Wissenschaftliches Programm

Einführung
Die Handgelenksprothetik hat über Jahrzehnte und mehrere Implantatgenerationen hinweg unzufriedenstellende Resultate geliefert und wird aufgrund der fehlenden Langzeitergebnisse der neuesten Generation weiterhin skeptisch beurteilt. Mit der Entwicklung der MOTEC^® Prothese, die sich durch eine stabile Verankerung im dritten Mittelhandknochen auszeichnet, hat sich eine neue Begeisterung eingestellt, welche durch die publizierten Studienergebnisse von Reigstad et al. verstärkt wurde.

Methodik
Retrospektive Analyse von 21 MOTEC®-Prothesen, implantiert durch den Senior-Autor zwischen Oktober 2020 und März 2025. Eingeschlossen wurden 20 Patienten (15 Männer, Ø Alter zum Zeitpunkt der Operation betrug 63 Jahren) mit posttraumatischer Arthrose, vorwiegend SLAC-wrist.

Ergebnisse
PROMs und CROMs wurden erhoben und bewegen sich im publizierten Rahmen. Mit Fokus auf generelle Probleme und Komplikationen sind folgende Punkte erwähnenswert:
- Intraoperative Perforationen des dritten Mittelhandknochens (1), des Radius (1) sowie Berstungen des Capitatums (2) – ohne Einfluss auf das postoperative Management
- Limitierte intraoperative Platzverhältnisse bedingt durch vorgängige PRC erforderte einen palmaren Kapselrelease (3)
- In der ersten Fallserie zeigte sich postoperativ eine deutliche Schwellungstendenz; das postoperative Management wurde mit einer Kortisonstosstherapie ergänzt
- Wundheilungsstörung (1)
- Periprothetische Ossifikation mit Impingement (1), Revision steht an
- Periprothetische Radiusfraktur (1) nach Sturz
- Postoperativer Hochstand des Kopfes des dritten Mittelhandknochens (2)
- Beobachtete Tendenz zur Flexionsstellung und Ulnardeviation des Handgelenkes
- Schlechtere Beweglichkeit nach vorgängiger PRC im Vergleich zu Patienten ohne PRC (durchschnittlicher Bewegungsumfang Flexion-Extension von 58° vs. 105°)

Schlussfolgerung
Mit strenger Indikationsstellung, Konzentrierung der Erfahrung auf einen Operateur und einem kurzen Nachbeobachtungszeitraum von maximal 2 Jahren zeigen sich in 21 mit MOTEC^® versorgten Handgelenken gute bis sehr gute Resultate. Nur in einem Fall steht eine Revision mit Erhalt des Implantates an. Gewisse Probleme wie Schwellungstendenz oder schlechtere Beweglichkeit nach früherer PRC sind in die präoperative Aufklärung und Planung miteinzubeziehen. Aufgrund der sehr hohen Patientenzufriedenheit und der bisherigen vielversprechenden Studienlage beabsichtigen wir, die Implantation der MOTEC^® weiterhin selektiv einzusetzen.

Introduction:
Unicompartmental resurfacing prostheses represent a potential treatment option for elderly patients with severely comminuted distal intraarticular radius fractures and poor bone quality. While early reports have shown promising results, data on long-term outcomes remain limited. The aim of this study was to evaluate both clinical and radiological medium-term outcomes following the implantation of the unicompartmental resurfacing prosthesis (Prosthelast®) in elderly patients with severly comminuted distal intraarticular radius fractures.

Patients and Methods:
Patient-reported outcome measurements included evaluation of the Visual Analogue Scale (VAS) pain score, along with evaluation of the PRWE and QuickDASH scores. Objective outcomes included the measurement of active wrist range of motion and Jamar® grip strength. Radiological evaluations assessed implant positioning, bone remodeling and potential complications such as implant loosening, migration, or heterotopic bone growth.

Results:
Between 2018 and 2023, 23 female patients with AO type C distal intraarticular radius fractures underwent treatment with the Prosthelast® isoelastic resurfacing prosthesis. Mean follow-up was 44 months, with a minimum of 24 months. Mean age of patients was 78 years. No prosthesis removal or revision surgeries were required. All patients expressed satisfaction with their treatment decision and reported no significant functional limitations in daily life. However, a reduction in wrist mobility and grip strength was observed compared to the contralateral, healthy wrist. QuickDASH and PRWE scores indicated minor degree of functional limitation in this low-demand patient cohort, though the limitations were mostly attributed to comorbidities such as stenosing tenosynovitis, carpal tunnel syndrome, and degenerative changes unrelated to the prosthesis (e.g., rhizarthrosis). Radiological complications related to the prosthesis were minimal and included asymptomatic perforation of the radial head and impingement caused by osteophyte formation on the scaphoid.

Conclusion:
At medium-term follow-up, the isoelastic resurfacing prosthesis appears to be a viable treatment option for complex intra-articular distal radius fractures in elderly, low-demand patients.

Introduction: Traditional wrist fusion for painful osteoarthritis presents unsatisfactory trade-offs between pain relief and functional preservation. The Motec wrist prosthesis offers a technological advancement with its cementless, modular ball-and-socket design, yet comprehensive outcome analyses combining objective measures and patient-reported outcomes remain limited.

Methods: This observational cohort study evaluated 22 patients (9 men, 13 women; mean age: 62 years) who underwent Motec wrist arthroplasty between March 2020 and March 2024. Outcomes were assessed preoperatively, at 3 months, and 12 months postoperatively using Numeric Pain Rating Scale (NPRS), Patient-Rated Wrist/Hand Evaluation (PRWHE), Total Active Motion (TAM), grip strength, and patient satisfaction measures using the outcome registry SUPEXOR.

Results: Significant pain reduction occurred at both rest and during loading (p<0.05). PRWHE scores improved progressively across all time intervals (p<0.05). TAM showed delayed improvement, with significant gains between 3 and 12 months (p<0.05). Grip strength significantly improved from baseline to 12 months (p<0.05). At 12 months, 77% of patients reported high satisfaction, and 100% would undergo the procedure again.

Discussion: Results demonstrated distinct recovery trajectories: pain improved rapidly, while motion and strength followed delayed patterns, informing rehabilitation protocols and patient counseling.

Conclusion: Motec wrist arthroplasty provides significant pain relief and functional improvement with high patient satisfaction at one-year follow-up.

Complex distal radius fractures (DRFs) in elderly patients are often complicated by osteoporosis and reduced bone density. This study examines the treatment of such fractures using wrist arthroplasty and presents our decision-making algorithm, which takes into account fracture morphology, patient age and needs, and associated wrist conditions.

