HAND最新文献

{"title":"Dedicated Trauma Operating Rooms in Hand Surgery: A North American Survey of Access, Impact, and Opportunities for System-Level Improvement.","authors":"Chloe R Wong, Heather L Baltzer","doi":"10.1177/15589447261487628","DOIUrl":"10.1177/15589447261487628","url":null,"abstract":"<p><strong>Background: </strong>Dedicated trauma operating rooms (DTORs) have improved surgical efficiency and outcomes in general and orthopedic surgery, yet their adoption and impact in hand surgery remain unclear. This study aimed to assess access to DTORs among hand surgeons and evaluate their observed impacts among those with access and perceived impacts among those without access on operating room efficiency, patient outcomes, surgeon wellness, and resident education.</p><p><strong>Methods: </strong>American Association for Hand Surgery members (N = 1453) and Canadian Society for Surgery of the Hand members (N = 415) were surveyed. The survey covered practice characteristics, DTOR availability, and perceived or actual impact on operating room efficiency, patient outcomes, surgeon wellness, and resident education. Quantitative responses were analyzed descriptively, and open-text responses underwent qualitative synthesis.</p><p><strong>Results: </strong>Of the 90 respondents, most practiced in the United States (79%) and had an academic practice (70%). Only 12% reported access to a DTOR for hand surgery, N = 4/70 in the United States, N = 6/16 in Canada, and N = 1/3 in another country. Among those with access, all reported a positive impact on clinical practice, and most perceived improvements in scheduling conflicts, after-hours cases, and patient outcomes. Similar results were found among those without access (88%). Free-text responses emphasized the need for adequate staffing, centralized scheduling, flexible models, and regional anesthesia support to optimize DTOR utilization.</p><p><strong>Conclusions: </strong>Access to DTORs in hand surgery is limited, yet both observed and perceived impacts suggest important benefits for clinical efficiency, patient outcomes, and provider wellness.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261487628"},"PeriodicalIF":1.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136409","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":"Nonoperative Management Is Associated With an Increased Risk of Adverse Mental Health Conditions in Elderly Patients With Distal Radius Fractures: A Retrospective Cohort Analysis.","authors":"Cameron J Bowers, Jad Lawand, Patrick Tansey, Umar Ghilzai, John J Faillace","doi":"10.1177/15589447261489326","DOIUrl":"10.1177/15589447261489326","url":null,"abstract":"<p><strong>Background: </strong>Previous research comparing operative versus nonoperative management of distal radius fractures in elderly patients has reported similar functional outcomes, leaving treatment decisions controversial. However, limited studies have analyzed how these approaches impact the mental well-being of patients. The purpose of this study is to compare the incidence of mental health conditions during the 1-year post-injury period following operative and nonoperative treatment.</p><p><strong>Methods: </strong>A retrospective query of the TriNetX database identified patients 65 years and older with distal radius fractures who underwent open reduction with internal fixation (ORIF) within 1 month of diagnosis. These patients were 1:1 propensity score matched to a cohort treated nonoperatively with closed reduction for demographic factors and confounding comorbidities. Mental health outcomes within 1 year post-fracture were analyzed. Results were calculated as risk percentages, risk ratios (RRs), 95% confidence intervals (CIs), and <i>P</i> values.</p><p><strong>Results: </strong>Patients undergoing ORIF had a significantly lower risk of major depressive disorder (MDD) (1.7% vs 2.2%; RR, 0.78; 95% CI, 0.66-0.93; <i>P</i> = .01), selective serotonin reuptake inhibitor (SSRI) use (3.1% vs 4.0%; RR, 0.79; 95% CI, 0.69-0.90; <i>P</i> < .01), and opioid dependence (0.1% vs 0.2%; RR, 0.48; 95% CI, 0.27-0.88; <i>P</i> = .01) compared to the nonoperative cohort. There was no significant difference in the risk of depressive episodes, generalized anxiety disorder, or alcohol dependence.</p><p><strong>Conclusions: </strong>Operative fixation of closed distal radius fractures in elderly patients is associated with a lower incidence of new-onset perioperative mental health conditions, including MDD, SSRI use, and opioid dependence, compared with nonoperative treatment.