The management of scaphoid nonunion, although relatively common, continues to pose challenges, especially if complicated by avascular necrosis of the proximal pole, humpback or dorsal intercalated segment instability deformities, and early scaphoid nonunion advanced collapse. In this round table article, four surgeons were asked to answer key questions on a clinical example of a proximal scaphoid nonunion to outline their approach and rationale in their preferred treatment choices. The current panel of experts leans towards arthroscopic methods of treatment and most agree that arthroscopic bone grafting has become an important and revolutionary treatment option, which has yielded excellent results. However, both open and arthroscopic grafting are validated methods of treatment and which is to be performed is largely based on the surgeon's preference.

This study aimed to investigate the association of socioeconomic factors, country of birth and comorbidities with poor patient-reported outcome 1 year after a distal radial fracture. The patient population was obtained from the Swedish Fracture Register. In the study, 17,468 patients 18 years or older were included. Poor outcome was the dependent variable in a multivariate logistic regression analysis. The factors with the strongest association with poor outcome were country of birth outside the European Union (odds ratio (OR) = 2.28; 95% CI = 1.91-2.73), high-energy trauma mechanism (OR = 1.76; 95% CI = 1.46-2.12), a history of anxiety or depression (OR = 1.46; 95% CI = 1.26-1.70), and a Charlson comorbidity index ≥3 (OR = 1.51; 95% CI = 1.17-1.94). Alleviating the effects of these factors could potentially decrease the proportion of patients with a disability after a distal radial fracture. III.

The aim of this study was to report the natural history of paediatric trigger thumbs, determining the rate and factors predictive of spontaneous resolution. A total of 62 patients presenting with 79 thumbs locked in flexion were observed for a mean of 4.2 years. The median age at presentation was 20.5 months. The spontaneous resolution rate was 37% at 5 years and 50% at 8 years of follow-up. Of the thumbs, 27% had undergone surgery at 5 years and 48% at 8 years. Thumbs that spontaneously resolved did so at a mean of 3.4 years. Thumbs presenting with an interphalangeal joint angle of less than 30° were likely to resolve spontaneously, with a sensitivity of 0.50 and specificity of 0.82. It is reasonable to offer observation alone for 4 to 5 years as the first line of management for paediatric trigger thumb.: III.

Palmar soft tissue defects of the digits are common. Severe multiple digit palmar soft tissue defects can lead to dysfunction and are difficult to treat. We report a case in which a variety of flaps were applied to repair the palmar soft tissue defects of five digits. V.

Four adult female patients were treated with an intramedullary Steinmann pin for an unstable extra-articular distal ulnar fracture associated with a distal radial fracture treated with plate osteosynthesis. All showed good radiographic and functional outcomes. One patient required removal of the Steinmann pin.

The aim of the present study was to train a natural language processing model to recognize key text elements from research abstracts related to hand surgery, enhancing the efficiency of systematic review screening. A sample of 1600 abstracts from a systematic review of distal radial fracture treatment outcomes was annotated to train the natural language processing model. To assess time-saving potential, 200 abstracts were processed by the trained models in two experiments, where reviewers accessed natural language processing predictions to include or exclude articles. The natural language processing model achieved an overall accuracy of 0.91 in recognizing key text elements, excelling in identifying study interventions. Use of the natural language processing reduced mean screening time by 31% without compromising accuracy. Precision varied, improving in the second experiment, indicating context-dependent performance. These findings suggest that natural language processing models can streamline abstract screening in systematic reviews by effectively identifying original research and extracting relevant text elements. IV.

We report a case of extensor digitorum bowstringing after complete rupture of the extensor retinaculum treated successfully with an ankle extensor retinaculum graft. Reconstruction of structure, form and mechanical properties of the extensor retinaculum is possible owing to the histological similarity of anatomical pulleys throughout the body. V.

In this randomized controlled trial, we assessed the non-inferiority of buddy taping to splinting after reduction of displaced extra-articular proximal and middle phalangeal finger fractures in children. The primary outcome was the rate of secondary fracture displacements; the secondary outcomes were patient comfort, analgesic efficacy and total range of active motion 6 months after injury. Eighty-one patients participated: 43 with taping and 38 with splinting. Secondary displacement occurred in eight patients: five in the splinting group and three in the taping group. Risk difference was below the predefined non-inferiority of 10%. Patient comfort was significantly higher in the taping group, with no group differences for other parameters. Our previous study recommended taping for undisplaced finger fractures in children. With the current data, we recommend taping these finger fractures irrespective of displacement or need for reduction. We are encouraged to propose taping as an alternative to splinting for increased patient comfort, lower cost, and shorter application time. I.

This study assessed authorship and publication trends in congenital upper limb difference literature. Congenital upper limb difference literature is widely distributed across multiple journals; no single journal published a clear majority. Female authorship was more likely, though reasons for this remain unclear.

This network meta-analysis of 13 randomized trials comparing injection treatments for trapeziometacarpal joint arthritis found no robust evidence for any treatment. There is low-quality evidence that corticosteroid and hyaluronic acid injections are superior to placebo for mid-term pain.

This study investigated the functional outcome of prophylactic carpal tunnel release during distal radial fracture fixation. A total of 60 patients undergoing anterior locking plate fixation for a distal radial fracture were randomized into two groups: one having prophylactic endoscopic carpal tunnel release and the other serving as a control. Functional outcomes were assessed using the Patient-Reported Wrist Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, EuroQol 5-Dimension 5-Level questionnaire, Boston Carpal Tunnel Questionnaire, Pain Numerical Rating Scale, grip strength and finger-to-palm distance over a 12-month period. The study found no significant differences in overall functional outcomes or complications between the groups. I.

This study describes patient-reported outcomes of robot-assisted percutaneous scaphoid fracture fixation of 62 patients from two medical centres and the learning curve of this new technique. One attempt to place the guidewire was sufficient in 97% of cases. All fractures achieved radiographic union at a mean of 9 weeks. There were no complications observed. At a mean follow-up of 36 months (range 12-68 months), the mean patient-rated wrist evaluation (PRWE) was 2 (range 0-22) and the mean Mayo Wrist Score was 96 (range 70-100). After the initial ten to 20 cases, the learning phase was reasonably surmountable with a marked reduction of operative duration and improvement of the screw accuracy. IV.

Vascularized periosteal grafts have been used to promote bone union in massive bone defects. We present a child with a failed distal humeral joint replacement for Ewing sarcoma reconstruction, successfully treated with a total elbow allograft augmented by vascularized periosteal grafts. V.

Hand surgery in Vietnam has evolved significantly, especially in cities like Ho Chi Minh City, Hanoi and Hue. Despite advancements, there remain challenges, including the lack of a unified national hand surgery society. This article highlights the contributions of key figures, advances and the future of the discipline in the country.

This systematic review reports the clinical, patient-reported, radiographic outcomes, complications and survivorship of dual-mobility trapeziometacarpal (TMC) joint arthroplasties including the MAÏA®, Moovis® and Touch® prostheses. Thirteen studies were included and outcomes reported for 1421 such arthroplasties. Overall, improvements in strength, range of motion, pain, function and satisfaction were demonstrated with a complication incidence of 13%. The risk of dislocation was 0.6%. The follow-up period was not long enough to draw conclusions about the long-term survival of the implants. Also, due to the low quality of the evidence, it was not possible to conclude that dual-mobility TMC arthroplasty was superior to trapeziectomy. This review highlights the need for Level I evidence with adequate long-term follow-up for TMC joint arthroplasty.