Abstract Scaphoid fractures are commonly fixated with headless compression screws. These devices generate intrinsic compression that is dependent on the bone-screw interface at the proximal and distal fragments as well as depth of insertion. To minimize the risk of prominent hardware, screws are countersunk beneath chondral surfaces, but the biomechanical implications of this practice have not been explored. The purpose of this study is to characterize fracture compression with and without countersinking in three fracture arrangements for a fully threaded headless compression screw. Tests were performed on three Sawbones models and two insertion techniques. The fracture models representing proximal, waist, and distal fractures were composed of a top foam sheet of varying thickness (10, 14, and 18 mm) and a bottom sheet (25 mm) spaced 2 mm apart. Both insertion techniques utilized a 30 mm fully threaded screw inserted with a force of 35 N at 30 rpm. Flush insertion concluded when the screw head was level with the top block, and countersunk insertion was concluded when the screw head was 2 mm beneath the top block surface. This process was completed five times in each configuration. Comparisons between groups were performed using a Wilcoxon Rank-Sum test with significance set at p = 0.05. Fracture compression was similar when countersinking screws in models of proximal or waist fractures but dropped significantly in the model of distal fracture. Driving torque was consistent regardless of screw position or model. There is a higher risk of compression loss when countersinking headless compression screws if the distal fragment is small. When using variable pitch headless compression screws, it is advisable to pick a trajectory where the smaller fragment is entered first to minimize the risk of fixation loss during countersinking.
Abstract Generative artificial intelligence (AI) models are designed to process a wide variety of inputs and produce responses that closely resemble natural human communication. There is a growing body of research evaluating the ability of these systems to answer common patient medical questions. The current evidence on AI in patient education for hand and wrist conditions is limited. This narrative review evaluates the literature on generative AI models for patient education in hand and wrist surgery. By characterizing the current evidence, the paper summarizes the utility of these systems for patient education and highlights gaps that can guide future research, helping optimize the use of generative AI in patient care. Studies evaluating generative AI models for patient education in hand and wrist surgery were identified through targeted literature review and reference screening. Relevant original studies were reviewed and synthesized narratively. Eight studies were included, all of which evaluated ChatGPT (Chat Generative Pre-trained Transformer). There was variability in question prompts and the method of evaluation of AI models. The studies suggested that ChatGPT performed well, and the conversational nature of the platform was identified as a strength. Limitations included a lack of comprehensive responses and concerns regarding readability. Clinical recommendations advised the use of ChatGPT as an adjunct, but not as a replacement for clinical counseling. Collectively, the studies suggest ChatGPT may serve as a supplementary tool for patient education in hand and wrist surgery, while highlighting the need for cautious integration and clinician oversight.
Abstract Osteoporosis is characterized by low bone mineral density and microarchitectural deterioration, increasing the relative risk of fragility fractures. In distal radius fractures, cortical bone quality influences fracture severity and fixation outcomes. Traditional dual X-ray absorptiometry (DXA) assesses overall bone density but is weighted toward trabecular bone and is limited in the acute setting. X-ray-derived second metacarpal index (XR-2MCI) is a validated surrogate marker for cortical bone evaluation. This study aimed to assess the correlation between computed tomography-derived second metacarpal index (CT-2MCI) and conventional XR-2MCI, and to explore the correlations with local Hounsfield unit (HU) measurements. A retrospective analysis was conducted on 87 patients who underwent both plain film and computed tomography (CT) of the ipsilateral hand within 3 months. HU measurements were taken at the distal radius and capitate. Intra/Interobserver reliability were assessed. Correlation between CT and radiographic indices, as well as HU values were evaluated. CT-2MCI showed strong correlation with XR-2MCI across all orientations and was highly reproducible. Radial HU measurements demonstrated strong internal consistency between sites but correlated poorly with both radiographic and CT-2MCI. Subgroup analysis suggested moderate correlations between Capitate HU and XR-2MCI in females, but not males. CT-2MCI is a reproducible, orientation-independent radiological index that demonstrated strong correlation with XR-2MCI, a validated surrogate marker for osteoporosis, thereby providing an opportunistic assessment of cortical bone status in patients undergoing wrist CT imaging. HU measurements should be interpreted according to the anatomical region and bony parameters being assessed. The study represent level of evidence III.
