Journal Of Hand And Microsurgery[JOURNAL]
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200 papers
Dissecting neural anomalies and clinical impact of aberrant median and ulnar nerve pathways in the forearm: A systematic review and meta analysis.
Jeff Walter Rajadurai OR, Prem Regis PA, Supadevi S … +1 more , Vinoth S
J Hand Microsurg · 2026 May · PMID 41959652 · Full text
Aberrant communications between the median and ulnar nerves in the forearm and hand are clinically important anatomical variants that can significantly influence electrophysiological interpretation and surgical decision-...
Aberrant communications between the median and ulnar nerves in the forearm and hand are clinically important anatomical variants that can significantly influence electrophysiological interpretation and surgical decision-making. This systematic review and meta-analysis aimed to synthesize available anatomical and electrophysiological evidence on the prevalence, subtypes, and clinical implications of median-ulnar nerve anastomoses, including Martin-Gruber, Marinacci, Riche-Cannieu, and Berrettini connections. A comprehensive search of major databases identified 20 eligible studies encompassing electrophysiological, anatomical, and clinical designs. Meta-analysis was performed using event-rate methodology with logit transformation under a random-effects model. The pooled prevalence of Martin-Gruber anastomosis (MGA), derived from six studies, was approximately 21%, indicating that nearly one in five individuals demonstrates median-to-ulnar nerve communication in the forearm. Subgroup analysis revealed a higher prevalence in healthy populations (≈25%) compared with carpal tunnel syndrome (CTS) populations (≈8-10%), suggesting that median nerve compression may obscure electrophysiological detection of MGA. Cadaveric studies reported lower detection rates (≈6%), reflecting methodological differences. Subtype analysis demonstrated that Type II MGA was more prevalent than Type I, with pooled prevalence estimates of approximately 62% and 31%, respectively, highlighting substantial anatomical variability. Considerable heterogeneity was observed across subgroup analyses, reflecting differences in population characteristics and electrophysiological protocols. Beyond MGA, Marinacci anastomosis was uncommon (≈0.7-4%), whereas Riche-Cannieu and Berrettini anastomoses were frequent, with reported prevalences exceeding 50% in anatomical and electrophysiological studies. Clinically, these variants are highly relevant, as unrecognized nerve communications may lead to pseudo-conduction block, mislocalization of neuropathies, underestimation of CTS severity, and iatrogenic injury during forearm or hand surgery. These findings underscore the necessity of incorporating anatomical awareness and targeted electrophysiological strategies into routine clinical practice.
Measuring the carbon cost of hand surgery: A single-centre observational study.
Leijonberg L, Hindocha S, Maheshwari K
J Hand Microsurg · 2026 May · PMID 41953546 · Full text
PURPOSE: Healthcare contributes considerably to global greenhouse gas emissions, with operating theatres amongst the most energy-intensive hospital environments. While carbon footprints have been quantified for several s...
PURPOSE: Healthcare contributes considerably to global greenhouse gas emissions, with operating theatres amongst the most energy-intensive hospital environments. While carbon footprints have been quantified for several surgical procedures, the environmental impact of hand surgery, characterised by high case volumes and short procedures, remains poorly studied. This study aims to quantify carbon emissions of hand surgery procedures. METHODS: This single-centre observational pilot study quantified the carbon emissions associated with hand surgery procedures performed during two half-day theatre lists at a UK NHS hospital. Data was collected under the Greenhouse Gas Protocol Scopes and emissions calculated using UK Government greenhouse gas conversion factors. Data collected included theatre electricity and heating, anaesthetic use, staff and patient transport, waste incineration, supply-chain emissions, and instrument sterilisation. RESULTS: Five trauma hand surgery cases were analysed. Case-level emissions ranged from 8.32 to 22.56 kg CO. When combined at a list level, total emissions were substantial, reaching 311.36 kg CO and 285.30 kg CO per half-day list. Purchased electricity (Scope 2) was the largest contributor, followed by heating and anaesthetic gases (Scope 1). Scope 3 emissions were largely attributed to staff travel and single-use consumable supply-chain emissions, while waste disposal and reusable instrument sterilisation contributed comparatively little. CONCLUSIONS: Individual hand surgery procedures have a relatively low carbon footprint, but the cumulative emissions at list-level are large. Theatre energy use, heating and staff transport represent key targets for emission reduction. Interventions focusing on energy-efficient infrastructure, renewable energy, greener staff travel, and reduced reliance on single-use consumables may result in meaningful environmental benefits. Larger multicentre studies with improved energy metering are needed to refine estimates and guide sustainable surgical practice. CLINICAL RELEVANCE: Quantifying the carbon emissions associated with common hand surgery procedures may help hand surgery teams and healthcare organisations identify opportunities to reduce emissions.
