Journal of Hand Surgery-American Volume最新文献

{"title":"Arthrodesis of the Thumb Metacarpophalangeal Joint: Tension Band Wiring Versus Intramedullary Screw Fixation.","authors":"C Richard Arendale, Ashar Ata, Richard L Uhl","doi":"10.1016/j.jhsa.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.09.005","url":null,"abstract":"<p><strong>Purpose: </strong>Tension band wiring (TBW) and intramedullary (IM) screw fixation represent two well-established methods for thumb metacarpophalangeal (MP) joint arthrodesis. Studies comparing these methods have included small sample sizes and reported inconsistent findings. The objective of this study was to provide a descriptive comparison of the 1-year union, clinical success, and complication rates for both methods.</p><p><strong>Methods: </strong>This retrospective review examined all cases of TBW and IM screw thumb MP arthrodesis at a single institution between January 2012 and August 2024. Exclusion criteria included fusion of nonthumb MP joints, <90 days of follow-up, revision fusions, and incomplete medical records. Data collection occurred via chart review. The 1-year union, clinical success, and complication rates were reported for TBW and IM screw groups.</p><p><strong>Results: </strong>One hundred twenty-one patients were fused with TBW and 31 with IM screw. Of those with radiographs at final follow-up, union was observed in 80/89 (90%) TBW constructs and 20/27 (74%) IM screws. Clinical success was noted in 112/121 (93%) TBW cases and 24/31 (77%) IM screw cases. Re-arthrodesis was required in 3/121 (2%) TBW cases and 5/31 (16%) IM screw cases. Removal of hardware (ROH) was noted in 27/121 (22%) TBW cases and 2/31 (6%) IM screw cases. Overall complication rates were 48/121 (40%) with TBW and 10/31 (32%) with IM screws. Reoperation occurred in 29/121 (24%) TBW constructs and 8/31 (26%) IM screw fixations, with ROH representing 26/29 (90%) TBW reoperations and re-arthrodesis representing 5/8 (63%) IM screw reoperations.</p><p><strong>Conclusions: </strong>In this retrospective descriptive study without inferential statistics, union occurred in 90% and 74% of TBW and IM screw arthrodesis cases, respectively. Reoperation was required in 24% of TBW cases and 26% of IM screw fixations. ROH represented the majority of TBW reoperations, whereas re-arthrodesis represented the majority of IM screw reoperations.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Explainable Prediction Model for Outcomes After Anterior Subcutaneous Ulnar Nerve Transposition in Idiopathic Cubital Tunnel Syndrome.","authors":"Jun-Hyuk Lim, Myung-Sun Kim","doi":"10.1016/j.jhsa.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.013","url":null,"abstract":"<p><strong>Purpose: </strong>To identify preoperative clinical and electrodiagnostic predictors of outcome after anterior subcutaneous ulnar nerve transposition for idiopathic cubital tunnel syndrome and to develop an explainable model for individualized prognosis.</p><p><strong>Methods: </strong>This retrospective cohort study included 119 patients who underwent anterior subcutaneous ulnar nerve transposition for idiopathic cubital tunnel syndrome between 2005 and 2022 with at least 1 year of follow-up. Candidate predictors included demographic factors, occupational category score, elbow carrying angle, modified McGowan grade, and electrodiagnostic parameters. Outcomes were graded using Messina's criteria and dichotomized as excellent/good versus fair/poor for prediction modeling. Conventional regression and six machine-learning algorithms were evaluated, with the machine-learning models internally validated using nested stratified 5-fold cross-validation repeated 50 times. Model performance was assessed using the area under the receiver operating characteristic curve, F1 score, and Brier score. Interpretation relied on feature importance and local interpretable model-agnostic explanations.</p><p><strong>Results: </strong>Sixty-eight patients (57.1%) had an excellent/good outcome, whereas 51 patients (42.9%) had a fair/poor outcome. The extremely randomized trees model achieved the highest mean area under the receiver operating characteristic curve and the lowest Brier score and was selected for model interpretation. Wrist-level compound muscle action potential amplitude and modified McGowan grade were the dominant prognostic features. Exploratory model interpretation supported wrist-level compound muscle action potential amplitude ≥6.6 mV and modified McGowan grade ≤IIA as reference values for an excellent/good outcome.