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Purpose: To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain. Methods: In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference. Results: In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference (p = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14 days. Conclusions: CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast. [ABSTRACT FROM AUTHOR]

Summary: A 1‐month‐old Paint filly was diagnosed with a latero‐distal luxation of the fourth carpal bone associated with avulsion fractures of the third and fourth carpal bones and rupture of intercarpal ligaments based on clinical, radiography and computed tomography examination. A carpometacarpal (CMC) joint arthrodesis was performed using a lateral 3.5 mm 5‐hole Locking Compression Plate (LCP) T‐plate and a medial 3.5 mm 5‐hole narrow LCP plate associated with mediocarpal arthroscopic exploration. An external coaptation was maintained for 6 weeks. No complication was reported and the filly was full loading the day after surgery. Radiographical follow‐up was available 6 and 14 weeks after surgery showing an intact construct and stable fixation with a complete fusion of the lateral part of the carpometacarpal joint at 14 weeks postoperatively. The filly was sound on pasture without angular deformity 4 months after surgery. Luxation of the fourth carpal bone was successfully stabilised using two LCP plates, leading to complete soundness and preservation of middle carpal joint motion. [ABSTRACT FROM AUTHOR]

The assessment of biological maturation is a central topic in pediatric exercise sciences. Skeletal age (SA) reflects changes in each bone of the hand and wrist from initial ossification to the adult state. This study examined intra-observer and inter-examiner agreement is Greulich-Pyle (GP) assessments of SA in 97 male tennis players 8.6–16.8 years of age. Two observers independently examined all films on two occasions using the GP method. The SA of each bone was evaluated. The mean and median of SAs assigned for each bone was the individual SA for each participant. The calculation was exclusively based on the bones that were not skeletally mature. Intra-observer mean differences were significant for several bones with better results by the experienced examiner (observer B). Comparisons between SA values of the two independent observers indicated significant differences for the ulna, metacarpals II and III, and distal phalanx V. Nevertheless, the magnitude of the bone-specific differences was small, perhaps trivial. Differences in individual SA values of the tennis players based on the non-mature bones of the hand-wrist were negligible based on the mean (0.04±0.39, t = 0.321, p = 0.749) or the median (0.05±0.58, t = 0.007, p = 0.994). Nevertheless, the current study confirmed examiners as a source of error in the estimation of SA using the Greulich-Pyle method and highlighted the importance of calculating SAs based on non-mature bones among adolescent players. [ABSTRACT FROM AUTHOR]

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine. [ABSTRACT FROM AUTHOR]

Objective: To develop MRI-derived carpal kinematic metrics and investigating their stability. Methods: The study used a 4D MRI method to track scaphoid, lunate, and capitate movements in the wrist. A panel of 120 metrics for radial-ulnar deviation and flexion–extension was created using polynomial models of scaphoid and lunate movements relative to the capitate. Intraclass correlation coefficients (ICCs) analyzed intra- and inter-subject stability in 49 subjects, 20 with and 29 without wrist injury history. Results: Comparable degrees of stability were observed across the two different wrist movements. Among the total 120 derived metrics, distinct subsets demonstrated high stability within each type of movement. For asymptomatic subjects, 16 out of 17 metrics with high intra-subject stability also showed high inter-subject stability. The differential analysis of ICC values for each metric between asymptomatic and symptomatic cohorts revealed specific metrics (although relatively unstable) exhibiting greater variability in the symptomatic cohort, thereby highlighting the impact of wrist conditions on the variability of kinematic metrics. Conclusion: The findings demonstrate the developing potential of dynamic MRI for assessing and characterizing complex carpal bone dynamics. Stability analyses of the derived kinematic metrics revealed encouraging differences between cohorts with and without wrist injury histories. Although these broad metric stability variations highlight the potential utility of this approach for analyzing carpal instability, further studies are necessary to better characterize these observations. [ABSTRACT FROM AUTHOR]

Background: Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion. Methods: A review protocol was established according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed/Medline, Cochrane, Embase, and Google Scholar were searched for articles on open and arthroscopic bone grafting for scaphoid nonunion with a minimum 12 month follow-up. The primary outcome was union rates in the two techniques. Secondary outcomes were changes in pain scores, complications, functional outcomes using different scoring systems, grip strength, range of motion at the wrist, and radiological parameters for restoring normal carpal alignment. Results: Forty studies reporting on 1534 wrists were included (1152 open, 382 arthroscopic). The union rate was 93.4% and 93.2% with open and arthroscopic techniques, respectively. The functional scores were comparable between the two techniques. All patients had a reduction in their pain scores. The radiological outcome parameters were not reported by any of the studies in the arthroscopic group. Conclusion: While bone grafting with both open and arthroscopic techniques for scaphoid nonunion showed comparable union rates and functional scores, further research is needed to assess the radiological outcomes of the arthroscopic technique. [ABSTRACT FROM AUTHOR]

Objective: To determine which bones and which grades had the highest inter-rater variability when employing the Tanner–Whitehouse (T-W) method. Materials and methods: Twenty-four radiologists were recruited and trained in the T-W classification of skeletal development. The consistency and skill of the radiologists in determining bone development status were assessed using 20 pediatric hand radiographs of children aged 1 to 18 years old. Four radiologists had a poor concordance rate and were excluded. The remaining 20 radiologists undertook a repeat reading of the radiographs, and their results were analyzed by comparing them with the mean assessment of two senior experts as the reference standard. Concordance rate, scoring, and Kendall's W were calculated to evaluate accuracy and consistency. Results: Both the radius, ulna, and short finger (RUS) system (Kendall's W = 0.833) and the carpal (C) system (Kendall's W = 0.944) had excellent consistency, with the RUS system outperforming the C system in terms of scores. The repeatability analysis showed that the second rating test, performed after 2 months of further bone age assessment (BAA) practice, was more consistent and accurate than the first. The capitate had the lowest average concordance rate and scoring, as well as the lowest overall concordance rate for its D classification. Moreover, the G classifications of the seven carpal bones all had a concordance rate less than 0.6. The bones with lower Kendall's W were likewise those with lower scores and concordance rates. Conclusion: The D grade of the capitate showed the highest variation, and the use of the Tanner–Whitehouse 3rd edition (T-W3) to determine bone age (BA) was frequently inconsistent. A more comprehensive description with a focus on inaccuracy bones or ratings and a modification to the T-W3 approach would significantly advance BAA. [ABSTRACT FROM AUTHOR]

