Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in the March 18, 2015 Specialty Update on hand surgery:
Distal Radial Fractures
–A study that randomized 50 patients with unstable radial fractures and Kirschner-wire fixation to receive demineralized bone-matrix allograft or no graft found no significant differences in bone density or function throughout one year of follow-up.
–Among 130 patients with a displaced distal radial fracture who were randomized for treatment with either a volar plate or percutaneous pins (with or without external fixation), plate-treated patients had a quicker return to function, but functional results were similar between the two groups at three months and one year.
Trapeziometacarpal Arthritis
–A randomized trial of 43 women aged 40 and older with trapeziometacarpal osteoarthritis comparing trapeziectomy with trapeziometacarpal arthrodesis (with plate and screws) was terminated early because of the high complication rate in the arthrodesis group.
Carpal Tunnel Release
–A Cochrane Database systematic review of 28 studies comparing endoscopic and open carpal tunnel release concluded that both techniques provided similar outcomes, but that the current literature on the subject is rife with low-quality studies.
–A meta-analysis of 21 studies comprising 1,859 patients that compared endoscopic and open carpal tunnel release showed that endoscopically treated patients had modestly greater strength at early follow-up but that the difference disappeared after six months.
This Specialty Update also includes many recent findings from papers presented at 2014 meetings of the American Society for Surgery of the Hand and the American Association for Hand Surgery.