Surgical treatment of hourglass-like nerve constrictions with allogeneic nerve: a series report of 4 cases.
Zhao M, Cao C, Wang M … +5 more , Wang H, Zhang H, Wang Y, Zhao J, Gong X
J Hand Microsurg · 2026 May · PMID 41908090 · Full text
PURPOSE: Hourglass-like constriction (HGC) is an anatomical finding of peripheral nerves, most commonly associated with immune-mediated inflammatory neuropathies such as neuralgic amyotrophy. Current treatment modalities...
PURPOSE: Hourglass-like constriction (HGC) is an anatomical finding of peripheral nerves, most commonly associated with immune-mediated inflammatory neuropathies such as neuralgic amyotrophy. Current treatment modalities primarily include conservative observation, neurolysis, autologous nerve grafting, and tendon transfer. Allogeneic nerves, as alternative graft materials for nerve reconstruction, have not been systematically reported in the management of hourglass-like constrictions. This study aimed to report the clinical outcomes of allogeneic nerve reconstruction in carefully selected cases of allogeneic nerve transplantation for treating multi-segmental radial nerve hourglass constrictions. METHODS: A retrospective analysis was performed on 4 patients (3 males, 1 female) with idiopathic radial nerve palsy treated in our department from February 2019 to February 2022. All cases presented with severe multi-segmental constrictions. Preoperative evaluation included electromyography and high-frequency ultrasound to assess nerve damage. Intraoperatively, constricted segments were completely resected, and allogeneic nerve grafts were used for reconstruction. Postoperative follow-up duration ranged from 18 to 26 months (mean 22 months). RESULTS: All incisions healed primarily without clinically apparent immune rejection or infection. Motor function was evaluated using the British Medical Research Council (BMRC) muscle strength grading scale, combined with electromyography for nerve regeneration assessment. At 18 months postoperatively, all patients achieved significant recovery of active thumb and finger extension: 3 patients demonstrated M4 strength in extensor pollicis longus and extensor digitorum communis, while 1 patient showed M3 for extensor pollicis longus and M4 for extensor digitorum communis. CONCLUSION: For severe multi-segmental hourglass-like constrictions, resection combined with nerve grafting is recommended. Allogeneic nerve transplantation may represent a safe and effective treatment option in selected cases of radial nerve hourglass constrictions. However, further large-scale randomized controlled trials are required to validate its long-term efficacy in repairing long-segment, thick mixed nerve defects.
Restoration versus stimulation: Meta-analysis of osteochondral autograft transplantation and microfracture for osteochondritis dissecans of the capitellum.
Dwidmuthe S, Barik S, Kotangale P … +5 more , Shahare P, Raj V, Kumar V, Jeyaraman M, Jeyaraman N
J Hand Microsurg · 2026 May · PMID 41858833 · Full text
OBJECTIVE: Surgical management of osteochondritis dissecans of the capitellum (OCDC) can range from simple arthroscopic debridement to microfracture to osteochondral autograft transplantation (OAT). The current review ai...
