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The treatment of edema and pain is crucial in hand trauma as it can interfere with rehabilitation. In this study, we have investigated the effectiveness of steroid and mannitol in alleviating edema and pain in patients with multiple metacarpal fractures with their anti-inflammatory and free radical neutralizing effects.

A total of 21 patients who underwent closed reduction and fixation with Kirschner wires for multiple metacarpal bone fractures were enrolled in the study from March 2015 to February 2019. 11 participants were designated to the control group and the other 10 participants to the treatment group. The treatment group was administered with mannitol and dexamethasone for five days, while the control group was treated conventionally. The degree of pain, the time to initiation of the rehabilitation and full grip, and the distance between the fingertip and the distal palmar crease were measured.

Pain was significantly reduced on the 5th postoperative day in the treatment group (2.91 vs 1.80; p=.013, Figure 1). The distance between the fingertip and the distal palmar crease showed a more rapid decrease in the treatment group from the 2nd post-operative week (3.27 vs 1.90; p=.002, Figure 2). The treatment group was able to initiate rehabilitation earlier and achieved faster recovery of full grip (6.73 vs 3.80; p=.002, 42.46 vs 32.70; p=.002, respectively, Table 1).

Administration of steroid and mannitol combination to the patients with multiple metacarpal fractures was helpful in improving the overall outcome of rehabilitation treatment through relieving edema and pain.

Nail plate replacement following nailbed repair is widely performed to splint the eponychial fold and improve nail growth. However, potential increases in infection risk, morbidity and clinic utilisation remain concerns. We evaluated whether routine nail replacement provides meaningful clinical benefit.

A structured synthesis of comparative studies assessing nail plate replacement versus discard or non-operative management following nailbed injury was performed using PubMed and citation chaining. Primary outcomes were early surgical site infection and cosmetic appearance. Secondary outcomes included complications, follow-up burden and functional outcome. Randomised and comparative observational studies in paediatric and adult populations were included.

Six comparative studies, including 689 patients, were analysed, comprising two paediatric randomised trials, two paediatric comparative studies, one adult randomised study and one adult cohort. In the multicentre paediatric randomised trial (n=451), infection was uncommon and not significantly different (2.2% replacement vs 0.9% discard), with equivalent cosmetic scores. A paediatric cohort demonstrated higher complication rates with replacement (17.6% vs 5%) and increased clinic visits. Adult studies showed no meaningful differences in pain, function or cosmesis, and non-operative management did not increase nail deformity risk. Across studies, replacement showed no consistent benefit and trended toward higher treatment burden.

Current comparative evidence does not support routine nail plate replacement following nail bed repair. Cosmetic and functional outcomes are equivalent, while complications and healthcare utilisation may increase. A selective rather than routine replacement strategy is justified and supports standardisation of hand trauma care pathways.

Small soft tissue defects of the fingers without involvement of the fingertips can be covered in various ways. In recent years, many publications have favored the SCIP flap for this indication because it can be raised very thinly and the donor site defect is small. However, the small SCIP flap is not easy to raise because the perforators must be precisely centered within the flap. In our search for alternatives, we came across the free flaps that involve the interosseous arteries of the forearm: the anterior and posterior interosseous flap.

We report on 9 cases of soft tissue damage to the fingers that were covered with free anterior and posterior interosseous flaps. The soft tissue damage affected different fingers, was predominantly located dorsally, and was a maximum of 7 cm long and 3-4 cm wide. In one case, a chimeric flap was used.

In all 9 cases the soft tissue defects were successfully treated. All flaps survived 100% of the time. In one case, secondary flap reshaping was necessary. There were absolutely no complications at the donor sites.

Although the SCIP flap is an excellent flap for reconstructing defects of the hand, it remains a high-risk flap for defects of the fingers. Arterialized venous flaps are not always without problems. The free microvascular anterior interosseous flap and the free posterior interosseous flap are reliable alternatives for this indication and are our first choice over the SCIP flap.

Hand injuries account for 19-23% of trauma related injuries that present to the Emergency Department (ED) in the UK. Responsibility for their management varies between institutions commonly falling into either Orthopaedic or Plastic Surgery services. Effective management relies on clinicians understanding the local service capabilities. This study assessed the awareness of ED and Orthopaedic clinicians regarding appropriate referral pathways for specific hand injuries.

