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The JAY (Joint Active Yoke) orthosis for a complex pip fracture-dislocation with failed volar plate repair: A case report. Lama, C. J., Jones, M. C., Dileso, S. and Weiss, A.-P. (2023) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Pipj stiffness - Yoke splint for mobilisation This case report focuses on the implementation of a relative motion splint called JAY (Joint Active Yoke) for a complex proximal interphalangeal (PIP) fracture-dislocation with failed volar plate repair. The patient, a 57-year-old neurosurgeon sustained the injury while snowboarding. They underwent hemi-hamate arthroplasty and volar plate repair of the pipj. After facing re-rupture and repair of the volar plate, the patient was fitted with the JAY orthosis to facilitate active controlled flexion of the repaired pipj. This splint was fitted at the middle phalanx of the MF, RF, and LF and was worn 24/7 from the 2 weeks mark following the second volar plate repair. The study showcased the benefits of the splint in promoting an active assisted motion of the pipj whilst providing buddy strapping support via the adjacent fingers. 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, a modified relative motion splint fitted to the middle phalanx can be utilised to limit range of movement as well as helping with active assisted mobilisation of complex pipj injuries. The splint can be used to promote active controlled flexion of the pipj whilst providing protection. If you are interested in relative motion splints, have a look at the database . URL : https://doi.org/10.1016/j.jht.2022.09.001 Abstract Introduction: This case report details the postsurgical rehabilitation and outcome of a 57-year old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained after a fall while snowboarding. Following re-rupture and repair of his volar plate, the patient was fitted for a “yoke” relative motion flexor orthosis, termed a JAY (Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for extensor-related injuries. Study Design/Methods: A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with failed volar plate repair undwent hemi-hamate arthroplasty and early active motion following using a custom-fabricated joint active yoke orthosis. Purpose of the Study: The purpose of this study is to illustrate the benefits of this orthosis design in allowing for active controlled flexion of the repaired PIP joint with assist from the adjacent fingers, while also reducing joint torque and dorsal displacement forces. Results: A satisfactory active motion outcome was achieved with maintenance of PIP joint congruity allowing the patient to return to work as a neurosurgeon at 2-months post-operatively. Discussion: There is little published literature on the use of relative motion flexion orthoses following PIP injuries. Most current studies are isolated case reports on boutonniere deformity, flexor tendon repair, and closed reduction of PIP fractures. The following therapeutic intervention was considered an important contributor to a favorable functional outcome, as it minimized unwanted joint reaction forces in a complex PIP fracture-dislocation and unstable volar plate. Conclusion: Future research with greater level of evidence is required to establish the various applications of relative motion flexion orthoses, as well as determine the appropriate time at which to place the patient in a relative motion orthosis following operative repair to prevent long-term stiffness and poor motion. 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

Electrodiagnostic severity does not predict short to mid-term outcomes of cubital tunnel release surgery. Pohl, N., et al. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Prognostic Topic : Cubital tunnel release – Outcomes in patients with and without nerve conduction impairments This study investigated the prognostic value of nerve conduction studies (NCS) in determining the efficacy of cubital tunnel release surgery for cubital tunnel syndrome. Data from patients undergoing surgery from 2012-2022 was analyzed, for a total of 257 patients. Outcomes measured included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. The results showed that NCS severity did not predict short to mid-term outcomes of surgery, and preoperative patient-reported disease severity may predict postoperative outcomes better than NCS. Older age was the only factor associated with larger postoperative functional improvement. 