Journal of Hand Surgery Global Online最新文献

{"title":"Anatomy at Risk: An App for Evaluating Hand Lacerations and Planning Surgical Incisions","authors":"Rustin Mahboubi Ardakani BS ,&nbsp;Rachid Barry MS ,&nbsp;Christina C. Rymond MD ,&nbsp;William Redman AA ,&nbsp;David E. Komatsu PhD ,&nbsp;Lawrence C. Hurst MD","doi":"10.1016/j.jhsg.2025.100777","DOIUrl":"10.1016/j.jhsg.2025.100777","url":null,"abstract":"<div><h3>Purpose</h3><div>Anatomy at Risk (AAR), a website and application, was developed to improve educational access and quality for medical and academic learners pertaining to the hand and wrist. It includes information on anatomy such as vessels, nerves, ligaments, musculature, and bones, as well as physical examinations to be performed by learners in order to help them diagnose injuries. Other resources are typically restricted to noninteractive media such as text-book diagrams and often lack the in-depth information required to gain a proper understanding of anatomy that often presents in the real world. The goal of this app was to provide a free, online, easy-to-access global resource for learning the anatomy of the hand and wrist.</div></div><div><h3>Methods</h3><div>In 2024, 16 medical learners at a US Medical School trialed the beta version of the app during development via a talk-aloud session and survey to provide constructive feedback on the practicality, usability, and potential benefits of applying the app in practice or for education. Subsequently, a cohort of physician assistant students also trialed the released version of the app and answered the same survey.</div></div><div><h3>Results</h3><div>The vast majority of learners in both groups responded and reported that the app had great educational value and commented on the ease-of-use, user interface, quality of videos, and detailed content. Initial critiques were associated with navigational issues and mobile use, which were addressed during development and not reported in the second trial.</div></div><div><h3>Conclusions</h3><div>AAR seeks to provide an easy-to-use global resource for learning hand anatomy and examination. Medical learners believed it had educational value. It was a resource for learning anatomy diagnosing damaged structures and provided easy to find lists of structures and examinations pertaining to a local injury or elective incisions.</div></div><div><h3>Clinical relevance</h3><div>AAR can aid users in locating anatomic structures at risk of injury and provide them with the key physical examinations to confirm their diagnoses.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100777"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518585","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":"Integrating Point-of-Care Ultrasound in Hand Clinic: A Systematic Review and Meta-Analysis","authors":"Jonah W. Perlmutter BSc ,&nbsp;Ennie Olajide BS ,&nbsp;Adham Elsherbini HBSc ,&nbsp;Adam Mosa MD, MSc","doi":"10.1016/j.jhsg.2025.100775","DOIUrl":"10.1016/j.jhsg.2025.100775","url":null,"abstract":"<div><h3>Purpose</h3><div>Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable adjunct to physical examination in various clinical settings. Despite this, integration into the routine clinical practice of hand surgeons remains limited. This systematic review and meta-analysis aims to evaluate the diagnostic and clinical utility of POCUS in hand clinics for the assessment and management of common hand pathologies.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE and Embase were searched. Prospective studies evaluating POCUS use in hand pathologies were included. Two reviewers independently screened, extracted, and assessed data. Meta-analysis of diagnostic performance measures was conducted using a bivariate random effects model when appropriate.</div></div><div><h3>Results</h3><div>Fifteen prospective studies involving 1,217 patients were included. POCUS was most commonly used to assess fractures (76.3%) and tendinous pathologies (20%). For hand fractures, pooled sensitivity and specificity were 81.95% (95% confidence interval [CI]: 78.03% to 85.31%) and 89.39% (95% CI: 87.12% to 91.30%), respectively. Among tendinous pathologies, POCUS demonstrated 100% sensitivity for trigger digits in three of four included studies. Limited evidence also supported high diagnostic performance for nail bed injuries (sensitivity: 97%, specificity: 95%).</div></div><div><h3>Conclusions</h3><div>POCUS demonstrates high diagnostic accuracy for evaluating hand fractures and tendinous injuries while showing promise in the evaluation of nail bed trauma. Heterogeneity in study design, operator expertise, and reference standards was noted.