</p><p><strong>Conclusions: </strong>Wrist-level compound muscle action potential amplitude and preoperative clinical severity were the key predictors of recovery after anterior subcutaneous transposition for idiopathic cubital tunnel syndrome. Among the evaluated algorithms, the extremely randomized trees model achieved the highest mean area under the receiver operating characteristic curve and the lowest mean Brier score, reinforcing the prognostic importance of these variables. Explainable prediction modeling may support individualized preoperative counseling.</p><p><strong>Type of study/level of evidence: </strong>Prognostic III.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restoration of Wrist Extension in Patients With Brachial Plexus Birth Injuries by Transfer of Two Flexor Digitorum Superficialis Tendons.","authors":"Dan A Zlotolow, Francisco Soldado, Hailey Huddleston, Natalie Williams, Santiago Salazar-Botero, Paula Diaz-Gallardo, Eugene Park, Scott H Kozin","doi":"10.1016/j.jhsa.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.011","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to assess the outcomes of flexor digitorum superficialis (FDS) transfer for wrist extension restoration in patients with residual brachial plexus birth injury.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients 4 years or older who underwent FDS transfer between January 2008 and February 2024. Clinical records were reviewed to evaluate preoperative wrist extension deficit, postoperative outcome, and complications. The main outcome measurement was the British Medical Research Council scale to assess postoperative wrist extension strength.</p><p><strong>Results: </strong>Seventy-three patients were included in the study. The average age was 7.5 years (range, 4-16 years). Mean follow-up was 45.0 ± 34 months (range, 6-129 months). The FDS tendon route and the chosen metacarpal for attachment evolved over the course of the study period. The FDS transfer resulted in considerable improvement in wrist extension, with 89% of patients achieving wrist extension with power grip (M4 grade wrist extension) after surgery. Interosseous membrane-routed FDS transfers and patients with preoperative M3 wrist extension strength had a greater-than-expected rate of M4 wrist extension strength after surgery. Complications included swan neck deformity, ulnar deviation, radial deviation, supination contracture, and pronation contracture.</p><p><strong>Conclusions: </strong>The FDS transfer is an effective technique for restoration of wrist extension in patients with residual brachial plexus birth injury. The technique provides outcomes comparable or superior to other traditional tendon transfer techniques in this population based on reports in the literature. Patients with greater preoperative wrist extension strength may have more reliable increases in wrist extension strength after surgery.</p><p><strong>Type of study/level of evidence: </strong>Prognostic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the Surgical Management of Clinodactyly: A Systematic Review.","authors":"Konstantinos Devetzis, Rebecca Beni, James McGhee, Emily Yeg Hei To, Wee Leon Lam, Maxim D Horwitz","doi":"10.1016/j.jhsa.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.014","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review evaluated outcomes of surgical management for congenital clinodactyly, focusing on physiolysis and osteotomy.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, registered on the International Prospective register of Systematic Reviews (PROSPERO). MEDLINE and EMBASE were searched for studies reporting operative management of congenital clinodactyly published up to December 2025. Data extraction and bias assessment (Newcastle-Ottawa Scale) were performed independently by two reviewers. Outcomes were analyzed descriptively.</p><p><strong>Results: </strong>Of 818 studies screened, 8 were included, comprising 119 patients (165 digits). Physiolysis was performed in 76% of cases and osteotomy in 24%. The mean age of the physiolysis group was 6.1 years (0.6-12.3) and 7.2 years (0.6-16.4) for the osteotomy group. Mean preoperative angulation was 41°, improving to 21° after surgery. All techniques demonstrated angular improvement; however, no clear criteria exist for guiding the choice of procedure alongside disparity in the threshold for surgical intervention, with some studies quoting >20° to 25° as an indication. The overall complication rate was 7.3%, and reoperation was required in 9% of cases; reoperations were most frequently following physiolysis. Outcome reporting was inconsistent, with variable definitions of success and limited distinction between clinical and radiological measures. There were no studies using validated patient-reported outcome measures; limited qualitative feedback suggested generally high levels of patient or parental satisfaction despite residual deformity.