搜索结果：The Journal of hand surgery

Patients treated for Dupuytren contracture in one digit are at risk for future intervention in other digits or the contralateral hand. Identifying predictive factors can aid in patient counseling. A single institutional database was queried for procedural codes for collagenase treatment or surgical fasciectomy. A total of 658 patients were identified in this query. Out of this cohort, 341 patients were eligible for inclusion. The cohort consists of 141 initially treated with fasciectomy and 200 initially treated with collagenase, between 2015 and 2019. The primary outcome was the need for subsequent treatment in the same digit, other digits of the same hand, or the contralateral hand. Predictor variables included demographics, medical history, and pretreatment contracture severity. At a mean follow-up of 5.3 years, 142 (42%) of patients underwent additional treatment. Revision procedures on the same digit occurred in 88 patients (26%) at a mean of 3.2 years, on another digit in the same hand in 35 patients (10%) at a mean of 3.6 years, and on the contralateral hand in 79 patients (23%) at a mean of 2.3 years. Procedure, multiple digits treated, and initial nontreated contracture are associated with subsequent procedures on the same digit. Younger age, active smoking, and initial nontreated contracture are associated with subsequent procedures on another digit in the same hand. Dominant hand was initially treated; initial nontreated contracture are associated with subsequent procedures on the contralateral hand. Within 5 years of initial treatment for Dupuytren contracture in one digit, patients have over 40% likelihood of future intervention for contracture. Patients have approximately a 10% likelihood of future treatment on another digit in the same hand and nearly a 25% likelihood of future treatment in the contralateral hand. Key risk factors include age, multiple digits treated, smoking, and the presence of initially nontreated fingers, which should be incorporated into patient counseling. 3-Retrospective cohort study, prognostic.

Ulnar nerve injury causes weak pinch strength through paralysis of the first dorsal interosseus and adductor pollicis muscles. Current reconstructive strategies provide variable reanimation of these muscles. It has been suggested that nerve transfer of the opponens pollicis (OPB) motor branch to the terminal division of the deep branch of the ulnar nerve (TDDBUN) may successfully restore pinch strength. The true effectiveness of this intervention remains unknown as there are few cases in the literature with all originating from a single author. We retrospectively identified patients who underwent transfer of OPB to TDDBUN at a single institution between 2019 and 2025 with at least 1-year clinical follow-up. Patients were excluded if they were unavailable to return for in-office strength testing. Key and subterminal key pinch, pinch-to-zoom, and grip strength (kg) were measured using dynamometers and compared with the contralateral side. First web space bulk (mm), Kapandji score, Froment's sign, and patient-reported outcomes (Disability of the Shoulder and Hand and Visual Analog Pain Scale) were assessed. Twelve patients underwent transfer of OPB to TDDBUN and were available for in-office strength testing at greater than 1 year follow-up. The median patient age was 42 years (range, 19-66 years). Mean key pinch and subterminal key pinch strength were 48% (SD 17) and 43% (SD 23) of the uninjured side, respectively. Average pinch-to-zoom strength was 58% (SD 31) of the uninjured side. Average grip strength was 56% (SD 36) of the uninjured side. Mean first web space bulk was 81% (SD 15) of the contralateral. Interestingly, at final follow-up, 10 of 12 patients retained a positive Froment sign, despite pinch strength recovery. All patients retained thumb opposition with a Kapandji score ≥5. Transfer of OPB to TDDBUN may reliably reinnervate the first dorsal interosseous and adductor pollicis, restoring approximately half of the pinch strength observed in the uninjured hand. Therapeutic IV.

