Faculty Bibliography

BACKGROUND:Both endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) are effective surgical treatments for carpal tunnel syndrome. Prior studies suggest that ECTR may facilitate faster early recovery and return to both work and activity; however, comparative outcomes among patients with varying occupational and recreational hand demands remain incompletely characterized. METHODS:A prospective comparative study was conducted in 125 patients undergoing carpal tunnel release, including 70 ECTR and 55 OCTR procedures. Primary outcomes included changes in Quick Disabilities of the Arm, Shoulder, and Hand scores, time to return to activities of daily living (ADLs), work, and recreational activities. Subgroup analyses were performed according to occupational and recreational hand-demand levels. RESULTS: = .0004). CONCLUSIONS:Endoscopic carpal tunnel release was associated with improved early functional recovery and earlier return to high hand-demand occupational and recreational activities compared with OCTR. Although overall return to ADLs and work was similar between groups, ECTR may provide clinically meaningful benefits for patients with physically demanding lifestyles.

BACKGROUND:The purpose of this study is to compare outcomes in patients with isolated unrepairable scapholunate (SL) injuries treated with the reduction and association of the scaphoid and lunate (RASL) screw technique versus suture anchors with an internal brace (IB). METHODS:Patients treated with either the RASL screw or IB technique for a complete, nonrepairable SL injury were identified. Radiographic and clinical data were recorded preoperatively, immediate postoperatively, and at final follow-up. Patients were then contacted via telephone survey, and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) questionnaire was administered. Patients with less than 6 months of follow-up were excluded. RESULTS:Twenty-five patients (19 men, 6 women) with an average age of 43 (range = 23-66) years were identified (RASL = 14 and IB = 11). There were no differences between groups in radiographic parameters or range of motion at final follow-up, except for a smaller SL gap at final follow-up in RASL patients (1.5 vs 2.4 mm, P = .03). Four patients in the RASL (29%) group required additional procedures for screw removal secondary to screw breakage (n = 1) or screw migration/loosening (n = 3). One patient in the IB group had complete failure/diastasis postoperatively, and 36% (4/11) of patients had osteolysis at final follow-up. At final follow-up, qDASH was 26 versus 31 in the IB versus RASL groups (P = .79). CONCLUSIONS:Both RASL and IB have similar postoperative outcomes when treating SL injuries. It is important to note complications of screw breakage/loosening associated with RASL and recurrent diastasis/gapping and high rate of osteolysis with IB, although this has an unknown clinical significance.

Conductive hydrogels have emerged as promising materials for soft tissue interfacing by combining tissue-like mechanical compliance with electrical conductivity, thereby enabling improved electrical communication with electroactive biological tissues. This work presents an electroconductive composite hydrogel fabricated via light-based vat-polymerization by integrating a choline-based bio-ionic liquid (IL) with gelatin methacryloyl (GelMA). The resulting hydrogels demonstrate tunable conductivity, structural integrity, and high print fidelity when fabricated using digital light processing (DLP) light-based 3D printing. Electrical conductivity was optimized at 20% v/v IL concentration, with the hydrogels demonstrating stable performance for over 28 days. A food-grade photoabsorber was integrated into the formulation to improve DLP resolution and was effectively removed after printing process. The hydrogels supported the human mesenchymal stem cells' viability and proliferation, confirming their cytocompatibility. They also promoted enhanced maturation of primary neurons, demonstrating a supportive microenvironment for neural cells. In vivo implantation of indocyanine green-loaded hydrogels exhibited sustained stability and robust retention of signal over a period of 4 weeks, with histological analysis indicating seamless integration with surrounding tissues. Impedance spectroscopy at both gut and spinal cord interfaces illustrated that GelMA/IL composites achieved the lowest impedance across a range of frequencies, outperforming both GelMA-only and tissue-only conditions. Collectively, these findings position light-based vat-polymerized electroconductive composites as a promising platform for the development of anatomically conformal materials tailored for soft tissue interfacing.

BACKGROUND:Chronic postamputation pain is frequently caused by symptomatic neuroma formation. Advanced nerve interface procedures, including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), were developed to enhance prosthetic control and have been shown to reduce phantom and residual limb pain. However, data regarding how surgical timing relates to postoperative complications and reoperations remain limited. This study evaluated postoperative outcomes after acute and delayed TMR/RPNI in upper-extremity amputees. METHODS:We retrospectively analyzed 48 upper-extremity amputations in 42 patients who underwent TMR and/or RPNI. Procedures were classified as acute (prophylactic) or delayed (symptomatic). Baseline and operative variables were analyzed using Mann-Whitney U and chi-square tests. Multivariable logistic regression was used to evaluate the association between surgical timing and postoperative complications after adjustment. RESULTS:Of 48 limbs, 25 (52.1%) underwent acute and 23 (47.9%) delayed procedures. Baseline characteristics differed in smoking history, amputation etiology, and number of nerves treated. Complication rates were 20.0% and 21.7%, respectively. Wound-related complications occurred predominantly after acute procedures, whereas recurrent neuroma reoperations occurred predominantly after delayed procedures. Unexpected reoperation rates at 1 year were 12.0% and 21.7%, respectively. Mean 1-year pain scores were lower after acute than delayed procedures (2.09 vs 3.70). CONCLUSIONS:Acute and delayed TMR/RPNI had similar complication and reoperation rates, with differing event patterns. Surgical timing was not significantly associated with complications after adjustment, though meaningful differences cannot be excluded due to heterogeneity and limited power. These findings support individualized timing and the need for larger prospective studies including patient-reported outcomes.

BACKGROUND:Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common upper extremity compressive neuropathies. Although often considered isolated conditions, they may occur concomitantly, and the clinical significance of dual compression remains poorly defined. This study evaluated whether concomitant CTS/CuTS represents a distinct clinical subgroup characterized by greater objective motor impairment compared with isolated entrapment syndromes. METHODS:Eighty-six adults evaluated between 2021 and 2025 were prospectively enrolled, including isolated CTS (n = 32), isolated CuTS (n = 26), and concomitant CTS/CuTS (n = 28). Standardized examinations assessed sensory findings and intrinsic motor strength using Medical Research Council grading. Multivariable logistic and ordinal regression analyses identified predictors of decreased intrinsic muscle strength. RESULTS: = .0471). CONCLUSIONS:Concomitant CTS/CuTS is associated with greater baseline intrinsic motor impairment despite similar sensory findings, suggesting that dual-site compression reflects greater motor involvement rather than the incidental coexistence of 2 isolated entrapment syndromes.

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.

Transradial amputation of appropriate length preserves forearm rotation and facilitates prosthetic use; however, high rates of phantom limb pain and neuropathic medication use persist. This case describes a multidisciplinary approach to transradial amputation that integrates targeted muscle reinnervation, regenerative peripheral nerve interfaces, and bone and soft tissue management to optimize pain control and prosthetic success. A 29-year-old man with a severe ballistic injury and complex regional pain syndrome underwent transradial amputation with targeted muscle reinnervation and regenerative peripheral nerve interface. Limb length was preserved in accordance with prosthetic guidelines, and myodesis was performed to improve residual limb stability and myoelectric signal quality. This case highlights how nerve management and prosthetic-informed surgical planning optimizes functional outcomes and quality of life after traumatic transradial amputation.

The upper extremity is a structure of incredible complexity able to perform unique tasks that span from the most delicate and intricate to highly strenuous and forceful. Fully functional and aesthetic replacement of the upper extremity after loss remains a medical and technological aspiration. Meaningful advancements continue to be made in all areas of upper extremity limb loss, specifically in traditional surgical reconstruction and prosthetics. This has generated a new field of treatment that is most accurately titled Bionic Reconstruction. Essentially, successful bionic reconstruction allows for the human body to effectively communicate and work in concert with the man-made technology.

Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.