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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.
Scapholunate dissociation is usually the result of failure of multiple wrist ligaments. With continued use other structures attenuate, which results in change in position of the carpal bones. It is presumed that load characteristics in the wrist joint change with changes in carpal bone position. This is thought to result in localized pressure overload and arthritic change. The purpose of this study was to evaluate radioscaphoid joint pressures and carpal kinematics after sectioning specific wrist ligaments. Our hypotheses are that there would be increased scaphoid flexion and ulnar deviation, increased lunate extension and radial deviation, increased contact pressure in the radioscaphoid fossa, and increased tendon forces. Eight cadaver wrists were instrumented with an electromagnetic motion tracking device and a pressure sensor was inserted into the radioscaphoid joint. Using a wrist joint motion simulator, motion and pressure data were obtained in the moving wrist in the intact state and after sectioning the dorsal radiocarpal, dorsal intercarpal, and scapholunate interosseous ligaments. After ligament sectioning there was increased scaphoid flexion, scaphoid ulnar deviation, lunate extension, and lunate radial deviation resulting in carpal instability. There was also an increase in pressure in the radioscaphoid fossa. Several specimens showed evidence of scaphoid subluxation. It is our conclusion that this combination of ligament sectioning produces scapholunate instability and increased pressures in the radioscaphoid fossa in the laboratory setting. We believe that if left untreated in the clinical setting, scapholunate advanced collapse could result.
Implant loosening is a serious complication after total wrist arthroplasty. Radiostereometric analysis has been the gold standard for measurement of implant migration; however, the use of bead free computer tomography radiostereometric analysis (CT-RSA) has emerged as an alternative due to its higher precision. In this study, the precision of a novel photon-counting detector CT (PCD-CT) was compared to conventional energy-integrating detector CT (EID-CT) at different radiation doses. One cadaveric wrist with total wrist arthroplasty (TWA) implant was scanned 40 times with EID-CT and PCD-CT at two radiation doses. Additionally, eight patients with the same implant were scanned with PCD-CT post-surgery, and after 6 and 12 months. PCD-CT scans were reconstructed with 0.2-mm and 1.0-mm slice thickness. Precision data for the cadaveric wrist and migration data for the patients were calculated using CT-RSA. The precision of total implant rotation was significantly better with PCD-CT at half the radiation dose (0.08°) compared to full-dose EID-CT (0.15°, p = 0.002). Similarly, translational precision at the implant tip was higher with half-dose PCD-CT (0.02 mm) than with EID-CT (0.03 mm, p = 0.04). For migration, the proximal component had moved (median) -0.04 mm distally at 6 months and 0.01 mm at 12 months. The rotation around the axis at these time points was 0.03° and 0.06°, respectively. In this cadaveric precision study, PCD-CT enabled CT-RSA measurements with high precision at a lower radiation dose than conventional EID-CT. The accompanying eight-patient in vivo cohort should be interpreted as a feasibility cohort and showed only small descriptive early migration values during the first postoperative year. Larger longitudinal studies are needed to determine clinically relevant migration thresholds and the value of this method for detecting implant loosening." Photon‑counting detector computed tomography and computed tomography micromotion analysis allow high-definition tracking of total wrist arthroplasty migration at half the radiation dose of conventional CT, offering a high‑precision, low‑dose tool for early detection of implant loosening.
To provide a clinical overview of selected common pathologies causing radial-sided wrist pain and to guide primary care physicians in the diagnostic approach and initial management of these conditions. A literature review was conducted using the PubMed MEDLINE database, supplemented by reference musculoskeletal clinical textbooks. Radial-sided wrist pain has a wide differential diagnosis due to the complex anatomy of the wrist. A thorough clinical evaluation-including detailed history, physical examination, and appropriate imaging-is essential for accurate diagnosis. Several common conditions are presented with diagnostic features, relevant physical examination tests, and an overview of treatment options. Radial-sided wrist pain requires careful clinical assessment to differentiate among multiple pathologies originating from anatomic causes. Primary care physicians can effectively manage many of these conditions with appropriate diagnostic strategies and conservative treatments. Early recognition and targeted interventions can prevent complications and improve patient outcomes.
