Journal of Hand Surgery-American Volume最新文献

{"title":"Modifier 22 Use in Surgical Treatment of Distal Radius Fractures Within an Integrated Health Care System.","authors":"Alexander Mayers, Mahmoud Mahmoud, Yagiz Ozdag, Jessica L Koshinski, Victoria C Garcia, Joel C Klena, Louis C Grandizio","doi":"10.1016/j.jhsa.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>Modifier 22 is a billing modifier that may provide additional reimbursement and can be used for complex operative procedures requiring greater surgeon time or effort. However, Modifier 22 utilization has been infrequently analyzed in the upper extremity. Our purpose was to assess patient, injury, and surgeon characteristics associated with Modifier 22 utilization associated with operative treatment of distal radius fractures (DRFs).</p><p><strong>Methods: </strong>A retrospective chart review of operatively treated adult DRFs between 2016 and 2020 was conducted within a single, integrated health care system. We recorded patient, surgeon, and injury characteristics as well as the utilization of a Modifier 22 code. A binary multiple logistic regression model was constructed from patient, injury and surgeon demographic factors. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were reported.</p><p><strong>Results: </strong>Twenty-one surgeons performed 934 included DRF cases, of which 101 cases (11%) used a Modifier 22 code. Modifier 22 utilization ranged from 0% to 38% by surgeon. Hand fellowship training was significantly associated with increased Modifier 22 utilization (OR 3.53, 95% CI [1.95-6.38]). Significantly increased Modifier 22 utilization was also associated with government/military insurance compared to private insurance (OR 9.63, 95% CI [1.89-49.12]), open fractures (OR 4.94, 95% CI [1.42-17.24]), and increased operative time (OR 1.05, 95% CI [1.03-1.08]). \"Increased service intensity or procedural time\" and \"increased technical difficulty\" were the most commonly cited coding justifications.</p><p><strong>Conclusions: </strong>For DRF, Modifier 22 utilization varies widely by the surgeon. Hand fellowship training, insurance status, and open fractures were significantly associated with increased utilization. Fracture classification (exclusive of open fractures) and body mass index were not associated with higher rates of Modifier 22 utilization.</p><p><strong>Clinical relevance: </strong>These data suggest that utilization of Modifier 22 codes associated with DRF is primarily driven by surgeon-specific billing practices, training and case length rather than complex fracture patterns and obesity.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276769","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":"Trapeziometacarpal Joint Arthrodesis Using a Locking Plate and Headless Compression Screw With an Autogenous Bone Graft.","authors":"Akihiro Hirakawa, Shingo Komura, Marie Nohara, Kazuichiro Ohnishi, Haruhiko Akiyama","doi":"10.1016/j.jhsa.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.021","url":null,"abstract":"<p><strong>Purpose: </strong>Trapeziometacarpal (TMC) joint arthrodesis is an established surgical option to manage TMC joint arthritis. However, nonunion remains a complication after arthrodesis. In this study, we aimed to evaluate the outcomes of using a locking plate and headless compression screw with autogenous bone grafting.</p><p><strong>Methods: </strong>We identified 21 thumbs that underwent TMC arthrodesis using this procedure. Radiographs and computed tomography scans were obtained to define bone union. Furthermore, we asked patients whether they had returned to their original work at every follow-up visit. To assess objective and subjective outcomes, we measured grip and pinch strengths; range-of-motion; radial and palmar abduction; Kapandji score; visual analog scale score; Disabilities of the Arm, Shoulder, Hand score; and Hand20 questionnaire scores before surgery and at 3, 6, and 12 months after surgery.</p><p><strong>Results: </strong>Bone union was achieved in all patients. Bone fusion was achieved within 8 weeks after surgery in 17 thumbs, the remaining thumbs achieved bony fusion within 11 weeks. Thirteen of the 14 patients who had paid employment returned to their original work after a mean of 7 weeks. Grip and pinch strengths decreased at 3 months but returned to baseline levels at 6 months after surgery. Metacarpophalangeal joint flexion and Kapandji score decreased at 3 months and did not recover to baseline levels at 1 year after surgery. The visual analog scale and Disabilities of the Arm, Shoulder, Hand scores, and the Hand20 questionnaire showed improvement in the early postoperative period, which continued until 1 year after surgery.</p><p><strong>Conclusions: </strong>Locking plate and headless compression screw fixation with an autogenous bone graft allows for a reliable bone union and return to work.</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":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276770","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":"Expanded Exposure of the Olecranon Osteotomy by Lateral Collateral Ligament Release.","authors":"Harrison R Ferlauto, Christoph A Schroen, Katrina S Nietsch, Brian G Beitler, Dave Shukla, Jaehon M Kim, Michael R Hausman","doi":"10.1016/j.jhsa.2025.04.023","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.023","url":null,"abstract":"<p><strong>Purpose: </strong>Intra-articular distal humerus fractures with anterior articular involvement necessitate anatomic reduction and stable fixation to restore maximal elbow motion. However, traditional approaches to the elbow provide incomplete exposure of the distal humerus articular surface. To improve visualization of the capitellum and anterior trochlea, we have found it useful to supplement the olecranon osteotomy (OO) with a release, and subsequent repair, of the lateral ulnar collateral ligament (LUCL). The purpose of this study was to quantify and characterize the additional distal humerus articular surface exposure provided by LUCL release.</p><p><strong>Methods: </strong>An OO approach was performed in 10 fresh frozen cadaver elbows. The margin of the distal humerus articular surface visible after OO was marked with ink. The LUCL was then released from its humeral origin and the additional region of visible articular surface was marked. The distal humerus was then excised. The region of the articular surface initially visible after OO alone was painted blue, and the additional region visible after LUCL release was painted red. The surface areas of the painted regions were quantified using a three-dimensional scanner.</p><p><strong>Results: </strong>The mean percent of total distal humerus articular surface, trochlear surface, and capitellar surface visible after OO alone was 50.4 ± 7.9%, 62.8 ± 8.2%, and 20.3 ± 7.8%, respectively. After OO plus LUCL release, 100% of the total articular surface, trochlear surface, and capitellar surface was visible.</p><p><strong>Conclusions: </strong>The OO is limited in that it only provides exposure of the posterior 63% of the trochlea and posterior 20% of the capitellum. Supplementary LUCL release significantly improves exposure of the OO, reliably providing access to the entire anterior articular surface of the distal humerus.</p><p><strong>Clinical relevance: </strong>The expanded exposure of the OO by LUCL release may be useful for optimizing visualization and fixation of complex, intra-articular distal humerus fractures involving the anterior articular surface.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267935","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":"State Disparities in Medicaid Versus Medicare Reimbursement for Hand Surgery.","authors":"Adam P Henderson, Lane Moore, Annika Hiredesai, Paul R Van Schuyver, Joseph C Brinkman, Jack M Haglin, Jeffrey D Hassebrock, Kevin J Renfree","doi":"10.1016/j.jhsa.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.013","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to compare the Medicaid and Medicare professional service reimbursement rates for a select group of hand surgery procedures.</p><p><strong>Methods: </strong>Medicare rates for 26 common hand procedures were obtained from the Center for Medicare & Medicaid fee schedule database using Medicare Administrative Contractor localities to approximate state lines. Medicaid rates were found at each state Medicaid online fee schedule website. State rates were compared with corresponding Medicare rates using mean values and dollar differences. Each state's reimbursement values were also adjusted using the Medicare Wage Index, a relative scale comparing state wages with the national average, to account for regional wage differences. Variability between states and between procedures was analyzed using the coefficient of variation values.</p><p><strong>Results: </strong>Medicaid reimbursement was lower than that of Medicare for 22 of the 26 procedures included in the analysis. On average, Medicaid reimbursement rates were 18% lower than Medicare for the same procedure, a difference that increased to 29% when accounting for wage differences via the Medicare Wage Index. The coefficient of variation values were low across Medicare procedures, indicating low variability between states. The coefficient of variation values were much higher for Medicaid rates and increased when adjusted for state wage differences, indicating high variability between state Medicaid rates.</p><p><strong>Conclusions: </strong>Professional fee reimbursement for select hand surgery procedures is substantially lower with Medicaid compared with Medicare, and there is a high degree of variability between states. Wage differences do not explain differences in state pricing.</p><p><strong>Clinical relevance: </strong>Low Medicaid reimbursement for hand surgery procedures may have negative implications for health care access in some states. The wide variability in reimbursement between states is concerning, given that Medicaid is supported mostly by federal funding.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250946","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":"Predictors of Patient Migration for Staged Bilateral Carpal Tunnel Release Procedures.","authors":"Adriana P Liimakka, Troy B Amen, Samuel S Rudisill, Duretti Fufa","doi":"10.1016/j.jhsa.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.017","url":null,"abstract":"<p><strong>Purpose: </strong>Staged bilateral carpal tunnel release (CTR) is a common surgical treatment for patients with bilateral carpal tunnel syndrome refractory to nonsurgical measures. Factors influencing whether a patient undergoes surgery on both hands by the same or different surgeons are not well characterized. This study aimed to identify patient and clinical factors associated with patient migration during staged bilateral CTR within 90 days of the index procedure.</p><p><strong>Methods: </strong>Adult patients who underwent CTR between 2015 and 2022 were identified using the PearlDiver Mariner Database. Differences in patient demographic and clinical characteristics, surgical technique, and postoperative course were assessed between patients who underwent contralateral CTR within 90 days with the same surgeon who performed the index procedure, and those with a different surgeon. Multivariable logistic regression identified factors associated with patient migration while adjusting for potential confounding factors.</p><p><strong>Results: </strong>A total of 213,676 patients underwent staged bilateral CTR within the study period, of which 182,008 (85.2%) had both procedures performed by the same surgeon and 31,668 (14.8%) had them performed by two different surgeons. Factors independently associated with greater odds of patient migration included utilization of endoscopic technique for the index procedure (OR 1.20, 95% CI 1.17-1.23), incidence of postoperative complications following the index procedure (1.22, 1.09-1.36), and being insured by Medicaid (1.29, 1.23-1.34) relative to commercial insurance. Those residing in rural regions were less likely to change surgeons than those living in urban areas (0.85, 0.82-0.89).</p><p><strong>Conclusions: </strong>Nearly 15% of patients had their contralateral CTR procedure performed by a different surgeon within three months of their index CTR. Patient migration was associated with Medicaid insurance, use of endoscopic techniques, postoperative complication, and urban residence.</p><p><strong>Clinical relevance: </strong>These results may inform the design of future prospective studies to better understand key factors contributing to patient migration.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235914","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":"Volar Plate Impingement Following Scaphoid Fracture Nonunion Surgery Using a Volar Locking Plate: A Retrospective Case Series.","authors":"Michael J Stoltz, Nolan Smith, Eric Metzman, James Gainer, John A Nyland, Victor L Fehrenbacher, Amit Gupta, Luke P Robinson","doi":"10.1016/j.jhsa.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.017","url":null,"abstract":"<p><strong>Purpose: </strong>Internal fixation using volar locking plates is one surgical option for addressing scaphoid fracture nonunion. Concerns about impingement and plate removal remain, and there is limited literature on imaging findings. This study assessed volar plate impingement (VPI) using a classification based on radiographs and computed tomography (CT) scans.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients who underwent open reduction and internal fixation of scaphoid waist nonunion with a volar plate and bone grafting. Exclusions included less than 90 days of follow-up, lack of postoperative CT scans, or continued nonunion, which were excluded to eliminate further confounding variables in plate impingement. Three hand surgeons independently reviewed postoperative CT scans and radiographs, classifying VPI into four groups: none, mild (extra-articular wear), moderate (wear/bone loss involving the articular surface), and severe (plate blocking flexion and \"spanning\" the joint). These findings were correlated with plate removal.</p><p><strong>Results: </strong>Twenty-one patients met the inclusion criteria. Computed tomography evaluation revealed five patients with no impingement, five mild, six moderate, and five severe. Only two patients exhibited impingement on X-ray evaluation. Eight patients (38%) underwent plate removal because of symptomatic impingement associated with pain or limited flexion. Three of five with severe impingement had plates removed, with one more planned for removal. Three of six with moderate impingement underwent plate removal. The impingement scale showed moderate inter-rater reliability.</p><p><strong>Conclusions: </strong>The diagnosis of VPI based on CT scans is common after volar locked plating and occurs along a spectrum of findings ranging from minimal bony change to articular wear/block to motion. Radiographs are less sensitive to VPI and do not correlate with CT. Plate removal should be based on clinical symptoms, and a CT scan is more diagnostic than plain radiographs when evaluating for plate impingement.</p><p><strong>Type of study/level of evidence: </strong>Level IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235916","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 Esmarch Bandage in Hand Surgery: Historical Overview, Clinical Utility, and Associated Risks.","authors":"Naomi Kelley, Nathan T Morrell","doi":"10.1016/j.jhsa.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.009","url":null,"abstract":"<p><p>There is no debating the impact of tourniquets on the field of hand surgery. Tourniquets provide considerable utility for surgeons, allowing improved tissue visualization and reduced intraoperative blood loss. Although there are a number of limb exsanguination techniques, the most common is the use of a thin, wide elastic bandage, commonly referred to as the \"Esmarch bandage.\" Described in 1873, the original \"Esmarch bandage\" exsanguinated the operative limb with a woven rubber bandage before application of a hollow rubber tube on the proximal limb to provide a bloodless surgical field. Johann Friedrich August von Esmarch's contribution was primarily the manner in which he maintained limb ischemia as the bandage used for exsanguination had been previously developed by others. von Esmarch's impact has nevertheless been memorialized by the use of thin, elastic bandage, despite the fact that the current \"Esmarch bandage\" bears little resemblance to his 19th century rubber tube. In this manuscript, we summarize the history, utility, complications, and current recommendations associated with the modern Esmarch bandage within the context of hand surgery.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235915","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":"Proximal Pole Scaphoid Fracture Nonunion Treated With Ipsilateral Hamate Transfer: A Case Series.","authors":"Reinaldo E Colon-Morillo, John P Waggoner, Jerrod C Hammes, Shian L Peterson, Dominic Gomez-Leonardelli, Darren D Thomas","doi":"10.1016/j.jhsa.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.022","url":null,"abstract":"<p><strong>Purpose: </strong>The scaphoid's retrograde blood flow renders it vulnerable to fracture nonunion proximally. As proximal fragmentation occurs, reconstructive options become challenging with little consensus regarding treatment. Proposed surgical techniques include vascularized or nonvascularized grafts and fragment excision with scapholunate (SL) ligament advancement. We hypothesized that ipsilateral proximal hamate with volar capitohamate ligament autograft would provide a viable treatment for proximal pole scaphoid nonunion in a sample drawn from a military population.</p><p><strong>Methods: </strong>Eleven patients with fragmented proximal pole scaphoid nonunion underwent open fragment excision and internal fixation with ipsilateral proximal hamate transfer by a single surgeon at a tertiary-referral military hospital. Patient demographics, clinical parameters, return-to-duty rates, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were obtained. Radiographs and computed tomography scans were evaluated to determine preoperative lunate height and proximal pole fragmentation and postoperative SL widening, carpal alignment, and bony healing. Descriptive statistics were used for analysis.</p><p><strong>Results: </strong>The 11 patients were male active-duty service members, with an average age of 24.3 years (range: 18-29 years) and an average follow-up of 96 weeks. The average preoperative lunate height was 7.2 mm. The harvested hamate graft length was equal to the lunate height. The average final postoperative SL widening was 1.5 mm, a reduction of 23.3% from initial postoperative radiographs. One patient was excluded, and one patient required reoperation for arthrofibrosis. At the last follow-up, 10 patients demonstrated radiographic evidence of union, and 6 returned to unrestricted military service. The average Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire score for 10 patients was 15.7 at the final follow-up.</p><p><strong>Conclusions: </strong>In the short-term follow-up, treating proximal pole scaphoid nonunion with ipsilateral proximal hamate autograft transfer results in reliable bony union, stable radiographic SL alignment, and low levels of disability while avoiding risks and morbidity associated with other options.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217611","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 Optimal Donor Site From the Foot as a Nonvascularized Osteochondral Graft for the Reconstruction of Lunate Facet Defects in Distal Radius Intra-Articular Fracture: A Computed Tomography and Cadaveric Study.","authors":"Marianne Therese S Feng, Seo-Jun Lee, Jae Jun Nam, Im Joo Rhyu, In Cheul Choi, Jong Woong Park","doi":"10.1016/j.jhsa.