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Context: Imbalances in upper-extremity soft tissue stiffness may play a role in the development of shoulder and elbow musculoskeletal injuries in tennis players. Ultrasound shear wave elastography provides quantifiable and specific data regarding muscle stiffness. The purpose of this study was to compare tendon and muscle stiffness in healthy tennis players to nontennis players. Design: Cross-sectional study. Methods: The shear wave modulus, measured in kilopascals, was obtained for the dominant pectoralis major, pectoralis minor, and common wrist-extensor tendon using 2-dimensional shear wave elastography ultrasound imaging (GE Logiq S8, L9 linear transducer). Independent t test was run to compare age, body mass index, and the activity index score between both groups. Within-day intrarater reliability was assessed using a within-examiner intraclass correlation coefficients (ICC [3, 1]) with 95% confidence intervals. A multivariate general linear model was run to compare the mean differences between the tennis and nontennis players for each of the soft tissues. Results: Twenty-six individuals (13 tennis players and 13 nontennis players) were recruited. Within-day ICCs were very good (ICC >.78 for the pectoralis musculature) and excellent (ICC >.94 for the common wrist extensor). Common extensor tendon stiffness was significantly higher in tennis players compared to nontennis players (mean difference = 114.8 [61.8], confidence interval, −22.8 to 252.5 kPa for the dominant arm [P =.039]). Mean pectoralis major and minor stiffness differences were not significant (P >.214). Conclusions: Common wrist-extensor stiffness in healthy recreational tennis players is higher than those who do not play tennis. Therefore, clinicians may need to facilitate a greater soft tissue stiffness response with resistance training when rehabilitating recreational tennis players as compared to those not playing tennis. Additional normative data on a larger sample of recreational tennis players should be collected. [ABSTRACT FROM AUTHOR]

UNLABELLED: Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older. INTRODUCTION: Physical functioning trajectory following lower arm or wrist fracture is not well understood. PURPOSE: This study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age. METHODS: We performed a nested case-control study of prospective data from the Womens Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical functioning trajectory groups: stable, improving, and declining. RESULTS: Mean (SD) number of physical functioning measurements was 5.2 (1.5) for cases and 5.0 (1.4) for controls. Declining physical functioning was observed among 20.4% of cases and 16.0% of controls. Compared to women without lower arm or wrist fracture, women with lower arm or wrist fracture were 33% more likely to experience declining physical functioning (adjusted odds ratio [aOR] 1.33 95% confidence interval [CI] 1.19-1.49, reference group stable or improving physical functioning trajectory). Associations varied by age: age ≥ 80 years aOR 1.56 (95% CI 1.29-1.88); age 70-79 years aOR 1.29 (95% CI 1.09-1.52); age

BACKGROUND: Playing guitar involves several physical demands, most inclusive of which are long hours of practice, which can make musculoskeletal symptoms common. OBJETIVE: To determine the epidemiology of neuromuscular injuries in guitar players residing in Portugal and risk factors. METHODS: The sample consisted of 105 guitar players, being 103 (98.10%) men, aged between 30–75 years (29,83±10,23). The measurement instrument used was a digital survey, shared by email, on social networks and in person. RESULTS: Fifty-six (53.30%) guitar players had injuries throughout their musical practice, totaling 132 injuries, 13 (12.40%) guitar players were injured at the time of assessment and 31 (29.5%) guitar players had injuries in the last 12 months, totaling 63 injuries. The value of injury proportion was 0.29 (CI 95% : 0.14–0.44) and the injury rate was 0.42 injuries per 1,000 hours of music practice. The most common types of injury were: tendinopathy (22; 34.92%) and low back pain (9; 14.29%). The most affected anatomical sites were: wrist (18; 28.57%) and lumbar spine (10; 15.87%). Repetitive movement was the injury mechanism most mentioned by guitar players (24; 35.29%) followed by maintaining postures for a prolonged period of time (15; 22.06%). Guitar players who did not warm up before practicing were 0.33 (CI: 0.13–0.79; p = 0.013) more likely to have an injury. CONCLUSIONS: There was a high percentage of injuries in guitar players and failure to warm up was a risk factor for the development of injuries. This type of study can help in creating injury prevention strategies in this type of population. [ABSTRACT FROM AUTHOR]