We investigated the complication profile and effectiveness of arthrodesis, trapeziectomy without suspensionplasty or ligament reconstruction (S/LR), trapeziectomy with S/LR, and joint replacement (JR) for the management of base-of-thumb arthritis. We included cases of interposition material placement within the trapeziectomy without the S/LR group. A systematic search of PubMed, Embase, and Web of Science was performed from their date of inception to November 2024. The primary complication outcome of interest was the reoperation risk, whereas the primary efficacy outcomes of interest were the pain score measured using a visual analog scale (VAS), Kapandji Opposition Score, and Disability of the Arm, Shoulder and Hand (DASH) or QuickDASH score at the end of the follow-up period. Network meta-analysis was performed. Surface under cumulative ranking (SUCRA) values were computed for studies published within the past 2 decades to rank each group against outcomes of interest, resulting in an approximate summary of the rank distribution of each intervention. A higher SUCRA value, therefore, indicates a better ranking. Cluster analysis was then used to provide an overall recommendation, balancing the risks and benefits of the procedure. Seventy-one studies were included in the final analysis. SUCRA values for reoperation risk in the arthrodesis, trapeziectomy without S/LR, trapeziectomy with S/LR and JR groups were 1.3%, 66.4%, 98.2%, and 34.1%, respectively. Likewise, the SUCRA values for each of these groups (in the same order) were 45.5%, 18.0%, 44.7%, and 91.7% for VAS pain scores; 0.0%, 76.8%, 34.4%, and 88.8% for Kapandji Opposition Score; and 2.0%, 44.9%, 53.2%, and 99.9% for DASH or QuickDASH score. Trapeziectomy with or without S/LR had a lower reoperation risk and improved patient-reported outcome measures. Balancing the modest improvement in impairment measures against a high reoperation risk, there is still insufficient evidence to recommend the routine use of JR. Therapeutic IV.

The application of arthroscopy in the proximal interphalangeal joints can avoid scar development and joint contracture. However, conventional arthroscopic techniques are difficult to apply to the palmar side of the joint. This study aimed to explore the feasibility and safety of the inside-out volar portal arthroscopic technique for the proximal interphalangeal joint, elucidating a new portal technique for the inspection and treatment of small joints. We performed the inside-out palmar portal arthroscopic technique on 10 cadavers. The distances between portals and important tissues were measured in both the extended (0°) and 90° flexed positions of the proximal interphalangeal joint. The full cohort demonstrated sufficient safety distances from portals to proper digital vessels and nerves, flexor digitorum tendons, and extensor digitorum tendons in all the fingers. Statistically significant differences were found in the distances to the ulnar interosseous vein, ulnar interosseous nerve, and ulnar flexor tendon among the four fingers. Specifically, the mean values were higher in the index and middle fingers compared to the ring and little fingers. Additionally, the measurements were similar between the ulnar and radial sides, suggesting that the inside-out volar portals can be established on either side of the proximal interphalangeal joint. The findings demonstrate the feasibility of the inside-out volar portal arthroscopic technique. This study provides a new portal selection for proximal interphalangeal joint arthroscopy. Surgical techniques for the proximal interphalangeal should consider the pathology of palmar structures to ensure optimal treatment. This study suggests that the inside-out volar portal arthroscopy of the proximal interphalangeal joint is a feasible technique for joint diseases.

Recommendations for perioperative management of biologic disease-modifying antirheumatic drugs (bDMARDs) in hand surgery were historically adopted from other surgical specialties. The purpose of our study was to estimate the risks of surgical site infections (SSIs) and wound healing failures in patients with rheumatoid arthritis (RA) treated with bDMARDs undergoing elective hand surgery. We queried the TriNetX Research Network for patients with RA taking disease-modifying antirheumatic drugs (DMARDs) within 6 months of elective hand surgery. Patients were stratified into conventional synthetic, biologic, and targeted synthetic DMARD subgroups. Among bDMARD users, patients with an active prescription within 1 dosing interval before surgery were classified as bDMARD continued; others were classified as discontinued. Ninety-day risks of SSIs, wound healing failures, and composite wound morbidity were estimated by coded data. Disease flare risks were estimated by treatment escalations at 30 and 90 days after surgery and included as exploratory analyses. Outcomes were compared across DMARD classes and between propensity-score matched cohorts of patients who continued versus discontinued bDMARDs perioperatively. A total of 7,929 patients with RA were treated with DMARDs. Complication risks were similar across DMARD classes. Among patients treated with biologic agents (n = 2,668; 33.6%), 908 (34.0%) continued and 1,760 (66.0%) discontinued bDMARDs. After matching 881 per cohort, patients who continued bDMARDs perioperatively had similar estimated risks of SSIs (2.0% vs 1.5%), wound healing failures (1.4% vs 1.4%), and composite wound morbidity (3.0% vs 2.5%), compared to those who discontinued therapy. Perioperative bDMARD continuation was associated lower risks of postoperative disease flares, as estimated by treatment-based proxies. Among patients with RA undergoing elective hand surgery, perioperative bDMARD continuation was not associated with significant increases in risks of wound healing failures or SSIs. A modest increase in SSI risk cannot be excluded given exposure misclassification and residual confounding. Prognosis IIc.

