HAND最新文献

{"title":"A Comparison of End-to-End Versus Reverse End-to-Side Nerve Transfer Techniques in Treating Brachial Plexus Birth Injury-Associated Glenohumeral Dysplasia.","authors":"Victoria Robbins, Nathan Khabyeh-Hasbani, Erin M Meisel, Mandana Behbahani, Steven M Koehler","doi":"10.1177/15589447251350164","DOIUrl":"10.1177/15589447251350164","url":null,"abstract":"<p><strong>Background: </strong>Glenohumeral dysplasia (GHD) commonly occurs following brachial plexus birth injuries and, if not addressed appropriately, can result in shoulder dysfunction. Despite its severity, there are no clearly defined surgical criteria for correcting GHD. This study compares the outcomes of end-to-end and reverse end-to-side spinal accessory to suprascapular nerve transfers for correction of GHD.</p><p><strong>Methods: </strong>All patients presented with shoulder functional limitations, as indicated by Active Movement Scale (AMS) scores in shoulder abduction, shoulder flexion, and external rotation, and evidence of GHD, confirmed by alpha angle measurements obtained on point-of-care-ultrasounds. Demographics, outcome measures, and differences between cohorts were analyzed and compared.</p><p><strong>Results: </strong>Seven infants underwent treatment with reverse end-to-side at a mean age of 6.0 months and 6 with end-to-end at a mean age of 10.3 months. The mean follow-up time for the reverse end-to-side cohort was 14.1 (<i>SD</i> 6.3) months and 15.1 (<i>SD</i> 5.3) months for the end-to-end cohort. At latest follow-up, both approaches demonstrated significant improvement in all outcome measures with the entirety of the reverse end-to-side cohort achieving full recovery of external rotation postoperatively (AMS 7). When comparing the 2 techniques, both groups exhibited similar functional outcomes with no significant differences noted in GHD correction between the 2 approaches.</p><p><strong>Conclusion: </strong>Depending on the clinical scenario, the reverse end-to-side nerve transfer offers a valuable addition to the therapeutic arsenal for correcting GHD and should be highly considered in treatment options.</p><p><strong>Level of evidence: </strong><b>II</b>.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350164"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600170","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":"Pediatric Arnold-Chiari I Malformation With Syrinx Presenting With Unilateral Hand Weakness: A Case Report.","authors":"Joseph Tingen, Erika McPhee","doi":"10.1177/15589447251352008","DOIUrl":"10.1177/15589447251352008","url":null,"abstract":"<p><p>Diagnostic suspicion of Chiari I malformations (CM-I) can be challenging in the pediatric population due to highly variable neurologic symptoms and cognitive immaturity impairing symptom identification. Especially in an atypical presentation without obvious central neurological abnormalities, the diagnosis can often be missed. We present a case of a left-hand-dominant 14-year-old boy presenting to an orthopedic hand clinic with right-hand weakness, tingling, and impaired grip strength. The medical history was notable for mild scoliosis and acute lymphoblastic leukemia in remission treated with chemotherapy. The patient denied headaches, neck pain, or balance dysfunction on initial presentation. Neurodiagnostic studies were consistent with C7 and C8 radiculopathies, and magnetic resonance imaging of the brain and entire spine revealed herniation of the cerebellar tonsils with expansive syrinx extending into the lower thoracic spine. After successful posterior fossa decompression, upper extremity strength and hand clawing improved, which was corroborated with postoperative imaging. The patient met his physical therapy goals 6 months after surgery. A thorough history and neurologic examination are essential for earlier detection of pediatric CM-I and a favorable prognosis, particularly in patients with an unclear neurologic cause.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251352008"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600172","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":"Matched Pair Analysis of Rotational Stability With 1 Versus 2-Screw Antegrade Fixation in Distal Metaphyseal Ulnar Shortening Osteotomy Constructs.","authors":"Joseph Cusano, Jacob M Johnson, Myles Dworkin, Patrick Morrissey, Jack C Casey, Lauren E Piana, Rachel M Schilkowsky, Janine Molino, Joseph A Gil","doi":"10.1177/15589447251348507","DOIUrl":"10.1177/15589447251348507","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to evaluate the rotational stability of 1-screw versus 2-screw antegrade fixation in distal metaphyseal ulnar shortening osteotomies (DMUSOs) using matched cadaveric forearm specimens. In addition, we aim to assess the mode of failure for each construct, specifically determining whether failure occurs due to hardware failure or peri-implant fractures.