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447261489326"},"PeriodicalIF":1.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136355","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":"Inhibition of Wallerian Degeneration Leads to Decreased Functional Recovery 6 Weeks After Delayed Repair of Transected Rat Sciatic Nerve.","authors":"Mark A Feger, Jesse Hu, Tony Lee, Christopher J Dy, David M Brogan","doi":"10.1177/15589447251392936","DOIUrl":"10.1177/15589447251392936","url":null,"abstract":"<p><strong>Background: </strong>Sterile Alpha and TIR Motif Containing 1 (SARM1) is the central executioner of Wallerian degeneration (WD) following axonal injury, with its inhibition having been shown to delay WD. However, little is known about its effect on functional recovery after nerve transection and repair. This study aimed to evaluate whether recovery after nerve transection and delayed repair is enhanced in an SARM1 knockout (KO) model.</p><p><strong>Methods: </strong>A total of 16 SARM1 KO and 16 wild-type (WT) Lewis rats underwent sciatic nerve transection, followed by repair at 4 days with functional analysis at either 2 or 6 weeks. Primary outcome measures included muscle tetanic force, compound nerve action potential (CNAP) amplitude and latency, and sciatic function index (SFI). Both SARM1 KO and WT groups were compared using independent <i>t</i> tests with a priori level of significance of <i>P</i> ≤ .05.</p><p><strong>Results: </strong>The SARM1 KO rats displayed significantly lower tibialis anterior (1.43 ± 0.98 N vs 2.56 ± 1.43 N, <i>P</i> = .016) and gastrocnemius (2.35 ± 0.64 N vs 4.48 ± 1.32 N, <i>P</i> = .002) muscle strength at 6 weeks. There were no differences in CNAP amplitudes or latencies at 2 or 6 weeks after delayed repair compared with WT. There was no difference in SFI between SARM1 KO and WT groups at 2 or 6 weeks after repair.</p><p><strong>Conclusions: </strong>The SARM1 KO impeded recovery of muscle strength after nerve transection and delayed repair. Knockout rodents also appeared to have increased scarring, reflective of poor axonal regeneration. Further work should aim to better understand the inhibitory effects of SARM1 deletion and its role in nerve regeneration.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1432-1438"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762642","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":"Outcomes of Arthrodesis for Thumb Carpometacarpal Joint Osteoarthritis Using a Headless Compression Screw and Locking Plate With Autologous Bone Grafting: A 1-Year Follow-up Study.","authors":"Akari Mori, Mika Akahane, Soichiro Honda, Kensho Suzuki, Kaoru Tada, Satoru Demura","doi":"10.1177/15589447251389649","DOIUrl":"10.1177/15589447251389649","url":null,"abstract":"<p><strong>Background: </strong>Thumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition that causes pain and dysfunction, particularly in middle-aged and elderly individuals. Arthrodesis offers reliable pain relief and joint stability but is associated with a risk of pseudarthrosis depending on the fixation method. This study aimed to evaluate the clinical outcomes of thumb CMC arthrodesis using a headless compression screw (HCS) and locking plate with autologous bone grafting.</p><p><strong>Methods: </strong>This retrospective case series included 17 patients (17 hands) who underwent thumb CMC arthrodesis between 2020 and 2022. The procedure involved curettage of the joint surface, bone grafting, fixation with an HCS, and dorsal locking plate. Postoperative outcomes were assessed using bone union rate, time to union, visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Kapandji score, grip strength, and pinch strength. All parameters were evaluated preoperatively and at 1-year follow-up.</p><p><strong>Results: </strong>All patients achieved radiographic union (100%) with a mean time to union of 10.5 weeks. Median VAS improved from 70 to 6, and DASH score improved from 39.8 to 11.2. Kapandji score remained unchanged. Grip strength showed mixed results, with a median decrease but mean increase. Lateral-pinch and tip-pinch strengths improved significantly. No major complications such as pseudarthrosis or hardware failure were observed.</p><p><strong>Conclusion: </strong>Thumb CMC arthrodesis using HCS, locking plate, and autologous bone grafting results in high union rates and substantial pain relief, offering a reliable technique particularly suited for patients with compromised bone quality.