Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.07.007
Feray Karademir PT, PhD , Adalet Elçin Yıldız MD , Kadir Mutlu Hayran MD, PhD , İbrahim Faruk Adıgüzel MD , Özlem Ülger PT, PhD , Tüzün Fırat PT, PhD
Purpose
Although recent studies have emphasized the importance of the adductor pollicis (AdP) and first dorsal interosseous (FDI) muscles in maintaining trapeziometacarpal (TMC) joint function, the viscoelastic properties of these muscles in the presence of TMC osteoarthritis (OA) remain unclear. This study aimed to investigate differences in the elasticity of the AdP and FDI muscles in patients with TMC OA, thereby contributing to the understanding of muscular changes associated with the disease.
Methods
Eighteen patients with TMC OA (29 thumbs) and 13 age- and sex-matched asymptomatic controls (26 thumbs) were included. The elasticity of the AdP and FDI muscles was measured using shear wave elastography (SWE). Data were analyzed using a linear mixed-effects model to assess differences between the groups.
Results
SWE values of the AdP muscle were notably higher in patients with TMC OA compared with controls, whereas no notable difference was found in the FDI muscle.
Conclusions
SWE provides a quantitative and real-time method for assessing the thenar muscle elasticity and detecting changes in the AdP muscle in TMC OA. Our findings suggest that shear wave elastography may be a promising tool for investigating biomechanical mechanisms involved in the pathogenesis of TMC OA.
Clinical relevance
SWE may inform clinical decision-making by identifying changes in the viscoelastic properties of the thenar muscles, which could support the assessment of muscle-targeted interventions in TMC OA.
{"title":"Shear Wave Elastography for the Assessment of Thenar Muscle Elasticity in Trapeziometacarpal Osteoarthritis: A Cross-Sectional Study","authors":"Feray Karademir PT, PhD , Adalet Elçin Yıldız MD , Kadir Mutlu Hayran MD, PhD , İbrahim Faruk Adıgüzel MD , Özlem Ülger PT, PhD , Tüzün Fırat PT, PhD","doi":"10.1016/j.jhsa.2025.07.007","DOIUrl":"10.1016/j.jhsa.2025.07.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Although recent studies have emphasized the importance of the adductor pollicis (AdP) and first dorsal interosseous (FDI) muscles in maintaining trapeziometacarpal (TMC) joint function, the viscoelastic properties of these muscles in the presence of TMC osteoarthritis (OA) remain unclear. This study aimed to investigate differences in the elasticity of the AdP and FDI muscles in patients with TMC OA, thereby contributing to the understanding of muscular changes associated with the disease.</div></div><div><h3>Methods</h3><div>Eighteen patients with TMC OA (29 thumbs) and 13 age- and sex-matched asymptomatic controls (26 thumbs) were included. The elasticity of the AdP and FDI muscles was measured using shear wave elastography (SWE). Data were analyzed using a linear mixed-effects model to assess differences between the groups.</div></div><div><h3>Results</h3><div>SWE values of the AdP muscle were notably higher in patients with TMC OA compared with controls, whereas no notable difference was found in the FDI muscle.</div></div><div><h3>Conclusions</h3><div>SWE provides a quantitative and real-time method for assessing the thenar muscle elasticity and detecting changes in the AdP muscle in TMC OA. Our findings suggest that shear wave elastography may be a promising tool for investigating biomechanical mechanisms involved in the pathogenesis of TMC OA.</div></div><div><h3>Clinical relevance</h3><div>SWE may inform clinical decision-making by identifying changes in the viscoelastic properties of the thenar muscles, which could support the assessment of muscle-targeted interventions in TMC OA.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 153.e1-153.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.07.028
Gustavo L. Gomez Rodriguez MD , Francisco R. Melibosky MD , Sze Ryn Chung MD , Sanjeev Kakar MD, MBA
The traditional management of distal radius fractures involves the use of fluoroscopy or capsulotomy to guide articular reduction. Arthroscopy is a tool that can aid in achieving articular congruity as well as the management of concomitant injuries, where indicated. In this article, we present a practical arthroscopic step-by-step guide in the treatment of distal radius fractures.
