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What's New — Hand — September 2026

51 new articles published this month.

Themes: Carpal Tunnel and Amyloidosis · Flexor Tendon Injury and Repair · Hand Tumors and Rare Lesions · Soft Tissue Reconstruction and Wound Care · Paediatric and Congenital Hand Conditions · Wrist and Small Joint Arthroplasty

Digest generated 2026-10-04 16:02:31+00:00.

Highlights

Carpal Tunnel and Amyloidosis

Carpal tunnel release features prominently this month, spanning surgical technique, systemic disease detection, and care equity. A randomised military trial found ultrasound-guided release in a procedure-room setting achieved comparable two-year outcomes to mini-open release [37]. Two studies highlight carpal tunnel tissue as a window on systemic amyloidosis: a propensity-matched cohort examined postoperative outcomes after release in systemic amyloidosis [5], while a systematic review and retrospective cohort evaluated tenosynovial and transverse carpal ligament biopsy for early transthyretin amyloid cardiomyopathy detection, particularly in African American patients [19]. Finally, census-tract-level socioeconomic status was associated with delays to consultation and surgery for carpal tunnel syndrome, underscoring inequities in the care pathway [34].

Flexor Tendon Injury and Repair

Zone 1 flexor digitorum profundus avulsion repair was addressed from several angles. A systematic review of suture anchor fixation across 161 patients found postoperative stiffness the most common complication, with poor outcomes in roughly a quarter of cases [4]. A combined cadaveric and clinical study showed a novel nondrilling pull-out technique provided similar biomechanical strength to Bunnell's technique with less postoperative pain and fewer bone- and nail-related complications [51]. Broader context comes from a five-year southern Italian cohort describing the epidemiology, functional outcomes, and socioeconomic burden of hand tendon injuries [46], and a ten-year analysis of 341 patients identifying predictive factors for outcomes in pyogenic flexor tenosynovitis [47].

Hand Tumors and Rare Lesions

Several reports illuminated rare and diagnostically challenging lesions of the hand. A narrative review with case report of fibro-osseous pseudotumor of the digit emphasized its infection-mimicking presentation and risk of inappropriate ablative surgery [16]. Case reports described multicentric calcifying aponeurotic fibroma with nerve compression and bony dysplasia [33], Merkel cell carcinoma of the hand requiring early recognition and aggressive multimodal treatment [28], a rare digital dermocutaneous fibroma of the flexor tendon sheath managed with wide excision and staged grafting [45], and polyethylene liner fracture in a Touch trapeziometacarpal prosthesis presenting as painless clicking [21]. A dual-plate allograft construct for metacarpal lytic lesions showed biomechanical strength sufficient for immediate loading [43].

Soft Tissue Reconstruction and Wound Care

Reconstructive coverage of complex hand defects was a recurring focus. A comparative retrospective study found the homodigital adipofascial reverse flap offered superior sensory recovery, less cold intolerance, and faster return to work than dermal substitute plus graft for fingertip pulp loss [7]. The posterior interosseous artery flap, alone or combined with local and fillet flaps, provided reliable coverage in severe hand injuries [42]. A randomised noninferiority trial validated a low-cost reverse aqua pump negative pressure wound therapy as clinically equivalent to commercial systems, with important affordability implications for developing countries [24]. Complementing these, a guidelines review concluded routine antibiotic prophylaxis is unnecessary for most clean soft tissue hand procedures [30], and vitamin D status was linked to early wound healing after trigger finger release [6].

Paediatric and Congenital Hand Conditions

Paediatric hand pathology appeared across trauma, congenital, and neuromuscular domains. A population-based Danish registry study characterized the epidemiology of childhood hand fractures [49], while a closed reduction technique using hyperextension, rotation, and ulnar deviation successfully treated complex dorsal metacarpophalangeal dislocations in 16 children [15]. In brachial plexus birth injury, three-dimensional motion analysis explored limb dominance and trumpeter posture during feeding tasks [3], and a letter clarified interpretation of the Narakas classification in relation to MRI injury patterns [38]. Muscle morphology studies in spastic cerebral palsy linked biceps and forearm ultrasound findings to the severity of forearm, wrist, and finger deformities [17], and a consensus classification of forearm involvement in multiple hereditary exostoses was discussed in commentary [10].

Wrist and Small Joint Arthroplasty

Degenerative and post-traumatic joint reconstruction of the wrist and digits generated several reports. Occupational therapy after total wrist arthroplasty showed no clear advantage in motion, complications, or cost in a small retrospective series [2]. For ulnar impaction syndrome, a bridge-combined fixation system simplified ulnar shortening osteotomy with reliable correction and no nonunion [18]. Biomechanical analysis linked lunate facet inclination and interfacet angles to lunate loading, informing Kienböck disease risk [27], and an Innovator's Corner interview highlighted vascularized medial femoral trochlear flaps for scaphoid nonunion and Kienböck reconstruction [39]. Distal interphalangeal arthrodesis with percutaneous reaming improved fusion and pain versus non-reamed technique [8], and meniscus allograft interposition with bioabsorbable pin fixation preserved motion in advanced PIP contracture [11].

