Wrist Region Research Articles

Volumetry of Hand and Forearm: A 3D Volumetric Approach.

Swelling and edema of the hand and forearm may occur in various traumatic and degenerative diseases. So far, no precise measurement protocol exists. The objective of this study was to evaluate an examination protocol with relevant regions of interest (ROIs) measured by a 3-dimensional (3D) scanner to achieve precise, reproducible, and objective measurements for an optimized detection of volumes of the hand and forearm. A 3D scan protocol was developed using an Artec, 3D scanner EVA to measure discrete hand volumes of healthy volunteers. Five areas were defined as ROIs, representing volumes of the finger, metacarpus, wrist, hand, and distal forearm. Contralateral limbs were used for volume comparisons and calculation of volume differences. For this study, 12 individuals (58.3% women, 24 hands and forearms) with a mean age of 27.1 ± 3 years were included. Mean volume values for left and right ROIs correlated with each other, with slightly higher volumes for the right upper extremity. Volume differences showed statistically significant results for the finger region (ROI I; P = .009), the metacarpal region (ROI II; P < .001), hand region (ROI IV; P = .001), and forearm region (ROI V; P = .006), with the exception of the wrist region (ROI III; P = .722). Our results demonstrate that this 3D volumetric approach is a reliable and objective tool for measuring volumes and circumferences in hand and forearm. Based on our determined ROIs, further studies are needed to explore the significance for clinical applications.

Infrared Thermal Imaging and Artificial Neural Networks to Screen for Wrist Fractures in Pediatrics

Paediatric wrist fractures are commonly seen injuries at emergency departments. Around 50% of the X-rays taken to identify these injuries indicate no fracture. The aim of this study was to develop a model using infrared thermal imaging (IRTI) data and multilayer perceptron (MLP) neural networks as a screening tool to assist clinicians in deciding which patients require X-ray imaging to diagnose a fracture. Forty participants with wrist injury (19 with a fracture, 21 without, X-ray confirmed), mean age 10.50 years, were included. IRTI of both wrists was performed with the contralateral as reference. The injured wrist region of interest (ROI) was segmented and represented by the means of cells of 10 × 10 pixels. The fifty largest means were selected, the mean temperature of the contralateral ROI was subtracted, and they were expressed by their standard deviation, kurtosis, and interquartile range for MLP processing. Training and test files were created, consisting of randomly split 2/3 and 1/3 of the participants, respectively. To avoid bias of participant inclusion in the two files, the experiments were repeated 100 times, and the MLP outputs were averaged. The model’s sensitivity and specificity were 84.2% and 71.4%, respectively. Further work involves a larger sample size, adults, and other bone fractures.

COVID-19 prevention, control and management during dental care in a school clinic

This study investigated the effectiveness of physical and mechanical barriers in the prevention, control and management of COVID-19 during dental care. In this cross-sectional study, two research students from the eighth period of the dentistry course performed 24 consultations from January to June 2022, in the 4 specialties under study: surgery (S), restorative dentistry (D), endodontics (E) and periodontics (P). For each specialty researched, there were 3 groups: control (CG), which adopted the current biosafety norms of the Federal Council of Dentistry (FCD); with circular shield (G1) and with rectangular shield (G2). For each specialty, the researcher performed 6 dental appointments, whose patients were chosen by lot to which group they would participate, so that the distribution wasequitable between the groups. Aerosol stains were found around office equipment, as well as on professionals' personal protective equipment (PPE) and close to the patient. The maximum distance found from aerosol splashes to the naked eye was 1.43m during prophylaxis procedures in the CG. In all groups, most of the splashes were found on the PPE used by professionals, especially on gloves, in the professionals' wrist region; on the patient, on the apron and neck. There was no statistically significant difference between the groups within the specialties (p-value &gt; 0.05), disregarding the comparison between pairs. It was concluded that there was dissemination of aerosol droplets in all dental visits in the 4 specialties studied. Although the PPE proposed by the FCD are effective as a physical barrier to reduce cross-infection and the spread of droplets and aerosols, as well as a preventive measure against COVID-19 during dental care, the professional can use other devices that demonstrate effectiveness, such as the circular screens and the acrylic box, during the dental procedures.