A cross-sectional survey was conducted involving clinicians across ED and Orthopaedic departments. Using a consultant-validated questionnaire, participants identified whether specific hand injuries should be managed locally by Orthopaedics or referred to Plastic Surgery at a tertiary centre.

Out of the total participants 58% were Orthopaedic clinicians and 42% were ED clinicians. Accuracy was 100% for common injuries such as burns on the hand, dislocations of the hand, carpal bone fractures and dislocations. Accuracy declined for more complex conditions: 88% for mallet injury, 85% for amputations requiring replantation, 82% for nail bed injuries, 76% for flexor tendon infections, 67% for extensor tendon injuries, 64% for avascular digits, 61% for ring avulsions, 55% for digital nerve injuries, 48% for flexor tendon injuries and 33% for amputations that do not need replantation. Average accuracy was 82% among Orthopaedic clinicians and 69% among ED clinicians.

Clinicians demonstrated strong knowledge of the referral pathway in common hand injuries. There was reduced accuracy for more complex and time-critical injuries, especially amongst ED clinicians. This study demonstrated that we need targeted education and clearer referral guidance to optimise patient care.

This study aims to describe the reconstructive approach for a patient in his 70s with Parkinson’s Disease, who presented following a circular saw injury to the 2nd web space of his left hand. A significant soft tissue defect was noted on the radial aspect of his middle finger, and XR revealed a 2nd metacarpal shaft fracture with segmental bone loss of 2.5cm.

Intraoperatively, the wound was evaluated and the following injuries were noted:
Left index finger –
30% loss of: ulnar side MC head
50% cut of: FDP, FDS
100% cut of: extensor tendon at zone 5, ulnar NVB
Loss of metacarpal shaft 2.5cm when compared to 3rd MC head

Left middle finger –
100% loss of: radial half of sagittal band, 3rd MCPJ radial collateral ligament, extensor hood, radial half of proximal phalanx and middle phalanx periosteum, PIPJ radial collateral ligament, radial digital neurovascular bundle up to DIPJ

After noting these findings, the decision was made to amputate the left index finger after considering the bone gap (which would require a vascularised bone graft if reconstructing) and the low likelihood of functional outcome following reconstruction. A heterodigital neurovascular island flap was raised from the radial digital neurovascular bundle of the index finger to reconstruct the collateral ligament loss from the middle finger with the collateral ligament and extensor hood of the index finger (Figure 1). Furthermore, RDN of index finger was coapted to RDN of middle finger at the level of DIPJ to ensure a neurotised flap.

Surgery time was 121 minutes. The patient was discharged within 24 hours of the operation with hand therapy outpatient follow up. Within 2 months, patient regained function to return to part time DIY work and food preparation, with minimal motor and sensory deficit.

We describe a novel vascularised, neurotised collateral ligament reconstruction with a heterodigital fillet flap following soft tissue injury.

The incidence of hand injuries in England was 110 injuries per 100,000 population between 2014- 2015, with tendon injuries accounting for 18% of cases. The British Society for Surgery of the Hand (BSSH) recommends primary repair within four days to minimise adhesion formation and facilitate early mobilisation. This closed loop audit assessed compliance against this standard within the Trauma and Orthopaedic department at Doncaster Royal Infirmary (DRI).

A retrospective audit was conducted on all primary repairs of flexor and extensor tendon injuries of the hand between 1/3/2024 to 31/5/2024 at DRI. Time from injury to surgery was recorded and cases with delayed presentation were excluded. Following the first audit cycle, departmental education on BSSH guidelines was implemented then a re-audit was performed using the same methodology.

Initial compliance with BSSH standards was 56%. This cohort had a mean age of 38 years, and all were male. After education within the department compliance improved to 83%. In the second cycle mean patient age was 35 years, with 83% male and 17% female.

Department-wide education resulted in considerable improvement in our compliance to the BSSH standards by 27%. This closed loop audit contributed to reducing delays in the department and improving patient care whilst highlighting the importance of continued departmental education.

Rhizarthrosis is a common pathology affecting up to 10% of middle-aged women. This condition is a major cause of loss of function and pain in older populations. When conservative treatment fails, carpo-metacarpal arthroplasty is a validated treatment.
In this paper, we present two cases of persistent pain after arthroplasty with a Touch Kerri Medical prosthesis, completely relieved by replacing a 15° angled neck size M with a straight neck size S, combined with an opening of the first extensor compartment.
Our hypothesis is that inserting a neck that is too long may be a cause of dissatisfaction and pain.

