Purpose Preoperative management of biological disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) undergoing hand surgery is a subject of ongoing debate. While consensus supports continuation of corticosteroids and conventional synthetic DMARDs, no definitive guidelines exist for bDMARDs. This study aimed to characterize the degree of perioperative medication management variability among patients with RA undergoing hand surgery and to examine whether continuation of bDMARD therapy is associated with an increased risk of postoperative surgical site infection. Methods A retrospective chart review was conducted at a single academic institution of patients with RA who underwent hand surgery between June 2015 and May 2020. Perioperative medication continuation rates were calculated for corticosteroids, conventional synthetic DMARDs, and bDMARDs. Results Of 171 patients included, 157 (92%) were on pharmacological therapy at the time of surgery. Continuation rates were 82% for corticosteroids, 73% for conventional synthetic DMARDs, and 70% for bDMARDs. Six patients (3.5%) developed a surgical site infection within 30 days. Conclusions Perioperative bDMARD management in patients with RA undergoing hand surgery is variable and lacks standardization. Prospective, multicenter studies are needed to establish evidence-based guidelines for this population. Study type Retrospective cohort study. Type of study/level of evidence Therapeutic III.

Carpal tunnel syndrome is the most common upper-extremity compressive neuropathy, resulting from increased pressure within the carpal tunnel leading to symptomatic median nerve dysfunction. While conservative measures may offer temporary relief, surgical decompression remains the definitive treatment for persistent or progressive disease. Multiple surgical techniques for carpal tunnel release (CTR) have been described, each with distinct advantages and limitations. This review provides an updated synthesis of the evidence surrounding CTR, beginning with an overview of the conventional open and the mini-open approaches. This is followed by an examination of endoscopic CTR techniques, including both single- and dual-portal methods. We further discuss the emergence of ultrasound-guided CTR with both standard and thread-based methods. Comparative analyses are presented regarding surgical outcomes, complication profiles, recovery trajectories, and other key considerations such as cost-effectiveness, anatomical variability, and procedural sustainability. The review concludes with a discussion of current controversies, future directions in surgical innovation, and representative clinical images to illustrate technique nuances.

PURPOSE:Carpal tunnel syndrome is one of the most prevalent upper-extremity disorders. It may present unilaterally, bilaterally, or on the contralateral hand at a subsequent time to initial carpal tunnel release (CTR). We aimed to assess the incidence, timing, and factors associated with contralateral CTR at the time of an index unilateral surgery. METHODS:We performed a retrospective chart review of 1,291 primary unilateral CTR surgeries performed from 2008 to 2013 with a minimum follow-up period of 10 years within our integrated health network. In total, 742 (58%) patients met our inclusion criteria. We conducted bivariate analyses to assess for risk factors associated with contralateral CTR. Odds ratios were calculated for variables with significant results. A Kaplan-Meier curve was generated to depict the overall cumulative rate of contralateral CTR-free survival. RESULTS:Of the 742 patients included, 314 patients (42%) underwent contralateral CTR surgery at a median of 10.6 months (IQR 4.2 months to 2.7 years) after primary surgery. The incidence of contralateral CTR after 1, 2, 5, and 10 years is 22%, 26%, 34%, and 40%, respectively. The strongest predictor was the presence of contralateral carpal tunnel syndrome symptoms at the time of index surgery (odds ratio [OR] 7.2, P < .05). Other significant risk factors included preoperative contralateral electrodiagnostic study severity (OR 1.43 per unit increase, P < .001) and a concurrent diagnosis of trigger finger (OR 1.80, P < .05). Black race was associated with significantly lower odds of contralateral surgery (OR 0.44, P < .05). CONCLUSIONS:The incidence of contralateral CTR surgery is substantial over long-term follow-up. The observed association among trigger finger, Black race, and contralateral CTR warrants further research. Our findings help to inform preoperative counseling for patients undergoing unilateral CTR. TYPE OF STUDY/LEVEL OF EVIDENCE:Prognostic III.

