Retrograde intramedullary headless screws are increasingly used for metacarpal fractures, but concerns regarding long-term complications, such as metacarpophalangeal osteoarthritis, persist. This study evaluated osteoarthritic changes following this fixation method.
Methods
A retrospective analysis of 41 patients treated with retrograde intramedullary headless screws between 2014 and 2018 was conducted, with a minimum follow-up of 72 months. Fracture healing and joint changes were evaluated through radiographs and computed tomography.
Results
At a mean follow-up of 87 months, no osteoarthritic changes or chondrolysis were observed on radiographs or computed tomography scans. The screw affected an average of 17.5% of the metacarpal head’s articular surface, with no evidence of erosion over time. Two early postoperative complications related to fracture treatment (one hardware failure and one malunion) occurred, both unrelated to osteoarthritic changes and without impact on long-term outcomes.
Conclusions
Retrograde intramedullary headless screw fixation is not associated with long-term osteoarthritic changes over a 6-year follow-up.
{"title":"Assessing Osteoarthritis Risk After Retrograde Intramedullary Headless Screw Fixation for Metacarpal Fractures: A Minimum Six-Year Follow-Up Study","authors":"Sergi Barrera-Ochoa MD, PhD , Pilar Saralegui MD , Rita Pereira Cavaca MD , Andrés Alvial-San Martín MD","doi":"10.1016/j.jhsa.2025.10.008","DOIUrl":"10.1016/j.jhsa.2025.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Retrograde intramedullary headless screws are increasingly used for metacarpal fractures, but concerns regarding long-term complications, such as metacarpophalangeal osteoarthritis, persist. This study evaluated osteoarthritic changes following this fixation method.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 41 patients treated with retrograde intramedullary headless screws between 2014 and 2018 was conducted, with a minimum follow-up of 72 months. Fracture healing and joint changes were evaluated through radiographs and computed tomography.</div></div><div><h3>Results</h3><div>At a mean follow-up of 87 months, no osteoarthritic changes or chondrolysis were observed on radiographs or computed tomography scans. The screw affected an average of 17.5% of the metacarpal head’s articular surface, with no evidence of erosion over time. Two early postoperative complications related to fracture treatment (one hardware failure and one malunion) occurred, both unrelated to osteoarthritic changes and without impact on long-term outcomes.</div></div><div><h3>Conclusions</h3><div>Retrograde intramedullary headless screw fixation is not associated with long-term osteoarthritic changes over a 6-year follow-up.</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 1","pages":"Pages 27-32"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453991","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.12.004
{"title":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2025.12.004","DOIUrl":"10.1016/j.jhsa.2025.12.004","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Page 120"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895852","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.09.009
Alexander Y. Shin MD , Francisco de Pinal MD, PhD
Prospective randomized controlled trials are widely regarded as the gold standard for evaluating therapeutic interventions. Although this model is appropriate for drug development, its application in surgical research has proven challenging and, in many cases, misleading. Surgery involves complex interactions between technical skill, patient variability, and intraoperative decision-making that cannot be easily standardized or controlled. This article outlines 10 reasons why prospective randomized studies in surgery are fundamentally different from drug trials, highlighting methodological, ethical, and practical concerns. Recognizing these distinctions is critical to developing more appropriate and context-sensitive research frameworks for surgical evaluation.
