What's New — Wrist — October 2026¶

47 new articles published this month.

Themes: Distal Radius Fracture Management · Carpal Tunnel and Nerve Disorders · Wrist Arthroscopy and Ligament Injury · Scaphoid Nonunion and Digital Surgery · Distal Ulna and DRUJ Surgery · Arthroplasty, Tendon, and Miscellaneous

Digest generated 2026-11-04 16:03:48+00:00.

Highlights¶

Distal Radius Fracture Management¶

This month's digest features substantial work on distal radius fractures, spanning reduction technique, fixation, and perioperative care. A randomised trial found no clear clinical advantage of manual manipulation over finger-trap traction for closed reduction [1]. Bayesian re-analysis of the CROSSFIRE trial illustrates how prior beliefs shape interpretation of fixation trials in older adults [16]. Perioperative studies address infection rates and antibiotic prophylaxis with volar locking plates [29], regional versus general anaesthesia and radiographic reduction quality [31], and a novel dorsal subchondral arc line marker to avoid dorsal screw prominence [32]. Concomitant carpal tunnel release at fixation did not reduce subsequent CTR [30], nonoperative management was linked to adverse mental health outcomes in the elderly [26], and reviews cover 3D-planned corrective osteotomy for malunion [44] and AI-based surgical decision support [25].

Carpal Tunnel and Nerve Disorders¶

Carpal tunnel syndrome and related nerve conditions generated considerable evidence. Endoscopic release showed better early functional recovery than open release across activity-demand subgroups [33], while timing of preoperative corticosteroid injection influenced wound complications after endoscopic release [4]. Large database studies found increased trigger finger risk after carpal tunnel release [8], no benefit of prophylactic release during distal radius fixation [30], longer time to surgery with higher BMI [27], and increased perioperative complications with non-tobacco nicotine dependence [34]. GLP-1 receptor agonist use after bariatric surgery was associated with more compressive neuropathy [12]. Guideline-focused work included an AAOS CTS guideline erratum [21] and evaluation of LLM concordance with those guidelines [11].

Wrist Arthroscopy and Ligament Injury¶

Several articles addressed arthroscopic diagnosis and treatment of wrist conditions. Standard-practice MRI showed limited diagnostic accuracy for scapholunate ligament injuries compared with arthroscopy [17], and a fluoroscopic seven-parameter algorithm demonstrated high reliability for diagnosing and staging scapholunate instability in distal radius fractures [23]. For ulnar-sided pathology, the arthroscopic wafer procedure provided durable midterm outcomes in idiopathic ulnar impaction syndrome [24], and a meta-analysis compared arthroscopic with open repair of foveal TFCC tears [41]. Arthroscopic interposition arthroplasty with acellular dermal matrix offered a joint-preserving option for chondral lesions [35], and scaphoidectomy with lunocapitate fusion remained a viable motion-preserving salvage for advanced collapse [22].

Scaphoid Nonunion and Digital Surgery¶

Scaphoid pathology and digital orthopaedic technology featured prominently. Pedicled vascularized bone grafting for scaphoid nonunion improved pain, motion, grip strength, and Mayo Wrist Scores in a retrospective series [10], while a review synthesized digital techniques, AI diagnosis, finite element analysis, navigation, robotics, and 3D printing, for scaphoid fracture management [40]. Related technology-focused work included a review of machine learning applications in hand pathology diagnosis [19] and a commentary on deep learning prediction of surgical recommendations for distal radius fractures [25]. Consumer-facing AI was also scrutinized: large language models showed variable diagnostic and triage performance for hand and wrist complaints [9].

Distal Ulna and DRUJ Surgery¶

Ulnar-sided fracture and instability management was a recurring focus. A systematic review compared surgical techniques for unstable distal ulna fractures accompanying distal radius fractures [5], and a prospective study of distal ulna hook locking plates showed favourable radiological and functional outcomes [20]. Cadaveric work characterized anatomic safety of retrograde intramedullary nailing in distal ulna fractures, including TFCC implications [46]. For post-traumatic deformity, 3D-planned corrective osteotomy restored stability and function in diaphyseal forearm malunions with DRUJ instability [13], and a letter emphasized that osteotomy is only one component of reconstruction in chronic radiocarpal dislocation [45].