PURPOSE:Patients treated for Dupuytren contracture in one digit are at risk for future intervention in other digits or the contralateral hand. Identifying predictive factors can aid in patient counseling. METHODS:A single institutional database was queried for procedural codes for collagenase treatment or surgical fasciectomy. A total of 658 patients were identified in this query. Out of this cohort, 341 patients were eligible for inclusion. The cohort consists of 141 initially treated with fasciectomy and 200 initially treated with collagenase, between 2015 and 2019. The primary outcome was the need for subsequent treatment in the same digit, other digits of the same hand, or the contralateral hand. Predictor variables included demographics, medical history, and pretreatment contracture severity. RESULTS:At a mean follow-up of 5.3 years, 142 (42%) of patients underwent additional treatment. Revision procedures on the same digit occurred in 88 patients (26%) at a mean of 3.2 years, on another digit in the same hand in 35 patients (10%) at a mean of 3.6 years, and on the contralateral hand in 79 patients (23%) at a mean of 2.3 years. Procedure, multiple digits treated, and initial nontreated contracture are associated with subsequent procedures on the same digit. Younger age, active smoking, and initial nontreated contracture are associated with subsequent procedures on another digit in the same hand. Dominant hand was initially treated; initial nontreated contracture are associated with subsequent procedures on the contralateral hand. CONCLUSIONS:Within 5 years of initial treatment for Dupuytren contracture in one digit, patients have over 40% likelihood of future intervention for contracture. Patients have approximately a 10% likelihood of future treatment on another digit in the same hand and nearly a 25% likelihood of future treatment in the contralateral hand. Key risk factors include age, multiple digits treated, smoking, and the presence of initially nontreated fingers, which should be incorporated into patient counseling. LEVEL OF EVIDENCE/TYPE OF STUDY:3-Retrospective cohort study, prognostic.

Purpose:Dupuytren disease (DD) is a fibroproliferative disorder that can result in progressive hand contractures and functional impairment. Multiple treatment options are available, ranging from minimally invasive procedures to surgical interventions. Current long-term trends in treatment utilization and reimbursement remain incompletely characterized. Understanding these trends is essential for clinical decision-making and resource allocation. Methods:A retrospective longitudinal analysis was conducted using Medicare data from 2005 to 2024. Treatment utilization and reimbursement data were extracted for current procedural terminology codes corresponding to percutaneous needle fasciotomy (PNF), open fasciotomy, collagenase Clostridium histolyticum injection (CCH) with manipulation, and fasciectomy-based procedures. Annual procedure volumes were normalized to Medicare enrollment. Reimbursement values were adjusted for inflation using the US Consumer Price Index. Temporal trends were assessed using the 2-tailed Mann-Kendall trend test. Results:Utilization of surgical procedures declined significantly over the study period, whereas PNF and CCH demonstrated no individual temporal trends. When grouped as minimally invasive procedures, PNF and CCH showed an overall increase in utilization. A transient decline in utilization across all procedures occurred in 2020, followed by partial recovery in subsequent years. Normalized annual procedure volumes for DD demonstrated no significant temporal trend. Inflation-adjusted Medicare reimbursement per service declined significantly by 38% over the study period; fasciectomy-based procedures remained the highest reimbursed interventions and showed no significant temporal change. In contrast, reimbursement for PNF and CCH declined significantly over time. Conclusions:Over the past 2 decades, minimally invasive treatment of DD has become more common, whereas fasciectomy has been declining. Nevertheless, fasciectomy remains the most commonly performed treatment for DD. Decreasing inflation-adjusted reimbursement highlights growing economic pressures on health care and providers. Type of study/level of evidence:Economic decision and analysis IV.