{"title":"Ten Reasons Why Prospective Randomized Studies in Surgery Are Flawed and Fundamentally Different From Drug Trials","authors":"Alexander Y. Shin MD , Francisco de Pinal MD, PhD","doi":"10.1016/j.jhsa.2025.09.009","DOIUrl":"10.1016/j.jhsa.2025.09.009","url":null,"abstract":"<div><div>Prospective randomized controlled trials are widely regarded as the gold standard for evaluating therapeutic interventions. Although this model is appropriate for drug development, its application in surgical research has proven challenging and, in many cases, misleading. Surgery involves complex interactions between technical skill, patient variability, and intraoperative decision-making that cannot be easily standardized or controlled. This article outlines 10 reasons why prospective randomized studies in surgery are fundamentally different from drug trials, highlighting methodological, ethical, and practical concerns. Recognizing these distinctions is critical to developing more appropriate and context-sensitive research frameworks for surgical evaluation.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 121-125"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423503","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.03.005
Mary E. Ziegler PhD , Melinda Lem MD , Jacklyn Melkonian BS , Tania Nasrollahi BS , Helia Rahimian , Abtin Shams MD , Nikhil Prabhakar BS , Seyedeh Saina Saifzadeh BS , Amalvin Fritz , Amber Leis MD , Alan Widgerow MBBCh, MMed
Purpose
Transforming myofibroblasts (MFs) into adipocyte-like cells may be a viable option for treating Dupuytren disease. Human Dupuytren MFs (DMFs) and adipose-derived stem cells (ASCs) cocultured in the presence of platelet-rich plasma (PRP) reprogrammed into lipid-laden cells. This treatment also reduced fibrosis markers in vivo. We aimed to determine whether this treatment transformed DMFs into adipocyte-like cells in vivo and characterize the PRP factors contributing to this transformation.
Methods
Dupuytren MFs and normal human dermal fibroblasts were transplanted into the forepaws of rats (Rowett Nude [rnu/rnu]). Two months later, the paws were treated with saline, ASCs + PRP, or Clostridium histolyticum (clinical comparison) once a week for three treatments. The paw tissue was harvested 1 week after each treatment and subjected to Masson trichrome staining, collagen I and III, α-smooth muscle actin (SMA), and perilipin detection by immunohistochemistry. Dupuytren MFs were cocultured with ASCs and PRP or insulin-like growth factor I (IGF-I) or IGF-I-depleted PRP. In addition, the IGF-I receptor was inhibited. Oil Red O or boron-dipyrromethene detected lipid-laden cells.
Results
Rodent paws implanted with DMFs showed enhanced α-SMA expression, imbalanced collagen III:I ratio, and reduced adipocytes compared with normal human dermal fibroblasts. After treatment with ASCs + PRP, DMF paws demonstrated reduced α-SMA, a balanced collagen III:I ratio, and a replenishment of adipocytes. Dupuytren MFs treated with ASCs + IGF-I transformed into adipocyte-like cells in vitro, which was validated by IGF-I-depletion and IGF-I receptor inhibition.
Conclusions
Adipose-derived stem cells + PRP reduce fibrosis markers and induce adipocyte renewal in vivo. As a PRP component, IGF-I works with ASCs to transform DMFs into adipocyte-like cells in vitro.
Clinical relevance
Identifying an active factor in PRP that synergizes with ASCs to transform DMFs into adipocyte-like cells may contribute to finding a novel therapeutic for Dupuytren disease. Such a treatment may allow for less-extensive surgical intervention coupled with therapeutic injection to reduce the recurrence of Dupuytren disease.
