Journal of Hand and Microsurgery最新文献

{"title":"Letter regarding \"Modified double fascicular nerve transfer to restore elbow flexion in brachial plexus injuries - A series of 32 cases\".","authors":"Hui-Kuang Huang","doi":"10.1016/j.jham.2025.100328","DOIUrl":"10.1016/j.jham.2025.100328","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100328"},"PeriodicalIF":0.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761743","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":"Antenatal ultrasound cannot detect all congenital Anomalies: Clinical limitations, India-specific barriers, and medicolegal perspectives.","authors":"Ilayaraja Venkatachalam, Mohamed Siddique","doi":"10.1016/j.jham.2025.100331","DOIUrl":"10.1016/j.jham.2025.100331","url":null,"abstract":"<p><strong>Background: </strong>Antenatal ultrasound is central to prenatal screening, enabling early detection of many congenital anomalies. However, its diagnostic accuracy is limited, especially for subtle, complex, or late-onset fetal abnormalities. In India, additional systemic, infrastructural, and legal factors further restrict its effectiveness.</p><p><strong>Objectives: </strong>To review the diagnostic limitations of prenatal ultrasound, highlight India-specific barriers to anomaly detection, and examine medico-legal perspectives, including landmark court rulings on alleged negligence.</p><p><strong>Methods: </strong>This article synthesizes global and Indian data on anomaly detection rates, analyzes categories of commonly missed anomalies, and reviews relevant Indian legal cases, including Supreme Court judgments. The policy implications of the PCPNDT Act are also critically discussed.</p><p><strong>Results: </strong>Ultrasound detects 50-70 % of major anomalies in ideal settings, but many conditions-such as cardiac defects, skeletal dysplasias, orofacial defects ( Cleft lip, Cleft palate etc) and limb abnormalities-remain undiagnosed. India-specific challenges include operator variability, delayed antenatal care, equipment disparities, and regulatory hurdles under the PCPNDT Act. Indian courts consistently require expert testimony to establish negligence and have ruled in favor of clinicians when standard protocols were followed.</p><p><strong>Conclusion: </strong>Missed anomalies on antenatal ultrasound typically reflect known technical and systemic limitations, not medical negligence. Indian jurisprudence has set a clinician-protective precedent when standard care is provided. Counseling, documentation, and legal awareness remain key to mitigating risk. Policy reforms should promote ethical ultrasound use while safeguarding both patient access and provider protection.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100331"},"PeriodicalIF":0.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761742","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":"Cold intolerance following microsurgical replantation of finger amputations: A retrospective cohort study.","authors":"Makoto Shiraishi, Mitsunaga Narushima, Chihena Hansini Banda, Yuta Moriwaki, Satoshi Miyamoto, Yuri Miyazaki, Mayu Okuyama, Kirito Kojima, Chizuki Kondo, Kosuke Yamagata, Kohei Mitsui, Kohei Hashimoto, Kento Hosomi, Ryohei Ishiura, Masakazu Kurita, Isao Koshima","doi":"10.1016/j.jham.2025.100327","DOIUrl":"10.1016/j.jham.2025.100327","url":null,"abstract":"<p><strong>Purpose: </strong>Cold intolerance following finger amputation is a major postoperative complication. Although current evidence suggests decreased blood flow to digital peripheral vessels may be associated with cold intolerance, the underlying mechanism remains controversial. This study aimed to investigate the relationship between skin perfusion in affected fingers and the presence of cold intolerance.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to evaluate patients who underwent finger replantation at two centers between 2008 and 2020. Demographic data were collected, and at least one of the following evaluative methods was used: the Semmes-Weinstein monofilament test (SW test), moving two-point discrimination (M2PD), contrast-enhanced computed tomography, or thermography.</p><p><strong>Results: </strong>A total of 41 amputated fingers in 20 patients were assessed, with a mean follow-up period of 18.7 ± 12.1 months. Most injuries were located in Tamai zone 4 (n = 18, 43.9 %), followed by zone 1 (n = 9, 22.0 %), zone 2 (n = 9, 22.0 %), and zone 3 (n = 5, 12.2 %). The most common injury type was crush (n = 24, 58.5 %), followed by guillotine (n = 13, 31.7 %) and crush-avulsion (n = 4, 9.7 %). A significant difference was observed in the SW test (p = .047) and average vessel diameter (p = .047) between patients with and without cold intolerance.