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Background: The anterior interosseus nerve (AIN) to ulnar motor nerve transfer has been popularized as an adjunct to surgical decompression in patients with severe cubital tunnel syndrome (CuTS) and high ulnar nerve injuries. The factors influencing its implementation in Canada have yet to be described. Methods: An electronic survey was distributed to all members of the Canadian Society of Plastic Surgery (CSPS) using REDCap software. The survey examined 4 themes: previous training/experience, practice volume of nerve pathologies, experience with nerve transfers, and approach to the treatment of CuTS and high ulnar nerve injuries. Results: A total of 49 responses were collected (12% response rate). Of all, 62% of surgeons would use an AIN to ulnar motor supercharge end-to-side (SETS) transfer for a high ulnar nerve injury. For patients with CuTS and signs of intrinsic atrophy, 75% of surgeons would add an AIN-SETS transfer to a cubital tunnel decompression. Sixty-five percent would also release Guyon's canal, and the majority (56%) use a perineurial window for their end-to-side repair. Eighteen percent of surgeons did not believe the transfer would improve outcomes, 3% cited lack of training, and 3% would preferentially use tendon transfers. Surgeons with hand fellowship training and those less than 30 years in practice were more likely to use nerve transfers in the treatment of CuTS (P <.05). Conclusions: Most CSPS members would use an AIN-SETS transfer in the treatment of both a high ulnar nerve injury and severe CuTS with intrinsic atrophy. [ABSTRACT FROM AUTHOR]

Purpose: Intramedullary (IM) screw fixation is gaining popularity in the treatment of metacarpal fractures. Despite its rapid adoption, there is a paucity of evidence regarding parameters to optimize effectiveness. This study aimed to quantify the relationship between stability, IM screw size, and canal fill using a cadaveric model., Methods: Thirty cadaveric metacarpals (14 index, 13 middle, and three ring fingers; mean age: 58.3 years, range: 48-70) were selected to allow for canal fill ratios of 0.7-1.1 for screws sized 3.0, 3.5, and 4.5 mm. Metacarpals underwent a 45° volar-dorsal osteotomy at the midpoint before fixation with an IM screw. Specimens were subjected to 100 cycles of loading at 10 N, 20 N, and 30 N before load-to-failure testing. Correlation coefficients for angular displacement on the final cycle at each load, peak load to failure, and average stiffness were assessed., Results: Correlation coefficients for the angular displacement on the 100th cycle were as follows: 10 N, R = 0.62, 20 N, R = 0.57, and 30N, R = 0.58. Correlation values for peak load to failure as a function of canal fit were as follows: 3.0 mm, R = 0.5, 3.5 mm, R = 0.17, and 4.5 mm, R = 0.44. The canal fill ratio that intersected the line-of-best fit at an angular deformity of 10° was 0.74. Average peak forces for 3.0-, 3.5-, and 4.5-mm screws were 79.5, 136.5, and 179.6 N, respectively. Average stiffness for each caliber was 14.8, 33.4, and 52.3 N/mm., Conclusions: Increasing screw diameter and IM fill resulted in more stable fixation, but marginal gains were seen in ratios >0.9. A minimum fill ratio of 0.74 was sufficient to withstand forces of early active motion with angular deformity <10°., Clinical Relevance: An understanding of the relationship of IM fill ratio of metacarpal screws to fracture stability may provide a framework for clinicians to optimally size these implants., 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 clinical significance of scaphoid malunion is debated and its effect on wrist kinematics is poorly understood. Alterations to scaphoid morphology in other pathologies result in significant sequelae and arthrosis. By understanding the impact of scaphoid malunion on carpal kinematics, better insight can be garnered to inform models of wrist motion and clinical treatment of this injury. Methods: Seven cadaveric upper extremities underwent active wrist flexion and extension in a custom motion wrist simulator with scaphoid kinematics being captured with respect to the distal radius. A three-stage protocol of progressive simulated malunion severity was performed [intact, 10° malunion (Mal 10°), 20° malunion (Mal 20°)] with data analyzed from 45° wrist extension to 45° wrist flexion. Scaphoid malunions were modelled by creating successive volar wedge osteotomies and reducing the resultant scaphoid fragments with two 0.062" Kirshner wires. Motion of the scaphoid, lunate, trapezium-trapezoid was recorded using optical trackers. Results: Increasing scaphoid malunion severity did not significantly affect scaphoid or trapezium-trapezoid motion ( p > 0.05); however, it did significantly alter lunate motion ( p < 0.001). Increasing malunion severity resulted in progressive lunate extension across wrist motion (Intact - Mal 10°: mean difference (mean dif.) = 7.1° ± 1.6, p < 0.05; Intact - Mal 20°: mean dif. = 10.2° ± 2.0, p < 0.05). Conclusions: In this in-vitro model, increasing scaphoid malunion severity was associated with progressive extension of the lunate in all wrist positions. The clinical significance of this motion change is yet to be elucidated, but this model serves as a basis for understanding the kinematic consequences of scaphoid malunion deformities.