Ozmen BB, Singh N, Shah K
… +5 more, Berber I, Singh D, Pinsky E, Rampazzo A, Schwarz GS
J Hand Microsurg
· 2025 Jul · PMID 40606653
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PURPOSE: Hand surgery decision-making requires integration of complex anatomical understanding, diverse patient-specific factors, and nuanced operative techniques. While artificial intelligence (AI), large language model...PURPOSE: Hand surgery decision-making requires integration of complex anatomical understanding, diverse patient-specific factors, and nuanced operative techniques. While artificial intelligence (AI), large language models (LLMs), and retrieval-augmented generation (RAG) models have advanced significantly in various fields, no AI-driven clinical decision support systems currently exist for hand surgery. A novel retrieval-enhanced AI large language model specifically tailored for hand surgery was developed, capable of effectively utilizing peer-reviewed published hand surgery literature for clinical decision support in real-time at point of care. METHODS: An AI clinical decision support system was developed integrating all available open-access 4510 peer-reviewed hand surgery publications from 2000 to 2024 identified through hand surgery-relevant keywords. Documents were processed using a hierarchical pipeline based on the RAPTOR methodology, which breaks down large texts into smaller segments to enhance accurate retrieval. The system was evaluated using 15 standardized clinical queries assessed using automated computational metrics for correctness and semantic similarity to source documents. RESULTS: The AI system demonstrated consistent performance with an average G-Eval correctness score of 0.79, SEM with an average similarity score of 0.75 (range: 0.54-0.86) and average maximum similarity score of 0.80 (range: 0.56-0.91), predominantly at moderate confidence levels. Generated recommendations were contextually appropriate and reliably linked to relevant hand surgery literature, providing accurate and clinically meaningful guidance. CONCLUSION: The AI system, HandRAG, incorporating RAG and LLM approach offers potential benefits for evidence-based clinical decision support and education in hand surgery.
J Hand Microsurg
· 2025 Jul · PMID 40606652
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BACKGROUND: Fractures of the proximal humerus are prevalent among the elderly, often posing challenges in anatomical reconstruction and internal fixation. Precise anatomical knowledge tailored to specific populations is...BACKGROUND: Fractures of the proximal humerus are prevalent among the elderly, often posing challenges in anatomical reconstruction and internal fixation. Precise anatomical knowledge tailored to specific populations is essential for optimal surgical outcomes. This study aims to quantitatively evaluate the anatomical characteristics of the proximal humerus in the Vietnamese population through multiplanar computed tomography (CT) and cadaveric measurements, and to determine the consistency between the two modalities. METHODS: A prospective descriptive study was conducted on 75 CT scans and 30 shoulder specimens from 15 fresh cadavers. Parameters measured included the neck-shaft angle, diameters of the humeral head (superior-inferior and anterior-posterior), width of the greater tuberosity, deltoid tuberosity index, and distances from the greater tuberosity to anatomical landmarks such as the lesser tuberosity, bicipital groove, and pectoralis major insertion. RESULTS: The average neck-shaft angle was 132.36° ± 2.44°, with most values within 130°-140°. The deltoid tuberosity index averaged 1.76 ± 0.20, exceeding thresholds reported in previous studies. No statistically significant differences were found between CT and cadaveric measurements across most parameters (p > 0.05). The anatomical measurements were found to be smaller than those reported in Western populations but comparable to other Asian populations. CONCLUSION: The study confirms that CT imaging provides reliable and accurate morphometric data comparable to cadaveric dissection. Key anatomical landmarks such as the pectoralis major insertion, lesser tuberosity, and bicipital groove can serve as consistent intraoperative references for implant positioning in Vietnamese patients.