</p><p><strong>Methods: </strong>Sixteen fresh-frozen cadaveric forearm specimens, organized into 8 matched pairs, were used. Ulnas were harvested, transected at the midshaft, and all soft tissue attachments were removed. A 5-mm oblique shortening osteotomy was created in the distal metaphysis, proximal to the ulnar head. Fixation was performed using either a single Acutrak 2 Mini 3.5 mm screw or 2 Acutrak 2 Micro 2.5 mm screws. Under a constant 10 N axial compressive load, specimens were cyclically loaded at 5°/second, beginning at 0.25 N m, and increasing by 0.25 N m every 500 cycles. Testing continued until failure, defined as either 10° of rotational displacement or catastrophic structural failure.</p><p><strong>Results: </strong>The 2-screw construct exhibited significantly greater torque resistance compared with 1-screw fixation (0.84 N m [95% confidence interval, CI: 0.61-1.08] vs 0.63 N m [95% CI: 0.52-0.73], <i>P</i> = .016). In all instances, failure occurred due to rotational displacement exceeding 10°.</p><p><strong>Conclusions: </strong>In a matched cadaveric study examining DMUSO constructs, 2 smaller headless compression screws provided greater rotational stability than a single larger headless compression screw. The antegrade 2-screw fixation may allow for improved rotational stability across the DMUSO, allowing short-arm immobilization postoperatively, with earlier wrist pronosupination.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251348507"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600171","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 Transfers for Treatment of Upper Extremity Paralysis in Acute Flaccid Myelitis.","authors":"Aishu Ramamurthi, Milan R Patel, Morgan Lucero, Rachel Cohen-Shohet, Patrick Hettinger","doi":"10.1177/15589447251350169","DOIUrl":"10.1177/15589447251350169","url":null,"abstract":"<p><p>Acute flaccid myelitis (AFM) is a rare, debilitating neurological disease resulting in pure motor deficits in school-aged children. Unfortunately, 90% of patients do not experience complete spontaneous recovery, and medical therapy has not proven efficacious. Herein, we report the course of 2 patients with AFM who underwent upper extremity nerve transfers to treat persistent upper extremity paralysis after failing roughly 6.5 months of conservative treatment. Objective comparisons were made between preoperative and postoperative examinations using the Active Movement Scale and Mallet Classification. Patient 1 underwent transfers of spinal accessory to suprascapular nerve, medial pectoral to axillary nerve, flexor carpi radialis motor fascicle to motor fascicles of the biceps and brachialis musculocutaneous nerve, and anterior interosseous transfer to deep motor branch of the ulnar nerve. Patient 2 underwent transfers of the left spinal accessory to suprascapular nerve and motor nerve of the long head of the triceps to axillary nerve. Both patients experienced significant improvement in muscle strength and ability to complete activities of daily living, with near complete recovery of function. Nerve transfers in the upper extremity within 1 year of symptom onset appear to be beneficial for children with persistent weakness.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350169"},"PeriodicalIF":1.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575365","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":"Bilateral Kienböck Disease: Associations With Demographic, Systemic, and Radiologic Findings.","authors":"Andrew F Emanuels, Jess Rames, Mehmet Furkan Tunaboylu, Steven L Moran","doi":"10.1177/15589447251350174","DOIUrl":"10.1177/15589447251350174","url":null,"abstract":"<p><strong>Background: </strong>Kienböck disease most frequently affects 1 wrist and rarely occurs bilaterally. The purpose of this study is to describe the natural history and identify risk factors for development of bilateral Kienböck disease.