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Editorial

What’s New in Hand Surgery

Dy, Christopher J. MD, MPH1

Author Information
The Journal of Bone and Joint Surgery: March 20, 2019 - Volume 101 - Issue 6 - p 479-485
doi: 10.2106/JBJS.18.01325
  • Free
  • Disclosures

It is my distinct pleasure to provide an overview of the hand and wrist surgery literature published in the last year. I would like to thank Sanjeev Kakar, MD, for his thoughtful updates over the past 3 years. In this Update, I have summarized articles published from October 2017 to September 2018 in The Journal of Hand Surgery (American), The Journal of Hand Surgery (European), and HAND.

Distal Radial Fractures

In a prospective randomized trial, Martinez-Mendez et al. compared volar plate fixation and cast management in patients who were >60 years of age and had AO type-C distal radial fractures1. At the time of the final follow-up, at least 24 months after the injury, the primary outcome measure (Patient-Rated Wrist Evaluation total score) was lower (indicating less disability) in the group randomized to volar plating. There were no losses of reduction in the volar plating group, but loss of reduction did occur in 26% (12 of 47) of the patients in the casting group. This Level-I evidence of superior patient-reported outcomes with volar plating for patients who were ≥60 years of age is contrary to a prior Level-I study conducted in Austria by Arora et al. published in The Journal of Bone and Joint Surgery (American volume) in 20112. There are interesting contrasts between the 2 studies: Arora et al. included patients who were ≥65 years of age and also included both AO type-A and type-C fractures. Interestingly, the mean Patient-Rated Wrist Evaluation scores reported at 12 months in both the volar plating group (12.8 points) and the casting group (14.6 points) in the study by Arora et al. were lower than those reported in both the volar plating group (17 points) and the casting group (30 points) in the study by Martinez-Mendez et al. at ≥24 months, suggesting that there are patient-level and surgeon-level differences between the 2 environments in which the studies were conducted. Baseline activity levels were not assessed in either study, with age and radiographic criteria used to determine eligibility; however, bias from differences in baseline activity was likely to have been accounted for in randomization.

Based on recent literature, many surgeons treat distal radial fractures in elderly patients with cast management, regardless of fracture appearance on radiographs. In many cases, both the surgeon and the patient expect a malunion that is unlikely to impede function. More information about the prevalence and natural history of these anticipated malunions can aid in patient counseling. Wadsten et al.3 examined 175 patients with distal radial fractures treated nonoperatively who had 3-month radiographic follow-up and 1-year clinical follow-up. Only patients with a radiographically acceptable reduction at 1 to 2 weeks were included in the study. At the 3-month follow-up, 28% of patients had late displacement or malunion. Cases with late displacement or malunion had lower grip strength and a loss of the total wrist range of motion. However, there was no difference in patient-reported functional measures between late displacement or malunion and non-malunion groups. The most common complication was carpal tunnel syndrome, occurring in 19% of the overall cohort (with no difference between the 2 groups).

Concerns remain with regard to potential complications involving extensor and flexor tendons after volar plating. In a prospective evaluation of patients with unicortical fixation in the distal row, Dardas et al. demonstrated that this strategy can effectively maintain reduction, with only 2 cases (of 75 total cases) with loss of reduction4. There were no cases of extensor tendon rupture or extensor tenosynovitis. The positioning of the volar plate relative to the watershed line is often discussed as a risk factor for flexor tendon irritation. In a cadaveric study, Wurtzel et al. demonstrated that increased contact between the flexor plexus longus and the volar plate is dependent not only on the position of the plate, but also on the residual sagittal angulation (maintenance or loss of volar tilt)5. With a distally positioned plate and a neutral volar tilt, contact between the flexor plexus longus and the volar plate occurred at approximately 45° of wrist extension. Contact between the flexor pollicis longus and the volar plate occurs at even lower amounts of wrist extension when there is a dorsal malunion, suggesting that surgeons should closely monitor for flexor plexus longus irritation as patients recover wrist flexion if the volar plate has been placed distally and/or if anatomic volar tilt has not been restored.