J Hand Microsurg
· 2025 Jul · PMID 40590012
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BACKGROUND: The Jamar dynamometer is the gold standard to assess hand grip strength, but is expensive. The Camry dynamometer is relatively cost-effective. There is a dearth of literature on Camry's validation in healthy...BACKGROUND: The Jamar dynamometer is the gold standard to assess hand grip strength, but is expensive. The Camry dynamometer is relatively cost-effective. There is a dearth of literature on Camry's validation in healthy Indian adults, which is important to establish as hand grip is known to vary with age, gender and race. OBJECTIVES: To establish the reliability and validity of the Camry dynamometer in comparison to the Jamar handheld dynamometer among healthy Indian adults in the age group of 20-59 years. METHODS: Following basic demographics, occupation and hand dominance, three trials of each dynamometer were performed in standardised positions for the non-dominant and dominant hand of each participant and the best value was recorded. A gap of 10 min was provided between the 2 dynamometers. Data was then recorded and analyzed. RESULTS: 120 participants were recruited, with an equal males and females. The mean isometric hand grip strength for the non-dominant hand was 26.71 ± 9.29 kgf, and for the dominant hand was 27.66 ± 9.12 kgf using the Camry hand-held dynamometer, while it was 26.43 ± 9.07 kgf for the non-dominant and 27.37 ± 9.26 kgf for the dominant side using the Jamar Hand Held dynamometer. Data was further analyzed with age and gender stratification. The Camry hand-held device had excellent reliability (ICC>0.97) and good validity with Pearson's correlation index of 0.97 (p < 0.05) for the dominant hand and 0.99 (p < 0.05) for the nondominant hand, and Bland-Altman's graphics showing more than 90 % of measures within confidence limits. CONCLUSION: Camry digital dynamometer is a reliable and valid device to measure isometric handgrip strength in healthy Indian adults compared to the Jamar hydraulic handgrip dynamometer.
Yoshida S, Takagi T, Kobayashi Y
… +1 more, Watanabe M
J Hand Microsurg
· 2025 Mar · PMID 40538649
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INTORDUCTION: There is little difference in the outcome of various surgical treatment for thumb carpometacarpal osteoarthritis. Suture suspension arthroplasty is a very simple technique without sacrifice of tendon or spe...INTORDUCTION: There is little difference in the outcome of various surgical treatment for thumb carpometacarpal osteoarthritis. Suture suspension arthroplasty is a very simple technique without sacrifice of tendon or specific implants and can be performed under regional anesthesia. We hypothesize that the technique yields similar good results to an approach under general anesthesia at less medical cost. METHODS: Eighteen patients underwent suture suspension arthroplasty by trapezial excision and metacarpal suspension using #2 high-strength suture passed from the attachment of abductor pollicis longus to the most distal part of flexor carpi radialis without tendon transfer or K-wire fixation. Nine patients received wide-awake anesthesia and 9 patients received general anesthesia. Postoperatively, patients were evaluated by clinical and radiographic outcomes. We investigated the first to second metacarpal angle, the first metacarpophalangeal angle, trapezial space ratio, grip strength, pinch strength, Kapandji score, DASH score, medical cost and patient satisfaction. RESULTS: Five of 18 patients were male. Average age was 66.3 (range 53-76). Eleven patients had Eaton stage 3 and 7 had stage 4. The mean follow-up was 17.9 months (range, 7-48 months). Postoperatively, the first to second metacarpal angle, the first metacarpophalangeal angle, grip strength, DASH and Kapandji score showed significant improvements. However, there is no significant difference of clinical and radiographic outcome between wide-awake anesthesia and general anesthesia. Medical cost was significantly less in wide-awake anesthesia than in general anesthesia. Most patients receiving wide-awake anesthesia would hope the same anesthesia if they were to have surgery again. CONCLUSION: Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis is a very simple technique and has good results. Because of the simplicity, wide-awake surgery is possible and yields similar good results to an approach under general anesthesia at less medical cost. Therefore, Suture suspension arthroplasty for thumb carpometacarpal osteoarthritis under wide-awake anesthesia is highly recommended.
Lonie SJ, Pafitanis G, Crowley TP
… +2 more, Ragbir M, Berner JE
J Hand Microsurg
· 2025 Mar · PMID 40538648
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Microvascular anastomotic couplers are a safe alternative to traditional vein suture techniques. They are versatile and widely used for flap vein anastomoses; however, the technique has limitations. Most problems which c...Microvascular anastomotic couplers are a safe alternative to traditional vein suture techniques. They are versatile and widely used for flap vein anastomoses; however, the technique has limitations. Most problems which can arise, have reasonable solutions that we have learned using this device. We describe advanced tips to avoid pitfalls and aid successful venous anastomoses with couplers in challenging situations.
