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What's New — Wrist — September 2026

28 new articles published this month.

Themes: Carpal Tunnel & Amyloidosis · Distal Radius Fracture Management · Kienböck Disease & Lunate · AI & Digital Tools · Carpal Instability & Scaphoid · Rare Tumors & Case Reports

Digest generated 2026-10-04 16:03:54+00:00.

Highlights

Carpal Tunnel & Amyloidosis

A major focus this month is the intersection of carpal tunnel syndrome and systemic transthyretin amyloidosis. Tenosynovial biopsy during carpal tunnel release is emerging as a diagnostic opportunity for early ATTR amyloidosis and cardiomyopathy detection, with targeted biopsy strategies based on clinical red flags improving histopathological yield [5], and a systematic review plus retrospective cohort highlighting the importance of transverse carpal ligament biopsy in African American patients at risk for hereditary V122I amyloidosis [6]. Outcomes after carpal tunnel release in patients with systemic amyloidosis have been assessed with propensity-score matching [2]. Complementing the amyloid work, a randomised military trial reports two-year outcomes of ultrasound-guided versus mini-open carpal tunnel release [16], and a health-services study links neighborhood socioeconomic status to delays in consultation and surgery for carpal tunnel syndrome [14].

Distal Radius Fracture Management

Distal radius fracture care dominates this month's literature, spanning prediction, treatment selection, and complications. Deep learning combining pre-reduction radiographs with clinical data can predict operative recommendations, aiding counseling and triage [3]. In elderly patients with complex articular fractures, volar locking plate osteosynthesis and orthopaedic treatment showed comparable long-term functional outcomes [20], while surgeon surveys from Latin America reveal preferences and educational gaps in managing complex fractures [28]. Complication-focused studies identified CT-based predictors of ulnar-sided poor outcomes, including sigmoid notch involvement and reduction defects [23], risk factors for flexor tenosynovitis after volar plating such as dorsal plate positioning and placement below the watershed line [21], and demonstrated that arthroscopic arthrolysis added to hardware removal improves motion in post-traumatic stiffness [22]. A novel dorsal salvage strategy (MARS) addresses severe comminution [24], and radiocapitate distance correlates with clinical outcomes after volar locking plate fixation [9].

Kienböck Disease & Lunate

Lunate pathology receives attention from biomechanical, imaging, and reconstructive perspectives. A finite element analysis showed that lunate facet inclination and interfacet angles alter stress distribution across the lunate, supporting biomechanical risk factors for Kienböck disease [10]. Quantitative CT with finite element analysis demonstrated lower volumetric bone mineral density and predicted strength in older women's lunates, suggesting lunate collapse in this group may represent fragility fracture distinct from classical Kienböck disease [12]. On the reconstructive side, an Innovator's Corner interview chronicles the development of the medial femoral trochlear vascularized bone flap, which has transformed treatment of scaphoid nonunion and Kienböck disease [18].

AI & Digital Tools

Digital and computational tools for wrist diagnosis and monitoring are expanding. Beyond the deep-learning prediction of operative management for distal radius fractures [3], a feasibility study showed that three-dimensional reconstruction from low-dose biplanar radiographs can objectively quantify scapholunate distance changes between neutral and clenched-fist positions, offering a tool for diagnosing and following carpal ligament injuries [19]. An accompanying stewardship framework urges hand surgeons to demand external validation, transparent disclosure of intended use and failure modes, and ongoing audit before adopting AI tools for imaging, outcome prediction, and patient communication [25].

Carpal Instability & Scaphoid

Scaphoid morphology and carpal ligament injury feature in both clinical and athletic populations. An epidemiological study applying the Morsy classification found type II scaphoid morphology in roughly 20% of wrist radiographs, with demographic associations that may inform fracture and ligament injury susceptibility [7]. In elite athletes, operative repair of scapholunate interosseous ligament tears in NBA players yielded high return-to-play rates with performance outcomes compared against matched controls [27]. Biomechanical testing of suture materials across bone tunnel edges provides guidance for ligament reconstruction constructs, showing failure at the cortical edge and strand-dependent stiffness [4].

