Biomechanical Stability of Diaphyseal Ulnar Shaft Fractures and Ulnar Shortening Osteotomies After Fixation.

BACKGROUND: To determine the amount of micromotion during forearm rotation after diaphyseal ulnar shaft fracture or osteotomy. METHODS: This was a biomechanical study using 7 paired-matched cadavers. The upper extremity was mounted in a custom rig and the forearm brought through full pronation and supination. A Hall effect sensor was placed at the fracture ends to measure micromotion for all tested conditions. There were 4 conditions tested: (1) intact ulnar shaft with plate to act as a control; (2) transverse fracture/osteotomy without stabilization; (3) fracture/osteotomy with cortical apposition stabilized with plate fixation; and (4) 50% comminuted fracture stabilized with plate. RESULTS: There was a significantly greater amount of fracture site motion in the fracture/osteotomy model without stabilization compared with all other tested conditions (P < .001, .0001, .0003, respectively). The fracture/osteotomy site with cortical apposition and the comminuted fracture models showed no statistically significant differences in the amount of micromotion compared with each another (P = .952) or compared with the intact ulnar shaft (P = .997, .889, respectively). CONCLUSIONS: There was no significant difference in the amount of motion between an intact ulnar shaft, an ulnar shaft fracture with cortical apposition stabilized with a plate, and a plated comminuted fracture. These findings may help surgeons decide on their type of postoperative immobilization in the setting of isolated ulnar shaft fractures or ulnar shaft osteotomies stabilized with plate fixation.

Dynamic Computed Tomography of the Distal Radioulnar Joint Versus Magnetic Resonance Imaging in Detecting Foveal Tears of the Triangular Fibrocartilage Complex.

BACKGROUND: Diagnosis of foveal triangular fibrocartilage complex (TFCC) tears remains difficult. The purpose of this study was to evaluate whether dynamic computed tomography (CT) of the distal radioulnar joint (DRUJ) has a higher sensitivity in detecting foveal tears of the TFCC when compared with magnetic resonance imaging (MRI). METHODS: A database query identified all patients above the age of 18 years with suspected foveal TFCC injuries who underwent bilateral dynamic CT imaging of the DRUJ, static 3T MRI, and subsequent wrist arthroscopy. All patients had evidence of foveal tenderness on clinical examination. The imaging results were validated with wrist arthroscopy. RESULTS: Twelve patients with a mean age of 31 years (range, 18-53 years) were identified. Eight patients were diagnosed with a complete foveal detachment of the TFCC on wrist arthroscopy. Of the 8 patients with a foveal tear on DRUJ arthroscopy, only 3 had a preoperative physical examination suggestive of DRUJ instability. Magnetic resonance imaging identified foveal injuries in 4 of these 8 patients (sensitivity, 50%), and 3 of these were identified as only partial tears. Dynamic CT identified instability of DRUJ in 6 of 8 patients (sensitivity, 75%). Seven of 8 patients had imaging findings suggestive of a foveal tear when including either MRI or CT imaging (sensitivity, 88%). Of the 4 patients with an intact foveal attachment on arthroscopy, 3 (specificity, 75%) had a stable DRUJ on CT and all 4 (specificity, 100%) had an intact foveal attachment on MRI. CONCLUSION: Sixty-two percent of patients with foveal tears on arthroscopy have a stable DRUJ on clinical examination. When combining MRI and dynamic CT imaging of the DRUJ, the sensitivity of detecting a foveal TFCC tear approaches 88% compared with a gold standard of wrist arthroscopy.

Investigation Into the Effects of Intra-Articular Steroid on Post-Traumatic Osteoarthritis in Distal Radius Fractures: A Randomized Controlled Pilot Study.