Twenty-two patients with complex DRFs were treated between September 2020 and January 2025. The cohort included 4 males and 18 females, with a mean age of 75 years (range: 63–89 years). Fractures were classified using the AO system, and associated injuries were identified through radiographic assessments (X-rays and CT scans) in order to determine individualized treatment strategies. Patients who met the criteria of our algorithm underwent wrist arthroplasty and were followed up at 6 weeks, 3 months, and 6 months, including radiographic monitoring of implant osseointegration. Subsequently, patients completed the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire and the PRWE (Patient-Rated Wrist Evaluation) test.

Our study reports satisfactory recovery of mobility (mean E/F 41-0-38°, P/S 64-0-66°) and grip strength (measured with the Jamar dynamometer, average of 16 kg). DASH and PRWE scores were comparable to current literature, considering the age of our study population.

Our study supports the effectiveness of Motec wrist arthroplasty as a viable treatment option for complex DRFs in a selected patient population, as determined by our decision-making algorithm. In future clinical scenarios, we aim to extend the follow-up period and increase the sample size.

Introduction: Perilunate dislocations (PLD) and fracture dislocations (PLFD) lead to a disruption of intrinsic and extrinsic ligaments of the wrist. The treatment includes open or arthroscopically assisted reduction, temporary transfixation of the carpal joints with or without ligament repair, and fracture fixation. Timely treatment and restoration of carpal alignment, can lead to satisfying clinical outcomes. Nonetheless, some restriction of range of motion and grip strength can be expected. While there is some literature on intercarpal kinematic changes after scapho-lunate injuries and scaphoid non-union, only little is known about these more complex injuries. 

Aim: To investigate intercarpal scaphoid and triquetrum motion in relation to the lunate and to compare this to the healthy wrist in patients after surgical treatment for PLD or trans-scaphoid PLFD.

Material & Methods: 6 patients after PLD and 7 patients after trans-scaphoid PLFD underwent 4D-CT scans of the affected and the healthy wrist. During 4D-CT scanning, they actively performed a guided E-F and R-U motion. The difference in the radio-scaphoid (RSA) and radio-lunate angles (RLA) in neutral wrist position between affected and healthy side was measured. The smallest and largest distances in the SL-and the LT-joint within the motion cycle were determined as a measure of joint stability. 

Results: Mean follow-up after surgery was 94months (26-166). The difference in the RSA and RLA in neutral position between affected and healthy side was 10.1° (2.9°-26.7°) and 8.2° (0.9°-25.2°). There was no statistically significant difference between PLD and PLFD group. Scaphoid sagittal plane rotation during E-F showed a similar pattern in the affected and healthy wrist but the differences in the other planes were larger. Axial plane scaphoid translation during E-F showed small differences while they were bigger in the other planes. The motion patterns during R-U by trend showed larger differences than during E-F. The motion patterns of rotation and translation of the triquetrum were close to normal in most cases. The maximal SL-distance during E-F and R-U was larger in the affected side (p=0.033). No differences were found for the LT-distance and between PLD and PLFD groups.

Conclusions: The intercarpal motion pattern for the SL- and LT-joints was quite similar in the healthy and the affected wrists. This indicates good restoration of the intrinsic carpal ligaments even though the SL-joint showed some widening.

Purpose: Due to the biological, anatomical, and biomechanical characteristics of the scaphoid, treating proximal pole nonunion remains challenging. The location of the nonunion (proximal or distal to the dorsal apex) may influence its natural history. Based on this concept, patients with a proximal pole nonunion located proximal to the dorsal apex and maintaining an intact insertion of the dorsal scapholunate ligament (DSLL) in the distal fragment of the scaphoid may benefit from simple excision of the proximal pole. This study evaluates the clinical and functional outcomes of this treatment approach.

Methods: A retrospective review was conducted on 11 patients who underwent proximal pole simple excision for proximal pole scaphoid nonunion. Postoperative outcomes were assessed using pain (VAS), Patient-Rated Wrist Evaluation (PRWE), Patient-Specific Functional Scale (PSFS), and EQ-5D. Patient satisfaction and return to work rates were also analyzed.

Results: Postoperative pain, PRWE, PSFS, and EQ-5D scores improved after surgery. 10/11 patients were highly satisfied with the procedure. 10/11 returned to their previous occupational activities. 4 patients reported dorsoradial discomfort, but only one required surgical revision for radial styloidectomy. No radiological progression to a scaphoid nonunion advanced collapse (SNAC) pattern or other complications were observed.

Conclusions: These findings support that proximal pole simple excision is a viable and relatively simple treatment for proximal pole scaphoid nonunion when the proximal fragment is non-viable and a competent DSSL remains inserted in the distal fragment.

PURPOSE

To assess the effect of scaphocapitate arthrodesis (SCA) on grip strength and wrist motion for patients with advanced stages of Kienbock disesase (KD) or avascular necrosis of the proximal pole of the scaphoid (AVNPPS) without joint preparation.

METHODS

A retrospective review was conducted of patients with advanced stages of KD (stage IIIB according to Lichtman classification) or avascular necrosis of the proximal pole of the scaphoid with a minimum of 1 year clinical follow-up. Outcome measures included preoperative and postoperative pain, range of motion, grip strength, complications, additional surgery, radiographic changes and the modified Mayo wrist score.

RESULTS

Twenty-two patients (21 males and 1 female) with a mean age of 34 years (range, 16-54 y) at the time of the SCA were included in the study. The mean follow-up period was 101 months (range 11-171 mo). The ave AROM of the wrist was 92.6°. The TAM ratio and Jamar ratio compared to the contralateral were 66.6% and 79.4% respectively. The Modified Mayo wrist scores were mostly fair (50%) being good and poor in 30% and 20% of cases respectively.  All patients returned to regular employement. The ave time out of work was 4.6 months (range 2-15 mo.). Most patients had a marked improvement of the wrist pain that passed from 7.9 to 1.8 at the VAS-score. Neither progressive radiographic carpal collapse and ulnar traslocation of the carpus in case of KD occurred nor signs of SNAC wrist of panarthritis occurred. In 50% of cases a bone resorption in the capitate was detectable but It was not associated with the time of follow-up and with post-operative pain. One case of hardware malposition required a conversion to total wrist joint fusion.

SUMMARY

SCA resulted in clinical improvement in cases of advanced stages of KD and AVNPPS  in medium-term follow-up even without preparation of the SC joint. No hardware related complications were observed, except in one case. SCA represents a valid salvage procedure in cases of advanced KD or AVNPPS.  

