Excision of the proximal pole of the scaphoid causes wrist instability. The often small proximal fragment can be challenging to retain, and multiple procedures are used to preserve the proximal pole. However, the mechanical implications of a proximal pole loss remain unclear. Possibly, under certain circumstances, the proximal pole can be excised without causing instability. This study aimed to use a validated finite element model (FEM) of normal Type 1 and Type 2 wrists to examine the effect of removal of the proximal scaphoid pole on forces moving through the midcarpal joint. We hypothesize that the amount of bone removed alters the transfer of forces through the midcarpal joint and that this effect will differ between Type 1 and Type 2 wrists. Fourteen wrist computed tomography (CT) scans were converted to .stl files: five Type 1 and nine Type 2. Using an established wrist FEM model, the proximal scaphoid was sequentially excised up to 50%. A 100-N computer-generated load was applied to the dorsal crests of the trapezoid and capitate. Carpal bone displacement was recorded in the x, y, and z directions. The percentage change from intact was calculated for Type 1 and 2 wrists, the direction of bony translation was recorded, and an index quantifying instability based on translation upon loading was calculated. The excision of the proximal pole of the scaphoid caused significant translation of the carpal bones in both wrist types, p  < 0.001. Type 2 wrists reached significant displacement after 15% excision, compared to 25% for Type 1 wrists. The direction of translation differed between Type 1 and 2 wrists.In general, Type 1 wrists seem to be less stable than Type 2 wrists. This study supports the importance of scaphoid proximal pole for wrist stability and the difference in carpal-bone translation between midcarpal joint types.This can be used in surgical planning when faced with fractures, nonunion, and complex fracture-dislocations.
Background and Objectives: The wrist is one of the most common sites of rheumatic disease. Based on the graded deformities of Larsen et al., surgery has been adapted to minimize harm while maximizing benefit to the individual. This study aims to survey the institutional experience, describing functional outcomes and patient satisfaction across several surgical approaches, without formal statistical comparison. Materials and Methods: The studies and results presented here are from one center specialized in rheumaorthopedic surgery and reflect the above concepts. The studies cover a broad spectrum of surgical techniques, which were categorized according to the Larsen stages of wrist destruction. All studies were retrospective or retrospective-like, and follow-up data were analyzed collectively. The primary endpoints were functional outcome scales and patient satisfaction, supplemented by pain relief, as well as strength and range of motion. The assessment utilized, amongst others, the QuickDASH, FFbH and Clayton score, as well as appropriate patient-reported measures such as ADL and SF-36. Radiological follow-ups were classified according to the Larsen-Dale-Eek classification; for endoprostheses/arthrodesis, carpal height was determined according to Youme. Results: Significant improvements in the Clayton score (consistently greater postoperatively than preoperatively) are evident for several procedures, particularly MPW® (+37 points) and APW® (+28 points). Postoperative reductions in VAS pain scores are marked for most procedures, e.g., MPW® from 7 to 1.8. The revision rates for most procedures are around 10-13% during the follow-up periods. In addition, the tendon and soft tissue functions of the hand(s) play critical roles in these PROMs. Conclusions: The studies present the results and limitations of surgical treatment for rheumatic wrists in the prebiological era. The results of individual studies need to be examined more closely to better assess the potential and limitations of surgery for patients.
Long-term sequelae of scapholunate instability predictably result in progressive arthritic changes. In early stages of arthritis, joint space narrowing, subchondral sclerosis, and osteophytic formation can be difficult to appreciate on posterior-anterior (PA) X-ray views of the wrist. In patients with scapholunate advanced collapse (SLAC) wrist, the pencil grip X-ray may more accurately define the joint space narrowing in the radioscaphoid and radiolunate articulations compared with standard PA radiographs. We conducted a retrospective chart review of all patients with pencil grip X-ray views and documented wrist arthritis at a single institution. A total of 29 patients met criteria. Two authors independently reviewed wrist X-rays and classified the X-rays based on radiographic stages of arthritis for both PA and pencil grip X-rays. Radioscaphoid and radiolunate joint spaces were measured, and mean comparisons were performed using student's t -test, and boxplot comparisons were calculated for each arthritis grade. In direct comparison of joint space narrowing, the radioscaphoid distance observed on the pencil grip radiographs was significantly lower than the PA wrist view in all arthritis grades ( p  < 0.05). The pencil grip view demonstrated more accurate joint space narrowing in patients with grade 2 osteoarthritis, but, not in other grades. There were no differences in radiolunate distance between pencil grip and PA wrist X-rays in all arthritis grades. The pencil grip X-ray view demonstrated significantly lower radioscaphoid distances across all arthritis grades compared with PA views, suggesting it may be more sensitive in detecting joint space narrowing. In particular, the pencil grip view more accurately demonstrated radioscaphoid joint space narrowing with grade 2 osteoarthritis. No significant differences were found in radiolunate distances between the two imaging methods. This study highlights the potential of the pencil grip X-ray view as a valuable tool for more accurately assessing early radioscaphoid wrist arthritis.
