Vergara-Merino L, Loza LF, Escobar-Liquitay CM
… +2 more, Zaidenberg EE, Prada C
J Hand Microsurg
· 2026 Jan · PMID 41362849
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OBJECTIVE: To identify and summarize all primary studies addressing clinical results of patients undergoing denervation surgery for hand and wrist conditions. METHODS: We searched seven electronic databases, including ME...OBJECTIVE: To identify and summarize all primary studies addressing clinical results of patients undergoing denervation surgery for hand and wrist conditions. METHODS: We searched seven electronic databases, including MEDLINE (Ovid MEDLINE ALL, 1946 to present), Embase (OVID, 1974 to present), and the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library. We included any primary study addressing clinical outcomes of patients undergoing denervation surgery of the hand and wrist, regardless of their design or language. Two independent authors screened the studies. Three reviewers extracted the data, and two assessed the risk of bias using the MINORS score. RESULTS: 72 studies were included in this review, 65 already published, and seven ongoing studies. Most studies are of low level of evidence, and the majority (66 %) were performed in Europe. Forty-three studies (60 %) reported outcomes on wrist denervation surgery, 16 on first carpometacarpal denervation surgery, and nine on digit joints denervation. CONCLUSIONS: Overall, hand and wrist denervation surgery seems to be a safe, pain-relieving, and motion-preserving treatment option for painful arthropathy. Nevertheless, surgeons must advise patients that revision surgery could be needed. High-quality, prospective, comparative studies are missing for wrist and hand denervation to provide strong evidence-based recommendations.
Hasan T, Hassan MS, Saran S
… +6 more, Loh WYC, Jose R, Jhaj J, Iyengar KP, Uldin H, Botchu R
J Hand Microsurg
· 2026 Jan · PMID 41362848
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INTRODUCTION: Basal thumb osteoarthritis, encompasses degenerative arthropathy of the first carpometacarpal joint (CMCJ) and the scaphotrapezotrapezoidal joint (STTJ), is a prevalent condition that significantly impairs...INTRODUCTION: Basal thumb osteoarthritis, encompasses degenerative arthropathy of the first carpometacarpal joint (CMCJ) and the scaphotrapezotrapezoidal joint (STTJ), is a prevalent condition that significantly impairs hand function. Complex orientation of these joints renders traditional radiographic assessments with anteroposterior (AP/True Robert's) and lateral views, prone to limitations in visualising peritrapezial joint spaces.The purpose of this study is to introduce a novel "hypersupinated view" and evaluates its efficacy in visualisation of peritrapezial joint spaces with implications in the clinical decision-making process. PATIENT AND METHODS: A total of 26 patients with basal thumb pain underwent radiography of the thumb in three projections: AP, lateral and hypersupinated orientations. Two consultant orthopaedic hand surgeons independently evaluated the visual clarity of the CMCJ and STTJ on a 5-point Likert ordinal scale, with 1 being 'poor' and 5 being 'excellent' views. Inter-rater agreement was assessed using weighted Cohen's Kappa. Differences in ratings between views were analysed using Friedman and post-hoc Wilcoxon signed-rank tests. RESULTS: For the first CMCJ, hypersupinated view ratings were highest (R1: 3.38, R2: 4.69), but inter-rater agreement was low (Kappa: 0.070). The AP view showed better agreement (Kappa: 0.160) despite slightly lower ratings (R1: 2.04, R2: 4.35). For the STTJ, the hypersupinated view again received the highest rating (R1: 2.38, R2: 4.62), while the AP view demonstrated the best agreement (Kappa: 0.460). Friedman tests showed significant differences for both raters for the first CMCJ and for rater 2 for the STTJ. Post-hoc tests confirmed that rater 1 preferred the hypersupinated view for first CMCJ, and rater 2 preferred hypersupinated and lateral views for STTJ. CONCLUSION: The hypersupinated view provides superior diagnostic detail for both joints though with reduced reproducibility between raters allowing better targeting to guide appropriate patient management.