{"title":"Transforming Myofibroblasts Into Lipid-Filled Cells to Treat Dupuytren Disease","authors":"Mary E. Ziegler PhD , Melinda Lem MD , Jacklyn Melkonian BS , Tania Nasrollahi BS , Helia Rahimian , Abtin Shams MD , Nikhil Prabhakar BS , Seyedeh Saina Saifzadeh BS , Amalvin Fritz , Amber Leis MD , Alan Widgerow MBBCh, MMed","doi":"10.1016/j.jhsa.2025.03.005","DOIUrl":"10.1016/j.jhsa.2025.03.005","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span><span>Transforming myofibroblasts (MFs) into adipocyte-like cells may be a viable option for treating </span>Dupuytren disease. Human Dupuytren MFs (DMFs) and adipose-derived stem cells (ASCs) cocultured in the presence of platelet-rich plasma (PRP) reprogrammed into lipid-laden cells. This treatment also reduced </span>fibrosis markers </span><em>in vivo</em>. We aimed to determine whether this treatment transformed DMFs into adipocyte-like cells <em>in vivo</em><span> and characterize the PRP factors contributing to this transformation.</span></div></div><div><h3>Methods</h3><div>Dupuytren MFs and normal human dermal fibroblasts were transplanted into the forepaws of rats (Rowett Nude [rnu/rnu]). Two months later, the paws were treated with saline, ASCs + PRP, or <span><span>Clostridium histolyticum</span></span><span><span> (clinical comparison) once a week for three treatments. The paw tissue<span> was harvested 1 week after each treatment and subjected to Masson trichrome staining, collagen I and III, α-smooth muscle actin (SMA), and </span></span>perilipin<span> detection by immunohistochemistry. Dupuytren MFs were cocultured with ASCs and PRP or insulin-like growth factor I (IGF-I) or IGF-I-depleted PRP. In addition, the IGF-I receptor was inhibited. Oil Red O or boron-dipyrromethene detected lipid-laden cells.</span></span></div></div><div><h3>Results</h3><div>Rodent paws implanted with DMFs showed enhanced α-SMA expression, imbalanced collagen III:I ratio, and reduced adipocytes compared with normal human dermal fibroblasts. After treatment with ASCs + PRP, DMF paws demonstrated reduced α-SMA, a balanced collagen III:I ratio, and a replenishment of adipocytes. Dupuytren MFs treated with ASCs + IGF-I transformed into adipocyte-like cells <em>in vitro</em>, which was validated by IGF-I-depletion and IGF-I receptor inhibition.</div></div><div><h3>Conclusions</h3><div>Adipose-derived stem cells + PRP reduce fibrosis markers and induce adipocyte renewal <em>in vivo</em>. As a PRP component, IGF-I works with ASCs to transform DMFs into adipocyte-like cells <em>in vitro</em>.</div></div><div><h3>Clinical relevance</h3><div>Identifying an active factor in PRP that synergizes with ASCs to transform DMFs into adipocyte-like cells may contribute to finding a novel therapeutic for Dupuytren disease. Such a treatment may allow for less-extensive surgical intervention coupled with therapeutic injection to reduce the recurrence of Dupuytren disease.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 93-102.e1"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058630","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}
This study aimed to evaluate the clinical outcomes of surgical treatment for chronic mallet injury with severe extension lag using an anatomic reconstruction of the terminal tendon and lateral band with a palmaris longus (PL) tendon graft.
Methods
Eleven patients with a mean age of 52 years (range, 24–82 years) who underwent surgical reconstruction for chronic tendon mallet injuries using the PL tendon were included. The harvested PL tendon was either folded longitudinally or divided into two slips. The graft was secured to the distal phalanx using a bone anchor and sutured to the soft tissues and remnants of the original terminal tendon distal to the distal interphalangeal (DIP) joint. Each half-slip tendon was passed under the transverse retinacular ligament and sutured side-to-side to the lateral band at approximately the midpoint of the proximal phalanx. The active range of motion of the affected finger was evaluated before and after surgery, and any complications were recorded.
Results
Before surgery, the extension of the DIP joint averaged −49.5° (range, −40° to −60°). The postoperative mean lag of the DIP joint improved to −7.8° (range, −20° to +20°). According to the Miller classification, four patients had excellent results, four had good results, and three had fair results. Two patients who underwent folded-PL tendon grafting developed superficial dorsal skin infections on the little finger that resolved with oral antibiotics or removal of the sutures.
Conclusions
Anatomical reconstruction of the terminal tendon and lateral bands using a PL tendon graft yielded satisfactory outcomes in chronic tendon mallet injuries. Dividing the PL tendon into two slips is recommended to reduce the risk of postoperative infection.