</p><p><strong>Conclusions: </strong>Narrowed blood vessels and impaired SW test scores are associated with cold intolerance after finger replantation. Nerve injury may potentially contribute to abnormal vasoconstriction. Further studies are needed to elucidate the underlying mechanisms of cold intolerance.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100327"},"PeriodicalIF":0.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745417","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":"The 'teres major first' approach for deltoid reinnervation in brachial plexus injuries with shoulder fracture-dislocations.","authors":"Prem S Bhandari","doi":"10.1016/j.jham.2025.100329","DOIUrl":"10.1016/j.jham.2025.100329","url":null,"abstract":"<p><strong>Background: </strong>In upper brachial plexus (C5-C6) avulsion injuries, deltoid reinnervation via radial-to-axillary nerve transfer is standard. However, fracture-dislocations around the shoulder complicate surgical exposure due to fibrosis and distorted anatomy.</p><p><strong>Methods: </strong>Fifteen male patients (mean age: 26.1 years) with C5-C6 avulsion injuries and concomitant shoulder fractures were treated between October 2019 and April 2022 using a modified posterior approach. The \"teres major first\" technique utilized the inferior border of the teres major muscle as a consistent landmark to identify and mobilize the long head triceps branch and anterior axillary nerve. A vertical slit in the teres major tendon improved access and allowed tension-free coaptation. All patients also received spinal accessory to suprascapular nerve transfers, and partial ulnar and/or median nerve transfers for elbow flexion restoration.</p><p><strong>Results: </strong>All patients had fibrous adhesions in the quadrangular space, and 3 had distal axillary nerve injuries. The teres major landmark enabled safe dissection in all cases. Twelve of 15 patients achieved deltoid reinnervation with active shoulder abduction between 110° and 170° (mean 156°; MRC grade III-IV). Three patients (2 with proximal humerus fractures and 1 with lateral clavicle fracture with coracoclavicular disruption) showed limited recovery (70°-80° abduction). Triceps donor site weakness (MRC grade ≥3 in 14/15) was tolerated well, and full elbow flexion was restored in all patients. EMG evidence of reinnervation appeared by week 21 (deltoid) and week 23 (infraspinatus), with improvement in active shoulder abduction from week 27 onward.</p><p><strong>Conclusion: </strong>The \"teres major first\" approach enables rapid and safe identification of target nerves in brachial plexus injuries complicated by shoulder fractures and dislocations. This technique minimizes dissection in fibrotic areas, ensures tension-free repair, and achieves reliable functional outcomes. However this study is limited by the relatively small sample size and a reduced statistical power.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100329"},"PeriodicalIF":0.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733803","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":"Impact of prompting on large language model performance: ChatGPT-4 performance on the 2023 hand surgery self-assessment examination.","authors":"Benjamin Fiedler, Olivia A Barron, Jeffrey Hauck, Jacob Scioscia, Todd Phillips, Adil S Ahmed, Scott Mitchell","doi":"10.1016/j.jham.2025.100326","DOIUrl":"10.1016/j.jham.2025.100326","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) such as ChatGPT are artificial intelligence programs designed to interpret and respond to text based input These programs can improve output based on prompting and tailored prompt engineering. Multiple studies have assessed the ability of various LLMs to perform on medical exams at different levels of training. The newest version of ChatGPT, GPT-4, allows image recognition which is relevant for many questions on orthopedic surgery exams. Performance of GPT-4, and the potential for LLMs to learn from prior exams remains unclear. The present study analyzed ChatGPT-4 performance on the 2023 hand surgery Maintenance of Certification (MOC) Self-Assessment Examination (SAE) before and after prompting with 5 previous versions of the test. It was hypothesized that GPT-4 would pass the exam and improve performance after prompting.