Introduction: Kienböck’s being a rare disorder, studies are underpowered to compare Proximal Row Carpectomy (PRC), Scapho-Trapezio-Trapezoid Arthrodesis (STTA), and Scapho-Capitate Arthrodesis (SCA). Complementing a recent meta-analysis focused on SCA (Bouri 2023), a comparison of clinical outcomes of PRC and STTA would thus be most desirable for surgeons and patients.
Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed and previous unsystematic reviews were searched for peer-reviewed publications until April 2025. We included patients with Kienböck’s who had undergone PRC or STTA, with no restrictions on date, language, or design. We excluded inseparable etiologies or therapies, and single case reports. Primary outcomes were pre- and post-operative pain on any scale, arc of motion, and dynamometric grip strength. Secondary outcomes were functional scores (DASH, Mayo Wrist) and radiographic measurements. Individual participant data were used where possible. Cochrane’s Review Manager calculated effect sizes via Weighted Mean Differences (WMD) and 95% Confidence Intervals (CI).
Results: Of 42, in part poor reports on 734 wrists only 21 reports on 312 wrists could be included. PRC significantly relieved pain (WMD 3.4, 95% CI 1.7 to 5.2, n = 69 wrists), improved extension by 14° (95% CI 3 to 24, n = 66) and non-significantly combined extension/flexion by 12° (95% CI –5 to 29, n = 115). It also increased grip strength (WMD 0.8, 95% CI 0.3 to 1.4, n = 80). STTA significantly relieved pain (WMD 4.9, 95% CI 1.3 to 8.4, n = 49), diminished radial/ulnar deviation by 11° (95% CI 8 to 14, n = 66) without impact on extension/flexion. It further increased grip strength (WMD 0.8, 95% CI 0.2 to 1.4, n = 95). Functional scores improved consistently. STTA affected most of the radiographic measurements.
Conclusions: This is the first meta-analysis to investigate PRC and STTA in Kienböck’s disease. Both of them are effective in alleviating pain and strengthening grip. PRC is able to obtain more active range of motion. The low-level evidence (IV) is currently due to mostly retrospective case series. Authors are encouraged to submit more usable data to corroborate our preliminary results.

Disclosures:
Grants/sponsoring: None.
Conflicts of interest: None.
Informed consent/ethical review: Not applicable.
Submission elsewhere: None.

Introduction / Objective:
Arthroscopic treatment of mid-proximal scaphoid nonunions can be technically challenging due to limited access and difficulty in thorough debridement. This study aims to describe a safe, inside-out, volar midcarpal portal that provides direct access to these lesions: the Volar Midcarpal Direct Scaphoid portal (VMDSc).

Material and Methods:
Ten fresh-frozen cadaveric upper limbs were used. A simulated mid-proximal scaphoid fracture was created in each specimen. The VMDSc portal was then established in an inside-out manner. Finally, the volar wrist area was dissected to identify adjacent anatomical structures and measure their distances from the portal’s exit path.

Results:
In the first four specimens, the guidewire pierced the flexor carpi radialis (FCR) tendon; in the remaining six, it exited radial to it. The cutaneous exit point was located on average 8.5 mm from the radial artery and 1.0 mm from its superficial palmar branch. The median nerve was an average of 7.0 mm away, and its palmar cutaneous branch 6.0 mm. The dorsal sensory branch of the radial nerve was located 10.5 mm from the portal exit point.

Discussion and Conclusions:
To reduce the risk of neurovascular injury, we recommend that the VMDSc portal exit the joint at the radial border of the radioscaphocapitate ligament, blindly oriented toward the FCR tendon. A 1 cm skin incision between the wrist creases at the radial margin of the FCR tendon provides safe external access. In combination with the radial dorsal midcarpal portal for visualization, the VMDSc portal enables effective debridement, grafting, and anatomical reduction of mid-proximal scaphoid nonunions or fractures. We consider this portal a safe and valuable tool that facilitates 360° arthroscopic management of scaphoid pathology.

Introduction: Scaphoid nonunions remain a common and challenging condition in hand surgery. With the advent of arthroscopy, bone graft reconstruction can now be performed using a minimally invasive, arthroscopically assisted technique. This study presents a series of 40 arthroscopically treated scaphoid nonunions, highlighting its adventage as a minimally invasive technique with excellent outcomes and potential for ambulatory implementation.

Material and Methods: We retrospectively evaluated 40 patients (on average 30 yeras, age range: 12- 58 years) treated with an arthroscopic reconstruction of a scaphoid nonunion at our institution. All surgeries were performed by the same surgical team. Follow-up ranged from 2 months to 2 years. The technique included arthroscopic debridement, bone grafting, and internal fixation, using one or two headless compression screws. Cases were assessed clinically and radiologically, focusing on union rates, correction of deformity, surgical time, and complications.

Results: Union was achieved in 38 of 40 cases (95%). In the two remaining cases, the proximal pole was significantly sclerotic both pre- and intraoperatively. Despite radiographic signs of persistent nonunion, both patients remained asymptomatic postoperatively. Importantly, no humpback deformities were observed in any case. Surgical time was significantly reduced compared to open techniques, and no conversions to open surgery were necessary. No infections or neurovascular injuries occurred.

Discussion and Conclusion: Arthroscopic reconstruction of scaphoid nonunions offers a safe, effective, and minimally invasive alternative to open procedures. The technique preserves soft tissues, reduces operative time, and delivers excellent anatomical and functional outcomes. Even in cases where radiologic healing is incomplete, the clinical results can be satisfying. Given its low morbidity and efficiency, this technique is ideally suited for ambulatory surgical settings—should future healthcare frameworks allow for it. Based on our results, we strongly recommend this approach as a standard option for treating scaphoid nonunions.

Introduction

Delayed diagnosis of scapholunate (SL) ligament injuries limits therapeutic options and often prevents direct ligament repair, requiring ligament reconstruction. The anatomical front and back (ANAFAB) procedure for SL instability proposed by Sandow and Fisher combines the reconstruction of the scaphotrapezium (ST), dorsal scapholunate (SL), and long radiolunate (LRL) ligaments addressing several important parts of the SL complex.

Methods

We conducted a single-center, retrospective trial including all patients treated for SL instability with the ANAFAB procedure at our clinic. No exclusion criteria were applied. Procedures were performed by 3 different surgeons with level 5 expertise.

We reviewed demographic data, pre- and postoperative (latest follow-up) range of motion (ROM), grip and pinch strength. We measured SL distance, scapholunate, radiolunate, and radioscaphoid angle (SL, RL, RS), carpal height and ulnar translation on standard radiographs. Patient-reported outcome measures (PROMs) were analysed if available.

Results

Between 2019 and 2025, 8 patients underwent the ANAFAB procedure for chronic SL instability. 1 patient had prior failed ligament repair. 1 had additional adaptive carpal instability from radial malunion and underwent corrective osteotomy in the same surgery. Male:female ratio was 6:2, median age at time of surgery 42.5 years (range 34 – 56), follow-up 24 months (3 – 55).