Scaphoid Fractures

Given the understandable concerns for nonunion, a common question in practice is the amount of cortical healing of a scaphoid fracture needed to allow unrestricted activity. In a biomechanical cadaver model, Guss et al. compared the load to failure of an intact scaphoid, of a 50% osteotomy without a compression screw, of a 50% osteotomy with a compression screw, of a 25% osteotomy with a compression screw, and of a 75% osteotomy with a compression screw6. There was no difference in load to failure between the intact scaphoid group and the 50% osteotomy and compression screw group. However, load to failure in the 75% osteotomy and compression screw group was lower than that in the intact scaphoid group. These findings suggest that 50% cortical healing is sufficient to allow unrestricted activity after scaphoid open reduction and internal fixation with a compression screw.

The indications for a nonvascularized bone graft, pedicled vascularized bone flap, or free bone flap remain debatable for the management of scaphoid nonunions. Rancy et al. challenged the traditional importance placed on the assessment of the proximal pole vascularity7. In their study of scaphoid nonunions treated with nonvascularized bone-grafting and a headless compression screw, Rancy et al. showed that 33 of 35 fractures went on to union (defined by the authors as ≥50% bridging the cortical bone) demonstrated by computed tomography (CT), despite evidence of compromised proximal pole vascularity in 14 of 32 patients with histopathological data available. Although no data are available to examine the effectiveness of nonvascularized bone-grafting relative to other techniques, the union rate in this series suggests that there may be a role for this treatment in the majority of scaphoid fractures. Additional series published in the past year using exclusively nonvascularized grafting and screw fixation by Kim et al. (union in 22 of 24 patients with scaphoid nonunions, all of which had magnetic resonance imaging [MRI]-demonstrated osteonecrosis in the proximal pole before the surgical procedure)8 and Luchetti et al. (union in 18 of 20 proximal pole fractures)9 corroborated the findings from Rancy et al. The reported success of nonvascularized bone graft in the treatment of scaphoid nonunion and osteonecrosis demonstrates the need for prospective, comparative studies to determine the most appropriate surgical techniques.

Thumb Ulnar Collateral Ligament

One popular technique to treat thumb ulnar collateral ligament injuries is to reattach the ligament to its insertion on the proximal phalanx using a single suture anchor. However, this technique does not restore the mechanical strength of the native ulnar collateral ligament at time zero, necessitating a period of immobilization and restricted activity. Gil et al. evaluated the biomechanical properties of a 2-anchor repair technique, finding that the yield load, maximum load at failure, and stiffness were lower following a 2-anchor repair compared with the intact ulnar collateral ligament10. One technique that is gaining interest to augment the strength of ulnar collateral ligament repairs is the addition of a thick suture tape to act as an internal brace. Shin et al. compared a single anchor repair with a single anchor and suture tape repair and found a higher load to failure in the latter group11. They did not compare the repair techniques with the intact ulnar collateral ligament, limiting the ability to discern whether the technique of the single anchor with suture tape could be strong enough to eliminate or decrease the need for postoperative immobilization and activity modification in the clinical application of this technique.

Thumb Arthritis

Almost one-fourth of the American Society for Surgery of the Hand (ASSH) survey respondents in practice for at least 5 years have changed their treatment preference for thumb arthritis within the 5 years prior to survey administration, demonstrating that many surgeons are still seeking the optimal procedure for their practice12. In a prospective randomized trial, Marks et al. compared patients who underwent trapeziectomy and suspension arthroplasty using either half of the flexor carpi radialis or a tendon allograft13. Clinical outcomes at 12 months were similar between the 2 groups. However, there were 7 cases of partial tendon rupture in the allograft group (among the 29 patients in this group). On the basis of similar clinical outcomes and higher complication risk with allograft, Marks et al. abandoned the use of the allograft in a primary trapeziometacarpal surgical procedure. However, the same allograft material has been used as an interposition arthroplasty material after arthroscopic partial trapeziectomy. Logli et al. reported their 5-year results using this technique, with improvements in pain scores and scores for the QuickDASH (abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] Scale) compared with the preoperative assessment14. None of the 24 patients available for the 5-year follow-up had undergone a revision trapeziometacarpal surgical procedure, but 1 patient had developed painful instability and subsidence (but declined further treatment). No inflammatory reactions were reported from the interposition allograft.