</p><p><strong>Methods: </strong>GPT-4 was tested with all text and image-based questions from the 2023 hand surgery SAE. Video-based questions were excluded. GPT-4 was then provided with questions, answers, and explanations from 5 previous SAEs from 2014 to 2020 and retested on the 2023 SAE text and imaging questions. Responses from GPT-4 on prompted and unprompted tests were recorded and compared.</p><p><strong>Results: </strong>Both prompted and unprompted versions of ChatGPT-4 exceeded SAE exam passing requirement of >50 % correct response rate. GPT-4 answered 67 % of all questions correctly unprompted and 71 % of all questions correctly after prompting (p = 0.51). Sub-analysis demonstrated GPT-4 answered 66 % of image-based questions correctly after prompting, compared to 56 % before prompting (p = 0.25). GPT-4 answered 75 % of text only questions correctly before prompting and 74 % correctly after prompting (p = 1.0). Fischer's exact test on total questions, image only, and text only showed no statistically significant differences between prompted and unprompted versions of GPT-4.</p><p><strong>Conclusion: </strong>GPT-4 demonstrated the ability to analyze orthopedic information, answer specialty-specific questions, and exceed the passing threshold of 50 % on the 2023 Hand Surgery Self-Assessment Exam. However, prompting GPT-4 with previous SAEs did not statistically significantly improve performance. With continued advancements in AI and deep learning, large language models may someday become resources in test simulation and knowledge checks in the realm of hand surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100326"},"PeriodicalIF":0.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709364","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":"Analyzing socioeconomic characteristics in brachial plexus birth injuries: A multicenter public health analysis.","authors":"Robbins Victoria, Khabyeh-Hasbani Nathan, O'Brien Devon, Behbahani Mandana, Meisel Erin, Steven M Koehler","doi":"10.1016/j.jham.2025.100325","DOIUrl":"10.1016/j.jham.2025.100325","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to examine and compare socioeconomic characteristics of infants with brachial plexus birth injury (BPBI) at two high-volume, distinct healthcare systems in the United States.</p><p><strong>Methods: </strong>All patients diagnosed with non-transient BPBI presenting between November 2021-November 2023 at either institution, New York City (\"NY\") or Los Angeles (\"LA\"), were included. To stratify based on socioeconomic background, Area Deprivation Index (ADI) and Child Opportunity Index (COI) were utilized. ADIs were presented in national percentiles (1-100 %) or state-normed deciles (1-10), with higher rankings indicating greater disadvantage. COI scores and quintiles were assigned using nationally-normed ZIP code-level data, with lower COI signifying lower childhood opportunity. Continuous variables underwent two-tailed, unpaired Mann-Whitney U and t-tests. Categorical variables underwent chi-square tests. The significance level was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>When comparing the LA (n = 92) and NY (n = 107) cohorts, the mean ADI scores were not significantly different: 24.5 % (SD 21.1) and 25.4 % (SD 13.5) respectively (p = 0.713). When comparing the COI scores, overall mean COI was significantly greater in LA (34.2, SD 26.9) compared to NY (17.3, SD 25.6; p < 0.001). While a significantly higher number of patients from NY than LA fell into categories of very low or low in education, social and economic, and overall COI, the distributions of these categories were more evenly spread across the LA cohort.</p><p><strong>Conclusion: </strong>Our findings underscore the importance of considering regional differences in patient populations when patients present with BPBI, as addressing such disparities may increase equitable access to treatment and optimize functional outcomes. Given the time-sensitive nature of BPBI care and implications of long-term disability if left under-treated, it is essential to allocate resources towards effectively treating BPBI in affected demographics, especially those experiencing resource deficits. By acknowledging geographic-specific differences in resource access among BPBI populations, physicians can develop targeted strategies to ensure equitable BPBI care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100325"},"PeriodicalIF":0.