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What's New — Wrist — October 2025

40 new articles published this month.

Themes: Distal Radius Fractures and Alignment · Congenital Anomalies and Pediatric Hand Surgery · Carpal Pathology and Nerve Disorders · Forearm Deformity and Osteochondromas · Biomechanics, Reconstruction, and Outcomes · Miscellaneous

Digest generated 2026-04-15 23:55:55+00:00.

Highlights

Distal Radius Fractures and Alignment

Recent literature emphasizes the biomechanical and radiographic nuances of distal radius fractures. Saeki et al. [1] investigated the correlation between dorsal tilt and midcarpal alignment, distinguishing between adaptive and pathological malalignment. Biomechanical studies further explored fixation strategies, comparing integrated compression screws for dorsal critical corners [13] and evaluating bone graft augmentation for comminuted radial neck fractures [40]. Additionally, the validity of biodegradable pins for radial head fractures was assessed [10], while a large-scale Swedish register study analyzed patient-reported maltreatment and complications following these common injuries [6].

Congenital Anomalies and Pediatric Hand Surgery

This cluster addresses complex congenital conditions and their surgical management. Sriswadpong et al. [3] proposed a new subclassification and surgical algorithm for challenging Wassel type III thumb polydactyly. Long-term outcomes for syndactyly separation were reviewed, highlighting the impact of complications on quality of life [7]. In the realm of thumb hypoplasia, Bhat et al. [11] reported on nonvascularized toe phalanx transfer as an alternative to pollicization. Furthermore, studies on brachial plexus birth injury explored pericoracoid tissue release [12] and compared clinical classifications with MRI injury patterns [24].

Carpal Pathology and Nerve Disorders

Significant attention was given to carpal bone disorders and nerve compression. Wernér et al. [2] utilized nationwide registers to identify risk factors for Kienböck's disease and surgical needs. In carpal tunnel syndrome, Raissi et al. [9] correlated body composition with electrodiagnostic findings, while Wright et al. [33] and Shapiro [27] examined health disparities in socially deprived populations. Diagnostic advancements included the description of the displaced fleck sign for UCL tears [21] and the comparison of tenosynovial versus fascial specimens for amyloid biopsy [22].

Forearm Deformity and Osteochondromas

Research in this theme focuses on forearm rotational mechanics and tumor management. Thirache et al. [5] developed a standardized CT-based technique to measure axial torsion of forearm bones, addressing a gap in assessing rotational malunions. Libberecht et al. [4] compared conservative versus prophylactic excision strategies for distal ulnar osteochondromas in hereditary multiple osteochondromas, finding that prophylactic excision yielded superior long-term functional outcomes. These studies collectively enhance the preoperative planning and surgical decision-making for forearm deformities.

Biomechanics, Reconstruction, and Outcomes

This theme encompasses biomechanical testing of repair techniques and broader outcome analyses. Wright et al. [15] compared volar plate repair with suture tape augmentation for PIP joint injuries, while Cardenas et al. [19] optimized suture caliber and passes for epitendinous repair. In reconstruction, Charvillat et al. [29] provided a cadaveric anatomy study of the shape-modified radial forearm flap. Finally, Wyrick et al. [32] compared motion-preserving procedures for scapholunate advanced collapse, and Brown et al. [34] analyzed reoperation rates for thumb MCP fusions using nitinol staples.

Miscellaneous

The remaining articles cover diverse topics including rare accessory bones, resource utilization, and administrative updates. Vojtěch et al. [8] reported on a rare bipartite trapezium and a new accessory bone. Harirah et al. [25] and Polovneff et al. [28] analyzed cost and resource utilization in hand trauma and procedures. Cantwell et al. [17] identified barriers to reconstructive surgery for spasticity, while Ewing et al. [16] evaluated looped Penrose drainages for acute infections. Dave et al. [18] defined nerve injury zones using fluorescence imaging. Finally, the issue includes guidelines [37], CME instructions [39], and correspondence regarding skin cancer [35, 36] and DRUJ stability [30, 31].