</p><p><strong>Methods: </strong>After institutional review board approval, 350 patients with surgically managed Kienböck disease from 1976 to 2023 were identified. A retrospective review of the electronic medical record was used to collect demographic, clinical, and radiographic information. Two-tailed student <i>t</i>-test was used for continuous variable, and Fisher's exact test was used for categorical variables with analysis of power.</p><p><strong>Results: </strong>Ten of 350 patients (2.9%) had bilateral disease. The mean age was 45 (range: 14-62) years, and 6 out of 10 patients were female. The mean follow-up time was 47 (range: 9-274) months. Three of the 10 patients were laborers. Antecedent trauma (n = 2), prior corticosteroid injection (n = 1), and concomitant autoimmune disease (n = 1) were rare events. There was no difference in Lichtman Stage comparing the dominant and nondominant hands, and 72.2% of wrists were ulnar negative. This was higher but not significantly different than the unilateral affected comparison cohort (60%). Sufficient power was demonstrated (0.99). Eighteen of 20 wrists were treated operatively. Two cases required operative revision due to progression of disease.</p><p><strong>Conclusions: </strong>The cause of bilateral versus unilateral Kienböck disease remains unclear. Bilateral disease was not associated with a higher incidence of autoimmune disease, systemic corticosteroid use, or exposure to heavy manual labor. However, thrombosis leading to avascular necrosis of the lunate may be influenced by hypercoagulable and inflammatory diseases. Surgeons should maintain a high index of suspicion for bilateral disease in patients with these comorbidities. Routine screening of the contralateral wrist is unjustified if the patient is asymptomatic.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350174"},"PeriodicalIF":1.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583764","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":"Incidence of Posttraumatic Carpal Tunnel Syndrome After Perilunate Injuries.","authors":"Christopher M Dussik, Amy Phan, Jeffrey Coombs, Thomas Carroll, Matthew St John, Danielle Wilbur","doi":"10.1177/15589447251350170","DOIUrl":"10.1177/15589447251350170","url":null,"abstract":"<p><strong>Background: </strong>Perilunate injuries are a spectrum of high-energy carpus injuries with significant long-term sequelae and generally poor outcomes. Posttraumatic carpal tunnel syndrome (CTS) is an established sequela of these injuries, although its incidence varies widely in literature. This study aims to evaluate the risk of posttraumatic CTS after these injuries and contrast between nonoperative and operative perilunate injuries.</p><p><strong>Methods: </strong>The TriNetX database was queried for all patients treated for either closed or open management of a perilunate injury between January 1, 2010, and December 31, 2023. Operative and nonoperative injuries were defined by inclusion/exclusion of their corresponding Current Procedural Terminology (CPT) codes. Posttraumatic CTS was evaluated using International Classification of Diseases codes and carpal tunnel releases (CTRs) tracked using CPT codes. Relative risk and odds ratios were used to assess differences between nonoperative and operative cohorts.</p><p><strong>Results: </strong>A total of 5,167 perilunate injuries were included in this study. Of these, 2715 (52.5%) underwent nonoperative management, whereas 2,452 (47.5%) received surgical stabilization. Among patients treated nonoperatively, 93 (3.4%) were diagnosed with CTS within 1 year, with 98 (3.6%) requiring CTR. Among operative patients, 565 (23%) were diagnosed with CTS within 1 year of their injury, while 927 operative patients (37.8%) underwent CTRs. Conservatively managed perilunate injuries were at less risk for developing CTS or undergoing CTRs.</p><p><strong>Conclusions: </strong>Approximately 13% of perilunate injuries were associated with CTS within 1 year of treatment. Patients treated operatively were diagnosed with CTS approximately 7 times as frequently and underwent CTR more than 10 times more frequently than their nonoperative counterparts.