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1452-1457"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762675","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":"Upper Extremity Reconstruction in Patients With Cervical Spinal Cord Injury.","authors":"Rachana Suresh, Mohammed Shahid, Anirudh Buddhiraju, Keith T Kuo, Zachary Zamore, Kitae Eric Park, William Padovano, Sami H Tuffaha, Ala Elhelali","doi":"10.1177/15589447251392943","DOIUrl":"10.1177/15589447251392943","url":null,"abstract":"<p><strong>Background: </strong>Regaining hand and upper extremity function is a functional priority for patients with cervical spinal cord injuries (SCI). Despite the high demand for upper extremity reconstruction (UER) to restore function, the utilization of these procedures remains low. This study evaluates the incidence and timing of UER in patients with cervical SCI.</p><p><strong>Methods: </strong>The TriNetX Research Network was queried to identify patients with cervical SCI. Then, we identified patients who underwent procedures to restore motor function (nerve transfer, tendon transfer, tenodesis, or arthrodesis) and procedures to treat spasticity and contractures (neurectomy, tendon lengthening, or tenotomy) using <i>International Classification of Diseases, 10th Revision</i>, <i>Current Procedural Terminology</i>, and <i>Systematized Nomenclature of Medicine</i> codes. Baseline characteristics were compared between patients who received UER and those who did not. Propensity score-matched analysis was used to compare UER rates between sex and racial groups.</p><p><strong>Results: </strong>Among 117 401 patients with SCI, only 0.8% of those with cervical SCI underwent UER, with higher utilization among patients with low cervical (C5-C8) and complete injuries. Tendon and joint procedures were more commonly performed than nerve procedures for both motor restoration and spasticity management. Nerve transfers were typically performed earlier post-injury than tendon procedures. Patients who received UER were significantly younger and more likely to have complete SCI, higher rates of psychiatric comorbidities, and lower prevalence of diabetes than those who did not undergo UER. Although overall UER rates did not differ significantly by sex, male and White patients were more likely to receive nerve-related procedures.</p><p><strong>Conclusions: </strong>Less than 1% of cervical SCI patients underwent any form of upper extremity reconstructive procedures. Significantly more tendon procedures were performed compared with nerve procedures to both treat spasticity and restore motor function. Patients of White race and male gender were more likely to receive nerve-related UER procedures.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1425-1431"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12668996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648044","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":"Stage-Based Surgical Strategies and Outcomes for Preiser Disease: A Single-Center Experience.","authors":"Hiroaki Kida, Yuichiro Matsui, Akio Minami, Daisuke Kawamura, Takeshi Endo, Daisuke Momma, Tsutomu Endo, Hirofumi Miyaji, Norimasa Iwasaki","doi":"10.1177/15589447251391379","DOIUrl":"10.1177/15589447251391379","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for Preiser disease, a rare avascular necrosis of the scaphoid, remains unclear. Our institution employs a stage-based strategy: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early disease (Herbert classification stages 1-2) and proximal row carpectomy (PRC) for advanced disease (stages 3-4). This study evaluates this stage-based surgical approach.</p><p><strong>Methods: </strong>We retrospectively analyzed 8 patients (mean age: 60.6 years) who underwent surgical treatment for Preiser disease between 2000 and 2019. Preoperative evaluation included Herbert and Kalainov classifications. Outcome measures included the range of motion (ROM), grip strength (GS), pain (numeric rating scale [NRS] score), Modified Mayo Wrist Score (MMWS), and radiological parameters. Mean follow-up was 50 months.</p><p><strong>Results: </strong>Five patients had stage 2, 1 had stage 3, and 2 had stage 4 disease. Seven patients were treated according to our strategy; 1 stage 4 patient deviated. In those treated per protocol, the VBG/CRWO group (n = 5) and the PRC group (n = 2) showed improvements across all clinical outcomes. Despite clinical gains, radiographic disease progression occurred in 4 of the 5 patients in the VBG/CRWO group. The patient treated outside the standard approach experienced clinical deterioration and developed dorsal intercalated segment instability deformity.