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Materials and Equipment

Surgical barrier integrity, glove selection (latex, nitrile, double-gloving), and equipment considerations for hand surgery infection control.

Overview

Advances in biomaterials have improved and expanded arthroplasty design [1]. Many recently available trapezium prosthetic implants have shown short-term success [2]. However, determining the medium- to long-term outcomes of trapezium prosthetic implants requires further study [2]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [3].

The literature is not clear as to which type of implant provides the most reliable results for small joint arthroplasty [25]. Silicone implants have been reliable for many years but carry risks of fracture and stiffness [25]. Newer small joint arthroplasty designs like pyrocarbon present unique problems such as dislocations and loosening [25]. The clinical success of any non-cemented or biologically stabilized implant must be judged in comparison with the results obtained using the most contemporary cementing techniques [12].

There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes [4]. The article provides an overview of the latest applications of 3D printing in hand surgery and practical experience of implementing them into daily clinical routine [6]. It is anticipated that 3D design and printing will become easier and more efficient, leading to mainstream utilization in clinics and hospitals [10].

Regarding soft tissue management, the One-per-Mil Tumescent Technique proved safe and effective for a wide range of indications in upper extremity surgeries [23]. Safe limits for application time and surface pressures under digital tourniquets are difficult to define [21]. The 'one size fits all' philosophy for digital tourniquet application is questioned [21].

Anatomy & Pathophysiology

Biomaterials and Prosthetic Design

Advances in biomaterials have improved and expanded arthroplasty design [1]. In the context of upper extremity reconstruction, a proximity sensor in a novel prosthesis for upper extremity phocomelia eliminates the need for forceful movements of the residual finger to use mechanical switches or levers, making operation more intuitive and easier to understand [44]. However, mechanical solutions to minimize force required at the wrist to activate grip are still required for 3D-printed custom-designed prostheses for partial hand amputation [51]. For active tendon implants of the hand, the PW technique for proximal tendon-prosthesis junction displayed greater stiffness and ultimate load compared with the TL technique [80].

3D Printing and Fabrication

3D printing has practical applications in hand surgery and is being implemented into daily clinical routine [6]. 3D design and printing are anticipated to become easier and more efficient, leading to mainstream utilization in clinics and hospitals [10]. Relative motion orthoses are fabricated with attention to detail to achieve intended goals of relative motion orthotic intervention [8].

Hand Biomechanics and Strength Measurement

The middle finger is the most important contributor to grip strength [41]. Isometric hand tests improve the measurement of intrinsic and extrinsic hand muscle strength [35]. The GripAble is a reliable tool for measuring grip strength [62]. Modifying core suture configurations in flexor tendon repairs is common among Finnish hand surgeons and does not seem to compromise the biomechanical competence of the repairs [58]. Composite bone models used in biomechanical studies of the hand and upper extremity lack soft tissues [79]. No biomechanical studies have recorded average values identical to human specimens for all metrics in composite bone model studies [79].

Wrist Kinematics and Radiocarpal Joint Tolerance

Incongruous radiocarpal joints are well tolerated due to wrist biomechanics, particularly the role of the midcarpal joint in the dart-throwing motion [47]. Aggressive treatment for stepoffs larger than 1 mm is questioned due to wrist biomechanics [47].

Surgical Techniques and Instrumentation

Accurate diagnosis and management of hand and carpal fractures and dislocations are predicated on a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [52]. The lever-action wrench mechanics provide easy application, great strength, rapid adjustability, and quick release [53]. Adalbert Ibrahim Kapandji made significant contributions to hand surgery and biomechanics, including innovative surgical techniques [61]. Hand surgery emphasizes the balance between restoring function and maintaining aesthetic appearance [71].

Robotics and Future Directions

Robotic surgery is a rapidly evolving field that will potentially play a pivotal role in future patient care, though its precise role in hand surgery remains a subject of further research [66].

Classification

Biomaterials and Implant Design: Advances in biomaterials have improved and expanded arthroplasty design [1]. Many recently available trapezium prosthetic implants have shown short-term success, but medium- to long-term outcomes require further study [2]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [3].