Arthroplasty, Tendon, and Miscellaneous¶

Remaining articles spanned arthroplasty, tendon, and diverse topics. Total wrist arthroplasty was represented by a first-in-human pilot of a bipolar dual-center implant [15] and Medicare projections showing a rising revision burden through 2060 [18]. Tendon topics included De Quervain's injection guidance [3], paediatric flexor tendon injury outcomes [43], and FDS transfer for wrist extension in brachial plexus birth injuries [39]. Additional studies covered PACU-free outpatient hand surgery [6], Arabic validation of the Duruöz Hand Index [7], opioid effects on fracture healing [38], distal radius as a marker of bone fragility [28], hockey and racket-sport injury epidemiology [36, 47], Poland syndrome [14], paediatric torus fracture commentary [42], and elbow arthroplasty for Monteggia fracture-dislocation [37].

Articles by Theme¶

Distal Radius Fracture Management (9)¶

1. Benedikt S, Horling L, Bode S, et al. Closed reduction in distal radius fractures: manual manipulation vs. finger trap traction—a prospective randomized controlled clinical trial. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06537-4

In this prospective randomised controlled trial, patients with dorsally displaced AO type A2, A3, or C distal radius fractures were assigned to closed reduction via finger-trap traction alone or finger-trap traction plus additional manual manipulation under haematoma block. The study sought to determine whether the more invasive manual reduction offers clinically meaningful advantages over traction alone. The findings inform initial fracture management by clarifying whether the added pain and complication risk of manual manipulation is justified.

16. Parisien R, Ring D, Teunis T. How prior beliefs shape the interpretation of a randomized trial: a Bayesian re-examination of the CROSSFIRE trial. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261481232

The CROSSFIRE trial of distal radius fracture fixation in older adults was re-analyzed under five literature-anchored Bayesian priors and two thresholds for meaningful benefit. Posterior probabilities of clinically meaningful benefit at 3 months ranged from 0% to 47% depending on the prior, though all priors converged on no meaningful difference at 12 months. Disagreement among careful readers of the same trial can reflect differing but defensible priors, so priors should be made explicit when interpreting trial results.

25. Chaoui J. Artificial Intelligence in the Trauma Suite: From Fracture Detection to Explainable Decision Support in Distal Radial Fractures. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00881

This commentary discusses a feasibility study evaluating whether deep learning can predict surgical recommendations for distal radial fractures, rather than merely detecting fractures on imaging. The author highlights that predicting operative treatment decisions is a more clinically relevant but harder task than fracture detection, as it integrates radiographic severity, patient factors, and surgeon preference. The commentary underscores the importance of explainable AI decision support in moving orthopaedic AI beyond image classification toward meaningful clinical judgment.

26. Bowers CJ, Lawand J, Tansey P, et al. Nonoperative Management Is Associated With an Increased Risk of Adverse Mental Health Conditions in Elderly Patients With Distal Radius Fractures: A Retrospective Cohort Analysis. HAND 2026. doi:10.1177/15589447261489326

This retrospective TriNetX cohort study propensity-matched elderly patients (65+) with distal radius fractures treated with ORIF versus closed reduction to compare mental health outcomes over 1 year post-injury. Patients undergoing ORIF had a significantly lower risk of major depressive disorder (1.7% vs 2.2%; RR 0.78) and reduced risk of other adverse mental health conditions. The findings suggest that operative management may confer psychological benefits in this population, adding a mental health dimension to the operative-versus-nonoperative treatment debate.

29. Muder D. Postoperative infection following volar locking plate fixation of closed distal radius fractures: a retrospective cohort study of infection rates and antibiotic prophylaxis practice. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10521-9

This single-center retrospective cohort study of adults undergoing volar locking plate fixation of closed distal radius fractures (2022-2024) described postoperative surgical site infection rates within one year and contemporary perioperative antibiotic prophylaxis practices. The study provides procedure-specific infection rate data for a common operation where such evidence is limited. The findings inform antibiotic prophylaxis practice patterns and infection risk counseling for patients undergoing distal radius plating.