Placement of a Resurfacing Capitate Pyrocarbon Implant (RCPI) after proximal row carpectomy represents a reliable option for patients with osteoarthritis of the capitate head.  Methods: This is a retrospective study that evaluated clinically and radiologically 18 patients who underwent RCPI implantation, with a mean follow-up of 34 months.  Results: The postoperative pain decreased significantly in all patients (from 6 to 2 on a scale of 1 to 10), and mobility and grip strength remained sufficient for activities of daily living in most patients. Radiological assessment showed progression of osteoarthritic changes in all wrists, and 11 demonstrated an increase in the radiolucent line around the implant, which stabilized after 1 year. One implant presented distal protrusion without clinical repercussion. Nearly 80% of patients reported satisfaction with the placement of the implant. The remaining 20% had residual pain in daily activities. Only 1 patient required total wrist arthrodesis.  Conclusion: Despite the evolution of osteoarthritic changes in all radiographs, such as osteophyte formation or rise of the radiolucent line around the implant, most patients were satisfied with the clinical outcomes, underscoring the discordance between the clinical status and radiologic images and supporting the use of interposition pyrocarbon materials.    Cite this article as: Bruyneel J, Gkotsi A, Madani A, Kassi WE. Resurfacing capitate implant after proximal row carpectomy in advanced wrist osteoarthritis: A retrospective study. Acta Orthop Traumatol Turc., 2026; 60(2), 0308 doi:10.5152/j.aott.2026.25308.
Volar locked plating (VLP) and dorsal bridge plating (DBP) are commonly used fixation techniques for distal radial fractures (DRFs). In patients older than 65 years, DRFs account for more than 18% of all fractures; however, a comparison of outcomes of these techniques in the geriatric population is absent. The purpose of our study was to use propensity score matching to compare both clinical and radiographic outcomes of VLP and DBP fixation of DRF in geriatric patients ≥65 years. In total, 2,181 patients at least 65 years old with closed DRFs were retrospectively analyzed. Wrist range of motion (ROM) and radiographic outcome data were calculated at 6-month follow-up. Patient Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) were calculated at each follow-up visit. Injury characteristics, surgical complications, and patient demographic data were also analyzed. A combination of propensity score matching, multivariate analysis, t -test, and chi-square tests were used to conduct the statistical analysis. After propensity matching, a total of 1,375 patients underwent VLP, whereas 275 patients underwent DBP. Within the univariate analysis, the DBP demonstrated a higher proportion of AO Foundation/Orthopaedic Trauma Association (AO/OTA) 23-C fracture patterns, with fewer AO/OTA 23-A compared with VLP ( p  < 0.05). Multivariate analysis demonstrated greater wrist flexion and extension, radial and ulnar deviation, supination, pronation, and grip strength, and higher PROMIS PF and PI among the VLP group ( p  < 0.05). At 6-month follow-up, VLP patients demonstrated greater radial inclination (21.2 vs. 20.3 degrees), lower articular step-off (0.76 vs. 0.86 mm), with similar volar tilt and radial height ( p  > 0.05). DBP patients had higher rates of malunion (6.2 vs. 3.0%), nonunion (4.0 vs. 2.0%), and tendon rupture (2.5 vs. 0.9%) but similar rates of revision surgery and infection ( p  > 0.05). VLP was associated with greater wrist flexion, extension, radial deviation, ulnar deviation, supination, pronation, grip strength, and PROMIS PF and PI compared with DBP. There were significantly higher complication rates with DBP; however, there was a similar rate of revision surgery. While the VLP group showed significantly greater ROM and radiographic outcomes, this likely did not represent a clinically significant difference in this population. Therapeutic III.
The impact of surgical timing on outcomes in orthopedic trauma surgery remains controversial. While most evidence derives from hip fractures and other major injuries, data on distal radius fractures is limited. This study aimed to assess whether surgical timing influences operative duration, reduction quality, complication rates, and functional outcome after operative treatment of distal radius fractures. This single-center, retrospective study included patients aged ≥ 16 years who underwent surgical treatment for distal radius fractures at our hospital between 01.01.2016 and 31.12.2024. Patients without postoperative radiographic follow-up, those treated conservatively, or those managed by other departments were excluded. Patients were grouped according to surgical timing into regular-hours surgery (08:00-16:00) and out-of-hours service. A 1:1 matched cohort analysis was performed with criteria being AO/OTA fracture classification and propensity scoring for age and sex. Analyses were stratified by AO/OTA fracture type (A, B, and C). Outcomes included operative time, radiographic reduction quality, complication rates, and functional outcome assessed by postoperative range of motion. A total of 660 patients were included, of whom 434 underwent surgery during regular hospital hours and 226 during out-of-hours service. From the out-of-hours cohort, matching was performed using an exact match for fracture morphology according to the AO/OTA classification and propensity score matching for age and sex, resulting in two well-balanced 1:1 matched groups comprising 128 patients each. Across both groups, operative duration, reduction quality, complication rates, and functional outcome assessed by postoperative range of motion did not differ between regular-hours and out-of-hours surgery. Surgical timing was not associated with differences in operative duration, reduction quality, complication rates, or functional outcome after operative treatment of distal radius fractures. Within this matched cohort, no measurable differences were detected between regular-hours and out-of-hours surgery. As the study was not designed to establish equivalence, these findings indicate the absence of a detectable difference in this specific institutional setting and should not be interpreted as support for routine out-of-hours fixation.