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700018","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":"Pedicled adipofascial flaps for treatment and prophylaxis of neurodesis and neuromas in continuity of the upper extremity: A case series of 22 patients.","authors":"Sergio Asensio Ramos, Rafael Sánchez-Del Hoyo, Francisco Javier García Bernal","doi":"10.1016/j.jham.2025.100320","DOIUrl":"10.1016/j.jham.2025.100320","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Trauma to a peripheral nerve can lead to neuromas in continuity and perineural adhesions or fibrosis (neurodesis), causing pain and functional impairment. We present a retrospective study regarding our experience in managing these types of injuries using pedicled adipofascial flaps.</p><p><strong>Material and methods: </strong>We present a series of twenty-two patients treated between 2012 and 2023 for neurodesis or neuromas in continuity in the upper limb, performing external neurolysis and twenty-three adipofascial flaps. The affected nerves were the median nerve (n = 22) and the superficial branch of the radial nerve (n = 1). The ulnar artery perforator adipofascial flap was used in ten cases, the hypothenar fat pad flap in ten cases and the radial artery perforator adipofascial flap in three cases. Pain outcomes were measured using the Visual Analog Scale (VAS) pre and postoperatively, and a statistical analysis of the data was performed. STROBE guidelines were followed.</p><p><strong>Results: </strong>The average pain VAS scores pre and postoperatively were 7.13 and 2.3, respectively, representing a statistically significant improvement (p < 0.001). No statistically significant differences were found based on the type of flap used (p = 0.38) or the patients' age (p = 0.47). Complications included one surgical wound dehiscence of the donor site of an ulnar flap and another one in the recipient site (n = 2).</p><p><strong>Conclusion: </strong>Adipofascial flaps are a useful therapeutic option for managing neuromas in continuity and neurodesis of peripheral nerves in the upper extremity, achieving a significant reduction in pain.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100320"},"PeriodicalIF":0.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676086","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":"Complex regional pain syndrome of wrist and hand following distal radius fracture: A long-term follow-up study: 16 years (range 10-22 years).","authors":"Raghavendra S Kulkarni, Kulkarni Aditya Prakash, SriRam R Kulkarni","doi":"10.1016/j.jham.2025.100317","DOIUrl":"10.1016/j.jham.2025.100317","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this longitudinal prospective research on distal radius fractures was to identify and analyse impairments resulting from complex regional pain syndrome at long term follow up.</p><p><strong>Material and methods: </strong>The clinical and radiological assessment was performed up to 16 weeks then at 6, 9, 12 months following distal radius fracture for 62 patients of diagnosed complex regional pain syndrome and were treated between 2000 and 2011 at one institute. All patients were invited for re-examination at final long term follow up and the clinical assessment which was performed after an average of 16 years (range 10 years-22 years). Out of the 62 patients 44 (70.9 %) attended for this long term clinical follow up. Women constituted 11 (25.0 %). The main outcome measures were the impairments assessed by standard physical examination, pain, grip strength, vasomotor instability and finger mobility. The mean duration of treatment was 274.4 ± 24.2 days.</p><p><strong>Results: </strong>The mean interval between distal radius fracture, inciting event and the diagnosis complex regional pain syndrome was 2.3 (range 1-5) months. At long term follow-up the pain and tenderness were present in 41 (93.2 %) and 36 (81.8 %) patients, this association was highly significant (chi-square = 29.3, P < 0.001). The prevalence of vasomotor instability was high, in 37 (84.1 %) patients. Grip strength was significantly lower on the affected fracture side than normal hand (57.4 ± 8.2 against 148.2 ± 12.4 mm of Hg, P < 0.001). There was a strong association between all three manifestations of sensory, motor and autonomic features in this study report (p < 0.001.