Journal of Hand Surgery Global Online最新文献

{"title":"Quantification of Articular Surface Involvement During Intramedullary Fixation of the Phalanges","authors":"Julie Mekhail MS,&nbsp;Rhiana Rivas BS,&nbsp;Carolyn A. Ardizzone MD,&nbsp;Jordan P. Pearce MD,&nbsp;Nikalus G. Skipp BS,&nbsp;Deana M. Mercer MD","doi":"10.1016/j.jhsg.2025.100928","DOIUrl":"10.1016/j.jhsg.2025.100928","url":null,"abstract":"<div><h3>Purpose</h3><div>Phalangeal fractures of the hand are the second most common upper-extremity fracture in the United States. Numerous studies have reported on the biomechanical efficacy of intramedullary (IM) hand nail fixation of the phalanges and increased utilization of IM hand nails. During IM fixation, the nail often penetrates the articular cartilage during insertion. This study seeks to quantify the percentage of cartilage involvement created by anterograde and retrograde intramedullary fixation of proximal and middle phalangeal fractures with 3.0 mm and 3.5 mm IM threaded hand nails.</div></div><div><h3>Methods</h3><div>Thirty-two frozen fingers were studied from eight cadaveric hands. Four different techniques for nail placement were used: (1) retrograde across an unflexed distal interphalangeal joint, (2) retrograde across a flexed distal interphalangeal joint into the middle phalanx, (3) retrograde through a flexed proximal interphalangeal joint into the proximal phalanx, and 4) antegrade through the metacarpal phalangeal joint into the proximal phalanx. Clinical photographs and fluoroscopy images were taken for each specimen, and the articular cartilage damage was quantified using Image J software.</div></div><div><h3>Results</h3><div>The average articular involvement using intramedullary hand nails for phalangeal fixation was less than 10% of the articular surface regardless of nail placement technique and nail size (mean range 3.56% to 9.73%). The damaged area was always greater with the 3.5 mm than the 3.0 mm nails.</div></div><div><h3>Conclusions</h3><div>Our results are consistent with the literature. Our study is unique in that we compare the different methods of hand nail insertion and the different diameter hand nails and evaluate the degree of articular surface involvement in an approach that has not been tested on cadaveric models. Phalanx fracture fixation with intramedullary hand nails may be beneficial, as it has acceptable joint cartilage damage based on our study data.</div></div><div><h3>Type of study/level of evidence</h3><div>Bench research/laboratory study V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100928"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Lunate Fracture Treated With Percutaneous Screw Fixation","authors":"Jordan T. Holler MD, MPH ,&nbsp;Timothy P. Liu MD ,&nbsp;Timothy A. Schaub MD","doi":"10.1016/j.jhsg.2025.100905","DOIUrl":"10.1016/j.jhsg.2025.100905","url":null,"abstract":"<div><div>Pediatric lunate fractures are exceedingly rare, with limited evidence to guide management. We present the case of a 12-year-old boy who sustained bilateral wrist injuries with a displaced right lunate fracture after an electric bicycle fall. The fracture was reduced and fixed percutaneously with a headless compression screw. At 8 months, radiographs confirmed union and the patient had full, pain free wrist motion without evidence of osteonecrosis or instability. We propose that percutaneous compression screw fixation is a reasonable option for achieving reliable union in older pediatric patients with a sufficiently ossified carpus.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100905"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Manifestation of Cosmetic Hand Rejuvenation With Calcium Hydroxyapatite","authors":"Alyssa Barré MD ,&nbsp;Ahmed Al-Bayati MD ,&nbsp;Chase Kluemper MD","doi":"10.1016/j.jhsg.2025.100902","DOIUrl":"10.1016/j.jhsg.2025.100902","url":null,"abstract":"<div><div>Hand rejuvenation procedures using dermal fillers are becoming increasingly popular as patients seek to restore dorsal hand volume and camouflage tendons and veins. Calcium hydroxyapatite is a commonly used filler that is inherently radiopaque and may produce imaging findings that mimic disease. We report the case of a 75-year-old woman who presented for follow-up of radiocarpal arthritis. Although her radiographs confirmed degenerative arthritis, they also demonstrated diffuse, clustered radiopaque foci in the dorsal soft tissues. These findings initially suggested metabolic or dystrophic calcification, but on further history, the patient disclosed recent cosmetic hand rejuvenation with calcium hydroxyapatite filler, establishing the true etiology. To our knowledge, the radiographic appearance of dermal filler in the hand has not been previously described. As the popularity of cosmetic hand rejuvenation continues to increase, both hand surgeons and radiologists should be aware of this phenomenon to prevent misdiagnosis and unnecessary diagnostic work-up.