Jackson GR, Serour P, Alvero AB
… +1 more, Smith MJ
J Hand Microsurg
· 2026 Jan · PMID 41362847
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Anatomic total shoulder arthroplasty (TSA) has advanced considerably in recent decades, with the glenoid component recognized as a pivotal determinant of patient outcomes. This review integrates current literature and bi...Anatomic total shoulder arthroplasty (TSA) has advanced considerably in recent decades, with the glenoid component recognized as a pivotal determinant of patient outcomes. This review integrates current literature and biomechanical insights surrounding contemporary glenoid implant designs, including all-polyethylene, hybrid, metal-backed, augmented, and inlay options. It examines key considerations such as the balance between conforming and nonconforming articulations, differences between keeled and pegged fixation, and how implant characteristics affect micromotion, radiolucency, and loosening risks. Additionally, innovative technologies like patient-specific instrumentation, computer-assisted surgery, and artificial intelligence are discussed in relation to improving implant positioning and surgical precision. By collating available evidence and implant strategies for glenoid replacement in anatomic TSA, this article aims to assist orthopaedic surgeons in making informed, patient-specific implant choices based on individual anatomy and functional requirements.
Aljohmani L, McShane N, Carr S
… +6 more, Marinescu I, Kelly L, Kneafsey S, O'Grady K, Carr E, Dolan R
J Hand Microsurg
· 2026 Jan · PMID 41333826
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INTRODUCTION: Frailty is a well-recognized predictor of adverse surgical outcomes of frailty indices has become more common across surgical specialties, AIM: To the awareness and institutional management of frailty amo...INTRODUCTION: Frailty is a well-recognized predictor of adverse surgical outcomes of frailty indices has become more common across surgical specialties, AIM: To the awareness and institutional management of frailty among consultant and fellow hand surgeons (HS) and hand therapists (HT) METHODS: A 16-item web-based questionnaire was distributed to HS and HT affiliated with the Irish Hand Surgery Society The survey awareness of frailty, use of assessment tools, availability and uptake of frailty pathways, and attitudes toward osteoporosis management. Descriptive and frequency statistics were used to summarize quantitative data, while qualitative responses were thematically summarized. RESULTS: Forty-two responses were received (21 HS, 21 HT Most respondents considered frailty a predisposing factor for hand fractures (HS 76.2 %, HT 85.7 %), but fewer routinely assessed it in clinical practice (HS 61.9 %, HT 71.4 %). Awareness of institutional frailty pathways was significantly higher among HT (80.9 %) compared with HS (23.8). Frailty influenced treatment decisions for most respondents (HS 76.2 %, HT 90.5 %), A diagnosis of osteoporosis/osteopenia significantly impacted management, particularly among HT compared to HS. CONCLUSION: This study considerable variability in the recognition and management of frailty among clinicians treating hand fractures in Ireland. While frailty intervention teams (FIT) or equivalent pathways are available in some institutions, These findings highlight the need for greater education and standardisation within the Irish setting, as results may not be directly generalisable to other healthcare systems. Encouraging similar surveys in other regions could support collaboration, harmonise practice, and improve outcomes for this vulnerable patient population.
Gibson A, Jerome T, Bain GI
… +1 more, MacLean SBM
J Hand Microsurg
· 2026 Jan · PMID 41333825
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Proximal interphalangeal joint (PIPJ) fracture dislocations are frequently injured during sports, and often present in a delayed fashion. Untimely management may lead to recurrent subluxation and chronic stiffness, arthr...Proximal interphalangeal joint (PIPJ) fracture dislocations are frequently injured during sports, and often present in a delayed fashion. Untimely management may lead to recurrent subluxation and chronic stiffness, arthrosis, and pain. Unstable injuries frequently require surgical management with either internal or external fixation to maintain articular reduction and allow early mobilization. Delay in presentation or extensive fracture comminution presents technical challenges and may necessitate a reconstructive or salvage procedure. We have defined reconstructive procedures as those that restore the articular surface using an osteochondral graft, and salvage procedures as those that do not involve restoring the articular surface. Various reconstructive techniques have been reported and popularised, including; hemi hamate arthroplasty, hemi capitate arthroplasty, full height hamate arthroplasty and toe osteochondral graft. Similarly, salvage techniques described include volar plate arthroplasty, implant arthroplasty and arthrodesis. In this review, we present the surgical options available to hand surgeons, and a suggested algorithm to assist management of PIPJ fracture dislocations that require either a reconstructive or salvage procedure.
