Journal Of Hand And Microsurgery[JOURNAL]
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200 papers
WALANT beyond anesthesia: The end of physiological silence in hand, microsurgical and peripheral nerve reconstruction.
Terrence Jose Jerome J
J Hand Microsurg · 2026 Jul · PMID 42394898 · Full text
Wide Awake Local Anesthesia No Tourniquet (WALANT) is often introduced as an anesthetic technique that avoids general anesthesia, regional blocks, sedation, and tourniquet discomfort. This description is accurate, but in...
Wide Awake Local Anesthesia No Tourniquet (WALANT) is often introduced as an anesthetic technique that avoids general anesthesia, regional blocks, sedation, and tourniquet discomfort. This description is accurate, but incomplete. The deeper significance of WALANT is that it restores living physiology to the operating theatre. For more than a century, reconstructive surgeons repaired tendons, transferred nerves, corrected deformities, balanced muscles, and reconstructed movement in patients whose physiology was temporarily silent. Tendon tension was estimated, nerve function was predicted, muscle balance was assumed, and the final judgment of success was delayed until rehabilitation revealed the truth. WALANT challenges this old paradigm by allowing movement, tension, balance, spasticity, sensory response, and patient-specific biomechanics to be observed during surgery itself. Its expanding role in tendon transfer, thumb reconstruction, peripheral nerve surgery, brachial plexus reconstruction, spasticity surgery, and ambulatory microsurgery suggests that its greatest contribution may not be anesthetic freedom, but the birth of physiology-guided reconstruction. This editorial argues that WALANT has moved beyond tendons and beyond anesthesia. It has become a new way of thinking about reconstructive surgery.
An international survey of 262 hand surgeons on the diagnosis and treatment of thumb ulnar collateral ligament injuries.
van de Lucht VAP, Legerstee IWF, Luan A … +6 more , van der Oest MJW, Zuidam JM, Eberlin KR, Chen NC, van der Heijden B, van Heijl M
J Hand Microsurg · 2026 Jul · PMID 42327693 · Full text
PURPOSE: Despite the frequent occurrence of thumb ulnar collateral ligament injury, evidence supporting current diagnostic and treatment recommendations remains limited. To identify areas where comparative research is ne...
PURPOSE: Despite the frequent occurrence of thumb ulnar collateral ligament injury, evidence supporting current diagnostic and treatment recommendations remains limited. To identify areas where comparative research is needed to support future evidence-based guidelines and potential challenges to their subsequent implementation, this study aimed to characterize international practice patterns, identifying consensus and variation. METHODS: A web-based international survey was distributed between May and December 2024 through professional societies for hand surgery and associated clinical networks. The questionnaire comprised twenty-five items covering clinician characteristics, diagnostic strategies, and treatment preferences. Responses were analyzed descriptively and stratified by geographic region and years of clinical experience. RESULTS: Of 293 returned questionnaires, 262 were eligible for analysis. Respondents had practiced for a median of thirteen years, and most were based in Europe. Physical examination was considered sufficient to diagnose a complete ligament tear by most respondents (78%), whereas far fewer regarded it sufficient to detect a Stener lesion (27%). Radiographs were routinely used by 69%, ultrasound by 51%, and MRI by 40%. There was consensus for operative treatment of Stener lesions (95%) and displaced avulsion fractures (79%). Considerable variation existed for complete tears without Stener lesion: 59% preferred surgery, 52% would also attempt nonoperative treatment, and 25% reported they would never consider conservative management for any full-thickness tear. CONCLUSION: These findings identify areas of variation in which comparative evidence may be most relevant, while also showing where existing practice patterns may influence future guideline implementation. LEVEL OF EVIDENCE: Not applicable.
Regarding: "reconstructive and salvage techniques for proximal interphalangeal joint fracture-dislocations".
Mishra R, Singh V, Prince A
J Hand Microsurg · 2026 Jul · PMID 42306788 · Full text
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Management of upper extremity burn injuries: A hand Surgery-Focused review.
Lopuch A, Gaviria M, Baker J … +2 more , Chan RK, Sabbag C
J Hand Microsurg · 2026 Jul · PMID 42254329 · Full text
Upper extremity burns comprise a significant proportion of severe burn injuries. Their effective management necessitates a multidisciplinary approach, with early integration of hand surgery specialists. This is a narrati...