Articles by Theme

Carpal Tunnel and Amyloidosis (4)

5. Kurbanov F, Dussik C, Phan A, et al. Systemic Amyloidosis and Postoperative Outcomes After Carpal Tunnel Release: A Propensity Score–Matched Cohort Study. HAND 2026. doi:10.1177/15589447261487629

A 1:1 propensity score, matched cohort study using the TriNetX EHR network compared early wound complications and intermediate-term symptom-driven care after carpal tunnel release between patients with and without systemic amyloidosis. The abstract does not report the final effect estimates, but the design matched on demographics, comorbidities, technique, and relevant exposures with prespecified 30-day and 90-365-day outcome windows. Results will clarify whether amyloidosis warrants heightened postoperative surveillance or altered management after CTR.

19. Dogar S, Punnakanta P, Williams MD, et al. Tenosynovial and Transverse Carpal Ligament Biopsy for Early Transthyretin Amyloidosis Cardiomyopathy Detection: A Systematic Review and African American Retrospective Cohort Study. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101020

A systematic review of 22 studies plus a retrospective cohort of African American patients undergoing carpal tunnel release with routine tenosynovial or transverse carpal ligament biopsy assessed amyloid detection for early transthyretin amyloid cardiomyopathy diagnosis. Amyloid deposits were found in 10-30% of carpal tunnel release specimens in the literature, supporting biopsy feasibility. Routine biopsy at carpal tunnel release, particularly in populations with the V122I mutation, offers hand surgeons an opportunity for early ATTR-CM detection before heart failure.

34. Franchino JT, Jahnke K, Hamdan S, et al. Association of Neighborhood Socioeconomic Status With Time to Consultation and Surgery for Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101080

In a retrospective review of 276 patients undergoing carpal tunnel release, census tract-level socioeconomic measures (Area Deprivation Index and Social Vulnerability Index) were linked to delays from symptom onset to hand-specialty consultation and to surgery. The study examined whether lower neighborhood SES predicted longer delays at earlier stages of the care pathway with higher geographic granularity than prior ZIP-code-level studies. Results inform whether socioeconomic disadvantage contributes to inequities in CTS care access and timing.

37. Smith MS, Yuan X, Deal JB, et al. Carpal Tunnel Release Using Ultrasound Guidance: Two-Year Outcomes of a Randomized Controlled Trial Within the Military. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101078

In a single-site randomised controlled trial within the US military, 41 patients with carpal tunnel syndrome were randomised to ultrasound-guided carpal tunnel release in a clinic procedure room versus mini-open release, with patient-reported outcomes followed to 2 years with 100% follow-up. The primary outcome was QuickDASH at 1 month, with additional pain, symptom severity, palmar pain, and adverse event measures. The trial tests whether the less invasive ultrasound-guided approach provides comparable short- and long-term outcomes to support its use in deployed or resource-limited military settings.

Flexor Tendon Injury and Repair (4)

4. Adeyiga A, Igwe C, Niemi K, et al. Suture Anchor Fixation for Zone 1 Flexor Digitorum Profundus Avulsion Injuries: A Systematic Review of Outcomes and Complications. HAND 2026. doi:10.1177/15589447261485595

A PRISMA-guided systematic review identified eight studies covering 161 patients who underwent zone 1 FDP avulsion repair with suture anchor fixation. Complications or poor outcomes occurred in 27% of cases, most commonly postoperative stiffness or decreased range of motion (17%), with infection, anchor problems, nail deformity, and repair failure each being uncommon. Clinicians can use these pooled estimates when counseling patients and weighing suture anchors against alternative fixation for zone 1 FDP injuries.

46. Delia G, Colonna MR, Di Blasi F, et al. Epidemiology, functional outcomes, and socioeconomic burden of hand tendon injuries: A five-year retrospective cohort study in southern Italy. Injury 2026. doi:10.1016/j.injury.2026.113691

This five-year retrospective cohort study from southern Italy characterized the epidemiology, functional outcomes, and socioeconomic burden of hand tendon injuries. It documented injury patterns, treatment results, and the associated costs and productivity losses for patients and the healthcare system. The clinical implication is that hand tendon injuries carry substantial socioeconomic consequences, underscoring the importance of optimised acute management and rehabilitation to reduce long-term functional and economic burden.

