Objective  The most common compressive neuropathy of the upper limbs is carpal tunnel syndrome (CTS). Historically, there has been a tendency to apply immobilization in the postoperative period, a practice that has decreased in recent years. This review aims to assess whether there is scientific evidence to justify the use of immobilization in the postoperative care of CTS decompression. Methods  The following databases were used: Biblioteca Virtual em Saúde (BVS), PubMed National Library of Medicine - (NLM), Cochrane Library, Scientific Electronic Library Online (SciELO), and EMBASE. The following inclusion criteria were used: 1) discussion of the postoperative period of median nerve decompression surgery in CTS; 2) comparison of results after surgical decompression in CTS between wrist immobilization or local dressing; 3) all languages, regardless of the year of publication; and 4) all types of publications. The following exclusion criteria were used: 1) studies that did not evaluate the postoperative period of CTS decompression; 2) lack of evaluation of the outcome related to the application of local dressing or some form of wrist immobilization after the surgical decompression procedure; and 3) repeated publications. Results  The literature search resulted in 336 relevant publications. In the end, 18 publications were chosen. Systematic reviews, randomized clinical trials, and cross-sectional studies were found. Conclusions  Due to the scarcity of evidence supporting the use of immobilization coupled with the higher costs associated with the practice, it has become less and less frequent in recent decades. Clinical relevance  In the literature, two approaches to postoperative care for CTS decompression are described: immobilization or just local dressing. According to the available scientific evidence, it is worth evaluating which one is better.

BACKGROUND: Early and accurate diagnosis is critical to preserve function and reduce healthcare costs in patients with hand and wrist injury. As such, artificial intelligence (AI) models have been developed for the purpose of diagnosing fractures through imaging. The purpose of this systematic review and meta-analysis was to determine the accuracy of AI models in identifying hand and wrist fractures and dislocations.
METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagnostic Test Accuracy guidelines, Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to October 10, 2023. Studies were included if they utilized an AI model (index test) for detecting hand and wrist fractures and dislocations in pediatric (<18 years) or adult (>18 years) patients through any radiologic imaging, with the reference standard established through image review by a medical expert. Results were synthesized through bivariate analysis. Risk of bias was assessed using the QUADAS-2 tool. This study was registered with PROSPERO (CRD42023486475). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS: A systematic review identified 36 studies. Most studies assessed wrist fractures (27.90%) through radiograph imaging (94.44%), with radiologists serving as the reference standard (66.67%). AI models demonstrated area under the curve (0.946), positive likelihood ratio (7.690; 95% confidence interval, 6.400-9.190), and negative likelihood ratio (0.112; 0.0848-0.145) in diagnosing hand and wrist fractures and dislocations. Examining only studies characterized by a low risk of bias, sensitivity analysis did not reveal any difference from the overall results. Overall certainty of evidence was moderate.
CONCLUSIONS: In demonstrating the accuracy of AI models in hand and wrist fracture and dislocation diagnosis, we have demonstrated that the potential use of AI in diagnosing hand and wrist fractures is promising.
METHODS: Level III. See Instructions for Authors for a complete description of levels of evidence.

UNASSIGNED: The proprioceptive approach can effectively improve strength, mobility, edema reduction, and pain reduction, which in turn has a positive impact on functionality.
UNASSIGNED: To identify proprioceptive rehabilitation strategies reported in the literature in adults with traumatic wrist injuries.
UNASSIGNED: A scoping review was performed following the parameters of the Prisma ScR strategy. We included research with adult patients diagnosed with posttraumatic wrist injuries who used proprioceptive rehabilitation. Pain, functionality, strength, joint mobility ranges, and edema were evaluated.
UNASSIGNED: After removing duplicates and applying the exclusion criteria, a total of 123 articles were found, which left six articles, including 125 patients. Rehabilitation protocols based on proprioceptive neuromuscular facilitation and using sensorimotor tools that promote wrist recovery have been generated. In addition, other approaches have been established, such as motor imagery, which generates a work of identification and organization of movement, improving pain and manual function. However, longer follow-ups, standardization of the instruments used during proprioceptive intervention, and increasing the observed population are needed to generate a recommendation for early intervention and cost-benefit estimates.
UNASSIGNED: Proprioceptive rehabilitation has demonstrated benefits in the recovery of the lower limb and hip or back. However, for the rehabilitation of traumatic wrist injuries, it is research pending. Well-described data and good quality designs are needed to routinely propose this strategy in the clinic.
UNASSIGNED: El enfoque propioceptivo puede mejorar de manera efectiva la fuerza, la movilidad, la reducción del edema y la disminución del dolor; lo que a su vez tiene un impacto positivo en la funcionalidad.
UNASSIGNED: Identificar las estrategias de rehabilitación propioceptiva reportadas en la literatura, en adultos con lesiones traumáticas de muñeca.
UNASSIGNED: Se efectuó una revisión de alcance siguiendo los parámetros de la estrategia Prisma ScR. Se incluyeron investigaciones con pacientes adultos, diagnóstico de lesión postraumática de muñeca, que utilizaron rehabilitación propioceptiva. Se evaluó el dolor, la funcionalidad, la fuerza, los rangos de movilidad articular y el edema.
UNASSIGNED: Se incluyeron seis artículos, que involucraron 125 pacientes al aplicar los criterios de exclusión. Se han generado protocolos de rehabilitación basados en facilitación neuromuscular propioceptiva y el uso de herramientas sensoriomotoras que promueven la recuperación de la muñeca. Además, se han establecido otros abordajes como la imaginería motora, que genera un trabajo de identificación y organización del movimiento, mejorando el dolor y la función manual. Faltan seguimientos de mayor tiempo, estandarización de los instrumentos utilizados durante la intervención propioceptiva y aumentar la población observada para generar una recomendación de intervención temprana y estimaciones entre el costo y el beneficio.
UNASSIGNED: La rehabilitación propioceptiva ha demostrado beneficios en la recuperación del miembro inferior y la cadera o espalda. Para la rehabilitación de las lesiones traumáticas de muñeca, es un pendiente de la investigación. La información bien descrita y los diseños de buena calidad son necesarios para proponer rutinariamente esta estrategia en la clínica.

