Journal of Hand Surgery Global Online最新文献

{"title":"Association Between Worker’s Compensation Status and Outcomes for Surgical Treatment of Lateral Epicondylitis","authors":"Asher B. Mirvish BA ,&nbsp;John R. Fowler MD","doi":"10.1016/j.jhsg.2025.100873","DOIUrl":"10.1016/j.jhsg.2025.100873","url":null,"abstract":"<div><h3>Purpose</h3><div>Evaluate for variation between patients undergoing surgery for lateral epicondylitis (LE) with and without worker’s compensation (WC) coverage.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on patients, identified by Current Procedural Terminology codes, who underwent LE surgery between 2008 and 2020. Following exclusions, there were 293 operative patients for LE, 34 of whom had WC coverage. Outcomes consisted of comparing before surgery and postoperative pain level reported by patient feedback during consultations, ability to perform job duties, and retaining employment. This study also assessed clinical workflow via time to surgery. Positive outcomes included having resolution or improvement in symptoms after surgery, returning to employment completely, and the ability to perform job duties appropriately. Negative outcomes included unchanged or worsened pain, incomplete return to work, loss of employment, and revisions. Patients were evaluated after surgery at approximately 2-week, 6-week, and 3-month milestones.</div></div><div><h3>Results</h3><div>Of the 34 WC cases, 12 (35%) had a negative outcome, whether persistent pain, reassignment to permanent and stationary employment, or loss of employment. Twenty percent of WC patients versus 3.5% of non-worker’s compensation (NWC) patients had unchanged symptoms. Twenty-five percent of WC patients returned to modified duty versus 7.3% of NWC. Two WC patients and one NWC patient lost their jobs. Patients on WC were more likely to have delays in time to surgery than NWC patients. Postoperative documentation reflected persistent epicondylitis as the reason for failure of complete return to work. By the 3-month postoperative consultation, 3% of patients without WC (NWC) had negative outcomes, whereas 20% of WC patients had a negative outcome. By the final consultation, 92% of NWC patients returned to work full duty, whereas 68% of WC patients were able to return to work full duty.</div></div><div><h3>Conclusions</h3><div>Overall, only approximately two-thirds of patients undergoing LE surgery under a WC claim returned to work within 3 months of surgery, compared to 92% without a WC claim. WC patients had more frequent delays in time to surgery versus NWC patients.</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":"8 2","pages":"Article 100873"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738978","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 Between Area Deprivation Index and the Time to Presentation of Scaphoid Fractures","authors":"Aidan M. Lynch BS, MS ,&nbsp;Muhammad H. Hamdan BS ,&nbsp;Jordan Bauer MD ,&nbsp;Rohan V. Rajan BS ,&nbsp;Rajendra Singh BS ,&nbsp;Joel V. Ferreira MD ,&nbsp;Anthony Parrino MD ,&nbsp;Craig M. Rodner MD","doi":"10.1016/j.jhsg.2025.100932","DOIUrl":"10.1016/j.jhsg.2025.100932","url":null,"abstract":"<div><h3>Purpose</h3><div>Scaphoid fractures are the most common carpal fractures and are prone to nonunion because of their retrograde blood supply. Delayed diagnosis or treatment increases the risk of nonunion and progression to scaphoid nonunion advanced collapse. Social determinants of health, measured by the area deprivation index (ADI), may contribute to such delays. This study examines the association between ADI, time to presentation, and the presence of nonunion at initial evaluation.</div></div><div><h3>Methods</h3><div>A retrospective chart review identified 168 patients with suspected scaphoid fractures between January 1, 2018 and June 30, 2025. State-level ADI scores were grouped into the following terciles: least-deprived (LDT), intermediately deprived (IDT), and most deprived (MDT). Patients presenting more than 5 years after injury or without confirmed fractures were excluded, leaving a total of 107 patients. Independent <em>t</em> tests compared the mean time from injury to presentation across ADI terciles, χ² tests compared the nonunion rates at presentation, and binomial regression assessed whether ADI predicted scaphoid nonunion.</div></div><div><h3>Results</h3><div>The mean time from injury to presentation increased with deprivation: LDT = 16.9 ± 23.5 days, IDT = 55.1 ± 97.9 days, and MDT = 173.5 ± 364.5 days. Both MDT and IDT patients presented significantly later than LDT patients (<em>P</em> = .0146 and <em>P</em> = .0315, respectively) and had a higher prevalence of nonunion at presentation (<em>P</em> = .025). The ADI independently predicted scaphoid nonunion, with each unit increase in state ADI associated with 23.8% higher odds of nonunion (<em>P</em> = .029).