HAND最新文献

{"title":"GLP-1 Receptor Agonist Use and A1 Pulley Release After Corticosteroid Injection for Trigger Finger in Type 2 Diabetes.","authors":"Asim A Khan, Kyleen Jan, Jason H Kim, Lia Gaccione-Barreto, Xavier C Simcock","doi":"10.1177/15589447261480181","DOIUrl":"10.1177/15589447261480181","url":null,"abstract":"<p><strong>Background: </strong>Patients with type 2 diabetes mellitus (T2DM) have a higher incidence of trigger finger and are more likely to require operative A1 pulley release. The impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy on treatment progression remains unclear. This study evaluated the association between GLP-1RA use and progression to operative A1 pulley release following corticosteroid injection for trigger finger in patients with T2DM.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the TriNetX Research Network to identify adults with T2DM and trigger finger who underwent an initial corticosteroid injection. Patients were grouped by GLP-1RA exposure and propensity-matched (1:1) for demographics, comorbidities, and other diabetic medications. The primary outcome was A1 pulley release at 6, 12, and 24 months after injection. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated, and balance was assessed using standardized mean differences <0.10.</p><p><strong>Results: </strong>A total of 69 222 patients met inclusion criteria (5871 with GLP-1RA exposure and 63 351 without). After matching, 5863 patients remained in each cohort. Glucagon-like peptide-1 receptor agonist use was not associated with a significant difference in 6-month release rates (6.1% in GLP-1RA users vs 6.8% in nonusers). However, GLP-1RA users had lower release rates at 12 (10.6% vs 11.9%; RR, 0.89; 95% CI, 0.81-0.99; <i>P</i> = .027) and 24 months (14.2% vs 15.7%; RR, 0.90; 95% CI, 0.83-0.98; <i>P</i> = .016). These differences corresponded to absolute risk reductions of 1.4% and 1.7%, or numbers needed to treat of 71 and 59, at 12 and 24 months, respectively.</p><p><strong>Conclusion: </strong>Glucagon-like peptide-1 receptor agonist therapy was associated with a small but statistically significant reduction in progression to A1 pulley release at 12 and 24 months after corticosteroid injection for trigger finger in patients with T2DM.<b>Level of evidence</b>: Level III.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261480181"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected Bennett Fracture: An Expanded Approach.","authors":"Renata Vaz, Pedro Martins Branco, Paulo Rego, Carolina Baptista","doi":"10.1177/15589447251387285","DOIUrl":"10.1177/15589447251387285","url":null,"abstract":"<p><strong>Background: </strong>Bennett fractures are unstable partial articular fractures of the thumb base, often leading to malunion/nonunion and trapeziometacarpal joint arthritis, if not treated promptly. This study presents 2 cases of neglected Bennett fracture nonunion treated with suture button suspension and small fragment excision, a technique not previously reported for this lesion.</p><p><strong>Methods: </strong>Two male manual workers (24 and 43 years old. respectively) presented with thumb base pain 4 to 6 months post-trauma. Radiographs and computed tomographic scans confirmed Bennett fracture nonunion with first metacarpal base subluxation. Both underwent suture button suspension using the Mini TightRope technique (Arthrex^®) and fragment excision, followed by 2 weeks of immobilization and progressive hand therapy.</p><p><strong>Results: </strong>One patient resumed all activities at 3 weeks, whereas the other required 5 months due to a post-traumatic second metacarpal fracture managed conservatively. At 5 months postop, both showed similar thumb motion to presurgery levels, improved visual analog scale score, and enhanced pinch and grip strength. Radiographs demonstrated satisfactory positioning and healing. The suture button suspension technique aims to recreate ligament stability between the first and second metacarpals, restoring thumb mobility and strength. This approach may offer advantages over traditional methods, allowing earlier mobilization and potentially faster recovery. However, it may not be suitable for cases with advanced arthritis.</p><p><strong>Conclusion: </strong>Suture button suspension and small fragment excision appears to be a viable treatment for Bennett fracture nonunion, offering successful outcomes and potentially overcoming some disadvantages associated with other techniques. Further research is needed to fully evaluate its long-term efficacy and safety.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1331-1337"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12588964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Medicare and Medicaid Reimbursement for Total Wrist Arthrodesis.","authors":"Adam P Henderson, Westin K Keime, Jayanth Kumar, Peter M Murray, Keith T Aziz","doi":"10.1177/15589447251383153","DOIUrl":"10.1177/15589447251383153","url":null,"abstract":"<p><strong>Background: </strong>Total wrist arthrodesis is a well-established procedure providing pain relief and stability for patients with symptomatic radiocarpal arthritis refractory to nonoperative measures. Little research exists on reimbursement and utilization trends for this procedure. This study aimed to characterize Medicare reimbursement trends for total wrist arthrodesis, along with trends in Medicare utilization and comparison with Medicaid reimbursement.