{"title":"Arthroscopic Management of Intraarticular Distal Radius Fractures: A Step-by-Step Approach","authors":"Gustavo L. Gomez Rodriguez MD , Francisco R. Melibosky MD , Sze Ryn Chung MD , Sanjeev Kakar MD, MBA","doi":"10.1016/j.jhsa.2025.07.028","DOIUrl":"10.1016/j.jhsa.2025.07.028","url":null,"abstract":"<div><div>The traditional management of distal radius fractures involves the use of fluoroscopy or capsulotomy to guide articular reduction. Arthroscopy is a tool that can aid in achieving articular congruity as well as the management of concomitant injuries, where indicated. In this article, we present a practical arthroscopic step-by-step guide in the treatment of distal radius fractures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 228.e1-228.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trapeziometacarpal (TMC) joint arthrodesis is an established surgical option to manage TMC joint arthritis. However, nonunion remains a complication after arthrodesis. In this study, we aimed to evaluate the outcomes of using a locking plate and headless compression screw with autogenous bone grafting.
Methods
We identified 21 thumbs that underwent TMC arthrodesis using this procedure. Radiographs and computed tomography scans were obtained to define bone union. Furthermore, we asked patients whether they had returned to their original work at every follow-up visit. To assess objective and subjective outcomes, we measured grip and pinch strengths; range-of-motion; radial and palmar abduction; Kapandji score; visual analog scale score; Disabilities of the Arm, Shoulder, Hand score; and Hand20 questionnaire scores before surgery and at 3, 6, and 12 months after surgery.
Results
Bone union was achieved in all patients. Bone fusion was achieved within 8 weeks after surgery in 17 thumbs, the remaining thumbs achieved bony fusion within 11 weeks. Thirteen of the 14 patients who had paid employment returned to their original work after a mean of 7 weeks. Grip and pinch strengths decreased at 3 months but returned to baseline levels at 6 months after surgery. Metacarpophalangeal joint flexion and Kapandji score decreased at 3 months and did not recover to baseline levels at 1 year after surgery. The visual analog scale and Disabilities of the Arm, Shoulder, Hand scores, and the Hand20 questionnaire showed improvement in the early postoperative period, which continued until 1 year after surgery.
Conclusions
Locking plate and headless compression screw fixation with an autogenous bone graft allows for a reliable bone union and return to work.
{"title":"Trapeziometacarpal Joint Arthrodesis Using a Locking Plate and Headless Compression Screw With an Autogenous Bone Graft","authors":"Akihiro Hirakawa MD, PhD , Shingo Komura MD, PhD , Marie Nohara AS , Kazuichiro Ohnishi MD, PhD , Haruhiko Akiyama MD, PhD","doi":"10.1016/j.jhsa.2025.04.021","DOIUrl":"10.1016/j.jhsa.2025.04.021","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Trapeziometacarpal (TMC) joint arthrodesis is an established surgical option to manage TMC joint arthritis. However, </span>nonunion<span> remains a complication after arthrodesis. In this study, we aimed to evaluate the outcomes of using a locking plate and headless compression screw with autogenous bone grafting.</span></div></div><div><h3>Methods</h3><div><span>We identified 21 thumbs that underwent TMC arthrodesis using this procedure. Radiographs and computed tomography scans were obtained to define </span>bone union<span>. Furthermore, we asked patients whether they had returned to their original work at every follow-up visit. To assess objective and subjective outcomes, we measured grip and pinch strengths; range-of-motion; radial and palmar abduction; Kapandji score; visual analog scale score; Disabilities of the Arm, Shoulder, Hand score; and Hand20 questionnaire scores before surgery and at 3, 6, and 12 months after surgery.</span></div></div><div><h3>Results</h3><div><span>Bone union was achieved in all patients. Bone fusion was achieved within 8 weeks after surgery in 17 thumbs, the remaining thumbs achieved bony fusion within 11 weeks. Thirteen of the 14 patients who had paid employment returned to their original work after a mean of 7 weeks. Grip and pinch strengths decreased at 3 months but returned to baseline levels at 6 months after surgery. Metacarpophalangeal joint flexion and Kapandji score decreased at 3 months and did not recover to baseline levels at 1 year after surgery. The visual analog scale and Disabilities of the Arm, Shoulder, Hand scores, and the Hand20 questionnaire showed improvement in the early </span>postoperative period, which continued until 1 year after surgery.</div></div><div><h3>Conclusions</h3><div>Locking plate and headless compression screw fixation with an autogenous bone graft allows for a reliable bone union and return to work.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic Ⅳ.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 154.e1-154.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.04.010
Harvey Chim MD , Sami H. Tuffaha MD , Johnny Chuieng-Yi Lu MD
Purpose
Reconstruction of wrist extension in C5–C8 root brachial plexus injuries (BPIs) is challenging, because of limited nerve and tendon donors. The purpose of this study was to report outcomes relating to the pronator quadratus branch of the anterior interosseous nerve (AIN) to extensor carpi radialis brevis (ECRB) nerve transfer from three BP surgeons.
