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Osteoporosis and fragility fractures incur substantial costs to quality of life and global health care systems. The current gold standard for quantifying bone density is dual-energy X-ray absorptiometry. Our hypothesis is that bone density can be accurately predicted with a simpler method using plain radiographs of the hand. This retrospective cohort study was undertaken in two centers in the United Kingdom, where the second metacarpal cortical percentage (2MCP) scores were calculated from radiographs. This study included patients who had sustained a distal radius fracture between 2020 and 2022 and had received both a posteroanterior radiograph of the hand and a dual-energy X-ray absorptiometry scan within 12 months of their radiograph and fracture. The Pearson correlation coefficient was calculated to determine the correlation between 2MCP scores and t-scores of the femoral neck on dual-energy X-ray absorptiometry scans. Of the 188 patients, the 2MCP score significantly correlated with bone density t-scores of the femoral neck. A 2MCP score <50% demonstrated 100% sensitivity and 100% specificity for differentiating osteoporotic from normal subjects, whereas a 2MCP score <60% demonstrated 94.4% sensitivity and 83.0% specificity in differentiating osteopenic from normal subjects. These data confirm that the likelihood of osteoporosis being present can be determined via the 2MCP score. Diagnostic I. [ABSTRACT FROM AUTHOR]

In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity. [ABSTRACT FROM AUTHOR]

Patients with wrist pain commonly present to primary care and emergency departments. A detailed history and examination, alongside relevant imaging, will help find the correct diagnosis and ensure that patients receive the correct treatment in a timely manner. This article summarises the key points in history and examination and the role of imaging, including suggestions of which modality should be requested. Finally, important acute pathologies are highlighted, including fractures, soft tissue injuries and infection, with examples of their relevant imaging. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) in hand surgery is an emerging and evolving field that will likely play a large role in the future care of our patients. However, there remain several challenges to makes this technology meaningful, acceptable and usable at scale. In this review article, we discuss basic concepts in AI, including challenges and key considerations, provide an update on how AI is being used in hand and wrist surgery and propose potential future applications. The aims are to equip clinicians and researchers with the basic knowledge needed to understand and explore the incorporation of AI in hand surgery within their own practice and recommends further reading to develop knowledge in this emerging field. [ABSTRACT FROM AUTHOR]

The purpose of this review article is to provide an update on the realm of emerging technology available for the assessment of dynamic functional movement of the hand and upper limb. A critical overview of the literature and a conceptual framework for use of such technologies is proposed. The framework explores three broad purpose categories including customization of care, functional surveillance and interventions through biofeedback strategies. State-of-the-art technologies are described, from basic activity monitors to feedback-enabled robotic gloves, along with exemplar trials and clinical applications. The future of technologies innovation in hand pathology is proposed in the context of the current obstacles and opportunities for hand surgeons and therapists. [ABSTRACT FROM AUTHOR]

The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Three-dimensional (3D) printing technology is increasingly commercially viable for pre-surgical planning, intraoperative templating, jig creation and customised implant manufacture. The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. The aim of this review is to determine the use of 3D printed technologies in the treatment of scaphoid fractures. Methods: This is a review of the Medline, Embase and Cochrane Library databases examining studies aimed at therapeutic use of 3D printing, also known as rapid prototyping or additive technology, in the treatment of scaphoid fractures. All studies published up to and including November 2020 were included in the search. Relevant data extracted included modality of use (as template/model/guide/prosthesis), operative time, accuracy of reduction, radiation exposure, follow-up duration, time to union, complications and study quality. Results: A total of 649 articles were identified, of which 12 met the full inclusion criteria. Analysis of the articles showed that 3D printing techniques can be utilised in myriad ways to aid planning and delivery of scaphoid surgery. Percutaneous guides for Kirschner-wire (K-wire) fixation of non-displaced fractures can be created; custom guides can be printed to aid reduction of displaced or non-united fractures; patient-specific total prostheses may recreate near-normal carpal biomechanics and a simple model may help graft harvesting and positioning. Conclusions: This review found that the use of 3D printed patient-specific models and templates in scaphoid surgery can improve accuracy and speed, and reduce radiation exposure. 3D printed prostheses may also restore near-normal carpal biomechanics without burning bridges for potential future procedures. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively. [ABSTRACT FROM AUTHOR]

Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92° arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon's mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates. [ABSTRACT FROM AUTHOR]

This human cadaver study investigated whether flexor tendon repairs performed with round-bodied needles had a higher risk of pull-out compared with those performed with cutting needles. Forty human cadaver tendons were repaired (20 with each type of needle), subjected to tensile traction testing and evaluated by failure load and mode of failure. The average failure load was 50 N (SD 13 N) for tendons repaired with round-bodied needles, compared with 49 N (SD 16 N) for tendons repaired with cutting needles. Round-bodied needles resulted in more suture pull-out (18 out of 20 tendons) than cutting needles (6 out of 20 tendons). We found no differences in failure load, but significant differences in the mode of failure between round-bodied and cutting needles when used for cadaveric flexor tendon repair. [ABSTRACT FROM AUTHOR]

Background: Trigger finger has a prevalence of 2% to 3% in the general population. Although anecdotal evidence exists, there is a lack of conclusive data that prove a relationship between repetitive power grip and flexion with triggering. Ocean rowing is becoming a popular sport, with the race across the Atlantic alone attracting more than 100 participants annually. Anecdotal reports suggest ocean rowing may be a significant cause of trigger finger. We aimed to identify whether the sport causes an increased prevalence of triggering, whether there were any alleviating or compounding factors, and, finally, whether there was any effect on performance. Methods: A prospective observational study was carried out. A questionnaire was sent to all participants of the Talisker Whisky Atlantic Challenge 2018, which included a trigger finger self-scoring system and the Oslo Sports Trauma Center Overuse Injury Questionnaire. Results: Responses were received from 67 rowers (83% response rate). Age ranged from 21 to 62 years, with a mean of 40 years. In all, 49.3% had clinical triggering, with 79.3% reporting bilateral symptoms. The length of continuous rest time had a significant impact on the incidence of finger triggering and disease stage (P =.0275 and.0353, respectively; multivariate logistic regression). High-grade triggering had a more negative effect on rowing performance than low grade or no triggering (not significant). Conclusion: Ocean rowers suffered a 15-fold increase in trigger finger prevalence compared with the general population. This was increased in those who took shorter, more frequent rest periods. This study provides new conclusive evidence that the repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger. [ABSTRACT FROM AUTHOR]

A human hand is a complex biomechanical system, in which bones, ligaments, and musculotendon units dynamically interact to produce seemingly simple motions. A new physiological hand simulator has been developed, in which electromechanical actuators apply load to the tendons of extrinsic hand and wrist muscles to recreate movements in cadaveric specimens in a biofidelic way. This novel simulator simultaneously and independently controls the movements of the wrist (flexion/extension and radio-ulnar deviation) and flexion/extension of the fingers and thumb. Control of these four degrees of freedom (DOF) is made possible by actuating eleven extrinsic muscles of the hand. The coupled dynamics of the wrist, fingers, and thumb, and the over-actuated nature of the human musculoskeletal system make feedback control of hand movements challenging. Two control algorithms were developed and tested. The optimal controller relies on an optimization algorithm to calculate the required tendon tensions using the collective error in all DOFs, and the action-based controller loads the tendons solely based on their actions on the controlled DOFs (e.g., activating all flexors if a flexing moment is required). Both controllers resulted in hand movements with small errors from the reference trajectories ($< 3.4^\circ$); however, the optimal controller achieved this with 16% lower total force. Owing to its simpler structure, the action-based controller was extended to enable feedback control of grip force. This simulator has been shown to be a highly repeatable tool ($< 0.25$  N and $< 0.2^\circ$ variations in force and kinematics, respectively) for in vitro analyses of human hand biomechanics. [ABSTRACT FROM AUTHOR]

