PURPOSE:Composite neuromuscular injuries involving damage to peripheral nerves and skeletal muscles result in poor functional recovery due to excessive scarring. Current therapies lack specificity or carry significant side effects. We investigated the efficacy of a recombinant anti-collagen antibody (ACA) designed to inhibit extracellular collagen fibril formation, thereby reducing scar formation without disrupting intracellular reparative pathways. MATERIALS AND METHODS:In a rabbit model of composite injury involving a peroneal nerve crush and volumetric muscle loss of the tibialis anterior muscle, animals received local injections of an ACA-loaded or control thermoresponsive hydrogel. We measured neuromuscular functional recovery after composite injury using biomechanical and electrophysiological assays. Tissue was analyzed using histology, immunohistochemistry, and Fourier transform infrared (FTIR) spectroscopy. RESULTS:While electrophysiological parameters of injured nerves declined in all injured groups, ACA treatment markedly improved biomechanical properties of the injured limbs at 4 weeks post-injury compared to controls. This functional benefit was sexually dimorphic; females, who exhibited a more robust fibrotic response and severe muscle atrophy compared to males, demonstrated the most pronounced therapeutic recovery with ACA treatment. FTIR spectroscopy and polarized light microscopy confirmed that ACA treatment modulated the scar architecture, showing a trend toward reduced collagen content and cross-link maturity. Notably, the uninjured contralateral limbs likely exhibited compensatory hypertrophy and electrophysiological changes, highlighting their active role in systemic adaptation. CONCLUSIONS:Together, these findings suggest that targeting extracellular collagen fibrillogenesis may modestly enhance early functional recovery in composite neuromuscular trauma, particularly in biological contexts prone to excessive fibrosis.

PURPOSE:This purpose of this study was to evaluate the patient-reported outcomes of surgically and nonsurgically treated complete and partial distal biceps tears (DBTs) and report the conversion-to-surgery rate for patients initially treated nonsurgically. METHODS:A retrospective cohort study was conducted of patients with DBTs treated surgically or nonsurgically at a single, large institution. Patients were identified through an international classification of disease code query of our institution's database from January 1, 2018, to December 31, 2022. Records were reviewed for demographics and to confirm DBT diagnosis via magnetic resonance imaging. Patients completed shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires for treatment and outcome assessment. Regression analyses were performed to compare QuickDASH scores and the rate of achieving a patient-acceptable symptom state (PASS). RESULTS:Of 1,549 patients surveyed, 488 responses were received (32% response rate), with a mean follow-up of 43.9 months. Among respondents, 423 were treated surgically, and 65 were treated nonsurgically. The conversion-to-surgery rate was 36%, with no significant differences between partial (34%) and complete tears (39%) (P = .7). For complete tears, regression analysis found that surgery was associated with better QuickDASH scores (adjusted mean difference -4.92, 95% confidence interval [CI] -9.75 to -0.09), but there was no difference in PASS achievement rate (odds ratio 3.01, 95% CI 0.90-8.69). For partial tears, there was no difference in QuickDASH score or PASS achievement rate between treatment groups; however, female sex was a predictor of worse QuickDASH scores (adjusted mean difference 25.50, 95% CI 13.65-37.35). CONCLUSIONS:Surgical management of DBTs was a predictor of improved patient-reported outcomes only for patients with complete tears. For patients initially treated nonsurgically, the conversion-to-surgery rate was 36%. Nonsurgical treatment of DBTs remains a reasonable first-line option as most patients achieve an acceptable symptom state. TYPE OF STUDY/LEVEL OF EVIDENCE:Therapeutic III.