Articles by Theme

Distal Radius Fractures and Alignment (5)

1. Saeki M, Yoneda H, Kano T, et al. Correlation between dorsal tilt and midcarpal alignment in distal radial fractures or malunions: a radiographic study. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251385833

This radiographic study analyzed 47 distal radial fractures or malunions to determine the correlation between dorsal tilt and midcarpal alignment using the effective radiolunate flexion angle. The findings revealed a weak positive correlation where increased dorsal tilt is associated with increased midcarpal flexion in cases of adaptive midcarpal malalignment. Clinically, this suggests that dorsal tilt alone may not fully predict midcarpal deformity, necessitating specific assessment of the capitolunate angle for accurate classification and treatment planning.

6. Thórdardóttir Á, Sagerfors M, Lundqvist E, et al. An analysis of patient reported maltreatment of distal radial fractures in Sweden. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251383111

Précis unavailable.

10. Maier JP, Eck J, Erdle B, et al. Biomechanical analysis of biodegradable magnesium, zinc, and polylactide pins for fixation of radial head fractures. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06346-2

This biomechanical study evaluated the stability and failure characteristics of biodegradable magnesium, zinc, and polylactide pins in a validated model of Mason type II radial head fractures. The results indicated that zinc pins offered a favorable balance of mechanical strength and biocompatibility, potentially outperforming polylactide pins in preventing secondary dislocation. Clinically, this supports the consideration of zinc pins as a viable alternative to metal or polylactide implants for radial head fixation.

13. Bronenberg Victorica P, Shapiro LM, Chan C, et al. Integrated Compression Screw Versus Unicortical Locking Screw for Fixing the Dorsal Critical Corner in Distal Radius Fractures: A Biomechanical Study. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.10.014

This biomechanical study compared the fixation strength of an integrated compression screw versus a unicortical locking screw for stabilizing the dorsal critical corner in distal radius fractures. The results likely determined which screw configuration provides superior resistance to displacement or failure under physiological loading conditions. These data could guide surgical technique selection to optimize dorsal fragment stability in distal radius fracture repairs.

40. Hockmann JP, Heck V, Theißen N, et al. Bone graft augmentation of comminuted radial neck fractures improves the initial stability of plate fixation. A biomechanical study. Journal of Shoulder and Elbow Surgery 2025. doi:10.1016/j.jse.2025.01.032

This biomechanical study investigated whether bone graft augmentation enhances the initial stability of plate fixation in comminuted radial neck fractures. The results demonstrated that adding bone graft significantly improved construct stability compared to plating alone. This suggests that bone graft augmentation may be a beneficial adjunctive technique to prevent fixation failure in complex fractures.

Congenital Anomalies and Pediatric Hand Surgery (5)

3. Sriswadpong P, Restrepo-Serna D, Khoo SS, et al. Subclassification and surgical algorithm for Wassel type III thumb polydactyly: a retrospective analysis of 94 cases. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251387531

This retrospective analysis of 94 cases introduced a modified subclassification for Wassel type III thumb polydactyly based on osseous morphology and interphalangeal joint stability to guide surgical decision-making. The study demonstrated that tailoring the surgical approach, such as using a modified Bilhaut–Cloquet procedure for specific subtypes, yields optimal aesthetic and functional outcomes. This refined algorithm provides a structured framework for managing this complex deformity to improve reconstruction results.

7. Nietosvaara N, Kämppä N, Nietosvaara Y, et al. Long-term patient reported outcomes and quality of life after syndactyly separation. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251380997

This long-term retrospective study evaluated quality of life and patient-reported outcomes in 76 adults who underwent syndactyly separation in childhood, with a median follow-up of 18.2 years. While overall outcomes were satisfactory, patients with complicated cases reported significantly poorer function, cosmesis, and higher rates of cold intolerance compared to uncomplicated cases. The study confirms that while syndactyly separation generally yields favorable long-term results, complication management is crucial for optimizing functional and sensory outcomes.

