Journal of Hand Surgery Global Online最新文献

{"title":"Perioperative Treatment of Neuropathic Pain (Nerve SPACE 2025)","authors":"Adam Mosa MD, MSc ,&nbsp;Neill Y. Li MD ,&nbsp;Alexander Chamessian MD, PhD ,&nbsp;Lara W. Crock MD, PhD ,&nbsp;Catherine M. Curtin MD ,&nbsp;Allan Belzberg MD ,&nbsp;Sarah Buday PhD ,&nbsp;Bryan J. Loeffler MD ,&nbsp;Christopher Janney ,&nbsp;Mark A. Mahan MD ,&nbsp;Amy M. Moore MD","doi":"10.1016/j.jhsg.2025.100936","DOIUrl":"10.1016/j.jhsg.2025.100936","url":null,"abstract":"<div><div>Neuropathic pain following brachial plexus and peripheral nerve injury represents one of the most debilitating and least effectively treated sequelae of nerve trauma.</div></div><div><h3>Where are we now?</h3><div>Neuropathic pain affects a majority of patients with severe nerve injuries and is frequently more disabling than associated motor or sensory deficits. The current scientific understanding implicates maladaptive peripheral and central nervous system changes, including neuroma formation, nociceptor hyperexcitability, central sensitization, and cortical reorganization. Contemporary management relies on multimodal strategies incorporating rehabilitation, pharmacotherapy, psychological support, neuromodulation, and select surgical interventions; however, most patients experience only partial or temporary relief, underscoring the persistent gap between mechanistic insight and durable clinical benefit.</div></div><div><h3>Where do we need to go?</h3><div>There remains a critical need for more effective, durable, and patient-centered approaches to neuropathic pain. Improved stratification tools, including biologic, imaging, and electrophysiologic biomarkers, are required to guide personalized treatment selection. Existing preclinical models inadequately capture the psychosocial and functional dimensions of pain, limiting translational relevance. Future therapies must better integrate biological, technological, and psychosocial domains while prioritizing pain relief as an outcome equal in importance to motor and sensory recovery.</div></div><div><h3>How do we get there?</h3><div>Progress will depend on multidisciplinary collaboration that aligns surgical innovation, targeted pharmacologic therapies, neuromodulation technologies, and structured psychological support. One target for growth in the field will be establishing multicenter registries and consensus-built outcome measures, which will be essential to evaluate real-world effectiveness and inform best practices. Continued refinement of biologically rational surgical strategies, emerging neuromodulation platforms, and integrative rehabilitation tools offer a pathway toward care models that address both pain and function. Meaningful improvements in quality of life for patients with nerve injury–related neuropathic pain may be achieved.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100936"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077553","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":"Intramedullary Threaded Nail Versus Dorsal Plate and Screw Fixation of Comminuted Metacarpal Shaft Fractures: A Cadaveric Biomechanical Study","authors":"Andrew D. Allen MD ,&nbsp;Alexander D. Jeffs MD ,&nbsp;Yukun Zhang PhD ,&nbsp;Stephen M. Himmelberg MD ,&nbsp;Zohair S. Zaidi MD ,&nbsp;Nathaniel C. Adams BA ,&nbsp;Bradley J. Lauck BA ,&nbsp;Matthew Fisher PhD ,&nbsp;J. Megan M. Patterson MD ,&nbsp;Reid W. Draeger MD","doi":"10.1016/j.jhsg.2025.100925","DOIUrl":"10.1016/j.jhsg.2025.100925","url":null,"abstract":"<div><h3>Purpose</h3><div>Indications are expanding for the use of intramedullary threaded nail (IMTN) fixation in metacarpal fractures. We hypothesized that IMTN fixation would have superior bending stiffness compared to dorsal plate and screw fixation and provide sufficient stability to withstand cyclic loading comparable with early range of motion.</div></div><div><h3>Methods</h3><div>Index, long, ring, and small finger metacarpals were harvested from matched pair cadaveric hands. A midshaft 1.75 mm transverse gap was created to simulate a comminuted fracture. Specimens were randomized into two groups for fixation with either a retrograde IMTN or dorsal plate and screws. Specimens underwent three-point bend testing with an Instron. Each specimen was cyclically loaded at 70 N for 2,000 cycles (composite grasp), followed by 120 N for 2,000 cycles (tip pinch). Specimens were then loaded to failure. Outcomes included cycles to failure, bending stiffness, peak load to failure, and location of failure.