This study investigated the influence of preoperative intra-articular steroid injections on surgical outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty and arthrodesis and aimed to determine whether preoperative steroid injections affect the choice of surgical procedures for treating painful thumb carpometacarpal osteoarthritis. We analyzed 49 and 51 thumbs treated with LRTI arthroplasty and arthrodesis, respectively. Preoperative intra-articular steroid injections were used for 12 and 15 thumbs in the LRTI and arthrodesis groups, respectively. Clinical outcomes were measured before surgery, 3 months after surgery, and at final follow-up using the Disabilities of the Arm, Shoulder, and Hand score, Hand20 questionnaire score, Kapandji score, and visual analog scale scores for pain, grip strength, and pinch strength. In the LRTI group, the trapezial space height and ratio were evaluated. In the arthrodesis group, the bone union rate and time to union were assessed. Radiological and clinical outcomes of both groups based on the use of steroid injections were compared at each time point. Chronological changes were also analyzed. Intra-articular steroid injections did not affect radiological outcomes, including the trapezial space height and ratio in the LRTI group and bone union in the arthrodesis group. Significant differences in clinical outcomes of both groups based on the use of steroid injections were not observed during follow-up. Chronological analyses revealed that grip strength and pinch strength in the steroid injection subgroup were less improved than those in the no steroid injection subgroup of the LRTI group. Conversely, no significant differences in clinical outcome improvements were observed in these subgroups of the arthrodesis group. Intra-articular steroid injections did not affect radiological and clinical outcomes of LRTI arthroplasty and arthrodesis. Both procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections. Therapeutic IV.

Carpal tunnel syndrome is one of the most prevalent upper-extremity disorders. It may present unilaterally, bilaterally, or on the contralateral hand at a subsequent time to initial carpal tunnel release (CTR). We aimed to assess the incidence, timing, and factors associated with contralateral CTR at the time of an index unilateral surgery. We performed a retrospective chart review of 1,291 primary unilateral CTR surgeries performed from 2008 to 2013 with a minimum follow-up period of 10 years within our integrated health network. In total, 742 (58%) patients met our inclusion criteria. We conducted bivariate analyses to assess for risk factors associated with contralateral CTR. Odds ratios were calculated for variables with significant results. A Kaplan-Meier curve was generated to depict the overall cumulative rate of contralateral CTR-free survival. Of the 742 patients included, 314 patients (42%) underwent contralateral CTR surgery at a median of 10.6 months (IQR 4.2 months to 2.7 years) after primary surgery. The incidence of contralateral CTR after 1, 2, 5, and 10 years is 22%, 26%, 34%, and 40%, respectively. The strongest predictor was the presence of contralateral carpal tunnel syndrome symptoms at the time of index surgery (odds ratio [OR] 7.2, P < .05). Other significant risk factors included preoperative contralateral electrodiagnostic study severity (OR 1.43 per unit increase, P < .001) and a concurrent diagnosis of trigger finger (OR 1.80, P < .05). Black race was associated with significantly lower odds of contralateral surgery (OR 0.44, P < .05). The incidence of contralateral CTR surgery is substantial over long-term follow-up. The observed association among trigger finger, Black race, and contralateral CTR warrants further research. Our findings help to inform preoperative counseling for patients undergoing unilateral CTR. Prognostic III.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been retracted at the request of Dr Brent Graham, former Editor-in-Chief. Post-publication, the journal received a Letter to the Editor alleging major methodological issues with the paper. The authors were requested to provide comment on these concerns and they agreed that the study had been done incorrectly, thus leading to inaccurate conclusions affecting a substantial portion of the work. The Editor is satisfied that no attempt to deceive was made on the part of the authors. However, the extent of changes required to correct the record is too significant to be addressed in a corrigendum. Consequently, the Editor has determined that the findings of the article in its present form cannot be relied upon, and has decided to retract the article. The authors agree with the retraction.