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

This propensity-matched TriNetX cohort study of 53,565 adults undergoing distal radius ORIF (5,090 matched pairs) evaluated whether concomitant carpal tunnel release at the time of fracture fixation reduces subsequent carpal tunnel release within 2 years. Concomitant CTR was not associated with a significantly reduced rate of subsequent CTR, and secondary complications were assessed over 90 days and 1 year. The findings do not support routine prophylactic carpal tunnel release during distal radius fracture fixation.

31. Pieringer A, Hinkelmann MA, Zumsteg J, et al. Regional versus general anesthesia in volar plate fixation of distal radius fractures: An AO/OTA-stratified matched-pair analysis of radiographic reduction quality. Injury 2026. doi:10.1016/j.injury.2026.113509

This single-center retrospective matched-pair study compared axillary brachial plexus block (regional anaesthesia) versus general anaesthesia in 660 operatively treated distal radius fractures, matched on AO/OTA fracture type and propensity score. The primary outcome was radiographic reduction quality across five parameters using a composite score, with secondary outcomes including operative time, complications, and wrist motion. The study addresses whether the growing use of regional anaesthesia compromises reduction quality in volar plate fixation.

32. Worhacz K, Castaneda P, Hui C, et al. Dorsal subchondral arc line: A novel radiographic marker to avoid dorsal screw prominence during distal radius fixation with volar locking plates. Injury 2026. doi:10.1016/j.injury.2026.113596

This cadaveric study of 10 matched pairs of forearms evaluated a novel lateral radiographic marker, the Dorsal Subchondral Arc Line (DSAL), for determining distal screw length during volar locking plate fixation of distal radius fractures. Screws measured with DSAL did not penetrate the dorsal cortex and provided fixation comparable to fully bicortical screws, including in a simulated comminuted extra-articular fracture model. The DSAL offers a practical intraoperative guide to avoid dorsal screw prominence while maintaining distal fixation.

44. Loonen TG, Maal TJ, Edwards MJ, et al. Past, present and future of distal radius corrective osteotomy: From 2D based reconstruction to 3D data-driven, patient specific care. Injury 2026. doi:10.1016/j.injury.2026.113447

This narrative review traces the evolution of distal radius corrective osteotomy from 2D radiograph-based planning to 3D virtual surgical planning with patient-specific guides and implants. While 3D technology has improved anatomical correction accuracy, greater precision has not automatically translated into superior functional outcomes. The authors call for standardised evaluation frameworks, multicenter data collection, and predictive models to establish the clinical value and cost-effectiveness of patient-specific 3D planning.

Carpal Tunnel and Nerve Disorders (8)¶

4. Wier J, Rusu D, Lindgren A, et al. Timing of Corticosteroid Injection Before Endoscopic Carpal Tunnel Release Influences Wound Complication Rates. HAND 2026. doi:10.1177/15589447261496358

In this retrospective national claims analysis, over 24,000 patients who received preoperative corticosteroid injection before endoscopic carpal tunnel release were propensity-matched to patients without recent injection, and wound complications within 3 months were compared across injection timing intervals (<1, 1-3, 6-12 months). The study found that the timing of corticosteroid injection relative to surgery influenced postoperative wound complication rates. Clinically, this suggests surgeons should consider the interval between recent steroid injection and endoscopic carpal tunnel release when counseling patients or timing surgery.

8. Fathi-Choghadeh M, Fellheimer HS, Culkin MC, et al. Incidence and Risk of Trigger Finger Following Carpal Tunnel Release: A Propensity-Matched Cohort Study Using a National Database. HAND 2026. doi:10.1177/15589447261496361

Using the TriNetX national database, this propensity-matched cohort study compared new-onset trigger finger over 5 years in 42,331 patients undergoing carpal tunnel release versus 42,331 matched non-surgical patients with carpal tunnel syndrome. Trigger finger developed in 9.2% of the surgical cohort versus 3.1% of controls (hazard ratio 2.56), with the highest risk in the first 6 months postoperatively (OR 5.38) that persisted at 5 years. Patients should be counseled about this elevated, long-lasting risk of trigger finger after carpal tunnel release.

