Journal of Hand Surgery Global Online最新文献

{"title":"Dynamic Tenodesis Technique for Ulnar Drift With Extensor Tendon Subluxation due to Rheumatoid Arthritis","authors":"Ryo Oda MD, PhD ,&nbsp;Naoki Okubo MD, PhD ,&nbsp;Shogo Toyama MD, PhD ,&nbsp;Shinji Tsuchida MD, PhD ,&nbsp;Kenji Takahashi MD, PhD","doi":"10.1016/j.jhsg.2025.100808","DOIUrl":"10.1016/j.jhsg.2025.100808","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the outcomes of an original functional reconstruction procedure for ulnar drift (UD) with extensor tendon subluxation due to rheumatoid arthritis.</div></div><div><h3>Methods</h3><div>From 2018 to 2022, reconstruction was performed in 10 patients (31 fingers), with UD due to rheumatoid arthritis and a minimum of 2-year follow-up. The mean age was 57 years, and the mean follow-up period was 4.5 years. Ulnar drift was assessed using the Fearnley classification and included 17 stage 1 cases and 14 stage 2 fingers. A half-slip tendon was created just above the metacarpal head. An anchor was driven into the center of rotation of the metacarpophalangeal (MCP) joint on the radial side of the metacarpal bone, and the half-slip tendon was sutured and fixed. If limitations were observed in the flexion of the MCP joint, the extensor tendon was step-cut, and the half-slip tendon was fixed via an interlacing suture to the step-cut distal extensor tendon. We investigated the patient’s background and range of motion. The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire of patient-reported outcome measures were scored as functional outcomes.</div></div><div><h3>Results</h3><div>At a mean of 54 months after the operation, the average extension in the MCP joint improved from −12° (range: −80° to 28°) before surgery to 1.5° (range: −40° to 20°) at the final follow-up (<em>P</em> &lt; .05), whereas the average flexion had no remarkable change. The average active arc of motion of the operated MCP joint was significantly increased to 95° (range: 60°–120°) compared with 82° (range: 34°–118°) before surgery (<em>P</em> &lt; .05). The Disabilities of the Arm, Shoulder, and Hand questionnaire and the Michigan Hand Outcomes Questionnaire scores improved significantly. No recurrence of UD, such as a decreased Fearnley stage, was documented.</div></div><div><h3>Conclusions</h3><div>We present good results with no recurrence using a dynamic tenodesis technique as a functional reconstruction for UD with finger extensor tendon subluxation caused by rheumatoid arthritis, with a particular focus on joint preservation via soft tissue reconstruction.</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":"7 6","pages":"Article 100808"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842915","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":"Associations of Preoperative Ultrasonography, Nerve Conduction Studies, and CTS-6 to Boston Carpal Tunnel Questionnaires Up to One Year Following Carpal Tunnel Release","authors":"Jenna L. Dvorsky MS ,&nbsp;Ryan T. Lin BS ,&nbsp;Shaquille Charles MD, MSc ,&nbsp;Madalyn Kostyal MD ,&nbsp;Hannah Ong BS ,&nbsp;John Fowler MD","doi":"10.1016/j.jhsg.2025.100767","DOIUrl":"10.1016/j.jhsg.2025.100767","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the association between preoperative ultrasound, nerve conduction studies (NCS), and/or carpal tunnel syndrome-6 (CTS-6) scores and the postoperative courses of patients undergoing carpal tunnel release (CTR).</div></div><div><h3>Methods</h3><div>This was a retrospective study of all patients indicated for CTR at a single institution between October 2014 and August 2021. Preoperative data, including age, sex, body mass index, and laterality of the involved hand(s), were collected. Ultrasound was performed with a median nerve cross-sectional area (CSA) of ≥10 mm² considered positive for CTS. Nerve conduction studies evaluated the distal sensory and motor latencies of the median nerve. Carpal tunnel syndrome-6 scores ≥12 were considered positive for CTS. The primary outcome measurement was the Boston Carpal Tunnel Questionnaire (BCTQ). Statistical analysis was performed to assess the correlation of preoperative studies to predict changes in postoperative BCTQ scores following CTR. Statistical significance was set to <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>In total, 106 patients were included in the analysis, of which 69 patients were positive for CTS on US with an average median nerve CSA of 15.2 ± 4.4 mm², whereas 37 patients were negative with an average CSA of 9.0 ± 1.3 mm² (<em>P</em> &lt; .001). Female sex, height, and weight were significantly different between the CTS-positive and -negative cohorts (<em>P</em> = .01, <em>P</em> = .02, and <em>P</em> = .01). Preoperative US, NCS, and CTS-6 were not associated with the ability to achieve minimal clinically important difference in change in BCTQ scores after surgery.