</div></div><div><h3>Conclusions</h3><div>Patients from socioeconomically deprived communities experienced significantly longer delays in presentation for scaphoid fractures and a higher incidence of nonunion, which may increase the risk of long-term complications such as scaphoid nonunion advanced collapse wrist arthritis. These findings highlight the importance of addressing neighborhood-level disparities to increase access to treatment in time-sensitive injuries such as scaphoid fractures.</div></div><div><h3>Type of study/level of evidence</h3><div>Prevalence IIIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100932"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023296","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":"Rat Bite Fever: It’s Still a Threat","authors":"Alexander J. Bergeson MS ,&nbsp;Kyler A. Hardie MD ,&nbsp;Robert E. Van Demark Jr MD ,&nbsp;Matthew C. Anderson MD","doi":"10.1016/j.jhsg.2025.100901","DOIUrl":"10.1016/j.jhsg.2025.100901","url":null,"abstract":"<div><div><em>Streptobacillus moniliformis</em> is considered normal flora of the upper respiratory tract of rodents and is the predominant cause of rat bite fever in North America. Although patients with rat bite fever oftentimes present with migratory polyarthralgia, cultures of affected joints do not grow bacteria in the vast majority of cases. We present a case of a 32-year-old woman who initially presented with a painful, swollen right index finger proximal interphalangeal (PIP) joint following a bite from her pet rat. After initial treatment with empiric antibiotics did not clear the infection, PIP joint irrigation and debridement revealed culture-positive septic arthritis. This case illustrates the patient’s unusual presentation of <em>S</em>. <em>moniliformis</em> infection through septic arthritis of the PIP joint.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100901"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884617","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 Influence of Glucagon-like Peptide-1 Receptor Agonists on Outcomes Following Trigger Finger Release","authors":"Laura S. Dameron BS ,&nbsp;Nicholas C. Bank MD ,&nbsp;Narayan Raghava MD ,&nbsp;Stephen Himmelberg MD ,&nbsp;Gregory M. Knoll MD","doi":"10.1016/j.jhsg.2025.100923","DOIUrl":"10.1016/j.jhsg.2025.100923","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary aim was to compare postoperative complications at 90 days and 1 year following trigger finger release (TFR) in patients with versus without glucagon-like peptide-1 receptor agonist (GLP-1 RA) exposure. GLP-1 RAs are increasingly used for managing diabetes and obesity. These drugs’ impact on surgical outcomes, particularly wound healing and fibrosis, is not well understood.</div></div><div><h3>Methods</h3><div>A retrospective matched cohort study was conducted using the TriNetX US Collaborative Network. Patients undergoing TFR were stratified by GLP-1 RA exposure within 1 year before or after surgery. Propensity score matching was applied to balance demographics, metabolic risk factors, and comorbidities. Primary outcomes included rates of scarring, postoperative pain, wound complications, and repeat TFR at both 90 days and 1 year.</div></div><div><h3>Results</h3><div>Each cohort included 4,283 matched patients. GLP-1 RA exposure was associated with significantly increased risk of scarring (90 days: 1.5% vs 0.9%, 1 year: 2.3% vs 1.5%), postoperative pain (90 days: 13.2% vs 10.6%, 1 year: 21.6% vs 16.9%), and wound complications (90 days: 1.7% vs 0.9%, 1 year: 2.3% vs 1.4%). Repeat TFR was significantly higher only at 1 year (11.4% vs 9.5%). There were no significant differences in infection rates, systemic complications, or health care utilization at either timepoint.</div></div><div><h3>Conclusions</h3><div>GLP-1 RA use is independently associated with increased risks of postoperative pain, scarring, wound complications, and repeat surgery following TFR. The delayed increase in repeat TFR suggests a possible long-term effect on tendon or wound healing that warrants further investigation.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100923"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077557","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":"Localizing Nerve Injury, Defining Injury Severity, and Estimating Prognosis (Nerve SPACE 2025)","authors":"John Fowler MD ,&nbsp;David Wright MD ,&nbsp;David Cholok MD ,&nbsp;Sandip Biswal MD ,&nbsp;Summer Gibbs PhD ,&nbsp;Sameer Shah MD ,&nbsp;Tom Quick MD ,&nbsp;Ek Tsoon Tan PhD ,&nbsp;Ryckie Wade PhD ,&nbsp;O. Kenny Nwawka MD ,&nbsp;Jonathan Winograd MD","doi":"10.1016/j.jhsg.2025.100940","DOIUrl":"10.1016/j.jhsg.2025.100940","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Localizing nerve injury, defining injury severity, and estimating prognosis are critical factors in surgical decision-making when indicating patients for operative intervention following traumatic nerve injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Where are we now?