New research in hand and wrist surgery is presented in the JBJS Guest Editorial What’s New in Hand and Wrist Surgery. Here, we highlight 6 compelling studies selected by coauthor Eric R. Wagner, MD.
Carpus
A level I randomized controlled trial (RCT) published in JBJS investigated the effect of low-intensity pulsed ultrasound (LIPUS) on time to union in surgically fixated scaphoid nonunions. The trial allocated 142 patients to receive either active or sham LIPUS. No differences were found with respect to time to union, total union rate, patient-reported outcome measures, or wrist function, apart from flexion. “Treatment with LIPUS had no effect on reducing time to union”, concluded the study authors1.
A retrospective study compared the outcomes of 3 common scapholunate ligament reconstruction techniques: dorsal capsulodesis (mean follow-up, 11.8 years), tri-ligament Brunelli tenodesis (5.9 years), and bone-ligament-bone reconstruction (8.9 years). Over the follow-up period, each of the techniques was associated with radiographic deterioration that did not always correlate with functional outcomes. Additionally, there were no differences in clinical outcomes between the techniques2.
Compressive Neuropathy
The prevalence of positive amyloidosis diagnoses among patients undergoing tenosynovial biopsy to screen for amyloidosis during carpal tunnel release was investigated in a retrospective study. When patients with spinal stenosis and cardiac disease who satisfied the screening questions were included, the cohort of 62 patients demonstrated a positive biopsy rate of 22.5%3.
Distal Radius
A JBJS study investigated radiographic and clinical outcomes following the treatment of distal radial fractures in 366 patients4. A dorsal tilt of >5° was strongly correlated with worsening clinical outcomes, except in patients >75 years old, in whom a difference was not observed until the dorsal tilt was >20°.
Opioid-Free Multimodal Analgesia
Opioid-free multimodal pain regimens were found to provide adequate pain relief following various hand surgeries, according to a recent system review that included 1,480 patients. The review also showed, however, that such regimens necessitated increased use of rescue analgesia5. As noted by Guest Editorial authors Drs. Wagner and Suh, “This highlights that the move toward limiting opioids prescribed in hand surgery is promising, but still has work to be done on optimizing the protocols.”
Artificial Intelligence (AI)
A recent study investigated a novel deep learning algorithm for detecting perilunate and lunate dislocations on lateral wrist radiographs. The algorithm had a sensitivity of 93.8%, a specificity of 93.3%, and an accuracy of 93.4%, leading the researchers to conclude that their algorithm “has potential to improve clinical sensitivity to ultimately prevent delayed or missed diagnosis of these injuries”6.
What’s New in Hand and Wrist 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
- White NJ, Patterson ED, Dhaliwal GS, Hildebrand KA; WECAN. Low-intensity pulsed ultrasound versus sham in the treatment of operatively managed scaphoid nonunions: the SNAPU randomized controlled trial. J Bone Joint Surg Am. 2024 Sep 4;106(17):1573-82.
- van Kampen RJ, Henk Coert J, Moran SL. Mid-term outcomes of three commonly used surgical reconstructions for scapholunate instability. J Hand Surg Eur Vol. 2024 Jul;49(7):852-8.
- Gannon NP, Ward CM. Results of implementation of amyloidosis screening for patients undergoing carpal tunnel release. J Hand Surg Am. 2024 Jul;49(7):675-80.
- Schmidt V, Gordon M, Tägil M, Sayed-Noor A, Mukka S, Wadsten M. Association Between Radiographic and Clinical Outcomes Following Distal Radial Fractures: A Prospective Cohort Study with 1-Year Follow-up in 366 Patients. J Bone Joint Surg Am. 2023 Aug 2;105(15):1156-1167. Epub 2023 May 12.
- Lawson J, Ngaage LM, El Masry S, Giladi AM. Efficacy of postoperative opioid-sparing regimens for hand surgery: a systematic review of randomized controlled trials. J Hand Surg Am. 2024 Jun;49(6):541-56.
- Pridgen B, von Rabenau L, Luan A, Gu AJ, Wang DS, Langlotz C, Chang J, Do B. Automatic detection of perilunate and lunate dislocations on wrist radiographs using deep learning. Plast Reconstr Surg. 2024 Jun 1;153(6):1138e-41e.