J Hand Microsurg
· 2026 Jan · PMID 41321429
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UNLABELLED: Finger fractures are among the most common fractures of the upper limb. The number and cost of maltreated and misdiagnosed finger fractures in Sweden is unknown. The aim was to study the number, complications...UNLABELLED: Finger fractures are among the most common fractures of the upper limb. The number and cost of maltreated and misdiagnosed finger fractures in Sweden is unknown. The aim was to study the number, complications, causes, and cost of maltreated and misdiagnosed finger fractures, 2011-2021, in Sweden.Claims matching the prespecified ICD-10-SE codes S62.6-7 (finger fractures) and T92.2 (sequelae after finger fracture) during the 2011-2021 timeframe were identified. The data were extracted from the Swedish National Patient Insurance Company Register and analyzed in terms of epidemiology and cost.Of the 1621 assessed cases, 384 reported maltreated and misdiagnosed finger fractures were found. The mean age was 41 years (range 2-88). Thirty-one percent of the healthcare-related injuries occurred in emergency care, primarily due to maltreatment leading to malunion after non-operative treatment. Thirty-six percent of healthcare-related injuries occurred in specialist departments, mostly due to malunion after surgical intervention. In primary care, the leading cause was misdiagnosis, often due to inadequate examination and lack of X-ray examination. The total aggregated direct and indirect costs amounted to SEK 25 557 200 (USD 2 505 608, Euro 2 165 864, Yen 424 249 520). CONCLUSION: Finger fractures affect people of all ages and can lead to significant socioeconomic and medical invalidity. Maltreated fractures mainly occur in emergency care (due to malunion after immobilization) and specialist care (due to malunion after surgery). Misdiagnosed fractures were more common in primary care. A suggestion for claims prevention would be improved physician education, updated guidelines regarding the use of X-rays, seeking specialist opinions in uncertain cases, evaluating surgical technique, and optimizing postoperative care could probably help reduce the number of these injuries.
Wang F, Jian D, Li M
… +4 more, YuyangChen, Feng X, Zhang J, Fan Y
J Hand Microsurg
· 2026 Jan · PMID 41280505
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PURPOSE: This study aimed to construct a forelimb contracture model in rabbits to mechanically quantify pronation-supination movements during the healing phase following joint capsule and ligament injuries. Additionally,...PURPOSE: This study aimed to construct a forelimb contracture model in rabbits to mechanically quantify pronation-supination movements during the healing phase following joint capsule and ligament injuries. Additionally, a finite element model of the human elbow joint was developed to investigate the mechanical environment of the elbow joint during pronation-supination movements in the healing phase. METHODS: White rabbits were randomly assigned to either a control group (no injury) or an injury group (joint capsule and ligament injury). The injured forelimbs were immobilized for 2, 4, 6, and 8 weeks (designated as 2IM, 4IM, 6IM, 8IM groups, respectively), and mechanical tests were performed on the joints. A finite element model of the human elbow joint was utilized to simulate elbow joint protonation from 0° to 50° during different healing periods, and changes in soft tissue forces within the elbow joint were analyzed. RESULTS: During the healing phase, the injured group experienced significant reductions in total range of motion (ROM), with decreases of 26.8°, 43.8°, and 57.4° at 4 IM, 6 IM, and 8 IM, respectively. These reductions were accompanied by histological phenomena such as cellular adhesion within the joint capsule. Additionally, internal soft tissue stress gradually increased over time, with the highest stress observed in the annular ligament. Throughout the healing process, stress on the humeral cartilage consistently exceeded that on the ulnar cartilage, with the maximum stress reaching 15.8 times that of the ulnar cartilage. Stress on the joint capsule also increased progressively, rising by 69.5 %, 87.5 %, and 139.2 % at 4, 6, and 8 weeks post-injury, respectively. CONCLUSION: Healing time is significantly negatively correlated with total joint range of motion, as evidenced by the continuous accumulation and transfer of internal soft tissue loading. These findings are associated with worsening histological changes within the joint capsule. These results are of great significance for further understanding the biomechanical environment within the joint cavity during elbow contracture and for guiding elbow contracture release surgery.