Upper extremity burns comprise a significant proportion of severe burn injuries. Their effective management necessitates a multidisciplinary approach, with early integration of hand surgery specialists. This is a narrative review article of current treatment modalities, prioritizing strategies to minimize acute-phase complications and optimize long-term outcomes. We cover initial management principles including resuscitation, thorough secondary assessment, and prompt debridement; elaborate on reconstructive surgical interventions such as skin grafting and flap techniques, paying close attention to strategies that preserve key anatomic locations for good functional outcomes; and outline common complications such as infection, heterotopic ossification, scar contractures, edema, and compartment syndrome, providing evidence-based prevention and treatment strategies. Although the management of upper extremity burn patients can be complex, utilizing a standardized and meticulous approach to the management of these devastating injuries can result in significantly improved functionality of the upper extremity.
Clinical characteristics and annual incidence of pickleball-related upper extremity injuries among patients presenting to emergency departments, 2015-2024.
Das RK, Thayer W, Elmaraghi S … +2 more , Hill JB, Drolet BC
J Hand Microsurg · 2026 Jul · PMID 42254328 · Full text
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Optimal management of pyogenic flexor tenosynovitis of the hand: a cohort study.
Hennessy M, Forder BH, Tucker S … +1 more , Wormald JCR
J Hand Microsurg · 2026 Jul · PMID 42239939 · Full text
BACKGROUND: Pyogenic flexor tenosynovitis (PFT) is a common hand infection associated with significant morbidity. Management varies due to lack of evidence-based guidelines, typically involving surgery and antibiotics. W...
BACKGROUND: Pyogenic flexor tenosynovitis (PFT) is a common hand infection associated with significant morbidity. Management varies due to lack of evidence-based guidelines, typically involving surgery and antibiotics. We conducted a cohort study, comparing outcomes between different surgical methods to see if one is optimal. METHODS: Retrospective data collection of patients who underwent surgery for PFT in a single tertiary plastic surgery unit between 21 August 2013 and 4 October 2023 was undertaken. Demographics, injury mechanism, operative details and antibiotic use were recorded. Cases involving cellulitis or osteomyelitis were excluded. Outcomes included length of stay, length of follow-up and post-operative complications. Multivariable regression analyses were performed, adjusting for age, diabetes and smoking status. RESULTS: A total of 174 patients (mean age 47.2 years [SD 18.7]) were included. PFT most commonly resulted from animal bites (23.7% of cases). There was wide variation in antibiotic prescribing practice. Open surgery was performed in 121 cases, whilst 53 underwent minimally invasive procedures. No statistically significant differences in outcomes were observed between techniques in unadjusted or adjusted analyses. Diabetes was associated with an increased likelihood of requiring further procedures on multivariable analysis. CONCLUSION: There is no evidence of differing outcomes for open or minimally invasive techniques. Diabetes may be associated with a requirement for further procedures. However, these results should be interpreted in the context of the retrospective design, missing data and potential for confounding by indication. Standardised, evidence-based management guidelines are required, with prospective multi-centre studies needed to better define optimal treatment strategies.
Patient-specific 3D-printed perforator mapping guide for propeller flap reconstruction in the hand.
Tong YT, Chung MMT, Poon TTL
J Hand Microsurg · 2026 Jul · PMID 42211389 · Full text
Reconstruction of hand soft tissue defects relies on accurate perforator localization, yet conventional planning with computed tomography angiography or handheld Doppler requires mental three-dimensional (3D) translation...
Reconstruction of hand soft tissue defects relies on accurate perforator localization, yet conventional planning with computed tomography angiography or handheld Doppler requires mental three-dimensional (3D) translation, and is associated with mapping errors or intraoperative adjustments. This article evaluates the use of an innovative patient-specific, surface-conforming 3D-printed guides that convert segmented preoperative magnetic resonance imaging (MRI) data into tangible templates to project dorsal metacarpal artery (DMA) perforator emergence points onto the skin with reproducible accuracy. In an illustrative case, a 66-year-old man underwent wide local excision of a digital porocarcinoma followed by propeller flap reconstruction. The third and fourth DMA perforators were identified from MRI, with a 2 mm-thick dorsal hand shell designed with 1 cm fenestrations corresponding to perforator emergence points. The perforators were marked onto the skin through the custom guide preoperatively, with skin markings cross verified with handheld Doppler. Reconstruction proceeded using a fourth DMA perforator-based propeller flap rotated to achieve tension-free coverage, with complete flap survival and restoration of full digital motion and satisfactory aesthetics. The 3D-printed guide reduced cognitive load, accelerated perforator localization, and minimized unnecessary dissection, supporting shorter tourniquet duration and safer elevation. The hand's distinct bony landmarks and stable contours enable reliable registration of rigid surface guides. As costs and workflows for imaging-to-print continue to decrease, patient-specific 3D-printed guides represent a practical, scalable adjunct that improved accuracy, efficiency, and reproducibility in perforator-based hand reconstruction.
Association between first ray lengthening and de Quervain tenosynovitis after trapeziometacarpal joint replacement.
Decroix L, Vanmierlo B, Decramer A … +2 more , Van Royen K, Degreef I
J Hand Microsurg · 2026 Jul · PMID 42211388 · Full text
PURPOSE: Trapeziometacarpal joint replacement is an effective treatment for trapeziometacarpal osteoarthritis, but postoperative de Quervain tenosynovitis remains a concern, with reported incidences of 4-17%. Thumb lengt...
PURPOSE: Trapeziometacarpal joint replacement is an effective treatment for trapeziometacarpal osteoarthritis, but postoperative de Quervain tenosynovitis remains a concern, with reported incidences of 4-17%. Thumb lengthening has been suggested as contributory. This study evaluated the association between postoperative thumb lengthening and de Quervain tenosynovitis using the M1-M2 arch described by Duché and Trabelsi. METHODS: A retrospective cohort study included 49 patients (53 procedures) who underwent primary trapeziometacarpal joint replacement with a dual-mobility ball-and-socket implant. Thumb lengthening was quantified radiographically with the M1-M2 arch on thumb abduction and Kapandji frontal views. De Quervain tenosynovitis was diagnosed clinically and using ultrasound. An association between thumb lengthening and de Quervain tenosynovitis was assessed using point-biserial correlation analysis. RESULTS: De Quervain tenosynovitis occurred in 14 of 53 wrists (26.4%), with a mean onset of 8.2 weeks. Patients with de Quervain tenosynovitis demonstrated greater thumb lengthening than those without, on both the abduction view (2.46 ± 1.46 mm vs. 0.75 ± 1.00 mm) and Kapandji frontal view (2.37 ± 1.39 mm vs. 0.34 ± 0.74 mm). Strong correlation was found between de Quervain tenosynovitis and thumb lengthening on the Kapandji frontal view and moderate correlation was found on the abduction view. Inter-observer reliability for the M1-M2 arch measurement was good, with an ICC of 0.88 for the Kapandji view and 0.84 for the thumb abduction view. CONCLUSION: Greater postoperative thumb lengthening was associated with de Quervain tenosynovitis following trapeziometacarpal joint replacement. These findings suggest that attention to restoration of thumb column length may be relevant in reducing the risk of postoperative de Quervain tenosynovitis. Prospective studies with large cohorts and standardized imaging protocols are warranted to clarify this relationship. LEVEL OF EVIDENCE: III.
Wrist and elbow arthroscopy case volume is low and declining in orthopedic residency and fellowship training.
Northrop MA, Pottanat PJ, Cahoy K … +5 more , Ment AJ, Otten MR, Lynch MK, Daley DN, Daly CA
J Hand Microsurg · 2026 Jul · PMID 42211387 · Full text
PURPOSE: Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that g...