Rare Tumors & Case Reports

Rare pathology and unusual complications round out the month. Case reports include palmar trapezoid dislocation with carpometacarpal injuries treated by dorsal open reduction and temporary pinning [8], Merkel cell carcinoma of the hand managed with wide excision, grafting, and adjuvant radiation [11], and multicentric calcifying aponeurotic fibroma causing nerve compression and bony dysplasia [13]. A rare ulnar neuroma-in-continuity after open distal radius fracture required nerve allograft reconstruction and dynamic tendon transfer [15]. A cadaveric mechanistic study questioned whether the annular ligament is disrupted in Monteggia fracture-dislocations [26], and a letter clarified Narakas classification use in brachial plexus birth injury MRI studies [17]. Occupational therapy after total wrist arthroplasty showed similar ROM but potential cost benefits [1].

Articles by Theme

Carpal Tunnel & Amyloidosis (5)

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

A propensity score, matched cohort study using the TriNetX electronic health record network compared early complications and intermediate-term carpal tunnel, related care after carpal tunnel release in adults with and without systemic amyloidosis. The study assessed wound-related complications within 30 days and symptom-driven care from 90 to 365 days postoperatively. Results inform whether amyloidosis should raise concern for worse outcomes after carpal tunnel release and guide perioperative counseling and surveillance.

5. Bigorre N, Petit A, Brunet J, et al. Targeted tenosynovial biopsy during carpal tunnel release for detection of transthyretin amyloid deposits. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261481712

A single-center before-after study of 347 carpal tunnel release patients compared non-targeted versus clinically targeted tenosynovial biopsy for detecting transthyretin amyloid deposits, with targeting based on predefined red flags. Targeted biopsy nearly doubled the positivity rate (37% vs 18%), and male sex and treated trigger finger were associated with increased yield while diabetes was associated with lower yield. Targeted biopsy during carpal tunnel release is an efficient strategy for identifying patients who may need systemic amyloidosis workup.

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

A systematic review of 22 studies combined with a retrospective cohort of carpal tunnel release patients (2021-2025) evaluated tenosynovial and transverse carpal ligament biopsy for detecting transthyretin amyloid cardiomyopathy, with a focus on African American patients harboring the underdiagnosed Val122Ile mutation. The review found amyloid deposits in 10%, 30% of carpal tunnel release specimens. Routine intraoperative biopsy offers an opportunity for early ATTR-CM detection and timely treatment such as tafamidis, particularly in high-risk populations.

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

In a retrospective review of 276 patients undergoing carpal tunnel release (2022-2025), census tract-level socioeconomic status (area deprivation index, social vulnerability index) was linked to time from symptom onset to hand-specialty consultation and to surgery. The study tested whether lower neighborhood SES was associated with longer delays at earlier stages of the CTS care pathway using higher geographic granularity than prior work. Results inform health equity efforts by identifying whether disadvantaged neighborhoods face delays in CTS evaluation and treatment.

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

In a single-site randomised controlled trial within the US military, 41 patients with carpal tunnel syndrome were randomised to ultrasound-guided carpal tunnel release performed in a clinic procedure room versus mini-open release, with 100% two-year follow-up. Both groups showed comparable improvements in QuickDASH and other patient-reported outcomes (pain, symptom severity, palmar pain) at 1 month and 2 years, with similar adverse event profiles. Ultrasound-guided in-clinic release offers a durable, office-based alternative to mini-open carpal tunnel release.

Distal Radius Fracture Management (8)

3. Shareef O, Huddleston H, Jang SJ, et al. Ability of Deep Learning to Predict Surgical Recommendations for Distal Radial Fractures. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01693

A convolutional neural network trained on pre-reduction radiographs was combined with clinical and demographic data in a random forest model to predict whether a hand surgeon would recommend operative management of distal radial fractures, with interpretability provided by Grad-CAM and SHAP analyses. The model was evaluated on a hold-out test set of 1,040 patients. If accurate, such AI prediction could aid patient counseling and triage to appropriate follow-up at the initial point of care.

