Recent Publications

Flexor pollicis longus (FPL) palsy — weakness of the muscle that bends the thumb — is an uncommon complication of both-bone forearm fractures (BBFFs), and its causes are not well understood. Researchers conducted a retrospective review of 29 patients who underwent surgical repair of BBFFs between 2005 and 2023, finding that 5 patients (17%) developed FPL palsy either at the time of injury or shortly after surgery, all involving fractures in the middle third of the radius. All five cases resolved on their own within an average of 33 days, suggesting the nerve was bruised rather than permanently damaged — a condition called neurapraxia. To better understand why this complication occurs, the team also performed dissections on 10 cadaver arms and found that the nerve branch supplying the FPL muscle is located between 7 and 9 centimeters from a common elbow landmark, placing it in a vulnerable position near mid-to-proximal radius fracture sites. These findings suggest that both the fracture itself and surgical manipulation — such as excessive pulling on surrounding tissue — may put this nerve branch at risk, which has important implications for surgical planning and patient counseling.

This study investigated how residency program directors in obstetrics and gynecology, plastic surgery, urology, and pediatrics view conscientious objection — when trainees refuse to provide care based on personal beliefs — specifically regarding gender-affirming care. Researchers surveyed program directors from accredited U.S. residency programs in 2023, analyzing open-ended written responses from 62 participants using a structured qualitative coding method. The findings revealed that attitudes toward conscientious objection varied widely depending on medical specialty, personal values, prior experience handling objections to other controversial procedures, and state or institutional regulations. Program directors broadly recognized conscientious objection to gender-affirming care as a significant and complex issue, but no consistent or standardized approach existed across programs. These results highlight an urgent need for clearer, more uniform policies that still account for regional legal restrictions and specialty-specific contexts, particularly as state-level legislation increasingly affects how training programs can respond to trainee objections.

Brachial plexus injuries can occasionally occur alongside distal biceps tendon ruptures, but the tendon injury may go undetected because the limb is already weak and painful from nerve damage. This case report describes two patients who each sustained a brachial plexus injury combined with an unrecognized distal biceps tendon rupture — one discovered six months after nerve transfer surgery, and the other found during a muscle transfer procedure. In both cases, the tendon rupture was missed initially because the paralysis masked the typical signs that would normally indicate such an injury. Both patients ultimately achieved gravity-assisted elbow flexion at one year following surgical reconstruction. The authors emphasize that surgeons should carefully review patient history and physically examine the biceps tendon during any operative procedure to avoid missing this concurrent injury, which could otherwise compromise the outcome of nerve repair efforts.

Medical schools and residency programs across the United States have been working to build a physician workforce that better reflects the diversity of the general population, but little was known about how diversity-related factors influence applicants' ranking decisions in competitive specialties like plastic surgery. This study surveyed 180 applicants to an integrated plastic surgery residency program across two application cycles (2022–2024), asking them to rate the importance of various program features—including diversity, equity, and inclusion (DEI) initiatives and faculty representation—using a five-point scale. The results showed that while all applicants prioritized quality of life and perceived program fit, female and underrepresented in medicine (URiM) applicants placed significantly greater importance on the presence of URiM faculty, diverse faculty in leadership roles, residents sharing their racial or ethnic background, and program involvement in DEI efforts. These differences were statistically significant, suggesting that diversity-related program features are not equally valued across all applicant groups but are particularly meaningful to those from historically marginalized backgrounds. The findings highlight an opportunity for residency programs to strengthen their recruitment of a broader range of applicants by intentionally showcasing and developing their diversity and inclusion efforts.

Spinal cord injuries (SCI), particularly those affecting the cervical spine, can severely limit upper extremity function and reduce a person's independence and quality of life. This article reviews surgical strategies used to restore movement in the hand, wrist, and elbow for people with tetraplegia, including established techniques such as tendon transfer, tenodesis, and arthrodesis, as well as the more recently adopted approach of nerve transfers. A thorough preoperative evaluation—combining physical examination and electrodiagnostic testing—is critical for identifying which muscles and nerves are suitable donors for reconstruction, guided by the International Classification of Surgery for the Hand in Tetraplegia (ICSHT) system. Surgical priorities focus on restoring elbow extension, wrist extension, pinch, and grasp, followed by individualized rehabilitation that balances joint protection with cortical retraining to help patients learn to use transferred tendons or nerves. The authors emphasize that the best outcomes depend on a collaborative, interdisciplinary team approach to patient assessment, surgical planning, and postoperative care.