</div></div><div><h3>Results</h3><div>Bending stiffness was significantly greater in the IMTN group compared to the plate group (136.71 ± 24.19 N/mm vs 39.89 ± 14.08 N/mm). Peak load to failure was greater in the plate group, but this difference was not statistically significant (365.33 ± 79.85 N vs 598.11 ± 372.76 N). During the cyclic loading phases, all specimens in the IMTN group completed the 70 N and 120 N loading phases without failure. In the plate group, two of nine specimens progressed to catastrophic failure during the 120 N cyclic loading phase.</div></div><div><h3>Conclusions</h3><div>In a comminuted metacarpal shaft fracture model, IMTN fixation had significantly greater bending stiffness and more consistent load to failure characteristics compared to dorsal plate and screw fixation.</div></div><div><h3>Clinical relevance</h3><div>IMTN fixation provided sufficient stability in comminuted metacarpal shaft fractures to withstand cyclic forces consistent with early range of motion, whereas dorsal plate and screw fixation demonstrated more variable results.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100925"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977648","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":"Perineural Lipoma of the Ulnar Nerve Within the Cubital Tunnel: A Brief Review of the Literature","authors":"J.J.E. Delahaije MSc ,&nbsp;J. van Boxtel MSc ,&nbsp;S.F.A. Raupp MSc ,&nbsp;E.L.W.G. van Haren MSc","doi":"10.1016/j.jhsg.2025.100889","DOIUrl":"10.1016/j.jhsg.2025.100889","url":null,"abstract":"<div><div>This study presents a case of a patient with a 6-month history of progressively worsening paresthesia, numbness, weakness, and shooting pain in the ulnar nerve distribution of the left hand. Ultrasound measurements showed an enlarged cross-sectional area of the ulnar nerve, confirming the diagnosis, and an isoechogenic and homogenous mass alongside the ulnar nerve. An open cubital tunnel release was performed for ulnar nerve decompression. Intraoperatively, a perineural lipoma was identified within the cubital tunnel and subsequently confirmed by histopathological analysis. Soft tissue lipomas rarely cause symptomatic compressive neuropathy. Although other space-occupying lesions within the cubital tunnel are well-documented in the literature, a perineural lipoma causing extrinsic ulnar nerve compression has not been previously reported. After surgery, shooting pain resolved, sensation normalized in digits four and five, and hand strength gradually improved. Therefore, we report the first case of a perineural lipoma extrinsically causing ulnar nerve compression in the cubital tunnel.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100889"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022673","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":"The Dorsal Scapholunate Ligament Complex: Anatomical Description and Correlation with Lunate Morphology","authors":"Sandro Castro Adeodato MD, MSc ,&nbsp;Nathalia Sundin Palmeira de Oliveira MD, PhD ,&nbsp;André Luiz de Campos Pessoa MD, PhD ,&nbsp;Moyses Messias Souza de Sant’Anna MSc, PhD ,&nbsp;Bernardo Couto Neto MSc, PhD ,&nbsp;Liszt Palmeira de Oliveira MSc, PhD","doi":"10.1016/j.jhsg.2025.100921","DOIUrl":"10.1016/j.jhsg.2025.100921","url":null,"abstract":"<div><h3>Purpose</h3><div>This anatomical study aimed to describe, quantify, and topographically correlate the insertions of the dorsal scapholunate complex (DSLC) components, specifically the dorsal scapholunate interosseous ligament (dSLIL), dorsal radiocarpal (DRC), dorsal intercarpal (DIC), and dorsal capsuloligamentous scapholunate septum (DCSS), with each other and in relation to lunate morphology (types I and II).</div></div><div><h3>Methods</h3><div>Twenty-seven cadaveric wrists (23 formalin fixed and 4 fresh frozen) were systematically dissected. Measurements of width and thickness for dSLIL, DRC, DIC, and DCSS insertions were performed using a 0.05-mm precision caliper. Lunate morphology was classified (Viegas type I or II). Statistical analysis included descriptive statistics, independent samples <em>t</em> tests or Mann-Whitney U tests for intergroup comparisons, and paired-sample tests for dSLIL insertion site differences.</div></div><div><h3>Results</h3><div>DRC width at the lunate insertion was significantly greater in type II lunates compared to type I (<em>P</em> &lt; .001, Cohen’s d = –1.647). No other DSLC component measurements differed significantly between lunate types. The dSLIL showed no notably difference in dimensions between its scaphoid and lunate insertions. Topographically, the scaphoid apex was identified as a consistent insertion site for dSLIL and DIC, with the DCSS located anterior and slightly ulnar to it.</div></div><div><h3>Conclusions</h3><div>This study provides a detailed morphological characterization of the DSLC components and their topographical relationships. Key findings include a more robust DRC at the lunate insertion in type II lunates and consistent insertion patterns of dSLIL and DIC at the scaphoid apex.