This study aims to evaluate outcomes and radiographic progression of arthritis following four-corner fusion (4CF) in patients with and without calcium pyrophosphate deposition disease (CPPD). A retrospective cohort study with prospective follow-up was conducted involving 21 patients who underwent 4CF for wrist arthritis with a mean follow-up period of 4.6± 2.8 years. Eleven patients with confirmed CPPD and 10 patients without CPPD were included. Demographic data, range of motion, return to work and recreational function, subjective outcomes, and radiographic progression of arthritis as per the Larsen scale were assessed and compared between groups. Both groups showed a comparable range of motion at final follow-up. All patients rated their surgery as successful, and both groups reported high levels of satisfaction. The CPPD group demonstrated a significantly lower recovery of work function, averaging 39.2% of full work function compared with 88.1% in the control group. About 81.8% of patients in the CPPD group showed significant progression of arthritis on radiographs, compared with only 10% in the control group. The CPPD group experienced significantly higher rates of perceived deterioration in wrist motion (36.4%) versus the control group (0%). 4CF provides satisfactory outcomes in patients with and without CPPD, although higher rates of radiographic progression of arthritis were observed in patients with evidence of CPPD. CPPD may lead to more rapid structural changes, however, the symptomatic benefits of 4CF remain considerable. III B.
To present our clinical experience with a volar scapholunate (SL) ligament reconstruction using a strip of the long radiolunate ligament. This was a single-institution observational study (2004-2022) of SL ligament injuries with evidence of a torn volar component on arthroscopy that received volar capsulodesis with/without a dorsal repair. The postoperative range of motion (ROM), grip strength, complications, and secondary surgery (e.g., four-corner fusion or total wrist fusion), and radiographic changes were reported. Disabilities of arm, shoulder, and hand/patient-rated wrist evaluation (DASH/PRWE) scores were prospectively collected. Patients were stratified by static versus dynamic/predynamic SL diastasis and by isolated volar versus volar and dorsal ligament injury. Twenty-eight patients (15 females and 13 males) with a mean age of 35.1 years (± 15.7) met the inclusion criteria. The follow-up was 86.3 months (± 53.4; minimum 11 months). Most (26/28) patients were right-handed. The majority (20/28) of the patients presented ≥ 6 weeks postinjury. Few (4/28) used tobacco. Most (20/28) patients had dynamic/predynamic injuries. Postoperatively, the mean pronation/supination was 83 degrees/83 degrees, flexion/extension was 56 degrees/61 degrees, ulnar deviation was 30 degrees, and radial deviation (RD) was 19 degrees ( n  = 13). The mean grip strength was 78.8% (± 30.4) of the contralateral normal side ( n  = 14). Except for increased RD in patients with dynamic/predynamic injuries ( p  = 0.02), there were no other ROM differences. SL widening (>3 mm) postoperatively was observed in 33.3% (2/6) of static versus none of the dynamic/predynamic injuries ( p  = 0.165). There were only two postoperative complications, both surgical site infections. Two patients had persistent pain and required secondary surgery at a median of 48 months. At 86.9 months, patients reported a mean DASH of 16.4 (± 17.8) and a PRWE of 24.6 (± 23.6), and 78.9% (15/19) returned to prior work. We report long-term functional outcomes after a volar capsulodesis for volar SL injuries. This appears to be a safe procedure with an acceptable complication rate and low disability after 7 years. Most (approximately 79%) patients returned to their previous employment. A larger comparative study will be required to prove superiority to other types of repairs. Level IV, Case series.