Small Joint Arthroplasty: The literature is unclear regarding which implant type provides the most reliable results for small joint arthroplasty [25]. Silicone implants have been reliable for many years but carry risks of fracture and stiffness [25]. Newer small joint implant designs, such as pyrocarbon, present unique problems such as dislocations and loosening [25].

Tendon Repair Classifications: Further clinical studies are needed to determine the effectiveness of the Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury [5]. Patients treated with a bioresorbable polylactide sheet (OrthoWrap®) showed better outcomes in Strickland's classification after extensor tendon repair, though the clinical significance of these differences requires further investigation [55].

Nerve Repair: No significant differences in functional outcomes were observed between the polymer-assisted peripheral nerve repair device and microsurgical neurorrhaphy [7].

Prosthesis Wear: Improved repeatability and accuracy in determining polyethylene wear facilitates the investigation of factors related to the prosthesis and patient that affect wear rates [9].

Other Considerations: 3D printing has been implemented into the daily clinical routine of hand surgery [6]. The first resection device in Germany was developed by A. von Lichtenberg and W. Heynemann [13]. Between 1886 and 1921, operative treatment witnessed a revolution where radiology became integral and all types of osteosynthesis were introduced into clinical practice [14]. Two pairs of gloves should be worn when performing a major orthopaedic procedure [24]. Commonly utilized screws in upper extremity surgery include headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws [30]. Reusable instrumentation for four-anchor rotator cuff repair leads to decreased waste disposal costs and lower waste-related carbon emissions [48]. Nano Boron nitride enhanced bone cement composites (h-BN/PMMA) demonstrate improved mechanical, thermal, and drug release properties [49].

Clinical Presentation

Advances in biomaterials have improved and expanded arthroplasty design [1]. Determining the medium- to long-term outcomes of recently available trapezium prosthetic implants requires further study [2]. The specific implant types include Silicone, Artelon, Metal, and Pyrocarbon [2]. Clinical outcomes and radiographic signs of loosening suggest that surrounding bone does not form a stable interface with pyrolytic carbon implants [17].

Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is critical for their utilization [3]. There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes [4]. It is anticipated that 3D design and printing will become easier and more efficient, leading to mainstream utilization in clinics and hospitals [10].

For hand surgery, guidelines for camera selection, standard views, and image formatting ensure accurate and precise presentation [15]. Defatting of skin flaps using arthroscopic instruments provided an effective treatment that did not require the purchase of specialized equipment [16]. Clinical assessment and plain radiography were very accurate in the series evaluating a novel sutureless, self-retaining system for wound exposure [18].

In trauma and reconstruction, further clinical studies are needed to determine the effectiveness of the Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury [5]. Fifteen years of surgical experience have proved the dependability of instruments for use with flexible steel wire in bone surgery and the value of their unique features [11]. A utility attachment for cineplastic artificial arms permits patients to perform work requiring heavier physical demands, allows for rapid grasp and release, and enables long-continued holding without fatigue via a lock device [19].

Regarding complications, immune reactions from implanted metals are much less common (< 0.1%) than dermal metal hypersensitivity in the general population [33]. Improved repeatability and accuracy in determining polyethylene wear using digital radiographs should facilitate the investigation of factors related to the prosthesis and patient that affect wear rates [9]. The manuscript on relative motion orthoses offers simple and practical fabrication tips for hand therapists to achieve intended goals through attention to detail [8].

Investigations

Plain radiography: Radiology has been integral to operative treatment since 1886, introducing all types of osteosynthesis into clinical practice [14]. In hand surgery, guidelines for camera selection, standard views, and image formatting ensure accurate and precise presentation [15]. For proximal interphalangeal joint surface replacement arthroplasty, standard X-rays reveal significantly more cases with radiologic evidence of loosening in the uncemented group compared to the cemented group at a mean 5-year follow-up (p < .001) [54]. Clinical outcomes and radiographic signs indicate that surrounding bone does not form a stable interface with pyrolytic carbon implants [17]. Judet's bipolar prosthesis achieved mainly good clinical results despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years [28]. Improved repeatability and accuracy in determining polyethylene wear using digital radiographs should facilitate the investigation of factors related to the prosthesis and patient that affect wear rates [9]. Clinical assessment and plain radiography were very accurate in evaluating a novel sutureless, self-retaining wound exposure system [18]. Serial radiographs should be made for at least three months to ensure all fractured vertebrae are identified and to document any progression of deformity [67]. Standing X-rays show that double semitendinosus anterior cruciate ligament reconstruction stabilizes the evolution of degenerative lesions [69]. A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up in central ray deficiency cleft reconstruction [72]. Standard X-rays showed osseous integration of spongy hydroxyapatite after 6 weeks, with active bone remodeling still occurring after several years [42].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [50].