</p><p><strong>Conclusions: </strong>Both techniques achieve reduction in angulation; however, standardized indications and robust outcome measures are needed to guide practice. Outcome reporting was heterogeneous, and most notably, there is a complete absence of validated patient-reported outcome measures across all included studies, despite generally high reported satisfaction, representing a major gap in patient-centered outcome assessment.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic IIIa.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Total Trapeziometacarpal Arthroplasty: From Early Prosthetic Designs to Contemporary Dual-Mobility Systems.","authors":"Charles P Nolte, Jonathan L Tueting, Louis W Catalano, Matthew Belton","doi":"10.1016/j.jhsa.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.007","url":null,"abstract":"<p><p>Trapeziometacarpal osteoarthritis is a common cause of pain, weakness, and functional impairment. Although trapeziectomy-based procedures remain the benchmark surgical treatment, concerns including metacarpal subsidence, prolonged rehabilitation, and delayed strength recovery have sustained interest in implant arthroplasty. Early implant designs were associated with high rates of loosening, instability, osteolysis, and failure, limiting their widespread adoption. Over the past five decades, advances in implant design, biomaterials, fixation strategies, and articulation mechanics have substantially improved the reliability of total trapeziometacarpal arthroplasty. Contemporary studies demonstrate improved implant survivorship and favorable clinical outcomes, with many of the benefits of arthroplasty realized during the early postoperative period, including accelerated recovery, earlier improvements in pain and function, faster return to work, and preservation of pinch strength. Patient selection has also evolved with greater recognition of the importance of trapezial morphology and a reassessment of traditional contraindications such as concomitant scaphotrapeziotrapezoid osteoarthritis. This Current Concepts review summarizes the evolution of total trapeziometacarpal arthroplasty and examines contemporary evidence regarding patient selection, outcomes, complications, revision strategies, and current surgical considerations.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Relationship Between Radial Translation and Functional Outcomes in Nonsurgical and Surgically Treated Distal Radius Fractures","authors":"Yusuf Yahşi MD,&nbsp;Yusuf Sülek MD,&nbsp;Süleyman Çakırtürk MD,&nbsp;Rodi Ertoğrul MD,&nbsp;Hacı Mustafa Özdemir MD","doi":"10.1016/j.jhsa.2026.02.037","DOIUrl":"10.1016/j.jhsa.2026.02.037","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the prognostic importance of radial translation on functional outcomes in patients treated nonoperatively or surgically for distal radial fractures. It was hypothesized that increased radial translation would be associated with worse functional scores, regardless of treatment modality.</div></div><div><h3>Methods</h3><div>This retrospective comparative study included 130 adult patients (aged 18–70 years) with unilateral AO/OTA 2R3A2 distal radius fractures, treated between January 2020 and December 2024. Group 1 (<em>n</em> = 60) underwent closed reduction and plaster casting, whereas group 2 (<em>n</em> = 70) underwent open reduction and volar locking plating performed by a consultant hand surgeon. Disabilities of the Arm, Shoulder, and Hand (DASH) scores and standard wrist radiographs were analyzed in patients with at least 12 months of clinical follow-up. Radiographic parameters, including radial inclination, radial length, volar tilt, ulnar variance, and radial translation, were assessed. Outcomes were assessed using the DASH score, visual analog scale pain scores, and the goniometric wrist range of motion. Correlation and multivariable regression analyses were performed to identify independent predictors of the DASH scores.</div></div><div><h3>Results</h3><div>A total of 130 patients were included. Across the entire cohort, radial translation demonstrated the strongest association with patient-reported disability, showing a substantial positive correlation with DASH scores (<em>R</em>² = 0.763). Other radiographic parameters, including radial length, ulnar variance, volar tilt, and radial inclination, showed only weak or minimal correlations with functional outcomes. Pain scores and wrist range of motion measurements did not display meaningful radiographic associations. In multivariable analysis, radial translation remained the most important independent variable related to DASH scores, whereas the contributions of other radiographic and demographic factors were limited.