The purpose of this study was to compare the failure rate of primary trigger finger corticosteroid injections (CSIs) using triamcinolone versus betamethasone. This was a retrospective cohort study of all primary trigger finger CSIs given by a single fellowship-trained, hand surgeon over two 8-month periods. From June 2022 to January 2023, all trigger finger CSIs were performed with triamcinolone (1 mL, 40 mg/mL). From June 2023 to January 2024, all trigger finger CSIs were performed with betamethasone (1 mL, 6 mg/mL). Patient charts were reviewed at 1 year following the CSI to determine the failure rate of the CSI. Failure was defined as reintervention with either a repeat CSI or trigger finger surgery. For those patients who failed the primary CSI, the time to failure was recorded. The two cohorts were similar in terms of finger laterality and finger distribution. In the triamcinolone cohort, 284 fingers in 238 patients received a primary trigger finger CSI. Within 1 year, 47 fingers (16.5%) had undergone either a repeat CSI (43 [15.1%]) or trigger release surgery (4 [1.4%]). In the betamethasone cohort, 255 fingers in 223 patients received a primary trigger finger CSI. Within 1 year, 89 fingers (34.9%) had undergone either a repeat CSI (73 [28.6%]) or trigger release surgery (16 [6.3%]). The percentage of patients undergoing repeat intervention was significantly greater in the betamethasone cohort (P < .05). Moreover, the betamethasone cohort had a significantly shorter mean time to failure as compared with the triamcinolone cohort (167 days vs 273 days, P < .05). For primary trigger fingers, patients treated with a betamethasone CSI were significantly more likely to undergo a repeat CSI or trigger finger release surgery within 1 year of the CSI compared with patients treated with a triamcinolone CSI (P < .05). Betamethasone CSIs resulted in a significantly shorter time to failure than triamcinolone CSIs (P < .05).

Unlike pediatric trigger thumb, which is cured by A1 pulley release, pediatric trigger fingers (PTFs) have a high rate of recurrence with A1 pulley release alone. The flexor digitorum superficialis (FDS) splitting technique has the potential to mitigate recurrence without the need for more extensive dissection. This study investigates the clinical outcomes of A1 pulley release with concomitant A2 pulley partial release and FDS splitting in the treatment of PTF. A retrospective review was conducted at our institution, examining patients with PTF from January 2010 to July 2025. Inclusion criteria consisted of patients aged >18 years who underwent surgical treatment for PTF. Descriptive statistics were used to determine the rate of retrigger and the average length of follow-up after surgery. A total of 25 patients and 38 fingers met the inclusion criteria. Average age at surgery was 7 years (range, 1-16 years) with most patients being woman (60%), not Hispanic or Latino (63%), and White (90%). Of the treated digits, 8% were index fingers, 18% were ring fingers, 26% were little fingers, and 47% were middle fingers. No cases of recurrent PTF were observed at the first postoperative visit, occurring at a median of 14 days (range, 4-79 days) after surgery. Three patients did report stiffness and pain, but these symptoms resolved with continued mobilization. At final follow-up, which occurred at a median of 6 years (range, 2-13 years) after the initial postoperative visit, no patients reported pain or recurrence of PTF. The A1 pulley release with concomitant A2 pulley partial release and FDS splitting demonstrated favorable outcomes in the treatment of PTF. Of the 38 treated digits, no cases of recurrence or pain were observed at the final postoperative follow-up. This suggests that incorporating FDS splitting may help reduce early recurrence without requiring extensive dissection beyond the A2 pulley. Therapeutic IV.

This study aimed to evaluate the prognostic importance of radial translation on functional outcomes in patients treated nonoperatively or surgically for distal radial fractures. It was hypothesized that increased radial translation would be associated with worse functional scores, regardless of treatment modality. This retrospective comparative study included 130 adult patients (aged 18-70 years) with unilateral AO/OTA 2R3A2 distal radius fractures, treated between January 2020 and December 2024. Group 1 (n = 60) underwent closed reduction and plaster casting, whereas group 2 (n = 70) underwent open reduction and volar locking plating performed by a consultant hand surgeon. Disabilities of the Arm, Shoulder, and Hand (DASH) scores and standard wrist radiographs were analyzed in patients with at least 12 months of clinical follow-up. Radiographic parameters, including radial inclination, radial length, volar tilt, ulnar variance, and radial translation, were assessed. Outcomes were assessed using the DASH score, visual analog scale pain scores, and the goniometric wrist range of motion. Correlation and multivariable regression analyses were performed to identify independent predictors of the DASH scores. A total of 130 patients were included. Across the entire cohort, radial translation demonstrated the strongest association with patient-reported disability, showing a substantial positive correlation with DASH scores (R2 = 0.763). Other radiographic parameters, including radial length, ulnar variance, volar tilt, and radial inclination, showed only weak or minimal correlations with functional outcomes. Pain scores and wrist range of motion measurements did not display meaningful radiographic associations. In multivariable analysis, radial translation remained the most important independent variable related to DASH scores, whereas the contributions of other radiographic and demographic factors were limited. Radial translation is a strong and independent predictor of functional outcomes in distal radius fractures. Intraoperative assessment and correction of coronal alignment, including radial translation, should be emphasized along with sagittal parameters. Routine radiographic assessment of this parameter may improve the functional prognosis. Prognostic III.

The purpose of this study was to compare the clinical and radiographic outcomes 5 years after randomization to volar plating or combined plating for surgical treatment of an AO (Arbeitsgemeinschaft f&#xfc;r Osteosynthesefragen) type C distal radius fracture (DRF). A total of 150 patients were previously randomized to a volar locking plate or combined plating for treatment of an AO type C DRF with strict inclusion and exclusion criteria. All participating patients were invited for a 5-year postoperative follow-up. Radiographs, pain (visual analog scale), grip strength, and range of motion were documented, along with the Patient-Rated Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, and EuroQol 5-Dimension questionnaires. Arthritis in the radiocarpal and distal radioulnar joint was graded on radiographs by a senior radiologist according to the Knirk and Jupiter classification. There were 135 patients (66 in the volar plate group and 69 in the combined plating group), corresponding to a 90% follow-up rate. Median age at follow-up was 67 years (interquartile range 57-75). There was no difference in radiographic arthritis between the two groups. The volar plate group had significantly better outcomes in flexion, extension, radial deviation, and Patient-Rated Wrist Evaluation (P < .05). There were no significant between-group differences in the Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension index, or EuroQol Visual Analog Scale (P > 05). Hardware removal was significantly more common in the combined plating group (64%) than in the volar plate group (30%) (P < .001). Among surgically treated patients with AO type C DRF, those operated with volar plating had better clinical outcomes 5 years after surgery compared to those treated with combined plating, but the minimal clinically important difference was not reached. These findings support volar plating as the preferred method for AO type C DRFs. Therapeutic I.

The purpose of this study was to assess outcomes after treatment of scaphoid nonunion with open reduction internal fixation and nonvascularized autograft (NVA). This was a retrospective case series assessing all patients with scaphoid nonunions treated with open reduction internal fixation and NVA at a multispecialty orthopedic hospital from 2014 to 2024. Inclusion criteria were 12 weeks or greater from date of injury to date of surgery. Exclusion criteria were absence of postoperative CT scan or presence of additional local procedures. Radiographic healing was defined as 50% bridging bone on CT scan. Ninety-nine patients were included in this study: 45 patients were treated with cancellous only autograft (COA), 52 were treated with corticocancellous autograft (CCA), and 2 were treated with osteochondral autograft. Ninety-five percent of patients healed. Median time to healing was 81 days. On first postoperative CT, obtained at a median of 77 days after surgery, 75% of patients were healed. Eighty-nine percent of patients had bridging bone present on first CT; 99% of these patients went on to heal. Thirteen patients in this study had a prior attempt at surgical fixation at another institution; all healed after revision surgery. There were no significant differences in the odds of healing at any time point or the time to healing for patients treated with CCA versus COA. Surgical treatment of scaphoid nonunion with NVA had a union rate of 95%. There were no significant differences in outcomes between patients treated with CCA and COA. Of patients who exhibited bridging bone on CT obtained at a median of 76 days after surgery, 99% went on to union. These findings support use of NVA for scaphoid nonunion and discourage the use of multiple postoperative CT scans to confirm healing. Therapeutic IV.

