Journal of Hand Surgery-American Volume最新文献

{"title":"Added Value of Wrist-to-Forearm Ratio to Single Measurement of Median Nerve Cross-Sectional Area for Diagnosis of Carpal Tunnel Syndrome.","authors":"Kikelola Afolabi-Brown, Andrew Liu, John R Fowler, Lenny Riviera Rosario, Michael Niemann","doi":"10.1016/j.jhsa.2026.07.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.010","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate whether utilization of wrist-to-forearm ratio (WFR) improves the diagnostic performance of ultrasound beyond the wrist cross-sectional area (CSA) alone.</p><p><strong>Methods: </strong>Prospective observational cohort study of patients evaluated for carpal tunnel syndrome in a hand surgery clinic. Median nerve CSA was measured at the carpal tunnel inlet and proximal forearm, and WFR was calculated. Carpal tunnel syndrome (CTS)-6 score and chart-documented clinical diagnosis served as reference standards. Demographic variables were obtained by retrospective chart review. Diagnostic performance of CTS-6, CSA, and WFR was assessed using Receiver operating characteristic analysis. Mixed-effects logistic regression evaluated the incremental value of WFR beyond CSA. Alternative WFR thresholds (1.6-2.0) were analyzed.</p><p><strong>Results: </strong>A total of 113 patients (196 wrists) were included; 113 wrists (57.7%) were clinically diagnosed with CTS. Mean age was 56.4 ± 16.0 years, and 50.4% were female. WFR ≥ 1.4 classified 76.5% of wrists as positive compared with 67.3% for wrist CSA ≥ 10 mm² and 44.9% for CTS-6 ≥12. CTS-6 demonstrated excellent discrimination (area under the curve [AUC] 0.977), wrist CSA good discrimination (AUC 0.813), and WFR weak discrimination (AUC 0.623). Adding WFR to models, including CTS-6 and wrist CSA, did not improve diagnostic performance. CSA misclassified 51 wrists; WFR reclassified 21 (41%) but resulted in more incorrect classifications overall. Increasing WFR thresholds improved specificity but reduced sensitivity, with no improvement in overall diagnostic performance.</p><p><strong>Conclusions: </strong>CTS-6 demonstrated excellent diagnostic discrimination in this cohort, and wrist CSA demonstrated good standalone ultrasound performance. WFR did not provide meaningful incremental diagnostic value beyond wrist CSA when clinical diagnosis was used as the reference standard.</p><p><strong>Clinical relevance: </strong>As ultrasound becomes more integrated into clinical practice, hand surgeons should be aware of the relative utility of different measurement techniques for diagnosing carpal tunnel syndrome.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801900","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 Hand Surgeon: The Dragon Warrior of Human Dignity.","authors":"Sreekanth Raveendran","doi":"10.1016/j.jhsa.2026.07.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.006","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801880","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":"Management Preferences of Geriatric Distal Radius Fractures: Insights From an American Society for Surgery of the Hand Surgeon Survey.","authors":"Zohair Zaidi, Ammer Dbeis, Youngjae Lee, Aiden Discordia, Peter Apel, Natalie Vaughn","doi":"10.1016/j.jhsa.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.04.007","url":null,"abstract":"<p><strong>Purpose: </strong>Distal radius fractures (DRFs) are common among the elderly. American Academy of Orthopaedic Surgeons Guidelines maintain a strong recommendation for nonsurgical treatment of these injuries, but acknowledge the importance of a patient-centered approach when making treatment decisions. This study aimed to characterize current practice trends and identify factors associated with treatment decisions for geriatric DRFs among members of the American Society for Surgery of the Hand. We hypothesized that fracture pattern and surgeon factors would be associated with surgeons' treatment decisions for geriatric DRFs.</p><p><strong>Methods: </strong>In 2025, a survey containing a clinical scenario of a 72-year-old patient sustaining a DRF with six different fracture patterns was distributed to American Society for Surgery of the Hand members. Surgeons' demographic data were collected, in addition to their preferred management (nonsurgical vs operative treatment) for each fracture. Respondents were also surveyed on injury/patient factors that would increase their likelihood to pursue operative treatment. Associations between variables were determined by chi-square or Fisher exact tests.