Ruby Grewal

Introduction: Carpal tunnel syndrome may occur in association with distal radial fractures, and decompression is sometimes considered at the time of fixation. The flexor carpi radialis approach used for anterior plating may allow decompression without extending the incision into the palm. This study compared intracarpal canal pressure reduction achieved through this approach and the standard technique. Methods: Twelve fresh-frozen upper extremities were studied. Within each pair, one limb underwent carpal tunnel release through the flexor carpi radialis approach and the contralateral limb through a standard open palmar incision. A balloon-tipped catheter connected to a pressure transducer was inserted proximal to the wrist crease and advanced distally to measure pressure at 5 mm intervals. The peak-pressure site was identified and used for measurements in the neutral position and during wrist flexion and extension. Measurements were obtained before and after release. Final dissection assessed completeness of release and iatrogenic injury. Results: Pressure increased distally, peaking at 114 (SD 70) mmHg approximately 29 (SD 5) mm distal to the wrist crease, near the hook of the hamate. Pressure increased with both flexion and extension, with higher values in extension (201 (SD 12) mmHg) than flexion (133 (SD 17) mmHg,). Both techniques reduced pressure in the neutral position by approximately 75–85 mmHg. Complete release was confirmed in all specimens without tendon or nerve injury. Conclusion: The flexor carpi radialis approach provides pressure reduction comparable to the standard open technique and may allow decompression without a separate palmar incision.

Objectives: To quantify patient preferences for key joint protection program (JPP) delivery components and identify preference segments to inform a patient-centred, technology-enabled program. Methods: Attributes and levels were developed via three focus groups with 16 people living with hand osteoarthritis (HOA). A discrete choice experiment (six attributes with two levels each; 16 choice tasks; three unlabelled alternatives; no opt-out) was fielded online. Choices were analysed using latent class choice models with effects coding. One to six class solutions were compared by Akaike Information Criterion/Bayesian Information Criterion and segment sizes. Within-class relative attribute importance was calculated from part-worth ranges and overall (class-adjusted) importance was computed using class membership probabilities. Results: A total of 150 participants with HOA completed the survey (89% women; mean age 68 years). Latent class modelling identified five distinct preference segments (segment sizes: 34%, 18%, 10.7%, 21.3% and 16%). Across segments, clinician-led question and answer (Q&A; class-adjusted importance 23.7%) and clinician-delivered exercise demonstrations (21.5%) consistently drove choices. Other features showed marked heterogeneity: one large segment strongly preferred short (2–7 min) videos (importance 56.1%) while others were indifferent to video length; interaction mode split respondents between asynchronous forums and live monthly meetings; and lived-experience guest speakers were valued by some segments but actively traded off by others. Quizzes were conflicting, adding value in some classes and reducing it in others. Conclusion: Delivery preferences were heterogeneous, but clinician involvement Q&A and clinician-led demonstrations anchored preferences. The remaining features functioned as tuneable options. A configurable JPP that preserves clinician touchpoints and allows patients to select preferred formats is best aligned with revealed preferences.

Background: Hand osteoarthritis (HOA) is a common and disabling condition that impairs hand function. Traditional joint protection programs (JPPs) are recommended for reducing pain and deformity and potentially slowing disease progression. While JPPs are supported by trials, programs are outdated, not co-designed and poorly implemented. Behavioral science frameworks and patient co-design methodologies may enhance relevance, adherence, effectiveness, and sustainability. Purpose: This study aimed to map and characterize the behavioral components of JPPs for adults with HOA and to examine the extent of patient co‑design. Methods: We conducted a scoping review with directed content analysis following Arksey and O’Malley’s framework. We used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Six databases and 1 clinical-trial registry were searched from inception to April 3, 2025. Eligible studies included any empirical design that included interventions described as “joint protection” or clearly aligned with its core components for adults with HOA. Two reviewers independently coded intervention content using the Behavior Change Technique Taxonomy version 1 and assessed the presence of patient co-design with criteria derived from Experience-Based Co-Design frameworks. Discrepancies were resolved by consensus. Results: A total of 32 studies met the inclusion criteria. We identified 22 unique behavioral change techniques across 11 clusters. “Instruction on how to perform the behavior” was the most common item (32 studies, 100%), followed by “Behavior substitution” (23 studies, 72%) and “Restructuring the Physical Environment” (17 studies, 53%). Patient co-design was explicitly integrated in 8 studies, with varying methods and levels of engagement. In most cases, patient input was included during the intervention design stage, while only a few studies involved patients in iterative feedback and refinement. Only 1 study combined theoretically informed behavioral content with active patient co-design, highlighting a substantial gap in the development of JPPs for HOA. Conclusions: Most JPPs for HOA incorporate behavioral change techniques but rarely systematically apply behavior change theory, clearly articulate behavioral change mechanisms or engage patients meaningfully in co-design. Integrating established behavioral frameworks with authentic patient co‑design could yield interventions that are both relevant and sustainable. Future programs development should embed systematic behavioral theory and genuine patient partnership from conception through refinement to support durable behavior change in people with HOA.

The purpose of this study was to evaluate carpal joint contact patterns after perilunate injuries and potential associations between functional and radiographic outcomes. Twenty-two patients with a computed tomography (CT) scan at least 2 years postoperatively were reviewed (mean follow-up 15 years). Assessment of carpal degenerative changes was done using Kellgren–Lawrence grading and CT-derived joint space area, which was calculated as the total area with interbone distance less than 2 mm. Increased joint space area signified a greater area with joint space narrowing and cartilage loss. Fifteen patients had severe joint space narrowing at the scaphocapitate and capitolunate joints. Nine and seven patients had severe narrowing at the radiolunate and radioscaphoid joints, respectively. Degenerative changes did not follow a typical scapholunate advanced collapse pattern. Increased scaphocapitate joint space area was associated with worse Patient Rated Wrist Evaluation scores ( r = −0.47, p =  0.02) and visual analogue scale pain scores ( r = −0.44, p =  0.03). This study suggests that patients with more severe degenerative changes after perilunate injuries may have worse functional outcomes. Level of evidence: IV

Perilunate fracture-dislocations represent a spectrum of devastating wrist injuries. They typically involve high-energy mechanisms, occur in young patients and are relatively uncommon. Our current knowledge on this rare wrist pathology is limited as most studies involve small retrospective case series and limited follow-up. The purpose of this study was to examine the functional, radiographic, and patient reported outcomes after perilunate injuries and evaluate surgical practice trends over time. A retrospective review identified 123 patients who had open reduction and internal fixation of an acute perilunate injury at a single academic centre over a 30-year study period. Post-operative functional, patient-reported, and radiographic outcomes were assessed. The association of various surgical and injury-related variables on outcomes was examined using independent t-tests and ANOVA testing, with post-hoc analysis. Significance was set at p < 0.05. Fourty-seven patients participated with a mean follow-up of 14 years. All patients underwent urgent or semi-urgent operative intervention with a dorsal or combined approach. At final follow-up, mean patient-rated wrist evaluation score was 24.2, visual analogue scale pain score was 2.4, flexion-extension arc was 56% of the contralateral side and grip strength was 76%. Patients who underwent re-operation or injured their dominant hand had worse outcomes. Only 9% of patients were unable to return to their same job or a similar job as a result of their injury. Overall, patients retain a relatively high level of function and report low pain scores long-term after perilunate injuries. Multi-centre, prospective studies are required going forward.