Other Considerations: Advances in biomaterials have improved and expanded arthroplasty design [1]. Determining the medium- to long-term outcomes of recently available trapezium prosthetic implants requires further study [2]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [3]. There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes [4]. Further clinical studies are needed to determine the effectiveness of the Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury [5]. The Trabecular Metal Monoblock Acetabular Cup System showed excellent early clinical and radiographic behavior [32]. A clear understanding of acetabular osseous anatomy and surrounding soft tissues is essential for evaluation and management of acetabular fractures [75]. For 3 cm of cortical contact, successful initial fixation can be achieved in most cases with both taper angle designs of titanium tapered splined stems [77].

Treatment

Non-Operative

Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures, with selection depending on disease stage and patient factors [64]. Simple and practical fabrication tips for hand therapists can achieve the intended goals of relative motion orthotic intervention through attention to detail [8].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral coxa vara deformity or leg-length discrepancy in childhood, while moderate nonprogressive deformity often does not require surgery [68].

Surgical Approach / Technique: Defatting of skin flaps using arthroscopic instruments is an effective treatment that does not require the purchase of specialized equipment [16]. Percutaneous release of the A1 pulley using a #15 blade was associated with good efficacy and an acceptable margin of safety in a cadaver study [40]. The one-per-mil tumescent technique is safe and effective for a wide range of upper extremity surgical indications [23].

Implant Selection: Advances in biomaterials have improved and expanded arthroplasty design [1]. The clinical success of non-cemented or biologically stabilized implants must be judged in comparison with results obtained using contemporary cementing techniques, not those from the early 1970s [12]. Determining the medium- to long-term outcomes of recently available trapezium prosthetic implants requires further study [2]. The poly-L-lactic acid scaffold is a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty for CMC arthroplasty, providing long-lasting satisfactory clinical results despite radiological findings of progressive collapse [73]. Commonly utilized headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws have basic dimensions that can be codified into a reference chart for treating bone of varying dimensions [30].

Adjuncts: Safe limits for application time and surface pressures under digital tourniquets are difficult to define, questioning the 'one size fits all' philosophy [21]. There are no significant advantages to using expensive commercially produced vancomycin-impregnated cement, and adding vancomycin powder by hand in the operating theatre is recommended [46].

Other Considerations: High-level evidence is needed to determine whether the use of 3-dimensional printed models improves clinical outcomes [4]. Further clinical studies are needed to determine the effectiveness of the Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury [5]. No significant differences in functional outcomes were observed between the novel atraumatic polymer-assisted peripheral nerve repair device and microsurgical neurorrhaphy [7]. Favorable cosmetic and functional outcomes were obtained using Integra artificial dermis to treat donor site defects after pedicle flaps in hand surgery [36]. Integra is an appropriate treatment for providing wound coverage and skin defects, offering advantages such as ease of use, decreased donor site morbidity, and durable functional skin coverage [38]. Published clinical results demonstrate significant improvements in upper limb function with the contralateral C7 transfer, confirming the procedure's safety and efficacy, with donor site morbidity that is typically mild and transient [37]. Achievement of tolerance is critical to the success of transplantation of composite tissue allograft [39]. Wound care required significantly more time when non-absorbable sutures were used compared to absorbable sutures for wound closure after fasciectomy for Dupuytren’s contracture [60]. Maintenance of reduction in the Whitman cast for childhood femoral neck fractures is difficult [65]. Two pairs of gloves should be worn when performing a major orthopaedic procedure [24]. Wearing cotton gloves over latex inner gloves is highly recommended during orthopaedic operations [45]. Repeat exposure to mesh-glue dressing is associated with allergic contact dermatitis, so clinicians should weigh the benefits of repeat use given this risk [76]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [3].