</p><p><strong>Results: </strong>A total of 636 surveys were reviewed (response rate 13%), with 563 (89%) completed by orthopedic-trained hand surgeons. Surgeon's preferred treatment was associated with fracture pattern (P < .001). For a displaced extra-articular fracture, 88% of surgeons preferred operative treatment. Surgeons' practice setup (P = .045) and their years in practice (P = .003) influenced the management of displaced extra-articular fractures. Acute carpal tunnel syndrome, volar shear fracture patterns, and type I open injuries were the top three factors to influence a surgeon's likelihood to operate.</p><p><strong>Conclusions: </strong>Our findings suggest a discordance between current clinical practice guidelines and surgeon preferences for treatment of geriatric DRFs.</p><p><strong>Clinical relevance: </strong>Understanding current practice patterns can inform decision-making frameworks that align with evidence-based care while supporting individualized treatment strategies for geriatric DRFs.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801877","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":"Index Metacarpal Fracture Risk in Suture Button Suspensionplasty and the Effects of Drill Hole Position: A Cadaveric Study.","authors":"Ian D Kretzmann, Emma Judge, Todd Baldini, Fraser J Leversedge, Jonathan Tueting, Louis W Catalano","doi":"10.1016/j.jhsa.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.009","url":null,"abstract":"<p><strong>Purpose: </strong>Suture button suspensionplasty (SBS) has gained popularity for the treatment of thumb carpometacarpal joint osteoarthritis; however, fractures of the index metacarpal (MC) at the site of fixation have been reported. The biomechanical effect of SBS on index MC integrity and the influence of K-wire drill hole trajectory remain incompletely understood. This cadaveric study evaluates the mechanical strength of the index MC following SBS using three commonly employed K-wire trajectories compared with native controls.</p><p><strong>Methods: </strong>Forty-three fresh-frozen cadaveric hands were randomized into four groups with differing K-wire hole trajectories: native control (n = 10); single central bicortical pass (BC; n = 11); dorsal unicortical followed by bicortical pass (DUC; n = 11); and volar unicortical followed by bicortical pass (VUC; n = 11). SBS was performed using a Mini TightRope. Index MCs were subjected to a custom cantilever bend test using a servo-hydraulic testing system until failure. Maximum load to failure and peak stress were calculated. Group comparisons were performed using heteroscedastic analysis of variance with post hoc testing, Welch t tests, and Bayesian analyses.</p><p><strong>Results: </strong>All index MCs failed via fracture at the K-wire hole fixation site. While a notable overall difference in maximum load among groups was observed, post hoc testing did not identify a single drill trajectory that conferred a statistically significant biomechanical advantage. When aggregated, SBS specimens demonstrated a 33% reduction in force-to-failure compared with native controls, with a large effect size and moderate to strong Bayesian evidence supporting reduced index MC strength after SBS. No statistically significant differences in peak stress were identified. Bayesian analysis of peak stress demonstrated weak evidence favoring VUC.</p><p><strong>Conclusions: </strong>Suture button suspensionplasty considerably reduces the load-bearing capacity of the index metacarpal, independent of drill hole trajectory. The VUC construct demonstrated more favorable stress characteristics than DUC. These findings provide biomechanical context for reported index metacarpal fractures following SBS and may inform surgical technique and patient counseling.</p><p><strong>Type of study/level of evidence: </strong>Bench Research V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801897","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":"AI Clinical Decision Making Compared with Fellowship-Trained Hand Surgeons: A Case-Based Study.","authors":"Claire A Donnelley, Chris J Lee, Andrea Halim, Peter C Noback, Xuan Luo","doi":"10.1016/j.jhsa.2026.06.010","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.06.010","url":null,"abstract":"<p><strong>Purpose: </strong>Large language model-based artificial intelligence (AI) platforms have attracted substantial interest as potential clinical adjuncts within surgical specialties, particularly as patients have begun using AI for clinical advice. This study compared the management concordance of four commercially available AI platforms to practicing fellowship-trained hand surgeons using a series of clinical case vignettes within the field of hand surgery.