Distal radius fractures rank among the most prevalent fractures in humans, necessitating accurate radiological imaging and interpretation for optimal diagnosis and treatment. In addition to human radiologists, artificial intelligence systems are increasingly employed for radiological assessments. Since 2023, ChatGPT 4 has offered image analysis capabilities, which can also be used for the analysis of wrist radiographs. This study evaluates the diagnostic power of ChatGPT 4 in identifying distal radius fractures, comparing it with a board-certified radiologist, a hand surgery resident, a medical student, and the well-established AI Gleamer BoneView™. Results demonstrate ChatGPT 4’s good diagnostic accuracy (sensitivity 0.88, specificity 0.98, diagnostic power (AUC) 0.93), surpassing the medical student (sensitivity 0.98, specificity 0.72, diagnostic power (AUC) 0.85; p = 0.04) significantly. Nevertheless, the diagnostic power of ChatGPT 4 lags behind the hand surgery resident (sensitivity 0.99, specificity 0.98, diagnostic power (AUC) 0.985; p = 0.014) and Gleamer BoneView™(sensitivity 1.00, specificity 0.98, diagnostic power (AUC) 0.99; p = 0.006). This study highlights the utility and potential applications of artificial intelligence in modern medicine, emphasizing ChatGPT 4 as a valuable tool for enhancing diagnostic capabilities in the field of medical imaging.

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.

Background and Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by chronic compression of the median nerve within the carpal tunnel. Patient education is a cornerstone of informed consent and postoperative outcomes, yet time constraints often limit traditional consultations. Recently, generative AI tools such as ChatGPT have emerged as potential adjuncts in delivering standardized medical information. Materials and Methods: This study evaluated the quality and comprehensiveness of ChatGPT-generated patient education on CTS and open carpal tunnel release. A standardized prompt was used with ChatGPT-4o to generate educational material. A structured and standardized questionnaire was then administered to both patients and physicians (n = 8) to assess content quality, clarity, comprehensiveness, and perceived usefulness. Results: Both patients and physicians reported high satisfaction with the information provided. The etiology, procedural risks, and general anatomical principles were well conveyed. However, certain intraoperative concepts—such as neurolysis, synovectomy, and hemostasis—were underrepresented. While conservative therapies were addressed, the omission of endoscopic surgical options limited informational completeness. Prognostic information and long-term consequences of untreated CTS were rated as average by some participants. Postoperative guidance was adequately covered but lacked individualized nuance. Conclusions: ChatGPT shows promise as an adjunct in surgical patient education, offering clear and standardized information. Nevertheless, it is not a substitute for clinician–patient interaction. While it may bridge preliminary knowledge gaps, emotional support and individualized consent discussions remain essential. Further refinement and clinical validation of AI-generated educational content are needed to ensure safe and effective integration into routine practice.

Various artificial intelligence-based applications have emerged as transformative tools across numerous domains. Among these, ChatGPT has earned global recognition with its capacity for dynamic user interaction and holds significant potential in the medical sector. However, the subject-specific accuracy of ChatGPT remains a matter of debate. This study assesses the capabilities and knowledge of different artificial intelligence chatbots (ChatGPT, Google Gemini, and Claude) in the domain of hand surgery. Each chatbot conducted a full written EBHS exam. The test results were analyzed according to the EBHS-guidelines, focused on the total scores and the ratio of correct to incorrect responses for each artificial intelligence model. Findings revealed that three out of the four chatbots achieved passing scores on the exam. Notably, ChatGPT-4o1 demonstrated significantly superior performance. This study highlights the subject-specific expertise of different artificial intelligence programs within the specialized field of hand surgery while also underscoring their variability and limitations.

Aims: In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness.Methods: Patients diagnosed with stage one to three OA received a single intra-articular autologous fat transplantation. Fat tissue was harvested from the abdomen and injected into the trapeziometacarpal (TMC) joint under radiological guidance, followed by one week of immobilization. Patients with a minimum three-year post-procedure period were assessed for pain level (numerical rating scale), quality of life (Mental Health Quotient (MHQ)), the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH)), and grip and pinch strength, as well as their overall impression of the treatment. Wilcoxon tests compared data from pre-intervention, and at one and three years post-intervention.Results: Out of 136 treated joints, the study involved 87 patients (37 patients were loss to follow-up, and 12 patients (9%) who underwent resection arthroplasty) with a median follow-up of 4.9 years (IQR 5.4 to 5.9). Pain, both at rest and during stress, significantly improved at one year and remained stable through three years. Sex, age, and stage of disease were not associated with postoperative pain levels. Patient-reported outcome measures for QuickDASH and MHQ improved up to at least three years post-treatment. Patients reported high satisfaction and willingness to recommend the procedure. Grip and pinch strength did not significantly change over time.Conclusion: The data show that autologous fat transfer has a longer-lasting effect in two-thirds of re-examined patients. If patients had an initial positive response, the pain-reducing effect lasted for at least three years. Therefore, this minimally invasive approach can offer a valuable treatment alternative for basal thumb OA.