Methods
Ten patients with C5–C8 BPI underwent AIN to ECRB nerve transfer. The mean age of the patients was 30.5 ± 15.9 years. All patients were men. The mean time to nerve surgery following initial injury was 4.5 ± 1.2 months. In all patients, wrist extension was absent at baseline. All patients had a minimum follow-up of 12 months (mean: 28.1 months) after surgery.
Results
Seven of 10 patients achieved Medical Research Council (M) grading system 4 wrist extension. In these patients, mean time to M2 was 12.7 ± 10.1 months, and mean time to M4 was 19.9 ± 10.0 months. The three patients who did not achieve M4 wrist extension had double fascicular transfer and relied strongly on the “Oberlin effect” where wrist flexion was required to initiate and achieve antigravity elbow flexion. Additionally, the three patients who did not achieve M4 wrist extension also had longer recovery to achieve antigravity (M3) elbow flexion, all presenting with poorer ability to initiate and achieve elbow flexion independent of the Oberlin effect. None of the patients had loss of forearm pronation after AIN to ECRB nerve transfer.
Conclusions
The AIN to ECRB nerve transfer can effectively reconstruct wrist extension in BPI patients with C5–C8 root injuries. Single fascicular transfer with the ulnar nerve as a donor and avoidance of multiple muscle targets for reinnervation from the median nerve may result in more consistent recovery through this nerve transfer.
{"title":"Wrist Extension Reconstruction Using Distal Anterior Interosseous to Extensor Carpi Radialis Brevis Nerve Transfer in Brachial Plexus Injuries","authors":"Harvey Chim MD , Sami H. Tuffaha MD , Johnny Chuieng-Yi Lu MD","doi":"10.1016/j.jhsa.2025.04.010","DOIUrl":"10.1016/j.jhsa.2025.04.010","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Reconstruction of wrist extension in C5–C8 root brachial plexus injuries<span> (BPIs) is challenging, because of limited nerve and tendon donors. The purpose of this study was to report outcomes relating to the pronator quadratus branch of the anterior interosseous nerve (AIN) to extensor </span></span>carpi<span> radialis brevis (ECRB) nerve transfer from three BP surgeons.</span></div></div><div><h3>Methods</h3><div>Ten patients with C5–C8 BPI underwent AIN to ECRB nerve transfer. The mean age of the patients was 30.5 ± 15.9 years. All patients were men. The mean time to nerve surgery following initial injury was 4.5 ± 1.2 months. In all patients, wrist extension was absent at baseline. All patients had a minimum follow-up of 12 months (mean: 28.1 months) after surgery.</div></div><div><h3>Results</h3><div><span>Seven of 10 patients achieved Medical Research<span> Council (M) grading system 4 wrist extension. In these patients, mean time to M2 was 12.7 ± 10.1 months, and mean time to M4 was 19.9 ± 10.0 months. The three patients who did not achieve M4 wrist extension had double fascicular transfer and relied strongly on the “Oberlin effect” where wrist flexion was required to initiate and achieve antigravity elbow flexion. Additionally, the three patients who did not achieve M4 wrist extension also had longer recovery to achieve antigravity (M3) elbow flexion, all presenting with poorer ability to initiate and achieve elbow flexion independent of the Oberlin effect. None of the patients had loss of forearm </span></span>pronation after AIN to ECRB nerve transfer.</div></div><div><h3>Conclusions</h3><div><span>The AIN to ECRB nerve transfer can effectively reconstruct wrist extension in BPI patients with C5–C8 root injuries. Single fascicular transfer with the ulnar nerve<span> as a donor and avoidance of multiple muscle targets for reinnervation from the </span></span>median nerve may result in more consistent recovery through this nerve transfer.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 175-180.e1"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.01.017
Won Sun Lee MD , Young Ho Shin MD, PhD , Jae Kwang Kim MD, PhD
Purpose
This study assessed the differences in clinical outcomes among the subtypes of type IV radial polydactyly and evaluated the distribution of the duplication range according to subtype.