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, preoperative patient-reported disease severity may be a better predictor of postoperative functional improvement after cubital tunnel release surgery compared to nerve conduction studies (NCS). This appears to be in line with another study looking at the association between NCS for the median nerve and improvements following carpal tunnel release . We can therefore reassure our patients undergoing cubital tunnel release, that they are likely to experience improvements independently of their NCS results. Something that has been suggested to be useful prior to undergoing cubital tunnel release is to have a conversation with the patients before surgery and set their expectations . URL : https://doi.org/10.1016/j.jse.2024.01.055 Abstract Hypothesis: This study aimed to explore the prognostic value of electrodiagnostic studies (EDS) to clarify their utility in clinical practice prior to cubital tunnel release surgery as well as identify patient factors associated with patient-reported functional improvement after surgery. Our hypothesis is that patients with severe preoperative findings on EDS will tend to experience less functional improvement after surgery given the extent of ulnar nerve compressive injury. Methods: Patients with cubital tunnel syndrome and preoperative electrodiagnostic data treated from 2012-2022 with cubital tunnel release were assessed regarding demographic information, preoperative physical exam findings, EDS findings, postoperative complications, and patient-reported outcomes. Short to mid-term qDASH scores were collected for all patients for further evaluation of preoperative EDS data. Patients were grouped into those who had met the MCID in delta qDASH at short to mid-term follow-up and those that did not. EDS data included sensory nerve onset latency, peak latency, amplitude, conduction velocity as well as motor nerve latency, velocity, and amplitude. Electromyogram (EMG) studies were also reviewed which included data pertaining to fibrillations, presence of abnormal fasciculation, positive sharp waves, variation in insertional activity, motor unit activity, duration of activity, and presence of increasing polymorphisms. Results: Of the 257 patients included, 160 (62.0%) were found to meet the MCID for short to mid-term qDASH scores. There were no significant differences between patients who did or did not meet the MCID regarding baseline demographics, comorbidities, preoperative exam findings, and operative technique. Patients who met MCID tended to have lower complication (3.80% vs 7.20%; p=0.248) and revision (0.60% vs 4.10%; p=0.069) rates but these findings were not statistically significant. The cubital tunnel severity as determined by the EDS was similar between cohorts (14.1% vs. 14.3%, p=0.498). Analysis of EMG testing showed there were no significant differences in preoperative, short to mid-term qDASH, or delta short to mid-term qDASH scores for patients with or without abnormal EMG findings. Multivariate regression suggested that only age (p=0.003) was associated with larger delta qDASH scores (Table 7). Conclusion: Patient-reported preoperative disease severity may predict the expected postoperative change in ulnar nerve functional improvement and EDS may not have prognostic value for patients undergoing cubital tunnel decompression. Therefore, physicians may suggest surgical treatment without positive EDS findings and still expect postoperative improvement in functional outcomes. 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

Carpal tunnel syndrome caused by an interosseous ganglion of the lunate. Heading, S. L., Duraku, L. S. and Lawson, R. (2024) Level of Evidence : 5 Follow recommendation : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. A 29-year-old healthy woman had been experiencing insidious onset of wrist pain for two years, after which they developed paraesthesias in the median nerve distribution at the hand. On objective examination there were no range of movement restrictions or abnormal findings on special tests, however, carpal tunnel tests were positive. Magnetic resonance imaging (MRI) was completed and one of the images is reported below. What the image shows is a cyst of the lunate, which grew to compress the median nerve at the carpal tunnel. The cyst was surgically removed and symptoms resolved within two weeks from surgery. The authors of this case study highlighted the rarity of carpal tunnel syndrome caused by space-occupying lesions, which accounts for 3-5% of cases, with tophaceous gout being the most common cause. They also reported how these lesions are rarely detected through objective testing and the importance of imaging. 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, we should remain vigilant for uncommon causes of carpal tunnel syndrome in patients presenting with atypical symptoms, such as diffuse wrist pain. Space-occupying lesions, like ganglions, though rare, can lead to carpal tunnel syndrome and must be considered as a differential diagnosis. Imaging modalities like x-ray and US can aid in accurate diagnosis and appropriate treatment planning. If you would like to read another interesting case of carpal tunnel syndrome cause by an anatomical variance, have a look at this synopsis . URL : https://doi.org/10.1177/17531934241227809 Abstract We present a case of a 29-year-old woman with diffuse, unilateral wrist pain and carpal tunnel syndrome secondary to an interosseous ganglion of the lunate and aim to highlight uncommon aetiologies when assessing patients with atypical carpal tunnel symptoms. 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

Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace. Asmus, A., et al. (2022) Level of Evidence : 4 Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Therapeutic Topic : Wrist widget - Symptoms change on weight-bearing This retrospective study focused on the impact of wrist braces on weight-bearing capacity in patients with triangular fibrocartilage complex (TFCC) lesions. A total of 23 patients with a TFCC lesion confirmed arthroscopically, were included in the present study. Participants measured weight-bearing capacity on the unaffected and affected side (see picture below). The affected and unaffected side weight-bearing capacity was assess with and without the WristWidget. The results showed that on the affected side, the splint increased weight-bearing capacity by 23%. Unfortunately, they did not compare these results to a control group wearing a placebo splint. 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 use of a WristWidget may help relieving symptoms in people with ulnar sided wrist pain. It is however unclear whether a placebo splint would have a similar effect. If you are interested in the topic, have a look at the entire database on TFCC . URL : https://doi.org/10.1016/j.jht.2021.03.006 Abstract Study design: Retrospective cross-sectional case series. Background: Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ. Purpose: In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint. Methods: Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values. Results: The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p <0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29) with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative). Conclusion: The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints. 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

Concurrent validity and test-retest reliability of Squegg™ - smart dynamometer and handgrip trainer in healthy individuals. Amin, Z., Gutierrez, G. and True, L. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Diagnostic Topic : Squegg dynamometer - Grip strength This cross sectional study assessed the reliability and validity of the Squegg Hand Dynamometer compared to the Jamar Hydraulic Hand Dynamometer for grip strength in healthy individuals. A total of 594 healthy individuals were included in the study. Three measurements were taken for each device. The order of device testing was not randomised. Results showed good concurrent validity between Jamar and Squegg values for both hands, with excellent test-retest reliability for the Squegg. One of the problems of this study is that there was no absolute comparison of the Squegg with the Jamar dynamometer. As a matter of fact, there could be high levels of correlation between the two devices despite a significant and consistent under or overestimation of the Squegg measurements compared to the Jamar. 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 Squegg dynamometer is reliable to measure grip strength. It is however unclear whether it is valid when compared to the Jamar hand dynamometer. In other words, it could be used to measure improvement over time in our patients, but the measurements should not be compared to normative values obtained through the Jamar dynamometer. Similar findings were shown when the k-force digital dynamometer was compared to the Jamar hand dynamometer . URL : https://doi.org/10.1177/17589983231223868 Abstract Introduction: Handgrip strength is crucial for overall health and is often evaluated using hand dynamometers. Two hand dynamometers were used in the study: the Jamar® Hydraulic Hand Dynamometer and Squegg™ Smart Dynamometer and Handgrip Trainer, which is a relatively new, Bluetooth-enabled device to measure handgrip strength. The purpose of the study was to compare Jamar and Squegg to determine concurrent validity and, separately, test-retest reliability of Squegg. Methods: The cross-sectional study measured bimanual handgrip strength using the Jamar and Squegg in two sessions, following standard protocols. Participants were 18+ years old, with no hand disease or dysfunction. Spearman’s rank correlations were used to evaluate concurrent validity between Jamar and Squegg. Test-retest reliability was evaluated with intraclass correlation coefficient (ICC) estimates and 95% confidence intervals calculated using a mean-rating (k = 2) absolute agreement, 2-way mixed effects model. Results: Data from 594 participants were used to evaluate concurrent validity. Moderately strong correlations between Jamar and Squegg values for the right hand (RH) (ρ = 0.670; p = .001) and Jamar and Squegg values for the left hand (LH) (ρ = 0.730; p = .001) were found, indicating ‘good’ concurrent validity. Test-retest reliability for Squegg ranged from good to excellent (RH, ICC = 0.911, 95% CI (0.895, 0.924), p = .001; LH, ICC = 0.928, 95% CI (0.915, 0.939), p = .001). Discussion: The Squegg demonstrated good concurrent validity with Jamar and good-to-excellent test-retest reliability. It can be recommended as an alternative to the Jamar as a handgrip strength measurement tool. Squegg, which uses Bluetooth technology, is a reliable and cost-effective option for consistent handgrip strength testing. 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