{"title":"Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury","authors":"Taku Suzuki MD, PhD , Yasuhiro Kiyota MD, PhD , Noboru Matsumura MD, PhD , Kazuki Sato MD, PhD , Masaya Nakamura MD, PhD , Takuji Iwamoto MD, PhD","doi":"10.1016/j.jhsa.2025.04.025","DOIUrl":"10.1016/j.jhsa.2025.04.025","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the clinical outcomes of surgical treatment for chronic mallet injury with severe extension lag using an anatomic reconstruction of the terminal tendon and lateral band with a palmaris longus (PL) tendon graft.</div></div><div><h3>Methods</h3><div>Eleven patients with a mean age of 52 years (range, 24–82 years) who underwent surgical reconstruction<span><span> for chronic tendon mallet injuries using the PL tendon were included. The harvested PL tendon was either folded longitudinally or divided into two slips. The graft was secured to the distal phalanx using a bone anchor and sutured to the soft tissues and remnants of the original terminal tendon distal to the distal interphalangeal (DIP) joint. Each half-slip tendon was passed under the transverse retinacular ligament and sutured side-to-side to the lateral band at approximately the midpoint of the </span>proximal phalanx. The active range of motion of the affected finger was evaluated before and after surgery, and any complications were recorded.</span></div></div><div><h3>Results</h3><div>Before surgery, the extension of the DIP joint averaged −49.5° (range, −40° to −60°). The postoperative mean lag of the DIP joint improved to −7.8° (range, −20° to +20°). According to the Miller classification, four patients had excellent results, four had good results, and three had fair results. Two patients who underwent folded-PL tendon grafting developed superficial dorsal skin infections on the little finger that resolved with oral antibiotics or removal of the sutures.</div></div><div><h3>Conclusions</h3><div>Anatomical reconstruction of the terminal tendon and lateral bands using a PL tendon graft yielded satisfactory outcomes in chronic tendon mallet injuries. Dividing the PL tendon into two slips is recommended to reduce the risk of postoperative infection.</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 1","pages":"Pages 92.e1-92.e7"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340654","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.07.011
Jayme A. Bertelli MD, PhD , Ismaray de Avila Díaz MD , Fernando Levaro MD , Juliana Andrea Rojas Neira MD , Francisco Soldado MD, PhD
Purpose
A subset of patients with brachial plexus birth injuries experiences a loss of internal rotation, resulting either from neurological paralysis, as a complication of surgical procedures intended to restore external rotation, or because of contractures of the external rotators. Although humeral internal rotation osteotomy can address this deficit, it often results in compromised external rotation. To mitigate this drawback, in supple shoulders, we investigated the pectoralis minor tendon transfer to the subscapularis footprint as an alternative.
Methods
Five patients with active internal rotation deficits, but a supple shoulder joint, secondary to brachial plexus birth injuries, underwent pectoralis minor tendon transfer to the lesser tuberosity of the humerus via a deltopectoral approach. Pre- and postoperative evaluations measured shoulder rotation with the shoulder adducted and the elbow flexed at 90°. Postoperative follow-up ranged from 9 to 14 months.
Results
All patients demonstrated improvement in internal rotation, with an average gain of 88°. After surgery, four patients were able to touch their abdominal flanks, whereas one patient, because of passive limitations, required wrist flexion to achieve this. External rotation was preserved in all cases.
Conclusions
Pectoralis minor tendon transfer presents a viable alternative for addressing internal rotation deficits while preserving external rotation. Its unique anatomy and innervation, derived from the lower roots of the brachial plexus, make it particularly well-suited for these cases.
