had lower rates of survey completion, and both Asian and Black patients demonstrated reduced participation of PROM surveys. Furthermore, patients from minority backgrounds and patients residing in areas with greater sociodemographic disadvantage were less likely to complete and participate in PROM surveys. Additionally, increasing age was also associated with decreased likelihood of both survey completion and participation.</div></div><div><h3>Conclusions</h3><div>This study found PROM completion and participation rates to be lower among hand surgery patients of Black race, racial/ethnic minorities, higher area deprivation index score, and older age. However, only participation rates were lower for Asian race and those with active smoking status. These findings support similar studies in other orthopedic subspecialties and support the need for equitable PROMs collection to better represent patients across all sociodemographic backgrounds.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100872"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420385","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":"Macro Fat Graft Application for Preventing Tendon Adhesion After Tendon Repair: An Experimental Study in Rats","authors":"Betha Egih Riestiano MD ,&nbsp;Arif Tri Prasetyo MD, M Clin Med ,&nbsp;Almahitta Cintami Putri MD, PhD ,&nbsp;Lisa Hasibuan MD, PhD ,&nbsp;Ali Sundoro MD, PhD ,&nbsp;Selvy Harianti MD","doi":"10.1016/j.jhsg.2025.100807","DOIUrl":"10.1016/j.jhsg.2025.100807","url":null,"abstract":"<div><h3>Purpose</h3><div>Tendon adhesion is a common postoperative complication following tendon repair, leading to impaired movement and increased morbidity. This study aimed to evaluate the effect of autologous macro fat grafts on preventing tendon adhesion following Achilles tendon repair in a Wistar rat model.</div></div><div><h3>Methods</h3><div>A laboratory experimental study was conducted using a randomized post-test-only control group design. Thirty-six female Wistar rats were divided into two groups: control (no fat graft) and treatment groups (autologous macro fat graft applied circumferentially around the Achilles tendon after incision and repair). Histopathological evaluation was performed 3 weeks postintervention, assessing tenocyte count, collagen density, and both clinical and microscopic adhesion scores. Data analysis was performed using Mann-Whitney U and χ² tests with a significance level of <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The treatment group showed a notable reduction in adhesion scores and adhesion grades compared with the control group. Collagen density was also lower in the treatment group than in the control group. However, no meaningful difference was observed in tenocyte count between the two groups, although the treatment group demonstrated a slightly lower mean tenocyte count.</div></div><div><h3>Conclusions</h3><div>The application of autologous macro fat grafts reduced tendon adhesion scores, adhesion grades, and collagen density postrepair, suggesting its potential as an effective strategy for preventing tendon adhesion. However, it did not considerably affect tenocyte proliferation.</div></div><div><h3>Clinical relevance</h3><div>This preclinical study suggests that autologous macro fat grafting may reduce postoperative tendon adhesions and improve surgical outcomes, supporting its potential translation into clinical settings.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 6","pages":"Article 100807"},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319486","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":"Cartilage Defect Articulation With the Proximal Phalanx After Retrograde Intramedullary Screw Fixation of Metacarpal Fractures: A Cadaveric Study","authors":"Clayton Hui BS ,&nbsp;Benjamin Watzig MD ,&nbsp;Luke Nicholson MD ,&nbsp;Joshua W. Hustedt MD, MHS","doi":"10.1016/j.jhsg.2025.100847","DOIUrl":"10.1016/j.jhsg.2025.100847","url":null,"abstract":"<div><h3>Purpose</h3><div>Retrograde intramedullary screw fixation for metacarpal fractures has become increasingly popular; however, the technique requires violation of the extensor mechanism at the metacarpophalangeal (MCP) joint and penetration of the metacarpal articular surface. Although prior studies have quantified the proportion of metacarpal articular surface involved in screw placement, none have evaluated how the resulting cartilage defect articulates with the proximal phalanx at the MCP joint as a potential source of altered wear patterns.</div></div><div><h3>Methods</h3><div>In a cadaveric study, six specimens (24 metacarpals) underwent fixation of simulated metacarpal neck fractures with either a 3.6 or a 4.5 mm metacarpal-specific screw inserted via peritendinous or percutaneous approach. The location and percentage of the metacarpal head articular surface damage were measured. The MCP joint was then taken through a full arc of motion in all planes to map contact between the metacarpal defect and the proximal phalanx articular cartilage.</div></div><div><h3>Results</h3><div>Retrograde screw placement resulted in an average of 8% metacarpal articular surface damage. The percutaneous approach produced a significantly more volar starting point compared with the peritendinous approach. Across the simulated arc of motion, 100% of the proximal phalanx articular cartilage came into contact with the cartilage defect on the metacarpal head.</div></div><div><h3>Conclusions</h3><div>Retrograde metacarpal screw fixation produces a focal cartilage defect on the metacarpal head that tracks across the entire proximal phalanx articular surface during MCP joint motion.</div></div><div><h3>Clinical relevance</h3><div>This focal damage articulating with the entire base of the phalanx may alter contact stress, potentially accelerating degradation and predisposing to MCP arthritis over time.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100847"},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690820","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}