Ulnar styloid fractures (USF) often occur in conjunction with distal radius fractures (DRF). This study aims to compare wrist prognosis between DRF patients with untreated USF and those with isolated DRF, and to assess the impact of different USF fracture types. A systematic search was conducted in databases such as PubMed, Embase, and the Cochrane Library, up to January 17, 2026. Randomized controlled trials (RCTs) and cohort studies comparing the wrist joint prognosis of patients with DRF combined with USF and those with isolated DRF were included. The primary outcome measure was the patient-reported wrist joint function score, and the secondary outcome measures were grip strength and wrist joint range of motion (ROM). 11 studies involving 1383 patients were included. In the short-term (≤6 months) follow-up, the wrist function score of patients with DRF combined with USF was statistically inferior to that of patients with DRF alone (SMD = 0.20, 95% CI: 0.05-0.34, P = 0.01), but the effect size was small and the clinical significance was limited. In the medium- to long-term (≥6 months) follow-up, there was no significant statistical difference in wrist function scores between the two groups (SMD = 0.11, 95% CI: -0.02-0.24, P = 0.11). Further analysis indicated that there was no significant statistical difference in prognosis between patients with base fractures and those with tip fractures at 3 and 12 months postoperatively. Additionally, there was no significant statistical difference in grip strength and wrist joint range of motion (including flexion, extension, pronation, supination, ulnar deviation, and radial deviation) between the two groups after surgery. Untreated USF do not compromise wrist function in patients with DRF, regardless of the USF fracture type. Based on the existing evidence, non-intervention for USF in clinical practice may not lead to poor prognosis. CRD420261286648.
Push-ups are performed ubiquitously as a means of strengthening/training and evaluating the upper extremity. However, push-ups performed on the hands with the wrist extended can cause wrist, elbow and shoulder injuries, which may result in disability. Conversely, individuals with a prior wrist or elbow injury are unable to perform push-ups. Our purpose was to evaluate movement patterns in two push-up styles (neutral and extended wrist) at the elbow and shoulder joints. We hypothesized that force-transfer will differ between the two styles, allowing the adjustment of training protocols according to athletic and physiologic needs. Fourteen healthy right-handed male volunteers performed push-ups on a neutral wrist and a hyperextended wrist in the gait analysis laboratory. Skin markers were applied over fixed points in the upper extremity. A Vicon motion capture system was used to follow the kinematics. Force vectors were measured using force plates. The movement and transfer of forces through the shoulder and elbow differ between the push-up styles. The shoulder moves more, in general, in a circular direction, when a push-up is performed on a neutral wrist compared to a push-up performed on an extended wrist. The shoulder is exposed to more load when the push-up is performed on a neutral wrist. The elbow moves less in general, and less in the medial and lateral planes, when the push-up is performed on a neutral wrist. The elbow is exposed to less load when the push-up is performed on a neutral wrist. The direction of forces through the joints differs between the two styles and the amount of force traversing the joints is inverse between the two styles. The movement through the elbow and shoulder is distributed differently during different styles of push-ups. The wrist and elbow can be relatively protected from ligament injury when push-ups are performed on a neutral wrist. Understanding the kinematics during different patterns of loading of the upper extremity can enable a tailored approach to strengthening training, treatment, and rehabilitation of the upper extremity. Specifically, differential strengthening and loading certain areas may be used for training protocols for a specific athletic task (such as throwing). Liegestütze werden allgemein als Mittel zur Kräftigung, zum Training und zur Beurteilung der oberen Extremität durchgeführt. Liegestütze, die auf den Händen mit überstrecktem Handgelenk ausgeführt werden, können Verletzungen des Handgelenks, des Ellenbogens und der Schulter verursachen, die zu einer Beeinträchtigung führen können. Umgekehrt sind Personen mit einer vorherigen Handgelenks- oder Ellenbogenverletzung häufig nicht in der Lage, Liegestütze auszuführen. Unser Ziel war es, die Bewegungsmuster in zwei Liegestütz-Stilen (neutrale, gestreckte Handgelenke) in den Ellenbogen- und Schultergelenken zu bewerten. Wir stellten die Hypothese auf, dass sich die Kraftübertragung zwischen den beiden Stilen unterscheidet, wodurch Trainingsprotokolle an sportliche und physiologische Bedürfnisse angepasst werden können.Vierzehn gesunde, rechtshändige männliche Freiwillige führten Liegestütze sowohl mit neutralem Handgelenk als auch mit überstrecktem Handgelenk im Ganganalyse-Labor durch. Hautmarker wurden an festen Punkten der oberen Extremität angebracht. Ein Vicon-Bewegungserfassungssystem wurde verwendet, um die Kinematik zu verfolgen. Kraftvektoren wurden mithilfe von Kraftmessplatten gemessen.Die Bewegung und Kraftübertragung durch Schulter und Ellenbogen unterscheiden sich zwischen den beiden Liegestütz-Stilen. Die Schulter bewegt sich im Allgemeinen mehr – in einer kreisförmigen Richtung – wenn ein Liegestütz mit neutralem Handgelenk ausgeführt wird, verglichen mit einem Liegestütz mit überstrecktem Handgelenk. Die Schulter ist bei Liegestützen mit neutralem Handgelenk einer höheren Belastung ausgesetzt. Der Ellenbogen bewegt sich insgesamt weniger und weniger in der medialen und lateralen Ebene, wenn der Liegestütz mit neutralem Handgelenk ausgeführt wird. Der Ellenbogen ist bei dieser Variante einer geringeren Belastung ausgesetzt. Die Richtung der Kräfte durch die Gelenke unterscheidet sich zwischen den beiden Stilen, und die Kraftverteilung durch die Gelenke ist zwischen ihnen invers.Die Bewegungen durch Ellenbogen und Schulter verteilen sich während der unterschiedlichen Liegestütz-Stile verschieden. Das Handgelenk und der Ellenbogen können relativ vor Bandverletzungen geschützt werden, wenn Liegestütze mit neutralem Handgelenk ausgeführt werden. Das Verständnis der Kinematik bei unterschiedlichen Belastungsmustern der oberen Extremität ermöglicht einen gezielten Ansatz für Krafttraining, Behandlung und Rehabilitation der oberen Extremität. Insbesondere kann die gezielte Kräftigung und Belastung bestimmter Bereiche für Trainingsprotokolle bei spezifischen sportlichen Aufgaben (wie dem Werfen) genutzt werden.