OBJECTIVE: Surgical management of osteochondritis dissecans of the capitellum (OCDC) can range from simple arthroscopic debridement to microfracture to osteochondral autograft transplantation (OAT). The current review aimed to pool the data from the published literature and analyse the outcomes of microfracture and OAT in OCDC. METHODS: Electronic databases of PubMed and Embase were searched from inception to March 31, 2024 following PRISMA 2020 guidelines. The population of interest was patients with OCDC managed surgically by either microfracture or OAT. Studies were included if they had ≥24 months of follow-up. A total of 21 eligible studies (14 OAT, 7 microfracture) involving 452 patients were analyzed. RESULTS: The search yielded 14 studies that reported on the outcome of OAT and 7 studies on microfracture. 452 patients were included in the review (OAT = 370, Microfracture = 182). There was no statistical difference in the duration of return to sports between the two groups. A statistically significant difference was noted in the number of patients returning to sports in both groups (OAT - 98%, 95% CI 97-100, Microfracture - 78%, 95% CI 61-96). Similarly, a significant difference was noted when comparing the number of patients returning to their original sports in the OAT group (92%, 95% CI 87-96) as compared to the microfracture group (66%, 95% CI 48-84). CONCLUSION: Early diagnosis and intervention in OCDC have the potential to lead to optimal functional outcomes in the elbow. The indication for a particular surgery depends on the patient's age, skeletal maturity, lesion stability, symptoms as well as vocation. Patients undergoing OAT have a higher statistical chance of returning to their original sports compared to those undergoing microfracture. Long-term studies will help us further understand the natural course of the procedure. LEVEL OF EVIDENCE: III.
Current evidence on non-surgical therapies for Dupuytren's disease: A clinical review.
Amigo I, Heras-Palou C
J Hand Microsurg · 2026 May · PMID 41809639 · Full text
Dupuytren's disease is a chronic fibroproliferative disorder characterized by progressive thickening and contracture of the palmar fascia, leading to nodules, cord formation, and varying degrees of digital flexion deform...
Dupuytren's disease is a chronic fibroproliferative disorder characterized by progressive thickening and contracture of the palmar fascia, leading to nodules, cord formation, and varying degrees of digital flexion deformity. Although the disease most commonly affects the longitudinal fibers of the palmar aponeurosis, it can also involve distal transverse fibers, natatory ligaments, and digital fascial extensions, including Grayson's and Cleland's ligaments. Its clinical presentation is highly heterogeneous, ranging from slowly evolving, stable nodules to rapidly progressive forms associated with aggressive phenotypes such as Garrod's knuckles or spiral cords that may compromise neurovascular structures. Current evidence suggests a multifactorial etiology involving genetic predisposition, aberrant Wnt/β-catenin signaling, biomechanical stimulation, and metabolic factors such as diabetes. While open surgery (limited fasciectomy) has long been considered the gold standard for advanced contractures, its associated morbidity has prompted increasing interest in minimally invasive or adjunctive non-surgical treatments. Collagenase (CCH) injections have demonstrated rapid functional recovery and acceptable safety, although recurrence rates remain higher than those of open surgery. Percutaneous needle aponeurotomy offers a simple, low-cost outpatient alternative with excellent short-term correction but significant long-term recurrence, particularly in PIP joints. Radiotherapy has been proposed for early nodular disease and may stabilize progression in selected patients, yet current evidence is methodologically weak and insufficient to support routine use. Pharmacologic approaches-including antifibrotic agents, tyrosine kinase inhibitors, intralesional corticosteroids, and emerging biologics such as anti-TNF therapies-remain experimental, with limited clinical validation to date. Rehabilitation, including supervised exercises and nighttime orthoses, is frequently used following minimally invasive interventions, although high-quality evidence supporting their long-term efficacy is lacking. Overall, non-surgical therapies expand the spectrum of management options for patients with Dupuytren's disease, particularly those presenting with early-stage nodular disease or mild-to-moderate contractures who seek less invasive alternatives to open surgery. However, these treatments vary considerably in durability, recurrence rates, and level of supporting evidence. Consequently, therapeutic decisions must be individualized, taking into account disease stage, anatomical involvement, patient expectations, risk tolerance, and clinician expertise. Continued research is needed to refine patient selection criteria, optimize treatment combinations, and evaluate emerging molecular therapies targeting the disease's underlying pathobiology.
Amandys® pyrocarbon interposition wrist arthroplasty: a systematic review of clinical outcomes and complications.
Smeraglia F, Marcovici LL, Basso MA … +3 more , Bernasconi A, Cozzolino A, Balato G
J Hand Microsurg · 2026 May · PMID 41809638 · Full text
BACKGROUND: Pyrocarbon interposition arthroplasty (Amandys®) has been proposed as a motion-preserving salvage procedure for advanced wrist degeneration. However, its clinical outcomes, complication profile, and role with...