Background:Both arthroscopic and open surgical shoulder procedures are effective when nonoperative treatment of shoulder disorders fails. Understanding how utilization and reimbursement for these procedures have evolved is essential for informing health-care policy. Methods:A retrospective analysis was performed using Medicare data to extract utilization and reimbursement data for Current Procedural Terminology from 2005 to 2024 regarding arthroscopic and open shoulder surgeries. Arthroscopic procedures included diagnostic shoulder arthroscopy, arthroscopic rotator cuff (RTC) repair, biceps tenodesis, labral repair/capsulorrhaphy, superior labrum anterior-posterior repair, arthroscopy with limited débridement, arthroscopy with extensive débridement, subacromial decompression, and distal clavicle excision. Open procedures included open RTC repair for acute tears, RTC repair for chronic tears, complete RTC avulsion reconstruction, biceps tenodesis, anterior capsulorrhaphy, acromioplasty, and distal clavicle excision. Reimbursement values were adjusted for inflation. Procedure volumes were normalized to Medicare enrollment. Temporal trends in utilization and reimbursement were assessed using the two-tailed Mann-Kendall trend test. Results:From 2005 to 2024, over 9 million shoulder procedures were performed for the selected Current Procedural Terminology codes. Overall normalized utilization demonstrated a significant decline (τ = -0.4, P < .05). Arthroscopic procedures demonstrated no significant utilization trend, whereas open procedures declined significantly (τ = -1.0, P < .001). Many procedures showed a decline in utilization in 2020, coincident with the COVID-19 pandemic. Arthroscopic RTC repair increased significantly by 92% (τ = 0.5, P < .05). All other open RTC repairs declined (τ = -1.0, P < .01). Both arthroscopic and open biceps tenodesis demonstrated significant increases (τ = 0.9, P < .01). Across the study period, open biceps tenodesis demonstrated significant increases in inflation-adjusted reimbursement (P < .01). Still, arthroscopic tenodesis consistently reimbursed at higher rates. From 2005 to 2024, arthroscopic RTC repair consistently had the highest reimbursement per service among all RTC repair procedures. Arthroscopic biceps tenodesis demonstrated higher reimbursement per service than open biceps tenodesis throughout the study period. Similarly, arthroscopic capsulorrhaphy maintained higher reimbursement per service compared with its open counterpart. Open acromioplasty demonstrated higher reimbursement per service than its arthroscopic equivalent, subacromial decompression. Conclusion:From 2005 to 2024, normalized utilization of shoulder procedures declined overall, driven primarily by a significant reduction in open surgical procedures. Inflation-adjusted Medicare reimbursement for both open and arthroscopic shoulder procedures remained stable. For most procedures, reimbursement per service was higher for arthroscopic procedures.

PURPOSE:Although carpal tunnel release (CTR) is the most common upper-extremity orthopedic procedure in the United States, revision surgery can be indicated when symptoms of carpal tunnel syndrome persist, recur, or worsen after primary surgery. Understanding the revision surgery profile after CTR is important for preoperative counseling and treatment decision-making, yet published rates of revision surgery vary widely. In our study, we aimed to establish the rate of revision CTR and describe temporal patterns of revisions after primary surgery for patients with long-term follow-up at our institution. METHODS:We performed a retrospective chart review of 1,328 primary CTR procedures performed from July 2008-June 2013 with a minimum follow-up period of 10 years at our center and at least one documented encounter within our integrated health network within the last 3 years (2021-present). Of the 1,328 cases originally reviewed, 783 (59%) met our inclusion criteria. We conducted bivariate analyses to assess for risk factors associated with revision CTR. RESULTS:Of the 783 patients included in our study, 20 (2.6%) underwent revision CTR at a median of 5.2 years (interquartile range [IQR], 0.48-8.2 years) after primary surgery. Of the revision CTRs, 80% were performed for recurrent symptoms and 20% for persistent symptoms. Median follow-up after primary surgery with the surgeon was 3.6 years (IQR, 0.4-9.6 years) and median follow-up within the integrated health system was 12.8 years (IQR, 11.9-14.4 years). The rate of revision surgery for recurrent carpal tunnel syndrome remained constant and linear throughout the follow-up period, whereas for persistent carpal tunnel syndrome, all revisions were performed within 2 years of the primary surgery. CONCLUSIONS:The rate of revision CTR with long-term follow-up is low. Our finding expands upon the existing literature to further characterize the revision surgery rate of this common hand procedure, helping to inform preoperative counseling. TYPE OF STUDY/LEVEL OF EVIDENCE:Prognostic IV.