The relationship between the lateral cutaneous antebrachial nerve and the superficial branch of the radial nerve and its impact on regional anesthetic and pain blocks of the thumb; What is more important: Nerves or dermatomes?

BackgroundInnervation of the thumb and radial part of the dorsum of the hand is achieved primarily by the radial nerve, which is usually blocked for hand surgery. Inefficient blocks occur because the lateral antebrachial cutaneous nerve also extends into this area. The question then arises, whether skin innervation and peripheral blocking techniques should be directed at from the innervation by these nerves or more by the dermatome and its spinal segments. MethodsIn 68 human upper limbs embalmed with Thiel’s method, the topography of the lateral antebrachial cutaneous nerve (LACN), the superficial branch of the radial nerve (sbRN) and communicating branch (CB) were investigated by meticulous dissection from the cubital fossa to the most distal macroscopically dissectible branch, and the areas reached by these nerves were compared to the described dermatome. ResultsIn 52.9% of all specimens, the LACN was found proximal to the rascetta, in 35.3% it extended to the base of the thumb, and in 8 cases (11.8%) it extended distally to the base of the thumb. In 50%, the LACN was anterolateral to the brachioradialis muscle, and in 38.2%, strictly lateral. Only in 8 cases (11.8%) the LACN presented itself running more dorsally and laterally. A CB was observed in 28 specimens (41.2%). Both investigated nerves were found to innervate the dermatomes of C6 and C7. ConclusionsThe LACN should be considered for individual targeted blocks for surgical procedures and pain therapy within the wrist and thumb region as all nerves that might contribute to innervation of a targeted dermatome should be blocked.

Isolated dorsal dislocation of the 5th carpometacarpal joint; a missed injury

Introduction: 5th carpometacarpal (CMC) joint dislocations of the wrist region are very rare and easily overlooked injuries. In this type of injury, which causes serious functional problems in the hand if not treated appropriately, closed methods are generally used in the treatment. In this study, we present a case with fracture-dislocation of the 5th CMC joint. &#x0D; Case: Fracture-dislocation of the 5th CMC joint of a 25-year-old patient who was admitted to the emergency department due to wrist pain was not noticed. The diagnosis was made during the follow-up of the patient, and the joint was reduced with closed method and fixed with a K wire. No serious problems were encountered in the patient's controls.&#x0D; Conclusion: Undiagnosed 5th CMC joint dislocation disrupts the transverse and longitudinal arches of the hand, so the patient has a weak and painful gripping function. Radiological findings may be unclear on anterior-posterior and lateral views, and additional images may be obtained if in doubt.

Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients

BackgroundHand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization.ObjectiveThe objective of this study is (1) to provide epidemiological information on hand injuries and their patterns and (2) to visualise the frequencies of affected areas of the hand in relation to the most common trauma mechanisms using color-coded heatmaps.MethodsThis prospective single-center observational trial conducted at a surgical emergency department in Germany collected data of hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, diagnostic and therapeutic measures were analyzed. Color-coded heatmaps were generated marking anatomic danger zones.Results435 patients with a mean age of 39.5 were included. Most patients admitted on their own initiative (79%). Leisure and sport injuries were most frequent (75%). Digiti II–V were injured most commonly (43%), followed by metacarpals (19%) and the thumb (14%). Blunt trauma and cuts accounted for most injuries (74%). Hand-graphics depicted color-coded frequencies of the affected areas of the palmar and dorsal aspect of the hand for the most common types of injury, as well as the most frequent circumstances of accident. Elective surgery was recommended in 25% of cases, and hand surgical follow-up was proposed in over 50% of cases.ConclusionsThe dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.

Occupational ergonomic assessment of MSDs among the artisans working in the Bagh hand block printing industry in Madhya Pradesh, India

Objectives. The hand block printing technique practiced in Dhar District of Madhya Pradesh involves highly repetitive tasks with awkward posture, which contribute to the development of musculoskeletal disorders (MSDs) among the artisans, The aim of this study was to determine the prevalence of MSDs and the risks factors involved. Methods. An observational study and a self-reported questionnaire study were conducted with a sample of 70 artisans. The working postures of the artisans were analyzed using rapid upper limb assessment (RULA) and the occupational repetitive actions (OCRA) method. p ≤ 0.05 was considered significant throughout the study. Results. MSDs in the neck, shoulders, elbows, wrist/forearm, lower back and hips/thighs were found to be highly prevalent among artisans of age greater than 31 years and experience greater than 11 years. Most complaints were reported in the wrist, neck and lower back region. Conclusion. From the findings, it was evident that artisans working in Bagh printing are at high risk of the development of MSDs; thus, an immediate intervention is needed to eliminate the ergonomic risks among the artisans.