</div></div><div><h3>Clinical relevance</h3><div>The observed robustness of the DRC in type II lunates suggests a potential protective effect against dorsal intercalated segment instability collapse. The precise anatomical data regarding DSLC component insertions offer crucial guidance for improving arthroscopic diagnostic accuracy and refining surgical reconstruction techniques for scapholunate instability.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100921"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977647","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":"Impact on Families of Upper Extremity Surgical Treatment for Children with Cerebral Palsy","authors":"Sarah Romans MD ,&nbsp;Adam Mosa MD ,&nbsp;Lindley B. Wall MD, MSc","doi":"10.1016/j.jhsg.2025.100943","DOIUrl":"10.1016/j.jhsg.2025.100943","url":null,"abstract":"<div><h3>Purpose</h3><div>Upper-extremity surgery for children with cerebral palsy (CP) aims to address spasticity, improve function, and enhance quality of life. Although previous research has focused on functional outcomes, limited data exist regarding the broader impact of these surgeries on families. This study examines the psychosocial, functional, and familial impacts of upper-extremity surgery in CP patients, which in turn would to inform preoperative education and postoperative support strategies.</div></div><div><h3>Methods</h3><div>Parents/guardians of children with CP who underwent upper-extremity surgery at least 6 months prior were recruited. Participants completed the validated Impact on Family Scale survey and participated in semistructured interviews exploring family experiences. Thematic analysis of interview transcripts was performed, with intercoder reliability achieved through independent coding. Survey data were analyzed to identify common family impacts.</div></div><div><h3>Results</h3><div>Thirteen interviews were conducted (11 parents, two patients). Thematic analysis identified six overarching themes: (1) functional and mobility improvements, including range of motion; (2) independence in activities of daily living; (3) positive cosmetic impacts; (4) patient psychosocial outcomes, such as increased confidence and social engagement; (5) family-level psychosocial outcomes, including stress during recovery and the importance of external family support systems; and (6) interactions with the care team. Impact on Family Scale survey results had a mean score of 55.1 and revealed that psychosocial and financial burdens varied, with the highest agreement for statements emphasizing normalization of the child’s condition.</div></div><div><h3>Conclusions</h3><div>Upper-extremity surgery for CP has profound physical and psychosocial impacts on both patients and their families. Improvements in functional independence, confidence, and aesthetics were commonly observed; however, emotional challenges during recovery were notable. The findings underscore the importance of setting realistic expectations, providing robust preoperative education, and ensuring access to psychosocial support systems. Future studies should investigate longitudinal outcomes and interventions to better support families during the surgical journey.</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 100943"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077552","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":"Personality and Perception: A Qualitative Investigation of Factors That Shape Mentorship Satisfaction Among Hand Surgery Fellows","authors":"Colby Newson MD ,&nbsp;Steven Kozusko MD ,&nbsp;Ava Chappell MD ,&nbsp;Kacy J. Peek MD ,&nbsp;A. Bobby Chhabra MD ,&nbsp;Brent R. DeGeorge Jr. MD, PhD","doi":"10.1016/j.jhsg.2025.100922","DOIUrl":"10.1016/j.jhsg.2025.100922","url":null,"abstract":"<div><h3>Purpose</h3><div>Mentorship is critical to the professional and personal development of surgical trainees, influencing clinical competence and career advancement. Although mentorship during residency has been widely studied, little is known about mentorship experiences during hand surgery fellowship, a brief and high stakes training period requiring rapid relationship formation. This study explored mentorship experiences and satisfaction among hand surgery fellows and to assess how personality traits, demographics, and program factors influence mentorship quality.