Abdelghafar M, Semaya A, Hasan M
… +1 more, Morsy H
J Hand Microsurg
· 2025 Nov · PMID 41268389
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PURPOSE: Trapeziectomy has a particularly significant role in relieving pain in patients with trapeziometacarpal arthritis. With the advantage of arthroscopy combined with hematoma distraction, arthroscopic distal trapez...PURPOSE: Trapeziectomy has a particularly significant role in relieving pain in patients with trapeziometacarpal arthritis. With the advantage of arthroscopy combined with hematoma distraction, arthroscopic distal trapeziectomy can achieve good pain relief with minimum wound complications. AIM: Evaluation of the clinical and functional results of arthroscopic distal trapeziectomy and hematoma distraction. PATIENTS AND METHODS: The study included thirty patients with stage II and III trapeziometacarpal arthritis. The articular surface & subchondral bone were resected. Then the joint was distracted using percutaneous Kirschner wires. The mean follow-up period was about 20 months. RESULTS: There was a statistically significant difference in pre- and post-operative pain scores with slight improvement of tip & key pinch strength. CONCLUSION: According to our study findings, arthroscopic distal trapeziectomy and hematoma distraction can be performed with significant improvements and satisfactory clinical and functional results in patients with stage II and III trapeziometacarpal arthritis.
Goorens CK, Peerlinck S, Van Ravestyn A
… +3 more, Van Royen K, Arnaout A, Atzei A
J Hand Microsurg
· 2026 Jan · PMID 41235354
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Wrist arthroscopy has gained in importance to treat chronic scapholunate instability, since it is a less invasive alternative to open surgery that allows proper staging of the scapholunate lesion and induces less stiffne...Wrist arthroscopy has gained in importance to treat chronic scapholunate instability, since it is a less invasive alternative to open surgery that allows proper staging of the scapholunate lesion and induces less stiffness. Arthroscopic capsuloligamentoplasty plications or ligamentous tightening intent to reinforce the remnant but insufficient ligaments by plication, without bone tunnels, large suture anchors or tendon grafts. In this study, we discuss the current existing arthroscopic capsuloligamentoplasty plications on the dorsal and volar side of the wrist.
Abdelmaksoud IM, Ahmad MH, Elmalky AR
… +2 more, Semaya AE, Kamal M
J Hand Microsurg
· 2025 Nov · PMID 41215974
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INTRODUCTION: the reconstruction of intercalary femoral defects after tumour resection is challenging. We have evaluated the clinical, functional, and oncological results of using free vascularized fibular graft combined...INTRODUCTION: the reconstruction of intercalary femoral defects after tumour resection is challenging. We have evaluated the clinical, functional, and oncological results of using free vascularized fibular graft combined with preserved pasteurized tumour segment. MATERIALS: this study was retrospective in nature and included 12 patients [eight males and four females]. The mean age was 21.3 years ± 11.3. The diagnoses of the patients were osteosarcoma (Five cases) and Ewing's sarcoma (seven cases). The resection was wide local excision, and the defect was reconstructed using combined free vascularized fibular graft and pasteurized tumour segment. RESULTS: the mean time to union was 7.1 ± 1.9 months while the mean time to full weight bearing was 12 ± 1.8 months. The mean size of skeletal defect was 17.7 cm ± 1.92. The mean duration of surgery was 12.1 h ± 1.88. Nonunion occurred in four cases, stress fractures occurred in two cases and metal failure occurred in one case. CONCLUSION: the combined technique of using free vascularized fibular graft and pasteurized tumour segment for intercalary femoral defects following tumour resection is a valuable technique with accepted complications and good results.