Objectives. Associations between shift-work, musculoskeletal symptoms and absenteeism are poorly investigated in the manufacturing industry. This study aimed to investigate associations between working schedule, musculoskeletal symptoms and days of absenteeism among pulp and paper industry workers. Methods. Musculoskeletal symptoms of 904 workers were assessed through the Nordic Musculoskeletal Questionnaire. χ2 tests assessed associations between being a day-worker or shift-worker, the prevalence of musculoskeletal symptoms and days of absenteeism. Results. A significant association was found between working schedule and symptoms in the lower back in the last 12 months, with shift-workers presenting higher prevalence than day-workers (p = 0.022). Significant associations were also found between days of absenteeism and symptoms in the shoulders (p = 0.002), which mostly led to absenteeism of 100–365 days; elbows (p < 0.001), wrists/hands (p = 0.045) and ankles/feet (p = 0.042), which produced absenteeism mostly of 25–99 days; and dorsal region (p = 0.001), which mainly led to absenteeism of 10–24 days. No associations were found between working schedule and days of absenteeism (p = 0.265). Conclusion. Shift-work is associated with increased prevalence of lower back symptoms, but seems not to influence days of absenteeism. Shoulders seem to be the region leading to higher days of absenteeism, followed by elbows, wrists/hands, ankles/feet and the dorsal region. [ABSTRACT FROM AUTHOR]

Abstract Background Treatment of displaced distal forearm fractures in children has traditionally been closed reduction and pin fixation, although they might heal and remodel without surgery with no functional impairment. No randomized controlled trials have been published comparing the patient-reported functional outcome following non-surgical or surgical treatment of displaced paediatric distal forearm fractures. Methods A multicentre non-inferiority randomized controlled trial. Children aged 4–10 years with a displaced distal forearm fracture will be offered inclusion, if the on-duty orthopaedic surgeon finds indication for surgical intervention. They will be allocated equally to non-surgical treatment (intervention) or surgical treatment of surgeon’s choice (comparator). Follow-up will be 4 weeks and 3, 6, and 12 months. The primary outcome is the between-group difference in 12 months QuickDASH score. We will need a sample of 40 patients to show a 15-point difference with 80% power. Discussion The results of this trial may change our understanding of the healing potential of paediatric distal forearm fractures. If non-inferiority of non-surgical treatment is shown, the results may contribute to a reduction in future surgeries on children, who in turn can be treated without the risks and psychological burdens associated with surgery. Trial registration www.clinicaltrials.gov (ID: NCT05736068). Date of registry: 17 February 2023.

Purpose: The optimal duration of immobilization for the conservative treatment of non- or minimally displaced and displaced distal radius fractures remains under debate. This research aims to review studies of these treatments to add evidence regarding the optimal immobilization period. Methods: A comprehensive database search was conducted. Studies investigating and comparing short (< 3 weeks) versus long (> 3 weeks) immobilizations for the conservative treatment of distal radius fractures were included. The studies were evaluated for radiological and functional outcomes, including pain, grip strength, and range of motion. Two reviewers independently reviewed all studies and performed the data extraction. Results: The initial database search identified 11.981 studies, of which 16 (involving 1.118 patients) were ultimately included. Patient-reported outcome measurements, grip strength, range of motion, and radiological outcomes were often better after shorter immobilization treatments. Radiological outcomes were better with longer immobilization in two studies and shorter immobilization in one study. Fourteen studies concluded that early mobilization is preferred, while the remaining two studies observed better outcomes with longer immobilization. The data were unsuitable for meta-analysis due to their heterogeneous nature. Conclusion: Shorter immobilization for conservatively treated distal radius fractures often yield equal or better outcomes than longer immobilizations. The immobilization for non- or minimally displaced distal radius fractures could therefore be shortened to 3 weeks or less. Displaced and reduced distal radius fractures cannot be immobilized shorter than 4 weeks due to the risk of complications. Future research with homogeneous groups could elucidate the optimal duration of immobilization. [ABSTRACT FROM AUTHOR]