47. Idarrha F, Demnati B, Boumediane EM, et al. Predictive Factors for Outcomes in Pyogenic Flexor Tenosynovitis: A 10-Year Analysis of 341 Patients. Injury 2026. doi:10.1016/j.injury.2026.113631

This 10-year retrospective analysis of 341 patients with pyogenic flexor tenosynovitis identified predictive factors associated with clinical outcomes. By analyzing demographic, clinical, and treatment variables, the study sought to determine which features portend worse results. The clinical implication is that early recognition of high-risk patients may guide more aggressive or expedited treatment decisions to improve outcomes in this hand infection.

51. Yildiran G, Kocak OK, Nur B, et al. Decreased Postoperative Pain and Similar Biomechanical and Functional Outcomes of a Nondrilling Pull-Out Technique Compared to Bunnell's Technique in Flexor Digitorum Profundus Zone 1 Injuries. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.016

This combined cadaveric and clinical study compared a novel nondrilling pull-out technique against Bunnell's pull-out technique for zone 1 flexor digitorum profundus tendon repairs. Biomechanical testing showed similar repair strength, while the nondrilling technique produced less postoperative pain with comparable functional outcomes at 6 months. The findings suggest the nondrilling approach can avoid bone drilling-related complications without sacrificing fixation security.

Hand Tumors and Rare Lesions (6)

16. Wong EJC, Sivakumar B, McCarron L, et al. Recurrent Fibro-Osseous Pseudotumour of the Digit Mimicking Infection: A Narrative Review and Case Report. HAND 2026. doi:10.1177/15589447261481209

This narrative review of 134 patients (22 case reports from 2015-2025 plus four large earlier series), with an accompanying recurrent case misdiagnosed as tenosynovitis, characterized fibro-osseous pseudotumour of the digit. Lesions typically present as rapidly enlarging painful nodules in young to middle-aged adults with slight female predominance and are frequently mistaken for infection or extraskeletal osteosarcoma. Complete surgical excision is definitive treatment, and awareness of this entity is critical to prevent misdiagnosis and unnecessary ablative surgery.

21. Schallmayer D, Sonbul AT, Borchert GH, et al. Polyethylene Liner Fracture in Touch Trapeziometacarpal Prosthesis: A Case Report. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101045

A case of polyethylene liner fracture in a Touch double-mobility trapeziometacarpal prosthesis presented with only slight clicking on thumb abduction and normal radiographs and examination. CT and dynamic imaging revealed head decentralization, and revision with head exchange after liner fracture identification restored normal, click-free motion. Subtle implant failure can be clinically and radiographically silent, warranting regular surveillance to enable early liner salvage rather than full component revision.

28. VanDerWolde B, Durkin V, Jerstad K, et al. Merkel Cell Carcinoma of the Hand. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101081

A case of Merkel cell carcinoma of the hand in a 79-year-old woman was diagnosed by punch biopsy and treated with wide local excision (1.5 cm margins), split-thickness skin grafting, negative sentinel node biopsy, and single-session adjuvant radiation. The report underscores that MCC, though rare on the hand, requires early recognition and aggressive treatment to optimise outcomes. It also highlights evolving adjuvant radiation protocols for this aggressive neuroendocrine skin cancer.

33. Toyoda Y, Bustos SS, Moran SL. Multicentric Calcifying Aponeurotic Fibroma of the Upper Extremity With Associated Nerve Compression and Bony Dysplasia. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101079

A 19-year-old woman initially diagnosed with a vascular/lymphatic malformation of the elbow and wrist was ultimately found on biopsy to have multicentric calcifying aponeurotic fibroma, with associated nerve compression, dysplastic distal radioulnar joint, and fatty muscle atrophy. Excision of both lesions confirmed the diagnosis. The case highlights that CAF is a rare mimic of vascular malformations, and clinicians should consider biopsy of atypical lesions to avoid prolonged misdiagnosis and delayed definitive treatment.

43. Sridharan M, Tomkinson A, Mefford M, et al. Dual-Plate Allograft Reconstruction for Expansile Lytic Lesions of the Metacarpal May Allow for Immediate Postoperative Weightbearing in a Biomechanical Setting. HAND 2026. doi:10.1177/15589447261479354

This biomechanical cadaveric study tested whether fibular allograft reconstruction with a dual-plate construct for simulated expansile metacarpal lesions could withstand loads comparable to standard dorsal plating of a transverse fracture. Using 12 matched pairs of middle finger metacarpals and robotic cantilever bending tests, the dual-plate allograft construct demonstrated sufficient load-to-failure strength. The clinical implication is that this reconstruction may permit immediate postoperative weightbearing and early mobilization after metacarpal tumour or lesion excision.

45. Ayodele T, DePascal M, Shearin J, et al. Management of a Rare Digital Dermocutaneous Fibroma of the Flexor Tendon Sheath. HAND 2026. doi:10.1177/15589447261480384

This case report describes a 19-year-old man with a rare dermocutaneous fibroma of the flexor tendon sheath involving both skin and sheath, treated with wide excision and staged full-thickness skin grafting. Given the lesion's reported recurrence rate of up to 24%, the authors emphasize an aggressive excision approach beyond simple excision used for typical subcutaneous cases. The clinical implication is that dermocutaneous involvement of digital fibroma of the tendon sheath requires wide excision with planned soft-tissue reconstruction to achieve definitive treatment.

Soft Tissue Reconstruction and Wound Care (5)

6. Gezer MC, Demir M. Association Between Preoperative Serum 25-Hydroxyvitamin D Levels and Early Wound Healing Following Open Trigger Finger Release. HAND 2026. doi:10.1177/15589447261487491

This retrospective study of 150 patients undergoing open trigger finger release examined whether preoperative serum 25-hydroxyvitamin D levels predict early wound healing at postoperative day 14. Delayed healing occurred in 20% of patients, and mean 25(OH)D levels were significantly lower in delayed healers (18.2 vs 29.8 ng/mL), with lower vitamin D remaining an independent predictor on multivariable analysis. Preoperative vitamin D assessment or correction may help identify patients at risk for wound healing complications after trigger finger surgery.

7. Delia G, Colonna MR, Troisi L, et al. Fingertip Reconstruction With Homodigital Adipofascial Reverse Flap Versus Dermal Substitute: A Comparative Retrospective Study. HAND 2026. doi:10.1177/15589447261487627

A retrospective single-center study compared 20 patients undergoing fingertip reconstruction with homodigital adipofascial reverse flap against 20 treated with dermal substitute plus skin graft for traumatic pulp loss. The flap provided superior sensory recovery (85% normal Semmes-Weinstein, 2PD <5 mm), less cold intolerance and nail deformity, and faster return to work, while dermal substitutes healed more slowly but gave good aesthetics without donor-site morbidity. Both are safe options, with flap choice favored when rapid sensory recovery and function are priorities and substitutes suited when avoiding donor sites matters.

24. Meirizal M, Muhammad H, Lo AS, et al. Reverse Aqua Pump Negative Pressure Wound Therapy: A Noninferiority Randomized Controlled Trial of Effectiveness and Affordability in Optimizing the Inflammatory and Proliferative Phases of Wound Healing in Developing Countries. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101032

A noninferiority randomised controlled trial in 24 patients compared a low-cost reverse aqua pump negative pressure wound therapy (RAP-NPWT) with commercial NPWT before skin grafting of complex wounds. Granulation progression, bone exposure effects, and treatment duration were equivalent between groups, while RAP-NPWT incurred significantly lower costs with a negative incremental cost-effectiveness ratio. RAP-NPWT offers an affordable, clinically equivalent alternative to commercial NPWT, expanding access to wound preparation in resource-limited settings.

30. Strelzow J, Solomon JS, Chaudhry S, et al. Antibiotics in Hand Surgery: Guidelines and Review. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101077

This review synthesizes current evidence and guidelines on preoperative antibiotic prophylaxis in hand surgery, stratified by procedure type and patient risk factors. Evidence consistently shows no significant reduction in surgical site infection with prophylaxis in clean soft tissue procedures (eg, carpal tunnel and trigger finger release) and, increasingly, in clean implant-related cases, though diabetes, immunosuppression, smoking, obesity, and prolonged operative time elevate risk. The clinical implication is more selective antibiotic use aligned with antimicrobial stewardship, reserving prophylaxis for higher-risk patients and procedures.

42. Ertem H, Adıgüzel İF, Özdeş HU, et al. Posterior interosseous artery flap for severe hand injuries: Outcomes of reconstruction combined with local and regional flaps. Injury 2026. doi:10.1016/j.injury.2026.113151

This retrospective study of 14 patients with severe hand injuries evaluated reconstruction using the posterior interosseous artery (PIA) flap, either alone or combined with local flaps such as fillet flaps from non-salvageable digits, between 2022 and 2025. Functional outcomes assessed by fingertip-to-palm distance, Quick DASH, and pain scores suggested that combining the PIA flap with regional and local flaps provides effective soft-tissue coverage. The clinical implication is that this combined approach offers a practical reconstructive solution for complex hand defects when tissue loss exceeds what a single flap can cover.

Paediatric and Congenital Hand Conditions (6)

3. Lovette M, Lottier LN, Richardson RT, et al. Assessment of Limb Dominance and Trumpeter Posture in Children With Brachial Plexus Birth Injury. HAND 2026. doi:10.1177/15589447261483206

Using 3-dimensional motion capture of feeding tasks in 23 typically developing children plus previously collected data from children with brachial plexus birth injury, the authors compared dominant versus nondominant limbs and affected versus unaffected BPBI limbs. No differences emerged between dominant and nondominant limbs in controls, whereas the unaffected BPBI limb differed from controls and the affected limb differed from both, with trumpeting children showing distinct patterns. This suggests trumpeter posture is not explained by limb dominance alone and that the unaffected limb in BPBI is not a clean internal control, informing how feeding assessments should be interpreted.

10. Chew DE. A Common Language for an Uncommon Problem. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00351

This commentary discusses the CoULD Study Group consensus classification of forearm involvement in multiple hereditary exostoses (MHE) by Vuillermin et al. It argues that although forearm deformity in MHE is a niche condition, classification systems provide a shared language for describing deformity, comparing outcomes, and building treatment evidence. The implication is that such consensus frameworks advance care even for rare pediatric hand conditions and serve as a model for other uncommon problems.

15. Castañeda JF, Rincón DF, Ojeda E. Closed reduction technique for complex dorsal metacarpophalangeal dislocation in children. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261473762

This study evaluated a closed reduction technique using hyperextension, rotation, and ulnar deviation for complex dorsal metacarpophalangeal dislocation of the index finger (Kaplan dislocation) in 16 children. The technique was applied in this rare paediatric injury cohort. It offers a practical closed-reduction option that may help avoid open surgery in selected paediatric patients.

17. Erkut Ü, Bingöl H. Biceps brachii and forearm muscle morphology related to forearm and hand deformities in spastic cerebral palsy. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261480554

Ultrasound measured muscle thickness, anatomical cross-sectional area, and pennation angle of the biceps brachii and forearm muscles in 87 children and adolescents with spastic cerebral palsy, stratified by Gschwind-Tonkin and Zancolli deformity grades. Muscle morphology differed significantly across deformity severities, with thickness and cross-sectional area declining as forearm, wrist, and finger deformities worsened. Upper limb muscle ultrasound may help stratify spasticity severity and inform surgical or rehabilitation planning for hand deformities.

38. Pettitt B, Friedman AJ, Koehler SM. Letter Regarding “Clinical Classification Versus MRI Patterns of Injury in Brachial Plexus Birth Injury”. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.01.006

This letter to the editor responds to a prospective study of MRI patterns in brachial plexus birth injury, arguing that the reported discordance between MRI findings and Narakas classification stems from use of a simplified version of the classification. The authors note that Narakas originally defined groups based on injury severity and recovery trajectory at 2-3 weeks of age, not static anatomic root involvement alone. The clarification underscores that static anatomic classifications have limitations and that proper application of the original Narakas system matters when correlating imaging with clinical groups.

49. Raja A, Faergemann C, Gundtoft P, et al. Epidemiology of hand fractures in children - A population-based study with data from the Danish National Patient Registry. Injury 2026. doi:10.1016/j.injury.2026.113678

This population-based study used Danish National Patient Registry data to characterize the epidemiology of paediatric hand fractures. It established incidence rates and fracture patterns across age groups in children nationwide. The findings provide population-level benchmarks that can guide resource planning and clinical suspicion for hand fracture management in paediatric trauma.

Wrist and Small Joint Arthroplasty (6)

2. Restrepo SB, Nguyen T, Hung VT, et al. The Impact of Occupational Therapy on Patient Outcomes Following Total Wrist Arthroplasty. HAND 2026. doi:10.1177/15589447261485504

A retrospective review of 35 total wrist arthroplasty patients compared outcomes between those who did and did not attend postoperative occupational therapy at the institution. Patients receiving specialised therapy had similar range of motion, grip strength, and other outcomes to those who did not, with no significant differences detected. The findings question the routine value of specialised postoperative occupational therapy after TWA, though the small sample and retrospective design limit strong conclusions.

8. Pardo Garcia JM, Sanchez-Urgelles P, Pardos Mayo B, et al. Reamed Percutaneous Arthrodesis for Distal Interphalangeal Joint Arthritis Improves Bone Fusion and Pain Compared With a Non-Reamed Technique. HAND 2026. doi:10.1177/15589447261487482

A retrospective comparison of reamed versus non-reamed percutaneous DIPJ arthrodesis with headless compression screws included 22 patients with minimum 2-year follow-up. The reamed technique showed improved bone union and pain outcomes relative to the non-reamed technique. This supports adding percutaneous articular reaming to minimally invasive DIPJ fusion to reduce nonunion risk.

11. Chou C, Lin Y, Li Y, et al. Meniscus Allograft Interpositional Arthroplasty With Elastic Intramedullary Bioabsorbable Pin Fixation for Proximal Interphalangeal Joint Contracture. HAND 2026. doi:10.1177/15589447261483166

This case report describes severe degenerative proximal interphalangeal (PIP) joint contracture (fixed at 60° flexion) treated with meniscus allograft interpositional arthroplasty plus elastic intramedullary bioabsorbable pin fixation. At 1 year, active motion improved to 20°, 105°, QuickDASH fell from 56.8 to 15.9, and pain dropped from 7 to 1, with maintained alignment and no graft complications. The technique may offer a motion-preserving alternative to arthrodesis or implant arthroplasty in selected patients with advanced PIP contracture.

