What's New — Wrist — August 2026¶

56 new articles published this month.

Themes: Distal Radius Fracture Management · Scaphoid Injury and Nonunion · Carpal Tunnel and Nerve Disorders · Wrist Arthritis and Kienböck Disease · TFCC and DRUJ Instability · Paediatric and Sports Wrist Topics

Digest generated 2026-09-14 07:55:18+00:00.

Highlights¶

Distal Radius Fracture Management¶

This month's largest cluster addresses distal radius fracture (DRF) care across operative technique, fixation biomechanics, and treatment selection. Cadaveric work examined distal screw number and fragment-specific stability [25], watershed line width as a guide to screw length [51], and ligament-sparing volar versus dorsal arthrotomy exposure for articular reduction [54]. Clinical studies compared dorsal bridge plating with volar locking plates in the elderly [16], retrograde intramedullary screw fixation of distal ulna fractures [14], and operative versus conservative treatment of associated ulnar metaphyseal fractures [8], while a meta-analysis found untreated ulnar styloid fractures do not compromise wrist function [47]. Radiographic risk factors for flexor tendon rupture after volar plating were identified [30], artificial intelligence was tested against LaFontaine criteria for instability assessment [28], national guidelines showed wide variation in surgical thresholds [48], and value analysis, surgeon survey, and frailty data informed decision-making [7, 53, 35].

Scaphoid Injury and Nonunion¶

Scaphoid fracture care and nonunion management featured prominently. Arthroscopic-assisted bone grafting showed equivalent outcomes with autograft versus allograft for unstable scaphoid nonunion [3], while cannabis and tobacco use were linked to nonunion after nonoperative management [17]. A dedicated axial fluoroscopic view was CT-validated for assessing screw centrality during fixation [10], and union rates and healing-time predictors were characterized in adolescent scaphoid fractures [12]. Complementing these clinical studies, cadaveric morphometry detailed the intrinsic scapholunate articular facets [18], and a radiographic scaphoid waist index was proposed as a predictor of nonunion after scaphocapitate fusion for Kienböck disease [55].

Carpal Tunnel and Nerve Disorders¶

Compressive neuropathy and nerve surgery generated several contributions. Surgeon expectations after open carpal tunnel release were compared with patient-reported PROMIS outcomes [1], and a pilot study found plastic building-block rehabilitation was associated with earlier recovery after carpal tunnel release [52]. A prospective cohort characterized concomitant versus isolated carpal and cubital tunnel syndromes [20], and ultrasound wrist-to-forearm ratio added diagnostic value to median nerve cross-sectional area measurement [42]. Cadaveric work showed the flexor carpi radialis approach permits carpal tunnel decompression during distal radius fixation [15], correspondence debated concomitant carpal tunnel release with DRF fixation [49, 50], and nerve-related topics extended to ballistic nerve injuries [29], nerve transfers for spastic wrist rebalancing [40], and intraoperative electrodiagnosis in neonatal brachial plexus palsy [5].

Wrist Arthritis and Kienböck Disease¶

Degenerative and avascular conditions of the wrist were well represented. A systematic review compared proximal row carpectomy with four-corner fusion for wrist osteoarthritis [23], and a multicentre study confirmed mid- to long-term durability of wrist denervation in delaying further surgery [24]. Total wrist arthroplasty featured in a MAUDE database analysis of failure modes [21] and a biomechanical evaluation of a novel reverse total wrist arthroplasty design [31]. Kienböck disease was addressed through a contemporary review of etiology and pathogenesis [43], mid-term outcomes of 4+5 extensor compartment pedicled vascularized bone grafting [22], and scaphocapitate fusion outcomes stratified by scaphoid waist index [55].

TFCC and DRUJ Instability¶

Triangular fibrocartilage complex (TFCC) injury and distal radioulnar joint (DRUJ) instability formed a focused cluster. Transosseous foveal repair combined with dorsal allograft reinforcement yielded strong pain relief and functional gains in severe DRUJ instability [32], and intermediate-term outcomes after foveal TFCC repair defined the recovery trajectory and return to sport or work [38]. An international reliability study quantified how consistently experienced surgeons diagnose and classify TFCC tears arthroscopically [39], and prospective 12-month data supported Adams-Berger ligament reconstruction for chronic DRUJ instability [41]. Arthroscopic treatment of scapholunate ligament injuries was also synthesized in a meta-analysis [13].