Given the growing global computer workforce, concerns exist about the escalation of computer related injury with Carpal tunnel syndrome (CTS) being one of the most reported work-related musculoskeletal disorders (WMSDs) among office workers. The optimal range of keyboard angles for sitting and standing positions based on wrist posture, forearm muscle activities and user preference as well as the keyboard location in relation to user position were analysed. 30 volunteers with an above 40 words per minute typing speed participated in this study. Result show that, although user prefer to use positive keyboard angle, the negatively tilted keyboard is more ergonomically friendly at both sitting and standing workstations, reducing muscle activity and awkward wrist posture while maintaining performance. The findings indicate that negative sloped keyboard might have the possibility to reduce the risk of developing CTS in office workers. Practitioner summary: This study determines the range of optimal slope of keyboard angle in a sit and stand workstation. Our results indicate a trend in the negative slope keyboard as an ergonomically friendly option for the intervention to Carpal tunnel pressure. [ABSTRACT FROM AUTHOR]

Background: Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. Purpose: The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. Patients and methods: In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. Results: The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. Conclusion: In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Level of evidence IV: Retrospective case series study. [ABSTRACT FROM AUTHOR]

Hamate fractures are uncommon, but early and accurate diagnosis is critical to prevent negative outcomes. Hamate fractures may present initially to emergency departments, and diagnosis can be challenging. This case report of a common hamate fracture may aid in increasing emergency advanced practice nurse knowledge to identify these fractures in practice. [ABSTRACT FROM AUTHOR]

Intra-articular lipomas are infrequently reported, with most reported cases occurring in the knee joint. A case of intra-articular lipoma in the small joints of the hand, specifically in the pisotriquetral joint, has been documented for the first time. A 24-year-old male visited the emergency department after a road traffic accident with a painful and swollen wrist. Radiographic examination revealed fractures of the distal radius and triquetrum. A subsequent wrist computed tomography scan identified an intra-articular lipoma within the pisotriquetral joint, further confirmed by ultrasonography. This article underscores the importance of recognizing that, though exceedingly rare, intra-articular lipomas should be considered in the differential diagnosis of soft-tissue tumors affecting the hand and wrist. [ABSTRACT FROM AUTHOR]

The capitate is the largest, most central bone and the first to ossify in the wrist. It has a well-protected anatomic location, making traumatic or stress fractures extremely rare in clinical practice. Isolated fractures of the capitate bone are very uncommon and often without displacement due to the great stability provided by the intracarpal ligaments. This study aimed to report a case of isolated stress fracture of the capitate related to the work activity of a mechanic. We report the case of a 23-year-old patient complaining of pain and swelling in the left wrist for 2 months without improvement after using analgesics. On physical examination, he presented pain on palpation in the central region of the wrist, pain when performing flexion and extension movements of the wrist, and frustrated edema. Magnetic resonance imaging diagnosed a stress fracture of the capitate bone. Conservative treatment with forearm-palmar immobilization for 2 months, analgesic medication, and physical therapy rehabilitation after immobilization were performed. After the complete resolution of the symptoms, the patient started to work in a new role. There are five case reports of stress fractures in the capitate—two in teenagers and three in adults, but none of them was a mechanic. Clinical suspicion can be formulated when repetitive activity is associated with the wrist in extension and specific location of pain and swelling. Individuals with an immature skeleton are more susceptible. The development of occupational disease should be considered in similar cases of insidious and persistent pain in the palm of people with high work demands. Stress fractures of the capitate bone are a disease that must be suspected in insidious and persistent pain in the palm of the hand. Magnetic resonance imaging is the best image test to diagnose this disorder, and conservative treatment is indicated. • Isolated stress fracture of the capitate is a rare fracture. • Radiography has low sensitivity for this fracture and raises the possibility of an underestimation of the incidence. • These fractures do not have an exuberant clinical picture and are often not diagnosed. [ABSTRACT FROM AUTHOR]

Background and Purpose: Scaphoid waist fractures are often stabilised with compression screws, Kirschner wires (K-wires), or a combination of both. While clinical and bio-mechanical studies evaluating their utility are available, the ideal configuration of implant that would provide adequate stability to permit early use of the hand is debatable. We examined configurations of a single screw, one screw along with a K-wire, and two K-wires used for a transverse scaphoid waist fracture fixation aiming to assess the stability provided by each in the immediate postoperative period. Methods: Computer-aided design (CAD) models of the scaphoid, K-wire, and headless compression screw were created. A transverse fracture was created at the scaphoid waist, and the CAD models of the screw and K-wire were used to fix the fracture in different configurations in a distal to proximal direction. Finite Element Analysis (FEA) was used to examine the strength of configurations when they were subjected to compression and distraction forces. The total maximum deformation (TDef) and factor of safety (FoS) for each configuration were calculated and used as indirect indicators of postoperative stability. Results: When a single screw was used, the configurations with the screw directed posteriorly from either centre or anterior had the best combined TDef and FoS values. For one screw and one K-wire, the configuration with screw and K-wire parallel to each other with the screw located along the long axis in the AP projection and anterior to the K-wire in the lateral projection had the best combined TDef and FoS values. When using two K-wires, configurations with the two wires diverging proximally on the lateral projection had the best combined TDef and FoS values. Conclusions: When fixing a transverse scaphoid waist fracture with a single screw, the screw directed posteriorly from either the centre or anterior aspect of the distal pole has the best stability, a parallel configuration has the best stability when fixing it using a screw and a K-wire, and divergent configuration has the best stability when fixing it with two K-wires only. [ABSTRACT FROM AUTHOR]