Carpal coalitions are congenital conditions that can cause ambiguous wrist pain and should be considered as a rare possibility in the differential diagnosis, especially in screening settings such as military hospitals. This case report presents the first domestic report of bilateral lunotriquetral coalitions in a 21-year-old military cook who presented with bilateral wrist pain. A radiographic evaluation confirmed a Minnaar type 3 complete osseous coalition. After conservative treatment, the symptoms improved. This case was rare in the Korean context, and the report provides various radiological images along with a review of previously reported cases in the Korean literature. [ABSTRACT FROM AUTHOR]

The scaphotrapeziotrapezoid (STT) joint is involved in load transmission between the wrist and thumb. A quantitative description of baseline STT joint morphometrics is needed to capture the variation of normal anatomy as well as to guide staging of osteoarthritis. Statistical shape modeling (SSM) techniques quantify variations in three‐dimensional shapes and relative positions. The objectives of this study are to describe the morphology of the STT joint using a multi‐domain SSM. We asked: (1) What are the dominant modes of variation that impact bone and articulation morphology at the STT joint, and (2) what are the morphometrics of SSM‐generated STT joints? Thirty adult participants were recruited to a computed tomography study of normal wrist imaging and biomechanics. Segmentations of the carpus were converted to three‐dimensional triangular surface meshes. A multi‐domain, particle‐based entropy system SSM was used to quantify variation in carpal bone shape and position as well as articulation morphology. Articular surface areas and interosseous proximity distributions were calculated between mesh vertex pairs on adjacent bones within distance (2.0 mm) and surface‐normal angular (35°) thresholds. In the SSM, the first five modes of variation captured 76.2% of shape variation and contributed to factors such as bone scale, articular geometries, and carpal tilt. Median interosseous proximities—a proxy for joint space—were 1.39 mm (scaphotrapezium), 1.42 mm (scaphotrapezoid), and 0.61 mm (trapeziotrapezoid). This study quantifies morphological and articular variations at the STT joint, presenting a range of normative anatomy. The range of estimated interosseous proximities may guide interpretation of imaging‐derived STT joint space. [ABSTRACT FROM AUTHOR]

Background/aim: This study aims to compare the Greulich-Pyle (GP) and Tanner-Whitehouse 2 (TW2) methods, both used in left wrist radiography for bone age determination in the pediatric age group, with the Capitohamatum method (CH) due to the importance of determining bone age in the pediatric period. Materials and methods: Direct radiographs of 210 female and 291 male individuals between the ages of 0-15 without any pathology in the left wrist bones were obtained; 501 os capitatum and os hamatum on anterior-to-posterior direct graphic images were measured using the GP, TW2, and CH planimetry methods. The estimated age of each measurement was calculated by evaluating the relationship between chronological age and sex. Results: In male individuals, it was determined that the estimates obtained using the GP method were, on average, 5.1 units lower than the actual ages; the estimates obtained with the TW2 method were, on average, 1.7 units higher than the actual ages. In the female individuals, age estimations obtained by the GP and TW2 methods were 1.4 and 0.5 units lower, respectively, than the chronological ages. It was determined that the ages estimated by the CH method were almost the same as the chronological ages, with no deviation in the estimation method. Conclusion: According to the study findings, it was concluded that the CH method can be used reliably with high accuracy for chronological age determination of children as an alternative estimation method to the GP and TW2 atlases. [ABSTRACT FROM AUTHOR]

In Chinese criminal law, the ages of 12, 14, 16, and 18 years old play a significant role in the determination of criminal responsibility. In this study, we developed an epiphyseal grading system based on magnetic resonance image (MRI) of the hand and wrist for the Chinese Han population and explored the feasibility of employing deep learning techniques for bone age assessment based on MRI of the hand and wrist. This study selected 282 Chinese Han Chinese males aged 6.0–21.0 years old. In the course of our study, we proposed a novel deep learning model for extracting and enhancing MRI hand and wrist bone features to enhance the prediction of target MRI hand and wrist bone age and achieve precise classification of the target MRI and regression of bone age. The evaluation metric for the classification model including precision, specificity, sensitivity, and accuracy, while the evaluation metrics chosen for the regression model are MAE. The epiphyseal grading was used as a supervised method, which effectively solved the problem of unbalanced sample distribution, and the two experts showed strong consistency in the epiphyseal plate grading process. In the classification results, the accuracy in distinguishing between adults and minors was 91.1%, and the lowest accuracy in the three minor classifications (12, 14, and 16 years of age) was 94.6%, 91.1% and 96.4%, respectively. The MAE of the regression results was 1.24 years. In conclusion, the deep learning model proposed enabled the age assessment of hand and wrist bones based on MRI. [ABSTRACT FROM AUTHOR]

Background: Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. Purpose: To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. Material and Methods: A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). Results: The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42–2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73–1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. Conclusion: CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy. [ABSTRACT FROM AUTHOR]