Abstract Scapholunate ligament (SL) injuries remain a difficult pathology to treat, both in the acute and chronic settings. An evolving technique has been the use of the internal brace (IB) to augment dorsal SL repairs. We evaluated our experience with this technique in both isolated SL injuries and those with concurrent perilunate (PL) injuries. Following institutional review board approval, a retrospective chart review was performed for patients who underwent SL repair or reconstruction with IB augmentation from 2019 to 2021 at our institution. Patients were divided into two cohorts: those with isolated SL injuries (standard IB) and those with concomitant PL pathology (PL/IB). Patients were contacted prospectively for patient-reported outcome measures (PROMs) and wrist range of motion (ROM). A total of 14 patients were included in this study (standard IB: n = 10 and PL/IB: n = 4) with mean follow-up of 46.9 months. There were no significant differences in postoperative ROM or PROMs between the standard IB and PL/IB cohorts. While postoperative Visual Analogue Scale pain and wrist subjective value demonstrated improvement from preoperative values, postoperative ROM either improved minimally or worsened between groups. Globally, there was low satisfaction with surgical intervention. Patients with isolated SL injuries were not highly satisfied, and a majority said they would undergo a revision if available. Patients with concomitant SL and PL injuries reported slightly better functional and subjective outcomes, although individuals also expressed minimal satisfaction and interest in a different revision option if available. Utilization of the IB system to augment SL repairs leads to variable outcomes at short-term follow-up. Although patients with concomitant PL injuries fared slightly better, patients overall had low rates of surgical satisfaction. Half of our cohort would not undergo surgery again, and 86% were interested in a better surgical option. This study illustrates the complexity and challenges when treating patients with SL injuries, highlighting the need for further investigation to better elucidate surgical algorithms. 2b—individual cohort study.
Objective To determine whether a zenithal three-dimensional computed tomography (3D CT) view with carpal subtraction improves interpretation of intra-articular distal radius fractures compared with radiographs (XR) and two-dimensional computed tomography (2D CT). Methods We conducted a cross-sectional reader study with 20 attending hand surgeons who evaluated 5 intra-articular distal radius fractures. Each case was reviewed sequentially (XR -> 2D CT -> 3D CT). For each imaging modality, readers drew the perceived articular fragments on a standardized distal radius template and indicated the presence or absence of comminution. The reference fracture pattern was defined using a zenithal 3D CT view with carpal subtraction. The primary outcome was overall correct interpretation (OCI), defined as the combination of correct fragment number, correct spatial disposition, and correct identification of comminution. Secondary outcomes included each individual component and the proportion of true articular fragments identified. Results Overall OCI was substantially higher with zenithal 3D CT than with XR or 2D CT. Similarly, zenithal 3D CT significantly improved correct identification of fragment number and spatial disposition compared with both XR and 2D CT, whereas no relevant differences were observed between XR and 2D CT. Correct identification of comminution did not differ meaningfully across imaging modalities. The proportion of true articular fragments identified increased progressively from XR to 2D CT and was highest with zenithal 3D CT. Qualitative overlays showed minimal change from XR to 2D CT and a marked contraction toward the reference with 3D CT (notably in cases 1, 3, and 5). Conclusion A zenithal 3D CT view with carpal subtraction improves global interpretive accuracy of intra-articular distal radius fractures, particularly for fragment number identification and spatial understanding, compared with XR and 2D CT. These findings support the use of zenithal 3D CT for fragment-specific preoperative planning in complex articular distal radius fractures.