PURPOSE: Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that graduating orthopedic surgery residents and fellows receive. METHODS: Accreditation Council for Graduate Medical Education (ACGME) case log data from 2014 to 2024 was reviewed for graduating orthopedic residents, hand surgery fellows, and orthopedic sports medicine fellows in the United States. Mean and median numbers of wrist and elbow arthroscopy cases logged per resident or fellow were compared to assess procedure volume. The 10th and 90th percentiles of case volumes were analyzed to assess variability. Trends were evaluated over time to determine changes in case exposure. RESULTS: Wrist arthroscopy volume reported by orthopedic residents decreased from 4.6 ± 5 (median 3, range 0-46) to 3.0 ± 3 (1, 0-23) cases per resident ( < 0.001). Elbow arthroscopy volume decreased from 2.1 ± 2 (2, 0-18) to 1.8 ± 3 (1, 0-38) cases per resident ( < 0.001). Among hand surgery fellows, wrist arthroscopy volume decreased from 18.5 ± 13 (15, 3-102) to 14.4 ± 8 (13, 5-65) cases per fellow ( < 0.001), and elbow arthroscopy volume from 5.2 ± 7 (4, 0-35) to 2.6 ± 3 (1, 0-20) cases per fellow ( < 0.001). Sports medicine fellow elbow arthroscopy volume decreased from 6.6 ± 8 (4, 0-48) to 3.1 ± 4 (2, 0-23) cases per fellow ( < 0.001). Wrist arthroscopy volume was not reported for sports medicine fellows. CONCLUSIONS: Despite the established role of wrist arthroscopy in upper extremity orthopedic surgery, resident exposure is limited and has declined over recent years. Fellowship training has not offset this decline, with wrist and elbow arthroscopy volume decreasing significantly in hand and sports medicine fellowships. These trends raise concerns over preparedness to safely and independently perform these technically demanding procedures in practice after training. LEVEL OF EVIDENCE: IV.
Surgical reconstruction of the extensor apparatus at P1 level following wide resection for lipofibromatosis: Description of an original technique.
Tos P, Filistad S, Parafioriti A … +3 more , Bastoni S, Cecconato V, Marini E
J Hand Microsurg · 2026 Jul · PMID 42199510 · Full text
PURPOSE: Wide excisions of the extensor tendons at the level of the proximal phalanx (P1) may be required during oncologic resections. We present an original, single-stage reconstructive technique of the extensor apparat...
PURPOSE: Wide excisions of the extensor tendons at the level of the proximal phalanx (P1) may be required during oncologic resections. We present an original, single-stage reconstructive technique of the extensor apparatus of the hand used after wide resection for Lipofibromatosis (LPF), a rare pediatric soft tissue tumor. METHODS: A 9-year-old girl presented to our institution with a mass on the dorsum of the left hand at the Metacarpophalangeal (MCP) joint of the third digit: following biopsy, the lesion was diagnosed as LPF. Wide surgical excision was performed, requiring complete resection of the extensor apparatus, including the central slip and lateral bands. Reconstruction was performed using a hemisection of the Extensor Digitorum Communis(EDC) tendon to reconstruct the central slip, combined with a Palmaris Longus (PL) autograft to reconstruct the sagittal and lateral bands sutured to the intrinsic muscles. RESULTS: At 2-year follow-up, the patient demonstrated near-complete active extension, full flexion, and no evidence of recurrence. A residual extension lag of 10° at the Proximal Interphalangeal (PIP) joint was observed. Grip strength was comparable to the contralateral side. CONCLUSION: This technique allows functional restoration of the extensor mechanism in a single stage and may represent an alternative in complex reconstructions. The good clinical outcome prompted us to report this technique, which, to our knowledge, has not been previously described. At a current follow-up of two years, the result remains stable, with no evidence of local recurrence.
Traction-induced suprascapular nerve injury: A six-type anatomical classification of injury patterns.
Bhandari PS, Pant P
J Hand Microsurg · 2026 Jul · PMID 42182541 · Full text
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Arthroscopy-assisted fixation of coronoid process fractures: technical description and case series.
Delgado PJ, Prada A, Trivino V … +2 more , Fischer P, Kaempf R
J Hand Microsurg · 2026 Jul · PMID 42182540 · Full text
The ulnar coronoid process is a primary static stabilizer of the elbow and its fractures, when associated with joint instability, usually require surgical treatment. Conventional open techniques may be difficult to perfo...