</div></div><div><h3>Clinical relevance</h3><div>The incorporation of POCUS into the clinical practice of hand surgeons, supported by formal training and technological advancements such as artificial intelligence integration, may improve diagnostic efficiency, guide management, and enhance care delivery.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100775"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518584","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":"Determining Risk Factors and Rate of Surgery After Collagenase Injections for Dupuytren Contracture","authors":"Ryan C. Cha BA ,&nbsp;Juliet S. Chung MD ,&nbsp;Sina Ramtin MD ,&nbsp;Asif M. Ilyas MD, MBA","doi":"10.1016/j.jhsg.2025.100768","DOIUrl":"10.1016/j.jhsg.2025.100768","url":null,"abstract":"<div><h3>Purpose</h3><div>Collagenase injections are a nonsurgical treatment for Dupuytren contracture, but their long-term effectiveness in preventing surgery remains unclear. This study aimed to evaluate the rate of surgical intervention following collagenase treatment and identify whether specific risk factors increase the likelihood of future surgical correction.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX US Collaborative network to identify patients diagnosed with Dupuytren contracture between January 2007 and September 2024. Patients initially treated with collagenase injections were identified using relevant current procedural terminology codes. Procedure-specific current procedural terminology codes were then used to determine which patients underwent a subsequent fasciectomy or fasciotomy within 5 years of their initial injection. Risk factors, including smoking, diabetes, alcohol abuse, epilepsy, and vascular disease, were identified by International Classification of Diseases, 10th Edition codes. Statistical analysis was performed to evaluate the association between these risk factors and the likelihood of undergoing surgery.</div></div><div><h3>Results</h3><div>Among 6,917 patients identified to have been treated with collagenase, 715 (10.2%) underwent surgery within 5 years of the injection. Tobacco use was associated with a significantly higher rate of surgery (12.98%, <em>P</em> = .03) compared with nonsmokers (10.1%). Similarly, patients with alcohol use disorder had a higher surgical correction rate (16.3%, <em>P</em> &lt; .001) compared with those without (9.8%).</div></div><div><h3>Conclusions</h3><div>Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. Smoking and alcohol use significantly increased the likelihood of surgery, representing a potential correlation. Further research is warranted to explore mechanisms underlying progression to surgery and prevention strategies.</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":"7 5","pages":"Article 100768"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518586","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":"Evaluating the Relationship Between Patients Diagnosed with Anxiety and Depression and Rates of Postoperative Opioid Use in Five of the Most Common Hand Surgeries","authors":"Martinus Megalla MD ,&nbsp;Zachary T. Grace MD ,&nbsp;Matthew J. Solomito PhD, MS ,&nbsp;Brian T. Ford MD ,&nbsp;Nicholas A. Bontempo MD","doi":"10.1016/j.jhsg.2025.100743","DOIUrl":"10.1016/j.jhsg.2025.100743","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared postoperative opioid utilization between patients with and without preoperative diagnoses of anxiety and/or depression undergoing elective upper-extremity surgery. We hypothesized that patients with these diagnoses would fill more opioid prescriptions within 30 days of surgery than those without.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis using the PearlDiver Mariner Patient Claims Database (2010–2021). Patients undergoing carpal tunnel release, cubital tunnel release, trigger finger release, and epicondylitis surgeries were identified via Current Procedural Technology and International Classification of Diseases-Ninth and Tenth Revision codes. Patients were categorized by diagnosis of depression only, anxiety only, both anxiety and depression, and control. The primary outcome was opioid prescriptions filled within 30 days postsurgery. Descriptive statistics and chi-square tests were employed.</div></div><div><h3>Results</h3><div>Among 4,166,706 carpal tunnel release patients, 22.4% with a diagnosis of anxiety and/or depression had a higher opioid fill rate (1.85%) than the control group (1.38%). For 1,409,802 trigger finger release patients, 20.7% with a diagnosis of anxiety and/or depression had a higher fill rate (1.62% vs 1.19%). In 913,929 cubital tunnel release patients, 23.0% with a diagnosis of anxiety and/or depression had a higher fill rate (2.41% vs 1.25%). Among 1,645,767 lateral epicondylitis surgeries, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (1.04% vs 0.71%). For 397,916 medial epicondylitis patients, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (0.92% vs 0.66%).