</div></div><div><h3>Conclusions</h3><div>Although helpful in establishing a diagnosis of CTS, positive findings on preoperative US, NCS, and CTS-6 alone are not associated with clinically significant changes in BCTQ symptom or function scores up to 1 year after surgery following CTR.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100767"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831376","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":"Ulnar Nerve Subluxation in the Overhead Athlete: Predicted Loss of Force Following Submuscular Versus Modified Subcutaneous Ulnar Nerve Transposition","authors":"Alexandria A. Bosetti BS ,&nbsp;Eileen M. Colliton MD ,&nbsp;Mark E. Baratz MD","doi":"10.1016/j.jhsg.2025.100762","DOIUrl":"10.1016/j.jhsg.2025.100762","url":null,"abstract":"<div><h3>Purpose</h3><div>Cubital tunnel syndrome and ulnar nerve subluxation are common issues for the overhead athlete and can be a considerable hindrance to their athletic performance. With the care of elite athletes in mind, there must be a balance between the relief of symptoms and preservation of capabilities. We quantified compromise of the flexor–pronator mass following modified subcutaneous versus submuscular ulnar nerve transposition.</div></div><div><h3>Methods</h3><div>Eight cadaveric upper-extremity specimens were studied to determine the amount of muscle compromise following modified subcutaneous and submuscular ulnar nerve transposition. The muscles of the flexor–pronator mass were then identified, including the flexor carpi ulnaris, flexor digitorum superficialis, flexor carpi radialis, and pronator teres. The muscles of the flexor–pronator mass were dissected along their length, and a line was marked where the ulnar nerve would cross the muscle during transposition. Each muscle of the flexor–pronator mass was excised from the forearm. The volume of each muscle was estimated by the technique of volume displacement using a graduated cylinder.</div></div><div><h3>Results</h3><div>There was a significant difference in the loss of muscle volume between the two techniques. This translates to the potential loss of force from the flexor–pronator mass. Submuscular transpositions resulted in 4.67× more muscle volume loss than the modified subcutaneous approach.</div></div><div><h3>Conclusions</h3><div>When the ulnar nerve needs to be transposed, subcutaneous or modified subcutaneous ulnar nerve transposition results in less damage to the flexor–pronator mass.</div></div><div><h3>Clinical relevance</h3><div>These findings aid in surgical decision making in the overhead athlete in order to preserve muscle volume and force of the flexor–pronator mass.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100762"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831377","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":"Salvage of a Distal Ulnar Nonunion with Teriparatide Therapy","authors":"Krishna Unadkat MS ,&nbsp;Camryn Payne BS ,&nbsp;Bithika M. Thompson MD ,&nbsp;Jeffrey D. Hassebrock MD ,&nbsp;Shelley S. Noland MD ,&nbsp;Erwin A. Kruger MD","doi":"10.1016/j.jhsg.2025.100785","DOIUrl":"10.1016/j.jhsg.2025.100785","url":null,"abstract":"<div><div>We present an 80-year-old woman with osteoporosis who sustained a fall, resulting in a closed left distal radius fracture and a grade I open ulna fracture. She underwent open reduction internal fixation. Four months later, the radius healed, but the ulna showed delayed union. Initial bone stimulator therapy was ineffective, and computed tomography scans confirmed nonunion at 6 and 9 months after surgery. Revision surgery was considered, but her treatment was changed to teriparatide, a parathyroid hormone analog that stimulates bone healing. Within 2 months, progressive ulnar healing was noted, avoiding revision surgery. At 15 months, x-rays confirmed full healing, and the patient resumed weight-bearing. This case underscores teriparatide as a promising nonsurgical option for fracture nonunion in osteoporotic patients, meriting further research.