Background: Metacarpal neck fractures are frequently encountered by hand surgeons. Certain operative metacarpal neck fractures are amenable to both retrograde intramedullary screw (IMS) fixation and closed reduction percutaneous pinning (CRPP). The purpose of this study was to compare functional outcomes and complications following these two techniques. Methods: All patients with metacarpal neck fractures treated with either IMS or CRPP from 2015 to 2021 at a large private academic institution were retrospectively identified. Electronic medical records were reviewed for demographics, Quick Disabilities of Arm, Shoulder, and Hand (qDASH) scores, metacarpophalangeal joint range of motion (ROM), and complications. Results: A total of 113 patients, consisting of 57 in the IMS cohort and 56 in the CRPP cohort, were included. The CRPP cohort was significantly younger, otherwise demographics were similar between both groups. Both cohorts had similar preoperative (47.5 IMS vs 43.9 CRPP), postoperative (17.6 IMS vs 9.9 CRPP), and delta (35.5 IMS vs 34.0 CRPP) qDASH scores. Retrograde IMS allowed for greater flexion at 4 to 6 weeks (81° vs 65°) postoperatively. The overall incidence of complications was similar among IMS and CRPP (21.1% vs 17.9%), although IMS had significantly more major complications (8.8% vs 0%). Conclusions: Despite earlier return to ROM, operative fixation of unstable metacarpal neck fractures with retrograde IMS may be at higher risk of major hardware complications and extensor lag.

BACKGROUND:Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures. QUESTIONS/PURPOSES:(1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation? METHODS:In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist. To determine whether rotation was present between the proximal and distal poles, radiographs of the wrist at terminal range of motion (ROM) were reviewed for relative change in wire position. The fracture was then reduced, and an HCS was then advanced across the fracture; rotation was again evaluated. Rotation was quantified in the group without fixation using a sensor that measured angular rotation. RESULTS:Before screw fixation, interfragmentary rotation was found to average 22.5° during flexion/extension, 19.0° during pronation/supination, and 34.0° during radial/ulnar deviation around the central axis. The radiographs after osteotomy demonstrated rotation in all specimens. After fixation with an HCS, radiographs demonstrated relative rotation of the two halves of the scaphoid in all ROMs for all specimens, except flexion for one specimen. DISCUSSION:Internal angular tension was observed within the scaphoid, and rotation of 20° to 30° was noted around the central axis during simulated ROM mimicking nonsurgical treatment. A single HCS failed to prevent fragment-relative rotation at the fracture site.

Objectives:Critical evaluation of implant costs may help mitigate the cost of orthopedic care. In an effort to decrease the financial burden of operative fixation for fractures of the distal radius, a standardized shelf price was established by a large orthopedic practice for all distal radius implants. We hypothesized that by negotiating a fixed reduced cost, total number of screws, number of locking screws, and number of wasted screws would be unchanged and overall implant utilization would not change. Methods:This was a retrospective analysis of the effect implant price standardization had on the operative care of distal radius fractures at a single outpatient urban surgical center. The total number of screws, as well as the number discarded during each procedure was reviewed. We analyzed the financials three months before and three months following price standardization. We surveyed the ten fellowship trained hand surgeons affected by the change regarding differences in operating procedure and perceived changes in the attendance and utility of the manufacturer's representative. Results:We reviewed 30 distal radius open reduction internal fixations three months before and 28 cases three months following shelf price implementation. On average, there was a 32% reduction in total implant costs after price standardization. No statistically significant difference in any clinical variables were noted. Negligible change was noted in the surgeon experience in representative availability and surgery-related attributes on the survey. 20% of surgeons switched implants due to the cost restrictions. Conclusion:Despite a set price for distal radius implants, there was no significant difference in the number of screws utilized or discarded after price standardization. Additionally, despite a 32% reduction in cost, the level of representative attendance and utility were similar before and after the change. Surgeons are willing to be flexible in implant choices based on a cost restriction model.

Index through small carpometacarpal joint dislocations and fracture dislocations are injuries that require early recognition to prevent future pain and dysfunction. This review article discusses the anatomy, mechanism of injury, classification, clinical examination, radiographic evaluation, and treatment options for these particular injuries. The goal of this review article is to provide the best treatment options for general orthopaedic surgeons and hand surgeons in the care of these injuries. The authors preferred method of treatment is also discussed.