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100902"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity Score-Matched Comparison of Ultrasound-Guided Versus Open Carpal Tunnel Release: Three-Month Outcomes From the MISSION Registry","authors":"Victor M. Marwin MD, MBA ,&nbsp;Christopher J. Lincoski MD ,&nbsp;Johnny T. Nelson MD ,&nbsp;James F. Watt DO ,&nbsp;Amy T. Moeller MD ,&nbsp;Paul E. Perry MD ,&nbsp;Nicholas A. Bontempo MD ,&nbsp;Steven R. Niedermeier MD ,&nbsp;Larry E. Miller PhD, PStat ,&nbsp;Kyle J. Moyles MD, MBA","doi":"10.1016/j.jhsg.2025.100931","DOIUrl":"10.1016/j.jhsg.2025.100931","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of the study was to compare the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR) in real-world clinical settings.</div></div><div><h3>Methods</h3><div>Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0–10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching.</div></div><div><h3>Results</h3><div>A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: −0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: −0.16 points), and pain severity (group difference: −0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%).</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon’s judgment.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100931"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Dupuytren Contracture Recurrence After Surgery With Collagenase Clostridium Histolyticum: A Retrospective Multicenter Series","authors":"Clayton A. Peimer MD ,&nbsp;Marie A. Badalamente PhD ,&nbsp;Philip Blazar MD ,&nbsp;Keith A. Denkler MD ,&nbsp;William Dzwierzynski MD ,&nbsp;Mark Elzik MD ,&nbsp;F. Thomas D. Kaplan MD ,&nbsp;Jason A. Nydick DO ,&nbsp;Gary M. Pess MD ,&nbsp;James Verheyden MD ,&nbsp;Mark A. Vitale MD ,&nbsp;Jeffrey Andrews MS ,&nbsp;Qinfang Xiang PhD ,&nbsp;David Hurley MD ,&nbsp;Lawrence C. Hurst MD","doi":"10.1016/j.jhsg.2025.100919","DOIUrl":"10.1016/j.jhsg.2025.100919","url":null,"abstract":"<div><h3>Purpose</h3><div>Dupuytren contracture (DC) is a fibroproliferative disorder characterized by collagen deposition in the palmar fascia. Treatment options include collagenase clostridium histolyticum (CCH) injection and surgery; however, DC frequently recurs after primary therapy. We hypothesized that CCH treatment could be effective and well tolerated for the treatment of contracture recurrence for patients unwilling to undergo reoperation or at high risk for complications.</div></div><div><h3>Methods</h3><div>This Phase 4, multicenter, noninterventional, retrospective study analyzed medical records from 10 clinical centers in the US. Patients were treated with CCH for DC recurrence ≥6 months after previously successful surgical correction performed between January 1, 2010, and August 15, 2020. Primary end points were the measured joint contracture change from baseline, at first and last clinical evaluation within 12 months of CCH treatment of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. Secondary end points were “clinical success” (percentage of joints with reduction in contracture to 0° to 5°) and adverse events.</div></div><div><h3>Results</h3><div>Of 113 patients screened, 101 were analyzed (mean age, 64.1 years; 75% men). Median time to DC recurrence was 36.0 months. A total of 144 treated joints were analyzed (MP, <em>n</em> = 64; PIP, <em>n</em> = 75; unspecified, <em>n</em> = 5). Overall mean (SD) baseline contracture was 52° (21°) (MP, 43° [19°]; PIP, 61° [20°]). Mean (SD) improvement of contracture from baseline at last evaluation was 38° (21°) for all joints (MP, 36° [17°]; PIP, 41° [24°]), with 58% of joints having clinical success (MP, 75%; PIP, 43%). All skin tears (20 events in 19% of patients) resolved spontaneously, with 50% resolving in ≤21 days; there was one flexor profundus rupture that did not require secondary reconstruction.</div></div><div><h3>Conclusions</h3><div>This retrospective analysis indicates that CCH treatment is an effective and well tolerated nonsurgical option for recurrent postsurgical contracture, with results comparable to patients without prior surgery.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100919"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating Techniques to Reduce Flexor Tendon Rupture Risk During Manipulation for Dupuytren Contracture","authors":"Peter Y. Joo MD, MPH ,&nbsp;Xuan Luo MD","doi":"10.1016/j.jhsg.2025.100909","DOIUrl":"10.1016/j.jhsg.2025.100909","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to explore the strength required to extend the small finger using these techniques.</div></div><div><h3>Methods</h3><div>Healthy adult participants without current hand injury or pathology were tested for small finger manipulation strength using a calibrated scale as the flexed small finger proximal interphalangeal joint was brought into extension with resistance. Both wrist flexion and quadriga effect were tested first, then quadriga effect alone, then wrist flexion, then without restrictions. This was to prevent fatigue as a confounding factor (weakest to strongest). Measurements were obtained for bilateral small fingers. The means of each of the categories were then compared using analysis of variance.