</p><p><strong>Conclusion: </strong>Pain along with loss of full fist muscle strength and restricted activities of daily living were the most evident factors leading to perceived disabilities, at long term follow-up of 16 (range-10 to 22) years after the onset of complex regional pain syndrome. Pain was the most important factor contributing to handicap. This study supports with strong evidence for long term loss of productive effort with prolonged treatment period having most unpredictable functional impairment.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100317"},"PeriodicalIF":0.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709363","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":"Uses of constraint-induced movement therapy (CIMT) in patients with brachial plexus birth injuries (BPBI).","authors":"Megan Gotlieb-Horowitz, Victoria Robbins, Victoria Ferrante, Tara M DeRosa, Mandana Behbahani, Steven M Koehler","doi":"10.1016/j.jham.2025.100316","DOIUrl":"10.1016/j.jham.2025.100316","url":null,"abstract":"<p><p>Constraint-induced movement therapy (CIMT) was originally implemented to address limb non-use in stroke recovery, and has more recently become a mainstay, evidence-based treatment approach to decrease developmental disregard in children. In addition to combating developmental disregard in the BPBI patient with residual deficit(s), CIMT can be applied in various ways across diverse cases in brachial plexus practice, including post-surgical use to aid in the activation of nerve transfers and/or tendon transfers. The timing, dosage, and setting of CIMT will vary depending on the patient's case and individual needs. This paper highlights how the individuality of CIMT implementation, when tailored to each patient's developmental stage and specific needs and circumstances outside of the clinic, contributes to its success. Rather than presenting the routine use of CIMT for BPBI developmental disregard, sample cases are presented to outline the variety of uses for CIMT in the surgical BPBI patient. Practical tips and clinical strategies are provided to support other clinicians in effectively incorporating CIMT in their care of children in this vulnerable population.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100316"},"PeriodicalIF":0.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676103","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":"Use of the trans-scaphoid portal for the arthroscopic treatment of scaphoid nonunion in the middle third with flexion deformity: technique description and patient series.","authors":"Ricardo Kaempf, Paula Fischer, Ahlam Arnaout, Lucian Lior Marchovich, Pedro J Delgado","doi":"10.1016/j.jham.2025.100324","DOIUrl":"10.1016/j.jham.2025.100324","url":null,"abstract":"<p><p>Nonunion is one of the main complications associated with scaphoid fractures. Over the past decades, the use of arthroscopy in the treatment of scaphoid nonunion has proven to be a valuable technique, even in cases presenting deformity and carpal instability. This approach facilitates rapid consolidation while minimizing damage to the joint capsule and ligaments, thereby preserving the already compromised vascular supply of the scaphoid. Due to their simpler anatomy, dorsal portals are commonly employed in wrist arthroscopy, reducing the risk of injury to neurovascular structures during joint access. Initial descriptions of arthroscopic treatment for scaphoid nonunion (SNU) used only dorsal portals throughout the procedure. However, correcting the scaphoid's flexion deformity caused the dorsal cortex to close and created a defect in the volar portion, introducing a technical challenge. Herein, we describe a novel access portal to assist in the arthroscopic treatment of mid-third scaphoid nonunion, which we have termed the trans-scaphoid portal. Located volar and distal to portal 1/2, just volar to the first extensor tendon compartment, it allows direct lateral access to the nonunion site. We used this portal in 10 patients with excellent results, observing that it simplified the correction of the scaphoid flexion deformity and allowed for direct placement of the bone graft in the volar region. The trans-scaphoid portal was developed to overcome the limitations of dorsal portals, enabling safe and straightforward debridement of the lesion, correction of deformity, and easier graft placement into the volar defect.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100324"},"PeriodicalIF":0.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676102","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}