</p><p><strong>Methods: </strong>Medicare reimbursement for Current Procedural Terminology codes 25800, 25805, and 25810 were collected from the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule from 2000 to 2025. Rates were inflation-adjusted to 2025 dollars, and percentage changes were calculated. Medicare utilization trends from 2000 to 2022 were analyzed using CMS Part B data. Most recent Medicaid reimbursement was collected from online state fee schedules and compared with 2025 Medicare rates, with additional analyses of variability and adjustment for work Relative Value Units.</p><p><strong>Results: </strong>Inflation-adjusted Medicare reimbursement for total wrist arthrodesis decreased by 49.1% from 2000 to 2025 (<i>P</i> < .0001), averaging a 1.96% annual decline. Utilization trends remained stable, with wrist arthrodesis with iliac or other autograft (CPT 25810) being the most commonly billed procedure. Medicaid reimbursed 13.6% less than Medicare on average, with substantial state variability, ranging from 44.7% (New Hampshire) to 135.4% (Alaska) of Medicare reimbursement.</p><p><strong>Conclusion: </strong>Reimbursement for total wrist arthrodesis has declined significantly despite stable utilization in the Medicare population. Medicaid reimbursement is consistently lower and highly variable by state, potentially impacting access to care. Given the effectiveness of wrist arthrodesis, policymakers should advocate for equitable reimbursement for this procedure.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1387-1392"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12568537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145376904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Spiral Fracture of the Right Fourth Metacarpal: \"Power Drill Kickback Fracture\"-A Distinct Fracture Pattern Caused by a Specific Mechanism of Injury.","authors":"Reni Paulose, Manoj V Kuriakose, Ahammed J Mettammal, Ammunje S Nayak","doi":"10.1177/15589447251378682","DOIUrl":"10.1177/15589447251378682","url":null,"abstract":"<p><strong>Background: </strong>Isolated spiral fractures of the metacarpals are relatively common injuries. However, we observed a distinct and consistent fracture pattern associated with a specific occupational mechanism of injury, which, to our knowledge, has not been previously reported in the literature.</p><p><strong>Methods: </strong>We retrospectively reviewed the charts of 43 construction workers who presented with metacarpal fractures following hand injuries sustained due to sudden drill kickback. This mechanism typically involved the drill bit becoming abruptly lodged in concrete, causing a forceful rotational load to be transmitted to the user's hand.</p><p><strong>Results: </strong>All 43 patients were male construction workers who sustained an isolated spiral fracture of the shaft of the right fourth metacarpal. None of the fractures was significantly displaced or required surgical fixation. Each case was managed conservatively with immobilization, and all patients achieved excellent short-term functional recovery with a full return to work.</p><p><strong>Conclusions: </strong>This study identifies a unique occupational injury mechanism producing an isolated spiral fracture of the right fourth metacarpal shaft in construction workers using power drills. Recognizing this pattern can aid clinicians in instituting effective conservative management and underscores the need for improved occupational safety training and preventive strategies.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1353-1358"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12531179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-Dimensional Computed Tomography-Derived Radiolunate Arthrokinematics With a Case Study in Four-Corner Arthrodesis.","authors":"Taylor P Trentadue, Andrew R Thoreson, Cesar Lopez, Shuai Leng, Peter Amadio, Sanjeev Kakar, Kristin D Zhao","doi":"10.1177/15589447251352124","DOIUrl":"10.1177/15589447251352124","url":null,"abstract":"<p><strong>Background: </strong>The radiolunate joint is conventionally thought to be spared from radiocarpal osteoarthritis, but proximal lunate degenerative changes have been noted. An investigation of radiolunate arthrokinematics in ostensibly healthy wrists may improve understanding of posttraumatic and postoperative outcomes. We hypothesize that four-dimensional computed tomography (4DCT)-derived radiolunate arthrokinematics during motion will differ between wrists with type 1 and type 2 lunates. The clinical-translational relevance of this analysis is highlighted using a 4DCT case study of scaphoid excision with 4-corner arthrodesis (SEFCA).</p><p><strong>Methods: </strong>Four-dimensional computed tomography data were collected during flexion-extension and radioulnar deviation in 19 healthy wrists (mean [SD] age: 43.6 [11.7] years, 21.1% female) and 1 wrist 3 years after SEFCA (male, 52 years). Carpal osteokinematics and joint arthrokinematics were calculated to derive median radiolunate interosseous proximities at each 4DCT-captured timepoint.</p><p><strong>Results: </strong>Median radiolunate interosseous proximities during motion are well approximated by second-order regressions in uninjured wrists. In the arthrodesed wrist, closest proximities occurred at the extremes of motion except maximum radial deviation.</p><p><strong>Conclusions: </strong>This study quantifies a normative range of median radiolunate interosseous proximities during wrist motion. The normative 4DCT datasets provide a reference range for evaluating postoperative arthrokinematics, suggesting the clinical-translational potential of dynamic imaging. The case study highlights applications for patient-level postoperative evaluation, which can be expanded to other pathologies, surgeries, or conditions in the future.