Objectives: Periarticular fractures of the shoulder and elbow are spatially complex injuries that mayAbe challenging to interpret on radiographs and advanced imaging. As three-dimensional (3D) printing technology has become less expensive and more available, 3D printed fracture models have gained attention for use in surgical preparation. In this study, we evaluated the effects of 3D printed fracture models on orthopedic trainee surgical planning and injury understanding for injuries of the shoulder and elbow. Methods: Models of periarticular fractures of the shoulder and elbow were manufactured by 3D printing at the medical school design lab. Eleven Orthopedic trainees viewed X-rays and computed tomography (CT) scans for each injury, and completed a preoperative questionnaires. They were then given access to the 3D model of each injury, in addition to the previously viewed imaging. They again completed a preoperative plan and questionnaire. Preoperative plans were graded for feasibility by a preestablished template. Results were compared for each participant with and without the 3D models. Results: Within all trainees and fractures, trainees were more likely to have feasible preoperative plans when given a 3D model, compared to access to x-rays and CT scans alone (74% vs. 62%). In all cases where preoperative plans were changed after handling the 3D models (46/77 changed, 60%), Athey stayed static or improved inAfeasibility. Participants reported significantly improved understanding of injury anatomy (P<0.0001), Aincreased confidence in choosing operative positioning and surgical approaches (P<0.0001), Adesired implants (P=0.011), and better conceptualization of how to perform fracture reduction (P=0.0038). Conclusion: Orthopedic trainees benefit from 3D printed fracture models when performing preoperative planning of complex periarticular shoulder and elbow injuries. Given the rarity and difficulty of these injuries, use of this technology could allow for shortened learning curves and improved surgical results in the field of orthopedic fracture care.

Background: Metacarpal fractures are among the most common orthopedic injuries. When metacarpal shaft fractures require surgical fixation, common options include closed reduction percutaneous pinning, open reduction internal fixation (ORIF) using plates and screws (PS), and intramedullary screw fixation (IMS). Certain metacarpal shaft fractures are amenable to ORIF with either PS or IMS. The purpose of this study is to compare the functional outcomes and complication rates between these techniques.Methods: A retrospective review was performed of all patients that underwent ORIF with PS or IMS of metacarpal shaft fractures between the years 2015-2021 at a single, large private-academic institution. Postoperative patient-reported outcome measures were collected and medical records were reviewed for complications and range of motion (ROM). In addition, complications were subdivided into major and minor complications in accordance with previously published data on the subject.Results: A total of 120 patients (60 PS, 60 IMS) were included in this study, and each of the groups were similar in age at the time of procedure, sex, hand dominance, laterality, and mechanism of injury. Postoperative functional scores were similar among both groups. Metacarpophalangeal joint ROM in the acute postoperative period was significantly greater in the IMS group when compared with PS. The overall complication rate was not significantly different between the 2 groups.Conclusion: When treating metacarpal shaft fractures, both ORIF with PS and IMS can achieve acceptable outcomes. Patients treated with either fixation method should be counseled on the risk of developing symptomatic hardware that may require removal.

