Hand Center Recent Publications

Ulnar-sided wrist pain is difficult to diagnose because several anatomical structures overlap in that region and can produce similar symptoms. This article provides a practical guide for surgeons on how to use magnetic resonance imaging (MRI) as a supplementary diagnostic tool to better identify the source of pain on the inner side of the wrist. The authors outline the key anatomical structures in this area and explain how they appear on MRI scans, helping clinicians recognize normal versus abnormal findings. A step-by-step, systematic approach to reviewing MRI images of the ulnar wrist is presented to reduce the chance of missing important pathology. This guide is significant because it equips surgeons with a structured framework for interpreting MRI findings, potentially leading to more accurate diagnoses and better treatment decisions for patients with this complex condition.

Researchers reviewed how artificial intelligence (AI), particularly natural language processing and machine learning, is being used in plastic surgery for both patient care and administrative tasks. The study examined AI applications across several areas, including monitoring patients after complex surgeries, assessing preoperative risks, analyzing clinical notes, and automating medical billing processes. Key findings showed that AI can accurately interpret procedural billing codes from clinical documentation, and that healthcare companies have already begun using AI to improve hospital revenue management cycles. Insurance companies have also started piloting AI to speed up the prior authorization process, which traditionally causes significant delays in patient care. These developments suggest that AI has strong potential to reduce administrative burdens, improve billing accuracy, and increase financial efficiency for plastic surgeons and healthcare systems more broadly.

This study investigated the causes of ulnar-sided wrist pain in children and teenagers and evaluated how accurately MRI scans detect these injuries compared to direct visualization through arthroscopic surgery. Researchers reviewed 40 patients under age 18 who received both an MRI and a diagnostic wrist arthroscopy between 2004 and 2021, with most patients having experienced prior trauma. The most common diagnoses found during surgery were tears of the triangular fibrocartilage complex (TFCC), particularly Palmer 1B tears, and ulnotriquetral ligament tears. MRI showed high specificity, meaning it rarely produced false positives, but low sensitivity, meaning it frequently missed injuries that were confirmed during surgery, with accuracy ranging from 70% to 83% depending on the injury type. These findings suggest that a negative MRI should not rule out significant wrist pathology in young patients, and surgeons should maintain strong clinical suspicion for TFCC injuries when physical examination findings are positive, even when imaging appears normal.

Intra-articular malunion of the distal radius occurs when a wrist fracture heals in an improper position, leaving the joint surface misaligned, which can cause pain, stiffness, and loss of function. This article reviews the clinical management of this condition, discussing when surgical correction is appropriate and how it can be carried out effectively. The primary surgical approach involves a corrective osteotomy — a procedure where the bone is re-cut and realigned — which may require multiple surgical incisions and the use of both front- and back-side implants to stabilize the wrist. Advanced tools such as arthroscopic cameras and custom 3D-printed surgical guides can improve the precision of the correction, especially in complex cases involving deformity in multiple planes. While surgery can meaningfully improve wrist movement, grip strength, and patient-reported outcomes, it is important to note that post-traumatic arthritis may still develop over time, meaning surgery can improve function but may not fully alter the long-term course of the injury.

Scaphoid nonunion, a condition where a fractured wrist bone fails to heal properly, remains difficult to treat even with modern surgical techniques. This article examines the use of nonvascularized bone grafting, a traditional approach that does not require transplanting bone with its blood supply, as a treatment option for fractures at the waist and proximal pole of the scaphoid bone. The method relies on key technical steps including thorough removal of damaged tissue, restoring the proper length and alignment of the scaphoid, and securing the bone with stable fixation using screws, wires, or plates. Surgeons can choose from several types of bone graft materials—including corticocancellous, cancellous, and strut grafts—to encourage healing and correct a common deformity called humpback deformity, where the bone collapses into an abnormal angle. When performed with careful technique, nonvascularized bone grafting can achieve good union rates and help patients regain functional use of the wrist, making it a viable option for managing this challenging condition.

Upper extremity replantation involves reattaching severed limbs or digits using microsurgery techniques that require highly specialized skills and careful planning. This review article examines the full process of managing these complex surgeries, covering everything from initial patient evaluation before surgery through recovery and follow-up care. The authors outline key principles of microvascular surgery, which involves reconnecting tiny blood vessels, nerves, and tendons under magnification to restore function to the injured limb. Important considerations include patient selection, the condition of the amputated part, surgical timing, and strategies to prevent complications such as blood clot formation or tissue death after reattachment. Understanding these principles is essential for improving outcomes in patients who suffer traumatic upper limb amputations, making this review a valuable resource for surgeons and medical professionals working in hand and reconstructive surgery.