Paediatric and Sports Wrist Topics¶

Paediatric and athletic populations rounded out the digest. Paediatric perilunate injuries were characterized in a 12-year tertiary-center review [27], open reduction of severe paediatric radial neck fractures achieved excellent functional outcomes with low complications [36], and 15 years of flexible intramedullary nailing data compared implant retention versus removal in paediatric forearm fractures [44]. In athletes, a narrative review covered upper-limb bone stress injuries [26], pitching studies examined segmental momentum sequencing across arm slots [33] and the link between lower-body and upper-extremity injury in MLB pitchers [34], and grip contraction with varying finger recruitment and wrist positions was shown to influence dynamic medial elbow stability [56].

Articles by Theme¶

Distal Radius Fracture Management (13)¶

7. Agoro KS, Borgida JS, Lawhorn HP, et al. Patient-Level Value Analysis for Operative Management of Distal Radius Fractures: Factors Affecting Value. HAND 2026. doi:10.1177/15589447261478322

This single health-system value analysis evaluated patients undergoing volar locking plate fixation of isolated distal radius fractures, using PRWHE scores at baseline and 3 months relative to cost to determine patient-level value. The study identified demographic, clinical, and cost factors that significantly influenced value within the first 3 months postoperatively. These findings can help target modifiable factors to improve value-based outcomes in distal radius fracture surgery.

8. Sakong S, Cho W, Kang S, et al. Operative versus conservative management of metaphyseal ulnar fractures in distal radial fractures fixed with a plate. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261474790

This retrospective study of 66 patients compared conservative treatment (n=35) versus surgical plate fixation (n=31) of distal ulnar metaphyseal fractures accompanying plate-fixed distal radius fractures, with ~33-month follow-up. DASH scores, range of motion, grip strength, and union times were similar between groups, though conservative treatment left greater ulnar angulation (median 9° vs 2°) and more frequent deformity exceeding 10°. Despite residual radiographic differences, functional outcomes support conservative management as a reasonable option for these ulnar metaphyseal fractures.

14. Crook BS, Lockwood CW, Landrum KR, et al. Short-Term Outcomes of Retrograde Intramedullary Screw Fixation of Distal Ulna Fractures. HAND 2026. doi:10.1177/15589447261467937

This retrospective cohort study compared retrograde intramedullary screw fixation of distal third ulna fractures against conventional plate fixation in adults treated at a single health system between June 2021 and February 2024, using inverse probability of treatment weighting to balance cohorts. Outcomes included radiographic, implant, complication, and clinical variables. Results inform implant selection for these challenging fractures, suggesting whether noncompressive intramedullary screws offer comparable outcomes with potential advantages over plating.

16. Eckels J, Rainwater RR, O’Brien PE, et al. Radiographic Outcomes of Dorsal Bridge Plating Versus Volar Locking Plate Fixation for Distal Radius Fractures in Elderly Patients: A Single-Center Retrospective Study. HAND 2026. doi:10.1177/15589447261465835

This single-center retrospective study compared radiographic outcomes and plate-related complications of dorsal wrist-spanning bridge plating (DBP) versus volar locking plating (VLP) for distal radius fractures in patients aged 65 and older. Radiographic parameters including radial height, radial inclination, volar tilt, ulnar variance, and metadiaphyseal involvement were assessed pre- and postoperatively, with concomitant injuries recorded. Results guide implant choice in elderly patients with osteoporotic distal radius fractures, where fixation strategy must balance stability against complication profiles.

25. Dietz L, Spiegel C, Kohler FC, et al. Effect of distal screw number on axial deformation and fragment-specific stability in AO/OTA 2R3 C2.1 distal radius fractures. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06454-6

In a paired cadaveric study of AO/OTA 2R3 C2.1 distal radius fractures with radiodorsal metaphyseal comminution fixed with volar locking plates, constructs with six distal screws were compared to four distal screws under cyclic axial loading with 3D optical motion tracking. Six screws significantly reduced global axial deformation and fragment-specific interfragmentary motion. Surgeons treating dorsally comminuted distal radius fractures should consider placing six distal screws to enhance construct stability during early rehabilitation.

28. Newson C, Bailey V, Chappell A, et al. Can Artificial Intelligence Assess Distal Radius Fracture Stability?. HAND 2026. doi:10.1177/15589447261465836

In a cross-sectional diagnostic accuracy study, a multimodal large language model was tested against five hand surgeons' majority assessments of the five LaFontaine instability criteria on 20 distal radius fracture radiographs. The study quantifies the AI's agreement and accuracy in structured radiographic fracture-stability assessment. Results clarify whether such models can serve as adjunctive triage tools for referral of distal radius fractures to hand specialists.