&lt;/h3&gt;&lt;div&gt;Current methods for localizing nerve injury and determining severity of injury include physical examination, electrodiagnostic studies, imaging including ultrasound and magnetic resonance imaging, and surgical exploration. However, these methods remain suboptimal, especially in cases of segmental or multilevel injury as is often seen in blunt force trauma as well as in cases of partial (axonotmetic) injury. A period of observation is often required to determine if spontaneous recovery will occur. In neurotmetic injuries, it is challenging to accurately determine the zone of injury intraoperatively to ensure that reconstruction is performed using healthy, viable nerve. As a result of these shortcomings, it has been difficult to accurately and consistently classify nerve injury according to location and severity which has resulted in difficulty estimating the prognosis for many injuries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Where do we need to go?&lt;/h3&gt;&lt;div&gt;Better diagnostic methods are needed to be able to accurately determine the location of nerve injury to direct surgical intervention and determine prognosis, especially in blunt, ballistic, multilevel, or segmental injuries. Additionally, improved methods are needed to evaluate partial axonotmetic injuries in which the epineurium remains grossly intact on inspection intraoperatively, but with varying degrees of axonotmetic injury within the nerve. This includes a need for both noninvasive preoperative imaging and biomarkers as well as intraoperative modalities to more accurately determine the degree of intraneural damage and assist in preoperative indications and intraoperative decision-making. Improving these diagnostic modalities will allow classification of injuries by location and severity on a more consistent and accurate basis, leading to improved ability to estimate prognosis, surgical indications, and intraoperative decision-making.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;How do we get there?&lt;/h3&gt;&lt;div&gt;Emerging diagnostic modalities, including simultaneous positron emission tomography and magnetic resonance imaging, nerve-specific fluorescence imaging, quantitative ultrasound and magnetic resonance imaging, peripheral nerve diffusion tensor imaging, magnetic resonance neurography, polarization-sensitive optical coherence tomography, and serum biomarkers for peripheral nerve injury, offer promising advances that may help better localize and define injury severity in peripheral nerve injury. More research and funding are needed to better understand how best to apply each of these modalities for traumatic nerve injury, leading to broader adoption, more accurate classification and consistent reporting of data that can be linked to patient outcomes ","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100940"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077671","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":"Training and Integrating Advanced Practice Providers in Pediatric Hand Surgery","authors":"Lauren Perry CPNP, RNFA ,&nbsp;Weston Thomas PA-C ,&nbsp;Carolina Gonzalez MSN, FNP-BC ,&nbsp;Aaron Berger MD, PhD ,&nbsp;Michael G. Galvez MD","doi":"10.1016/j.jhsg.2025.100926","DOIUrl":"10.1016/j.jhsg.2025.100926","url":null,"abstract":"<div><div>The utilization of advance practice providers (APPs), such as a nurse practitioner or a physician assistant, in pediatric hand surgery has seen an increase over time within this growing field. In a pediatric setting, these skilled providers offer invaluable support as physician extenders, improving efficiency and capable of managing patient care independently. In the specialized field of pediatric hand surgery, APPs perform a multitude of roles within a multidisciplinary team that help streamline complex care in the clinic and operating room. Through their versatile skillset, APPs contribute to the overall quality and delivery of care in these specialized settings. Here, we provide a structured outline for training and integrating APPs in pediatric hand surgery.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100926"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977654","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":"Achilles Allograft in the Upper Extremity: A Systematic Review","authors":"Mahmoud Mahmoud MBBS ,&nbsp;Sanjum Singh MD ,&nbsp;Yagiz Ozdag MD ,&nbsp;Ryan Kempski BA ,&nbsp;Louis C. Grandizio DO","doi":"10.1016/j.jhsg.2025.100929","DOIUrl":"10.1016/j.jhsg.2025.100929","url":null,"abstract":"<div><h3>Purpose</h3><div>Achillies tendon allografts (ATAs) are used in a variety of upper-extremity reconstructive procedures. The purpose of this study was to systematically review the existing literature on the complications, reoperation rates and outcomes associated with the use of ATAs in upper-extremity reconstructions.