Correlation of serum cornitine levels with bone mineral density among Indian male tobacco users.

It is of interest to assess levels of serum cornitine in male tobacco users and also find its correlation with bone mineral density. Assessment for serum cotinine levels was done using commercially available Enzyme Linked Immunosorbent Assay (ELISA Kit). While bone mineral density was measured using bone densitometry through ultrasound in the wrist region. Karl Pearson's coefficient was used to assess correlation between BMD values and serum cotinine (ng/ml) levels. Inter group BMD association was measured using Chi square test. The present study showed that the first 3 groups had a low BMD level compared to control group, indicative of osteopenia. BMD values were lesser for chewers from group II as compared to smokers from group I and individuals using both smoked and smokeless form of tobacco from Group III. In group III (both forms of tobacco), osteopenic individuals were more. Thus, data shows effect of tobacco usage on bone mineral density. Smokeless form of tobacco has relatively serious effects on bone density.

Prevalence and pattern of work-related musculoskeletal disorders among Nigerian bricklayers.

Typically, bricklayers in developing countries' contexts manually lay bricks, concrete blocks and other similar materials to construct walls and buildings which make them susceptible to work-related musculoskeletal disorders (WRMSDs). The burden of WRMSDs among this high-risk group seems has not been well documented. This study examined the prevalence of WRMSDs among bricklayers in Nigeria. A cross-sectional survey of 118 consenting bricklayers from a Nigerian setting was carried out. The standardized Nordic musculoskeletal disorder questionnaire and a proforma were used to profile the prevalence of WRMSDs and socio-demographic information of the respondents. Data was analyzed using descriptive and inferential statistics. Alpha level was set at p < 0.05. The 12-months and 7-days prevalence of WRMSDs were 87.3% and 67.4%. Shoulder (61.0%) and the low-back (59.3%) were the two most affected anatomical sites based on 12-month prevalence. WRMSDs affecting the knees (6.8%) was the most disabling in carrying normal work routines. Working for less than 10 years was significantly associated with high prevalence of WRMSDs in the shoulder (odd ratio (OR) = 0.27, 95% confidence interval (CI) = 0.09 to 0.87) and wrist region (OR = 0.24, 95% CI 0.08 to 0.73). Having neck pain led to higher odds (OR = 0.29, 95% CI 0.13 to 0.68) of taking a break from work among the bricklayers. WRMSDs were high among Nigerian bricklayers. Years of work experience was associated with high prevalence of WRMSDs in the shoulder and wrist. In addition, taking work breaks was associated with neck pain.

Bias in Hand Surgical Randomized Controlled Trials: Systematic Review and Meta-Epidemiological Study

Inappropriately reported or conducted studies may decrease the quality of care due to under- or overestimation of the benefits or harms of interventions. Our aim was to evaluate how often hand surgical randomized controlled trials (RCTs) use and report adequate methods to ensure internal validity, and whether inadequate reporting or methods are associated with the magnitude of treatment effect estimates. Data Sources were the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases until November 2020. We included published RCTs investigating the effects of any surgical intervention in the hand and wrist region. We assessed internal validity using the Cochrane Risk of Bias (RoB) tool for 6 domains: selection, performance, detection, attrition, selective reporting, and "other" bias. We extracted the primary outcome and calculated the effect size for each study. We used mixed-effect meta-regression to assess whether the RoB modified the magnitude of the effects. For 207 assessed trials, the RoB was unclear or high for 72% in selection, 93% in performance, 88% in detection, 25% in attrition, 22% in selective reporting, and 34% in the "other" bias domain. Trials with a high or unclear risk of selection bias yielded 0.28 standardized mean difference (95% confidence interval, 0.02-0.55) larger effect sizes compared to studies with a low risk. Risks of bias for other domains did not modify the intervention effects. The risk for selection bias declined over time: the odds ratio for a high or unclear RoB was 0.90 (95% confidence interval, 0.85-0.95) per additional year of publication CONCLUSIONS: The internal validity and credibility of hand surgical RCTs can be improved by using established methods to achieve true randomization, blinding of the participants and study personnel, publishing the trial protocol and avoiding selective reporting of the outcomes, and reporting the trial as recommended in the Consolidated Standards of Reporting Trials statement. Clinicians should be aware that RCTs that do not use or report proper randomization and allocation concealment may overestimate the treatment effects.