Purpose:The purpose of this study was to describe the demographic and operative characteristics of patients undergoing revision thumb carpometacarpal (CMC) arthroplasty and to characterize technique transitions from primary to revision surgery. Methods:A retrospective review of revision thumb CMC arthroplasty cases was performed within a single health system from August 2015 to August 2025. Cases were identified by querying Current Procedural Terminology code 25447 and screening operative notes for revision-related terminology. For each case, primary and revision operative details were extracted, including reconstruction technique, interposition material, implant(s) used, and trapezium and/or trapezoid excision. Demographics, laterality, dominant hand, smoking status, and diabetes mellitus were recorded. Results:Forty-two patients who underwent 54 ipsilateral revision thumb CMC arthroplasties were included. The cohort was predominantly women (79%) with a mean age at revision surgery of 62.9 ± 8.6. The median time from primary arthroplasty to first revision was 19 months (interquartile range, 10.9-43.2) with no difference by primary technique. Thirty-five patients (83%) underwent a single revision, six (14%) required two revisions, and one patient underwent seven revisions. The most common primary reconstruction techniques were flexor carpi radialis ligament reconstruction and tendon interposition (38%) and abductor pollicis longus suspensionplasty (33%), while suture-button suspensionplasty was used in only two cases (5%). Suture-button suspensionplasty was the most frequently performed revision technique (33%) followed by abductor pollicis longus suspensionplasty (19%). Approximately 95.2% (40/42) underwent a change in technique at revision. Partial trapezoid excision was performed in 4 of 42 (10%) primary procedures, and trapezoidectomy was performed in 12 of 54 (22%) revision procedures (11 partial, 1 complete). Conclusions:Ninety-five percent of patients underwent a change in reconstruction technique at revision, and no single primary technique was immune to failure. Trapezoid excision was performed more than twice as often at revision, highlighting the role of adjacent joint pathology in the revision setting. Type of study/level of evidence:Retrospective review IV.

Purpose Out-of-pocket charges (OOPCs) are growing faster than the total cost of care. Carpal tunnel release (CTR) is performed in variable surgical settings under different anesthetic protocols. OOPC of CTR may impact patient choice and patient perception of the value of their insurance. The primary objective of this study was to identify factors associated with OOPC after CTR. Methods We retrospectively identified patients who underwent CTR between January 1, 2019, and November 4, 2022 by three hand surgeons at a tertiary referral center in the Northeast United States. The final cohort comprised 808 patients. OOPC was defined as surgical and anesthesia fees billed to the patient for CTR surgery following primary and secondary insurance payment. Multivariable logistic regression analysis was performed to identify explanatory variables independently associated with our response variables. Results The mean age of the final cohort was 61.7 years, with 66% women, 79% White, and 100% insured. The multivariable logistic regression analysis showed protective factors against OOPC after CTR included Hispanic ethnicity and diabetes mellitus. Risk factors for having OOPC included no secondary insurance, procedure in a minor procedure room, and out-of-state residence. Conclusions As overall health care costs balloon, patients are bearing more financial responsibility for care. Our results may aid surgeons in shared decision-making discussions about modifiable surgical choices such as surgical setting and anesthesia choice.Type of study/level of evidence: Economic Analysis IV.

BACKGROUND:Volar locking plates are widely used for open reduction and internal fixation (ORIF) of distal radius fractures; however, variation exists in implant selection, construct complexity, and overall cost. MATERIALS AND METHODS:Patients who underwent ORIF with a volar locking plate for distal radius fractures between January 2023 and December 2024 were identified using current procedural terminology codes 25607, 25608, and 25609. Demographic and clinical variables were extracted from the electronic health record. Implant, supply, and total material costs were obtained from cost reports, and screw counts were verified on radiographs. Bivariate analyses of costs and explanatory variables were performed using Student's t test, Mann-Whitney U test, or chi-squared tests. RESULTS:In a cohort of 496 patients, median age was 63 years and 81.9% were women. The median implant cost was $1,641 (interquartile range: $1,417 to $1,944), and the median total material cost was $1,830 (interquartile range: $1,633 to $2,264). A mean of 8.7 ± 1.4 screws were used per case. Both implant costs and total costs were significantly associated with implant manufacturer, total screw count, bone allograft use, fracture type, and operating time (all P < .05). Costs were not associated with age, sex, body mass index, race, diabetes, smoking status, dominant hand fracture, open fracture, surgeon subspeciality, or surgical assistant type (P > .05). CONCLUSION:Implant costs for distal radius ORIF are largely influenced by variables related to fracture complexity, such as screw count, bone allograft use (and usage), and operation time, as well as system-level variables, such as implant manufacturer.