</div></div><div><h3>Conclusions</h3><div>Preoperative depression and/or anxiety were linked to higher postoperative opioid prescriptions across all surgeries, emphasizing the need to consider these diagnoses in opioid prescribing.</div></div><div><h3>Level of evidence</h3><div>Prognostic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100743"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470820","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":"Upper Extremity Manifestations of Beckwith–Wiedemann Syndrome: A Unique Case Presentation and Management of a Pediatric Patient Over 9 Years","authors":"Vidhur Sohini MD ,&nbsp;Nancy Jimenez MD ,&nbsp;Savannah Yeh MD ,&nbsp;Jonathan R. Sorelle MD","doi":"10.1016/j.jhsg.2025.100772","DOIUrl":"10.1016/j.jhsg.2025.100772","url":null,"abstract":"<div><div>Beckwith–Wiedemann syndrome is a rare congenital genetic condition with various clinical manifestations, notably isolated lateralized overgrowth. Literature regarding hemihyperplasia of the hand and upper extremity is scarce. We present a 9-year-old right handedgirl with right upper-extremity hemihypertrophy who was followed extensively over 9 years for various soft tissue complaints. Despite adequate nerve decompressions, asymmetric growth recurred. After puberty, the patient developed wrist and finger contractures, resulting in diminished range of motion and function, which caused considerable psychosocial distress in school. The patient underwent extensor indicis proprius tendon release, dorsal wrist capsular release, proximal row carpectomy, and total wrist arthrodesis to neutralize the wrist. One-year after surgery, the patient’s function and psychosocial status improved. The remaining finger contractures are being addressed with staged tendon lengthening procedures. The management of Beckwith–Wiedemann syndrome hand pathologies requires a tailored approach, likely involving individualized preoperative planning, incremental treatments, and frequent reassessments.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100772"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321006","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":"What Do Patients Want? Outcome Measures in a Diverse World","authors":"Ashley L. Titan MD ,&nbsp;Elspeth Hill MD, PhD ,&nbsp;Camille Brenac MD ,&nbsp;Tiffany Yue BS ,&nbsp;Elisabet Hagert MD, PhD ,&nbsp;Fabian Köninger MD ,&nbsp;Johnny Chuieng-Yi Lu MD ,&nbsp;Yu-Te Lin MD ,&nbsp;Elisabeth Russe MD ,&nbsp;Catherine Curtin MD","doi":"10.1016/j.jhsg.2025.100766","DOIUrl":"10.1016/j.jhsg.2025.100766","url":null,"abstract":"<div><h3>Purpose</h3><div>Quantifying the outcomes of medical interventions has evolved, but challenges remain in hand surgery. Initially, hand surgeons used concrete assessments like range of motion and/or pinch strength. With a shift toward patient-centered care, numerous pathology-specific patient-reported outcome measures (PROMs) were developed. These measures typically used standardized closed-ended outcomes and mostly originated from Western country languages. However, it is unclear how well measures with specific items capture diverse patient values. Therefore, we used an open-ended PROM, the patient-specific functional scale (PSFS) to assess patients’ difficulties associated with daily living for the following two common hand diagnoses: carpal tunnel syndrome (CTS) and trigger finger (TF), allowing us to evaluate the breadth of variation of experiences and treatment goals across cultures.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional, international study on patients with a diagnosis of CTS and TF. Patient desires were recorded using the PSFS. Data were qualitatively interrogated using template analysis.</div></div><div><h3>Results</h3><div>Patient responses from 225 PSFS scores from three continents and five countries were evaluated. Patients provided diverse functional impacts from CTS/TF, which were categorized according to the International Classification of Functioning. There were diverse patient responses with variations in the proportion of domains represented in each country. Closed-ended PROMS (Quick disabilities of arm, shoulder, and hand; Boston carpal tunnel score; and PROM information system) did not fully capture the priorities identified by patients in each country. Although these PROMS measure specific outcomes, they do not address the broader range of issues that patients in different countries consider most important.</div></div><div><h3>Conclusions</h3><div>This study highlights the diversity of patients’ priorities in hand function. There is a clear cultural influence on the perception and prioritization of specific hand functions in daily life.