</p><p><strong>Methods: </strong>Nine hand surgery clinical vignettes with multiple-choice answer options were developed, including representative radiographs and clinical images. Four cases were classified as straightforward (\"easy\") and five as clinically complex (\"hard\"). The cases were then distributed anonymously to fellowship-trained hand surgeons from three institutions using an online survey. Four AI platforms were queried using a standardized prompt: ChatGPT-4 (OpenAI), Claude Opus 4.6 (Anthropic), Gemini (Google DeepMind), and Open Evidence. All AI platforms were accessed in March 2026. Each platform was queried once per case without regeneration to reflect real-world single-query usage. The primary outcome was concordance between each AI platform and the surgeon plurality response for each case.</p><p><strong>Results: </strong>Fifteen fellowship-trained hand surgeons completed the survey. Surgeon consensus was high on easy cases (73% to 100% plurality agreement). All four AI platforms achieved concordance with the surgeon plurality on all four easy cases (100%). Performance diverged on complex cases: Claude Opus 4.6 and Gemini each achieved concordance on 3 of 5 complex cases (60%), whereas ChatGPT-4 and Open Evidence each achieved concordance on 1 of 5 (20%). Overall concordance was 7 of 9 (78%) for Claude Opus 4.6 and Gemini and 5 of 9 (56%) for ChatGPT-4 and Open Evidence.</p><p><strong>Conclusions: </strong>AI platforms were in agreement with surgeon responses in the majority of low-complexity cases, but had reduced agreement in clinically complex cases.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801858","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":"Radiographic Risk Factors for Flexor Tendon Ruptures Following Distal Radius Volar Plating.","authors":"Abdo Bachoura, Jonas Matzon, Kassem Ghayyad, Temitope Ayodele, Pedro Beredjiklian, Rick Tosti","doi":"10.1016/j.jhsa.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.04.021","url":null,"abstract":"<p><strong>Purpose: </strong>To identify radiographic risk factors for flexor tendon ruptures following volar distal radius plating.</p><p><strong>Methods: </strong>This was a case-control study of 27 patients with complete flexor tendon rupture following volar plating of distal radius fractures and 73 control patients who underwent volar plating and did not rupture. Demographic and radiographic parameters were recorded including radial inclination, Soong class, lateral carpal alignment using the capitate-to-axis-of-radius distance (CARD), and volar tilt. Univariable and multivariable logistic regression modeling were used to determine independent predictors of rupture.</p><p><strong>Results: </strong>The rupture group consisted of 25 females and 2 males. The mean age at flexor tendon rupture was 66.9 years. When radiographic variables were included in the multivariable model, analysis revealed that CARD was the only significant predictor of tendon rupture when a plate was prominent. The mean CARD for the rupture group was 9.8 mm, with a range of 4.9-20 mm. The mean CARD for the control group was 3.5 mm, with a range of -2.9 mm to 11.6 mm.</p><p><strong>Conclusion: </strong>In this analysis, CARD was the strongest predictor of attritional flexor tendon rupture in the setting of a prominent volar plate. Intraoperative correction of lateral carpal alignment based on CARD may decrease the risk of flexor tendon rupture when the plate is prominent.</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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801866","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":"Operative Evaluation and Treatment of Civilian Ballistic Nerve Injuries: A Case Series.","authors":"Kanad Ghosh, Sarthak Aggarwal, Ethan Blum, David M Brogan, Christopher J Dy, Jeffrey G Stepan","doi":"10.1016/j.jhsa.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>Gunshot wounds (GSWs) to the extremities can be debilitating because of their effect on peripheral nerves and the subsequent loss of function experienced by patients. However, intraoperative findings seen upon nerve exploration in ballistic injuries have not been widely reported in the civilian population. In this study, we examine our experience in the operative management of low-velocity civilian GSW injuries to the extremities with concomitant nerve palsies in regard to indications for exploration, intraoperative findings, and methods of reconstruction.</p><p><strong>Methods: </strong>We performed a retrospective review of patients undergoing surgical intervention for GSW-related nerve injuries from two large academic centers. Included patients had a documented motor nerve or mixed-motor-sensory-nerve injury of either the upper or lower extremity after GSW. The primary outcomes were the intraoperative status of the nerve as well as the method of nerve reconstruction.