Search Results

The terrible triad of the shoulder: Injury characteristics and outcomes of axillary nerve reconstruction. Wilson, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Axillary nerve injury - Upper limb trauma The patient I saw, had an upper limb injury, which resulted in anterior shoulder dislocation and a hand fracture. When I started seeing them, it appeared that they were unable to shoulder flex beyond 80deg and this was associated with significant scapular elevation. Their deltoid did not appear to be working, and upon MRI and nerve conduction studies, an axillary nerve injury was confirmed. This retrospective study assessed outcomes of axillary nerve injuries combined with shoulder injuries requiring surgical intervention. Surgical interventions like nerve grafting or transfer were implemented for 32 patients presenting with axillary nerve injury and supraspinatus tear/greater tuberosity fracture as a result of anterior shoulder dislocations. The results showed that shoulder flexion improved to 110° after surgery. Younger patients and those with a greater tuberosity fracture rather than supraspinatus tear experiences better outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, axillary nerve injuries due to anterior shoulder dislocations, that are associated with either rotator cuff tears or greater tuberosity fractures, have poor functional outcomes. This is despite nerve grafting or nerve transfer. Keep this differential diagnosis in mind if your patients present with an upper limb injury which is also affecting their shoulder. If you want to know about other differential diagnoses for shoulder pathology associated with hand injuries as well as how shoulder injuries affect upper limb fracture recovery, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934251333250 Abstract We aimed to describe outcomes, including shoulder motion, deltoid strength and Disabilities of Arm, Shoulder and Hand scores, in 19 patients with terrible triad shoulder injuries (anterior shoulder dislocation, rotator cuff tear or greater tuberosity fracture, and axillary nerve injury) who required axillary nerve reconstruction. The type of nerve surgery (grafting vs. nerve transfer), demographic factors and injury characteristics were not significantly associated with outcomes. The mean postoperative abduction and Disabilities of Arm, Shoulder and Hand score were 95° and 28, respectively. Patients with rotator cuff tears had a higher Disabilities of Arm, Shoulder and Hand score (more disability) than those with isolated greater tuberosity fractures. We conclude that spontaneous recovery of the axillary nerve may not occur in patients with a terrible triad injury. Functional outcomes after axillary nerve repair are poor with respect to motion, strength and patient-reported outcomes compared with reported results for axillary nerve reconstruction in the absence of rotator cuff injury. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Are preoperative corticosteroid injections in large or intermediate joints associated with surgical site infection after soft tissue hand surgery? A retrospective database analysis. Zhuang, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Systemic effect of CSI - Infections after hand surgery This retrospective study assessed the effect of cortisone injections to large (e.g. shoulder) and intermediate size (e.g. elbow) joints on the risk of post surgical infections following hand surgery. A total of 1,338,077 participants were included. The results showed that independently of the time of delivery and size of the joint injected (e.g. shoulder/elbow), cortisone injections did not increase the risk of infection or complication following hand surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, corticosteroid injections of large joints (e.g. knee/hip) do not have a negative effect on risk of infections even if they are delivered in temporal proximity of hand surgery. However, keep in mind that cortisone or hyaluronic injections to joints (e.g. thumb) that are about to be operated on (trapeziectomy within the next three months) increase the risk of post surgical complications. This has been shown for trigger finger surgery (both in terms of number of injections and time-frames ) as well as trapeziectomy ( cortisone and hyaluronic acid ). Additional evidence is also available from other joints such as the hip, where CSI injections in close proximity of surgery increase the chance of infections ( https://pubmed.ncbi.nlm.nih.gov/36592824/ ). URL : https://doi.org/10.1016/j.jhsa.2025.03.020 Abstract Purpose: In this study, we asked the following question: Is intra-articular corticosteroid injection at a distant site prior to hand surgery associated with an increased risk of (1) surgical site infection, (2) reoperation for infection, or (3) wound dehiscence? Methods: Using a national administrative claims database, we identified adult patients undergoing carpal tunnel, trigger finger, or DeQuervain release. Patients were divided into four cohorts: intra-articular corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery or no injection within 90 days prior to surgery. Large and intermediate joints were considered. We measured surgical site infection incidence, reoperation, and