BACKGROUND: Pyrocarbon interposition arthroplasty (Amandys®) has been proposed as a motion-preserving salvage procedure for advanced wrist degeneration. However, its clinical outcomes, complication profile, and role within the contemporary wrist salvage algorithm remain incompletely defined. OBJECTIVE: To systematically review the clinical outcomes, complications, and revision patterns associated with Amandys® pyrocarbon interposition wrist arthroplasty, without performing a direct comparative analysis with other wrist salvage procedures, and to clarify its role among current treatment options. MATERIALS AND METHODS: A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases. The search term "Amandys" was used without additional filters. Clinical studies reporting outcomes of Amandys® wrist arthroplasty were included. Data extraction focused on study characteristics, clinical outcomes, complications, and revision procedures. Methodological quality was assessed using the Coleman Methodology Score. RESULTS: Ten clinical studies met the inclusion criteria, comprising a total of 224 wrists treated with Amandys® interposition arthroplasty. Pain reduction and improvement in patient-reported outcome measures were consistently reported across studies, with preservation of wrist range of motion. Complication rates were substantial, with approximately one fifth of wrists experiencing postoperative complications and nearly one fifth requiring reoperation. Most secondary procedures were related to early mechanical instability and consisted of technically oriented revisions rather than implant removal. Conversion to total wrist arthrodesis occurred less frequently. The overall methodological quality of the included studies was moderate. CONCLUSION: Amandys® pyrocarbon interposition arthroplasty provides clinical improvement and preserves wrist motion but is associated with a relevant and less predictable rate of complications and reoperations. When feasible, proximal row carpectomy remains the preferred motion-preserving procedure. Amandys® arthroplasty should be regarded as a highly selective salvage option, particularly in patients unsuitable for proximal row carpectomy-based solutions, with careful patient selection being essential to optimize outcomes.
Pedicled distal-radius vascularized bone graft with shape-memory staple fixation for scaphoid nonunion: A modified technique.
Cruciani A, Pietramala S, Greco A … +3 more , Rocchi L, Merendi G, Fulchignoni C
J Hand Microsurg · 2026 May · PMID 41809637 · Full text
Scaphoid nonunion remains a challenging condition due to the scaphoid's retrograde vascular supply, its susceptibility to collapse, and the risk of progressive carpal malalignment and degenerative changes. Pedicled vascu...
Scaphoid nonunion remains a challenging condition due to the scaphoid's retrograde vascular supply, its susceptibility to collapse, and the risk of progressive carpal malalignment and degenerative changes. Pedicled vascularized bone grafts harvested from the distal radius preserve intrinsic perfusion but require stable fixation to allow graft incorporation. This study describes a modified surgical technique combining a pedicled distal-radius vascularized bone graft based on the recurrent volar intercarpal artery with fixation using a shape-memory nitinol compression staple and reports early clinical and radiographic outcomes in a consecutive series. A retrospective analysis of 8 consecutive patients treated between January 2024 and January 2025 was performed. Clinical outcomes included wrist range of motion, pain assessed using a visual analog scale (VAS), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the Michigan Hand Outcomes Questionnaire (MHQ). Radiographic union was evaluated using standard radiographs and computed tomography (CT). Bony union was achieved in all patients (100%) by six months. Mean QuickDASH scores improved from 36 preoperatively to 6 at final follow-up, while mean MHQ scores improved from 60 to 91. Mean clinical follow-up was 7 months. No implant-related complications or donor-site morbidity were observed. This modified technique appears feasible and was associated with early radiographic union and functional improvement in this small retrospective series. However, these findings represent preliminary results, and larger comparative studies with longer follow-up are required to determine its long-term clinical effectiveness and potential advantages over established fixation methods.
Management of infected flexor tendon injuries: A narrative review.
Seedat L, Kyei P, Sefeane T … +2 more , Bhamjee M, Biddulph G
J Hand Microsurg · 2026 May · PMID 41756813 · Full text
PURPOSE: Flexor tendon injuries are a common result of trauma to the hand. The mechanisms of injury often result in open wounds with contamination and infection. The complications associated with infected wounds pose cha...