As historically noted, the reoperation rate after trapeziometacarpal arthroplasty is relatively low. This has been substantiated by a case series from Wilkens et al.15, in which the authors noted that 4% of 458 trapeziometacarpals underwent an unplanned reoperation (two-thirds of which occurred within a year of the original surgical procedure). The risk factors associated with an unplanned reoperation were younger patient age, surgeon experience of <12 years in practice, and the type of technique used (higher risk with trapezium excision and interposition alone, without ligament reconstruction or suspensionplasty). Historically, the patient-reported outcomes after a revision trapeziometacarpal surgical procedure are suboptimal16. Papatheodorou et al. reported a case series of 32 patients who underwent a revision surgical procedure to address a combination of recurrent subsidence, scaphotrapezoidal arthritis, and metacarpophalangeal deformity after a prior trapeziometacarpal arthroplasty17. At a mean follow-up of nearly 5 years (minimum, 2 years), pain levels were reduced, and grip and pinch measures were improved. However, there is no comparison group to contextualize these results.

Wrist Arthroplasty

The utilization of total wrist arthroplasty has been limited by concerns for complications such as distal implant loosening. Kennedy et al. provided a mean 7-year follow-up following the implantation of the Universal 2 total wrist arthroplasty (Integra LifeSciences) (48 wrists in 46 patients), noting improvements in patient-reported outcomes, satisfaction, and range of motion18. However, half of the patients had radiographically detectable loosening in the wrist; 6 of these cases were noted as having symptomatic loosening. Seven wrists underwent revision arthroplasty or arthrodesis and 4 were diagnosed with carpal tunnel syndrome (2 had carpal tunnel release). Despite the promising clinical outcomes, the complication risk should be noted when counseling patients about their treatment options.

In an effort to address the shortcomings of total wrist arthroplasty, a hemiarthroplasty that replaces the proximal carpal row and preserves the midcarpal joint has been introduced. Among the 20 patients who had a mean follow-up of 4 years, Anneberg et al. demonstrated improvements in wrist flexion and extension, radial and ulnar deviation, grip strength, and patient-reported outcomes19. Three patients underwent a manipulation under anesthesia for stiffness, 1 patient underwent a conversion to total wrist arthroplasty due to component loosening, and 1 patient had a wrist arthrodesis to treat ulnar-sided wrist pain. Although these results are promising, long-term results and reproducibility by other centers are needed before recommending widespread use.

Triangular Fibrocartilage Complex

Our collective understanding of the anatomy and pathophysiology of the triangular fibrocartilage complex continues to grow. Recent studies have examined some of the fundamental beliefs in the assessment of ulnar-sided wrist pain. Park et al. evaluated the interrater reliability of wrist arthroscopy to diagnosis triangular fibrocartilage complex injuries, demonstrating modest agreement among 3 observers as to whether a triangular fibrocartilage complex tear was present, whether a trampoline test was considered positive, and the location of a tear20. The results of this study suggest that wrist arthroscopy may not be an appropriate reference standard for the diagnosis of triangular fibrocartilage complex tears. In a cadaver model, Trehan et al. also demonstrated suboptimal performance of the trampoline test among 3 reviewers, with the arthroscopic hook test being a more reliable and highly sensitive and specific marker for isolated triangular fibrocartilage complex foveal detachment21.

Although MRI has an established role in aiding the diagnosis of ulnar-sided wrist pain, relatively little information exists about the likelihood of incidental findings. A review of 1,134 wrist MRI scans demonstrated that 28% had incidental triangular fibrocartilage complex signal changes, with the frequency of incidental findings increasing with patient age22. These findings corroborate other studies describing the frequency of incidental degenerative changes with advanced imaging and provide a reference that can guide clinical decision-making.