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic review was conducted of studies published between January 1990 and August 2024. Eligible studies included adult patients who underwent shoulder, elbow and wrist tendon reconstruction using ATAs to provide insight into the overall performance of ATA reconstruction in the upper extremity. Studies which did not report complications and/or functional outcomes were excluded. Retrospective, prospective, and randomized controlled trials were included, whereas cadaveric, biomechanical, and nonhuman studies were excluded.</div></div><div><h3>Results</h3><div>A total of 23 studies comprising 408 cases met inclusion criteria. The most common indications for ATA use were distal biceps reconstruction (26%), irreparable rotator cuff tears (24%) and failed distal ulna resection (20%). The overall complication rate was 19%, with graft-related failure (43%) and infection (20%) as the most frequent complications. Reoperation was required in 10% of cases; predominantly because of graft failure (42%) and deep infection (29%). Despite these complications, patient-reported outcomes were favorable, with a mean postoperative-visual analog scale score of two and a Mayo Elbow Performance Score of 88, indicating substantial pain relief and functional improvement.</div></div><div><h3>Conclusions</h3><div>ATAs in upper-extremity reconstructive procedures appear to result in low levels of postoperative pain and improvements in function. However, overall complication and reoperations rates following ATA use were 19% and 10%, respectively.</div></div><div><h3>Clinical relevance</h3><div>ATA is advantageous in the sense that it can be used for a variety of shoulder, elbow, and wrist procedures; however, surgeons need to carefully weigh the benefits of decreased donor-site morbidity against the relatively high rates of complications.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 2","pages":"Article 100929"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977653","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":"Concordance Between Subjective Sleep and PSQI/ISI in Carpal Tunnel Syndrome Patients: A Comparative Study Before and After Surgery","authors":"Sang Anh Nguyen MD, MSc ,&nbsp;Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100870","DOIUrl":"10.1016/j.jhsg.2025.100870","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel syndrome (CTS) is frequently associated with sleep disturbances that considerably impair quality of life. Most studies have focused on either subjective sleep or standardized patient-reported (SPR) measures, but the concordance between these measures before and after surgery remains unclear. We aimed to determine the rates of concordance and discordance, along with the associated factors, ultimately proposing strategies to enhance the assessment process and postoperative care for these patients.</div></div><div><h3>Methods</h3><div>We conducted a single-center observational study including 104 adult CTS patients who underwent carpal tunnel release, divided into retrospective (n = 71) and prospective (n = 33) cohorts. Subjective sleep quality was assessed by patient self-report, whereas SPR included the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Assessments were performed before surgery and at 1, 3, and 12 months after surgery. Concordance between subjective and SPR results was determined at each time point.</div></div><div><h3>Results</h3><div>Before surgery, 100% of patients reported poor sleep, with all having PSQI &gt; 5 and ISI &gt; 7 (full concordance). After surgery, both subjective and SPR sleep quality improved significantly. At 12 months, 95.77% of patients self-reported good sleep; 95.77% had PSQI ≤ 5, and 91.55% had ISI ≤ 7. Concordance between subjective and SPR assessments increased over time, but a minority of patients continued to exhibit discordance, with self-perceived improvement preceding SPR normalization in some cases. Strong positive correlations were found between PSQI and ISI at all time points.</div></div><div><h3>Conclusions</h3><div>Carpal tunnel release leads to substantial improvements in both subjective and SPR sleep quality in CTS patients, with increasing concordance over time. However, persistent discordance in some individuals underscores the need for multidimensional assessment and individualized management.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IIb.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100870"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420386","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":"Training Tomorrow’s Hand Surgeons: Clinical, Leadership, and Structural Trends in Fellowship Education","authors":"Ogonna N. Nnamani Silva MD ,&nbsp;Aaron I. Dadzie BS ,&nbsp;Chinenye Ogbonnah BA ,&nbsp;Lydia A. Helliwell MD, MMSc ,&nbsp;Abhiram R. Bhashyam MD, PhD ,&nbsp;Catherine M. Curtin MD ,&nbsp;Tamara D. Rozental MD ,&nbsp;Krystle R. Tuaño MD","doi":"10.1016/j.jhsg.2025.100871","DOIUrl":"10.1016/j.jhsg.2025.100871","url":null,"abstract":"<div><h3>Purpose</h3><div>Hand surgery fellowships include trainees from orthopedic, plastic, and general surgery. These pathways present an opportunity to examine variations in graduate medical education structures, such as program size, sponsoring department, and leadership composition. Limited research exists on the characteristics of these programs. The purpose of this study is to assess the structural and leadership characteristics of the Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States. We hypothesized that characteristics (ie, faculty-to-fellow ratios and case volume) vary by specialty sponsorship. Leadership, although shaped by merit-based criteria, faces challenges in achieving broader demographic diversity.