</div></div><div><h3>Results</h3><div>A total of eight participants (16 hands), seven right-handed and one left-handed, were included. Five women and three men were included, with an average age of 28. The force required to fully extend the small finger using both wrist flexion and quadriga effect was 2.5 kg. The force to extend the small finger with quadriga alone was 2.8 kg, wrist flexion alone was 3.0 kg, and baseline without any restrictions was 3.2 kg. The combined intervention required significantly less force to fully extend the small finger compared to other methods (<em>P</em> &lt; .001). Quadriga alone was also noted to require significantly less force to extend the small finger compared to baseline (6.1 vs 7.1, <em>P</em> = .048).</div></div><div><h3>Conclusions</h3><div>Collagenase clostridium histolyticum injection and manipulation for treatment of Dupuytren contracture has a small risk of flexor tendon rupture. While wrist flexion is described in the technique guide, using the quadriga effect to lessen the force needed to extend the small finger has not been explored. This study found that combining wrist flexion and remaining finger extension during manipulation decreases the force required to extend the small finger, suggesting a decrease in stress seen by the flexor tendons during manipulation.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100909"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Osteomyelitis of the Distal Forearm and Wrist With Function-Preserving Debridement","authors":"Timothy P. Liu MD ,&nbsp;Nirbhay S. Jain MD ,&nbsp;Katherine Choi MD ,&nbsp;Prosper Benhaim MD ,&nbsp;Kodi K. Azari MD ,&nbsp;Arezou Yaghoubian MD","doi":"10.1016/j.jhsg.2025.100908","DOIUrl":"10.1016/j.jhsg.2025.100908","url":null,"abstract":"<div><h3>Purpose</h3><div>Osteomyelitis of the wrist and distal forearm is rare but functionally devastating because of the extensive debridement needed for infection control and reconstructive surgery needed to regain function. Management guidelines and outcomes are poorly defined and often default to amputation as a last resort strategy for infection control. In this study, we present a series of wrist and distal forearm osteomyelitis patients managed with antibiotics and debridement, with minimal reconstruction in select cases, to help guide decisions on management and prognosis.</div></div><div><h3>Methods</h3><div>Patients over the age of 18 years diagnosed with wrist and/or distal forearm osteomyelitis were identified at a single institution between the years 2013 and 2023. A retrospective review was performed to identify demographics, infection characteristics, treatment strategies, and outcomes. Statistical analysis was performed via GraphPad.</div></div><div><h3>Results</h3><div>Eleven cases of distal forearm and wrist osteomyelitis were identified. Of those, 55% had primarily distal forearm osteomyelitis of the radius and ulna, and 45% had carpal or metacarpal involvement. Most patients had postoperative infection of hardware. All but one patient required surgical debridement with hardware removal and five patients required serial debridements. No patients required amputation. Antibiotic spacers were rarely used. Patients reported residual pain and stiffness in the wrist, and salvage procedures included wrist arthrodesis and tendon transfers.</div></div><div><h3>Conclusions</h3><div>Osteomyelitis of the distal forearm and carpus in this cohort is most commonly because of postoperative infection from contaminated hardware. These patients require aggressive debridement for infection control including frequent bony resection with salvage via arthrodesis, but amputation can often be avoided.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100908"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Intramedullary Reduction of Impacted Fractures at the Base of the Middle Phalanx: Surgical Technique","authors":"J. Terrence Jose Jerome MBBS, DNB","doi":"10.1016/j.jhsg.2025.100904","DOIUrl":"10.1016/j.jhsg.2025.100904","url":null,"abstract":"<div><div>Impacted fractures of the base of the middle phalanx frequently lead to joint incongruity and functional impairment. Although percutaneous intramedullary elevation of depressed articular fragments has been described previously, PRIME (Percutaneous—Pin, Reduce, Internal Fixation, Mobilize Early) represents a technical refinement that emphasizes true closed intramedullary disimpaction under local anesthesia, fully subcutaneous short-cut K-wire fixation, and a protocol of immediate active postoperative proximal interphalangeal (PIP) motion. It was applied in six consecutive patients with acute impacted base of the middle phalanx fractures involving the PIP joint. At final follow-up, patients demonstrated average PIP flexion of 90°, a mean visual analog scale pain score of 0.5, and a Disability of the Arm, Shoulder and Hand score of 1.3. Radiographs confirmed maintained reduction and union in all cases, with no major complications. The PRIME technique may provide a reproducible, minimally invasive method for restoring joint congruity and promoting early motion while reducing the risk of stiffness and soft tissue trauma. By integrating stable fixation and immediate rehabilitation, PRIME facilitates rapid recovery and excellent functional outcomes with minimal postoperative discomfort.