Complications

Other Considerations: Determining the medium- to long-term outcomes of trapezium prosthetic arthroplasty requires further study [2]. There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes [4]. Fifteen years of surgical experience have proved the dependability of instruments for use with flexible steel wire in bone surgery [11]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [20]. It is still unknown whether surgical intervention significantly improves the natural history of Kienböck's disease [27]. Long-term outcomes for pelvic fractures are complicated by posterior pelvic pain and are largely multifactorial, depending on the pelvic ring injury and associated injuries [29].

Prosthetic Arthroplasty Outcomes: The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up [26]. Major primary complications and a high incidence of radiographic signs of degenerative changes occur after 8.8 years with Judet's bipolar prosthesis for radial head arthroplasty [28].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return. However, resin-plaster bandages are noted as convenient and useful for casts requiring lightness and strength, particularly for long-term wear or exposure to moisture [31]. For upper-extremity neuroprostheses, the implanted stimulator has proved safe and reliable with seven years as the longest time in situ [78]. In recent fractures, nonoperative treatment yielded proportionately more good results than operative treatment for simple fractures, with 87.5% of traced patients cured [74].

Full activity (months): Specific month ranges for full activity return are not provided in the available evidence. For trapezium prosthetic arthroplasty, determining medium- to long-term outcomes requires further study [2]. The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up [26]. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs functioned equivalently at the time of early follow-up in a low-to-moderate-demand patient group [81].

Complete recovery / outcome plateau (months): Long-term outcomes for pelvic fractures are dependent on the pelvic ring injury as well as associated injuries, and are complicated by posterior pelvic pain but also largely multifactorial [29]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis for focal cartilage defects in the knee will maintain structural and functional integrity over time [20]. The clinical success of non-cemented or biologically stabilized implants must be judged in comparison with results obtained using contemporary cementing techniques, not with results from procedures performed using cementing techniques of the early 1970s [12].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are detailed in the evidence. Advances in biomaterials have improved and expanded arthroplasty design [1]. Understanding the current evidence and appropriate indications of emerging technologies is critical for their utilization [3]. There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes [4].

Functional milestones: Validated PROM trajectories or outcome-measure benchmarks are not provided. No significant differences in functional outcomes were observed between the polymer-assisted peripheral nerve repair system and microsutures [7]. Direct exchange for the treatment of infection after total hip replacement can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [63]. The trabecular metal monoblock acetabular cup system showed excellent early clinical and radiographic behavior [32].

Other Considerations: Fifteen years of surgical experience proved the dependability of instruments for use with flexible steel wire in bone surgery and the value of its unique features [11]. The utility attachment for cineplastic artificial arms permits patients to perform work requiring heavier physical demands and allows for rapid grasp and release, while a lock device enables long-continued holding without fatigue [19]. It is still unknown whether surgical intervention significantly improves the natural history of Kienböck’s disease [27].