Upper-extremity spasticity is a functionally limiting symptom of upper motor neuron syndrome that can lead to musculotendinous and joint contractures. Surgical interventions, including hyperselective and selective neurectomies, have shown sustained efficacy in treating the spastic upper limb and have recently gained notable traction. We hypothesized that, in the long-term, surgical procedures are a cost-effective option for management of upper-extremity spasticity compared with neurotoxin therapy. Reimbursement rates were obtained from the Centers for Medicare and Medicaid Services Physician Fee Schedule using Current Procedural Terminology codes. Surgical costs incorporated both physician reimbursement and facility fees in hospital outpatient and Ambulatory Surgery Center settings, whereas neurotoxin costs included physician reimbursement and drug costs, modeled at 3-month intervals. Cost estimates were generated for each anatomic level of the upper extremity, with analyses and figures created using Python 3.13.1. Although neurotoxin therapy incurred lower short-term expenses, cumulative costs surpassed surgical management across all anatomic levels. Cost-parity was consistently achieved around 5 years. Over 10 years, neurotoxin therapy ranged from $18,990 to $65,810, depending on the anatomic region treated, whereas average surgical management ranged from $4,009 to $24,880, with the lowest costs observed in ambulatory surgery centers. For example, repeated neurotoxin treatment for elbow spasticity reached $65,810 at 10 years versus $3,875 for hyperselective neurectomy in an Ambulatory Surgery Center. Hyperselective neurectomy and tendon procedures provide a cost-effective treatment for the management of upper-extremity spasticity, as compared with widely accepted treatment standards of repeated neurotoxin injection. Although surgical interventions come with a high initial cost, cost-parity is reached when compared with 5 years of neurotoxin treatment. Future research should further investigate the utility, financial burden, and indirect costs of surgery and long-term neurotoxin therapy from a patient perspective. Economic and decision analysis IV.

Considerable variation exists in strategies for the diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS). Additionally, different subtypes of NTOS present with different constellations of symptoms and signs. The aim of this study was to gather and evaluate different treatment plans from high-volume NTOS surgeons for standardized case scenarios. Six case scenarios were distributed to 19 self-designated level IV expert NTOS surgeons. These included standardized patients presenting with Gilliat-Sumner hand, upper plexus involvement with scapular winging, pectoralis minor syndrome, electrically negative TOS with pain and sensory changes only, NTOS with concomitant distal double crush compression neuropathies, and recurrent NTOS following previous first rib resection. Each surgeon independently reviewed case information and formulated an investigative and treatment plan using a free-text response. The most common investigation ordered was a cervical spine or brachial plexus magnetic resonance imaging. Where exposure of the supraclavicular brachial plexus was indicated, the preferred surgical approach was a supraclavicular approach, with the majority of experts also recommending a concomitant pectoralis minor tenotomy. In the presence of scapular winging, some surgeons would perform a long thoracic nerve neurolysis or nerve transfer. In the absence of motor symptoms, all experts would recommend surgery only after failure of conservative treatment. With findings suggesting concomitant distal nerve compression sites, the most common recommendation was a comprehensive surgical approach to decompress the brachial plexus and distal sites simultaneously. A smaller proportion of experts preferred a "distal first" approach. Consistent trends were seen in recommendations for work-up and treatment of NTOS patients. Compared with other surgical specialties treating NTOS, hand surgeons have a tendency toward (1) a supraclavicular approach for brachial plexus decompression, (2) increased preference for rib-sparing scalenectomy over first rib resection, and (3) consideration of concomitant or staged surgery to address distal nerve compression sites. Therapeutic V.