</div></div><div><h3>Methods</h3><div>A mixed-methods study was conducted across 10 US hand surgery fellowship programs with Institutional Review Board approval. Participants completed an online questionnaire assessing demographics, fellowship characteristics, mentorship satisfaction, and personality traits. Semistructured interviews were conducted, transcribed, and analyzed using inductive content analysis to identify common themes. Quantitative data were analyzed using descriptive statistics, Pearson correlations, and analysis of variance with significance set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>A total of 10 fellows from 10 programs participated. Fellows valued personal mentor attributes (eg, altruism, honesty, patience) over relational and professional qualities and rated shared demographics as least important. Mentorship satisfaction showed nonsignificant trends: higher satisfaction among fellows who rated themselves as more emotionally stable and lower satisfaction among those scoring higher in openness to experience. Program structure showed similar trends, with greater satisfaction reported by fellows with more mentors and fewer cofellows. Qualitative analysis identified seven themes: (1) ideal mentor qualities, (2) organic relationship building, (3) mutual investment and communication, (4) diverse mentor expertise, (5) demographics and representation, (6) sponsorship beyond mentorship, and (7) dealing with time and other challenges.</div></div><div><h3>Conclusions</h3><div>Hand surgery fellows reported overall positive mentorship experiences and emphasized personal qualities over demographic similarity. Although quantitative associations were limited by sample size, trends suggest that personality traits and program structure may influence mentorship satisfaction. Recognizing these dynamics may help fellowship directors identify trainees at risk for poor mentorship alignment and implement early, targeted support within the 1-year fellowship’s limited timeframe.</div></div><div><h3>Type of study/level of evidence</h3><div>Differential diagnosis/symptom prevalence study IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100922"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023227","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":"Reduced Pain and Edema Following Delayed Therapy for Flexor Tenolysis","authors":"Sarah Mart MS, OTR ,&nbsp;Nancy M. Cannon OTR ,&nbsp;Danielle Sparks DHS, OTR ,&nbsp;Courtney D. Jensen PhD","doi":"10.1016/j.jhsg.2025.100895","DOIUrl":"10.1016/j.jhsg.2025.100895","url":null,"abstract":"<div><h3>Purpose</h3><div>Traditionally, therapy has been initiated 1 day after surgery following flexor tenolysis to prevent the development of early adhesions. Pain and edema are limiting factors in the initial days after surgery and can interfere with the opportunity to effectively initiate a home therapy program. The purpose of this study was to demonstrate the safety and effectiveness of delaying the initiation of therapy to 3 days post-op following flexor tenolysis.</div></div><div><h3>Methods</h3><div>10 patients undergoing flexor tenolysis initiated therapy at 3 days post-op. Pain, edema, and range of motion were measured at baseline, day 3 post-op, day 12 ± 2, and weeks 3, 4, 8, and 12. Functional limitations and level of anxiety were assessed at the initial post-op visit, as well as week 4 and week 12.</div></div><div><h3>Results</h3><div>Most range of motion improvements occurred in the first 2–3 weeks. Mean total active motion of the interphalangeal joints increased from 64.0° ± 24.9° at baseline to 142.5° ± 24.6° at 3 weeks post-op. Differences in interphalangeal joint total active motion were significant between baseline and 3 weeks, and these improvements were maintained through the 8-week follow-up visit. At 8 weeks post-op, five patients had excellent results, three had good, and two had fair, according to the Original Strickland Classification system.</div></div><div><h3>Conclusions</h3><div>Early and effective management of pain and edema is critical to ensuring a positive outcome. Patients with less initial postoperative edema had better range of motion at 3 weeks post-op. Results were maintained through 8 weeks, and the patients required fewer therapy visits. Delaying the initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results and is safe for clinical practice.</div></div><div><h3>Clinical relevance</h3><div>This case series demonstrates that delaying initiation of therapy to 3 days post-op following flexor tenolysis can yield favorable results. Delaying therapy can mitigate the ill effects of surgery and allow reduction of pain and edema for improved range of motion and overall outcome.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100895"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739081","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":"Challenges in Clinical Research for Nerve Injuries (Nerve SPACE 2025)","authors":"Eliana B. Saltzman MD ,&nbsp;Daniel Y. Hong MD ,&nbsp;Roger Cornwall MD ,&nbsp;Heather L. Baltzer MD, MSc ,&nbsp;Thomas J. Wilson MD ,&nbsp;Jenny M. Dorich PhD, CHT ,&nbsp;Caroline Miller ,&nbsp;Avi M. Giladi MD, MS ,&nbsp;Paige M. Fox MD, PhD","doi":"10.1016/j.jhsg.2025.100939","DOIUrl":"10.1016/j.jhsg.2025.100939","url":null,"abstract":"<div><div>Because of the relative infancy of peripheral nerve injury research, there is a lack of standardization of nomenclature and language. The lack of consistency among researchers and publications leads to difficulties assessing outcomes and comparing across patients, surgeons, and interventions.