</div></div><div><h3>Clinical relevance</h3><div>Standardized tools with closed formats miss the richness of the individuals’ goals, cannot adapt to new hand uses, and overlook cross-cultural differences. This weakness hinders the accurate evaluation of patient satisfaction and limits intercultural comparisons. Achieving truly patient-focused care necessitates more open and inclusive assessment tools.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100766"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331019","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":"Evaluating the Impact of Trauma on Carpal Tunnel Syndrome Onset and Postsurgical Recovery: A Retrospective Study in Orthopedic Practice","authors":"Ashley A. Ellingwood BS ,&nbsp;Uzoma Nwakibu MD ,&nbsp;Maya Sternberg PhD ,&nbsp;Obinwanne Ugwonali MD","doi":"10.1016/j.jhsg.2025.100774","DOIUrl":"10.1016/j.jhsg.2025.100774","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to investigate the relationship between previous trauma to upper extremities and the subsequent development of carpal tunnel syndrome (CTS). By comparing cases of traumatically induced CTS with idiopathic CTS, the study aims to evaluate differences in symptom severity and postsurgical treatment outcomes. Additionally, the study explores other factors associated with higher pain scores and longer lengths of care.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on patients who underwent carpal tunnel release surgery by a single hand surgeon from January 1, 2014 to October 1, 2020. Pre- and postoperative care duration and pain levels, assessed using a visual analog scale, were the primary outcomes. To analyze the predictors of pain levels and recovery time, unadjusted means were generated, followed by the development of a model to account for potential correlations and contributions.</div></div><div><h3>Results</h3><div>The study included 478 patients (324 women and 154 men) with a mean age of 53.2 years, all of whom underwent carpal tunnel release surgery. Patients with traumatic injuries had higher initial and final pain scores compared with those with nontraumatic causes. Notably, trauma was not a significant factor in the length of care model, despite its association with pain scores. Meanwhile, worker’s compensation was a factor associated with prolonged length of care.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that traumatic injuries and other factors, such as worker’s compensation, gender, and race/ethnicity, significantly influence both pain levels and length of care in patients undergoing carpal tunnel release surgery. These findings emphasize that CTS can develop after trauma and is not exclusively idiopathic. Addressing various clinical and socioeconomic factors is essential for enhancing treatment effectiveness and managing expectations following surgery.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapy/Prevention, Etiology/Harm; IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100774"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313379","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":"Surgical Management of Double Crush Syndrome: Outcomes of Cervical Decompression With and Without Peripheral Nerve Release","authors":"Eric J. Gullborg MS ,&nbsp;Justin Castonguay BA ,&nbsp;Vincent P. Federico MD ,&nbsp;Sayyida Hasan BS ,&nbsp;Xavier C. Simcock MD ,&nbsp;Matthew W. Colman MD","doi":"10.1016/j.jhsg.2025.100770","DOIUrl":"10.1016/j.jhsg.2025.100770","url":null,"abstract":"<div><h3>Purpose</h3><div>Double crush syndrome involves two distinct compressive lesions along a single peripheral nerve. Patients with compressive neuropathies at the wrist and elbow may experience exacerbated symptoms from cooccurring cervical radiculopathy. Surgical management aims to decompress at either or both proximal and distal sites. This study compares outcomes of anterior cervical discectomy and fusion (ACDF) alone versus ACDF with subsequent peripheral nerve decompression.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated patients with double crush lesions, diagnosed with magnetic resonance imaging-confirmed cervical radiculopathy and carpal or cubital tunnel syndrome via electrodiagnostic confirmation. Two cohorts were matched and analyzed: (1) ACDF alone and (2) those with ACDF with subsequent peripheral nerve decompression. All procedures were performed at a single institution between 2004 and 2020, with a minimum 1-year follow-up. Postoperative symptoms, examination findings, patient-reported outcomes, and reoperations were compared.