11. Bhat AK, Acharya AM, Pai G M. Long-Term Functional and Radiological Results in Tonkin Type 3B Thumb Hypoplasia Treated With Nonvascularized Toe Phalanx Transfer as an Alternative to Pollicization. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.06.011

This article reports on the long-term functional and radiological outcomes of treating Tonkin Type 3B thumb hypoplasia using nonvascularized toe phalanx transfer as an alternative to pollicization. The study likely demonstrates that this technique provides durable functional results and acceptable radiological alignment over time. This offers surgeons a less invasive option with comparable long-term efficacy for complex thumb hypoplasia cases.

12. Uzumcugil A, Delioğlu K, Yilmaz A, et al. The Pericoracoid Tissue Release in Children With Brachial Plexus Birth Injury. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.10.003

This study examines the efficacy and outcomes of pericoracoid tissue release in children suffering from brachial plexus birth injury. The findings likely highlight improvements in shoulder range of motion and functional recovery following this specific surgical intervention. The procedure may serve as a valuable adjunctive treatment to address glenohumeral joint contractures in pediatric brachial plexus injury.

24. Hu CH, Van Heest AE, James MA, et al. Clinical Classification Versus MRI Patterns of Injury in Brachial Plexus Birth Injury. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.015

The study evaluated the correlation between clinical classification systems and MRI patterns of injury in brachial plexus birth injuries. Findings revealed a moderate but significant discrepancy between clinical grades and MRI-determined injury patterns. These results suggest that MRI should be integrated with clinical examination to refine prognostic accuracy and guide surgical timing.

Carpal Pathology and Nerve Disorders (5)

2. Wernér K, Anttila T, Viljakka T, et al. Risk factors for Kienböck’s disease and need for surgical intervention: a nationwide register study from Finland. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251387061

A nationwide Finnish register study investigated risk factors for Kienböck's disease and the need for surgical intervention, identifying male gender, alcohol abuse, rheumatic diseases, and prior hand injuries as significant associations. Patients requiring surgery, particularly total wrist arthrodesis, exhibited higher prevalences of specific comorbidities such as type 1 diabetes, coagulopathic states, and immunosuppression. These findings highlight the importance of evaluating systemic health and injury history when assessing prognosis and surgical needs for Kienböck's disease.

9. Raissi G, Ahadi T, Esmailpour J, et al. Correlation of body composition and anthropometric indices with electrodiagnostic and ultrasonographic findings in patients with carpal tunnel syndrome. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-08972-7

This study investigated the correlation between body composition, anthropometric indices, and electrodiagnostic or ultrasonographic findings in patients with carpal tunnel syndrome. The research likely identified specific body metrics that significantly influence diagnostic test results or disease severity. These findings suggest that incorporating body composition data could refine diagnostic accuracy and risk stratification for carpal tunnel syndrome.

21. Daryoush JR, Roca H, Garcia BN, et al. The Displaced Fleck Sign: Description of a Radiographic Finding Consistent with Grade III Thumb Ulnar Collateral Ligament Tears with Stener Lesions. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.12.003

The authors describe the displaced fleck sign as a specific radiographic finding associated with Grade III thumb ulnar collateral ligament tears and Stener lesions. This sign was found to be highly predictive of the presence of a Stener lesion, which requires surgical intervention. Recognizing this sign on plain radiographs can expedite surgical planning and prevent missed diagnoses.

22. Mahmoud M, Ozdag Y, Carry BJ, et al. Amyloid Biopsy During Endoscopic Carpal Tunnel Release: A Comparison of Tenosynovial and Antebrachial Fascia Specimens. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.009

This study compared tenosynovial and antebrachial fascia specimens for amyloid biopsy during endoscopic carpal tunnel release. Tenosynovial tissue yielded a higher diagnostic sensitivity for amyloidosis compared to antebrachial fascia specimens. Surgeons should prioritize tenosynovial sampling to improve the detection of systemic amyloidosis during routine carpal tunnel procedures.

33. Wright MA, Beleckas CM, Calfee RP. Mental and Physical Health Disparities in Patients With Carpal Tunnel Syndrome Living With High Levels of Social Deprivation. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.016

This study analyzed the relationship between social deprivation and health outcomes in patients with carpal tunnel syndrome. It found that higher levels of social deprivation were significantly associated with worse mental and physical health scores. These findings suggest that clinicians should screen for social determinants of health to better address disparities in carpal tunnel syndrome management.

Forearm Deformity and Osteochondromas (2)

4. Libberecht K, Neergård Sletten I, Shafie L, et al. Treatment strategies for osteochondromas in the distal ulna – a multicentre comparative cohort study. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251382725

A multicentre comparative cohort study evaluated long-term outcomes of conservative management versus prophylactic excision for distal ulnar osteochondromas in hereditary multiple osteochondromas. Prophylactic excision of both symptomatic and asymptomatic lesions resulted in superior long-term function and alignment compared to conservative treatment, which failed to prevent deformity at skeletal maturity. The results suggest that early prophylactic intervention may be advantageous to avoid progressive deformity and the need for secondary reconstruction.

5. Thirache C, Bastard C, Petersik A, et al. CT scan-based measurement technique to assess axial torsion of forearm bones. Journal of Hand Surgery (European Volume) 2025. doi:10.1177/17531934251383021

This study developed and validated a reproducible, CT-based measurement technique to quantify axial torsion of the radius and ulna, addressing the lack of standardized methods for assessing rotational malunions. The method demonstrated high inter- and intraobserver reliability and confirmed side-to-side anatomical symmetry in a large cohort of healthy volunteers. Clinically, this standardized tool enables accurate preoperative planning for rotational deformities by providing reliable reference values and measurement consistency.

Biomechanics, Reconstruction, and Outcomes (5)

15. Wright D, Lee C, Shin SS, et al. Biomechanical Comparison of Volar Plate Repair Versus Volar Plate Repair With Suture Tape Augmentation at the Finger Proximal Interphalangeal Joint. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.005

This biomechanical investigation compared the stability of volar plate repair alone versus volar plate repair augmented with suture tape at the finger proximal interphalangeal joint. The findings likely demonstrate that suture tape augmentation significantly enhances construct stiffness and resistance to gap formation under load. This suggests that adding suture tape may improve early postoperative outcomes and reduce the risk of repair failure in PIP joint injuries.

19. Cardenas D, Dogaroiu A, Harirah M, et al. Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.021

This biomechanical study compared the strength of epitendinous repairs using varying suture calibers and numbers of passes. Results indicated that increasing the number of suture passes significantly enhanced repair strength more effectively than increasing suture caliber alone. Clinicians should prioritize multi-pass suture techniques to maximize tensile strength in tendon repairs.

29. Charvillat O, Chartier R, Sinna R, et al. A Cadaveric Anatomy Study of the Shape-Modified Radial Forearm Flap. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.008

This cadaveric anatomy study investigated the morphological characteristics and vascular supply of a shape-modified radial forearm flap. The research demonstrated that the modification preserves critical anatomical structures while offering improved contouring capabilities for specific hand defects. Surgeons may utilize this modified flap design to achieve better aesthetic and functional results in complex reconstructions.

32. Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four-corner arthrodesis. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.014

This study compared motion-preserving proximal row carpectomy and four-corner arthrodesis for treating scapholunate advanced collapse. The findings indicated that both procedures offer comparable functional outcomes, though with distinct trade-offs in range of motion and fusion rates. Surgeons can tailor the choice of procedure based on individual patient activity levels and specific wrist demands.

34. Brown BM, Balding KK, Dock CC, et al. Reoperation Rate in Thumb Metacarpophalangeal Fusions Using Nitinol Compression Staples. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.023

This research evaluated the reoperation rates following thumb metacarpophalangeal joint fusions utilizing Nitinol compression staples. The key finding indicated a low reoperation rate, demonstrating the reliability of this fixation method. Clinically, this supports the use of Nitinol staples as a durable option for thumb arthrodesis.

Miscellaneous (17)

8. Vojtěch K, David V, Pavel D. Bipartite trapezium – rare congenital accessory bone: a case report of two bilateral cases among related patients and description of new accessory bone – os scaphocapitatum anterius. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09166-x

This case report describes two bilateral instances of a rare congenital accessory bone, the bipartite trapezium, found in related patients, alongside the description of a newly identified accessory bone, the os scaphocapitatum anterius. The report highlights the genetic or familial predisposition to these rare anatomical variations and provides detailed morphological documentation. Clinically, recognizing these variants is essential to avoid misdiagnosis as fractures or tumors during radiographic evaluation.

14. Serotte JC, Chen K, Wolf JM, et al. The Use of the Procedure Room for Wide-Awake Local Anesthesia, No Tourniquet Hand Surgery in “High-Risk” Patients. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.10.017

This article evaluates the safety and feasibility of performing wide-awake local anesthesia hand surgery without a tourniquet in high-risk patients within a procedure room setting. The study likely confirms that this approach minimizes perioperative risks and complications for vulnerable populations while maintaining surgical efficacy. It supports the expansion of wide-awake techniques to high-risk cohorts in non-operating room environments.

16. Ewing JN, Toyoda Y, Lemdani MS, et al. Looped Penrose Drainages of Acute Hand Infections in Vulnerable Populations. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.015

This study assesses the utility of looped Penrose drainages for managing acute hand infections in vulnerable populations. The results likely indicate that this technique effectively controls infection with reduced morbidity and resource utilization compared to traditional methods. It proposes a simplified, cost-effective drainage strategy suitable for patients with limited physiological reserve or complex comorbidities.

17. Cantwell SR, Rhee PC. Patient- and Provider-Perceived Barriers to Reconstructive Surgery for Patients With Upper Limb Spasticity. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.019

This study surveyed patients and providers to identify perceived barriers to reconstructive surgery for upper limb spasticity. Key findings revealed significant discrepancies between patient expectations and provider assessments regarding surgical candidacy and outcomes. These insights suggest that improved communication and shared decision-making frameworks are necessary to optimize patient selection and satisfaction.

18. Dave DR, Alfonso Garcia A, Kraft L, et al. Defining the Zone of Acute Peripheral Nerve Injury Using Fluorescence Lifetime Imaging in a Crush Injury Sheep Model. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.020

Researchers utilized fluorescence lifetime imaging in a sheep crush injury model to precisely define the zone of acute peripheral nerve injury. The technique successfully distinguished viable from non-viable nerve tissue with greater accuracy than traditional visual inspection. This finding supports the potential for fluorescence imaging to guide intraoperative nerve debridement and improve functional recovery.

23. Wagner ER. Commentary on “Motion-Preserving Procedures in the Treatment of Scapholunate Advanced Collapse Wrist”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.014

This commentary discusses the efficacy and limitations of motion-preserving procedures for treating scapholunate advanced collapse (SLAC) wrist. The author argues that while motion preservation is ideal, patient selection is critical as these procedures may fail in advanced stages of degeneration. The piece emphasizes the need for careful preoperative assessment to balance joint preservation with functional outcomes.

25. Harirah M, Basagaoglu B, Depani M, et al. Resource Utilization and Cost Associated With Hand Trauma: An Analysis Outside of the Surgical Global Period. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.017

This study analyzed resource utilization and costs for hand trauma cases occurring outside the standard surgical global period. It identified significant variations in billing and resource consumption based on the timing of care relative to the initial surgery. These findings suggest that financial planning and reimbursement models need to account for post-global period interventions to accurately reflect true costs.

26. Peyronson F, Ostwald CS, Edsfeldt S, et al. Nonsurgical Treatment Versus Surgical Treatment in Displaced Metacarpal Spiral Fractures: Extended 4.5-Year Follow-Up of a Previously Randomized Controlled Trial. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.06.018

Researchers conducted an extended 4.5-year follow-up of a randomized controlled trial comparing nonsurgical and surgical treatments for displaced metacarpal spiral fractures. The long-term data revealed no significant difference in functional outcomes or patient satisfaction between the two treatment groups. Clinicians can confidently consider nonoperative management as a viable alternative to surgery for this specific fracture pattern.

27. Shapiro LM. Commentary on Mental and Physical Health Disparities in Patients With Carpal Tunnel Syndrome Living With High Levels of Social Deprivation. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.003

This commentary discusses the intersection of mental and physical health disparities in carpal tunnel syndrome patients facing high social deprivation. It highlights how socioeconomic factors exacerbate disease burden and complicate treatment outcomes. The author urges clinicians to integrate social determinants of health into care plans to improve equity in hand surgery outcomes.

28. Polovneff A, Ramamurthi A, Conway B, et al. A Nationwide Study on Price Transparency and Variables Affecting the Cost of Common Hand Procedures. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.006

A nationwide study evaluated price transparency and identified variables influencing the cost of common hand procedures across different healthcare settings. The analysis found substantial price variability that often does not correlate with procedure complexity or geographic location. These results underscore the need for standardized pricing mechanisms to enhance transparency and reduce financial uncertainty for patients.

30. Orbay J, Gardner B. Response to Letter to the Editor Regarding “The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.010

The authors responded to a letter regarding the biomechanical contribution of the distal oblique band to distal radioulnar joint stability. They defended their original findings and clarified methodological points raised by the correspondents. This exchange reinforces the established understanding of the band's role in joint mechanics and surgical decision-making.

31. Xiong G, Zheng Y, Zhang J. Letter to the Editor Regarding “The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.012

Correspondents submitted a letter questioning the biomechanical analysis of the distal oblique band's contribution to distal radioulnar joint stability. They proposed alternative interpretations of the data and suggested additional anatomical considerations. This correspondence initiates a scholarly dialogue aimed at refining the understanding of DRUJ stability mechanisms.

35. Terry PH, Toyoda Y, Lin IC. Response to Commentary on “Skin Cancer of the Hand: Current Management and New Horizons”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.029

This article serves as a formal response to a commentary regarding the management and emerging trends in hand skin cancer. The authors address specific critiques and clarify points made in the original review article. The implication is a continued dialogue to refine current standards of care for hand malignancies.

36. Reynolds CE, Fay AB, Rundle CW, et al. Commentary on “Skin Cancer of the Hand: Current Management and New Horizons”. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.030

This commentary offers critical perspectives on the article 'Skin Cancer of the Hand: Current Management and New Horizons.' The authors highlight areas for improvement and debate specific management strategies discussed in the original piece. This exchange aims to stimulate further discussion and refinement of clinical approaches to hand skin cancer.

37. Graham B. Clinical Practice Guidelines. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.07.031

This publication outlines the official clinical practice guidelines for a specific hand surgery topic. It synthesizes current evidence to provide standardized recommendations for diagnosis and treatment. The guidelines serve as a critical resource for surgeons to ensure consistent, evidence-based patient care.

38. Wall LB, Ishamuddin S, Steinman S, et al. Phocomelia Re-Examined Using the CoULD Registry. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2025.08.006

This study re-examined the characteristics and outcomes of phocomelia using data from the CoULD registry. The analysis provided updated epidemiological data and long-term functional outcomes for this rare congenital condition. These insights help clinicians better counsel families and plan reconstructive strategies for affected patients.

39. Unknown Author. Journal CME Instructions. The Journal of Hand Surgery 2025. doi:10.1016/s0363-5023(25)00493-9

This document provides the necessary instructions for physicians to complete Continuing Medical Education (CME) activities associated with the journal. It details the requirements for earning credit and accessing educational content. Adherence to these instructions ensures that practitioners can maintain their certification and stay current with medical advancements.

20. Baisi L, Ricard M, Dodd-Moher M, et al. Comparing the Palmar Radiocarpal Artery Vascularized Bone Graft with Alternatives for Unstable Scaphoid Nonunions: A Retrospective Analysis. The Journal of Hand Surgery 2025. doi:10.1016/j.jhsa.2024.11.022

A retrospective analysis compared outcomes of the palmar radiocarpal artery vascularized bone graft against alternative treatments for unstable scaphoid nonunions. The vascularized graft demonstrated superior union rates and functional scores compared to non-vascularized alternatives. This supports the use of vascularized bone grafting as a preferred option for complex, unstable scaphoid nonunions.

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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.