Methods
This retrospective study included 85 patients with 89 affected thumbs, who were treated at a single center from October 2017 to May 2023. The patients were classified according to the modified Wassel–Flatt classification, and only those with type IV radial polydactyly were included. The collected data included demographics, surgical techniques, clinical outcomes, and radiological outcomes. Clinical outcomes were analyzed using the Japanese Society for Surgery of the Hand (JSSH) scoring system.
Results
The most common subtype of radial polydactyly was IV-B, accounting for 50 patients. Types IV-C and IV-D accounted for 17 and 22 patients, respectively. The median age at the time of surgery was 10 months, and the median follow-up was 24 months. Type IV-D demonstrated significantly lower total JSSH scores and functional parameter scores than types IV-B and IV-C. Regarding functional parameters, type IV-D exhibited significantly poorer outcomes in terms of interphalangeal joint stability and alignment, as well as range of motion; however, metacarpophalangeal joint stability and alignment were similar among the types. Type IV-D also exhibited significant differences in the distribution of the duplication range compared with type IV-B and IV-C. It had a more distal duplication level.
Conclusions
Type IV-D radial polydactyly requires more complex surgical interventions and has less favorable outcomes than types IV-B and IV-C. It exhibits poorer functional outcomes, particularly in the interphalangeal joint and range of motion assessments. Furthermore, type IV-D exhibits differences in the duplication range compared with other subtypes, and has a more distal duplication level.
{"title":"Clinical Outcome of Modified Wassel–Flatt Type IV Radial Polydactyly: Analysis of Subtype and Morphology","authors":"Won Sun Lee MD , Young Ho Shin MD, PhD , Jae Kwang Kim MD, PhD","doi":"10.1016/j.jhsa.2025.01.017","DOIUrl":"10.1016/j.jhsa.2025.01.017","url":null,"abstract":"<div><h3>Purpose</h3><div>This study assessed the differences in clinical outcomes among the subtypes of type IV radial polydactyly and evaluated the distribution of the duplication range according to subtype.</div></div><div><h3>Methods</h3><div>This retrospective study included 85 patients with 89 affected thumbs, who were treated at a single center from October 2017 to May 2023. The patients were classified according to the modified Wassel–Flatt classification, and only those with type IV radial polydactyly were included. The collected data included demographics, surgical techniques, clinical outcomes, and radiological outcomes. Clinical outcomes were analyzed using the Japanese Society for Surgery of the Hand (JSSH) scoring system.</div></div><div><h3>Results</h3><div>The most common subtype of radial polydactyly was IV-B, accounting for 50 patients. Types IV-C and IV-D accounted for 17 and 22 patients, respectively. The median age at the time of surgery was 10 months, and the median follow-up was 24 months. Type IV-D demonstrated significantly lower total JSSH scores and functional parameter scores than types IV-B and IV-C. Regarding functional parameters, type IV-D exhibited significantly poorer outcomes in terms of interphalangeal joint<span> stability and alignment, as well as range of motion; however, metacarpophalangeal joint stability and alignment were similar among the types. Type IV-D also exhibited significant differences in the distribution of the duplication range compared with type IV-B and IV-C. It had a more distal duplication level.</span></div></div><div><h3>Conclusions</h3><div>Type IV-D radial polydactyly requires more complex surgical interventions and has less favorable outcomes than types IV-B and IV-C. It exhibits poorer functional outcomes, particularly in the interphalangeal joint and range of motion assessments. Furthermore, type IV-D exhibits differences in the duplication range compared with other subtypes, and has a more distal duplication level.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 192.e1-192.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.07.015
Parunyu Vilai MD , Andrew R. Thoreson MS , Cheng-Yu Yin MD , Alexander W. Hooke MA , Taylor P. Trentadue BS , Kristin D. Zhao PhD , Sanjeev Kakar MD, MBA
Purpose
The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the distal radioulnar joint (DRUJ). Injury to the TFCC’s foveal insertion can cause ulnar-sided wrist pain and DRUJ instability. The aim of this study was to assess DRUJ stability, as measured by volar-dorsal translation, after TFCC foveal repair using an arthroscopic “over-the-top” technique.
Methods
After obtaining institutional biospecimens approval, eight fresh-frozen cadavers were procured. Distal radioulnar joint instability was defined as an increase in sagittal translation of the distal ulna relative to the radius. A custom biomechanical testing protocol was implemented, which involved applying a linear translation to the radius and measuring both the applied force and bone displacement in the dorsal–volar direction. The stability of the DRUJ was tested with an intact foveal insertion and ulnar styloid insertion, after release of the entire TFCC foveal insertion and transection of the superficial TFCC attachment to the ulnar styloid, and then after the “over-the-top” technique repair with three different suture configurations. Distal radioulnar joint stability was assessed in the following three wrist positions: neutral, 60° pronation, and 60° supination using both translation and stability improvement as outcomes.