</p><p><strong>Results: </strong>Forty-nine patients (57 nerves) were included in this study, 85.7% of whom were men with an average age of 28.9 ± 10.5 years. The median time from injury to surgery was 99 days, and most patients (61.2%) underwent exploration because of lack of improvement in function. Upon exploration, 33.3% had a neuroma in continuity (NIC), 21.1% had partial transection, 21.1% had a complete transection, and 24.6% were found to be in continuity. Nerve transfer and neurolysis were the most performed procedures, followed by autologous nerve graft and nerve decompression. Only 1.8% of nerve injuries were amenable to a direct repair. Comparison of patients who underwent early nerve exploration because of concomitant fracture fixation versus those who had delayed exploration because of lack of return of function demonstrated a considerably lower rate of NIC among patients with earlier exploration.</p><p><strong>Conclusions: </strong>Our study is one of the few to document intraoperative nerve findings in civilian ballistic injury. Our results demonstrate that nerves affected by ballistic trauma are rarely amenable to direct repair and high rates of NIC with delayed exploration; as such, surgeons should be prepared for grafting and other reconstructive options. Early exploration in the carefully selected patients may help surgeons address nerve injuries in a timelier fashion before the development of NIC.</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":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698342","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":"Establishing and Maintaining Congenital Upper Limb Difference Registries: Insights From Global Experiences","authors":"Adam Mosa MD, MSc,&nbsp;Sarah Romans MD,&nbsp;Charles A. Goldfarb MD,&nbsp;Lindley B. Wall MD, MSc","doi":"10.1016/j.jhsa.2026.02.017","DOIUrl":"10.1016/j.jhsa.2026.02.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Prospective clinical registries that apply standardized diagnostic criteria and established outcome measures have been developed globally to better understand congenital upper limb differences. This study explores the perspectives of surgeons who have been instrumental in forming and maintaining Congenital Upper Limb Difference registries in the United States (Congenital Upper Limb Difference), Northern Europe (Congenital Upper Limb Anomalies North), Australia (Australia Hand Difference Registry), and the United Kingdom (UK Hand Registry). Objectives included capturing early experiences, identifying logistical challenges, assessing research output, and evaluating the feasibility of an international congenital hand registry.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Semistructured qualitative interviews were conducted with 8 hand surgeons, 2 from each registry: Congenital Upper Limb Difference, Congenital Upper Limb Anomalies North, Australia Hand Difference Registry, and the UK Hand Registry. Participants were selected for their leadership in establishing and sustaining their registries. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Themes, challenges, and recommendations were identified through iterative coding and consensus review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;All participants expressed the value of the registries in enabling longitudinal, aggregated data analysis to generate clinically meaningful insights and address research questions. The participants highlighted the positive impact of the registry on collaborative relationships. Recurring themes included the requirements for success being a clear vision, a defined purpose, and a robust administrative and financial infrastructure. Additionally, all acknowledged the challenges unique to pediatric outcomes measurement. All participants used the Oberg-Manske-Tonkin classification and diagnosis-specific subclassifications; there was variability in the ease of updating data as clinical impressions evolved or diagnoses were revised. Discrepancies existed regarding the ease of conducting research using registry data. Participants discussed possible benefits of establishing a collaborative international registry but emphasized prerequisites, limitations, and the need to address ethical, logistical, and interoperability challenges.