MRI and MR Arthrography Imaging of the Pathologies of the Wrist: A Pictorial Essay

Magnetic Resonance Imaging (MRI) has a special advantage over radiographs and Computed Tomography (CT) in evaluating an anatomically complex structure like wrist, owing to its excellent soft-tissue resolution and multiplanar imaging functionality. MR arthrography further improves the diagnostic value of MRI by virtue of its meticulous depiction of even small tears involving the Triangular Fibrocartilage Complex (TFCC), intrinsic and extrinsic ligaments of the wrist. This article focuses on the MRI and MR arthrography illustration of various traumatic as well as non traumatic pathologies affecting the wrist region and is mainly intended to educate the residents by comprehensively reviewing the imaging features of the major afflictions of this complex joint in a systematic fashion using checklists.

Deep Learning Based Hand Wrist Segmentation using Mask R-CNN

Deep learning is one of the trending technologies in computer vision to identify and classify objects. Deep learning is a subset of Machine Learning and Artificial Intelligence. Detecting and classifying the object was a challenging task in traditional computer vision techniques, and now there are numerous deep learning Techniques scaled up to achieve this. The primary purpose of the research is to detect and segment the human hand wrist region using deep learning methods. This research is widespread to deep learning enthusiasts who needs to segment custom objects using instance segmentation. We demonstrated a segmented hand wrist using the Mask Regional Convolutional Neural Network (R-CNN) technique with an average accuracy of 99.73%. This work also compares the performance evaluation of baseline and custom Hand Wrist Mask R-CNN. The achieved validation class loss is 0.00866 training and 0.02736 validation; both the values are comparatively deficient compared with baseline Mask R-CNN.

Pigmented Villonodular Synovitis of the Wrist Simulating Carpal Tunnel Syndrome

Diffuse pigmented vellonodular synovitis in the wrist region behaving like a carpal tunnel syndrome is rare. The objective of this article is to present a patient with diffuse pigmented vellonodular synovitis of the right wrist simulating a carpal tunnel syndrome resolved with surgical treatment, obtaining optimal results. The patient began with pain in the area of the right wrist, accompanied by paresthetic sensations as well as a diffuse increase in volume in the distal third of the forearm that increased with work activity. During surgery, diffuse proliferation of the synovium of the sheath of the flexor tendons of the fingers was verified, it was resected and sent to Pathology, diagnosing diffuse pigmented vellonodular synovitis. After surgery, the symptoms disappeared with a very satisfactory evolution.

A three years’ experience of Arteriovenous Fistula (AVF) cases in a tertiary care hospital of East Java, Indonesia: a descriptive observational study

Introduction: The incidence of end-stage renal disease (ESRD) globally is 700 million people approximately. Patients with ESRD need vascular access for hemodialysis as renal replacement therapy (RRT). Among hemodialysis access, arteriovenous fistula is considered as the most preferred form of vascular access due to its characteristics. This study aimed to to present a descriptive characteristic of arteriovenous fistula creation cases in a tertiary care hospital with a specific view of demographic parameters, fistulas' sites, type of fistulas. Methods: We conducted a descriptive study of single-center in the Department of Thoracic, Cardiac and Vascular Surgery of Dr. Soetomo Academic General Hospital Surabaya, collected data from January 1st, 2017 to December 31st, 2020. All patients who undergo arteriovenous fistula creation considered as a subject in this study. We retrieved the characteristics of the patients, the type of fistula, the site, surgical technique, and underlying disease from patients’ electronic medical data records. Results: A total of 167 patients requiring long-term hemodialysis in our center. Females were dominantly in our study with 56.9% (95). Most of AVFs were created on the left arm. Radiocephalic type of AVF was the most common arteriovenous fistula type found in 111 subjects (66.5%). The highest postoperative successful rate was found in brachiocephalic type in 78.8%, followed by radiocephalic AVF type with 66.7%. The wrist region was favorable in subjects (43.1%). Conclusions: Arteriovenous fistulas for hemodialysis are needed and in our center. Radiocephalic AVFs are the most common type. Further study to learn the different aspects of arteriovenous fistula cases is needed to fulfill queries in the local population.