Purpose: Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II–III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Materials and Methods: Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. Results: A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared. Conclusions: The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level of Evidence: Level III, Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Objective: This study is to assess the diagnostic performance of magnetic resonance imaging (MRI) findings for type 1B triangular fibrocartilage complex (TFCC) tear of the wrist. Materials and methods: This study retrospectively enrolled 78 patients to examine the diagnostic performance of preoperative MRI examinations in patients with type 1B TFCC tears. Thirty-nine participants had confirmed type 1B TFCC tear. The control group included 39 patients who were randomly selected from 1157 patients who underwent MRI for wrist pain. Both groups underwent a review of 19 MRI findings by two independent radiologists, and the correlation between each diagnostic finding and type 1B TFCC tear was assessed using the chi-squared test. The 19 MRI findings comprised eight primary signs of abnormalities in the distal or proximal lamina, in conjunction with 11 secondary signs suggestive of abnormalities in the surrounding structures. Results: The TFCC tear group demonstrated a significantly higher incidence of two primary MRI signs, i.e., fiber discontinuity and signal alteration in the distal lamina, as observed by both readers (R1, 74.4% vs. 38.5%, p = 0.003, and 87.2% vs. 43.6%, p < 0.001; R2, 74.4% vs. 35.9%, p = 0.001, and 87.2% vs. 53.8%, p < 0.003, respectively). Reader 2 identified a higher prevalence of two additional primary MRI signs: fiber discontinuity and signal alteration in the proximal lamina (all p < 0.05). None of the 11 secondary MRI signs demonstrated statistically significant associations with type 1B TFCC. Conclusion: MRI manifestations of fiber discontinuity and signal alteration in the distal lamina may provide predictive markers for type 1B TFCC wrist tear. [ABSTRACT FROM AUTHOR]

Volar dislocation of the distal radioulnar joint is a rare injury that is often missed at initial presentation. We report a 21-year-old male patient who presented 2 months after sustaining this injury. He was successfully managed by open reduction and reconstruction of the dorsal radioulnar ligament using a partial distally based extensor carpi ulnaris tendon strip. A literature review showed only a few reported cases with varied methods for management. The technique utilised is analysed in comparison to the others. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effect of a combination of sports injury massage therapy and exercise therapy on the recovery of wrist and elbow injuries in athletes. This research uses an experimental design with the Randomized Controlled Trial (RCT) method. Participants in this research were students who were members of various sports Student Activity Units. Data collection instruments include a Visual Analog Scale (VAS) to measure pain levels, as well as a Goniometer to measure Range of Motion (ROM) at the wrist and elbow. The data analysis technique was carried out using the independent t-test. The results of data analysis show that combining sports injury massage therapy and exercise therapy has a more positive impact in reducing pain in wrist and elbow injuries compared to just carrying out sports injury massage therapy. The conclusion of this study is that massage therapy for sports injuries is better than exercise therapy where the reduction in massage therapy can reduce pain significantly. However, actually combining the two therapies has a more positive effect on injury recovery than just doing one form of therapy. [ABSTRACT FROM AUTHOR]

Aims: The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Methods: Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. Results: In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Conclusion: Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs. Cite this article: Bone Jt Open 2024;5(4):312–316.

Purpose of reviewThe aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation.Recent findingsShoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes. There is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.