Objectives: Detection of synovitis is essential for assessing the activity and predicting the prognosis of rheumatoid arthritis (RA). The aim of this study was to investigate the diagnostic performance of superb microvascular imaging (SMI) in RA patients with high, moderate, and low activity. Methods: One hundred four patients with active RA were selected from the hospital between May 2022 and August 2023. The study observed the correlation between bone erosion of the carpal joint, joint cavity effusion, thickness of synovial hyperplasia of the carpal joint, positivity rate of synovial blood vessels, and their semiquantitative scores with the clinical disease activity of RA using SMI examination. Results: The detection of synovial hyperplasia thickness and joint effusion in the high-activity group was higher than that in the low-activity group, and the difference was statistically significant (P < 0.05). The quantitative SMI test demonstrated that the synovial blood flow grading and semiquantitative grade increased gradually with activity level (P<0.05). During the high, moderate, and low-activity groups, the vascular index (VI) value of the hyperplastic synovial membrane decreased gradually, showing statistical significance both between and within the groups (P<0.05). Conclusion: SMI technology exhibited high sensitivity and accuracy in assessing disease activity in RA. It holds significant clinical application value as a reliable auxiliary tool for assessing disease activity in RA and treatment. Key Points • Super micro-vascular imaging (SMI) demonstrated higher detection rates of microvessels in RA patients with high disease activity compared to those with low activity, showing statistical significance. • The quantitative SMI test revealed a clear correlation between synovial blood flow grading and disease activity levels in RA patients, highlighting the potential of SMI as a valuable tool for disease activity and treatment of rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Case history: A 4-month-old male Shih Tzu dog (Case 1) and an 11-month-old female Devon Rex cat (Case 2) were referred to specialist veterinary hospitals for evaluation of right thoracic lameness and growth abnormality in the distal aspect of the forelimb. Clinical findings: Non-weight-bearing lameness and decreased range of motion were noted in the affected limbs of both cases. Case 1 had a plantigrade stance, and a cleft separation between the first and second digits extending upwards to the distal third of the antebrachium. There was no pain on palpation, and the affected limb was shorter than the contralateral. Radiographic examination revealed cleft separation between metacarpal bones I and II, and carpal bone fusion (I, II, III), and the distal radius ended freely and was attached to the first metacarpal bone. Case 2 had a small cleft medial to metacarpal III. The limb was consistently held in abduction and had marked carpal varus. The limb had never been used for weight bearing. Radiographic examination showed agenesis of metacarpal bone II and separation of metacarpals I and III. The radius and ulna were separated and the radial head did not articulate normally at the elbow, leading to marked elbow incongruity. Diagnosis: Ectrodactyly in both cases. Treatment and outcome: Amputation of the radius followed by ulnocarpal arthrodesis were performed in both cases. Follow-up evaluations up to 1 year (Case 1) and 10 weeks (Case 2) after surgery indicated satisfactory arthrodesis fusion, owner satisfaction, and a good clinical outcome. Clinical relevance: Ectrodactyly is a rare congenital deformity of the forelimb with a heterogeneous character, requiring an individualised treatment plan. These are the first cases reported in the literature of ectrodactyly in small animals that were treated successfully with ulnocarpal arthrodesis. This case series therefore provides evidence in support of this treatment option for this heterogeneous congenital deformity. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the downsides of surgical treatment of scaphoid fracture nonunion in patients with minor preoperative symptoms. Patients were classified with minor symptoms based on the Patient-Rated Hand/Wrist Evaluation questionnaire. Of the 35 included patients, most patients encountered problems with patient-specific activities; 9% reported worse postoperative functional outcomes, 34% were not satisfied with the treatment and 9% were reoperated. The risk of a worse functional outcome after surgery with the need for further operations and the chance of developing wrist osteoarthritis, along with the possibility of poor patient satisfaction and ongoing daily functional impairment, should be considered during preoperative counselling. Level of evidence: III [ABSTRACT FROM AUTHOR]

This article, published in the Annals of Laboratory Medicine, presents a case study of a 72-year-old man who developed tenosynovitis in his right wrist after surgery. The condition was caused by a mold species called Thyridium endophyticum, which is discussed in detail along with its susceptibility to antifungal drugs. The authors suggest that the patient may have been exposed to the mold during agricultural activities. The article provides valuable information for library patrons researching infectious diseases and looking for specific case studies. [Extracted from the article]

Fractures of the carpal bones are less common than fractures of the metacarpals and phalanges. The triquetrum and scaphoid are the most commonly affected bones, while injuries to other bones are less prevalent. The study aimed to provide updated information on carpal bone fractures other than the scaphoid, focusing on the incidence, fracture mechanism and pattern, diagnosis, methods, and treatment results. Each wrist bone fracture was thoroughly discussed in relation to these aspects. Additionally, the study presented the results of a literature review conducted in PubMed and Medline databases. In conclusion, fractures of the carpal bones other than the scaphoid are moderately common, with conservative treatment being the primary approach. Both conservative and surgical treatments yield good results. [ABSTRACT FROM AUTHOR]

Background: Carpal fractures (incidence: 30-60 per 100 000 persons per year) are one of the more commonly overlooked fracture types. They can have serious consequences, as the use of the hand is indispensable in everyday life. In the following article, we present the elements of the diagnosis and treatment of fractures of the carpal bones. Methods: This review is based on meta-analyses and randomized controlled trials (RCTs) published from 2013 to 2023 that were retrieved by a structured literature search, supplemented by guideline recommendations and expert consensus statements. In addition, data on the administrative prevalence of carpal fractures were obtained from the German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV) and from the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). Results: The administrative prevalence of carpal fractures in 2022 was 44 496 outpatient cases (KV, DGUV) in one year. After clinical history-taking, physical examination and x-ray have been performed, thin-slice computed tomography is recommended as part of the diagnostic evaluation. Treatment recommendations are based on evidence of levels II to IV. Multiple RCTs have been carried out on the treatment of scaphoid fractures, and a clinical guideline exists. Proximal, dislocated and unstable scaphoid fractures should be treated surgically. Non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks). The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobilization of both of these joints. Failure to treat an unrecognized scaphoid fracture can lead to pseudarthrosis, avascular bony necrosis, and misalignment. Other, rarer types of carpal fractures must be managed on an individual basis, as the available evidence is limited to expert consensus. Conclusion: Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases. Although the available evidence on their proper treatment is growing, many questions are subject to expert consensus, and decisions about treatment must be made individually. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the process whereby the screening of racing Thoroughbreds with accelerometer-based inertial measurement unit (IMU) sensors followed by clinical evaluation and advanced imaging identified potentially catastrophic musculoskeletal injuries in 3 horses. ANIMALS: 3 Thoroughbred racehorses. CLINICAL PRESENTATION: All cases demonstrated an abnormal stride pattern either during racing (cases 1 and 2) or while breezing (case 3) and were identified as being at very high risk of catastrophic musculoskeletal injury by an algorithm derived from IMU sensor files from > 20,000 horses' race starts. Veterinary examination and 18F-sodium fluoride (18F-NaF) positron emission tomography were performed within 10 days of the respective race or breeze in each of the cases. RESULTS: The intensity and location of the 18F-Na F uptake in thecondylesof thethird metacarpal bone in cases land 2 identified them asat potential increased risk of condylar fracture. The pattern and intensity of the 18F-NaF uptake in case 3 indicated that the third carpal bone was likely responsible for the horse's lameness, with an impending slab fracture subsequently identified on radiographs. Following periods of convalescence, cases 1 and 2 returned to racing and were identified by the sensor system as no longer being at high risk of catastrophic musculoskeletal injury. Case 3 returned to training but has yet to return to racing. CLINICAL RELEVANCE: When worn by Thoroughbreds while racing or breezing, these IMU sensors can identify horses at high risk of catastrophic musculoskeletal injury, allowing for veterinary intervention and the potential avoidance of such injuries. [ABSTRACT FROM AUTHOR]