PURPOSE: The aim of this prospective, randomized, controlled, double-blinded pilot study was to determine the rates of post-traumatic osteoarthritis and assess joint space width in the presence or absence of a single intra-articular injection of corticosteroid after an acute, intra-articular distal radius fracture (DRF). METHODS: Forty patients received a single, intra-articular, radiocarpal joint injection of 4 mg of dexamethasone (DEX) (n = 19) or normal saline placebo (n = 21) within 2 weeks of a surgically or nonsurgically treated intra-articular DRF. The primary outcome measure was minimum radiocarpal joint space width (mJSW) on noncontrast computed tomography scans at 2 years postinjection. Secondary outcomes were obtained at 3 months, 6 months, 1 year, and 2 years postinjection and included Disabilities of the Arm, Shoulder, and Hand; Michigan Hand Questionnaire; Patient-Rated Wrist Evaluation; wrist range of motion; and grip strength. RESULTS: At 2-year follow-up, there was no difference in mean mJSW between the DEX group (2.2 mm; standard deviation, 0.6; range, 1.4-3.2) and the placebo group (2.3 mm; standard deviation, 0.7; range, 0.9-3.9). Further, there were no differences in any secondary outcome measures at any postinjection follow-up interval. CONCLUSIONS: Radiocarpal joint injection of corticosteroid within 2 weeks of an intra-articular DRF does not appear to affect the development of post-traumatic osteoarthritis within 2 years follow-up in a small pilot cohort. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Validation of the Clenched Fist View in Detecting Scapholunate Ligamentous Injury.

BACKGROUND: The purpose of this study was to determine the predictive value of the clenched fist stress views in identifying scapholunate ligament injuries. METHODS: An institutional review board-approved retrospective chart review was conducted of adult patients who underwent diagnostic arthroscopy with a ligamentous wrist injury from 2015 to 2020. Standard posteroanterior, lateral, and clenched fist stress radiographs were reviewed and scapholunate ligament gaps recorded. RESULTS: A total of 124 patients were included, of which 88 had normal standard radiographs and clenched fist radiographs. The positive predictive value of the clenched fist view was 69%, whereas the negative predictive value was 58%. The sensitivity of the clenched fist view was 40%, while the specificity was 82%. Of those patients with a negative clenched fist view, 42% were found to have an arthroscopic Geissler classification of 3 or higher scapholunate ligament injury. CONCLUSIONS: Despite the emphasis on stress radiographic views, a normal stress clenched fist view does not preclude arthroscopic findings of a Geissler class 3 or greater injury in symptomatic patients. The sensitivity of a clenched fist view is only 40%. These findings question the utility of stress radiographs when assessing for scapholunate ligament injuries.

Volar Wrist Arthroscopy Portals Using the NanoScope Are Safer than Traditional Arthroscopy.

BACKGROUND: The NanoScope, given its smaller size, may be further from critical structures when establishing volar wrist arthroscopy portals compared to the traditional 2.7-mm arthroscope. METHODS: Ten fresh-frozen latex-injected cadaver specimens were utilized. The volar radial (VR) and volar ulnar (VU) portals were created using an inside-out approach. The volar radial midcarpal (VR-MC) and volar ulnar midcarpal (VU-MC) portals were created using an inside-out approach. The arm was then dissected under 3.5-mm loupe magnification. Digital calipers were used to measure the distance between the portals and the surrounding anatomic structures by two fellowship-trained hand surgeons. RESULTS: The median nerve was on average 1.6, 7.2, 1.8, and 5.6 mm away from the trochar for the VR, VU, VR-MC, and VU-MC, respectively. The median nerve fascia was pierced by the VR portal in one specimen. The radial artery, ulnar artery, and ulnar nerve were not pierced in any specimen. Compared to historical controls, for the VR-MC portal, the NanoScope was further from all critical structures, aside from the radial artery, and did not pierce any neurovascular structures. For the VU-MC portal, the NanoScope was further from the ulnar artery and median nerve and did not pierce any neurovascular structures. CONCLUSION: In developing volar portals, after placing the cannula through the volar capsule from an inside-out approach, we recommend making a volar incision and dissecting the local anatomic structures to guard against injury. Compared to historical controls, the NanoScope was typically further from neurovascular structures.

Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury.