</div></div><div><h3>Conclusions</h3><div>Radial translation is a strong and independent predictor of functional outcomes in distal radius fractures. Intraoperative assessment and correction of coronal alignment, including radial translation, should be emphasized along with sagittal parameters. Routine radiographic assessment of this parameter may improve the functional prognosis.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1086.e1-1086.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Institution Validation Study of the Mangled Digit Severity Score for Predicting Salvageability of Severe Digital Injuries","authors":"Andrew A. Monhollen DO,&nbsp;Nash D. Kolb BS,&nbsp;Gillian Hark BS,&nbsp;Daniel A. London MD, MS","doi":"10.1016/j.jhsa.2026.06.001","DOIUrl":"10.1016/j.jhsa.2026.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div>A single institution external validation study was conducted to evaluate the recently created Mangled Digit Severity Score (MDSS). We hypothesized that the MDSS would demonstrate good discriminatory ability in predicting amputation versus successful salvage in an independent external cohort of patients with mangled digital injuries.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of all patients diagnosed with a mangled digit who presented to a level 1 trauma center and subsequently underwent revision amputation or digit salvage procedures from 2019 to 2025. MDSS scores were calculated as published. Performance statistics for predicting amputation versus salvage were first evaluated using the original published MDSS cutoffs. Institution specific cutoff optimization was then performed using receiver operating characteristic analysis to determine the refined lower cutoff (favoring salvage) and upper cutoff (favoring revision amputation).</div></div><div><h3>Results</h3><div>Forty patients with mangled digital injuries were identified, involving a total of 85 affected digits. Using the original published cutoffs, the MDSS achieved an overall accuracy of 76.2% (95% CI, 65.6% to 85.9%), sensitivity of 74.4% (95% CI: 55.2% to 90.6%), specificity of 77.2% (95% CI, 61.8% to 90.0%), and area under the curve of 0.76 (95% CI, 0.70–0.89). Following institution specific receiver operating characteristic-based optimization of cutoffs (score &lt;23 indicates salvage, score ≥23 and &lt;39 indicates indeterminant, score ≥39 indicates amputate), performance improved, with accuracy increasing to 82.5% (95% CI, 71.6% to 92.4%), sensitivity to 87.5% (95% CI, 75.0% to 100%), specificity to 78.9% (95% CI, 61.8% to 93.8%), and area under the curve of 0.84 (95% CI, 0.73–0.93).</div></div><div><h3>Conclusions</h3><div>This external validation supports the generalizability of the MDSS in our independent cohort, where it demonstrated reliable performance using the original published cutoffs. Institution specific optimization resulted in modest changes to threshold values while maintaining overall performance characteristics. These findings support the generalizability of the MDSS as a decision-support tool for predicting digit survival following severe digital trauma.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic IIb.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1116.e1-1116.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragility Fractures in Focal Neurological Conditions","authors":"Aslan Baradaran MD,&nbsp;Tamara D. Rozental MD","doi":"10.1016/j.jhsa.2026.02.027","DOIUrl":"10.1016/j.jhsa.2026.02.027","url":null,"abstract":"<div><div>Survivors of focal neurological injuries experience accelerated bone loss, particularly in the paretic upper extremity, substantially increasing the risk of fragility fractures. Mechanical unloading, neuromuscular impairment, and altered bone remodeling contribute to rapid reductions in bone mineral density and unfavorable changes in bone geometry within the first year after stroke and brachial plexus palsy. Despite growing evidence, bone health assessment is rarely incorporated into routine poststroke care, and referrals often occur only after fracture. This article discusses the role of hand surgeons and proposes practical screening, multidisciplinary care strategies, and interventions to improve early detection, prevention, and management of upper extremity fragility fractures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1132-1137"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Likelihood of Future Dupuytren Disease Intervention After Initial Treatment in the Same Digit, Another Digit, and Contralateral Hand","authors":"Rayan El Bachaoui BSc,&nbsp;Ethan Cossu BS,&nbsp;Dafang Zhang MD,&nbsp;Brandon E. Earp MD,&nbsp;Philip E. Blazar MD","doi":"10.1016/j.jhsa.2026.05.004","DOIUrl":"10.1016/j.jhsa.2026.05.