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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)

The number of domestic animal bites is on an uptrend, but the numbers are underestimated as not all patients visit hospitals to seek treatment [Lee KJ et al. Domestic dog and cat bites: Epidemiology and analysis of 823 cases over the last 5 years. J Wound Manag Res 15 (2): 68-77, 2019]. Among all bites, bites to the extremities such as hands and fingers have a higher rate of infection than elsewhere in the body due to superficial structures and high vascularity, which can aid the rapid spread of the infection [Lim JS, Byun JH, Min KH, Lee HK, Choi YS. Osteomyelitis following domestic animal bites to the hand: Two case reports and practical guidelines. Arch Plast Surg 43 (6): 590–594, 2016]. The general perception of the public about pet animal bite is that wounds that are larger and have extensive tissue involvement are dangerous, while meager puncture wounds or scratches are harmless [Kim JWK, Kim JY, Kim UG, Kang DH, Kim DS, Kim JD. Treatment of phalangeal osteomyelitis caused by a cat bite. Clin Case Reports 9 (10): 1–10, 2021]. In contrast, a small penetrating puncture injury by a pet is often considered harmless and is not treated properly, which eventually requires surgical procedure and results in permanent functional impairment for the patient [Lim JS, Byun JH, Min KH, Lee HK, Choi YS. Osteomyelitis following domestic animal bites to the hand: Two case reports and practical guidelines. Arch Plast Surg 43(6): 590–594, 2016]. Animal bites to the extremities, particularly the hands and fingers are commonly encountered as they are the most exposed parts of the body. Such bites can result in inflammation of the tendon sheath, septic arthritis, and in some cases, osteomyelitis, depending on the depth of the bite [Lim JS, Byun JH, Min KH, Lee HK, Choi YS. Osteomyelitis following domestic animal bites to the hand: Two case reports and practical guidelines. Arch Plast Surg 43 (6): 590–594, 2016]. Dog bites usually do not reach up to bone-deep, while cat bites tend to cause deep, penetrating wounds due to their sharp needle-like teeth, which can pierce joint capsules and inoculate oral flora deeper into joint capsule and periosteum [Lee KJ et al. Domestic dog and cat bites: Epidemiology and analysis of 823 cases over the last 5 years. J Wound Manag Res 15(2): 68–77, 2019; Kim JWK, Kim JY, Kim UG, Kang DH, Kim DS, Kim JD. Treatment of phalangeal osteomyelitis caused by a cat bite. Clin Case Reports9(10): 1–10, 2021; Elcock KL, Reid J, Moncayo-Nieto OL, Rust PA. Biting the hand that feeds you: Management of human and animal bites. Injury 53(2): 227–236, 2022, https://doi.org/10.1016/j.injury.2021.11.045]. Conversely, dog bites are more destructive causing large wounds that drain freely [Lim JS, Byun JH, Min KH, Lee HK, Choi YS. Osteomyelitis following domestic animal bites to the hand: Two case reports and practical guidelines. Arch Plast Surg 43(6): 590–594, 2016]. This is one of the most important reasons why cat bites are more harmful than dog bites. Pasteurella multocida, a small Gram-negative coccobacillus, is an oral commensal in many domestic animals, particularly dogs (isolated in 50–60% of cultures) and cats (isolated in 70–90% of cultures) harbor a higher proportionate of this organism in their oral cavity [Chodakewitz J, Bia FJ. Septic arthritis and osteomyelitis from a cat bite. Yale J Biol Med 61(6): 513–518, 1988]. Human infections with P. multocida are commonly encountered following animal bites or scratches [Kim JWK, Kim JY, Kim UG, Kang DH, Kim DS, Kim JD. Treatment of phalangeal osteomyelitis caused by a cat bite. Clin Case Reports 9(10): 1–10, 2021]. However, these can also occur in the absence of trauma in cases where the animal’s secretions come in contact with a wound or mucous membrane of an individual [Elcock KL, Reid J, Moncayo-Nieto OL, Rust PA. Biting the hand that feeds you: Management of human and animal bites. Injury 53(2): 227–236, 2022, https://doi.org/10.1016/j.injury.2021.11.045; Chodakewitz J, Bia FJ. Septic arthritis and osteomyelitis from a cat bite. Yale J Biol Med 61(6): 513–518, 1988]. We present a case report of a child with a pet cat bite to the right hand, leading to osteomyelitis of the trapezoid bone due to negligence.

The wrist and thumb postures adopted during the use of three different types of computer mouse (mini mouse; standard mouse; MouseMan) to perform eight standardized tasks were evaluated. Thirty elementary students between seven to twelve years of age were studied using a magnetic tracking system. The peak value and angular range of motion of the wrist and thumb extension/flexion and radial/ulnar deviation were measured during performing 8 standard tasks. There were statistically significant larger values in the standard mice with regard to extreme wrist extension. Angular range of wrist extension observed for the standard mice were also much higher than the mini mouse and MouseMan. There were statistically significant larger values in the MouseMan with regard to extreme wrist ulnar deviation, and an average decrease in extreme thumb flexion and angular range of thumb flexion. The results from the questionnaire showed that most elementary students preferred to use the standard mouse (40%) next was the MouseMan (37%); and the last the mini mouse (23%). The recommendation of mouse types based on the hand length for elementary students was not statistically significant in our study.