The primary aim of the present study was to present a case series of 24 patients with foveal triangular fibrocartilage complex (TFCC) injuries that were treated with arthroscopically assisted TFCC foveal repair. In total, 19 patients had a stable distal radioulnar joint (DRUJ) and five had an unstable DRUJ. Despite this, all patients were found to have a foveal tear upon DRUJ arthroscopy. Magnetic resonance imaging (MRI) scans detected only eight out of 23 patients with foveal injuries. In addition to their foveal injury, 19 of the 24 patients had additional pathology that required treatment. At a mean follow-up of 18 months, there was a statistically significant improvement in pain, range of motion, grip strength and functional scores. In this study, we demonstrate that having a stable DRUJ upon clinical examination and normal MRI findings does not rule out foveal TFCC injury and a high index of clinical suspicion is needed when managing patients with ulnar sided wrist pain.Level of evidence: IV.

Bilateral lunotriquetral coalition: a dynamic four-dimensional computed tomography technical case report.

Lunotriquetral coalitions are the most common form of carpal coalition wherein the cartilage between the lunate and triquetrum ossification centers failed to undergo apoptosis. This technical case report examines the arthrokinematics of bilateral lunotriquetral coalitions with dissimilar Minnaar types in one participant with one asymptomatic wrist and one wrist with suspected distal radioulnar joint injury. Static and dynamic (four-dimensional) CT images during pronosupination were captured using a photon-counting detector CT scanner. Interosseous proximity distributions were calculated between the lunotriquetral coalition and adjacent bones in both wrists to quantify arthrokinematics. Interosseous proximity distributions at joints adjacent to the lunotriquetral coalition demonstrate differences in median and minimum interosseous proximities between the asymptomatic and injured wrists during resisted pronosupination. Altered kinematics from lunotriquetral coalitions may be a source of ulnar-sided wrist pain and discomfort, limiting the functional range of motion. This case report highlights potential alterations to wrist arthrokinematics in the setting of lunotriquetral coalitions and possible associations with ulnar-sided wrist pain, highlighting anatomy to examine in radiographic follow-up. Furthermore, this case report demonstrates the technical feasibility of four-dimensional CT using photon-counting detector technology in assessing arthrokinematics in the setting of variant wrist anatomy.

Dorsal Subluxation of The Proximal Carpal Row with the Use of a Bridge Plate.

Background Spanning bridge plates were first popularized for fixation of complex distal radius fractures. However, indications for their use have expanded including the surgical treatment algorithm for treating conditions such as Kienböck's disease. Traditionally, initial surgical treatment of Lichtman Stages II to III Kienböck's disease included lunate decompression, unloading, and revascularization procedures. The addition of a dorsal spanning bridge plate further facilitates lunate offloading and may improve bone revascularization. Case Description We report a complication of proximal carpal row dorsal subluxation secondary to dorsal spanning plate fixation in a patient with Stage IIIb Kienböck's disease. The patient had undergone wrist arthroscopy, lunate forage, radius core decompression, and spanning plate fixation. At 6 weeks after surgery, radiographic imaging demonstrated dorsal subluxation of the proximal carpal row that was corrected upon bridge plate removal. Serial radiographs during follow-up showed no further carpal subluxation without Kienböck's disease progression at 12 months postremoval of hardware. Patient remains pain free and has returned to elite level sport. Literature Review To our knowledge no previous cases of proximal carpal row subluxation with the use of dorsal bridge plate has been reported in the literature. Clinical Relevance Proximal row carpal subluxation can occur with dorsal bridge plate fixation.

Clinical Outcomes of Arthroscopic-Assisted Volar Scapholunate Capsulodesis: A Case Series.

