HAND最新文献

{"title":"Syndactyly and Risk of Cancer.","authors":"Kira L Smith, Matthew V Abola, Logan M Good, Raymond W Liu, Apurva S Shah, Samir K Trehan, Aaron Daluiski","doi":"10.1177/15589447261416115","DOIUrl":"10.1177/15589447261416115","url":null,"abstract":"<p><strong>Background: </strong>Syndactyly is the most common upper-extremity congenital condition, and cases can be associated with genetic syndromes or arise sporadically (nonsyndromic). The purpose of this investigation was to determine rates of both malignant and benign neoplasms among pediatric patients diagnosed with nonsyndromic syndactyly compared to matched controls.</p><p><strong>Methods: </strong>The TriNetX US Collaborative database was queried using International Classification of Disease, 10th Revision codes to identify patients aged 10 years or younger diagnosed with syndactyly. Patient history of syndactyly was utilized to categorize patients into 2 cohorts. These cohorts were propensity-matched by age, sex, race, ethnicity, and congenital malformation syndromes. Subsequent rate of neoplasms was compared between patients with and without syndactyly.</p><p><strong>Results: </strong>A total of 7478 patients aged 10 years or younger diagnosed with syndactyly were identified. After 1:1 propensity matching, both cohorts included 5461 patients. The rate of digestive malignancies was significantly higher int he syndactyly cohort than that in the control cohort. The rate of benign neoplasms was significant at >5 years follow-up duration (<i>P</i> = .016, 95% CI 0.001-0.005) but was not significant at 1 year or 1 to 5 years. Similarly, rate of any neoplasm was significant at >5 years follow-up duration (<i>P</i> = .013, 95% CI 0.001-0.005) but not at 1 year or 1 to 5 years.</p><p><strong>Conclusions: </strong>Nonsyndromic syndactyly is associated with an increased rate of benign neoplasms and digestive malignancies. Further investigation is needed to better understand the relationship between the syndactyly phenotype and risk of malignancy.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261416115"},"PeriodicalIF":1.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377182","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":"Survivorship and Patient Satisfaction With Stablyx Implant for Thumb Carpometacarpal Arthroplasty.","authors":"Camden O Novikova, Kelsey M Gray, Nicholas J Peterman, Miles C Farlow, Micheala I McCarthy, Anthony E Capito, Peter J Apel","doi":"10.1177/15589447261422505","DOIUrl":"10.1177/15589447261422505","url":null,"abstract":"<p><strong>Background: </strong>Many surgical techniques and devices are available to address thumb carpometacarpal (CMC) joint arthritis. To date, limited evidence exists regarding patient satisfaction, patient-reported outcomes, and revision-free survivorship of the Stablyx implant. We sought to examine these metrics for these implants against conventional CMC arthroplasty techniques.</p><p><strong>Methods: </strong>Six hundred and thirty-one patients who underwent CMC arthroplasty were identified at our institution. Patients were contacted to obtain patient satisfaction scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and potential revision dates. Retrospective chart review was then performed on all 287 respondents. Respondents were placed into cohorts based on the arthroplasty surgical technique: (1) Stablyx (n = 53); (2) ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (n = 90); (3) abductor pollicis longus (APL) suspensionplasty (n = 71); and (4) TightRope suspensionplasty (n = 73). Minimum follow-up was 6 months with an average follow-up of 3.6 ± 2.2 years for the Stablyx cohort and 5.3 ± 2.8 years for all other CMC arthroplasty techniques (AOCAT). Patient demographics, including age, sex, smoking status, Eaton score, and operating surgeon, were also examined.</p><p><strong>Results: </strong>Through multivariable modeling, higher revision rates were observed in patients who received Stablyx than those who underwent LRTI (control), APL suspensionplasty, or TightRope suspensionplasty. Dissatisfaction was greater in the Stablyx cohort (35%) than the AOCAT cohort (6.8%). No difference in QuickDASH scores were observed between groups.</p><p><strong>Conclusions: </strong>Higher revision rates and lower patient satisfaction scores were seen in patients who underwent Stablyx CMC hemiarthroplasty compared with other arthroplasty techniques.