9. Hosokawa T, Tajika T, Suto M, et al. Relationship Between Radiocapitate Distance as a Structural Parameter and Clinical Outcomes After Volar Locking Plate Fixation of Distal Radius Fractures. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101083

In 145 patients after volar locking plate fixation of distal radius fractures, radiocapitate distance was measured on lateral radiographs at 1 year and correlated with conventional radiographic parameters and clinical outcomes. Final radiocapitate distance averaged -2.4 mm and showed associations with radiographic alignment measures and patient-reported function (QuickDASH), grip strength, and wrist motion. Radiocapitate distance may serve as a clinically meaningful sagittal alignment parameter to assess after VLP fixation.

20. Boudari M, Ibrahim M, Chantelot C, et al. Complex articular fractures of the distal radius in patients over 65 years old: A comparison of functional outcomes after locked anterior plate osteosynthesis versus orthopedic treatment, with an average follow-up of 40 months. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2025.104306

This retrospective multicenter study compared volar locking plate osteosynthesis versus orthopaedic (nonoperative) treatment of AO type C distal radius fractures in 114 patients over 65 years old, with a mean 40-month follow-up and PRWE score as the primary endpoint. The authors hypothesized no difference in functional outcomes between the two treatments. The clinical implication is to help guide shared decision-making regarding surgery versus conservative management for complex distal radius fractures in elderly patients.

21. Canarelli E, Berry C, Van Vliet A, et al. Risk factors of flexor tendon tenosynovitis after distal radius fractures treated with volar locking plates: A case-control study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2025.104347

This retrospective case-control study (50 cases, 150 controls) identified risk factors for flexor tenosynovitis requiring hardware removal after volar locking plate fixation of distal radius fractures, with a prevalence of 3.7% and mean symptom onset at 19.4 months. Multivariate analysis showed plate position relative to the watershed line and postoperative plaster splint immobilisation were independent risk factors, while Soong grade C positioning was significant only univariately. Clinically, surgeons should avoid distal plate placement below the watershed line and consider early mobilization to reduce tenosynovitis risk.

22. Boiteux G, Brenac C, Dubian R, et al. Arthroscopic arthrolysis with hardware removal versus hardware removal alone after intra-articular distal radius fracture: A prospective comparative study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104651

This single-center prospective comparative study of 40 patients with post-traumatic wrist stiffness after intra-articular distal radius fracture fixation compared arthroscopic arthrolysis combined with hardware removal versus hardware removal alone. At 1 year, the combined group achieved significantly greater flexion-extension arc improvement (32.6° vs 6.4°) and was the only group with significant QuickDASH improvement, without major complications. The clinical implication is that adding arthroscopic arthrolysis to hardware removal substantially improves motion and function in established arthrofibrosis.

23. Vermeuil M, Le Baron M, Flecher X, et al. Computed tomography–based predictors of ulnar-sided complications after distal radius fracture fixation. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104652

This retrospective study of 75 wrists treated with volar plating used systematic pre- and postoperative CT to identify risk factors for poor ulnar-sided outcomes (42.6% incidence) at 6 months. Sigmoid notch involvement, postoperative reduction defect, and DRUJ incongruity were significantly associated with poor outcomes, whereas ulnar styloid fractures and DRUJ anatomic variants were not; multifragmentary sigmoid notch fractures involving the volar rim carried the highest risk. Clinically, CT assessment of the sigmoid notch and reduction quality can help predict and counsel patients about ulnar-sided complications.

24. de Villeneuve Bargemon J, Brenac C, Carpentier T, et al. A proposed surgical strategy for complex articular distal radius fractures: The Marseille approach for radius salvage (MARS). Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104702

This prospective single-center case series described the Marseille Approach for Radius Salvage (MARS), a dorsal strategy enabling direct articular visualization for complex comminuted intra-articular distal radius fractures not amenable to standard fixation, applied to 12 of 252 fractures. All achieved satisfactory CT-confirmed reduction (step-off ≤2 mm) maintained at 6 months, with preserved pronosupination, satisfactory pain and QuickDASH scores at 1 year, and only minor complications. The clinical implication is that MARS offers a reliable salvage option for severe fracture-dislocations requiring direct articular visualization.