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1286-1296"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Volar Central Approach for Distal Radius Fracture: A Prospective Nerve Conduction Study of 38 Patients.","authors":"Hugo Jakobsson, Eva Lundqvist, Sara Nordkvist, Kathe Dahlbom, Marcus Sagerfors","doi":"10.1177/15589447251366459","DOIUrl":"10.1177/15589447251366459","url":null,"abstract":"<p><strong>Background: </strong>In distal radius fracture (DRF) surgery with volar locking plates, the flexor carpi radialis approach is commonly used. However, the volar central approach (VCA), between the median nerve and the finger flexors, may improve visualization of the volar ulnar corner. A similar approach has been linked with a higher risk of iatrogenic median neuropathy. This study evaluated the risk of median neuropathy after operative treatment using the VCA.</p><p><strong>Methods: </strong>Thirty-eight patients with Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C DRF were assessed prospectively with sensory nerve conduction studies preoperatively and at 6 weeks, 3 months, and 12 months postoperatively.</p><p><strong>Results: </strong>At 6 weeks, 30 of the 38 patients exhibited median neuropathy, decreasing to 12 of the 35 at 12 months. Subjective sensory deficit was reported by 12 of the 38 patients at 6 weeks and 8 of the 37 at 12 months. Patients with median neuropathy (MN) had significantly higher frequency of subjective sensory deficit of the median nerve 12 months postoperatively, but did not have significantly worse patient-reported outcome.</p><p><strong>Conclusions: </strong>Our results suggest that the VCA should be reserved for cases needing optimal exposure of the volar ulnar corner.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1265-1272"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Dorsal Wrist Spanning Plates Versus External Fixation in Distal Radius Fractures With a Simultaneous Axial and Bending Load.","authors":"Umar Ghilzai, Aaron Singh, Jamie Alexander, Scott Mitchell, David T J Netscher","doi":"10.1177/15589447251376587","DOIUrl":"10.1177/15589447251376587","url":null,"abstract":"<p><strong>Introduction: </strong>External fixators have traditionally been used for comminuted distal radius fractures not amenable to plate fixation but are associated with complications. Dorsal spanning plates have emerged as an alternative. Prior biomechanical studies comparing these constructs typically assess forces in a single vector. This study compares dorsal spanning plates and external fixators under combined axial loading with simultaneous flexion, extension, radial, and ulnar bending to better replicate physiologic wrist forces.</p><p><strong>Methods: </strong>Twenty-four identical laser-sintered bone models were created, with 12 assigned to the dorsal spanning plate group and 12 to the external fixator group. Constructs were tested using a servohydraulic test machine under combined axial and bending loads. Stiffness, maximum load, and yield load were recorded. Statistical analysis was performed using the Mann-Whitney U test with Monte Carlo exact testing.</p><p><strong>Results: </strong>The dorsal spanning plate group demonstrated significantly greater stiffness than the external fixator group in radial and ulnar deviation. No significant differences in stiffness, maximum load, or yield load were observed between groups during flexion. In extension, the plate group exhibited significantly higher maximum load, while stiffness and yield load were not statistically different.</p><p><strong>Conclusion: </strong>Dorsal spanning plates demonstrate increased stiffness compared with external fixators under physiologic multivector loading. These findings may support their use in patients expected to load the wrist postoperatively, such as individuals with polytrauma or elderly patients reliant on assistive walking devices.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1280-1285"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-Plate Allograft Reconstruction for Expansile Lytic Lesions of the Metacarpal May Allow for Immediate Postoperative Weightbearing in a Biomechanical Setting.","authors":"Mathangi Sridharan, Alyssa Tomkinson, Mikayla Mefford, Kasra Rahmati, Tyler Clites, Lauren E Wessel","doi":"10.1177/15589447261479354","DOIUrl":"10.1177/15589447261479354","url":null,"abstract":"<p><strong>Background: </strong>This biomechanical study investigates whether reconstruction of expansile lesions of the metacarpal with fibular allograft and a dual-plate construct is strong enough for immediate postoperative weightbearing.</p><p><strong>Methods: </strong>Twelve cadaveric middle finger metacarpals (6 matched pairs) from adult donors were used. One side of each pair was randomly assigned to undergo allograft reconstruction with dual plating (experimental construct). The matched contralateral side was assigned to the control construct, a transverse fracture with standard, 8-hole dorsal plating. In the experimental construct, an expansile bone lesion was simulated in the native metacarpal by resecting 1.5 cm from the proximal carpometacarpal joint to 1.5 cm from the distal articular surface and was reconstructed with fibular allograft. Biomechanical testing was performed by a 6-degree-of-freedom robotic KUKA manipulator. The distal portion of each specimen was clamped in place, and a cantilever bending force was applied by the KUKA to test the load to failure. Failure was defined as periprosthetic fracture, fracture displacement, or screw pullout. Paired <i>t</i> tests were used to compare load to failure between matched pairs (R studio). Significance was set at <i>P</i> < .05.