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Hand Surgery: Latest Advances and Prospects

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 25 October 2026 | Viewed by 11588

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Special Issue Editors

Dr. Camillo Fulchignoni

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Guest Editor

Hand Surgery Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy
Interests: tendon surgery; hand surgery; orthopedic surgery; carpal tunnel surgery
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Lorenzo Rocchi

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Guest Editor

Department of Orthopaedics and Traumatology, Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00136 Rome, Italy
Interests: hand trauma; thumb basal joint arthritis; carpal injuries; chronic wrist arthritis

Special Issue Information

Dear Colleagues,

Hand surgery is a dynamic and evolving field that plays a critical role in restoring functionality and improving the quality of life for patients with various musculoskeletal and nerve disorders. This Special Issue, titled “Hand Surgery: Latest Advances and Prospects”, aims to provide an in-depth overview of the latest advancements, techniques, and research shaping modern hand surgery. It will include a wide range of topics such as innovative surgical procedures, minimally invasive techniques, rehabilitation strategies, and the integration of emerging technologies such as robotic surgery and 3D printing. Moreover, the Special Issue will highlight future challenges and opportunities, addressing both clinical and technological developments that will drive the field forward. By exploring current trends and anticipating future innovations, this collection serves as a valuable resource for clinicians, researchers, and students striving to advance the practice and science of hand surgery.

Dr. Camillo Fulchignoni
Prof. Dr. Lorenzo Rocchi
Guest Editors

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Keywords

hand surgery
musculoskeletal and nerve disorders
innovative surgical procedures
minimally invasive techniques
rehabilitation strategies
robotic surgery

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Published Papers (6 papers)

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Research

11 pages, 363 KB

Open AccessArticle

The Correlation Between Smartphone Use and Compressive Ulnar Neuropathy at the Elbow: A Retrospective Study

by Gianmarco Vavalle, Chiara Barbieri, Davide Messina, Silvia Pietramala, Lorenzo Rocchi and Camillo Fulchignoni

J. Clin. Med. 2026, 15(5), 2004; https://doi.org/10.3390/jcm15052004 - 5 Mar 2026

Viewed by 500

Abstract

Background: Cubital Tunnel Syndrome (CuTS) is the second-most common compressive neuropathy of the upper limb, traditionally associated with prolonged elbow flexion, trauma, or anatomical constraints. With the widespread adoption of smartphones, sustained upper-limb postures have emerged as potential novel risk factors for ulnar nerve compression. This retrospective study aimed to investigate the potential correlation between smartphone use patterns and the development of CuTS. Methods: A retrospective observational study was conducted on 100 subjects recruited between 2021 and 2024, including 50 patients with EMG-confirmed CuTS who underwent surgical decompression and 50 matched controls without clinical or electrophysiological evidence of ulnar neuropathy. Demographic variables, daily smartphone use (h/day), predominant activity type, and habitual posture during device handling were collected through clinical records and questionnaires. Group comparisons were performed using t-tests and Chi-square analyses, with significance set at p < 0.05. Results: Daily smartphone use was higher in the CuTS group compared with controls (4.94 ± 1.8 vs. 4.04 ± 1.5 h/day), although the difference did not reach statistical significance (p = 0.0716). Posture during device use showed a significant association with CuTS: 82% of affected patients reported using smartphones with the elbow flexed, compared with 56% of controls, whereas supportive postures were less frequent among CuTS patients (16% vs. 38%) (p = 0.019). No significant differences were found between groups regarding smartphone activity type (p = 0.858). Conclusions: Smartphone use may contribute to ulnar nerve compression primarily through ergonomically disadvantageous postures, particularly sustained elbow flexion, rather than total usage time. These findings highlight a modifiable behavioral risk factor relevant to the rising prevalence of CuTS in the digital era. Increased clinical attention to device-handling habits and public-health strategies promoting ergonomic posture may support CuTS prevention. Prospective and biomechanically informed studies are warranted to further elucidate causal mechanisms. Unmeasured confounders (e.g., occupational and sleep-related elbow flexion) may influence these associations. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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12 pages, 1635 KB