Abstract The detection of scaphoid fractures presents a unique challenge, leading to delayed diagnosis and potential complications such as non-union or avascular necrosis (AVN). This study investigates whether the timing of fracture detection influences complication rates. A retrospective study of patients with confirmed scaphoid fractures. Patients were divided into two primary groups: initial radiograph positive (n = 121) and initial radiograph negative but follow-up radiograph positive (n = 70). The follow-up group was further stratified into early detection (≤2 weeks, n = 19) and late detection (>2 weeks, n = 51). Complications rates including non-union, delayed union, AVN, scapholunate interval widening, fracture displacement, carpal instability (VISI/DISI), and progression to surgery were compared across cohorts. A total of 191 patients was included. The follow-up positive group overall had significantly higher rates of non-union (48.6% vs. 24.8%, p = 0.0008) and AVN (42.9% vs. 16.5%, p < 0.0001) compared to the initial positive group. However, subgroup analysis revealed that patients in the early follow-up group (≤2 weeks) had complication rates statistically similar to the initial positive group (non-union: 21.1% vs. 24.8%, p = 0.72). Conversely, late detection (>2 weeks) resulted in nearly a three-fold increase in non-union (58.8% vs. 21.1%, p = 0.005) and significantly higher carpal instability (58.8% vs. 26.3%, p = 0.015) compared to early detection. Initial radiographic occultness is not an independent predictor of poor outcomes; rather, complications are driven by diagnostic delays exceeding 14 days. Occult fractures identified within 2 weeks maintain a prognosis comparable to those diagnosed immediately. Clinicians should consider advanced imaging (CT or MRI) to ensure a definitive diagnosis is reached within the critical 14-day window.
Abstract Volar components of the scapholunate interosseous ligament play an important role in carpal stability but remain underrecognized in reconstructive strategies. Arthroscopic techniques addressing volar capsuloligamentous insufficiency may restore stability while minimizing surgical morbidity. We describe an arthroscopic volar scapholunate capsuloligamentous plicature performed through a mini-open volar approach using a doubled-suture Nice knot configuration. The technique incorporates the volar capsule, short radiolunate ligament, and radioscaphocapitate ligament to restore volar restraint. A 38-year-old man presented with wrist pain following axial trauma. At 6-month follow-up, the patient demonstrated complete pain resolution and return to activities without limitation. Arthroscopic volar capsuloligamentous plicature represents a minimally invasive option for selected cases of dynamic volar scapholunate instability. V (Technical Note).
Abstract While tendon graft augmentation for severe triangular fibrocartilage complex (TFCC) tears has been described using different techniques, the indications, tear definitions, and clinical outcomes remain inconsistently reported. This study presents a novel tendon graft repair that reconstructs the foveal ligament and corrects the radial displacement of the TFCC and evaluates its clinical outcomes. A retrospective review of 11 patients who had a tendon graft procedure performed over a 6-year period was performed. The anatomy of the tear and the integrity of the foveal ligament were defined by dry arthroscopy of the distal radioulnar joint (DRUJ). Preoperative and postoperative measurements were compared. There was a 30 kg improvement in both pronation and supination strength. A total of 10 of the 11 patients had other pathologies in the wrist, which were arthroscopically repaired during the same procedure. One minor complication was reported. The unique tendon graft technique described in this study appears effective in treating severe tears of the TFCC. This is the first study to report on pronation and supination strength postoperatively and define the anatomy of the tear as identified using dry arthroscopy of the DRUJ.
Background Distal radius fractures (DRFs) are common injuries in orthopaedic emergency care and often require open reduction and internal fixation (ORIF) for displaced and intra-articular fractures. Volar locking plates (VLPs) and dorsal locking plates (DLPs) are widely used options, each with specific anatomical considerations and distinct complication profiles. This study aims to compare functional and radiographic outcomes and complication rates between fixation with a VLP and a DLP in the treatment of DRFs. Methods This retrospective cohort study included patients with DRFs treated surgically between 2015 and 2021. A total of 32 patients who underwent DLP fixation were first identified. Subsequently, 32 matching VLP controls were manually selected during the same period based on age, sex, and fracture classification, resulting in a total study population of 64 patients. Functional outcomes were assessed using the Patient-Rated Wrist Evaluation (PRWE) questionnaire and the Visual Analog Scale (VAS), with a minimum follow-up of 6 months. Radiographic outcomes and complications were also analyzed. Statistical significance was set at p < 0.05. Results Functional outcomes (PRWE and VAS) showed no statistically significant differences between the VLP and DLP groups. Radiographic analysis demonstrated significant improvements between preoperative and postoperative parameters in both groups, with no significant differences between them. Complications occurred in 25% of patients in the VLP group and 15.6% in the DLP group, including hardware removal in 9.4% and 3.1%, respectively, with no statistical significance. Both techniques adequately restored anatomical parameters and provided satisfactory functional outcomes. Although a higher absolute frequency of complications was observed in the VLP group, the findings are consistent with the literature, suggesting comparable efficacy and safety between techniques. The choice of approach should consider fracture complexity and surgeon experience. Conclusion Fixation with a VLP and a DLP demonstrated similar functional and radiographic results, with no significant differences in complication rates, supporting the use of both techniques according to patient and fracture characteristics.