PURPOSE: Flexor tendon injuries are a common result of trauma to the hand. The mechanisms of injury often result in open wounds with contamination and infection. The complications associated with infected wounds pose challenges to flexor tendon repair. Management entails adequate eradication of infection and tissue healing prior to tendon repair. Whilst guidelines exist for the management of flexor tendon injuries of the hand, the literature puts little emphasis on the management of these cases with the presence of concomitant infection. Creating clear outlines to adequately manage such cases would aid future management for optimal outcomes. METHODS: A comprehensive search of literature was conducted. Articles published in English within the last 20 years were used. RESULTS: Wounds with macroscopic wound contamination should receive empiric antibiotics. There is little evidence supporting prophylactic antibiotics. Pyogenic flexor tenosynovitis should be immediately taken to theatre. If possible, primary tendon repair is the ideal method of repair, however this is often limited by infection. The choice of secondary reconstruction depends on timing and extent of injury. If there is loss of nerve function, a tendon transfer is required. Tendon grafts are used in cases of loss of tendon length. A damaged tendon sheath requires two-stage tendon reconstruction. CONCLUSION: Infected wounds are a common complicating presenting factor in flexor tendon injuries. Empiric antibiotics in complex and contaminated wounds is essential. Primary tendon repairs have the best outcomes, however repair should be withheld until granulation tissue develops. Secondary repair options should be looked at on a case-specific basis.
Companian Editorial Letter.
Lalonde DH
J Hand Microsurg · 2026 Jan · PMID 41736954 · Full text
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Wide awake anesthesia has awakened us widely.
Gueffier X, Terrence Jose Jerome J
J Hand Microsurg · 2026 Jan · PMID 41736953 · Full text
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The recent advances in histopathological and molecular profiling of giant cell-rich tumors.
Ichikawa J, Kawasaki T, Wako M … +2 more , Hagino T, Mitsui K
J Hand Microsurg · 2026 Mar · PMID 41716649 · Full text
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Intralesional bevacizumab injection for symptomatic glomus tumors of the hand: A prospective pilot study.
Svorai Band S, Israeli R, Gannot G … +1 more , Oron A
J Hand Microsurg · 2026 Mar · PMID 41716648 · Full text
BACKGROUND: Glomus tumors of the hand are painful vascular neoplasms that are typically treated by surgical excision. However, surgery carries the risk of recurrence, nail deformity, and scarring. Given the highly vascul...
BACKGROUND: Glomus tumors of the hand are painful vascular neoplasms that are typically treated by surgical excision. However, surgery carries the risk of recurrence, nail deformity, and scarring. Given the highly vascular nature of these tumors, we hypothesized that intralesional inhibition of Vascular Endothelial Growth Factor (VEGF) could reduce tumor vascularity and alleviate pain. This pilot study evaluated the safety, feasibility, and short-term clinical effects of intralesional bevacizumab injections for symptomatic glomus tumors. METHODS: A prospective, single-center pilot study was conducted on five adult patients with clinically and MRI-confirmed glomus tumors. Under standard digital nerve block and high-frequency ultrasound guidance (18-24 MHz), each patient received a single intralesional injection of bevacizumab (3.75 mg/0.15 mL). The primary outcomes included the Visual Analog Scale (VAS) pain scores at baseline and follow-up. The secondary outcomes included the duration of symptom relief and the histological findings in patients who subsequently underwent surgery. Data were analyzed using descriptive statistical methods. RESULTS: The procedure was technically feasible and well tolerated, with no adverse events other than transient, injection-related pressure. The mean VAS pain scores decreased from 7.4 (range, 4-10) at baseline to 2.5 (range, 1-4) at two weeks post-injection. The duration of symptom relief varied from 1 to 12 months. Four patients eventually underwent surgical excision, while one was lost to follow-up after six months. Histopathological analysis of one excised specimen revealed central necrosis, suggesting a potential anti-angiogenic therapeutic effect. CONCLUSIONS: Intralesional bevacizumab injection is a safe and feasible intervention that provides meaningful but temporary pain relief for glomus tumors of the hand. While surgical excision remains the definitive treatment, this minimally invasive approach may serve as a temporizing measure or a bridge to surgery for patients awaiting surgery or those at high surgical risk. LEVEL OF EVIDENCE: IV (prospective pilot study).
Epinephrine and hand surgery.
Stevens C, White K, Cathcart E … +3 more , Fones L, Khak M, Ilyas AM
J Hand Microsurg · 2026 Mar · PMID 41676068 · Full text
PURPOSE: The growing emphasis on value-based care and the adoption of the "Wide Awake Local Anesthesia with No Tourniquet" (WALANT) surgical technique have led to increased use of epinephrine in hand surgery. Although th...
PURPOSE: The growing emphasis on value-based care and the adoption of the "Wide Awake Local Anesthesia with No Tourniquet" (WALANT) surgical technique have led to increased use of epinephrine in hand surgery. Although this practice is considered safe, some surgeons still worry about elective epinephrine use in the finger. The aim of this systematic review was to determine the rate of ischemic complications associated with epinephrine use in hand surgery to better inform surgeons and patients. METHODS: A systematic search of the Scopus database was conducted for studies published between 2005 and 2022. Of 1477 studies identified, 1339 were excluded after title and abstract screening and 138 after full-text review, leaving 51 studies for the final review. Inclusion criteria were hand surgery patients with epinephrine injected into the hand (carpus and distal). Exclusion criteria were case reports, reviews, animal studies, cadaveric studies, or studies not available in English, or without available complication data. Patient and complication data were extracted from the full text articles. Complication rates were pooled, with results expressed as weighted means and 95 % confidence intervals (CIs). Study heterogeneity was assessed using the I statistic. RESULTS: Across 51 studies including 14,735 patients, no cases of digital ischemia or necrosis were reported. CONCLUSIONS: Epinephrine use in hand surgery at standard concentrations was not associated with ischemic complications, supporting its safety profile in use in hand surgery. This systematic review shows that epinephrine, when used at standard concentrations, is safe in hand surgery, particularly within the WALANT solution in 1:100,000 concentrations. CLINICAL RELEVANCE: The use of epinephrine in the hand is safe in hand surgery.
Reconstruction of complex bone defects in the hand with composite flaps including vascularized bone segments: the 3D reconstruction concept.
Beltran Pardo AG, Reyes Carrillo AI, Bernal Niño MA … +2 more , Galan T, Baeza Ramos JH
J Hand Microsurg · 2026 Mar · PMID 41659838 · Full text
The concept of three dimensional reconstruction not only aims to replace missing tissues, also seeks to restore histological continuity and vascular integration. This text wants to illustrate this showing some cases of c...
The concept of three dimensional reconstruction not only aims to replace missing tissues, also seeks to restore histological continuity and vascular integration. This text wants to illustrate this showing some cases of complex bone defects in the hand, which requires structural replacement of lost tissue with integration of living anatomical components and tissue interfaces. This article describes two clinical cases of vascularized bone free flaps incorporating both, osseous and soft tissues and its histological transitions as peritenon and periosteum, in order to restore the three-dimensional anatomical structure and functionality of the hand. The first case, a 38 year old man who had a giant cell tumor in the middle phalanx of the fifth finger with loss of pulleys A4 and A5. Reconstruction was performed using a vascularized medial femoral condyle block of bone with periosteal extensions to replace the missing pulley. The second case, a 23 year old woman who suffered a bicycle fall resulting in a transverse fracture of the middle phalanx of the third finger, treated with plate and screws, which later of plate broke developed defects on the skin and extensor tendon. A composite flap based on the first and second dorsal metacarpal arteries was harvested, including skin, the Extensor Indicis Propius tendon, and vascularized second metacarpal bone. Postoperative follow-up demonstrated smooth movement of the tendon and a solid bone union in the first patient, while in the second patient, complete restoration of tendon function and bone consolidation was achieved; the donor site morbidity was minimal in both cases. Both of these outcomes support that complex free flaps allow the reconstruction of various tissue types at the same time, while also providing durable function and low donor site morbidity.