30. Bachoura A, Matzon J, Ghayyad K, et al. Radiographic Risk Factors for Flexor Tendon Ruptures Following Distal Radius Volar Plating. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.04.021

This case-control study compared 27 flexor tendon ruptures after volar distal radius plating with 73 non-rupture controls, analyzing radial inclination, Soong class, volar tilt, and capitate-to-axis-of-radius distance (CARD) via multivariable logistic regression. CARD was the only significant independent predictor of rupture when the plate was prominent (mean 9.8 mm in rupture vs 3.5 mm in controls). Measuring CARD on lateral radiographs may help identify patients at risk of attritional flexor tendon rupture after volar plating.

35. MacLeay C, Murphy J, Giglio V, et al. In older adults undergoing surgical fixation or arthroplasty following upper limb fractures, does frailty predict post-operative complications and mortality? A systematic review and meta-analysis. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100764

This systematic review and meta-analysis evaluated whether pre-operative frailty predicts post-operative mortality and complications in older adults undergoing fixation or arthroplasty for upper limb fractures, with secondary outcomes including reoperation, adverse discharge destination, and length of stay. Pooled analysis quantified the association between frailty and adverse outcomes after upper limb fracture surgery. Results support routine frailty assessment in preoperative planning and risk stratification for these patients.

47. Li C, Gao W, Yang C, et al. Untreated ulnar styloid fractures do not compromise wrist function in patients with distal radius fractures: A systematic review and meta-analysis. Injury 2026. doi:10.1016/j.injury.2026.113479

This systematic review and meta-analysis of 11 studies (1,383 patients) compared wrist outcomes after distal radius fractures between patients with untreated ulnar styloid fractures and those with isolated distal radius fractures. Untreated USF was associated with only a small, clinically limited deficit in wrist function scores at ≤6 months, with no significant difference at ≥6 months; grip strength and ROM findings were similarly reassuring. Routine treatment of ulnar styloid fractures accompanying distal radius fractures appears unnecessary, as they do not compromise long-term wrist function.

48. Oftebro I, Olsen B, Enger MM, et al. Variation in surgical indications across national distal radius fracture guidelines: A comparative review. Injury 2026. doi:10.1016/j.injury.2026.113480

This comparative review analyzed eight national guidelines (one US, seven European) for surgical indications in dorsally displaced distal radius fractures. Ulnar variance, dorsal tilt, and intra-articular step-off were consistently cited as key radiographic thresholds, but cutoff values and age-related modifications varied substantially, along with consideration of comminution, osteoporosis, and volar cortical alignment. This guideline heterogeneity likely drives practice variation and has implications for standardizing treatment decisions and resource utilisation.

51. Ivin S, Daoulas T, Dardenne G, et al. Distal radius plate: correlation between the length of distal epiphyseal screws and the width of the watershed line. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104822

In 51 retrospectively analyzed wrist CT scans, virtual fixed-angle volar plate placement was used to measure distal epiphyseal screw lengths (B1-B5) relative to watershed line width (mean 28.6 ± 2.6 mm). Watershed line width correlated positively with screw lengths for positions B1-B4 (r = 0.46-0.65) but not B5, and conservative screw-length recommendations were derived from the 10th percentile of distributions. The findings suggest the watershed line width on preoperative imaging can serve as an anatomic guide for selecting distal screw lengths that maximise subchondral support while minimising dorsal cortical penetration.

53. Zaidi Z, Dbeis A, Lee Y, et al. Management Preferences of Geriatric Distal Radius Fractures: Insights From an American Society for Surgery of the Hand Surgeon Survey. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.04.007

A 2025 survey of American Society for Surgery of the Hand members presented six fracture-pattern scenarios in a 72-year-old distal radius fracture patient to characterize management preferences for geriatric DRFs. Preliminary results indicate that fracture pattern and surgeon factors influence the choice between nonsurgical and operative treatment, consistent with AAOS guideline emphasis on patient-centered decisions. Clinically, the study maps real-world practice variation and identifies which injury and patient characteristics push hand surgeons toward surgery in elderly patients.

54. Rakowski DR, Richman EH, Kahan R, et al. Distal Radius Articular Surface Visualization: Comparison of Ligament-Sparing Volar and Dorsal Radiocarpal Arthrotomies for Distal Radius Fracture Reduction. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.004

In 12 matched pairs of fresh-frozen cadaver wrists, ligament-sparing volar versus dorsal radiocarpal arthrotomies were compared for intra-articular distal radius fracture reduction using photogrammetric 3D models to quantify visible articular surface area. The dorsal approach visualized a greater mean percentage of the articular surface (77.3%) than the volar approach (63.7%), with regional differences characterized by overlay mapping. Surgeons can use these data to choose the arthrotomy approach that best exposes the anticipated fracture fragments when direct articular visualization is needed.