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100904"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Gaps and Future Directions in Brachial Plexus, Upper-Extremity and Lower-Extremity Nerve Injuries (Nerve SPACE 2025)","authors":"Ethan Blum MEng ,&nbsp;David J. Wright MD ,&nbsp;Yusha Katie Liu MD, PhD ,&nbsp;Christopher J. Dy MD, MPH.","doi":"10.1016/j.jhsg.2025.100935","DOIUrl":"10.1016/j.jhsg.2025.100935","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of peripheral nerve injury remains one of the most challenging aspects of reconstructive surgery. Functional outcomes remain inconsistent, high-quality evidence is limited, and major knowledge gaps persist.</div></div><div><h3>Where are we now?</h3><div>When evaluating patients for peripheral nerve injury, the treating physician must ascertain several critical factors to help inform decision-making, including the timing, mechanism, localization, and severity of the injury. Current algorithms rely on history, physical examination, electrodiagnostic studies, imaging, and occasionally operative exploration to establish a diagnosis. The surgeon must decide if the injury will recover spontaneously or if further operative intervention is indicated to achieve the best possible functional outcome. Accurate prognostication remains challenging secondary to the difficulty grouping patients into homogenous cohorts based on patient and injury characteristics, as well as heterogenous outcome measures. Intraoperatively, determining both the severity and zone of injury remains challenging. Surgical treatment strategies include neurolysis, primary repair, nerve grafting, nerve transfer, or tendon transfers. Functional outcomes assessment is currently performed using Medical Research Council muscle grading, range of motion measures, and various sensory measures, which remain subjective with inconsistent intraobserver and interobserver reliability. Nerve-specific patient reported outcomes measures remain limited.</div></div><div><h3>Where do we need to go?</h3><div>Diagnostic improvements are needed to more quickly and accurately define injury severity and determine which patients will benefit from surgical intervention. Intraoperatively, accurate determination of both the zone of injury and the functional status of the proximal nerve is also needed. Reproducible outcome measures that can be easily adopted across multiple institutions are needed to facilitate high-quality evidence that can help guide treatment decisions.</div></div><div><h3>How do we get there?</h3><div>Multicenter collaborative efforts are needed to focus clinical research priorities using reproducible diagnostic criteria to accurately define injury severity, establish consistency in surgical techniques and treatment algorithms, and accurately and reproducibly measure outcomes. Further translational efforts in imaging, biomaterials, and basic science research are also needed. By aligning research priorities with patient-centered outcomes, the field can begin to close the gap between surgical innovation and functional recovery.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100935"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Plate Versus Intramedullary Screw Fixation for Extra-Articular Metacarpal Base Fractures","authors":"Majd Mzeihem MD ,&nbsp;Dmitriy Peresada MD ,&nbsp;Yeseop Park PhD ,&nbsp;Jiries A. Fakhouri BS ,&nbsp;Danil Rybalko MD ,&nbsp;Mark H. Gonzalez MD, PhD ,&nbsp;Farid Amirouche PhD","doi":"10.1016/j.jhsg.2025.100897","DOIUrl":"10.1016/j.jhsg.2025.100897","url":null,"abstract":"<div><h3>Purpose</h3><div>Intramedullary (IM) screws are commonly used for metacarpal shaft and neck fractures, but their application in extra-articular metacarpal base fractures has not been thoroughly evaluated. This study aims to compare the biomechanical performance (load to failure) of IM screw fixation versus dorsal plate fixation for extra-articular fractures at the base of the metacarpal.</div></div><div><h3>Methods</h3><div>Twenty-four cadaveric metacarpals from 12 upper extremities were prepared and randomized to receive either IM screw fixation or dorsal plate fixation following a standardized transverse fracture near the base. All specimens were potted and tested using cantilever bending in a materials testing system. The primary outcome was ultimate load to failure; stiffness was evaluated as a secondary measure.</div></div><div><h3>Results</h3><div>Dorsal plate fixation demonstrated greater load to failure compared to IM screw fixation when all specimens were analyzed collectively. Subgroup analysis indicated this difference was more pronounced in the thumb metacarpals. In contrast, IM screw constructs consistently exhibited greater stiffness across all specimens, including both thumb and small finger metacarpals.</div></div><div><h3>Conclusions</h3><div>Dorsal plating offered greater resistance to fracture displacement, while IM screw fixation provided superior construct stiffness. Both fixation methods surpassed expected physiologic loading during hand use, indicating that either approach may be biomechanically acceptable depending on the clinical context.</div></div><div><h3>Clinical relevance</h3><div>The IM screws may serve as a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures. These findings may help guide surgical decision-making regarding fixation selection and promote individualized treatment strategies.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100897"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}