J Hand Microsurg
· 2025 Mar · PMID 40538647
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PURPOSE: To prospectively address our patients seeking carpal tunnel release (CTR) to evaluate the incidence, intensity, and duration of pillar pain (PP) and its correlation with catastrophic thinking, depression, and he...PURPOSE: To prospectively address our patients seeking carpal tunnel release (CTR) to evaluate the incidence, intensity, and duration of pillar pain (PP) and its correlation with catastrophic thinking, depression, and health anxiety.Methods: this is a prospective cohort study consisting of patients who underwent mini-open CTR under WALANT. Pillar pain was evaluated using the table test and was recorded as dichotomous variable and rated with a visual analogue scale (VAS). Patients with a positive result were evaluated on a monthly basis until the test yielded a negative result.To assess catastrophic thinking, health anxiety and depression levels, we employed the Pain Catastrophizing Scale (PCS) the Short Health Anxiety Inventory (SHAI), and the Beck scale respectively. RESULTS: The study enrolled 170 patients who underwent CTR using WALANT technique. Among them, 84 patients (49 %) exhibited a positive table test. With exception of age and diabetes, both groups showed comparable demographic characteristics.The mean pain score for patients with a positive test was 3.5 ± 1.5, and the median duration of it was 3 months (interquartile range [IQR] 2-4). The median PCS score was 8 (IQR 2-14) in patients without PP, compared to 8 (IQR 4-11) in patients with PP. In the logistic regression model, the PCS variable had a crude odds ratio (OR) of 1 (95 % CI: 0.96-1.03) and an adjusted OR of 1 (95 % CI: 0.97-1.04). The SHAI score showed a crude OR of 0.97 (95 % CI: 0.93-1.01) and an adjusted OR of 0.97 (95 % CI: 0.92-1.01). The BECK score had a crude OR of 0.99 (95 % CI: 0.96-1.03) and an adjusted OR of 1.02 (95 % CI: 0.98-1.06). CONCLUSION: Patients undergoing mini-open CTR have a risk of 49 % of experiencing PP, which typically registers a pain intensity of approximately 3 points and will last for a median of 3 months. The likelihood of experience it does not depend on catastrophic thinking, depression, and health anxiety. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
J Hand Microsurg
· 2025 Mar · PMID 40538646
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Wide-Awake Local Anesthesia with No Tourniquet shifted how we provide hand surgery and liberated us from anesthesia-related constraints. This change led to the realization that hand surgery can be done in the office sett...Wide-Awake Local Anesthesia with No Tourniquet shifted how we provide hand surgery and liberated us from anesthesia-related constraints. This change led to the realization that hand surgery can be done in the office setting as long as safety requirements are fulfilled. This review focuses on what we know about office surgery from safety, society, facility, patient, and surgeon perspectives, and looks at the barriers that impede further expansion.
Carreño A, Cequier LS, Trepat AD
… +2 more, Carnicero N, Barreda DM
J Hand Microsurg
· 2025 Mar · PMID 40538645
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Flexor tendon pulley reconstruction in patients with multiple pulley ruptures and proximal interphalangeal joint contracture after closed injuries is relatively uncommon. The paucity of evidence in the literature support...Flexor tendon pulley reconstruction in patients with multiple pulley ruptures and proximal interphalangeal joint contracture after closed injuries is relatively uncommon. The paucity of evidence in the literature supporting one technique can make these surgical decisions and surgeries challenging. This article presents the surgical technique we use for treatment of the proximal interphalangeal joint stiffness and pulley reconstruction at the same time, using wide-awake local anesthesia with no tourniquet (WALANT). The clear advantage of this anesthetic technique for this procedure is the ability to directly verify the contracture release and tendon's gliding through the reconstructed pulley system during the patient's active mobilization, allowing the surgeon to make adjustments during the surgery and educating the patient on the postoperative therapy.
Kaempf de Oliveira R, Fischer P, Trivino V
… +2 more, Marcovici LL, Delgado PJ
J Hand Microsurg
· 2025 Jul · PMID 40534829
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Only 4 % of metacarpal fractures affect the distal articular region. In the literature, some studies have ended up causing confusion by mixing up extraarticular neck fractures with subcapital fractures, a term that shoul...Only 4 % of metacarpal fractures affect the distal articular region. In the literature, some studies have ended up causing confusion by mixing up extraarticular neck fractures with subcapital fractures, a term that should only be used to define transverse articular fractures of the head that are distal to the origin of the collateral ligament. Due to the need for anatomical reduction, displaced metacarpal head fractures must be reduced and fixed, mostly by open surgery. Recently, the use of intramedullary fixation has become the method of choice in the treatment of transverse metacarpal diaphyseal and neck fractures. Having this in mind, we describe the so-called "lollipop" technique for the treatment of subcapital metacarpal fractures, in which a cortical mini-fragment screw is inserted through the head by intramedullary retrograde fixation in the diaphysis, leaving the final assembly in the shape of the candy. By using minimal fixation, the already impaired vascularity of the head articular fragments is protected, providing enough rigid stability for the fracture to heal in an anatomical position and allowing early mobility.
