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Background: Partial wrist arthrodesis (PWA) is a salvage procedure used in advanced wrist arthritis and has traditionally been performed via an open dorsal approach. In recent years, surgeons have moved towards arthroscopic fusions to minimise soft tissue damage and preserve vascular supply, increase union rates and hasten recovery. The purpose of this study is to synthesise the current literature on the outcomes of arthroscopic PWA.

Methods: A systematic review was performed to survey the literature regarding outcomes of PWA. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. Data collected included patient demographics, operation time and technique, complications and postoperative patient outcomes in the form of patient-rated surveys, grip strength, range of motion and the pain visual analogue scale (VAS).

Results: Twelve studies were eligible for inclusion, with a total of 191 patients. 94% of patients achieved union, with a mean time to fusion of 12.5 weeks. VAS, Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist scores were significantly improved after the procedure, and complication rates were comparable to open procedures. Range of motion varied greatly across studies, due to heterogeneity in carpal intervals fused.

Conclusions: Arthroscopic PWA is a safe and effective procedure in the treatment of advanced arthritis of the wrist. Further comparative studies would be useful in assessing benefits of arthroscopic arthrodesis over an open approach.

Level of Evidence: Level III (Therapeutic)

Background: Palmar midcarpal instability (PMCI) is often neglected in diagnosis and lacks a gold standard treatment. It is primarily associated with dorsal radiocarpal (DRC) ligament insufficiency. We used a combined approach of arthroscopic thermal capsular shrinkage and open DRC ligament suture tensioning for symptomatic PMCI and present our outcomes.

Methods: From 2018 to 2022, nine PMCI patients (mean age: 32 years) underwent this treatment. The mean symptom duration was 15.3 months, with a mean follow-up of 16.8 months. Outcomes were measured by wrist ROM, grip strength, VAS for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and modified Mayo Wrist scores.

Results: All patients showed significant improvement in pain, grip strength and function, with maintained radiocarpal stability at final follow-up. Although wrist ROM showed mild limitation after surgery, all patients returned to their previous work and activities.

Conclusions: This approach may provide an effective and less aggressive treatment for PMCI.

Level of Evidence: Level IV (Therapeutic)

This paper presents a systematic literature review on optimizing feature extraction for palm and wrist multimodal biometrics. Identifying informative features across different modalities can be computationally expensive and time-consuming in such complex systems. Optimization techniques can streamline this process, making it more efficient thereby improving accuracy and reliability. The paper frames four research questions on input traits, approaches for feature extraction, classification approaches, and performance metrics of image data. The search query is generated based on the research questions that help retrieve the information on the above parameters. The focus of this paper is to provide the comprehensive and exhaustive gestalt of the appropriate input traits for image data from the information retrieved as well as optimal feature extraction and selection. However, the paper also intends to highlight the various classification approaches taken as well as the performance indicators against those classifiers. Further, the paper aims to analyze the effectiveness of various filtering techniques in eliminating image noise and improving overall system performance using MATLAB 2018. The paper concludes that a combination of palm and wrist biometrics could be a good input-trait combination. This work is novel as it covers multi-faceted processing, addressing various aspects of optimizing feature extraction and selection for palm and wrist multimodal biometrics.

Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.

We report the outcome of a five-year follow-up after wrist arthroscopy and excision of painful dorsal wrist ganglia. The findings at the time of surgery have previously been published. Patients responded to a validated postal questionnaire regarding ganglion recurrence, wrist pain and function. None of the responding patients had recurrence of the ganglia since surgery but only one patient had remained pain free with normal function following surgery. Three of the remaining patients reported moderate to severe problems with work and four reported minimal work problems. Our findings suggest patients with arthroscopic confirmed ligament injuries leading to joint instability or localised osteoarthritis may develop functional disability but less severe injuries are unlikely to cause persistent problems in the short- to medium-term. Surgical excision of the ganglion can give lasting satisfactory cosmetic outcome despite persisting underlying ligament pathology.

Synovial chondromatosis is a rare lesion in the wrist and it is extremely uncommon in the distal radioulnar joint. This case presented with wrist pain, swelling and locking secondary to synovial chondromatosis of distal radioulnar joint.

To compare the radioscapholunate (RSL) arthrodesis and radiolunate (RL) arthrodesis as a treatment for radiocarpal osteoarthritis following fractures of the distal radius, nine patients, 23 to 70 years old (average 41) at the time of surgery, were assessed two to 33 years after surgery. The periods between injury and surgery ranged from four months to 30 years. RSL arthrodesis was performed in three cases and RL arthrodesis in six. Post-operative wrist pain disappeared in six and was decreased in the other three. In the RSL group, the total arc of wrist flexion and extension was reduced from 50° pre-operatively to 35° post-operatively. In the RL group, it was increased from 72° to 76° after surgery. Grip strength improved in most patients, from 7 to 18 kg in the RSL group, and from 16 to 27 kg in the RL group. On roentogenogram, three patients showed arthritic changes in the adjacent joints, but there were no symptoms in two of the three patients. We concluded that partial radiocarpal arthrodesis (preferably RL arthrodesis) is a reliable procedure for radiocarpal osteoarthritis following fractures of the distal radius.

We report a case of ulnar tunnel syndrome due to an anatomical variant branch of the ulnar artery. Anatomical variants can cause compression not visible on imaging and need to be considered for successful surgical decompression.

Anatomical variations of the ulnar nerve have been described at the level of the elbow and in Guyon's canal, while the path in the forearm has always been assumed to be constant. We present a case of compressive ulnar neuropathy at the wrist pre-disposed by a presumed congential variation of the path of the ulnar nerve at the level of the wrist which improved following surgical release of the constriction caused as a result of it.

Pain and disability caused by ganglia of the hand and wrist were assessed using a patient-rated wrist evaluation questionnaire in 75 patients. Dorsal wrist ganglia were the most painful and disabling. However, the majority of ganglia cause little pain or disability. Consequently, referral by General Practitioners should be confined to those with pain, disability or failure of conservative management.

We report an abnormal muscle on the radial aspect of the wrist, which presented clinically as a ganglion and radial wrist pain. Existence of muscles in the first compartment has been accounted earlier, however its atypical presentation advocates its inclusion in the differential diagnosis of a dorso-radial ganglion and wrist pain.

The authors present the procedure and results of five years of arthroscopic treatment of wrist radiocarpal and midcarpal ganglia. Thirty cases of dorsal ganglia and seventeen cases of volar ganglia were operated on arthroscopically. The technique was easy to perform in all the radiocarpal ganglia, not easy in midcarpal dorsal ganglia and very difficult in midcarpal volar ganglia. The results were recorded with a mean follow-up of 15 months. Twenty-seven cases of dorsal ganglia and twelve cases of volar ganglia had excellent results with active motion recovery, no complications, absence of scars and no recurrence. Two cases had a recurrence. There were four complications: a case of injury of a radial artery branch, a case of extensive haematoma, and two cases of neuropraxia. In three cases the procedure was converted into open surgery: they had a longer time of healing and a residual scar. The arthroscopic resection has been in our experience effective and safe for the treatment of all radiocarpal ganglia. Good results have been obtained also in the treatment of dorsal midcarpal ganglia. Concerning the uncommon cases of volar midcarpal (STT) ganglia, an open approach seems still indicated.

The aim was to study the relationship between impairment (function) and disability (participation) in wrist surgery, according to the WHO definitions.

The outcome of 205 wrist operations were studied. The impairment was expressed as range of motion (ROM) and gripping force, the disability as the DASH score.

There was a significant correlation between DASH and gripping force (R = 0.47). The correlation between ROM and DASH was weaker (R = 0.24).

In manual workers, shorter temporary disability periods were significantly associated with lower DASH score.

In (reconstructive) wrist surgery, impairment, disability and working status are significantly correlated. Gripping force measurement is a reliable tool for evaluation and gives a good impression of the disability. Preservation of some mobility is important, however the amount of ROM is not essential for the disability.

As the distal radius fracture is one of the most commonly encountered upper limb injuries, the aim of this study was to provide a quick and easy method to aid in the assessment of fractured wrists, both pre- and post-fixation, by utilising the relationship of the radial shaft and the lunate.

A retrospective analysis on 100 consecutive patients with normal wrist radiographs was performed. The results demonstrated that the variations of radiolunate anatomy followed a normal distribution. The normal anatomical relationship was then described.

A second part to the study consisted of reviewing our method of radiocarpal analysis on a cohort of patients who had sustained a distal radius fracture. Carpal alignment pre- and post-fixation was measured, with the results demonstrating that by using this assessment method, it was possible with a quick glance of the radiograph, to determine whether satisfactory correction of the fracture had been achieved.

Wrist glomus tumours are extremely rare. We report a case of an unusually large wrist glomus tumour with atypical presentation. Magnetic resonance imaging (MRI) findings correlated well to those previously described for digital glomus tumours. This rare differential should be considered when evaluating lesions around the wrist.

We report a case of carpal instability complex, which presented apparent volar intercalated segmental instability (VISI) caused by acute injury. Proper diagnosis and treatment by ligament repair and Kirschner wire fixation yielded good clinical results.

A retrospective analysis of 227 patients undergoing ultrasonography (US) of the hand/wrist over a three-year period in a district general hospital trust was performed. The usefulness in each case was assessed by two independent reviewers using a qualitative rating system, as (A) Useful: determines management, (B) Useful: contributory, (C) Not useful: not misleading, or (D) Not useful: misleading/potentially harmful. US was useful in 74.8% of cases but misleading/potentially harmful in 13.1%. Misleading rates exceeding 10% in sub-categories including tendinopathy, carpal tunnel syndrome, foreign body and lumps, where US findings may influence the decision to operate or not, are particularly worrying. There were a number of cases where US led to unnecessary operations or suggested operating on the wrong structures, and also cases where US findings wrongly suggested that surgery was unnecessary. Various recommendations aimed to improve the usefulness of US in the Hand and Wrist, including mandatory/formal musculoskeletal US training, are made.

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease.

Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study.

Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228).

Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.

Wrist arthroscopy has been successfully used with many modifications and improvements. However, distal radioulnar joint (DRUJ) arthroscopy is still uncommon. We experienced 2 cases of ulnar-sided wrist pain due to isolated triangular fibrocartilage complex (TFCC) disk tear within the DRUJ. DRUJ arthroscopy in these cases showed horizontal tear and fibrillation of TFCC disk without TFCC tear at the radiocarpal joint. Foveal attachment was intact in both cases. These were treated with debridement, which relieved pain after surgery and achieved good functional recovery. Although DRUJ arthroscopy is technically difficult, it is mandatory for making a diagnosis and treating ulnar-sided wrist pain.

Total dislocation of the capitate is an extremely rare event. We report on one such unusual case. The complete expulsion of the capitate from its physiological position is difficult to diagnose. Standard parameters of the antero-posterior and lateral radiological do not head to a definite diagnosis.

In our patient, the only real diagnostic tool was the clinical assessment and the Gilula arches alteration to the standard antero-posterior projection. In the period following trauma, the patient reported a very high level of pain in the wrist. Since this could not be correlated to the lesions that had been diagnosed, we hypothesized the presence of any carpal bones damage. A definite diagnosis was obtained at CT scan, which also revealed the absence of any fractures.