Purpose: Carpal tunnel release (CTR) is the most commonly performed hand surgery procedure, yet there is limited literature on patients’ subjective assessment of full recovery after surgery. Our primary aim was to assess the time until patients report they have achieved full recovery. Methods: Patients who had CTR were prospectively enrolled between January 2019 and August 2020 and completed questionnaires before surgery and at standardized postoperative intervals until full recovery was reported. Study questionnaires included the Likert pain scale; the Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH); and the Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Patients were also asked if they had fully recovered. We performed bivariate analyses to identify variables associated with time to patient-reported full recovery. Results: Fifty-one of 86 total patients completed the study and were included in the final cohort (59%). The mean time to patient-reported full recovery was 5.5 months. Six of 51 patients enrolled (11.8%) did not fully recover by 1 year. The mean Likert pain score, QuickDASH, BCTQ-SSS, and BCTQ-FSS considerably improved from before surgery to full recovery, and the mean differences in these four measures exceeded the minimal clinically important difference. Postoperative scores improved compared with preoperative scores for the four metrics above by 8, 11, 14, and 15 weeks, respectively. Higher preoperative Likert pain score, preoperative QuickDASH, BCTQ-SSS, and BCTQ-FSS were all associated with lack of self-reported full recovery by one year after surgery. Conclusions: Patients did not report full recovery until an average of nearly 6 months after CTR, which is substantial. The reported time to full recovery was notably longer than the time to reach minimal clinically important difference for our patient-reported outcome measures. This may be useful in preoperative discussions about recovery after surgery. Type of study/level of evidence: Prognostic II.

Purpose Patient-reported outcome measures (PROMs) are widely used in hand surgery to assess symptom severity prior to surgical intervention; however, little is known about how food insecurity, an important social determinant of health, influences these scores. We aimed to measure the correlation between county-level food insecurity and baseline PROMs in a cohort of patients undergoing carpal tunnel release (CTR) for idiopathic carpal tunnel syndrome (CTS). Methods Baseline PROMs were prospectively collected in 114 patients with electrodiagnostic study, ultrasound, or CTS-6 confirmed CTS treated with CTR at a single tertiary referral center. Feeding America’s Map the Meal Gap Dataset was used to identify county-level food-insecurity rate, average meal cost, and percent eligible for Supplemental Nutritional Assistance Program. Correlations between food-insecurity parameters and PROMs were assessed using correlation coefficients; bivariate analyses of continuous explanatory variables were performed using linear regression. Results Mean age was 61.6 ± 12.7 years. A total of 57.9% were women, and 93.9% were White. In total, 14.9% and 19.3% of our cohort reside in Massachusetts counties falling within the upper quartile and upper half of food-insecurity rates, respectively. No significant correlations were found between food-insecurity variables and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Younger age was associated with worse Boston Carpal Tunnel Questionnaire–Symptom Severity Scale scores and PROMIS Pain Interference scores. Conclusions We found no evidence that patients with food insecurity present with greater symptom severity at time of CTR. Type of study/level of evidence Prognostic IIb.

Background:Carpal tunnel release (CTR) is a common surgery with a well-described complication profile, but it is unclear whether patients' self-reported risk acceptance is higher than, equal to, or lower than actual surgical risks. We aimed to investigate patients' self-reported levels of risk acceptance for complications of CTR, factors associated with higher risk acceptance, and whether PROMIS Upper Extremity, PROMIS Pain Interference, and PROMIS Pain Intensity scores correlate with risk acceptance. Methods:A prospective, cross-sectional study was conducted of 47 adult patients with idiopathic carpal tunnel syndrome (CTS) who were indicated for mini-open CTR using a standard published technique with a well-described complication profile. A standardized questionnaire was used to survey patients about the highest acceptable risk of infection, persistent or recurrent symptoms, and nerve or vessel injury as a percentage from 0 % to 100 %. Our explanatory variables included PROMIS Upper Extremity, PROMIS Pain Interference, PROMIS Pain Intensity, and other patient-related factors. Results:The median patient-reported risk acceptance for infection after CTR surgery was 30 % (interquartile range 10 %-50 %), for persistent or recurrent symptoms was 40 % (interquartile range 20 %-50 %), and for nerve or vessel injury was 20 % (interquartile range 10 %-50 %). Diabetes mellitus was associated with higher risk acceptance for nerve or vessel injury during CTR. Lower PROMIS Upper Extremity scores were weakly correlated with higher risk acceptance for nerve or vessel injury during CTR. Higher PROMIS Pain Interference scores were weakly correlated with higher risk acceptance for persistent or recurrent symptoms after CTR. Conclusions:The actual risks of common complications after CTR are much lower than most patients' self-reported risk acceptance. The severity of preoperative CTS symptoms affects patients' acceptance of the risk of surgical complications and symptom persistence after CTR.