{"title":"Pectoralis Minor Transfer for Internal Rotation Reconstruction in Brachial Plexus Birth Injuries","authors":"Jayme A. Bertelli MD, PhD , Ismaray de Avila Díaz MD , Fernando Levaro MD , Juliana Andrea Rojas Neira MD , Francisco Soldado MD, PhD","doi":"10.1016/j.jhsa.2025.07.011","DOIUrl":"10.1016/j.jhsa.2025.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>A subset of patients with brachial plexus birth injuries experiences a loss of internal rotation, resulting either from neurological paralysis, as a complication of surgical procedures intended to restore external rotation, or because of contractures of the external rotators. Although humeral internal rotation osteotomy can address this deficit, it often results in compromised external rotation. To mitigate this drawback, in supple shoulders, we investigated the pectoralis minor tendon transfer to the subscapularis footprint as an alternative.</div></div><div><h3>Methods</h3><div>Five patients with active internal rotation deficits, but a supple shoulder joint, secondary to brachial plexus birth injuries, underwent pectoralis minor tendon transfer to the lesser tuberosity of the humerus via a deltopectoral approach. Pre- and postoperative evaluations measured shoulder rotation with the shoulder adducted and the elbow flexed at 90°. Postoperative follow-up ranged from 9 to 14 months.</div></div><div><h3>Results</h3><div>All patients demonstrated improvement in internal rotation, with an average gain of 88°. After surgery, four patients were able to touch their abdominal flanks, whereas one patient, because of passive limitations, required wrist flexion to achieve this. External rotation was preserved in all cases.</div></div><div><h3>Conclusions</h3><div>Pectoralis minor tendon transfer presents a viable alternative for addressing internal rotation deficits while preserving external rotation. Its unique anatomy and innervation, derived from the lower roots of the brachial plexus, make it particularly well-suited for these cases.</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 1","pages":"Pages 73.e1-73.e10"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859949","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.11.001
Gregory A. Merrell MD
{"title":"The Journal of Hand Surgery in 2026 and Beyond: It Takes a Village","authors":"Gregory A. Merrell MD","doi":"10.1016/j.jhsa.2025.11.001","DOIUrl":"10.1016/j.jhsa.2025.11.001","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 1-2"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895853","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.09.017
Zayd Al Rawi BS , Elizabeth Graesser MD , Lindley B. Wall MD, MSc
Purpose
The management of distal radius fractures (DRF) in patients aged ≥65 years is debated because there is evidence that operative and nonsurgical treatment yield similar outcomes 1 year after injury. When more than one reasonable treatment option exists, shared decision-making between the patient and physician should be used. This study elicited preferences for the treatment of DRF using a survey of participants aged ≥65 years.
Methods
A survey for participants ≥65 years was administered using Amazon Mechanical Turk. Participants were presented with a theoretical scenario in which they sustained a DRF, followed by two treatment options (surgery or casting) and evidence-based information on benefits, risks, and outcomes. Participants then responded to a series of 12 statements regarding the treatment options, rating their level of agreement on a Likert scale. At the end of the survey, they were asked to select their preferred treatment option.
Results
There were 393 respondents that met inclusion criteria, and 74% were men. Fifty-three percent reported a prior history of a wrist fracture, with 84% of those participants undergoing surgery. Thirty-nine percent strongly agreed that avoiding surgical risks is an important part of their decision, and 36% strongly agreed that they were willing to accept a longer time in a cast. Despite this, 82% of participants selected surgery as their preferred treatment for a theoretical DRF.
Conclusions
Although most participants selected surgery as their preferred treatment, many responses regarding individual treatment factors aligned with nonsurgical treatment. This may be attributed to participants’ belief that surgery leads to better outcomes or may highlight a disconnect between participants’ values and their treatment choice.
Clinical relevance
The results of this study can be used to facilitate shared decision-making conversations regarding the treatment of DRF in this patient population.