Results
Distal radioulnar joint translation increased between the intact and injured conditions in neutral, pronation, and supination. Suture repair improved DRUJ translation compared with the injured state. Percent stability improvement, calculated relative to the injured condition, was higher across all repair groups. A single suture repair restored approximately half the stability relative to the injured condition, whereas the three-suture repair demonstrated the greatest improvement in DRUJ stability.
Conclusions
“Over-the-top” TFCC foveal repairs can enhance postoperative DRUJ stability.
Clinical relevance
“Over-the-top” TFCC foveal repair using three sutures provides the greatest improvement in DRUJ stability in a cadaveric model. These findings may help guide surgical decision-making regarding the optimal number of sutures needed to restore DRUJ stability following foveal TFCC injuries.
{"title":"Over-the-Top Foveal Triangular Fibrocartilage Complex Repairs With Distal Radioulnar Joint Instability: A Biomechanical Study","authors":"Parunyu Vilai MD , Andrew R. Thoreson MS , Cheng-Yu Yin MD , Alexander W. Hooke MA , Taylor P. Trentadue BS , Kristin D. Zhao PhD , Sanjeev Kakar MD, MBA","doi":"10.1016/j.jhsa.2025.07.015","DOIUrl":"10.1016/j.jhsa.2025.07.015","url":null,"abstract":"<div><h3>Purpose</h3><div>The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the distal radioulnar joint (DRUJ). Injury to the TFCC’s foveal insertion can cause ulnar-sided wrist pain and DRUJ instability. The aim of this study was to assess DRUJ stability, as measured by volar-dorsal translation, after TFCC foveal repair using an arthroscopic “over-the-top” technique.</div></div><div><h3>Methods</h3><div>After obtaining institutional biospecimens approval, eight fresh-frozen cadavers were procured. Distal radioulnar joint instability was defined as an increase in sagittal translation of the distal ulna relative to the radius. A custom biomechanical testing protocol was implemented, which involved applying a linear translation to the radius and measuring both the applied force and bone displacement in the dorsal–volar direction. The stability of the DRUJ was tested with an intact foveal insertion and ulnar styloid insertion, after release of the entire TFCC foveal insertion and transection of the superficial TFCC attachment to the ulnar styloid, and then after the “over-the-top” technique repair with three different suture configurations. Distal radioulnar joint stability was assessed in the following three wrist positions: neutral, 60° pronation, and 60° supination using both translation and stability improvement as outcomes.</div></div><div><h3>Results</h3><div>Distal radioulnar joint translation increased between the intact and injured conditions in neutral, pronation, and supination. Suture repair improved DRUJ translation compared with the injured state. Percent stability improvement, calculated relative to the injured condition, was higher across all repair groups. A single suture repair restored approximately half the stability relative to the injured condition, whereas the three-suture repair demonstrated the greatest improvement in DRUJ stability.</div></div><div><h3>Conclusions</h3><div>“Over-the-top” TFCC foveal repairs can enhance postoperative DRUJ stability.</div></div><div><h3>Clinical relevance</h3><div>“Over-the-top” TFCC foveal repair using three sutures provides the greatest improvement in DRUJ stability in a cadaveric model. These findings may help guide surgical decision-making regarding the optimal number of sutures needed to restore DRUJ stability following foveal TFCC injuries.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 155-161"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.03.021
Etka Kurucan MD , Bradley Wiekrykas MD , Alec Talsania MD , Gabriel Alonso BS , Joseph Thoder MD , Mark Solarz MD
Purpose
Upper-extremity compartment syndrome can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma, in recent years, opioid and substance-related overdose has led to a rise in patients with “found down” compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism.
Methods
A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups.
Results
Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with rhabdomyolysis and kidney injury requiring hemodialysis.
Conclusions
Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of rhabdomyolysis and acute kidney injury requiring hemodialysis.