Abstract The purpose of this study was to assess the recent trends among hand surgeons regarding the role of partial trapezoid excision (PTE) in carpometacarpal (CMC) arthroplasty in both the absence and presence of concomitant scaphotrapeziotrapezoidal (STT) arthritis. In addition, surgeon and patient demographic data were evaluated to determine trends and factors that contribute to the decision-making process for trapezoid management. An 11-question survey was distributed to the U.S. practicing body of hand surgeon members of the American Society for Surgery of the Hand. Survey questions collected information regarding surgeon training background, CMC arthroplasty techniques, and trapezoid management. Data were analyzed for trends using analyses of variance with Tukey post hoc tests, chi-square tests of independence, and Fisher's exact tests with post hoc comparisons with statistical significance set at p = 0.05. The survey had an 18.7% response rate with 623 completed surveys. The most common treatment choice for intraoperative identification of STT arthritis was proximal trapezoid resection (80.4%). Surgeons with greater than 10 years in practice preferred trapeziectomy with ligament reconstruction and tendon interposition as their CMC treatment choice. Surgeons with less than 10 years in practice preferred suture suspensionplasty and were more influenced by STT arthritis and advanced Eaton–Littler arthritis stage to perform a PTE. Surgeons who frequently perform PTE were more influenced by patient demographic factors such as age and gender compared with surgeons who rarely perform PTE. The predominant factor that influences surgeons to perform PTE is when concomitant STT arthritis is present. Patient demographic factors such as age and gender also influence a subset of surgeons to perform PTE; however, this may be based out of personal clinical judgement and experience rather than previously established evidence. The current trends regarding PTE during CMC arthroplasty vary among hand surgeons and is based on experience rather than clinical evidence. Questionnaires such as this may be the nidus needed to initiate future studies to help standardize care. Therapeutic Level IV.
Introduction Posttraumatic limitation of forearm rotation can occur anywhere along the forearm. It is often the result of scar formation at the distal radioulnar joint (DRUJ) following injury to the distal forearm. In previous literature, very little emphasis has been placed on the DRUJ capsule and its role in limiting pronation and supination. Our purpose was to determine the safety and effectiveness of open volar, dorsal, and combined DRUJ capsular release on restoring forearm rotation in patients with posttraumatic rotational stiffness, including when used in combination with a proximal forearm release. Methods We retrospectively identified 13 patients who had undergone an open volar, dorsal, or combined DRUJ capsular release for posttraumatic rotational contracture. Patients who had proximal forearm or elbow contracture releases in combination with a DRUJ release were included. Patients were excluded if they had arthroscopic surgery, contractures secondary to congenital deformities, or had undergone revision surgery. Our primary outcome of interest was final supination and pronation in degrees. Results Between 2011 and 2023, 13 patients were identified meeting inclusion criteria with an average age of 43 +/- 16 years. The mean time from procedure to follow-up was 6.5 +/- 4.3 years. At final follow-up, supination and pronation were significantly improved compared with preoperative. Average preoperative supination was 32 +/- 30 degrees, and postoperative was 68 +/- 15 degrees. Average preoperative pronation was 42 +/- 36 degrees, and postoperative was 69 +/- 25 degrees. At final follow-up, the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 21 +/- 18. There was one postoperative complication, DRUJ instability that resolved after an ulnar shortening osteotomy ( n = 1). Four patients had mild degenerative changes in the DRUJ noted on X-ray at final follow-up. Conclusions DRUJ capsular release is a viable option for rotational contractures of the forearm with a good restoration of both pronation and supination, good functional outcomes, and a low incidence of complications. It may be used in isolation or in combination with a proximal forearm contracture release. Level of Evidence Prognosis; Level IIC.