Scaphoid Injury and Nonunion (6)¶

3. Chang C, Wu C, Wang J, et al. No Difference in Outcome Comparing Autograft and Allograft in Arthroscopic‐Assisted Bone Grafting for Treating Unstable Scaphoid Nonunion. Arthroscopy 2026. doi:10.1002/arj.70498

This retrospective comparative study compared arthroscopic bone grafting with autograft (n=47) versus allograft (n=27) for unstable scaphoid nonunion with minimum 12-month follow-up. Nonunion rates (6.4% vs 11.1%), healing times, and radiographic and functional outcomes were comparable between graft types. Arthroscopic-assisted grafting with either autograft or allograft yields similar results, supporting surgeon preference and availability in graft choice.

10. Tzaytlin I, Benkovich V, Abialevich A, et al. Assessment of Scaphoid Screw Centrality Using a Dedicated Axial Fluoroscopic View: A CT-Validated Study. HAND 2026. doi:10.1177/15589447261476241

In a retrospective series of 54 scaphoid fixation patients, the authors validated a dedicated axial fluoroscopic view for intraoperative assessment of screw centrality against postoperative CT measurements of deviation from the scaphoid waist geometric center. Spearman correlation and Bland-Altman analysis assessed agreement between the two modalities. If reliable, this view offers surgeons a practical intraoperative tool to confirm near-central screw placement within the narrow scaphoid corridor, potentially reducing malpositioned fixation.

12. Torun Ö, Girgin AB, Kaşıkçı M, et al. Union outcomes and associated factors in adolescent scaphoid fractures. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06480-4

This study evaluated 77 adolescents aged 10-18 years with scaphoid fractures to identify clinical, radiological, and treatment-related factors associated with union and healing time, using CT-based morphometric measurements and functional outcomes (QuickDASH, PRWE). Union was achieved in 81.8% at a median of 8 weeks, with distal pole fractures uniting most reliably (100%) and proximal pole fractures least reliably (33.3%). These findings help counsel adolescent patients and families regarding prognosis based on fracture location and displacement, and guide decisions about operative versus nonoperative management.

17. Gordon AM, Nian PP, Said M, et al. Association Between Cannabis Use and Tobacco Use With Nonunion of Nonoperative Management of Scaphoid Fractures. HAND 2026. doi:10.1177/15589447261472087

This study examined whether cannabis use, alone or with tobacco, increases nonunion risk after nonoperative management of scaphoid fractures. Tobacco use was confirmed as a risk factor for nonunion and subsequent surgery, while the independent contribution of cannabis use was less clearly defined. Clinicians should counsel patients on tobacco cessation when managing scaphoid fractures nonoperatively, with cannabis use considered as a potential adjunctive risk factor.

18. Adeodato SC, de Oliveira NSP, Favorito LA, et al. Asymmetry of the Intrinsic Scapholunate Articular Facets: A Cadaveric Morphometric Analysis. HAND 2026. doi:10.1177/15589447261469596

This cadaveric morphometric study measured the intrinsic articular facets of the scaphoid and lunate in 26 wrists to characterize the scapholunate articulation. The analysis demonstrated measurable asymmetry between the scaphoid and lunate intrinsic facets, defining dimensions of an interface that had been poorly characterized. These anatomic data may inform interpretation of scapholunate instability and improve surgical reconstruction or implant design.

55. Nishimura K, Ward C, Tunaboylu MF, et al. Radiographic Scaphoid Waist Index and Nonunion After Scaphocapitate Fusion for Kienböck Disease. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.002

A retrospective review of 22 scaphocapitate fusions for Kienböck disease (1996-2025) tested whether a low radiographic scaphoid waist index on preoperative lateral radiographs predicts nonunion, which occurred in 5 of 22 wrists (23%). The scaphoid waist index was measured independently by two observers and analyzed as a continuous variable, with an exploratory dichotomized type II threshold (WI < 0.40 requiring agreement). If validated, this simple preoperative radiographic measure could help identify patients at elevated risk of nonunion after scaphocapitate fusion and inform fixation construct or grafting choices.

Carpal Tunnel and Nerve Disorders (10)¶

1. Cullom ME, Hajj JP, Ahmed S, et al. Comparison of Surgeon Expectations to Patient-Reported Outcomes Following Open Carpal Tunnel Release. HAND 2026. doi:10.1177/15589447261476240

This study compared hand surgeons' expectations of recovery after open carpal tunnel release with patient-reported outcomes (PROMIS pain interference and upper extremity scores) collected at 2 weeks, 6 weeks, and 3 months postoperatively. The findings reveal the degree of alignment or discordance between surgeon-anticipated and patient-experienced recovery trajectories. Clinically, this highlights opportunities to improve preoperative counseling and set more accurate patient expectations following carpal tunnel surgery.