Key Evidence

  • [L5] Advances in biomaterials have improved and expanded arthroplasty design. (10.1016/j.hcl.2017.12.008)
  • [Paper] While many recently available implants have been shown to have short-term success, determining the medium- to long-term outcomes require further study. (10.1016/j.hcl.2012.08.020)
  • [L5] There remains a need for high-level evidence regarding whether the use of 3-dimensional printed models can improve clinical outcomes. (10.1016/j.jhsa.2021.05.028)
  • [L5] Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques. (10.1186/s12891-022-05279-9)
  • [L5] This article provides an overview of the latest applications of 3D printing in hand surgery and practical experience of implementing them into daily clinical routine. (10.1155/2021/4650245)
  • [L5] No significant differences in functional outcomes were observed between the polymer-assisted system and microsutures. (10.1016/j.jhsg.2025.100812)
  • [L5] The manuscript offers simple and practical fabrication tips for hand therapists to achieve the intended goals of relative motion orthotic intervention through attention to detail. (10.1016/j.jht.2022.12.004)
  • [L4] Improved repeatability and accuracy in the determination of polyethylene wear should facilitate the investigation of factors related to the prosthesis and to the patient that affect the rates of wear. (10.2106/00004623-199711000-00004)
  • [L5] It is anticipated that 3D design and printing will become easier and more efficient, leading to mainstream utilization in clinics and hospitals. (10.1016/j.jht.2019.12.018)
  • [L5] Fifteen years of surgical experience have proved the dependability of this instrument and the value of its unique features. (10.2106/00004623-195840020-00009)
  • [L5] The clinical success of any non-cemented or biologically stabilized implant must be judged in comparison with the results that are obtained using the most contemporary cementing techniques, not with the results of procedures that were performed using the cementing techniques of the early 1970's. (10.2106/00004623-198769090-00026)
  • [Paper] The article describes the historical development and technical specifications of the first resection device in Germany, developed by A. v. (10.1007/s00120-003-0330-7)
  • [L5] During the 35 years from 1886 to 1921, operative treatment witnessed an unprecedented revolution where radiology became integral and all types of osteosynthesis were introduced into clinical practice. (10.1007/s00402-010-1082-7)
  • [L5] The authors provide guidelines for camera selection, standard views, and image formatting to ensure accurate and precise presentation. (10.1016/j.jhsa.2013.03.038)
  • [L4] This method provided an effective treatment for our patients and did not require the purchase of specialised equipment. (10.1054/jhsb.2000.0390)
  • [L5] The clinical outcomes and radiographic signs of loosening suggest that the surrounding bone does not form a stable interface with pyrolytic carbon implants. (10.2106/jbjs.k.00527)
  • [L4] Clinical assessment and plain radiography were very accurate in our series. (10.1177/1753193411409125)
  • [L5] The utility attachment permits the patient with a cineplastic prosthesis to perform work requiring heavier physical demands and allows for rapid grasp and release, while a lock device enables long-continued holding without fatigue. (10.2106/00004623-194830010-00028)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L5] Safe limits for application time and surface pressures are difficult to define, and the 'one size fits all' philosophy is questioned. (10.1177/1753193413492059)
  • [L4] It proved safe and effective for a wide range of indications. (10.1016/j.jhsa.2013.09.034)
  • [L1] Based on the current evidence, two pairs of gloves should be worn when performing a major orthopaedic procedure. (10.1016/j.arth.2025.10.110)
  • [L5] The literature is not clear as to which type of implant provides the most reliable results, though silicone implants have been reliable for many years with risks of fracture and stiffness, while newer designs like pyrocarbon present unique problems such as dislocations and loosening. (10.1016/j.hcl.2010.01.003)
  • [L4] The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up. (10.1177/1753193415614251)
  • [L5] One hundred years on we still do not know whether what we do as surgeons significantly improves the natural history of Kienböck's disease. (10.1177/1753193410381188)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L5] This article highlights the basic dimensions of commonly used headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws to codify their dimensions into a readily available reference chart for the treatment of bone of varying dimensions. (10.1016/j.jhsa.2014.11.012)
  • [L4] The implant showed excellent early clinical and radiographic behavior. (10.1016/j.arth.2008.09.027)
  • [L5] While dermal metal hypersensitivity is common in the general population, immune reactions from implanted metals are much less common (< 0.1%), and understanding the epidemiology, etiology, and diagnostic testing aids surgeons in managing patients with suspected metal allergy. (10.1016/j.jhsa.2017.06.009)
  • [L4] The new isometric hand tests improve the measurement of intrinsic and extrinsic hand muscle strength. (10.1177/1753193410363532)
  • [L4] Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. (10.1016/j.jhsa.2014.08.014)
  • [L5] Published clinical results have demonstrated significant improvements in upper limb function, confirming the procedure's safety and efficacy, with donor site morbidity that is typically mild and transient. (10.1177/17531934251314640)
  • [L5] Integra is an appropriate treatment for providing wound coverage and for skin defects, offering advantages such as ease of use, decreased donor site morbidity, and durable functional skin coverage. (10.1016/j.jhsa.2011.11.007)