Perilunate dislocation is a severe complex injury associated with carpal bone fracture. The most common pattern is trans-scaphoid perilunate dislocation. A transradial, trans-scaphoid, transcapitate, and transtriquetral perilunate dislocation pattern, an extremely rare complex injury of the wrist joint, may be the first reported case of a combination of three carpal bone fractures and radial styloid fracture associated with perilunate dislocation. [ABSTRACT FROM AUTHOR]

Large bone defects of the distal radius and/or carpus following tumor resection, trauma, or infection are extremely rare. There are few case reports and series in the literature on the reconstruction approaches required in such cases. Therefore, large studies cannot be used to guide the therapeutic decisions of reconstructive plastic and hand surgeons. The objective of this study is to propose a treatment algorithm to predict the functional outcome and quality of life for the different techniques of free vascularized bone reconstruction in the interval between the distal radius, the carpus, and/or the proximal metacarpal. The algorithm was developed based on our own case studies and the few treatment approaches described in the literature. It can be applied to rare cases of massive bone defects in the wrist. The flowchart enables surgeons to develop an individualized reconstruction concept for various intervals of bone defects in the area of the distal radius and proximal metacarpal bones. Ultimately, the treatment algorithm aims to maximize future quality of life (QoL) and function of the distal upper extremity in rare cases of massive wrist-bone defects. [ABSTRACT FROM AUTHOR]

A 1-year-old, male, neutered German shepherd dog was presented for a chronic atraumatic non-healing fracture of the right accessory carpal bone, stranguria and polyuria/polydipsia. Biochemistry and urinalysis showed azotaemia. Ultrasound and computed tomography of the abdomen both demonstrated bilateral renal infarcts with pyelectasia, bilateral ureteral dilation and bladder distension. Cystoscopy of the bladder identified a fungal ball obstructing the pelvic urethral sphincter, which was adhered to the bladder mucosa in the region of the ureterovesicular junction. The obstruction was traversed endoscopically, but could not be removed transurethrally. The combination of elevated serum galactomannan titres (6.4) and Aspergillus terreus cultured from urine, confirmed a diagnosis of disseminated aspergillosis. The dog was euthanased due to poor quality of life, guarded prognosis and lengthy timeframe before an expected medical response. This is the first case report describing Aspergillus fungal balls in a dog causing partial urethral and bilateral ureteral obstruction, identified using cystoscopy. [ABSTRACT FROM AUTHOR]

Rheumatoid Arthritis (RA) is a chronic autoimmune illness that occurs in the joints, resulting in inflammation, pain, and stiffness. X-ray examination is one of the most common diagnostic procedures for RA, but manual X-ray image analysis has limitations because it is a time-consuming procedure and is prone to errors. A specific algorithm aims to a lay stable and accurate segmenting of carpal bones from hand bone images, which is vitally important for identifying rheumatoid arthritis. The algorithm demonstrates several stages, starting with Carpal bone Region of Interest (CROI) specification, dynamic thresholding, and Gray Level Co-occurrence Matrix (GLCM) application for texture analysis. To get the clear edges of the image, the component is first converted to the greyscale function and thresholding is carried out to separate the hand from the background. The pad region is identified to obtain the contours of it, and the CROI is defined by the bounding box of the largest contour. The threshold value used in the CROI method is given a dynamic feature that can separate the carpal bones from the surrounding tissue. Then the GLCM texture analysis is carried out, calculating the number of pixel neighbors, with the specific intensity and neighbor relations of the pixels. The resulting feature matrix is then employed to extract features such as contrast and energy, which are later used to categorize the images of the affected carpal bone into inflamed and normal. The proposed technique is tested on a rheumatoid arthritis image dataset, and the results show its contribution to diagnosis of the disease. The algorithm efficiently divides carpal bones and extracts the signature parameters that are critical for correct classification of the inflammation in the cartilage images. [ABSTRACT FROM AUTHOR]

Objective Bone inflammation (osteitis) in early RA (ERA) manifests as bone marrow oedema (BME) and precedes the development of bone erosion. In this prospective, single-centre study, we developed an automated post-processing pipeline for quantifying the severity of wrist BME on T2-weighted fat-suppressed MRI. Methods A total of 80 ERA patients [mean age 54 years (s. d. 12), 62 females] were enrolled at baseline and 49 (40 females) after 1 year of treatment. For automated bone segmentation, a framework based on a convolutional neural network (nnU-Net) was trained and validated (5-fold cross-validation) for 15 wrist bone areas at baseline in 60 ERA patients. For BME quantification, BME was identified by Gaussian mixture model clustering and thresholding. BME proportion (%) and relative BME intensity within each bone area were compared with visual semi-quantitative assessment of the RA MRI score (RAMRIS). Results For automated wrist bone area segmentation, overall bone Sørensen–Dice similarity coefficient was 0.91 (s. d. 0.02) compared with ground truth manual segmentation. High correlation (Pearson correlation coefficient r  = 0.928, P  < 0.001) between visual RAMRIS BME and automated BME proportion assessment was found. The automated BME proportion decreased after treatment, correlating highly (r  = 0.852, P  < 0.001) with reduction in the RAMRIS BME score. Conclusion The automated model developed had an excellent segmentation performance and reliable quantification of both the proportion and relative intensity of wrist BME in ERA patients, providing a more objective and efficient alternative to RAMRIS BME scoring. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of dual-energy CT (DECT) for bone marrow detection in trauma settings, highlighting the need for collaboration between radiologists and clinical partners. DECT offers benefits such as shorter scan times, higher availability, and lower carbon footprint compared to MRI. The authors emphasize the importance of educating clinical partners on new technology and fostering respectful engagement for the advancement of radiology practices. [Extracted from the article]