5. Albdewi MJ, Malessy MJ, Saadeh YS. Intraoperative electrodiagnostic testing as a decision-making tool for neonatal brachial plexus palsy: a scoping review. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261478357

This PRISMA-guided scoping review identified nine studies (eight retrospective, one prospective) evaluating intraoperative electrodiagnostic modalities, nerve action potentials, evoked potentials, compound muscle action potentials, and electromyography, in neonatal brachial plexus palsy surgery. Substantial heterogeneity existed in how electrodiagnostic findings were used to distinguish candidates for neurolysis versus nerve reconstruction. The evidence base remains too inconsistent to establish a standardised role for intraoperative electrodiagnosis in neonatal surgical decision-making.

15. Marcano-Fernández F, Campbell M, Gurel R, et al. Carpal tunnel decompression through the flexor carpi radialis approach: a cadaveric comparative study. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261472374

In this cadaveric study of 12 paired upper extremities, carpal tunnel release through the flexor carpi radialis (FCR) approach, used for volar distal radius plating, was compared with standard open palmar incision using intracarpal pressure measurements via balloon-tipped catheter at 5-mm intervals. Pressure peaked approximately 29 mm distal to the wrist crease near the hook of the hamate, and both techniques were assessed for pressure reduction, completeness of release, and iatrogenic injury. If the FCR approach achieves comparable decompression, it would allow simultaneous carpal tunnel release at the time of distal radius fixation without extending the incision into the palm.

20. Lee KK, Sadeh O, Barrientos A, et al. Clinical Characteristics of Concomitant Versus Isolated Carpal and Cubital Tunnel Syndromes: A Prospective Cohort Study. HAND 2026. doi:10.1177/15589447261475385

This prospective cohort study of 86 adults compared clinical characteristics of isolated carpal tunnel syndrome, isolated cubital tunnel syndrome, and concomitant CTS/CuTS. Concomitant dual compression represented a distinct clinical subgroup with greater objective motor impairment than either isolated entrapment. Findings support careful assessment for combined median and ulnar nerve compression, as it may warrant more aggressive or expedited treatment.

29. Ghosh K, Aggarwal S, Blum E, et al. Operative Evaluation and Treatment of Civilian Ballistic Nerve Injuries: A Case Series. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.003

This retrospective case series from two academic centers reviewed 49 patients (57 nerves) undergoing surgery for low-velocity civilian gunshot nerve injuries, reporting indications for exploration, intraoperative nerve findings, and reconstruction methods (median injury-to-surgery interval 99 days). It provides rarely documented data on the operative status of ballistic-injured nerves in civilians. The findings inform surgical decision-making regarding timing and reconstruction strategy for gunshot-related nerve palsies.

40. Wu KY, Stephens T, Shahriarirad R, et al. Nerve Transfers to Rebalance the Spastic Wrist: An Anatomical Feasibility Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.004

In ten fresh-frozen cadaveric upper extremities, motor branches to the flexor carpi ulnaris and radial nerve branches to the ECRL/ECRB were mapped to assess feasibility of nerve transfers (FCU branch to ECRB and/or ECRL) for spastic wrist flexion deformity. The number, entry points, and available lengths of donor and recipient branches were documented relative to the interepicondylar line. The anatomy appears feasible for these transfers, providing a nerve-transfer option to rebalance the spastic wrist alongside traditional tendon-lengthening procedures.

42. Afolabi-Brown K, Liu A, Fowler JR, et al. Added Value of Wrist-to-Forearm Ratio to Single Measurement of Median Nerve Cross-Sectional Area for Diagnosis of Carpal Tunnel Syndrome. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.010

In a prospective cohort of 113 patients (196 wrists) evaluated for carpal tunnel syndrome, the wrist-to-forearm ratio (WFR) of median nerve cross-sectional area was tested as an adjunct to wrist CSA alone against CTS-6 and clinical diagnosis standards. WFR ≥1.4 classified more wrists as positive (76.5%) than wrist CSA ≥10 mm² (67.3%) or CTS-6 ≥12 (44.9%), with regression analysis assessing incremental value beyond CSA. Adding WFR may improve ultrasound diagnostic performance for CTS, though its incremental benefit over CSA alone requires weighing against the reported discrimination data.

49. Sima J, Jiang M, Chen X, et al. Beyond the null result: Unpacking the clinical nuance of concomitant carpal tunnel release with distal radius fracture fixation. Injury 2026. doi:10.1016/j.injury.2026.113590

This letter to the editor comments on a large propensity score-matched TriNetX cohort study (5090 matched pairs) that found concomitant carpal tunnel release during distal radius fracture ORIF did not reduce subsequent CTR within 2 years and was associated with higher revision surgery, malunion/nonunion surgery, and 90-day ED visit rates. The authors commend the study's rigor while emphasizing that the null result warrants nuanced clinical interpretation rather than a blanket prohibition on prophylactic release. Clinically, the exchange underscores that decisions about concomitant CTR should remain individualized given real-world trade-offs in complications and healthcare utilisation.

50. Dinesh A, Poursalehian M, Marjoua Y, et al. Response to “Beyond the null result: Unpacking the clinical nuance of concomitant carpal tunnel release with distal radius fracture fixation”. Injury 2026. doi:10.1016/j.injury.2026.113628

This is the original authors' formal response to a letter critiquing their propensity score-matched TriNetX study of concomitant carpal tunnel release during distal radius fracture ORIF. The authors defend their methodology and interpretation of the null association with subsequent CTR and the observed increases in revision surgery and ED visits. The reply reinforces their conclusion that routine prophylactic CTR at the time of distal radius fixation is not supported by real-world data, supporting selective, case-by-case use.

52. Brenac C, de Villeneuve Bargemon JB, Merlini L. Rehabilitation using plastic building-block toys was associated with early recovery following carpal tunnel release: a prospective comparative observational pilot study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104823

This item is a letter to the editor commenting on a prospective comparative observational pilot study by Brenac et al. that reported rehabilitation using plastic building-block toys was associated with earlier recovery after carpal tunnel release. The commenters engage with the pilot's methodology and findings regarding this low-cost, play-based hand therapy approach. The clinical implication is that structured toy-based rehabilitation may be a feasible, engaging adjunct to accelerate functional recovery post-carpal tunnel release, pending confirmation in larger trials.

Wrist Arthritis and Kienböck Disease (6)¶

21. Shabbir R, Layton B, Kang Z, et al. Failure Modes of Total Wrist Arthroplasty: Cross-Sectional Analysis of FDA MAUDE Adverse Event Reports (2015-2025). HAND 2026. doi:10.1177/15589447261476239

This cross-sectional analysis reviewed FDA MAUDE adverse event reports for total wrist arthroplasty devices from 2015 to 2025, manually assigning primary failure modes to event narratives. The analysis characterized real-world failure patterns, such as component loosening and implant-related complications, complementing reported 10-year survivorship of 70% to 80%. These findings can guide implant selection, patient counseling, and surveillance for TWA durability concerns.

22. Önel Y, Ancar C. Clinical outcomes of using 4 + 5 extensor compartment pedicled vascularized bone graft in Kienböck’s disease. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10347-5

This retrospective study of 30 patients (31 wrists) evaluated a 4th-5th extensor compartment artery pedicled vascularized distal radius bone graft for Lichtman stage II and IIIa Kienböck's disease, with mean follow-up of 27.5 months. VAS pain scores decreased significantly (6.1 to 2.6) and Mayo Wrist Scores improved, with MRI evidence of lunate revascularization and outcomes varying by disease stage. The technique appears effective for early-stage disease, supporting its use before advanced lunate collapse.

23. Boever J, Unglaub F, Wulf J, et al. Conservative and surgical treatment of wrist osteoarthritis: a systematic review. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06423-z

This systematic review following PRISMA guidelines compared proximal row carpectomy and four-corner fusion for wrist osteoarthritis, including eight studies from 2010 to 2025. Both procedures significantly reduced pain and improved function; PRC offered better range of motion and fewer complications, while 4CF provided greater grip strength. The findings support individualized procedure selection based on patient priorities regarding motion versus strength.

24. Kwee E, Nieuwdorp NJ, Blaaker C, et al. Durability of wrist denervation for osteoarthritis: a multicentre outcome study. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261468563

This prospective multicentre study of 112 patients (114 wrists) evaluated wrist denervation for symptomatic osteoarthritis with a median 4-year follow-up. At final follow-up, 86% of wrists avoided further osteoarthritis-related surgery, with most reoperations occurring within 2 years, alongside favourable pain, satisfaction, and willingness-to-repeat outcomes. Denervation is a durable, motion-preserving option that can delay or avoid more invasive arthrodesis or arthroplasty.

31. Norman-Puim E, Lalone E, Kadar A, et al. Reverse Total Wrist Arthroplasty: New Design and Biomechanical Advantages. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.005

Eight cadaveric wrists were implanted with both a custom load-sensing conventional total wrist arthroplasty and a novel reverse total wrist arthroplasty (RTWA) that shifts the center of rotation, then actuated through flexion-extension and radioulnar deviation with muscle force and articular loading recorded. The RTWA generally required lower muscle forces, with four of five muscles needing less force in flexion-extension. Shifting the center of rotation may reduce muscular demand and address persistent failure of current TWA designs.