Patient-reported pain and hand function: important determinants of the postoperative results one year after PIP arthroplasty.
Notermans BJW, Teunissen JS, Selles RW … +3 more , de Boer LHL, van der Heijden BEPA, Hand-Wrist Study Group∗
J Hand Microsurg · 2026 Mar · PMID 41659837 · Full text
AIM: This study aimed to assess determinants associated with patient-reported pain and hand function 12 months after proximal interphalangeal joint arthroplasty for osteoarthritis. METHODS: Prospectively gathered data of...
AIM: This study aimed to assess determinants associated with patient-reported pain and hand function 12 months after proximal interphalangeal joint arthroplasty for osteoarthritis. METHODS: Prospectively gathered data of 113 patients, who completed the Michigan Hand outcomes Questionnaire preoperatively and 12 months postoperatively, was used. We compared pre- and 12-month postoperative (categorized) MHQ pain and hand function scores and assessed determinants associated with the postoperative scores. RESULTS: The Michigan Hand outcomes Questionnaire pain and hand function scores at intake were 41 (SD 19) and 52 (SD 17), respectively, and 65 (SD 23) and 63 (17) after surgery. Less pain at intake was associated with less pain 12 months postoperatively. The following determinants were associated with better hand function after surgery: better hand function at intake, surgery on the dominant hand, and the use of surface replacement implants. CONCLUSION: MHQ scores at intake were significantly associated with postoperative MHQ scores. This knowledge can be used during preoperative consultation to improve shared decision making and create adequate patients' expectations. LEVEL OF EVIDENCE: III.
Metabolic syndrome features and surgical outcomes in Dupuytren's disease: A single-centre retrospective cohort study.
Bakr A, Yusuf YM, Regmi A … +3 more , Jain VK, El-Nahas W, Iyengar KP
J Hand Microsurg · 2026 Mar · PMID 41659836 · Full text
BACKGROUND: Dupuytren's disease (DD) is a chronic fibroproliferative disorder increasingly linked to metabolic dysregulation. The relationship between metabolic syndrome-related features and surgical recurrence, however,...
BACKGROUND: Dupuytren's disease (DD) is a chronic fibroproliferative disorder increasingly linked to metabolic dysregulation. The relationship between metabolic syndrome-related features and surgical recurrence, however, is uncertain. This study assessed the prevalence of metabolic syndrome-related features in patients undergoing DD surgery and explored their association with a history of documented recurrence. PATIENTS AND METHODS: A retrospective cohort study was conducted at a single NHS hand unit. Demographic and clinical data, including diabetes mellitus, obesity, and hypercholesterolaemia, were extracted from electronic records. Recurrence was defined as documented Dupuytren's disease reappearing in the same digit or hand following any previous surgical intervention, rather than recurrence after the index procedure. Descriptive statistics summarised the cohort, and odds ratios (OR) with 95 % confidence intervals (CI) evaluated associations between metabolic syndrome-related features and recurrence. RESULTS: Eighty patients were included (mean age 69.4 years; 77 % male). Diabetes was present in 14 (17.5 %), obesity in 18 (22.5 %), and hypercholesterolaemia in 20 (25.0 %) of patients; 32 patients (40 %) had at least one metabolic syndrome-related feature. Recurrence occurred in 12 patients (15.0 %). Hypercholesterolaemia demonstrated a borderline association with higher recurrence (30.0 % vs 10.0 %; OR 3.90, 95 % CI 1.08-13.81). Obesity showed a non-significant trend toward higher recurrence (27.8 % vs 11.3 %; OR 3.00). Diabetes demonstrated a non-significant trend toward recurrence (28.6 % vs 12.1 %; OR 2.90). Patients with ≥1 metabolic syndrome-related feature had a higher recurrence rate than those without (25.0 % vs 8.3 %; OR 3.70; p = 0.056). CONCLUSION: Metabolic syndrome-related features were common and showed trends toward higher odds of recurrent Dupuytren's disease, particularly hypercholesterolaemia and obesity. These findings are exploratory and hypothesis-generating, highlighting the need for larger prospective studies.
Editorial: Reframing progress in shoulder arthroplasty.