Wide-awake local anesthesia no tourniquet (WALANT) hand surgery produces less waste and carbon emissions than traditional operating room surgery. High procedural volumes and expanding adoption among hand surgeons' position WALANT as a continued optimal target for waste-reduction initiatives. This study quantifies waste reduction after recycling implementation in a WALANT procedure room and identifies materials most contributory to total waste production. A prospective recycling intervention study was conducted at a single institution. Baseline waste generation was measured for 33 WALANT hand procedures over 5 days in a clinic procedure room prior to the recycling intervention. A recycling intervention was then initiated, wherein clean recyclable materials were separated from total waste and recycled. All waste was segregated into nonrecyclable versus recyclable streams and weighed over 4 days. Waste per case before and after intervention was calculated. Additionally, weight and recycling status (recyclable/nonrecyclable) were recorded for every item included in a WALANT carpal tunnel release kit at our facility. Preintervention WALANT procedures generated 3.30 lbs (1.50 kg) of waste per case on average. After recycling implementation, 9.3 lbs (4.22 kg) was diverted to recycling, corresponding to 0.49 lbs (0.22 kg) per case and 16% of the postintervention total waste stream. Nonrecycled waste decreased from 3.30 lbs (1.50 kg) per case before intervention to 2.50 lbs (1.13 kg) per case after intervention, a reduction of 0.80 lbs (0.36 lbs) per case. Major contributors to remaining nonrecyclable waste included surgical drapes and sterile solution bottles, constituting &#x223c;43% and &#x223c;27% of nonrecyclable waste by weight, respectively. Recycling implementation in the WALANT procedure room diverted approximately 16% of the total waste to recycling. The intervention required minimal workflow modification and demonstrated measurable reductions in procedural waste, with effects that increase proportionally in high-volume clinical settings. These findings highlight the importance of ongoing innovation in surgical material management. Economic/decision analysis IV.

Trigger finger, or stenosing tenosynovitis, is a common musculoskeletal disorder characterized by pain, stiffness, and locking of the affected digit. This prospective case series evaluated the outcomes of a commercially available proximal interphalangeal (PIP) joint orthosis combined with therapeutic exercise in patients with Green grades I-III trigger finger. Thumbs were excluded. Patients aged &#x2265;18 years with trigger finger (Green grades I-III) were treated with a PIP joint orthosis worn during sleep and as needed during the day, together with a structured exercise program including flexor tendon gliding and stretching exercises for 6 weeks. Pain intensity (Numeric Pain Rating Scale [NPRS]), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, and Green's grades were assessed at baseline and after 6 weeks. Treatment success was defined based on initial Green grade. Seventy-nine patients (107 affected digits) were enrolled, with a mean age of 51.8 &#xb1; 9.8 years and a women-to-men ratio of 3.4:1. After 6 weeks of intervention, median NPRS pain scores significantly decreased from 6 to 1 during movement, and QuickDASH scores improved from 25 to 10. The proportion of digits with Green grade III decreased from 8.0% to 2.3%, whereas grade I increased to 71.3%. The overall treatment success rate was 55.2%. In this prospective case series, the combination of PIP joint orthosis and therapeutic exercise was associated with reduced pain, improved hand function, and decreased triggering severity in patients with Green grades I-III trigger finger. Because of the absence of a control group, these findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments. Therapeutic IV.

Timely and high-quality hand and upper-extremity care should be accessible to all patients. Certain demographic factors like age and body mass index have been consistently linked to differences in care, yet the influence of the social determinants of health (SDOH) remains a growing area of research. This study uses the three-delays model to evaluate associations between health inequities, as measured by the PROGnosis RESearch Strategy (PROGRESS) framework, and access to timely and high-quality hand and upper-extremity care. A systematic review of PubMed, EMBASE, and Web of Science was conducted using terms describing SDOH in hand and upper-extremity care. Studies were categorized based on the health inequity focus of the PROGRESS framework. The three-delays model was then used to assess how each PROGRESS factor contributed to suboptimal access, delivery, or receipt of hand and upper-extremity care. Descriptive statistics were used to report data. Our initial search yielded 2587 articles, 75 of which were included. The most common pathologies studied were distal radius fractures (20 studies), general elective upper-extremity surgery (15 studies), and upper-extremity trauma (6 studies). Socioeconomic status was the most common health inequity-contributing factor studied (44 studies), followed by place of residence (24 studies) and gender/sex (24 studies). Within socioeconomic status, the most common factor studied was insurance status (24 studies), which was associated with all three delays. The most common delay studied was related to delay 3 (delays in receiving adequate care [51 studies]), followed by delay 2 (delays in reaching care [20 studies]) and delay 1 (delays in deciding to seek care [12 studies]). Numerous SDOH-related factors have been correlated to access to timely and high-quality hand and upper-extremity care. In this study, we highlight the largely economic disparities in receipt of care and highlight opportunities for further research. With this analysis, we identify areas for intervention with the goal of providing equitable opportunities for patients to seek, access, and receive care. Economic/decision analysis II.

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). 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. 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. 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. Prognosis IV.