{"title":"Upper-Extremity Compartment Syndrome: Comparison of Substance-Related Found Down and Acute Trauma Mechanisms","authors":"Etka Kurucan MD , Bradley Wiekrykas MD , Alec Talsania MD , Gabriel Alonso BS , Joseph Thoder MD , Mark Solarz MD","doi":"10.1016/j.jhsa.2025.03.021","DOIUrl":"10.1016/j.jhsa.2025.03.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Upper-extremity compartment syndrome<span> can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma<span>, in recent years, opioid and substance-related overdose has led to a rise in patients with “found down” compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism.</span></span></div></div><div><h3>Methods</h3><div>A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups.</div></div><div><h3>Results</h3><div><span>Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness<span> and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen<span>, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with </span></span></span>rhabdomyolysis<span><span> and kidney injury requiring </span>hemodialysis.</span></div></div><div><h3>Conclusions</h3><div><span><span>Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of </span>rhabdomyolysis and </span>acute kidney injury<span> requiring hemodialysis.</span></div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 215.e1-215.e9"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.02.009
Nicholas B. Pohl MS , Parker L. Brush MD , Jory P. Parson BS , Patrick Fitzgerald BS , Alex Charlton BS , Pedro K. Beredjiklian MD , Daniel J. Fletcher MD
Purpose
To assess the incidence of subsequent treatment of trigger finger in the same or additional digits after the initial trigger finger release, as well as identify patient characteristics associated with the need for subsequent treatment.
Methods
This study retrospectively analyzed 1,715 patients with a trigger finger who underwent surgical release from 2015 to 2017. Bivariate analysis was performed to determine the percentage of patients requiring further trigger finger treatment by either steroid injection or operative release. Patient factors were then compared in those who did and did not undergo subsequent treatment. Cox proportional hazards models and survival analysis were performed to identify patient characteristics associated with requiring subsequent treatment, injection, and surgery.
Results
Overall, 690 (40.2%) patients required subsequent treatment with either steroid injection or surgical release in either the same or an additional finger. Four hundred sixty patients (26.8%) underwent at least one subsequent injection, with 36 (2.1%) of these on the same finger. Additionally, 230 (13.4%) patients received at least one subsequent first annular pulley release, with 14 (0.8%) on the same finger as the initial release. Cox proportional hazards models showed patients with a higher comorbidly burden and current smoking status were more likely to receive subsequent treatment. Higher body mass index and greater comorbidity burden were also associated with requiring subsequent surgery. Additionally, current smokers or patients with a greater comorbidity burden had a higher risk of requiring subsequent treatment in an additional digit not initially released.
Conclusions
Subsequent release or injection in the same or another digit was common following an initial trigger finger release. Patient characteristics such as higher body mass index and greater comorbidity burden were associated with requiring subsequent surgery, and smoking status as well as comorbidity burden were associated with subsequent treatment in an additional digit not initially released.
{"title":"Incidence and Predictors of Subsequent Triggering Requiring Treatment After Trigger Finger Release","authors":"Nicholas B. Pohl MS , Parker L. Brush MD , Jory P. Parson BS , Patrick Fitzgerald BS , Alex Charlton BS , Pedro K. Beredjiklian MD , Daniel J. Fletcher MD","doi":"10.1016/j.jhsa.2025.02.009","DOIUrl":"10.1016/j.jhsa.2025.02.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the incidence of subsequent treatment of trigger finger in the same or additional digits after the initial trigger finger release, as well as identify patient characteristics associated with the need for subsequent treatment.</div></div><div><h3>Methods</h3><div><span>This study retrospectively analyzed 1,715 patients with a trigger finger who underwent surgical release from 2015 to 2017. Bivariate analysis was performed to determine the percentage of patients requiring further trigger finger treatment by either steroid injection or operative release. Patient factors were then compared in those who did and did not undergo subsequent treatment. Cox </span>proportional hazards models and survival analysis were performed to identify patient characteristics associated with requiring subsequent treatment, injection, and surgery.</div></div><div><h3>Results</h3><div>Overall, 690 (40.2%) patients required subsequent treatment with either steroid injection or surgical release in either the same or an additional finger. Four hundred sixty patients (26.8%) underwent at least one subsequent injection, with 36 (2.1%) of these on the same finger. Additionally, 230 (13.4%) patients received at least one subsequent first annular pulley release, with 14 (0.8%) on the same finger as the initial release. Cox proportional hazards models showed patients with a higher comorbidly burden and current smoking status were more likely to receive subsequent treatment. Higher body mass index and greater comorbidity burden were also associated with requiring subsequent surgery. Additionally, current smokers or patients with a greater comorbidity burden had a higher risk of requiring subsequent treatment in an additional digit not initially released.</div></div><div><h3>Conclusions</h3><div>Subsequent release or injection in the same or another digit was common following an initial trigger finger release. Patient characteristics such as higher body mass index and greater comorbidity burden were associated with requiring subsequent surgery, and smoking status as well as comorbidity burden were associated with subsequent treatment in an additional digit not initially released.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 203.e1-203.e8"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.10.005
Jad Lawand MS , Jeffrey Hauck BS , Umar Ghilzai MD , Dawn LaPorte MD
Purpose
Malnutrition has been associated with increased postoperative complications, yet its influence on distal radius open reduction and internal fixation (ORIF) remains unexplored. This study compared the impact of malnutrition on complications following ORIF within both 90-day and 2-year postoperative periods.