The article discusses a case of forelimb lameness in a 5-year-old mixed-breed female spayed dog. The dog presented with a firm swelling in the left distal antebrachium, decreased flexion in the carpus, and muscle atrophy. Radiographic findings suggested osteomyelitis or neoplasia, with subsequent histopathology revealing granulomatous inflammation due to Coccidioides immitis. Treatment included forelimb amputation and antifungal therapy, with a positive outcome post-surgery. The case highlights the challenges in diagnosing and treating coccidioidomycosis in dogs, especially in non-endemic regions like Japan. [Extracted from the article]

In cases of distal radius fractures, the fixation of the volar lunate facet fragment is crucial for preventing volar subluxation of the carpal bones. This study aims to clarify the sex differences in the volar morphology of the lunate facet of the distal radius and its relationship with the transverse diameter of the distal radius. Sixty-four CT scans of healthy wrists (30 males and 34 females) were evaluated. Three-dimensional (3D) images of the distal radius were reconstructed from the CT data. We defined reference point 1 as the starting point of the inclination toward the distal volar edge, reference point 2 as the volar edge of the joint on the bone axis, and reference point 3 as the volar edge of the distal radius lunate facet. From the 3D coordinates of reference points 1 to 3, the bone axis distance, volar−dorsal distance, radial−ulnar distance, 3D straight-line distance, and inclination angle were measured. The transverse diameter of the radius was measured, and its correlations with the parameters were evaluated. It was found that in males, compared to females, the transverse diameter of the radius is larger and the protrusion of the volar lunate facet is greater. This suggests that the inclination of the volar surface is steeper in males and that the volar locking plate may not fit properly with the volar cortical bone of the lunate facet, necessitating additional fixation. [ABSTRACT FROM AUTHOR]

Introduction: The long-term effects of a capitate fracture are unknown. The aim of this study was to assess both clinical and radiological long-term outcomes after a capitate fracture. Materials and methods: From a cohort of 526 consecutive patients with post traumatic radial sided wrist pain, 23 were identified diagnosed with a capitate fracture. 16 of these (11 males and 5 females) with a median age at injury of 17.5 years (range 11–27 years) were eligible for a follow-up after a median of 16 years (range 8 to 17 years). In this study patients were examined using conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) at the time of injury and with CT at the follow-up. At follow-up radiological signs of osteoarthritis were graded in four stages and clinical outcome was evaluated by measuring range of wrist motion and grip and pinch strength. The subjective outcome was assessed using DASH and PRWE questionnaires. Results: Five patients had isolated capitate fractures and 11 had concomitant fractures, 10 of which had a simultaneous scaphoid fracture. 14 patients had been treated non-surgically in a cast and two patients were treated surgically. None of the fractures were visible on conventional radiographs at the time of injury. At follow-up all fractures had healed without signs of avascular necrosis. In one patient, CT examination revealed osteoarthritis between the capitate and lunate. This did not cause clinical symptoms. Functional impairments and pain scores were low: median DASH score 0, median PRWE 3 and median VAS pain score 0. We found no impairment in range of motion or grip and pinch strength. Conclusions: At a median of 16-year follow-up, patients with a capitate fracture report normal self-assessed hand function as well as good wrist motion and strength. The risk of development of posttraumatic arthritis in the joints around the capitate is low. [ABSTRACT FROM AUTHOR]

Background: Factors such as age and joint structure affect normal wrist motion. The midcarpal joint participates in flexion/extension, radial-ulnar/deviation (RUD), and since lunate/wrist type-2 is likely more stable than a lunate/wrist type-1, we suggest that midcarpal joint structure will affect wrist motion. Our purpose was to compare wrist motion in Caucasian and Japanese populations and to associate motion with midcarpal joint morphology. We hypothesised that radiographic structure would correlate with wrist motion. Methods: A total of 164 patients with normal wrist radiographs were included. Clinical measurements included wrist extension, flexion and RUD. Radiographic measurements included the radiocarpal joint: ulnar variance, radial height, radial inclination, volar inclination and carpal joint measurements: lunate type, capitate circumference and each of its joints contact measured and calculated as a proportion of capitate circumference. Results: The groups differed in wrist motion and in multiple radiographic measurements. When the two populations were analysed together, there were no significant associations between midcarpal joint type and wrist motion. The radiocarpal joint: ulnar variance was correlated with extension and radial deviation. Radial height was directly related to flexion, and both radial height and radial inclination were directly correlated with ulnar deviation. The intracarpal measurements: The main measurement affecting motion was the contact between the capitate and the scaphoid (as a proportion of capitate circumference) with lesser correlations of the contact of the capitate with the trapezoid and hamate. The most significant measurement associated with a lunate type-2 was scaphoid contact with the capitate p = 0.01. Logistic regression demonstrated that the measurements most associated with wrist motion were scaphoid contact with the capitate/capitate circumference and hamate contact with the capitate/capitate. Conclusions: This study supports discrepancies in wrist motion amongst different racial cohorts, and a relationship between bone/joint structure in the wrist and wrist motion. This can help treat wrist pathology. Level of Evidence: Level III (Diagnostic) [ABSTRACT FROM AUTHOR]