  • [L5] Achievement of tolerance is critical to the success of transplantation of composite tissue allograft. (10.1016/j.jhsa.2006.10.013)
  • [L5] Percutaneous release of the A1 pulley using a #15 blade was associated with good efficacy and an acceptable margin of safety in this series. (10.1016/j.jhsa.2012.08.019)
  • [L4] The middle finger was the most important contributor to grip strength. (10.1016/j.jhsa.2014.06.121)
  • [L4] Standard X-rays showed osseous integration after 6 weeks in all patients, with active bone remodeling still occurring after several years. (10.1054/jhsb.2001.0686)
  • [L4] The use of a proximity sensor eliminates the need for forceful movements of the residual finger to use mechanical switches or levers and makes the operation more intuitive and easier to understand. (10.1177/17531934231209645)
  • [L1] The authors highly recommend wearing cotton gloves over latex inner gloves during orthopaedic operations. (10.2106/00004623-199072060-00019)
  • [L4] The authors found no significant advantages of using expensive commercially produced vancomycin-impregnated cement and recommend the addition of vancomycin powder by hand in the operating theatre. (10.1302/0301-620x.99b1.bjj-2016-0566.r1)
  • [Commentary] The author argues that incongruous radiocarpal joints are well tolerated due to wrist biomechanics, particularly the role of the midcarpal joint in the dart-throwing motion, and questions the necessity of aggressive treatment for stepoffs larger than 1 mm. (10.1016/j.jhsa.2013.04.038)
  • [L2] According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. (10.5435/jaaos-d-23-00200)
  • [L5] The comprehensive performance evolution evaluation of h-BN/PMMA composites provides a reference for the innovative application of modified bone cement, demonstrating improved mechanical, thermal, and drug release properties. (10.1186/s13018-025-05626-1)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L4] Mechanical solutions to minimize force required at the wrist to activate grip are still required. (10.1016/j.jht.2020.04.005)
  • [L5] The mechanics embodied in the lever-action wrench provides easy application, great strength, rapid adjustability, and quick release. (10.2106/00004623-195436010-00033)
  • [L3] There were significantly more cases with radiologic evidence of loosening in the uncemented group (p < .001). (10.1016/j.jhsa.2008.01.030)
  • [L1] While patients treated with OrthoWrap® showed better outcomes in Strickland's classification, the clinical significance of these small differences and their impact on patient function requires further investigation. (10.1186/s12891-024-08241-z)
  • [L5] Modifying the core suture configurations in flexor tendon repairs is common among Finnish hand surgeons, although this does not seem to compromise the biomechanical competence of the repairs. (10.1177/1753193416641624)
  • [L1] Wound care required significantly more time when non-absorbable sutures were used. (10.1177/1753193409105728)
  • [Paper] This in memoriam article honors Adalbert Ibrahim Kapandji, a pioneering figure in hand surgery and biomechanics, recognizing his significant contributions to the field, his innovative surgical techniques, and his legacy as a visionary and mentor. (10.1016/j.otsr.2019.02.011)
  • [L3] The GripAble is a reliable tool for measuring grip strength. (10.1186/s12891-022-05026-0)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L4] Maintenance of reduction in the Whitman cast is difficult. (10.1007/s11999-007-0024-3)
  • [L5] Robotic surgery is a rapidly evolving field that will potentially play a pivotal role in future patient care, though its precise role in hand surgery remains a subject of further research. (10.1177/17531934251326153)
  • [L3] Serial radiographs should be made for at least three months to ensure all fractured vertebrae are identified and to document any progression of deformity. (10.2106/00004623-198870090-00006)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray. (10.1007/s001670050076)
  • [L5] The prosthesis tested exhibits kinematic behavior similar to that in their normal state, with no difference in quadriceps force required for extension. (10.1016/j.arth.2012.02.008)
  • [L4] A new technique of quantifying the radiographic divergence of the border rays of the cleft demonstrates improved alignment at long-term follow-up. (10.1016/j.jhsa.2008.05.010)
  • [L4] Despite radiological findings of progressive collapse, the poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results. (10.1177/1558944720918366)
  • [L4] In recent fractures, 87.5% of traced patients were cured, with nonoperative treatment yielding proportionately more good results than operative treatment for simple fractures. (10.1007/s11999-007-0033-2)
  • [L2] Although symptoms uniformly resolved with treatment, clinicians should weigh the benefits of repeat use of this dressing given the risk of ACD. (10.1016/j.arth.2025.05.001)
  • [L5] For 3 cm of cortical contact, successful initial fixation can be achieved in most cases with both taper angle designs. (10.1016/j.arth.2021.04.013)
  • [L4] The implanted stimulator has proved to be safe and reliable, with seven years as the longest time in situ at the time of writing. (10.2106/00004623-199704000-00008)
  • [L5] However, investigators must remain aware of limitations, including the lack of soft tissues and the fact that no biomechanical studies have recorded average values identical to human specimens for all metrics. (10.1016/j.jhsa.2012.12.005)
  • [L5] The PW technique displayed greater stiffness and ultimate load compared with the TL. (10.1016/j.jhsa.2014.10.034)
  • [L1] The two designs functioned equivalently at the time of early follow-up in this low-to-moderate-demand patient group. (10.2106/jbjs.j.00157)