Methods
This retrospective cohort study used electronic medical records. Patients were divided into two cohorts: those with malnutrition, defined by having one or more of the following laboratory findings: albumin <3.5 g/dL; transferrin <204 mg/dL; or total leukocyte count <1,500/μL within 3 months prior to surgery, and those without malnutrition. Propensity score matching accounted for demographic and comorbidity differences. Risk ratios (RRs) were calculated to assess relative complication risks between the cohorts.
Results
The study included 1,877 patients in the malnutrition group and 18,168 in the control group, with 1,871 per cohort after matching. Over 90 days, malnutrition patients had higher rates of skin infection (RR: 2.00; 95% confidence interval [CI]: 1.39–2.88), deep vein thrombosis (RR: 2.70; 95% CI: 1.68–4.33), sepsis (RR: 2.92; 95% CI: 1.56–5.47), wound disruption (RR: 2.11; 95% CI: 1.22–3.62), pulmonary embolism (RR: 2.50; 95% CI: 1.41–4.45), and acute kidney disease (RR: 2.78; 95% CI: 1.34–5.76). There were no significant differences in rates of nerve injury, myocardial infarction, or stroke. At 2 years, malnutrition at the time of the initial injury was associated with increased risk of hardware loosening following ORIF (RR: 1.79; 95% CI: 1.18–2.71) and nonunion (RR: 2.49; 95% CI: 1.57–3.94).
Conclusions
Malnutrition significantly increases the risk of postoperative complications following ORIF for distal radius fractures. Within 90 days, malnourished patients experienced higher rates of skin infections, deep vein thrombosis, sepsis, wound disruption, pulmonary embolism, and acute kidney disease. At 2 years, malnutrition at the time of injury was associated with elevated risks of loosening of ORIF hardware and nonunion.
{"title":"The Influence of Malnutrition on Postoperative Complications Following Open Reduction and Internal Fixation for Distal Radius Fractures","authors":"Jad Lawand MS , Jeffrey Hauck BS , Umar Ghilzai MD , Dawn LaPorte MD","doi":"10.1016/j.jhsa.2025.10.005","DOIUrl":"10.1016/j.jhsa.2025.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Malnutrition has been associated with increased postoperative complications, yet its influence on distal radius open reduction and internal fixation (ORIF) remains unexplored. This study compared the impact of malnutrition on complications following ORIF within both 90-day and 2-year postoperative periods.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used electronic medical records. Patients were divided into two cohorts: those with malnutrition, defined by having one or more of the following laboratory findings: albumin <3.5 g/dL; transferrin <204 mg/dL; or total leukocyte count <1,500/μL within 3 months prior to surgery, and those without malnutrition. Propensity score matching accounted for demographic and comorbidity differences. Risk ratios (RRs) were calculated to assess relative complication risks between the cohorts.</div></div><div><h3>Results</h3><div>The study included 1,877 patients in the malnutrition group and 18,168 in the control group, with 1,871 per cohort after matching. Over 90 days, malnutrition patients had higher rates of skin infection (RR: 2.00; 95% confidence interval [CI]: 1.39–2.88), deep vein thrombosis (RR: 2.70; 95% CI: 1.68–4.33), sepsis (RR: 2.92; 95% CI: 1.56–5.47), wound disruption (RR: 2.11; 95% CI: 1.22–3.62), pulmonary embolism (RR: 2.50; 95% CI: 1.41–4.45), and acute kidney disease (RR: 2.78; 95% CI: 1.34–5.76). There were no significant differences in rates of nerve injury, myocardial infarction, or stroke. At 2 years, malnutrition at the time of the initial injury was associated with increased risk of hardware loosening following ORIF (RR: 1.79; 95% CI: 1.18–2.71) and nonunion (RR: 2.49; 95% CI: 1.57–3.94).</div></div><div><h3>Conclusions</h3><div>Malnutrition significantly increases the risk of postoperative complications following ORIF for distal radius fractures. Within 90 days, malnourished patients experienced higher rates of skin infections, deep vein thrombosis, sepsis, wound disruption, pulmonary embolism, and acute kidney disease. At 2 years, malnutrition at the time of injury was associated with elevated risks of loosening of ORIF hardware and nonunion.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 164-171"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jhsa.2025.04.013
Adam P. Henderson BS , Lane Moore MD, MBA , Annika Hiredesai BA , Paul R. Van Schuyver MD , Joseph C. Brinkman MD , Jack M. Haglin MD, MS , Jeffrey D. Hassebrock MD , Kevin J. Renfree MD
Purpose
The purpose of the study was to compare the Medicaid and Medicare professional service reimbursement rates for a select group of hand surgery procedures.