PURPOSE:Virtual visits have become increasingly popular in North American health care. This study assessed differences in patient-reported outcome measures, satisfaction, travel costs, and complication rates between patients who had either virtual video-based or in-person 2-week postoperative visits after undergoing carpal tunnel release (CTR) or trigger digit release (TDR). METHODS:We performed a prospective, randomized trial of patients who underwent isolated TDR or CTR. Subjects were randomized to receive their 2-week postoperative visit via a virtual video-based platform or an in-person visit. All patients received the same immediate postoperative care instructions. Our primary outcome variable was Press Ganey Outpatient Medical Practice Survey (PG) score at 2 weeks after surgery. Secondary outcomes included PG score at 3 months after surgery, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) at 2 weeks and 3 months after surgery. Demographics, complications, and patient expenses were collected. RESULTS:Sixty subjects were randomized with 30 in each group. The average age was 59 years, 40 subjects were women, and 35 subjects underwent CTR. The median 2-week PG in the in-person group was 4.7 and 4.1 in the virtual visit group. This was a statistically significant difference; however, there was no difference at the 3-month visit. Male sex and older age were significantly associated with lower PG scores at 3 months after surgery. There was no difference in QuickDASH at either time point. The virtual visit follow-up group had significantly fewer hours off work, lower transportation costs, and less travel distance. CONCLUSIONS:Although overall patient satisfaction is high following CTR and TDR, a lower self-reported patient satisfaction was seen in the virtual visit group as compared with the in-person group at 2 weeks, which equalized by 3 months. CLINICAL RELEVANCE:Individualized discussions with patients about postoperative visit options that factor in cost and travel may optimize the patient experience.

PurposeTenosynovial biopsy at the time of carpal tunnel release affords a unique opportunity for the early diagnosis of amyloidosis. We aimed to build a risk score to stratify patients likely to have undiagnosed amyloidosis.MethodsWe conducted a prospective cohort study of 320 adult patients with carpal tunnel syndrome undergoing carpal tunnel release. Patients underwent tenosynovial biopsy at the time of surgery. The primary outcome measure was a positive biopsy for amyloid deposition as assessed by Congo red and sulfated Alcian blue staining. We generated a risk score by assigning points to each variable independently associated with a positive biopsy in a logistic regression model, with weights proportional to parameter estimates (log odds ratio).ResultsThe cohort mean age was 63 years, and 65% were female. Forty-nine out of 320 subjects (15.3%) had positive tenosynovial biopsies for amyloidosis. In the logistic regression model, independent predictors of a positive biopsy included age 70 to 79 years (odds ratio [OR] 14.6, 95% confidence interval [CI] 1.83–115.7) and age ≥ 80 years (OR 33.9, 95% CI 4.1–279.3) compared with age < 50 years, male sex (OR 2.6, 95% CI 1.3–5.3), and history of trigger digit (OR 2.4, 95% CI 1.2–4.9). We assigned weights proportional to the log odds ratios from the logistic model to generate a summary amyloidosis risk score based on age, sex, and history of trigger digit. A score of 0 corresponds to 2.5% risk and 6 to 75% risk.ConclusionsThe likelihood of a positive biopsy for amyloidosis is independently associated with older age, male sex, and history of trigger digit.Clinical relevanceA routine biopsy strategy maximizes sensitivity for the early detection of amyloidosis with a 15% positive biopsy rate. We furthermore present a risk score for a selective biopsy strategies with associated sensitivities and specificities.

Background: This objective of this study was to identify risk factors for complications and reoperations after distal interphalangeal joint arthrodesis. Methods: A retrospective study was performed of all patients who underwent isolated distal interphalangeal joint arthrodesis between 2006 and 2019 at an integrated health system consisting of 2 Level I trauma centers and 2 community teaching hospitals. Demographics, implant, and treatment characteristics were collected from the medical record. The primary outcome was complication, and the secondary outcome was reoperation. Bivariate analyses were used to identify factors associated with our study outcomes. Results: A total of 209 fingers in 187 patients were included in this study. The radiographic union rate of our cohort was 96.7%. Forty patients (21.4%) had a postoperative complication, and 30 patients (16.0%) underwent reoperation. The use of a graft was significantly associated with decreased risk of reoperation, however, smoking, diabetes mellitus and type of implant were not associated with complication or reoperation. Conclusion: Although there are no specific risk factors associated with negative outcomes, the use of graft was associated with a decreased reoperation rate. Level of Evidence: III, Therapeutic