Background Distal ulna fractures frequently accompany distal radius fractures but are often underappreciated in both clinical and research contexts. While conservative management is frequently employed, particularly following volar locking plate (VLP) fixation of the radius, certain indications, such as distal radioulnar joint (DRUJ) instability, comminution, or high-energy trauma, may necessitate surgical fixation. This study evaluates patient-reported outcomes among patients with distal radius fractures treated operatively, comparing those with and without concomitant distal ulna fractures, and further stratifying based on the method of ulna fixation. Methods This retrospective review included 477 patients treated operatively for distal radius fractures by a single Rothman hand surgeon from 2014 to 2024. Patients were grouped based on the presence and management of a concomitant distal ulna fracture: no ulna fracture, ulna fracture without fixation, or ulna fracture with fixation (plating or intramedullary screw). Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were collected and compared across groups. Results A total of 477 patients were analyzed in this study. 214 patients sustained a distal radius fracture without an associated distal ulna fracture. Among these, 140 patients had a mean VAS score of 2, and 118 patients had a mean DASH score of 34. In contrast, 248 patients sustained a distal radius fracture with a concomitant distal ulna fracture that was not surgically treated. Of these, 139 patients had a mean VAS score of 5, while 133 patients had a mean DASH score of 48. 15 patients underwent surgical fixation of a concomitant distal ulna fracture. Among the 11 patients treated with a distal ulnar intramedullary screw, eight had a mean VAS score of 1, and five had a mean DASH score of 46. Two patients underwent plating of the distal ulna; one had a VAS score of 0, and one had a DASH score of 59. Overall, for patients who received any form of ulnar fixation, the mean VAS score was 1, and the mean DASH score was 50. Conclusions Distal radius fractures without an associated distal ulna fracture are linked to lower pain and better function. Conversely, untreated distal ulna fractures in the setting of distal radius fixation are associated with worse patient-reported outcomes. Surgical fixation of the distal ulna may improve outcomes, with intramedullary screw fixation associated with the lowest VAS scores. Therefore, intramedullary screw fixation may be a viable technique for pain reduction in patients with concomitant distal ulna fractures.

Purpose Proximal interphalangeal (PIP) joint sprains are common injuries that often result in prolonged swelling, stiffness, and dysfunction; however, the duration of these sequelae is unknown. The purpose of this study was to determine the duration of time that patients experience finger swelling, stiffness, and dysfunction following a PIP joint sprain. Methods This was a prospective, longitudinal, survey-based study. To identify patients with PIP joint sprains, the electronic medical record was queried monthly using International Classification of Disease, Tenth Revision, codes for PIP joint sprain. A five-question survey was emailed monthly for 1 year or until their response indicated resolution of swelling, whichever occurred sooner. Two cohorts were established: patients with (resolution cohort) and patients without (no-resolution cohort) self-reported resolution of swelling of the involved finger within 1 year of a PIP joint sprain injury. The measured outcomes included self-reported resolution of swelling, self-reported limitations to range of motion, limitations to activities of daily living, Visual Analog Scale (VAS) pain score, and return to normalcy. Results Of 93 patients, 59 (63%) had complete resolution of swelling within 1 year of a PIP joint sprain. Of the patients in the resolution cohort, 42% reported return to subjective normalcy, with 47% having self-reported limitations in range of motion and 41% having limitations in activities of daily living. At the time of resolution of swelling, the average VAS pain score was 0.8 out of 10. In contrast, only 15% of patients in the no-resolution cohort reported return to subjective normalcy, with 82% having self-reported limitations in range of motion and 65% having limitations in activities of daily living. For this cohort, the average VAS pain score at 1 year was 2.6 out of 10. Conclusions It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. (J Hand Surg Am. 2024;49(11):1138.e1-e6. Copyright (c) 2024 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Prognostic IV.

Peripheral nerve injuries can be devastating. Although neuropraxic and some axonotmesis injuries will recover spontaneously, nerve repair or reconstruction is required to restore function in high-grade axonotmesis or neurotmesis injuries. The first step of nerve repair or reconstruction is adequate nerve debridement with removal of necrotic and fibrous tissues. Debridement decreases neuroma formation at the repair site and produces an optimal surface for axonal regeneration. This article discusses nerve debridement, including the goals of debridement, debridement techniques, and signs of adequate nerve debridement before repair.

