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Ilse Degreef, Kira Vande Voorde, and Maarten Van Nuffel

  • In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren’s contracture.

  • The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue.

  • Meticulous surgical technique is mandatory.

  • Microsurgery increases magnification from four times (with surgical loupes) up to 40 times.

  • Using the microscope in Dupuytren’s surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications.

  • Increased experience with microsurgery will benefit Dupuytren’s treatment and hand surgery in general.

Andrea Fidanza, Stefano Necozione, and Lorenzo Garagnani


  • Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures.

  • The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy.


  • A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining ‘wrist denervation’, ‘PIN neurectomy’, ‘AIN neurectomy’, anterior interosseous nerve neurectomy’ and ‘posterior interosseous nerve neurectomy’. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was ‘Failures’, including all patients who have required a second surgery or those who are left with pain (defined as ‘bad’).


  • Overall, 10 studies totalling 347 wrists were included in this systematic review, with a ‘moderate’ CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501).


  • Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.

Lorenzo Massimo Oldrini, Pietro Feltri, Jacopo Albanese, Stefano Lucchina, Giuseppe Filardo, and Christian Candrian


  • The aim of this systematic review and meta-analysis was to evaluate whether volar locking plate (VLP) fixation leads to better clinical and radiological outcomes than those of closed reduction and cast immobilization for the treatment of distal radius fractures (DRFs).

Materials and methods

  • A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane databases up to January 2022. Inclusion criteria included randomized controlled trial (RCT) studies comparing VLP fixation with cast immobilization for DRFs. Investigated parameters were Patient-Rated Wrist Evaluation questionnaire, Disabilities of the Harm, Shoulder, and Hand score (DASH), range of motion (ROM), grip strength, quality of life (QoL), radiological outcome, and complication and reoperation rate, both at short- and mid-/long-term follow-up. Assessment of risk of bias and quality of evidence was performed with Downs and Black’s ‘Checklist for Measuring Quality’.


  • A total of 12 RCTs (1368 patients) were included. No difference was found for ROM, grip strength, QoL, and reoperation, while the DASH at 3 months was statistically better in the VLP group (P <  0.05). No clinical differences were confirmed at longer follow-up. From a radiological perspective, only radial inclination (4°) and ulnar variance (mean difference 1.1 mm) at >3 months reached statistical significance in favor of the VLP group (both P < 0.05). Fewer complications were found in the VLP group (P < 0.05), but they did not result in different reintervention rates.


  • This meta-analysis showed that the surgical approach leads to a better clinical outcome in the first months, better fracture alignment, and lower complication rate. However, no differences in the clinical outcomes have been confirmed after 3 months. Overall, these findings suggest operative treatment for people with higher functional demand requiring a faster recovery, while they support the benefit of a more conservative approach in less demanding patients.

Joris Duerinckx and Frederik Verstreken

  • Total joint replacement has certain advantages over other surgical treatment methods for osteoarthritis of the thumb carpometacarpal joint, including restoration of thumb length and alignment, good cosmetical result, fast recovery of hand function and prevention of iatrogenic complications at neighbouring joints.

  • Disadvantages include the technical difficulty to perform this surgery and a possible higher complication rate.

  • A meticulous surgical technique is mandatory.

  • Combined with a cementless and modular ball-in-socket implant with a metal-on-polyethylene friction couple, a 10-year survival rate higher than 90% can be expected.

  • Revision surgery is possible with implant exchange or conversion to trapeziectomy.

Jonny K Andersson, Pelle Gustafson, and Philippe Kopylov

  • Misdiagnosed and maltreated scaphoid fractures filed to the Swedish National Patient Insurance Company (LÖF) 2011–2018 were analyzed in terms of complications and costs for society. All filed claims are database-registered (altogether 200 000 claims since 2000). This database was assessed in June 2019 through injury ICD10-SWE-diagnoses. Demographics, complications, complaints, corrective surgeries and costs were analyzed. The numbers of claims for scaphoid fractures were reviewed and compared with all claims.

  • There was a statistically significant trend towards decreasing numbers of notified scaphoid fracture cases during this time. This is not the case compared with the total annually notified injuries to LÖF during the same time, where we instead can see statistically significant increased numbers.