Microsurgery

Despite their growing popularity, there is little information about electronic cigarettes to guide hand surgeons and microsurgeons with regard to electronic cigarettes’ effect on circulation. Pywell et al. measured hand microcirculation in smokers after smoking an electronic cigarette with 24 mg of nicotine, demonstrating a maximum reduction of 77% in superficial flow and 29% in deep flow within 20 minutes of inhalation23. These reductions are similar to those seen with conventional cigarettes, suggesting that the clinical implications of potentially compromised healing capacity with continued nicotine use are the same.

The time to the surgical procedure has traditionally been considered a critical factor in the likelihood of digital survival after replantation. In a retrospective cohort study, Cavadas et al. questioned whether replantation outcomes differ on the basis of the time to the surgical procedure24. They compared 185 digital replantations that were performed in a delayed time frame (performed during daytime hours the following day) with 412 digital replantations performed immediately. There were no differences noted in patient age, zone of amputation, or presence of multiple amputations between the 2 groups. Digit survival rates were high in both groups (91% in the immediate replantation group and 93% in the delayed replantation group). Although these findings will stimulate interest in performing delayed replantation at other centers, the survival rates reported exceed those recently reported in the United States, suggesting that a main driver of success is the technical ability of the surgical team at this particular center in Spain. Furthermore, a substantial investment is needed to ensure that resources are available to rearrange electively scheduled duties to accommodate delayed replantation.

Carpal Tunnel Syndrome

The role of electrodiagnostic studies in the diagnosis and management of carpal tunnel syndrome continues to evolve. Although the American Academy of Orthopaedic Surgeons (AAOS) has declared in its clinical practice guidelines that electrodiagnostic studies are not necessary to establish a diagnosis of carpal tunnel syndrome, many surgeons continue to use electrodiagnostic studies as a predictor of response to carpal tunnel release. In their prospective study, Rivlin et al. demonstrated improvement in functional and patient-reported outcomes at 3 months after carpal tunnel release in patients with electrodiagnostic studies graded as mild, moderate, and severe carpal tunnel syndrome25. There was no difference in the magnitude of improvement among the 3 groups, suggesting that electrodiagnostic studies may not be a useful prognostic indicator for patient-reported recovery after carpal tunnel release. Neurologic outcomes such as muscle strength and sensation were not evaluated.

An increased focus on the pervasive impact of mental health and psychosocial factors is reflected in a series of recently published articles on carpal tunnel syndrome. In separate prospective studies, both Shin et al.26 and Datema et al.27 demonstrated that depressive symptoms decrease after carpal tunnel release and are correlated with improvements in patient-reported outcomes. Beleckas et al. also found carpal tunnel syndrome to be a predictor of anxiety and depression detected using computer-adaptive Patient-Reported Outcomes Measurement Information System (PROMIS) scores28. These findings suggest that there is a relationship between carpal tunnel syndrome symptoms and depression, indicating that this association deserves further investigation in future studies and substantiating the call for an increased role of incorporating psychosocial evaluation into surgical practices29. In their evaluation of prospectively collected PROMIS scores, Wright et al. found that patients from areas of higher social deprivation (poorer socioeconomic status) had worse PROMIS scores for physical function, pain interference, depression, and anxiety30. Patients from areas of higher social deprivation were also more likely to have a higher comorbidity burden and were more likely to use tobacco, both of which may potentially influence ultimate outcomes after carpal tunnel syndrome treatment. Greater attention must be directed to accounting for socioeconomic status when predicting health outcomes, not only to address health disparities but also to provide appropriate risk stratification in value-based care models.

Cubital Tunnel Syndrome

There is continued high variation in the treatment of cubital tunnel syndrome. A survey of the ASSH membership conducted by Yahya et al. demonstrated a preference for in situ ulnar nerve decompression in a number of clinical scenarios ranging from mild to severe disease31. One key advantage of in situ decompression is the shorter recovery period. In their prospective cohort study comparing patients undergoing in situ decompression and those undergoing ulnar nerve transposition, Staples et al. demonstrated that patients undergoing transposition had greater patient-reported disability at early time points (up to 8 weeks after the surgical procedure), but that these differences resolved at the time of final follow-up (>8 weeks after the surgical procedure)32. Narcotic consumption and olecranon paresthesias were also greater in the transposition group. Although that study did not include long-term clinical follow-up data to aid in determining the most appropriate treatment for cubital tunnel syndrome, the results provided were helpful in counseling patients about the expected postoperative recovery after each surgical procedure.