Time-dependent change in carpal tunnel cross-sectional area and transverse carpal ligament thickness using serial magnetic resonance imaging studies: An anatomical study. Hinckley, N. B., et al. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 thumbs up) Type of study : Aetiologic Topic : Carpal tunnel - Size and thickness over time This longitudinal study investigated changes in carpal tunnel area and transverse carpal ligament thickness over time in patients with carpal tunnel syndrome (CTS). A total of 56 participants with MRI imaging, which was repeated 5 years apart were included in the study. Results showed a decrease in carpal tunnel are and an increase in ligament thickness over time. No factors like sex, age, and medical history were associated with these changes. It is important to keep in mind that this study did not include a control group. We are therefore not sure whether these changes occur solely in people with CTS or in healthy people as well. 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, carpal tunnel area and transverse carpal ligament thickness change over time in people with carpal tunnel syndrome. It is unknown whether similar changes occur in people without carpal tunnel syndrome. It is however possible that these changes may worsen symptoms in people who are already suffering from this condition. Unfortunately, the study did not report associations between symptoms and anatomical changes. Considering the genetic contribution to carpal tunnel syndrome , it is possible that people affected by this condition are more likely to have a greater rate of carpal tunnel and ligament thickness changes over time or that they start with an already narrower tunnel or thicker ligament, which is more likely to cause their symptoms. URL : https://doi.org/10.1016/j.jhsa.2023.10.010 Abstract Purpose: Idiopathic carpal tunnel syndrome (CTS) is a common compressive neuropathy. Aging and female sex are risk factors, but the reasons are unclear. The purpose of this study was to evaluate whether identifiable radiographic changes resulting in a decrease in carpal tunnel area (CTA) over time exist. Methods: A database search of a multicenter, academic, tertiary institution from 1998 to 2021 identified 433 patients with serial wrist magnetic resonance images (MRI) at least 5 years apart. Fifty-six met the inclusion criteria with adequate films to measure CTA and transverse carpal ligament (TCL) thickness at the same slice location—the carpal tunnel inlet, hook of the hamate, and carpal tunnel outlet—independently by two observers who were blinded to each other’s measurements. Rates for the change in CTA and TCL thickness were calculated at all three locations. Results: Thickness of the TCL increased, whereas that of the CTA decreased over time. Inlet CTA decreased by 0.9 mm2 per year (95% CI: 0.34–1.5), outlet CTA decreased by 1.8 mm2 per year (95% CI: 1.2–2.5), and CTA at the hook of the hamate decreased by 1.6 mm2 per year (95% CI: 1.0–2.0 per year). The TCL thickened by 0.02 mm per year at all three sections. Taller patients had a decreased rate of CTA loss. Conclusions: In this select cohort, TCL thickened and CTA decreased with time. TCL thickening accounted for about half of the variation in CTA, suggesting that this is a possible contributor to this change. Hypertrophy of the carpal tunnel floor may account for the remaining variation in CTA. The question of whether these results are reliable and generalizable to the general population, or a major influence in the pathophysiology of CTS, is unknown. Clinical relevance: Small decreases in CTA and thickening of the TCL occur with aging. Whether this is a contributing factor in the development of CTS requires further study. 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

Management of stable proximal interphalangeal joint volar plate injuries with figure-of-8 orthoses: A parallel-group randomized controlled trial. Grange, M., Carra, K., Barrett, S. and McKinstry, C. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Pipj volar plate injury - Figure eight splint This randomised controlled trial compared the effectiveness of figure-of-8 orthoses and dorsal blocking orthoses in managing stable proximal interphalangeal joint volar plate injuries. A total of 30 participants were included in the study. Participants were randomised to either a dorsal blocking splint or a figure 8 splint which maintained the pipj in 20 deg of flexion. Both splints were worn for four weeks. The results showed that both types of splinting provided similar outcomes in terms of pain, function, and range of movement. However, the group using the figure-of-8 orthosis required fewer therapy appointments on average than the group using the dorsal blocking orthosis. 