BACKGROUND:The primary aim of this study was to quantify radiation exposure during the surgical fixation of distal radius fractures (DRF). Secondary aims included determining patient and surgeon factors associated with higher intraoperative fluoroscopic use. MATERIALS AND METHODS:This retrospective study included 342 patients with DRF who underwent acute surgical fixation between January 1, 2017, and June 1, 2019. Inclusion criteria were patient age older than 18 years with acute DRF undergoing surgical fixation. Exclusion criteria were patient age younger than 18 years, additional fractures undergoing simultaneous fixation, and bilateral DRF requiring fixation. Patient demographics, surgeon factors, and fluoroscopy data were collected through chart reviews. Univariate and bivariate analyses were performed, and P<0.05 was considered significant. RESULTS:The median patient age was 59 years, and 77.8% were women. The median dose area product (DAP) was 9.24 cGy*cm2 per case. The median number of images obtained per case was 36, and the median fluoroscopy time was 60 seconds, equating to a dose of 0.39 mGy/min. Higher radiation exposure was associated with male patients, more complex fracture morphology, type of implant chosen, junior attendings as primary surgeon, surgeon subspecialty, and surgical assistant training level. CONCLUSION:Intraoperative fluoroscopic use during DRF surgical fixation is associated with both patient injury characteristics as well as surgeon factors. Male patients and fracture morphology, as well as surgeon experience and the presence of trainees, all increase fluoroscopic use and radiation exposure.

Purpose Long-established patient-reported outcome measures (PROMs), such as the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the QuickDASH, have been used traditionally to measure baseline symptoms and treatment effects before and after carpal tunnel release (CTR), but more recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been used increasingly in the CTR patient population. We aimed to measure the correlation between legacy and PROMIS PROMs for baseline pain and function in a cohort of patients undergoing CTR for idiopathic carpal tunnel syndrome (CTS). Methods Baseline PROMs were collected prospectively in 86 patients with electrodiagnostically confirmed CTS treated with CTR at a single tertiary referral center. The legacy PROMs used were the BCTQ and the QuickDASH. The PROMIS instruments used were computer adaptive test versions of the PROMIS Pain Interference (PI), Upper Extremity (UE), and Physical Function (PF). Given normal distributions, correlation between PROMs was assessed using the Pearson correlation coefficient. Results The mean age of the cohort was 59.7 years, and 56% were women. When assessing pain, the BCTQ – Symptom Severity Scale (SSS) was correlated moderately with PROMIS – PI (ρ = 0.59). When assessing function, the BCTQ – Functional Status Scale (FSS) was strongly inversely correlated with PROMIS – UE (ρ = −0.71) and moderately inversely correlated with PROMIS – PF (ρ = −0.58). The QuickDASH was strongly inversely correlated with PROMIS – UE (ρ = −0.75) and moderately inversely correlated with PROMIS – PF (ρ = −0.62). Finally, when comparing the two legacy PROMs for function, the BCTQ – FSS was strongly correlated with QuickDASH (ρ = 0.88). Conclusions We demonstrated at least moderate correlation between legacy and PROMIS outcome measures of baseline pain and function in CTS patients. Clinical Relevance Our findings support the use of either legacy or PROMIS outcome measures for this patient population.

Acute compartment syndrome of the upper extremity is a rare but serious condition of elevated intracompartmental pressures leading to tissue ischemia. Prompt diagnosis and emergent fasciotomy are critical to optimize patient outcomes, and delays to care can result in myonecrosis, contracture, and limb dysfunction. Acute compartment syndrome of the upper extremity most commonly occurs in the forearm but may also affect the arm and the hand. Upper-extremity acute compartment syndrome most commonly occurs following trauma, but nontraumatic etiologies include prolonged decubitus position, bleeding conditions, and reperfusion injury after critical limb ischemia. This review article will provide a general overview of acute compartment syndrome of the upper extremity with specific sections on the prevalence, treatment, and outcomes for each anatomic location. This review will also address management options and current controversies, including the treatment of delayed presentation or missed compartment syndrome as well as discuss recent advancements in diagnosis and management.