The ulnar coronoid process is a primary static stabilizer of the elbow and its fractures, when associated with joint instability, usually require surgical treatment. Conventional open techniques may be difficult to perform and require wide surgical exposure, with greater morbidity and risk to neurovascular structures, in addition to causing injury to other healthy tissues, increasing the risk of fibrosis, stiffness, infection, and decreasing the vascularization of the fracture fragments. The objective of this study was to describe an arthroscopic technique and to present the results of a series of patients with fractures of the ulnar coronoid process associated with elbow instability treated with arthroscopy-assisted transosseous fixation using high-strength sutures. Thirteen patients were retrospectively evaluated, with a mean age of 30.0 years and a mean follow-up of 22.0 months. Bone union was achieved in all cases. The mean final flexion was 130.3°, with a mean extension deficit of 7.3°. The mean final protonation and supination were 88.8° and 86.9°, respectively. The mean functional score was 10.7 on the QuickDASH and 92.6 on the MEPS. Arthroscopy-assisted transosseous fixation proved to be a reliable option in the treatment of coronoid process fractures associated with instability, allowing early mobilization, a low complication rate, and good clinical and functional results, provided that it is performed by surgeons experienced in elbow arthroscopy.
Latissimus dorsi and/or serratus anterior - rib composite flap for posttraumatic long bones reconstruction.
Georgescu AV, Olariu O, Matei IR
J Hand Microsurg · 2026 Jul · PMID 42182539 · Full text
Posttraumatic bone defects or their sequels represent one of the most challenging problems in limbs reconstruction. It is proved that due to their advantages, i.e. regenerative properties, shorter time to obtain bone fus...
Posttraumatic bone defects or their sequels represent one of the most challenging problems in limbs reconstruction. It is proved that due to their advantages, i.e. regenerative properties, shorter time to obtain bone fusion, better stability, better power to fight against infection, the use of vascularized bone grafts (VBGs) represents the best choice in such cases. If large soft tissue defects are concomitant to bone defects, composite flaps including bone segments should be the choice. This paper provides details about such flaps - vascularized rib (R) as part of the latissimus dorsi (LD) and/or serratus anterior (SA) flap. In all alternatives, i.e. LD-R, SA-R, and LD-SA-R, the flap can be used as a free flap in both upper and lower limb, or as a pedicled flap in upper extremity. We hypothesized that these flaps could offer the same advantages and possible results as other VBGs.
Free functional muscle transfer in children: A long-term case series from a single microsurgical unit.
El-Gammal TA, El-Sayed A, Kotb MM … +4 more , Saleh WR, Ragheb YF, El-Gammal YT, Refai OA
J Hand Microsurg · 2026 Jul · PMID 42182538 · Full text
BACKGROUND: Restoration of active motion in children with upper-limb paralysis or muscle loss remains challenging. Free functional muscle transfer (FFMT) is a reconstructive option when local muscle donors are unavailabl...
BACKGROUND: Restoration of active motion in children with upper-limb paralysis or muscle loss remains challenging. Free functional muscle transfer (FFMT) is a reconstructive option when local muscle donors are unavailable, but uncertainties persist regarding optimal timing, donor nerve selection, and long-term effects of growth and secondary deformities. This study reports a single-institution experience addressing these issues. METHODS: A retrospective review was conducted of 35 children (<18 years) who underwent upper-limb FFMT with a minimum follow-up of 24 months. All reconstructions used the gracilis muscle to restore finger flexion, elbow flexion, elbow extension, or combined functions. Donor nerves included the anterior interosseous nerve (AIN) with or without median nerve fascicles, intercostal nerves, spinal accessory nerve, and phrenic nerve. Outcomes included time to muscle activation, range of motion, Medical Research Council (MRC) strength, secondary procedures, complications, bimanual use, and patient or caregiver-reported satisfaction. Pre- and postoperative outcomes were compared using paired and groupwise statistical tests. RESULTS: Mean age at surgery was 7.6 years, with a mean follow-up of 68 months (range, 24-166 months). Flap survival was 100%. Initial muscle activation occurred at a mean of 4.1 months. Significant improvements in motion and strength were observed across all functions (p < 0.001). MRC grade ≥4 strength was achieved in 80.0% of elbow-flexion reconstructions and 78.3% of finger-flexion reconstructions. Finger-flexion reconstructions demonstrated higher bimanual use and more consistent recovery than elbow-flexion reconstructions. In construct-level analysis, single-function transfers showed clearly superior finger-flexion outcomes, whereas elbow-flexion results differed by endpoint: single-function transfers achieved greater ROM, while all dual-function elbow-flexion transfers reached MRC grade ≥4 in this small subgroup. Secondary procedures were required in 51.4% of patients. Overall satisfaction was reported by 71.4% and correlated more strongly with final strength and completion of reconstruction than with range of motion. CONCLUSIONS: Gracilis FFMT provides durable restoration of active motion and strength in children. Outcomes are influenced by indication and reconstructed function rather than donor nerve selection alone. Strength recovery and functional integration are primary determinants of bimanual use and satisfaction. Findings support the use of FFMT as part of a staged reconstructive strategy in pediatric patients.
