Background Despite the increasing representation of women in medical schools, surgical specialties, particularly hand surgery, remain male-dominated. Gender disparities persist across multiple career stages, with women underrepresented in leadership positions within national and international hand surgery societies. The purpose of this study is to analyze the current landscape of women leadership in national and international hand surgery societies. Methods In December 2024, an internet search was conducted to identify hand surgery societies with publicly available leadership data. The proportion of female leaders in each society was calculated to evaluate gender representation. Results Among 51 national societies across six continents and three international federations (Asia Pacific Federation of Societies for Surgery of the Hand, Federation of European Societies for Surgery of the Hand, and International Federation of Societies for Surgery of the Hand), women held 22% of international and 20% of national leadership roles. Regional female representation was highest in Oceania (44%) and lowest in North America (7%). Twelve societies had no female leaders, while one was entirely led by women. Conclusion Substantial gender disparity persists globally in hand society leadership. Targeted efforts to enhance transparency, mentorship, and systemic change should be implemented or expanded to foster inclusive leadership environments.
The article describes the special surgical anatomy of the extensor carpi ulnaris tendon (ECU) and the sixth extensor compartment, including the most common pathological conditions. The sixth extensor compartment is only loosely covered and not connected by the extensor retinaculum. The ECU has its own retinaculum at the ulnar head, for which the Latin name "retinaculum privatum" (English: subsheath) is proposed. Dislocation of the extensor tendon (ECU), first described by Schlesinger in 1907, can be treated using various techniques for reconstructing the retinaculum privatum (from the extensor retinaculum, transosseous with a free tendon graft, or using fibers from the Linea jugata). 1 Tendovaginosis of the extensor compartment was first surgically treated by Stein in 1927; the first detailed description was provided by Pfeiffer in 1969 in Volume 1 of this journal.(2,3) The sixth extensor compartment is frequently affected in rheumatic diseases. In these cases, significant structural damage is found in the ECU tendon and tendon sheath due to aggressive inflammatory synovitis and instability of the ulnar head (caput ulnae syndrome).
Abstract Inadequate treatment of acute scaphoid fractures often leads to nonunion and subsequent scaphoid nonunion advanced collapse. Patients with stage II–III scaphoid nonunion advanced collapse are commonly managed with limited intercarpal arthrodesis or proximal row carpectomy via a dorsal approach. A retrospective review was conducted of 14 patients (12 men and 2 women; mean age 46 y) who underwent capitolunate arthrodesis via a radial approach with titanium mini T-plate fixation between April 2023 and March 2025. All procedures included scaphoidectomy and cancellous grafting. Clinical outcomes included union rate, Quick Disabilities of the Arm, Shoulder and Hand score, Modified Mayo Wrist score, grip strength, and range of motion. Radiographic assessments comprised carpal height ratio, lunate shift ratio, radiolunate, and capitolunate angles. Radiographic union was achieved in all patients at a mean of 2.5 months (range: 2–3.5 mo). The mean follow-up was 15 months. The mean flexion–extension arc was 71°, and the mean grip strength reached 82% of the contralateral side. The mean postoperative Quick Disabilities of the Arm, Shoulder and Hand and Modified Mayo Wrist scores were 19.4 and 68.3, respectively; 10 of 14 patients (71%) were very or moderately satisfied with their outcomes. Late complications occurred in three patients (two mild localized superficial branch radial nerve paresthesia and one implant impingement requiring removal). One patient required total wrist arthrodesis 8 months postoperatively due to intractable pain. Radiographically, carpal alignment was restored with significant improvements in all angular parameters: a carpal height ratio increased from 0.37 to 0.47 (p<0.05); a radiolunate angle improved from−13.2° to 3.8° (p<0.05); and a capitolunate angle from 35.2° to 18.0° (p<0.05). T-plate fixation through a radial approach offers stable and reliable fixation for capitolunate arthrodesis, providing excellent union rates, satisfactory functional recovery, and restoration of carpal alignment. This approach represents an alternative to the traditional dorsal capitolunate arthrodesis technique for managing stage II–III scaphoid nonunion advanced collapse wrist.
Abstract Mastectomy skin flap necrosis poses a significant challenge for reconstructive surgeons. Diabetes mellitus, obesity, radiation therapy, and smoking are known risk factors. Mastectomy skin flap necrosis occurs when the metabolic demand of tissues is greater than blood supply. No objective measurements exist to quantify the pre-operative risk of mastectomy skin flap necrosis. We hypothesized that subcutaneous tissue thickness correlates with the risk of mastectomy skin flap necrosis. As pre-operative mammography is routinely performed, it can be used to measure subcutaneous tissue thickness. By determining a relationship between the subcutaneous tissue thickness and the mastectomy skin flap necrosis risk, surgeons may tailor their pre-operative counseling and intra-operative decision making. A retrospective chart review of 50 patients undergoing nipple-sparing mastectomy followed by implant-based or autologous reconstruction was performed. Six patients were excluded as pre-operative mammograms were not available. Thus, the final analysis included 44 patients, comprising 73 operated breasts. Six pre-operative mammographic measurements of subcutaneous tissue thickness were made to determine an average value. Multi-variable logistic regression was used to identify the predictors of mastectomy skin flap necrosis. Twenty-six patients (59.1%) and 38 breasts (52.1%) experienced mastectomy skin flap necrosis. The average subcutaneous tissue thickness was 5.6 mm in those with mastectomy skin flap necrosis compared to 6.4 mm in those without. On multivariable regression, subcutaneous thickness (p=0.04), body mass index (p=0.02), and smoking status (p=0.02) were found to be predictive of mastectomy skin flap necrosis. Subcutaneous tissue thickness was predictive of mastectomy skin flap necrosis. Pre-operative mammography serves as an effective measurement tool to measure the subcutaneous tissue thickness pre-operatively. Further studies may elicit an absolute value for tissue thickness below which mastectomy skin flap necrosis can be reliably predicted.
