Background: Fingertip avulsions are one of the most common pediatric hand injuries with composite “cap” grafting being a typical intervention. However, composite grafting can be unpredictable, and little is published on its expected clinical course. Therefore, we sought to determine if there is an age cutoff for superior graft outcomes. We hypothesized that graft success would be highest in children under 8 years old. Secondarily, we aimed to characterize a postoperative timeline for graft failure versus success. Methods: A retrospective chart review was performed with the following inclusion criteria: patients < 18 years old with complete or near-complete amputation at or distal to the DIP joint in the fingers or IP joint in the thumb. Graft success, defined clinically, was the primary outcome. Secondary outcomes included complications and time to graft failure. Univariate logistic regression was performed to identify predictors of graft success. Results: Sixty-one fingertips were included in this study. The cohort’s average age was 6.4 ± 4.7 years. The long finger was the most commonly affected (30.0%, n = 18), often due to blunt force trauma (82%, n = 50). Composite graft success rate was 67% (n = 41). Age did not significantly predict graft failure (OR: −0.04, 95% CI: −0.17-0.08, P value: .5). Conclusions: Composite grafting for pediatric fingertip amputations remains a viable treatment option with a 67% success rate in this cohort. Although no significant age threshold was identified, graft failure generally occurred 2 weeks after the index procedure, which provides a timeline for the clinical course for pediatric composite grafts.
Background: Total wrist arthroplasty (TWA) is an alternative to arthrodesis for end-stage wrist arthritis, offering preserved wrist motion and functional improvement. Historically limited by high complication and revision rates, TWA has seen renewed interest with advances in implant design and expanding indications beyond rheumatoid arthritis. The purpose of this study was to analyze national trends in TWA utilization and project future procedure volumes for both primary and revision TWA through 2060 using Medicare data. Methods: Procedure volumes for Medicare Part B beneficiaries undergoing primary or revision TWA between 2000 and 2022 were obtained from Centers for Medicare and Medicaid Services Medicare Part B data and adjusted for Medicare Advantage enrollment. Forecasting models were applied to project annual volumes through 2060. Results: From 2000 to 2022, primary TWA increased from 107 to 292 procedures, and revision TWA increased from 47 to 283 procedures. By 2060, annual primary TWA volume is projected to increase to approximately 1040 procedures, while annual revision TWA volume is projected to increase to approximately 3262 procedures. Revision procedures are expected to grow at a faster annual rate (6.6%) compared to primary TWA (3.8%). Conclusions: Total wrist arthroplasty volumes among Medicare beneficiaries are projected to rise through 2060, particularly for revision procedures. These projections may inform future resource planning and highlight the importance of ongoing surveillance of long-term utilization patterns.
Background: Distal ulna fractures, particularly when displaced or unstable, play a critical role in the stability and function of the distal radioulnar joint. Inadequate treatment may result in persistent pain, instability, and impaired wrist function. Recent advances in angular stable fixation have led to the development of anatomically contoured distal ulna hook locking plates; however, clinical data regarding their outcomes remain limited. Objective: To evaluate the radiological and functional outcomes of distal ulna fractures treated with open reduction and internal fixation using a distal ulna hook locking compression plate. Methods: This prospective study included 30 patients with displaced or unstable distal ulna fractures treated with a distal ulna hook locking plate. Patients were followed for a minimum of 6 months. Clinical assessment included wrist range of motion, grip strength, and functional evaluation using the Modified Mayo Wrist Score. Results: Radiological union was achieved in all patients, with a mean time to union of 12.7 ± 3.4 weeks (range, 8-24 weeks). Three patients (10%) demonstrated delayed union, and no cases of nonunion were recorded. At final follow-up, mean wrist flexion and extension were 70° and 71°, respectively, while mean pronation and supination were 73.2° and 73°. Mean grip strength was 89% of the contralateral side. The mean Modified Mayo Wrist Score was 82.4 ± 9.1, with excellent results in 19 patients (63.3%), good results in 8 patients (26.7%), and satisfactory results in 3 patients (10%); no patient had a poor outcome. Conclusion: Distal ulna hook locking plate fixation provides reliable fracture union, satisfactory functional outcomes, and a low complication rate in the treatment of displaced and unstable distal ulna fractures.
Machine learning (ML), a subset of artificial intelligence (AI), is revolutionizing health care. Given the intricate anatomy and functional complexity of the hand, AI applications in hand pathology are gaining prominence, particularly in the diagnosis of fractures, nerve injuries, and musculoskeletal disorders. This review summarizes ML advancements in hand pathology diagnosis, enhancing clinical history analysis, examination findings interpretation, and imaging assessment. A systematic search of PubMed, Google Scholar, EMBASE, Cochrane CENTRAL, Scopus, and Web of Science from 1901 to March 2025 was conducted, focusing on ML applications in diagnosing hand fractures, tendon injuries, and nerve compressions. The inclusion criteria encompassed original research, systematic reviews, meta-analyses, and observational studies that demonstrated the use of AI in diagnostic imaging, preoperative assessment, or postoperative management. Studies that did not involve AI-driven diagnostic applications or lacked sufficient methodological transparency were excluded. Machine learning models, particularly convolutional neural networks (CNNs), have demonstrated high diagnostic accuracy in detecting fractures. Studies have validated CNNs in the detection of distal radius and ulna fractures, outperforming trainees and urgent care physicians. In addition, AI has enhanced clinical examination by integrating wearable motion sensors for objective joint assessment. However, challenges such as external validation, interpretability, and integration into clinical workflows remain, limiting broader clinical adoption. Machine learning shows promise in hand pathology diagnosis, but widespread adoption requires improved external validation, standardized methods, and interdisciplinary collaboration. Future research should prioritize multicentric studies and explainable AI to enhance trust and integration.
Background: Cubital tunnel syndrome is the second most common upper extremity neuropathy and is treated surgically with either in situ decompression or anterior transposition of the ulnar nerve. Although both approaches achieve comparable long-term outcomes, variation persists in surgical selection and reported complication rates. Limited data describe how patient characteristics, electrodiagnostic severity, and early patient-reported outcomes differ between techniques. Methods: Adult patients who underwent cubital tunnel release between 2015 and 2022 at a single institution were retrospectively reviewed. Patients with prior trauma, elbow surgery, or concomitant procedures were excluded. Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, Physical Function, Pain Interference, and Depression scores were collected preoperatively and at 2-week and 6-week follow-up. Longitudinal mixed-effects regression assessed score changes, adjusted for demographic and clinical covariates. Complications, revisions, and operative characteristics were compared between groups. Results: Of 1892 screened patients, 210 met inclusion criteria (147 in situ, 63 transposition). Demographics and electrodiagnostic severity were comparable, though instability was more frequent in the transposition group. Complication (0.7% vs 3.2%) and revision rates (4.1% vs 1.6%) were low, precluding statistical analysis. At 2 weeks, transposition patients demonstrated greater decline in Physical Function (−6.1) and Upper Extremity (−4.4) and increased Pain Interference (+2.9, below minimal clinically important difference [MCID]) relative to baseline, with convergence of scores between groups by 6 weeks. In situ patients had a modest decrease in pain interference scores from pre-op to six weeks post-operatively (-3.2, below MCID). Conclusions: Patient-Reported Outcomes Measurement Information System detected transient early differences in recovery between techniques, with slower initial improvement after transposition but comparable outcomes by 6 weeks. These findings highlight PROMIS as a sensitive measure for short-term recovery and a useful tool for postoperative monitoring and patient counseling. Type of Study/Level of Evidence: Therapeutic, Level III.