Convolutional neural network (CNN) models were devised and evaluated to classify infrared thermal (IRT) images of pediatric wrist fractures. The images were recorded from 19 participants with a wrist fracture and 21 without a fracture (sprain). The injury diagnosis was by X-ray radiography. For each participant, 299 IRT images of their wrists were recorded. These generated 11,960 images (40 participants × 299 images). For each image, the wrist region of interest (ROI) was selected and fast Fourier transformed (FFT) to obtain a magnitude frequency spectrum. The spectrum was resized to 100 × 100 pixels from its center as this region represented the main frequency components. Image augmentations of rotation, translation and shearing were applied to the 11,960 magnitude frequency spectra to assist with the CNN generalization during training. The CNN had 34 layers associated with convolution, batch normalization, rectified linear unit, maximum pooling and SoftMax and classification. The ratio of images for the training and test was 70:30, respectively. The effects of augmentation and dropout on CNN performance were explored. Wrist fracture identification sensitivity and accuracy of 88% and 76%, respectively, were achieved. The CNN model was able to identify wrist fractures; however, a larger sample size would improve accuracy. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the anatomy of forearm bones and the pathophysiology of bowing fractures • To increase your awareness of the diagnostic challenges and complications associated with bowing fractures • To enhance your understanding of the management of children with bowing fractures. Bowing fractures of the forearm are characterised by numerous micro-fractures on the concave surface of the affected bone(s), usually caused by a fall on an outstretched arm. Children are more susceptible to this type of injury than adults because their long bones have more elasticity. Bowing fractures of the forearm are challenging to diagnose because there are no obvious cortical defects, which can lead to inappropriate management and associated complications, including loss of movement range and loss of function. This article discusses bowing fractures of the forearm in children, including their pathophysiology, diagnosis and management. It aims to enhance emergency nurses’ awareness and knowledge of this type of injury in children and of the challenges surrounding diagnosis and management. [ABSTRACT FROM AUTHOR]

Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI. Midcarpal instability (MCI) is a disabling condition and treatment options are limited. Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the wrist muscles. Participants improved in hand/wrist function and 78% did not convert to surgery. Non-invasive treatment should be the primary treatment choice for these patients. [ABSTRACT FROM AUTHOR]

Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term. [ABSTRACT FROM AUTHOR]

The field of wrist proprioception, as it relates to rehabilitation and surgery, has gone through a period of intense growth in the past decade. From being primarily focused on the function of the joint and ligaments in patients with wrist trauma or after wrist surgery, the understanding is now that of a greater complexity in treating not just the wrist but the hand and arm as a whole. Proprioception is derived from the Latin words "proprius" – belonging to (oneself) and "-ception" to sense. In other words, how to sense ourselves. To have a complete sense of self, multiple sensory afferents originating from joints, ligaments, muscles, tendons, nerves, skin, vision, and hearing work together to orchestrate a balanced integration of sensorimotor functions, with the true goal to perceive and adapt to the physical world around us. In this update on wrist proprioception, we review current developments in the understanding of proprioception, with an implication for our everyday work as hand therapists and hand surgeons. Each contributing sense—joint, ligaments, muscles, skin, and brain—will be reviewed, and the clinical relevance will be discussed. An updated wrist rehabilitation protocol is proposed where the therapist is guided to rehabilitate a patient after wrist trauma and/or surgery in 4 stages: (1) basic hand and wrist rehabilitation with a focus on reducing edema, pain, and scar formation; (2) proprioception awareness to improve the sense of joint motion and position; (3) conscious neuromuscular rehabilitation where isometric exercises of muscles that are beneficial for a particular injury are promoted, whereas others that are potentially harmful are avoided; and (4) unconscious neuromuscular rehabilitation with training of the reflex and joint protective senses. • Proprioception is a multisensory modality originating from receptors in skin, muscles, joints. • This article offers updates on the latest scientific findings in proprioception. • Wrist proprioception is dependent on input from all proprioceptive senses. • Clinical applications and a 4-stage wrist proprioception rehabilitation protocol are reviewed. [ABSTRACT FROM AUTHOR]