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100785"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831372","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":"“Patient-Specific” Cost and Quality Value Comparison of Endoscopic Carpal Tunnel Release in Two Surgical Settings","authors":"Alex Lindahl BS ,&nbsp;Trae Hill BS ,&nbsp;Emily Mazier BS ,&nbsp;Meet Patel BS ,&nbsp;Geoffrey Kahn PhD ,&nbsp;Yueren Zhou PhD ,&nbsp;Charles S. Day MD, MBA","doi":"10.1016/j.jhsg.2025.100802","DOIUrl":"10.1016/j.jhsg.2025.100802","url":null,"abstract":"<div><h3>Purpose</h3><div>Prior studies have demonstrated that transitioning surgeries from a hospital outpatient department (HOPD) to an ambulatory surgical center (ASC) lowers costs. With 500,000 carpal tunnel release (CTR) surgeries annually, CTR offers an opportunity to determine the value of one of the most performed upper-extremity surgeries. We aim to quantify the value of an endoscopic CTR in a HOPD compared to an ASC by analyzing differences in costs and patient outcomes. We hypothesize the ASC will provide greater value by lowering costs while maintaining patient outcomes.</div></div><div><h3>Methods</h3><div>Total costs were comprised of time-driven activity-based labor costs (TDABC), activity-based supply costs, and claims-based facility costs. Differences in preoperative Patient-Reported Outcome Measure (PROM) Information System Upper Extremity (UE) and Pain Interference (PI) scores and 3-month postoperative PROM Information System UE and PI scores were calculated to determine PROM Information System Quality-Adjusted Life Years (QALY_UE/PI). Total costs were divided by QALYs for each PROM to calculate the Value_UE/PI of each cohort. The magnitude of the difference in value between cohorts was elucidated by calculating incremental cost-effectiveness ratios.</div></div><div><h3>Results</h3><div>A total of 25 patients comprised each cohort. The ASC generated 28% lower costs compared to the HOPD ($3,370.73 ± $128.80 vs $4,654.75 ± $140.19). Average QALY_UE and QALY_PI gain was not significantly greater for patients at the ASC compared to the HOPD (QALY_UE 1.06 vs 0.89; QALY_PI 1.22 vs 0.92). The ASC demonstrated 40% to 45% greater value, represented by a lower cost/QALYs, compared to the HOPD (Value_UE $3,168.81/QALY vs $5,242.78/QALY, Value_PI $2,759.90/QALY vs $5,038.04/QALY).</div></div><div><h3>Conclusions</h3><div>We observed between 40% to 45% greater value by performing CTRs in the ASC. Although ASCs lowered costs by 28%, costs alone do not fully explain the value differential. Patient-reported outcomes serve a valuable role in providing a holistic picture of the value being delivered to patients. Providers can use this information to guide patient decision-making regarding operative treatment options for carpal tunnel syndrome.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic/Decision Analysis II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100802"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830001","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":"Clinical Outcomes Following Endoscopic Carpal Tunnel Release With the Arthrex NanoScopic Release System—A Single Surgeon Experience","authors":"Sina Ramtin MD ,&nbsp;Asif M. Ilyas MD, MBA","doi":"10.1016/j.jhsg.2025.100780","DOIUrl":"10.1016/j.jhsg.2025.100780","url":null,"abstract":"<div><h3>Purpose</h3><div>Endoscopic carpal tunnel release (ECTR) is a minimally invasive alternative to open release, offering faster recovery and reduced postoperative discomfort. The Arthrex NanoScopic ECTR system, a novel single-use device using chip-on-tip digital imaging and designed for use under local anesthesia without arthroscopic equipment, may further streamline care and expand surgical access.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of the first 50 consecutive ECTR procedures performed using the Arthrex NanoScopic system by a single hand fellowship-trained hand surgeon. All procedures were completed under wide-awake local anesthesia no tourniquet technique in an outpatient surgical center. Outcomes included operative times, adverse events, infections, need for reoperation, and anesthesia conversion rates. Patients were followed for a minimum of 3 months after surgery.</div></div><div><h3>Results</h3><div>A total of 50 procedures were performed on 37 patients (13 bilateral), with a median age of 58 years. All cases were completed under local anesthesia without conversion to sedation or general anesthesia. The average operative time was 8 minutes, with the total room time averaging 22 minutes. No reoperations occurred. Four patients (8%) developed postoperative median neuritis, with three cases resolving spontaneously and one attributed to underlying polyneuropathy. One patient presented to the emergency department for pain unrelated to the surgical site, and one patient developed a superficial wound infection resolved with oral antibiotics.