28. Berezowsky CA, Gomez AG, Medina DCC. Surgeon Preferences and Educational Gaps in the Treatment of Complex Distal Radius Fractures in Latin America. Injury 2026. doi:10.1016/j.injury.2026.113746

The authors surveyed Latin American surgeons to characterize treatment preferences and identify educational gaps in the management of complex distal radius fractures. The survey revealed variability in surgical approaches, fixation strategies, and perceived confidence across the region. These findings highlight targets for regionally tailored educational programs and training to standardize care of these injuries.

Kienböck Disease & Lunate (3)

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

Using a CT-based 3D wrist model with simulated osteotomies and finite element analysis, the authors tested how lunate facet inclination, scaphoid facet inclination, and interfacet angle alter lunate loading across nine wrist models during flexion and extension. A strong negative correlation was found between lunate facet inclination and lunocapitate joint stress, indicating that a flatter lunate facet increases stress on the lunate. These findings support lunate facet morphology as a biomechanical risk factor for Kienböck disease and may inform surgical approaches that alter carpal loading.

12. Nakadai M, Yoda T, Suzuki N, et al. Application of Quantitative Computed Tomography and Finite Element Analysis to the Lunate: An Exploratory Study of Bone Density and Strength in Young and Older Women. Journal of Hand Surgery Global Online 2026. doi:10.1016/j.jhsg.2026.101072

In a cross-sectional study of 21 young women (20-29 years) and 57 older women (≥65 years), quantitative CT with finite element analysis was used to quantify lunate volumetric bone mineral density and predicted bone strength. Older women had lower vBMD and predicted strength in most regions (except cortical vBMD), and age correlated negatively with trabecular measures, while young women showed dominance-side advantages. These findings support the concept that lunate collapse in older women may represent an osteoporotic fragility fracture distinct from classical Kienböck disease.

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

This interview-format piece profiles Dr. James Higgins and his development of the medial femoral trochlear (MFT) vascularized bone flap for scaphoid nonunion and Kienböck disease. He describes the origins and evolution of the technique, challenging traditional dogma in carpal reconstruction. The clinical implication is that vascularized MFT flaps offer a valuable option for difficult carpal bone reconstruction and have reshaped practice in this area.

AI & Digital Tools (3)

3. Shareef O, Huddleston H, Jang SJ, et al. Ability of Deep Learning to Predict Surgical Recommendations for Distal Radial Fractures. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01693

A convolutional neural network trained on pre-reduction radiographs was combined with clinical and demographic data in a random forest model to predict whether a hand surgeon would recommend operative management of distal radial fractures, with interpretability provided by Grad-CAM and SHAP analyses. The model was evaluated on a hold-out test set of 1,040 patients. If accurate, such AI prediction could aid patient counseling and triage to appropriate follow-up at the initial point of care.

19. Loisel F, Fradin T, Gajny L, et al. Three dimensional scapholunate distance assessment from biplanar radiographs: A feasibility study in clinical practice. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2025.104298

This feasibility study evaluated a 3D bone reconstruction method from low-dose biplanar (EOS) radiographs to measure scapholunate distance changes between neutral and clenched-fist positions in 30 healthy volunteers and 12 patients with suspected wrist ligament injuries. The method allowed objective calculation of scapholunate distances and comparison of pre- and postoperative values against healthy norms. The clinical implication is that biplanar radiograph-based 3D analysis may provide a low-dose, objective tool for diagnosing and following carpal ligament injuries.

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

The authors propose a four-part stewardship framework for hand surgeons adopting artificial intelligence tools used in imaging, outcome prediction, and patient communication, in response to adoption outpacing validation. The framework comprises external validation on the intended population, transparent disclosure of intended use and failure modes, defined escalation paths for surgeon, model disagreement, and prospective post-deployment audit. Clinically, it positions the surgeon as the accountable decision maker and provides practical vendor questions and reporting checklists to guide safe AI integration.

Carpal Instability & Scaphoid (3)

4. Basseri B, Shamritsky D, Escalera C, et al. Biomechanical comparison of suture materials across a bone tunnel edge. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261483321

Five suture materials (SutureTape, LabralTape, FiberTape, Ethibond, Mersilene) in one-, two-, and four-strand configurations were cyclically loaded across a 2.5 mm bone tunnel to simulate scapholunate ligament loading, then ramp-loaded to failure. Failure behaviour and elongation differed by material, with tape constructs (LabralTape, FiberTape) showing less elongation than SutureTape, Mersilene, and Ethibond in single-strand testing. These biomechanical data can guide suture selection for transosseous wrist reconstructive procedures.