</p><p><strong>Conclusion: </strong>Our stage-based surgical strategy for Preiser disease yields favorable clinical outcomes. While radiographic progression may occur regardless of treatment, clinical improvements are generally maintained when procedures are appropriately selected based on disease stage.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1525-1532"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12668994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648351","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":"Short- to Mid-term Evaluation of Patient-Reported Outcomes of Carpometacarpal Denervation for the Treatment of Osteoarthritis of the Thumb: A Prospective Clinical Trial.","authors":"Joshua W Hustedt, Benjamin Watzig, Crystal Tijerino, Kaylee Brady, Andrew Ishikawa, Briana L Silvestri","doi":"10.1177/15589447251392942","DOIUrl":"10.1177/15589447251392942","url":null,"abstract":"<p><strong>Background: </strong>Denervation of the carpometacarpal (CMC) joint has been described as a treatment to decrease pain and increase function for patients with base-of-thumb osteoarthritis. However, few short- to mid-term outcome studies have been conducted.</p><p><strong>Methods: </strong>A prospective clinical trial was conducted on patients who received CMC denervation at our institution. Preoperative and postoperative evaluations were conducted on patients including evaluation of pain with the visual analogue score (VAS), functional outcomes via the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcome measure, quality of life with the EuroQol-5D (EQ-5D), and need for revision to CMC suspension arthroplasty.</p><p><strong>Results: </strong>Eighty-seven CMC denervation procedures were performed in 77 patients. The average age of the study population was 66 years, with a range of 35 to 89 years. The median follow-up time was 2.8 years, with a range of 1.5 to 4 years. VAS pain scores improved from an average of 7.2 to 2.1, QuickDASH scores improved from 54.8 to 31.2, and EQ-5D scores improved from 0.40 to 0.68. Eighty-seven percent of patients reported improved hand function following denervation, and patients reported a 72% reduction in pain. Three of 87 (3.4%) denervation procedures were revised to a CMC arthroplasty procedure.</p><p><strong>Conclusion: </strong>Carpometacarpal denervation appears to provide pain reduction and improvement in function and quality of life in short- to mid-term follow-up with a low need for revision to arthroplasty. A vast majority of patients saw improvement in hand function. Carpometacarpal denervation may offer lasting pain relief with quick return of function for patients suffering from base-of-thumb osteoarthritis.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1447-1451"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12714557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774364","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":"Nerve Transfer for Intrinsic Hand Dysfunction in Brown-Vialetto-Van Laere Syndrome: Expanding the Role of SETS in Motor Neuronopathies.","authors":"Luis Guilherme Rosifini Alves Rezende","doi":"10.1177/15589447261441825","DOIUrl":"10.1177/15589447261441825","url":null,"abstract":"<p><p>Brown-Vialetto-Van Laere syndrome (BVVLS) is a rare neurodegenerative disorder associated with progressive cranial and spinal motor neuron involvement. While typically managed conservatively, select patients may present with focal peripheral deficits amenable to surgical intervention. We report the first known case of intrinsic hand dysfunction in BVVLS treated using a supercharged end-to-side (SETS) anterior interosseous-to-ulnar motor nerve transfer. Electroneuromyography revealed isolated postganglionic ulnar motor dysfunction with preservation of the median nerve, supporting surgical candidacy. The procedure resulted in restored hand function within 6 months and sustained improvement at 5-year follow-up. This case highlights the potential for SETS nerve transfer to expand beyond compressive neuropathies and serve as a targeted strategy in progressive motor neuron disorders with preserved donor pathways.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"NP1-NP5"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769952","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":"Improving Evidence in Hand and Wrist Surgery: A Systematic Assessment of Randomized Controlled Trials Quality and Impact.","authors":"Cameron O'Brien, Alexandra Shumard, David Mitchell, Chance Bratten, Eli Paul, Matt Vassar","doi":"10.1177/15589447251389662","DOIUrl":"10.1177/15589447251389662","url":null,"abstract":"<p><strong>Background: </strong>Randomized controlled trials (RCTs) are the gold standard for generating clinical evidence; however, many in hand and wrist surgery fall short in delivering clinically relevant insights. We systematically evaluated RCTs published over the last 25 years to assess their clinical usefulness and utility.