Introduction: Range of motion impairment of the hand are essential to evaluate the outcome of surgery or rehabilitation therapy. However, the procedure of traditional manual method could be time-consuming and inconvenient in some aspect. This study aims to provide an automatic measurement method using smartphone and hand pose estimation algorithm and verify the reliability of the method. Methods: The range of motion of the hand was recorded in images of six gestures. Then the images were analyzed using hand pose estimation algorithm to automatically calculate the impairment percentage to the hand motor function. The impairment evaluation followed the guideline of the Hand Surgery Society of Chinese Medical Association and the American Medical Association. The reliability of automatic method was compared with manual method by an experienced hand surgeon. Result: A total of 25 healthy volunteers and 34 patients with hand motor dysfunction participated in the study, and 2124 images from 118 hands were collected. Compared with manual method, the mean error of the automatic method was 2.10±2.87%, showing strong consistency (ICC: 0.953) and strong correlation (r: 0.953). According to the Bland-Altman plot, the 95% limit of agreement of automatic method was (-4%, 8%). Conclusion: The proposed automatic method could effectively evaluate the impairment of the hand from smartphone images with hand pose estimation algorithm. The result suggested the automatic method was reliable.

Classically, The Pronator quadratus (PQ) is released of the radial side of the distal radius to gain access to fracture site and later repaired after plate application. The repair is often not feasible or not reliable. We present our experience using the PQ sparing approach for distal radius fractures in a Level I major trauma centre with a specialized dedicated hand service. We present our methods, outcomes, complications, difficulties and learning curve using this approach.
Patient and Methods: Sixty patients who suffered from distal radius fractures were treated with volar locking plate fixation using PQ muscle preservation approach. Patients are evaluated for their functional outcome using the DASH score at 1 year. Assessment of grip strength using a dynamometer and range of motion (ROM) using a goniometer. The contralateral side is used as the reference and results are presented as a percentage of it. Any complications during their follow up were recorded. The radiological outcome is evaluated for loss of fixation, malunion and union.
Results : All the patients united by time of final follow up with no loss of fixation, malunion or non-union.
Conclusion : PQ sparing approach is readily adopted and can be used for majority of DRFs achieving a good functional and radiological outcome. Its use can enhance recovery and reduce hardware related complications. Nonetheless, reduction should not be compromised, and the PQ sparing can be converted readily to FCR approach.

The fovea tears in the triangular fibrocartilage complex often appear in association with ulnar wrist pain and limited wrist function in work or sport. This study addressed the arthroscopic repair of fovea tears in the TFCC with suture anchor, in a sample of 67 athletes who were undergoing TFCC fovea repair by wrist arthroscopy. From September 2018 to February 2021, 67 athletes' patients underwent TFCC fovea repair with suture anchor by wrist arthroscopy. The mean follow-up period was 25.6 months (range, 22–28 months), and the patients’ average age was 26.7 years. The study included 52 men and 15 women. All patients had early fovea TFCC tears and no wrist fractures. The 1.3mm suture anchor with outside-in method was used to repair the foveal tears and with splinting was applied for 6 weeks. Complications were also recorded. The results were graded with a Mayo Modified Wrist Score and DASH scores. Twenty-eight of the 67 wrists were rated excellent, 34 were good, and 5 were fair. Overall, 62 of 67 patients (92.5%) rated satisfactorily and returned to sporting or work activities. Five (7.5%) patients experienced mild pain during work or exercise. Although motion remained normal for these patients, grip strength on the affected hand was at least 85% of that on the other hand. Arthroscopic repair of early fovea tears of the triangular fibrocartilage complex is a satisfactory method of repair. The procedure can enhance patients’ wrist function by relieving pain and increasing tolerance for sport.