This study aimed to evaluate distal radial epiphyseal maturation using the Dedouit MRI staging system and to assess its applicability for forensic age estimation. In this retrospective study, clinical wrist MRI examinations of 516 subjects (252 females and 264 males) aged 10-27 years were evaluated. Coronal FS PD-weighted TSE images acquired on a 1.5 T MRI scanner were assessed independently by two radiologists according to the five-stage Dedouit classification system. Sex-specific age characteristics, minimum age thresholds, diagnostic performance at the 15- and 18-year age thresholds, and intra- and interobserver agreement were evaluated. Significant sex-related differences were observed in stages 3-5, with males reaching equivalent maturation stages at older ages than females (p < 0.05). Intra- and interobserver agreement was very good (weighted κ = 0.894 and 0.849, respectively). According to the minimum age concept, stage 5 was observed only in individuals older than 15 years in both sexes. The stage 4 or higher cutoff showed higher sensitivity, whereas stage 5 showed higher specificity for identifying individuals aged 15 years or older. Diagnostic performance for the 18-year threshold was limited. In conclusion, the Dedouit staging system demonstrated excellent reproducibility for the assessment of distal radial epiphyseal maturation on wrist MRI. The presence of stage 5 may support that an individual is older than 15 years. However, the method was insufficient for assessing the 18-year age threshold. These findings should be interpreted with caution because of the unbalanced age distribution of the study population. Further studies involving larger and more age-balanced populations are warranted.
Parkinson's disease (PD) is typically assessed during short clinical visits using rating scales such as the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). These assessments provide only a snapshot of symptom severity and may not capture fluctuations in daily life. In this study, we examined whether wrist-worn actigraphy can be used to estimate MDS-UPDRS scores in people with Parkinson's disease (PwP). Continuous accelerometer recordings at 25 Hz were collected over up to 28 days using GeneActiv devices. From these recordings, three feature representations were derived: non-embedding actigraphy features, self-supervised accelerometer embeddings, and a combined feature set. A small set of regression models was evaluated using strict leave-one-participant-out cross-validation (LOPO-CV). Estimation performance varied across targets and feature sets. The strongest result was observed for MDS-UPDRS Part IV, where non-embedding features with Elastic Net achieved a mean absolute error (MAE) of 1.6 and a correlation of 0.83 between estimated and actual values. The combined feature set performed best for Part I (MAE = 3.0, r = 0.60), Part III (MAE = 8.2, r = 0.47), and the total MDS-UPDRS score (MAE = 13.3, r = 0.49), whereas non-embedding features performed best for Part II (MAE = 2.7, r = 0.61). Embedding-only models were competitive for some outcomes, but were not the best overall. Overall, the results show that month-long wrist-worn actigraphy contains information related to PD severity in daily life, although estimation accuracy remains limited and depends on the MDS-UPDRS target. Wearable-derived measures may therefore provide complementary information to clinical assessments, particularly for motor complications.
This study provides a comprehensive analysis of the application of artificial intelligence (AI) in diagnosing acute traumatic wrist joint injuries (WJIs), including fractures and ligament damage. AI has demonstrated significant potential in identifying fractures and ligament damage. The study highlights the use of various AI technologies and algorithms, including Convolutional Neural Networks (CNNs), Gradient Class Activation Mapping (Grad-CAM), deep learning models, object detection models, automated assessment algorithms, traditional machine learning techniques, data augmentation and preprocessing, Natural Language Processing (NLP), and integration with other imaging modalities. Compared with traditional diagnostic methods, AI offers substantial benefits, such as efficient processing of large datasets, minimizing diagnostic errors and missed cases, aiding in interpreting complex fracture patterns, optimizing workflow, enhancing diagnostic efficiency, and providing comprehensive diagnoses through multimodal integration. AI has significantly improved the precision and efficiency of fracture detection, reduced unnecessary imaging procedures, expedited the diagnostic and reporting process, optimized resource allocation, and improved patient outcomes. However, clinical application of AI faces challenges, including ethical considerations, regulatory hurdles, data privacy and security issues, algorithm transparency and interpretability problems, and unclear liability definitions. The future of AI in diagnosing WJIs is promising, with potential advancements in fracture detection, treatment planning, and rehabilitation strategies. However, challenges such as model validation and training of healthcare professionals must be addressed to fully integrate AI into orthopedic practice and advance the management of WJIs.
