Hand Center Recent Publications

Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Description
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range...

Publication Date
2023-10-12

Faculty
Jerry Huang, MD

Selective nerve transfers to restore shoulder abduction and flexion in acute flaccid myelitis: A case report

Description
Acute flaccid myelitis (AFM) is a polio-like condition predominantly affecting children that is characterized by acute-onset, asymmetric flaccid paralysis, often preceded by a prodromal fever or viral illness. With prompt diagnosis and early surgical referral, nerve transfers may be performed to improve function. Highly selective nerve transfers are ideal to preserve existing functions while targeting specific deficits. In this report, we present a case of a double fascicular nerve transfer of...

Publication Date
2023-08-30

Faculty
Yusha Katie Liu, MD

Staple Fixation in Ulnar-Shortening Osteotomies

Description
Ulnar-sided wrist pain is commonly caused by the ulnar impaction syndrome. Ulnar-shortening osteotomy is a surgical treatment that is used to address ulnar impaction syndrome that fails conservative management. Unfortunately, hardware irritation and nonunion are well-known complications of this procedure. This case report details the course of two patients with nonunion after ulnar-shortening osteotomy who were treated with a combination of a nitinol compression staple and neutralization plate....

Publication Date
2023-07-31

Faculty
Jerry Huang, MD

Approach to Tendinopathies of the Upper Limb: What Works

Source
Hand Clinics

Description
Tendinopathies are some of the most common diagnoses treated by hand surgeons. Diagnoses such as trigger digit, de Quervain tenosynovitis, extensor carpi ulnaris tendinitis, and epicondylitis often resolve with nonoperative treatment and/or a single ambulatory procedure. When symptoms persist or worsen after surgery, patients are disappointed and treatment can be challenging. This article reviews practical points in evaluation of such cases, and surgical options that work in revision scenarios.

Summary
Tendinopathies of the upper limb — including trigger finger, de Quervain tenosynovitis, extensor carpi ulnaris tendinitis, and epicondylitis — are among the most frequently encountered conditions in hand surgery practices. This review article examines current approaches to evaluating and managing these conditions, with a particular focus on cases where initial treatments have failed. The authors highlight that most of these diagnoses respond well to conservative care or simple outpatient procedures, but persistent or worsening symptoms after surgery present a significant clinical challenge. The article outlines practical evaluation strategies and surgical revision options for patients who do not improve with standard treatment. This work is significant because it provides hand surgeons with a structured framework for managing difficult, treatment-resistant tendinopathy cases, ultimately aiming to improve patient outcomes and reduce frustration when first-line approaches fall short.

Publication Date
2023-07-15

Faculty
Stephen Kennedy, MD

Fixation Techniques for Scaphoid Nonunion

Description
Scaphoid fractures are common injuries with high risk of nonunion. Various fixation techniques exist for managing scaphoid nonunions, including Kirschner wires, single or dual headless compression screws, combination fixation techniques, volar plating, and compressive staple fixation. The indication for each fixation technique varies depending on the patient, type of nonunion, and clinical scenario.

Publication Date
2023-06-12

Faculty
Jerry Huang, MD

Intra-Articular Antegrade Intramedullary Screw Fixation for Proximal Phalanx Fractures: Impact of Articular Surface Defects on Joint Contact Pressures

Description
CONCLUSIONS: Our study demonstrates that antegrade intramedullary fixation of proximal phalanx fractures can increase MCP joint peak contact pressures, particularly in an extended joint position. Effect increases with defect size. This has implications for the management of proximal phalanx fractures using this technique.

Publication Date
2023-05-26

Faculty
Chelsea Boe, Md

Ideal Length and Diameter for Intramedullary Screw Fixation of Metacarpal Fractures: A Biomechanical Study

Description
CONCLUSIONS: The results demonstrated significantly higher torsional strength and resistance to 3-point bending with larger intramedullary screw diameters. Further, when selecting the intramedullary screw length, the screw tip should pass at least 10 mm beyond the fracture.

Publication Date
2023-03-28

Faculty
Jerry Huang, MD

Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review

Description
CONCLUSIONS: Both TMR and RPNI may be beneficial for preventing and treating pain originating from peripheral nerve dysfunction compared to traditional techniques. Randomized trials with longer term follow-up are needed to directly compare the effectiveness of TMR and RPNI with traditional nerve management techniques.

Publication Date
2023-03-25

Faculty
Yusha Katie Liu, MD

Ganglions in the Hand and Wrist: Advances in 2 Decades

Description
Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to...

Publication Date
2022-12-29

Faculty
Nicholas Iannuzzi, MD