The Effects of Age and Initial Shoulder Posture on the Upper Limb Range of Harvesting Movements among Oil Palm Harvesters

The occurrence of musculoskeletal diseases (MSDs) among oil palm harvesters has been studied extensively, but there is a lack of published studies on the evaluation of the range of harvesting movements. This information is important to design the ergonomic tools needed in the manual harvesting of oil palm. We examined the upper limb motion of oil palm harvesters to determine the effects of age and initial shoulder postures on their range of harvesting movements. Twenty male harvesters performed a manual push-pull-cutting technique (≥3 m fresh fruit branches (FFBs) height). The study was conducted by capturing the 1-D push-pull cutting technique harvesting movement via the Quintic system at the sagittal plane. The active range of harvesting movements during the harvesting phases and the range of the harvesting movement of the initial and maximum postures of their upper arms were calculated based on the kinematic data generated with the Quintic Biomechanics system (Version 29). Participants were divided into three groups based on their age, and two groups based on their initial support shoulder position, and dominant shoulder position. Data were analysed using the ANOVA and t-test. The joint movement angle pattern of the harvesters was classified into three phases: preparation, execution, and ending. The age-related variances for the initial and maximum support shoulder postures were determined. The range of harvesting movements and the active range of harvesting movements during the preparation phase at the support shoulder and wrist region were also observed. The initial support shoulder posture displayed a statistical variance in the maximum support and dominant range of harvesting movements of the shoulder. It was also linked to a reduced active range of harvesting movements for the support shoulder flexion and dominant wrist ulnar deviation at the preparation phase. Furthermore, the initial dominant shoulder exhibited a statistically significant difference for the dominant arm and a reduced active range of harvesting movements in the dominant wrist ulnar deviation at the preparation phase. This study produced important evidence about factors to be considered for the ergonomic design of harvesting tools and workplaces, especially within the oil palm industry.

Tendon of Flexor Carpi Radialis in carpal tunnel: a radiologic and cadaveric study

Background/aimCarpal tunnel is an important anatomical passage that carries the flexor tendons into the hand. As there is still no consensus about its contents among the anatomy textbooks, the main purpose of this study was to identify the relations of the flexor carpi radialis tendon in the carpal tunnel.Materials and methodsThis retrospective study was completed in April 2018 at authors’ university’s hospital. Seventy-four female and 44 male patients’ wrists without any pathology were examined by using magnetic resonance images. The series of axial sections where the pisiform exist were evaluated by using T1 sequence and the structures in the carpal tunnel were identified.ResultsResults of this study showed that the tendon of the flexor carpi radialis was found above the flexor retinaculum within its own septal compartment in all patients.ConclusionAccording to the results, tendon of flexor carpi radialis crosses the wrist region superficial to the carpal tunnel. Thus, tendon of flexor carpi radialis doesn’t have any effect on the carpal tunnel syndrome. Further cadaveric studies would be useful for identifying the contents of the carpal tunnel and morphological organization of the wrist.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war: Reverse posterior interosseous flap.

All of the injuries were the open injuries with bone or tendon structures in the hand and wrist region as a result of the firearm injury (FI) in the Syria. In the study, we assessed the outcomes of the posterior interosseous flap (PIF) on hand and wrist that we used for the Syrian injured people including civilians and soldiers in this War. PIF was applied to 77 patients who composed of 43 female and 34 male that all patients were evaluated for tissue loss resulting from gunshot wounds and injured in the War between 2014 and 2020 years with tissue loss in hand and wrist as a result of FI. The flap survival rate was 100% for all the patients. The dimensions of flaps ranged from 4.1 cm × 2.2 cm to 9cm × 5.4 cm with 0.51 ± 0.12 cm thickness. The mean pedicle length was 6.33 ± 1.08 cm. The surgery for PIF took 68.8 ± 22.1 minutes, while blood loss was 60 ± 24 mL. We observed no palsy conditions including the posterior interosseous nerve. The donor sites were treated by primary intention in the patients. We found the superiority of PIF with the postoperative follow-up comfort, ease of fracture healing, easy and fast, easy-to-apply method and no second additional session requirement in FI patients. We did not detect flap necrosis in any patient or observe a flap-related complication. As a result of the present study, it strongly supports the thesis that PIF is the best option in these cases.

Deep neural networks based wrist print region segmentation and classification

In recent years, biometric recognition based systems have become widespread. One of these is wrist-based recognition systems. In this study, wrist print based recognition system was developed by using near infrared (NIR) camera. Totally 220 NIR camera images taken from 10 for each both hands of 11 people. The obtained data set is allocated 70% (154 images) for training and 30% (66 images) for testing. The wrist regions are labeled on the training set images. Data sets were created with two different labeling methods. In the first data set, only the wrist regions were labeled and it was aimed to segment the wrist region from the image. In the second data set, the wrist images were labeled according to 22 classes and these classes were tried to be predicted. The labeled data was trained with YOLOV2 architecture supported by ResNet50 one of the deep neural network models. The trained model was tested with the remaining 30% of the data set. In the test process, the wrist region was determined in the NIR images with the trained model. As a results of the study, it was seen that the wrist regions were correctly detected in all first data set test images and the mean value of obtained similarity rates was 95.26%. In the test results of the second dataset, 92.43% classification success was obtained. Therefore, it can be said that the deep learning architectures ResNet and YOLO are effective in the segmentation of the wrist region.

Ergonomic evaluation of ergonomically designed chalkboard erasers on shoulder and hand-arm muscle activity among college professors

Teaching professionals regularly use the chalk board eraser or duster throughout their life which leads to several unnoticed musculoskeletal disorders. The purpose of this study was to provide an alternate design for the existing Indian model chalk board eraser, because current eraser design causes noticeable amount of biomechanical load on the wrist, hand and shoulder region when its frequency of usage was high and repetitive. Initially, pilot study was conducted through an online modified Nordic questionnaire among 60 college professors to identify the risky regions of the body due to the use of existing chalk board eraser. This was followed by an experimental trial using surface Electromyography Sensors (sEMG) in which the muscle behaviour was evaluated during the chalkboard erasing process employing three newly designed dusters and a traditional duster. The results revealed that Model A designed with a large palm rest to align the palm and the forearm had better usability and the musculoskeletal distress was reduced when compared with the traditional duster. Whereas Model C designed with slip guards to improve the gripping forces was found to have better performance rating after Model A. Model B provided with separate handle was found to be the worst performer when compared with the conventional duster. Results suggested that providing an improved palm rest and slip guards such as grooves reduces the musculoskeletal distress.

A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series.

Objectives This study aims to describe our surgery technique and discuss patients treated through the dorsoulnar artery (DUA)-based technique of osseous and osteo-fascio-cutaneous vascularized ulnar bone grafting.Patients and methods Between January 2011 and January 2015, six male patients (median age: 22.5 years; range, 20 to 24 years) who underwent surgery during which the technique of DUA ulnar bone graft was utilized. One patient with scaphoid nonunion, three patients with Kienböck’s disease, and two patients with a traumatic metacarpal defect were retrospectively evaluated. The joint range of motion (ROM), grip strength, Disabilities of the arm, shoulder and Hand (DASH) questionnaire score and Visual Analog Scale (VAS) score, and radiographies before and after surgery were examined. Scintigraphy was performed at 12 weeks postoperatively to monitor the viability of the bone graft.Results All patients showed improvements in the ROM, grip strength, VAS, and DASH scores. According to the radiographic examination, bone union was achieved in all patients and the scintigraphy revealed that vascularization was detected in the bone tissue.Conclusion The advantages of DUA-based vascularized bone graft are good bone quality and quantity and versatility due to its long pedicle. The osteo-fasio-cutaneous DUA flap seems to be effective in the treatment of traumatic metacarpal bone defects accompanied by skin loss. The DUA-based vascularized ulnar bone may be a source for scaphoid and lunate biological bone reconstruction.