18. He X, Zhang J, Mo W, et al. The Ortho-Bridge System for Simplified Ulna-Shortening Osteotomy. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2025.10.009

Twenty-five patients with ulnar impaction syndrome underwent ulnar shortening osteotomy using a bridge-combined internal fixation system, with ~13.5 months follow-up. Ulnar variance was corrected in all cases without rotation, angulation, or nonunion, with improved pain, Mayo wrist scores, grip strength, and motion. This simplified fixation technique appears reliable for ulnar shortening osteotomy and may reduce technical complications.

27. Namazi H, Jamshidi MM, Karimi MT. Association of Lunate Facet Inclination Angle and Interfacet Angle With Kienböck Disease: A Biomechanical Study. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101082

A finite element analysis using a 3D wrist model from CT images tested nine simulated configurations of lunate facet inclination (LFI), scaphoid facet inclination, and interfacet angles to assess lunate stress during flexion and extension. A strong negative correlation was found between LFI and lunocapitate joint stress, suggesting a flatter lunate facet increases load on the lunate. This supports LFI as a biomechanical risk factor for Kienböck disease and may inform preventive or surgical strategies.

39. Chim H, Higgins JP. Innovator’s Corner: Vascularized Bone Flaps for Carpal Reconstruction—Challenging Dogma. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.05.018

This Innovator's Corner interview with James Higgins explores the development and popularization of the medial femoral trochlear (MFT) flap for reconstruction of scaphoid nonunion and Kienböck disease. Higgins describes the origins of the idea and how the flap has changed approaches to carpal reconstruction, challenging existing dogma. The piece offers insight into the innovation process behind a technique that has transformed treatment options for these difficult carpal pathologies.

1. Kodumuri P, Pathan A. The surgical value framework in hand surgery: a conceptual model for evaluating surgical pathways. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261477704

The authors developed a Surgical Value Framework, a conceptual model for evaluating any hand surgery pathway (open, WALANT, arthroscopy, image-guided) across five domains: clinical, patient experience, recovery, economic, and environmental value. Clinical safety and effectiveness remain foundational, but the framework is designed to test rather than assume value across pathways. Clinically, it offers a structured tool for comparing established and newer surgical pathways without presupposing superiority, potentially guiding pathway selection and resource decisions.

9. Funao H, Ideura K, Isogai N, et al. Upper-extremity disability in cervical myelopathy: insights from the Disabilities of the Arm, Shoulder, and Hand questionnaire. International Orthopaedics 2026. doi:10.1007/s00264-026-07043-3

This study evaluated the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in cervical myelopathy patients and examined factors linked to discordance between DASH scores and the Japanese Orthopaedic Association (JOA) score. The key finding was that DASH captures day-to-day upper-extremity disability not fully reflected by conventional neurological scoring. Clinically, DASH may complement standard assessments to better identify functional limitations and guide management in cervical myelopathy.

12. Ross LA, Stirling PH, McEachan JE, et al. A photograph-based virtual pathway for patients with Dupuytren’s disease. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261481573

This study assessed a photograph-based virtual pathway for Dupuytren's disease, in which referred patients submitted hand photographs and functional questionnaires for remote review. Of 242 patients, 176 submitted photographs; the pathway cut non-essential clinic appointments by 46% while achieving 86% satisfaction and a net promoter score of 41. Virtual triage can therefore streamline Dupuytren care without compromising patient experience or access to surgery.

13. Auvray-Maisonneuve A, Abdallah Z, Aboudiwan R, et al. Influence of digital artery patency on sensory recovery after unilateral digital neurovascular injury. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261483768

This retrospective single-centre study of 89 unilateral proper palmar digital neurovascular bundle injuries compared sensory recovery between patients with patent versus non-patent repaired digital arteries, assessed by Doppler with superb microvascular imaging. No statistically significant differences were found in static two-point discrimination, BMRC sensory scores, or cold intolerance between groups. The findings suggest that when overall digit vascularization is preserved, concomitant digital artery repair may not substantially improve sensory recovery after nerve repair.

14. Raygoza CP, Noland SS. A Woman’s Hands in the OR. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00879

This arts and humanities perspective recounts a female hand surgeon's formative experiences, domestic expectations, hair braiding, and beading, that unknowingly cultivated the patience, precision, and adaptability essential to surgical practice. It highlights how gendered upbringing shapes, and can be reframed as, the development of manual skill. The piece underscores the value of diverse pathways to surgical craftsmanship and mentorship for women in surgery.

20. Afshar A, Tabrizi A, Shariyate MJ. Extensor Pollicis Longus Tendon Translocation with a History of Thumb Polydactyly Surgery. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101060

A 41-year-old woman with childhood thumb polydactyly reconstruction developed painful ulnar translocation of two EPL tendons at the thumb MP joint due to radial sagittal band deficiency, after a prior failed surgery for presumed wrist-level EPL snapping. Ulnar sagittal band release with reefing of the radial aponeurosis to the MP capsule centralized the tendons, yielding symptom resolution and stable tracking at 6 months. Late EPL instability should be suspected after polydactyly reconstruction, and sagittal band reconstruction can restore tendon alignment.

22. Tabrizi A, Afshar A, Abbasi A. Progressive Giant Orf Disease With Recurring. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101059

An immunocompromised patient developed giant, atypical Orf (Parapoxvirus) lesions extensively involving the hand and lower limb, with rapid spread to other areas caused by contamination of surgical instruments during primary lesion excision. Giant orf in immunodeficiency is difficult to manage, and iatrogenic autoinoculation can disseminate disease. Surgeons should recognize atypical orf in immunocompromised hosts and take strict instrument precautions when excising lesions.

23. Krasnoff CC, Hathaway BA, Lipira AB. Epidemiology and Clinical Implications of Scaphoid Morphology Based on Morsy Classification. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101062

Radiographic measurements of 363 wrists from 345 patients without scaphoid pathology determined the population prevalence of Morsy scaphoid morphology types. Type I scaphoids comprised 80.2% and type II 19.8%, with type II significantly more common in left-handed individuals and no other demographic differences. These prevalence data contextualize scaphoid anatomy for fracture management, vascularized grafting decisions, and surgical planning.

25. Ridet T, Barret H, Bozon O, et al. Palmar Dislocation of the Trapezoid with Associated Carpometacarpal Injuries: Two Case Reports and Literature Review. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101065

Two cases of palmar trapezoid dislocation after motorcycle accidents, treated with open reduction through a dorsal approach, temporary Kirschner-wire fixation, and ligamentous repair, were reported alongside a literature review identifying eight prior cases. Anatomical reduction was maintained without avascular necrosis at follow-up, while functional outcomes reflected the severity of associated injuries. The findings support dorsal-approach open reduction over trapezoid excision, which was linked to poorer outcomes from secondary dorsal migration of the second metacarpal.

26. Woo D, Kulber DA. Use of Internal Brace for the Surgical Management of the “Baby Stener” Lesion of the Radial Collateral Ligament to the Small Finger. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101050

A case of isolated radial collateral ligament injury at the small finger metacarpophalangeal joint with a 'Baby Stener' lesion, where the torn ligament buttonholes through the radial sagittal band, was reported with the authors' surgical technique using an internal brace. This interposition prevents ligament healing, analogous to the thumb Stener lesion. Early recognition and surgical repair may prevent chronic pain, instability, and functional impairment.

29. Liddy N, Hamilton-Hall MN, Strike SA, et al. Novel Utilization of a Preangulated, Osseointegrated Implant in a Case of Metacarpophalangeal Amputation: Design, Technique, and Rehabilitation Protocols Plus Functional Outcomes. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101047

The first U.S. thumb osseointegration and first worldwide use of a preangulated thumb implant were reported in a single-stage procedure for metacarpophalangeal-level thumb amputation. At 13 months there was no loosening or skin complications, with restored thumb-small finger opposition, improved sensation, a 28-point Action Research Arm Test gain, and reduced QuickDASH score. The case demonstrates feasibility, safety, and substantial functional benefit of single-stage preangulated thumb osseointegration with a structured rehabilitation protocol.

31. Mattos EDSRD, Guedes A, Vilaboim MDCCDF. Functional Outcomes of Miniplate/Screw Versus Suzuki Frame Fixation in Eaton Type III Middle Phalanx Base Fractures: A Case Series. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101075

This letter critiques a comparative study of Suzuki frame versus volar miniplate fixation for Eaton type III middle phalanx base fractures, emphasizing that nonrandomized allocation introduced severity bias, the Suzuki frame was used for the most comminuted, irreducible fractures. This structured imbalance makes baseline characteristics incomparable, so outcome differences cannot be attributed to technique performance. The authors call for adjustment or more rigorous design before drawing conclusions about relative efficacy.

32. Amen TB, Shareef O, Torabian KA, et al. Evolving Trends in Outpatient Hand Surgery Utilization Across Ambulatory Surgical Centers and Hospital-Based Outpatient Departments. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101070

A retrospective analysis of the New York State Ambulatory Database (2015-2022) examined utilisation trends for four common hand procedures in ambulatory surgical centers (ASCs) versus hospital outpatient departments (HOPDs). Black, Hispanic, and Asian/Pacific Islander patients, along with Medicaid-insured and lower socioeconomic status patients, were less likely to undergo all four procedures at both settings compared with White patients. The findings indicate that disparities in hand surgery access persist across delivery settings as ASC use grows, highlighting targets for equity-focused policy.

35. Lim QX, Chang MK, Chung SR, et al. Ulnar Neuroma-in-Continuity Following Distal Radius Fracture: A Rare Complication Requiring Reconstruction with Nerve Allograft and Dynamic Tendon Transfer. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101074

A 57-year-old man developed intrinsic muscle wasting and persistent ulnar sensory deficits two months after fixation of an open distal radius fracture, and imaging plus electrodiagnostic studies confirmed a ulnar neuroma-in-continuity with axonotmesis. He was treated with neuroma excision, nerve allograft reconstruction, and dynamic tendon transfer using the middle finger flexor digitorum superficialis, achieving resolution of claw deformity at 9 months. Persistent or progressive neurological deficits after distal radius fracture should prompt early investigation for structural nerve injury rather than being attributed to transient neuropraxia.

36. Ackerman C, Puri S, Wrightson D, et al. Orthopedic Provider Accuracy for Ultrasound Detection of Peripheral Nerve Injuries: A Cadaveric Educational Study. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101073

Fifteen orthopaedic providers used handheld and cart-based ultrasound to identify cadaveric peripheral nerve injury patterns (lacerations, intact nerves, end neuromas, neuromas-in-continuity) at three upper-extremity sites, before and after a brief educational module. Accuracy improved for lacerations and intact nerves after the module, but neuroma identification remained limited; prior ultrasound experience helped, and handheld and cart-based devices performed similarly. Short targeted training can modestly improve point-of-care nerve ultrasound skills, though neuroma assessment may require greater expertise.

40. Merrell G. A New Series in the Journal of Hand Surgery: Innovator’s Corner. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.001

This editorial introduces Innovator's Corner, a new interview-style series in the Journal of Hand Surgery featuring fireside chats with innovators about the process of innovation rather than the techniques themselves. The inaugural installment is an interview with James Higgins on osteochondral transfer for carpal pathology conducted by Harvey Chim. The series aims to educate the field about navigating the path from idea to treatment option to benefit future patients.

41. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2026. doi:10.1016/s0363-5023(26)00542-3

This is a continuing medical education (CME) program description for The Journal of Hand Surgery, in which participants read selected clinically relevant articles and complete an online examination to earn CME credit and MOC points. The program, administered by the American Society for Surgery of the Hand, aims to increase or affirm hand surgeons' knowledge and their ability to evaluate and apply clinical data to patient care. Its clinical implication is that hand surgeons can maintain competency and lifelong learning requirements through structured journal-based education.

44. Khan AA, Jan K, Kim JH, et al. GLP-1 Receptor Agonist Use and A1 Pulley Release After Corticosteroid Injection for Trigger Finger in Type 2 Diabetes. HAND 2026. doi:10.1177/15589447261480181

This large retrospective TriNetX analysis of 69,222 patients with type 2 diabetes and trigger finger, propensity-matched 1:1 (5,863 per cohort), examined whether GLP-1 receptor agonist exposure affected progression to A1 pulley release after initial corticosteroid injection. The study assessed operative release rates at 6, 12, and 24 months post-injection. The clinical implication is that GLP-1RA therapy may influence the trajectory of trigger finger treatment in diabetic patients, informing whether injection alone is likely to suffice or whether surgical counseling is warranted.

48. Cievet-Bonfils M, Burnier M, Locquet V. Beyond the Algorithm: A Stewardship Framework for the Hand Surgeon Adopting Artificial Intelligence. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.006

This perspective article addresses the rapid adoption of artificial intelligence in hand surgery, including imaging interpretation, outcome prediction, and patient communication, where validation has lagged behind deployment. The authors propose a four-part stewardship framework: external validation on the intended population, transparent disclosure of intended use and failure modes, defined escalation paths for surgeon-model disagreement, and prospective post-deployment audit. The clinical implication is that hand surgeons remain accountable for AI-informed outcomes and should apply structured oversight questions and checklists when integrating these tools into practice.

50. Lee J, Chung JI, Yun Y, et al. Return to Duty After Suture Anchor Repair of Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries in Active Duty Soldiers. Injury 2026. doi:10.1016/j.injury.2026.113711

This study evaluated return-to-duty outcomes in active duty soldiers undergoing suture anchor repair of thumb metacarpophalangeal ulnar collateral ligament injuries. It reported the proportion and timing of soldiers returning to full military duty after surgical repair. The results support suture anchor fixation as an effective strategy for restoring operational readiness in this military population.

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