wound dehiscence within 90 days after surgery. We created multivariable logistic regression models to evaluate the association between preoperative corticosteroid injection and each outcome, adjusting for age, sex, region, insurance plan, Elixhauser comorbidities, and history of tobacco use. Results: Receiving a large-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with surgical site infection or reoperation. Receiving a large-joint corticosteroid injection between 0 and 30 days before surgery was associated with a slightly higher incidence of wound dehiscence compared to no injection (0.5% vs 0.4%). Receiving an intermediate-joint corticosteroid injection between 0 and 30, 31 and 60, or 61 and 90 days before surgery was not associated with the incidence of surgical site infection, reoperation, or wound dehiscence. In patients with diabetes, receiving a corticosteroid injection within 90 days before surgery in a large or intermediate joint was not associated with an increased risk of surgical site infection, reoperation, or wound dehiscence. Conclusions: Corticosteroid injections into large- and intermediate-sized joints can be safely administered before hand surgery from a surgical site infection perspective, including in patients with diabetes. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and meta-analysis. Albert-Lucena, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic study Topic : Neurodynamic tests - Diagnostic accuracy Cx radiculopathy & CST This systematic review and meta-analysis assessed the diagnostic accuracy of Upper neurodynamic tests for upper-limb entrapment neuropathies, including carpal tunnel syndrome and cervical radiculopathy. A total of 12 studies, involving 957 participants, were included in the review. The overall evidence quality was very low due to study bias, imprecision, and heterogeneity. The results showed that neurodyanamic tests have moderate sensitivity but low to moderate specificity, with likelihood ratios varying based on diagnostic criteria, particularly when structural differentiation was applied. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, neurodynamic tests should not be utilised as a standalone diagnostic tools for carpal tunnel syndrome or cervical radiculopathy. While neurodynamic tests can be part of an assessment, they are best used alongside patient history, physical exams, and imaging studies. In particular, for physical examination, several tests have been described as potentially useful when we suspect a carpal tunnel syndrome . Equally, if we suspect a cervical radiculopathy, the arm squeeze test as well as neurodynamic tests would be useful . Keep in mind, that cervical radiculopathies are associated with motor and sensory changes that need to be assessed and monitored. URL : https://doi.org/10.1016/j.msksp.2025.103317 Abstract Background: Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria. Objective: To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies. Methods: A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria. Results: Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+:1.65 and LR-:0.57, for cervical radiculopathy were LR+:2 and LR-:0.47, and for carpal tunnel syndrome were LR+:1.45 and LR-:0.66. The upper-limb neurodynamic test 2A showed the highest diagnostic accuracy (AUC: 0.76), with LR+:2.59 and LR-:0.42 for cervical radiculopathy, while test 3 had the highest specificity (0.92; LR+:7, LR-:0.48). Diagnostic accuracy for carpal tunnel syndrome was lower (AUC: 0.62). Meta-regression showed significant diagnostic criteria interaction, favoring structural differentiation maneuvers (p = 0.002). Conclusion: Upper-limb neurodynamic tests show moderate sensitivity and low to moderate specificity for diagnosing upper-limb entrapment neuropathies, with diagnostic accuracy varying across conditions. The certainty of evidence ranges from very low to moderate, emphasizing the need for cautious clinical interpretation. Diagnostic reference criteria significantly influence test performance. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Does endoscopic carpal tunnel release during distal radial fracture fixation improve outcomes? A randomized controlled trial. Monteerarat, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Carpal tunnel release - Distal radius ORIF This randomised controlled study investigated the outcomes of prophylactic endoscopic carpal tunnel release (CTR) during distal radius fracture open reduction internal fixation (ORIF) compared to no CTR. A total of 60 participants were included and they were ransomised to CTR or not. The results showed that patient-reported functional outcomes, quality of life, and symptoms related to carpal tunnel syndrome (CTS) were comparable between the two groups. However, prophylactic CTR was associated with a reduced incidence of finger stiffness in patients with type C DRFs. Nevertheless, given the number of subgroup analyses, there is a 35% chance that the difference in finger stiffness between type of fracture is simply due to a random occurrence. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, endoscopic carpal tunnel release during distal radius fracture ORIF offers no benefit in patient-reported functional outcomes, quality of life, or CTS symptoms compared to no release . This study is a nice addition to the randomised controlled trial comparing ulnar styloid repair or not during distal radius fracture ORIF . Overall, it appears that as long as the main fracture is repaired, additional interventions provide no added value. URL : https://doi.org/10.1177/17531934241288216 Abstract This study investigated the functional outcome of prophylactic carpal tunnel release during distal radial fracture fixation. A total of 60 patients undergoing anterior locking plate fixation for a distal radial fracture were randomized into two groups: one having prophylactic endoscopic carpal tunnel release and the other serving as a control. Functional outcomes were assessed using the Patient-Reported Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension 5-Level questionnaire, Boston Carpal Tunnel Questionnaire, Pain Numerical Rating Scale, grip strength and finger-to-palm distance over a 12-month period. The study found no significant differences in overall functional outcomes or complications between the groups. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Neglected posterior interosseous nerve injury. Lee, et al. (2024) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Laceration - PIN lesion A 49 years old person underwent emergency surgery as they had a penetrating injury of the volar and dorsal forearm caused by a kitchen knife. Objectively, they had limited ability to flex the thumb as well as extend the thumb and the other fingers. There were no sensory deficits in the hand. Surgical exploration revealed lesions of the ECRL, ECRL, EDC, EDM, APL, EPL, and EPB. All of these were repaired. The patient was discharge one week later without evidence of complications. They were then reviewed at two months after surgery, which identified a 20° to 30° extension lag of the thumb, index, and little finger. Extension of the wrist, middle and ring finger was possible. These findings raised the suspect of a posterior interosseous nerve (PIN) palsy resulting from delayed diagnosis following trauma. During exploration surgery, a transected PIN with a neuroma was identified, leaving a 2.5 cm nerve gap between the two edges. After resection of the neuroma, a delayed nerve repair was performed using a harvested posterior antebrachial cutaneous nerve as a cable graft. The patient was lost at follow up and we therefore do not know whether thumb, index, and little finger active extension was recovered. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : B ased on what we know today, penetrating injuries of the forearm require a full neurovascular assessment before and after surgery. Early recognition of PIN injuries is vital to prevent long term neurological deficits. Thus it appears that l onger duration before repair and larger defects have lower probability of recovery. Furthermore, it seems that younger patients (under 45 yrs old) are more likely to obtain full functional recovery following nerve repair. URL : https://doi.org/10.1016/j.tcr.2024.100994 Abstract Posterior interosseous nerve (PIN) injury is uncommon due to its anatomically deep location. We report a neglected, rare case of PIN injury presenting the loss of extension of thumb, index, and small fingers with weakness of thumb abduction in a 49-year-old male patient. The patient sustained a penetrating injury to his right forearm caused by a kitchen knife that was repaired primarily through an emergency surgery under general anesthesia. During the regular follow-up on the 52nd postoperative day, the patient presented 20° of extension lags in the right thumb and index finger and 30° in the small finger. Wrist extension was intact, and there was no sensory deficit. We explored the wound and traced the PIN completely, identifying a club-shaped neuroma formation at the proximal cut end of the PIN. Delayed nerve repair was performed with a double-strip cable graft. Hand surgeons should be aware of the probable PIN injury in certain situations of forearm-penetrating injury and perform proper preoperative physical examination to rule out neurovascular deficits. Careful exploration and immediate repair of severe PIN are mandatory, even in emergency situations. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Triceps tendon avulsions in children and young adult patients: A commonly delayed diagnosis. Antonellis, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Avulsion fleck - Triceps avulsion This is a retrospective review of triceps tendon avulsions (TTAs) in pediatric and young adult populations. A total of 19 participants were included. The results showed that TTAs typically occured during sports or daily activities rather than being associated with underlying medical conditions, affecting both males and females equally. Most cases were diagnosed using advanced imaging techniques like MRI, but the "avulsion fleck" sign on lateral radiographs (see picture below) was a consistent finding in 89% of complete avulsion injuries, even more prominently observed in younger patients compared to adults. Out of the whole sample, 84% of patients underwent surgery to repair the tendon avulsion. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, triceps tendon avulsions are rare injuries in pediatric and young adult populations. The "avulsion fleck" sign on lateral radiographs is a critical diagnostic clue, consistently observed in 89% of complete avulsion injuries, particularly prominent in younger patients compared to adults. These injuries are often underrecognised due to their limited incidence and lack of widespread awareness. If you want to know more about triceps injuries and treatment, have a look at the whole database . URL : https://doi.org/10.1016/j.jse.2025.02.031 Abstract Background: Triceps tendon avulsions (TTAs) are rare injuries previously reported in active young men or elderly adults. Little information exists when this injury pattern presents in younger patients. TTAs are at risk of being missed or misdiagnosed at initial presentation, leading to delays in treatment and recovery. We hypothesized that formally diagnosed TTAs in young patients can be detected early on plain radiographs using the avulsion fleck sign, leading to earlier diagnosis and treatment. Methods: A retrospective case series of patients diagnosed with TTAs within the past 15 years at a tertiary pediatric referral center was reviewed. All patients were aged less than 21 years at diagnosis. Patient demographics, injury characteristics, clinical presentation, comorbidities, and radiographs were investigated to describe the presentation of TTAs in younger patients. Radiographs and advanced imaging were reviewed to assess for the avulsion fleck sign and examine if TTA diagnoses could have been made earlier if this sign was recognized. Results: Nineteen patients met inclusion criteria, including 11 males and 8 females. The average age at the time of injury was 14.95 years (range: 12-19 years). 42.1% of subjects were injured during sports participation and 36.8% during play and daily activity. Only 2 patients had comorbidities. Initial radiographs occurred a median 0 days after injury (range: 0-14, interquartile range: 1). One of the 19 patients had their TTA diagnosed at initial presentation on a lateral radiograph. Eighteen patients had advanced imaging leading to diagnosis. Diagnosis was made a median of 7 days after injury, ranging from 0 to 520 days. One in 4 patients was diagnosed more than a month after injury. On retrospective radiographic review, 17 of 19 patients had the avulsion fleck sign detectable on initial radiographs. Advanced imaging characterized the avulsion and led to the diagnosis of associated imaging in 14 of 16 patients. Conclusions: There is limited information about TTAs in younger populations. TTAs present in both young females and males, and occur during sports participation, play, and daily activity. One in 4 patients had a delay in diagnosis more than 1 month from injury. Although advanced imagining was commonly used to diagnose TTAs, plain radiographs showed a consistent finding of an avulsion fleck sign. Accurate interpretation of plain radiographs can lead to a faster diagnosis of TTAs. Advanced imaging is indicated to fully assess the injury including associated pathologies. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Social determinants of health are independently predictive of increased hospital length of stay and complications following total elbow arthroplasty. George, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic and Decision Analysis Study Topic : Elbow arthroplasty - Social determinants of health This retrospective study investigated the impact of social determinants of health (SDOH) on hospital resource use, costs, and discharge patterns of patients undergoing Total Elbow Arthroplasty (TEA). a total of 316 patients were compared to more than 5,000 controls. Logistic regression in identified SDOH as being associated with higher rates of complication. Nevertheless, due to the multiple comparisons in this study, there is a 25% chance that these results are due to chance. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, social determinants of health (SDOH) influence access to Total Elbow Arthroplasty (TEA), healthcare resource utilisation, costs, and complications . These findings appear in line with previous research showing that social deprivation in term of poor nutrition have negative effects on our patients following upper limb surgery . URL : https://doi.org/10.1016/j.jse.2025.03.028 Abstract Background: Social determinants of health (SDOH) are the social, educational, environmental, and economic factors that affect health. The purpose of this study was to determine the effects of preoperative SDOH on the outcomes of total elbow arthroplasty (TEA). Methods: The Nationwide Readmissions Database was used to identify 316 patients with a SDOH diagnosis and 5426 controls who underwent primary TEA from 2016 to 2020. Primary outcomes included cost of admission and hospital length of stay (LOS), adverse clinical outcomes within 180 days and postoperative medical and surgical complications. Binary logistic regression identified independent predictors of postoperative complications. Multiple linear regression identified independent predictors of increased cost and hospital LOS. Results: Compared to controls, patients with SDOH had higher odds of experiencing any complication (odds ratio [OR] 1.3; confidence interval [CI] 1.0-1.7), acute renal failure (OR 1.6; CI 