Abstract Scapholunate (SL) instability is the most common form of carpal instability and may progress to scapholunate advanced collapse (SLAC) wrist if untreated. Although various open surgical treatment options have been described, arthroscopic techniques offer minimally invasive stabilization with reduced morbidity. This study aimed to evaluate the clinical and functional outcomes of a novel arthroscopic procedure—vertical dorsal capsulodesis—for the management of dynamic SL instability up to Geissler/European Wrist Arthroscopy Society (EWAS) grade 3(c). We retrospectively reviewed 34 consecutive patients who underwent arthroscopic vertical dorsal capsulodesis between 2011 and 2023, with a minimum follow-up of 18 months. The technique involves placing a vertically oriented dorsal suture loop through the SL interval and capsule, reinforcing the dorsal SL complex without direct ligament repair. Feasibility is determined using a catch-test. Objective outcomes included wrist range of motion (ROM), grip strength, and key pinch strength compared with the contralateral side. Subjective outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH), the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaires, and the Visual Analog Scale (VAS) for pain and satisfaction. Complications, salvage surgeries, and return-to-work rates were also recorded. At a mean follow-up of 70 months (range, 18–168), the operated wrist maintained 86% to 100% of contralateral ROM and 96% of grip strength. Mean DASH and PRWHE scores were 18.9 and 22.6, respectively, while mean VAS scores for pain and satisfaction were 1.9 and 1.6, respectively. All 31 patients eligible for return to work resumed their occupations postoperatively. Three patients (9%) underwent salvage surgery due to persistent pain or instability. Arthroscopic vertical dorsal capsulodesis offers reliable stabilization for dynamic SL instability while preserving wrist motion and strength. The technique is associated with high functional recovery, low complication incidence, and excellent patient satisfaction. Level IV, therapeutic case series.
Abstract Wrist ligament injuries are common sources of pain, instability, and functional impairment, but their diagnosis remains challenging. Several imaging modalities are used in clinical practice, including radiography, ultrasound, computed tomography, and magnetic resonance imaging (MRI). Each provides useful information, but all have important limitations. Small ligamentous structures may be difficult to visualize directly, partial tears may be missed, and dynamic instability may remain occult on static imaging. Among these modalities, MRI is currently the most widely used and most informative noninvasive technique for evaluating wrist ligaments, although its diagnostic performance remains variable. Artificial intelligence (AI) has emerged as a potential diagnostic adjunct in musculoskeletal imaging. In larger joints, particularly the knee, AI-based models have demonstrated high diagnostic performance and, in some settings, improved reader specificity and overall diagnostic accuracy. In wrist imaging, however, AI applications remain limited and are largely focused on selected tasks. Although early findings are promising, important challenges persist, including small datasets, heterogeneous imaging protocols, limited external validation, and imperfect reference standards. AI is therefore unlikely to improve wrist ligament diagnostics through detection alone. Its real clinical value will likely depend on whether it can help distinguish clinically meaningful pathology from imaging findings of uncertain significance. Level of Evidence IV.
Abstract Standardized and validated administrative case definitions, or “algorithms,” are essential to population-based hand trauma surveillance and research. This systematic review identified studies validating administrative algorithms for hand trauma. Medline, Embase, and the Cochrane Database of Systematic Reviews were searched up to February 2025. Eligible studies were randomized controlled trials or retrospective or prospective cohort studies that validated administrative case definitions or algorithms for hand trauma using medical record review as the reference standard. A total of 15 studies met the inclusion criteria. Fourteen studies validated definitions for hand, wrist, or forearm fractures, whereas only one study addressed a nonfracture injury (mallet finger). Six of the fracture studies focused on osteoporosis. Studies were conducted in nine countries and used diverse administrative data sources, including hospital discharge abstracts, national registries, and physician billing claims. Most (n = 13) used ICD-9 or ICD-10 codes from hospital or claims data. Positive predictive value (PPV) was the most frequently reported metric, ranging from 58 to 100%. Six studies focused on osteoporotic or fragility fractures, and most achieved a PPV above 90%. Most studies focused on validating fracture definitions. Algorithm performance was consistently strong across data sources and coding systems, supporting the use of administrative data to identify hand and wrist fractures for surveillance and outcomes research. Future work should extend validation to nonfracture hand trauma conditions, including tendon, nerve, and vascular injuries, and adopt standardized approaches to algorithm development and reporting.
