Introduction: Distal radius fractures (DRFs) are among the most frequent injuries treated by orthopaedic surgeons. Although postoperative infection is uncommon, it represents a clinically relevant complication that may affect outcomes. This systematic review aimed to evaluate the incidence, subtypes, and treatment of infections following surgical management of DRFs. Materials and methods: A systematic search of MEDLINE/PubMed and Cochrane Library was performed from inception to June 2024, following PRISMA guidelines. English-language longitudinal studies (prospective or retrospective) reporting infection after DRF surgery were included. Case reports, meta-analyses, animal studies, and articles without relevant outcomes were excluded. Extracted data included infection incidence, classification, microbiological findings, and reported management. Results: Fifty-five studies met inclusion criteria, encompassing 6499 patients and 6451 procedures. A total of 341 infections were reported (5.3%). Superficial surgical site infections accounted for 22.6% of cases, deep infections for 12.0%, and pin-tract infections for 61.0%. Infection rates differed by fixation method: approximately 2.0% for open reduction and internal fixation, 12.0% for Kirschner-wire fixation, and 13.9% for external fixation. Microbiological confirmation was reported only in a minority of studies; when available, Staphylococcus aureus was the most frequently isolated organism. Management strategies ranged from oral antibiotics and local wound care for superficial infections to intravenous antibiotics with debridement and hardware removal for severe cases. Conclusions: Infections following DRF surgery are relatively rare but vary across fixation techniques, with pin-tract infections predominating in percutaneous and external constructs. The heterogeneity of infection definitions and the scarcity of microbiological reporting limit comparability between studies. Standardized SSI/FRI classification and more consistent documentation are needed to improve evidence-based prevention and treatment strategies.

Thumb carpometacarpal (CMC) osteoarthritis in advanced stages is frequently associated with metacarpophalangeal (MCP) hyperextension, resulting in the characteristic Z-deformity and reduced pinch stability. Standard basal joint reconstruction may fail to correct MCP hyperextension, contributing to persistent functional impairment. Prosthetic trapeziometacarpal arthroplasty may partially correct Z-deformity but becomes unreliable when MCP hyperextension exceeds 30 degrees. This article describes a reproducible surgical technique combining trapeziectomy, APL suspension arthroplasty, and EPB reinsertion onto the dorsal aspect of the first metacarpal head to restore sagittal balance of the MCP joint. In this configuration, the EPB is intentionally converted from an active extensor into a passive dorsal stabilizer, providing a tenodesis-like restraint against hyperextension while preserving flexion arc. In 10 consecutive patients with Eaton-Littler stage III-IV disease and MCP hyperextension ≥30 degrees, mean hyperextension improved from 38.6 degrees preoperatively to 5.4 degrees at 12-month follow-up, with preservation of MCP flexion and improvement of key pinch strength and QuickDASH scores. This approach provides stable correction of MCP hyperextension while maintaining MCP motion, offering a motion-preserving alternative to capsulodesis or arthrodesis.

Background: Secretan’s syndrome is a rare and under-recognized condition characterized by chronic, indurated, non-pitting edema of the dorsal hand with thumb sparing. Twelve studies reporting 17 patients have been published worldwide, mostly as isolated case reports, and its pathogenesis remains debated between traumatic, inflammatory, and factitious mechanisms. This article presents a surgically managed hyperplastic case and a literature review, highlighting how precision medicine principles can guide diagnosis and treatment. Materials and Methods: A 36-year-old healthcare worker developed progressive dorsal swelling of the left hand following minor trauma, with marked restriction of metacarpophalangeal flexion. Laboratory tests and radiographs were normal. MRI demonstrated peritendinous fibrosis encasing the extensor tendons. Psychiatric evaluation excluded factitious behavior. Due to functional limitation and MRI evidence of fibrosis, selective fasciotomies and tenolysis were performed. A systematic literature review was conducted, in accordance with the PRISMA 2020 guidelines, to summarize epidemiology, clinical and imaging features, histopathology, and management options. Results: Histology revealed fibro-adipose tissue with chronic inflammatory changes and CD68+ histiocytic aggregates; microbiological cultures were negative. Postoperative rehabilitation enabled significant functional recovery. The literature review confirmed the scarcity of published cases and the absence of standardized guidelines. MRI proved the most informative imaging tool, while surgery was described only in refractory forms. Conclusions: This case and review illustrate how a precision medicine approach can optimize management of rare disorders. Early MRI-based diagnosis, multidisciplinary assessment, and phenotype-driven surgical intervention allowed tailored treatment and favorable outcome. Personalized care that integrates clinical features, imaging findings, and patient-specific factors may improve results despite the limited evidence base.

Aim Metacarpal fractures are common hand injuries, frequently treated with closed reduction and internal fixation (CRIF) using Kirschner wires (K-wires). While exposed K-wires allow for simple hardware removal and early mobilization, their use is traditionally associated with a higher risk of pin tract infections. There is a lack of studies focusing exclusively on exposed K-wires in metacarpal fractures. Methods It was retrospectively reviewed 134 patients who underwent CRIF with exposed K-wires for metacarpal fractures between January 2023 and March 2024. After applying inclusion and exclusion criteria, 118 patients were analyzed. Demographics, fracture characteristics, complications, and follow-up data were collected. Functional outcomes were assessed using the QuickDASH and the Michigan Hand Outcomes Questionnaire (MHQ) before hardware removal. Results Most patients were male, 88 (75%), with a mean age of 39.3 years. The little finger was the most frequently injured, 71 (60%). In 102 (86%) cases, a single metacarpal fracture was observed. The average number of wires used was 1.7, and hardware was removed after a mean of 40.1 days. The rate of pin tract infection was <4%, all classified as superficial and managed conservatively. Only one case required reoperation due to secondary displacement. The mean QuickDASH score was 25, and the average MHQ score was 70.15, indicating overall good functional and patient-reported outcomes. Conclusion Exposed K-wire fixation for metacarpal fractures appears safe and reliable, with low complication rates and favorable patient-reported outcomes, supporting its use in outpatient pathways without compromising safety.