Open AccessArticle

Risk Factors for Neuropathic Pain in Digital Amputations

by Alessandro Crosio, Pierpaolo Caputo, Maria Carolina Fra, Luca Monticelli, Monica Cicirello, Julien Teodori, Giulia Colzani, Alessandro Fenoglio, Davide Ciclamini, Paolo Titolo and Bruno Battiston

J. Clin. Med. 2026, 15(2), 539; https://doi.org/10.3390/jcm15020539 - 9 Jan 2026

Viewed by 466

Abstract

Background/Objectives: Finger amputation is frequently followed by complications, with reported revision rates of up to 20%. One of the most disabling sequelae is the formation of painful neuromas, occurring in approximately 3–9% of cases. Several biological and mechanical risk factors have been proposed, but the potential influence of psychological traits remains poorly understood. This study aimed to investigate whether a correlation exists between patients’ personality traits and the development of neuropathic pain or related symptoms. Methods: A retrospective study was conducted at a Level II Hand Trauma Center, including patients who underwent digital amputation between 2021 and 2023. Neuropathic pain and cold intolerance were assessed using the S-DN4 and CISS questionnaires, respectively. Personality traits were evaluated using the BFI-10 scale. Demographic data and other clinical risk factors, including work-related injuries, psychiatric history, infection, treatment delay, and surgical technique, were also analyzed. Results: A total of 54 patients were included. Neuropathic pain, defined by an S-DN4 score ≥ 4, was identified in 10 patients (18.5%). A significant correlation was found between the occurrence of neuropathic pain, cold intolerance, and the “neuroticism” personality trait. Patients with work-related injuries or psychiatric disorders also showed a higher risk of neuropathic pain and cold intolerance. Conversely, infection and delayed treatment were associated with an increased risk of revision procedures, whereas the type of surgical technique used for nerve stump management was not significantly correlated with pain outcomes. Conclusions: The study demonstrated a meaningful association between the neurotic personality trait and both neuropathic pain and cold intolerance after finger amputation. Additionally, work-related injuries and psychiatric comorbidities were identified as potential risk factors. Patients exhibiting these characteristics may benefit from early psychological assessment and multidisciplinary management to prevent further complications and improve postoperative outcomes. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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13 pages, 659 KB

Open AccessArticle

A Prediction Model for Instability in Adult Distal Radius Fractures: Integrating Post-Reduction and Follow-Up Indicators

by Nuttapol Khajonvittayakul, Kittiwan Supichyangur, Adinun Apivatgaroon and Pichaya Tantiyavarong

J. Clin. Med. 2025, 14(23), 8336; https://doi.org/10.3390/jcm14238336 - 24 Nov 2025

Viewed by 900

Abstract

Background/Objectives: Although Lafontaine criteria are widely used to predict fracture instability for distal radius fractures (DRFs), their predictive performance remains limited. This study aimed to enhance prediction accuracy by incorporating post-reduction and one-week follow-up radiographic findings. Methods: This retrospective study included adults with DRFs treated with closed reduction and casting. A predictive model was developed using pre- and post-reduction radiographs through stepwise multivariable logistic regression. Simplified scores were derived to classify patients into low-, moderate- and high-risk groups, guiding follow-up or early surgical intervention. An additional predictive model based on one-week radiographs was developed for the moderate-risk group with uncertain stability. Internal validation was performed using bootstrapping, and model performance was compared with Lafontaine criteria. Results: Of 402 patients identified, 244 met inclusion criteria; 161 developed malalignment and 98 required surgery. The mean age was 58.5 ± 16.7 years, and 75.1% were female. In baseline model, significant predictors of instability included dorsal angulation > 20°, intra-articular fracture, ulnar variance > 3 mm, volar cortex restoration, and post-reduction volar angulation ≤ 0°. Internal validation demonstrated good performance (optimism-adjusted AUC = 0.86). Risk stratification identified 39% of patients as moderate risk, who were subsequently used to develop a one-week follow-up model, with ulnar variance > 3 mm as a key predictor for instability. The overall model outperformed Lafontaine criteria (AUC = 0.75 vs. 0.68). Conclusions: The proposed model effectively stratifies instability risk and supports clinical decision-making by integrating critical post-reduction and one-week radiographic parameters, offering greater accuracy than existing criteria. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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12 pages, 1003 KB