</div></div><div><h3>Conclusions</h3><div>The Arthrex NanoScopic ECTR system appears to be a safe, efficient, and minimally invasive option for carpal tunnel syndrome decompression under wide-awake local anesthesia no tourniquet. Its single-use, portable design may reduce the procedural burden and expand access to endoscopic release in office-based or ambulatory settings. Early outcomes demonstrate low complication rates and high procedural success, supporting further evaluation of this technique in broader clinical practice, particularly in an office setting.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic II.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100780"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831378","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":"Gunshot-Related Metacarpal Fractures: A Retrospective Study and Single Urban Center Experience","authors":"Hussein Abdul-Rassoul MD, MSc ,&nbsp;Jordan Serrote MD ,&nbsp;Jeffrey G. Stepan MD, MSc ,&nbsp;Jennifer Moriatis Wolf MD, PhD ,&nbsp;Jason Strelzow MD, FRCSC","doi":"10.1016/j.jhsg.2025.100789","DOIUrl":"10.1016/j.jhsg.2025.100789","url":null,"abstract":"<div><h3>Purpose</h3><div>As gun violence continues to grow, hand surgeons are increasingly called upon to manage complex ballistic hand fractures. However, there is a relative scarcity of literature on civilian gunshot-related metacarpal fractures. In this study, we examine the management strategies and outcomes for ballistic metacarpal fractures at a high-volume, level-1 urban trauma center.</div></div><div><h3>Methods</h3><div>Through the use of an institutional database of all patients with firearm-related fractures who presented to our level 1 trauma center, we identified all patients with ballistic hand fractures over a 4-year period (2019–2023). Charts were reviewed for metacarpal fractures and associated injuries, and physical examination characteristics at initial presentation. We evaluated the surgical treatments, postoperative complications, and outcomes following the treatment of these injuries.</div></div><div><h3>Results</h3><div>Over a 4-year period, 98 patients sustained a total of 139 firearm-related metacarpal fractures. Of these, 28 patients with 39 fractures were lost to follow-up. Among the remaining, a total of 100 metacarpal fractures were treated with a mean follow-up of 5.5 months (range, 2–24 months). Of these, 79 (79%) required surgical intervention. Soft tissue injuries associated with these fractures were observed in 36% of cases. Among the 79 surgically treated fractures, complications included a 13% nonunion rate, an 18% malunion rate, and a 4% incidence of deep infections. Overall, the most common complication was stiffness, reported in 62% of operative metacarpals. The average active range of motion at the metacarpophalangeal joint was 58.</div></div><div><h3>Conclusions</h3><div>This large retrospective series of gunshot-related metacarpal injuries treated at a high-volume trauma center presents findings and outcomes for a challenging injury. The findings showed a moderate risk of nonunion and high rates of stiffness following these injuries, emphasizing the critical need for further research to develop optimal management strategies aimed at reducing complications in the treatment of firearm-related metacarpal fractures.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IV</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100789"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820072","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":"A Review of Perilunate Wrist Dislocations.","authors":"Jenna L Dvorsky, Seth Rosenberry, Antonio Da Costa, Anna Green, John Fowler","doi":"10.1016/j.jhsg.2025.100803","DOIUrl":"10.1016/j.jhsg.2025.100803","url":null,"abstract":"<p><p>Perilunate dislocations are relatively rare carpal injuries that can have long-term consequences. This review consolidates the existing evidence on perilunate dislocations, synthesizing available data on surgical techniques and outcomes to inform clinical decision making and highlight areas in need of further research.</p>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"100803"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875623","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":"Functional Outcomes of Spherical Pyrocarbon HAPY Metacarpophalangeal Interposition Arthroplasty for Long Fingers: A Retrospective Study of 16 Cases.","authors":"Cerise Gosselin, Hugo Barret, Clémentine Rieussec, Romain Mari, Alexandra Forli, Denis Corcella","doi":"10.1016/j.jhsg.2025.100804","DOIUrl":"10.1016/j.jhsg.2025.100804","url":null,"abstract":"<p><strong>Purpose: </strong>Metacarpophalangeal (MCP) joint osteoarthritis is a major cause of pain and functional limitation. When conservative treatment fails, arthroplasty is a surgical option, with silicone implants historically being the most widely used. The HAPY spherical metacarpal pyrocarbon implant is a new prosthetic solution. This study aims to evaluate the clinical and radiological outcomes of this spherical pyrocarbon MCP implant.