Aims. Hand trauma accounts for one in five of emergency department attendances, with a UK incidence of over five million injuries/year and 250,000 operations/year. Surgical site infection (SSI) in hand trauma surgery leads to further interventions, poor outcomes, and prolonged recovery, but has been poorly researched. Antimicrobial sutures have been recognized by both the World Health Organization and the National Institute for Clinical Excellence as potentially effective for reducing SSI. They have never been studied in hand trauma surgery: a completely different patient group and clinical pathway to previous randomized clinical trials (RCTs) of these sutures. Antimicrobial sutures are expensive, and further research in hand trauma is warranted before they become standard of care. The aim of this protocol is to conduct a feasibility study of antimicrobial sutures in patients undergoing hand trauma surgery to establish acceptability, compliance, and retention for a definitive trial. Methods. A two-arm, multicentre feasibility RCT of 116 adult participants with hand and wrist injuries, randomized to either antimicrobial sutures or standard sutures. Study participants and outcome assessors will be blinded to treatment allocation. Outcome measures will be recorded at baseline (preoperatively), 30 days, 90 days, and six months, and will include SSI, patient-reported outcome measures, and return to work. Conclusion. This will inform a definitive trial of antimicrobial sutures in the hand and wrist, and will help to inform future upper limb trauma trials. The results of this research will be shared with the medical community through high impact publication and presentation. Cite this article: Bone Jt Open 2022;3(7):529–535

Aims. Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma. Methods. This will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria. Discussion. The Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication. Cite this article: Bone Jt Open 2024;5(4):361–366

The December 2015 Wrist & Hand Roundup360 looks at: Fuse or replace? The index PIPJ; A solution for the unstable DRUJ at last; Anatomical reconstruction in place of arthroplasty?; The Welsh ‘fight bite’; Does surgeon empathy improve results?; Regional or local for wrist analgesia; The evidence for wrist arthroplasty; FPL rupture a hidden problem?; Deciding on surgery in the distal radius; Composing that paper in hand surgery

Aims. Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alternative methods that have been suggested for assessing BMD include: 1) cortical measures, such as cortical ratios and combined cortical scores; and 2) aluminium grading systems from preoperative digital radiographs. However, limited research has been performed in this area to validate the different methods. The aim of this study was to investigate the evaluation of BMD from digital radiographs by comparing various methods against DXA scanning. Methods. A total of 54 patients with distal radial fractures were included in the study. Each underwent posteroanterior (PA) and lateral radiographs of the injured wrist with an aluminium step wedge. Overall 27 patients underwent routine DXA scanning of the hip and lumbar spine, with 13 undergoing additional DXA scanning of the uninjured forearm. Analysis of radiographs was performed on ImageJ and Matlab with calculations of cortical measures, cortical indices, combined cortical scores, and aluminium equivalent grading. Results. Cortical measures showed varying correlations with the forearm DXA results (range: Pearson correlation coefficient (r) = 0.343 (p = 0.251) to r = 0.521 (p = 0.068)), with none showing statistically significant correlations. Aluminium equivalent grading showed statistically significant correlations with the forearm DXA of the corresponding region of interest (p < 0.017). Conclusion. Cortical measures, cortical indices, and combined cortical scores did not show a statistically significant correlation to forearm DXA measures. Aluminium-equivalent is an easily applicable method for estimation of BMD from digital radiographs in the preoperative setting. Cite this article: Bone Joint Res 2021;10(12):830–839

The October 2012 Wrist & Hand Roundup. 360. looks at: osteoarticular flaps to the PIPJ; prognosis after wrist arthroscopy; adipofascial flaps and post-traumatic adhesions; the torn TFCC alone; ulna-shortening osteotomy for ulnar impaction syndrome; Dupuytren’s disease; when a wrist sprain is not a sprain; and shrinking the torn intercarpal ligament

The August 2012 Wrist & Hand Roundup. 360. looks at: the Herbert ulnar head prosthesis; the five-year outcome for wrist arthroscopic surgery; four-corner arthrodesis with headless screws; balloon kyphoplasty for Kienböck's disease; Mason Type 2 radial head fractures; local infiltration and intravenous regional anaesthesia for endoscopic carpal tunnel release; perilunate injuries; and replanting the amputated fingertip

The February 2013 Wrist & Hand Roundup. 360 . looks at: to splint or not to splint; salvage of the unsalvageable; a close shave for malunions; a classic approach to malunion; diabetic carpal tunnel; capsulodesis; a wrist from a fibula; thumb-based osteoarthritis - a further opinion from the Editor-in-Chief

Introduction. The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures. Materials and methods. The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site. Results. Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p< 0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p< 0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (> 2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (< 1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position. Discussion. Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form

Introduction. The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures. Materials and methods. The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site. Results. Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p< 0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p< 0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (> 2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (< 1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position. Discussion. Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form

The December 2013 Wrist & Hand Roundup. 360 . looks at: Scapholunate instability; three-ligament tenodesis; Pronator quadratus; Proximal row carpectomy; FPL dysfunction after volar plate fixation; Locating the thenar branch of the median nerve; Metallosis CMCJ arthroplasties; and timing of flap reconstruction

The June 2013 Wrist & Hand Roundup. 360 . looks at: whether size is a limitation; cancellous bone grafting in scaphoid nonunion; the Kienböck’s dichotomy; late displacement of the distal radius; flexor slide for finger contracture; aesthetic syndactyly; flexor tendon repair; and fixation of trapeziometacarpal cups

The June 2012 Wrist & Hand Roundup. 360. looks at; radial osteotomy and advanced Kienböck's disease; fixing the Bennett fracture; PEEK plates and four-corner arthrodesis,;carpal tunnel release and haemodialysis; degloved digits and the reverse radial forearm flap; occupational hand injuries; trapeziometacarpal osteoarthritis; fixing the fractured metacarpal neck and pyrocarbon implants for the destroyed PIPJ

The October 2013 Wrist & Hand Roundup. 360 . looks at: Cost effectiveness of Dupuytren’s surgery; A 'new horizon' in distal radius imaging; Undisplaced means undisplaced; The mystery of the distal radial fracture continues; How thick is thick enough?: articular cartilage step off revisited; Is the midcarpal joint more important than we think?; Plates and Kirschner wires; Better early results with an IM nail?

The April 2013 Wrist & Hand Roundup. 360 . looks at: whether botox is just for Hollywood; supercharging nerve repairs; YouTube research; options for Keinbock’s disease; volar plates; driving and plasters; symptomatic radial malunion; and MRI and acute scaphoid fractures

The August 2013 Wrist & Hand Roundup. 360 . looks at: random group therapy is no good at treating OA of the hand; salvaging failed CMCJ arthroplasty; scaphocapitate arthrodesis for instability in manual workers; Brunelli tenodesis and scapholunate instability; night splints for Dupytren’s revisited; the smallest IM nail?; early diagnosis of CRPS?; and endoscopic carpal tunnel release?

The December 2012 Wrist & Hand Roundup. 360. looks at: the imaging of scaphoid fractures; splinting to help Dupuytren’s disease; quality of life after nerve transfers; early failure of Moje thumbs; electra CMCJ arthroplasty; proximal interphalangeal joint replacement; pronator quadratus repair in distal radius fractures; and osteoporosis and wrist fractures

Introduction. The human wrist is a highly complex joint, offering extensive motion across various planes. This study investigates scapholunate ligament (SLL) injuries’ impact on wrist stability and arthritis risks using cadaveric experiments and the finite element (FE) method. It aims to validate experimental findings with FE analysis results. Method. The study utilized eight wrist specimens on a custom rig to investigate Scapho-Lunate dissociation. Contact pressure and flexion were measured using sensors. A CT-based 3D geometry reconstruction approach was used to create the geometries needed for the FE analysis. The study used the Friedman test with pairwise comparisons to assess if differences between testing conditions were statistically significant. Result. The study found significant variations in scaphoid and lunate bone movement based on ligament condition. Full tears increased scapholunate distance in the distal-proximal direction and decreased in the medial-lateral direction. Lunate angles shifted from flexion to extension with fully torn ligaments. Conversely, the scaphoid shifted significantly from extension to flexion with full tears. A proximal movement was observed in the distal-proximal direction in all groups, with significant differences in the partial tear group. Lateral deviation of the scaphoid and lunate occurred with ligament damage, being more pronounced in the partial tear group. All groups exhibited statistically significant movement in the volar direction, with the full tear group showing the least movement. Also, radiocarpal joint and finger contact pressure and contact area were studied. Whereas the differences in contact area were not significant, scapholunate ligament tears resulted in significantly decreased finger contact pressures. FEA confirmed these findings, showing notable peak radiocarpal contact pressure differences between intact and fully torn ligaments. Conclusion. Our study found that SLL damage alters wrist stability, potentially leading to early arthritis. The FEA model confirmed these findings, indicating the potential for the clinical use of computer models from CT scans for treatment planning