Preoperative E/F was 60/60 (30/40 – 70/80, n = 5), R/U 15/25 (10/10 – 35/40), P/S 90/85 (60/75 – 90/95); grip strength was 27.5 kp (21 – 36, n = 4); SL distance 3.4 mm (1.8 – 4, n = 7); pain on a 10-point VAS (n = 3) was 4 at rest (1 – 4), 6 under load (6 – 8).

Postoperative E/F was 61/45 (40/20 – 80/60, n = 6), R/U 17.5/30 (5/20 – 20/35), P/S 77.5/89 (60/70 – 90/100); grip strength was 36 kp (10 – 55, n = 7); SL distance 3.5 mm (2 – 4, n = 7); pain on VAS (n = 3) 1 at rest (0 – 3), 1 under load (1 – 6). 7 out of 8 patients returned to previous work.

Conclusion

In our small cohort, the ANAFAB procedure was effective in reducing pain allowing patients to return to daily activities and work. Although radiological results were not always satisfactory and some flexion was lost, we can expect preserved extension, improved strength and high patient satisfaction. Therefore, this technique currently remains our treatment of choice in these cases.

Disclosures
Grants/sponsoring: none

Conflicts of interest: none

Informed consent: obtained

Submission elsewhere: none

Introduction :

L’objectif de ce travail était d’évaluer les résultats cliniques et facteurs pronostiques de 12 ans d’expérience du transfert nerveux de la longue portion du triceps sur le nerf axillaire (TSL).

Matériel et Méthodes :

Cette étude rétrospective monocentrique, évaluait les patients opérés d'un TSL (2008-2019) avec un recul minimum de 18 mois. Les résultats étaient évalués globalement puis en sous-groupe soit TSL isolé (TSLi) contre TSL + autre transfert (TSL+). Les critère de jugement principal était l'échelle du test BMRC, les critères de jugement secondaies étaient la mesure des mobilités de l'épaule et un test isocinétique de l'abduction. Un deltoïde moyen (DM) DM M3 ou plus sur l'échelle BMRC témoignait d’une récupération.

Résultats :

Trente-six patients étaient inclus avec un recul moyen de 47 ±4 mois, âgés de 28 ans (15-68) et opérés à 8 mois post-traumatique (4-28). On retrouvait un Deltoïde supérieur ou égal à M3 pour 72% de deltoïdes antérieurs, 75% de moyens et postérieurs. Les mobilités augmentées étaient l'élévation antérieure et l'abduction (+35 et +55°, p=0,003). Le pic de couple était significativement diminué en concentrique par rapport au côté sain de -30% à 60°/s, de -31% à 180°/s, et de -26% en excentrique à 30°/s (p<0,001). Les résultats en force et mobilités étaient supérieurs pour le groupe TSLi. Les facteurs pronostiques significatifs étaient : TSL + autre transfert (p=0,007), l'âge (p=0,03), un triceps et un nerf suprascapulaire (NSS) déficitaires préopératoire (p=0,005).

Conclusion :

Le TSL procure une nette amélioration de la force et de la mobilité de manière fiable et reproductible. La force procurée par ce transfert atteignait en moyenne 70% du côté sain en isocinétisme. Ces résultats étaient nettement supérieurs lors des transferts isolés chez les patients jeunes.

Introduction :

La morbidité du transfert de la longue portion du triceps (LPT) sur le nerf axillaire (NA) selon Somasak Leechavengvongs (TSL) est rapportée comme négligeable mais n'est pas l'objet de mesure objective dans la littérature. Nous en avons évalué la morbidité sur la force par un protocole standardisé et reproductible.

Matériel et Méthodes :

Par cette étude rétrospective monocentrique, 38 patients opérés d'un TSL entre 2008 et 2020 avec un triceps BMRC M5 préopératoire étaient éligibles. La force en extension du coude était évaluée par questionnaire, test BMRC, et isocinétisme de 90 à 0° en concentrique à 60 - 180°/s et en excentrique à 30°/s.

Résultats :

Vingt patients d'âge moyen de 25 ans (15 - 48) étaient volontaires pour une évaluation. Le recul était de 58 mois (6 -174). L’amyotrophie était visible pour 15/20 patients (75%), 7/20 (35%) avaient des contractures sur le triceps, et 12/20 (60%) une fatigabilité à l'exercice. Neuf triceps étaient M4 (11%) et 11 M5 (55%) au BMRC. La force en concentrique à 60, 180°/s et en excentrique à 30°/s était diminuée (respectivement -16,9 Nm, -14,8 Nm, et -16,3 Nm, p<0,001) soit -24%, -23% et -23% du membre sain. Les mesures objectives et subjectives étaient discordantes.

Conclusion :

La morbidité du TSL sur la force en extension du triceps se traduit par une diminution de force à M4 pour 11% des patients et -23% de force moyenne par rapport au côté sain en isocinétisme de manière homogène sur les différentes capacités du muscle. Cette morbidité, bien que non négligeable, ne semble pas avoir de conséquences à l’évaluation subjective.

Introduction:
C6-T1 brachial plexus palsy often results in the loss of elbow extension due to triceps palsy. Traditional methods, like posterior deltoid transfer using a fascia lata graft have limitations, particularly when performed after six months after the injury. The nerve transfer of the teres minor motor branch to the long head of the triceps muscle, first described by Bertelli et al. in 2011, is an innovative and underexplored alternative. This case assesses its feasibility and effectiveness to restore elbow extension in lower brachial plexus injuries.

Method:
A 22-year-old male with a partial right brachial plexus injury (C6-T1) originating from a motorcycle accident. The clinical and radiological examination using MRI confirmed C8-T1 root avulsion and complete palsy of the hand and the elbow. Six months after injury, a nerve transfer from the teres minor muscle to the long head of the triceps muscle was performed. The diameter match between the motor branches of the teres minor and the long head of the triceps was adequate. Concomitantly, we conducted the transfer of the 3rd, 4th, and 5th intercostal nerves to the biceps branch of the musculocutaneous nerve. Rehabilitation followed with clinical evaluations at 1, 3, 6 and 12 months.

Results:
At 12 months, active elbow flexion reached 130 degrees with M3+ strength, whereas active extension was complete with M3+ strength. Elastography showed a significant increase in the shear wave of both the long head of the triceps and the biceps in active motion, correlating with functional restoration.

Conclusions:
This case demonstrates that nerve transfer from the teres minor motor branch to the motor branch of the long head of the triceps is an effective method to restore elbow extension in lower brachial plexus injuries. The technique described provides a physiological alternative, particularly if done within six months post-injury. The matching nerve diameter between the teres minor and long head of the triceps support the functional viability of this technique. This type of nerve transfer seems a promising technique to improve upper limb function after traumatic plexus injuries and offers a novel solution.