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350170"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567377","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":"Evaluating Outcomes of Flexor Tendon Excision During Trigger Finger Release.","authors":"Joydeep Baidya, Olivia A Opara, Nicholas B Pohl, Harrison Patrizio, Sebastian Fras, Abbey Glover, Pedro K Beredjiklian, Daniel J Fletcher","doi":"10.1177/15589447251350167","DOIUrl":"10.1177/15589447251350167","url":null,"abstract":"<p><strong>Background: </strong>Patients with trigger finger who are refractory to nonsurgical treatments require trigger finger release (TFR) using A1 pulley release, while those with persistent triggering or severe proximal interphalangeal joint contracture may necessitate additional flexor tendon excision (FTE). This study characterizes the frequency of FTE performed at the time of primary TFR and compares outcomes between isolated TFR and TFR with additional FTE for trigger finger management.</p><p><strong>Methods: </strong>A total of 8551 patients who underwent TFR were retrospectively reviewed, among whom 218 (2.5%) required additional FTE. A 2:1 matched isolated TFR group was used for comparison. Patient demographics, complications, and outcomes were compared.</p><p><strong>Results: </strong>A total of 121 patients undergoing TFR with FTE were matched to 243 patients undergoing isolated TFR. The TFR with complete FTE group was youngest and predominantly male. The long finger was most commonly affected across all groups. Wide Awake Local Anesthesia No Tourniquet was the most frequently used type of anesthesia in isolated TFR procedures. While local anesthesia with sedation was more commonly used for TFR with FTE. The proportion of patients who received at least one preoperative steroid injection was highest in the isolated TFR group. All other demographic variables, complications, and patient-reported outcomes were comparable between groups.</p><p><strong>Conclusions: </strong>This study found high rates of postoperative improvement in TFR with FTE groups, as well as similar oral and steroid injections, complication rates, and Disabilities of the Arm, Shoulder, and Hand scores compared to the isolated TFR group. Therefore, TFR with FTE can be a safe and effective surgery with similar outcomes to isolated TFR and no additional risks in appropriately indicated patients.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350167"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567376","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":"Investigating the Impact of Health Insurance on the Treatment of Distal Radius Fractures in New York State.","authors":"Lawrence J Lin, Matthew L Duenes, David Merkow, Charles C Lin, Utkarsh Anil, Jadie De Tolla","doi":"10.1177/15589447251350166","DOIUrl":"10.1177/15589447251350166","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have demonstrated that socioeconomic factors can influence decisions regarding care. The purpose of this study is to evaluate the impact of insurance type on the treatment of distal radius fractures.</p><p><strong>Methods: </strong>This was a retrospective study of patients in the New York Statewide Planning and Research Cooperative System database undergoing treatment for distal radius fractures. We stratified patients by insurance type, including private, Medicare, Medicaid, Workers' Compensation, self-pay, or other coverage (disability insurance, government programs, no charge, no payment). Demographic information and comorbidities were identified, and multivariable regression analysis was used to control for potential confounders to determine factors associated with the likelihood of undergoing surgery.</p><p><strong>Results: </strong>A total of 37 053 patients with distal radius fractures were identified. And 5919 underwent operative intervention. The most common type of coverage was private insurance (40.9%), followed by Medicare (37.6%) and Medicaid (10.1%). Multivariable regression demonstrated a significantly lower rate of surgery in patients with Medicare (odds ratio [OR]: 0.80; 95% confidence interval [CI], 0.74-0.87; <i>P</i> < .001) and self-pay (OR: 0.45; 95% CI, 0.38-0.52; <i>P</i> < .001). There was a higher rate of surgery in patients with Workers' Compensation (OR: 1.21; 95% CI, 1.07-1.37; <i>P</i> = .002).</p><p><strong>Conclusions: </strong>We show that rates of surgery for distal radius fractures vary by insurance type. Patients with Workers' Compensation were more likely to undergo operative intervention for their injuries, while those with Medicare and self-pay were less likely to do so. In addition, there was no difference in surgical use among patients with commercial insurance or Medicaid.