Brachial Plexus and Peripheral Nerve

Reconstructive techniques to restore rudimentary grasp have gained popularity in recent years. Shen et al. presented a series of patients in which the distal brachialis tendon was transferred to the flexor digitorum profundus and flexor pollicis longus, with an interposed tendon autograft33. A rudimentary grasp (measured as active flexion of the middle finger within 2.5 cm of the palm) was present in 6 of 10 patients. In the remaining 4 patients, a distal tenolysis was performed, with improvement in grasp in all patients. Although this technique may not be available in cases with weak elbow flexion, it is a useful option to restore extrinsic finger and thumb flexion. A free functional muscle transfer has also been used to restore extrinsic finger flexion. In some brachial plexus injury cases, the use of a free functional muscle transfer may be limited because of a lack of available extraplexal donor nerves. Mull et al. reported the use of rectus abdominis motor nerves as donor nerves for free functional muscle transfer during brachial plexus injury reconstruction34. Their cadaveric study demonstrated motor axon counts that were comparable with axon counts of the intercostal nerve, the anterior branch of the thoracodorsal nerve, and medial pectoral branches. The potential need for interpositional nerve grafts may limit the quality of reinnervation obtained, but the limited clinical results presented demonstrated outcomes that are comparable with conventional donor nerves.

The restoration of thenar innervation after a high median nerve injury has been very difficult to attain given the long distance to the target. Bertelli et al. described a distal nerve transfer of the abductor digiti quinti branch of the ulnar nerve to the thenar motor branch of the median nerve35. Cadaveric dissection demonstrated the ability to perform a direct nerve coaptation, with similar axon counts for the 2 nerves. Their case series provided promising results, with improvement in thenar eminence bulk and motor strength at a mean of 13 months after the surgical procedure. Although this nerve transfer is typically not an option in brachial plexus injuries involving the lower trunk, it may hold tremendous value in situations in which the donor branch is available.

Shifting attention to other aspects of care for patients with brachial plexus injuries, Yannascoli et al. used an administrative database to demonstrate that depression and anxiety occur frequently in patients with brachial plexus injuries36. Patients with brachial plexus injuries were more likely than age-matched and sex-matched controls to develop new-onset depression and anxiety. Landers et al. reported similar findings in a retrospective series from a single center, furthering calls for greater attention to psychological well-being during treatment of brachial plexus injuries37.

Flexor Tendon Repair

Research continues in the quest for optimal outcomes after flexor tendon repair. There are relatively few comparative studies of the most popular postoperative therapy protocols, with prior Level-I evidence demonstrating superiority of place-and-hold over passive motion. However, Rigó et al. provided the first Level-I comparison of early active motion with passive motion38. In their prospective randomized trial, patients with flexor tendon repairs were randomized to early active motion (active flexion and extension) or a modified Kleinert passive motion protocol (active extension and passive flexion with a palmar rubber-band pulley). There were no differences in total active motion at the time of final follow-up (12 months), but better functional outcomes in the active motion group were seen at 1 month. This difference was not present at later assessments (at 2, 3, 6, and 12 months).

Giesen et al. called the tenets of A2/A4 pulley preservation and epitendinous suture into question, as they reported a series of 27 flexor tendon repairs treated with a 6-strand repair technique without an epitendinous suture, with liberal division of the A2 and A4 pulleys, and with early active motion39. Twenty-four of the 27 fingers had good to excellent outcomes using the Strickland criteria, with no ruptures. Similarly promising results have been reported using a comparable protocol for thumb flexor tendon repairs by Pan et al.40, suggesting that a paradigm shift may be underway in the treatment of flexor tendon injuries.

