Background: Activity modification to reduce mechanical stress on the ulnar nerve is an effective treatment for mild to moderate cubital tunnel syndrome (CuTS). However, some patients do not improve with nonsurgical management and ultimately require surgical intervention. This study aimed to identify predictors associated with nonsurgical treatment failure in CuTS. Methods: We retrospectively reviewed data from patients with CuTS classified as McGowan grades 1 and 2. Non-surgical management primarily consisted of activity modification, with adjunctive treatments including vitamin B12, nonsteroidal anti-inflammatory drugs, pregabalin or mirogabalin and corticosteroid injections. Treatment failure was defined as the need for subsequent surgical intervention (transition-to-surgery group). The success group included 37 patients, and the transition-to-surgery group included 26 patients. Univariate and multivariate regression analyses were performed to evaluate predictors of nonsurgical treatment failure, including age, sex, body mass index, disease duration, comorbidities (diabetes mellitus, thyroid disease and radiographic cervical spondylosis) and concomitant elbow disorders (osteoarthritis, ganglion cysts and cubitus varus or valgus deformity). Elbow osteoarthritis was assessed radiographically using the Broberg and Morrey classification system. Results: Univariate analysis showed that corticosteroid injections, current smoking, radiographic cervical spondylosis and elbow osteoarthritis were more common in the transition-to-surgery group than in the success group. Multivariate analysis identified corticosteroid injections, radiographic cervical spondylosis and elbow osteoarthritis as independent predictors of nonsurgical treatment failure. Conclusions: Patients who received corticosteroid injections and those with radiographic cervical spondylosis or elbow osteoarthritis were more likely to experience nonsurgical treatment failure for mild to moderate CuTS and subsequently require surgical intervention. Early recognition of these risk factors may help clinicians identify patients who are less likely to respond to conservative management and consider earlier surgical treatment to prevent persistent symptoms and disease progression. Level of Evidence: Level IV (Therapeutic)
Epidermolysis bullosa (EB) results in blistering of the skin and impaired wound healing. These factors increase the risk of developing cutaneous squamous cell carcinoma (cSCC), which may require amputation. Reconstructive options post upper limb amputation are limited in patients with EB, for reasons discussed below. We present a case report of one such patient with advanced cSCC of the hand who underwent a distal forearm amputation followed by a primary Krukenberg procedure. This patient had already undergone a contralateral forearm amputation for the same reason. The patient had an uneventful post-operative recovery and regained full independence in basic activities of daily living. In conclusion, the Krukenberg procedure can be considered as a reconstructive option in cases of severe EB with locally advanced cSCC requiring hand amputation. Level of Evidence: Level V (Therapeutic)
Dupuytren disease is commonly treated with collagenase Clostridium histolyticum (CCH) injection followed by manual manipulation within 24–72 hours. Delays in manipulation may occur in clinical practice, yet data regarding outcomes beyond this window remain limited. In this case report, we describe two patients with Dupuytren contracture in whom manipulation was performed 14 and 21 days after CCH injection. Despite the prolonged interval, both patients achieved successful release of metacarpophalangeal joint contractures with meaningful functional improvement. Minor complications included palmar skin tearing at the time of manipulation, which healed without long-term sequelae. These cases demonstrate that successful manipulation beyond the recommended timeline is possible and warrants further investigation in larger studies. Level of Evidence: Level V (Therapeutic)
Background: Ulnar shortening osteotomy (USO) is a common surgical treatment for ulnar impaction syndrome (UIS). Various fixation methods and specialised instruments have been developed to promote bone union; however, these approaches can increase both cost and technical complexity. The study aimed to describe a simplified technique combining freehand transverse osteotomy, interosseous wire fixation and locking compression plate fixation and to evaluate its clinical outcomes. Methods: Twenty-five wrists from 23 patients (median age: 45 years) who underwent USO for UIS between January 2014 and July 2023 were retrospectively reviewed. All procedures were performed without specialised jigs or cutting guides. The primary outcome was time to radiographic union. Operative time, complications, implant-related events and patient-reported outcomes were evaluated using the Numerical Rating Scale (NRS), Hand10, Patient-Rated Wrist Evaluation (PRWE) and EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaires. Results: Radiographic and clinical union was achieved in all patients in a median of 10 weeks (interquartile range [IQR]: 7–13), with no delayed unions or non-unions. The median operative time was 68 minutes. NRS pain scores during activity improved from 5 (IQR: 4–7) preoperatively to 2 (IQR: 2–3) at the final follow-up. Amongst the 11 patients who completed patient-reported outcome measures, Hand10 and PRWE scores improved significantly (p < 0.001). The EQ-5D-5L score showed a trend towards improvement (p = 0.053). No postoperative infections, nerve injuries or refractures occurred after plate removal. Conclusions: This simplified freehand USO technique demonstrated consistent bone healing and functional improvement in this cohort, without the need for specialised instrumentation. It may offer a practical option for the surgical management of UIS. Level of Evidence: Level IV (Therapeutic)
Laurin–Sandrow syndrome (LSS) is a rare congenital limb malformation defined by mirror-image polydactyly, often associated with tibial haemimelia and nasal anomalies. We report monozygotic twin siblings, evaluated at age 6 following international adoption, presenting with bilateral mirror hands and lower limb deformities without craniofacial involvement. Twin 1 presented with five-fingered mirror hands, complex syndactyly, a right transtibial amputation secondary to tibial haemimelia and contralateral equinovarus deformity. Twin 2 demonstrated bilateral polysyndactyly (six metacarpals with radial hypoplasia on one side; distal phalangeal duplication on the other), tibia vara and an accessory talus. Both underwent staged reconstruction, including syndactyly release and pollicisation of the preaxial-most digit. At 18-month follow-up, both achieved stable opposition and functional pinch (T-GAP scores 43–46). These cases highlight the significant intrafamilial phenotypic variability of LSS and demonstrate that favourable functional outcomes are achievable even with delayed surgical intervention. Level of Evidence: Level V (Therapeutic)