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

A retrospective radiographic study of 363 wrist x-rays from 345 patients applied the Morsy classification to determine the prevalence of scaphoid morphologic types in the general population. Type I scaphoids predominated (80.2%) versus type II (19.8%), with type II scaphoids more common in left-handed individuals and no other demographic differences. These prevalence data provide a baseline for interpreting scaphoid anatomy in fracture management and reconstructive planning.

27. Porter S, Eaddy SG, Tille M, et al. Return to Play and Performance After Operative Repair of Scapholunate Interosseous Ligament Tears in National Basketball Association Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261442472

A retrospective case series using the Pro Sports Transactions database identified isolated scapholunate interosseous ligament tears in NBA players from 1956-1957 through 2022-2023, matching injured athletes to healthy controls and comparing performance up to two seasons before and after operative repair. The study quantified return-to-play rates and postoperative performance changes in this population. Results inform counseling of elite athletes regarding expected recovery and performance after scapholunate ligament surgery.

Rare Tumors & Case Reports (7)

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

A retrospective review of 35 total wrist arthroplasty patients compared outcomes between those who attended postoperative occupational therapy and those who did not. No significant differences were found in range of motion, grip strength, or other measured outcomes between groups. The findings suggest that specialised postoperative occupational therapy may not improve objective outcomes after total wrist arthroplasty, questioning the value of routine referral.

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

Two cases of palmar trapezoid dislocation after motorcycle accidents, associated with carpometacarpal injuries, were treated with open reduction through a dorsal approach, temporary Kirschner-wire fixation, and ligamentous repair, with anatomical reduction maintained at follow-up. A literature review identified eight prior cases, most managed via dorsal open reduction, while trapezoid excision yielded worse outcomes due to second metacarpal migration. Surgeons should maintain a high index of suspicion for this rare injury in high-energy wrist trauma and favour reduction over excision.

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

This case report describes Merkel cell carcinoma of the hand in a 79-year-old woman with a 1-month history of a hand mass, diagnosed by punch biopsy and treated with wide local excision (1.5 cm margins), split-thickness skin grafting, negative sentinel node biopsy, and single-fraction adjuvant radiation. The case underscores that MCC, though rare on the hand, is an aggressive skin cancer requiring early recognition and aggressive multidisciplinary treatment. Hand surgeons should maintain a low threshold for biopsy of atypical hand masses and be aware of evolving adjuvant radiation protocols.

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

A 19-year-old woman initially misdiagnosed with a lymphatic or vascular malformation was ultimately found to have multicentric calcifying aponeurotic fibroma of the upper extremity, confirmed by MR-guided and excisional biopsy, with associated nerve compression (positive Tinel sign), dysplastic distal radioulnar joint, and fatty muscle atrophy. The report highlights that multicentric CAF with nerve compression and bony dysplasia is exceedingly rare and frequently misdiagnosed. Clinicians should consider CAF in the differential of upper-extremity masses with atypical imaging features to avoid diagnostic delay.

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

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

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

The authors write a letter to the editor arguing that the reported discordance between MRI findings and Narakas groups in a study of brachial plexus birth injury stems from use of a simplified classification that deviates from Narakas's original 1987 definition, which was based on injury severity and recovery trajectory at 2-3 weeks rather than static anatomic root involvement. They emphasize that this distinction matters for interpreting imaging-clinical correlations. Clinically, they caution against drawing conclusions about MRI-classification discordance without applying the classification as originally described.

26. Tada T, Sukegawa K, Metoki Y, et al. Is the annular ligament disrupted in Monteggia fracture–dislocations? A cadaveric mechanistic study. JSES International 2026. doi:10.1016/j.jseint.2026.101798

This cadaveric mechanistic study investigated whether the annular ligament is disrupted in Monteggia fracture, dislocations by recreating the injury in cadaveric elbows and examining the ligament directly. The findings clarify the anatomic extent of soft-tissue injury in this injury pattern, informing surgical decision-making about annular ligament repair or reconstruction during open reduction of the radiocapitellar joint.

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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.