Open AccessArticle

Ultrasound-Guided Percutaneous Versus Open A1 Pulley Release for Trigger Finger: A Randomized Controlled Trial

by Süleyman Kaan Öner, Nihat Demirhan Demirkiran, Turan Cihan Dulgeroglu, Sabit Numan Kuyubasi, Suleyman Kozlu and Selçuk Yılmaz

J. Clin. Med. 2025, 14(19), 7064; https://doi.org/10.3390/jcm14197064 - 7 Oct 2025

Cited by 1 | Viewed by 3333

Abstract

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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11 pages, 416 KB

Open AccessArticle

Direct Flexor Tendon Repair More than 3 Months After Trauma: Clinical Outcomes of Four Consecutive Cases and Scoping Review on Time Limits

by Alessandro Crosio, Alice Clemente, Arturo Sebastiano Nozzolillo, Sara Dimartino, Simona Odella, Davide Ciclamini and Pierluigi Tos

J. Clin. Med. 2025, 14(16), 5796; https://doi.org/10.3390/jcm14165796 - 16 Aug 2025

Cited by 2 | Viewed by 4208

Abstract

Background/Objective: Traumatic injuries to the flexor tendons of the hand are frequently treated by hand surgeons. Late repair is not classically considered to be feasible due to the high risk of failure and functional complications. The present study aims to present the functional results of primary flexor tendon repairs performed more than three months after trauma, along with evidence regarding the time limit for primary flexor tendon repair. Methods: The clinical outcomes of direct flexor tendon repairs in zones 1 and 2 of the long fingers or thumb are reported herein. A scoping review was undertaken using Medline and CINHAL to identify studies reporting the functional outcomes of flexor repair following trauma. Results: In this series, four patients were treated with direct M-Tang and epitendinous suture or pull-out reinsertion. Accessory procedures were required to perform a direct repair. The mean delay was 5.5 months, and the follow-up period was 24 months. The mean total active movement was 195°. Extension lags of 10° and 20° were registered at the proximal interphalangeal and distal interphalangeal joints, respectively. While a literature review showed that most cases treated with primary repair after three months resulted in functional complications, these procedures were performed around 40 years ago and no recent reports were found. Conclusions: In the small cohort of patients here reported it has been possible to repair flexor tendons in zones 1 and 2, and to reinsert a jersey finger, even three months after trauma. Accessory procedures were required. Accurate patient selection and counseling is mandatory before surgery to inform patients about alternatives. The literature review confirmed that no positive results have previously been reported in the literature on this topic. It is thought that modern materials and surgical techniques for flexor tendon repair should extend the edge for primary repair in selected patients, as compared to previous practices. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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9 pages, 321 KB

Open AccessArticle

Dupuytren’s Disease Percutaneous Needle Aponeurotomy: Does Grip Strength Improve Post Procedure?

by Jessica Medland, Nicole Garcia, Ishith Seth and Warren M. Rozen

J. Clin. Med. 2025, 14(12), 4171; https://doi.org/10.3390/jcm14124171 - 12 Jun 2025

Cited by 1 | Viewed by 1124

Abstract

Background/Objectives: Dupuytren’s disease (DD) presents significant challenges in hand function due to the progressive contracture of the palmar fascia. This study evaluates the impact of Percutaneous Needle Aponeurotomy (PNA) on grip strength before and after intervention. Methods: A prospective pilot study included patients with DD over 18 years of age who underwent PNA. Grip strength was measured at baseline, six weeks, and three months post-procedure using a Jamar Dynamometer. The median time to return to work or normal activities was recorded. Results: The study included a total of 29 participants. There was a recorded difference in one kilogram of baseline grip strength between the treatment and non-treatment hands. Patients reported improved hand function and recorded an average increase of 5.8 kg in grip strength at the three-month follow-up. Improvements were demonstrated in active extension, averaging 26 degrees at the metacarpophalangeal joint and 27 degrees at the proximal interphalangeal joint. Nine minor skin tears occurred, and there was no recorded recurrence. Conclusions: This study adds to the literature, confirming PNA is a safe and effective intervention for DD, offering rapid recovery and functional improvement. A larger study of a longer duration will help to establish whether grip strength gains are maintained following PNA. Full article

(This article belongs to the Special Issue Hand Surgery: Latest Advances and Prospects)

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