Hand : Official Journal of the American Association for Hand Surgery

BACKGROUND: As racial/ethnic disparities in management of distal radius fractures (DRFs) have not been well elucidated in the literature, this study sought to evaluate the correlation of race/ethnicity on surgical versus nonsurgical management of DRFs in a Medicare population. METHODS: The PearlDiver Standard Analytical Files Medicare claims database was used to identify patients ≥65 years old with isolated DRF. Patients with polytrauma or surgery performed for upper extremity neoplasm were excluded...

BACKGROUND: While complexity of distal radius fractures varies, volar plating is the most prevalent surgical option in adult injuries. The time between date of injury and surgical intervention varies according to several factors, including the timing of presentation and the surgeon's availability. This study aims to understand the impact of a delay in surgical intervention on operative time, patient-reported outcomes, and reoperation rates. METHODS: A retrospective review was performed on patients treated with volar plating of distal radius fractures from 2017 to 2020 at a single institution by multiple surgeons...

Radiation-induced brachial plexopathy (RIBP) is a rare long-term complication of radiation therapy often causing pain, motor deficit, and overall quality of life reduction for affected patients. While a standard treatment for RIBP is yet to be established, management consists mostly of symptom management through the use of medications and physical therapy. There is a lack of evidence regarding the efficacy of surgical treatment. Omentoplasties and other vascularized flaps are commonly discussed options for eliminating neuropathic pain associated with RIBP...

BACKGROUND: The purpose of this study was to evaluate the association between timing of nerve repair and the ability to perform a primary nerve repair versus a bridge repair requiring the use of allograft, autograft, or a conduit in lacerated upper extremity peripheral nerve injuries. METHODS: This is a retrospective case-control study of patients who underwent upper extremity nerve repair for lacerated peripheral nerves identified by Current Procedural Terminology codes...

BACKGROUND: Magnetic resonance imaging (MRI) is commonly used to diagnose and assess the extent of partial distal biceps injuries. The aim of this study was to report on the accuracy of MRI and the effect of injury history and study timing on its performance. METHODS: A retrospective review of all patients who underwent surgical treatment of partial thickness distal biceps tears at a single center by multiple surgeons was performed. Inclusion criteria consisted of the performance of a preoperative MRI and documentation of the intraoperatively visualized extent of the tear, and 68 patients met the criteria for inclusion...

BACKGROUND: Kirschner wire (K-wire) insertion during surgery for distal radius fractures carries a risk of damaging the radial nerve's superficial branch. In this prospective study, we investigated the relationship between the radial nerve's superficial branch and the radius using ultrasound to minimize risk. METHODS: We collected data from 101 healthy volunteers (202 limbs; 51 men; mean age: 40.6 years). We ultrasonographically assessed the courses of the radial nerve's dorsal and superficial palmar branches at 0, 1, 2, and 3 cm proximal to the radial styloid process tip...

BACKGROUND: Proximal phalanx fractures are common, with surgical fixation indicated for unstable fractures. Traditionally, closed reduction percutaneous pinning (CRPP) resulted in decreased stiffness and tendon irritation compared to open reduction internal fixation (ORIF). We hypothesized that more recent studies would have more similar outcomes to CRPP. The purpose of this study was to compare CRPP and ORIF in terms of range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and complications...

BACKGROUND: The purpose of this study was to gather information regarding current practices in the care of carpometacarpal (CMC) arthroplasty including the use of hand therapy, immobilization, and surgical technique, and to determine which factors influence these patterns. METHODS: We conducted a survey from February 24, 2022, through March 26, 2022, of 3648 currently practicing members of the American Society for Surgery of the Hand. We developed an 11-item questionnaire that contained questions about surgical technique, immobilization, and postoperative therapy utilization...

BACKGROUND: Arthroplasty is commonly performed in the management of osteoarthrosis of the hand and wrist by orthopedic or plastic surgeons with a fellowship in hand. The differences between operative outcomes between the 2 groups have not been described. Therefore, we analyzed a national database to determine acute outcomes between orthopedic and plastic surgery when performing arthroplasty for osteoarthrosis of the hand and wrist. METHODS: A retrospective cross-sectional analysis was performed by including patients with osteoarthrosis of the hand and wrist by International Classification of Diseases codes...

BACKGROUND: There is increased interest in ultrasound (US) for the diagnosis of cubital tunnel syndrome (CuTS). We hypothesize that ulnar nerve cross-sectional area (CSA) correlates with disease severity and electrodiagnostic studies (EDX). METHODS: ARetrospective review was performed at a tertiary medical center. One hundred seventeen patients (166 ulnar nerves) were evaluated. Maximum CSA at 3 points around the elbow (proximal, groove, and distal) and EDX results (American Board of Electrodiagnostic Medicine-certified physiatrist's interpretations) were collected...

BACKGROUND: Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS). METHODS: We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX...

No abstract text is available yet for this article.

Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging such as magnetic resonance imaging and ultrasound is often obtained. These modalities have the disadvantages of reduced sensitivity or increased cost and time, respectively. We present a unique case of a triquetral fracture and pisiform dislocation causing index finger flexor digitorum profundus (FDP-I) entrapment that was diagnosed preoperatively with computed tomography (CT) imaging with 3-dimensional (3D) volume rendering...

BACKGROUND: Posterolateral rotatory instability (PLRI) results from lateral ulnar collateral ligament (LCL) deficiency. The lateral pivot shift test is used to diagnose PLRI but can be difficult to perform and is poorly tolerated. We present a new maneuver, the Posterior Radiocapitellar Subluxation Test (PRST), that we believe is easier to perform. The purpose of this study was to compare the efficacy and reproducibility of the PRST with the lateral pivot shift test. METHODS: We obtained 10 cadaveric upper extremity specimens, performed a Kocher approach on each, released the LCL origin in 5, then closed...

BACKGROUND: Scaphoid excision and 4-bone fusion (4BF) is a surgical procedure to treat scapholunate advanced collapse. Some surgeons align the lunate over the capitates, whereas others leave the capitate in its uncovered native position. The capitolunate angle may affect long-term outcomes. This study examined whether postsurgical outcomes differed based on these differences in positioning. METHODS: A retrospective analysis was performed for patients that underwent a 4BF between 2006 and 2020...

BACKGROUND: Dupuytren is a fibroproliferative pathology leading to contracture of the palmar fascia. Several approaches have been described for the surgical treatment with partial fasciectomy with few comparisons in literature. Our purpose is to compare the functional outcomes between the partial fasciectomy performed by Bruner type incision and zetaplasty incision. METHODS: The method used was a randomized clinical trial including adult patients of both sexes with surgical indication for Dupuytren disease presented to a reference center...

BACKGROUND: Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis...

BACKGROUND: Open A1 pulley release for trigger finger has generally been considered a minor procedure with infrequent complications. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1% to 4%. We aimed to describe the potentially devastating sequelae of these major complications and the subsequent consequences...

BACKGROUND: Intramedullary screw fixation of the proximal ulna can be used for fixation of the ulnar component in total elbow arthroplasty. Our purpose was to use computed tomography (CT) to characterize proximal ulna anatomy with respect to intramedullary screw fixation, and then to validate this templating process by inserting intramedullary screws into 3-dimensional (3D)-printed models. METHODS: Thirty elbow CT scans were reformatted in the axis of the proximal ulna...

BACKGROUND: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls...