Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education.

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.

Zusammenfassung: Das Karpaltunnelsyndrom (KTS) kann ein frühes klinisches Zeichen einer systemischen Amyloidose sein. Muskuloskelettale Manifestationen wie KTS, Tendovaginosis stenosans oder Morbus Dupuytren treten oft Jahre vor kardialen oder neurologischen Symptomen auf und eröffnen damit ein potenziell relevantes diagnostisches Zeitfenster. Wir führten eine retrospektiv-prospektive Analyse aller Karpaldachspaltungen (2013–2025) durch. Für 2013–2023 wurden demografische Daten sowie die Entnahme und Untersuchung von Gewebe erfasst. Für 2024 erfolgte retrospektiv zusätzlich eine erneute histologische Nachuntersuchung der Präparate mittels Kongorot-Färbung in polarisiertem Licht. Ab Mai 2025 wurden Biopsien auch im Rahmen von Ringbandspaltungen und partiellen Aponeurektomien bei Morbus Dupuytren prospektiv untersucht. Ergänzend erfolgte eine narrative Literaturübersicht zur klinischen Bedeutung muskuloskelettaler Manifestationen bei Amyloidose. Von insgesamt 990 Karpaldachspaltungen erfolgte in 32,4% (n=321) eine Gewebeentnahme, wovon 25,2% (n=81) histologisch analysiert wurden. Amyloidablagerungen wurden in 18,8% (n=15) der untersuchten Proben nachgewiesen. Das mediane Alter der Amyloid-positiven Patienten betrug 82 Jahre, Männer waren häufiger betroffen (73%, OR 4,6; p=0,001). Begleitende muskuloskelettale Erkrankungen traten signifikant häufiger bei Amyloid-positiven Patienten auf (RR 6,0; p<0,001). Kardiale Vorerkrankungen fanden sich bei 37,5% der Amyloid-positiven Patienten, davon zwei mit bestätigter kardialer Amyloidose. Fünf Patienten zeigten weder kardiale noch neurologische Symptome. In Ringbandspaltungen lag die Amyloid-Nachweisrate bei 15,4%, während in Aponeurektomien bei Morbus Dupuytren bislang kein Nachweis gelang. Unsere Ergebnisse ergänzen die Beobachtung, dass Amyloidablagerungen bei handchirurgischen Eingriffen nachweisbar sein können. Die gezielte histologische Untersuchung synovialer Gewebeproben im Rahmen von Karpaldachspaltungen oder Ringbandspaltungen kann einen wertvollen Beitrag zur Früherkennung systemischer Amyloidosen leisten. Angesichts der hohen Dunkelziffer und der prognostischen Relevanz sollte die Integration einer risikoadaptierten Biopsiestrategie in handchirurgische Standardverfahren und Leitlinien geprüft werden.

Background: Hamate-lunate impingement or osteoarthritis can be a cause of ulnar-sided wrist pain. In the literature, the lunate has commonly been classified according to the configuration of its distal articular surface into type 1 and type 2, as described by Viegas. A type 1 lunate possesses only a distal articular surface for the capitate, while a type 2 lunate shows an additional medial facet articulating directly with the hamate. Type 2 lunates have been identified as a risk factor for ulnar-sided wrist pain and the development of osteoarthritis in the midcarpal wrist. However, this does not sufficiently explain all arthritic changes between the hamate and lunate. Methods: In this prospective anatomical-radiological cadaver study, 60 wrists were examined. The midcarpal articulation was documented using conventional X-ray, CT arthrography, and anatomical dissection. The study specifically analyzed the positioning of the lunate relative to the hamate apex and its association with the development of hamate-lunate osteoarthritis. For this purpose, the classification by Viegas was refined. Based on posterior-anterior (p.a.) X-ray examinations of the wrist lunates were divided into type 1a, type 1b, and type 2. The type 1a lunate articulates only with the capitate in the midcarpal joint. The type 1b lunate also articulates only with the capitate; however, medially, the apex of the hamate protrudes beyond a Differentiation Line (D-line), which extends from the radial border of the trapezium or the ulnar border of the lunotriquetral (LT) space, without forming a facet with the lunate. A type 2 lunate articulates distally with the capitate and has an additional medial facet with the hamate. Results: Osteoarthritis between the hamate and lunate was observed in both Viegas type 1 and type 2 lunates. According to our refined lunate classification, both in situ and radiologically, type 1b and type 2 lunates showed a substantially higher prevalence and severity of hamate-lunate osteoarthritis compared to type 1a lunates. However, there was no significant difference in the prevalence of hamate-lunate osteoarthritis between type 1b and type 2 lunates. Conclusions: Assessing lunate type and signs of osteoarthritis is essential when evaluating patients with ulnar-sided wrist pain. Our study demonstrates that osteoarthritis in Viegas type 1 lunate is influenced by the position of the hamate apex relative to the D-line. The refined lunate classification, based on correlated radiological and anatomical studies of the wrist, provides a straightforward method for identifying a potential cause of ulnar-sided wrist pain on p.a. X-rays. This classification can help guide further diagnostic and therapeutic decisions, such as wrist arthroscopy with possible resection of the hamate apex.

