To Örebro University

Introduction: Total wrist arthroplasty (TWA) is a motion-preserving treatment option for wrist arthritis. High-precision measurement methods for implant migration such as computed tomography motion-analysis (CTMA) can potentially detect poor implant fixation. The aim of this pilot study was to assess CTMA as a complementary method to diagnose aseptic loosening of TWA.

Materials and Methods: Three patients with a TWA and wrist pain during activity underwent induced displacement CT (CTMA) with alternated provocations as a complement to plain radiographs.

Results: Two of the three patients had displacement of the carpal component on CTMA. The radial component was stable in all cases. The tool was adapted to clinical routine use.

Conclusions: CT motion-analysis could be a valuable adjunct to plain radiographs in assessing component loosening in TWA.

Arthroscopy has evolved significantly with advancements in instrumentation and surgical techniques. The introduction of needle arthroscopy represents a promising minimally invasive alternative and, has for the wrist proven to offer a reduced soft tissue trauma with still maintained diagnostic and therapeutic efficacy. The purpose of this study was to evaluate the safety and visualization capabilities of needle arthroscopy of the elbow using cadaveric specimens. Six fresh-frozen cadaveric elbows (three right, three left) were examined using a needle arthroscope, followed by dissection to assess portal safety and proximity to neurovascular structures. The arthroscopic portals evaluated included the proximal anteromedial (PAMP), anteromedial (AMP), mid-anterolateral (MALP), postero-lateral (PLP), direct lateral, and direct posterior portals. The visualization quality of the needle arthroscope was found satisfactory and the smaller diameter (1.9 mm), allowed enhanced maneuverability. Needle arthroscopy offers improved access and acceptable visualization, potential risks remain, particularly concerning neurovascular structures. Notably, the anteromedial portal was in close proximity to the median nerve and medial antebrachial cutaneous nerve (MABCN), with one documented case of PBMACN (Posterior Branch of the MA-BCN)injury. Our results support the use of the needle arthroscope for elbow arthroscopy. However, caution is required to minimize neurovascular injury. Further studies are needed to establish standardized protocols and confirm the long-term safety and efficacy of needle arthroscopy in clinical practice.

Introduction: Wrist arthroplasty is a motion-preserving procedure. However, despite improvements in implant design, implant failure remains an issue. The aim of this secondary analysis was to assess failures associated with synovitis and to report histopathological findings in an initial patient cohort (n = 40) reported previously.

Materials and Methods: Eleven cases of implant failure and synovitis were identified among hemi and total wrist arthroplasties with a carbon fiber reinforced poly-ether-ether-ketone (CFR-PEEK) articulation.

Results: Six cases had undergone component exchange/revision; of these, five were revised to a radiocarpal arthrodesis. Pronounced wear of the CFR-PEEK articulating surface was noted. Histopathological examination indicated that CFR-PEEK particles were incorporated by macrophages, but no giant cell reactions could be seen.

Conclusion: A high frequency of synovitis warranting reoperation was noted. We recommend caution and close monitoring of CFR-PEEK articulations in the wrist.

BACKGROUND: Ulnar neuropathy at Guyon's canal is rare, but when it occurs, it is frequently due to underlying masses, including extraneural and intraneural ganglion cysts, as well as adventitial cysts. The pathogenesis of these cysts, especially at a rare site, remains controversial. The articular theory, which is gaining popularity, posits that a joint connection via a nerve (or vascular) branch to a neighboring joint represents the pathway for their formation and propagation.

OBSERVATIONS: A recently published case of a patient with an ulnar intraneural ganglion at the wrist with a series of postoperative cystic recurrences was reevaluated, as it challenged the articular theory. No discrete articular branch had been identified on imaging or at surgery. Serial MR images were reinterpreted, which revealed that the original intraneural cyst was treated; new sequential cysts-an adventitial cyst and then a soft tissue ganglion-developed, all arising from the same wrist joint.

LESSONS: This case strengthens the principles of the articular theory for intraneural ganglion, adventitial, and soft tissue ganglion cysts. A small wrist connection from the ulnar intraneural ganglion was unrecognized and untreated. Scarring disrupted the original nerve pathway and pressure dynamics. New cysts developed through neighboring joint capsular rents along different pathways into other "compartments" (vessel or soft tissues). https://thejns.org/doi/10.3171/CASE25618.

PURPOSE: To evaluate patient experience after a revised pathway combining same-day shared medical appointments with in-office wide-awake local anesthesia with no tourniquet (WALANT) carpal tunnel release, and to assess efficiency, waste generation, and costs.

METHODS: This prospective observational pilot study included patients undergoing carpal tunnel release using a revised pathway at a Swedish hand surgery department. Approximately six patients per half-day session attended a structured preoperative shared group information session before surgery, with an opportunity for individual questions before local anesthesia. Procedures were performed in two consultation rooms using WALANT, field sterility, limited draping, absorbable sutures, and simplified follow-up. No anesthesiologist or anesthesia personnel were involved. Patient experience was assessed with the Picker Patient Experience-15 (PPE-15) questionnaire and postoperative questions. Waste was weighed and a cost-reduction analysis was performed.