J Hand Microsurg
· 2025 Nov · PMID 41210624
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BACKGROUND: Fingertip and nail bed injuries represent complex reconstructive challenges in hand surgery, requiring restoration of both function and aesthetics. The nail unit's intricate anatomy-comprising the matrix, bed...BACKGROUND: Fingertip and nail bed injuries represent complex reconstructive challenges in hand surgery, requiring restoration of both function and aesthetics. The nail unit's intricate anatomy-comprising the matrix, bed, and surrounding tissues-necessitates precise surgical techniques to prevent long-term deformities and sensory deficits. This study presents and evaluates the "clover flap," a novel homodigital advancement technique designed for dorsal fingertip injuries involving partial or complete nail bed loss. METHODS: In this retrospective cohort study, 63 patients with dorsal fingertip defects were treated between 2005 and 2023 using the clover flap at a primary referral center. The flap involves volar V-Y advancements redirected dorsally in a trifoliate configuration, allowing one-stage coverage without grafts. Outcomes were assessed using standardized clinical, functional, and aesthetic metrics including Quick-DASH, 2PD, POSAS, FIOS, and OFNAS scores. RESULTS: No complete flap necrosis occurred. Nail deformities were limited to 17.5 % of cases, with minimal donor site morbidity. Patients achieved a mean Quick-DASH score of 14.6, 2PD of 7.3 mm, and an active ROM of 224°. Grip and pinch strength recovered to 79 % and 81 % of the contralateral side, respectively. Aesthetic outcomes were favorable, with an OFNAS of 4.5 and FIOS of 11.3. Multivariate analysis confirmed functional and cosmetic stability over time, regardless of complication presence. CONCLUSION: The clover flap offers a reliable, one-stage reconstructive option for dorsal fingertip injuries, combining high functional recovery with excellent nail bed and scar aesthetics. Its design preserves nail matrix integrity, avoids microsurgery, and is particularly suitable in acute care settings.
Marinescu I, Hehir CM, Browne F
… +14 more, Curran S, Abdul Jalil KI, O'Brien A, Canas-Martinez A, Woods R, Stenson C, Stratford N, Kelly L, Sullivan P, Dempsey M, Quinlan C, Kearney L, Joyce K, Dolan RT
J Hand Microsurg
· 2025 Nov · PMID 41141301
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PURPOSE: Fluoroscopic radiographic imaging is indispensable in modern hand surgery. Challenges in positioning patient digits during complex hand injury assessments can result in direct radiation exposure to operating sta...PURPOSE: Fluoroscopic radiographic imaging is indispensable in modern hand surgery. Challenges in positioning patient digits during complex hand injury assessments can result in direct radiation exposure to operating staff. The adverse health risks associated with radiation exposure, including malignancy, are well documented and demand clear risk reduction strategies. The EURATOM 2013/59 directive provides guidance on reducing occupational exposure under the 'as low as reasonably achievable' (ALARA) principle. This study aims to assess the prevalence of non-patient (surgeon) anatomy in intra-operative radiographs and outline prevention strategies to optimise radiation safety practices for hand surgeons. METHODS: A national multi-centre audit of direct occupational hand surgeon radiation exposure was performed. Intra-operative radiographic images obtained during hand surgery cases across six plastic and reconstructive surgery centres were retrospectively reviewed. The primary outcome was the presence of non-patient (surgeon) anatomy in intra-operative radiographic images. Secondary outcomes include timing of surgery (working hours vs. out-of-hours), procedure type and surgeon seniority (consultant vs. trainee). RESULTS: A total of 852 hand trauma procedures performed across the six national centres across a three-year period were included. Non-patient digits were present in intra-operative radiographs in 51.7 % of cases (range, 22.3-78.3 %). The most common procedure was fracture reduction and k-wire fixation (n = 515, 60.4 %). There was significant variance between the surgical units in the rate of non-patient anatomy captured, indicating inter-hospital differences in radiation safety practice adherence. Twenty-two percent of procedures were performed out-of-hours. There was no significant relationship between radiation exposure and procedure timing or surgeon seniority. CONCLUSIONS: Hand surgeons are frequently exposed to excess intra-operative radiation. Radiation safety training, strict adherence to intra-operative radiation safety protocol, formal radiation safety education, and use of innovative surgical equipment, may help reduce the rates of radiation exposure in hand surgery. TYPE OF STUDY: Differential diagnosis/symptom prevalence study. LEVEL OF EVIDENCE: 2c.
