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During a 15-year period, 145 patients presenting with cubital tunnel syndrome were operated upon. They are divided into two groups: (1) Primary tunnel syndrome — 27 cases (18.6%), with a "pure" past history, and (2) secondary — 118 cases (81.4%) with the lesion occurring after a known causative event. Investigation of 100 healthy persons, 50 men and 50 women (200 extremities) show, when elbow flexes, the ulnar nerve moves around the epicondyle in 50% of men, whereas in the remainder nerve subluxation or dislocation anteriorly to the epicondyle occurs. In women, the figures are 72% and 28%, respectively. Apparently in men, the nerve being more mobile is more sensitive to gliding impairment in the tunnel compared to women. In the series of 145 patients, there is a 4.5 : 1 men-to-women ratio, the men being affected much more often. The role of traction in the pathomechanic is further suggested by two facts: the presence of elbow flexion contracture (52%) of the patients and firm ulnar nerve adhesions to the tunnel wall (73%).

Skin electroresistance assessment using a high-sensitivity microamperimeter was conducted in 100 patients. Skin electroresistance may remain within normal limits even in cases of expressed sensory and motor impairment. This points to the great resistance of sympathetic fibres against the compression and traction within the canal. Concerning the type of anterior transfer, a combined procedure was used by placing the nerve subcutaneously for the proximal part, and intramuscularly for the distal one. Nerve recovery may proceed even ten years after anterior transfer.

In anterior interosseus nerve syndrome, reconstruction of the paralyzed flexor pollicis longus is occasionally required. Traditionally, the brachioradialis has been used as a motor, but we utilised the palmaris longus, which is expendable. The palmaris longus tendon was transferred in an end-to-side manner, leaving the flexor pollicis longus in situ. The procedure was performed in three patients. All patients regained a full range of thumb interphalangeal joint motion and an average 90% of the pinch strength. The only complication noted was thenar pain due to the adhesion of the palmar branch of the median nerve with the transferred tendon in one patient. This can be avoided if the interlacing suture was placed more proximally. Palmaris longus transfer is a simple technique that gives a satisfactory result.

Metacarpals are unique bones that support the finger to aid hand function. Metacarpals are also the commonest bones to get fractured in the hand. Historically, most metacarpal fractures were managed conservatively. Due to increased patient expectations as well as advancements in diagnosis and osteosynthesis, various surgical options are now available for metacarpal fractures. The goal of operative management of metacarpal management is no longer limited to achieving clinical or radiological union. To restore hand function to a preinjury level, the surgeon must achieve adequate anatomical reduction and stable fixation with minimal soft tissue damage. Similar to tendon repair, to start early active motion should be the goal after metacarpal fracture fixation. Intraoperative consideration should also include minimizing soft tissue damage and avoiding tendon, ligament or capsular entrapment. The aim of this article is to explain the principles of surgical management, the different options available for metacarpal fractures, the techniques, pearls, advantages and disadvantages of each technique, so the surgeon can choose the ideal option to achieve the best result.

Background: Clinical manifestations of camptodactyly are varied and no official consensus on the etiopathogenesis or best treatment is available. Conservative treatment is generally preferred and, in refractory patients, surgery might be considered. However, reported results of surgery are often unsatisfactory and it is difficult to compare outcomes as different classification systems are adopted. We reported the outcomes of surgical treatment of camptodactyly with the Malek cutaneous approach and stepwise release, assessed using the Siegert classification.

Methods: A retrospective analysis of paediatric patients (≥1 and ≤18 years) with congenital camptodactyly refractory to conservative management (flexion contracture >30°), treated with Malek cutaneous approach and stepwise release surgery between June 2009 and June 2019 with at least 1 year of follow-up was performed. Pre- and post-operative clinical and radiographic assessments were evaluated for degrees of flexion contractures and early (<30 days) or late (>30 days) complications were recorded.

Results: A total of 59 patients underwent surgery, of whom 38 (64%), including 42 fingers, were enrolled; mean patient age was 8 years (range 1–18). Post-operative mean flexion contracture was significantly improved (p > 0.001) and no infections were recorded. Mean follow-up was 6 years (range 1–10) and proximal interphalangeal joint extension deficits were rated according to Siegert classification as excellent (69%), good (12%), or fair (9.5%) and poor (9.5%).

Conclusions: The Malek cutaneous approach and stepwise release of the retracting soft tissues allow prompt evaluation of the anatomical structures involved in the deformity and seem to be an effective surgical correction in the long term.

Level of Evidence: Level IV (Therapeutic)

The Buck-Gramcko (BG) technique of pollicisation has stood the test of time and provides good to excellent prehensile function in thumb hypoplasia. Proponents of the technique favour it because it provides good exposure to the palmar neurovascular structures. However, the skin flap design may occasionally lead to a ‘finger-like’ appearance with a sharp interdigital cleft and a triphalangeal form. In this report, we describe some of the important aspects of the operative technique so that the outcome is aesthetically pleasing in addition to providing good function.

Level of Evidence: Level V (Therapeutic)

Background: Dual mobility total joint arthroplasty is gaining popularity for trapeziometacarpal joint (TMCJ) arthritis, with evolving indications, surgical technique and rehabilitation. The aim of this study was to obtain detailed insight into the variations in indications, surgical technique and rehabilitation for TMCJ arthroplasty with dual mobility implants, across a large international cohort of surgeons. The secondary aim was to analyse if there were differences in TMCJ arthroplasty between highly and less experienced surgeons.

Methods: An anonymised online survey was developed and distributed to the international hand surgery community of surgeons performing TMCJ arthroplasty. Responses were summarised, and a sub-analysis comparing indications, contra-indications, surgical technique, implant placement, rehabilitation and complications between highly and less experienced surgeons was performed.

Results: Of the 203 included respondents, 59 were considered highly experienced. Most respondents perform TMCJ arthroplasty under regional anaesthesia (84%), via a dorsolateral approach (78%) and with image-guidance for cup placement (84%). However, there is considerable variation in handling of scaphotrapeziotrapezoidal (STT) arthritis, cup positioning landmarks, postoperative immobilisation, first extensor compartment release and revision techniques. Highly experienced surgeons performed TMCJ arthroplasty for a larger proportion of their patients undergoing surgery for TMCJ arthritis, and a trapezium smaller than 8 mm or STT-OA was less frequently considered a contra-indication. Highly experienced surgeons preferred freehand osteotomy of the metacarpal and allowed office workers to return to work earlier.

Conclusions: This survey shows that there is considerable variation in (contra)indications, surgical technique and rehabilitation amongst surgeons performing TMCJ arthroplasty, but only a few differences between highly and less experienced surgeons were identified. This data provides a reference for surgeons who want to familiarise themselves with increasingly popular procedure and may help surgeons already performing TMCJ arthroplasty to identify potential topics for future research to optimise its outcome.

Level of Evidence: Level V (Therapeutic)

Complications of the anterior and posterior surgical approaches to cervical spondylosis are uncommon, however, they can have devastating consequences. It is with an understanding of the potential complications that may occur that improvements in technique and results may follow. In order to treat these problems, the surgeon must first understand the etiology and consequences of their occurrence. A more appropriate plan management of a complication can then be formulated.