Purpose: To evaluate the results of management of comminuted intra-articular distal-end radius fractures in osteoporotic patients using bridging plate technique as a temporary ligamentotaxis method till acheiving union.
Material and Methods: twenty patients (8 Males and 12 Females) were included in the study and treated for comminuted osteoporotic distal-end radius fracture during a period from January 2021 to January 2022 using percutaneous dorsal bridging plating technique. Patients were evaluated clinically by El-Hadara wrist function scoring system which is based on subjective and objective outcomes of patients and it includes 24 points.
Results: the average follow-up period was one year, patients were assessed by El-Hadara wrist function scoring system. Results showed that two patients (10 %) had excellent results (scores between 21 and 22), fifteen patients (75%) had good results (scores between 17 and 20) and three patients (15%) had fair results (scores between 14 and 15). No patients were graded as poor. Results showed that the mean final score was 18.0 ± 2.13.
Conclusions: the use of dorsal distraction bridge plating is a good surgical option in the management of comminuted osteoporotic distal-end radius fractures without the fear of faliure of fixation, it is also safe and fast procedure that helps early return of function due to the stability of the fixation.

Introduction: Triangular fibrocartilage complex(TFCC) peripheral tears and foveal tears can be treated by many options. Capsular repairs with arthroscopic assisted sutures are beginning to be used more in recent times. We retrospectively analysed our results for patients operated between 2015-2021 with capsular repairs and results are presented. Materials and methods: All patients who underwent TFCC capsular repairs for type 1B Palmar classification from 2015-2021 were retrospectively analysed and followed up for clinical outcomes. Only post traumatic patients with delayed TFCC repair were included. Open repairs and degenerative tears were excluded. Patients with gross DRUJ instability were considered for open foveal repair and not included. Patient had capsular rein-in sutures with 3-0 or 4-0 prolene. Patient were followed up for grip strength, DASH score, ROM examination and clinical examination of instability or pain. Results: Total of 80 patients were operated for TFCC of which 35 patients were identified to have undergone arthroscopic capsular repairs. 8 patients were female and rest were male. Average age group was 33 (Range 22 – 40) years. 7 patients had left side non dominant hand involvement and others had right side involvement. Follow-up of patients for done for a minimum of 1-2 years. Patients after repair had good improvement of DASH scores and ROM without pain. One patient had suture irritation and required secondary removal. Conclusion: Patients have good stability post capsular repairs of TFCC tears. Patients showed early return to activity with satisfactory grip strength and function.

Objective: To classify different clinical manifestations after arterialized venous flap transplantation in order to take targeted nursing interventions for the improvement of flap survival. Methods: All the cases reconstructed with free arterialized venous flaps in our hospital from June 2010 to March 2019 were collected. A systematic analysis was carried out in terms of the color and tension of the flaps, the degree of swelling, the formation of blisters and the congestion status. Nursing interventions were adopted individually according to different clinical features. The survival of the flaps was taken as the main evaluation parameter. Results: A total of 64 cases including 68 arterialized venous flaps were included. According to their postoperative features, they were divided into three types: the normal physiological flap type (NPF type, 25 cases, 27 flaps), the blister formation type (BF type, 18 cases, 18 flaps), and the congestion swelling type (CS type, 21 cases, 23 flaps). Among them, all the NPF type survived uneventfully; only one partial flap loss occurred in the BF type and two partial and one total flap loss were encountered in the CS type after active conservative management. Conclusion: The clinical manifestations of arterial venous flaps are quite different. It is essential to strengthen postoperative observation and nursing interventions according to different clinical types.

Objective: To investigate the feasibility and results of performing transplantation of chimera of the superficial to vastus lateralis muscle to repair severe crush injury to forearms.Methods: Emergency primary repair of severely injured forearms caused by crush in 30 cases.Comminuted fractures of the ulnar radius, skin defects, or combined injuries of blood vessels, bone and muscle tissues were found in all of them. The skin defect area ranged from 5cm×5cm to 32cm×23 cm; the muscle defect was seen in 15 cases; the bone defect was found in 9 cases.The chimeric flaps of the anterolateral thigh were used in 27 cases, including 3 cases in which double chimeric flaps were used. Wound covering, muscle tamponade, reconstruction of muscle dynamics and bone repair were performed. The flap area was 11cm×5cm to 21cm×19cm, and the muscle volume was 8cm×4cm×1cm to20cm×13cm×1cm. Patients came to the hospital every 3 months after surgery for reexamination,for how well the flaps looked, bone healed and the functions of forearms and hands restored.Results: The forearms of 28 cases were treated, and the limb salvage rate was 93.33%. The average number of operations was 2.6.The infection rate was 6.67%. It took an average of 6.7 months for the bone to heal. According to the Andsion score, the rate of excellent and good outcomes of surgery was 71.4%.Conclusion: The limb salvage rate was high when the transplantation of chimera of the superficial to vastus lateralis muscle was used to repair the combined injuries of forearms caused by the severe crush.

Ulnar impaction syndrome is a frequent cause for ulnar sided wrist pain and upper extremity disability. The aim of the present study was to evaluate the results of ulnar shortening osteotomy. Between 2015 and May 2022, 45 cases were treated through ulnar shortening osteotomy at our clinic. Thirty patients (18 women and 12 men) could be included and examined at an average follow up of 39,9 months (range 10-95). The mean age at index operation was 48,7 years (range 23-77). Eleven operated hands were dominant and 12 cases were treated due to a posttraumatic secondary ulnar impaction syndrome. Ulnar shortening osteotomy alone was performed in 17 cases, while 13 received a combination of procedures. Implant removal was necessary in 5 cases, however resolving symptoms. Five complications were reported: 1 plate loosening undergoing revision; 1 complex regional pain syndrome; 1 pseudarthrosis successfully treated through extracorporeal shock wave therapy; 2 cases of hypoesthesia. At last follow up the median Patient Rated Wrist Evaluation score was 7 (range 0-43,5), the median Quick Disabilities of Arm, Shoulder & Hand score 4,5 (range 0-56,8); in 19 patients the wrist range of motion and grip strength was bilaterally equal. Functional limitations and persisting pain were significantly correlated with comorbidities and combined procedures. Radiologically an average ulnar shortening of 2,8mm was measured between preoperative and postoperative (range 1,0-5,5mm); all osteotomies were radiologically consolidated. The results from this study suggest that ulnar shortening osteotomy is an effective surgical procedure with good results, in accordance with published literature.

Background: Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical
treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this
study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment
option for stage III Kienbock’s disease.
Methods: This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage
III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-
dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a
lawyer. The average follow up period was 14.2 months.
Results: Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5.
Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and
extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar
deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation
was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90
mmHg representing 93.2% of the contralateral side.
Conclusions: Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with
lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion.

Background: Scaphoid fracture nonunion is a troublesome complication that if untreated will led to avascular necrosis of proximal pole then carpal collapse and degenerative arthritis . The proximal pole of the scaphoid vascular status is an important factor in determining the type of bone graft used whether vascularized or non-vascularized .
The purpose of this study was to evaluate the results of a new technique in the reconstruction of avascular necrosis proximal pole scaphoid fractures nonunion by using proximal Hamate as an autograft to restore the shape of scaphoid and scapholunate mechanics and the effect of graft size on wrist mechanics.
Patients and methods : This was an interrupted time series clinical trial (quasi experimental) study, that included twenty patients with non-united proximal scaphoid fractures with avascular necrosis of the proximal part treated with excision of the proximal pole of scaphoid and reconstruct with the proximal pole of Hamate and reconstruction of scapho-lunate ligament.
Results: All fractures united except two fractures , with a mean period of 10.2 weeks , a mean follow up period was 11 months , there was an improvement in VAS score from 8 (7-9) preoperative to 2 (0-5) post-operative and final Mayo wrist score was 93.1(range 79-98).
Conclusion: The use of proximal hamate as an autograft to reconstruct the proximal osteocartilaginous surface of the scaphoid nonunited fractures with AVN of the proximal pole is a promising technique.
Keywords: scaphoid nonunion , avascular necrosis(AVN) , capito-hamate ligament(CH) , Triquetro-hamate ligament (TH)