Upper limb amputation is among the most functionally disabling conditions, affecting an estimated 1.6 million people in the United States, with prevalence projected to double by 2050. Despite decades of technological progress, device abandonment rates remain persistently high, up to 45% for body-powered and 35% for myoelectric prostheses in the paediatric population, due to inadequate functionality, poor sensory feedback, discomfort, and social stigma. This narrative review aims to provide a structured and up-to-date synthesis of upper limb prosthetic technologies, with a focus on hand, wrist, and elbow devices, analysing their structural characteristics, control mechanisms, clinical evidence on functional outcomes, and user satisfaction. A structured literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library, combining terms related to upper limb amputation and prosthetic devices. A primary corpus of peer-reviewed articles was selected to cover the full spectrum of upper limb prosthetics, from foundational biomechanics to advanced bionic and neural interface systems; a narrative approach was adopted to accommodate the heterogeneity of available study designs. Across all device categories, no single prosthetic solution proved universally superior. Each category presents distinct functional, biomechanical, and psychosocial trade-offs, with prescription choices driven by amputation level, residual musculature, user priorities, and activity demands. Two limitations recur across every category. The first is the instability of surface EMG signals, which constrains reliable myoelectric control; the second is the absence of effective sensory feedback, which raises cognitive load and contributes to abandonment. Bridging the gap between laboratory performance and real-world usability, through more robust control algorithms, meaningful sensory restoration, and a shift toward user-centred, outcomes-driven development, remains the central challenge for the future of upper limb prosthetics.
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BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral neuropathy in adults but is rarely encountered in children. Pediatric CTS is usually secondary to specific underlying conditions, contrasting with the largely multifactorial nature of adult cases.Case presentationWe report the case of a right-handed 11-year-old girl who developed CTS. Extensive investigations including imaging, metabolic and genetic testing, as well as histopathologic and electroneuromyography analysis, excluded metabolic, anatomical, tumoral, and traumatic causes, leading to the diagnosis of an idiopathic form. After surgery, ultrasonography confirmed a complete decompression whereas EMG was improved but remained persistently abnormal. The patient was clinically improved but still had slight residual paresthesia.ConclusionThis case underlines the diagnostic and etiologic workup of CTS in children. Early recognition is essential to prevent irreversible median nerve damage and to uncover potential systemic underlying causes. A multidisciplinary approach, combining detailed family and medical history, clinical examination, imaging, electrophysiology, and targeted metabolic and genetic testing, is fundamental to ensure accurate diagnosis, comprehensive care, and improved outcomes.
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Perilunate dislocations are uncommon and frequently missed wrist injuries that can lead to significant morbidity, such as median nerve injury, carpal instability, and poor functional outcomes, if not promptly identified and treated. Early recognition and coordinated management are especially important in rural trauma settings where subspecialty resources are limited. This case describes a 17-year-old male who presented to a rural emergency department following a motorcycle accident. Initial evaluation showed extensive road rash and a gross deformity of the left elbow. Radiographs of the chest, pelvis, left elbow, and right wrist were obtained. The right wrist demonstrated a scaphoid fracture with a perilunate dislocation. A telemedicine consultation was performed with an emergency medicine physician and the patient was transferred for higher-level care. Upon arrival, orthopedic surgery was consulted. Physical exam showed tenderness to palpation and pain with passive wrist motion. Attempted closed reduction of the perilunate injury was unsuccessful. The wrist was splinted, and the orthopedic hand surgeon was consulted. Open reduction of the perilunate dislocation and carpal tunnel release were performed under general anesthesia. A volar approach was performed, with a longitudinal incision made over the palmar aspect of the hand along the radial border of the ring finger. The median nerve was decompressed, a hematoma was removed, and the capitate was reduced back over the lunate with traction, wrist flexion, and direct pressure on the dorsal aspect of the capitate. Reduction was confirmed on orthogonal fluoroscopic views. The wound was irrigated, closed with nylon suture, and a splint was applied. At 2 month follow-up, the patient was doing well and demonstrated stable wrist alignment with interval healing of all injuries. This case highlights the complexity of managing perilunate dislocations in resource-limited healthcare settings and the importance of prompt diagnosis, appropriate care, and timely surgical referral.
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.
At SAE Level 2 automation, the human driver retains full supervisory responsibility, making unobtrusive monitoring relevant for maintaining supervision under real-world driving conditions. Driver monitoring systems capable of operating robustly under such conditions are therefore essential, but wearable-based personalized approaches remain underexplored, particularly when the target labels are derived from experimental scenarios. This study presents a real-world SAE Level 2 on-road acquisition campaign and evaluates a target-driver intra-subject classification approach using non-intrusive wrist-derived signals. Physiological and motion data recorded with the Empatica E4 wristband, including blood volume pulse, electrodermal activity, heart rate, skin temperature, and triaxial wrist acceleration, were converted into image representations and processed with a frozen ResNet-50 feature extractor, principal component analysis, and a supervised classifier. The labels were scenario-derived operational driver-state classes defined from experimental phases and scenario groups. Personalization was assessed via a Leave-One-Experience-Out protocol on the target driver. Classification accuracy was 50% under external-user-only training, 54% under mixed target/external-user training, and 60% under target-driver-only training, with the target-driver-only configuration yielding the highest mean performance in the evaluated setting. For the low-demand baseline class, the one-vs.-rest classifier achieved 88.4% accuracy and an F1-score of 70%. These results provide initial evidence of the feasibility of personalized wrist-worn classification of scenario-derived operational driver-state classes under the real-world automated driving conditions evaluated in this study.