Background: Rodeo is a globally popular sport, with its athletes prone to various types of injuries. There is no systematic review discussing rodeo injuries across all age groups. Purpose: To (1) review the published literature on incidence, types of injuries, and factors leading to injuries in rodeo athletes; (2) provide prevention recommendations for health care providers; and (3) identify gaps in the research. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive search of available literature was electronically performed through MEDLINE, Embase, and SPORTDiscus databases using the key terms “rodeo” and “injury” or “trauma” between 1995 and 2021. A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which identified 116 eligible studies. Outcome data included frequency of injuries, risk factors for injury, and types of injury. Results: A total of 23 studies met the inclusion criteria (N = 2105 athletes), of which 13 were retrospective studies. In the included studies, the injury rate per competition exposure (CE) ranged from 4.2 to 19.1 injuries per 1000 CE. Sprains and strains accounted for the highest percentage of injury types, ranging from 15% to 34%. The knee was the most common location of injury, making up 11.1% to 17% of injuries. Concussions occurred in up to 15.3% of injuries for all events and up to 77% of injuries in roughstock events. Of all rodeo events reported, bull riding caused the highest percentage of injuries, making up 19.4% to 58.4% of injuries, and bareback had the second highest at 15.3% to 28.8% of injuries. Conclusion: There was a high prevalence of various injury types and mechanisms in rodeo. Improved injury surveillance and the introduction of a comprehensive standardized injury reporting system would be helpful in the future prevention, diagnosis, and treatment of rodeo injuries. [ABSTRACT FROM AUTHOR]

Suicide is one of the major global health issues specially in countries having low to medium socioeconomic condition. Hanging is method of choice for adults to commit suicide. Near hanging defined as person who survive a hanging injury for enough time to reach hospital. Tentative cut or self-inflicted injury is an intentional and direct injury to own's body part. It is also known as self-harm, self-wounding, moderate self-mutilation and parasuicide. Various factors responsible for high mortality in near hanging are low systolic blood pressure (<90), injury severity score (ISS) >15, Glassgow coma scale (GCS) <8, hypoxic brain injury on CT scan. Immediate arrival to hospital and aggressive management of near hanging and its complication can improve the final outcome. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Scaphocapitate syndrome is a rare clinical entity consisting of a combined scaphoid and capitate fracture along with a 90- or 180-degrees rotation of the proximal capitate fragment. The syndrome is scarcely described in the literature, with proximal migration of the capitate fragment being reported only by Mudgal et al in 1995. Concurrent compression of the median nerve is a highly unfortunate event, suggesting a unique case presented here. Case Report: We present a unique case of scaphocapitate fracture-dislocation in a 25-year-old man with volar dislocation of the capitate's fragment deep to the median nerve. X-rays and CT scan were performed and the patient was treated few hours after the injury by a hand specialist, in order to prevent median neuropathy and avascular necrosis of the fragment. Open reduction and internal fixation utilizing a Herbert screw for the scaphoid fracture and 3 additional K-wires was performed. Immediately post-operatively, the acute neurological symptoms had subsided and good reduction was acquired radiologically. One year post-operatively the patient had regained good hand and wrist functionality, with no extension or flexion ROM deficits. Conclusions: Immediate intervention in a specialized center with reduction and fixation utilizing a Herbert screw and K-wires showed favorable 1-year results in our case of scaphocapitate syndrome. The impending complications of median neuropathy and capitate avascular necrosis were avoided despite the high-risk injury pattern. [ABSTRACT FROM AUTHOR]

Objectives Scaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot‐assisted fixation for the treatment of scaphoid nonunions. Methods Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)‐wires or a headless compression screw using a robotic navigation system. Results Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K‐wires. All the guidewires were placed with a single‐attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow‐up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient‐rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients. Conclusion Arthroscopic bone grafting with robot‐assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single‐attempt using a robotic navigation system.

Background: This study was conducted explicitly on the efficacy of task-oriented exercises paired with wrist flexibility training on enhancing wrist mobility and reducing wrist injuries in badminton players. Purpose: The purpose of this study was to see how a structured intervention integrating task- oriented exercises and wrist flexibility training benefited wrist mobility and injury prevention in badminton players. Materials and Methods: A randomized controlled trial design was used, with a sample of 70 intermediate- level badminton players participating. The participants were split into two groups: conventional and intervention. The intervention group participated in a four-week programme that included task-oriented workouts with badminton movements and targeted wrist flexibility training. The typical group continued with their regular training schedule, with no wrist mobility modification. Validated metrics - ROM and Quick DASH score - were used to assess wrist mobility and function. (Study period: September 2022-May 2023) Result: Preliminary research found that the intervention group had significantly better wrist mobility than the control group. They also demonstrated enhanced ROM, flexibility, and functional performance of the wrist joint, as well as a significant decrease in wrist injury occurrence. Conclusion: These data indicate that combining task-oriented exercises with wrist flexibility training in badminton players can successfully improve wrist mobility and lower the incidence of wrist injuries. [ABSTRACT FROM AUTHOR]