Hintergrund Patient-reported outcome measures (PROMs) nehmen einen immer größeren Stellenwert in der gegenwärtigen Patientenversorgung ein. Leider sind die gängigsten PROMs in der Handchirurgie sehr zeitaufwändig und decken meist nicht die tatsächlichen, diagnosespezifischen Beschwerden der Patienten ab. Zur Diagnostik und Verlaufskontrolle bei Rhizarthrose entwickelten und validierten Noback und Mitarb. den Fragebogen “Thumb Disability Examination” (TDX). Dieser aus 20 Fragen bestehende Fragebogen erfasst gezielt die Alltagseinschränkungen und Schmerzen sowie die patientenberichtete Zufriedenheit der Daumenfunktion. Ziel dieser Studie ist die Validierung der deutschen Übersetzung des TDX, der Thumb Disability Examination – German (TDX-G), und dessen Vergleich mit den derzeitig als Goldstandard verwendeten deutschsprachigen Versionen des MHQ und qDASH. Material und Methoden Die Übersetzung und Rückübersetzung erfolgte gemäß anerkannten Richtlinien. Zur statistischen Validierung des TDX-G wurden 30 konsekutive Patienten mit Rhizarthrose unter standardisierten Bedingungen befragt. Die interne Konsistenz wurde mit Hilfe des Cronbach’s alpha berechnet. Die Bestimmung der Test-Retest-Reliabilität erfolgte an 10 Patienten, die den TDX-G in einem Intervall von 2 Wochen zweimal ausfüllten. Die Validität des TDX-G wurde durch die Berechnung der Korrelationskoeffizienten des TDX-G mit dem MHQ und qDASH, der subjektiven Schmerzempfindung (NRS) und den Kraftgraden der Hand (Grob- und Pinchkraft) bestimmt. Darüber hinaus wurde die Zeit zur Erhebung der einzelnen Fragebögen verglichen. Ergebnisse Der TDX-G weist eine hohe interne Konsistenz (Cronbach’s alpha 0,932) und Test-Retest-Reliabilität (Intraklassen-Korrelationskoeffizient 0,963 [0,850–0,991]) auf. Es besteht eine signifikante Korrelation zwischen TDX-G und MHQ (− 0,782; p<0,001) sowie qDASH (0,833; p<0,001). Alle Fragebögen korrelieren signifikant mit den Schmerzen bei Belastung und der Pinchkraft, wobei der TDX-G jeweils die höchste Korrelation aufweist. Die Zeit zur Erfassung des TDX-G (110±28 s) ist signifikant geringer als zur Erfassung des MHQ (413±98 s). Schlussfolgerung Der TDX-G ist ein reliables Instrument zur Diagnostik und Verlaufskontrolle der Rhizarthrose, das sowohl in der Patientenversorgung als auch der klinischen Forschung gezielt eingesetzt werden kann und die Beschwerden präzise ablichtet. Background Patient-reported outcome measures (PROMs) are becoming increasingly important in today’s patient care. Unfortunately, the most common PROMs in hand surgery are very time-consuming and usually do not cover the actual, diagnosis-specific complaints of the patients. For diagnosis and follow-up of thumb carpometacarpal joint osteoarthritis, Noback et al. developed and validated the Thumb Disability Examination (TDX) questionnaire. This 20-item questionnaire specifically assesses daily living limitations and pain as well as patient-reported satisfaction of thumb function. The aim of this study is to validate the German translation of the TDX, the Thumb Disability Examination – German (TDX-G), and to compare it with the German-language versions of the MHQ and qDASH, which are currently used as gold standard. Material und Methods Translation and back-translation were performed in accordance with accepted guidelines. For statistical validation of the TDX-G, 30 consecutive patients with thumb carpometacarpal joint osteoarthritis were interviewed under standardised conditions. Internal consistency was calculated using Cronbach’s alpha. Test-retest reliability was determined in 10 patients who completed the TDX-G twice at an interval of 2 weeks. The validity of the TDX-G was determined by calculating the correlation coefficients of the TDX-G with the MHQ and qDASH, subjective pain sensation (NRS), and hand strength levels (coarse and pinch strength). In addition, the time to collect each questionnaire was compared. Results The TDX-G has high internal consistency (Cronbach’s alpha 0.932) and test-retest reliability (intraclass correlation coefficient 0.963 [0.850–0.991]). There is a significant correlation between TDX-G and MHQ (− 0.782; p<0.001) and qDASH (0.833; p<0.001). All questionnaires correlate significantly with pain on exertion and pinch force, with the TDX-G having the highest correlation in each case. Significantly less time is needed to record the TDX-G (110±28 s) than to record the MHQ (413±98 s). Conclusion The TDX-G is a reliable tool for diagnosing and monitoring the progression of thumb carpometacarpal joint osteoarthritis. It can be used in both patient care and clinical research and accurately mirrors the symptoms. ^* geteilte Erstautorenschaft Received: 07 July 2023 Accepted: 10 October 2023 Article published online: 07 December 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany