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What's New — Hand — October 2026

40 new articles published this month.

Themes: AI and Digital Tools · Carpal Tunnel Syndrome Management · Trapeziometacarpal Arthritis and Arthroplasty · Fingertip and Soft-Tissue Reconstruction · Trauma, Replantation, and Fixation · Paediatric and Congenital Hand

Digest generated 2026-11-04 16:01:58+00:00.

Highlights

AI and Digital Tools

Several studies evaluated artificial intelligence in hand surgery. Large language models showed limited diagnostic and triage accuracy for patient-voice hand and wrist vignettes [5] and modest agreement with surgeons when assessing Dupuytren contracture images [7]. A narrative review mapped machine learning applications across fracture, tendon, and nerve compression diagnosis [10], while another study found AI-generated patient education materials exceeded recommended sixth-grade readability, as did ASSH website content [18].

Carpal Tunnel Syndrome Management

Carpal tunnel research this month spanned perioperative systems and risk factors. Direct discharge from the outpatient operating room after local-anaesthesia carpal tunnel release proved safe without PACU recovery [3]. Endoscopic release showed better early functional recovery than open release, particularly relevant across occupational demands [28]. Non-tobacco nicotine dependence was associated with increased perioperative complications after release [29], and higher BMI was linked to longer time to surgery after diagnosis [21]. Concomitant release during distal radius fixation did not reduce subsequent release rates [25].

Trapeziometacarpal Arthritis and Arthroplasty

Basal joint arthritis featured prominently. A pooled analysis of randomised trials compared reconstructive, non-reconstructive, and dual-mobility implant procedures for first carpometacarpal osteoarthritis [13]. A review traced the evolution of total trapeziometacarpal arthroplasty from early designs to contemporary dual-mobility systems with improved survivorship [35], and a retrospective series reported outcomes of the Touch prosthesis in an Asian population [1]. Nationwide data also characterized trends and 30-day outcomes of metacarpophalangeal arthroplasty in rheumatoid and osteoarthritis patients [17].

Fingertip and Soft-Tissue Reconstruction

Reconstructive studies addressed fingertip and digital coverage. Composite cap grafting outcomes in children depended on age, with better success in younger patients [8], and independent predictors of composite graft failure in Allen Zone II amputations were identified in adults [26]. Dermal regeneration templates offered a viable alternative to flap reconstruction for finger soft-tissue defects [23], and a perforator-based axial adipofascial turnover flap with juncturae tendinum grafting was described for complex dorsal phalangeal defects [24].

Trauma, Replantation, and Fixation

Trauma research covered fracture fixation and salvage. Metacarpal shaft fixation strategies were compared across plating, intramedullary screw, and percutaneous wiring [32], with radiographic shortening assessed after spiral and oblique fractures [33]. Hemi-hamate arthroplasty showed durable long-term results for PIP fracture dislocations [22], and thumb MP arthrodesis outcomes were compared between tension band wiring and intramedullary screws [39]. Paediatric digit replantation outcomes [27], pull-in suture repair for severe musculotendinous avulsions [16], and irreducible PIP dislocation entrapment mechanisms [20] rounded out the trauma literature.

Paediatric and Congenital Hand

Paediatric hand conditions received focused attention. A systematic review of surgically treated congenital clinodactyly found physiolysis and osteotomy both improved alignment, with mean angulation improving from 41 to 21 degrees [37]. A 13-year retrospective review characterized injury patterns, treatment, and outcomes of paediatric flexor tendon injuries [38], complementing the paediatric fingertip and replantation literature published this month.

Articles by Theme

AI and Digital Tools (4)

5. Counihan CM, Duncan RJD, Bullock MG, et al. Diagnostic and Triage Performance of Large Language Models in Hand and Wrist Complaints: A Standardised Vignette Evaluation. HAND 2026. doi:10.1177/15589447261497439

Fifty standardised first-person patient-voice vignettes covering common elective and traumatic hand/wrist conditions were entered into three freely available consumer large language models (ChatGPT, Google Gemini, Microsoft Copilot) to assess diagnostic and triage accuracy. Overall diagnostic accuracy was 84.7%, but performance varied markedly by presentation type: 96.7% for elective conditions versus only 65.0% for trauma. Clinicians and patients should be cautious using LLMs for hand and wrist complaints, particularly traumatic injuries, where inaccurate responses risk false reassurance and treatment delays.

7. Romero M, Hu S, Noland S. Performance of Large Language Models in Image-Based Evaluation of Dupuytren Contracture. HAND 2026. doi:10.1177/15589447261495085

Three large language model-based AI systems (ChatGPT, Gemini, and Claude) were evaluated for their ability to characterize Dupuytren contracture and recommend treatment based solely on patient images, compared against consensus assessments of three board-certified hand surgeons. The models showed limited accuracy in characterizing contracture involvement, and although treatment recommendations were often within one ordinal tier of surgeon consensus, agreement with surgeons was no better than chance. Current LLM-based AI is unreliable for image-based evaluation of Dupuytren contracture and should not substitute for specialist assessment.

10. Lim B, Seth I, Ross RJ, et al. Machine Learning in Hand Pathology Diagnosis: A Narrative Review of Current Insights. HAND 2026. doi:10.1177/15589447261493988

This narrative review synthesized studies of machine learning applications in diagnosing hand fractures, tendon injuries, and nerve compressions, drawing on searches of multiple databases through March 2025. Convolutional neural networks in particular showed high diagnostic accuracy across imaging, history, and examination data. The findings suggest ML tools are approaching clinical utility for hand pathology diagnosis, though validation and methodological transparency remain limiting factors.

18. Momin NR, Azap RA, Yousaf Z, et al. Comparative Analysis of Readability Levels of Hand Surgery Patient Information on the ASSH Website and Artificial Intelligence. HAND 2026. doi:10.1177/15589447261478323

The authors assessed readability of 98 hand surgery patient education topics from the ASSH website versus AI-generated materials (Google Gemini 2.0 Flash and ChatGPT-4) using Flesch Reading Ease and Flesch-Kincaid Grade Level scores, benchmarked against the AMA's sixth-grade recommendation. Original ASSH materials read at 10th-12th grade and initial AI outputs at college level, exceeding recommended levels. The implication is that both society-produced and AI-generated patient materials require deliberate simplification to be accessible to typical patients.

Carpal Tunnel Syndrome Management (5)

3. Nieves-Lopez B, Aziz KT, Ardon AE, et al. The Recovery Room Is Not Needed Following Hand Surgery With Local Anesthesia in the Outpatient Operating Room: A Prospective Study. HAND 2026. doi:10.1177/15589447261497437

This prospective study of 102 patients undergoing carpal tunnel release and/or trigger finger surgery under local anaesthesia assessed whether post-anaesthesia care unit (PACU) monitoring is necessary after outpatient operating room (OPOR) hand surgery, discharging patients directly after a single set of postoperative vital signs. No intraoperative or postoperative complications, reinterventions, or deaths occurred, and only 3.9% of patients visited the emergency department within 90 days. These results support safely bypassing the recovery room for local-anaesthesia hand surgery in the OPOR, offering potential efficiency and cost savings.

21. Ni A, Williamson T, Rose R, et al. Does Body Mass Index Influence Time to Surgery After Diagnosis of Carpal Tunnel Syndrome?. HAND 2026. doi:10.1177/15589447261489856

In a retrospective multicenter registry cohort of 272,713 patients with carpal tunnel syndrome (52,467 undergoing surgery), the authors examined whether BMI category was associated with time from diagnosis to open or endoscopic carpal tunnel release. BMI was significantly associated with time to surgery for both open and endoscopic CTR (P < .001). The finding suggests that higher BMI may influence surgical timing, whether through disease behaviour, treatment response, or access barriers, which clinicians should consider when counseling and monitoring patients with CTS.

25. Dinesh A, Poursalehian M, Marjoua Y, et al. Carpal tunnel release during distal radius fracture fixation is not associated with reduced subsequent carpal tunnel release: A propensity-matched cohort study. Injury 2026. doi:10.1016/j.injury.2026.113484

A propensity-matched cohort study of 53,565 distal radius fracture fixations using the TriNetX database compared patients who did versus did not undergo concomitant carpal tunnel release. Prophylactic carpal tunnel release at the time of fixation was not associated with a reduced rate of subsequent carpal tunnel release within 2 years. Routine prophylactic release during distal radius fixation is not supported by these data and should not be assumed to prevent symptomatic carpal tunnel syndrome.

28. Lee KK, Barrientos A, Sadeh O, et al. Endoscopic Versus Open Carpal Tunnel Release: Is Early Functional Recovery Different Across Occupational and Recreational Hand Activity Demands?. HAND 2026. doi:10.1177/15589447261487486

A prospective comparative study of 125 carpal tunnel releases (70 endoscopic, 55 open) evaluated recovery stratified by occupational and recreational hand demands. Endoscopic release yielded greater QuickDASH improvement and earlier return to recreational activities (14 vs 31 days), though return to activities of daily living and work was similar between techniques. The advantage of endoscopic release appears greatest for patients with higher recreational hand-activity demands, informing procedure selection based on lifestyle.

29. Rankin WH, Holle AM, Moore ML, et al. Non-tobacco Nicotine Dependence Is Associated With Increased Perioperative Complications After Carpal Tunnel Release. HAND 2026. doi:10.1177/15589447261487702

Using a large national database with propensity matching, this study compared 90-day and 2-year outcomes after carpal tunnel release among patients with non-tobacco nicotine dependence, tobacco users, and controls. Non-tobacco nicotine dependence was associated with increased 90-day medical complications (2.4% vs 1.7%) and emergency department visits compared with controls. Nicotine exposure from any source, not just tobacco, should be considered when assessing perioperative risk and counseling patients before carpal tunnel release.

Trapeziometacarpal Arthritis and Arthroplasty (4)

1. Unknown Author. Abstracts presented at the BSSH Autumn Scientific Meeting 2026, 4-6 November 2026 at the EICC, Edinburgh, Scotland. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261493931

A retrospective study evaluated outcomes of trapeziometacarpal joint arthroplasty using the Touch® prosthesis in an Asian population at Singapore General Hospital between 2020 and 2024. The study assessed pain improvement, range of motion, and other clinical outcomes in patients undergoing this procedure. The findings support the use of the Touch® prosthesis for trapeziometacarpal arthritis in Asian patients, informing surgical decision-making in this population.

13. Le J, Kermanshahi N, Tran J, et al. A Comparative Analysis of Surgical Treatment for First Carpometacarpal Osteoarthritis: A Systematic Review and Pooled Analysis of Randomized Controlled Trials. HAND 2026. doi:10.1177/15589447261487487

This systematic review and pooled analysis of seven RCTs (409 hands) indirectly compared reconstructive procedures, non-reconstructive procedures, and dual-mobility implants for first carpometacarpal osteoarthritis. Dual-mobility implants showed the greatest early pain reduction at 3 months (VAS Δ = 6.05 vs 3.52 for reconstructive), with outcomes also assessed for grip, pinch, DASH, and complications at 12 months. The results suggest dual-mobility arthroplasty may offer faster early pain relief, though indirect comparison limits definitive conclusions about long-term superiority.

17. Schluttenhofer A, Rizzo M. Metacarpophalangeal Arthroplasty: A 14-Year Nationwide Analysis of Trends and Acute Perioperative Outcomes in Rheumatoid Arthritis and Osteoarthritis. HAND 2026. doi:10.1177/15589447261485505

Using the NSQIP database (2010-2023), the authors compared 668 MCP arthroplasties performed for rheumatoid arthritis (n=216) versus osteoarthritis (n=452), analyzing case volume trends and 30-day perioperative outcomes. RA patients were more often female, smokers, and on chronic steroids, and more frequently required multi-joint replacement, soft tissue balancing, plastic surgery involvement, and inpatient admission, while OA case volumes rose 5.9% annually. Clinically, the two populations have distinct perioperative profiles, so preoperative planning and risk stratification for MCP arthroplasty should be tailored to the underlying diagnosis.

35. Nolte CP, Tueting JL, Catalano LW, et al. Evolution of Total Trapeziometacarpal Arthroplasty: From Early Prosthetic Designs to Contemporary Dual-Mobility Systems. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.007

This narrative review traces the evolution of total trapeziometacarpal arthroplasty from early prosthetic designs, which suffered high failure rates, to contemporary dual-mobility systems. Advances in implant design, biomaterials, and fixation have improved survivorship, with arthroplasty offering faster recovery, earlier pain relief, and preserved pinch strength compared with trapeziectomy-based procedures. The review highlights refined patient selection, including reassessment of trapezial morphology and former contraindications, to guide surgical decision-making in basal thumb arthritis.

Fingertip and Soft-Tissue Reconstruction (4)

8. Tipps JA, Vaile JR, Allen BE, et al. Composite Cap Grafting for Fingertip Amputations in Pediatric Patients: Does Patient Age Matter?. HAND 2026. doi:10.1177/15589447261487696

A retrospective review of 61 paediatric fingertip amputations at or distal to the DIP joint (or thumb IP joint) treated with composite cap grafting examined whether age predicts graft success and characterized the timeline of graft failure. The cohort's average age was 6.4 years, with blunt force trauma the most common mechanism, and univariate logistic regression was used to identify predictors of graft success. The findings help define age-related expectations for composite graft outcomes in children and guide postoperative counseling and monitoring.

23. Atilgan N, Rizvanoglu İH. Flap reconstruction versus dermal regeneration template for finger soft-tissue defects: comparative clinical outcomes. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07280-7

In a retrospective comparative study of 99 fingers (89 patients) with isolated soft-tissue defects, outcomes of flap reconstruction (n=47) were compared with dermal regeneration template (DRT)-based reconstruction (n=52) using total active motion, QuickDASH, key pinch strength, Vancouver Scar Scale, and operative variables. The study provides comparative functional data on DRT as an alternative to flap coverage, a technique classically favored for preserving tendon gliding but carrying donor-site morbidity. The results inform selection between single-stage flaps and DRT-based reconstruction for finger defects.

24. Ozer K. The perforator-based axial adipofascial turnover flap combined with juncturae tendinum grafting for complex dorsal phalangeal defects. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06425-x

The author presents a loco-regional reconstructive strategy for complex dorsal phalangeal defects with exposed bone and extensor apparatus, combining a perforator-based axial adipofascial turnover flap with juncturae tendinum grafting. Building on the evolution from random-pattern to axial-pattern adipofascial flap designs, the approach aims to improve vascular reliability while minimising donor-site morbidity and technical complexity. The technique offers a structured single-region option for combined dorsal soft-tissue and extensor defects that may otherwise require more complex reconstruction.

26. Gürhan U, Kahve Y, Sarı E, et al. Composite graft survival in allen zone II fingertip amputations: Independent predictors of graft failure. Injury 2026. doi:10.1016/j.injury.2026.113587

A retrospective study of 42 patients treated with composite grafting for Allen Zone II fingertip amputations identified independent clinical predictors of graft failure, with secondary analysis of ischemia duration. Graft survival at 6 weeks varied with patient and injury-related factors, and ischemia time was examined as a potential threshold for failure. These findings can help surgeons counsel patients and select candidates for composite grafting in Zone II amputations.

Trauma, Replantation, and Fixation (7)

16. Izawa Y, Futamura K, Nishida M, et al. Efficacy of Pull-In Suture for Tendon Avulsion Injury Associated With Severe Forearm Open Fracture, Forearm Amputation, and Hand Amputation. HAND 2026. doi:10.1177/15589447261490133

Ten patients with musculotendinous avulsion injuries from severe open forearm fractures, forearm amputations, or hand amputations, all industrial machine injuries, underwent pull-in suture repair, in which the distal tendon stump is sutured into the proximal muscle belly. Functional outcomes were assessed with total active motion, DASH, and HAND20 scores at final follow-up. The technique appears to be a viable salvage option for devastating musculotendinous avulsions where direct tendon repair is impossible.

20. Honda Y, Takita H, Nishi K, et al. Entrapment of the Proximal Phalangeal Head by the Flexor Digitorum Superficialis Tendon as a Mechanical Block to Reduction in Open Dorsal Proximal Interphalangeal Joint Dislocations: Two Case Reports. HAND 2026. doi:10.1177/15589447261493182

Two case reports of open dorsal PIP joint dislocations describe irreducibility caused not only by FDP tendon displacement but by entrapment of the proximal phalangeal head by the FDS tendon, either around the ulnar condyle or with the head passed between the two FDS slips. Surgical release of the FDS entrapment allowed reduction and volar plate repair, yielding good final motion (0°-100° and -10°-100°) without instability. Surgeons should suspect FDS entrapment when a dorsal PIP dislocation remains irreducible after the FDP tendon is restored to its normal volar position.

22. Cansü E, Ilgaroglu S, Msangi WJ, et al. Hemi-hamate arthroplasties for proximal interphalangeal joint fracture dislocations: long-term follow-up in acute, subacute and chronic cases. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06429-7

A single-surgeon series of 22 patients treated with hemi-hamate arthroplasty for unstable PIP joint fracture-dislocations between 2013 and 2025 reported mid-to-long-term outcomes stratified by acute (<6 weeks), subacute, and chronic presentation. Mean PIP motion was 80.6° with an 11° extension lag, and grip strength on the operated side reached 91.7% of the contralateral side. The results support hemi-hamate arthroplasty as a durable option for PIP fracture-dislocations, including in delayed and chronic presentations.

27. Saoud K, Bruce JG, Bettlach C, et al. Pediatric digit replantation: A mixed methods outcomes study. Injury 2026. doi:10.1016/j.injury.2026.113641

A mixed-methods study at a Level 1 paediatric trauma hospital reviewed 1364 upper extremity trauma presentations, of which 19 children underwent digit replantation/revascularization and 12 digits survived, with 10 patients interviewed at a mean of 89 months. Long-term outcomes reflected differing perspectives between children and their parents regarding treatment and function. The data support broadened paediatric replantation indications while highlighting the importance of family-centered counseling about expectations and recovery.

32. Jodoin Z, Walsh W, Hussien D, et al. Fixation Strategies for Metacarpal Shaft Fractures: A Comparison of Plate-and-Screw, Intramedullary Screw, and Percutaneous Wire Techniques. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.015

A retrospective review of 104 metacarpal shaft fractures in 84 patients at a Level I trauma center compared Kirschner wire pinning, plate-and-screw ORIF, and intramedullary screw fixation with respect to time to motion, range of motion, and complications. Intramedullary fixation and ORIF allowed earlier initiation of motion (approximately 14-16 days) than percutaneous pinning. These results support intramedullary screw fixation as an option that facilitates early mobilization without increased complications.

33. Ostwald CS, Peyronson F, Hailer NP, et al. Radiographic Assessment of Metacarpal Shortening After Nonoperative and Operative Treatment of Spiral and Oblique Metacarpal Shaft Fractures. Injury 2026. doi:10.1016/j.injury.2026.113757

This radiographic study assessed metacarpal shortening in patients with spiral and oblique metacarpal shaft fractures treated either nonoperatively or operatively. Shortening was measured and compared between treatment groups to determine how often and to what degree fractures shortened despite intervention. The findings help guide clinical decision-making on operative fixation by clarifying which patients are at risk of clinically relevant shortening.

39. Arendale CR, Ata A, Uhl RL. Arthrodesis of the Thumb Metacarpophalangeal Joint: Tension Band Wiring Versus Intramedullary Screw Fixation. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.09.005

This retrospective single-institution study compared tension band wiring (n=121) with intramedullary screw fixation (n=31) for thumb metacarpophalangeal joint arthrodesis. Union (90% vs 74%) and clinical success (93% vs 77%) rates favored tension band wiring, with re-arthrodesis required more often after intramedullary screw fixation. The results suggest tension band wiring may be the more reliable technique for thumb MP fusion, though the groups were unequal and the design descriptive.

Paediatric and Congenital Hand (2)

37. Devetzis K, Beni R, McGhee J, et al. Outcomes of the Surgical Management of Clinodactyly: A Systematic Review. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.014

This systematic review of 8 studies (119 patients, 165 digits) evaluated surgical outcomes of congenital clinodactyly, comparing physiolysis (76% of cases) with osteotomy (24%). Mean coronal angulation improved from 41° preoperatively to 21° postoperatively, with all techniques achieving angular correction. However, the lack of clear criteria for procedure selection and inconsistent thresholds for surgical intervention highlight the need for standardised indications in managing clinodactyly.

38. İbrahimov J, Bagır M, Bolat İ, et al. Pediatric Flexor Tendon Injuries: A 13-Year Retrospective Review of Injury Characteristics, Treatment, and Outcomes. Injury 2026. doi:10.1016/j.injury.2026.113798

This 13-year retrospective review characterized injury patterns, treatment methods, and outcomes of paediatric flexor tendon injuries. The study describes the epidemiology and repair outcomes in children, a population in which evidence is largely extrapolated from adult series. The findings inform surgical technique and rehabilitation expectations for flexor tendon repairs in paediatric patients.