RESULTS: Sixty patients (mean age 55 years, 70% women) underwent 62 carpal tunnel releases. The mean PPE-15 score was 97.8, and 57 of 60 respondents reported no pain. Of the 17 patients with previous contralateral standard carpal tunnel release, 16 rated the revised pathway as better and one as equal. Five patients met the criteria for physician wound assessment; none had infection. Waste was reduced from 2.20 kg to 0.55 kg per procedure. The estimated saving was 225 Euro per procedure at the clinic level and 289 Euro at the regional level when reduced follow-up was included.

CONCLUSION: Same-day shared medical appointments combined with in-office WALANT carpal tunnel release were associated with high patient satisfaction, low reported pain, reduced waste, improved efficiency, and lower estimated costs. Larger comparative studies are needed to confirm the safety and evaluate the independent effect of group information.

Basosquamous carcinoma (BSC) is a rare, aggressive skin cancer with histologic features of both basal and squamous cell carcinoma. This report describes an unusual case of rapidly growing and extensive BSC of the forearm in a 52-year-old male, a rare location for this cancer type. Despite surgical excision with near-complete margins and postoperative wound management using negative-pressure wound therapy (NPWT), the tumor recurred within eight weeks. The case raises concerns about the adequacy of margin control, the possible role of intraoperative tumor cell seeding, and the influence of NPWT and subsequent skin grafting on tumor recurrence. Following re-resection and radiotherapy, the patient achieved excellent functional outcomes, regaining good hand use and returning to competitive motorcycle racing. This case highlights key diagnostic, surgical, and postoperative challenges in managing aggressive BSC in an atypical location and suggests the need for further research into the safety of NPWT in oncologic surgery.

PURPOSE: Arthroscopy remains the gold standard to diagnose ligamentous lesions in the wrist. The coronavirus disease (COVID)-19 pandemic put a strain on resources, prompting an increase in procedures performed under local anesthesia. Dry needle arthroscopy of the wrist has previously been used in the operating room. The purpose of this study was to assess the results and patient satisfaction of wrist arthroscopy under local anesthesia in an office setting.

METHODS: A prospective series of 15 patients presenting with wrist trauma and a suspected ligamentous injury to the wrist were included. All patients underwent radiography and magnetic resonance imaging (MRI) before the procedure. Dry needle arthroscopy was performed by a surgeon with a nurse assistant, in the office under local anesthesia, using a traction device for distraction of the wrist. Patient satisfaction was assessed with the Picker Patient Experience-15 (PPE-15) questionnaire.

RESULTS: The patient's mean age was 34 years (range: 18-51). There were no intraoperative complications or postoperative infections. The median PPE-15 score was 90 of 100. Visualization of the intraarticular structures was excellent.

CONCLUSIONS: Dry needle arthroscopy of the wrist under local anesthesia in an office setting seems to be a feasible method to diagnose ligament injuries of the wrist. Patient satisfaction with the procedure was high.

CLINICAL RELEVANCE: Dry needle arthroscopy of the wrist under local anesthesia in-office could facilitate and expedite diagnosis of wrist injuries.

Salvage radiocarpal arthrodesis is an option in the treatment of failed wrist arthroplasty. If bony union is achieved the results can be comparable to primary wrist arthrodesis. Substantial bone loss and decreased vascularity of the bone may be an issue in some cases. The present case report describes the case of a 58-yearold man with posttraumatic wrist arthritis after an intraarticular distal radius fracture. He was treated with a wrist hemiarthroplasty which ultimately failed and was converted to a radiocarpal arthrodesis. After two failed arthrodeses with bone grafting and a dorsal locking plate, we performed a free vascularized fibula transfer which resulted in bony union and a pain-free wrist. Free vascularized fibula transfer may be a salvage option in select cases of failed radiocarpal arthrodesis.

BACKGROUND: Distal radius fractures (DRFs) are among the most common orthopedic injuries requiring surgical intervention. Understanding whether single- or dual-surgeon setting correlates to operation time, radiological results, or complication rates is essential for optimizing resource allocation and training strategies in clinical settings.

METHODS: All DRFs treated operatively with volar plate fixation in 2023 were included in the study. Data were collected on the number of surgeons involved in each procedure and their respective levels of experience. These variables were analyzed in relation to operative time, radiological outcomes, postoperative complications, and AO classification.

RESULTS: The study cohort included 163 operatively-treated DRFs with a mean follow-up of 15 months (range: 9-20). The most common fracture types were AO types A (n = 80, 49%) and C (n = 80, 49%). Of all procedures, 45% (n = 73) were performed by a single surgeon, while 55% (n = 90) involved two surgeons. Operative time was significantly shorter when surgeries were performed by a single surgeon. Radiological outcomes and complication rates did not differ significantly based on the number of surgeons involved, irrespective of their experience level. When less experienced surgeons were excluded and only more complex fractures were analyzed, the trend toward shorter operative time with a single surgeon persisted, though the difference did not reach statistical significance.

CONCLUSIONS: The involvement of two surgeons does not necessarily correlate to operative time in the treatment of DRFs. Furthermore, radiological outcomes and complication rates appear unaffected by the number of surgeons. These findings may support more efficient allocation of surgical resources in hospital settings. The impact and importance of teaching and training in this context warrants further investigation.