Distal radius fractures are common in elderly patients and often lead to functional impairment. This study compared closed reduction with external fixation (EF) and open reduction with locking plate fixation (LP) in elderly patients. A retrospective analysis was conducted on 80 elderly patients with unilateral distal radius fractures treated in our hospital from 2021 to 2024. Patients were divided into a closed reduction and EF group (n = 40) and an open reduction and locking plate internal fixation group (n = 40), according to the surgical procedure. General demographic and fracture-related data were collected and compared between the 2 groups. Perioperative parameters, including operation time, perioperative hemoglobin changes (ΔHb), Hb decrease (ΔHb), and postoperative hospital stay, were evaluated. Perioperative outcomes, complications, Disabilities of the Arm, Shoulder and Hand (DASH) scores, wrist range of motion (ROM), and visual analogue scale (VAS) pain scores were compared. Baseline characteristics were comparable between the 2 groups. In terms of surgical parameters, the EF group demonstrated significantly shorter operative time, shorter postoperative hospital stay, and smaller perioperative hemoglobin decrease (all P < .001). Functionally, DASH scores at 3 and 6 months postoperatively were significantly lower in the locking plate group than in the EF group, and the excellent/good functional rate at 6 months was 85.0% versus 62.5% (P < .05). Wrist ROM improved over time in both groups, but the locking plate group showed better motion in all directions at 3 and 6 months, as well as a higher excellent ROM rate at 6 months (82.5% vs 65.0%, P < .05). Regarding pain, early postoperative VAS scores were similar between groups; from 1 month onward, VAS scores remained slightly lower in the locking plate group (P < .01). EF offers advantages of shorter surgery, less perioperative trauma, and faster recovery, making it suitable for patients with limited surgical tolerance. LP provides better functional recovery, wrist mobility, and long-term pain relief, and may be preferred for elderly patients with higher functional demands. Individualized treatment should be based on patient condition and functional expectations.
To investigate the clinical and radiographic outcomes following volar open wedge osteotomy (VOWO) in patients with volar carpal instability resulting from volar marginal fragment (VMF) escape after distal radius fixation. This retrospective cohort study reviewed records of 21 consecutive adult patients treated with VOWO at two urban tertiary care centers in India. All patients had volar carpal translation following failed fixation of a VMF and a minimum follow-up of 1 year. Adjunctive procedures included short radiolunate ligament repair, refixation of large VMFs, and dorsal wrist-spanning fixation when indicated. The primary outcome was osteotomy healing with restoration of radiocarpal stability. Secondary outcomes included wrist range of motion, Mayo wrist score, and complications. Osteotomy healing with restoration of radiocarpal stability was achieved in all patients. At a mean follow-up of 23 months (range, 14-48 months), significant improvements were observed in wrist motion and function. The mean wrist flexion-extension arc improved from 46° preoperatively (range, 25-70°) to 110°° postoperatively (range, 80-140°, P < 0.001), while the mean pronation-supination arc improved from 90° to 124° (P = 0.023). The mean Mayo wrist score improved from 23 preoperatively (range, 5-50) to 83 at final follow-up (range, 75-100, P < 0.001). Radiographic arthritis involving the radiocarpal joint and distal radioulnar joint (DRUJ) was observed in 2 patients, and DRUJ instability was noted in 2 patients. Volar open wedge osteotomy should be considered a salvage procedure, which reliably restores radiocarpal stability while preserving functional wrist and forearm motion in the short term, with minimal complications, in patients with volar carpal instability secondary to VMF escape following distal radius fixation. IV, Therapeutic study.