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, both figure 8 and dorsal blocking splints are effective in managing stable volar plate injuries of the pipj. Early mobilisation with a figure 8 splint in 15-20 degrees of flexion can be beneficial in the initial management stages following the injury. If you are interested in reading more research about pipj, have a look at the database for splinting options . URL : https://doi.org/10.1016/j.jht.2023.11.001 Abstract Background: Volar plate injuries of the proximal interphalangeal (PIP) finger joint are common. Conservative treatment involves orthoses to limit hyperextension at the PIP joint yet allow movement of the joints to prevent joint stiffness and deformity. Custom-made dorsal blocking orthoses are recommended treatments. Previous research also supports the use of a figure-of-8 orthosis, although the comparative effectiveness of these orthoses is not currently known. Purpose: This study aimed to compare the figure-of-8 orthosis and dorsal blocking orthosis for changes in the range of movement, pain, and function following stable volar plate PIP joint injuries and to compare the number of hand therapy appointments required. Study Design: A parallel-group pilot randomized controlled trial. This trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: CTRN12619000449134). Methods: Participants aged 13-65 years were recruited from an outpatient hand therapy service and randomly assigned to experimental or control groups. The experimental group of 20 participants received a custom-made thermoplastic figure-of-8 orthosis limiting the extension to 15-20 degrees. The control group of 22 participants had a dorsal blocking orthosis, which was serially extended by 10 degrees weekly starting at 30 degrees flexion. Participants were blinded to their group allocation. Outcome measures included range of movement, edema, pain, function, and number of hand therapy appointments. Data collection was completed by the treating therapist who was not blinded to group assignment. Data analysis included a series of mixed-model analyses of variance to examine changes over time. Results: Forty-two participants were recruited and had their data analyzed. No significant between-group differences were observed for DIP flexion, PIP flexion, pain, and function from baseline to follow-up. Both groups exhibited significant improvements in these outcomes over time (p < 0.001); effect sizes ranged from small to large (0.28-0.79). On average, the intervention group required 4 (±1.5) appointments compared to 6 (±1.5) in the control group over the same period representing a significant difference (p < 0.001). Conclusions: Both dorsal blocking and figure-of-8 orthoses provide similar outcomes. The use of a figure-of-8 orthosis, or a dorsal block orthosis fabricated in maximal comfortable extension depending on severity, could reduce the number of appointments and increase convenience for patients. 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

Depression, anxiety, and post-traumatic stress disorder following upper versus lower extremity fractures. Chen, K., Hynes, K. K., Dirschl, D., Wolf, J. M. and Strelzow, J. A. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Symptoms prevalence Topic : Mental health after injury - Upper vs lower limb The study investigated the prevalence of depression, anxiety, and PTSD following upper extremity fractures (UEF) compared to lower extremity fractures (LEF) using a national insurance claims database. A total of 310,000 UEF and 360,000 LEF participants were included. These participants were compared to a group of people undergoing carpal tunnel release (600,000) for the upper limb and knee arthroscopy (1,145,000) for the lower limb. Both UEF and LEF participants showed higher rates of psychiatric diagnoses compared to the controls, with isolated UEF associated with all three psychiatric diagnoses (depression, anxiety, post-traumatic stress disorders - see adjusted odds ratios forest plots below). The study emphasized the importance of normalizing psychiatric care, early intervention, and stigma reduction. Factors such as injury location, trauma severity, and pre-injury psychiatric history were identified as key variables affecting psychiatric pathology. 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, psychiatric pathology is prevalent following orthopaedic trauma, particularly in patients with upper extremity fractures. It is crucial for us to be aware of the increased risk of major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) in these patients. Normalising psychiatric care, early intervention, and reducing stigma around mental health are essential aspects of orthopaedic trauma management. Screening for psychiatric symptoms and providing support for mental health concerns alongside physical rehabilitation can enhance overall patient well-being and recovery. This study is part of a growing body of evidence showing that mental health is an important aspect of people affected by hand and upper limb conditions . URL : https://doi.org/10.1016/j.injury.2023.111242 Abstract Introduction: Orthopaedic trauma has been linked to major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Post-injury rates of psychiatric diagnoses and their relationship to various injury characteristics are not well characterized. We aimed to determine the association between orthopaedic trauma and MDD, GAD, and PTSD diagnoses at 5-year follow-up. Methods: A national insurance claims database was used to create upper extremity fracture (UEF) and lower extremity fracture (LEF) cohorts, with further stratification by isolated versus multiple fractures. Patient undergoing elective upper or lower extremity orthopaedic procedures served as