</p><p><strong>Methods: </strong>We assessed the usefulness of 88 RCTs published between 2000 and 2025 involving surgical, perioperative, or nonoperative interventions in hand and wrist surgery. Studies were identified through Medline and Embase. Each trial was evaluated using a validated 13-item framework incorporating 8 usefulness criteria and 5 transparency indicators. Screening and data extraction were performed in masked duplicate fashion. The protocol was pre-registered on the Open Science Framework.</p><p><strong>Results: </strong>Of the 88 included RCTs, 99% addressed a clinically important question, but only 13% employed a pragmatic study design. Patient-centered outcomes were included in 52% of trials, and validated patient-reported outcome measures were used in just 39%. While 47% of trials were pre-registered, only 5% shared raw data. Overall, just 11% of studies achieved a usefulness score of 75% or greater on our 13-item framework. Trials most frequently originated from Europe (38%) and were published in hand surgery journals (42%).</p><p><strong>Conclusions: </strong>Many RCTs in hand and wrist surgery lack pragmatic design, patient-centered outcomes, and transparency. Improving these areas can increase real-world relevance and guide practicing surgeons' clinical decision-making.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1517-1524"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632618","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":"Enhancing Preoperative Decision-Making in Trapeziometacarpal Joint Replacement: CT Hounsfield Units as a Reliable Predictor of Bone Quality.","authors":"Ishith Seth, Bryan Lim, Gianluca Marcaccini, Jennifer Novo, Reece Tso, Georga Bruechert, Quentin Fogg, Warren M Rozen","doi":"10.1177/15589447251391377","DOIUrl":"10.1177/15589447251391377","url":null,"abstract":"<p><strong>Background: </strong>Successful trapeziometacarpal (TM) joint arthroplasty depends heavily on bone quality, particularly of the trapezium, where cup loosening remains a leading cause of implant failure. While dual-energy x-ray absorptiometry measures bone mineral density (BMD), it lacks regional specificity. Computed tomography (CT)-derived Hounsfield units (HU) offer quantitative, site-specific bone density estimation and may serve as a surrogate for BMD in preoperative planning. This study investigated the relationship between CT-derived HU values and tactilely perceived bone hardness of the trapezium to evaluate HU as a reliable predictor of bone quality.</p><p><strong>Methods: </strong>Ten embalmed Body Donor hands were scanned using a Philips Spectral CT 7500 scanner. Bone segmentation and density analyses were conducted in 3D Slicer software, focusing on trabecular regions of the trapezium (proximal, ridge, and submetacarpal) and the first metacarpal (proximal, medial, and distal). Hounsfield unit values were converted to density (g/cm³) using validated equations. An experienced anatomist assessed trapezium hardness (\"soft\" or \"hard\") using bone forceps. Correlations between HU values, bone volume, and perceived hardness were analyzed using Pearson correlation coefficient.</p><p><strong>Results: </strong>The mean trapezium HU was 354 (682.88 g/cm³), with regional trabecular variation: proximal 160.7 HU, ridge 286.5 HU, submetacarpal 241.7 HU. The first metacarpal demonstrated broader density variation (-285.8 to 228.8 HU). Hounsfield unit values correlated significantly with perceived hardness (<i>r</i> = .71, <i>P</i> = .02), whereas bone volume showed no correlation (<i>r</i> = .08, <i>P</i> = .82). Male trapezia displayed higher HU and density (472.7 ± 89.8 HU; 740.9 ± 44.0 g/cm³) than females (436.1 ± 87.2 HU; 723.0 ± 42.7 g/cm³).</p><p><strong>Conclusions: </strong>Computed tomography-derived HU values strongly correlate with perceived bone hardness and provide an objective surrogate for assessing bone quality in TM joint arthroplasty. Incorporating preoperative HU assessment may guide implant selection and fixation strategies, reducing trapezium cup loosening and implant failure.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"1458-1465"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714116","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}