</div></div><div><h3>Where Are We Now?</h3><div>Current efforts in nerve research are focused on determining appropriate-study outcomes and the validation of these for both physicians and patients to reflect the goals of care. Siloed efforts across multiple institutions and specialties limit progress.</div></div><div><h3>Where Do We Need to Go?</h3><div>Future efforts in peripheral nerve injury clinical research should focus on aligning multiple core outcome sets in a reproducible fashion across similar conditions while integrating the patient experience. As outcomes are being implemented, there is a need to measure them accurately using group consensus and technology to limit bias.</div></div><div><h3>How Do We Get There?</h3><div>Collaboration between experts through individual surgeons and societal efforts to align on a minimal core set of outcomes is paramount. Integration into the electronic medical record will increase the feasibility of surgeons to use these outcomes as both research and clinical tools.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100939"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022675","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":"Comment on “Outcomes of Thumb Metacarpophalangeal Joint Arthrodesis Using the XMCP Intramedullary Interlocking Device”","authors":"Shyam Sundar Sah MD ,&nbsp;Abhishek Kumbhalwar PhD","doi":"10.1016/j.jhsg.2025.100900","DOIUrl":"10.1016/j.jhsg.2025.100900","url":null,"abstract":"","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100900"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841033","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":"Distal Radius Fracture Classifications in Real Life: Reliability and How They Change Treatment","authors":"Sang Anh Nguyen MD, MSc ,&nbsp;Anh Hoang Dang MD, PhD ,&nbsp;Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100910","DOIUrl":"10.1016/j.jhsg.2025.100910","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the reliability, clinical utility, and prognostic value of distal radius fracture (DRF) classification systems and to translate current evidence into a decision-oriented framework for everyday care.</div></div><div><h3>Methods</h3><div>We conducted a PRISMA-guided narrative review with structured searches of PubMed and Scopus (January 2010 to September 2025). Eligible adult studies assessed at least one DRF classification (eg, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, Fernandez, Frykman, Melone, IDEAL) and reported reliability, clinical utility (treatment selection, complications/reoperation), or prognostic associations (patient-reported outcome measures, radiographic restoration). Study selection, extraction, and risk of bias assessment followed predefined procedures; data were synthesized thematically by imaging modality, rater expertise, and category granularity.</div></div><div><h3>Results</h3><div>Interobserver agreement was typically fair–moderate on radiographs; computed tomography yielded modest improvements. Increasing granularity (more categories/subcategories) consistently reduced κ/intraclass correlation coefficient, while a brief rater calibration session improved agreement. Across studies linking taxonomy to care, classification alone rarely changed management once radiographic thresholds of instability (shortening, tilt, intra-articular step-off) and patient factors (age/bone quality, functional demand) were applied. Prognostic associations between subtype and patient-reported outcome measures were inconsistent after adjustment for reduction quality. We operationalize these findings via reliability, morphology, age of bone, patient demands, yielding actionable pathways with explicit quality targets: restoration of radial height and tilt, intra-articular step-off ≤2 mm, and early motion.</div></div><div><h3>Conclusions</h3><div>The DRF classifications remain valuable as a shared language and research scaffold, but their stand-alone reliability and prognostic power are limited. A pragmatic, reliability, morphology, age of bone, patient demands, yielding actionable pathway-based approach integrates classification with instability thresholds and patient factors to support auditable, evidence-based decisions.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100910"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841031","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}