Murthi AM
J Hand Microsurg · 2026 Mar · PMID 41640816 · Full text
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Successful reconstruction of segmental femoral bone defect by folded free vascularized fibular bone graft: a retrospective report.
Yifan W, Xin W, Chao J … +3 more , Baiwen Q, Aixi Y, Zonghuan L
J Hand Microsurg · 2026 Mar · PMID 41623417 · Full text
OBJECTIVE: Vascularized fibular bone grafts are an efficient method for repairing various segmental bone defects. The objective of this report is to introduce our experience with folded free vascularized fibular bone gra...
OBJECTIVE: Vascularized fibular bone grafts are an efficient method for repairing various segmental bone defects. The objective of this report is to introduce our experience with folded free vascularized fibular bone grafts for segmental femoral bone defects. PATIENTS AND METHODS: Clinical data collected by surgeons and the Hospital Information System (HIS) were screened. Cases with segmental femoral bone defects repaired by folded free vascularized fibular bone grafts were collected. Clinical data, including demographic characteristics, defect size, coinfection, perioperative treatment and imaging data during follow-up, were collected for analysis. RESULTS: Twelve patients (10 males and 2 females), aged from 6 to 58, were included in this report. The defect range was 3-10 cm, with an average of 6.2 cm. Three cases were complicated with infection, and the others were not. Folded free vascularized fibular bone grafts were harvested for the reconstruction of segmental femoral bone defects. The grafts were fixed with plates in 9 cases and external fixators in 3 cases. All grafts healed uneventfully with an average healing time of 5.2 months (range 4∼8 months). Internal fixation failure occurred in one case. The follow-up time ranged from 15 to 130 months (average 58.3 months). CONCLUSION: Folded free fibula grafts are one of the optional methods for segmental bone defects of the femur. Through this method, patients can undergo a one-time operation to reconstruct the bone defect of the affected limb.
A geospatial analysis of open and endoscopic carpal tunnel surgery in the United States.
Berglas E, Lavi AB, Schwartz LB … +6 more , Mastrokostas PG, Shimanov MM, Liddy N, Razi AE, Choueka J, Ng MK
J Hand Microsurg · 2026 Mar · PMID 41623416 · Full text
BACKGROUND: Well-established disparities are limiting the use of carpal tunnel release (CTR). Prior studies have not identified geographic areas with limited use of CTR, nor have they evaluated geographic or socioeconomi...
BACKGROUND: Well-established disparities are limiting the use of carpal tunnel release (CTR). Prior studies have not identified geographic areas with limited use of CTR, nor have they evaluated geographic or socioeconomic differences between open and endoscopic approaches. METHODS: A cross-sectional study was conducted using open and endoscopic CTR Medicare data from 2013 through 2022. Moran's I statistic was calculated using geospatial analysis on the county level to determine hotspots (high rates) and coldspots (low rates). Logistic regression determined the socioeconomic factors associated with hotspots (OR>1) or coldspots (OR<1). RESULTS: The majority of the 1,411,972 patients underwent open surgery (73.9 %). For all CTR, a greater percentage living in a rural community (OR = 0.96, [95 % CI: 0.94, 0.99]; = 0.0018) was associated with coldspots. For open surgery, a greater percentage living in a rural community (OR = 0.97, [95 % CI: 0.94, 0.99]; = 0.018) and a greater percentage uninsured (OR = 0.80, [95 % CI: 0.67, 0.96]; = 0.018) were associated with coldspots. For endoscopic surgery, the percentage of adults with obesity (OR = 0.85, [95 % CI: 0.75, 0.96]; = 0.0072) was a significant predictor of coldspots. CONCLUSIONS: Significant utilization disparities for both open and endoscopic CTR exist in the Medicare population. Living in a rural environment was the primary determinant of reduced utilization, underscoring the possible need for more hand surgeons in these areas. These findings may be generalizable to CTS care for all ages and insurance statuses.
Combining free vascularized bone grafting to the ulna with 3D deformity analysis of radius and ulna to optimize functional outcome after subtotal forearm amputation.
Moors M, Decramer A, Van Royen K … +2 more , Thielman L, Vanmierlo B
J Hand Microsurg · 2026 Mar · PMID 41623415 · Full text
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