Gomez Rodriguez GL, Irigoitia NA, Muratore A
… +2 more, Arnaout A, Clembosky G
J Hand Microsurg
· 2025 Jul · PMID 40529385
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Scapholunate instability is a common wrist injury that significantly affects wrist function and biomechanics. This study compares three internal brace fixation methods for stabilizing the scapholunate interval in cadaver...Scapholunate instability is a common wrist injury that significantly affects wrist function and biomechanics. This study compares three internal brace fixation methods for stabilizing the scapholunate interval in cadaveric models with a control group with intact ligaments (Group C): (1) internal brace without interference screw (Group N), (2) internal brace outside the interference screw (Group O), and (3) internal brace within the interference screw (Group I). The study aims to evaluate biomechanical stability, bone integrity, and osteolysis risk. Thirty-two cadaveric wrists were divided into four groups and subjected to biomechanical testing, including static, dynamic, and failure tests. Results showed that Group C exhibited a maximum failure load at 347.6 ± 21.4N; Group I exhibited the highest maximum failure load (319.4 N ± 28.7 N) and no recurrence of Dorsal Intercalated Segment Instability (DISI) during dynamic testing. Group N demonstrated the lowest biomechanical strength (118.5 N ± 15.3 N) and a 75 % DISI recurrence rate. Group O showed intermediate performance, with a maximum failure load of 221.7 N (±24.6 N) and a 37.5 % DISI recurrence rate. Imaging evaluation revealed that Group I had the least bone damage (2.1 % ± 0.9 %), while Group N had the most (24.8 % ± 2.3 %). The study concludes that placing the internal brace within the interference screw (Group I) offers superior biomechanical stability and bone protection, making it a promising technique for scapholunate stabilization. However, further clinical studies are needed to confirm these findings.
J Hand Microsurg
· 2025 Jul · PMID 40529384
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BACKGROUND: The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in c...BACKGROUND: The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in conjunction with open reduction and internal fixation (ORIF) and hardware placement. Secondary objectives were to determine incidence of fracture union and limb salvage. Finally, we sought to identify flap-related factors that might impact rates of infection, flap failure, and nonunion. METHODS: A consecutive single-surgeon series was studied. Baseline patient characteristics, flap-related factors, incidence of hardware failure, amputation, and non-union were extracted and analyzed. RESULTS: A total of 37 consecutive patients with a mean age of 38.9 ± 16.4 years were included, with a mean postoperative follow-up of 703.4 ± 459.6 days. There were 9 patients (24.3 %) with hardware failure and deep tissue infection. Time from injury to flap and time from last ORIF to flap were not significantly different between patients with hardware failure and those without. Flap type (muscle versus fasciocutaneous), smoking status, diabetes and body mass index were not associated with hardware failure. Multivariate regression analysis controlling for potential confounders showed that older age in patients was the only significant factor predicting hardware failure. Bone union was achieved in 29 (78.4 %) patients. Mean time from surgery to radiological signs of union was 329.3 ± 425.3 days. CONCLUSION: In patients requiring free flap reconstruction and ORIF for open tibial and ankle fractures, age was the only significant non-modifiable risk factor for hardware failure.
Dorniol M, Pouedras M, Lestienne V
… +3 more, Labbe F, Leroy M, Chaves C
J Hand Microsurg
· 2025 Jul · PMID 40529383
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BACKGROUND: Tissue coverage of the hand in a traumatic setting is challenging given the limited treatments available, the functional issues and the risk of amputation in case of failure. Artificial dermal substitutes hav...BACKGROUND: Tissue coverage of the hand in a traumatic setting is challenging given the limited treatments available, the functional issues and the risk of amputation in case of failure. Artificial dermal substitutes have been used in reconstructive surgery for decades but their indications and results in hand surgery need to be further evaluated. The aim of our study was to evaluate skin reconstruction of the hand with an artificial dermal substitute in a traumatic setting. METHODS: We retrospectively reviewed patients suffering from traumatic hand wounds defect with neurovascular, and/or osseous, and/or tendinous exposure. Patients underwent reconstruction with an artificial dermal substitute between 2017 and 2020 in a hand-trauma and reimplantation center. Primary outcomes included the success of the dermal substitute and the surgical revisions dues to failure. Patient satisfaction, QuickDASH and Vancouver scar scale (VSS) were also evaluated. RESULTS: Thirteen cases were retrieved. The average follow-up length was 22 months. Average age was 56,5 years. The mean surface to be covered was 7.9 cm. In eleven patients (85 %) the dermal substitute successfully covered the required surface. Two patients (15 %) required revision, one for finger ray amputation and another for revision of the dermal substitute. Seventy-seven percent of patient were satisfied, the mean QuickDASH was 30.7, and the VSS 6.3. CONCLUSION: Dermal substitutes allow skin coverage of traumatized hand particularly when used in first instance immediately after the trauma. They offer good quality scars and good functional results.
Wong CXL, Xie JLS, Sechachalam S
… +2 more, Wong JHK, Lee MYT
J Hand Microsurg
· 2025 Jul · PMID 40520944
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INTRODUCTION: Our study aims to share our surgical experiences in utilising the dorsoulnar artery perforator-based (DUAP) free flap for reconstruction of medium-sized defects of the digits. METHODS: Five patients, from 2...INTRODUCTION: Our study aims to share our surgical experiences in utilising the dorsoulnar artery perforator-based (DUAP) free flap for reconstruction of medium-sized defects of the digits. METHODS: Five patients, from 2014 to 2022, all of whom sustained critical defects of the digit(s), either due to trauma or infection, underwent resurfacing with an ipsilateral DUAP free flap. The size of the defects ranged from 2.5 to 3.5 cm in width and 3.5 to 7 cm in length. The main outcomes included active range of movement, sensory recovery of the flap, and time to return to work. RESULTS AND TECHNIQUES: All five patients demonstrated favourable outcomes following reconstruction of medium-sized digital defects using the DUAP free flap. The patients were followed up for an average of 5 months postoperatively. There were no cases of partial or complete flap failure, and none of the cases required re-exploration of anastomoses. Flap neurotisation was performed in selected cases using either end-to-end or end-to-side neurorrhaphy, achieving a 2-point discrimination of up to 7 mm at 10 weeks postoperatively. All donor sites had healed well and demonstrated good final wrist range of movement, even when flaps extended into the ulnar wrist crease. Technicial refinements included adjusting the flap position to accommodate longer pedicle lengths for defects with short recipient vessels or a wider zone of injury, using a cuff of the main ulnar artery for anastomosis in cases of vessel size mismatch, and using either the dorsal digital vein or superficial dorsal hand vein to mitigate venous congestion.End-to-side (ETS) neurotization was performed in one of the cases, which allowed for preservation of thumb sensation. CONCLUSION: The DUAP free flap is reliable and consistently reproducible and serves as a good option for reconstruction of medium-sized defects of the digit. It provides satisfactory functional and aesthetic outcomes, minimal donor site morbidity and the potential for sensory restoration through end-to-end and end-to-side neurotisation. Our experience supports the application of this flap beyond pulp defects, especially when selected technical modifications are employed to address the individual anatomical challenges and optimze outcomes. LEVEL OF EVIDENCE: 4.
Magtoto IJ, Xu J, Zhi Wei Tan NM
… +1 more, Sechachalam S
J Hand Microsurg
· 2025 Jul · PMID 40520943
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UNLABELLED: Distal Radius Malunion may occur with closed treatment and may result in various complications including stiffness and decrease in grip strength. Several techniques for correction of malunion have been devise...UNLABELLED: Distal Radius Malunion may occur with closed treatment and may result in various complications including stiffness and decrease in grip strength. Several techniques for correction of malunion have been devised and may broadly be classified into either hinge or distraction osteotomies. We present a "Volar Sliding Hinge Osteotomy" technique for correction of extra articular distal radius malunion, even with excessive radial shortening, without the use of distant bone grafts. The outcomes of three consecutive patients who underwent the procedure were also documented. Our technique may present as a good alternative to radial distraction or ulnar shortening osteotomies in correction of extra articular distal radius malunions with significant radial shortening. LEVEL OF EVIDENCE: IV.
