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Purpose: To review the existing literature to (1) determine the diagnostic efficacy of artificial intelligence (AI) models for detecting scaphoid and distal radius fractures and (2) compare the efficacy to human clinical experts., Methods: PubMed, OVID/Medline, and Cochrane libraries were queried for studies investigating the development, validation, and analysis of AI for the detection of scaphoid or distal radius fractures. Data regarding study design, AI model development and architecture, prediction accuracy/area under the receiver operator characteristic curve (AUROC), and imaging modalities were recorded., Results: A total of 21 studies were identified, of which 12 (57.1%) used AI to detect fractures of the distal radius, and nine (42.9%) used AI to detect fractures of the scaphoid. AI models demonstrated good diagnostic performance on average, with AUROC values ranging from 0.77 to 0.96 for scaphoid fractures and from 0.90 to 0.99 for distal radius fractures. Accuracy of AI models ranged between 72.0% to 90.3% and 89.0% to 98.0% for scaphoid and distal radius fractures, respectively. When compared to clinical experts, 13 of 14 (92.9%) studies reported that AI models demonstrated comparable or better performance. The type of fracture influenced model performance, with worse overall performance on occult scaphoid fractures; however, models trained specifically on occult fractures demonstrated substantially improved performance when compared to humans., Conclusions: AI models demonstrated excellent performance for detecting scaphoid and distal radius fractures, with the majority demonstrating comparable or better performance compared with human experts. Worse performance was demonstrated on occult fractures. However, when trained specifically on difficult fracture patterns, AI models demonstrated improved performance., Clinical Relevance: AI models can help detect commonly missed occult fractures while enhancing workflow efficiency for distal radius and scaphoid fracture diagnoses. As performance varies based on fracture type, future studies focused on wrist fracture detection should clearly define whether the goal is to (1) identify difficult-to-detect fractures or (2) improve workflow efficiency by assisting in routine tasks., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. Methods: A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. Results: A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: -2.2° ± 11.8° to -10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Conclusions: Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.

Management of scaphoid nonunions requires thoughtful preoperative and intraoperative consideration to evaluate for scaphoid flexion or humpback deformity, carpal collapse, and proximal pole vascularity. Most scaphoid nonunions do not require vascularized bone grafts; however, in the setting of avascular necrosis of the proximal pole, vascularized bone grafts should be used to optimize union rates. In addition, scaphoid geometry and carpal stability must be restored to enhance functional outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To assess the effect of scaphocapitate arthrodesis (SCA) on grip strength and wrist motion for patients with advanced stages of Kienböck disease., Methods: A retrospective review was conducted of patients with advanced stages of Kienböck disease (stages III-IV) who underwent SCA at our institution between 1991 and 2010 with a minimum of 1 year clinical follow-up. Outcome measures included preoperative and postoperative pain, range of motion, grip strength, complications, additional surgery, radiographic changes, and the modified Mayo Wrist and Lichtman Outcome scores., Results: Twenty-seven patients (17 males and 10 females) with a mean age of 41 years (range, 15-66 y) at the time of SCA were included in the study. The mean follow-up period was 60 months (range, 12 mo-16 y). Union was achieved in all 27 patients. Significant loss of mean motion was noted from preoperative to postoperative in wrist flexion (14°), extension (11°), and ulnar deviation (9°). However, significant improvement in grip strength was noted (+7 kg). Modified Mayo Wrist scores were mostly fair to poor and Lichtman scores were satisfactory in 32% (n = 7) of patients, yet 74% of patients returned to regular employment. Progressive radiographic carpal collapse and ulnar translocation of the carpus occurred, particularly in patients who had lunate excisions. However, no patients had symptoms attributable to carpal collapse or ulnar translocation that necessitated additional surgery., Conclusions: SCA resulted in improved grip strength with correction of carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up. Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. Patients should be counseled that decrease in wrist range of motion will likely occur., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Scaphoidectomy and 4-corner arthrodesis can be a successful salvage procedure for scaphoid nonunion advanced collapse and scapholunate advanced collapse. Traditional methods of fixation include Kirschner wires, staples, and/or headless compression screws. Nonlocking, dorsal circular plates, manufactured from stainless steel, have been advocated to allow early wrist range of motion and improved union rates. However, the reported union rates have been variable and inconsistent. This wide results have been attributed to the difficulty in assessing union with plain film radiograph due to the radio-opaque plate. Recently, a locking, dorsal circular plate, comprised of a radiolucent polyether-ether-ketone (PEEK-Optima), has been introduced with the additional benefit of providing a fixed-angle construct and allowing a more accurate assessment of bone union with plain film imaging studies.

Purpose: Type II lunate morphology has recently been shown to decrease the incidence of dorsal intercalated segment instability (DISI) deformity in patients with scaphoid nonunions. A similar association has been suggested for scapholunate dissociation, but a formal comparison has yet to be performed. The purpose of this study was to determine if an association exists between lunate morphology and DISI in cases of scapholunate dissociation., Methods: A retrospective review was performed on 58 patients with the diagnosis of scapholunate dissociation as determined by use of radiographs, magnetic resonance imaging, arthrotomy, and arthroscopy. Posteroanterior radiographs were used to assess the presence of a medial facet on the lunate and to determine the distance between the capitate and the triquetrum. A DISI deformity was defined as a radiolunate angle >15 degrees, and scapholunate instability was defined as a scapholunate angle >60 degrees using the tangential method. Statistical analysis was performed with a chi-squared test and kappa test., Results: Twenty-five patients had a type I lunate, and 33 patients had a type II lunate. A total of 15 patients had DISI deformity on preoperative radiographs; of these, 10 patients with a type I lunate and 5 patients with a type II lunate had DISI deformity. This difference was found to be significant., Conclusions: In cases of scapholunate dissociation, type II lunates were associated with a significantly lower incidence of DISI despite having radiographic or arthroscopic evidence of a complete scapholunate interosseous ligament tear. Osseous morphology may play a role in the development of a radiographic DISI deformity. Further research is required to assess the clinical importance of this finding and the biomechanical cause of this phenomenon., Type of Study/level of Evidence: Prognostic II.