Traumatic brachial plexus injuries in Cambodia: Demographics, interventions, and post-operative outcomes.
Wood H, Jowett V, Tan V … +5 more , Kim YJ, Yam A, Lam WL, Rajaratnam V, Pogn S
J Hand Microsurg · 2026 Jul · PMID 42182537 · Full text
PURPOSE: Brachial plexus injury (BPI) is a major cause of disability in low- and middle-income countries due to road traffic accidents. There are no studies reporting the epidemiology of BPIs in Cambodia. Therefore, the...
PURPOSE: Brachial plexus injury (BPI) is a major cause of disability in low- and middle-income countries due to road traffic accidents. There are no studies reporting the epidemiology of BPIs in Cambodia. Therefore, the purpose of this study was to report the demographics, surgical interventions, and post-operative outcomes of surgically treated BPIs at the Children's Surgical Centre (CSC), Cambodia, and reflect on the service development. METHODS: We retrospectively reviewed all surgically treated traumatic BPIs at CSC between January 1, 2012 and April 30, 2025. Extracted data included patient demographics, injury mechanism, BPI subtype, operative details, injury to surgery interval, international involvement, and ≥12-month post-operative elbow flexion and shoulder abduction Medical Research Council (MRC) strength. RESULTS: 303 patients had 419 BPI surgeries at CSC. Mean age was 28.51 years (range: 2 - 61 years) and 279 (92.08%) were males. The aetiology was blunt trauma in 296 (97.68%) and the most common subtype was pan-plexal injury in 176 (58.1%) patients. Mean injury to index surgery interval was 6.66 months. Annual case volume increased up to 2019 and international surgical involvement shifted to Cambodian involvement. At ≥12 months post-operatively, 49/71 (69.01%) and 36/53 (67.92%) achieved ≥3 MRC strength in elbow flexion and shoulder abduction, respectively. CONCLUSIONS: There is a high BPI burden among young males following road traffic accidents in Cambodia. CSC has developed a sustainable, self-sufficient BPI service with encouraging functional outcomes. Future priorities include earlier referral after BPI injury and improved outcome capture.
Does addition of a bupivacaine improve postoperative pain after carpal tunnel release in WALANT? A prospective randomized trial.
Rellan I, De Carli P, Bronenberg Victorica P … +6 more , Holc F, Donndorff AG, Martinez EF, Abrego MO, Gallucci G, Boretto JG
J Hand Microsurg · 2026 Jul · PMID 42100467 · Full text
PURPOSE: To compare the intensity and duration of pain during the first and second 24-h postoperative (PO) periods following carpal tunnel release (CTR). Secondary objectives were to compare the total number of analgesic...
PURPOSE: To compare the intensity and duration of pain during the first and second 24-h postoperative (PO) periods following carpal tunnel release (CTR). Secondary objectives were to compare the total number of analgesic tablets consumed, the time to first analgesic intake, and the degree of sleep disruption and nocturnal pain intensity during the first PO night. METHODS: We conducted a prospective, randomized, controlled trial of patients undergoing CTR with WALANT. Participants were randomly assigned to:10 mL of 1% lidocaine with epinephrine combined with 10 mL of 0.5% bupivacaine hydrochloride, or 20 mL of 1% lidocaine with epinephrine. All patients received a standardized, self-administered questionnaire designed to document pain intensity, the timing and amount of analgesic consumption, and subjective sleep quality during the first 48 PO hours. Pain intensity was recorded using a numerical rating scale, and analgesic use was documented in detail. RESULTS: Eighty-two patients were included. Mean PO pain scores were similar between groups across both 24-h periods. On PO day one, mean scores were 0.6 (SD 1.73; range 0-7) in the bupivacaine group and 0.6 (SD 1.65; range 0-6) in the lidocaine group. On PO day two, scores decreased to 0.06 (SD 0.20) and 0.02 (SD 0.28), respectively. The bupivacaine group experienced a delayed onset of peak pain by 4 h and a longer pain-free interval before requiring the first analgesic intake.Pain trajectories, total analgesic consumption, timing of first analgesic intake, and sleep disruption demonstrated no clinically meaningful differences. CONCLUSIONS: The addition of bupivacaine to the standard WALANT solution did not modify PO pain intensity after CTR. Total analgesic use, timing to first intake, and sleep disruption were also comparable between groups. TRIAL REGISTRY NAME AND URL: NCT05697276 https://clinicaltrials.gov/study/NCT05697276?lat=-34.6062243&lng=-58.42563990000001&locStr=Hospital%20Italiano%20de%20Buenos%20Aires,%20Teniente%20General%20Juan%20Domingo%20Perón,%20Buenos%20Aires,%20Argentina&distance=50&term=WALANT&rank=2. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Ib.