11. Spaan J, Streepy JT, Hornung AL, et al. Evaluation of Large Language Model Concordance With AAOS Clinical Practice Guidelines for Carpal Tunnel Syndrome. HAND 2026. doi:10.1177/15589447261495072

Four LLMs were queried with standardised prompts derived from AAOS carpal tunnel syndrome clinical practice guidelines, and 252 recommendations were graded for concordance by blinded reviewers. Overall concordance was only 72.6%, ranging from 92.1% (ChatGPT) to 52.4% (Mistral). More than one in four LLM-generated CTS recommendations deviated from or were indeterminate against guideline standards, supporting clinician verification of AI-generated advice.

12. Biaggi-Ondina A, Boukind A, Izadi L, et al. Glucagon-Like Peptide-1 Receptor Agonist Use Is Associated With Increased Peripheral Nerve Compression After Bariatric Surgery. HAND 2026. doi:10.1177/15589447261494000

A propensity-matched TriNetX cohort of 11,158 bariatric surgery patients per group compared new upper-extremity nerve compressions in those with versus without concurrent GLP-1 receptor agonist therapy. GLP-1RA use was associated with a 63% higher risk of developing carpal tunnel syndrome. Rapid weight loss on GLP-1RAs may contribute to compressive neuropathy, warranting clinician awareness in this population.

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

This erratum corrects the authorship of the April 2025 AAOS/ASSH Clinical Practice Guideline Summary on Management of Carpal Tunnel Syndrome, which omitted guideline development work group members and AAOS staff from the byline. The full corrected author list is provided, acknowledging all contributors to the guideline. No changes to the guideline's clinical recommendations are described; readers should simply cite the corrected authorship.

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

This retrospective multicenter registry study of 272,713 patients with carpal tunnel syndrome examined whether body mass index is associated with time to carpal tunnel release after diagnosis, stratifying patients into six BMI categories. BMI was significantly associated with time to surgery for both open and endoscopic release (P < .001). The results suggest that higher BMI may influence surgical timing, potentially reflecting differences in symptom severity, conservative treatment pathways, or healthcare access.

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

In a prospective comparative study of 125 carpal tunnel release patients (70 endoscopic, 55 open), investigators compared QuickDASH improvement and time to return to activities, stratified by occupational and recreational hand demands. Endoscopic release yielded greater overall QuickDASH improvement and faster return to recreational activities (14 vs 31 days), while return to ADLs and work was similar between techniques. Clinically, the choice of endoscopic release may be favored for patients eager to resume recreational hand activities, though functional gains otherwise favour it only modestly.

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

Using a large national database with propensity-score matching, this study compared 90-day complications and 2-year revision rates after carpal tunnel release among patients with non-tobacco nicotine dependence, tobacco users, and controls. Non-tobacco nicotine dependence was associated with increased 90-day medical complications (2.4% vs 1.7%) and emergency department visits compared with controls, with some outcomes differing from tobacco users. Surgeons should counsel patients using non-tobacco nicotine products that they carry elevated perioperative risk after carpal tunnel release, not just tobacco smokers.

Wrist Arthroscopy and Ligament Injury (6)¶

17. Spodzieja S, Boever J, Rau J, et al. Diagnostic accuracy of standard practice wrist MRI for scapholunate ligament injuries: a retrospective arthroscopic correlation study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06541-8

In a retrospective cohort of 864 patients who underwent preoperative wrist MRI followed by arthroscopy, MRI performance for detecting scapholunate ligament lesions was compared against arthroscopic findings. MRI showed high specificity (91.1%) for identifying tears, though it underestimated the burden of partial tears relative to arthroscopy. Clinicians should recognize that a negative standard-practice MRI does not exclude scapholunate ligament injury when suspicion is high, and arthroscopy remains warranted as the reference standard.

22. Tan HS, Yadav S, Baba M. Scaphoidectomy and Lunocapitate Fusion: A Systematic Review. HAND 2026. doi:10.1177/15589447261485502

This systematic review of 19 studies (329 patients) evaluated scaphoidectomy with lunocapitate fusion as a motion-preserving salvage procedure for SLAC and SNAC wrist arthritis. Pooled results showed modest motion preservation (flexion-extension arc ~77°), improved grip strength (19.3 to 28.9 kg), marked pain reduction (VAS 5.9 to 1.2), and mean DASH of 21, but a 10% nonunion rate and 13.4% reoperation rate driven largely by hardware complications. Lunocapitate fusion is a viable salvage option, but patients should be counseled about nonunion and hardware-related reoperation risk.