controls. Rates of post-injury psychiatric diagnoses were calculated. Univariate logistic regression was conducted after matching in a 1:1 ratio based on relevant comorbidities such as psychiatric history. All significant variables were included in multivariate analysis. Results: A total of 308,578 UEF patients and 360,510 LEF patients were identified. Within the UEF cohort, the diagnosis rates following either isolated or multiple fractures were identified: MDD (25% to 30%), GAD (10% to 11%), and PTSD (4%). LEF cohort rates were as follows: MDD (30% to 38%), GAD (11% to 14%), and PTSD (4% to 7%). Compared to non-injured controls, both the UEF and LEF cohorts were associated with higher rates of all psychiatric diagnoses. In comparing UEF and LEF cohorts, isolated UEF was associated with MDD, GAD, and PTSD; however, multiple UEF was associated with MDD and GAD, whereas multiple LEF was associated with PTSD. Conclusion: Psychiatric pathology is prevalent following orthopaedic trauma. Even after controlling for psychiatric history, orthopaedic trauma is independently associated with post-injury psychiatric diagnoses and may be more predictive of PTSD and GAD than of MDD. Upper extremity fractures may portend higher psychiatric risk. With negative stigma surrounding mental health and the early role of orthopaedic surgeons in providing care, it is imperative to normalize psychiatric care with patients and discuss warning symptoms that may indicate the onset of psychiatric disorders. 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 : 👍 (1/4 thumbs up) Type of study : Diagnostic/Therapeutic This is the answer to last week's Sherlock Handy. A 29-year-old healthy woman had been experiencing insidious onset of wrist pain for two years, after which they developed paraesthesias in the median nerve distribution at the hand. On objective examination there were no range of movement restrictions or abnormal findings on special tests, however, carpal tunnel tests were positive. Magnetic resonance imaging (MRI) was completed and one of the images is reported below. What is it?

Clinical outcomes following surgical management of post-traumatic elbow contractures in the pediatric age group: A meta-analysis and systematic review. Onggo, J. R., Chua, N. S. H., Onggo, J. D., Wang, K. K. and Ek, E. T. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 (3/4 thumbs up) Type of study : Therapeutic Topic : Pediatric post-traumatic elbow stiffness - effect of surgery This systematic review and meta-analysis assessed the effect of surgical management of post-traumatic elbow contractures in pediatric patients under 18 years old. A total of 13 papers were included in the present review. The results showed that overall surgical interventions were effective in improving range of motion. On average there was an improvement of 50deg in elbow e/f and 20def for supination/pronation. The results also highlighted that older children, those with radial head fractures, and individuals undergoing open releases tended to experience greater improvements in motion. 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, surgical management of pediatric elbow contractures has shown to be effective in improving range of motion in both flexion-extension and prono-supination by an average of 50 and 20 deg on average . It appears that older children, those with radial head fractures, and patients undergoing open releases are more likely to experience greater improvements post-operatively. Such improvements in elbow range of movement are very important because we have evidence suggesting that elbow stiffness is associated with greater mental health burden in our patients . If you are interested in determining which other factors contribute to improvement in elbow ROM post surgery for post-traumatic stiffness, have a look at this synopsis . URL : https://doi.org/10.1016/j.jhsa.2024.01.010 Abstract Purpose: Post-traumatic elbow stiffness is a common occurrence resulting in potentially substantial functional limitations in both daily activities and recreational endeavors. In children, this can be particularly difficult given the early stages of childhood and development and the challenges of rehabilitation. Several studies have reported favorable results of elbow contracture releases in children, resulting in improvements in outcomes. This meta-analysis aimed to determine the efficacy and safety of elbow contracture releases in the pediatric population (<18 years), along with subgroup analyses comparing age groups, operative approach, and post-traumatic versus nontraumatic etiologies. Methods: Meta-analysis was performed with a multidatabase search (PubMed, OVID, EMBASE, and Medline) according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on September 25, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed. Results: Seven studies were included, comprising 114 post-traumatic elbow contractures. Mean age was 13.7 years. Contracture releases of the elbow led to improvements in flexion-extension arc of motion by 48º, and pronosupination arc of motion by 22º. Subgroup analysis comparing age groups of <10, 10–14 and 15–18 years showed greater improvements in flexion-extension arc in the older age group, whereas subgroup analysis comparing injury patterns revealed a larger improvement in pronosupination motion for radial head fractures. Comparing open and arthroscopic procedures, open releases had greater improvement in both flexion-extension and pronosupination motion by 18º and 21º, respectively, although there were limited patients in the arthroscopy group. Conclusion: Operative management of pediatric elbow contractures is effective. Older children, children with radial head fractures, and those receiving open contracture releases may be more likely to have greater improvements. 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