</p><p><strong>Results: </strong>The load to failure of dual-plate allograft constructs did not significantly differ from that of the control construct, 494.7 ± 239.07 N (95% CI, 243.81-745.59 N) versus 342.2 ± 99.9 N (95% CI, 237.45-447.04 N), <i>P</i> = .19. Experimental constructs failed at the proximal allograft-native bone interface. Control constructs failed via fracture displacement.</p><p><strong>Conclusions: </strong>Dual-plate fixation constructs for allograft reconstruction of the metacarpal are comparable in mechanical stability to standard metacarpal fracture fixation that allow for immediate postoperative range of motion.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261479354"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Reduction and Association of the Scaphoid, Capitate, and Lunate Procedure: A Biomechanical Analysis.","authors":"C Edmond Awah, Pierce J Ferriter, Philip Nasser, Christoph A Schroen, Amanda Walsh, Michael R Hausman","doi":"10.1177/15589447251387286","DOIUrl":"10.1177/15589447251387286","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates whether augmentation of the reduction and association of the scaphoid and lunate (RASL) procedure with a temporary scaphocapitate (SC) screw will improve the stability of the carpus and scapholunate (SL) joint. Primary endpoint was SL joint diastasis with simulated clenched fist grip.</p><p><strong>Methods: </strong>Twelve cadaveric wrists were subjected to repeated cycles at a range of physiologic transcarpal axial forces simulating clenched-fist loading. We measured SL joint motion in scapholunate interosseous ligament (SLIL)-intact wrists and after transecting the SLIL. Outcomes measured included static diastasis and cyclic motion diastasis, defined as the change in SL diastasis from zero newtons to peak force during clenched-fist loading. The RASL procedure was tested with and without the addition of the SC screw. Repeated-measures analysis of variance and Sidak's tests were used to analyze results.</p><p><strong>Results: </strong>No failures were observed in either group when examined manually and radiographically. Static diastasis results showed reduction and association of the scaphoid, capitate, and lunate (RASCL) reduced the scaphoid and lunate more anatomically, resembling SLIL-intact wrists, while RASL over-reduced the scaphoid and lunate. RASCL had less cyclic motion diastasis than the RASL. The RASCL cyclic motion mimicked the SLIL-intact model while RASL cyclic motion was not significantly different from the SLIL injury modelConclusions:The addition of the SC screw decreased SL joint diastasis under simulated clenched-fist loading. Reduction and association of the scaphoid, capitate, and lunate is a biomechanically stronger construct allowing for more robust healing of secondary carpal stabilizers; however, it requires SC screw removal prior to weight bearing.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1312-1319"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Impacts of Unnecessary Transfers of Patients With Hand Injuries at a Level 1 Trauma Center.","authors":"James Rex, Eric Taleghani, Jonas Keller, Henry Keuchley, Kagan Ozer","doi":"10.1177/15589447251378680","DOIUrl":"10.1177/15589447251378680","url":null,"abstract":"<p><strong>Background: </strong>Unnecessary transfers for hand surgery evaluation result in significant costs to patients and consume valuable resources at trauma centers. The financial ramifications of these transfers on the receiving institution is largely unknown. This study was constructed to determine the impact of nonindicated transfers at our level 1 trauma center.</p><p><strong>Methods: </strong>We reviewed the records of 505 patients transferred from another facility to our emergency department between 2018 and 2023. Demographics and transfer specific information were collected. The American Society for Surgery of the Hand ER Hand Care Committee transfer guidelines were used to stratify patients into necessary and unnecessary transfers. The direct and indirect costs and total reimbursement for each unnecessary transfer were reviewed to determine the net operating margin over the 5-year period.</p><p><strong>Results: </strong>Three hundred and nine patients (61%) did not need an urgent transfer to a higher level of care. Patients transferred unnecessarily were more likely to be uninsured (23% vs 15%). Most of these patients were discharged from the emergency department (73%). The payer mix for this analysis was 27% commercial, 25% Medicare, 22% Medicaid, 12% self pay, and 14% other. The net operating margin over 5 years was -$2628. Commercial insurance accounted for most of the financial gains.</p><p><strong>Conclusions: </strong>The financial impact of unnecessary transfers to our tertiary referral center for hand surgery consultation is not significant. The added benefits of lowering costs to patients and improving the use of emergency care resources by mitigating these transfers likely outweighs any financial impacts that may be experienced by receiving institutions.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1366-1371"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}