Four-corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow-up period was 44.5 months (range, 22-68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion-extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion-extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain-free wrist. Moreover, these results were maintained at follow-up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four-corner fusion for advanced degenerative osteoarthritis of wrists.

Finger extension stiffness is a common post-traumatic complication that results in the hand’s functional impairment. In clinical practice, a dynamic splint enables the patient to stretch the affected finger independently. However, current dynamic splints have drawbacks, such as limited stretching efficacy, and interfere with the hand’s functional activities. Therefore, this study aimed to develop a dynamic finger flexion orthosis capable of stretching each finger joint using additive manufacturing (AM) technology, thereby enabling hand functional activity, and analyze the clinical improvement in the range of motion (ROM). One subject with a hand fracture was recruited while undergoing a 7-week home-based rehabilitation program for the orthosis. The outcome measurements included the total active motion (TAM), the tip-to-finger distance (TPD), and the score on the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The results show that the TAM of the participant’s fingers increased by 72.7 degrees on average, the TPD decreased by 3.5 cm on average, and the DASH score decreased to 9.5 points. The 7-week home-based rehabilitation program for the orthosis resulted in a 53.6% increase in the TAM on average. The developed orthosis improved hand function and enabled a more complete ROM in finger flexion.

Background: Ulnar-side carpometacarpal joint (CMCJ) fracture-dislocation is a rare hand injury, accounting for <1% of all hand and wrist injuries, and is often overlooked on plain radiographs. Surgical treatment is usually required, but the optimal approach depends on the fracture pattern and timing of diagnosis. The aim of this study is to explore the factors that make open reduction necessary for proper fracture alignment and to evaluate patient recovery after such procedures. Methods: This study retrospectively reviewed patients who underwent surgical treatment for ulnar-side CMCJ fracture-dislocation between 2009 and 2022. Data on demographics, injury mechanism, time from injury to surgery, and surgical techniques were recorded. Postoperative outcomes were assessed using functional scores, including the Mayo Wrist Score (MWS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Visual Analogue Scale (VAS), and radiographic evaluations. Results: A total of 44 patients (median age 36.4 years; 34 men and 10 women) were included. The median time from injury to surgery was 7 days (range, 1 to 61 days). Open reduction was required in all 17 patients with delayed surgery (≥2 weeks; p < 0.01). Among the 13 patients in the acute group who required open reduction, 11 patients presented with impacted type or intra-articular comminution fractures ( p = 0.04). Anatomic reduction was achieved in 42 of 44 patients (95.2%), who demonstrated favorable outcomes with high functional scores, minimal pain, and absence of radiographic evidence of post-traumatic arthritis during follow-up. Conclusion: Surgical delay and fracture pattern are key determinants for the need for open reduction. Early recognition and timely surgical management are crucial in the treatment of ulnar-side CMCJ fracture-dislocations. Even in delayed cases, restoring alignment and joint stability can still yield good functional outcomes and reduce the risk of long-term complications.

Dynamic ulnar impingement is a common and painful symptom after the Darrach procedure. However, the current detection method with static radiographs often falls short of examining the dynamically symptomatic wrists. We, therefore, investigate the utility of ultrasonography to assess dynamic ulnar impingement. In this cross-sectional study, 20 patients, with 22 wrists, who had undergone the Darrach procedure were evaluated at a mean of 55 months (range, 25–171) from the index procedure. Real-time ultrasonographic imaging in the axial plane of the bone and soft tissue was performed during three different dynamic testing methods, including weight-stressed (WS), pronation-supination (PS), and forceful fist clenching (FC), to investigate ulnar impingement. Dynamic radiographs were obtained for comparison. Clinical outcomes were evaluated with grip strength and patient-reported outcomes including pain in daily activities on a numeric rating scale (NRS), the Patient-Rated Wrist Evaluation (PRWE), and the Quick Disability of the Arm, Shoulder and Hand (QDASH). Ultrasonographic ulnar impingement found during PS method was associated with worse pain and function, yet impingement diagnosed with dynamic radiographs or ultrasonography with WS and FC method was not associated with worse outcomes. While radiographic impingement was found in a total of 12 wrists (55%), ultrasonography with the WS and PS method revealed true bone contact in only 2 (9%) and 4 (18%) of the wrists, respectively. The addition of ultrasonography may be valuable in follow-up evaluations after the Darrach procedure.