We present the cases of two patients, aged 54 and 58, who had both benefited from Touch prosthesis arthroplasty with a 15° angled neck, complicated by postoperative pain which limited their return to work and severely disabled them in their activities of daily living.
The first case benefited from a revision 5 months later, under WALANT, during which the neck was changed and the first extensor compartment was sectioned longitudinally.
The second case benefited from a revision at 16 months post operatively, after multidisciplinary treatment had considerably reduced the pain associated with a complex regional pain syndrome, without however enabling a full return to work. The neck was also changed and the first extensor compartment opened.

In both cases, patients were able to resume their full activity at 6 weeks postoperatively, after being immobilized for two weeks in an antebrachial splint extended to the metacarpophalangeal joint, followed by occupational therapy.

Although latest-generation prostheses such as the Touch offer excellent functional results, these cases illustrate the need for critical intraoperative assessment of length/tension ratios to avoid early failure.
Down-sizing the neck (from M to S) restores optimal tension balance, while preserving the intrinsic stability of the dual-mobility prosthesis.
Systematic opening of the first extensor compartment may also play a role in improving results.

This meta-analysis aimed to evaluate and compare the effectiveness of different rehabilitation programs for non-thumb metacarpal fractures, focusing on improvements in hand function, grip strength, and ROM.

A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus from inception to January 2025. Randomized controlled trials (RCTs) and cohort studies evaluating rehabilitation for non-thumb metacarpal fractures were included. Interventions studied included conventional physiotherapy, home-based exercise, gamification, early mobilization, and immobilization techniques (e.g., buddy taping vs. plaster). Data extraction and bias assessments were performed independently by two reviewers. Meta-analyses were conducted using Review Manager 5.4. This study was preregistered with PROSPERO (CRD42024619888).

Five studies (three RCTs, two cohort studies) met the inclusion criteria. Rehabilitation significantly improved hand function (SMD = –1.04, 95% CI: –1.54 to –0.54), grip strength (MD = 21.33, 95% CI: 18.81 to 23.83), and ROM (MD = 23.43, 95% CI: 20.15 to 26.72). Early mobilization and gamification strategies were associated with enhanced functional outcomes and patient adherence.

Structured rehabilitation programs, especially those incorporating early mobilization and digital adherence strategies, are effective in improving outcomes for non-thumb metacarpal fractures. Minimal immobilization approaches such as buddy taping may be suitable for stable fractures.

The Sauvé-Kapandji (SK) procedure is a well-established treatment for distal radioulnar joint (DRUJ) osteoarthritis and instability, but long-term instability of the proximal ulnar stump remains a common cause of pain and functional limitation. Soft-tissue stabilization using an extensor carpi ulnaris (ECU) tendon slip has shown reliable outcomes, though heterotopic ossification or synostosis at the osteotomy site may limit forearm rotation. Pyrolytic carbon implants, valued for their biocompatibility and durability, have proven effective in small joint arthroplasty. We present a modified SK procedure incorporating a PyroDisk implant to maintain the distal ulnar osteotomy gap, combined with ECU tendon stabilization to enhance proximal stump stability.

Between May 2022 and December 2023, three female patients (aged 27–52 years) with symptomatic DRUJ osteoarthritis or instability underwent the modified SK procedure. Two had autoimmune inflammatory arthritis (rheumatoid and juvenile idiopathic arthritis), and one had a prior SK with heterotopic ossification. The procedure involved DRUJ arthrodesis, distal ulnar osteotomy and implantation of a PyroDisk interposed at the osteotomy. A distally based ECU tendon slip was passed through the implant and anchored for dynamic stabilization. Postoperative management included immobilization for 8 weeks, followed by staged rehabilitation with progressive loading under supervision of occupational therapy.

At an average follow-up of 14 months (range 12–19), all patients demonstrated pain relief, improved grip strength, and increased pronation–supination range of motion. Notable rotation gains ranged from 10° to 85°, and grip strength measured by Jamar dynamometer improved up to twofold. Radiographs confirmed maintenance of the osteotomy gap and stable implant positioning, with no signs of infection, implant loosening, or recurrent ossification.

This modified SK technique combining PyroDisk interposition and ECU tendon slip stabilization appears to provide durable pain relief, restored motion, and improved stability of the proximal ulnar stump, while effectively preventing recurrent ossification. The PyroDisk offers a promising solution to maintain the pseudarthrosis and enhance long-term outcomes in complex DRUJ pathology.