The Dietary Oxidative Balance Score (DOBS) and Dietary Inflammatory Index (DII) reflect dietary oxidative and inflammatory status. This study investigated their associations with the prevalence of wrist, hip, and spine fractures. DOBS and DII were scored based on 16 and 28 dietary factors, respectively. Multivariate logistic regression models and restricted cubic spline (RCS) models were used to assess the associations of DOBS and DII with the prevalence of wrist, hip, and spine fractures. Temporal trends of DOBS and DII and their associations with fracture trends were also analyzed, with subgroup analyses for robustness. Compared with the lowest DOBS tertile, the highest DOBS tertile was associated with lower prevalence of hip and spine fractures [OR = 0.57 (0.32, 0.72); OR = 0.79 (0.48, 1.00)]. In contrast, the highest DII tertile was associated with an increased prevalence of hip and spine fractures compared with the lowest DII tertile [OR = 1.85 (1.49, 2.72); OR = 1.75 (1.18, 2.58)]. Anti-inflammatory and antioxidant diets were associated with lower prevalence of hip and spine fractures compared with pro-inflammatory and pro-oxidative diets [OR = 0.45 (0.24, 0.85); OR = 0.66 (0.44, 0.84)]. No significant associations were observed for wrist fractures. The overall DOBS trended upward among U.S. adults, while the DII showed opposite trend during the same period, with consistent results observed in subgroup analyses. Higher DOBS and/or lower DII were significantly associated with lower hip and spine fracture prevalence, but not with wrist fracture prevalence.
Early identification of active synovitis is essential for treat-to-target management in inflammatory arthritis. While MRI and ultrasound are highly sensitive, their clinical use is constrained by high costs, operator dependence, and lack of portability. Infrared thermography (IRT) is rapid and contactless, but conventional temperature-based approaches are sensitive to ambient conditions and inter-individual baseline variability, and contralateral comparison is unreliable in bilaterally involved disease. This study evaluates whether consumer-grade thermal cameras, augmented with texture-based features and complementary differencing strategies, can detect and differentiate joint inflammation. Thermal images of knees, ankles, wrists, and metacarpophalangeal (MCP) joints were acquired from 239 participants (167 with inflammatory arthritis, osteoarthritis (OA), or fibromyalgia; 72 healthy controls). Beyond absolute temperature, higher-order texture features (e.g., entropy, skewness) were extracted to quantify spatial heterogeneity in heat distributions. To reduce environmental and inter-individual variability, two normalization strategies were applied: contralateral left-right (L-R) differencing for unilateral disease and a novel anterior-posterior (A-P) differencing for bilateral or subclinical presentations. Group comparisons used the Mann-Whitney U test (p < 0.05), and effect sizes were summarized using Cohen's d. Compared with non-differenced features, contralateral differencing markedly strengthened discrimination for unilateral inflammation, with very large effects at the knee (d = 2.15) and ankle (d = 1.83). Texture features, specifically entropy and skewness, outperformed absolute temperature in detecting latent (subclinical) wrist inflammation via A-P differencing ([Formula: see text]). Thermographic signatures also supported differential characterization, distinguishing inflammatory arthritis from OA ([Formula: see text]) and fibromyalgia ([Formula: see text]). Furthermore, A-P gradients showed anatomical specificity, with inflammation reducing gradients in wrists but increasing them in MCP joints (d = 0.64). Texture-enhanced thermography, combined with L-R and A-P differencing, shows promise as an accessible approach for identifying active and subclinical joint inflammation. This approach addresses the limitations of bilateral disease in traditional thermography and widens the clinical applicability of IRT screening.