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261422505"},"PeriodicalIF":1.8,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354784","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":"Ambulatory Free Medial Femoral Condyle and Trochlea Flaps for Management of Scaphoid Fractures and Nonunions.","authors":"Benjamin A Sarac, Hisham M Awan, Ryan W Schmucker","doi":"10.1177/15589447261422499","DOIUrl":"10.1177/15589447261422499","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the scaphoid are the most common carpal bone fracture and have high rates of nonunion. Management of nonunions is crucial to preventing the predictable pattern of arthritis seen with scaphoid nonunion advanced collapse (SNAC). The medial femoral condyle (MFC) and trochlea (MFT) flaps have become a popular option for the management of recalcitrant nonunions. We analyzed our experience with outpatient free vascuarlized MFC/MFT flaps for management of scaphoid fractures and nonunions.</p><p><strong>Methods: </strong>A retrospective review of a 2-surgeon approach to outpatient MFC/MFT flap reconstruction of scaphoid nonunions without postoperative flap monitoring was performed. Baseline demographic details, injury history, preoperative and postoperative radiographic analysis, operative details, and postoperative union were collected. Patients were discharged either on the day of surgery or the follow morning.</p><p><strong>Results: </strong>Ten patients met inclusion criteria. Four patients had involvement of the proximal pole and received an MFT as opposed to an MFC. Eight patients were discharged on the day of surgery, and the remaining 2 were discharged on the first postoperative day. Nine patients (90%) showed postoperative union on imaging, with no residual dorsal intercalated segment instability deformity.</p><p><strong>Conclusions: </strong>Vascularized bone grafting with a free MFC/MFT for management of recalcitrant scaphoid nonunion can be successfully and safely performed without postoperative monitoring in an outpatient surgery center setting. This series is the first to report on ambulatory free MFC/MFT flap reconstruction, and to our knowledge, it is the second in the literature to describe free vascularized tissue transfer of any kind performed with same-day discharge.</p><p><strong>Level of evidence: </strong>Level IV, Therapeutic.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261422499"},"PeriodicalIF":1.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12960259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354771","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":"ECTR With Tourniquet and Local Anesthesia Only: Efficiency and Patient Satisfaction.","authors":"Kasparas Zilinskas, Reena Bakshi, Kristin Clemmons, Melanie Bertolino Zilinskas, Alexander Hoey, Manoucher Lance Tavana","doi":"10.1177/15589447261418695","DOIUrl":"10.1177/15589447261418695","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Carpal tunnel release (CTR) is commonly performed using wide-awake local anesthesia no tourniquet (WALANT) in a clinic or ambulatory surgery center and is shown to have similar satisfaction rates and postoperative complication profile compared to operating room (OR) procedures. Endoscopic carpal tunnel release (ECTR) is commonly performed; however, it is usually done in an OR setting with the use of anesthesia (OR-ECTR). We present a single institution's experience performing ECTR utilizing a tourniquet under local only anesthesia (LO-ECTR). We compared procedural efficiency and environmental impact between OR-ECTR and LO-ECTR. In addition, patient satisfaction with LO-ECTR was assessed via a postprocedural survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review identified patients who underwent OR-ECTR and LO-ECTR from June 2021 to June 2023 by a single surgeon at our institution. Efficiency was measured by comparing procedure, recovery, and total time spent in the hospital. Environmental impact was assessed by measuring OR waste weight. Student's &lt;i&gt;t&lt;/i&gt;-tests for continuous variables and Chi-squared tests for categorical variables were performed. Patients in the LO-ECTR group answered a survey immediately postoperatively that included pain scores on a Likert scale and overall satisfaction. Inclusion criteria included primary carpal tunnel syndrome (CTS), diagnosis based on clinical or electromyography studies, and no concurrent procedures. The Microaire SmartRelease ECTR system was used in the OR-ECTR cases, and the Trice Seg-WAY ECTR-d system was used in the LO-ECTR cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 137 cases in the LO-ECTR and 104 cases in the OR-ECTR group met inclusion criteria. Age, body mass index, operative hand, and race were similar between both groups. LO-ECTR procedures were faster than OR-ECTR procedures for all time metrics. Total procedure and operating time improved (9 ± 2 minutes vs 14 ± 4 minutes and 15 ± 2 minutes vs 28 ± 6 minutes). Preoperative holding time improved (35 ± 15 minutes vs 89 ± 30 minutes). Recovery time was notably faster (7 ± 4 minutes vs 48 ± 22 minutes), which affected total hospital time (61.9 ± 18.6 minutes vs 166.9 ± 38.3 minutes). All differences were statistically significant with &lt;i&gt;P&lt;/i&gt; &lt; .001. Waste weights were significantly lower in the LO-ECTR cohort than those in the OR-ECTR cohort; however, sample sizes were small in both cohorts (1.3 ± 0.04 kg in LO-ECTR vs 6.0 ± 0.7 kg in OR-ECTR, &lt;i&gt;P&lt;/i&gt; &lt; .001). Within the LO-ECTR group, the overall pain level experience was mild/moderate. The average overall satisfaction with the experience was 96.6%, with 98.5% of patients stating they would recommend this procedure to a friend.