Abstract Traditionally, the procedure for proximal interphalangeal (PIP) joint fusion has been described with an open approach using a dorsalcurvilinear incision. Due to the inherent risk of soft tissue complications with this technique, we propose a percutaneous technique for resecting bone cartilage and achieving a stable fusion angle with two mini-incisions, one lateral and one dorsal. The goal of all arthrodesis techniques is to create a stable joint fusion at the most functional angle for activities of daily living. A small, low speed high torque straight burr was introduced into the joint through a lateral joint line stab incision. The joint space was enlarged with manual traction, and chondral resection was performed under fluoroscopy. The PIP joint was then fused in adequate position with a headless compression screw through a dorsal stab incision. The joints were subsequently dissected to evaluate the degree of resection, the percentage of appropriately prepped joint surface, and any evidence of tissue damage. This study was conducted using 10 cadaver hands and included 39 joints. This study demonstrated that joint preparation and fusion angle can be reproducibly achieved while preserving a non-disrupted soft tissue envelope. Taken together, these findings suggest that the described percutaneous PIP arthrodesis technique has strong potential for achieving favorable clinical outcomes. Minimally invasive percutaneous PIP joint arthrodesis appears to be a feasible alternative technique that offers the advantage of minimal soft tissue disruption while achieving a stable construct for joint fusion.

Abstract The purpose of this investigation was to assess whether the use of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or selective cyclooxygenase-2 (COX-2) inhibitors in the perioperative period is associated with the risk of nonunion after partial wrist fusion. We hypothesized that exposure to nonselective NSAIDs or selective COX-2 inhibitors would not increase the rate of nonunion after partial wrist fusion when compared with control cohorts. The TriNetX U.S. Collaborative database was queried using Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Revision (ICD-10) codes to identify patients aged 18 and older who underwent partial wrist fusion between 2008 and 2023. Patients were stratified according to the chronicity and type of NSAID use, including chronic NSAID use (within 90 days of surgery), acute NSAID use (within 30 days of surgery), perioperative ketorolac (Toradol) use (within 24 hours of surgery), and selective COX-2 inhibitor use (within 30 days of surgery). The cohorts were propensity-matched by age, gender, race, ethnicity, body mass index (BMI; kg/m2), and presence of type 2 diabetes mellitus. The risk of nonunion, defined as the need for revision fusion, conversion to total wrist arthrodesis, or conversion to total wrist arthroplasty, was assessed within the 1-year postoperative period. Chi-square analyses were used to compare the rate of nonunion for each cohort. Statistical significance was determined to be a p-value <0.05. A total of 3,073 patients undergoing partial wrist fusion were identified, of which 2,072 had a documented history of perioperative NSAID use. After 1:1 propensity score matching, the cohorts included 1,148 patients in the chronic NSAID group, 889 in the acute NSAID group, 482 in the Toradol group, and 140 in the COX-2 inhibitor group. The rate of nonunion was significantly higher in patients exposed to NSAIDs within 30 days of surgery (5.96%) compared with the control cohort (3.04%; p = 0.003). However, chronic exposure to NSAIDs or perioperative Toradol was not associated with a higher rate of nonunion (p = 0.17 and p = 0.56, respectively). Additionally, use of selective COX-2 inhibitors versus nonselective COX-2 inhibitors had no significant impact on the rate of nonunion (p = 0.66). Patients exposed to NSAIDs within 30 days of a partial wrist fusion had an increased risk of nonunion when compared with a control cohort. Acute use of NSAIDs may be a risk factor for impaired bone healing after partial wrist fusion, and their use should be carefully considered in high-risk patients.

Abstract Preiser's disease (PD), or idiopathic avascular necrosis of the scaphoid, is a debilitating condition leading to wrist pain, dysfunction, and pan-carpal arthritis. While impaired scaphoid vascularity is central to its pathogenesis, identifying individuals at risk is challenging due to the morphological distortion of the scaphoid as the disease progresses. This study aims to investigate the association between a novel capitate morphology classification, scaphoid morphology, and their impact on PD prevalence and characteristics. We also re-evaluate negative ulnar variance (NUV) as a potential risk factor for PD. This retrospective case–control study included 34 PD patients and 340 age-matched controls. Capitate morphology was classified into Type I/II on anteroposterior (AP) radiographs based on capitotrapezoid–scaphocapitate (CT–SC) joint line angle and ratio. Scaphoid morphology was assessed via the waist index on contralateral healthy wrists. Radiographic measurements of ulnar variance and PD staging were also performed. Statistical analyses compared morphological prevalence and risk factors between groups. Type II capitate was significantly more prevalent in the PD group (35.3%) than in controls (17.1%, p = 0.018). Similarly, NUV was significantly higher in PD patients (29%) compared with controls (6.8%, p < 0.001). We found a strong correlation between Type II capitate and slender (Type II) scaphoid morphology in healthy wrists. No significant differences in age, gender, or affected side were observed. Interobserver and intraobserver agreements for capitate classification were substantial (kappa ≥0.882). Our study introduces a reliable radiographic method for classifying capitate morphology, which strongly correlates with intrinsic scaphoid shape and potential vascular vulnerability. Both Type II capitate morphology and NUV are significant predisposing factors for PD. These findings offer valuable insights for identifying at-risk individuals and improving understanding of PD's multifactorial etiology. Diagnostic Level III.

Abstract Scaphoid nonunion can progress to wrist pain, stiffness and an established pattern of wrist arthritis. The effect of scaphoid malunion on clinical outcomes is largely unknown. In this study, the effect of scaphoid morphology on union rates and clinical outcomes is explored using a prospectively collected database of surgeries. The primary aim of the study is to understand the effect of initial post-surgical scaphoid morphology on union. The secondary aim examines the effect of final scaphoid morphology on long-term functional outcomes among patients that underwent surgical fixation for scaphoid nonunion and ultimately went on to union. 84 participants were included in this study. 74 (88.1%) nonunions went to union, and 10 (11.9%) remained persistent nonunions after surgery. After nonunion surgery, the initial post-operative height-to-length (H/L) ratio was predictive of scaphoid union. For every 0.1 increase in H/L ratio, odds of union were reduced by 53.7%. Of the patients who progressed to union, there was a significant relationship (p=0.019) between initial post-operative H/L ratio and final DASH scores. It was found that there was a 35.9% increase in DASH score for every 0.1 increase in H/L ratio. Similarly, there was a significant relationship (p=0.013) between final post-operative H/L ratio and final DASH scores where an increase of 0.l in H/L ratio translated to a 33.5% increase in DASH. The authors propose that the restoration of initial post-operative H/L ratio can predict odds of union after surgical fixation of an established scaphoid nonunion. Improved morphology at union as measured by H/L ratio also demonstrated improved functional outcomes, such as DASH score.

Wrist fractures account for approximately 18% of all fractures and are especially common in older adults with osteoporosis and in younger patients following high-energy trauma. Predicting healing outcomes in these cases remains clinically challenging due to variability in fracture types, patient-specific factors, and treatment pathways. Although artificial intelligence (AI) systems have already demonstrated diagnostic accuracies exceeding 95% in detecting and classifying wrist fractures on radiographs, their use in prognostic modeling is still emerging. This narrative review examines recent developments in AI-driven approaches aimed at improving clinical prognosis following wrist fractures. Advanced models-such as convolutional neural networks (CNNs), transformers, and hybrid architectures-can identify subtle imaging and clinical features associated with complications like malunion, delayed healing, or nonunion. The integration of multimodal data, including comorbidities, imaging, and even osteogenomic profiles, shows promise in enhancing risk stratification and guiding more personalized follow-up strategies. Emerging technologies such as explainable AI, synthetic data generation, and federated learning offer potential solutions to challenges related to data availability, interpretability, and model generalization across care settings. Despite encouraging results, further validation in real-world clinical environments and standardization of outcome definitions are needed. In summary, AI-based prognostic tools for wrist fractures could support orthopedic decision-making by identifying high-risk patients early, tailoring follow-up protocols, and improving long-term outcomes through more individualized care.

Abstract Dorsal lunate dislocation (DLD) is an exceptionally rare injury, typically resulting from high-energy trauma. Due to the scarcity of reported cases, its exact mechanism of injury is not well understood. This study aimed to present three cases of DLD treated at our institution and to perform a systematic review of the literature to evaluate the mechanisms of injury and treatment approaches for pure DLD. A retrospective review was conducted of three patients with pure DLD treated at a single tertiary care center. Data were collected through medical record analysis and radiographic review. Additionally, a systematic literature review was performed to identify reported cases of DLD. Patient demographics, mechanisms of injury, treatment modalities, and clinical outcomes were analyzed. We identified three cases of DLD, while the systematic review uncovered 17 additional cases. Overall, men represented 95% of cases, with high-energy trauma accounting for 85% of injuries. Forced wrist flexion was the most commonly reported mechanism, occurring in 55% of cases. Radiographic analysis showed concomitant wrist fractures in 55% of cases. Treatment strategies included fixation in 65% of patients, ligament repair in 45%, and lunate resection or proximal row carpectomy in 15%. The median follow-up duration was 12 months, with half of the patients achieving favorable outcomes. Notably, two of the three low-energy injury cases were associated with preexisting arthritis. Pure DLD is an extremely rare clinical entity, possibly resulting from axial loading on a flexed wrist or forced hyperflexion. Characteristic radiographic findings include disruption of Gilula's lines and dorsal displacement of the lunate on lateral radiographs. Optimal management involves initial closed reduction followed by surgical fixation and ligamentous repair when indicated to enhance outcomes and restore wrist function.