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"15589447251350166"},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553362","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":"Predictors of True Scaphoid Fractures in Children.","authors":"Daniel Milad, Aneesh Karir, Kevin Smit, Sasha Carsen, Kevin Cheung","doi":"10.1177/15589447241231311","DOIUrl":"10.1177/15589447241231311","url":null,"abstract":"<p><strong>Background: </strong>The scaphoid is the most commonly fractured carpal bone in children. True scaphoid fractures have proven to be difficult to diagnose, as they may not be apparent on initial imaging. Children with clinical suspicion of a scaphoid fracture may be treated with continued immobilization, even in the absence of radiographic evidence of a fracture. The purpose of this study is to identify predictors of true scaphoid fractures in children to help guide management.</p><p><strong>Methods: </strong>This study is a retrospective cohort study of children presenting to a tertiary pediatric hospital with hand or wrist injuries. Patients were grouped based on the presence of a true scaphoid fractures (confirmed on imaging) or those with clinical suspicion of a scaphoid fracture alone (no radiographic evidence of fracture). Demographic and clinical characteristics were compared with univariate and multivariate statistics to identify fracture predictors.</p><p><strong>Results: </strong>One hundred and thirty patients were included in the study: 57 in the true scaphoid fracture group and 73 in the clinical scaphoid fracture group. Patients with a true scaphoid fracture were older than those with a clinical scaphoid fracture (median age [interquartile range], 14.2 [13.0-15.4] vs 12.9 [11.9-14.4], <i>P</i> = .01). Men were more likely to sustain a true scaphoid fracture (65.0% vs 35.0%, <i>P</i> = .01). Older age and male sex were shown to be independent predictors of true scaphoid fractures (odds ratio [95% confidence interval], 1.25 [1.03-1.50] and 2.93 [1.39-6.17], respectively).</p><p><strong>Conclusions: </strong>In the pediatric population, older age and male children may be at increased risk of true scaphoid fractures. This may help guide decisions surrounding further imaging and treatment.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"706-710"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971697","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":"A Comparison of Outcomes in Acute Perilunate Injuries: Systematic Review and Meta-Analysis of Treatment Approaches.","authors":"Matthew V Abola, Brett A Gerber, Madeline C Rocks, Jeffrey S Chen, Jacques H Hacquebord, Ali Azad","doi":"10.1177/15589447241231291","DOIUrl":"10.1177/15589447241231291","url":null,"abstract":"<p><strong>Background: </strong>Perilunate dislocations (PLD) and fracture-dislocations (PLFD) comprise a spectrum of high-energy wrist injuries. The purpose of this review was to review operative strategies for perilunate injuries based on approach and compare outcomes.</p><p><strong>Methods: </strong>A systematic review of literature on PLD and fracture-dislocations was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and EMBASE databases were queried for literature. Inclusion criteria included English studies reporting clinical or functional outcomes of acute PLD and PLFD.</p><p><strong>Results: </strong>Twenty-nine full-text articles (604 PLD and PLFD injuries) were included. The most common method of PLD and PLFD fixation is through an open approach with combined volar and dorsal exposure. There were no differences between approaches with regard to total arc range of motion, grip strength, Mayo Wrist Score, or mean scapholunate angle. Similarly, there was no difference between approaches and postoperative radiographic arthritis or complications. Most patients were able to return to their prior level of function and work. The incidence of postoperative complications ranged from 0% to 22.5%.</p><p><strong>Conclusion: </strong>Current evidence shows no difference in postoperative total wrist arc range of motion, grip strength (as compared to contralateral), or Mayo Wrist Score with regard to surgical approach. The most common method of PLD and PLFD fixation in the literature is through an open approach with combined volar and dorsal exposure. There is a large difference in reported rates of radiographic arthritis, although this finding does not appear to correlate with postoperative pain or disability.</p><p><strong>Level of evidence: </strong>I, Systematic Review.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"725-732"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982813","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}