The surgical management of thumb carpometacarpal osteoarthritis is extensive, with numerous techniques describing both open and arthroscopic approaches. However, there is limited literature on the outcomes of arthroscopic trapeziectomy. The primary objective of this study is to evaluate the clinical and functional outcomes of total arthroscopic trapeziectomy combined with suture-button suspensionplasty. The secondary objective is to assess patient satisfaction with the surgery. We evaluated a total of 42 patients (34 women) with a mean age of 62.34 years, all diagnosed with severe trapeziometacarpal osteoarthritis according to Eaton's classification (grades III and IV). Measurements were taken preoperatively and more than 1 year postoperatively, including range of motion, Kapandji test, pinch strength (tip-to-tip and key pinch), and grip strength (Jamar). All patients completed the disabilities of the arm, shoulder, and hand (DASH) questionnaire and visual analog scale (VAS) for pain. Finally, patient satisfaction levels were recorded at 1 year postsurgery. The mean preoperative DASH and VAS scores were 48.81 ± 17.97 and 7.2 ± 1.48, respectively, showing significant improvement to 7 ± 10.32 and 0.52 ± 1.50 at 1 year postoperatively ( p  < 0.05). We found a significant weak positive correlation between the collapse of the first metacarpal and the DASH and VAS scores ( p  < 0.05). Regarding the range of motion, similar results were found in terms of range (palmar and radial abduction and Kapandji test) compared with preoperative values. Pinch strength showed slight improvements in tip-to-tip strength (3.2 ± 1.69 vs. 3.42 ± 1.75) and JAMAR grip strength (15.76 ± 9.53 vs. 17.61 ± 9.64), with a slight decrease in key pinch strength (4.26 ± 2.29 vs. 4.11 ± 1.68), although these differences were not statistically significant. The mean patient satisfaction was 4.5/5, with less than 5% of the sample rating their satisfaction below 3/5 postsurgery. Total arthroscopic trapeziectomy combined with suture-button suspensionplasty is an effective technique for improving pain and hand disability in patients with severe trapeziometacarpal osteoarthritis. 2b therapeutic, individual cohort study.
Foveal tears of the triangular fibrocartilage complex (TFCC) present challenges for hand and wrist surgeons due to their impact on wrist stability and function. This study aims to evaluate the safety and effectiveness of a modified 3-portal all-arthroscopic technique using a bony anchor. A retrospective review of 19 consecutive TFCC tear repairs was conducted. Patients with ulnar-sided wrist pain and confirmed TFCC tears underwent surgery by a single surgeon. Clinical data, surgical techniques, and outcomes were analyzed. The majority of patients experienced significant improvements in pain, grip strength, and range of motion following surgery. The technique showed improvements in pain relief (74% reported no pain), grip strength restoration (mean restoration of 93%), and range of motion(mean restoration of 97%). Utilizing the modified Mayo wrist score, 12 patients (63%) achieved excellent outcomes, 6 patients (32%) attained good outcomes, and 1 patient (5%) had satisfactory outcomes. This modified 3-portal arthroscopic TFCC repair technique using a bony anchor technique can effectively alleviate symptoms and improve wrist function in patients with TFCC tears. Level IV.
In the management of articular distal radius fractures, achieving an accurate reduction of joint fragments is essential for a favorable prognosis. Fixation of the volar rim remains a surgical challenge, as volar plates may be improperly positioned despite adequate joint reduction. This study aims to analyze anatomical variations in the distal radius, focusing on the distance between the watershed line (WL) and the radiocarpal articular surface. These anatomical variations may partially explain the difficulty in achieving optimal plate placement during distal radius fracture fixation. We conducted a single-center study between October 2023 and May 2024, collecting three key measurements from computed tomography scans (CT scans) of healthy wrists. Based on distribution and correlation analyses, the wrists were categorized into two groups according to the distance from the most palmar point of the WL to the joint margin (SFWL). Group 1 included wrists with an SFWL ≥ 2.5 mm, and group 2 included those with an SFWL < 2.5 mm. The 2.5 mm threshold was selected based on the diameter of commonly used distal radius screws. This analysis revealed two emerging anatomical patterns. Then, four operators independently classified the CT scans as type 1 or 2 distal radius anatomy. Interoperators' variability was assessed using Cochran's Q test and Fleiss's kappa. A total of 100 wrists from 100 patients were included. Eighty-nine patients (89%) were classified in group 1 (SFWL ≥ 2.5 mm), and 11 (11%) in group 2 (SFWL < 2.5 mm). In group 1, three patients (3.4%) showed a negative or zero value in the minimal distance from the WL (MDFWL) to the articular surface, indicating a high risk of intra-articular screw penetration. This risk was notably higher in group 2, with three patients (27.3%) exhibiting similar findings. Interoperator variability was strong, with a Fleiss's kappa of 0.73. Our findings suggest that the distal radius exhibits a spectrum of anatomical variation, which may contribute to suboptimal volar plate placement in some distal radius fractures. Recognizing these variations preoperatively may improve implant selection and reduce the risk of flexor tendon complications. Level IIIA.