2. Unknown Author. James Randolph Urbaniak, MD 1936-2026. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.01283

This is an obituary for James Randolph Urbaniak, MD, a pioneering orthopaedic surgeon-scientist and Virginia Flowers Baker Distinguished Professor Emeritus at Duke University who died in 2026. His career spanned over six decades and included transformative innovations in hand surgery, microsurgery, limb replantation, and hip preservation. The tribute highlights his dual legacy of surgical advancement and mentorship, commemorating a figure whose work improved thousands of patients' lives worldwide.

4. Boutros M, Awad G, Hassan C, et al. Cross-Cultural Adaptation and Psychometric Validation of the Arabic Duruöz Hand Index: A Reliable Patient-Reported Measure for Hand Disability in Arabic-Speaking Populations. HAND 2026. doi:10.1177/15589447261496353

This study translated, culturally adapted, and psychometrically validated an Arabic version of the Duruöz Hand Index (DHI-AR) in 439 Arabic-speaking adults with hand or wrist conditions, following established cross-cultural adaptation guidelines. The DHI-AR demonstrated excellent internal consistency (Cronbach's α = 0.980) and excellent test-retest reliability, with strong convergent validity against the Arabic Patient-Rated Wrist/Hand Evaluation. The validated DHI-AR now enables reliable patient-reported assessment of hand disability in Arabic-speaking populations for clinical practice and research.

6. Pandey VK, Dash C, Singh H. Clinical Outcomes of Pedicled Vascularized Bone Grafting for Scaphoid Nonunion. HAND 2026. doi:10.1177/15589447261496463

This retrospective review of 30 consecutive patients treated with pedicled vascularized bone grafting for scaphoid nonunion, dorsal 1,2 intercompartmental supraretinacular artery grafts for proximal pole nonunions and volar radial pedicled grafts for waist nonunions, assessed union, pain, motion, grip strength, and functional scores. All patients showed significant improvement, with Mayo Wrist Scores rising from 51.47 to 72.13 and VAS pain scores falling from 4.40 to 2.03, and no persistent nonunion or revision surgery. Pedicled vascularized bone grafting is an effective option for scaphoid nonunion, with comparable outcomes for dorsal and volar approaches.

9. Moore JW, Minerva AJ, Daley DN, et al. Net present value analysis of total salary compensation in hand surgery: academic versus non-academic careers. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06547-2

Using 2025 MGMA and AMGA salary benchmarks, the authors modeled 32-year career net present values for academic versus non-academic hand surgeons, with sensitivity analyses and Monte Carlo simulation. MGMA data showed academic practice yielding 19.7% lower lifetime compensation ($12.6M vs $15.7M), while AMGA data showed a slight academic advantage (2.7%). Trainees choosing academic careers should recognize a potentially substantial financial trade-off, though the estimate is highly sensitive to the data source used.

11. Shapiro LM, Kamal RN. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Carpal Tunnel Syndrome: Erratum. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00731

This erratum corrects the authorship of the April 2025 AAOS/ASSH Clinical Practice Guideline Summary on carpal tunnel syndrome management, adding guideline work group members and AAOS staff omitted from the original byline. The corrected author list now includes all contributors such as Brault, Chen, Erickson, and others. No clinical content of the guideline was changed; readers should cite the corrected authorship.

12. Goswami D, Das P, Chatterjee D, et al. Hand Geometry in Forensic Application: Estimating Hand Length Derived from Phalangeal Lengths. HAND 2026. doi:10.1177/15589447261480182

The authors measured phalangeal segment lengths from bilateral palm impressions of 100 Bengali university students to derive regression models estimating hand length and to assess sexual dimorphism for forensic identification. Most phalangeal lengths were significantly larger in men, with the middle phalanx of the ring finger among the strongest predictors. These regression equations can help estimate hand length and sex from partial hand remains in forensic investigations of this population.

14. Lavagnolo U, Andrioli A, Bernardi P, et al. Morpho-histological Analysis of the Ultrastructure of the Dupuytren Cord Subjected to Progressive Distraction Using an External Fixator. HAND 2026. doi:10.1177/15589447261487485

Cords from six stage IV Dupuytren disease patients, three treated with progressive distraction via external fixator before fasciectomy and three controls, were examined by light and electron microscopy with morphometric collagen analysis. Distracted cords showed increased cellularity, vascularization, and a more regular collagen architecture with significantly thicker (9.23 vs 7.33 µm) and more widely spaced (21.3 vs 13.4 µm) collagen fibres. Mechanical distraction appears to induce favourable tissue remodeling, providing a biological rationale for combining distraction with fasciectomy.

15. Tsumura T, Matsumoto T, Imanaka T, et al. Coronal Alignment and Ulnar Deviation After Radial-Sided Lateral-Approach Silicone Arthroplasty of the Proximal and Distal Interphalangeal Joints: A Prospective Case Series. HAND 2026. doi:10.1177/15589447261487499

In this prospective case series, 40 PIP and 13 DIP silicone arthroplasties were performed through a radial-sided lateral approach with structured collateral ligament repair, and coronal alignment was measured on signed radiographic deviation. Mean PIP deviation improved from −10.9° (ulnar deviation) preoperatively to −4.0° at a mean 42-month follow-up, with secondary outcomes including pain, motion, and QuickDASH. Radial-sided exposure with ligament repair appears to maintain or improve coronal alignment and limit postoperative ulnar drift.

19. Wong CR, Baltzer HL. Dedicated Trauma Operating Rooms in Hand Surgery: A North American Survey of Access, Impact, and Opportunities for System-Level Improvement. HAND 2026. doi:10.1177/15589447261487628

A survey of American and Canadian hand surgery society members (90 respondents) assessed access to dedicated trauma operating rooms (DTORs) and their perceived or actual impact on efficiency, patient outcomes, surgeon wellness, and resident education. Only 12% of respondents had DTOR access, but all with access reported positive impacts, suggesting substantial untapped system-level opportunity. The findings support advocacy for expanded DTOR availability in hand surgery to improve operative efficiency and surgeon and trainee experience.

30. Fenoglio AK, Son SL, Milman R, et al. Treating Pregnant/Postpartum Patients in Hand Surgery Clinic: Answers to Common Questions that Every Hand Surgeon Should Know. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.005

This review addresses common clinical questions regarding hand and upper extremity care in pregnant and postpartum patients, including fetal risk considerations, radiation safety thresholds, imaging choices, and medication management. It consolidates guidance for nonsurgical management in the hand clinic setting. The article serves as a practical reference for hand surgeons who are less familiar with the nuances of caring for this population.

31. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2026. doi:10.1016/s0363-5023(26)00632-5

This article provides instructions for The Journal of Hand Surgery continuing medical education program, describing its objectives, format, and accreditation. Learners read selected clinically relevant articles and complete an online examination to earn CME credit and MOC points. It is administrative content rather than a research study, with no direct clinical implications.

34. Muder D, Swarén M. Mechanisms and Anatomic Distribution of Hand and Wrist Injuries in the Swedish Hockey League: A 3-Season Registry Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486943

This prospective registry study analyzed 113 hand, wrist, and forearm injuries among professional ice hockey players in the Swedish Hockey League over three seasons. Fractures were the most common injury (54%) and caused the greatest time loss (median 32 days), with puck contact the leading mechanism (45%). The results underscore the need for targeted prevention strategies, such as improved protective equipment, focused on puck-impact injuries in elite hockey.

36. Bigorre N, Raimbeau G. Dupuytren's disease: from the first signs to the most advanced stages. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104924

This narrative review summarizes current epidemiological, pathophysiological, and therapeutic data on Dupuytren's disease, a fibroproliferative palmar fascial condition driven by genetic and environmental factors. It outlines a staged management approach ranging from observation and medical therapies (radiotherapy, collagenase) in early disease to percutaneous fasciotomy, fasciectomy, dermofasciectomy, or phalangectomy for advanced contracture. The clinical implication is the use of a structured decision-tree incorporating Tubiana stage, diathesis, and progression to individualize treatment.

40. Bollard SM, Kneafsey SL, Duggan J, et al. Hand fracture as a sentinel event for frailty in older adults. Injury 2026. doi:10.1016/j.injury.2026.113819

This study investigated hand fractures in older adults as a potential sentinel event marking underlying frailty. It examined whether sustaining a hand fracture identifies patients with diminished physiologic reserve who are at increased risk of adverse outcomes. The clinical implication is that hand fracture presentation in elderly patients should prompt frailty screening and comprehensive geriatric assessment rather than isolated fracture management.

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.