Opioids

The opioid epidemic in the United States has increased awareness about prescribing patterns for analgesics after a surgical procedure. A prospective cohort study by Miller et al. demonstrated that mean opioid consumption after carpal tunnel release was 4.9 pills for 2.3 days and mean tramadol consumption was 3.3 pills for 1.8 days41. Peters et al. reported that, although many patients undergoing carpal tunnel release at their center were prescribed 40 tablets of medications including codeine or tramadol, more than half of the patients consumed <2 tablets42. In a separate study, Miller et al. reported similar opiate consumption after carpal tunnel release and trigger finger release performed under wide-awake local anesthesia or sedation43. Stepan et al. evaluated the role of perioperative celecoxib in an elective hand surgical procedure, but found no difference in opioid consumption when comparing the celecoxib group and the control group44. All of these studies emphasized the relative overprescription of opiates after minor hand surgical procedures, with regard to both quantity and potency of prescription.

Evidence-Based Orthopaedics

The editorial staff of The Journal reviewed a large number of recently published research studies related to the musculoskeletal system that received a higher Level of Evidence grade. In addition to articles cited already in the Update, 3 other articles with a higher Level of Evidence grade were identified that were relevant to hand surgery. A list of those titles is appended to this review after the standard bibliography. We have provided a brief commentary about each of the articles to help guide your further reading, in an evidence-based fashion, in this subspecialty area.

Evidence-Based Orthopaedics

Logli AL, Bear BJ, Schwartz EG, Korcek KJ, Foster BJA. A prospective, randomized trial of splinting after minicarpal tunnel release. J Hand Surg Am. 2018 Aug;43(8):775.e1-8. Epub 2018 Feb 24.

The use of postoperative immobilization after carpal tunnel release varies throughout the hand surgery community. Logli et al. provided Level-I evidence demonstrating no difference in patient-reported outcomes at 12 months after mini-open carpal tunnel release among patients randomized to no orthosis, a removable orthosis, or a plaster orthosis. The findings of this study are aligned with the AAOS clinical practice guidelines, which were issued during the conduct of the study.

Shoji KE, Earp BE, Rozental TD. The effect of bisphosphonates on the clinical and radiographic outcomes of distal radius fractures in women. J Hand Surg Am. 2018 Feb;43(2):115-22. Epub 2017 Oct 18.

With an increased emphasis on recognizing bone health issues in patients with a fragility fracture, the question of whether to continue bisphosphonate treatment during fracture-healing may arise. Shoji et al. demonstrated similar union rates when prospectively comparing female patients who continued bisphosphonate therapy after a distal radial fracture with control patients without bisphosphonate treatment. Both groups were treated with cast management. Time to fracture union was the primary outcome, with sample size estimates requiring 30 patients in each group to detect a mean difference in 14 days for time to radiographic union. Fracture union was not measured by days to healing, but was instead assessed by the percentage of patients healed at each time interval follow-up (6, 9, and 12 weeks and 1 year). There were no significant differences in the percentage of patients with fracture union at each interval, but the study was underpowered to detect significant differences (11 and 22 patients in each group). Given the lack of difference between groups in the patient-reported outcomes measured (Patient-Rated Wrist Evaluation and DASH) at all intervals, the authors advocated that bisphosphonates could be safely continued in postmenopausal patients with a distal radial fracture treated nonoperatively.

Wilson JM, Holzgrefe RE, Staley CA, Schenker ML, Meals CG. Use of a 5-item modified frailty index for risk stratification in patients undergoing surgical management of distal radius fractures. J Hand Surg Am. 2018 Aug;43(8):701-9. Epub 2018 Jul 3.

Harnessing the power of the prospective National Surgical Quality Improvement Program (NSQIP) database, Wilson et al. examined the records for 6,494 patients who were >50 years of age and underwent open reduction and internal fixation of a distal radial fracture. The authors calculated the 5-item modified Frailty Index (1 point each for history of diabetes mellitus, congestive heart failure, hypertension requiring medication, history of chronic obstructive pulmonary disease or pneumonia, and non-independent functional status within 30 days prior to the surgical procedure) and evaluated the likelihood of life-threatening complications with end-organ dysfunction (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, and renal failure). The rate of these events was low overall, but the risk was greater (by more than tenfold) in patients with a modified Frailty Index of ≥2 than in those with a modified Frailty Index of 0. The length of hospitalization and the likelihood of discharge to a location other than home were also greater in those with a modified Frailty Index of ≥2. Although studies of this nature are unable to examine details about the contributors to increased complications and adverse events (such as uncontrolled chronic disease), this study provided a high-level estimator of a patient’s risk of serious medical complications after open reduction and internal fixation of a distal radial fracture and should be incorporated into the decision-making process.