</p><p><strong>Methods: </strong>This single-center retrospective study included 16 patients who underwent MCP arthroplasty with the HAPY implant for osteoarthritis with a follow-up of more than 2 years. Clinical evaluation included pain (visual analog scale), range of motion, and disabilities of the arm, shoulder, and hand score, and grip strength. Complications were also recorded. Radiological assessment focused on implant positioning, bone erosion, peri-implant bone remodeling, proximal migration, and material integrity.</p><p><strong>Results: </strong>After a mean follow-up of 48 months (range: 24-95 months), functional outcomes demonstrated considerable improvement in MCP flexion (41° ± 10° to 64° ± 20°), pain reduction (visual analog scale: 7.4 ± 1 to 0.8 ± 0.9), and improvement in the disabilities of the arm, shoulder, and hand score (42.5 ± 11.3 to 20.2 ± 22.5). Grip strength remained stable. No complications such as dislocation, instability, or infection were reported. Radiological outcomes showed proper implant positioning in 62.5% of cases, with moderate peri-implant bone remodeling and a low incidence of proximal migration or considerable erosion.</p><p><strong>Conclusions: </strong>The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes, with consderable improvements in pain relief and joint mobility. Radiological findings support good bone tolerance with signs of progressive integration, despite moderate erosion and bone remodeling in some cases. These results are consistent with outcomes reported for other pyrocarbon implants. A multicenter study with a longer follow-up is needed to confirm the durability and safety of this technique.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"100804"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875624","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":"Midterm Outcomes of Four-Corner Fusion Surgery Using Nitinol Staples.","authors":"Arya A Ahmady, Mohammad Zalzaleh, Barth B Riedel","doi":"10.1016/j.jhsg.2025.100805","DOIUrl":"10.1016/j.jhsg.2025.100805","url":null,"abstract":"<p><strong>Purpose: </strong>Wrist arthritis because of scaphoid nonunion advanced collapseand scapholunate advanced collapse can be treated through scaphoid excision and four-corner arthrodesis. There are many fixation techniques; however, there are few studies reporting outcomes in which only Nitinol staples were used. This study aimed to evaluate whether patients undergoing a four-corner arthrodesis using this fixation technique as well as intraoperative modifications to minimize complications will have successful outcomes.</p><p><strong>Methods: </strong>Retrospective study of patients who underwent scaphoid excision and four-corner arthrodesis using DynaNite Nitinol Staple (Arthrex Inc) to treat scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist arthritis at a single academic institution by a single surgeon. The technique and our modifications are described below. Outcome measures included radiographic union, range of motion, strength, and patient-reported outcomes such as Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcomes questionnaire, Likert patient satisfaction scale, and the visual analog scale.</p><p><strong>Results: </strong>Eight patients were included with mean follow-up of 27 months (9-42 months). When compared to the contralateral side, patients maintained 76% wrist flexion-extension, 83% radial-ulnar deviation, and 99% pronation-supination. Key pinch, three-point pinch, and grip strength testing were 95%, 89%, and 86%, respectively. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 17, and the mean Michigan Hand Outcomes score was 85% compared to the contralateral side. The visual analog pain scale had a mean of 2.5 (range 0-6). Radiographic imaging showed that all patients had undergone union of their four-corner arthrodesis with intact hardware.</p><p><strong>Conclusions: </strong>The results of this study show that midterm outcomes of four-corner fusions performed with Nitinol staples have promising results in overall functional and patient-reported outcomes. In addition, they offer reliable fixation for achieving union of the four-corner arthrodesis.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"100805"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875635","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}