Methods
Medicare rates for 26 common hand procedures were obtained from the Center for Medicare & Medicaid fee schedule database using Medicare Administrative Contractor localities to approximate state lines. Medicaid rates were found at each state Medicaid online fee schedule website. State rates were compared with corresponding Medicare rates using mean values and dollar differences. Each state’s reimbursement values were also adjusted using the Medicare Wage Index, a relative scale comparing state wages with the national average, to account for regional wage differences. Variability between states and between procedures was analyzed using the coefficient of variation values.
Results
Medicaid reimbursement was lower than that of Medicare for 22 of the 26 procedures included in the analysis. On average, Medicaid reimbursement rates were 18% lower than Medicare for the same procedure, a difference that increased to 29% when accounting for wage differences via the Medicare Wage Index. The coefficient of variation values were low across Medicare procedures, indicating low variability between states. The coefficient of variation values were much higher for Medicaid rates and increased when adjusted for state wage differences, indicating high variability between state Medicaid rates.
Conclusions
Professional fee reimbursement for select hand surgery procedures is substantially lower with Medicaid compared with Medicare, and there is a high degree of variability between states. Wage differences do not explain differences in state pricing.
Clinical relevance
Low Medicaid reimbursement for hand surgery procedures may have negative implications for health care access in some states. The wide variability in reimbursement between states is concerning, given that Medicaid is supported mostly by federal funding.
{"title":"State Disparities in Medicaid Versus Medicare Reimbursement for Hand Surgery","authors":"Adam P. Henderson BS , Lane Moore MD, MBA , Annika Hiredesai BA , Paul R. Van Schuyver MD , Joseph C. Brinkman MD , Jack M. Haglin MD, MS , Jeffrey D. Hassebrock MD , Kevin J. Renfree MD","doi":"10.1016/j.jhsa.2025.04.013","DOIUrl":"10.1016/j.jhsa.2025.04.013","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of the study was to compare the Medicaid and Medicare professional service reimbursement rates for a select group of hand surgery procedures.</div></div><div><h3>Methods</h3><div>Medicare rates for 26 common hand procedures were obtained from the Center for Medicare & Medicaid fee schedule database using Medicare Administrative Contractor localities to approximate state lines. Medicaid rates were found at each state Medicaid online fee schedule website. State rates were compared with corresponding Medicare rates using mean values and dollar differences. Each state’s reimbursement values were also adjusted using the Medicare Wage Index, a relative scale comparing state wages with the national average, to account for regional wage differences. Variability between states and between procedures was analyzed using the coefficient of variation values.</div></div><div><h3>Results</h3><div>Medicaid reimbursement was lower than that of Medicare for 22 of the 26 procedures included in the analysis. On average, Medicaid reimbursement rates were 18% lower than Medicare for the same procedure, a difference that increased to 29% when accounting for wage differences via the Medicare Wage Index. The coefficient of variation values were low across Medicare procedures, indicating low variability between states. The coefficient of variation values were much higher for Medicaid rates and increased when adjusted for state wage differences, indicating high variability between state Medicaid rates.</div></div><div><h3>Conclusions</h3><div>Professional fee reimbursement for select hand surgery procedures is substantially lower with Medicaid compared with Medicare, and there is a high degree of variability between states. Wage differences do not explain differences in state pricing.</div></div><div><h3>Clinical relevance</h3><div>Low Medicaid reimbursement for hand surgery procedures may have negative implications for health care access in some states. The wide variability in reimbursement between states is concerning, given that Medicaid is supported mostly by federal funding.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 2","pages":"Pages 214.e1-214.e16"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号