23. Waitayawinyu T, Sopasilapa P, Pinitchanon P, et al. An Algorithmic Approach to the Diagnosis and Staging of Scapholunate Instability in Distal Radius Fractures Using 7 Fluoroscopic Parameters Shows High Reliability and Accuracy. Arthroscopy 2026. doi:10.1002/arj.70599

Intraoperative fluoroscopic assessments using seven parameters (including SL gap, SL translation, scaphoradius translation, and dynamic angle measures) were compared with wrist arthroscopy for diagnosing and staging scapholunate instability in 88 unstable distal radius fractures. The parameters showed high intra- and interobserver reliability (ICC > 0.89) and good diagnostic accuracy, allowing development of a reliable staging algorithm aligned with Geissler and EWAS classifications. This algorithm may allow surgeons to detect and stage scapholunate instability fluoroscopically during distal radius fixation, potentially reducing reliance on arthroscopy.

24. Kim S, Cho J, Kim J, et al. The Arthroscopic Wafer Procedure Provides Successful Midterm Outcomes for Idiopathic Ulnar Impaction Syndrome: A Minimum 5‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70602

Forty patients with idiopathic ulnar impaction syndrome and <4 mm positive ulnar variance underwent arthroscopic wafer procedure with a mean follow-up of 73 months. All clinical outcomes improved significantly, including VAS pain (5.5 to 1.7), Mayo Wrist Score (51.9 to 86.5), DASH (47.7 to 14.3), and grip strength, with improvements exceeding cohort-specific minimal clinically important differences. The arthroscopic wafer procedure provides durable midterm success for appropriately selected patients (mildly positive ulnar variance), though radiographic distal radioulnar joint changes warrant monitoring.

35. Delgado PJ, Kaempf R, Prada A, et al. Arthroscopic Treatment of Wrist Chondral Lesions Using Interposition Arthroplasty With Acellular Dermal Matrix: A Case Series and Surgical Technique. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.010

Seventeen patients with advanced (Outerbridge IV) wrist chondral lesions underwent arthroscopic interposition arthroplasty using acellular dermal matrix, with a mean 28-month follow-up. QuickDASH scores improved from 54.1 to 13.4 and pain from 6.8 to 2.1, while wrist motion was essentially preserved; complications were minor except one conversion to arthrodesis. This joint-sparing technique may offer meaningful pain relief and function preservation as an alternative to salvage arthrodesis in carefully selected patients.

41. Pan B, Chen W, Luo H. Arthroscopic versus open repair for triangular fibrocartilage complex foveal tears: a systematic review and meta-analysis. EFORT Open Reviews 2026. doi:10.1530/eor-2026-0088

This systematic review and meta-analysis compared arthroscopic versus open repair techniques for triangular fibrocartilage complex foveal tears. The pooled analysis evaluated clinical and radiographic outcomes between the two surgical approaches. The findings inform surgeon decision-making regarding the choice of technique for foveal TFCC repair.

Scaphoid Nonunion and Digital Surgery (5)¶

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

Fifty first-person patient-voice vignettes of hand and wrist conditions were entered into three consumer LLMs (ChatGPT, Gemini, Copilot) to assess diagnostic and triage accuracy. Overall diagnostic accuracy was 84.7%, but was substantially lower for trauma presentations (65.0%) than elective conditions (96.7%). Clinicians and patients should be cautious relying on chatbots for acute hand and wrist injuries, where false reassurance and treatment delays are most likely.

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

Thirty patients with scaphoid nonunion underwent pedicled vascularized bone grafting (dorsal 1,2 ICSRA grafts for proximal pole, volar radial grafts for waist nonunions). All showed significant improvements in Mayo Wrist Score (51.5 to 72.1), VAS pain (4.4 to 2.0), motion, and grip strength, with no persistent nonunion or revision surgery. Pedicled vascularized grafting is a reliable option for scaphoid nonunion regardless of nonunion location.