References

1. Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol. 2018 Feb;43(2):142-7. Epub 2017 Sep 4.
2. Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am. 2011 Dec 7;93(23):2146-53.
3. Wadsten MÅ, Sjödén GO, Buttazzoni GG, Buttazzoni C, Englund E, Sayed-Noor AS. The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. J Hand Surg Eur Vol. 2018 Feb;43(2):131-6. Epub 2017 Jul 31.
4. Dardas AZ, Goldfarb CA, Boyer MI, Osei DA, Dy CJ, Calfee RP. A prospective observational assessment of unicortical distal screw placement during volar plate fixation of distal radius fractures. J Hand Surg Am. 2018 May;43(5):448-54. Epub 2018 Feb 1.
5. Wurtzel CNW, Burns GT, Zhu AF, Ozer K. Effects of volar tilt, wrist extension, and plate position on contact between flexor pollicis longus tendon and volar plate. J Hand Surg Am. 2017 Dec;42(12):996-1001. Epub 2017 Sep 18.
6. Guss MS, Mitgang JT, Sapienza A. Scaphoid healing required for unrestricted activity: a biomechanical cadaver model. J Hand Surg Am. 2018 Feb;43(2):134-8. Epub 2017 Nov 7.
7. Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW; Scaphoid Nonunion Consortium. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol. 2018 Jan;43(1):32-40. Epub 2017 Sep 24.
8. Kim J, Park JW, Chung J, Jeong Bae K, Gong HS, Baek GH. Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis. J Hand Surg Eur Vol. 2018 Jan;43(1):24-31. Epub 2017 Sep 11.
9. Luchetti TJ, Rao AJ, Fernandez JJ, Cohen MS, Wysocki RW. Fixation of proximal pole scaphoid nonunion with non-vascularized cancellous autograft. J Hand Surg Eur Vol. 2018 Jan;43(1):66-72. Epub 2017 Nov 22.
10. Gil JA, Chambers A, Shah KN, Crisco JJ, Got C, Akelman E. A biomechanical evaluation of a 2-suture anchor repair technique for thumb metacarpophalangeal joint ulnar collateral ligament injuries. Hand (N Y). 2018 Sep;13(5):581-5. Epub 2017 Aug 24.
11. Shin SS, van Eck CF, Uquillas C. Suture tape augmentation of the thumb ulnar collateral ligament repair: a biomechanical study. J Hand Surg Am. 2018 Sep;43(9):868.e1-6. Epub 2018 Mar 16.
12. Deutch Z, Niedermeier SR, Awan HM. Surgeon preference, influence, and treatment of thumb carpometacarpal arthritis. Hand (N Y). 2018 Jul;13(4):403-11. Epub 2017 Jul 7.
13. Marks M, Hensler S, Wehrli M, Scheibler AG, Schindele S, Herren DB. Trapeziectomy with suspension-interposition arthroplasty for thumb carpometacarpal osteoarthritis: a randomized controlled trial comparing the use of allograft versus flexor carpi radialis tendon. J Hand Surg Am. 2017 Dec;42(12):978-86. Epub 2017 Sep 9.
14. Logli AL, Twu J, Bear BJ, Lindquist JR, Schoenfeldt TL, Korcek KJ. Arthroscopic partial trapeziectomy with soft tissue interposition for symptomatic trapeziometacarpal arthritis: 6-month and 5-year minimum follow-up. J Hand Surg Am. 2018 Apr;43(4):384.e1-7. Epub 2017 Nov 11.
15. Wilkens SC, Xue Z, Mellema JJ, Ring D, Chen N. Unplanned reoperation after trapeziometacarpal arthroplasty: rate, reasons, and risk factors. Hand (N Y). 2017 Sep;12(5):446-52. Epub 2016 Nov 15.
