Scott W. Wolfe

Case: We present 3 patients with anterior interosseous nerve syndrome (AINS) who demonstrated thumb interphalangeal flexion despite complete denervation of the flexor pollicis longus. Advanced imaging revealed a Gantzer muscle in all cases that was confirmed at surgery in the 2 patients who required microneurolysis. Conclusion: In patients with suspected AINS, retention of thumb IP flexion should prompt suspicion for a Gantzer muscle. Preservation or return of thumb flexion does not rule out AINS nor indicate recovery.

Background: The use of large language models (LLMs) such as ChatGPT and Gemini in clinical settings has surged, presenting potential benefits in reducing administrative workload and enhancing patient communication. However, concerns about the clinical accuracy of these tools persist. This study evaluated the concordance of ChatGPT and Gemini’s recommendations with American Academy of Orthopedic Surgeons (AAOS) clinical practice guidelines (CPGs) for carpal tunnel syndrome, distal radius fractures, and glenohumeral joint osteoarthritis. Methods: ChatGPT (version 4o) and Gemini (version 1.5 Flash) were queried using structured text-based prompts aligned with AAOS CPGs. The LLMs’ outputs were analyzed by blinded reviewers to determine concordance with the guidelines. Concordance rates were compared across models, topics, and guideline strength using descriptive statistics and McNemar’s test. The transparency of responses, including source citation, was also assessed. Results: A total of 174 recommendations were generated, with an overall concordance rate of 62.1%. When comparing concordance rates between LLMs, there was no statistically significant difference between ChatGPT and Gemini (66.7% vs 57.5%, P = .131). Concordance varied by topic and guideline strength, with ChatGPT performing best for moderately supported guidelines. Both models demonstrated low citation transparency. Gemini provided sources for 39.1% of recommendations, significantly more than ChatGPT’s 3.5% ( P < .0001). Conclusions: Despite modest concordance rates, both models exhibited significant limitations, including variability across topics and guideline strengths, as well as insufficient citation transparency. These findings highlight the challenges in integrating LLMs into clinical practice and emphasize the need for further refinement and evaluation before adoption in hand surgery.

Fused rendering of three-dimensional (3D) MR neurography and zero echo time MRI for peripheral nerve and bone structures, respectively, provides the potential for improved surgical planning, interphysician communication, patient education, and creation of 3D-printed anatomic models.

Background Surgical management of scaphoid nonunions requires not only stable fixation but restoration of carpal alignment and reconstruction of bone defects. The latter can be done with either vascularized or non-vascularized bone grafts, depending largely on surgeon preference. Materials and Methods This article describes the use of non-vascularized bone grafts for scaphoid nonunions and examines reported outcomes. We also describe the senior author's preferred surgical treatment, the hybrid Russe procedure. Description of Technique The hybrid Russe procedure utilizes a corticocancellous strut from the volar aspect of the distal radius to restore anatomy in scaphoid nonunions with flexion deformities. Once the alignment of the scaphoid and associated lunate postural deformities are corrected, fixation then proceeds with a headless compression screw. This combination resulted in healing of 17 scaphoid fracture nonunions at an average time of 15 weeks. Conclusions The literature does not demonstrate a difference in union rates when comparing the use of vascularized and non-vascularized grafts for scaphoid nonunions. When the proximal pole of the scaphoid can be salvaged, the choice of fixation is left to the surgeon's discretion.

Multiple techniques exist to reconstruct the scapholunate interosseous ligament, though none have demonstrated superiority. This study compares 1-year radiographic outcomes of the three-ligament tenodesis and the anatomical front and back reconstruction. All patients who underwent reconstruction of their scapholunate interosseous ligament at one institution with either anatomical front and back reconstruction or three-ligament tenodesis between 2011 and 2020 were retrospectively reviewed. At 52-week follow-up, anatomical front and back reconstruction maintained a statistically significant improvement in scapholunate gap, corrected radiolunate angle and dorsal scaphoid translation, while three-ligament tenodesis demonstrated no sustained improvement in any parameter. The improvement in dorsal scaphoid translation was significantly greater for patients undergoing anatomical front and back reconstruction compared with three-ligament tenodesis at the 16-weeks postoperative timepoint (−1.0 mm, −0.3 mm). Anatomical front and back reconstruction demonstrates sustained improvement in radiographic outcomes at 1 year when compared with three-ligament tenodesis. By addressing both volar and dorsal critical ligament restraints, adoption of anatomical front and back reconstruction for advanced stage scapholunate interosseous ligament injuries should be considered. Level of evidence: IV