Tranexamic acid (TXA) has gained increasing popularity in plastic and reconstructive surgery for minimizing perioperative bleeding and improving postoperative outcomes. However, standardized guidelines on its use remain lacking. Methods: An anonymous international survey was distributed to over 400 plastic surgeons worldwide to evaluate current TXA usage patterns, including dosage, timing, route of administration as well as perceived efficacy and safety. Sixty-nine fully completed responses from 17 countries were analyzed. Overall, 86.9% of respondents reported TXA use, primarily to reduce blood loss and postoperative bruising. Intravenous administration was preferred by 55.9%, topical by 15.3%, and 28.8% used both. The most common intravenous dose was 10–14 mg/kg BW, usually given intraoperatively or within 30 min before incision. Topical TXA was typically applied during hemostasis or wound closure, most frequently undiluted (100 mg/mL) or in diluted solutions (10–50 mg/mL). Use was highest in aesthetic bodycontouring and breast procedures but remained low in microvascular and burn surgery. Almost all respondents (98%) reported no TXA-related complications. No thromboembolic or neurological adverse events occurred. TXA is widely and safely implemented in plastic surgery, particularly in aesthetic procedures, but substantial heterogeneity exists regarding dosage, timing, and route of application. These findings underscore the need for procedure-specific, evidence-based protocols and prospective multicenter trials to standardize TXA use in plastic and reconstructive surgery.

Aesthetic outcomes are a crucial determinant of the overall success of breast reconstruction. Recently, aesthetic assessment has evolved from relying mainly on subjective impressions to incorporating more quantitative methods. This systematic review summarizes current concepts and emerging technologies in aesthetic outcome assessment after breast reconstruction. A comprehensive search of studies evaluating aesthetic outcomes following implant-based, autologous or hybrid breast reconstruction was performed between 2000 and 2025. Assessments were classified as subjective or objective. Extracted variables included assessment characteristics, aesthetic outcome domains, and patient-centered outcomes. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine. A total of 51 studies involving 7711 participants from 16 countries were included. Subjective tools were most frequently employed, led by the BREAST-Q (35/51, 69%), followed by expert- or panel-based evaluations (17/51, 33%) and the visual analog scale (2/51, 4%). Objective methods were applied in 19 studies and included 3-dimensional surface imaging (8/51, 16%), BCCT.core (7/51, 14%), eye tracking (3/51, 6%), and artificial intelligence–based analyses (3/51, 6%). Although subjective tools captured satisfaction with breast appearance, objective tools quantified morphological parameters and positional landmarks. BREAST-Q remains the cornerstone of outcome evaluation after breast reconstruction, providing patient-centered perspectives, including, but not limited to, aesthetic perception. A progressive shift toward multimodal evaluation was noticed, as no single modality comprehensively addressed all aesthetic domains. Future research should focus on integrating subjective and objective assessment methods within a unified framework. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.