Purpose: Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors. Methods: Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported. Results: This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5–20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN. Conclusion: With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics. Level of Evidence IV: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: A scaphoid fracture is a common injury affecting the wrist joint. A fracture of the carpus scaphoid can heal uneventfully or be complicated by non-union. Scaphoid non-union can result in persistent wrist pain, and with functional difficulties affecting all activities of daily living of the patients, this disability is expected to be significant since most of these patients are young active adults. Hypothesis: Extensive removal of the bone from the scaphoid, with the application of a large amount of cancellous bone graft and fixation with two to three wires, could lead to a high union rate and a good functional outcome. Methods: Eighteen patients with scaphoid fracture non-union were recruited during their visit to the upper limb clinic at our institute. Demographic data were collected, and data regarding comorbidities, smoking, manual work, and others were recorded. Data regarding the interval between injury and surgery, time to radiographic union, and functional wrist scores were reported as well. Results: A cohort of 18 patients was included. The mean age of patients was 30 years; most of our patients were healthy (83.3%), and more than two-thirds were smokers (72.2%). The mean follow-up time was 18 months (1.5 years), 15 patients (83.3%) achieved radiographic unions by 2–3 months, and the remaining 3 patients (16.7%) achieved radiographic unions by (4–5) months, i.e., all patients achieved successful radiographic unions by 5 months at maximum. The mean Mayo score for our series was 83.6 (± 12.4), with 5 patients (27%) achieved ≥ 95% which indicates a significantly high functioning wrist in our cohort. Conclusion: Our modified technique with enhanced stability from using three k-wires can achieve full clinical and radiographic unions and result in enhanced recovery postoperatively with cast immobilization limited to 6 weeks total. Level of evidence: IV Case series study. [ABSTRACT FROM AUTHOR]

Objectives: Scaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot‐assisted fixation for the treatment of scaphoid nonunions. Methods: Patients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)‐wires or a headless compression screw using a robotic navigation system. Results: Six male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K‐wires. All the guidewires were placed with a single‐attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow‐up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient‐rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients. Conclusion: Arthroscopic bone grafting with robot‐assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single‐attempt using a robotic navigation system. [ABSTRACT FROM AUTHOR]

The "carpal boss" is a variant present in 19% of the population according to cadaveric studies but becomes symptomatic in only 1% of cases. With the rising popularity of "yoga," which includes prolonged hyperextension at the wrist joint with weight bearing, an increasing number of individuals with silent carpal boss present with dorsal wrist pain due to impingement over the dorsal soft tissues by this innocuous bony protuberance. This warrants the attention of radiologists and clinicians while dealing with wrist pain. It can be challenging to identify this bossing on routine radiographs, necessitating special views. We describe the use of dynamic ultrasound in diagnosing "symptomatic" carpal boss, the effects of which become even more evident on imaging during hyperextension—the triggering movement. [ABSTRACT FROM AUTHOR]

Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. This was a prospective cohort study. Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t -test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without. • The wrist widget increases the weight-bearing capacity by around 4 kg. • The effect is similar for cases with traumatic and degenerative lesions of the TFCC. • Weight-bearing capacity cannot identify traumatic TFCC lesions with DRUJ instability. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. Methods: Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). Results: Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. Conclusions: A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed. [ABSTRACT FROM AUTHOR]