The injury of the scapholunate (SL) ligament is common in wrist traumas leading to pain and reduced wrist function. The wrist's unique joint design and possible underlying theories as the carpal row theory were subject to earlier investigations studying wrist kinematics. Nevertheless, a comprehensive understanding of how SL ligament injuries affect wrist biomechanics is still lacking. Through a quantitative analysis of carpal bone motion patterns, we evaluated the impact on wrist kinematics occurring after SL ligament injury. We conducted a study using computer tomography imaging to analyse wrist kinematics after SL ligament transection in 21 fresh‐frozen anatomical specimens. The collected data were then transformed into 3D models, employing both standardized global and object coordinate systems. The study encompassed the evaluation of rotation and translation for each individual carpal bone, as well as the ulna, and all metacarpal bones in reference to the radius. The study showed a significant increase in rotation towards palmar (p < 0.01), particularly notable for the scaphoid, following transection of the SL ligament during palmar flexion. Ulnar deviation did not significantly affect rotation or translation, and radial deviation also showed no significant changes in rotation or translation. The study highlights the significance of the SL ligament in wrist kinematics, revealing that SL ligament tears lead to changes in wrist motion. While we observed significant rotational changes for the scaphoid, other carpal bones showed less pronounced alterations, emphasizing the complexity of wrist biomechanics. [ABSTRACT FROM AUTHOR]

The study aimed to provide a detailed anatomical description of the forelimb of the capybara using gross anatomy, radiography images, and three-dimensional reconstruction. Four adult animals were used for macroscopic dissections, one for the acquisition of radiographic images and reconstructions, and one specimen for bone descriptions. The results showed the anatomical details of the scapula with a developed hamate process and the absence of a clavicle. Radius and ulna do not fuse. The hand has five metacarpal bones, and the first digit is rudimentary. The proximal row of the carpal comprises the intermedioradial, ulnar, and accessory carpal bones, and the distal row comprises four carpal bones. The muscles present a general pattern similar to other groups of domestic animals; however, the absence of the accessory head of the triceps brachii muscle has been demonstrated. The resulting images provided excellent detail of the main anatomical structures of the capybara's thoracic limb. The illustrations in the present study are a valuable reference for the interpretation of normal and pathological imaging studies in the species in the present study. [ABSTRACT FROM AUTHOR]

Introduction Radiography is the most often accessible and affordable imaging modality. Accurate assessments of wrist X-rays can aid in the diagnosis and prognostic evaluation of various wrist problems. This study aims to identify normal radiographic anthropometry reference values and variations of carpal bones and joints by gender and age in sample Indian population, with the potential to be clinically applicable. Materials and Methods Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology Information Systems and Picture Archiving and Communication Systems were used to collect standard digitized normal X-rays without significant osseous pathology over a year. We conducted measurements of length, angles, and indices in a standard posteroanterior and lateral wrist X-rays in order to establish the standard dimensions and variances based on age and gender. Results A total of 18 measurements which included eight linear measurements, eight angles, and two ratios were documented. A total of 500 X-rays of 250 males and 250 females with 125 of each in two age groups of 20 and 40 years and 41 and 60 years were evaluated. Conclusion This work is a comprehensive database of the Indian population measuring parameters in normal wrist radiographs of posteroanterior and lateral views. The results of our study indicate that men and younger individuals had a significantly higher carpal height ratio. The width of distal radial ulnar joint space was significantly lesser in older subjects. Additionally, males showed a significantly higher lunate uncovered ratio and radial height. When compared to the literature, the study revealed a significant positive ulnar variance in elderly people and women. However, we noted an overall increase in the percentage of positive ulnar variance individuals in our study. We also recorded a marginal increase in radial inclination with no variations across gender and age. [ABSTRACT FROM AUTHOR]

Vascularized bone grafts of the wrist and hand help to achieve bone union in various clinical settings such as bone fusion or nonunion treatment. Among the multiple possible donor sites, the base of the second metacarpal is convenient because of its relatively straightforward harvesting, lack of impairment of the hand vascularization, sufficient bone supply for small joint fusion and phalanx or metacarpal nonunion management. The flap is versatile as it can reach any carpal and metacarpal bone as well as the proximal phalanx of all fingers. The arc of rotation of the flap depends on which side of the dorsal intercarpal arch it is based, either radially or ulnarly. It can also be pedicled distally by a retrograde flow through the second dorsal metacarpal artery. The robust vascularization of the flap allows for reliable healing. We present five new indications in various clinical settings that illustrate the versatility of the arc of rotation of the flap. [ABSTRACT FROM AUTHOR]

Summary Background Objective Study design Methods Results Conclusions A palmar approach for centesis of the carpal flexor tendon sheath has not been reported.To determine the feasibility and accuracy of a palmar approach to an undistended carpal flexor tendon sheath.In vivo and experimental.Both forelimbs of six horses were used. A 20‐gauge, 8.9‐ or 7.62‐cm spinal needle was inserted 3–4 cm proximal to the dorsal border of the accessory carpal bone in the space between the ulnaris lateralis and flexor carpi ulnaris muscles and directed sagittally and perpendicular to the long axis of the limb until the needle contacted the radius. The needle was retracted slightly, contrast medium was injected, and a laterally projected radiograph of the carpus and distal aspect of the radius was obtained and examined.The technique, when performed on 12 limbs of six horses, was 92% accurate. For one limb, the needle was inadvertently directed slightly ventrally, rather than perpendicular to the long axis of the limb, causing it to contact the radius near its physeal remnant, resulting in centesis of the antebrachiocarpal joint.The palmar approach to the carpal flexor tendon sheath appears to be highly accurate. [ABSTRACT FROM AUTHOR]

Septic arthritis is common in newborn calves due to poor birth and housing hygiene. This study investigated the pathological deformities caused by arthritis in the carpal bones of calves using geometric morphometry. The changes in the carpal joint bones of newborn calves with septic arthritis were examined through shape analysis. The study included 20 healthy Simmental calves and 30 Simmental calves with septic arthritis. Dorso‐palmar x‐ray images of the carpal joint were taken, and geometric morphometry was performed on these images using 25 landmarks. The first principal components (PC1) represented 26.92% of the total variation, while PC2 represented 13.84%. One of the most significant shape changes with increasing PC1 occurred in the os carpi intermedium. The study found that it was statistically possible to discriminate between radiometric carpal joint images of Simmental calves in the control and arthritis groups using geometric morphometry. In newborn calves with septic arthritis, the trochlea radi was located more proximally. There was an enlargement of the os carpi intermedium and a tendency towards the os carpi ulnare in female calves with septic arthritis. These results indicate significant bone deformation due to septic arthritis. Geometric morphometric methods can be clinically useful, as demonstrated in this study. Researchers can statistically explore these shape analyses, opening new avenues for research in this field. This method not only enhances our understanding of morphological changes but also provides a framework for clinical investigations and discoveries in related areas. [ABSTRACT FROM AUTHOR]