Purpose We have previously described arthroscopic-assisted volar scapholunate (SL) capsulodesis as an alternative technique for addressing volar SL interosseous ligament (SLIL) injuries. In this article, we report the outcomes of this procedure in a cohort of patients. Methods Postoperative outcomes including range of motion, grip strength, visual analog scale (VAS) pain score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Mayo Wrist Score were assessed through a prospective review of six patients in a single center who underwent this procedure. Results Six patients (four male and two female) with a mean age of 43 ± 14 years were evaluated in the study. The mean duration of follow-up was 41 ± 17 weeks. Postoperative outcomes noted a reduction in VAS pain score from 8 before surgery to 0.7 postoperatively ( p = 0.00004) and improvement in Mayo Wrist Score (42 preoperatively to 80 postoperatively; p = 0.001), grip strength (86% of contralateral side; p = 0.20), and flexion arc (81% of contralateral side; p = 0.08). QuickDASH was 20 ± 8 and Patient-Rated Wrist Evaluation score was 13 ± 2 at the last clinical follow-up. There was an improvement in SL gap ( p = 0.03), SL angle ( p = 0.11), and radiolunate angle ( p = 0.15) measurements postoperatively. Conclusions The described arthroscopic-assisted volar SL capsulodesis in this study presents an alternative method to address volar SLIL pathology with positive short-term clinical outcomes. Clinical Relevance Arthroscopic-assisted volar SL capsulodesis may be considered in the treatment algorithm for volar SLIL injuries.

BMP2 and GDF5 for Compartmentalized Regeneration of the Scapholunate Ligament.

Background Chronic injuries to the scapholunate ligament (SLIL) alter carpal kinematics and may progress to early degenerative osteoarthritis. To date, there is no consensus for the best method for SLIL reconstruction. This study aims to assess the use of growth factors (bone morphogenetic protein [BMP]2 and growth and differentiation factor 5 [GDF5]) for compartmentalized regeneration of bone and ligament in this multiphasic scaffold in a rabbit knee model. Case Description A total of 100 µg of BMP2 and 30 µg of GDF5 were encapsulated into a heparinized gelatin-hyaluronic acid hydrogel and loaded into the appropriate compartment of the multiphasic scaffold. The multiphasic scaffold was implanted to replace the native rabbit medial collateral ligament ( n = 16). The rabbits were randomly assigned to two different treatment groups. The first group was immobilized postoperatively with the knee pinned in flexion with K-wires for 4 weeks ( n = 8) prior to sacrifice. The second group was immobilized for 4 weeks, had the K-wires removed followed by a further 4 weeks of mobilization prior to sample harvesting. Literature Review Heterotopic ossification as early as 4 weeks was noted on gross dissection and confirmed by microcomputed tomography and histological staining. This analysis revealed formation of a bony bridge located within and over the ligament compartment in the intra-articular region. Biomechanical testing showed increased ultimate force of the ligament compartment at 4 weeks postimplantation consistent with the presence of bone formation and higher numbers of scaffold failures at the bone-tendon junction. This study has demonstrated that the addition of BMP2 and GDF5 in the bone-ligament-bone (BLB) scaffold resulted in heterotopic bone formation and failure of the ligament compartment. Clinical Relevance The implantation of a three-dimensional-printed BLB scaffold alone demonstrated superior biomechanical and histological results, and further investigation is needed as a possible clinical reconstruction for the SLIL.

Partial Denervation of the Thumb Carpometacarpal Joint: A New Technique.

BACKGROUND: To report the clinical outcomes of partial denervation for the treatment of basilar thumb joint arthritis. METHODS: Patients who underwent partial denervation of the basilar thumb joint for osteoarthritis from a single center between 2019 and 2021 were recruited into the study. This involved a technique that involved cauterization of the joint capsule and its innervation through the branches of the superficial radial, palmar cutaneous branch of the median, lateral antebrachial, and ulnar nerves. Patients were followed up postoperatively to record clinical (grip strength, thumb apposition and opposition pinch grip strength, Kapandji score) and patient-reported outcomes (visual analogue scale [VAS], Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Patient-reported Wrist Evaluation [PRWE]). RESULTS: Twelve patients (15 carpometacarpal joints; 9 female and 3 male patients) underwent a partial denervation of the thumb (Eaton stage 3-4). The mean age at the time of surgery was 63 ± 5 years (range 56-72). The mean clinical follow-up duration was 23 ± 11 months (range 9-42 months), and functional score follow-up duration was 27 ± 7 months (range 14-42 months). At the latest clinical follow, VAS score, Kapandji score, grip strength, and thumb apposition/opposition pinch strength all improved significantly (P < .05). The mean QuickDASH score was 30 ± 16, and PRWE score was 32 ± 17. Patients who had unilateral partial thumb denervation demonstrated greater improvement in grip strength than patients who had bilateral partial thumb denervation procedures (P = .01). CONCLUSION: In this clinical case series, our method of basilar thumb joint partial denervation has been effective in improving clinical outcomes and reducing pain due to osteoarthritis. LEVEL OF EVIDENCE: IV, case series.

