What’s New in Hand Surgery 2024

Nonoperative treatment outcomes, the efficacy of waterproof cast protectors, and other topics of interest are presented in the new JBJS Guest Editorial What’s New in Hand Surgery. Here, we highlight the 6 most impactful studies, as selected by author Deborah C. Bohn, MD. 

Carpal Tunnel Syndrome

Patients with peripheral neuropathy who met the American Diabetes Association criteria for testing in asymptomatic adults were found to have a high incidence of undiagnosed diabetes or prediabetes¹. The rates of prediabetes (51.3%) and diabetes (12.8%) in this group were nearly double those in the control group (27.3% and 6.8%, respectively). Studies such as this one “highlight the need for surgeons to be aware of and screen for occult, serious, treatable medical problems in patients presenting with carpal tunnel syndrome,” notes Guest Editorial author Dr. Bohn. 

Arthritis

A study assessed radiographic changes, range of motion, and patient-reported pain and function at a mean 12.1 years after nonoperative treatment of osseous mallet injury². The contralateral distal interphalangeal (DIP) joint was utilized as the control. Relative to the control, 23% to 25% of injured DIP joints had increased radiographic arthritis; however, a clinically meaningful decrease in range of motion was not shown. There was no clinically meaningful difference in patient-reported pain or function. 

Trauma

A combined randomized and observational trial evaluated radiographic alignment following nonoperative vs. operative treatment for distal radial fracture treatment in patients ≥60 years old³. A total of 113 patients were treated with an anterior locking plate following an initial treatment using closed reduction and 187 patients were treated with closed reduction only. Alignment was significantly worse in the closed reduction group. However, patient-reported function at the 12-month follow-up did not differ between the groups for any of 4 malalignment measures on secondary analysis. 

In a retrospective study including 113 geriatric patients with a distal radial fracture treated with closed reduction and casting, researchers investigated the relationship between malunion and patient outcomes by age group⁴. Patients were divided into early geriatric (60 to 72 years old) and late geriatric (>77 years old) groups. At the 1-year follow-up, significant and clinically meaningful functional differences were observed between the 2 age groups, but no differences were found between the acceptable union and malunion subgroups in either age group. 

Thirty-seven finger metacarpal shaft fractures that did not meet surgical criteria at presentation were evaluated for changes in alignment over a 6-week period⁵. Of these, only 1 had a change necessitating surgery (a change from 25° to 32° of flexion). None of the other observed changes in angulation, rotation, and shortening were clinically meaningful. These findings suggest “that routine follow-up for mildly displaced metacarpal fractures is, indeed, unnecessary,” writes Dr. Bohn. 

Practice Management

A study evaluated 6 different commercially available cast protectors and a single-layer plastic bag sealed with duct tape in terms of their efficacy in keeping a cast dry⁶. Moisture accumulation in the cast was estimated via the change in weight of a paper towel held between the fingers of the subject when the covered arm was submerged in water for 30 seconds, first without finger movement and then with finger movement. Five of the 6 cast protectors provided excellent protection from moisture. The plastic bag performed significantly worse and was ranked the lowest by participants. 

What’s New in Hand Surgery is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Pediatric Orthopaedics, What’s New in Adult Reconstructive Knee Surgery, and What’s New in Musculoskeletal Tumor Surgery. 

References 

1. Nelson JT, Gay SS, Diamond S, Gauger M, Singer RM. Warning signs: occult diabetes and dysglycemia in the hand surgery patient population. Hand (N Y). 2022 Dec 23:15589447221142893. 
2. Slichter ME, Mathijssen NMC, Yau CCL, Koobs L, Kraan GA. Posttraumatic osteoarthritis of the distal interphalangeal joint: a follow-up study of 12 years after nonsurgical treatment of mallet finger fractures. J Hand Surg Am. 2023 Jul;48(7):691-8. 
3. Lawson A, Naylor J, Mittal R, Kale M, Xuan W, Harris IA. Does radiographic alignment correlate with patient-reported functional outcomes and posttreatment complications in older patients treated for wrist fractures? J Hand Surg Am. 2023 Jun;48(6):533-43. 
4. Hosokawa T, Tajika T, Suto M, Chikuda H. Relationship between malunion and short-term outcomes of nonsurgical treatment of distal radius fractures in the elderly: differences between early- and late-geriatric patients. J Hand Surg Am. 2023 Feb 8:S0363-5023(23)00001-1. 
5. Crawford Z, Ponce RB, Moore M, Schumaier A, Ross P, Stern P. Six-week radiographic follow-up does not change management for nonoperatively treated extraarticular metacarpal shaft fractures. Hand (N Y). 2023 May 24:15589447231170249. 
6. Kwan S, Santoro A, Cheesman Q, Matzon J, Wang M, Beredjiklian P, Rivlin M. Efficacy of waterproof cast protectors and their ability to keep casts dry. J Hand Surg Am. 2023 Aug;48(8):803-9.