16. Sadhu A, Calfee RP, Guthrie A, Wall LB. Revision ligament reconstruction tendon interposition for trapeziometacarpal arthritis: a case-control investigation. J Hand Surg Am. 2016 Dec;41(12):1114-21. Epub 2016 Oct 15.
17. Papatheodorou LK, Winston JD, Bielicka DL, Rogozinski BJ, Lourie GM, Sotereanos DG. Revision of the failed thumb carpometacarpal arthroplasty. J Hand Surg Am. 2017 Dec;42(12):1032.e1-7. Epub 2017 Sep 6.
18. Kennedy JW, Ross A, Wright J, Martin DJ, Bransby-Zachary M, MacDonald DJ. Universal 2 total wrist arthroplasty: high satisfaction but high complication rates. J Hand Surg Eur Vol. 2018 May;43(4):375-9. Epub 2018 Mar 8.
19. Anneberg M, Packer G, Crisco JJ, Wolfe S. Four-year outcomes of midcarpal hemiarthroplasty for wrist arthritis. J Hand Surg Am. 2017 Nov;42(11):894-903. Epub 2017 Sep 18.
20. Park A, Lutsky K, Matzon J, Leinberry C, Chapman T, Beredjiklian PK. An evaluation of the reliability of wrist arthroscopy in the assessment of tears of the triangular fibrocartilage complex. J Hand Surg Am. 2018 Jun;43(6):545-9. Epub 2018 Mar 28.
21. Trehan SK, Wall LB, Calfee RP, Shen TS, Dy CJ, Yannascoli SM, Goldfarb CA. Arthroscopic diagnosis of the triangular fibrocartilage complex foveal tear: a cadaver assessment. J Hand Surg Am. 2018 Jul;43(7):680.e1-5. Epub 2018 Feb 1.
22. Bendre HH, Oflazoglu K, van Leeuwen WF, Rakhorst H, Ring D, Chen NC. The prevalence of triangular fibrocartilage complex signal abnormalities on magnetic resonance imaging relative to clinical suspicion of pathology. J Hand Surg Am. 2018 Sep;43(9):819-26.e1.
23. Pywell MJ, Wordsworth M, Kwasnicki RM, Chadha P, Hettiaratchy S, Halsey T. The effect of electronic cigarettes on hand microcirculation. J Hand Surg Am. 2018 May;43(5):432-8. Epub 2018 Feb 3.
24. Cavadas PC, Rubí C, Thione A, Pérez-Espadero A. Immediate versus overnight-delayed digital replantation: comparative retrospective cohort study of survival outcomes. J Hand Surg Am. 2018 Jul;43(7):625-30. Epub 2018 May 8.
25. Rivlin M, Kachooei AR, Wang ML, Ilyas AM. Electrodiagnostic grade and carpal tunnel release outcomes: a prospective analysis. J Hand Surg Am. 2018 May;43(5):425-31. Epub 2018 Feb 1.
26. Shin YH, Yoon JO, Kim YK, Kim JK. Psychological status is associated with symptom severity in patients with carpal tunnel syndrome. J Hand Surg Am. 2018 May;43(5):484.e1-8. Epub 2018 Jan 3.
27. Datema M, Tannemaat MR, Hoitsma E, van Zwet EW, Smits F, van Dijk JG, Malessy MJA. Outcome of carpal tunnel release and the relation with depression. J Hand Surg Am. 2018 Jan;43(1):16-23. Epub 2017 Sep 23.
28. Beleckas CM, Wright M, Prather H, Chamberlain A, Guattery J, Calfee RP. Relative prevalence of anxiety and depression in patients with upper extremity conditions. J Hand Surg Am. 2018 Jun;43(6):571.e1-8. Epub 2018 Feb 1.
29. Zale EL, Ring D, Vranceanu AM. The future of orthopaedic care: promoting psychosocial resiliency in orthopaedic surgical practices. J Bone Joint Surg Am. 2018 Jul 5;100(13):e89.
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