Innovations in Small Joint Arthroscopy.

With advancements in surgical instrumentation and techniques, the role of arthroscopic and arthroscopic-assisted surgical procedures is ever-growing. Arthroscopy offers direct, magnified visualization of pathology and reductions and is more accurate than relying on intraoperative fluoroscopy alone. It also minimizes soft tissue stripping, which is of particular importance to smaller fracture fragments whose vascularity is precarious and can be injured through open approaches.

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations.

ABSTRACT: Thumb metacarpophalangeal joint ulnar collateral ligament injuries are common in athletes and range from mild sprains to complete retracted tears. The typical injury mechanism of a valgus force directed onto an abducted or extended thumb is frequently seen in certain sporting activities, such as skiing, football, and baseball. Ultrasound and magnetic resonance imaging are excellent imaging supplements to the clinical evaluation for diagnosis confirmation. Positive treatment outcomes have been demonstrated when these injuries are appropriately managed both nonoperatively and surgically. When deciding on a treatment plan, it is paramount to take the athlete's injury severity and sport-specific factors into account. The aim of this review is to summarize the sport epidemiology, diagnosis, treatment options, and return to play considerations for athletes who sustain an acute thumb metacarpophalangeal joint ulnar collateral ligament injury.

Assessing carpal kinematics following scapholunate interosseous ligament injury ex vivo using four-dimensional dynamic computed tomography.

BACKGROUND: Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics. METHODS: Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities. FINDINGS: The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated. INTERPRETATION: Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity.

Periarticular distal radius fractures and complex ligamentous injury: The role of arthroscopic evaluation.

Purpose: Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater identification of such tears, discerning which lesions pose a functional consequence remains a challenge for the hand surgeon. A review and guideline for arthroscopic evaluation of suspected combined injuries is presented. Results: Arthroscopic evaluation of distal radius fractures provides several unique advantages in such instances. Articular reduction can be performed via direct visualization with improvement in step-off and gapping. Furthermore, ligamentous injuries and carpal alignment can be directly assessed and treated. Conclusions: Subtle features of combined ligamentous trauma may be overlooked in the presence of more obvious fracture patterns. Wrist arthroscopy allows not only for a gold-standard method of evaluating of these soft tissue injuries, but also a means of treatment.

Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases.

Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.

Demographics and Characteristics of Orthopaedic Surgery Residency Program Directors: A Cross-sectional Review.

To date, there has been a paucity of research evaluating the demographics, characteristics, and surgical training of orthopaedic residency program directors (PDs). Purpose: To determine the objective characteristics of orthopaedic residency PDs by analyzing their demographic characteristics, academic backgrounds, institutional histories, research productivity, and professional leadership affiliations. Methods: Data for each PD were collected by searching publicly available curriculum vitae, LinkedIn, Healthgrades, Doximity, and/or institutional biographies and consolidated into a database. Research productivities were collected by searching PubMed and Scopus. Results: Of the 210 PDs, 188 (89.5%) were male and 22 (10.5%) were female. One hundred seventy-four (82.9%) were non-Hispanic White, 14 (6.7%) Asian American and Pacific Islander, 12 (5.7%) Black or African American, 4 (1.9%) Hispanic or Latino, and 6 (2.9%) other/unknown. Twenty-four (11.4%) PDs had a military affiliation. Moreover, the most common subspecialties among orthopaedic PDs were orthopaedic traumatology (19.5%, n = 41), sports medicine (15.7%, n = 33), and hand surgery (11.9%, n = 25). The mean Scopus h-index, total number of publications at the time of data collection (June 2022), and total number of citations for all orthopaedic residency PDs were 10.5 ± 9.5, 33.9 ± 51.0, and 801.9 ± 1,536.4, respectively. Among all PDs, the mean tenure in the position was 8.9 ± 6.2 years to date, and the mean time from completion of residency to appointment as PD was 10.0 ± 6.2 years. Conclusions: Among orthopaedic surgery residency PDs, there is sparse female and minority representation. Overarchingly, orthopaedic PDs are White men in their early 50s. Moreover, 59.1% of PDs were appointed at an institution where they completed medical school, residency, or fellowship. orthopaedic traumatology (19.5%), sports medicine (15.7%), and hand surgery (11.9%) were the subspecialties most represented in current orthopaedic surgery PDs. Clinical Relevance: This study outlines important demographic characteristics among orthopaedic surgery residency PDs. Level of Evidence: III.

