What’s New in Hand Surgery 2019

Every month, JBJS publishes a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in one of 13 subspecialties. Click here for a collection of all OrthoBuzz subspecialty summaries.

This month, Christopher J. Dy, MD, MPH, author of the March 20, 2019 “What’s New in Hand Surgery,” selected the five most compelling findings from among the 47 noteworthy studies summarized in the article.

Distal Radial Fractures
—A randomized trial comparing volar plate fixation to cast management in patients >60 years of age who had AO type-C distal radial fractures¹ found that the volar plating group had better Patient-Rated Wrist Evaluation scores than the casting group after a minimum 24 months of follow-up. Maintenance of reduction was also better in the volar plating group. These findings are contrary to those of a similar randomized trial published in 2011, suggesting that there are patient-level and surgeon-level differences between the 2 environments in which the studies were conducted.

—Among 175 elderly patients with distal radial fractures treated nonoperatively and who showed acceptable radiographic reduction at 1 to 2 weeks, 28% had late displacement or malunion at the 3-month follow-up.² Relative to cases in which reduction was maintained, cases with late displacement or malunion had lower grip strength and loss of the total wrist range of motion. However, there was no between-group difference in patient-reported functional measures, and the incidence of the most common complication—carpal tunnel syndrome—was the same in both groups.

Scaphoid Fractures
—Findings from a biomechanical study with cadavers suggest that 50% cortical healing of a scaphoid fracture after open reduction and internal fixation with a compression screw is sufficient to allow unrestricted activity.³ Constructs with a 50% osteotomy and compression screw showed the same load to failure as intact scaphoids, but load to failure in a group with a 75% osteotomy and compression screw was lower than that in the intact scaphoid group.

—Traditionally, surgeons have emphasized proximal pole vascularity in cases of scaphoid nonunion. However, a study of 35 scaphoid nonunions treated with nonvascularized bone grafting and a headless compression screw⁴ found that 33 fractures went on to union, despite evidence of compromised proximal pole vascularity in 14 of 32 patients who had histopathological data available.

Carpal Tunnel Syndrome
—A cross-sectional study analyzing data from 367 patients who presented for evaluation of carpal tunnel syndrome (CTS)⁵ found that those with the poorest socioeconomic status had worse PROMIS scores for physical function, pain interference, depression, and anxiety, compared with those in the least-deprived quartile. Deprived patients were also more likely to have a higher comorbidity burden and to use tobacco, both of which may influence outcomes after CTS treatment.

References

1. Martinez-Mendez D, Lizaur-Utrilla A, de-Juan-Herrero J. Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating. J Hand Surg Eur Vol.2018 Feb;43(2):142-7. Epub 2017 Sep 4
2. Wadsten MÅ, Sjödén GO, Buttazzoni GG, Buttazzoni C, Englund E, Sayed-Noor AS. The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. J Hand Surg Eur Vol.2018 Feb;43(2):131-6. Epub 2017 Jul 31.
3. Guss MS, Mitgang JT, Sapienza A. Scaphoid healing required for unrestricted activity: a biomechanical cadaver model. J Hand Surg Am.2018 Feb;43(2):134-8. Epub 2017 Nov 7.
4. Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW; Scaphoid Nonunion Consortium. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol.2018 Jan;43(1):32-40. Epub 2017 Sep 24.
5. Wright MA, Beleckas CM, Calfee RP. Mental and physical health disparities in patients with carpal tunnel syndrome living with high levels of social deprivation. J Hand Surg Am.2018 Jun 23. [Epub ahead of print].