{"title":"A Survey-Based Assessment of Treatment Preferences for Distal Radius Fractures in Participants Aged 65 Years and Older","authors":"Zayd Al Rawi BS , Elizabeth Graesser MD , Lindley B. Wall MD, MSc","doi":"10.1016/j.jhsa.2025.09.017","DOIUrl":"10.1016/j.jhsa.2025.09.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The management of distal radius fractures (DRF) in patients aged ≥65 years is debated because there is evidence that operative and nonsurgical treatment yield similar outcomes 1 year after injury. When more than one reasonable treatment option exists, shared decision-making between the patient and physician should be used. This study elicited preferences for the treatment of DRF using a survey of participants aged ≥65 years.</div></div><div><h3>Methods</h3><div>A survey for participants ≥65 years was administered using Amazon Mechanical Turk. Participants were presented with a theoretical scenario in which they sustained a DRF, followed by two treatment options (surgery or casting) and evidence-based information on benefits, risks, and outcomes. Participants then responded to a series of 12 statements regarding the treatment options, rating their level of agreement on a Likert scale. At the end of the survey, they were asked to select their preferred treatment option.</div></div><div><h3>Results</h3><div>There were 393 respondents that met inclusion criteria, and 74% were men. Fifty-three percent reported a prior history of a wrist fracture, with 84% of those participants undergoing surgery. Thirty-nine percent strongly agreed that avoiding surgical risks is an important part of their decision, and 36% strongly agreed that they were willing to accept a longer time in a cast. Despite this, 82% of participants selected surgery as their preferred treatment for a theoretical DRF.</div></div><div><h3>Conclusions</h3><div>Although most participants selected surgery as their preferred treatment, many responses regarding individual treatment factors aligned with nonsurgical treatment. This may be attributed to participants’ belief that surgery leads to better outcomes or may highlight a disconnect between participants’ values and their treatment choice.</div></div><div><h3>Clinical relevance</h3><div>The results of this study can be used to facilitate shared decision-making conversations regarding the treatment of DRF in this patient population.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 33-41"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531010","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 : 2026-01-01DOI: 10.1016/j.jhsa.2025.12.003
{"title":"Journal CME Questions","authors":"","doi":"10.1016/j.jhsa.2025.12.003","DOIUrl":"10.1016/j.jhsa.2025.12.003","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Page 113"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895851","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}
This study aimed to objectively evaluate the sensitivity and specificity of the scratch collapse test (SCT) for the diagnosis of cubital tunnel syndrome (CuTS). We conducted a comparative experimental study to measure the force of shoulder external rotation using a dynamometer instead of the subjective outcome reported by examiners.
Methods
The force of shoulder external rotation was measured using a dynamometer while performing a SCT. Sixteen patients with electrodiagnostically confirmed CuTS and 20 healthy volunteers were included in this study. The difference between the external rotation force before and after the SCT was calculated in Newtons and expressed as a percentage change. A negative value indicated a reduction in force after the scratch maneuver. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated from the test results of the patient and control groups.
Results
The sensitivity of the SCT was 37%, whereas the specificity was 75%. The positive predictive value was 0.55, and the negative predictive value was 0.60. The overall accuracy of the SCT was 58%.
Conclusions
The SCT has been described initially as an accurate and useful diagnostic test for CuTS. Our result using a more objective method of measurement demonstrated relatively lower accuracy compared with previous studies.
{"title":"Objective Evaluation of the “Scratch Collapse Test” for the Diagnosis of Cubital Tunnel Syndrome Using Dynamometer","authors":"Navapong Anantavorasakul MD , Isarapong Duangmee MD , Sineenart Honglertkawin MD , Sopinan Siripoonyothai MD , Piyabuth Kittithamvongs MD, MSc , Kanchai Malungpaishrope MD , Somsak Leechavengvongs MD","doi":"10.1016/j.jhsa.2025.11.006","DOIUrl":"10.1016/j.jhsa.2025.11.006","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to objectively evaluate the sensitivity and specificity of the scratch collapse test (SCT) for the diagnosis of cubital tunnel syndrome (CuTS). We conducted a comparative experimental study to measure the force of shoulder external rotation using a dynamometer instead of the subjective outcome reported by examiners.</div></div><div><h3>Methods</h3><div>The force of shoulder external rotation was measured using a dynamometer while performing a SCT. Sixteen patients with electrodiagnostically confirmed CuTS and 20 healthy volunteers were included in this study. The difference between the external rotation force before and after the SCT was calculated in Newtons and expressed as a percentage change. A negative value indicated a reduction in force after the scratch maneuver. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated from the test results of the patient and control groups.</div></div><div><h3>Results</h3><div>The sensitivity of the SCT was 37%, whereas the specificity was 75%. The positive predictive value was 0.55, and the negative predictive value was 0.60. The overall accuracy of the SCT was 58%.</div></div><div><h3>Conclusions</h3><div>The SCT has been described initially as an accurate and useful diagnostic test for CuTS. Our result using a more objective method of measurement demonstrated relatively lower accuracy compared with previous studies.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 1","pages":"Pages 61.e1-61.e5"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895854","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}
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