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients treated for Dupuytren contracture in one digit are at risk for future intervention in other digits or the contralateral hand. Identifying predictive factors can aid in patient counseling.</div></div><div><h3>Methods</h3><div>A single institutional database was queried for procedural codes for collagenase treatment or surgical fasciectomy. A total of 658 patients were identified in this query. Out of this cohort, 341 patients were eligible for inclusion. The cohort consists of 141 initially treated with fasciectomy and 200 initially treated with collagenase, between 2015 and 2019. The primary outcome was the need for subsequent treatment in the same digit, other digits of the same hand, or the contralateral hand. Predictor variables included demographics, medical history, and pretreatment contracture severity.</div></div><div><h3>Results</h3><div>At a mean follow-up of 5.3 years, 142 (42%) of patients underwent additional treatment. Revision procedures on the same digit occurred in 88 patients (26%) at a mean of 3.2 years, on another digit in the same hand in 35 patients (10%) at a mean of 3.6 years, and on the contralateral hand in 79 patients (23%) at a mean of 2.3 years. Procedure, multiple digits treated, and initial nontreated contracture are associated with subsequent procedures on the same digit. Younger age, active smoking, and initial nontreated contracture are associated with subsequent procedures on another digit in the same hand. Dominant hand was initially treated; initial nontreated contracture are associated with subsequent procedures on the contralateral hand.</div></div><div><h3>Conclusions</h3><div>Within 5 years of initial treatment for Dupuytren contracture in one digit, patients have over 40% likelihood of future intervention for contracture. Patients have approximately a 10% likelihood of future treatment on another digit in the same hand and nearly a 25% likelihood of future treatment in the contralateral hand. Key risk factors include age, multiple digits treated, smoking, and the presence of initially nontreated fingers, which should be incorporated into patient counseling.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1097-1106"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Treatment of Scaphoid Nonunion With Open Reduction Internal Fixation and Nonvascularized Autograft","authors":"Lynn Ann Forrester MD,&nbsp;Rafa Rahman MD,&nbsp;Raylin Xu MD,&nbsp;Michelle Carlson MD,&nbsp;Daniel Osei MD,&nbsp;Samir K. Trehan MD","doi":"10.1016/j.jhsa.2026.05.006","DOIUrl":"10.1016/j.jhsa.2026.05.006","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to assess outcomes after treatment of scaphoid nonunion with open reduction internal fixation and nonvascularized autograft (NVA).</div></div><div><h3>Methods</h3><div>This was a retrospective case series assessing all patients with scaphoid nonunions treated with open reduction internal fixation and NVA at a multispecialty orthopedic hospital from 2014 to 2024. Inclusion criteria were 12 weeks or greater from date of injury to date of surgery. Exclusion criteria were absence of postoperative CT scan or presence of additional local procedures. Radiographic healing was defined as 50% bridging bone on CT scan.</div></div><div><h3>Results</h3><div>Ninety-nine patients were included in this study: 45 patients were treated with cancellous only autograft (COA), 52 were treated with corticocancellous autograft (CCA), and 2 were treated with osteochondral autograft. Ninety-five percent of patients healed. Median time to healing was 81 days. On first postoperative CT, obtained at a median of 77 days after surgery, 75% of patients were healed. Eighty-nine percent of patients had bridging bone present on first CT; 99% of these patients went on to heal. Thirteen patients in this study had a prior attempt at surgical fixation at another institution; all healed after revision surgery. There were no significant differences in the odds of healing at any time point or the time to healing for patients treated with CCA versus COA.</div></div><div><h3>Conclusions</h3><div>Surgical treatment of scaphoid nonunion with NVA had a union rate of 95%. There were no significant differences in outcomes between patients treated with CCA and COA. Of patients who exhibited bridging bone on CT obtained at a median of 76 days after surgery, 99% went on to union. These findings support use of NVA for scaphoid nonunion and discourage the use of multiple postoperative CT scans to confirm healing.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1078-1083"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}