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of 95 US hand surgery fellowship programs was conducted in 2025. Program characteristics were compared by region and specialty sponsorship.</div></div><div><h3>Results</h3><div>Most programs were orthopedic-sponsored (n = 74, 77.9%), followed by plastic surgery (n = 19, 20.0%) and general surgery (n = 2, 2.11%). Programs averaged 2.22 fellows (SD = 1.35), with a faculty-to-fellow ratio of 3.98 (SD = 2.01) and an annual case volume of 846 per fellow (SD = 332). Orthopedic-sponsored programs had more fellows on average, a lower faculty-to-fellow ratio, and were less open to general surgery applicants compared to plastic surgery-sponsored programs. No notable regional differences were found in these characteristics. Program directors were predominantly men (n = 81, 85.3%) and orthopedic-trained (n = 70, 73.7%).</div></div><div><h3>Conclusions</h3><div>Hand surgery fellowships show consistent structural features, with notable differences between orthopedic- and plastic surgery-sponsored programs in enrollment, faculty-to-fellow ratios, and openness to general surgery applicants. Women leadership underrepresentation warrants further evaluation.</div></div><div><h3>Type of study/level of evidence</h3><div>Cross-sectional descriptive study, level IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"8 1","pages":"Article 100871"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420375","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":"Adults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication Prevention","authors":"Sang Anh Nguyen MD, MSc ,&nbsp;Anh Hoang Dang MD, PhD ,&nbsp;Doanh Quoc Tran MD, PhD","doi":"10.1016/j.jhsg.2025.100886","DOIUrl":"10.1016/j.jhsg.2025.100886","url":null,"abstract":"<div><h3>Purpose</h3><div>Closed distal radial fractures (DRFs) are among the most common adult fractures with high socioeconomic impact. Clinical decision-making remains challenging, particularly in low- and middle-income countries (LMICs), because of the heterogeneous nature of evidence and resource constraints. This study aimed to develop a risk-stratified framework for treatment selection and the prevention of complications.</div></div><div><h3>Methods</h3><div>A structured literature search was conducted in Pubmed, Scopus, and Embase databases from January 2015 to August 2025. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and guidelines addressing closed DRF management in adults. Two reviewers independently screened titles, abstracts, and full texts.</div></div><div><h3>Results</h3><div>Fifteen studies met the inclusion criteria: three randomized controlled trials, five systematic reviews/meta-analyses, three cohort studies, two cadaveric/technical imaging studies, one guideline summary, and one narrative review. Radiographic thresholds of radial shortening &gt;3 mm, dorsal tilt &gt;10°, and intra-articular step-off &gt;2 mm were supported as surgical indications in younger or high-demand adults, but not consistently in older low-demand patients. Instability predictors, such as Lafontaine criteria, were cited frequently; however, no single factor reliably predicted redisplacement. Volar locking plate (VLP) fixation yielded earlier functional recovery in unstable or high-demand patients, but long-term outcomes converged across techniques. The SAFE-VLP checklist (safe plate position, appropriate screw length, fixation stability, and early rehabilitation) emerged as a practical tool to reduce complications related to tendon, nerve, and complex regional pain. For LMICs, pragmatic pathways emphasize high-quality casting for low-demand elderly patients, percutaneous pinning as a cost effective alternative for moderate instability, and day-surgery VLP for unstable or working-age patients, supported by tele-rehabilitation strategies.</div></div><div><h3>Conclusions</h3><div>The management of closed DRFs should integrate radiographic criteria, instability predictors, functional demand, and health care context, rather than relying solely on radiographs for decision-making. This review provides a risk-stratified algorithm, a validated safety checklist, and an LMIC-adapted pathway to optimize outcomes and reduce complications.</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 1","pages":"Article 100886"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526463","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}