Recent Publications

Scaphoid nonunion, a condition where a fractured wrist bone fails to heal properly, remains difficult to treat even with modern surgical techniques. This article examines the use of nonvascularized bone grafting, a traditional approach that does not require transplanting bone with its blood supply, as a treatment option for fractures at the waist and proximal pole of the scaphoid bone. The method relies on key technical steps including thorough removal of damaged tissue, restoring the proper length and alignment of the scaphoid, and securing the bone with stable fixation using screws, wires, or plates. Surgeons can choose from several types of bone graft materials—including corticocancellous, cancellous, and strut grafts—to encourage healing and correct a common deformity called humpback deformity, where the bone collapses into an abnormal angle. When performed with careful technique, nonvascularized bone grafting can achieve good union rates and help patients regain functional use of the wrist, making it a viable option for managing this challenging condition.

Intra-articular malunion of the distal radius occurs when a wrist fracture heals in an improper position, leaving the joint surface misaligned, which can cause pain, stiffness, and loss of function. This article reviews the clinical management of this condition, discussing when surgical correction is appropriate and how it can be carried out effectively. The primary surgical approach involves a corrective osteotomy — a procedure where the bone is re-cut and realigned — which may require multiple surgical incisions and the use of both front- and back-side implants to stabilize the wrist. Advanced tools such as arthroscopic cameras and custom 3D-printed surgical guides can improve the precision of the correction, especially in complex cases involving deformity in multiple planes. While surgery can meaningfully improve wrist movement, grip strength, and patient-reported outcomes, it is important to note that post-traumatic arthritis may still develop over time, meaning surgery can improve function but may not fully alter the long-term course of the injury.

Upper extremity replantation involves reattaching severed limbs or digits using microsurgery techniques that require highly specialized skills and careful planning. This review article examines the full process of managing these complex surgeries, covering everything from initial patient evaluation before surgery through recovery and follow-up care. The authors outline key principles of microvascular surgery, which involves reconnecting tiny blood vessels, nerves, and tendons under magnification to restore function to the injured limb. Important considerations include patient selection, the condition of the amputated part, surgical timing, and strategies to prevent complications such as blood clot formation or tissue death after reattachment. Understanding these principles is essential for improving outcomes in patients who suffer traumatic upper limb amputations, making this review a valuable resource for surgeons and medical professionals working in hand and reconstructive surgery.

Acute flaccid myelitis (AFM) is a rare but serious polio-like condition that mainly affects children, causing sudden muscle weakness or paralysis, often following a viral infection. In this case report, surgeons performed highly targeted nerve transfer surgeries on a 5-year-old girl who developed severe shoulder weakness from AFM after an upper respiratory infection, with the goal of restoring her ability to raise and move her arm. The surgical approach involved redirecting nerve fibers from the median, ulnar, and spinal accessory nerves to the damaged nerves controlling the shoulder muscles, carefully chosen to avoid affecting muscles that were still functioning normally. At two years following surgery, the patient showed dramatic improvement, achieving full range of shoulder flexion and near-full abduction with no loss of function in the areas where donor nerves were taken. This case suggests that carefully selected nerve transfer surgeries can effectively restore movement in AFM patients while preserving existing function, and that using multiple nerve sources may supply enough nerve fibers to support meaningful recovery.

Tendinopathies of the upper limb — including trigger finger, de Quervain tenosynovitis, extensor carpi ulnaris tendinitis, and epicondylitis — are among the most frequently encountered conditions in hand surgery practices. This review article examines current approaches to evaluating and managing these conditions, with a particular focus on cases where initial treatments have failed. The authors highlight that most of these diagnoses respond well to conservative care or simple outpatient procedures, but persistent or worsening symptoms after surgery present a significant clinical challenge. The article outlines practical evaluation strategies and surgical revision options for patients who do not improve with standard treatment. This work is significant because it provides hand surgeons with a structured framework for managing difficult, treatment-resistant tendinopathy cases, ultimately aiming to improve patient outcomes and reduce frustration when first-line approaches fall short.

This study examined how intramedullary headless screw fixation for broken finger bones (proximal phalanx fractures) affects pressure within the knuckle joint (metacarpophalangeal joint), since the screws must be inserted through the joint surface. Using seven cadaver hand specimens, researchers simulated the surgical technique by creating drill hole defects of two different sizes (2.4 mm and 3.5 mm) in the joint surface and measured peak contact pressures during repeated loading cycles. They found that larger drill holes caused greater increases in joint contact pressure, with the 3.5 mm defect raising peak pressure by 52% when the finger was in a straightened (extended) position, a statistically significant change. The smaller 2.4 mm defect increased pressure by 24% in extension but did not produce consistent, statistically significant changes. These findings suggest that using larger screws with this surgical technique may place increased stress on the knuckle joint, potentially raising the risk of developing arthritis over time, and that screw size selection should be carefully considered when treating these fractures.

Nerve pain, including neuroma pain and phantom limb pain, is a common and debilitating complication following amputations, and current surgical treatments often provide limited relief. This systematic review evaluated the effectiveness of two newer surgical techniques — targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) — in both preventing and treating this type of pain. Researchers analyzed 17 studies involving 441 patients, finding that both procedures significantly reduced neuroma pain in 75–100% of patients and phantom limb pain in 45–80% of patients when used as treatment, with average pain score reductions of 2.4 to 6.2 points on a standard 10-point scale. When performed preventively at the time of amputation, many patients reported little to no pain at follow-up, suggesting these techniques may also be valuable as a prophylactic approach. While these results are promising, the authors emphasize the need for more rigorous randomized controlled trials with longer follow-up periods to better compare TMR and RPNI against traditional nerve management methods and establish clearer clinical guidelines.

Ganglion cysts are the most common soft-tissue lumps found in the hand and wrist, typically appearing on the back or front of the wrist, though they can also develop along tendons, finger joints, or even within bones and nerves. This review article summarizes two decades of progress in diagnosing and treating these cysts, drawing on advances in imaging, surgical techniques, and clinical outcomes. Diagnosis still relies mainly on physical examination, but ultrasound and MRI have become valuable tools for ruling out more serious conditions like tumors or sarcomas. Nonsurgical options, including observation and aspiration, lead to cyst resolution in more than half of patients, while surgical removal carries a recurrence rate of 7% to 39%, with newer arthroscopic techniques achieving results comparable to traditional open surgery. This review is significant because it consolidates current best practices and highlights how improved technology and surgical approaches have enhanced care for patients with this very common condition.

Rotator cuff injuries, especially those involving the supraspinatus tendon (SST), are common and often result from repetitive stress rather than a single traumatic event. This review examines how cyclic loading below the level needed to cause an immediate tear can gradually accumulate damage in the SST, eventually overwhelming the body's natural repair processes and increasing the risk of full tendon rupture. The authors analyzed findings across multiple model systems and found a consistent pattern of fatigue damage progression, suggesting that tendons respond to overuse in a predictable, generalizable way. This consistency is significant because it raises the possibility of identifying early warning signs and developing interventions before serious injury occurs. The authors call for future research to better define the SST's fatigue life — including how much load, how often, and for how long it can be applied before injury — and to enable real-time strain analysis during everyday activities.