Distal radius fractures (DRF) account for up to 18% of adult fractures, with malunion occurring in up to 25% of conservatively managed cases and 10% of surgically managed cases. Symptomatic malunion can lead to significant morbidity, including loss of forearm rotation, adaptive carpal instability, and arthritis. Corrective osteotomy is a key surgical intervention, yet there is no consensus on the optimal surgical approach, fixation technique, or necessity of bone grafting. The purpose of this systematic review is to evaluate surgical outcomes of distal radius osteotomy for extra-articular malunion, compare volar and dorsal approaches, and assess the need for bone grafting. A search of PubMed (2000-2023) was conducted using predefined search terms to identify relevant studies. A total of 17 studies met inclusion criteria, which required primary data on DRF malunion correction, comparative analyses of volar versus dorsal approach, bone graft necessity, and patient-reported outcomes. Data on complication rates, patient satisfaction, and clinical questionnaire scores were analyzed. Volar plate fixation outcomes were assessed in 10 studies, with 5 using bone grafting and 5 without. Both the groups demonstrated significant improvement in patient-reported outcome measures (PROMs), radiographic measures, and grip strength. Four studies without bone grafting reported zero cases of nonunion, while one study was discontinued due to persistent malunion in 20% of cases. Bone grafting, including autologous and synthetic options, was associated with similar functional and radiographic outcomes. Two studies directly compared volar and dorsal approaches. Both the approaches demonstrated significant improvements in range of motion and patient-reported outcomes. However, the volar approach resulted in significantly greater wrist flexion ( p  = 0.012) and fewer hardware-related complications compared with dorsal plating. Three studies assessed the necessity of bone grafts and showed mixed results. While some demonstrated successful outcomes without grafting, others reported improved union rates with cancellous grafts. One study found no difference between autologous and synthetic grafts. Corrective osteotomy for DRF malunion significantly improves patient outcomes, with volar plate fixation trending toward better outcomes over dorsal plating. Bone grafting may not be essential for all cases, particularly when stable fixation is achieved with cortical bony contact. Further high-quality comparative studies are needed to refine surgical decision-making.
The present study aims to evaluate the patient-reported outcomes of endoscopic carpal tunnel release (CTR) compared with open release in patients with electrodiagnostically confirmed severe carpal tunnel syndrome (CTS). Patients with severe CTS who underwent either open or endoscopic CTR between 2017 and 2021 were included in the study, with 38 patients in the open group and 35 in the endoscopic group. Electronic medical records were reviewed for demographic and clinical data, including preoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) scores. Patient outcomes, including postoperative QuickDASH scores, were collected via telephonic survey. At the time of surgery, the median age of patients in the open group was 61 years (interquartile range [IQR]: 54-69) and 66 years (55-76) in the endoscopic group. At a mean of 5 years follow-up, complete resolution of symptoms was reported in 34 of 38 (89.5%) cases in the open group. In the endoscopic group, all 35 cases showed complete resolution at a mean of 3 years follow-up. This difference was not statistically significant ( p  = 0.116). Preoperative to postoperative QuickDASH scores improved by a median of 33.0 (IQR: 14.0-42.1) and 34.0 (25.0-54.3) points in the open and endoscopic groups, respectively ( p  = 0.136). Minimal clinically important difference (MCID) on QuickDASH was achieved in 68.4% of open releases and 85.6% of endoscopic releases ( p  = 0.101). There were no complications in either group, and patients reported high satisfaction rates. After surgery, the length of time away from work was 9 (6-25) days in the open group and 7 (2-23) days in the endoscopic group ( p  = 0.454). The present study suggests that endoscopic and open CTR offer similar outcomes, supporting both options as safe and effective treatment for severe CTS.
Foveal triangular fibrocartilage complex (TFCC) repair can restore distal radioulnar joint (DRUJ) stability, but whether open or arthroscopic techniques provide superior clinical outcomes remains uncertain. This systematic review and meta-analysis compared functional outcomes, DRUJ stability, and complications between open versus arthroscopic foveal TFCC repair for acute and chronic post-traumatic DRUJ instability. PubMed, Scopus, and Cochrane CENTRAL were searched initially in January 2026 and updated on 15 April 2026 to identify comparative studies of open versus arthroscopic TFCC foveal repair published from January 2000 onward. Adult patients undergoing open or arthroscopic TFCC foveal repair for DRUJ instability were included. Non-comparative studies, abstracts, and non-English publications were excluded. Extracted outcomes included Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analogue Scale (VAS) score for pain, grip strength, range of motion, recurrent instability, and complications. Random-effects meta-analysis pooled standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. Risk of bias was assessed using ROBINS-I, and certainty of evidence using GRADE. Exploratory subgroup analysis by injury chronicity at study level was performed. Five observational studies (Level II-III evidence; 322 wrists: 181 open, 141 arthroscopic) met inclusion criteria. ROBINS-I rated two studies at moderate and three at serious risk of bias; GRADE certainty was low to very low across outcomes. Pooled results showed no statistical differences: MMWS (SMD - 0.12, 95% CI - 0.47 to 0.23; I² = 0%, τ² = 0; p = 0.719); DASH score (SMD 0.22, 95% CI - 0.96 to 1.40; I² = 86.7%, τ² = 0.48; p < 0.0001); PRWE (SMD - 0.24, 95% CI - 2.85 to 2.38; I² = 93.3%, τ² = 1.03; p < 0.0001); VAS (SMD - 0.35, 95% CI - 1.69 to 0.99; I² = 89.9%, τ² = 0.63; p < 0.0001); recurrent instability OR (1.00, 95% CI 0.19 to 5.37; I² = 63.2%, τ² = 1.18; p = 0.028). Exploratory subgroup synthesis restricted to predominantly chronic cohorts did not materially alter pooled estimates. Both open and arthroscopic foveal TFCC repair can improve function, pain, motion, grip strength, and distal radioulnar joint stability, but current comparative evidence does not demonstrate clear superiority of either technique. Because the available evidence is limited to a small number of non-randomized studies with substantial heterogeneity and low certainty, the absence of statistically significant differences should be interpreted cautiously and should not be considered evidence of clinical equivalence. In addition, although SMDs were appropriate for the present meta-analysis given heterogeneity in outcome reporting, they reduce the clinical interpretability. Surgical choice should therefore remain individualized until higher-quality comparative studies become available. PROSPERO registration: CRD42025638530.