Current and traditional reconstructive techniques for bone diaphyseal defects: selection criteria, advantages, outcomes. A study of 24 cases.
Ignatiadis IA, Tsiampa VA, Arapoglou DK … +3 more , Dasakalakis EG, Polyzois VD, Fandridis EM
J Hand Microsurg · 2026 Jul · PMID 42100466 · Full text
PURPOSE: Diaphyseal bone defects of the upper and lower limbs represent a significant reconstructive challenge, often arising from high-energy trauma, posttraumatic osteomyelitis, or postoperative bone necrosis. This stu...
PURPOSE: Diaphyseal bone defects of the upper and lower limbs represent a significant reconstructive challenge, often arising from high-energy trauma, posttraumatic osteomyelitis, or postoperative bone necrosis. This study evaluates the applicability, advantages, limitations, and outcomes of various reconstructive techniques for segmental diaphyseal defects in a cohort of 24 patients. METHODS: Between 2004 and 2011, 24 patients (age range 15-74 years) with diaphyseal defects ranging from 4 to 15 cm were treated using the following reconstructive approaches: 1.Ilizarov bone transport (IBT), 2.Taylor spatial Frame bone transport (TSFBT) (one Trifocal), 3.Εxternal fixation bone transport (ExFixBT), 4.free vascularized fibular graft (FVFG), 5.pedicle vascularized serratus-rib transfer i, 6.Masquelet-modified technique, 7.demineralized blocks or frozen cadaveric allografts. 8.Modified Papineau procedure + flaps with Dynamic (TSFBT) or static Taylor Frame (with TSFBT or with static Taylor Frame). Upper limb defects (n = 8) were managed predominantly with microsurgical techniques, while lower limb defects (n = 16) employed bone transport strategies. Clinical evaluation incorporated the Gustilo classification, Mangled Extremity Severity Score (MESS) for lower limbs, and SATTy scoring for upper limbs. Functional outcomes were assessed using Quick DASH (upper limb) and Lower Extremity Functional Scale (LEFS, lower limb) scores after a minimum 5-year follow-up. RESULTS: Upper limb reconstructions achieved bone healing in all cases, with Quick DASH scores showing two excellent, one good, three satisfactory, and two borderline satisfactory outcomes. Lower limb reconstructions also achieved successful union, with LEFS outcomes ranging from mild to severe difficulty; no patient was entirely disabled. Techniques were tailored according to defect size, infection status, soft tissue condition, and surgical expertise. Notably, modified Papineau open cancellous grafting provided reliable resolution in cases of persistent osteomyelitis. Complex reconstructions, including simultaneous nerve and bone grafting, demonstrated successful functional recovery. CONCLUSIONS: Successful management of diaphyseal bone defects relies on individualized selection of reconstructive techniques based on defect characteristics, infection status, and multidisciplinary expertise. Close collaboration between orthopedic and microsurgical teams is essential. Historically underutilized techniques, such as the Papineau procedure, remain valuable options in the setting of chronic infection. Careful, patient-specific planning enables favorable anatomical and functional outcomes.
Digital splinting for acute closed bony mallet finger: A case series.