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;LO-ECTR was faster than OR-ECTR for all studied time metrics. Data are suggestive of improvement in the environmental impact factor. Limitations include a lack of meaningful postoperative ","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261418695"},"PeriodicalIF":1.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12960268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354738","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":"Understanding Stakeholder Priorities in Dupuytren Disease: A Qualitative Study.","authors":"Marta Karpinski, Caroline Hircock, Lucas Gallo, Emily Dunn, Jessica Murphy, Manraj N Kaur, Achilles Thoma","doi":"10.1177/15589447241306143","DOIUrl":"10.1177/15589447241306143","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is no recommended standard set of outcomes to report in Dupuytren disease treatment studies, nor are there guidelines on how the outcomes themselves should be reported. This study aimed to elicit the most salient issues for patients living with and undergoing treatment for Dupuytren disease, as well as for the hand surgeons, occupational therapists, and physical therapists caring for these patients.</p><p><strong>Methods: </strong>A qualitative, interpretive description study employing one-on-one semi-structured interviews was conducted. Ten surgeons, 12 occupational and physical therapists, and 10 patients were interviewed.</p><p><strong>Results: </strong>Priorities related to Dupuytren disease treatment and recovery differed by stakeholder group. Surgeons prioritized range of motion, recovery time, and recurrence. Physical and occupational therapists frequently mentioned range of motion, grip strength, activities of daily living, return to meaningful activities, wound healing, edema, lack of sensation, and pain as important treatment outcomes. Patients described extension deficit, activities of daily living, holding objects, and lack of sensation.</p><p><strong>Conclusions: </strong>Through the present study, we have identified outcomes of high importance to patients, hand surgeons, occupational therapists, and physical therapists. These results can be used to inform the development of a core outcome set for Dupuytren contracture.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"472-477"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894073","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":"Cancellous Grafting Versus Corticocancellous Graft With Volar Locked Plating for Scaphoid Waist Fracture Nonunion: An Evaluation of Early Bony Bridging.","authors":"Michael J Stoltz, James Gainer, John A Nyland, Victor L Fehrenbacher, Amit Gupta, Luke P Robinson","doi":"10.1177/15589447241308598","DOIUrl":"10.1177/15589447241308598","url":null,"abstract":"<p><strong>Background: </strong>Achieving bony union in scaphoid nonunion fractures is challenging. Various bone grafts have been studied using headless compression screws (HCS) fixation. However, the impact of bone graft choice on bone healing with volar locking plates (VLP) use is less clear. This study evaluates osseous bridging using packed cancellous grafting versus corticocancellous grafting when used during scaphoid waist nonunion repair with volar plating.</p><p><strong>Methods: </strong>A retrospective case series was performed of 22 consecutive patients with a scaphoid waist fracture nonunions that were treated with VLP fixation and bone autografts. Inclusion criteria required ≥90-day follow-up clinical examination and postoperative computed tomography (CT) scan. Graft types included corticocancellous or packed cancellous autograft harvested from the radius or iliac crest. Amount of bone healing and presence of residual dorsal intercalated segmental instability were determined by 3 fellowship-trained hand surgeons.</p><p><strong>Results: </strong>Twenty-two patients with scaphoid fracture nonunions that met study inclusion criteria were evaluated. Postoperative CT scan showed osseous bridging in 95% (21/22) of patients. Despite less time between surgery and the final follow-up CT scan (102.7 ± 59 days for packed cancellous autografts vs 133.6 ± 73 days for corticocancellous autografts), the packed cancellous autograft group displayed higher osseous bridging percentages compared with the corticocancellous graft (80.7% ± 17% vs 47.8% ± 35%, <i>P</i> = .013).