BACKGROUND: Triangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist.
METHODS: In this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery.
RESULTS: The cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%.
CONCLUSIONS: Arthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.

暂无摘要。

Wrist pathologies, particularly fractures common among children and adolescents, present a critical diagnostic challenge. While X-ray imaging remains a prevalent diagnostic tool, the increasing misinterpretation rates highlight the need for more accurate analysis, especially considering the lack of specialized training among many surgeons and physicians. Recent advancements in deep convolutional neural networks offer promise in automating pathology detection in trauma X-rays. However, distinguishing subtle variations between pediatric wrist pathologies in X-rays remains challenging. Traditional manual annotation, though effective, is laborious, costly, and requires specialized expertise. In this paper, we address the challenge of pediatric wrist pathology recognition with a fine-grained approach, aimed at automatically identifying discriminative regions in X-rays without manual intervention. We refine our fine-grained architecture through ablation analysis and the integration of LION. Leveraging Grad-CAM, an explainable AI technique, we highlight these regions. Despite using limited data, reflective of real-world medical study constraints, our method consistently outperforms state-of-the-art image recognition models on both augmented and original (challenging) test sets. Our proposed refined architecture achieves an increase in accuracy of 1.06% and 1.25% compared to the baseline method, resulting in accuracies of 86% and 84%, respectively. Moreover, our approach demonstrates the highest fracture sensitivity of 97%, highlighting its potential to enhance wrist pathology recognition.

UNASSIGNED: To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury.
UNASSIGNED: A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation.
UNASSIGNED: All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05).
UNASSIGNED: For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.
UNASSIGNED: 比较单纯关节镜下缝合三角纤维软骨复合体（triangular fibrocartilage complex，TFCC）、缝合TFCC联合切开复位内固定与单纯切开复位内固定尺骨茎突骨折治疗桡骨远端骨折合并尺骨茎突基底部骨折伴TFCC损伤的近期疗效。.
UNASSIGNED: 回顾性分析2019年9月—2022年9月收治且符合标准的97例桡骨远端骨折合并尺骨茎突基底部骨折并伴TFCC损伤患者临床资料。桡骨远端骨折复位内固定后，37例单纯关节镜下缝合TFCC（TFCC组）、31例缝合TFCC联合切开复位内固定尺骨茎突骨折（联合组）、29例单纯切开复位内固定尺骨茎突骨折（内固定组）。3组患者性别、年龄、受伤侧别、受伤至手术时间以及术前桡骨高度、掌倾角、尺偏角、握力、腕关节旋转活动度、尺桡偏活动度、屈伸活动度等基线资料比较，差异均无统计学意义（ P>0.05）。比较3组患者术前及术后12个月桡骨高度、掌倾角、尺偏角，腕关节旋转活动度、尺桡偏活动度、屈伸活动度及握力差值（变化值），术后12个月采用改良Gartland-Werley评分评价疗效。.
UNASSIGNED: 术后切口均Ⅰ期愈合。患者均获随访，随访时间12～18个月，平均14个月。X线片复查示，TFCC组4例尺骨茎突骨折不愈合，其余患者术后3个月时骨折均愈合；术后12个月3组桡骨高度、掌倾角、尺偏角均优于术前（ P<0.05），但上述指标变化值组间差异均无统计学意义（ P>0.05）。术后12个月，TFCC组、联合组腕关节旋转、尺桡偏、屈伸活动度变化值均优于内固定组（ P<0.05），TFCC组与联合组间差异无统计学意义（ P>0.05）。联合组握力变化值优于内固定组，差异有统计学意义（ P<0.05）；其余组间差异均无统计学意义（ P>0.05）。TFCC组、联合组、内固定组腕关节改良Gartland-Werley评分优良率分别为91.89%（34/37）、93.54%（29/31）、72.41%（21/29）；TFCC组、联合组优良率高于内固定组，差异有统计学意义（ P<0.05）；TFCC组与联合组间差异无统计学意义（ P>0.05）。.
UNASSIGNED: 对于合并TFCC损伤的尺骨茎突基底部骨折，与单纯切开复位内固定相比，关节镜下单纯缝合修复TFCC或联合内固定治疗均有利于术后早期腕关节功能恢复，且两者疗效相似，因此关节镜下单纯修复缝合TFCC可能是更好选择。.

BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes.
METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient\'s medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported.
RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively.
CONCLUSIONS: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF.
METHODS: level IV evidence.

CONCLUSIONS: The distal radioulnar joint (DRUJ) is vital to the stability and function of the wrist and forearm. The osseous morphology is variable and provides little stability. A complex of confluent soft tissues is the primary stabilizer; however, the contribution of each component has yet to be elucidated. It has become increasingly clear that the anatomic fixation of distal radius fractures restores DRUJ stability, obviating the need for additional DRUJ stabilization. This review will describe the anatomy and biomechanics of the DRUJ and discuss injury patterns, treatments, and clinical results.

OBJECTIVE: This study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature.
METHODS: A total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides.
RESULTS: Among the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo\'s wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures.
CONCLUSIONS: Staged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures.
METHODS: 4.