INTRODUCTION. Tuberculosis (TB) is a public health challenge. However, musculoskeletal involvement represents 10–15% of all extrapulmonary cases. Upper extremity involvement is extremely rare. The slow progressive course of clinical symptoms and lack of radiological signs lead to difficulties in establishing early diagnosis. Hence, the patients who have tuberculosis of the wrist are usually misdiagnosed. We report 5 cases of tuberculosis of the wrist seen in our unit from the year 2012 to 2021. METHODS. Cases were retrospectively evaluated on demographics, nature of history, clinical presentation, culture finding, and histopathological findings from 2012 to 2021 at our unit. RESULTS. A total of 5 cases were evaluated retrospectively. Three patients were more than 60 years old and two were less than 30 years old. Four of the patients presented with wrist swelling 2 of them had wrist pain and only 1 patient had discharge from the wound. The duration of the symptoms ranges from 2 months to 3 years. Only one of the patients had a history of pulmonary TB contact whereas the others didn't. All patients underwent surgery. All of the patients had positive cultures for Mycobacterium tuberculosis complex and histopathological examination showed necrotizing granulomatous inflammation from specimens taken intraoperatively, which confirmed the diagnosis of tuberculosis of the wrist. DISCUSSIONS. Our cases show that the common presentation of tuberculosis of the wrist was comparable to other literature. Most of the patients presented with chronic wrist swelling with or without wrist pain. The diagnosis of the disease was delayed an average of 10 - 12 months from symptoms onset to diagnosis. S. Bayram et al reported a case where the diagnosis was made 45 months later. Due to its rarity, it often is misdiagnosed, resulting in delays in the proper treatment. CONCLUSION. The diagnosis of the TB wrist remains difficult because of insidious and non-specific. presentation. However, early diagnosis is essential to avoid delays in treatment and complications. Hence, chronic wrist pain, and swelling with or without unexplained bone erosion around the wrist area must be highly suspected of being osteoarticular tuberculosis

Aims. Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. Methods. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. Results. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. Conclusion. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results. Cite this article: Bone Jt Open 2023;4(4):219–225

Introduction. The wrist arthroscopy has been performed since 1979. With the advances in technology and surgical expertise, wrist arthroscopy has become third commonest procedure after knee and shoulder joint. Wrist arthroscopy has become a gold standard for diagnosing TFCC pathologies and other intercarpal disorders. Our aim was to compare the clinical, MRI and arthroscopic findings while treating various wrist pathologies. Materials/Method. In retrospective trial, 30 patients (19 male and 11 female) with clinical evidence of wrist lesions were evaluated with MRI followed by wrist arthroscopy. The mean age of the patients at the time of outpatient appointment was 44 years with an average waiting time of 6.6 months. Inclusion criteria: all patients undergoing wrist surgery. Exclusion criteria: septic arthritis, acute distal radius fractures. Kappa analysis was used to compare the three methods of wrist pathology assessment. The total 30 patients were assessed for clinical findings, MRI report and corresponding arthroscopic findings. Results. According to the clinical findings, 22 patients (68% of all patients) were diagnosed with suspected TFCC injury. In 21 patients, the MRI showed TFCC tear (partial to complete) and this was confirmed by arthroscopy in 22 patients. There was a correlation of clinical, MRI and arthroscopy in detecting TFCC lesions in 95% cases. Sensitivity 93%, specificity 90%, positive predictive value 89% and negative predictive value 94%. The Scapho-lunate ligament tear was suspected in 8 (28% of all patients). In 6 patients, MRI showed scapho-lunate tear and this was confirmed by wrist arthroscopy in 10 patients. Correlation with wrist arthroscopy was 80%, sensitivity 94%, specificity 92%, positive predictive value 90% and negative predictive value 93%. 15 patients (50% of all patients) showed signs of moderate to severe cartilage wear and 12 patients had confirmation with MRI. Correlation with wrist arthroscopy was 75%, Sensitivity 90%, Specificity 91%, positive predictive value 89% with negative predictive value 92%. However clinical examination and MRI had poor correlation with wrist arthroscopy in diagnosing synovitis. Discussion. The MRI and wrist arthroscopy has fair correlation, though MRI sensitivity approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intra-articular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future. Our results showed clinical examination is crucial for diagnosing wrist pathologies, MRI can be used as an adjunct but the wrist arthroscopy still remains the gold standard tool for diagnosis and therapeutic interventions