Casey Imbergamo, Gongliang Zhang, Gabriel Yohe, Kyle Sanniec, Allan Fong, Aviram M Giladi
{"title":"Open Versus Endoscopic Carpal Tunnel Release: A Decision Tool Guided by Multi-Criteria Decision Analysis Incorporating Patient-Reported Outcomes, Complications, and Cost.","authors":"Casey Imbergamo, Gongliang Zhang, Gabriel Yohe, Kyle Sanniec, Allan Fong, Aviram M Giladi","doi":"10.1016/j.jhsa.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.016","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this work was to develop a multi-criteria decision analysis model guided in part by early postoperative patient-reported data to compare open (OCTR) and endoscopic carpal tunnel release (ECTR) and create an interactive platform in the shared decision-making process. Our null hypothesis was that there would be no difference in patient-reported outcomes following OCTR or ECTR, and with all variables weighted equally, OCTR would be the preferred procedure, owing primarily to its lesser cost.</p><p><strong>Methods: </strong>Data from patients who underwent OCTR or ECTR at an institution from 2018 to 2023 were collected. Patient-reported outcome data used in this study to reflect early postoperative experiences/value were collected in real time at the 2-week postoperative time point. Institutional financial data were collected. Complication data were pulled from the existing literature. Multi-criteria decision analysis modeling was then used to create an interface whereby patients and providers can manually adjust weights for each variable based on individual priorities.</p><p><strong>Results: </strong>Nine hundred and eight patient encounters were included for data set modeling. When preferentially weighting transient nerve injury, recurrence, or patient cost as variables of importance, OCTR is the preferred procedure. When weighing permanent nerve injury, infection, or early improvement in pain/function, ECTR is the preferred procedure. The Curtis National Hand Center Carpal Tunnel Decision Matrix was subsequently created to provide real time results as the weight of each variable is adjusted.</p><p><strong>Conclusions: </strong>This study presents a model guided by patient-reported outcome data as a reflection of the patient experience surrounding carpal tunnel release surgery. This decision aid tool is intended to be used for individual patient-level knowledge and decision-making as a reflection of patient attitudes.</p><p><strong>Level of evidence/type of study: </strong>Decision analysis IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163858","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":"Long-Term Outcomes of Radial Shortening Osteotomy for Kienböck Disease: Minimum 20-Year Follow-Up Study.","authors":"Tomoaki Suzuki, Yuichiro Matsui, Daisuke Momma, Takeshi Endo, Hirofumi Miyaji, Norimasa Iwasaki","doi":"10.1016/j.jhsa.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.018","url":null,"abstract":"<p><strong>Purpose: </strong>We have been performing radial shortening osteotomies for patients with negative ulnar variance and Lichtman stage 2 or higher Kienböck disease. Although we previously reported the results of this procedure 10 years after surgery, reports on follow-up beyond 10 years remain scarce. This study aimed to investigate the results of radial shortening osteotomy for Kienböck disease based on long-term clinical and radiographic outcomes for a minimum of 20 years after surgery.</p><p><strong>Methods: </strong>The cohort comprised seven patients with eight wrists treated between 1991 and 2002, whose average age at the time of surgery was 25.9 years (range: 17-44 years). The preoperative Lichtman classification was stage 3A in one wrist, 3B in five, and stage 4 in one; the mean preoperative ulnar variance was -2.2 mm (range: -1.0 to -3.5 mm). Changes in pain, range of motion, grip strength, modified Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and radiographs were evaluated from 10 years after surgery to the last follow-up at least 20 years after surgery.</p><p><strong>Results: </strong>Pain remained reduced in all patients at 20 years after surgery. Improvements in wrist extension and flexion observed 10 years after surgery were maintained at the last follow-up. Grip strength at 10 years after surgery was maintained at the last follow-up. The mean modified Mayo wrist score and the mean DASH score were maintained from 10 years after surgery to the last follow-up. Radiography showed no progression of lunate collapse in any case, although one case showed progression of degeneration in the radiocarpal joint and the distal radioulnar joint.</p><p><strong>Conclusions: </strong>Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after surgery.</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":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152435","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":"Impact of Surgical Timing on Functional Outcomes in Radial Club Hand: A Retrospective Study of Bayne-Klug Type IIIb/IV Cases.","authors":"İsmail Bülent Özçelik, Muath Mamdouh Mahmod Al-Chalabi, Yücel Ağırdil, Berkan Mersa","doi":"10.1016/j.jhsa.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.027","url":null,"abstract":"<p><strong>Purpose: </strong>Radial club hand is a congenital malformation characterized by varying degrees of radial deviation and radial bone hypoplasia or absence. However, the optimal timing for corrective surgery remains a subject of debate. This study aimed to assess the impact of the timing of radial club surgery on functional outcomes.</p><p><strong>Methods: </strong>Eligibility for inclusion was limited to patients exhibiting type IIIb or type IV deformities according to the Bayne and Klug classification, who began hand therapy and splinting postnatally, and underwent all surgical interventions before 10 months of age. Regular assessments were conducted for a minimum of 2 years, and up to 6 years after intervention. Data, including demographics, surgical interventions, post-intervention ranges of motion, and complications, were collected retrospectively.</p><p><strong>Results: </strong>All 22 patients (34 hands) included in this study underwent surgical intervention before age 10 months. Our results demonstrated a mean preoperative hand-forearm angulation of 86.8° (range, 20°-150°) and a mean postoperative hand-forearm angulation of 3.8° (range, 0°-20°). The final range of motion showed a mean flexion of 84.3° (range, 70°-90°) in 30 hands, mean extension of 65.7° (range, 60°-70°) in 28 hands, mean ulnar deviation of 35.6° (range, 30°-40°) in 25 hands, and mean radial deviation of 17.4° (range, 15°-20°) in 27 hands. Skin necrosis occurred in 3 cases (9%).</p><p><strong>Conclusions: </strong>A comprehensive management approach immediately after birth, integrating exercises, splinting, and surgical correction before age 10 months is effective and safe.</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":2.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152311","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}
Tiffany Tse, Annie Wang, Daniel Antflek, Christine Novak, Heather Baltzer
{"title":"Culturally Sensitive Care in Amputations: Recognition and Strategies.","authors":"Tiffany Tse, Annie Wang, Daniel Antflek, Christine Novak, Heather Baltzer","doi":"10.1016/j.jhsa.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.007","url":null,"abstract":"<p><p>The dignified disposal of limbs post-amputation is important to many cultural groups but is often not addressed. There is limited understanding from physicians and surgeons around the disposal process and its impact on patients, their beliefs, and their experiences within the health care system. In this overview, cultural and spiritual perspectives are reviewed and coupled with recommendations regarding the disposal and reclamation process. The current handling and management process of amputated parts is centered around hospital priorities. The beliefs and wishes of patients are not routinely considered, nor are the barriers to this adequately discussed. These implications affect groups with spiritual or cultural preferences that do not align with hospital standards, further exacerbating health inequity. This review provides information for health care providers surrounding the disposal of amputated parts to provide culturally sensitive and dignified approaches to patient care.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136604","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":"Wrist Extension Reconstruction Using Distal Anterior Interosseous to Extensor Carpi Radialis Brevis Nerve Transfer in Brachial Plexus Injuries.","authors":"Harvey Chim, Sami H Tuffaha, Johnny Chuieng-Yi Lu","doi":"10.1016/j.jhsa.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.010","url":null,"abstract":"<p><strong>Purpose: </strong>Reconstruction of wrist extension in C5-C8 root brachial plexus injuries (BPIs) is challenging, because of limited nerve and tendon donors. The purpose of this study was to report outcomes relating to the pronator quadratus branch of the anterior interosseous nerve (AIN) to extensor carpi radialis brevis (ECRB) nerve transfer from three BP surgeons.</p><p><strong>Methods: </strong>Ten patients with C5-C8 BPI underwent AIN to ECRB nerve transfer. The mean age of the patients was 30.5 ± 15.9 years. All patients were men. The mean time to nerve surgery following initial injury was 4.5 ± 1.2 months. In all patients, wrist extension was absent at baseline. All patients had a minimum follow-up of 12 months (mean: 28.1 months) after surgery.</p><p><strong>Results: </strong>Seven of 10 patients achieved Medical Research Council (M) grading system 4 wrist extension. In these patients, mean time to M2 was 12.7 ± 10.1 months, and mean time to M4 was 19.9 ± 10.0 months. The three patients who did not achieve M4 wrist extension had double fascicular transfer and relied strongly on the \"Oberlin effect\" where wrist flexion was required to initiate and achieve antigravity elbow flexion. Additionally, the three patients who did not achieve M4 wrist extension also had longer recovery to achieve antigravity (M3) elbow flexion, all presenting with poorer ability to initiate and achieve elbow flexion independent of the Oberlin effect. None of the patients had loss of forearm pronation after AIN to ECRB nerve transfer.</p><p><strong>Conclusions: </strong>The AIN to ECRB nerve transfer can effectively reconstruct wrist extension in BPI patients with C5-C8 root injuries. Single fascicular transfer with the ulnar nerve as a donor and avoidance of multiple muscle targets for reinnervation from the median nerve may result in more consistent recovery through this nerve transfer.</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":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136606","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}
Andrew I Abadeer, Austin Hembd, Daina Brooks, James P Higgins, Aviram M Giladi, Valeriy Shubinets
{"title":"Arterial Perfusion of the Medial Femoral Trochlea Flap Examined by Micro-Computed Tomography Angiography.","authors":"Andrew I Abadeer, Austin Hembd, Daina Brooks, James P Higgins, Aviram M Giladi, Valeriy Shubinets","doi":"10.1016/j.jhsa.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.04.008","url":null,"abstract":"<p><strong>Purpose: </strong>The medial femoral trochlea (MFT) flap is a source of vascularized articular cartilage that has most commonly been used for reconstruction of proximal pole scaphoid nonunions and lunate osteonecrosis in Kienbock disease. This study aimed to describe the arterial perfusion of the MFT.</p><p><strong>Methods: </strong>Selective injection of the descending genicular artery (DGA) was performed with radiopaque dye in eight cadaveric lower extremities. Micro-computed tomography was performed on the medial femoral condyle including the MFT segment, with digital analysis quantifying vessel location and internal diameter within the territory of the MFT flap.</p><p><strong>Results: </strong>All specimens had adequate perfusion up to the MFT from the transverse branch of the DGA. The transverse branch and longitudinal branches of the DGA were of similar caliber (0.45 ± 0.19 and 0.49 ± 0.29 mm, respectively). The segment of bone and cartilage included in MFT harvest had an average of 5.9 ± 1.2 terminal periosteal vessels and 2.8 ± 1.9 nutrient vessels. The greatest number of nutrient vessels to the MFT were contained within 6.3 ± 2.19 mm from the cartilage margin. More nutrient vessels were found penetrating the cortex on the proximal aspect of the trochlea. The nutrient vessels demonstrated a consistent pattern of perfusion penetrating the cortex and coursing perpendicular to the surface of the femur.</p><p><strong>Conclusions: </strong>The MFT flap is reliably perfused by the transverse branch of the DGA with a rich supply of periosteal and nutrient vessels adjacent to cartilage. These vessels often collateralize with terminal vessels of the longitudinal branch. Periosteal and nutrient vessels to the flap are within 6.3 mm from the edge of the cartilage, which translates to a safe margin for osteotomy/flap harvest.</p><p><strong>Clinical relevance: </strong>Understanding MFT microperfusion guides optimal flap harvest by maximizing the capture of osseous perforators.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129218","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}
Ausberto R Velasquez Garcia, Adam J Wentworth, Hiroki Nishikawa, Shawn W O'Driscoll
{"title":"Three-Dimensional Orientation of the Radial Neck Axis Angulation: Implications for Radial Head Replacement.","authors":"Ausberto R Velasquez Garcia, Adam J Wentworth, Hiroki Nishikawa, Shawn W O'Driscoll","doi":"10.1016/j.jhsa.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.023","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the 3-dimensional (3D) orientation of the radial neck axis with respect to the forearm rotation axis and explore its theoretical implications for radial head prosthetic replacement.</p><p><strong>Methods: </strong>Computed tomography scans of the forearm of healthy individuals were used to construct 3D bone models defining the relationship between the forearm rotation and radial neck axes (FRANA). These models were adjusted to achieve neutral forearm rotation. A comprehensive method for measuring FRANA in 3D was developed, and the results were compared with those of clinical simulated 2-dimensional (2D) projections.</p><p><strong>Results: </strong>In 20 patients, the 3D FRANA angle averaged 5.1° (SD: 2.2°, 95% confidence intervals [CI]: 4.1-6.2°) consistently oriented toward the palmar side. This was strongly correlated (r = 0.87) with 2D measurements in the anterior view with the forearm in neutral rotation (mean: 4.5°, SD: 2.3°, 95% CI: 3.5°-5.6°), but not with the measurements in the lateral view (mean: -0.1°, SD: 2.5°, 95% CI: -1.3° to 1.0°). Angular measurements in the anterior view were strong predictors of 3D FRANA (R<sup>2</sup> = 0.8).</p><p><strong>Conclusions: </strong>The axis of the radial neck does not line up precisely with the axis of forearm rotation but points to a location that is approximately 2 cm palmar to the fovea of the distal ulna. Significant differences were found between 3D and 2D lateral measurements, which highlights the benefits of computer-assisted modeling for analyzing proximal radial geometry.</p><p><strong>Clinical relevance: </strong>With the forearm in neutral rotation, the proximal radial canal is aligned with the axis of forearm rotation in the sagittal plane but points to a mean of 5° palmarly in the coronal plane. This information can be used to optimize the radial neck cut and direction of canal preparation prior to prosthesis insertion.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121410","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 Impact of Emerging Therapies and Declining Physician Reimbursement on Dupuytren Disease Treatment: A 21-Year Review.","authors":"Evan H Richman, Dylan Rakowski, Alexander Lauder","doi":"10.1016/j.jhsa.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.013","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the trends in treatment and physician reimbursement for Dupuytren contracture (DC) within the Medicare population over a 21-year period, with a focus on how the introduction of collagenase clostridium histolyticum (CCH) has affected treatment patterns. Additionally, this study examines public interest in DC treatments through Google search trends.</p><p><strong>Methods: </strong>Medicare Part B data from 2000 to 2021 were analyzed to assess procedure volumes, charges, and reimbursements using Current Procedural Terminology codes for percutaneous needle fasciotomy (PNF), open fasciectomy, and CCH injection. Inflation-adjusted reimbursement rates were calculated. Google Trends data from 2012 to 2023 were analyzed to assess public interest in DC and its treatments.</p><p><strong>Results: </strong>From 2000 to 2021, DC treatment volumes increased by 468%, with CCH becoming the most widely used treatment, accounting for 61% of all procedures in 2021. PNF increased by 468%, whereas open fasciectomy decreased by 39%. Reimbursement for all DC treatments declined by 18% after inflation adjustment, with the greatest decline in PNF (32%) and the smallest in CCH (5%). Public interest, as measured by Google Trends, demonstrated a 525% increase in searches related to DC, with a 1,033% rise for CCH.</p><p><strong>Conclusions: </strong>The introduction of CCH has led to a considerable increase in the treatment of DC, possibly driven in part by rising public awareness of emerging therapies. Furthermore, the declining reimbursement rates for all procedures underscore the financial challenges faced by clinicians, particularly given the high cost of treatments like CCH.</p><p><strong>Clinical relevance: </strong>The growing use of CCH as the dominant treatment for DC underscores how marketing and public awareness may influence treatment practices. Physicians have a responsibility to understand these influences, ensuring that treatment decisions are guided by clinical efficacy and cost-effectiveness while managing patient expectations and prioritizing long-term outcomes over trends driven by marketing.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082173","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}
Etka Kurucan, Bradley Wiekrykas, Alec Talsania, Gabriel Alonso, Joseph Thoder, Mark Solarz
{"title":"Upper-Extremity Compartment Syndrome: Comparison of Substance-Related Found Down and Acute Trauma Mechanisms.","authors":"Etka Kurucan, Bradley Wiekrykas, Alec Talsania, Gabriel Alonso, Joseph Thoder, Mark Solarz","doi":"10.1016/j.jhsa.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.021","url":null,"abstract":"<p><strong>Purpose: </strong>Upper-extremity compartment syndrome can result in functional deficits, loss of limb, and loss of life. Although most commonly caused by trauma, in recent years, opioid and substance-related overdose has led to a rise in patients with \"found down\" compartment syndrome. Our purpose was to compare clinical presentations and outcomes in patients with upper-extremity compartment syndrome caused by a substance-related found down mechanism to those caused by an acute trauma mechanism.</p><p><strong>Methods: </strong>A retrospective chart review was performed to confirm a diagnosis of upper-extremity compartment syndrome. Inclusion criteria consisted of patients 18 years and older who underwent treatment for upper-extremity compartment syndrome from a substance-related found down or acute trauma mechanism. Patient demographics, clinical presentations, comorbidities, laboratory values, and outcomes were collected and compared between the two groups.</p><p><strong>Results: </strong>Over the 10-year study period, 51 patients were identified and included in our final cohort. The trauma group had 24 patients, and the found down group had 27 patients. The forearm was the most affected compartment in both groups, and the found down group had more patients with multiple affected compartments. On clinical examination, muscle weakness and skin blisters were seen more in the found down group. Hemoglobin, potassium, blood urea nitrogen, and creatine kinase levels were higher in the found down group. The patients in the found down group had a higher number of surgical procedures and length of stay. The found down group had more patients with rhabdomyolysis and kidney injury requiring hemodialysis.</p><p><strong>Conclusions: </strong>Upper-extremity compartment syndrome because of a substance-related found down mechanism most commonly affects the forearm compartment. Patients with a found down mechanism overall require more surgeries and muscle debridement in subsequent surgeries. They also have higher lengths of stay and higher rates of rhabdomyolysis and acute kidney injury requiring hemodialysis.</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":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082176","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}
Clinton J Ulmer, Luke Verlinsky, Ritu Agarwal, Richard Hum, Sean Sequeira, Connor A Armstrong, Brandon L Driggs, Kavya K Sanghavi, Aviram M Giladi, Ryan A Rose
{"title":"The Association Between Distal Screw and Articular Subsidence in the Open Treatment of Intra-articular Distal Radius Fractures.","authors":"Clinton J Ulmer, Luke Verlinsky, Ritu Agarwal, Richard Hum, Sean Sequeira, Connor A Armstrong, Brandon L Driggs, Kavya K Sanghavi, Aviram M Giladi, Ryan A Rose","doi":"10.1016/j.jhsa.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2025.03.016","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the association between volar plate screw position and postoperative radiographic outcomes in the open treatment of comminuted intra-articular distal radius fractures (DRFs). We hypothesized that increased distance from distal screws to subchondral bone is associated with early loss of reduction and articular subsidence.</p><p><strong>Methods: </strong>We performed a two-center retrospective review over 10 years (2013-2023) for Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C3 DRF treated with open reduction and volar locking plate fixation. We measured the distance from the distal screw to the subchondral bone (STSB), ulnar variance (UV), and volar tilt (VT) on initial postfixation and 6-week postoperative nonstandardized wrist radiographs, as well as second metacarpal cortical percentage (2MCP) on initial radiographs. Plate positioning was categorized using the Soong classification, and instability was graded using the Lafontaine criteria. Immediate after surgery and 6-week follow-up radiographic measurements were compared. Multivariable logistic regression models were used to evaluate factors associated with loss of UV and VT.</p><p><strong>Results: </strong>Initially, 540 patients were identified, with 178 remaining after exclusion. We found a statistically significant difference in median STSB distance between the immediate postoperative period (2.8 mm) and the 6-week follow-up (2.0 mm). A significant difference between immediate and 6-week postoperative UV was also present. After adjusting for appropriate covariates (age, initial 2MCP, and Lafontaine's criteria for instability), patients with initial STSB >3 mm had increased odds of an increase in UV >2 mm compared to patients with <3 mm STSB. Bone density (2MCP), perioperative Soong classification, and instability were not associated with UV change.</p><p><strong>Conclusions: </strong>In this two-center retrospective cohort of comminuted intra-articular DRFs, we found that placing the distal row of screws greater than 3mm from subchondral bone was associated with increased odds of worsening UV.</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":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082170","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}