We describe a case of an adult patient presenting with cubital tunnel syndrome in the setting of previously undiagnosed macrodactyly. Early diagnosis and management of macrodactyly is important to help prevent symptoms associated with compromised peripheral nerves and reduce the likelihood of the permanent motor and sensory sequelae of prolonged nerve compression. [ABSTRACT FROM AUTHOR]

Studies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement. A validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI). Trapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions. This study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. Trapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability. [ABSTRACT FROM AUTHOR]

The management of hand and wrist nonunions is challenging and alternatives or adjuncts to surgery to promote healing are an attractive prospect. Low-intensity pulsed ultrasound (LIPUS) is reported to improve bone healing and is supported for use in nonunions. However, evidence supporting its use for established nonunions is based largely on long bones, with little evidence guiding use in the hand and wrist. The objective of this study is to present our experience using LIPUS in established nonunions of the hand and wrist. This is a retrospective cohort study of hand and wrist nonunions managed with LIPUS in two UK tertiary referral centers. Nonunion was defined as the failure of fracture healing at a minimum of 9 months post injury. Demographic and clinical data including nonunion site, union rates, surgery and time from surgery to LIPUS application were obtained from electronic patient and LIPUS device records. Patients were subcategorized into early or delayed LIPUS applications groups. Twenty-six hand and wrist nonunions were treated with LIPUS alone or as a surgical adjunct. The overall union rate was 62%. Age, sex, fracture characteristics and previous treatment had no significant effect on union rates. There was no association between LIPUS timing and union following adjustment for co-variates. Our findings suggest previously quoted union rates using LIPUS for lower limb nonunions may not be achievable in the hand and wrist. However, LIPUS offers a safe adjunct to surgery and may offer a potential alternative when surgery is not feasible. Further prospective comparative studies are required before the efficacy of LIPUS for hand and wrist nonunions is proven. [ABSTRACT FROM AUTHOR]

Once a validation training scenario had been tested, 102 images with fractures and 107 images without fracture were provided to four hand surgeons, as well as a second CNN to assess or detect fractures. The use of artificial intelligence (AI) is becoming increasingly prevalent in clinical practice. Evaluation of a convolutional neural network to identify scaphoid fractures on radiographs. [Extracted from the article]

Even in the patient cohort of [5], only 77 patients were suspected to have wrist septic arthritis over a 3-year period, with just 15 diagnoses of septic arthritis being made, equating to less than one patient every 10 weeks. Moreover, patients with a diagnosis of cellulitis or abscess were excluded and discounted from having septic arthritis when both conditions are well established as causes of septic arthritis in the underlying joint. However, as septic arthritis of the wrist is the most serious joint-threatening condition ([2]), the diagnosis of a septic wrist trumps that of a non-septic wrist when they co-exist. [Extracted from the article]

In the prospective study of [1], digital nerve repair resulted in S3+/S4 sensation in 90% of cases by 2 years, whereas not repairing the nerve achieves this in only 6%. The conclusion that would be made when 90% recovery is compared with 6% recovery is very different to suggesting that there is no evidence of a difference between repairing and not repairing a nerve. In contrast, no repaired nerves of their patients had less than S3 sensation (protective sensation without over-response), and none formed painful neuromas. We believe that scientific endeavour should be directed towards improving the outcome following nerve repair rather than determining whether to stop repairing the nerve. [Extracted from the article]

Injuries to manual workers are often similar to do-it-yourself injuries, but were separated as professionals should have more training, and guidance on reducing injury in the workplace already exists. When classified by injury description, the most common injuries were: nail injuries (25%), lacerations (23%), closed fractures (23%) and tendon/ligament injures (9%). Dear Editor, The annual incidence of hand injuries in England is estimated to be 110 per 100,000 population ([2]), accounting for a notable proportion of attendances at Accident and Emergency Departments. [Extracted from the article]

It demonstrates that WALANT is safe and well tolerated by patients as compared with LRA for patients undergoing volar locking plate fixation for fractures of the distal radius. Previous work has established a minimum clinically important difference (MCID) of 25.8 points for the QuickDASH in patients who have undergone operative intervention for distal radius fractures using anchor-based methods ([4]). Re: Dukan R, Krief E, Nizard R. Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia. [Extracted from the article]