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

This narrative review synthesized literature on machine learning applications in diagnosing hand pathology, including fractures, tendon injuries, and nerve compressions, drawing on studies through March 2025. Convolutional neural networks in particular showed high diagnostic accuracy for imaging-based detection and also supported history-taking, examination interpretation, and preoperative assessment. The findings suggest ML tools are approaching clinical utility as diagnostic adjuncts in hand surgery, though methodological transparency remains a limitation in the field.

25. Chaoui J. Artificial Intelligence in the Trauma Suite: From Fracture Detection to Explainable Decision Support in Distal Radial Fractures. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00881

This commentary discusses a feasibility study evaluating whether deep learning can predict surgical recommendations for distal radial fractures, rather than merely detecting fractures on imaging. The author highlights that predicting operative treatment decisions is a more clinically relevant but harder task than fracture detection, as it integrates radiographic severity, patient factors, and surgeon preference. The commentary underscores the importance of explainable AI decision support in moving orthopaedic AI beyond image classification toward meaningful clinical judgment.

40. Wang S, Yi Z, Chen W, et al. A review of digital orthopedic techniques in pre- and intra-operative management of scaphoid fracture. EFORT Open Reviews 2026. doi:10.1530/eor-2026-0084

This narrative review synthesizes digital orthopaedic technologies, artificial intelligence, 3D mapping, finite element analysis, navigation, robotics, and 3D printing, for pre- and intraoperative management of scaphoid fractures. AI achieves high diagnostic accuracy, navigation reduces radiation and guidewire attempts, and robotic assistance improves screw accuracy, though setup time, cost, and limited evidence remain barriers. Adoption should be individualized, as current evidence is predominantly low-level and each technology carries practical constraints.

Distal Ulna and DRUJ Surgery (5)¶

5. den Hengst S, Ghaderi N, Adams AJ, et al. Surgical Management of Unstable Distal Ulnar Fractures With Concomitant Distal Radius Fractures: A Systematic Review. HAND 2026. doi:10.1177/15589447261496464

This PRISMA-compliant systematic review of 24 studies (608 patients, mean age 65, 80% women) compared surgical techniques, plate fixation (58%), pin/wire fixation (22%), Darrach resection (19%), and screw fixation, for unstable distal ulnar fractures accompanying distal radius fractures. Outcomes assessed included range of motion, pain, complications, and reoperation rates. The review addresses the lack of consensus on optimal fixation strategy and can guide operative decision-making for these common combined injuries.

13. Fischer JS, van Es EM, Colaris JW. Diaphyseal forearm malunions with distal radioulnar joint instability treated by 3D-planned osseous correction. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261483320

Nine patients with diaphyseal forearm malunion and symptomatic DRUJ instability after childhood fracture underwent 3D-planned corrective osteotomy using patient-specific guides, without additional soft-tissue DRUJ repair. At 12 months, all showed clinically relevant improvements in PRWHE (44.5 to 5.5), activity pain (NRS 7 to 1), and function, with stable DRUJs. Bony realignment alone can reliably restore DRUJ stability in this setting.

20. Nabil Amin S, Mahmoud Hassanin M, Mahmoud Mansour A, et al. Distal Ulna Hook Locking Plate Fixation for Unstable Distal Ulna Fractures: A Prospective Clinical Study. HAND 2026. doi:10.1177/15589447261493991

Thirty patients with displaced or unstable distal ulna fractures were treated with open reduction and internal fixation using an anatomically contoured distal ulna hook locking compression plate and followed for at least 6 months. Radiographic union was achieved in all patients at a mean of 12.7 weeks, with 10% delayed unions, no nonunions, and favourable wrist motion, grip strength, and Modified Mayo Wrist Score outcomes. Hook locking plate fixation appears to be a reliable option for unstable distal ulna fractures, supporting distal radioulnar joint stability and function.

45. de Villeneuve Bargemon J, Audiffret L. Letter: Radiocarpal stability in chronic radiocarpal dislocation: Osteotomy is only one part of reconstruction. Injury 2026. doi:10.1016/j.injury.2026.113815

This letter responds to prior work on chronic radiocarpal dislocation, arguing that corrective osteotomy alone is insufficient for restoring radiocarpal stability. The authors emphasize that soft tissue reconstruction addressing ulnar translation and ligamentous instability must accompany bony correction. The letter underscores the need for a comprehensive reconstructive approach in chronic radiocarpal dislocation.

46. Clarke E, Mehta S, Peck K, et al. Anatomic Considerations of Retrograde Intramedullary Nail Placement in Distal Ulna Fractures. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.09.007

This cadaveric study characterized the anatomic relationships of retrograde intramedullary nail placement for distal ulna fractures, with particular focus on the triangular fibrocartilage complex. Pre- and post-insertion arthroscopy and dissection showed the nail path disrupted the distal extensor retinaculum in all specimens and involved the superficial TFCC and deep radioulnar ligament footprint in the majority, though no direct injury to the extensor tendons or dorsal cutaneous branch of the ulnar nerve occurred. Surgeons should be aware of the consistent risk of TFCC and retinacular penetration when using this fixation technique.

Arthroplasty, Tendon, and Miscellaneous (14)¶

3. Dash J, Ye A, Kauffman T, et al. Ultrasound-Guided Versus Landmark-Guided Corticosteroid Injections for De Quervain’s Tenosynovitis: A Retrospective Comparative Study. HAND 2026. doi:10.1177/15589447261496356

This retrospective single-institution cohort study compared corticosteroid injection outcomes for De Quervain's tenosynovitis in 189 patients (93 ultrasound-guided, 96 landmark-guided), with treatment success at 3, 12, and 24 months as the primary outcome. No significant differences were found between the two guidance techniques. The findings suggest that ultrasound guidance may not be necessary for routine De Quervain's injections, supporting landmark-guided injection as a reasonable, less resource-intensive first-line approach.

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

In this prospective study, 102 patients undergoing carpal tunnel release and/or trigger finger surgery under local anaesthesia in an outpatient operating room were discharged directly home without post-anaesthesia care unit recovery after a single set of vital signs. No intraoperative or postoperative complications, reinterventions, or deaths occurred, and only 3.9% visited the emergency department within 90 days. The results support bypassing PACU monitoring after local-anaesthesia hand surgery, offering potential efficiency and cost savings.

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

This prospective cross-sectional study translated, culturally adapted, and psychometrically validated an Arabic version of the Duruöz Hand Index (DHI-AR) in 439 Arabic-speaking patients with hand or wrist conditions, using established forward/back-translation and expert review procedures. The DHI-AR demonstrated excellent internal consistency (Cronbach's α = 0.980) and test-retest reliability, along with convergent validity against the Arabic PRWHE. The validated instrument enables standardised assessment of hand disability in Arabic-speaking populations in clinical practice and research.

14. Chang MK, Chiew J, Chew DEM. Poland Syndrome with transverse upper limb deficiency: beyond the vascular disruption hypothesis. Journal of Hand Surgery (European Volume) 2026. doi:10.1177/17531934261475583

A neonate presented with Poland syndrome featuring right pectoral deficiency combined with carpal-level transverse upper limb deficiency without ectodermal elements. This rare phenotype is difficult to explain by a single-point vascular disruption event. The case supports a dynamic embryonic capillary plexus model over the classic vascular hypothesis.

15. Israeli R, Gorelick L, Gannot G, et al. First-in-human prospective pilot study of a bipolar dual-center total wrist arthroplasty: early mechanical stability and clinical outcomes. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06493-z

Five patients with end-stage wrist arthritis received a novel bipolar dual-center total wrist arthroplasty designed to preserve both radiocarpal and midcarpal motion, in a first-in-human prospective pilot. At mean 19.2-month follow-up, implant survivorship was 100% with no loosening, alongside improvements in pain, PRWE, and DASH scores. Early results support continued evaluation of this dual-center implant design.

18. Mastrokostas PG, Schwartz LB, Friedman AJ, et al. Rising Revision Burden in Total Wrist Arthroplasty: National Medicare Trends and Projections to 2060. HAND 2026. doi:10.1177/15589447261495094

Using Medicare Part B data from 2000-2022 with forecasting models, national trends in primary and revision total wrist arthroplasty (TWA) were analyzed and projected to 2060. Primary TWA grew from 107 to 292 annual procedures and revisions from 47 to 283, with projections of roughly 1040 primary and 3262 revision procedures annually by 2060, meaning revisions will far outpace primaries. The rising revision burden highlights the need for improved implant durability, patient selection, and health system capacity planning as TWA utilisation expands.