Background:
The distal anterior interosseous nerve (AIN) to ulnar motor branch transfer, as described by McKinnon, is widely adopted for intrinsic muscle reinnervation following high ulnar nerve injury. While it offers a short regeneration distance, its effectiveness in restoring full pinch function remains under debate. This study critically evaluates functional outcomes in a series of patients who underwent this transfer.

Methods:
Eight patients with ulnar nerve injuries proximal to the upper third of the forearm underwent distal nerve transfer of the AIN branch to pronator quadratus (PQ) to the ulnar motor branch at wrist level, within a maximum of 9 months post-injury. Clinical follow-up included assessment of clawing, finger abduction/adduction strength (MRC grading), key pinch strength, and presence of Froment’s sign.

Results:
At 15-month follow-up finger abduction and adduction recovered to M4 in all but one patient (M3), and mild clawing was corrected in all cases. However, subterminal key pinch strength averaged only 0.8 kg, and Froment’s sign remained positive in six of eight patients. No donor site morbidity was observed.

Discussion:
Recovery of intrinsic function indicates that the nerve transfer effectively reached the correct ulnar motor fascicles. However, consistently poor reinnervation of the first dorsal interosseous suggests it may be the least likely to receive sufficient regenerating axons. This contrasts with direct nerve repairs at the wrist, which appear to deliver a higher axonal load. Our findings challenge the assumption that this transfer alone can restore functional pinch and suggest that combining it with a more distal, selective motor transfer—such as opponens to first dorsal interosseous—may be necessary for optimal outcomes.

Conclusion:
The distal AIN-to-ulnar motor branch transfer restores intrinsic tone and basic function but falls short in reanimating the first dorsal interosseous and enabling effective pinch. Selective augmentation should be considered to improve results in high ulnar nerve injuries.

Background:
Isolated palsy of the distal posterior interosseous nerve (PIN) is rare and may present spontaneously without clear etiology. Recurrence after initial recovery raises suspicion of neuralgic amyotrophy (Parsonage-Turner syndrome), particularly in the context of a post-infectious event. We present a unique case of recurrent PIN palsy managed successfully with decompression and selective nerve transfer.

Case Presentation:
A young woman presented with spontaneous paralysis of thumb extension (IP joint), retroversion, and abduction. Sonography showed no compressive pathology. Electroneuromyography (ENMG) demonstrated acute denervation of EPL, EPB, and APL, with pathological neurography of the PIN distal to the supinator canal. After 8 months of conservative treatment with hand therapy and no functional improvement, surgical decompression of the PIN in the supinator tunnel was performed. First signs of reinnervation appeared at 6 weeks, with full thumb ROM at 3 months.

One year later, following a flu-like illness, the patient developed progressive recurrence of thumb extension and abduction weakness, leading to complete paralysis within 6 months. Hand therapy failed. Sonography suggested possible compression, prompting surgical re-exploration. Intraoperatively, an hourglass deformity of the PIN distal to the supinator canal was identified. Given the nerve’s poor appearance and uncertain prognosis, a distal nerve transfer was performed: the distal anterior interosseous nerve (AIN) was coapted to the distal PIN through a dorsal approach via membrana interossea dissection, selectively reinnervating APL, EPB, and EPL.

Results:
At 9 months postoperatively, the patient achieved full extension of the thumb at the CMC, MCP, and IP joints. Strength remains at M3. No complications were observed.

Conclusion:
This case illustrates the potential for recurrence of spontaneous distal PIN palsy due to neuralgic amyotrophy, supported by post-viral onset and hourglass deformity findings. A combination of decompression and selective distal nerve transfers provided a favorable functional outcome and represents a viable surgical strategy in recurrent cases with limited regenerative potential.

Introduction

Brachial plexus injuries (BPI) are associated with severe functional impairments of the affected limb, despite the availability of different treatment options. The incidence of these injuries is increasing among elderly individuals, likely due to a more active aging population; however, the underlying biology often remains unforgiving. The objective of this study was to assess which treatment strategies are most appropriate for patients aged >50 years with traumatic BPI.

Materials and Methods

In this retrospective analysis we evaluated patient data extracted from the electronical clinical records. We included consecutive patients with a traumatic BPI, aged >50 years, that were treated at our institution either operatively or conservatively. All cases exist in the period from September 2007 to January 2024. Patients with BPI other than trauma and < 50 years were excluded.

Results

The study included 10 patients, of which 9 were males. with a median age at time of injury of 63 (range 52-76 years). In 8 cases the BPI was due to polytrauma. This included 3 motorbike accidents, 2 ski injuries, 1 bike accident, 1 car accident and 1 non specified polytrauma. The remaining 2 cases were isolated traumatic BPI due to either fall or bike injury. C5-C6 segments were involved in 6 cases, 2 of which also affecting C7, 1 patient had distal BPI (C7-Th1), 3 patients a complete BPI. The right side was affected in 60% cases. Operative treatment was performed in 9 cases, median time from injury to first surgery 31.4 weeks (range 17-42.4). Of the 9 cases, 6 nerve transfers, 2 nerve reconstructions and one neurolysis were performed. Seven of these patients underwent a 2nd operation with a muscle transfer in 5 cases, neurolysis in 1 case and implantation of a pain electrode in 1 case. Two patients underwent a third surgery - 1 tendon transfer and 1 implantation of pain electrode. 50% patients suffered from persistent pain at last follow up. Only one patient benefited from the chosen surgical treatment. Nevertheless, 70% patients were satisfied and perform daily life activities with aids and trick movements to overcome the BPI consequences.

Discussion

Traumatic BPI in the elderly population is a challenging condition and the available operative options may not be of benefit for these patients. Despite the rather moderate results, an individual decision for surgery according to the needs and not just the age should be evaluated.

Introduction

High ulnar nerve injury commonly leads to severe intrinsic hand muscle weakness and sensory deficits in the ulnar digits. In 2018, Bertelli described a novel nerve transfer technique utilizing the motor branch of the opponens pollicis (OPB) to reinnervate the terminal division of the deep branch of the ulnar nerve (TDDBUN) with the goal of restoring key pinch. In this case series we report our preliminary experience with this technique in four patients who presented with intrinsic denervation following high ulnar nerve injury.

Methods

Four patients with confirmed proximal ulnar nerve injury were treated in our center, three of them were due to iatrogenic nerve injury following upper extremity surgery. Diagnosis was made by nerve imaging, electroneuromyography, and clinical examination, demonstrating loss of intrinsic function with a positive Froment sign and claw hand deformity. All patients underwent nerve transfer surgery in which, among others, the OPB motor branch was connected to the TDDBUN in the first commissure. Mean postoperative follow-up for all patients was 6 (2-12) months.