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.014","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify the best donor sites for a nonvascularized osteochondral graft from the foot to reconstruct lunate facet defects in malunited distal radius fractures.</p><p><strong>Methods: </strong>Fifty-six wrist computed tomography (CT) scans, obtained from scaphoid fracture patients, assessed the lunate facet's articular surface for dorsal and volar width, dorsovolar length, and concavity depth. Additionally, 60 foot CT scans, obtained from calcaneus fracture patients, assessed the second and third metatarsals and cuneiforms for dorsal and plantar width, dorsoplantar length, concavity/convexity, inflection point, and articular cartilage thickness. A cadaver study of 20 feet recorded the same parameters along with cartilage thickness using ultrasound and further examined the accessory fibular and tibial facets of the four bones.</p><p><strong>Results: </strong>The lunate facet measured 11.4 mm dorsally, 13.9 mm volarly, and 17.4 mm long with a 3 mm concavity. The sizes of dorsal and plantar width and dorsoplantar length of articular surfaces of all four foot bones were large enough for lunate facet reconstruction. The second metatarsal and second cuneiform showed concave and convex surfaces in 100% of the cases, respectively. The third metatarsal was concave in 21.7% and convex in 78.3% of the cases. The third cuneiform was concave in 78.3% and convex in 21.7% of the cases. The cadaver study confirmed similar results, with cartilage thickness ranging from 0.5 to 0.7 mm. The dorsofibular accessory facet was oval and larger on the base of the third metatarsal.</p><p><strong>Conclusions: </strong>The third metatarsal base and third cuneiform are the best donor sites for lunate facet reconstruction. A convex donor site is suboptimal for reconstructing the concave lunate facet; therefore, a preoperative CT scan is mandatory for identifying an appropriate concave donor site.</p><p><strong>Clinical relevance: </strong>The study recommends the third metatarsal base or third cuneiform for lunate facet reconstruction in distal radius fractures.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217612","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":"A Machine Learning Algorithm to Estimate the Probability of a True Scaphoid Fracture After Wrist Trauma","authors":"Anne Eva J. Bulstra MD","doi":"10.1016/j.jhsa.2025.01.021","DOIUrl":"10.1016/j.jhsa.2025.01.021","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify predictors of a true scaphoid fracture among patients with radial wrist pain following acute trauma, train 5 machine learning (ML) algorithms in predicting scaphoid fracture probability, and design a decision rule to initiate advanced imaging in high-risk patients.</div></div><div><h3>Methods</h3><div>Two prospective cohorts including 422 patients with radial wrist pain following wrist trauma were combined. There were 117 scaphoid fractures (28%) confirmed on computed tomography, magnetic resonance imaging, or radiographs. Eighteen fractures (15%) were occult. Predictors of a scaphoid fracture were identified among demographics, mechanism of injury and examination maneuvers. Five ML-algorithms were trained in calculating scaphoid fracture probability. ML-algorithms were assessed on ability to discriminate between patients with and without a fracture (area under the receiver operating characteristic curve), agreement between observed and predicted probabilities (calibration), and overall performance (Brier score). The best performing ML-algorithm was incorporated into a probability calculator. A decision rule was proposed to initiate advanced imaging among patients with negative radiographs.</div></div><div><h3>Results</h3><div>Pain over the scaphoid on ulnar deviation, sex, age, and mechanism of injury were most strongly associated with a true scaphoid fracture. The best performing ML-algorithm yielded an area under the receiver operating characteristic curve, calibration slope, intercept, and Brier score of 0.77, 0.84, −0.01 and 0.159, respectively. The ML-derived decision rule proposes to initiate advanced imaging in patients with radial-sided wrist pain, negative radiographs, and a fracture probability of ≥10%. When applied to our cohort, this would yield 100% sensitivity, 38% specificity, and would have reduced the number of patients undergoing advanced imaging by 36% without missing a fracture.</div></div><div><h3>Conclusions</h3><div>The ML-algorithm accurately calculated scaphoid fracture probability based on scaphoid pain on ulnar deviation, sex, age, and mechanism of injury. The ML-decision rule may reduce the number of patients undergoing advanced imaging by a third with a small risk of missing a fracture. External validation is required before implementation.</div></div><div><h3>Type of study/level of evidence</h3><div>Diagnostic II.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"50 6","pages":"Pages 711-720"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194554","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}