J Hand Microsurg
· 2025 Jul · PMID 40510297
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Plate osteosynthesis is a core modality commonly employed for rigid surgical fixation of middle phalangeal fractures. It is conventionally done via a dorsal extensor-splitting approach, which bears the risk of plate irri...Plate osteosynthesis is a core modality commonly employed for rigid surgical fixation of middle phalangeal fractures. It is conventionally done via a dorsal extensor-splitting approach, which bears the risk of plate irritation and adhesion formation with the extensor apparatus that can lead to significant postoperative stiffness. While utilizing a lateral surgical approach may avoid this issue, literature on it remains scarce within the context of middle phalangeal fractures. Here, we outline our extensor-sparing technique of lateral plate fixation in middle phalangeal fractures. We demonstrate that it is a feasible and safe method for rigid surgical fixation with favorable clinical outcomes.
Muramatsu K, Tani Y, Ueda M
… +2 more, Carolino DKD, Sugimoto H
J Hand Microsurg
· 2025 Jul · PMID 40510296
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BACKGROUND: Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. Th...BACKGROUND: Tenosynovial giant cell tumor (TGCT) is a benign tumor arising from the synovial tissue and frequently occur in the digits. The treatment is surgical excision, but a high local recurrence rate is reported. The utilization of the surgical microscope during resection of digital TGCTs appears to be beneficial for more detailed visualization. We presented the outcomes of microsurgical resection of TGCT and discussed how to prevent recurrence of TGCT. METHODS: We reviewed 34 consecutive patients with TGCT cases operated by the single operator. The age at surgery ranged from 9 to 77 years, with an average of 48. The most common affected digit was the thumb (n = 13). In all cases, an operating microscope was utilized. The postoperative follow-up period was an average of 27.6 months. RESULTS: Intraoperative findings with the use of a microscope revealed an unexpectedly large number of cases with continuity to the adjacent joints. In cases of joint invasion, the capsule was opened to directly visualize the inside of the joint, and intra-articular tumor was resected enbloc together with extra-articular components. The classification of the disease was mixed type in 17 digits, localized type in 17. Postoperative recurrence was found in only one case (2.9 %). CONCLUSION: Microsurgery may be a beneficial tool for TGCT resection, but there have been only few reports. Invasive TGCT into the volar plate or infiltrating into the bone near the tendon attachment are well visualized and could be more certainly resected. The recurrence rate after microscopic TGCT resection was only 2.9 %, which is probably the lowest rate in the previously reported literature. Microsurgery allows sufficient visualization of the TGCT invasion and is useful for dissection of digital nerves and arteries.
Gupta SK, Holla N, Suwas S
… +2 more, Chatterjee K, Vamsi Krishna S
J Hand Microsurg
· 2025 Jul · PMID 40503244
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PURPOSE: Three-dimensional (3D) technology is rapidly emerging as a valuable tool in the medical and healthcare industry, particularly for performing corrective osteotomies in upper limb extremities. This study involved...PURPOSE: Three-dimensional (3D) technology is rapidly emerging as a valuable tool in the medical and healthcare industry, particularly for performing corrective osteotomies in upper limb extremities. This study involved patients with impaired upper limb function who underwent corrective osteotomies using a computer-assisted 3D surgical planning process with 3D-printed, patient-specific plates. The biomechanical performance of these 3D-printed, patient-specific plates was enhanced while maintaining crucial properties such as corrosion resistance and biocompatibility, ensuring their safety for clinical application in humans. The surgical outcomes were analyzed by visualizing bone healing, and an evaluation was conducted to assess the success of these methodologies by comparing the clinical outcomes achieved with those planned during the surgical planning phase. PATIENTS AND METHODS: Eight cases involving malunions and deformities were treated using patient-specific bone plates fabricated through metal additive manufacturing. Preoperative computed tomography (CT) scans were used to generate virtual bone models for surgical planning. Normal/anatomical bone alignment was achieved by mirroring the contralateral healthy bone and projecting it onto the affective bone model. Surgical guides and patient-specific bone implants were then designed. These implants underwent an innovative cyclic heat treatment to optimize their strength and ductility for enhanced biomechanical performance. RESULTS: The final outcomes for the patients were assessed using functional scoring and radiographs. The 3D-printed surgical guides facilitated accurate osteotomy angulation and precise positioning of drilled holes, ensuring optimal placement of customised, mechanically enhanced bone plates. All patients demonstrated improved DASH scores and experienced reduced or no pain after healing. CONCLUSIONS: This study demonstrates the success of personalized treatment for upper limb disorders using 3D-printed, patient-specific plates, which showed improved biomechanical performance after tailored heat treatment. This method of preparing patient-specific implants offers a safe and highly effective approach to treating malunions and deformities in the upper limbs with reduced surgical time.