Abstract Wrist tuberculosis (TB) is a rare manifestation of osteoarticular TB that presents substantial diagnostic challenges, particularly in TB-endemic regions. Its insidious onset and nonspecific clinical manifestations frequently lead to misdiagnosis and delayed treatment. This systematic review aimed to synthesize the available evidence regarding the diagnostic challenges associated with wrist TB. A systematic literature search was conducted in PubMed/MEDLINE, EMBASE, Scopus, and Web of Science from database inception to January 2026. Observational studies reporting wrist-specific diagnostic findings in suspected or confirmed wrist TB were included. Case reports and case series were excluded from the evidence synthesis but considered for contextual discussion. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in study design and outcome reporting, a qualitative narrative synthesis was performed. Four observational studies conducted in TB-endemic regions met the inclusion criteria. Patients commonly presented with chronic wrist pain, swelling, and limited range of motion, symptoms that frequently mimicked other musculoskeletal conditions and contributed to delayed clinical suspicion. Plain radiography was typically used as the initial imaging modality, but often demonstrated nonspecific findings. Magnetic resonance imaging improved the detection of synovial inflammation and bone involvement but lacked sufficient specificity to confirm the diagnosis. Microbiological tests, including smear microscopy, culture, and polymerase chain reaction, showed limited sensitivity because osteoarticular TB is typically paucibacillary. Histopathological examination of biopsy specimens demonstrating granulomatous inflammation remained the most reliable diagnostic method. Wrist TB remains difficult to diagnose due to nonspecific clinical presentation and limitations of conventional diagnostic tests. Histopathological confirmation continues to represent the diagnostic standard. Increasing clinical awareness and improving diagnostic pathways may help reduce diagnostic delay and prevent irreversible joint damage.
Abstract Volar locking plates (VLPs) are commonly used to treat displaced intra-articular distal radius fractures (DRFs), but multi-fragmented fractures may require additional dorsal fixation. This study assessed the outcomes of a technique combining VLP and a dorsal bone clamp, described here as “scaffold fixation,” and evaluated whether dorsal ulnar corner (DUC) fixation is essential for radiocarpal alignment. In this retrospective cross-sectional study of the ICUC database, 87 patients with DRF with preoperative CT-identified DUC fragments were included. The range of motion was measured, and radiocarpal alignment was evaluated on postoperative and final follow-up radiographs. In addition, we compared cases with long screw purchases or short screw purchases in the DUC with respect to DUC size. No significant differences were found in flexion, extension, supination, or pronation. DUC size was not associated with screw purchase nor with ROM outcomes. Radiocarpal malalignment was seen in 2% of patients postoperatively and 7% at final follow-up, with no difference between screw purchase groups. Scaffold fixation with a VLP, aided by reduction using a dorsal bone clamp, effectively restores ROM and generally preserves radiocarpal alignment in DRF fixation, regardless of DUC screw purchase or DUC size in this cohort. Level III.
Background Volar dislocation of the distal radioulnar joint (DRUJ) is rare and is frequently missed, especially when associated with distal radius malunion. Chronic or locked volar DRUJ instability presents substantial diagnostic and surgical challenges, and practical guidance in the literature remains limited. This study describes a case series of patients with malunited distal radius fractures and volar DRUJ instability and proposes a practical treatment approach based on residual joint mobility and chronicity. Methods We retrospectively reviewed eight women with a mean age of 41.3 years who presented between 2021 and 2025 with volar DRUJ instability in the setting of distal radius malunion. Clinical findings, radiographs, and intraoperative assessment were used to classify cases as either flexible or locked dislocations. Patients with residual pronation underwent attempted closed or open reduction, whereas patients with fixed deformity underwent salvage procedures. Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS) and wrist/forearm range of motion. Results Two flexible DRUJ dislocations were treated successfully, one with closed reduction and plaster immobilization and one with open reduction and temporary pinning. Five locked dislocations required salvage procedures: Two Sauv & eacute;-Kapandji procedures, two Darrach procedures (one combined with distal radius osteotomy), and one Baldwin osteotomy. One additional patient with partial pronation did not undergo further intervention and was later lost to follow-up. Overall, two patients were lost to follow-up. Preoperatively, all patients had limited pronation. Among the remaining six patients, the mean follow-up was 11.2 months (range, 8-18 months), the mean supination was 81.7 degrees, and the mean pronation was 65 degrees. MMWS values ranged from 60 to 95. Outcomes were recorded as excellent in two patients, good in two, and fair in two. Radiographs in the followed patients showed maintained reduction without postoperative complications. Conclusion Volar DRUJ instability associated with distal radius malunion requires a high index of suspicion and an individualized treatment strategy. Closed or open reduction may be effective in selected flexible cases, whereas chronic locked dislocations usually require salvage procedures to restore functional forearm rotation. Larger studies are needed before definitive treatment recommendations can be made.
