Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. This month, co-author Deborah C. Bohn, MD selected the 5 most clinically compelling findings from among the studies highlighted in the most recent “What’s New in Hand and Wrist Surgery.”
Carpal Tunnel Syndrome
–A randomized clinical trial compared local corticosteroid injection vs. wrist immobilization with a night splint for the management of carpal tunnel syndrome¹. Among the 95 patients who completed follow-up, the investigators found that corticosteroid injection was superior with respect to remission of nocturnal paresthesia, pain scores, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.
–In a recent prospective study, researchers randomized patients to opioid or non-opioid medications following carpal tunnel release². They assessed 2-week QuickDASH, BCTQ, and Numeric Pain Rating Scale (NPRS) scores and satisfaction. No difference in reported satisfaction was found, but the non-opioid group had lower NPRS and QuickDASH scores, indicating less pain and better function among the patients who did not take opioids after surgery.
– Evaluating the nonoperative management of osseous mallet injuries, investigators prospectively followed 218 such fractures in 211 adult patients who were treated using a custom-made thermoplastic splint³. The distal interphalangeal joint was congruent in 168 fingers and subluxated in 50 fingers. The authors found no differences in range of motion, extensor lag, or the Patient Evaluation Measure associated with articular subluxation or articular fragment size. They concluded that nonoperative management of osseous mallet injuries should be considered even when the joint is subluxated when discussing treatment options.
– In another recent study, 72 patients were randomized to buddy taping or closed reduction and cast immobilization for the treatment of a fifth metacarpal neck fracture4. The group treated with buddy taping returned to work 28 days sooner than those with cast immobilization and had fewer complications, similar functional scores, and similar residual angulation.
Equity, Policy, and Education
– A recent article addresses the importance among hand surgeons “to employ cultural competence and antiracist education to provide better care and support for patients, staff, students, and colleagues”5. The authors provide a definitional framework, clinical examples, and practical suggestions to promote change. As stated by the authors, “To foster an environment of equality among hand surgeons, trainees, and patients, we must commit to making unbiased choices and being antiracist in all aspects of our lives”5.
To access the full text of the JBJS Guest Editorial “What’s New in Hand and Wrist Surgery” click here.
The JBJS.org collection of “What’s New” articles by subspecialty can be found here.
- de Moraes VY, Queiroz J Jr, Raduan-Neto J, Fernandes M, Okamura A, Belloti Nonsurgical treatment for symptomatic carpal tunnel syndrome: a randomized clinical trial comparing local corticosteroid injection versus night orthosis. J Hand Surg Am. 2021 Apr;46(4):295-300.e1.
- Grandizio LC, Zhang H, Dwyer CL, Goldberg SH, Klena JC. Opioid versus nonopioid analgesia after carpal tunnel release: a randomized, prospective study. Hand (N Y). 2021 Jan;16(1):38-44.
- Trickett RW, Brock J, Shewring DJ. The non-operative management of bony mallet injuries. J Hand Surg EurVol. Vol 2021 Jun;46(5):460-5.
- Martínez-Catalán N, Pajares S, Llanos L, Mahillo I, Calvo E. A prospective randomized trial comparing the functional results of buddy taping versus closed reduction and cast immobilization in patients with fifth metacarpal neck fractures. J Hand Surg Am. 2020 Dec;45(12):1134-40.
- Bradford PS, Dacus AR, Chhabra AB, Butler PD, De George Jr BR. How to be an antiracist hand surgery educator. J Hand Surg Am. 2021 Jun;46(6):507-11. Epub 2021 Mar 21.