Prieto-Garzón AC, Martínez-Arboleda JJ, Castañeda-López JF … +2 more , Rincón-Cardozo DF, Kafury ÁA
J Hand Microsurg · 2026 Jul · PMID 42079778 · Full text
AIM: To assess clinical, radiographic and functional outcomes of digital splinting in acute closed bony mallet finger injuries. METHODOLOGY: This Level IV case series included 19 patients with acute bony mallet finger. P...
AIM: To assess clinical, radiographic and functional outcomes of digital splinting in acute closed bony mallet finger injuries. METHODOLOGY: This Level IV case series included 19 patients with acute bony mallet finger. Patients with loss to follow-up, chronic injuries, open lesions, or unstable, irreducible, or clearly displaced distal interphalangeal (DIP) joint subluxations not corrected by splint positioning at presentation were excluded. All patients were treated with volar splint immobilisation of the DIP joint in extension for six weeks and followed for a minimum of 12 months. Extension deficit, range of motion, radiographic consolidation and classification (Wehbe and Schneider), and functional outcomes using the DASH score were assessed. RESULTS: The average age of the patients was 33.6 years. The little finger was the most affected (52.6%). Most patients (84.2%) presented a fracture with an articular fragment greater than one-third of the articular surface. Overall satisfaction had a mean rating of 9.5 on a 0-10 scale (0 = lowest, 10 = highest). The mean DASH score was 4.3 ± 2.8. All fractures achieved bone consolidation, and no treatment-related complications were observed. CONCLUSIONS: Conservative digital splinting is a reasonable nonoperative option for acute bony mallet finger treated within four weeks of injury. Satisfactory consolidation and functional outcomes were observed in fractures with larger articular fragments and in selected cases of mild, splint-reducible distal interphalangeal joint subluxation. These findings do not extend to unstable or irreducible subluxations and should be interpreted within the constraints of a descriptive case series.
The effect of acute caffeine abstinence on microsurgical performance: A pilot randomised crossover study using a low-cost mechanical simulation model.
Niu R, Franks D, Knee CJ … +2 more , Sivakumar BS, Lawson RD
J Hand Microsurg · 2026 Jul · PMID 42079777 · Full text
BACKGROUND: Rapid alterations in coffee consumption may result in increased tremors affecting surgical performance. This pilot study aimed to assess the effect of acute caffeine abstinence relative to usual caffeine inta...
BACKGROUND: Rapid alterations in coffee consumption may result in increased tremors affecting surgical performance. This pilot study aimed to assess the effect of acute caffeine abstinence relative to usual caffeine intake on microsurgical performance and to evaluate a custom-built mechanical model for future testing and training purposes. METHODS: Decaffeinated and caffeinated beverages were consumed by eight blinded and fasted orthopaedic registrars. The registrars were then tasked with completing a task mimicking the skills inherent to microsurgery using a novel custom-built mechanical model. Outcomes assessed included total time to complete the task, as well as contact time between the suture needle and eyelet through which the needle was passed (as a surrogate for fine tremors and agitation), and were compared between decaffeinated and caffeinated conditions using the Wilcoxon signed-rank test RESULTS: Eight orthopaedic registrars (mean age 31.8 years) with an average of 11.3 prior microsurgery cases (range, 1-24) participated. The mean daily caffeine intake was 522.3 mg (range, 214-900 mg). Higher caffeine intake correlated with increased sleepiness on the Stanford Sleepiness Scale. Median (IQR) contact time was 1024 ms (304.5-1994.5) and 1018.5 ms (457-1527) for decaffeinated and caffeinated conditions, respectively. Median (IQR) total task time was 5620 ms (3939-6768) and 5412.5 ms (3745.3-5899.5), respectively. No significant differences were observed in contact time (median paired difference 58.5 ms, p = 0.23) or total task time (median paired difference 434.5 ms, p = 0.53). CONCLUSION: This preliminary pilot study did not detect a statistically significant difference in performance between participants who abstained from caffeine and those who consumed their usual amount. It also suggests the feasibility of a low-cost and replicable mechanical model to assess microsurgical performance for training or research purposes, although validation in larger cohorts is required.
Stroke, reward, and the reluctant hand: Why nucleus accumbens ultrasound neuromodulation matters to hand surgeons.
Rajaratnam V, Omar UF, Eisa A … +1 more , Jerome JTJ
J Hand Microsurg · 2026 May · PMID 42027397 · Full text
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