Motor imagery (MI) engages neural networks involved in movement execution and modulates corticospinal excitability (CSE). Proprioceptive inputs associated with movement may further influence corticospinal engagement during MI. Tendon vibration (TV) provides proprioceptive stimulation without requiring actual movement and has also been shown to increase CSE. This study investigated whether combining MI with TV enhances corticospinal excitability and whether these effects are reproducible across sessions. Sixteen healthy participants (11 males; 24.9 ± 6.3 years) completed two similar sessions. Transcranial magnetic stimulation was used to elicit motor-evoked potentials from the wrist muscle under four conditions: rest (REST), MI of maximal wrist flexion, TV applied to the wrist, and the combination of both MI and TV (MITV). CSE was quantified during each condition as the area under the recruitment curve, obtained by progressively increasing TMS intensity. The MITV condition led to a significantly greater increase compared to REST, MI, and TV (P < 0.001). Specifically, MITV showed a 80% greater increase in CSE compared with MI. In addition, the TV and MI conditions both exhibited greater CSE than REST. Reproducibility analysis revealed poor to good reliability across sessions. Results suggest that combining MI with TV may enhance corticospinal engagement compared with MI alone.
Distal radius fractures (DRFs) are among the most common adult fractures and are frequently treated with volar plate fixation. While intraoperative 3D imaging has been proposed to improve detection of malreduction and implant malposition, its impact on clinical and radiological outcomes remains unclear. This study aimed to evaluate whether intraoperative 3D imaging provides advantages over conventional 2D fluoroscopy. Outcome criteria were accuracy of fracture reduction, plate positioning relative to the watershed line, complication rates, operative time, and functional outcomes following volar plate fixation of distal radius fractures. This retrospective single-centre study included patients aged ≥ 16 years who underwent volar plate fixation for distal radius fractures between 2016 and 2024. Patients were assigned to a 3D imaging group or a conventional 2D fluoroscopy group. To ensure comparability, patients were matched 1:1 using exact AO/OTA subgroup matching and propensity score matching for age and sex. Outcomes included operative duration, radiographic reduction quality, plate positioning, complications, and wrist range of motion. Matched-pair comparisons were performed using appropriate paired statistical tests. Of 1,259 patients screened, 418 patients (209 matched pairs) were included after exact AO/OTA subgroup matching and propensity score matching for age and sex. Operative time was significantly longer in the 3D group across AO type A, B, and C fractures (all p < 0.05), with the largest difference observed in complex C3 fractures. Reduction quality was comparable in AO type A fractures, whereas higher reduction scores were observed in the 3D group for AO type B fractures and complex C3 fractures. No significant differences were observed in plate positioning, complication rates, or wrist range of motion between groups. Intraoperative 3D imaging was associated with longer operative times than conventional 2D fluoroscopy and did not improve plate positioning, complication rates, or short-term wrist range of motion. While reduction quality was comparable in simple fracture patterns, exploratory analyses demonstrated higher reduction scores in AO type B and complex intra-articular C3 fractures treated with 3D imaging. These findings suggest that the potential benefit of intraoperative 3D imaging may be concentrated in selected complex fracture patterns rather than routine distal radius fracture fixation. Prospective studies are required to confirm these findings.
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.
Scaphoid nonunion is a common complication of missed or inadequately treated scaphoid fractures and is generally considered an indication for surgical treatment because of the risk of progressive carpal collapse and degenerative arthritis. Spontaneous union of an established scaphoid nonunion is exceptionally rare, particularly in the presence of radiological findings suggestive of proximal pole vascular compromise. We report the case of a 23-year-old right-handed manual worker with a chronic scaphoid nonunion. The patient sustained an initial wrist injury in 2017 that was treated conservatively after normal radiographs and was subsequently lost to follow-up. Following a new wrist trauma in 2023, imaging revealed a stage IIA scaphoid nonunion according to the Alnot classification. Computed tomography demonstrated a persistent fracture line with sclerotic margins and increased density of the proximal fragment, suggestive of avascular compromise. Surgical reconstruction using a vascularized bone graft according to the Zaidemberg technique was planned. However, radiographs obtained 13 months after the diagnosis and immediately before surgery unexpectedly demonstrated complete union of the scaphoid. Computed tomography confirmed trabecular bridging and complete consolidation, leading to cancellation of the planned procedure. Spontaneous healing of an established scaphoid nonunion has been reported only rarely in the literature. Although the mechanisms remain poorly understood, progressive revascularization, favorable biological healing potential, and intrinsic mechanical stability have been proposed as possible explanations. This case highlights the exceptional possibility of spontaneous union in chronic scaphoid nonunion, even in the presence of adverse radiological features, and emphasizes the importance of repeat imaging before undertaking surgical treatment.