</p><p><strong>Conclusion: </strong>Nearly all patients displayed osseous bridging on postoperative CT scan with VLP and autograft use. However, study findings suggest that packed cancellous autograft use displayed more robust early healing.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"390-395"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894067","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":"Effect of Time to Surgery on Surgical Site Infection in Open Distal Radius Fractures: A Review of the ACS Trauma Quality Improvement Program Database.","authors":"Walter Sobba, Lawrence J Lin, Gerardo E Sanchez-Navarro, Jadie De Tolla, Omri Ayalon, Jacques H Hacquebord","doi":"10.1177/15589447241305422","DOIUrl":"10.1177/15589447241305422","url":null,"abstract":"<p><strong>Background: </strong>Managing open distal radius fractures (DRFs) poses challenges. While preventing surgical site infection (SSI) involves prompt antibiotic administration and thorough irrigation and debridement, the impact of urgent intervention on reducing postoperative infection rates is debated. We hypothesize that timing of surgery does not significantly affect the incidence of SSI in open DRF treated within or after 24 hours from time of injury.</p><p><strong>Methods: </strong>We retrospectively analyzed the American College of Surgeons Trauma Quality Improvement Program from 2011 to 2021. We focused on outcome variables, including superficial SSI and deep SSI or osteomyelitis. To evaluate the relationship between time to operative intervention and SSI rates, we employed least absolute shrinkage and selection operator and multivariate regression models, adjusting for patient-specific factors and injury severity.</p><p><strong>Results: </strong>A total of 14 486 patients were included. Regression modeling demonstrated a 23% increase in the odds of deep SSI with each 1-day delay in surgery (<i>P</i> = .010). However, no association was found between time to surgery and superficial SSI (odds ratio [OR] = 0.96, <i>P</i> = .768). Injury severity score (ISS) was associated with increased odds of superficial SSI (OR = 1.06, <i>P</i> < .001) and deep SSI (OR = 1.06, <i>P</i> < .001) while diabetes (OR = 3.56, <i>P</i> = .013) was significantly associated with increased rates of superficial SSI.</p><p><strong>Conclusions: </strong>Extended time to surgery correlates with a modest rise in deep SSI incidence in open DRF. However, there was no heightened risk of superficial SSI in patients with delayed surgery. Polytrauma, alcohol use disorder, and diabetes were linked to elevated SSI rates in open DRF.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"358-364"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885574","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":"Machine Learning-Aided Diagnosis Enhances Human Detection of Perilunate Dislocations.","authors":"Anna Luan, Lisa von Rabenau, Arman T Serebrakian, Christopher S Crowe, Bao H Do, Kyle R Eberlin, James Chang, Brian C Pridgen","doi":"10.1177/15589447241308603","DOIUrl":"10.1177/15589447241308603","url":null,"abstract":"<p><strong>Background: </strong>Perilunate/lunate injuries are frequently misdiagnosed. We hypothesize that utilization of a machine learning algorithm can improve human detection of perilunate/lunate dislocations.</p><p><strong>Methods: </strong>Participants from emergency medicine, hand surgery, and radiology were asked to evaluate 30 lateral wrist radiographs for the presence of a perilunate/lunate dislocation with and without the use of a machine learning algorithm, which was used to label the lunate. Human performance with and without the machine learning tool was evaluated using sensitivity, specificity, accuracy, and F1 score.</p><p><strong>Results: </strong>A total of 137 participants were recruited, with 55 respondents from emergency medicine, 33 from radiology, and 49 from hand surgery. Thirty-nine participants were attending physicians or fellows, and 98 were residents. Use of the machine learning tool improved specificity from 88% to 94%, accuracy from 89% to 93%, and F1 score from 0.89 to 0.92. When stratified by training level, attending physicians and fellows had an improvement in specificity from 93% to 97%. For residents, use of the machine learning tool resulted in improved accuracy from 86% to 91% and specificity from 86% to 93%. The performance of surgery and radiology residents improved when assisted by the tool to achieve similar accuracy to attendings, and their assisted diagnostic performance reaches levels similar to that of the fully automated artificial intelligence tool.</p><p><strong>Conclusions: </strong>Use of a machine learning tool improves resident accuracy for radiographic detection of perilunate dislocations, and improves specificity for all training levels. This may help to decrease misdiagnosis of perilunate dislocations, particularly when subspecialist evaluation is delayed.