Abstract Distal radioulnar joint (DRUJ) dysfunction is a complication observed acutely with forearm fractures. However, there is some evidence associating delayed presentation of dysfunction to previous forearm fractures in childhood. The purpose of this to review the presence of delayed DRUJ dysfunction and factors contributing to dysfunction, following metaphyseal or diaphyseal forearm fractures sustained in childhood. Utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we conducted a systematic review using the PubMed database. Papers that reported cases of delayed DRUJ dysfunction in the context of metaphyseal or diaphyseal forearm fractures in children < 18 years of age at time of fracture were included. A total of 85 cases fit the inclusion criteria. Onset of dysfunction ranged from 6 weeks to 32 years. Limited supination was seen in 65 cases and pronation in 65. Overall, 76/85 (89%) of patients had deficits in range of motion. A total of 58 cases had both bone fractures. A total of 64/85 (74%) had a concurrent malunion at the time of symptom onset. Symptomatic dysfunction and malunion was treated with corrective osteotomies to one or both bones. Of cases discussing subsequent osteotomies, 50% were treated with computed tomography-guided 3-dimensional customized operative guides for corrective osteotomy. In all cases, there was improvement in dysfunction after osteotomy. Delayed DRUJ dysfunction can be observed following metaphyseal and diaphyseal fractures in childhood. Dedicated wrist radiographs on discharge from follow-up for childhood forearm fractures and advanced imaging if DRUJ dysfunction suspected is recommended. There is a clear lack of research, limiting the ability to assess the relationships between initial intervention, DRUJ dysfunction, and malunion morphologies.
Abstract Kienböck's disease is avascular necrosis of the lunate, causing wrist pain, functional impairment, and osteoarthritis. Autologous lunate replacement with tendon arthroplasty, local pedicled osteochondral flaps, or free flaps has emerged as a joint-preserving alternative to prosthetic implants or salvage, aiming to restore carpal mechanics. This systematic review evaluated outcomes of autologous lunate replacement for Kienböck's disease. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies with ≥ 6 months follow-up using tendon arthroplasty, local flaps, or free vascularized bone flaps. Outcomes included pain, motion, grip strength, carpal alignment, complications, and reoperations. Pooled estimates used random-effects meta-analysis. Thirty-five nonrandomized studies (n = 593) were included. Tendon arthroplasty (palmaris longus, extensor carpi radialis longus, or pronator quadratus with or without bone core) was reported in 17 studies (n = 306), yielding flexion 46.6 degrees, extension 47.9 degrees, grip strength 75.4%, and complication/reoperation rates 6.5%/1.3%. Local pedicled osteochondral flaps—including capitate osteotomy (Graner), vascularized os pisiform (Saffar), and pedicled scaphoid—were described in 13 studies (n = 189), with flexion 45.2 degrees, extension 44.6 degrees, grip 80.9%, and complication/reoperation 8.7%/4.1%. Free vascularized femoral trochlea flaps in six studies (n = 98) achieved flexion 46.4 degrees, extension 42.7 degrees, and grip 82.7%, but with higher complication (25.5%) and reoperation (8.5%) rates. Autologous lunate replacement appears to preserve motion, relieve pain, and maintain function in patients with Kienböck's disease. Tendon arthroplasty remains the simplest technique, but it may provide lower grip strength. Local pedicled osteochondral flaps yield intermediate results with moderate strength recovery, while free osteochondral flaps tend to offer similar grip and carpal alignment at the cost of higher technical complexity and complication rates. Level III