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The international experience of establishing and maintaining a Congenital Upper Limb Difference registry varies in execution, logistics, collaboration, and research productivity. However, the registries share notable similarities related to outcome measures, diagnostic criteria, and complexity of collected data. Insights from this international qualitative study can guide optimization of existing registries and inform design of future local or collaborative international efforts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Type of study/Level of evidence&lt;/h3&gt;&lt;div&gt;Qualitati","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 8","pages":"Pages 883.e1-883.e8"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596195","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 Evaluation of Y-Strut Dual Headless Compression Screws Versus Single Intramedullary Screw Fixation in Proximal Phalanx Fractures","authors":"Samuel Lie MBBS,&nbsp;Philippe Massard-Combe MBBS,&nbsp;Sara Sadat Farshidfar PhD,&nbsp;Mohammed Baba MBBS","doi":"10.1016/j.jhsa.2025.09.016","DOIUrl":"10.1016/j.jhsa.2025.09.016","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether a Y-strut configuration of dual headless compression screws provides greater force to failure when compared with a single intramedullary screw (IMS) in the fixation of proximal phalanx fractures.</div></div><div><h3>Methods</h3><div>A biomechanical cadaveric study comparing Y-strut fixation with a single IMS in proximal phalanx fractures was performed. Sixteen proximal phalanges were dissected out from 4 hands of 2 fresh frozen cadavers and a fracture was created with a surgical saw. Specimens were divided into 2 groups and underwent fixation. Phalanges were mounted to a 3-point bending jig and tested to determine stiffness and load to failure.</div></div><div><h3>Results</h3><div>The specimens in the single screw group demonstrated higher load to failure than in the dual screw group (250.8 N vs 197.0 N). Stiffness also generally was higher although this result was not statistically significant.</div></div><div><h3>Conclusions</h3><div>Fixation of simple proximal phalanx fractures with a single 3.0 mm IMS had a greater force to failure than with dual 2.2 mm screws in a Y-strut configuration, although there was no significant difference in stiffness.</div></div><div><h3>Clinical relevance</h3><div>Fixation of a simple base of proximal phalanx fracture with dual 2.2 mm screws in Y-strut configuration results in a lower load to failure than with a single 3.0 mm screw. The shorter length of the second screw in this configuration may contribute to this result. Further investigation is required to investigate other configurations of dual screws.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 8","pages":"Pages 864.e1-864.e6"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423498","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":"Kirschner Wire Skeletal Fixation in the Hand and Wrist: Risk of Infection and Predictors of Progression to Major Complications","authors":"Mitchell S. Mologne BS,&nbsp;Julia M. Perugini BS,&nbsp;Nicholas A. Calotta MD,&nbsp;Lindley B. Wall MD,&nbsp;Charles A. Goldfarb MD","doi":"10.1016/j.jhsa.2026.01.005","DOIUrl":"10.1016/j.jhsa.2026.01.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Kirschner wire (K-wire) infections continue to be a challenge in hand surgery. Our purpose was to quantify the frequency of K-wire site infections of the hand and wrist, to tabulate major and minor infectious manifestations, to identify factors that may predispose a patient to major complications, and to generate an updated algorithm for prognostication and treatment of K-wire site infections.</div></div><div><h3>Methods</h3><div>Patients treated with K-wires in the fingers, hand, and wrist who developed infections between 2018 and 2024 at our institution were identified. Information regarding patient factors, injury, treatment, and subsequent infectious complications was collected. Variables from single variable regression were entered into a standard multiple variable regression model.</div></div><div><h3>Results</h3><div>A total of 3425 patients treated with K-wires in the finger, hand, or wrist were assessed; 113 patients with a mean age of 46 years had an infection and were included in this study (36 women [32%]), giving an overall infection rate of 3.3%. The mean time to presentation of infection was 29 ± 18 days. Major infection-related complications occurred in 23 patients (20.4%). The presence of postoperative purulence and the necessity of a second course of oral antibiotics were significant predictors of major infection on multivariable regression.</div></div><div><h3>Conclusions</h3><div>K-wire associated infections were present in 3.3% of patients, manifesting, on average, 29 days after surgery. Purulence as an initial manifestation of infection and the necessity for a second course of antibiotics were significantly associated with developing major complications. Clinicians should closely follow patients for the entire course of K-wire presence, as well as consider a lower threshold for intervention.</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 8","pages":"Pages 856-863"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328190","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}