Do Patients Want to Be Involved in Their Carpal Tunnel Surgery Decisions? A Multicenter Study.

PURPOSE: Carpal tunnel syndrome requires multiple decisions during its management, including regarding preoperative studies, surgical technique, and postoperative wound management. Whether patients have varying preferences for the degree to which they share in decisions during different phases of care has not been explored. The goal of our study was to evaluate the degree to which patients want to be involved along the care pathway in the management of carpal tunnel syndrome. METHODS: We performed a prospective, multicenter study of patients undergoing carpal tunnel surgery at 5 academic medical centers. Patients received a 27-item questionnaire to rate their preferred level of involvement for decisions made during 3 phases of care for carpal tunnel surgery: preoperative, intraoperative, and postoperative. Preferences for participation were quantified using the Control Preferences Scale. These questions were scored on a scale of 0 to 4, with patient-only decisions scoring 0, semiactive decisions scoring 1, equally collaborative decisions scoring 2, semipassive decisions scoring 3, and physician-only decisions scoring 4. Descriptive statistics were calculated. RESULTS: Seventy-one patients completed the survey between November 2018 and April 2019. Overall, patients preferred semipassive decisions in all phases of care (median score, 3). Patients preferred equally collaborative decisions for preoperative decisions (median score, 2). Patients preferred a semipassive decision-making role for intraoperative and postoperative decisions (median score, 3), suggesting these did not need to be equally shared. CONCLUSIONS: Patients with carpal tunnel syndrome prefer varying degrees of involvement in the decision-making process of their care and prefer a semipassive role in intraoperative and postoperative decisions. CLINICAL RELEVANCE: Strategies to engage patients to varying degrees for all decisions during the management of carpal tunnel syndrome, such as decision aids for preoperative surgical decisions and educational handouts for intraoperative decisions, may facilitate aligning decisions with patient preferences for shared decision-making.

Outcomes Following Surgical Treatment of Hamate Arthrosis Lunotriquetral Ligament Injuries.

BACKGROUND: An institutional review board-approved study of the functional outcomes of patients after surgical treatment of hamate arthrosis lunotriquetral ligament tear (HALT) lesions was conducted. METHODS: In all, 21 wrists in 19 patients underwent arthroscopic, open, or combined treatment of HALT lesions. Seven patients underwent isolated hamate debridement and 14 had concomitant procedures to address lunotriquetral pathology. Nineteen wrists underwent procedures to address additional pathology, including triangular fibrocartilage complex, ulnotriquetral ligament split, and scapholunate ligament injuries. RESULTS: Mayo wrist scores increased from 54 to 71. Sixteen patients had no or mild pain postoperatively, compared with none preoperatively. When stratified by lunotriquetral interosseous ligament management, 75% of the limited treatment group (none or debridement) and 78% of the additional treatment group reported improved pain. Three patients underwent additional surgeries for persistent pain. CONCLUSION: Resection of the proximal pole of the hamate can improve pain and function for patients with ulnar-sided wrist pain secondary to a HALT lesion. Concomitant wrist pathologies should be considered when determining treatment plans.