Background: Triangular fibrocartilage complex (TFCC) injury is a frequent soft tissue injury that has been observed to accompany distal radius fractures (DRFs) with concomitant changes in radiologic parameters. The aim of this study was to investigate the relevance of distal radial radiologic parameters associated with DRF and traumatic TFCC injury. Methods: A total of 172 patients with distal radius fractures who underwent X-ray, CT, and MRI before undergoing volar locking plate or external splint fixation between October 2021 and December 2022 were included in this study. An analysis of various radiologic parameters and the classification of fracture type and TFCC injuries by CT and MRI was performed. All patients were divided into the TFCC uninjured group and the injured group. The incidence and relevant radiologic parameters were compared. Results: This study included 76 males and 96 females with a mean age of 56.1 years. Among all patients, 33 (19.2%), 40 (23.2%), and 99 (57.6%) had DRF with A, B, and C fractures, respectively, according to the AO/OTA classification. In patients with fractures, the TFCC was found to be injured in 54.1% (93/172) of patients (type 1A in 21, 1B in 46, 1C in 39, and 1D in 35) but uninjured in 45.9% (79/172). There were significant differences between the TFCC injured and uninjured groups regarding the radius length (p = 0.044) and DRUJ distance (p = 0.040) of radiologic parameters that changed with DRF, although there were no differences between the two groups regarding gender, age, injured side, intra- and extra-articular, radius inclination and palmer tilt angle, or sagittal translation. Within the TFCC injured group, the radius length and DRUJ distance were 4.83 mm and 2.95 mm less or wider than 7.19 mm and 1.83 mm of the uninjured group. Moreover, shorter radius length was related to type lB TFCC injury (p = 0.041). Both radius length (AUC = 0.658) and DRUJ distance (AUC = 0.582) had no convincing predictive value for TFCC injury in DRF. Conclusion: 1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. Both radius length and DRUJ distance have a significant statistical correlation with TFCC injury, and patients with TFCC injury tend to have a shortened radius and wider DRUJ distance, although they have no predictive value for TFCC injury in DRF. In addition, a shorter radius length was related to type lB TFCC injury. [ABSTRACT FROM AUTHOR]

An instructional review of the anatomy, investigation, and management of scapholunate ligament injuries. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination. [ABSTRACT FROM AUTHOR]

This study sought to provide a comprehensive assessment of the incidence of sports injuries among athletes participating in the Olympic Winter Games and to investigate contributing factors. We gathered injury data from athletes participating in the recent four Olympic Winter Games, incorporating details on the sports event, sex, injury location, and type. Through a meta-analysis, we calculated the injury incidence rates for each sport and examined the influence of sex and the type of sport on these incidence rates. Out of 11,197 registered athletes, we documented 1,304 sports injuries. The sports events with the highest injury rates were free-style skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey, with the most frequent injury locations being the knees, thoracic/lumbar/back regions, and the wrist/hand/fingers. Contusions, hematomas, and bruises were the most prevalent injuries, followed by strains (including muscle rupture, tearing, or tendon rupture) and sprains (covering dislocations, subluxations, and ligament ruptures). In the Olympic Winter Games, events such as freestyle skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey pose a particularly high risk. Predominant injury sites include the knee, spine/back, and wrist and hand, with injuries ranging from contusions and hematomas to strains and sprains. For effective injury prevention, it is crucial to emphasize proper medical resource allocation, specialized training for medical personnel, and meticulous venue maintenance. [ABSTRACT FROM AUTHOR]

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

Abstract Background Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are common types of wrist osteoarthritis (OA). Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain. However, in case a course of conservative treatment is unsuccessful, operative treatment is needed. The two most conventional operative approaches for SLAC/SNAC OA are four-corner arthrodesis (FCA) and proximal row carpectomy (PRC). Although FCA is the gold-standard operative technique and may lead to superior grip strength, the evident benefit of PRC is that it obviates any need for hardware removal and controlling for bony union. To date, no high-quality randomized controlled trial comparing FCA and PRC exists. As clinical outcomes seem comparable, a trial that assesses patient-reported outcomes, adverse events, and secondary operations may guide clinical decision making between these two procedures. Thus, the aim of this multi-institutional double-blind randomized controlled trial is to study whether PRC is non-inferior to FCA in treating SLAC/SNAC OA. We hypothesize that PRC is non-inferior to FCA with lower economic expanses. Methods The trial is designed as a randomized, controlled, patient- and outcome-assessor blinded multicenter, two-armed 1:1 non-inferiority trial. Patients with SLAC/SNAC-induced wrist pain meeting trial inclusion criteria will undergo wrist arthroscopy to further assess eligibility. Each patient eligible for the trial will be randomly assigned to undergo either FCA or PRC. The primary endpoint of this study is the Patient Rated Wrist Evaluation (PRWE) at 1-year after FCA versus PRC. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand, EQ-5D-5L, pain, grip strength, wrist active range of motion, radiographic evaluation, and adverse events. Trial design, methods, and statistical analysis plan will be presented here. Discussion We present an RCT design comparing FCA vs PRC for SLAC/SNAC-induced OA. The results of this trial will assist in decision making when planning surgery for SLAC/SNAC. Trial registration ClinicalTrials.gov NCT04260165 . Registered February 7, 2020.