See Also

References

[1] Advances in Proximal Interphalangeal Joint Arthroplasty. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.008

[2] Trapezium Prosthetic Arthroplasty (Silicone, Artelon, Metal, and Pyrocarbon). Hand Clinics. 2013. DOI: 10.1016/j.hcl.2012.08.020

[3] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[4] Three-Dimensional Printing in Hand Surgery. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.05.028

[5] Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05279-9

[6] Overview of In‐Hospital 3D Printing and Practical Applications in Hand Surgery. BioMed Research International. 2021. DOI: 10.1155/2021/4650245

[7] A Novel Atraumatic Polymer-Assisted Peripheral Nerve Repair Device Compared With Microsurgical Neurorrhaphy. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100812

[8] Relative motion orthoses: fabrication tips. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.004

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[17] Questions about Implant-Bone Interface with Pyrolytic Carbon. Journal of Bone and Joint Surgery. 2011. DOI: 10.2106/jbjs.k.00527

[18] Novel method for wound exposure using a sutureless, self-retaining system. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411409125

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[20] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[21] Variability in local pressures under digital tourniquets. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413492059

[23] One-per-Mil Tumescent Technique for Upper Extremity Surgeries: Broadening the Indication. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.09.034

[24] 2025 ICM: Gloves. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.110

[25] Complications of Small Joint Arthroplasty. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.01.003

[26] MatOrtho proximal interphalangeal joint arthroplasty: minimum 2-year follow-up. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415614251

[27] Kienböck’s disease. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410381188

[28] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[29] Chapter 32 Pelvic Fractures: Definitive Treatment and Outcomes. 2021.

[30] Nuts and Bolts: Dimensions of Commonly Utilized Screws in Upper Extremity Surgery. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.012

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[32] Migration of the Trabecular Metal Monoblock Acetabular Cup System. The Journal of Arthroplasty. 2010. DOI: 10.1016/j.arth.2008.09.027

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[35] An isometric hand tester: quantifying motor function in the hand. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410363532

[36] Use of Integra Artificial Dermis to Reduce Donor Site Morbidity After Pedicle Flaps in Hand Surgery. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.08.014

[37] Harnessing the uninjured hemisphere for treatment of the stroke or brain-injured patient – evolution of the contralateral C7 transfer. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251314640

[38] The Use of Integra in Hand and Upper Extremity Surgery. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.11.007

[39] Pharmacologic Approaches to Composite Tissue Allograft. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2006.10.013

[40] Percutaneous Release of the A1 Pulley: A Cadaver Study. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.08.019

[41] Comparison of Grip Strength Among 6 Grip Methods. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.121

[42] Spongy Hydroxyapatite in Hand Surgery – A Five Year Follow-Up. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2001.0686

[44] Novel prosthesis with proximity sensor for upper extremity phocomelia. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231209645

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[47] Commentary on “Articular Cartilage Thickness at the Distal Radius: A Cadaveric Study”. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.038

[48] Does Reusable Instrumentation for Four-Anchor Rotator Cuff Repair Offer Decreased Waste Disposal Costs and Lower Waste-Related Carbon Emissions?. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00200

[49] Performance evolution of the Nano Boron nitride enhanced bone cement composites. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05626-1

[50] Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507306465

[51] 3D-printed custom-designed prostheses for partial hand amputation: Mechanical challenges still exist. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2020.04.005

[52] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

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[54] Cemented Versus Uncemented Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint With a Mean 5-Year Follow-Up. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.030

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[60] A prospective randomised trial of absorbable versus non-absorbable sutures for wound closure after fasciectomy for Dupuytren’s contracture. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409105728

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