1.0-2.4), cellulitis (OR 11; CI 5.1-23), surgical site infection (OR 2.7; CI 1.7-4.3), urinary tract infections (UTI) (OR 3.2; CI 2.2-4.6), and wound dehiscence (OR 5.7; CI 1.9-18). SDOH was shown to be independently predictive of postoperative cellulitis (OR 7.2; CI 2.9-18) and UTI (OR 2.0; CI 1.3-3.1). SDOH was correlated with increased hospital LOS (3.5 days vs. 5.8 days.). Preoperative SDOH diagnosis was shown to be independently predictive of a 1.67 day increase in hospital LOS following primary TEA (B = 1.67, SE 0.198)."how do social determinants shape access to total elbow arthroplasty and healthcare resource use?" Conclusion: Preoperative SDOH diagnosis, though associated with many complications, was only shown to be independently predictive of postoperative cellulitis and UTI, indicating the presence of confounding variables associated with SDOH. SDOH were correlated with increased cost and independently predictive of increased LOS. These findings are crucial for both physicians and patients to evaluate before proceeding with TEA, as they highlight the significant healthcare resource demands linked to SDOH, a significant concern for a patient population already economically disadvantaged. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Spontaneous rupture of the extensor pollicis longus tendon: A systematic review . Lister, et al. (2023) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic/Prognostic Topic : EPL rupture - Aetiologies This systematic review investigated the causes, management, and outcomes of spontaneous extensor pollicis longus (EPL) tendon ruptures. A total of 29 studies, including case reports, were part of this review. The EPL tendon was characterised by the authors as vulnerable due to its poor vascularisation at Lister’s tubercle, making it susceptible to trauma, compression, or tenosynovial invasion. Common inciting factors included steroid use, repetitive exercises, trauma, and inflammation. Surgical management options—such as primary repair, tendon transfer (often using extensor digitorum communis or palmaris longus), and grafting (e.g., semitendinosus) generally yielded favorable outcomes. Recovery time frames varied from 6 weeks to over a year, with the average recovery time being 2 months. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the extensor pollicis longus (EPL) seems to be more vulnerable to rupture due to its poor vascularisation at the Lister's tubercle. Steroid use, direct injury, and inflammatory conditions appear to make rupture more likely . Remember that a differential diagnosis for EPL tenosynovitis at the wrist is distal intersection syndrome . URL : https://doi.org/10.1177/15589447231175513 Abstract Background: Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture. Methods: We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis. Results: We identified 29 articles that met the inclusion criterion. Conclusions: A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic A 49 years old person underwent emergency surgery as they had a penetrating injury of the volar and dorsal forearm caused by a kitchen knife. Objectively, they had limited ability to flex the thumb as well as extend the thumb and the other fingers. There were no sensory deficits in the hand. Surgical exploration revealed lesions of the ECRL, ECRL, EDC, EDM, APL, EPL, and EPB. All of these were repaired. The patient was discharge one week later without evidence of complications. They were then reviewed at two months after surgery, which identified a 20° to 30° extension lag of the thumb, index, and little finger. Extension of the wrist, middle and ring finger was possible. What is going on?

Secondary posterior interosseous nerve lesions associated with humeral fractures. Erra, et al. (2016) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Posterior interosseous nerve lesion - Humeral fractures This cross sectional study assessed the occurrence of double traumatic nerve lesions involving both the radial nerve (at the humerus) and the posterior interosseous nerve (PIN) following humeral fractures. The study highlights that while most patients with combined injuries showed significant clinical improvement, several patients had radial nerve lesion in the proximal third of the forearm (Arcade of Frohse). Ultrasound imaging played a crucial role in diagnosing these lesions and monitoring recovery, revealing reductions in nerve cross-sectional area over time. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, fractures of the humerus can cause nerve lesions not only at the radial groove but also at the posterior interosseous nerve (PIN). Despite these multilevel lesions, most patients showed significant improvement, often without surgery. Early neurological assessments post-humeral fracture are essential to identify and monitor nerve injuries and incorporating ultrasound into routine evaluations can aid in monitoring progress. URL : https://doi.org/10.1002/mus.24752 Abstract Introduction: Radial nerve lesions associated with humeral shaft fractures are the most common traumatic nerve lesions observed with long bone fractures. Secondary indirect posterior interosseous nerve (PIN) lesions can be associated with traumatic radial nerve palsy. The aim of this study was to identify cases of traumatic double‐site radial nerve involvement through ultrasound (US). Methods: Patients with traumatic radial nerve lesions referred to our laboratory from January 2010 to January 2014 were evaluated. Results: Of the 35 patients, 18 had US evidence of a radial nerve lesion at the fracture site associated with secondary PIN involvement at the arcade of Frohse. Conclusions: Multiple‐site nerve lesions are difficult to demonstrate through electrodiagnostic tests. In our case series, half of the patients with traumatic radial nerve damage had US evidence of PIN injury. Prospective studies with follow‐up are needed to determine the clinical and prognostic relevance of this finding and the best therapeutic approach. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Total elbow arthroplasty versus hemiarthroplasty for acute distal humeral fractures: A retrospective cohort study of revision rates in 366 consecutive patients. Nielsen, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Study Topic : Elbow replacement - Total vs hemiarthroplasty This study compares Total Elbow Arthroplasty (TEA) and Hemiarthroplasty (EHA) for treating unreconstructable distal humeral fractures, focusing on mid- to long-term outcomes. Both procedures showed comparable but high revision rates, with no significant difference between TEA and EHA in terms of functional or patient-reported outcomes. Male patients exhibited a four times higher risk of revision compared to female counterparts, though the proportion of male patients in the study was low. The study highlights that EHA is often preferred for its potential benefits in active or mobility-dependent patients, particularly those with higher functional demands. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know, for unreconstructable distal humeral fractures, Total Elbow Arthroplasty (TEA) or Hemiarthroplasty (EHA) provide similar high revision rates, indicating that these surgeries may not offer long-term solutions for all patients. Male patients face a four times higher risk of revision. This suggests a need for closer monitoring and tailored approaches for male patients. URL : https://doi.org/10.1016/j.jse.2025.02.034 Abstract Background: Elbow arthroplasty is an established treatment of distal humeral fractures not amenable to internal fixation. Total elbow arthroplasty (TEA) is the most common modality, but elbow hemiarthroplasty (EHA) is becoming more popular, and it is still unclear which option provides the best results. We hypothesized that EHA is associated with a lower revision rate than TEA, due to fewer mechanical complications. Methods: This study is a retrospective multicenter cohort study. We identified all patients with an acute distal humeral fracture treated with an elbow arthroplasty in Denmark in the period from January 1, 2008, until December 1, 2021. Data were collected retrospectively using electronic health records. Kaplan-Meier analysis was used to estimate the cumulative revision rates for TEA and EHA. Hazard ratios (HRs) were estimated using the Cox proportional hazards model with mutual adjustment for age, sex, body mass index, American Society of Anesthesiologists classification, and implant type (TEA or EHA). Results: Two hundred twenty-five TEA and 141 EHA procedures were included. There were 21 revisions of TEAs and 11 of EHAs. The 2-, 5- and 10-year revision rates were 5.8% (95% confidence interval [CI] 2.5%-9.2%), 8.6% (95% CI 4.4%-12.8%), and 20.5% (95% CI 9.2%-31.9%) for TEA and 4.0% (95% CI 0.5%-7.5%), 9.3% (95% CI 3.0%-15.6%), and 18.7% (95% CI 4.8%-32.7%) for EHA. After adjustment, the HR of revision for male patients was 3.8 (95% CI 1.6-9.1). The HR of revision for EHA was 0.9 (95% CI 0.4-1.9) with TEA as reference. Conclusion: We found comparable but high revision rates of TEA and EHA after unreconstructable distal humeral fracture. An important finding was a 4 times higher risk of revision for male patients. Larger studies are needed for more reliable estimates. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Digital wound assessment by hand specialists is moderately reliable. Ring, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Wounds - Assessment This study evaluated the reliability of digital wound assessment by hand specialists after minor surgery. A group of 125 hand surgeons assessed 20 digital photographs of wounds, focusing on four criteria: wound separation, erythema, hematoma/ecchymosis, and purulence. The interobserver agreement was measured using kappa statistics. Results showed moderate reliability for erythema (κ = 0.40) and wound separation (κ = 0.49), while purulence (κ = 0.36) and hematoma/ecchymosis (κ = 0.34) had fair agreement. Demographic factors did not influence reliability. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, clinicians have moderate reliability when assessing digital wound after minor surgery. It appears that they tend to be better at assessing erythema and wound separation compared to purulence and ecchymosis. Despite these limitations, I still think that asking surgeon's about their opinion in terms of pictures of wound taken in clinic is useful. URL : https://doi.org/10.1016/j.jht.2024.07.001 Abstract publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings