Faculty Bibliography

BACKGROUND:Total wrist arthroplasty (TWA) is a motion-preserving alternative to wrist fusion for end-stage wrist arthritis, but concerns regarding long-term durability continue to limit broader use. Reported 10-year survivorship ranges from 70% to 80%, although real-world failure patterns remain poorly defined. METHODS:Adverse events were reviewed for TWA devices submitted to the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database from January 1, 2015, to September 30, 2025. Reports were identified using the wrist arthroplasty device code and confirmed by manufacturer and implant name. Nonwrist devices and duplicate submissions were excluded. Event narratives were manually reviewed and assigned a primary failure mode using a predefined taxonomy. Reports lacking sufficient detail were excluded from analyses. RESULTS:Among 313 unique reports with adequate information, loosening or component migration was the most common failure mode (37%), followed by dislocation or instability (18%) and infection (13%). Less common complications included tendon or nerve injury, polyethylene wear or metallosis, implant fracture, and periprosthetic fracture. Annual failure-mode reports peaked in 2022, with additional clustering in 2018 and 2019. Loosening/migration was most frequent in 2022, whereas dislocation/instability clustered in 2019. Manufacturer-year reporting was mostly by Stryker and Zimmer Biomet, though reports involved all manufacturer groups. CONCLUSIONS:These findings describe submitted adverse events rather than true failure rates and reflect the limitations of passive reporting. Contemporary TWA continues to encounter substantial mechanical and fixation-related complications, highlighting the need for improved implant design, refined technique, and stronger post-market surveillance.

BACKGROUND/UNASSIGNED:Pneumatic tourniquets are routinely used in upper extremity surgery to create a bloodless operative field, often at a standard pressure of 250 mm Hg. However, high pressures may lead to complications, including tissue damage and increased pain. This study investigates whether tailoring tourniquet pressures to individual systolic blood pressure (SBP) can achieve comparable surgical field visualization while reducing inflation pressure. MATERIALS AND METHODS/UNASSIGNED:-tests. RESULTS/UNASSIGNED: = 0.27). Tourniquet adjustments were rare (2.13%, intervention only). CONCLUSION/UNASSIGNED:SBP-based tourniquet pressures effectively maintain surgical field visualization at lower pressures without compromising safety or increasing pain. These findings support wider adoption of this method and warrant further large-scale studies.

Vaccine hesitancy threatens global health by diminishing herd immunity and permitting the return of vaccine-preventable diseases (VPDs) including poliomyelitis, measles and coronavirus disease 2019 (COVID-19). These infections carry short-term and long-term musculoskeletal consequences, such as paralysis, limb deformities, septic or reactive arthritis, osteomyelitis and chronic pain, that place an ever increasing burden on orthopaedic services. This narrative review synthesizes clinical and epidemiological evidence linking sub-optimal immunization to orthopaedic morbidity caused by major VPDs. Outbreak data show that low vaccination coverage precipitates spikes in invasive bacterial disease after varicella, post-polio deformities, tetanus-related fractures, rubella-associated arthritis and COVID-19-related avascular necrosis (AVN). This impact is amplified in rapidly ageing regions such as Asia, where the population ≥ 60 years will nearly double by 2050, significantly increasing the prevalence of sarcopenia and osteoporosis that exacerbate VPD complications. Although orthopaedic surgeons are not primary vaccinators, they routinely manage these downstream effects and hold a trusted position in society from which they are able to strongly advocate for immunization. Integrating brief vaccine counselling, perioperative vaccination checks, and public health initiatives into orthopaedic practice can improve uptake and reduce preventable disability. Strengthening immunization programs and countering hesitancy are essentially critical not only for infection control but also for safeguarding a rapidly declining global musculoskeletal health. A coordinated strategy involving public-health authorities, primary-care providers, and specialists, including orthopaedic surgeons, is essential to mitigate vaccine hesitancy and its orthopaedic sequelae.

Perilunate dislocations and perilunate fracture-dislocations are marked by a wide range of high energy trauma to the wrist. Chronic perilunate injuries are defined by a treatment delay of at least 6 weeks. This systematic review aims to compare the various operative techniques and outcomes for chronic perilunate injuries. A systematic review of literature on chronic perilunate dislocations and perilunate fracture-dislocations were performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis statement guidelines using PubMed, Embase, Scopus, and Web of Science. A total of 326 articles were included, of which ultimately comprised of 13 articles with 158 patients. We demonstrate a rate of 59% perilunate fracture-dislocations, 30% perilunate dislocations, and 11% lunate dislocations. Mechanisms of injury were mostly high energy falls (31%) and motor vehicle accidents (50%). Fifty percent of patients had median nerve symptoms/paresthesias at time of initial presentation. Surgical technique included proximal row carpectomy (34%), open reduction internal fixation (49%), scaphoid excision with four corner fusion (7%), wrist arthrodesis (2%), partial lunate/scaphoid excision (1%), total lunate excision (5%), and isolated carpal tunnel release (1%). Average follow-up of time was 5 years. There was a 28% incidence of radiologic osteoarthritis at final follow-up with only 3 patients undergoing conversion to total wrist arthrodesis. Regardless of surgical technique, patients experienced improved levels of pain with a low reoperation rate, but decreased wrist range of motion and grip strength post-operatively.

BACKGROUND:Corticosteroid injections are a first-line treatment of trigger finger and de Quervain's tenosynovitis. Little research has evaluated preinjection patient-reported outcomes as a predictive factor for treatment success following corticosteroid injection. We hypothesized that patients with less pretreatment impairment would demonstrate greater post-treatment improvement than patients whose function was more severely impaired. METHODS:We retrospectively reviewed prospectively collected Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) scores in patients undergoing corticosteroid injection for trigger finger or de Quervain's tenosynovitis from 2017 to 2023. Independent variables were patient baseline characteristics, comorbidities, and baseline PROMIS UE. The primary outcome was treatment success between 30 days and 12 weeks, defined as achieving the minimal clinically important difference for PROMIS UE without undergoing surgery. RESULTS:= .44). CONCLUSION/CONCLUSIONS:Corticosteroid injection provides meaningful improvement for a subset of trigger finger and de Quervain's tenosynovitis patients. Corticosteroid injection remains a first-line treatment for trigger finger and de Quervain's tenosynovitis patients, especially for those with more severe functional impairment.

Imaging plays an important role in evaluating peripheral nerves. In the preoperative setting, imaging helps overcome pitfalls of electrodiagnostic testing and provides key anatomical information to guide surgical management. In the postoperative setting, imaging also offers key information for treating physicians, although it comes with several challenges due to postsurgical changes and alteration of normal anatomy. This article reviews our approach to peripheral nerve imaging, including how we use imaging in the pre- and postoperative setting for several common indications.

BACKGROUND: While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction. METHODS: A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups. RESULTS: A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%). CONCLUSION/CONCLUSIONS: Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.

BACKGROUND/UNASSIGNED:The needle scope is a less invasive intervention to evaluate carpal pathology. We hypothesize that there is no difference in the evaluation and diagnostic capability of the needle scope versus the conventional wrist arthroscope. METHODS/UNASSIGNED:Twenty patients indicated for wrist arthroscopy were prospectively enrolled. Prior to insertion of the 2.7-mm arthroscope, the needle scope evaluated for synovitis; cartilage damage (location and modified Outerbridge classification); integrity of the volar, scapholunate (SL), and lunotriquetral ligaments; and the triangular fibrocartilage complex (TFCC). Following needle scope evaluation, the surgeon completed a survey regarding the visualization and diagnosis. The 2.7-mm arthroscope was then inserted, and the surgeon completed the second portion of the survey. Statistical analysis was then completed to determine statistical significance. RESULTS/UNASSIGNED:Twelve patients were female (60%), and the mean age was 39.8 years (±11.8 years). Eleven patients underwent arthroscopy for TFCC pathology, 4 patients for SL tearing, and 5 patients for extensive synovitis. There was no difference between the needle scope and wrist arthroscopy diagnosis. There was no difference between radiocarpal and midcarpal visualization. Surgeon-rated ease of use and diagnostic confidence were the same between two groups. The needle scope was better able to visualize the scapho-trapezium-trapezoid and carpometacarpal joints; however, the image was of marginally decreased quality. CONCLUSION/UNASSIGNED:In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. LEVEL OF EVIDENCE/UNASSIGNED:II (prospective cohort study)-Diagnostic.

BACKGROUND/UNASSIGNED:Perilunate dislocations (PLD) and fracture-dislocations (PLFD) comprise a spectrum of high-energy wrist injuries. The purpose of this review was to review operative strategies for perilunate injuries based on approach and compare outcomes. METHODS/UNASSIGNED:A systematic review of literature on PLD and fracture-dislocations was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed and EMBASE databases were queried for literature. Inclusion criteria included English studies reporting clinical or functional outcomes of acute PLD and PLFD. RESULTS/UNASSIGNED:Twenty-nine full-text articles (604 PLD and PLFD injuries) were included. The most common method of PLD and PLFD fixation is through an open approach with combined volar and dorsal exposure. There were no differences between approaches with regard to total arc range of motion, grip strength, Mayo Wrist Score, or mean scapholunate angle. Similarly, there was no difference between approaches and postoperative radiographic arthritis or complications. Most patients were able to return to their prior level of function and work. The incidence of postoperative complications ranged from 0% to 22.5%. CONCLUSION/UNASSIGNED:Current evidence shows no difference in postoperative total wrist arc range of motion, grip strength (as compared to contralateral), or Mayo Wrist Score with regard to surgical approach. The most common method of PLD and PLFD fixation in the literature is through an open approach with combined volar and dorsal exposure. There is a large difference in reported rates of radiographic arthritis, although this finding does not appear to correlate with postoperative pain or disability. LEVEL OF EVIDENCE/UNASSIGNED:I, Systematic Review.