</div></div><div><h3>Results</h3><div>Among 130 patients (66 receiving ACDF alone, 64 with additional peripheral nerve decompression), those with both procedures had a significantly longer duration of preoperative radicular/peripheral symptoms (29.2 months vs 18.3 months). At the latest follow-up, patients receiving ACDF alone had significantly more persistent numbness (42.4% vs 17.2%), nerve irritability (21.2% vs 4.7%), and reduced 2-point discrimination (20.3% vs 12.1%) when compared with those who had bimodal decompression. Patients receiving both procedures reported significantly greater improvements in visual analog scale neck pain (−5.62 vs −3.63), visual analog scale arm pain (−4.73 vs −3.54), and neck disability index scores (−17.50 vs −6.80).</div></div><div><h3>Conclusions</h3><div>Isolated cervical decompression may be insufficient for double crush neuropathies. Treatment of both proximal and distal sites can provide superior pain and symptom relief. Management of compressive pathology at both sites should be strongly considered by treating surgeons.</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":"7 5","pages":"Article 100770"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313253","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 Severe Elbow Arthritis in a Young Patient","authors":"Robert A. Kaufmann MD ,&nbsp;Marc J. Richard MD ,&nbsp;Alexandria A. Bosetti BS ,&nbsp;Brian K. Foster MD ,&nbsp;Mark E. Baratz MD","doi":"10.1016/j.jhsg.2025.100736","DOIUrl":"10.1016/j.jhsg.2025.100736","url":null,"abstract":"<div><div>Elbow osteoarthritis is occasionally primary and most often post-traumatic. Nonoperative treatment is frequently the best course of action. Available surgical options are governed by the location of cartilage deterioration, bone structure, and preoperative joint instability. Debridement of osteophytes can achieve modest, temporary increases in motion and comfort. Surgical management benefits from knowledge of the substantial varus torque that is exerted when the arm is abducted. In the elbow that is resurfaced or replaced, these forces may strain the soft tissue support and lead to premature subluxation and failure. Understanding the influence of these forces may improve clinical outcomes. Interposition arthroplasty can restore mobility to a stiff elbow with advanced posttraumatic arthritis and adequate medial and lateral columns of the distal humerus, but the elbow may subluxate with varus stress (shoulder abduction) or progressive loss of the bone. When the bone structure and cartilage of the distal humerus are damaged and the ulna is spared, then elbow hemiarthroplasty can be considered. Both interposition arthroplasty and elbow hemiarthroplasty benefit from restoration of soft tissue elbow support to prevent postoperative subluxation. Elbow hemiarthroplasty is currently not a US Food and Drug Administration-approved procedure. In exceptional cases, it has been used off-label. When both sides of the ulnohumeral joint have substantial loss of their bone architecture, total elbow arthroplasty can be considered. It is desirable to avoid total elbow arthroplasty in healthy, active patients, who are the vast majority of people with posttraumatic or primary elbow arthritis. Although this can work in elderly, low-demand patients, the worst results are in young, active patients. Four surgical options and barriers to future management options are discussed.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100736"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313256","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":"Extension Osteotomy for Radiolunate Joint Osteoarthritis","authors":"Koji Moriya MD ,&nbsp;Masahiko Yamada MD ,&nbsp;Yutaka Maki MD","doi":"10.1016/j.jhsg.2025.100771","DOIUrl":"10.1016/j.jhsg.2025.100771","url":null,"abstract":"<div><div>Osteoarthritis (OA) of the radioscaphoid joint is the most common type of wrist OA; involvement of the radiolunate (RL) joint is comparatively less frequent. A 56-year-old man presented with right wrist pain, with radiographic findings of ulnar-plus variance, increased palmar tilt, and a subtle ulnar head osteophyte. Despite 7 years of conservative treatment, progressive OA of the RL joint developed. The patient opted for surgical intervention to relieve pain and preserve motion. A closed-wedged extension osteotomy of the distal radius was performed. At 1 year and 3 months after surgery, he had pain-free wrist motion, confirmed bony union, and preserved RL joint space. Extension osteotomy of the distal radius may be a viable surgical option for OA of the RL joint caused by bone morphology changes leading to increased palmar tilt.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 5","pages":"Article 100771"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313257","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}