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.
{"title":"Proximal Ulna Adamantinoma","authors":"Liam H. Wong MD , Rosanna Wustrack MD , Nicolas Lee MD , Leah Demetri MD","doi":"10.1016/j.jhsg.2025.100899","DOIUrl":"10.1016/j.jhsg.2025.100899","url":null,"abstract":"<div><div>Adamantinoma is a rare, malignant tumor that is typically seen in the tibia but has been reported in all long bones. We present the case of a woman who presented as a teenager with a pathologic fracture of the proximal ulna that was initially diagnosed as osteofibrous dysplasia and treated with internal fixation. After the lesion was identified in adulthood as adamantinoma, she was converted to a one-bone forearm procedure as a salvage treatment.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100899"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100898
Roshan V. Patel BS , Gnaneswar Chundi BS , David Mothy BS , Aayush Mehta BS , Tamara D. Rozental MD , Monica M. Shoji MD
Purpose
The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.
Methods
We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.
Results
A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.
Conclusions
There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.
{"title":"Where Are the Hand Surgeons? Examining the Socioeconomic and Geographic Gaps in Patients’ Access to Care in the United States","authors":"Roshan V. Patel BS , Gnaneswar Chundi BS , David Mothy BS , Aayush Mehta BS , Tamara D. Rozental MD , Monica M. Shoji MD","doi":"10.1016/j.jhsg.2025.100898","DOIUrl":"10.1016/j.jhsg.2025.100898","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.</div></div><div><h3>Methods</h3><div>We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.</div></div><div><h3>Results</h3><div>A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.</div></div><div><h3>Conclusions</h3><div>There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.</div></div><div><h3>Level of Evidence</h3><div>Cross-sectional study, III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100898"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100887
John R. Vaile MD , John A. Tipps BA , Rachel Hurley MD, PhD , Sarah L. Struble MD , Brooke E. Allen BS , Lea F. Surrey MD , Laura S. Finn MD , Frank M. Balis MD , Theodore W. Laetsch MD , Shaun D. Mendenhall MD
Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its NTRK fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.
{"title":"Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection","authors":"John R. Vaile MD , John A. Tipps BA , Rachel Hurley MD, PhD , Sarah L. Struble MD , Brooke E. Allen BS , Lea F. Surrey MD , Laura S. Finn MD , Frank M. Balis MD , Theodore W. Laetsch MD , Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2025.100887","DOIUrl":"10.1016/j.jhsg.2025.100887","url":null,"abstract":"<div><div>Infantile fibrosarcoma is a locally aggressive tumor that traditionally requires chemotherapy and radical excision or amputation. Recently, neoadjuvant therapies that exploit its <em>NTRK</em> fusion oncogenes have been used to decrease the extent of surgical resection. However, the management of morphologically similar infantile fibrosarcoma-like tumors has not been well characterized. We report a case of an anaplastic lymphoma kinase-driven infantile fibrosarcoma-like neoplasm of the hand that was managed using a multimodal, limb-sparing approach. A 35-week gestation neonate presented with a vascular mass on the volar aspect of his left hand. Neoadjuvant treatment with the anaplastic lymphoma kinase inhibitor lorlatinib led to considerable tumor regression, which enabled conservative surgical resection and preservation of the hand. At 2 years of follow-up, the patient remains on lorlatinib therapy without recurrence and demonstrates excellent hand function despite moderate scar contractures. This case highlights the efficacy of neoadjuvant therapy combined with resection in managing infantile fibrosarcoma-like tumors.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100887"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100896
Alex G. Lambi MD, PhD, FACS , Tomas Holy MD , Ryan E. Tomlinson PhD , Mary F. Barbe PhD, FAAA, FASBMR
Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.
{"title":"Radiation-Induced Brachial Plexopathy: Current Understanding, Diagnosis, and Treatment Options","authors":"Alex G. Lambi MD, PhD, FACS , Tomas Holy MD , Ryan E. Tomlinson PhD , Mary F. Barbe PhD, FAAA, FASBMR","doi":"10.1016/j.jhsg.2025.100896","DOIUrl":"10.1016/j.jhsg.2025.100896","url":null,"abstract":"<div><div>Radiation-induced brachial plexopathy (RIBP) is a gruesome complication of cancers treated with radiation therapy around the lung and chest wall, head and neck, and breast and axilla. It can occur in an early-onset (transient) or a late-onset (chronic) fashion. The diagnosis involves exclusion of a compressive neoplastic process, either new or recurrent, and relies largely on patient symptomatology without well-validated, objective scoring systems. Treatment options remain limited as no major advances have been made to prevent or halt disease progression. This article reviews the background incidence, pathophysiology, and diagnosis of RIBP. In addition to surgical treatment options, nonsurgical modalities, often the mainstay of symptom management, are discussed. Lastly, the current challenges in treating RIBP are highlighted with an emphasis on targeting the underlying culprit—radiation-induced fibrosis.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100896"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jhsg.2025.100891
Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD
There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.
{"title":"Temporary Dorsal Staple Fixation of Scapholunate Interosseous Ligament Repair and Reconstruction","authors":"Rafa Rahman MD, MPH , Matthew V. Abola MD , Michelle G. Carlson MD","doi":"10.1016/j.jhsg.2025.100891","DOIUrl":"10.1016/j.jhsg.2025.100891","url":null,"abstract":"<div><div>There is a wide variety of techniques to address scapholunate interosseous ligament injury, including both repair and reconstruction of the ligament. What many of these techniques have in common is the protection of the repair or reconstruction by the use of Kirschner wires (K-wires) temporarily placed across the scapholunate and sometimes scaphocapitate articulations to provide immobilization. There are multiple potential downsides to K-wire utilization, including possible interference with the repair or reconstruction, distraction of the scapholunate articulation as the K-wire is passed, occasional need for multiple passes for proper placement, contribution to stress risers within the bone, and unintentional K-wire complications, including breakage, migration, and infection. We describe the use of a dorsal, partially-inserted nitinol staple at the scapholunate articulation as an improved technique over K-wire use for temporary immobilization of the joint. Utilization of the staple allows for compression of the scapholunate interval, direct visualization during insertion, and the ability to avoid interference with the scapholunate interosseous ligament repair or reconstruction. In addition to a description of our surgical technique, we provide a summary of our experience using this technique in patients and a case illustration.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100891"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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