The skeletal anatomy of wild animals plays a major role in their adaptation to their habitats. Information regarding the skeletal architecture of the Egyptian long‐eared hedgehog (Hemiechinus auratus aegyptius), a terrestrial and nocturnal insectivorous mammal, was lacking. Current work described the detailed bone formation of this species' skeleton grossly and morphometrically. Skeletons of five adults, apparently healthy hedgehogs of both sexes, aged 10 ± 2 months, were obtained. Preparation of the bones was accomplished by using a hot water maceration procedure. The skull was elongated. The external sagittal crest and temporal lines were unclear. The mental foramen was ventral to P2. The angular process of the mandible was large. The vertebral formula was C7, T13, L6, S3, Ca 13–15. The transverse foramen was absent in the seventh cervical vertebra. The sternum was formed of five sternal segments. There was a supratrochlear foramen on the distal part of the humerus diaphysis, connecting the radial and the olecranon fossae. The radius and ulna were fused by connective tissue. The carpals had three bones in the proximal row and four bones in the distal row. There were five metacarpals with five digits. The acetabulum was circular and had deep acetabular fossa. The foramen obturatum was ovoid. The pelvic symphysis was confined only to the ischium. The greater trochanter of the femur was lower than the level of the femoral head. The trochanteric fossa was deep and oval. Tibia and fibula fused distally. Two tarsals were in the proximal row and four in the distal row. There were five metatarsals with five digits. These findings provide the anatomical basis for understanding the adaptation mechanisms of this hedgehog species to their feeding habits and habitats and aim to help veterinarians, taxonomists, and wildlife biologists' in future biomedical and comparative skeletal anatomical studies. [ABSTRACT FROM AUTHOR]

Background: The main objective of the present study was to present the biomechanical properties of the wrist in patients who underwent scaphotrapeziotrapezoid arthrodesis when compared to a healthy control hand. Methods: The study group consisted of 29 consecutive patients who underwent a scaphotrapeziotrapezoid wrist arthrodesis at least 1 year before the research onset. Both hands of all patients were examined in 4 main categories. Results: Average score obtained in the VAS, before the surgery, without motion of the wrist was 5.21 (SD = 3.04), whereas with wrist motion, it was 8.10 (SD = 1.37). Nineteen (65.52%) patients exhibited weakened wrist muscle strength. After the surgery, only 5 (17.24%) patients declared pain in the wrist. Furthermore, the results obtained in the VAS statistically significant differed from the ones before (p < 0.05). Twenty-eight (96.55%) patients were able to resume their profession. Twenty-seven (93.10%) patients stated that they would opt for the operation again. The peak torque during the analysis of extension of the wrist in the isometric protocol was found to be 8.1 Nm (SD = 2.9), 7.9 Nm (SD = 2.3), and 7.9 Nm (SD = 2.5) in the operated hands and 10.9 Nm (SD = 3.2), 9.6 Nm (SD = 2.9), and 9.1 Nm (SD = 3.8) in non-operated hand for 30° extension, no-flexion, and 30° flexion positions, respectively (p < 0.05). Conclusion: The current study is the first to present the biomechanical parameters of flexor and extensor muscles of the wrist and fingers in patients after the said procedure. Biomechanical assessments with additional isometric, isotonic, and isokinetic tests provide an opportunity to objectify treatment outcomes and guide appropriate rehabilitation by monitoring its effects. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Lunotriquetral coalitions are the most common form of carpal coalition wherein the cartilage between the lunate and triquetrum ossification centers failed to undergo apoptosis. This technical case report examines the arthrokinematics of bilateral lunotriquetral coalitions with dissimilar Minnaar types in one participant with one asymptomatic wrist and one wrist with suspected distal radioulnar joint injury. Static and dynamic (four-dimensional) CT images during pronosupination were captured using a photon-counting detector CT scanner. Interosseous proximity distributions were calculated between the lunotriquetral coalition and adjacent bones in both wrists to quantify arthrokinematics. Interosseous proximity distributions at joints adjacent to the lunotriquetral coalition demonstrate differences in median and minimum interosseous proximities between the asymptomatic and injured wrists during resisted pronosupination. Altered kinematics from lunotriquetral coalitions may be a source of ulnar-sided wrist pain and discomfort, limiting the functional range of motion. This case report highlights potential alterations to wrist arthrokinematics in the setting of lunotriquetral coalitions and possible associations with ulnar-sided wrist pain, highlighting anatomy to examine in radiographic follow-up. Furthermore, this case report demonstrates the technical feasibility of four-dimensional CT using photon-counting detector technology in assessing arthrokinematics in the setting of variant wrist anatomy. [ABSTRACT FROM AUTHOR]

Background: The risk of carpal injury in racehorses may be related to the morphology, yet whether carpal morphologies are set from birth or change through growth remains unclear. Objective: To quantify carpal bone changes through growth. Method: Twenty privately owned Thoroughbred foals born between January 2022 and May 2023 were radiographed bimonthly from birth to 10 months of age. Imprint training was used to take radiographs safely without chemical restraints. Fifteen individual and 11 relative angular carpal parameters were measured using ImageJ on dorsopalmar radiographs of the carpus at zero degrees of vertical and horizontal rotation. Associations with age (growth), sex and the differences between left and right limbs were analysed separately using a linear mixed effects model. Results: Six individual carpal parameters changed with age (radial carpal joint [RCJ], Prx.dor. radial carpal [Cr], Prx.Cu, Dis.dor. third carpal [C3], Dis.pal.C3 and Dis.pal. intermediate carpal), and one was influenced by side, that is higher in the left carpus (Dis.pal.Cr). Seven relative parameters changed with age, and one relative parameter was influenced by side, that is higher in the left (Ra.met‐RCJ). The proximo‐dorsal bone surface angle of Cr and disto‐dorsal bone surface angle of C3 became flatter over time, which may be associated with the re‐direction of the load towards the sagittal carpal plane. Sex did not influence any of the carpal parameters, nor did the combined effect of age, side of the limb and sex. Conclusion: Specific individual and relative angular carpal parameters changed significantly over time and some differed between the left and right limb, whereas other parameters did not change. The steeper carpal bone angles achieved proximally with the parameters that did change may improve stability by redirecting the load more medially through the carpus and the proximal and distal bones. [ABSTRACT FROM AUTHOR]