43. MacLean SB, Bain GI. Modern Concepts in the Etiology and Pathogenesis of Kienbock Disease. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.013

This narrative review synthesizes modern concepts in Kienböck disease etiology, integrating advances in basic science and advanced imaging from the past decade. It highlights the interplay of demographic predisposition, wrist and lunate morphology affecting central column loading, arterial and venous factors producing a 'compartment syndrome of bone,' and ligamentous disruption leading to carpal collapse. A refined pathogenetic model can guide more rational, stage- and mechanism-specific surgical strategies.

TFCC and DRUJ Instability (5)¶

13. Rojer LA, Juttmann JY, Schep NW. Arthroscopic treatment of scapholunate interosseous ligament injuries: a systematic review and meta-analysis. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261472361

This systematic review and meta-analysis included 16 studies (434 patients) reporting patient-reported outcomes after arthroscopic treatment of scapholunate interosseous ligament injuries with minimum 12-month follow-up, covering capsulodesis, electrothermal treatment, debridement with percutaneous K-wire fixation, and arthroscopic reduction and association of the scaphoid-lunate. Meta-analysis of six capsulodesis studies (N=250) demonstrated significant improvement in patient-reported outcomes versus baseline. The findings support arthroscopic capsulodesis as a reasonable option for appropriate-grade scapholunate injuries while highlighting the limited evidence base for other arthroscopic techniques.

32. Zhang W, Wu T, Wang C, et al. The Efficacy of Transosseous Foveal Repair Combined With Dorsal Reinforcement in the Treatment of Chronic Triangular Fibrocartilage Complex Injury With Severe Distal Radioulnar Joint Instability. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.007

In an uncontrolled series of 21 patients with chronic TFCC injury and severe DRUJ instability (mean follow-up 44.5 months), arthroscopically assisted transosseous foveal repair was augmented with allogeneic tendon graft dorsal reinforcement. Pain (VAS 5.5 to 0.7), grip strength (75.1% to 86.6% of the contralateral side), Mayo wrist score (68.9 to 90.3), and PRWE (50.4 to 8.9) all improved significantly, with all patients achieving clinically meaningful PRWE improvement. Adding dorsal graft reinforcement to foveal repair may be effective for severe chronic DRUJ instability, though controlled studies are needed.

38. Hong DY, Bailey KN, Goldfarb CA. Intermediate-Term Patient-Reported Outcomes After Foveal TFCC Repair: Timing of Recovery and Successful Return to Sports or Work. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.007

Forty-six adolescents and adults undergoing ulnar tunnel foveal TFCC repair by a single surgeon (2018-2023) were followed with serial PROMIS scores, range of motion, and complications, with 32 completing minimum 2-year questionnaires. Pain improved significantly by 12 weeks, whereas upper-extremity and physical function measures improved later, with good intermediate-term outcomes at ~32 months. Patients should be counseled that pain relief precedes functional recovery, with return to sport/work expected on a delayed timeline.

39. Räisänen MP, Smeraglia F, Clementson M, et al. Inter- and Intraobserver Reliability of Wrist Arthroscopy for TFCC Tears: An International Study. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.06.011

Five experienced European hand surgeons reviewed 43 standardised wrist arthroscopy cases (vignette, radiographs, video) at two time points, classifying TFCC tear presence, Palmer and Atzei-Luchetti classifications, and treatment decisions, with a consensus meeting between rounds. Interobserver reliability for tear presence was fair (modestly improved after consensus), classification agreement was slight-to-fair, and treatment agreement was low. Arthroscopy-based TFCC diagnosis and classification remain inconsistently reproducible, underscoring the need for standardised assessment before arthroscopic findings drive surgical decisions.

41. Dhabal H, Chandra M, Mallick SK, et al. Adams–Berger Reconstruction for Chronic Distal Radioulnar Joint Instability: Prospective 12-Month Outcomes. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.07.008

Thirty patients with chronic DRUJ instability refractory to nonsurgical treatment underwent Adams, Berger ligament reconstruction with autologous tendon graft and were followed prospectively for 12 months. Stability was substantially restored with a firm end point, improved grip strength, preserved forearm rotation, and marked reductions in patient-reported disability scores. The findings support Adams, Berger reconstruction as an effective option for chronic DRUJ instability in patients without advanced arthritis or fixed deformity.

Paediatric and Sports Wrist Topics (7)¶

26. Bojovic M, Hagert E. Bone stress fractures and injuries of the upper limb in athletes. International Orthopaedics 2026. doi:10.1007/s00264-026-06978-x

This narrative review synthesizes current literature and clinical experience on upper-limb bone stress injuries in athletes, covering mechanisms, risk factors, regional anatomical patterns, imaging, and management from shoulder to hand. It emphasizes that early radiographs are often normal while MRI best detects early stress reactions, and that continued loading risks progression to cortical disruption. Clinicians should maintain a low threshold for advanced imaging in athletes with subtle, non-specific upper-limb symptoms to avoid diagnostic delay and guide return-to-sport decisions.

27. Wollstein A, Wang AA, Huntsman A, et al. Pediatric and Adolescent Perilunate Injuries: Clinical Presentation, Injury Characteristics, and Outcomes. HAND 2026. doi:10.1177/15589447261468027

This retrospective review with prospective follow-up examined 15 skeletally immature patients (mean age 14.2 years) operatively treated for perilunate injuries at a tertiary center over 12 years, capturing injury characteristics, surgical details, complications, and patient-reported outcomes. The study defines presentation patterns and outcomes for this rare paediatric carpal fracture-dislocation population. Findings help hand surgeons counsel families and guide operative decision-making for paediatric perilunate injuries.

33. Cheng K, Zappa RM, Jump IP, et al. Segmental Momentum Sequencing: Implication for Injury and Performance Between Collegiate Pitchers With Different Arm Slots. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261453310

Markerless motion capture and radar ball tracking were used to quantify the timing of peak angular momentum in the torso, upper arm, forearm, and hand among 363 NCAA Division I pitchers grouped by arm slot (overhand, three-quarter, sidearm). Segmental momentum sequencing differed by arm slot and predicted ball velocity and shoulder/elbow joint loading. Findings suggest training and injury-prevention programs should be tailored to a pitcher's arm slot rather than applying a universal kinetic-chain model.

34. Menta S, Locascio L, Sciascia A, et al. Poster 173. Leg Up or Letdown? Exploring the Link Between Lower-Body Injury and Upper Extremity Injury in MLB Pitchers. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00471

A retrospective cohort of MLB pitchers (2017-2024) using public injury data and Statcast metrics tested whether prior lower-extremity injury predicted subsequent same-season upper-extremity injury, with multivariable logistic regression adjusting for age, workload, fastball velocity, year, and a novel pitch-mix entropy metric. The study provides large-scale epidemiologic evidence on the kinetic-chain link between lower- and upper-extremity injury in professional pitchers. Results inform whether protecting or rehabilitating the lower body may reduce upper-extremity injury risk in MLB pitchers.

36. Puglia F, Tanel L, Priano D, et al. Excellent functional outcomes and low complication rate following open reduction for severe pediatric radial neck fractures: A retrospective analysis. Injury 2026. doi:10.1016/j.injury.2026.113386

A retrospective single-institution cohort of 53 children (mean age 8 years) with severe Judet 4 radial neck fractures treated with open reduction after failed closed reduction assessed functional outcomes, complications, and risk factors. The mean Oxford Elbow Score was 96, indicating excellent function, with a low complication rate (13.5%, most commonly heterotopic ossification). Open reduction appears to yield reliably good outcomes even for severe paediatric radial neck fractures, with surgical delay and severity factors informing counseling.

44. Ismayl G, Alabbas A, Howard A, et al. Flexible intramedullary nailing in the treatment of paediatric forearm fractures: 15-years’ experience at a level one trauma centre, comparison of implant retention versus removal and cost-effectiveness analysis. Injury 2026. doi:10.1016/j.injury.2026.113432

This retrospective cohort of 268 paediatric forearm fractures treated with flexible intramedullary nailing (FIN) at a level-1 trauma center compared routine implant removal (pre-COVID) versus retention (post-COVID) over 15 years. The primary outcome was unplanned secondary surgery, with secondary outcomes including indications for surgery, time to removal, and patient/parent satisfaction, plus cost-effectiveness analysis. The results inform whether FIN can be safely left in situ, potentially avoiding elective removal surgery and its associated costs.

56. Sato R, Ishigaki T, Okochi T, et al. Effects of grip contraction with different finger recruitment and different wrist positions on dynamic medial elbow joint stability. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.08.008

In 20 healthy right-handed men, ultrasonographic medial elbow joint space was measured at rest, under 60 N valgus stress, and during 50% maximal grip contraction with selective exclusion of the second or third digits and varying wrist positions. The study tested the distinct contributions of superficial (third/fourth digit) versus deep (second/fifth digit) flexor digitorum superficialis layers and wrist position to dynamic medial ulnar collateral ligament stability. Results inform injury-prevention and rehabilitation strategies for baseball players by clarifying which finger recruitment patterns and wrist positions best protect the medial elbow during throwing.

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