  • Median age for the 128 patients was 24 years. Men represented 76%. Seventy-eight of the 128 (61%) claims were judged as avoidable, compared with 42% in terms of all notified injuries. Pseudoarthrosis dominated as complication (n  = 71). Total numbers of complications were 117, and 47 of the 78 patients had medical invalidity as a consequence. Up to six secondary corrective surgeries per patient were required. Complications and disabilities were more severe if patients needed more than one surgery. The total costs were calculated to €1 226 193.

  • Level of Evidence: LoE III, Therapeutic.

Michael Millrose, Markus Gesslein, Till Ittermann, Simon Kim, Hans-Christoph Vonderlind, and Mike Ruettermann

  • Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results.

  • Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally.

  • The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies.

  • A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring.

  • All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Marco Guidi, Florian S. Frueh, Inga Besmens, and Maurizio Calcagni

  • The intramedullary headless compression screw (IMCS) technique represents a reliable alternative to percutaneous Kirschner-wire and plate fixation with minimal complications.

  • Transverse fractures of the metacarpal shaft represent a good indication for this technique. Non-comminuted subcapital and short oblique fractures can also be treated with IMCS.

  • This technique should not be used in the presence of an open epiphysis, infection and, most of all, in subchondral fractures, because of the lack of purchase for the head of the screw.

  • A double screw construct is recommended for comminuted subcapital fractures of the metacarpal to avoid metacarpal shortening. IMCS can even be applied for peri-articular fractures of the proximal third of the phalanx and in some multi-fragmentary proximal and middle phalangeal fractures.

  • Usually the intramedullary screws are not removed. The main indications for screw removal are joint protrusion, infection and screw breakage after new fracture.

Cite this article: EFORT Open Rev 2020;5:624-629. DOI: 10.1302/2058-5241.5.190068

Toni Luokkala, Minna K. Laitinen, Teemu P. Hevonkorpi, Lauri Raittio, Ville M. Mattila, and Antti P. Launonen

  • We found no clear evidence of the clinical superiority of distal radius fracture surgery among older adults at one year.

  • Surgical treatment, however, may yield a faster recovery to previous level of activity in elderly patients.

  • With operative treatment, hardware-based problems may warrant secondary operations and implant removal, whereas in non-operative treatment, symptomatic loss of alignment and malunion can occur.

  • In elderly patients, non-operative treatment can be considered to be the gold standard.

Cite this article: EFORT Open Rev 2020;5:361-370. DOI: 10.1302/2058-5241.5.190060

Elena Bravo, Raul Barco, and E. Carlos Rodríguez-Merchán

  • Musculo-skeletal complications of the hand in the haemophilia patient are rare, and they include synovitis, arthropathy, pseudotumours, carpal tunnel syndrome and vascular aneurysms and pseudoaneurysms.

  • The best way to prevent the aforementioned musculo-skeletal complications is early continuous haematological primary prophylaxis (intravenous infusion of the deficient coagulation factor, ideally from cradle to death).

  • There is a wide range of procedures that a hand surgeon treating these patients should be able to manage, including synovectomy, prosthetic replacement of small joints, removal or curettage of pseudotumours, release of carpal tunnel and, occasionally, vascular reconstruction of aneurysms.

  • The treatment of these patients should be made at an institution with close collaboration between haematologists and hand surgeons (all surgical procedures must always be performed under cover of the deficient coagulation factor).

Cite this article: EFORT Open Rev 2020;5:328-333. DOI: 10.1302/2058-5241.5.190078

Bedri Karaismailoglu, Mehmet Fatih Guven, Mert Erenler, and Huseyin Botanlioglu

  • Scaphoid nonunion is a challenging situation for orthopaedic surgeons. Nonunion rate is especially high in proximal pole fractures of the scaphoid due to tenuous retrograde blood supply.

  • The use of pedicled vascularized bone grafts for the treatment of scaphoid nonunion provides both good clinical and radiological outcomes.

  • The preserved vascularity of the graft leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the conventional non-vascularized grafting.

  • Pedicled vascularized bone grafts also allow the correction of the carpal alignment and humpback deformity of the scaphoid.

  • Clinical and radiological results have been satisfactory and promising, making us anticipate that the role of vascularized bone grafting for the treatment of carpal diseases will increase.

Cite this article: EFORT Open Rev 2020;5:1-8. DOI: 10.1302/2058-5241.5.190021