28. Aziz KT. Don’t Just Own the Bone. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00984

This commentary discusses a Japanese population-based study identifying distal radial fractures as an early marker of bone fragility. The author connects the findings to the 'Own the Bone' quality improvement program, emphasizing that fragility fractures present a critical opportunity for orthopaedic surgeons to diagnose osteoporosis and initiate medical management. The clinical implication is that secondary fracture prevention should be an integral part of treating distal radius fractures, not just fracture fixation itself.

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

A professional ice hockey injury registry was analyzed over three Swedish Hockey League seasons to characterize 113 hand, wrist, and forearm injuries. Fractures were the most common injury (54%) and caused the greatest time loss (median 32 days), with puck contact the leading mechanism (45%). These findings underscore the need for puck-impact protection strategies targeting fracture prevention in professional hockey players.

37. Higashi T, Takahara S, Takayama H, et al. Primary total elbow arthroplasty with ulna fixation for a Jupiter type IID posterior Monteggia fracture-dislocation: A case report. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100897

This case report describes primary total elbow arthroplasty combined with ulnar fixation for a Jupiter type IID posterior Monteggia fracture-dislocation. The report demonstrates a management strategy for a complex, comminuted elbow injury in which stable fixation and joint reconstruction were achieved in a single setting. It provides a treatment option for elderly or low-demand patients with unreconstructible distal humerus and proximal ulna fractures.

38. Rajha HE, Abugharbieh L, Talhami M, et al. The impact of analgesic opioid use on fracture healing and nonunion: a systematic review and meta-analysis. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104918

A systematic review and meta-analysis of seven retrospective cohort studies including over one million fractures evaluated the association between chronic opioid use and fracture nonunion. Chronic opioid use was associated with markedly higher odds of nonunion across all bone types (OR 5.10), with elevated risks at the humerus, radius, tibia, and metatarsals. Clinicians should weigh potential impairment of bone healing when prescribing opioids for fracture pain and consider alternatives where feasible.

39. Zlotolow DA, Soldado F, Huddleston H, et al. Restoration of Wrist Extension in Patients With Brachial Plexus Birth Injuries by Transfer of Two Flexor Digitorum Superficialis Tendons. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.08.011

Seventy-three patients aged 4 years or older with residual wrist extension deficit from brachial plexus birth injury underwent flexor digitorum superficialis tendon transfer, with mean follow-up of 45 months. The transfer produced substantial improvement, with 89% achieving powerful wrist extension (M4) sufficient for grip, and outcomes were better with interosseous membrane routing and in patients with preoperative M3 strength. FDS transfer is a reliable option to restore active wrist extension in these children, with technique refinements improving results.

42. Zhang X. Comment on “Soft bandage vs rigid immobilisation in pediatric distal radius torus fractures: A cost and patient burden analysis—A retrospective cohort study”. Injury 2026. doi:10.1016/j.injury.2026.113775

This is a commentary on a retrospective cohort study comparing soft bandage versus rigid immobilisation for paediatric distal radius torus fractures, focusing on cost and patient burden outcomes. The author provides critical appraisal of the original study's methodology and conclusions. The comment highlights considerations for applying these findings to clinical practice in paediatric fracture management.

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

This 13-year retrospective review analyzed injury characteristics, treatment approaches, and outcomes of paediatric flexor tendon injuries. The study characterized the epidemiology and management results of these injuries in a large paediatric cohort over more than a decade. The findings provide guidance on treatment strategies and expected outcomes for paediatric flexor tendon repairs.

47. Kiehl D, Ibrado R, Axelrod A, et al. Comparative Trends of Musculoskeletal Injury in Pickleball and Tennis: An 11-Year Analysis of U.S. Emergency Department Visits. Injury 2026. doi:10.1016/j.injury.2026.113791

This 11-year analysis of U.S. emergency department visits compared musculoskeletal injury trends between pickleball and tennis players. The study characterized the epidemiology and changing patterns of injuries in these two increasingly popular racquet sports. The findings inform injury prevention strategies and resource planning as pickleball participation continues to grow.

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