Background: Metacarpal fracture fixation using the retrograde intramedullary screw technique can be performed through two different approaches. The mini-open approach requires greater soft tissue dissection but allows for direct visualization of the metacarpal head compared with the percutaneous approach. Our aim was to determine which approach resulted in optimal screw position. Methods: Eighty-one consecutive patients that underwent intramedullary screw fixation for metacarpal fractures from 2016 to 2021 were identified. Patients were treated by 4 fellowship-trained orthopedic hand surgeons who employed the mini-open or percutaneous approach. Postoperative radiographs were reviewed for screw position. Results: A total of 81 patients (41 mini-open, 40 percutaneous) were included in this study. There were no significant differences between the two groups in age, sex, hand dominance, or affected digit. Postoperative screw position at first postoperative visit was not significantly different between the two groups on anteroposterior or lateral radiographs. Conclusion: Postoperative screw position is not significantly different between the mini-open and percutaneous approaches for intramedullary screw fixation of metacarpal fractures. Level of Evidence: Level III, therapeutic.

Superficial acral fibromyxoma (SAFM) is a rare, slow-growing benign soft tissue tumor that is typically asymptomatic in nature and usually affects the acral regions of the hands and feet. The majority of these lesions are subungual. Excisional biopsy is the primary treatment modality. Despite the distinct clinical and histopathological features, misidentification of this slow-growing tumor persists. This case report contributes to the existing literature by delineating the clinicopathologic features, radiographic and MRI findings, and treatment strategies of SAFM.

Purpose The optimal timing for surgical treatment of open distal radius fractures remains an area of debate. The purpose of this study was to examine the outcomes of open distal radius fractures treated surgically before or after 24 hours. Methods A multicenter retrospective review was performed on all open distal radius fractures treated over 11 years. Patient demographics, injury mechanism, and initial treatment were recorded. Fracture severity was graded by the Gustilo-Anderson classification. Comparisons were made between those treated surgically within and after 24 hours. Outcomes examined included infection, revision surgery, osteomyelitis, and nonunion. Results A total of 230 cases met the inclusion criteria. The cohorts of early and delayed surgical intervention were similar with regard to preoperative demographics. The most common mechanism of injury was motor vehicle accident. Approximately 40% of cases were graded as type I, 40% as type II, and 20% as type III. Mean time to debridement in the group treated after 24 hours was 5 days. A mean postoperative follow-up of greater than 6 months was obtained in both cohorts. Similar outcomes were found between cohorts with respect to postoperative infection, revision surgery, osteomyelitis, and nonunion. Conclusions Similar outcomes with regards to infection, revision, osteomyelitis, and nonunion were found between open distal radius fractures treated emergently versus those managed in a delayed fashion. Patient- and injury-specific factors are important in dictating care. Type of study/level of evidence Prognostic IIB.

Introduction The current method for determining the appropriate wrist splint size in the clinical setting relies on measuring wrist circumference, but this approach often fails to ensure optimal fit. This study evaluates additional hand features using 3-dimensional (3D) scanned data and Artificial Intelligence (AI) to improve the fit of pre-fabricated wrist splints. We hypothesize that wrist and forearm widths can provide a more accurate fitting than wrist circumference alone. Materials and methods We recruited 54 healthy volunteers to be scanned. Each volunteer was fitted with a standard wrist brace (Short Arm Brace, Ossur, Iceland), and 3D data from their hands were collected using an infrared-based 3D scanner (Einscan Pro, Shining3D, China). The 3D scanned data were then analyzed to identify and measure 14 distinct hand features. To explore the relationship between these hand features and the optimal splint size, we generated a categorical correlation map. This map identified hand features that were most strongly correlated with splint size categories (small, medium, large). Subsequently, we developed a classification algorithm to predict the appropriate splint size based on the correlated hand features. We utilized three different machine learning models for this purpose: Extreme Gradient Boosting (XGB) Classifier, RandomForestClassifier, and Support Vector Classifier (SVC). Each of these classifiers was trained and evaluated to determine their accuracy and effectiveness in predicting the correct splint size. Results Wrist width showed the highest classification accuracy (91%) for both the XGB Classifier and RandomForestClassifier. The measurements including hand wrist width, mid-forearm width, and hand crease line width also performed well with the XGB Classifier, achieving an accuracy of 90%. The SVC showed consistent performance across various feature sets, with the highest accuracy of 81% for the measurements. Overall, these findings suggest that wrist width is the most predictive feature for splint size classification, with additional features providing minimal enhancement. Conclusions Artificial intelligence, combined with 3D scanning, can accurately predict wrist splint size from a single image acquisition, enabling contactless, personalized fitting. This approach can improve patient outcomes by enhancing the fit of prefabricated splints.