Results

Three patients were operated in 2024 and one in early 2025. Follow-up evaluations for the first patients demonstrated early functional recovery, with increasing function of the 1^st interosseus and adductor pollicis muscles. Key pinch strength reached 47% (44-50) compared to the contralateral side in 3 patients at a mean follow up of 8 (3-12) months. The fourth patient was recently seen for her first follow-up 6 weeks after surgery and did not yet show measurable improvement. Notably, all patients reported subjective improvement in pain symptoms. Thumb opposition was strong and reached Kappandji 10 in all patients.

Conclusion

While longer follow-up and larger case series are required to draw definitive conclusions, our initial findings support the efficacy of the OPB-to-TDDBUN nerve transfer to restore key pinch function following high ulnar nerve injuries without significant donor morbidity.

Background:
Tendon transfers are the traditional approach for restoring function in radial nerve palsy, but they disrupt native biomechanics and limit functional refinement. Nerve transfers provide a physiological alternative that preserves joint mechanics and enables selective muscle reinnervation. This study presents the clinical outcomes of nerve transfers in patients with radial nerve palsy.

Methods:
A prospective case series included six patients (aged 25–52 years) with radial nerve palsy, presenting 3 to 8 months post-injury. The following nerve transfers were performed: (1) distal branch of the pronator teres to the extensor carpi radialis brevis (ECRB), (2) branch to the flexor carpi radialis (FCR) to the posterior interosseous nerve (PIN), and (3) distal anterior interosseous nerve (AIN) branch to the pronator quadratus to the distal PIN for selective reinnervation of APL, EPB, and EPL. Patients were followed for 15 months. Outcome measures included wrist, finger and thumb extension MRC grading, range of motion (ROM), donor site morbidity, and complications.

Results:
All six patients regained active wrist extension, with a mean wrist extension of 62° and MRC grade 4 strength. Full finger extension with the wrist extended was achieved in all cases (MRC 4). Thumb extension at the CMC and IP joints was complete in all patients. At the MCP joint, three patients achieved full extension, while three showed an extension lag of 25°. No loss of donor function was observed; pronation and wrist flexion strength remained unchanged compared to preoperative status while no surgical complications occurred. 

Conclusion:
Distal nerve transfers offer reliable restoration of wrist, finger, and thumb extension in radial nerve palsy, with high functional recovery and preservation of donor site strength. These preliminary results support nerve transfers as a safe and effective alternative to tendon-based reconstruction. The study is ongoing, and larger case series as well as controlled comparisons with outcomes following tendon transfers are needed to further validate these findings.

Introduction

Spasticity has been shown to negatively influence quality of life by restricting arm function, hindering self-care, causing pain, pressure sores and arthrosis. Personal care is often difficult, time-consuming, painful and place a significant burden on caregivers.

Surgical interventions on the spastic upper limb aim to provide lasting correction of the deformities, thereby improving functional ability and facilitating activities of daily life such as hygiene and dressing.

The aim of this study was to evaluate the impact of upper limb spasticity-correcting surgery using a comprehensive mixed-methods approach to gain deeper insights into the personal experiences of both patients and caregivers. 

Methods

Qualitative semi-structured interviews were conducted 2.8 years (range 1-6 years) after surgery with nine caregivers and six patients. In addition, quantitative data were collected preoperatively and at 6 and 12 months postoperatively. This included the Arm Activity Measure (ARMA) score, resting limb posture, active and passive range of motion (AROM and PROM) of shoulder, elbow, wrist, fingers, and the thumb, as well as the House Functional Classification, which assesses the level of functional use of the upper extremity.

Results

The ARMA score improved from 12 preoperatively to 4.8 at 12-months follow-up, while hand function assessed by House score increased from 0.8 (does not use) to 2.4 (faire passive assist). The resting posture improved across all assessed joints with elbow position improving from 110° to 43° flexion and wrist position from 47° flexion to 12° extension.

Qualitative data analysis corroborated these findings: both patients and caregivers reported easier personal care and dressing due to the improved limb position, as well as enhanced psychological well-being and satisfaction with the arm’s appearance: the more natural and relaxed appearance of the limb helped patients feel more confident and accepted in social interactions.

Conclusion

All participants, both patients and caregivers, experienced improvements in their everyday lives after spasticity-correcting surgery. The improved posture not only influences function but also psychological factors, leading to improved quality of life.

Aim: To develop and validate two machine learning models for predicting pain and hand function one year after thumb carpometacarpal (CMC) joint implant arthroplasty.

Methods: We analyzed data from 377 patients who received a Touch® prosthesis (KeriMedical, Switzerland) between 2018 and 2024 and were prospectively documented in a clinical registry. Two models predicted pain during daily activities (Numeric Rating Scale [NRS], 0-10) and hand function (brief Michigan Hand Questionnaire [MHQ], 0-100) one year postoperatively. Extreme gradient boosting (XGBoost) was used with 23 clinical, radiographic, and patient-reported baseline variables. Models were trained with repeated cross-validation, tested on a held-out set, and evaluated using mean absolute error (MAE) and root mean squared error (RMSE). To quantify individual uncertainty, 80% prediction intervals (PI) were computed. SHAP (SHapley Additive exPlanations) values identified key predictors and their directional influence on outcomes. A dashboard was developed to visualize individual predictions along with prediction intervals and bootstrapped distributions.

Results: The pain model achieved a bootstrapped MAE of 1.49 (95% CI: 1.45-1.54) and RMSE 2.24 (95% CI: 2.15-2.32), with predictions typically within 1.5-2 points of observed pain scores on the 0-10 NRS. SHAP analysis showed that better baseline health (EQ-5D-5L and EQ-5D-VAS), greater belief in treatment success, younger age, stronger grip strength, and lower baseline pain levels predicted lower residual pain.

The function model reached a bootstrapped MAE of 12.44 (95% CI: 12.13–12.77) and RMSE of 17.27 (95% CI: 16.62–17.98). Patients with better baseline function (higher brief MHQ scores), stronger grip, better health (EQ-5D-5L), more thumb mobility, greater surgeon experience, and younger age were more likely to regain better hand function.

Conclusion: We present interpretable machine learning models for individualized one-year outcome predictions after thumb CMC arthroplasty, including predictive uncertainty (Figure 1). These tools may support more realistic counseling and shared decision-making.

Funding: None

Conflicts of interest: Daniel B. Herren and Stephan Schindele have speaker contracts with KeriMedical. Other studies conducted at our clinic are funded by KeriMedical.

Aim: The aim was to perform a cost-utility analysis comparing thumb carpometacarpal (CMC) implant arthroplasty with resection-suspension-interposition arthroplasty (RSIA) during one year after surgery. We hypothesized that thumb CMC implant arthroplasty would be more cost-effective than RSIA, with an ICER below the Swiss threshold of CHF 100,000 per quality-adjusted life year (QALY).

Methods: In this prospective clinical trial, 80 working patients with thumb CMC osteoarthritis who underwent implant arthroplasty (Touch®) were included. Data were compared to 39 working patients from a previous study who received RSIA. Quality of life (EQ-5D-5L questionnaire), direct medical costs and productivity loss were measured for up to one year after surgery. The ICER was calculated to assess the costs per QALY. Sensitivity analyses were conducted for a 5-year extrapolation, including the higher risk of revision surgery for implant patients and outcomes for non-working patients.

Results: One year after surgery, the implant group had a significantly higher quality of life (0.89 vs. 0.85 QALYs) and lower total costs (CHF 24'372 vs. CHF 30'866) compared to RSIA. Despite CHF 2'397 higher medical costs, implant arthroplasty was associated with CHF 8'892 lower productivity costs (Figure 1). The resulting negative ICER indicates implant arthroplasty is more cost-effective, with ≥99% probability of being cost-effective, even accounting for higher revision risks and non-working patients.

Conclusion: Implant arthroplasty results in higher quality of life and lower overall costs than RSIA over one year. Despite higher direct medical costs, it is more cost-effective due to faster return to work and reduced productivity loss. Sensitivity analyses confirmed implant arthroplasty’s cost-effectiveness over five years, even with higher revision risks and a larger proportion of non-working patients.

Aim: The aim of this study was to (1) determine the learning curve for thumb carpometacarpal (CMC) implant arthroplasty and estimate the number of cases required for proficiency; (2) assess whether surgical experience influences the number of cases required to reach proficiency and (3) compare 2-year outcomes and revision rates between patients treated before and after the learning curve plateau.

Methods: Data of 338 patients who received a Touch® prosthesis (KeriMedical) and who were prospectively documented in a registry were used. We included all operations performed by two highly experienced hand surgeons (A, B) and one less experienced specialist (C). The primary outcome measure was the number of surgeries required to achieve surgical proficiency, using the cumulative sum (CUSUM) method. In this method, surgery time and intraoperative radiographic exposure time are used as proxies for calculating the learning curve.

Results: Surgery and intraoperative radiographic exposure times decreased for all surgeons as the number of cases increased. The resulting learning curve showed that surgical proficiency was achieved at case 33 for surgeon A and B, and case 40 for surgeon C (Figure 1). Mean surgery times were 39±8min, 43±7min and 59±19 min, respectively, and radiographic exposure times were 25±19s, 57±25s and 97±46s. Two-year outcomes and revision rates were not worse for patients who underwent surgery before achieving proficiency.  The most frequent reason for revision was cup loosening. This stems from various factors beyond the technical learning curve. With increasing experience, broader indications led to selecting more challenging cases with bone deficiency and difficult soft tissue conditions. This increases the risk of intraoperative complications and less favourable postoperative outcomes.

Conclusion: Our findings indicate a considerable learning curve for TMJ implant arthroplasty, with experienced surgeons achieving proficiency more quickly. Although outcomes before reaching the learning curve did not differ from those operated on later, we recommend comprehensive training when introducing this procedure and a high case volume to improve surgical skills.

Aim: The safety and efficacy of thumb carpometacarpal (CMC) implant arthroplasty in older patients remains uncertain, particularly due to the potential impact of osteoporosis on implant integration. The aim of this study was to investigate whether outcomes at one year post-surgery are comparable in patients over 80 years of age compared to those aged 60–70 years.

Methods: This prospective registry-based study included patients who underwent thumb CMC implant arthroplasty (Touch®, KeriMedical, Switzerland). The one-year outcomes of patients aged ≥80 years (older group) were compared to those of patients aged 60–70 years (younger group). The primary outcome was pain during daily activities, measured on a 0–10 Numeric Rating Scale. Secondary outcomes included the brief Michigan Hand Outcomes Questionnaire (brief MHQ, 0–100), key pinch strength, and complications. Differences between the two groups were analyzed using the Mann-Whitney U test.

Results: Eighteen patients aged 80–86 years and 175 patients aged 60–70 years were included. Preoperative pain scores were 6.9 (SD 2.1) for older and 7.1 (SD 1.8) for younger patients (p=0.88). At one year, pain decreased significantly to 1.3 (SD 1.8) in the older and 1.5 (SD 1.8) in the younger group, with no significant difference between the two groups (p=0.46, Figure 1). One-year brief MHQ scores were 80 (SD 20) for older patients and 86 (SD 17) for younger patients (p=0.27). Key pinch strength was 6.3kg (SD 2.2) in older and 6.7kg (SD 1.9) in younger patients (p=0.37). Intra- and postoperative complications such as trapezium fractures or implant loosening were absent in patients over 80 years.

Conclusion: No significant differences in pain, hand function, or key pinch strength were found between patients aged ≥80 and 60–70 years at one year, with no complications in the older group. Although the sample size was small, the results suggest that thumb CMC implant arthroplasty is a safe and effective treatment for patients over 80 years when surgical indications are met.

Introduction / Purpose of the Study
Trapeziectomy has long been the standard treatment for carpometacarpal I (CMC I) osteoarthritis. In recent years, joint prostheses have emerged as alternatives, potentially enabling faster recovery and earlier return to work. This study aimed to compare postoperative rehabilitation time, total treatment costs, and work absenteeism between prosthetic arthroplasty and trapeziectomy. A secondary objective was to evaluate overall cost-effectiveness, including indirect costs due to sick leave.

Materials and Methods
This retrospective single-center study included 213 patients who underwent prosthetic CMC I arthroplasty for primary osteoarthritis between January 2021 and December 2024. The mean age was 62 years, with an average follow-up of 18 months. Data collected included duration of sick leave, number of postoperative physiotherapy or occupational therapy sessions, direct treatment costs (surgery, implant, rehabilitation), and estimated indirect costs based on average daily wage. Results were compared to published data on trapeziectomy. Statistical analysis used the Mann–Whitney U test with p < 0.05.

Results
Patients with a prosthesis returned to work significantly earlier than those treated with trapeziectomy (Average: 48 vs. 123 days, p < 0.001). They also required fewer therapy sessions (Average: 9 Sessions vs. 35 Sessions, p < 0.001). Although direct costs were higher in the prosthesis group, the overall economic burden was lower due to shorter work absence.

Discussion and Conclusion
Prosthetic arthroplasty offers faster recovery and lower indirect costs compared to trapeziectomy, despite higher surgical expenses. These findings suggest a favorable cost-benefit profile for the prosthesis, particularly in working-age patients. Surgical decision-making should consider not only clinical but also socioeconomic factors.

Clinical Relevance
Choice of surgical technique impacts both patient outcomes and societal costs. A prosthesis may represent a valuable alternative in patients with high functional demands or early return-to-work goals.

Introduction

Scaphometacarpal impingement is one of the reasons for unsatisfying results after trapeziectomy. However, it remains unclear, why thumb subsidence after trapeziectomy occurs in some cases. A recent study recommended tendon-interposition and -suspension arthroplasty for revision in this situation, risking again instability and impingement. Other surgical options include implant arthroplasty and arthrodesis. We suppose that achieving stability with fusion of the first metacarpal base to the second metacarpal may be favorable in some cases.

Methods

Retrospective, multi-center case series of 8 cases undergoing fusion of the first to the second metacarpal since 2000. We reviewed surgical technique and follow-up with fusion or revision surgery. Patient satisfaction was rated as good, fair or poor according to the clinical records.

Results

Stable bony fusion was achieved in 6 cases at 3 months follow-up. Two cases needed revision arthrodesis with stable bony fusion at final follow-up. Bone graft from iliac crest was used in all cases, while fixation included k-wires, (cannulated) screws, plates or a combination of those.

Conclusion

Fusion of the base of the first to the second metacarpal bone should be considered in cases with failed revision suspension arthroplasty on either side or as initial revision surgery after failed trapeziectomy in patients with manual work. Temporary transfixation of the first to the second metacarpal shaft reduces the lever arm on the arthrodesis site, enhances stability and may promote fusion.

Introduction

Chronic distal radioulnar joint (DRUJ) instability impairs wrist kinematics, leading to a highly disabling condition and degenerative lesions. Numerous reconstructive techniques have been described either intra-articular, extra-articular or both. Recent literature has focused attention on the distal interosseous membrane (DIOM) and its contribution to DRUJ stability in all forearm position in addition to the TFCC.
Here, we describe a new ligament reconstruction of the DIOM to treat chronic DRUJ instability and report the results of a series of four cases.

Material and methods

We operated four patients who had chronic post-traumatic DRUJ instability. Preoperative clinical evaluation confirmed the instability, associated with painful pronosupination and a grip strength weakness (48 to 60% compared to the contralateral side). Arthrogram excluded arthritis in the DRUJ and TFCC lesion.
We use a free palmaris longus (or extensor carpi radialis brevis slip) graft to reconstruct the DIOM and the DOB. The ligamentoplasty is located 15% of the length of the ulna from the ulnar head, midway between the radial and ulnar insertions of the DOB. The graft is passed through two tunnels, a bicortical posteroanterior ulnar tunnel and a 15° oblique transverse blind radial tunnel.

Results

All patients were reviewed one year after the surgery. DRUJ instability was systematically resolved. All patients were painless during pronosupination. Grip strength improved from 85 to 90% relative to the contralateral side. There was no difference in flexion–extension and pronation. Supination was reduced by 10 to 20°. All patients were able to resume working in the same occupation at a mean time of 4 months. Postoperative axial CT scans confirmed joint congruence restoration in pronation and supination.

Discussion
Longitudinal axis of the reconstruction mechanically provide the best possible support against posterior-anterior instability. We believe that having an exact graft length avoids overtensioning the graft and allows easier control over the tension of the reconstructed ligament. Using interference screw reinforces the strength of the ligamentoplasty.

Conclusion
This surgical reconstruction of the DOB may offer an alternative technique, allowing it to be purely extra-articular, thus reducing stiffening of the radiocarpal and ulnocarpal joints. It appears to be technically simple and effective procedure to contend posterior-anterior ulnar head instability.

Introduction/Purpose of the study/Hypothesis

A palmar dislocation of the distal radioulnar joint (DRUJ), which is also fractured and misaligned locked, is a rare injury that can be overlooked at initial presentation. Based on current literature and a personal case, this rare injury is highlighted.

Material and method

This case report presents a 23-year-old man with a three-month-old, volar locked fracture dislocation of the DRUJ resulting from a fall down stairs, which was initially overlooked. A complex open reconstruction of the DRUJ was performed to restore the function of the injured forearm and wrist. Postoperatively, the patient was immobilized for several weeks using an upper arm cast and the patient received accompanying hand therapy.

Results

The patient's follow-up examination 12 months postoperatively showed pain at rest with a score of 0 (VAS 0–10), pain with load with a score of 1 (VAS 0–10), a relative grip strength compared to the unaffected side of 98%, a relative range of motion of the wrist compared to the uninjured side of 71%, a DASH score of 10 points, a Mayo Modified Wrist Score of 80 points as well as a Krimmer Wrist Score of 80 points. No complications occurred, and the patient was able to return to his original job and his martial arts activities.

Discussion and conclusion, clinical relevance

Persistent wrist movement limitations after trauma, even with a seemingly correct x-ray, may indicate a serious injury to the DRUJ. Careful planning of a complex reconstructive surgery and the necessary follow-up care should be undertaken to achieve a satisfactory outcome for patients with an initially overlooked DRUJ dislocation.

The operative treatment of thumb carpometacarpal osteoarthritis has recently undergone a paradigm shift due to excellent early results of CMC-I prosthesis. However, with limited long-term outcomes beyond 10 years and challenges faced by earlier implants generations, careful consideration of their indications remains essential. This study presents the experiences of a teaching hospital’s hand surgery team over the first 5 years of implanting Touch® type CMC-I prosthesis, focusing on challenges and complications as “lessons learned”.

In our clinic, all patients who received a CMC-I prosthesis from 2019 to 2025 were identified. 182 cases were reviewed, involving 134 women, 48 men (average age 62y, range: 40-80y). Indications inculuded rhizarthrosis stages 2 or 3. Procedures were mainly outpatient under axillary plexus anaesthesia. Surgical technique involved: dorsal access between EPL and EPB, dorsal capsule resection, circumferential release of the MC I base, removal of trapezial osteophytes and radiologically guided cup drilling. Most cases involved a conical cup and a 15° angled neck. Postoperative care included rigid splinting for a week, followed by standardised therapy with a Comfort Cool brace and mobilisation, and initiation of load-bearing after 6 weeks, if X-ray controls were unremarkable. Beyond strength and mobility measurements, perioperative and postoperative complications and challenges were recorded. The analysis focuses on "lessons learned" rather than classic CROMs.

Complications occurred in 25.2% (46/182) of the cases. Revision surgery was required in 9.3% (17 patients). Issues included trapezium fractures (3) and dislocations due to incorrect cup placement (5). 4 cases needed a repositioning, while 2 required conversion to RSI arthroplasty. Tendinitis was observed in 22 cases, degeneration of the STT joint in 6 and MCP joint in 3 cases, respectively. Other complications included heterotopic ossifications (3), implant failure including polyethylene fracture (1) and neuropathic pain (8). While most were managed conservatively, some required surgical revision such as a 1st extensor compartment release, MCP joint arthrodesis, reoperation or neurolysis.

Results from the first five years of implanting CMC-I prothesis align with existing literature. We highlight challenges and the surgeon’s progression to guide less experienced colleagues in anticipating and avoiding issues or complications.