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"380-389"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004530","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":"Aggressive Digital Papillary Adenocarcinoma: A Meta-Analysis of the Presentation, Treatment, and Outcomes of a Rare Hand Tumor.","authors":"Shaun D Mendenhall, Emily M Graham, Natasha N Lewis, Ryan W Schmucker, Jacob P Veith, Jennifer L Koechle, Michael W Neumeister","doi":"10.1177/15589447241308612","DOIUrl":"10.1177/15589447241308612","url":null,"abstract":"<p><strong>Background: </strong>Aggressive digital papillary adenocarcinoma (ADPA) is a rare skin adnexal tumor with a predilection for the hand. The presentation, treatment, and outcomes of ADPA remain poorly defined due to the scarcity of reports and low-level evidence of published findings.</p><p><strong>Methods: </strong>We performed a meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines with the intent to provide hand surgeons a better understanding of the diagnosis and treatment of the disease. Three additional cases of ADPA from our institution were combined with the results from the systematic review.</p><p><strong>Results: </strong>A total of 238 cases were included in the meta-analysis. Most ADPAs were painful, evolving, and less than 2 cm in size. Regional sentinel lymph node biopsies were performed in 55 patients, of which 25.5% were positive. Overall cohort recurrence and distant metastasis rates were 24.3% and 18.1%, respectively. Patients who obtained clear margins within 6 months of diagnosis had significantly lower rates of recurrence, metastasis, and mortality (<i>P</i> < .001, <i>P</i> = .04, <i>P</i> = .003, respectively). There were no differences in recurrence or metastasis rates in those who obtained clear margins by excision or amputation (<i>P</i> = .27 and <i>P</i> = .07, respectively). In patients who died from disease (6.0%), 5.0 years was the average time to death.</p><p><strong>Conclusions: </strong>Aggressive digital papillary adenocarcinoma should be included in the differential diagnosis of hand lesions with unusual presentations or lack of response to other therapies. Clear margins should be obtained within 6 months of diagnosis, and routine surveillance should be provided by an oncologic physician familiar with ADPA as these tumors have high recurrence rates.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"462-471"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964553","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":"Documented Cannabis Use Is a Risk Factor for Nonunion After Nonoperative Management of Scaphoid Fractures: A Retrospective Review of 159 998 Patients.","authors":"Neil Pathak, Phillip P Ratnasamy, Oghenewoma P Oghenesume, Xuan Luo, Jonathan N Grauer, Andrea Halim","doi":"10.1177/15589447251317225","DOIUrl":"10.1177/15589447251317225","url":null,"abstract":"<p><strong>Background: </strong>The purpose of the present study was to assess whether an association exists between cannabis use and nonunion among patients with acute scaphoid fractures initially treated nonoperatively.</p><p><strong>Methods: </strong>Using the PearlDiver national data set (2010-2020), adult patients with a scaphoid fracture were identified. Patients initially treated with nonoperative management were selected, and 3 subgroups were defined: non-cannabis/non-tobacco (non-users), tobacco-only, cannabis-only. Matched cohorts for each subgroup controlled for age, sex, and comorbidities. Nonunion rates at 6 months, 12 months, and 2 years after fracture diagnosis were determined for each subgroup's matched cohort. Rates of subsequent nonunion surgery were also determined. Multivariable analysis was then done to determine potential associations.</p><p><strong>Results: </strong>A total of 159 998 scaphoid fracture patients were identified. The non-users' group exhibited a nonunion rate of 7.7%. The nonunion rates for the tobacco-only and cannabis-only groups (11.8% and 10.1% respectively) were significantly greater than that of the non-users group. Based on multivariable analysis, cannabis use and tobacco use were individually associated with a greater risk of scaphoid nonunion as well as subsequent nonunion surgery at 6 months, 12 months, and 2 years after index fracture.</p><p><strong>Conclusion: </strong>Documented cannabis use in the electronic medical record is associated with an increased risk of scaphoid nonunion and subsequent nonunion surgery. Further studies are necessary to clarify if this association can be contributed solely to cannabis use, to mixing cannabis or tobacco, or to other variables. In the meantime, physicians can counsel their patients on this potential association and increased risk.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"396-401"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448231","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}