Perilunate and lunate dislocations are serious wrist injuries that are frequently missed on imaging, which can lead to significant complications for patients. This study tested whether a machine learning algorithm designed to label the lunate bone on wrist X-rays could help physicians more accurately identify these injuries. Researchers recruited 137 participants across emergency medicine, radiology, and hand surgery — including both residents and attending physicians — and had them evaluate 30 lateral wrist X-rays with and without the AI tool. Using the machine learning aid improved diagnostic accuracy from 89% to 93% and specificity from 88% to 94% across all participants, with residents showing particularly notable gains that brought their performance close to attending-level accuracy. These findings suggest that AI-assisted diagnosis could serve as a valuable safety net for reducing missed perilunate dislocations, especially in clinical settings where specialist consultation may not be immediately available.

This study examined a rare and previously underrecognized pattern of brachial plexus injury in which patients retain the ability to flex their fingers despite sustaining a complete injury to the entire brachial plexus nerve network. Researchers reviewed 989 patients who underwent surgery for brachial plexus injuries between 2010 and 2022, identifying 16 cases (1.6%) that fit this distinct presentation. All 16 patients showed avulsion of the C8 and T1 nerve roots on imaging and displayed Horner's sign, yet retained partial finger flexion, though the small finger and certain wrist muscles were consistently paralyzed. Various surgical nerve transfer techniques were used to restore shoulder and elbow function, with elbow flexion successfully recovering in over 90% of patients with adequate follow-up, though roughly 29% of those who donated median nerve fascicles experienced some reduction in finger strength. These findings are significant because they establish a new clinical subtype of total brachial plexus injury that surgeons must recognize to avoid misdiagnosis and to make more informed decisions about which nerves can safely be used as donors during reconstructive surgery.

Fingertip injuries are one of the most frequent reasons people visit the emergency department, making it important for clinicians to understand the best approaches to treatment. The goals of treatment include preserving the length and function of the finger, ensuring that exposed bone or tendon is adequately covered by soft tissue, maintaining a normal-looking nail, and preventing long-term pain. Bone injuries in the fingertip are usually treated without surgery, though certain situations—such as unstable fractures or injuries to the tendon that flexes the finger—may require an operation. Injuries to the nail bed can be addressed through simple procedures like draining blood from beneath the nail or more involved repairs depending on the severity of tissue damage. When soft tissue needs to be replaced or covered, surgeons can use a range of techniques including allowing the wound to heal on its own, using skin grafts, or repositioning nearby tissue flaps, with most patients achieving good functional and cosmetic outcomes when managed appropriately.

Traumatic brachial plexus injuries (BPIs) are severe nerve injuries that can result in significant loss of arm and shoulder function, yet no standardized surgical treatment guidelines currently exist. This study surveyed eight expert U.S. surgeons, each independently reviewing the same four real patient cases and providing their preferred surgical reconstruction plans. The results revealed considerable disagreement among surgeons, particularly regarding whether to use nerve grafting, how to restore shoulder stability, and which nerve transfer techniques to prioritize — especially in complex cases involving the entire brachial plexus. Some areas of moderate agreement did emerge, such as favoring triceps-to-axillary nerve transfers and double fascicular transfers for elbow and shoulder function in upper trunk injuries. These findings highlight an urgent need for standardized treatment protocols, as the wide variability in expert recommendations suggests that patients with similar injuries may receive very different care depending on which surgeon they see.

Peripheral nerve injuries can cause lasting loss of movement and sensation, making effective treatment strategies critically important. This review examines how electrical stimulation (ES) may support peripheral nerve regeneration by exploring its proposed biological mechanisms, which include promoting the release of growth factors and enhancing the activity of neurons that support nerve repair. The authors analyzed evidence from both animal studies and human clinical trials to assess how well ES works in practice. Findings suggest that ES can meaningfully accelerate nerve regeneration and improve functional recovery, particularly when applied shortly after injury or surgery. This review highlights ES as a promising therapeutic tool and calls for further standardized clinical research to establish optimal treatment protocols and expand its use in patient care.