Effective patient education and activity expectation-setting following knee replacement requires understanding postoperative recovery patterns. We investigated step-count recovery patterns, identified recovery trajectory clusters, and examined differences in postoperative outcomes and preoperative factors associated with those clusters. Using wrist-worn accelerometer, step-counts were measured for one week preoperatively and six weeks postoperatively in patients with knee osteoarthritis undergoing total or unicompartmental knee replacement (UKR). Patient-reported outcomes (OKS, EQ-5D-3L, EQ-VAS) were collected preoperatively and at six postoperative weeks. The proportion of participants exceeding their preoperative step-count was calculated. Latent class growth analysis identified trajectories of absolute (postoperative) and relative (postoperative-to-preoperative ratio) step-counts. Kruskal-Wallis with Dunn's test assessed differences in postoperative outcomes across trajectories, and multinomial logistic regression assessed associations between trajectories and preoperative factors. Eighty-two participants (aged 42-89 years; 52% women) were included. Within six weeks, 32% exceeded preoperative step-counts. Three trajectories (high, moderate and low recovery) were identified for both absolute and relative step-counts. For absolute steps, the "high recovery" group (n = 30, 37%) began with a median of 991 steps [IQR 1,335] at Week1 and achieved a median of 6,606 steps [IQR 2,940] by Week6. This compares to the "moderate" group (n = 24, 29%) who improved from 360 steps [IQR 481] at Week1 to 3,739 steps [IQR 1,918] at Week6, and the "low" group (n = 28, 34%) who increased from 29 steps [IQR 176] at Week1 to 1,452 steps [IQR 1,504] by Week6. For relative steps, the "high recovery" group (n = 39, 47%) reached 92% [IQR 29%] of their preoperative step-count at Week6, compared with 64% [IQR 25%] in the "moderate" group (n = 26, 32%) and 31% [IQR 7%] in the "low" group (n = 17, 21%). Patients in the high recovery trajectories reported less pain, better knee function (OKS) and better health status at six weeks versus low recovery trajectories. Membership of the high trajectories was more likely in those with higher preoperative step-count and for those managed with UKR. Patients with lower preoperative step-count were unlikely to achieve high absolute step-count and less likely to achieve high- or moderate-relative recovery trajectories versus those with a higher preoperative step-count. One in three individuals regained preoperative step-count by six weeks, with heterogeneity in recovery patterns. Greater recovery was associated with higher preoperative step-count and UKR procedures.
This study aims to investigate the effects of increasing handgrip strength by applying Kinesio taping to the wrist extensors on the functional level in patients undergoing lower extremity surgery who ambulate with a walker. This retrospective study analyzed data from 100 patients aged 65 years and older who underwent lower extremity surgery and ambulated with a walker. The patients were divided into two groups: a control group (CG) that was kept under the standard rehabilitation program and a Kinesio taping group (KT) in which Kinesio taping was applied to the forearm extensor muscles in addition to the group being under standard rehabilitation program. The patients' handgrip strength (HGS), pain, and functional levels (Functional Independence Measurements (FIM), Iowa Level of Assistance Scale (ILAS), and Iowa Walking Speed Scale (IWSS)) were retrospectively assessed before treatment and at discharge. Compared to the CG group, the right and left HGS, functional levels, and IWSS of the patients increased significantly in the KT group, and their activity-related pain levels decreased significantly (p < 0.005). A significant positive correlation was observed between the change in HGS and the change in ILAS and FIM scores, and a statistically significant negative correlation was found between the change in HGS and the change in activity-related pain and IWSS (p < 0.05). Our findings suggest that Kinesio taping application is a simple and cost-effective method that increases HGS in patients and is an effective method in controlling pain, improving walking speed, and enhancing functionality in patients undergoing lower extremity surgery. https://clinicaltrials.gov/study/NCT06072261.