Objectives Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Methods Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. Results There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). Conclusion All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. Level of Evidence III

Distal radius fractures are common injuries that often require surgical intervention. Commonly, these fractures are fixed using open reduction internal fixation with plating and screws. This often requires a more extensive soft tissue dissection and exposure. In contrast for certain cases, percutaneous headless compression screws may be appropriate. We present a technique for minimally invasive arthroscopic-assisted reduction and percutaneous screw fixation with an extremity traction device. A case is provided to demonstrate the technique as a viable option for the treatment of intra-articular distal radius fractures.

Introduction We aimed to evaluate orthotic hygiene, preference for immobilization material, and frequency of unplanned orthotic adjustments and replacements. Methods All patients with fiberglass casts, thermoplastic splints, or prefabricated braces who presented at a large private academic institution between January 2020 and July 2023 were provided an 11-item survey assessing the length of immobilization, frequency of orthotic changes, orthotic hygiene, preference of immobilization, and whether patients recall instructions regarding orthotic care. Results A total of 385 surveys were collected, consisting of 96 (24.9%) casts, 202 (52.5%) thermoplastic splints, and 87 (22.6%) prefabricated braces. Patients were most frequently immobilized for two to six weeks. Of those, 106 (27.5%) patients required an unplanned adjustment or replacement. Almost half (182 patients, 47.3%) attempted to clean their orthotics, which was significantly greater among thermoplastic splints. A total of 229 (59.5%) respondents reported either not receiving or were unsure if they received instruction on proper orthotic hygiene. Conclusion Orthotic care and hygiene instructions are often overlooked or not retained by patients. Nearly one-third of patients required an unplanned adjustment or replacement, which was most frequent with thermoplastic orthotics.

Background: Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period. Methods: A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively. Results: Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution. Conclusion: Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period. Level of Evidence: Prognosis Level I

Purpose Ligament reconstruction and tendon interposition is a common technique for thumb basal joint arthroplasty. Recently, a variation of this technique, a suture suspensionplasty, has been introduced. The goal of our study was to assess the optimal position of the bone anchor in the thumb metacarpal. We hypothesized that an anchor placed in the radial aspect of the thumb metacarpal base would provide improved stability and resist subsidence more effectively than an ulnar-based thumb anchor. Methods Eight fresh-frozen cadaver arms were imaged fluoroscopically in anteroposterior and lateral views centered over the thumb carpometacarpal joint before and after trapeziectomy and after the placement of radial-based and ulnar-based bone anchors. The intermetacarpal angle between the thumb and index metacarpals was measured on all images after the application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, and adduction were measured. Subsidence was calculated as the percentage loss of the trapezial space. Results Both radially and ulnarly placed internal brace constructs allowed more radial abduction, opposition, and palmar abduction than the pretrapeziectomy constructs. They both also reduced subsidence by approximately 20% to 29% compared with the posttrapeziectomy constructs. Comparing radial to ulnar constructs, motion and subsidence were similar. Conclusions There was immediate stability of the thumb with respect to axial load and subsidence after anchor placement, and this was independent of the anchor position. The position of the bone anchor in the thumb metacarpal base did not affect the range of motion. Although the device can limit subsidence, it does not appear to restrict any range of motion of the thumb, irrespective of anchor position. Clinical relevance This cadaver study can help hand surgeons understand the effect of positioning of bone anchors when performing a specific suture suspensionplasty technique. (J Hand Surg Am. 2024;49(4):380.e1-e6. Copyright (c) 2024 by the American Society for Surgery of the Hand. All rights reserved.)