In this study, we aim to share the volumes of the carpal bone and the ratio of these volumes to the total volume of wrist bones from Computed Tomography (CT) images obtained from individuals of different ages and sex using 3D Slicer. Right wrist CT images of 0.625 mm slice thickness of 42 healthy individuals (21 female, 21 male) of both sexes were included in our study. Volume calculations were made by loading the images into 3D Slicer, an open-source software package. In this study, mean capitate volume was the largest in both sexes (male 3479.9±679.2; female 2207.1±272.1 mm3), while pisiform had the smallest mean volume (male 810.0±141.2; female 566.6±97.7 mm3). This order was ordered from largest to smallest as hamate, scaphoid, trapezium, lunate, triquetrum, trapezoid, and pisiform. According to this study, carpal bone volumes were larger in males than in females (p<0.001). The ratio of each carpal bone volume to the total carpal bone volume was calculated according to sex and it was found that there was no difference (p>0.05). In this study, it was seen that carpal bone volume differed according to sex. However, it was observed that the bone volumes of both sexes took up the same amount in the total bone volume. This information will be very useful in sex determination, 3D anatomical material creation, implant applications and reconstructive surgery. [ABSTRACT FROM AUTHOR]

To date, no clinical test provides specific objective information on the integrity of key ligamentous support of the trapeziometacarpal (TMC) joint. To examine the potential of the TMC joint screw home torque mechanism (SHTM) in estimating the integrity of the posterior ligament complex in older adult population. Cross-sectional laboratory-based study. Twenty cadaver hands presenting with various degrees of TMC joint degradation ranging from none to severe osteoarthritis (OA) were radiographed in multiple positions to establish their degeneration status, joint mobility, and amount of dorsal subluxation at rest and with the application of the SHTM. Comparisons and correlations between degeneration status, joint mobility, subluxation reduction and ligament status obtained from dissection were calculated. No significant statistical correlation was demonstrated with the subluxation reduction ratio of the SHTM and the combined ligament complex value however, a moderate negative correlation was found with dorsal central ligament injury at 21 Nm (τ b = −0.46, p < 0.05) and 34 Nm (τ b = −0.45, p < 0.05). A statistically significant reduction of radial subluxation of the TMC joint was observed between the subluxation at rest (M = 5.2, SD = 1.9) and subluxation with SHTM of 21 Nm (M = 4.4, SD = 2.4), t (19) = 3.2, p = 0.01, 95% CI [0.3, 1.4] and subluxation with SHTM of 34 Nm (M = 4.3, SD = 2.6), t (19) = 2.6, p = 0.02, 95% CI [0.2, 1.5]. Our results did not support the SHTM as indicator of the TMC posterior ligament complex integrity however, it demonstrated 100% stabilization effect with non-arthritic TMC population. • SHTM was not a clear indicator of TMC joint posterior ligament complex integrity. • DCL damage was moderately correlated with a decline in subluxation reduction. • SHTM demonstrated positive stabilization results with non-arthritic population. • Decreased radial abduction may suggest more significant joint degradation. [ABSTRACT FROM AUTHOR]

Several accessory bones can be found around the wrist, which may pose a diagnostic challenge. Hereby, we report a unique case of a traumatic fracture of an aberrant os styloideum in a 66-year-old male. The patient presented with a swollen dominant right hand and a hematoma on its anterior and posterior aspects, as a result of a fall on an outstretched hand. The diagnosis was based on a CT scan, which showed a fractured accessory bone between the distal portion of the capitate bone and the base of the third metacarpus. Due to its typical location, the ossicle was identified as os styloideum. The patient was treated conservatively and the symptoms subsided on a short forearm cast after 2 weeks. At a 12-month follow-up, no other episodes were declared. Strong anatomical knowledge and sharing of such cases is essential for proper diagnosis and treatment of this very rare condition. [ABSTRACT FROM AUTHOR]

Purpose: Hamate fractures are infrequent and often overlooked wrist injuries. Our objective is to present the Shish-Kebab method, a surgical approach utilized in the treatment of intra-articular Hamate body fractures occurring concurrently with fourth metacarpal base fractures and dislocations. Methods: This study was conducted at a single-center using a prospective design. It included patients aged 16–65 with Kim Type IIB fractures affecting the dominant side. Patients with the same features of fracture and carpometacarpal (CMC) instability findings were divided into two groups according to the success of the closed reduction procedure. In the conservative group (8 patients), all fractures and instability findings were successfully resolved with closed reduction and a short arm plaster cast. The surgical group (8 patients), comprising those requiring open reduction and internal fixation, underwent the application of the 'shish kebab' method. Results: At the 6th and 12th week follow-ups, no significant differences were observed between the groups concerning pVAS and QuickDash scores. However, upon examining the QuickDash scores, a statistically significant difference emerged between the 6th and 12th weeks within both the conservative (p = 0.017) and surgical (p = 0.012) groups in the intragroup analysis. Grip strength, measured as 83.78% of the contralateral side in the surgical group and 79.51% in the conservative group, did not exhibit a statistically significant difference (p = 0.462). Conclusion: In the management of Hamate body intra-articular fractures and accompanying fourth metacarpal base fracture dislocations, good clinical results can be achieved with the 'Shish–Kebab' method in cases where closed reduction is unsuccessful. [ABSTRACT FROM AUTHOR]