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Background: Reasonable functional outcomes for nonoperative management of isolated, closed fifth metacarpal neck fractures with up to 70° angulation have been reported; however, reported outcomes for fractures with greater than 70° angulation are limited. This study describes clinical outcomes of nonsurgically treated fifth metacarpal neck fractures with angulation of greater than 70°. Methods: A retrospective review of patients treated between May 1, 2016, and May 1, 2020, included: (1) patients aged 18 years and above with an isolated, closed, fifth metacarpal neck fracture; (2) nonsurgical treatment; (3) healed fractures with angulation greater than 70° measured on oblique radiographs; and (4) minimum 6-month follow-up after injury. Photographic hand motion and patient-rated outcomes (Functional Hand Scale, Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], 12-item Short-Form Health Survey [SF-12]) were collected and reported. Results: A total of 364 fractures were identified; 11% (40/364) demonstrated angulation of greater than 70° (range: 71°-82°); and 15 patients (inclusion rate: 38%, 15/40) with mean fracture angulation of 73° (range: 71°-77°) participated in the study. Mean follow-up was 32 months (range: 8-120 months), the dominant hand was injured in 87% (13/15) of patients, and 47% (7/15) of patients worked in manual labor. All patients scored the highest rating of "very good" (range: 26-30 of 30 points) on the functional hand scale. A QuickDASH score of zero (no morbidity) was reported in 80% (12/15) of patients. About 87% (13/15) of patients had average or above-average scores on the SF-12 (mean = 109, range: 84-115). Conclusions: Patients with healed, isolated, closed fifth metacarpal neck malunions with severe angulation greater than 70° demonstrated acceptable functional outcomes based on patient-rated outcomes scoring. [ABSTRACT FROM AUTHOR]

Background: The goal in the treatment of stages II and III Kienböck disease is to restore lunate vascularity and halt the progression of avascular necrosis. Methods: We report the outcomes for patients with stages II and III Kienböck disease treated with fourth extensor compartment artery vascularized bone grafting and temporary radiocarpal spanning internal fixation. Nine patients with a mean age of 28.8 years were included. Mean clinical and radiographic follow-up were 4.9 and 1.9 years, respectively. Results: Six patients had no change in Lichtman stage, 2 patients regressed 1 stage, and 1 patient progressed 1 stage. Mean postoperative quick disabilities of the arm, shoulder, and hand (QuickDASH) was 17.4. Mean postoperative visual analogue pain scale (VAS) was 1.8. Patients under age 25 trended toward improved clinical outcomes compared with patients over age 25. Two patients, aged 33 and 65, underwent proximal row carpectomy at a mean 30.5 months postoperatively. Conclusions: In conclusion, the use of local vascularized bone graft with temporary internal radiocarpal spanning fixation provides a treatment option with outcomes comparable to existing literature with benefits inherent to internal immobilization. [ABSTRACT FROM AUTHOR]

Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair. Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area. The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%–90%), including both the scaphoid facet, lunate facet, and scapholunate ridge. Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets. Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach. [ABSTRACT FROM AUTHOR]

Background: Radiocarpal dislocations are rare injuries that result from high-energy forces across the wrist with the hallmark finding of radiocarpal ligament disruption. Published treatment methods are comprehensive with moderate-to-good outcomes. The purpose of this study was to review the treatment of radiocarpal dislocations with a dorsal wrist spanning plate. Methods: A retrospective review was conducted analyzing the radiographic and clinical outcomes of patients treated for a radiocarpal dislocation using a dorsal wrist spanning plate over a 10-year period. Outcomes assessed included radiographic joint incongruity and arthrosis, wrist range of motion, grip strength, Visual Analogue Scale (VAS) score, surgical complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results: Thirteen patients were treated with a dorsal wrist spanning plate for radiocarpal dislocation with a mean follow-up of 615 days from the time of initial surgery. Six patients (46%) had associated distal radioulnar joint instability. The mean wrist range of motion at the final follow-up was: flexion 39°, extension 44°, pronation 79°, and supination 84°. One patient (8%) developed ulnar translation of the carpus, and 11 patients (85%) developed radiographic posttraumatic wrist arthrosis. Mean VAS and DASH scores were 4 and 18, respectively. Conclusions: Acute treatment with a dorsal wrist spanning plate in this series resulted in comparable outcomes to what have been previously reported in the literature. The dorsal wrist spanning plate offers the surgeon a reliable method of stabilization, with minimal additional surgical trauma to the wrist, while avoiding the potential for infections that develop with other treatment methods. [ABSTRACT FROM AUTHOR]