In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: A randomized controlled trial. Guebeli, A., Thieringer, F., Honigmann, P. and Keller, M. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Distal radius fracture – 3D-printed splints This randomised controlled trial compared patient satisfaction and effectiveness of 3D-printed custom splints to conventional fiberglass casts in treating distal radial fractures. A total of 39 participants were included. To be suitable for inclusion, participants had to present with a minimally displaced distal radius fracture. Participants were randomised to either 3D-printed splints, created using digital light processing technology, or traditional fiberglass casting. Participants in both groups were immobilisation for 6 weeks. The study showed that 3D-printed splints were well tolerated and effective, although complications (e.g. pressure sores, temporary paraesthesias) were twice as likely compared to fiberglass casting. These new 3D-printed splints may be useful for young and active patients. 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, 3D-printed splints may present a safe alternative to conventional fiber glass casts, especially for non-operative treatment of distal radial fractures in young, active patients. However, it is important to keep in mind that at this point in time, they are more likely to be associated with pressure sores and transient numbness/P&N/Tingling. If you are interested in knowing what other complications may be associated with distal radius fractures, especially when ORIFed, have a look at this synopsis . URL : https://doi.org/10.1177/17531934231187554 Abstract We compared patient satisfaction and clinical effectiveness of 3D-printed splints made of photopolymer resin to conventional fibre glass casts in treating distal radial fractures. A total of 39 patients with minimally displaced distal radius fractures were included and randomized. Of them, 20 were immobilized in a fibre glass cast and 19 in a 3D-printed forearm splint. The 3D-printed splints were custom-designed based on forearm surface scanning with a handheld device and printed in-house using digital light processing printing technology. Patient satisfaction and clinical effectiveness were assessed with questionnaires 1 and 6 weeks after the initiation of immobilization. Fracture healing, pain, range of motion, grip strength and the DASH and PRWE scores were assessed up to 1-year follow-up. 3D-printed splints proved to be equally well tolerated by the patients and equally clinically effective as conventional fibre glass casts although there was a higher rate of minor complications. 3D-printed splints present a safe alternative, especially in young, active patients, for non-operative treatment of distal radial fractures. 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

Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist: A systematic review and meta-analysis. Hones, K. M., et al. (2024) Level of Evidence : 2b Follow recommendation : 👍 👍 👍 👍 (4/4 thumbs up) Type of study : Therapeutic Topic: SLAC and SNAC wrist – 4CF vs proximal row carpectomy This systematic review and meta-analysis compared Proximal Row Carpectomy and Four-Corner Fusion (4CF) in treating scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists. A total of 61 studies were included. Amongst these studies, only three were randomised controlled trials. The resultsh showed that Proximal Row Carpectomy showed significantly better postoperative outcomes in terms of extension, ulnar deviation, pain scores, and lower complication rates compared to 4CF. 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, Proximal Row Carpectormy demonstrated superior outcomes in terms of range of movement, pain, and number of complications compared to 4CF for SNAC and SLAC wrists. These results appear to be similar to what has been shown when trapeziectomy vs other interventions have been compared for the treatment of thumb OA . Other interventions available for SLAC and SNAC wrist include denervation. You can find more about this topic in this snopsis . URL : https://doi.org/10.1016/j.jhsa.2024.01.011 Abstract Purpose: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. Methods: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. Results: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12–216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. Conclusions: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. 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