Journal of Hand Surgery-American Volume最新文献

{"title":"Radiographic Scaphoid Waist Index and Nonunion After Scaphocapitate Fusion for Kienböck Disease","authors":"Ken Nishimura MD,&nbsp;Cameron Ward BS,&nbsp;Mehmet Furkan Tunaboylu MD,&nbsp;Andrew F. Emanuels MD,&nbsp;Steven L. Moran MD","doi":"10.1016/j.jhsa.2026.07.002","DOIUrl":"10.1016/j.jhsa.2026.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether lower radiographic scaphoid waist index (WI), measured on routine preoperative lateral wrist radiographs, is associated with nonunion after scaphocapitate fusion for Kienböck disease.</div></div><div><h3>Methods</h3><div>We performed a retrospective chart and imaging review of patients who underwent scaphocapitate fusion for Kienböck disease within a single integrated multicampus health system (1996–2025). The primary outcome was nonunion. Symptomatic adjacent-joint osteoarthritis within 1 year was evaluated separately as a descriptive secondary outcome. WI was measured independently by two observers on preoperative lateral radiographs. Rater-averaged WI was analyzed as a continuous variable. A conservative dichotomized scaphoid type analysis was performed exploratorily, with type II assigned only when both observers measured WI &lt; 0.40.</div></div><div><h3>Results</h3><div>Of 98 scaphocapitate fusions identified, 22 met inclusion criteria after excluding cases with nonretrievable archived imaging or follow-up &lt;1 year. Median available postoperative follow-up was 23.7 months (interquartile range [IQR]: 14.4–41.2 months); range, 12.0–185.4 months. Nonunion occurred in 5 of 22 wrists (23%). Rater-averaged WI was numerically lower in wrists with nonunion than in wrists without nonunion: median 0.365 (IQR: 0.364–0.365) versus 0.429 (IQR: 0.375–0.452). The Hodges–Lehmann median difference was −0.0568, with a bootstrap 95% CI: −0.0981 to 0.0087. In the exploratory conservative dichotomized analysis, nonunion occurred in four of nine scaphoid type II wrists and 1 of 13 scaphoid type I wrists; the odds ratio estimate was imprecise and included the null (OR: 9.60; exact 95% CI: 0.64–510.98). Symptomatic adjacent-joint osteoarthritis occurred in two wrists.</div></div><div><h3>Conclusions</h3><div>In this small, selected cohort, rater-averaged radiographic WI was numerically lower in wrists with nonunion, suggesting a preliminary, hypothesis-generating WI-nonunion signal. The conservative scaphoid type I versus type II dichotomization was imprecise and should not be interpreted as definitive. Larger studies with more complete follow-up and adjustment for technical and clinical confounders are needed.</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 1076.e1-1076.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801869","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 Comparative Study of Short-Term Outcomes Between INTEGRA and AVANTA Silicone Implants for Metacarpophalangeal Joints in Patients With Rheumatoid Arthritis","authors":"Shuichi Naniwa MD, PhD,&nbsp;Keiichiro Nishida MD, PhD,&nbsp;Yoshihisa Nasu MD, PhD,&nbsp;Ryuichi Nakahara MD, PhD,&nbsp;Masahiro Horita MD, PhD,&nbsp;Toshifumi Ozaki MD, PhD","doi":"10.1016/j.jhsa.2026.04.003","DOIUrl":"10.1016/j.jhsa.2026.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the short-term clinical outcomes and fracture rate of the silicone implants AVANTA and INTEGRA for metacarpophalangeal (MCP) joint arthroplasty in patients with rheumatoid arthritis (RA).</div></div><div><h3>Methods</h3><div>The current single center retrospective cohort study included consecutive RA cases who underwent MCP joint arthroplasty for the index through little fingers between August 2017 and July 2023. After exclusions, the data from 184 fingers of 58 patients (AVANTA, 96 fingers of 28 patients; INTEGRA, 88 fingers of 30 patients) were analyzed. Outcomes of MCP joint arc of motion, extension range, flexion range, ulnar deviation, grip and pinch strength, Disabilities of the Arm, Shoulder, and Hand disability/symptom (DASH d/s) score, and Hand20 score were assessed preoperatively, at 1 year, and at 2–5 years. The primary analysis was performed using mixed-effects models incorporating patient-level clustering and adjustment for baseline differences. Radiographs at each time point were reviewed for implant fracture.</div></div><div><h3>Results</h3><div>Both implants yielded improvements in arc of motion, extension range, flexion range, and ulnar deviation postoperatively with no significant differences. Grip strength improved in both groups, with significantly greater gains in the INTEGRA group. Pinch strength improved at 1 year in the INTEGRA group. In the INTEGRA group, DASH d/s score and Hand20 score was better than AVANTA at final follow-up. During follow-up, implant fractures occurred in 11.5% of the AVANTA group and none in the INTEGRA group, resulting in a survival rate of 77.1% for AVANTA and 100% for INTEGRA patients at 5 years after surgery.</div></div><div><h3>Conclusions</h3><div>Both AVANTA and INTEGRA silicone MCP arthroplasty improved arc of motion and finger alignment in patients with RA. INTEGRA showed advantages in greater grip strength, earlier pinch strength, DASH d/s score, and Hand20 score. No implant fractures were observed in the INTEGRA group during the study period.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognosis IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1075.e1-1075.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037819","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":"Ten Minutes of Intraoperative Nerve Stimulation May Improve Outcomes Following End-to-End Nerve Transfer","authors":"Madeline Rieker MD,&nbsp;Stephanie Choo MD,&nbsp;Katherine Snipes MD,&nbsp;V.V.N. Manohar Devarasetty MD,&nbsp;Henry Kuechly MD,&nbsp;Nicole Covell DO,&nbsp;Richard Arendale BS,&nbsp;Kennedy Gachigi MS,&nbsp;R. Glenn Gaston MD,&nbsp;Bryan J. Loeffler MD","doi":"10.1016/j.jhsa.2026.07.005","DOIUrl":"10.1016/j.jhsa.2026.07.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Brief intraoperative electrical nerve stimulation (ES) has shown potential to improve outcomes of peripheral nerve surgery, including nerve repair, grafting, and transfer. This study compares clinical outcomes of nerve transfers receiving ES to those that did not.</div></div><div><h3>Methods</h3><div>Retrospective cohort study was performed of adults undergoing radial to axillary or median/ulnar to musculocutaneous nerve transfers at a single center between 2015 and 2025. Patients were divided into 2 groups: those who received 10 minutes of continuous ES (2 mA and 100 μs) intraoperatively (ES group) and those who did not (No ES group). Primary outcome was postoperative Medical Research Council motor grade. Chi-square tests were used to test associations between categorical variables and <em>t</em> tests for continuous measures.</div></div><div><h3>Results</h3><div>Sixty surgeries (n = 44, no ES; n = 16, ES) in 46 patients were analyzed. Groups were similar in age (median 40 years, <em>P</em> = .622) and time to surgery (median 6 months, <em>P</em> = .261). Surgical characteristics were similar, including transfer type (<em>P</em> = .6884). All patients (n = 60) received end-to-end constructs. Among ES patients, 88% reached M4-M5 recovery versus 61% in nonstimulated patients (<em>P</em> = .136). Median follow-up was 26 months for no ES and 15 months for ES (<em>P</em> = .029). Controlling for age and time to surgery, stimulated patients were more likely to reach at least M4 (odds ratio 6.0, 95% confidence interval 1.03-35.34, <em>P</em> = .046).</div></div><div><h3>Conclusions</h3><div>Ten minutes of intraoperative ES may increase rates of excellent (M4-M5) motor recovery following end-to-end nerve transfer. Brief intraoperative ES is a readily implementable technique, requiring only 10 minutes of operative time, and represents a promising adjunct that may enhance outcomes for nerve transfers in brachial plexus reconstruction. Our practice has since adopted routine use of ES for nerve transfer surgeries.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1096.e1-1096.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765569","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":"Is PIP Denervation for Osteoarthritis a Durable Solution? Results from a Multicenter Outcome Study","authors":"Esmee Kwee MD,&nbsp;Niek J. Nieuwdorp MSc,&nbsp;Camille Blaaker MSc,&nbsp;Liron S. Duraku MD, PhD,&nbsp;J. Michiel Zuidam MD, PhD","doi":"10.1016/j.jhsa.2026.06.006","DOIUrl":"10.1016/j.jhsa.2026.06.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Proximal interphalangeal (PIP) joint osteoarthritis frequently causes pain and functional limitation. Arthroplasty and arthrodesis can provide pain relief but are invasive, require prolonged rehabilitation, and carry substantial complication risks. PIP joint denervation has emerged as a less invasive, motion-preserving alternative. However, evidence remains limited, and its durability is unclear.</div></div><div><h3>Methods</h3><div>In this multicenter prospective study, 87 patients (105 joints) with symptomatic osteoarthritis underwent PIP denervation between 2016 and 2024 and had at least 12 months of follow-up. The primary outcome was procedural success, which was defined as the absence of subsequent arthroplasty or arthrodesis for persistent or recurrent symptoms. Secondary outcomes, assessed in the subgroup without repeat surgery (76 joints), included pain and function measured on 0–100 visual analog scales (VAS), as well as patient satisfaction and willingness to undergo the procedure again.</div></div><div><h3>Results</h3><div>At a median follow-up of 43 months (range, 12–107 months), 81% of PIP joints had not undergone conversion to arthroplasty or arthrodesis after denervation surgery. Most repeat surgeries occurred within the first postoperative year. VAS pain at rest improved from 44 ± 25 before surgery to 18 ± 26 (26-point reduction), and pain during activity improved from 63 ± 22 to 29 ± 31 (34-point reduction). VAS function increased from 47 ± 19 to 60 ± 24 (13-point improvement). Overall, 62% of patients rated their satisfaction as excellent or good, and 79% reported that they would choose the procedure again.</div></div><div><h3>Conclusions</h3><div>PIP denervation was associated with encouraging midterm outcomes in selected patients with symptomatic PIP joint osteoarthritis, with 81% of joints not requiring conversion to arthroplasty or arthrodesis over a 4-year follow-up.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1067-1074"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finite Element Analysis of Dual Screw Configurations for Enhanced Stability in Scaphoid Fracture Fixation","authors":"Esin Rothenfluh MD,&nbsp;Sambhav Jain,&nbsp;William R. Taylor PhD,&nbsp;Seyyed Hamed Hosseini Nasab PhD","doi":"10.1016/j.jhsa.2025.12.014","DOIUrl":"10.1016/j.jhsa.2025.12.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Internal fixation with a headless compression screw has become the gold standard for the surgical treatment of scaphoid fractures. Some authors reported on the theoretical benefit of dual screw fixation. Our aim was to investigate the optimal dual screw configuration for fixing scaphoid fractures with regard to biomechanical stability.</div></div><div><h3>Methods</h3><div>In a previously established finite element model of the scaphoid, a fracture plane at the scaphoid waist was modeled. Two 1.7 mm cannulated, partially threaded compression screws were positioned in parallel. The distance between the screws and their angulation relative to each other were systematically varied, using multiples of the screw diameter for the interscrew distance (3.4 mm, 5.1 mm, and 6.8 mm) and 5° increments for angle variation (5°, 10°, 15°, 15°, and 20°). For each scenario, maximum interfragmentary displacement (IFD in mm) and maximum von Mises stress (MPa) within the fracture planes of the distal and proximal fragments were compared.</div></div><div><h3>Results</h3><div>IFD values were 0.057, 0.031, and 0.0227 mm for screw distances of 3.4, 5.1, and 6.8 mm, respectively. Von Mises stress was 105.6 MPa, 105.36 MPa, and 84.84 MPa in the proximal fragment and 86.3 MPa, 73.68 MPa, and 56.6 MPa in the distal fragment, for the same distance variants. For angles of 5°, 10°, 15°, and 20° between the screws, the IFD was 0.0217 mm, 0.0219 mm, 0.0221 mm, and 0.0224 mm, respectively. The corresponding von Mises stress was 84.84 MPa, 83.95 MPa, 82.85 MPa, 82.78 MPa, and 82.09 MPa for the proximal fragment and 56.6 MPa, 56.14 MPa, 60.04 MPa, 58.84 MPa, and 58.56 MPa for the distal fragment for screw angulations of 5°, 10°, 15°, and 20°.</div></div><div><h3>Conclusions</h3><div>Despite morphologic limitations of the scaphoid to place two screws maximally apart, a larger distance is biomechanically advantageous and provides more rigid fracture fixation. Angulation, however, has no relevant biomechanical influence, although it may facilitate easier placement of the two screws.</div></div><div><h3>Clinical relevance</h3><div>The study provides a basis for before surgery planning to optimize biomechanical stability in dual screw fixation of scaphoid fractures.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1084.e1-1084.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Strength of Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Reconstruction With Button Autograft and Suture Suspension (BASS) Technique in a Cadaveric Osteolysis Model","authors":"Riley Kahan MS,&nbsp;Dylan R. Rakowski MD,&nbsp;Evan H. Richman MD,&nbsp;Adam Peszek MD,&nbsp;Todd Baldini MS,&nbsp;Matthew Belton MD,&nbsp;Alexander Lauder MD","doi":"10.1016/j.jhsa.2026.04.009","DOIUrl":"10.1016/j.jhsa.2026.04.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Polyetheretherketone anchors used for thumb metacarpophalangeal (MP) joint ulnar collateral ligament (UCL) repair/reconstruction may be associated with osteolysis and subsequent failure, which presents challenges to revision reconstruction. This study evaluated the biomechanical integrity of thumb UCL reconstruction in a cadaveric osteolysis model.</div></div><div><h3>Methods</h3><div>Twelve thumb MP joints at 0° of flexion were loaded to failure by applying valgus force to produce UCL injury. Both clinical failure, defined as the force necessary to elicit 30° of angular displacement or 11.5 mm of vertical displacement across the MP joint, and structural failure, the maximum force applied to produce a decrease in resistance, were recorded. One specimen fractured during testing and was excluded. In the remaining 11 specimens, osseous tunnels (5 mm diameter × 10 mm depth) were drilled at the ligament proximal origin and distal insertion to simulate osteolysis. The UCL was reconstructed with button suspension of palmaris longus tendon autograft and nonabsorbable suture (button autograft and suture suspension, BASS), and the MP joints were again loaded to clinical and structural failure recording force, anatomic location, and mode of failure. The experimental group was compared to intrinsic native ligament controls using paired <em>t</em> tests.</div></div><div><h3>Results</h3><div>Eleven specimens had complete data for comparison of the reconstruction to native ligament. Native UCLs failed clinically at 112 ± 38 N and structurally at 169 ± 75 N, whereas BASS UCL reconstruction in the osteolysis model failed at significantly less force: clinically 27 ± 12 N and structurally at 68 ± 37N. All UCL reconstructions failed by fracture: 8/11 at the proximal phalanx and 3/11 at the metacarpal.</div></div><div><h3>Conclusions</h3><div>BASS UCL reconstruction in the setting of osteolysis produced a weaker construct than the native UCL but provided biomechanical strength similar to established UCL reconstruction methods.</div></div><div><h3>Clinical relevance</h3><div>This study detailed the biomechanical strength of this technique and informs postoperative rehabilitation considerations when osteolysis is present.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1077.e1-1077.e11"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037862","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":"Postoperative Reduction and Persistent Enlargement of Median Nerve Cross-Sectional Area in Carpal Tunnel Syndrome: Influence of Metabolic Syndrome","authors":"Yotaro Yamada MD,&nbsp;Tadahiro Natsume MD, PhD,&nbsp;Michiro Yamamoto MD, PhD","doi":"10.1016/j.jhsa.2026.04.019","DOIUrl":"10.1016/j.jhsa.2026.04.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Carpal tunnel syndrome (CTS) causes enlargement of the median nerve cross-sectional area (CSA), which often decreases after carpal tunnel release. However, the clinical relevance of postoperative median nerve CSA changes remains unclear. This study aimed to assess the association between postoperative changes in median nerve CSA and clinical outcomes and to identify factors linked to a persistent or increased CSA.</div></div><div><h3>Methods</h3><div>We enrolled 117 patients (136 wrists) with CTS who underwent endoscopic carpal tunnel release. Preoperative and 12-month postoperative assessments included ultrasonographic measurement of the median nerve CSA at the carpal tunnel inlet, nerve conduction studies, the Semmes-Weinstein monofilament test, and the Japanese version of the CTS instrument (CTSI). Correlations between changes in inlet CSA and clinical measures (nerve conduction studies, Semmes-Weinstein monofilament test, and the CTSI symptom severity and function scores) were analyzed. Patients were divided into two groups based on their postoperative condition: those whose CSA decreased and those whose CSA was either unchanged or increased. Factors associated with unchanged or increased CSA were identified by logistic regression.</div></div><div><h3>Results</h3><div>No significant correlations were found between changes in inlet CSA and nerve conduction study, SWMT, or CTSI scores. Inlet CSA was unchanged or increased in 35 wrists (25.7%). This group had a significantly higher proportion of males and patients with metabolic syndrome compared to the decreased CSA group. Multivariate analysis showed metabolic syndrome was independently associated with unchanged or increased postoperative CSA.</div></div><div><h3>Conclusions</h3><div>Changes in median nerve CSA after carpal tunnel release do not correlate well with clinical or electrophysiological outcomes. Metabolic syndrome may contribute to persistent nerve swelling after surgery.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic III.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 10","pages":"Pages 1095.e1-1095.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachial Plexus Injury Patterns and Root Graftability: Implications for Reconstruction in 105 Patients.","authors":"Kevin Kuan-I Lee, Tommy Nai-Jen Chang, Yen-Po Lin, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.1016/j.jhsa.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.004","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brachial plexus injuries exhibit diverse patterns with variable reconstructive possibilities. Because the availability of graftable spinal nerves is largely determined by the extent of root injury, understanding the relationship between injury patterns and root graftability may facilitate surgical planning. This study aimed to characterize brachial plexus injury patterns and evaluate their relationship with root graftability.</p><p><strong>Methods: </strong>A retrospective review was performed on 105 consecutive brachial plexus injury patients who underwent surgical reconstruction between 2021 and 2024 at a tertiary referral center. Preoperative clinical examination and magnetic resonance neurography were correlated with intraoperative findings to determine injury patterns and root graftability.</p><p><strong>Results: </strong>Among the 105 patients, 40% presented with panplexus injuries, 42% with upper plexus injuries, and 14% with infraclavicular injuries. The most frequent injury pattern was complete root avulsion from C5-T1 (21%), followed by panplexus with at least one graft-eligible root (19%). The proportion of grafted spinal nerves was 35.8% for C5, 11.5% for C6, and 5.7% for C7. Magnetic resonance neurography (MRN) demonstrated similar rates of potentially graftable C5 in panplexus and upper type injuries (49% vs 36%). Intraoperative exploration confirmed graftability in 28 of 29 C5 roots predicted to be graft-eligible by MRN.</p><p><strong>Conclusions: </strong>Brachial plexus injury patterns influence root graftability and reconstructive planning. Despite greater severity, panplexus injuries demonstrated comparable rates of graft-eligible C5 roots to upper plexus injuries. These findings support routine exploration and highlight the value of MRN in identifying graftable spinal nerves.</p><p><strong>Type of study/level of evidence: </strong>Diagnostic IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082986","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 Spinal Accessory Nerve to Musculocutaneous Nerve Transfer in Brachial Plexus Birth Injuries.","authors":"Lauren E Tagliero, Aliya G Feroe, Robert J Spinner, Nicholas Pulos, Alexander Y Shin","doi":"10.1016/j.jhsa.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.009","url":null,"abstract":"<p><strong>Purpose: </strong>Brachial plexus birth injuries (BPBI) can be life-changing for both the patient and family. While most resolve spontaneously, surgical intervention is indicated for those who fail to improve. This can be performed via nerve grafting or nerve transfer. The spinal accessory nerve is a commonly used extraplexal donor in brachial plexus surgery. In cases of BPBI, it can be transferred to the musculocutaneous nerve to restore elbow flexion. While there are short-term reports in BPBI, few, if any, long-term outcome data are available.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent spinal accessory nerve to musculocutaneous nerve transfer for a BPBI was undertaken. Patients were excluded if they had <2 years of follow-up or could not follow instructions for manual motor testing at the most recent follow-up. Patient demographics, including age at time of surgery, were recorded. The primary outcome was final elbow flexion using a modified British Medical Research Council (mBMRC) grade. Secondary outcomes included time to varying Active Movement Scale scores, final trapezius mBMRC grade, Mallet grade, Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, PROMIS physical function, and any secondary surgeries.</p><p><strong>Results: </strong>Six patients were included. Surgery was performed at an average of 3 months of age. All patients sustained global plexus injuries. Average clinical follow-up was 12 years. Patients first showed signs of muscle contraction (Active Movement Scale grade 1) at an average of 6 months after surgery. All patients reached mBMRC grade 4 or greater elbow flexion strength by final follow-up. All patients had mBMRC grade 5 upper trapezius strength at final follow-up. Average Mallet grade for global shoulder abduction was 3.2 and global shoulder external rotation 4.2. Both PROMIS pain interference and physical function scores were within normal limits at final follow-up, with averages of 48.3 and 49.0, respectively. Four of 6 patients had secondary surgery; however, none had additional surgery to address elbow flexion.</p><p><strong>Conclusions: </strong>Spinal accessory nerve to musculocutaneous nerve transfer effectively restores elbow flexion strength in patients with BPBI who need elbow flexion. Outcomes remained durable with over a decade of follow-up, without compromising upper trapezius strength.</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":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083028","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":"Decreased Postoperative Pain and Similar Biomechanical and Functional Outcomes of a Nondrilling Pull-Out Technique Compared to Bunnell's Technique in Flexor Digitorum Profundus Zone 1 Injuries.","authors":"Gokce Yildiran, Oguz Kagan Kocak, Bahriye Nur, Hande Akdeniz, Oguz Eker, Sergen Karatas","doi":"10.1016/j.jhsa.2026.08.016","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.016","url":null,"abstract":"<p><strong>Purpose: </strong>Zone 1 injuries of the flexor digitorum profundus (FDP) tendon pose technical and functional challenges due to the confined anatomy of the distal phalanx and the need for secure fixation. The classical Bunnell pull-out technique (BPT), although biomechanically reliable, is associated with nail deformities, postoperative pain, and bone-related complications. This study aimed to evaluate the biomechanical and clinical outcomes of a novel nondrilling pull-out technique (NDPT) designed to eliminate the need for bone drilling while maintaining repair strength.</p><p><strong>Methods: </strong>This study consisted of two parts: a cadaveric biomechanical analysis and a clinical comparative evaluation. In the cadaveric study, 15 FDP zone 1 repairs (8 BPT, 7 NDPT) were performed and tested for maximum tensile stress and pull-out force. In the clinical study, 37 patients with FDP zone 1a injuries were treated using either BPT (n = 20) or NDPT (n = 17). Pain was assessed using the visual analog scale at 24 hours, 3 days, and 7 days postoperatively. Functional outcomes were evaluated at 6 months using distal interphalangeal joint range of motion and Moiemen-Elliot criteria.</p><p><strong>Results: </strong>Biomechanical testing showed no significant differences in maximum tensile stress or pull-out force between BPT and NDPT (P > .05). Clinically, NDPT patients exhibited significantly lower median visual analog scale scores at 24 hours and 3 days postoperatively (P < .05). At 6 months, range of motion and the distribution of functional outcome categories were clinically comparable between the groups.</p><p><strong>Conclusions: </strong>The NDPT provides biomechanical performance equivalent to the Bunnell technique while offering distinct clinical advantages, notably reduced early postoperative pain and enhanced patient comfort. By preserving bone integrity and eliminating the need for drilling, NDPT represents a bone-preserving and patient-friendly alternative for FDP zone 1 repairs.</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":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082964","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}