Corella F, Kaempf de Oliveira R, Fischer P
… +1 more, Ocampos Hernández M
J Hand Microsurg
· 2025 Nov · PMID 41127553
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INTRODUCTION: Carpal Boss is a bony protuberance located on the dorsal region of the wrist, at the base of the carpometacarpal joint of the second and third rays. It is a lesion of uncertain origin and, when associated w...INTRODUCTION: Carpal Boss is a bony protuberance located on the dorsal region of the wrist, at the base of the carpometacarpal joint of the second and third rays. It is a lesion of uncertain origin and, when associated with osteophytes and osteoarthritis, may be linked by a congenital change due to the presence of an accessory bone (), which causes a change in biomechanics, thus creating instability. In symptomatic patients, surgery may be indicated and consists of resecting the sclerotic bony prominence in layers until all degenerative tissue is removed, finding healthy cancellous bone and cartilage. PURPOSE: to describe arthroscopic surgical access portals for the treatment of carpal boss. MATERIAL AND METHODS: The intra-articular arthroscopic treatment of the carpal boss that is accessed through the midcarpal joint, associated with the use of one or two additional portals that are strategically located radially and ulnarly to the carpometacarpal joint and the extensor carpi radialis longus tendon. RESULTS: These portals provide direct access to the carpal boss and allow the surgeon to maneuver the instruments with precision while avoiding injury to critical structures. CONCLUSION: This technique lets complete and safe resection of the carpal boss, allowing the surfaces of the second and third metacarpals and the trapezoid to be flattened to create a smooth, level contour. In addition, when compared to open techniques, it provides a wide and direct view of the region with less soft tissue damage, cosmetic advantages and rapid recovery.
Apard T, Brutus JP, Ferembach B
… +2 more, Tayor A, Hagert E
J Hand Microsurg
· 2025 Nov · PMID 41080209
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Peripherally-induced movement disorder (PIMD) is a group of conditions manifested by involuntary movements or other motor abnormalities that are induced by or emerge in the context of injury to the peripheral nervous sys...Peripherally-induced movement disorder (PIMD) is a group of conditions manifested by involuntary movements or other motor abnormalities that are induced by or emerge in the context of injury to the peripheral nervous system. Peripheral nerve entrapment (PNE) in the upper extremities is common and their clinical signs are very well known by hand surgeons. Only 3 cases of tremor with PNE have already been reported (one in 1986 and two very recently). The aim of this multicentric retrospective study is to report clinical cases of tremors caused by PNE and to analyze their clinical findings and treatment. 17 patients was referred to 5 hand centers for tremors of their hand after being examined by a neurologist clinically and electrophysiologically. The clinical examination showed simple, double or multiple crush nerve entrapment at the upper limb (elbow was involved for all of them except one). The treatment was conservative (myofascial manipulation and taping) for 8 patients and surgical (wide awake nerve release) for 9 others after failure of conservative treatments. The tremors disappeared for all of them. Our study showed upper limb peripheral nerve entrapment can be a cause of tremor of the hand in rare but misdiagnosed situations. We suggest that tremor induced by peripheral nerve entrapment can be a new type of tremor classified in the PIMD group. Hand physiotherapist and surgeons must be questioned by medical doctors who take care of tremors (family doctors, neurologists …) and so, be awared of that etiology.