Three cases are presented in which neurosurgical reconstruction of a Neonatal Brachial Plexus Palsy was combined with orthopaedic reconstruction of a posterior glenohumeral dislocation. The authors believe that a combined procedure is indicated if the neurological deficit meets the criteria for neural reconstruction and the complication of a posterior glenohumeral dislocation has occurred prior to nerve surgery. Two children with C5-6 lesions and a third child with a pan-plexus lesion obtained good shoulder function following the combined reconstruction. [ABSTRACT FROM AUTHOR]

The article explores the current regulations on clinical photography including the Australian Freedom of Information Act 2000, Great Britain's Data Protection Act 1998, and the Health Insurance Portability and Accountability Act 1996, and examines some of the mobile applications currently in use.

The article discusses the hand manifestation if one has a neurological disease that leads to common hand disorders, such as carpal tunnel syndrome. It cites the motor neurone disease (MND) that begins in mid-50s in which the lower and combined motor neurone types may first present with wasting of the thenar muscles in the hands.

The authors reflect on the significance of orthopaedic one-stop clinics in Great Britain. They examine the feasibility on the initiative of the British National Health Service on the introduction of one-stop clinics, targeting to provide quality elective care without the need for any unnecessary wait. Furthermore, they explore the advantages and challenges of one-stop clinics toward the patient and the radiologist.

The author reflects on the bare below the elbows policy as advocated by the Health Secretary Alan Johnson in September 2007 and hospital-acquired infection in Great Britain. He looks on the key elements in the bare below the elbows policy. He stresses that it is vital for physicians to have public perception and confidence concerning their adherence on the said policy and to prevent nosocomial infections.

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK., Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively., Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial., Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject., Competing Interests: B. J. F. Dean and M.Mikhail report a British Society for Surgery of the Hand (BSSH) pump priming grant for this study. B. J. F. Dean also reports a British Medical Association Doris Hillier grant which was unrelated to this study. B. J. F. Dean is also a member of the BSSH research committee. D. J. Beard holds a Senior Investigator grant from the National Institute for Health and Care Research, unrelated to this study. M. Mikhail reports a BSSH grant to the ULCTEAR steering group for this study, allocated under his name. N. Riley reports consulting fees from Acumend, Arthrex, and Meshworks, unrelated to this study., (© 2024 Mikhail et al.)

The aim of this prospective study was to report the psychological experiences of parents caring for children with a congenital upper limb difference and to compare these to population norms. Contributing factors were explored, including access to support and coping strategies. Finally, parents with a congenital upper limb difference themselves were compared to those without. Data recorded included demographics, a validated wellbeing and family impact measure, a unique measure of emotions experienced and exploratory questions. Wellbeing and family impact scores were significantly lower than populations norms. Mothers experienced significantly more negative emotions than fathers. There was no significant different between parents with and without a congenital upper limb difference. Of the parents, 68% felt there should be improved access to psychological support. This demonstrates that parents of children with congenital upper limb differences have unique psychological experiences and needs. They may benefit from specialist psychological support and further research is needed. Level of evidence: III., Competing Interests: Declaration of conflicting interestsThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention., Competing Interests: All authors have completed an ICJME conflict of interest form that is uploaded with the article; (http://www.icmje.org/conflicts-ofinterest/) no support was received from any organization for this study., (© 2023 The Authors.)

The purpose of this review article is to provide an update on the realm of emerging technology available for the assessment of dynamic functional movement of the hand and upper limb. A critical overview of the literature and a conceptual framework for use of such technologies is proposed. The framework explores three broad purpose categories including customization of care, functional surveillance and interventions through biofeedback strategies. State-of-the-art technologies are described, from basic activity monitors to feedback-enabled robotic gloves, along with exemplar trials and clinical applications. The future of technologies innovation in hand pathology is proposed in the context of the current obstacles and opportunities for hand surgeons and therapists.

The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.